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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
What is scarlet fever? Its features?
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
Tests and management of scarlet fever
Throat swab Penicillin V (clarithromycin if allergic) for 10 days
27
Differntials of fever, rash and conjunctivitis
Measles Adenovirus Kawasaki disease
28
What is kawasaki disease?
A febrile systemic vasculitis disease Rare but can cause coronary aneurysms Needs prompt treatment
29
Diagnostic criteria of kawasaki disease
``` Fever >5 days 4 of the following: Conjuncitivitis Lips / oral mucosa changes Cervical lymphadenopathy Polymorphus rash Changes to peripheries - redness and swelling ```
30
Tests for kawasaki disease
``` 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
Treatment of Kawasakis disease
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
What is slapped cheek syndrome?
Cause - parovirus B19 Can cause haemoglobin to be low Self-limiting disease
33
What is henock schonlein purpura? Features?
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
Investigations of HSP
``` Increase ESR Increased IgA U+E BP Urinalysis - proteinuria ```
35
Management of HSP
Steorids for abdo pain | Most recover on their own
36
What is impetigo and its management?
Localised, highly contagious Staphy infection Occurs around mouth Lesions begin as erythematous Macules which become vesicular/ pustular Management - flucloxacillin. Co-amoxiclav for severe
37
Causes of jaundice in first 24 hours of life
Rhesus hemolytic disease ABO hemolytic disease Hereditary spherocytosis G6DP
38
Jaudice from 2-14 days of life causes
Usually physiological
39
Risk factors for physiological jaundice in a newborn
Red blood cells- shorter lifespan in neonates Metabolism of bilirubin slower in neonates Breastfeeding closely linked
40
Causes of prolonged jaundice
``` Biliary atresia Hypothyroidism Galaxtosemia UTI Breast milk jaundice Prematurity - immature liver function Congenital infections ```
41
What tests to do for prolonged jaundice
``` Screen - conjugated and unconjugated bilirubin - raised conjugated = biliary atresia Coombs test THIS FBC and blood film Urine and MC&S U&Es LFTs ```
42
Which is more severe Gilbert's or Crigler-Najjar syndrome
CN syndrome
43
Management of neonatal jaundice
Depends on the treatment threshold graph/table Phototherapy Red cell exchange
44
What is vesicoureteric reflux and what is the pathophysiology behind them?
Abnormal backflow of urine from the bladder to ureter and kidneys Ureters are displaced laterally, entering bladder more perpendicular Shortened intramural course
45
Presentation of vesicoureteric reflux and investigations
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
What pulse is associated with a patent ductous arteriosus?
Collapsing or bounding pulse
47
Vaccines at 2 months
6 in 1 - diphtheria, tetanus, whooping cough, polio, Hib, hepatitis B Rotavirus (oral) Men B
48
When are MMR vaccines given?
12-13 months | 3-4 years
49
What is erythema infectosium?
Slapped cheek syndrome | Parvovirus B19 infection
50
What is developmental dysplasia of the hip and its presentation?
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
What is perthes disease? What is its presentation?
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
Slipped upper femoral epiphysis presentation
``` Commonest adolescent hip disorder Occurs mainly in males Overweight Knee is normal but knee pain referred from the hip Teenage, obese, running difficulty ```
53
X Ray findings of perthes disease
Flattening of the femoral head | Fragmentation of the femoral head
54
When can a child not consent to sex?
Under the age of 13
55
What is the management for ADHD?
Mild/moderate symptoms - parents attend educational course Drug therapy - first-line = methylphenidate Then switch to lisdexamfetamine
56
Patent ductous arteriosus management
Give ibuprofen or indomethacin
57
Presentation of measles
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
Management and complications of measles
Mainly supportive Admit if pregnant or immunosuppressed ``` Otitis media most common Pneumonia Encephalitis Subacute sclerosing panencephalitis Febrile convulsions Diarrhoea Myocarditis ```
59
Features of acute lymphoblastic leukaemia
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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