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Paediatrics Flashcards

1
Q

What is the commonest Congenital heart disease?

A

VSD

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2
Q

Which congenital heart disease is associated with Turner?

A

CoA

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3
Q

Which congenital heart disease is associated with Down Syndrome?

A

ASD

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4
Q

What is the presentation of VSD?

A

Holosystolic murmur

LLSB

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5
Q

What is the presentation of ASD?

A

Systolic ejection murmur

USB

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6
Q

What is the treatment of ASD/VSD?

A 
Small: spontaneous closure  
Surgical management if 
- failed medical management 
- pulmonary HTN 
- large defects
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7
Q

What is the presentation of a PDA?

A

Continuous machinery murmur
Pounding peripheral pulse
Wide pulse pressure

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8
Q

Where does the blood flow in a PDA?

A

Aorta to pulmonary artery

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9
Q

What is the treatment of a PDA?

A

Indomethacin (NSAID)

If indomethacin fails/child > 6-8mo: surgery

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10
Q

Come IN and CLOSE the door

A

Give INdomethacin to CLOSEE the PDA

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11
Q

What is the presentation of CoA?

A

High BP In upper extremities
Low BP in lower extremities
Weak femoral pulses

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12
Q

What are signs of CoA on CXR?

A

3 sign

Rib notching

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13
Q

What is the commonest cyanotic congenital heart lesion in the newborn?

A

Transposition of Great Vessels

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14
Q

When does Transposition of great vessels present?

A

Within first few hours after birth

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15
Q

What is the anatomy of transposition of great vessels?

A

Aorta on R ventricle
Pulmonary vessels on L ventricle

Need ASD/VSD and PDA to be compatible with life

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16
Q

What are maternal RF for Transposition of great vessels?

A

Diabetic mother

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17
Q

Mnemonic for DiGeorge Syndrome

A 
Cardiac abnormalities (transposition)
Abnormal facies (retrognathia, micrognatia, long face)
Thymic aplasia 
Cleft palate 
Hypocalcemia 
22q11 deletion
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18
Q

What is seen on CXR of transposition of great vessels/

A

Egg shaped silhouette

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19
Q

What is the treatment of transposition of great vessel?

A

IV PGE1
Surgical correction
Balloon atrial septostomy if cannot do surgery in first few days of life

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20
Q

What is the commonest cyanotic congenital heart lesion in childhood?

A

Tetralogy of Fallot

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21
Q

What is the anatomy of a tetralogy of fallot?

A

RV outflow tract obstruction
Overriding aorta
VSD
RVH

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22
Q

What is the presentation of a tetralogy of fallot?

A

Cyanosis in first 2 years of life but not immediately
SOB
Fatiguability
Get spell relieved by squat

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23
Q

What is seen on CXR of tetralogy of Fallot?

A

Boot shaped heart

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24
Q

What is the treatment of tetralogy of Fallot?

A

Immediate PGE1 to keep PDA open
Surgical
consultation

Tet spells” oxygen, morphine,

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25
What are features of Edward Syndrome?
Rocker-bottom feet Micrognathia Clenched hands Prominent occiput
26
What is the genetic mutation in cystic fibrosis?
Autosomal recessive | CFTR gene mutation on Kr 7
27
What is the newborn presentation of cystic fibrosis?
Obstruction of distal ileum
28
What is the > 1yo presentation of cystic fibrosis?
FTT Chronic sinopulmonary disease/sputum production Recurrent pulmonary infections Digital clubbing Chronic cough Nasap polyps Pancreatic insufficiency: greasy stools, rectal prolapse
29
Whar are CF patients at risk of?
Fat soluble vitamin deficiency secondary to malabsorption
30
What is the treatment of CF?
Antibiotics to cover Pseudomonas Pancreatic enzymes and fat soluble vitamins High calorie high protein diet
31
What is the age of onset of intussusseption?
6 mo - 3 yo
32
What is the presentation of intussusseption?
non-bilious vomit red currant jelly stool (late sign) colicky pain sausage shape RUQ mass
33
What is the sign on U/S for intussusseption?
target sign
34
What is the diagnostic test if high clinical suspicion of intussusseption
Air insufflation enema
35
What are the associations of pyloric stenosis?
First born infant Boy Formula fed Maternal erythromycin ingestion
36
What is the presention of pyloric stenosis?
Non-bilious vomit After a feed Projectile vomit Palpable olive mass
37
What is the age of onset of pyloric stenosis?
3 weeks - 6 weeks
38
What laboratory finding for pyloric stenosis?
Hypochloremic hypokalaemic metabolic alkalosis
39
Treatment of pyloric stenosis?
Initially: - NPO - IV access - Correct dehydration and acid-base abnormalities - Pyloromyotomy
40
What is the cause of Meckel's Diverticulum?
Omphalomesenteric duct fails to obliterate
41
What is the presentation of Meckel's diverticulum and age of onset?
< 2 yo Painless rectal bleeding Usually incidental finding
42
Rule of 2 for Meckel
``` 2% of population Symptomatic by age 2 2 x more common in boys 2 types of tissues" gastric, pancreatic 2 inches long 2 feet from iliocecal valve ```
43
Investigation of choice for Meckel?
Scintigraphy scan
44
Whar ia Hurschsprung disease?
Lack of ganglion cells in distal colon | Decreased motility due to unopposed smooth muscle tone
45
What diseases is Hurschsprung disease associated with?
Male Down Syndrome Waardenbur syndrome MEN 2
46
Presentation of Hurschsprung disease?
Failure to pass meconium in first 48 hours of birth On Physical exam: explosive stool after rectal exam Lack of stool in rectum Abnormal sphincter tone
47
Investigation of choice for Hurshsprung?
Barium enema | Rectal biopsy confirms diagnosis
48
Presentation of malrotation?
Bilius vomit | First month of life
49
What is the characteristic appearance of malrotation on imaging?
Bird beak appearance
50
Treatment of malrotation?
NG tube insertion to decompress intestine IV fluid hydration Emergent surgical repair
51
What are risk factors for necrotizing enterocolitis?
Low birth weight Premature infant Hypotension Enteral feed: formula
52
What portion of the bowel undergoes necrosis in NEC?
Terminal ileum/proximal colon
53
Presentation of necrotizing enterocolitis?
``` First few days of life Feeding intolerance Delayed gastric emptying Abdominal distension Bloody stools ``` Can complicate to shock, intestinal perforation, abdominal erythema
54
What is the investigation for NEC? | What is the pathomneumonic finding?
Plain abdominal radiograph Pneumatosis intestinalis
55
Treatment of pneumatosis intestinalis?
Supportive treatment: NPO, orogastric tube for gastric decompression Correct dehydration Electrolyte abnormality
56
What are the complications of NEC?
Strictures | Short bowel syndrome
57
What are the risks of Kawasaki's disease?
Aneurysmal expansion | MI
58
What investigations are done for Kawakasi's
ESR, CRP Platelets: thrombocytopenia Echocardiogram baseline
59
Treatment of Kawasaki?
High dose ASA | IVIG
60
Clinical manifestations of Kawasaki?
WARM CREAM Fever ``` NEED 4/5 Conjuctivitis bilateral Rash: polymorphous Erythema on palms and soles Adenopathy: cerival, unilateral Mucous membrane changes: strawberry tongue ```
61
Presentation of Juvenile idiopathic arthritis
Morning stiffness < 16 yo 95% cases resolve by puberty
62
Treatment of juvenile idiopathic arthritis?
NSAID
63
Pathogens causing otitis media?
H. influenza Strep. pneumonia M. catarrhalis
64
Treatment of otitis media?
High dose amoxicillin (80-90) x 10 days
65
Complications of otitis media?
Perforation Mastoiditis Meningitis Cholesteatoma
66
Which organism causes bronchiolitis?
RSV
67
Which organism causes croup?
Parainfluenza
68
What age does bronchiolitis present?
< 2 yo
69
Presentation of Bronchiolitis?
Tachypnoea Hypoxia Crackles or coarse breath sounds +/- wheeze
70
Treatment of bronchiolitis?
Supportive with oxygen
71
Presentation of croup?
Inspiratory stridor | Barking cough
72
Which sign on Neck film is seen for croup?
Steeple sign
73
What is the treatment of mild, mod, severe croup?
Mild: outpatient cool mist therapy and fluids Moderate: Supp. O2, IM CSC, nebulized racemic epinephrine Severe: Hospital, neb racemic epinephrine
74
What is the causative organism of epiglottitis?
H. influenza type b
75
Presentation of epiglotittis?
``` Acute onset fever Dysphagia Drooling Neck hyperextension Tripod position to maximise air entry ```
76
Treatment of epiglotittis?
Endotracheal intubation | IV abx: ceftriaxone, cefuroxamine
77
Which bacteria cause meningitis in neonate?
Group B step Listeria E Coli
78
Which virus causes meningitis?
Enterovirus
79
Which bacteria cause meningitis in infant?
N meningitidis H. influenza Strep pneumo
80
Which investigations are done to diagnose meningitis?
CT to rule out raised ICP if patient high risk | LP: glucose, protein, gram stain, culture
81
What is the treatment of meningitis?
Neonate: ampicillin and cefotaxime older child: ceftriaxone
82
What is the presentation of a peritonsilar abscess?
Hot potato voice Trismus Drooling Uvula displacement
83
Which organism causes peritonsilar abscess?
Gp A strep
84
What is treatment of peritonsilar abscess?
Incision and drainage Abx +/- tonsillectomy
85
Symptoms of pertussis?
< 6mo Paroxysmal cough Posttusive emesis Apnea
86
Treatment of pertussis?
Hospitalize if < 6mo Azythromycin x 10 Close contact must get prophylaxis
87
What is the gold standard ix of pertussis?
Nasopharyngeal culture
88
What does APGAR stand for?
Activity: movement, arms and legs flexed, none Pulse: > 100, < 100, none Grimace: Active, some flexion of extremities, flaccid Appearance: pink, pink bod blue extremities, blue/pale Resp: vigorous cry, slow irregular resp, absent
89
Other things associated with tracheoesophageal fistula ?
``` VACTERL Vertebral Anal Cardiac Tracheal Renal Limb ```
90
Presentation of tracheoesophageal fistula?
Polyhydramnios in utero Increased oral secretions Cannot feed Aspiration pneumonia
91
How is tracheoesophageal fistula diagnosed?
NG tube coil in oesophagus
92
What is the presentation of diaph. hernia?
Respiratory distress Sunken abdomen Bowel sounds in thorax
93
Diagnosis of diaph. hernia?
U/S in utero | Confirmed at birth on CXR
94
What is gastroschisis?
Herniation of intestine through abdominal wall next to umbilicus with no sac
95
What is the treatment of gastroschisis?
Wrap exposed bowel with saline soaked gauze and wrap in plastic after birth Surgical repair
96
What is an omphalocele
Herniation of abdominal viscera through abdominal wall at the umbilicus into a sac covered in peritonium and amniotic membrane
97
What congenital abnormalities is omphalocele present with?
Beckwith-Wiedmann Syndrome | Trisomy
98
What is treatment of omphalocele?
C-section to prevent sac rupture Keep sac covered with petroleum and gauze Surgical correction NG suction to prevent abdominal distension
99
What is duodenal atresia?
Complete/partial failure of the duodenal lumen to recanalize
100
Presentation of duodenal atresia?
Bilious emesis within hours after first feed | Polyhydramnios in utero
101
What is seen on AXR with duodenal atresia?
Double bubble sign
102
Commonest cause of resp failure in preterm infant?
RDS
103
What is the cause of RDS?
Surfactant deficiency leading to poor lung compliance
104
CXR findings of RDS?
Ground glass appearance | Air bronchogram
105
Treatment of RDS?
CPAP or intubation and mechanical ventilation | Artificial surfactant
106
How do you treat mothers who are at risk of preterm delivery to prevent RDS?
< 30 weeks: CSC
107
What is the age group of febrile seizures?
6mo - 5 yo
108
What are the symptoms of lymphoma?
``` Bone pain with limp Refusal to bear weight Fever (from neutropenia) Anemia Ecchymoses Petechiae Hepatosplenomegaly ```
109
When can tumour lysis syndrome present?
After treatment of cancers with high cell turnover hyperkalemia, hyperphosphate, hyperurecemia, hypocalcemia
110
What is the age of onset of Neuroblastoma and Wilms
< 2yo 2-5yo
111
Presentation of neuroblastoma
Non tender abdominal mass that crosses the midline Horner syndrome HTN Opsoclonus/myoclonus
112
How is neuroblastoma diagnosed?
FNA of tumour : blue tumour cells with rosette pattern | Elevated 24 hour urine catecholamine
113
Which syndrome is Wilm's tumour associated with?
``` WAGR Wilms tumor Aniridia Genitourinaty abnormalities Mental retardation ```
114
Presentation of Wilms tumour?
Asymptomatic nontender abdominal mass that does not cross the midline
115
Where does Ewing's Sarcoma originate from?
Sarcoma associated with chromosome 11:22 translocation
116
What is the presentation of Ewing Sarcoma?
Midshaft of long bones | Systemic symptoms of fever, anorexia, fatigue
117
What is seen on CXR of Ewing Sarcoma?
Leukocytosis, raised ESR | Lytic bone lesion with onion skin
118
What is the presentation of osteosarcoma?
Metaphyses of long bones Local pain Swelling RARE to have systemic symptoms
119
What is seen on CXR of Osteosarcoma?
Raised ALP | Sunburst lytic bone lesion
120
Cause of Duchenne Muscular Dystrophy?
X-linked recessive disorder | Dystrophin deficiency
121
When is DDH seen?
Firstborne girl | Breech position
122
What is the treatment of DDH at different ages < 6mo 6-15 mo 15-24 mo
Splint with Pavlik harness Spica cast Open reduction followed by spica cast
123
Perthe's disease what is it and age of onset?
Osteonecrosis of femoral head | 4-10 yo
124
What is the presentation of Perthe's Disease?
Painless limp Antalgic gate Thigh muscle atrophy Limited abduction and internal rotation
125
What is the treatment of Perthe's Disease?
Observation Good prognosis if: < 6 yo, full ROM, reduced femoral head involvement, stable joint
126
What is a SUFE?
Displacement of the femoral epiphysis from the femoral neck through the growth plate
127
In which children does SUFE present?
Obese children | Age 10-16
128
What is the presentation of SUFE?
Painful limp | Inability to weight bear
129
What is the treatment of SUFE?
Immediate surgical screw | No weight bearing
130
Until what age is strabismus normal?
3 mo
131
What is the presentation of a child with lead poisoning?
``` Intermittent abdominal pain Peripheral neuropathy (wrist or foot drop) ```
132
What is seen on blood smear of lead poisoning?
microcytic hypochromic anemia basophilic stippling +/- sideroblastic anaemia
133
What is the treatment of lead poisoning?
< 45 and asx: retest at 1-3 mo 45-69: chelation therapy (EDTA inpatient) > 70: chelation therapy (EDTA and BAL)
134
Facts about hypertrophic cardiomyopathy in pediatrics
Autosomal dominant Close relatives affected Worsens with age Should participate in exercise

MCCEE (16 decks)

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