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C TO REVISE - PHASE 3A > PAEDS - CARDIO, RESP, GI AND NEONATAL > Flashcards

PAEDS - CARDIO, RESP, GI AND NEONATAL Flashcards

1
Q

VSD
What are some complications of VSD?

A
  • Increased risk of infective endocarditis > Abx prophylaxis during surgery
  • AR, Eisenmenger’s syndrome + right heart failure
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2
Q

COARCTATION OF AORTA
What is the clinical presentation of coarctation of aorta?
How may it present if severe?

A
  • Weak femoral pulses + radiofemoral delay
  • Systolic murmur between scapulas or below L clavicle
  • Heart failure, tachypnoea, poor feeding, floppy
  • LV heave (LVH)
  • Acute circulatory collapse at 2d as duct closes (duct dependent)
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3
Q

RHEUMATIC FEVER
What are the major criteria in rheumatic fever?

A

JONES –

  • Joint arthritis (migratory as affects different joints at different times)
  • Organ inflammation (pancarditis > pericardial friction rub)
  • Nodules (subcut over extensor surfaces)
  • Erythema marginatum rash (pink rings of varying sizes on torso + proximal limbs)
  • Sydenham chorea
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4
Q

RHEUMATIC FEVER
What are the minor criteria in rheumatic fever?

A

FEAR –

  • Fever
  • ECG changes (prolonged PR interval) without carditis
  • Arthralgia without arthritis
  • Raised CRP/ESR
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5
Q

SUPRAVENTRICLAR TACHYCARDIA
What is the management of a supraventricular tachycardia?

A
  • 1st line = Vagal stimulation (carotid sinus massage, cold ice pack to face)
  • 2nd line = IV adenosine
  • 3rd line = Electrical cardioversion
  • Long term = ablation of pathway or flecainide
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6
Q

TOF
What are some risk factors?

A
  • Rubella,
  • maternal age >40,
  • alcohol in pregnancy,
  • maternal DM
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7
Q

SUPRAVENTRICLAR TACHYCARDIA
What is the ECG like?

A
  • Narrow complex tachycardia (250-300bpm)
  • WPW = delta wave (slurred upstroke to QRS) with a short PR interval
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8
Q

RESP OVERVIEW
What are some risk factors for respiratory infections?

A
  • Parental smoking
  • Poor socioeconomic status
  • Male gender
  • Immunodeficiency
  • Underlying lung disease
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9
Q

BRONCHIOLITIS
What are some criteria for admission?

A
  • Apnoea
  • Severe resp distress (RR>60, marked chest recession, grunting)
  • Central cyanosis
  • SpO2 < 92%
  • Dehydration
  • 50–75% usual intake
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10
Q

BRONCHIOLITIS
What can be given as prevention against bronchiolitis?
Who would be given this?

A
  • Monoclonal Ab to RSV = palivizumab as monthly IM
  • Reduces hospital admissions in high-risk infants (preterm, cystic fibrosis, congenital heart disease)
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11
Q

PNEUMONIA
How can CXR indicate what the causative organism may be?

A
  • Lobar consolidation (dense white area in a lobe) = pneumococcus
  • Rounded air-filled cavities (pneumatoceles) + multi-lobar = S. aureus
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12
Q

PNEUMONIA
What is the management of pneumonia?

A
  • Newborns = IV benzylpenicillin
  • Older = co-amoxiclav
  • erythromycin to cover for mycoplasma, chlamydia or if unresponsive
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13
Q

ASTHMA
What are the characteristics of asthma?

A
  • Airflow limitation due to bronchospasm (reversible spontaneously or with Tx)
  • Airway hyperresponsiveness to various triggers
  • Bronchial inflammation
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14
Q

ASTHMA
What is classed as a severe asthma exacerbation?

A
  • PEFR 33–50% predicted
  • Unable to complete full sentences
  • RR>50 (2-5y), or >30 (>5y)
  • HR >130 (2-5y) or >120 (>5y)
  • Signs of resp distress (chest recessions)
  • SpO2 <92%
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15
Q

CYSTIC FIBROSIS
What is the pathophysiology of cystic fibrosis?

A
  • Decreased Cl- excretion into airway lumen + increased reabsorption of Na+ into epithelial cells means less excretion of salt (+ so water) > increased viscosity of airway secretion
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16
Q

CYSTIC FIBROSIS
How does cystic fibrosis present in older children + adolescents?

A
  • DM (pancreatic insufficiency)
  • Cirrhosis + portal HTN
  • Distal intestinal obstruction
  • Pneumothorax or recurrent haemoptysis
  • Sterility in males as absent vas deferens
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17
Q

CYSTIC FIBROSIS
What are some signs of cystic fibrosis?

A
  • Low weight or height on growth charts
  • Hyperinflation due to air trapping
  • Coarse inspiration crepitations ± expiratory wheeze
  • Finger clubbing
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18
Q

CYSTIC FIBROSIS
What are some typical causes of respiratory tract infections in cystic fibrosis?

A
  • S. aureus
  • H. influenzae
  • Pseudomonas aeruginosa
  • Bulkholderia cepacia associated with increased morbidity + mortality
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19
Q

ASTHMA
What are some risk factors for asthma?

A

LBW, FHx, bottle fed, atopy, male, pollution

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20
Q

VIRAL INDUCED WHEEZE
What are some risk factors?

A

Maternal smoking during/after pregnancy + prematurity

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21
Q

ASTHMA
What is the mechanism of action for theophyllines?

A

Relaxes bronchial smooth muscle + reduces inflammation

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22
Q

ASTHMA
What are the important side effects of ICS?

A

Oral thrush,
adrenal + growth suppression,
DM,
osteoporosis

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23
Q

ASTHMA
What are the important side effects of theophylline?

A

Vomiting,
insomnia,
headaches

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24
Q

PNEUMONIA
What are the common causes of pneumonia in infants + young children?

A

RSV most common,
pneumococcus #1 bacterial,
H. influenzae,
Bordatella pertussis,
chlamydia trachomatis

(S. aureus rarely but = serious)

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25
Q

PNEUMONIA
What are the common causes of pneumonia in children >5?

A

Pneumococcus,
mycoplasma pneumoniae,
chlamydia pneumoniae

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26
Q

MALABSORPTION
What are some causes of malabsorption?

A
  • Small intestine disease = coeliac
  • Exocrine pancreas dysfunction = CF
  • Cholestatic liver disease, biliary atresia
  • Short bowel syndrome (NEC, bowel removal)
  • Loss of terminal ileum function (resection, Crohn’s, absent bile acid)
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27
Q

IBD
How do you induce remission in Ulcerative colitis?

A

Mild to moderate disease
- 1st line = aminosalicylate (e.g. mesalazine oral or rectal)
- 2nd line = corticosteroids (e.g. prednisolone)

Severe disease
- 1st line = IV corticosteroids (e.g. hydrocortisone)
- 2nd line = IV ciclosporin

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28
Q

IBD
How do you maintain remission in Ulcerative colitis?
What should be cautioned?

A
  • PO/PR mesalazine, azathioprine or mercaptopurine
  • Mesalazine can cause acute pancreatitis
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29
Q

COELIAC DISEASE
What is the consequence of the autoimmune response in coeliac disease?

A
  • Autoantibodies in response to gluten exposure target epithelial cells of intestine > inflammation + atrophy of the intestinal villi > malabsorption of nutrients
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30
Q

COELIAC DISEASE
What are some complications of coeliac disease?

A
  • Anaemias
  • Osteoporosis
  • Lymphoma (EATL)
  • Hyposplenism
  • Lactose intolerance
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31
Q

PYLORIC STENOSIS
What is the management of pyloric stenosis?

A
  • Correct fluid + electrolyte disturbances (0.45% saline, 5% dextrose + K+ supplements) before any surgery
  • Laparoscopic Ramstedt’s pyloromyotomy
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32
Q

APPENDICITIS
What are the signs of appendicitis?

A
  • Low grade fever
  • Abdominal pain aggravated by movement
  • RIF tenderness + guarding (McBurney’s point)
  • Rebound + percussion tenderness (precipitated by cough, jump)
  • Rovsing’s sign = LIF pressure causes RIF pain
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33
Q

MECKEL’S DIVERTICULUM
What is Meckel’s diverticulum?

A
  • Ileal remnant of the vitello-intestinal duct which contains ectopic gastric mucosa or pancreatic tissue
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34
Q

CONSTIPATION
What are some causes of constipation?

A
  • Usually idiopathic
  • Meds (opiates)
  • LDs
  • Hypothyroidism
  • Hypercalcaemia
  • Poor diet (dehydration, low fibre)
  • Occasionally forceful potty training
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35
Q

CONSTIPATION
What are some red flags in constipation?

A
  • Delayed passage of meconium = Hirschsprung’s, CF
  • Failure to thrive = hypothyroid, coeliac
  • Abnormal lower limb neurology = lumbosacral pathology
  • Perianal bruising or multiple fissures = ?abuse
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36
Q

CONSTIPATION
What is the process of constipation and overflow diarrhoea?

A
  • Prolonged faecal status = resorption of fluids = increase in size + consistency
  • This leads to rectal stretching + reduced sensation > overflow + soiling (very smelly)
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37
Q

GORD
What are the investigations for GORD?

A
  • Usually clinical but if atypical Hx, complications or failed Tx…
    – 24h oesophageal pH monitoring
    – Endoscopy + biopsy to identify oesophagitis
    – Contrast studies like barium meal
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38
Q

GORD
What are some complications of GORD?

A
  • Failure to thrive from severe vomiting
  • Oesophagitis = haematemesis, discomfort on feeding or heartburn, Fe anaemia
  • Aspiration > recurrent pneumonia, cough/wheeze
  • Sandifer syndrome = dystonic neck posturing (torticollis)
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39
Q

GASTROENTERITIS
What are signs of clinical shock?

A
  • Pale/mottled
  • Hypotension
  • Prolonged CRT
  • Cold
  • Decreased GCS
  • Sunken fontanelle
  • Weak pulses
  • Anuria
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40
Q

GASTROENTERITIS
What are some complications of gastroenteritis?

A
  • Isonatraemic + hyponatraemic dehydration
  • Hypernatraemic dehydration
  • Post-infective lactose intolerance (remove lactose + slowly reintroduce)
  • Guillain-Barré
  • Dehydration #1 cause of death
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41
Q

BILIARY ATRESIA
What are the investigations for biliary atresia?

A
  • Serum split bilirubin = conjugated elevated
  • USS abdo gold standard for Dx, laparotomy confirms
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42
Q

BILIARY ATRESIA
What is the management of biliary atresia?

A
  • Kasai portoenterostomy (attach section of small intestine to opening of liver where bile duct attaches)
  • Some will need full liver transplant
  • Success decreases with age so early Dx crucial
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43
Q

NEONATAL HEPATITIS
What are some investigations for neonatal hepatitis syndrome?

A
  • Deranged LFTs with raised unconjugated + conjugated bilirubin
  • Liver biopsy = multinucleated giant cells + Rosette formation
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44
Q

NEONATAL HEPATITIS
What are 4 main causes of neonatal hepatitis?

A
  • Congenital infection
  • Alpha-1-antitrypsin (A1AT) deficiency
  • Galactosaemia
  • Wilson’s disease
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45
Q

NEONATAL HEPATITIS
What are the complications of galactosaemia?

A
  • Rapidly fatal course with shock, DIC + haemorrhage due to gram -ve sepsis
  • Liver failure, cataracts + Developmental delay if untreated
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46
Q

NEONATAL HEPATITIS
What is the management of galactosaemia?

A
  • Stop cow’s milk, breastfeeding C/I
  • Dairy-free diet
  • IV fluids
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47
Q

NEONATAL HEPATITIS
What is Wilson’s disease?

A
  • Reduced synthesis of caeruloplasmin (normally binds to copper + allows it to be excreted with bile)
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48
Q

NEONATAL HEPATITIS
How does Wilson’s disease present?

A

Sx of copper accumulation

  • Eyes (Kayser-Fleischer rings)
  • Brain (Parkinsonism + psychosis)
  • Kidneys (vit D resistant rickets)
  • Liver (jaundice)
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49
Q

NEONATAL HEPATITIS
What are the investigations for Wilson’s disease?

A
  • 24h urine copper assay (high),
  • serum caeruloplasmin (low)
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50
Q

FAILURE TO THRIVE
What are some causes of malabsorption?

A
  • Cystic fibrosis
  • Cow’s milk protein intolerance
  • Coeliac disease
  • IBD
  • Short gut syndrome
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51
Q

CMPA
What is the management for cows milk protein allergy (CMPA)?

A
  • Breastfeeding mothers should avoid dairy
  • Replace formula with extensive hydrolysed formula
  • Amino acid-based formula if severe or no response to eHF
  • Food challenge may be performed in hospital setting
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52
Q

KWASHIOKOR
what are the clinical features?

A
  • growth retardation
  • diarrhoea
  • anorexia
  • oedema - defining characteristic
  • skin/hair depigmentation
  • abdominal distension with fatty liver
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53
Q

MARASMUS
what are the clinical features?

A
  • height is relatively preserved compared to weight
  • wasted appearance
  • muscle atrophy
  • listless
  • diarrhoea
  • constipation
54
Q

HERNIA
what are the risk factors for developing a hernia?

A
  • premature, underweight babies
  • male gender
  • family history
  • medical conditions - undescended testes, CF
  • African descent
55
Q

CHOLEDOCHAL CYST
what are the investigations?

A

can be detected on ultrasound before the child is born

after the baby is born, the parent’s may notice lump in RUQ, the following tests are then done:
- CT scan
- cholangiography

56
Q

LIVER FAILURE
what are the causes?

A
  • chronic hepatitis
  • biliary tree disease
  • toxin induced
  • A1AT deficiency
  • autoimmune hepatitis
  • wilson’s disease
  • CF
  • budd-chiari syndrome
  • primary sclerosing cholangitis
57
Q

IBD
what is the histology of ulcerative colitis?

A
  • Increased crypt abscesses,
  • pseudopolyps,
  • ulcers
58
Q

COELIAC DISEASE
What is the pathophysiology?

A

Autoimmune response to alpha-gliadin portion of protein gluten causes inflammation in small intestine (particularly jejunum)

59
Q

COELIAC DISEASE
What conditions is coeliac disease associated with?

A
  • T1DM,
  • thyroid,
  • Down’s syndrome,
  • FHx = test for it
60
Q

GASTROENTERITIS
How is shock managed in gastroenteritis?

A

Rapid IVI (0.9% NaCl 20ml/kg), repeat if necessary, Abx if septicaemia

61
Q

BILIARY ATRESIA
What genetic mutation is biliary atresia associated with?

A

Associated with CFC1 gene mutations

62
Q

NEONATAL HEPATITIS
What is the presentation of A1AT deficiency?

A
  • Prolonged neonatal jaundice (cholestasis), worse on breast feeding,
  • can have (prolonged) bleeding due to vitamin K deficiency,
  • COPD
63
Q

NEONATAL HEPATITIS
What are the genetics for Wilson’s disease?

A

AR on chromosome 13

64
Q

FAILURE TO THRIVE
What are some causes of inability to process nutrients properly?

A
  • T1DM,
  • inborn errors of metabolism
65
Q

NEONATAL HEPATITIS
What is the management of Wilson’s disease?

A

Penicillamine for copper chelation

66
Q

ASTHMA
What is the stepwise management of chronic asthma in <5y? (BTS guidance)

A
  • 1 = PRN SABA
  • 2 = Low dose ICS OR PO montelukast
  • 3 = Other option from 2
  • 4 = refer to specialist
67
Q

ASTHMA
What is the stepwise management of chronic asthma >5y? (BTS guidance)

A
  • 1 = PRN SABA
  • 2 = SABA + low dose ICS
  • 3 = SABA + low dose ICS + LABA (only continue if good response)
  • 4 = increase ICS dose (?LTRA or PO theophylline)
  • 5 = PO steroids in lowest tolerated dose
  • May need immunosuppression or immunomodulation therapy with specialist referral
68
Q

ASTHMA
What is the management of asthma in <5 year olds (NICE guidance)

A
  1. PRN SABA
  2. SABA + 8 week trial of moderate ICS
  3. SABA + low ICS + LTRA
  4. Stop LTRA and refer to specialist
69
Q

ASTHMA
What is the management for children >5yrs old? (NICE guidance)

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + low dose ICS + LTRA
  4. SABA + low dose ICS + LABA
  5. SABA + MART (including low dose ICS)
  6. SABA + MART (including mod dose ICS) / LABA + moderate dose ICS
  7. SABA + high dose ICS / theothylline + refer to specialist
70
Q

ASTHMA
What are the stages of management for acute asthma of moderate severity in children?

A

Moderate: Inhaled SABA 10 puffs, PO prednisolone, reassess in 1h

71
Q

ASTHMA
What are the stages of management for acute asthma of severe/life-threatening severity in children?

A
  1. High flow O2 if sats <92%
  2. Salbutamol inhaler (10 puffs every 2 hours)
  3. nebuliser with salbutamol and ipratropium bromide
  4. IV hydrocortisone
  5. IV Magnesium sulfate
  6. IV salbutamol
  7. IV aminophylline
72
Q

RESP PHARMACOLOGY
Give an example of a SABA

A

Salbutamol

73
Q

RESP PHARMACOLOGY
Give an example of a SAMA

A

Ipratropium Bromide

74
Q

RESP PHARMACOLOGY
Give an example of a LABA

A

Salmeterol

75
Q

RESP PHARMACOLOGY
Give an example of a LAMA

A

tiotropium

76
Q

RESP PHARMACOLOGY
Give an example of an LTRA?

A

montelukast

77
Q

RESP PHARMACOLOGY
Give an example of an ICS

A

Beclometasone

78
Q

CHILD ABUSE
What are some risk factors for child abuse?

A
  • Child = failure to meet expectations (disabled, wrong sex), born after forced or commercial sex work
  • Parent = MH issues, substance abuse, LD, young
  • Family = stepparents, domestic abuse, multiple or closely spaced births
  • Environment = low socioeconomic status
79
Q

CHILD ABUSE
What features in the history are suspicious for child abuse?

A
  • Too many injuries, wrong site, unusual shape or pattern
  • Delay in presenting (old injuries), multiple A&E visits
  • No Hx, Hx inconsistent with injuries or that changes
80
Q

CHILD ABUSE
Where are normal and abnormal places for a child to bruise?

A
  • Shins, knees, elbows, toddlers can bump their heads
  • Abdo, genitalia, insides of arms/legs, behind neck or other soft bits, young babies that cannot roll
81
Q

CHILD ABUSE
What other features may raise alarms for child abuse?

A
  • # = metaphyseal, multiple # at different healing stages, posterior rib # in babies v. specific, radial, humeral, femoral
  • Bruising, burns, scalds, failure to thrive
  • Torn frenulum (forcing bottle into mouth)
82
Q

CHILD ABUSE
What is the management for suspected child abuse?

A
  • FBC, clotting screen, bone profile, radiology
  • Developmental + social services assessment
  • If suspected > hospital admission + can break confidentiality
  • Fundoscopy for retinal haemorrhages
83
Q

CHILD ABUSE
What law is relevant to child abuse?

A
  • Child act 2004 allows to speak to child without parents’ consent, safeguards children
84
Q

FAS
How much alcohol is safe in pregnancy?
What are some features of foetal alcohol syndrome?

A
  • None
  • Microcephaly
  • Short palpebral fissures, hypoplastic upper lip, small eyes, smooth philtrum
  • LDs, poor growth + cardiac malformations
  • Can have alcohol withdrawal Sx a birth = irritable, hypotonic, tremors
85
Q

SWELLINGS + CYSTS
What is mastoiditis?
How does it present?
Management?

A
  • Med emergency as can cause meningitis, sinus thrombosis
  • External ear may protrude forwards, severe otalgia (classically behind), fever
  • Swelling, erythema + tenderness over mastoid process
  • Abx ±mastoidectomy
86
Q

PAEDS FLUIDS
What are 3 essential components to a safe fluid prescription?

A
  • Fluid constituents + bag size = NaCl 0.9% + dextrose 5% + KCl 10mmol (500ml)
  • Rate of administration in ml/hour
  • Signature
87
Q

PAEDS FLUIDS
What are important things to consider prior to prescribing fluids?

A
  • Weight ([Age + 4] x 2), including weight change
  • Fluid input/output in past 24h
  • Fluid status (dehydrated)
  • Recent bloods (electrolytes)
88
Q

PAEDS FLUIDS
What is used for maintenance fluids?
How are they calculated?

A
  • 0.9% NaCl + 5% dextrose + KCl 10mmol
  • 100ml/kg/day for first 10kg
  • 50ml/kg/day for next 10kg
  • 20ml/kg/day for every kg after 20kg
  • Divide by 24 = ml/hour
89
Q

PAEDS FLUIDS
How can you calculate % dehydration?
How do you calculate fluids to correct dehydration?

A
  • (Well weight [kg] – current weight [kg]) ÷ well weight

- % dehydration x 10 x weight (kg)

90
Q

PAEDS FLUIDS
What is the general rule for fluid boluses?

A
  • Given in shock
  • 0.9% NaCl at 20ml/kg over <10m
  • After >3 boluses call for paeds intensive care support as risk > pulmonary oedema
91
Q

PAEDS FLUIDS
What fluids do neonates require?
What are their intake requirements?

A
  • Day 1 = just 10% dextrose
  • From day 2 = Na (3mmol/kg/day) + K (2mmol/kg/day)
  • Day 1 = 60ml/kg/day
  • Day 2 = 90ml/kg/day
  • Day 3 = 120ml/kg/day
  • Day 4 + beyond = 150ml/kg/day
92
Q

DEVELOPMENTAL STAGES
How do the developmental milestones correspond with prematurity?

A
  • Age correct up to 2 years
  • 9m born 2 months early should only be expected to be at developmental stage of 7m
93
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a new born?

A

New born = Limbs flexed, symmetrical posture, head lag on pulling up

94
Q

DEVELOPMENTAL DELAY
What are some prenatal causes of developmental delay?

A
  • Genetics (Down’s, fragile X)
  • Congenital hypothyroidism
  • Teratogens (alcohol + drug abuse)
  • Congenital infection (TORCH)
  • Neurocutaneous syndromes (tuberous sclerosis, neurofibromatosis)
95
Q

DEVELOPMENTAL DELAY
What are some perinatal causes of developmental delay?

A
  • Extreme prematurity (intraventricular haemorrhage)
  • Birth asphyxia (HIE)
  • Hyperbilirubinaemia
  • Hypoglycaemia
96
Q

DEVELOPMENTAL DELAY
What are some postnatal causes of developmental delay?

A
  • Infection (meningitis, encephalitis)
  • Anoxia (suffocation, near-drowning, seizures)
  • Head trauma (accidental or NAI)
  • Hypoglycaemia
97
Q

DEVELOPMENTAL DELAY
What are some risk factors for developmental delay?

A
  • Bio = prems, LBW, birth asphyxia, hearing/vision impairment
  • Environment = poverty, poor parental education, maternal substance abuse
98
Q

MEASUREMENT
How might the accuracy of measurements be compromised?
A part of measurement is working out the mid-parent height.
How is this done for boys and girls?

A
  • Faulty technique (inexperienced staff), faulty equipment (wrongly calibrated), uncooperative child
  • Boys = [(Dad + mum height in cm) ÷ 2] + 7
  • Girls = [(Dad + mum height in cm) ÷ 2] – 7
99
Q

CHILD ABUSE
what are the features of shaken baby syndrome

A

Retinal haemorrhages
Encephalopathy
Subdural haemotoma

100
Q

PAEDIATRIC LIFE SUPPORT
If breathing stimulation fails what is the next stage of neonatal resuscitation?

A

Inflation breaths if gasping or not breathing –

  • 2 cycles of 5 inflation breaths
  • No response + HR low = 30s of ventilation breaths
  • No response, HR <60bpm = chest compressions (3:1 with ventilation breaths)
101
Q

RDS
What are some risk factors of RDS?

A
  • Prematurity #1
  • Maternal DM
  • 2nd premature twin
  • C-section
102
Q

NEC. ENTEROCOLITIS
What are some risk factors for necrotising enterocolitis?

A
  • Very LBW + premature
  • Formula feeds (breast milk protective)
  • RDS + assisted ventilation
  • Sepsis
  • PDA + other CHD
103
Q

NEC. ENTEROCOLITIS
What are some investigations for necrotising enterocolitis?

A
  • Blood culture (sepsis)
  • CRP
  • Capillary blood gas = metabolic acidosis
  • AXR is diagnostic
104
Q

NEC. ENTEROCOLITIS
What would an AXR show in necrotising enterocolitis?

A
  • Dilated loops of bowel
  • Bowel wall oedema (thickened bowel walls)
  • Pneumatosis intestinalis (intramural gas)
  • Pneumoperitoneum (free gas in peritoneum = perf)
  • Football sign = air outlining falciform ligament
  • Rigler’s sign = air both inside/outside bowel wall
  • Gas in portal veins
105
Q

JAUNDICE
What are some risk factors for jaundice?

A
  • LBW
  • Breastfeeding
  • Prematurity
  • FHx
  • Maternal diabetes
106
Q

JAUNDICE
What are some causes of jaundice 24h–2w after birth?

A
  • Physiological + breast milk jaundice (common)
  • Infection (UTI, sepsis)
  • Haemolysis, polycythaemia, bruising
  • Crigler-Najjar syndrome (rare inherited disorder with no UGT enzyme)
107
Q

JAUNDICE
What are some causes of jaundice >2w after birth?

A
  • Unconjugated = physiological or breast milk, UTI, hypothyroid, high GI obstruction (pyloric stenosis), Gilbert syndrome
  • Conjugated (>25umol/L) = bile duct obstruction (biliary atresia), neonatal hepatitis
108
Q

JAUNDICE
What is Gilbert’s syndrome?
How does it present?

A
  • AR deficiency of UDP-glucuronyltransferase = defective bilirubin conjugation
  • Unconjugated hyperbilirubinaemia (not in urine), jaundice may only be present if ill, exercising or fasting
109
Q

JAUNDICE
What investigations would you perform in neonatal jaundice?

A
  • FBC + blood film (polycythaemia, G6PD, spherocytosis)
  • Bilirubin levels
  • Blood type testing of mother + baby for ABO/Rh incompatibility
  • Direct Coombs (antiglobulin) test for haemolysis
  • TFTs, LFTs + urine MC&S
110
Q

JAUNDICE
What increases the risk of kernicterus?

A
  • Prematurity as immature liver
111
Q

HIE
What happens as a result of cardiorespiratory depression?

A
  • Hypoxia, hypercarbia + metabolic acidosis
  • Compromised cardiac output reduces tissue perfusion > hypoxic ischaemic injury to brain
112
Q

HIE
What is used to stage the severity of HIE?
What are the stages?

A

Sarnat staging –

  • Mild = poor feeding, generally irritable + hyperalert, resolves in 24h
  • Moderate = poor feeding, lethargic, hypotonic, seizures, can take weeks to resolve
  • Severe = reduced GCS, apnoeas, flaccid + reduced/absent reflexes, half die
113
Q

TORCH
What are the characteristic features of toxoplasmosis?

A
  • Cerebral calcification, chorioretinitis + hydrocephalus
114
Q

TORCH
What is the clinical presentation of CMV?

A
  • 90% normal at birth
  • 5% = hepatosplenomegaly, petechiae at birth, growth issues, neurodevelopmental disabilities (cerebral palsy, epilepsy, microcephaly)
  • 5% = problems later in life, mainly sensorineural hearing loss
115
Q

TORCH
How does herpes simplex virus present?

A
  • Herpetic lesions on skin or eye, encephalitis or disseminated disease
116
Q

TORCH
How does syphilis present?

A
  • Rash on soles of feet + hands
  • Hutchinson’s triad = keratitis, deafness, small + pointed teeth
117
Q

MECONIUM ASPIRATION
What are some risk factors for meconium aspiration?

A
  • Post-term deliveries at 42w
  • Maternal HTN or pre-eclampsia
  • Smoking or substance abuse
  • Chorioamnionitis
118
Q

MECONIUM ASPIRATION
What investigation would you do in meconium aspiration?

A
  • CXR = hyperinflation, accompanied by patches of collapse + consolidation
  • High incidence of air leak > pneumothorax
119
Q

CLEFT LIP AND PALATE
What is the management of cleft lip + palate?

A
  • MDT = plastic + ENT surgeons, paeds, orthodontist, SALT
  • Cleft lip repair ≤3m
  • Cleft palate repair 6-12m
120
Q

BRONCHOPULMONARY DYSPLASIA
What investigations would you do for bronchopulmonary dysplasia?

A
  • CXR = widespread areas of opacification, cystic changes, fibrosis
  • Formal sleep study to assess SpO2 during sleep supports Dx + guides Mx
121
Q

BRONCHOPULMONARY DYSPLASIA
How can bronchopulmonary dysplasia be prevented?

A
  • Corticosteroids to mothers in premature labour <34w
  • CPAP rather than intubation where possible
  • Use caffeine to stimulate resp effort
  • Do not over oxygenate
122
Q

BRONCHOPULMONARY DYSPLASIA
What is the management of bronchopulmonary dysplasia?

A
  • Some babies go home with low dose oxygen, weaned over first year
  • Monthly IM palivizumab for RSV (+ bronchiolitis) protection
123
Q

GROUP B STREP INFECTION
what are the possible complications in newborns?

A
  • meningitis
  • pneumonia
  • sepsis
124
Q

PREMATURITY
What are some metabolic complications of prematurity?

A
  • Hypoglycaemia,
  • hypocalcaemia,
  • electrolyte imbalance,
  • fluid imbalance
  • hypothermia
125
Q

JAUNDICE
How does kernicterus present?
What are the outcomes?

A
  • Lethargy, poor feeding > hypertonia, seizures + coma
  • Permanent damage = dyskinetic cerebral palsy, LD + deafness
126
Q

NEONATAL HYPOGLYCAEMIA
What are some risk factors for neonatal hypoglycaemia?

A
  • Preterm + intrauterine growth restriction (IUGR) = lack of glycogen stores
  • Maternal DM = infantile hyperinsulinaemia
  • LGA, polycythaemia or ill
  • Transient hypoglycaemia common in first hours after birth
127
Q

TORCH
How is syphillis managed?

A
  • If fully treated ≥1m before delivery = no treatment
  • Any doubts = benzylpenicillin
128
Q

CLEFT LIP AND PALATE
What causes cleft lip?

A

Failure of fusion of the frontonasal + maxillary processes

129
Q

CLEFT LIP AND PALATE
What causes cleft palate?

A

Failure of the palatine processes + nasal septum to fuse

130
Q

OESOPHAGEAL ATRESIA
What is it associated with?

A
  • Tracheo-oesophageal fistula + polyhydramnios
131
Q

LISTERIA INFECTION
what is the clinical presentation?

A

symptoms are similar to sepsis - listlessness, irritable, poor feeding
- Early onset = low birth weight, obstetric complications, evidence of sepsis soon after birth
- late onset = usually full-term, previously healthy neonates, present with meningitis/sepsis

132
Q

LISTERIA INFECTION
what is the management?

A

ampicillin + aminoglycoside (gentamycin)

C TO REVISE - PHASE 3A (11 decks)

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