Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals HH > Child health > Flashcards

Child health Flashcards

1
Q

APGAR mnemonic stand for?

A

Activity
Pulse
Grimace
Appearance
Respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is capput succedaneum and how long to resolve?

A

Oedema collection outside scalp
Self-resolving in a few days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is cephalohematoma and how long to resolve?

A

Collection of blood between skull and periosteum

Self-resolving in a few months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Difference between Capput succedaneum and Cephalohematoma?

A

Capput succedaneum - fluid crosses suture lines

Cephalohematoma - fluid does not cross suture lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Erbs palsy?

A

Injury to C5/C6 nerves in brachial plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When to suspect Erbs palsy?

A

Lack of movement in arm and:
- Internally rotated shoulder
- Extended elbow
- Flexed wrist facing backwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Erb’s palsy mx?

A

Function returns in a few months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is given antenatally to prevent respiratory distress syndrome?

A

Mother given dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to prevent neonate hypothermia?

A

Dry baby, warm towel over head and body, skin-skin with mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Red flags of neonate infection?

A
  • Suspected mother sepsis
  • Signs of shock
  • Resp distress > 4 hours after birth
  • Seizures
  • Term baby needing ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Mx for neonate infection?

A

Any red flag -> antibiotics
Benzylpenicillin + gentamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Common causes of early and late onset neonate infection?

A

Early onset (<72h) – mother/birth (group B step, e.coli)

Late onset (>72h) – environment (staph e, staph a)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is neonatal jaundice pathological?

A

<24 hours or >14 days is prolonged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of neonate pathological jaundice <24 hrs?

A

Haemolysis:
* Rh incompatibility
* ABO incompatibility
* G6PD deficiency
* Spheroctosysis

Congenital infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is jaundice dangerous in neonates?

A

Unconjugated bilirubin crossess BBB in neonates -> Kernicterus – seizures, hypotonia, lethargy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mx of pathological jaundice in neonate

A

Mx – phototherapy (converts bilirubin)
* Severe -> exchange transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mx of neonatal abstinence syndrome?

A

Opiate withdrawal -> Morphine sulphate

Non-opiate withdrawal -> Phenobarbitone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ix for hypoxic-ischaemic encephalopthy

A

Sarnat staging

Assess:
- Level of consciousness
- Brainstem and autonomic function
- Motor function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is apnoea of prematurity and mx?

A

Immaturity of autonomic system which controls RR & HR

Neonate attached to apnoea monitor which identifies apnoea and provokes tactile stimulation to prompt baby to restart breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is retinopathy of pre-maturity?

A

Hypoxia -> blood vessels develop

Preterm often get O2 in care, once this is removed, there is rebound neovascularization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mx of retinopathy of pre-maturity?

A

Screening every 2 weeks

Mx - Transpupillary laster photocoagulation

Other mx – cryotherapy, anti-VEGF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mx of neonatal hypoglycaemia?

A

Asymptomatic -> encourage feeding + monitor

Symptomatic -> Admit + IV 10% dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of jaundice from 24h-2 weeks?

A

Physiological jaundice
Breast milk jaundice
* May last up to 12w
Infection (UTI)
Bruising
Polycythaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of prolonged jaundiced (>2 weeks)

A

Unconjugated:
* Physiological
* Breast milk jaundice
* Infection – UTI
* High G.I obstruction (pyloric stenosis)
* Congenital hypothyroidism

Conjugated:
* Bile duct obstruction (Biliary atresia)
* Hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cause of bacterial meningitis in neonates (<3 months) and mx?

A

Group B strep

Mx - Cefotaxime + amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cause of bacterial meningitis in >3 months and mx?

A

Cause - N.menigitis, strep pneumoniae

Mx - Ceftriaxone +/- dexamethasone to reduce neurological dmg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is Kernig’s test?

A

Meningitis test

Patient lying flat on back and hip flexed with knees at 90 degrees. Straightening leg stretched meninges -> spinal pain and resistance to movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is
Brudzinski’s test?

A

Meningitis test

Patient lying flat on back and head lift -> involuntary flexion of hip and knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Px of neonate mengitis?

A

Hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle
Arched back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Px of child meningitis?

A

Fever
Neck stiffness
Vomiting
Headache
Photophobia
Altered consciousness
Seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What urgent mx if meningitis suspected prior to hospital transfer?

A

Urgent IM or IV benzylpenicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is raised in CSF in bacterial meningitis?

A

Polymorphs, protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is raised in CSF in viral meningitis?

A

Lymphocytes, slightly protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Px of encephalitis?

A

Altered consciousness / cognition, unusual behaviour, acute focal neurology, seizures, fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When is lumbar puncture contraindicated and alternative Ix?

A

Contraindicated if GCS <9, haemodynamically unstable or active seizures -> CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Mx for HSV or VZV encephalitis?

A

Aciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Mx for CMV encephalitis?

A

Ganciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Cause of scarlet fever?

A

Exotoxin from group A strep (pyogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Px of scarlet fever?

A
  • After throat infection
  • Diffuse maculopapular rash with a sandpaper texture
  • Red strawberry tongue
  • Fever, lethargy, flushed face
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Mx of scarlet fever?

A

Phenoxymethylpenicillin for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Impetigo cause?

A

Staph aureus or strep pyogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Px of impetigo?

A

“Golden crusty lesions” usually on face, neck, and hands

Can be bullous or non-bullous
Painful, itchy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Mx of impetigo?

A

Ix – Swabs

Mx:
* Non-bullous – topical fusidic acid
* Bullous – Flucloxacillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Px of staphylococcal skin syndrome?

A

Impetigo complication where toxin separates epidermal skin

Widespread erythema and tenderness of the skin

Nikolsky sign positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Toxin shock syndrome cause?

A

Toxin producing staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Triad of toxic shock syndrome?

A
  • Fever > 39
  • Hypotension
  • Diffuse erythematous, macular rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Mx of toxic shock syndrome?

A

Mx – intensive care

Ab – ceftriaxone + clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What type of hypersensitivity reaction is rheumatic fever and Px?

A

Type 2 hypersensitivity

2-4 weeks after strep infection:
* Fever, joint pain, rash, shortness of breath, chorea, nodules
* Carditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Jones criteria for rheumatic fever?

(JONES FEAR)

A

Major criteria:
J – Joint arthritis
O – Organ inflammation (carditis)
N – Nodules
E – Erythema margintum rash
S – Sydenham chorea

Minor criteria:
F – Fever
E – ECG changes
A – Arthralgia without arthritis
R – Raised inflammatory markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Complications of rheumatic fever?

A

Mitral stenosis, chronic heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is gingivostomatitis?

A

HSV infection -> Vesicular lesions on the lips, gums, tongue and hard palate -> painful ulceration & bleeding

+ high fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

When to consider acyclovir for chicken pox?

A

Consider aciclovir if:
>14 yrs
Immunocompromised
Neonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Px of chicken pox?

A

Fever
Whole body vesicular rash (starts trunk/face then spreads peripherally)
Itching and scratching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Px of glandular fever?

A

Fever, fatigue
Malaise
Tonsillitis
Lymphadenopathy
Splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

CMV mx?

A

IV ganciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What causes ‘Slapped cheek syndrome’

A

Human parvovirus B19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Px of Human parvovirus B19 infection?

A

Fever, malaise, headache and myalgia followed by rash on face a week later which progresses to a maculopapular rash on the trunk and limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Complication of Human parvovirus B19 infection in pregnancy?

A

Hydrops fetalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What virus causes hand, foot and mouth disease?

A

Enterovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Enterovirus px

A

Non-specific febrile illness + blanching rash over trunk with fine petechiae
Loose stools, vomiting

Or

Hand, foot & mouth disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Measles px?

A

Fever, coryzal symptoms, conjunctivitis

Rash – starts at ears -> rest of body
- Severe erythematous, macular rash

Koplick spots – greyish white buccal mucosa spots

Px is 10-12 days after exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Mumps px?

A

Flu-like symptoms before parotid swelling – fever, myalgia, lethargy, headache, dry mouth

Parotid swelling – unilateral or bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Rubella px?

A

Mild erythematous macular rash starting face then spreading to whole body
+ mild fever, joint pain, sore throat, lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What to ask in history suspecting immunodeficiency?

A

S – severe (meningitis or peritonsillar abscess)

P – persistent (does not improve with usual antibiotics)

U – unusual (pneumocystis jirovecii)

R – recurrent (appear to have resolved but reapparead)

+ is there a family history of unexplained deaths?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What mx to prevent PCP in immunodeficient patient?

A

Cotrimoxazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What mx to prevent fungal infections in immunodeficient patient?

A

Fluclonazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What cell is defective in SCID?

A

T-cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Px of SCID?

A
  • Persistent, severe diarrhoea
  • Failure to thrive
  • Opportunistic infections (PCP, CMV, VZV)
  • Unwell after vaccinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What cell is defective in selective IgA deficiency and common px?

A

B-cells

Recurrent mucinous membrane infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is Kawasaki disease?

A

Systemic medium sized vessel vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Px of kawaski disease?

A

Fever >5 days

+ widespread erythematous maculopapular rash

+ skin peeling (desquamation) of palms and soles

+/-:
- Strawberry tongue
- Cracked lips
- Cervical lymphadenopathy
- Bilateral conjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Ix in Kawasaki disease?

A
  • Echocardiogram to check for coronary artery aneurysms
  • FBC, LFT, urinalysis, ESR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Mx of Kawasaki disease?

A

High dose aspirin – reduce rx of thormbosis

IV immunoglobulins – reduces rx of coronary artery aneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is Henoch-Schoenlein purpura

A

IgA vasculitis affecting skin, kidneys and G.I tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Px of Henoch-Schoenlein purpura?

A

Hx - URTI or gastroenteritis

Px – Purpuric rash affecting lower limbs and buttocks in children +/- joint pain, abdo pain, nephritis

  • IgA nephritis -> microscopic or macrosocpic haematuria + proteinuria -> nephrotic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is juvenile idiopathic arthritis?

A

Autoimmune arthritis lasting >6 weeks in patient under age of 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Px of Dow syndrome?

A
  • Hypotonia
  • Brachycephaly
  • Short neck
  • Flattened face/nose
  • Prominent epicanthic folds
  • Single palmar crease
  • Atria-ventricular septal defect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Px of Edward syndrome?

A
  • Prominent occiput
  • Small mouth and chin
  • Short sternum
  • Flexed, overlapped fingers
  • Rocker bottom feet (soles are convex)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Px of Patau syndrome?

A
  • Structural defect of brain
  • Scalp defects
  • Small eyes
  • Cleft lip and palate
  • Rocker bottom feet (soles are convex)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Px of Turnery syndrome?

A
  • Short stature
  • Webbed neck
  • Broad chest with widely place nipples
  • Underdeveloped ovaries with reduced function (infertile)
  • Late or incomplete puberty
  • Coarctation of the aorta
81
Q

What are trisomy 21, 18 and 13?

A

Trisomy 21 - Down’s
Trisomy 18 - Edward
Trisomy 13 - Patau

82
Q

Px of klinefelter syndrome?

A
  • Taller height
  • Wider hips
  • Weaker muscles
  • Small testicles
  • Reduced libido, infertility
83
Q

Px of Cri du chat?

A
  • High pitched cry like a cat
  • Intellectual disability
  • Microcephaly, hypotonia
  • Low set, posteriorly rotated ears
84
Q

Px of DiGeorge syndrome?

A
  • Cleft palate
  • Heart defects
  • Recurrent infections
  • Feeding problems
  • Intellectual disability
85
Q

Px of Williams syndrome?

A
  • Intellectual disability
  • Broad forehead
  • Starburst eyes
  • Flattened nasal bridge, long philtrum
  • Very sociable trusting personality
86
Q

Px of angelman syndrome?

A
  • Happy demeanour
  • Fascination with water
  • Hand flapping, laughter
  • Epilepsy, microcephaly
  • Widely spaced teeth
87
Q

Px of charot-marie tooth?

A
  • Peripheral neuropathy (sensory and motor)
  • Abnormal gait, walking difficulties (weak ankles)
  • Pes cavus
88
Q

Px of Marfan syndrome?

A
  • Tall stature
  • Long neck
  • Long limbs, long fingers
  • Hypermobile
  • Pectus carinatum or pectus excavatum
89
Q

Px of Fragile X syndrome?

A
  • Intellectual disability
  • Long, narrow face
  • Large ears
  • Large testicles after puberty
  • Hypermobile joints
90
Q

Px of Prader-Willi syndrome?

A
  • Constant insatiable hunger
  • Hypotonia
  • Intellectual disability
  • Fairer, soft skin that is prone to bruising
  • Thin upper lip, narrow forehead
91
Q

Px of Noonan syndrome?

A
  • Wide space between the eyes (hypertelorism)
  • Short stature, broad forehead
  • Prominent nasolabial fold
  • Webbed neck, widely spaced nipples
92
Q

Mx of respiratory wheeze?

A
  1. 10 puffs SABA + check technique
  2. More puffs needed? (every hour?) or nebuliser
  3. Consider prednisolone
93
Q

Mx of asthma?

A
  1. SABA – salbutamol (reliever)
    • Inhaled corticosteroids – beclomethasone (preventer)
  3. Either:
    a. + Leukotriene receptor agonists – montelukast
    b. + Inhaled LABA
  4. Other options:
    a. LAMA – tiotropium
    b. Theophylline (narrow therapeutic window)
    c. Maintenance and reliever therapy (MART) - ICS + LABA
94
Q

Ix of asthma?

A
  1. Either:
    o Fractional exhaled nitric oxide
    o Spirometry with bronchodilator reversibility
  2. If diagnostic uncertainty:
    o Peak flow variability (diary)
    o Direct bronchial challenge test with histamine or methacholine
95
Q

Acute asthma ABG?

A

Initially – respiratory alkalosis

Late – respiratory acidosis (very bad)

96
Q

Moderate acute asthma px and mx?

A

Px:
- PEFR 50-75% predicted

Mx:
- Nebulised SABA
- Neublised ipratromium bromide
- Oral prednisolone

97
Q

Severe acute asthma Px and Mx?

A

Px:
- PEFR 33-50% predicted
- Resp rate >25
- Heart rate >110
- Unable to complete sentences

Mx:
- Oxygen to maintain stats
- Aminophylline infusion
- Consider IV SABA

98
Q

Life-threatening acute asthma Px and Mx?

A

Px:
- PEFR <33%
- Sats <92%
- Fatigued
- No wheeze (no air entry at all)
- Shock

Mx:
- Magnesium sulphate
- HCU / ICU admission
- Intubation in worst case

99
Q

What is croup?

A

Inflammation of upper airways causing oedema in the larynx in children aged 6months to 2 years

Mainly viral (parainfluenza)

100
Q

Px of croup?

A
  • Increased work of breathing
  • “Barking cough”, occurring in clusters of coughing episodes
  • Hoarseness
  • Stridor
  • Low grade fever
101
Q

Mx of croup?

A

Mild -> Oral dexamethasone

Moderate -> Oral dexamethasone + monitor for 2-3hrs

Severe -> Adrenaline, gives 30mins more time, O2 by facemask, IV/oral dexamethasone

102
Q

What is bronchiolitis?

A

Inflammation and infection in the bronchioles usually caused by RSV in children under 1 year

103
Q

Px of bronchiolitis?

A

Px:
- Coryzal symptoms (viral URTI)
- Signs of respirotry distress
- Dyspnoea
- Tachypnoea
- Poor feeding
- Mild fever
- Wheeze and crackles on auscultation

104
Q

Signs of resp distress in a baby?

A

Raised RR

Accessory muscle use:
- Sternocleidomastoid
- Abdominal
- Intercostal

Intercostal and subcostal recession

Nasal flaring

Head bobbing

Tracheal tugging

Cyanosis

105
Q

How long to recover from bronchiolitis?

A

2-3 weeks?

106
Q

Mx of bronchiolitis?

A

Supportive

107
Q

Typical cause of epiglotitis?

A

Haemophilus influenza type B

108
Q

Ix of epiglottis?

A

Lateral x-ray of neck -> “thumb sign”

109
Q

Px of epiglottitis?

A

Sore throat & stridor
Drooling
Sat forward with a hand on each knee
High fever
Odynophagia

110
Q

What causes whooping cough?

A

Bordetella pertussis (GM -ve bacteria)

111
Q

Px of whooping cough?

A

Mild coryzal symptoms
-> severe coughing fits after a week or more, paroxysmal coughs

Loud inspiratory whoop when cough ends

Complications -> fainting, vomiting, pneumothorax

112
Q

Ix for pertussis?

A

Nasal swab -> PCR or bacterial culture

If >2weeks can test for anti-pertussis toxin immunoglobulin G

113
Q

Prognosis of whooping cough?

A

Symptoms typically resolve within 8 weeks
- Complication -> bronchiectasis

114
Q

What does ductus venosus connect?

A

Umbilical vein to IVC

115
Q

What causes ductus venosus to close?

A
  1. Clamping of umbilical cord
  2. No flow in umbilical vein
  3. Few days later -> ligamentum venosum
116
Q

What does the foramen ovale connect?

A

Right atrium to left atrium

117
Q

What causes the foramen ovale to close?

A

At birth:
1. Decrease in PVR
2. Less pressure in RA
3. LA pressure > RA pressure
4. Foramen ovale closes
5. In few weeks becomes fossa ovalis

118
Q

What does the ductus arteriosus connect?

A

Pulmonary artery with aorta

119
Q

What causes the ductus arteriosus to close?

A

At birth:
1. Increased blood oxygenation
2. Drop in circulating prostaglandins
3. Closure -> ligamentum arteriosum

120
Q

Px of PDA?

A

Murmur (continuous crescendo-decrescendo “machinery” murmur):

  • Small PDA can be asymptomatic and present in adulthood with heart failure
  • Additional px – Shortness of breath, difficulty feeding, poor weight gain, LRTI
121
Q

Mx of PDA?

A

Monitor until 1 year with ECHO

> 1 year, unlikely to physiologically close -> surgery

122
Q

Px of atrial septal defect?

A
  • Mid-systolic, crescendo-decrescendo murmur loudest at left sternal border
  • Fixed splitting of second heart sound (closure of aortic and pulmonary valves at different times)
  • Childhood px – SOB, difficulty feeding, poor weight gain, LRTI
  • Adulthood – dyspnoea, heart failure or stroke
123
Q

Px of VSD?

A

Pan-systolic murmur heard at left sternal border in 3rd & 4rth ICS

Possible systolic thrill on palpation

124
Q

What is Eisenmenger syndrome?

A

Left to right shunt in heart reverses to become right to left shunt -> blood bypasses lungs and cyanotic patient

125
Q

What is coarctation of the aorta?

A

Narrowing of the aortic arch around ductus arteriosus

-> Reduced pressure in arteries distal to narrowing

-> Increased pressure proximally to narrowing such as heart, first three branches of aorta

126
Q

Px of coarctation of the aorta?

A
  • Low BP in arteries distal to narrowing (weak femoral pulse)
  • High BP in arteries proximal to narrowing
  • Systolic murmur in left infraclavicular area and below left scapula
  • Infancy:
    o Tachypnoea
    o Poor feeding
    o Grey and floppy baby
  • Other:
    o Left ventricular heave (due to LVH)
    o Underdeveloped of limbs distal to narrowing
127
Q

When do we give prostaglandins to keep ductus arteriosus open?

A

Coarctation of aorta and tetralogy of Fallot

128
Q

What congenital conditions make-up tetralogy of fallot?

A
  • Ventricular septal defect
  • Overriding aorta (aorta further to right than normal)
  • Pulmonary valve stenosis -> ejection systolic murmur
  • Right ventricular hypertrophy
129
Q

Px of tetralogy of fallot?

A
  • Cyanosis
  • Clubbing
  • Poor feeding / weight gain
  • Ejection systolic murmur heard loudest in 2nd ICS left sternal edge
130
Q

Px of aortic valve stenosis?

A

Ejection systolic murmur loudest at 2nd ICS right sternal border
- Crescendo-descendo
- Radiates to carotids

Mild – Incidental murmur

Severe – fatigue, SOB, dizziness & fainting
- Symptoms worse on exertion

131
Q

What is pulmonary valve stenosis associated with?

A
  • Tetralogy of Fallot
  • William syndrome
  • Noonan syndrome
  • Congenital rubella syndrome
132
Q

Px of pulmonary valve stenosis?

A

Ejection systolic murmur loudest at 2nd ICS, left sternal border
- Palpable thrill
- Right ventricular heave
- Raised JVP

Mild – Incidental murmur

Severe – fatigue, SOB, dizziness & fainting
- Symptoms worse on exertion

133
Q

Initial mx for baby reflux?

A
  • Small, frequent meals
  • Keep baby upright after eating
  • Alter cot position
134
Q

Mx for problematic reflux?

A
  • Gaviscon with feeds
  • Thickened milk formula
  • PPI (omeprazole)
  • Faltering growth -> empty stomach faster (domperidone)
135
Q

Dx and Mx of pyloric stenosis?

A

Dx – abdominal ultrasound

Mx – laparoscopic pyloromyotomy
- Widened pylorus

136
Q

What is biliary atresia?

A

Section of bile duct is narrowed or absent -> cholestasis

P - prolonged jaundice (>14 days from birth)

137
Q

Dx and Mx of biliary atresia?

A

Dx – high levels of conjugated bilirubin

Mx – Kasai portoenterostomy

138
Q

Px of intussessecption?

A

Bowel telescopes into itself
- Severe colicky abdo pain
- “Redcurrant jelly stool”
- Sausage-shaped RUQ mass on palpation
- Intestinal obstruction / vomiting

139
Q

Dx and Mx of intussusception?

A

Dx – ultrasound or contrast enema

Mx:
- Therapeutic enema
- Surgical reduction

140
Q

Dx and Mx of Hirschsprung’s disease?

A

Ix – Abdo x-ray

Dx – Rectal biopsy
- Absence of ganglionic cells

Mx – fluid resuscitation
- If Hirschsprung-associated enterocolitis -> antibiotics

141
Q

What is Hirschsprung’s disease?

A

Congenital disease where nerve cells of myenteric plexus are absent in distal bowel and rectum

142
Q

Causative organism of gastroenteritis associated with fried rice left at room temperature?

A

Bacillus cereus

143
Q

Causative organism of gastroenteritis associated with raw or undercooked pork?

A

Yersinia enterocolitica

144
Q

Causative organism of gastroenteritis associated with eggs?

A

Salmonella
Staph A enterotoxin

145
Q

Causative organism of gastroenteritis associated with faeces contaminated drinking water, swimming pools, food

A

Shigella

146
Q

Campylobacter jejuni spread?

A

Raw or improperly cooked poultry
Untreated water
Unpasteurised milk

147
Q

Dx of gastroenteritis?

A

Stool sample -> microscopy, culture and sensitivities

148
Q

Gastroenteritis associated with nurseries?

A

Rotavirus

149
Q

Gastroenteritis associated with sudden outbreaks?

A

Norovirus

150
Q

Mx of Giardiasis?

A

Metronidazole

151
Q

Stool pattern of constipation?

A

<3 a week
Hard large stools or rabbit droppings
Overflow soiling - very loose, smelly stool passed without sensation

152
Q

Mx of constipation?

A

High fibre diet and good hydration (give extra water)
Regular toileting and behavioural interventions (praise visiting the toilet)
Start laxatives (Movicol)

153
Q

Mx of faecal impactation?

A

Movicol + polyethylene glycol 3350
o + stimulant if no response in 2 weeks

154
Q

Auto-antibodies involved in coeliac disease?

A

Anti-TTG
Anti-EMA
Anti-DGPs

(IgA)

155
Q

Px of coeliac disease?

A
  • Failure to thrive in young children
  • Diarrhoea, fatigue, weight loss
  • Mouth ulcers
  • Anaemia secondary to iron, B12 or folate deficiency
  • Dermatitis herpetiformis – itchy blistering skin rash
156
Q

Dx of coeliac disease?

A

Check IgA levels are normal and raised anti-TTG / raised anti-EMA

Biopsy would show crypt hypertrophy and villous atrophy

157
Q

Mnemonic for Crohns?

A

N – No blood or mucus
E – Entire GI tract
S – “Skip lesions” on endoscopy
T – Transmural (full thickness) inflammation
S – Smoking is a rx

158
Q

Mnemonic for ulcerative colitis?

A

C – Continuous inflammation
L – Limited to colon and rectum
O – Only superficial mucosa affected
S – Smoking Is protective
E – Excrete blood and mucus

U – Use aminoacylates
P – Primary sclerosing cholangitis

159
Q

Extra-intestinal px of IBD?

A
  • Finger clubbing
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Episcleritis & scleritis
  • Inflammatory arthritis
160
Q

Screening for IBD?

A
  • Bloods (raised CRP indicates active inflammation)
  • Screening – Faecal calprotectin (raised when intestines are inflamed)
161
Q

Crohn’s Mx?

A

Inducing remission:
1. Steroids (oral prednisolone or IV hydrocortisone)
2. Add immunosuppressant under guidance
o Azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab

Maintaining remission:
1. Azathioprine or mercaptopurine
2. Alternative – methotrexate, infliximab, adalimumab

Surgical resection of distal ileum if needed

162
Q

Mx of UC?

A

Inducing remission:
- Mild-moderate:
1. Aminosalicylate (mesalazine)
2. Corticosteroids
- Severe:
1. IV corticosteroids
2. IV ciclosporin

Maintaining remission:
- Aminosalicylate
- Azathioprine
- Mercatopurine

Surgery to remove colon or rectum

163
Q

Triad of T1DM?

A

o Polyuria
o Polydipsia
o Weight loss

164
Q

DKA px?

A

Hyperglycaemia, dehydration, acidosis
o + N&V, “fruity breath”, altered consciousness

165
Q

Mx of DKA?

A

Correct dehydration over 48h, give fixed rate insulin infusion

166
Q

Mx of T1DM?

A
  • Subcut insulin
    o Basal – Lantus
    o Bolus before meals– Novorapid
  • Monitoring dietary carbohydrate intake
  • Monitor BG levels
167
Q

What do adrenal glands produce?

A

Steroid hormones:
- Cortisol
- Aldosterone

168
Q

Types of adrenal insufficiency?

A

Primary - Damaged adrenal glands

Secondary - Inadequate ACTH stimulating adrenal glands due to loss or damage of pituitary

Tertiary - Inadequate CRH from hypothalamus

169
Q

Biochemistry of primary adrenal insufficiency?

A

Low cortisol
High ACTH
Low aldosterone
High renin

170
Q

Biochemistry of secondary adrenal insufficiency?

A

Low cortisol
Low ACTH
Normal aldosterone
Normal renin

171
Q

What causes tertiary adrenal insufficiency?

A

Long term oral steroids (>3 weeks) which suppresses the hypothalamus

172
Q

Px of adrenal insufficiency in children?

A
  • Nausea and vomiting
  • Poor weight gain or weight loos
  • Reduced appetite
  • Abdominal pain
  • Muscle weakness or cramps
  • High ACTH -> bronze hyperpigmentation
173
Q

Dx of adrenal insufficiency?

A

Short synacthen test

174
Q

Mx of adrenal insufficiency?

A

Replace steroids:
- Hydrocortisone (glucocorticoid)
- Fludrocortisone (mineralocorticoid)

175
Q

What is adrenal crisis?

A

Severe addisons due to a trigger - infection, trauma, acute illness, sudden withdrawal of steroids

Px:
- Reduced consciousness
- Hypotension
- Hypoglycaemia, hyponatraemia and hyperkalaemia

176
Q

Mx of adrenal crisis?

A

ICU:
- Parenteral steroids, IV fluids, correct hypoglycaemia

177
Q

Growth hormone px?

A

Neonates:
* Micro-penis
* Hypoglycaemia
* Severe jaundice

Children:
* Poor growth
* Short stature
* Delayed puberty

178
Q

Ix / Mx of growth hormone deficiency?

A

Ix – Growth hormone stimulation test

MRI brain for pituitary / hypothalamus issues

Mx – Daily subcut GH (somatropin) + monitor

179
Q

What commonly happens before LOC event suggestive of syncope?

A
  • Prolonged standing
  • Lightheaded
  • Sweating
  • Blurring or clouding vision
180
Q

What happens during a LOC event suggesting seizure?

A
  • Head turning and abnormal limb positions
  • Tonic clonic activity
  • Tongue biting
  • Cyanosis
181
Q

Ix after syncope?

A
  • ECG (assess for arrhytmia)
  • Echocardiogram (if structural heart disease suspected)
  • Bloods, U&Es, BM
182
Q

Mx of generalised tonic-clonic seizures?

A
  1. Sodium valproate
  2. Lamotrigine or carbamazepine
183
Q

Mx of focal seizures?

A
  1. Lamotrigine or carbamazepine
  2. Sodium valproate or levetiracetam
184
Q

Px of focal seizure?

A

Seizure starts in temporal lobe affecting hearing, speech, memory and emotions
- Hallucinations
- Memory flashbacks
- Déjà vu
- Doing strange things on autopilot

185
Q

Mx of infantile spasms?

A
  1. Prednisolone
  2. Vigabatrin
186
Q

Febrile convulsion mx?

A

Paracetamol + Ibuprofen

187
Q

When to consider an MRI after a seizure?

A

o <2 years of age
o Focal seizures
o No response to first line anti-epileptic mx

188
Q

Advice for seizures?

A
  • Shower instead of bath
  • Cautious swimming, with heights, traffic, hot or electrical equipment
  • During seizure -> recovery position + soft object under head
  • If >5 mins -> call ambulance
189
Q

S/e of phenytoin?

A

Folate and VitD deficiency -> megaloblastic anaemia, osteomalacia

190
Q

S/e of sodium valproate?

A

Teratogenic, liver damage, hair loss, tremor

191
Q

S/e of carbamazepine?

A

agranulocytosis, aplasticanaemia

192
Q

S/e of lamotrigine?

A

Stevens-johnson syndrome or DRESS syndrome, leukopenia

193
Q

What is status epilepticus?

A

Seizure lasting more than 5 minutes or 2+ seizures without regaining consciousness

194
Q

Mx of status epilepticus?

A
  • Secure airway
  • High concentration oxygen
  • Assess cardiac and respiratory function
  • Check BM
  • Gain IV access

Then pharmacological mx:
1. IV lorazapeam
2. 10 mins later -> repeat IV lorazepam
3. No response -> IV phenobarbital or phenytoin

195
Q

Causes of cerebral palsy?

A

Antenatal:
- Maternal infections
- Trauma during pregnancy

Perinatal:
- Birth asphyxia
- Pre-term birth

Postnatal:
- Meningitis
- Severe neonatal jaundice
- Head injury

196
Q

Types of cerebral palsy?

A
  • Monoplegia – one limb affected
  • Hemiplegia – one side of the body affected
  • Diplegia – four limbs are affects, mostly legs
  • Quadriplegia – four limbs affected more severely +/- seizures, speech disturbance
197
Q

Px of cerebral palsy?

A
  • Failure to meet milestones
  • Increased or decreased tone
  • Hand preference < 18 months
  • Problems with coordination, speech or walking
  • Feeding or swallowing problems
  • Learning difficulties
198
Q

Px of congenital hydrocephalus?

A
  • Sutures of skull close at 2 years of age -> enlarged and rapidly increasing head circumference
  • Bulging anterior fontanelle
  • Poor feeding and vomiting
  • Poor tone, sleepiness
199
Q

Mx of congenital hydrocephalus?

A

VP shunt (CSF drained into peritoneal cavity)

Finals HH (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions