Paediatrics

Question 1

1) What percentage of babies get physiological jaundice?
2) Cause of physiological jaundice?
3) When does it normally develop?

Answer 1

1) 60% term babies, 80% pre-term babies
2) RBC fragile - increased RBC lysis so increased bilirubin- liver too slow processing so build up of unconjugated bilirubin
3) First or second week of life

Question 2

What is considered pathological jaundice (7 categories)

Answer 2

1. Jaundice notable in first 24 hours of life
2. Requires phototherapy/ treatment
3. Rapid rise in bilirubin
4. Bilirubin related encephalopathy
5. Jaundice on palms or soles
6. Prolonged jaundice (more than 2 weeks for term, 3 weeks for prem)
7. Conjugated hyperbilirubinaemia

Question 3

What are the causes of pathological jaundice and when do they typically present?

Answer 3

1. PRE-HEPATIC: ie increased haemolysis: Rhesus or ABO incompatability, RBC abnormality such as spherocytosis, polycythaemia, cephalohaematoma. Normally within 1st week of life
2. HEPATIC: ie delayed processing (conjugation) of RBC- enzyme deficiency eg Gilbert’s or dysfunction eg crigler najjar. congential hypothyroidism, galactosaemia- Normally after 1st week of life
3. POST HEPATIC: obstruction (atresia, stenosis, meconium ileus look at stool, breast feeding failure (causes inadequate gut function so not clearing), or breast milk jaundice (BM contains enzyme that slows conjugation

Question 4

Newborn baby check:
1. What are you looking for in eyes? What is referral timeline if anything is found?
2. What are you looking for in heart exam? What is referral timeline if anything found?

Answer 4

1. Check for symmetry & looking for red reflexes- absence may suggest cataracts. White reflex may be sign of retinoblastoma. Refer to opthalmology to be seen by 11 weeks.
2. Listen for murmur, check femorals, feel for apex. Refer if abnormality, urgency depends on clinical picture.

Question 5

MMR vaccine:
1) When is this usually given?
2) How should it be given if missed planned vaccination?
3) Live/ not live?
4) Contraindications?

Answer 5

1) 12-15m & 3-4y
2) Dose immediately then another in 3m, can be given as little as 1m if >10y or urgent situation eg outbreak
3) Live vaccine
4) Other live vaccine within past 4 weeks, immunocompromised, allergy to neomycin

Question 6

UTI in children:
1) Which children require an USS?
2) How should UTI be confirmed?
3) What is micturating cystourethrography (MCUG) used to diagnose and when should it be performed?

Answer 6

1) <6m - need USS within 6 weeks OR >6m and feature of atypical UTI:
Atypical UTI: very unwell, raised creatinine, non E.coli bug, abdominal/ pelvic mass felt, poor urinary flow, failure to respond to Abx in 48h, septicaemia
2) MSU (many kids don’t have WCC so urinalysis insufficient)
3) Detects VU reflux- used for <6m with recurrent or atypical UTI’s

Question 7

What is the school exclusion policy for the following illnesses?
1) Pertussis
2) Glandular Fever
3) Mumps
4) Fifth disease
5) Chickenpox

Answer 7

1) 48h after Abx started or 21 days from onset if no Abx
2) No exclusion
3) 5 days after swelling of glands started
4) No exclusion
5) Until lesions have crusted over

Question 8

What is the school exclusion policy for the following conditions?
1) Threadworms
2) Impetigo
3) Head lice
4) Scabies
5) Scarlet fever

Answer 8

1) None
2) Until lesions crusted and healed or 48h after starting Abx
3) None
4) Until treated
5) 24hours after starting Abx

Question 9

What is the school exclusion criteria for the following illnesses:
1) Rubella
2) Measles
3) Hand, foot & mouth
4) Roseola
5) D&V

Answer 9

1) 5 days from rash onset
2) 4 days from rash onset
3) No exclusion
4) No exclusion
5) 48h until last symptom

Question 10

What are the 1) clinical features 2) associated conditions of Downs syndrome?

Answer 10

Features: Hypotonia, Hyperreflexia, palpebral fissures, high arched palate, protruding tongue, single palma crease, brushfields spots in eyes, sandle gap toe
Associated conditions: cataracts, otitis media, deafness, laryngomalacia/ tracheo-oesphageal fistula, learning disability, hypothyroidism, transient myelodysplasia, leukaemia, polycythaemia, hip dislocation, congenital heart disease (most common AVSD, OSA, Coeliac, hirschprungs

Question 11

What are the clinical features of fragile X syndrome?
Does it affect fertility?

Answer 11

Learning disability, developmental delay, large testicles, high forehead, mitral valve prolapse, flexible fingers, facial asymmetry and long ears.
Can cause premature ovarian failure in females and sperm insufficiency in male.

Question 12

Klinefelter’s:
1) Clinical features?
2) Associated conditions?
3) Fertility?
4) Management

Answer 12

1) Tall, small testicles, infertility, central obesity, gynaecomastia, reduced body hair, tiredness, low muscle strenght low testosterone, high FSH/LH
2) T2DM, metabolic syndrome, CVD, Autoimmune conditions, breast cancer, osteoporosis, germ cell tumours,
3) If mosacism may be able to conceive
4) Testosterone replacement (reduces risk of associated conditions)

Question 13

Edward’s syndrome:
1) Which trisomy?
2) Diagnosis?
3) Features?

Answer 13

1) 18
2) Antenatally via CVS - thick nuchal scan, typical findings on USS
3) Microcephaly, rockerbottom feet, cleft palate, congenital heart disease, oomphacele, duodenal atresia, learning disablility, seizures, urological abnormalities, micrognathia, low set ears, pulmonary hypoplasia and more.