Cardio and Resp Flashcards
how many live births have CHD
1%
two genetic conditions associated with heart defects
Trisomy 21 and Turners syndrome
Acyanotic HD with shunts
ASD
VSD
PDA
Acyanotic HD without shunts
Coarction of the aorta
Cyanotic HD with shunts
Tetralogy of fallot
Transposition of great arteries
Cyanotic HD without shunts
Severe pulmonary stenosi
Tricuspid / pulmonary atresia
Hypoplastic left heart
Symptoms of congenital HD
Problems breast feeding Failure to thrive Shortness of breath Syncope Squatting in older children Symptoms of cardiac failure - cyanosis, oedema, sweating, poor feeding
Signs of congenital HD
Murmur Tachycardia Tachypnoea Cyanosis - especially during feeding Clubbing
Complications in cogentila HD
Infective endocarditis
Paradoxical embolism
Polycythaemia
Pulmonary hypertension
Sign of ASD on examination
Parasternal heave in right ventricle
Signs of VSD on examination
Pan-systolic heart murmur - heard best at left sternal edge
Can be a parasternal heave
Signs of PDA on examination
Continuous machinery murmur below the left clavicle
Thrill
Bounding pulse
What can be used to close a PDA
Prostaglandin inhibitor - indometacin
Symptoms of coactation of the aorta
Headache / nose bleeds / intermittent claudication and cold legs
Signs of coarctation of the aorta
hypertension in the UL
Weak distal leg pulses
Maybe a systolic murmur over the upper back
Signs of heart failure in older children
difficulties in weight gain tired SOB Chest pain and palpitations recurrent chest infections
Signs of heart failure in younger children
takes longer to complete feeds but seems hungry
may look puffy and sweaty
increasing resp difficulties
sudden weight gain - fluid retention
Investigations for heart failure in children
Clinical diagnosis
confirmed by US, echo, ECG and Echo
Acute management of HF in children
ABC
Stable - give diuretic
ACE inhibitor
Increase calorific intake
Most common cause of bronchiolitis
RSV infection
other- adenovirus and rhinovirus
Signs of respiratory distress
Tachypnoea Head bobbing Tracheal tug Subcostal / intercostal recession abdominal movements to aid ventilation
Ddx in respiratory distress in a child
Bronchiolitis Pneumona GI reflux with aspiration HF Pneumothorax Collapsed lung
Management of bronchiolitis
minimal handling
o2 and ventilation
hydration support
inhaled therapies
Mild croup
Mild – seal-like barking cough but no stridor or sternal/intercostal recession at rest.
Moderate croup
Moderate – seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy.
Severe croup
Severe – seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
When should a child with croup be admitted ?
Moderate, severe or impending respiratory failure
Mild croup but should still be admitted
<3m old
inadequate fluid
immunocompromised
CHD significant
treatment of mild croup
supportive treatment
treatment of moderate croup
oral dex
treatment of severe croup
may require adrenaline, O2, involve ENT and anesthetics
incidence of CF
1,2000
Clinical features of CF
recurrent infections
faltering growth
nasal obstruction / polyps
bowel obstruction
test used in new borns to detect CF
immune reactive trypsinogen
Gold standard test for CF
Sweat test
Long term monitoring required in CF
Serial CXR
USS abdo
Bone scans
Monitor insulin function
Long term therapy in CF
Regular physiotherapy
Monitor nutrition
Prophylactic AB
Nebulisers -help clear the lungs
Nutritional support in CF
Creon - pancreatic enzyme supplements
Micronutrient supplements
Complications of CF
Exocrine function of pancreas Diabetes Liver disease Infertility Early mortality
Ddx for asthma in <5 y/o
Viral induced wheeze
Causes of acute asthma
Viral URTI Change in enviro Allergen Exercise Strong emotional triggers
3rd line in asthma management
<5 y/o
>5 y/o
Leukotriene receptor agonist
LABA
Mild croup treatment
Single dose of dex
Resolves within 48hrs
emergency croup treatment
oxygen and nebulised adrenaline
Peak incidence of bronchiolitis
3-6m
Most common cause of serious LRTI i < 1y
Bronchiolitis
What makes a bronchiolitis infection more severe
bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis
Symptoms of bronchiolitis
coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine inspiratory
crackles (not always present)
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
Tetralogy of fallot is a combination of…
Ventricular septal defect (VSD)
Pulmonary stenosis (PS)
Right ventricular hypertrophy (RVH)
Overriding aorta
Risk factors for cardiac congenital abnormalities
Maternal diabetes Rubella infection Foetal alcohol syndrome Downs syndrome VACTERL
Main cause of resp problems in neonates
Resp distress syndrome
Main cause of resp problems in infants
Bronchiolitis
Pneumonia
Croup
Main cause of resp problems in under 5
viral induced wheeze
croup
pneumonia
Main cause of resp problems in >5
asthma
pneumonia
Sings of resp distress
head bobbing nasal flaring tracheal tug IC recession Abdo recession
Length of typical bronchiolitis infection
9 days
bronchiolitis vs pneumonia
pneumonia - focal signs on resp exam and higher grade fever
Astham exacerbation in children - those with mild / moderate asthma
For children with mild to moderate acute asthma:
Bronchodilator therapy
give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask)
give 1 puff every 30-60 seconds up to a maximum of 10 puffs
if symptoms are not controlled repeat beta-2 agonist and refer to hospital
Steroid therapy
should be given to all children with an asthma exacerbation
treatment should be given for 3-5 days
2 - 5 years 20 mg od 1-2 mg/kg od (max 40mg)
> 5 years 30 - 40 mg od 1-2 mg/kg od (max 40mg)
Complication of kawasaki disease
coronary artery aneurysms - therefore should echo
Treatment of whooping cough
Azithromycin or clarithromycin within the 1st 21 days
