Paediatrics Flashcards
Describe a heart murmur.
Loudness (1-6).
Presence of a thrill ensures murmur is at least a grade 4 or above.
Timing (systolic, diastolic, continuous).
Duration (ejection, mid or pansystolic).
Site - where loudest.
Radiation.
Features of an innocent murmur.
Asymptomatic. No thrills or heaves. Soft systolic murmur. varies with position. Localised to one area.
Cyanotic congenital heart lesions.
Tetralogy of Fallot.
Transposition of the great arteries.
Tricuspid atresia.
Pulmonary atresia.
5 causes of cyanosis.
- Respiratory disease.
- Cardiac.
- During a seizure.
- Stress: infection, hypoglycaemia, adrenal crises.
- CNS depression: drugs, trauma, asphyxia.
Common causes of cardiac failure.
- Cardiac:
- neonatal: PDA, hypoplastic left heart syndrome, coarctation of the aorta, cardiomyopathy, critical aortic stenosis.
- infant: VSD, AVSD, cardiomyopathy.
- child: cardiomyopathy, failing complex congenital heart disease. - Stress: fever, hypoxia, infection, acidosis.
- Anaemia.
- Fluid overload.
Types of cardiac abnormalities associated with Down’s Syndrome.
AVSD, VSD, ASD, Tetralogy of Fallot.
Types of cardiac abnormalities associated with Turner’s syndrome.
Aortic stenosis, coarctation of the aorta, bicuspid aortic valve.
Atrial Septal Defect.
Secundum defect, in the centre of the atrial septum.
Primum defect (partial AVSD_ at the crux of the heart.
Usually asymptomatic in childhood.
Incidental murmur.
Later in life may present with breathlessness and arrhythmias.
Treatment - transcatheter device closure (secundum only) or surgical repair (secundum and primum).
Good long term outlook.
Ventricular Septal Defect.
2/1000 births.
Membranous or muscular part of the septum - small, medium or large.
Small - usually asymptomatic and ~80% close spontaneously.
Large/haemodynamically significant VSDs repaired in 1st 6 months of life.
Large - effects are left ventricular overload and increased pulmonary blood flow causing cardiac failure.
Heart failure - medical management with diuretics, ACE inhibitors, maximising nutrition (often with NG feeds).
Earlier surgery if failure to thrive.
Patent Ductus Arteriosus.
Associated with prematurity and maternal rubella.
Continuous murmur under left clavicle.
Complications include heart failure and failure to thrive.
Treatment in preterm infants - NSAIDs and surgical ligation if medical management fails.
Older children - occlusion by cardiac catheterisation.
Coarctation of the Aorta.
Neonates - collapse, cardiac failure, weak/absent femoral pulses.
Older children/adults - hypertensive, absent femoral pulses or radio-femoral delay.
CXR - cardiomegaly, rib notching.
Treatment - surgery in infants, balloon dilatation/stenting more common in adults.
Transposition of the Great Arteries.
Most common cyanotic condition.
2 separate circulations - mixing occurs at atrial level and arterial duct.
Effortless tachypnoea and acidotic when duct closes.
May not have a murmur.
CXR - ‘egg on side’.
Prostaglandin to open arterial duct.
May need urgent balloon arterial septostomy (BAS) to increase mixing at atrial level.
Definitive surgery - arterial switch (good long-term outcome).
What conditions make up Tetralogy of Fallot?
- Ventricular septal defect.
- Right ventricular outflow obstruction (RVOTO).
- Aortic override of VSD.
- Right ventricular hypertrophy.
Tetralogy of Fallot.
Can be pink if minimal RVOT obstruction (progressively cyanosed due to fixed obstruction).
Hypercyanotic spells due to dynamic RVOT obstruction.
Polycythaemia (haematocrit of 55-80%) is characteristic.
CXR - boot shaped heart with an upturned apex.
Associated with Di George Syndrome (22q 11 microdeletion),
Define cerebral palsy.
A dynamic/changing disorder of posture and movement caused by a non-progressive lesion to the developing brain.
Comorbidities of cerebral palsy.
Epilepsy. Learning disability. Behavioural problems. Feeding problems/GORD. Osteoporosis.
Define myelomeningocele.
Outpouching of the spinal cord and its coverings through a defect in posterior elements of vertebral arches.
Define an epileptic seizure.
A transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Definition of epilepsy.
- At least 2 unprovoked seizures occurring more than 24 hours apart.
- 1 unprovoked seizure and a probability of further seizures similar to the general recurrence risk after 2 unprovoked seizures (75%).
- At least 2 seizures in a setting of reflex epilepsy. +
Causes of amblyopia.
Amblyopia = poor vision in a structurally normal eye.
- Reduced view through eye (e.g. ptosis, cataract).
- Unequal focus (e.g. anisometropia).
- Misalignment of eyes (e.g. squint).
Causes of leukocoria.
Cataract.
Retinoblastoma.
Many others - retinal detachment, toxoplasmosis, uveitis etc.
Describe Gower’s sign.
When a child uses their hands to splint their legs to help them rise from sitting.
- function of weakness.
- classically in DMD.
- but may occur in any condition with muscle weakness.
Top 3 bacterial causes of septic arthritis.
Staph aureus.
Strep pneumoniae.
Haemophilus influenzae.
