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Phase 3a > Paeds 1 - Cardio and Resp > Flashcards

Paeds 1 - Cardio and Resp Flashcards

1
Q

What is the name of the condition where the larynx and trachea is infected?

A

Croup

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2
Q

What is the most common organism the causes croup?

A

Parainfluenza virus

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3
Q

What are the four causes of stridor in children?

A

Croup
Epiglottitis
Bacterial tracheitis
Foreign body

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4
Q

Give three symptoms of croup

A 
Barking cough
Hoarse voice
Fever
Coryza
Difficulty breathing, worse at night
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5
Q

Give three signs of croup

A

Stridor, worsened by crying
Recession
Hoover’s sign - indrawing of chest wall

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6
Q

What age group typically suffers from croup?

A

6 months to 6 years

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7
Q

What is the Steeple sign?

A

Narrowed trachea, seen on X-Ray in croup

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8
Q

What is the Wesley score?

A

Score for severity of croup

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9
Q

What is the treatment of croup?

A

PO dexamethasone and prednisolone

Nebulised adrenaline with oxygen

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10
Q

What are the three stages of wheeze in the Tucson model?

A

Transient early wheeze
Viral episodic wheeze
IgE-associated asthma

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11
Q

What are three risk factors for transient early wheeze?

A

Maternal smoking
Prematurity
Early viral exposure

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12
Q

What is a typical trigger for viral-induced episodic wheeze?

A

URTI

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13
Q

What is the treatment for viral-induced wheeze?

A

Inhaled bronchodilators, oxygen

No treatment for interval

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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

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15
Q

What is the commonest pathogen that causes bronchiolitis?

A

Respiratory Syncytial Virus

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16
Q

How does bronchiolitis present?

A

Coryza, dry cough, shortness of breath, feeding difficulty

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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
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18
Q

How is bronchiolitis diagnosed?

A

PCR analysis of nasopharyngeal secretions
Pulse oximetry
Blood gas looking for respiratory acidosis

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19
Q

What is bronchiolitis obliterans?

A

Permanent damage following adenovirus infection

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20
Q

What is the treatment of bronchiolitis?

A

Supportive treatment
Humidified oxygen delivered
Fluids
Assisted ventilation - nasal or facemask CPAP/full ventilation

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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

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22
Q

How is pneumonia diagnosed?

A

CXR - consolidation and pleural effusion

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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

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24
Q

What is the treatment of pneumonia?

A

PO amoxicillin if under 5

Erythomycin if >5

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25
Q

What is the cause of obstructive sleep apnoea in children?

A

Upper airway obstruction secondary to adenotonsillar hypertrophy

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26
Q

What are the risk factors for obstructive sleep apnoea?

A

Hypotonia or neuromuscular disease
Down syndrome
Cerebral palsy

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27
Q

What are the symptoms of obstructive sleep apnoea?

A

Loud snoring
Apnoeas (pauses in breathing)
Disturbed sleep and daytime sleepiness
Restlessness

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28
Q

What are the complications of obstructive sleep apnoea?

A

Obesity, growth failure, learning and behavioural problems, acute life-threatening cardio respiratory events

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29
Q

How is obstructive sleep apnoea diagnosed?

A

Overnight pulse oximetry for desaturation

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30
Q

What is the treatment of obstructive sleep apnoea?

A

Adenotonsillectomy
Perform overnight oximetry prior to surgery to identify severe hypoxaemia (increased risk of peri-operative complications)

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31
Q

What are the symptoms of sinusitis?

A

Viral URTI

Pain, swelling, and tenderness over the cheek

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32
Q

Which sinus is commonly affected in sinusitis?

A

Maxillary

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33
Q

What are the symptoms of tonsillitis?

A

Headache, apathy, cervical lymphadenopathy, white tonsillar exudate
NO COUGH

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34
Q

What pathogens cause tonsillitis?

A

Group A beta-haemolytic strep

EBV

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35
Q

What antibiotics are used in tonsillitis?

A

Penicillin/erythromycin

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36
Q

What is infection of the middle ear called?

A

Acute otitis media

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37
Q

What are the symptoms of acute otitis media?

A

Fever, ear pain, bright red bulging tympanic membrane

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38
Q

Why are infants and young children more prone to acute otitis media?

A

Eustachian tubes are short, horizontal, and poorly functioning

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39
Q

Name a complication of acute otitis media

A

Meningitis
Mastoiditis
Facial nerve palsy

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40
Q

What is the treatment of acute otitis media?

A 
Analgesia
If severe (systemically unwell/child under 2 with bilateral infection/increased risk of complications) then 5-7 days amoxicillin
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41
Q

What is the cause of glue ear) otitis media with effusion?

A

Recurrent acute otitis media

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42
Q

What is seen in glue ear?

A

Dull and retracted eardrum

Fluid level

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43
Q

What type of hearing loss occurs with glue ear?

A

Conductive

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44
Q

How is conductive hearing loss diagnosed in glue ear?

A

Flat trace on tympanometry
Pure tone audiometry - hearing loss
Distraction hearing test if younger

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45
Q

What is the treatment of glue ear?

A

1st line: conservative as usually resolves

2nd line: grommet insertion (ventilation tube)

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46
Q

What are the long term consequences of glue ear?

A

Speech and learning difficulties

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47
Q

What is bacterial tracheitis?

A

Pseudomemembranous croup

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48
Q

What are the causative organisms in bacterial tracheitis?

A

Usually follows a viral URTI

S.aureus

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49
Q

What is the presentation of bacterial tracheitis?

A

High fever, stridor, copious thick secretions

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50
Q

What is the treatment of bacterial tracheitis?

A

IV antibiotics, intubation and ventilation

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51
Q

Haemophilus Influenzae Type B causes what life threatening bacterial infection?

A

Epiglottitis

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52
Q

What does a child with epiglottitis look like?

A

Very ill and toxic
Sits upright and immobile with mouth open, drooling
No speaking or swallowing
Soft inspiratory stridor

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53
Q

What is the management of a child with epiglottitis?

A

Intubation/tracheostomy
IV cefuroxime
Prophylactic rifampicin for family

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54
Q

What are the symptoms of bronchitis in children?

A

Cough, fever, retrosternal pain on deep breathing or coughing

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55
Q

What does the organism Bordetella Pertussis cause?

A

Pertussis = Whooping cough

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56
Q

What occurs during the paroxysmal cough in whooping cough?

A

Characteristic inspiratory whoop
Red/blue in face
Cough worse at night
May lead to vomiting/epistaxis/subconjunctival haemorrhage

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57
Q

How is pertussis diagnosed?

A

Nasal swab for culture

Lymphocytosis > 15x10^9/L

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58
Q

Which antibiotic is prescribed for whooping cough?

A

Neonates: clarithromycin
Children and adults: azithromycin or clarithromycin
Pregnant women: erythromycin

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59
Q

Which congenital cardiac defects have a left-to-right shunt (breathless)?

A

Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus

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60
Q

Which congenital cardiac defects have a right-to-left shunt (cyanosed)?

A

Tetralogy of Fallot
Transposition of the Great Arteries
Tricuspid atresia

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61
Q

In which condition does common mixing occur?

A

Atrio-ventricular septal defect

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62
Q

What conditions causing outflow obstruction occur in a) a well child and b) a sick neonate

A

a) pulmonary and aortic stenosis (asymptomatic with a murmur)
b) aortic coarctation (collapsed with shock)

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63
Q

In the fetus, the pressure in which atrium is higher and why?

A

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

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64
Q

What occurs when the newborn takes their first breaths?

A

Resistance to pulmonary blood flow falls and volume of blood flowing across the lungs increases x6

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65
Q

When the placenta is excluded from the circulation, what happens to the blood pressure in the RA?

A

It decreases, causing the flap of the foramen ovale to close.

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66
Q

When does the ductus arteriosus close?

A

Within hours - days

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67
Q

What happens to babies with heart defects that rely on blood flow through the duct (from pulmonary artery to aorta)

A

Duct dependent - condition rapidly deteriorates

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68
Q

Which type of murmur can be innocent if heard when febrile or under perfused?

A 
Short - ejection Systolic murmur (increased cardiac flow)
Soft
No Systemic features
No radiation and no thrills
S1 and S2 normal
Standing and sitting variation
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69
Q

Which type of murmur is always pathological?

A

Pansystolic murmur

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70
Q

What congenital cardiac conditions can cause heart failure in the neonate?

A

Obstructed duct dependent circulation - hypoplastic left heart syndrome, critical aortic stenosis, severe aortic coarctation, interruption of the aortic arch

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71
Q

Heart failure can occur in patients with VSD, ASD, and a large PDA, in which age group?

A

Infants

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72
Q

What conditions can cause heart failure in older children?

A

Rheumatic heart disease
Cardiomyopathy
Eisenmenger syndrome

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73
Q

What are the symptoms of heart failure?

A

Breathlessness, especially with feeding
Sweating
Recurrent chest infection
Poor feeding

74
Q

What are the signs of heart failure?

A

Tachypnoea and tachycardia
Failure to thrive
Cardiomegaly/hepatomegaly
Murmur/gallop rhythm

75
Q

Heart failure in the first week of life usually results from what group of conditions?

A

Left heart obstruction

76
Q

Heart failure after the first week of life usually results from what group of conditions?

A

L to R shunt, as increase in pulmonary vascular resistance causes pulmonary oedema and breathlessness. Shunt reversal, then Eisenmenger’s.

77
Q

What are the five presentations of congenital heart disease?

A 
Antenatal cardiac ultrasound
Detection of cardiac murmur
Heart failure
Shock
Cyanosis
78
Q

What are the causes of cyanosis in the newborn?

A

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
Q

What is the immediate treatment of cyanotic congenital heart disease?

A

Prostaglandin infusion (5ng/kg/min)

80
Q

What is the Hyperoxia (Nitrogen washout) test?

A

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
Q

What are the two types of atrial septal defects?

A

Secundum (80%)

Primum/Partial

82
Q

What are the risk factors of ASD?

A

Down Syndrome
Ebstein’s anomaly
Foetal alcohol syndrome
Idiopathic

83
Q

What heart sounds are commonly heard with ASD and why?

A

Ejection systolic murmur at left sternal edge
Increased blood flow across pulmonary valve due to L-R shunt
Split S2

84
Q

What symptoms are present in a child with ASD?

A

Asymptomatic
Recurrent chest infections/wheeze
Fatigue

85
Q

What is seen on a chest X-Ray in a child with ASD?

A

Cardiomegaly

Increased pulmonary vasculature

86
Q

What is the definitive investigation for diagnosis of an ASD?

A

Echocardiography

87
Q

What are the consequences of a severe ASD?

A

Right ventricular dilatation

88
Q

What is the management of a child with ASD?

A

Percutaneous closure of defect by 3-5 years to avoid right heart failure and arrhythmias in later life.

89
Q

Perimembranous ventricular septal defects are located where?

A

Next to the tricuspid valve

90
Q

What are the two types of VSD?

A

Perimembranous or muscular

91
Q

What are the risk factors for VSD?

A

Down syndrome
MI
Incomplete looping of the heart during days 24-28

92
Q

How do the signs and symptoms of small (<3mm) and large (>3mm) VSDs differ?

A

Small - asymptomatic; loud blowing pansystolic murmur LLSE
Large - HF, SOB, recurrent chest infections, tachypnoea, tachycardia; soft/no pansystolic murmur, apical mid-diastolic murmur

93
Q

How is pulmonary hypertension demonstrated in a patient with a large VSD?

A

Increased pulmonary vasculature on Chest X-Ray

Echo

94
Q

What is the management of a small VSD?

A

Will close spontaneously

Good dental hygiene to reduce the risk of bacterial endocarditis

95
Q

What is the management of a large VSD?

A

Treat HF with diuretics and captopril
Additional calories
Surgery 3-6m

96
Q

What does a patent ductus arteriosus connect?

A

Pulmonary artery to descending aorta

97
Q

When should a PDA have closed?

A

1 month after the expected date of delivery

98
Q

What murmur is heard in PDA?

A

Continuous systolic-diastolic murmur beneath left clavicle

99
Q

Why does a PDA not close?

A

Defect in constrictor mechanism

100
Q

How is a PDA closed?

A

Occlusion device by 1 year of age

101
Q

What are the four components of Tetralogy of Fallot?

A

Large VSD
Overriding aorta
Pulmonary stenosis (RV outflow obstruction)
RV hypertrophy

102
Q

What are the symptoms and signs of TOF?

A 
Cyanosis
Hypercyanotic spells (breathless, pallor, crying)
Squatting on exercise
Clubbing
Loud harsh ejection systolic murmur LSE
103
Q

What can a hypercyanotic spell lead to?

A

MI, cerebral infarction, death

104
Q

What is seen on CXR in TOF?

A

Small boot-shaped heart (uptilted apex)

Decreased pulmonary vascular markings

105
Q

What shunt is seen in TOF?

A

Right to left

106
Q

The surgery to treat TOF involves what?

A

Closing VSD

Relieving pulmonary stenosis

107
Q

What is the acute treatment of a hypercyanotic spell lasting longer than 15 minutes?

A 
Sedation
Morphine
IV propranolol and fluids
Bicarbonate
Artificial ventilation
108
Q

The atrial switch procedure is used to treat what condition?

A

Transposition of the Great Arteries

109
Q

What X-Ray appearance is seen with TGA?

A

Egg on side

110
Q

What are the symptoms and signs of TGA?

A

Cyanosis
Occurs with duct closure
Loud S2, no murmur

111
Q

What defect causes a single 5-leaflet common valve be present?

A

Complete VSD

112
Q

What is tricuspid atresia?

A

Small and non-functional right ventricle with absence of tricuspid valve

113
Q

What is the presentation of tricuspid atresia?

A

Cyanosis in the newborn if duct dependent

114
Q

What is the main risk factor for aortic stenosis?

A

Bicuspid valve

115
Q

What are the CXR findings in severe aortic stenosis?

A

Prominent LV

Post-stenotic dilatation of aorta

116
Q

What indicates left ventricular hypertrophy on an ECG?

A

Deep S wave in V2
Tall R wave in V6
T wave inversion

117
Q

What is the murmur in aortic stenosis?

A

Ejection systolic murmur at URSE radiating to axilla

118
Q

Most people with aortic stenosis become symptomatic with angina and dyspnoea in their 50s. How does a neonate present?

A

Severe heart failure and shock

119
Q

When would you surgically correct aortic or pulmonary stenosis?

A

Symptoms on exertion

High resting pressure gradient (>64mmHg)

120
Q

Stenosis of which valve causes right ventricular hypertrophy?

121
Q

What indicates RVHT on the ECG?

A

Upright T wave in V1

122
Q

What is the murmur heard in pulmonary stenosis?

A

Ejection systolic murmur ULSE

123
Q

How does paediatric coarctation of the aorta differ from adult-type coarctation?

A

Outflow obstruction in the sick neonate: narrowing proximal to duct insertion
Adult - In descending aorta

124
Q

What occurs when the duct closes in aortic coarctation?

A

The aorta constricts, causing severe obstruction to left ventricular outflow

125
Q

What is the presentation of neonatal aortic coarctation?

A

Circulatory collapse day 2 of life

Absent femoral pulses, severe heart failure and metabolic acidosis

126
Q

What is interruption of the aortic arch?

A

No connection between the proximal aorta and aorta distal to the arterial duct

127
Q

What syndrome has an increased risk of IAA?

128
Q

How does IAA present?

A

Shock in the neonatal period, heart failure (duct dependent)

129
Q

What is the management of IAA?

A

Prostaglandin infusion

Surgical repair

130
Q

What is hypoplastic left heart syndrome?

A

Underdevelopment of the entire left side of the heart, including mitral and aortic valves, and aorta.

131
Q

How is HLS diagnosed?

A

Antenatal ultrasound

132
Q

What is the presentation of HLS?

A

very sick - duct dependent circulation
Profound acidosis
cardiovascular collapse, absence of peripheral pulses

133
Q

What is the most common childhood arrhythmia?

A

Supraventricular tachycardia

134
Q

Define supraventricular tachycardia

A

250/300BPM, narrow complex tachycardia

135
Q

What ECG finding indicates myocardial ischaemia?

A

T wave inversion

136
Q

What ECG finding signifies Wolff-Parkinson-White syndrome?

A

Short PR wave

Delta wave

137
Q

What is the cause of supraventricular tachycardia?

A

Usually a re-entry pathway

138
Q

What are the symptoms of SVT in the neonate?

A

Heart failure symptoms
Poor feeding
Dyspnoea
Pallor

139
Q

What are the symptoms of SVT in the foetus?

A

Hydrops fetalis/intrauterine death

140
Q

How do you acutely manage SVT?

A

Vagal/Valsalva manoeuvre (carotid sinus massage)
IV adenosine to induce AV block
DC cardioversion if shocked

141
Q

What is maintenance therapy for SVT?

A

Flecainide or sotalol

Ablation of accessory pathway

142
Q

Which antibodies is congenital complete heartblock related to?

A

Anti-Ro or Anti-La antibodies in maternal serum

143
Q

What causes the symptoms of heart failure or stillbirth in congenital complete heart block syndrome?

A

Atrophy and fibrosis of the AV node

144
Q

How does long QT syndrome present?

A

Sudden loss of consciousness during exercise/stress

145
Q

What are the five main causes of syncope in children?

A 
Neurocardiogenic
Situational e.g. cough
Orthostatic (BP fall >20mmHg)
Ischaemic
Arrhythmic e.g. SVT
146
Q

What is rheumatic fever?

A

An abnormal immune response to a preceding infection with Group A beta-haemolytic strep

147
Q

What occurs in the 2-6 weeks latent interval in rheumatic fever?

A

Pharyngeal infection
Polyarthritis
Fever and malaise

148
Q

What major symptoms occur with rheumatic fever?

A 
Pancarditis
Syndenham chorea
Erythema marginatum
Subcutaneous nodules
Polyarthritis
Mitral stenosis in early adult life
149
Q

What is the treatment of rheumatic fever?

A

Corticosteroids if fever does not resolve rapidly

Aspirin

150
Q

Who is at risk of endocarditis?

A

Children with congenital cardiac conditions, due to turbulence in the heart, and prosthetic material inserted at surgery

151
Q

What is the presentation of endocarditis?

A 
Fever and malaise
Raised ESR
Unexplained anaemia and pallor
Splinter haemorrhages, clubbing, retinal infarcts
Changing cardiac signs
Arthralgia
152
Q

How is endocarditis diagnosed?

A

Echocardiogram for vegetations

153
Q

What is the treatment of endocarditis?

A

Penicillin and aminoglycoside IV

154
Q

What causes the first and second heart sounds?

A

S1 - mitral valve/tricuspid valve

S2 - aortic valve/pulmonary valve

155
Q

After birth, what is the first breath triggered by?

A

Hypoxia secondary to cord clamping

156
Q

What is the murmur heard in TOF?

A

Ejection systolic murmur, left parasternal heave

157
Q

What is the mnemonic for Down’s syndrome?

A 
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
Q

Why is rib notching seen in aortic coarctation?

A

Increased blood flow through collaterals

159
Q

What blood pressure measurement is needed in aortic coarctation and what is the result?

A

Four limb BP: arms > legs

160
Q

What is the most common causative organism in endocarditis?

A

Strep.viridans

161
Q

Which pulse would you palpate in assessing the circulation of children younger than and older than 1?

A

Younger than 1 - brachial/femoral

Older than 1 - carotid/femoral

162
Q

What is biphasic anaphylaxis?

A

Rebound symptoms in anaphylaxis, around 12 hours later

163
Q

What clinical signs would indicate a child was having a life threatening asthma attack?

A 
Decreased respiratory rate
Silent chest
Decreased GCS
SpO2<92%
Cyanosis
164
Q

What are the differentials of wheeze at birth?

A

Congenital heart disease
Bronchiogenic cysts
Laryngeal abnormalities

165
Q

What are the differentials of wheeze a few days after birth?

A

GORD
CF
Ciliary dyskinesia

166
Q

Give three signs of respiratory distress

A 
Head bobbing
Nasal flaring
Tracheal tug
Tachypnoea
Recessions
Use of accessory muscles
Abdominal breathing
167
Q

Which children are at risk of severe bronchiolitis?

A

Prematurity
Chronic lung disease
Heart conditions
Immunodeficient

168
Q

What is the commonest mutation in cystic fibrosis?

A

Delta F508

169
Q

When is the peak incidence of bronchiolitis?

A

3-6 months

170
Q

When is bronchiolitis more common?

171
Q

What condition can cause bronchiolitis to be more severe?

A

Congenital heart disease

Prematurity

172
Q

What are the risk factors for bronchiolitis?

A

Fed on formula milk

Less than 3 months old

173
Q

What are three risk factors for pulmonary hypoplasia?

A

Oligohydramnios
Congenital diaphragmatic hernia
Tetralogy of fallot

174
Q

When should children by reviewed by the community paediatrician for poor growth?

A

Below the 0.4th centile for height

175
Q

What are the symptoms of primary ciliary dyskinesia?

A

Recurrent respiratory infection
Recurrent otitis media
Infertility?

176
Q

What pulse do you see with PDA?

A

Bounding/collapsing

177
Q

What is the most common congenital cardiac condition associated with trisomy 21 and what is seen on ECG?

A

AVSD

Superior QRS axis on ECG

178
Q

What is the most common cause of stridor in the neonate?

A

Laryngomalacia

179
Q

What syndrome is associated with Ebstein’s anomaly?

A

Wolff-Parkinson White

180
Q

What is the rate of compression and ventilation in the newborn?

181
Q

What is transient tachypnoea of the newborn?

A

The most common cause of respiratory distress in the neonatal period
Caused by delayed fluid resorption in the lungs –> Caesarian sections

182
Q

What is given to prevent respiratory syncytial virus in infants at risk of severe bronchiolitis?

A

Palivizumab

Phase 3a (18 decks)

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