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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
Q

Causes of prolonged jaundice

A 
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
congenital infections e.g. CMV, toxoplasmosis
26
Q

stridor causes congenital

A

Laryngomalacia

◦ Vocal cord paralysis ◦ Subglottic stenosis

27
Q

stridor causes acquired

A 
Acquired
◦ Laryngotracheobronchitis
(croup)
◦ Epiglottitis
◦ Retropharyngeal abscess
◦ Foreign bodies
◦ Iatrogenic
28
Q

normal birthweights

A

2.5-4.5kg
<2.5kg small
<1.5kg v small

29
Q

neonate age limit

A

birth to 28 days

30
Q

hypoxic ischemic enceph rx

A

resusc
abcde
glucose

mild therapeutic hypothermia with aEEG monitor

prognosis depends on severe

31
Q

shoulder dystocia brachial plexus

A

erbs palsy
upper brachial plexus
waiters tip

usually resolves

32
Q

Respiratory distress syndrome is common in what age gestation

A

<28 weeks

33
Q

signs of RDS newborn

A

RR >60
incr work of breathing
grunting
cyanosis

34
Q

cxr of rds newborn

A

diffuse granular opacity
ground glass
+ air bronchogram

35
Q

rds newborn rx

A

raised ambient o2 (not hyperoxia!!)
surfactant therapy via ET
CPAP/ventilation BE CAREFUL AS CAN CAUSE PNEUMOTHORAX

36
Q

suspect pneumothorax how detect neonate

A

transilluminate if suspect /Cxr

37
Q

PDA closure how?

A

Indomethacin/ibuprofen

surgical ligation

38
Q 
feed intolerance
vomiting with bile
distension of abdo
bloody stool
shock
<34 weeker
A

nec enterocolitis

39
Q

nec enterocolitis abdo xray findings

A

pneumocystis intestinalis
distended bowel
pneumoperitoneum
air in portal tract

40
Q

rx of nec enterocolitis

A

stop oral feeds
broad abx
parenteral nutrition
mechanical ventilation

surgery if perf

41
Q

infections in neonates

A 
gbs
l monocytogenes
gram -
conjunctivitis
umbilical infection
herpes simplex
hep b
42
Q

Atrial Septal Defect

A

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
Q

Patent ductus arteriosus - failure to close by 1 month after expected date of delivery

A

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
Q

Large VSD - defect same/bigger size than aortic valve

A

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
Q

Small VSD - defect smaller than aortic valve

A

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
Q

Blue, Breathless or mixed congenital heart defects

A

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
Q

innocent murmur features

A

7s

Soft
Systolic
S1, S2 normal
Standing and sitting variation
Symptomless 
Special tests normal (CXr, ECG, Echo)
48
Q

Around what saturation does blueness occur?

A

<85%

49
Q

Sweaty when feeding sign of what

A

usually large VSD
also will see heart failure
faltering growth
recurrent chest infections

50
Q

Tetralogy of fallot features

A

PROVE

Pulmonary stenosis
RVH
Overriding aorta, L-R shunt across-
-VSD
Ejection systolic murmur

Embryologically: Unequal partitioning of truncus arteriosus

51
Q

Tetralogy of fallot rx

A

duct dependent so cyanotic spells happen when duct closes

blalock-taussig shunt increased blood flow to pulmonary arteries

+/- b blockers

52
Q

TPA

A

ass e diabetes in mum
duct dependent therefore need PG infusion
atrial septostomy
then switch operation

53
Q

phenotypical features of downs

A

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
Q

Roseola or 6th disease is caused by what?

A

Herpesvirus 6

3 days fever 3 days viral macules on chest

55
Q

cxr narrow upper mediastinum

A

boot

tpa

56
Q

5 hours old neonate cyanosed no rds

A

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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