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Phase 3a ILA > Paeds > Flashcards

Paeds Flashcards

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1
Q

27 week gestation baby, struggling to breath, reliant on 02

likely cause and treatment

A

Respiratory distress syndrome

Give surfactant therapy via tracheal tube
If anticipated give GCS antenatally
Clear airway, give high dose 02, CPAP, mechanical vent
Monitor SATs and vital signs, glucose and BG
Central venous line for parenteral nutrition

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2
Q

What Abx do you prescribe for resp distress syndome

A

Benpen 25mg/kg every 12 hours

+gentamicin 5mg/kg for ? infection

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3
Q

Why does hypoglycaemia occur in premature babies and how is it treated

A

Poor glycogen stores

  • prevented by early and frequent milk feeding
  • IV glucose to maintain levels about 2.6

IV dextrose conc can be increased

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4
Q

What is the risk of quick fluid increase in babies

A

GORD

aspiration

necrotising enterocolitis

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5
Q

How do you clinically assess jaundice level

A

bilirubin = 80umol/L

blanching skin starting on head and face -> trunk and limbs

Ix: transcutaneous bilirubin meter or blood sample

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6
Q

How do you manage neonatal jaundice

A

phototherapy - blue UV light converts unconjugated bili -> water soluble pigment excreted in urine

severe: blood transfusion

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7
Q

Is infantile jaundice serious?

A

over 50% newborns become visibly jaudiced - most physiological

jaundice from 2 days - 2 weeks is physiological

jaundice <24 hours likely haemolysis (rhesus haemolytic disease, ABO incompatability)

jaundice > 2 weeks ?biliary atresia

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8
Q

Differentials of newborn jaundice

A

rhesus

ABO incompatability

G6PD deficiency

congenital infection

physiological

breast milk jaundice

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9
Q

4 fields of development

A
  1. gross motor
  2. fine motor
  3. hearing speech and language
  4. social, emotional, behavioural
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10
Q

what is moro reflex

what would you be worried about if it persisted past 6 months?

A

sudden extension of head -> symmetrical extension then flex of arms

-cerebral disorder

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11
Q

what is cerebral palsy

A

Movement disorder resulting from a non-progressive lesion of motor pathways

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12
Q

Later appearing symptoms of cerebral palsy

A

depend on where lesion is, symptoms appear gradually as child does not develop as expected

  • learning difficulties
  • epilepsy
  • squint
  • visual/hearing/speech and language impairment
    *
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13
Q

Cerebral palsy causes

A

80% antenatal - gene deletions, infection, vascular occlusion

10% hypoxic ischaemic birth injury

10% post natal - trauma, meningitis, encephalitis

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14
Q

Early signs of cerebral palsy

A
  • floppy baby
  • feeding difficulties
  • delayed motor milestones
  • persistence of primitive symptoms
  • asym hand movement (preference of hand <12m)
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15
Q

Patterns of sypmtoms in Cerebral palsy

A
  1. spastic - 70% - lesion in pyramidal or corticospinal tract
  2. dystonic - 10% - lesion in basal ganglia
  3. ataxic - 10% cerebellum
  4. mixed - 10%
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16
Q

Presentation of spastic cerebral palsy

A

UMN signs

  • hemiplegic - unilat asymmetrical arm> leg
  • quadriplegic - all limbs arm>leg
  • diplegic - all limbs legs>arms
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17
Q

Cerebral palsy management

A

No cure

physiotherapy

splinting of affected contracted joints

botox injections - relax muscle in hyperonia, particularily for gait

SALT

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18
Q

EEG results from absence seizures

A

3Hz spike and wave

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19
Q

Absence seizure 1st line and side effects

A

Sodium Valproate

SE= weight gain, hair loss

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20
Q

How would you manage a squint in a child?

A

Refer to paediatric eye service

corrective glasses (refractive error)

occulsion with patch or penalisation with atropine drops (amblyopia - lazy eye)

surgery

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21
Q

Causes of faltering growth

A

inadequate intake

  • neglect, availability of food
  • impaired suck/swallow (cerebral palsy, cleft palate)

Inadequate retension: vomiting, GORD

malabsorpion: coeliac, CMPI

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22
Q

Urinalysis results suggesting UTI

A

Large amounts of leucocytes and nitrates

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23
Q

2 possible causative agents of UTI in children

A

e.coli

klebsiella

proteus

pseudomonas

strep faecalis

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24
Q

Medical mangement of UTI in chidren

A

IV cefotaxime

PO co-amox or trimethoprim

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25
What imaging would you consider doing in child with UTI symptoms
USS MCUG (micturating cystourethrogram) catheter passes contrast into bladder that shows up on XRay DMSA - injecting isotope pics taken with gamma camera
26
Diarrhoea differentials
chronic constipation with overflow intussusception meckel diverticulum IBS, IBD GE coeliac, CMPI toddler diarrhoea hyperthyroid
27
Management of overflow dirrhoea
1- disimpaction, evacuate overloaded rectum completely -osmotic lax e.g. movicol or stimulant lax e.g. senna may be required 2-maintenance movicol to ensure ongoing pain free defecation, gradually reducing dose \*sufficient fluid and balanced diet, enouraged to sit on toilet after meals, star charts
28
Causes of proteinuria in children
orthostatic proteinuria (found only when child upright) Glomerular abnormalities (minimal change disease, glomerulonephritis, abnormal glomerule basement membrane) Nephrotic syndrome increased glomerule filtration pressure reduced renal mass HTN DM
29
Nephrotic syndrome symptoms and investigations
* 1st =periorbital oedema (particularly on waking) * scrotal/vulval, leg and ankle oedema * ascites * breathlessness (bc pleural effusions and abdo distension) Ix: heavy proteinuria and low plasma albumin
30
Features of steriod sensitive nephrotic syndrome
* 1-10 years * no macroscopic haematuria * normal BP * normal complement levels * normal renal function * responds well to steriods
31
Management of steriod-sensitive nephrotic syndrome
oral pred 60mg 4 weeks then 40mg on alt days 4 weeks urine protein free approx 11 days No response to above treatment - renal biopsy ?minimal change disease
32
Complications of nephrotic syndrome
* hypovolaemia * thrombosis * infection * hypercholesterolaemia
33
Prognosis for steroid sensitive nephrotic syndrome
1/3 resolve directly 1/3 infrequent relapse 1/3 frequent relapse (steriod dependent)
34
Stridor diff diagnosis
croup epiglottitis foreign body acute anaphylaxis
35
Symptoms of croup
prodome - coryzal and fever barking cough harsh stridor
36
Croup cause and epi
parainfluenza virsus, RSV, influenza 6m-6y commonest in autumn
37
croup management
mild - home severe - hospital, oral dexamethasone, oral pred and neb steroids (budnesonide)
38
What to watch for a child after giving nebulised epinephrine?
rebound symptoms after its worn off
39
Bronchiolitis symptoms
coryzal dry cough and breathlessness, feeding difficulty
40
Bronchiolitis possible causative organsism
RSV parainfluenza, rhinovirus, adenovirus
41
What factors increase risk of bronchioltitis?
Preterm infants who develop bronchopulmonary dysplasia or underlying lung disease (CF) or have congential heart disease
42
ix for bronchiolitis
Normally clinical PCR analysis of nasopharyngeal secretions CXR shows hyperinflation of lungs due to small airway obstruction, air trapping and focal atelectasis
43
Bronchiolitis treatment
supportive humidified oxygen via nasal canulae monitor for apnoea fluids NG or IV
44
How can bronchiolitis be prevented
Vaccine monoclonal antibody to RSV (palivizumab) given to * \<2 yo with chronic lung disease who have required at least 28 days of 02 from birth or who are receving home 02 * \<6m with L-\>R shunt, pulmonary hypertension * \<2 with severe congential immunodeficiency
45
How is CF confirmed
Guthrie test - heel prick blood showing raised immunoreactive trypsinogen (IRT) screening for common CF mutation and infants with 2 mutations have sweat test to confirm
46
Which conditions are picked up on newborn screening test?
MCADD/MSUD Glutaric Acidemia Isovaleric acidemia Congential hypothryoidism / CF Homocystinuria PKU SC
47
CF inheritance pattern
autosomal recessive defection CFTR gene on chromosome 7
48
CF pathophysiology
abnormal ion transport across epithelial cells airway: reduction in airway surface liquid layer, impaired cillary function, retention of mucopurulent secretions intestine: thick viscid meconium produced -\> meconium ileus pancreas: blocked ducts, pancreatic enzyme deficiency and malabsorption sweat glands: abnormal function -\> XS sodium and chloride in sweat
49
How does CF present at diff ages
**_Antenatal_**: amniocentesis/CVS **_Perinatal_**: Screening, bowel atresia, jaundice **_Infancy_**: recurrent resp infections, diarrhoea, FTT, pancreatitis, nasal polyps **_Adolescence_**: recurrent resp infections, bronchiectasis, atypical asthma, male infert
50
6w infant with 3w hx wheeze, poor feeding - SOB on feeding, poor weight gain dx
Heart failure
51
VSD examination findings
thrill, harsh pansystolic murmur loudest at left sternal edge tachypnoea, intercostal and sternal recession fine creps both lungs hepatomegaly
52
heart failure secondary to VSD invesitgations
CXR (cardiomegaly, enlarged pul arteries, increased pul vasular markings, pul oedema) ECG (biventricular hypertrophy by 2m) Echo (anatomy of defect
53
Management for HR secondary to VSD
diuretics + captopril additional calorie input surgery at 3-6m to prevent Eisenmenger syndrome
54
Management of dehydrated child after rehydration fluids and maintenance fluids have been prescribed
insulin - started after 1 hour, monitor BG regularly to aim for gradual reduction (2mmol/h) potassium - will fall with insulin treatment so give K replacement as soon as urine is passed, give until K stable Acidosis - normally self corrects
55
Most likely cause of congential hypothyroidism in UK, worldwide and consanguineous pedigree
UK- maldescent of thyroid and athyrosis world - iodine deficiency CP- dyshormonogenesis - error of thyroid hormone synthesis
56
Clinical features of congential hypothyroidism
* aysmptomatic picked up on screening * FTT, feeding problems * prolonged jaundice * constipation * pale dry skin * delayed development
57
management of congential hypothryoidism
thyroxine started 2-3 weeks of age \*early treatment essential to prevent LD\* lifelong oral thyroxine titrating dose to maintain normal growth, TSH and T4 levels start on 10-15mcg/kg OD increase by 5mcg/kg every 2 weeks
58
Diff diagnosis for unwell neonate
**T**rauma, tumour, thermal **H**eart disease, hypovolaemia, hypoxia **E**ndocrine **M**etabolic disturbances **I**nborn errors of metabolism **S**eizures, CNS abnormality **F**orumula error **I**ntestinal catastrophe **T**oxins **S**epsis
59
Adrenal corticol insufficiency presentation
salt losing crisis, hypotension and/or hypoglyaemia GE like illness -\> dehydration -\> recovery until next episode
60
adrenal corticol insufficiency diagnosis
hyponatraemia and hyperkalaemia, often associated with metabolic acidosis and hypoglycaemia low plasma cortisol and plasma ACTH conc high synacthen test plasma cortisol conc remain low
61
Adrenal cortical insufficiency management
adrenal crisis = urgent treatment with IV saline, gluocose and hydrocortisone (parents taught how to inject IM hydrocortisone during emergency) long term = glucocorticoid and mineralocorticoid replacement GCC dose X3 when ill or for an operation
62
Causes of adrenal cortical insufficiency
cortiocosteriod therapy congential adrenal hyperplasia addisons (rare in children)
63
Adrenal layers and produts
Glomerulosa - mineralocorticoids (aldosterone) Fasciculata - glucocorticoids (cortisol) Reticularis - sex (DHEA)
64
What is involved in a septic screen
BC (sepicaemia) Urine (UTI) CXR (LRTI, pneuomia) LP (meningitis) FBC/U+E/CRP
65
CSF results for meningococcal septicaemia with meningitis
WCC raised neutrophils glucose low portein raised gram -ve diplococci
66
Management for meningococcal septicaemia with meningitis
ABCDE \<3m IV cefotaxime 50mg/kg \>3m ceftriaxone OD benpen in community -\> hospital +amoxicillin to cover listeria
67
What is purpura and what causes it?
red/purple discolourations on skin non blanching caused by bleeding under the skin Neisseria meningitides lyses -\> releases endotoxin -\> clotting factor XII activated -\> DIC
68
How is meningitis passed on and how can you prevent this?
exchange of resp secretions during close contact Ciprofloxain (rifampicin if allergic) Vaccinations
69
Rifampicin SE and CI
SE: fever, chills, aching, flu CI: liver disease, pregnancy/breast feeding, warfarin
70
Kawasaki diagnosis criteria
fever for 5 days + 4/5 below bilateral conjutival infection MM changes (dry lips, strawberry tongue) rash swollen red hands/feet (later) cervical lymphadenopathy
71
Kawasaki management
IVIG aspirin echo for CAA

Phase 3a ILA (4 decks)

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