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Flashcards in Paeds Deck (96)
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1

Give hx structure in paeds minus developmental hx

1. PC + HPC:
a. Feeding - volume + frequency
b. Vomiting
c. Fever
d. Wet nappies?
e. Stools - consistency and look
2. PMH:
a. Antenatal period
b. Birth - deliver, premature, birth weight
c. Neonatal period - illnesses and admissions
d. Medical conditions
e. Surgeries
3. Drug history + allergies
4. 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
5. Immunisations
6. Dietary history:
a. Special requirements
b. Type of food
7. FHx
8. SHx:
a. Foreign travel
b. Second hand smoke

2

Average birth weight

3.5kg

3

when should micturition and meconium occur post birth?

• Micturition - within 24hr
• Meconium - within 48hr

4

How much milk should a baby have?

150 ml/kg per day

5

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

○ 0-1 - 110kcal/kg/day
○ 1yr+ - 1000 + (100xage) kcal/day

6

Maintenance fluids of child

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

7

Give 3 benefits of breast feeding to mum and baby

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

8

Paed wheeze differentials

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

9

Paeds acute cough differentials

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

10

Paeds chronic cough differentials

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

11

Paeds stridor differentials

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

12

S&S of asthma in paeds

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

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

13

Ix of asthma paeds

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

14

Tx of asthma paeds

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

15

S&S of CF

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

16

Ix of CF

Ix:
• Sweat test
• CXR - hyperinflation, infiltrates

17

Tx of CF

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

18

S&S of bronchiolitis

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

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

19

Ix of bronchiolitis

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

20

Tx of bronchiolitis

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

21

Cause of croup

parainfluenza virus

22

S&S of croup

Symptoms:
• Barking cough
• Stridor
• SOB worse at night
• Fever

23

Tx of croup. Epi

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

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

24

Epi, S&S and tx of epiglottitis

Epi:
• 1-6 years

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

Tx:
• Urgent review to secure airway
• IV abx

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