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Finals > Paeds > Flashcards

Paeds Flashcards

1
Q

When are heart defects usually picked up?

A

USS at 20weeks –> fetal echo

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2
Q

Features of L –> R shunt? Common defects? Causes?

A

Breathless / aSx
VSD, PDA, ASD
Maternal rubella, SLE, DM, Warfarin,
Downs, Edwards, Patau, Turners

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3
Q

Features of a R–>L shunt?

Usual cause?

A

Cyanotic blue child

ToF, TGA

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4
Q

Most common DDx for well baby with systolic murmur at ULSE? What to rememer?

A

Innocent/physiolog murmur

4Ss (soft, systolic, left Sternal edge, aSx)

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5
Q 
Well baby w/ loud pan-systolic murmur? 
Prognosis?
What if larger defect? 
How to judge size? 
Risks?
A 
VSD (louder = smaller) - tend to spont. close
Large VSD --> more Sx (SOB, FTT) 
Judged in relation to aortic valve
Surgery 3-6m to prevent PulmHTN.
Eisenmenger's
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6
Q

Assos. w/ PDA?
Murmur?
Signs?
Mx?

A

Prem.
Continuous murmur beneath L clavicle
Collapsing and bounding pulse
Closure with coil at 1yr

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7
Q

Blue, pale, irritable, breathless baby Ddx

A

ToF
TGA
AVSD

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8
Q

4 part of ToF?
X-ray?
Mx?

A

Large VSD, overriding aorta, pulm stenosis, RVH
Boot-shaped heart
PGs until surgery at 6m

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9
Q 
What happens in TGA? 
Classic presentation?
Assos?
X-Ray?
Mx?
A 
Aorta to RV. Pulm artery to LV.
Presents day2 when DA closes.
VSD, ASD, PDA
'Egg on side'
PGs until surgery urgent
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10
Q

AVSD pres?

Assos?

A

cyanosis - blue and sob –> HF 2-3weeks

Downs

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11
Q

Which medications close PDA?

A

Indomethacin/ibuprofen

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12
Q

Murmur in AS?

Murmur in PS?

A

ESM at URSE

ESM at ULSE

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13
Q

Coarctation of aorta / hypoplasitc left heart syndrome signs?

A

Collapse at day2

Absent fem pulses

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14
Q 
3yo brought into A+E;
SoB, barking cough, intercostal recession.
DDx?
Likely?
Cause?
Usual age?
Sx?
Mx?
If SpO2 low?
A 
Croup/asthma/bronchiolitis/pneumonia/URTI/epiglottitis/foreign body
Likely CROUP (laryngotracheobronchitis)
Parainfluenze
6m - 6y
Barking cough, stridor, fever, coryza
Dexamethasone 0.15mg/kg
High flow 02 and neb adrenaline
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15
Q

6mo to GP, 24h of increased work of breathing, coryza, lethargy, and reduced oral intake.
o/e - fine insp crackles, subcost recession, temp37.9, SaO2=92%
1. Dx
2. Cause
3. Mx
4. Prevention

A
  1. Bronchiolitis
  2. RSV
  3. Self-lim. –> o2, fluids
  4. Palivizumab
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16
Q 
Child refusing to walk + upset.
o/e hip red, tender warm.
1. Rule out what? Usual cause?
2. Ix
3. Mx
4. Ddx
A
  1. Septic arthritis –> S. aureus
  2. Joint aspiration + cultures. BC
  3. IV Abx (fluclox)
  4. Osteomyelitis, DDH, Perthes, SUFE, NAI, JIA, Transient synovitis
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17
Q

Transient synovitis vs SA?

A

Viral, less systemically unwell, no pain at rest. –> normal WCC, CRP, ESR

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18
Q

DDH? Signs? Complication?

A

Infant esp preterm
Barlow & ortolani
Asymmetric skin folds
Necrosis of fem head

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19
Q

Perthes disease?
Who in?
Presentation?
Ix?

A

Avasc necrosis of fem epiphysis
Boys 5-10y
Insidious limp / hip / knee pain
X-Ray

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20
Q

SUFE?

Signs

A

Fat boys 10 - 16. Maybe post minor trauma

Reduced abduction & rotation of hip

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21
Q

NAI worried?

A

fractures before walking age. Rpt admissions

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22
Q

Pres of JIA?
Usually in?
Need to do?

A

Persistent joint swelling for >6w
F>M
Exclude infection / malig

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23
Q

3wo baby. Non-projectile vom after feeding
o/e - poor wt gain, dehydrated, mass in RUQ
1. Diagnosis?
2. Physiology
3. Metabollic abnorm
4. Radiolog fts
5. Mx

A
  1. Pyloric stenosis
  2. Hypertrophy of pylorus –>
  3. hypoCl hypoK, metabol alkalosis
  4. USS
    X-ray
  5. Stop oral feeds, IV fluids, admit –> pyloromyotomy
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24
Q

1yo, bile stained vom, crying and drawing in legs to chest

  1. Diagnosis
  2. Pathophys
  3. common site
  4. o/e
  5. Comps
  6. mx
A
  1. intussusception (obstruction)
  2. telescoping bowel
  3. terminal ileum / ileo caecal valve
  4. sausage mass in abdo, redcurrant jelly stool
  5. perf, necrosis, peritonitis
  6. enema –> insufflation. Resect any afected bowel
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25
Q

27/40 neonate. RR=60. Recession, grunting, cyanosis

  1. Diagnosis
  2. Likely cause (in prem)
  3. Antenatal prophylaxis
  4. CXR
  5. Mx
  6. Comps
  7. C-S, what would dx be?
A
  1. RDS
  2. Lack of surfactant
  3. steroids
  4. Ground glass
  5. o2, ventilation, surfactant, supportive
  6. pneumothorax, CLD
  7. TTN
26
Q

Surfactant prod starts?

A

20-24/40.

27
Q

Neonatal jaundice normal?

Abnormal?

A

> 24h
Before 2weeks

<24h –> haemolytic
>2weeks –> biliary atresia

28
Q

Stool colour in biliary atresia?

Other causes of persistent jaundice?

A

Pale

Breast milk, UTI, Congenital hypothyroid

29
Q

Comp of neonatal jaundice?
Ix?
Mx?

A

Kernicterus - encephalopathy
Transcut bilirubin, serum bilirubin
Plot on chart –> phototherapy / exchange transf

30
Q
  1. NEC?
  2. Who in?
  3. Sx?
  4. Comp?
  5. Mx?
A
  1. Bact infect of ischaemic bowel
  2. Prem
  3. Vom, poor feeding, distended abdo, bloody stool
  4. Shock, perf
  5. IV abx, TPN, ITU, surgery
31
Q 
4yo ill for 4d, fever, coryza, rash, conjunct 
o/e T=40.5
1. Dx
2. Pres of rash
3. Infective for how long
4. Sx
5. Ix
6. Mx
7. Comps
A
  1. Measles
  2. starts behind ears –> face –> trunk (maculopapular
  3. 4d before rash - 4d after
  4. Koplik, non-prod cough
  5. saliva swab - measles IgM / RNA
  6. Self lim. PHE!
  7. encephalitis, pneumonia, febrile convulsions
32
Q

2yo boy with fever for 5d, rash, swelling of lips and tongue, conjunctivits
o/e - cervical lymphadenopathy, temp 39.2, irritable
1. dx
2. criteria
3. mx
4. comps

A
  1. kawasakis
  2. fever >39 for 5d plus 4/5 of (cervical lymph, rash, conjunct, desquamation of hands/feet, inflam lips
  3. IV Ig, aspirin
  4. aneurysm (ECHO!)
33
Q
  1. Downs features?
  2. Common defects?
  3. LT comps?
A
  1. craniofacioal - epicanthic folds, flat nasal bridge, brusfield spots
  2. AVSD, duodenal atresia
  3. leukaemia, deaf, AD, epilepsy
34
Q

CHDs picked up?

A

Fetal USS at 20/40

35
Q

Murmur in PDA?

Mx?

A

Constant below L clavicle

NSAID / coil at 1y

36
Q

Life threatening fts of asthma?

A

33,92,CHEST

PEFR<33%. SpO2<92% cyanosis, hypotension, exhaustion, silent chest, tachycardia

37
Q

Acute asthma mx?

A 
OSHITME 
O2
Salbutamol neb
Hydrocort
Ipratroptium bromide neb
Theophylline
MgSO4
Escalate
38
Q
  1. Screen for CF?
  2. Dx?
  3. Chronic bacterial infection?
A
  1. immuoreactive trypsinogen
  2. sweat test
  3. psudoonas aeruginosa
39
Q

Bronchiolitis

  1. age
  2. typical organism
  3. Sx
  4. Ix
  5. Mx
A
  1. <2y
  2. RSV
  3. sob following coryza
  4. swab, O2 sats
  5. supportive
40
Q

Croup

  1. age
  2. typical organism
  3. Sx
  4. Ix
  5. Mx
A
  1. 6m to 6y
  2. parainfluenza
  3. barking cough, stridor, sob, worse at night
  4. SpO2, AVOID EXAMINING THROAT
  5. Dexamethasone 0.15mg/kg, O2
41
Q

Epiglottitis

  1. Age?
  2. typical organism
  3. Sx
  4. Ix
  5. Mx
A
  1. 1-6y
  2. HIb
  3. toxic, high grade fever, stridor, drooling, rapid onset
  4. SpO2
  5. Intubate under GA –> cultures and abx
42
Q

Whooping cough

  1. age
  2. typical organism
  3. sx
  4. ix
  5. mx
A
  1. <4m (before first jab)
  2. Bordetella pertussis
  3. coryza –> paroxysmal cough (lasts up to 6w)
  4. Nasal swab
  5. erythromycin
43
Q

Septic arthritis

  1. usual cause
  2. ix
  3. mx
A
  1. S. aureus
  2. joint aspiration + culture. BC
  3. IV abx (fluclox)
44
Q

Hip.

  1. infants
  2. 4-10
  3. teens
A
  1. DDH
  2. perthes
  3. SUFE
45
Q

1 Rapid onset hip pain?

2. Prolonged fever?

A

Infective

JIA

46
Q

Causes of limp?

A 
Septic arthritis, osteomyelitis
perthes, DDH, SUFE, 
JIA
Transient synovitis
Malignancy 
NAI
47
Q

Ddx of vomiting in baby

A 
V - intracranial haemorrhage
I - UTI, gastro, meningitis, otitis nedia
T - NAI
A - coeliac
M - GORD, pyloric stenosis, intussusception, Hirschprungs
I - overfeeding
N - intracranial tumour
D- malrotation
48
Q

Pyloric stenosis

  1. age
  2. classic features
  3. blood gas
  4. pathology
  5. ix
  6. mx
A
  1. 3-6w
  2. vomiting post feeds, prokectile, hunger, wt loss
  3. hypoCl, hypoK, metabol alk
  4. hypertrophy. Vom causes loss of HCl, loss of H+ is compensated in kidneys by retaining H+ in exchange for K+
  5. USS
  6. stabilise with fluids +/- KCl, pyloromyotomy
49
Q

GORD

  1. aetiology
  2. sx
  3. ix
  4. mx
A
  1. 40% of infants. Resolves by 1y in 90%
  2. recurrent regurg, resp problems, feeding, FTT
  3. usually not req. imaging
  4. Reassurance, review feeding, i) smaller more freq feeds. ii) Thickened feeds, iii) alginate. iv) PPI
50
Q

Intussusception

  1. patholog
  2. usual age
  3. Sx
  4. Signs
  5. ix
  6. mx
A
  1. telescope
  2. <1y
  3. paroxysmal colic abdo pain, bilous vom, redcurrant jelly poops
  4. shock, sausage mass in RUQ
  5. USS - target sign
  6. Resus with fluids + NG tube. Insufflation
51
Q

Hirschprungs

  1. pathology
  2. aetio
  3. sx
  4. ix
  5. mx
  6. other cause of failure to pass meconium
A
  1. congen agenesis of colonic ganglion
  2. neonatal
  3. abdo distension, failure to pass meconium in 48h, rpt vom, PR - tight anal sphicnter
  4. AXR, biopsy
  5. excision +/- colostomy
  6. CF
52
Q

HSP

  1. aetio
  2. triad
  3. natural history
  4. mx
  5. comps
A
  1. AI IgA small vessel vasculitis. Kids 2-8yo
  2. Rash, arthritis, abdo pain
  3. URTI 1-3wk ago. Self lim
  4. supportive
  5. renal –> check U&Es
53
Q

Meningitis

  1. cause in neonate
  2. mx
  3. cause in >3mo
  4. mx
A
  1. GBS, Listeria, E. coli
  2. Ampicillin + cefotaxime
  3. N. meningitidis, S. pneumoniae
  4. Ceftriaxone
54
Q

Comps of meningitis

A

ST - sepsis, shock, DIC, cerebral oedema, subdural effusion, seizure
LT - hearing loss, CN dysfunct, hydrocephalus, Watergouse-Friedrichsen syndrome

55
Q

RFs for subdural effusion in meningitis?

A

young, rapid onset, high CSF, low WCC

56
Q

Measles

  1. spread
  2. sx
  3. ix
  4. mx
  5. comps
A
  1. droplet
  2. cough, coryza, conjunctivitis, fever, koplik, rash
  3. swab
  4. supportive + vaccinate contacts
  5. encephalitis, pneumonia, febrile convulsions
57
Q

Rubella

  1. spread
  2. sx
  3. ix
  4. mx
  5. copms
A
  1. droplet
  2. low grade fever, maculopap rash, luymphadenopathy ( suboccipital & post auricular)
  4. supportive + vaccinate contacts
  5. encephalopathy & arthralgia
58
Q

Mumps

  1. sx
  2. mx
  3. comps
A
  1. fever, malaise, parotitis,
  2. supportive + vaccinate contacts
  3. orchitis, viral mening
59
Q
  1. Meckels?
  2. sx
  3. ix
  4. mx
A
  1. True diverticulum
  2. GI bleed, pain, obstruction, diarrhoea, vom, diverticulitis
  3. Technetium, CT (worm like), stool smear, FBC
  4. surgery, iron tablets/transfusion if bleeding
60
Q

Goodpastures

  1. aetio
  2. sx
  3. RFs.
  4. leads to..
  5. ix
  6. mx
A
  1. anti-basement memb T2 hypersensitiviy
  2. haemoptysis, haematuria
  3. HLA-DR15
  4. restrictive lung disease, nephritic kidney disease
  5. biopsy of kidney –> inflamed basement memb
  6. steroids, immunosuppress, plasmapheresis

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