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MRCEM INTERMEDIATE > Paediatrics & Neonatology > Flashcards

Paediatrics & Neonatology Flashcards

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1
Q

Maintenance fluid calculator for children

A

Routine maintenance fluids for children are calculated by weight using the Holliday-Segar formula:

100 ml/kg/day for the first 10kg of weight
50 ml/kg/day for the next 10kg of weight
20 ml/kg/day for weight over 20kg

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2
Q

Initial fluid bolus in shock for children

A

10ml/kg

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3
Q

If child required a bolus for shock, how much fluid should be added to maintenance to rehydrate?

A

Add 100ml/kg

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4
Q

If child did not require a bolus for shock, how much fluid should be added to maintenance to rehydrate?

A

Add 50ml/kg

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5
Q

When is jaundice physiological in neonates ?

A

Usually appears at day 2, peaks 3-5, gone by 10 days

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6
Q

Neonatal sepsis abx choice

A

Ben Pen and Gent

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7
Q

Continuous murmur in a neonate most likely?

A

Machinery murmur -> PDA

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8
Q

Most common cause of early onset neonatal sepsis =

A

Group B strep

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9
Q

Kocher criteria for osteomyeletis in children

A

non-weight-bearing status, fever>38.5°C, white blood cell>12 K, and erythrocyte sedimentation rate>40 mm/h

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10
Q

How to diagnose SUFD on XR

A

Klein’s line, if it doesn’t transcect the femoral epiphysis it is a positive Trethowan’s sign

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11
Q

School exclusion advice for whooping cough

A

Can return 48hrs after abx started or 21 days if not treated

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12
Q

Treatment for whooping cough

A

Clarithromycin

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13
Q

Treating cerebral oedema in a child with DKA

A

Mannitol or hypertonic saine

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14
Q

NLS, CRP ratio

A

3:1

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15
Q

Pre ductal SpO2 accepted

2 mins
5mins
10 mins

A

65%
85%
90%

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16
Q

5th disease is dangerous to who?

A

Pregnant women - causes marrow problems in the fetus
Sick cell

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17
Q

What to do in children with a fever of 38 or higher (unexplained)

A

Urine dipstick

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18
Q

Fever in

1 month old

1-3 month old + unwell

A

Treat with IV Abx

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19
Q

Treatment for Kawasaki

A

HIGH dose aspirin
and IgG

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20
Q

BRUE low risk

A

Age > 60 days
Born >32 wks gestation post conceptual age > 45 days

No CPR
< 1 min
1st event

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21
Q

Calculation for fluid to replace % dehydration

A

10 x weight x %

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22
Q

Most common cause for early onset neonatal sepsis

A

Group B strep

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23
Q

Cyanotic CHDs

A

Tetraology of fallot
Transposition of GA
Tricuspid atresia
Total anomalous pulmonary vascular return
Truncus arteriosus

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24
Q

When to admit a neonate with Jaundice

A

< 24hr hours old
or < 35 weeks gestation

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25
Most concerning complication of neonatal jaundice
Kernicterus (encephalopathy)
26
Shock strength for children
4J/Kg
27
After rescue breaths in NLS, at what HR do we then commence CPR
<60 BPM
28
Upper limit of RR for children of certain ages 6-12 month >12 months
50 breaths/min 40
29
Upper limit of HR for children of certain ages < 12 months 12-24 months 2-5 yrs
160 150 140
30
Temp of concern in: 3-6 months < 3months
39 38
31
How to monitor temp in a child < 4 weeks old
Temp probe in the axilla
32
Dose of Ben Pen in the community for meningitis (suspected) <1 yr 1-9 yrs 10+ yrs
300 600 1.2g
32
Burns (>10%) in children calculation
% X KG X 3 (over 24hrs)
33
Shock dose in SVT in children
DC synchronous shock at 1-2 J/kg.
34
Westle croup score
35
DKA in children, over what time frame should deficit be corrected?
48hrs
36
Calculating fluid requirement in DKA in a child
When calculating the fluid requirement for children and young people with DKA, assume a 5% fluid deficit in mild-to-moderate DKA (indicated by a blood pH of 7.1 or above), or a 10% fluid deficit in severe DKA (indicated by a blood pH below 7.1). The total replacement fluid to be given over 48 hours is calculated as follows: Hourly rate = (deficit/48 hours) + maintenance per hour
37
Treatment for cerebral oedema following DKA tx in children
If cerebral oedema occurs, treat with hypertonic (3%) saline 3 ml/kg or a mannitol infusion (250-500 mg/kg over 20 min).
38
Causes of pneumonia in Term / near term infants Low birth weight infants
Group B haemolytic Streptococcus E.coli
39
APGAR scoring for Appearance (skin colour) 0 1 2
Blue or pale all over Blue at extremities (acrocyanosis) No cyanosis Body and extremities pink
40
APGAR scoring for Pulse 0 1 2
Absent <100 >100
41
APGAR scoring for Grimace 0 1 2
No response to stimulation Grimace on suction or aggressive stimulation Cry on stimulation
42
APGAR scoring for Activity 0 1 2
None Some limb flexion Flexed arms and legs that resist extension
43
APGAR scoring for Respiratory effort 0 1 2
None Weak, irregular, gasping Strong cry
44
4 categories of neonatal jaundice
Haemolytic unconjugated hyperbilirubinaemia Non-haemolytic unconjugated hyperbilirubinaemia Hepatic conjugated hyperbilirubinaemia Post-hepatic conjugated hyperbilirubinaemia
45
Which type of neonatal jaundice is always pathological?
Conjugated
46
Haemolytic unconjugated hyperbilirubinaemia is split into 2 categories
Intrinsic Extrinsic
47
Haemolytic unconjugated hyperbilirubinaemia Intrinsic causes of haemolysis
Hereditary spherocytosis G6PD deficiency Sickle-cell disease Pyruvate kinase deficiency
48
Haemolytic unconjugated hyperbilirubinaemia Extrinsic causes of haemolysis:
Haemolytic disease of the newborn Rhesus disease
49
Non-haemolytic unconjugated hyperbilirubinaemia causes
Breastmilk jaundice Cephalhaematoma Polycythemia Infection (particularly urinary tract infections) Gilbert syndrome
50
Hepatic conjugated hyperbilirubinaemia causes
Hepatitis A and B TORCH infections Galactosaemia Alpha 1-antitrypsin deficiency Drugs
51
Post-hepatic conjugated hyperbilirubinaemia causes
Biliary atresia Bile duct obstruction Choledochal cysts
52
Tetralogy of fallot is associated with which congenital syndromes (4)
DiGeorge syndrome (22q11 microdeletion syndrome) Trisomy 21 Foetal alcohol syndrome Maternal phenylketonuria
53
Pyloric stenosis blood gas
hypochloraemic metabolic alkalosis
54
When should an APGAR assessment be done after birth?
1 & 5 mins
55
Dose of prednisolone in children with asthma exacerbation Age 2-5 Age 5+ If already on a maintenance dose of pred
Use a dose of 20 mg prednisolone for children aged 2–5 years and a dose of 30–40 mg for children >5 years. Those already receiving maintenance steroid tablets should receive 2 mg/kg prednisolone up to a maximum dose of 60 mg.
56
When is magnseium added to salbutamol nebs in the management of paediatric asthma?
Consider adding 150 mg magnesium sulphate to each nebulised salbutamol and ipratropium in the first hour in children with a short duration of acute severe asthma symptoms presenting with an oxygen saturation less than 92%.
57
Defining tachypnoea in different age groups 0-5 months 6-12 months 12 months +
RR >60 breaths/minute, age 0-5 months; RR >50 breaths/minute, age 6-12 months; RR >40 breaths/minute, age older than 12 months
58
Severe asthma attacks in children characterised by? Age 2-5 5+
RR >40, HR >140 RR >30, HR > 125
59
SpO2 indicating life threatening asthma in children?
<92%
59
Dosing of benzos in status epilepticus (paediatrics) Lorazepam IV / IO Buccal midazolam Rectal diazepam
Lorazepam 0.1 mg/kg Buccal midazolam 0.5 mg/kg or rectal diazepam 0.5 mg/kg
60
Step 3 in paediatric SE (after 2nd benzo)
IV levetiracetam, 40mg/kg (max 3g) over 5 mins
61
Paediatric epilepsy If seizures continue despite loading with levetiracetam then termination with induction of anaesthesia and intubation is expected. However, if the advanced airway team is not yet prepared and the ABCDE assessment is stable, then:
If not already on phenytoin, then a phenytoin infusion should be set up (20 mg/kg IV infusion over 20 minutes) If already taking phenytoin, then phenobarbitone can be used in its place (20 mg/kg IV infusion over 20 minutes)
62
Anatomical land mark of needle thoracocentesis for tension pneumothorax in children?
2nd IC space, mid clavicular line
63
First line treatment for Croup
Oral dex, 0.15mg/kg
64
Management of those with moderate croup
Monitor for 4 hours and reassess (+ dex)
65
Westley croup score thresholds: Mild Moderate Severe Impending respiratory failure
Mild (croup score 0-2) Moderate (croup score 3-5) Severe (croup score 6-11) Impending respiratory failure (croup score 12-17)
66
When using ORS to replace fluid deficit, how is this done?
Replace over 4 hours in frequent but small amounts (total replacement rate is usually 10-20ml/kg/hr) Estimated deficit (in ml) is 5% (or 10%) X child’s weight in kg X 10 Daily maintenance
67
What determines the severity of tetralogy of Fallot?
The severity of cyanosis is determined by the degree of obstruction to pulmonary blood flow
68
Severity of dehydration as per the pH Mild Mod Severe and % dehydrated
7.2-7.3 7.1-7.2 <7.1 5% 5% 10%
69
What is needed for a diagnosis of DKA in children
Acidosis and raised lactate ANY GLUCOSE
70
Bronchiolitis admission criteria
apnoea (observed or reported) persistent oxygen saturation (when breathing air) of: - less than 90%, for children aged 6 weeks and over -less than 92%, for babies under 6 weeks or children of any age with underlying health conditions inadequate oral fluid intake (50% to 75% of usual volume) persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute. [2015]
71
Kawasaki diagnosis
4/5 of ... Eyes Mouth Fingers / toes Rash Lymphadeopathy
72
When is IN diamorphine used in children?
FOR SEVERE PAIN
73
After admission for an asthma attack, what triggers a child to be referred to a respiratory specialist?
Life threatening features

MRCEM INTERMEDIATE (19 decks)

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