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Phase 3A content > Paeds resp and cardio > Flashcards

Paeds resp and cardio Flashcards

1
Q

What are the characteristic symptoms of croup?

A

Harsh barking cough, stridor, hoarseness and fever

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2
Q

What ages does croup present between?

A

6months to 3 years

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3
Q

When is the peak incidence of croup?

A

2 years

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4
Q

What time of day are croup symptoms worse?

A

Night

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5
Q

What might you hear on examination of someone with croup?

A

Stridor
Decreased chest sounds

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6
Q

What signs of resp distress are common in croup?

A

Tachypnoea
Intercostal recession

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7
Q

What advice should be given to parents in order to treat patients at home?

A

Symptoms usually resolve within 24 hours
Viral illness, antibiotics aren’t needed
Paracetamol/ibuprofen to control fever

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8
Q

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

A

Single dose of oral dexamethasone
Nebulised adrenaline
Oxygen therapy as required

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9
Q

What is the most common organism to cause bronchiolitis?

A

RSV

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10
Q

Which age group does bronchiolitis affect?

A

Children under the age of 2

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11
Q

Name 3 risk factors for bronchiolitis?

A

Breast fed for less than 2 months
Smoke exposure
Siblings at nursery or school
Chronic lung disease due to prematurity

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12
Q

What are the clinical features of bronchiolitis?

A

Feeding difficulty
Low grade fever
Nasal congestion
Rhinorrhoea
Cough

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13
Q

What type of cough do patients with bronchiolitis present with?

A

Dry wheezy cough

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14
Q

When would you consider a child with bronchiolitis for admission?

A

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

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15
Q

What investigations can you do for a child with bronchiolitis?

A

Nasopharyngeal swabs
O2 sats
Blood and urine cultures

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16
Q

What is the management of bronchiolitis?

A

Humidified oxygen
Fluids
Nutrition

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17
Q

What should you not give in the management of bronchiolitis?

A

Antibiotics
Steroids
Bronchodilators

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18
Q

What are the 3 main types of wheeze?

A

Viral episodic wheeze
Multiple trigger wheeze
Asthma

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19
Q

What is the pathophysiology of asthma?

A

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

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20
Q

What are 3 risk factors for asthma?

A

Genetic
Prematurity
Low birth weight
Viral bronchiolitis in early life.

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21
Q

When are asthma symptoms typically worse?

A

At night and in the early morning

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22
Q

What investigations should be carried out to diagnose asthma?

A

Spirometry
Peak flow diary (diurnal variation)

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23
Q

What does spirometry show in asthma?

A

FEV1:FVC ratio is less than 70%

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24
Q

What is the stepwise management of chronic asthma?

A

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

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25
Q

What is the acronym for acute asthma management?

A

OSHITME

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26
Q

What does OSHITME stand for?

A

Oxygen high flow
Salbutamol
Hydrocortisone
Ipratropium bromide
Theophylline
Mag sulph
Escalate care

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27
Q

Which organism is whooping cough caused by?

A

Bordetella pertussis

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28
Q

When is whooping cough vaccinated against?

A

2,3 and 4 months of age

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29
Q

What are the symptoms of whooping cough?

A

Paroxysmal cough followed by inspiratory whoop
Sore throat
Low grade fever

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30
Q

When is coughing worse in whooping cough?

A

Worse at night

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31
Q

How long does the paroxysmal phase of whooping cough last?

A

2 and 8 weeks

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32
Q

When should a nasopharyngeal aspirate be taken in cases of whooping cough?

A

Within 2 weeks of illness starting otherwise the culture will not grow the bacterium

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33
Q

What is the treatment for whooping cough?

A

Macrolide antibiotic. ending in mycin

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34
Q

What is the genetic inheritance of CF?

A

Autosomal recessive

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35
Q

How is CF usually diagnosed?

A

Heel prick testing at birth

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36
Q

What is the test for CF which is performed after the heelprick testing?

A

Sweat test, raised chloride ions

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37
Q

What are the clinical features of CF?

A

Recurrent chest infections
Meconium ileus
Faltering growth
Malabsorption
Steatorrhea
Clubbing

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38
Q

Which prophylactic Abx are used in CF?

A

Flucloxacillin

39
Q

Which are the most common organisms causing pneumonia in newborns?

A

Group B strep
Gram negative enterococci and bacilli

40
Q

Common organisms for pneumonia in infants and young children?

A

RSV, Strep pneumonia, H.influenza

41
Q

Common organisms for pneumonia in children over 5?

A

Mycoplasma pneumonia
Strep pneumonia
Chlamydia pneumonia

42
Q

What signs might you see on examination in children with pneumonia?

A

Tachypnoea
Nasal flaring
Recession
Coarse crackles
Decreased O2 sats

43
Q

What investigations for pneumonia?

A

CXR showing consolidation
Nasopharyngeal aspirate for viral cause

44
Q

What antibiotics are given for pneumonia?

A

Oral amoxicillin

45
Q

What is acute epiglottis?

A

Intense swelling of the epiglottis and surrounding tissues

46
Q

Which organism causes acute epiglottitis?

A

HIB

47
Q

What does a child with epiglottitis look like?

A

Sitting upright
Tripoding to maximise breathing

48
Q

Symptoms of epiglottitis?

A

High fever
Difficulty swallowing
Stridor
NO COUGH

49
Q

What must you not do in epiglottitis?

A

Examine the throat

50
Q

Management of epiglottitis?

A

Refer to ENT and anaesthetists
Blood cultures
Broad spec Abx such as cefuroxime

51
Q

What treatment should contacts of a patient with epiglottitis have?

A

Rifampicin

52
Q

Name the acyanotic heart defects.

A

ASD
VSD
Atrioventricular septal defect
PDA

53
Q

Which way is the shunt in ASD?

A

Left to right

54
Q

What type of murmur is heard in ASD?

A

Mid-systolic, crescendo decrescendo murmur at the left upper sternal edge

55
Q

What causes the fixed splitting in ASD?

A

Pulmonary valve closes after the aortic valve due to increased blood flow leading to a fixed splitting

56
Q

How does an ASD present in childhood?

A

Often asymptomatic

57
Q

If an ASD is symptomatic what symptoms often present?

A

SOB
Difficulty feeding
Poor weight gain
LRTI’s

58
Q

What are some of the complications of increased blood flow to the lungs?

A

This can lead to pulmonary hypertension, and cause right sided HF

59
Q

What is Eisenmenger syndrome?

A

Where the pulmonary pressure is greater than the systemic pressure

60
Q

What is the most common type of congenital heart defect?

A

Ventricular septal defect

61
Q

Which way does the blood shunt in VSD?

A

Left to right

62
Q

What type of murmur is heard in VSD?

A

Pansystolic murmur

63
Q

How are murmurs treated by paediatric cardiologists?

A

Transvenous catheter closure

64
Q

What are the differentials for a pansystolic murmur?

A

Mitral regurgitation
Tricuspid regurgitation
VSD

65
Q

What is the gold standard investigation for septal defects?

A

ECHO

66
Q

What heart condition are patients with a VSD more at risk of?

A

Infective endocarditis

67
Q

What is a PDA?

A

Patent ductus arteriosus, hole between the aorta and pulmonary artery

68
Q

Which way does blood shunt in a PDA?

A

From the aorta to pulmonary artery

69
Q

What are the pulses like in PDA?

A

Bounding pulses
Wide pulse pressure

70
Q

What type of murmur is heard in PDA?

A

Machinery murmur

71
Q

What type of murmur is heard in pulmonary stenosis?

A

Ejection systolic murmur with radiation to the back

72
Q

When does a coarctation of the aorta typically present?

A

In the first few days of life after the PDA closes

73
Q

What are the signs of coarctation of aorta?

A

Discrepancy of BP in upper and lower limb

74
Q

How is a coarctation of the aorta managed?

A

Keep the PDA open with a prostaglandin infusion

75
Q

What are the symptoms of HF in babies and infants?

A

Breathlessness on feeding
Sweating
Poor feeding
Recurrent chest infections

76
Q

Name 3 causes of HF in neonates?

A

Hypoplastic left heart (left side cannot pump blood around body)
Critical aortic valve stenosis
Severe coarctation of the aorta

77
Q

Causes of HF in infants?

A

VSD
ASD
Persistent PDA

78
Q

Causes of HF in older children and adolescents?

A

Eisenmenger syndrome
Rheumatic heart disease
Cardiomyopathy

79
Q

What are the 2 main cyanotic heart defects?

A

Tetralogy of fallot
Transposition of the great arteries

80
Q

When does tetralogy of fallot present?

A

Within the first few months of life

81
Q

When does TGA present?

A

Within the first few days of life when the PDA closes

82
Q

What are the 4 features of tetralogy of fallot?

A

Pulmonary stenosis
Right ventricular hypertrophy
Large VSD
Overriding aorta

83
Q

What drug can keep the PDA open?

A

Alprostadil

84
Q

What has occurred in TGA?

A

Aorta and pulmonary artery has swapped, so aorta provides deoxygenated blood to the body

85
Q

How can a TGA be managed?

A

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

86
Q

Which is the most common arrythmia in children?

A

Supraventricular tachycardia

87
Q

What typically triggers rheumatic fever?

A

A bacterial throat infection

88
Q

What are the symptoms of rheumatic fever?

A

Inflamattion in the joints
Small bumps under the skin
Red rash with odd edges
Fever
Weight loss

89
Q

Which valve does rheumatic fever most commonly affect?

A

Mitral valve leading to mitral stenosis

90
Q

What is the treatment for rheumatic fever?

A

Antibiotics
Anti inflam
Bed rest and limitation of exercise

91
Q

What medication is used to promote duct closure in PDA?

A

Indomethacin

92
Q

In an acute asthma attack when is IV hydrocortisone given?

A

Only if the patient is vomiting and cannot tolerate oral pred

93
Q

What symptoms of asthma suggests a life threatening disease?

A

Less than 33% expected peak expiratory flow rate

94
Q

What discharge medications should be prescribed for children after having an asthma attack?

A

Salbutamol inhaler plus 2-5 days of oral pred

Phase 3A content (15 decks)

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