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Year 4 - Paeds > General Paeds > Flashcards

General Paeds Flashcards

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1
Q

Neonate fluid requirements

Day 1
Day 5

A

Neonate fluid requirements

Day 1 - 50ml/kg/day
Day 5 - 150ml/kg/day

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2
Q

Paeds Fluid requirements

ml/kg/day

A

Paeds Fluid requirements

> 10kg - 100ml/kg/day
20kg - 50ml/kg/day
<20kg - 20ml/kg/day

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3
Q

Paeds Fluid requirements

5 kg child
15 kg child
25 kg child
50kg child

A

Paeds fluid requirements

5 kg child
= 500ml (5 x 100)

15 kg child
= 1250ml (10 x 100 + 5 x 50)

25 kg child
= 1600ml
[(10 x 100) + (10 x 50) + (5 x 20)]

50 kg child
= 2100ml
[(10 x 100) + (10 x 50) + (30 x 20)]

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4
Q

Working weight
- Measurement

A

Working weight
- Birthweight
- Until Current Weight exceeds

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5
Q

Neonatal disease
- 3 Aetiologies

A

Neonatal diseases

  1. Congenital
  2. Infectious
  3. Nutritional
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6
Q

Neonatal jaundice

  1. Prevalence
  2. Physiology
A

Neonatal jaundice

  1. Prevalence
    - 60% term
    - 80% pre-term
  2. Physiology
    - Excess bilirubin (RBCs)
    - Immature liver
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7
Q

Neonatal Jaundice

  • Pathological aetiologies and causes
A

Neonatal jaundice
- Pathologies

  1. Increased RCB breakdown
    - Extensive bruising
    - Cephalohaematoma
  2. Haemolytic disease
    - Rhesus, ABO
    - G6PD
    - Spherocytosis
  3. Dehydration
  4. Unwell
    - Infection
  5. Prolonged
    - Infection
    - Metabolic
    (hypothyroid, pituitarism, galactosaemia)
    - Breast milk
    - GI
    (Biliary atresia, choledochal cyst)
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8
Q

Physiological jaundice

  • Natural History
A

Natural jaundice history

  1. Starts d2-3
  2. Peaks d5
  3. Resolves d10
  4. Self limiting
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9
Q

Jaundice
- Presentation

A

Jaundice presentation

  1. Colour
  2. Drowsy
  3. Short feeds
  4. Tone/seizures
  5. Unwell (infection, uring output, abdo sign, black stool)
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10
Q

Jaundice
- Ix

A

Jaundice Ix

  1. TCB
    >35/40wk
    > 24 hrs
    <250 micromol
  2. SBR
    <35/40wk
    <24 hrs
    TCB >250micromol
  3. Baby (and mother)
    - Blood group
    - DCT (direct Coombs)
    - FBC
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11
Q

Jaundice
- Tx

A

Jaundice Tx

  1. Phototherapy
    - NICE Threshold Graph
    - Eye protection
    - Check for rebound hyperbilirubinaemia
    - EBM preferred, no additional fluid
  2. Exchange transfusion
    - Encephalopathy
    - ICU
    - Umbilical line (V or A)
  3. IVIG
    - Haemolytic disease
    (rhesus/ABO)
    - Adjunct to phototherapy
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12
Q

Neonatal Jaundice
- Complications

A

Kernicterus from Jaundice

  1. Brain dysfunction
  2. Irreversible grey-matter damage
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13
Q

Perinatal History
- 7 Steps

A

Perinatal History

  1. Anti-natal history
    - All scans ok
  2. Mode of delivery
    - Why c?
  3. Gestation
    - Term?
  4. Birth weight
  5. Resus?
  6. Admission?
    - NNU, SCBU, PNW
  7. When first BO/PU?
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14
Q

Paeds History
- Feeding

A

Paeds Feeding Hx

  1. Enteral vs PN
  2. Breast/bottle
    - EBM
  3. Quality/Regularity/Frequency
    eg. 150mlg/kg/day til weaned
  4. When weaned?
  5. Eating now?
    - 1Y -> Home food
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15
Q

Child Imms
- Timings

A

Child Imms Timings

2mo (Six in one, MenB, Rotavirus)
3mo (6in1, PCV (Pneumo conj), Rota)
4mo (Six in 1, MenB)

1yr (Hib/MenC, PCV, MMR, MenB boost)

3-5yr (DTap/IPV, MMR)

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16
Q

Developmental Timeline

8 Weeks - 5 years

A

Developmental timeline

8 weeks - Embryogenesis

3-9 months - Fetus

22 weeks - 7 days - Perinatal

0-28 days - Neonate

1mo-1 year - Infant

1 year - 3 years - Toddler

3-5 years - Pre-school

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17
Q

Three Trisomies

A

Trisomy conditions

  1. Trisomy 13 (Patau)
    - 1/15,000
    - 80% CHD
  • Holoprosencephaly
  • Cleft lip and palate
  • Microphthalmia / anophthalmia
  • Hypotelorism/cyclops
  1. Trisomy 18 (Edward’s)
    - 1/6,000LBs
    - 8% 1Y survival
    - 90% CHD
  • GI/GU abnormaliites
  • Neurological abnormalities
  • Micrognathia (small jaw)
  • Small facial features/head
  • Cleft lip/palate
  • Overriding fingers
  1. Trisomy 21 (Down)
    - 1/691
    - 50% CHD (AVS 31%+)
    - 5% GI obstruction
  • Brachycephaly with flat occiput
  • Epicanthal folds
  • Uplsanting palpebral fissure
  • Low nasal bridge, low-set ears
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18
Q

Aneuploidies
- Sex chromosome

A

Aneuploidies

  1. 45, X0 (Turner)
    - 1/2500 (detected at puberty)
  • Intelligence normal
  • CHD, IHD, DM, OP
  1. 47, XXY (Klinefelter)
    - 1/660
  • Tall
  • Hypogonadism
  • Sparse hair
  • Gynaecomastia
  • Minor LDs
  1. 47, XYY (Jacob’s)
    - 1/1000
  • No symptoms
  • Tall
  • Low muscle
  • ASD/LD
  1. 47 XXX (Trisomy X)
    - 1/1000
  • No symptoms
  • Tall
  • Curved little finger
  • Epicanthal fold
  • Flat feet
  1. Mosaicism
    - 45, X/ 46, XX
    - 45, X/ 46, XY
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19
Q

Nephrotic syndrome

  1. S&S
  2. Ix
  3. Mx
A

Nephrotic syndrome

  1. Triad
    - Oedema
    - Proteinuria
    - Hypoalbuminaemia
  2. Ix
    - Varicella IgG
  3. Mx
    - Steroid (60mg/m2)
    - Oral pred 4/7
    - Home urine dip
    - Steroid dependence management
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20
Q

Post-strep GN

  1. S&S
  2. Mx
A

Post-strep GN

  1. S&S
    - HTN
    - Haematuria
    - Low C3 complement
    - High ASOT (Antistreptolysin O titre)
  2. Mx
    - Furosemide
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21
Q

Nephritis
- Causes

A

Nephritis causes

  1. Post-infective GN
  2. IgA vasculitis
    - HSP/Henoch-Schonlein Purpura
  3. SLE
  4. MPGN II
    - Membranoproliferative
  5. Vasculitis (ANCA)
  6. Anti-GBM
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22
Q

Safeguarding
- Children’s Acts

A

Children’s Acts

1989 Children’s Act
- Needs of the Child are paramount

2004 Children’s Act
- Statutory Duty

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23
Q

Working together to safeguard children
- Aims
- Years

A

Working together to safeguard children

  • Aims
    1. Keep all safe from harm
    2. Inter-professional working
  • Years
    1. 2006
    2. 2010. 2014, 2018
    3. 2021
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24
Q

Lord Laming Reports
- Focuses

A

Lord Laming Reports

  1. 2003 - Victoria Climbié
  2. 2009 - Baby Peter Connelly
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25
Safeguarding - When can a baby roll?
Safeguarding 1. Back to front 4-5 months 2. Front to back 6-8 months
26
Safeguarding - Bruising
Safeguarding - I can't move so I can't bruise - Ear injuries are non-accidental
27
Under-2 Investigation - Protocol
Under-2 investigation protocol 1. Skeletal survey (27 films) 2. CT Head 3. Ophthalmology 4. Clotting screen
28
Accidental bruising - Locations
Accidental bruising 1. Bony prominences (93%) 2. Front sided - Knees - Shins
29
Birthmarks
Birthmarks - Grey slate nevus 1. 0-4 yo 2. Buttocks, upper leg, Lower back Salmon patches 1. 0-2yo 2. Eyelids, head, neck Haemangioma/strawberry 1. 0-7yo 2. Blood vessels, maybe blue Port wine stains 1. From birth 2. Face/neck Cafe-au-lait 1. Common dark patches 2. Anywhere Congenital mole 1. Cancer risk if large 2. Pigment overgrowth
30
Child development - Four elements
Child development elements 1. Gross motor 2. Fine motor and visual 3. Speech and hearing 4. Social
31
Development milestones - Gross motor 6wks - 6mo
Gross motor milestones 6wks - Turn head to both sides - Lifts head on belly - Head lag with pull to sit - Kicking legs and moving arms on back 3-4mo - No head lag when pulled to sit - Pushes up on forearms on belly - Rolls from belly to back 5-6mo - Rolls from back to belly - Brings feet to mouth on back
32
Development milestones - Gross motor 6-12 mo
Gross motor 6-12mo 6-8 mo - Sits alone - Reaches for toys - Crawls on belly 9-11mo - Crawls on hands and knees - Pulls to standing - Cruises - Walks with hands held 11-12-mo - Walks with one hand held - Stands along for a few seconds
33
Development milestones - Gross motor 12-24mo
Gross motor 12-24 mo 13-14 mo - Crawls up stairs - Stands from floor - Walks alone 15-18 mo - Kick a ball - Run with falling - Stairs with help 24 mo - Walks and runs fairly well - Jumps with both feet - Stairs alone - Kicks with either foot
34
Baby Development - Reflexes
Reflex disappearing 2 mo - Stepping, Moro 3mo - Rooting 5-6mo - Palmar grasp, sucking 5-7mo - Tonic neck/fencing 9-12 - Plantar grasp
35
Speech and hearing 1. Screen 2. Development
Speech and hearing 1. Day 1/day 2 screening hearing 2. 3mo making sounds
36
Tonsillectomy - Criteria - Post-op
Tonsillectomy - Criteria 4 x 3 years 5 x 2 years 7 x 1 year - Post-op 1. Food and fluids 2. Sats Monitoring
37
Neonatal Thrombocytopenia levels 1. Normal 2. For procedure 3. For transfusion
Neonatal Thrombocytopenia 150 - Normal 75 - For procedure 50 - For transfusion
38
NAS - S&S - Management
Neonatal abstinence syndrome - S&S 1. Continuous cry 2. Tachypnoea 3. Restlessness 4. Scratching 5. Tremor 6. Hypertonia 7. Difficulty feeding 8. D/V 9. Fever 10. Convulsions Mx 1. HepB Vaccine 2. Lipsitz score 3. Oral morphine 4. Phenobarbital
39
Fontanelles - Five bones of cranium
Cranium 1. Frontals 2. Parietals 3. Occipital
40
Anterior fontanelle - Borders
Anterior fontanelle 1. L/R Frontal - Metopic suture 2. L/R Parietal - Sagital suture - Coronal suture
41
Fontanelles - Closure timeline
Fontanelle closure - Intramembranous ossification 1. Anterior - 13-24 months - Males before females 2. Posterior - 6-8 weeks
42
Fontanelle associations - Large - Delayed closure
Large fontanelle conditions 1. T21 2. Achondroplasia 3. Congenital hypothyroidism 4. Rickets 5.Raised ICP
43
Neonate - Dehydration signs
Neonatal dehydration 1. Sunken fontanelle 2. Dry membranes 3. Sunken eyes 4. Poor tears 5. Peripheral perfusion 6. Dry diapers
44
Bulging anterior fontanelle - Conditions
Bulging a. fontanelle 1. Raised ICP 2. Hydrocephalus 3. Hypoxemia 4. Meningitis 5. Trauma 6. Haemorrhage
45
Posterior fontanelle - Borders
Posterior fontanelle 1. Parietal lobes 2. Occipital lobe - Lambdoid suture
46
Posterior fontanelle - Delayed closure
Open p. fontanelle - 8+weeks 1. Hydrocephalus 2. Hypothyroid
47
Mastoid fontanelle - Borders - Closure
Mastoid fontanelle (x2) - Anterolateral - Borders 1. Parietal 2. Temporal 3. Occipital - Closure 1. 6-18 months
48
Sphenoid fontanelle - Borders - Closure
Sphenoid fontanelles (x2) Borders 1. Frontal 2. Parietal 3. Temporal 4. Sphenoid Closure - 6 months
49
Third fontanelle - Epidemiology
Third fontanelle 1. 6% 2. Associations - T21 - Rubella
50
B symptoms - Origin - Examples
Symptoms - Origin 1. Ann Arbour Grading 2. Lymphoma - B Symptoms 1. Fever 2. Night sweats 3. Weight loss (10%/6mo)
51
Haemolysis - Causes
Haemolysis DDx 1. Autoimmune - Cold agglutinin-mediated (IgM) (M. pneumonia/EBV/mumps/CMG) - Warm agglutinin-mediated (IgG) (HIV, Hep C, Mono) - Paroxysmal cold haemoglobinuria (IgG) (URTI, chickenpox, mono) 2. Infectious - Malaria - C. perfringens 3. Haematological - MAHA (TTP, HUS, DIC) 4. Congenital
52
Haemolysis - Ix
Haemolysis Ix 1. Reticulocytes - Low = Anaemic 2. Smear - Schistocytes = destruction 3. (+)LDH and (-)Haptoglobin - Destruction/haemolysis 4. INR, PT, aPPT, fibrinogen - Affected by DIC, not HUS/TTP
53
Paeds - General examination
Paeds general exam 1. Demographic 2. Succinct development - eg. GM normal for age 3. HPC Eg. RDS - SVIA/HFNC - Good cry - Intra/subcostal recessions - Grunting/Tracheal tug/Nasal flare
54
Febrile Seizure - Pres - Mx
Febrile Seizure - Pres 1. 6mo-5yo 2. 38º 3. Male 4. 3-5 min seizure, rapid recovery - Mx 1. CBG 2. R/O Meningitis/Encephalitis - ?LP 3. Electrolytes if vomiting/ketotic - Ca, P, Mg 4. Fever management - Para/Ibu 5. Status management - Midazolam - Phenytoin
55
Floppy Baby 1. Pres 2. Aetiologies
Hypotonia - Pres 1. Transient in newborn - Not severe 2. Profound/persistent - Causes 1. Acutely unwell child 2. Central - Chromosomal/Genetic 3. Spinal - Cord Injury/Ischaemia - SMA (spinal muscular atrophy) 4. Polyneuropathies 5. NMJ - Transitory myasthenia - Familial infantile myasthenia 6. Myopathy - Muscular dystrophies - Myotonic dystrophies
56
Floppy Baby 1. Ix 2. Mx
Hypotonic infant - Ix 1. HF exam 2. Organomegaly 3. Temperature/septic screen 4. AVPU 5. HIE assessment 6. Genetic testing - Mx 1. Bedside - Airway management - Resp and feeding support - VBG - Hx and Ex 4. Bloods - FBC, U&E, Glucose, Electrolytes, TFTs - CRP + Culture - CSF 5. Imaging - USS 6. Special tests - Urine AAs - Urine GAGs - EEG
57
Childhood gait - Ten Differentials
Childhood gait DDx 1. NAI - <12mo - Inconsistent 2. Toddler’s fracture - Spiral tibia 3. Septic arthritis - <10yo (3-7) - Sudden-onset hip - Fever 4. DDH - 12-24mo - First-born breech females - Barlow’s/Ortolani’s 5. Perthes - 4-10yo - Weeks/days 6. Osgood-Schlatter - Older child after activity - Active growth 7. JIA - Oligo (pre-school, girls) - Poly (older,girls) 8. SCFE - 11-15yo, boys - obesity, hypothyroid, delayed 2º sexual 9. CP 10. Muscular distrophies - Boys, delayed walking - Family history
58
Muscular dystrophies - Epidemiology - Pathophysiology
Muscular dystrophies - Epidemiology 1. DMD most common - 1/3000 male births - 2/3 x-linked 2. Becker MD - 1/25,000 - Pathophysiology 1. Dystrophin protein deficiency 2. Muscle fibre necrosis 3. Rapidly progressive dystrophy - More common than hypotonia at birth - Delayed motor milestones
59
Muscular dystrophies - Staging - Mx
Muscular Dystrophies Stage 1 - Ambulatory 1 Psychological support 2 PT - Muscles - Contractures (CSTs, surgery) 3 Glucocorticoid therapy - Muscle strength and function Stage 2 - Non-ambulant 1 ADLs - Vehicles - Computers 2 Nutrition - Swallow (PEG/RIG) - Tachypnoea 3 Scoliosis prevention Stage 3 - Ventilator-supported 1 Muscle rest - IPPV - MAC (mechanically-assisted-coughing) - Support
60
Paediatric oedema - 10 General Causes
Generalised paeds oedema 1. Nephrotic 2. CKD 3. CHD 4. Protein-losing enteropathy 5. CF 6. Malnutrition 7. Refeeding 8. Water overload 9. SIADH 10. Hypothyroid
61
Paediatric oedema - 10 Localised causes
Localised paeds oedema 1. Infections/bites 2. Trauma 3. Henoch-Schonlein P (HSP) 4. Graves' 5. Juvenile dermatomyositis 6. Venous obstruction 7. PD 8. Lymphoedema

Year 4 - Paeds (11 decks)

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