High Yield Paeds

Question 1

Give some causes of global developmental delay

Answer 1

Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders

Question 2

Give some causes of gross motor delay

Answer 2

Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment

Question 3

Give some causes of fine motor delay

Answer 3

Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment

Question 4

Give some causes of speech and language delay

Answer 4

Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
Hearing impairment
Learning disability
Autism
Cerebral palsy
Neglect

Question 5

Give some causes of social delay

Answer 5

Emotional and social neglect
Parenting issues
Autism

Question 6

What atrial septal defects may be seen in children?

Answer 6

Ostium secondum : septum secondum fails to fully close, leaving a hole in the wall

Patent foramen ovale: foramen ovale fails to close (although this not strictly classified as an ASD)

Ostium primum: septum primum fails to fully close, leaving a hole in the wall. This tends to lead to atrioventricular valve defects

Question 7

What are the potential complications of ASDs in children?

Answer 7

Stroke in the context of venous thromboembolism
Atrial fibrillation or atrial flutter
Pulmonary hypertension and right sided heart failure
Eisenmenger syndrome - reversal of left to right shunt due to pulmonary hypertension

Question 8

What may be heard on auscultation of an ASD?

Answer 8

mid-systolic, crescendo-decrescendo murmur loudest at the upper left sternal border with a fixed split second heart sound (doesn’t change with inspiration or expiration)

Question 9

How can ASDs be managed?

Answer 9

should be referred to a paediatric cardiologist for ongoing management

If the ASD is small and asymptomatic, watching and waiting can be appropriate

can be corrected surgically using a transvenous catheter closure (via the femoral vein) or open heart surgery

anticoagulants (such as aspirin, warfarin and NOACs) are used to reduce the risk of clots and stroke

Question 10

How may ASDs present in children?

Answer 10

may be picked up on antenatal screening / newborn examination

may be symptomatic:
Shortness of breath
Difficulty feeding
Poor weight gain
Lower respiratory tract infections

may be asymptomatic in childhood and present in adulthood with dyspnoea, heart failure or stroke

Question 11

What conditions are commonly associated with VSDs in children?

Answer 11

Down’s Syndrome and Turner’s Syndrome

Question 12

What is the usual direction of flow of blood in a VSD? What may this cause?

Answer 12

from left to right

patient remains acyanotic but too much blood flow into the lungs may cause right sided overload / right heart failure

pulmonary hypertension may cause reversal of the shunt (Einsenmengers syndrome)

Question 13

What sxs may VSDs present with?

Answer 13

Poor feeding
Dyspnoea
Tachypnoea
Failure to thrive

Question 14

What may be heard on auscultation of the chest of a patient with a VSD?

Answer 14

pan-systolic murmur more prominently heard at the left lower sternal border in the third and fourth intercostal spaces

may be a systolic thrill on palpation

Question 15

How should VSDs be managed?

Answer 15

referred to paediatric cardiologist

small VSDs with no symptoms or evidence of pulmonary hypertension / HF can be watched and often close spontaneously

can be corrected surgically using a transvenous catheter closure via the femoral vein or open heart surgery

increased risk of infective endocarditis in patients with a VSD =antibiotic prophylaxis should be considered during surgical procedures

Question 16

Give some symptoms of aortic stenosis

Answer 16

fatigue, shortness of breath, dizziness and fainting

sxs typically worse on exertion as the outflow from the left ventricle cannot keep up with demand

severe aortic stenosis will present with heart failure within months of birth.

Question 17

Describe the murmur heard in aortic stenosis

Answer 17

ejection systolic murmur heard loudest at the aortic area (second intercostal space, right sternal border)

It has a crescendo-decrescendo character and radiates to the carotids

Question 18

Besides a murmur, what might you find on examination of aortic stenosis?

Answer 18

Ejection click just before the murmur
Palpable thrill during systole
Slow rising pulse and narrow pulse pressure

Question 19

How can aortic stenosis be investigated and managed?

Answer 19

gold standard for dx is an echocardiogram

monitoring with regular echos, exercise testing and ECGs

Mx options:
Percutaneous balloon aortic valvoplasty
Surgical aortic valvotomy
Valve replacement

Question 20

Give some complications of aortic stenosis

Answer 20

Left ventricular outflow tract obstruction
Heart failure
Ventricular arrhythmia
Bacterial endocarditis
Sudden death, often on exertion

Question 21

What conditions may be associated with congenital pulmonary valve stenosis?

Answer 21

Tetralogy of Fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome

Question 22

Give some signs of pulmonary stenosis found on examination

Answer 22

Ejection systolic murmur heard loudest at the pulmonary area (second intercostal space, left sternal border)
Palpable thrill in the pulmonary area
Right ventricular heave due to right ventricular hypertrophy
Raised JVP with giant a waves

Question 23

What are the two most common causes of nephritis in children?

Answer 23

post-streptococcal glomerulonephritis and IgA nephropathy (Berger’s disease)

Question 24

What is the FEVER PAIN criteria for diagnosis of tonsilitis?

Answer 24

Fever over 38°C
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
severely Inflamed tonsils
No cough or coryza

0-1 = no abx
2-3 = consider abx
4-5 = abx almost definitely indicated

Question 25

What abx are given if indicated in tonsillitis ?

Answer 25

if antibiotics are indicated then either phenoxymethylpenicillin or erythromycin (if the patient is penicillin allergic) should be given

7 or 10 day course should be given

Question 26

Potential complications of tonsillitis?

Answer 26

Peritonsillar abscess or neck abscess
Acute otitis media
Acute sinusitis
Acute post-streptococcal glomerulonephritis
Streptococcal toxic shock syndrome
Scarlet fever
Acute rheumatic fever

Question 27

What are the 5 Ss of innocent childhood murmurs?

Answer 27

Soft
Short
Systolic
Symptomless
Situation dependent, particularly if the murmur gets quieter with standing or only appears when the child is unwell or feverish

Question 28

What innocent childhood murmur is heard as a continuous blowing noise heard just below the clavicles?

Answer 28

Venous hums - Due to the turbulent blood flow in the great veins returning to the heart

Question 29

What innocent childhood murmur is heard as a low-pitched sound at the lower left sternal edge?

Answer 29

Still’s murmur

Question 30

Characteristics of an innocent ejection murmur in a child include:

Answer 30

soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
localised with no radiation
no diastolic component
no thrill
no added sounds (e.g. clicks)
asymptomatic child
no other abnormality

Question 31

What causes S2 splitting on auscultation?

Answer 31

During inspiration the right side of the heart fills faster as it pulls in blood from the venous system.

The increased vol in the RV causes it to take longer to empty during systole, causing a delay in the pulmonary valve closing.

When the pulmonary valve closes slightly later than the aortic valve, this causes the second heart sound to be “split”.

Question 32

Jaundice in the first 24 hours is always pathological. What can cause it?

Answer 32

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

Question 33

What should be done if there are still signs of neonatal jaundice after 14 days ?

Answer 33

a prolonged jaundice screen is performed:

urine for MC&S

FBC, U&Es and LFTs
TFTs
conjugated and unconjugated bilirubin: look for biliary atresia
Direct antiglobulin test (Coombs’ test)

Blood film

Question 34

What can cause prolonged jaundice (over 14 days)?

Answer 34

prematurity ( immature liver function)

congenital infections e.g. CMV, toxoplasmosis

biliary atresia

breast milk jaundice (jaundice is more common in breastfed babies)

galactosaemia

hypothyroidism

UTI