neonate, community, emergency Flashcards
(186 cards)
1
Q
with regards to blood sugars, when is a baby allowed home
A
when CBG is stable after 2 feeds
2
Q
if symptomatic of hypoglycaemia or very low sugars, what is given
A
10% dextrose
3
Q
signs of hypoglycaemia in neonate
A
weak cry, apnoea, hypothermia, irritation, jittery, hypotonia, poor feeding
4
Q
symptoms of fragile X
A
learning difficulties, microcephaly, big testis, mitral valve prolapse
5
Q
signs of patau T13
A
cleft palate, polydactyl, small eyes, microcephaly
6
Q
signs of Edwards T18
A
rocker bottom feet, low set ears, overlapping fingers and micrognathia
7
Q
is intellect normal in turners
A
YES
8
Q
what investigations do you do for paracetamol OD
A
paracetamol level 4 hr from ingestion, U+E, salicylate level, LFT, glucose, clotting screen, blood gas
9
Q
what do you do if a paracetamol OD presents within 8 hours
A
take bloods at 4 hr
10
Q
what do you do if a paracetamol OD presents > 8 hr
A
if taken >150mg/kg start Tx straight away, otherwise wait for paracetamol levels
11
Q
what do you do if someone presents >24 hours after OD
A
start Tx if they have any symptoms
12
Q
criteria for liver transplant
A
24 hours after OD:
1) pH <7.3
OR all three of
1) deranged clotting (prothrombin time)
2) creatinine > 300
3) grade III or IV encephalopathy
13
Q
phenotypical features of someone with FAS
A
smooth philtrum, low set ears, short palpebral fissures, microcephaly
-+signs of withdrawal on birth
14
Q
a cause for GDD is rett syndrome, what is this?
A
rare neurological disorder that affects young girls and they lose previously acquired skills like purposeful hand movements
-microcephaly + hand wringing
15
Q
congenital cause of GDD
A
spina bifida
16
Q
broad causes for GDD
A
-neurological
-infection
-neuromuscular disorders
-genetic disorders
-metabolic disorders (PKU)
-FAS
17
Q
what investigations do you do firstline for a global developmental delay
A
-FBC and haemantics
-U+E
-CK
-TFT
-LFT (metabolic disorder)
-hearing tests
then second line do karyotyping
18
Q
what is the limit age of a milestone
A
the age at which the milestone should be met, this is normally 2 standard deviations form the median age of acquisition
19
Q
what’s the social red flag for developmental milestone
A
no smile by 10 weeks
20
Q
what’s the gross motor milestone red flag
A
not sitting unsupported by 12 months
21
Q
what does a health visitor do
A
they assess a Childs development at 6/8 weeks, 9-12 months and 2-2.5 years. They provide support and encouragement to families in the early years
22
Q
spasticity is velocity
A
dependent
23
Q
what is dyskinetic cerebral palsy
A
involuntary, unpredictable movement with fluctuating muscle tone
24
Q
complications of CP
A
epilepsy, hip pain/dislocation, drooling, pain, learning difficulties
25
signs of PKU
hypopigmentation, learning difficulties, microcephaly
26
when is the newborn exam done and then when is the infant exam done
newborn at 72 hours and then infant at 6-8 weeks
27
shaken baby syndrome is a triad of
retinal haemorrhage, subdural haematoma and encephalopathy
28
in a child < 3months, presenting with a fever, what investigations do you do?
blood culture, urine dip, FBC, CRP, stool culture, CXR, lumbar puncture
29
signs of TTN on CXR
fluid in horizontal fissure and hyperinflation of the lungs
30
RF of neonatal sepsis
PROM, mum pyrexia in labour, premature, LBW
31
Mx of neonatal sepsis
IV benzylpenicillin with gentamicin, monitor CRP at 24 hours to check progress
32
what's early vs late neonatal sepsis
early = birth - 72 hours ]
late = 72 hours - 28 days
33
causes for late onset neonatal sepsis
organisms from environment like staph epidermis or pseudomonas or klebsiella
34
sepsis 6 in children
1) get senior help
2) consider early inotropic support
3) give Abx
4) give fluids
5) give O2
6) take bloods and cultures
35
how do you treat late onset neonatal sepsis
ceftriaxone and amoxicillin
36
red flags of neonatal sepsis
apnoea, seizures, needing CPR at birth, resp distress starting > 4 hours after birth
37
RF for neonatal jaundice
sibling being jaundice + requiring phototherapy, prem, exclusively breastfed
38
causes for jaundice >14 days (or >21 days if preterm)
-physiological
-biliary obstruction
-neonatal hepatitis
-hypothyroidism
-infection
-gilberts
39
when must a serum bilirubin be measured
if baby <35/40 weeks, TCB >250 or if <24 hours old
40
what IX do you do if baby if jaundice
serum bilirubin, measure blood group of mum and baby and check ABO and RhD, TFT, Coombs LFTs, TFT, G6PDH, percutaneous liver biopsy with intraoperative cholangioscopy if delayed
41
how does phototherapy work for jaundice
the blue/green light converts the bilirubin into lumirubin which is easily soluble and easily excreted
42
if a baby starts showing signs of bilirubin encephalopathy (kernicterus) what needs to happen
exchange transfusion
43
how does kernicterus present
lethargy, hypotonia, poor suck reflex which then progresses to hypertonia, seizures and a high pitched cry
44
three cardiac causes of cyanosis in the neonate
tricuspid atresia, TOF, TGA
45
apart from cardiac causes of central cyanosis in the newborn, give some other causes
1) choanal atresia (cyanosis will be worse when baby feeds)
2) micrognathia
3) congenital lobar emphysema (hyperinflation of one or more pulmonary lobes which then compresses the surrounding lung)
4) CDH (causes pulmonary hypoplasia)
5) apnoea
6) SMA type 1
7) infection
46
what are the issues with neonatal resuscitation
hypoxia, babies have a large SA to weight ratio so get cold very easily and are born wet
47
how many times do you repeat inflation breaths in neonatal resuscitation
after drying baby you give 5 inflation breaths, then reassess and then give another 5 inflation breaths
48
when do you start CPR on neonate
if after 30s of ventilation, HR is still below 60 or not detectable
49
how often do you reassess for HR and chest movement in neonatal resuscitation
every 30 seconds (at rate of 3:1)
50
where is a cephalohaematoma vs a caput succadeneum
cephalohaeamtoma is subperiosteal
caput succadeneum is extraperiosteal
51
what is the definition of apnoea
periods where baby stops breathing for 20s + or less time if there is concurrent bradycardia
52
why does apnoea of prematurity occur
immature respiratory control centre
53
apart from prematurity, what are some other causes of apnoea
infection (sepsis and whooping cough), GORD, anaemia, hypoglycaemia
54
MX of apnoea
1) caffeine therapy (stimulates the peripheral chemoreceptors)
2)apnoea monitors in NICU which stimulate baby to start breathing again by tactile stimulation
55
Rf for SIDS other than cosleeping and parenteral smoking
prone sleeping, hyperthermia
56
protective factors of SIDS
breastfeeding, room sharing and use of dummies
57
although SIDS normally affects premature babies, it can also affect term babies - what is a risk factor for this?
maternal diabetes
58
Xray appearance of surfactant deficiency
ground glass appearances
59
complications of surfactant deficiency
pneumothorax, apnoea, IVH, chronic lung disease of prematurity
60
what causes PPHON
MAS or infection (it is caused by the vascular bed being remodelled. Get raised R side pressure in heart and R-L shunting if cardiac defect)
61
what are the complications of the baby passing meconium in utero
1) pneumonitis
2) can cause a pneumothorax
62
RF for MAS
gestation >42 weeks, foetal distress, oligohydraminos, IUGR, maternal hypertension, OC
63
how can MAS be distinguished from TTN
TTN clears spontaneously
64
what does a chest XR show for MAS
hyper inflated lung fields and patchy pulmonary opacities
65
how can we avoid MAS
avoid post dates gestation and fetal hypoxia and if there is evidence of meconium stained liquor then do suctioning
66
Mx of MAS post delivery
suction, O2, Abx for pneumonia cover, surfactant bolus
67
Rf for premature baby
previous premature, multiple preg, being underweight or overweight in pregnancy, smoking or illicit drug use, incompetent cervix
68
what can be done to prevent preterm labour
if the cervix if <25mm then can give vaginal progesterone or do cervical cerclage
69
what Ix may you do once a preterm baby is born
cranial US to check for IVH, blood group and Coombs test, FBC, urea, creatinine, CRP, CXR
70
list some complications of the preterm infant
IVH, NEC, jaundice, RDS, immature renal function, sepsis, immature skin barrier, immature thermoregulation and retinopathy of prematurity
71
long term complications of the preterm infant
-neurodevelopment outcomes
-chronic lung conditions
-hearing and visual impairment
72
RF of retinopathy of prematurity (new vessels form in response to hypoxia)
premature, LBW and artificial ventilation
73
Tx of retinopathy of prematurity
laser photocoagulation of intravitreal VEGF inhibitors
74
pathophysiology of retinopathy of prematurity
in utero the retinall blood vessels are stimulated by hypoxia. When baby is supplemented with oxygen this signal is removed and then when the hypoxia environment returns, the retina responds by producing excessive blood vessels
75
complications of CDH
pulmonary hypoplasia and pulmonary hypertension
75
6 advantages of breast feeding
1) free
2) lower rates of postnatal depression
3) reduced rates of allergies in adult
4) reduced risk of NEC
5) less likely to become obese as adult
6) IgA transfer
76
what factors determine prognosis in a congenital diaphragmatic hernia
1) liver position
2) lung-to-head ratio
77
drugs which can cause cleft lip/palate
phenytoin and ondansetron
78
what can cause cleft lip/palate
drugs, genetic syndromes like di George, family history
79
what causes cleft lip
failure of the nasal prominences and the maxillary prominences to fuse properly
80
what causes cleft palate
failure of the palatine processes and nasal septum to fuse
81
complications of cleft lip/palate
glue ear, feeding problems, psychosocial
82
who should treat people with cleft lip
specialist cleft lip service (MDT)
83
when is cleft lip vs cleft palate surgery done
lip - 3-6 months
palate 6-12 months
84
when does face Development begin in embryology
week 4
85
describe pharyngeal arches
there are 6 pharyngeal arches - made from development of mesoderm. The inner surface is endoderm, the bulk of tissue is mesoderm and the external surface is ectoderm. Each is associated with a cranial nerve, artery and cartilage.
The 5th regresses very quickly after development. On the inner surface there are pharyngeal pouches. The outer surface there are pharyngeal clefts. Only the first pharyngeal cleft becomes a structure in the adult and this becomes the external auditory meatus.
The face and palate form from the first pharyngeal arch and neural crest cells
86
what forms from the endoderm, mesoderm and ectoderm (this trilaminar disc formed in gastrulation)
endoderm - epithelial surface of GI tract and resp tract
Mesoderm - notochord, MSK and circulatory system
ectoderm - skin, nervous system and eye
87
what causes branchial cyst to develop
failure of the 2nd pharyngeal cleft to obliterate
88
RF of HIE
blood pressure extremes in mother, CHD, problems during labour, infection
89
what stages HIE
sarnat staging
90
criteria to use therapeutic hypothermia for HIE
it must be moderate or severe and mustt be done in the 6 hours after birth. The infant must be>36 weeks
91
monitoring done in therapeutic cooling
EEG and cardioresp monitoring
92
compilations of therpeutic cooling
arrhythmias, electrolyte imbalance, infection, bleed risk, PPH
93
when to suspect HIE
acidotic on blood gas, poor APGAR score
94
what are the levels like for a Down syndrome screening quadruple test
bHCG - high
AFP - low
unconjugated oestradiol - low
inhibin A - high
95
in the quadruple test what causes an isolated rise in AFP
neural tube defects
96
screening which is done on a Down syndrome baby once born
echo, heel prick test (looking at hypothyroidism!), hearing and eye sight
97
complications of downs
subfertiity, AML, Alzheimer's, recurrent ear infections, sight problems, AVSD, hirschsprungs, duodenal/anal atresia
98
features of fragile X
X linked dominant
-autism, learning difficulties
-large low set ears
-large testis
99
features of fetal alcohol syndrome
flat philtrum, learning disabilities, short palpebral fissure, microcephaly, growth retardation
100
features of pataus (T13)
cleft palate, polydactyly, microcephaly
101
features of Edwards (T18)
rocker bottom soles, low set ears, micrognathia, overlapping fingers
102
features of noonans (turners in boys)
webbed neck, pectus excavatum, pulmonary stenosis
103
how might you treat turners
give growth hormone, monitor heart and may give oestrogen replacement
104
neurological causes for GDD
spina bifida, IVH
Rett --> acquired
105
causes for GDD
neurological
infection
neuromuscular disorders
genetics --> downs, fragile X
Metabolic - PKU
Prematurity
106
Investigations for GDD
1) FBC and haemantics
2) U+E
3) CK
4) TFT
5) LFT
6) Vit D
7) Hearing
2nd line --> karyotyping and DNA analysis
107
what are the red flags of development
-not smiling by 10 weeks
-not sitting unsupporting by 12 months
-hand preference by 12 months
-speech and language - not knowing 2-6 words by 18 months
108
what is the purpose of a healthy visitor
assess a Childs development at 6/8 weeks / 9/12 months and 2-2.5 years + PROVIDE SUPPORT AND ENCOURAGEMENT TO FAMILIES IN THE EARLY YEARS
109
What is the definition of cerebral palsy
permanent, not progressive neurological damage that causes a gross motor delay
110
what are some early signs of cerebral palsy
poor feeding, abnormal reflexes and abnormal muscle tone
111
what happens in dyskinetic cerebral palsy
involuntary, uncontrolled, recurring movements with fluctuating muscle tone and persistent reflexes
112
what is used for pain in CP
diazepam
113
what is used for spasticity in CP
baclofen
114
complications of CP
hip dislocation, excess salivation, epilepsy, constipation
115
what investigation should be done if suspecting NAI
skeletal surgery --> this should then be repeated after 11-14 days
and CT head if any signs of head injury
116
what is checked in the newborn exam
eyes, heart, hips and testes
117
117
when should a vaccine be delayed
when child is unwell with fever or when on immunoglobulin therapy
118
example of inactivated (whole killed) vaccine
polio
119
when is MMR (live vaccine) given
at 1 year and before school
120
when is the pneumococcal vaccine given
at 12 weeks and one year
121
when is the rotavirus given
8 weeks and 12 weeks
122
when is the MMR vaccine given
at 1 year and at preschool
123
what vaccines are given at 1 year
Hib/Men C
MMR
PCV
Men B
124
when is the Men B vaccine given
8 weeks and 16 weeks
125
what vaccines are given at 3-4 years
MMR and 4 in 1 booster
126
signs of achondroplasia
short limbs, mid face hypoplasia and large head with frontal bossing
127
RF for ASD
advanced maternal/paternal age, conditions like fragile X, genetic, prenatal infection
128
what is the triad of symptoms for ASD
social interaction (delay in smile/lack of eye contact), communication (lack of non verbal communication and delay in speech) and restricted and repetitive interests
129
Tx for ASD
-support family
-ABA (applied behavioural analysis)
-special schooling / preschool programme
-control environment
-melatonin for sleep
-SALT
-respite care
130
screening questionnaire for ASD
GARS
131
what gives a poor prognosis of ASD
IQ < 50, no communicative speech by age 5
132
examples of inattention in ADHD
easily distracted, loses things, hard to organise
133
examples of impulsivity in ADHD
hard to wait their turn, often interrupts others
134
when can drug therapy be used for ADHD
age 5 and above
135
MOA of methylphenidate
dopamine and NA reuptake inhibitor
136
screening questionnaire for ADHD
conners and strengths and difficulties
137
RF for refeeding syndrome
lost 15% of body weight, alcohol abuse, had little to eat for 6 days
138
iron OD is common in children as it is found in many multivitamins, what are the stages:
1) 0-6 hours --> GI symptoms
2) GI symptoms ay then resolve before getting worse again --> coagulopathy
139
at what age do febrile seizures occur
6 months to 6 years (most common around 12-18 months)
140
RF of febrile seizures
family Hx, fever >40, winter
141
simple vs complex seizures
simple - less than 15 minutes, post ictal less than one hour and only one in a 24 hour period
complex - longer than 15 minutes, prolonged post octal state and more than one seizure in 24 hours
142
when is assessment by paeds needed for complex seizures
if it is the first febrile seizure, if they are recurrent or if they are complex
143
emergency Mx of anaphylaxis
1) lay pt flat
2) IM adrenaline (repeat after 5 mins)
3) oxygen
4) apply monitoring - ECG, BP, pulse oximetry
ALWAYS ADMIT CHILDREN DUE TO POTENTIAL OF A BIPHASIC REACTION
-give fluids at 10ml/kg
144
what management is done after the initial anaphylaxis
-occur after Tx
-normally do a mast cell tryptase within 6 hours
-refer to allergy clinic
145
causes for hypoglycaemia
starvation, metabolic (glycogen storage disorder), insulinoma, hepatitis, poisoning
146
when do paeds need a CT head after head injury
-any suspicion of NAI
-GCS < 15 2 hr after injury or < 14 at presentation
-any laceration over 5 cm
-seizure
-focial neurological deficit
VOMITING IS NOT PART OF THIS
147
what parameters can score on a PEWS
-resp rate
-resp distress
-oxygen requirement
-heart rate
-level of consciousness
-child and family concern
148
what does decorticate mean
bilateral flexing to pain
149
what does decerebrate mean
bilateral extension to pain
150
RF for erbs palsy
gestational diabetes, macrosomia, mothers with pelvic abnormality
151
RF for klumpkes palsy (C7/C8/T1)
abducted arm in childhood
152
signs of klumpkes palsy
claw hand
153
why is dehydration more common in children
they have higher metabolic rates, cannot communicate thirst and have a greater water requirement
154
RF of dehydration in children
LBW, <6 months, poor oral intake, vomit > twice in 24 hours, diarrhoea > 5
155
signs of clinical dehydration
reduced urine output, sunken eyes, dry mucous membranes and reduced skin turgor, may be tachycardic
BUT
-normal BP, normal pulses, normal CRT
156
signs of clinical shock
hypotension! cold extremities! pale/ mottled skin!
157
what is the best way to assess dehydration in paeds
through weight loss
mild (>5%)
moderate (5-9%)
severe/shock (10% or more)
158
if there is no evidence of clinical dehydration, what is the MX
-continue BF
-encourage oral intake but discourage carbonate juice
-assess rehydration risk
159
what is the Mx for signs of clinical dehydration
ORS over 4 hours - replace 50ml/kg
-continue breast feeding
160
what fluid is used for maintenance in paeds (IF OVER 28 DAYS)
0.9% NaCl and 5% dextrose
161
what fluid is used for neonates
10% dextrose !!!!
162
how much fluid is boluses in shock
10ml/kg of 0.9% NaCl
163
what can rapid correction of hypernatraemia cause
cerebral oedema
164
what can rapid correction of hyponatraemia cause
central pontine myelinolysis
165
what is the most sensitive sign of shock
change in mental state
166
what is a nitrogen washout test
if a baby has low O2, give them 100% O2 for 10 minutes and then take an ABG. If the PaO2 is <15kPa then this indicates a CYANOTIC CONGENTIAL HEART DISEASE!!! not a resp cause
167
how are mitochondrial diseases inherited?
spread from the mum only!
so mum gives it to all her children
when it reaches a male there is an abrupt stop
168
causes for neonatal hypothyroidism
prader willi and hypothyroidism
169
mx of viral wheeze
1) inhaled SABA
2) oral montelukast or ICS
for multi trigger wheeze trial ICS or montelukast for 4-8 weeks
170
how long is US the firstline Ix for DDOH
until child is 4.5 months old
171
5 signs of sepsis in neonate
1) resp distress 2) apnoea 3) tachycardia 4) jaundice 5) poor feeding 6) vomiting
172
Ix for sepsis in neonate
1) blood cultures
2) CRP and FBC can be misleading in neonate
3) urine culture
4) LP
5) cxr
173
what causes spina bifida
failure of the vertebral arches to close
174
Mx of PKU
low protein diet and tyrosine replacement
-need to avoid aspartate too as this is converted into phenylalanine in body
-tyrosine replacement as phenylalanine --> tyrosine in the body
175
features of prader willi
hypotoni, obesity, almond eyes, small hands
176
what's a specific sign for opiate withdrawal in neonate
yawning and excessive crying
177
in someone you are suspecting non accidental injury what should you do
full skin check, ophthal review for retinal haemorrhages and skeletal survey
178
what happens in androgen insensitivity syndrome
person looks female but has no female sexual organs
-presents with amenorrhoea or palpable undescended testis
-may also have a lack of pubic hair
-the female uterus does not develop due to the testis producing antimullerian hormone
Ix --.> high LH and FSH
Mx --> counselling, orchichedectomy , oestrogen replacement
179
what is the NICE traffic light system for
children under the age of 5 who present with a fever
AMBER signs --> reduced wet nappies, nasal flaring, dry mucous membranes
RED signs --> grunting, mod/severe intercostal recession, mottled, cannot rouse, any baby < 3 months with a temp >38, reduced skin turgor, looks unwell to the healthcare professional, resp rate > 60
180
Mx of the traffic light system for any child under 5 presenting with a fever
green can be managed at home
amber should be assessed by paediatrician OR safety net
red needs urgent assessment by paediatrician
181
what is the fluid management of DKA in children
10ml/kg over first hour, then minus this of the total amount unless they present in shock
182
cause of septic arthritis in SCD
salmonella
183
what conditions co-exist with ASD
epilepsy, fragile X, ADHD. tuberous sclerosis, hearing impairment,
184
electrolyte imbalances in refeeding
hypophosphataemia, hypomagnesaemia, hypokalaemia, hyperglycaemia, thiamine deficienc
