Paediatrics Flashcards
1
Q
What is the calculation to estimate paediatric weight?
A
(age in years + 4 ) x 2
2
Q
When is the DTaP vaccine given?
A
2 months, 3 months, 4 months, 3-5 years and 13-18 years
3
Q
When is the MMR vaccine given?
A
12 months and 3-5 years
4
Q
When is the polio vaccine given?
A
2months, 3 months, 4months + 3-5 years
5
Q
When is Men B vaccine given?
A
2 months, 4 months, 12 months
6
Q
When is MEN with C + W135 + Y given?
A
13-15 years
7
Q
When is the rotavirus vaccine given?
A
2 months + 3 months
8
Q
What are risk factors for sudden infant death syndrome? (8)
A
- Passive smoking
- Male
- Winter
- Sleeping prone
- Premature babies
- Twins
- Co-sleeping
- Lower socio-economic status1
9
Q
What must we ensure in ED in cases of sudden infant death syndrome? (6)
A
- Clear documentation - weight, condition of baby. Any marks from procedures
- Retain clothes and bedding and put in paper bag
- Ensure blood/urine/skin samples taken (inborn errors of metabolism)
- If twin/siblings council on preventative measures
- Cancel all hospital appointments
- Inform police will be in contact as matter of course
10
Q
What 3 things must be present to diagnose BRUE?
A
- < 1 year
- <1 mins
- Sudden return to baseline
11
Q
What 4 signs/symptoms characterise a BRUE (need at least one of these)
A
1, Cyanosis/pallor
2. Absent/irreg breathing
3. Increased or decreased tone
4. Altered GCS
12
Q
Which low risk factors might allow a BRUE to be managed as an outpatient? (5)
A
- Over 60 days old
- Born over 32 weeks
- No CPR from healthcare professional
- 1st event
- < 1min
13
Q
What is the management for infected umbilical cord?
A
IV abx
Refer paeds
14
Q
What are the serious causes of neonatal jaundice? (7)
A
- Rh haemolytic disease
- ABO incompatibility
- Congenital spherocytosis
- G6PD deficiency
- CMV infection
- Hypothyroidism
- Biliary atresia
15
Q
How much of a babies birth weight is expected to be lost by week one and when should they regain it?
A
- 10%
- Week 2
16
Q
How well patients with inborn errors of metabolism present?
A
- Early
- Very unwell
- Can appears septic but no cause found
17
Q
What biochemical abnormalities will patients with inborn errors of metabolism present with?
A
- Raised lactate
- Hypoglycaemia
- Raised ammonia
- Acidosis
- Ketonuria
18
Q
How should patients with inborn errors of metabolism be managed immediately?
A
- IV dextrose - nil oral until which disease it is
- Early bloods very useful
19
Q
In neonates what is milia?
A
Rash with white papules - benign and self limiting
20
Q
What is erythema toxicum?
A
Neonatal rash - erythematous lesions with central white vesicles.
Benign and self limiting
21
Q
What is a monilial infection?
A
Nappy rash infected by candida albicans
Erythema of flexures
22
Q
What is seborrhoeic dermatitis
A
Erythematous, greasy rash involving nappy area/occipute and behind ears. Can become infected with candida
23
Q
How is seborrhoeic dermatitis treated?
A
Nyastatin
24
Q
How should temperature be measured in babies <4 weeks?
A
Electronic axilla thermometer
25
How should temp be measured in children 4 weeks to 5 years?(3 options)
1. Electronic axilla thermometer
2. Chemical dot thermometer
3. Infra-red tympanic thermometer
26
Under what age should babies have full septic work up?
3 months
27
What are the signs are different in herpes simplex encephalitis compared with other meningo-encephalitis in children?
1. Focal neurology
2. Focal seizures
28
What does a rapid decrease in temp post anti-pyretics show?
Nothing - do not use response to anti-pyretics decide severity of illness
29
What investigations should babies under 3 months with a fever have? (7)
1. FBC
2. BC
3. CRP
4. Urine
5. CXR if signs
6. Stool culture if diarrhoea
7 LP if < 1month or unwell or high/low WCC
30
Which children presenting with a fever should have an LP? (3)
1. < 1 month
2. 1-3 months and unwell
3. 1-3 months and either raised or low WCC
31
In children > 3 months and 1 or more red feature what should be performed (4) and what should be considered (4)
1. FBC
2. BC
3. CRP
4. Urine
5. CXR regardless of WCC and temp
6. LP
7.U+E
8. Blood gas
32
In children > 3 months with 1 or more amber feature what investigation should they have (4) and what should be considered (2) ?
1. Urine
2. FBC
3. CRP
4. BC
1. Consider LP
2. CXR if fever >39 and WCC >20
(difference between red is CXR needs another reason and no U+Es/VBG)
33
If a child > 3 months with a fever only has green features but no source what should be done? (2)
1. Urine sample
2. Assess for signs of pneumonia
34
What is an amber flag for paeds re: skin colour
Pallor reports by parents
35
What are red flags for paeds re: skin colour? (3)
1. Pale
2. Mottled
3. Blue
36
What are amber flags for paeds re: activity? (4)
1, Not responding normally to social cues
2. No smile
3. Only wakes on prolonged stimulation
4. Decreased acitivity
37
What are red flags for paeds re: activity (4)
1. No response to social cues
2. Appears ill to healthcare professional
3. Does not wake or stay awake
4. Weak/high pitched/continous cry
38
What are amber flags in paed re: resp (4)
1. Nasal flaring
2. RR > 50 in 6-12 months
RR > 40 > 12 months
3. <95% SATs
4. Crackles on chest
39
What are red flags in paeds re: resp (3)
1. Grunting
2. RR >60
3. Mod-severe chest indrawing
40
What are amber flags in paeds re: CVS (4)
1. HR
>160bpm < 1year
> 150bpm 1-2 years
> 140bpm 2-5 years
2. CRT > secs
3. Poorer feeding
4. Decreased UO
41
What are paeds red flags re: CVS? (1)
Increased skin turgor
42
What are the other paeds amber flags (5)
1. 3-6 months and fever >39
2. Fever 5 days or more
3. Rigors
4. Swelling of joint/limb
5. NWB limb
43
What are the other paeds red flags? (7)
1. <3 months and fever >38
2. Non blanching rash
3. Bulging fontanelle
4. Neck stiffness
5. Status epilepticus
6. Focal neurology
7. Focal seizures
44
What is the appropriate management of a child < 3 months with suspected UTI?
MC+S
Refer paeds
45
In 3 month- 3yrs which ? UTI should get abx based on urine dip?
Either leuc/nit +ve
Send MC+S as well
46
> 3 years old and urine dip shows +ve nit but -ve leuc
What is the tx?
Abx and MC+S
47
> 3 years old urine dip:
+ve leuc / -ve nit
How should they be managed?
No abx unless good clinical evidence of UTI
Send MC+S
48
Which UTIs in paeds should be referred to paeds? (3)
1. Unwell
2. < 3 months
3. Over 3 months but upper UTI
49
Which children should have an US in the acute phase of their UTI?
1. Atypical (septic, no response abx, non E.coli)
2. Recurrent if < 6 months old (reccurent = 3 lower UTI, or 2 if one was upper UTI)
50
Which children should have an US <6 weeks after their UTI? (2)
1. All under 6 months
2. > 6 month old but recurrent (3 lower UTIs or 2 if one is upper UTI)
51
Which organisms cause pneumonia in neonates? (5)
1. E.coli
2. B haemolytic strep
3. Listeria
4. Chlamydia
5. CMV
52
Which organisms cause pneumonia in infants/toddlers? (5)
1. RSV
2. Parainfluenza
3. S. pneumoniae
4. H. influenza
5. Mycoplasma
53
Which organisms cause pneumonia in older children and which is the most common? (3)
1. Step pneumoniae (>common)
2. H. influenza
3. Mycoplasma
54
What do children with Mycoplasma pneumonia typically present like? (4)
Headache
Abdominal pain
Joint pain
Maculopapular rash
55
Would does BTS recommend re: management of CAP and:
1. NGT
2. IVI
3. Chest physio
1. Try and avoid NGT, if needed then smallest possible
2. Daily U+Es if on IVI
3. No role for chest physio
56
What is first line for CAP in children?
Amoxicillin
57
What antibiotic should be added if CAP in children not responding to abx or severe?
A macrolide
58
What antibiotic should be used in influenza associated CAP in children?
Co-amoxiclav
59
When should IV abx be used in management of CAP in children?
If unable to take orally
Even severe should be treated to PO if can take orally
60
How long should children with severe CAP of empyema be followed up for?
Until normal CXR
61
What age group is normally affect by Kawasakis disease?
< 5 years
62
What are the features of Kawasaki disease? (8)
1. Erythematous rash (early, may have resolved by presentation)
2. Desquamousation palms/soles (late sign)
3. Conjunctivitis/uveitis with no exudate
4. Fissured lips
5. Strawberry tongue
6. Arthritis
7. Unilateral cervical lymphadenopathy
8. Raised inflam markers
63
What is the treatment for Kawasaki disease? (2)
1. Aspirin
2. IV immunoglobulin
64
What can Kawasaki disease lead to?
Coronary artery aneurysm
65
What is dermatitis herpatiformis? (3)
Skin manifestation of coeliac
Itchy ++
Vesicles/papules knees/elbows/buttocks
66
What is the treatment for dermatitis herpatiformis?
Dapsone
67
What does erythema multiforme look like? (2)
Target lesions with pale centre
Usually extensor surfaces
68
What are the causes of erythema multiforme? (3 infective, 2 drugs)
1. Herpes
2. Mycoplasma
3. TB
4. Sulphanamides (all begin with sulf-)
5. Barbiturates
69
How does erythema nodosum present? (4)
1. Painful red nodules anterior surface both shins
2. Fever
3. Lethargy
4. Arthralgia
70
Give 5 causes of erythema nodosum?
1. Strep
2. TB
3. Sulphonamides (sulf-)
4. UC
5. Sarcoid
71
What is erythema marginatum?
Transient rash with raised edges in 20% causes of rheumatic fever
72
What is erythema chronicum migrans?
Lyme disease
Begins red papules then spreads to produce erythematous lesions with pale centres and bright edges
73
What is the treatment for uncomplicated Lyme disease in patients > 9 years?
Doxycycline PO
74
What is treatment for uncomplicated Lyme disease in children < 9 years?
PO amoxicillin
75
What is the treatment for Lyme disease in patients with CNS involvement or myocarditis with haemodynamic compromise?
IV ceftriaxone
76
What organism is generally responsible for croup?
Parainfluenza
77
What are the 5 parts of the Westley croup score?
1. Stridor
2. Retractions
3. Air entry
4. SATs <92%
5. Reduced GCS`
78
Describe the Westley croup score
79
Give 3 features of diptheria?
1. Exotoxin
2. 'Bull neck'
3. Adherent exudate
80
What is the treatment for diptheria?
IV erythromycin
Anti-toxin
81
What is the management of acute epiglotitis? (3)
1. Call anaesthetics and calm child
2. Neb adrenaline (0.5ml/kg 1:1000, max 5ml)
3. IV cefotaxime with I+V (gas induction)
82
How will acute epiglotitis present differently to croup? (3)
1. Less stridor
2. Quicker onset
3 More unwell
83
What are the criteria for diagnosis of paeds DKA? (3)
1. Gluc > 11 (can be normal)
2. Acidosis - PH <7.3 of HCO3 <15
3. Blood ketones > 3mmol/l
84
What is the management of paed DKA who is alert, not vomiting and not dehydrated?
1. sc insulin
2. PO fluids
85
What is the dose of insulin to be given in paeds DKA?
0.05-0.1 IU/mg/kg
86
When should insulin be started in paeds DKA?
After at least 1 hour of fluids
87
Over what period should IV maintenance be calculated in paeds DKA and why?
1. 48 hours
2. Avoid cerebral oedema
88
What should be given in paeds DKA in the case of cerebral oedema and at what dose?
20% mannitol 0.5-1.0g/kg over 15 mins
or
5ml/kg hypertonic saline
89
What is the pathophysiology of Henoch-Schonlen Purpura?
Vasculitis affected the skin/kidneys and GI tract
90
What age groups does HSP affect?
4-11 years
91
What does HSP rash looks like? (2)
1. Erythematous macules becoming palpable purpuric lesions
2. Buttocks and extensor surfaces usually
92
What are the symptoms of HSP (4)
1. Rash
2. Abdo pain
3. Arthralgia
4. Testicular pain
93
What can HSP lead to?
Nephritis can lead to renal failure
94
What investigations should be carried out in HSP? (4)
1. FBC
2. U+E
3. Urine dip
4. BP
95
What is the mechanism leading to ITP?
Autoimmune ?viral trigger
96
How is ITP managed?
Conservatively
Platelets if bleeding
97
What features point to a diagnosis of ALL in paeds purpura? (4)
1. Heptato-splenomegaly
2. Lymphocytosis
3. Blast cells on blood film
4. Low platelets
98
What are appropriate sedative agents for painless procedures in paeds? (2)
1. Chloral hydrate
2. Midazolam
99
What sedative agents are appropriate for minimal to moderately painful procedures in children? (2)
1. Entonox
2. Midazolam
100
What sedative agents are useful for painful procedures in children? (3)
1. Ketamine
2 IV midazolam + fentanyl
101
What monitoring is mandatory for min-mod paeds sedation?
1. RR
2. Pulse oximetry
102
What monitoring is mandatory for deep sedation in paeds?
1. 3 lead ECG
2. ETCO2
3. 5 mins BP
103
What is the issue with using chloral hydate/ propofol and sevoflorane for paeds sedation?
No marketing authorisation for paeds
104
When should we be cautious using midazolam in paeds?
< 6 months as has no marketing authorisation
105
When is chicken pox infective?
48 hours before rash (most infective) until crusting (usually 5 days after rash commences)
106
If a child has a petechial rash and a fever but none of the high risk clinical manifestations, what should trigger IV abx?
Raised WCC or CRP
107
What is the strongest determining feature of Kawasakis?
Fever >38 degrees for > 5 days
108
What is the earliest and what is the latest sign of Kawasakis?
1. Rash - may have resolved be time of presentaiton and usually in first 5 days
2. Desquamation
109
What are the most common causative organisms causing meningitis in neonates? (4)
1. Strep agalactiae (group B)
2. E. coli
3. Strep pneumonia
4. Listeria
110
What are the most common causative organisms in meningitis in children > 3 months
1. Neisseria meningitidis
2. Strep pneumonia
3. H. influenza
111
When is parvovirus infective?
10 days pre-rash until rash develops
112
What are two concerns with regards to parvovirus?
1, Can trigger transient aplastic crisis in patients with sickle cell/heriditary spherocytosis etc.
2. Pregnant women can pass it on to fetus leading to complications inc fetal death.
113
What are 5 'red flags' for patients presenting with eating disorders?
1. HR < 40bpm
2. syncope
3. postural drop
4. high levels of dysfunctional exercise
5. possible daily episodes of purging behaviours)
114
Under what age should all limping children be investigated?
Under 3 years
115
What are the criteria for conservative management of a limping child? (4)
1. 3–9 years
2. Afebrile
3. Mobile
4. Symptoms for less than 72 hours, or more than 72 hours and improving
116
Hows should patients with a 'red flag' from the Medical Emergency in Eating Disorders framework (MEED) be managed?
Admission
117
What causes 'slap cheek' rash?
Parvovirus B19
118
What virus causes 'hand, foot and mouth'?
Cocksackie A16
119
What organism causes Scarlet Fever?
Step pyogenes
120
What is the clinical course of scarlet fever?
1. Sandpaper rash after 12-48hours on chest/stomach first, then flexor surfaces.
2. After one week can develop desquamation of fingers/toes
3. Strawberry tongue can occur
121
What is the criteria for diagnosing nephrotic syndrome in children? (3)
1. Oedema
2. 3+ protein urine
3. Albumin < 25
Need all 3
122
What criteria are needed to diagnose Pertussis?
2 weeks of cough and at least one of the following:
- inspiratory whooping
- coughing paroxysm or fits
- apnea with or without cyanosis in infants
- Post-tussive vomiting without any obvious cause
123
When is Hib vaccine given?
2 months, 3 months, 4 months (as part of 6 in 1)
and 1 year
124
What is in the 6 in 1 vaccine given a 2,3 and 4 months?
1. Diptheria
2. Tetanus
3. Pertussis
4. Hep B
5. Polio
6. Hib
125
How is mild/moderate/severe DKA defined in paeds?
1. Mild = PH 7.2-7.29 or HCO3 < 15
2. Moderate = 7.1-7.19 or HC03 < 10
3. Severe = PH < 7.1 or HC03 < 5
126
How much fluid should be given in paeds DKA initially and over what time in:
1. No shock
2. Shock
1. 10ml/kg over 1 hour
2. 10ml/kg bolus up to maximum of 40ml/kg (above this call PICU)
127
What is the formula for paeds fluid replacement in DKA?
Fluid replacement = fluid deficit + maintenance fluids over 48 hour
128
How do we calculate the fluid deficit in paeds DKA?
% dehydration x weight (kg) x 10
Minus the 10ml/kg initial bolus if no shock, if shock present do not subtract
e.g. 12 kg child not shocked
= 7 x 12 x 10
= 840ml
- 12 x 10ml
= 720ml
129
What is the paeds maintenance fluids calculations?
1. 4ml/kg for first 10kg
2. 2ml/kg for second 10kg
3. 1ml/kg thereafter (max 80kg)
130
What fluids should for replacement in paeds DKA?
1. Isotonic saline
2. Add potassium when PU'ing
3. Once glucose < 14 mmol then switch to 5% dextrose
131
What period should children with Pertussis be excluded from school?
1. 48 hours from start of abx
or
2. 21 days from onset of symptoms
132
What abx should be used in Pertussis
Macrolides
133
When should PHE be notified re: Pertussis ?
Within 3 days of it being suspected (do not need proven diagnosis)
134
What defines a moderate asthma exacerbation?
PEFR more than 50–75% best or predicted (at least 50% best or predicted in children)
135
