Paeds - Aimee / Lydia Flashcards

1
Q

Streptococcus pneumonae on a microscope? Possible severe illness caused ?

A

Gram positive
Alpha haemolytic
Facultative anaerobic

Meningitis
Invasive pnemococcal disease - pneumonia with septicaemia

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2
Q

What might cause you to admit a URTI?

A

Poor feeding
Parental concern
Unknown diagnosis

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3
Q

Viruses causing coryzal sx?

A

Rhinovirus
Coronavirus
RSV

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4
Q

When is tonsillectomy an option?

A

Recurrent severe tonisilitis
Quincy
Obstructive sleep apnea

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5
Q

Which bacteria can cause tonsillitis in older children? Usual viral causes?

A

B haemolytic strep

Adenovirus, enterovirus, rhinovirus

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6
Q

What criteria can you use to determine if tonsillitis is likely bacterial?

A

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

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7
Q

Laryngeal / tracheal infection seen in?

A

Croup
Bacterial tracheitis
Acute epiglottis

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8
Q

Croup is what? Onset over? Cause? Age? Treat of moderate? Severe?

A

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

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9
Q

What causes psuedomembranous croup? Sx? Mx?

A

Staph aureus - bacterial tracheitis

High fever, toxic, rapidly progressing airway obstruction by thick secretions

IV Abx
Intubation and ventilation if required

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10
Q

Onset of acute epiglotits?
Cause?
Signs it has progressed to septicaemia ?
Management?

A

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

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11
Q

Basic management principles for child with laryngeal / tracheal infections?

A
Keep calm 
Quiet room 
DO NOT examine 
Observe for hypoxia 
Call anaesthetist 
Nebulised adrenaline
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12
Q
Pertussis 
Sx? 
How long? 
Ix?
Treat? 
Prophylaxis?
Complications?
A

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

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13
Q

What important DD with pneumonia? Usual crackle in pneumonia ?

A

TB

End-inspiratory coarse crackles

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14
Q

4 S’s of innocent murmurs

A

aSymtomatic patient
Soft blowing murmur
Systolic murmur only
Left Sternal edge

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15
Q

Features of a large VSD? O/e? CXR? Mx?

A

> 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

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16
Q

When should a PDA close ? Shunt? What happens if it is large?

A

1 month
L->R
HF, pulmonary HTN

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17
Q
Most common ASD? 
Sx? 
Murmur? 
CXR? 
ECG?

Mx?

A

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

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18
Q

What is ASD primum also called? What happens? Murmur?
CXR?
ECG?

Mx?

A

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

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19
Q

Murmur in TOF ?

A

Loud, harsh ejection systolic at L sternal edge

20
Q

When would AS lead to HF and shock? Associations? What does it lead to? Auscultation? What other feature?

A

If it is duct dependant
Mitral valve stenosis & coarctation of the aorta

LVH

Carotid thrill
Small -> slow rising pulse

21
Q

O/e of coarctation of aorta

A

Systemic HTN in right arm
Radiofemoral delay
Weak femoral pulses

22
Q

PS and AS lead to respectively?

23
Q

Causes of outflow obstruction with well baby ?

24
Q

Outflow obstruction but sick baby causes? Features?

A

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

25
``` 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
26
Which cardiomyopathy is risk of sudden death in young athletes? Features?
Hypertrophic LVH Diastolic dysfunction
27
Most common cardiomyopathy? Features?
Dilated Enlargement of all heart chambers Systolic dysfunction
28
What happens in restrictive cardiomyopathy ?
Rigid ventricular walls Diastolic dysfunction [least common]
29
Rf/ Mx of cardiomyopathy?
FH, infection Large heart Diuretics + ACEi
30
``` 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
31
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
32
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) ```
33
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
34
Bar minimal change what are the other rare causes of nephrotic syndrome?
Focal segmental glomerulosclerosis Mesangiocapillary glomerulonephritis Membranous nephropathy
35
Congenital nephrotic syndrome genetics? Mx?
Recessive ‘Finnish type’ Nephrectomy
36
Complications of nephrotic syndrome?
``` Hypovolaemia Thrombosis Infection Hypercholesterolaemia Spontaneous peritonitis! Strep pneumoniae ```
37
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
38
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
39
Nephritis IX?
``` Dipstick, MSU U&E, albumin, creatinine C3/C4 levels Anti-Dnase B. Throat swab Biopsy Blood pressure ```
40
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
41
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
42
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
43
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
44
Presentation of UTI infant? Toddler?
Infants - collapse, septicaemia, poor feeding Toddler - vomiting, FTT, colic
45
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)
46
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
47
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