Paeds 1 - Cardio and Resp Flashcards
1
Q
What is the name of the condition where the larynx and trachea is infected?
A
Croup
2
Q
What is the most common organism the causes croup?
A
Parainfluenza virus
3
Q
What are the four causes of stridor in children?
A
Croup
Epiglottitis
Bacterial tracheitis
Foreign body
4
Q
Give three symptoms of croup
A
Barking cough Hoarse voice Fever Coryza Difficulty breathing, worse at night
5
Q
Give three signs of croup
A
Stridor, worsened by crying
Recession
Hoover’s sign - indrawing of chest wall
6
Q
What age group typically suffers from croup?
A
6 months to 6 years
7
Q
What is the Steeple sign?
A
Narrowed trachea, seen on X-Ray in croup
8
Q
What is the Wesley score?
A
Score for severity of croup
9
Q
What is the treatment of croup?
A
PO dexamethasone and prednisolone
Nebulised adrenaline with oxygen
10
Q
What are the three stages of wheeze in the Tucson model?
A
Transient early wheeze
Viral episodic wheeze
IgE-associated asthma
11
Q
What are three risk factors for transient early wheeze?
A
Maternal smoking
Prematurity
Early viral exposure
12
Q
What is a typical trigger for viral-induced episodic wheeze?
A
URTI
13
Q
What is the treatment for viral-induced wheeze?
A
Inhaled bronchodilators, oxygen
No treatment for interval
14
Q
Detail the asthma management pathway
A
1) SABA PRN
2) SABA + ICS
3) SABA + ICS + LTRA
4) SABA + ICS + LABA
5) SABA + MART (low dose ICS)
6) SABA + MART (mod dose ICS)
7) SABA + MART (high dose ICS) OR theophylline
15
Q
What is the commonest pathogen that causes bronchiolitis?
A
Respiratory Syncytial Virus
16
Q
How does bronchiolitis present?
A
Coryza, dry cough, shortness of breath, feeding difficulty
17
Q
What are the signs of bronchiolitis?
A
Tachypnoea Subcostal and intercostal recession Hyperinflation of the chest Fine end-inspiratory crackles High pitched wheeze expiratory > inspiratory Cyanosis or pallor
18
Q
How is bronchiolitis diagnosed?
A
PCR analysis of nasopharyngeal secretions
Pulse oximetry
Blood gas looking for respiratory acidosis
19
Q
What is bronchiolitis obliterans?
A
Permanent damage following adenovirus infection
20
Q
What is the treatment of bronchiolitis?
A
Supportive treatment
Humidified oxygen delivered
Fluids
Assisted ventilation - nasal or facemask CPAP/full ventilation
21
Q
What organisms cause pneumonia in newborns, infants, and children over 5?
A
Newborn - Group B strep
Infants - RSV, s.pneumoniae, hib
>5 - m and s.pneumoniae
22
Q
How is pneumonia diagnosed?
A
CXR - consolidation and pleural effusion
23
Q
What is increased respiratory rate in the age groups 0-2 months, 2-11 months, >11 months?
A
0-2m - >60/min
2-11m - >50/min
>11m - >40/min
24
Q
What is the treatment of pneumonia?
A
PO amoxicillin if under 5
Erythomycin if >5
25
What is the cause of obstructive sleep apnoea in children?
Upper airway obstruction secondary to adenotonsillar hypertrophy
26
What are the risk factors for obstructive sleep apnoea?
Hypotonia or neuromuscular disease
Down syndrome
Cerebral palsy
27
What are the symptoms of obstructive sleep apnoea?
Loud snoring
Apnoeas (pauses in breathing)
Disturbed sleep and daytime sleepiness
Restlessness
28
What are the complications of obstructive sleep apnoea?
Obesity, growth failure, learning and behavioural problems, acute life-threatening cardio respiratory events
29
How is obstructive sleep apnoea diagnosed?
Overnight pulse oximetry for desaturation
30
What is the treatment of obstructive sleep apnoea?
Adenotonsillectomy
Perform overnight oximetry prior to surgery to identify severe hypoxaemia (increased risk of peri-operative complications)
31
What are the symptoms of sinusitis?
Viral URTI
| Pain, swelling, and tenderness over the cheek
32
Which sinus is commonly affected in sinusitis?
Maxillary
33
What are the symptoms of tonsillitis?
Headache, apathy, cervical lymphadenopathy, white tonsillar exudate
NO COUGH
34
What pathogens cause tonsillitis?
Group A beta-haemolytic strep
| EBV
35
What antibiotics are used in tonsillitis?
Penicillin/erythromycin
36
What is infection of the middle ear called?
Acute otitis media
37
What are the symptoms of acute otitis media?
Fever, ear pain, bright red bulging tympanic membrane
38
Why are infants and young children more prone to acute otitis media?
Eustachian tubes are short, horizontal, and poorly functioning
39
Name a complication of acute otitis media
Meningitis
Mastoiditis
Facial nerve palsy
40
What is the treatment of acute otitis media?
```
Analgesia
If severe (systemically unwell/child under 2 with bilateral infection/increased risk of complications) then 5-7 days amoxicillin
```
41
What is the cause of glue ear) otitis media with effusion?
Recurrent acute otitis media
42
What is seen in glue ear?
Dull and retracted eardrum
| Fluid level
43
What type of hearing loss occurs with glue ear?
Conductive
44
How is conductive hearing loss diagnosed in glue ear?
Flat trace on tympanometry
Pure tone audiometry - hearing loss
Distraction hearing test if younger
45
What is the treatment of glue ear?
1st line: conservative as usually resolves
| 2nd line: grommet insertion (ventilation tube)
46
What are the long term consequences of glue ear?
Speech and learning difficulties
47
What is bacterial tracheitis?
Pseudomemembranous croup
48
What are the causative organisms in bacterial tracheitis?
Usually follows a viral URTI
| S.aureus
49
What is the presentation of bacterial tracheitis?
High fever, stridor, copious thick secretions
50
What is the treatment of bacterial tracheitis?
IV antibiotics, intubation and ventilation
51
Haemophilus Influenzae Type B causes what life threatening bacterial infection?
Epiglottitis
52
What does a child with epiglottitis look like?
Very ill and toxic
Sits upright and immobile with mouth open, drooling
No speaking or swallowing
Soft inspiratory stridor
53
What is the management of a child with epiglottitis?
Intubation/tracheostomy
IV cefuroxime
Prophylactic rifampicin for family
54
What are the symptoms of bronchitis in children?
Cough, fever, retrosternal pain on deep breathing or coughing
55
What does the organism Bordetella Pertussis cause?
Pertussis = Whooping cough
56
What occurs during the paroxysmal cough in whooping cough?
Characteristic inspiratory whoop
Red/blue in face
Cough worse at night
May lead to vomiting/epistaxis/subconjunctival haemorrhage
57
How is pertussis diagnosed?
Nasal swab for culture
| Lymphocytosis > 15x10^9/L
58
Which antibiotic is prescribed for whooping cough?
Neonates: clarithromycin
Children and adults: azithromycin or clarithromycin
Pregnant women: erythromycin
59
Which congenital cardiac defects have a left-to-right shunt (breathless)?
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
60
Which congenital cardiac defects have a right-to-left shunt (cyanosed)?
Tetralogy of Fallot
Transposition of the Great Arteries
Tricuspid atresia
61
In which condition does common mixing occur?
Atrio-ventricular septal defect
62
What conditions causing outflow obstruction occur in a) a well child and b) a sick neonate
a) pulmonary and aortic stenosis (asymptomatic with a murmur)
b) aortic coarctation (collapsed with shock)
63
In the fetus, the pressure in which atrium is higher and why?
RA>LA as it receives all venous blood flow including blood from the placenta, and LA has relatively little blood return from the lungs due to PFO
64
What occurs when the newborn takes their first breaths?
Resistance to pulmonary blood flow falls and volume of blood flowing across the lungs increases x6
65
When the placenta is excluded from the circulation, what happens to the blood pressure in the RA?
It decreases, causing the flap of the foramen ovale to close.
66
When does the ductus arteriosus close?
Within hours - days
67
What happens to babies with heart defects that rely on blood flow through the duct (from pulmonary artery to aorta)
Duct dependent - condition rapidly deteriorates
68
Which type of murmur can be innocent if heard when febrile or under perfused?
```
Short - ejection Systolic murmur (increased cardiac flow)
Soft
No Systemic features
No radiation and no thrills
S1 and S2 normal
Standing and sitting variation
```
69
Which type of murmur is always pathological?
Pansystolic murmur
70
What congenital cardiac conditions can cause heart failure in the neonate?
Obstructed duct dependent circulation - hypoplastic left heart syndrome, critical aortic stenosis, severe aortic coarctation, interruption of the aortic arch
71
Heart failure can occur in patients with VSD, ASD, and a large PDA, in which age group?
Infants
72
What conditions can cause heart failure in older children?
Rheumatic heart disease
Cardiomyopathy
Eisenmenger syndrome
73
What are the symptoms of heart failure?
Breathlessness, especially with feeding
Sweating
Recurrent chest infection
Poor feeding
74
What are the signs of heart failure?
Tachypnoea and tachycardia
Failure to thrive
Cardiomegaly/hepatomegaly
Murmur/gallop rhythm
75
Heart failure in the first week of life usually results from what group of conditions?
Left heart obstruction
76
Heart failure after the first week of life usually results from what group of conditions?
L to R shunt, as increase in pulmonary vascular resistance causes pulmonary oedema and breathlessness. Shunt reversal, then Eisenmenger's.
77
What are the five presentations of congenital heart disease?
```
Antenatal cardiac ultrasound
Detection of cardiac murmur
Heart failure
Shock
Cyanosis
```
78
What are the causes of cyanosis in the newborn?
Cyanotic congenital heart disease (R-L shunts)
Respiratory disorders such as surfactant deficiency and pulmonary hypoplasia
Persistent pulmonary hypertension of the newborn
Infection - Group B sepsis
Metabolic acidosis and shock
79
What is the immediate treatment of cyanotic congenital heart disease?
Prostaglandin infusion (5ng/kg/min)
80
What is the Hyperoxia (Nitrogen washout) test?
Determines the presence of heart disease in a cyanosed infant - infant placed in 100% oxygen ventilator for 10 mins
If the right radial arterial PaO2 remains <15kPA - diagnose
81
What are the two types of atrial septal defects?
Secundum (80%)
| Primum/Partial
82
What are the risk factors of ASD?
Down Syndrome
Ebstein's anomaly
Foetal alcohol syndrome
Idiopathic
83
What heart sounds are commonly heard with ASD and why?
Ejection systolic murmur at left sternal edge
Increased blood flow across pulmonary valve due to L-R shunt
Split S2
84
What symptoms are present in a child with ASD?
Asymptomatic
Recurrent chest infections/wheeze
Fatigue
85
What is seen on a chest X-Ray in a child with ASD?
Cardiomegaly
| Increased pulmonary vasculature
86
What is the definitive investigation for diagnosis of an ASD?
Echocardiography
87
What are the consequences of a severe ASD?
Right ventricular dilatation
88
What is the management of a child with ASD?
Percutaneous closure of defect by 3-5 years to avoid right heart failure and arrhythmias in later life.
89
Perimembranous ventricular septal defects are located where?
Next to the tricuspid valve
90
What are the two types of VSD?
Perimembranous or muscular
91
What are the risk factors for VSD?
Down syndrome
MI
Incomplete looping of the heart during days 24-28
92
How do the signs and symptoms of small (<3mm) and large (>3mm) VSDs differ?
Small - asymptomatic; loud blowing pansystolic murmur LLSE
Large - HF, SOB, recurrent chest infections, tachypnoea, tachycardia; soft/no pansystolic murmur, apical mid-diastolic murmur
93
How is pulmonary hypertension demonstrated in a patient with a large VSD?
Increased pulmonary vasculature on Chest X-Ray
| Echo
94
What is the management of a small VSD?
Will close spontaneously
| Good dental hygiene to reduce the risk of bacterial endocarditis
95
What is the management of a large VSD?
Treat HF with diuretics and captopril
Additional calories
Surgery 3-6m
96
What does a patent ductus arteriosus connect?
Pulmonary artery to descending aorta
97
When should a PDA have closed?
1 month after the expected date of delivery
98
What murmur is heard in PDA?
Continuous systolic-diastolic murmur beneath left clavicle
99
Why does a PDA not close?
Defect in constrictor mechanism
100
How is a PDA closed?
Occlusion device by 1 year of age
101
What are the four components of Tetralogy of Fallot?
Large VSD
Overriding aorta
Pulmonary stenosis (RV outflow obstruction)
RV hypertrophy
102
What are the symptoms and signs of TOF?
```
Cyanosis
Hypercyanotic spells (breathless, pallor, crying)
Squatting on exercise
Clubbing
Loud harsh ejection systolic murmur LSE
```
103
What can a hypercyanotic spell lead to?
MI, cerebral infarction, death
104
What is seen on CXR in TOF?
Small boot-shaped heart (uptilted apex)
| Decreased pulmonary vascular markings
105
What shunt is seen in TOF?
Right to left
106
The surgery to treat TOF involves what?
Closing VSD
| Relieving pulmonary stenosis
107
What is the acute treatment of a hypercyanotic spell lasting longer than 15 minutes?
```
Sedation
Morphine
IV propranolol and fluids
Bicarbonate
Artificial ventilation
```
108
The atrial switch procedure is used to treat what condition?
Transposition of the Great Arteries
109
What X-Ray appearance is seen with TGA?
Egg on side
110
What are the symptoms and signs of TGA?
Cyanosis
Occurs with duct closure
Loud S2, no murmur
111
What defect causes a single 5-leaflet common valve be present?
Complete VSD
112
What is tricuspid atresia?
Small and non-functional right ventricle with absence of tricuspid valve
113
What is the presentation of tricuspid atresia?
Cyanosis in the newborn if duct dependent
114
What is the main risk factor for aortic stenosis?
Bicuspid valve
115
What are the CXR findings in severe aortic stenosis?
Prominent LV
| Post-stenotic dilatation of aorta
116
What indicates left ventricular hypertrophy on an ECG?
Deep S wave in V2
Tall R wave in V6
T wave inversion
117
What is the murmur in aortic stenosis?
Ejection systolic murmur at URSE radiating to axilla
118
Most people with aortic stenosis become symptomatic with angina and dyspnoea in their 50s. How does a neonate present?
Severe heart failure and shock
119
When would you surgically correct aortic or pulmonary stenosis?
Symptoms on exertion
| High resting pressure gradient (>64mmHg)
120
Stenosis of which valve causes right ventricular hypertrophy?
Pulmonary
121
What indicates RVHT on the ECG?
Upright T wave in V1
122
What is the murmur heard in pulmonary stenosis?
Ejection systolic murmur ULSE
123
How does paediatric coarctation of the aorta differ from adult-type coarctation?
Outflow obstruction in the sick neonate: narrowing proximal to duct insertion
Adult - In descending aorta
124
What occurs when the duct closes in aortic coarctation?
The aorta constricts, causing severe obstruction to left ventricular outflow
125
What is the presentation of neonatal aortic coarctation?
Circulatory collapse day 2 of life
| Absent femoral pulses, severe heart failure and metabolic acidosis
126
What is interruption of the aortic arch?
No connection between the proximal aorta and aorta distal to the arterial duct
127
What syndrome has an increased risk of IAA?
Di-George
128
How does IAA present?
Shock in the neonatal period, heart failure (duct dependent)
129
What is the management of IAA?
Prostaglandin infusion
| Surgical repair
130
What is hypoplastic left heart syndrome?
Underdevelopment of the entire left side of the heart, including mitral and aortic valves, and aorta.
131
How is HLS diagnosed?
Antenatal ultrasound
132
What is the presentation of HLS?
very sick - duct dependent circulation
Profound acidosis
cardiovascular collapse, absence of peripheral pulses
133
What is the most common childhood arrhythmia?
Supraventricular tachycardia
134
Define supraventricular tachycardia
250/300BPM, narrow complex tachycardia
135
What ECG finding indicates myocardial ischaemia?
T wave inversion
136
What ECG finding signifies Wolff-Parkinson-White syndrome?
Short PR wave
| Delta wave
137
What is the cause of supraventricular tachycardia?
Usually a re-entry pathway
138
What are the symptoms of SVT in the neonate?
Heart failure symptoms
Poor feeding
Dyspnoea
Pallor
139
What are the symptoms of SVT in the foetus?
Hydrops fetalis/intrauterine death
140
How do you acutely manage SVT?
Vagal/Valsalva manoeuvre (carotid sinus massage)
IV adenosine to induce AV block
DC cardioversion if shocked
141
What is maintenance therapy for SVT?
Flecainide or sotalol
| Ablation of accessory pathway
142
Which antibodies is congenital complete heartblock related to?
Anti-Ro or Anti-La antibodies in maternal serum
143
What causes the symptoms of heart failure or stillbirth in congenital complete heart block syndrome?
Atrophy and fibrosis of the AV node
144
How does long QT syndrome present?
Sudden loss of consciousness during exercise/stress
145
What are the five main causes of syncope in children?
```
Neurocardiogenic
Situational e.g. cough
Orthostatic (BP fall >20mmHg)
Ischaemic
Arrhythmic e.g. SVT
```
146
What is rheumatic fever?
An abnormal immune response to a preceding infection with Group A beta-haemolytic strep
147
What occurs in the 2-6 weeks latent interval in rheumatic fever?
Pharyngeal infection
Polyarthritis
Fever and malaise
148
What major symptoms occur with rheumatic fever?
```
Pancarditis
Syndenham chorea
Erythema marginatum
Subcutaneous nodules
Polyarthritis
Mitral stenosis in early adult life
```
149
What is the treatment of rheumatic fever?
Corticosteroids if fever does not resolve rapidly
| Aspirin
150
Who is at risk of endocarditis?
Children with congenital cardiac conditions, due to turbulence in the heart, and prosthetic material inserted at surgery
151
What is the presentation of endocarditis?
```
Fever and malaise
Raised ESR
Unexplained anaemia and pallor
Splinter haemorrhages, clubbing, retinal infarcts
Changing cardiac signs
Arthralgia
```
152
How is endocarditis diagnosed?
Echocardiogram for vegetations
153
What is the treatment of endocarditis?
Penicillin and aminoglycoside IV
154
What causes the first and second heart sounds?
S1 - mitral valve/tricuspid valve
| S2 - aortic valve/pulmonary valve
155
After birth, what is the first breath triggered by?
Hypoxia secondary to cord clamping
156
What is the murmur heard in TOF?
Ejection systolic murmur, left parasternal heave
157
What is the mnemonic for Down's syndrome?
```
R - round face
O - occipital and nasal flattening
S - speckled iris (Brushfield spots)
E - epicanthic folds
O - open mouth with protruding tongue
L - low set ears
A - almond upward slanting eyes
```
158
Why is rib notching seen in aortic coarctation?
Increased blood flow through collaterals
159
What blood pressure measurement is needed in aortic coarctation and what is the result?
Four limb BP: arms > legs
160
What is the most common causative organism in endocarditis?
Strep.viridans
161
Which pulse would you palpate in assessing the circulation of children younger than and older than 1?
Younger than 1 - brachial/femoral
| Older than 1 - carotid/femoral
162
What is biphasic anaphylaxis?
Rebound symptoms in anaphylaxis, around 12 hours later
163
What clinical signs would indicate a child was having a life threatening asthma attack?
```
Decreased respiratory rate
Silent chest
Decreased GCS
SpO2<92%
Cyanosis
```
164
What are the differentials of wheeze at birth?
Congenital heart disease
Bronchiogenic cysts
Laryngeal abnormalities
165
What are the differentials of wheeze a few days after birth?
GORD
CF
Ciliary dyskinesia
166
Give three signs of respiratory distress
```
Head bobbing
Nasal flaring
Tracheal tug
Tachypnoea
Recessions
Use of accessory muscles
Abdominal breathing
```
167
Which children are at risk of severe bronchiolitis?
Prematurity
Chronic lung disease
Heart conditions
Immunodeficient
168
What is the commonest mutation in cystic fibrosis?
Delta F508
169
When is the peak incidence of bronchiolitis?
3-6 months
170
When is bronchiolitis more common?
Winter
171
What condition can cause bronchiolitis to be more severe?
Congenital heart disease
| Prematurity
172
What are the risk factors for bronchiolitis?
Fed on formula milk
| Less than 3 months old
173
What are three risk factors for pulmonary hypoplasia?
Oligohydramnios
Congenital diaphragmatic hernia
Tetralogy of fallot
174
When should children by reviewed by the community paediatrician for poor growth?
Below the 0.4th centile for height
175
What are the symptoms of primary ciliary dyskinesia?
Recurrent respiratory infection
Recurrent otitis media
Infertility?
176
What pulse do you see with PDA?
Bounding/collapsing
177
What is the most common congenital cardiac condition associated with trisomy 21 and what is seen on ECG?
AVSD
| Superior QRS axis on ECG
178
What is the most common cause of stridor in the neonate?
Laryngomalacia
179
What syndrome is associated with Ebstein's anomaly?
Wolff-Parkinson White
180
What is the rate of compression and ventilation in the newborn?
3:1
181
What is transient tachypnoea of the newborn?
The most common cause of respiratory distress in the neonatal period
Caused by delayed fluid resorption in the lungs --> Caesarian sections
182
What is given to prevent respiratory syncytial virus in infants at risk of severe bronchiolitis?
Palivizumab
