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Paediatrics Flashcards

1
Q

Describe the changes to fetal circulation that occur at birth

A

In utero blood bypasses lungs. Goes from RV to aorta via DA. Right sided pressure high because of blood from placenta. Left sided pressure lower because no blood coming from lungs. So R –> L via foramen ovale. At birth baby breathes, umbilical arteries constrict, pulmonary arteries dilate, DA closes.

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2
Q

Causes of congenital heart defects

A

Diabetes
Rubella
SLE
Lithium, anticonvulsants, fetal alcohol syndrome
Turners, Downs, Edwards, Pataus, DiGeorge, Marfarns

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3
Q

Which direction is the shunt in acyanotic congenital heart defects

A

Left to right

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4
Q

Which direction is the shunt in cyanotic congenital heart defects

A

Right to left

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5
Q

Are cyanotic or acyanotic congenital heart defects more common

A

Acyanotic

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6
Q

Causes of acyanotic congenital heart defects

A 
Septal defects
Patent ductus arteriosus 
Coarctation of the aorta
Aortic stenosis
Pulmonary stenosis
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7
Q

Causes of cyanotic congenital heart defects

A

Tetralogy of Fallot
Transposition of great arteries
Atresia

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8
Q

What is Eisenmenger reaction

A

When an acyanotic shunt (left to right) becomes a cyanotic shunt (right to left)

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9
Q

Ventricular septal defect murmur

A

Pansystolic at left lower sternal border

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10
Q

Atrial septal defect murmur

A

Mid-diastolic murmur at the left upper sternal border

Also get widely split S2

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11
Q

Murmur associated with patent ductus arteriosus

A

Continuous machine like murmur at the left upper sternal border

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12
Q

Findings associated with coarctation of the aorta

A

Upper limb hypertension
Weak/absent femoral pulses
Headache, chest pain, cold peripheries

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13
Q

Causes of paediatric heart failure

A 
Anaemia
Arrhythmia
Myocarditis
Cardiomyopathy
Structural defects
Hypertension
Kawasaki disease
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14
Q

Signs of right sided cardiovascular congestion

A 
Hepatomegaly
Ascites
Abdo pain
Oedema
JVP
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15
Q

Signs of left sided cardiovascular congestion

A

High resp rate
Respiratory distress
Pulmonary oedema

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16
Q

Features of decreased cardiac output in a child

A 
Fatigue
Pallor
Sweating
Cool extremities
Nausea/vomiting
Poor growth
Dizziness
Syncope
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17
Q

Features of heart failure in infants

A 
High HR
High RR
Restless/irritable
SOB
Acidosis
Sweating
Trouble feeding
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18
Q

What is the hyperoxia test

A

Used to differentiate cause of cyanosis in infants
If cause is pulmonary then cyanosis resolves with 100% oxygen
If cause is cyanotic congenital heart defect then cyanosis will persist

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19
Q

Management of heart failure in children

A 
If duct dependent give prostin and stop oxygen
Diuretics
ACE inhibitors
High calorie diet
Inotropes
Surgery
Drain pleural effusions
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20
Q

Duct dependent congenital heart disease

A 
Hypoplastic left heart
Coarctation of the aorta
Severe aortic stenosis
Pulmonary atresia
Severe tetralogy of fallot
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21
Q

What are the 4 features of tetralogy of fallot

A

Ventricular septal defect
Over-riding aorta
Pulmonary stenosis
Right ventricular hypertrophy

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22
Q

Causes of myocarditis

A

Viral - coxsackie, parvovirus, mononucleosis
Bacterial - beta haemolytic strep A, diphtheria, TB
Fungal - candida, aspergillus
SLE
Kawasaki
Radiation/chemotherapy
Alcohol/cocaine

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23
Q

Clinical features of Kawasaki disease

A 
Children <5
High fever
Desquamative rash
Conjunctivitis
Mucositis - strawberry tongue
Cervical lymphadenopathy
Erythema and oedema of distal extremities 
!! coronary artery aneurysm
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24
Q

Treatment for Kawasaki disease

A

IV immunoglobulins

High dose Aspirin

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25
Q

Symptoms of acute rheumatic fever

A 
JONES
Joints
Pancarditis
Nodules
Erythema marginatum
Sydenham chorea
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26
Q

Causative organism of rheumatic fever

A

Group A beta-haemolytic streptococcus

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27
Q

Differential diagnosis of stridor

A 
Croup
Bacterial tracheitis
Epiglottitis
Laryngomalacia
Inhaled foreign body
Anaphylaxis
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28
Q

Causative organism of croup

A

Parainfluenza virus

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29
Q

Causative organism of whooping cough

A

Bordetella pertussis

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30
Q

Causative organism of bronchiolitis

A

Respiratory syncytial virus

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31
Q

3 key features of epiglottitis

A

Dysphagia
Drooling
Distress

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32
Q

Typical presentation of bacterial tracheitis

A

Rapid deterioration following a cold/croup

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33
Q

At roughly what age should laryngomalacia have resolved by

A

2 years

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34
Q

Management of chronic asthma in children

A 
SABA
Low dose ICS
LABA/LTRA
Increase ICS
Refer
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35
Q

Management of acute asthma in children

A 
Oxygen
Salbutamol pMDI + spacer or Neb
Steroids (continue for 3 days)
Ipratropium bromide
MgSO4 nebuliser
IV salbutamol
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36
Q

Discharge criteria for children following an acute asthma episode

A

Stable on 3-4 hourly salbutamol
Sats >94%
PEFR >75%

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37
Q

Definition of anaphylaxis

A

Airway compromise and hypotension in the setting of an allergic reaction

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38
Q

Management of anaphylaxis

A 
Oxygen
Raise legs
Adrenaline
Antihistamines
Steroids
Fluids
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39
Q

What are the 4 different types of hypersensitivity reaction

A

Type 1 - immediate
Type 2 - cytotoxic (autoimmune)
Type 3 - immune complex (vaccinations and vasculitis)
Type 4 - delayed (SJS, transplant rejection)

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40
Q

Management of choking

A

Assess cough effectiveness - if effective encourage

If cough not effective then: 5 back blows followed by 5 abdo thrusts (chest if <1)

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41
Q

Inheritance pattern of cystic fibrosis

A

Autosomal recessive

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42
Q

Systems affected by cystic fibrosis

A 
Respiratory
Pancreas
Liver
Bile duct
Bowel
Fertility
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43
Q

Gold standard test for cystic fibrosis

A

Sweat test

44
Q

Management of cystic fibrosis

A 
Phsyio
Dietary supplements
Vitamins ADEK replacement
Pancreatic enzyme replacement
Hypertonic saline, mucolytics
Bronchodilators 
Vaccinations
45
Q

Intake requirements of a <1 month old and an >1 month old

A

<1 month: 150ml/kg/day

>1 month: 100ml/kg/day

46
Q

At what age would you expect GORD to be getting better in infants

A

6-9 months

47
Q

If a child has had gastroenteritis what should you advise them about going to school

A

Stay off school until 48hrs symptom free

48
Q

Is fecal calprotectin raised or lowered in IBD

A

Raised

49
Q

Causes of gastroenteritis

A

Viral - rotavirus
Bacterial - campylobacter, salmonella, e.coli
Parasites - giardia

50
Q

Indications for stool microscopy

A 
Recent travel
No improvement in diarrhoea by day 7
Blood/mucus in stool
Sepsis
Immunocompromise
51
Q

What % fluid loss counts as mild, moderate and severe dehydration

A

Mild 4%
Moderate 4-7%
Severe 7%

52
Q

How much ORS should be given after each loose stool

A

5ml/kg

53
Q

Fluid replacement for shock

A

20ml/kg 0.9% NaCl IV bolus by rapid infusion

54
Q

Maintenance fluids

A

0.9% NaCl + 5% glucose with 10mmol KCl

100ml/kg for the first 10kg
50ml/kg for the next 10kg
20ml/kg for each kg after that

This gives total 24hrs so divide by 24 to get ml/hr rate

55
Q

Calculation to work out % dehydration

A

(weight loss/original weight) X 100

56
Q

Calculation to work out fluid deficit

A

(% dehydration X current weight) X 10

57
Q

What is Kernigs sign

A

When hip is flexed can’t straighten leg

Sign of meningism

58
Q

What is Brudzinski sign

A

Neck flexion causes hips/knees to flex too

Sign of meningism

59
Q

When does the posterior fontanelle close

A

1-2 months old

60
Q

When does the anterior fontanelle close

A

9-18 months old

61
Q

Sepsis 6

A 
Oxygen
Antibiotics
Fluids
Blood cultures
Lactate
Urine output
62
Q

Common causes of meningitis in children < 3 months old

A

Group B strep
E.coli
Listeria

63
Q

Common causes of meningitis in children > 3 months old

A

Niesseria meningitides

Strep penumoniae

64
Q

Viral causes of meningitis

A 
Coxsackie
Adenovirus
Mumps
Varicella zoster
EBV
65
Q

Antibiotics for bacterial meningitis/meningococcal treatment in < 3 month olds vs > 3 month olds

A

< 3 months: IV Cefotaxime + Amoxicillin

> 3 months: IV Ceftriaxone

66
Q

Why do you give steroids within the first 12 hours of the first antibiotic dose

A

To reduce the chance of deafness

67
Q

How does listeria look on microscopy

A

Gram positive rod

68
Q

Differentials for seizure in children

A 
Febrile convulsions
Encephalitis/meningitis
Sepsis/shock
Epilepsy
Metabolic disease
Poisoning
Trauma
SOL
Hydrocephalus
69
Q

Definition/diagnostic criteria of epilepsy

A

2 unprovoked seizures >24hrs apart or dx of epilepsy syndrome or dx of high chance of recurrence

70
Q

What is a reflex anoxic seizure

A

A seizure after insult e.g. knock on head

71
Q

Features of non-epileptic attack disorder

A

Mainly trunk/proximal movements
Crying
Eyes shut

72
Q

Age range for febrile convulsions

A

6 months - 5 years

73
Q

Management of seizures in children

A

Buccal midazolam/rectal diazepam
IV Lorazepam dose 1
If not improved in 10 mins dose 2 of Lorazepam
IV Phenobarbitol/Phenytoin
If not stopped in 20 mins then IV Midazolam/Thiopental

74
Q

Early hand dominance occurs before what age

A

12 months

75
Q

Early hand dominance and persistent toe walking should make you think of which disease

A

Cerebral palsy

76
Q

Features of autism spectrum disorder

A

Difficulty with communication and social interaction
Inflexible thinking
Repetitive/restricted/stereotyped behaviour
Motor stereotypies
Sensory interests
Often associated medical conditions - Down’s, epilepsy, ADHD, fragile X

77
Q

Which medication is used to treat ADHD

A

Methylphenidate

78
Q

What monitoring advice is required for Methylphenidate

A

BMI, HR, BP, ECG: frequency depends on if younger or older than 10
If weight loss concern then take after food, add snacks, high calorie foods, take planned break from treatment

79
Q

Diagnostic criteria for ADHD

A

Must be present by age 12 and in two or more settings (e.g. home and school)

80
Q

What are the 3 main types of cerebral palsy

A

Spastic
Ataxic
Dyskinetic

81
Q

3 physical/developmental key features/red flags for cerebral palsy

A

Early hand dominance
Persistent toe walking
Outswinging of leg when running

82
Q

What is the inheritance pattern of duchenne muscular dystrophy

A

X linked recessive

83
Q

Chance of someone with DMD having an affected a) child b) son

A

1 in 4 chance of affected child

1 in 2 chance of affected son

84
Q

Clinical features of duchenne muscular dystrophy

A

Calf hypertrophy with proximal muscle weakness
Gowers sign
Muscles gradually weaken over time

85
Q

Why do you avoid 100% oxygen in premature babies

A

Risk of retinopathy of prematurity

86
Q

Most common UTI pathogen in children

A

E.coli

87
Q

What age group with suspected UTI warrants urgent admission

A

<3 months old

88
Q

How long after discharging a child with UTI do you perform USS

A

Within 6 months

89
Q

2 specialist urology investigations

A

DMSA - radionucleotide scan

MCUG - micturating cystourogram

90
Q

How long after UTI do you wait before performing DMSA

A

4-6 months

91
Q

How long after UTI do you wait before performing MCUG

A

A few weeks

92
Q

Definition of secondary nocturnal enuresis

A

Nocturnal enuresis after a minimum of 6 months dry period

Developmental age needs to be > 5 years

93
Q

At what age is encopresis considered a medical condition

A

Developmental age needs to be >4 years

94
Q

What is the difference between renal hypoplasia, renal dysplasia and renal agenesis

A

Hypoplasia is less nephrons
Dysplasia is undifferentiated
Agenesis is absence

95
Q

Features of colic

A 
Cries >3 hours per day, 3 days a week, for at least 1 week
Hard to soothe
Clenched fists
Goes red in the face
Brings knees up and arches back
Wind
96
Q

When age does colic usually resolve by

A

6 months

97
Q

General advice if baby has colic

A

Hold upright during feeds
Wind after feeds
Gentle rocking
Warm baths

98
Q

Signs/symptoms of cows milk allergy

A 
Typically develops when cows milk first introduced. 
Two main types; immediate CMA (sx within minutes), delayed CMA (sx hours or days after)
Skin reactions - mouth, face, eyes
Stomach ache
Vomiting
Colic
Diarrhoea/constipation
Coryzal symptoms
Eczema
99
Q

Management of cows milk allergy

A

Remove cows milk protein from mums diet if breastfeeding, or change formula if bottle fed (Aptamil Pepti, Nutramigen)
Review every 6-12 months and introduce small amount to see if they’ve developed a tolerance
Usually grow out of it by age 5

100
Q

Is lactose intolerance an allergy?

A

No - it’s an inability to digest lactose

101
Q

What food intolerance can develop after an infection (e.g. gastroenteritis)

A

Lactose intolerance

102
Q

Features of reflux in infants

A 
Vomits after feeds
Hiccups/coughing when feeding
Unsettles
Crying
Not gaining weight
103
Q

Management options for reflux in children

A

Thickened formulas
PPI
Fundoplication

104
Q

When does reflux usually start and get better by

A

Starts before 8 weeks old and usually better by 1 year

105
Q

What is coeliac disease

A

An autoimmune reaction to gluten

106
Q

What is gluten

A

A protein found in wheat, barley and rye

107
Q

Features of coeliac disease

A 
Diarrhoea
Abdo pain
Flatulance
Indigestion
Constipation
Fatigue
Malnutrition
Weight loss
Dermatitis herpetiformis
IDA
B12 anaemia 
Other autoimmune diseases - T1DM, thyroid

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