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Medicine > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What type of heart shunts are described as ‘breathless’

A

Left to right shunts

Ventricular septal defect
Persistent arterial duct
Atrial septal defect

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2
Q

What congenital heart disease is described as ‘blue’?

A

Right to left shunts
Tetralolgy of fallot
Transposition of great arteries

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3
Q

Changes in fetal circulation after birth

A

First breath = resistance to pulmonary blood flow falls. Blood increases to the lungs, results in a rise in a left atrial pressure

Meanwhile blood returning to the right atrium falls as placenta is excluded from circulation. This closes the foramen ovale

Doctors arteriosus closes within the first few hours -days of life

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4
Q

What are ventricular septal defects and symptoms/signs?

A

Defect in septum - leads to blood from the left ventricle to the right - causes breathlessness but not cyanosis

Mild/asymptomatic
Harsh loud pansystolic murmur - smaller defect = louder murmur
Large defects- HF, failure to thrive, recurrent chest infections.

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5
Q

What is eisenmengers syndrome?

A

Reversal of a left to right shunt

Leads to pulmonary hypertension and cyanosis

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6
Q

Management of a VSD

A

Small resolve spontaneously
Prevention of bacterial endocarditis - good dental hygiene
Large defects need surgery
Therapy for HF - furosemide

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7
Q

What are atrial septal defects? Symptoms.

A

Defect in the atria causing a left to right shunt

Usually none symptoms 
Recurrent chest infections 
Wheeze 
Ejection systolic murmur 
Widely split fixed S2, second heart sound (increased flow across the pulmonary valve due to left to right shunt)
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8
Q

Management of AVD

A

Only those with significant disease need treatment
Secundum - cardiac Cathersation- insertion of occlusion device
Partial AVSD - surgical correction (3-5 years old to prevent right heart failure)

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9
Q

What is a patent ductus arteriosus. Symptoms

A

Connects the pulmonary artery to descending aorta

Continuous murmur beneath left clavicle
Collapsing or bounding pulse
Symptoms rare

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10
Q

Mangement of patent ductous arteriosus

A

Closure recommended to abolish bacterial endocarditis risk
If persistant - closure with coil or occlusion device via catheter at 1 year
Treat with oral or IV ibuprofen ??

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11
Q

What is tetralology of fallot?

A

Large VSD
Overriding of the aorta with respect to the ventricular septum
Sub-pulmonary stenosis causing right ventricular outflow obstruction
Right ventricular hypertrophy as a result

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12
Q

Symptoms /signs of tetralogy of fallot

A

Severe cyanosis
Hypercyanotic spells and squating on exercise
Clubbing in older children
Loud harsh ejection systolic murmur

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13
Q

Management of tetralogy of fallot

A

Corrective surgery at 6 months old

Hypercyanotic spells- usually self-limiting
Sedation and pain relief, prolonged = sedation and pain relief, IV propranolol, bicarb

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14
Q

What is transposition of the great arteries. Presentation

A

Swapping of the aorta and pulmonary artery
Incompatible with life but associated with conditions that cause mixing

Cyanosis
Usually no murmur

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15
Q

Management of transposition of great arteries

A

Improve mixing in neonate
Maintain ductous arteriosus potency with prostaglandin infusion
Balloon atrial septostomy mag bd life saving - tears atrial septum
Surgery - arterial switch

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16
Q

Features of innocent murmurs

A

Asymptomatic
Soft blowing murmur
Systolic murmur
Left sternal edge

Normal heart sounds, no added sounds
No thrill
No radiation

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17
Q

What is a macule rash?

A

Flat, non-palpable change in skin colour (<0.5 cm) - think freckle

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18
Q

What is a patch?

A

Flat skin change >0.5 cm

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19
Q

What is a papule?

A

Raised area of skin <0.5 cm

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20
Q

What is purpura?

A

Rash caused by blood in the skin
> 2 cm
Non-blanching

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21
Q

What is petichae?

A

Tiny, purple, red spots on skin
Non-blanching
<2mm

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22
Q

What is a maculopapular rash?

A

Macule = flat. Papule = raised

Therefore it means an alternating flat and raised lesion

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23
Q

Causes of maculopapular rashes

A 
Enterovirus 
Exanthum sibitum 
Roseola infantum 
EBV
Rubella
Measles
Scarlet fever
Kawasakis disease 
Meningicoccal infection
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24
Q

What is exanthum subitum?

A 
Roseola infection (HHV-6)
Common mild and self limiting 
Common in babies and toddlers
Can cause febrile seizures 
Features - maculopapular rash that begins on trunk. Tiredness and irritability. Fever
25
Q

What is scarlet fever? Its features?

A

Caused by exotoxins released by group A streptococcus

First - flu symptoms
Then rash - maculopapular on chest, axilla or behind ears (coalescent- comes together)
Facial flushing
Strawberry tongue

26
Q

Tests and management of scarlet fever

A

Throat swab

Penicillin V (clarithromycin if allergic) for 10 days

27
Q

Differntials of fever, rash and conjunctivitis

A

Measles
Adenovirus
Kawasaki disease

28
Q

What is kawasaki disease?

A

A febrile systemic vasculitis disease
Rare but can cause coronary aneurysms
Needs prompt treatment

29
Q

Diagnostic criteria of kawasaki disease

A 
Fever >5 days 
4 of the following: 
Conjuncitivitis 
Lips / oral mucosa changes 
Cervical lymphadenopathy 
Polymorphus rash 
Changes to peripheries - redness and swelling
30
Q

Tests for kawasaki disease

A 
Diagnosis is on clinical findings 
ESR and CRP - high inflammatory markers 
Bilirubin 
Platelets - rise in 2nd week of infection 
Serial echo 
MRI to define aneurysms
31
Q

Treatment of Kawasakis disease

A

Immunoglobulin as a single IV dose
Aspirin - reduces risk of thrombosis - give high dose initially until inflammatory markers norma then low dose until echo at 6 weeks
Large aneurysms- may need long term wayfarin
Persistant inflammation - may require infliximab, steroids and ciclosporin

32
Q

What is slapped cheek syndrome?

A

Cause - parovirus B19
Can cause haemoglobin to be low
Self-limiting disease

33
Q

What is henock schonlein purpura? Features?

A

Autoimmune vasculitis

Characteristic skin rash - purpura, symmetrical, over buttocks, extensor surfaces of arms and legs. Trunk usually spared usually palpable
Joint pain
Periarticular oedema
Cockily abdo pain
Nephritis (blood in urine) can be a feature

Often pervious infection (massive immune response)

34
Q

Investigations of HSP

A 
Increase ESR
Increased IgA
U+E
BP
Urinalysis - proteinuria
35
Q

Management of HSP

A

Steorids for abdo pain

Most recover on their own

36
Q

What is impetigo and its management?

A

Localised, highly contagious Staphy infection
Occurs around mouth
Lesions begin as erythematous Macules which become vesicular/ pustular

Management - flucloxacillin. Co-amoxiclav for severe

37
Q

Causes of jaundice in first 24 hours of life

A

Rhesus hemolytic disease
ABO hemolytic disease
Hereditary spherocytosis
G6DP

38
Q

Jaudice from 2-14 days of life causes

A

Usually physiological

39
Q

Risk factors for physiological jaundice in a newborn

A

Red blood cells- shorter lifespan in neonates
Metabolism of bilirubin slower in neonates
Breastfeeding closely linked

40
Q

Causes of prolonged jaundice

A 
Biliary atresia 
Hypothyroidism 
Galaxtosemia 
UTI
Breast milk jaundice 
Prematurity - immature liver function 
Congenital infections
41
Q

What tests to do for prolonged jaundice

A 
Screen - conjugated and unconjugated bilirubin - raised conjugated = biliary atresia
Coombs test
THIS
FBC and blood film 
Urine and MC&S
U&Es 
LFTs
42
Q

Which is more severe Gilbert’s or Crigler-Najjar syndrome

A

CN syndrome

43
Q

Management of neonatal jaundice

A

Depends on the treatment threshold graph/table
Phototherapy
Red cell exchange

44
Q

What is vesicoureteric reflux and what is the pathophysiology behind them?

A

Abnormal backflow of urine from the bladder to ureter and kidneys

Ureters are displaced laterally, entering bladder more perpendicular
Shortened intramural course

45
Q

Presentation of vesicoureteric reflux and investigations

A

Antenatal period - hydronephrosis on US
Recurrent childhood UTIs
Reflux nephropathy - chronic pyelonephritis
Renal scars - produce renin = hypertension
Chronic pyelonephritis

Normally diagnosed following a micturating cystourethrogram

46
Q

What pulse is associated with a patent ductous arteriosus?

A

Collapsing or bounding pulse

47
Q

Vaccines at 2 months

A

6 in 1 - diphtheria, tetanus, whooping cough, polio, Hib, hepatitis B
Rotavirus (oral)
Men B

48
Q

When are MMR vaccines given?

A

12-13 months

3-4 years

49
Q

What is erythema infectosium?

A

Slapped cheek syndrome

Parvovirus B19 infection

50
Q

What is developmental dysplasia of the hip and its presentation?

A

Where hip joint does not form properly.
Presentation - birth - baby, check if hip can be dislocated posteriorly
Abnormal gait or limp
On and off hip pain at an older age

51
Q

What is perthes disease? What is its presentation?

A

Avascular necrosis due to interruption of blood supply followed by revascularisation and re-ossification over 18-36 months
Mainly affects boys
Presents around 6 years old - no trauma history. Normal birth. Antalgic gait, limitation of passive and active movement of the hip

52
Q

Slipped upper femoral epiphysis presentation

A 
Commonest adolescent hip disorder 
Occurs mainly in males 
Overweight 
Knee is normal but knee pain referred from the hip 
Teenage, obese, running difficulty
53
Q

X Ray findings of perthes disease

A

Flattening of the femoral head

Fragmentation of the femoral head

54
Q

When can a child not consent to sex?

A

Under the age of 13

55
Q

What is the management for ADHD?

A

Mild/moderate symptoms - parents attend educational course
Drug therapy - first-line = methylphenidate
Then switch to lisdexamfetamine

56
Q

Patent ductous arteriosus management

A

Give ibuprofen or indomethacin

57
Q

Presentation of measles

A

Prodrome - irritable, conjunctivitis, fever
Koplik spots - before rash - on buccal mucosa
Rash - starts behind the ears then spreads everywhere (day 3-5)
Diarrhoea in 10%

58
Q

Management and complications of measles

A

Mainly supportive
Admit if pregnant or immunosuppressed

Otitis media most common 
Pneumonia
Encephalitis
Subacute sclerosing panencephalitis
Febrile convulsions 
Diarrhoea 
Myocarditis
59
Q

Features of acute lymphoblastic leukaemia

A

Divided into bone marrow
Anaemia - lethargy and pallor
Neutropenia- frequent infections
Thrombocytopenia - easy brusing, petechiae

Other features - bone pain, splenomegaly, heatomegaly, fever, testicular swelling

Medicine (25 decks)

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