paeds brief Flashcards
wheeze is associated with ______
viral induced wheeze, asthma and bronchiolitis
what is apnoea
cessation of breathing for at least 10 seconds
what commonly causes sore throat
- normally viral in children under 3
- could also be caused by strep pyogenes (beta haemolytic strep)
- epstein barr is a common cause of exudative tonsilitis
which criteria indicate the likelihood of a sore throat being caused by a bacrterial infection and what does it include
- Centor criteria
- tender lymphadenopathy
- tonsilar exudate
- fever
- absence of cough
what is the treatment if strep throat is suspected
10 days of penicillin V
what is croup
acute laryngotracheobronchitis
what causes croup most commonly
parainfluenza virus
could also be RSV or bacterial
what age is croup most common
2
management of croup
- most get better at home within 24 hours
- children may require hospitalisation due to
- more severe illness
- being under 12 months old
- signs of fatigue or resp failure
- managemnet
- single dose dex or nebulised budesonide
- nebulised adrenaline if need to get to ITU
what organism causes acute epiglottitis
haemophilus influenzae type B
rare to HiB vaccination
age of acute eppiglotitis
1-6
management of acute eppiglottitis
- do not
- lie child down
- examine throat
- upset child (no bloods)
- managed in resus room
- examination of throat under anaesthetic
- cherry red, swollen epiglottis on laryngoscopy
- intubate
- blood cultures
- IV cefuroxime
what is bacterial tracheitis
- rare but more common than epiglottitis
- often seen as an acute deterioration after a vira infection
- children systemically very unwell
- no drooling
- hoarse voice
what organisms commonly cause bacterial tracheitis
staphylococcus aureus
H. influenzae
strep spp.
neisseria spp.
management of bacterial tracheitis
- secure airway
- blood cultures
- IV cefuroxime
distinguish croup, acute epiglottitis and bacterial tracheitis
organism for whooping cough
bordatella pertussis
how long can whooping cough last
3 months
(100 day cough)
what is the management of whooping cough
erythromycin given early reduces infectivity and complications but does not reduce duration of illness
managment is largely supportive but 1% will need hospital admission
what are the two types of LRTIs
bronchiolitis
pneumonia
what causes bronchiolitis
- viruses rather than bacteria
- most commonly RSV
- less commonly
- adenovirus
- influenza
- parainfluenza
- rarely: mycoplasma pneumoniae
what would an X ray of bronchiolitis show
hyperinflation and patchy consolidation bilaterally
what is the management of bronchiolitis
supportive
oxygen
some may be ill enough to need ng feeds
what does pneumonia mean
inflammation of the lung parenchyma with consolidation within the alveoli
what organisms cause pneumonia
- viruses (more common in children <2)
- RSV
- influenza
- parainfluenza
- adenovirus
- bacteria
- strep pneumoniae (most common)
- s. aureus (common in CF)
- pseudomonas (common in CF)
- HiB (in unvaccinated)
what are the classic signs of consolidation on the lungs (pneumonia)
decreased breath sounds
dullness to percussion
crackles
bronchial breathing
what three features suggest bacterial pneumonia
polymorphoneuclear leucocytosis
lobar consolidation
pleural effusion
first line antibiotic for bacterial pneumonia
oral amoxicillin
what are the aims of asthma treatment
no daytime symptoms or waking in the night due to symptoms
no exacerbations
no need for reliever therapy
no limitations on activity
normal lung function
minimal side effects of therapy
what’s the difference between brown and blue inhalers
- brown - preventors
- ICS
- blue - relievers
- salbutamol
describe the steps of asthma therapy
- regular preventor
- very low dose ICS
- initial add on preventor
- inhaled LABA
- additional add on therapies
- if no response to LABA stop it and increase ICS to low dose
- if benefit from LABA but not enough then keep LABA AND increase ICS to low dose
- if still inadequate add LTRA
- high dose therapy
- increase ICS to medium dose
- addition of theophyline
- refer to specialist
what is the carrier rate of CF
1:25
incidence of CF
1:2500 live births
what is the most common CF mutation
three base pair deletion at F508
Common pathogens in CF chest infection
- S.aureus
- H.influenzae
- Pseudomonas
what is the gold standard of CF diagnosis
pilocarpine ionotophoresis sweat test
what are the cornerstones of CF management
prevention of colonisation and infection of the lungs
effective mucocillary clearance
nutritional support
ear ache is usually caused by:
infection of the middle ear
otitis media
what is acute otitis media usually caused by
- can follow viral URTI
- can also be bacterial
- s.pneumoniae
- pneumococcus spp.
- h. influenzae
management of otitis media
symptomatic treatment is usually sufficient
abx can reduce symptoms but not complications
what is conductive hearing loss usually due to
OME: otitis media with effusion aka glue ear
down’s syndrome is associated with which congenital heart disease
ASD
turner’s syndrome is associated with which congenital heart disease
coarctation of the aorta
bicuspid aortic valve
noonan syndrome is associated with which congenital heart disease
pulmonary stenosis
fetal alcohol syndrome is associated with which congenital heart disease
atrial septal defect
ventricular septal defect
describe the different types of cyanosis and what they mean
- central cyanosis
- blue lips, blue tongue
- always pathological
- peripheral cyanosis
- blueness of hands and feet
- can be normal in first 24hrs of life
hallmarks of innocent murmurs
an asymptomatic child
a normal cardiovascular examination
systolic or continuous
no radiation
variation with posture
what kind of murmur is always pathological and needs investigation
diastolic
clinical features of heart failure in infants
poor feeding and breathlessness
faltering growth
excessive sweating
recurrent chest infections
CVS signs
initial investigations for suspected heart failure
- ecg
- chest x ray
- diagnosis normally needs echo
cxr finding of teratology of fallot
boot shape
cxr finding of transposition of great arteries
egg on side
what are the two cyanotic congenital heart conditions
teratology of fallot
transposition of great arteries
what is the most commonn congenital heart disease
vsd
complications of a left to right shunt
permanent irreversable pulmonary HTN
compare the three severities of VSD
- small vsd
- pansystolic murmur
- no symptoms
- may close spontaneously but if murmer persists to 12 months do echo to look for complications
- medium vsd
- has symptoms
- treated with diuretics and ACE inhibitors
- spontenous improvement often occurs and surgery can often be avoided
- large
- presents early with cardiac failure
- medical management
- then surgical correction
management of ASD
many close spontaneously before school age
management is to prevent heart failure and arrhythmias
transcatheter closure at age of 3-5
if very large might need surgical closure
when should the ductus arteriosus close
within hours of delivery
PDA diagnosed if duct doesn’t close in 1 month following birth
what are the clinical features of a PDA
bounding pulses
wide pulse pressure
continuous machinery hum murmer
management of PDA
ibuprofen to inhibit prostaglandin and encourage closure
can also be closed in first few months of life by cardiac catheterisation
clinical fetures of teratology of fallot
cyanosis
loud single S2
clubbing in older children if uncorrected
loud ejection systolic murmer
what are tet spells
- in teratology of fallot when peripheral vascular resistance falls
- increases right to left shunt
- can be triggered by exertion, emotion, dehydration or illness
- includes
- worsenning cyanosis and pallor
- distress/agitation
- hypotonia
- children squat
managmenet of TOF
- treat ‘tet’ or hypercyanotic events with:
- high flow oxygen
- morphine
- IV fluids
- bicarbonate for acidosis
- intubation and ventilation in severe cases
- definitive treatment is surgical
managment of transposition of great arteries
- initial aim is to promote mixing of blood
- infusion of prostaglandin E1 to newborn
- maintains patency of DA
- emergency cardiac catheterisation and atrial septostomy
- life saving procedures
- infusion of prostaglandin E1 to newborn
- definitive repair achieved with arterial switch surgery at a few weeks of age
rheumatic fever is a complication of what and how frequently does it occur
group A beta haemolytic strep
a sore throat
occurs in <1% of cases of strep throat
what age does rheumatic fever affect
5-15
use of antibiotics for bacterial throat infection have made it rare in UK
but is most common cause of cardiac valvular disease worldwide
what are the jones criteria and how can they be used
- used to diagnose rheumatic fever
- for diagnosis patient needs to meet required criteria AND have either of:
- two major
- one major and two minor
what are the required criteria of jones criteria
- evidence of streptococcal infection. either:
- positive bacterial throat swab
- raised antistreptolysin O titre
what are the major criteria of the jones criteria
- polyarthritis (can be fleeting)
- erythema marginatum
- subcutaneous nodules
- carditis
- chorea
minor criteria of jones criteria
- fever
- arthralgia
- raised ESR, CRP or WCC
- previous rheumatic fever
- prolonged PR on ECG
ecg finding in rheumatic fever
prolonged PR
they may not have this
it is one of the minor criteria
acute management of rheumatic fever
- bed rest
- high dose aspirin
- steroids for severe carditis
- diuretics and ace inhibitors for heart failure
- Abx for acute illness and for prophylaxis of endocarditis
- for 5-10yrs
what is the most common complication of rheumatic fever
rheumatic valvular disease
any child with fever and a murmer what should you expect
endocarditis
what is the most common causative organism in endocarditis
strep viridans
this is alpha haemolytic streptococcus
diagnosis of endocarditis
cross sectional echocardiography can confirm diagnosis but cannot exclude
three blood cultures taken in first 24hrs of admission
treatment for infective endocarditis
4-6 weeks of IV abx
e.g. high dose ampicillin
investigations in a child presenting with abdominal pain
- urinalysis
- dipstick
- mcs if indicated
- bloods
- fbc
- crp
- lfts if jaundiced
- imaging
- abdo x ray rarely useful
- USS
- can diagnose intussusception
- can sometimes see appendicitis but cannot rule out
organic causes of recurrent abdo pain
recurrent UTI
renal calculi
Helicobacter pylori gastritis
IBD
malrotation with intermittent volvolus
gallstones
recurrent pancreatitis
compare dehydration and shock with the following features
Sunken eyes and depressed fontanelle
Mucous membranes
Skin turgor
Alertness
HR and RR
Urine output
Skin colour
Extremities
Cap refill
Blood pressure
7 red flags with vomiting
bilious vomiting
localised abdo pain
persistent fever
altered consciousness/bulging fontanelle
meningism
petechial rash
respiratory distress
vomiting blood in first few days of life could be
swallowing maternal blood
acute diarrhoea is most commonly caused by
gastroenteritis
what is a positive rovsing sign and what does it mean
palpation of the left iliac fossa causes pain in the right
appendicitis
bloody diarrhoea should raise suspicion of
Bacterial gastritis particularly HUS (e.coli)
constipation red flags (6)
starts in first few weeks of life
meconium passed >24 hours
abdo distension or bilious vomiting
faltering growth
delayed walking or lower limb neurology
child protection concerns
what age does colic most commonly occur
2 weeks until about 4 months
7 differentials for inconsolable crying in an infant
colic
GORD
cows milk protein allergy
incarcerated hernia
intussusception
otitis media
UTI
infantile colic managment
benign and has a good prognosis
sympathetic explanation of the condition is helpful but there is no evidence for medication
infants at risk of severe GORD
preterm infants
infants with congenital oesophageal anomalies
infants with cerebral palsy
complications of GORD in infants and how many develop complications
- 10% infants with symptomatic reflux develop complications
- bronchospasm and wheeze
- recurrent aspiration pneumonia
- oesophagitis
- could lead to haematemasis and anaemia
- faltering growth
investigation of GORD
- Diagnosed clinically
- posseting
- vomiting
- crying after feeds
- worse when lying down
- sometimes to confirm diagnosis/assess severity
- 24hr oesophageal pH monitoring in older kids
- endoscopy if suspected oesophagitis
management of GORD
- majority will resolve spontaneously by 18 months
- following drugs can be used in severe reflux
- H2 antagonists: ranitidine
- proton pump inhibitors: omeprazole
- prokinetic drugs: domperidone
- reduce lower oesophageal sphincter pressure
- surgery very rarely
- nissen fundoplication
pyloric stenosis is due to
hypertrophy of the smooth muscle of the pyloric sphincter
complications of pyloric stenosis
weight loss
constipation
dehydration
mild jaundice
what is the characteristic electrolyte disturbance in pyloric stenosis
why
hypochloraemic hypokalaemic metabolic alkalosis
due to loss of gastric acid contents
then kidneys retain H ions at expense of potassium
managment of pyloric stenosis
correction of fluid and electrolyte abnormalities
difinitive treatment is ramstedt pyloromyotomy
what is the most common surgical emergency
appendicitis
common associated symptoms with appendicitis other than the pain
anorexia
nausea
vomiting
diarrhoea
constipation
diagnosis and investigations of appendicitis
- usually clinical
- FBC
- CRP
- abdo US may confirm but cannot exclude
management of appendicitis
appendicectomy
if there is diagnostic uncertainty, a period of observation may be indicated
what is mesenteric adenitis
- inflammation of the intraabdominal lymph nodes that can mimic appendicitis
- commonly follows viral infection
- URTI
- gastroenteritis
- obs in hospital since diagnosis difficult
- management is conservative
peak age of incidence of intussusception
5-10 months