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Yr 5 - paeds > paeds cardio/gastro/surgery/neuro > Flashcards

paeds cardio/gastro/surgery/neuro Flashcards

1
Q

RF of PDA

A

high altitude, maternal rubella, prem

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1
Q

signs of PDA

A

heaving apex beat, subclavicular thrill, continuous machinery murmur

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2
Q

when does west syndrome (infantile spasm) present (progressive mental handicap/developmetal regression)

A

4-8 months of life

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3
Q

what metabolic disturbance do you get with pyloric stenosis

A

hypocholoraemic, hypokalaemia metabolic alkalosis

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4
Q

what might you find O/E of intussusception

A

pain, baby (normally 5-7months) bringing knees up to chest, red current jelly stool, right upper quadrant mass (sausage shaped)

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5
Q

RF of intussusception

A

lead point (meckles), concurrent viral infection, boys, CF

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6
Q

what are the features of innocent murmurs

A

soft, systolic, no radiation, varies with posture, no heaves or thrill, come with viral infection, no symptoms

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7
Q

Investigations for TOF

A

ECG - right axis deviation
microarray - if genetic syndrome
CXR - boot shaped heart
Echo

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8
Q

O/E of TOF

A

central cyanosis, thrill or heave, pan systolic murmur heard best at the left sternal edge

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9
Q

complications of TOF

A

pulmonary regurg, SCD, infective endocarditis, arrhythmias

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10
Q

what’s the role of the umbilical vein

A

carries oxygenated blood from the placenta to the babies liver

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11
Q

what does the umbilical artery do

A

returns deoxygenated blood to the placenta

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12
Q

what do the ductus arterioles and the ductus venous become In the adult

A

ligamentum arteriosum and ligamentum venosum

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13
Q

what causes TGA

A

failure of the aorticopulmonary septum to spiral in septation

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14
Q

O/E of TGA

A

RV heave, loud S2 and centrally cyanosed

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15
Q

what does CXR of TGA show

A

egg on string

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16
Q

Mx of TGA

A

1) PGE2
2) emergency atrial balloon septostomy
3) surgery

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17
Q

what kind of VSD are most common

A

perimembranous

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18
Q

MX of eisenmengers

A

heart-lung transplant

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19
Q

what murmur do you get in VSD

A

pan systolic heard best on left lower sternal border

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20
Q

Mx of VSD

A

-if large –> need surgery
-medical Mx –> diuretics and ACEi to reduce after load (reduce pressure in L heart to prevent eisenmengers)

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21
Q

complications of VSD

A

endocarditis, growth failure and sudden death

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22
Q

is epstein anomaly cyanotic ?

A

it can be as often associated with a ASD and a R–>L shunt

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23
Q

O/E of Epstein anomaly

A

gallop rhythm, cyanosis, tachypnoea, signs of heart failure

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24
Q

O/E of ASD

A

ejection systolic murmur and fixed splitting of the S2

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25
Q

Mx of ASD

A

if <5mm –> should close by 12 months of birth

Surgery if >1cm

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26
Q

complications of ASD

A

arrhythmias, stroke if DVT (paradoxical embolism), eisenmengers if large

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27
Q

shunt in AVSD

A

large L to R

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28
Q

murmur in AVSD

A

mid-diastolic rumbling murmur

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29
Q

signs of coarctation of aorta

A

radio-femoral delay, weak peripheral pulses

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30
Q

Mx of coarctation of aorta

A

surgery
-if very bad may need prostaglandins to keep the ductus arteriosus open while awaiting surgery

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31
Q

what should pre and post ductal saturations be

A

difference of no more than 3%

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32
Q

explain the relevance of pre and post ductal saturations

A

pre ductal saturation - measured in right arm and measure saturations before the ductus arteriosus is

post ductal - measure in leg and measure saturations after ductus arteriosus.

If there is a difference of >3% this indicates mixing of the pulmonary circuit and a PDA dependent lesion eg severe coarctation of aorta / TGA

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33
Q

associations of pulmonary stenosis

A

TOF and Noonan

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34
Q

MX of pulmonary stenosis

A

balloon valvuloplasty

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35
Q

O/E of aortic stenosis

A

ejection systolic murmur, slow rising pulse, palpable thrill, narrow pulse pressure

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36
Q

Mx of aortic stenosis

A

percutaneous balloon aortic valvuloplasty or surgical aortic valvotomy

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37
Q

which type of ASD is most common

A

ostium secundum

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38
Q

what else is ASD associated with

A

fetal alcohol syndrome

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39
Q

a baby cyanosed at birth most likely to be

A

TGA

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40
Q

a baby cyanosed a 1-2 months after birth most likely to be

A

TOF

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41
Q

describe formation of the atrial septum

A

first septum primum forms (when looking at image, this is the septum closest to Left atrium). At bottom of here is the ostium primum. This then closes and the ostium secundum forms half way down the septum primum.

The septum secundum then forms (closest to the Right atrium) and a gap in this septum –> foramen ovale.

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42
Q

what is pulses parodoxus

A

in cardiac tamponade / severe asthma >10mmHg pressure fall in inspiration

43
Q

what kind of pulse do you get in aortic regurg

A

collapsing

44
Q

what is a bisferiens pulse

A

two peaks in the peripheral pulse in systole

45
Q

what side is gastroschisis more common on

A

right

46
Q

Rf of gastroschisis

A

maternal age <20, maternal smoking

47
Q

worse prognosis of gastroschisis

A

intestinal atresia

48
Q

presentation of NEC

A

feeding intolerance, abdo distension, bloody stools –> abdo discolouration and peripheral shut down

49
Q

Ix for NEC

A

1) bloods (anaemia, thrombocytopenia and leucocytosis)
2) blood cultures
3) blood gas (metabolic acidosis)
4) US FIRSTLINE
5) Xray - pneumatosis intestinalis

50
Q

complications of NEC

A

intestinal structure, short bowel syndrome, sepsis, perforation

51
Q

give 5 causes of liver failure in paeds

A

1) Wilsons
2) alpha 1 antitrypsin deficiency
3) hepatitis
4) paracetamol OD
5) autoimmune

52
Q

IX for alpha 1 antitrypsin deficiency

A

serum A1 antitrypsin and genetic testing

53
Q

MX of alpha 1 antitrypsin deficiency

A

liver transplant and lung volume reduction surgery

54
Q

who does autoimmune hepatitis normally affect

A

young females

55
Q

how does autoimmune hepatitis present

A

fever, jaundice (in 25%), amenorrhoea

56
Q

antibodies in autoimmune hepatitis

A

ANA and anti smooth muscle

57
Q

what should happen when a baby is born to a mum who is infected with Hep B

A

complete course of Hep B vaccination and Hep B immunoglobulin on birth

58
Q

conditions associated with omphalocele

A

downs and beckwith wiedemann

59
Q

RF of omphalocele

A

maternal smoking and age >40

60
Q

AFP is low in the quadruple test for DS, what conditions is it high in

A

gastroschisis, omphalocele and neural tube defects

61
Q

term for faecal incontinence

A

encopresis

62
Q

conditions which cause constipation in children

A

hirschsprungs, CF, hypothyroidism, anal stenois, coeliac

63
Q

red flags of constipation in children

A

not passing meconium in 48 hours, ribbon stools, severe acute abdo pain, failure to thrive, any leg weakness or neurological abnormality

64
Q

complications of chronic constipation

A

pain, reduced sensation, anal issues, haemorrhoids, UTI (bladder neck compressed)

65
Q

disimpaction regime –> escalating dose of movicol. When is a stimulant laxative added?

A

if not disimpacted after two weeks

66
Q

firstline laxative for children

A

a macrogol like movicol

67
Q

what is sandifer syndrome

A

abnormal movements of the baby’s head/neck in response to reflux

68
Q

IX of GORD

A

clinical Dx but can do a 24 hour oesophageal pH

69
Q

when to suspect GORD

A

infant excessively crying, hoarseness of voice, unexplained pneumonia, child over 2 who has retrosternal pain

70
Q

Mx of GORD in breastfed baby

A

1/2 week trial of gaviscon infant, if this does not work try 4 week trial omeprazole

71
Q

complications of Hirschsprung disease

A

Hirschsprung associated enterocolitis (overgrowth of E coli and C diff)

Faecal incontinence

72
Q

maintenance Tx for UC vs crohns

A

crohns - azathioprine / mercaptopurine ARE ALWAYS FIRSTLINE

UC - aminosalicylate firstline. Add azathioprine / mercaptopurine if had >2 relapses in one year.

73
Q

can methotrexate be used in Tx of crohns or UC

A

crohns only

74
Q

what’s a really important Mx point for crohns

A

STOP smoking

75
Q

what is psoas sign

A

in appendicitis, RIF pain with extension of the right hip

76
Q

how long to get back to normal activities after appendicitis

A

2-4 weeks

77
Q

who might appendicitis have an atypical presentation in

A

old people, children and pregnant

78
Q

Dx of biliary atresia

A

percutaneous liver biopsy with intraoperative cholangioscopy

79
Q

surgery for biliary atresia

A

kasai portoenterostomy

(and then need bile enhancers and abx for the first year of life)

80
Q

complications of biliary atresia

A

liver cirrhosis, ascending cholangitis, portal hypertension

81
Q

Investigation for meckels

A

meckels scan using technetium

82
Q

presentation of meckels

A

can be asymptomatic or can present similarly to appendicitis and can cause GI bleed!!!!

83
Q

one undescended testis should be referred at what age

A

3 months

84
Q

if bilaterally undescended testis, when should they be reviewed by a specialist

A

within 24 hours

85
Q

Rf for undescended testis

A

prem, FHx

86
Q

when is orchidopexy done for cryptorchidism

A

12 months

87
Q

where is the deep inguinal ring found

A

midpoint of inguinal lig (half way between ASIS and pubic tubercle)

88
Q

presentation of retinoblastoma

A

normally at 18 months, get absence of red reflex and it gets replaced by a white pupil, strabismus

89
Q

VACTERAL associations

A

vertebral abnormalities
anal atresia
cardiovascular anomalies
TOF
oesophageal atresia
renal anomalies
limb anomalies

90
Q

Ix for tracheooeophogeal fistula

A

AXR shows air in the stomach

91
Q

causes for intestinal obstruction in paeds

A

anal atresia, Hirschsprung, volvulus, meconium ileus, strangulate hernia

92
Q

what normally causes a hydrocele

A

patent processus vaginalis

93
Q

what else does a patent processus vaginalis necessitate

A

inguinal hernia

94
Q

how does an acute subdural haemorrhage present on CT

A

hyper dense (bright/white)

95
Q

apart from hydrocephalus, what are some other causes for raised ICP

A

haemorrhage, brain tumour

95
Q

CSF causes of a raised ICP

A

hydrocephalus –> due to aqueduct stenosis / problems draining

96
Q

MX points for raised ICP

A

elevate head of bed, analgesics, anticonvulsants, controlled hyperventilation, sedation, manitol, shunts, invasive ICP monitoring, reverse any coagulopathies

97
Q

what is the difference between cyanotic breath holding spells and pallid breath holding spells (AKA reflex anoxic)

A

cyanotic –> let out a long cry, then breath hold and become cyanotic / lose consciousness

pallid breath holding –> when child is startled and their vagus nerve is stimulated –> reduce CO and cause cerebral hypo perfusion

98
Q

how motor neurones are affected in SMA

A

lower motor neurones (so get hypotonia, hyporeflexia, fasciculations, reduced muscle bulk and reduced power
-may have respiratory muscle involvement and swallow difficulties

99
Q

what type of SMA is most common

A

type 1 (will nerve sit)

100
Q

investigations for SMA

A

genetic testing for the SMN1 gene

101
Q

Mx of SMA

A

MDT, physio, NIV, PEG

102
Q

signs of hydrocephalus in child

A

increase in head circumference, sunsetting of eyes, bulging anterior fontanelle

103
Q

both a craniopharyngioma and a pituitary adenoma cause bitemporal hemianopia - but what distinguishes them

A

craniopharyngioma - predominately inferior defect

pituitary macroadenoma - predominately superior defect

104
Q

what’s a fluid challenge

A

drinking 0.2ml.kg every 10 minutes. Should be able to tolerate without vomiting. If they vomit give antiemetic (ondansetron is the antiemetic of choice in children)

105
Q
A

3

Yr 5 - paeds (4 decks)

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