Paeds Flashcards
When are heart defects usually picked up?
USS at 20 weeks -> fetal echo
Features of a L->R shunt? Common defects? Causes?
Breathless / aSx
VSD, PDA, ASD
Maternal Rubella, SLE, diabetes
Warfarin
Downs, Edwards, Patau, turners
Features of a R->L shunt ? Usual cause?
Cyanotic blue child
Tetralogy of fallot, transposition of the great arteries
Fetal circulation ?
Circulation after birth ?
Fetal - Low pressure in LA as little blood return from lung
-High pressure in RA as all systemic and placental venous return
-foramen ovale (between atria) and Ductus arteriosus (between Pulm artery and aorta to bypass lungs)
Blood flows R->L
Birth - Breath increases pulmonary blood flow -> increase LA pressure
- No placenta -> decrease RA pressure
- pressure LA>RA so foramen ovale closes
First few days of life - ductus arteriosus closes
Most common DD for well baby with a systolic murmur at upper left eternal edge? What to remember?
Innocent/physiological murmur
4 Ss
Soft, systolic murmur only, left Sternal edge, aSx
well baby with a ejection systolic murmur at upper left sternal edge? Probable cause of this defect? What else to remember?
Probably ASD (get increased flow over the pulmonary valve)
Usually due to foramen ovale failing to close
Risk of recurrent chest infections
well baby with loud pan systolic murmur ? Prognosis? How would this change if it was a larger defect? Was do you use to judge size? What is risk with large defect? What else would you do with a large defect?
VSD (louder = smaller) - tend to spontaneously close
Large VSD -> more Sx Eg breathlessness, failure to thrive
Size of VSD judged in relation to aortic valve
Give surgery 3-6 months to prevent pulmonary hypertension
Eisenmenger’s syndrome
What is Eisenmenger’s syndrome?
Long standing L->R shunt caused by CHD causes pulmonary hypertension and swap to R->L shunt -> Cyanosis
Associations with PDA? Murmur? Mx?
Prematurity
Continuous murmur beneath L clavicle
Collapsing and bounding pulse
Closure with coil at 1yr to prevent pulmonary HTN (Eisenmenger’s)
Blue pale, irritable, breathless baby
DDx
Tetralogy
TGA
AVSD
4 Parts of tetralogy of fallot? Seen on X-ray? Mx?
Large VSD, overriding aorta, pulmonary stenosis, RV hypertrophy
X-ray - boot shaped heart (due to RVH)
Prostaglandins to keep defect open until surgery at 6/12
What happens in TGA? When does it classically present? Associations? Seen on X-ray ? Mx?
Aorta connected to RV, Pulm artery to LV
Presents day 2 when ductus arteriosus closes
VSD, ASD, PDA
‘Egg on side’ cardiac shadow
PG to keep defect open until definitive surgery as a neonate
AVSD presentation? Associated with which condition?
Mixing of blood so blue and breathless
Cyanotic at birth / HF at 2-3 weeks
Downs
What can be used to help close defects in hearts ?
Prostaglandin inhibitors Eg IV indomethacin / ibuprofen
Murmur in AS?
Murmur in PS?
AS- LVH, ejection systolic murmur at upper RIGHT sternal edge
PS - RVH, ejection systolic murmur at upper LEFT sternal edge
Seen in coarctation of Aorta / hypoplastic left heart syndome?
Circulatory collapse at 2 days old
Absent femoral pulses
3 year old brought into A&E Difficulty breathing, barking cough, mild intercostal recessions 1- DDx 2- Likely 3- Cause 4- Usual age affected 5- 4 Sx 6- Mx 7- Mx in low o2 sats
1 - Croup, asthma, bronciolotis, pneumonia, URTI, acute epiglottis is, Foreign body
2- Croup (Laryngotracheobronchitis)
3- Parainfluenza
4- 6month- 6yr
5- Barking cough, strider, fever, coryzal Sx
6- single dose Dexamethoasone (/pred) 0.15mg/kg
7- high flow O2 and nebuliser adrenaline
6month old to GP with 24hr with increased work of reaching, coryzal, lethargy, and reduced oral intake
OE - Fine inspiratory crackles, subcostal recesson, temp 37.9 and SaO2 92%
1- diagnosis
2- cause
3- Mx
4- Prevention
1 - bronchiolotis
RSV
Self limiting so supportive (O2 / fluids )
Palivizumab
Child refusing to walk and is upset OE - hip is red tender and warm 1- what do you need to rule out and usual cause? 2- investigations 3- management 4 DDx
1 - septic arthritis - staph aureus
2 - Joint aspiration + culture, blood cultures
3- IV Abx (flucloxacilin )
4- Transient synovitis
Osteomyelitis - similar presentation to SA
-> MRI / X-ray for diagnosis
DDH Perthes disease Slipped upper femoral epiphysis Non accidental JIA
Transient synovitis vs SA
viral, less systemically unwell, no pain at rest but painful on internal rotation
-> Normal WWC, CRP, ESR
Who do you see DDH in? Signs? Important complication
Infant esp preterm
Barlow and ortolani manouvers test in neonatal screening / asymmetric skin folds
Necrosis of the femoral head
What is Perthes disease? Who is it seen in? Presentation? Investigation to diagnosis?
Avascular necrosis of the femoral epiphysis
Boys 5-10
Insidious limp / hip/knee pain
Shown on X-RAY
Who do you see slipped upper femoral epiphysis in? Signs ?
10-15 especially obese boys - often follows minor trauma but can be insidious
Reduced abduction / rotation of hip
Who would you be worried about non accidental injury in?
Fractures before walking age, repeated admissions
Presentation of jia ? Usually in? Need to do?
Persistent joint sweeping for over 6 weeks
Usually females
Exclude infection / malignancy
2 non abdo causes of abdo pain ?
Testicular torsion
Lower lobe pneumonia
3 week baby, no PMH / normal birth Non projectile vomiting after feeding O/E - poor weight gain, dehydrated and mass in RUQ 1- Likely diagnosis? 2- Physiology 3- metabolic abnormally is found? 4- radiological features? 5 Mx
Hypertrophic pyloric stenosis
2- Hypertrophy of the pylorus causing impaired gastric emptying -> stomach contents leaves as vomit
3- Hypochloraemic hypokalaemic metabolic alkalosis
4- USS -> non passage of gastric contents to proximal duodenum
X-ray -> delayed gastric emptying, peristalstic waves, string sign, beak sign
5 - Stop oral feeds, IV fluids (0.9 NaCl, 5% Dextrose, 20mmol KCl), admit to paeds
1- Atropine (requires long hospital stay)
2- pyloromyotomy (ramstedt’s proceure )
1yr old Bile stained vomit, crying in pain and drawing of legs to chest area 1- likely diagnosis 2- pathophysiology 3- most common site 4- signs O/E 5- complications 6- Mx
1 - intersusception / obstruction
2- intestine folds into the next part of it causing obstruction
3- terminal ileum / ileo-coecal valve
4- sausage shaped mass in abdo and re currant jelly stool
5- bowel perforation, necrosis, peritonitis
6- enema -> water soluble contrast / air contrast, resection of affected bowel
27 week neonate
Resp rate 60, chest wall recession, exploratory grunting, cyanosis
1- diagnosis
2- Likely cause (in premature) - what can be given antenatal?
3- seen on CXR
4 - Mx
5- complications
6- if this baby was c section what could the diagnosis be?
RDS - widespread alveolar collapse with inadequate gas exchange
Lack of surfactant production - give steroids
3- ‘ground glass appearance’
4- o2, ventilation, supportive, surfactant
5- pneumothorax, chronic lung disease
6- CS is a risk factor for transient tachypnea of the new born (too much fluid in the lungs)
When does surfactant production start ?
20-24 weeks and increases
Babies born at 31 weeks still have a 50% risk of RDS
When is jaundice in the neonate normal / abnormal? Cause?
<24 hrs - abnormal Eg. Haemolytic ( Rhesus, G6PD deficiency) / infection
>24 hrs - physiological Eg Dehydration / breast milk
immature liver and increased RBC breakdown
After 2 weeks - Bilary atresia
Colour of stools in biliary atresia? Other causes for persistent jaundice over 2 weeks ?
Pale and dark Breast milk (max 5weeks), UTI, congenital hypothyroidism
Complications of neonatal jaundice?
Investigations?
Treatment?
Kernicterus - encephalopathy from unconjugated bilirubin in the brain
Transcutaneous bilirubin meter, diagnosis with serum bilirubin
Plot bilirubin on generation specific chart according to age since birth, phototherapy or exchange transfusion
What is NEC? Who is it seen in? Sx? Complications? Mx?
Bacterial invention of ischemic bowel wall
Premature infants
Vomiting, poor feeding, distended abdo, blood in stool
May progress to shock / perforation
IV Abx, total parenteral nutrition, Intensive therapy unit
