General Paediatrics Flashcards
what is the alternative name for croup?
laryngotracheobronchitis
what is are some differentials for croup that you must rule out?
epiglottis or foriegn body because can cause obstruction
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
what is the cause of croup?
viral infection- parainfluenza
what should you exclude or consider in a child with a prolonged fever?
kawasaki disease
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)
what are some important causes of fever in a child that you have to exclude?
meningitis/encephalitis meningococcal sepsis osteomyelitis septic arthritis UTI
what are some important causes of prolonged fever in a child to exclude?
kawasaki
malignancy
autoimmune
HSP
what can cause projectile vomiting in a child?
pyloric stenosis
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)
what is the general cause of febrile convulsions in a child?
viral infections
what age group do febrile convulsions generally occur?
from 6months to 6yrs of age
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
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?
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
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
what are the measurements we need to take for a child’s growth chart?
height weight head circumference (until 2 years old)
what are signs of respiratory distress in a child?
intercostal recession and subcostal recession + tracheal tug + nasal flare + head bobbing + grunting + paradoxical abdominal movements
what are the 2 bacterial/viral causes of tonsilitis we have to exclude in a child
Strep throat (bacterial) EBV (viral)
what are some consequences of strep throat
Post strep glomerulitiis Rheumatic fever tonsil abscess acute OM cervical adenitus acute bacterial sinusitus
what are some acquired causes for stridor?
croup epiglottitis bacterial tracheitis retropharyngeal abscess quinsy dipthethria foreign body
what are some congenital causes for stridor?
subglottic stenosis
vocal cord palsy
laryngomalacia
what is the age usually seen for inhaled foreign body?
6months to 4yrs
what are some examination findings for inhaled foreign body in a child?
tracheal deviation reduced air entry localised wheeze fever? stridor
describe bronchiolitis
acute viral infection of the Lower respiratory tract
what age group do we see bronchiolitis?
common under 1yr old but can present up to 2yrs
what are some examination findings for bronchiolitis?
subcostal recession hyperinflated chest fine inspiratory crackles wheeze mild fever tachypnoea
how do we treat bronchiolitiis?
supportive management only
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?
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
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
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.
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
what are the main features of ADHD?
hyperactivity
impulsivity
inattention/easy distractibility
describe a general fluid replacement order for a dehydrated child in hospital?
give boluses of 10-20mls/kg every hr- normal saline
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
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
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
