PALS Flashcards
(89 cards)
1
Q
What 8 sections are there to an annual review?
A
Symptoms Targets Emotions Medications Blood tests Lifestyle Extra info Demographics
2
Q
What 4 questions come under ‘symptoms’?
A
- What symptoms were you diagnosed with?
- Any new symptoms?
- Ask about specific complications of condition
- Any hospital admissions?
3
Q
What is Stage 1 hypertension?
A
BP >140/90
AND
>135/85 ambulatory
4
Q
How do you manage stage 1 HTN?
A
Lifestyle and diet
Follow up in 2-4 weeks
5
Q
What is Stage 2 HTN?
A
BP >160/100
AND
>150/95 ambulatory
6
Q
What happens at stage 2 HTN?
A
Start antihypertensives
7
Q
When do you start statins?
A
If QRISK >10-20%
OR if secondary prevent, have CKD/T1DM
8
Q
What 5 sections are there to ‘medications’?
A
- Drugs - dose, frequency, durations
- Compliance
- Side effects
- Safety net complications
- Re-iterate interactions
9
Q
What are the 6 sections of lifestyle advice?
A
Smoking Alcohol Diet Exercise Pregnancy eg. DM need 5mg folic acid daily Extra eg. avoid caffeine in AF
10
Q
What 4 extra things should you check with DM?
A
- Retinal screen
- Foot screen
- Urine ACR
- Injection sites
11
Q
What 5 things come under ‘demographics’?
A
- Height
- Weight
- BMI
- Waist circumference
- BP
12
Q
How much blood is lost in Stage 1 shock?
A
<750ml
13
Q
How are the obs in Stage 1 shock?
A
Normal
14
Q
How much blood is lost in Stage 2 shock?
A
750-1500ml
15
Q
What are the obs of Stage 2 shock like?
A
HR <120, BP reduced
16
Q
How much blood is lost in Stage 3 shock?
A
1500-2000ml
17
Q
What are the obs of Stage 3 shock like?
A
HR <140, confused
18
Q
How much blood is lost in Stage 4 shock?
A
> 2000ml
19
Q
What are the obs for Stage 4 shock like?
A
HR >140, lethargic
20
Q
When do you consider transfusing blood?
A
Stage 3 shock
21
Q
What are the 5 criteria for the Major Haemorrhage Protocol?
A
HR >110 BP <90 Blood loss >5L in 24hrs Blood loss >2.5L in 2hrs Blood loss >150ml/min
22
Q
What is the Major Haemorrhage Protocol?
A
Call blood bank
4 units RBC
4 units FFP
Tranexamic acid - factor 2 activator
23
Q
What is placenta accreta?
A
Placenta attached to the myometrium, often follows LSCS
24
Q
What is placenta increta?
A
Placenta invading the myometrium
25
What is placenta percreta?
Placenta invading the serosa
26
How does a placenta praevia present?
Painless vaginal bleeding
27
What is the management of placenta praaevia if shocked or >37wks?
LSCS + X-match 4-6 units
28
What is the management of placenta praaevia if not shocked or <37wks?
Admit
Give steroids and Anti-D
Elective LSCS at 39wks
29
How does a vasa praaevia present?
Vaginal bleeding following SRoM
| Fetal bradycardia from torn fetal blood vessels
30
What is the management of vasa praaevia?
Continuous CTG +/- FBS in bradycardia continues
| pH <7.2 = LSCS
31
How does a placental abruption present?
Painful vaginal bleeding with a tense woody uterus
32
What is the management of a placental abruption?
Admit
Give steroids and Anti-D
CTG
33
What is the management of a placental abruption with a CTG showing 1) distress 2) no distress >37wks 3) distress <37wks?
1) Distress = LSCS
2) No distress >37 wks = amniotomy to induce
3) No distress <37wks = conservative Mx, may discharge as high-risk
34
How does a uterine rupture present?
Very painful, less vaginal bleeding
35
What is the management of uterine rupture?
Surgery
36
What is the Save the Baby 5 for worrying CTGs?
1. Left Lateral position
2. STOP syntocinon
3. Give Mum fluids
4. Fetal scalp stimulation
5. FBS - pH <7.20 = LSCS
37
What is fetal scalp stimulation?
Stroke baby's scalp for 15 seconds
| Well baby will show 15 second acceleration on CTG
38
What is a primary PPH?
>500ml blood loss within 24hrs of delivery OR >1L blood loss within 24hrs of LSCS
39
What is a secondary PPH?
>500ml blood loss 24hrs - 6wks post-delivery
40
How much blood is lost due to inefficiently contracting uterus?
700ml ish
41
What are the 4 T's (causes) of PPH?
Tone - uterus doesn't contract
Tissue - retained placenta
Tears - perianal, vaginal, cervical
Thrombin - clotting dysfunction
42
What would you perform in 'C' of ABCDE during a PPH?
IV access with 2x large bore cannulas in ACF
500ml 0.9% NaCl
Bloods = FBC, U&E, LFT, Clotting, G&S/X-match depending how unstable
43
What are the 11 risk factors for VTE in pregnancy?
```
Obesity
Age >35yrs
P3
Smoking
Varicose veins
Pre-eclampsia
Immobility
Fix in 1st degree relative
Low-risk thrombophilia
Multiple pregnancy
IVF/ART
```
44
What are the 7 pre-pregnancy risk factors for VTE in pregnancy?
```
Obesity
Age >35yrs
Smoking
P3
Varicose veins
Low-risk thrombophilia
Fix in 1st degree relative
```
45
What are the 4 intra-pregnancy risk factors for VTE in pregnancy?
Immobility
Multiple pregnancy eg twins
Pre-eclampsia
IVF/ART
46
What is the management if 2 or less risk factors for VTE in pregnancy are present?
Mobilise and hydrate
47
What is the management if 3 risk factors are present for VTE in pregnancy?
LMWH from 28wks to 6wks postpartum
48
What is the management if 4+ risk factors are present for VTE in pregnancy?
LMWH from 1st trimester to 6wks postpartum
| Stockings also useful
49
What is the management if the patient has previously had an unprovoked VTE?
LMWH from 1st trimester to 6wks postpartum
Stocking
Referral to obstetric haematologist
50
What are cafe au lait spots associated with?
NF2 = neurofibromatosis type 2
51
What is NF2 associated with?
Bilateral vestibular schwannomas (accoustic neuromas)
52
When do milia resolve?
In a few weeks
53
When do haemangiomas arise?
After 1st month of life
54
Do haemangiomas need treatment?
They regress spontaneously at 2-4yrs
| May need propranolol if in eye field
55
When do you need to investigate a port win stain?
If in the ophthalmic branch of the trigeminal nerve
56
What investigations need performing on a port wine stain?
Retinal exam and MRI head - associated with Sturgge-Weber syndrome
57
What is Sturgge-Weber syndrome?
Intracranial angiomas
| Causes LD and focal epilepsy
58
What is erythema toxicum?
Confluent pink macular rash with overlying pustules on otherwise well baby
Arises about day 2-5, goes away about 2-3wks
59
There is a lump following a ventuose delivery that dose not cross suture lines, what is it?
Cephalohaematoma
60
What may a cephalohaematoma be associated with?
Jaundice due to RBC breakdown from haematoma
61
How will RDS appear on a CXR?
Ground glass appearance
62
What is the management of RDS?
ET tube with surfactant replacement + O2
| Prevented with steroids/tocolytics
63
What is the correct name for clubfoot?
Talipes equinovarus
64
What is the management of clubfoot?
Ponseti method
65
What do you need to do if a pregnant women comes into contact with chicken pox?
Confirm immunity status
| Consider immunoglobulins
66
When is cow's milk protein allergy usually outgrown by?
5 years
67
When do non-IgE-mediated hypersensitivity reactions present?
2-7 days following exposure
| Consider patch test
68
How does foreign body inhalation show on CXR?
Affected lung will be inflated during expiration as doesn't change size during respiratory cycle
69
What is the management of testicular torsion?
Urgent scrotal exploration and fixation of BOTH testicles
70
When will cryptorchidism likely correct itself by?
6 months
71
When should you refer a child with undescended testes to the surgeons?
3 months
72
When do you need to refer a suspected indirect inguinal hernia to the surgeons?
Urgent <4wks
| High risk of incarceration
73
What presents at 6m with sudden onset severe abdominal pain and drawing up of legs?
Intussusception
74
What in the management of intussusception?
Air enema
75
How does mesenteric adenitis present?
7yo with central abdominal pain and preceding URTI
Fever + malaise
Other causes excluded
76
What is the management of DDH?
Pavlik harness
77
What are the 7 risk factors for DDH?
```
Female
Breech
Multiple pregnancy
Fix
Oligohydramnios
1st born child
Cerebral palsy
```
78
Teenager with 2 stiff joints in the morning for >6wks?
JIA
79
What is the management of impetigo?
Topical fusidic acid or oral flucloxacillin
80
What factor is involved in Haemophilia A?
Factor 8
81
What factor is involved in Haemophilia B?
Factor 9
82
How much more common in HA than HB?
5x more common
83
What is the inheritance of the haemophilias?
X-linked
84
What clotting test is prolonged in Haemophilia?
APTT
85
What is the most common childhood cancer?
ALL
86
What is the most common childhood brain tumour?
Astrocytoma
87
What is the most common monogenetic condition?
SCD, Glut -> Val
88
What is Ricketts?
Vitamin D deficiency
89
What are 3 features of Ricketts? FFBB
Frayed metaphyses
Frontal bossing
Bowing of long bones
