Paeds Flashcards

Question

Differentials for a drowsy baby

Answer 1

Sepsis Intracranial pathology - bleed - enceph/meningitis Hypoglycaemia including poor feeding technique ELectrolyte abnormalities NAI

Answer 2

Bedwetting is a common thing we see in children a lot and it is important to remember that at some point all children will be able to achieve continence. It is no ones fault as it happens when the volume of urine becomes too much for the bladder and as is the case in your child this sensation is not being felt by them There are a few things that we can do - remember to remain neutral as i said its no ones fault so remember not to punish them - things like drinking all of your fluid in the day a few hours before bed can really help and making sure they go to wee before bed can go a long way to stopping it from happening so often in the cases does this is important to reward these behavioiurs and not having a dry night

Answer 3

Obs Examine- signs of dehydration Measure weight and height Refer if signs of faltering growth, no response to medical treatment, avoiding feeding

Answer 4

Very common cause of vomiting, caused by slower development of what we call the sphincter at the bottom of your feeding tube which goes into the stomach. It acts as valve and as its not working yet it is hard to keep the food in the stomach

Answer 5

Croup Pneumonia Inhaled foreign object Bronchiolitis Pertussis

Answer 6

Bronchiolitis Inhaled foreign object Croup Pneumonia GORD Pertussis

Answer 7

Dry? Blood? How long? Is it always there? Infrequent bouts? Vomiting at all?

Answer 8

A- if needed B- oxygen, nebulised salbutamol C- fluids PEFR

Answer 9

A-E If shocked then give bolus over 10 minutes and oxygen If not give bolus over 30 mins Repeat until no longer shocked Insulin 0.05-0.1 units/Kg Add potassium if needed Add dextrose when glucose below 5%

Answer 10

2 main insulin regimes - continuous pump-programmable pump and insulin storage reservoir that gives a regular or continuous amount of insulin - multiple short and long acting injections- long acting give baseline protection and short action to cover for when eat Done in diabetes clinic Will see dietician and community nurse who can liase with for any concerns

Answer 11

Bedside - neuro examination - ECG Bloods - glucose - U&Es Imaging - EEG within 72 hours - MRI if focal

Answer 12

An abnormal sudden burst of electrical activity in the brain which can cause your symptoms In meantime going to refer you to first fit clinic who are specialists in treating people with seizures Here they will carry out a thorough assessment and carry out some more investigations and give you a detailed management plan- can talk about likely plan if want? In the meantime until then it is important to know what to do if suffers another seizure in meantime So firstly it is important to make sure in a safe environment- so make sure ndangerous objects in vicinity where could hit head or hurt themselves Place them on their side and make sure they are able to breathe so if got any tight clothings around enck remove or loosen these Also important to as soon as it starts, start watch and time it- if this lasts over 5 then it is important you call ambulance as soon as possible. Other things that are important are that if afterwards they are extremely drowsy or just do not smm right then call ambulance or bring them in to A and E

Answer 13

Tension Migraine Myopia / hypermetropia Post-ictal Meningitis / encephalitis / abscess Sinusitis Idiopathic intracranial hypertension Raised intracranial pressure / space occupying lesion

Answer 14

SOCRATES Include - morning - triggers- chocolate,cheese Bright lights and neck stiffness Abdo pain Vomiting Been themselves Fever Coryzal Neuro symptoms- vision, fits, weakness

Answer 15

A-E Neuro examination BMI Headache diaries

Answer 16

Common - mesenteric adenitis - appendicits - UTI - constipation - somatisation Less common - pneumonia - DKA - HSP - Hep A - SCD

Answer 17

Temp dot in axilla <4 weeks Tympanic membrane >4 weeks

Answer 18

Common - understimulation - neglect - IDA - CP Less common - congenital hypothyroidism - inherited metabolic disorder

Answer 19

A special type of light shines on the skin, which alters the bilirubin into a form that can be more easily broken down by the liver

Answer 20

In primary care - IM benzylpenicillin - call 999 Secondary care - abx - fluids - steroids if needed - public health notification- ciprofloxacin Long term management= hearing loss, learning difficulties and CP

Answer 21

The MMR is a vaccine which contains weakened versions of live measles, mumps rubella viruses. Why and when is it given? It is given to a child soon after their first birthday when they are most at risk of getting infected by the viruses (because natural immunity fades from maternal antibodies). The vaccine helps protect your child from experiencing the full blown symptoms of the viruses, if any at all. The vaccine is very effective and is recommended as part of the UK Immunisation Schedule.

Answer 22

Mumps is caused by a virus which causes headache, fever and large neck lumps. Measles and rubella present similarly with a rash which starts on the face and then spreads downwards- flu like symptoms, lots of long term complications- infertility and deafness in mumps. measles can lead to long term brain complications. rubella has severe effects on pregnant women

Answer 23

As with any medical intervention there are some side effects The most common occurs in about 1 in 10 children who may experience a bit of a fever There is a very small risk of about 1 in 1000 children who may have a fitcaused by a fever, which is called a ‘febrile convulsion’. However, to put this into context, if a child has not been immunised and gets measles they are five times more likely to get a fit (1 in 200).

Answer 24

There has been some speculation in 1998 that the MMR was associated with Autism and that subsequently received quite a bit of publicity. However, since then there have been numerous scientific papers written which show absolutely no risk associated The WHO have categorically stated there is no risk. The MMR is given at the same sort of time as the symptoms of autism appear The doctor who published the paper Dr Andrew Wakefield has subsequently, been struck off the medical register. Dr Wakefield had shares in a pharmaceutical company that was trying to market an alternative MMR vaccine. The papers have also subsequently been retracted.

Answer 25

Investigations- full head to toe examinations, skeletal survey, head CT Management- ontact on call social services and Child Protection team Inform senior paediatrician Deal with injury/fracture Document everything in the notes Liaise with social services – consider Child Protection Case Conference

Answer 26

If under 12 use weight centiles - overweight above 91st centile - obese above 98th centile - severe above 99.6 centile If over 12 use BMI - overweight above 25 - obese above 30

Answer 27

Bedside - phyiscal examination - BMI - BP Bloods - TSH - cortisol - HbA1c

Answer 28

Imipramine or oxybutynin

Answer 29

I understand it can be frustrating, how do you react to it? Do you ever discipline him?

Answer 30

Tall( typically above 50th centile) - simple obesity Short Prader willi - endocrine; hypothyroidism, cushings, PCOS

Answer 31

Common Hearing impairment Visual impairment Low IQ Rarer Specific learning impairments

Answer 32

Bedside - full examination - BMI - urine dip Bloods - FBC, U&E, TFTs, GH, HbA1c

Answer 33

Karyotyping Bone X ray

Answer 34

Have they lost any skills Hand dominance Appear floppy or muscles are tense Crawling or bottom shuffling?

Answer 35

What we can see by plotting his weight is that he really has not been growing as we would expect and is not putting on weight at the rate we would expect

Answer 36

Safety net about red flags - losing their progress - floppiness - hand dominance

Answer 37

Cystic fibrosis Metabolic disorder Diabetes Bowel disease Chronic illness- sickle cell and IDA Malnourishment Neglect Endocrine- hypothyroidism, GH CKD

Answer 38

Bedside - observations - head to toe examination - stool sample- calprotectin, elastase - sweat test Bloods - FBC, U&Es, LFTs, Hb electrophoresis, iron screen, vitamins - coeliac antibodies

Answer 39

Familial normal variant IUGR or extreme prematurity Delayed puberty (normally familial) Endocrine causes- cushings syndrome, IGF-1 or GH deficiency, hypothyroidism Chronic illness Nutritional deficit - GI diseases - insufficient food Chronic disease - crohns - coeliac - CF - CKD from renal tubular acidosis Psychosocial deprivation

Answer 40

Nutritional cause or chronic illness

Answer 41

Bloods - FBC - U&Es - calcium and phosphate - TSH - CRP - coeliac hormones - GH provocation, IGF-1, dexamethasone provocation test If neuro symptoms MRI X ray of wrist and hand

Answer 42

CP Congenital myopathy Spinal chord lesions Spina bifida Part of global delay Varied initial moving- commando crawl or bottom shuffling

Answer 43

Prenatal - genetic conditions- downs, fragile X - metabolic (hypothyroidism, inborn errors of metabolism) - congenital infections Perinatal - prematurity linked IVH - HIE - hypoglycaemia - kernicterus Postnatal - meningitis/encephalitis - anoxia - trauma

Answer 44

So we have done an examination of timmy and during this we have found some signs which suggest that Timmy may have been physically hurt which is of concern to us because his safety is our top priority It is important to state at this point that we are not accusing anyone of this just that this is what we have found and that we are going to need to investigate what has happened- do you have any idea how this may have happened In the meantime what we are going to do is admit him to hospital where he is in a safe place and the proper investigation can be done. we have contacted the safeguarding team who are going to come and figure out what is best for him as that is their speciality

Answer 45

From the history what were most concerned is that your sons basic needs are not being met which worries us because these things are necessary for him to thrive and develop as a healthy young boy We are unsure what has been going on here and are not accusing anyone however what we need to do is to contact the safeguarding team who are going to figure out what is best for him

Answer 46

Today you have described thse behaviours of restlessness and having lots of energy In people with these behaviours what we consider as a diagnosis is ADHD. Have you heard of this before Yes so there are 2 main parts the first of which is attention deficit where people struggle to concentrate and remain focussed on something The second part is hyperactivity where people are full of energy and struggle to sit still What causes? - no one is at fault for this, it is not a disease that is caused by the environment that they have grown up in, instead we have seen that is does run in families and is due to changes in the area of the brain involved in controlling impulses

Answer 47

Parent training programmes which help you learn specific ways of talking to your child and working with them to improve their attention and behaviour

Answer 48

Weigh General inspection- posture, colour and jaundice Head - measure - shape and fontanelles Face - asymmetry - nose - skin Eyes - red reflex and look in eyes Ears - insepct pinna and tags- will undergo hearing test before discharge Mouth - palate - tongue tie Neck and clavicles - fracture - lumps Arms - tone - number of fingers - 2 palmar creases Chest - resp rate - work of breathing - listen to lungs - listen to heart - pulse oximetry

Answer 49

Abdomen - inspection and palpation Genitalia Lower limps - tone - club foot - number of toes Hips - barlow= bring hip in while applying pressure on knee which is flexed - ortolani= bringing it back out (abduction) Turn over - back scoliosis and inspection - anus check patency Reflexes - check a couple of these

Answer 50

MORO- hand on back of head and let fall backwards SUCKLING- if something touches roof of mouth will suckle Rooting- turn its head if stroke mouth Palmar grasp- touch hand and will close fingers Stepping- if feet touch floor then will put 1 foot in front of other

Paeds Flashcards

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