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Forgotten EOY4 > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Differentials for acute painful limp in a 1-3 yo

A

Septic arthritis
Transient synovitis
Trauma
NAI

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2
Q

Differentials for painless limp in 1-3 yo

A

DDH

cerebral palsy

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3
Q

Differentials for acute painful limp in 3-10 yo

A 
Transient synovitis
rule out SA
JIA
Perthes acute
Malignancy
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4
Q

Painless limp in 3-10 yp

A

perthes

jia

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5
Q

Painful limp in 10-16

A 
SUFE
Jia
septic arthritis
malignancy
osteochondritis dissicans
complex regional pain syndrome
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6
Q

painless limp 10-16

A

sufe

jia

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7
Q

DDH risk factors

A 
Female
Breech
FHx
Primigravada
>5kg baby
oligohydramnios
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8
Q

Ix for DDH

A

Ultrasound if baby <3months

x-ray if 4 months or more

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9
Q

rx for DDH

A

child under 4 months Reduce dislocation - pavlick harness for 6-12 weeks (flexion n abduction)

after 4 months bones will have started to ossify
- osteotomy
hip realignment

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10
Q

Septic arthritis common organisms

A

S, aureus
h influenzae
GBS

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11
Q

sept arth hx

A

acute painful limp
fever
pain at rest

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12
Q

sept arth examination findings

A

decres range of movements
pain
joint effusion
§

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13
Q

sept arth ix

A

FBC
crp
joint aspirate MCS = diagnostic

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14
Q

rx sept arthri

A

abx - fluxlox

surgical drainage and washout

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15
Q

Turner’s features

A 
webbed neck
short stature
low set ears
co-arc of aorta
adhd
cystic hygroma
high arched palate?
hypothyroidism
lymphoedema
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16
Q

rx Turners

A 
GH to help stature
oestrogen therapy - pill/patch
education
adaptation at school
screen DM, hypothyroidism, BP, ears
annual r/w with paeds
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17
Q

Rickets features

A 
Ricketic rosary
fontanelles - delayed closure
frontal bossing
bangle sign
pectus carinatum
harrison sulcus
bowing of the legs
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18
Q

what is rickets?

A 
Vit D deficiency
leading to inadequate ca absorption
loss of mineralisation of bones
makes bones soft and weak
in adults - osteomalacia
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19
Q

ix for rickets

A

serum ca and phosphate decreased
ALP raised
x-rays of long bones

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20
Q

Duchenne muscular dystrophy is what

A

Sex-linked recessive

genetic mutation of the dystrophin gene
this is an important molecule in the muscle that keeps the cell held together when contractions happen
without it, the cells become deformed and damaged and over time you have damage to the muscles that results in scar tissue

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21
Q

duchennes presentation

A

presents 2-3 years of age
pseudohypertrophy of the calf muscles
weakness of proximal muscles (gower’s test will be +)

CK - creatinine kinase will be raised

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22
Q

duchennes prognosis

A

Braces to walk by 10
Wheelchair bound by 20
dead by 25

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23
Q

duchennes management

A 
MDT approach
physio
splints for contractures
surgery if scoliosis
overnight CPAP!!! because they are at risk of sleep apnoea
corticosteroids 
atalurin - can be rx for 10-15% of cases

ID female carriers + do CK

24
Q

prolonged >14 days jaundice screen

A

If there are still signs of jaundice after 14 days a prolonged jaundice screen is performed, including:
conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention
direct antiglobulin test (Coombs’ test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs

25
Causes of prolonged jaundice
``` biliary atresia hypothyroidism galactosaemia urinary tract infection breast milk jaundice congenital infections e.g. CMV, toxoplasmosis ```
26
stridor causes congenital
Laryngomalacia | ◦ Vocal cord paralysis ◦ Subglottic stenosis
27
stridor causes acquired
``` Acquired ◦ Laryngotracheobronchitis (croup) ◦ Epiglottitis ◦ Retropharyngeal abscess ◦ Foreign bodies ◦ Iatrogenic ```
28
normal birthweights
2.5-4.5kg <2.5kg small <1.5kg v small
29
neonate age limit
birth to 28 days
30
hypoxic ischemic enceph rx
resusc abcde glucose mild therapeutic hypothermia with aEEG monitor prognosis depends on severe
31
shoulder dystocia brachial plexus
erbs palsy upper brachial plexus waiters tip usually resolves
32
Respiratory distress syndrome is common in what age gestation
<28 weeks
33
signs of RDS newborn
RR >60 incr work of breathing grunting cyanosis
34
cxr of rds newborn
diffuse granular opacity ground glass + air bronchogram
35
rds newborn rx
raised ambient o2 (not hyperoxia!!) surfactant therapy via ET CPAP/ventilation BE CAREFUL AS CAN CAUSE PNEUMOTHORAX
36
suspect pneumothorax how detect neonate
transilluminate if suspect /Cxr
37
PDA closure how?
Indomethacin/ibuprofen | surgical ligation
38
``` feed intolerance vomiting with bile distension of abdo bloody stool shock <34 weeker ```
nec enterocolitis
39
nec enterocolitis abdo xray findings
pneumocystis intestinalis distended bowel pneumoperitoneum air in portal tract
40
rx of nec enterocolitis
stop oral feeds broad abx parenteral nutrition mechanical ventilation surgery if perf
41
infections in neonates
``` gbs l monocytogenes gram - conjunctivitis umbilical infection herpes simplex hep b ```
42
Atrial Septal Defect
Atrial Septal Defect Asymptomatic Recurrent chest infections, wheeze or heart failure Arrhythmias common in 30s to 40s (SVT, AF) +/- ejection systolic murmur Fixed, widely split second heart sound i.e. delayed P2 CXr- heart failure ECG - RBBB, RVH Echo Cardiac catheterisation with double umbrella occluder device before age of 5, to prevent arrhythmias and allow early socialisation
43
Patent ductus arteriosus - failure to close by 1 month after expected date of delivery
Duct should usually have closed by 3 days after birth. In duct-dependent lesions, prostaglandin analogues (i.e. Prostin) can be used to keep duct open. In a prolonged PDA, blood is shunted from Left -> Right -shunt at ductal level (i.e. systemic -> pulmonary, aorta -> pulmonary artery). This, over time, causes fluid overload of the LA, pulmonary congestion and consequently, heart failure. There is also an increased life-long risk of bacterial endocarditis. Signs/symptoms well neonate if shunt=small machinery murmur - loudest below left clavicle and radiates to back collapsing/bounding pulse high systolic, low diastolic pulmonary overload -> pulmonary congestion -> repeated chest infections heart failure Ix echocardiogram, (CXr and ECG usually normal, but in severe cases show signs) Rx Ibuprofen (NSAID -> PG inhibitor) If PDA persists, surgery at 1 year of age (usually with a cardiac catheter +coil/occlusion device.
44
Large VSD - defect same/bigger size than aortic valve
Heart failure, breathlessness and faltering growth at 1 week of age ?4-6 wks? Difficulty feeding - "does your baby get sweaty when they feed or when they cry?" Recurrent chest infections O/E: Tachypnoea, tachycardia, hepatomegaly Soft pansystolic murmur or no murmur apical mid-diastolic murmur - as more blood across mitral valve once it's come back from lungs Left parasternal heave (RVH) Loud P2 - because raised pulmonary arterial pressure slams it shut CXr - cardiomegaly, enlarged pulmonary arteries, increased pulmonary vascular markings, pulmonary oedema ECG - biventricular hypertrophy by 2 months of age, RVH - dominant R wave in V1 Diuretics +/- captopril for heart failure Additional calorie input for faltering growth Surgery by 3-6 months of age to prevent Eisenmenger's Eisenmenger's -> complication -> shunt reversal -> cyanosis
45
Small VSD - defect smaller than aortic valve
Signs/symptoms: Asymptomatic O/E: Pansystolic loud murmur Ix: CXr - normal ECG - normal Echo - abnormal, can do doppler to see blood flow Rx: Conservative, spontaneously close - murmur disappears + normal ECG at follow-up - until then, take care of dental hygiene to prevent endocarditis.
46
Blue, Breathless or mixed congenital heart defects
Blue i.e. cyanotic Transposition of the great arteries Univentricular heart Mixed - Tetralogy of Fallot ``` Breathless ASD VSD - most common PDA - second most common AVSD Co-arctation of the aorta ```
47
innocent murmur features
7s ``` Soft Systolic S1, S2 normal Standing and sitting variation Symptomless Special tests normal (CXr, ECG, Echo) ```
48
Around what saturation does blueness occur?
<85%
49
Sweaty when feeding sign of what
usually large VSD also will see heart failure faltering growth recurrent chest infections
50
Tetralogy of fallot features
PROVE ``` Pulmonary stenosis RVH Overriding aorta, L-R shunt across- -VSD Ejection systolic murmur ``` Embryologically: Unequal partitioning of truncus arteriosus
51
Tetralogy of fallot rx
duct dependent so cyanotic spells happen when duct closes blalock-taussig shunt increased blood flow to pulmonary arteries +/- b blockers
52
TPA
ass e diabetes in mum duct dependent therefore need PG infusion atrial septostomy then switch operation
53
phenotypical features of downs
ROSEOLA ``` Round face Occipital flattening Speckled iris (brushfield spots) Epicanthic folds Open mouth with protruding tongue Low set ears Almond upward slanting eyes ``` single palmar crease, clinodactyly, sandal gap, DUODENAL ATRESIA also associated w coeliac, hirrsprungs, leukemia, hypothyroidism, early onset alzheimers, obstructive sleep apnoea cardiac abnormalities - need echo when diagnose
54
Roseola or 6th disease is caused by what?
Herpesvirus 6 | 3 days fever 3 days viral macules on chest
55
cxr narrow upper mediastinum
boot | tpa
56
5 hours old neonate cyanosed no rds
hyperoxia test - if get better, lung. if not, cardio. probs pda emergency management commence PG infusion emergency balloon atrial septostomy arterial switch operation

Forgotten EOY4 (5 decks)

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