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Toni's Paeds > What Is/Are..... > Flashcards

What Is/Are..... Flashcards

1
Q

Possible consequences of NEC

A

Strictures, with incr risk of obstruction

Malabsorption if substantial resection was required

TPN complications:
Thrombophlebitis, central line infection, hyperglycaemia, cirrhosis, metabolic imbalance, acidosis, osteopenia, cholestasis

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2
Q

Respiratory Distress Syndrome

A

RDS aka Hyaline Membrane Disease

Absence of surfactant in lungs at birth due to prematurity
Type 2 pneumocytes begin to produce surfactant at 22wks
Surfactant reduces surface tension in the alveoli preventing them from collapsing, it also enhances gas exchange

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3
Q

Complications of RDS

A

Pneumothorax: high pressure O -> alveoli-> interstitium
Lobar collapse
Chronic lung disease of prematurity: pressure and volume trauma caused by long term ventilation
Cor pulmonale: due to pulm htn
Intra ventricular haemorrhage: due to fluctuations in BP and pH

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4
Q

Diaphragmatic hernia

A

Abdominal contents herniate up into the thorax (L side)
Usually detected on antenatal USS
Mass effects during development -> pulmonary hypoplasia
Asymmetrical chest signs & CXR
NG tube -> stabilise -> surgical repair
Vigorous resus -> pneumothorax

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5
Q

Tracheo-oesophageal fistula

A

Failure of normal development
Abnormal connection between trachea and oesophagus
Frothing at mouth seen as infant unable to swallow saliva
May lead to aspiration pneumonia

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6
Q

Laryngomalacia

A

Congenital laryngeal stridor
Flaccid supraglottic structures
Presents later than RDS
Most severe in older babies

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7
Q

Nitrogen Washout Test

A

Differentiates betw resp and cardiac causes of cyanosis
10 mins 100% Oxygen = max saturation of pulm circulation

Cyanosis improves: resp cause
No improvement: R -> L shunt

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8
Q

VATER / VACTERL

A

Vertebral anomalies, Anal malformations, Tracheoesophogeal-oesophageal fistula, Radial and Renal abnormalities

+ Cardiac deformity
+ Limb deformity
Three or more req to apply the term

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9
Q

Total Parenteral Nutrition

A

Elemental feed delivered through a catheter into a central vein

When enteral feeding is inappropriate because:
gut needs to be rested
absorption is inadequate
following severe trauma/burns

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10
Q

Patent Ductus Arteriosus

A

Failure of ductus between aorta and pulmonary artery to close
Left to right shunt
Bounding pulse, systolic murmur
If more severe -> HF : desaturation and respiratory distress
If symptomatic -> indomethacin or surgical ligation

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11
Q

Tetralogy of Fallot

A

An overriding aorta
Right ventricular outflow tract obstruction
Ventricular septal defect
Right ventricular hypertrophy

Assoc with: Noonan’s, Down’s,

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12
Q

Congenital heart disease:

L -> R shunt

Breathless

A

Ventricular Septal Defect
Persistent Ductus Arteriosus
Atrial Septal Defect

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13
Q

Congenital heart disease:

R -> L shunt

Blue

A

Tetralogy of Fallot

Transposition of the Great Arteries

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14
Q

Congenital heart disease:

Mixed

Breathless and Blue

A

Atrioventricular septal defect

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15
Q

Congenital heart disease:

Outflow obstruction in well child

Asymptomatic with murmur

A

Pulmonary stenosis

Aortic stenosis

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16
Q

Congenital heart disease:

Outflow obstruction in sick neonate

Collapsed with shock

A

Coarctation of the aorta

Hypo plastic left heart syndrome

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17
Q

Innocent murmurs

A

aSymptomatic
Soft blowing murmur
Systolic murmur only
left Sternal edge

No parasternal thrill
No radiation

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18
Q

Physiological jaundice

A 
>50% term babies, >80% preterm babies
Mild
Day 2-3 until end of first week
Inefficient bilirubin metabolism
Immature hepatic function 
Frequent RBC breakdown due to short 70 day lifespan
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19
Q

Breast milk jaundice

A

Diagnosis of exclusion
Appears within first 2 weeks, may last weeks
Mild, self limiting
? Dehydration due to poor feeding technique
? Component of breast milk inhibiting bilirubin metabolism

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20
Q

Kernicterus

A

Too much unconjugated bilirubin
Fat solubility -> crosses blood brain barrier
Deposited in: basal ganglia and brain stem nuclei

Lethargy, poor feeding, irritability, incr tone, seizures, coma
Less common due to prevention of resus haemolytic disease w. anti-D

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21
Q

Jaundice

A 
Rhesus haemolytic disease
ABO incompatibility
G6PD deficiency
Spherocytosis
Congenital infection
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22
Q

Jaundice at 2 days - 2 weeks

A

Physiological jaundice
Breast milk jaundice
Dehydration
Infection

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23
Q

Rhesus haemolytic disease

A 
Usually identified antenatally
Severe presentation: anaemia, hydrops, hepatosplenomegaly 
D
Kell
Duffy
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24
Q

ABO incompatibility

A

ABO antibodies = mostly IgM don’t cross placenta

Gp O women may have IgG anti A/B haemolysin

Peak jaundice at 12-72 hrs
Positive direct antibody (Coombs) test

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25
Q

G6PD deficiency

A 
Mediterranean/Middle East/Far East/Afro-Caribbean descent
X linked
Haemolysis precipitated by:
Infection
Drugs: ?
Favs beans
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26
Q

Phototherapy

A

450nm light (blue-green visible spectrum)
Photoisomerizes unconjugated BR -> water soluble
Excreted in urine
Cover eyes
Regular serum BR

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27
Q

Hypoxic-Ischaemic Encephalopathy

A

Perinatal hypoxia
Clinical manifestations can present up to 48hr post asphyxia
Neuronal damage: primary death, delayed reperfusion secondary death
Delay allows neuroprotection using hypothermia

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28
Q

Caput succedaneum

A

Bruising + oedema of presenting part
Extends beyond margins skull bones
Resolves in a few days

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29
Q

Cephalhaematoma

A

Bleeding below periosteum
Haematoma confined by skull suture margins, soft centre
Often involves parietal bone
Resolves over several weeks

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30
Q

Chignon

A

Oedema and bruising from Ventouse delivery

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31
Q

Subaponeurotic haemorrhage

A

Diffuse boggy swelling of scalp
V uncommon
–>severe blood loss, hypovolaemic shock and coagulopathy

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32
Q

Brachial nerve palsy

A

Traction to brachial plexus nerve roots
Breech delivery or shoulder dystocia
C5+6 = Erb’s palsy +/- phrenic nerve palsy (elevated diaphragm)
If not resolved by 2-3 months -> ortho/plastics

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33
Q

Intraventricular haemorrhage

A 
In 25% V low birthweight infants
Diagnosed on cranial ultrasound
First 72 hrs
Germinal matrix above caudate nucleus 
Assoc with perinatal asphyxia and RDS
May impair CSF drainage -> vent dilatation -> hydrocephalus
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34
Q

Retinopathy of prematurity

A

Vascular proliferation at junction betw vasc + non vasc retina
–> retinal detachment –> fibrosis –> blindness
Oxygen therapy
35% V low birthweight infants
Screened weekly by opthalmology
Laser therapy reduces visual impairment

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35
Q

Bronchopulmonary Dysplasia

A

Oxygen requirement at 36 wks post-menstrual age
Due to pressure and volume trauma
From artificial ventilation, oxygen toxicity, infection

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36
Q

Transient tachypnoea of the newborn

A

Diagnosis of exclusion
Delay in resorption of lung liquid
Most common cause of resp distress, more post c-section

Additional ambient oxygen, may take a few days to resolve
CXR: fluid in horizontal fissure

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37
Q

Meconium aspiration

A

Increased with incr gestation
Lung irritant -> mech obstruction + chemical pneumonitis
Artificial ventilation
CXR: overinflation, patches of collapse + consolidation
Air leak –> pneumothorax/pneumomediastinum
Persistent pul htn -> inadequate oxygenation despite ventilation

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38
Q

Neonatal pneumonia

A

PROM
Chorioamnionitis
Low birthweight

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39
Q

Persistent pulmonary hypertension of the newborn

A 
High pulm vasc resistance: R -> L shunt
Cyanosis soon after birth
Mech vent + circulatory support 
Inhaled NO beneficial
CXR: normal heart size, pulm oligaemia
Urgent echo to rule out congenital heart disease
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40
Q

Early onset sepsis

A

PROM, chorioamnionitis
Resp distress, apnoea, T instability
Broad spec IV abx:
Gp B strep, gram +ve, gram -ve: benzylpenicillin + gentamycin
Blood cultures: if -ve with no clinical signs stop abx after 48hrs
LP: if neuro signs/+ve blood cultures

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41
Q

Congenital Adrenal Hyperplasia

A

AR

absence 21 hydroxylase

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42
Q

Systemic Juvenile Idiopathic Arthritis - Still’s disease

A 
High fever, nocturnal spikes
Malaise + anorexia
Salmon pink rash
Anaemia
Raised platelets + neutrophils
Raise CRP
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43
Q

Kawasaki’s

A

Vasculitis
Bacterial toxin acts as super-antigen
6 months - 4 yrs
Prolonged fever, cervical lymphadenopathy, strawberry tongue, conjunctival infection, rash, arthralhia, finger tip desquamation
Coronary artery involvement -> aneurysm or thrombosis

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44
Q

Contraindications to LP

A 
Resp compromise
Cardiac compromise
Raised ICP
Coma/rapid decr in consciousness
Focal neuro signs
Coag disorder or thrombocytopenia 
Local infection at LP site
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45
Q

UTI: causative organisms

A 
E.coli
Proteus: common in boys 
Pseudomonas: with urinary tract abnormality
Klebsiella
Strep.faecalis
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46
Q

Vesicoureteric reflux

A

Ureters enter bladder at perpendicular angle
= shorter intramural course
-> reflux of urine on bladder contraction
Severe reflux: renal pelvis dilatation, calyces
Incomplete bladder emptying: predisposition to infection
Infection -> scarring, serious bilat scarring ->chronic renal failure

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47
Q

Pyloric stenosis

A 
Projectile vomiting
4 - 8 wks
M-4:F-1
1/500 males
Incr risk with family history
Rapid dehydration: untreated -> death
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48
Q

Gastro-oesophageal reflux

A

Severe vomiting
0 - 3 months
Full abdomen
Worsens over weeks

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49
Q

Posseting

A

Normal
Follows feeding
Non-forceful regurgitation of milk

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50
Q

Signs of hypovolaemic shock

A

Incr HR
Decr BP
Poor perfusion: slow CRT, cool peripheries

51
Q

Signs of cellular dehydration

A

Decr tissue turgor
Sunken eyes
Depressed ant fontanelle

52
Q

Signs of mild dehydration

A

Dry mucous membranes

Dry nappies

53
Q

Signs of raised intracranial pressure

A 
Bulging, tense anterior fontanelle
Focal neuro signs
Unequal pupils
Htn + low HR: cushing's reflex
Papilloedema
54
Q

Signs of neck stiffness

A

Opisthotonos: lying with arched back
Brudzinski’s sign:
flexion of neck when lying supine -> flexion of hips + knees
Kernig’s sign:
extension of knees when supine with flexed hips + knees -> back pain

55
Q

Meningitis causing pathogens:

Infants

A

Gp B strep
E.coli and other G-ves
Listeria

56
Q

Meningitis causing pathogens:

Children 1 month - 6 yrs

A

Neisseria meningitidis
Haemophilus influenzae
Streptococcus pneumoniae

57
Q

Meningitis causing pathogens:

Children > 6 yrs

A

Neisseria meningitidis

Streptococcus pneumoniae

58
Q

Complications of meningitis

A

Deafness: inflammatory damage to hair cells
Cranial nerve palsies: local vasculitis
Cerebral abscesses: raise ICP, require surgical drainage
Epilepsy: abscess/ local infarction
Hydrocephalus: inflammation/exudate block reabsorption of CSF
Mental impairment: more common with pneumococcal meningitis

59
Q

CSF features of bacterial meningitis

A

Turbid appearance
Polymorphs ++
Protein: >1.5 g/L
Glucose:

60
Q

CSF features of viral meningitis

A

Clear appearance
Some lymphocytes
Protein: 66% plasma glucose

61
Q

CSF features of TB meningitis

A

Fibrin web visible
Some lymphocytes
Protein: 1-5 g/L
Glucose

62
Q

Trisomy 13

1/14000

A 
Patau's syndrome
IUGR
Poldactyly
Cleft lip + palate
Scalp, cardiac + renal abnormalities
63
Q

Trisomy 18

1/8000

A 
Edward's syndrome
IUGR
Flexed overlapping fingers
Rocker bottom feet
Cardiac + renal abnormalities
64
Q

Trisomy 21

1/700

A

Developmental delay + mod-sev learning disabilities, Avg IQ 50
Round face, epicanthic folds, protruding tongue, hypotonia, single palmar crease, sandle-gap toes, flat occipitut
Duodenal + biliary atresia, VSD + ASD

65
Q

XXY

1/1000 male

A 
Klinefelter's syndrome
Tall
Female pattern body fat + hair growth
Gynaecomastia 
Small testicles
Mild-mod learning disabilities
Incr risk osteoporosis + breast cancer
66
Q

X0

1/2500 female

A 
Turner's syndrome
Short stature + wide carrying angle
Widely spaced nipples
Normal intelligence
Assoc w. Coarctation of the aorta
Webbed neck, lymphoedema of hands + feet
Amenorrhoea
Treat with GH and oestrogen
67
Q

Fragile X syndrome

1/4000

A

Most common cause of intellectual impairment in men
X linked dominant triple repeat: fmr1
Expansion of CGG at xq27.3 to > 200 repeats
= severe learning disabilities + autistic features
High forehead, large ears, long face, prominent jaw

68
Q

Fetal alcohol syndrome

A

Growth restriction
Cardiac + GU abnormalities
Intellectual impairment + emotional disturbance

69
Q

Intrauterine disruption

A

Severe oligohydramnios: compression induced deformity e.g. contractures
Amniotic bands: limb reduction deformities + lateral cleft lips

70
Q

Health problems assoc w. Down’s syndrome

A 
Structural abnormalities, congenital heart disease, duodenal + biliary atresia
Sinusitis + otitis media -> conductive hearing problems
Hypothyroidism
Cataracts
Acquired heart disease
Incr risk: AML, testicular cancer
Early onset Alzheimer's 
Atlanto-axial instability
71
Q

Cri du chat

A

Deletion: end of Chr 5
Severe mental retardation
High pitched cry

72
Q

Wolf-hirschhorn

A

Deletion: end of Chr 4
Severe mental retardation
Failure to thrive

73
Q

William’s

A

Micro deletion: 7q11

Peri orbital fullness, everted lower lip, full checks, developmental delay, engaging personality, heart defects

74
Q

Prader-Willi

A

Microdeletion: Chr15q11-13 from father
Initially: hypotonia + poor feeding
Later: insatiable appetite, obesity, mental retardation

75
Q

Angelman

A 
Microdeletion: Chr15 q11-13 from mother
Inappropriate laughter
Convulsions
Ataxia
Flapping
Mental retardation
76
Q

DiGeorge

A

Microdeletion: Chr22 q11-12
Cardiac defects, absent thymus, under active parathyroid glands
Anaemia, immune deficiency, hypoglycaemia, seizures
Cleft palate, cognitive defects

77
Q

Screening for Down’s

A

Nuchal translucency at 11-14wk dating scan
Triple serum test at 15 wks:
Oestradiol, BetaHCG: incr, Alpha-fetoprotein: decr
Probability of Down’s calculated
High risk: amniocentesis from15 wks, chorionic villus sampling from 11wk
0.5-2% risk spontaneous miscarriage
Termination offered

78
Q

Risk of obstruction with inguinal hernia

A

6 month old: >50-60%
1year old: >10%
2 year old: >2%

79
Q

Indirect inguinal hernia

A

1/50 boys
Due to patent processus vaginalis
Usually right sided
More common in premature infants

80
Q

Genetic causes trisomy 21

A

94% meiotic non-dysjunction
5 % Robertsonian translocation
1% Mosaicism

81
Q

Tay Sachs

A

Deaf
Blind
Repeated infections

82
Q

Screening for Down’s syndrome

A

11-14 wk dating scan: nuchal translucency
15 wk triple serum test: oestriol, beta- hCG (incr), alpha-fetoprotein (decr)
= probability of Down’s
Diagnostic tests:
Amniocentesis >15 wks, chorionic villus sampling >11wks
0.5-2% risk of miscarriage
Option to terminate upon diagnosis

83
Q

What is Osgood-Schlatter disease?

A

10-15 yrs 1/100000
traction apophysitis
(cartilage detachment from tibial tuberosity)
due to repeated avulsion during growth spurt i.e. overuse
usually a lump over the tibial tubercle
self limiting

84
Q

What is slipped femoral epiphysis?

A

overweight boys 10-15 yrs
1/50000
FE displaced posterolaterally following minor trauma/spontaneously
bilateral in 1/5

85
Q

What is Perthe’s disease?

A 
avascular necrosis of the femoral head
boys 5-10 yrs
limp develops over 1 month
may be preceded by infection/trauma
over 18-36 months revacularisation and reossification occurs
may be fhx, 1/5 bilateral
more common in SCD
86
Q

Osteogenic sarcoma

A 
girls 10-14 yrs
boys 15-18 yrs
1/100000
persistent pain in long bones of leg
P53 mutation + Li Fraumeni synd predispose
87
Q

Ewing’s sarcoma

A

5-20yrs
1000000
local disease 60-70% survival
metastatic disease 20-30%

88
Q

What are the complications of corrective surgery for a slipped femoral epiphysis?

A

avascular necrosis
fusion in the new position, slight coax vara deformity
chondrolysis -> pain + arthritis

89
Q

Systemic Juvenile Idiopathic Arthritis

A 
1-4 yrs
1/100000
fever rash hepatomegaly
usually self limiting
polyarticular > 4 joints
pauciarticular 4 or less
systemic
needs to be present for 3 months to make the diagnosis
90
Q

What is Septic Arthritis?

A 
recent URTI
strep pyogenes
haemophilus influezae
strep pneumoniae
staph aureas
91
Q

What is Transient Synovitis?

A 
2-12 yrs
common
often initiated by viral illness
may have fever and incr acute phase reactants
spontaneous resolution
92
Q

Developmental hip dysplasia

A

at birth
‘clicky hips’ on Ortolani’s and Barlow’s manoeuvres
6-10/100 live births

93
Q

What do different immune deficiencies predispose to?

A 
immunoglobulin deficiency (agammaglobulinaemia)-> severe bacterial infections
complement disorder -> encapsulated organisms and AI disorder
phagocyte dysfunction (chronic granulomatous disease) -> severe bacterial and fungal infection
94
Q

What is Severe Combined Immune Deficiency?

A

usually X linked inherited
affects humoral and cellular components
-> early, severe, atypical infections
only possible cure - BM transplant

95
Q

How many resp tract infections per year is normal

A

preschool age 6-8 is normal

most will be self limiting viral infections

96
Q

What causes secondary immune deficiency?

A

drugs
infection
malignancy

97
Q

What are the causes of HIV in children?

A

vertical transmission:
in utero, during delivery, breast feeding
infected blood products
dirty needles

98
Q

What are AIDS defining illnesses?

A

TB

candidiasis

99
Q

What are common presentations of HIV infection?

A

mild immunosuppression: lymphadenopathy, parotitis, persistent diarrhoea, recurrent bacterial infection
moderate immunosuppression:
failure to thrive, candidiasis, lymphocytic interstitial pneumonitis, opportunistic infections, focal organ disease

100
Q

How do you manage HIV?

A

antiretroviral therapy
starting regimens incl:
2 nucleoside analogue reverse transcriptase inhibitors (zidovudine, zalcitabine) with a non nucleoside reverse transcriptase inhibitor (nevirapine) or a protease inhibitor (ritonavir)

101
Q

What is the toxic dose of paracetamol?

A

> 130mg/kg

102
Q

When is gastric lavage used for paracetamol OD?

A

if patient presents within 1 hr with potentially life-threatening OD
risks incl: aspiration, GI perforation or haemorrhage
never perform with reduced consciousness unless intubated

103
Q

When might activated charcoal be used for OD?

A

if presentation is within 1 hr of ingestion or 2hrs of a drug known to delay gastric emptying
given orally or by NG tube

104
Q

How to manage paracetamol OD acutely

A

blood paracetamol level at 4 hrs post ingestion
plot on treatment graph
if in toxic range give N-acteylcysteine
if presentation >8hr post injestion start NAC immed and send bloods
if level not toxic OR if INR, ABG + renal function are normal and level is 24 hrs NAC use depends on RF

105
Q

What puts patients in high risk category after paracetamol OD

A 
chronic alcohol misuse
malnutrition/anorexia
pre-existing liver disease
HIV +ve
on liver enzyme inducing drugs e.g. carbamazepine, phenytoin, phenobarbitone, rifampicin
106
Q

Managing OD

A

admit all paediatric self harm / attempted suicide

107
Q

Modifiable risk factors of sudden infant death syndrome?

A

Sleeping position: on back
Smoking: avoid maternal + paternal smoking
16-20 degree room temp, don’t tuck blanket higher than shoulders
Breastfeed

108
Q

Rosving’s sign

A

Pain in RIF in response to left sided palpation

Suggests peritoneal irritation in the RIF

109
Q

McBurney’s point

A

1/3 of distance between ASIS and umbilicus

Typically tenderness and guarding is seen over this point in appendicitis

110
Q

Cough sign

A

Pain in RIF after a voluntary cough

Suggests peritoneal irritation in the RIF

111
Q

Obturator sign

A

Pain on internal rotation of flexed right thigh

Caused by inflammatory mass overlying the psoas muscle

112
Q

MCADD

A

Medium Chain Acetyl co-a Dehydrogenase Deficiency
Inborn error of metabolism
Fat can’t be broken down
Low energy + hypoglycaemic episodes

113
Q

Ddx chronic cough

A

asthma, inhaled foreign body, sinusitis, post nasal drip, habit cough, allergic rhinitis, TB, CF, bronchiectasis, immune deficiency

114
Q

Bone age

A

A test used in assessment of short stature
Age is defined from amt of ossification seen in their bones
Radiographs of carpal bones are used
Each of the centres of ossification is scored and converted into bone age

115
Q

Transient tachypnoea of the newborn (TTN)

A

Due to delayed clearance of fluid from fetal lungs
More common in babies born by c section
Incr adrenaline -> active uptake of fetal lung fluid by sodium channels
Rr can be 100-120
CXR to rule out congenital pneumonia
Will show hyperinflation, oedema + fluid
Oxygen + empirical abx as initially sepsis cannot be ruled out

116
Q

Prehn’s sign

A

Tenderness relieved by elevating the scrotum

+ve indicates epididymitis

117
Q

Bloom’s syndrome

A 
AR
Short stature
Facial photosensitive rash
Narrow face
Subfertility
Immune deficiency
118
Q

The most common causes of ophthalmia neonatorum

A 
I.e. Conjunctivitis in first few wks of life
Staph aureas
Chlamydia trachomatis
Neisseria gonorrhoea
Chemical irritation (silver nitrate)
119
Q

Indications of NAI

A

Discrepancy between presentation and history given
Change in history over time/ between different people
Delay in presentation
Unusual reaction to the injury
Repeated injuries
Hx of NAI/ suspicious injury in sibling
Other signs of neglect/FTT

120
Q

Barlow’s test

A

Neonatal screening for DDH
Hip can be easily displaced posterior lay out of acetabulum
On adduction of leg with post pressure

121
Q

Ortolani’s test

A

Neonatal screening for DDH
Femoral head can be reduced back into acetabulum
On abduction of leg with anterior pressure

122
Q

Hand foot syndrome?

A

Children with SCD
Present with tender swelling of hand/wrist/feet
Precipitated by stress or cold

123
Q

Schilling test

A

IM vit B12
Radioactive cobalt labelled oral vit B12 given
If excreted in urine = normal
If not: oral radiolabelled b12 given with IF
If not radiolabelled b12 excreted pernicious anaemia confirmed
Still no excretion = bowel related malabsorption

Toni's Paeds (16 decks)

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