Paeds Flashcards
When are heart defects usually picked up?
USS at 20weeks –> fetal echo
Features of L –> R shunt? Common defects? Causes?
Breathless / aSx
VSD, PDA, ASD
Maternal rubella, SLE, DM, Warfarin,
Downs, Edwards, Patau, Turners
Features of a R–>L shunt?
Usual cause?
Cyanotic blue child
ToF, TGA
Most common DDx for well baby with systolic murmur at ULSE? What to rememer?
Innocent/physiolog murmur
4Ss (soft, systolic, left Sternal edge, aSx)
Well baby w/ loud pan-systolic murmur? Prognosis? What if larger defect? How to judge size? Risks?
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
Assos. w/ PDA?
Murmur?
Signs?
Mx?
Prem.
Continuous murmur beneath L clavicle
Collapsing and bounding pulse
Closure with coil at 1yr
Blue, pale, irritable, breathless baby Ddx
ToF
TGA
AVSD
4 part of ToF?
X-ray?
Mx?
Large VSD, overriding aorta, pulm stenosis, RVH
Boot-shaped heart
PGs until surgery at 6m
What happens in TGA? Classic presentation? Assos? X-Ray? Mx?
Aorta to RV. Pulm artery to LV. Presents day2 when DA closes. VSD, ASD, PDA 'Egg on side' PGs until surgery urgent
AVSD pres?
Assos?
cyanosis - blue and sob –> HF 2-3weeks
Downs
Which medications close PDA?
Indomethacin/ibuprofen
Murmur in AS?
Murmur in PS?
ESM at URSE
ESM at ULSE
Coarctation of aorta / hypoplasitc left heart syndrome signs?
Collapse at day2
Absent fem pulses
3yo brought into A+E; SoB, barking cough, intercostal recession. DDx? Likely? Cause? Usual age? Sx? Mx? If SpO2 low?
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
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
- Bronchiolitis
- RSV
- Self-lim. –> o2, fluids
- Palivizumab
Child refusing to walk + upset. o/e hip red, tender warm. 1. Rule out what? Usual cause? 2. Ix 3. Mx 4. Ddx
- Septic arthritis –> S. aureus
- Joint aspiration + cultures. BC
- IV Abx (fluclox)
- Osteomyelitis, DDH, Perthes, SUFE, NAI, JIA, Transient synovitis
Transient synovitis vs SA?
Viral, less systemically unwell, no pain at rest. –> normal WCC, CRP, ESR
DDH? Signs? Complication?
Infant esp preterm
Barlow & ortolani
Asymmetric skin folds
Necrosis of fem head
Perthes disease?
Who in?
Presentation?
Ix?
Avasc necrosis of fem epiphysis
Boys 5-10y
Insidious limp / hip / knee pain
X-Ray
SUFE?
Signs
Fat boys 10 - 16. Maybe post minor trauma
Reduced abduction & rotation of hip
NAI worried?
fractures before walking age. Rpt admissions
Pres of JIA?
Usually in?
Need to do?
Persistent joint swelling for >6w
F>M
Exclude infection / malig
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
- Pyloric stenosis
- Hypertrophy of pylorus –>
- hypoCl hypoK, metabol alkalosis
- USS
X-ray - Stop oral feeds, IV fluids, admit –> pyloromyotomy
1yo, bile stained vom, crying and drawing in legs to chest
- Diagnosis
- Pathophys
- common site
- o/e
- Comps
- mx
- intussusception (obstruction)
- telescoping bowel
- terminal ileum / ileo caecal valve
- sausage mass in abdo, redcurrant jelly stool
- perf, necrosis, peritonitis
- enema –> insufflation. Resect any afected bowel
27/40 neonate. RR=60. Recession, grunting, cyanosis
- Diagnosis
- Likely cause (in prem)
- Antenatal prophylaxis
- CXR
- Mx
- Comps
- C-S, what would dx be?
- RDS
- Lack of surfactant
- steroids
- Ground glass
- o2, ventilation, surfactant, supportive
- pneumothorax, CLD
- TTN
Surfactant prod starts?
20-24/40.
Neonatal jaundice normal?
Abnormal?
> 24h
Before 2weeks
<24h –> haemolytic
>2weeks –> biliary atresia
Stool colour in biliary atresia?
Other causes of persistent jaundice?
Pale
Breast milk, UTI, Congenital hypothyroid
Comp of neonatal jaundice?
Ix?
Mx?
Kernicterus - encephalopathy
Transcut bilirubin, serum bilirubin
Plot on chart –> phototherapy / exchange transf
- NEC?
- Who in?
- Sx?
- Comp?
- Mx?
- Bact infect of ischaemic bowel
- Prem
- Vom, poor feeding, distended abdo, bloody stool
- Shock, perf
- IV abx, TPN, ITU, surgery
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
- Measles
- starts behind ears –> face –> trunk (maculopapular
- 4d before rash - 4d after
- Koplik, non-prod cough
- saliva swab - measles IgM / RNA
- Self lim. PHE!
- encephalitis, pneumonia, febrile convulsions
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
- kawasakis
- fever >39 for 5d plus 4/5 of (cervical lymph, rash, conjunct, desquamation of hands/feet, inflam lips
- IV Ig, aspirin
- aneurysm (ECHO!)
- Downs features?
- Common defects?
- LT comps?
- craniofacioal - epicanthic folds, flat nasal bridge, brusfield spots
- AVSD, duodenal atresia
- leukaemia, deaf, AD, epilepsy
CHDs picked up?
Fetal USS at 20/40
Murmur in PDA?
Mx?
Constant below L clavicle
NSAID / coil at 1y
Life threatening fts of asthma?
33,92,CHEST
PEFR<33%. SpO2<92% cyanosis, hypotension, exhaustion, silent chest, tachycardia
Acute asthma mx?
OSHITME O2 Salbutamol neb Hydrocort Ipratroptium bromide neb Theophylline MgSO4 Escalate
- Screen for CF?
- Dx?
- Chronic bacterial infection?
- immuoreactive trypsinogen
- sweat test
- psudoonas aeruginosa
Bronchiolitis
- age
- typical organism
- Sx
- Ix
- Mx
- <2y
- RSV
- sob following coryza
- swab, O2 sats
- supportive
Croup
- age
- typical organism
- Sx
- Ix
- Mx
- 6m to 6y
- parainfluenza
- barking cough, stridor, sob, worse at night
- SpO2, AVOID EXAMINING THROAT
- Dexamethasone 0.15mg/kg, O2
Epiglottitis
- Age?
- typical organism
- Sx
- Ix
- Mx
- 1-6y
- HIb
- toxic, high grade fever, stridor, drooling, rapid onset
- SpO2
- Intubate under GA –> cultures and abx
Whooping cough
- age
- typical organism
- sx
- ix
- mx
- <4m (before first jab)
- Bordetella pertussis
- coryza –> paroxysmal cough (lasts up to 6w)
- Nasal swab
- erythromycin
Septic arthritis
- usual cause
- ix
- mx
- S. aureus
- joint aspiration + culture. BC
- IV abx (fluclox)
Hip.
- infants
- 4-10
- teens
- DDH
- perthes
- SUFE
1 Rapid onset hip pain?
2. Prolonged fever?
Infective
JIA
Causes of limp?
Septic arthritis, osteomyelitis perthes, DDH, SUFE, JIA Transient synovitis Malignancy NAI
Ddx of vomiting in baby
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
Pyloric stenosis
- age
- classic features
- blood gas
- pathology
- ix
- mx
- 3-6w
- vomiting post feeds, prokectile, hunger, wt loss
- hypoCl, hypoK, metabol alk
- hypertrophy. Vom causes loss of HCl, loss of H+ is compensated in kidneys by retaining H+ in exchange for K+
- USS
- stabilise with fluids +/- KCl, pyloromyotomy
GORD
- aetiology
- sx
- ix
- mx
- 40% of infants. Resolves by 1y in 90%
- recurrent regurg, resp problems, feeding, FTT
- usually not req. imaging
- Reassurance, review feeding, i) smaller more freq feeds. ii) Thickened feeds, iii) alginate. iv) PPI
Intussusception
- patholog
- usual age
- Sx
- Signs
- ix
- mx
- telescope
- <1y
- paroxysmal colic abdo pain, bilous vom, redcurrant jelly poops
- shock, sausage mass in RUQ
- USS - target sign
- Resus with fluids + NG tube. Insufflation
Hirschprungs
- pathology
- aetio
- sx
- ix
- mx
- other cause of failure to pass meconium
- congen agenesis of colonic ganglion
- neonatal
- abdo distension, failure to pass meconium in 48h, rpt vom, PR - tight anal sphicnter
- AXR, biopsy
- excision +/- colostomy
- CF
HSP
- aetio
- triad
- natural history
- mx
- comps
- AI IgA small vessel vasculitis. Kids 2-8yo
- Rash, arthritis, abdo pain
- URTI 1-3wk ago. Self lim
- supportive
- renal –> check U&Es
Meningitis
- cause in neonate
- mx
- cause in >3mo
- mx
- GBS, Listeria, E. coli
- Ampicillin + cefotaxime
- N. meningitidis, S. pneumoniae
- Ceftriaxone
Comps of meningitis
ST - sepsis, shock, DIC, cerebral oedema, subdural effusion, seizure
LT - hearing loss, CN dysfunct, hydrocephalus, Watergouse-Friedrichsen syndrome
RFs for subdural effusion in meningitis?
young, rapid onset, high CSF, low WCC
Measles
- spread
- sx
- ix
- mx
- comps
- droplet
- cough, coryza, conjunctivitis, fever, koplik, rash
- swab
- supportive + vaccinate contacts
- encephalitis, pneumonia, febrile convulsions
Rubella
- spread
- sx
- ix
- mx
- copms
- droplet
- low grade fever, maculopap rash, luymphadenopathy ( suboccipital & post auricular)
- supportive + vaccinate contacts
- encephalopathy & arthralgia
Mumps
- sx
- mx
- comps
- fever, malaise, parotitis,
- supportive + vaccinate contacts
- orchitis, viral mening
- Meckels?
- sx
- ix
- mx
- True diverticulum
- GI bleed, pain, obstruction, diarrhoea, vom, diverticulitis
- Technetium, CT (worm like), stool smear, FBC
- surgery, iron tablets/transfusion if bleeding
Goodpastures
- aetio
- sx
- RFs.
- leads to..
- ix
- mx
- anti-basement memb T2 hypersensitiviy
- haemoptysis, haematuria
- HLA-DR15
- restrictive lung disease, nephritic kidney disease
- biopsy of kidney –> inflamed basement memb
- steroids, immunosuppress, plasmapheresis