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Paediatrics 4 Flashcards

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1
Q

Outline the types of febrile convulsions, the management and prognosis:

A

6months - 5 years
*> 5 years warrants further investigation

Simple:

  • 1 seizure for that febrile illness
  • <15 mins
  • no focal neurology

Complex:

  • > 15 mins
  • > 2 seizure for that illness
  • focal neurology

Management:
Simple:
- anti-pyretics

> 5mins:
- Benzodiazepines

Education and advice. >5mins to call ambulance

Complex:
- admit to hospital

Also admit to hospital if:
- <18 months

Prognosis:
- 2% chance of developing epilepsy over 1% as normal

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2
Q

Discuss the management of a child with epiglottitis:

A

Immediately contact:

  • ICU
  • Anaesthetist

*do not annoy, examine or distress the child.

Definitive management:

  • Intubation
  • IV Ceftriaxone + Clindamycin
  • Nebulized adrenaline
  • High Flow oxygen
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3
Q

Describe the x-ray appearances of respiratory distress in the new born and transient tachypnoea of the new born:

A

Respiratory distress:
- ground glass appearance

Transient tachypnoea of newborns:

  • Perihilar mass
  • cardiomegaly
  • horizontal fissure lines
  • pleural effusion

*this is essentially fluid in the lungs like seen with congestive heart failure

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4
Q

What is the management of a neonate with respiratory distress syndrome and what neonates are at risk of it?

A

Artificial surfactant via endotracheal tube
Supportive care
+/-
Intubation

Risk:

  • preterm
  • those with diabetic mothers
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5
Q

What is the management of transient tachypnoea of the new born?

A

Supportive therapy

- usually resolves in the first hour

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6
Q

Outline what is meant by atypical and recurrent UTIs in children:

A

Atypical:

  • seriousness illness
  • sepsis
  • non- respondent to antibiotics within 48 hours
  • Abdo/ renal masses felt
  • Infection of non-E. Coli
  • Renal dysfunction

Recurrent:

  • > 2 episodes of pyelonephritis
  • > 1 episode cystitis + Pyelonephritis
  • > 3 episodes of cystitis
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7
Q

What investigations should be implemented of a <6 month old who develops a UTI?

A

Typical UTI:
- Renal US: within 6 weeks

Atypical UTI:

  • Immediate US
  • DMSA
  • MCUG

Recurrent:

  • Immediate US
  • DMSA
  • MCUG
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8
Q

What investigations should be implemented of a >6 month old who develops a UTI?

A

Typical:
- no further investigations

Atypical:

  • Immediate US
  • DMSA

Recurrent:

  • USS within 6 weeks
  • DMSA
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9
Q

What is the treatment of a UTI in a < 3 month old baby?

A

Admit to hospital

  • IV antibiotics
  • Supportive therapy

*will require further investigations including renal USS, and if atypical a MCUG and DMSA to establish any damage and structural abnormalities

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10
Q

If a child is in shock - how much fluid are you going to give and what is your management if not working?

A

20ml/kg fluid bolus of:
- blood
or
- Hartmanns

*this can be done twice. after this ITU should be contacted as the child is either very ill or bleeding

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11
Q

What is the calculation for 24 hour fluid maintenance in a child and what fluids is used for maintenance and how does this differ to fluids used in shock?

A

Calculation for 24hour management:

  • <10kg = 100ml/kg
  • 10-20kg = 50ml/kg
  • > 20kg = 20ml/kg
  1. 45% saline + 5% dextro for maintenance
    * normal saline used for shock
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12
Q

In a feverish child who will always get a LP?

A

Feverish child < 3 months

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13
Q

How does a child with congenital heart disease present and what are the general investigations carried out into congenital heart disease?

A

Presentation:

  • Cyanosis
  • Shock
  • Heart failure

Investigations:

  • ECG
  • CXR
  • Echocardiogram
  • Cardiac Catherization
  • 4 limb BP
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14
Q

What is the immediate management of a child with cyanotic congenital heart disease?

A

Acutely:
- Infusion of prostaglandin - keeping the ductus arterioles opening allowing shunting from the aorta to pulmonary vessels

All children should be referred to a Tertiary Cardiology centre
- to await surgical input

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15
Q

Outline the differences between viral induced wheeze and asthma?

A

Wheeze

  • more common in preschool age
  • Symptoms only exacerbated by chest infection
  • No nocturnal symptoms (unless active infection)
  • Dilators only help during infective periods
  • Steroids of no benefit

Asthma:

  • affects all age groups
  • symptoms exacerbated by multiple triggers
  • nocturnal symptoms present
  • dilators help even when stable
  • steroids reduce severity and duration
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16
Q

At what are the stages for asthma management in children and what stage in the management should referral to paediatrician with special interest be made?

A

Step 1.
- SABA

Step 2.
- SABA + ICS

Step 3.
<5 years: Leukotriene antagonist (Montelukast)
>5 years: LABA (salmeterol)

Step 4.
<5 years: Increase ICS dose
>5 years: Leukotriene antagonist (Montelukast)

Step 5.
- Oral steroids

**step 3 is when referral should be made

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17
Q

When is there said to be complete control of asthma?

A

No daytime symptoms
No need for reliver meds unless exercising
No limitation on daily activity
Normal lung function

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18
Q

What are the symptoms of life threatening asthma?

A

33 92 CHEST

<33% PEF
<92% sats

Cyanosis 
Hypotension 
Exhaustion 
Silent chest 
Tachycardia
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19
Q

Outline the management of a mild asthma attack in children:

A

2-10 puffs of salbutamol

Stable in 4 hours?
Yes - discharge with reducing regime
No - Admit for increased frequency

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20
Q

Outline the management of a severe asthma attack in a child:

A 
10 puffs of salbutamol 
\+
Steroids (prednisone or IV hydrocortisone) 
\+/- 
Oxygen

20mins reassess:
no improvement?
- Nebulised Ipratropium
3x back to back nebs

If no improvement of 3x back to back nebs then:

  • IV salbutamol
  • IV magnesium
  • IV theophylline
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21
Q

What are the two most common causes of tachyarrhythmias in children and how do you differentiate SVT from normal sinus?

A

Most common:

  • SVT
  • VT
SVT is distinguished by: 
>180bpm (in children)
>220bpm (in babies) 
- no P waves 
- Acute onset
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22
Q

How is SVT managed in children?

A

Vagal Manoeuvres :

  • Ice in face of infant (trigger vagal reflex)
  • children Valsalva manoeuvres (blow into empty 10ml syringe)

Unstable child:

  • adenosine
  • DC cardioversion
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23
Q

Outline some causes of bradycardia in children:

A

Benign
Vagal stimulation (suctioning)
Drugs (Clonidine)

Heart block:

  • congenital
  • Rheumatic fever
  • Lyme disease
  • Maternal SLE

*note that maternal SLE associated with Anti- Ro and Anti- La is associated with congenital heart block

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24
Q

If a child has a fainting episode or seizure what important investigations should be conducted and what is a common abnormality which may cause this?

A

ECG

Long QT syndrome
- usually there is a family history

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25
What are the general causes of congenital heart disease?
Chromosomal defects Intrauterine infection - especially rubella Maternal disease - diabetes - SLE - heart block Drugs in pregnancy - alcohol - anti-convulsant
26
What treatment option should be avoided in tetrology of fallot and what murmur is typically heard?
Initially Oxygen therapy should be avoided as it can worsen symptoms Ejection systolic murmur over the pulmonary valve - the VSD is too large to really cause a murmur
27
How are mitochondrial diseases inherited?
maternal | - only DNA for mitochondria is passed through them
28
If a child is premature do you delay the vaccine schedule?
No - vaccination is carried on at normal rate
29
What is the time frame for neonatal sepsis?
Sepsis within the first 28 days of life <48 hours being early onset and life from the mother (Group B, Benzylpenicillin + gent)
30
What is the management for meningitis in infants?
<3 months: - Amoxicillin + Ceftriaxone (cover for listeria monocytogenes) >3 months - Ceftriaxone + steroids
31
What kind of face is William's syndrome patients said to have?
Elfin Faces | - looks like elfs
32
What is the signs of severe hypoxic ischemic encephalopathy and what is the management of a baby with HIE?
Severe: - stupor - coma - hypotonia - poor respiratory effort - irregular heart rhythm Management: - Respiratory support - Therapeutic cooling (full body or head cooling)
33
List some conditions seen in paediatrics which are AD and AR inheritance:
``` AD: Neurofibromatosis Tubal sclerosis Marfan's syndrome Achondroplasia ``` ``` AR: Cystic fibrosis PKU Congenital adrenal hyperplasia Sickle cell disease ```
34
What ages are children with Henock scholien likely to be and what are the absolute investigations that must be done? What are some of the important complications to be aware of?
Usually primary school age Investigations that must be done: - BP - Urine analysis: PCR Complications: - nephritis - intussupection - orchitis - severe arthritis
35
What is the key investigations and management of minimal change disease?
Bloods: - FBC - U&Es - Bone profile - Albumin levels Orifices: - PCR Examination: - BP ``` Management: 1st line: High dose Steroids - on a reducing regime Albumin infusions antibiotic prophylaxis pneumococcal vaccine ```
36
What are the complications of minimal change disease?
• Hypovolaemia - They are actually depleted due to the fluid shifts that are occurring • Bacterial infection - especially spontaneous bacterial peritonitis - This is especially true in those with ascites • Thrombosis - Loss of anti-thrombin III - Most common is cerebral venous sinus thrombosis - presents as a headache Hypercholesteremia
37
When can you start antibiotics in children with suspected UTI?
As long as there is positive nitrites then ABx can be started. if only leukocytes are present then hold off for cultures
38
How is antibiotics delivered in a < 3 month year old baby with a UTI?
IV for at least 48 hours
39
What is the most common type of anaemia in children?
Iron deficiency - usually due to dietary insufficiency * will tend to eat things like soil **remember not to rule out other causes such as absorption defects. treatment: - dietary advice - Iron supplementation
40
What are the definitions of faltering growth/ failure to thrive?
Inadequate weight gain in and infant or young child who: - Drops >2 centiles of weight or - persistently below <5th centile Specifics: Fall of more than >1 centile if Birth weight was <9th centile Fall of more than >2 centiles if Birth weight was between 9th - 91st centile Fall of more than >3 centiles if Birth weight was >91st centile Weight loss >10% in last 3-6 months
41
Is Hep C transmitted through breast milk?
No.
42
What are the causes of constipation in children:
Idiopathic: - Lack of exercise - Diet Nerve pathology: - Spinal cord injury - spina bifida - Hirschsprung Blockages: - Atresia - Stenosis - Meconium ileum Psychological: - stool holding Medications: Hormonal: - Hypothyroidism - Hyperparathyroidism
43
What are some red flags relating to constipation?
No passage of meconium in first 48 hours Excessive thirst Anal ulcers Severe pain Abdominal distension
44
What are some causes of speech delay in a child?
Hearing impairment Learning difficulties ASD Cerebral palsy Psychological deprivation
45
What are some non-pharmacological treatments for ADHD?
Tight boundaries Single task instruction *not "go get ready for school" but instead "brush your teeth" "get shoes on" Physical activity Sleep hygiene
46
What are some of the outcomes of adverse childhood experiences (ACEs)? What is the number of ACEs which increase the risk to these?
More likely to attempt suicide More like to use drink and drugs More like to engage in under-age sex More likely to develop psychiatric illness (esp depression) >4 or more ACEs
47
What the differentials to epilepsy?
Vasovagal Arrhythmia Breath holding attacks Reflex Anoxic Seizures - massive vasovagal reflex in response to stress Pseudoseizures
48
What is the vaccine given for epiglottis?
H. Influenzas Type B vaccine/ HiB vaccine
49
What are some red flags to a limping child?
Suspected NAI >2 weeks Pallor/ petechia Multiple joints Hepatosplenomegaly LLD Abnormal neurology Night sweats
50
What investigations are you going to do into a limping child?
Bloods: - FBC - CRP - U&Es - Blood cultures X-ray: - AP pelvis - AP and frog leg (<8 years old) Special tests: - aspiration if needed *before antibiotics * *aspiration is not done for septic arthritis
51
What is the criteria for septic arthritis in a child?
Kocher's criteria: - non- weight baring - CRP >20/ ESR >40 - WCC >12 - Temperature >38.5 *tells you the likelihood of there being septic arthritis
52
What investigations do you want to do into Kawasaki disease and what is the management?
Blood: - FBC - CRP - ESR - Coagulation Xrays: - Echocardiogram *to check for coronary aneurysm ECG Diagnosis: - Persistent fever + 4 of the features or fewer than 4 if aneurysms are present Management: - High dose aspirin - IV immunoglobulins - PPI Discharge: - low dose aspirin Follow up: - Echocardiogram (6-8 weeks later)
53
What is the management of Scarlet fever?
10 days of penicillin V *it is also a notifiable disease
54
What is the diagnostic investigation and What is the general management for sickle cell disease?
Investigation: - Hb Electrophoresis Lifelong prophylactic Penicillin V Vaccinations Hydroxycarbamide Blood transfusions *in the young a haematopoietic stem cell transplant can be done.
55
What are the main differentials for ITP and what is the management?
Differentials: - sepsis - DIC - HUS - Leukaemia Management: - Intravenous immunoglobulins - steroids **note that unless severe bleeding a bone aspirate should be done prior to steroids as this can mask leukaemia Severe cases: - Platelet transfusion - splenectomy
56
What are the main causes for iron deficiency in a child and what are some risk factors and what is the management?
Dietary intake Malabsorption Bleeding (Merkel's diverticulum) Risk factors: - exclusively breast fed >6 months - preterm - low birth weight Management: - Dietary advice - Iron supplements (needs 2-3 months prior to working)
57
What is the definition of global developmental delay and what are some routine tests which should be done into it? and what is the subsequent management?
Global development delay = >2 or more developmental delays in at least 2 domains Routine investigations: Bloods: - FBC (anaemia) - B12/ Folate - U&Es (chronic kidney disease) - LFTs (metabolic disease) - Bone profile + vitamin D - CK levels (Duchene) - TFTs (hypothyroidism) - hearing tests special tests: - karyotyping - metabolic screen - MRI of brain - EEG
58
How should hypoglycaemia in a child be managed?
Oral route of dextrose tablets or fizzy drink if possible Non-oral: Neonate: 2.5ml/kg 10% dextrose Child: 2ml/kg 10% dextrose *both then placed on IV infusion of dextrose to prevent rebound hypoglycaemia
59
What are the numbers for hypoglycaemia in children and neonate and list some common risk factors:
neonate: <2.6mmol Child: <3mmol Diabetic child: <4mmol ``` Risk factors: Neonate: - preterm - low birth weight - hypothermia - sepsis - diabetic mothers - drug induced - labetalol ``` child: - over use of insulin - perfuse D&V - Congenital adrenal hyperplasia
60
What are children with Henoch schonlein at risk of?
HTN Intussusception Nephritis Orchitis Severe joint pain
61
What skin finding may you see in congenital adrenal hyperplasia and what is the enzyme defect?
Pigmented skin - due to the excessive ACTH release 21- hydroxylase
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