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Phase 3a > Paeds cardio and resp > Flashcards

Paeds cardio and resp Flashcards

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1
Q

What are the most common pathogens associated with infective endocarditis?

A 
Strep viridans (dental stuff)
Staph aureus (central venous catheters)
Enterococcus
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2
Q

What are the symptoms of infective endocarditis?

A

Fever - may be the only feature

+ myocarditis, arthralgia + other B symptoms basically

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3
Q

What are the signs of infective endocarditis?

A 
Pallor
Splinter haemorrhages
Osler's nodes
Janeway lesions
Clubbing
(+ bare others)
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4
Q

How would you diagnose infective endocarditis?

A

Bloods:

  • Raised WCC
  • High ESR / CRP
  • +ve blood cultures

Diagnostic = ECHO to look at valve vegetations

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5
Q

How would you treat a child with infective endocarditis?

A

IV Penicillin / Vancomycin - minimum 6 weeks
Bed rest
Surgery to remove infected prosthetic material

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6
Q

How would you prevent infective endocarditis?

A

Good dental hygiene

Prophylaxis for high risk groups

  • Amoxicillin before dental surgery
    • prophylactic amoxicillin in other surgeries that involve infection
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7
Q

What organism is involved in the pathophysiology of rheumatic fever?

A

Group A beta-haemolytic strep

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8
Q

What are the risk factors for rheumatic fever?

A 
Old people
Living in less well developed countries
Babies
Previous RF
Immunosuppressed / immunocompromised
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9
Q

CASE:

A child presents with non-specific malaise, pain in their knees, a non-itchy rash, bumps on their skin. A few weeks ago they had a sore throat.

Diagnosis?

A

Rheumatic fever

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10
Q

How do you diagnose rheumatic fever?

A

Jones criteria - 2 major features or 1 major + 2 minor + evidence of previous group A strep

Major:
Pancarditis
Polyarthritis
Erythema marginatum
Subcutaneous nodules
Sydenham's chorea
Minor:
Pyrexia
Arthralgia
Abnormal ECG (prolonged PR interval)
Elevated ESR / CRP
Evidence of strep infection
History of rheumatic fever
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11
Q

How do you treat rheumatic fever?

A 
Anti-inflammatory eg aspirin
Corticosteroids
Diuretics / ACE inhibitors for heart failure
Pericardiocentesis
Penicillin V for 10 days
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12
Q

How would you prevent rheumatic fever?

A

Antibiotic prophylaxis

Daily oral penicillin / oral erythromycin

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13
Q

What are the complications of rheumatic fever?

A

Long term valvular problems

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14
Q

At what age do children get Croup?

A

6 months to 6 years

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15
Q

What are the pathogens associated with Croup?

A

Parainfluenza
RSV
Influenza
Human metapneumovirus

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16
Q

What should you not do in a child with croup and why?

A

Examine the throat

Risk of obstruction (narrowing of trachea)

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17
Q

What are the symptoms of croup?

A 
Fever and coryzal symptoms
Barking cough
Harsh stridor
Hoarse voice
Chest recessions
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18
Q

When are the symptoms of croup worse?

A

At night

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19
Q

What condition do you need to exclude in a child presenting with stridor?

A

Epiglottitis

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20
Q

What are the features associated with severe croup?

A 
Frequent barking cough
Prominent stridor at rest - can be expiratory
Marked sternal wall recessions
Significant distress in child
Signs of hypoxaemia
Decreased level of consciousness
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21
Q

How do you treat croup?

A

Singe dose oral dexamethasone 0.15mg/kg

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22
Q

How do you treat croup in a child who is too unwell to take oral medication?

A

Inhaled budesonide 2mg or IM dexamethasone

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23
Q

How would you treat a child who has severe croup?

A

High flow oxygen

Nebulised adrenaline

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24
Q

Which pathogen causes epiglottitis?

A

Hib

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25
How does a child with epiglottitis present?
``` High fever Toxic looking Throat pain stops them from speaking and swallowing, saliva drooling Stridor Sitting upright Open mouth No cough ```
26
How would you investigate a child with suspected epiglottitis?
DONT EXAMINE THE THROAT + take blood cultures once they are stabilised
27
How do you treat a child with epiglottitis?
Stabilise airway - might be tracheostomy | IV cefuroxime 3-5 days
28
How you do prevent epiglottitis in close contacts of an affected child?
Rifampicin
29
What organism causes whooping cough?
Bordatella pertussis
30
What are the clinical stages of whooping cough?
Catarrhal 1-2 weeks Paroxysmal 2-6 weeks Convalescent 2-4 weeks
31
Describe what you'd hear / see in a child with whooping cough
Severe paroxysmal cough followed by inspiratory whoop and vomiting During paroxysm - child goes red or blue, epistaxis, subconjunctival haemorrhages
32
How would you make a diagnosis of whooping cough?
Clinical + per-nasal swab and culture or PCR Blood count - lymphocytosis CXR?
33
When would you treat a child with whooping cough?
If the cough has only just begun and they've been in contact with a child with whooping cough If they are young - close monitoring due to seizures, encephalopathy If history of apnoea, cyanosis or significant paroxysms
34
CASE A child comes to you with a cough, and his mother says that his friend at school has had whooping cough. What would you prescribe?
Erythromycin If they haven't been vaccinated - give them the vaccine
35
What are the common causes of pneumonia in a newborn child?
Group B strep Gram neg enterococci (from mother's genital tract)
36
What are the common pathogens that cause pneumonia in a small child?
RSV + other resp viruses Strep pneumoniae Haemophilus influenzae
37
What are the common pathogens that cause pneumonia in children older than 5?
Mycoplasma pneumoniae Strep pneumoniae Chlamydia pneumoniae
38
CASE A child presents with 4 day history of fever, cough, poor feeding, and is becoming increasingly tired. The parents are worried that the child is struggling to breathe. What would you look for on examination? + What is the diagnosis?
``` Resp rate (tachypnoea) Nasal flaring Chest indrawing Grunting Use of accessory muscles Crackles (end-inspiratory) O2 sats (decreased) Dullness on percussion Breath sounds (decreased, bronchial breathing) ``` LRTI (pneumonia)
39
How do you make a diagnosis of pneumonia?
Clinical + CXR showing consolidation on affected area
40
How would you differentiate between bacterial and viral pneumonia?
FBC (increased WCC in bacterial) CRP (raised in bacterial) ESR (raised in bacterial)
41
How would you treat a child with suspected pneumonia first-line?
Oral amoxicillin
42
How would you treat a child with suspected pneumonia caused by mycoplasma or chlamydia pneumoniae?
Atypical organisms, so macrolide antibiotic - erythromycin or clarithromycin
43
Other than antibiotics, how would you treat a child with pneumonia?
Antipyretics for fever - calpol etc IV fluids if dehydrated Supplemental oxygen if sats low Chest drain if collections
44
At what age do children get bronchiolitis?
1-9 months | Basically under 1 year
45
What are the risk factors for bronchiolitis?
Premature babies who develop bronchopulmonary dysplasia Underlying lung disease eg CF Congenital heart disease
46
What are the common pathogens that cause bronchiolitis?
RSV | + human metapneumovirus, parainfluenza, rhinovirus, adenovirus, influenza
47
CASE A 6 month old child presents with a 1 week history of coryzal illness, with a 2 day history of a dry cough and increasing breathlessness. What is the most likely diagnosis?
Bronchiolitis
48
What are the common symptoms associated with bronchiolitis?
Coryzal symptoms Dry cough Breathlessness
49
What would you find on examination in a child with bronchiolitis?
``` Sharp dry cough Tachypnoea High pitched wheeze Tachycardia Recession - intercostal / subcostal Hyperinflation End-inspiratory crackles Cyanosis / pallor ```
50
How would you treat a child with bronchiolitis?
Supportive!!! Humidified oxygen Fluids CPAP Good hygiene
51
How do you prevent bronchiolitis? | what, when, how
Pavilizumab Monoclonal antibody to RSV To high risk groups IM monthly Starting October for 5 months
52
To which groups of children would you give prophylaxis for bronchiolitis?
Premature Chronic lung disease Congenital heart disease
53
What are the symptoms associated with asthma?
Wheeze Cough Breathlessness Limitation in exercise performance
54
What would you expect to see on examination of a child with asthma?
Barrel shaped chest Hyperinflation Wheeze Prolonged expiration
55
What would you ask about a child's symptom's if you suspect they might have asthma?
Diurnal variation Triggers Interval symptoms between acute exacerbations
56
How would you investigate a child with asthma?
``` Skin prick tests for common allergens CXR to rule out other conditions PEFR: - <80% predicted for height - Diurnal variation - Improved post bronchodilator ``` Spirometry - FEV1/FVC radio <80% predicted
57
What would you expect to see in the PEFR of a child with asthma?
<80% predicted for height Diurnal variation (lower in the morning) Day to day variability Increase of more than 15% post bronchodilator
58
Outline the stepwise management of asthma for children over 5 years of age
``` SABA Add ICS Add Montelukast Add LABA Change LABA + ICS to MART Increase dose of ICS ```
59
How would you manage a child presenting with an acute asthma attack?
``` Oxygen SABA IV hydrocortisone IV salbutamol bolus MgSO4 / salbutamol infusion ```
60
How does a child with viral induced wheeze present?
WHEEZE (duh) + cough, URTI generally (asthma symptoms)
61
At what age do children develop viral induced wheeze?
Over 1 basically (less than that is bronchiolitis)
62
How would you treat a child with viral induced wheeze?
Bronchodilators | Can use oral steroids
63
Which 3 people would you call for a child with acute epiglottitis?
Paediatrician Anaesthetist ENT surgeon
64
What are the differentials for epiglottitis?
Croup | Bacterial tracheitis
65
What is the main differentiating feature between croup / epiglottitis and bacterial tracheitis?
Bacterial tracheitis = thick secretions
66
Which organism causes bacterial tracheitis?
Staph aureus
67
What are the signs of respiratory distress?
``` Nasal flaring Intercostal / subcostal recession Grunting Tracheal tug Use of accessory muscles Purse lip breathing Tachypnoea ```
68
What chromosome is affected in CF?
7
69
What is the inheritance pattern of CF?
Autosomal recessive
70
Which gene is affected in CF?
CFTR
71
The transport of which ion is affected in CF?
Chloride
72
How would CF present in a newborn?
Meconium ileus | On guthrie test
73
What would you look for on the Guthrie test to identify CF?
Immunoreactive trypsinogen
74
How would a baby (post-neonatal period) present with CF?
Prolonged jaundice Recurrent chest infections Failure to thrive Malabsorption - pale, floating stools
75
How would a child present with CF (no longer a baby)?
``` ABPA Diabetes Malabsorption Nasal polyps Sterility in males Portal hypertension / cirrhosis ```
76
Who would be involved in the care of a patient with CF?
``` Doctor Nurse Chest physio School teacher Psychiatrist + support groups (online) ```
77
What organisms should be watched out for in a child with CF?
Aspergillus Pseudomonas aeruginosa Burkholderia cepacia
78
Give examples of how you would manage a child with CF in the long term?
Creon - pancreatic supplements High calorie diet Pick line (for antibiotics if they have a chronic or bad infection) Treatment of anxiety and depression Chest physio Flu vaccine Fluclox prophylaxis against staph aureus when young
79
Which novel drug is being used to treat patients with certain forms of CF?
Lumacaftor (CFTR corrector)

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