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Phase 3a > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are the organisms causing newborn pneumonia?

A

Group B streptococcus from mother’s genital tract
Gram-neg enterococci

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2
Q

What organisms cause pneumonia in infants and young children?

A

Respiratory viruses (RSV in particular)
Streptococcus pneumonia
Haemophilus influenza
Bordetella pertussis

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3
Q

What organisms cause pneumonia in children over 5

A

Mycoplasma pneumoniae
Streptococcus pneumoniae
Chlamydia pneumoniae

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4
Q

What are the classic signs of consolidation?

A

Dullness on percussion
Decreased breath sounds
Bronchial breathing over the affected area

(these are often absent in young children)

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5
Q

What is the antibiotic of choice for pneumonia

A

Amoxicillin or erythromycin for over 5 year olds
Co-amoxiclav if complicated or unresponsive

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6
Q

What is the defect in cystic fibrosis

A

Defective protein in the cystic fibrosis transmembrane conductance regulator (CFTR) on chromosome 7

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7
Q

What is CFTR

A

A cyclic AMP-dependent chloride channel

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8
Q

What is the pathophysiology of CF?

A

Abnormal ion transport across epithelial cells

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9
Q

What are the other complications of CF apart from resp?

A

Meconium ileus
Blocks pancreatic ducts - pancreatic enzyme deficiency and malabsorption
Abnormal sweat gland function

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10
Q

What is the diagnostic test for CF

A

The sweat test - high chloride concentration
And gene testing

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11
Q

What is the most common causative organisms for peri orbital cellulitis

A

Staphylococcus Aureus
Group A strep
Haemophilus Influenzae

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12
Q

What should be excluded in diagnosis of a squint

A

Retinoblastoma - check red reflexes
Cataracts

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13
Q

After how many months old should a baby with a squint be referred to a specialist?

A

3 months - newborn babies normally have transient misalignments

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14
Q

What are the two types of squints?

A

Concomitant (usually due to a refractive error in one eye)
Paralytic (sinister causes such as a space-occupying lesion)

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15
Q

How to test for a squint with a pen-torch

A

Red reflex in both eyes at the same time - if not, there is a squint

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16
Q

Severe GORD is more common in children with what?

A

Cerebral palsy and neurodevelopment disorders
Preterm infants
Following surgery fro oesophageal atresia or diaphragmatic hernia

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17
Q

Complications of GORD

A

Failure to thrive due to severe vomiting
Oesophagitis
Recurrent pulmonary aspiration
Dystonic neck posturing
Apparent life-threatening events (ALTE)

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18
Q

How is failure to thrive defined on a growth chart?

A

Mild: a fall across 2 centile lines
Severe: a fall across 3 centime lines

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19
Q

Causes of failure to thrive

A

Inadequate intake
Inadequate retention
Malabsorption
Failure to utilise nutrients
Increased requirements

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20
Q

What is marasmus

A

Weight for height 3 standard deviations below the median and a wasted, wizened appearance
Skin-fold appearance and id-arm circumference markedly reduced

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21
Q

What is Kwashiorkor

A

Severe protein malnutrition with generalised oedema as well as severe wasting. Weight may not be reduced due to oedema
Can happen when infants are weaned from the breast quite late or if diet is high in starch

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22
Q

Features of Kwashiorkor

A

‘Flaky-paint’ skin rash with hyper keratosis and desquamation
Distended abdomen and enlarged liver
Angular stomatitis
Hair which is sparse and depigmented
Diarrhoea, hypothermia, bradycardia and hypotension
Low plasma albumin, potassium, glucose and magnesium

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23
Q

Management of severe acute malnutrition

A

Hypoglycaemia
Hypothermia
Dehydration (but avoid being overzealous with IV fluids as can lead to heart failure)
Electrolytes
Infection
Micronutrients

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24
Q

What is Hirschprung disease

A

The absence of myenteric plexuses of rectum and variable distance of colon. Causes a narrow, contracted segment

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25
Q

How does Hirschsprung disease present

A

Intestinal obstruction in the newborn period following delay in passing meconium. Or in later childhood - profound chronic constipation, abdominal distension and growth failure. Digital rectal exam can cause a release of stool and flatus

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26
Q

How does Meckel diverticulum present

A

Generally asymptomatic, but may present with bleeding, intussusception, volvulus or diverticulitis

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27
Q

What is biliary atresia

A

Destruction or absence of the extra hepatic biliary tree and intra-hepatic biliary ducts. Untreated, it leads to chronic liver failure and death.

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28
Q

What is the surgical management of biliary atresia?

A

Hepatoportoenterostomy (Kasai procedure) to bypass the fibrosed ducts

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29
Q

What are choledochal cysts?

A

Cystic dilatations of the extra hepatic biliary system

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30
Q

How do choledochal cysts present?

A

In infancy with cholestasis. In older age, present with abdominal pain, a palpable mass, jaundice or cholangitis.

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31
Q

How does neonatal hepatitis syndrome present?

A

Prolonged neonatal jaundice and hepatic inflammation
May have intrauterine growth restriction and hepatosplenomegaly at birth

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31
Q

How does neonatal hepatitis syndrome present?

A

Prolonged neonatal jaundice and hepatic inflammation
May have intrauterine growth restriction and hepatosplenomegaly at birth

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32
Q

What can cause neonatal hepatitis syndrome

A

Alpha1-antitrypsin deficiency
Galactosaenia
+ other causes

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33
Q

Causes of acute liver failure in children

A

Paracetamol overdose
non-A to G viral hepatitis
Metabolic conditions

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34
Q

How does acute liver failure in children present?

A

Jaundice
Encephalopathy
Coagulopathy
Hypoglycaemia
Electrolyte disturbance

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35
Q

Investigation findings in acute liver failure

A

Very high transaminases
Very abnormal coagulation
Elevated plasma ammonia

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36
Q

What are the complications of acute liver failure

A

Cerebral oedema
Haemorrhage from gastritis or coagulopathy
Sepsis
Pancreatitis

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37
Q

Management of acute liver failure

A

Maintain blood glucose - IV dextrose
Prevent sepsis - broad spectrum Abx and antifungals
Prevent haemorrhage - IV vit K, fresh frozen plasma or cryoprecipitate and H2-blocking drugs or PPIs
Treat cerebral oedema - fluid restrict and mannitol diuresis
LIVER TRANSPLANT

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38
Q

What medication is Reye syndrome linked to

A

Aspirin in under 12s

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39
Q

What is Reye syndrome

A

Acute non-inflammatory encephalopathy with micro vesicular fatty infiltration of the liver

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40
Q

When do you consider treatment for nocturnal enuresis

A

After 6 yrs old

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41
Q

What is the management for nocturnal enuresis

A

Star charts
Enuresis alarm
Sometimes desmopressin

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42
Q

Pre-renal causes of acute renal failure (most common in children)

A

Hypovolaemia (D&V, burns, sepsis, haemorrhage, nephrotic syndrome)
Circulatory failure

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43
Q

Renal causes of acute renal failure

A

Vascular (haemolytic uraemia syndrome, vasculitis, embolus, renal vein thrombosis)
Tubular (acute tubular necrosis, ischaemic, toxic, obstructive)
Glomerular (glomerulonephritis)
Interstitial (interstitial nephritis, pyelonephritis0

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44
Q

Post-renal causes of acute renal failure

A

Obstruction (congenital or acquired)

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45
Q

What is haemolytic uraemic syndrome?

A

Triad of:
Acute renal failure
Haemolytic anaemia
Thrombocytopaenia.

Often occurs after an infectious diarrhoea like Shigella

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46
Q

Causes of chronic renal failure in children

A

Structural malformations
Glomerulonephritis
Hereditary nephropathies
Systemic diseases

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47
Q

Features of chronic renal failure in children

A

Anorexia and lethargy
Polydipsia and polyuria
Failure to thrive/growth failure
Bony deformities from renal osteodystrophy (renal rickets)
Hypertension
Acute-on-chronic renal failure (precipitated by infection or dehydration)
Incidental finding of proteinuria
Unexplained normochromic, normocytic anaemia

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48
Q

What does acute nephritis lead to:

A

Decreased urine output and volume overload
Hypertension, which may cause seizures
Oedema, characteristically around the eyes
Haematuria and proteinuria

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49
Q

What can cause nephritic syndrome (acute nephritis)?

A

Post-streptococcal or post-infectious nephritis
Henoch-schönlein Purpura (or other types of vasculitis)
IgA nephropathy and mesangiocapillary glomerulonephritis
Anti-glomerular basement membrane disease (Goodpasture syndrome)
Familial (Alport syndrome. An X-linked recessive)

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50
Q

Signs and symptoms of Henoch-Schönlein purpura

A

Rash - buttocks, extensor surfaces of legs and arms, ankles
Joint pain and swelling
Abdo pain (haematemesis and melaena, intussusception)
Renal (microscopic/macroscopic haematuria, nephrotic syndrome)

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51
Q

What is hereditary angioedema

A

Rare autosomal dominant
No urticaria but subcutaneous swellings with abdominal pain.
Usually triggered by trauma
Can cause resp obstruction
Can be treated in the short term with fresh frozen plasma replacement

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52
Q

What is erythema nodosum

A

Tender nodules over the legs
Often also have a fever and arthralgia

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53
Q

Causes of erythema nodosum

A

Streptococcal infection
Primary TB
IBD
Drug reaction
Idiopathic

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54
Q

What is erythema multiforme

A

Target lesions with a central papule surrounded by an erythematous ring. Lesions may also be vesicular or bullous

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55
Q

Causes of erythema multiforme

A

HSV

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56
Q

What is the age range for febrile seizures?

A

6 months to 6 years old

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57
Q

Febrile seizures don’t normally increase risk of epilepsy. What types of febrile seizures do?

A

Focal, prolonged or repeated in the same illness. Need to rule out intracranial infection like meningitis or encephalitis

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58
Q

What is the age of onset for West syndrome (epileptic syndrome)

A

4-6 months

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59
Q

What is the age of onset for Lennox-Gastaut syndrome (epileptic syndrome)

A

1-3 years

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60
Q

What is the age of onset for childhood absence epilepsy?

A

4-12 years

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61
Q

What is the age of onset for benign epilepsy, with centrotemporal spikes (BECTS)

A

4-10 years

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62
Q

What is the age of onset for early-onset benign childhood occipital epilepsy?

A

1-14 years

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63
Q

What is the age of onset for juvenile myoclonic epilepsy

A

Adolescence-adulthood

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64
Q

What can absence seizures be induced by?

A

Hyperventilation

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65
Q

What is the prognosis for childhood absence seizures

A

95% remission in adolescence, 5-10% develop tonic-clonic seizures in adult life

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66
Q

What is the treatment for West syndrome (epileptic syndrome)

A

Corticosteroids or vigabatrin

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67
Q

What is the first line drug for focal seizures?

A

Lamotrigine

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68
Q

What two features of development are autistic children grossly delayed in?

A

Social skills
Communication skills

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69
Q

What is the limit age for sitting without support?

A

9 months (median is 6 months)

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70
Q

What is the limit age for pushing up on arms and holding head up

A

3 months (median is 6 weeks)

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71
Q

What is the median age fro cruising around furniture

A

9-10 months (limit is 13 months)

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72
Q

What are the median and limit ages for fixing and following?

A

6 weeks
3 months

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73
Q

What are the median and limit ages for reaching out for toys

A

4 months
6 months

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74
Q

What are the median and limit ages for transferring between hands?

A

7 months
9 months

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75
Q

What are the median and limit ages for pincer grip

A

10 months
12 months

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76
Q

What are the median and limit ages for polysyllabic babble

A

3-4 months
7 months

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77
Q

What are the median and limit ages for indiscriminate consonant babble (dada, mama)

A

7 months
10 months

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78
Q

What are the median and limit ages for saying 6 words with meaning

A

12 months
18 months

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79
Q

What is the limit age for joining words

A

2 years

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80
Q

What is the limit age for 3 word sentences

A

2 1/2 years

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81
Q

What are the median and limit ages for a responsive smile

A

6 weeks
8 weeks

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82
Q

What are the median and limit ages for symbolic play

A

18-24 months
2-2 1/2 years

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83
Q

What are the median and limit ages for interactive play

A

2.5-3 years
3-3.5 years

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84
Q

Features of fractures that are likely to be inflicted

A

Fracture in an immobile child
Rib fractures
Multiple fractures
Multiple fractures of different ages

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85
Q

Features of bruises that are likely to be inflicted

A

Shape of a hand or object
On neck like strangulation
Wrists or ankles that look like ligature marks
Bruises to the buttocks in a child less than 2 years or any age without a good explanation

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86
Q

Features of burns that are likely to be inflicted

A

Any burn in a child who is not mobile
A burn in the shape of an implement - cigarette, iron
A ‘glove or stocking’ burn consistent with forced immersion

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87
Q

Features of bites that are likely to be inflicted

A

Bruising in the shape of a bite thought unlikely to have been caused by a young child

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88
Q

What investigation should be done in patients you suspect physical abuse fractures?

A

Full radiographic skeletal survey with oblique views of the ribs if under 30 months of age (2.5 yrs old)

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89
Q

What medical conditions should you consider in suspected child abuse?

A

Coagulation disorders
Osteogenesis imperfecta
Scalds and cigarette burns - may be bullies impetigo or scalded skin syndrome

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90
Q

What investigations should be done in suspected brain injury

A

CT immediately followed by MRI
Skeletal survey
Expert ophthalmological examination to identify retinal haemorrhages
Coag screen

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91
Q

What chromosomal abnormality is present in Edward’s syndrome

A

Trisomy 18

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92
Q

What chromosomal abnormality is present in Patau’s syndrome

A

Trisomy 13

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93
Q

Clinical features of Edwards syndrome

A

Low birthweight
Prominent occiput
Small mouth and chin
Short sternum
Flexed, overlapping fingers
Rocker-bottom feet
Cardiac and renal malformations

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94
Q

Clinical features of Patau’s syndrome

A

Structural defect of brain
Scalp defects
Small eyes(microphthalmia) and other eye defects
Cleft lip and palate
Polydactyly
Cardiac and renal malformations

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95
Q

What is the prevalence of fragile X syndrome

A

1 in 4000

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96
Q

What causes fragile x syndrome

A

CGG trinucleotide repeat expansion
Normal is below 50 repeats
Pre-mutation is 55-199
Full mutation is 200 +

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97
Q

Do female carriers of fragile x syndrome experience any symptoms

A

50% do and have mild to moderate learning difficulties

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98
Q

What are some of the characteristic facies of someone with fragile X

A

Protruding/everted ears
Long face
Prominent mandible
Broad forehead

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99
Q

What are the non-facial features of fragile X

A

Macrocephaly
Macro-orchidism
Mitral valve prolapse, joint laxity, scoliosis, autism, hyperactivity

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100
Q

What are the clinical features of Noonan syndrome

A

Occasional mild learning difficulties
Short webbed neck with trident hair line
Pectus excavatum
Short stature
Congenital heart disease (especially pulmonary stenosis, atrial septal defect)
Characteristic facies

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101
Q

What is the inheritance pattern for Noonan syndrome

A

Autosomal dominant

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102
Q

What are the clinical features of Williams syndrome

A

Short stature
Transient neonatal hypercalcaemia (occasionally)
Congenital heart disease (supravalvular aortic stenosis)
Mild to moderate learning difficulties
Characteristic facies

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103
Q

Signs of respiratory distress in a neonate

A

Tachypnoea (>60 breaths/min)
Laboured breathing, with chest wall recession (particularly sternal and subcostal indrawing) and nasal flaring
Expiratory grunting
Cyanosis if severe

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104
Q

Is meconium passed more frequently the more pre term or the more term

A

The greater the gestational age, affecting 20-25% of deliveries by 42 weeks

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105
Q

Meconium causes resp distress in two ways. What are they

A

Mechanical obstruction
Chemical pneumonitis (it is a lung irritant)

106
Q

What are the chest X-ray signs of meconium aspiration

A

Overinflation
Patches of consolidation and collapse
High incidence of pneumothorax and pneumomediastinum
May develop PPH of he newborn

107
Q

What is the main complication of diaphragmatic hernia

A

Pulmonary hypoplasia due to fatal development being prevented (high mortality)

108
Q

What is the most common cause of respiratory distress in term infants

A

Transient tachypnoea of the newborn - due to delay in resorbing lung liquid, more common after a C-section

109
Q

What can RDS cause in the lungs

A

PIE pulmonary interstitial emphysema
Or
Pneumothorax due to overdistended alveoli - increased O2 requirement and reduced breath sounds and chest movement. Use lowest pressures possible to prevent pneumothorax.

110
Q

What is bronchopulmonary dysplasia

A

Chronic lung disease - oxygen still required at post-menstrual age 36 weeks

111
Q

What are the CXR findings in bronchopulmonary dysplasia

A

Widespread areas of opacification (fibrosis), sometimes with cystic changes

112
Q

Grades of HIE

A

Mild - irritable infant, responding excessively to stimulation, staring or the eyes, hyperventilation, impaired feeding
Moderate - marked abnormalities of tone and movement, cannot feed and may have seizures
Severe - no normal spontaneous movements or response to pain. Fluctuate from hypotonia to hypertonia, prolonged seizures, multi-organ failure.

113
Q

What does TORCH stand for

A

Toxoplasmosis
Other agents (parvovirus, VZV, Syphilis)
Rubella
Cytomegalovirus
Herpes simplex Virus

114
Q

What does Rubella cause before 8 weeks gestation

A

Deafness
Congenital heart disease
Cataracts
(in over 80%)

115
Q

Beyond what gestational age is the risk of Rubella to the foetus minimal?

A

18 weeks

116
Q

What can congenital cytomegalovirus cause at birth

A

Hepatosplenomegaly
Petechiae
Most will have neurodevelopment disabilities such as sensorineural hearing loss, cerebral palsy, epilepsy and cognitive impairment

90% are normal at birth

117
Q

How can Toxoplasma gondii be transmitted

A

Consumption of raw or undercooked meat
Contact with faeces of recently infected cats

118
Q

While rare, what are the clinical features of toxoplasmosis in an infected infant?

A

Retinopathy, an acute fundal chorioretinitis which sometimes interferes with vision
Cerebral calcificaiton
Hydrocephalus
(long term neurological disabilities)

119
Q

What is the treatment regime for infants infected with toxoplasmosis

A

Pyrimethamine
Sulfadiazine
1 year

120
Q

What periods in the pregnancy is the foetus at risk if the mother develops chickenpox?

A

First half of pregnancy (small risk of severe scarring of skin and possible ocular and neurological damage and digital dysplasia)
Within 5 days before or 2 days after delivery - 25% develop a vesicular rash with a mortality as high as 30%

121
Q

While rare, what are the specific clinical features of congenital syphilis

A

Rash on soles of feet and hands
Bone lesions.
If mother is treated at least 1 month before delivery, foetus protected

122
Q

Clinical features of TORCH infection

A

Growth restriction
Eye defects
Pneumonitis
Hepatomegaly
Virus in urine
Bone abnormalities
Intracerebral calcification
Hydrocephalus
Microcephalus
Deafness
Heart defects
Splenomegaly
Rash: blueberry muffin or petechial
Anaemia
Neutropenia
Thrombocytopenia

123
Q

What is a risk factor for necrotising enterocolitis in pre terms

A

Cows milk formula

124
Q

Symptoms of NEC

A

Infant stops tolerating feeds
Bile-stained vomit
Distended abdomen
Stool sometimes containing fresh blood
Shock

125
Q

Characteristic signs on Xray of NEC

A

Distended loops of bowel and thickening of the bowel wall with intramural gas

126
Q

What is the treatment for NEC

A

Stop oral feeding
Broad spectrum antibiotics
Parenteral nutrition
Artificial ventilation and circulatory support
Surgery if perforated bowel

127
Q

What is gastroschisis

A

Bowel protruding through a defect in the anterior abdominal wall adjacent to the umbilicus with no covering sac

128
Q

What are the risks of gastroschisis

A

Dehydration
Protein loss

129
Q

What is oesophageal atresia usually associated with?

A

Tracheo-oesophageal fistula
Polyhydramnios

130
Q

How does oesophageal atresia present?

A

Drooling and persistent salivation
Coughing and choking when fed and having cyanotic episodes

131
Q

What trisomy is duodenal atresia associated with?

A

Down’s syndrome

132
Q

Why does maternal hyperglycaemia cause macrosomia?

A

Glucose crosses the placenta but insulin doesn’t, causing an increased insulin secretion by the foetus, promoting growth.

133
Q

What foetal problems are associated with maternal diabetes?

A

Congenital malformations
Intrauterine growth restriction (microvascular disease)
Macrosomia

134
Q

What neonatal problems are associated with maternal diabetes?

A

Hypoglycaemia
Respiratory distress syndrome
Hypertrophic cardiomyopathy
Polycythaemia

135
Q

When is hypoglycaemia most common in neonates?

A

First 24hrs in babies with IUGR, maternal diabetes, large-for-dates, hypothermic, polycythaemic or ill
- due to poor glycemic stores or hyperinsulinaemia

136
Q

When does Group-B strep infection present in neonates

A

Early-onset - respiratory distress and pneumonia as a newborn
Late-onset - meningitis or focal infection up to 3 months old.

137
Q

What causes cleft lip and palate?

A

failure of fusion of the frontonasal and maxillary processes

138
Q

What are the 8 week immunisations?

A

6-in-1
Rotavirus
MenB

139
Q

What are the 12 weeks immunisations?

A

6-in-1 (2nd dose)
Pneumococcal vaccinee (PCV)
Rotavirus (2nd dose)

140
Q

What are the 16 week immunisations?

A

6-in-1 (3rd vaccine)
MenB (2nd dose)

141
Q

What are the 1 year immunisations?

A

HiB/MenC (1st dose)
MMR (1st dose)
Pneumococcal vaccine (PCV)
MenB (3rd dose)

142
Q

What are the 3 year 4 months immunisations?

A

MMR (2nd dose)
4-in-1 preschool booster

143
Q

What is the 12-13 years immunisation?

A

HPV

144
Q

What are the 14 year old immunisations?

A

3-in-1 teenage booster
MenACWY

145
Q

What is radio-femoral delay a sign of in neonates?

A

Coarctation of the aorta

146
Q

What type of murmur does a VSD cause?

A

Pansystolic murmur at the lower left sternal edge
Doesn’t radiate to the back
Second heart sound is normal (unlike the splitting that happens in ASD)

147
Q

What age range for bronchiolitis

A

Usually under 1 year olds

148
Q

How to manage an unconscious child who has choked

A

5 rescue breaths mouth-to-mouth then CPR

149
Q

How is malrotation of the bowel diagnosed?

A

Upper gastrointestinal contrast study

150
Q

Children with Down syndrome have a four-fold increased risk of which malignancy?

A

Acute lymphocytic leukaemia

151
Q

Under what age is jaundice always pathological

A

Jaundice in the first 24 hrs is always pathological

152
Q

Why is IM Vit K offered to all newborn babies?

A

All babies are born Vit K deficient. Can lead to jaundice due to increased bleeding.

153
Q

What are the indications for tonsillectomy in recurrent tonsillitis?

A

Seven or more episode in 1 year
Five or more episodes/ year for 2 years
Three or more episodes/year for 3 years

154
Q

Which human herpes virus is Varicella Zoster?

A

Human herpes virus 3

155
Q

Which human herpes virus causes cold sores and genital warts?

A

Human herpes virus 1/2

156
Q

Which human herpes virus causes roseola (red lace like rash and high fever)

A

Human herpes virus 6/7

157
Q

Which human herpes virus causes Epstein Barr Virus?

A

Human herpes virus 4

158
Q

Which human herpes virus causes Kaposi’s sarcoma in HIV children?

A

Human herpes virus 8

159
Q

What investigation do you need to do when suspected diagnosis of Henoch-Schönlein purpura

A

Urine dipstick to test for renal impairment (can cause nephritis)

160
Q

How does biliary atresia present?

A

Prolonged jaundice, hepatomegaly and raised conjugative bilirubin level.

161
Q

Features of hydrocephalus

A

Enlarged head circumference
Features of raised ICP: irritability, lethargy, vomiting, sunsetting of the eyes,
Tense anterior fontanelle
Distended scalp veins

162
Q

Causes of hydrocephalus

A

Congenital malformation (stenosis of the aqueduct or a Chiari malformation)
Tumour or vascular malformation in the posterior fossa
Intraventricular haemorrhage(in premature infants in particular)
Failure to reabsorb CSF due to injury to arachnoid villi
Meningitis or encephalitis

163
Q

What causes acute chest syndrome in sickle cell disease

A

Infarction of the lung parenchyma

164
Q

How do you diagnose Hirschsprung’s?

A

Rectal suction biopsy

165
Q

When is the onset for haemolytic anaemia?

A

from 24hrs of life

166
Q

What is a hallmark sign on an X-ray of duodenal atresia

A

Double bubble - one gas bubble in the stomach and the other in the proximal small intestine

167
Q

What are the features of rickets?

A

Bow legs
Harrison’s sulci (groove at the lower end of the rib cage seen in children with weak bones or with chronic respiratory disease)
Constipation

168
Q

What are some risk factors for rickets?

A

Dark skin
Breastfed for a long time

169
Q

What are the features of osteosarcoma?

A

Pain and swelling with a prolonged onset
Typically occurs in the metaphyses of long bones

170
Q

What are the x-ray features of osteosarcoma

A

Disorganised bony growth with a poorly defined border
Periosteal reaction causing a sunburst appearance

171
Q

What type of vaccine is the MMR?

A

Live attenuated

172
Q

Which vaccines are killed pathogens?

A

RIP
Rabies
Influenza
Polio

173
Q

Which vaccines are conjugate vaccines?

A

HiB
PCV (pneumococcal conjugate vaccine)

174
Q

Which vaccine is a polysaccharide vaccine?

A

PPV (pneumococcal polysaccharide vaccine)

175
Q

Which vaccines are toxoid vaccines?

A

Diphtheria
Tetanus
(molecules similar to bacterial toxins)

176
Q

What are the doses of adrenaline 1:1000 for anaphylaxis in different ages?

A

150 micrograms if under 6
300 micrograms if 6-12
500 micrograms if above 12

177
Q

Which scan is used to confirm a diagnosis of Meckel’s diverticulum?

A

Technetium scan

178
Q

What is the commonest cause of rectal bleeding in children?

A

Meckel’s diverticulum

179
Q

What is the management for Tetralogy of Fallot spells?

A

1st line. Lie babies on their back and bend their needs. + oxygen if in hospital
Prophylaxis: propranolol
Last line. Phenylephrine - vasoconstriction increases systemic vascular resistance helping reverse the shunt and improve cyanosis
Mainly need surgery

180
Q

When does breast milk jaundice start and resolve by

A

Stars in the first 2 weeks
Resolved by 4 weeks old

181
Q

What medication is give for prophylaxis of bronchiolitis?

A

Palivizumab - monoclonal antibody against RSV
Given monthly subcutaneously
To children with acyanotic heart disease for example (e.g. VSD in Down’s)

182
Q

Which syndrome are aortic arch defects associated with?

A

DiGeorge syndrome

183
Q

Which genetic abnormality causes DiGeorge syndrome?

A

22q11.2 deletion

184
Q

What congenital heart defects are associated with Turner’s syndrome?

A

Coarctation of the aorta
Bicuspid aortic valves

185
Q

What congenital heart defects are associated with Noonan syndrome?

A

Pulmonary stenosis

186
Q

What congenital heart defects are associated with Edward’s syndrome?

A

Septal defects

187
Q

What congenital heart defect is associated with Patau syndrome?

A

Dextrocardia

188
Q

What are the signs of impending respiratory failure in a patient with an asthma attack?

A

Silent chest
Low RR
Normalising CO2
Respiratory muscles are getting tired

189
Q

What is the first line treatment for croup?

A

Oral dexamethasone

190
Q

What are the 5 things assessed in APGAR?

A

Appearance
Pulse
Grimace
Activity
Respiration

191
Q

How do you keep duct patency in a duct dependent congenital heart defect (E.g. Trasnposition of the great arteries)?

A

Prostaglandins
DON’T give ibuprofen with this because it antagonises the action of prostaglandins

192
Q

What is a possible long term complication of measles infection?

A

Subacute Sclerosing encephalitis

193
Q

What cardia condition is a rare but serious complication of Kawasaki’s disease?

A

Coronary artery aneurysms

194
Q

How would you monitor a patient with an asthma attack?

A

Peak expiratory flow and continuous oxygen saturation monitoring

195
Q

What investigation do you need to do if you suspect orbital cellulits?

A

Contrast CT of orbits, sinuses and brain

196
Q

What is the antibiotic of choice for orbital cellulitis in paediatrics?

A

IV Co-amoxiclav

197
Q

When should a newborn have an ultrasound of the hip?

A

Any abnormal screening teste (Barlow or Ortolani)
Breech delivery
First-degree family history

198
Q

What causes a silent chest in asthma?

A

Severe bronchoconstriction meaning that a wheeze isn’t even possible
Life-threatening sign

199
Q

What is the most common cause of febrile seizures

A

Roseola caused by human herpes virus 6

200
Q

What is a common trigger for orbital cellulits?

A

Bacterial sinusitis

201
Q

How does preseptal cellulitis present?

A

Eye is oedematous and erythematous but no visual symptoms.
Like orbital cellulitis, it is often preceeded by bacterial sinusitis

202
Q

What is the commonest feature of Turner’s syndrome?

A

Short stature
only 30% of patients have webbed neck

203
Q

What is the most common malignant bone tumour in children?

A

Osteosarcoma

204
Q

Where do osteosarcomas often happen?

A

Distal femur and proximal tibia

205
Q

How does Ewing’s sarcoma usually present?

A

Like an infection with a fever. usually affects the diaphysis of long bones

206
Q

a smooth olive-sized mass, projectile vomiting after feeds in a neonate suggests what?

A

Pyloric stenosis

207
Q

What test is used to determine whether leg length discrepancy is femoral or tibial?

A

Galleazi

208
Q

What are the main features of Turner’s syndrome?

A

Shield shaped chest,
Low posterior hairline
Webbed neck
May present with not started periods yet

209
Q

What is the incubation period for chicken pox?

A

up to 3 weeks

210
Q

What is the triad of symptoms in Henoch Schonlein Purpura?

A

Arthralgia
Non blanching purpuric rash
Abdo pain

211
Q

What is an important investigation in Henoch Schonlein Purpura?

A

Urine dip - look for blood and protein. IgA immune complexes can deposit in the kidneys and can cause renal involvement

212
Q

What can precede/trigger transient synovitis (inflammation of the join space)?

A

Viral upper resp infection

213
Q

What are the features of Slipped Upper Femoral Epiphysis?

A

Obesity
Lack of internal rotation
Limp
Knee pain
Adolescents

214
Q

What is the investigation for Hirschsprung’s disease?

A

Rectal suction biopsy and histological examination

215
Q

What is the most sensitive view on xray for slipped upper femoral epiphysis?

A

Frog-leg because slip is usually posterior

216
Q

What is the classic finding on ultrasound in intussuseption

A

‘target’ sign with echogenic and hypogenic bands - demostrating the invagination of the bowel

217
Q

Where do you feel for a pulse in Paeds life support in infants vs over 1s

A

Under 1 - brachial pulse
Over 1 - Carotid

218
Q

What is another name for 6th disease?

A

Roseola infantum
HHV6

219
Q

What are the features of 6th disease?

A

Febrile and lethargic for a few days followed by a rose coloured, blanching maculopapular rash that starts on the torso/neck.

220
Q

What is another name for 5th disease

A

Slapped cheek syndrome

221
Q

What sign on general inspection would be seen in babies with congestive cardiac disease?

A

Hepatomegaly

222
Q

What are the features of Pierre Robin sequence?

A

Cleft lip
Retracted tongue
Small jaw
Infants often struggle with feeding and breathing

223
Q

What is Tuberous Sclerosis

A

Autosomal dominant, neurocutaneous syndrome characterised by cellular hyperplasia, tissue dysplasia, haematomas affecting multiple organs

224
Q

What is an important differential of croup?

A

Bacterial tracheitis

225
Q

What haematological condition are children with Down’s syndrome at increased risk of developing?

A

ALL

226
Q

Why is it important to admit a patient after an anaphylactic reaction, even if they are well and normal?

A

Anaphylaxis can often occur in a bi-phasic reaction (4-6 hours apart)

227
Q

What genetic karyotype commonly causes recurrent otitis media?

A

Turner syndrome

228
Q

What is the honeymoon period in type 1 diabetes?

A

When there is a period of time where the beta cells in the pancreas still have some function, therefore not requiring lots of exogenous insulin
Children need to be monitored carefully

229
Q

How soon after starting phototherapy for newborn jaundice should the serum bilirubin be checked again?

A

4-6 hours after

230
Q

What is Perthes disease?

A

Avascular necrosis of the femoral head in children aged 4-8

231
Q

What can accentuate innocent murmers?

A

febrile illness

232
Q

At what age should a child be able to use a cup and spoon to feed themselves?

A

18 months

233
Q

What is Hb SC in sickle cell disease?

A

Milder form of sickle cell disease

234
Q

What is another name for Slapped Cheek Syndrome?

A

Erythema infectiosum or fifth disease

235
Q

When do es ALL typically present in children?

A

Under age 6

236
Q

What is a “starry-sky appearance” on bone marrow biopsy characteristic of ?

A

Burkitt’s Lymphoma

237
Q

What is Burkitt’s lymphoma?

A

A high grade B cell lymphoma. which is common in tropical Africa

238
Q

What are the features of Burkitt’s lymphoma on a blood film?

A

Nucleated red cells
Left shift
Basophilic vacuolated lymphoma cells

239
Q

What are some causes of pathological jaundice in the first 24 hours of life?

A

Rhesus haemolytic disease
ABO incompatibility
G6PD
TORCH screen

240
Q

What is a positive Brudzinski’s sign in meningitis?

A

Neck flexion triggers involuntary knee/hip flexion

241
Q

What congenital infection can cause aqueductal stenosis leading to congenital hydrocephalus?

A

Rubella

242
Q

What is the inheritance pattern of DMD?

A

X-linked recessive

243
Q

What are the two conditions that are X-linked dominant?

A

X-linked hypophosphateaemic rickets
Alport syndrome

244
Q

How long is slapped cheek infectious for?

A

Until the rash appears

245
Q

Until what age do you use correction for gestational age in development of ex-prem children?

A

2 years old

246
Q

What is the most common cause of persisting proteinuria in children?

A

Orthostatic proteinuria
Increases after being on feet for a while

247
Q

What is a Branchial cyst?

A

Embryological remnant from the development of the branchial arches which form parts of the head and neck
Manifests as a painless cystic mass anterior to the sternocleidomastoid muscle
Presents in late adolescence and doesn’t move on swallowing
Anechoic mass on USS

248
Q

What is the most common cause of LATE-onset neonatal sepsis (after 72 h of life)?

A

Staph aureus

249
Q

What is the most common cause of neonatal jaundice with conjugated hyperbilirubinaemia?

A

Biliary atresia (surgically treated by the Kasai procedure)

250
Q

What do you give to keep the ductus arteriosus open?

A

Prostaglandins - Alprostadil (Prostaglandin E1)

251
Q

How is vesicoureteric reflux diagnosed?

A

Micturating cystourethrogram.
Should be postponed until 3 months after a UTI

252
Q

What is a DMSA scan?

A

Used to identify scarring of renal tissue
Less specific than a MCUG
Should be taken 3 months after the UTI has resolved

253
Q

What do investigations show in G6PD?

A

Haemolysis (normocytic anaemia, high reticulocyte count, high LDH) and the blood film may show Heinz bodies and bite cells

254
Q

How is thalassaemia diagnosed?

A

Haemoglobin electrophoresis

255
Q

Why aren’t SSRIs used commonly in the elderly?

A

SSRIs are associated with increased risk of bleeding when prescribed with anticoagulants

256
Q

What electrolyte upset is commonly seen as a complication in bronchiolitis caused by RSV?

A

Hyponatraemia

257
Q

What is the investigation for Perthes’ disease?

A

X ray

258
Q

What food allergies are associated with eczema?

A

Egg, soy, gluten, nuts and fish allergies

259
Q

What are the symptoms of a varicocele?

A

Usually asymptomatic but can cause a dull discomfort

260
Q

What are some risk factors for cerebral palsy?

A

Birth complications
Maternal infections
Maternal thyroid dysfunction
Prematurity

261
Q

Is IV sodium bicarbonate used in children with DKA?

A

No only considered in adults with a pH greater than 6.9

262
Q

What are some side effects of corticosteroids?

A

Acne, striae, telangiectasia, skin thinning

Phase 3a (12 decks)

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