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3 Child health EJR > week 1 > Flashcards

week 1 Flashcards

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1
Q

what does BINDS stand for in paeds hx taking

A 
birth
immunisation
nutrition
development
social
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2
Q

what are the 4 domains in development

A

gross motor
fine motor and vision
speech and language
social and emotional

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3
Q

what to ask in birth hx

A

antenatal
perinatal
neonatal

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4
Q

what to ask for in social circumstances

A

siblings
parents
relationships
jobs

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5
Q

what does HEADSS stand for in adolescent history

A 
home
education
activities
drugs/alcohol
sexuality
suicide/depression/mood
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6
Q

how to do BLS in children

A

DRS ABC

airway - don’t hyperextend
breathing - give 5 rescue breaths after assessing that child is not breathing
circulation - 15 compression 2 breaths

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7
Q

4Hs and 4Ts of causes of cardiac arrest

A

hyperkalaemia/natraemia etc
hypoxia
hypothermia
hypovolaemia

tamponade
toxins
thrombus
tension pneumothorax

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8
Q

why do you start with 5 rescue breaths in children BLS

A

because children are more likely to arrest due to respiratory failure

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9
Q

in an emergency setting, what to assess for in ABCDE approach

A

airways - any foreign body, head tilt chin lift, adjunct PRN
breathing - expansion, sounds, recessions, cyanosis, (effort, efficacy, effects), RR, o2 sats
circulation - heart rate, CRT, skin, urine, BP
disability - AVPU, BM, pupils,
exposure - bleeding/fractures/trauma

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10
Q

in an emergency setting what can be administered in the ABCDE approach

A

airway - position,adjuncts, tubes, intubation
breathing - o2 mask, nasal cannula, bvm, drugs
circulation - cpr, drugs, IV fluids

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11
Q

indications for IVT in children

A 
shock
dehydration
pre-operative (NBM)
unable to tolerate fluids
bleeding
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12
Q

considerations for IVT

A

shock/dehydration status (compensate for losses)
nutrition status
cardiac/renal status

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13
Q

what types of fluids are there

A

crystalloids

colloids

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14
Q

what is the fluid of choice for basic maintenance fluid

A

0.9% sodium chloride + 5% dextrose (mixed or alternate)

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15
Q

what is different about colloids from crystalloids

A

addition of proteins which can increase oncotic pressures

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16
Q

hartmann’s solution is used extensively in paediatrics - T or false

A

false, not used often in paeds because of high potassium and low dextrose

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17
Q

how to calculate volume required for maintenence fluids

A

100ml/kg for 1st 10kg
50ml/kg for next 10 kg
20ml/kg for everything after 20kg

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18
Q

what is the fluid requirement for shock

A

bolus of 0.9% saline - STAT

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19
Q

how to calculate volume required for shock treatment

A

20ml/kg

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20
Q

BP RR HR, which goes first in paediatric shock?

A

RR, then HR then BP

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21
Q

what cases of shock do you reduce the volume required for the bolus of IV fluid

A

trauma, cardiac, renal failure

10ml/kg

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22
Q

what are the 3 volumes of calculations required in IVT for paediatrics

A

1) maintenence fluids
2) +/- shock
3) added 24hr requirement if patient presented in shock or dehydration

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23
Q

how to calculate added IVT requirements if patient presented in shock or dehydration

A

shock - add 100ml/kg for the 24hr period

dehydration - add 50ml/kg for 24hr period

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24
Q

what to do after prescription of IVT

A

reassess after every bag

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25
development stage at 3 months - gross motor
head lag pull to sit prone: hip and knee extensions walking reflex prone: head/neck extension
26
development stage at 3 months - fine motor
two hand midline grasp tracking eyes palmar reflex waning
27
development stage at 3 months - social/emotional
social smile | -ve stranger anxiety
28
development stage at 3 months - speech and hearing
coos/babble | quietens to nice sounds
29
development stage at 6 months - gross motor
sit with support pull to sit - head midline neck control and head movement
30
development stage at 6 months - fine motor
palmar grasp transfer reaches for objects
31
development stage at 9 months - gross motor
``` sit unsupport crawl prone: push off floor weight bear with support crusing ```
32
development stage at 9 months - fine motor
pyramid grip object permanency slight stranger anxiety
33
development stage at 12 months - gross motor
walking | cruising
34
development stage at 12 months - fine motor
pincer grip
35
other developmenta milestones above 1 year old
stacking cubes, talking in longer sentences, playing with self -> playing with friends, walking confidently, echolalia
36
common presentions of cystic fibrosis
neonatal screening neonatal meconium ileus ``` recurrent chest infections malabsorption failure to thrive abdominal distension cough/wheeze loose/offensive stools ```
37
cardinal symptoms of CF
failure to thrive loose/offensive stools (steatorrhea) recurrent chest infection
38
differential diagnosis for CF
``` coeliacs disease (abdominal distension and weight loss) ```
39
investigations for CF
sweat testing | serum immunoreative trypsin
40
treatment for CF
chest physio antibiotics bronchodilators lung transplant
41
signs of paediatric respiratory distress
``` nasal flaring tachypnea recessions head bobbing seesaw breathing grunting wheeze/stridor low O2 sats cyanosis altered mental state ```
42
pathophysiology of CF
mutation in gene that makes the CFTR protein results in faulty chloride ion secretion which then impedes water secretion. this leads to low water content in lung secretions and thick mucus.
43
common presentation of CF
``` neonatal screening meconium ileus recurrent respiratory infections steatorrhoea clubbing bloating with malabsorption ```
44
investigation for CF
sweat testing | serum immunoreactive trypsin
45
management of CF
prophylactic antibiotics digestive enzymes bronchodilators nebulised mucolytics chest physio frequent reviews family and school education/support plans
46
long term complications of CF
lung failure DM male infertility portal hypertension
47
3 common things that can cause wheezing in children
VIW multiple-trigger wheeze asthma
48
causes of asthma
genetic predisposition atopy environmental triggers like URTI, allergens, smoke, cold air
49
common triggers of asthma attacks
``` emotion exercise cold air allergens infection ```
50
clinical features of an asthma attack
wheeze dyspnea coughing
51
how to determine severity of asthma from history
``` frequency of attacks timing of attacks triggers frequency of inhaler use - number of puffs types of inhaler used any hospital admissions steroid use other allergies/atopy - anaphylaxis/eczema etc ```
52
investigations in asthma
blood antibody testing sking prick test spirometry PEF meter
53
acute management of asthma
O SHIT ME ``` oyxgen salbutamol hydrocortisone ipratripium bromide theophylline magnesium escalate care ```
54
long term management of asthma
blue inhaler - salbutamol brown inhaler - steroid inhaler purple inhaler - seratide (steroid + LABA) volumetric technique PEFR diary regular reviews
55
cause of GOR in infants
immaturity of lower esophageal sphincter
56
complications of GOR in infants
failure to thrive oesophagitis recurrent pulmonary aspiration
57
management of GOR
thickening agent advise on more upright feeding position PPI ranitidine domperidone surgical management - nissen fundoplication
58
causes/risk factors of recurrent chest infections in children
``` CF bronchiecstasis foreign body airway obstruction immunocompromise airway anatomicaly abnormality ``` ``` lak of breast feeding malnutrition passive tobacco smoke inhalation asthma air pollution ```
59
vomiting in children - causes
``` GOR gastroenteritis UTI/URTI/Infection intestinal obstructions dietary protein intolerance meningitis ``` testicular torsion coeliacs raised ICP DKA pregnancy alcohol drugs
60
red flags of vomiting in children
``` bile stained vomit haematemesis projectile vomiting peritonism dehydration/shock ```
61
what causes croup
viral infection of URT, causing inflammation of larynx and trachea
62
difference between croup and VIW
VIW is just a cold, caused by the common cold virus, that causes a wheeze in younger children who have smaller airways croup is similar but involves the larynx and trachea which gives it the characteristics barking cough
63
symptoms of croup
barking cough, stridor, harsh cry coryzal symptoms
64
treatment of croup
usually conservatively but if severe treat as respiratory distress with oral/nebulised steroids
65
differentials of croup
epiglottitis airway foreign body bacterial tracheitis
66
symptoms of pneumonia
``` increased work of breathing fever poor feeds anuria agitation vomiting after cough pains (non-specific in young) ```
67
signs of pneumonia
``` wheeze crepitations ronchi cyanosis tachypnea respiratory distress cough ```
68
investigations of pneumonia
chest exam CXR blood cultures/FBC/CRP
69
differentials of pneumonia
``` bronchiolitis asthma bronchiectasis heart fialure gord foreign body airway obstruction ```
70
acute management of pneumonia
ABCDE antibiotics
71
how to differentiate viral and bacterial pneumonia
viral commonly have URTI symptoms (coryzal) | less toxic signs
72
what is bronchiolitis
a severe respiratory infection in infants, most commonly due to RSV or rhinovirus. affects the bronchioles but can spread to become pneumonia
73
symptoms of bronchiolitis
``` coryzal symptoms fever increased work of breathing cough respiratory distress in severe cases ```
74
signs of bronchiolitis
``` tachypnea wheeze recessions cough crackles hypoxemia ```
75
differentials of bronchiolitis
``` VIW pneumonia foreign body airway obstruction CHD heart failure ```
76
most common causative organism of croup?
parainfluenzae virus
77
Examples of left to right shunting CHDs
ASD VSD PDA
78
Examples of right to left shunting CHDs
tetralogy of fallot | transposition of great arteries
79
examples of common mixing CHDs
AVSD (complete)
80
examples of outflow obstruction in well child
aortic and pulmonary stenosis
81
examples of outflow obstruction in unwell child
coarctation of the aorta
82
changes in fetal and neonate circulation
first breath causes left pressure to increase over right. closes foramen ovale and ductus arteriosus
83
causes of CHD
maternal drugs/infection | genetic/chromosomal abnormalities
84
example of maternal medication that can cause a CHD
warfarin
85
what are features of an innocent heart murmur in a child
symptompless soft sternal left edge systolic murmur
86
what to do if a murmur is found in a newborn
escalate investigate - cxr echo ecg
87
symptoms of heart failure in children
``` weight faltering breathlessness poor feeding sweating recurrent chest infections ```
88
causes of heart failure in children
obstructed systemic circulation high pulmonary blood flow rheumatic heart disease cardiomyopathy
89
presentation of left to right shunting CHDs
breathless murmur poor feeding
90
why is there breathlessness in left to right shunting CHDs
increased blood flow to right heart causes increase blood flow to the lungs, causing pulmonary edema
91
what type of CHD is a PDA
left to right shunting
92
signs of PDA
continuous murmurm beneath left clavicle which radiates to the back
93
4 features of tetralogy of fallot
overriding aorta high VSD hypertrophic right ventricle pulmonary stenosis
94
what kind of presentation would ToF show?
cyanotic
95
is ToF right or left shunting
right to left
96
explain why ToF shunts the way it does
pulmonary stenosis causes increased right heart pressure, allowing blood to flow through the VSD to the left heart.
97
what is the management for transposition of the great arteries
prostaglandin to keep the duct open balloon catheter to keep the foramen ovale open surgery
98
what CHD is commonly seen in Down's syndrome
complete AVSD
99
presentation type for complete AVSD
blue and breathless
100
presentation of critical aortic and pulmonary stenosis
severe heart failure and shock - duct dependent
101
presentation and signs of coarctation of the aorta
severe HF, lactic acidosis - metabolic acidosis | weak femoral pulses
102
what is Eisenmenger syndrome
permantely raised pulmonary vacular resistance due to prolonged left to right shunting CHD, causing a reverse in septal flow, causing right to left shunting, causing cyanosis
103
what are most anaphylactic reactions caused by
food allergy - IgE mediated
104
which age range is anaphylaxis most prevelant
<5 year olds
105
acute management of anaphylaxis
adrenaline IM
106
symptoms of acute anaphylaxis
airway swelling, hoarsness, stridor tachypnea, wheeze, cyanosis, low sats poor circulation - shock symptoms +/- angioedema/urticaria
107
management of acute anaphylaxis
Airway management O2 IV - shock IVT antihistamine (chlorpheniramine) hydrocortisone +/- salbutamol
108
cause of pyloric stenosis
pyloric muscle hypertrophy obstructing outlet
109
most common presentation for pyloric stenosis (age, gender)
2-8 weeks after birth boys > girls (4:1) some family history firstborn
110
clinical features and signs of pyloric stenosis
dehydration projectile vomiting weight loss on test feeds - pyloric mass RUQ low plasma sodium, potassium and chloride
111
what electrolyte imbalances are present in pyloric stenosis
low sodium, potassium and chloride
112
management of pyloric stenosis
correction of fluid and electrolyte imbalances | surgery
113
what is an intussusception
invagination of a segment of the intestine into itself, usually proximal to distal end.
114
clinical features of an intussusception
``` paroxysmal severe pain pallor poor appetite +/- billous vomiting depending on site palpable sausage shape in abdomen red currant stool - blood stained mucus abdominal distension bowel perforation ```
115
what is a red currant stool a sign of?
intussusception
116
what is rectal air insufflation a management option for?
intussusception
117
how to investigate possible intussusception
AXR with contrast | ulrasound
118
presentation of a child with malrotation
dark green vomit abdominal pain peritonitis ischaemic bowel signs - shock
119
what is hirschsprung disease
absence of ganglion cells and adequate innervation in colon, usually rectosigmoid. leads to constricted and narrowed distal colon
120
presentation of hirshsprung disease
usually neonate failure to pass meconium in first 24 hours intestinal obstruction abdominal distension bile stained vomit
121
what will a PR on a child with hirshsprung disease do
release gush of liquid stool and flatulence might delay diagnosis
122
symptoms of appendicitis
anorexia vomiting abdomen pain
123
description of abdomen pain characteristic of appendicitis
umbilical pain moving to RIF
124
signs of appendicitis
fever abdominal pain worse on moving tenderness with guarding RIF
125
investigation for appendicitis
bloods, USS, exploratory laparoscopy
126
what are some organ dysfunctions trisomy 21, down's syndrome is associated with?
``` heart - septal defects GI - duodenal atresia blood - acute lymphoblastic leukaemia brain - mental retardation, ahlzeimer's disease reproductive - sterility in males ```
127
what are 4 blood markers that can be measure during pregnancy to assess risk of down's syndrome
reduced alfa-fetoprotein reduced unconjugated estriol (uE3) increased HCG increasd inhibin A
128
4 physical features of down's syndrome
flat face profile simian fold on palm epicanthal fold sandal gap deformity
129
what murmur is heard in a VSD?
pansystolic murmur
130
what murmur is heard in ASD?
mid-systolic murmur with split S2
131
what murmur is heard in PDA?
continuous murmur
132
what congenital heard defects are right to left shunting?
transposition of the great arteries and tetralogy of fallot,
133
what congenital heart defect can cause a differential cyanosis? (what is differential cyanosis?)
patent ductus arteriosus with eisenmenger syndrome -> cyanosis in lower half of the body
134
what congenital heart defects are emergency cases after birth? (duct dependent)
``` transposition of the great arteries AVSD tetralogy of Fallot coarctation of the aorta critical stenosis of pulmonary or aortic arteries ```
135
presentation of testicular torsion
acute onset pain in groin, lower abdomen, or scrotum with swelling and redness
136
presentation of idiopathic thrombocytopaenia purpura?
children 2-10 years old, 1-2 weeks after viral illness, present with bruising, or persistent bleeding somewhere.
137
definition of thrombocytopaenia?
platelet <150 x10^9/L
138
cause of ITP ?
autoimmune, antibodies made against platelets
139
diagnosis of ITP?
diagnosis of exclusion, BM biopsy if other blood abnormalities, otherwise, no need.
140
treatment for ITP?
usually self-limiting in 6-8weeks. | if treatment is imperative, then use oral prednisolone, or anti-D or immunoglobulins
141
what are 5 features of HSP
``` rash swollen joints painful joints abdominal pain nephritis/haematuriea ```
142
what is the typical characteristics of someone presenting with HSP
child 3-10 y/o preceded by URTI peaks in winter
143
what causes HSP
possibly immune complex deposition in joints/kidney/vessels
144
clinical features of HSP
``` low grade fever rash - symmetrical over extensor surfaces, arms, legs, ankles, buttocks joint pain periarticular edema renal involvement colicky abdominal pain ```
145
what is abdominal pain in HSP treated with
steroids
146
what can renal involvement in HSP progress to?
microscopic/macroscopic haematuria, nephrotic syndrome
147
investigations for suspected HSP?
``` urine microscopy and culture U&E + protein + calcium excretion serum calcium, phosphate, albumin FBC, coagulation, sickle cell screen auto antibody screen ``` US KUB and abdomen
148
differentials for HSP
ITP intussusception other causes of glomerulonephritis
149
treatment for HSP
usually self limiting, NSAIDs/analgesia, steroids for nephropathy or arthralgia

3 Child health EJR (3 decks)

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