Paeds Flashcards
(151 cards)
1
Q
31 w, PROM, vag delivery, no meconium, resp distress, ventilated, CXR ground glass appearance - Dx?
A
surfactant deficiency
2
Q
37w, elective csec for PET, no meconium, mild resp distress @ 12h, CXR fluid in horizontal fissure - Dx?
A
TTN
3
Q
37w, PROM at 35w, spontaneous labour @37w, normal vaginal delivery, increasing resp distress day3 - Dx?
A
neonatal pneumonia
4
Q
correct position of ET tube
A
2cm above carina, level D2/3
5
Q
where does air collect in neonatal pneumothorax
A
anteriorly! bcos CXR is taken supine
6
Q
no. of umbilical veins in baby
A
1
7
Q
correct position of umbilical vein catheter
A
at or just below R hemidiaphragm
8
Q
no. of umbilical arteries in baby
A
2
9
Q
correct position of umbilical artery catheter
A
low tip - lower lumbar (L3/4, below renal arteries)
high tip - between D6-10
10
Q
cause of bronchioitis
A
RSV
11
Q
orienation of inhaled foreign body in oesophagus
A
coronal
12
Q
orientation of inhaled foreign body in trachea
A
sagittal
13
Q
Ix of UTI in child <6m
A
- USS (in acute phase)
then 4-6m later if atypical UTI or recurrent UTI do…
- VCUG
- renogram
14
Q
Ix of UTI in child 6m-3y
A
no imaging if uncomplicated UTI
then 4-6m later if atypical UTI or recurrent UTI do…
- USS + renogram
15
Q
Ix of UTI in child > 3y
A
no imaging if uncomplicated UTI
then 4-6m later if recurrent UTI do…
- USS + renogram
16
Q
stepping reflex
A
up to 6w then reappear 8m-1y
baby steps legs when put near ground
17
Q
moro reflex
A
up to 2m
when baby is startled they throw arms up, clench fists and cry
18
Q
sucking reflex
A
baby begins to suck when anything touches the roof of its mouth
19
Q
rooting reflex
A
assists with breast feeding - stroking the corner of baby’s mouth they open it and move towards the direction of the stroke
20
Q
palmar grasp reflex
A
up to 5-6m
21
Q
components of APGAR score
A
Appearance Pulse Grimace Activity Resp Effort
22
Q
no. of umbilical veins in fetus and what does it carry
A
1 umbilical vein
carrys oxygenated blood from placenta to fetus
23
Q
no. of umbilical arteries in fetus anad what does it carry
A
2 umbilical arteries
carries mixed blood from fetus to placenta
24
Q
ductus venosus role
A
shunts oxygenated blood away from the liver to the IVC
25
ductus arteriosus role
shunts blood from pulmonary artery through into aorta so that blood bypasses fetal lungs
26
foramen ovale role
R - L shunt
| blood to pass through RA to LA
27
caput succanedum - timing
straight after birth
28
caput succanedum presentation
oedema swelling of the head
| crosses suture lines
29
caput succanedum causes
ventouse deliveries
| mechanical trauma
30
caput succanedum - how long to resolve
a few days
31
cephalohaematoma presentation
swelling of head due to bleed between periosteum and skull
32
cephalohaematoma timing
a few hr after birth
33
cephalohaematoma causes
prolonged deliveries
34
cephalohaematoma - how long to resolve
a few mths
35
causes of cyanosis in newborn
cardiac causes -
- tricuspid atresia
- transposition of the great arteries
- tetralogy of fallot
non-cardiac causes -
- RDS
- TTHN
- tracheo-oesophageal fistula
- pleural effusion
- pneumothorax
36
test for distinguishing between causes of cyanosis in newborn
nitrogen wash-out test
- give 100% O2 to baby for 15 mins
- pO2 of <15kPa = cyanotic congenital heart disease
37
causes of neonatal jaundice 2-14d
usually physiological
- due to increased bili production due to shorter RBC lifespan
- reduced conjugation by the liver due to hepatic immaturity
38
causes of prolonged neonatal jaundice
usually pathological
- hypothyroidism
- galactosaemia
- biliary atresia
- UTI
- breast milk jaundice
- congenital infection
39
Mx neonatal jaundice
phototherapy +/- exchange transfusion
40
kernicterus
acute bilirubin encephalopathy
- consequence of untreated neonatal jaundice
- presentation - hypotonia, shrill cry
- reduced IQ, deafness (long term)
41
RF for haemorrhagic disease of the newborn
maternal use of epileptics
| breast feeding
42
prevention of haemorrhagic disease of the newborn
Im or Oral vit K at birht (offered to all babies)
43
what group of babies is meconium aspiration syndrome more common in
post-term deliveries
44
calculation for corrected gestational age
(no. of weeks old) - (term(40)-gestational age)
45
1st line for neonatal sepsis
IV benzylbenicillin + gentamicin
46
2nd line for neonatal sepsis
IV flucloxacillin + gentamicin
47
3rd line for neonatal sepsis
IV vancomycin + gentamicin
48
Mx apnoea of prematurity
caffeine citrate
ventilation
- also find cause
49
Mx retinopathy of prematurity
laser diode therapy
50
neonate born v agitated - what has mum taken during pregnancy -
alcohol
51
neonate born v quiet and inactive - what has mum taken during pregnancy
opiates
52
diabetic mother - most likely complication in baby
neonatal hypoglycaemia
53
cause of croup
parainfluenza
54
Mx croup
severe croup - O2 and nebulised adrenaline 5ml of 1:1000
55
cause epiglottitis
haemophilus influenze B
56
Mx epiglottitis
```
give O2 via mask until anaesthetist arrives
nasopharyngeal intubation
nebulised adrenaline
IV dexamethasone
IV cefotaxime
```
57
cause whooping cough
bordatella pertussis
58
Mx whooping cough
usually self resolves in around 8w
59
Dx asthma children 5-16y
spirometry and bronchodilator reversibillity test
60
Dx asthma children <5y
clinical Dx
61
Mx asthma children 5-16y
1. SABA
2. SABA + paed low dose ICS
3. SABA + paed low dose ICS + LTRA
4. SABA + paed low dose ICS + LABA +/- LTRA (stop it if no response)
5. SABA + MART (has LABA + ICS in one)
6. SABA + moderate dose MART
7. SABA + any of:
- add theophylline
- high dose ICS
- refer to specialist
62
Mx asthma children <5y
1. SABA
2. SABA + 8w trial of mod dose ICS
- if symptoms not resolved - alt diagnosis
- if symtpoms resolved & return <4 w - start low-dose maintenance ICS
- if symptoms resolved & return >4 - redo trial
3. SABA + low dose paed ICS + LTRA
4. Stop LTRA and refer
63
Mx acute asthma attack children
B2 agonist via spacer - 1 puff every 30-60 secs for 10 puffs
- can repeat if not controlled
+
Steroids - 3-5d course
64
cause bronchiolitis
RSV
65
Mx bronchiolitis
Supportive
- O2 by head box if sats <92%
- NG tube if poor oral intake/not drinking
- suction if excess upper airway secretions
66
causes of neonatal jaundice 1st 24h
always pathological
- G6PD deficiency
- hereditary spherocytosis
- rhesus haemolytic disease
- ABO haemolytic disease
67
9 month old baby with striodr, better with crying - Dx and Ix?
Laryngomalacia
Ix - flexible laryngoscopy
68
heart disease associated with Trisomy 21
VSD, AVSD
69
Trisomy 18
Edward's syndrome
70
heart disease associated with Trisomy 18
VSD, DORV
71
Trisomy 13
Patau syndrome m
72
heart disease associated with Trisomy 13
VSD, DORV
73
heart disease associated with Turner's syndrome
Coarctation of the aorta
74
heart disease associated with DiGeorge Syndrome
Truncus arteriosus
Tetralogy of Fallot
Interrupted Aortic Arch
75
innocent murmur presentation
always systolic
| gets more prominent when high CO - fever
76
acyanotic congenital HD
VSD, ASD, AVS, PDA, coarctation of the aorta
77
cyanotic congenital HD
Tetralogy of Fallot
| Transposition of the Great Arteries
78
what is the problem in systemic duct-dependent lesions (congenital HD)
Obstruction of blood out of the left side of the heart
79
examples of systemic duct-dependent lesions in congenital HD
Hypoplastic Left Heart Syndrome
Critical Aortic Stenosis
Interrupted Aortic Arch
80
what is the problem in cyanotic duct-dependent lesions (congenital HD)
Obstruction to pulmonary blood flow OR lack of oxygenation of systemic blood
81
ASD pathology
hole connecting atria
L - R shunt
blood still gets to lungs for oxygenation
82
ASD presentation
asymptomatic until adulthood
splitting of S2
ejection systolic murmur
83
presentation VSD
pansystolic murmur, lower left sternal edge
84
pathology of PDA
PDA usually closes within the first few weeks of life.
| There is a L-R shunt because the pressure in the left side of the heart has increased.
85
presentation PDA
```
continuous machinery murmur
crescendo-descrescendo
poor wt gain
SOB difficulty feeding
LTRI
```
86
Presentation of Tetralogy of Fallot
cyanosis
SOB on feeding /crying/exertion
Failure to thrive
87
"Tet Spells"
occurs when there is increased venous return to the heart
- sudden onset SOB
- triggered by slight decrease in O2 conc
- toddler squats to decrease venous return to heart and increase blpood O2
88
presentation coarctation of aorta
```
weak femoral pulses
grey and floppy baby
hepatosplenomegaly
tachypnoea
poor feeding
```
89
Ix coarctation of aorta
pre-ductal & post-ductal pressures (upper body HTN, lower body hypotension)
90
Mx coarctation of aorta
Iv prostaglandin - keep PDA open until surgery
91
pathology of transposiition of the great arteries
aorta arises from R ventricle - delivers unoxygenated blood to body
pulmonary artery arises from L ventricle - delivers oxygenated blood back to lungs
92
Mx transposiition of the great arteries
Iv prostaglandins - keep PDA open until surgery
93
pathology hypoplastic left heart syndrome
hypoplastic left ventricle, ascending aorta and aortic arch
94
Mx hypoplastic left heart syndrome
IV prostaglandins - to keep PDA open until surgery
95
presentation orofacial granulomatosis
lip swelling
facial rash
no Crohn's features
96
inheritance of peutz jegher's syndrome
AD
97
presentation of GORD in baby
incessant crying
back arching
vomiting
red colour change
98
Mx GORD in baby
1. Gaviscon
| 2. + Ranitidine
99
presentation tracheo-oesophageal fistula
cough
aspiration pneumonia
choking
cyanosis on feeding
100
presentation oesophageal atresia
unable to swallow own saliva
gastric distension
cyanosis
unable to pass NG tube
101
presentation choanal atresia
difficulty breathing
| unable to nurse and breathe at same time - more pronounced when feeding
102
Ix coeliac in a child
can Dx by blood tests only if: clinical symptoms + tTG >10x upper limit of normal
Gold-standard: endoscopy + duodenal biopsy
103
vomiting green bile
malrotation
104
Ix malrotation
upper GI contrast enema
105
presentation biliary atresia
symptoms of cholestasis
- pale stools
- dark urine
- jaundice
106
Mx biliary atresia
Kasai operation - connect liver to small intestine
107
presentation of toddler's diarrhoea
up to 10 stools x day
undigested food in stool
otherwise well and thriving
108
Ix pyloric stenosis
abdo US
109
ABG in pyloric stenosis
hypochloraemia hypokalaemic metabolic alkalosis
110
Mx constipation in child
1. Magrocol (laxido) - a softener
+/- Senna (stimulant) - DON't give if stools hard
111
Ix intussception
abdo USS
112
presentation NEC
abdo distension
blod/mucus PR
tenderness
shock
113
Ix NEC
plain abdo xray - shows portal venous gas
114
Mx NEC
supportive - gastric aspiration, NBM
115
presentation meconium ileus
not wanting to feed
not passing bowels
fullish stomach
116
Ix meconium ileus
contrast enema (will show loops of bowel that are impacted and parts that haven't been used)
117
Mx meconium ileus
1. rpt contrast enema
| 2. laparotomy
118
Ix Hirschsrungs
rectal biopsy
119
Mx Hirschprungs
remove uninnervated bowel
120
presentation of congenital diaphragmatic hernia
bowel in one hemithorax
| resp distress
121
Ix congenital diaphragmatic hernia
pre-natal: USS
| post-natal: CXR
122
Mx umbilical hernia in baby
can leave alone - will resolve spontaenously by age 4-5
123
Mx inguinal hernia in baby
urgent repair - strangulation risk
124
presentation measles
prodromal illness
Koplick spots - white spots on buccal mucosa
then
maculopapular rash starting behind ears, spreads to whole of body & becomes confluent
125
complications of measles
```
otitis media
pneumonia
encephalitis
keratoconjunctivitis sicca
increased incidence of appendicitis
myocarditis
```
126
presentation mumps
fever, muscular pain, parotitis
127
complications of mumps
orchitis
hearing loss
meningoencephalitis
pancreatitis
128
presentation rubella
prodromal illness
rash starting on face then spread to whole of body
lymphadenopathy
129
cause of scarlet fever
reaction to toxins produced by Group A strep
130
presentation scarlet fever
```
fever, malaise, N+v, headache
strawberry tongue
rash
- sandpaper texture
- torso first, spares palms and soles
```
131
Ix scarlet fever
throat swab
132
Mx scarlet fever + when kid can go back to school
oral pen V for 10d
can go back 24h after starting Abx
133
complications scarlet fever
otitis media
rheumatic fever
glomerulonephritis
134
what is cytolomegalovirus
one of the herpes viruses
135
presentation congenital CMV
```
pinpoint blueberry muffin rash
microcephaly
sensorineural deafness
seizures
hepatosplenomgaly
```
136
mneumonic for kawasaki disease presentation
CRASH & Burn
```
C - conjunctivitis
R - rash
A - adenopathy
S - strawberry tonue
H - hands & feet - burning and peeling
```
137
Mx kawasaki disease
high dose aspirin
| IVIG
138
What is HSP
IgA vasculitis
139
cause of HSP
triggered by infection (e.g. tonsilitis or gastroenteritis)
140
presentation HSP
4 classic features
1. abdo pain
2. joint pain
3. purpura
4. renal involement (IgA nephritis)
141
hypospadius
urethral meatus located ventally on undersurface of penis
142
renal agenesis presentation
oligohydramnios
| Potter's facies
143
when is undescended testis considered congenital
if testis not descended by 3m
144
Mx cryptorchidism
orchidopexy (6-18m)
orchidectomy - if presents in teenage y
145
Mx nocturnal enuresis
1. Reward systems
2. Enuresis alarams (<7y)
2. Desmospression (>7y)
146
what is horseshoe kidneys
fusion of the lower poles of the kidneys
147
presentation wilm's nephroblastoma
- abdo pain - most common
painless haematuria
flank pain
anorexia
148
Mx phimosis
Can leave alone - most resolve by 2y
149
presentation juvenile polyp
rectal bleeding
| prolapsing cherry red mass post defecation
150
Ix always needed in Kawasaki disease & why
Echo
| - can get coronary artery aneurysms
151
meconium ileus associated with what condition
cystic fibrosis
