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Paeds Flashcards

1
Q

Causes of acyanotic congenital heart disease

A 
ASD
VSD
PDA
Coarctation of aorta 
Isolated valve lesion 
Aortopulmonary window
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2
Q

What is reversal of a acyanotic L to R shunt to a cyanotic R to L shunt called?

A

Eisenmenger’s syndrome

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3
Q

Causes of cyanotic congenital heart disease

A 
Tetrology of fallot's
Transposition of great arteries 
Tricuspid or pulmonary atresia 
Hypoplastic left heart
Univentricular heart
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4
Q

What do cyanotic conditions such as tricuspid atresia and transposition of the great arteries require to be viable?

A

A shunt, either an ASD, VSD or PDA

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5
Q

S+S of VSD

A

Mild symptoms

Harsh blowing pansystolic murmur +/- thrill (widespread but especially left sternal edge)

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6
Q

ECG and CXR findings in VSD

A

ECG - normal progressing to LVH

CXR - pulmonary engorgement

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7
Q

Prognosis and management of VSD

A

20% close by 9 months

Large may need surgery

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8
Q

S+S of ASD

A

Usually asymptomatic

Widely split S2 and systolic pulmonary flow murmur (left sternal edge 2nd ics)

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9
Q

Signs of decompensation in a child with congenital heart disease?

A

Heart failure (sob, hepatomegally, jvp, tachycardia)
Acidosis
Failure to thrive
Poor feeding

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10
Q

Standard advice to patients with congenital heart disease

A

Avoid competitive sport and contact (relevant to most)
Ensure good dental hygiene
Avoid tattoos and piercings

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11
Q

ECG and CXR findings of ASD

A

RVH +/- RBBB

Cardiomegally / globular heart

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12
Q

S+S of PDA

A 
Failure to thrive
Pneumonia 
CCF
Thrill 
Systolic pulmonary murmur or continuous hum
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13
Q

ECG findings of PDA

A

LVH

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14
Q

Prognosis and management of PDA

A

Usually spontaniously closes in a couple of weeks
If distress or compromise - treat CHF, IV indomethacin or ibuprofen to close
Catheter occlusion or surgical ligation

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15
Q

What must be done before closing a PDA?

A

Ensure no other cardiac defects - eg pulmonary atresia, which may rely on the PDA for function

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16
Q

S+S of coarctation of the aorta

A

Decreased femoral pulses
Raised arm BP
Systolic murmur left upper sternum
Heart failure

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17
Q

When do symptoms of coarctation of the aorta tend to occur?

A

Day 2-10 post birth as the DA closes

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18
Q

Components of tetralogy of fallot?

A

RVH
Overriding aorta
Right ventricular outflow tract obstruction (pulmonary stenosis)
VSD

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19
Q

S+S of tetralogy of fallot

A

Cyanosis
Dysponea
Faints
Squatting (increases pvr so decreases r-l shunt)

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20
Q

Treatment of suspected fallots tetrad

A 
O2
Knees to chest
Morphine to sedate 
Beta blockers
Surgical repair
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21
Q

What is ebsteins anomaly

Effect?

A

Downward displacement of tricuspid valve

Atralises right ventricle causing RHF

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22
Q

A patient with duct dependent cyanotic heart disease needs their duct kept open! How is this done?

A

Administration of alprostadil

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23
Q

What is an example of a benign murmur in a kid? Other terms? What are the features?

A

Stills murmur.
Flow murmur. Functional murmur.
Lack of worrying signs (heaves, thrills, chf, clubbing, cyanosis, arrhythmia, failure to thrive), grade 1/2 only, normal variable splitting of S2, vibratory or musical, lower left sternum, decreased on standing or arching back

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24
Q

What congenital defects would cause fixed splitting of S2?

A

ASD

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25
Q

What congenital defects would eliminate splitting of S2

A

Fallots
Pulmonary atresia
Pulmonary stenosis
Transposition of great arteries

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26
Q

Initial end of bed assessment for paeds

A

PAT triangle
Appearance
Work of breathing
Circulation to skin

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27
Q

Assessment of young childs appearence (pneumonic)

A 
TICLS
Tone
Interactiveness
Consolability 
Look/gaze
Speech/cry
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28
Q

Heart rate changes from infant to adolecent

A 
Infant 100-160
Toddler 90 - 150
Preschooler 80-140
School aged 70-120
Adolescent 60-100
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29
Q

Resp rate changes for age of paed

A 
Infant 30-60
Toddler 24-40
Preschooler 22-34
School aged 18-30
Adolescent 12-16
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30
Q

Systolic blood pressure changes with age (minimum)

A 
Infant >60
Toddler >70
Preschooler >75
School aged >80
Adolescent >90
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31
Q

Average newborn temperature?

A

37.5

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32
Q

Airway/head changes in paeds vs adults

A 
Short neck and small mandible 
Large head
High u-shaped epiglottis 
Large posterior tongue 
Narrowest at cricoid 
Large tonsils
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33
Q

Normal developmental milestones of an infant (0-1yr) (not social)

A

6 weeks - smile
12 weeks - lifts head
5 months - reaches for and holds objects (palmar grasp), rolls over
6 months - sounds, passes things between hands, sit supported
7 months - responds to voice
8 months - sits unsupported, raking grasp
9 months - teething, crawls, pulls self upright, pincer grasp
11 months - hands things over or drops them
12 months - simple words, responds to name, may be able to walk

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34
Q

Normal developmental milestones in 2nd year of life (not social)

A

15 months - tries to feed self, tries to change clothes
18 months - walk unaided, interested in words, builds with bricks
24 months - kicks or throws a ball, at least 2 words together

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35
Q

Developmental milestones above 2 years (not social)

A

4 - Talks well in sentences, draws recognisable person, bladder control,
5 - holds a crayon, uses a knife and fork

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36
Q

When should a baby wean onto solids?

A

4-6 months

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37
Q

How much mild should a baby have per day? ml and oz

A

150ml/kg/day

5oz/kg/day

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38
Q

How long would a baby generally latch for in breast feeding?

A

15 minutes

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39
Q

What proportion of neonates develop jaundice?

A

60%

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40
Q

What is the major complication of neonatal jaundice? Presentation?

A

Kernicterus (encephalopathy)
Lethargy, poor feeding, hypertonicity, shrill cry,
Long term sequela of movement disorders and deafness

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41
Q

How can bilirubin levels be tested in neonates?

A

Transcutanious bilirubin levels after 24 hrs life if above 35 weeks gestation. If before either use serum levels. Confirm high readings with serum levels

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42
Q

What are the causes of physiological neonatal hyperbilirubinaemia?

A

Increased amounts of haemoglobin
Increased bilirubin production due to short rbc lifespan
Hepatic immaturity decreasing bilirubin conjugation
Lack of gut flora decreasing elimination (less steatobillagen so more urobillagen reabsorbed)

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43
Q

What are the characteristics of physiological neonatal hyperbilirubinaemia?

A

Onset after 24 hours

Gone by 14 days

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44
Q

Other than timing, what would suggest a neonatal jaundice was pathological?

A 
Rapidly rising bilirubin 
Very high bilirubin 
Steatorrheoa 
Billirubinurea 
Unwell
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45
Q

Causes of jaundice within 24 hours?

A

Sepsis
Rh haemolytic disease or ABO incompatibility
Red cell disorder

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46
Q

What leaves a neonate at risk of sepsis in the first 24 hours?

A

Membrane rupture >24 hrs prior to delivery
Mother GBS +ve
Chorioamnioitis (discoloured amniotic fluid)
Prematurity
Maternal UTI

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47
Q

History and investigations in a neonate with jaundince before 24 hours

A

Risk factors for neonatal sepsis
FBC, Film, Group, Coombs test
TORCH screen, consider cultures (blood, urine)
Consider testing for G6PD deficiency

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48
Q

Causes of jaundice over 14 days post birth in a neonate?

A 
Dehydration (often 2o to insufficiant breastfeeding)
Sepsis
Hypothyroidism
Cystic fibrosis
Billiary atresia
Hepatitis
Prolonged haemolysis (e.g. Malaria)
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49
Q

How would a neonate with billiary atresia present differently to one with other causes of neonatal jaundice?

A

Steatorrheoa and high conjugated bilirubin as opposed to unconjugated

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50
Q

Treatment options for neonatal jaundice? Brief mechanism

A

Phototherapy - light converts bilrubin to soluble form allowing excretion
Exchange transfusion - removal of fetal blood replacing with donated blood to remove the toxin

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51
Q

Complications of neonatal phototherapy

A

Temperature change
Eye damage
Diarrhoea
Fluid loss

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52
Q

When would exchange transfusion be considered in hyperbilirubinaemia in a neonate?

A

Active haemolysis
Level above the transfusion line
Features of encephalopathy

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53
Q

Side effects of neonatal exchange transfusion

A

Bradycardia, thrombocytopenia, hypoglycaemia, hyponatraemia, decreased SpO2 (due to loss of HbF)

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54
Q

What factors suggest that a baby is at risk of significant hyperbilirubinaemia

A

Premature
Sibling has had jaundince needing phototherapy
Mother intends to breastfeed exclusively
Onset within 24 hours

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55
Q

Commonest cause of gastroenteritis in paeds?

A

Rotavirus

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56
Q

Causes of paediatric acute diarrhoea with pertinent history/examination/complications?

A

Viral
Bacterial - Hx: travel, dodgy foods, blood - comp: HUS
Appendicitis - O/E: rebound tenderness etc.
Intersusseption - Hx: blood
Constipation!

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57
Q

Examinations in benign sounding D+V in paeds prior to discharge?

A

Fluid challenge to ensure they can stay hydrated

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58
Q

Investigations of chronic diarrheoa in a paed with relevant causes

A 
TFTs - thyrotoxicosis
Infection - stool culture 
Coeliac screen - coeliac 
Trial without cows milk - cows milk protein allergy
Trial without milk - lactose intolerance
Hx/OE - constipation, surgical
Fecal calprotectin - IBD
Exclusion: IBS
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59
Q

What is the cause and presentation of HUS?

A

Usually follows ecoli 0157 infection - though can be other bacteria or even without infection. Linked to a toxin released by the bacteria.
Presents with haemolytic anaemia, uraemia and kidney failure, low platelets along with organ dysfunction and encephalopathy. Usually a week or so after an episode of bloody diarrheoa

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60
Q

Treatment of HUS

A

Supportive. Including transfusion and dialysis

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61
Q

Causes of petechia in paeds and differentiating factors

A

Severe vomiting/coughing - distribution of SVC only
HSP - buttocks and back of legs +/- joint and abdo pain
Viral infection - including enterovirus and influenza
Meningococcal septicaemia - bloody poorly
Thrombocytopenia (ITP, leukaemia) - low platelet count

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64
Q

How do UTIs present differently in children vs adults?

A

As unable to convey symptoms when very young often present with sepsis, collapse, D+V, failure to thrive or colic.

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65
Q

What percentage of children with UTIs have an anatomical defect? Which?

A

35% have vesico-ureteric reflex
15% have renal scarring - usually as a result of above
5% have stones

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66
Q

How can urination be induced in an infant to get a clean sample?

A

Wash the genitals

1 hr post feed tap over the bladder

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67
Q

In an unwell child who needs a urine sample taking what technique could be considered?

A

Supra pubic aspiration

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68
Q

Investigations in first uti in a child?

A

Dip, msc

USS (though low sensitivity)

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69
Q

If recurrent utis in children what tests should be considered? What treatments?

A

Technetium renography (for scarring) - dmsa

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70
Q

Good test to monitor level of IBD and response to treatment?

A

Fecal calprotectin

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71
Q

Why are frequent exacerbations of IBD especially bad for children?

A

Require steroid therapy stunting growth

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72
Q

What often occurs between exacerbations in UC but not crohns that may mimic an exacerbation?

A

Constipation resulting in pain and overflow diarrheoa

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73
Q

When should merconium usually be passed by post delivery? When are we concerned? How does this change in premature neonates?

A

24hrs
48hrs
Delayed

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74
Q

When should merconium swap to be normal stools?

A

Day 4

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75
Q

Causes of delayed merconium passage?

A 
Meconium ileus 
Duodenal atresia
Malrotation
Volvulus 
Hirchsprungs
Anorectal malformation
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76
Q

Other than delayed passage of merconium, other red flags of constipation in pades?

A 
In first few weeks of life
Faltering growth
Weakness or slow reflexes in legs
Delayed walking
Abnormal appearing anus or sacral skin
Abdominal distension with vomiting
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77
Q

Causes of constipation in paeds

A 
Diet and fluid intake 
Perianal disease leading to reluctance
Cycle of hard stools to pain to harder stools to more pain 
Behavioural 
Hirschprungs disease
Anorectal malformation
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78
Q

What is hirschsprungs disease?

A

Congenital absence of ganglia in segment of colon, usually starting rectally. Can progress through small bowel.

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79
Q

Diagnosis, treatment and complication there of of hirschsprungs disease

A

Biopsy
Bowel resection +/- colostomy
Short bowel syndrome

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80
Q

What is and presentation of gut malrotation

A

Failure of gut attaching to mesentery resulting in volvulus or obstruction by fibrotic bands. If necrotic pr bleeding.
Neonatal billious vomiting and failure to pass merconium

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81
Q

Presentation of pyloric stenosis?

A

Projectile non billious vomiting within minutes of a feed
At 3-8 weeks
Malnutrition or dehydration often

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82
Q

What signs are visible post feed in pyloric stensosis

A

Left to right peristalsis in luq

Olive sized pyloric mass on left side

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83
Q

Metabolic abnormalities commonly seen in pyloric stenosis

A

Hyponatraemia
Hypocholoraemia
Hypokalaemia
Metabolic alkalosis

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84
Q

Tests for pyloric stenosis

A

Uss

85
Q

Management of pyloric stenosis

A

Correct electrolyte disturbance
Ng tube
Surgery

86
Q

Commonest cause of intestinal obstruction in children?

A

Intussusception

87
Q

Commonest age range of intussusception? Gender? Presentation?

A

5-12 months, male

Episodic incosolable crying, colic (drawing legs in), vomiting and pr blood

88
Q

Examination of a infant with intussuseption

A

Abdominal mass and may be shocked

89
Q

Managment of intussuseption

A

Ng tube
Air enema
Surgery

90
Q

In severe constipation what surgical technique may help?

A 
MACE
Malone 
Antigrade 
Continence 
Enema
91
Q

Contraindications to breast feeding

A

Hiv
Some chemo drugs
Amiodarone
Antithyroid drugs

92
Q

Benefits of breast feeding

A 
Bonding
Immunity 
Decreased infant mortality 
Decreased dm, ra, ibd and atopy 
Mother looses weight 
Decreased maternal ca breast
Higher iq
Cost - milk and steralising 
Convenience
93
Q

First breast milk? Difference?

A

Colostrum

Very high antibody and protein content

94
Q

How long should a baby be breast fed for exclusivly?

A

6 months.

95
Q

How much would you expect a newborn baby to feed?

A 
D1 - 50ml/kg/d
D2 - 75
D3 - 100
D4 - 125
D5 - 150
96
Q

How should a baby under 28 weeks gestation be fed

A

By ng tube as no suck reflex

Preferably with expressed breast milk maybe with breast milk fortifier

97
Q

Risk factors for neonatal hypoglycaemia

A 
Maternal diabetes
High or low birth weight 
Preterm
Septic 
Labetalol in mother
Incurrent illness
Steroid deficient (eg CAH)
Metabolic disorder (eg glycogen storage disease)
Polycythemia
98
Q

What happens to a babies hb concentration over the first year of life? Why?

A

Initially high as transfusion from cord - aprox 18
Drops due to haemolysis and lack of epo to a low of 8-10 at 6 months
Epo kicks in and raises to adult levels by about 1

99
Q

At what bm thresholds should a newborn be treated?

A

Aim to maintain prefeed level >2

If treating aim for 2.6

100
Q

When should a newborn be treated for hypoglycaemia actively?

A

If symptomatic

BM <1.1

101
Q

What dose of iv dextrose to use in a neonate?

A

3ml/kg iv 10% dextrose bolus

Maintenance at 75ml/kg/day

102
Q

Advice when counselling use of epipen to parents or patient?

A 
Familiar with signs and symptoms 
Remove cap
Hold in clenched fist
Inject into thigh holding in for 10 seconds 
Rub area 
Dial 999
103
Q

What is the prognosis of a cows milk protein allergy?

A

20% outgrow by 1, most by 3

104
Q

What other allergies may children with cows milk protein allergies have?

A

Goat and other mammal milks

Soy milk

105
Q

What are the two main categorisations of cows milk protein allergy? Presentations?

A

IgE with immediate response - urticaria, oedema, vomiting, diarrhoea, wheeze, sob, cramps, anaphylaxis
Non IgE with delayed response - poor feeding, colic, back arching, diarrhoea, bloody stools, constipation, failure to thrive

106
Q

How is a ige mediated cows milk protein allergy diagnosed?

A

Allergy skin prick testing

107
Q

How is a non ige cows milk protein allegy diagnosed

A

Removal for 6 weeks relieves symptoms and reintroduction causes them to return.

108
Q

Treatment of cows milk protein allergy?

A

Avoid cows milk! Replace with hypoallergenic formula.

Epipen if severe

109
Q

Symptoms and signs of a runny nose!

A 
Runny nose
Sniffling and snorting 
Wiping upper lip
Sore throat
Cough 
Stomach ache
110
Q

Signs and symptoms of blocked nose

A

Sniffing
Rubs nose
Mouth breaths
Snores and poor sleep

111
Q

Characteristic of inflammed nasal mucosa

A

Pale!

112
Q

What are the characteristics of pollen food syndrome?

A

Allergic reaction to foods due to cross reactivity with pollen proteins
Worse during hayfever season
Can often tolerate cooked foods as proteins denatured
Symptoms limited to mouth and throat as stomach acid denatures

113
Q

What age range tends to get pollen food syndrome?

A

Teenagers to adults

114
Q

Symptoms of a pollen food allergy

A

Mouth itching or burning

Swelling of lips and moth

115
Q

Prevalence of nut allergy?

A

1-2%

116
Q

Risk factors for nut allergy?

A

FHx
Atopy
Egg allergy

117
Q

Does a pregnant women eating nuts raise or lower the risk of offspring having a nut allergy?

A

Neither - no effect

118
Q

Dose early introduction of nuts to a diet raise or lower the risk of a nut allergy?

A

Lower

119
Q

Do peanut allergic patients react to other legumes?

A

Not commonly, only 5%

120
Q

If you are allergic to one tree nut what is the risk you will be allergic to another?

A

40%

121
Q

What advice is prudent to give a nut allergic child about ‘may contain nut’ labels?

A

There is a risk but it is low. Cutting them out is likely to severely limit your diet. Be sensible - dont eat if you feel unwell (e.g asthma is playing up) eat if you want but make sure you have and epipen and are somewhere help could get too fast

122
Q

Prevalence of egg allergy in under 5s

A

1-2%

123
Q

Prognosis of egg allergy?

A

Generally passes with age but some stay allergic into adulthood

124
Q

How can eggs be reintroduced into the diet of an egg allergic patient?

A 
Supervised challenge (if very allergic or atopic) then slowly e.g.
Start with biscuit crumbs, then biscuit, then cake, then well cooked egg, then scrambled egg, then mayonnaise
125
Q

What vaccines should be avoided in egg allergic patients

A

Rabies
Yellow fever
Flu - though has been shown to be safe as very small amounts

126
Q

What medication is used early in the management of paediatric asthma?

A

Monteleukast

127
Q

Differences between infant and adult xray

A

Infants more triangular shape
Flatter diaphragm due to more superior insertion
Presence of thymus
Flatter ribs

128
Q

How can respiratory distress be inferred on a paediatric xray?

A

Anterior ribs superior to inferior in superior chest from pulling
Large amount of air in stomach from gasping

129
Q

What causes respiratory distress syndrome?

Risk factors?

A

Lack of surfactant

Prem, maternal diabetes, 2nd twin, caesarian

130
Q

Presentation of respiratory distress syndrome

A

Distress (tachypnoea, grunting, nasal flaring, recession, cyanosis)
Within 4 hrs of birth

131
Q

Cxr signs of respiratory distress syndrome

A

Ground glass appearing opacity

132
Q

Differential diagnosis of respiratory distress syndrome with one hallmark of each

A

Transient tachypnea of newborn (resolves in 24 hrs)
Merconium aspiration (merconium stained fluids)
Trachoesophageal fistula (symptoms post feed)
Sepsis (infection risk factors)

133
Q

Treatment of respiratory distress syndrome?

A

Delayed cord clamp to promote transfusion
Oxygen (lowest possible amount)
CPAP or tube
Surfactant down tube

134
Q

What is necrotising enterocolitis?

Risk factors

A

Inflammatory bowel necrosis of uncertain origin

Prematurity, entral feeding, rapid weight gain

135
Q

Presentation of necrotising enterocolitis?

A

Distension
Blood or mucus pr
Colic
Shock

136
Q

Patheneumonic sign of necrotising enterocolitis on axr?

A

Pneumatosis intestinalis - gas in gut wall

137
Q

Treatment of necrotising enterocolitis

A

Stop oral feeding apart from oral probiotics
Antibiotics
Consider surgery if progressive or perforation

138
Q

A well neonate presents with a macular rash with central white pustules on day 4? What are they? Prognosis?

A

Erythema toxicum

Will pass usually in 24 hrs. All gone by day 14

139
Q

A baby appears with what looks like a bruise on the buttock. Parents dont know why its there. Medical differential to nai. And differentiating factors

A

Mongolian blue spot

These are present from birth, static and uniform in colour, well defined and should be multiple.

140
Q

What group is more likely to have a mongolian blue spot? Prognosis?

A

Downs syndrome and afrocarribean

Lifelong but decrease in intensity with time.

141
Q

A neonate presents with a macular erythenatous rash over brow and back of the neck. What is it? Cause? Prognosis?

A

Stork mark
Capillary dilatation
Fade with time

142
Q

What is cradle cap? Features?

A

Seborrhoeic dermatitis
Overactive sebaceous glands
Greasy yellow scaly patch on scalp

143
Q

Treatment of cradle cap

A

Massage with olive oil
Water based creams
Avoid shampoo

144
Q

A baby presents with a papular rash on their forehead and upper lip, with clusters of clear vesicles mms across. What is it? Cause?

A

Milia acrystalina

Blockage of pilosebaceous glands

145
Q

Other than acrystalina what other variants of milia exist? How do they appear

A

Rubra - blocked sebum - milky

Nigra - gunk - black

146
Q

Presentation of nappy rash. Commonest complication?

A

Erythematous with spots, blisters, sores and dry skin in nappy distribution. Can be painful but usually not. Ripe for infection as dark moist and warm.

147
Q

Cause of a petichial rash? Distinguishing features?

A 
Vomiting or coughing - only on upper trunk and face
Meningococcal septicemia - very unwell
Viral infection - coryza etc. 
Thrombocytopnea - low platelets 
Vasculitis - e.g. Hsp distribution
148
Q

Mangement of uncomplicated nappy rash

A

Change nappies often
Clean area thoroughly with baby wipe
Bath no more than once a day
Dry thoroughly post wash
Leave baby out of nappy for periods of time
Refrain from use of soaps, talcs, bubble baths etc.

149
Q

Commonest infection of nappy rash? Identifying features?

A

Candidia

Satellite lesions

150
Q

Treatment of candidia infected nappy rash

A

10 days of antifungals as well as standard care

151
Q

In candidia infected nappy rash what should be checked to assess for potential source of infection?

A

Tongue

Can come from cracked nipple or unsterilised bottle and travel down gi tract

152
Q

What is the patheneumonic feature of molluscum contagiosum? What other features does it have?

A

Umbillication - central indentation

Generally a firm papular pustular rash

153
Q

What causes molluscum contagiosum? Treatment and prognosis?

A

Molliscum contagiosum virus
Individual spots heal in 2 months however they can spread thus infection lasts a lot longer.
In severe cases or if weak immune system tx with cryotherapy, podophyllotoxin, imuiqimod etc.

154
Q

Physical differentials for adhd with how they present and differentiation

A

Tuberous sclerosis - aggression - shagreen patch
Neurofibromatosis - aggression - cafe au lait spots
Vision/hearing problems - poor communication - vision/hearing test
Anaemia - inattentive - Hb and ferritin
Thyroid - TFTs

155
Q

Mental differentials for ADHD

A 
ADD
Poor parenting
Depression/anxiety 
Conduct disorder 
Autism
156
Q

When would a child begin to exhibit hand dominance? What should be thought of if it occurs early?

A

1yr. If before then think hemiplegia - ?cerebral palsy

157
Q

Changes in child grip with time as an infant

A

Palmar - rake - pincer (9months)

158
Q

Normal age of starting to walk in a child

A

12-18 months

159
Q

Normal age of sitting in a child

A

6months supported

9months unsupported

160
Q

How should a 18 month old child play?

A

Symbolic - imitates behaviour, selfish

161
Q

When should children start to interact with other children and share during play

A

3-4 years

162
Q

What are the 5 categories of development that should be considered in a child?

A 
Gross motor
Fine motor
Social, speech and language
Senses
Self help skills
163
Q

How much maintenance fluid should a child be prescribed? What should be used?

A

100ml/kg/day 1st 10kg
50ml/kg/day 2nd 10kg
20ml/kg/day subsequently
5%dextrose with 0.9%sodium chloride

164
Q

If a child has a 10% volume deficiency whilst unwell how much fluid should be replaced on top of maintenance?

A

10% of body weight in litres!

165
Q

What are the different sorts of lactose intolerance?

A

Congenital absence of lactase
1o lactose intolerance due to genetic decreased expression
2o lactose intolerance due to gi disease e.g. Following infection

166
Q

Why does lactose intolerance cause symptoms? What are they?

A

High lactose broken down by bacteria in gut causing osmotic effect and fermentation
Results in diarrhoea, flatulance, perianal itching and bloating

167
Q

How can lactose intolerance be tested for?

A

Elimination and re challenge
Hydrogen breath testing post milk feed
Intestinal biopsy?

168
Q

Severe complication of cows milk protein allergy? Presentation? What does it mimic?

A

Food protein induced enterocolitis syndrome (fpies)
D+V
Third space loss
Severe dehydration and shock

Mimics sepsis

169
Q

What sort of reaction is fpies (food protein induced enterocolitis syndrome)? Consequence of this for diagnosis?

A

Non-ige

Negative skin prick testing

170
Q

Treatment options of croup (inc conservative and severe)

A 
Keep calm 
Paracetamol if in pain (likely)
Dexamethasone 
Nebulised adrenaline 
Intubation and ventilation
171
Q

What is the usual demographics of bronchiolitis? What is important about when it occurs? Signs and symptoms? Course?

A

Usually

172
Q

Cause of bronchiloitis

Treatment? Include conservative

A

Usually rsv
Conservative (paracetamol, fluid, sit up etc)
Medical (ng tube, oxygen etc)

173
Q

What antibiotics should be used in a paediatric patient with community acquired pneumonia?

A

Cefuroxime and clarythromycin

174
Q

How should clarythromycin be given in an ill paediatric patient with a pneumonia?

A

Orally! It damages veins

175
Q

Causes of stridor

A 
Croup 
Laryngitis 
Epiglottitis  
Foreign body 
Congenital 
Tumour 
Trauma 
Anaphylaxis
176
Q

How can the severity of croup be graded?

A

1 - inspiratory stridor and barking cough
2 - + expiratory stridor
3 - + pulsus paradoxus
4 - + cyanosis or confusion

177
Q

Commonest cause of croup

A

Parainfluenza usually. Can be bacterial but unusual

178
Q

Main congenitial cause of stridor
Presentation
Prognosis and tx

A

Trachomalacia - floppy glottis and aryepiglotic folds
Onset of inspiratory stridor hours to months after birth. Worse when asleep
Usually resolves by 2 but may need surgery

179
Q

What would suggest epiglotitis over croup?

A 
Sudden onset 
Continous stridor 
Soft stridor 
Drooling 
Muffled voice 
Septic 
Not much of a cough
180
Q

What is the presentation of bacterial tracheitis in comparison to croup?

A

Fails to respond to croup therapy
Continuous often biphasic stridor
Septic

181
Q

What would the cxr findings of a patient with a congenital diaphragmatic hernia be immidiately post delivery?

A

White out as no gas in bowels until you start to swallow!

182
Q

In paediatric patients what is a good sign of RHF?

A

Hepatomegally

183
Q

A smooth hump is seen on the cxr of a dysponic neonate. Potential cause?

A

Eventration of diaphragm

184
Q

What conditions should be assessed for on the skin of a child with developmental / behavioural problems? What are the signs

A

Neurofibromatosis - cafe au lait
Tuberous sclerosis - harmatomas, shagreen patch, ash leaf marks
Pseudohyperparathyroidism - calcium deposits

185
Q

What is tuberous sclerosis? Inheritance?

A

A genetic condition causing benign tumours to grow in brain, skin, kidneys, heart, eyes, lungs
3/4 spontanious
1/4 autosomal dominant

186
Q

Main problems with tuberous sclerosis

A 
Epilepsy 
Learning difficulty 
Behavioural problems /asd
Skin abnormalities 
Kidney problems 
Breathing difficulty 
Hydrocephalus
187
Q

What loss of bowel would lead to short bowel syndrome?

A

50-70%

188
Q

What are the stages of short bowel syndrome?

A

Acute - malnutrition and fluid/electrolyte loss
Adaption - improving absorption
Maintainance - plateau

189
Q

S+S of short bowel syndrome

A

Failure to thrive
Diarrhoea
Fatigue/malaise
Deficiencies

190
Q

What specific symptom may be present in short bowel syndrome with loss of the ilium?

A

Steatorrhoea

191
Q

Causes of short bowel syndrome

A

Surgery
Congenital
Extensive bowel pathology

192
Q

Treatment of short bowel syndrome

A

Paraentral nutrition
Artificial bowel
Bowel transplant

193
Q

Extra items of a paed history

A

Birth
Feeding
Immunisation
Development

194
Q

What vaccines should a child have in first year of life?

A

Pneumococcal
Meningitis B and C
Rotavirus
5in1 (tetnus, diptheria, HIB, pertussis, polio)

195
Q

What additional vaccinations are given at one year

A

MMR

196
Q

What additional vaccines do children receive between 2 and 6

A

Annual flu

197
Q

What vaccines do teenagers receive?

A

HPV

Meningitis ACWY

198
Q

What conditions mimics newborn rspiratory distress syndrome? Risk factors?

A

Transient tachypneoa of the newborn - csection

Aspiration pneumonia - merconium staining

199
Q

Categories of abuse in paeds

A

Emotional
Physical
Neglect
Sexual

200
Q

When does a febrile convulsion become complex?

A

More than 15 mins
Reoccur within 24 hours
Affect only one side off the body.
More than 1 hour post ictal

201
Q

When should a parent dial 999 in a case of a seizing child known to have febrile convulsions?

A

After 5 mins of seizing

202
Q

What age ranges do febrile convulsions usually occur in? Whendo they become rare?

A

6months to 3 years

Rare over 6 years

203
Q

When in an illness does a febrile convulsion usually occur?

A

Early - as the temperature is rising

204
Q

Do antipyretics help febrile convulsions?

A

No

205
Q

Conservative advice for tx of febrile child at risk of convulsions

A

Remove clothing
Fan to cool room
Plenty of fluids

206
Q

Long term risk of epilepsy in child with febrile convulsions?

A

1:100

FPE (11 decks)

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