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Yr 4C > Paediatrics - General & Cardio > Flashcards

Paediatrics - General & Cardio Flashcards

1
Q

Paeds systems review

A

BIGDAD

  • Birth/ pregnancy
  • Immunisations
  • Growth
  • Diet (input & output)
  • Allergies
  • Development
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2
Q

Adolescent systems review

A

HEADSS

  • Housing/ home/ environment
  • Education/ employment
  • Activities
  • Drugs
  • Sexuality
  • Suicide/depression
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3
Q

Denver development screening questions

A 
Smiling (6wks)
Turns to sound (6mnths)
Sitting (9mnths)
First words (18mnths)
Walking (18mnths)
Stairs (3yrs)
3 word sentences (3yrs)
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4
Q

Closure of foramen ovale

A

Usu in first few breaths (due to LA pressure increase due to breathing)

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5
Q

Closure of ductus arteriosus

A

Usu w/i first few hrs to days, often Day 2-3 (becomes ligamentum arteriosum)
- Prostaglandin – ‘PROPs’ open the ductus arteriosus (^pO2 lowers PGE2)
- Indomethacin (prostaglandin inhibitor) – ‘INvolutes’ the ductus arteriosus
DA connects pulmonary artery to descending aorta

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6
Q

Cyanotic congenital HD causes

A

5T + H

  • Tetralogy of Fallot
  • Transposition of great arteries
  • Total anomalous pulmonary drainage
  • Truncus arteriosus
  • Tricuspid atresia
  • Hypoplastic left heart
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7
Q

Cyanotic heart disease

A

<85% SaO2 - caused by not enough oxygenated blood reaching tissues/ too much deoxygenated blood reaching tissues
Usu R –> L shunt

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8
Q

Acyanotic congenital HD causes

A 
4 'non-Ts'
- ASD
- VSD
- AVSD (can have both acyanotic &amp; cyanotic features) 
- PDA 
(Usu L --> R shunt)
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9
Q

Ductal dependent congenital HD

A

Circulation is dependent on a patent ductus arteriosus (PDA) to preserve systemic circulation (L) or pulmonary circulation e.g. TOF w pulmonary atresia or TGA
–> may rapidly decline on 2-3 Day due to closure of ductus arteriosus

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10
Q

TOF features

A

PROV

  1. Pulmonary stenosis
  2. RV hypertrophy
  3. Overriding aorta (sits directly over VSD instead of LV = blood from both ventricles)
  4. VSD
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11
Q

TOF risk factors

A 
Downs syndrome ("fall DOWN a lot" due to tet spells)
DiGeorge syndrome - chromosome 22 deletion ("Sir George di Fallot")
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12
Q

Onset of cyanosis wks/mnths after birth, difficulty feeding, failure to thrive, tet spells, harsh ejection systolic murmur over pulmonary area (identified w/i first 2mnths of life), clubbing

A

TOF

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13
Q

TOF murmur

A

harsh EJS over left sternal edge (pulmonary area)

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14
Q

Cyanotic child squats to avoid fainting

A

Tet spell in TOF (cyanotic for 15mins due to vasospasm, may lead to syncope, child often squats to increase venous return to heart, usu self-limiting but can lead to MI, stroke or death if untreated)

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15
Q

Boot-shaped heart on CXR (coeur-en-sabot)

A

TOF (“booted out of the TOF”)

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16
Q

Term baby presents w cyanosis & feeding difficulty at Day 2-3

A

TGA (usu ductal dependent according to Monash EMQs)

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17
Q

Early cyanosis, single S2, usu no murmur (may be flow murmur)

A

TGA

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18
Q

TGA features

A

switching of great vessels (aorta –> RV, pulmonary artery –> LV), only compatible w life if ASD, VSD or PDA

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19
Q

“Egg on a string” CXR

A

TGA (RV hypertrophy) NB: CXR may be normal in early life

20
Q

TGA management

A
  1. Prostaglandin E1 (maintain PDA)
  2. Balloon atrial septostomy (temporary - buys time until surgery)
  3. Surgery - arterial switch operation (w/i 1st week of life)
21
Q

Patent ductus arteriosus

A

failure of closure of ductus arteriosus by 1 month after expected due date (EDD)
L –> R shunt

22
Q

PDA risk factors

A

prematurity, congenital rubella syndrome

23
Q

premature child, bounding pulse, continuous murmur

A

PDA

  • Many children asymptomatic for a long time
  • If severe may lead to heart failure (FTT, tachypnoea, difficulty feeding)
24
Q

Continuous machinery murmur under left clavicle

A

PDA (esp older children, may be more systolic in younger children)

25
Q

PDA Management

A
  1. Indomethacin (prostaglandin synthetase inhibitor)
  2. NSAID
  3. If fails –> Fluid restrict & diuretics + surgery (coil impaction)
26
Q

Wide, fixed splitting of S2 + mid-systolic/ejection systolic murmur at L sternal edge

A

ASD (NB: larger ASD = louder murmur)

27
Q

Atrial septal defect features

A

Usu asymptomatic, mid-systolic/ ejection systolic murmur at L sternal edge on routine exam

28
Q

Baby with Down Syndrome has poor feeding with difficulty breathing and sweating. He has a systolic murmur

A

AVSD (NB: may have cyanotic component)

29
Q

Apical pansystolic murmur

A

AVSD (murmur due to AV valve regurg)

30
Q

Most common congenital HD

A

VSD (~30%)

31
Q

A 3 or 4 month old patient presents with poor weight gain, poor feeding, tachypnoea, and a loud systolic murmur heard across the entire praecordium

32
Q

Sx of HF in infant

A

Failure to thrive, tachypnoea, tachycardia, difficulty feeding, excessive sweating, fatigue, SOB, enlarged liver, frequent chest infections, irritability, gallop murmur

33
Q

Harsh apical pansystolic murmur + parasternal heave

A

VSD (NB: VSD murmur may spontaneously disappear)

–> louder murmur = smaller VSD (more turbulence)

34
Q

Sx HF + pansystolic murmur

35
Q

Patent foramen ovale

A

Failure of the foramen ovale to close after birth (normally closes w first breath), mostly asymptomatic

36
Q

PFO risks

A

ischaemic stroke secondary to paradoxical embolism

37
Q

Sudden change from acyanotic HD (ie ASD, VSD, PDA) to cyanotic HD

A

Eisenmenger’s syndrome (due to pulmonary HTN leading to reversal of L to R shunt, very poor prognosis, requires heart/lung transplant)

38
Q

Prevention of Eisenmenger’s syndrome

A

Fix hole (VSD, ASD, PDA) before pulmonary HTN develops

39
Q

Benign, musical/humming systolic murmur at left sternal border

A

Still’s murmur

40
Q

Coartication of aorta

A

a congenital condition where the aorta narrows in the area where the ductus arteriosus inserts (–> severe obstruction to LV outflow), duct dependent

41
Q

Coartication of aorta RFs

A

Turner’s syndrome

42
Q

Asymptomatic at birth, cyanosis & shock at Day 2-3, absent femoral pulses, radio-femoral delay, higher BP in arms>legs, EJS murmur radiating to back (posterior left scapulae), severe HF

A

Coartication of aorta

43
Q

Rib notching on CXR

A

Coartication of aorta

44
Q

Congenital pulmonary stenosis RFs

A

Noonan syndrome

45
Q

Alagille syndrome associations

A

TOF, pulmonary stenosis

46
Q

Classic congenital HD associations

A

Down syndrome: AVSD (most common), Tetralogy of Fallot, VSD
Turner’s syndrome: Coarctation of aorta (pretty classic), Aortic stenosis (but coarctation more common)
Noonan syndrome: Pulmonary stenosis
Alagille syndrome: Pulmonary stenosis, TOF
Congenital rubella syndrome: PDA

Yr 4C (6 decks)

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