Paediatrics Flashcards
What is the commonest Congenital heart disease?
VSD
Which congenital heart disease is associated with Turner?
CoA
Which congenital heart disease is associated with Down Syndrome?
ASD
What is the presentation of VSD?
Holosystolic murmur
LLSB
What is the presentation of ASD?
Systolic ejection murmur
USB
What is the treatment of ASD/VSD?
Small: spontaneous closure Surgical management if - failed medical management - pulmonary HTN - large defects
What is the presentation of a PDA?
Continuous machinery murmur
Pounding peripheral pulse
Wide pulse pressure
Where does the blood flow in a PDA?
Aorta to pulmonary artery
What is the treatment of a PDA?
Indomethacin (NSAID)
If indomethacin fails/child > 6-8mo: surgery
Come IN and CLOSE the door
Give INdomethacin to CLOSEE the PDA
What is the presentation of CoA?
High BP In upper extremities
Low BP in lower extremities
Weak femoral pulses
What are signs of CoA on CXR?
3 sign
Rib notching
What is the commonest cyanotic congenital heart lesion in the newborn?
Transposition of Great Vessels
When does Transposition of great vessels present?
Within first few hours after birth
What is the anatomy of transposition of great vessels?
Aorta on R ventricle
Pulmonary vessels on L ventricle
Need ASD/VSD and PDA to be compatible with life
What are maternal RF for Transposition of great vessels?
Diabetic mother
Mnemonic for DiGeorge Syndrome
Cardiac abnormalities (transposition) Abnormal facies (retrognathia, micrognatia, long face) Thymic aplasia Cleft palate Hypocalcemia 22q11 deletion
What is seen on CXR of transposition of great vessels/
Egg shaped silhouette
What is the treatment of transposition of great vessel?
IV PGE1
Surgical correction
Balloon atrial septostomy if cannot do surgery in first few days of life
What is the commonest cyanotic congenital heart lesion in childhood?
Tetralogy of Fallot
What is the anatomy of a tetralogy of fallot?
RV outflow tract obstruction
Overriding aorta
VSD
RVH
What is the presentation of a tetralogy of fallot?
Cyanosis in first 2 years of life but not immediately
SOB
Fatiguability
Get spell relieved by squat
What is seen on CXR of tetralogy of Fallot?
Boot shaped heart
What is the treatment of tetralogy of Fallot?
Immediate PGE1 to keep PDA open
Surgical
consultation
Tet spells” oxygen, morphine,
What are features of Edward Syndrome?
Rocker-bottom feet
Micrognathia
Clenched hands
Prominent occiput
What is the genetic mutation in cystic fibrosis?
Autosomal recessive
CFTR gene mutation on Kr 7
What is the newborn presentation of cystic fibrosis?
Obstruction of distal ileum
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
Whar are CF patients at risk of?
Fat soluble vitamin deficiency secondary to malabsorption
What is the treatment of CF?
Antibiotics to cover Pseudomonas
Pancreatic enzymes and fat soluble vitamins
High calorie high protein diet
What is the age of onset of intussusseption?
6 mo - 3 yo
What is the presentation of intussusseption?
non-bilious vomit
red currant jelly stool (late sign)
colicky pain
sausage shape RUQ mass
What is the sign on U/S for intussusseption?
target sign
What is the diagnostic test if high clinical suspicion of intussusseption
Air insufflation enema
What are the associations of pyloric stenosis?
First born infant
Boy
Formula fed
Maternal erythromycin ingestion
What is the presention of pyloric stenosis?
Non-bilious vomit
After a feed
Projectile vomit
Palpable olive mass
What is the age of onset of pyloric stenosis?
3 weeks - 6 weeks
What laboratory finding for pyloric stenosis?
Hypochloremic hypokalaemic metabolic alkalosis
Treatment of pyloric stenosis?
Initially:
- NPO
- IV access
- Correct dehydration and acid-base abnormalities
- Pyloromyotomy
What is the cause of Meckel’s Diverticulum?
Omphalomesenteric duct fails to obliterate
What is the presentation of Meckel’s diverticulum and age of onset?
< 2 yo
Painless rectal bleeding
Usually incidental finding
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
Investigation of choice for Meckel?
Scintigraphy scan
Whar ia Hurschsprung disease?
Lack of ganglion cells in distal colon
Decreased motility due to unopposed smooth muscle tone
What diseases is Hurschsprung disease associated with?
Male
Down Syndrome
Waardenbur syndrome
MEN 2
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
Investigation of choice for Hurshsprung?
Barium enema
Rectal biopsy confirms diagnosis
Presentation of malrotation?
Bilius vomit
First month of life
What is the characteristic appearance of malrotation on imaging?
Bird beak appearance
Treatment of malrotation?
NG tube insertion to decompress intestine
IV fluid hydration
Emergent surgical repair
What are risk factors for necrotizing enterocolitis?
Low birth weight
Premature infant
Hypotension
Enteral feed: formula
What portion of the bowel undergoes necrosis in NEC?
Terminal ileum/proximal colon
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
What is the investigation for NEC?
What is the pathomneumonic finding?
Plain abdominal radiograph
Pneumatosis intestinalis
Treatment of pneumatosis intestinalis?
Supportive treatment: NPO, orogastric tube for gastric decompression
Correct dehydration
Electrolyte abnormality
What are the complications of NEC?
Strictures
Short bowel syndrome
What are the risks of Kawasaki’s disease?
Aneurysmal expansion
MI
What investigations are done for Kawakasi’s
ESR, CRP
Platelets: thrombocytopenia
Echocardiogram baseline
Treatment of Kawasaki?
High dose ASA
IVIG
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
Presentation of Juvenile idiopathic arthritis
Morning stiffness
< 16 yo
95% cases resolve by puberty
Treatment of juvenile idiopathic arthritis?
NSAID
Pathogens causing otitis media?
H. influenza
Strep. pneumonia
M. catarrhalis
Treatment of otitis media?
High dose amoxicillin (80-90) x 10 days
Complications of otitis media?
Perforation
Mastoiditis
Meningitis
Cholesteatoma
Which organism causes bronchiolitis?
RSV
Which organism causes croup?
Parainfluenza
What age does bronchiolitis present?
< 2 yo
Presentation of Bronchiolitis?
Tachypnoea
Hypoxia
Crackles or coarse breath sounds
+/- wheeze
Treatment of bronchiolitis?
Supportive with oxygen
Presentation of croup?
Inspiratory stridor
Barking cough
Which sign on Neck film is seen for croup?
Steeple sign
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
What is the causative organism of epiglottitis?
H. influenza type b
Presentation of epiglotittis?
Acute onset fever Dysphagia Drooling Neck hyperextension Tripod position to maximise air entry
Treatment of epiglotittis?
Endotracheal intubation
IV abx: ceftriaxone, cefuroxamine
Which bacteria cause meningitis in neonate?
Group B step
Listeria
E Coli
Which virus causes meningitis?
Enterovirus
Which bacteria cause meningitis in infant?
N meningitidis
H. influenza
Strep pneumo
Which investigations are done to diagnose meningitis?
CT to rule out raised ICP if patient high risk
LP: glucose, protein, gram stain, culture
What is the treatment of meningitis?
Neonate: ampicillin and cefotaxime
older child: ceftriaxone
What is the presentation of a peritonsilar abscess?
Hot potato voice
Trismus
Drooling
Uvula displacement
Which organism causes peritonsilar abscess?
Gp A strep
What is treatment of peritonsilar abscess?
Incision and drainage
Abx
+/- tonsillectomy
Symptoms of pertussis?
< 6mo
Paroxysmal cough
Posttusive emesis
Apnea
Treatment of pertussis?
Hospitalize if < 6mo
Azythromycin x 10
Close contact must get prophylaxis
What is the gold standard ix of pertussis?
Nasopharyngeal culture
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
Other things associated with tracheoesophageal fistula ?
VACTERL Vertebral Anal Cardiac Tracheal Renal Limb
Presentation of tracheoesophageal fistula?
Polyhydramnios in utero
Increased oral secretions
Cannot feed
Aspiration pneumonia
How is tracheoesophageal fistula diagnosed?
NG tube coil in oesophagus
What is the presentation of diaph. hernia?
Respiratory distress
Sunken abdomen
Bowel sounds in thorax
Diagnosis of diaph. hernia?
U/S in utero
Confirmed at birth on CXR
What is gastroschisis?
Herniation of intestine through abdominal wall next to umbilicus with no sac
What is the treatment of gastroschisis?
Wrap exposed bowel with saline soaked gauze and wrap in plastic after birth
Surgical repair
What is an omphalocele
Herniation of abdominal viscera through abdominal wall at the umbilicus into a sac covered in peritonium and amniotic membrane
What congenital abnormalities is omphalocele present with?
Beckwith-Wiedmann Syndrome
Trisomy
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
What is duodenal atresia?
Complete/partial failure of the duodenal lumen to recanalize
Presentation of duodenal atresia?
Bilious emesis within hours after first feed
Polyhydramnios in utero
What is seen on AXR with duodenal atresia?
Double bubble sign
Commonest cause of resp failure in preterm infant?
RDS
What is the cause of RDS?
Surfactant deficiency leading to poor lung compliance
CXR findings of RDS?
Ground glass appearance
Air bronchogram
Treatment of RDS?
CPAP or intubation and mechanical ventilation
Artificial surfactant
How do you treat mothers who are at risk of preterm delivery to prevent RDS?
< 30 weeks: CSC
What is the age group of febrile seizures?
6mo - 5 yo
What are the symptoms of lymphoma?
Bone pain with limp Refusal to bear weight Fever (from neutropenia) Anemia Ecchymoses Petechiae Hepatosplenomegaly
When can tumour lysis syndrome present?
After treatment of cancers with high cell turnover
hyperkalemia, hyperphosphate, hyperurecemia, hypocalcemia
What is the age of onset of Neuroblastoma and Wilms
< 2yo
2-5yo
Presentation of neuroblastoma
Non tender abdominal mass that crosses the midline
Horner syndrome
HTN
Opsoclonus/myoclonus
How is neuroblastoma diagnosed?
FNA of tumour : blue tumour cells with rosette pattern
Elevated 24 hour urine catecholamine
Which syndrome is Wilm’s tumour associated with?
WAGR Wilms tumor Aniridia Genitourinaty abnormalities Mental retardation
Presentation of Wilms tumour?
Asymptomatic nontender abdominal mass that does not cross the midline
Where does Ewing’s Sarcoma originate from?
Sarcoma associated with chromosome 11:22 translocation
What is the presentation of Ewing Sarcoma?
Midshaft of long bones
Systemic symptoms of fever, anorexia, fatigue
What is seen on CXR of Ewing Sarcoma?
Leukocytosis, raised ESR
Lytic bone lesion with onion skin
What is the presentation of osteosarcoma?
Metaphyses of long bones
Local pain
Swelling
RARE to have systemic symptoms
What is seen on CXR of Osteosarcoma?
Raised ALP
Sunburst lytic bone lesion
Cause of Duchenne Muscular Dystrophy?
X-linked recessive disorder
Dystrophin deficiency
When is DDH seen?
Firstborne girl
Breech position
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
Perthe’s disease what is it and age of onset?
Osteonecrosis of femoral head
4-10 yo
What is the presentation of Perthe’s Disease?
Painless limp
Antalgic gate
Thigh muscle atrophy
Limited abduction and internal rotation
What is the treatment of Perthe’s Disease?
Observation
Good prognosis if: < 6 yo, full ROM, reduced femoral head involvement, stable joint
What is a SUFE?
Displacement of the femoral epiphysis from the femoral neck through the growth plate
In which children does SUFE present?
Obese children
Age 10-16
What is the presentation of SUFE?
Painful limp
Inability to weight bear
What is the treatment of SUFE?
Immediate surgical screw
No weight bearing
Until what age is strabismus normal?
3 mo
What is the presentation of a child with lead poisoning?
Intermittent abdominal pain Peripheral neuropathy (wrist or foot drop)
What is seen on blood smear of lead poisoning?
microcytic hypochromic anemia
basophilic stippling
+/- sideroblastic anaemia
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)
Facts about hypertrophic cardiomyopathy in pediatrics
Autosomal dominant
Close relatives affected
Worsens with age
Should participate in exercise