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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
Q

CF nutrition management

A

Pancreatic enzyme replacement - Pancreatin
High calorie and high fat diet - 120-150% RDA
Fat soluble vitamins - ADEK
Overnight feed with gastrotomy

26
Q

CF complications

A

Cor pulmonale
Pheumothorax
Recurrent infections

Cholestasis
Liver cirrhosis

27
Q

CF prognosis

A

Death from respiratory failure - 95%

Average life expectancy - 40 years

28
Q

UTI aetiology

A 
E. Coli 
Enterobacter 
Klebsiella 
Proteus - Phosphate stones 
Pseudomonas - Structural defect
29
Q

UTI presentation in infants

A

Irritability
Poor feeding
FTT
Jaundice

D/V

30
Q

Lower UTI presentation

A

Frequency
Urgency
Dysuria
Nocturia

Subrapubic pain

Fever

31
Q

Upper UTI presentation

A

Abdo pain
Loin pain
N/D/V
Fever

32
Q

UTI investigations

A 
Urine sample - Dip, MC&amp;S
Bloods - FBC, U/E, ESR, CRP, culture 
USS - Check for abnormalities 
MCUG - Check for abnormalities 
DMSA - Check for scarring
33
Q

UTI management

A

< 3 months - Refer

> 3 months - Treat

  • Upper - Cephalosporin and co-amox
  • Lower - Nitrofurantoin
34
Q

UTI complications

A

Renal scarring - HTN and CKD

35
Q

Preventing UTIs

A

Good hygiene
Regular voiding
Lactobacillus acidophilus

Prophylaxis - Trimethoprim

36
Q

Complicated UTIs

A 
Non-E. Coli 
Raised creatinine 
Not responding to Abx in 48 hours 
Septicaemia 
Poor urinary flow
37
Q

Reasons to follow-up UTIs

A

Reflux
Structural abnormality
Recurrent

38
Q

Constipation management

A

Faeces palpable - Supervision and psychological support

No faeces palpable

  • Osmotic laxative - Lactulose
  • Stimulant laxative - Senna
  • Sodium phosphate enema
39
Q

Coeliac presentation

A

GI > Malabsorption > Systemic

GI

  • Pale floating stools
  • Abdominal distension and pain

Malabsorption

  • Buttock wasting
  • FTT
  • Osteoporosis

Systemic

  • Dermatitis herpetiformis
  • Dental defects
40
Q

Coeliac associated conditions

A

DM1
Downs
Hashimoto’s thyroiditis

Family history

41
Q

Coeliac blood screening

A

Anti-TTG
Anti-endomysial antibodies
Anti-gliadin IgG/A

42
Q

Coeliac colonoscopy

A

Jejunum biopsy

Villous atrophy
Crypt hyperplasia

Increased intraepithelial lymphocytes
Lymphocytic infiltration of the lamina propria

43
Q

Coeliac complications

A

FTT
Osteoporosis
Hyposplenism

Subfertility

Deficiencies…

  • B12
  • Anaemia
  • Folate
  • Calcium
  • Vitamin D
44
Q

Crohn’s GI features

A

Diarrhoea
Constipation
Tenesmus
Mucus in the stool

Perianal disease - Fissures

45
Q

Crohn’s non-GI features

A 
Arthralgia 
Episcleritis 
Polyderma gangrenosum 
Erythema nodosum 
Anaemia 
Clubbing
46
Q

Crohn’s investigations

A 
FBC - Anaemia 
CRP ^ 
Faecal calprotectin ^ 
B12 and folate deficiency - Reduced MCV 
Calcium - LOW 
Vitamin D - LOW
47
Q

Crohn’s biopsy findings

A

Mouth to anus
Skip lesions

Granulomas
Goblet cells

48
Q

Crohn’s small bowel enema findings

A

Rose thorn ulcers
String sign
Fistulae

49
Q

Crohn’s management

A 
Prednisolone 
5 ASA - Mesalazine 
Azathioprine 
Infliximab 
Methotrexate
50
Q

Crohn’s complications

A

MALNUTRITION

Cancer risk
Osteoporosis

51
Q

Ulcerative colitis GI features

A

Bloody diarrhoea
Tenesmus
Urgency

Pain in LIF

52
Q

Ulcerative colitis non-GI features

A

Arthritis
Clubbing
Primary sclerosing cholangitis

53
Q

Ulcerative colitis biopsy findings

A

Granulomas

Crypt abscesses
Goblet cell depletion

Inflammatory cells in the lamina propria

54
Q

Ulcerative colitis barium enema findings

A

Loss of haustrations

Pseudopolyps

55
Q

Ulcerative colitis XR findings

A

Lead pipe sign
Dilatation of bowel
Rigler’s sign

56
Q

Ulcerative colitis management

A

SPAM!

5 ASA - Sulfasalazine
Prednisolone
Azathioprine

! Methotrexate is CONTRAINDICATED

57
Q

Nephrotic syndrome aetiology

A

PSG
HSP
EBV

Focal segmental glomerulonephritis
Membranous glomerulonephritis

Minimal change disease
NSAIDS

58
Q

Nephrotic syndrome presentation

A

TRIAD

  1. Proteinuria
  2. Hypoalbuminaemia
  3. Oedema

Recurrent infections - Loss of Ig
Hypercoagulability - Loss of antithrombin
Hyperlipidaemia

59
Q

Nephrotic syndrome investigations

A

LIV€R

  • Lipids - Hyperlipidaemia
  • Infection
  • VTE
  • Calcium
  • Renal

Urinalysis - Proteinuria
Hypoalbuminaemia

C3+4
ASO - PSG?

CXR

  • Oedema
  • Pleural effusion

Renal USS

60
Q

Nephrotic syndrome management

A

Steroid sensitive - Normal renal function

  • Prednisolone
  • Cyclophosphamide
  • Salt restriction
  • Diuretics

Non-sensitive

  • ACE-I
  • Cyclophosphamide
  • Salt restriction
  • Diuretics
61
Q

Nephrotic syndrome complications

A 
Hypercholesterolaemia 
Hyponatraemia 
Hypocalcaemia 
Thrombosis 
Infection 
AKI

Final day prep (8 decks)

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