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3A > 3a paeds > Flashcards

3a paeds Flashcards

1
Q

What treatment do most resp tract infections need?

A

nothing as most are self limiting

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2
Q

what is Croup and Sx?

A

An upper respiratory tract infection causing oedema in the larynx and a barking cough

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3
Q

Common causes of Croup?

A

parainfluenza virus
(Respiratory Syncytial Virus (RSV))

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4
Q

What age group are typically affected by croup?

A

6 month - 2 years

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5
Q

Tx croup?

A

(O2 if needed)
oral dexamethasone

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6
Q

What is epiglottitis?

A

inflammation of epiglottis
EMERGENCY!!!

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7
Q

Causative organism of epiglottitis?

A

haemophilus influenza type B
(H.influenzae B)
Now immunised against in UK

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8
Q

most susceptible to epiglottitis?

A

4-6 years old, but can affect all ages

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9
Q

Sx epiglottitis?

A

ACUTE onset, high fever, painful throat
DROOLING
Tripod position, sat forward with a hand on each knee

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10
Q

Tx epiglottitis?

A

Do not lie patient down
Do not distress patient or parent
Get a senior and secure airway

once airway is secure
IV antibiotics (e.g. ceftriaxone)
Steroids (i.e. dexamethasone)

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11
Q

Whooping cough

A

LRTI
Prolonged cough + fever for >2 weeks
Primary vaccinations completed @ 4 months
14 days erythromycin/7 days clarithromycin

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12
Q

What is bronchiolitis

A

Inflammation and infection in the bronchioles
RSV invades nasopharyngeal epithelium → increased mucus production → bronchial obstruction

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13
Q

Causative organism of bronchiolitis

A

Respiratory syncytial virus (RSV)

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14
Q

RFs for bronchiolitis?

A

prematurity, CF, immunodeficiency

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15
Q

Sx bronchiolitis?

A

winter months,
coryza/rhinitis/stuff nose
Followed by fever + dry cough, progressive dyspnoea

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16
Q

Tx bronchiolitis

A

Often nothing
O2, NGT, CPAP (continuous positive airway pressure)

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17
Q

Wheeze

A

A whistling sound caused by narrowed airways, typically heard during expiration

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18
Q

Stridor

A

A high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup

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19
Q

Grunting

A

Caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure

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20
Q

What is pneumonia?

A

Infection of the lower respiratory tract and lung parenchyma which leads to
consolidation

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21
Q

What is consolidation in relation to respiratory disease

A

Air-filled spaces of the lung are filled with the products of disease

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22
Q

Common causes of pneumonia

A

Can be bacterial or virus
viral = RSV

Neonates: Group B Strep,
Infants: Strep pneumoniae=pneumonitis
School age: Strep pneumoniae=pneumonitis

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23
Q

Sx Pneumonia

A

Cough (typically wet and productive)
High fever (> 38.5ºC)

Can get some symptoms secondary due to sepsis Tachypnoea (raised respiratory rate)
Tachycardia (raised heart rate)
Hypoxia (low oxygen)
Hypotension (shock)

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24
Q

ix pneumonia

A

Mainly via clinical signs
CXR helpful but not necessary

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25
Q

Tx pneumonia

A

neonates - board spec IV Abx
usually amoxicillin but local guidelines

O2 if needed

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26
Q

what is asthma

A

Chronic inflammatory disease of airways with REVERSIBLE airway obstruction

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27
Q

Atopy

A

Asthma + Eczema + Hay fever

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28
Q

sx asthma

A

wheeze, dry cough, SoB, chest tightness
worse at cold, allergy, exercise and night

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29
Q

Asthma diagnosis

A

normally not before 3
history and examination
peak flow diary, spirometry with reversibility test

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30
Q

tx asthma step 1

A

short-acting beta-2 agonist inhaler (e.g. salbutamol)

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31
Q

tx asthma step 2

A

a regular low dose corticosteroid inhaler (beclomethasone)

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32
Q

tx asthma step 3

A

a long-acting beta-2 agonist inhaler (e.g. salmeterol). Continue salmeterol only if the patient has a good response

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33
Q

tx asthma step 4

A

Titrate up the corticosteroid inhaler to a medium dose. Consider adding:
Oral leukotriene receptor antagonist (e.g. montelukast)
inhaled long acting muscarinic antagonist (i.e. tiotropium)

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34
Q

tx asthma set 5

A

Add the one you didn’t add out of
Oral leukotriene receptor antagonist (e.g. montelukast)

inhaled long acting muscarinic antagonist (i.e. tiotropium)

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35
Q

For asthma before adding a new drug what must you check

A

Inhaler use and check with parents and child compliance

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36
Q

moderate acute asthma Sx and stats

A

breathless, but NOT distressed. O2 <92%, Peak expiratory flow rate >50% predicted

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37
Q

severe acute asthma Sx and stats

A

some signs of distress. Too breathless to talk/feed, tachypnoea, tachycardia, O2<92%, PEFR 33-50% predicted

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38
Q

life threatening acute asthma Sx and stats

A

silent chest, confusion, normal pCO2, PEFR <33% predicted

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39
Q

moderate asthma tx

A

Inhaled SABA 10 puffs, PO prednisolone, reassess in 1h

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40
Q

severe / life-threatening acute asthma tx

A

High flow O2 if sats <92%
SABA + SAMA (10 puffs, repeat every 20-30 min)
IV hydrocortisone

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41
Q

Otitis media

A

An infection in the middle ear. The middle ear is the space that sits between the tympanic membrane (ear drum) and the inner ear.

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42
Q

3 bones of the middle ear

A

Malleus
Incus
stapes

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43
Q

Why are ear infections common

A

The bacteria enter from the back of the throat through the eustachian tube. A bacterial infection of the middle ear is often preceded by a viral upper respiratory tract infection

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44
Q

Sx otitis media

A

ear pain, reduced hearing in the affected ear and URTI sx

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45
Q

ix otitis media

A

otoscope shows a tympanic membrane that is red and inflamed
not grey and shiny

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46
Q

Tx otitis media

A

most self limiting
Abx if bad

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47
Q

What is glue ear

A

otitis media with effusion
occurs when Eustachian tube is blocked

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48
Q

Glue ear ix

A

Dull tympanic membrane (with air bubbles)

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49
Q

Tx glue ear

A

Grommet

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50
Q

What are grommets

A

Tiny tubes inserted into the tympanic membrane allow fluid out

fall out on their own

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51
Q

How is hearing checked

A

screening at birth?? and school??

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52
Q

First poo name

A

meconium

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53
Q

how long is normal for first poo

A

48 hours

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54
Q

secondary causes of constipation (7)

A

Hirschprung’s disease
Cystic fibrosis
Hypothyroidism
Spinal cord lesions
Sexual abuse
Intestinal obstruction
Cows milk intolerance

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55
Q

Not passing meconium

A

Hirschsprung’s disease

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56
Q

tx constipation

A

idiopathic constipation can be diagnosed clinically, once red flags have been
considered.

Correction of any reversible contributors e.g. high fibre diet, good hydration

Laxatives: Movicol is first line

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57
Q

Why is GORD so common in infants

A

immaturity of the lower oesophageal sphincter

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58
Q

sx of GORD

A

failure to thrive
chronic crying
difficulty feeding

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59
Q

ix GORD

A

rule out UTI

60
Q

Tx GORD

A

usually resolved within a year
Gaviscon
thickened formula
PPI trial for 4 weeks

61
Q

what is the pyloric sphincter

A

ring of smooth muscle between the stomach and the duodenum

62
Q

What is pyloric stenosis

A

Hypertrophy and therefore narrowing of the pylorus

63
Q

cause of projectile vomiting in pyloric stenosis

A

peristaltic waves trying to force food into duodenum become more powerful
eventually ejects food into oesophagus

64
Q

features of pyloric stenosis

A

Projectile vomiting + not keeping down food
presents in first few weeks
failure to thrive
large olive in upper abdomen

65
Q

blood gas pyloric stenosis

A

Blood gas analysis will show a hypochloric (low chloride) metabolic alkalosis as the baby is vomiting the hydrochloric acid

66
Q

Dx pyloric stenosis

A

abdo USS

67
Q

tx pyloric stenosis

A

laparoscopic pyloromyotomy
Incision in the smooth muscle of the pylorus to widen the canal

68
Q

viral causes of diarrhoea in children

A

Rota virus

69
Q

Tx gastroenteritis

A

infection control
microscopy, culture and sensitivities
Fluids

70
Q

what is coeliac

A

autoimmune condition where exposure to gluten causes an immune reaction that creates inflammation in the small intestine

71
Q

autoantibodies in coeliac

A

anti-tissue transglutaminase (anti-TTG) and anti-endomysial (anti-EMA)

72
Q

specific problem in coeliac

A

atrophy of intestinal villi specifically jejunum

73
Q

Sx coeliac (7)

A

asymptomatic
failure to thrive
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Dermatitis herpetiformis is an itchy blistering skin rash that typically appears on the abdomen

74
Q

genetic association in coeliac

A

HLA-DQ2

75
Q

Tx coeliac

A

REMAIN EATING GLUTEN
check for specific antibodies

Endoscopy and intestinal biopsy show:
Crypt hypertrophy
Villous atrophy

76
Q

IBD

A

Chrons and Ulcerative colitis
Inflammation of GI tract. periods of exacerbation and remission

77
Q

simulation day notes

A

puerperium in obs notes

78
Q

what is biliary atresia

A

narrowing or absent bile duct
leads to cholestasis

79
Q

how does biliary atresia present

A

Jaundice for >14 days
due to increased conjugated bilirubin
(conjugated bilirubin is secreted from bile duct)

80
Q

Mx biliary atresia

A

Kasai procedure
(surgery)

81
Q

Intestinal obstruction Sx

A

vomiting (often bilious (green))
absolute constipation
abdo pain
distention

82
Q

Common caused of intestinal obstruction in kids (4)

A

Meconium ileus
Hirschsprung’s disease
Oesophageal atresia
Intussusception

83
Q

Dx intestinal obstruction

A

abdo xray
showing dilated loops of bowel

84
Q

Mx intestinal obstruction

A

Nil by mouth
paediatric surgery unit
inserting a nasogastric tube to help drain the stomach
IV fluids

85
Q

what is Hirschsprung’s disease

A

A congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum

86
Q

what is the myenteric plexus (Auerbach’s plexus)

A

The enteric nervous system.

87
Q

function of enteric nervous system

A

stimulating peristalsis of the large bowel (gut motility)

88
Q

Pathophysiology of Hirschsprung’s disease

A

absence of parasympathetic ganglion cells
causing constant constriction of large bowel
lack of motility and bowel distention

89
Q

presentation of Hirschsprung’s (5)

A

Delay in passing meconium (more than 24 hours)
Chronic constipation since birth
Abdominal pain and distention
Vomiting
Poor weight gain and failure to thrive

90
Q

What is Hirschsprung-Associated Enterocolitis

A

inflammation and obstruction of the intestine

life threatening and can lead to toxic megacolon and perforation of the bowel

urgent antibiotics, fluid resuscitation and decompression of the obstructed bowel

91
Q

Mx Hirschsprung’s

A

Abdominal xray incase of HAEC

Rectal biopsy is used to confirm the diagnosis

Definitive management is by surgical removal of the aganglionic section of bowel

92
Q

what is Intussusception

A

One piece of the bowel telescopes inside another leading to ischaemia and bowel
obstruction
Most common in the distal ileum at the ileocecal junction

93
Q

Epidemiology of Intussusception

A

most common in boys
3 months to 3 years
Most commonly < 1
Most common cause of obstruction in neonates

94
Q

presentation of Intussusception (6)

A

Severe, colicky abdominal pain
Pale, lethargic and unwell child
“Redcurrant jelly stool”
Right upper quadrant mass on palpation. This is described as “sausage-shaped”
Vomiting
Intestinal obstruction

95
Q

Mx Intussusception

A

Dx via ultrasound
Air enema
Surgical resection

96
Q

most common appendicitis age

A

10-20

97
Q

Where does pain start in appendicitis

A

central abdominal pain

98
Q

where does pain move to in appendicitis

A

right iliac fossa

99
Q

where is tender in appendicitis

A

McBurney’s point
1/3 the distance from the ASIS to the umbilicus

100
Q

What is Rovsing’s sign

A

In appendicitis palpation of the LIF causes pain in the RIF

101
Q

features of appendicitis

A

Loss of appetite
N+V
Rovsing’s sign
Guarding on abdominal palpation

102
Q

features of peritonitis secondary to Appendix rupture

A

Rebound tenderness
Percussion tenderness

103
Q

Differentials of appendicitis

A

Ectopic Pregnancy
ovarian cysts
Meckel’s Diverticulum

104
Q

Tx appendicitis

A

Laparoscopic appendectomy

105
Q

two types of cows milk allergy

A

IgE mediated - reaction in 2hours
non IgE mediated - reaction slowly over several days

106
Q

presentation of cows milk allergy

A

Symptoms when breast milk ->formula
D+V
Abdo pain
bloating
Rash
swelling

107
Q

Mx cows milk allergy

A

breast feeding mothers avoid cows milk
special formula
wait until they outgrow it

108
Q

Cystitis

A

inflammation of the bladder

109
Q

Sx UTI young children (6)

A

Very general
Fever
Lethargy
Irritability
Vomiting
Poor feeding
Urinary frequency

110
Q

Sx UTI older children

A

Fever
Suprapubic pain
Vomiting
Dysuria
Urinary frequency

111
Q

Urine dipstick

A

Nitrites - bacteria
Leukocytes - WBCs
Protein - nephrotic syndrome
glucose - diabetes
Ketones - DKA?

112
Q

Mx children under 3 months with a fever

A

All children under 3 months with a fever should start immediate IV antibiotics (e.g. ceftriaxone)

113
Q

Abx for UTI in kids

A

LOCAL GUIDLINES
Trimethoprim
Nitrofurantoin

114
Q

Recurrent UTI ix

A

Ultra sound to check for underlying cause or renal damage

115
Q

Vulvovaginitis

A

Inflammation and irritation of the vulva and vagina
3-10

116
Q

Why is vulvovaginitis less common after puberty

A

Oestrogen helps keep the skin and vaginal mucosa healthy and resistant to infection.

117
Q
A
118
Q

Mx vulvovaginitis

A

Good toilet hygiene
Keeping the area dry

119
Q

nocturnal enuresis

A

bed wetting
normal when v young
can be underlying problems

120
Q

Nephrotic syndrome science

A

Basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.

121
Q

nephrotic syndrome presentation

A

Frothy urine
Generalised oedema
Pallor

122
Q

Nephrotic syndrome triad

A

Low serum albumin
High urine protein content (>3+ protein on urine dipstick)
Oedema

123
Q

most common cause of nephrotic syndrome

A

minimal change disease

124
Q

minimal change diagnosis

A

Urinalysis will show small molecular weight proteins and hyaline casts
renal biopsy will be normal

125
Q

Mx minimal change disease

A

high dose corticosteroids (i.e. prednisolone).

126
Q

Nephritic syndrome

A

nephritis/inflammation of kidneys

127
Q

Sx nephritis syndrome

A

Reduction in kidney function
Haematuria: invisible or visible
Proteinuria: although less than in nephrotic syndrome

128
Q

Common causes of nephritic syndrome

A

Post-streptococcal glomerulonephritis

IgA nephropathy (Berger’s disease)

129
Q

post strep glomerular nephritis

A

1-3 weeks after a B-haemolytic streptococcus (tonsillitis)

Immune complexes get lodged in the glomeruli and cause inflammation and
AKI

130
Q

IgA nephropathy (Berger’s disease)

A

Related to an IgA vasculitis
IgA deposits in the nephrons of the kidneys causing inflammation

131
Q

post strep glomerular nephritis Mx

A

evidence of recent strep
conservative management
diuretics if oedema

132
Q

IgA nephropathy (Berger’s disease) Mx

A

supportive treatment of the renal failure and immunosuppressant medications such as steroids

133
Q

Haemolytic Uraemic Syndrome causes

A

Thrombosis in small blood vessels throughout the body
Triggered by Shiga toxins from E. coli or Shigella

134
Q

Haemolytic uraemic syndrome triad

A

Microangiopathic haemolytic anaemia
Acute kidney injury
Thrombocytopenia (low platelets

135
Q

Haemolytic uraemic syndrome presentation

A

Diarrhoea that turns bloody at day 3ish

136
Q

Haemolytic uraemic syndrome Mx

A

Stool culture is used to establish the causative organism
Hospital admission and supportive management

137
Q

2 types of polycystic kidney disease

A

Autosomal recessive polycystic kidney disease (ARPKD)
Autosomal dominant (ADPKD)
Autosomal dominant usually shows up later in life

138
Q

Polycystic kidney disease presentation

A

Oligohydramnios and polycystic kidneys seen on antenatal scans
oligohydramnios = lack of amniotic fluid

139
Q

What is Potter syndrome

A

Underdeveloped ear cartilage, low set ears, a flat nasal bridge and abnormalities of the skeleton.
and Pulmonary hypoplasia
Due to the lack of amniotic fluid

140
Q

Tx Polycystic kidney disease

A

Breathing support due to pulmonary hypoplasia
Dialysis
Liver failure due to congenital liver fibrosis

141
Q

WIlms tumour

A

Tumour in kidneys usually under 5

142
Q

movement of the testes

A

Develop in the abdomen move through the inguinal canal into the scrotum

Normally reach scrotum prior to birth

143
Q

risks of undescended testes

A

most spontaneously descend
Testicular torsion, infertility, cancer
if not done by 6 months surgery (Orchidopexy) considered and done before 1 year

144
Q

Hypospadias

A

A congenital condition affecting babies from birth and diagnosed on examination

Opening of the urethra is in wrong place

145
Q

hydrocele

A

fluid within the tunica vaginalis that surrounds the testes
soft + non tender
Light on it causes it to light up
Mx Ultrasound

146
Q
A

3A (3 decks)

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