Paeds 5 Flashcards by John Darlington

What are some poor prognostic factors for ALL?

<1 years, >10 years old 
WCC >50
T cell markers 
Non - Caucasian 
Male
BCR ABL

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What classical features are found on examination of a child with coeliac disease? and list some other differentials for the disease:

Distended abdomen

Pale

Wasting of the gluteal muscles

Dermatitis herpetiformis
- this isn’t always found

Differentials:

IBD
IBS
Cystic fibrosis
Bacterial over growth

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Outline some general causes of failure to thrive:

Increased metabolic demand:

congenital heart disease
recurrent infection
malignancy
hyperthyroidism

Inadequate absorption:

coeliac disease
cystic fibrosis
pancreatic insufficiency

Poor intake:

reflux
cleft palate
neurological defects

Environmental:

poor access
poor economics
maternal depression

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List some causes of non-biological causes of failure to thrive:

Low socioeconomic status
- unable to afford good food

Inadequate intake
- insufficient food offered

Maternal depression
- poor feeding

Neglect

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In a child with coeliac disease what food groups can they not eat from? and is coeliac disease for life?

Wheat

Rye

Barley

if diagnosis is before <2 years old a trial of gluten can be done in childhood with jejunum biopsies taken to check for changes.
some children may recover.

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What are the major causes of conjugated bilirubin?

TORCH infections

Biliary atresia

Neonatal hepatitis

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List the three main causes of non-pathological or life threatening causes unconjugated bilirubin in the neonate:

Breast milk

Hypothyroidism

Polycythemia

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In a child with jaundice how often should bilirubin levels be taken?

2-4 hours with careful monitoring

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What are the signs of kernicterus?

Opisthotonus - arching of the back

Sleepiness

Hypotonia

Poor feeding

Poor munro response

High pitched cry

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What are some mild signs of dehydration in a child and what are some severe signs?

Mild:

sunken eyes
sunken fontaelle
reduced skin turgor

severe:
- dry nappies
- weak pulse
- reduced BP

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Which babies are at risk of severe bronchiolitis?

Preterms 
Low birth weight 
Chronic lung disease 
Congenital heart disease 
Immuno-deficiency

*Palivizumab can be given to these kids as prophylaxis

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What are the types of Undescended testes and what is the investigations and management?

Two major types:

palpable and non palpable (Cryptorchidism)
Retractile and non-retractile

Investigations:
Palplable is clinical
Non-palpable: laparoscopy

Management:
Palpalble: Inguinal orchiopexy (done at 3 months)
- and beta - hCG
Non-palpable: laparoscopic surgery

**bilateral non-palpable testes requires genetic workout

Complications:

fertility
Seminomas’
Cosmetic

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Which babies get an US of the hips to check for DDH and when is this done?

Anyone with 1st degree relative

Breech presentation

Multiple pregnancy

Barlow/ Ortolani findings

Outpatients in 2 weeks if clunk identified
Outpatients within 6 weeks if risk factor identified

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What signs suggest over feeding rather than an underlying condition?

> 200ml/kg/ day

Over fed babies will have normal growth and look healthy. Will usually only have vomiting as a the symptom

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What are the causes of GORD in a child?

Immature muscular

Neurological illness
- cerebral palsy

Liquid only
- Recumbent positioning

Positioning

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What is a syndrome that can be seen in neonates with GORD which involves the neurological system?

Sandifer syndrome

Torticollis
Opisthotonus

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What are some risk factors to colic? and what is the diagnostic criteria?

< 5 months

Exposure to cigarette smoke

Formula fed

Diagnosis:

> 3 hours per episode
> 3 days a week
> 3 weeks

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What are the red flags for constipation?

> 48 hours of meconium

Distention of abdomen

Neurological disorders
- locomotor failure

Ribbon stools

Excessive vomiting

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What are the two type of Cow’s milk protein intolerance seen in children and how do they present?

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Two types:

IgE mediated (type I hypersensitivity)
Non- IgE mediated (type IV hypersensitivity)

IgE:

2-4 hour onset
Urticarial rash
pruritus’
Angioedema **this can potentially be fatal and helps distinguish it from non-IgE
colic
D&V
Respiratory wheeze
rhinosinusitis symptoms

Non- IgE:

48- 2 week onset
eczema rash
pruritus’
Colic
Bloody diarrhoea
Respiratory wheeze

Treatment:

hydrolysed formula
if being breast fed ask mother to not drink cow’s milk

What is Baclofen and when is it used?

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Baclofen is a muscle relaxant.

used in cerebral palsy to help relax tight muscles.

Regarding injection sites for DM, should they be rotated around on and why?

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Yes

- avoids complications such as lipohypertrophy and lipodystrophy

What is the effective of growth hormone on blood glucose levels?

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Increases blood glucose level
- supresses insulin

*this is why you can do a glucose suppression test in acromegaly

Give account for relative hyperglycaemia seen in the morning of teenagers:

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Increased sex and GH hormones increases cortisol and release of sugars.
- dawn phenonium

Any girl who is primary amenorrhoeic, should they have karyotyping carried out?

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Yes they should

- to rule out turners syndrome

What is tested for to confirm a diagnosis of congenital adrenal hyperplasia?

17 hydroxyprogesterone - it accumulates due to lack of 21 hydroxylase other tests: - ACTH - renin - cortisol *serum steroid is diagnostic as well

What is the typical management of ITP and should you give steroids?

Observation and advice. - usually self resolves following 6-8 weeks - if child injuries head they should come to A&E due to risk of bleed Steroids are not recommended until the diagnosis is absolutely certain due to risk of it being leukaemia

What viruses are associated with type I diabetes, and what other conditions should you screen for at diagnosis?

Enteroviruses Mumps CMV Other diseases to screen for at diagnosis: - coeliac disease - Thyroid disease

What advice would you give to a child who is newly diabetic?

Technique of injections Sick day rules - increase monitoring - up insulin if needed Hypo recognition and management Importance of moving injection sites

When should insulin be started in a child with DKA? and what monitoring are you going to do of a child with DKA?

Start insulin 1 hour after initiating fluid therapy Monitoring during treatment: - Blood glucose level - BP - HR - GCS - ECG (for hypokalamia)

Can prematurity be associated with delay in milestones?

Yes

What is the only absolute indication for circumcision? and What is an absolute contraindication for circumcision?

Balanitis Xerotica Obliterans Hypospadius - often foreskin is used to repair the defect

If a child is dehydrated how much fluid should they receive?

You should aim to correct the dehydration in 48 hours. This is achieved by: - If 5% dehydrated: Add 50mls/kg on top of maintenance fluid over 48 hours - if 10% dehydrated: Add 100mls/kg on top of maintenance fluid over 48 hours

Whats the pathology, risk factors and management of retinopathy of prematurity?

Excessive oxygen shuts off vascular endothelial growth factor in the retina creating relative hypoxia - this leads to excessive blood vessel formation damaging retina. Risk factors: - preterm <32 weeks - oxygenation - low birth weight Management: - 90-95% oxygen - Laser therapy

Outline some of the differences in ABCDE management of a child:

Airway: - <6 months obligated nasal breathers - Larger heads - more prone to flopping forward - larger tongue - horseshoe epiglottis *head bobbing in children is accessory muscle use Breathing: Circulation - higher HR due to reduced stroke volume - Higher circulating volume per Kg but overall lower so minimal blood loss may be a lot to a child * urine output <1ml/kg * *IO access is often needed over IV Disability: - AVPU - Posture (hypotonic?) - Fontanelle - Glucose *glucose bolus 2ml/kg of dextrose followed by infusion Exposure: - bruising - skin rashes

Prior to given fluids what things should you check in a paediatric patient?

Clinical condition Weight Input/ output BP Bloods which have recently being done

In which settings are the fluid boluses and maintenance fluids different and what are they?

DKA, Major Haemorrhage , trauma 10ml/kg bolus ``` 0-10kg = 2ml/kg/ hour 10-40kg = 1ml/kg/ hour >40kg = fixed volume of 40ml/kg/ hour ```

Which of the manoeuvres for DDH do what?

Barlow's - dislocates Ortalini - reconnects

List some causes of a neonate presenting with shock:

Sepsis - No.1 Congenital cardiac disease Metabolic - hypoglycaemia Surgical - malrotation - NEC

Outline your management of a child with croup:

Mild (no symptoms at rest) - Dexamethasone 0.15mg/ kg - discharge home Moderate (symptoms at rest) - Dexamethasone 0.15mg/ kg - admit for observations Severe: (high RR, severe stridor, distressed) - Oxygen - Nebulised adrenaline 5ml 1:1000 - Dexamethasone IV - PICU support

What are the types of spina-bifida and what are some complications and what are some treatment of the more severe forms?

Spina -bifida occult Meningocele Myelomeningocele Complications: - Hydronephrosis (atonic bladder) - hydrocephaly (Arnold Chari formation) - Constipation/ incontinence - Spinal tethering - Shunt blocking *presents with change in behaviour - ADHD - seizures Investigations: - Anomaly scan 20 weeks - Alpha-fetal protein levels (high) - MRI of head and spine (Arnold Charlie malformation) - US of abdomen (usually for meningocele initially) Management: - Surgical closure - Physiotherapy - Intermittent catherization and - Orthopaedics - Seizure medication

What is called when there is neural tube defect causing protrusion of the brain and meninges in the skull?

Encephalocele

What are some of the clinical signs and complications of Duchene muscular dystrophy? investigations and management:

X-linked Signs: - Trendelenburg gait - Pseudohypertrophy of the calve muscles - Gower's sign - Kyphoscoliosis Comorbidities: - Cardiomyopathy - Respiratory distress - GORD - intellectual impairment Investigation: - Creatine kinase level - Dystrophin (can be done by biopsy) Management: - Nutrition - ACE + Beta blockers - Respiratory support (BiPAP, tracheostomy) - Surgery (lengthen tendons) - Corticosteroids

What are the differences in DMD and BMD?

DMD: * out of frame deletion - More common - more severe - Early onset ~ 3 years - Life expectancy ~20 years old BMD: * in frame deletion - less common - less severe - Around 10 years old - 40 years old life expectancy

In suspected congenital heart disease what immediate tests do you want?

Echocardiogram ECG CXR

What are some differentials on auscultation of a wheezy chest?

Asthma Viral induced wheezed Bronchiolitis Bronchiectasis (CF)

List some causes of collapse with poor respiratory effort in a 6 week old baby:

Sepsis Congential cardiac disease NAI Post seizures

Paeds 5 Flashcards

(46 cards)