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phase 3a > DK lecture > Flashcards

DK lecture Flashcards

1
Q

Causes of neonatal collapse

A
  • sepsis
  • PPHN
  • metabolic
  • cardiac (transpositition of great arteries, coarctation)
  • NAI
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2
Q

What is PPHN

A

persisent pulmonary hypertension of the newborn

lungs dont dilate properly after first breath

pressure remains high

blood cant oxygenate enough

hypoxic

R-> L shunt

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3
Q

Describe normal fetal circulation

A

lungs filled with fluid, vessels constricted, pressure inside lung vessels high

LA pressure low, so foramen ovale open

after first breath/cry lungs fill with air, vessels dilate, oxygenated blood supplies brain and body. Lung and blood vessel pressure now low, LA pressure high foramen ovale closes

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4
Q

Symptoms of PPHN

Ix

A

hypoxia - blue or pale, diff breathing

ix: 02 sats >92%, echo shows constricted vessels

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5
Q

PPHN management

A

Mec ventilation and circulatory support

inhaled nitric oxide and sildenafil

high frequency or oscillatory ventilation

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6
Q

Descrive transposition on the great arteries

A

R->L shunt

Aorta from RV and Pul artery from LV

PDA occrs at the same time allowing life (sometimes also VSD or ASD)

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7
Q

presentation of transposition of great vessels

A

cyanosis on day 2 when DA would close, less profound if VSD/ASD also present

O/E second heart sound loud and single

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8
Q

Transposition of great arteries ix and mx

A

echo

prostagladin IV to keep DA open

atrial septostomy (reopens FO)

surgery - arterial switch

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9
Q

Symptoms/Signs of coarctation

A

more severe over years

asymptomatic

  • systemic HTN
  • Radio-femoral delay (blood bypasses obstruction via colat vessels in chest wall)
  • ejection systolic mumur at upper sternal edge
  • collaterals heard with continous mumur at back
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10
Q

Ix coarctation

A

CXR

  • rib notching (dev of larger colat intercostal arteries running under ribs posterior to bypass obstruction)
  • 3 sign- visible notch in descending aorta at site of coartaction

ECG - LVH

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11
Q

Coarctation management

A

stent or surgical repair

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12
Q

What is sepsis what ix would you do

A

dysregulated repsonse to infection that leads to end organ failure

ix: FBC, UE, LFT, CRP, BC(inc lactate)

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13
Q

Sepsis managemtn

A

Keep 02 >92%

fluid resuscitation if tachy, hypo, increased CRP, (20mls/kg of 0.9% saline) repeat X3

call intensive care if no improvement and give cefotaxime

Refer

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14
Q

Bronchiolitis Ex, Ax

A

<1 year

RSV

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15
Q

Bronchiolotis sx and ix

A

prodrome coryzal

SOB, cough, diff feeding

clinical Dx

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16
Q

Bronchiolitis management

A

Supportive

  • 02, feeds
  • resp support (CPAP, intubation ventilation)
  • neb adrenaline ±oral dexamethasone
  • hypertonic saline
  • heliox
  • abx
17
Q

Neonatal collapse management

(inc investigations and treatment)

A

A/B – intubation and ventilation, NGT

C- lines , fluid, inotropes (dopamine/dobutamine)

D- glucose, assess neurology

Ix: CXR/ AXR, echo, FRC/CRP/cultures

Abx

Treat underlying cause

18
Q

Kawsaki investigations and management

A

clinical

high platelets, echo (inpt and 4-6 weeks after)

Mx: oral aspirin, IVIG, cardiac follow up

19
Q

PPHN causes

A

sepsis

pneumonia

meconium aspiriation

20
Q

General symptoms of childhood malig

A
  • systemically unwell
  • bone marrow failure (nose bleeds, bruising infections, anaemia, pallor, fatigue)
  • localised mass
  • consequences of pressure from a mass on structures (airway obstruction)
21
Q

Chemo side effects

A

Bone marrow suppression (anaemia, bleeding)

Immunosuppression

N&V, anorexia, alopecia

22
Q

Haematological tumour signs and Ix

A

ALL most common

  • bone marrow failure (bleeding, bruising, infections, anaemia)
  • Dx confirmed by bone marrow aspiration
  • Hb low, thrombocytopenia, CXR
23
Q

Brain tumour sx and ix

A

astrocytoma and glioblastoma

  • raised ICP, focal (back pain, peripheral weakness, bladder/bowel dysfunction)
  • Ix: MRI
24
Q

Neuroendocrine tumours

A

neuroblastoma

  • pallow, weight loss, abdo mass, hepatomeg, bone pain
25
Q

Kidney and bone tumours

A

Nephroblastoma (wilms)

  • large abdo mass otherwise well

Osteosarcoma

  • bone pain, mass, limp
26
Q

How to assess control of asthma

A
  • how often do you use your blue?
  • how many courses of oral steroids in last 6m
  • how any hospital admissions last 6 m
  • ever been to intensive care
27
Q

How to treat an acute asthma exacerbation

A

OHSHITME

  • O2
  • Salbutamol
  • Hydrocortisone
  • Ipratropium bromide
  • Theophylline
  • Magnesium
  • check inhaler technique and compliance

phase 3a (9 decks)

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