Paeds Flashcards
(60 cards)
1
Q
When are heart defects usually picked up?
A
USS at 20weeks –> fetal echo
2
Q
Features of L –> R shunt? Common defects? Causes?
A
Breathless / aSx
VSD, PDA, ASD
Maternal rubella, SLE, DM, Warfarin,
Downs, Edwards, Patau, Turners
3
Q
Features of a R–>L shunt?
Usual cause?
A
Cyanotic blue child
ToF, TGA
4
Q
Most common DDx for well baby with systolic murmur at ULSE? What to rememer?
A
Innocent/physiolog murmur
4Ss (soft, systolic, left Sternal edge, aSx)
5
Q
Well baby w/ loud pan-systolic murmur? Prognosis? What if larger defect? How to judge size? Risks?
A
VSD (louder = smaller) - tend to spont. close Large VSD --> more Sx (SOB, FTT) Judged in relation to aortic valve Surgery 3-6m to prevent PulmHTN. Eisenmenger's
6
Q
Assos. w/ PDA?
Murmur?
Signs?
Mx?
A
Prem.
Continuous murmur beneath L clavicle
Collapsing and bounding pulse
Closure with coil at 1yr
7
Q
Blue, pale, irritable, breathless baby Ddx
A
ToF
TGA
AVSD
8
Q
4 part of ToF?
X-ray?
Mx?
A
Large VSD, overriding aorta, pulm stenosis, RVH
Boot-shaped heart
PGs until surgery at 6m
9
Q
What happens in TGA? Classic presentation? Assos? X-Ray? Mx?
A
Aorta to RV. Pulm artery to LV. Presents day2 when DA closes. VSD, ASD, PDA 'Egg on side' PGs until surgery urgent
10
Q
AVSD pres?
Assos?
A
cyanosis - blue and sob –> HF 2-3weeks
Downs
11
Q
Which medications close PDA?
A
Indomethacin/ibuprofen
12
Q
Murmur in AS?
Murmur in PS?
A
ESM at URSE
ESM at ULSE
13
Q
Coarctation of aorta / hypoplasitc left heart syndrome signs?
A
Collapse at day2
Absent fem pulses
14
Q
3yo brought into A+E; SoB, barking cough, intercostal recession. DDx? Likely? Cause? Usual age? Sx? Mx? If SpO2 low?
A
Croup/asthma/bronchiolitis/pneumonia/URTI/epiglottitis/foreign body Likely CROUP (laryngotracheobronchitis) Parainfluenze 6m - 6y Barking cough, stridor, fever, coryza Dexamethasone 0.15mg/kg High flow 02 and neb adrenaline
15
Q
6mo to GP, 24h of increased work of breathing, coryza, lethargy, and reduced oral intake.
o/e - fine insp crackles, subcost recession, temp37.9, SaO2=92%
1. Dx
2. Cause
3. Mx
4. Prevention
A
- Bronchiolitis
- RSV
- Self-lim. –> o2, fluids
- Palivizumab
16
Q
Child refusing to walk + upset. o/e hip red, tender warm. 1. Rule out what? Usual cause? 2. Ix 3. Mx 4. Ddx
A
- Septic arthritis –> S. aureus
- Joint aspiration + cultures. BC
- IV Abx (fluclox)
- Osteomyelitis, DDH, Perthes, SUFE, NAI, JIA, Transient synovitis
17
Q
Transient synovitis vs SA?
A
Viral, less systemically unwell, no pain at rest. –> normal WCC, CRP, ESR
18
Q
DDH? Signs? Complication?
A
Infant esp preterm
Barlow & ortolani
Asymmetric skin folds
Necrosis of fem head
19
Q
Perthes disease?
Who in?
Presentation?
Ix?
A
Avasc necrosis of fem epiphysis
Boys 5-10y
Insidious limp / hip / knee pain
X-Ray
20
Q
SUFE?
Signs
A
Fat boys 10 - 16. Maybe post minor trauma
Reduced abduction & rotation of hip
21
Q
NAI worried?
A
fractures before walking age. Rpt admissions
22
Q
Pres of JIA?
Usually in?
Need to do?
A
Persistent joint swelling for >6w
F>M
Exclude infection / malig
23
Q
3wo baby. Non-projectile vom after feeding
o/e - poor wt gain, dehydrated, mass in RUQ
1. Diagnosis?
2. Physiology
3. Metabollic abnorm
4. Radiolog fts
5. Mx
A
- Pyloric stenosis
- Hypertrophy of pylorus –>
- hypoCl hypoK, metabol alkalosis
- USS
X-ray - Stop oral feeds, IV fluids, admit –> pyloromyotomy
24
Q
1yo, bile stained vom, crying and drawing in legs to chest
- Diagnosis
- Pathophys
- common site
- o/e
- Comps
- mx
A
- intussusception (obstruction)
- telescoping bowel
- terminal ileum / ileo caecal valve
- sausage mass in abdo, redcurrant jelly stool
- perf, necrosis, peritonitis
- enema –> insufflation. Resect any afected bowel
25
27/40 neonate. RR=60. Recession, grunting, cyanosis
1. Diagnosis
2. Likely cause (in prem)
3. Antenatal prophylaxis
4. CXR
5. Mx
6. Comps
7. C-S, what would dx be?
1. RDS
2. Lack of surfactant
3. steroids
4. Ground glass
5. o2, ventilation, surfactant, supportive
6. pneumothorax, CLD
7. TTN
26
Surfactant prod starts?
20-24/40.
27
Neonatal jaundice normal?
Abnormal?
>24h
Before 2weeks
<24h --> haemolytic
>2weeks --> biliary atresia
28
Stool colour in biliary atresia?
| Other causes of persistent jaundice?
Pale
| Breast milk, UTI, Congenital hypothyroid
29
Comp of neonatal jaundice?
Ix?
Mx?
Kernicterus - encephalopathy
Transcut bilirubin, serum bilirubin
Plot on chart --> phototherapy / exchange transf
30
1. NEC?
2. Who in?
3. Sx?
4. Comp?
5. Mx?
1. Bact infect of ischaemic bowel
2. Prem
3. Vom, poor feeding, distended abdo, bloody stool
4. Shock, perf
5. IV abx, TPN, ITU, surgery
31
```
4yo ill for 4d, fever, coryza, rash, conjunct
o/e T=40.5
1. Dx
2. Pres of rash
3. Infective for how long
4. Sx
5. Ix
6. Mx
7. Comps
```
1. Measles
2. starts behind ears --> face --> trunk (maculopapular
3. 4d before rash - 4d after
4. Koplik, non-prod cough
5. saliva swab - measles IgM / RNA
6. Self lim. PHE!
7. encephalitis, pneumonia, febrile convulsions
32
2yo boy with fever for 5d, rash, swelling of lips and tongue, conjunctivits
o/e - cervical lymphadenopathy, temp 39.2, irritable
1. dx
2. criteria
3. mx
4. comps
1. kawasakis
2. fever >39 for 5d plus 4/5 of (cervical lymph, rash, conjunct, desquamation of hands/feet, inflam lips
3. IV Ig, aspirin
4. aneurysm (ECHO!)
33
1. Downs features?
2. Common defects?
3. LT comps?
1. craniofacioal - epicanthic folds, flat nasal bridge, brusfield spots
2. AVSD, duodenal atresia
3. leukaemia, deaf, AD, epilepsy
34
CHDs picked up?
Fetal USS at 20/40
35
Murmur in PDA?
| Mx?
Constant below L clavicle
| NSAID / coil at 1y
36
Life threatening fts of asthma?
33,92,CHEST
| PEFR<33%. SpO2<92% cyanosis, hypotension, exhaustion, silent chest, tachycardia
37
Acute asthma mx?
```
OSHITME
O2
Salbutamol neb
Hydrocort
Ipratroptium bromide neb
Theophylline
MgSO4
Escalate
```
38
1. Screen for CF?
3. Dx?
2. Chronic bacterial infection?
1. immuoreactive trypsinogen
2. sweat test
3. psudoonas aeruginosa
39
Bronchiolitis
1. age
2. typical organism
3. Sx
4. Ix
5. Mx
1. <2y
2. RSV
3. sob following coryza
4. swab, O2 sats
5. supportive
40
Croup
1. age
2. typical organism
3. Sx
4. Ix
5. Mx
1. 6m to 6y
2. parainfluenza
3. barking cough, stridor, sob, worse at night
4. SpO2, AVOID EXAMINING THROAT
5. Dexamethasone 0.15mg/kg, O2
41
Epiglottitis
1. Age?
2. typical organism
3. Sx
4. Ix
5. Mx
1. 1-6y
2. HIb
3. toxic, high grade fever, stridor, drooling, rapid onset
4. SpO2
5. Intubate under GA --> cultures and abx
42
Whooping cough
1. age
2. typical organism
3. sx
4. ix
5. mx
1. <4m (before first jab)
2. Bordetella pertussis
3. coryza --> paroxysmal cough (lasts up to 6w)
4. Nasal swab
4. erythromycin
43
Septic arthritis
1. usual cause
2. ix
3. mx
1. S. aureus
2. joint aspiration + culture. BC
3. IV abx (fluclox)
44
Hip.
1. infants
2. 4-10
3. teens
1. DDH
2. perthes
3. SUFE
45
1 Rapid onset hip pain?
| 2. Prolonged fever?
Infective
| JIA
46
Causes of limp?
```
Septic arthritis, osteomyelitis
perthes, DDH, SUFE,
JIA
Transient synovitis
Malignancy
NAI
```
47
Ddx of vomiting in baby
```
V - intracranial haemorrhage
I - UTI, gastro, meningitis, otitis nedia
T - NAI
A - coeliac
M - GORD, pyloric stenosis, intussusception, Hirschprungs
I - overfeeding
N - intracranial tumour
D- malrotation
```
48
Pyloric stenosis
1. age
2. classic features
3. blood gas
4. pathology
5. ix
6. mx
1. 3-6w
2. vomiting post feeds, prokectile, hunger, wt loss
3. hypoCl, hypoK, metabol alk
4. hypertrophy. Vom causes loss of HCl, loss of H+ is compensated in kidneys by retaining H+ in exchange for K+
5. USS
6. stabilise with fluids +/- KCl, pyloromyotomy
49
GORD
1. aetiology
2. sx
3. ix
4. mx
1. 40% of infants. Resolves by 1y in 90%
2. recurrent regurg, resp problems, feeding, FTT
3. usually not req. imaging
4. Reassurance, review feeding, i) smaller more freq feeds. ii) Thickened feeds, iii) alginate. iv) PPI
50
Intussusception
1. patholog
2. usual age
3. Sx
4. Signs
5. ix
6. mx
1. telescope
2. <1y
3. paroxysmal colic abdo pain, bilous vom, redcurrant jelly poops
4. shock, sausage mass in RUQ
5. USS - target sign
6. Resus with fluids + NG tube. Insufflation
51
Hirschprungs
1. pathology
2. aetio
3. sx
4. ix
5. mx
6. other cause of failure to pass meconium
1. congen agenesis of colonic ganglion
2. neonatal
3. abdo distension, failure to pass meconium in 48h, rpt vom, PR - tight anal sphicnter
4. AXR, biopsy
5. excision +/- colostomy
6. CF
52
HSP
1. aetio
2. triad
3. natural history
4. mx
5. comps
1. AI IgA small vessel vasculitis. Kids 2-8yo
2. Rash, arthritis, abdo pain
3. URTI 1-3wk ago. Self lim
4. supportive
5. renal --> check U&Es
53
Meningitis
1. cause in neonate
2. mx
3. cause in >3mo
4. mx
1. GBS, Listeria, E. coli
2. Ampicillin + cefotaxime
3. N. meningitidis, S. pneumoniae
4. Ceftriaxone
54
Comps of meningitis
ST - sepsis, shock, DIC, cerebral oedema, subdural effusion, seizure
LT - hearing loss, CN dysfunct, hydrocephalus, Watergouse-Friedrichsen syndrome
55
RFs for subdural effusion in meningitis?
young, rapid onset, high CSF, low WCC
56
Measles
1. spread
2. sx
3. ix
4. mx
5. comps
1. droplet
2. cough, coryza, conjunctivitis, fever, koplik, rash
3. swab
4. supportive + vaccinate contacts
5. encephalitis, pneumonia, febrile convulsions
57
Rubella
1. spread
2. sx
3. ix
4. mx
5. copms
1. droplet
2. low grade fever, maculopap rash, luymphadenopathy ( suboccipital & post auricular)
3.
4. supportive + vaccinate contacts
5. encephalopathy & arthralgia
58
Mumps
1. sx
2. mx
3. comps
1. fever, malaise, parotitis,
2. supportive + vaccinate contacts
3. orchitis, viral mening
59
1. Meckels?
2. sx
3. ix
4. mx
1. True diverticulum
2. GI bleed, pain, obstruction, diarrhoea, vom, diverticulitis
3. Technetium, CT (worm like), stool smear, FBC
4. surgery, iron tablets/transfusion if bleeding
60
Goodpastures
1. aetio
2. sx
3. RFs.
4. leads to..
5. ix
6. mx
1. anti-basement memb T2 hypersensitiviy
2. haemoptysis, haematuria
3. HLA-DR15
4. restrictive lung disease, nephritic kidney disease
5. biopsy of kidney --> inflamed basement memb
6. steroids, immunosuppress, plasmapheresis
