PAEDS Flashcards
(222 cards)
1
Q
What vomiting problem causes low Cl, K and metabolic acidosis
A
Pyloric stenosis- non-bile stained
2
Q
Meningitis B immunization schedule
A
2, 4, 12 months
(8 weeks, 16 weeks, a year)
3
Q
In 5-16 after SABA fails what do you add
A
LOW DOSE inhaled corticosteroids
4
Q
Large right atrium and small right ventricle cause
A
Ebstein’s anomaly. Low insertion of the tricuspid valve (?lithium overdose, pan-systolic murmur)
5
Q
Roseola infantum most common complication
A
Febrile convulsions (rapid rise in body temp due to viral illness)
6
Q
Congenital CMV presentation
A
low birth weight, generalized Petechial rash, microcephaly, seizures, hepatosplenomegaly with jaundice
7
Q
How can CF present in stool
A
Steatorrhoea due to fat malabsorption
8
Q
Which Abx for whooping cough if onset <21 days ago
A
Azithromycin or clarithromycin (oral macrolide)
If after 21 days no Abx?
9
Q
First line treatment for threadworm
A
Single dose mebendazole for whole household and lifestyle advice
10
Q
‘Machinery-like murmur’, left-sided thrill diagnosis andMx
A
Patent ductus areriosus, give indomethacin in postnatal period
11
Q
Scarlet fever presentation
A
Fever, throat ache, strawberry tongue, ‘sandpaper-like’ rash more intense in cubital fossa
12
Q
PAEDS BLS algorithm start with B in under 1 (infant)
A
Look listen feel for breathing-> 5rescue breaths-> check brachial pulse-> 15:2 two-thumb encircling technique
13
Q
What is given in transposition of the great arteries and why
A
Ductus arteriosus is a passage between the aorta and the PA during foetus. Mums placenta provides O2 and so it doesn’t need to use its lungs. It then closes when baby is born to prevent O2 an unO2 blood getting mixed up. Prostaglandins keep it open and so are given in transposition of the great arteries to keep it mixed until surgery
14
Q
Absent heart sounds but tinkling in newborn diagnosis and Mx n
A
Congenital diaphragmatic hernia (tinkling is bowel sounds) Mx with NG tube insertion and/or intubate and ventilate before surgical repair
15
Q
Which infection stops lung transplants
A
Burkholderia cepacia (gram negative, often resistant)
16
Q
Most common associated feature with hypospadias
A
Cryptochidism (undescended testes)- 1 in 10
Most often in isolation though
17
Q
Most common complications of VSD 2
A
Pulmonary hypertension
Endocarditis
18
Q
What do you give to all children with an asthma attack for 5 days after
A
Oral pred (steroid)40mg
19
Q
What Otho problem is common in obese 12 year old boys (abnormal gait)
A
Slipped upper femoral epiphysis
20
Q
When born via breech what do you have to do 6 weeks postnatal
A
USS pelvis (paediatric hip USS) as increased risk of developmental dysplasia of the hips (DDH)
21
Q
When delivered by ventouse delivery what is a common complication involving head appearance
A
Caput succadeaneum,-localised edema from prolonged application of suction cup (crosses suture lines)
22
Q
How to remember childhood immunizations (3,4,6 in one)
A
6in1 before 6 months old
4in1 3-4years
3in1 >13 years
23
Q
What is the causative organism of whooping cough
A
Bordatella pertussis
24
Q
Which heart murmur can you hear with Turner’s syndrome
A
Ejection systolic murmur due to biscuspid aortic valves
Upper left sterns edg
25
What condition is red-currant jelly a late sign in
Intussusception. Treat with air insufflation
26
Which Paeds rash has fever before then rash after
Roseola
27
Sore throat sandpaper rash strawberry tongue
Scarlet fever
28
Cough conjunctivitis Coryza
Measles
29
Slapped cheek
Parvo
30
4 features of tetralogy of fallot
Ventricular septal defect
Right ventricular hypertrophy
Pulmonary stenosis
Overriding aorta
31
Which murmur is tetralogy of fallot
Ejection systolic (due to pulmonary stenosis)
32
Loose stools 4-5 weeks after gastroenteritis
Transient Lactose intolerance
33
Triad of shaken baby
Retinal haemorrhage
Subdural haematoma
Encephalopathy
34
Impetigo when can they go to school
Not until the lesions are crusted and healed OR 48 hours after commencing Abx treatment
35
What is the organism called in threadworms
Enterobius Vermicularis (vermin)
36
What is the first line treatment/ best treatment in under 7 for bed wetting
Enuresis alarm
37
When to refer to ortho in bow legs
4
38
Meningitis tx under 3 months
iv cefotaxime and amox
39
What are poor prognostic factors in ALL for age at diagnosis, sex, WCC at diagnosis and one other
Less than 2 or more than 10 at diagnosis
male sex
WCC more than 20
Having B or T cell surface markers
40
Pierre-Robin presentation
Robin me of my airway so small mandible , tongue retraction, cleft palate
41
Which condition rocker bottom feet
Edwards
42
Supravalvular aortic stenosis with learning difficulties
William’s
43
Turners presentation 2 main
Primary a,enorrhoea
Shirt stature
44
Most common organism for croup
Parainfluenza virus
45
Hirschsprungs presentation
pr bleeding
Pain like appendicitis
From birth
46
What do you give in patent ductus arteriosus
Indomethacin or ibuprofen
47
Prolonged jaundice, hepatomegaly, splenomegaly, abnormal growth from birth
Biliary atresia - surgery heptoportoenterostomy to allow bile drainage
48
Milestones in premature babies under 2
Add on the amount of time they were premature so 6 weeks milestone would be 12 weeks if 6 weeks early
49
What Abx for whooping cough
Azithromycin or clarithromycin
50
Acute limp in under 3 MX
Urgent referral for Paeds assessment to rule out septic arthritis or traumatic injury. Can even present asymptomatic but limp
51
Forward lean with strider
?Acute epiglottitis
52
Which cardiac abnormality is associated with bipolar disorder treatment in pregnancy
Ebstein’s anomaly
Lithium
Posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle causing regurg (systolic murmur) and stenosis (diastolic) of the TV
53
Why is bicarbonate elevated in pyloric stenosis
Loss of H+ ions in profuse vomiting so equilibrium shifts to the left to make it back up
54
Is ballotable mass in abdomen of a child a red flag
Yes for Wilm’s tumour. (median 3 yrs) . Abdo mass, painless haematuria, flank pain, anorexia, fever
Urgent referral
55
First line tx for DDH in under 6 months
Pavlik harness- holds hips in optimal position for joint and socket development to correct the dysplasia
Oat older maybe surgery
56
Which congenital condition presents with elfin facies
William’s syndrome (will Ferrell in elf)
57
Picks up objects with a preference for a hand under 12 months
Suggests neuro problems with the other limb- most likely cerebral palsy
58
First step in Mx for potential epiglottitis
Call anaesthetist to assess for intubation to protect the airway
Then give o2 and IV Abx
59
UTI Mx in under 3 months in GP
Immediate referral to Paeds
60
Difference in rash in scarlet and Kawasaki
Scarlet is sandpaper (erythematous, rough texture)
Kawasaki is widespread maculopapular
61
Diagnoses in cyanotic CHD in first days of life vs 1-2 months
Cyanotic congenital heart disease presenting within the first days of life is TGA.
Cyanotic congenital heart disease presenting at 1-2 months of age is TOF
62
Roseola infantum presentation
High fever lasting a few days
Then later followed by maculopapular rash, diarrhoea, cough, ?febrile convulsions
63
What age group are you concerned about pulling up of legs and why
3 months- 3 years as this is when you get intussuception- in under 3 months it’s probably just infantile colic
64
What might u give in recurrent febrile seizures
Oral midazolam or rectal diazepam (benzodiazepine rescue meds)
65
Immediate mx of croup
Stat dose dexamethazone 0.15mg/kg
66
Which surgical name for Mal rotation with volvulus
Ladd’s procedure
67
How does neonatal hypoglycaemia present
Irritable
Feeding poorly
Jittery And high RR on examination
Preterm birth is key risk factor as liver cant generate glucose
68
What is Barlow manoeuvre (ortho)
Attempting to dislocate an articulated femoral head (adduction with downward pressure)
Tests for instability in DDH
69
Which surgical problem is associated with congenital diaphragmatic hernia and/ or exomphalos
Malrotation
70
At what age are we concerned by bow legs
Age 4 or 5
Below this is a normal variant in children
71
How does necrotising enterocolitis present
Feeding intolerance
Abdo distension
Bloody stools
Then progresses to Abdo discolouration, perforation, peritonitis
72
What is ITP
Immune thrombocytopenia purpura
Type 2 hypersensitivity reaction (immune mediated) leading to a reduction in the platelet count
(Body attacking own platelets)
May follow infection/ vaccination and more acute in kids
Usually doesn’t require treatment as it resolves in 6 months either way, but if the platelet count is under 10 you may give oral/ IV corticosteroid
73
What is the difference between exomphalos and gastroschisis and how does Mx differ
Exomphalos is bowel protruding out of Abdo wall but it is has a peritoneal covering around it -> staged closure starting asap with completion at 6-12 months (to prevent respiratory complications
Grastroschisis is bowel protruding out of Abdo wall but with no peritoneum around it -> immediate urgent correction
74
Which genetic condition is associated with supravalvular aortic stenosis
William’s syndrome
75
Which neonatal condition causing jaundice would have high conjugated bilirubin and which would have high unconjugated bilirubin
Biliary atresia has high conjugated as its already been conjugated in the liver
Gilbert’s has high unconjugated as lack of enzyme that mediates conjugation
76
What are the 8 S’s of an innocent murmur
Soft
Systolic
Short
S1 and S2 normal
Symptomless
Special tests normal
Standing/ sitting (postural variation)
Sternal depression
77
How does bronchiolitis present
Coryzal prodrome
Mild fever
Persistent cough
Wheeze
red flag is grunting, no nappy wetting, cyanosis, exhaustion, other signs of RDS
78
How does whooping cough present
Catarrhal phase like a viral URTI lasting 1-2 weeks
Paroxysmal phase of cough increasing in severity, worse at night and after feeding, and can cause vomit/ central cyanosis. Whoop sometimes present. Subsides over weeks/ months
Give oral azithromycin if presented within 3 weeks of symptomatic onset
79
How to treat whooping cough
Oral azithromycin
80
Which vaccine is given in 16-32 weeks pregnant women to protect newborns
Pertussis (whooping cough)
81
Child between 4 and 12 presenting with partial seizures at night, otherwise normal
Benign Rolandic epilepsy
Will usually stop by adolescence
82
Adolescent presenting with infrequent generalised myoclonus seizures in the morning/following sleep deprivation
Juvenile myoclonic epilepsy
83
Definitive Mx for SUFE
Internal fixation across the growth plate (surgical management)
84
First line drug for ADHD in kids and side effects
Methylphenidate
Can cause Abdo pain, nausea, dyspepsia- can cause stunted growth and weight loss
85
What is ratio for compressions and ventilations is a newborn
3:1
86
Which heart lesion is most commonly associate with duchenne’s muscular dystrophy
Dilated cardiomyopathy
DMD presents with progressive proximal muscle weakness from 5 years, calf pseudohypertrophy, Gower’s sign
Typical prognosis 25-30 years
87
Most common heart problem with fragile X
Mitral valve prolapse
88
Mx of perthes in under 6 vs over 6
Under 6 observe
Over 6 surgical mx.
89
How do u get a definitive diagnosis for hirschsprungs
Rectal biopsy for absence of ganglionic cells
90
What extra vaccine would be offered to kids with relatives born in South Asia
Bcg for tuberculosis
91
What age do febrile convulsions typically stop
5
92
Which type of seizure shows hypaarrythmia on EEG and prognosis
West’s syndrome (infantile spasms)
Poor prognosis
93
What age is puberty precocious in women?
8
94
What heart condition is the most serious long term health complications of turners
Aortic dilatation and dissection
Most common is biscupsid aortic valve and coarctation of the aorta
95
How does mitochondrial inheritance work?
In the zygote mitochondria is only present from the ovum not the spermicide so a mitochondrial disease can only be passed form mum to baby
96
How does the management of meningitis in under 3 months vs over 
Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)
97
How do you treat scarlet fever (not too unwell )
Oral penicillin V for 10 days 
98
What age do we refer for undecscended testes
3 months to be seen at 6 surgery at 12
99
What is mesenteric adenitis
Inflamed lymph nodes in the mesentery
Causes similar symptoms,s to appendicitis’s
Follows recent viral infection
Requires no treatment
100
Until what age would you urgently refer all kids with acute limp
3 years
Risk of septic arthritis
Above that likely transient Synoptics
101
How does rickets present
Aching bones and joints
Bow legs, kyphoscolosis,
widening of wrist joints
102
First line inv for DDH in different ages
Less than 4-5 months = USS (most co,mon)
More than = XR
103
Hepatosplenomegaly with signs of anaemia I’m under 6
ALL
104
How do you treat cystic fibrosis
Regular physiotherapy and drainage
high calorie diet
supplements
in those who are homozygous for the gene mutation give lumacaftor/ivacftor (orkambi)
105
What events in pregnancy cause orofacial clefts? 
Smoking, antiepileptics, benzodiazepines, rubella 
106
What do you give to prevent RSV in kids who are at increased risk of severe disease
Palivizumab
Monoclonal antibody
107
Which condition will present with primary amenorrhoea and testicles in the groin
Androgen insensitivity syndrome
Resistance to testosterone so genotypically male (46XY) but female phenotype
Breast development can still occur due to conversion of testosterone to oestradiol
108
Gold standard diagnosis of hirschprungs
Rectal biopsy - shows lack of ganglionic nerve cells
109
How do u measure bilirubin in less than and more than 24 hour year old kids
Under= serum bilirubin within 2 hoirs
Over= transcutaneous bilirubinometer
110
How do u investigate ITP
Clinical exam
FBC shows isolated thrombocytopenia
BONE MARROW EXAM OMLY REQUIRED IF ATYPICAL FEATURES E.G. splenomegaly, lymphadenopathy
111
How do u treat ITP
Normally you don’t and it resolved in 6 months
Can give steroid* immunoglobulin if v low platelet count
112
What is ITP
Immune mediated reduction in platelets
Petechial rash in otherwise well child
May often be triggered by precedin* viral illness
Presents with bruising, petechial/ purpuric rash, ?epistaxis
113
Which gender is perthes more common in
Boys
114
When do you refer for surgery in umbilical hernia
5 years unresolved
115
What are the two possible underlying causes of muconeum lieu’s (not passing Meconium due to obstruction )
Hischsprung or CF
116
Complications of undescended testes
Infertility
Torsion
Cancer
117
What is maternal labetalol a Rf for
Neonatal hypoglycaemia
118
Salmon pink rash with joint pain
Juvenile idiopathic arthritis
119
How to treat biliary atresia
Early surgical intervention
(Kasai procedure - heptoportoenterostomy)
120
How does meckles diverticulum present?
 painful massive rectal bleed (bright red)
Cam have constipation, n and v, Abdo pain 
Most common cause of massive big bleed in under 2s
121
Lice household contact tx
Nothing unless also have lice
If so treat with insecticide (malathion)
122
School exclusion for lice
None
123
Which type of seizures happen at night (partial seizures)
Benign Rolandic epilepsy
124
Why do you not give ibrupofen in chicken pox
Increases risk of necrotising facitis
125
Q27
What is the first sign of puberty in boys?
increase in testicular volume.
126
When is the MMR vaccine given
12 months
3 yrs 4 months
127
Investigations for coeliac
Anti-TTG antibiody test
Mildly elevated could do scope and biopsy
128
What chronic condition is nasal polyps associated with
Cystic fibrosis
129
How does eczema present in infants
Rash on face and extensor surfaces as opposed to classical flexor distribution
130
Does a single episode of vomiting following a head injury indicate a CT
Apparently not
Needs to be 3
131
What is meckels diverticulum
Small outpouching of intestine in the lower portion of the SI
Can still produce acid so causes ulceration and bleeding
Rule of 2s:
- 2% of pop
- 2 feet from ileocaecal valve
- 2 inches long
- usually presents under the age of 2
Most common cause of painless massive GI bleed requiring a transfusion in kids
132
What is the rule of 2s GI
For Meckels diverticulum
2% of pop
2 feet from ileocaecal valve
2 inches long
Usually presents <2
133
How do you investigate meckels diverticulum in a stable and severe case
Stable= Meckel’s scan= 99m technetium pertechnetate (has an affinity for gastric mucosa)
Severe= mesenteric arteriography
134
Which investigation looks for renal scarring in vesicoureteric reflux?
DMSA
Taken up by healthy renal tubular cells and not scarred ones
135
Which organism is the most likely cause of skin complications from chicken pox e.g. necrotising fasciitis
B-Haemolytic Group A Strep e.g. strep throat
136
What kind of laxative is first line in constipation
Osmotic to soften the stool
E.g. movicol
137
What do you give in severe croup after oral steroids
Oxygen and nebulised adrenaline
Causes vasoconstriction in upper airway, reducing airway edema which is the main problem in croup
Salbutamol has no effect on this, used in severe bronchiolitis/ asthma
138
Until what age is 39 degrees a red flag
3 months
139
When is RR of over 60 a reg flag
At any age
140
6 year old girl
Foot pain after walking
Writing slow, needs rests after prolonged
Pain in legs at night after lots of activity during the day
Otherwise very well
Hypermobility
141
Which rash is most intense on cubital fossa
Scarlet fever
142
Rf for DDH
girls
firstborn children
families where there have been childhood hip problems (parents, brothers or sisters)
babies born in the breech position (feet or bottom downwards) after 28 weeks of pregnancy
143
Abx choice in mycoplasma pneumoniae causing pneumonia in kids
Azithromycin
144
Abx in simple pneumonia not caused by mycoplasma pneumoniae or associated with influenza
, amoxicillin
145
Abx choice in kids with pneumonia associated with influenza
Coamoxiclav
146
Abx choice in kids with suspected meningitis
Benzylpenicillin
147
Roseola infantum causative organism
Roseola infantum is caused by human herpes virus 6
148
Kocher’s criteria for diagnosing septic arthritis
Kocher's criteria is used to assess the probability of septic arthritis in children using 4 parameters:
Non-weight bearing - 1 point
Fever >38.5ºC - 1 point
WCC >12 * 109/L - 1 point
ESR >40mm/hr
149
What can a child do at 2 months
2 months:
lift head 45 degrees (when laying on face), turns to sound, follows objects past midline, social smile
Parents Little Baby: looks up to sound, smiles because he sees both his parents, one on either side of midline
150
What can a child do at 4 months
4 months: lift head 90 degrees/raise up to chest, roll over, find midline, reach for objects, puts objects in mouth, coos (these are vowel sounds), and laughs
Fat Happy Baby: baby is rolling and laughing and cooing because he just discovered midline and is reaching for cake that he will cram into his mouth
151
What can a child do at 6 months
6 months: sit up with no head lag, raking grasp, transfer objects between hands, babbles (consonants), recognizes familiar faces
Street-Corner Baby: sitting up on sidewalk, transferring a rake from hand to hand while babbling at people he thinks he recognizes
152
What can a child do at 9 months
9 months: Crawl, pull to stand, point, specific babbling (mama, dada), stranger anxiety
Watch Dog Baby: crawls to window, pulls to stand to see out, points at stranger in yard and says mama to get attention of parents.
153
What can a child do at 12 months
12 months: Walk, pincer grasp, 1 word, patacake, bye bye, peekaboo
Playful Zombie Baby: walking at you, snapping pincers, repeating one word over and over (brrraaaaains), and just wants to play patacake and peekaboo before waving bye bye.
154
What can a child do at 15 months
15 months: walks well, imitates, controlled release of blocks (can stack 2)
Little Sister Baby: wants to be just like big sister, walks confidently to the blocks and imitates making a 2 block tower
155
What can a child do at 18 months
18 months: Throw, scribble, 4 block tower, 1 step command, uses spoon/cup, points to parts of body
Sir Charming Baby: needs to get note to Rapunzel so scribbles note on paper to throw into high 4 block tower, catapult has cup on end, shoves note in with spoon, and throws note at tower, hitting Rapunzel in the face
156
What can a child do at 2 years
2 years: Run, stairs (1 foot at a time), 20-50 words, 2 step command, parallel play
Bad Twins: mom gives two commands to twin boys to run to the stairs, then walk up the 25 stairs. Each walks up the 25 stairs not helping the other.
157
Whaf can a child do at 3 years
3 years: Jump, Tricycle, dresses self (shirt, pants, shoes), full name, you, me, I
James Bond Baby: springs into action . . . jumps into 3-piece suit, stands in front of mirror and says full name, jumps on tricycle. You.Me. I, is his pickup line.
158
What can a child do at 4 years
4 years: Stairs (alternating feet), hop, undresses, 1 foot (4 seconds), 4 word phrases (complete sentences), cooperative play
Bedtime Story Baby: really wants story time, so runs up stairs, hops on one foot to undress, so she and mom can read a story together. A Wrinkle in Time.
159
What can a child do at 5 years
5 years: Skip, Tie shoes, Difference between reality/fantasy
Oz Baby: ties ruby shoes, skips down Yellow Brick Road back to Kansas
160
Hand foot and mouth disease school exclusion
None if they feel well
161
What contraception is given to trans FTM not undergone surgery but on testosterone having sex with male partner
Copper coil as no hormones to interfere with testosterone therapy
162
What is the most dangerous form of delivery in terms of neonatal bleeding
Prolonged ventouse delivery
High pressure exerted by vacuum
163
Which congenital heart condition is associated with a continuous murmur
Patent ductus arteriosus
Loudest under left clavicle
164
Which genetic condition is associated with hirschprungs
Downs
165
What do you add to a child under 5 with SABA and ICS that needs more
Leukotrine receptor agonist e,g, montelukast
I’m 5-16 add LABA instead
166
When do you refer if a child can’t sit without support
12 months
Should be 7-8 months
167
When do you refer if a child can’t walk unsupported
18 months
13-15 is normal
168
Atrial septal defect describe murmur
Ejection systolic murmur (pulmonary region)
Fixed splitting of the second heart sound
169
Classic triad of Sx for Henoch-Schönlein purpura
Purpuric rash
Abdo cramping
Haematuria
Can give achey joints
170
What do all breech babies need at 6 weeks
USS of hip
171
What vaccine do you offer to kids with parents born in South Asia
BCG vaccine for TB
172
What movement. Can’t you do in SUFE
Passively
loss of internal rotation of the leg in flexion
173
5 core Sx of Kawasakis
Conjunctival infection (bilateral, no discharge)
Rash (never vesicular or bulbous, is generalized)
Adenopathy (usually cervical)
Strawberry tongue
Hands and feet changes
174
What is the definitive surgical Mx for pyloric stenosis
Ramstedt pyloromyotomy
Dividing he pyloric muscle to increase the diameter of the gastric outlet
175
Which disease causes hand foot and mouth
Coxsackie A16
Manage symptomatically - hydration and analgesia. No exclusion
176
What is the most common presenting feature of wilms tumor
Abdo mass
Unexplained avoid mass in kids approx 3 refer urgently
Rare kidney cancer
177
triad of nephrotic syndrome
Low serum albumin
High urine protein content (>3+ protein on urine dipstick)
Oedema
178
investigations when suspecting nephrotic syndrome
urine dip for proteins (high)
serum albumin (low)
179
cause of nephrotic syndrome
90% minimal change disease
can be secondary to another kidney problem or e.g. HSP
180
what kind of murmur in TOF
harsh ejection-systolic murmur
due to the pulmonary stenosis
181
What does CSF show for viral and bacterial meningitis
Will look turbid in bacterial
Pressure will be high in bacterial
Protein will be high in bacterial (maybe both)
Glucose will be low in bacterial
WBC is high in both (mostly neutrophils in bacterial, lymphocytes in viral)
TLDR everything high for bacterial apart from glucose
182
How to work out paediatric maintainance fluids
0-10 kg= 100mls/kg
10-20kg= 50mls/kg
>20kg= 20mls/kg
This is for a day so would have to divide by 24 to give the hourly rate
So a child weighing 21kg would need 1520mls in a day so hourly rate of 63.3mls/hr
Prescribe 500 mls Hartmanns / NaCl with 5% dextrose
183
How to work out paediatric resuscitation fluids
0.9% sodium chloride with no additives via intravenous (IV) in a standard bolus of 10 mL/kg over <10 minutes.
So 10ml/kg over 10 mins of 0.9% sodium chloride
184
How to calculate how much fluid to give to a child who is dehydrated
Fluid deficit (mL) = % dehydration x weight (kg) x 10
Given as a bolus
So a 12kg child with 5% dehydration= 600mls
Replace over a certain amount of time so give with maintainance fluids
So their maintainance fluid requirement is 1100mls over 24 hours
Plus 600= 1700mls /24= 71mls /hour
185
How to interpret urine dip for UTI
leukocytes +ve and nitrites +ve= treat as UTI
Leukocytes +ve and nitrites -ve= send microscopy and culture and treat as UTI if <3
Leukocytes -ve and nitrites +ve= treat as UTI
Both negative= consider other diagnoses
186
Croup management
Oral steroids first e.g. oral dexamethasone
Then oxygen
Then nebulised budesonide ?
Then nebulised adrenaline
Then intubation and ventilation
187
Croup management
Oral steroids first e.g. oral dexamethasone
Then oxygen
Then nebulised budesonide ?
Then nebulised adrenaline
Then intubation and ventilation
188
Bronchiolitis management
Supportive
Ensure adequate intake
Clear nasal secretions using suctioning and nasal drops
Supplementary O2
189
Bronchiolitis management
Supportive
Ensure adequate intake
Clear nasal secretions using suctioning and nasal drops
Supplementary O2
190
What is cystic fibrosis
Autosomal recessive disease
Mutation of gene that codes for chloride channels
Causing thick secretions causing duct blockage for digestive enzymes and reduced airway clearance
Can also cause bilateral absence of the vas deferens in boys meaning there is no way for sperm to get from tests to ejaculate
191
How to diagnose cystic fibrosis
3 ways:
Blood spot testing (heel prick) which picks up most cases
Sweat test- bit of skin made to sweat and then sent to the lab for chloride concentration- CF=> 60mmol/L
192
Two key colonizers of patients with cystic fibrosis
Staph aureus and pseudomonas aeruginosa
CF patients take long term prophylactic fluclox to prevent staph aureus infection but pseudomonas is hard to treat
These are common organisms that live in airways of CF patients due to reduced airway clearance
193
How to treat impetigo
Hydrogen peroxide cream / fusidic acid if they are well
It is a bacterial infection highly infectious
Can give oral fluclox if a bit more unwell
194
How does perthes present on X-ray
Initially would show increased density of the femoral head
Then the femoral head would have an irregular edge
You should specifically request a ‘frog leg’ hip X-ray view
X-ray is first line investigation
195
How long are patients with chicken-pox infectious for
Up to 3 days before lesions appear and until the last lesion dries up
196
How long is the incubation period for chicken pox
Up to 3 weeks
197
How to differentiate between peri-orbital and orbital cellulitis
Periorbital is better. Presents with swelling in front of the septum (eyelid vibes). Treat with oral Abx but refer if any suspicion of OC
Orbital is bad and sight-threatening. Presents with pain on movement, reduced vision, color blindness, proptosis. Managed with IV Abx +/- surgical drainage of pus. MDT for sure
Periorbital usually caused by some injury, orbital usually caused by spread of infection from e.g. the sinuses
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Triad of haemlytic uremic syndrome
Microangiopathic haemolytic anaemia (normocytic)-> pallor, confusion
Acute kidney injury -> hypertension
Thrombocytopenia (low platelets) -> bruising
Also can present with abdominal pain
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What is the cause of of haemolytic uraemic syndrome
E.coli / Shigella causes gastroenteritis
Which then causes the destruction of red blood cells due to a pathology in the small blood vessels where tiny thrombi partially obstruct the small blood vessels and churn up the RBCs as they pass through causing rupture
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Management of haemolytic uraemic syndrome
Medical emergency -> admit
Supportive management-> fluids, blood transfusion, haemodialysis
Stool culture for causative organism
It is self-limiting and patients will recover
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Criteria for septic arthritis
fever >38.5C, non-weight bearing, ESR > 40, WCC > 12
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Fetal alcohol syndrome presentation n
features of foetal alcohol syndrome: microcephaly, short palpebral fissures, hypoplastic upper lip, absent philtrum, reduced IQ, and cardiac abnormalities
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Duchennes muscula dystrophy which form of inheritance
X-linked recessive
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barking cough,
Croup
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How to diagnose gestational diabetes
either fasting glucose is 5.6mmol/L or above, or two-hour glucose is 7.8mmol/L or above. Manage with lifestyle changes THEN metformin
Give insulin if if the fasting blood glucose is 7.0mmol/L or above, or if the fasting blood glucose is between 6.0 and 6.9 mmol/L and there is evidence of macrosomia or polyhydramnios
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When can you do PCI after an MI
12 hours after symptoms onset
Recommended that its done <2 hours after medical attention as that’s how long it would take for fibrinolytics to work
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human herpes virus 6 which disease
Roseola infantum
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When are Abx indicated for otitis media
tympanic membrane is perforated
under 3-months old,
under 2 years and the infection is bilateral
4 or more day duration of symptoms
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Which blood test is raised in biliary atresia
Conjugated bilirubin
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New born baby exam
You would want a maternal history and baby history, and weigh the baby
General obs for pallor, jaundice, cyanosis
Tone: (hypotonia in Down’s syndrome-> reduced feeding)
Head: size (measure circumference) and shape (e.g. Caput succadedenum), fontanelle. Face for appearance, asymmetry, trauma, nose, eyes. OPTHALMOSCOPE for fundal reflex, ears. Mouth for cleft palate
Neck: webbed neck (Turner’s), neck lumps)
Upper limbs: symmetry, inspect fingers and palms(2 palmer creases), palpate brachial pulse
Chest: observe for IWoB (40-60 normal), chest expansion, listen to lungs and heart
Abdomen: observe for distension, umbilicus, inguinal hernia. Palpate organs
Genitalia: look for urethral meatus, penis size, palpate for testicles, discharge
Lower limbs: symmetry, oedema, tone and movement, femoral pulses, barlows and ortolanis test (back and out)
Back: inspect spine, anus for patency
Reflexes: palmar grasp, sucking, rooting, stepping , Moro
Skin: top to toe for bruises/ lacerations
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PGALS screening quetions
Do you have any pain/ stiffness in muscles, joints or back?
Do you have any difficulty getting yourself dressed without any help?
Do you have any problems going up or down the stairs?
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Inspection part of pGALS
General:
- body habitus
- scars
- muscle wasting
- psoriasis
Objects:
- walking aids
- prescriptions/ meds
Anterior:
- leg length discrepancy
- joint swelling/ erythema
- muscle bulk/ wasting
- elbow extension (5-15)
- valgus and varus (knees are away in varus)
Lateral:
- lordosis, kyphosis
- knee joint extension (hypermobility)
- foot arch
Posterior:
- scoliosis
- iliac crest alignment (leg length discrepancy)
- popliteal swelling
- shoulder alignment
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What is Trendelenburg gait
Defective hip abductor mechanism
Hip dips down to the side that is not weight bearing
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What is the cause of waddling gait
Usually a myopathy e.g. muscular dystrophy
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Arm movements in pGALS
Hands behind head and poin elbows out (abduction and external rotation, elbow flexion)
Hands held out in front with palms facing down (shoulder flexion, elbow extension, small joint extension). Inspect dorsal hand and nails
Palms up (supination)
Make a fist (flexion of small hand joints)
Precision grip
Praying position
Reach up to the sky with arms straight (extension and abduction)
Look up and down
Then squeeze their MCPJs
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Reflexes in a newborn baby exam
Palmar
Sucking
Rooting
Stepping
Moro
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SUFE Mx
Internal fixation across the growth plate is definitive
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Double bubble sign Abdo X-ray
Duodenal atresia
Ass with Down syndrome
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Stridor from birth
Laryngomalacia
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Which vaccine do you not give in a child with HIV
MMR
?cos its live
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Continuous machinery murmur over the upper left sternal edge.
PDA
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3 ECG changes in hypokalaemia
T-wave inversion
U-waves
Long QT interval -> increased risk of tornadoes des points
