Paeds 3B Flashcards
What murmur is associated with ASD?
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)
What murmur is associated with VSD?
Loud pansystolic murmur at the lower left sternal edge, quiet pulmonary second heart sound
Which defects require surgical correction in tetralogy of Fallot?
Close the VSD
Relive the right ventricular outflow obstruction
How may hypercyanotic spells in tetralogy of Fallot be treated?
place patient in knee-to-chest position
administer oxygen
Insert IV line and give phenylephrine, morphine sulphate and propranolol (reduce infundibular muscle contractility and therefore improves blood flow out of RVOT towards lungs) IV fluids (improve pulmonary blood flow)
refer to cardiac centre
Which temporary life-saving procedure may be performed for patients with transposition of the great arteries to enhance mixing of the blood?
Balloon atrial septostomy - this is a temporary measure to buy time for definitive surgery (arterial switch)
How is tricuspid atresia treated?
initial management: prostaglandin e1 transfusion
surgical = Blalock-Taussig shunt (bt subclavian and pulmonary arteries)
How is aortic stenosis treated?
Balloon valvulotomy (valvuloplasty) Aortic valve replacement
NOTE: same for pulmonary stenosis
How is SVT managed?
If haemodynamically stable:
1 - vagal manoeuvres
2 - IV adenosine
3 - one of the following: DC cardioversion, amiodarone, procainamide, flecainide
If hemodynamically unstable:
attempt vagal manouevres and adenosine as above but do not delay cardioversion
catheter ablation is recommended if recurrent/acessory pathway
90% of children have no further attacks
How is acute rheumatic fever treated?
Bed rest and anti-inflammatory agents (e.g. aspirin)
Penicillin V if evidence of persistent infection
What is the most effective prophylaxis for rheumatic fever?
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 is infective endocarditis treated?
Beta-lactam (benzylpenicillin, ampicillin, ceftriaxone, amoxicillin) and gentamicin
Usually for 6 weeks
How would you treat an umbilical granuloma?
Regular application of salt to the wound (draws water out and causes it to shrink)
Cauterise with silver nitrate (to burn off tissue)
List some contraindications for MMR ( a live attenuated vaccine)
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 should neonates, infants and <6 weeks with a UTI be managed?
Admit to hospital immediately after a full septic screen
IV antibiotics ampicillin and gentamicin or co-amoxiclav for at least 5-7 days
oral therapy after clinical response and blood/csf culture being negative
Which clinical features are suggestive of an upper UTI?
Bacteriuria + fever
Bacteriuria + loin pain
How should an upper UTI be treated?
Consider admission
Oral antibiotics for 7-10 days - CEFALEXIN or CO-AMOXICLAV
If oral cannot be used, give IV antibiotics
How should simple cystitis/lower uti be treated?
Oral antibiotics (e.g. trimethoprim) for 3 days
Which children should have an ultrasound after a UTI?
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
Which children should have a DMSA and MCUG after a UTI?
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
How should enuresis in < 5 year olds be managed?
Reassure that this usually resolves without investigation
Ensure easy access to the toilet at night
Encourage bladder emptying before bed
How should enuresis in > 5 year olds be managed?
If infrequent (< 2 per week) 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
List some causes of secondary enuresis.
UTI
Constipation
Diabetes
Psychological/Family problems
How is nephrotic syndrome treated?
fluid restrict and low salt diet
Oral prednisolone for 4 weeks
Wean and stop after 4 weeks
very advanced minimal change disease may need albumin and furosemide
If the child does not respond or has atypical features, consider renal biopsy
List some complications of nephrotic syndrome.
Hypovolaemia
Thrombosis
Infection due to loss of IgG
Hypercholesterolaemia
How is Henoch-Schonlein purpura managed?
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
