Paeds 3B Flashcards

1
Q

What murmur is associated with ASD?

A

ejection systolic murmur (due to increased stroke volume of the right ventricle through the pulmonary outflow tract), widely split heart sound (because of increased stroke volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What murmur is associated with VSD?

A

Loud pansystolic murmur at the lower left sternal edge, quiet pulmonary second heart sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which defects require surgical correction in tetralogy of Fallot?

A

Close the VSD
Relive the right ventricular outflow obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How may hypercyanotic spells in tetralogy of Fallot be treated?

A
Sedation and pain relief
IV propranolol (reduce infundibular muscle contractility and therefore improves blood flow out of RVOT towards lungs) 
IV fluids (improve pulmonary blood flow)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which temporary life-saving procedure may be performed for patients with transposition of the great arteries to enhance mixing of the blood?

A

Balloon atrial septostomy - this is a temporary measure to buy time for definitive surgery (arterial switch)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is tricuspid atresia treated?

A

Blalock-Taussig shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is aortic stenosis treated?

A

Balloon valvulotomy
Aortic valve replacement

NOTE: same for pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is SVT managed?

A

1 - vagal manoeuvres
2 - IV adenosine (DC cardioversion if this fails)
3 - maintenance therapy with fleicainide or sotalol

90% of children have no further attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is acute rheumatic fever treated?

A

Bed rest and anti-inflammatory agents (e.g. aspirin)
Penicillin V if evidence of persistent infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most effective prophylaxis for rheumatic fever?

A

Monthly injections of benzathine penicillin (not the same as benzyl;enicillin)
Alternative: oral penicillin OD

NOTE: prophylaxis recommended for 10 years after last episode of rheumatic fever or until 21 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is infective endocarditis treated?

A

Beta-lactam and gentamicin

Usually for 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How would you treat an umbilical granuloma?

A

Regular application of salt to the wound (draws water out and causes it to shrink)
Cauterise with silver nitrate (to burn off tissue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List some contraindications for MMR ( a live attenuated vaccine)

A

Severe immunosuppression (high dose steroids leave you immunocompromised for 3 months)

Allergy to neomycin (additive in MMR)

Received another live vaccine by injection within 4 weeks

Pregnancy should be avoided for at least 1 month afterwards (you dont want pregnant women getting infected so just want to be safe you ask them to not get pregnant for long enough to make sure theyre definitely ok)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should children < 3 months with a UTI be managed?

A
Admit to hospital immediately 
IV antibiotics (e.g. amoxicillin) for at least 5-7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which clinical features are suggestive of an upper UTI?

A

Bacteriuria + fever
Bacteriuria + loin pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How should an upper UTI be treated?

A
Oral antibiotics (e.g. trimethoprim for 7 days)
If this cannot be used, give IV antibiotics (e.g. coamoxiclav) for 2-4 days and discharge with oral antibiotics
17
Q

How should simple cystitis be treated?

A

Oral antibiotics (e.g. trimethoprim) for 3 days

18
Q

Which children should have an ultrasound after a UTI?

A

Children who have had an atypical UTI (seriously unwell, not caused by ecoli, sepsis etc)

Children who have had a recurrent UTI
Children < 6 months

19
Q

Which children should have a DMSA and MCUG after a UTI?

A

infant <6 months with a standard UTI would need an USS

child any age presenting with atypical UTI (non ecoli, seriously ill, sepsis, abdominal mass, failure to respond to antibiotics, basically anything that isnt a classic UTI) : USS + dimercaptosuccinic acid scan (DMSA) + micturating cystourethrogram (MCUG)

recurrent UTI = same as atypical UTI

20
Q

How should enuresis in < 5 year olds be managed?

A

Reassure that this usually resolves without investigation
Ensure easy access to the toilet at night
Encourage bladder emptying before bed

21
Q

How should enuresis in > 5 year olds be managed?

A

If infrequent (< 2 weeks) reassure and watch-and-wait

1st line if < 7: enuresis alarm and positive reward system
2nd line: desmopressin

Desmopressin may be used first line if rapid short-term control is necessary, or if > 7 years old

22
Q

List some causes of secondary enuresis.

A

UTI

Constipation

Diabetes

Psychological/Family problems

23
Q

How is nephrotic syndrome treated?

A

Oral prednisolone for 4 weeks

Wean and stop after 4 weeks

If the child does not respond or has atypical features, consider renal biopsy

24
Q

List some complications of nephrotic syndrome.

A

Hypovolaemia

Thrombosis

Infection due to loss of IgG

Hypercholesterolaemia

25
Q

How is Henoch-Schonlein purpura managed?

A

Most resolve spontaneously within 4 weeks

Joint pain can be managed with paracetamol/ibuprofen

IV corticosteroids are recommended for nephrotic-range proteinuria or declining renal function

Oral prednisolone may be given for severe scrotal oedema or abdominal pain