Paediatrics

Question 1

Where is the ductus arteriosus?

Answer 1

Between the aorta and pulmonary artery

Question 2

Where is the foramen ovale?

Answer 2

Between the right and left atrium (allows bloodflow from right to left)

Question 3

What age gestation is considered premature?

Answer 3

35wks gestation

Question 4

What is the most common cause of liver transplant in children?

Answer 4

Biliary atresia

Question 5

What is biliary atresia?

Answer 5

Ideopathic cause, progressive destruction of the extrahepatic biliary system (common hepatic and common bile ducts)

Question 6

What are the three types of biliary atresia?

Answer 6

Type 1: common bile duct atresia
Type 2: atresia of hepatic ducts
Type 3: porta hepatis atresia (entry point of vessels and ducts to liver). Most common.

Question 7

What are the clinical features of biliary atresia?

Answer 7

Jaundice from birth-8wks
Pale stools
Dark urine
Hepatomegaly

Question 8

How is biliary atresia diagnosed (gold standard investigation)?

Answer 8

Intraoperative cholangiogram showing biliary obstruction.

Question 9

What is the initial management for biliary atresia?

Answer 9

Hepatoportoenterostomy (Kasai procedure).

Aims to restore bile flow from the biliary system to the intestines. A roux-en-Y loop of small intestine is anastomosed directly to the hilum of the liver after excision of the remnant biliary system. The proximal end of the intestine at the point of excision is then rejoined side-on.

Patients will likely eventually need liver transplant

Question 10

Is bronchiolitis an upper or lower respiratory tract infection?

Answer 10

Lower

Question 11

How do patients with bronchiolitis present?

Answer 11

Cough
Reduced oral intake
Wheeze and crepitations on auscultation
Dehydration
Increased respiratory effort

Question 12

How is bronchiolitis managed?

Answer 12

Supportive management:
General: Children should be made as comfortable as possible (held in a parent’s arms or sitting in a position of comfort)
Anti-pyretics: e.g. paracetamol, ibuprofen if fever causing distress
Airways: Consider nasal saline drops or nasal/oral suctioning
Fluids: Maintenance of hydration with oral fluids. If advanced may require IV
Oxygen: Supplemental humidified oxygen to maintain saturations > 92%. CPAP or mechanical ventilation for those in severe respiratory distress

Abx only if cause is bacterial not viral

Question 13

What is the most common cause of bronchiolitis?

Answer 13

Respiratory synctial virus (RSV)

Question 14

How would a patient with perthes disease present?

Answer 14

Atraumatic hip pain (usually unilateral) and a limp

Question 15

A 4 year boy presents with an abnormal gait. He has a history of recent viral illness. His WCC is 11 and ESR is 30.

What is the most likely diagnosis?

Answer 15

Transient synovitis

Question 16

A 6-year-old boy presents with an groin pain. He is known to be disruptive in class. He reports that he is bullied for being short. On examination he has an antalgic gait and pain on internal rotation of the right hip.

What is the most likely diagnosis?

Answer 16

Perthes disease

Question 17

An obese 12-year-old boy is referred with pain in the left knee and hip. On examination he has an antaglic gait and limitation of internal rotation. His knee has normal range of passive and active movement.

What is the most likely diagnosis?

Answer 17

Slipped upper femoral epiphysis

Question 18

A 4-year-old girl with a three month history of a limp. Her parents report that she has ‘not been right’ for a few weeks now. She typically complains of pain in her left hip and right knee in the morning which gets better during the day.

What is the most likely diagnosis?

Answer 18

Juvenile idiopathic arthritis

Question 19

A 7-year-old boy is brought in by his mother. For the past day he has felt generally unwell with a headache and nausea. This morning he complained of pain in his right hip and now just able to walk with a limp. On examination flexion, extension and rotation of the hip is painful and limited. Examination of the ears, throat and chest is normal. His temperature is 38.2ºC.

What is the most likely diagnosis?

Answer 19

Septic arthritis

Question 20

6-year-old boy with a limp. His parents report that this has been getting steadily worse over the past few weeks. He complains of pain in the right groin/hip region. An x-ray shows widening of the right hip joint space with flattening of the femoral head.

What is the most likely diagnosis?

Answer 20

Perthes disease

Question 21

A 7-year-old with a one day history of a painful right hip. Just about able to walk but painful. Looks flushed and has a temperature of 38.7ºC

What is the most likely diagnosis?

Answer 21

Septic arthritis/osteomyelitis

Question 22

An 8-month-old child is noted to have a discrepancy between the skin creases behind the right and left hips

What is the most likely diagnosis?

Answer 22

Development dysplasia of the hip

Question 23

An obese 13-year-old boy presents with a two week history of right sided knee pain associated with a stiff right hip. There is no history of trauma

What is the most likely diagnosis?

Answer 23

SUFE (Slipped upper femoral epiphysis)

Question 24

An obese 14-year-old boy presents with difficulty running and mild knee and hip pain. There is no antecedent history of trauma. On examination internal rotation is restricted but the knee is normal with full range of passive movement possible and no evidence of effusions. Both the C-reactive protein and white cell count are normal.

What is the most likely diagnosis?

Answer 24

SUFE (Slipped upper femoral epiphysis)