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Paeds A conditions Flashcards

1
Q

What are innocent murmurs?

A

Flow murmurs caused by fast blood flow through various areas of heart during systole

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2
Q

What are the features of innocent murmurs?

A 
Soft 
Short
Systolic
Symptomless
Situation dependent (infection, anaemia, exercise)
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3
Q

What are the features of a pathalogical murmur?

A

Murmur louder than 2/6
Diastolic Murmurs
Louder on standing

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4
Q

What investigations should be done if a heart murmur is heard in a child?

A

ECG
CXR
Echo

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5
Q

What are pan-systolic murmurs?

A

Murmurs that start at s1 and extend up to s2

Sign of Mitral Regurg if heard at 5th ICS mid clavicular line

Tricuspid regurg if heard at tricuspid area

VSD if heard at Left lower sternal border

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6
Q

What conditions are associated with ejection systolic murmur?

A

Aortic stenosis at aortic area
Pulmonary stenosis
HOCM (fourth intercostal space, left sternal border)

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7
Q

What is heard during auscultation of an atrial septal defect?

A

Mid-systolic, crescendo-decrescendo murmur loudest at upper left sternal border, with a fixed splitting heart sound.

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8
Q

What is heard in patent ductus arteriosus?

A

Small patent ductus arteriosus may not cause abnormal heart sounds

Larger ones cause a continuous crescendo-decrescendo machinery murmur that may continue during a second heart sound

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9
Q

What is heard in tetralogy of fallot?

A

Arises from pulmonary stenosis so ejection murmur at the pulmonary area is heard

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10
Q

What is cyanotic heart disease?

A

When deoxygenated blood enters the systemic circulation as it bypasses the pulmonary circulation and the lungs.

Occurs due to a right-to-left shunt

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11
Q

What conditions cause cyanotic heart disease ?

A

VSD
ASD
PDA
Transposition of the great arteries

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12
Q

What is Eisenmenger syndrome ?

A

When blood flows from the right side of the heart to the left across a structural heart lesion.

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13
Q

What three conditions result in Eisnmenger syndrome?

A

ASD
VSD
Patent Ductus Arteriosus

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14
Q

What is coeliac disease?

A

An autoimmune condition where exposure to gluten causes an immune reaction which creates inflammation in small intestines

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15
Q

What autoantibodies are involved in coeliacs?

A

anti-TTG

antiEMA

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16
Q

Where does the inflammation in coeliacs disease occur?

A

The jejunum

- causes atrophy of the intestinal villi (malabsorption of nutrients and disease related symptoms)

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17
Q

How does coeliac disease present?

A 
can be asymptomatic 
if not:
- failure to thrive 
- Diarrhoea
- Fatigue
- Weight loss
- Mouth ulcers
- Anaemia second to iron, b12 or folate deficiency
- dermatitis herpetiformis
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18
Q

What genes are associated with coeliac?

A

HLA-DQ2 gene (90%)

HLA-DQ8 gene

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19
Q

How is coeliac diagnosed?

A

investigations should be carried out whilst patient remains on a diet containing gluten

Total IgA levels
Specific antibodies - anti TTG and anti-EMA

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20
Q

What does coeliac disease show on endocscopy?

A

Crypt hypertrophy and villous atrophy on intestinal biopsy

21
Q

What diseases are associated with coeliac?

A 
Type 1 diabetes
Thyroid diseases
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Down's syndrome
22
Q

What are the complications of untreated coeliac disease

A 
Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T cell lymphoma of the intestine
Non-Hodgkin Lymphoma 
Small bowel adenocarcinoma
23
Q

How is coeliac disease treated ?

A

Patient education and a gluten free diet

24
Q

How does constipation present in children?

A 
<3 stools a week 
hard stools that are difficult to pass
Rabbit dropping stools
Straining and painful passages of stools
Abdominal pain 
Holding an abnormal posture 
Rectal bleeding + hard stools
Faecal impaction = overflow soiling. 
Palpable stool on abdo exam
Loss of sensation of need to open bowels
25
What is encopresis?
Faecal incontinence Not pathological until age 4 Usually sign of chronic constipation Large hard stools stay in rectum, loose stools bypass the blockage and leak out, causing soiling
26
What are some causes of encopresis?
``` Spina bifida Hirschprung's disease Cerebral palsy Learning disability Psychosocial stress Abuse ```
27
What lifestyle factors contribute to constipation?
``` Habitually not opening bowels Low fibre diet Poor fluid intake and dehydration Sedentary lifestyle Psychosocial problems such as a difficult school or home environment ```
28
What are red flag signs regarding constipation?
Not passing meconium within 48 hours of birth (CF/Hirschsprung's) Neurological signs or symptoms (cerebral palsy or spinal cord lesion) Vomiting (intestinal obstruction or Hirschsprung's disease) Ribbon stool (anal stenosis) Abnormal anus (anal stenosis, IBD, sexual abuse) Abnormal lower back or buttocks (spina bifida, spinal cord lesion, or sacral agenesis) Failure to thrive (coeliac disease, hypothyroidism or safeguarding) Acute severe abdominal pain and bloating
29
What are the complications of constipation?
``` Pain Reduced sensation Anal fissures Haemorrhoids Overflow and soiling Psychosocial morbidity ```
30
What is the management of constipation?
Idiopathic constipation can be diagnosed without investigation, provided red flags have been considered Correct reversible contributing factors (dehydration, low fibre diet) Start laxatives (movicol) Disimpaction regimen Encourage and praise visiting the toilet
31
What is acute gastritis?
Inflammation of the stomach and presents with nausea and vomiting
32
What is enteritis?
Inflammation of the intestines and presents with diarrhoea
33
What is gastroenteritis?
Inflammation from the stomach to the intestines, presents with nausea, vomiting and diarrhoea
34
What viruses are responsible for viral gastroenteritis?
Rotavirus Norovirus Adenovirus
35
What bacteria can cause gastroenteritis?
E.Coli - E.Coli 0157 - produces shiga toxin = HUS Campylobacter Jejuni - Raw or improperly cooked meat, untreated water, unpasteurised milk Shigella - faeces contaminated drinking water, swimming pools and food Salmonella - raw eggs or poultry Bacillus Cereus - fried rice Giardia - foods contaminated with giardia cysts
36
What is treatment for campylobacter jejuni?
Incubation lasts for 2-5 days and symptoms end after 3-6. Usually supportive management Azithromyin or ciprofloxacin if severe symptoms or patient is HIV positive or has Heart Failure
37
What are symptoms of salmonella?
Watery diarrhoea +/- mucus or blood, abdo pain and vomiting
38
What are the symptoms of bacillus cereus?
Abdo cramping and vomiting within 5 hours of ingestion, followed by watery diarrhoea around 8 hours after ingestion of food. Resolves within 24 hours
39
How should gastroenteritis be managed?
Barrier nursing and infection control Staying off school for 48 hours after symptoms have completely resolved Microscopy, culture and sensitives of stool Fluid challenge Rehydration (dioralyte) IV fluids AVOID ANTIDIARRHOEALS AND ANTIEMETICS
40
What are the complications of gastroenteritis ?
Lactose intolerance Irritable bowel syndromes Reactive arthritis Guillian Barre
41
What is pyeloric stenosis?
Thickening of the pylorus of the stomach which prevents food travelling from the stomach to the small intestine After feeding, there is increasingly powerful peristalsis as it tries to push food into the duodenum and eventually ejects food into the oesophagus = projectile vomiting
42
What are the features of pyloric stenosis?
Presents in first few weeks of life = failure to thrive Projectile vomiting Mass that feels like an olive in the upper abdomen Visible peristalsis
43
What will blood gas analysis look like in pyloric stenosis?
Hypochloric metabolic alkalosis as baby is vomiting hypochloric acid from stomach
44
What is the management of pyloric stenosis?
Abdo ultrasound - thickened pylorus Laparoscopic pyloromyotomy
45
What is intestinal obstruction ?
Physical obstruction prevents flow of faeces through the intestines = back pressure through the GI system, causing vomiting
46
What are the causes of intestinal obstruction?
``` Meconium ileus Hirschsprung's disease Oesophageal atresia Duodenal atresia Intussusception Imperforate anus Malrotation of the intestines with a volvulus Strangulated hernia ```
47
How does intestinal obstruction present?
Bilious vomiting Abdo pain and distension Failure to pass stools or wind Abnormal bowel sounds (high pitched and tinkling, or absent)
48
How is intestinal obstruction diagnosed?
Abdo X-Ray - dilated loops of bowel - absence of air in the rectum
49
How is intestinal obstruction managed?
Nil by mouth NG tube to drain stomach and stop vomiting IV fluids Look for underlying cause

Paediatrics (11 decks)

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