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Phase 3a > Paeds cardio and resp > Flashcards

Paeds cardio and resp Flashcards

1
Q

What are the most common pathogens associated with infective endocarditis?

A 
Strep viridans (dental stuff)
Staph aureus (central venous catheters)
Enterococcus
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2
Q

What are the symptoms of infective endocarditis?

A

Fever - may be the only feature

+ myocarditis, arthralgia + other B symptoms basically

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3
Q

What are the signs of infective endocarditis?

A 
Pallor
Splinter haemorrhages
Osler's nodes
Janeway lesions
Clubbing
(+ bare others)
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4
Q

How would you diagnose infective endocarditis?

A

Bloods:

  • Raised WCC
  • High ESR / CRP
  • +ve blood cultures

Diagnostic = ECHO to look at valve vegetations

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5
Q

How would you treat a child with infective endocarditis?

A

IV Penicillin / Vancomycin - minimum 6 weeks
Bed rest
Surgery to remove infected prosthetic material

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6
Q

How would you prevent infective endocarditis?

A

Good dental hygiene

Prophylaxis for high risk groups

  • Amoxicillin before dental surgery
    • prophylactic amoxicillin in other surgeries that involve infection
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7
Q

What organism is involved in the pathophysiology of rheumatic fever?

A

Group A beta-haemolytic strep

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8
Q

What are the risk factors for rheumatic fever?

A 
Old people
Living in less well developed countries
Babies
Previous RF
Immunosuppressed / immunocompromised
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9
Q

CASE:

A child presents with non-specific malaise, pain in their knees, a non-itchy rash, bumps on their skin. A few weeks ago they had a sore throat.

Diagnosis?

A

Rheumatic fever

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10
Q

How do you diagnose rheumatic fever?

A

Jones criteria - 2 major features or 1 major + 2 minor + evidence of previous group A strep

Major:
Pancarditis
Polyarthritis
Erythema marginatum
Subcutaneous nodules
Sydenham's chorea
Minor:
Pyrexia
Arthralgia
Abnormal ECG (prolonged PR interval)
Elevated ESR / CRP
Evidence of strep infection
History of rheumatic fever
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11
Q

How do you treat rheumatic fever?

A 
Anti-inflammatory eg aspirin
Corticosteroids
Diuretics / ACE inhibitors for heart failure
Pericardiocentesis
Penicillin V for 10 days
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12
Q

How would you prevent rheumatic fever?

A

Antibiotic prophylaxis

Daily oral penicillin / oral erythromycin

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13
Q

What are the complications of rheumatic fever?

A

Long term valvular problems

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14
Q

At what age do children get Croup?

A

6 months to 6 years

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15
Q

What are the pathogens associated with Croup?

A

Parainfluenza
RSV
Influenza
Human metapneumovirus

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16
Q

What should you not do in a child with croup and why?

A

Examine the throat

Risk of obstruction (narrowing of trachea)

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17
Q

What are the symptoms of croup?

A 
Fever and coryzal symptoms
Barking cough
Harsh stridor
Hoarse voice
Chest recessions
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18
Q

When are the symptoms of croup worse?

A

At night

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19
Q

What condition do you need to exclude in a child presenting with stridor?

A

Epiglottitis

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20
Q

What are the features associated with severe croup?

A 
Frequent barking cough
Prominent stridor at rest - can be expiratory
Marked sternal wall recessions
Significant distress in child
Signs of hypoxaemia
Decreased level of consciousness
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21
Q

How do you treat croup?

A

Singe dose oral dexamethasone 0.15mg/kg

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22
Q

How do you treat croup in a child who is too unwell to take oral medication?

A

Inhaled budesonide 2mg or IM dexamethasone

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23
Q

How would you treat a child who has severe croup?

A

High flow oxygen

Nebulised adrenaline

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24
Q

Which pathogen causes epiglottitis?

A

Hib

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25
Q

How does a child with epiglottitis present?

A 
High fever
Toxic looking
Throat pain stops them from speaking and swallowing, saliva drooling
Stridor
Sitting upright
Open mouth
No cough
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26
Q

How would you investigate a child with suspected epiglottitis?

A

DONT EXAMINE THE THROAT

+ take blood cultures once they are stabilised

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27
Q

How do you treat a child with epiglottitis?

A

Stabilise airway - might be tracheostomy

IV cefuroxime 3-5 days

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28
Q

How you do prevent epiglottitis in close contacts of an affected child?

A

Rifampicin

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29
Q

What organism causes whooping cough?

A

Bordatella pertussis

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30
Q

What are the clinical stages of whooping cough?

A

Catarrhal 1-2 weeks
Paroxysmal 2-6 weeks
Convalescent 2-4 weeks

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31
Q

Describe what you’d hear / see in a child with whooping cough

A

Severe paroxysmal cough followed by inspiratory whoop and vomiting
During paroxysm - child goes red or blue, epistaxis, subconjunctival haemorrhages

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32
Q

How would you make a diagnosis of whooping cough?

A

Clinical
+ per-nasal swab and culture or PCR

Blood count - lymphocytosis

CXR?

33
Q

When would you treat a child with whooping cough?

A

If the cough has only just begun and they’ve been in contact with a child with whooping cough

If they are young - close monitoring due to seizures, encephalopathy

If history of apnoea, cyanosis or significant paroxysms

34
Q

CASE

A child comes to you with a cough, and his mother says that his friend at school has had whooping cough.

What would you prescribe?

A

Erythromycin

If they haven’t been vaccinated - give them the vaccine

35
Q

What are the common causes of pneumonia in a newborn child?

A

Group B strep
Gram neg enterococci

(from mother’s genital tract)

36
Q

What are the common pathogens that cause pneumonia in a small child?

A

RSV + other resp viruses
Strep pneumoniae
Haemophilus influenzae

37
Q

What are the common pathogens that cause pneumonia in children older than 5?

A

Mycoplasma pneumoniae
Strep pneumoniae
Chlamydia pneumoniae

38
Q

CASE

A child presents with 4 day history of fever, cough, poor feeding, and is becoming increasingly tired. The parents are worried that the child is struggling to breathe.

What would you look for on examination?

+ What is the diagnosis?

A 
Resp rate (tachypnoea)
Nasal flaring
Chest indrawing
Grunting
Use of accessory muscles
Crackles (end-inspiratory)
O2 sats (decreased)
Dullness on percussion
Breath sounds (decreased, bronchial breathing)

LRTI (pneumonia)

39
Q

How do you make a diagnosis of pneumonia?

A

Clinical

+ CXR showing consolidation on affected area

40
Q

How would you differentiate between bacterial and viral pneumonia?

A

FBC (increased WCC in bacterial)
CRP (raised in bacterial)
ESR (raised in bacterial)

41
Q

How would you treat a child with suspected pneumonia first-line?

A

Oral amoxicillin

42
Q

How would you treat a child with suspected pneumonia caused by mycoplasma or chlamydia pneumoniae?

A

Atypical organisms, so macrolide antibiotic - erythromycin or clarithromycin

43
Q

Other than antibiotics, how would you treat a child with pneumonia?

A

Antipyretics for fever - calpol etc
IV fluids if dehydrated
Supplemental oxygen if sats low
Chest drain if collections

44
Q

At what age do children get bronchiolitis?

A

1-9 months

Basically under 1 year

45
Q

What are the risk factors for bronchiolitis?

A

Premature babies who develop bronchopulmonary dysplasia
Underlying lung disease eg CF
Congenital heart disease

46
Q

What are the common pathogens that cause bronchiolitis?

A

RSV

+ human metapneumovirus, parainfluenza, rhinovirus, adenovirus, influenza

47
Q

CASE

A 6 month old child presents with a 1 week history of coryzal illness, with a 2 day history of a dry cough and increasing breathlessness.

What is the most likely diagnosis?

A

Bronchiolitis

48
Q

What are the common symptoms associated with bronchiolitis?

A

Coryzal symptoms
Dry cough
Breathlessness

49
Q

What would you find on examination in a child with bronchiolitis?

A 
Sharp dry cough
Tachypnoea
High pitched wheeze
Tachycardia
Recession - intercostal / subcostal
Hyperinflation
End-inspiratory crackles
Cyanosis / pallor
50
Q

How would you treat a child with bronchiolitis?

A

Supportive!!!

Humidified oxygen
Fluids
CPAP
Good hygiene

51
Q

How do you prevent bronchiolitis?

what, when, how

A

Pavilizumab
Monoclonal antibody to RSV
To high risk groups IM monthly
Starting October for 5 months

52
Q

To which groups of children would you give prophylaxis for bronchiolitis?

A

Premature
Chronic lung disease
Congenital heart disease

53
Q

What are the symptoms associated with asthma?

A

Wheeze
Cough
Breathlessness
Limitation in exercise performance

54
Q

What would you expect to see on examination of a child with asthma?

A

Barrel shaped chest
Hyperinflation
Wheeze
Prolonged expiration

55
Q

What would you ask about a child’s symptom’s if you suspect they might have asthma?

A

Diurnal variation
Triggers
Interval symptoms between acute exacerbations

56
Q

How would you investigate a child with asthma?

A 
Skin prick tests for common allergens
CXR to rule out other conditions
PEFR:
- <80% predicted for height
- Diurnal variation
- Improved post bronchodilator

Spirometry - FEV1/FVC radio <80% predicted

57
Q

What would you expect to see in the PEFR of a child with asthma?

A

<80% predicted for height
Diurnal variation (lower in the morning)
Day to day variability
Increase of more than 15% post bronchodilator

58
Q

Outline the stepwise management of asthma for children over 5 years of age

A 
SABA
Add ICS
Add Montelukast
Add LABA
Change LABA + ICS to MART
Increase dose of ICS
59
Q

How would you manage a child presenting with an acute asthma attack?

A 
Oxygen
SABA
IV hydrocortisone
IV salbutamol bolus
MgSO4 / salbutamol infusion
60
Q

How does a child with viral induced wheeze present?

A

WHEEZE (duh)
+ cough, URTI generally
(asthma symptoms)

61
Q

At what age do children develop viral induced wheeze?

A

Over 1 basically (less than that is bronchiolitis)

62
Q

How would you treat a child with viral induced wheeze?

A

Bronchodilators

Can use oral steroids

63
Q

Which 3 people would you call for a child with acute epiglottitis?

A

Paediatrician
Anaesthetist
ENT surgeon

64
Q

What are the differentials for epiglottitis?

A

Croup

Bacterial tracheitis

65
Q

What is the main differentiating feature between croup / epiglottitis and bacterial tracheitis?

A

Bacterial tracheitis = thick secretions

66
Q

Which organism causes bacterial tracheitis?

A

Staph aureus

67
Q

What are the signs of respiratory distress?

A 
Nasal flaring
Intercostal / subcostal recession
Grunting
Tracheal tug
Use of accessory muscles
Purse lip breathing
Tachypnoea
68
Q

What chromosome is affected in CF?

A

7

69
Q

What is the inheritance pattern of CF?

A

Autosomal recessive

70
Q

Which gene is affected in CF?

A

CFTR

71
Q

The transport of which ion is affected in CF?

A

Chloride

72
Q

How would CF present in a newborn?

A

Meconium ileus

On guthrie test

73
Q

What would you look for on the Guthrie test to identify CF?

A

Immunoreactive trypsinogen

74
Q

How would a baby (post-neonatal period) present with CF?

A

Prolonged jaundice
Recurrent chest infections
Failure to thrive
Malabsorption - pale, floating stools

75
Q

How would a child present with CF (no longer a baby)?

A 
ABPA
Diabetes
Malabsorption
Nasal polyps
Sterility in males
Portal hypertension / cirrhosis
76
Q

Who would be involved in the care of a patient with CF?

A 
Doctor
Nurse
Chest physio
School teacher
Psychiatrist + support groups (online)
77
Q

What organisms should be watched out for in a child with CF?

A

Aspergillus
Pseudomonas aeruginosa
Burkholderia cepacia

78
Q

Give examples of how you would manage a child with CF in the long term?

A

Creon - pancreatic supplements
High calorie diet
Pick line (for antibiotics if they have a chronic or bad infection)
Treatment of anxiety and depression
Chest physio
Flu vaccine
Fluclox prophylaxis against staph aureus when young

79
Q

Which novel drug is being used to treat patients with certain forms of CF?

A

Lumacaftor (CFTR corrector)

Phase 3a (11 decks)

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