Paeds resp and cardio Flashcards
What are the characteristic symptoms of croup?
Harsh barking cough, stridor, hoarseness and fever
What ages does croup present between?
6months to 3 years
When is the peak incidence of croup?
2 years
What time of day are croup symptoms worse?
Night
What might you hear on examination of someone with croup?
Stridor
Decreased chest sounds
What signs of resp distress are common in croup?
Tachypnoea
Intercostal recession
What advice should be given to parents in order to treat patients at home?
Symptoms usually resolve within 24 hours
Viral illness, antibiotics aren’t needed
Paracetamol/ibuprofen to control fever
If a patient is hospitalised with croup what is the treatment?
Single dose of oral dexamethasone
Nebulised adrenaline
Oxygen therapy as required
What is the most common organism to cause bronchiolitis?
RSV
Which age group does bronchiolitis affect?
Children under the age of 2
Name 3 risk factors for bronchiolitis?
Breast fed for less than 2 months
Smoke exposure
Siblings at nursery or school
Chronic lung disease due to prematurity
What are the clinical features of bronchiolitis?
Feeding difficulty
Low grade fever
Nasal congestion
Rhinorrhoea
Cough
What type of cough do patients with bronchiolitis present with?
Dry wheezy cough
When would you consider a child with bronchiolitis for admission?
Recurrent apnoeic episodes
Sats below 90% on air
Grunting and recession
What investigations can you do for a child with bronchiolitis?
Nasopharyngeal swabs
O2 sats
Blood and urine cultures
What is the management of bronchiolitis?
Humidified oxygen
Fluids
Nutrition
What should you not give in the management of bronchiolitis?
Antibiotics
Steroids
Bronchodilators
What are the 3 main types of wheeze?
Viral episodic wheeze
Multiple trigger wheeze
Asthma
What is the pathophysiology of asthma?
Environmental triggers causes oedema, excessive mucus production and infiltration with cells
Bronchial hyperresponsiveness
Airway narrowing
What are 3 risk factors for asthma?
Genetic
Prematurity
Low birth weight
Viral bronchiolitis in early life.
When are asthma symptoms typically worse?
At night and in the early morning
What investigations should be carried out to diagnose asthma?
Spirometry
Peak flow diary (diurnal variation)
What does spirometry show in asthma?
FEV1:FVC ratio is less than 70%
What is the stepwise management of chronic asthma?
SABA
ICS
In over 5 use LABA. In under 5 use LTRA
What is the acronym for acute asthma management?
OSHITME
What does OSHITME stand for?
Oxygen high flow
Salbutamol
Hydrocortisone
Ipratropium bromide
Theophylline
Mag sulph
Escalate care
Which organism is whooping cough caused by?
Bordetella pertussis
When is whooping cough vaccinated against?
2,3 and 4 months of age
What are the symptoms of whooping cough?
Paroxysmal cough followed by inspiratory whoop
Sore throat
Low grade fever
When is coughing worse in whooping cough?
Worse at night
How long does the paroxysmal phase of whooping cough last?
2 and 8 weeks
When should a nasopharyngeal aspirate be taken in cases of whooping cough?
Within 2 weeks of illness starting otherwise the culture will not grow the bacterium
What is the treatment for whooping cough?
Macrolide antibiotic. ending in mycin
What is the genetic inheritance of CF?
Autosomal recessive
How is CF usually diagnosed?
Heel prick testing at birth
What is the test for CF which is performed after the heelprick testing?
Sweat test, raised chloride ions
What are the clinical features of CF?
Recurrent chest infections
Meconium ileus
Faltering growth
Malabsorption
Steatorrhea
Clubbing
Which prophylactic Abx are used in CF?
Flucloxacillin
Which are the most common organisms causing pneumonia in newborns?
Group B strep
Gram negative enterococci and bacilli
Common organisms for pneumonia in infants and young children?
RSV, Strep pneumonia, H.influenza
Common organisms for pneumonia in children over 5?
Mycoplasma pneumonia
Strep pneumonia
Chlamydia pneumonia
What signs might you see on examination in children with pneumonia?
Tachypnoea
Nasal flaring
Recession
Coarse crackles
Decreased O2 sats
What investigations for pneumonia?
CXR showing consolidation
Nasopharyngeal aspirate for viral cause
What antibiotics are given for pneumonia?
Oral amoxicillin
What is acute epiglottis?
Intense swelling of the epiglottis and surrounding tissues
Which organism causes acute epiglottitis?
HIB
What does a child with epiglottitis look like?
Sitting upright
Tripoding to maximise breathing
Symptoms of epiglottitis?
High fever
Difficulty swallowing
Stridor
NO COUGH
What must you not do in epiglottitis?
Examine the throat
Management of epiglottitis?
Refer to ENT and anaesthetists
Blood cultures
Broad spec Abx such as cefuroxime
What treatment should contacts of a patient with epiglottitis have?
Rifampicin
Name the acyanotic heart defects.
ASD
VSD
Atrioventricular septal defect
PDA
Which way is the shunt in ASD?
Left to right
What type of murmur is heard in ASD?
Mid-systolic, crescendo decrescendo murmur at the left upper sternal edge
What causes the fixed splitting in ASD?
Pulmonary valve closes after the aortic valve due to increased blood flow leading to a fixed splitting
How does an ASD present in childhood?
Often asymptomatic
If an ASD is symptomatic what symptoms often present?
SOB
Difficulty feeding
Poor weight gain
LRTI’s
What are some of the complications of increased blood flow to the lungs?
This can lead to pulmonary hypertension, and cause right sided HF
What is Eisenmenger syndrome?
Where the pulmonary pressure is greater than the systemic pressure
What is the most common type of congenital heart defect?
Ventricular septal defect
Which way does the blood shunt in VSD?
Left to right
What type of murmur is heard in VSD?
Pansystolic murmur
How are murmurs treated by paediatric cardiologists?
Transvenous catheter closure
What are the differentials for a pansystolic murmur?
Mitral regurgitation
Tricuspid regurgitation
VSD
What is the gold standard investigation for septal defects?
ECHO
What heart condition are patients with a VSD more at risk of?
Infective endocarditis
What is a PDA?
Patent ductus arteriosus, hole between the aorta and pulmonary artery
Which way does blood shunt in a PDA?
From the aorta to pulmonary artery
What are the pulses like in PDA?
Bounding pulses
Wide pulse pressure
What type of murmur is heard in PDA?
Machinery murmur
What type of murmur is heard in pulmonary stenosis?
Ejection systolic murmur with radiation to the back
When does a coarctation of the aorta typically present?
In the first few days of life after the PDA closes
What are the signs of coarctation of aorta?
Discrepancy of BP in upper and lower limb
How is a coarctation of the aorta managed?
Keep the PDA open with a prostaglandin infusion
What are the symptoms of HF in babies and infants?
Breathlessness on feeding
Sweating
Poor feeding
Recurrent chest infections
Name 3 causes of HF in neonates?
Hypoplastic left heart (left side cannot pump blood around body)
Critical aortic valve stenosis
Severe coarctation of the aorta
Causes of HF in infants?
VSD
ASD
Persistent PDA
Causes of HF in older children and adolescents?
Eisenmenger syndrome
Rheumatic heart disease
Cardiomyopathy
What are the 2 main cyanotic heart defects?
Tetralogy of fallot
Transposition of the great arteries
When does tetralogy of fallot present?
Within the first few months of life
When does TGA present?
Within the first few days of life when the PDA closes
What are the 4 features of tetralogy of fallot?
Pulmonary stenosis
Right ventricular hypertrophy
Large VSD
Overriding aorta
What drug can keep the PDA open?
Alprostadil
What has occurred in TGA?
Aorta and pulmonary artery has swapped, so aorta provides deoxygenated blood to the body
How can a TGA be managed?
Maintain patency of PDA
Open foramen ovale with balloon atrial septostomy
Surgery within the first few weeks of life to swap the aorta and pulmonary vessels
Which is the most common arrythmia in children?
Supraventricular tachycardia
What typically triggers rheumatic fever?
A bacterial throat infection
What are the symptoms of rheumatic fever?
Inflamattion in the joints
Small bumps under the skin
Red rash with odd edges
Fever
Weight loss
Which valve does rheumatic fever most commonly affect?
Mitral valve leading to mitral stenosis
What is the treatment for rheumatic fever?
Antibiotics
Anti inflam
Bed rest and limitation of exercise
What medication is used to promote duct closure in PDA?
Indomethacin
In an acute asthma attack when is IV hydrocortisone given?
Only if the patient is vomiting and cannot tolerate oral pred
What symptoms of asthma suggests a life threatening disease?
Less than 33% expected peak expiratory flow rate
What discharge medications should be prescribed for children after having an asthma attack?
Salbutamol inhaler plus 2-5 days of oral pred
