General Paediatrics Flashcards Preview

Olivia MD3 2nd semester > General Paediatrics > Flashcards

Flashcards in General Paediatrics Deck (95):
1

what is the alternative name for croup?

laryngotracheobronchitis

2

what is are some differentials for croup that you must rule out?

epiglottis or foriegn body because can cause obstruction

3

describe the signs and symptoms of croup?

barking cough
inspiratory stridor
signs of hypoxia (if obstruction present)
signs of increased WOB (subcostal recession etc)
coryzal prodrome
symptoms worse at night

4

what is the cause of croup?

viral infection- parainfluenza

5

what should you exclude or consider in a child with a prolonged fever?

kawasaki disease

6

what is the diagnostic criteria for kawasaki disease?

Fever for 5 days or more, plus

4 out of 5 of:

-polymorphous rash
-bilateral (non purulent) conjunctival injection-=mucous
-membrane changes, e.g. reddened or dry cracked lips, strawberry tongue, diffuse redness of oral or pharyngeal mucosa
-peripheral changes, e.g. erythema of the palms or soles, oedema of the hands or feet, and in convalescence desquamation
-cervical lymphadenopathy (> 15 mm diameter, usually unilateral, single, non purulent and painful)

7

what are some important causes of fever in a child that you have to exclude?

meningitis/encephalitis
meningococcal sepsis
osteomyelitis
septic arthritis
UTI

8

what are some important causes of prolonged fever in a child to exclude?

kawasaki
malignancy
autoimmune
HSP

9

what can cause projectile vomiting in a child?

pyloric stenosis

10

what defines 'failure to thrive' in a child?

If a child falls across two major centiles= failure to thrive

if the baby's weight is less than the 3rd centile= failure to thrive (not as sensitive)

11

what is the general cause of febrile convulsions in a child?

viral infections

12

what age group do febrile convulsions generally occur?

from 6months to 6yrs of age

13

what are some symptoms of a febrile child which may think they are very unwell?

bulging fontanelles
non blanching rash
reduced conscious state
focal neurological signs
status epilepticus
neck stiffness
bile stained vomiting
mottled skin
tachycardia/tachypnoea/severe increased WOB

14

what is the first thing you need to ask yourself if a neonate/infant presents with vomiting and fever?

Bilious or non bilious?- is the vomit green?

15

what are some causes of bilious vomiting in an infant? you're in GP land. what would you do?

obstruction (mal-rotation, volvulus, duodenal atresia, necrotising enterocolitis)

- refer for surgical admission + fluid resuscitation in hospital

16

what are some causes of non-bilious vomiting in an infant?

intussuception 5mths-3yrs old, pyloric stenosis 3-6 weeks post birth, infection/sepsis)

Or metabolic causes (e.g. adrenal insufficiency) + CNS causes

17

what are the measurements we need to take for a child's growth chart?

height weight head circumference (until 2 years old)

18

what are signs of respiratory distress in a child?

intercostal recession and subcostal recession + tracheal tug + nasal flare + head bobbing + grunting + paradoxical abdominal movements

19

what are the 2 bacterial/viral causes of tonsilitis we have to exclude in a child

Strep throat (bacterial)
EBV (viral)

20

what are some consequences of strep throat

Post strep glomerulitiis
Rheumatic fever
tonsil abscess
acute OM
cervical adenitus
acute bacterial sinusitus

21

what are some acquired causes for stridor?

croup
epiglottitis
bacterial tracheitis
retropharyngeal abscess
quinsy
dipthethria
foreign body

22

what are some congenital causes for stridor?

subglottic stenosis
vocal cord palsy
laryngomalacia

23

what is the age usually seen for inhaled foreign body?

6months to 4yrs

24

what are some examination findings for inhaled foreign body in a child?

tracheal deviation
reduced air entry
localised wheeze
fever?
stridor

25

describe bronchiolitis

acute viral infection of the Lower respiratory tract

26

what age group do we see bronchiolitis?

common under 1yr old but can present up to 2yrs

27

what are some examination findings for bronchiolitis?

subcostal recession
hyperinflated chest
fine inspiratory crackles
wheeze
mild fever
tachypnoea

28

how do we treat bronchiolitiis?

supportive management only

29

how might we assess the severity of asthma in a child?

night symptoms?
increased frequency of exacerbations
no. of hospitalisations
how often are they using their puffer?

30

what is the BMI definition of overweight for a child aged between 2-18yrs?

For children 2 – 18 years or age, overweight is defined as BMI above the 85th centile on BMI chart

31

what is the BMI definition of obese for a child aged between 2-18yrs?

Obese is defined as BMI >95th centile on CDC BMI chart or above the 97th centile on WHO BMI chart

32

how might we assess whether a child less than 2 yrs old is overweight?

For children under 2 years, overweight is defined as above the 97th percentile on WHO growth charts and gaining weight rapidly.

33

describe pyloric stenosis

Hypertrophic Pyloric Stenosis (HPS) is due to progressive thickening of the circular muscle of the pylorus. This leads to gastric outlet narrowing.

The condition usually presents between 2 and 6 weeks of age.

projectile, non-bilious vomiting

hypochloremic hypokalemic metabolic alkalosis can be associated

34

what are the main features of ADHD?

hyperactivity
impulsivity
inattention/easy distractibility

35

describe a general fluid replacement order for a dehydrated child in hospital?

give boluses of 10-20mls/kg every hr- normal saline

36

for a child with moderate dehydration due to vomiting, how might you fluid resuscitate them (think route)?

NGT tube even if the child is vomiting

37

for fluid maintenance, what types of fluid can we use in children?

plasma lyte
normal saline with glucose (NaCL 0.9 or 0.45% + 5% dextrose)

consider if K+ is required

38

what are some signs of severe dehydration in a child?

Very delayed CRT > 3 secs, mottled skin
Other signs of shock (tachycardia, irritable or reduced conscious level, hypotension)
Deep, acidotic breathing
Decreased tissue turgor

39

what are the Kocher's criteria for differentiating septic arthritis and transient synovitis in a child?

1. Inability to weightbear
2. high fever
3. high ESR in first hour >40
4. high WCC >12

4/4 criteria would be a strong indicator of septic arthritis

40

what are some ddx for a child with an acute limp?

septic arthritis
osteomyelitis
Perthe's- AVN of capital femoral epiphysis
slipped upper femoral epiphysis
bony malignancy

41

how might we differentiate between septic arthritis and osteomyelitis in a child?

osteomyelitis- subacute onset, pain on movement, swelling/fever/erythema may be late onset, tenderness/localised pain

septic arthritis- acute onset, more likely to present with a high fever, pain on movement and at rest, loss of movement/range of motion

42

what are the ddx for asthma in a young child?

tracheomalacia
viral respiratory infection
inhaled foriegn body
cystic fibrosis
reflux

43

what are some complications of pertussis?

rib fracture
subconjunctival haemorrhage
pneumonia
Otitis Media (most common)
fainting post cough
respiratory muscle fatigue--> apnoea
encephalopathy and seizure

44

what are some classical features of pertussis?

inspiratory whoop
uncontrollable violent coughing associated with vomiting
prodrome of mild respiratory illness

45

what are some signs/symptoms of intussuception in a baby?

red current jelly stools, bloody diarrhoea
vomiting +++ nonbilious--> bilious
colicky abdo pain
abdominal mass- sausage shape
pallor and lethargy
signs of hypovolemic shock

46

tell me about transient synovitis of hip?

Commonest reason for a limp in the pre-school age group.
Usually occurs in 3-8 year olds
History of recent viral URTI (1-2 weeks)
Child usually able to walk but with pain
Child otherwise afebrile and well
Mild-moderate decrease in range of hip movement - especially internal rotation.
Severe limitation of hip movement suggests septic arthritis.
Transient synovitis is a diagnosis of exclusion.

47

tell me about perthes disease?

Avascular necrosis of the capital femoral epiphysis.
Age range 2-12 years (majority 4-8yrs)
20% bilateral
Present with pain and limp
Restricted hip motion on examination

48

tell me about slipped upper femoral epiphysis?

Late childhood/early adolescence.
Weight often > 90th centile.
Presents with pain in hip or knee and associated limp.
The hip appears externally rotated and shortened.
There is decreased hip movement - especially internal rotation.
May be bilateral.

49

what is the most common cause of constipation in kids?

functional constipation

50

how might we manage functional constipation in kids?

Position – footstool to ensure knees are higher than hips. Lean forward and put elbows on knees.

Toilet sits –5 minutes three times a day, preferably after meals. Praise child for sitting on toilet, keep toileting a positive experience.

A healthy diet and adequate fluid intake is important for children’s general health and wellbeing.

Excessive cow milk intake may exacerbate constipation in some children.

oral laxatives like movicol can be used

51

how might we manage nappy rash in infants?

Use disposable nappies.
Increase the frequency of nappy changing and cleansing the skin.

Application of a barrier cream at every change. Effective barrier creams include zinc paste, white soft paraffin and vaseline.

Letting the child spend as long as possible without a nappy on, lying on a soft absorbent sheet that is changed as soon as it is wet. Sunlight plays a role.

If there is associated candidal infection, leading to erythema in the folds and satellite pustules then topical anti-candidal therapy (an imidazole or nystatin) should be applied. This therapy is often combined with 1% hydrocortisone to reduce the associated inflammation.

52

what level of BP is ABNORMAL for children?

if BP is majorly low; this is not normal as it can mean that the child has lost up to 30% of their blood volume.

Other than this, BP is not a reliable measure in children.

53

define a neonate

baby less than 28 days corrected

54

at what ages do infants nose breathe?

4-6months exclusively through the nose

55

what are the 3 top causes of lumps in children?

congenital
inflammatory
cancer

56

what are some causes of apnoea?

whooping cough
obstruction
OSA
acidosis
anaemia
patent ductus arteriosus

croup (may require intensive care in this case)

57

what is the most common respiratory pathogen causing infection in kids?

RSV

58

what are some signs of pathological paediatric murmurs?

all diastolic murmurs
pansystolic murmurs
murmurs associated with failure to thrive or cardiac failure
murmurs with a palpable thrill

59

in which states can a child's murmur become accentuated?

can become accentuated in anaemia or fever (high output states)

60

what is vesicoureteral reflux. What might it cause?

abnormal retrograde flow of urine back up to kidneys due to impaired valve-like mechanism at the vesicoureteral junction

predisposes UTIs and hydronephrosis

61

define colic?

uncontrolled crying for >3hrs per day for 3 or more days of a week in an otherwise well healthy infant

62

what are the differentials for colic?

GORD/reflux
cow's milk allergy
malabsorption

63

when might we consider cow's milk allergy as a cause for prolonged crying in an infant and what can we try?

when a crying baby (crying for prolonged periods of time) is vomiting, having diarrhoea or has feeding difficulties, and history of atopy/eczema consider cow's milk allergy.

can try a cow's milk free diet either by choosing cow's milk free infant formula or asking the mother to avoid cow's milk in her diet

64

what is the triad of symptoms for henoch schloens purpura?

purpuric rash on the extensor surfaces of limbs (mainly lower) and buttocks, joint pain/swelling and abdominal pain.

65

how much formula does an infant require per day?

150mls/kg a day

66

how often do infants require breastfeeding?

every 3-4 hourly or demand breastfeeding

67

what are the typical characteristics of an innocent murmur in a child?

ejection systolic murmur
soft blowing sound
left sternal edge
symptom free child
no radiation

68

what are some differential diagnoses of congenital stridor?

laryngomalacia
laryngeal cyst/web
laryngeal stenosis
GORD
subglottic stenosis

69

A young child becomes profoundly cyanotic when agitated. What is your diagnosis and what is this called?

Hypercyanotic or tet episodes due to complete right ventricular outflow obstruction, usually related to
Untreated TOF

70

What are your ddx for an older child with liver derangement?

Hepatitis
Paracetamol overdose
Autoimmune cause
Wilsons
NASH
Other drug reactions

71

In what newborn period is jaundice abnormal?

In the first 24 hrs post birth

72

at what position should the baby be to accurately palpate the anterior fontanelle?

at 45 degrees

73

how might we assess skin turgor in a child?

pinching the abdomen lightly

74

what on history might give us a sense of cardiovascular function in an infant and why?

history of feeds
Feeding is the most metabolically demanding activity that occurs in infants, and so can be used as a form of exercise tolerance

75

what is the technical term for bedwetting?

nocturnal enuresis

76

what is the difference between primary and secondary enuresis?

primary= continously be wet for at least 6 months
secondary- was dry for a period of time (6months) but relapsed

77

what are some causes of secondary enuresis to consider?

UTI
neurogenic bladder
Diabetes
epilepsy
sexual abuse

78

what does monosymptomatic nocturnal enuresis?

bedwetting without urinary incontinence during the day

79

when do we start treating nocturnal enuresis?

usually at 7 yrs and above

80

what is faecal incontinence usually associated with in children?

constipation

81

what are the medical causes of haematuria in children?

hypercalciuria
thin basement membrane disease
alport syndrome
GN-IgA
HSP
coagulopathy/bleeding disorder

82

If a child with haematuria complains of pain, what do we think?

think surgical cause
such as calculi, tumour, stricture, trauma

83

if you have a child with microscopic haematuria what must you exclude?

illness in a child can cause microscopic haematuria. Wait until the child is well before checking the urine again

84

what are the complications of nephrotic syndrome in children?

infection, thrombosis, dehydration (because intravascular fluid leak out to extravascular spaces), effusions

85

if a child presents with nephrotic syndrome, what is our first line of action?

give steroids.

If the child responds to steroids= minimal change disease

If it doesn't respond by 4 weeks, refer for a renal biopsy

86

what is the most sensitive test for post streptococcal glomerulonephritis? what can it also indicate?

low C3, C4

low C3 and C4 can also indicate lupus/SLE or membrano-glomerulonephritis

87

how do we treat post streptococcal glomerulonephritis?

frusemide to manage fluid overload + fluid restriction

88

what is a long term complication of HSP?

nephritis, which looks like IgA nephropathy

89

what are the main causes of CKD in the age group from 0-4?

posterior urethral valve
renal hypoplasia/dysplasia --> obstructive uropathy

90

a child lying in ED with abdo pain is drawing their legs up. what sort abdo pain may they have?

colicky abdo pain

91

how might we assess peritonism in a child with abdo pain?

Ask the child to suck their belly in as much as they can and then puff their tummy out to the level of your hand.

Ask the child to cough.

They may walk slowly with a hunched over posture

92

what are the two main causes of idiopathic nephrotic syndrome in children? which is more likely to progress to chronic kidney disease?

minimal change disease- usually steroid responsive and good prognosis

focal segmental glomerulosclerosis- Not immunosuppressive responsive and 60% progress to CJD

93

what is the clinical presentation of a child with IgA nephropathy?

episodes of macroscopic haematuria +/- abdominal flank pain often concurrent with viral infections

94

why are children with nephrotic syndrome at risk of thrombosis?

loss of anti-thrombin 3 in the urine

95

an ultrasound at 6 weeks confirms that a baby has dysplasia of the hips. what is your next line of action?

refer to orthopaedics