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3A Revision > paediatrics > Flashcards

paediatrics Flashcards

1
Q

Name the 3 fetal shunts

A

ductus venosus
ductus arteriosus
foramen ovale

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2
Q

what circulatory changes happen at birth

A
  • reduced ciruclating prostaglandins at birth causes closure of the ductus arteriosus
  • babies 1st breath causes pulmonary flow resistance to fall meaning pressure in the R atrium decreases, and pressure in the L atrium increases because more blood returns from the lungs, meaning L ventricular pressure also increases causing the forman ovale to close.
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3
Q

Name 3 causes of a left to right shunt

A

ventricular septal defect
atrial septal defect
patent ductus arteriosus

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4
Q

what are the 2 types of atrial septal defect and describe them

A
  1. secundum ASD = a hole in the centre of the septum, often involves the foramen ovale
  2. partial ASD = a hole in the very bottom of the atrial septum often involving the AV valve and displaces the AV node.
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5
Q

name the symptoms of an atrial septal defect in children

A
  • asymptomatic
  • recurrent chest infections
  • difficulty feeding
    wheeze
  • failure to thrive?
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6
Q

what type of murmur is heard with a secundum atrial septal defect and where is it heard

A

a crescendo-descendo ejection systolic murmur with a split second heart sound heard at the upper left sternal edge

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7
Q

what type of murmur is heard with a partial ASD and where is it heard

A

apical pansystolic murmur with a split second heart sound

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8
Q

What investigations would you order to diagnose an atrial septal defect

A
  • ECG
  • CXR
  • echo with doppler ultrasound
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9
Q

what chest xray findings would you see in a infant with an ASD

A

cardiomegaly (may be R ventricle hypertrophy)
enlarged pulmonary arteries
increased pulmonary vascular markings

^ because the blood is shunted from left to right so more blood is in the R ventricle and pulmonary flow is increased

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10
Q

what would you find on an ECG of a baby with a secundum ASD

A

partial RBBB

R axis deviation

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11
Q

what would you find on an ECG of a baby with a partial ASD

A

superior QRS axis

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12
Q

how do you manage small ASD’s

A

watch and wait

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13
Q

how do you manage larger ASD’s

A

secundum = cardiac catheterisation to insert occlusion device via the femoral vein

partial ASD = surgery to close the hole

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14
Q

At what age is surgical correction of ASD’s undertaken

A

at 3-5 years of age to prevent R heart failure later on in life.

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15
Q

which syndromes are associated with ventricular septal defects

A

turners syndrome

downs syndrome

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16
Q

which vessel is used for cardiac catheterisation

A

femoral vein

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17
Q

define a small ventricular septal defect

A

a hole less than 3mm in size

  • usually asymptomatic and will close spontaneously
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18
Q

define a large ventricular septal defect

A

a defect that is the same size of/bigger than the aortic valve.

  • requires treatment
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19
Q

name symptoms of a large ventricular septal defect

A
  • can present with heart failure and SOB in the 1st week of life
  • recurrent chest infections
  • poor feeding, poor weight gain
  • dyspnoea
  • tachypnoea
  • tachycardia
  • enlarged liver
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20
Q

name the signs of a large ventricular septal defect

A
  • tachycardia
  • tachypnoea
  • hepatomegaly
  • soft pansystolic murmur
  • sometimes no murmur
  • loud pulmonary 2nd sound
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21
Q

what type of murmur is heard in a large ventricular septal defect and where

A

soft pansystolic murmur at the left lower sternal edge

  • no murmur indicates a larger hole
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22
Q

what investigations would you order to diagnose a ventricular septal defect

A

CXR
Echo
ECG

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23
Q

what would you find on chest xray of patient with a large VSD

A

cardiomegaly
increased pulmonary vascular markings
enlarged pulmonary arteries
pulmonary oedema

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24
Q

name a complication of large untreated VSD

A

R heart failure

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25
Q

how would you manage a small VSD

A

watch and wait if no pulmonary hypertension or heart failure evident

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26
Q

how would you manage a large VSD

A
  • prophylactic antibiotics to reduce risk of bacterial/infective endocarditis
  • whilst waiting for surgery manage heart failure with diuretics, additional calories for growth and Catopril (ACE inhibitor). Digoxin can also be used to reduce sympathetic tone and improves growth outcomes.
  • surgery at 3-6 months of age to close the hole
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27
Q

at what age is surgery for large ventricular septal defects carried out

A

at 3-6 months of age

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28
Q

where is the ductus arteriosus located

A

connects the pulmonary artery to the descending aorta

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29
Q

name a risk factor for patent ductus arteriosus

A

maternal rubella infection

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30
Q

name symptoms of patent ductus arteriosus

A

SOB, poor feeding, poor weight gain, recurrent chest infection

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31
Q

name signs of a patent ductus arteriosus

A
  • crescendo descendo murmur below the left clavicle

- increased pulse pressure presenting as a collapsing or sounding pulse

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32
Q

name 6 common causes of vomiting in infants

A
  • GORD
  • infection (non specific) e.g UTI, resp infection, gastritis, meningitis
  • intestinal obstruction - volvulus, malrotation, intersusseption, pyloric stenosis, hirschprungs disease, duodenal atresia, strangulated hernia
  • inborn error of metabolism
  • food allergy or intolerance
  • cows milk protein
  • eosinophilic oesophagitis
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33
Q

name 6 common causes of vomiting in pre-school aged children

A

Gastritis
Infection - UTI, resp, gastritis, meningitis
coeliac disease
intestinal obstruction - volvulus, intersusseption, malrotation, constipation
renal failure
testicular torsion
raised ICP

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34
Q

name 6 causes of vomiting in older children/adolescents

A 
gastroenteritis 
coeliac disease
peptic ulcer
intestinal obstruction 
bulemia 
testicular torsion
raised ICP
migraine 
diabetic DKA
pregnancy 
appendicitis 
infection - sepsis/meningitis
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35
Q

define GORD

A

involuntary reflux of gastric contents into the oesophagus

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36
Q

Management of GORD in children

A

thicken feeds
PPI - omeprazole
H2 receptor antagonst - ritanidine

surgery if severe/persists

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37
Q

why is GORD common in the 1st year of life

A

because infants spend a lot of time horizontal, have a fluid only diet and have involuntary relaxation of the lower oesophageal spinchter possibly due to underdevelopment/low tone

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38
Q

symptoms of GORD

A 
regurgitation of food
vomiting
cough in older children
poor feeding 
faltering growth if severe
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39
Q

risk factors for GORD in children

A

prematurity
bronchopulmonary dysplasia
cystic fibrosis

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40
Q

which surgical procedure can be used to treat GORD if severe

A

Nissen fundoplication

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41
Q

how would you investigate GORD

A

24 hour oesophageal pH monitoring
mainly a clinical diagnosis

endoscopy with biopsy can be used to confirm if there are complications associated with GORD

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42
Q

name complications that can arise from GORD

A

oesophagitis = haematemesis, poor feeding, iron deficiency anaemia

pulmonary aspiration of contents = recurrent infection, wheeze, cough

failure the thrive/poor growth

dystonic neck posturing

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43
Q

what is eosinophilic oesophagitis?

A

inflammation of the oesophagus caused by infiltration and activation of eosiniphils in the oesophageal mucosa and submucosa

more common in children with other atopic diagnoses e.g asthma, eczema

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44
Q

symptoms of eosiniphilic oesophagitis

A

vomiting
bolus dysphagia (getting stuck in chest)
pain on swallowing

45
Q

treatment of eosinophilic oesophagitis

A

oral corticosteroids e.g viscous budenoside

46
Q

what is pyloric stenosis

A

hypertrophy of the pyloric muscle (usually fundus) causing projectile vomiting in infants

47
Q

symptoms of pyloric stenosis

A
  • projectile vomiting that gradually increases in frequency
  • presents at 2-8 weeks of life
  • poor feeding, cant keep food down
  • poor weight gain
  • hungry after vomiting so crys
48
Q

signs/examination findings shown in pyloric stenosis

A

gastric peristalsis seen in upper right quadrant

olive shaped mass palpable

if abdomen is distended gas should be removed via NG tube to allow for examination

49
Q

investigations in pyloric stenosis?

A

ultrasound scan of abdomen

U+E, blood gas will show hypochloraemic metabolic alkalosis with low potassium and low sodium due to vomiting.

50
Q

management of pyloric stenosis?

A 
correction of alkalosis
pyloromyotomy surgery (either by a periumbillical incision or laparoscopy)
51
Q

Which virus is responsible for the majority of gastroenteritis in childrem

A

rota virus

52
Q

name causative organisms of gastroenteritis in children

A 
rotavirus
adenovirus
campylobacter jejuni
e.coli
shigella
salmonella
53
Q

most common causative bacteria of gastroenteritis in children

A

campylobacter jejuni

54
Q

what signs indicate an salmonalla/shigella gastro infection

A

blood and mucus in the stools, diarrhoea/vomiting

55
Q

symptoms of gastroenteritis

A

rapid onset loose watery stools and vomiting, abdo pain, contact with someone with D+V or travel abroad or eating out at restaurant

56
Q

how would you investigate suspected gastroenteritis

A
  • FBC. U+E, LFT
    imflammatory markers
    stool and blood culture
    check plasma electolytes, creatinine and glucose if there is prolonged diarrhoea or if fluids are required (dehydration)
57
Q

what should you always check for in children with prolonged diarrhoea

A

dehydration =

physical exam
stool and blood culture
check plasma electrolytes, creatinine and glucose

if shocked check blood gases

58
Q

differential diagnosis for diarrhoea and vomiting in children

A 
cow milk protein allergy
coeliacs
lactose intolerance
intestinal obstruction e.g volvulus intersusseption malrotation
pyloric stenosis
acute appendicitis
DKA
sepsis
meningitis
migraines in older kids
59
Q

define clinical dehydration

A

a loss of bodyweight between 5-10%

60
Q

define shock (hypovolaemic?)

A

a loss of bodyweight over 10%

61
Q

what are the signs of hypovolaemic shock

A 
pale motted skin
prolonged capillary refill
loss of skin turgor
sunken eyes
sunken fontanelle
cold extremities
dry mucous membranes
reduced urine output
hypotension
tachypnoea
reduced consciousness
62
Q

what puts infants at risk of dehydration

A
  • passing 6+ watery stools over 24 hours
  • malnutrution
  • preterm
  • low birthweight
  • unable to tolerate feeds/fluids
  • not offered fluids
  • vomiting
63
Q

management of gastroenteritis

A

correct dehydration with oral rehydration solution/fluids if needed

antibiotics not helpful unless sepsis

64
Q

give indications for antibiotics in children with gastroenteritis

A

only indicated if sepsis/ immunocompromised/ extra intestinal spread of infection.

65
Q

what is post gastroenteritis syndrome

A

where the child has watery diarrhoea when you re-introduce feeds after infection depsite no infection being present (just has to re adjust and treat with oral rehydration solution)

66
Q

name 5 causes of gastritis

A 
h.pylori infection
autoimmune gastritis 
crohns 
NSAID use
increased stomach acid secretion
67
Q

even though P.U.D is rare in children, when should you consider peptic ulcers in children

A

when they show symptoms and they have a 1st degree relative with P.U.D

68
Q

name symptoms of gastritis

A

nausea
vomiting (usually no blood unless severe)
abdominal (epigastric) pain
dyspepsia

69
Q

name possible complications of gastritis

A

bleeding - iron deficiency anaemia

sepsis

70
Q

treatment of h.pylori

A

triple therapy -
amoxicillin
omeprazole (PPI)
and Clarythromycin or metronidazole

71
Q

how do you diagnose gastritis caused by h.pylori infection

A

C breath test
serum serology for h.pylori
stool antigen test

72
Q

when should children with suspected gastritis be referred for further investigation

A

when they don’t respond to treatment - refer for upper GI endoscopy

73
Q

what is functional dyspepsia

A

sort of like IBS, affects the stomach causing vomiting, cramps etc usually after food, delayed gastric emptying,

no real cause.
usually diagnosed after suspected gastritis doesnt improve with treatment and upper GI endoscopy is normal

74
Q

how do you treat functional dyspepsia

A

hypoallergenic diet

75
Q

symptoms of ibs in children

A 
non specific:
abdo pain
watery/loose stools
bloating
constipation
feeling of incomplete defecation
76
Q

what is a common cause of appendicitis in children

A

faecoliths

77
Q

describe abdo pain in apendicitis

A

begins peri umbilical and general then localises in the right illiac fossa (mcburneys point).
Pain aggravated by moving, walking and coughing

severe sharp pain

78
Q

what is abdominal guarding a sign of

A

peritonitis

79
Q

symptoms of acute appendicitis

A 
severe abdo pain R illiac fossa
vomiting 
anorexia
fever
diarrhoea
80
Q

what would you find on abdominal examination of child with acute appendicitis

A 
guarding 
rebound tenderness
severe pain
R illiac fossa mass
child may prefer to sit/lie still with knees to chest
81
Q

how would you manage a child with suspected acute appendicitis

A

review and observations every couple of hours initially (bc can rapidly progress in children)

IV fluids and antibiotics to try and clear infection

USS to confirm appendix with increased blood flow/inflamed

appendicectomy

82
Q

name 2 complications of acute appendicitis in children

A

peritonitis

abscess formation

83
Q

what is intersusseption

A

Invagination of one section of bowel into the other. when proximal bowel telescopes into distal bowel

84
Q

where does intersusseption most commonly occur

A

at the illeocaecal valve (junction between small and large bowel)

85
Q

what age does intersusseption commonly present

A

between 2 months - 3 years of age

86
Q

what is the most common cause of intestinal obstruction in neonates

A

intersusseption

87
Q

what causes intersusseption

A

unknown. associated with viral infection causing enlargement of peyers patches. Usually requires a lesion that obstructs normal peristalsis causing the lesion and that section of bowel to move forwards into the next section with peristaltic waves.

common lesions include polyps, meckels diverticulum, areas of intramural haemorrhage (e.g henoch-schonlein purpura)

88
Q

what bowel lesions are associated with causing intersusseption

A

viral infection causing enlargement of peyers patched
polyps
meckels diverticulum
henoch schonlein purpura

89
Q

symptoms of intersusseption

A
  • abdo pain (severe colicky that gradually gets worse)
  • child goes pale and draws legs up to their chest
  • child falls asleep between episodes
  • vomiting
  • constipation (from obstruction)
  • refuses feeds
  • lethargy
  • abdominal distension (trapped gas)
  • may present with hypovolaemic shock due to pooling of fluid in the bowel
90
Q

what is found on examination of a child with intersusseption

A

red currant jelly stools
sausage shaped mass in abdomen
distension

91
Q

what investigations would you do to diagnose intersusseption

A

abdo X ray - shows distended small bowel, no gas in distal colon

USS confims diagnosis = doughnut sign!

92
Q

A doughnut sign is found on abdominal ultrasound scan, what is the diagnosis

A

intersusseption

93
Q

redcurrant jelly stool is associated with which disease

A

intersusseption

94
Q

treatment of intersusseption

A
  • fluid resus is shocked
  • if no complications radiologist performs rectal air insufflation
  • if complications surgery to correct the bowel
95
Q

complications associated with intersusseption

A

bowel perforation
peritonitis
bowel necrosis
hypovolaemic shock from pooling of fluid in the bowel

96
Q

what is a meckels diverticulum

A

embryological remenant of the vitello-intestinal duct that contains pancreatic tissue and ectopic gastric mucosa

97
Q

where is meckels diverticulum found

A

an outpouching in the small intestine

98
Q

what can meckels diverticulum cause

A

usually asymptomatic but can cause GI bleeding or obstruction i.e volvulus, malrotation, intersusseption

can also cause diverticulitis

99
Q

how is meckels diverticulum diagnosed

A

technetrium scan shows increased isotope uptake

or laparoscopy

100
Q

treatment of meckels diverticulum

A

surgical resection only required if symptomatic

101
Q

what is malrotation

A

intestinal obstruction caused by incomplete rotation of the intestine during fetal development. often leads to volvulus which is a life threatening acute emergency.

102
Q

name complications of a volvulus

A 
volvulus
ischaemic bowel
bowel necrosis
peritonitis 
shock (hypovolaemic)
103
Q

symptoms of malrotation with volvulus

A

BILE STAINED DARK GREEN VOMITING
abdo pain
abdo distension
abdo wall oedema

104
Q

what investigations would you order in a child with suspected malrotation

A

urgent upper GI contrast study

bloods

105
Q

how would you manage malrotation

A

if obstruction = fluid resus and antibiotics

surgery - ladds procedure is used if the bowel is healthy

if bowel unhealthy then laparotomy used to untwist the volvulus

if ischaemic bowel then may need resection of the bowel.

106
Q

How would you test renal function in children

A
  • plasma creatinine concentration
  • eGFR
  • plasma urea concentration
  • creatinine clearance
107
Q

name causes of high plasma urea that isn’t renal failure in children

A

gastrointestinal bleeding
catabolic states
high protein diet

108
Q

what tests would you do in suspected sepsis in a child

A 
blood culture
FBC
CRP
urine dipstick MC+S
lumbar puncture - rapid antigen screening
consider CXR
109
Q

symptoms of kawisaki disease

A 
high fever lasting > 5 days
conjunctivitis
rash (red palms and feet)
adenopathy (cervical lymph nodes)
strawberry tongue
hands and feet changes (eg palmar erythema, arthralgia)

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