General Knowledge Quiz

Pediatric Cardiology

• Congenital Heart Diseases (CHD) affect 8 per 1000 live births.
• Risk factors include genetic predisposition, prenatal exposures (drugs/disease), and chromosomal abnormalities.
• Acyanotic CHD (80% of all CHD) involves left-to-right shunts.
• Common lesions include Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA), and Atrial Septal Defect (ASD).
• Clinical features of left-to-right shunts vary based on shunt size and pressure gradient, often manifesting as poor feeding, recurrent infections, chest wheezes, and growth failure.
• Heart failure is less common in full-term newborns, but can occur in infancy as pulmonary vascular pressure declines.
• Obstructive lesions include aortic coarctation, aortic stenosis, and pulmonary stenosis.

Acyanotic Congenital Heart Diseases (ACHD)

• 80% of all CHD cases.
• Shunts are left-to-right.
• The common lesions include Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA), and Atrial Septal Defect (ASD)
• Clinical Features include signs of high pulmonary blood flow, such as poor feeding, recurrent chest infections, and growth retardation.

Ventricular Septal Defect (VSD)

• A hole in the interventricular septum.
• Blood is shunted from the left ventricle (higher pressure) to the right ventricle (lower pressure).
• Increased pulmonary blood flow often results
• Pulmonary congestive symptoms
• Volume overload from right ventricular, left atrium, and left ventricle.

Atrial Septal Defect (ASD)

• A hole in the interatrial septum.
• Blood is shunted from the left atrium (higher pressure) to the right atrium (lower pressure).
• Increased blood flow to the lungs is common.
• Pulmonary congestive symptoms

Patent Ductus Arteriosus (PDA)

• A persistent connection between the aorta and the pulmonary artery.
• Present in the fetus to allow blood flow but should close after birth.
• Blood shunts from the aorta(higher pressure) to the pulmonary artery(lower pressure).
• May cause increased pulmonary blood flow
• Associated with congenital Rubella syndrome and premature births.
• Typically treated with IV indomethacin during the first week of life.

Atrioventricular septal defect (AVSD)

• Also Endocardial cushion defects, ECD.
• Associated with Down syndrome.
• Usually asymptomatic, and only discovered accidentally if the defect is small.
• Large defects can create symptoms such as dyspnea during feeding and recurrent chest infections, signifying pulmonary congestion.
• Physical examination may reveal tachypnea, dyspnea, tachycardia, and enlarged liver (suggestive of heart failure)

Cyanotic Congenital Heart Disease (CCHD)

• Decreased pulmonary blood flow is the cause of cyanosis.
• The most common cause is Tetralogy of Fallot: This involves pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect (VSD), and overriding aorta.
• Other clinical features include cyanotic clubbing, poor growth, squatting position for relief of dyspnea, and paroxysmal hypercyanotic spells.
• Increased pulmonary blood flow is not a cause of cyanosis in this type.

Investigations

• Chest Xrays
• Echocardiography
• ECG
• Complete Blood Count
• Blood Culture

Heart Failure

• Inability of the heart to pump blood adequately to meet the body's needs.
• Common causes in infancy include congenital heart disease, rheumatic heart disease, myocarditis, infective endocarditis, severe anemia, and nutritional deficiencies (eg. Kwashiorker).
• Infants present with poor feeding, dyspnea, excessive sweating, and poor weight gain, while older children may present with dyspnea on exertion, effort intolerance, and ankle edema.
• Signs include tachycardia, gallop rhythm & weak pulse, cold & sweaty skin, and cardiomegaly.

Acute Rheumatic Fever (ARF)

• Immunologic disease primarily affecting the heart and joints, less frequently involving the central nervous system and skin.
• Risk factors include a history of group A streptococcal pharyngitis (GAS) previously, and develops in children between 5-15 years of age.
• Major criteria for ARF include arthritis, carditis, chorea, and subacute migratory arthritis.
• Minor criteria for ARF include fever, arthralgia, elevated acute phase reactants, evidence of preceding GAS infection.
• Cardiac complications of ARF may lead to mitral stenosis and heart failure.

Infective Endocarditis

• Infection of the endocardium including heart valves and the lining of chambers of heart.
• Most common causes are bacterial infection, fungal infections, and rarer cases from parasites.
• Risk factors include prosthetic heart valves; previous infective endocarditis; congenital heart disease (except ASD), and valve damage from rheumatic heart disease or other causes.
• The organisms most frequently involved are streptococci viridans, staphylococcus aureus, and group D enterococci.

Pediatric Hematological Disease: Anemia

• Anemia is defined as a decrease in hemoglobin and/or RBC count below the average for age and sex.
• Common causes in Pediatrics include decreased intake, decreased absorption, decreased iron stores, Increased loss, and increased requirements.
• Signs & Symptoms in infants include pallor, tachycardia, hemodynamic murmurs, and signs of heart failure in severe cases.
• Common causes are iron deficiency, vitamin deficiency, blood loss leading to Iron Deficiency Anemia, Megaloblastic Anemia, Hemolytic Anemia, and Thalassemia.

Thalassemia

• Autosomal recessive blood disorders impacting the production of alpha or beta globin proteins, leading to abnormal hemoglobin synthesis.
• Common types include alpha thalassemia and beta thalassemia.
• Alpha thalassemia is due to the deletion of one or more alpha globin genes on chromosome 16.
• Beta thalassemia is due to mutations in the beta globin genes on chromosome 11

Iron Deficiency Anemia (IDA)

• The most common cause of anemia in pediatrics, due to decreased intake, absorption, or increased loss.
• Decreased intake is usually due to delayed weaning, low iron content in infant formulas, or insufficient dietary iron.
• Manifestations commonly include pallor, fatigue, and decreased growth rate.
• Elevated blood tests showing hemoglobin below normal is necessary for diagnosis

Megaloblastic Anemia: Vitamin B12 & Folic Acid Deficiency

• Megaloblastic anemia is due to deficiency in Vitamin B12 and Folic Acid.
• These deficiencies lead to abnormal red blood cell production, resulting in larger-than-normal red blood cells (megaloblasts).
• Symptoms of this anemic condition include lethargy and fatigue, as well as a pale, or jaundiced appearance.

Acute Bronchiolitis

• Acute inflammation of the bronchioles (small airways) often caused by a viral infection like RSV.
• Peak incidence is in infants and young children during winter or spring.
• Clinical symptoms primarily involve respiratory distress, which presents as tachypnea, retractions, and/or cyanosis.
• Usually manages with supportive treatments like oxygen therapy and hydration.

Acute Pharyngitis

• Sore Throat, Fever, Red/congested throat, Exudates on inflamed tonsils, swollen tender lymph nodes on front neck area.
• Commonest cause: Group A Beta-hemolytic streptococci
• Management is symptomatic for fever and specific antibiotics dependent on organism sensitivity.

Acute Otitis Media (AOM)

• Infection of the middle ear; characterized by inflammation and fluid build-up behind the eardrum.
• Mostly a viral infection, which can be followed by a bacterial infection.
• Clinical symptoms commonly include fever, ear pain (noted in infants by ear pulling, irritability), earache, and bulging/congested tympanic membrane.
• Management typically involves symptomatic treatment (analgesics ) and antibiotics as needed.

Acute Sinusitis

• Inflammation of the paranasal sinuses
• Commonly seen in context of upper respiratory tract infection.
• Features include fever, Headache, Purulent nasal discharge, post nasal discharge, and/or cough.
• Treatment typically: symptomatic and antibiotics depending on sensitivity

Acute Infectious Stridor (Croup)

• Acute viral infection of the larynx, trachea, bronchi and bronchioles - common in infants and young children during winter and early spring.
• Patients present with inflammation of the upper airways, causing a characteristic barking cough and/or stridor.
• Treatment is usually supportive therapy like oxygen support, humidification & saline nebulizers, oral corticosteroids which will support respiratory distress.

Acute Epiglottitis

• Life-threatening infection of the epiglottis - most prevalent bacterial infection causing inflammation to the epiglottis.
• Very rapid onset, characterized by acute onset of fever, severe sore throat, drooling, dysphagia (difficulty swallowing), stridor, and a preference for an upright position.
• Treatment involves securing the upper airway immediately with intubation/tracheostomy followed by broad-spectrum antibiotics as appropriate.

Pneumonia

• Infection of the lung parenchyma.
• Typically viral or bacterial
• Most infants and young children have viral pneumonia that resolves without complications.
• Bacterial pneumonia is more severe and can sometimes lead to respiratory distress syndrome.
• Symptoms usually include fever, cough, dyspnea, and chest discomfort; and tachypnea and cyanosis may be apparent.

Acute Hemorrhagic Cyst

• Caused by a hemorrhagic lesion, can occur at any age due to varied circumstances.
• Characterized by sudden onset of severe abdominal pain or discomfort or acute deterioration after a specific episode.
• The etiology remains unclear in many cases.
• Management usually involves prompt and appropriate medical care with fluids to relieve pain and discomfort initially

Sickle Cell Disease

• Genetic condition affecting hemoglobin production in red blood cells, leading to abnormal cell shape and reduced oxygen carrying capacity.
• Clinical presentation involves acute (pain crises) and chronic (hemolytic anemia) complications. The clinical picture may range from asymptomatic carriers to severe anemia with varying types and degrees of complications
• Management focuses on preventing crises, treating complications, and managing acute episodes.

Hemophilia A

• Sex-linked recessive bleeding disorder impacting the coagulation cascade (inability of blood to clot normally).
• Deficiency in factor VIIIC.
• Characterized by recurrent mucocutaneous bleeding, hemarthrosis (bleeding in the joints), intramuscular hematomas, and occasionally intracranial bleeding.
• Prophylactic factor VIII replacement is typically used to prevent bleeding episodes.

Tuberculosis (TB)

• Infectious disease caused by Mycobacterium tuberculosis
• Transmission occurs through airborne droplets.
• Clinical disease varies depending on the location of the infection in body.
• Symptoms in infants and children may be unclear or nonspecific, including failure to thrive, poor weight gain, fever and prolonged cough.
• Diagnosis involves a combination of clinical clues and diagnostic tests.

Scarlet Fever

• Bacterial infection caused by group A streptococcus.
• Clinical presentation includes sore throat, fever, and a characteristic diffuse erythematous rash that begins on the chest and spreads to other areas.
• Initial assessment needs rapid diagnosis of GAS.
• Treatment typically involves antibiotic therapy.

Measles

• Acute viral infection that primarily affects the respiratory system, characterized by fever, cough, coryza, conjunctivitis, and a characteristic maculopapular rash that spreads across the body.
• Most are asymptomatic.
• Management typically focuses on supportive care and preventing complications.

Rubella

• Acute viral infection, clinically characterized by a mild fever and mild upper respiratory symptoms and a characteristic maculopapular rash that emerges approximately one week after the initial infection and lasts 2 days.
• Complications include infection of the developing fetus, resulting in fetal abnormalities.

Chicken Pox

• Viral infection causing skin lesions and a distinctive itchy rash.
• Spread through respiratory droplets.
• Symptoms generally include malaise, fever, and a characteristic rash with fluid-filled vesicles.
• Treatment often involves symptomatic care like anti-itching medications and fluid support.

Mumps

• Viral infection primarily affecting the salivary glands.
• Generally characterized by swelling of one or more salivary glands (parotitis), typically in combination with fever and malaise.
• Treatment is typically supportive, focusing on alleviating symptoms.

Acute Sinusitis

• Inflammation of the sinuses, usually secondary to inflammation in the upper respiratory system, characterized by symptoms such as facial pain, nasal congestion, and postnasal drip.
• Associated risk factors often include upper respiratory tract viral infections.

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