Paediatrics Flashcards
(44 cards)
What features may be seen in a baby with congenital diaphragmatic hernia?
Respiratory distress
Scaphoid abdomen
What would you see on a chest xray in a child with congenital diaphragmatic hernia?
Abdominal organs in the thoracic cavity
Which genetic conditions are associated with congenital diaphragmatic hernia?
Trisomy 13
Trisomy 18
Trisomy 21
CHARGE syndrome
Fryn syndrome
Cornelia de Lange syndrome
Which structural cardiac abnormalities are seen most commonly in patients with congenital diaphragmatic hernia?
Ventricular septal defect
Atrial septal defect
Coarctation of the aorta
Hypoplastic left heart
Which features correlate with a poor prognosis in congenital diaphragmatic hernia?
Large hernia
Bilateral hernia
Cardiac anomalies
Chromosomal anomalies
Severe pulmonary hypertension
Low birth weight
Low APGAR score at five minutes
Small contralateral lung
What pharmacological options are useful in patients with congenital diaphragmatic hernia?
Neuromuscular blockers to improve chest wall compliance in ventilated patients
Inotropes and vasopressors if haemodynamically unstable
Prostaglandins to maintain ductus arteriosus and reduce right heart strain
Prostacyclin or sildenafil to reduce pulmonary hypertension
What are the requirements of the CDH Euro-Consortium guidelines, for a congential diaphragmatic hernia patient to be deemed fit for surgical correction?
Lactate less than 3mmol/litre
Normalised mean arterial pressure
Adequate urine output of >1ml/kg/hour
Preductal oxygen saturations of 85-95% on less than 50% oxygen
A 6 week old girl presents with projectile vomiting immediately after feeding. Which of the following increases the risk of pyloric stenosis?
- Male gender
- Afro-Carribean ethnicity
- Pre-term delivery
- Maternal C.difficile infection
- Ventoux delivery
- Male Gender (4:1)
The risk factors for pyloric stenosis are as follows:
- Male gender
- White ethnicity
- Term delivery
- First-born child
- Caesarean section
- Bottle feeding
Which of the following is the most common complication of corrective surgery for oesophageal atresia?
- Gastro-oesophageal reflux
- Oesophageal stricture
- Tracheomalacia
- Anastomotic leak
- Post-operative pneumonia
GORD affects around 40-50% of patients
Anastomotic leak 10-20%, and half of these develop a stricture
Tracheomalacial and post-operative pneumonia are recognised complications but are rarer
A four year old child presents to the emergency department with a two day history of fever and drowsiness, and is now tachycardic and hypotensive. She has been given 600ml of fluid so far with no significant response. What should be done next?
- Rapid sequence induction and intubation
- Dopexamine 10mcg/kg/min
- Phenylephrine 0.5mg/min
- Fluid bolus 20ml/kg
- Noradrenaline 0.1mcg/kg/min
- Fluid bolus 20ml/kg
This child’s weight is estimated at 16kg, making a 20ml/kg bolus 320ml.
This means the child has had two boluses so far, and can have a third as part of sepsis management prior to starting vasopressors.
What is the incidence of congenital tracheoesophageal fistula?
1 in 3000 live births
What congenital abnormalities are associated with tracheoesophageal fistula?
- Cardiac
- Vertebral
- Anorectal
- Urogenital
- Laryngo-trachial
- Palatal
- Musculoskeletal
- Gastrointestinal
- Renal
What chromosomal abnormalities are associated with tracheoesophageal fistula?
Holt-Oram syndrome
Pierre-Robin syndrome
Trisomy 18
Trisomy 21
Polysplenia
DiGeorge syndrome
What are the important aspects of induction and intubation with regards to tracheoesophageal fistula?
- Avoid facemask ventilation to prevent insufflation of the stomach
- Gaseous induction
- Suction of upper oesophageal pouch
- Topicalisation of the airway
- Maintenance of spontaneous ventilation
- Use of flexible bronchoscope to ensure tube beyond fistula site
- Muscle relaxant only once tube sited correctly
What are the haematological differences between neonates and adults?
- Foetal haemoglobin has higher oxygen affinity
- Higher red cell mass
- Hb 180-200g/l is typical
- Reduced platelet function
- Reduced vitamin k dependent clotting factors
- Higher red cell mass
What are the cardiovascular differences between neonates and adults?
- Cardiac output is rate dependent, with minimal ability to increase stroke volume
- Less compliant myocardium
- Dominant parasympathetic tone, with predisposition to bradycardia
- Increased blood volume per kg than adult patients
- Circulation in transition from foetal to adult
- Severe hypoxia and acidosis can result in re-opening of ductus arteriosus
What are the respiratory differences between neonates and adults?
- Respiratory
- Ventilation is mainly diaphragmatic
- Prone to diaphragmatic splinting by abdomen
- Smaller Functional residual capacity with faster desaturation
- Fixed tidal volume
- Closing volume greater than functional residual capacity
- Respiratory muscles tire quickly
- Fewer alveoli
What are the airway differences in the neonate?
Large head with prominent occiput
Short neck
Large tongue and anterior larynx at level of C3-C4
Long, floppy U-shaped epiglottis
Preferential nasal breathers
Funnel shaped airway narrowest at cricoid cartilage
What are the effects of hypothermia in the neonate?
- Respiratory depression
- Acidosis
- Bradycardia
- Platelet dysfunction
- Reduced drug clearance and metabolism
- Increased risk of infection
Why are neonates more at risk of hypothermia?
- Higher surface area to volume ratio
- Less subcutaneous tissue
- Poor shivering ability
- Poor vasoconstriction
- Thermogenesis by brown fat has enormous oxygen requirement
What clinical signs are suggestive of severe dehydration in a child?
- Drowsiness
- Sunken anterior fontanelle
- Weak rapid pulse
- Rapid respiratory rate
- Low urine output
- Dry mucous membranes
What examination findings would suggest pyloric stenosis?
- Visible peristalsis
- ‘Olive’ shaped mass in epigastrium, approximately 2-3cm in size
Which hormones are released in response to severe dehydration?
- ADH is released from the posterior pituitary as a direct response to increased serum osmolarity
- Renin is released from the kidney as a response to hypoperfusion of the macula densa, or in reponse to reduced tubular flow rate
- Aldosterone is released as an indirect response (via renin), and causes fluid and sodium retention in exchange for hydrogen and potassium ions. This produces acidic urine, with a metabolic alkalosis and hypokalaemia
What treatment should be started immediately after delivery of a neonate with known Transposition of the Great Arteries?
Prostaglandin E2 infusion
This will maintain patency of the ductus arteriosus, upon which the circulation is dependent prior to definitive surgical correction
