Flashcards in Paediatrics Deck (51)
When is congenital heart disease detected?
Picked up during antenatal ultrasound screening at 20 weeks --> fetal echo
In which congenital heart diseases do you get L --> R shunt?
VSD, PDA, ASD
Patient breathless, asymptomatic
More common than R --> L shunt
In which congenital heart diseases do you get R --> L shunt?
Tetralogy of fallot
Transposition of great arteries
Less common than L --> R
Causes of congenital heart disease?
Maternal rubella, SLE and diabetes
Fetal alcohol syndrome
Down's syndrome - leads to AVSD, VSD
Other syndrome's e.g. Edward's, Patau's, Turner's
Fetal circulatory changes around birth
-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
-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
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
DDx of breathless child?
Croup, asthma, bronchiolitis, pneumonia, URTI, acute epiglottitis, foreign body inhalation
Most likely diagnosis of breathless child with barking cough and mild intercostal recessions?
Cause of croup?
What age group does croup affect?
6 months to 6 year olds
Symptoms of croup?
Barking cough, stridor, fever, coryzal symptoms
Management of croup?
Single dose dexamethasone (or prednisolone) - 0.15mg/kg
Management of croup in patient with low sats?
High flow O2 and nebulised adrenaline
Cause of bronchiolitis?
Respiratory syncytial virus (RSV)
Management of bronchiolitis?
Self-limiting so supportive only: O2, fluids
Prophylaxis for RSV in high-risk children?
Prophylaxis for RSV in high-risk children?
Cause of septic arthritis?
Investigations for septic arthritis?
Joint aspiration (+ culture), blood cultures, infection more likely to be systemic in children
Management of septic arthritis?
IV antibiotics (probably flucloxacillin)
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
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
Physiology of hypertrophic pyloric stenosis?
Hypertrophy of pylorus --> impaired gastric emptying --> stomach contents forced to leave stomach as vomit.
Metabolic abnormality in pyloric stenosis?
Hypochloraemic hypokalaemic metbolic alkalosis.
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
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)
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
Pathophysiology of intussusception
Intestine folds into the next part of it causing obstruction
Where in bowel is most common site of intussusception?
Terminal ileum/ileo-coecal valve