PAEDS 1 Flashcards by Eira Hegarty

Most common cyanotic congenital heart disease, and how might it present?

Tetralogy of Fallot - right to left shunt that leads to cyanosis usually within the first few weeks of life.

Cyanotic
O2 <94%
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What is included in a full septic screen of a <3 month old baby?

Urine Culture
Blood Culture
Throat swab
Lumbar puncture

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2 common cardiac associations in Turner syndrome?

Coarctation of the aorta

Aortic stenosis

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2 features that would suggest a submandibular duct stone / sialolithiasis:

Submandibular region

Pain on eating

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Prolonged jaundice in a neonate is defined as persisting 14 days after birth, and 21 days in pre-term birth. Give 4 causes of prolonged jaundice, highlighting the most common.

Breast milk jaundice

Congenital infections

Prematurity and immature liver function

Biliary atresia - late presentation associated with worse prognosis; identify with high CONJUGATED bilirubin

Hypothyroidism

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Most common congenital heart disease in Trisomy 21:

AVSD

All patients with Trisomy 21 should have an echocardiogram.

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A patient presents with pain at the proximal femur, worse at night and relieved by aspirin. What is the most likely diagnosis?

Osteoid osteoma

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ITP presents with petechiae and purpura, often preceded by coryzal symptoms. What are some atypical features that would indicate bone marrow biopsy?

Lymphadenopathy
Hepatosplenomegaly
Bone or joint pain
Fever
Weight loss
Neutropenia
Leucocytosis
Blasts on blood film
Insufficient response to treatment with steroids

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Most cases of ITP can be managed with a watch and wait approach if no bleeding or mild cutaneous bleeding. If there is more serious bleeding, what are the treatment options?

IV Immunoglobulin

Steroids

?Platelet transfusions but these are destroyed quickly by antibodies

Splenectomy

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When does ITP tend to resolve, and give 2 pieces of lifestyle advice whilst the illness is still ongoing:

Resolves within 6 months for 80% of children

Avoid contact sports

Avoid antiplatelet medications e.g. aspirin, ibuprofen

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Complications of malignant bone tumours:

Pathological bone fracture

Metastasis

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A boy with suspected malignant bone cancer has an x-ray that comes back clear. He has symptoms such as nocturnal pain, anorexia, anaemia and a pathological fracture. What is the next best step?

Urgent MRI - high clinical suspicion.

XR can sometimes miss lesions

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X-ray appearance of osteosarcoma:

Codman’s triangle due to periosteal elevation

Sunburst pattern

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X-ray appearance of Ewing’s sarcoma:

Onion skin

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Criteria used to diagnose rheumatic fever, and which organism is associated?

Jones criteria

Group A Streptococcus / strep pyogenes e.g.

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Major and minor criteria for rheumatic fever:

Major:
Carditis
Polyarthritis
Subcutaneous nodules
Chorea
Erythema marginatum

Minor:
Joint pain
Fever
Raised ESR/CRP
Prolonged PR interval

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Treatment of rheumatic fever:

Suspicion of GAS infections e.g. tonsillitis, 10 days Penicillin V

Carditis: aspirin, steroids
Fever: paracetamol
Joint pain: NSAIDs

Prophylactic IM penicillin into adulthood

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Most common valve pathology that can occur as a complication of rheumatic fever:

Mitral stenosis

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Dry power / breath-attenuated inhalers are difficult for children to use as they require coordinated to take a deep breath as they press. What is an alternative, and at what age can a breath-attenuated inhaler be considered?

MDI = easier for children, but must be given with a spacer.

Children can try a breath-attenuated inhaler from the age of 8 if proper education.

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3 pathophysiological mechanisms in asthma:

Smooth muscle constriction

Oedema of the bronchial walls due to inflammation

Mucous hypersecretion

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6 infective causes of bloody diarrhoea:

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Salmonella
Shigella
Yersinia
Campylobacter
Enterohaemorrhagic E.coli
C.Diff

Risk factors for IBD:

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HLA-B27 positive

FHx IBD

FHx autoimmunity, especially seronegative e.g psoriasis, psoriatic arthritis, acute uveitis, ankylosing spondylitis

Parental smoking (Crohn’s)

3 clinical features of PDA before repair:

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Pansystolic / machinery murmur

Loudest at subclavicular area

Pulmonary oedema

Bounding femoral pulses

Where is the abnormal connection in PDA, and what how does it normally close?

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Descending aorta and pulmonary trunk.

Usually closes when infant takes first breath, as this increases pulmonary flow and prostaglandin clearance.

3 risk factors for PDA:

Pre-term birth Born at high altitude Maternal rubella infection in first trimester

Management of PDA depends on whether the infant is pre-term, term and if there is another congenital heart defect present. Describe management in a PRE-TERM infant.

Watch and wait for 1 week to see if they can become not vent-dependent or have haemodynamic sequelae of the PDA. Then, medical closure e.g. Paracetamol, Indomethacin, Ibuprofen = prostaglandin inhibitors.

Management of PDA depends on whether the infant is pre-term, term and if there is another congenital heart defect present. Describe management in a TERM infant.

TRANSCATHETER CLOSURE Indications for closure include: Moderate / large PDA Small but audible PDA Endocarditis

State 3 heart defects that are cyanotic conditions, the most common, and when they are likely to present:

Tetralogy of Fallot - most common, presents 1-2 months Transposition of the Great Arteries - the more likely one to present as a neonate. Tricuspid Atresia

Give 5 acyanotic heart lesions, and indicate the most common.

VSD most common, 30% ASD PDA Coarctation of the aorta Aortic valve stenosis

Complications of not correcting a PDA:

Reduced systemic blood flow, leading to increased risk of hypotension and therefore NEC and IVH. Increased pulmonary blood flow, leading to pulmonary haemorrhage, pulmonary hypertension, failure to thrive and chronic lung disease.

When do patients receive Haemophilus influenzae B vaccinations, and what condition has this greatly reduced?

Epiglottitis 2,3,4 and 12 months

Differential diagnoses for acute stridor in children:

Epiglottitis Foreign body Anaphylaxis Croup Burns

4 features of Tetralogy of Fallot:

VSD Overriding aorta RV hypertrophy Right ventricular outflow obstruction (pulmonary stenosis)

Which of the classical 4 features in TOF determines the degree of cyanosis and clinical severity? A 'boot shaped heart' is seen on CXR.

Right ventricular outflow obstruction e.g. pulmonary stenosis Results in an end-systolic murmur

'Tet spells' refer to episodes of hypercyanosis due to near total occlusion of RV outflow tract. Give 2 sympoms of a tet spell, 3 precipitating features and positional management.

Cyanosis Tachypnoea Sometimes LOC Fever, pain, upset Knee-chest position to reduce systemic venous return and increase systemic vascular resistance

Feeding strategy for a baby with bronchiolitis?

Reduce volume Increase frequency

3 common non-surgical causes of vomiting in infancy?

Reflux Possetting Overfeeding

Most common causes of bilious vomiting in infancy (6).

Malrotation volvulus Biliary / duodenal atresia Hirschprung's Meconium Ileus NEC *See bilious vomiting on passmed*

Congenital diaphragmatic hernias are rare, but can be seen, 85% being left sided and posterolateral. Can be identified on a CXR where the NG tube is in the stomach above the diaphragm. What is mortality from this condition predominantly dependent on?

Pulmonary hypoplasia Thought to be due to the compression of the lung, leading to hypoxia and pulmonary hypertension. 50% of patients die

In a supracondylar fracture, which nerve is most commonly affected during the injury, and which as a result of the corrective operation?

Injury - anterior interosseous nerve Surgical repair - ulnar nerve

Loss of the red reflex in a child can be due to ... (give 2 conditions):

Congenital cataract Retinoblastoma (bad!)

What is an important and sight-threatening complications of a squint / strabismus?

Abmlyopia - brain stops processing information from one eye so can cause permanent visual impairment in that eye over time.

Most common complication of measles:

Otitis media

Describe the classic development of a prodrome and measles rash, and what test can confirm the diagnosis:

Prodrome: irritable, conjunctivitis, fever, Koplik spots Rash starts behind the ears and then spreads to whole body. Incubation period is 10-14 days. Saliva IgM can be tested for.

Presentation of septic arthritis in a child:

Systemically unwell, may have another site of infection e.g. chickenpox cellulitis, pharyngitis, meningitis. Pyrexia >38..5 ESR >40 WCC >12 Extremely painful joint Pseudoparalysis / unable to weight bear

Discuss measles exposure in pregnancy.

Can cause increased risk of intrauterine death and pre-term birth. Not associated with congenital infection or abnormalities. Most women are immune, so can offer IgM to women who are likely to be susceptible, based on age, history, and/or measles IgG antibody screening.

A boy presents with testicular pain of gradual onset over the last 2-3 days. On transillumination there is a 'blue dot'. What is the likely diagnosis?

Torted hydatid of Morgagni

What is Prehn's sign?

Elevation of the testes relieves pain - points towards epididymitis. Relief does NOT occur in testicular torsion.

What is the metabolic abnormality associated with pyloric stenosis?

Hypochloraemia, hypokalaemia metabolic alkalosis. There is partial respiratory compensation usually, and renal loss of potassium, preserving as many H+ as possible.

Definitive surgical treatment for pyloric stenosis?

Ramstedt pyloromyotomy

PAEDS 1 Flashcards

(50 cards)