Paediatrics Flashcards
Which age has the greatest childhood mortality?
<1 year
Hepatomegaly is associated heavily with which disease state?
Heart failure
Congenital heart disease
What is the number one cause of splenomegaly?
Malaria
What is Pectus excavatum?
A hollow in the anterior chest wall
What is ‘Pigeon chest’?
Pectus carinatum i.e. bulging of the sternum
What is ‘diaphragmatic tug’?
Indrawing of the chest wall
causes Harrison sulcus (google it - seen in ricket’s)
What is sternal recession and when is it seen?
An indent in chest wall. Seen in acute cases e.g. Respiratory distress syndrome (RDS).
What can a sweat test be used to test for?
Cystic Fibrosis. Will be positive in Cystic Fibrosis.
What is the commonest cause of clubbing?
Cystic Fibrosis
Give x3 causes of clubbing
Cystic Fibrosis (If positive sweat test)
Primary Ciliary Dyskinesia (If negative sweat test)
Crohn’s Disease (If GI symptoms accompany)
What does the phrase ‘stony dullness’ specifically signify?
Pleural effusion.
Name 3 classic signs of pneumonia.
Fever
Dull to percussion
Inspiratory crepitations
What is the normal milestone by which a baby’s squint should disappear?
12 weeks.
What is exanthema?
a group of diseases where a rash presents as the main symptom. e.g. measles, scarlet fever, rubella
In which diagnosis can we find Koplik spots?
Measles
Measles is what type of virus?
RNA paramyxovirus
Name two notifiable diseases
Measles
Which rash characteristically starts behind the ears?
Measles
What is the most common complication of measles?
Otitis media
What is the most common cause of death in measles?
Pneumonia
What is the incubation period for chickenpox?
10-21 days.
What do we give to pregnant women who have never had chickenpox before?
VZIG - Varicella zoster immunoglobulins.
If a pregnant woman develops chickenpox, what is the first treatment we manage them with?
Acyclovir
Which virus most commonly causes hand, foot and mouth disease?
Cocksackie virus.
Give 3 characteristics of Rubella (German measles).
- Caused by rotavirus
- Maculopapular rash starts on face and spreads to the rest of the body (cephalocaudal rash)
- Lymphadenopathy
‘rash starting behind the ears’ - should make one think of what?
Measles.
What is the most common cause of a nappy rash?
Contact dermatitis
‘sandpaper rough rash and sore throat’ think what?
Scarlet fever; the rough rash is a big indicator
How do we treat Scarlet fever?
Penicillin: One of the few viruses whereby we use antibiotics - rest are conservative management.
What is strawberry naevus and how do we treat it?
Hemangaemioma which we treat with propranolol if really needed (treatment not necessarily required often)
What is one large red flag for rashes? What must we be on the lookout for?
Non-blanching. Should be on the lookout for meningococcal septicaemia.
What age baby is classified as premature?
<37 weeks.
What type of virus is ‘slapped cheek virus’ caused by?
Parvovirus aka. 5th disease
Which are the two main differentials in a patient with a ‘strawberry tongue’?
Scarlet fever (more accompanied with rough rash) Kawasaki's disease
What is scarlet fever caused by?
Group A Haemolytic streptococci
Name 5 features of Kawasaki’s disease.
Vasculitis = has systemic features
Clinical criteria = strawberry rash, conjunctivitis, ‘cracked lips’, swelling.
Treat with aspirin and IV immunoglobulin.
What is a key complication of Kawasaki’s disease and so which test must we use as a result?
Aneurysms; kawasaki’s is a vasculitis. This means we have to do an echocardiogram.
How do we treat Kawasaki’s disease?
Aspirin and iV immunoglobulin.
Give x3 key pieces of advice for eczema management.
Avoid irritants
Simple emollients
Topical steroids
What is roseola?
A rash caused by Herpes virus-6 infection aka 6th disease. ‘rose-pink macules with surrounding pale halos’.
Which rash?
Rose-pink macule with surrounding pale halos.
Roseola.
What is a fontanelle?
The SPACE where the bones have not fused as the brain is still growing.
There are two fontanelles: anterior and posterior.
List the most common GI diseases affecting nutrition
Coeliac
IBD - Crohn’s, ulcerative colitis
Food allergies
Lactose intolerance
Describe the advantages of breastfeeding over the life course.
Natural product, natural antibodies
Requires all nutrients for development
Proper temperature
Infant-mother bonding
What is the single contraindication to breastfeeding?
HIV infection.
How do we give parenteral nutrition?
Through a vein (intravenously
Give x3 sources of iron.
Eggs, red meat, fortified cereals, wholemeal bread.
What is a fontanelle?
Where the bones have not fused as the brain is still growing.
There are two fontanelles: anterior and posterior.
Give two causes of increased fontanelle sizes.
Hydrocephalus
Bleeding
Give a formula to measure height velocity.
Height change/ age change (cm/year)
Describe the growth hormone axis
GnRH from the hypothalamus stimulates GH release from the anterior pituitary gland which stimulates IGF-1 release from the liver.
Which is the most rapid phase of growth?
Antenatal (before birth i.e. during pregnancy)
Define antenatal
During pregnancy.
Centiles define normal ranges. True or false.
False; you can be taller or shorter than centile lines and still be completely normal and healthy.
Give 3 causes of short stature.
- Genetic
- Endocrine disorders (hypothyroidism, GH deficiency)
- Puberty/ growth delay
- Psychosocial deprivation
Which questions will you ask in a history assessing causes of short stature?
Birth weight? Chromosomal abnormalities Psychosocial deprivation Endocrine illness Parent's height? Chronic illnesses?
What are some signs of respiratory distress in children?
Head bobbing nasal flaring intercostal/subcostal recessions tracheal tug 'tripoding' grunting
What can we check test wise to assess growth deficiency?
FBC, Iron, thyroid, coeliac screen, liver function, IGF-1, bone age.
What is croup?
URTI most commonly caused by parainfluenza virus
‘barking cough’
What is mesenteric adenitis?
Inflamed lymph nodes within the mesentery
What is the most common cause of anal itching in children?
Threadworms
What is the most common cause of ambiguous genitalia in children?
Congenital adrenal hyperplasia.
What are some signs of respiratory distress in children?
Head bobbing nasal flaring intercostal recessions tracheal tug 'tripoding'
What is bronchiolitis?
An LRTI mostly caused by RSV.
What is croup?
URTI most commonly caused by parainfluenza virus
What is whooping cough?
Which microorganism causes it?
Bacterial infection caused by Bordetella pertussis.
What do we often give in neonates to stimulate the respiratory centre?
Caffeine
How do you manage acute asthma in children?
OSHITME oxygen salbutamol hydrocortisone ipratropium bromide theophylline magnesium escalate
Why do we get worried in children who are having an asthma attack where CO2 levels are levelling?
Starting to get tired and retain CO2 rather than hyperventilating
How would you expect bronchiolitis to present?
Virus like symptoms
cough, wheezing, reduced feeding.
How would you manage a case of mild/ moderate croup?
Fluids
One off dose of dexamethasone.
What is the causative organism of epiglottis?
Hepatitis B.
Give three important initial questions to ask in history taking.
- Number of wet nappies (indicates hydration status)
- Waking up for feeds
- Maternal illness
Give 2 signs of cardiovascular compromie in a baby.
Cool peripheries
Mottled appearance
Give 3 ways of describing the anterior/ posterior fontanelles.
Soft (normal)
Sunken (dehydration)
Tense (raised intracranial pressure).
In a baby with infection, which are the three most appropriate initial investigations?
Bloods (FBC, U+Es, CRP, blood culture)
Urine sample
Lumbar puncture
NOT Stool culture.
In a newborn baby, what is the most likely pathogen for infection?
Group B Streptococcus.
Hypotonic, mottled and floppy baby point toward which diagnosis?
Sepsis.
Herpes simplex with CNS infection points toward which main diagnosis?
Encephalitis.
Name 3 signs of meningitis.
Non-blanching rash
neck stiffness
Fever
What is the most common causative microorganism of meningitis in neonates vs. babies >1month?
Neonates - Gp B Streptococcus, pneumococcus.
Babies >1 month - Meningococcus, pneumococcus.
What is the name of the virus that commonly causes bronchiolitis?
RSV - Respiratory syncytial virus.
How do children with cystic fibrosis typically present?
Failure to thrive
diarrhoea
respiratory symptoms
‘barking cough’ could be indicative of which respiratory diagnosis?
Croup.
Why would signs such as stridor and sternal recession point away from pneumonia?
They are signs of an upper airway problem.
How would pyelonephritis present?
Fever
Foul smelling, scanty urine
Tachycardia
If testicular torsion is confirmed in theatre, what is the next stage indicated?
Bilateral orchidopexy (fixation) as both sides are at risk.
Name one key risk factor for testicular torsion.
Undescended testis.
Is Molluscum contagiosum caused by bacteria or virus?
Virus. DNA pox virus.
What is the cause of epiglottitis in children?
Haemophilus influenza type B
Give 3 causes of developmental delay
Neglect, Cerebral palsy, iron deficiency
Which disorder typically describes poor social skills and repetitive behaviour?
Autism spectrum disorder
Describe 3 dysmorphism disorders
Down’s
Turner’s
Noonan’s
Give 2 causes of collapse in neonates
Sepsis
Congenital heart defect
Give 2 causes of jaundice in neonates
Physiological
Breast milk jaundice
Sepsis
Give 3 causes of rashes in children
Nappy rash
Mongolian blue spot (disappear by 3-5 years)
Give x1 main cause of a jittery baby
Hypoglycaemia
Give x3 differentials of breathing difficulty in a baby
Transient tachypnoea of newborn
Sepsis
Pneumonia
What causes ‘blue baby’?
Cyanotic CHD
Give x3 causes of a pre-term baby
Hypothermia Hypoglycaemia RDS Infection Anaemia
Give x3 causes of abdominal pain in a baby
Mesenteric adenitis
Appendicitis
Constipation
UTI
Give x2 differentials of limp/ joint pain.
Reactive arthritis
Trauma (NAI)
‘Purpura fulminans’ is due to which diagnosis?
Meningococcal meningitis
= skin necrosis and intravascular coagulation.
Give x3 eye problems in the infants
Otitis Media
Conjunctivitis
Pharyngitis
Give x3 causes of pallor in children
Iron deficiency anaemia
Beta Thalassaemia
SCA
Give x3 causes of short stature in children
Constitutional delay
Down’s syndrome
Hypothyroidism
Malnutrition
Which bacterium causes bronchiolitis?
RSV
Which bacteria cause UTIs?
E Coli, Klebisella, pseudomonas
Which viruses can cause a cold?
Rhinovirus, EBV.
Which disease presents similarly to Measles?
Kawasaki disease
Which are the three most common conditions in children?
Jaundice
Feeding difficulties
Gastroenteritis
Give 3 risk factors for sepsis
PROM (rupture of amniotic membranes)
Maternal Sepsis (mother had antibiotics during labour).
GBS
Give 3 red flags in infant/ children presentation.
Fever, headaches, vomiting.
What could fever, vomiting and headache indicate in a child?
Meningitis
What could fever, drooling and stridor indicate in a child?
Epiglottis
What can a sudden cough and wheeze indicate in a child?
Foreign body
Which are the four aspects of paediatric development?
Gross motor
Fine motor/ vision
Social skills
Speech and language
What would we expect at 6 weeks of development?
Social smile (visual issue if not)
Whooping cough is also known as what?
Pertussis
Which is one of the most common causes of abdominal obstruction in children?
Intussusception
What do we use to treat low potassium
KCl - potassium chloride.
What will the biochemical profile look like for someone who is dehydrated?
Low potassium, high sodium, low chloride.
Which is the virus responsible for the ‘slapped cheek rash’?
Parvovirus
Monospot test tests for:
Glandular fever (caused by EBV)
Which test is commonly used to diagnose Legionella and Salmonella?
Urinary antigen tests (antigen shedding in the urine).
What is normal and what is abnormal in haemophilia A?
Normal INR
Prolonged APTT
What is the most accurate way to assess degree of dehydration?
To calculate the difference between current weight and predicted weight
(rather than skin turgor, fontanelle etc.)
A 3-year-old boy attends the Paediatric A+E Department because he has developed an itchy rash whilst at a birthday party. Of the following features, which requires immediate treatment with 0.01 ml/kg of 1:1000 adrenaline i.m.?
Blood pressure of 88/50 Generalised urticaria Lip swelling Respiratory rate of 22/minute Wheeze on auscultation
Wheeze on auscultation
What is the first line of treatment for someone fitting in A+E?
Administer high flow oxygen.
; A-E approach (breathing)
A 15-month-old girl presents with a 3-day history of intermittent fevers and vomiting and poor feeding. On examination her temperature is 38.6 C but there are no localising signs. What is the most likely cause?
UTI; mainly because of poor feeding.
A three year old girl presents with a two day history of fever of 37.8º and inspiratory stridor. She has a loud barking cough which is worse in the night. What is the most likely diagnosis?
Croup.
VSD and overriding aorta point toward which diagnosis?
Tetralogy of Fallot.
Which is the diagnostic test for haemolytic anaemia?
G6PD level - enzyme involved in proper production of red blood cells.
What is haemolytic anaemia and wow may it present in a neonate?
Red blood cells are destroyed faster than they are made. Can often be due to G6PD enzyme deficiency.
What is the main immunological mediator for hereditary angioedema?
C1 esterase inhibitor.
Baby shows grunting and respiratory distress with a low oxygen saturation.
Chest X-ray shows reticulonodular shadowing. What is your first though for diagnosis?
Bacterial pneumonia.
Cardiac defects, oral candidiasis and tetany (hypocalcaemia) in the newborn. What is the most likely immunological deficiency?
T cells.
Di George syndrome shows cardiac defects, low calcium. Thymus gland is dysfunction in D- George syndrome = affects T cell production.
Turner syndrome is often associated with which cardiac abnormality?
Bicuspid aortic valve.
When using C3 and C4 as diagnostic indicators, what are we commonly testing for?
SLE
Give three causes of non-blanching rashes
Meningococcal sepsis
Henoch-Schonlein purpura
Haemolytic uraemic syndrome
A 7 year old girl with severe wheeze, a peak expiratory flow rate of 40% and a heart rate of 120 bpm presented to A+E an hour ago. She has been treated with burst therapy using Salbutamol and Ipratroprium Bromide but has had no response. What is the next most appropriate treatment?
Salbutamol iv.
A 14-year-old girl presents with a 5 day history of abdominal pain, submandibular and parotid gland enlargement, low grade fever and severe headaches. She has not received any antibiotics. On examination she is photophobic with neck stiffness, but is well perfused. She has no rash. On lumbar puncture the cerebrospinal fluid has normal protein and glucose, 50 WBC/ml (95% lymphocytes) and no RBC. What is the most likely diagnosis?
Mumps; submandibular nad parotid swelling!!
What does failure to thrive mean?
Failure to gain weight.
What are the main ways in which congenital hypothyroidism present?
Growth and development delay
What do we use to treat paracetamol overdose?
N-acetylcysteine.
‘briefly unresponsive’ seizure is what type?
Absence seizure: blank out for a few seconds.
What is the most likely immunological mediator of a positive result in a child whose mother has HIV
IgG antibodies.
Bulky urine and distended abdomen can be signs of which diagnosis?
Coeliac disease; poor absorption.
Which is a common medication used to treat bacterial infections in infants?
Ceftriaxone
Give the diagnosis of a swollen and prominent tibial tubercle with unremarkable x ray.
Osgood-Schlatter’s disease
A 14 year old girl is stung by a bee and develops urticaria within 20 minutes of the sting. What is the most likely immunological mediator?
IgE antibodies.
A 2 year old presents with frank haematuria, some abdominal pain and rigors. Which investigation is most likely to reveal the underlying diagnosis?
Urine M, C&S.
What does a basic clotting screen involve?
APTT
Blood film
INR
FBC
Which marker will be elevated in Haemophilia A?
APTT
Which marker will be elevated in Viral hepatitis?
INR
Where may we see pancytopaenia?
Acute Leukaemia
What will APTT and INR look like in Haemophilia A?
APTT = prolonged INR = normal
What is likely to be abnormal in Juvenile idiopathic arthritis?
Inflammatory markers (not bleeding abnormalities).
Which medication should be avoided in haemophilia?
NSAIDS; can affect platelet function.
Which is the most common vasculitis in children?
HSP.
Henoch Schonlein Purpura
What should hepatosplenomegaly indicate?
Leukaemia
Which are the two diagnostic factors for acute lymphoblastic leukaemia
High white cell count
Hepatosplenomegaly.
What is allopurinol used for?
Reduce uric acid levels e.g. in acute lymphoblastic leukaemia.
Which of the following is a sign of anaphylactic shock?
Lip swelling
Blood pressure 88/50
Wheeze on auscultation
Generalised urticaria
Wheeze on auscultation
Unconjugated jaundice will present how in the child?
Blood in the urine
Conjugated shows dark stool.
What does Hb electrophoresis look for?
Sickle cell anaemia and thalassaemia
Name a food which can trigger a haemolytic crisis?
Flava beans
What does prolonged rupture of membranes indicate?
Infection
Respiratory distress syndrome affects which babies?
Premature babies
only <37 weeks
Respiratory distress syndrome affects which babies?
Premature babies
(only <37 weeks)
;unusual for term babies to have surfactant deficiency i.e. the cause of RDS.
Is BP 110/65 normal in an infant?
No. This is high - check guidelines
When would we use adrenaline IV. compared with im?
Cardiac arrests
In acute wheeze how must magnesium sulphate be given?
IV; orally will only make the wheeze worse.
In acute wheeze how must magnesium sulphate/prednisolone be given?
IV; orally will only make the wheeze worse.
What will show on an xray for RDS?
Diffuse white shadowing
What is the upper limit of normal in which children should walk?
18 months
A 7-year-old boy has a red, slightly raised circular rash on the inside of his right thigh for one week. It is itchy and has got larger over the time. The rash shows a . A 2 x 3 cm erythematous, annular rash on inner right thigh. What will you prescribe?
This requires anti-fungal treatment.
e.g. Clotrimazole 1% application to the skin x3 a day.
Insulin should be omitted if oral intake is poor for children diagnosed with Type 1 Diabetes. True or false.
False; insulin should never be stopped.
What can we commonly prescribe for children with UTIs?
Nitrofurantoin
How many microgram in a mg?
1000 (to pay attention to in guidelines)
Which diuretic often causes hyperkalaemia?
Spironolactone
A 38-year-old man visits his GP. Last week he sustained a laceration to the lateral aspect of his left calf while at work on a construction site. Since then, an area of painful, red swelling has developed around the wound. There is well demarcated warm erythema. What would you prescribe?
Flucloxacillin
Which medications can you think of to treat cellulitis?
Flucloxacillin
Clarithromycin
Doxacyclin
Name x5 signs of cardiogenic shock.
Raised JVP
Crackles
Swollen ankles
Sacral oedema
Name 3 differentials for a child with shortness of breath.
Bronchiolitis
Croup (where there is stridor, barking cough)
Foreign object
Viral induced wheeze
What is the difference between mild/ moderate and severe asthma?
Mild/ moderate = <92% saturation
Severe/ life threatening = >92%
How do we manage moderate asthma compared with severe asthma?
Moderate asthma = Salbutamol puffs via spacer + prednisolone
How do we manage severe asthma?
Oxygen
Salbutamol nebuliser 2.5-5mg
Prednisolone
How do we manage life threatening asthma compared with severe asthma?
Life threatening = add Ipratropium bromide and 5mg salbutamol nebuliser
Give the four steps to managing acute asthma.
- Inhaled Salbutamol
- Nebulised salbutamol
- Ipratropium bromide
- Magnesium sulphate
- Steroids e.g. prednisolone
- IV salbutamol if no response to inhaled treatment.
5 year old. Initial examination shows a child who is sat up and audibly wheezy from the end of the bed. RR of 25, HR 115, SpO2 93% in air. He has mild subcostal recession. On auscultation of the chest you hear widespread polyphonic wheeze.
Given the likely diagnosis, what is the most appropriate initial management?
Salbutamol 2.5mg nebulised driven by air
Salbutamol 5mg nebulised driven by air
Salbutamol 2.5mg nebulised driven by oxygen
Salbutamol 5mg nebulised driven by oxygen
Salbutamol 10 puffs inhaled via spacer
Child has moderate asthma; >92%
RR <30
HR <125
= Salbutamol inhaled 10 puffs via spacer.
Define uncontrolled asthma.
> 3 days per week with symptoms
3 days per week requiring a SABA for symptom relief
<1 night per week awakening due to asthma cough.
A 5-year-old girl is brought into hospital due to shortness-of-breath. Her saturations are 93% with a peak expiratory flow rate of 40%. She is started on salbutamol. What is the most likely electrolyte derangement due to this medication?
Low salbutamol.
Salbutamol lowers potassium and is used in the treament of hyperkalaemia.
What are two main side effects of salbutamol?
Tachycardia
Tremor
Name the 3 main steps in acute anaphylaxis management:
- Secure airway, give 100% O2
- Give IM adrenaline
- Get IV access for hydrocortisone and fluids.
What is the most common complication of meningitis?
Otitis Media
Which two signs may we see in Meningitis?
Brudzinski’s sign = neck flexion to knee flexion
Kernig’s sign = pain on leg extension, severe stiffness
What is the name of the sign which describes neck flexion to knee flexion?
Brudzinski’s sign.
Where may we see Brudzinski’s sign?
Meningitis.
What is the name of the sign which describes severe pain and stiffness upon flexion of the leg up to 90 degrees?
Kernig’s sign
Where may we see Kernig’s sign?
Meningitis.
Which are the two main ways of diagnosign meningitis?
Sepsis screen
Lumbar puncture
Name four clinical signs of meningitis:
Headache, photophobia
Non-blanching rash
Brudzinski’s sign
Kernig’s sign
In which infections will there be high protein in the CSF?
Bacterial infections
What will the protein concentration look like in viral infections in CSF culture?
Low/ normal.
How will glucose concentrations compare in bacterial vs. viral infections?
Bacterial = low glucose Viral = high glucose
Give x2 contraindications for LP.
Airway compromise
Haemodynamically unstable
Signs of raised ICP
What is the most common cause of febrile seizures?
Roseola infantum.
(most febrile seizures are due to viral infections e.g. roseola infantum) in children.
What is Rovsing’s sign?
Palpation in left iliac fossa causes pain in the right iliac fossa.
Where is the pain primarily felt in appendicitis?
Central abdominal pain which spreads to the right iliac fossa.
Apart from appendicitis, which diagnosis can cause right iliac fossa pain?
Mesenteric adenitis.
How can we differentiate between appendicitis and mesenteric adenitis?
Mesenteric adenitis = no fever, no rebound tenderness.
‘drawing knees into chest’
‘red jelly like stool’
likely to describe which diagnosis?
Intusussception.
What is the management for intusussception?
Reduction via air inflation.
Where does intusussception most commonly occur?
Ileo-caecal region.
What is intussusception?
Invagination of one part of the bowel into the lumen of another part of the bowel.
Give some differentiates of abdominal pain in children.
Constipation Appendicitis Intusussception Mesenteric adenitis Diabetic Ketoacidosis (DKA) - NEVER FORGET THIS ONE!
How do we diagnose Diabetic ketoacidosis?
Blood glucose > 11mmol/L
Blood pH < 7.30
Bicarbonate < 15mmol/L
Blood ketones > 3mmol/L or urine ketones ++
Which are the four variables we look at when diagnosing DKA?
Blood glucose
Blood pH
Bicarbonate
Blood/urine ketones.
Are 15:2 compressions adult or paediatric BLS?
Paediatric BLS.
In paediatric BLS, how many rescue breaths do we give?
5 (vs. 2 in adult BLS).
How does paediatric BLS differ from adult BLS?
Paediatric BLS = 5 rescue breaths, 15:2 compressions
Adult BLS = 2 rescue breaths
30:2 compressions
Which vaccinations are required at 8 weeks?
Diptheria Tetanus Polio Pertussis HiB (Haemophilus influenzae B) Hepatitis B
Is jaundice in the newborn more likely to be due to unconjugated or conjugated bilirubin?
Unconjugated bilirubin.
How do we treat jaundice in the newborn?
Phototherapy = lowers bilirubin levels.
Give 3 causes of neonatal jaundice
PHYSIOLOGICAL (If resolves by day 10)
Infection
Haemolytic disease (increases bilirubin production)
Gilbert’s syndrome (reduces bilirubin clearance)
What is the name of the folds in Down’s syndrome?
Epicanthic folds.
A single palmar crease is associated with which condition?
Down’s syndrome.
What is the normal respiratory rate of the newborn?
40-60 breaths per minute.
What is Pectus Carinatum?
Protrusion of sternum and ribs.
Why does physiological jaundice occur?
Because babies have more red blood cells with shorter lifespan
A 1-year-old girl has not been responding when called, seemed agitated and has been
pulling on her ears for the last 4 days. What is the likely diagnosis? What would you prescribe?
Otitis Media.
Clarithromycin/ erythromycin; penicillin allergy.
What is a main difference between mild/ moderate and severe asthma attacks?
Mild/ moderate = RR <30, Sp02 >92%
Severe = RR >30, SpO2 < 92%
Which medication is prescribed for otitis media for those allergic to penicillin?
Clarithromycin.
What type of antibiotic is Clarithromycin?
A Macrolide.
Which medication is contraindicated to take with Clarithromycin?
Atorvastatin; Clarithromycin is a macrolide which inhibits cytochrome P450. Atorvastatin is cleared by cytochrome P450 enzymes so Clarithromycin can cause increased levels of statins in the blood.
What is the first line treatment for Polymyalgia rheumatica?
Prednisolone; raised ESR.
Which analgesic should be avoided in breast feeding?
Codeine; can cause breathing difficulties in the infant.
Give 5 indications for a CT head in children
Loss of consciousness lasting more than 5 minutes
>3 discrete episodes of vomiting
Amnesia more than 5 minutes
Focal neurological deficit
Clinical suspicion of non accidental injury
What is the normal age for bed wetting until?
5 years - desmopressin if short control is needed.
Therapeutic cooling is used for what in babies?
Prevent hypoxia and brain injury.
A 2-week-old baby boy presents to the emergency department with persistent vomiting. The father states that the child’s vomiting is ‘like a fountain’. What one investigation is most appropriate to help you confirm your suspected diagnosis?
Pyloric stenosis; projectile vomiting. Definitive test = ultrasound.
Name one cause of primary amenorrhoea. What is primary amenorrhoea?
Complete androgen insensitivity. Primary amenorrhoea = having never had a period.
What is secondary amenorrhoea?
Cessation of regular menses.
What is the most appropriate management of a neonate to reduce hypoxic ischemic encephalopathy (HIE)?
Therapeutic cooling
What are the signs of hand, foot and mouth disease and how do we treat?
Fever, mouth ulcers,
Treat with simple analgesia and hydration.
What is Candida dermatitis characterised by?
Typically an erythematous rash which involve the flexures and has characteristic satellite lesions
How would you describe psoriasis?
A less common cause characterised by an erythematous scaly rash also present elsewhere on the skin
Which is the most common cause of nappy rashes?
Irritant dermatitis
A two-week-old child is brought to the emergency department by his parents. He was slow to establish on feeds but was discharged home three days following delivery. During the past 7 hours he has been vomiting and the vomit is largely bile stained. On examination, he has a soft, distended abdomen.
Intestinal malrotation
A 4-week old baby is developing well and develops profuse and projectile vomiting after feeds. He has been losing weight and the vomit is described as being non-bilious.
Pyloric stenosis
A 1-day old child is born by emergency cesarean section for foetal distress. On examination, he has decreased air entry on the left side of his chest and a displaced apex beat. Abdominal examination demonstrates a scaphoid abdomen but is otherwise unremarkable
Displaced apex beat and decreased air entry are suggestive of diaphragmatic hernia. The abdomen may well be scaphoid in some cases. The underlying lung may be hypoplastic and this correlates directly with prognosis
What is the standard NaCl bolus dose?
20ml/kg.
Symmetrical contracting of his neck and drawing up of his legs, followed by extending of his arms. He repeats this movement around 50 times before stopping. ?Diagnosis
Infantile spasms - classically characterised by repeated flexion of head/arms/trunk followed by extension of arms.
When ‘repeated’ is mentioned = spasm.
What is a tonic clonic seizure?
Tonic-clonic seizures are characterised by a contracting of the musculature and then a rapid shaking of the muscles.
child with petechiae and no fever. Differential? There is no history of trauma and no relevant past medical history. The boy is afebrile with normal vital signs. He has petechiae over his lower limbs. There is no bony pain or splenomegaly.
Immune thrombocytopenia
Features of irritability and jitteriness, drowsiness and poor feeding point toward which diagnosis?
Hypoglycaemia.
What is the most likely risk factor for neonatal sepsis?
Group B streptococcus
What is a low birth weight?
<2.5kg
Describe the symptoms of Meningitis
Non blanching rash, fever, poor feeding, lethargy.
Atlantoaxial instability is a sign of which condition?
Down’s syndrome
jitteriness is a key sign of what in neonates?
Hypoglycaemia
What is Hirschsprung’s disease?
A functional obstruction = causes problem to cause meconium
Give 3 investigations for Hirschprung’s disease.
Abdominal x ray
Rectal biopsy
Management = bowel irrigation, rectal washouts
Neonatal hypotonia is associated with which condition?
Prader-Willi syndrome
Is bronchiolitis associated with a high or low grade fever?
Low grade fever.
Whooping cough is treated with what? Do we need to notify Public Health England?
Oral azithromycin. We do; is a notifiable disease.
Inspiratory cough, paroxysmal coughing fits and fever. Diagnosis?
Whooping cough.
Which is the most common cancer to affect children?
Acute lymphoblastic leukaemia.
Which are the features of bone marrow failure?
Anaemia - fatigue and pallor
Neutropenia - infection
Thrombocytopenia - bleeding
What is the typical distribution of atopic eczema in children?
Face and trunk
How do we manage Atopic eczema?
Avoid irritants
Simple emollients
Large amounts of emollients under wet bandages
In severe: oral ciclosporin
In suspected cow’s milk protein intolerance, what should the doctor try?
Extensive hydrolysed formula (proteins which trigger the allergy are hydrolysed)
Which are the main features to point toward a cow’s milk protein intolerance?
Rash and runny nose.
