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Medicine > Paeds (Neuro, CVS, Resp, GI, Renal) > Flashcards

Paeds (Neuro, CVS, Resp, GI, Renal) Flashcards

1
Q

Headache Sx Red Flags

A 
Persistent in < 6yo 
Duration > 6 months 
Change in severity/pattern 
Worse w/ coughing/straining 
Worse overnight/early morning 
Early morning N+V 
Behaviour changes (Uncooperative) 
Seizures 
Rapid/Faltering growth, Developmental regression
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2
Q

Headache Signs Red Flags

A

Abnormal Neuro Ex (Ataxia, Weakness, Squint/Head tilt)
Papilloedema
Cranial bruit
Growth Abnormality (Obesity, Abnormal/Early Pubertal changes)

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3
Q

Febrile Convulsions Features

A

(6mo-5yo)

Seizures occurring w/ High Fever (no underlying pathology)

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4
Q

Febrile Convulsions Mx

A

Tx Fever (Paracetamol, Ibuprofen)

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5
Q

Infantile Spasms Features

A

West Syndrome

(4mo – 2yo)

Clusters of whole-body spasms (1sec) w/ full recovery (+/- Ext of Limbs)

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6
Q

Infantile Spasms Mx

A

Prednisolone, Vigabatrin

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7
Q

Cerebral Palsy Cause

A

Brain Injury => Permanent, Non-progress Disorder of movement + Posture

(Caused by Inf, Hypoxia, Haem, Trauma, Malformation)

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8
Q

Cerebral Palsy Classification

A

I: Walks w/out limitations

II: Walks w/ limitations

III: Walks w/ hand-held mobility device

IV: Self-mobility w/ limitations

V: Transported in manual wheelchair

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9
Q

Cerebral Palsy Types

A

Spastic (UMND)

Ataxic (Cerebellum)

Dyskinetic (Basal Ganglia => Dystonia, Chorea, Athethosis)

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10
Q 
Epilepsy Mx:
Focal
New Ton-Clon
Est Ton-Clon
Atonic/Tonic/Myoclonic
Absence
Pregnant
A

Focal: Carbamazepine, Lamotrigine

New Ton-Clon: Na-Val, Lamotrigine

Est Ton-Clon: Lamotrigine

Atonic/Tonic/Myoclonic: Na-Val

Absence: Ethosuximide, Na-Val

Pregnant: Lamotrigine, Levitiracetam

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11
Q

Muscular Dystrophy Def

Spinal M Atrophy Def

A

MD: Progress Weakness/Wasting of M
=> Gowers sign (Downward Dog -> Tripod -> Standing Up)

SMA: Progress loss of LMN w/in Spinal Cord
=> Hypotonia, Hyporeflexia, Atrophy, Fasciculations

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12
Q

Hydrocephalus Patho + Cause

A

(Abnormal build-up of CSF w/in brain + spinal cord)

Caused by:
Overproduction,
Abnormal drainage (Acqueductal Stenosis, Arachnoid cysts, Cerebellum herniation)

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13
Q

Normal Prod of CSF + movement

A

CSF created by Choroid plexus + walls of Lat Ventricles

  • > 3rd Ventricle
  • > Cerebral Acqueduct
  • > 4th Ventricle
  • > Dural Venous Sinus
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14
Q

Hydrocephalus Mx

A

CSF (Ventriculo-peritoneal) Shunt

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15
Q

Innocent Murmurs Features

A 
Soft
Short
Symptomless
Systolic
Situation-dependent (Quiet w/ Standing)
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16
Q

PDA Features

A

Normal S1
Continuous Cres-Decres machine-like
(Difficult to hear S2)

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17
Q

ASD Features

A

Mid-systolic, Cres-decres at L sternal edge

w/ fixed split S2 – no change w/ Insp/Exp

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18
Q

VSD Features

A

Pan-systolic, L sternal edge 3rd/4th IC space

+/- systolic Thrill on palpation

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19
Q

Coarctation of Aorta Features - 4

A

Grey, floppy baby w/ Limb Hypoplasia
Weak Fem Pulses
Systolic Murmur
LV Hypertrophy

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20
Q

Coarctation of Aorta Mx

A 
IV PGs (maintain DA)
Surg (Correct Coarctation + Ligate DA)
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21
Q

Tetralogy of Fallot Patho

A

Pulmon Stenosis
VSD
Overriding Aorta
RV Hypertrophy/Strain

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22
Q

Tetralogy of Fallot Features

A 
Poor Feeding/Weight gain
Tet Spells (Intermittent Cyanotic episodes)
Eject-Systolic murmur
Clubbing
Cyanosis
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23
Q

Transposition of GA Mx

A

IV PGs
Cardiopulmon bypass
Arterial switch Surg

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24
Q

Resp Distress Features

A 
Raised RR​
Cyanosis
Use of accessory M (SCM, Abdo, Ext IC)​
IC/SC recessions​
Nasal flaring, Head-bobbing, Tracheal tugging​​
Abnormal airway noises (Exp Grunting)
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25
Q

Epiglottitis Patho + Sx

A

Inflamm of Epiglottis caused by Haemophilus B in Unvaccinated Child

Fever,
Sore Throat/Diff swallowing,
Stridor,
Quiet child w/ Muffled voice in Tripod position

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26
Q

Epiglottitis Mx

A

No throat swabs (=> Airway Obstruct)

Mx: 
Avoid distressing (Keep parents close)
Secure Airway, 
IV Abx (Ceftriaxone) +/- Steroids, 
Check Vaccination (HiB)
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27
Q

Bronchiolitis Patho

A

Inflamm of Bronchioles (Resp Synctival V)​

Affects the V small airways in neonates (<1yr)
– only requires little Inflamm/Mucus to cause obstruction​

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28
Q

Bronchiolitis Sx - 5

A 
Coryzal Sx (Rhinits, Sinusitis, Sneezing, Fever)​
S.O.B, Tachypnoea/Resp distress, 
Apnoea episodes​, 
Wheeze + crackles on Auscultation​
Poor Feeding​
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29
Q

Bronchiolitis Mx

A 
Rest, Fluids, Adequate Intake
Paracetamol
Supp O2
Palivizumab (mAb targeting RSV) 
- given to Premature babies or w/ Cong HD
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30
Q

Bronchiolitis Ix

A

CBG:
Raised pCO2: Airway collapse
pH < 7: (Resp) Acidosis
Hypoxia: (T2) Resp Fail

31
Q

Bronchiolitis Admission

A 
Age < 3 months​
Comorbidity (Prematurity, Downs, CF)​
Dehydration​
Reduced milk intake (< 50-75%)​
RR > 70, SpO2 < 92%, Apnoeas, Resp Distress​
32
Q

Croup Cause + Patho

A

Caused by:
Parainfluenzae V, Influenzae V, AdenoV, RSV​

​URTI in 6 months – 2yo => Oedema of Larynx (+/- Epiglottitis)​

33
Q

Croup Ix + Mx

A

Ix: Westley Scoring

Fluids, Rest, Isolation​

PO Dexamethasone 150 micrograms/Kg​

34
Q

Whooping Cough Cause + Patho

A

URTI caused by Bordatella Pertussis​

35
Q

Whooping Cough Sx

A

Fever, Mild dry cough​, SOB

Coughing fits (w/ Loud Inspiratory Whoops)​

(+/- Apnoeas, Fainting, Vom, Pneumothorax)​

36
Q

Whooping Cough Mx + Admission criteria

A

(Normally resolves by 8wks):​
Notify Public health​
If w/in 21 days: Abx (PO Azithromycin) + Prophylactic Abx for contacts​

Admission:
Apnoeas, Cyanosis, Severe fits

37
Q

Asthma vs Viral-Induced Wheeze

A

Occurs in children < 3yo (VIW)
No Hx of Atopy (VIW)
Not Exercise/Cold-sensitive (VIW)
Triggered by Viral Inf (VIW)

38
Q

Asthma Mx (< 5yo)

A

SABA
SABA + ICS
+ LTRA

39
Q

Asthma Mx (5-16yo)

A 
SABA
SABA + ICS
LABA + ICS
\+ LTRA
(+/- LAMA - Ipratropium/Tiotropium)
(+/- Aminophylline)
40
Q

Chronic LD of Prematurity Mx:
Prevention
Tx

A

Prevention:​
2x IM Betamethasone doses​ (24hrs apart)

​
Mx:​
CPAP (Maintain airway + avoid over-oxygenation => Resp Fail)​
Caffeine (Stim Resp effort)​
Monthly Inj of Palivizumab (Protect against RSV + Bronchiolitis)​

41
Q

CF Patho + Features

A

(Auto-Recess): Mutation of CF Transmembrane Conductance Reg Gene => Abnormal Cl- channels:​

Thick Pancreatic/Biliary secretions (=> Blockage + Enzyme Def)​

Thick airway secretions (=> Blockage + Inf)​

Congenital Bilat absence of Vas deferens (Normal healthy sperm, no Ducts => Infertility)​

42
Q

CF Ix

A

Newborn Spot testing​

Sweat test (Cl- conc: > 60mmol/L)​

Amniocentesis/Chorionic villus sampling (w/ genetic testing for CFTR gene)​

43
Q

CF Mx​

A

Exercise + Chest Physio ​(Improves Lung funct)
Bronchodilators (Reverse Bronchoconstriction)​
Neb Dnase (Dornase-alpha): Breakdown DNA (Reduce viscosity of secretions)​
Prophylactic Flucloxacillin (Reduce Bact Inf – S. Aureus)​
Vaccinations (Pneumococcal, Influenzae, Varicella)​
High-calorie diet (Malabsorption) + CREON (Replace Lipase enzymes)​

44
Q

Abdo Pain Red Flags - 8

A 
Fever​
Dysphagia​
Persistent/Bilious Vomiting​
Abdo tenderness​
Night-time pain​
Weight loss (Fail to Thrive)​
Severe Chronic Diarrhoea​
Rectal bleeding​
45
Q

Biliary Atresia Patho,

A

Narrow/Absent Bile Duct =>

Cholestasis + Persistent Jaundice (High conjugated BiliR)

46
Q

Biliary Atresia Mx

A

Kasai Portoenterostomy

Attach S Intestine -> Liver opening: Relieves Jaundice + aids digestion

47
Q

Hirschprungs D Patho + Features

A

Absence of parasympathetic N cells w/in Myenteric plexus (=> Reduced peristalsis)
Aganglionic bowel cannot relax (=> Excess constrict w/ Prox bowel obstructed + distended)

=> Meconium Delay > 24hrs, (Chronic constipation from birth)

48
Q

Hirschprungs D Ix + Mx

A 
AXR (Intestinal Obstruct), 
Rectal biopsy (Absence of ganglionic cells)

Mx:
NBM
NGT + IV Fluids,
Surg (Remove diseased bowel => Pull-through + form End-colostomy)

49
Q

Intusussception Eped + Patho

A

(6mo-2yo, M comm: <9mo, ass w/ Concurrent Viral Inf – Enlargement of Peyers patches)

Invagination of Prox bowel (Ileum of S Intestine) -> 
Dist bowel (Caecum of L Intestine)
50
Q

Intusussception Sx + Ex

A

Severe Colicky Abdo Pain,
Vom,
Red-currant jelly Stool

O/E:
Thickened bowel wall (Sausage-shaped RUQ mass)
Constipation

51
Q

Intusussception Ix + Mx

A

USS, Contrast enema

Mx:
Therapeutic Enema,
Surg reduction,
If gangrenous/perf: Surg resection

52
Q

UTI Mx

A

PO Trimethoprim 3 days,
(If < 3mo: IV Abx)
(If upper UTI: IV 4 days w/ PO 10 days)

53
Q

UTI Referral/USS Indications

A

Younger than 6mo

Severe/Atypical (Fail to Resp to Abx, Non-Ecoli Inf, Oliguria, Raised Cr, Abdo/Bladder mass)

Recurrent Inf (> 2 Upper, Upper + Lower, > 3 Lower)

54
Q

USS Abnormality Mx + Indications

A

DMSA scan:​
Injection of Dimercaptosuccinic Acid w/ gamma-camera to view empty patches w/in Kidneys (Scarring)​

If Vesico-ureteric Reflux suspected (FHx, Poor UO, Dil on USS, non E-coli UTI) =>
MCUG:​ Micturating Cystourethrogram (X-ray w/ contrast to identify any reflux)​

55
Q

Causes of Nephrotic Synd

A 
Min change D, 
Intrinsic Kidney D (Focal Segmental Glomerulosclerosis), 
Systemic Illness (HSP, DM, Inf – HIV, Hep, Malaria)
56
Q

Nephrotic Synd Ix

A

(Oedema)
Low serum Albumin
High Urine Protein (High A:Cr)
(Renal Biopsy)

57
Q

Nephrotic Synd Mx - 5

A

High dose Pred 4wks (Weaned off for 8wks)
Low salt diet (+/- Diuretics => Reduce Oedema)
Albumin Infusion (If severe HypoAlb)
Abx prophylaxis
(If Steroid-resist: ACEi + Immunosuppression: Cyclosporin, Tacrolimus)

58
Q

Nephritis Patho + Sx

A

Inflamm of Nephrons w/in Kidneys =>

Reduced Kidney Funct (Low eGFR)
Haematuria
Proteinuria

59
Q

Causes of Nephritis

A

Post-strep GN:
Occurs 1-3wks post Tonsillitis (beta-haemolytic S.Pyogenes)

IgA Nephropathy:
Deposition of IgA Immune complexes w/in Nephrons (Post-URTI/GI Inf)

60
Q

Nephritis Ix

A

Post-Strep:
(+) Throat swab,
(+) Anti-Streptolysin O Ab’s

IgA: 
Renal biopsy (IgA deposits)
61
Q

Nephritis Mx

A

Post-strep:
ACEi/ARB + Diuretic (Reduce HT + Oedema)

IgA:
Immunosupp (Steroids, Cyclophosphamide)

62
Q

Wilms Tumour Patho + Sx

A

(< 5yo):

Renal/Abdo mass (=> Abdo Pain), 
Haematuria
HT
Fever
Weight loss
Lethargy
63
Q

Wilms Tumour Ix

A

Abdo USS (Assess size + location),
CT/MRI (Staging + Metastases)
+/- Biopsy (Grade)

64
Q

Wilms Tumour Mx

A 
Surg Excision (+/- Nephrectomy), 
\+/- Chemo/RadioTx
65
Q

Post Urethral Valve Patho + Sx

A

(Extra tissue at Prox end of Urethra => Obstruct):

Diff/Weak Urination,
Chronic retention (=> Palpable bladder),
Recurrent UTIs

66
Q

Post Urethral Valve Ix

A

Abdo USS (Enlarged Bladder w/ Bilat hydronephrosis)
MCUG (Tissue + reflux)
Cystoscopy (View Urethra + Bladder)

67
Q

Post Urethral Valve Mx

A

(Temp catheter),

Cystoscopy (View Urethra + Ablation/Excision)

68
Q

Cryptorchidism Mx

A

If < 6mo: watch + wait

If 6-12mo: Orchidopexy (Surg correction)

69
Q

Hypospadias Ix + Mx

A

(Identified during Newborn Ex)

Surg correction at 3-4mo

70
Q

Hydrocoele Features

A

Soft,
Smooth,
Non-tender
Transilluminates

71
Q

Hydrocoele Ix + Mx

A

Confirm on USS (Excl Tumour, Haematoma, Varicoele, Hernia)

If simple: Self-resolve w/in 2yrs

If communicating: Surg removal/ligation of Processus Vaginalis

72
Q

Monitoring Asthma control

A

Confirm Adherence

Review Technique
(Shake + Breathe out, Press + Breathe in, Hold breath > 10s, Wait 30s, Repeat)

Minimise exposure to Triggers, Allergens, Smoke

73
Q

Constipation Red Flags - 7

A

Meconium Ileus (CF, Hirschprungs)
Fail to Thrive (HypoTh, Coeliacs)
Sacral dimple (Spina Bifida Occulta)
Abnormal Anal position/tone (Anorectal Abnormality)
Abnormal LL (Lumbosacral Abnormality)
Perianal bruising/fissures (Sexual Abuse)
Perianal fissures/Fistulas/strictures (CD)

Medicine (13 decks)

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