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Finals > Paeds > Flashcards

Paeds Flashcards

1
Q

Sepsis 6.

A

3 in 3 out
Out
- blood cultures
- lactate
- urine output
In
- high flow O2
- fluids
- antibiotics

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2
Q

Fluid bolus vol in children?

A

10mls/kg. Over <10mins
Use normal saline 0.9% NaCl

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3
Q

Maintenance fluid vols in children?

A

First 10kg- 100mls/kg/day
Second 10kg- 50mls/kg/day
Over 20kg- 20mls/kg/day

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4
Q

Estimating child weight 1-10yo?

A

Weight (kg)= (Age + 4) x2

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5
Q

2 signs of meningism can be found on examination?

A

Brudzinski sign- hips and knees flex in response to neck flex ion

Kernig’s sign-resistance to knee extension when the hip is flexed

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6
Q

Most common causative organisms of meningococcal sepsis in children over 3 months?

A

Neisseria meningitidis- gram -ve diplococci
Haemophilus influenzae (type B)- gram -ve bacilli
Streptococcus pneumoniae- gram +ve cocci

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7
Q

Most common causative organism of meningococcal septicaemia in under 3 month olds?

A

Group B streptococcus- gram +ve cocci
Escherichia coli- gram negative rod
Listeria monocytogenes- gram +ve rod
Strep pneumoniae- gram +ve cocci

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8
Q

Signs and symptoms of meningococcal disease?

A

High temp
Vomiting
Headache
Drowsiness
Stiff neck
Photophobia
Non-blanching rash
In babies- bulging fontanelle

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9
Q

Meningitis- Household contact prophylaxis?

A

Ciprofloxacin single dose within 24 hours of diagnosis
Ensure up to date with vaccinations at later point
2nd line- rifampicin twice a day for 2 days

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10
Q

A gram -ve diplococci confirmed cause in ?meningitis. What organism most likely?

A

Neisseria meningitidis

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11
Q

Less than 3 months old with meningococcal septicaemia. What antibiotics? Why?

A

Cefotaxime or ceftriaxone AND amoxicillin or ampicillin
To cover for listeria monocytogenes which can cross the placenta and is resistant to cephalosporins

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12
Q

Other meningitis investigations?

A

Lumbar puncture. Send for biochem, cultures and PCR

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13
Q

Bacterial finding on LP?

A

Yellow/ turbid colour
⬆️⬆️⬆️ Neutrophils
〰or⬆️ Lymphocytes
⬆️⬆️⬆️ Protein
⬇️⬇️⬇️ Glucose

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14
Q

Viral findings on LP?

A

Clear fluid
〰or⬆️ Neutrophils
⬆️⬆️⬆️ Lymphocytes
〰or⬆️ Protein
〰 Glucose

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15
Q

TB findings on LP?

A

Yellow and viscous
〰or⬆️Neutrophils
⬆️⬆️⬆️ Lymphocytes
⬆️⬆️Protein
⬇️⬇️⬇️ Glucose

Ie combo of bacterial and viral. Looks like bacterial with potentially normal neutrophils

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16
Q

Fungal findings on LP?

A

Yellow and viscous colour
〰or⬆️Neutrophils
⬆️⬆️⬆️ Lymphocytes
〰or⬆️Protein
〰or⬇️Glucose

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17
Q

Tx is suspected meningitis in community?

A

IM Benzylpenicillin and transfer to hospital

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18
Q

1st line abx of meningitis in hospital?

A

IV 3rd gen cephalosporin e.g. cefotaxime or ceftriaxone.

Acyclovir if suspecting HSV
+/- dexamethsone, O2, fluids, ITU if comatose

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19
Q

LP contraindications?

A

Raised ICP: reduced consciousness, bradycardia & HTN, focal neurology, unequal/dilated pupils

Coagulation abnormalities- inc platelets <100

Local infection

Extensive or spreading purpura

Shock

Ongoing convulsions

Resp insufficiency- LP can cause resp arrest

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20
Q

3 initial investigations to confirm DKA?

A

BM- raised blood sugars?
ABG- acidotic?
Ketones- raised?

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21
Q

Key presenting features of DKA?

A

Confusion, vomiting, abdo pain
Thirsty, passing lot of urine
Thin/losing weight. Increased appetite

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22
Q

3 diagnostic features for DKA?

A

Acidosis- pH<7.3 OR bicarb <15mmolL

Ketonaemia >3mmolL

Hyperglycaemia- >11mmolL (can be normal in known diabetics)

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23
Q

High bloods sugars (>30mmolL) with little or no acidosis or ketones. Diagnosis?

A

Hyperosmolr hyperglycaemic state- requires different tx to DKA

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24
Q

DKA management?

A

ABC
Cannula & bloods
Fluid resus. 10ml/kg bolus
Ongoing fluids
Insulin- start 1-2hours after fluids. 0.05-0.1 units/kg/hr
Nursing obs hourly
Change fluids to 5%glucose+0.9% NaCl+20mmolKCl when glucose drops to 14mmolL

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25
Q

Initial mx of DKA?

A

Iv fluids then insulin

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26
Q

Ongoing fluid therapy? Vol and type?

A

Hourly rate:
[(Deficit - vol of unshackled bolus) / 48hrs ] /maintenance hourly

0.9% Saline + 20mmol K+ in every 500ml bag

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27
Q

DKA therapy complications?

A

Cerebral oedema
Hypokalaemia
Hypoglycaemia
Aspiration pneumonia
Death

28
Q

DKA severity?

A

pH <7.1 = Severe DKA (10% dehydration)

pH <7.2 = Moderate DKA (5% dehydration)

pH <7.3 = Mild DKA (5% dehydration)

29
Q

Fluid deficit calc?

A

Fluid Deficit (ml) = Weight (kg) x Dehydration x 10

30
Q

Fluid deficient example

In 5% Dehydration and 20kg child without shock

A

Fluid Deficit = 20 x 5 x 10 = 1000ml
Hourly rate = [(Deficit – Initial unshocked bolus) ÷ 48] + Maintenance
= (1000 – 200) ÷ 48) + Maintenance
= 17 + 62 (using formula for maintenance) = 79ml/hr

31
Q

Fluid deficiencies example

In 10% Dehydration and 60kg child with shock

A

Fluid Deficit = 60 x 10 x 10 = 6000ml (Do not subtract bolus!) Hourly rate = (Deficit ÷ 48) + Maintenance
= (6000 ÷ 48) + Maintenance
= 125 + 96 (using formula for maintenance) = 221ml/hr

Cerebral Oedema

32
Q

Features of cerebral oedema?

A

Headache
• Agitation or irritability
• Unexpected fall in heart rate
• Increased blood pressure
• Deteriorating level of consciousness • Abnormal breathing patterns
• Oculomotor palsies
• Abnormal posturing
• Pupillary inequality or dilatation

33
Q

Drugs to manage cerebral oedema?

A

Hypertonic saline

Mannitol

+restrict maintenance fluids, senior support

34
Q

3yo girl. 7d high temp. B/l neck lumps on d3. Maculopapular rash on torso and back. Skin peeling on hands and feet. Lips cracked and inflamed tongue. Both eyes red. Diagnosis?

A

Kawasaki disease

  • a vascular disease affecting small and medium vessels. Need to rule out in all children with fever >5days
35
Q

Important extra investigation if suspecting Kawasaki disease?

A

Request echo to look for coronary artery echo

36
Q

Treatment for Kawasaki?

A

IV immunoglobulins
High dose aspirin

37
Q

2yo boy. 3d fever, cough, coryzal, b/l red eyes. Widespread maculopapular rash started behind ears and spread. Buccaneers mucosa has red spots with white but in middle. Diagnosis?

A

Measles

38
Q

Measles complications?

A

Pneumonia- 6% cases
Otitis media- 7% cases
Giant cell pneumonitis- in immunocompromised

Neurological
- Acute demyelination encephalitis
- Subacute sclerosis panencephalitis
- Measles inclusion body encephalitis- months after, often fatal

GI- diarrhoea

Vit A deficiency and visual impairment

39
Q

What gestation is risk of congenital rubella syndrome highest?

A

Weeks 8-10 (first trimester) of pregnancy- 90% surviving infants have defects

40
Q

Congenital rubella syndrome triad?

A

Deafness
Eye abnormalities
Cardiac defects

41
Q

Slapped cheek syndrome aka?

A

Parvovirus B19
Erythema infectiosum
Fifth disease

42
Q

Why to pregnant women need to avoid parvovirus?

A

Infection in 1st trimester associated with 19% risk of foetal death. Or serious abnormalities

And severe anaemia of last 18weeks

43
Q

10yo boy. Raised purpuric rash on legs and buttocks. Abdo pain 2days. No D+V. Mild pain in knees. Otherwise well and stable.
Urine dip proteinuria 2+, haematuria 1+
Diagnosis?

A

Henoch-Schönlein purpura

Raised red/purple bruise looking area mostly lower body.
Abdo pain, n v + bloody d.

Joint inflammation and pain

Proteinuria and haematuria

44
Q

Management of Henoch-Schönlein purpura?

A

Usually self limiting, by 6w.
Symptomatic tx. Nephrology referral if severe renal involvement e.g. macroscopic haematuria, hypertensive, proteinuria >3m, haematuria >1y

45
Q

What advice would you give to newly diagnosed patients with ITP?

A

ITP- Immune thrombocytopenia

Avoid NSAIDS
Avoid contact sports and high risk things e.g. climbing frames. Closer supervision at school
Avoid IM injections
Recognise head injuries

46
Q

Mild bleeding in ITP tx? E.g. epistaxis, gum bleeding

A

Transexamic acid
20-25mg/kg TDS up to 5d

47
Q

ITP treatment

A

1st line- prednisolone
2nd line- IV immunoglobulins

Chronic
- ?splenectomy- of >5yo and steroid ineffective
- platelet infusions
- rituximab

48
Q

Tx for broncholitis?

A

Supportive
O2
CPAP if resp failure likely

49
Q

Most common cause of bronchiolotis?

A

RSV- Respiratory syncytial virus

50
Q

Prophylaxis for bronchiolitis in high risk children?

A

Palivizumab

Only in premature/chronic lung disease of newborn
Haemodinamicly affected congenital heart disease
Severe immunodeficiency

51
Q

Done up to case 6 of PowerPoint James sent me

A
52
Q

3yo boy with recent cold, now has barking cough, a fever and noisy breathing. Inspiratory stridor and subcostal recessions. 1st line tx?

A

It’s Croup
Oral dexamethasone- 150 mcg/kg stat

53
Q

Croup peak incidence age? Most common presenting features?

A

6 months to 3 years

Struggling to breath, stidor- seal/dog like barking cough
Hoarse voice
Low grade fever- up to 38.5

54
Q

Most common cause of croup?

A

Parainfluenza virus
Causes airway inflammation of supraglottic, glottic, subglottic and trachea

55
Q

Initial management of croup?

A

Keep child calm
Oral dexamethasone

If severe- nebulised adrenaline

56
Q

What organism classically causes epiglottitis?

A

Haemophilus influenzae B
Now very rare due to HiB immunisation

57
Q

Epiglottis 1st line management?

A

Keep child calm! Ie leave alone
IV abx- IV cephlosporin (ceftriaxone or cefuroxime or cefotaxime) for 7-10days
Steroids e.g. dexamethasone
?ITU and intubation

58
Q

Stridor differentials?

A

Croup
Epiglottitis
Foreign body
Masses- haemangiomas, goitre, lymphomas
Quinsy- peritonsillar abscess
Laryngomalacia- congenital abnormality of voice box
Subglottic stenosis

59
Q

Cause of whooping cough?

A

Bordetella pertussis- a gram negative bacteria

60
Q

What is quinsy?

A

Aka peritonsillar abscess
Can cause:
- sore throat
- fever
- referred ear pain
- swollen tender lymph nodes
Specifically:
- trismus- can’t open mouth
- “hot potato voice” due to pharyngeal swelling
- swelling and erythema next to tonsils

61
Q

Most common cause of quinsy?

A

Often had recent tonsillitis
Usually caused by:
- Group A Strep (streptococcus pyrogenes)
Can be caused by:
- staphylococcus aureus
- Haemophillus influenzae

62
Q

Management of quinsy?

A

Hospital for needle aspiration or surgical drainage
Abx: broad spec e.g. co-amoxiclav
Sometimes: steroids e.g. dexamethasone

63
Q

Acute asthma. Peak flow % for
- moderate exacerbation
- severe
- life threatening

A

Moderate- >50% predicted
Severe <50% predicted
Life threatening <33% predicted

64
Q

Signs of life threatening asthma attack? (6)

A

Peak flow <33% predicted
O2 sats <92%
Silent chest
Exhaustion and poor respiratory effort
Hypotension
Cyanosis
Altered consciousness/confusion

65
Q

Staple acute asthma management?

A

O2 of <92% sats
Bronchodilators
- salbutamol
- Ipratropium bromide
- MgSO4
Steroids- prednisone oral or IV hydrocortisone
(Antibiotics- of bacterial cause e.g. amoxicillin or erythromycin)

66
Q

Stepwise approach to acute asthma attack?

A

Salbutamol inhaler- via spacer, 10 puffs every 2hours
Nebulisers- salbutamol and Ipratropium bromide
Oral prednisolone e.g. 1mg/jug/day
IV hydrocortisone
IV MgSO4
IV salbutamol
IV aminophylline

Finals (13 decks)

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