PAEDS Notes with Complete Solutions
- ANSWER-Down syndrome
MY CHILD HAS PROBLEM
Head &Neck
-Round face
-rolling neck
-Low set ears
-Epicanthus ,ear fold
-Short neck
CVS
congenital heart disease
ASD
Resp
GIT
Duodenal atresia
Hirsch prung
CNS
-Developmental delay
-Mental retardation
Haem
-Lymphoma,Leukemia
Squint
Brushfield spots
- ANSWER-Equipment for paeds/neonatal resus(FAQ)
- ANSWER-FEVER different criterias
- ANSWER-Foreign body -Airway/Inhalation
-Sudden and catastrophic event
-Coughing, choking ± vomiting
-Severe respiratory distress
-Stridor
-Drooling and voice changes
-Cyanosis
-Altered mental state
-Total obstruction will rapidly progress to unconsciousness and cardiorespiratory arrest
,-May be present in a child in cardiorespiratory arrest who is impossible to ventilate
- ANSWER-NAI IX-(R)
- ANSWER-PECARN C SPINE
PECARN C-Spine Imaging Rulefor evaluation of children after blunt trauma
GCS 3-8 or AVPU = U
Abnormal airway, breathing, or circulation
Focal neurologic deficits→ Consider CT
GCS 9-14, AVPU = V or P, or other signs of AMS
Self-reported neck pain or neck tenderness on examination
Substantial head or torso injury*→ Consider X-Rays
No risk factors→ Consider Clinical Clearance
- ANSWER-PECARN head trauma
- ANSWER-Risk factors for jaundice
-Maternal ( ABO,Haem,Previous child)
-Child -(sepsis,Feeding,Haem,GIT)
- ANSWER-Sick Neonate -THEMISFITS
- ANSWER-Sick Neonate-Assesment triangle
Assesment of infant
T-Tone
I-Ineractiveness
C-Consolability
L-Look/gaze
S-Speech
- ANSWER-Signs of neonatal sepsis
- ANSWER-Stridor- causes (FAQ-seeRosen table)
- ANSWER-Tet Spell Mx-(TOF)
3 to 36 months (Dunn) - ANSWER--UTI is now the most common cause of fever without
focus (on clinical examination) in age range 3-36 months
-Also responsible for approximately 90% of cases of bacteraemia
-E Coli, Staph aureus and Salmonella species are now the most commonly grown
pathogens
,Admission indication (bronchiolitis,Croup etc)
1)Disease severity
2)Disease complication-dehydration,
3) Predisposing-past hx- - ANSWER-Paeds- Gneral Issues /SAQ answeringPaediatric
Ø Different anatomical/physiological parameters
Ø Pharmacological considerations - always mention drugs and doses
Ø Parents/consent
Ø Child friendly environment
Ø Non pharmacological adjuncts
Ø Implications for IV access and imaging
Ø NAI (think about - don't write if not relevant)
Anaphylaxis
-Ranitidine 1 mg/Kg
-Hydrocortisone ( )
-Loratidine
Refractory cases-Glucagon used as 2nd line - ANSWER-Definition -ASCIA
- Rapid onset skin features(urticarial/flushing/angioedema) +
- Respiratory - SOB, wheeze, bronchospasm, stridor, hypoxia- esp Children
- Cardiovascular - hypotension, or symptoms of end-organ dysfunction - hypotonia,
syncope - esp Adults
GI - crampy, abdominal pain, vomiting
Or
Hypotension/Bronchospasm/Upper airway Obstruction without skin features
APGAR score - ANSWER-
Asthma -Drug Doses/PRAM score - ANSWER-Salbutamol:
< 6 years old: 6 puffs MDI
6 years or older: 12 puffs MDI
Ipratropium bromide (21 mcg/puff) dose:
< 6 years old: 4 puffs MDI
6 years or older: 8 puffs MDI
Oral prednisolone 2 mg/kg (max 60 mg) initially, only continuing with 1 mg/kg daily for
further 1-2 days if there is ongoing need for regular salbutamol.
->if vomiting give IV Methylprednisolone (1 mg/kg; maximum 60mg) 6 hourly
IV hydrocort- 4 mg/Kg
Bilious vomiting-Neonate - ANSWER-Bilious vomiting in neonate -Causes
-Intestinal atresia/stenosis (typically ileal or colonic >24hrs but accept duodenal)
-Hirschsprung's disease
, -Malrotation with/without volvulus
-Irreducible inguinal hernia
-Intestinal duplication
Anorectal abnormalities
- Imperforate anus
-Meconium Ileus
Medical
-Sepsis
-Meconium plug syndrome
-Hypothyroidism
Bowel Obstruction- features
-Vomiting-
-Failure to pass meconium in 1st 24 hrs
-Increased Gastric residuals before feed
- Distended abdomen
-Absent-decreased Bowel sounds
-
Vomiting -Causing Failure to thrive
-GERD
-Inborn errors of metabolism
Vomiting- Blood
-Swallowed maternal blood during births
-Swallowed from cracked nipples
-Haemorrhagic disease of newborn
(Mat Hx of anticonvulsants, anticoagulants)
-Stress ulceration (those Treated with Steroids,Indomethacin) - ANSWER-Vomiting in
unwell child
Associated features
-Metabolic acidosis
-Failure to thrive
-Decreased conscious state
Surgical
-Tracheo ooesophageal fistula
-Oesophageal atresia
- ANSWER-Down syndrome
MY CHILD HAS PROBLEM
Head &Neck
-Round face
-rolling neck
-Low set ears
-Epicanthus ,ear fold
-Short neck
CVS
congenital heart disease
ASD
Resp
GIT
Duodenal atresia
Hirsch prung
CNS
-Developmental delay
-Mental retardation
Haem
-Lymphoma,Leukemia
Squint
Brushfield spots
- ANSWER-Equipment for paeds/neonatal resus(FAQ)
- ANSWER-FEVER different criterias
- ANSWER-Foreign body -Airway/Inhalation
-Sudden and catastrophic event
-Coughing, choking ± vomiting
-Severe respiratory distress
-Stridor
-Drooling and voice changes
-Cyanosis
-Altered mental state
-Total obstruction will rapidly progress to unconsciousness and cardiorespiratory arrest
,-May be present in a child in cardiorespiratory arrest who is impossible to ventilate
- ANSWER-NAI IX-(R)
- ANSWER-PECARN C SPINE
PECARN C-Spine Imaging Rulefor evaluation of children after blunt trauma
GCS 3-8 or AVPU = U
Abnormal airway, breathing, or circulation
Focal neurologic deficits→ Consider CT
GCS 9-14, AVPU = V or P, or other signs of AMS
Self-reported neck pain or neck tenderness on examination
Substantial head or torso injury*→ Consider X-Rays
No risk factors→ Consider Clinical Clearance
- ANSWER-PECARN head trauma
- ANSWER-Risk factors for jaundice
-Maternal ( ABO,Haem,Previous child)
-Child -(sepsis,Feeding,Haem,GIT)
- ANSWER-Sick Neonate -THEMISFITS
- ANSWER-Sick Neonate-Assesment triangle
Assesment of infant
T-Tone
I-Ineractiveness
C-Consolability
L-Look/gaze
S-Speech
- ANSWER-Signs of neonatal sepsis
- ANSWER-Stridor- causes (FAQ-seeRosen table)
- ANSWER-Tet Spell Mx-(TOF)
3 to 36 months (Dunn) - ANSWER--UTI is now the most common cause of fever without
focus (on clinical examination) in age range 3-36 months
-Also responsible for approximately 90% of cases of bacteraemia
-E Coli, Staph aureus and Salmonella species are now the most commonly grown
pathogens
,Admission indication (bronchiolitis,Croup etc)
1)Disease severity
2)Disease complication-dehydration,
3) Predisposing-past hx- - ANSWER-Paeds- Gneral Issues /SAQ answeringPaediatric
Ø Different anatomical/physiological parameters
Ø Pharmacological considerations - always mention drugs and doses
Ø Parents/consent
Ø Child friendly environment
Ø Non pharmacological adjuncts
Ø Implications for IV access and imaging
Ø NAI (think about - don't write if not relevant)
Anaphylaxis
-Ranitidine 1 mg/Kg
-Hydrocortisone ( )
-Loratidine
Refractory cases-Glucagon used as 2nd line - ANSWER-Definition -ASCIA
- Rapid onset skin features(urticarial/flushing/angioedema) +
- Respiratory - SOB, wheeze, bronchospasm, stridor, hypoxia- esp Children
- Cardiovascular - hypotension, or symptoms of end-organ dysfunction - hypotonia,
syncope - esp Adults
GI - crampy, abdominal pain, vomiting
Or
Hypotension/Bronchospasm/Upper airway Obstruction without skin features
APGAR score - ANSWER-
Asthma -Drug Doses/PRAM score - ANSWER-Salbutamol:
< 6 years old: 6 puffs MDI
6 years or older: 12 puffs MDI
Ipratropium bromide (21 mcg/puff) dose:
< 6 years old: 4 puffs MDI
6 years or older: 8 puffs MDI
Oral prednisolone 2 mg/kg (max 60 mg) initially, only continuing with 1 mg/kg daily for
further 1-2 days if there is ongoing need for regular salbutamol.
->if vomiting give IV Methylprednisolone (1 mg/kg; maximum 60mg) 6 hourly
IV hydrocort- 4 mg/Kg
Bilious vomiting-Neonate - ANSWER-Bilious vomiting in neonate -Causes
-Intestinal atresia/stenosis (typically ileal or colonic >24hrs but accept duodenal)
-Hirschsprung's disease
, -Malrotation with/without volvulus
-Irreducible inguinal hernia
-Intestinal duplication
Anorectal abnormalities
- Imperforate anus
-Meconium Ileus
Medical
-Sepsis
-Meconium plug syndrome
-Hypothyroidism
Bowel Obstruction- features
-Vomiting-
-Failure to pass meconium in 1st 24 hrs
-Increased Gastric residuals before feed
- Distended abdomen
-Absent-decreased Bowel sounds
-
Vomiting -Causing Failure to thrive
-GERD
-Inborn errors of metabolism
Vomiting- Blood
-Swallowed maternal blood during births
-Swallowed from cracked nipples
-Haemorrhagic disease of newborn
(Mat Hx of anticonvulsants, anticoagulants)
-Stress ulceration (those Treated with Steroids,Indomethacin) - ANSWER-Vomiting in
unwell child
Associated features
-Metabolic acidosis
-Failure to thrive
-Decreased conscious state
Surgical
-Tracheo ooesophageal fistula
-Oesophageal atresia
