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Phase 3A HH > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

When is congenital heart disease detected?

A

Picked up during antenatal ultrasound screening at 20 weeks –> fetal echo

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2
Q

In which congenital heart diseases do you get L –> R shunt?

A

VSD, PDA, ASD

Patient breathless, asymptomatic

More common than R –> L shunt

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3
Q

In which congenital heart diseases do you get R –> L shunt?

A

Tetralogy of fallot
Transposition of great arteries

Patient cyanotic

Less common than L –> R

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4
Q

Causes of congenital heart disease?

A 
Maternal rubella, SLE and diabetes
Warfarin
Fetal alcohol syndrome
Down's syndrome - leads to AVSD, VSD
Other syndrome's e.g. Edward's, Patau's, Turner's
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5
Q

Fetal circulatory changes around birth

A

In utero:

  • Low pressure in LA as little blood returns from the lung
  • High pressure in RA as receives all systemic and placental venous return
  • Foramen ovale (between atria) and ductus arteriosus (between PA and aorta to bypass lungs) are open, blood flows R → L

At birth:

  • First breath increases pulmonary blood flow and LA pressure
  • No placenta decreases RA pressure
  • LA pressure> RA pressure so foramen ovale closes

First hours/days of life:
-Ductus arteriosus closes

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6
Q

Treatment of shunts (what keeps open/closes defect)?

A

Prostaglandins keep shunts open, important when baby cyanotic (i.e. in R –> L shunts in TOF and TGA) - keeps open until surgery

Prostaglandin inhibitors i.e. NSAIDS e.g. IV indomethacin/ibuprofen close defect in L –> R shunts

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7
Q

DDx of breathless child?

A

Croup, asthma, bronchiolitis, pneumonia, URTI, acute epiglottitis, foreign body inhalation

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8
Q

Most likely diagnosis of breathless child with barking cough and mild intercostal recessions?

A

Croup (laryngotracheobronchitis)

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9
Q

Cause of croup?

A

Parainfluenza virus

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10
Q

What age group does croup affect?

A

6 months to 6 year olds

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11
Q

Symptoms of croup?

A

Barking cough, stridor, fever, coryzal symptoms

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12
Q

Management of croup?

A

Single dose dexamethasone (or prednisolone) - 0.15mg/kg

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13
Q

Management of croup in patient with low sats?

A

High flow O2 and nebulised adrenaline

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14
Q

Cause of bronchiolitis?

A

Respiratory syncytial virus (RSV)

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15
Q

Management of bronchiolitis?

A

Self-limiting so supportive only: O2, fluids

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16
Q

Prophylaxis for RSV in high-risk children?

A

Palivizumab

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17
Q

Prophylaxis for RSV in high-risk children?

A

Palivizumab

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18
Q

Cause of septic arthritis?

A

Staph. aureus

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19
Q

Investigations for septic arthritis?

A

Joint aspiration (+ culture), blood cultures, infection more likely to be systemic in children

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20
Q

Management of septic arthritis?

A

IV antibiotics (probably flucloxacillin)

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21
Q

DDx for limp in child

A

Septic arthritis; transient synovitis (would be viral, less systemically unwell, no pain at rest but pain & reduced int. rot.n, normal WCC, CRP, ESR); osteomyelitis (similar presentation to SA, MRI, XR);
DDH –infant, barlow and otolani manouvres test in neonatal screening, asymetric skin folds, breech delivery assoc, important complication – necrosis of femoral head;
Perthes disease – avascular necrosis of femoral epiphysis of femoral head, boys 5-10, insidious limp or hip/knee pain, shown on XR;
Slipped upper feomral epiphysis – 10 – 15 yrs esp. obese boys, can follow minor trauma or be insidious, reduced abduction and internal rotation’
NAI - esp. in fractures before walking age, repeated admissions to A&E;
JIA – presistent joint swelling for over 6 weeks, mostly females, exclude infection, malignancy etc

22
Q

Most likely diagnosis in 3 wk old baby with non-bilious projectile vomiting after feeding? No PMH, on exam: poor weight gain, dehydrated, mass felt in RUQ.

A

Hypertrophic pyloric stenosis

23
Q

Physiology of hypertrophic pyloric stenosis?

A

Hypertrophy of pylorus –> impaired gastric emptying –> stomach contents forced to leave stomach as vomit.

24
Q

Metabolic abnormality in pyloric stenosis?

A

Hypochloraemic hypokalaemic metbolic alkalosis.

25
Q

Radiological features of pyloric stenosis?

A

USS - non-passage of gastric contents into prox duodenum.

XR - delayed gastric emptying, peristaltic waves, string sign/double-track sign, beak sign

26
Q

Management of pyloric stenosis?

A

Stop oral feeds, IV fluids – 0.9% sodium chloride, 5% dextrose, 20mmol KCl (apart from for resus), admit to paeds:

  • Atropine (oral or IV) – 85% success rate and requires long hospital stay
  • Pyloromyotomy (Ramstedt’s procedure)
27
Q

Intussusception symptoms?

A

Sudden onset paroxysms of colicky abdo pain +/- crying
Child may appear well between paroxysms initially
Early vomiting - rapidly becomes bilious
Neuro sx e.g. lethargy, hypotonia or sudden alterations of consciousness
Dehydration, pallor, shock
Drawing up of legs to chest
Irritability, sweating

28
Q

Pathophysiology of intussusception

A

Intestine folds into the next part of it causing obstruction

29
Q

Where in bowel is most common site of intussusception?

A

Terminal ileum/ileo-coecal valve

30
Q

What signs of intussusception would you find on exam?

A

Sausage shapen mass in abdomen, red currant jelly stool

31
Q

Complications of intussusception?

A

Bowel perforation, necrosis, peritonitis.

32
Q

Management of intussusception?

A

Enema - water soluble contrast or air contrast, resection of affected bowel

33
Q

Management of intussusception?

A

Enema - water soluble contrast or air contrast, resection of affected bowel

34
Q

What causes jaundice <24h of birth?

A

PATHOLOGICAL. Caused by haemolysis, congenital infection etc.

35
Q

Causes of jaundice >24h of birth?

A

Physiological, dehydration, breast milk

36
Q

Causes of jaundice after 2 weeks of age?

A

Biliary atresia (pale stools, dark urine), UTI, congenital hypothyroidism

37
Q

Main complication of jaundice?

A

Kernicterus - encephalopathy from unconjugated bilirubin in the brain

38
Q

Ix for jaundice?

A

Transcutaneous bilirubinmeter, diagnose with serum bilirubin

39
Q

Management of jaundice in babies?

A

Plot bilirubin on gestation specific chart according to age since birth, phototherapy of exchange transfusion.

40
Q

What is necrotising enterocolitis (NEC)?

A

Bacterial invasion of ischaemic bowel wall, typically seen in premature infants.

41
Q

Symptoms of NEC?

A

Vomiting, poor feeding, distended abdomen, blood in stool

May progress to shock, perforation

42
Q

Treatment of NEC?

A

IV antibiotics, TPN, ITU

43
Q

Pattern of measles rash?

A

Maculopapular rash - becoming patchy and confluent.

Starts behind ears, spreads to face and then trunk.

44
Q

How long is child with measles infective for?

A

4 days before rash appears to 4 days post appearance of rash.

45
Q

Othr sx of measles besides rash?

A

Presence of Koplik’s spots (white spots on buccal mucosa), non-productive cough, conjunctivitis, fever, running nose

46
Q

How can diagnosis of measles be confirmed?

A

Saliva swab or serum for measles-specific IgM or RNA

47
Q

Management of measles?

A

Self-limiting disease. Treat sx, stay at home to stop spread

48
Q

Complications of measles?

A

Encephalitis, giant cell pneumonia, subacute sclerosing panencephalitis (5-10 years later), febrile convulsions, keratoconjunctivitis, corneal ulceration

49
Q

Criteria for diagnosing Kawasaki’s?

A

Fever of >39 for 5 days plus 4/5 of:

  • Cervical lymphadenopathy >1.5cm
  • Non-vesicular rash
  • Bilat. dry conjunctivitis
  • Erythema, odema/desquamation of extremities
  • Inflammation of lips, mouth, tongue (strawberry tongue)
50
Q

Management of Kawasaki’s disease?

A

IV immunoglobulins (10-20% don’t respond), aspirin (reduces thrombosis risk), other: corticosteroids, anti-TNF, immunosuppressive therapies

51
Q

Complications of Kawasaki’s disease?

A

Coronary artery aneurysms, cardiac valve disease (mitral regurg.), MI, sudden cardiac death etc.

Phase 3A HH (6 decks)

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