What type of murmur do the following create: 1. ASD 2. VSD 3. PDA 4. Coarctation in aorta

1. Midsystolic crescendo-decrescendo 2. Loud pansystolic murmur 3. Continuous machinery murmur 4. Loud systolic murmur in left intraclavicular region

Paediatrics Flashcards by S Usher

Which blood vessels does the PDA connect?

Pulmonary artery and descending aorta

How well did you know this?

Not at all

Perfectly

What type of murmur do the following create:

ASD
VSD
PDA
Coarctation in aorta

Midsystolic crescendo-decrescendo
Loud pansystolic murmur
Continuous machinery murmur
Loud systolic murmur in left intraclavicular region

How well did you know this?

Not at all

Perfectly

How can someone present with an ASD in later life?

Stroke - a clot from a DVT can bypass lungs

How well did you know this?

Not at all

Perfectly

What are the 4 features of Tetralogy of Fallot?
What murmur does it present with?
What will you see on CXR?

Overiding aorta, VSD, pulmonary stenosis, RVH
Loud ejection systolic
Boot shaped heart

How well did you know this?

Not at all

Perfectly

What cardiac arrhythmia is associated with Ebstein’s anomaly?

Wolff-Parkinson-White

How well did you know this?

Not at all

Perfectly

What will you see on CXR with transposition of the great arteries?

Heart looks like an “egg on a string”

How well did you know this?

Not at all

Perfectly

What is the medical management of heart failure in children? (4)
When should oxygen not be used?
What other management should you consider for a child presenting with heart failure and failure to thrive?

ACE-I (e.g. catopril), diuretics (e.g. furosemide), prostaglandins, inotropes (e.g. dobutamine)
Duct-dependent heart failure as can cause ducts to close
High calorie feeds

How well did you know this?

Not at all

Perfectly

What is tested for on the newborn heel prick test?

Sickle cell, cystic fibrosis, congenital hypothyroidism, 5 metabolic disorders

How well did you know this?

Not at all

Perfectly

What are you likely to see on neck x-ray with epiglottitis?

Thumbprinting

How well did you know this?

Not at all

Perfectly

What are signs of respiratory distress? (8)

Raised respiratory rate
Use of accessory muscles
Intercostal and subcostal recession
Nasal flaring
Tracheal tug
Head bobbing
Cyanosis
Abnormal airway sounds

How well did you know this?

Not at all

Perfectly

What is the characteristic cough of croup?
What symptoms would suggest severe croup? (2)
When should croup usually resolve in mild cases?

Seal-like barking cough
Agitation, lethargy
48h

How well did you know this?

Not at all

Perfectly

What are the signs and symptoms of anaphylaxis?

A (3)
B (4)
C (3)

A - stridor, hoarseness, swelling in larynx
B - tachypnoea, wheeze, cyanosis, low O2%
C - hypotension, pale, clammy

How well did you know this?

Not at all

Perfectly

What is the NICE criteria for diagnosing bronchiolitis? (4)

1 to 3 day history of coryzal symptoms with :
Persistent cough AND
Either tachypnoea or chest recession AND
Either wheeze or crackles on auscultation

How well did you know this?

Not at all

Perfectly

How long does it take for bronchiolitis to resolve?

2-3 weeks

How well did you know this?

Not at all

Perfectly

What can happen with severe coughing fits in whooping cough? (3)
How long does it take for whooping cough to resolve?
What should you do after managing child?

Vomiting, apnoea, LOC
8 weeks
Notify Public Health

How well did you know this?

Not at all

Perfectly

Which tests can you use to diagnose cystic fibrosis? (2)

What is the general management of CF? (4)

Sweat test, genetic testing

MDT :) chest physiotherapy, bronchodilators, prophylactic antibiotics, high calorie diet

How well did you know this?

Not at all

Perfectly

What can you assess to determine dehydration in a child? (9)

Body weight - >4% is significant, >7% is severe
Skin turgor
Tears (present vs absent)
Urine output
Eyes (sunken vs not sunken)
Anterior fontanelle (sunken vs not sunken)
Mucuous membranes
Blood pressure
Heart rate

How well did you know this?

Not at all

Perfectly

How do you cause a hyponatraemic dehydration?

Lose sodium and water at same rate with vomiting/diarrhoea

However, drink water to compensate without salts = hyponatraemic

How well did you know this?

Not at all

Perfectly

How many stools and vomits put you at higher risk of dehydration in 24h?

> 5 stools

>2 vomits

How well did you know this?

Not at all

Perfectly

What are the principles of management of gastroenteritis in children? (2)

How should you manage shock caused by gastroenteritis? (3)

Isolate child
Prevent dehydration e.g. ORS, continue to breastfeed

Fluid bolus (20ml/kg)
Then maintenance fluids
Monitor U&Es, glucose, weight daily

How well did you know this?

Not at all

Perfectly

When does gastroenteritis tend to resolve?

Diarrhoea - 5-7 days, resolves completely in 2 weeks

Vomiting - 1-2 days, resolves completely by 3 days

How well did you know this?

Not at all

Perfectly

What are the complications of gastroenteritis? (4)

Lactose intolerance
IBS
GBS
HUS

How well did you know this?

Not at all

Perfectly

What are the complications of GORD in children? (4)

Failure to thrive
Oesophagitis
Recurrent pulmonary aspiration
Sandifer syndrome - severe arching of spine, dystonic neck posturing

How well did you know this?

Not at all

Perfectly

What are the causes for urgent referrals for constipation in children? (7)

What are some medical causes of constipation that can initially be managed in primary care whilst referring? (3)

Study These Flashcards

Cystic fibrosis
Hirschprung's
Anal stenosis
Spina bifida
Cerebral palsy 
Intestinal obstruction
Sexual abuse

Coeliac disease
Cow’s milk protein allergy
Congenital hypothyroidism

What examination is very important (!) when investigating constipation?

Lower limb neurological exam !

What are the physical and psychological causes of emaciation in children?

Endocrine: T1DM, hypothyroidism, Addison's GI: coeliac, IBD, achalasia Malignancy JIA Psychological: eating disorder, depression, OCD Autism

What electrolyte abnormalities would you expect to see in refeeding syndrome? (5)

``` Hyponatraemia Hypokalaemia Hypomagnesaemia Hypophosphataemia Hypocalcaemia ```

What are some of the features of refeeding sydrome? (4)

Rhabdomyolysis Arrhythmias Seizures Sudden Death

How do you manage refeeding syndrome? (5)

``` Pabrinex Refer to dietician Slowly reintroduce food Monitor fluid balance Monitor electrolytes ```

How do you treat intussuception?

Rectal air insufflation

What features would suggest NAI? (7)

Delay in seeking help Vague, inconsistent history Injury not compatible with history/developmental age of child Injuries of different ages Multiple A&E attendances and to different sites Pattern/artefact burns or injuries Inappropriate affect from child or parent

Which percentage of weight loss in the newborn would indicate a referral to paediatrics? Weight loss can be normal in a newborn. By what week should they return to their birth weight?

>10% 3 weeks

What is the normal feed for a newborn?

150ml/kg/d if <1 month (every 4 hours) | 100ml/kg/d if >1 month

What drop in centiles on the growth chart would warrant a referral to paediatrics?

2 or more centiles OR anyone below 2nd centile NB, if below 9th centile, then just 1 drop; if above 91st centile, then 3 or more

What are important infective causes of fever to rule out according to NICE? (5)

``` Meningitis Pneumonia UTI Herpes simplex encephalitis Kawasaki ```

What are the most common causes of meningitis in: 1. Under 3 months 2. Over 3 months

1. GBS, E. Coli, Listeria | 2. Neisseria meningitidis, S pneumonia, Haemophilus influenzae (if not vaccinated)

What are aseptic causes of meningitis? | Which cause should be considered in the immunocompromised?

Viral, fungal, TB, inflammatory, malignancy, sarcoidosis Fungal

What blood test is required to test for N meningitidis?

PCR

Which antibiotic is most commonly used to treat meningitis? Which antibiotic is required for: - GBS - Listeria

Ceftriaxone - Cefotaxime - Amoxicillin

When should dexamethasone not be used in the treatment of meningitis? (2)

If over 12h since starting antibiotics | Meningococcal septicaemia

What increases the risk of developing bacterial meningitis (environmental and medical)?

Overcrowded day care Low family income Maternal infection during birth Basal skull fracture Periorbital or orbital cellulitis, sinusitis, septic arthritis Asplenism

What are the complications of meningitis? 1. Acute (6) 2. Long term (5)

Seizures, raised ICP, metabolic disturbance, coagulopathy, anaemia, coma, death Hearing impairment, neurological impairment, epilepsy, learning or developmental difficulties, psychosocial problems

What is the long-term management after recovery from meningitis? (2)

Refer to paediatrician for follow up | Hearing assessment at 4 weeks

What can cause a prolonged fever in children? (2)

Lyme disease | Kawasaki disease

What are the important differentials for an acutely unwell neonate? (4)

Sepsis Meningitis Inborn errors of metabolism NAI

What investigations should you order for an acutely unwell neonate? 1. Bloods 2. Imaging 3. Microscopy

1. FBC, U&Es, LFTs, CRP, lactate, blood gas, blood cultures, ammonia, bicarbonate, glucose, coagulation 2. CT head or cranial USS, CXR 3. LP, urine dip and culture

What should you calculate if a neonate presents with metabolic acidosis?

Anion gap

What are the differentials for a non-blanching rash in a child? 1. Will cause child to be unwell 2. Child will be generally well

1. Meningicoccal septicaemia, Leukaemia, DIC, HUS, measles | 2. ITP, HSP, aplastic anaemia

What is are the investigations and follow-up for a child presenting with HSP?

U&Es, eGFR, urine analysis, PCR, blood pressure BP and urine for one year checking for renal involvement

When should children generally recover from ITP? When should you refer? What management options are there for ITP? (3)

6 weeks - can take up to 3 to 6 months to fully revoer 6 months - examine bone marrow for inherited disorders Tranexamic acid for bleeding, steroids, immunoglobulins

What are features of the following types or UTI: 1. Atypical (6) 2. Recurrent (3)

1. Poor urine flow, septic, non- E coli, raised creatinine, abdominal mass, failure to respond to antibiotics in 48h 2. 2 or more upper UTI, 1 of both upper and lower UTI, 3 lower UTIs

When should the following scans be used to investigate UTI in children? 1. Renal USS 2. MCUG 3. DMSA

1. <6 months, atypical UTI 2. <6 months with recurrent or atypical UTI 3. All those with recurrent UTI, <3 years with atypical

At what age should interventions be trialled in children with enuresis? What are these interventions? (2)

Over 5 years | Enuresis alarm, desmopressin

What specific signs are found in someone with Duchenne muscular dystrophy? (2) What blood test will be raised in Duchenne muscular dystrophy?

Gower's sign, pseudohypertrophy of calves | Creatinine kinase

Which conditions are ASD associated with? (3)

Fragile X Tuberous sclerosis Williams syndrome

What are some causes of delayed walking?

Neurological: cerebral palsy, spina bidifia, central cause Neuromuscular i.e. Duchenne's Environmental: bottom shuffler, psychosocial deprivation Developmental dysplasia of hip Metabolic conditions Hypothyroidism

When should the insulin be started in DKA in children?

1-2 hours after starting IV fluids

What are the complications of DKA in children?

Cerebral oedema Hypokalaemia VTE

Paediatrics Flashcards

(58 cards)