Common Paeds Qs Flashcards
What are breech babies at risk of and how is it investigated/screened for?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
Give at least 4 factors that can point towards child abuse
- story inconsistent with injuries e.g. a twisting fracture but mum says the baby ‘was napping’
- repeated attendances at A&E departments
- delayed presentation
- child with a frightened, withdrawn appearance - ‘frozen watchfulness’
What is the most common heart lesion associated with Duchenne muscular dystrophy?
Dilated cardiomyopathy
Why is a throat examination never performed on a child with epiglottitis?
There is a very high risk of airway obstruction
How is cradle cap, or seborrheic dermatitis managed?
- Baby shampoo
- Baby oil
- Gentle brushing also helps to remove scales
What antibiotics are given for whooping cough (pertussis)
A macrolide: clarithromycin, azithromycin or erythromycin
IF the onset of the cough is within the previous 21 days to eradicate the organism and reduce spread
What are the possible consequences of a missed DDH diagnosis?
child with missed DDH dx may present with a Trendlenberg gait and leg length discrepancy
For patients with Trisomy 21 and that wish to perform sports, what is it important to screen for?
Screen for atlanto-axial instability in people with Down syndrome who participate in sports that may carry an increased risk of neck dislocation (e.g. trampolining, gymnastics, boxing, diving, rugby and horse riding)
Common signs of epiglottitis
shortness of breath, has a muffled voice, and is drooling into a bowl (increased salivation and too swollen to swallow)
What is the difference between MCUG and DMSA?
Micturating cystourethrogram (MCUG) is used to diagnose vesicoureteric reflux itself rather than its complications like renal scarring.
DMSA renal scintigraphy is considered the gold standard for detecting renal parenchymal defects, such as scarring due to vesicoureteric reflux
At what age can hypospadia surgery be performed?
Usually around 12 months of age
Common features of cystic fibrosis that can present in childhood
- Meconium ileus and prolonged jaundice
- Recurrent chest infections
- Malabsorption (steatorrhoea)
- Short stature/delayed puberty
- Nasal polyps
How long is a child with whooping cough excluded from school for?
48 hours after commencement of antibiotics (azithromycin)
What are the features of an atypical UTI?
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms.
What investigation results indicate Rickets disease?
low vitamin D levels
reduced serum calcium - symptoms may results from hypocalcaemia
raised alkaline phosphatase
Predisposing factors of Rickets (4)
- dietary deficiency of calcium
- prolonged breastfeeding
- unsupplemented cow’s milk formula
- lack of sunlight
What are the most common causes of cardiac arrest in paediatric patients?
Respiratory conditions that lead to hypoxia e.g. Bronchiolitis with a history of poor feeding, cough and fever and the patient’s examination findings such as crackles, wheezing and increased respiratory effort.
What are the 3 causes of childhood hypothyroidism?
- Autoimmune thyroiditis
- Post total body irradiation (ALL treatment)
- Iodine deficiency - most common cause in the leading world
What type of hearing test is performed on newborns?
Automated otoacoustic emission testing
What heart condition is associated with William’s syndrome?
supravalvular aortic stenosis
What 2 heart conditions are associated with Turner’s syndrome?
Coarctation of the aorta
Bicuspid aortic valve
How does age influence Phimosis treatment?
- In a child under two, an expectant approach should be taken in case this is physiological phimosis which will resolve in time.
- If the child is over 2 years of age and has recurrent balanoposthitis or urinary tract infection then treatment can be considered.
What is Phimosis?
The foreskin cannot be retracted so the penis appears to have “rings” around it
What is the treatment/management approach to Umbilical hernias?
Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age. If small and asymptomatic perform elective repair at 4-5 years of age.
What age should a child respond to their own name?
9-12 months
What is Benign rolandic epilepsy?
A form of childhood epilepsy that typically occurs between the age of 4 and 12 years.
Seizures occur at night, can cause paraesthesia of the face but can cause some tonic-clonic movements too.
Child is otherwise normal
What is the investigation of choice for reflux nephropathy?
Micturating cystography
What is the difference between onset of Perthes disease and Transient synovitis?
Perthes disease presents with a slow onset of pain in the hip and limp
Transient synovitis presents more acutely with a recent viral illness
What is the name of the prostaglandin given to neonates with transposition of the great arteries to maintain the patent ductus arteriosus?
Alprostadil
What age can a child ask ‘what’ and ‘who’ questions?
3 years
What age should a child ask ‘why’, ‘when’ and ‘how’ questions?
4 years
What type of imaging is used for intususception and pyloric stenosis?
Abdominal ultrasound
What type of imaging is used for Necrotising Enterocolitis?
Abdominal X ray
What is the NICE guidance for a child under 3 years old presenting with a limp?
Urgent specialist assessment (as transient synovitis is rare in this age group and septic arthritis is more common).
What is the most common cause of nephrotic syndrome in children?
Around 80% of cases in children are due to a condition called minimal change glomerulonephritis. The condition generally carries a good prognosis with around 90% of cases responding to high-dose oral steroids
Typical hx of Perthes disease
- Short stature
- Hyperactivity and disruptive behaviour
- Pain on internal rotation of the hip
Management of unilateral undescended testis
referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
Orchiopexy surgery performed around 1 year of age
Management of Bilateral undescended testes
Should be reviewed by a senior paediatrician within 24 hours as the child may need urgent endocrine or genetic investigation
At what age is a hand preference abnormal?
Hand preference before 12 months is abnormal - it could be an indicator of cerebral palsy
Treatment for Immune thrombocytopenia (ITP)
No treatment is usually required for children with petechia/purpura only and no significant bleeding
If significant bleeding:
1. oral/IV corticosteroid
2. IV immunoglobulins
3. platelet transfusions can be used in an emergency (e.g. active bleeding) but are only a temporary measure as they are soon destroyed by the circulating antibodies
What hearing test is done for newborns?
Otoacoustic emission test
What hearing test is done if the Otoacoustic emission test is abnormal?
Auditory Brainstem Response test
Which hearing test is done at school entry age e.g. 3 years old?
Pure tone audiometry
management of recurrent febrile convulsions
benzodiazepine rescue medication may be considered - should only be started on the advice of a specialist (e.g. a paediatrician)
rectal diazepam or buccal midazolam may be used
mx of a baby under 3 months with a UTI
infants less than 3 months old should be referred immediately to a paediatrician
What are the red flags in a child with a fever? (5)
-Moderate or severe chest wall recession
- Does not wake if roused
- Reduced skin turgor
- Mottled or blue appearance
- Grunting
What are the amber signs in a child with a fever/feverish illness? (6)
-Nasal flaring
- Lung crackles on auscultation
- Not responding normally to social cues
- Reduced nappy wetting
- Dry mucous membranes
- Pallor reported by parent or carer
What is Henoch-Schonlein purpura?
IgA small vessel vasculitis with a degree of IgA nephropathy
Blood pressure and urinalysis needs to be monitored to detect progressive renal involvement
Features of HSP
purpuric rash over buttocks and extensor surfaces or arms and legs
abdominal pain
polyarthritis
