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Paediatrics Flashcards

1
Q

Describe the changes to fetal circulation that occur at birth

A

In utero blood bypasses lungs. Goes from RV to aorta via DA. Right sided pressure high because of blood from placenta. Left sided pressure lower because no blood coming from lungs. So R –> L via foramen ovale. At birth baby breathes, umbilical arteries constrict, pulmonary arteries dilate, DA closes.

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2
Q

Causes of congenital heart defects

A

Diabetes
Rubella
SLE
Lithium, anticonvulsants, fetal alcohol syndrome
Turners, Downs, Edwards, Pataus, DiGeorge, Marfarns

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3
Q

Which direction is the shunt in acyanotic congenital heart defects

A

Left to right

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4
Q

Which direction is the shunt in cyanotic congenital heart defects

A

Right to left

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5
Q

Are cyanotic or acyanotic congenital heart defects more common

A

Acyanotic

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6
Q

Causes of acyanotic congenital heart defects

A 
Septal defects
Patent ductus arteriosus 
Coarctation of the aorta
Aortic stenosis
Pulmonary stenosis
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7
Q

Causes of cyanotic congenital heart defects

A

Tetralogy of Fallot
Transposition of great arteries
Atresia

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8
Q

What is Eisenmenger reaction

A

When an acyanotic shunt (left to right) becomes a cyanotic shunt (right to left)

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9
Q

Ventricular septal defect murmur

A

Pansystolic at left lower sternal border

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10
Q

Atrial septal defect murmur

A

Mid-diastolic murmur at the left upper sternal border

Also get widely split S2

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11
Q

Murmur associated with patent ductus arteriosus

A

Continuous machine like murmur at the left upper sternal border

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12
Q

Findings associated with coarctation of the aorta

A

Upper limb hypertension
Weak/absent femoral pulses
Headache, chest pain, cold peripheries

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13
Q

Causes of paediatric heart failure

A 
Anaemia
Arrhythmia
Myocarditis
Cardiomyopathy
Structural defects
Hypertension
Kawasaki disease
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14
Q

Signs of right sided cardiovascular congestion

A 
Hepatomegaly
Ascites
Abdo pain
Oedema
JVP
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15
Q

Signs of left sided cardiovascular congestion

A

High resp rate
Respiratory distress
Pulmonary oedema

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16
Q

Features of decreased cardiac output in a child

A 
Fatigue
Pallor
Sweating
Cool extremities
Nausea/vomiting
Poor growth
Dizziness
Syncope
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17
Q

Features of heart failure in infants

A 
High HR
High RR
Restless/irritable
SOB
Acidosis
Sweating
Trouble feeding
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18
Q

What is the hyperoxia test

A

Used to differentiate cause of cyanosis in infants
If cause is pulmonary then cyanosis resolves with 100% oxygen
If cause is cyanotic congenital heart defect then cyanosis will persist

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19
Q

Management of heart failure in children

A 
If duct dependent give prostin and stop oxygen
Diuretics
ACE inhibitors
High calorie diet
Inotropes
Surgery
Drain pleural effusions
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20
Q

Duct dependent congenital heart disease

A 
Hypoplastic left heart
Coarctation of the aorta
Severe aortic stenosis
Pulmonary atresia
Severe tetralogy of fallot
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21
Q

What are the 4 features of tetralogy of fallot

A

Ventricular septal defect
Over-riding aorta
Pulmonary stenosis
Right ventricular hypertrophy

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22
Q

Causes of myocarditis

A

Viral - coxsackie, parvovirus, mononucleosis
Bacterial - beta haemolytic strep A, diphtheria, TB
Fungal - candida, aspergillus
SLE
Kawasaki
Radiation/chemotherapy
Alcohol/cocaine

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23
Q

Clinical features of Kawasaki disease

A 
Children <5
High fever
Desquamative rash
Conjunctivitis
Mucositis - strawberry tongue
Cervical lymphadenopathy
Erythema and oedema of distal extremities 
!! coronary artery aneurysm
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24
Q

Treatment for Kawasaki disease

A

IV immunoglobulins

High dose Aspirin

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25
Symptoms of acute rheumatic fever
``` JONES Joints Pancarditis Nodules Erythema marginatum Sydenham chorea ```
26
Causative organism of rheumatic fever
Group A beta-haemolytic streptococcus
27
Differential diagnosis of stridor
``` Croup Bacterial tracheitis Epiglottitis Laryngomalacia Inhaled foreign body Anaphylaxis ```
28
Causative organism of croup
Parainfluenza virus
29
Causative organism of whooping cough
Bordetella pertussis
30
Causative organism of bronchiolitis
Respiratory syncytial virus
31
3 key features of epiglottitis
Dysphagia Drooling Distress
32
Typical presentation of bacterial tracheitis
Rapid deterioration following a cold/croup
33
At roughly what age should laryngomalacia have resolved by
2 years
34
Management of chronic asthma in children
``` SABA Low dose ICS LABA/LTRA Increase ICS Refer ```
35
Management of acute asthma in children
``` Oxygen Salbutamol pMDI + spacer or Neb Steroids (continue for 3 days) Ipratropium bromide MgSO4 nebuliser IV salbutamol ```
36
Discharge criteria for children following an acute asthma episode
Stable on 3-4 hourly salbutamol Sats >94% PEFR >75%
37
Definition of anaphylaxis
Airway compromise and hypotension in the setting of an allergic reaction
38
Management of anaphylaxis
``` Oxygen Raise legs Adrenaline Antihistamines Steroids Fluids ```
39
What are the 4 different types of hypersensitivity reaction
Type 1 - immediate Type 2 - cytotoxic (autoimmune) Type 3 - immune complex (vaccinations and vasculitis) Type 4 - delayed (SJS, transplant rejection)
40
Management of choking
Assess cough effectiveness - if effective encourage | If cough not effective then: 5 back blows followed by 5 abdo thrusts (chest if <1)
41
Inheritance pattern of cystic fibrosis
Autosomal recessive
42
Systems affected by cystic fibrosis
``` Respiratory Pancreas Liver Bile duct Bowel Fertility ```
43
Gold standard test for cystic fibrosis
Sweat test
44
Management of cystic fibrosis
``` Phsyio Dietary supplements Vitamins ADEK replacement Pancreatic enzyme replacement Hypertonic saline, mucolytics Bronchodilators Vaccinations ```
45
Intake requirements of a <1 month old and an >1 month old
<1 month: 150ml/kg/day | >1 month: 100ml/kg/day
46
At what age would you expect GORD to be getting better in infants
6-9 months
47
If a child has had gastroenteritis what should you advise them about going to school
Stay off school until 48hrs symptom free
48
Is fecal calprotectin raised or lowered in IBD
Raised
49
Causes of gastroenteritis
Viral - rotavirus Bacterial - campylobacter, salmonella, e.coli Parasites - giardia
50
Indications for stool microscopy
``` Recent travel No improvement in diarrhoea by day 7 Blood/mucus in stool Sepsis Immunocompromise ```
51
What % fluid loss counts as mild, moderate and severe dehydration
Mild 4% Moderate 4-7% Severe 7%
52
How much ORS should be given after each loose stool
5ml/kg
53
Fluid replacement for shock
20ml/kg 0.9% NaCl IV bolus by rapid infusion
54
Maintenance fluids
0.9% NaCl + 5% glucose with 10mmol KCl 100ml/kg for the first 10kg 50ml/kg for the next 10kg 20ml/kg for each kg after that This gives total 24hrs so divide by 24 to get ml/hr rate
55
Calculation to work out % dehydration
(weight loss/original weight) X 100
56
Calculation to work out fluid deficit
(% dehydration X current weight) X 10
57
What is Kernigs sign
When hip is flexed can't straighten leg Sign of meningism
58
What is Brudzinski sign
Neck flexion causes hips/knees to flex too Sign of meningism
59
When does the posterior fontanelle close
1-2 months old
60
When does the anterior fontanelle close
9-18 months old
61
Sepsis 6
``` Oxygen Antibiotics Fluids Blood cultures Lactate Urine output ```
62
Common causes of meningitis in children < 3 months old
Group B strep E.coli Listeria
63
Common causes of meningitis in children > 3 months old
Niesseria meningitides | Strep penumoniae
64
Viral causes of meningitis
``` Coxsackie Adenovirus Mumps Varicella zoster EBV ```
65
Antibiotics for bacterial meningitis/meningococcal treatment in < 3 month olds vs > 3 month olds
< 3 months: IV Cefotaxime + Amoxicillin > 3 months: IV Ceftriaxone
66
Why do you give steroids within the first 12 hours of the first antibiotic dose
To reduce the chance of deafness
67
How does listeria look on microscopy
Gram positive rod
68
Differentials for seizure in children
``` Febrile convulsions Encephalitis/meningitis Sepsis/shock Epilepsy Metabolic disease Poisoning Trauma SOL Hydrocephalus ```
69
Definition/diagnostic criteria of epilepsy
2 unprovoked seizures >24hrs apart or dx of epilepsy syndrome or dx of high chance of recurrence
70
What is a reflex anoxic seizure
A seizure after insult e.g. knock on head
71
Features of non-epileptic attack disorder
Mainly trunk/proximal movements Crying Eyes shut
72
Age range for febrile convulsions
6 months - 5 years
73
Management of seizures in children
Buccal midazolam/rectal diazepam IV Lorazepam dose 1 If not improved in 10 mins dose 2 of Lorazepam IV Phenobarbitol/Phenytoin If not stopped in 20 mins then IV Midazolam/Thiopental
74
Early hand dominance occurs before what age
12 months
75
Early hand dominance and persistent toe walking should make you think of which disease
Cerebral palsy
76
Features of autism spectrum disorder
Difficulty with communication and social interaction Inflexible thinking Repetitive/restricted/stereotyped behaviour Motor stereotypies Sensory interests Often associated medical conditions - Down's, epilepsy, ADHD, fragile X
77
Which medication is used to treat ADHD
Methylphenidate
78
What monitoring advice is required for Methylphenidate
BMI, HR, BP, ECG: frequency depends on if younger or older than 10 If weight loss concern then take after food, add snacks, high calorie foods, take planned break from treatment
79
Diagnostic criteria for ADHD
Must be present by age 12 and in two or more settings (e.g. home and school)
80
What are the 3 main types of cerebral palsy
Spastic Ataxic Dyskinetic
81
3 physical/developmental key features/red flags for cerebral palsy
Early hand dominance Persistent toe walking Outswinging of leg when running
82
What is the inheritance pattern of duchenne muscular dystrophy
X linked recessive
83
Chance of someone with DMD having an affected a) child b) son
1 in 4 chance of affected child | 1 in 2 chance of affected son
84
Clinical features of duchenne muscular dystrophy
Calf hypertrophy with proximal muscle weakness Gowers sign Muscles gradually weaken over time
85
Why do you avoid 100% oxygen in premature babies
Risk of retinopathy of prematurity
86
Most common UTI pathogen in children
E.coli
87
What age group with suspected UTI warrants urgent admission
<3 months old
88
How long after discharging a child with UTI do you perform USS
Within 6 months
89
2 specialist urology investigations
DMSA - radionucleotide scan | MCUG - micturating cystourogram
90
How long after UTI do you wait before performing DMSA
4-6 months
91
How long after UTI do you wait before performing MCUG
A few weeks
92
Definition of secondary nocturnal enuresis
Nocturnal enuresis after a minimum of 6 months dry period | Developmental age needs to be > 5 years
93
At what age is encopresis considered a medical condition
Developmental age needs to be >4 years
94
What is the difference between renal hypoplasia, renal dysplasia and renal agenesis
Hypoplasia is less nephrons Dysplasia is undifferentiated Agenesis is absence
95
Features of colic
``` Cries >3 hours per day, 3 days a week, for at least 1 week Hard to soothe Clenched fists Goes red in the face Brings knees up and arches back Wind ```
96
When age does colic usually resolve by
6 months
97
General advice if baby has colic
Hold upright during feeds Wind after feeds Gentle rocking Warm baths
98
Signs/symptoms of cows milk allergy
``` Typically develops when cows milk first introduced. Two main types; immediate CMA (sx within minutes), delayed CMA (sx hours or days after) Skin reactions - mouth, face, eyes Stomach ache Vomiting Colic Diarrhoea/constipation Coryzal symptoms Eczema ```
99
Management of cows milk allergy
Remove cows milk protein from mums diet if breastfeeding, or change formula if bottle fed (Aptamil Pepti, Nutramigen) Review every 6-12 months and introduce small amount to see if they've developed a tolerance Usually grow out of it by age 5
100
Is lactose intolerance an allergy?
No - it's an inability to digest lactose
101
What food intolerance can develop after an infection (e.g. gastroenteritis)
Lactose intolerance
102
Features of reflux in infants
``` Vomits after feeds Hiccups/coughing when feeding Unsettles Crying Not gaining weight ```
103
Management options for reflux in children
Thickened formulas PPI Fundoplication
104
When does reflux usually start and get better by
Starts before 8 weeks old and usually better by 1 year
105
What is coeliac disease
An autoimmune reaction to gluten
106
What is gluten
A protein found in wheat, barley and rye
107
Features of coeliac disease
``` Diarrhoea Abdo pain Flatulance Indigestion Constipation Fatigue Malnutrition Weight loss Dermatitis herpetiformis IDA B12 anaemia Other autoimmune diseases - T1DM, thyroid ```

Finals (32 decks)

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