Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Paediatrics > Paeds - Breathless Baby > Flashcards

Paeds - Breathless Baby Flashcards

1
Q

When taking a Hx, what questions are important to ask a parent whose child presents with poor feeding?

A
  1. Volumes of milk / food before and now?
  2. Timescale of decline in feeding (gives idea of duration of illness as poor feeding is often the 1st sign)
  3. Why does the child stop feeding? - e.g. out of breath, turns blue / pale
  4. Any change in behaviour e.g. sleepiness (worrying sign)
  5. What does the parent think might be the cause?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Up to 1-month of age the minimum milk requirement to provide enough calories to grow is what?

A

150mls/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

After 1-month of age the minimum milk requirement to provide enough calories to grow is what?

A

100/mls/kg/day - provided that they are still gaining weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many mls are there in an Oz?

A

28.4 mls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What topics might you want to cover as part of an antenatal history?

A

Maternal heath:

  • Trauma
  • Congenital infections, vascular episodes following antenatal bleeds
  • Medications
  • Teratogenic agents (including hyperglycaemia)

Gestation:

  • Abnormalities on any scans

Delivery:

  • Prolonged rupture of membranes
  • Increased risk of infection
  • Mode of delivery
  • Weight

Post-delivery:

  • Any time spent on neonatal unit - looking at respiratory causes, hypoglycaemic screening, sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When does a newborns immunisation schedule start?

A

At 2-months (8-weeks)

Unless the baby was born in a different country which has different exposure risks e.g. Pakistan = TB at birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is a cardiothoracic ratio of 60% or higher normal during the newborn period?

A

It can be!

Normally we consider 45-50% cardiothoracic ratio normal but in newborns a higher ratio can be normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What congenital abnormalities can cause cardiomegaly?

A
  1. Large L –> R shunts:
    1. VSD
    2. PDA (patent ductus arteriosus)
  2. TGA (transposition of the great arteries) - where aorta and pulmonary artery are swapped
  3. Tricuspid atresia - tricuspid valve develops abnormally causing occlusion –> reduced/no blood flow to right ventricle
  4. Single ventricle
  5. Truncus arteriosus - single arterial trunk arising from the heart i.e. the pulmonary artery & aorta are combined
  6. Ebstein’s anomaly - low insertion of the tricuspid valve –> large R atrium and small R ventricle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What congenital abnormalities can result in a small heart?

A
  1. Tetralogy of Fallot (TOF) - combination of four congenital abnormalities (can also be of normal size)
  2. TAPVD (total anomalous pulmonary venous drainage) - all four pulmonary veins make anomalous connection to the systemic venous virculation e.g. infradiaphragmatic (blood drains into portal or hepatic veins)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name some congenital cardiac abnormalities which have a normal sized heart?

A
  1. TGA (transposition of the great arteries) - where aorta and pulmonary artery are swapped
  2. Pulmonary atresia - pulmonary valve doesn’t form properly causing obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is pulmonary oligaemia?

A

Dark appearance of lung fields on CXR due to reduced blood flow to the lungs

e.g. Tetralogy of Fallot, pulmonary atresia, pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is pulmonary plethora?

A

Lighter / whiter appearance of lung fields on a CXR due to increased blood flow to lungs

e.g. L to R shunts, VSD, PDA or cardiac failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is posseting?

A

Bringing up milk after a feed

  • Not a cause for concern unless baby isn’t gaining weight at normal rate
  • Painless / no discomfort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of murmur is caused by a VSD?

A

Classically a pan-systolic murmur

(often louder the smaller the VSD is due to increased turbulent flow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What cardiac abnormalities cause systolic murmurs?

A
  • Tetralogy of Fallot
  • VSD
  • Pulmonary / Aortic stenosis
  • Truncus arteriosis
  • Single ventricle
  • DORV (double outlet right ventricle) - aorta and pulmonary artery arise from the right ventricle
  • TAPVD (total anomalous pulmonary venous drainage) - can be present without murmur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What cardiac abnormalities cause a diastolic murmur?

A
  • Truncus arteriosus
  • Mitral stenosis
  • Pulmonary / aortic regurgitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does the term ‘ductal-dependent lesions’ refer to?

A

Lesions which are dependent on a patent ductus arteriosus (PDA) for adequate circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs / symptoms of cardiac failure in children?

A
  • SoB
  • Tachypnoea
  • Poor feeding - weight can go up or down
  • Tachycardia
  • Poor pulses
  • Heart murmur
  • Hepatomegaly (will occur in either L or R HF in young children and only in R-HF in older children)
  • Acidosis
  • Sweating
  • Oedema (only seen in children older than 2/3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you manage heart failure in children?

A
  • Diuretics - Furosemide, amiloride etc
  • ACE inhibitors
    • In children, shorter acting ones are used e.g. Captopril, Enalapril
    • As child gets older you can used Lisinopril or Ramipril
  • O2 - don’t use in cases with duct-dependant lesions –> O2 will close the duct
  • Prostaglandins - Prostin (prostaglandin E1)
  • Diet & fluid control - small children need lots of calories in restricted volume
    • Consider NG feeds of PEG/PEJ if child is too tired to take in any food orally
  • Inotropes - dopamine, dobutamine –> increased cardiac output (increase force of cardiac contractions)
  • Catheter intervention eg. balloon angioplasty
  • Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Congenital heart defects are often split into two categories - what are they?

A
  1. Acyanotic
  2. Cyantoic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which is more common acyanotic or cyanotic congenital heart disease?

A

Acyanotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the most common acyanotic congenital heart diseases?

A

Left to Right Shunt lesions:

  1. VSD - accounts for ~30% of all congenital heart defects
  2. ASD
  3. PDA (patent ductus arteriosus)

Obstructive lesions:

  1. Aortic / Pulmonary valve stenosis
  2. Coarctation of the aorta (narrowing)
  3. Mitral / Tricuspid stenosis
23
Q

What are the most common cyanotic heart diseases?

A
  1. Tetralogy of Fallot
  2. Tricuspid atresia
    • Also aortic and mitral atresia
  3. TGA (Transposition of Great arteries)
  4. TAPVD (Total Anomalous Pulmonary Venous Drainage)
  5. DORV (Double outlet right ventricle)
  6. Single ventricle
24
Q

What is PDA (patent ductus arteriosus)?

A
  • Acyanotic congenital heart defect
    • If uncorrected can cause cynaosis in lower extremeties
  • Ductus arteriosus = connection between pulmonary trunk and descending aorta
  • Normally closes in first few breaths due to increased pulmonary flow which enhanves prostaglandin clearance
  • More common in:
    • Premature babies
    • Born at high altitude
25
Q

What are the common features of PDA?

A
  1. Left subclavicular thrill
  2. Continuous‘manchinery’ murmur - often best heard beneath left clavicle
    • Continuous = murmur occurs in both systole & diastole (because pulmonary artery pressure is < aorta pressure throughout cardiac cycle)
  3. Heaving apex beat
  4. Pulse:
    • Large volume, bounding, collapsing pulse
    • Wide pulse pressure
26
Q

How is PDA managed?

A
  • Indomethacin (inhibits prostaglandin synthesis) –> closes the connection in the majority of cases
  • If PDA + duct-dependant lesion:
    • Prostin (prostaglandin E1) can be used to keep the duct open until post-surgical repair
  • Closure via coil / occlusion device
27
Q

What are the features of Coarctation of the aorta?

A
  1. Infancy:
    • Heart failure
    • Metabolic acidosis (depends on severity of coarctation)
  2. Adult –> HTN of upper limbs
  3. Radio-femoral delay
  4. Femoral pulse weak / absent on examination
  5. Mid-systolic murmur (loudest over back)
  • Associated with:
    • Newborns –> risk of necrotising enterocolitis (portion of bowel dies)
    • Bicuspid aortic valve
    • Berry aneurysms
    • Turner’s syndrome
28
Q

What is the most common cause of cyantoic congenital heart disease?

A

Tetralogy of Fallot

29
Q

When does TOF commonly present?

A

Often at 1-2 months

May not be picked up till 6-months old

30
Q

What are the 4 characteristic features of TOF?

A
  1. Ventricular septal defect (VSD)
  2. Right ventricular hypertrophy
  3. Right ventricular outflow tract obstruction (pulmonary stenosis)
    • Loud ejection systolic murmur (due to pulmonary stenosis)
    • Pulmonary oligaemia on CXR due to decreased blood flow
  4. Overriding aorta - aorta position directly over VSD instead of over the left ventricle (causes aorta to recieve some blood from right ventricle)
31
Q

What features are present in TOF besides the main 4?

A
  • Central Cyanosis
  • Ejection systolic murmur (pulmonary stenosis)
    • The VSD doesn’t normally cause a murmur
  • CXR shows a ‘boot-shaped’ heart
  • ECG shows right ventricular hypertrophy
  • Clubbing of fingers/toes in older children
32
Q

Name 6 genetic conditions associated with congenital heart defects.

A
  1. Trisomy 13 Edwards’ - 80%
  2. Trisomy 18 Patau’s - 80-100%
  3. Trisomy 21 Down’s syndrome - 40%
  4. Turner’s (45, XO)
  5. Kartagener’s Syndrome
  6. DiGeorge syndrome
33
Q

What are the characteristics of autosomal dominant inheritance?

A
  • Males and female affected equally
  • Transmitted by both sexes
  • Incomplete penetrance - can have the autosomal dominant gene but not exhibit the pathogenic phenotype
  • Variable expression - variable severity of condition between sufferers
  • New mutations - parents don’t necessarily have to have the pathogenic genotype, mutation occurs for first time in the sufferer
  • Risk to offspring = 50%
34
Q

Name some conditions that the

neonatal heel prick test can test for?

A
  1. MCAD
  2. HCU - homocystinuria
  3. Sickle cell
  4. Isovalaric acidaemia
  5. Cystic fibrosis - test for immunoreactive trypsinogen
  6. Hypothyroidism - test for TSH levels
  7. Phenylketonuria - disorder where an error in amino acid metabolism can impair brain development
35
Q

What should sick babies be presumed to have until proven otherwise?

A

Sepsis

36
Q

What 3 tests should always be checked even if you suspect the baby of simply having broncholitis?

A

We want to know if the babies tachypnoea or tachycardia is due to primary cardiac or respiratory failure

  1. Ammonia - increased ammonia + decreased glucose may indicate Reye’s syndrome (severe, progressive encephalopathy affecting children, mortality is 15-25%)
  2. Glucose
  3. ABG (blood gas)
37
Q

A child aged 3 weeks is seen in A+E with a 2 week history of poor feeding and being short of breath. No snuffles and no cough. On examination oxygen saturation is 91% in air, heart rate 182. Respiratory rate 65 breaths per minute. 2 heart sounds are heard with a loud systolic murmur. Femorals are palpable. Capillary refill time is 3 seconds.

The most likely diagnosis is:

  • Congenital heart disease
  • Childhood asthma
  • Inborn error of metabolism
  • Bronchiolitis
  • Sepsis
A

Congenital heart disease

The longish history is against sepsis or bronchiolitis. The child is too young for asthma. An inborn error of metabolism is possible but very rare. Congenital heart disease is more likely and the murmur is suggestive of this. Quite complex congenital heart disease may not be detected at the baby check (there may be normal sats and no murmur) and present insidiously.

38
Q

What is an innocent flow murmur?

A

It is a murmur observed often in children with a normal heart

  • Often heart during febrile illness or anaemia as CO is ↑
    • Thus it is important to re-auscaultate the child when other illnesses have been corrected
  • In a previously well child this is the most likely cause of the murmur
39
Q

When does the ductus arteriosus normally close?

A

Within several days of birth

40
Q

Which congenital heart defects can be caused by maternal alcohol consumption during pregnancy?

A

CHDs:

  • ASD
  • VSD
  • TOF
41
Q

What congenital heart defects can maternal Warfarin use during pregnancy cause?

A

Pulmonary valve stenosis

& PDA

42
Q

Which condition in a pregnant mother can cause complete heart block in the foetus?

A

SLE (anti-Ro and anti-La antibody)

43
Q

Which condition in a pregnant mother can cause peripheral pulmonary stenosis or PDA in the foetus?

A

Rubella infection

44
Q

When are the majority of CHD detected?

A

During fetal anomaly scan

18-20 weeks gestation

45
Q

What are the 4 hallmark of an ‘InnoSent mumur’?

A

Hallmarks of an ‘innoSent murmer’ are:

  1. aSymptomatic pt
  2. Soft blowing murmur
  3. Systolic murmur only, not diastolic
  4. left Sternal edge

Soft, Sytolic, aSymptomic, left Sternal edge

46
Q

What are the two types of ASD?

A
  1. Ostium Secundrum (most common ~ 80%)
    • ECG = RBBB & right axis deviation (due to right ventricular enlargement)
  2. Ostrium Primum or Partial atrioventricular septal defect (AVSD)
    • ECG = RBBB + left axis deviation + prolonged PR interval
    • Associated with abnormal AV-valves
47
Q

What are the features of a ASD?

A
  • Ejection systolic murmur (best heart at left sternal edge) - due to ↑ flow across the pulmonary valve beacause of the L-to-R shunt
  • Fixed, widely split second heart sound (S2)
  • In ostium primum –> pansystolic murmur (due to atrioventricular valve regurgitation)
48
Q

Which is the most likely congenital heart defect to be found in adulthood?

A

Atrial septal defect (ASD)

49
Q

What is the most common management of VSD?

A

Often None!!

The majority close with intervention (ascertained by disappearance of murmur + normal ECG)

50
Q

Which chromosomal disorders are VSDs associated with?

A
  • Down’s syndrome
  • Edward’s syndrome
  • Patau syndrome
51
Q

What are the features of VSD?

A
  • Asymptomatic
  • Pan-systolic murmur at left sternal edge (louder in small defects - due to ↑ turbulence)
52
Q

What is TGA - transposition of the great arteries?

A

Aorta is connected to the right ventricle + pulmonary artery is connected to the left ventricle

i. e. aorta and pulmonary are swapped = 2 parralel circulations
* Not compatible with life without VSD, ASD or PDA

53
Q

What are the features of TGA?

A
  • Cyanosis - can be profound if no other CHDs on day 2 when ductus arteriosis closes
  • Often no murmur
  • S2 is loud and single
54
Q

Exposure to what medication in-utero can cause Ebstein’s anaomaly?

A

Lithium

Year 4 - Paediatrics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions