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3A Flashcards > Paediatrics > Flashcards

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

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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

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3
Q

examples of left to right shunt

A

atrial or ventricular septum defect

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4
Q

what is the appearance of a neonate with left to right shunt

A

breathless

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5
Q

examples of right to left shunt

A

tetralogy of Fallot/transposition of great arteries

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6
Q

what is the appearance of a neonate with right to left shunt

A

blue

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7
Q

examples of common mixing

A

atrioventricular septal defect

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8
Q

symptoms of common mixing

A

blue and breathless

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9
Q

Key investigations for paediatric cardiology

A

ECG and doppler ultrasound (diagnostic)

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10
Q

What heart defects are associated with SLE

A

Complete heart block (due to anti Ra and Anti Lo)

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11
Q

What heart defects are associated with foetal alcohol syndrome

A

Septal defects and tetralogy of Fallot

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12
Q

What heart defects are associated with maternal use of warfarin

A

pulmonary stenosis

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13
Q

What heart defects does trisomy 21/downs cause

A

Atrial septal defect/tetralogy of Fallot

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14
Q

What heart defect does turners syndrome cause

A

Coarctation of aorta/aortic stenosis

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15
Q

What heart defect does Williams syndrome (deletion on chromosome 7) cause

A

Aortic/pulmonary stenosis

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16
Q

what are the symptoms of heart failure

A

sweating, breathlessness, poor feeding

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17
Q

what are the signs of heart failure

A

poor weight gain, tachycardia, tachypnoea, galloping murmur, cardio/hepatomegaly

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18
Q

Causes of heart failure in neonates (under 1 week)

A

Coarctation of aorta

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19
Q

Causes of heart failure in infants over 1 weeks

A

persistant ductus arteriosus,

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20
Q

causes of heart failure in older children

A

rheumatic fever/cardiomyopathy

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21
Q

Causes if peripheral cyanosis

A

cold, illness, polycythaemia

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22
Q

where is central cyanosis seen in neonates

A

on the tongue

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23
Q

Atrial septal defect symptoms +signs (murmur)

A

Asymptomatic, may cause arrythmia in older children
ejection systolic murmor at upper left sternal edge

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24
Q

what is a secundum atrial septal defect

A

defect in centre of septum involving foramen ovale

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25
Q

what is a Primium septal defect

A

Defect at bottom of septum involving atrioventricular valves

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26
Q

What are the investigations for atrial septal defects

A

chest radiograph - cardiomegaly and enlarged pulmonary artery
echocardiogram - gold standard diagnostic

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27
Q

What is the management for atrial septal defect

A

cardiac catheterisation and occlusion device, or surgery at 3 to 4 years if large

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28
Q

what type of shunt is an atrial septal defect

A

left to right

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29
Q

ventricular septal defect pathopysiology

A

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

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30
Q

what size is a small ventricular septal defect

A

3mm/smaller than aortic valve

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31
Q

small ventricular septal defect symptoms + signs (murmur)

A

NO symptoms
Pansystolic murmur best heard at lower left sternal edge

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32
Q

Investigation of small ventricular septal defects

A

echocardiogram to visualise anatomy

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33
Q

management of small ventricular septal defects

A

None - will close spontaneously

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34
Q

Symptoms of large ventricular septal defects

A

poor feeding, breathlessness, faltering growth after 1 week

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35
Q

signs of large ventricular septal defects

A

Oedema, hepatomegaly, tachycardia, tachypnoea

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36
Q

murmur of large ventricular septal defects

A

Loud pansystolic murmur best heard at lower left sternal edge

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37
Q

Investigations for large ventricular septal defect

A

chest radiograph shows heart failure - cardiomegaly/enlarged pulmonary arteries
echocardiogram shows anatomy/is diagnostic

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38
Q

Management of large ventricular septal defects

A

Diuretics to prevent oedema
increased calorie milk to aid growth
surgery at 3-6 months to prevent Eisenmenger’s syndrome

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39
Q

Persistant ductus arteriosus pathophysiology

A

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)

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40
Q

What type of shunt is a ventricular septal defect

A

Left to right

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41
Q

Signs and symptoms of persistent ductus arteriosus

A

symptoms (tachycardia/tachypnoea/poor feeding)
signs (persistent murmur between left clavicle, bounding pulse)

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42
Q

Investigation of persistent ductus arteriosus

A

echocardiogram

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43
Q

Management of persistent ductus arteriosus

A

closure with coil/occlusion device via catheter

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44
Q

Management of duct dependent heart failure

A

Give IV prostaglandins to prevent closure

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45
Q

What are the 4 cardinal features of tetralogy of Fallot

A

Large ventricular septal defect
overriding of the aorta
Subpulmonary stenosis causing
right ventricular hypertrophy

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46
Q

symptoms and signs (murmur) of tetralogy of Fallot

A

Respiratory distress and poor feeding, self limiting cyanotic spells

Signs: ejection systolic murmur at left sternal edge starting within one day of life

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47
Q

Investigations of tetralogy of Fallot

A

chest radiograph shows boot shaped heart (due to right ventricular hypertrophy
Echocardiogram shows cardinal features

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48
Q

Management of tetralogy of Fallot

A

surgery at 6 months to repair

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49
Q

what conditions/syndromes cause tetralogy of Fallot

A

foetal alcohol syndrome/di George’s syndrome

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50
Q

Transposition of great arteries explanation/pathophysiology

A

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

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51
Q

Transposition of great arteries presentation

A

picked up up on congenital abnormality screening
OR
severe cyanosis

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52
Q

Transposition of great arteries management

A

immediate surgery to create shunt in atrial septum then surgery to switch aorta and pulmonary artery later in life

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53
Q

What is pneumonia

A

infection of the lungs and airways causing inflamation and speutum production

54
Q

Symptoms of pneumonia

A

productive wet cough
fever over 38.5
tachycardia
tachypnoea/respiratory distress
lethargy/fatigue
delerium

55
Q

what do you hear in a stethoscope for pneumonia

A

focal corse crackles
bronchial breath sounds equally loud on inspiration and expiration

56
Q

what physical signs do you expect in pneumonia

A

deranged - signs of sepsis - high fever, tachycardia, tachypnoea, hypoxia, hypotension

57
Q

signs of respiratory distress

A

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
Q

Causes of pneumonia - bacteria

A

bacteria
streptococcus pneumonia
streptococcus A - strep pyrogens
Strep group B - if under 1 month
staphylococcus aureus

59
Q

viral causes of pneumonia

A

RSV - respiratory syncytial virus
Infuenzae virus
parainfluenzae

60
Q

other causes of pneumonia and treatment

A

Mycoplasma - clarithromycin/erythromycin

61
Q

investigation of pneumonia

A

chest x ray - dense or fluffy opacity in lung
blood culture
speutum culture/throat swabs
inflamatory markers/CRP

62
Q

treatment of pneumonia

A

amoxycillin + erythromycin
oxygen if required

63
Q

what is croup

A

a viral infection that causes oedema in the larynx

64
Q

what age group does croup affect

A

6 months to 2 year

65
Q

what organisms cause croup

A

Adenovirus
influenzae virus
parainfluenza virus
respiratory syncytial virus (RSV)

66
Q

Symptoms of croup

A

increased work of breathing
stridor
low grade fever
barking cough
horse voice

67
Q

croup treatment

A

conservative management
Oral dexamethasone 150mcg/kg if severe. prednisolone second line

68
Q

What is asthma

A

asthma is a chronic condition characterised by reversible airway constriction

69
Q

asthma pathophysiology

A

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
Q

Symptoms of asthma

A

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
Q

signs of asthma

A

bilateral variable polyphonic expiratory wheeze

72
Q

Triggers for asthma

A

excersice
cold

dust
mould
smoke
pets
shellfish/peanuts

73
Q

Asthma investigations

A

if over 5 peak flow diary
spirometry with reversibility testing

74
Q

Asthma treatment goals

A

no daytime symptoms
no limits to excersice
no nocturnal waking
no need to rescue medication
no asthma attacks

75
Q

under 5’s asthma treatment

A

SABA - salbutamol
Then: corticosteroid inhaler Leukotriene receptor agonist eg oral Montelukast
Then: both

76
Q

5+ asthma treatment

A

SABA - salbutamol
low dose corticosteroid inhaler
LABA - salmeterol
Leukotriene report agonist eg Montelukast

77
Q

asthma risk factors

A

low birth weight, prematurity, parental smoking

viral bronchiolitis in early life
family History of Atopy

78
Q

salbutamol mechanism of action

A

stimulates beta 2 adrenergic receptors

79
Q

What are the characteristics of a mild/moderate asthma attack

A

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
Q

what are the characteristics of a severe asthma attack

A

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
Q

what are the characteristics of life threatening asthma attacks

A

O2 below 92%
peak flow below 33% of expected
Silent chest
cyanosis
reduced respiratory effort
altered conscousness/confusion
hypotension

82
Q

Treatment of an acute asthma attack

A

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
Q

Side effects of high dose salbutamol

A

tachycardia/tremor
Low potassium as it causes it to be absorbed into cells

84
Q

what age group can get viral induced wheeze

A

under 3

85
Q

what organisms cause viral induced wheeze

A

rhinovirus or respiratory syncytial virus (RSV)

86
Q

what is the pathophysiology behind viral induced wheeze

A

rhinovirus or respiratory syncytial virus (RSV) causes inflamation and oedema. In young children with small airways, this causes a wheeze and respiratory distress

87
Q

Viral induced wheeze vs asthma

A

Viral induced wheeze occurs in under 3’s, only when ill, has no other atopic conditions

88
Q

Presentation of viral induced wheeze

A

fever (cough/runny nose)
shortness of breath
expiratory wheeze
respiratory distress

89
Q

How to manage Viral induced wheeze

A

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
Q

what is bronchiolitis (pathophysiology, age and organism cause)

A

bronchiolitis is an infection in under 1 year olds caused by RSV that casues inflamation of the bronchioles

91
Q

Symptoms of bronchiolitis and what on auscultation

A

Corysal symptoms - runny nose, sneeze, runny eyes
dyspnoea
tachypnoea
poor feeding
apnoea - stopping breathing
respiratory distress

wheeze and crackles on auscultations

92
Q

What does bronchiolitis make more likely at a later age

A

Viral induced wheeze

93
Q

Investigation + findings for bronchiolitis

A

capilary blood gass - respiratory acidosis (rising CO2 falling pH) - respiratory failure

94
Q

Management

A

supportive - NG tube, nasal saline drops, CPAP/high flow humidified oxygen

If severe
Palivizumab injection - monoclonal antibody against RSV

95
Q

what is Epiglottitis and what is the causative organism

A

infection and inflamation of the epiglottis, typically with haemophilus influenzae group B, that may completely occlude the airway

96
Q

Epiglottis presentation

A

Stridor
Tripod position
drooling

difficulty swallowing
sore throat
fever

97
Q

what is stridor

A

a high pitched sound when breathing in or out

98
Q

Investigations for epiglottitis

A

NONE - do not distress child
Xray may show thumbprint sign but not necessary

99
Q

Management of epiglottitis

A

IV ceftriaxone - antibiotic
Dexamethasone to reduce inflamation

If required (rarely)
Intubation/Tracheostomy

100
Q

What is scoliosis

A

lateral curvature of the spine

101
Q

when is scoliosis early/late onset

A

early when it occurs before 10

102
Q

Scoliosis presentation

A

Pain
unable to stand straight
tilting shoulders to one side
turning head
dyspnoea if lung compression

103
Q

Scoliosis treatment

A

physiotherapy/braces
rarely spinal straightening surgery

104
Q

What is Torticollis

A

a congenital condition where the sternocleidomastoid is shortened making it difficult for babies to turn their head to one side

105
Q

when does torticollis present

A

6-8 weeks

106
Q

what condition is torticollis associated with

A

developmental hip dysplasia

107
Q

risk factors for torticollis

A

shoulder dystocia/first child

108
Q

Presentation of torticollis

A

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
Q

treatment for torticollis

A

encourage baby to look on affected side
put toys/changing table/stand do that side
Tummy time

surgical lengthening possible

110
Q

what is transient synovitis/irritable hip

A

temporary inflamation and irritation of the synovial membrane of the hip, associated with recent Upper respiratory infection

111
Q

Transient synovitis/irritable hip presentation

A

NO current infection
Virus 2 weeks ago
pain
refusal to weigh bear
limp

112
Q

transient synovitis/irritable hip management

A

analgesia + safety net. spontaneously improve in 24 hours.

113
Q

What is septic arthritis and when does it occur

A

an infection in the joint, under 4 most common

114
Q

what organisms cause of septic arthritis

A

staphylococcus aureus
group A strep (streptococcus pyrogens)
If sexually active Neisseria gonorrhoea
haemophilus influenzae

115
Q

Symptoms of septic arthritis

A

sudden onset unilateral red hot swolen painful joint (knee or hip)
refusal to weight bear
loss of range of motion
fever, lethargy, sepsis

116
Q

Management of septic arthritis

A

IV antibiotics
Surgical drainage

117
Q

Septic arthritis investigation

A

joint aspiration + gram staining + sensitivity

118
Q

what is Kocher criteria for

A

assessment of septic arthritis

119
Q

what components make up the Kocher criteria

A

arthritis
refusal to weight bare
Raised white cells over 11
Raised ESR
Fever over 38.5

120
Q

what is osteomyelitis and where is it common

A

infection of the bone or bone marrow, particularly common around the epiphysis of long bones (distal femur)

121
Q

What organisms cause osteomyelitis

A

Staphylococcus aureus (most common) (gram positive cocci in clumps)
Streptococcus (gram positive chains)
Haemophilus influenzae

122
Q

Osteomyelitis presentation

A

pain
refusal to weight bear
swelling/tenderness

?fever - septic arthritis possible

123
Q

What can osteomyelitis progress to

A

Septic arthritis

124
Q

Risk factors for osteomyelitis

A

Boys
under 10
open fracture/orthopaedic surgery
HIV/immunocompromise
sickle cell anaemia

125
Q

Investigations for osteomyelitis

A

X-ray first line
MRI diagnostic
Blood culture/joint aspiration to establish causative organism

126
Q

Treatment of osteomyelitis

A

Long course antibiotics (IV cefuroxime for 6 weeks OR Flucloxacillin for 3 weeks)
MAYBE
surgical drainage /debridlement

127
Q

What is osteogenesis imperfecta

A

A genetic condition causing brittle bones due to the incorrect production of collagen

128
Q

where is collagen found in the body

A

Bones, Skin, tendons and connective tissue

129
Q

osteogenesis imperfecta key symptoms

A

inappropriate recurrent fractures and blue grey sclera of eyes

130
Q

Osteogenesis imperfecta ALL symptoms

A

inappropriate recurrent fractures
blue/grey sclera

hypermobility
short stature
bone pain
problems with teeth formation

131
Q

Investigations for osteogenesis imperfecta

A

Genetic testing
X-ray to assess fractures

132
Q

treatment for osteogenesis imperfecta

A

Vitamin D supliments
Bisphosphonates for bone mineral density

3A Flashcards (9 decks)

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