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Sheff 3a > Paeds - Aimee / Lydia > Flashcards

Paeds - Aimee / Lydia Flashcards

1
Q

Streptococcus pneumonae on a microscope? Possible severe illness caused ?

A

Gram positive
Alpha haemolytic
Facultative anaerobic

Meningitis
Invasive pnemococcal disease - pneumonia with septicaemia

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2
Q

What might cause you to admit a URTI?

A

Poor feeding
Parental concern
Unknown diagnosis

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3
Q

Viruses causing coryzal sx?

A

Rhinovirus
Coronavirus
RSV

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4
Q

When is tonsillectomy an option?

A

Recurrent severe tonisilitis
Quincy
Obstructive sleep apnea

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5
Q

Which bacteria can cause tonsillitis in older children? Usual viral causes?

A

B haemolytic strep

Adenovirus, enterovirus, rhinovirus

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6
Q

What criteria can you use to determine if tonsillitis is likely bacterial?

A

Centor criteria

Age 5-15 
Season Late autumn, early spring, winter 
Fever >38.3 
Cervical lymphadenopathy 
Pharyngeal erythema, oedema or exudate 
No cough

If 5 -> 50%, 6->75% likelihood of bacterial

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7
Q

Laryngeal / tracheal infection seen in?

A

Croup
Bacterial tracheitis
Acute epiglottis

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8
Q

Croup is what? Onset over? Cause? Age? Treat of moderate? Severe?

A

Laryngotracheobronchitis - onset over days
95% viral - parainfluenza, RSV
6month-6years

Moderate - PO dexamethosone, PO prednisolone, Nebulised steroids

Severe - Nebulised adrenaline + O2, anaesthetist incase airway lost

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9
Q

What causes psuedomembranous croup? Sx? Mx?

A

Staph aureus - bacterial tracheitis

High fever, toxic, rapidly progressing airway obstruction by thick secretions

IV Abx
Intubation and ventilation if required

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10
Q

Onset of acute epiglotits?
Cause?
Signs it has progressed to septicaemia ?
Management?

A

Hours (age 1-6)
H influenza type B

Septicaemia -> swelling of epiglottis and soft tissues -> airway obstruction
High fever, toxic child
Painful throat - no speaking + drooling
Soft inspiration stridor -> increasing respiratory difficulty

Immobile child with extended neck

Mx
Anaesthetist, ENT surgeon, paediatrician
Secure airway then blood cultures
Transfer to ICU

Rifampicin to household contacts

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11
Q

Basic management principles for child with laryngeal / tracheal infections?

A 
Keep calm 
Quiet room 
DO NOT examine 
Observe for hypoxia 
Call anaesthetist 
Nebulised adrenaline
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12
Q 
Pertussis 
Sx? 
How long? 
Ix?
Treat? 
Prophylaxis?
Complications?
A

Epidemic every 3-4y
1 wk coryza → paroxysmal cough → insp whoop (apnoea in infants)
Cough WORSE AT NIGHT. May → vomiting
Lasts 3-6 wks

Per-nasal swab – culture or PCR
Treat: erythromycin – eases symptoms if started in coryzal phase
Prophylaxis : erythromycin or vaccination
Complications: pneumonia, convulsions, bronchiectasis

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13
Q

What important DD with pneumonia? Usual crackle in pneumonia ?

A

TB

End-inspiratory coarse crackles

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14
Q

4 S’s of innocent murmurs

A

aSymtomatic patient
Soft blowing murmur
Systolic murmur only
Left Sternal edge

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15
Q

Features of a large VSD? O/e? CXR? Mx?

A

> 1wk: HF, breathlessness, failure to thrive, recurrent chest infections, tachypnea, hepatomegaly

Soft murmur
Apical mid diastolic murmur (bilateral from lungs across mitral valve)
Loud pulmonary 2nd sound

CXR
Cardiomegaly
Enlarged pulmonary artery
Pulmonary oedema

Diuretics + captopril
Surgery to prevent eisenmenger syndrome

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16
Q

When should a PDA close ? Shunt? What happens if it is large?

A

1 month
L->R
HF, pulmonary HTN

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17
Q 
Most common ASD? 
Sx? 
Murmur? 
CXR? 
ECG?

Mx?

A

Secundum (usually due to foramen ovale) - 80% of ASD

Can be aSx
Recurrent chest infections , arrhythmia (4th decade +)

Ejection systolic murmur at left sternal edge (pulmonary valve)

CXR : cardiomegaly, ↑pulmonary arteries, ↑pulmonary vascular markings
ECG : partial R bundle branch block R axis deviation
Echo
Cardiac catheterisation (carotid angiography) @ 3-5y

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18
Q

What is ASD primum also called? What happens? Murmur?
CXR?
ECG?

Mx?

A

Partial AVSD
Communication between atria and valves
Leaky 3 leaved mitral valve → regurg
Apical pansystolic murmur from valve regurg
CXR : cardiomegaly, ↑pulmonary arteries, ↑pulmonary vascular markings
ECG : -ve AVF = superior QRS
Echo

Surgical repair

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19
Q

Murmur in TOF ?

A

Loud, harsh ejection systolic at L sternal edge

20
Q

When would AS lead to HF and shock? Associations? What does it lead to? Auscultation? What other feature?

A

If it is duct dependant
Mitral valve stenosis & coarctation of the aorta

LVH

Carotid thrill
Small -> slow rising pulse

21
Q

O/e of coarctation of aorta

A

Systemic HTN in right arm
Radiofemoral delay
Weak femoral pulses

22
Q

PS and AS lead to respectively?

A

RVH

LVH

23
Q

Causes of outflow obstruction with well baby ?

A

AS
PS
CoA

24
Q

Outflow obstruction but sick baby causes? Features?

A

Aortic interruption
Very sick babies - VSD / Duct dependent
Absent peripheral pulses

Coarctation of the aorta
Circulatory collapse at 2 days old
Absent femoral pulses

Hypo-plastic left heart syndrome
100% duct dependant

25
Q 
Infective endocarditis  features? RFs? 
Diagnosis based on? 
Usual causes? 
Treatment? - what marker for monitoring? 
Prophylaxis? 
Complications?
A

Sustained fever, malaise, raised ESR, anaemia / haematuria
-splinter haemorrhages, clubbing, arthralgia

RF - VSD, CoA, PDA, prosthetic valves

Diagnosis - blood cultures, echo

A-haemolytic strep: strep Viridans

IV penicillin + aminoglycoside for 6/52
-use acute phase protein levels to monitor treatment

Prophylaxis - good dental hygiene

Complications - infected emboli & infarcts
-retinal, pulmonary, neuro

26
Q

Which cardiomyopathy is risk of sudden death in young athletes? Features?

A

Hypertrophic LVH

Diastolic dysfunction

27
Q

Most common cardiomyopathy? Features?

A

Dilated

Enlargement of all heart chambers
Systolic dysfunction

28
Q

What happens in restrictive cardiomyopathy ?

A

Rigid ventricular walls
Diastolic dysfunction

[least common]

29
Q

Rf/ Mx of cardiomyopathy?

A

FH, infection
Large heart

Diuretics + ACEi

30
Q 
What common complication of rheumatic fever? 
Usual cause? 
Criteria for diagnosis? 
Treatment? 
Prophylaxis?
A

Mitral stenosis
Group A B-haemolytic strep

Jones criteria - 2 major OR 1 major and 2 minor

Major
Pericarditis , polyarthritis, Sydenham chorea, erythema marginatum, subacute nodules

Minion
Fever, polyarthlargia, Hx RF, raised acute phase proteins, raised p-r interval

Treatment 
Bed rest 
Anti-inflammatory - high dose aspirin 
Steroids if not resolving 
Treat HF

Prophylaxis
Benzathine penicillin IM for 1 month

31
Q

Triad in nephrotic syndrome? Other sx? What is the usual cause?

A

Oedema
-periorbital, scrotal / vulval, leg

Hypoalbuminaemia

Proteinuria
-throthy urine

±ascities, breathlessness

Minimal change disease - not much to see on histological examination

32
Q

Ix in nephrotic syndrome?

A 
Urine dipstick
MSU C+S
U&E, creatinine
Albumin
FBC, ESR
Complement C3 and C4 levels
Anti-Dnase B titre/throat swab (for strep)
33
Q

Usual mx of nephrotic syndrome? Dose? What happens if it is resistant to this?

A 
Steroid sensitive  (90%)-> Prednisolone
60mg/m2 /day for 4 weeks, then 40mg/m2 alternate days 4 weeks

Steroid resistant -> immunosuppression (cyclophosphamide, cyclosporin)
diuretics, ACE inhibitor, salt restriction, NSAIDs

34
Q

Bar minimal change what are the other rare causes of nephrotic syndrome?

A

Focal segmental glomerulosclerosis
Mesangiocapillary glomerulonephritis
Membranous nephropathy

35
Q

Congenital nephrotic syndrome genetics? Mx?

A

Recessive
‘Finnish type’

Nephrectomy

36
Q

Complications of nephrotic syndrome?

A 
Hypovolaemia
Thrombosis
Infection 
Hypercholesterolaemia
Spontaneous peritonitis!
Strep pneumoniae
37
Q

Features of nephritis ? What would brown vs red urine indicate?

A

Haematuria

Reduced urine output - oliguria

Proteinuria

Brown-> glomerular bleeding
Red - lower tract defect and is uncommon in children

38
Q

Causes of nephritis ?

A

Post-infectious -> normally group A strep
Hx of sore throat (1-3w ago)
Anti-Dnase B, throat swab

IgA nephropathy

Goodpasteur’s syndrome
Lung symptoms

Vasculitis

HSP, SLE, PAN, Wegener’s

39
Q

Nephritis IX?

A 
Dipstick, MSU
U&E, albumin, creatinine
C3/C4 levels
Anti-Dnase B. Throat swab
Biopsy
Blood pressure
40
Q

What is henoch-schonlein purpura? Follows what? Triad? What is often involved?

A

Acute, immune complex-mediated vasculitis
Follows URTI

Classic triad:
Purpura on buttocks, extensor surfaces, lower legs
Abdominal pain
Arthritis/arthralgia

Renal involvement

41
Q

Ix in HSP? Mx? Complication?

A 
Raised ESR
Raised IgA
Urinalysis – proteinuria
Antistreptolysin O (ASO) titer [test for antibodies against a substance produced by group A strep]
U+E
BP
Abdo US to exclude intussusception

Steroids may help. Most recover spontaneously.

Risk of chronic renal failure

42
Q

What is haemolytic uraemic syndrome? Features? Risk of?
Usually follows?
What treatment may be required?

A

Acute microangiopathic haemolytic anaemia

AKI
Thrombocytopenia
Anaemia

Renal failure

Typically follows E.coli 0157 dysentery -> history of bloody diarrhoea

Dialysis

43
Q

Possible complication of UTI ? What type of uti can be ASx?

Congenital causes of uti?

A

Renal scaring -> renal failure and hypertension
Bacteriuria - often asx

Structural abnormality

44
Q

Presentation of UTI infant? Toddler?

A

Infants - collapse, septicaemia, poor feeding

Toddler - vomiting, FTT, colic

45
Q

When would you investigate a UTI? What ix?

A

Complicated / atypical
-seriously ill, abdo mass, raised creatinine, failure to repond to Abx <48hrs, non-E. Coli

Dipstick all urine
-nitrates and WCC -> likely for all UTIs
MSU ‘clean catch’
USS
DMSA scan - radioactive isotope injected to scan kidneys (CT / X-RAY)

46
Q

Treatment of a UTI in <3months? >3months? With pyelonephritis? When would you start treatment? Who would you give prophylaxis to and what would you give?

A

<3months - IV amoxicillin + gentamicin

> 3months [uncomplicated] - 3days PO trimethoprim / nitrofuantoin / co-amoxiclav

Pyelonephritis -> gentamicin

Treat immediately without waiting for culture

Prophylaxis for those with renal abnormalities / recurrent UTI
-> trimethoprim

47
Q

Usual cause of vesicouretic reflux? What happens?

A

Developmental abnormality of the vesicouretic junction
Ureters displaced laterally
Urine reflexes up into ureters
->pyelonephritis and renal damage

Sheff 3a (30 decks)

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