Paediatrics Flashcards
1
Q
What are the 3 shunts in foetal circulation and what do they do
A
ductus venosus - umbilical artery to inferior vena cava to bypass liver
foramen ovale - right to left atrium to bypass pulmonary circulation
ductus arteriosus - pulmonary artery to aorta to bypass pulmonary circulation
2
Q
what happens during the first breath a neonate takes to the cardiovascular system
A
expands alveoli reducing pulmonary vascular resistance, which reduces pressure in the right atrium. this means left atrial pressure is greater than right atrial pressure, closing the foramen ovale
3
Q
examples of left to right shunt
A
atrial or ventricular septum defect
4
Q
what is the appearance of a neonate with left to right shunt
A
breathless
5
Q
examples of right to left shunt
A
tetralogy of Fallot/transposition of great arteries
6
Q
what is the appearance of a neonate with right to left shunt
A
blue
7
Q
examples of common mixing
A
atrioventricular septal defect
8
Q
symptoms of common mixing
A
blue and breathless
9
Q
Key investigations for paediatric cardiology
A
ECG and doppler ultrasound (diagnostic)
10
Q
What heart defects are associated with SLE
A
Complete heart block (due to anti Ra and Anti Lo)
11
Q
What heart defects are associated with foetal alcohol syndrome
A
Septal defects and tetralogy of Fallot
12
Q
What heart defects are associated with maternal use of warfarin
A
pulmonary stenosis
13
Q
What heart defects does trisomy 21/downs cause
A
Atrial septal defect/tetralogy of Fallot
14
Q
What heart defect does turners syndrome cause
A
Coarctation of aorta/aortic stenosis
15
Q
What heart defect does Williams syndrome (deletion on chromosome 7) cause
A
Aortic/pulmonary stenosis
16
Q
what are the symptoms of heart failure
A
sweating, breathlessness, poor feeding
17
Q
what are the signs of heart failure
A
poor weight gain, tachycardia, tachypnoea, galloping murmur, cardio/hepatomegaly
18
Q
Causes of heart failure in neonates (under 1 week)
A
Coarctation of aorta
19
Q
Causes of heart failure in infants over 1 weeks
A
persistant ductus arteriosus,
20
Q
causes of heart failure in older children
A
rheumatic fever/cardiomyopathy
21
Q
Causes if peripheral cyanosis
A
cold, illness, polycythaemia
22
Q
where is central cyanosis seen in neonates
A
on the tongue
23
Q
Atrial septal defect symptoms +signs (murmur)
A
Asymptomatic, may cause arrythmia in older children
ejection systolic murmor at upper left sternal edge
24
Q
what is a secundum atrial septal defect
A
defect in centre of septum involving foramen ovale
25
what is a Primium septal defect
Defect at bottom of septum involving atrioventricular valves
26
What are the investigations for atrial septal defects
chest radiograph - cardiomegaly and enlarged pulmonary artery
echocardiogram - gold standard diagnostic
27
What is the management for atrial septal defect
cardiac catheterisation and occlusion device, or surgery at 3 to 4 years if large
28
what type of shunt is an atrial septal defect
left to right
29
ventricular septal defect pathopysiology
high pressure in the left side of the heart forces blood through the defect to the right side of the heart, which then travels through the pulmonary artery and causes pulmonary over circulation
30
what size is a small ventricular septal defect
3mm/smaller than aortic valve
31
small ventricular septal defect symptoms + signs (murmur)
NO symptoms
Pansystolic murmur best heard at lower left sternal edge
32
Investigation of small ventricular septal defects
echocardiogram to visualise anatomy
33
management of small ventricular septal defects
None - will close spontaneously
34
Symptoms of large ventricular septal defects
poor feeding, breathlessness, faltering growth after 1 week
35
signs of large ventricular septal defects
Oedema, hepatomegaly, tachycardia, tachypnoea
36
murmur of large ventricular septal defects
Loud pansystolic murmur best heard at lower left sternal edge
37
Investigations for large ventricular septal defect
chest radiograph shows heart failure - cardiomegaly/enlarged pulmonary arteries
echocardiogram shows anatomy/is diagnostic
38
Management of large ventricular septal defects
Diuretics to prevent oedema
increased calorie milk to aid growth
surgery at 3-6 months to prevent Eisenmenger's syndrome
39
Persistant ductus arteriosus pathophysiology
failure of ductus arteriosus (connecting pulmonary artery to descending aorta) to close 1 month after expected delivery, due to failure of constrictor mechanism or high levels of prostaglandins (low levels cause closure)
40
What type of shunt is a ventricular septal defect
Left to right
41
Signs and symptoms of persistent ductus arteriosus
symptoms (tachycardia/tachypnoea/poor feeding)
signs (persistent murmur between left clavicle, bounding pulse)
42
Investigation of persistent ductus arteriosus
echocardiogram
43
Management of persistent ductus arteriosus
closure with coil/occlusion device via catheter
44
Management of duct dependent heart failure
Give IV prostaglandins to prevent closure
45
What are the 4 cardinal features of tetralogy of Fallot
Large ventricular septal defect
overriding of the aorta
Subpulmonary stenosis causing
right ventricular hypertrophy
46
symptoms and signs (murmur) of tetralogy of Fallot
Respiratory distress and poor feeding, self limiting cyanotic spells
Signs: ejection systolic murmur at left sternal edge starting within one day of life
47
Investigations of tetralogy of Fallot
chest radiograph shows boot shaped heart (due to right ventricular hypertrophy
Echocardiogram shows cardinal features
48
Management of tetralogy of Fallot
surgery at 6 months to repair
49
what conditions/syndromes cause tetralogy of Fallot
foetal alcohol syndrome/di George's syndrome
50
Transposition of great arteries explanation/pathophysiology
aorta and pulmonary artery are swapped, so aorta is on the right side of the heart and pulmonary artery is on the left. this means deoxygenated blood from the body is sent back to the body, and oxygenated blood from the lungs is sent back to the lungs. This is a surgical emergency
51
Transposition of great arteries presentation
picked up up on congenital abnormality screening
OR
severe cyanosis
52
Transposition of great arteries management
immediate surgery to create shunt in atrial septum then surgery to switch aorta and pulmonary artery later in life
53
What is pneumonia
infection of the lungs and airways causing inflamation and speutum production
54
Symptoms of pneumonia
productive wet cough
fever over 38.5
tachycardia
tachypnoea/respiratory distress
lethargy/fatigue
delerium
55
what do you hear in a stethoscope for pneumonia
focal corse crackles
bronchial breath sounds equally loud on inspiration and expiration
56
what physical signs do you expect in pneumonia
deranged - signs of sepsis - high fever, tachycardia, tachypnoea, hypoxia, hypotension
57
signs of respiratory distress
tachypnoea
use of surrounding muscle
subcostal and intercostal recession - skin under ribs sucked in with breath
hypoxia
nostril flaring
tracheal tugging
abnormal breath sounds/grunting/wheezing/stridor
58
Causes of pneumonia - bacteria
bacteria
streptococcus pneumonia
streptococcus A - strep pyrogens
Strep group B - if under 1 month
staphylococcus aureus
59
viral causes of pneumonia
RSV - respiratory syncytial virus
Infuenzae virus
parainfluenzae
60
other causes of pneumonia and treatment
Mycoplasma - clarithromycin/erythromycin
61
investigation of pneumonia
chest x ray - dense or fluffy opacity in lung
blood culture
speutum culture/throat swabs
inflamatory markers/CRP
62
treatment of pneumonia
amoxycillin + erythromycin
oxygen if required
63
what is croup
a viral infection that causes oedema in the larynx
64
what age group does croup affect
6 months to 2 year
65
what organisms cause croup
Adenovirus
influenzae virus
parainfluenza virus
respiratory syncytial virus (RSV)
66
Symptoms of croup
increased work of breathing
stridor
low grade fever
barking cough
horse voice
67
croup treatment
conservative management
Oral dexamethasone 150mcg/kg if severe. prednisolone second line
68
What is asthma
asthma is a chronic condition characterised by reversible airway constriction
69
asthma pathophysiology
IgE mediated inflamation bronchoconstriction and oedema formation. Triggers are detected by T-cells that use IgE to cause mast cells to release histamine. This casues the hypersensitive smooth muscles of the airway to constrict
70
Symptoms of asthma
wheeze
shortness of breath
diurnal variation/cough at night
Dry cough
Not asthma:
wheeze only when infected
unilateral wheeze
finger clubbing - cystic fibrosis/bronchiectasis
71
signs of asthma
bilateral variable polyphonic expiratory wheeze
72
Triggers for asthma
excersice
cold
dust
mould
smoke
pets
shellfish/peanuts
73
Asthma investigations
if over 5 peak flow diary
spirometry with reversibility testing
74
Asthma treatment goals
no daytime symptoms
no limits to excersice
no nocturnal waking
no need to rescue medication
no asthma attacks
75
under 5's asthma treatment
SABA - salbutamol
Then: corticosteroid inhaler Leukotriene receptor agonist eg oral Montelukast
Then: both
76
5+ asthma treatment
SABA - salbutamol
low dose corticosteroid inhaler
LABA - salmeterol
Leukotriene report agonist eg Montelukast
77
asthma risk factors
low birth weight, prematurity, parental smoking
viral bronchiolitis in early life
family History of Atopy
78
salbutamol mechanism of action
stimulates beta 2 adrenergic receptors
79
What are the characteristics of a mild/moderate asthma attack
O2 above 92
Peak flow above 50 of expected
respiratory rate below 30 in over 5's (40 in under)
able to speak in full sentences
wheeze
80
what are the characteristics of a severe asthma attack
O2 below 92%
Peak flow below 50% of expected
resp rate over 30 in over 5's, 40 in under 5's
heart rate over 125 in over 5's, 140 in under 5's
unable to speak or feed
wheeze
accessory chest muscle use
81
what are the characteristics of life threatening asthma attacks
O2 below 92%
peak flow below 33% of expected
Silent chest
cyanosis
reduced respiratory effort
altered conscousness/confusion
hypotension
82
Treatment of an acute asthma attack
Supplemental oxygen
Salbutamol nebuliser
Then salbutamol nebuliser + ipratropium bromide
Then Oral prednisolone (1mg/kg) continued for 3 days
Then IV Salbutamol bolus
Then IV magnesium sulfate
83
Side effects of high dose salbutamol
tachycardia/tremor
Low potassium as it causes it to be absorbed into cells
84
what age group can get viral induced wheeze
under 3
85
what organisms cause viral induced wheeze
rhinovirus or respiratory syncytial virus (RSV)
86
what is the pathophysiology behind viral induced wheeze
rhinovirus or respiratory syncytial virus (RSV) causes inflamation and oedema. In young children with small airways, this causes a wheeze and respiratory distress
87
Viral induced wheeze vs asthma
Viral induced wheeze occurs in under 3's, only when ill, has no other atopic conditions
88
Presentation of viral induced wheeze
fever (cough/runny nose)
shortness of breath
expiratory wheeze
respiratory distress
89
How to manage Viral induced wheeze
Same as asthma
Nebulised salbutamol
Then nebulised salbutamol + Ipratropium Bromide
Then oral dexamethasone/prednisolone (continue for 3 days, 1mg/kg)
Then IV salbutamol bolus
Then IV magnesium sulfate
90
what is bronchiolitis (pathophysiology, age and organism cause)
bronchiolitis is an infection in under 1 year olds caused by RSV that casues inflamation of the bronchioles
91
Symptoms of bronchiolitis and what on auscultation
Corysal symptoms - runny nose, sneeze, runny eyes
dyspnoea
tachypnoea
poor feeding
apnoea - stopping breathing
respiratory distress
wheeze and crackles on auscultations
92
What does bronchiolitis make more likely at a later age
Viral induced wheeze
93
Investigation + findings for bronchiolitis
capilary blood gass - respiratory acidosis (rising CO2 falling pH) - respiratory failure
94
Management
supportive - NG tube, nasal saline drops, CPAP/high flow humidified oxygen
If severe
Palivizumab injection - monoclonal antibody against RSV
95
what is Epiglottitis and what is the causative organism
infection and inflamation of the epiglottis, typically with haemophilus influenzae group B, that may completely occlude the airway
96
Epiglottis presentation
Stridor
Tripod position
drooling
difficulty swallowing
sore throat
fever
97
what is stridor
a high pitched sound when breathing in or out
98
Investigations for epiglottitis
NONE - do not distress child
Xray may show thumbprint sign but not necessary
99
Management of epiglottitis
IV ceftriaxone - antibiotic
Dexamethasone to reduce inflamation
If required (rarely)
Intubation/Tracheostomy
100
What is scoliosis
lateral curvature of the spine
101
when is scoliosis early/late onset
early when it occurs before 10
102
Scoliosis presentation
Pain
unable to stand straight
tilting shoulders to one side
turning head
dyspnoea if lung compression
103
Scoliosis treatment
physiotherapy/braces
rarely spinal straightening surgery
104
What is Torticollis
a congenital condition where the sternocleidomastoid is shortened making it difficult for babies to turn their head to one side
105
when does torticollis present
6-8 weeks
106
what condition is torticollis associated with
developmental hip dysplasia
107
risk factors for torticollis
shoulder dystocia/first child
108
Presentation of torticollis
head tilts to opposite side as chin
limited range of motion
flat head from lying on it
small lump on shoulder that goes away after 6 months
109
treatment for torticollis
encourage baby to look on affected side
put toys/changing table/stand do that side
Tummy time
surgical lengthening possible
110
what is transient synovitis/irritable hip
temporary inflamation and irritation of the synovial membrane of the hip, associated with recent Upper respiratory infection
111
Transient synovitis/irritable hip presentation
NO current infection
Virus 2 weeks ago
pain
refusal to weigh bear
limp
112
transient synovitis/irritable hip management
analgesia + safety net. spontaneously improve in 24 hours.
113
What is septic arthritis and when does it occur
an infection in the joint, under 4 most common
114
what organisms cause of septic arthritis
staphylococcus aureus
group A strep (streptococcus pyrogens)
If sexually active Neisseria gonorrhoea
haemophilus influenzae
115
Symptoms of septic arthritis
sudden onset unilateral red hot swolen painful joint (knee or hip)
refusal to weight bear
loss of range of motion
fever, lethargy, sepsis
116
Management of septic arthritis
IV antibiotics
Surgical drainage
117
Septic arthritis investigation
joint aspiration + gram staining + sensitivity
118
what is Kocher criteria for
assessment of septic arthritis
119
what components make up the Kocher criteria
arthritis
refusal to weight bare
Raised white cells over 11
Raised ESR
Fever over 38.5
120
what is osteomyelitis and where is it common
infection of the bone or bone marrow, particularly common around the epiphysis of long bones (distal femur)
121
What organisms cause osteomyelitis
Staphylococcus aureus (most common) (gram positive cocci in clumps)
Streptococcus (gram positive chains)
Haemophilus influenzae
122
Osteomyelitis presentation
pain
refusal to weight bear
swelling/tenderness
?fever - septic arthritis possible
123
What can osteomyelitis progress to
Septic arthritis
124
Risk factors for osteomyelitis
Boys
under 10
open fracture/orthopaedic surgery
HIV/immunocompromise
sickle cell anaemia
125
Investigations for osteomyelitis
X-ray first line
MRI diagnostic
Blood culture/joint aspiration to establish causative organism
126
Treatment of osteomyelitis
Long course antibiotics (IV cefuroxime for 6 weeks OR Flucloxacillin for 3 weeks)
MAYBE
surgical drainage /debridlement
127
What is osteogenesis imperfecta
A genetic condition causing brittle bones due to the incorrect production of collagen
128
where is collagen found in the body
Bones, Skin, tendons and connective tissue
129
osteogenesis imperfecta key symptoms
inappropriate recurrent fractures and blue grey sclera of eyes
130
Osteogenesis imperfecta ALL symptoms
inappropriate recurrent fractures
blue/grey sclera
hypermobility
short stature
bone pain
problems with teeth formation
131
Investigations for osteogenesis imperfecta
Genetic testing
X-ray to assess fractures
132
treatment for osteogenesis imperfecta
Vitamin D supliments
Bisphosphonates for bone mineral density
