High Yield Paeds Flashcards
Give some causes of global developmental delay
Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
Give some causes of gross motor delay
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
Give some causes of fine motor delay
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Give some causes of speech and language delay
Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
Hearing impairment
Learning disability
Autism
Cerebral palsy
Neglect
Give some causes of social delay
Emotional and social neglect
Parenting issues
Autism
What atrial septal defects may be seen in children?
Ostium secondum : septum secondum fails to fully close, leaving a hole in the wall
Patent foramen ovale: foramen ovale fails to close (although this not strictly classified as an ASD)
Ostium primum: septum primum fails to fully close, leaving a hole in the wall. This tends to lead to atrioventricular valve defects
What are the potential complications of ASDs in children?
Stroke in the context of venous thromboembolism
Atrial fibrillation or atrial flutter
Pulmonary hypertension and right sided heart failure
Eisenmenger syndrome - reversal of left to right shunt due to pulmonary hypertension
What may be heard on auscultation of an ASD?
mid-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border with a fixed split second heart sound (doesn’t change with inspiration or expiration)
How can ASDs be managed?
should be referred to a paediatric cardiologist for ongoing management
If the ASD is small and asymptomatic, watching and waiting can be appropriate
can be corrected surgically using a transvenous catheter closure (via the femoral vein) or open heart surgery
anticoagulants (such as aspirin, warfarin and NOACs) are used to reduce the risk of clots and stroke
How may ASDs present in children?
may be picked up on antenatal screening / newborn examination
may be symptomatic:
Shortness of breath
Difficulty feeding
Poor weight gain
Lower respiratory tract infections
may be asymptomatic in childhood and present in adulthood with dyspnoea, heart failure or stroke
What conditions are commonly associated with VSDs in children?
Down’s Syndrome and Turner’s Syndrome
What is the usual direction of flow of blood in a VSD? What may this cause?
from left to right
patient remains acyanotic but too much blood flow into the lungs may cause right sided overload / right heart failure
pulmonary hypertension may cause reversal of the shunt (Einsenmengers syndrome)
What sxs may VSDs present with?
Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive
What may be heard on auscultation of the chest of a patient with a VSD?
pan-systolic murmur more prominently heard at the left lower sternal border in the third and fourth intercostal spaces
may be a systolic thrill on palpation
How should VSDs be managed?
referred to paediatric cardiologist
small VSDs with no symptoms or evidence of pulmonary hypertension / HF can be watched and often close spontaneously
can be corrected surgically using a transvenous catheter closure via the femoral vein or open heart surgery
increased risk of infective endocarditis in patients with a VSD =antibiotic prophylaxis should be considered during surgical procedures
Give some symptoms of aortic stenosis
fatigue, shortness of breath, dizziness and fainting
sxs typically worse on exertion as the outflow from the left ventricle cannot keep up with demand
severe aortic stenosis will present with heart failure within months of birth.
Describe the murmur heard in aortic stenosis
ejection systolic murmur heard loudest at the aortic area (second intercostal space, right sternal border)
It has a crescendo-decrescendo character and radiates to the carotids
Besides a murmur, what might you find on examination of aortic stenosis?
Ejection click just before the murmur
Palpable thrill during systole
Slow rising pulse and narrow pulse pressure
How can aortic stenosis be investigated and managed?
gold standard for dx is an echocardiogram
monitoring with regular echos, exercise testing and ECGs
Mx options:
Percutaneous balloon aortic valvoplasty
Surgical aortic valvotomy
Valve replacement
Give some complications of aortic stenosis
Left ventricular outflow tract obstruction
Heart failure
Ventricular arrhythmia
Bacterial endocarditis
Sudden death, often on exertion
What conditions may be associated with congenital pulmonary valve stenosis?
Tetralogy of Fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome
Give some signs of pulmonary stenosis found on examination
Ejection systolic murmur heard loudest at the pulmonary area (second intercostal space, left sternal border)
Palpable thrill in the pulmonary area
Right ventricular heave due to right ventricular hypertrophy
Raised JVP with giant a waves
What are the two most common causes of nephritis in children?
post-streptococcal glomerulonephritis and IgA nephropathy (Berger’s disease)
What is the FEVER PAIN criteria for diagnosis of tonsilitis?
Fever over 38°C
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
severely Inflamed tonsils
No cough or coryza
0-1 = no abx
2-3 = consider abx
4-5 = abx almost definitely indicated
What abx are given if indicated in tonsillitis ?
if antibiotics are indicated then either phenoxymethylpenicillin or erythromycin (if the patient is penicillin allergic) should be given
7 or 10 day course should be given
Potential complications of tonsillitis?
Peritonsillar abscess or neck abscess
Acute otitis media
Acute sinusitis
Acute post-streptococcal glomerulonephritis
Streptococcal toxic shock syndrome
Scarlet fever
Acute rheumatic fever
What are the 5 Ss of innocent childhood murmurs?
Soft
Short
Systolic
Symptomless
Situation dependent, particularly if the murmur gets quieter with standing or only appears when the child is unwell or feverish
What innocent childhood murmur is heard as a continuous blowing noise heard just below the clavicles?
Venous hums - Due to the turbulent blood flow in the great veins returning to the heart
What innocent childhood murmur is heard as a low-pitched sound at the lower left sternal edge?
Still’s murmur
Characteristics of an innocent ejection murmur in a child include:
soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
localised with no radiation
no diastolic component
no thrill
no added sounds (e.g. clicks)
asymptomatic child
no other abnormality
What causes S2 splitting on auscultation?
During inspiration the right side of the heart fills faster as it pulls in blood from the venous system.
The increased vol in the RV causes it to take longer to empty during systole, causing a delay in the pulmonary valve closing.
When the pulmonary valve closes slightly later than the aortic valve, this causes the second heart sound to be “split”.
Jaundice in the first 24 hours is always pathological. What can cause it?
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
What should be done if there are still signs of neonatal jaundice after 14 days ?
a prolonged jaundice screen is performed:
urine for MC&S
FBC, U&Es and LFTs
TFTs
conjugated and unconjugated bilirubin: look for biliary atresia
Direct antiglobulin test (Coombs’ test)
Blood film
What can cause prolonged jaundice (over 14 days)?
prematurity ( immature liver function)
congenital infections e.g. CMV, toxoplasmosis
biliary atresia
breast milk jaundice (jaundice is more common in breastfed babies)
galactosaemia
hypothyroidism
UTI
