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A3 ME3034 SPECIALTIES > W07 - PAEDS: Cardiology; Infectious Diseases; Derm > Flashcards

W07 - PAEDS: Cardiology; Infectious Diseases; Derm Flashcards

1
Q

Ventricular Septal Defect Types & general mgmt

A

SUBAORTIC

PERIMEMBRANOUS

MUSCULAR

L->R Shunt

> Loop diuretics + amiloride/spironolactone/ACEi

> amplatzer; other occlusion device
patch closure, open heart sx

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2
Q

Presentation of septal defects

A

Pansystolic murmur lower left sternal edge, + thrill

very small VSDs, early systolic murmur

very large VSDs diastolic rumble due to relative mitral stenosis

Signs of cardiac failure in large VSDs, leading to biventricular hypertrophy and pulmonary hypertension

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3
Q

Eisenmenger Syndrome

A

irregular blood flow in the heart and lungs.
= blood vessels in the lungs to become stiff and narrow.

pulmonary arterial hypertension

Eisenmenger syndrome permanently damages the blood vessels in the lungs.

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4
Q

Patent ductur Arteriosus

A

common in premies
> fluid restriction
> diuretics
> prostaglandin inhibitors
> indomethacin
> surgical ligation

  • spontaneous closure
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5
Q

Atrial Septal Defects

A

Few clinical signs, spontaneous closure chance, ACYANOTIC

  • detected with AF in adults, HD, or Pulm HT
  • recurrent chest infections/wheeze

wide dixed splitting of 2nd heart sound pulmonary flow murmur

-trisomy21 association

1) Secundum ASD - PATENT FORAMEN OVALE

2) PARTIAL AVSD: minority

> Cardiac catheresiation = closure
Sx

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6
Q

Coarctation of Ao

A

*narrowing of ao.; often descending arch / also commonly where ductus enters the ao.
- associated with turner’s, and M>F
*weak/absent femoral pulse
*radio-femoral delay (chronic co-arctation)
*systolic murmur - loudest on back
*sudden deterioration and collapse

  • delayed duct closure = aortic blood flow flow through ductus art. into pulmonary trunk = reduced workload on LHS
  • suprasternal ECHO
  • MRI
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7
Q

Mgmt of Coarctation of Ao

A

> re-open ductus arteriosus via prostaglandin E1 or E2
=> transfer to centre

sick neonate:
> frusemide, correct HT: BB

> resection w/ end to end anastomosis
subclavian patch repair
balloon aortoplasty (via femoral art.)

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8
Q

Cyanotic Heart Defects

A

not as prevalent in incidence
* central cyanosis; significant cause dt RtoL shunt
* delayed if ductus arteriosus is delayed

dt transposition of great arteries
or
Fallot’s Tetralogy

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9
Q

transposition of great arteries

A

Ao comes out of the RV, pulm art exits LV, nil shunt = separate blood flows of oxygenated and systemic.
= ID’d antenatally

surviival depends on:
* open ductus arteriosus
* large ASD or VSD

> IV prostaglandins, umbillical catheter = ensure duct open and stabilisation
Rashkind procedure via femoral vein into RA = closure of foreamen ovale

> SWITCH PROCEDURE = swapping over vessels under cardiopulm bypass.
- avoid dmg to vessels = MI under reperfusion
thus surrounding tissue = stump transposed too.

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10
Q

Fallot’s Tetralogy

A
  • narrowing of right ventircular outflow: pulmonary valve stenosis
  • right ventricular hypertrophy
    = RtL shunt
  • ventricular septal defect
  • aorta = overriding aoirta
  • good prognosis usually, mgmt at ~6mos
  • boot shaped heart but rarely seen with early correction methods

> BB
Sx correction at 5kg body weught
Life long f-up dt recurring RV outflow obstruction
for critical pulmonary valve stenosis = subclavian artery shunt with pulm art.
- tendency to block and worsen

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11
Q

Common causes of death for children

A

INFECTIOUS DISEASES: pneumoniaa, diaarrheala diseases, measles etc.

Preterm birth
Neonatal asphyxia and traumaa
neonatal sepsis

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12
Q

Pneumonia

A

a

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13
Q

Meningitis

A

a

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14
Q

Pneumonia

A

a

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15
Q

Gastroenteritis

A

a

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16
Q

Staph and Strep Infection

A

a

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17
Q

Sepsis

A

Sepsis = SIRS + infection

Severe Sepsis = Sepsis + Organa dysfunction

Septic Shock = Sepsis + CVS Dysfunction

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18
Q

Flags for Children Sepsis

A

<3yo
- immsuppr., LT steroids
-recent sx
-indwelling
- complex neruodisability = PEWS may not pick up
- sig. parentaal concern
- group B strep.
- maternal group b strep. / UTI

> O2, Abx, Fluids, ADRENALINE
- CEPHALOSPORIN (Cefotaxime, Ceftriaxone)
+ IV amox if <1m y/o
Blood cultures, blood glc, blood lactate
+ fluid resus.

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19
Q

ORganisms for Sepsis in Children

A

Neonates:
- Group B Strep
- E coli
- Listeria monocytogenes

Older infaants & Children:
- Strep pneumon.
- Nisseria mingitidis
- Group A Strep
- S. aureus

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20
Q

Pathogenesis of Sepsis

A

LPS & bacterial component triggering inflamm response of neutrophils, monocytes, endothelium, cytokines and complement
* microvascular occlusion & vascular instability
* widespread coag., fever, vasodilation, capillary leak
* sepsis and multiple organ failure

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21
Q

Triad of mengism

A

FEVER
HEADACHE
NECK STIFFNESS

*focal deficit = raised ICP
* babies = apnoea. (resp distress), buldging fonatenelle (ICP)

22
Q

Clinical Signs of Meningitis

A

NUCHAL RIGIDITIY

BRUDZINSKI’S SIGN = hips and knee flex on passive flexion of knee

KERNIG’S SIGN = pain on passive extension of the knee

23
Q

Causes of Childhood Meningitis

A

1) mainly enterovirus

  • bacterial
  • Group B strep, E colo, Listeria
  • Strep pneumonia, N meningitidis, Haemo. influenz. type B (low now dt vax)
  • fungal
  • unknown/ aseptic
24
Q

H influenz.

A

small non-motile gram neg. coccobacillus
- nasopharyngeal carriage

  • bacteraemia, meningitis, epiglottitis, pneumonia
25
Nisseria meningitidis
gram neg, diplococcus - human natural hosts - nasopharyngeal * follows viral URTI * endotoxin
26
RF for Nisseria meningitidis
*unimmunised * crowded living conditions * household or kissing contact * cigarette smoking * recent viral infection
27
Meningitis Vs Septicaemia
* petechial rash common in both meningitis: headache, fever, vom, neck, fonatenelle, seizures septicemia: fever, headache, myalgia, vom, abdo pain, limb pain, shock
28
Pneumococcus
LANCETshapred, diplococcus, gram+ - colonises nasopharynx
29
Mgmt of Meningitis
ABCD > fluid bolus > abx CEPHALOSPORIN: ceftriaxone/cefotaxime + amox if <1m. yo *glucose! hypos.
30
Treatment Duration Depending on Causative Agent in Bact. Meningitis
Neisseria meningitidis 7 days Haemophilus influenzae 10 days Streptococcus pneumoniae 14 days Group B Streptococcus ≥14 days Listeria monocytogenes 21 days
31
Interpretation of Lumbar Puncture
Bacterial meningitis has HIGH OPENING PRESSURE, LOWER GLUCOSE and LOWER WBC than VIRAL meningitis viral meningitis = clearer
32
Commonest Dermatological Pres in Children
*ATOPIC ECZEMA - eczema, asthma, hayfever - typically spreads from face, neck, cheeks - older: flexural pattern, hands, ankles
33
Eczema Variants
DISCOID: scattered circular patches, itchy POMPHYLX ECZEMA : hand and foot, vesicular, itchy+++ EXOGENOUS: allergic type IV hypersens, irritant eczema
34
Eczema mgmt
Emollients Topical steroids - DERMOVATE - BETNOVATE - EUMOVATE - HYDROCORTISONE once daily, 1-2w progress to alternate days to few, FTU Calcineurin inhibitors (e.g protopic – steroid sparing topical agents) UVB light therapy Immunosuppressive medication
35
Impetigo
Common bact. Pustules, honey-coloured crusted erosions STAPH AUREUS > topical abx = fucidin > oral abx = fluclox.
36
Molluscum contagiosum
common benign, self-limiting molluscipox virus close contact transmission *pearly papules, umbilicated centre >reassure
37
Viral Warts
non cancerous growths w/ HPV * sole foot = verruca > salicylic acid + cryotherapy = stimulate imm system
38
Viral exanthems
Associated viral illnesses = response to organism toxin Common Fever, malaise, headache
39
Chickenpox - VARICELLA ZOSTER
varicella zoster virus *red papule progressing to vesicles, common start at trunk, itchy, viral symptoms > self-limiting infection control = nursery
40
Parvovirus
Slapped Cheek; Fifth Disease; ERYTHEMA INFECTIOSUM * erythemous rash cheek initally then develop to lace rash on trunk and limbs self-limiting, viral symptoms. !hemolytic crisis in disorders ! risk to pregnany women = abortion, intrauterine death, hydrops fetalis
41
Hand Foot and Mouth
ENTEROVIRUS Usually Coxsackie virus A16 Blisters on hand, feet, and moouth, + viral symptoms late summer or autumn months self limiting > supportive +eczema variant; eczema herpeticum: monomorphic punched out lesions > aciclovir, withold steroids
42
SYSTEMIC. DERMATOLOGICAL PRESENTATIONS
1. OROFACIAL GRANULOMATOSIS cobblestone appearance +crohns + fecal caprotectin if GI symptoms 2. ERYTHEMA NODODSUM painful erythematous subcutaneous nodules, shins slow resolution strep, URTI, IBD, sarcoid, drugs, myco. 3. DERMATITIS HERPETIFORMIS coeliac disease, rare. itchy blisters appearing in clusters, symmetrical, trunk + shoulders butt, flexural 4. URTICARIA wheals hives, angioedema 6w+ = chronic otherwise acute * multiple associations > antihistamines: deskiratadube
43
S. aureus Vs S pyogenes
s. aureus - gram + - coagulase + exotoxin superantigens - skin and mucosaa - MRSA! strep pyogenes - gram + , Bhemolytic - oro-pharyngeal - sensitive to penicillin predominant cause of. skin and soft tissue infection in children
44
Staph. Scalded Skin Syndrome
<5yo, toxin mediated, starts w/ bullous lesion => widespread nikolsky sign +, pyrexic, purulen conjuctivities > IV Fluclox > IV Fluids
45
Nikolsky Sign
Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when rubbed. Nikolsky sign is a condition caused by a staphylococcal infection in which the superficial layers of skin slip free from the lower layers with a slight rubbing pressure.
46
Scarlet Fever
Group A Strep. fever sore throat; STRAWBERRY TONGUE => skin peeling (desquamation) spares palms and soles - notifiable disease > 10d penicillin V !rheumatic fever ! abscess ! post-strept glomerulonephritis
47
Toxic Shock Syndrome
Acute febrile illness caused by Gram +ve bacteria (S. aureus & GAS) multiorgan failure dt superantigen = intense t response and cytokinestorm Fever Diffuse, maculopapular, ‘sunburn’ rash Mucosal changes +diarrhoea (s. aureus) + progression to shock > ABC > Fluids > Cultures > IV Fluclox + Clindamycin > IV Ig > Sx debridement !avoidNSAIDs
48
Pres. of Infant with Congestive HF and subsequent mgmt
Tachyopnea on exertion - feeding, sweating /panting with feeds Tachycardia Hepatomegaly No peripheral oedema Cardiomegaly, faltering growth ?murmurs ? femorals palpable > furosemide > spironolactone > fluid restrict., high nutr. and cal.feed.
49
Tetralogy of Fallot; Presentation
Large VSD Right ventricular outflow obstruction Overriding of the aorta Right ventricular hypertrophy common cause of CYANOTIC BABY * Dyspnoea on feeding / crying / exertion * murmur * failure to thrive - improved by squatting ! TET SPELLS = EMERGENCY Sudden onset dyspnoea / cyanosis Typically triggered by an event that slightly reduces O2 concentration, e.g. crying, defecating, feeding, distress > corrective sx.
50
TGA pres and mgmt
neonatal period = cyanotic baby = high suspicion >prostaglandin
51
Innocent Murmurs
*asymptomatic child 1) STILL'S MURMUR: commonest, school age children - left of sternum - systolic; vibratory - decreased in standing, sitting, valsalva (POSTURAL) 2) PULM. FLOW MURMUR: common in older children and teenagers, thin chest walls 3) VENOUS HUM: continuous soft blowing - above aortic valve site - disappears lying down 4) CAROTID BRUIT: children and young adults - supraclavic, carotids - decreases with hypertextension of shoulder 5) PHYSIOLOGICAL PULM FLOW MURMUR OF NEONATE 6) Physiological pulmonary stenosis: common in newborns - pulm. valve => radiate to the back

A3 ME3034 SPECIALTIES (27 decks)

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