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Paediatrics Flashcards

1
Q

birth to 10min - action of events

A

0min - stimulation
60-65% (Suction, PPV, Intubation)
HR >100
–> oxygenation issue

1-5min 
APGAR score
80-85% (Fi02) (PPV, Fio2)
HR >100
<60 --> CPR, epi

10mins

  • Apgar 2, apgar 3
  • Need to reach milestone, same as before
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2
Q

APGAR scoring

A 
Appearance
pulse
grimace
activity 
respirations
normal is 7-10
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3
Q

Transient tachypnoea of newborn

Respiratory distress syndrome

A 
TTN
-c-section (not stimulated enough)
-term birth, grunting
Dx  hyper-extended, wet lungs
Tx - PEEP 
RDS
-not enough surfactant
-premature infant
-Xray - hypoextended, atelectasis 
Tx - intuabtion + surfactant 
Hypoglycaemia
-Rule out sepsis 
-sga, lga, DM, IUGR
-Decrease BG, sweaty, tremor, lethargy 
Tx - Oral, IV sugar (D50)
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4
Q

ICU conditions

  • Bronchopulmonary dysplaisa
  • Retinoapthy of prematurity
  • IVH
  • Nectrotising entercolitis
A

BPD - premature, decreased surfactant, decreased alveoli
Xray - Ground glass opacities
Tx - Surfactant, steroids
F/U - DPLD

ROP 
-neonagiogenesis, worsened by increased O2
-Preme, increased fio02
Dx - eye exam
Tx - lazer abblation
F/U - glaucoma 
IVH 
-ayx, increased ICP
Dx - cranial doppler
Tx - Decreased ICP, VP shunts, drains
F/U - MR, seizure 
NEC 
-dead gut, bloody bowel motion 
-Xray - air in wall of bowels 
-(pneumotosis intestinlis)
NPO, IV abx, TPN, surgery
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5
Q

Failure to pass meconium problems (>48hrs)

Imperforated anus
Meconium ileus

A

IA

  • Vacteral
  • no hole
  • Tx - mild fix straight away, severe, colostomy, fix later
  • Need to investigate for VACTERAL
  • Also US sacrum, xray, echo, cather xray, voiding cystouretrogram, xray wrist
Meconium ileus 
Path: Cystic fibrosis, no prenatal care 
Dx - xray, transition point
gas filled plug 
Tx - water enema 
F/U - sweat chloride test, vitamines ADEK , pancreatic enzymes 
pulmonary toilet  
Hirrchprungs (FTPM or constipation) 
-Path - failure of migration of neurons
-cannot get relaxation of nerves at distal colon 
-FFTPM withing 48hrs 
-palpable colon
-explosive on rectal examination  or chronic diarrhea w overflow incontinence 
Dx - Xray 
Biopsy - no plexus 
Tx - surgically re-sect bad colon 
Voluntary holding 
-pain, embarrassment, cognitive impairment 
Dx- clinical 
Stool softeners, behavior
disimpaction - under anaesthetsia
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6
Q

VACTERAL

A 
vetebral
Anus
Cardiac
TE fistula
Eosophageal atresia
renal 
limb
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7
Q

Bilious and non-bilious causes of Baby emesis

revisit this

A

Normal vomit - After feed, formula colored, non bilious, non projectile

Billious
-malrotation
-duodenal atresia
-annular pancrease 
-intestinal atresia
(all require surgery)

Non-billious

  • transoesophageal fistual
  • pyloric stenosis
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8
Q

Causes of Jaundice

need further work

A

Causes of prolonged neonatal jaundice

 Unconjugated hyperbilirubinaemia

Blood group incompatibility

Bacterial infection

Breast milk jaundice

Hypothroidism

Physiological

Conjugated hyperbilirubinaemia

Biliary atresia

Bacterial infections ( UTI)

Hepatitis ( CMV, toxo, rubella , syphilis, EBV, parvovirus)

Choledochal cyst

Cystic fibrosis

Rare metabolic disorders: galactosaemia, tyrosinaemia

Causes of jaundice in older children

Hepatitis A other viral infections eg EBV

G6PD deficiency and other haemolytic disease

Autoimmune hepatitis

Drugs

Rare metabolic diseases

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9
Q

Developmental milestones

A

fill i

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10
Q

Genetic defects

A 
Diagaphramatic hernia
Extrophy of bladder
Cleft lip, cleft palate
Gastroscesis, omephaocele
Biliary atresia
NTDs
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11
Q

Burns formulae for Kids

A 
Face, head - both 9 
Chest, abdo - 18 front, 18 back 
Each arm 9 
Genitalia - 1
2x legs - 9 + 9 + 9
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12
Q

Burns formulae for Kids

A 
Face, head - both 9 
Chest, abdo - 18 front, 18 back 
Each arm 9 
Genitalia - 1
2x legs - 9 + 9 + 9

8: 16
50: 50

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13
Q

Paeds Rashes

-Erythema infectiousum

A

Erythema infectiosum - Parovirus B19 - slapped check
Fever + Rash

Measels - (paroixovirus( Rash and fever
-Prodrome - cough, coryza, conjunctivities, koplik

Rubella

  • rash on face, spreads to trunk and arms + high fever
  • generalized and tender lymphadenoptahy

Roseola - HHV6
High spiking fever then rash
-Rash starts on trunk, goes outward

Varicella zoster

  • Rash without fever
  • Shingles (acylcovir, trigeminal nueralgia)

Mumps - pubertal males, parotid swelling, orchitis

HFMD - coxasikle

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14
Q

Infectious disease

  • meningitis
  • HIV
  • Oseomylitis
  • Septic joint
  • Skin infections
  • Pneumonia + TB
A

Meningitis - FAILS positive = increased ICP
CT before LP
Abx +/- steroids
(reduced GCS, focal neurological sign, rasied ICP, seizure)
-Cefotaxime + vanc

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15
Q

ENT diagnosis

A
  • Otitis media
  • Otitis externa - drops
  • Sinusitis
  • Viral cold
  • Pharyngitis
  • Foreign body
  • Epistaxis
  • choanal atresia (cyanotic w feeds, catheter fail to pass)

Upper airway

  • Croup
  • tracheitis
  • epiglottits
  • retropharyngeal abscess
  • peritonsillar abscess
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16
Q

Whooping cough
Croup
Bronchiolitits
epiglotitis

Main causes

A

Whooping cough - pertussis bacteria (immunized)
Croup - parainfluenza virus, RSV, adeno, influenza
Bronchiolitits - RSV
epiglotitis - h.influenza (rare due to vaccine)

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17
Q

Kawasaki disease

A

Vasculitits, common in Asian populations
Fever > 5 days
-Large lymph nodes
-rash in genital area, red eyes, lips, palms, soles of feet
-conjunctivities
-Strawberry tongue
-not responsive to paracetamol/ibuprofen

-Coronary artery anerusyms

Dx - CRP, ESR
echo
Tx - High dose aspirin
-immunoglobulin

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18
Q

Henoch-Schonlein Purpura

A

Post group A strep infection

  • Rash
  • arthritis
  • abdo pain
  • neprhitis
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19
Q

Hemolytic–uremic syndrome

A

Caused by an infectious diarrhea (blood diahorrea, fever, vomiting)
-low RBCs, AKI, low platelets

Tx - supportive care

20
Q

Causes of failure to thrive (organic vs nonorganic)

A

Organic - CF, CHD, Coeliac, pyloric stenosis, infection, GERD
Non-organic - child neglect, poverty, not calculating formula correctly, maternal depression

21
Q

Pathologic puberty delay

A

IBD, malnourishment, anorexia
Goandal dysgensis - klinefelter, tner
endocrine - hypopituiarism, hypothyrodism, kallmann syndrom, androgen insensitivity, prader-willi syndrome

22
Q

Downs syndrome key features

A

Trisomy 21 (drinking - 21)

  • advanced maternal age
  • Intellectual disabilities, flat face, upslanted eyes, epicanthal folds, single palmar crease, hypotonia, extra neck folds, delayed growht
  • emotional instability, duodenal atresia. hirsprungs, CHD (asd, vsd pda)
  • Increased risk of ALL, hypotyrodi, alzheimers
23
Q

Edwards syndrome

A

Trisomy 18 (elections - 18)

  • Intellectual disabilities, flat feet, low set ears, micrognathia (jaw offset), clenched hands ,prominent occiput
  • CHD, horseshoe kidney
24
Q

Patau syndrome

A

Puberty (13)

  • intellecual disabilites, eye abnormality, microcephaly, celft lip/palate, scalp lesions, extra fingers, CHD
  • death usually within 1 year
25
Prader willi
chormosome 15 - weak muscles, poor feeding, slow development - narrow head, small hands and feet -obesity, T2DM
26
Di george syndrome
chromosome 22 , CHD, facial features, developmental delay, learning difficulties
27
Klinefelter syndrome
XXY - advanced maternal age sexual characteristic differences -Treat testosterone
28
Turners
XO - female, sexual characteristics differences - coartation associated
29
guthrie test (look up on concerto next time)
dfds
30
Fragile X syndrome
- intellectual disability - autistic behavior - large jaw, testes, ears
31
Cystic fibrosis
- Autosomal recessive, chloride channel - Newborn screen - Thick meconium, obstruction - Increased resp infections (psudomanas, staph) - FTT - Clubbing fingers, chronic cough, brocnhiectasis, chronic sinusittis, nasal polups - steatosis - GI symptoms - salty skin - DM type 2 - fat soluble deficiency Dx - Sweat chloride test -genetic testing Tx - abx - chest physio - steroids - pancreatic enzymes given - high calorie, high protein diets - lung or pancreas transplant
32
Types of Immune-mediated disease
B cell (bacteria) T cell (fungi, virus) Phagocytic Complement (spleen)
33
Kawasaki disease
``` CRASH AND BURN Conjunctivitis Rash Adeonpathy Strawberry tongue Fever ``` Dx - CRP, ESR, FBC, echo (rule out coronary artery anursyms) Tx - aspirin, IVIG, maybe long term anti-coagulation
34
Types of arthritis - juvenile idiopathic arthritis
- Pauciarticular (uveitis associated, weight bearing joints) - Polyarthritis (multiple joints, systemic symptoms) - Stills disease (fever, hepatosplenomegaly, rash) Nsaids, corticosteroids (cardittis), immunosuprresant mediction
35
COmplications of acute OM
- mastoiditis, cholestatoma, meningitis, TM perforation, chronic OM - If at risk of speech and development delay may need gromits
36
Risk factors for poor prognosis bronch
- RSV, parainfluenza - <6 monhts, premature, heart or lung disease, nueromuscular disease, immunodeficiencey (can progress to resp failure) Day 3 - is worst Symptoms- 1-3 fever, rhinorhea, cough 4-6 - resp distress, tachypnea, hypoxia Exam - tachypnea, hypoxia, intercostal retractions, crackles, wheezing Dx - no bloods needed -Swab? Xray - rule out pneumonia, hyperinflation, flattened diaphragms, interstitial infiltrates, atelectasis Tx - supportive 02, feeding support can try bronchodilators severe - intubation
37
Croup
``` Parainfluenza signs/symptoms - Prodrome URTI, fever, dyspnoea, inspiratory stridor, barking cough -Tx - o2 -corticosteroids -nebulized racemic epinephrine severe - intubation ```
38
Epiglottitis
H.influenza - high fever, dysphagia, drooling, muffled voice, inspiratory retractions, stridor, cyanosis - tripod position Dx - clinical - secure airway - fiberoptic visualisation - cherry red swollen epiglottis and arytenoids (ENT) - shows thumbprint sign on xray Tx - intubation -IV antibitoics - ceftriaxone, cefuroxime
39
Meningitis signs
high fever, headache, nuchal rigitiiy -rash (n.meningitits) - Kernig, brudzinksis sign - (hip and knee flexion - causes meningeal irritation) - Increased ICP, bulging fontanel, vomiign - CT before LP
40
most common causes of paediatric conjunctivitis
-C.trichomatis, HSV, n.gonorrheoea Dx - culture, PCR, (corneal ulcer_ mother - STI check
41
Cerebral palsy causes
- Low birth weight - Intrauterine exposure to maternal infection - perinatal asphyxia - trauma - brain malformation - neonatal cerebral haemorhage Symptoms - learning delays, seizure, behaviour disroders, hearing or vision impairment, speech deficits -Hyperreflexia, increased reflexes, increased tone Supportive - education, physical therapy -diazepam, dantrolene, baclofen
42
Leukaemia
Most common - ALL - anorexia, fatigue - bone pain, limp, refusal to bear weight, fever, anaemia, bleeding skin, petechiae, hepatosplenomegaly Dx - FBC, coags, blood smear - high blasts , WCC low, normal or high - bone marrow aspirate/biopsy + genetoanalysis, immunophenotying --> diagnosis - CXR - rule out mediastinal mass Tx - chemo
43
Tumor lysis syndrome
-Lysis of neoplastic cells release of stuff into blood -Hyperkalaemia, hyperphosphataemia, hyperuricemia, hypocalcemia (due to phosphate released and bindign to the calcium) -can result in - renal failure, arrhythmia, death Treat - fluids, diuretics, allopurinol
44
Neuroblastoma
embryonal cancer - distant mets Associated w Nuerofibromatosis, hirsphrungs disease Abdo, thorax, cervical Symptoms - non-tender abdominal mass, horners syndrome, hypertension, cord compression -Anaemia, FTT, fever FNA elevated urine catecholamines -CT scan, bone scan, bone marrow aspirate - staging chemo + radiation, surgery
45
Wilms tumor
- Above kidney - Beckwiedemann syndrome, nuerofibromatosis asymptomatic, nontedner smooht mass - does not cross the midli ne Dx - biosy or fna - US - CT sacan of chest and abdo - mets Tx - local resection, nephrectoym, post surgical chemo and radiation
46
Ewings and osteoscarcoma
Ewings - onion skin (midshaft) | Osteo - sunburst (endshaft), elevated ALP

TI year (16 decks)

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