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Final day prep > Paeds ILAs - 3 and 4 > Flashcards

Paeds ILAs - 3 and 4 Flashcards

1
Q

Stridor

A

Inspiratory
High pitched
Harsh vibratory sound

Caused by disrupted airflow
Usually in the upper airway

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2
Q

Stridor DDx

A 
Croup 
Epiglottitis 
Bacterial tracheitis 
Inhaled foreign body 
Anaphylaxis 
Laryngomalacia
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3
Q

Wheeze

A

Expiratory
High pitched
Continuous sound

Caused by oscillation of opposing airway walls

Most likely cause - Asthma or bronchiolitis

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4
Q

Croup aetiology

A

Parainfluenza
RSV
Human metapneumovirus

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5
Q

Croup presentation

A

Initial fever
Coryzal symptoms

Barking cough
Stridor

Hoarseness
Worse at night

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6
Q

Croup investigations

A

O2 sats

DO NOT EXAMINE THROAT

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7
Q

Croup management

A

O2
Dexamethasone
Nebulised epinephrine

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8
Q

Bronchiolitis aetiology

A

RSV

Parainfluenza
Human metapneumovirus

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9
Q

Bronchiolitis presentation

A 
Coryzal 
SOB 
Poor feeding 
Sharp dry cough 
Wheeze

Respiratory distress

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10
Q

Bronchiolitis investigations

A

RSV swab - Nasopharyngeal aspirate
O2 sats

CXR - Hyperinflation

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11
Q

Bronchiolitis management

A

Supportive
Fluids

Nebulised salbutamol
Humidified O2

Suction of secretions

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12
Q

Bronchiolitis prophylaxis

A

IM Palivizumab - Monoclonal antibody
October - February

At risk groups…

  • Premature
  • Immunocompromised
  • Downs
  • CHD
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13
Q

Bronchiolitis RED FLAGS

A 
Poor feeding 
Apnoea 
Lethargy 
RR > 70 
Cyanosis 
Severe chest wall recession 
Nasal flaring 
Fluid intake < 50-70%
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14
Q

Cystic fibrosis genetics

A

Autosomal recessive

CFTR gene mutation
Chromosome 7
Delta-F508 deletion

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15
Q

CF pathophysiology

A 
Faulty cAMP channel 
Na+/Cl- pump affected 
Reduced Cl- out 
Increased Na+ reabsorption 
Cellular water retention

Thickened secretions
Impaired ciliary function

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16
Q

CF primarily affects which organs

A

GI tract
Lungs
Pancreas

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17
Q

CF presentation in infants

A

Meconium ileus - Failure to pass meconium in 24 hours

Malabsorption
FTT
Prolonged jaundice

Steatorrhoea
Rectal prolapse

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18
Q

CF presentation in young children

A

Nasal polyps
Sinusitis
Bronchiectasis

Pancreatic insufficiency

Intestinal obstruction
Rectal prolapse

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19
Q

CF presentation in adolescents

A

Male infertility
DM
Cirrhosis and portal HTN
Distal intestinal obstruction syndrome

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20
Q

CF respiratory features

A

Cough - Purulent sputum
Recurrent infections
Clubbing

O/E

  • Hyperinflation
  • Coarse inspiratory crackles
  • Expiratory wheeze
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21
Q

CF respiratory pathogens

A

Staph aureus
HiB
Pseudomonas aeruginosa
Burkholderia

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22
Q

CF newborn screening

A

Guthrie heel prick test

Immunoreactive trypsinogen - Pancreatic enzyme precursor

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23
Q

CF diagnosis

A

Sweat test - Elevated Cl- concentration

Genetic testing - CFTR gene on Ch7

Bloods

  • Decreased lipase/amylase
  • Faecal elastase

CXR

  • Hyperinflation
  • Peribronchial shadowing
  • Bronchial wall thickening
  • Ring shadows / train tracks
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24
Q

CF respiratory management

A

Physiotherapy - Deep breathing and exercise
Airway clearing - Mucolytics, chest percussion, postural drainage
Vaccinations and Abx prophylaxis - Oral flucloxacillin

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25
CF nutrition management
Pancreatic enzyme replacement - Pancreatin High calorie and high fat diet - 120-150% RDA Fat soluble vitamins - ADEK Overnight feed with gastrotomy
26
CF complications
Cor pulmonale Pheumothorax Recurrent infections Cholestasis Liver cirrhosis
27
CF prognosis
Death from respiratory failure - 95% | Average life expectancy - 40 years
28
UTI aetiology
``` E. Coli Enterobacter Klebsiella Proteus - Phosphate stones Pseudomonas - Structural defect ```
29
UTI presentation in infants
Irritability Poor feeding FTT Jaundice D/V
30
Lower UTI presentation
Frequency Urgency Dysuria Nocturia Subrapubic pain Fever
31
Upper UTI presentation
Abdo pain Loin pain N/D/V Fever
32
UTI investigations
``` Urine sample - Dip, MC&S Bloods - FBC, U/E, ESR, CRP, culture USS - Check for abnormalities MCUG - Check for abnormalities DMSA - Check for scarring ```
33
UTI management
< 3 months - Refer > 3 months - Treat - Upper - Cephalosporin and co-amox - Lower - Nitrofurantoin
34
UTI complications
Renal scarring - HTN and CKD
35
Preventing UTIs
Good hygiene Regular voiding Lactobacillus acidophilus Prophylaxis - Trimethoprim
36
Complicated UTIs
``` Non-E. Coli Raised creatinine Not responding to Abx in 48 hours Septicaemia Poor urinary flow ```
37
Reasons to follow-up UTIs
Reflux Structural abnormality Recurrent
38
Constipation management
Faeces palpable - Supervision and psychological support No faeces palpable - Osmotic laxative - Lactulose - Stimulant laxative - Senna - Sodium phosphate enema
39
Coeliac presentation
GI > Malabsorption > Systemic GI - Pale floating stools - Abdominal distension and pain Malabsorption - Buttock wasting - FTT - Osteoporosis Systemic - Dermatitis herpetiformis - Dental defects
40
Coeliac associated conditions
DM1 Downs Hashimoto's thyroiditis Family history
41
Coeliac blood screening
Anti-TTG Anti-endomysial antibodies Anti-gliadin IgG/A
42
Coeliac colonoscopy
Jejunum biopsy Villous atrophy Crypt hyperplasia Increased intraepithelial lymphocytes Lymphocytic infiltration of the lamina propria
43
Coeliac complications
FTT Osteoporosis Hyposplenism Subfertility Deficiencies... - B12 - Anaemia - Folate - Calcium - Vitamin D
44
Crohn's GI features
Diarrhoea Constipation Tenesmus Mucus in the stool Perianal disease - Fissures
45
Crohn's non-GI features
``` Arthralgia Episcleritis Polyderma gangrenosum Erythema nodosum Anaemia Clubbing ```
46
Crohn's investigations
``` FBC - Anaemia CRP ^ Faecal calprotectin ^ B12 and folate deficiency - Reduced MCV Calcium - LOW Vitamin D - LOW ```
47
Crohn's biopsy findings
Mouth to anus Skip lesions Granulomas Goblet cells
48
Crohn's small bowel enema findings
Rose thorn ulcers String sign Fistulae
49
Crohn's management
``` Prednisolone 5 ASA - Mesalazine Azathioprine Infliximab Methotrexate ```
50
Crohn's complications
MALNUTRITION Cancer risk Osteoporosis
51
Ulcerative colitis GI features
Bloody diarrhoea Tenesmus Urgency Pain in LIF
52
Ulcerative colitis non-GI features
Arthritis Clubbing Primary sclerosing cholangitis
53
Ulcerative colitis biopsy findings
Granulomas Crypt abscesses Goblet cell depletion Inflammatory cells in the lamina propria
54
Ulcerative colitis barium enema findings
Loss of haustrations | Pseudopolyps
55
Ulcerative colitis XR findings
Lead pipe sign Dilatation of bowel Rigler's sign
56
Ulcerative colitis management
SPAM! 5 ASA - Sulfasalazine Prednisolone Azathioprine ! Methotrexate is CONTRAINDICATED
57
Nephrotic syndrome aetiology
PSG HSP EBV Focal segmental glomerulonephritis Membranous glomerulonephritis Minimal change disease NSAIDS
58
Nephrotic syndrome presentation
TRIAD 1. Proteinuria 2. Hypoalbuminaemia 3. Oedema Recurrent infections - Loss of Ig Hypercoagulability - Loss of antithrombin Hyperlipidaemia
59
Nephrotic syndrome investigations
LIV€R - Lipids - Hyperlipidaemia - Infection - VTE - Calcium - Renal Urinalysis - Proteinuria Hypoalbuminaemia C3+4 ASO - PSG? CXR - Oedema - Pleural effusion Renal USS
60
Nephrotic syndrome management
Steroid sensitive - Normal renal function - Prednisolone - Cyclophosphamide - Salt restriction - Diuretics Non-sensitive - ACE-I - Cyclophosphamide - Salt restriction - Diuretics
61
Nephrotic syndrome complications
``` Hypercholesterolaemia Hyponatraemia Hypocalcaemia Thrombosis Infection AKI ```

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