Paediatrics

Question 1

You’re asked to see a 5-hour old baby on the post-natal ward. They were born by ventouse and have now developed a swelling over the side of their scalp which does not cross the suture lines. What is the most likely diagnosis?

Answer 1

Cephalohaematoma

Question 2

What is craniosynostosis?

Answer 2

Premature fusion of the skull sutures

Question 3

During the routine NIPE, a new mum asks you about a strange mark on her 16 hour old baby. There is a large dark blue macular lesion overlying the baby’s sacrum. What is the most likely diagnosis and what will you tell the mum?

Answer 3

This is a Mongolian blue spot. Although benign, it cant take a few years to start to fade. Most are resolved within 10 years.

Question 4

You are completing a NIPE on a 10-hour old baby. The delivery was complicated by shoulder dystocia. The right arm is held in fixed flexion at the elbow and wrist. What is the likely diagnosis and what structure is injured?

Answer 4

Klumpke’s palsy - Caused by injury to the T1 and C8 roots of the brachial plexus

Question 5

What are the risk factors associated with DDH?

Answer 5

Female, Firstborn, Family Hx, Breech presentation, oligiohydramnios, fetal neuromuscular disorders

Question 6

What are thr risk factors associated with SUFE

Answer 6

Male sex, Obesity, Puberty, Afro-Carribean ethnicity, Delayed skeletal maturity, Hyopopituitarism

Question 7

What clinical features are associated with SUFE?

Answer 7

Limp, hip - knee pain, pain on movement in all directions, shortened externally rotated leg

Question 8

What are the radiological features associated with SUFE?

Answer 8

Steel sign (double density at metaphysis on AP), widening of ipsilateral growth plate, decreased epiphyseal height, Trethowan’s sign (Klein’s line does not intersect the upper femoral epiphysis)

Question 9

What are the causes of VUR?

Answer 9

Primary (abnormal but normal anatomy i.e. large ureteric orifice) Secodary - posterior urethral valve, meatal stenosis, neuropathic bladder, dysfunctional bladder

Question 10

What investigations are used in the diagnosis of VUR?

Answer 10

Micturating cystourethrogram (gold standard) DMSA scan (renal scarring) Ultasound (hydronephrosis)

Question 11

What is the pathogenesis of ITP?

Answer 11

A viral infection leads to the development of platelet membrane glycoprotein specific antibodies leading to immune mediated destruction of platelets.

Question 12

What investogations are indicated in the diagnosis of ITP?

Answer 12

FBC - thrombocytopaenia, coagulation studies (excludes DIC), Inflammatory markers (excludes infection) blood film (excludes haemolytic anaemia etc)

Question 13

How does ITP present?

Answer 13

Petechial rash, purpura, unexplained bleeding

Question 14

How should ITP be managed?

Answer 14

IVIG, steroids, IV anti-D

Question 15

What are the potential complications of ITP?

Answer 15

Intracranial haemorrhage, Intraabdominal haemorrhage. Manage with high dose IVIG, steroids +/- splenectomy

Question 16

What are the clinical features of Down syndrome?

Answer 16

Depressed nasal bridge, prominent epicanthic folds, upslanting palpebral fissues, low set ears, protruding tongue, widened sandal gap clinodactyly, single palmar crease, hypotonia, brushfield spots,

Question 17

How is Down syndrome screened for and diagnosed?

Answer 17

Triple test - nuchal translucency, elevated beta-hCG, low PAPP-A
Quadruple test - AFP, beta-hCG, inhibin-A, oestriol
Diagnosis - FISH/karyotyping from amniocenesis or CVS

Question 18

What are the four defects that make up tetrallogy of fallot?

Answer 18

Pulmonary stenosis, VSD, RVH and overriding aorta

Question 19

What are the cyanotic congenital heart defects?

Answer 19

TOF, TGA, Pulmonary atresia, total anomolous pulmonary venous drainage, tricuspd atresia, truncus arteriosus, complete AVSD

Question 20

What are the management otpions for a Tet-spell?

Answer 20

Position in knee to chest position - increases systemic vascular resistance, decreasing R->L shunt.
Medical management - High flow oxygen and oral mrphine, or IV morphine and beta blockers

Question 21

What advice can be given to parents to reduce the risk of SUDI sudden unexpected death in infancy (aka SIDS sudden infant death syndrome)

Answer 21

Always put baby to sleep on their backs with their feet at the bottom of the bed, use child safety approved matresses, don’t co sleep with the baby, keep soft objects out of the rib other than one blanket not over the face, do not smoke, control the room temperature,, use a pacifier with a string attached

Question 22

What are the red flags in a febrile child?

Answer 22

Age < 3m, non-blanching rash, bulging frontanelle, neck stiffness, status epilepticus, focal neurology, pale/mottled skin, unresponsive to social cues, unable to stay awake, weak/high pitched,/continuous cry, unresponsive, reduced skin turgour

Question 23

What are the risk factors for neonatal sepsis?

Answer 23

Previous baby with invasive GBS infection, maternal GBS colonisation, PPROM, prematurity, intrapartum fever or suspected chorioamionitis, infection in the other twin/triplet etc, maternal sepsis

Question 24

What are the causes of neonatal seizures?

Answer 24

infection, hypoglycaemia, hypocalcaemia, neonatal abstinence syndrome, HIE, intraventricular haemorrhage, cerebral malformation

Question 25

What are the risk factors for neonatal hypoglycaemia?

Answer 25

Gestational diabetes, IUGR, prematurity, macrosomia, maternal beta blockers, sepsis

Question 26

How does mucular dystrophy present?

Answer 26

Delayed walking, frequent falls, developmental delay, wadling gait, calf pseudohypertrophy, grower’s sign, kyphoscoliosis,

Question 27

How is muscular dystrophy managed?

Answer 27

Optomised nutrition, manage infections, cardiac monitoring, NIV/tracheostomy, physio for strength, OT for functional improvement, steroids, surgery for contractures

Question 28

What is the most common cause of bronchiolitis?

Answer 28

RSV

Question 29

What are the typical features of bronchiolitis?

Answer 29

Cough, tachypnoea, head bobbing, tracheal tug, subcostal retraction, pyrexia, poor feeding, apnoea, wheezem reduced air entry, crepitations

Question 30

What investgations may be indicated in bronchiolitis?

Answer 30

Nasopharyngeal aspirate, ABG (only if absolutely necessary), CXR, CRP, FBC, U&Es,

Question 31

How should bronchiolitis be managed?

Answer 31

Minimal handling, oxygen, ventillation, hydration support.

Question 32

What are the potential complications of bronchiolitis?

Answer 32

Lung collapse, superadded pneumonia. respiratory failure, bronhiolitis obliterans

Question 33

What gene is affected in cystic fibrosis and what is the most common mutation?

Answer 33

CFTR gene. Mutation = p.Phe508del (deltaF508)

Question 34

What are the clinical features of cystic fibrosis?

Answer 34

Recurrent chest infections, fatering growth, nasal obstriction and nasal polyps, bowel obstruction

Question 35

How is cystic fibrosis diagnosed?

Answer 35

Immune-reactive trypsinogen, sweat test, genetic testing, fecal elastase

Question 36

How is CF managed?

Answer 36

Treat infections aggressively including supplememtal oxygen. Prophylactic PO Abx, NEB Abx, and PO antifungals. nebulised hypertonic saline and DNase. Bronchodilators, ICS, Creon, Vit ADEK supplementation, Omeprazole, insulin

Question 37

What are the complications of cystic fibrosis?

Answer 37

Diabetes, liver failure, infertility

Question 38

What is failure to thrive?

Answer 38

Weight falling across centile lines compared to height

Question 39

What are the causes of short stature?

Answer 39

Constitutional, neglect, steroids, turners, CF, coeliac, hypothyroidism, infection

Question 40

What tests should be considered in failure to thrive?

Answer 40

Clean catch urine, coeliac serology, U&Es, fasting glucose, LFTs, immunoglobulins, CRP, TSH, sweat test, amino acid and organic acid chromatography

Question 41

What are the risk factors for NAI?

Answer 41

Low brith weight, low maternal age, unwanted pregnancy, low socioeconomic status,