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Paeds Flashcards

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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
Initial mx of DKA?
Iv fluids then insulin
26
Ongoing fluid therapy? Vol and type?
Hourly rate: [(Deficit - vol of unshackled bolus) / 48hrs ] /maintenance hourly 0.9% Saline + 20mmol K+ in every 500ml bag
27
DKA therapy complications?
Cerebral oedema Hypokalaemia Hypoglycaemia Aspiration pneumonia Death
28
DKA severity?
pH <7.1 = Severe DKA (10% dehydration) pH <7.2 = Moderate DKA (5% dehydration) pH <7.3 = Mild DKA (5% dehydration)
29
Fluid deficit calc?
Fluid Deficit (ml) = Weight (kg) x Dehydration x 10
30
Fluid deficient example In 5% Dehydration and 20kg child without shock
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
Fluid deficiencies example In 10% Dehydration and 60kg child with shock
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
Features of cerebral oedema?
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
Drugs to manage cerebral oedema?
Hypertonic saline Mannitol +restrict maintenance fluids, senior support
34
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?
Kawasaki disease - a vascular disease affecting small and medium vessels. Need to rule out in all children with fever >5days
35
Important extra investigation if suspecting Kawasaki disease?
Request echo to look for coronary artery echo
36
Treatment for Kawasaki?
IV immunoglobulins High dose aspirin
37
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?
Measles
38
Measles complications?
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
What gestation is risk of congenital rubella syndrome highest?
Weeks 8-10 (first trimester) of pregnancy- 90% surviving infants have defects
40
Congenital rubella syndrome triad?
Deafness Eye abnormalities Cardiac defects
41
Slapped cheek syndrome aka?
Parvovirus B19 Erythema infectiosum Fifth disease
42
Why to pregnant women need to avoid parvovirus?
Infection in 1st trimester associated with 19% risk of foetal death. Or serious abnormalities And severe anaemia of last 18weeks
43
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?
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
Management of Henoch-Schönlein purpura?
Usually self limiting, by 6w. Symptomatic tx. Nephrology referral if severe renal involvement e.g. macroscopic haematuria, hypertensive, proteinuria >3m, haematuria >1y
45
What advice would you give to newly diagnosed patients with ITP?
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
Mild bleeding in ITP tx? E.g. epistaxis, gum bleeding
Transexamic acid 20-25mg/kg TDS up to 5d
47
ITP treatment
1st line- prednisolone 2nd line- IV immunoglobulins Chronic - ?splenectomy- of >5yo and steroid ineffective - platelet infusions - rituximab
48
Tx for broncholitis?
Supportive O2 CPAP if resp failure likely
49
Most common cause of bronchiolotis?
RSV- Respiratory syncytial virus
50
Prophylaxis for bronchiolitis in high risk children?
Palivizumab Only in premature/chronic lung disease of newborn Haemodinamicly affected congenital heart disease Severe immunodeficiency
51
Done up to case 6 of PowerPoint James sent me
52
3yo boy with recent cold, now has barking cough, a fever and noisy breathing. Inspiratory stridor and subcostal recessions. 1st line tx?
It’s Croup Oral dexamethasone- 150 mcg/kg stat
53
Croup peak incidence age? Most common presenting features?
6 months to 3 years Struggling to breath, stidor- seal/dog like barking cough Hoarse voice Low grade fever- up to 38.5
54
Most common cause of croup?
Parainfluenza virus Causes airway inflammation of supraglottic, glottic, subglottic and trachea
55
Initial management of croup?
Keep child calm Oral dexamethasone If severe- nebulised adrenaline
56
What organism classically causes epiglottitis?
Haemophilus influenzae B Now very rare due to HiB immunisation
57
Epiglottis 1st line management?
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
Stridor differentials?
Croup Epiglottitis Foreign body Masses- haemangiomas, goitre, lymphomas Quinsy- peritonsillar abscess Laryngomalacia- congenital abnormality of voice box Subglottic stenosis
59
Cause of whooping cough?
Bordetella pertussis- a gram negative bacteria
60
What is quinsy?
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
Most common cause of quinsy?
Often had recent tonsillitis Usually caused by: - Group A Strep (streptococcus pyrogenes) Can be caused by: - staphylococcus aureus - Haemophillus influenzae
62
Management of quinsy?
Hospital for needle aspiration or surgical drainage Abx: broad spec e.g. co-amoxiclav Sometimes: steroids e.g. dexamethasone
63
Acute asthma. Peak flow % for - moderate exacerbation - severe - life threatening
Moderate- >50% predicted Severe <50% predicted Life threatening <33% predicted
64
Signs of life threatening asthma attack? (6)
Peak flow <33% predicted O2 sats <92% Silent chest Exhaustion and poor respiratory effort Hypotension Cyanosis Altered consciousness/confusion
65
Staple acute asthma management?
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
Stepwise approach to acute asthma attack?
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

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