PAEDS 1 Flashcards
Most common cyanotic congenital heart disease, and how might it present?
Tetralogy of Fallot - right to left shunt that leads to cyanosis usually within the first few weeks of life.
Cyanotic
O2 <94%
Collapse
What is included in a full septic screen of a <3 month old baby?
Urine Culture
Blood Culture
Throat swab
Lumbar puncture
2 common cardiac associations in Turner syndrome?
Coarctation of the aorta
Aortic stenosis
2 features that would suggest a submandibular duct stone / sialolithiasis:
Submandibular region
Pain on eating
Prolonged jaundice in a neonate is defined as persisting 14 days after birth, and 21 days in pre-term birth. Give 4 causes of prolonged jaundice, highlighting the most common.
Breast milk jaundice
G6PD deficiency
Biliary atresia - late presentation associated with worse prognosis; identify with high CONJUGATED bilirubin
Hypothyroidism
Most common congenital heart disease in Trisomy 21:
AVSD
All patients with Trisomy 21 should have an echocardiogram.
A patient presents with pain at the proximal femur, worse at night and relieved by aspirin. What is the most likely diagnosis?
Osteoid osteoma
ITP presents with petechiae and purpura, often preceded by coryzal symptoms. What are some atypical features that would indicate bone marrow biopsy?
Lymphadenopathy
Hepatosplenomegaly
Bone or joint pain
Fever
Weight loss
Neutropenia
Leucocytosis
Blasts on blood film
Insufficient response to treatment with steroids
Most cases of ITP can be managed with a watch and wait approach if no bleeding or mild cutaneous bleeding. If there is more serious bleeding, what are the treatment options?
IV Immunoglobulin
Steroids
?Platelet transfusions but these are destroyed quickly by antibodies
Splenectomy
When does ITP tend to resolve, and give 2 pieces of lifestyle advice whilst the illness is still ongoing:
Resolves within 6 months for 80% of children
Avoid contact sports
Avoid antiplatelet medications e.g. aspirin, ibuprofen
Complications of malignant bone tumours:
Pathological bone fracture
Metastasis
A boy with suspected malignant bone cancer has an x-ray that comes back clear. He has symptoms such as nocturnal pain, anorexia, anaemia and a pathological fracture. What is the next best step?
Urgent MRI - high clinical suspicion.
XR can sometimes miss lesions
X-ray appearance of osteosarcoma:
Codman’s triangle due to periosteal elevation
Sunburst pattern
X-ray appearance of Ewing’s sarcoma:
Onion skin
Criteria used to diagnose rheumatic fever, and which organism is associated?
Jones criteria
Group A Streptococcus / strep pyogenes e.g.
Major and minor criteria for rheumatic fever:
Major:
Carditis
Polyarthritis
Subcutaneous nodules
Chorea
Erythema marginatum
Minor:
Joint pain
Fever
Raised ESR/CRP
Prolonged PR interval
Treatment of rheumatic fever:
Suspicion of GAS infections e.g. tonsillitis, 10 days Penicillin V
Carditis: aspirin, steroids
Fever: paracetamol
Joint pain: NSAIDs
Prophylactic IM penicillin into adulthood
Most common valve pathology that can occur as a complication of rheumatic fever:
Mitral stenosis
Dry power / breath-attenuated inhalers are difficult for children to use as they require coordinated to take a deep breath as they press. What is an alternative, and at what age can a breath-attenuated inhaler be considered?
MDI = easier for children, but must be given with a spacer.
Children can try a breath-attenuated inhaler from the age of 8 if proper education.
3 pathophysiological mechanisms in asthma:
Smooth muscle constriction
Oedema of the bronchial walls due to inflammation
Mucous hypersecretion
6 infective causes of bloody diarrhoea:
Salmonella
Shigella
Yersinia
Campylobacter
Enterohaemorrhagic E.coli
C.Diff
Risk factors for IBD:
HLA-B27 positive
FHx IBD
FHx autoimmunity, especially seronegative e.g psoriasis, psoriatic arthritis, acute uveitis, ankylosing spondylitis
Parental smoking (Crohn’s)
3 clinical features of PDA before repair:
Pansystolic / machinery murmur
Loudest at subclavicular area
Pulmonary oedema
Bounding femoral pulses
Where is the abnormal connection in PDA, and what how does it normally close?
Descending aorta and pulmonary trunk.
Usually closes when infant takes first breath, as this increases pulmonary flow and prostaglandin clearance.
3 risk factors for PDA:
Pre-term birth
Born at high altitude
Maternal rubella infection in first trimester
Management of PDA depends on whether the infant is pre-term, term and if there is another congenital heart defect present. Describe management in a PRE-TERM infant.
Watch and wait for 1 week to see if they can become not vent-dependent or have haemodynamic sequelae of the PDA.
Then, medical closure e.g.
Paracetamol, Indomethacin, Ibuprofen = prostaglandin inhibitors.
Management of PDA depends on whether the infant is pre-term, term and if there is another congenital heart defect present. Describe management in a TERM infant.
TRANSCATHETER CLOSURE
Indications for closure include:
Moderate / large PDA
Small but audible PDA
Endocarditis
State 3 heart defects that are cyanotic conditions, the most common, and when they are likely to present:
Tetralogy of Fallot - most common, presents 1-2 months
Transposition of the Great Arteries - the more likely one to present as a neonate.
Tricuspid Atresia
Give 5 acyanotic heart lesions, and indicate the most common.
VSD most common, 30%
ASD
PDA
Coarctation of the aorta
Aortic valve stenosis
Complications of not correcting a PDA:
Reduced systemic blood flow, leading to increased risk of hypotension and therefore NEC and IVH.
Increased pulmonary blood flow, leading to pulmonary haemorrhage, pulmonary hypertension, failure to thrive and chronic lung disease.
When do patients receive Haemophilus influenzae B vaccinations, and what condition has this greatly reduced?
Epiglottitis
2,3,4 and 12 months
Differential diagnoses for acute stridor in children:
Epiglottitis
Foreign body
Anaphylaxis
Croup
Burns
4 features of Tetralogy of Fallot:
VSD
Overriding aorta
RV hypertrophy
Right ventricular outflow obstruction (pulmonary stenosis)
Which of the classical 4 features in TOF determines the degree of cyanosis and clinical severity? A ‘boot shaped heart’ is seen on CXR.
Right ventricular outflow obstruction e.g. pulmonary stenosis
Results in an end-systolic murmur
‘Tet spells’ refer to episodes of hypercyanosis due to near total occlusion of RV outflow tract. Give 2 sympoms of a tet spell, 3 precipitating features and positional management.
Cyanosis
Tachypnoea
Sometimes LOC
Fever, pain, upset
Knee-chest position to reduce systemic venous return and increase systemic vascular resistance
Feeding strategy for a baby with bronchiolitis?
Reduce volume
Increase frequency
3 common non-surgical causes of vomiting in infancy?
Reflux
Possetting
Overfeeding
Most common causes of bilious vomiting in infancy (6).
Malrotation volvulus
Biliary / duodenal atresia
Hirschprung’s
Meconium Ileus
NEC
See bilious vomiting on passmed
Congenital diaphragmatic hernias are rare, but can be seen, 85% being left sided and posterolateral. Can be identified on a CXR where the NG tube is in the stomach above the diaphragm. What is mortality from this condition predominantly dependent on?
Pulmonary hypoplasia
Thought to be due to the compression of the lung, leading to hypoxia and pulmonary hypertension.
50% of patients die
In a supracondylar fracture, which nerve is most commonly affected during the injury, and which as a result of the corrective operation?
Injury - anterior interosseous nerve
Surgical repair - ulnar nerve
Loss of the red reflex in a child can be due to … (give 2 conditions):
Congenital cataract
Retinoblastoma (bad!)
What is an important and sight-threatening complications of a squint / strabismus?
Abmlyopia - brain stops processing information from one eye so can cause permanent visual impairment in that eye over time.
Most common complication of measles:
Otitis media
Describe the classic development of a prodrome and measles rash, and what test can confirm the diagnosis:
Prodrome: irritable, conjunctivitis, fever, Koplik spots
Rash starts behind the ears and then spreads to whole body.
Incubation period is 10-14 days.
Saliva IgM can be tested for.
Presentation of septic arthritis in a child:
Systemically unwell, may have another site of infection e.g. chickenpox cellulitis, pharyngitis, meningitis.
Pyrexia >38..5
ESR >40
WCC >12
Extremely painful joint
Pseudoparalysis / unable to weight bear
Discuss measles exposure in pregnancy.
Can cause increased risk of intrauterine death and pre-term birth.
Not associated with congenital infection or abnormalities.
Most women are immune, so can offer IgM to women who are likely to be susceptible, based on age, history, and/or measles IgG antibody screening.
A boy presents with testicular pain of gradual onset over the last 2-3 days. On transillumination there is a ‘blue dot’. What is the likely diagnosis?
Torted hydatid of Morgagni
What is Prehn’s sign?
Elevation of the testes relieves pain - points towards epididymitis.
Relief does NOT occur in testicular torsion.
What is the metabolic abnormality associated with pyloric stenosis?
Hypochloraemia, hypokalaemia metabolic alkalosis.
There is partial respiratory compensation usually, and renal loss of potassium, preserving as many H+ as possible.
Definitive surgical treatment for pyloric stenosis?
Ramstedt pyloromyotomy
