notes from quesmed

Question 1

APGAR score stands for

Answer 1

appearance
pulse (over or under 100bpm or absent)
grimace (reflex irritability. sneeze cough vigorous cry or grimaces or none)
activity (muscle tone. active or arms and legs flex or none)
respirations

0-2 on all of them

Question 2

most likely pathogen causing croup

Answer 2

parainfluenza virus

Question 3

most likely pathogen causing epiglottitus

Answer 3

Haemophilus influenza B bacteria (most have hib vaccine so not so common these days)

Question 4

most likely pathogen causing tracheitis

Answer 4

staph aureus (drooling)

crouo that doesnt get better

Question 5

most likely pathogen causing pneumonia

Answer 5

Streptococcus pneumococcus

Question 6

tetrad of henoch schlonlein purpura

Answer 6

rash
adbo pain
arthralgia
glomerulonephritis

can also be fever
history of URTI

(most common vasculitis in children)

Question 7

what must you do after HSP resolves

Answer 7

Following an episode of HSP, regular urine tests should be conducted for 12 months to monitor for potential renal impairment.

Question 8

what is gowers sign and what does it indicate

Answer 8

patient that has to use their hands and arms to ‘walk’ up their own body in order to stand up from a supine position

Duchenne muscular dystrophy (DMD) due to proximal muscle weakness

Question 9

what murmur is commonly caused by rheumatic fever

Answer 9

mitral stenosis

Question 10

sign on x ray for rickets

Answer 10

Widened epiphyseal plates

Question 11

sign on x ray for ewings sarcoma

Answer 11

Onion-skin periosteal reaction

Question 12

management of ADHD in children over 6

Answer 12

methylphenidate or amphetamines
These medicines have some activity in the frontal lobe, thus increasing executive function, attention, and reducing impulsivity.

also support in school and CBT

dexamfetamine in treatment resistant

Question 13

investigation of choice for pertussis

Answer 13

PCR is most sensitive

Culture of organism on per-nasal swab firstline investigation but is not the most sensitive. The sensitivity of the culture is dependent on the timing with swabs only swabs taken up to 3 weeks after onset useful

(bordetella pertussis)

Question 14

management of pertussis

Answer 14

Macrolide antibiotics first-line (azithromycin, clarithromycin)
or doxycycline
alleviate symptoms in the patient but also reduce transmission to others
Late initiation of antibiotics may not alter the course of the disease for the patient but can help minimise transmission to others.

notifiable disease

Question 15

treatment of croup

Answer 15

Oral and Nebulised Steroids e.g. dexamethasone

Question 16

treatment of pneumonia

Answer 16

• Observation if symptoms are mild
• If presenting with 2 days fever, cough +/- crepitations, and focal signs (i.e. in one area)
  
  • First-line: Amoxicillin
  • If Penicillin-Allergic: Clarithromycin OR Doxycycline

Question 17

treatment of bronchitis (if needed!! usually not)

Answer 17

• bacterial
  
  • Antibiotics
• Viral
  
  • Supportive management (drinking more fluid, paracetamol, bronchodilators.. etc.)

Question 18

treatment of bronchiolitis (if needed!! usually not)

Answer 18

• Maximal observation and Minimal intervention
  Provide reassurance, normally resolves within 2 weeks.
• Supportive treatment (Oxygenation, Hydration, Nutrition)
  • Airway (nasal) suctioning (usually before feeds)
  • Oxygen supplementation (usually via nasal cannulae). Typically where oxygen saturations are less than 90-92%
  • Nasogastric tube feeding when feed oral volumes are significantly reduced
  • Some very severe cases (typically <2-3m old) need IV fluids but the vast majority of infants do not need this

Question 19

treatment of tracheitis (if needed!! usually not)

Answer 19

Co-amoxiclav (Augmentin)

Question 20

causative organism of bronchiolitis

Answer 20

• Respiratory syncytial virus (RSV)
• Paraflu III
• Human Metapneumovirus (hMPV)

Question 21

causative organism of tracheitis

Answer 21

staph/strep

Question 22

causative organism of bronchitis

Answer 22

• Viral e.g. rhinovirus, adenovirus, influenza, parainfluenza
• Strep. pneumoniae
• Haemophilus influenzae

Question 23

investigations for DDH

Answer 23

Barlow (tests for posterior dislocation) and Ortolani (tests for relocation on hip abduction) manoeuvres are primary screening tools.

If DDH is clinically suspected, hip ultrasonography should be ordered for confirmation, especially in infants less than 6 months of age.

For older infants and children, pelvic radiography may be more suitable.

Question 24

test for glandular fever

Answer 24

A heterophile antibody ‘Paul Bunnell’ test

Question 25

eisenmenger syndrome

Answer 25

reversal of left to right shunt (patent ductus arteriosus, atrial septal defect or ventricular septal defect) to a right to left shunt
secondary to pulmonary hypertension and is associated with right ventricular hypertrophy.

Question 26

kawasaki disease

Answer 26

medium vessel vasculitis
fever
unresponsive to paracetamol
polymorphous rash
sore tongue
desquamation of the extremities
tender cervical lymphadenopathy
echo needed for risk of coronary artery aneurysms

high-dose Aspirin and intravenous Immunoglobulin

Question 27

investigation for pyloric stenosis

Answer 27

ultrasound

Question 28

life threatening asthma signs

Answer 28

silent chest
cyanosis
poor/no respiratory effort
peak expiratory flow rate <33%
hypotension
an altered level of consciousness
Oxygen saturations <92%

Question 29

signs of foetal alcohol syndrome

Answer 29

microcephaly
short palpebral fissures
hypoplastic upper lip
absent philtrum
reduced IQ
cardiac abnormalities

Question 30

what can maternal smoking cause

Answer 30

increases the risk of miscarriage
pre-term labour
stillbirth
intrauterine growth retardation

Question 31

Congenital rubella syndrome

Answer 31

microcephaly
cataracts
micrognathia
low birth weight
“blueberry rash”
Later, children may have developmental delay and learning disability

cataracts, brain damage and deafness

Question 32

when is FeNO

Answer 32

considered in children and young people (aged 5 to 16) if there is diagnostic uncertainty after initial assessment and they have either: normal spirometry or obstructive spirometry with a negative bronchodilator reversibility (BDR) test.

FeNO level of 35 ppb or more is seen as a positive test

Question 33

what test is done in newborns for cystic fibrosis

Answer 33

immunoreactive trypsinogen

Question 34

what is pica

Answer 34

urges to eat things that arent food

Question 35

measles

Answer 35

high fever, coryzal symptoms, conjunctivitis, and a characteristic rash. Pathognomonic Koplik spots may be seen on the oral mucosal membranes

measles-specific IgM and IgG serology, and measles RNA detection by PCR

Supportive care, usually involving antipyretics.
Vitamin A administration for all children under 2 years

complications:
Acute otitis media
Bronchopneumonia
Encephalitis

most common in unvaccinated children.

Question 36

transient tachypnoea of the newborn

Answer 36

tachypnoea shortly after birth, and often resolves within the first day of life with supportive therapy with Oxygen.

caused by delayed resorption of fluid in the lungs
strongly associated with caesarean section and prematurity
X-ray signs include hyperinflation, and fluid in the horizontal fissure

Question 36

unconjugated hyperbilirubinaemia

Answer 36

breastmilk jaundice

Question 36

klinefelter syndrome gene thing

Answer 36

47 XXY
a womanly boy

Question 37

edwards syndrome is what trisomy

Answer 37

18

Question 37

conjugated hyperbilirubinaemia

Answer 37

biliary atresia
bile ducts of a newborn are progressively fibrosed and destroyed
hepatoportoenterostomy or the Kasai procedure.

Question 37

fragile x syndrome presentation

Answer 37

intellectual disability
long narrow face
large ears
hypermobile joints
large testicles
ADHD
autism
seizures

x linked mutation in FMR1 gene
males always affected

Question 38

whta is most common extrarenal association with PKD

Answer 38

Hepatic cysts

Question 39

asthma treatment

Answer 39

trial ICS
SABA
>5 ICS then add LABA if still bad
<5 LTRA then add ICS if still bad

Question 40

asthma acute exacerbation management

Answer 40

moderate- non rebreath O2, SABA
ibatropium bromide and prednisolone if still bad

IV SABA in severe,

Question 41

neisseria meningitis presentation

Answer 41

can present either as meningitis (non-specific signs such as lethargy, headache, fever, rigors and vomiting) or meningococcaemia (septicaemia), or a mixture of both, associated with a rapidly developing purpuric skin rash. When this is associated with massive adrenal haemorrhage and septic shock, the presentation is known as Waterhouse-Friderichsen syndrome

Question 42

impetigo

Answer 42

infectious
staph aureus
strep pyogenes
around his mouth and nose.

Question 43

candida dermatitis

Answer 43

erythematous ‘nappy rash’ involving the flexures, along with characteristic satellite lesions

Question 44

Irritant dermatitis

Answer 44

produces a ‘nappy rash’ that characteristically spares the creases. It is caused by irritation by urinary ammonia and faeces

Question 45

molluscum contagiosum

Answer 45

pearly white papules that are umbillicated centrally, and are usually seen on the trunk, in flexures and in the anogenital region