Medicine Phase 3a > PAEDIATRICS - 6 > Flashcards

PAEDIATRICS - 6 Flashcards

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1
Q

Upper respiratory tract symptoms

A 
Coryza
Sore throat
Earache
Sinusitis
Stridor
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2
Q

Lower respiratory tract symptoms

A

Cough
Wheeze
Respiratory distress

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3
Q

Moderate respiratory distress symptoms

A 
Tachypnoea
Tachycardia
Nasal flaring
Use of accessory respiratory muscles
Intercostal and subcostal recessions
Head retraction
Inability to feed
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4
Q

Severe respiratory distress symptoms

A

Cyanosis
Tiring because of increased work of breathing
Reduced consciousness
Oxygen sats <92 despite O2 therapy

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5
Q

Most common respiratory infection at age 6 months

A

Bronchiolitis

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6
Q

Most common respiratory infection at age 18 months - 2 years

A

Viral croup

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7
Q

Most common respiratory infection at age 2

A

Pneumonia

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8
Q

Most common respiratory infection at age 3

A

Epiglottitis

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9
Q

Most common respiratory infection at age 2 and 7

A

URTI

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10
Q

Conditions that make children more susceptible to respiratory infection

A

Preterm (bronchopulmonary dysplasia)
Congenital heart disease
Cystic fibrosis
Immunodeficiency

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11
Q

Physiology of inspiration

A

Negative intrapleural pressure
Dilates intrathoracic airways
Collapses extrathoracic airway

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12
Q

Physiology of expiration

A

Positive intrapleural pressure
Collapses intrathoracic airways
Dilates extrathoracic airway

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13
Q

Consequence of extra thoracic obstruction

A

Difficulty on inspiration

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14
Q

Consequence of intra thoracic obstruction

A

Difficulty on expiration

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15
Q

Airway noises on inspiration

A 
Stridor
Stertor (snoring)
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16
Q

Airway noises on expiration

A

Wheeze

Crepitations

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17
Q

Types of upper respiratory tract infection (URTI)

A
  1. ) Common cold (coryza)
  2. ) Sore throat (pharyngitis inc. tonsillitis)
  3. ) Aute otitis media
  4. ) Sinusitis (relatively uncommon)
    - -> children most commonly present with a mixture of the above.
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18
Q

Potential complications of URTI

A
  • Difficulty in feeding
  • Febrile seizures
  • Acute exacerbations of asthma
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19
Q

The common cold (coryza): features

A

Clear or mucopurulent nasal discharge

Nasal blockage

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20
Q

The common cold (coryza): pathogens

A

Rhinoviruses (>100 serotypes)
Coronaviruses
Respiratory syncytial virus (RSV)

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21
Q

The common cold (coryza): management

A

Self-limiting
Paracetamol/ Ibuprofen for pain
Cough may persist for <4 weeks post infection

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22
Q

Conditions associated with sore throat

A 
Pharyngitis 
Tonsilitis (type of pharyngitis)
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23
Q

Pharyngitis: features

A

Pharynx and soft palate inflamed

Local lymph nodes enlarged and tender

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24
Q

Pharyngitis: pathogens

A

Adenovirus
Enterovirus
Rhinovirus
(Group A beta-haemolytic streptococcus is common in older children)

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25
Tonsilitis: features
``` Intense inflammation of tonsils Purulent exudate In bacterial: - Headache - Abdo pain - White tonsillar exudate - Cervical lymphadenoapthy ```
26
Tonsilitis: pathogens
Group A beta-haemolytic streptococci (bacterial tonsillitis) | Epstein-Barr virus (infectious mononucleosis)
27
Tonsilitis: treatment
Antibiotics - Penicillin 10 days - -> amoxicillin is best avoided as it may cause widespread maculopapular rash if tonsillitis is due to infectious mononucleosis
28
Tonsilitis: potential complications
Rheumatic fever Scarlet fever (from group A streptococcal) - Fever in 2-3 days post infection - Sandpaper like maculopapular rash - Flushed cheeks with perioral sparing - White sore + swollen tongue - Further complication of this is glomerulonephritis
29
Types of otitis media
1. ) Acute otitis media (AOM) 2. ) Otitis media with effusion (OME) 3. ) Chronic suppurative otitis media (CSOM) 4. ) Mastoiditis 5. ) Cholesteatoma
30
AOM features
- Inflammation of middle ear - Caused by bacteria or virus - suppurative = presence of pus - ear drum perforates in 5%
31
OME features
- Follows AOM | - Effusion of glue-like fluid behind intact tympanic membrane
32
CSOM features
- Long standing suppurative (pus) middle ear | - persistently perforated tympanic membrane
33
Mastoiditis features
- Inflammation of mastoid periosteum and air cells | - Occurs when AOM spreads out from middle ear
34
Cholesteatoma features
-Skin is present in middle ear due to tympanic membrane retraction
35
Pathophysiology of otitis media in children
• Children more vulnerable - Bigger angle between eustachian tube and wall of pharynx - Coughing and sneezing doesn’t push it shut like it does in adults - Infected material can therefore be transmitted from nasopharynx --> eustachian tube --> middle ear
36
Otitis media: most common bacteria
1. ) Haemophilus influenzae (common) 2. ) Streptococcus pneumoniae (common) 3. ) Moraxella catarrhalis 4. ) Streptococcus pyogenes
37
Otitis media: most common virus
1. ) RSV (respiratory syncytial virus) | 2. ) Rhinovirus
38
Otitis media: risk factors
- Young - Male - Smoking in the house - Daycare/ nursery attendance - Formula feeding (breast feeding is protective in first 3 months) - Craniofacial abnormalities
39
Associations with recurrent AOM
- Early first episode - GORD - Dummy use - Winter - Supine feeding
40
Otitis media: symptoms
* Pain (younger children may pull at ear) * Malaise * Irritability, crying, poor feeding, restlessness * Fever * Coryza/ rhinorrhoea * Vomiting
41
Otitis media: signs
* Febrile * Red, yellow or cloudy tympanic membrane * Bulging of tympanic membrane * Air-fluid level behind tympanic membrane * Discharge in auditory canal secondary to perforation of tympanic membrane * Red pinna
42
Otitis media: investigations
1. ) Otoscopy 2. ) Culture discharge if chronic/ recurrent perforation 3. ) Audiometry if chronic hearing loss suspected 4. ) CT or MRI if complications suspected
43
Otitis media: indications for admission
- Children under 3 months with temperature of 38 or more | - Children with suspected complications of AOM e.g. meningitis, mastoiditis or facial nerve paralysis
44
Otitis media: considerations for admitting
- Systemically unwell - Under 3 months - Children 3-6 months with temperature of 39 or more
45
Otitis media: management in community
1. ) Treat pain and fever with paracetamol or NSAID 2. ) NO antibiotic prescribing OR DELAYED prescribing 3. ) Warm compress over ear may help reduce pain 4. ) Safety net to come back if symptoms are not improving within 4 days
46
Otitis media: indications for prescribing antibiotics
- Systemically unwell - High risk of complications due to significant heart, lung, kidney, liver or neuromuscular disease or immunocompromised - Symptoms lasted for 4 days or more and are not improving - Bilateral AOM in children younger than 2 - Perforation or discharge in ear canal
47
Otitis media: antibiotic of choice
5-day course of amoxicillin | If allergic, prescribe erythromycin or clarithromycin
48
Recurrent AOM: management
- Consider referral to ENT | - Manage acute episodes in same way as initial presentation
49
Otitis media: complications
* Most resolve spontaneously * Perforation of ear drum is common * Labyrinthitis, meningitis or facial nerve palsy are VERY RARE * Recurrent episodes may lead to scarring of ear drum with permanent hearing impairment
50
Causes of stridor
``` Viral croup (laryngotracheobronchitis) --> MOST COMMON ``` Epiglottitis Bacterial tracheitis Forgein body Allergic laryngeal angioedema
51
Signs used to assess severity of stridor
Degree of chest retraction
52
Investigation you must NOT attempt if suspected croup/ epiglottis
Examine throat with spatula --> can lead to total obstruction of the airway
53
Croup: viruses
Parainfluenza virus Rhinovirus RSV Influenza
54
Epidemiology of croup
Most common in autumn | Peak incidence = 2 years
55
Croup: clinical features
``` Onset is over days Preceding coryza Harsh stridor Hoarsness (inflammation of vocal cords) Barking cough (sea lion - tracheal oedema) Breathing difficulty Chest retraction Worse at night ```
56
Epiglottitis: clincial features
``` Onset is over hours No preceding coryza No cough Unable to drink Drooling saliva Temp >38.5 Soft stridor Muffled voice (reluctant to speak) ```
57
Croup causing chest recessions at rest: management
1. ) Oral dexamethasone 2. ) Oral prednisolone 3. ) Nebulized budesonide
58
Croup causing severe upper airway obstruction: management
1.) Nebulized epinephrine with O2 by face mask
59
Epiglottitis: organism
Hib
60
Epiglottitis: management
1. ) Urgent admission to ITU 2. ) Intubation 3. ) Blood cultures 4. ) IV cefuroxime
61
Epiglottitis: prophylaxis for household contacts
Rifampicin
62
Bacterial tracheitis: organism
Staphylococcus aureus
63
Pathophysiology of wheeze
Mucosal inflammation Mucosal swelling Bronchoconstriction
64
Bronchiolitis: organism
RSV Parainfluenza Rhinovirus Adenovirus
65
Bronchiolitis: features
``` Dry wheezy cough Tachypnoea and tachycardia Subcostal and intercostal recession Hyperinflation of chest Fine end-inspiratory crackles High-pitched wheeze ```
66
Bronchiolitis: indications for admission
Apnoea Persistent O2 sats of <90 when breathing air Inadequate oral fluid intake Severe respiratory distress (grunting, marked recessions, RR >70)
67
Bronchiolitis: management
1. ) Humidified O2 (nasal canulae or head box) 2. ) Nasogastric/ IV fluids 3. ) CPAP (continuous positive airway pressure)
68
Bronchiolitis prophylaxis
Given to preterm infants | Palivizumab (monoclonal antibody to RSV)
69
4 main causes of wheeze
``` 1 = Viral episodic wheezing (e.g. bronchiolitis) 2 = Multiple trigger wheeze (in response to multiple triggers) 3 = Asthma 4 = CF ```
70
Risk factors for viral episodic wheezing
Maternal smoking during / after pregnancy Prematurity Male
71
Pathophysiology of asthma
Bronchial inflammation Bronchial hyper-responsiveness Airway narrowing
72
Pathophysiology of bronchial inflammation
Oedema Excessive mucous production Infiltration with cells (eosinophils, mast cells, neutrophils, lymphocytes)
73
Pathophysiology of bronchial hyper-responsiveness
Exaggerated 'twitchiness' to inhaled stimuli
74
Pathophysiology of airway narrowing
Reversible airflow obstruction
75
Asthma: clinical features
``` Polyphonic wheeze Worse at night Worse early morning Atopy Hyperinflated chest ```
76
Asthma: investigations
1. ) Clinical diagnosis usually 2. ) PEFR 3. ) Spirometry 4. ) Checking response to bronchodilator (PEFR or FEV1 before and after, >12% improvement = asthma)
77
Examples of short-acting B2-agonists (SABA)
Salbutamol | Terbutaline
78
Example of anticholinergic bronchodilator (SAMA - short acting muscarinic antagonist)
Ipratropium bromide
79
Examples of inhaled steroids
Budesonide Beclometasone Fluticasone Mometasone
80
Examples of long-acting B2 agnostic (LABA)
Salmeterol | Formoterol
81
Example of methylxanthines
Theophylline
82
Example of leukotriene receptor antagonists (LTRA)
Montelukast
83
Example of oral steroids
Prednisolone
84
Example of anti-IgE monoclonal antibody
Omalizumab
85
Duration of effectiveness of LABAs
12 hours
86
Duration of effectiveness of SABAs
2-4 hours
87
Monitoring in children who have been prescribed a steroid
Growth
88
Asthma: initial management
1. ) SABA (salbutamol) | 2. ) Inhaled steroid (budesonide)
89
Asthma: management <5 years
3. ) LTRA | 4. ) Refer to paediatrics
90
Asthma: management >5 years
3. ) LABA 4. ) Increase ICS to 800 (5-12 years) or 1600 (>12 years) 5. ) LTRA 6. ) SR theophylline 7. ) Issue steroid replacement warning card 8. ) Oral steroids
91
Acute, severe asthma attack: features
``` SpO2 <92% PEF 33-50% best or predicted -Can’t complete sentences in one breath or too breathless to talk or feed -Heart rate: >140/min (age 1-5) >125/min (age >5) -Respiratory rate: >40/min (age 1-5) >30/min (age >5) ```
92
Life-threatening asthma attack: features
``` SpO2 <92% PEF <33% best or predicted -Exhaustion -Hypotension -Cyanosis -Silent chest -Poor respiratory effort -Confusion ```
93
Asthma attack: management
1.) Oxygen If SpO2 <94%, high-flow oxygen via tight-fitting face mask or nasal canula to achieve 94-98% 2.) Nebulised bronchodilators Inhaled B2 agonists 3.) Add ipratropium bromide if poor response to 3 4.) Add magnesium sulphate to nebulised salbutamol + ipratropium if SpO2 <92% Magnesium induces smooth muscle relaxation --> bronchodilation 5.) Oral steroids 20mg for 2-5 years Continue this treatment for 3 days. Can continue for up to 14 days, after which point dose needs to be tapered.
94
Persistent asthma attack after initial treatment: management
1. ) Single bolus dose of IV salbutamol 2. ) Aminophylline for severe/ life-threatening asthma 3. ) IV magnesium sulphate
95
Asthma attack: discharge planning and follow up
Children can be discharged when stable on 3-4 hourly inhaled bronchodilators. PEF +/or FEV1 should be >75% of best or predicted and SpO2 >94%. - Arrange follow up by GP within 2 working days - Arrange follow up in paediatric asthma clinic at about 1 month post admission - Arrange referral to paediatric respiratory specialist if there have been life-threatening features
96
Asthma attack: indications for admission
Not responsive to normal treatment Becoming exhausted Markedly reduced PEFR or FEV1 Reduced O2 sats in air (<92%)
97
Most common cause of acute cough in children
Tracheobronchial spread of URTI (common cold)
98
Organism responsible for whooping cough
Bordetella pertussis
99
Whooping cough clinical features
``` Week of coryza Followed by paroxysmal/ spasmodic cough Inspiratory whoop Worse at night Mucus production ```
100
Whooping cough complications
Pneumonia Seizures Bronchiectasis
101
Whooping cough: investigations
Pernasal swab and culture PCR of swab Lymphocytosis (raised lymphocytes)
102
Whooping cough: treatment
Azithromycin (macrolide)
103
Whooping cough: treatment of close contacts
Prophylactic macrolide antibiotic
104
Causes of persistent or recurrent cough
``` Recurrent respiratory infections Pertussis RSV Mycoplasma Asthma Persistent lobar collapse (following pneumonia) Cystic fibrosis GORD Smoking TB ```
105
Define persistent cough
Cough that lasts more than 8 weeks or not improved after 3-4 works
106
Most common pathogens that cause pneumonia in newborns
Group B strep | Gram -'ve enterococci and bacilli (E coli, klebsiella, pseudomonas)
107
Most common pathogens that cause pneumonia in infants and young children
RSV Strep pneumoniae Influenza Staph aureus (serious)
108
Most common pathogens that cause pneumonia in children >5 years
Mycoplasma pneumoniae Streptococcus pneumoniae Chlamydia pneumoniae
109
Most common pathogens that cause pneumonia in all ages
Mycobacterium TB
110
Pneumonia clinical features
``` Fever Cough Rapid breathing (tachypnoea) Lethargy Poor feeding Nasal flaring Chest indrawing End-inspiratory coarse crackles over affected area ```
111
Pneumonia investigations
1. ) Clinical diagnosis 2. ) Chest X-ray 3. ) Nasopharyngeal aspirate
112
Pneumonia treatment
1.) Antibiotics Newborn = broad-spectrum IV Older infants = oral amoxicillin Children >5 = oral amoxicillin or oral erythromycin
113
Pneumonia - indications for hospital admission
O2 sats <92% Recurrent apnoea Grunting Inability to maintain adequate fluid/ feed
114
Pneumonia - unresponsive to treatment
May have developed parapneumonic effusions (empyema) | - requires drainage under US guidance (small-bore chest drain and fibrinolytic agent to break down fibrin strands)
115
Causes of chronic lung infection
Persistent bacterial bronchitis | Bronchiectasis
116
Common organisms associated with persistent bacterial bronchitis
Haemophilus influenza | Moraxella catarrhalis
117
Persistent bacterial bronchitis: management
1. ) Refer to specialist in paediatric respiratory disorders 2. ) Sputum - bacterial growth 3. ) High dose co-amoxiclav 4. ) Physiotherapy
118
Define bronchiectasis
Permanent dilatation of bronchi | Can be generalised or focal (restricted to single lobe)
119
Causes of generalised bronchiectasis
Cystic fibrosis Primary ciliary dyskinesia Immunodeficiency Chronic aspiration
120
Causes of focal bronchiectasis
Previous severe pneumonia Congenital lung abnormality Obstruction by foreign body
121
Bronchiectasis: investigations
CT chest | Bronchoscopy (focal disease)
122
Cystic fibrosis: inheritance
Autosomal recessive
123
Cystic fibrosis: genetics
CFTR (cystic fibrosis transmembrane conductance regulator) defect on chromosome 7 --> Most common mutation is F508
124
Function of CFTR gene
Cyclic AMP-dependent Cl channel in memorable of cells
125
Cystic fibrosis: pathophysiology
- Abnormal ion transport across epithelial cells - In the airways, leads to thick secretions + reduced ciliary function --> there is retention of mucopurulent secretions - Thick meconium --> meconium ileus - Blockage of pancreatic ducts --> pancreatic enzyme deficiency + malabsorption - Excessive conc. of sodium and chloride in sweat
126
Cystic fibrosis: screening
Screened at birth 1. ) IRT (immunoreactive trypsinogen) raised in newborns with CF 2. ) If IRT raised --> sample is screened for common CF gene mutations 3. ) If 2 mutations are present --> sweat test to confirm
127
Cystic fibrosis clinical features: newborn
Newborn screening | Meconium ileum
128
Cystic fibrosis clinical features: infancy
Prolonged neonatal jaundice Growth faltering Recurrent chest infections Malabsorption --> steatorrhoea
129
Cystic fibrosis clinical features: young child
Bronchiectasis (persistent wet cough) Rectal prolapse Nasal polyp Sinusitis
130
Cystic fibrosis clinical features: older child
``` Allergic bronchopulmonary aspergillosis Finger clubbing Hyperinflated chest DM Cirrhosis + portal hypertension Distal intestinal obstruction ```
131
Cystic fibrosis: organisms that cause recurrent infection
Staph aureus Haemophilus influenza Pseudomonas aeruginosa
132
Cystic fibrosis: other conditions that CF predisposes these patients to
Pancreatic exocrine insufficiency (lipase, amylase and proteases) --> faltering growth
133
Investigation and result for pancreatic exocrine insufficiency
Low faecal elastase
134
Meconium ileus clinical presentation
Vomiting Abdominal distension Failure to pass meconium in first few days of life
135
Meconium ileus treatment
Surgery | Gastrografin enema
136
Cystic fibrosis: investigation
1. ) Sweat test - Elevated chloride 2. ) Testing for gene abnormalities in CFTR protein
137
Cystic fibrosis: management
- Physiotherapy 2x a day - Prophylactic oral flucloxacillin - Azithromycin given regularly - Regular nebuliser hypertonic saline - Oral pancreatic replacement therapy taken with all meals - High calorie diet (may have gastrostomy for overnight) - Fat-soluble vitamin supplements
138
Cystic fibrosis: end stage CF lung disease management
Bilateral sequential lung transplant
139
Cystic fibrosis: fertility
Females have normal fertility | Males are infertile due to absence of vas deference
140
Features of an innocent ejection murmur
aSymptomatic Soft blowing murmur Systolic murmur only left Sternal edge
141
Circulatory changes at birth
``` First breath Volume of blood flowing through lungs increases x6 pLA rises vRA falls = flap over foramen ovale closes ``` Ductus arterioles closes within first few hours
142
Heart failure: symptoms
Breathlessness (esp. on feeding) Sweating Poor feeding Recurrent chest infection
143
Heart failure: signs
``` Poor weight gain Tachypnoea Tachycardia Heart murmur Enlarged heart Hepatomegaly Cool peripheries ```
144
Most common cause of heart failure in a newborn
Left heart obstruction
145
Causes of left heart obstruction
Hypoplastic left heart syndrome AV stenosis Coarctation of aorta
146
Most common cause of heart failure in infants
High pulmonary blood flow
147
Most common cause of heart failure in older children
Right or left heart failure
148
Causes of high pulmonary blood flow
Ventricular septal defect Atrioventricular septal defect Large persistent ductus arteriosus
149
Causes of right or left heart failure in older children
Eisenmenger syndrome (right heart failure) Rheumatic heart disease Cardiomyopathy
150
Symptoms of a left --> right shunt
Breathless OR asymptomatic
151
Symptoms of a right --> left shunt
Blue (cyanotic)
152
Examples of left --> right shunts
Atrial septal defect Ventricular septal defect Patent ductus arteriosus
153
Examples of right --> left shunts
Tetralogy of fallot | Transposition of the great vessels
154
Symptoms of mixed blood
Breathless AND blue
155
Example of congenital heart defects that result in mixed blood
AVSD
156
Examples of congenital heart defects that cause obstruction of blood flow but are asymptomatic
Aortic stenosis Pulmonary stenosis Adult-type coarctation of aorta
157
Examples of congenital heart defects that cause obstruction of blood flow and can lead to collapse/ shock
Coarctation of the aorta | Hypoplastic left heart syndrome
158
Causes of peripheral cyanosis
Cold weather Generally unwell Polycythaemia
159
Causes of central cyanosis
Fall in arterial blood oxygen tension
160
Causes of cyanosis and respiratory distress in a newborn infant
``` Congenital heart disease Respiratory distress syndrome (surfactant deficiency) Persistent pulmonary hypertension Infection Inborn error of metabolism ```
161
Causes of cyanosis in an otherwise well infant
Structural heart disease
162
Congenital heart disease: investigations
1. ) Chest X-ray 2. ) ECG 3. ) Echo + US
163
ECG findings: right ventricular hypertrophy
Upright T wave in V1
164
ECG findings: left ventricular hypertrophy
Inverted T wave in V6
165
Cyanosis: immediate management
Prostaglandin --> maintains ductal potency
166
Atrial septal defect: symptoms
Commonly none Recurrent chest infections Arrhythmia's (>4 years)
167
Atrial septal defect: signs
Ejection systolic murmur at upper left sternal edge Fixed and widely split second heat sound In partial AVSD --> apical pan systolic murmur
168
Atrial septal defect: investigations
1. ) Chest x-ray | 2. ) ECG
169
Atrial septal defect: findings on chest x-ray
Cardiomegaly Enlarged pulmonary arteries Increased pulmonary vascular markings
170
Atrial septal defect: management
ASD: Cardiac catheterisation with insertion of occlusion device ``` AVSD: Surgical correction (usually between age 3-5) ```
171
Small ventricular septal defects: symptoms
Asymptomatic
172
Small ventricular septal defects: signs
Loud pan systolic murmur at lower left sternal edge (louder the murmur --> smaller the defect) Quiet pulmonary second sound
173
Small ventricular septal defects: investigations
1. ) Chest x-ray - normal 2. ) ECG - normal 3. ) Echo + doppler - -> NO pulmonary hypertension
174
Small ventricular septal defects: management
These lesions close spontaneously Maintain good dental hygiene to prevent endocarditis
175
Large ventricular septal defects: symptoms
Heart failure with breathlessness and faltering growth Recurrent chest infections
176
Large ventricular septal defects: signs
``` Tachypnoea, tachycardia Hepatomegaly Active precordium Soft pan systolic murmur (or no murmur) Apical mid-diastolic murmur Loud pulmonary second sound ```
177
Reason for mid-diastolic murmur in a large ventricular septal defect
Increased flow across mitral valve after blood has circulated through the lungs
178
Large ventricular septal defects: investigations
1. ) Chest X-ray 2. ) ECG 3. ) Echo
179
Large ventricular septal defect chest x-ray findings
Cardiomegaly Enlarged pulmonary arteries Increased pulmonary vascular markings Pulmonary oedema
180
Large ventricular septal defect ECG findings
Biventricular hypertrophy
181
Large ventricular septal defects: management
1. ) Diuretics 2. ) Catopril (ACE-inhibitor) 3. ) Additional calories 4. ) Surgery at 3-6 months
182
Persistent ductus arteriosus: clinical features
Continuous murmur beneath left clavicle Murmur continues into diastole Collapsing or bounding pulse
183
Persistent ductus arteriosus: investigations
1. ) Chest radiograph (normal) 2. ) ECG (normal) 3. ) ECHO
184
Persistent ductus arteriosus: management
1. ) Closure: - Coil - Occlusion device via cardiac catheter
185
Test to confirm cyanosis
Hyperoxia (nitrogen washout) test - Infant placed in 100% O2 for 10 minutes - If right radial artery PaO2 from blood gas remains low (<15kPa) --> cyanosis
186
Management of cyanosis
1. ) ABC - stabilise airway - breathing - circulation 2. ) Start prostaglandin infusion (5ng/kg/min)
187
Side effects of prostaglandin
``` Apnoea Jitteriness Seizures Flushing Vasodilatation Hypotension ```
188
Most common cause of cyanotic congenital heart disease
Tetralogy of Fallot
189
Tetralogy of Fallot anatomical features
Large VSD Overriding aorta Pulmonary stenosis Right ventricular hypertrophy
190
Tetralogy of Fallot: symptoms
Usually asymptomatic for first 2 months of life | Cyanosis
191
Tetralogy of Fallot: signs
Clubbing of fingers and toes (older children) | Loud harsh ejection systolic murmur at left sternal edge
192
Tetralogy of Fallot: investigations
1. ) Chest radiograph 2. ) ECG - normal at birth - later shows signs of RVH 3. ) ECHO
193
Tetralogy of Fallot chest radiograph findings
Small heart Uptilted apex (boot shaped) RV hypertrophy Pulmonary artery 'bay'
194
Tetralogy of Fallot: management
1. ) Blalock-Taussig shunt | 2. ) Surgery at 6 months to close VSD and relieve RV obstruction
195
Hypercyanotic spells management
1. ) Sedation and pain relief (morphine) 2. ) IV propranolol 3. ) IV fluids 4. ) HCO3- to correct acidosis 5. ) Muscle paralysis and artificial ventilation to reduce metabolic oxygen demand
196
Transposition of great vessels: clinical presentation
Cyanosis Loud second heart sound No murmur
197
Transposition of great vessels: investigations
1. ) Chest radiograph 2. ) ECG 3. ) Echo
198
Transposition of great vessels chest x-ray findings
Narrow upper mediastinum Egg on side appearance of cardiac shadow Increased pulmonary vascular markings
199
Transposition of great vessels: management
1. ) Prostaglandin 2. ) Balloon atrial septostomy 3. ) Surgical correction
200
Define Eisenmenger syndrome
Large left --> right shunt causes high pulmonary blood flow If left untreated, pulmonary arteries become thick walled Gradually, shunt decreases At 10-15 years, shunt reverses --> cyanosis
201
Medical condition associated with complete AVSD
Down's syndrome
202
Complete AVSD features
Cyanosis at birth | Lesion detected on routine echo screening in those with Down's syndrome
203
Complete AVSD management
1. ) Diuretics 2. ) Catopril (ACE-inhibitor) 3. ) Additional calories 4. ) Surgery at 3-6 months
204
Define hypoplastic left heart syndrome
Underdevelopment of entire left side of heart
205
Hypoplastic left heart syndrome: clinical features
Circulatory collapse | All peripheral pulses absent
206
Hypoplastic left heart syndrome: management
Maintain ABC Prostaglandin infusion Surgery: - Norwood procedure
207
Coarctation of the aorta: clinical features
Circulatory collapse | Absent femoral pulses
208
Coarctation of the aorta: management
Maintain ABC | Prostaglandin infusion
209
Most common arrhythmia of childhood
Supraventricular tachycardia
210
Define supraventricular tachycardia
250-300 beats/ minute
211
Supraventricular tachycardia: presentation
Heart failure symptoms | - Breathless
212
Supraventricular tachycardia: ECG findings
``` Narrow complex tachycardia Delta wave (specific to wolff-parkinson-white syndrome) ```
213
Supraventricular tachycardia: management
1. ) Correct acidosis 2. ) Positive pressure ventilation 3. ) Stimulation of vagus nerve 4. ) IV adenosine 5. ) Electrical cardio version if adenosine fails
214
Manœuvres to stimulate vagus nerve
Carotid sinus massage | Cold ice pack to face
215
Mechanism of action of adenosine in treating supraventricular tachycardia
Terminates the re-entry circuit that is set up between the AV node and accessory pathway
216
Supraventricular tachycardia maintenance therapy
1.) Flecainide or solatol
217
Maternal antibodies associated with congenital heart block
anti-RO and anti-La
218
Management of congenital heart block
Endocardial pacemaker
219
Which infection does a congenital heart disease increase your risk of
Infective endocarditis
220
Infective endocarditis: clinical signs
``` Fever Anaemia and pallor Splinter haemorrhages Clubbing (late) Necrotic skin lesions Splenomegaly Haematuria ```
221
Infective endocarditis: investigations
1. ) Blood cultures 2. ) ECHO - vegetations 3. ) Raised ESR/ CRP
222
Define vegetation
Contains fibrin, platelets and the causative organism
223
Infective endocarditis: most common causative organism
alpha haemolytic streptococcus (strep viridans)
224
Infective endocarditis: management
6 weeks IV of: 1. ) Penicillin 2. ) Aminoglycoside
225
Infective endocarditis: prophylaxis
Good dental hygiene Avoid body piercing Avoid tattoos
226
Causes of dilated cardiomyopathy
Inherited Metabolic disease Viral infection of myocardium
227
Dilated cardiomyopathy: clinical features
Enlarged heart | Heart failure
228
Dilated cardiomyopathy: investigations
ECHO
229
Dilated cardiomyopathy: management
1. ) Diuretics 2. ) Catopril 3. ) Carvedilol 4. ) Propranolol
230
Define myocarditis
Inflammation of heart muscle
231
Myocarditis: management
Usually resolves spontaneously | Heart transplant may be required
Medicine Phase 3a
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