Paeds - Aimee / Lydia Flashcards
Streptococcus pneumonae on a microscope? Possible severe illness caused ?
Gram positive
Alpha haemolytic
Facultative anaerobic
Meningitis
Invasive pnemococcal disease - pneumonia with septicaemia
What might cause you to admit a URTI?
Poor feeding
Parental concern
Unknown diagnosis
Viruses causing coryzal sx?
Rhinovirus
Coronavirus
RSV
When is tonsillectomy an option?
Recurrent severe tonisilitis
Quincy
Obstructive sleep apnea
Which bacteria can cause tonsillitis in older children? Usual viral causes?
B haemolytic strep
Adenovirus, enterovirus, rhinovirus
What criteria can you use to determine if tonsillitis is likely bacterial?
Centor criteria
Age 5-15 Season Late autumn, early spring, winter Fever >38.3 Cervical lymphadenopathy Pharyngeal erythema, oedema or exudate No cough
If 5 -> 50%, 6->75% likelihood of bacterial
Laryngeal / tracheal infection seen in?
Croup
Bacterial tracheitis
Acute epiglottis
Croup is what? Onset over? Cause? Age? Treat of moderate? Severe?
Laryngotracheobronchitis - onset over days
95% viral - parainfluenza, RSV
6month-6years
Moderate - PO dexamethosone, PO prednisolone, Nebulised steroids
Severe - Nebulised adrenaline + O2, anaesthetist incase airway lost
What causes psuedomembranous croup? Sx? Mx?
Staph aureus - bacterial tracheitis
High fever, toxic, rapidly progressing airway obstruction by thick secretions
IV Abx
Intubation and ventilation if required
Onset of acute epiglotits?
Cause?
Signs it has progressed to septicaemia ?
Management?
Hours (age 1-6)
H influenza type B
Septicaemia -> swelling of epiglottis and soft tissues -> airway obstruction
High fever, toxic child
Painful throat - no speaking + drooling
Soft inspiration stridor -> increasing respiratory difficulty
Immobile child with extended neck
Mx
Anaesthetist, ENT surgeon, paediatrician
Secure airway then blood cultures
Transfer to ICU
Rifampicin to household contacts
Basic management principles for child with laryngeal / tracheal infections?
Keep calm Quiet room DO NOT examine Observe for hypoxia Call anaesthetist Nebulised adrenaline
Pertussis Sx? How long? Ix? Treat? Prophylaxis? Complications?
Epidemic every 3-4y
1 wk coryza → paroxysmal cough → insp whoop (apnoea in infants)
Cough WORSE AT NIGHT. May → vomiting
Lasts 3-6 wks
Per-nasal swab – culture or PCR
Treat: erythromycin – eases symptoms if started in coryzal phase
Prophylaxis : erythromycin or vaccination
Complications: pneumonia, convulsions, bronchiectasis
What important DD with pneumonia? Usual crackle in pneumonia ?
TB
End-inspiratory coarse crackles
4 S’s of innocent murmurs
aSymtomatic patient
Soft blowing murmur
Systolic murmur only
Left Sternal edge
Features of a large VSD? O/e? CXR? Mx?
> 1wk: HF, breathlessness, failure to thrive, recurrent chest infections, tachypnea, hepatomegaly
Soft murmur
Apical mid diastolic murmur (bilateral from lungs across mitral valve)
Loud pulmonary 2nd sound
CXR
Cardiomegaly
Enlarged pulmonary artery
Pulmonary oedema
Diuretics + captopril
Surgery to prevent eisenmenger syndrome
When should a PDA close ? Shunt? What happens if it is large?
1 month
L->R
HF, pulmonary HTN
Most common ASD? Sx? Murmur? CXR? ECG?
Mx?
Secundum (usually due to foramen ovale) - 80% of ASD
Can be aSx
Recurrent chest infections , arrhythmia (4th decade +)
Ejection systolic murmur at left sternal edge (pulmonary valve)
CXR : cardiomegaly, ↑pulmonary arteries, ↑pulmonary vascular markings
ECG : partial R bundle branch block R axis deviation
Echo
Cardiac catheterisation (carotid angiography) @ 3-5y
What is ASD primum also called? What happens? Murmur?
CXR?
ECG?
Mx?
Partial AVSD
Communication between atria and valves
Leaky 3 leaved mitral valve → regurg
Apical pansystolic murmur from valve regurg
CXR : cardiomegaly, ↑pulmonary arteries, ↑pulmonary vascular markings
ECG : -ve AVF = superior QRS
Echo
Surgical repair
Murmur in TOF ?
Loud, harsh ejection systolic at L sternal edge
When would AS lead to HF and shock? Associations? What does it lead to? Auscultation? What other feature?
If it is duct dependant
Mitral valve stenosis & coarctation of the aorta
LVH
Carotid thrill
Small -> slow rising pulse
O/e of coarctation of aorta
Systemic HTN in right arm
Radiofemoral delay
Weak femoral pulses
PS and AS lead to respectively?
RVH
LVH
Causes of outflow obstruction with well baby ?
AS
PS
CoA
Outflow obstruction but sick baby causes? Features?
Aortic interruption
Very sick babies - VSD / Duct dependent
Absent peripheral pulses
Coarctation of the aorta
Circulatory collapse at 2 days old
Absent femoral pulses
Hypo-plastic left heart syndrome
100% duct dependant
Infective endocarditis features? RFs? Diagnosis based on? Usual causes? Treatment? - what marker for monitoring? Prophylaxis? Complications?
Sustained fever, malaise, raised ESR, anaemia / haematuria
-splinter haemorrhages, clubbing, arthralgia
RF - VSD, CoA, PDA, prosthetic valves
Diagnosis - blood cultures, echo
A-haemolytic strep: strep Viridans
IV penicillin + aminoglycoside for 6/52
-use acute phase protein levels to monitor treatment
Prophylaxis - good dental hygiene
Complications - infected emboli & infarcts
-retinal, pulmonary, neuro
Which cardiomyopathy is risk of sudden death in young athletes? Features?
Hypertrophic LVH
Diastolic dysfunction
Most common cardiomyopathy? Features?
Dilated
Enlargement of all heart chambers
Systolic dysfunction
What happens in restrictive cardiomyopathy ?
Rigid ventricular walls
Diastolic dysfunction
[least common]
Rf/ Mx of cardiomyopathy?
FH, infection
Large heart
Diuretics + ACEi
What common complication of rheumatic fever? Usual cause? Criteria for diagnosis? Treatment? Prophylaxis?
Mitral stenosis
Group A B-haemolytic strep
Jones criteria - 2 major OR 1 major and 2 minor
Major
Pericarditis , polyarthritis, Sydenham chorea, erythema marginatum, subacute nodules
Minion
Fever, polyarthlargia, Hx RF, raised acute phase proteins, raised p-r interval
Treatment Bed rest Anti-inflammatory - high dose aspirin Steroids if not resolving Treat HF
Prophylaxis
Benzathine penicillin IM for 1 month
Triad in nephrotic syndrome? Other sx? What is the usual cause?
Oedema
-periorbital, scrotal / vulval, leg
Hypoalbuminaemia
Proteinuria
-throthy urine
±ascities, breathlessness
Minimal change disease - not much to see on histological examination
Ix in nephrotic syndrome?
Urine dipstick MSU C+S U&E, creatinine Albumin FBC, ESR Complement C3 and C4 levels Anti-Dnase B titre/throat swab (for strep)
Usual mx of nephrotic syndrome? Dose? What happens if it is resistant to this?
Steroid sensitive (90%)-> Prednisolone 60mg/m2 /day for 4 weeks, then 40mg/m2 alternate days 4 weeks
Steroid resistant -> immunosuppression (cyclophosphamide, cyclosporin)
diuretics, ACE inhibitor, salt restriction, NSAIDs
Bar minimal change what are the other rare causes of nephrotic syndrome?
Focal segmental glomerulosclerosis
Mesangiocapillary glomerulonephritis
Membranous nephropathy
Congenital nephrotic syndrome genetics? Mx?
Recessive
‘Finnish type’
Nephrectomy
Complications of nephrotic syndrome?
Hypovolaemia Thrombosis Infection Hypercholesterolaemia Spontaneous peritonitis! Strep pneumoniae
Features of nephritis ? What would brown vs red urine indicate?
Haematuria
Reduced urine output - oliguria
Proteinuria
Brown-> glomerular bleeding
Red - lower tract defect and is uncommon in children
Causes of nephritis ?
Post-infectious -> normally group A strep
Hx of sore throat (1-3w ago)
Anti-Dnase B, throat swab
IgA nephropathy
Goodpasteur’s syndrome
Lung symptoms
Vasculitis
HSP, SLE, PAN, Wegener’s
Nephritis IX?
Dipstick, MSU U&E, albumin, creatinine C3/C4 levels Anti-Dnase B. Throat swab Biopsy Blood pressure
What is henoch-schonlein purpura? Follows what? Triad? What is often involved?
Acute, immune complex-mediated vasculitis
Follows URTI
Classic triad:
Purpura on buttocks, extensor surfaces, lower legs
Abdominal pain
Arthritis/arthralgia
Renal involvement
Ix in HSP? Mx? Complication?
Raised ESR Raised IgA Urinalysis – proteinuria Antistreptolysin O (ASO) titer [test for antibodies against a substance produced by group A strep] U+E BP Abdo US to exclude intussusception
Steroids may help. Most recover spontaneously.
Risk of chronic renal failure
What is haemolytic uraemic syndrome? Features? Risk of?
Usually follows?
What treatment may be required?
Acute microangiopathic haemolytic anaemia
AKI
Thrombocytopenia
Anaemia
Renal failure
Typically follows E.coli 0157 dysentery -> history of bloody diarrhoea
Dialysis
Possible complication of UTI ? What type of uti can be ASx?
Congenital causes of uti?
Renal scaring -> renal failure and hypertension
Bacteriuria - often asx
Structural abnormality
Presentation of UTI infant? Toddler?
Infants - collapse, septicaemia, poor feeding
Toddler - vomiting, FTT, colic
When would you investigate a UTI? What ix?
Complicated / atypical
-seriously ill, abdo mass, raised creatinine, failure to repond to Abx <48hrs, non-E. Coli
Dipstick all urine
-nitrates and WCC -> likely for all UTIs
MSU ‘clean catch’
USS
DMSA scan - radioactive isotope injected to scan kidneys (CT / X-RAY)
Treatment of a UTI in <3months? >3months? With pyelonephritis? When would you start treatment? Who would you give prophylaxis to and what would you give?
<3months - IV amoxicillin + gentamicin
> 3months [uncomplicated] - 3days PO trimethoprim / nitrofuantoin / co-amoxiclav
Pyelonephritis -> gentamicin
Treat immediately without waiting for culture
Prophylaxis for those with renal abnormalities / recurrent UTI
-> trimethoprim
Usual cause of vesicouretic reflux? What happens?
Developmental abnormality of the vesicouretic junction
Ureters displaced laterally
Urine reflexes up into ureters
->pyelonephritis and renal damage
