Week 3 - E - Respiratory and Cardiac Problems

Question 1

What are some of the key features of sepsis?

Answer 1

Hot

Lethargy

Tachycardic

Low blood pressure

Question 2

What is the sepsis 6 bundle?

Answer 2

Bloods

Urine

Fluids

Antibiotics

Lactate dehydrogenase

Oxygen - high flow

Question 3

To rule out meningitis in sepsis, what is carried out?

Answer 3

A lumbar puncture is done to rule out meningitis

Question 4

What type of bacteria causes meningitis with a rash?

Answer 4

Neisseria meningitidis - causes meningococcal meningitis

Question 5

If you are in the community and a child has a purpuric rash, what test do you carry out? What do you give since no access to IV lines?

Answer 5

Tumbler’s test - hlds glass to arm to test for non blanching rast

Give IM benylpenicillin in the community

Question 6

What is given to the child once reaching the hospital?

Answer 6

IV ceftriaxone

Question 7

What must be carried out in the child before performing a lumbar puncture and why?

Answer 7

Child requires a clotting screen before carrying out a lumbar puncture

Question 8

What abnormality of the fontanelles may occur in meningitis?

Answer 8

May have enlarged fontanelles

Question 9

What is the cause of a respiratory distress in a premature child? Define premature child?

Answer 9

Child born earlier than 37 weeks grestatiion

Premature children do not have full pulmonary surfactant and therefore alveoli tend to collapse making it difficult to breathe

Question 10

What cells produce pulmonary surfactant?

Answer 10

Type II alveolar cells aka type II pneumocyte

Question 11

• Trouble in PE, feels quite short of breath inexercise, can have other atopy eg eczema and asthma What does this child have? How should you assess the child?

Answer 11

Child has asthma - assess using peak flow meter

Question 12

What is laryngeotracheobronchitis more commonly known as? What organism mainly causes it?

Answer 12

More commonly known as croup

Caused by Parainfluenza Virus

Question 13

What causes this condition?

Answer 13

Classic presentation of bronchioloitis

Caused by respiratory syncitial virus

Question 14

Child complaining of flu like symptoms, usually gets cough and has difficulty sleeping due to obstructed airway What is this? What is the sign on xray?

Answer 14

This is croup

Steeple sign on Xray

Question 15

What is the cough described as in croup? What causes the blockage of the airway? What is treatment of croup?

Answer 15

Barking cough

Virus causes inflammation and swelling of airway

Give steroids as treatment

Question 16

• Can get prolonged bouts of violent coughing, children being unable to breathe and vomiting Vomtiing is so violent it causes vomiting What is this?

(had a stroke reading this <3)

Answer 16

This is pertussis - whooping cough

Question 17

What causes pertussis? What is the treatment?

Answer 17

Bordatella pertussis

Like bronchiolitis it is self limiting and supportive care

Question 18

Child with sternal recession, slight fever and high pitched bronchi with cough What is this?

Answer 18

Bronchiolitis

Question 19

What is the difference between acyanotic and cyanotic breathlessness?

Answer 19

Acyanotic is the absence of cyanosis due to a left to right shunt

Cyanotic - cyanosed due to a right to left shunt of blood and therefore the blood is not being oxygenated in the lungs

Question 20

Things like septal defects and patent ductus arteriosum tend to cause left to right shunts (acyanotic) What type of murmur does a ventricular septal defect sound like? What type of murmur is patent ductus arteriosus?

Answer 20

Harsh systolic murmur at left sternal edge

Continous machine like murmur

Question 21

What is the ductus arteriosus knwon as after birth?

Answer 21

Ligamentum arteriosum

Question 22

What are 3 of the causes of cyanotic heart disease?

Answer 22

Tetralogy of Fallot

Transposition of the great vessels

Truncus arteriosus

Question 23

What is the tetralogy of Fallot?

Answer 23

• Right ventricular hypertrophy
• Ventricular septal defect
• Overriding aorta
• Pulmonary stenosis

Question 24

What ventricles does transposition of the great vessels cause attachment to?

Answer 24

Aorta attaches to the right ventricle causing deoxygenated blood to pass to the body

Pulmonary trunk attaches to the left ventricle therefore oxgenated blood goes to the lungs

Requires surgery

Question 25

What does truncus arteriosus cause? also known as common truncus What is a truncus arterious often accompanied by?

Answer 25

It can cause life threatening pulmonary hypertension due to too much blood flowing to the lungs

Often accompanied by a ventrciular septal defect - blood mixes with both ventricles and blood from both vessels mix resulting in cyanosis

Question 26

Congenital heart defect where all 4 pulmonary veins drain to the right atrium instead of the left?

Answer 26

This is TAPVC (Total Anomalous Pulmonary Venous connection) - causes hypoxia to the rest of the body

Question 27

In a child with abdominal pain and weight loss with smelly stools, what is it important not to miss?

Answer 27

Dont miss Coeliac Disease

Question 28

Child presents with scabs on his face that appear gold and crusty What is this?

Answer 28

This is impetigo

Question 29

What causes impetigo and what is the treatment?

Answer 29

Staph aureus causes it

Treat with flucloxacillin

Question 30

affected skin is red, can often present as a butterfly spread on face, usually caused by Group A strep What is this?

Answer 30

Erypsileas

Question 31

What causes slapped cheek disease? Slapped cheek disease can also cause a fever and sore throat

Answer 31

Parvovirus B19 causes it

Question 32

Small vessel IgA mediated vasculitis Common in children aged 2-11 What is this?

Answer 32

Henoch-Schonlein Purpura

Question 33

How does HSP present? What is the treatment?

Answer 33

palpable purpura usually in lower limbs / buttocks with abdominal pain and joint pain

Usually self limiting in about 8 weeks

Can use steroids and analgesics