paeds Flashcards
1
Q
how would you treat croup?
A
oral dexamethasone
consider adrenaline nebuliser for upper airway obstruction
consider the need for oxygen
2
Q
features of croup
A
stridor
seal like barking cough
respiratory distress
voice hoarseness
3
Q
what causes croup
A
inflammation of the upper airway usually as a result of parainfluenza virus 1 or 3
peak season is late autumn
4
Q
who gets croup
A
children aged 6 months - 6 years
male > female
5
Q
croup differentials
A
epiglottitis
bacterial laryngotracheitis
foreign body inhalation
6
Q
what are the features of epiglottitis and what causes it?
A
high fever, drooling, sore throat, toxic appearance
it is caused by haemophilus inluenzae (should be rare now because of vaccination)
7
Q
what is epiglottitis
A
cellulitis of the supraglotis
8
Q
how should you manage epiglottitis
A
DO NOT EXAMINE THE THROAT
secure the airway and start IV Abx
9
Q
what investigation is first line if you suspect inhaled foreign body
A
CXR
10
Q
What are the signs of respiratory distress in a child
A
Tracheal tug, indrawing of the intercostal and subcostal areas, nasal flaring,
11
Q
What causes a systolic murmur in children
A
VSD
Pulmonary or aortic stenosis
fallots tetralogy (pulmonary stenosis)
12
Q
What could cause a diastolic murmur in children
A
Mitral stenosis
Truncus arteriosus (one vessel from RV and LV)
Pulmonary or aortic regurgitation
13
Q
What are the signs and symptoms of heart failure in children?
A
SOB increasing RR Dyspnoea Poor feeding Struggle to gain weight or losing weight Increasing heart rate Poor pulses Hepatomegaly Acidosis Sweating
14
Q
How would you manage cardiac failure in a child?
A
- diuretics (furosemide, amiloride)
- Short acting ace inhibitors (captopril ans enalopril)
- Oxygen
- prostins (for duct to be kept open)
- Diet/ fluid intake (they need their calories)
- Inotropes (dopamine , dobutamine, to boost cardiac output)
- Catheter intervention or surgery may be necessary
15
Q
What kind of murmur is a VSD / Asd
A
Pan systolic
16
Q
What kind of murmur is a pulmonary stenosis murmur
A
Ejection systolic
17
Q
Signs of cyanotic heart disease in a child?
A
Central cyanosis
Pulmonary oligaemia on CXR
May have a murmur
18
Q
Name a cyanotic CHD
A
Tetralogy of fallot
Transposition of great arteries
AVSD
19
Q
What are the features of tetralogy of fallot
A
VSD
Aorta dextroposition
Pulmonary stenosis
RV hypertrophy
20
Q
Acyanotic heart disease
A
VSD/Asd Coarctation aorta Aortic and pulmonary stenosis PDA Mitral and tricuspid stenosis
21
Q
What isa PDA
A
Normal part of fetal circulation between aorta and pulmonary artery is still open
Causes oxygenated blood to mix with non oxy blood
Can put strain on the heart
22
Q
Cough and breathless child differentials
A
Asthma LRTI Cardiac failure Upper airway obstruction (incl foreign body) Pneumothorax
23
Q
Signs of upper airway obstruction
A
Drooling Stridor Hoarse voice Respiratory distress Recession and tracheal tug
24
Q
Signs of chronic chest disease
A
Clubbing
Harrison’s sulcus
Recurrent cough and chest infections
25
Management of asthma in kids?
SABA!
SABA + ICS
SABA + ICS + leukotriene receptor antagonist
26
Signs of life threatening asthma
o2 sats less than 92
Cyanosis
Feeble resp effort
Hypotension
27
What are the two types of wheeze in pre school children
Episodic viral wheeze
| Multiple trigger wheeze
28
Management of cystic fibrosis
```
Regular chest physio / postural drainage
High calorie diet incl high fat intake
Vitamin supplement
Pancreatic enzyme supplement
Eventually heart and lung transplantation.
```
29
How are ppl diagnosed w cf
Via bloodspot screening test as a newborn
| Can do sweat test
30
What is acute Resp distress syndrome
Non cardio genie pulmonary oedema and diffuse lung inflammation syndrome
31
Causes of ARDS
Pneumonia
Sepsis
Aspiration
Severe trauma
32
Kawasaki disease features
```
CRASH and BURN
C= conjunctival injection and cervical lymphadenopathy
R= rash
A=Arthralgia
S=Strawberry Tongue
H= Hands and skin peeling
and BURN = high grade fever >5 days
```
33
How do you treat Kawasaki?
High dose aspirin
| They also need echo - they are at risk of coronary artery aneurysm
34
what is volvuius?
when a part of intestine wraps around itself and its mesentery and causes bowel obstruction
35
what is Meckels Diverticulum?
an embryological remnant. may be asymptomatic but may also lead to profuse rectal bleeding, volvulus and intussusception
36
what does billious vomiting in first 1-3 days of life suggest?
intestinal obstruction
causes
intestinal malrotation
volvulus
37
abdo pain red flags
```
delayed growth/ weight loss
bloody stools
under age 5
oral ulcers
billious or blood vomit
fever
dysphagia
NSAID use
fhx IDB/coeliac/PID
```
38
how would coelic present
weight loss
gluteal muscle wasting
loose stools
39
when to start weaning
4-6 months
40
what are some causes of weight loss in children?
```
IBD
Coeliac
Anorexia
DIabetes
Addisons
Malignancy
Juvenile Arthritis
Hyperthyroid
Achalasia
```
41
what are the risks of rapid weight loss?
refeeding syndrome
cardiac arrythmias
infection
hypoglycaemia
42
how would you treat life threatening anorexia
admit for fluids (10% dextrose and 0.45% saline) and thiamine and vitamin B complex
regular obs
monitor bloods - esp Phosphate (refeeding)
monitor ecg (refeeding and cardiac arrythmias)
BMs
contact local eating disorder team
diet plan
43
how do you manage anorexia?
- Anorexia focused family therapy
| CBT
44
what are the clinical signs of dehydration?
```
dry mucous membranes
prolonged cap refill
weak thready pulse
hypotension
tachycardia
reduced urine output
thirst
reduced skin turgor
lethargy
dyspnoea
sunken eyes
mottled cool limbs
shock
altered consciousness
```
45
most common causes of viral gastroenteritis in children
- rota virus
- norovirus
- adenovirus
46
most common causes of bacterial gastroenteritis
campylobacter
| e coli
47
features of intussusception
peak presentation 3 mo - 2 yrs
legs drawn up (colicky pain)
pallor during episodes
red currant jelly stool
48
Haemolytic Uraemic Syndrome is a triad of ...
thrombocytopenia
renal failure
haemolytic anaemia
49
how do kids get HUS
typically following gastroenteritis from E coli.
50
how do you treat HUS?
- fluids
- dialysis
- plasmapheresis
51
what does vomiting with paroxysmal cough represent?
whooping cough
52
what can cause febrile illness in kids
- Infections (UTI, GI, LRTI/URTI, ENT, Joints, rashes, CNS, )
- Kawasaki
- Autoimmune eg SLE, JIA
- Malignancy
53
how would you manage HSP
-Analgesia
Supportive care
monitor urine for progression to nephrotic/nephritic syndrome
if renal problems then corticosteroids
54
features of measles
starts as general malaise and coryzal symptoms
progresses to kolpik spots inside the mouth, and rash on face and behind ears
rash then spreads to the trunk and limbs
palms and soles are often spared
high fever is present
cough may be present too
rash is non painful and non itchy
55
Symptoms of ADHD?
Inattention
Hyperactivity
Impulsivity
Impaired functioning (in more than one domain )
56
sits w/o support straight back?
7-8 months
57
runs?
16months-2years
58
rides a tricycle
3 years
59
palmar grasp
6 months
60
draws a circle
3 years
61
tower of 3-4 blocks
18 months
62
starts playing alongside, but not interacting with other children
2 years
63
pulls to standing
8-10 months
64
hops on one leg
3-4 years
65
squats to pick up a ball
18 months
66
responds to own name
9-12 months
67
talks in short sentences
aged 2.5- 3 years
68
little or no head lag
3 months
69
walks
15 months`
70
crawls
8-10 months
71
what is hirsprungs disease?
absence of ganglion cells. Red flag is delayed passage of meconium (>48 hours) and ribbon like stools and weight loss
72
choice of imaging in intussuption
USS
73
at what age should children achieve day and night time continence?
3- 4 years
74
what are the features of autism
- global language and communication impairment
- ritualistic and compulsive behaviour
- impairment of social relationships
75
Developmental delay ddx
- non specific developmental delay
- cerebral palsy
- muscular dystrophy
- undiagnosed condition
- delayed motor maturation
76
what is the most common cause of viral meningitis?
enteroviruses eg cocksackie and echovirus
77
what are the commonest causes of meningitis in neonates
- group b strep
- e coli
- listeria
78
what are the commonest causes of meningitis > 3 months
N. meningitidis
Pneumococcous
Hib
79
what are commonest cause of meningitis >6 yrs
meningococcus
| pneumococcus
80
what may cause nephrotic syndrome in children?
- Minimal change disease
- HSP
- SLE
81
what are the features of nephrotic syndrome?
- proteinuria
- oedema
- hypoalbuminaemia
82
complications of nephrotic syndrome?
think loss of protein
- thrombosis
- infections
- peritonitis
83
how do you treat minimal change disease?
- steroids
- prophylactic antibiotics
- for frequent relapses cytotoxics eg cyclosporin
84
how can you manage nocturnal eneuresis
exclude DM and UTI
- psychosocial training , behaviour training and rewards
- 1st line = alarm training
- 2nd line desmopressin
85
how would you manage AKI in children?
- ABCDE
- Monitor PEWS, fluid status, urine output, creatinine
- maintain circulation
- minimise further harm
86
what are risk factors for UTI and serious underlying pathology in kids?
- fhx vesicoureteric reflux
- high BP
- antenatal hydronephrosis
- poor urine flow
87
features of aplastic anaemia
- anaemia
- thrombocytopenia
- leucopenia
88
clinical signs of leukaemia
- anaemia/fatigue
- bruising bleeding and infections
- spleno and hepato megaly
- testicular swelling
- bone pain
- fever
89
how to treat lyme disease?
- doxycycline >12 yrs
| - amoxicillin <12 yrs
90
`risk factors for epilepsy
- neuro disease eg cerebral palsy, tuberous sclerosis. mitochondrial disease
- fhx epilsepsy
91
features of a febrile seizure
following high fever
brief tonic clonic
age 3 month-5 yrs
92
first line drug for generalised seizures?
- sodium valproate
93
first line drug for focal seizures
carbamazepine or lamotrigine
94
tmt of meningtis in the community?
IM Benzylpenicillin
95
what can cause global developmental delay
cerebral palsy
96
features of cerebral palsy
abnormal limb/trunk movements
delayed milestones
poor feeding/oromotor coordination
assymetric hand function`
97
what to do if u suspect cerebral palsy
mri
98
how to manage cerebral palsy?
```
occupational therapy
physiotherapy
speech therapy
adaptive environment orthoses
injections botox ,baclofen, surgery
counsel
```
99
neonatal jaundice
```
in first 24 hours is ALWAYS PATHOLOGICAL
causes:
-rhesus haemolytic disease
-ABO haemolytic disease
-Heredirtary spherocytosis
_GP6D deficiency
```
JAUNDICE IN NEONATE FROM DAY 2 - 14 IS USUALLY PHYSIOLOGICAL (Breast milk jaundice)
as long as they're feeding properly and monitoring the bilirubin then it is fine
CAUSES OF PROLONGED JAUNDICE
- biliary atresia (bile ducts blocked/absent)
- hypothyroidism
- UTI
- galactocaemia
- congenital infections (CMV toxoplasmosis)
100
what are the red flags for development
```
smiling 2/12
good eye contact 3/12
sitting 9/12
walking 18/12
2-3 word sentence construction 2.5years
```
101
common developmental assessment stations
late walker >18 months
visual or hearing impairment
developmental disorder autism
emotional disorder eneuresis (>5y) , elective mutism, sleep disorder
behavioural disorder eg conduct disorder , ADHD
gross developmental delay eg from mental retardation , genetic abnormality, brain injury, congenital infection,endocrine disorder.
102
red flags when spotting a seriously ill child?
- mottled/ashen/pale skin
- RR >60
- grunting
- no response to social cues
- reduced skin turgor
- does not wake /if awoken does not stay awake
- appears ill to a health care professional
- focal neuro signs
- status epilepticus
- <3 months old
- fever > 38
- non blanching rash
- bulging fontanelle
- neck stiffness
- chest indrawing
- continuous high pitched cry
103
otitis media examination findings?
bulging tympanic membrane
104
symptoms of otitis media
```
otalgia
irritability
decreased feeding
vomiting
fever
preceding URTI
sleep disturbance
```
105
what is Kernigs sign?
flexion of the hip and knee and then pain once these are then extended
106
what is Brudzinskis sign?
passive flexion of the neck results in felxion of the knees and hips
