Paediatrics Flashcards
describe the traffic light system for assessment of a child with fever
green
- colour: normal
- activity: content, smiling, normal cry
- breathing: normal resp exam
- hydration: normal skin and eyes
- other: no amber or red features
amber
- colour: pallor
- activity: decreased activity, not responsive
- breathing: increased resp rate, crackles in chest, nasal flaring
- hydration: dry mucous membranes, reduced urine output, dry nappies, poor feeding
- other: fever >5 days, not weight bearing
red
- colour: pale, mottled
- activity: high pitched cry, unarousable
- breathing: grunting, severe intercostal recession
- hydration: reduced skin turgor
- other: non-blanching rash, bulging fontanelle, focal neurological deficit
green: discharge with fever leaflet and worsening advice
amber: intervene then reassess
> if improves and all green, discharge
> if remains amber, admit for observation
red: proactive intervention and admit; assess for safety and suitability for transfer
state the paediatric dose of paracetamol and ibuprofen
paracetamol - 15mg/kg
ibuprofen - 7.5mg/kg (half of paracetamol)
describe bronchiolitis
commonly caused by respiratory syncytial virus (RSV)
most commonly affects under 2s
clinical features
- increasing breathlessness
- fever
- generalised coryzal symptoms
describe the categorisation of acute wheeze in children
mild:
- >92% O2
- Normal PEFR
- normal mental state
- able to talk normally
- subtle or no increased WOB
- normal HR and RR
moderate
- >92% O2
- PEFR >50% of best
- normal mental state
- dyspnoea resulting in limitation of full sentences
- moderate increase in WOB (accessory muscle use and chest wall recession)
- HR PEWS <2 RR PEWS <2
severe
- <92% O2
- PEFR 33-50% of best
- agitated/distressed
- marked dyspnoea resulting in <3 word sentences
- severe increased WOB
- HR PEWS <=2 RR PEWS >=2
life-threatening
- <92% O2
- PEFR <33% of best
- confused / drowsy
- unable to talk due to dyspnoea
- cyanosed
- maximal WOB
- exhaustion may lead to poor respiratory effort
- silent chest
describe the clinical features of croup
aka laryngotracheitis
causes: parainfluenza virus, RSV
viral upper respiratory tract infection leading to supra-glottic narrowing secondary to inflammation
features
- night cough
- barking or seal-like cough
- biphasic harsh stridor
- hoarseness
- respiratory distress
describe the categorisation of severity of croup and its management
mild:
- no signs of severe croup, no symptoms at rest
- give oral dexamethasone 0.15mg/kg
- home with croup discharge leaflet
moderate:
- no signs of severe croup
- symptomatic at rest
- worsened by exertion
- give oral dexamethasone 0.15mg/kg, observe for 2-3 hours
- if changes to mild croup discharge
- if remains moderate give nebulised adrenaline (1mg (1ml 1:1000) diluted to 5ml in saline and admit
severe:
- respiratory distress
- cyanosis
- exhaustion
- quiet chest and lack of respiratory effort are pre-terminal signs
- management: nebulised adrenaline, oral/IV dexamethasone 0.15mg/kg, oxygen, admit and consider ICU r/v
describe the clinical features of UTI in children
lower UTI
- frequency
- bed wetting
- vomiting
- loin pain
- frank haematuria
upper UTI
- fever
- abdominal pain
- lethargy and malaise
- urgency
atypical UTI
- seriously ill child
- poor urine flow
- septicaemia
- failure to respond to antibiotics after 48h
first-line antibiotic: trimethoprim 4mg/kg
describe pulled elbow
occurs when a child’s arm is suddenly pulled resulting in subluxation of proximal radioulnar joint
exam
- no specific findings
- child refuses to use arm
reduction
- move hand into pronation
- gently flex elbow
describe buckle fracture
common paediatric fracture to distal radius
injury to cancellous bone without actual break in cortex
manage symptomatically unless rotational deformity (requires manipulation)
describe toddler’s fracture
torus or twisting injury resulting in spiral fracture of distal tibia
examination
- mild disseminated tenderness over anterior tibia
- localised erythema or warmth
- non-weight bearing child
management
- analgesia
- below-knee back-slab
describe a hair tourniquet
clinical features
- inconsolable child
- unilaterally isolated swollen digit
remove with scalpel
describe transient synovitis
aka irritable hip
usually affects hip and preceded by viral illness
clinical features
- mild/moderate hip pain (referred thigh/knee pain)
- acute onset <1 week
- no/mild restriction of hip movements (especially abduction and internal rotation)
- positive log roll test
- able to weight bear with limp
- otherwise well and afebrile
self-resolves within 7-14 days
advise regular analgesia and rest
describe Perthes disease
avascular necrosis of capital femoral epiphysis
onset over weeks between ages 3-9
can be bilateral
clinical features
- mild hip/groin pain
- referred pain to knee/thigh
- limp
- limitation of hip rotation
AP pelvis X-ray shows flattening of femoral head with joint space widening
> may be absent for early disease
child is systematically well with no other joint involvement and no evidence of joint inflammation
describe slipped upper femoral epiphysis (SUFE)
occurs in late childhood/adolescence
common in overweight children
onset can be acute or subacute, can be bilateral
examination
- antalgic gait out-toeing with external rotation and shortening of affected limb
- afebrile
- systemically well
- no other joint involvement
diagnosis: AP pelvis X-ray +/- frog leg view
unstable slips can lead to avascular necrosis of the femoral head
describe the presentation of malignancy/leukaemia in children
- malaise
- anorexia
- weight loss
- bone pain
- nocturnal pain
- neurological symptoms: paralysis / paraesthesia
- new incontinence/retention/constipation
- fever
- pallor/jaundice
- lymphadenopathy
- organomegaly
- mass/swelling in bones
- erythema / inflammation at tumour site
describe juvenile idiopathic arthritis (JIA)
diagnosis of exclusion
clinical features
- joint swelling affecting more than one joint
- symptoms (pain/stiffness) worse in the morning
- relevant family history
- symptoms persistent >6 weeks
