Paediatrics

Question 1

Pyloric stenosis - Dx. by?

Answer 1

Ultrasound

Question 2

Pyloric stenosis Mx.

Answer 2

Ramstedt pyloromyotomy

Question 3

Pyloric stenosis px.

Answer 3

Projectile vomiting - 30 mins after food
May have palpable mass
Constipated and dehydrated

Question 4

Pyloric stenosis electrolyte disturbance

Answer 4

Hypochloraemic hypokalaemic alkalosis due to persistent vomiting

Question 5

Distinction between asthma and viral induced wheeze:

Answer 5

VIW:
Presents before age 3
No hx. of atopy
only occurs during viral infections

Question 6

viral induced wheeze mx.

Answer 6

Managed as per Asthma guidelines

Question 7

Whooping cough px.

Answer 7

Severe coughing fits in which pts. cannot draw breath resulting in the ‘whoop’ sound’
Usually starts with mild coryzal symptoms

Question 8

Pertussis dx.

Answer 8

Nasal swab PCR or bacterial culture

Question 9

Is pertussis a notifiable disease

Answer 9

Yes

Question 10

Abdominal pain investigations:

Answer 10

FBC: anaemia -> IBD
CRP/ESR: IBD, general inflammation
Anti-TTG or Anti-EMA -> Coeliac disease
Faecal calprotectin: differentiates IBD
Urine dipstick: UTI

Question 11

Paediatric constipation Mx.

Answer 11

Ensure lifestyle factors are optimised (e.g Hydration, increase fibre etc.)
-> Laxative (movicol)

Give praise for using toilet and schedule in toilet breaks/star charts

Question 12

How long must children stay off school following gastroenteritis

Answer 12

48 hours

Question 13

Possible complications of gastroenteritis

Answer 13

Lactose intolerance
Guillane Barre syndrome
Reactive arthritis
irritable bowel syndrome

Question 14

Biliary atresia px.

Answer 14

Jaundice early after birth

Question 15

Biliary atresia key investigation:

Answer 15

CONJUGATED bilirubin -> suggests bilirubin metabolised in the liver but then nowhere to go (biliary atresia)

Question 16

What is Kernicterus?

Answer 16

Brain damage arising from elevated bilirubinaemia

Question 17

Breast milk jaundice: should breastfeeding be stopped?

Answer 17

No, breastfeeding should continue as benefits outweigh risks

Question 18

Prolonged jaundice Ix.:

Answer 18

FBC and blood film (polycythaemia/anaemia)
Direct coomb’s test (haemolysis)
Thyroid function tests
Conjugated bilirubin (elevated in hepatobiliary disease)
Blood type testing
G6PD def. tests
Blood and urine culture tests (infection)

Question 19

New diagnosis of DM bloods:

Answer 19

FBC and renal profile - baseline
HbA1C - establish length of disease
Formal lab glucose
Anti-TTG/Anti-EMA antibodies - coeliac screen
Thyroid antibodies for other autoimmune disorders
Insulin antibodies (anti-GAD)

Question 20

Children w/ DKA are particularly at risk of which complication:

Answer 20

Cerebral oedema

Question 21

DKA diagnostic parameters

Answer 21

BM: >11
Ketones >3
Acidosis <7.3

Question 22

Recurrent UTIs investigation:

Answer 22

abdominal ultrasound within 6 weeks