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Paediatrics Flashcards

1
Q

By what age should a child be able to momentarily hold their head up?

A

6 weeks

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2
Q

By what age should a child be able to full-hand grasp?

A

3-6 months

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3
Q

When can a child support their head?

A

3 months

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4
Q

By what age should a child start to sit unsupported?

A

6 months

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5
Q

By what age should a child crawl/shuffle?

A

9 months

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6
Q

By which age should a child walk?

A

12-18 months, after 18 definite delay

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7
Q

By what age should a child start to pincer grip?

A

9-12 months

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8
Q

By what age should a child be able to draw a circle?

A

3 years

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9
Q

By what age should a child be able to draw a cross/square

A

4 years

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10
Q

What language skills would you expect a child to have at 12 months?

A

One to two words

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11
Q

What language skills would you expect a child to have at 2 years?

A

The ability to join 2-3 words

Vocabulary of 20-50 words

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12
Q

By what age would you expect a child to be able to make basic sentences?

A

3 years

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13
Q

By what age would you expect a child to drink from a cup?

A

1 year

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14
Q

By what age would you expect a child to eat with a spoon?

A

2 years

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15
Q

What social behaviour would you expect from a 3 year old?

A

Dress self with help and undress self
Mostly toilet trained in the day
Eat with a fork and spoon

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16
Q

What are the risk factors for Croup?

A

Age 6m-6 years

Autumn months

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17
Q

What virus is responsible for croup?

A

Parainfluenza virus

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18
Q

What are the symptoms of croup?

A

Dry, barking cough
Stridor, hoarse voice
Symptoms worse at night
Tachypnoea, fever, fatigue

Signs of hypoxia and exhaustion in severe disease

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19
Q

How is croup managed?

A

Oral dexamethasone= definitive treatment, can be given in GP

Admit to hospital if <12m, signs of exhaustion/respiratory compromise
Humidified oxygen
Nebulised adrenaline in severe cases

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20
Q

What are the risk factors for bronchiolitis?

A

Age <2
Winter months
Smoke exposure, asthma, other lung problems
Premature
Congenital heart disease, immunosuppression

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21
Q

What virus is responsible for bronchiolitis?

A

Respiratory Syncytial Virus

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22
Q

What are the symptoms of bronchiolitis?

A 
Cough- can be dry or wet
Wheeze and crackles OA
Tachypnoea, fever, fatigue
Respiratory effort: grunting, nostril flaring, retractions
Irritability and poor feeding
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23
Q

How is bronchiolitis managed?

A

Supportive treatment
If well enough to be at home: lots of fluids, calpol for fever
If admitted (need for respiratory support, poor feeding, poor urine output etc) then respiratory support is given- supplemental oxygen -> nasal high flow -> CPAP -> I&V + fluid support

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24
Q

What are symptoms of GORD in a baby?

A

Usually <18 months
Vomiting and distress after feeding, reluctance to feed
Respiratory difficulty/stridor after feeding
Irritability
Excessive burping, BACK ARCHING after feeds

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25
How is GORD managed in children?
Sit up to feed and place in a head 30degree prone position for 30 mins after Feed thickeners Baby gaviscon - can cause constipation Omeprazole
26
What are the differentials for stridor in a child?
``` Croup GORD Epiglottitis Bacterial tracheitis Inhaled foreign object Anaphylaxis Acute asthma Laryngomalacia ```
27
What is the causative organism of epiglottitis?
Haemophilus influenzae B (HiB)
28
What is given for prophylaxis in contacts of epiglottitis?
Rifampicin
29
What is the management of acute epiglottitis?
Airway management- urgent ICU admission IV antibiotics: cefuroxime IV steroids for inflammation Supplementary oxygenation, fluid resuscitation
30
What organisms are usually causative of bacterial tracheitis?
Staphylococcus aureus | Group A B-haemolytic streptococci
31
How is bacterial tracheitis managed?
Airway management- ICU involvement IV antibiotics: rifampicin and cefuroxime Supplementary oxygenation and fluid resuscitation
32
What features would make you think epiglottitis over croup?
Rapid onset and progression High fever Drooling and unable to close mouth, inability to swallow Muffled voice
33
What are the triad of symptoms associated with anaphylaxis?
Allergic symptoms- hives, urticaria, angioedema Bronchoconstriction Hypotension
34
How is anaphylaxis managed in a child?
Airway management + oxygenation IM adrenaline 1:1000: 150micro-g <6 300micro-g 6-12 500micro-g >12 IV hydrocortisone Antihistamines IV fluids resuscitation
35
By what age would you expect laryngomalacia to resolve spontaneously?
2 years old
36
How would you manage a choking child?
If conscious and effective cough (loud and can take a breath before) then encourage to cough If ineffective cough + conscious: 5 back blows -> 5 thrusts If ineffective cough + unconscious: CPR: open airway, 5 breaths, 15:2
37
What are the symptoms of heart failure in a neonate?
Dyspnoea/cyanosis/grunting - especially on feeding, crying, exertion Sweating on the above also Reduced feeding and failure to thrive Lethargic, recurrent chest infection
38
What are signs of neonatal heart failure?
``` Tachypnoea and increased WOB, tachycardia Cyanosis and hypoxia Murmurs on auscultation Cardiomegaly, hepatomegaly Weak pulses and cold peripheries Prolonged CRT ```
39
How would you investigate suspected HF in a neonate?
``` Cardiovascular examination SO2 + other obs ECG Echo CXR ```
40
What are the managements for HF in neonates?
``` Diuretics: furosemide, spironolactone ACE-I: enalapril Oxygen unless oxygen-dependent lesion Inotropes: dopamine, dobutamine Surgery ```
41
What are the acyanotic congenital heart defects?
Atrial Septal defects Ventricular Septal defects Patent Ductus arteriosus Coarctation of the aorta
42
What are the cyanotic congenital heart defects?
Tetralogy of fallot Transposition of the great arteries Truncus arteriosus Tricuspid valve deformity
43
What is the most common congenital heart defect?
Ventricular septal defect
44
What murmur is associated with VSD?
Pansystolic murmur + may also have a thrill
45
What murmur is associated with ASD?
Ejection systolic murmur, split second heart sound
46
What murmur is associated with PDA?
Continuous machinery murmur heard under the L clavicle
47
How is PDA managed?
Preterm: ibuprofen/indomethacin to encourage closure Term: surgical ligation
48
What are the signs of coarctation of the aorta in a neonate?
``` Murmur between the scapulae LVH/cardiomegaly Cold extremities Weak femoral pulses High systolic BP ```
49
How is coarctation of the aorta managed?
IV prostaglandins to maintain patency of ductus arteriosus dopamine/dobutamine to improve contractility Surgical repair Supportive rx
50
What four characteristics make up tetralogy of fallot?
PROV Pulmonary stenosis RVH Overlying aorta VSD
51
What is the definitive treatment for tetralogy of fallot?
Blalock-Taussig shunt
52
Which congenital heart problem is associated with Down's syndrome?
VSD | ASD and AVSD also increased prevalence in this population
53
What congenital heart defects are associated with Turner's syndrome?
Coarctation of the aorta | Aortic stenosis
54
What is the treatment algorithm for paediatric stable asthma?
1. SABA 2. SABA + ICS (initially BD, then OD once well controlled) 3. SABA + ICS + trial of leukotriene receptor antagonist (montelukast) 4. Stop montelukast and trial LABA + ICS + SABA breakthrough 5. Consider trial of ipratropium 6. Oral prednisolone in severe, refractory asthma
55
What advice should be given regarding managing an asthma attack?
Use salbutamol inhaler- one puff every 30-60 seconds with 5 tidal breaths in between If no relief after 10 puffs, seek help
56
Following management of acute asthma, how should patients be stabilised?
PRN bronchodilator nebs- can be discharged once down to 4 hourly Oral steroids 3-7 days Review of medication and inhaler technique at discharge Follow-up arranged at discharge
57
What is first-line management of suspected pneumonia in children?
Amoxicillin Or if associated with flu- co-amoxiclav
58
How is bronchiectasis diagnosed?
CXR Spirometry- obstructive picture High-resolution chest CT Culture of sputum to rule out exacerbating infection
59
What are the differentials for cough in a child?
``` Asthma Respiratory tract infection / pneumonia Croup Bronchiolitis Bronchiectasis Pertussis Cystic fibrosis Congenital heart abnormality Choking ```
60
What are the symptoms of pertussis?
Dry cough with inspiratory whoop Vomiting after episodes of coughing Fever, sneezing, runny nose
61
How is pertussis managed?
First line = macrolide antibiotics
62
What is the mutation associated with cystic fibrosis?
Autosomal recessive mutation in CFTR gene on chromosome 7 (delta F508)
63
How is CF diagnosed?
Newborn heel prick test Chloride sweat test Genetic counselling and DNA testing
64
What are the features of CF?
``` Chronic cough and sputum production Recurrent respiratory infection Malabsorption and malnutrition Meconium ileus in newborns Bronchiectasis Diabetes Salty sweat Infertility ```
65
What are the symptoms of coeliac disease?
``` Failure to thrive- buttock wasting, faltering growth Abdominal distension Diarrhoea Irritability Anaemia ```
66
Which conditions are associated with coeliac disease?
Type 1 diabetes Autoimmune thyroid disease First degree family history Down's syndrome
67
How is coeliac disease diagnosed?
Anti-TTG antibody testing IgA testing- to rule out false negatives of the above Duodenal biopsy- must still be eating gluten
68
What are the symptoms of shaken baby syndrome?
``` Inconsistent history Altered mental state Hypotonia Areflexia Vomiting Papilloedema/retinal haemorrhages Suspicious bruising and fractures Bulging fontanelle Seizures Apnoea ```
69
What are the criteria for IBS diagnosis?
ROME criteria: 1. Improves with defecation 2. Onset associated with change in stool frequency 3. Onset associated with change in stool consistency
70
What electrolyte disturbances are associated with refeeding syndrome?
Low: phosphate, potassium, magnesium, thiamine High serum glucose ECG abnormality
71
How is refeeding syndrome managed?
Supplementation of thiamine, fat soluble vitamins and electrolytes Careful fluid resuscitation Gradual nutrition replacement
72
What fluid resuscitation should be prescribed in children?
Rapid IV bolus 0.9% NaCl <15 mins 20ml/kg Second bolus if shock persists
73
How are maintenance fluids prescribed for children?
First 10kg: 100ml/kg 10-20kg: 50ml/kg 20+: 20ml/kg
74
What antibiotic can be given in campylobacter infection?
Erythromycin
75
What antibiotics can be given in c-difficile?
Metronidazole and vancomycin
76
What are complications of rotavirus?
Dehydration | Post-infective lactose intolerance
77
What are the complications of E-coli 0157?
Haemolytic Uraemic Syndrome | Bloody diarrhoea
78
What are the classic symptoms of intussusception?
Vomiting- often bilious Abdominal pain, distension and tenderness- draw legs up Episodes of colic where baby may go very pale Red-current jelly like stool Palpable sausage-shaped mass in the abdomen
79
Where is the most common site of intussusception
80
Where is the most common site of intussusception?
Ileum -> caecum
81
How is intussusception diagnosed?
Gold std- USS showing target sign AXR may also show target sign or small bowel obstruction Contrast enema= most sensitive but most invasive
82
How is intussusception managed?
Make NBM- IV fluids, pain relief Contrast enema or gas reduction (if stable) Surgical fixation
83
What is a Meckel's Diverticulum?
Congenital defect causing outpouching of the small bowel- can cause obstruction, bleeding, inflammation or perforation
84
What are the symptoms of Meckel's diverticulum?
Haematochezia- PR passage of bright red blood Abdominal pain, bloating and distension Vomiting- may be bilious Small bowel obstruction May present with intussusception
85
How is Meckel's diverticulum diagnosed?
Meckel's scan- technetium 99m- technetate scan AXR CT
86
What are the symptoms of pyloric stenosis?
Vomiting after feeds- becoming increasingly frequent and forceful (projectile) Refusing to feed Failure to thrive/dehydration Palpable mass- olive-like
87
How is pyloric stenosis diagnosed?
Abdominal USS
88
How is pyloric stenosis managed?
Pyloromyotomy | Feed within 6 hours of procedure
89
What are the potential complications of intestinal malrotation?
Volvulus Bowel ischaemia and necrosis Bowel obstruction Failure to thrive
90
What are the symptoms of intestinal malrotation?
Vomiting- often bilious Abdominal pain, distension and tenderness Bloody stool Tachycardia, tachypnoea -> SIRS, acidosis and hypotension if ischaemia occurs
91
How is malrotation best diagnosed?
Upper GI contrast series- showing odd course of the right-sided duodenum May also show volvulus
92
What is Hirschprung's disease?
A lack of ganglion cells in the myenteric and submucosal plexi, affecting the rectum and some of the large bowel proximally (extent varies)
93
How does Hirschprung's present?
Delayed/failure to pass meconium Abdominal distension, pain, tenderness Bilious vomiting Digitation of the rectum causes gush of stool and flatus May present with Hirschprung's enterocolitis
94
How is Hirschprung's diagnosed?
Rectal biopsy showing absence of ganglion cells
95
What rash is characteristic of meningococcal disease?
Non-blanching purpuric/petechial rash | Associated with fever, malaise, meningism, bulging fontanelle
96
What rash is characteristic of SJS?
Extensive haemorrhagic rash -> blistering and peeling of skin Mucous membrane involvement Usually starts on face and spreads distally Associated with medication, infection, inflammation
97
What rash is characteristic of Kawasaki disease?
Erythematous maculopapular rash- may be erythema-multiform like Associated with 5 day fever, conjunctivitis, lymphadenopathy, strawberry tongue, induration of palms and soles
98
What rash is characteristic of staphylococcal scalded skin?
Blistering and desquamation of skin Often starts from small graze/rash that gets infected Group A strep Managed with IV flucloxacillin
99
What rash is characteristic of eczema herpeticum?
HSV 1 infection of eczema Painful blistering on face and neck Rapid spread-> can cause blindness Req acyclovir ASAP
100
What rash is characteristic of measles?
Widespread maculopapular rash which starts to coalesce Rash beginning on the head and spreading to the trunk and extremities over a few days. Resolution of fever soon after rash appearance. Fever, coryza, cough, conjunctivitis Mucosal involvement- oral koplik spots
101
What rash is characteristic of chicken pox?
Varicella zoster virus Macules -> papules -> pustules -> crusted blisters Associated with headache, URTI, itch and fever Affects face and trunk then spreads to limbs
102
What rash is characteristic of Scarlet fever?
Sandpaper rash affecting face, chest and upper arms Caused by group A strep Associated with sore throat, strawberry tongue 12-48 hours BEFORE rash
103
What rash is characteristic of Rubella?
Pale pink/red spots starting on the face and spreading distally Can affect mucosa Rash + swollen glands + fever RF: not had MMR vaccine
104
What rash is characteristic of shingles?
Prodromal itching and burning pain Vesicular rash in dermatomal distribution: erythematous maculopapular rash, which is followed by the appearance of clear vesicles. DOES NOT CROSS THE MIDLINE Need acyclovir
105
What rash characterises parvovirus B19?
Slapped-cheek rash | Lace-like rash on the trunk
106
What are differentials for purpuric rash in a child?
``` Meningococcal HUS HSP ITP Leukaemia NAI ```
107
What is HSP?
IgA-mediated vasculitis Usually presents following streptococcal infection- URTI or gastroenteritis Tetrad: rash, abdominal pain, arthralgia, glomerulonephritis Usually self-resolving, supportive rx
108
What is ITP?
Idiopathic thrombocytopenic purpura purpuric rash + low platelets with no clear cause Associated with epistaxis Usually presents following viral infection Usually supportive rx
109
What is HUS?
Haemolytic Uraemia syndrome Haemolytic anaemia + AKI + thrombocytopenia Usually occurs post e-coli 0157 infection Present with bloody diarrhoea, abdo pain, vomiting, rash Supportive rx
110
What are the most common causes of meningitis in neonates?
Group B strep E-coli Listeria
111
What are the most common causes of meningitis in kids >3m?
Neisseria meningitides | Streptococcus pneumoniae
112
How would you manage a child with suspected meningitis?
A-E assessment and observation IV access + catheterise (measure urine output) Give O2 (if indicated) and IV fluids Bloods: FBC, CRP, U&E, LFT, cultures, blood gas Urine culture LP if stable enough IV abx / acyclovir + steroids
113
What antibiotics are usually indicated in meningitis?
IV ceftriaxone | Add amoxicillin in neonates to cover for listeria
114
Why do you give steroids in meningitis?
Reduce meningeal inflammation | Reduces risk of deafness and neurological complications
115
What LP results would you expect in BACTERIAL meningitis?
Raised opening pressure Raised neutrophil count, low or normal lymphocytes Elevated protein content Low glucose May have turbid appearance
116
What LP results would you expect in VIRAL meningitis?
Raised opening pressure High lymphocyte count, low neutrophils Elevated protein Normal glucose Clear looking fluid
117
What LP results would you expect in TB meningitis?
``` Raised opening pressure Straw-coloured fluid Low neutrophils, raised lymphocytes High protein Very low glucose ```
118
What are red flags for sepsis in kids?
``` Low GCS Parental concern Weak/high-pitched/continuous cry Grunting/apnoea Low sats, severe tachypnoea, tachy/bradycardia No wet nappy Rash, mottled, cyanotic hypo/hyperthermia ```
119
What are the sepsis 6 steps in paeds?
1. High-flow oxygen 2. IV/IO access- blood cultures, gas, glucose, FBC, U&E 3. IV antibiotics 4. IV fluids 5. Call in senior help 6. Consider inotropes
120
What is the most common type of leukaemia in children?
ALL
121
Red flags for leukaemia in children:
``` Unexplained bruising/petechiae Hepatosplenomegaly Pallor/anaemia Recurrent infection Persistent fever and lymphadenopathy Bone pain Weight loss/failure to thrive ```
122
How would you investigate suspected leukaemia?
FBC: high WBC or pancytopenia Blood film: high proportion of blast cells Clotting: deranged LDH + uric acid elevated due to high cell turnover Bone marrow aspirate = gold standard
123
What is the most common type of brain tumour in children?
Medulloblastoma
124
What is the characteristic sign of Ewing's sarcoma?
Bone pain | Onion-like structure on imagine
125
What is the most common type of bone cancer in children?
Osteosarcoma
126
What is the characteristic sign of retinoblastoma?
Leukocoria - white instead of red reflex | May have family history
127
What characterises an indirect hernia?
Emergence through the deep inguinal ring | Holding over deep ring and asking to cough with prevent emergence of the hernia
128
How would you differentiate an inguinal hernia from a hydrocele?
Can't get above a hernia on examination | Hernia will not transilluminate on examination, hydrocele will
129
How are inguinal hernias managed?
Stable: taxis (compression with analgesia) and planned surgery If incarcerated/irreducible: emergency surgery to avoid strangulation
130
How are hydroceles managed?
Usually no management and resolve on their own | If not resolved by 2 years, surgery may be considered
131
At what age should undescended testes be reassessed?
By 3 months - majority descend on their own by this stage
132
What is the management for persistently undescended testes?
Orchidopexy performed by the age of 1 year
133
Which congenital deformity increases the risk of testicular torsion?
Bell-Clapper deformity
134
What is the management for testicular torsion?
Surgical fixation of BOTH testes
135
What is the most common cause of nephrotic syndrome in children?
Minimal change syndrome | Usually steroid-responsive
136
What are the symptoms of nephrotic syndrome in children?
Peri-orbital oedema- esp on waking Breathlessness Ascites Infections (due to loss of immunoglobulins in the urine)
137
How do you manage nephrotic syndrome?
8 week tapering course of prednisolone + prophylactic antibiotics
138
At what age are UTIs more common in boys?
<1 year
139
How should upper UTIs be managed?
Co-amoxiclav or cefalexin
140
When should UTIs be investigated more thoroughly?
Recurrent infection Atypical bacteria <6m old
141
What is the gold standard investigation for vesicoureteric reflux?
Micturating cystogram
142
How should nocturnal enuresis be investigated?
Urine dip- to rule out infection Urine osmolality: assessment of ability to concentrate urine USS renal tract to rule out anatomical causes
143
What is the management algorithm for nocturnal enuresis?
1. Behavioural changes: no drinking before bed, avoid caffeinated drinks, ensure adequate fluid intake in the daytime, manage constipation, correct voiding posture 2. Positive reinforcement of behaviour 3. Enuresis alarms 4. Desmopressin (increases water reabsorption) 5. Psychological therapies
144
How does ADPKD usually present in children?
Abdominal pain/mass | Incidental finding of hypertension
145
What infection causes Lyme disease?
Borrelia Burgdorferi - from Tics
146
What are the symptoms of Lyme disease?
Erythema migrans: target rash appearing at the site of the tic bite + non-specific flu symptoms Several weeks later: aseptic meningitis, facial palsy, arthritis, carditis Months-years later: neuropsychiatric manifestations
147
What is the management of Lyme disease?
``` Prophylactic doxycycline within 72 hours of the bite Amoxicillin treatment (doxycycline if >12 due to tooth staining) ```
148
What are the symptoms of Kawasaki disease?
``` Fever > 5 days Conjunctivitis Strawberry tongue Arthralgia Induration on hands and feet Erythematous rash Cervical lymphadenopathy ```
149
How would you investigate Kawasaki disease?
Echo= gold standard to rule out aneurysms ECG Bloods: raised ESR and CRP, normocytic anaemia, high WBC and platelets
150
What is the treatment for Kawasaki disease?
Aspirin IVIG within 10 days Echo at 6 weeks May need long term anticoagulation
151
What score is used to guide treatment for Kawasaki disease?
Z score | How much larger coronary artery diameter is compared to average
152
What features suggest a simple febrile seizure?
``` < 15min duration Self-terminating No recurrence in 24 hours Occurring during a febrile episode No acute neurological disease ```
153
When is admission necessary for a febrile seizure?
Complex seizure < 18m Recurrence in 24 hours Not during a febrile episode
154
What features suggest a complex febrile seizure?
Lasting over 15 minutes / anticonvulsants used to terminate before this point Recurring within 24 hours Post-ictal neurological abnormalities (Todd's palsy)
155
What is the most important condition to rule out in a child presenting with febrile seizures?
Meningitis - should do LP
156
What parental advice should be given re. febrile seizures?
1. Clear mouth and loosen anything around neck 2. Protect head but do not restrain 3. Call ambulance if persisting >5min or if rescue meds ineffective >5min 4. May receive buccal midazolam/rectal diazepam rescue packs for use at 5 mins 5. Record seizure if possible
157
What are differentials for seizures in a child?
``` Febrile seizure Inborn error of metabolism Epilepsy Meningitis Head trauma Ingestion of toxin Iatrogenic- medication ```
158
What is first line management for generalised tonic-clonic seizures in children?
Lamotrigine- esp for girls | Valproate can be considered in boys
159
What is first line management for absence seizures in children?
Ethosuxamide in girls | Valproate appropriate for boys
160
What is first line management for myoclonic seizures in children?
Leviteracetam- esp in girls | Valproate can be considered in boys
161
What doses should be used in the management of paediatric status epilepticus?
1. IV lorazepam 0.1mg/kg | 2. buccal/rectal preparations 0.5mg/kg
162
What are the risk factors for developing cerebral palsy?
Antenatal: prematurity, SGA, IU infection, multiple gestation, maternal smoking/drinking/drug usage, anything causing inflammation/ischaemia Perinatal: complicated labour, asphyxia, cord around neck Postnatal: NAI, head trauma, meningitis, encephalitis, cardiopulmonary arrest, hypoglycaemia, stroke, choking/drowning
163
What are characteristic features of cerebral palsy?
``` Developmental delay Seizures Altered tone and power in the limbs, head lag Speech and language difficulty Jerky/clumsy/uncontrolled movements Seizures, scoliosis, hip dislocation Muscle spasm and tiptoe walking ```
164
What management is available for cerebral palsy?
1. Physiotherapy to maintain and improve strength- splinting and stretching to prevent contractures 2. SALT and OT 3. School support 4. Symptom control: Baclofen/botox for spasm Diazepam/botox for stiffness Anticonvulsants Laxatives Analgesia
165
How would you treat group B strep infections of a newborn?
Benzylpenicillin or ampicillin + gentamycin If over a month old: cefuroxime, cefotaxime or ceftriaxone
166
What are characteristic features of autism spectrum disorders in children?
1. Speech and language delay/difficulty 2. Social impairment 3. Rigid behaviours and interests 4. Motor stereotypes: hand flapping, flicking, bouncing, rocking 5. Inability to grasp social cues and difficulty making friends 6. Difficulty and stress in new situations
167
What are the three domains of ADHD?
1. Impaired attention 2. Hyperactivity 3. Impulsivity
168
How is ADHD diagnosed?
6+ features of impaired attention 6+ features of hyperactivity/impulsivity - > Present in more than 1 environment/situation - > Duration >6 months
169
What is the first line medical management for ADHD?
Methylphenidate
170
What should be monitored regularly in children taking pharmacological management for ADHD?
Height and weight
171
What is the inheritance pattern for Duchenne muscular dystrophy?
X-linked recessive
172
What are the key features of Duchenne's?
``` Waddling gait Language delay Gower's sign: pronating and using hands to walk back up body to stand Calf hypertrophy as initial compensation Scoliosis Nocturnal hypoxia Cardiomyopathy and respiratory failure ```
173
What pH places DKA in the severe category?
<7.1
174
What complication of DKA treatment must be avoided?
Cerebral oedema - Do not routinely give fluid boluses - Lower limits for maintenance fluids
175
What must be added to fluids in treating DKA?
Potassium - insulin causes shift into the cells | 0.9% NaCl + 40mmol/L KCl should be used
176
How is DKA managed in children?
1. A-E assessment, full set of obs, blood gas 2. IV fluids first 3. Commence IV insulin 1-2 hours afterwards Fluid: 0.9% NaCl + 40mmol KCl Assume 5% deficit or 10% if severe For each kg <10= 2ml/kg/hr then for each kg 10-40= 1ml/kg/hour If >40kg= 40ml/hr max Start insulin IV 0.05-0.1unit/kg/hr Once glucose <14mmol/L, introduce NaCl with 5% glucose IV fluids can be stopped once ketosis resolved Patients should have continuous ECG monitoring due to the risk of potassium disturbance.
177
How would you manage cerebral oedema?
IV mannitol | Hypertonic saline
178
What is the diagnostic test for vesicoureteric reflux?
DMSA scan
179
At what ages do children have the DTPP vaccine?
8 weeks 12 weeks 16 weeks 3 years 4 months
180
At what ages do children have the HiB vaccine?
``` 8 weeks 12 weeks 16 weeks 1 year 3 years 4 months ```
181
At what ages do children have the hep B vaccine?
8 weeks 12 weeks 16 weeks 3 years 4 months
182
At what ages do children have the men B vaccine?
8 weeks, 16 weeks, 1 year
183
At what ages do children have the MMR vaccine?
1 year | 3 years 4 months
184
At what age is corrective surgery for hypospadias performed?
12m

Finals Revision (23 decks)

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