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Paeds Flashcards

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1
Q

Give hx structure in paeds minus developmental hx

A
  1. PC + HPC:
    a. Feeding - volume + frequency
    b. Vomiting
    c. Fever
    d. Wet nappies?
    e. Stools - consistency and look
    1. PMH:
      a. Antenatal period
      b. Birth - deliver, premature, birth weight
      c. Neonatal period - illnesses and admissions
      d. Medical conditions
      e. Surgeries
    2. Drug history + allergies
    3. Weight, height & Developmental history (milestones):
      a. 6 weeks - smiles and lifts head
      b. 6 months - rolls over, moves objects hand to hand, social
      c. 8 months - sits unsupported
      d. 12 months - pincer grip, 2 syllable words, stranger anxiety, unstable walking
      e. 15 months - stable walking, points at what they want
      f. 18 months - scribbles with crayons
      g. 2 years - 2/3 word sentences, up & down stairs
      h. 3 years - stands on one foot, counts to 10, can dress and undress
      i. 4 years - hops on 1 foot, toilet trained
    4. Immunisations
    5. Dietary history:
      a. Special requirements
      b. Type of food
    6. FHx
    7. SHx:
      a. Foreign travel
      b. Second hand smoke
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2
Q

Average birth weight

A

3.5kg

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3
Q

when should micturition and meconium occur post birth?

A
  • Micturition - within 24hr

* Meconium - within 48hr

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4
Q

How much milk should a baby have?

A

150 ml/kg per day

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5
Q

Give caloric needs of a 0-1 and 1+ yr old

A

○ 0-1 - 110kcal/kg/day

○ 1yr+ - 1000 + (100xage) kcal/day

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6
Q

Maintenance fluids of child

A

Maintenance fluids:
1st 10kg - 100 ml/kg/day
2nd 10kg - 50 ml/kg/day
Subsequent kg - 20ml/kg/day

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7
Q

Give 3 benefits of breast feeding to mum and baby

A 
Benefits to baby:
	• More easily digested
	• Antibodies that fight infection
	• Lowers risk of allergies
	• Fewer hospitalisations
	• Higher IQ in later life
	• Bonds with mother
	• Lowers risk of SIDS

Benefits to mother:
• Bonds with baby
• Burns calories so lose baby weight
• Releases oxytocin which reduces uterine bleeding after birth
• Lowers risk of breast and ovarian cancer
• Saves money

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8
Q

Paed wheeze differentials

A 
Wheeze:
	• Pneumonia
	• Asthma
	• Bronchiolitis
	• Bronchitis
	• Cystic Fibrosis
	• Inhalation of foreign body
	• Aspiration
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9
Q

Paeds acute cough differentials

A 
Acute Cough:
	• Upper airways:
		○ Rhinovirus
		○ Croup
		○ Allergy
	• Lower airways:
		○ Asthma
		○ Bronchitis, bronchiolitis
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10
Q

Paeds chronic cough differentials

A 
Chronic cough:
	• Upper airways:
		○ Infection - chronic sinusitis, tonsillitis
		○ GORD
	• Lower airways:
		○ Asthma
		○ Foreign body
		○ Bronchiectasis
		○ CF
	• Psychogenic cough
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11
Q

Paeds stridor differentials

A 
Stridor:
	• Nose and nasopharynx:
		○ Inflammation eg rhinitis and sinusitis
	• Mouth:
		○ Tonsillar hypertrophy
		○ Foreign body
	• Larynx:
		○ GORD
		○ Epiglottitis
		○ Abscess
		○ Foreign body
	• Trachea:
		○ Tracheomalacia
		○ Tracheitis
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12
Q

S&S of asthma in paeds

A 
History:
	• Cough after exercise
	• SOB
	• Limited exercise
	• Peak in school age (4)

Examination:
• Barrel shaped chest
• Hyperinflation
• Wheeze and prolonged expiration

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13
Q

Ix of asthma paeds

A

Investigation:
• PEFR <80% predicted
• Bronchodilator response to beta agonist

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14
Q

Tx of asthma paeds

A

Management:

1. ICS + SABA
2. + LABA (>5yrs) or montelukast (<5yrs)
3.  
	a. Response to LABA? - increase
	b. No response to LABA? - Get rid of + increase ICS
4. Increase ICS or + theophylline
5. Daily oral steroid

Consider moving up if using 3+ doses of SABA a week
ALWAYS USE SPACER

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15
Q

S&S of CF

A 
History:
	• Cough and wheeze - recurrent chest infections
	• SOB
	• Sputum
	• Haemoptysis
	• Pale fatty stools - malabsorption
	• Weight loss - failure to thrive
	• Neonates - meconium ileus
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16
Q

Ix of CF

A

Ix:
• Sweat test
• CXR - hyperinflation, infiltrates

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17
Q

Tx of CF

A 
Tx:
	• Non pharm:
		○ Physiotherapy
		○ Annual flu immunisation
		○ High calorie diet
		○ Pancreatic enzyme supplements
		○ Multivitamins
	• Pharm:
		○ Abx ppx
		○ Bronchodilators
		○ Mucolytics
		○ Azithromycin - anti inflammatory and abx
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18
Q

S&S of bronchiolitis

A 
History:
	• Dry cough
	• Wheeze
	• Feeding problems
	• Apnoea episodes

Examination:
	• Resp distress
	• Dry cough
	• Tachypnoea
	• Subcostal and intercostal recession
	• Prolonged expiration
	• Wheeze and crackles
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19
Q

Ix of bronchiolitis

A

Ix:
• Pulse oximetry
• CXR - hyperinflation, patchy change
• Nasopharyngeal swab

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20
Q

Tx of bronchiolitis

A

Tx:
• Oxygen
• If tachypnoea - limit oral feeds and use NGT
• Bronchodilators for wheeze
• Mechanical ventilation for apnoea or severe resp distress

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21
Q

Cause of croup

A

parainfluenza virus

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22
Q

S&S of croup

A 
Symptoms:
	• Barking cough
	• Stridor
	• SOB worse at night
	• Fever
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23
Q

Tx of croup. Epi

A 
Tx:
	• Paracetemol
	• Oral Dexamethasone
	• Adrenaline neb
	• Oxygen

Epi:
• 6 mths to 6 years
• Peak age of 2

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24
Q

Epi, S&S and tx of epiglottitis

A

Epi:
• 1-6 years

S&amp;S:
	• Fever
	• Toxic looking child
	• Stridor
	• Drooling
	• Minimal cough

Tx:
• Urgent review to secure airway
• IV abx

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25
s&s of pneumonia
History: • Fever • SOB • Cough Examination: • Resp distress signs • Desaturation and cyanosis • Dullness to percussion, crackles, decreased breath sounds, bronchial breathing
26
Ix of pneumonia
BOXES ``` Ix: • Sputum • Blood culture • CXR • Pleural fluid if pleural effusion ```
27
Tx of pneumonia
Tx: • Amoxicillin or erythromycin • Severe- co amox • HAP (48 hrs post admission) - piperacillin with tazobactam
28
cause of whooping cough
bordetella pertussis
29
S&S, ix and tx of pertussis
History: • Coughing bouts - worse at night and after feeding. • May vomit • Inspiratory whoop Ix: • Nasal swab culture • PCR and serology Tx: • Azithromycin
30
CXR finding of neonatal resp distress syndrome
CXR: • Diffuse ground glass lungs • Bell shaped thorax
31
Centor criteria and tx
``` The Centor criteria* are as follows: • presence of tonsillar exudate • tender anterior cervical lymphadenopathy or lymphadenitis • history of fever • absence of cough ``` 3+ = cause is Group A beta hemolytic Strep Tx: • <3 = Paracetemol • 3+ = phenoxymethylpenicillin or erythromycin
32
S&S of HF in paeds
``` History: • Sweating • Breathless, • Tachypnoea • Poor feeding • Failure to thrive • Tachycardia ```
33
Tx of HF in paeds
Tx: • Diuretics • ACEi
34
Causes of vomiting acute in paeds
○ GI infection ○ GI obstruction eg pyloric stenosis Poisoning
35
Causes of chronic vomiting in paeds
``` • Chronic: ○ Peptic ulcer disease ○ GORD ○ Chronic infection Gastritits ```
36
ix of vomiting in paeds acute and chronic
Ix: • FBCs, U&E, Creatinine • Stool for culture • AXR Chronic: • +Abdo USS • +Endoscopy
37
Causes of constipation paeds
``` Causes: • Commonest - Low fibre, lack of exercise, poor colonic motility (FHx) • Hirschprungs • Partial obstruction • Coeliac disease • Infection • Hypercalcaemia ```
38
Tx for constipation
Tx: • Diet - increase fluid and fibre, natural laxatives eg fruit juice • Behavioural measures - toilet footrests, regular 5 mins toilet time after meals • Treat for as long as constipation has been there: ○ Movicol (1st line) or lactulose ○ Enemas if no response
39
Causes of failure to thrive
``` Causes: • 95% caused by malnutrition • Organic causes: ○ GI problems ○ GORD ○ DM ○ Malabsorption ○ CF ```
40
Causes of jaundice
Unconjugated causes: • Hemolysis • Gilbert syndrome Mixed causes (liver damage): • Infection • Drugs - eg paracetemol OD or TB drugs • Wilsons disease Conjugated causes (bile tract obstruction): • Biliary atresia • Primary sclerosing cholangitis • CF
41
Ix of jaundice
Ix: • Liver biopsy • USS • Bloods
42
GORD paeds S&S
``` History: • Oesophagitis • Failure to thrive • Apnoea • Regurgitation ```
43
Ix of GORD and tx
Ix: • Upper GI endoscopy • CXR • Barium Swallow Tx: • Position babies head 30 degrees above prone • Avoid food before sleep • Thicker milk feeds for babies and small frequent meals • Omeprazole if oesophagitis and gaviscon
44
S&S of gastroenteritis
``` History: • Diarrhoea • Vomiting • Crampy abdo pain • Fever • Dehydration ```
45
ix and tx of gastroenteritis
Ix: • Stool and blood culture • Sigmoidoscopy if IBD suspected Tx: • Rehydration Consider ampicillin if scoring for sepsis
46
pyloric stenosis hx
Presents in weeks 2 - 4 of life with vomiting History: • Projectile vomiting, 30 mins after feed • Constipation and dehydration • Palpable mass in upper abdomen • Hyochloremic, hypokalaemic alkalosis due to vomiting
47
Intussesception epi and S&S
Epidemiology: • Affects 6-18 months old. • 2:1 M:F ``` S&S: • Paroxysmal abdo colic pain • Child draws knees up and turns pale • Vomiting • Blood stained stool • Sausage shaped mass in RLQ ```
48
Ix and tx of intussesception
Ix: • USS Tx: • Reduction by air insufflation • Surgery if signs of peritonitis
49
Allergic colitis patho and S&S
Commonest cause of non infective diarrhoea in infants S&S: • Diarrhoea with blood and mucus • Failure to thrive • Most common allergen is cows milk protein
50
Ix and tx for allergic colitis
Tx: • Exclude allergies from diet and offer substitute Ix: • Eosinophilia • Raised IgE • Positive skin prick test to specific foods
51
S&S of malrotation
S&S: • Infant - bile stained vomiting • Older child - GORD, vomiting, abdo pain
52
Hirschprung S&S. ix
Presentations: • Neonatal period - failure or delay to pas meconium • Bilious vomiting, abdo distension, constipation • Older children - constipation, abdo distension Ix: Rectal biopsy
53
Necrotising enterocolitis S&S
``` Symptoms: • Feeding intolerance • Abdo distension • Bloody stools • Commonly Occurs in neonates <3 months old ```
54
Coeliac disease S&S and ix
``` History - Coincides with introduction of gluten in diet: • Failure to thrive • Diarrhoea • Abdo distension • Foul smelling stools ``` Ix: • Jejunal biopsy showing villous atrophy • TTG antibodies
55
S&S of meningitis in young and older children
S&S: • Young children - fever, poor feeding, bulging fontaneles • Older children - headache, neck stiffness, photophobia, kernigs sign
56
Anaphylaxis emergency tx
Algorithm - Signs of shock, SOB, or Stridor: 1. High flow oxygen 2. IM adrenaline 1 in 1000, 10 micrograms - repeat in 10-15 mins if no improvement 3. a. If wheezing - Neb salbutamol b. If croupy - Neb adrenaline c. If systemic symptoms of shock - fluid bolus up to 30ml/kg 4. Antihistamines and oral steroids for 72 hours. 5. Allergy clinic follow up + consider epi pen
57
Tx of UTI in paeds
Tx: • <3 mths old - immediate referral to paediatrician • >3mths + pyelonephritis - admission • >3 mths + cystitis - trimethoprim for 3 days + safety net
58
Tx of Minimal change GN
Tx: • Steroids • Cyclophosphamide if steroid resistant
59
S&S of henoch shenolein purpura | patho
S&S: • Palpable purpuric rash over buttocks and extensors • Abdo pain • Polyarthritis • Features of IgA nephropathy - Haematuria and renal failure Patho: • IgA mediated small vessel vasculitis • Usually seen in children following infection
60
Epi and tx of henoch schonlein purpura
Peak - 4-6 yrs Tx: • Analgesia for arthralgia • Supportive tx for nephropathy
61
Undescended testes tx
Tx: • Watch and wait • If undescended by 9 mths refer to urologist
62
Tx of absence seizure
sodium valproate
63
S&S of tuberous sclerosis
``` S&S: • Cutaneous: ○ Rough skin patches over lumbar spine ○ Café au lait spots ○ Depigmented ash leaf spots which fluoresce under UV light • Neuro: ○ Development delay ○ Epilepsy ○ Intellectual impaired ```
64
Ix of tuberous sclerosis
Ix: • CT head • Gene studies
65
Causes of cerebral palsy
Patho: • Insult to developing brain ``` Causes: • Ischemia • Congenital infection • Neonatal meningitis • Premature ```
66
S&S of cerebral palsy
S&S: • Spastic - increased tone, reduced power • Dystonic - involuntary movements • Ataxic - wide gait, nystagmus, intention tremor
67
Hydrocephalus S&S and ix
``` S&S: • Irritability • Poor feeding • Headaches • Vomiting • Seizures • Enlarging head size • Widened sutures • Bulging fontanelles • Papilloedema ``` Ix: • Cranial CT
68
Febrile convulsions S&S
S&S: | • Brief generalised tonic clonic seizure with fever
69
Ix and tx of febrile convulsions
``` Ix: • Urine dipstick • Inflammatory markers • CXR • LP if indicated • Consider EEG and brain imaging if concerned ``` Tx: • Parental reassurance • Abx if needed • BZD if seizure >5 mins
70
S&S of duchennes and ix
``` S&S: • Waddling gait • Speech and motor delay • Proximal weakness • Gowers' sign +ve • Muscle wasting ``` Ix: • Elevated CK • Abnormal EMG and nerve conduction • Muscle biopsy
71
S&S of hand foot and mouth disease and tx
History: • Mild systemic upset - sore throat, small fever • Oral ulcers • Vesicles on palms and soles of feet Tx: • Hydrate + analgesia • Reassurance • No need to exclude from school
72
Patho of hypoxic ischemic encephalopathy and S&S
Pathology: • Neonatal brain injury secondary to asphyxia during pregnancy or labour S&S: • Mild - increased tone and reflexes, poor feeding, staring eyes • Moderate - lethargy, reduced tone and reflexes, seizures • Severe - coma, reduced tone, multi organ failure
73
Ix and tx of hypoxic ischemic encephalopathy
Ix: • EEG • MRI brain Tx: • Resp and circ support • Anticonvulsants
74
Cx of prematurity
``` Cx: • RDS • Persistent ductus arteriosus • Retinopathy of prematurity • Sepsis ```
75
RDS patho, S&S, and tx
``` RDS: • Patho - lack of surfactant in lungs • S&S - resp distress, tachycardia, hypoxia, CXR has ground glass appearance • Tx - Antenatal steroids, resp support • Cx - chronic lung disease ```
76
PDA patho, S&S, tx
Patent ductus arteriosis: • Patho - left-right shunting, fluid overload --> HF • S&S - continuous murmur, bounding pulses, wide pulse pressure • Tx - Fluid restriction, indometacin, surgery to ligate duct • Cx - HF
77
Retinopathy of prematurity patho, S&S, tx
``` Retinopathy of prematurity: • Patho - Proliferation of frail BVs • S&S - asymptomatic • Tx - Laser therapy if severe • Cx - Retinal detachment, severe visual impairment ```
78
Causes of first 24 hr jaundice in neonate
• Hemolysis eg Rh disease • Sepsis Red cell membrane defects
79
Causes of post 24 hr jaundice in neonates
day 2-14 Physiological/breast milk hemolysis, sepsis, red cell defects 2 wks +: • Unconjugated - breast milk, UTI, hypothyroidism, as above Conjugated - biliary atresia, neonatal hepatitis
80
Ix of neonatal jaundice
FBC, blood group, LFT Direct Coombs test TFT
81
Causes of neonatal sepsis
``` Causes: • PROM >24 hrs • Maternal sepsis • Chorioamnionitis • Maternal carriage of GBS • Prematurity ```
82
S&S of neonatal sepsis
``` S&S: • Resp distress • Apnoea • Poor feeding • Temp instability ```
83
S&S of scarlett fever, tx
``` History: • Fever • Malaise • Tonsillitis • Strawberry tongue • Rash - pinhead erythema appearing first on torso and spares face ``` tx - penicillin v
84
S&S of CNS tumours paeds
S&S: • Early morning headache/vomiting • Focal neuro signs • Papilledema
85
Ix and tx of CNS tumours
``` Ix: • MRI brain Tx: • Surgery • Chemoradiotherapy ```
86
What is wilms tumour. S&S
Patho: • Nephroblastoma ``` S&S: • Painless abdo swelling • Haematuria • Weight loss • HTN ```
87
Ix and tx of wilms tumour
Ix: • CT staging • Biopsy Tx: • Surgical resection • Chemotherapy
88
S&S and tx of bone tumours
S&S: • Pain • Swelling • Pathological fractures of long bones Tx: • Surgical excision • Endoprosthetic replacement
89
Downs syndrome associations
hypothyroid, hirschprung, epilepsy, PDA, tetralogy of fallot
90
Cx of turners. chromosomes?
Cx: • Coarctation of aorta • Infertile 45,X
91
Kleinfelters S&S. chromosomes?
``` S&S: • Tall stature • Hypogonadism and small testes • Gynaecomastia • Behavioural problems ``` 47,XXY
92
S&S of autism
``` S&S: • Delay in speech and language skills • Repetitive behaviour • Poor eye contact • Rigidity of thought • Lack of imagination ```
93
Tx of autism
Tx: • Education • OT • SALT
94
Tx of ADHD
Tx: • Methylphenidate • CBT
95
Tx of breath holding attacks
Benign and self limiting
96
developmental hx
a. 6 weeks - smiles and lifts head b. 6 months - rolls over, moves objects hand to hand, social c. 8 months - sits unsupported d. 12 months - pincer grip, 2 syllable words, stranger anxiety, unstable walking e. 15 months - stable walking, points at what they want f. 18 months - scribbles with crayons g. 2 years - 2/3 word sentences, up & down stairs h. 3 years - stands on one foot, counts to 10, can dress and undress i. 4 years - hops on 1 foot, toilet trained

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