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Paediatrics Flashcards

1
Q

“A” of ABCs of Sick Child

A
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2
Q

“B” of ABCs of Sick Child

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3
Q

“C” of ABCs of Sick Child

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4
Q

“D” of ABCs of Sick Child

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5
Q

“E” of ABCs of Sick Child

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6
Q

“F” of ABCs of Sick Child

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7
Q

“G” of ABCs of Sick Child

A

Glucose:

• Normal random BGL 3.5-5.5 for children

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8
Q

Recognition of Sick Child Summary

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9
Q

Yale Criteria for Sick Child

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10
Q

Dehydration classification, symptoms and treatment in children

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11
Q

Why give Fluids in Kids?

A
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12
Q

Signs of dehydration

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13
Q

How will I give Fluids in Kids

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14
Q

What fluids to give kids?

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15
Q

How much fluids to give kids

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16
Q

How to monitor Fluids in Kids

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17
Q

Pre-made fluid bags at RCH

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18
Q

Definition, Epidemiology and Aetiology of Kawasaki Disease

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Definition:

• Acute vasculitis, especially of the coronary arteries

Epidemiology:

  • Vast majority < 5 years (80%)
  • Asians populations more likely affected
  • One of the most common causes for acquired heart disease

Aetiology

– Unknown. Not contagious

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19
Q

Clinical features of Kawasaki Disease

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20
Q

Investigations and treatment for Kawasaki Disease

A

Ix:

  • Echocardiogram
  • ↑WBC, ESR, CRP, ↑↑↑Platelets
  • Sterile pyuria

Rx:

  • IVIg (IV immunoglobulin)
  • High-dose aspirin
  • No role for steroids
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21
Q

Complications and prognosis of Kawasaki Disease

A

Complications:

• Coronary artery aneurysm in 25% of pts if left untreated

Prognosis:

  • Acute and usually self-limiting
  • Untreated leads to significant morbidity/mortality – Rx < 3% develop CAA
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22
Q

Definition of acute bacterial meningitis

A

Acute Bacterial Meningitis

Definition:

  • Inflammation of the meninges, which covers the brain and spinal cord, caused by various bacterial species
  • Medical emergency that if not treated results in nearly 100% mortality
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23
Q

Epidemiology of Acute Bacterial Meningitis

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24
Q

Aetiology of Acute Bacterial Meningitis

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25
Q

Risk factors for Acute Bacterial Meningitis

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Risk Factors:

  • Recent exposure to an individual with meningoccal or Hib meningitis
  • Recent infection (especially URTI or otic infection)
  • Recent travel to areas of endemic meningococcal disease (e.g. Sub-Saharan Africa)
  • Penetrating head trauma or skull fracture
  • Cochlear implant devices
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26
Q

Pathophysiology of Acute Bacterial Meningitis

A

Pathophysiology:

  1. Breach of the CNS either by haematogenous spread (most common) or trauma
  2. Bacteria multiple once they enter subarachnoid space
  3. Bacteria in CSF induce inflammatory cascade and leukocyte migration
  4. Results in cerebral oedema, raised ICP and neurological damage
  5. Can lead to Septic shock, DIC, renal and heart failure
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27
Q

Clinical Features of Acute Bacterial Meningitis

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28
Q

Physical examination in Acute Bacterial Meningitis

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29
Q

Investigations and diagnosis of Acute Bacterial Meningitis

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30
Q

Contraindications of a Lumbar Puncture

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31
Q

Management of Acute Bacterial Meningitis

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32
Q

Complications of Acute Bacterial Meningitis

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33
Q

Prognosis of Acute Bacterial Meningitis

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34
Q

Definition and Epidemiology of Viral Meningitis

A

Viral (aseptic) Meningitis

Definition:

• Viral infection of the meninges and/or brain tissue (meningo-encephalitis)

Epidemiology:

  • One of the most common infections of the CNS
  • Under-diagnosed since some just present with flu-like symptoms
  • Most common in children
  • Males > females
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35
Q

Aetiology and Pathophysiology of Viral Meningitis

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36
Q

Clinical features of Viral Meningitis

A

Clinical Features:

  • Headaches
  • Non-specific signs in infants – irritability, poor feeding, fever, vomiting
  • Photophobia, neck or back stiffness
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37
Q

Diagnosis and Management of Viral Meningitis

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38
Q

Complications and Prognosis of Viral Meningitis

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39
Q

Definition of the febrile child

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40
Q

Key factors in assessing a febrile child

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41
Q

Investigations of the Febrile Child

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42
Q

Treatment of a Febrile Child

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43
Q

Definition and Epidemiology of Measles

A

Definition:

• Measles is a highly infectious disease caused by the measles virus and characterised by a maculopapular rash, cough, coryza, conjunctiivtis and Koplikʼs spots

Epidemiology:

  • Measles is ubiquitous in non-immunised populations, especially in developing worlds
  • Highest incidence in children aged 5-9 years
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44
Q

Aetiology and pathophysiology of Measles

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45
Q

Clinical features of Measles

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46
Q

Investigations, diagnosis and management of Measles

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47
Q

Complications and Prognosis of Measles

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48
Q

Signs, causative organisms and work-up for Viral Meningio-Enchephalitis

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49
Q

Definition of Asthma

A

Definition:

  • Chronic respiratory disorder characterised by variable airway inflammation, airway obstruction and airway hyper-responsiveness
  • In older children and adults this may lead to permanent structural alterations of the airways (remodelling)
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50
Q

Epidemiology of Asthma

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51
Q

Aetiology of Asthma

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52
Q

Risk factors for asthma

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53
Q

Pathophysiology and classification of Asthma

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54
Q

Clinical Features of Asthma

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55
Q

Investigations for Asthma

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56
Q

Differential Diagnosis of Asthma

A

DDx:

  • Bronchiolitis - no associated atopy. Onset 18-24 months
  • Inhaled foreign body - sudden onset of cough, wheeze or choking
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57
Q

Long term management of Asthma

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58
Q

Acute asthma management

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59
Q

Asthma treatment summary including MOA and side effects

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60
Q

Complications and prognosis of Asthma

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61
Q

Asthma Risk Factors infographic

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62
Q

Asthma treatment infographic

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63
Q

Bronchitis:

  • Definition
  • Epidemiology
  • Aetiology
  • Pathophysiology
A
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64
Q

Bronchitis:

  • Clinical features
  • Investigations
  • Management
  • Prognosis
A
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65
Q

Definition and epidemiology of Bronchiolitis

A

Bronchiolitis:

Definition:

• Acute viral infection of the LRT characterised by obstruction of the small airways with air trapping

Epidemiology:

  • < 2 years of age (most severe 1-2 months), leading cause of hospital admissions in this age group
  • Uncommon in children < 1month or >2 years - Almost exclusively an infantile disease
  • Seasonal – mainly winter
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66
Q

Risk factors for Bronchiolitis

A

Risk factors:

  • < 3 years – lungs and immune system have not developed fully
  • Winter months
  • Premature birth - impaired lungs and immune system
  • Underlying heart or lung condition - E.g. CF or congenital heart disease
  • Passive smoking
  • Infants with older siblings – bring the infection home
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67
Q

Aetiology and Pathophysiology of Bronchiolitis

A

Aetiology:

  • RSV is the most common cause (>50%)
  • Others: Parainfluenza virus and adenovirus

Pathophysiology:

  1. Virus infection of the respiratory epithelial cells causing necrosis, inflammation, oedema and mucous secretion/plugging
  2. Cellular destruction and inflammation leads to obstruction of the small airways
  3. Results in hyperinflation, cilia dysfunction, atelectasis and wheezing
  4. Re-growth of the epithelial cell layers does not occur until ~ 2 weeks post infection
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68
Q

Clinical features of Bronchiolitis

A

Clinical Features:

  • Prodrome of 1-3 days of irritating cough, nasal congestion and rhinorrhoea
  • Wheezing – due to airway narrowing with mucus and necrotic debris
  • Fluctuating clinical findings – Hallmark of bronchiolitis
  • ↑ WOB – Tachypnoea + grunting, nasal flaring, subcostal retraction (common)
  • Fever > 38.5°C
  • Apnoea may be presenting feature, especially in very young or premature or low birth weight infants (uncommon)
  • Worst day 3-4
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69
Q

Investigations, management and prognosis of Bronchiolitis

A

Investigations:

• Clinical

Rx:

  • Supportive
  • Hospitalise with respiratory distress
  • Donʼt use steroids

Prognosis:

  • Most cases are mild and self-limiting (3-10 days)
  • Most get better in 2-3weeks (when resp. epithelium regenerates)
  • Only 1% require hospitalisation
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70
Q

Definition of Paediatric Pneumonia

A
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71
Q

Epidemiology of Paediatric Pneumonia

A

Epidemiology:

  • Can occur at any age - but more common in children < 4 years
  • Accounts for 13% of all infectious illnesses in infants < 2 years
  • Cause of significant morbidity and mortality in developing countries
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72
Q

Aetiology of Paediatric Pneumonia

A
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73
Q

Risk Factors for Paediatric Pneumonia

A

Risk factors:

  • Recent respiratory infection
  • Bronchopulmonary dysplasia - chronic lung condition of infants born preterm
  • CF
  • Asthma
  • Congenital heart disease
  • Congenital and acquired immunodeficiency disorders
  • Smoking
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74
Q

Pathophysiology of Paediatric Pneumonia

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75
Q

Clinical Features of Paediatric Pneumonia

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76
Q

Investigations for Paediatric Pneumonia

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77
Q

Management of Paediatric Pneumonia

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78
Q

Complications and prognosis of Paediatric Pneumonia

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79
Q

Sore throat - serious conditions of exclusion and serious features

A
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80
Q

Paediatric assessment of sore throat

A
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81
Q

Bacterial Pharyngitis - key organism and key features

A
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82
Q

Definition and epidemiology of laryngotracheobronchitis (croup)

A

Laryngotracheobronchitis (croup)

Definition:

• Viral infection of the upper airways characterised by sudden onset seal-like barking cough, stridor, voice hoarseness and respiratory distress

Epidemiology:

  • Most common cause of stridor in children 3 months – 5years
  • Winter months
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83
Q

Aetiology and pathophysiology of laryngotracheobronchitis (croup)

A

Aetiology:

  • Parainfluenza virus (1 or 3)
  • RSV (common < 6 months + wheeze)
  • Others: Adenovirus, Influenza A or B, Coronavirus

Pathophysiology:

  • Upper airways obstruction caused by generalised inflammation and oedema of the airways
  • Cellular level, necrosis and shedding of the epithelium
  • Narrowed & subglottic inflammation is responsible for the seal-like barky cough and stridor
  • If upper airways obstruction worsens it can lead to respiratory failure
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84
Q

Clinical Features of laryngotracheobronchitis (croup)

A
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85
Q

Investigations and management of laryngotracheobronchitis (croup)

A
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86
Q

Prognosis of laryngotracheobronchitis (croup)

A
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87
Q

Definition, Epidemiology and Aetiology of Epiglottitis

A

Epiglottitis:

Definition:

  • Bacterial infection causing severe epiglottic/supra-glottic inflammation
  • Medical Emergency

Epidemiology:

  • 3–7 years
  • Year-round disease

Aetiology:

  • Strep pyogenes, strep pneumoniae, Staph. aureus and previously HiB
  • Suspect HiB in young patients with incomplete immunisations
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88
Q

Clinical Features, Diagnosis and Management of Epiglottis

A
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89
Q

Prognosis of Epiglottitis

A

Prognosis

– Good if airway is controlled. Patients can be extubated within a few days (once infection has settled)

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90
Q

Bacterial Tracheitis:

  • Definition
  • Epidemiology
  • Aetiology
  • Clinical Features
  • Diagnosis
  • Management
A
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91
Q

Acute Infectious Laryngitis:

  • Definition
  • Epidemiology
  • Aetiology
  • Clinical Features
  • Diagnosis
  • Management
A
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92
Q

Definition of Infective Endocarditis

A

Infective Endocarditis:

Definition:

• Infection involving the endocardial surface of the heart, including valvular structures

Epidemiology:

  • Males > females
  • Half of the patients are > 60 years
93
Q

Aetiology and Pathophysiology of Infective Endocarditis

94
Q

Clinical Presentation of Infective Endocarditis

95
Q

Investigations and Criteria for Infective Endocarditis

96
Q

Management and Complications of Infective Endocarditis

97
Q

Definition, Epidemiology and Aetiology of Acute Rheumatic Fever

98
Q

Criteria for Acute Rheumatic Fever

99
Q

Investigation and management of Acute Rheumatic Fever

100
Q

Complications and Prognosis of Acute Rheumatic Fever

101
Q

Fetal circulation

102
Q

Epidemiology of Congenital Heart Disease

A

Epidemiology:

  • Leading cause of death in infancy
  • Most are Dx by 1 month
  • 30% have mother abnormalities
103
Q

Clinical Presentation of Congenital Heart Disease

104
Q

Aetiology, Risk Factors and Investigations for Congenital Heart Disease

105
Q

Grades of murmurs

106
Q

Characteristics of Pathological Murmurs

107
Q

Innocent murmurs

108
Q

Classification of Congenital Heart Disease

109
Q

Types of Left-Right Shunts and their Characteristics in Acyanotic Heart Disease

110
Q

Types of Obstructive Lesions and their characteristics in Acyanotic Heart Disease

111
Q

Types of Obstructive Lesions and their characteristics in Cyanotic Heart Disease

112
Q

Admixtures in Cyanotic Heart Disease

113
Q

Type of murmur indication which lesion

114
Q

Description, exam and management of Functional Constipation

115
Q

Hirschsprung’s Disease:

  • Description
  • Investigation
  • Differential Diagnosis
  • Management
  • Complications
116
Q

Definition of Diarrhoea

117
Q

Aetiology of Diarrhoea

118
Q

Clinical Work Up for Diarrhoea

119
Q

Pathophysiology of Diarrhoea

120
Q

Life-threatening conditions associated with Diarrhoea

121
Q

Definition and Epidemiology of Gastroenteritis

A

Definition:

  • Inflammation of the GIT caused usually by a viral infection
  • Usually self-limiting but can lead to morbidity and mortality 2° to dehydration and electrolyte imbalances

Epidemiology:

  • Most common cause of death in children of developing world (associated with poverty and poor hygiene)
  • 95% of gasteroenteritis hospitalisations occur in children < 5 years
122
Q

Aetiology and Risk Factors of Gastroenteritis

123
Q

Pathophysiology of Gastroenteritis

124
Q

Clinical Features, Investigations and Diagnosis of Gastroenteritis

125
Q

Management, Complications and Prognosis of Gastroenteritis

126
Q

Definition of Vomiting and Nausea

127
Q

Red Flags for Vomiting

128
Q

Aetiology of Vomiting

129
Q

Age specific aetiologies of vomiting

Oesophageal Atresia and Tracheo-oesophageal Fistula in Neonates and infants:

  • Description
  • Presentation
  • Diagnosis
  • Management
130
Q

Age specific aetiologies of vomiting

GORD in Neonates and Infants:

  • Description
  • Features
  • Investigation
  • Diagnosis
  • Management
131
Q

Age specific aetiologies of vomiting

Pyloric Stenosis in Neonates and Infants:

  • Description
  • Presentation
  • Investigations
  • Management
132
Q

Age specific aetiologies of vomiting

Duodenal Atresia in Neonates and Infants

  • Description/Causes
  • Presentation
  • Investigation
  • Management
133
Q

Age specific aetiologies of vomiting

Malrotation with Volvolus in Neonates and Infants

  • Description
  • Type
  • Clinical Features
  • Investigation
  • Management
134
Q

Age specific aetiologies of vomiting

Intussusception in Neonates and Infants

  • Description
  • Clinical Features
  • Investigation
  • Management
  • Complications
  • Prognosis
135
Q

Age specific aetiologies of vomiting

Adrenal Insufficiency in Neonates and Infants

136
Q

Age specific Aetiologies of vomiting in older infants and children

137
Q

Age specific Aetiologies of vomiting in Adolescents

138
Q

Electrolyte disturbances in vomiting

139
Q

Aetiology of Acute Renal Failure in Children

A

Aetiology:

  • Acute tubular necrosis from severe dehydration
  • Acute post-streptococcal GN
  • Haemolytic uraemic syndrome
140
Q

Pathophysiology of Acute Renal Failure in Children

141
Q

Clinical Features of Acute Renal Failure in Children

A

Clinical Features:

  • Unwell patient with Oliguria
  • Macroscopic haematuria
  • Bloody diarrhoea followed by reduced urine output
  • Periorbital oedema or abdominal oedema
  • Headache and signs of dehydration
  • Seizures
  • Fevers, rash, signs of infection, fluid retention
142
Q

Investigations for Acute Renal Failure in Children

143
Q

Management for Acute Renal Failure in Children

144
Q

Definition of Glomerulonephritis

145
Q

Aetiology of Glomerulonephritis

146
Q

Pathophysiology of Glomerulonephritis

147
Q

Classification of Glomerulonephritis

148
Q

Clinical Presentation of Glomerulonephritis

149
Q

Investigations and Management of Glomerulonephritis

150
Q

Complications and Prognosis of Glomerulonephritis

151
Q

Post-strep Glomerulonephritis

152
Q

Definition and Epidemiology of Haemolytic Uraemic Syndrome

153
Q

Aetiology and Pathophysiology of Haemolytic Uraemic Syndrome

154
Q

Clinical Presentation of Haemolytic Uraemic Syndrome

155
Q

Investigations and diagnosis of Haemolytic Uraemic Syndrome

156
Q

Management and Prognosis of Haemolytic Uraemic Syndrome

157
Q

Definition and Epidemiology of Henoch-Schonlein Purpura

158
Q

Aetiology and Pathophysiology of Henoch-Schonlein Purpura

159
Q

Clinical Presentation of Henoch-Schonlein Purpura

160
Q

Investigation and Diagnosis of Henoch-Schonlein Purpura

161
Q

Management and Prognosis of Henoch-Schonlein Purpura

162
Q

Definition and Aetiology of Nephrotic Syndrome

163
Q

Pathophysiology of Nephrotic Syndrome

164
Q

Clinical Features of Nephrotic Syndrome

A

Clinical Features:

  • Periorbital oedema, peripheral oedema or anasarca (generalised oedema) develops later
  • Hx of recent viral illness
  • Absence of haematuria • Normotensive
165
Q

Investigations and Diagnosis of Nephrotic Syndrome

166
Q

Management and Complications of Nephrotic Syndrome

167
Q

Definition and Epidemiology of UTI in Children

168
Q

Aetiology of UTI in Children

169
Q

Risk Factors of UTI in Children

170
Q

Pathophysiology of UTI in Children

171
Q

Clinical Features of UTI in Children

172
Q

Investigations of UTI in Children

173
Q

Management of UTI in Children

174
Q

Complications and Prognosis of UTI in Children

175
Q

Foetal Circulation

176
Q

Transition of Foetal Circulation at Birth

177
Q

Shunt closure after delivery

178
Q

Patent Ductus Arteriosus

179
Q

Patent Foramen Ovale

180
Q

Definition and Epidemiology of Cystic Fibrosis

181
Q

Aetiology and Pathophysiology of Cystic Fibrosis

182
Q

Clinical Features of Cystic Fibrosis

183
Q

Investigations for Cystic Fibrosis

184
Q

Management of Cystic Fibrosis

185
Q

Complications and Prognosis of Cystic Fibrosis

186
Q

Neonatal check - Inspection

187
Q

Neonatal check - Head and Neck

188
Q

Neonatal check - Chest

189
Q

Neonatal check - Abdomen

190
Q

Neonatal check - Hips and Feet

191
Q

Barlow and Ortolani’s test + Developmental Dysplasia of Hip

192
Q

Neonatal Heel Prick Test

193
Q

Definition and Epidemiology of Neonatal Jaundice

A

Definition:

• Neonatal jaundice is a rise in serum bilirubin > 3x normal, in the first 28 days of life

Epidemiology:

  • All infants develop elevated bilirubin levels in the 1st week of life
  • Affects 50-70% of term babies and 80% of preterm babies
  • Infants with severe hyperbilirubinaemia are at risk of Bilirubin-induced Neurological Dysfunction
194
Q

Aetiology of Neonatal Jaundice

195
Q

Risk Factors of Neonatal Jaundice

A

Risk Factors:

  • Decreased gestational age
  • Maternal diabetes - Mothers have 3x more β-glucaronidase in their breast milk –> neonatal jaundice
  • East Asian - genetic factors
  • Decreased caloric intake and weight loss
  • Breastfeeding
196
Q

Classification and Pathophysiology of Neonatal Jaundice

197
Q

Clinical Features of Neonatal Jaundice

198
Q

Investigations for Neonatal Jaundice

199
Q

Management of Neonatal Jaundice

200
Q

Complications of Neonatal Jaundice

201
Q

Description of Respiratory Distress in Infants

202
Q

Definition and Epidemiology of Infant Respiratory Distress Syndrome

203
Q

Aetiology of Infant Respiratory Distress Syndrome

204
Q

Pathophysiology of Infant Respiratory Distress Syndrome

205
Q

Clinical Features of Infant Respiratory Distress Syndrome

206
Q

Investigations and Diagnosis of Infant Respiratory Distress Syndrome

207
Q

Differential Diagnosis of Infant Respiratory Distress Syndrome

208
Q

Management of Infant Respiratory Distress Syndrome

209
Q

Complications of Infant Respiratory Distress Syndrome

210
Q

Neonatal period and evaluation of the new born

211
Q

Newborn Screening

212
Q

Definition of Pre-term baby

213
Q

Epidemiology of Pre-term baby

214
Q

Risk Factors of Pre-term baby

215
Q

Physiological challenges of Pre-term baby

216
Q

Complications of Pre-term baby

217
Q

Definition and key points to note about Failure to Thrive

218
Q

Normal patterns of growth in the context of Failure to Thrive

219
Q

Aetiology for Failure to Thrive

220
Q

History questions to ask for Failure to Thrive

221
Q

Examinations to cover for Failure to Thrive

222
Q

Investigations for Failure to Thrive

223
Q

Disease entities relating to Failure to Thrive

224
Q

IBD in children

225
Q

Advantages of breastmilk and contraindications for breastfeeding

226
Q

Supplements for feeding infants

227
Q

Breast Milk Vs Cow’s Milk

228
Q

Advice on introducing foods to infants

P2 (5 decks)

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