Paediatrics Flashcards
What type of heart shunts are described as ‘breathless’
Left to right shunts
Ventricular septal defect
Persistent arterial duct
Atrial septal defect
What congenital heart disease is described as ‘blue’?
Right to left shunts
Tetralolgy of fallot
Transposition of great arteries
Changes in fetal circulation after birth
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
What are ventricular septal defects and symptoms/signs?
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.
What is eisenmengers syndrome?
Reversal of a left to right shunt
Leads to pulmonary hypertension and cyanosis
Management of a VSD
Small resolve spontaneously
Prevention of bacterial endocarditis - good dental hygiene
Large defects need surgery
Therapy for HF - furosemide
What are atrial septal defects? Symptoms.
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)
Management of AVD
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)
What is a patent ductus arteriosus. Symptoms
Connects the pulmonary artery to descending aorta
Continuous murmur beneath left clavicle
Collapsing or bounding pulse
Symptoms rare
Mangement of patent ductous arteriosus
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 ??
What is tetralology of fallot?
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
Symptoms /signs of tetralogy of fallot
Severe cyanosis
Hypercyanotic spells and squating on exercise
Clubbing in older children
Loud harsh ejection systolic murmur
Management of tetralogy of fallot
Corrective surgery at 6 months old
Hypercyanotic spells- usually self-limiting
Sedation and pain relief, prolonged = sedation and pain relief, IV propranolol, bicarb
What is transposition of the great arteries. Presentation
Swapping of the aorta and pulmonary artery
Incompatible with life but associated with conditions that cause mixing
Cyanosis
Usually no murmur
Management of transposition of great arteries
Improve mixing in neonate
Maintain ductous arteriosus potency with prostaglandin infusion
Balloon atrial septostomy mag bd life saving - tears atrial septum
Surgery - arterial switch
Features of innocent murmurs
Asymptomatic
Soft blowing murmur
Systolic murmur
Left sternal edge
Normal heart sounds, no added sounds
No thrill
No radiation
What is a macule rash?
Flat, non-palpable change in skin colour (<0.5 cm) - think freckle
What is a patch?
Flat skin change >0.5 cm
What is a papule?
Raised area of skin <0.5 cm
What is purpura?
Rash caused by blood in the skin
> 2 cm
Non-blanching
What is petichae?
Tiny, purple, red spots on skin
Non-blanching
<2mm
What is a maculopapular rash?
Macule = flat. Papule = raised
Therefore it means an alternating flat and raised lesion
Causes of maculopapular rashes
Enterovirus Exanthum sibitum Roseola infantum EBV Rubella Measles Scarlet fever Kawasakis disease Meningicoccal infection
What is exanthum subitum?
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
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
Tests and management of scarlet fever
Throat swab
Penicillin V (clarithromycin if allergic) for 10 days
Differntials of fever, rash and conjunctivitis
Measles
Adenovirus
Kawasaki disease
What is kawasaki disease?
A febrile systemic vasculitis disease
Rare but can cause coronary aneurysms
Needs prompt treatment
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
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
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
What is slapped cheek syndrome?
Cause - parovirus B19
Can cause haemoglobin to be low
Self-limiting disease
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)
Investigations of HSP
Increase ESR Increased IgA U+E BP Urinalysis - proteinuria
Management of HSP
Steorids for abdo pain
Most recover on their own
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
Causes of jaundice in first 24 hours of life
Rhesus hemolytic disease
ABO hemolytic disease
Hereditary spherocytosis
G6DP
Jaudice from 2-14 days of life causes
Usually physiological
Risk factors for physiological jaundice in a newborn
Red blood cells- shorter lifespan in neonates
Metabolism of bilirubin slower in neonates
Breastfeeding closely linked
Causes of prolonged jaundice
Biliary atresia Hypothyroidism Galaxtosemia UTI Breast milk jaundice Prematurity - immature liver function Congenital infections
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
Which is more severe Gilbert’s or Crigler-Najjar syndrome
CN syndrome
Management of neonatal jaundice
Depends on the treatment threshold graph/table
Phototherapy
Red cell exchange
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
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
What pulse is associated with a patent ductous arteriosus?
Collapsing or bounding pulse
Vaccines at 2 months
6 in 1 - diphtheria, tetanus, whooping cough, polio, Hib, hepatitis B
Rotavirus (oral)
Men B
When are MMR vaccines given?
12-13 months
3-4 years
What is erythema infectosium?
Slapped cheek syndrome
Parvovirus B19 infection
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
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
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
X Ray findings of perthes disease
Flattening of the femoral head
Fragmentation of the femoral head
When can a child not consent to sex?
Under the age of 13
What is the management for ADHD?
Mild/moderate symptoms - parents attend educational course
Drug therapy - first-line = methylphenidate
Then switch to lisdexamfetamine
Patent ductous arteriosus management
Give ibuprofen or indomethacin
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%
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
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
