Paeds resp and cardio Flashcards by Caitlin E Furness

What are the characteristic symptoms of croup?

Harsh barking cough, stridor, hoarseness and fever

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What ages does croup present between?

6months to 3 years

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When is the peak incidence of croup?

2 years

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What time of day are croup symptoms worse?

Night

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What might you hear on examination of someone with croup?

Stridor
Decreased chest sounds

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What signs of resp distress are common in croup?

Tachypnoea
Intercostal recession

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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

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If a patient is hospitalised with croup what is the treatment?

Single dose of oral dexamethasone
Nebulised adrenaline
Oxygen therapy as required

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What is the most common organism to cause bronchiolitis?

RSV

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Which age group does bronchiolitis affect?

Children under the age of 2

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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

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What are the clinical features of bronchiolitis?

Feeding difficulty
Low grade fever
Nasal congestion
Rhinorrhoea
Cough

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What type of cough do patients with bronchiolitis present with?

Dry wheezy cough

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When would you consider a child with bronchiolitis for admission?

Recurrent apnoeic episodes
Sats below 90% on air
Grunting and recession

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What investigations can you do for a child with bronchiolitis?

Nasopharyngeal swabs
O2 sats
Blood and urine cultures

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What is the management of bronchiolitis?

Humidified oxygen
Fluids
Nutrition

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What should you not give in the management of bronchiolitis?

Antibiotics
Steroids
Bronchodilators

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What are the 3 main types of wheeze?

Viral episodic wheeze
Multiple trigger wheeze
Asthma

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What is the pathophysiology of asthma?

Environmental triggers causes oedema, excessive mucus production and infiltration with cells
Bronchial hyperresponsiveness
Airway narrowing

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What are 3 risk factors for asthma?

Genetic
Prematurity
Low birth weight
Viral bronchiolitis in early life.

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When are asthma symptoms typically worse?

At night and in the early morning

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What investigations should be carried out to diagnose asthma?

Spirometry
Peak flow diary (diurnal variation)

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What does spirometry show in asthma?

FEV1:FVC ratio is less than 70%

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What is the stepwise management of chronic asthma?

SABA
ICS
In over 5 use LABA. In under 5 use LTRA

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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