Paediatrics

Question 1

What are three features of an innocent murmur

Answer 1

Innocent murmurs arise from increased velocity of blood flow through a tstructurally normal heart.

Features are

1: soft <2/6 intensity
2: ejection systolic (short duration)
3: minimal radiation
4: musical quality
5: changes with childs position

Question 2

Ddx acute scrotal pain or swelling (5)

Answer 2

Testicular torsion
Torsion of testicular appendage 
Irreducible hernia 
Epididymo orchitis
Testicular or epididymal rupture

Question 3

Features of testicular torsion

Answer 3

Pubertal age group (rarely neonates)
Pain is sudden and severe (may radiate to iliac fossa or thigh)
Nausea and vomiting common 
High-riding or horizontal testicle
Tender to palpate
Cremasteric reflex usually absent

Question 4

Features of torsion testicular appendage

Answer 4

Pre-pubertal (7-12yo)
Pain usually sudden, minimal at rest 
Nausea and vomiting uncommon 
Normal position of testis
Focal tenderness of upper pole of testicle

Question 5

Influenza vaccination for kids

Answer 5

2 doses for primary course for kids 6 months - 9yo spaced 4 weeks apart
Then single dose annually after that

Question 6

Communication milestones

Answer 6

6mo: should be babbling (ooh, ahh)
9mo: should use 2 part babble (mama, dada)
should be using gestures (pointing, waving, showing)
12months: should have babbled phrases that sound
like talking
should respond to familiar words
18 mo: should have some clear words
should understand short requests (‘wheres the ball?’)
2yo: should put 2 words together
should be learning new words
3yo: familiar people should understand speech
should use simple sentences
4yo: speech should be understood by most people
should be able to follow 2 step commands
5yo: should answer simple questions
should be able to tell parents what is wrong

Question 7

Erythema infectiosum (slapped cheek)

Answer 7

Parvovirus B19
Mild fever and headache
Bright red, firm, hot rash on cheeks 
>followed by pink lace rash on limbs and sometimes trunk 
Not infectious by the time rash appears

Question 8

Hand, foot and mouth

Answer 8

Coxsackie virus
Mild fever, sore throat, LOA, malaise, swollen LN, mild diarrhoea
Small vesicles and painful ulcers around mouth, palate and pharynx
Flat red macules around bottom and genitalia

Blisters infective until dry

Question 9

Scarlet Fever

Answer 9

Group A Strep
Recent impetigo or sore throat
Sudden fever, cervical LN, swollen red strawberry tongue, abode pain, body aches
Rash appears 12-48 hr after fever
Looks like sunburn with goose pimples, rough, sandpaper feel’

Question 10

Measles

Answer 10

fever, malaise, LOA
conjunctivitis
Koplik spots (D2-3)
Rash starts on face and behind ears - spreads to body, palms and soles are rarely involved

Question 11

Roseola

Answer 11

HHV6/7
Mild illness, benign, self limiting
Raised, red rash starts on body and spreads to limbs, face rarely involved
Not contagious once symptoms have appeared

Question 12

Which childhood exanthems are no longer infectious by the time the rash appears?

Answer 12

Roseola (HHV6/7)

Erythema infectiosum/slapped cheek (Parvovirus B19)