Cardio-Resp and Haematology Flashcards
(97 cards)
1
Q
What are the symptoms of Von Willebrand disease?
A
Bruising easily Frequent or long nosebleeds Bleeding gums Prolonged bleeding from cuts Menorrhagia
2
Q
Which medications help with Von Willebrand disease?
A
Desmopressin
Tranexamic acid
VWF concentrate
3
Q
What does ITP stand for?
A
Immune thrombocytopenia purpura
4
Q
What is the pathology behind ITP?
A
Antibodies are made against platelets therefore platelets are removed quickly by the spleen
5
Q
What are the features of ITP?
A
Bruising or red/purple rashes
Nosebleeds
Menorrhagia
Often occurs 2-3 weeks after an infection
6
Q
What is the management of ITP?
A
Prednisolone
IV Ig
Platelet transfusion
Splenectomy
7
Q
Give a differential diagnosis for cyanosis in children
A
Meconium aspiration Pulmonary atresia/hypertension/stenosis Tetralogy of fallot Tricuspid atresia Trachea-oesophageal fistula Transposition of great arteries Hypoplastic left heart Patent ductus arteriosus Birth asphyxia Transient tachypnoea of newborn Respiratory distress syndrome
8
Q
What defects are part of tetralogy of fallot?
A
Pulmonary stenosis
Overriding aorta
VSD
Right ventricular hypertrophy
9
Q
Give a differential diagnosis for a cough in a child
A
Croup Asthma Viral induced wheeze Pneumonia Bronchiolitis Whooping cough/TB Reflux CF Tracheo-oesophageal fistula Passive smoking Croup Inhaled foreign body Post-nasal drip
10
Q
Give a differential diagnosis for strider in a child
A
Croup Quinsy Anaphylaxis Inhaled foreign body Laryngeal anomalies/laryngomalacia Upper airway obstruction Vascular ring Tracheal abnormality
11
Q
Why is epiglottis so rare today?
A
Introduction of HiB vaccine
12
Q
What is bronchiolitis?
A
An acute obstruction of the small airways usually caused by RSV
Causes respiratory distress and wheeze in infants
13
Q
When does bronchiolitis tend to occur?
A
Winter
14
Q
Which virus is most likely to cause bronchiolitis?
A
Respiratory syncytial virus
15
Q
What might you find on examination of a child with bronchiolitis?
A
Widespread wheeze
Fine crackles
Over expansion of chest
16
Q
What investigations should you order for suspected bronchiolitis?
A
Bloods
Chest X-ray
Nasopharyngeal aspirate
17
Q
What is the usual length of disease for bronchiolitis?
A
7-10 days
18
Q
What is the management of bronchiolitis?
A
Supportive
Oxygen
Bronchodilators- although no evidence for this
19
Q
What can be given to protect high risk individuals from bronchiolitis?
A
Palivizumab
Monoclonal antibody against RSV
20
Q
Which organism causes whooping cough?
A
Bordetella pertussis
21
Q
What is the presentation of whooping cough?
A
Paradoxical coughing spasms during expiration followed by a sharp intake of breath (whoop)
22
Q
How should we investigate whooping cough?
A
Culture from a nasal swab
23
Q
What is the management of whooping cough?
A
Supportive
24
Q
How long can the cough last in whooping cough?
A
Months - 100 days
25
What is the medical name for croup?
Acute laryngotracheobronchitis
26
Between which ages do children usually get croup?
6 months - 3 years
27
What organism causes croup?
Parainfluenza virus
28
What is the presentation of whooping cough?
Coryzal symptoms that proceeds to strider
Barking cough- classically at night
Hoarse voice
29
What is the management of whooping cough?
Self limiting
Observation/reassurance
Steroids if needed
30
Acute epiglottitis is cause by which organism?
Haemophilus influenzae B
31
What is the presentation of acute epiglottitis?
Inability to swallow and talk
Stridor
Barking cough
32
What is the management of epiglottitis?
Intubation
| Do not look down throat as this can cause respiratory distress
33
What is the commonest chronic illness of childhood?
Asthma
34
Name some triggers of asthma
```
Dust mite
Air pollution
Cigarette smoke
Cold air
Viral infection
Stress
Exercise
```
35
How is the clinical diagnosis of asthma made?
Recurrent cough/wheeze
| Reversible with bronchodilators
36
What might be seen on a CXR of an asthmatic?
Hyperinflation
| Areas of collapse - mucus plugging
37
Describe the stepwise approach to managing asthmatic children
```
SABA
+ inhaled steroid
+ leukotriene antagonist or oral theophylline
increase dose inhaled steroid
+ oral steroids
```
38
What combination of devices should a <5 year old be given for inhaled medications?
Metered dose inhaler
| Spacer device
39
What features define a severe asthma attack?
```
Too breathless to talk/feed
RR >30 (>5y/o), RR >40 (2-5 y/o)
HR >120 (>5), HR > 140 (2-5)
PEFR <50%
O2 says <92%
```
40
Describe the features of life threatening asthma
```
PEFR <33%
O2 sats <92%
Silent chest/cyanosis
Fatigue/drowsy
Confusion
Hypotension
```
41
How is CF inherited?
Autosomal recessive
42
How many people are carriers for cystic fibrosis?
One in 25
43
What is the pathophysiology of cystic fibrosis?
A molecular defect in the cellular membrane chloride channel leads to production of excessively thick mucus in many systems
44
What is the defining test for cystic fibrosis?
Sweat test >60 mmol/L
45
Which chromosome is affected in cystic fibrosis?
Chromosome seven
46
What percentage of cystic fibrosis is due to the Delta F508 gene mutation?
75%
47
How is cystic fibrosis usually diagnosed?
The heel prick test
| Or antenatally in an affected family
48
How might an infant present with cystic fibrosis?
Meconium ileus
| Failure to thrive and malabsorption
49
Which two organisms are more likely to occur in cystic fibrosis patients?
Pseudomonas
| Burkholderia cepacia
50
How do you manage the respiratory symptoms in cystic fibrosis?
```
Regular bronchodilators
Antibiotics and steroids
Nebulised DNase
Preventative physiotherapy
Prophylactic immunisations
```
51
What are the consequences of pancreatic failure in cystic fibrosis?
Malnutrition and deficiency in fat soluble vitamins
| A DE and K
52
How do you manage the GI effects of CF?
Creon
Enzyme capsules taken with food to aid absorption
High calorie diet
Fat soluble vitamin supplements
53
What percentage of CF patients will develop an impaired glucose tolerance?
25%
54
What is the effect of cystic fibrosis on the liver?
A decreased rate of bile flow leading to biliary disease and cirrhosis
55
What medication helps with the liver effects of CF?
Ursodeoxycholic acid
56
What is the most common childhood cancer?
Leukaemia
| Acute lymphoblastic leukaemia
57
What is the most common type of leukaemia in children?
Acute lymphoblastic leukaemia
58
How does leukaemia present in children?
Malaise, anaemia, bruising, bone pain and lymphadenopathy
59
What kind of therapy is used for leukaemia?
Chemotherapy
60
What is the overall prognosis for the acute leukaemias in childhood?
ALL is 85% survival
| AML is 60 to 70% survival
61
Define leukaemia
A malignant proliferation of white cell precursor is in marrow
Blast cells escape into circulation and maybe deposited in lymphoid all of the tissue
62
What is the peak age group for acute lymphoblastic leukaemia?
2 to 5 years old
63
What will the blood show in an acute leukaemia?
Anaemia
Thrombocytopenia
Increased white cells
Blast cells seen on peripheral blood film
64
How is the diagnosis of leukaemia confirmed?
Bone marrow aspirate
65
Tumour lysis syndrome causes an increase of which metabolites?
Urate
Phosphate
Potassium
66
How do we prevent the tumour lysis syndrome?
Good hydration
| Allopurinol
67
Give some late consequences of treatment for leukaemias
Short stature
Delayed puberty/growth hormone deficiency/hypothyroidism/gonadal failure
Neuro cognitive effects
Subfertility, nephrotoxicity, deafness, pulmonary fibrosis, cardiomyopathy-chemotherapy
68
Give some causes of normocytic normochromic anaemia
Chronic renal disease
Hypothyroidism
Chronic inflammatory disease
Chronic infection
69
Why is iron deficiency anaemia common in childhood?
High demand for iron due to rapid growth
| Poor intake of iron rich food
70
How is breastmilk protective for iron deficiency anaemia?
Iron binding protein lactoferrin is found in breastmilk therefore iron is absorbed more efficiently
71
Describe the blood film showing iron deficiency anaemia
Microcytosis
Hypochromia
Poikilocytosis - variation in cell shape
72
What type of thalassaemia is most common?
Beta
73
Which type of thalassaemia may be confused with iron deficiency anaemia and why?
Heterozygous - beta trait
| Mild hypochromic, microcytic anaemia
74
How is thalassaemia diagnosed?
Haemoglobin electrophoresis
| Increased HbA2 and HbF
75
What is the management of beta thalassaemia?
Regular blood transfusions
76
What are the complications of having thalassaemia?
Haemosiderosis due to iron overload
Cardiomyopathy
Diabetes
Skin pigmentation
77
Describe the pathophysiology of sickle-cell anaemia
One amino acid substitution in the gene
This causes unstable haemoglobin which when in the deoxygenated state is a highly structured polymer that causes brittle red blood cells
This can occlude vessels and cause ischaemia
78
What can precipitate crises of sickle-cell anaemia?
Dehydration
Hypoxia
Infection
Acidosis
79
What is the management of the sickle-cell crisis?
Painkillers
Fluids
Warmth
Antibiotics if required
80
If an infant is still cyanosed after stabilisation what should you give?
Prostaglandin E
| To keep the ductus arteriosus open
81
Which congenital heart conditions give a cyanotic appearance?
Transposition of the great vessels
Hypoplastic left or right heart
Tetralogy of Fallot
Critical pulmonary stenosis
82
How is the patient kept alive with transposition of the great vessels before surgery?
Patent ductus arteriosus or ventricular septal defect
83
When would you operate on a baby with transposition of the great arteries?
Day one or two
84
What is the most common congenital cyanotic heart disease?
Transposition of the great vessels
85
How does tetralogy of fallot become a cyanotic heart disease?
If the pulmonary stenosis is critical
86
What murmurs can be heard in a baby with the tetralogy of fallot?
Pulmonary stenosis-ejection systolic that radiates to the left shoulder or back
Ventricular septal defect-pansystolic murmur that is heard at the left sternal edge
87
What needs to be done for a baby with tetralogy of fallot?
Balloon dilatation of the pulmonary stenosis and correction of the ventricular septal defect
88
What are Tet spells?
Occur if a patient with TOF is dry or dehydrated
The pulmonary vessels are narrowed and vascular shuts down
need an increased pressure to reopen
Causes symptoms of pain, crying and poor feeding
89
How do we treat a Tet spell?
Put knees up to the chest to increase the pulmonary flow
Morphine
Oxygen
Fluids
90
What is the most common congenital heart defect?
Ventricular septal defect
91
How does heart failure present in a child?
```
Poor feeding
Shortness of breath on feeding
Tiredness
Increased sweating
Oedema-pitting legs and crackles on chest
```
92
Describe the murmur of a patent ductus arteriosus
Systolic, constant, machinery like
93
Describe the murmur of an atrial septal defect
Ejection systolic murmur
| Splits the second and first heart sounds
94
What are the viral causes of pneumonia in children?
```
RSV
Influenza
Parainfluenza
Adenovirus
Coxsackie virus
```
95
What is the most common type of bacterial pneumonia in a newborn?
Group B beta haemolytic strep
96
What do you find on examination of a pneumonia?
Dullness to percussion
Bronchial breathing
Crackles
97
What is the first antibiotic for community-acquired pneumonia?
Amoxicillin
| Or erythromycin
