Curriculum

Question 1

1) You are the paediatrician assessing an infants growth. Where would you record the measurements of height, weight and head circumference?
2) You have recorded the measurements above. What would indicate a growth problem in the chart?

Answer 1

1) Assessing growth in children record = Growth Chart in Red Book
2) Growth faltering = Crossing Centiles,

Question 2

1) How can you recognise whether the growth pattern is normal in infancy and childhood
2) How can you recognise whether the growth pattern is abnormal in infancy and childhood
3) Name of the puberty staging tool?
4) What instrument helps you assess a boys pubertal development?

5) What may indicate abnormal pubertal development in boys on examination
- Early
- Late

6) What may indicate abnormal pubertal development in girls on examination
- Early
- Late

Answer 2

1 + 2) Look at growth chart, calculate child’s expected height from parent.

3)
Orchidometer

4) Pubertal staging = Tanner Staging

5)
Early puberty (before 8)
- Increase in testes volume

Late puberty (after 15)
In boys: the absence of testicular development (or a testicular volume lower than 4 ml) by age 14 years

6)
Early puberty (before 9)
- Breast Development

Late puberty (after 15)
In girls: the absence of breast development by the age of 13 years, or primary amenorrhoea with normal breast development by the age of 1

Question 3

1) What are the most common causes of precocious puberty in boys
2) What are the most common causes of precocious puberty in girls
3) What are the most common causes of delayed puberty in boys
4) What are the most common causes of delayed puberty in girls
5) Rare Cause delayed puberty in boys hint genetics
6) Rare Cause delayed puberty in girls hint genetics + syndrome

Answer 3

1) Boys precocious puberty = any androgen secreting tumour
• pituitary tumour
• Leydig cell tumour
• CAH

2) Girls precocious puberty
• McCune - Albright syndrome
• CAH (precocious)

3) Boys Delayed Puberty =
•  Constitutional Delay in growth
•  Congenital hypothyroidism
pituitary tumour
•  craniopharyngioma

4) Girls Delayed Puberty
• Constitutional Delay in growth
• Congenital hypothyroidism

5) Hypogonads secondary to Klinefelters

6) Genetics
Turner Syndrome
Androgen insensitivity syndrome
Polycystic ovary syndrome

Question 4

1) 4 Broad causes of abnormally short stature in children
S.H,O,R,T

2) abnormally short stature in children malabsorption?
3) abnormally short stature in children hormonal?
4) abnormally short stature in children social?
5) Causes of abnormally tall stature in children
6) When to refer appropriately

Answer 4

1) abnormally short stature =
• Social, Syndromes 
• Hormonal, 
• Orthopedics,
• Reduced nutrition 
• Treatment for Leukaemia

2) Malnutrition short stature
• Crohns
• Cystic Fibrosis
• Coeliac - IgA TTG

3) Hormonal short stature
• Hypothyroid
• Cushing
• GH deficiency

4) Social causes of short stature
• Neglect
• Abuse

5) Tall Stature
Hormonal
Genetics

Question 5

Advantages of breast feeding

How can overcome common difficulties

Answer 5

Immunity
Asthma Eczema (weak)

Sore Nipples - position change
Mastitis - antibiotics

Insufficient milk - encouragement

Question 6

infant weaning advice

When should solid foods be introduced?

Answer 6

(solid) foods should be introduced at 6 months of age (26 weeks)

Question 7

• Understand fluid and electrolyte requirements of the ill neonate
• Understand fluid and electrolyte requirements of the ill child

Answer 7

Treat suspected or confirmed shock with a rapid intravenous infusion of
20 ml/kg of 0.9% sodium chloride solution

Correction of deficit: deficit in ml = wt (kg) x % dehydrated x 10 (ideally the pre-dehydration weight should be used).
Therefore, a 14 kg child who is 5% dehydrated has a deficit of 14 x 5 x 10 = 700 ml.

Maintenance requirements:
100 ml/kg for the first 10 kg
50 ml/kg for the next 10 kg
20 ml/kg for any weight after 20 kg

Question 8

• Define growth faltering
• Recognize growth faltering
• State the common causes of growth faltering

Answer 8

Weight faltering is defined as weight falling through centile spaces, low weight for height or no catch-up from a low birth weight.

Growth faltering is defined as crossing down through length/height centile(s) as well as weight. A low height centile or height less than expected from parental heights.

Causes
Prenatal
Postnatal
Feeding Problems
Poor Absorption

Question 9

• Recognise obesity

* Assess Obesity

Answer 9

Height and weight should be in light clothing with no shoes

Test urine for protein and glucose

Check blood pressure

Question 10

• Vitamin A deficiency present
• Vitamin A deficiencies treatment
• Vitamin D deficiency present
• Vitamin D deficiency treatment

Answer 10

Vitamin A
Eye and vision, Skin and hair

Management
vitamin A-rich foods - for example, liver, beef, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes and leafy green vegetables

Vitamin D

Management
For a fair-skinned person, it is estimated that around 20-30 minutes of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the UK

Supplements
ergocalciferol or calciferol

Question 11

• Know how to nutritionally support the chronically sick child

Answer 11

richer formulas of milk

check email from diluki

Question 12

Recognise the
common causes of breathlessness

Below 1 year

Up to 3 Years

At any age

Answer 12

Viral Bronchiolitis
-(First 6 months)

CAP
-(Above 2 due to vaccination)

TB
(Any age)

Viral associated wheeze
-(Up to 3 years old)

Asthma
-(to be confirmed)

Cystic Fibrosis
-(Newborn infant - heel prick)

Croup
(6 months to 3 years)
(patient.info)
dexamethasone

Stridor

Question 13

Recognise the common causes of wheeze

In the first 6 months

Up to 3 years

Answer 13

Viral Bronchiolitis
(First 6 months)

Viral associated wheeze
(Up to 3 years old)

Asthma
(to be confirmed)

Question 14

Diagnostic tools for asthma in the school aged child

Significance of readings obtained

Answer 14

Peak Flow Meter
Oxygen Sats
Heart Rate
Resp Rate

Moderate Asthma
PEF>50–75% best or predicted

Acute severe asthma
PEF 33–50% best or predicted

Life-threatening asthma
PEF<33% best or predicted

Question 15

Measure the peak flow rate and instruct the older child in this technique.

Answer 15

Peak Flow Diary

CAPS LOG

Question 16

• Manage asthma in childhood according to the SIGN/British Thoracic Society guidelines.

Moderate

Acute Severe

Life Threatening

Answer 16

MODERATE ASTHMA

1
Treat at home or in surgery and ASSESS RESPONSE TO TREATMENT

2
β2 bronchodilator:
– via spacer (give 4 puffs initially
and give a further 2 puffs every
2 minutes according to response
up to maximum of 10 puffs)

3
If PEF >50–75% predicted/best:
Nebuliser (preferably oxygen driven)
(salbutamol 5 mg)
Give prednisolone 40–50 mg
Continue or increase usual treatment

4
If good response to first treatment
(symptoms improved, respiration and
pulse settling and PEF >50%) continue
or increase usual treatment and
continue prednisolone

ACUTE SEVERE ASTHMA
Consider admission
Oxygen to maintain SpO2 94–98% if
available
β2 bronchodilator:
– nebuliser (preferably oxygen
driven) (salbutamol 5 mg)
– or via spacer (give 4 puffs initially
and give a further 2 puffs every
2 minutes according to response
up to maximum of 10 puffs)
y Prednisolone 40–50 mg or IV
hydrocortisone 100 mg
y If no response in acute severe
asthma: ADMIT

LIFE THREATENING ASTHMA
1
Arrange immediate ADMISSION

2
Oxygen to maintain SpO2 94–98%

3
β2 bronchodilator and ipratropium:
– nebuliser (preferably oxygen
driven) (salbutamol 5 mg and
ipratropium 0.5mg)
– or via spacer (give 4 puffs initially
and give a further 2 puffs every
Two min according to response
up to maximum of 10 puffs)

4
Prednisolone 40–50 mg or IV
hydrocortisone 100 mg immediately

Question 17

• Discuss with parents and children the causes of asthma
• Discuss with parents and children the management
• Discuss with parents and children and prognosis of asthma.

Answer 17

Risk Factors

The management of asthma is based on four principles:

Control symptoms, including nocturnal symptoms and those related to exercise.

Prevent exacerbations and need for rescue medication.

Achieve the best possible lung function (practically, FEV1 and/or PEFR >80% predicted or best).

Minimise side-effects

(Patient info Treatment)
1 SABA
2 add inhaled steroid
3 LABA
4 increase inhaled steroid
5 add oral steroid

Prognosis
Many children will wheeze early in life (about 30% of those aged under 3 years) in response to respiratory tract infections but most appear to grow out of it by the time they go to school

Question 18

• Instruct children and parents how to use an

MDI
Accuhaler
Turbohaler
Spacer

Answer 18

CAPS LOG

Question 19

• Recognise acute stridor
• Recognise chronic stridor
• State the causes of acute stridor
• State the causes of chronic stridor
• When to refer

Answer 19

Acute Stridor
Epiglottitis (Rare - Hib vacc)
Immediate referral

Chronic Stridor
Croup (dexamethasone)
If red flags present immediate referral otherwise managed at home
(tachypnoea, recession, drowsiness, cyanosis)
Treatment
oral dexamethasone

Laryngotracheomalacia
- floppy epiglottis

Question 20

• Describe the causes of LRTI.

* Describe treatment of LRTI.

Answer 20

LRTI lower than larynx

CAUSES
Viral
RSV
Influenza A

Bacterial
Strep Pneumoniae 
H. influenzae
Staph
Mycoplasma (atypical)

TREATMENTS
Antibiotic
Amoxicillin in a child-friendly formulation, should be used first-line

Question 21

• presentation of cystic fibrosis in infancy
• presentation of cystic fibrosis in childhood
• presentation of cystic fibrosis in adolescence
• the principles of therapy of cystic fibrosis

Answer 21

Lung: viscid mucous and respiratory infections
Gut: pancreatic insufficiency, meconium ileus
Sweat glands: increased sweat Cl-

Treatment
Nutritional support
Total energy, pancreatic supplements
Micronutrients (fat soluble vitamins)

Physiotherapy

Mucolytics: rhDNAse, hypertonic saline

Antibiotics
H. influenzae, Staphylococcus aureus
Pseudomonas aeruginosa

Question 22

Understand the transition from fetal to extrauterine circulation
6 points

its impact on the presentation of cardiac disease in infants.

Answer 22

Clearance of fetal lung fluid
Surfactant secretion,
Transition of fetal to neonatal circulation
Decrease in pulmonary vascular resistance Increased pulmonary blood flow
Cortisol Surge

https: //acutecaretesting.org/en/articles/fetaltoneonatal-transition-what-is-normal-and-what-is-not-part-1
https: //acutecaretesting.org/en/articles/fetaltoneonatal-transition-part-2

Cardiovascular problems that lead to cyanosis include congenital heart defects, shock, systemic hypotension or significant anemia that prevents adequate levels of oxygen from being delivered to the body tissues.

Question 23

Recognise the possibility of cyanotic and acyanotic cardiac disease at different ages and know the principles of therapy.

6 cyanotic diseases

Answer 23

Cyanotic Diseases
Right to Left Shunts
1 Tetralogy of Fallot clubbing (MBTS)
2 Eisenmenger
3 Pulmonary Atresia
4 Ebstein
5 Transposition of the great arteries (Prostaglandin, urgent atrial septostomy
The definitive corrective procedure is the arterial switch operation)

aCyanotic Diseases 
Left to Right Shunts
1 ASD
2 VSD
3 PDA

Mixed Shunt
AVSD

Principles of therapy covered in treatment deck

Question 24

Recognise congestive cardiac failure and know principles of initial treatment.

Answer 24

Cold Peripheries
Displaced apex
Dynamic precordium
Hepatomegaly
Tachypnoea (WOB)
Thin 
Sweaty

Yellow Blood Bottle U&E
ACEi

Question 25

``` Be able to identify the clinical signs associated with the common paediatric cardiac abnormalities including 1 ventricular septal defect (VSD), 2 patent ductus arteriosus (PDA), 3 atrial septal defect (ASD), 4 coarctation, 5 pulmonary stenosis, 6 aortic stenosis, 7 Tetralogy of Fallot. ```

Answer 25

1 (pink generally asymptomatic) if severe reduced feeding Pan Systolic at Left Lower Sternal Edge +/- Thrill 2 Diastolic murmur at ULSE 3 normally asymptomatic pink bikini incision (soft systolic ejection murmur ULSE if large defect) 4 radio/radial delay or radio femoral delay Crescendo-decrescendo murmur in the upper left sternal border 5 Pulmonary Stenosis Asymptomatic (Not blue) Ejection systolic murmur at upper left sternal edge 6 Aortic Stenosis Asymptomatic Carotid Thrill Ejection systolic murmur at upper sternal edge 7 Tetralogy of Fallot Loud murmur 3/6 at ULSE

Question 26

Be aware of the common arrhythmias of childhood understand treatment principles.

Answer 26

Atrial ectopics If well, do ECG and 24 hour tape, fax to Bristol If sick, tachycardia etc, urgent transfer Ventricular ectopics Usually resolve Check Na, K, Ca, Mg Complete Heart Block Sick Sinus Syndrome

Question 27

Presentation and management of myocarditis Presentation and management of cardiomyopaty

Answer 27

``` 1 Myocarditis Usually postviral – history? Dilated cardiomyopathy Cardiomegaly Pleural effusions ECG – low voltage ``` 2 Cardiomyopathy May present with collapse Dilated Cardiomyopathy Usually unknown cause Postviral Metabolic ``` Hypertrophied Cardiomyopathy Infiltration Metabolic Non-compaction Genetic HOCM, Noonan ``` ``` Management ECG Urine Dip Bloods Carnitine decreased, CPK Echo ```

Question 28

Know which children are at risk of infective endocarditis, recognise its clinical signs and treat appropriately

Answer 28

Children at Risk Valves, VSD, prosthetic component Usually streptococcus viridans or pyogenes Occasionally staphylococcus aureus, MRSA or CNSA ``` Clinical Signs - History Fever, malaise, chest/abdo, arthralgia New embolic events, Haematuria ``` ``` Clinical Signs - Examination HepatoSplenomegaly, Temperature Roth, Osler, Janeway, splinters murmurs ``` Investigations Blood cultures x6 at different times over 2 days, FBC, CRP, ESR, WBC, Throat Swab Echocardiogram + ECG Treatment 6 weeks IV antibiotics Surgical treatment

Question 29

Know the general principles of medical and surgical therapy used in treating children with cardiovascular disease.

Answer 29

Congenital Heart Defects MBTS Atrial Balloon Septostomy Arterial Switch Patching

Question 30

Recognise the common causes of vomiting in infancy, childhood and adolescence and know how these are initially managed.

Answer 30

``` Gastroenteritis UTI Raised ICP DKA Allergies Alcohol Migraine Pregnancy ``` Pyloric Stenosis Ranstedt Pylomyotomy Gastro Oesophageal Reflux H2 Antacids HUS Volvulus ``` Initial Management Rehydration Antibiotics Anti-emetics NG tube Surgery ```

Question 31

Recognise the common causes of acute and chronic diarrhoea in infancy, childhood and adolescence and know how these are initially managed.

Answer 31

acute infective diarrhoea ``` Viral - rotavirus (causes gastroenteritis) vaccine treatment 1st dose must be given before 15 weeks - norovirus Bacterial - salmonella - campylobacter ``` ``` Management Assessment of dehydration Rehydration – iv vs oral Infection control Stool samples antibiotics eg ciprofloxacin for shigella, metronidazole for amoebic dysentery ``` Parasitic - giardia, metronidazole - amoeba Chronic Diarrhoea Thriving Toddler Diarrhoea - Mgx (self resolves) Constipation with overflow ``` Not thriving Cystic Fibrosis Coeliac Lactose intolerance Crohns UC ```

Question 32

Recognise the common causes of constipation in infancy, childhood and adolescence and initiate management.

Answer 32

Dietary ``` Treatment Initial advice -Fluid intake -Dietary management -Toileting routine -Laxatives (movicol) ```

Question 33

Recognise the common causes of acute, chronic and recurrent abdominal pain in children.

Answer 33

``` Acute Intussuscpetion 6 - 9 months Appendicitis Mesenteric Adenitis Lower Lobe Pneumonia Testicular Torsion 12 - 13 Chronic ```

Question 34

causes of acute bowel obstruction in infants, children and adolescents, presents principles of management.

Answer 34

intussusception 6-9 months 4:1 ratio M:F

Question 35

Recognise the common causes of an abdominal mass in infancy childhood and adolescence.

Answer 35

``` wilms - nephrectomy + chemo neuroblastoma hepatoblastoma constipation - osmotic laxative intussusception 6-9 months 4:1 ratio M:F ```

Question 36

Know the different causes of jaundice in childhood, how to investigate and the treatments that should be initiated.

Answer 36

Biliary Atresia | Duodenal Atresia

Question 37

Give advice to parent on gastroenteritis including oral rehydration therapy.

Answer 37

PC: Diarrhoea Mgx - Plenty of fluids Advice - good hygiene

Question 38

Recognise how haematuria may present and know the underlying causes and initial therapies that may be required.

Answer 38

acute nephritic syndrome

Question 39

Recognise how proteinuria may present and know the common underlying causes and initial therapies that may be required.

Answer 39

nephrotic syndrome swelling steroids

Question 40

Understand how urinary tract infections present at different ages, how they are investigated, and the treatments that are used.

Answer 40

``` High temperature (fever). Being sick (vomiting) and/or diarrhoea. Drowsiness. Crying, going off feeds and generally seeming unwell. Appearing to be in pain. Blood in the urine (uncommon). Yellowing of the skin (jaundice). Cloudy or smelly urine. nephrotic syndrome Urine dip ``` 3 day course atbx as per local guidelines

Question 41

Know the major causes of acute and chronic renal failure in childhood. Appreciate how they present and the initial treatment options.

Answer 41

Pre Renal Hypovolaemia Cardiac failure Hypoxia ``` Renal HUS Acute GN Interstitial Nephritis Nephrotoxic insults infection ``` ``` Post renal PUV Stone Tumour Retroperitoneal fibrosis ``` Lethargy Growth failure Haemolytic uraemic syndrome

Question 42

Understand the physiological consequences of renal failure.

Answer 42

``` hyperkalaemia fluid overload hypertension toxin excretion anaemia acid base ```

Question 43

Recognise polyuria, know the common and important causes and how to investigate and treat.

Answer 43

Infection | Diabetes

Question 44

Identify the common causes of bedwetting and be able to give advice to parents.

Answer 44

primary bedwetting - since childhood The child cannot yet hold urine for the entire night. The child does not waken when his or her bladder is full. The child produces a large amount of urine during the evening and night hours. The child has poor daytime toilet habits. Daytime wetting ``` UTI Diabetes Structural or anatomical abnormality Neurological Problems Emotional Problems (parentala problems / stress / change / abuse) Constipation ``` ``` MGX • 1st Reassure your child • no drink hour before bed • wee before going to sleep • 2nd Enuresis alarm. • Don't tell them off or punish them • Normal age for unrinary continence 3 or 4 ```

Question 45

Know the causes, investigations and treatments of hypertension presenting in childhood. Know how to measure and interpret childhood blood pressure.

Answer 45

renal disease ``` Renal artery stenosis. Renal parenchymal disease. Coarctation of the aorta. Cushing's syndrome. Hyperthyroidism. Obstructive sleep apnoea and sleep disordered breathing. Phaeochromocytoma. ```

Question 46

Be able to examine the inguinal area and distinguish between a hernia and a hydrocoele.

Answer 46

transillumination + slow to fill slow to empty + can get above the swelling vs abdo pain, constipation, nausea vomiting, bowel sounds in mass

Question 47

Understand the normal development of external genitalia including the foreskin and labia/vulva.

Answer 47

Testes should descend within the 1st couple of months

Question 48

Recognise abnormalities and when to initiate treatment of balanitis and dysuria.

Answer 48

``` pathological phimosis paraphimosis balanoposthitis torsion of testicle torsion of a hydatid of Morgagni Epididymo-orchitis idiopathic scrotal oedema incarcerated hernia ```

Question 49

Have knowledge of normal descent of the testis, recognize abnormalities and know the management of retractile and undescended testis.

Answer 49

undescended ectopic impalpable if palpable orchidopexy ``` impalpable laparoscopy orchidopexy staged procedure microvascular transplant ```

Question 50

Know how cerebral palsy presents, the possible causes and the therapies used.

Answer 50

delayed developmental milestones floppy stiff milestones not sitting by 8 months not walking by 18 months late head control ataxic mixed spastic athetoid

Question 51

Define febrile convulsions in children and know how to differentiate these from other seizure disorders.

Answer 51

6 months to 5 years peaking at 18 - 22 monnths whilst child feverish

Question 52

Know the causes of and how to assess the ‘floppy’ infant.

Answer 52

paralytic - muscular dystrophy - guillain barré - spinal cord tauma - myasthenia gravis non-paralytic - cerebal palsy - downs - prader willi - hypothyroid - congenital heart

Question 53

Recognise epilepsy in infancy, childhood and adolescence. Know the different common types and how they are diagnosed and managed.

Answer 53

Focal e.g.CECTS Absence Tonic Clonic Myoclonic Absence 2-10 brief sodium valproate or ethosuximde ``` CECTS childhood epilepsy with centrotemporal spikes 7-10 retain conscious 1- 2min EEG no treatment needed ``` Juvenile Myoclonic sodium valproate

Question 54

Be able to outline to parents the nature, treatment and prevention of febrile convulsions and epilepsy.

Answer 54

``` Secondary to infection cant prevent no treatment needed if lasts too long call ambulance dont put anything into mouth recovery position ```

Question 55

Understand how neuromuscular diseases present in children, how they are investigated and how they are managed.

Answer 55

Duchenne muscular dystrophy (DMD) | Becker muscular dystrophy (BMD)

Question 56

Know the causes and treatments of headaches in childhood.

Answer 56

- migraine - most common - tension headache - 2nd most common - meningitis - red flag - lack of sleep - missing meals - stress Treatment ibuprofen triptans (sumatriptan)

Question 57

Know the causes of cerebral haemorrhage and stroke in children and how they are assessed and managed.

Answer 57

``` trauma intraventricular haemorrhage - neonates sickle cell (clot) vasculitis arteriovenous malformations (AVMs) ``` CT MRI

Question 58

Recognise the presentation of meningitis in different age groups of children, know how to investigate and initiate management.

Answer 58

non-blanching rash fever increased cap refill bulging fontanelle Mgx 3mths or older Children IV ceftriaxone Younger than 3 months Cefotaxime + amoxicillin

Question 59

Recognise the common causes of gait disturbance in infancy, childhood and adolescence.

Answer 59

SUFE Perthes Disease BMD DMD

Question 60

Know the common causes of delayed development in childhood.

Answer 60

``` Hearing Problem Hypothyroid Obstructive Sleep Apnoea Coeliac Duodenal Atresia CNS tumours ```

Question 61

Recognise the importance of loss of or failure to acquire milestones in the major developmental domains.

Answer 61

Physical development Turner GH deficiency ``` Fragile X Downs (language) Prematurity Lack of Oxygen (language) Deprivation (all) Maternal Depression Autism (social) Cerebral Palsy (gross motor) Williams Syndrome ```

Question 62

Know how the important neurocutaneous and neurodegenerative disorders present and how they are managed.

Answer 62

neurofibromatosis | cerebral palsy

Question 63

Appreciate the contribution of the multidisciplinary team to the care of children with chronic neurological problems.

Answer 63

Psychological Assessment | In the lecture given by the nice black lady

Question 64

Know the causes and signs of raised intracranial pressure in infancy and childhood.

Answer 64

Causes - shaken baby syndrome - meningitis - epilepsy - hydrocephalus - SOL Signs - lowered GCS - seizures - papilloedema - vomiting - bulging fontanelle - pupils

Question 65

Recognise spina bifida and its associated problems.

Answer 65

- Occulta - Meningocoele - Myelomeningocoele - Movement problems - Bowel Problems - Bladder Problems - Hydrocephalus -Surgery within 48 hours of birth

Question 66

Know the causes and treatments required for infants/children and adolescents with depressed conscious states.

Answer 66

``` Sepsis Febrile Convulsions Epilepsy Hypoglycemia Meningitis Hydrocephalus Abscess Epiglottitis Trauma ```

Question 67

Assess anaemia in infancy and childhood

Answer 67

FBC

Question 68

Know the different presentations of childhood leukaemia

Answer 68

``` AML bone pain frequent nosebleeds bleeding and swollen gums easy bruising excessive sweating (particularly at night) shortness of breath unexplained weight loss heavier than normal periods in women ``` ``` CML fatigue, most likely due to anemia rash bruising or bleeding easily bone and joint pain enlarged spleen increased risk of infection ``` ``` ALL pallor bleeding from the gums a fever bruises petechiae, lymphadenopathy, neck, pitts or groin hepatomegaly, splenomegaly, bone pain joint pain weakness fatigue shortness of breath testicular enlargement cranial nerve palsies ``` ``` CLL fatigue fever frequent infections or illness unexplained or unintended weight loss night sweats ```

Question 69

Assess a child with bruising and bleeding disorders, including petechial and purpuric rashes

Answer 69

AML CLL ALL CLL Blood Clotting Disorder ITP DIC HSP (HUS) Meningitis

Question 70

Understand how and why thrombosis may present in childhood

Answer 70

``` Factor V Leiden. DVT Prothrombin thrombophilia. second most common type. DVT Protein C deficiency. Protein S deficiency. Antithrombin deficiency. ```

Question 71

Recognise lymphadenopathy and know its differential diagnosis at different ages in childhood

Answer 71

``` Hodgkins Neck Lymphadenopahty Mediastinal Mass (SVC obstruction) Fever Night Sweats Weight Loss ``` ``` Non Hodgkins neck, armpit or groin Lymphadenopathy Fever Night Sweats Weight Loss ``` Burkitts

Question 72

- Know the major causes of childhood malignancies, - how children present with malignancy, how they are treated and the medical and psychological challenges associated with both disease and therapies.

Answer 72

Leukaemia - ALL - chemo Brain + spinal tumour - medulloblastoma (most common) - 3-5 yr Group C - 6 - 15yr Group D - astrocytoma - incurable - presentation - macrocephaly - faiure to thrive - vomiting - developmental delay Lymphoma - HL - chemo + radio Neuroblastoma - constipation diarrhoea fever - racoon eyes - Mgx -High dose intensity induction - surgery - chemo - radio - immuno SE infertility poor growth Soft tissue sarcoma Wilms Retinoblastoma - chemo Li fraumeni syndrome

Question 73

Diagnose, assess and know the principles of managing diabetes mellitus in children, including the management of Diabetic Ketoacidosis.

Answer 73

Vomiting Fluids (calculate based on formula) Insulin

Question 74

Be able to recognize, investigate and treat hypoglycaemia in infants/children and adolescents.

Answer 74

reduced conscious state | BM

Question 75

Know how corticosteroid and mineralocorticoid steroid excesses and deficiencies present and are managed.

Answer 75

``` Cushing Syndrome CAH HTN Addisons Hypernatraemia Hyponatraemia Conns ```

Question 76

Understand the principles of screening for inherited metabolic and other conditions at birth (including phenylketonuria, hypothyroidism, cystic fibrosis) and what to do when positive results are detected.

Answer 76

Heel Prick Test (Guthrie Card) | Performed 5-9 days of life

Question 77

Recognise and investigate thyroid problems in the child.

Answer 77

TSH (blood test)

Question 78

Know the causes and management of ambiguous genitalia the disorders of sexual differentiation.

Answer 78

CAH | salt losing crisis

Question 79

1) Understand the principles of inborn errors of metabolism 2) know how inherited metabolic conditions may present in childhood.

Answer 79

- CAH - Phenylketonuria - MCAD - G6P deficiency - Homocystinuria - Homocystinuria - methionine metabolism - heel prick test - vitamin b6

Question 80

Recognise the common skin conditions in infancy, childhood and adolescence.

Answer 80

``` hand foot and mouth disease viral illness very contagious but can go to school if child feels well roseola infantum chicken pox eczema psoriasis acne ```

Question 81

Recognise the exanthematous infections of childhood and their clinical courses.

Answer 81

roseola infantum | - HHV6

Question 82

Know how Eczema presents and how it is managed.

Answer 82

itchy flexures

Question 83

Understand how staphylococcal and streptococcal skin disease present and their consequences.

Answer 83

scalded skin syndrome impetigo scarlet fever

Question 84

Know how Herpes presents in the skin in children and is managed (including gingivostomatitis and eczema herpeticum)

Answer 84

Oral Herpes eczema herpeticum looks like impetigo

Question 85

Know the skin manifestations of common and serious systemic diseases of childhood.

Answer 85

eczema herpeticum Scalded skin syndrome necrotising fasciitis

Question 86

Know the importance of trauma and accidents in childhood for morbidity and mortality.

Answer 86

shaken baby syndrome

Question 87

Be able to assess the significance and sequelae of head injuries in infancy and childhood.

Answer 87

A to E CT head MRI

Question 88

Be able to advise parents on strategies to reduce the risk of accidents in the home.

Answer 88

to be completed

Question 89

Understand the causes of accidental and non-accidental poisoning in childhood and how to manage them.

Answer 89

Bruising in abnormal places | behind the ears

Question 90

Be aware of non-accidental injuries (including sexual abuse) and know the outline strategy for handling them.

Answer 90

Inform Social Services

Question 91

Know the principles of underlying management of thermal injury (burns) and chest/abdominal injury. Superficial epidermal First degree Red and painful Partial thickness (superficial dermal) Second degree Pale pink, painful, blistered Partial thickness (deep dermal) Second degree Typically white but may have patches of non-blanching erythema. Reduced sensation Full thickness Third degree White/brown/black in colour, no blisters, no pain

Answer 91

• Immediate first aid airway, breathing, circulation • heat burns - remove the person from source. Within 20 minutes irrigate the burn with cool (not iced) water for 10 - 30 min layered cling film * electrical burns: switch off power supply, remove the person from the source * chemical burns: brush any powder off then irrigate with water. not recommended to neutralise the chemical • Assessing the extent of the burn Wallace's Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9% • Lund and Browder chart: the most accurate method the palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA

Question 92

Know variations of normal posture in children.

Answer 92

to be completed

Question 93

Know the causes of limp in childhood and how to investigate and treat them.

Answer 93

Cerebral Palsy

Question 94

• Know the reasons children get painful swollen joints and how to treat them.

Answer 94

JIA

Question 95

Know the causes and how to assess a young child with pseudoparesis of a limb

Answer 95

to be completed

Question 96

Understand the principles for joint deformities and contracture formation in children with disabilities and how they are prevented and managed.

Answer 96

Perthes

Question 97

Understand the reasons children get limb pains and how to treat them.

Answer 97

JIA

Question 98

Know the common causes of abnormality to the spine and neck and how to manage them.

Answer 98

Scoliosis | Spina Bifida

Question 99

Know the common genetic causes of skeletal abnormality.

Answer 99

SUFE Scoliosis Perthes

Question 100

• Know the principles of active and passive immunization and be able to advise parents on childhood vaccinations.

Answer 100

to be completed

Question 101

• Be able to recognize the septic infant /child/adolescent.

Answer 101

Sepsis 6

Question 102

• Know when to suspect immunodeficiency

Answer 102

Recurrent Infections

Question 103

• Know the symptoms and signs of the common exanthematous diseases of childhood

Answer 103

to be completed

Question 104

• Know the common and important reasons for acute and prolonged fever in the infant/child/adolescent

Answer 104

``` scarlet fever (grpA strep) kawasaki disease ```

Question 105

``` Know the presentations, management and potential consequences of the common viral infections including measles, mumps, rubella, herpes virus, parvovirus B19 enterovirus ```

Answer 105

Measles - Parvovirus B19 - white spots inside the mouth - fever - irritable - conjuntivitis Mumps - earache Rubella - vesicles in mouth - vesicles on palm

Question 106

Know the presentations, management and potential consequences of common bacterial infections including Staphylococcus, Group a strep, meningococcus pneumococcus.

Answer 106

meningococcal septicaemia

Question 107

``` • Recognise the uncommon manifestations of common diseases including toxic shock syndrome, necrotizing faciitis Kawasaki’s disease. ```

Answer 107

to be completed

Question 108

``` Recognise rare but potentially serious infections including Septicaemia, meningitis, Encephalitis, Tuberculosis, HIV Lyme disease. ```

Answer 108

to be completed

Question 109

Know how the common tropical disease may present when children have returned from abroad including Malaria typhoid.

Answer 109

to be completed

Question 110

Be able to investigate the child with hearing difficulties

Answer 110

Newborn otoacoustic emission test 6-9 months Distraction 1.5 -2.5 years Where is the teddy test 2.5 - 3 years Kendall Toy test, McCormick Toy Test 3 years Pure tone audiometry

Question 111

Know the causes investigations and management of children with sore throats

Answer 111

Viral | Bacterial

Question 112

Understand the presentation and management of obstructive sleep apnoea in childhood and how it differs from adults.

Answer 112

to be completed

Question 113

• Recognise the common causes of genetic and chromosomal abnormalities in childhood and how to investigate and treat them.

Answer 113

- Trisomy 21 Downs - Trisomy 18 Edwards - Trisomy 13 Patau - WIlliams Syndrome - Noonans Sydrome - Fragile X syndrome - microcephaly

Question 114

Recognise how trisomy 21 presents & the best way to council parents. Have knowledge of associated problems with this condition.

Answer 114

Downs AVSD

Question 115

• Know how to obtain the information necessary for genetic counselling.

Answer 115

to be completed

Question 116

Know the common causes of infant and childhood mortality globally and in the UK and understand how and why these have changed over time.

Answer 116

to be completed

Question 117

• Recognize the main contributors that have improved health of children in the UK

Answer 117

Vaccinations

Question 118

Understand the impact of social class and inequality for child health

Answer 118

to be completed

Question 119

``` Know the normal pattern of development of the child from birth to 5 years (Patterns of gross motor, fine motor + visual, hearing + language social skills ```

Answer 119

to be completed

Question 120

Understanding of how | vision and hearing are assessed in children.

Answer 120

Vision Squint - cover test / corneal light reflection test Kays Picture Cards

Question 121

Know the UK healthy child programme including the UK immunisation programme, universal screening, the role of the heath visitor and healthy nutrition.

Answer 121

to be completed

Question 122

Appreciate the impact of family, genes and the environment on the physical, emotional and developmental well being of the child (0-5) and young person (5-15)

Answer 122

to be completed

Question 123

• Safeguarding - Identify the signs and symptoms that suggest children may be suffering from abuse/neglect or may be at risk of significant harm (physical, emotional and sexual) and know what action to take to safeguard their welfare.

Answer 123

to be completed

Question 124

Understand multi-agency pathways, procedures used to protect children and the process of serious case reviews

Answer 124

to be completed

Question 125

• Know how to identify and manage Chronic Fatigue Syndrome (CFS/ME) and identify and manage common pain problems

Answer 125

6 months symptoms + Manage Symptoms

Question 126

``` • Know the presentation and management of high prevalence impairments in childhood (attention deficit hyperactivity disorder (ADHD), developmental coordination disorder, high functioning autistic spectrum disorder (Aspergers), specific and mild /moderate learning difficulties) ```

Answer 126

ADHD - Impulsivity - Hyperactivity - Poor Concentration

Question 127

• Know the presentation and management of low prevalence but severe impairments in childhood (autistic spectrum disorders, severe global learning difficulties, cerebral palsy)

Answer 127

Autism - male - before 3

Question 128

Understand the function of the multi-disciplinary ‘team around the child’, particularly related to the disabled child.

Answer 128

to be completed

Question 129

Recognise eating disorders including anorexia and bulimia. Know how to investigate and treat.

Answer 129

Restricted Intake Body Dysmorphia Increased Exercise

Question 130

• diagnose and treat the common behavioural problems in the preschool child

Answer 130

to be completed

Question 131

diagnose and treat the common psychiatric disorders in pre-school and primary school age children.

Answer 131

to be completed

Question 132

Adolescence : common presentations of mental health disorders in adolescence.

Answer 132

Anxiety OCD Aspergers ADHD

Question 133

Describe the prevalence and clinical presentation of common psychiatric conditions presenting in young people including: eating disorders; mood disorders (eg anxiety and OCD (obsessive compulsive disorder); ADHD (attention deficit and hyperactivity disorder); ASD (autism spectrum disorder) psychotic illness; conduct and emotional disorders and attachment difficulties

Answer 133

to be completed

Question 134

Understand normal life adjustments and transitions (including between age groups) and recognise the difference between mental illness and the range of normal responses to stress and life events.

Answer 134

to be completed

Question 135

Describe the current common psychological, physical and social and lifestyle treatments for these conditions.

Answer 135

to be completed

Question 136

Understand the doctor’s duties and the patient’s rights under mental health legislation, Including the importance of confidentiality and when to override this for young people.

Answer 136

to be completed

Question 137

Describe the range of services and professionals involved in the network of young people, and understand the roles of self help, carer / parent groups, schools, social services etc.

Answer 137

to be completed

Question 138

``` Understand diagnostic criteria for the above conditions, and be aware of common assessment / diagnostic tools (e.g. Connor’s) ```

Answer 138

to be completed

Question 139

Communicate effectively with patients, families and multidisciplinary colleagues about psychiatric difficulties. Discuss with patients and relatives the nature of their illness, (i.e. basic psycho education), management options and prognosis.

Answer 139

to be completed

Question 140

In young people with mental health difficulties, evaluate information about family relationships and other social factors (e.g. school) and the impact on a young person.

Answer 140

to be completed

Question 141

Evaluate the impact of psychiatric illness on the young person, their family and others around them.

Answer 141

to be completed