Paeds Flashcards
31 w, PROM, vag delivery, no meconium, resp distress, ventilated, CXR ground glass appearance - Dx?
surfactant deficiency
37w, elective csec for PET, no meconium, mild resp distress @ 12h, CXR fluid in horizontal fissure - Dx?
TTN
37w, PROM at 35w, spontaneous labour @37w, normal vaginal delivery, increasing resp distress day3 - Dx?
neonatal pneumonia
correct position of ET tube
2cm above carina, level D2/3
where does air collect in neonatal pneumothorax
anteriorly! bcos CXR is taken supine
no. of umbilical veins in baby
1
correct position of umbilical vein catheter
at or just below R hemidiaphragm
no. of umbilical arteries in baby
2
correct position of umbilical artery catheter
low tip - lower lumbar (L3/4, below renal arteries)
high tip - between D6-10
cause of bronchioitis
RSV
orienation of inhaled foreign body in oesophagus
coronal
orientation of inhaled foreign body in trachea
sagittal
Ix of UTI in child <6m
- USS (in acute phase)
then 4-6m later if atypical UTI or recurrent UTI do…
- VCUG
- renogram
Ix of UTI in child 6m-3y
no imaging if uncomplicated UTI
then 4-6m later if atypical UTI or recurrent UTI do…
- USS + renogram
Ix of UTI in child > 3y
no imaging if uncomplicated UTI
then 4-6m later if recurrent UTI do…
- USS + renogram
stepping reflex
up to 6w then reappear 8m-1y
baby steps legs when put near ground
moro reflex
up to 2m
when baby is startled they throw arms up, clench fists and cry
sucking reflex
baby begins to suck when anything touches the roof of its mouth
rooting reflex
assists with breast feeding - stroking the corner of baby’s mouth they open it and move towards the direction of the stroke
palmar grasp reflex
up to 5-6m
components of APGAR score
Appearance Pulse Grimace Activity Resp Effort
no. of umbilical veins in fetus and what does it carry
1 umbilical vein
carrys oxygenated blood from placenta to fetus
no. of umbilical arteries in fetus anad what does it carry
2 umbilical arteries
carries mixed blood from fetus to placenta
ductus venosus role
shunts oxygenated blood away from the liver to the IVC
ductus arteriosus role
shunts blood from pulmonary artery through into aorta so that blood bypasses fetal lungs
foramen ovale role
R - L shunt
blood to pass through RA to LA
caput succanedum - timing
straight after birth
caput succanedum presentation
oedema swelling of the head
crosses suture lines
caput succanedum causes
ventouse deliveries
mechanical trauma
caput succanedum - how long to resolve
a few days
cephalohaematoma presentation
swelling of head due to bleed between periosteum and skull
cephalohaematoma timing
a few hr after birth
cephalohaematoma causes
prolonged deliveries
cephalohaematoma - how long to resolve
a few mths
causes of cyanosis in newborn
cardiac causes -
- tricuspid atresia
- transposition of the great arteries
- tetralogy of fallot
non-cardiac causes -
- RDS
- TTHN
- tracheo-oesophageal fistula
- pleural effusion
- pneumothorax
test for distinguishing between causes of cyanosis in newborn
nitrogen wash-out test
- give 100% O2 to baby for 15 mins
- pO2 of <15kPa = cyanotic congenital heart disease
causes of neonatal jaundice 2-14d
usually physiological
- due to increased bili production due to shorter RBC lifespan
- reduced conjugation by the liver due to hepatic immaturity
causes of prolonged neonatal jaundice
usually pathological
- hypothyroidism
- galactosaemia
- biliary atresia
- UTI
- breast milk jaundice
- congenital infection
Mx neonatal jaundice
phototherapy +/- exchange transfusion
kernicterus
acute bilirubin encephalopathy
- consequence of untreated neonatal jaundice
- presentation - hypotonia, shrill cry
- reduced IQ, deafness (long term)
RF for haemorrhagic disease of the newborn
maternal use of epileptics
breast feeding
prevention of haemorrhagic disease of the newborn
Im or Oral vit K at birht (offered to all babies)
what group of babies is meconium aspiration syndrome more common in
post-term deliveries
calculation for corrected gestational age
(no. of weeks old) - (term(40)-gestational age)
1st line for neonatal sepsis
IV benzylbenicillin + gentamicin
2nd line for neonatal sepsis
IV flucloxacillin + gentamicin
3rd line for neonatal sepsis
IV vancomycin + gentamicin
Mx apnoea of prematurity
caffeine citrate
ventilation
- also find cause
Mx retinopathy of prematurity
laser diode therapy
neonate born v agitated - what has mum taken during pregnancy -
alcohol
neonate born v quiet and inactive - what has mum taken during pregnancy
opiates
diabetic mother - most likely complication in baby
neonatal hypoglycaemia
cause of croup
parainfluenza
Mx croup
severe croup - O2 and nebulised adrenaline 5ml of 1:1000
cause epiglottitis
haemophilus influenze B
Mx epiglottitis
give O2 via mask until anaesthetist arrives nasopharyngeal intubation nebulised adrenaline IV dexamethasone IV cefotaxime
cause whooping cough
bordatella pertussis
Mx whooping cough
usually self resolves in around 8w
Dx asthma children 5-16y
spirometry and bronchodilator reversibillity test
Dx asthma children <5y
clinical Dx
Mx asthma children 5-16y
- SABA
- SABA + paed low dose ICS
- SABA + paed low dose ICS + LTRA
- SABA + paed low dose ICS + LABA +/- LTRA (stop it if no response)
- SABA + MART (has LABA + ICS in one)
- SABA + moderate dose MART
- SABA + any of:
- add theophylline
- high dose ICS
- refer to specialist
Mx asthma children <5y
- SABA
- SABA + 8w trial of mod dose ICS
- if symptoms not resolved - alt diagnosis
- if symtpoms resolved & return <4 w - start low-dose maintenance ICS
- if symptoms resolved & return >4 - redo trial - SABA + low dose paed ICS + LTRA
- Stop LTRA and refer
Mx acute asthma attack children
B2 agonist via spacer - 1 puff every 30-60 secs for 10 puffs
- can repeat if not controlled
+
Steroids - 3-5d course
cause bronchiolitis
RSV
Mx bronchiolitis
Supportive
- O2 by head box if sats <92%
- NG tube if poor oral intake/not drinking
- suction if excess upper airway secretions
causes of neonatal jaundice 1st 24h
always pathological
- G6PD deficiency
- hereditary spherocytosis
- rhesus haemolytic disease
- ABO haemolytic disease
9 month old baby with striodr, better with crying - Dx and Ix?
Laryngomalacia
Ix - flexible laryngoscopy
heart disease associated with Trisomy 21
VSD, AVSD
Trisomy 18
Edward’s syndrome
heart disease associated with Trisomy 18
VSD, DORV
Trisomy 13
Patau syndrome m
heart disease associated with Trisomy 13
VSD, DORV
heart disease associated with Turner’s syndrome
Coarctation of the aorta
heart disease associated with DiGeorge Syndrome
Truncus arteriosus
Tetralogy of Fallot
Interrupted Aortic Arch
innocent murmur presentation
always systolic
gets more prominent when high CO - fever
acyanotic congenital HD
VSD, ASD, AVS, PDA, coarctation of the aorta
cyanotic congenital HD
Tetralogy of Fallot
Transposition of the Great Arteries
what is the problem in systemic duct-dependent lesions (congenital HD)
Obstruction of blood out of the left side of the heart
examples of systemic duct-dependent lesions in congenital HD
Hypoplastic Left Heart Syndrome
Critical Aortic Stenosis
Interrupted Aortic Arch
what is the problem in cyanotic duct-dependent lesions (congenital HD)
Obstruction to pulmonary blood flow OR lack of oxygenation of systemic blood
ASD pathology
hole connecting atria
L - R shunt
blood still gets to lungs for oxygenation
ASD presentation
asymptomatic until adulthood
splitting of S2
ejection systolic murmur
presentation VSD
pansystolic murmur, lower left sternal edge
pathology of PDA
PDA usually closes within the first few weeks of life.
There is a L-R shunt because the pressure in the left side of the heart has increased.
presentation PDA
continuous machinery murmur crescendo-descrescendo poor wt gain SOB difficulty feeding LTRI
Presentation of Tetralogy of Fallot
cyanosis
SOB on feeding /crying/exertion
Failure to thrive
“Tet Spells”
occurs when there is increased venous return to the heart
- sudden onset SOB
- triggered by slight decrease in O2 conc
- toddler squats to decrease venous return to heart and increase blpood O2
presentation coarctation of aorta
weak femoral pulses grey and floppy baby hepatosplenomegaly tachypnoea poor feeding
Ix coarctation of aorta
pre-ductal & post-ductal pressures (upper body HTN, lower body hypotension)
Mx coarctation of aorta
Iv prostaglandin - keep PDA open until surgery
pathology of transposiition of the great arteries
aorta arises from R ventricle - delivers unoxygenated blood to body
pulmonary artery arises from L ventricle - delivers oxygenated blood back to lungs
Mx transposiition of the great arteries
Iv prostaglandins - keep PDA open until surgery
pathology hypoplastic left heart syndrome
hypoplastic left ventricle, ascending aorta and aortic arch
Mx hypoplastic left heart syndrome
IV prostaglandins - to keep PDA open until surgery
presentation orofacial granulomatosis
lip swelling
facial rash
no Crohn’s features
inheritance of peutz jegher’s syndrome
AD
presentation of GORD in baby
incessant crying
back arching
vomiting
red colour change
Mx GORD in baby
- Gaviscon
2. + Ranitidine
presentation tracheo-oesophageal fistula
cough
aspiration pneumonia
choking
cyanosis on feeding
presentation oesophageal atresia
unable to swallow own saliva
gastric distension
cyanosis
unable to pass NG tube
presentation choanal atresia
difficulty breathing
unable to nurse and breathe at same time - more pronounced when feeding
Ix coeliac in a child
can Dx by blood tests only if: clinical symptoms + tTG >10x upper limit of normal
Gold-standard: endoscopy + duodenal biopsy
vomiting green bile
malrotation
Ix malrotation
upper GI contrast enema
presentation biliary atresia
symptoms of cholestasis
- pale stools
- dark urine
- jaundice
Mx biliary atresia
Kasai operation - connect liver to small intestine
presentation of toddler’s diarrhoea
up to 10 stools x day
undigested food in stool
otherwise well and thriving
Ix pyloric stenosis
abdo US
ABG in pyloric stenosis
hypochloraemia hypokalaemic metabolic alkalosis
Mx constipation in child
- Magrocol (laxido) - a softener
+/- Senna (stimulant) - DON’t give if stools hard
Ix intussception
abdo USS
presentation NEC
abdo distension
blod/mucus PR
tenderness
shock
Ix NEC
plain abdo xray - shows portal venous gas
Mx NEC
supportive - gastric aspiration, NBM
presentation meconium ileus
not wanting to feed
not passing bowels
fullish stomach
Ix meconium ileus
contrast enema (will show loops of bowel that are impacted and parts that haven’t been used)
Mx meconium ileus
- rpt contrast enema
2. laparotomy
Ix Hirschsrungs
rectal biopsy
Mx Hirschprungs
remove uninnervated bowel
presentation of congenital diaphragmatic hernia
bowel in one hemithorax
resp distress
Ix congenital diaphragmatic hernia
pre-natal: USS
post-natal: CXR
Mx umbilical hernia in baby
can leave alone - will resolve spontaenously by age 4-5
Mx inguinal hernia in baby
urgent repair - strangulation risk
presentation measles
prodromal illness
Koplick spots - white spots on buccal mucosa
then
maculopapular rash starting behind ears, spreads to whole of body & becomes confluent
complications of measles
otitis media pneumonia encephalitis keratoconjunctivitis sicca increased incidence of appendicitis myocarditis
presentation mumps
fever, muscular pain, parotitis
complications of mumps
orchitis
hearing loss
meningoencephalitis
pancreatitis
presentation rubella
prodromal illness
rash starting on face then spread to whole of body
lymphadenopathy
cause of scarlet fever
reaction to toxins produced by Group A strep
presentation scarlet fever
fever, malaise, N+v, headache strawberry tongue rash - sandpaper texture - torso first, spares palms and soles
Ix scarlet fever
throat swab
Mx scarlet fever + when kid can go back to school
oral pen V for 10d
can go back 24h after starting Abx
complications scarlet fever
otitis media
rheumatic fever
glomerulonephritis
what is cytolomegalovirus
one of the herpes viruses
presentation congenital CMV
pinpoint blueberry muffin rash microcephaly sensorineural deafness seizures hepatosplenomgaly
mneumonic for kawasaki disease presentation
CRASH & Burn
C - conjunctivitis R - rash A - adenopathy S - strawberry tonue H - hands & feet - burning and peeling
Mx kawasaki disease
high dose aspirin
IVIG
What is HSP
IgA vasculitis
cause of HSP
triggered by infection (e.g. tonsilitis or gastroenteritis)
presentation HSP
4 classic features
- abdo pain
- joint pain
- purpura
- renal involement (IgA nephritis)
hypospadius
urethral meatus located ventally on undersurface of penis
renal agenesis presentation
oligohydramnios
Potter’s facies
when is undescended testis considered congenital
if testis not descended by 3m
Mx cryptorchidism
orchidopexy (6-18m)
orchidectomy - if presents in teenage y
Mx nocturnal enuresis
- Reward systems
- Enuresis alarams (<7y)
- Desmospression (>7y)
what is horseshoe kidneys
fusion of the lower poles of the kidneys
presentation wilm’s nephroblastoma
- abdo pain - most common
painless haematuria
flank pain
anorexia
Mx phimosis
Can leave alone - most resolve by 2y
presentation juvenile polyp
rectal bleeding
prolapsing cherry red mass post defecation
Ix always needed in Kawasaki disease & why
Echo
- can get coronary artery aneurysms
meconium ileus associated with what condition
cystic fibrosis