Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3A Medicine > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are signs of respiratory distress in children?

A

Increased RR and HR
Nasal flaring
agitation
Recession/retraction: subcostal (milder), intercostal (moderate), sternal (severe)
Accessory muscle use and head bobbing (severe)
Grunting: expiratory noise due to an attempt to maintain PEEP (severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are signs of respiratory failure in children?

A

Decreased RR and HR
Low O2 sats despite supplemental O2
Somnolence (drowsiness)
Cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the DDx for cough in children?

A 
Infection
Asthma, allergic rhinitis
2nd hand smoke
Inhaled foreign body
CF
Habit cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a wheeze?

A

A course, expiratory whistling sound - suggests lower respiratory tract problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the Ddx for wheeze in children?

A 
Infection: bronchiolitis, pneumonia
Allergic: asthma, milk allergy
Transient early wheeze, viral wheeze
Severe disease: heart failure, CF
Inhaled foreign body and/or aspiration pneumonia
Tracheomalacia (and/or stridor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is stridor?

A

a harsh, high pitched sound which is usually inspiratory - suggests upper respiratory tract problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the Ddx for stridor in children?

A 
Infection: croup (barking cough), bacterial tracheitis, epiglottitis
Anaphylaxis
Inhaled foreign body
Laryngomalacia
Tracheomalacia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the Ddx for respiratory crackles in children?

A

Fine crackles point to inflammation in the smaller airways - bronchioles - while coarse crackles point to bronchial involvement
Usually inspiratory, but they can be expiratory too if there are voluminous secretions
Bronchiolitis causes bilateral, fine end-expiratory crackles
Pneumonia causes uni or bilateral coarse crackles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What would be seen on a CXR of a child with pneumonia?

A

Consolidation: lobar if strep pneumonia
Cavitation if staph a or TB
Pleural effusion/empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CXR child with severe bronchiolitis

A

hyperinflation
>6 anterior ribs
flat diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Other CXR signs

A

inhaled foreign body: requires inspiratory and expiratory film. hyper lucent object and collapse distal to it
CF: bronchiectasis shadowing
HF: hyperinflation, cardiomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is croup?

A

Acute laryngotracheobronchitis with subglottic inflammation and oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Croup: epidemiology and causes

A

Viral URTI due to parainfluenza (80%), RSV
6 months to 6 years of age, commonest aged 1-2
Highest prevalence in autumn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Croup: signs and symptoms

A 
Coryza 1st
Stridor: harsh and intermittent
Barking cough
Hoarsness
Mild fever
Respiratory distress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Croup: management

A

Dexamethasone PO

Adrenaline neb if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Epiglottitis: epidemiology and causes

A

Hib is traditionally the commonest cause but less so due to Hib vaccine
Commonest in kids ages 1-6 years, especially 2-3 years
Incidence is falling in kids due to vaccine but rising in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Epiglottitis: signs and symptoms

A

Acute onset of high fever, sore throat, and drooling (can’t swallow secretions)
Stridor: soft and continuous. Late sign suggesting airway obstruction
Whispering
Tripoding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Epiglottitis: management

A

GET SENIOR HELP FROM ANAESTHETICS/ENT
DO NOT PERFORM ORAL EXAMINATION
Oxygen can be given in meantime but do not do anything to cause distress to the child. If there is airway compromise then nebulised adrenaline can buy some time.
Definitive treatment is intubation and antibiotics.
Diagnosis is usually by laryngoscopy during intubation but a lateral neck XR showing thumb print sign can aid diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is bronchiolitis?

A

An infection of the bronchioles, usually viral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Bronchiolitis: epidemiology and causes

A

Pathogens: RSV (75%), parainfluenza, adenovirus (usually severe)
Commonest in kinds <9m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bronchiolitis: signs and symptoms

A

1-3 days coryza prodrome with clear secretions
Wet or dry cough
Respiratory distress. Apnoea may occur if >4m old
Fever, usually <39
Poor feeding and dehydration
On auscultation: wheeze, bilateral fine end-inspiratory crackles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Bronchiolitis: investigations

A

Usually clinical diagnosis
O2 sats to assess severity
PCR of nasopharyngeal aspirate to confirm pathogen but not routinely indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bronchiolitis: management

A

conservation
Suction secretions if causing respiratory distress, feeding difficulties of apnoea
If o2 sats are low, humidifies o2
IF respiratory failure impending, consider CPAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is viral-induced wheeze

A

Wheeze following a viral infection such as bronchiolitis
Often responds to bronchodilators
If it persists beyond a few weeks, child may be more likely to go on to get an asthma diagnosis when over 2y old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What pathogens cause pneumonia?

A

Neonates: group B strep
<5 years: Strep pneumo, Staph aureus, RSV
>5 years: mycoplasma pneumo, Strep pneumo, Chlamydia pneumo, Group A Strep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Pneumonia: signs and symptoms

A

General URTI signs first
High fever
Respiratory distress
Malaise and poor feeding
Auscultation: bronchial breathing and unilateral coarse end-inspiratory crackles
Pathogen specific signs: wheeze if viral or mycoplasma, abdomen or neck pain if bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pneumonia: management

A

Amoxicillin PO 7 days

IV if very young or very ill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Whooping cough: pathogen and epidemiology

A

Bordatella pertussis, a gram negative coccobacillus

Accounts for 20% of persistent coughs (>2 weeks) in school age kids, even if vaccinated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Whooping cough: clinical features

A

Typical URTI 1st
Followed by a paroxysmal stage: episodes of prolonged hacking cough then inspiratory whoop, possibly accompanied by a red face, bulging eyes, vomiting or syncope. May be triggered by a startle and often worse at night.
Can last up to 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Whooping cough: management

A

Macrolide (clarythromycin/azithromycin) PO if <3 weeks since onset
Prophylactic macrolide to all household contacts if any one is at high risk
Can return to school 5 days after starting antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Inhaled foreign body: signs and symptoms

A

Classic triad:
Persistent cough following choking episode
Wheeze
decreased lung sounds

32
Q

Inhaled foreign body: investigations and management

A

CXR, though only 25% of inhaled items are radiopaque
If location known, rigid bronchoscopy under general anaesthetic (GA) to remove it
If location unknown, flexible bronchoscopy under sedation to find it then rigid bronchoscopy under GA to remove it

33
Q

Inhaled foreign body: complications

A

Complete airway obstruction
Pneumonia. Can be recurrent and lead to abscesses and bronchiectasis
Pneumothorax
Lobar collapse

34
Q

Cystic fibrosis: genetics and pathophysiology

A

Autosomal recessive mutation in CFTR gene on chromosome 7, 1/25 of population are carriers
CFTR is a chloride channel, chloride movement across cell membranes is often followed by Na+ and H2O
In upper airways, CFTR dysfunction leads to reduced fluid in the airways causing a failure of mucus clearance. This leads to recurrent pneumonia and eventually bronchiectasis. Pancreatic interlobular ducts also become clogged with mucus, leading to impaired secretion of digestive enzymes and eventually pancreatic destruction
In sweat glands, impaired chloride removal from the ducts leads to salty sweat

35
Q

CF: presentation

A

Recurrent pneumonia - staph aureus
Neonatal meconium ileum (failure to pass the first stool) PC in 10%
Other GI: steatorrhea, rectal prolapse, SBO, GORD, PUD
Slow growth
Clubbing
Nasal polyps, sinusitis

36
Q

CF: ddx

A

A chronic wet cough or recurrent/prolonged pneumonia may also be caused by:
Immunodeficiency: congenital/HIV
TB
Other causes of bronchiectasis e.g. primary ciliary dyskinesia

37
Q

CF: investigations

A

Newborn screening picks up most cases. Diagnosis confirmed by 2 tests:
Sweat test showing >60mmol/L chloride
Genetic testing showing 2 disease-causing mutations

Other tests:
CXR
PFT: FEV1 is a key prognostic factor
Sputum culture

38
Q

CF: management

A 
MDT
Resp
- Mucus clearance: chest physio and nebuliser mucolytics
- Anti-microbials
- Anti-inflammatories

Non-resp
- if pancreatic insufficiency, give enteric coated pancreatic enzymes before each meal

39
Q

CF: complications

A

Resp failure
Diabetes
Osteoporosis
Cirrhosis

40
Q

CF: prognosis

A

predicted median survival 40-50 years if born today

41
Q

Heart failure in children: causes and epidemiology

A

Structural heart defects: VSD, PDA, coarctation of the aorta, valve disease
Arrhythmias and myocardial disease
Most commonly presents in the first 3 months

42
Q

HF in children: presentation

A 
SOB, especially exertional
Poor feeding and poor weight gain
Cool peripheries and/or sweating
Recurrent chest infection
Increased heart rate, murmur
Cardio- and/or hepatomegaly
43
Q

ddx acute abdo pain in children

A

Inflammatory:

  • abdo infection: appendicitis, gastroenteritis, UTI, mesenteric adenines (post URTI), pancreatitis, hepatitis
  • lower lobe pneumonia
  • autoimmune: IBD, HSP, DKA

Anatomical

  • GI obstruction, constipation
  • Meckel’s complication e.g. obstruction, inflammation, internal herniation
  • renal and genitourinary: hydronephrosis, menstruation
  • compressed anatomy: strangulated inguinal hernia, testicular torsion, ovarian torsion

Non-specific abdominal pain

44
Q

ddx chronic and recurrent abdominal pain in children

A

Usually non-organic (functional)
Organic causes:
- Upper GI: GORD, PUD
- Dietary: Cow’s milk protein allergy, lactose intolerance, coeliac disease
- Lower GI: IBD, constipation
- Malrotation
- Abdominal migraines (headaches, paroxysmal midline pain, facial pallor, nausea)
- Genitourinary: recurrent UTI, gynaecological problems
- Hepatobiliary: pancreatitis, hepatitis

45
Q

Define posseting

A

Non-forceful return of milk with wind

46
Q

Define regurgitation

A

non-forceful but more volume than possessing, usually due to GORD

47
Q

Define vomiting

A

Forceful return of upper GI contents. Most commonly due to GORD or gastroenteritis. Worry if bilious, prolonged or accompanied by systemic symptoms.

48
Q

Ddx acute vomiting in children

A

Infection: gastroenteritis, respiratory tract infection, UTI, meningitis
Pyloric stenosis

49
Q

Ddx blood-stained vomit in children

A

Oesophagitis/PUD
Malrotation
Pertussis

50
Q

What does bile-stained vomit suggest?

A

GI obstruction

51
Q

Ddx chronic vomiting (paeds)

A

GORD

Overfeeding

52
Q

Ddx non-bloody diarrhoea (paeds)

A

Infection: gastroenteritis or any infection (UTI, appendicitis)
Malabsorption: coeliac (also causes constipation), CF
Dietary: cow’s milk protein allergy, lactose intolerance
IBD: Crohn’s more common than UC
IBS

53
Q

Ddx bloody diarrhoea (paeds)

A

Infectious and inflammatory: bacterial GE, IBD > Crohn’s if bloody), NEC, haemolytic uraemia syndrome
Obstruction: intussusception, midgut volvulus
Cow’s milk protein allergy (flecks of blood)
Juvenile polyps of Meckel’s may cause PR bleeding without diarrhoea

54
Q

Ddx Toddler diarrhoea (paeds)

A

Common, chronic diarrhoea syndrome, but the child is otherwise well
Bits of poorly-digested vegetables often seen in the diarrhoea
Usually resolves by 5 years old

55
Q

GI obstruction: causes

A 
Pyloric stenosis
Duodenal atresia (usually presents in first 24 hours of life
Intussusception
Malrotation and volvulus
Meckel's diverticulum
Strangulated inguinal hernia
Hirschprung's
Meconium ileus
56
Q

GI obstruction: signs and symptoms

A

Vomiting, possibly bile-stained if obstruction is below the sphincter of Oddi
Abdominal distension, especially if lower

57
Q

Intussusception: pathophysiology and epidemiology

A

Telescoping of bowel, usually of lieu into cecum
Usual age 6-36 months
May be linked to infection (e.g. rotavirus, adenovirus) , leading to Peyer’s patch (lymphatic hypertrophy.
In older children and adults (rare), it is often secondary to a polyp of tumour

58
Q

Intussusception: signs and symptoms

A

Episodic sever colicky pain and pallor, with knees drawn up
Sausage-shaped mass in abdomen and/or abdominal distension
Recurrent jelly stool (blood stained). A late sign, suggesting bowel ischaemia has occurred
Bile-stained vomit
Shock

59
Q

Intussusception: investigations

A

USS: doughnut sign

60
Q

Intussusception: management

A

USS-guided air enema insufflation

Surgery is needed in 25%

61
Q

Hirschprung’s disease: pathophysiology and epidemiology

A

Congenital absence of ganglion cells in the myenteric and submucosal plexus. Usually affects the rectosigmoid, but can be the whole colon.
Absence of parasympathetic action leads to bowel obstruction
Usually presents <1 year old but sometimes not diagnosed until much later
Around 1/10 patients also have Down’s syndrome
Prevalence 1/5000

62
Q

Hirschprung’s disease: signs and symptoms

A

Abdominal distension
Delayed meconium passage is seen in 50% of Hirschprung’s and is the cause of 50% of delayed meconium
Chronic constipation and occasionally overflow diarrhoea
Vomiting, may be bilious
Enterocolitis is a serious complication, leading to explosive diarrhoea and potentially sepsis

63
Q

Hirchsprung’s disease: investigations

A

Barium enema x-ray with show dilated proximal colon and contracted distal colon
Plain abdo XR may show a dilated colon
Rectal biopsy can confirm the diagnosis, showing absence of ganglion cells

64
Q

Hirschprung’s disease: management

A

Surgical removal of ganglionic bowel segment
Preceeded by bowel irrigation to clear out and reduce distension
Fluid and antibiotics for enterocolitis

65
Q

Malrotation and volvulus: pathophysiology and epidemiology

A

Malrotations are a range of congenital anatomical abnormalities of the GI tract
Volvulus is a sever complication in which a loop of bowel is trusted on it’s mesentery, causing intestinal obstruction. (midgut volvulus, twisting around SMA is a common site)
Volvulus usually occurs <1 year old and carries a high risk of bowel ischaemia

66
Q

Volvulus: signs and symptoms

A

Bilious vomiting
Sever, acute abdominal pain
Abdo distension
systemic symptoms if ischaemia - high HR, low BP
Malrotation alone is often asymptomatic or may cause intermittent, self-resolving obstruction

67
Q

Malrotation and volvulus: investigations

A

Upper GI contrast study with contrast through NG tube or bottle. Shows “corkscrew” duodenum in volvulus

68
Q

Malrotation and volvulus: management

A

Volvulus: ‘drip and suck’ (IV fluids and nasogastric decompression) followed by urgent surgery. If patient is systemically unwell and diagnosis clear, skip imaging
Malrotation: elective surgery
Ladd’s procedure is the commonest surgical approach, involving untwisting bowel, dividing congenital peritoneal bands which compress the duodenum and widening the mesentary.

69
Q

Pyloric stenosis: risk factors

A

Male
first born
family history

70
Q

Pyloric stenosis: signs and symptoms

A

Presents and 2-7 weeks with: projectile, non-bilious vomiting after feeds
Hunger
Olive shaped mass in RUQ
Visible peristalsis

71
Q

Pyloric stenosis: investigations

A

USS only needed if examination unclear
U&E: low sodium, low potassium
Blood gas: metabolic acidosis

72
Q

Pyloric stenosis: management

A

Fluids

Surgical repair through pylorotomy, which involves longitudinal splitting of the pyloric muscle

73
Q

Meckel’s diverticulum: pathophysiology and epidemiology

A

Congenital, ‘true’ diverticulum (includes all bowel layers) in the distal ileum. A vestige of the embryological vitelline duct which connect the yolk sac to the midgut lumen.
Often comprises ectopic, acid-secreting gastric mucosa.
Rule of 2s: 2% prevalence, 2 feet proximate the ileocaecal valve, 2 inches in length, 2:1 male:female ratio, usually <2 years old
It can lead to to bowel obstruction from intussusception, midgut volvulus around a fibrotic attachment to the abdominal wall, and/or adhesions or strictures from chronic inflammation

74
Q

Meckel’s diverticulum: presentation

A

Usually asymptomatic, but in 5% it presents with a complication such as bleeding, bowel obstruction (commoner in kids), or diverticulitis (commoner in adults). Rarely, it can be part of herniated bowel (little hernia)

75
Q

Meckel’s diverticulum: signs and symptoms

A

Painless, bright red PR bleeding
Meckel’s diverticulitis presents with diarrhoea and umbilical pain, nausea and vomiting, and recurrent jelly stool (in intussusception)

76
Q

Meckel’s diverticulum: investigations

A

Meckel’s scan: technetium-99m pertechnetate scintigraphy, a nuclear medicine scan. Pertechnetate

Phase 3A Medicine (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions