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MCQS Flashcards

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1
Q

Does fever reduce length of illness in children?

A

Yes

Fever is thought to be a generally
beneficial adaptive response that promotes the immune response and inhibits the invading pathogen, potentially
reducing the duration of certain infections

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2
Q

What % of children with fever will have an identifiable source?

A

80%

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3
Q

Can teething cause a fever >38.5?

A

NO

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4
Q

What % of children <5yo with fever have a serious bacterial infection and which ones are they?

A

7.5%

Of this:
3.4% UTI
3.4% Pneumonia
**0.4% bacteraemia
**0.1% Meningitis

Bacteraemia causes: osteomyelitis | septic arthritis | cellulitis | bacterial enteritis etc.

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5
Q

What non-bacterial diagnoses can present with fever in children?

A

Kawasaki disease
Vaccination reactions
Arthritis
Connective tissue disorders
Malignancies
Drug fever
Inflammatory bowel disease

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6
Q

What % of infants <3 months with fever have a serious bacterial infection?

A

7-25%!

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7
Q

What are common pathogens for infants <3 months?

A

Group B strep
E. Coli
HSV
Listeria

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8
Q

What are the empiric antibiotics for neonatal sepsis?

<2 months of age

A

BENPEN 60mg/kg IV
Cefotaxime 50mg/kg IV

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9
Q

What antibiotic should be added to routine sepsis treatment if there is evidence of umbilical infection?

<2 months of age

A

Flucloxacillin 50mg/kg

Suspect staph aureus

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10
Q

What are the empiric antibiotics for neonatal sepsis suspected to be from an abdominal source?

<2 months of age

A

Ampicillin 50mg/kg
Metronidazole 15mg/kg
Gentamicin 5mg/kg

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11
Q

What are the common pathogens in sepsis in children >2 months?

A

Strep pneumoniae
Neisseria meningitidis
Staph Aureus
Group A strep

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12
Q

What are the empiric antibiotics for sepsis in infants/children?

> 2 months

A

Ceftriaxone 50mg/kg
Flucloxacillin 50mg/kg

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13
Q

What change would you make to the empiric antibiotics for sepsis regimen in infants/children who return a normal CSF result on LP?

> 2 months

A

Remove ceftriaxone
Add gentamicin 7.5mg/kg

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14
Q

List some risk factors for MRSA in Australia?

A

Aboriginal and Torres Strait Islander or Pacific Islander child
Recent travel/live in NT or remote QLD
Previous colonisation with MRSA

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15
Q

Which antibiotics could you substitute for flucloxacillin if there was concern for MRSA or the patient had a penicillin allergy?

A

Vancomycin 15mg/kg
Clindamycin 15mg/kg
Trimethoprim/sulfamoxazole 4/20mg/kg BD

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16
Q

“Pain unlocks a secret doorway in the mind, one that leads to both peak performance, and beautiful silence.”

Who said this?

A

David Goggins

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17
Q

What are the target trough levels for gentamicin(pre-third dose) and vancomycin?

A

Gent = <1mg/L

Vanc = 15-20mg/L

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18
Q

What is the concomitant UTI rate in infants < 3months with bronchiolitis?

A

5%

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19
Q

What is the % of bacteraemia for UTI patients <3months?

A

50%!

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20
Q

Name some paediatric risk factors for serious bacterial infection

A

Congenital immune deficiency syndrome
Indigenous demographic
Sickle cell
Asplenia
Cancer
Nephrotic syndrome
Intracranial shunt
HIV

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21
Q

What CRP levels in children represent a 70% and 5% risk of serious bacterial infection and when should it be taken?

A

At least 12 hours AFTER first fever

CRP > 80 = 70%

CRP < 20 = 5%

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22
Q

What is the concomitant serious bacterial infection rate with a positive viral swab?

A

7%

Mostly UTI (hence CRP < 20 being 5% risk = better test but harder to perform)

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23
Q

What are the difference between normal neonatal and infant LP results?

A
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24
Q

What is the sensitivity of the “step-by-step” score in infants < 3 months and what are the criteria?

A

99% rule out serious bacterial infection

NOT “ill-appearing” including normal WOB
>21 days old
No leukocyturia
Procalcitonin <0.5
CRP <20

The astute amoung you will realised how utterly useless this is given procalitonin is not a widely available test so until it is you can’t use this. Also the infant/neonate has to appear completely well : /

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25
List methods of urine capture in infants from most to least sensitive
In/out catheter (lowest failure rate) Suprapubic aspirate (20-90% success) Clean catch Bag urine ## Footnote Most kids and parents can manage a clean catch
26
What are the NICE guidlines for starting antibiotics in neonates/infants based on urine dipstick?
Start antibiotics IF: Nitrates & leukocytes + Only Nit + Do a urine MCS if: Only Leuk + Leuk/nit -ve = look elsewhere
27
According to NICE when should antibiotics be started for UTI based on urine MCS results?
Start Abx if: Pyuria & bacteruria + Only bacteruria + Only Pyruria + (if they clinically have a UTI) | PYURIA MAY BE ABSENT IN EARLY UTI IN VERY YOUNG CHILDREN ## Footnote Pyuria = WBCs Bacteriuria you can see the bugs ennit
28
When should a UTI be considered pyelonephritis in an infant?
Fever >38 Unwell Malaise Vomiting Loin tenderness
29
What are common UTI pathogens <2 months and >2 months
<2 months : E.coli Klebsiella >2 months: E.coli! Proteus Enterobacter Morganella Serratia (PEMS lol)
30
What antibiotics should be given for UTI + pyelonephritis in children?
RCH guidelines: Cefalexin 33mg/kg PO BD 3-7 days (max 500mg) Pyelo = 45mg/kg oral TDS 7-10 days (max 1.5grams) UTI sepsis = gent and benpen (60mg/kg)
31
List 3 risk factors for UTI in children
Constipation Failure to thrive Vesico-ureteric reflux ## Footnote These are just the ones from the NICE guideline. Im sure there's plenty more
32
List features associated with atypical UTI
NON E.coli organisms Treatment failure after 48 hrs Seriously ill e.g. sepsis Poor urine flow Abdo or bladder mass Raised creatinine
33
What is the definition of recurrent UTI?
>3 episodes of cystitis OR 2 episodes of pyelo OR 1 cystitis + 1 pyelo
34
What imaging is required in children with UTI under 6 months
Normal UTI = ALL get USS at 6 weeks ATYPICAL or RECURRENT: Acute phase USS PLUS MCUG and DMSA (4-6 months post) ## Footnote Normal UTI = responds to therapy within 48 hours
35
What imaging is required in children with UTI 6 months - 3 years
Normal UTI = No imaging Atypical = acute USS + DMSA Recurrent = 6 week USS + DMSA ## Footnote Normal UTI = responds to therapy within 48 hours
36
What imaging is required in children with UTI >3 years
Normal UTI = no imaging Atypical = acute USS only Recurrent = USS 6 weeks ## Footnote Normal UTI = responds to therapy within 48 hours
37
What is HUS?
Haemolytic uraemic syndrome The most common cause of AKI in children Non-immune, coombs negative microangiopathic haemolytic anaemia with thrombocytopaenia
38
What are the two types of HUS?
Shiga-toxin HUS (90% cases) E.coli O157 produces shiga 0-4 yo 75% have diarrhoea 85% will recover renal function with supportive care Non-shiga HUS (10% cases) Mostly adults: sporadic or familial Strep Pneumonia = 40% Other causes: drugs | malignancies | antiphospholipid | pregnancy HIGH mortality rate (25% in acute phase)
39
What are some complications of HUS?
* Renal failure * Stroke * Coma * Seizures * Bleeding * Chronic hypertension ## Footnote 50% of non-stx HUS patients develop ESRD
40
What investigations for HUS?
MAHA Thrombocytopaenia Coombs negative (no autoantibodies) Positive O157 stool/blood culture Low ADAMST13 (cleaves vWF)
41
What are differentials for HUS?
* Disseminated Intravascular Coagulation * Malignant Hypertension * Pediatric Antiphospholipid Antibody Syndrome * Preeclampsia * Thrombotic Thrombocytopenic Purpura (TTP)
42
What are treatments for HUS?
STX-HUS: Supportive Renal transplant (5-10% recurrence) Non-STX HUS that is NOT strep pneumonia driven: plasma exchange AND Eculizumab Renal transplant not an option in non-stx HUS due to high recurrence rate ## Footnote plasma exchange worsens strep pneumonia HUS becaudse adult plasam contains antibodies against the Thomsen-Friedenreich antigen
43
What is the definition of paediatric hypoglycaemia?
<3.3mmol/L <2.6mmol/L = severe
44
What is the most common cause of hypoglycaemia in children?
Ketotic hypoglycaemia RCH calls it "accelerated starvation" ## Footnote Diagnosis of exclusion
45
What are paediatric causes of hypoglycaemia by age other than sepsis/T1DM complication? | Sepsis + T1DM all ages
Neonate <72hrs: PREM | IUGR | diabetic mom | perinatal asphyxia 72-hrs - 2 years: Congenital hyperinsulinism | inborn erros of metabolism | Gh deficiency >2: Accelerated starvation | hypopituitarism | GH deficiency Adolescent: insulinoma | adrenal insufficiency | TOXIN ingestion: sulfonuylureas | EtOH | beta-blockers | Aspirin ## Footnote Congenital hyperinsulinism = most common cause in age group
46
What is the treatment for severe hypoglycaemia with reduced GCS?
2ml/kg of 10% dextrose stat THEN Full maintenance Neonate: 10% dextrose 60mls/kg/day Child: 10%Dex/0.9% NaCl No IV access = IM glucagon <25kg = 0.5 units >25kg = 1 unit Replace deficit if dehydrated as well (add to maintenance) ## Footnote 4:2:1 ml/kg 0-10, 0-20, >20 kg rule
47
How do you calculate paediatric fluid deficit?
Weight x % dehydration + 10 (add to full maintenance 24hr requirments) ## Footnote E.g. 30kg, 5% dehydration = 30 x 5 + 10
48
What are the discharge criteria for neonates and infants?
Neonates: >2.6 for 3 consecutive feeds Infants/children: >3 4 hrs post meal ## Footnote Discharge them with a glucose gel if unclear
49
What is a "sick day" plan for a child who's had a hypoglycaemia?
When sick: pause normal diet and: 1 - 4 yo 10% carbohydrate solution for meals >4 = 15% > 12 = 20%
50
What is included on a hypoglycaemia panel?
Insulin and c-peptide FFAs Carnitine Ammonia GH Cortisol Amino acids
51
What causes high c-peptide?
T2DM Cushings Insulinoma Sulfonylureas
52
What causes low c-peptide?
T1DM Insulin therapy Diuretics Addisons
53
Palpable pulses paradoxus if present in which severity of asthma?
Severe & life-threatening
54
What are the four best indicators of asthma severity on examination?
General appearance Mental state Activity level Work of breathing: RR | recession | tug
55
What is the main difference in treatment of moderate asthma in the 1-5 age group vs >6?
>6 give 1mg/kg of steroids
56
What is the treatment for life-threatening asthma?
## Footnote Life-threatening = B2B nebs, severe i.e. can still inhale MDIs
57
Learn this
## Footnote Ciclesonide instead of fluticasone is cheaper, once daily and has lower side effect profile
58
What features are consistent with a simple febrile seizure?
6months - 6 years Generalised tonic clonic seizure <15mins No signs of CNS infection Complete recovery within 1 hour No recurrence within same illness
59
Whats the seizure treatment guideline?
>5 mins, new dose every 5 minutes Midazolam 0.15mg/kg IV/IM (x2 for buccal) Repeat midaz Leviteracetam 40mg/kg Levit-er-forty-am Phenytoin 20mg/kg (Phenytwenty) Phenobarb 20mg/kg Phwends (same dose) Thiopentone or Propofol 2.5mg/kg then 1-3mg/kg/hr if ready to intubate GIVE pyridoxine 100mg if refractory | Always check BSL! ## Footnote Pyridoxine for the rare pyridoxine dependent epilepsy
60
What are important acute side effects of AEDs?
Respiratory depression Negative inotropes (monitor BP) Arryhthmogenic
61
What disadvantages does diazepam have versus midazolam in seizures?
Can't give IM Longer half-life (for assessing neurology and d/c)
62
What are the main differences when treating neonatal seizures?
Give anticonvulsants if: > 3minutes > 2-3 seizures/hr All should get a CT head to exclude ICH
63
List neonatal anti-seizure medication in order of effectiveness
Clonazepam 0.2mg IV (total) Phenytoin 20mg/kg Phenobarbitone 20mg/kg ## Footnote Clonaz = 90-100% phenytoin = 85% Phenobarbitone = 70%
64
What are common causes of neonatal seizures?
Hypoxic ischaemic encepahlopathy (50%) Cerebral infarction Cerebral trauma CNS infection Narcotic drug withdrawal Hypoglycaemia | Most to least common ## Footnote HIE most common
65
What are the 3 main neonatal differentials for seizures?
Seizures/infantile spasms Jitteriness Benign neonatal sleep myoclonus ## Footnote Infantile spasms = 3-7 months is peak: clusters of flexor/extensor spasms (can be head nodding) Jitteriness = Stimulus sensitive symmetrical movements of hands and feet that stop when limb held BNSM = Bilateral or unilateral jerking during sleep
66
What are the 4 main types of neonatal/infant seizures?
Subtle: oral (chewing sucking/lip smacking), cycling/rowing, apnoea Clonic: one limb or one side 1-4beats/second Myoclonus: Focal or multifocal muscle jerking ## Footnote Subtle = includes infantile spasms Clonic = assoc with ICH/CVA Myoclonic = drug withdrawal Tonic = sustained posturing of the limbs
67
What's the treatment of infantile spasms?
10mg QID for 1 week then wean if seizures persist Increase to 20mg TDS if persisting
68
What is the treament of tuberous sclerosis seizures?
Vigabatrin ## Footnote GABA transminase inhibitor (increases GABA)
69
What are the risk factors for severe bronchiolitis?
Gestational age <37 weeks Corrected age <10 weeks Failure to thrive Indigenous ethniticity Breast feeding for <2months Congenital heart disease
70
What are 2 types of benign jaundice and when do they occur?
Physiological (>24hrs - 10 days) Breast milk jaundice (5-14 days) ## Footnote Physiological = higher conc of RBCs and shorter lifespan = increased bili Breast = B-glucornidase in breast milk = increased deconj and reabsorption of bili
71
What are the two types of pathological jaundice and when do they occur?
Jaundice within 24 hrs (always pathological) Prolonged jaundice or ONSET of jaundice >10 days ## Footnote There will be pathological jaundice within 24hr-10day group but physiological most common
72
Why is hyperbilirubinaemia an issue in neonates?
Causes kernicterus: staining on basal nuclei Encompassess acute and chronic bilirubinaemia Acute = Hypotonia/lethargy/irritability/poor feeding Chronic = Developmental delay/hearing deficit/parinaud's sign/intellectual impairment
73
What is parinaud's sign?
Upward gaze paralysis Lid retraction Nystagmus ## Footnote Tectal plate lesion - think MS in adult
74
What are the 4 main risk factors for severe hyperbilirubinaemia?
Gestational age <38wks Exclusive breast feeding Jaundice within first 24 hours Previous sibling requiring phototherapy
75
76
What are the risk factors for neurotoxicity in jaundice?
Preterm Rapid rate of rise in bili Hypoalbuminaemia Sepsis | asphyxia | acidosis
77
Ultrasound in shocked infants secondary to trauma is useful?
"Doesn't change outcomes" | Exam answer ## Footnote The study quoted for this MCQ was on the PEM revision course was on 975 haemodynamically stable patients!!!! Also not indicated in adults looool

Paediatrics (5 decks)

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