Paediatrics 2 Flashcards by John Darlington

Name some specific types of epilepsy that can be diagnosed in a child:

Childhood onset Absent seizures
~ 6 years old
- Sodium Valproate
- Ethosuximide

Lennox- Gastuat syndrome

multiple seizure types, usually atonic
cognitive impairment
Slow spike wave on EEG

Juvenile myoclonic epilepsy
- muscle twitches/ contractions/ jumps

West’s syndrome/ Infantile spasms:
~4-6 months
- Extension of trunk and extension of arms
- usually underlying neurological condition
- poor prognosis
- predinislone is 1st line

Dravet syndrome

severe myoclonic epilepsy
resistant to drugs

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What are the different types of cerebral palsy seen?

Spastic hypertonia
- motor cortex

Dyskinetic (basal ganglia)

Athenoid (hyper movement, grimace, drooling)
Dystonic

Ataxic
- cerebellum

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What are some gait changes seen with cerebral palsy?

Circumductive gait
- seen with spastic hemiplegia

Scissoring
- spastic diplegia

Ataxic gait

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What are some causes of cerebral palsy?

Antenatal:

Maternal infection (rubella, toxoplasmosis)
intrauterine injury
maternal disease (hypothyroidism)

Perinatal:

birth asphyxia
pre-term

Post-natal:

meningitis
severe neonatal jaundice
heady injury

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What prostaglandin drug can be given to maintain the ductus arterioles?

Alprostadil

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How is vesicoureteral reflux diagnosed and how is scarring assessed?

Micturating Cystourethrogram
- diagnosis

DMSA Scan
- for evidence of scaring

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If a neonate goes into cardio-respiratory arrest and on auscultation you can hear tingling in the chest, what is the most likely diagnosis?

Diaphragmatic hernia
- leading to bowel within the thoracic cavity which affects lung maturity

Intubation is needed as the baby can fail quickly after birth

Causes pulmonary aplasia

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What is your emergency treatment of croup?

High flow oxygen
Nebulised adrenaline
IV dexamethasone

*used for severe croup

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What are some features of cystic fibrosis in the new born and later life?

Meconium ileus
Recurrent chest infections
Malabsorption
Nasal polyps

Later life:

short stature
delayed puberty onset
male infertility

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What are some features in children with cystic fibrosis (usually in those who were missed at birth)

Short stature
Reduced growth (drop in centiles)
Diabetes
Nasal polyps

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What are the serious complications of measles?

Acute otitis media
Pneumonia
Encephalitis

Subacute sclerosing panencephalitis
appears some 5-10 years after infection due to reactivation and inappropriate immune response
behaviour changes / personality changes
memory changes
Seizures

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What investigations would be warranted into suspected biliary atresia?

Bilirubin

conjugated
unconjugated

LFTs

Sweat tests (check for cystic fibrosis)

Alpha -1 antitrypsin

Biopsy**
Ultrasound**
HIDA scan**

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What testing is done at birth to assess for hearing loss, and what is the follow on test if abnormal?

Otoacoustic emission test
- small click generated which then creates an echo if the cochlear is normal

Auditory brainstem response
- done next if Otoacoustic emission test is abnormal

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What is the formula for blood resuscitation in paediatrics?

Change in Hb (g) x Weight (kg) x 4

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How is pyloric stenosis diagnosed and what will be seen? and what is the mangement?

Diagnosed via ultrasound
- thickened pyloric muscle

Correct Electrolyte imbalance
NG tube
Ramstedt pyloromyotomy

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List some causes of bilious vomiting in a child:

Intestinal atresia 
Necrotizing enterocolitis 
Hirschsprung disease 
Intussusception 
Malrotation volvulus 
Meconium plug

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What are the signs and symptoms of NEC and how is it investigated and treated?

Stable preterm who goes off feeding 
Abdominal distention 
Bloody stools 
Bilious vomit/ aspirates 
Pyrexia 
Haemodynamically unstable

Investigations:

FBC **platelets reflect severity
Cultures
CRP
ABG
Culture stool
Abdominal x-ray
left lateral decubitus

Management:

Stop feeds and insert TPN
IV fluids
Antibiotics IV broad spectrum
NG tube - for aspirates

Surgical:
needed for stage III onwards
- bowel resection
- stoma formation

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How does malrotation of the gut present and what is the diagnostic procedure?

Due to failure of intestinal rotation typically affected the duodenal-jejunal flexure which comes to lie on the right instead of the left of the midline.

Presentation:

Bilious vomiting
abdominal distention
blood per rectum (late sign due to gut ischemia)
Metabolic acidosis

Diagnosed:
- G.I contrast study

Treatment:

IV fluids
NG drainage
IV broad spectrum antibiotics
Emergancy laparotomy *surgical Emergancy
if necrotic gut it removed and stoma
if entire midgut is affected palliative care

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What condition is intestinal atresia highly associatted with and what sign is seen on x-ray?

Down’s syndrome

Double bubble

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What condition is a meconium plug associated with and how is it diagnosed and treated?

Cystic fibrosis
- 5-10& will have CF

Features:

obstruction
bilious vomit

Diagnosed:
- Gastrografin

Treatment:

Bowel rest
IV fluids
NG tube decompression
Antibiotics
Gastrografin - breaks up material

if medical failure then:
- lapartomy +/- ileostomy

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When approaching a Surgical abdomen what investigations should be done in what order?

History 
Examination 
Urine Beta hCG 
Blood tests 
Repeat examination 
Ultrasound

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In a female child patient presenting with abdominal pain what must one make sure to ask:

Have they started menarche

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What are the signs and symptoms of intussusception:

*most common place is the ileocaecal valve, usually due to enlarged Peyer Patches following viral infection (in older children there tends to be a history of HSP or lymphoma)

Abdominal pain
Pale and unwell
Redcurrent jelly stools
Floppy and hemodynamically unstable

Classic triad is:

abdominal pain
Bilious vomit
redcurrent jelly stools

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What are the maximum hourly rates of fluids for children?

104ml/hr for males

83ml/hr for females

What calculation can be done if the weight of a child is not available to work out how much fluids should be given?

(Age (years) +4) x 2

What fluid should be used for resuscitation in paediatrics?

Normal saline 0.9% | - no additional electrolytes

If a girls of 50kg requires maintanance fluids what is amount that should be given?

this would equate to 90ml/hour which is above the max dose, therefore answer is: - 83ml/hour

In a trauma patient how much fluid bolus should a child recieve?

10ml/kg *10ml/kg for trauma. if you do not have childs weight you need to age. then: (Age +4) x 2

When should inguinal hernias be fixed in a neonate/ infant:

Neonate: before discharge Infant: next available list *if there is an emergency they should be seen as such i.e. incarceration

When is surgery indicated for a hydrocele.

If not closed by age 3 *90% close by 1 year old

Name some situations which may suggest non-accidental injury:

Discrepancy between the history and degree of injury Prolonged time between injury and seeking care Repeats of injury Inconsistent history between caregivers History of "doctor hospital shopping" When parents do not comply with medical advice Area of injuries: - groin - face - metaphysis - multiple bruises of varying age - injury not consistent with age of child

What types of injuries are suggestive of NAIs?

Injuries to the genital/ perianal area Fractures of long bones <3 years old - especially humorous Skull and rib fractures <24 month year old Metaphysis fractures Well demarcated burns Subdural haemorrhages Retinal haemorrhages Bruises of different colours - multiple at different healing states Injuries not consistent with age of child - child with shin bruises but doesn't walk

What advice can be given out to help parents with a child after a concussion?

After concussion - Return to normality | - ACoRN

Which ribs in children are least likely to get fractured? and if they are what does this suggest?

1st ribs. if these are fractured then it is very likely there are much more severe injuries present

If you suspect NAI in a child what is the most important action you should take?

Inform the most senior person on shift Admit the child Safe guard for other children

What is the most common benign cause of inspiratory stridor in an infant?

Laryngomalacia - congenitally soft larynx which leads to partial collapse during inspiration usually self resolves by age 2

How is whooping cough treated?

Macrolides (if within the 1st 21 days) + Notify public health

What is the history and investigations into whooping cough?

History: - severe coughing that causes child to turn red in face and flail arms - Inspiratory whoop Diagnosis: - FBC - lymphocytosis - Peri-nasal swabs - diagnostic - CXR - atelectasis

What are the first set of vaccines given and when?

2 months: - DTaP - IPV - Hib - HepB - MenB - PCV - Rotavirus

When is the MMR vaccine given?

12 months and 3 years 4 months

What type of test should be done of a LP sample for S.Pneumonia and Meningococcus?

PCR testing

When is chicken pox no longer contagious?

After all the lesions have crusted over - usually 5 days after rash starts

What is the schedule regime for immunisations for 12- 18 year olds:

DTaP PCV MMR HPV Men ACWY

What is the initial management of Hirschsprung disease before surgical input?

Bowel irragation

What is the management of a child with mild and severe croup?

Mild - Dexamethasone - PO - Supportive Severe: - Nebulised adrenaline - Oxygen - Dexamethasone - IV

At what age do you start steroids in suspected meningitis? and what antibiotics should be given?

> 3 months old Antibiotics only: - ceftriaxone - amoxicillin * for listeria cover as well

If a child is diagnosed with threadworms what is the medication that should be used and who should be treated?

Mebendazole *the whole family needs to be treated

Lymphadenopathy is very common in children and usually benign, list the features which are suggestive of malignancy and list some differentials:

Features: - Supraclavicular site - Epitrochlear site - Systemic symptoms - Hepatosplenomegaly - Signs of bone marrow failure Differential malignancies: - leukaemia (ALL) - Lymphoma (Hodgkins, Burkits) - Neuroblastoma - Rhabdomyosarcoma

What are the fluid resuscitations volumes used in paediatrics:

20ml/kg 10ml//kg used when: - haemorrhagic shock - cardiogenic shock - DKA - Neonate - Trauma **if a child is requiring >2 boluses then ICU should be contacted.

What is the algorithm for paediatric life support? 1 - puberty:

Get help Assess airway and open Look, feel, listen 5 rescue breathes Check for ciruclation 15:2 ratio compression

What diet advice would you give to CF?

High calorie + high fat + pancreatic supplements

What diagnostic tests should be done into kawasaki disease? and what is the management:

There is no definitive test: Bloods: - FBC - raised plts - CRP - raised - ESR - raised - LFTs - raised ALT ECG - looking for conduction defects pericarditis signs Echocardiogram - coronary artery aneurysm Management: - IV immunoglobulin - Aspirin - Serial echocardiograms

Following a diagnosis of diabetes type I in a child, what is likely to occur regarding their insulin regimen in the first 3-6 weeks?

The regime is likely to be lower than usual because there is a honeymoon period. Typically a child needs 1unit/kg/ day but in the first 3-6 weeks this can be as low as 0.5units/kg/day

What is the phenomenon called when children wake up with hyperglycaemia and why is this? What is it called when they wake up with hypoglycaemia?

Dawn Phenomenon - due to growth hormone and sex hormone released during growth Somogyi phenomenon - hypoglycaemia in the morning

What tests are important to conduct in a female who is primary ammenoreachic?

FSH, LH TFTs Karyotyping - Turner's syndrome - Androgen insensitivity (XY chromosome) - but lack the androgen sensitivity

In a neonate with poor feeding, what are the main differentials to consider?

Infection Sepsis Congenital heart disease Bronchiolitis

What would you expect to see on the biochemical results for congenital adrenal hyperplasia? and what test is conducted to establish the cause?

Hyponatremia Hyperkalemia Acidosis *they will also be tachycardia and underfilled Hyperpigmentation may also be seen, especially of testes due to excessive ACTH release Test: 17 - hydroxyprogesterone - precursor to 21-alpha hydroxylase which doesn't come about

What is the assessment score used to assess croup?

Modified Westley Clinical Scoring System - stridor - intercostal recession - Air entry - Cyanosis - Level of consciousness

Outline the differences between cephalohematoma and caput succedaneum:

Cephahaematoma forms later and is between the bone and periosteum and thus does not cross the periosteal/ suture lines. caput succedaneum forms immediately after birth and is above the periosteum and this can cross the suture lines.