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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
name the TORCH infections
``` toxoplasmicosis other (parvovirus, varicella) rubella CMV herpes/hepatitis ```
26
how does congenital hypothyroidism present
``` macroglossia (bc thyroid descends from the tongue in embryology) failure to thrive hypotonia prolonged jaundice umbilical hernia pale mottled skin hoarse cry puffy face ```
27
3 day old has hypotonia, puffy face, hoarse cry, jaundice and macroglossia what is it
congenital hypothyroidism
28
how do you manage congenital hypothyroidism
thyroxine replacement must be started within the 1st 2 weeks of life to avoid irreversible cognitive impairment (low TSH stunts growth)
29
what is the most common cause of congenital hypothyroidism
failure to thyroid to migrate or iodine deficiency globally
30
what is digeorge sydrome
congenital hypoparathyroidism thymic aplasia causes a lowered immune system cardiac defects
31
what is the pathophysiology behind congenital adrenal hyperplasia
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
symptoms of congenital adrenal hyperplasia
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
how do you manage congenital adrenal hyperplasia
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
what do you screen for in new born babies (exam and tests)
``` 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
what is hypoxic ischaemic encephalopathy and what is the complication of it
perinatal asphyxia during birth either due to placental or pulmonary issues causes cerebral palsy or death
36
name 5 causes of hypoxic ischaemic encephalopathy
``` cord compression/prolapse prolonged uterine contractions placental or uterine abruption maternal hypotension intrauterine growth restriction ```
37
how does hypoxic ischaemic encephalopathy present
``` presents immediately with.. irritable infant abnormal movements hypo or hyper tonia seizures cant feed hyperventilation / impaired brething multi organ failure ```
38
how do you manage a baby with hypoxic ischaemic encephalopathy
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
how do you differentiate between caput seccedaneum and cephalohaematoma
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
what is a subaponeurotic haemorrhage
a birth injury that causes diffuse boggy swelling of the entire scalp and can causes severe blood loss and shock
41
what is erbs palsy
damage to C6 and c5 after a breech or shoulder delivery | refer child at 2-3 months if not resolved
42
which babies are more prone to respiratory distress syndrome
pre term babies and babies of diabetic mothers
43
what is respiratory distress syndrome caused by
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
why are steroids given to pre term babies
to develop the lungs to avoid respiratory distress syndrome and bronchopulmonary dysplasia also decreases risk of intraventricular haemorrhage
45
how does respiratory distress syndrome present
resp distress (tachypnoea, increased WOB, recessions, grunting, nasal flaring, cyanosis) within 4 hours of birth or at delivery
46
how do you manage respiratory distress syndrome
give surfactant via tracheal tube | CPAP / high flow o2 via nasal cannula
47
how should neonates be ventilated
at lowest effective pressures to avoid pneumothorax
48
what is bronchopulmonary dysplasia and what causes it
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
how do you manage bronchopulmonary dysplasia
CPAP - dont over oxygenate tho steroids caffeine!!
50
what is apnoea of prematurity and how do you treat it
spontaneous stopping breathing and desaturations | managed with IV caffeine and tactile stimulation when apnea monitor goes off
51
what is transient tachypnoea of the newborn and how can you differentiate it from respiratory distress syndrome
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
what is meconium aspiration syndrome, who is it more common in and how do you manage it
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
name 3 causes of persistent pulmonary hypertension of the newborn
birth asphyxia meconium aspiration sepsis RDS
54
how does persistent pulmonary hypertension of the newborn present
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
how do you manage persistent pulmonary hypertension of the newborn
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
what 3 things are seen on abdo xray in necrotising enterocolitis
1. dilated loops of bowel 2. bowel wall oedema 3. pneumonitis intestinalis (intramural gas)
57
how does nectrotising entercolitis present
``` in 1st few weeks of life billious vomiting, poor feeding, failure to thrive then.. fresh blood in stool abdo distension shock ```
58
what is riglers sign
air inside and outside the bowel
59
how do you manage necrotising enterocolitis
``` stop feeds broad spec abx mechanical ventilation parentral nutrition surgery to correct perforation ```
60
what complication does coarctation of the aorta increase your risk of
cerebral aneurysms
61
how does biliary atresia present
``` prolonged jaundice over 14 days palpable liver pale stools dark urine conjugated bilirubin and raised alp and ast bc obstructive jaundice ```
62
how is billiary atresia diagnosed
cholangiography shows absence of billiary tree | liver uss shows fibrotic changes
63
causes of billous vomit in kids
``` intestinal obstruction (volvulus) duodenal atresia ```
64
management of pyloric stenosis
abcde fluids and electolyte replacement intubate / ng feed ramsteds pylorotomy
65
diagnosis and management of suspected volvulus
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
what is intususseption and when does it happen
invagination / telescoping of proximal bowel into distal bowel neonates or aged 2/3
67
what causes intususseption
peyers patch enlargement | meckel diverticulum
68
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
intusseption | USS abdomen shows donut sign
69
how do you manage intususseption
if no complications do radiological insufflation | if shocked fluid resus and surgery
70
what is meckels diverticulum, what are the symptoms and how do you diagnose
embryological remenent of intesinal duct can cause severe rectal bleeding diagnose with techtenium scan treat with surgery to resect it
71
what is duodenal atresia, what condition is it associated with, how does it present and what is the management
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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