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paeds Flashcards

1
Q

name 4 signs of respiratory distress in infants

A 
head bobbing
grunting
nasal flaring
use of accessory muscles
tracheal tug
tachypnoea
cyanosis
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2
Q

most common cause of pneumonia in neonates

A

group B streptococcus

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3
Q

most common cause of pneumonia in older kids

A

s.pneumonia or h.influenza

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4
Q

how would you investigate suspected pneumonia in a child

A

capillary blood gas to look for T2 resp failure
septic screen
CXR
sputum culture

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5
Q

1st line treatment of pneumonia in neonates

A

broad spec!!

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6
Q

1st line treatment of pneumonia in older kids

A

amoxicillin, co-amox if suspected h.influenzae

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7
Q

clinical presentation of pneumonia in neonates

A 
non specific
hypoxia
failure to thrive
poor feeding
grunting
recessions 
fever
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8
Q

organism causing bronchiolitis

A

RSV

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9
Q

organism causing whooping cough

A

bordatella pertussis

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10
Q

organism causing croup

A

parainfluenza virus 1-3

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11
Q

differences between croup and whooping cough

A

no stridor in whooping cough
croup can cause stridor
croup is more acute whooping cough lasts for weeks
can get complications from severe coughing fits in whooping cough eg vomiting pneumothorax retinal haemorrhages

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12
Q

management of croup

A

po dexamethasone stat dose
supportive: o2 fluids ng feed
nebulised adrenaline or budenoside if severe distress

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13
Q

management of whooping cough

A

1st like azithromycin or clarithromycin

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14
Q

management of bronchiolitis

A

supportive

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15
Q

presentation of bronchiolitis

A 
winter months
toddler aged under 2 years
cough
coryza
resp distress
wheeze and inspiratory crackles
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16
Q

what should you always monitor when giving salbutamol for acute asthma

A

potassium levels (hypokalaemia)

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17
Q

how do you manage a strawberry naevus

A

topical propanolol

will regress in 3-6 months

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18
Q

widespread white pinpoin papules develop on neonate day 3 of life, what is the cause

A

erythema toxicum neonatorum

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19
Q

boggy superficial scalp swelling that crosses the suture lines on neonate, what is the diagnosis

A

capput succedanum

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20
Q

superficial scalp swelling confined within the suture lines on neonate

A

cephalohaematomab - a sub periosteal haemorrhage

can cause jaundice when the haematoma is broken down due to the haemolysis overwhelming the new born liver

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21
Q

when is jaundice classed as normal vs abnormal in neonates

A

always abnormal in 1st 24 hours of life
up to 2 weeks considered physiological
develops after 2 weeks can be either normal or abnormal

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22
Q

name 3 causes of jaundice in first 24 hours of life

A 
rhesus haemolytic disease of newborn
abo incompatibility
TORCH infections
hereditary spherocytosis
g6pd deficiency
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23
Q

describe rhesus haemolytic disease of the newborn

A

jaundice in 1st 24 hours of life
where neonate is rhesus positive and mother is rhesus negative and blood mixes during birth trauma and causes mother to produce antibodies against fetal blood so causes haemolysis (pre hepatic so causes unconjugated bilirubin levels to be high)

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24
Q

describe ABO incompatibility in newborns

A

more common than rhesus disease
where mum is group O and baby is A or B
causes jaundice in 1st 24 hours of life due to haemolysis

diagnose by doing coombes test

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25
Q

name the TORCH infections

A 
toxoplasmicosis
other (parvovirus, varicella)
rubella
CMV
herpes/hepatitis
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26
Q

how does congenital hypothyroidism present

A 
macroglossia (bc thyroid descends from the tongue in embryology)
failure to thrive
hypotonia
prolonged jaundice
umbilical hernia
pale mottled skin
hoarse cry
puffy face
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27
Q

3 day old has hypotonia, puffy face, hoarse cry, jaundice and macroglossia what is it

A

congenital hypothyroidism

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28
Q

how do you manage congenital hypothyroidism

A

thyroxine replacement must be started within the 1st 2 weeks of life to avoid irreversible cognitive impairment (low TSH stunts growth)

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29
Q

what is the most common cause of congenital hypothyroidism

A

failure to thyroid to migrate or iodine deficiency globally

30
Q

what is digeorge sydrome

A

congenital hypoparathyroidism
thymic aplasia causes a lowered immune system
cardiac defects

31
Q

what is the pathophysiology behind congenital adrenal hyperplasia

A

21 hydroxylase deficiency means the adrenals cant produce cortisol or aldosterone (basically congenital addisons), meaning the pituitary over produces ACTH to try and stimulate the adrenals, but this causes excess testosterone to be produced (bc produced by the adrenals but doesnt require 21 hydroxylase) meaning the baby will get symptoms of excess testosterone and salt losing

32
Q

symptoms of congenital adrenal hyperplasia

A

within 1st 3 weeks of life…

  • vomiting, weight loss, hypotonia, circulatory collapse = hyponatraemia, hyperkalaemia and metabolic acidosis due to low aldosterone
    note: doesn’t present immediately after birth bc babies still have some steroid hormones left from placenta from mum

older children:
- clitoral hypertrophy
- fusion of the labia
- enlarged penis with dark coloured scrotum
tall, muscular, adult body odour, precoicious pubarche, acne

33
Q

how do you manage congenital adrenal hyperplasia

A
  1. IV fluid resus with sodium replacement
  2. glucose
  3. hydrocortisone acutely and life long to suppress excess ACTH
  4. can use fludrocortisone to boost bp in severe cases
34
Q

what do you screen for in new born babies (exam and tests)

A 
Developmental dysplasia hip - ortholini and bartlow test
congenital heart disease
congenital cataracts (red reflex)
undescended testes
newborn hearing - otoacoustic emission testing (if this is abnormal then do auditory brainstem response testing)
Guthrie heel prick test:
CF
congenital hypothyroid
sicklecell/thalassamemia
6 x inherited metabolic disorders
35
Q

what is hypoxic ischaemic encephalopathy and what is the complication of it

A

perinatal asphyxia during birth either due to placental or pulmonary issues
causes cerebral palsy or death

36
Q

name 5 causes of hypoxic ischaemic encephalopathy

A 
cord compression/prolapse
prolonged uterine contractions
placental or uterine abruption
maternal hypotension
intrauterine growth restriction
37
Q

how does hypoxic ischaemic encephalopathy present

A 
presents immediately with..
irritable infant
abnormal movements
hypo or hyper tonia
seizures
cant feed
hyperventilation / impaired brething
multi organ failure
38
Q

how do you manage a baby with hypoxic ischaemic encephalopathy

A

immediate resus to reduce neuronal damage
rescue breaths and ventilation
anti convulsants
inotropes for hypotension
correct electrolytes and fluid imbalance
wrap baby in a cooling blanket after birth (therapeutic hypothermia)
EEG monitors can be useful to identify HIE

39
Q

how do you differentiate between caput seccedaneum and cephalohaematoma

A

caput succedaneum extends beyond the skull sutures and often resolves in a couple of days, is only made of bruising and oedema

cephalohaematoma is bleeding below the periosteum so is confined within skull sutures, feels soft and usually resolves in a few weeks but can cause jaundice from haemolysis of the haematoma

40
Q

what is a subaponeurotic haemorrhage

A

a birth injury that causes diffuse boggy swelling of the entire scalp and can causes severe blood loss and shock

41
Q

what is erbs palsy

A

damage to C6 and c5 after a breech or shoulder delivery

refer child at 2-3 months if not resolved

42
Q

which babies are more prone to respiratory distress syndrome

A

pre term babies and babies of diabetic mothers

43
Q

what is respiratory distress syndrome caused by

A

a deficiency of surfactant in the lungs in prem babies means lungs cant maintain adequate surface tension meaning alveoli collapse causing reduced gas exchange
almost always in babies less than 28 weeks

44
Q

why are steroids given to pre term babies

A

to develop the lungs to avoid respiratory distress syndrome and bronchopulmonary dysplasia
also decreases risk of intraventricular haemorrhage

45
Q

how does respiratory distress syndrome present

A

resp distress (tachypnoea, increased WOB, recessions, grunting, nasal flaring, cyanosis) within 4 hours of birth or at delivery

46
Q

how do you manage respiratory distress syndrome

A

give surfactant via tracheal tube

CPAP / high flow o2 via nasal cannula

47
Q

how should neonates be ventilated

A

at lowest effective pressures to avoid pneumothorax

48
Q

what is bronchopulmonary dysplasia and what causes it

A

occurs in babies who have had respiratory distress syndrome (surfactant deficiency) at birth and still have an oxygen requirement at 28 days post birth = classed as bronchopulmonary dysplasia

49
Q

how do you manage bronchopulmonary dysplasia

A

CPAP - dont over oxygenate tho
steroids
caffeine!!

50
Q

what is apnoea of prematurity and how do you treat it

A

spontaneous stopping breathing and desaturations

managed with IV caffeine and tactile stimulation when apnea monitor goes off

51
Q

what is transient tachypnoea of the newborn and how can you differentiate it from respiratory distress syndrome

A

RDS = prem babies
TTN = TERM BABIES
more common following C-sections
caused by delayed fluid resorption in the lungs, may see fluid in the horizontal fissure on CXR
presents with signs of resp distress
often self resolving within 48 hours but can use o2 and cpap if needed

52
Q

what is meconium aspiration syndrome, who is it more common in and how do you manage it

A

where meconium is released due to fetal hypoxia/distress and is aspirated in the lungs = causes hyperinflation and obstruction and a chemical pneumonitis so more prone to infection.
more common with increasing gestational age so uncommon in prem babies
treated with suctioning and ventilation

53
Q

name 3 causes of persistent pulmonary hypertension of the newborn

A

birth asphyxia
meconium aspiration
sepsis
RDS

54
Q

how does persistent pulmonary hypertension of the newborn present

A

cyanosis immediately after birth due to a right to left shunt in the lungs, without murmurs or any other signs of heart failure

but still need to do echo to exclude CHD

55
Q

how do you manage persistent pulmonary hypertension of the newborn

A
  1. ventilation
  2. inhaled nitric oxide or slidenafil to vasodilate pulmonary vessels
  3. if severe can place newborn on a heart and lung bypass machine (extracorpeal membrane oxygenation)
56
Q

what 3 things are seen on abdo xray in necrotising enterocolitis

A
  1. dilated loops of bowel
  2. bowel wall oedema
  3. pneumonitis intestinalis (intramural gas)
57
Q

how does nectrotising entercolitis present

A 
in 1st few weeks of life
billious vomiting, poor feeding, failure to thrive
then..
fresh blood in stool
abdo distension
shock
58
Q

what is riglers sign

A

air inside and outside the bowel

59
Q

how do you manage necrotising enterocolitis

A 
stop feeds
broad spec abx
mechanical ventilation
parentral nutrition
surgery to correct perforation
60
Q

what complication does coarctation of the aorta increase your risk of

A

cerebral aneurysms

61
Q

how does biliary atresia present

A 
prolonged jaundice over 14 days
palpable liver
pale stools
dark urine
conjugated bilirubin and raised alp and ast bc obstructive jaundice
62
Q

how is billiary atresia diagnosed

A

cholangiography shows absence of billiary tree

liver uss shows fibrotic changes

63
Q

causes of billous vomit in kids

A 
intestinal obstruction (volvulus)
duodenal atresia
64
Q

management of pyloric stenosis

A

abcde
fluids and electolyte replacement
intubate / ng feed
ramsteds pylorotomy

65
Q

diagnosis and management of suspected volvulus

A

upper gi contrast and USS
surgical emergency to save bowel (ischaemia if superior mesenteric artery compressed)
laparotomy to untwist bowel
or lads procedure if bowel remains healthy

66
Q

what is intususseption and when does it happen

A

invagination / telescoping of proximal bowel into distal bowel
neonates or aged 2/3

67
Q

what causes intususseption

A

peyers patch enlargement

meckel diverticulum

68
Q

colicky abdo pain in neonate, child goes pale and pulls legs up to abdo, gen unwell, been vomiting, red currant jelly stool in rectum, sausage shaped mass in abdo, hypovolaemic shocked
what is diagnosis and how do you diagnose

A

intusseption

USS abdomen shows donut sign

69
Q

how do you manage intususseption

A

if no complications do radiological insufflation

if shocked fluid resus and surgery

70
Q

what is meckels diverticulum, what are the symptoms and how do you diagnose

A

embryological remenent of intesinal duct
can cause severe rectal bleeding
diagnose with techtenium scan
treat with surgery to resect it

71
Q

what is duodenal atresia, what condition is it associated with, how does it present and what is the management

A

where duodenum not formed properly so not connected to rest of the bowel
downs syndrome
CP: not tolerating feeds, billous vomiting, abdo distension, delayed/failed to pass meconium
management: surgery to connect the bowel

finals (18 decks)

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