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Flashcards in Paediatrics Deck (51)
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1

When is congenital heart disease detected?

Picked up during antenatal ultrasound screening at 20 weeks --> fetal echo

2

In which congenital heart diseases do you get L --> R shunt?

VSD, PDA, ASD

Patient breathless, asymptomatic

More common than R --> L shunt

3

In which congenital heart diseases do you get R --> L shunt?

Tetralogy of fallot
Transposition of great arteries

Patient cyanotic

Less common than L --> R

4

Causes of congenital heart disease?

Maternal rubella, SLE and diabetes
Warfarin
Fetal alcohol syndrome
Down's syndrome - leads to AVSD, VSD
Other syndrome's e.g. Edward's, Patau's, Turner's

5

Fetal circulatory changes around birth

In utero:
-Low pressure in LA as little blood returns from the lung
-High pressure in RA as receives all systemic and placental venous return
-Foramen ovale (between atria) and ductus arteriosus (between PA and aorta to bypass lungs) are open, blood flows R → L

At birth:
-First breath increases pulmonary blood flow and LA pressure
-No placenta decreases RA pressure
-LA pressure> RA pressure so foramen ovale closes

First hours/days of life:
-Ductus arteriosus closes

6

Treatment of shunts (what keeps open/closes defect)?

Prostaglandins keep shunts open, important when baby cyanotic (i.e. in R --> L shunts in TOF and TGA) - keeps open until surgery

Prostaglandin inhibitors i.e. NSAIDS e.g. IV indomethacin/ibuprofen close defect in L --> R shunts

7

DDx of breathless child?

Croup, asthma, bronchiolitis, pneumonia, URTI, acute epiglottitis, foreign body inhalation

8

Most likely diagnosis of breathless child with barking cough and mild intercostal recessions?

Croup (laryngotracheobronchitis)

9

Cause of croup?

Parainfluenza virus

10

What age group does croup affect?

6 months to 6 year olds

11

Symptoms of croup?

Barking cough, stridor, fever, coryzal symptoms

12

Management of croup?

Single dose dexamethasone (or prednisolone) - 0.15mg/kg

13

Management of croup in patient with low sats?

High flow O2 and nebulised adrenaline

14

Cause of bronchiolitis?

Respiratory syncytial virus (RSV)

15

Management of bronchiolitis?

Self-limiting so supportive only: O2, fluids

16

Prophylaxis for RSV in high-risk children?

Palivizumab

17

Prophylaxis for RSV in high-risk children?

Palivizumab

18

Cause of septic arthritis?

Staph. aureus

19

Investigations for septic arthritis?

Joint aspiration (+ culture), blood cultures, infection more likely to be systemic in children

20

Management of septic arthritis?

IV antibiotics (probably flucloxacillin)

21

DDx for limp in child

Septic arthritis; transient synovitis (would be viral, less systemically unwell, no pain at rest but pain & reduced int. rot.n, normal WCC, CRP, ESR); osteomyelitis (similar presentation to SA, MRI, XR);
DDH –infant, barlow and otolani manouvres test in neonatal screening, asymetric skin folds, breech delivery assoc, important complication – necrosis of femoral head;
Perthes disease – avascular necrosis of femoral epiphysis of femoral head, boys 5-10, insidious limp or hip/knee pain, shown on XR;
Slipped upper feomral epiphysis – 10 – 15 yrs esp. obese boys, can follow minor trauma or be insidious, reduced abduction and internal rotation'
NAI - esp. in fractures before walking age, repeated admissions to A&E;
JIA – presistent joint swelling for over 6 weeks, mostly females, exclude infection, malignancy etc

22

Most likely diagnosis in 3 wk old baby with non-bilious projectile vomiting after feeding? No PMH, on exam: poor weight gain, dehydrated, mass felt in RUQ.

Hypertrophic pyloric stenosis

23

Physiology of hypertrophic pyloric stenosis?

Hypertrophy of pylorus --> impaired gastric emptying --> stomach contents forced to leave stomach as vomit.

24

Metabolic abnormality in pyloric stenosis?

Hypochloraemic hypokalaemic metbolic alkalosis.

25

Radiological features of pyloric stenosis?

USS - non-passage of gastric contents into prox duodenum.
XR - delayed gastric emptying, peristaltic waves, string sign/double-track sign, beak sign

26

Management of pyloric stenosis?

Stop oral feeds, IV fluids – 0.9% sodium chloride, 5% dextrose, 20mmol KCl (apart from for resus), admit to paeds:
-Atropine (oral or IV) – 85% success rate and requires long hospital stay
-Pyloromyotomy (Ramstedt’s procedure)

27

Intussusception symptoms?

Sudden onset paroxysms of colicky abdo pain +/- crying
Child may appear well between paroxysms initially
Early vomiting - rapidly becomes bilious
Neuro sx e.g. lethargy, hypotonia or sudden alterations of consciousness
Dehydration, pallor, shock
Drawing up of legs to chest
Irritability, sweating

28

Pathophysiology of intussusception

Intestine folds into the next part of it causing obstruction

29

Where in bowel is most common site of intussusception?

Terminal ileum/ileo-coecal valve

30

What signs of intussusception would you find on exam?

Sausage shapen mass in abdomen, red currant jelly stool