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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
Q

Nisseria meningitidis

A

gram neg, diplococcus
- human natural hosts
- nasopharyngeal

  • follows viral URTI
  • endotoxin
26
Q

RF for Nisseria meningitidis

A

*unimmunised
* crowded living conditions

  • household or kissing contact
  • cigarette smoking
  • recent viral infection
27
Q

Meningitis Vs Septicaemia

A
  • petechial rash common in both

meningitis: headache, fever, vom, neck, fonatenelle, seizures

septicemia: fever, headache, myalgia, vom, abdo pain, limb pain, shock

28
Q

Pneumococcus

A

LANCETshapred, diplococcus, gram+
- colonises nasopharynx

29
Q

Mgmt of Meningitis

A

ABCD
> fluid bolus
> abx
CEPHALOSPORIN: ceftriaxone/cefotaxime
+ amox if <1m. yo

*glucose! hypos.

30
Q

Treatment Duration Depending on Causative Agent in Bact. Meningitis

A

Neisseria meningitidis
7 days
Haemophilus influenzae
10 days
Streptococcus pneumoniae
14 days
Group B Streptococcus
≥14 days
Listeria monocytogenes
21 days

31
Q

Interpretation of Lumbar Puncture

A

Bacterial meningitis has HIGH OPENING PRESSURE, LOWER GLUCOSE and LOWER WBC than VIRAL meningitis

viral meningitis = clearer

32
Q

Commonest Dermatological Pres in Children

A

*ATOPIC ECZEMA
- eczema, asthma, hayfever
- typically spreads from face, neck, cheeks
- older: flexural pattern, hands, ankles

33
Q

Eczema Variants

A

DISCOID: scattered circular patches, itchy

POMPHYLX ECZEMA : hand and foot, vesicular, itchy+++

EXOGENOUS: allergic type IV hypersens, irritant eczema

34
Q

Eczema mgmt

A

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
Q

Impetigo

A

Common bact.
Pustules, honey-coloured crusted erosions

STAPH AUREUS

> topical abx = fucidin
oral abx = fluclox.

36
Q

Molluscum contagiosum

A

common benign, self-limiting
molluscipox virus

close contact transmission

*pearly papules, umbilicated centre

> reassure

37
Q

Viral Warts

A

non cancerous growths w/ HPV
* sole foot = verruca

> salicylic acid + cryotherapy = stimulate imm system

38
Q

Viral exanthems

A

Associated viral illnesses = response to organism toxin
Common
Fever, malaise, headache

39
Q

Chickenpox - VARICELLA ZOSTER

A

varicella zoster virus
*red papule progressing to vesicles, common start at trunk, itchy, viral symptoms

> self-limiting

infection control = nursery

40
Q

Parvovirus

A

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
Q

Hand Foot and Mouth

A

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
Q

SYSTEMIC. DERMATOLOGICAL PRESENTATIONS

A
  1. OROFACIAL GRANULOMATOSIS
    cobblestone appearance

+crohns
+ fecal caprotectin if GI symptoms

  1. ERYTHEMA NODODSUM
    painful erythematous subcutaneous nodules, shins
    slow resolution
    strep, URTI, IBD, sarcoid, drugs, myco.
  2. DERMATITIS HERPETIFORMIS
    coeliac disease, rare. itchy blisters appearing in clusters, symmetrical, trunk + shoulders butt, flexural
  3. URTICARIA
    wheals hives, angioedema
    6w+ = chronic otherwise acute
    * multiple associations

> antihistamines: deskiratadube

43
Q

S. aureus Vs S pyogenes

A

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
Q

Staph. Scalded Skin Syndrome

A

<5yo, toxin mediated, starts w/ bullous lesion => widespread
nikolsky sign +, pyrexic, purulen conjuctivities

> IV Fluclox
IV Fluids

45
Q

Nikolsky Sign

A

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
Q

Scarlet Fever

A

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
Q

Toxic Shock Syndrome

A

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
Q

Pres. of Infant with Congestive HF and subsequent mgmt

A

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
Q

Tetralogy of Fallot; Presentation

A

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
Q

TGA pres and mgmt

A

neonatal period = cyanotic baby = high suspicion

> prostaglandin

51
Q

Innocent Murmurs

A

*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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