Corrections Flashcards
Gastroschisis vs omphalocele?
Gastroschisis - defect lateral to the umbilicus
Omphalocele - defect in the umbilicus itself
Mx of exomphalos?
gradual repair to prevent respiratory complications (staged closure starting immediately with completion at 6-12m)
Mx of gastroschisis?
urgent correction
What can increase the risk of 2ary bacterial infections in chickenpox?
NSAIDs
2ary bacterial infections in chickenpox?
- commonly may manifest as a single infected lesion/small area of cellulitis
- in a small number of patients invasive group A streptococcal soft tissue infections may occur resulting in necrotising fasciitis
What bacteria can cause 2ary nec. fash. in chickenpox?
group A streptococci (strep. pyogenes)
What childhood infection has the following prodrome:
- conjunctivitis
- irritability
- fever
Measles
When should you refer for surgical repair of an umbilical hernia?
If small & asymptomatic –> 4-5 y/o
If large or symptomatic –> 2-3 y/o
When should CPR be started in paeds?
HR <60pm
Compression rate in paeds?
15:2
When can a child with scarlet fever return to school?
24h after starting abx
When can a child with impetigo return to school?
a) 48h after starting abx
or
b) all lesions are healed/crusted
When will most children with non-IgE-mediated cow’s milk protein allergy be milk tolerant?
At 3 y/o
What test is used to screen newborns for hearing problems?
Otoacoustic emission test
What is the most common childhood leukaemia?
ALL
What movement is limited in SUFE?
Reduced internal rotation in flexion
What is the investigation of choice for intussusception?
US
1st line mx of scarlet fever?
Oral phenoxymethylpenicillin
What group of conditions exhibit genetic anticipation?
Trinucleotide repeat disorders e.g. Huntington’s disease, myotonic dystrophy
What is the repeat sequence in myotonic dystrophy?
CTG repeat sequence
Definitive mx option for intestinal malrotation w/ volvulus?
Ladd’s procedure (includes division of Ladd bands and widening of the base of the mesentery)
1st line mx of viral induced wheeze?
SABA
2nd line mx of viral induced wheeze?
Oral montelukast or ICS
How long should patients with whooping cough be excluded from school?
48h after starting abx
or
21 days from onest of symptoms if no abx
At what age would the average child start to smile?
6 weks
At what age would you expect the symptoms of infantile colic to resolve completely?
Around 6m of age
Does hand foot and mouth disease require exclusion from a childcare setting or school?
No
What test is involved in the Newborn Hearing Screening Programme (i.e. ALL newborns have it)?
Otoacoustic emission test
What test can be done next if the otoacoustic emission test is abnormal?
Auditory brainstem response test
What hearing test is done at school entry in most areas of the UK?
Pure tone audiometry
What is the most common cause of childhood hypothyroidism in the United Kingdom?
Autoimmune thyroiditis AKA Hashimoto’s
What murmur is heard in Ebstein’s anomaly?
Tricuspid regurg –> causes a pansystolic murmur
Tricuspid stenosis –> causes a mid-diastolic murmur
Why can females with Turner’s syndrome develop X-linked recessive disorders (When these are normally seen in men)?
As patients with Turner’s syndrome only have one X chromosome
Where does the rash in measles typically start?
Behind the ears
How many episodes of vomiting in children is indicative for a CT head?
≥3 more discrete episodes
What is the gold standard investigation for diagnosis of intussusception?
Abdo US
Mx of intestinal malrotation with volvulus?
Ladd’s procedure (includes division of Ladd bands and widening of the base of the mesentery)
When is a bone marrow biopsy indicated in ITP?
only required if there are atypical features e.g.
1) lymph node enlargement/splenomegaly, high/low white cells
2) failure to resolve/respond to treatment
What investigation is indicated in Perthe’s disease (after xrays)?
MRI scan
When do all breech babies require an USS?
All breech babies at or after 36w gestation require an US scan of both hips at 6w
What is used for definitive diagnosis of DMD?
Genetic analysis
Mx of mycoplasma pneumoniae in paeds?
Macrolide e.g. Erythromycin
Mx of infants <30d old with suspected ophthalmia neonatorum?
Refer for same day assessment
Head size in prader willi?
Macrocephaly
At what age is an urgent specialist assessment is therefore indicated for a child with an acute limp?
<3 y/o
NICE guidance states transient synovitis is rare in this age group and septic arthritis more common
At what age should a child respond to their own name?
9-12m
Mx of whooping cough?
azithromycin or clarithromycin if the onset of cough is within the previous 21 days
At what age would the average child start to play alongside, but not interacting with, other children?
2y
Chest compression technique in:
a) infants <1 y/o
b) children >1 y/o
a) two thumb encircling technique
b) 1 hand compressing lower half of sternum
What is seen on a newborn heelprick test in CF?
Raised immunoreactive trypsinogen (IRT) result –> get a sweat test
How can a missed DDH present in older children?
1) Trendlenberg gait
2) Leg length discrepancy
In what genetic condition can a child have learning difficulties and macrocephaly?
Fragile X syndrome
In what genetic condition can a child have a webbed neck and pectus excavatum?
Noonan syndrome
In what genetic condition can a child have small eyes & polydactyly?
Patau syndrome
Features suggestive of hypernatraemic dehydration?
1) jittery movements
2) increased muscle tone
3) hyperreflexia
4) convulsions
5) drowsiness or coma
Where are the appropriate places to check for a pulse in paediatric BLS?
Brachial or femoral
What is the most approriate method to ascertain obesity in children?
BMI adjusted to age and gender
Role of lumacaftor/Ivacaftor (Orkambi) in treatment of CF?
These are CFTR modulators.
There are two main types of CFTR modulators approved for clinical use: potentiators (ivacaftor) and correctors (lumacaftor), which are used together.
Potentiators increase the amount of time that the CFTR channel is open whilst correctors help the CFTR protein form so that it can move to the cell surface.
By addressing the underlying CFTR defects, lumacaftor/ivacaftor can help reduce the severity of symptoms and improve lung function.
What is typically heard on auscultation in TGA?
TGA presents with no murmur but typically a loud single S2 is audible and a prominent right ventricular impulse is palpable on examination.
At what age would the average child start to say ‘mama’ and ‘dada’?
9-10m
How long after birth is passage of meconium a red flag?
> 48h
At what age does Perthe’s disease require only obesrvation?
<6 y/o
School exclusion in scarlet fever?
24h after starting abx
School exclusion in rubella?
5 days from onset of rash
Describe rash seen in rubella
Erythematous, maculopapular rash that starts on face or behind ears and spread to the neck and body.
How long after contracting rubella does the rash take to appear?
2-3w
School exclusion in hand foot & mouth?
None
What may infants with pertussis present with instead of the classic whoop?
Apnoeas
In what congenital syndrome is supravalvular stenosis seen?
William’s syndrome
At what age should children combine 2 words?
2 years
At what age should children ask ‘what’ and ‘who’ questions?
3y
At what age should children ask ‘why’, ‘when’ and ‘how’ questions?
4y
What is the purpose of testing anti-mullerian hormone (AMH)?
can be measured to indicate ovarian function and fertility (corresponds to egg count)
AMH levels in Turner’s?
Low
What is the most likely cause of bacterial pneumoniae in children?
Strep. pneumoniae
Are children with Down’s syndrome prone to snoring?
Yes
This is due to the low muscle tone in the upper airways and large tongue/adenoids.
There is also an increased risk of obesity which in people with Down’s syndrome which is another predisposing factor to snoring.
Mx of neonatal hypoglycaemia if they are symptomatic?
Admit to NICU for IV 10% dextrose
1st line mx of intussusception?
Air insufflation
Compression & ventilation rate in newborns?
3:1
What triad of features is seen in Pierre Robin syndrome?
1) micrognathia (undersized jaw)
2) posterior displacement of tongue
3) cleft palate
Why should babies with Pierre Robin syndrome be placed prone?
Due to posterior displacement of tongue –> risk of upper airway obstruction
Can those under 18 refuse treatment?
No
Those over 16 can CONSENT to treatment but cannot refuse treatment under 18.
What is the average age of diagnosis of retinoblastoma?
18m
Inheritance of retinoblastoma?
Autosomal dominant
What is the most common presenting symptom of retinoblastoma?
absence of red-reflex, replaced by a white pupil (leukocoria)
other features:
- strabismus
- visual problems
Prognosis of retinoblastoma?
excellent, with > 90% surviving into adulthood
Mx options in retinoblastoma?
1) enucleation
2) external beam radiation therapy, chemotherapy and photocoagulation
What are the 3 most common fractures associated with child abuse?
1) radial
2) humeral
3) femoral
What age does infantile colic typically affect?
<3m
1st line mx of bruising in a non-mobile infant?
Refer for same day paeds assessment
Definitive mx of SUFE?
In situ fixation with a cannulated screw
What is the most appropriate method to confirm a diagnosis of pertussis?
Per nasal swab
In what syndrome can you see polydactyly?
Patau syndrome (trisomy 13)
XR finding in rickets?
Joint widening
When is bow legs in a child a normal variant?
<3 y/o
Usually resolves by the age of 4
At what age should children with a limp be referred for an urgent paeds assessment?
<3 y/o
What is trident hand deformity a feature of?
Achondroplasia
