General Paediatrics

Question 1

At what age is handedness ususally established?

Answer 1

• Handedness is usually established by 3 years of age.
• Developing handedness before 18 months indicates weakness or hypotonia on the less dominant side which may be an early sign of CP.

Question 2

What is the mechanism of action in phototherapy?

Answer 2

• Structural isomerisation to lumirubin (non-reversible) which is more polar and soluble than bilirubin and therefore readily excreted in to bile and urine without conjugation.
• Photoisomerisation to a less toxic bilirubin isomer (reversible) which is also more soluble and able to be excreted in bile.
• Photo-oxidisation to polar molecules which are excreted primarily in the urine is a very slow process.

Question 3

What is the average weekly weight gain from birth to 3m?

Answer 3

• 200g (30g/day).
• Drops to 20g/day at 3 months.
• Infants up to 3m of age require 115kcal/kg/day to grow.

Question 4

How do you calculate corrected Na?

Answer 4

• Corrected Na = Measured Na + (0.3x [measured gluc - 5.5])

Question 5

Hos do you calculate a GCS?

Answer 5

• > 2y.
• EMV.
• Eyes: Spontaneous (4), to voice (3), to pain (2), no response (1).
• Motor: Obeys commands (6), localises to pain (5), flexion withdrawal (4), abnormal flexion (3), extension (2), no response (1).
• Voice: Orientated (5), confused (4), inappropriate (3), incomprehensible (2), no response (1)

Question 6

What are risk factors for abusive head trauma?

Answer 6

• Unmarried single mothers associated with greatest risk.
• Young maternal age also associated.
• Short interpregnancy interval.
• Decreased gestational age.

Question 7

What factors are not found to increase the risk of abusive head trauma?

Answer 7

• Maternal drug and alcohol use.
• Medical or psychiatric history.
• Smoking.
• Socioeconomic status.

Question 8

What is a macule?

Answer 8

• Circumscribed flat area, recognisable by colour variation from surrounding skin <1cm.

Question 9

What is a patch?

Answer 9

• Large macule >1cm.

Question 10

What is a papule?

Answer 10

• A circumscribed elevation <1cm.

Question 11

What is a plaque?

Answer 11

• A well circumscribed, elevated, superficial, solid lesion >1cm.

Question 12

What is a nodule?

Answer 12

• A circumscribed solid elevation >1cm.

Question 13

How do you estimate the correct sized ETT tube?

Answer 13

• Under 8 use uncuffed.

- (Age + 16)/4

Question 14

What is pellagra?

Answer 14

• Vitamin B3 (niacin) deficiency.

- Diarrhoea, dermatits, dementia and dilated cardiomyopathy.

Question 15

What is acrodermatitis enteropathica?

Answer 15

• Zn deficiency.

- Perioral and perianal rash.

Question 16

What is the most important factor influencing prognosis in ASD after intellect?

Answer 16

• Functional speech.

- Level of verbal communication and IQ before 5y are the strongest predictors of outcome.

Question 17

What predictors at 3-5y are associated with more severe ASD at 8-10y?

Answer 17

• At 3-5y, more severe preoccupations with parts of objects, sensory interests and stereotyped motor movements predict less developed cognitive and adaptive skills, and greater ASD symptom severity at 8-10y.

Question 18

• What percetage of cases of hearing loss are syndromic?

Answer 18

• 30%.

Question 19

What are the most common syndromic causes of hearing loss?

Answer 19

• Usher and Pendred syndrome.

Question 20

What are features of Pendred syndrome?

Answer 20

• Most common AR form of sensorineural hearing loss.

- Also present with thyroid abnormalities.

Question 21

What are features of Waadenburg syndrome?

Answer 21

• Sensorineural hearing loss and and pigmentation abnormalities.
• WS type 1 has the added feature of dystopia canthorum,
• WS3 has skeletam abnormalities of the upper lims and WS 4 is associated with Hirschsprungs.

Question 22

What gene mutation is associated with atopic dermatitis and alopecia areata?

Answer 22

• FLG (profilaggrin).