Paediatrics Flashcards

1
Q

What is Kernig’s Sign?

A

Pain on leg straightening

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2
Q

What is Brudzinski’s sign?

A

Supine neck flexion resulting in Knee/hip flexion

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3
Q

What are the clinical manifestations of meningitis?

A

Bulging fontanelle, hyperextension of the neck and back (opisthotonos)
-Headache, photophobia, neck stiffness, fever

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4
Q

What is Cushing’s Triad?

A
  1. High Blood Pressure
  2. Low heart rate
  3. Irregular Respiratory Rate
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5
Q

What is the routine first-line diagnostic investigation for meningitis if there are no signs of raised ICP?

A

Lumbar puncture

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6
Q

What ABx is prescribed to children <3 months with meningitis?

A

IV Cefotaxime
IV Amoxicillin/ampicillin

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7
Q

Which type of abnormal cell is characteristic of Hodgkin’s lymphoma?

A

Reed-Sternberg Cells

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8
Q

What B symptoms are associated with Hodgkin’s lymphoma?

A

-Fever (Pel-Ebstein) for 3 consecutive days
-Weight Loss
-Pruritus
-Night sweats

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9
Q

What is the clinical presentation of Hodgkin’s lymphoma?

A
  1. B symptoms
  2. Lymphadenopathy - painless non-tender cervical/supraclavicular, asymmetric
    -Alcohol-induced
  3. Medistinal mass
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10
Q

What is the diagnostic investigation for Hodgkin’s lymphoma?

A

Excisional lymph node biopsy

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11
Q

What does a CXR reveal in Hodgkin’s lymphoma?

A

Mediastinal disease burden + hilar lymphadenopathy

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12
Q

What does FBC with differential show in Hodgkin’s lymphoma?

A
  1. Low Hb and platelets
  2. Eosinophilia
  3. Raised LDH
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13
Q

What are Reed-Sternberg cells?

A

Multinucleated cells (with bilobed nucleus and prominent eosinophilic inclusion-like nucleoli)

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14
Q

What investigation is used to stage Hodgkin’s lymphoma?

A

PET-CT scan to assess progression and staging

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15
Q

What chemotherapy regimen is initiated for Hodgkin’s lymphoma?

A

Doxorubicin, bleomycin, vinblastine and dacarbazine (administered intravenously).

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16
Q

What is bronchiectasis?

A

Abnormal bronchial dilatation secondary to recurrent infections

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17
Q

What is the leading cause of bronchiectasis?

A

Cystic fibrosis

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18
Q

What is the leading cause of bronchiectasis?

A

Cystic fibrosis

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19
Q

What is the clinical manifestation of bronchiectasis?

A

-Chronic wet/productive cough
-Recurrent infections - >3 episodes of protracted bacterial bronchitis
-Haemoptysis
-Dyspnoea

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20
Q

What is the clinical manifestation of bronchiectasis?

A

-Chronic wet/productive cough
-Recurrent infections - >3 episodes of protracted bacterial bronchitis
-Haemoptysis
-Dyspnoea

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21
Q

What are the physical findings associated with bronchiectasis?

A
  • Crackles
    -Digital clubbing
    -Chest rhonchi and wheeze
    -Hyperinflation, Harrison sulci, pectus carinatum
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22
Q

What feature is observed on chest radiograph in a paediatric patient with bronchiectasis?

A

Tram track appearance

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23
Q

What is the gold standard diagnostic investigation for paediatric bronchiectasis?

A

HRCT + Multidetector CT

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24
Q

What is the gold standard diagnostic investigation for paediatric bronchiectasis?

A

HRCT + Multidetector CT

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25
Q

What is observed on HRCT in bronchiectasis?

A
  1. Increased bronchoarterial ratio
  2. Signet ring sign
  3. Bronchial wall thickening
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26
Q

What type of pattern is observed in spirometry in a patient with bronchiectasis?

A

Obstructive pattern (Reduced FEV1, normal FVC)

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27
Q

What type of pattern is observed in spirometry in a patient with bronchiectasis?

A

Obstructive pattern (Reduced FEV1, normal FVC)

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28
Q

What investigations should be performed in a paediatric patient with bronchiectasis?

A

HRCT + Multidetector CT
Spirometry
Sweat chloride testing
Screeing for antibody deficieincy

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29
Q

What 2 screening investigations should be performed in a patient with bronchiectasis?

A

Sweat chloride testing - CF
Antibody deficiency - IgG, IgM, IgA

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30
Q

What is the first-line ABx therapy for bronchiectasis (aged 1 month - 11 years)?

A

Amoxicillin or Clarithromycin

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31
Q

For patients aged 12-17 years, what Oral ABx should be prescribed in bronchiectasis?

A

Doxycycline

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32
Q

What IV ABx is administered for severely unwell patients with bronchiectasis?

A

Co-amoxiclav
Pipieracillin and tazobactam

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33
Q

What is the management strategy for paediatric bronchiectasis?

A

Chest physiotherapy
Antibiotic therapy
Inhaled hypertonic saline for high sputum load

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34
Q

What vaccinations should be offered in bronchiectasis?

A

Streptococcus pneumonia
Seasonal influenza

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35
Q

What is Epiglotitits?

A

Inflammation of the epiglottis and adjacent supraglottic structures

It is a life-threatening obstruction

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36
Q

What is the most common causative pathogen for Epiglottitis?

A

Haemophilusinfluenzae type B

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37
Q

What is the characteristic voice associated with Epiglottitis?

A

Hot potato voice - muffled

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38
Q

A tripod position with drooling and a muffled voice is associated with what diagnosis?

A

Epiglottitis

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39
Q

What is the clinical presentation of Epiglottitis?

A

Irritability, fever, dysphonia (‘hot potato voice’), and dysphagia
Respiratory distress with tripoding (child sitting up, leaning forward, neck hyperextended and bracing upper body)
Drooling/increased oral secretions
Tachycardia and tachypnoea
Oedematous and cherry-red epiglottis
Absence of cough
Anxiety
Fever > 38.8-40.0°C
Stridor
Due to airway obstruction

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40
Q

What is the first-line management for Epiglottitis?

A

Endotracheal intubation
Immediate ENT and anaesthetics referral + 100% inspired oxygen

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41
Q

What radiological sign is observed in Epiglottitis?

A

Thumb sign

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42
Q

What ABx is administered in Epiglottitis?

A

3rd generation cephalosporins - ceftriaxone for 7-10 days.

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43
Q

What prophylaxis should be offered to close contacts in Epiglottitis?

A

Rifmapicin

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44
Q

What is the most common causative organism in bronchiolitis?

A

RSV

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45
Q

What is the clinical presentation of bronchiolitis?

A

Fever - <38.3°C
Cough
Respiratory distress
Increased RR, retractions, wheezing, crackles
Preceded by 1-3 day Hx of symptoms of URTI (Nasal congestion, rhinorrhoea)
Rapid onset of wheezing
Irritability, malaise, and poor feeding

TYPICALLY RESOLVES within 2 WEEKS.

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46
Q

When is an urgent referral indicated in bronchiolitis?

A

Apnoea
The child looks seriously unwell
Severe respiratory distress
Grunting, marked chest recession or a RR > 70 breaths/minute

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47
Q

What is the diagnostic investigation for bronchiolitis?

A

Immunofluorescence of nasopharyngeal secretions –> RSV

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48
Q

What is the management for non-severe bronchiolitis?

A

Oxygenation and hydration
Humidified oxygen via a headbox if Spo2 <92%
Nasogastric feeding if cannot tolerate feed by mouth
Paracetamol > 3 years

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49
Q

What is the management for severe bronchiolitis?

A

Trial of inhaled bronchodilator
Nebulised hypertonic saline
CPAP for impending respiratory failure
Intravenous fluids

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50
Q

What RSV prophylaxis should be administered in high-risk preterm infants?

A

palivizumab

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51
Q

Projectile non-bilious vomiting occurring 30 minutes post-feed is associated with what diagnosis?

A

Pyloric stenosis

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52
Q

What type of alkalosis is associated with pyloric stenosis?

A

Hypercholraemic alkalosis - due to a loss of gastric acid

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53
Q

What palpable mass is observed in pyloric stenosis?

A

Olive-like mass

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54
Q

What is the diagnostic investigation indicated in pyloric stenosis?

A

Ultrasound - direct visualisation of pyloric muscle
- >3mm
>15 mm length

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55
Q

What is the definitive management of pyloric stenosis?

A

Surgical pyloromyotomy (Ramstedt)
- Can be open or laparoscopic

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56
Q

What pre-operative management is indicated for pyloric stenosis?

A
  • Pre-operative fluid and electrolyte therapy to correct electrolyte disturbance.
  • 0.45% Saline + 1.5x Maintenance rate with 5% dextrose
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57
Q

What is included in the 6 in 1 vaccine?

A

Polio, whooping cough, Haemophilus influenzae type B, diphtheria, tetanus and hepatitis B

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58
Q

What vaccines are administered at 2 months?

A

6 in 1 Vaccine
Oral rotavirus vaccine
Men B

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59
Q

What vaccines are administered at 3 months?

A

6 in 1 Vaccine
PCV - Pneumococcal (13 serotypes)
Rotavirus

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60
Q

How many serotypes are included in the PCV vaccine?

A

13

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61
Q

When is the PCV vaccine administered in infants?

A

12 weeks

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62
Q

What vaccines are administered at 4 months (16 weeks)?

A

6 in 1
Men B

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63
Q

What vaccines are administered at 12-13 months?

A

Hib/Men C
MMR
PCV
Men B

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64
Q

When is the MMR vaccine is administered?

A

1 year

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65
Q

When is the HPV (Gardasil) vaccine administered?

A

12-13 years - 2 doses 6-24 months apart.

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66
Q

What are the contraindications to vaccination?

A
  1. Acute febrile illness
  2. Egg allergy - Influenza, yellow fever, and tick born encephalitis
  3. Previous anaphylaxis to vaccine containing ro constituent antigens/components
  4. Immunocompromised
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67
Q

What is the definitive management of biliary atresia?

A

Kasai hepatoportoenterostomy
- with ABx cover for the first year of life.

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68
Q

What is administered for biliary atresia post-Kasai HPE?

A

Choleretics - Ursodeoxycholic acid - to promote bile flow.

Nutritional supplementation - medium chain triglyceride formula

Fat-soluble vitamin

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69
Q

Which ABx is prescribed in a patient with bacterial meningitis < 3 months?

A

IV amoxicillin + cefotaxime

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70
Q

Management of bacterial meningitis >3 months?

A

IV Ceftriaxone

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71
Q

Management of bacterial meningitis in primary care?

A

IM Benzylpenicillin + arrange emergency transfer to secondary care centre.

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72
Q

What follow-up is required post-meningitis?

A

Auditory assessment within 4 weeks after discharge

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73
Q

What prophylactic ABx should be prescribed to close meningitis contacts?

A

Ciprofloxacin

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74
Q

What is the causative organism of pertussis?

A

Bordetella pertussis (Gram-negative)

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75
Q

When is the pertussis immunisation?

A

2,3,4 months (as part of the 6 in 1 vaccination schedule) + 3-5 years.

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76
Q
  • Paroxysms of coughing
  • Inspiratory whoop
  • Post-tussive vomiting.
  • Apnoea, with or without cyanosis.
    What is the most likely diagnosis?
A

Pertussis

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77
Q

What is the first stage of pertussis?

A

Catarrhal stage
-Viral upper respiratory tract infection symptoms:
-Low-grade fever, cough gradually increases, coryza
-Most. infectious stage

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78
Q

What is the paroxysmal stage of pertussis?

A

Coughing spells increase in severity

Gagging, breathlessness

Sweating episodes between paroxysms

Bothersome at night

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79
Q

What is the first-line investigation for pertussis?

A

Nasal swab culture for Bordetella pertussis - nasopharyngeal aspirate or swab

(Suitable for all age groups <21 days of cough duration)

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80
Q

What is the gold-standard investigation for pertussis?

A

PCR and serological testing

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81
Q

What are the admission criteria for pertussis?

A

Admit:
1. Significant breathing difficulties – apnoea episodes, severe paroxysm, or cyanosis.
2. Low threshold for children <6 months
3. Significant complications – pneumonia or seizures.

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82
Q

What is the age threshold for admission in a paediatric patient presenting with whooping cough?

A

< 6 months

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83
Q

What class of ABx is prescribed in pertussis?

A

Macrolide (cough within 21 day duration).

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84
Q

Which macrolide is prescribed for pertussis?

A

Clarithromycin for infants <1 month of azithromycin aged >1 year

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85
Q

What is the school exclusion protocol for pertussis?

A

Children are to return to school having completed 48 hours of Abx management.

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86
Q

What are the three major risk factors for bronchopulmonary disorder?

A
  • Less than 28 weeks’ gestation
  • IUGR infants
  • Chorioamnionitis – Increases risk of developing a systemic inflammatory response.
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87
Q

What is the presentation of bronchopulmonary disorder?

A
  • Breathing difficulties and is oxygen-dependent.
  • Poor growth
  • Feeding problems
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88
Q

What CXR changes are present in bronchopulmonary dysplasia?

A

Hyperinflation, cystic changes and streaky infiltrates

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89
Q

What prophylactic measure is necessitated for BPD?

A

Corticosteroids for suspected/established preterm labour (<34 weeks).

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90
Q

What respiratory support is indicated in BPD?

A

High flow oxygen via a nasal cannula or if >2L/min - humidified oxygen

CPAP

Invasive ventilation + prescribe surfactant

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91
Q

What medications are prescribed in BPD?

A
  • Dexamethasone – If > 8 days and on ventilator
  • Caffeine criteria – If <30 weeks corrected gestational age
  • Consider if preterm and apnoeic
  • Nitric oxide
  • Only if pulmonary hypoplasia or pulmonary hypertension
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92
Q

When is dexamethasone prescribed in BPD?

A

If >8 days and on ventilator

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93
Q

When is caffeine prescribed in BPD?

A

In preterm and apnoeic patients

OR

<30 weeks corrected gestational age

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94
Q

What is PPHN?

A

Persistent Pulmonary Hypertension of the Newborn
PPHN occurs when pulmonary vascular resistance remains abnormally elevated after birth.
* Resulting in right-to-left shunting of blood through foetal circulatory pathways.
- Associated with hypoxic-ischaemic encephalopathy, meconium aspiration and RDS.

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95
Q

What are the risk factors for PPHN?

A
  1. Maternal diabetes
  2. Maternal obesity
  3. Advanced maternal age
  4. In utero exposure of SSRIs
  5. Meconium-stained amniotic fluid
  6. Prolonged premature rupture of membranes
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96
Q

Which vessel does blood bypass pulmonary circulation in PPHN?

A

Ductus arteriosus (resulting in a right-to-left shunt)

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97
Q

What is the clinical presentation of PPHN?

A

Presentation within the first 24 hours of life with signs of respiratory distress:
* Tachypnoea
* Retractions
* Grunting
* Cyanosis
* Meconium staining of skin and nails.
- Indicative of intrauterine stress.

Cardiovascular examination
* Prominent precordial impulse
* Narrowly split and accentuated S2

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98
Q

What monitoring investigation is indicated in PPHN?

A

Pre- and post-ductal oxygen saturation
- A difference >10% indicates PDA right-to-left shunting.

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99
Q

What is the diagnostic investigation to confirm PPHN?

A

Echocardiography

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100
Q

What is the management support for PPHN?

A
  • Oxygen
  • Maintain high PO2 (10-13 kPa in infants born >34 weeks’ gestation).
  • Ventilation
  • Intubate
  • High-frequency oscillatory ventilation
  • Minimise handling
  • Surfactant – To optimise lung function
  • Suction of secretions from ETT
  • Fluids and inotropes – to optimise cardiac output
  • Inhaled nitric oxide.
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101
Q

What is the most common cause of respiratory distress in newborns?

A

TTN

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102
Q

What are the 3 major risk factors for TTN?

A
  • Caesarean section
  • Maternal diabetes
  • Maternal asthma
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103
Q

What is the pathophysiology of TTN?

A

Characterised by pulmonary oedema resulting from delayed resorption and clearance of foetal alveolar fluid.
* Reduced pulmonary compliance –> Compensatory tachypnoea.
* Fluid accumulation in the peribronchiolar lymphatics and interstitium –> Partial collapse of the bronchioles.

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104
Q

What is the time of onset for TTN?

A

Between time of birth and two hours post-delivery

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105
Q

What are the features of respiratory distress?

A
  • Nasal flaring
  • Expiratory grunting
  • Cyanosis
  • Subcostal and intercostal retractions
  • Tracheal tug
  • Increased anterior-posterior diameter of the chest.
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106
Q

What features are revealed on CXR in TTN?

A

Fluid in horizontal fissure + hyperinflation

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107
Q

When does TTN resolve?

A

12-24 hours

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108
Q

What are the target O2 sats in TTN?

A

> 94%

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109
Q

What are the indications for nutritional support in TTN?

A

RR is 60-80 breaths per minute

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110
Q

What are the indications for prescribing Ampicillin + gentamicin in TTN?

A

If tachypnoea persists >4-6 hours

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111
Q

What ABx are prescribed if TTN lasts >4-6 hours?

A

Ampicillin + gentamicin

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112
Q

What radiographic sign is observed in a lateral neck radiograph in epiglottitis?

A

Thumb sign

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113
Q

What is the most common causative organism for bronchiolitis?

A

RSV

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114
Q

What criterions are associated for admitting a patients with bronchiolitis?

A
  • Apnoea – Observed or reported
  • Persistent SpO2 <92% in RA
  • Inadequate fluid intake (50-70% normal)
  • Features of severe respiratory distress
  • RR >70 breaths per minute
    -Cyanosis
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115
Q

What is the diagnostic investigations for RSV?

A

Immunofluorescence of nasopharyngeal secretions  RSV
- + Rapid antigen testing

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116
Q

Which type of infection is associated with Hodgkin’s lymphoma?

A

Epstein-Barr virus

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117
Q

Which type of cell is associated with Hodgkin’s lymphoma?

A

Reed-Sternberg Cells

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118
Q

What is the most common type of Hodgkin’s lymphoma?

A

Nodular Sclerosis

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119
Q

What is the peak incidence of ALL?

A

2-5 years of age

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120
Q

What WBC is a poor prognostic factor for ALL?

A

> 2 X 109/L at diagnosis

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121
Q

What are the poor prognostic factors for ALL?

A
  • Age <2 years or >10 years
  • WBC > 2 x109/L at diagnosis
  • T or B cell surface markers
  • Non-Caucasian
  • Male sex
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122
Q

What type of cell is associated with ALL?

A

Lymphoid progenitor cells

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123
Q

What are the clinical features associated with ALL?

A

Bone Marrow Failure
1. Thrombocytopenia
- Bruising and petechiae
2. Anaemia
- Pallor, fatigue
3. Neutropenia
- Fever, and frequent infections

Lymphadenopathy

Hepatosplenomegaly
* Anorexia, weight loss, abdominal distension, and abdominal pain

Musculoskeletal pain – Limp or refusal to bear weight.

Testicular swelling – A persistent, painless, solid testicular mass

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124
Q

What is the first-line investigation for ALL?

A

FBC with differential

Peripheral blood smear

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125
Q

What is the gold-standard diagnostic investigation for ALL?

A

Bone marrow aspiration and trephine biopsy

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126
Q

What is the diagnostic result on bone marrow aspiration in ALL?

A

> 20% lymphoblasts

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127
Q

Which gene is associated with Burkitt lymphoma?

A

MYC gene on chromosome 8

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128
Q

What is endemic Burkitt lymphoma associated with?

A

Equatorial Africa and New Guinea - with jaw or facial bone tumours

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128
Q

What are the two types of Burkitt lymphoma?

A
  1. Endemic
  2. Sporadic
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129
Q

Clinical presentation of endemic Burkitt lymphoma?

A
  • Jaw or facial bone tumour
  • Involves the mandible or maxilla
  • Extranodal sites: Mesentery, ovary, testis, kidney, breast and meninges.
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130
Q

Clinical presentation of sporadic Burkitt lymphoma?

A

Sporadic
Abdominal presentation
* Ascites
* Ileo-caecal tumours
* Mimic acute appendicitis
* ~25% involve jaw or facial bones
* Localised lymphadenopathy

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131
Q

What syndrome is associated with Burkitt Lymphoma?

A

Spontaneous tumour lysis syndrome
-Raised serum lactate dehydrogenase and uric acid

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132
Q

What is revealed on histological examination of Burkitt lymphoma?

A

Starry Sky Appearance
Medium-sized cells with basophilic cytoplasm and a high Ki67 fraction

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133
Q

What is the induction regimen for ALL?

A
  1. Prednisolone or Dexamethasone
  2. Cyclophosphamide
  3. Vincristine
  4. Doxorubicin
  5. L-asparaginase
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134
Q

What drug is prescribed to prevent cardiotoxicity from doxorubicin?

A

Dexrazone

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135
Q

What tyrosine kinase inhibitor is indicated in ALL, Philadelphia chromosome-positive patient?

A

Imatinib

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136
Q

What prophylactic is prescribed to ALL patients at risk of febrile neutropenia?

A

CSF - Filgrastim

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137
Q

How should anaemia be treated in ALL prior to management?

A

Blood transfusions

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138
Q

What prophylaxis should be prescribed to prevent tumour lysis syndrome in ALL?

A

Allopurinol
Rasburicase

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139
Q

What is the CNS prophylaxis in ALL?

A

Intrathecal methotrexate

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140
Q

What is the management of TLS in Burkitt’s?

A

Management of tumour lysis syndrome
* Rasburicase – Recombinant version of urate oxidase.

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141
Q

What is the management of Burkitt’s lymphoma?

A

Chemotherapy
CODOX-M with IVAC
* Cyclophosphamide
* Vincristine
* Doxorubicin
* High-dose methotrexate
* Ifosfamide, cytarabine, etoposide and intrathecal methotrexate.

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142
Q

What type of hypersensitivity is associated with immune thrombocytopenia?

A

Type 2 hypersensitivity

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143
Q

What is the common presentation of Meckel diverticulum?

A
  • Symptomatic
  • Intermittent painless lower GI bleeding  Excision of the diverticulum with blood transfusion
  • Obstruction  Excision of diverticulum and lysis of adhesions
  • Perforation/peritonitis  Laparoscopic excision of the diverticulum or small bowel segmental resection with perioperative antibiotics.
    o Cefotaxime, clindamycin/metronidazole
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144
Q

What is the diagnostic investigation for Meckel Diverticulum?

A

Meckel’s scan (Technetium-99m Scan).
- Reveals ectopic focus or hot spot

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145
Q

What is the most common symptomatic presentation of Meckel Diverticulum?

A

Intermittent painless lower GI bleeding

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146
Q

What is the pathogenesis of Intestinal malrotation?

A

Fibrous bands called ‘Ladd bands’ tether the caecum to the RUQ, and these cause intestinal obstruction by compression of the duodenum.

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147
Q

What is the most common complication with intestinal malrotation?

A

Volvulus

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148
Q

What is the characteristic presentation of intestinal malrotation?

A

Presents in the first few days of life.
* Bilious vomiting – dark green vomiting  Urgent gastrointestinal contrast study to assess intestinal rotation.
* Abdominal pain
* Signs of vascular compromise
* Scaphoid abdomen (concave)

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149
Q

What type of vomiting is associated with intestinal malrotation?

A

Bilious vomiting - dark green.

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150
Q

What is the most urgent investigation performed for intestinal malrotation?

A

Upper GI contrast study

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151
Q

What findings are revealed in an upper GI contrast study?

A

Right-sided duodenum
Bird-beak cut-off
Corkscrew

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152
Q

What does a plain abdominal X-ray reveal in intestinal malrotation?

A

Distended stomach and proximal duodenum with a paucity of bowel gas seen distally.

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153
Q

What surgical procedure is corrective for intestinal malrotation?

A

Ladd’s procedure

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154
Q

Where is the maximal tenderness point in Appendicits?

A

McBurney’s point

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155
Q

What does an FBC reveal in appendicitis?

A

Leuckocytosis

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156
Q

What clinical scoring system is used to assess paediatric appendicitis?

A

PAS > 7 or 8 - high risk - surgical consultation

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157
Q

What investigation is performed in children with an atypical presentation of appendicits?

A

Abdominal ultrasound

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158
Q

What are the risk factors for perforation in appendicits?

A
  • Abdominal pain >48 hours
  • WBC >18 micro/mol
  • Raised CRP
  • Appendicolith present on imaging
  • Appendix diameter >1.1 cm on imaging
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159
Q

What is the pre-operative management for appendicitis?

A

– Nil-by-mouth from the time of diagnosis
* Intravenous hydration + analgesia
* Consider prophylactic IV ABx (cefoxitin, ampicillin, piperacillin/tazobactam)

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160
Q

What is the definitive management for appendicitis?

A

Perform appendectomy without delay – open/laparoscopic.
* With peritoneal lavage, if perforation
* In complicated appendicitis e.g., with perforation, abscess, appendix mass present:
- If there is generalised guarding consistent with perforation  IV fluids, and Abx prior to laparotomy.

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161
Q

What is the presentation of biliary atresia?

A

Infants are born full term, have a normal birth weight and initially thrive.
* Jaundice (Birth-8 weeks).
- Scleral icterus
- Jaundice extends beyond the physiological two weeks
* Alcoholic stool
- Range in colour from white to tan or light yellow
* Dark urine
- Bilirubin excretion into the urine
* Bruising
- Secondary to Vitamin K deficiency related to chronic cholestasis.

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162
Q

What is the gold-standard investigation for biliary atresia?

A

Abdominal ultrasound

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163
Q

What does an abdominal ultrasound reveal in biliary atresia?

A
  • Absence of gallbladder, irregular morphology, polysplenia
  • Triangular cord sign
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164
Q

What is the definitive management for biliary atresia?

A

A Kasai Hepatoportoenterostomy (HPE) to restore bile flow from the liver to the proximal small bowel.
- 2nd line: Liver transplantation following unsuccessful HPE or at presentation infants have end-stage liver disease.

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165
Q

What is the most common site of Intussusception?

A

Ileocolic Intussusception

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166
Q

What is the presentation of Intussusception?

A

Sudden onset of intermittent, severe, crampy, progressive abdominal pain.
- Associated with inconsolable crying + pallor.
- Drawing up of the legs toward the abdomen, often pallor.
- Episodes last ~ 15–20-minute intervals
- Inter-episode free pain.

  • Vomiting – Bilious emesis as intestinal obstruction progresses.
  • Sausage-shaped abdominal mass
  • Palpated in the RUQ
  • Redcurrant jelly stools/blood per rectum
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167
Q

What is a late sign of Intussusception?

A

Redcurrant jelly stools

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168
Q

What type of mass is palpated in Intussusception?

A

Sausage-shaped abdominal mass

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169
Q

What age group is commonly affected by Intussusception?

A

3-12 months

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170
Q

What is the diagnostic investigation for Intussusception?

A

Ultrasound

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171
Q

What ultrasound sign is observed in Intussusception?

A

Target sign

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172
Q

What is the definitive first line management for Intussusception?

A

Pneumatic pressure or saline/contrast enema under fluoroscopic/US guidance respectively

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173
Q

What is the second line management for Intussusception?

A

Surgical reduction using immediate laparotomy with broad-spectrum antibiotics (clindamycin + gentamicin).

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174
Q

Which age group is predominantly affected by bilious vomiting?

A

3-6 week old infants
MALES 5:1

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175
Q

What is the characteristic presentation of pyloric stenosis?

A
  • Projectile non-bilious vomiting
  • Progressively more forceful over time
  • Typically occurs ~30 minutes post-feeding
  • Difficulty feeding
    o Multiple formula changes
  • Constipation and dehydration
  • Dry mucous membranes
  • Decreased wet nappies
  • Tachycardia
  • Hypochloraemic alkalosis– Due to loss of gastric acid
  • Palpable olive-like mass
  • Strong appetite
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176
Q

What type of alkalosis is observed in pyloric stenosis?

A
  • Hypochloraemic alkalosis
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177
Q

What type of mass is palpable in pyloric stenosis?

A

Olive-like mass

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178
Q

What is the definitive management for pyloric stenosis?

A

Surgical pyloromyotomy (Ramstedt)
- Can be open or laparoscopic

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179
Q

What is the diagnostic investigation for pyloric stenosis?

A

Ultrasound – Direct visualisation of pyloric muscle and canal.
- Diagnosis is based on the thickness (>3 mm) of the muscle measured on a transverse view and pyloric canal length >15mm.

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180
Q

What is the pre-operative management for pyloric stenosis?

A
  • Pre-operative fluid and electrolyte therapy to correct electrolyte disturbance.
  • 0.45% Saline + 1.5x Maintenance rate with 5% dextrose
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181
Q

What is the most common malignancy in children under aged 5?

A

Nephroblastoma (Wilm’s tumour)

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182
Q

What syndrome is associated with Wilm’s tumour?

A

Beckwith-Wiedemann Syndrome

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183
Q

What is the clinical presentation for Wilms tumour?

A
  • Abdominal mass (Most common presenting feature)
  • Unilateral
  • Painless haematuria
  • Flank pain
  • Anorexia, fever
  • Metastases in ~20% of patients (predominantly within the lung).
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184
Q

What is the management for an unexplained abdominal mass in children?

A

Arrange a paediatric review within 48 hours

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185
Q

What is the diagnostic investigation for Wilm’s tumour?

A

Surgical excision or biopsy - histological confirmation

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186
Q

What is the initial investigation for a Wilm’s tumour?

A

Abdominal ultrasound

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187
Q

What is the definitive management for Wilms tumour?

A

Nephrectomy

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188
Q

What is the leading cause of mortality among preterm infants?

A

Necrotising enterocolitis

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189
Q

What is the main risk factor for NEC?

A

IUGR

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190
Q

What is the presentation for NEC?

A
  • Feeding intolerance AND vomiting
  • Bile-stained
  • Abdominal distension
  • Can cause shock  Require mechanical ventilation.
  • Rectal bleeding

Non-specific systemic findings: Apnoea, respiratory failure, lethargy, or temperature instability.

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191
Q

What characteristic sign is observed in NEC?

A

Intramural gas - pneumatosis intestinalis

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192
Q

What findings are observed in NEC (XR)?

A
  • Asymmetrical dilated bowel loops
  • Bowel wall oedema
  • Pneumatosis intestinalis (intramural gas)
  • Portal venous gas
  • Rigler sign – Air both inside and outside the bowel wall
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193
Q

What is the management for NEC?

A

Store oral feeding and prescribe broad-spectrum antibiotics. Stop Feed for 7 days in confirmed NEC.

Start parenteral nutrition

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194
Q

What ABx is indicated NEC?

A
  • Ampicillin + Gentamicin + metronidazole.
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195
Q

When does reflux in an infant typically resolve by?

A

Resolves by 2 years

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196
Q

What is the most common cause of vomiting in infants?

A

GORD

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197
Q

What are the risk factors for GORD in infants?

A

Risk factors
* Premature birth
* Parental history of heartburn or acid regurgitation
* Obesity
* Hiatus hernia
* History of congenital diaphragmatic hernia, oesophageal atresia and neurodisability.

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198
Q

What is the presentation of GORD?

A
  • Distressed behaviour shown:
  • Excessive crying, crying while feeding, and adopting unusual neck postures (Sandifer syndrome)
  • Hoarseness and/or chronic cough
  • Single episode of pneumonia
  • Pulmonary aspiration
  • Unexplained feeding difficulties – refusing to feed, gagging, or choking.
  • Faltering growth.
  • Oesophagitis  Haematemesis, discomfort on feeding or heartburn.
  • Vomiting/Regurgitation
  • Milky vomits after feeds
  • May occur after being laid flat.
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199
Q

What is the first-line therapy for patients with GORD and are breastfed?

A

1–2-week trial of alginate therapy (Gaviscon).

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200
Q

What is the first line of management for formula-fed infants with GORD?

A

Review feeding history (reduce the volume of the feeds if excessive for the child’s weight): Total feed = 150 mL/kg body weight over 24 hours. 1–2-week trial of smaller, more frequent feeds

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201
Q

What is the second line for fomulra-fed infants with GORD?

A

Feed thickeners

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202
Q

What is the third line therapy for GORD in infants?

A

Consider 1–2-week trial of alginate therapy.

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203
Q

If 1-2 week trial of alginate therapy does not work in GORD, what is indicated next?

A

4 weeks of PPI – Omeprazole suspension

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204
Q

What is the clinical presentation of ITP?

A

cutaneous bleeding - petechiae, purpura, and ecchymoses.

Mucosal bleeding - nasal passages, buccal and gingival surfaces.

Bruising

Preceding illness

N.B: There is an absence of systemic symptoms

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205
Q

What investigation findings are consistent with a diagnosis of ITP?

A

Isolated thrombocytopenia (<100 x 10^9/L)

WCC is normal

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206
Q

What is the first-line management for a patient with ITP?

A

Self-limiting in 80% children, resolves within 6-8 weeks.

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207
Q

What is the management for severe life-threatening ITP (e.g., intracranial bleeding)?

A

Intravenous immunoglobulin + platelet transfusion

Antifibrinolytics

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208
Q

Define disseminated intravascular coagulation:

A

An ACQUIRED syndrome characterised by systemic activation of coagulation

  • Haemorrhage and thrombosis.
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209
Q

What is the main cause of DIC in children?

A

Sepsis - in meninigoccocaemia
Neontal viral infections - Rubella, Herpes, CMV and enterovirus + TORCH infections.

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210
Q

What are the clinical manifestations associated with DIC?

A

Bleeding (Bleeding from at least three unrelated sites).
* Venepuncture sites and gastrointestinal tract
* Fever and confusion
* Thrombosis – widespread ischaemia or infarction leading to renal failure, liver failure and CNS involvement.
* Purpura fulminans
* Gangrene
* Petechiae, ecchymosis or haematuria
* Circulatory collapse
- Oliguria, hypotension, or tachycardia

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211
Q

What investigations are consistent with the diagnosis of DIC?

A

Platelet count (<100,000/microL)

Prolonged PT and aPTT

Decreased Factor V and VIII levels

Fibrin formation
* Decreased fibrinogen - low
* D-dimer/fibrin-degradation products.
- Elevated

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212
Q

What is the fibrinogen level in a patient presenting with DIC?

A

Low

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213
Q

What replacement therapy is indicated in DIC?

A

Platelet transfusion, FFP an cryoprecipitate transfusions.

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214
Q

What is prescribed in a patient with purpura fulminans due to meningococcal septicaemia?

A

Protein C concentrates

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215
Q

How many settings must ADHD symptoms of impulsivity and inattention need to occur in for diagnosis?

A

Two or more settings - including social, familial or educational.

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216
Q

What is the indication of a watchful waiting period in ADHD?

A

Children with behaviour/inattention problems adversely affecting their life in one setting.

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217
Q

How long is the watchful waiting period in a patient with suspected ADHD?

A

10 weeks

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218
Q

What is the first-line management for a pre-school aged child (4-6 years) with ADHD?

A

Parent training in behaviour management

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219
Q

What is the first-line management for a school-aged child (Aged 6-18 years) with ADHD?

A

methylphenidate or amphetamine + psychoeducation

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220
Q

What is the side effect profile of methylphenidate?

A

Abdominal pain, nausea, and dyspepsia.

Weight and height - stunted growth

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221
Q

What should be monitored every 6 months in a patient with ADHD managed by methylphenidate?

A

Height and Weight

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222
Q

What investigation should be performed before initiating methylphenidate?

A

ECG

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223
Q

What medication should be prescribed in a patient with known tic disorder or stimulant induced tics with ADHD?

A

Guanfacine or clonidine.

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224
Q

What is the second-line therapy if methylphenidate is unsuccessful in ADHD?

A

lisdexamfetamine

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225
Q

What is a febrile seizure?

A

A seizure occurs in a febrile child (>38.0°C) between the ages of 6mo-6 years.

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226
Q

Which age category is most commonly affected by febrile seizures?

A

6 months to 6 years

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227
Q

How long do febrile seizures typically last?

A

Approximately 2-3 minutes (<5 minutes)

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228
Q

Which type of seizure is associated with febrile seizures?

A

Generalised tonic-clonic
- Stiffening followed by rhythmical jerking
-Post-ictal period - drowsiness, irritability or confusion with complete recovery in 1 hour.

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229
Q

What risk factors are associated with febrile seizures?

A

High fever
Viral infection
Recent immunisation
Family history

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230
Q

Which is the most common causative virus for febrile seizures?

A

Human herpes simplex virus 6 (HH6) in Roseola.

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231
Q

Management for febrile seizure >5 minutes

A

Ambulance - call

Seizure lasts >5minutes
(drugs available)→administer one of the below:
* PR diazepam (repeated once after 5 minutes if the seizure hasn’t stopped); OR
* Buccal midazolam
▪ 10 minutes after first dose ongoing seizure,twitching, or another seizure

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232
Q

What is the rescue for febrile convulsions?

A

Buccal midazolam

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233
Q

Advice during febrile convulsion

A

Monitor the duration of the seizure; cushion their head and remove harmful objects.
* Do not restrain and check the airway.

There is a 2-6% increased risk of epilepsy,

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234
Q

Management of fever in febrile convulsions

A

Do not try and cool the child

Regular paracetamol and ibuprofen

Adequate fluid intake

Seek advice if prolonged fever

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235
Q

Definition of a complex seizure

A
  • 15-30 minutes
  • Focal seizure
  • Repeat seizures within 24 hours
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236
Q

What chromosomal aberration is characterised by Down’s syndrome?

A

Trisomy 21 - meiotic nondisjunction

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237
Q

What craniofacial appearances are associated with Down’s syndrome?

A

Microcephaly
Flattened occiput
Flat facial profile
Midface hypoplasia
Upward slanting eyes with epicanthal folds
Brush field spots on the iris
Flat nasal bridge
Small dysplastic ears
Third fontanelle

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238
Q

With ocular abnormalities is associated with Down’s syndrome?

A

Brush field spots on the iris

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239
Q

What is the presentation of Down’s syndrome?

A
  • Craniofacial appearance:
  • Microcephaly, flattened occiput, flat facial profile, midface hypoplasia, upward slanting eyes with epicanthal folds, brush field spots on the iris, flat nasal bridge, small dysplastic ears, third fontanelle.
  • Hypotonia (Improves with age)
  • Poor Moro reflex
  • Short stature
  • Small feet, hands, digits
  • Wide gap between first and second toes (sandal gap)
  • Single palmar crease.
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240
Q

What cardiac abnormalities is associated with Down’s syndrome?

A

AV Canal defect
VSD
ASD
TOF
PDA
Pulmonary HTN

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241
Q

What gastrointestinal abnormalities is associated with Down’s syndrome?

A

Duodenal atresia
Hirshprung’s disease
Omphalocele

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242
Q

What joint laxity is associated with Down’s syndrome?

A

Atlantoaxial instability

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243
Q

What advanced medical co-morbidities is associated with Down’s syndrome?

A
  1. Delayed motor milestones
  2. Learning difficulty
  3. Short stature
  4. OSA (50-75%)
  5. Visual impairment
  6. Secretory otitis media (75%).
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244
Q

What type of Leukaemia is associated with Down’s syndrome?

A

ALL

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245
Q

What antenatal testing is performed at 11-13 weeks to detect Down’s syndrome?

A

Nuchal translucency measurement

  • Serum B-HCG - raised
    -Pregnancy-associated plasma protein (PAAP-A reduced).
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246
Q

Which antenatal biomarker is reduced in Down’s syndrome?

A

Pregnancy-associated plasma protein

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247
Q

What is the quadruple diagnostic antenatal test for Down’s syndrome?

A

AFP, Unconjugated oestriol, HCG, and inhibin A

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248
Q

What is the immediate management plan for Down’s syndrome?

A

Echocardiogram -ASVD
Genetic counselling
Early intervention programme
- Physiotherapy
-OT
-SALT

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249
Q

Definition of autism

A

A neurodevelopmental disorder characterised by qualitative impairment in social interaction, and communication.
* Repetitive stereotyped behaviour, interests, and activity.

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250
Q

What are the core symptoms of autism (2)?

A

CORE SYMPTOM 1: Impaired social communication and interaction

CORE SYMPTOM 2: Restricted and repetitive behaviour, interests, and activities
Stereotyped behaviours

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251
Q

What screening and diagnostic questionnaires are performed for the diagnosis of Autism Spectrum disorder?

A

Autism diagnostic observational schedule

DISCO

SCQ, CAST, CARS, SRS, ASQ

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252
Q

Define Breath Holding Attacks:

A

These typically occur in toddlers.
* Provoked by temper, frustration, or strong emotion.
- Cries rigorously for <15 seconds  silent
* The screaming toddler holds his or her breath  Cyanosis and loss of consciousness.
* Rapid recovery

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253
Q

Which vitamin is deficient in haemorrahgic disease of the newborn?

A

Vitamin K

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254
Q

Which type of babies are at an increased risk of haemorrhagic disease of the newborn?

A

Breast-fed babies - poor source of vitamin K

+ Maternal use of anti-epileptic drugs

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255
Q

What is the management for haemorrhagic disease of the newborn?

A

Once-off Intramuscular injection of vitamin K

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256
Q

What murmur is associated with the following description:
A continuous blowing noise heard below both clavicles

A

A venous hum

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257
Q

What causes a venous hum?

A

Turbulent blood flow in the great veins and returns to the heart - a continuous bilateral blowing noise inferior to the clavicles

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258
Q

Where is a venous hum predominantly heard?

A

Inferior to both clavicles

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259
Q

What is a Still’s murmur?

A

Low-pitched sound heard at the lower left sternal edge

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260
Q

Where is a Still’s murmur heard?

A

At the lower left sternal edge

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261
Q

What antibiotic management is prescribed in Scarlet Fever?

A

10-day cause of an oral penicillin (benzylpenicillin or azithromycin is penicillin allergic).

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262
Q

What is the first line management for Kawasaki disease?

A

High-dose aspirin and intravenous immunoglobulin

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263
Q

What investigations are necessitated in a patient with Kawasaki disease?

A

Echocardiogram to detect coronary artery aneurysm

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264
Q

A slapped cheek appearance is associated with what viral exanthem?

A

Fifth disease - Parvovirus B19 infection - Erythema infectiosum

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265
Q

Define West’s Syndrome:

A

Infantile spasms - characterised by hypsarrythmia on an EEG

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266
Q

What EEG pattern is observed in infantile spasms?

A

Hypsarrhythmia

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267
Q

What is the first-line management for infantile spasms?

A

vigabatrin

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268
Q

What characteristic feature is associated with infantile spasms?

A

‘salaam’ attacks

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269
Q

What is the first line management for transposition of the great arteries?

A

Prostaglandin E1 - to maintain the PDA until surgical correction is performed

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270
Q

Name 3 causes of cyanotic congenital heart disease

A

Tetralogy of Fallot
Transposition of great arteries (TGA
Tricuspid atresia

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271
Q

What is the causative organism for acute epiglotitis?

A

Haemophilus influenzae type B

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272
Q

What is the management for asymptomatic neonatal hypoglycaemia?

A

Encourage normal feeding and monitor glucose

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273
Q

What is the threshold for neonatal hypoglycaemia?

A

<2.6 mmol/L

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274
Q

What are the symptomatic features associated with neonatal hypoglycaemia?

A

Jitteriness
Irritabile
Tachypnoea
Pallor

+ neuroglycopenic symptoms - poor feeding, weak cry, drowsy, hypotonia, seizures

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275
Q

What is the most common causative organism for early-onset neonatal sepsis?

A

GBS and Escherichia coli, L. monocytogenes

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276
Q

What is the management for symptomatic hypoglycaemia?

A

Intravenous infusion of 10% dextrose

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277
Q

What is the inheritance pattern for Tay-Sachs disease?

A

Autosomal recessive

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278
Q

What are the four features of tetralogy of fallot?

A

ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta

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279
Q

What are the CXR features in ToF?

A

Boot shaped heart

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280
Q

What ECG findings are associated with ToF?

A

Right ventricular hypertrophy

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281
Q

What is the 1st line management for Scarlet fever?

A

Oral Penicillin V for 10 days

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282
Q

What school exclusion advice is recommended for Scarlet fever?

A

Return to school 24 hours after commencing ABx
Is a notifiable disease

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283
Q

What is the causative organism for Scarlet Fever?

A

Streptococcus pyogenes (group A)

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284
Q

What is the most common complication associated with Scarlet Fever?

A

Otitis media

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285
Q

target sign on ultrasound is consistent with what diagnosis?

A

Intussusception

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286
Q

What is the diagnostic investigation for Intussusception?

A

Abdominal ultrasound revealing target sign

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287
Q

What is the definitive management for Intussusception?

A

Air insufflation under radiographic guidance or barium enema

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288
Q

What investigation is performed as part of the newborn hearing screening programme?

A

Otoacoustic emissions

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289
Q

What investigation follows an abnormal hearing test at birth?

A

Auditory brainstem response test

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290
Q

What prophylaxis is prescribed in immunocompromised patients exposed to varicella zoster?

A

Varicella zoster immunoglobulin

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291
Q

What is the first line management for nocturnal enuresis?

A

Enuresis alarm and reward systems - star charts (given for agreed behaviour not dry nights)

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292
Q

What is the second line management for nocturnal enuresis if an enuresis alarm is ineffective?

A

Desmopressin

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293
Q

What is the first step for newborn resucitation?

A

Dry the baby followed by 5 inflation breaths

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294
Q

Name the childhood syndrome characterised by a small chin, posterior displacement of the tongue and cleft palate.

A

Pierre-Robin Syndrome

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295
Q

Supravalvular aortic stenosis , short stature, learning difficulties and an extrovert personality is associated with what childhood syndrome

A

William’s Syndrome

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296
Q

Rocker bottom feet, small chin, overlapping of fingers is associated with what childhood syndrome?

A

Edward’s syndrome

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297
Q

Which condition is associated with hypospadias?

A

Cryptorchidism

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298
Q

What is the causative organism for croup?

A

Parainfluenza virus

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299
Q

What is the management for a patient with Perthes disease <6 years?

A

Observation

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300
Q

What is the definitive management for SUFE?

A

In situ screw fixation

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301
Q

What condition is associated with precipitating meconium ileus?

A

Cystic fibrosis

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302
Q

What is a poor prognostic factor for congenital diaphragmatic hernia?

A

The presence of the liver in the thoracic cavity

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303
Q

Respiratory rate admission criteria in neonate?

A

> 60 breaths per minute

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304
Q

What is the first line of management for Hirschprung’s disease?

A

Rectal washout/bowel irrigation

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305
Q

What is the gold-standard investigation for Hirschprung’s disease?

A

Rectal biopsy

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306
Q

Which age group is most affected by SUFE?

A

10-15 years

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307
Q

Which demographic of patients is most affected by SUFE?

A

10-15 Year olds
Boys
Obese

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308
Q

What is the presentation of SUFE?

A

Common: Altered gait, and pain.
* Nonradiating, dull, aching pain in the hip, groin, thigh, or knee.
* Loss of internal rotation of the leg in flexion.

Gait
* Trendelenburg’s gait
* Affected leg externally rotated.
- Unable to bear weight on the affected leg.

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309
Q

Define SUFE:

A

Displacement of the femoral head epiphysis postero-inferiorly

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310
Q

What radiological investigations are performed in SUFE?

A

Bilateral AP X-rays

Lateral (frog-leg X-rays)

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311
Q

What specific radiological sign is consistent with SUFE?

A

Klein’s lines do not intersect the femoral head
- Trethowan’s sign

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312
Q

What is the first line management for SUFE?

A

Immediate (urgent) orthopaedic referral for in situ screw fixation across the growth plate

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313
Q

Define Perthe’s disease:

A

LCP is an idiopathic osteonecrosis of the hip.
* Avascular necrosis of the femoral head.

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314
Q

What is the peak age incidence of Perthes diseae?

A

5-8 years

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315
Q

Which sex is most affected by Perthes disease?

A

5x boys

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316
Q

Presentation of Perthes disease

A

nsidious onset of hip pain
* Activity-related
* Progressive over weeks
* Pain referred down the anterior hip and medial thigh.

Limp
* Short stature
* Muscle wasting
- Gluteal muscles and quadriceps

Positive roll test
Supine position: Roll the affected extremity into internal and external rotation  Guarding.

Stiffness and reduced range of hip movement
* Limited abduction and internal rotation.

N.B: No history of trauma

Bilateral in 10-20%

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317
Q

What is the first line Ix for suspected Perthes disease (+ findings)?

A

Bilateral AP X-rays: - reveals femoral head collapse and fragmentation

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318
Q

What is the confirmatory diagnostic Ix for Perthe’s disease?

A

Technetium bone scan

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319
Q

What is the acute management for Perthe’s disease?

A

Analgesia + supportive (protective pad over tibial tubercule)

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320
Q

What is the definitive management for a patient with Perthe’s disease <5 years of age?

A

Mobilisation and monitoring

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321
Q

What is the definitive management for Perthe’s disease in patients aged 7-12 years?

A

Surgical containment - keep femoral head within the acetabulum.

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321
Q

Presentation of transient synovitis

A

Limited movement
* Limited arch of motion – apparent in abduction and internal rotation.
* Pain on passive movement
* Tenderness on palpation of the hip or groin.

Limp
* Refusal to weight bear

Positive log roll
Most SENSITIVE test for transient synovitis.
* Supine: Involuntary muscle guarding in affected limb.

N.B: Fever is a red flag – consider septic arthritis.
* Urgent specialist assessment in fever.

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321
Q

What is transient synovitis?

A

Predominantly affects children between 2-12 years with a recent URTI
* Self-limiting inflammatory disorder of the hip; more common in boys.

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322
Q

Management of limp + fever?

A

Red flag for septic arthritis - urgent specialist assessment using kocher criteria

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322
Q

What are the first line investigations for transient synovitis?

A

FBC - WCC within normal range (Raised = septic arthritis).

X-ray - Exclude Perthe’s disease (normal in TS)

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323
Q

What is the management for transient synovitis?

A

Symptomatic relief – ibuprofen, naproxen or paracetamol.

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323
Q

A painful swelling of the growing tibial tuberosity in adolescents is diagnostic of what disease?

A

Osgood-Schlatter Disease

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324
Q

What is the aetiology of Osgood-Schlatter disease?

A

Osteochondrosis secondary to repeated avulsion and microtrauma of the apophysis into the patellar tendon insertion.

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325
Q

What is the presentation of Osgood-Schlatter Diseae?

A
  • Gradual onset of pain and swelling of the tibial tubercle.
  • Worsening of pain with athletic activity
  • Dull ache exacerbated by jumping or climbing stairs.
  • Tenderness to touch over tibial tubercle, particularly with restricted knee extension.
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326
Q

What are the radiological findings on lateral x-ray for OSD?

A

Separation and fragmentation of the upper tibial epiphysis

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327
Q

What is the acute management approach for OSD?

A
  • ICE after exercise (over the tibial tuberosity, 10-15 minutes up to 3 times per day).
  • Pain relief: NSAIDs/Paracetamol
  • Quadriceps stretching exercises and cross-training with low-impact sports
  • Protective knee pads (relieve pain when walking)
  • Injections of local anaesthetic mixed with dextrose
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328
Q

How long should ice after exercise be applied over the tibial tuberosity for in OSD?

A

10 to 15 minutes up to 3 times per day

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329
Q

What specific guided advice referral should be given to patients with OSD?

A

Victorian Paediatric Orthopaedic Network – Fact sheet + instructions on stretches.

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330
Q

what is the most common causative organism of septic arthritis in children?

A

Staphylococcus aureus

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331
Q

Causative organism of septic arthritis in SCD patients?

A

Salmonella

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332
Q

Risk factors for septic arthritis

A

RhA, osteoarthritis, joint prosthesis, crystal arthritis, chronic disease, immunosuppression.

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333
Q

Presentation of septic arthritis:

A
  • Single joint – Knee, hip, and ankle (~80%).
  • Limited range of motion
  • Infants will hold their limbs still (pseudoparalysis)/cry
  • Erythematous, warm and tender joint
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334
Q

What is the common causative organism of septic arthritis in neonates?

A

GBS, N. gonorrhoea and gram-negative enteric bacilli.

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335
Q

What are the first line investigations in a patient presenting with a hot, tender, erythematous joint?

A

Septic screen, - raised crp, esr
FBC - Raised WCC

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336
Q

What is the gold standard investigation and management for septic arthritis?

A

Joint aspiration of synovial fluid - to identify causative organism for MCS

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337
Q

Radiographic findings for septic arthritis (x4)?

A
  1. Capsular swelling, soft tissue swelling
  2. Widening of the joint space
  3. Increased opacity within the joint
  4. Distension of the joint capsule
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338
Q

What criteria is used to screen for septic arthritis in a child?

A

Kocher criteria

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339
Q

What are the 4 parameters of Kocher’s criteria?

A
  • Fever >38.5
  • Non-weight bearing
  • Raised ESR
  • Raised WCC
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340
Q

What ABx is prescribed in a neonate <3 months with septic arthritis?

A

IV cefotaxime + amoxicillin

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341
Q

What ABx is prescribed in a child 3 months to <5 years with septic arhritis?

A
  • IV ceftriaxone
  • Penicillin allergic – Clindamycin
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342
Q

What ABx is prescribed to patients with septic arthritis (Aged >6 years)?

A
  • IV flucloxacillin
    o Allergic - Clindamycin
    o MRSA - Vancomycin
    o Gram-negative - Cefotaxime
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343
Q

What is the peak incidence age of osteosarcoma?

A

13-16 years of age - coincides with adolescent growth spurt

  • occurs at an earlier age in children - more frequently in black children
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344
Q

What are the risk factors of osteosarcoma?

A

Risk factors: Radiation therapy, chemotherapy (alkylating agents).
o Syndromes: Gardner Syndrome, Li-Fraumeni, NFT1, Retinoblastoma

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345
Q

Which syndromes are associated with osteosarcoma?

A

Gardner Syndrome, Li-Fraumeni, NFT1, Retinoblastoma

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346
Q

What are the common sites of osteosarcoma?

A

Metaphysis of long bones:
1. Distal femur
2. Proximal tibia
3. Proximal humerus
4. Middle and proximal femur

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347
Q

Presentation of osteosarcoma?

A
  • Worsening pain over weeks to months
  • More severe at rest and at night.
  • Dull, deep, boring, and relentless
  • Mass/swelling – Firm, tender and warm to the touch.
  • Decreased range of motion of the affected limb
  • Rapid metastases to the lungs.
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348
Q

What is the first line investigation in patients with suspected osteosarcoma?

A

Plain conventional radiograph

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349
Q

Unexplained bone swelling in children and young people (NICE Ix recommendation)?

A

Urgent direct access X-ray within 48 hours

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350
Q

What are the radiological findings associated with osteosarcoma?

A

Codman’s triangle - Elevated periosteum

Sunburst appearance - soft tissue calcification

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351
Q

What is Codman’s triangle in osteosarcoma?

A

Elevated periosteum

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352
Q

What is the confirmatory diagnostic Ix in osteosarcoma?

A

Bone biopsy - highly pleomorphic spindle cell neoplasm with lace-like appearance

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353
Q

What is the management for low-grade disease at presentation?

A

Resection and reconstruction

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354
Q

What is the management approach for high-grade non-metastatic disease?

A

Complete surgical resection of the primary tumour

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355
Q

What is the prognosis of osteosarcoma?

A

POOR
60% - 5 year survival rate

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356
Q

Definition of Ewing Sarcoma:

A

A malignant tumour of the bone or soft tissue is characterised by the presence of small, round, blue cells of immunohistochemical evaluation.

  • Primitive neuroendocrine tumour (PNET)
  • Associated t (11:22) (EWSR1/FLI1) (q24; q12)
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357
Q

Presentation of Ewing Sarcoma:

A
  • Painful soft tissue mass is often present.
  • The midshaft of a long bone is usually affected.
  • Long bone of arms, legs, chest, skull and trunk.
  • Weight loss, fever, and lethargy
  • Localised pain or swelling of a few weeks or months’ duration.
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358
Q

What is the radiological finding associated with Ewing Sarcoma?

A

(Bone destructions with overlying onion-skin layers of periosteal bone formation).

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359
Q

What is the histological appearance of Ewing Sarcoma?

A

Small round blue cells

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360
Q

What is the definition of DDH?

A

DDH refers to the abnormal development of the acetabulum and proximal femur and mechanical instability of the hip joint.

  • Aetiology: Ligamentous laxity  Spontaneous dislocation and reduction of the femoral head.
  • Results in: Flattening of the acetabulum, muscle contractures that limit motion and joint capsule tightening.
    o Left hip – Affected 3x than the right hip.
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361
Q

Which sex is most affected by DDH?

A

Female infants are at a higher risk 9:1 ratio

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362
Q

What are the main risk factors for DDH?

A

Breech presentation (>34 weeks)

Firstborn child

Oligohydramnios

Positive family history

Macrosomia (birth weight >5kg)

Congenital calcaneovulagus foot deformity

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363
Q

What is the Barlow test?

A
  • Attempts to dislocate an articulated femoral head.
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364
Q

What is the Ortolani test for DDH?

A
  • Evaluates the stability of the hips.
    o Attempts to relocate a dislocated femoral head.
    o Used in infants 3-6 months of age.
    o Palpable clunk
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365
Q

What is the Galeazzi sign for DDH?

A
  • Limb-length discrepancy (Galeazzi sign – baby on back, legs together and knees flexed)
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366
Q

what is the diagnostic investigation for DDH?

A
  • Ultrasonography:
  • Diagnostic investigation for assessing morphology and stability of the infant’s hip.
  • > 4.5 months then X-ray.
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367
Q

What are the indications for a 6 week ultrasound scan to check for DDH?

A
  • Breech presentation at 36/40 weeks (regardless of presentation at delivery)
  • Breech delivery (including <36/40)
  • Family history of DDH

note: from >6 months = hip x-ray

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368
Q

What are the complications of DDH?

A

Avascular necrosis

Temporary femoral nerve palsy

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369
Q

What is the first line of management for osteomyelitis?

A

High dose IV empirical antibiotics - - Flucloxacillin

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370
Q

What is the most common site for osteomyelitis?

A

Distal femur and proximal tibia.

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371
Q

What disease staging classification is used for osteomyelitis?

A

Cienry-Mader classification

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372
Q

What are the indicators for NAI?

A
  • Delay in seeking medical help.
  • Mechanism inconsistent with injury or developmental stage of child
  • Signs of neglect
    o Failure to meet basic physical or psychological needs (food, shelter, medical care, and supervision).
  • Unusual behaviour of child (e.g., withdrawn, overly affectionate with strangers, distress/recurrent nightmares.
  • Multiple injurie
  • Injuries suggestive of an implement
    o Rib fractures
    o Fractures in a nonambalant child
    o Multiple bruisers in unusual locations
    o Shaken baby syndrome.
     Irritability
     Retinal haemorrhages
     Sign of raised intracranial pressure.
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373
Q

What are the three features associated with shaken baby syndrome?

A

o Shaken baby syndrome.
 Irritability
 Retinal haemorrhages
 Sign of raised intracranial pressure.

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374
Q

What types of bruising should be recognised in suspected NAI?

A

In shape of a hand, ligature, stick, teeth mark, grip or implement.

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375
Q

What types of fractures are concern for NAI?

A

Rib or long bone fractures

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376
Q

What physical features should be recognised for NAI?

A
  • Bruising – in shape of a hand, ligature, stick, teeth mark, grip or implement.
    o Petechiae (unexplained) – in clusters, similar shape/size, non-bony part (e.g. face, eyes, ears and buttocks); ankles and neck (attempted strangulation).
  • Bites
  • Lacerations, abrasions, or scars
  • Burns or scald injuries – glove and stocking.
  • Fractures – X-ray of occult fractures.
  • Torn frenulum labii superioris.
    o Rib fractures.
  • Intracranial injury
    o Under <3 years
    o Retinal haemorrhages
    o Rib or long bone fractures
    o Subdural haemorrhages.
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377
Q

Anogenital warts under what age should warrant further escalation?

A

Under the age of 13 - suspected sexual abuse

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378
Q

What is a feature of sexual abuse in children?

A

anogenital warts

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379
Q

What is the first line management for a patient with suspected NAI?

A
  1. Admit the child to a place of safety,
  2. Contact child abuse investigation team (CAIT)
  3. Contact Social services
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380
Q

Which factor is deficient in Haemophilia A?

A

Factor VIII

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381
Q

What is the most common causative organism for late-onset neonatal sepsis?

A

Coagulase-negative Staphylococcus (CoNS)
▪ I.E.Staphylococcusepidermidis

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382
Q

What are the red flag signs for high-risk sepsis in paedaiaitric patients?

A

Hypotension

Prolonged capillary refill time >5s

Oxygen saturation <92% (requiring oxygen saturation)

Pale/mottled skin or non-blanching purpuric rash

RR>60 breaths per minute

Grunting

AVPU - V, P or U

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383
Q

What is the initial fluid resuscitation infusion rate for paediatric sepsis?

A

20 mL/kg 0.9% NaCl bolus over 5-10 minutes

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384
Q

What is the preferred ABx of choice for meningococcal sepsis? (Community versus hospital)

A

Community - IM benzylpenicillin

Hospital - IV cefotaxime

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385
Q

What is the time frame for early onset sepsis?

A

<72 hours

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386
Q

What is the ABx option for late-onset sepsis (>72 hours) for Coagulase negative staphylococcus aureus?

A

IV meropenem + amikacin + ampicillin

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387
Q

What are the risk factors for neonatal sepsis?

A

PROM/PPROM, chorioamnionitis (i.e. fever during labour)

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388
Q

What is the first step for neonatal Resuscitation?

A

Dry the baby (note the time) and within 30s, assess tone, RR, and HR

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389
Q

Where is HR palpated in neonates?

A

Femoral , brachial

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390
Q

How many inflation breaths are administered within 60s of neonatal resuscitation?

A

5 (1:2:3, 2:2:3, 3:2:3, 4:2:3, 5:2:3)

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391
Q

How many 5 inflation breaths should be administered prior to ventilation?

A

3

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392
Q

What is the ventilation rate in neonates?

A

15 over 30s

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393
Q

What is the compression to breath ratio in neonates?

A

3:1

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394
Q

When is the Apgar score assessed?

A

First minute and 5 minutes post-delivery

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395
Q

What are the parameters of the APGAR score?

A

Appearance
Pulse
Grimace
Activity Respiration

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396
Q

What is the chromosomal abnormality associated with Patau Syndrome?

A

Trisomy 13

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397
Q

What are the features associaaited with Patau syndrome?

A

Microcephaly (and brain defects)
* Microphthalmia (small eyes)
* Other eye defects
* Cleft lip/palate
* Polydactyl
* Omphalocele / Gastroschisis

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398
Q

Trisomy 18 is defined as what chromosomal syndrome?

A

Edward’s syndrome

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399
Q

What are the clinical features associated with trisomy 18?

A

LBW
* Small mouth/chin
* Low-set ears
* ‘Rocker-bottom’ feet
* Overlapping fingers
* Intellectual disability
* Cardiac, renal and GI abnormalities
* Omphalocele / Gastroschisis

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400
Q

What are the characteristic features associated with Trisomy 21?

A

Characteristic facies
* Hypotonia and short neck
* Single palmar crease
* ‘Sandal gap’ on feet
* Short stature
* Upslanting palpebral fissures
* Flat occiput
* Congenital heart defects in 40%
* Omphalocele / Gastroschisis

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401
Q
  • Webbed neck
  • Trident hairline
  • Pectus excavatum
  • Short stature
  • Pulmonary stenosis

Diagnosis?

A

Noonan Syndrome

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402
Q

Pulmonary stenosis is associated with what chromosomal syndrome?

A

Noonan syndrome

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403
Q

What are the clinical features associated with Prader-willi?

A

Prader-Willi Syndrome
* Hypotonia
* Hyperphagia
* Almond-shaped eyes
* Hypogonadism
* Obesity (in later childhood)
* Epicanthal folds
* Flat nasal bridge + upturned nose
* Learning disability

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404
Q

What are the characteristic features associated with Turner’s syndrome?

A

Lymphoedema of hands/feet in neonate
* Short stature, spoon-shaped nails
* Wide carrying angle
* Thick or webbed neck
* Infertility
* Bicuspid aortic valve > Aortic coarctation
o ESM over aortic valve
* Delayed puberty
* Hypothyroidism
* Omphalocele / Gastroschisis

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405
Q

What genetic mechanism is assocaited with Prader-Willi Syndrome?

A

Genetic imprinting - Expression of gene is influenced by the sex of the parent who has transmitted it.

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406
Q

What paternal PWS chromosome is affected in PWS?

A

chromosome 15

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407
Q

Which type of mutation is associate with Fragile X syndrome?

A

CGG trinucleotide repeat expansion of the FMR1 gene.

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408
Q

What are the characteristic clinical features associated with Fragile X?

A

IQ 20-80 (mean 50) – 2nd most common cause of low IQ after Down’s Syndrome
* Macrocephaly, macroorchidism
* Characteristic facies:
o Large, low-set ears
o Long, thin face
* Other – autism, joint laxity, scoliosis
* Complication: Mitral valve prolapse

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409
Q

Which cardiac complication is associated with Fragile X?

A

Mitral Valve prolapse

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410
Q

Microcephaly, absent philtrum, reduced IQ, and IUGR are associated with what congenital aberration?

A

Foetal alcohol syndrome

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411
Q

When is Patau and Edward Syndrome diagnosed?

A

USS analysis during the 2nd trimester - chromosomal analysis from amniocentesis and cffDNA (NIPT)

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412
Q

What is the inheritance pattern assocaited with Noonan’s syndrome?

A

Autosomal dominant

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413
Q

What are the neonatal complications associated with Turner’s syndrome?

A

Pyloric stenosis
Coarctation of the aorta
Biscuspid aortic valve - aortic stenosis -ESM murmur

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414
Q

What murmur is associated with Turner’s syndrome?

A

Ejection systolic murmur secondary to biscspid aortic valve

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415
Q

What is the term used to describe the skin on the back of the neck in Turner’s syndrome?

A

Cystic hygroma

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416
Q

What is the management of Turner’s syndrome?

A

Growth hormone replacement therapy - plot growth and height charts

Oestrogen replacement at the time of puberty for the development of secondary sexual characteristics

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417
Q

What is the most common genetic chromsomal pathogenesis for trisomy 21?

A

Meiotic non-disjunction

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418
Q

What neonatal complications are associated with trisomy 21?

A

Congenital heart defects - AVSD

Duodenal atresia

Hirschprung’s disease

Omphalocele

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419
Q

What childhood complications are associated with trisomy 21?

A

Secretory otitis media

Learning difficulty

Short stature

Delayed developmental milestones

OSA

ALL

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420
Q

What are the late-stage complications associated with trisomy 21?

A

ALL

Hypothyroidism and Coeliac’s disease

Epilepsy

Early-onset Alzheimer’s disease

Joint laxity - screen for atlantoaxial instability

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421
Q

Which congenital heart defect is most commonly associated with Trisomy 21?

A

ASVD

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422
Q

What defines as a low birth weight baby?

A

<2.5 kg

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423
Q

Very low birthweight baby?

A

<1.5kg

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424
Q

Extremely low birthweight baby?

A

<1 lg

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425
Q

What is the first newborn auditory investigation in neonates?

A

Evoke otoacoustic emission testing

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426
Q

What is the second line investigation post-failed EOAE?

A

Automated auditory brainstem repsonse audiometry

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427
Q

What is the preferred hearing modality in >4 year olds?

A

Pure tone audiometry

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428
Q

Define positional talipes?

A

Feet remain in the in-utero position due to intrauterine compression

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429
Q

What is the management of talipes equinovarus?

A

Ponsetti method - plaster casting and bracing

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430
Q

What trisomy is associated with Patau syndrome?

A

Trisomy 13

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431
Q

Trisomy 18 describes which syndrome?

A

Edward’s syndrome

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432
Q

What is the prophylaxis for bronchopulmonary dysplasia?

A

Maternal corticosteroids <34 weeks (consider 34-36 weeks)

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433
Q

What is the first line respiratory support for BPD?

A

High flow oxygen followed by CPAP

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434
Q

What effect does caffeine citrate have in the management of BPD?

A

Stimulates respiratory effort

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435
Q

What prophylactic drug for bronchiolitis is prescribed infants with bronchopulmonary dysplasia?

A

Paliviziumb

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436
Q

What is the first line management for cleft palate?

A

Refer to the cleft lip and palate MDT team - EARLY REFERRAL

Speech and language therapy input for long-term

Definitive surgical closure

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437
Q

When is the primary closure of the cleft lip done?

A

3 months

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438
Q

When is the primary closure of the cleft palate occur?

A

6-12 months

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439
Q

Feeding support for infants with cleft lip and palate?

A

Dental plates, specially shaped bottles, teats

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440
Q

How is CMV diagnosis made in a newborn?

A

Urine or saliva PCR testing within the first 2 weeks.

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441
Q

What is the first line drug to management CMV in the newborn?

A

Oral valgancilovir or IV ganciclovir (if oral not tolerated)

+ Barrier nursing (CMV is shed in the urine and body secretions).

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442
Q

Mode of delivery for CDH?

A

Elective c-section

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443
Q

Neonatal management of congenital diaphragmatic hernia?

A

Intubation and ventilation

ECMO - used if pulmonary hypertension is not improving

Wide-bore NG tube - decompress the stomach to prevent vomiting and swelling

Neonatal ICU

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444
Q

When should surgical repair of CDH be performed?

A

Within 48 to 72 hours

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445
Q

Management of opthalamia neonatorum?

A

Same-day referral to ophthalmologist.
Topical chloramphenicol eye drops for mild to moderate

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446
Q

Most common cause of opthalamia neonatorum?

A

Chlamydia

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447
Q

ABx of choice for chlamydia induced opthalamia neonatorum?

A

Oral erythromycin

Treat partner and mother

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448
Q

Abx choice for gonococcal induced opthalamia neonatorum?

A

Single dose of parenteral (IV or IM) cefotaxime/ceftriaxone

Treat partner and mother

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449
Q

Complications of Down Syndrome?

A

Hypothyroidism

Duodenal atresia

Hirschprung’s disease

Coeliac disease

Epilepsy

Atlantoaxial instability

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450
Q

Frequency of TFT investigations for hypothyroidism in Down syndrome?

A

At birth, 6 months, 1 year and annual surveillance

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451
Q

Which malignant blood disorder is associated with Down syndrome?

A

ALL

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452
Q

Which charity is used for Down’s syndrome?

A

Down’s syndrome association

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453
Q

Prophylaxis for Group B streptococcal infection (obstetrics)?

A

Intrapartum benzylpenicillin (or vancomyin if allergic)

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454
Q

Indications for Group B prophylaxis in mothers?

A

Previous baby born with invasive group B streptococcal infection

Group B colonisation, bacteriuria, or infection

Are in pre-term labour

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455
Q

Neonatal infection management for Group B streptoccous?

A

Penicillin (IV benzylpenicillin) and gentamicin

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456
Q

What is the prophylaxis prescribed for haemolytic disease of the newborn to mothers?

A

Anti-D immunoglobulin to RhD negative non-sensitised mothers at 28 weeks (single dose of 1500 IU)

or two doses of 500 IU at 28 and 34 weeks and delivery

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457
Q

Neonatal management for haemolytic disease of the newborn?

A

Resus protocol

Initiate phototherapy

Exchange transfusion (if Bilirubin is rising rapidly 8-10 umol/L/hr despite adequate phototherapy; significant anaemia <100 g/L or severe hyperbilirubinaemia)

IVIG for immune haemolysis

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458
Q

HepB virus for HBsAG positive mothers?

A

Monovalent Hepatitis B vaccine within 24 hours of birth (and at 4 weeks + 1 year)

6 in 1 vaccine at 8,12,16 weeks

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459
Q

Indications for HBIG in neonates?

A

Maternal HBeAg positive
Maternal anti-Be negative
Maternal HBV DNA ≥1x106 IU/ml
Acute maternal HBV infection during pregnancy
Birthweight <1.5 kg.

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460
Q

Prophylaxis in primary genital herpes mothers (<28 weeks)?

A

Prophylactic regular aciclovir is given from 36 weeks onwards

Vaginal delivery if asymptomatic and >6 weeks after initial infection

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461
Q

What is the indication for C-section in HSV positive mothers?

A

Symptomatic presentation

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462
Q

Management for primary genital herpes after 28 weeks gestation?

A

C-section + acyclovir

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463
Q

What clinical grading is used for HIE?

A

Sarnat grading - classifies into 3 stages

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464
Q

First line management for HIE?

A

A-E resuscitation

-Therapeutic hypothermia within neonatal ICU

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465
Q

How does therapeutic hypothermia work?

A

Active cooling the core temperature of the baby to between 33 and 34 degrees - reduces inflammation and neurone loss following an acute hypoxic injury

Over 72 hours.

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466
Q

Management of listeria monocytogenes infection?

A

Amoxicillin and gentamicin

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467
Q

Asymmetrical patchy opacities on chest X-ray post-term delivery are associated with what diagnosis in the neonate?

A

Meconium aspiration

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468
Q

Management of meconium aspiration in normal term infant without history of GBS?

A

Observation

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469
Q

Management of high-risk meconiun aspiration neonate?

A

IV ampicilllin and gentamicin

Oxygen and non-invasive ventilation

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470
Q

What is the first line approach for NEC?

A

Stop feeding and begin TPN for 7 days.

NG tube - used to drain fluid and gas from the gut; monitor hourly aspirates

Broad-spectrum IV antibiotics - cefotaxime and vancomyin

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471
Q

What is the surgical approach for necrotising eneterocolitis?

A

Laparotomy with resection of the necrosed bowel with either a primary anastomosis or a defunctioning stoma

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472
Q

How is neonatal hypoglycaemia prevented?

A

Feed baby within 30 minutes; subsequent feeding 2-3 hours.

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473
Q

Management of asymptomatic neonatal hypoglycaemia?

A

Confirm hypoglycaemia via blood glucose assay.

  • Support breastfeeding technique; consider supplement breast milk substitute or IV glucose

Remeasure glucose every 1 hour

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474
Q

Indications for IV glucose infusion in neonatal hypoglycaemia?

A

Symptomatic

OR

Pre-feed glucose <2 mmol/L

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475
Q

What initial bolus of glucose should be administered for neonatal hypoglycaemia?

A

2 ml/Kg of 10% glucose infusion

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476
Q

Management for neonatal hypoglycaemia if <1mmol/L

A

1st line - buccal glucose gel
arrange IV glucose infusion (2 ml/Kg 10% glucose bolus)

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477
Q

Which non-invasive screening test is performed for low-risk neonates of jaundice?

A

Transcutaneous bilirubin

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478
Q

First line investigation for pathological jaundice?

A

Serum bilirubin (<24 hours of age onset or born <35 weeks)

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479
Q

Management of physiological jaundice?

A

Reassurance

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480
Q

Management of unconjugated pathological jaundice (1st line)

A

Phototherapy

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481
Q

What investigation determines the indication for phototherapy in pathological jaundice?

A

Serum bilirubin threshold (between lower blue and upper red line)

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482
Q

Second line management for pathological jaundice following phototherapy?

A

Intensified phototherapy and adjuncts (IVIG)

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483
Q

First line management for severe (above upper red line) pathological neonatal jaundice?

A

Exchange transfusion

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484
Q

Common cause of pathological CONJUGATED jaundice?

A

Biliary atresia

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485
Q

Protective precautions for phototherapy?

A

Eye protection

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486
Q

What resources are available for neonatal jaundice?

A

NHS choices neonatal jaundice factsheet

The breastfeeding network

Bliss (for premature and sick babies)

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487
Q

Management for persistent pulomnary hypertension of the newborn?

A

Oxygen
Ventilation
Surfactant
Suction of secretions from ETT
Inhaled nitric oxide

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488
Q

Management for small pneumothorax in neonate?

A

Close observation and 100% oxygen for 1-2 hours to wash out nitrogen

Consider needle decompression

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489
Q

Management for tension pneumothorax?

A

Chest drain insertion

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490
Q

What prophylaxis is prescribed to mitigate the risk of respiratory distress syndrome in neonates?

A

Antenatal corticosteroids - increases foetal lung maturation

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491
Q

Management of toxoplasmosis in the newborn?

A

Refer to paediatric infectious diseases
-Pyrimethamine + Sulfadiazine + Folinic acid

Continue all 3 for 1 year

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492
Q

Management for active chorioretinitis in toxoplasmosis?

A

Prednisolone

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493
Q

Follow-up investigations for asymptomatic toxoplasmosis newborns with positive serology?

A

Ophthalmology and audiology assessment

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494
Q

Management for Type A Transoesophageal fistula?

A

Stabilisation and gastrostomy + replacement

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495
Q

Management for type B/D Transoesophageal fistula?

A

Suction catheter and surgical correction

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496
Q

Management for type E Transoesophageal fistula?

A

NBM and surgical division of the fistula

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497
Q

Management for transient tachypnoea of the newborn if the respiratory rate is 60-80 breaths/minute?

A

Nutritional support - NGT or TPN

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498
Q

Indication for TPN/NGT in transient tachypnoea of the newborn?

A

Respiratory rate 60-80 breaths/minute

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499
Q

What is the gold-standard investigation for aortic stenosis?

A

Echocardiogram

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500
Q

What is the definitive management for aortic stenosis?

A

Percutaneous balloon aortic valvuloplasty

OR
Transcatheter aortic valve replacement (TAVR) or surgical valvotomy

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501
Q

What are the three main types of atrial septal defect?

A
  1. Ostium secondum - septum secondum fails to completely close
  2. Patent foramen ovale
  3. Ostium primum
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502
Q

Which is the commonest ASD observed?

A

Ostium secondum

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503
Q

Which murmur is auscultated in ASD?

A

Mid-systolic, crescendo-descrescendo murmur loudest at the upper left sternal border with fixed splitting of the second heart sound.

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504
Q

Management for ASD (ostium secondum)?

A

Transcatheter closure after 2 years. of age in asymptomatic patients

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505
Q

Definitive management for ostium primum ASD?

A

Open heart surgery

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5
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506
Q

Indications for surgical closure in ASD?

A

Right heart enlargement
Symptomatic pulmonary over circulation

Evidence of substantial left-to-right shunting (ratio of pulmonary to systematic blood flow >1.5)

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507
Q

Commonest site of coarctation of the aorta?

A

Distal to the left subclavian artery - at the origin of the ductus arteriosus

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508
Q

What is the first line management for coarctation of the aorta?

A

Prostaglandin E1 infusion - to maintain duct patency

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509
Q

What is the definitive surgical repair coarctation of the aorta?

A

End-to-end anastomosis or arch reconstruction or bypass graft

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510
Q

What are the three main causes of congenital cyanotic heart disease?

A
  1. Tetralogy of Fallot
  2. Transposition of the great arteries
  3. Tricuspid atresia
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511
Q

Drug to maintain duct patency?

A

Prostaglandin E1 infusion

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512
Q

Drugs to reduce preload in heart failure?

A

Diuretics Furosemide
Venous dilators - Nitroglycerin

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513
Q

Drugs to enhance cardiac contractility in heart failure?

A

Using IV agents (e.g., dopamine)
Other options - dobutamine, digoxin, adrenaline

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514
Q

Drugs to reduce afterload in heart failure?

A

Oral ACE inhibitors

IV agents (e.g., hydralazine, nitroprusside, alprostadil)

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515
Q

Drugs to improve oxygen delivery

A

Beta-blockers (e.g., carvedilol)

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516
Q

Initial empirical therapy for infective endocarditis in native valves?

A

Beta-lactams +/- low-dose gentamicin
low-dose gentamicin + vancomycin

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517
Q

Complications of PDA?

A

Bacterial endocarditis

Pulmonary vascular disease

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518
Q

Management of PDA

A

IV indomethacin - 1st line

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519
Q

What class of drug is indomethacin

A

Prostacyclin synthetase inhibitor

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520
Q

Surgical options for PDA

A

Surgical ligation or percutaneous catheter device closure

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521
Q

Management for moderate to severe pulmonary stenosis

A

Transcatheter balloon dilatation
Surgical valvuloplasty (2nd line)

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522
Q

Rheumatic fever prophylaxis?

A

Benzathine penicillin every 3-4 weeks

523
Q

Which type of antibiotics indicated for rheumatic fever?

A

Anti-streptococcal antibiotics - benzathine penicillin, benzylpenicillin, amoxicillin, penicillin V

524
Q

Drug management for Rheumatic fever?

A

NSAIDs (naproxen/ibuprofen)

Anti-streptococcal antibiotics

525
Q

Criteria for diagnosis of Rheumatic fever?

A

Jones criteria

526
Q

Management of symptomatic heart failure in rheumatic fever?

A

ACE inhibitors and diuretics

527
Q

1st line management for SVT?

A

Vagal manoeuvres

528
Q

2nd line for SVT?

A

Adenosine

529
Q

3rd line for SVT?

A

DC cardioversion, amiodarone, procainamide, flecainide

530
Q

ToF management shunting device?

A

Blalock-Taussig Shunt - artificial tube between subclavian artery and pulmonary artery

531
Q

1st line management for worsening/severe ToF?

A

Prostaglandin E1 infusion
Blalock-Taussing Shunt

532
Q

Definitive surgical management for ToF?

A

Total surgical repair by open heart surgery - performed from 4 months of age onwards

533
Q

What determines the severity of ToF?

A

Right ventricular outflow tract obstruction

534
Q

What are the complications associated with ToF?

A

Hypercyanotic ‘Tet’ spells - intermittent symptomatic periods when the right-to-left shunt worsens due to increased pulmonary vascualr resistance.

535
Q

Management of Tet spells?

A

Place the patient in the knee-to-chest position

Supplementary oxygen
IV fluids
Beta-blockers
Morphine
Sodium bicarbonate
Phenylphrine infusion

536
Q

Admission criteria for acute otitis media?

A

Severe systemic infection

Complications e.g. meningitis, mastoiditis, facial nerve palsy

Children <3 months with a temperature >38 degrees

537
Q

Common bacterial cause of otitis media (3)?

A

Haemophilus influenzae
Streptoccous pneumoniae
Moraxella catarrhalis

538
Q

Risk factors for acute otitis media?

A

Daycare attendance, limited or no breastfeeding, tobacco smoke exposure, pacifier use.

539
Q

Which clinical feature is the best predictor for acute otitis media?

A
  • Ear pain (otalgia) – rapid-onset
540
Q

What are the complications associated with acute otitis media?

A
  1. Perforation with ottohorea
  2. Acute mastoiditis – Postauricular swelling and protrusion of the auricle.
  3. Facial nerve palsy
  4. Vestibular symptoms
    - Dizziness, vertigo, balance, and motor problems.
541
Q

First line investigation for suspected acute otitis media?

A

Otoscopic examination

542
Q

Otoscopic findings observed in acute otitis media?

A
  • Moderate to severe bulging of the tympanic membrane, with loss or normal landmarks.
  • Obscures the malleus.
  • Loss of normal light reflex.
  • Perforation of the tympanic membrane
  • Purulent discharge
543
Q

How long does acute otitis media typically last?

A

3 days to one week - offer symptomatic relief - ibuprofen for pain (oral or rectal) or paracetamol

544
Q

What is the mainstay management for acute otitis media?

A

AOM spontaneously resolves within 3 days; provide symptom relief with analgesia

Provide back-up antibiotic prescription

545
Q

What are the criteria for antibiotic prescription in acute otitis media?

A
  • Otorrhoea, and aged <2 years with bilateral infection.
  • Back-up antibiotic prescription – if symptoms do not improve within 3 days or significantly worsen.
  • 5–7-day course of amoxicillin (or clarithromycin).
546
Q

Which antibiotics are prescribed for acute otitis media?

A

Amoxicillin or clarithryomycmocyin for 5-7 days.

547
Q

What are the risk factors for glue ear?

A

Risk factors:
* Palate abnormalities
* Decreased muscle tone.
* Cleft palate – Impaired function of the eustachian tube
* Primary ciliary dyskinesia
* Allergic rhinitis
* Down Syndrome – Mucociliary function impairment.

Acquired: Smoking, exposure to other children, low socioeconomic group, frequent URTIs, bottle feeding.

547
Q

What is the diagnosis of the following clinical features:
Absent infective signs – the predominant symptom – hearing loss (speech and language delays).
* Mild intermittent ear pain with aural fullness or ‘popping’.
* Aural discharge – foul-smelling (persistent = urgent referral).
* Recurrent acute otitis media infections, URTIs, and rhinorrhoea.
* Paroxysmal sneezing or nasal itching.
* Snoring

A

Acute otitis media with effusion - Glue ear

548
Q

What is the characteristic developmental feature assocaiaited with glue ear?

A

Hearing loss – Failed newborn hearing screen (Auditory brainstem response).
* Conductive hearing loss – mild-to-moderate and fluctuating  Communication difficulties, withdrawal and inattention.

549
Q

What type of hearing loss is observed in glue ear?

A

Conductive hearing loss

550
Q

What is the first line investigation for glue ear?

A

Pneumatic otoscopy

551
Q

What are the findings for glue ear revealed by pneuamamtic otoscopy?

A
  • An effusion can be serous, mucoid, or purulent:
  • Loss of light reflex
  • Abnormal colour of the drum
  • Opacification of the drum
  • Air bubbles
  • Retracted, concave or indrawn drum.
  • No signs of inflammation or discharge.
552
Q

What are the NICE recommended formal hearing assessment tools for glue ear (2)?

A
  1. Auditory brainstem response
  2. Tympanometry
553
Q

Monitoring period for glue ear?

A

3 month period - audiology + speech and language assessment

554
Q

What is the management for persistent bilateral glue ear and hearing loss?

A

Hearing aids

555
Q

What is the surgical management for glue ear?

A

Myringotomy and insertion of grommets

556
Q

What are the complications associated with grommets?

A

Complications associated with Grommets:
* Otorrhoea (Consider ciprofloxacin for 5-7 days).
* Tympanosclerosis
* Perforation
* Fibrosis
* Cholesteatoma
* Bleeding

557
Q

What high-risk groups are predisposed to severe malaria infection?

A

Young children (6 to 59 months)
Low birth weight newborns

558
Q

What is the incubation period for malaria?

A

12 to 35 days

559
Q

What are the clinical features of malaria (paediatric)?

A
  • Fever - >39°C, sweats and/or chills – the absence of fever should not remove the suspicion of malaria.
  • Headache
  • General malaise, lethargy, and fatigue – Somnolence in children
  • Anorexia
  • Poor feeding
  • Sore throat, cough, lower respiratory tract symptoms and respiratory distress
  • Confusion
  • Hepatomegaly, splenomegaly, and somnolence on examination.
560
Q

What are the features of complicated malaria in children (6 features)?

A
  1. Cerebral malaria – impaired conscious level – GCS <11
  2. Severe anaemia
  3. Respiratory distress or acidosis
  4. Hypoglycaemia (<2.2 mmol/L)
  5. Prostration (inability to stand or sit)
  6. Parasitaemia >2% red blood cells parasitised.
561
Q

What are the prophylactic measures for malaria?

A
  • Malaria chemoprophylaxis
  • Precautions against biting insects
  • Travel immunisations.
562
Q

What is the gold-standard investigation for malaria?

A

Microscopy of thick and thin films with Giemsa staining

563
Q

What is the management of uncomplicated malaria?

A
  • Artemisinin combination therapy (artemether with lumefantrine or artenimol with piperaquine phosphate).
564
Q

What is the management of severe malaria?

A
  • Parenteral artesunate then after at least 24 hours of treatment, switch to oral artemisinin combination therapy.
  • Supportive care +/i intensive care.
565
Q

What are the non-falciparum strains of malaria?

A

Plasmodium vivax and less commonly P. ovale, P. malariae, and P. Knowlesi

566
Q

What are the main complications associated with malaria?

A
  • AKI – Renal tubular necrosis
  • Cerebral malaria – due to severe P. falciparum infection with coma, or coma >30 minutes post-seizure.
  • ARDS
  • Spontaneous bleeding and coagulopathy
  • Severe anaemia – direct red cell lysis
  • Sepsis
  • Hypoglycaemia
  • Metabolic acidosis
  • Nephrotic syndrome
  • Splenic rupture - seen in P. vivax infection.
567
Q

What is cerebral malaria defined as?

A

due to severe P. falciparum infection with coma, or coma >30 minutes post-seizure.

568
Q

Which malaria strain is associated with splenic rupture?

A

P. vivax

569
Q

Which coma scale is used to assess GCS in children too young to talk?

A

Blantyre Coma scale

2 or less - coma

570
Q

What are the 7 red-flag features for paediatric sepsis?

A
  1. Hypotension
  2. Prolonged capillary refill time > 5 seconds
  3. Oxygen needed to maintain saturation >92%
  4. AVPU = V, P or U
  5. Pale/mottled or non-blanching (purpuric) rash
  6. RR >60 min-1 or >5 below normal or grunting.
  7. Abnormal behaviour*
571
Q

What RR is a red flag feature?

A

> 60 breaths per minute

572
Q

What are the common causative organisms associated with sepsis?

A

Group B Streptococcus

Listeria monocytogenes

E coli

573
Q

What are the common causative organism for late ons-et neonatal sepsis?

A

Coagulase-negative staphylococcus (CoNS)

574
Q

What are the risk factors associated with neonatal sepsis?

A
  • Premature (<37 weeks) - Approximately 85% of neonatal sepsis.
  • Low birth weight (<2.5 kg) – Approximately 80% are low birthweight.
  • Evidence of maternal chorioamnionitis
575
Q

What time period defines early-onset sepsis?

A

Within 72 hours of birth

576
Q

What is a significant risk factor for early onset sepsis?

A

PROM

577
Q

What is an independent risk factor for neonatal sepsis?

A

Black ethnicity

578
Q

What is the presentation for neonatal sepsis?

A
  • Respiratory distress (85%)
  • Grunting
  • Nasal flaring
  • Use of accessory respiratory muscles
  • Tachypnoea
  • Tachycardia: common but non-specific
  • Apnoea (40%)
  • Apparent change in mental status/lethargy
  • Jaundice
  • Seizures
  • Poor/reduced feeding
  • Abdominal distension
  • Vomiting
579
Q

What is the ABx of choice for GBS infection (neonatal sepsis <72 hours)

A

IV cefotaxime + amikacin + ampicillin.

580
Q

What is the antibiotic of choice for late-onset sepsis (>72 hours)?

A

IV meropenem + amikacin + ampicillin

581
Q

Which ABx are indicated for meningococcal sepsis?

A
  • IM benzylpenicillin (in the community)
  • IV cefotaxime (in hospital)
  • Age up to 17 years old
  • IV ceftriaxone 80 mg/kg OD (max 4g)
582
Q

What is the sepsis 6 protocol for neonatal sepsis?

A
  • Give high-flow oxygen
  • Obtain IV/IO access and take bloods.
  • Blood gas and lactate (FBC, U&E, CRP)
  • Blood glucose (treat hypoglycaemia)
  • Blood cultures
  • Give IV/IO antibiotics.
  • Blood cultures
583
Q

Which virus causes mumps?

A

paramyxovirus

584
Q

How is mumps transmitted?

A

Respiratory droplets, fomites, or saliva.

585
Q

Incubation period for mumps?

A

16-18 days

586
Q

When is the most infectious period for mumps?

A

1-2 days before onset of symptoms

587
Q

What is the clinical presentation of mumps?

A
  • Fever
  • Headache
  • Myalgia
  • Fatigue
  • Anorexia
  • Salivary gland swelling within 48 hours of symptom onset
  • Parotitis occurs among children 2-9 years of age.
  • Tenderness associated with earache precedes parotid swelling
    o Parotid swelling persists for ~10 days.
  • Epidiymo-orchitis – Affects up to 38% of infected men.
  • Dimmish sperm count, mobility, and morphology transiently
  • In bilateral orchitis  30-87% risk of infertility.
588
Q

What is the characteristic clinical feature associated with mumps?

A

Bilateral parotid swelling

589
Q

How long does parotid swelling approximately persist for in mumps?

A

~10 days

590
Q

What long-term reproductive complication is associated with mumps?

A

Epidiymo-orchitis - diminished sperm count and infertility

591
Q

What are the complications associated with mumps?

A
  1. Meningitis
  2. Encephalitis
  3. Orchitis
  4. Deafness – Sensorineural hearing loss.
592
Q

Is mumps a notifiable disease?

A

Yes - notify HPU

593
Q

What is the diagnostic investigation to confirm the diagnosis of mumps?

A

Saliva sample to detect IgM mumps antibody

594
Q

Which enzyme is raised in parotitis in mumps?

A

Serum amylase

595
Q

What is the school exclusion time for mumps?

A

5 days after the development of parotitis

596
Q

What is the first line drug therapy for head lice?

A

Malathion

597
Q

In preterm infants <32 weeks, what retinal complication is commonly observed?

A

Retinopathy of prematurity

598
Q

Which mass is Located in the anterior triangle, usually in the midline and below the hyoid (65% cases) and moves on tongue protrusion?

A

Thyroglossal cyst

599
Q

For recurrent vaginal candidiasis, which investigation should be performed to assess for underlying cause?

A

HbA1C

600
Q

What investigation is performed for jaundice >24 hours and <2 weeks?

A

Transcutaneous bilirubin

601
Q

What investigation is performed for jaundice <24 hours?

A

Serum bilirubin

602
Q

Which investigation is performed for jaundice >2 weeks?

A

Split bilirubin, TFTs and LFTs

603
Q

What is the major complication of unmanaged pathological jaundice?

A

Kernicterus

604
Q

Kernicterus can develop into which type of cerebral palsy?

A

dyskinetic cerebral palsy

605
Q

What is the management of pathological jaundice?

A

Phototherapy + IVIG or exchange transfusion.

606
Q

Phototherapy works on which type of bilirubin?

A

Unconjugated bilirubin

607
Q

When should phototherapy be stopped in the management of jaundice?

A

Once BR >50 umol/L

608
Q

What is the threshold for exchange transfusion in term infants?

A

> 450 total serum bilirubin

609
Q

What is the threshold for phototherapy in term infants?

A

350-450 total serum BR

610
Q

What is the first line immediate management for a patient with Congenital diaphragmatic hernia?

A

Immedaite ventilation and intubation

611
Q

When are most CGH detected?

A

Routine antenatal scans

612
Q

Once a CDH is detected through antenatal screening what is the next line of management?

A

Transferred to the specialist neonatal surgical unit – a planned delivery (induction of labour or caesarean section)

613
Q

What is the definitive management for Congenital Diaphragmatic Hernia?

A

Delayed surgical repair within 48-72 hours, once the patient is stabilised.

614
Q

What is type A oesophageal atresia?

A
  • Type A: OA without TOF (6%)
615
Q

What is type B TOF?

A
  • Type B: OA with a TOF to the proximal oesophageal segment (5%)
616
Q

What is type C TOF?

A
  • Type C: OA with a TOF to the distal oesophageal segment (84%)
  • Mx: Stabilisation and surgical correction.
617
Q

What is type E TOF?

A
  • Type D: OA with a TOF to the proximal and distal oesophageal segments (~1%).
618
Q

What is type E TOF?

A
  • Type E: A TOF without OA (H-type fistula) – 4%.
  • NBM and surgical division of fistula.
619
Q

What is the characteristic finding for a patient with TOF?

A

Respiratory distress with cyanotic episodes + inability to pass a nasogastric tube

620
Q

What is the first line investigation for TOF?

A

Chest X-ray

621
Q

What is the main cause of neonatal respiratory distress syndrome?

A

Surfactant deficiency

622
Q

When do type 2 pneumocytes begin secrete surfactant? to

A

At 20 weeks’ gestation

623
Q

What is the peak incidence for NRDS?

A

24-34 weeks’

624
Q

Which type of pneumocytes secrete surfactant?

A

Type 2

625
Q

What is the characteristic radiograph appearance seen in a patient with NRDS?

A

Ground-glass reticulo-grannular appearance

626
Q

What is the first line management for NRDS?

A

A-E - immediate respiratory support with CPAP and high flow oxygen (91-95%)

and exogenous surfactant therapy

627
Q

Which ABx are used for the management of NRDS?

A

Benzylpenicillin and gentamicin

628
Q

Which criteria is used to diagnose ARDS?

A

Berlin criteria

629
Q

Which gene is implicated in cystic fibrosis?

A

Delta f508

630
Q

What is the inheritance pattern for cystic fibrosis?

A

Autosomal recessive

631
Q

What is the neonatal presentation for cystic fibrosis?

A

Meconium ileus

632
Q

What is the most common cause of bronchiectasis in a child?

A

Cystic fibrosis, followed by primary ciliary dyskinesia

633
Q

What test is performed to diagnose CF at 5 days?

A

Immunoreactive trypsinogen

634
Q

What test is used to help diagnose cystic fibrosis?

A

Sweat chloride test >60 mmol/L

635
Q

Which drug (not licensed in the UK) is effective in mediating respiratory symptoms in patients >2 years with CF?

A

Kaftrio

636
Q

What is the first line management (NICE) for patients with respiratory symptoms associated with cystic fibrosis?

A

rhDNase (dornase alfa)

637
Q

Which prophylactic antibiotic is prescribed to CF patients against staph aureus pneumonia?

A
  • Flucloxacillin
638
Q

What is the common causative pathogen of bronchiectasis in cystic fibrosis patients?

A

Pseudomonas aeuroginosa

639
Q

What antibiotics are prescribed to patients with Pseudomonas aeruginosa respiratory tract infections in cystic fibrosis?

A

ceftrizaide, ciprofloxacin followed by chronic azithromycin therapy

640
Q

What dietary advice is recommended for patients with cystic fibrosis?

A
  • High-calorie diet
641
Q

What is the first step for anaphylaxis management?

A

Call for Help, remove trigger and lie the patient flat

642
Q

Where should IM adrenaline be prescribed for anaphylaxis?

A

Anterolateral aspect - middle third of the thigh

643
Q

What is the first drug prescribed for anaphylaxis management?

A

IM adrenaline

644
Q

What dose of adrenaline is given to patients under the age of 6 years to 6 months?

A

150 micrograms

645
Q

Adrenaline dose for anaphylaxis in 6-12 years?

A

300 micrograms

646
Q

No response to adrenaline after 5 minutes in anaphylaxis, management?

A

Repeat dose of adrenaline and administer a fluid bolus

647
Q

Which enzyme is deficient in a patient with hereditary angiodema?

A

C1 esterase deficiency

648
Q

What are the three anatomical location affected by hereditary angioedema?

A
  1. Cutaneous attacks
  2. Gastrointestinal attacks
  3. Upper airway attacks
649
Q

Episodic wheeze in under 5 years old, diagnosis?

A

Viral induced wheeze

650
Q

What term describes a depression at the base of the thorax in asthmatics?

A
  • Harrison’s sulci
651
Q

What is the diagnostic test for confirming asthma >5 years?

A

Spirometry testing + bronchodilator reversibility and PEFR variability

652
Q

Waht pattern is seen on spirometry in a patient with asthma?

A

Restrictive pattern FEV1/FVC <70%

653
Q

What pre-post difference value is associated with bronchodilator reversibility in asthma?

A

12%

654
Q

What test should be performed if there is diagnostic uncertainty regarding asthma?

A

Fractional exhaled nitric oxide (>35 ppb = positive test)

655
Q

What PEFR value - life-threatening asthma?

A

<33%

656
Q

PEFR value for severe asthma?

A

33-50%

657
Q

What SPO2 value = life-threatening asthma?

A

<92%

658
Q

What are the indicators for life-threatening asthma?

A

Altered consciousness
PEFR <33%
SPO2 <92%
Normal/elevated PaCO2
Exhaustion
hypotesion
Cyanosis
Silent chest
signs of respiratory distress

659
Q

What is the first-line management for mild-moderate asthma attack?

A

1 puff every 30-60s, maximum of 10 puffs

660
Q

Other than salbutamol, what drug should be co-prescribed to patients with acute exacerbation on asthma, following discharge?

A

Short-course of oral prednisolone for 3-5 days

661
Q

What should a follow-up be conducted following an acute exacerbation of asthma?

A

48 hours

662
Q

What is the first line management for an acute exacerbation of asthma?

A

Supplemenary oxygen using a venturi face mask or nasal cannula (6 L/minute)

663
Q

What is the salbutamol dose for acute exacerbation of asthma in <5 years?

A

5 mg

664
Q

What is the salbutamol dose for acute exacerbation of asthma in 2-5 years old?

A

2.5 mg

665
Q

What is the oxygen flow rate for an acute exacerbation of asthma?

A

6L/min

666
Q

What is the maximum number of salbutamol doses for acute exacerbation of asthma?

A

3 every 20 minutes

667
Q

What drug is co-prescribed to patients with acute exacerbation of asthma with salbutamol?

A
  • Nebulised ipratropium bromide (250 micrograms) is considered in life-threatening asthma or unresponsive to nebulised salbutamol x2.
668
Q

What drug is prescribed with ipratropium bromide and salbutamol?

A

Prednisolone and IV hydrocortisone

669
Q

If burst therapy fails to work, what is the next line of management?

A
  1. IV bolus step – Magnesium sulphate
  2. IV bolus salbutamol – Monitor ECG
  3. IV bolus aminophylline – Monitor ECG, infuse slow (arrhythmia).
670
Q

What is the first line of management for chronic asthma?

A

SABA PRN

671
Q

When should asthma management be stepped up from step 1?

A

More than 3 exacerbations a week

672
Q

What is step 2 of asthma management?

A

low-dose inhaled corticosteroid

673
Q

What is step 3 of asthma management?

A

Leukotriene receptor antagonist

674
Q

What is step 4 of asthma management following montelukast?

A
  1. Stop LTRA and add a LABA
675
Q

What is step 5 of asthma management?

A
  1. Switch ICS and LABA to a MART regimen with a paediatric low-dose ICS.
676
Q

What is the diagnostic investigation for laryngomalacia?

A
  • Flexible fibreoptic laryngoscopy
677
Q

What is the management for mild laryngomalacia?

A

Observation and reassure; consider GORD therapy

678
Q

What is the most common cause of bacterial pneumonia in children?

A

Streptococcus pneumonia

679
Q

What is the most common cause of bacterial pneumonia in a neonate?

A

Group B streptococcus

680
Q

What is the commonest cause of pneumonia in children <2 years?

A

RSV (influenza).

681
Q

When is oxygen therapy indicated for a child with pneumonia?

A

<92% saturations

682
Q

Define walking pnuemonia

A

Respiratory symptoms do not interfere with normal activity.

683
Q

What is the first-line drug for moderate pneumonia in a child?

A

Amoxicillin (or clarithromycin)

684
Q

What is the commonest cause of tonisllitis?

A

Group A streptococcus

685
Q

What is the CENTOR criteria?

A
  • Tonsillar exudate or swelling
  • Age (3-14 yo)
  • Tender/swollen anterior lymphadenopathy.
  • Absence of cough
  • Fever >38C
686
Q

A score of 2-3 on CENTOR criteria warrants what maangement?

A

Optional rapid strep testing and/or culture

687
Q

What is the CENTOR criteria threshold for prescribing antibiotics?

A

4-5

688
Q

What is the 1st line investigation for tonsillitis?

A

Throat culture or a rapid streptococcal antigen test

689
Q

What drug and course is recommended for tonsilitis?

A

Phenoxymethylpenicillincilin, 10 days, QDS

690
Q

Why should amoxicillin be avoided for sore throat?

A

Can cause widespread maculopapular rash if due to infectious mononucleosis

691
Q

What indicates are severe recurrent tonsilitis?

A

Severe recurrent tonsillitis (a frequency of more than 7 episodes/year).
* OR 5 per year for 2 years
* OR 3 per year for 3 years

692
Q

What is the most common cause of OSA in a child?

A
  • Adenotonsillar hypertrophy , obesity
693
Q

Which first line investigation scales can be performed to screen OSA?

A

STOP-bang questionnaire or Epworth Sleepiness Scale.

694
Q

What is the diagnostic investigation for OSA?

A

Polysomnography (PSG-overnight) AND/OR referral to a sleep specialist.

695
Q

What is the first line management fro OSA?

A

Adenotonsillectomy – to correct the anatomic obstruction causing symptoms – curative approach.

696
Q

What is the first line management for pneumothorax?

A

Immediate needle decompression

697
Q

What is the management for a tension pneumothorax?

A

Chest drain

698
Q

Radiograph findings for meconium aspiration syndrome?

A

patches of collapse and consolidation.

699
Q

What is the commonest cause of sinusitis in a child?

A

Viral upper respiratory tract infection – rhinovirus, RSV, parainfluenza, influenza –

700
Q

What investigation is indicated for sinusitis?

A
  • Anterior rhinoscopy
701
Q

What is the management for acute sinusitis <10 days?

A

Self-management - paracetamol OR ibuprofen, nasal saline etc.,

702
Q

When should you consider high dose nasal corticosteroids for 14 days for children >12 years, for sinusitis?

A

If symptoms >10 days

703
Q

When do you consider a back-up prescription of phenoxymethylpenicillin for sinusitis?

A

If symptoms do not improve within 7 days or rapidly worsen

704
Q

Most common cause of perennial sinusitis?

A

House dust mites

705
Q

Most common cause of seasonal sinusitis?

A

Pollen

706
Q

What is the first line test for diagnosing allergic rhinitis?

A

Skin-prick testing or measuring serum IgE

707
Q

What is the first line of management for mild allergic rhinitis?

A

Oral non-sedating antihistamines or intranasal (have a faster onset)

708
Q

What is the management for moderate to severe allergic rhinitis?

A

Intranasal corticosteroids and oral antihistamines

709
Q

When are patients reviewed following treatment for allergic rhinitis?

A

2-4 weeks

710
Q

How is oropharyngeal candidiasis diagnosed?

A

Clinical diagnosis

711
Q

What is the first line drug for candidiasis in a child (oral)?

A

Oral miconazole, consider nystatin suspension in a child

712
Q

What is the common cause of candida diaper dermatitis?

A

Candida albicans

713
Q

What is the commonest cause of diaper dermatitis?

A

Irritant contant dermatitis

714
Q

Does non-candida diaper dermatitis affect the skin folds?

A

No (skin-fold sparing)

715
Q

What is the appearance of candidal diaper dermatitis?

A

Beefy red papules, satellite papules and superficial pustules – does not spare skin folds.

716
Q

When should you consider candida in terms of >days?

A

> 3 days

717
Q

What is the first line management for non-candida diaper dermatitis?

A
  • Topical barrier and good nappy practice
  • Frequent nappy changes: Changed every 2 hours and cleansed the nappy area with warm water, using alcohol-free and fragrance-free wipes.
  • Zinc oxide barrier cream
  • Nappy free time is advised.
718
Q

What is the second line management for diaper dermatitis?

A

Consider nystatin topical or miconazole or low potency corticosteroids for non candida

719
Q

What is the characteristic presentation of bacterial conjunctivitis?

A

Purulent discharge

720
Q

What is the cause of hyperacute bacterial conjunctivitis?

A

Neisseria

721
Q

What is the first step in management for suspected Neisseria cojunctivitis?

A
  • Requires immediate ophthalmologic referral.
722
Q

What is the presentation for hyperacute bacterial conjuntcivitis?

A
  • Characterised by profuse purulent discharge within 12 hours – copious.
  • Tenderness to palpation
  • Irritation, marked chemosis, lid swelling and tender preauricular adenopathy.
723
Q

What is the characteristic presentation for viral cojunctivitis?

A
  • Watery conjunctival injection (mucoid discharge)
  • Profuse tearing
  • Gritty sensation
  • Tender pre-auricular lymphadenopathy
  • Conjunctival follicles – follicular appearance on the tarsal follicles.
  • Bilateral presentation within 24-48 hours
  • Petechial subconjunctival haemorrhages
724
Q

Conjunctival follicles are associated with what type of conjunctivitis?

A

Viral

725
Q

What is Hutchinson’s sign in terms of viral herpes?

A

lesions present at the tip of the nose.

726
Q

What is the most common bacterial organism in conjunctivitis?

A

Haemophilus Influenza
Streptococcus pneumoniae
Moraella cararrhalis

727
Q

What is the most common viral aetiology for viral conjunctivitis?

A

Adenovirus, enterovirus

728
Q

What is the first line management for viral conjunctivitis?

A

Viral conjunctivitis (Resolves within 1-2 weeks)
* Clean with saline/boiled and cooled water
* Cool compresses around the eye area
* Artificial tears or lubricating drops
* Topical antihistamines
- Epinastine ophthalmic (>2 years), azelastine (>3 years), naphazoline (>6).
- First-line adenoviral

729
Q

First line management for bacterial conjunctivitis?

A

Self-limiting and resolves within 5-7 days without treatment

730
Q

By how many days should you wait before prescribing antibiotics in bacterial conjunctivits?

A

than 3 - four

731
Q

Which antibiotic is recommended for staph/strep conjunctivitis?

A
  • Chloramphenicol or neomycin
732
Q

What is the management step for Ophthalmia Neonatorum ?

A

Immediate same-day referral to an ophthalmologist; chloramphenicol eye drops.

733
Q

What is the most common cause of opthahlmia neonatorum?

A
  • Chlamydia
734
Q

What two medications are prescribed for moderate disease allergic conjunctiitis?

A

Anti-histamines and a mast cell stabiliser e.g. sodium cromoglicate

735
Q

What is the most common cause for cellulitis?

A

Streptococcus pyogenes (Group A beta-haemolytic streptococci)

736
Q

Which classification is used to assess for cellulitis?

A

ERON classification

737
Q

What i the first line drug for ERON-I cellulitis?

A

Oral flucloxacillin

738
Q

What is the admission management for ERONIII-IV cellulitis?

A
  • Admit + Oral/IV Co-amoxiclav, clindamycin, cefuroxime, or ceftriaxone
739
Q

What are the common organisms implicated in peri-orbital cellulitis?

A

Staphylococcus aureus, streptococcus pneumoniae, haemophilus influenzae.

740
Q

How does orbital cellulitis present?

A

Proptosis, painful or limited ocular movement with or without reduced visual acuit

741
Q

What is the next step for suspected orbital cellulitis?

A

CT or MRTI scan of the orbits and refer

742
Q

Which antibiotics are prescribed for orbital cellulitis?

A

High dose ceftriaxone

743
Q

What is the mot common complication of scarlet fever?

A

Otitis media

744
Q

When can a child return to school with Scarlet fever?

A

24 hours after commencing antibiotics and notify HPU

745
Q

Which ABx and duration is prescribed for scarlet fever?

A

Penicillin V for 10 days

746
Q

Which spots are seen in measels?

A

Koplik spots

747
Q

Where does the rash begin for measles?

A

Rash – cephalocaudal progression (behind the ears, head, neck)

748
Q

School exclusion for measles duration?

A

5 days

749
Q

What are the complications are associated with measles

A

Otitis Media – Common

Pneumonia – Common cause of mortality

Encephalitis - 1-2 weeks post-onset

Subacute sclerosing panencephalitis - Rare

750
Q

What spots are seen on the soft palate in rubella?

A

Forchheimer spots

751
Q

Rubella duration of exclusion?

A

5 days

752
Q

What virus is the cause of Roseola infantum?

A

Human herpesvirus 6

753
Q

Which spots are seen in roseola infantum?

A
  • Nagayama spots – papular enanthem on the uvula and soft palate.
754
Q

What is the common complication for roseola infantum?

A

Febrile convulsions

755
Q

What is the characteristic rash seen in erythema infectiosum?

A

Slapped-cheek

756
Q

What is the cause of Erythema infectiosum?

A

Parvovirus b19

757
Q

Which HPV strains cause anogenital warts?

A

6 and 11

758
Q

What is suspected in a child with anogenital warts <13 years?

A

Sexual abuse - begin safeguarding protocol

759
Q

What is the first line drug for anorectal genital warts?

A

Imiquimod (5% cream) and podophyllotoxin (Anti-mitotic agent)

760
Q

What is the common cause of acute otitis media?

A
  • Haemophilus influenzae
  • S pneumoniae
  • Moraxella catarrhalis
761
Q

What clinical sign is the best predictor for acute otitis media?

A

Ear pain - rapid onset

762
Q

What are the complications for acute otitis media?

A

Complications
1. Perforation with ottohorea
2. Acute mastoiditis – Postauricular swelling and protrusion of the auricle.
3. Facial nerve palsy
4. Vestibular symptoms
- Dizziness, vertigo, balance, and motor problems.

763
Q

What is is seen on examination in acute otitis media?

A

Investigations
Otoscopic examination: Distinctly red, yellow, or cloudy tympanic membrane.
* Moderate to severe bulging of the tympanic membrane, with loss or normal landmarks.
- Obscures the malleus.
- Loss of normal light reflex.
- Perforation of the tympanic membrane
- Purulent discharge

764
Q

What is the first line management fora acute otitis media?

A
  • Regular doses of paracetamol or ibuprofen for pain (oral or rectal).
765
Q

What are the indications for antibiotics for acute otitis media?

A
  • Otorrhoea, and aged <2 years with bilateral infection.
  • Back-up antibiotic prescription – if symptoms do not improve within 3 days or significantly worsen.
  • 5–7-day course of amoxicillin (or clarithromycin).
766
Q

What is the pathogenesis of Acute Otitis Media with Effusion (Glue ear)?

A

Pathogenesis: Persistence of otitis media with effusion (OME) – impaired eustachian tube causing poor aeration of the middle ear.
* Low-grade viral or bacterial infection.
* Adenoidal infection or hypertrophy
* Persistent local inflammatory reaction.

767
Q

Which syndrome is associated with glue ear?

A

Down syndrome

768
Q

What are common acquired factors for Acute Otitis Media with Effusion (Glue ear)?

A

Smoking

769
Q

What is the common presentation of Acute Otitis Media with Effusion (Glue ear)?

A

Hearing loss, mild ear pain, aural discharge, recurrent ear infections, snoring

770
Q

What type of hearing loss is associated with Acute Otitis Media with Effusion (Glue ear)?

A

Conductive hearing loss

771
Q

What is the first line investigation for Acute Otitis Media with Effusion (Glue ear)?

A

Pneumatic otoscopy

772
Q

What is the formal assessment for glue ear?

A

Hearing loss - Auditory brainstem response and tympanometry

773
Q

What is the monitoring period for glue ear?

A

Monitor for 3 months with regular follow-up + speech and audiology support

774
Q

Management for glue ear without hearing loss?

A

Reassurance and monitor

775
Q

When are hearing aids recommended for patients with glue ear?

A

Patients with hearing loss and persistent bilateral OME

776
Q

What is the surgical management for glue ear?

A
  • Myringotomy and insertion of grommets (ventilation tubes to equalise air pressure – immediate improvement of hearing).
  • Advice: Avoid swimming and take care when bathing or washing hair – 2 weeks post-grommet care.
  • Grommet will fall out (weeks to months) – eardrum healing.
777
Q

What is the management for uncomplicated malaria?

A
  • Artemisinin combination therapy
778
Q

Which type of malaria is associated with splenic rupture?

A

Vivax

779
Q

What are the common causes of early onset neonatal sepsis?

A
  1. GBS and E. coli, listeria monocytogenes
780
Q

What are the common causes for late onset neonatal sepsis?

A
  1. Coagulase-negative staphylococcus (CoNS) – Late-onset neonatal sepsis
    - Staphylococcus epidermis
781
Q

When is early onset sepsis (duration)?

A

Within 72 hours of birth

782
Q

Drug regimen for early onset sepsis?

A

IV cefotaxime + amikacin + ampicillin.

783
Q

Drug regimen for late onset sepsis?

A

IV meropenem + amikacin + ampicillin

784
Q

What are the indications for intrapartum benzylpenicillin during pregnancy?

A
  • A previous baby with an invasive group B streptococcal infection
  • Group B streptococcal colonisation, bacteriuria, or infection in the current pregnancy
  • Are in pre-term labour
785
Q

What is the main cause of toxic shock syndrome?

A

Methiccillin-suspectible S. aureus

786
Q

Which toxin is produced by staph aureus in toxic shock syndrome?

A

TSST-1 exotoxin.

787
Q

Risk factor for toxic shock syndrome?

A

Recent tampon use, recent surgery, recent soft tissue/skin infection.

788
Q

What is a severe subcutaneous infection of chickenpox?

A

Necrotising fasciitis

789
Q

Which organism causes necrotising fasciitis?

A

Group A streptococcus or S. aureus.

790
Q

What is the management for necrotising fasciitis?

A

Surgical debridement of necrotic tissue

791
Q

What is the diagnostic investigation for TB?

A

Acid-fast bacilli microscopy smear from sputum sample/sputum culture

792
Q

What screening investigation for latent TB >2 years if recommended?

A
  • Interferon-gamma release assays
793
Q

Which screening investigation is recommended for latent TB in children <2 years?

A
  • Tuberculin skin test (Mantoux test)
794
Q

Which screening test for TB is susceptible to prior BCG vaccination?

A

Mantoux test

795
Q

What is the drug regimen for tuberculosis?

A

Rifampicin, isoniazid (for 6 months), pyrazinamide, ethambutol (for first 2 months)

796
Q

Which TB drug is associated with orange secretions?

A
  • Rifampicin
797
Q

Which TB drug is administered and causes peripheral neuropathy?

A
  • Isoniazid
798
Q

Which is co-prescribed with Isoniazid ?

A

pyridoxine) – Vitamin B6

799
Q

Which TB drug is associated with gastro-intestinal symptoms, gout and hepatitis?

A
  • Pyrazinamide
800
Q

What is the complication of ethambutol?

A
  • Optic neuritis.
801
Q
A
802
Q

What are the indications to perform an ultrasound during an acute urinary tract infection in a child?

A

<6 months (recurrent or atypical)

803
Q

What are the indications to perform an ultrasound scan within 6 weeks of a UTI in a child?

A

> 6 months and recurrent
<6 month and typical

804
Q

Which scan assesses for bladder scarring following a UTI?

A

DMSA

804
Q

When is a DMSA scan performed?

A

4-6 months following an atypical or recurrent UTI in a child <6 months?

804
Q

Which scan is performed to assess for vesicoureteric reflux?

A

Micturating urethrogram

805
Q

What urine dipstick test confirms a UTI?

A

Positive leucocyte esterase and nitrite

806
Q

Which is the specific urine dipstick marker for a UTI?

A

Nitrite

807
Q

What is the management for a <3 month child with a UTI?

A

<3 months  Admit to Hospital, IV co-amoxiclav, 5-7 days  Switch to oral prophylaxis  Refer to paediatrician.

808
Q

What is the management for a child with a UTI >3 months (Upper)?

A

Consider hospital admission and IV ABx; OR oral ABx – 7-10 days.

809
Q

What is the management for a >3 month with lower uTI?

A

Oral ABx (trimethoprim, nitrofurantoin), 3 days.

810
Q

What are the features for an atypical UTI?

A

Poor urine flow, abdominal or bladder mass, raised creatinine, septicaemia, failure to respond to treatment within 48 hours, infection with non-E-coli organisms.

811
Q

What is a sign of upper UTI?

A

Loin pain and tenderness

812
Q

Lower UTI is also known as?

A

Cystitis

813
Q

CREAM mnemonic for Kawasaki disease criteria?

A

WARM = Fever for >5 days
* C – Conjunctivitis without exudate
* R – Rash
* E – Edema or erythema of hands or feet followed by desquamation and nail changes (Beau’s lines)
* A – Adenopathy, unilateral, cervical node >1.5 cm
* M – Mucosal erythema, fissures, or crushing of lips or Strawberry tongue

814
Q

What is the route of transmission for hepatitis A?

A

Faecal-oral route

815
Q

What is the route of transmission for hepatitis B?

A

IV drug user - blood products and vertical transmission

816
Q

What anti-viral is prsecribed to patients with a recent infection of hepatitis C?

A

Peiginterferon alpha 2b

817
Q

What are the chronic antiviral treatment modalities for hepatitis C?

A
  • Glecaprevir/Pibrentasvir
  • Sofosbuvir/velpatasvir.
818
Q

What is the immediate management for a newborn born to a hepatitis S Ag positive mother?

A

immediate monovalent hepatis B vaccine within 24 hours at birth

819
Q

When should HBig be considered to the neonate when born to a hepb positive mother?

A
  • Maternal HBeAg positive
  • Maternal anti-Be negative
  • Maternal HBV DNA ≥1x106 IU/ml
  • Acute maternal HBV infection during pregnancy
  • Birthweight <1.5 kg.
820
Q

What is the most common cause of meningitis in a neonate?

A

Streptococcus agalactiae (GBS), Escherichia coli, S. pnuemoniae and listeria monocytogenes.

821
Q

What is the most common cause of meningitis in a child >3 months <3 years?

A

Streptococcus pneumoniae

822
Q

What is the most common cause of meningitis from >3 years to 10 years?

A

N. meningitides

823
Q

Define Kernig sign?

A

Supine position with the hip and knee flexed at 90 degrees – cannot extend the knee more than 135 degrees.

824
Q

Which sign is demonstrated by this?
‘Supine position, flexes the lower extremities during attempted passive flexion of the neck’

A
  1. Brudzinski sign
825
Q

What is Cushing’s triad?

A

High blood pressure
Low heart rate
Irregular respiratory rate

826
Q

What is the first line drug for suspected meningitis in the community?

A

IM benzylpenicillin

827
Q

What is the antibiotic treatment for a child <3 months with meningitis?

A

o IV cefotaxime AND IV amoxicillin/ampicillin.

828
Q

What is the antibiotic treatment for a child >3 months with meningitis?

A

o IV Ceftriaxone

829
Q

When should you prescribe steroids in meningitis?

A

Steroids (dexamethasone) if CSF shows:
* Purulent CSF, WBC >1,000 U/L, Raised CSF WCC + protein >1g/L, bacteria gram stain, >1m old & HiB.
* NON-MENINGOCOCCAL.
* Do not prescribe dexamethasone if <3 months.

830
Q

What drug is prescribed as prophylaxis to manage patients with meningitis?

A

ciprofloxacin

831
Q

What are the most common causes for viral meningitis?

A
  • Coxsackie Group B, Echovirus
832
Q

What antigen is used by influenza to enter into a host cell?

A

Haemagglutinin

833
Q

Which surface antigen for influenza is used to leave a host cell?

A

neuraminidase

834
Q

When should an anti-viral be prescribed in a child with influenza?

A

Within 48 hours of onset and offered to reduce the duration of symptoms to high risk patients

835
Q

Which is a common neuraminidase inhibitor?

A

oseltamivir

836
Q

How long should a child be excluded from school for with influenza?

A

1 week

837
Q

What are at risks for influenza?

A
  1. Children <6 months
  2. Asthma, cystic fibrosis
  3. Previous admission for lower respiratory tract disease
838
Q

What respiratory complication is associated with infleunza?

A

Secondary pneumonia by staph aureus

839
Q

What virus is the most common cause of encephalitis?

A

HSV type 1

840
Q

What is the gold standard investigation for confirming encephalitis?

A

Lumbar puncture

841
Q

What is seen on lumbar puncture in a encephalitis?

A
  • CSF pleocytosis (present in 60-80%): Lymphocytic predominance.
  • Absent red blood cells
  • Protein-CSF protein normal or moderately elevated
  • Glucose normal
842
Q

What is the first line management for a child with encephalitis?

A

All suspected cases of encephalitis  Admitted and treated as an emergency (A-E approach).
1st line: Empirical IV acyclovir (age-dependent dose).
- Consider empirical antibiotics (vancomycin, cefotaxime) for suspected bacterial origin.

NOTE: For HSV-1/2 – High dose acyclovir for 2-3 weeks, as relapses may occur.
* Varicella zoster – Acyclovir or ganciclovir.
* CMV – Ganciclovir + foscarnet – 2-3 weeks.

843
Q

When is chickenpox most infectious?

A

From 24 hours before the rash appears until the vesicles are dry or have crusted over ~5 days

844
Q

What are the complications associated with varicella zoster infection following NSAID use?

A
  • Secondary infections – bacterial pneumonia (superinfection) – if using NSAIDs (increased risk of necrotising fascititis).
844
Q

Where does the varicella zoster virus persist?

A

Sensory nerve root ganglia - reactivtion - shingles

845
Q

What is the first line symptomatic management for a patient with chickenpox?

A
  • Topical calamine lotion to alleviate itch.
  • Chlorphenamine for treating itching - >1 years.
846
Q

What is the management for severe chickenpox?

A

Oral acyclovir 700 mg 5 times a day for 7 days

847
Q

Which parasite causes scabies?

A

Sarcoptes scabiei

848
Q

How is scabies transmitted?

A

Skin to skin contact

849
Q

what are the risk factors for crusted scabies?

A

Crusted scabies (due to attenuated immune response):
* People with HIV, lymphoma, or long-term corticosteroid treatment.
* Reduced ability to scratch.
* Learning difficulties e.g., Down’s syndrome, dementia.

850
Q

What are the common sites that are affected in patients with scabies?

A

Webs of the fingers, wrists, axillae, areolae, and genitalia.

851
Q

What is the presentation for classical scabies?

A

severe and worse at night (delayed-type IV hypersensitivity reaction to the mite, mite faeces and mite eggs) – begin 3-6 weeks after primary infestation.

852
Q

What type of hypersensitivity reaction is associated with scabies?

A

Type IV hypersensitivity

853
Q

What are the examination findings associated with scabies?

A

serpiginous lines

854
Q

What is the pathognomonic sign for scabies?

A

burrows

855
Q

What is the definitive diagnosis for scabies?

A

Confirmed through the detection of scabies mite, eggs, or faecal pellets (scybala) + Dermoscopy.

OR ink burrow test

856
Q

What is the first line drug for the management of scabies?

A

5% permethrin cream

857
Q

What is the management used to treat post-scabietic itch?

A

Crotamiton 10% cream

858
Q

What are the complications associated with scabie?

A
  • Secondary staphylococcal or streptococcal infections – impetigo, ecthyma, paronychia and furunculosis.
  • Secondary eczematisation due to scratching.
  • Nodular scabies – Pruritic nodules of the axillae, groin and male genitalia can persist for weeks or months following treatment due to a prolonged immune response to mite antigens.
859
Q

What is the cause for infectious mononucleosis?

A

Epstein–Barr virus (HHV-4)

860
Q

How is glandular fever transmitted?

A

Contact with saliva

861
Q

What is the peak incidence for glandular fever?

A

15 and 24 years

862
Q

What is the triad of infectious mononucleosis?

A

Fever

Tonsillar pharyngitis

Severe sore throat characterised by whitewash tonsillar exudate

Lymphadenopathy

863
Q

What organomegaly is a major concern associated with infectious mononucleosis?

A

Splenomegaly - risk of splenic rupture

864
Q

What is the diagnostic test for a patient with IM <12 years?

A

EBV serology

865
Q

What is the diagnostic test for glandular fever in children >12 years?

A
  • FBC with differential white cell count AND monospot test (heterophile antibodies) in the second week of illness.
866
Q

What is the management for glandular fever?

A

Analgesia (e.g., ibuprofen/paracetamol) – symptoms last ~2-4 weeks.

867
Q

When is a monospot test performed in glandular fever?

A

Within the second week of illness

868
Q

What is the definition for vesicourethral reflux?

A

VUR – Abnormal retrograde flow of urine from the bladder into the ureter and kidney into the upper urinary tract.

869
Q

When should a patient with bilateral undescended testes be EXAMINED for?

A

Reviewed within 24 hours - indicates Klinefelters or genetic cause

870
Q

What is the cause of hand foot and mouth disease?

A

Coxsackie A16 virus.

871
Q

School exclusion protocol for hand foot and mouth disease?

A

Not required

872
Q

What are the clinical presentations of Hand foot and mouth disease?

A

Mild systemic upset: Sore throat, fever
* Mouth or throat pain (dysphagia)
* Oral ulcers
* Followed later by vesicles on the palms and soles of the feet.

Examination findings:
* Oral exanthem – oral lesions are anterior to the faucial pillars – tongue and the buccal mucosa.
- Begins as: Erythematous macules – and progresses as vesicles surrounded by a thin halo of erythema.

873
Q

What is the first hearing assessment test as part of the newborn hearing screening programme?

A

Otoacoustic emission test

874
Q

If the otoacoustic test is abnormal, what is the next investigation?

A

Auditory brainstem response test

875
Q

What assessment is performed for a child at 6-9 months regarding hearing?

A

Distraction test (Requires 2 trained staff).

876
Q

Which auditory investigation is performed at school entry for children >3 years?

A

Pure Tone Audiometry

877
Q

What lateral radiograph sign is seen in croup?

A

Steeple sign

878
Q

What is the glucose threshold for neonatal hypoglycaemia?

A

<2.6 mmol/L

879
Q

What are the risk factors associated with neonatal hypoglycaemia?

A
  • Preterm birth (< 37 weeks)
  • Maternal diabetes mellitus
  • Intrauterine growth retardation
  • Hypothermia, neonatal sepsis, inborn errors of metabolism, nesidioblastosis, Beckwith-Wiedemann syndrome.
880
Q

What are the autonomic symptoms associated with neonatal hypoglycaemia?

A
  • Jitteriness
  • Irritable
  • Tachypnoea
  • Pallor
881
Q

What are neuroglycopenic symptoms associated with neonatal hypoglycaemia?

A
  • Poor feeding/sucking
  • Weak cry
  • Drowsy
  • Hypotonia
  • Seizures
882
Q

What is the prevention for neonatal hypoglycaemia?

A

Feed baby within 30 minutes of birth

883
Q

What is the glucose threshold of beginning IV 10% glucose?

A

<1.5 mmol/L or if there are symptoms

884
Q

What is the management for a neonate with hypoglycaemia without symptoms?

A

support breast-feeding technique; offer additional feed if willing and increase the frequency thereafter.

885
Q

What is the most common type of atrial septal defect?

A

Secondum ASD (70%)

886
Q

What is the most second common type of atrial septal defect?

A

Primum ASD

887
Q

What are the two main risk factors for ASD?

A
  1. Female sex
  2. Maternal alcohol consumption
888
Q

Where and which murmur is seen in ASD?

A

Ejection systolic murmur at the left upper sternal border radiating to the back

889
Q

What is immediate management for ASD once detected?

A

Referred to paediatric cardiology for management.

890
Q

What is the investigation of choice for a patient with ASD?

A

Echocardiography demonstrating left to right shunting

891
Q

When is ASD surgical correction usually deferred until?

A

2 years of age

892
Q

What are the indications for surgical treatment for a patient with ASD?

A

Indications for treatment:
Measurement ratio of pulmonary to systemic blood flow (Qp:Qs).
* >1.5
* ASD is large enough to cause right ventricular dilatation.
* Symptomatic: Fatigue, exertional dyspnoea, palpitations, and syncope.

893
Q

What Qp:Qs ratio indicates management for ASD?

A

> 1.5

894
Q

What is the surgical approach for the management of secondum ASD?

A

Transcatheter approach

895
Q

What is the surgical approach for primum ASD?

A

Open heart surgery - direct repair

896
Q

Which syndrome associated with abnormalities of the hand is associated with ASD?

A
  • Holt-Oram Syndrome
897
Q

What is the most common type of septal defect?

A

Ventricular septal defect

898
Q

Which septal defect is associated with tetralogy of fallot?

A

VSD

899
Q

Which chromosomal disorder (4) are associated with VSD?

A
  • Down’s syndrome
  • Edward’s syndrome
  • Patau syndrome
  • Cri-du-chat syndrome
900
Q

Which murmur and where is associated with VSD?

A

Loud pan systolic murmur at the lower eft sternal edge

901
Q

Where does the aorta rise from in TGA?

A

Aorta arises anteriorly from the right ventricle - hence deoxygenated blood enters into systemic circulation

902
Q

What radiographic appearance is associated with transposition of the great arteries?

A

Egg on string’ appearance.

903
Q

What is the diagnostic investigation that is performed for transposition of the great arteries?

A

Echocardiography

904
Q

What drug is the first line management for transposition of the great arteries?

A

Prostaglandin (Alprostadil, PGE1) infusion (IV 0.05 mcg/kg/minute) to maintain patency of ductus arteriosus

905
Q

What is the first surgical stage for management of TGA?

A
  1. Blalock–Taussig shunt insertion
906
Q

When is an arterial SWITCH procedure performed in TGA?

A

Within 2 weeks of life

907
Q

What is the definitive management for TGA?

A

Balloon atrial septostomy

908
Q

What are the four major features of ToF?

A
  1. Right ventricular outflow tract obstruction
  2. Malalignment ventricular septal defect
  3. Overriding aorta
    - Blood flows from both ventricles, entering the aorta.
  4. Concentric RV hypertrophy
909
Q

The severity of ToF is dictated by what?

A

right ventricular outflow tract obstruction

910
Q

What is the main symptomatic complication in infants with ToF?

A

Tet spells

911
Q

Which murmur is associated with ToF?

A

Ejection systolic murmur

912
Q

What type of shunting is associated with ToF?

A

Right to left shunting (due to right ventricular outflow tract obstruction)

913
Q

What is the radiological appearance seen on CXR seen in ToF?

A

Boot-shaped heart

914
Q

What is seen on ECG for ToF?

A

Right ventricular hypertrophy

915
Q

What is the first line medical therapy for ToF?

A
  1. Prostaglandin E1 infusion
916
Q

Which test is used to diagnose cyanotic heart disease?

A

hyperoxia test: start 10 minutes 100% oxygen; if SpO2 persistently low = congenital cyanosis heart disease.

917
Q

What is the DEFINITIVE management for TOF?

A

Definitive surgery to repair underlying heart defect from 4 months of age onwards.

918
Q

Coarctation of the aorta is distal to which artery?

A

left subclavian artery

919
Q

CoA occurs at the origin of what?

A

ductus arteriosus

920
Q

CoA is associated with what (4)?

A

o Turner’s syndrome
o Bicuspid aortic valve
o Berry aneurysms
o Neurofibromatosis

921
Q

What systolic feature is observed in coarctation of the aorta?

A
  • Systolic apical click
922
Q

In infants what is seen with coarctation of the aorta?

A
  • Blood pressure – Lower systolic blood pressure in the lower extremities < Upper extremities.
  • Upper extremity hypertension.
  • Radio-femoral delay.

and rib notching

923
Q

What is the diagnostic test for coarctation fo the aorta?

A

Two-dimensional and Doppler transthoracic echocardiography – Discrete narrowing in the thoracic aorta – pressure gradient across.

924
Q

Posterior rib notching is seen in which congenital heart disease?

A

Coarctation of the aorta

925
Q

What is the definitive surgical management for coarctation of the aorta?

A

Percutaneous balloon angioplasty with or without stenting or surgical repair (arch reconstruction, end-to-end anastomosis).

926
Q

Diastolic component with innocent murmur, true or false?

A
  • NO diastolic component
927
Q

Which type of murmur varies with posture?

A

Innocent murmurs

928
Q

A venous humis heard where?

A

Heard as a continuous blowing noise heard infraclavicular.

929
Q

What innocent murmur has this description?

A

Low-pitched sound heard at the lower left sternal edge.

930
Q

What syndrome is characterised by a switch to right to left shunting?

A

Eisenmenger Syndrome

931
Q

Which congenital infection is associated with patent ductus arteriosus?

A

Rubella infection

932
Q

PDA is associated with a life-long risk of what?

A

Bacterial endocarditis

933
Q

Which type of murmur is associated with patent ductus arteriosus?

A

Continuous ‘machine-like’ murmur

934
Q

What is the first-line drug prescribed to neonates with PDA?

A

indomethacin to neonate.

935
Q

What class of drug is indomethacin ?

A
  • Prostacyclin synthetase inhibitor
936
Q

What is the surgical management for PDA?

A

percutaneous catheter device closure.

937
Q

What is the first step for neonatal resus?

A
  1. Dry/warm/stimulate the baby – Note time/start clock.
938
Q

Within 60 seconds after drying the babies and assessing colour, tone HR, what should be done for neonetal resus?

A

5 inflation breaths

939
Q

Where is HR assessed for a neonate?

A

Femoral and brachial

940
Q

Following 5 inflation breaths - what is the next step for neonatal resus?

A

Ventilate for 30s 15 over 30s

941
Q

What i the chest compression and ventilation rate for a neonate?

A

3:1

942
Q

What is a normal Apgar scale?

A

> 7

943
Q

What are the five categories for APGAR?

A

Appearance, Pulse, Grimace, Activity, Respiration.

944
Q

When is the APGAR scoring system used?

A

Used at 1 minute and 5 minutes after delivery and every 5 minutes if remains poor

945
Q

What is the compression rescue breath rate for a paediatric infant?

A

15:2

946
Q

What is the neonatal compression technique?

A

two thumb or two fingers

947
Q

What is the commonest cause of rheumatic fever?

A

Group A streptococcus (GAS) Lancefield group

948
Q

What are the major manifestations for rheumatic fever?

A
  • Arthritis – Migratory polyarthritis
  • Presents within 21 days.
  • Carditis and valvulitis
  • Mitral regurgitation – pansystolic murmur (Carey–Coombs murmur)
  • Sydenham chorea
  • Non-rhythmic, involuntary and abrupt movements – present within 1-8 months.
  • Subcutaneous nodules
  • Painless lesions
  • Erythema marginatum
949
Q

What are the minor manifestations for acute rheumatic fever?

A

Fever, arthralgia, elevated ESR/CRP and prolonged PR interval (>200 ms) on ECG.

950
Q

What criteria is used for rheumatic fever?

A

Jones criteria

951
Q

What is the medication for acute rheuammatic fevever?

A

Pen V, or amoxicillin or benzylpenicillin

952
Q

What is the monthly prophylaxis antibiotic for rheumatic fever?

A

Monthly injections of benzathine penicillin.
* Until 10 years after the last episode OR until the age of 21 years (OR lifelong if severe valve disease)

953
Q

What are the prenatal causes of cerebral palsy?

A
  • Prenatal – 80%
  • Cortical migration disorders or structural maldevelopment during gestation
  • Cerebrovascular haemorrhage or ischaemia
  • Rubella, CMV or toxoplasmosis
954
Q

What are the perinatal causes of cerebral palsy?

A
  • Hypoxic-ischaemic injury before or during delivery
  • Neonatal sepsis
  • Periventricular leukomalacia
  • Birth asphyxia/trauma
955
Q

What are the postnatal causes for cerebral palsy?

A
  • Meningitis/encephalitis/encephalopathy
  • Head trauma from NAI
956
Q

What is the limit age for walking unsupported?

A

18 months

957
Q

What is the most common type of cerebral palsy?

A

Spastic cerebral palsy

958
Q

What is the site of injury for spastic cerebral palsy?

A

Pyramidal or corticospinal tract

959
Q

For diplegic cerebral palsy what body part is affected the most?

A

Legs

960
Q

Dyskinetic cerebral palsy affects which structure of the brain?

A

Basal ganglia and the substantia nigra

961
Q

What are the common causes of dyskinetic cerebral palsy?

A

HIE or kernicterus

962
Q

What type of cerebral palsy is associated with chorea?

A

Dyskinetic cerebral palsy

963
Q

What is the characteristic features of dyskinetic cerebral palsy>

A
  • Athetoid movements and oro-motor problems.
    o Causes: HIE or kernicterus.
    o Variable muscle tone predominated by primitive motor reflexes.
    o Chorea – Irregular, sudden, brief non-repetitive movements.
    o Athetosis  Slow, writhing movements distally  Fanning fingers
    o Dystonia
964
Q

Which drug is prescribed to manage stiffness in a patient with CP?

A

Diazepam, baclofen

965
Q

What disability charity is used for CP?

A

SCOPE disability charity

966
Q

what staging is used to stage HIE?

A

Sarant staging

967
Q

What is is grade 1 HIE?

A
  1. Grade 1 (mild): Irritability, responds excessively to stimulation – staring of the eyes, and hyperventilation.
    - Complete recovery can be expected.
968
Q

What is grade 2 HIE?

A
  1. Grade 2 (Moderate): Marked abnormalities of movement, hypotonia, cannot feed as cannot suck, brief apnoea’s, seizures.
    - Good prognostic indicator: Complete recovery by 2 weeks of age.
969
Q

what is grade 3 HIE?

A
  1. Grade 3 (Severe): No normal spontaneous movements or response to pain, hypotonic, prolonged, and refractory seizures + multi-organ failure.
970
Q

What intervention can be done to reduce the progression of HIE to cerebral palsy?

A

Therapeutic hypothermia

971
Q

Which is the most common type of paediatric brain tumour?

A

Pilocytic astrocytoma

972
Q

Pilocytic astrocytoma on histology shows what type of fibres?

A

Rosenthal fibres

973
Q

What is the second most common brain tumour type?

A

Medulloblastoma

974
Q

What risk factors are there for brain tumours?

A
  • Personal or family history of a brain tumour, leukaemia, sarcoma
  • Prior therapeutic CNS irradiation
  • Neurofibromatosis 1 and 2
  • Tuberous sclerosis 1 and 2
  • Von Hippel-Lindau syndrome
975
Q

Which type of cell is associated with pilocytic astrocytoma?

A

Piloid hairy cell

976
Q

Which mutation is commonly implicated in pilocytic astrocytoma?

A

BRAF mutation

977
Q

What focal signs are associated with supratentorial brain tumours?

A

Focal neurological deficits, seizures, personality change.

978
Q

What focal signs are associated with subtentorial brain tumours?

A

Cerebellar ataxia, long tract signs, cranial nerve palsies

979
Q

What is the investigation of choice for brain tumours?

A

Brain MRI

980
Q

What is the definitive management for brain tumours?

A

Maximal safe resection

981
Q

What the most common intra-ocular malignancy?

A

Retinoblastoma

982
Q

What is the average age of diagnosis for Retinoblastoma ?

A

18 months

983
Q

Which gene is implicated for Retinoblastoma ?

A

RB1 on chromosome 13

984
Q

What is the inheritance pattern for Retinoblastoma ?

A

Autosomal dominant

985
Q

What ocular sign is seen in retinoblatoma?

A
  • Leukocoria (<3 years)
  • White reflex or white pupil
986
Q

What is the diagnostic investigation for retinoblastoma?

A

Fundoscopy and examination under anaesthesia
Dilated fundus examination with 360-degree scleral depression to identify peripheral tumours.
* White-grey retinal mass
* Retinal detachment with retinal vessels behind the lens

987
Q

What is the first step of management for a patient with suspected retinoblastoma?

A

Consider an urgent referral within 2 weeks for assessment

988
Q

What is the first line management for retinoblastoma with gross vitreous seeding?

A

Enucleation

989
Q

What is the management for retinoblasatoma in a child without vitreous seeding?

A

Systemic chemotherapy

990
Q

What EEG pattern is characteristic for West syndrome?

A

Hypsarrhythmia

991
Q

What is the age of onset for infantile spasms?

A
  • Age of onset – 3 and 12 months.
992
Q

What are the risk factors for infantile spasms?

A

Tuberous sclerosis (ash-leaf macules), brain malformation, intraventricular haemorrhage, intrauterine infection.

993
Q

What is the characteristic feature of infantile spasms?

A

o ‘Salaam attacks’

994
Q

When do infantile spams occur the most?

A

With waking or before sleeping

995
Q

Which drug is used to manage West Syndrome?

A
  • Vigabatrin
996
Q

What is seen on EEG for benign rolandic seizures?

A

centrotemporal spikes

997
Q

Benign rolandic seizures affect which cortex?

A

perisylvian sensorimotor cortex

998
Q

Which seizure is associated with sleep, hypersalivation and drooling?

A

Benign Rolandic Seizures

999
Q

What is required for a diagnosis of epilepsy?

A
  1. At least two unprovoked seizures occurring more than 24 hours apart.
1000
Q

What type of seizure is associated with a Jacksonian march?

A

Focal motor seizures

1001
Q

Which type of seizure is associated with a sudden profound impairment of consciousness for ~5-10 s?

A

Absence

1002
Q

Which seizure is this * Patients fall unconscious.
* Violent muscle contractions and shaking
* Eye may roll back, tongue biting, incontinence.

A

Tonic-clonic

1003
Q

Which type of seizure occurs after waking up and is associated after puberty?

A

Juvenile myoclonic epilepsy

1004
Q

Following a seizure, what is the next step?

A

Referral to a neurologist if 1st (First fit clinic) within 2 weeks.  Whilst waiting referral, advice:
* How to recognise a seizure, video record future seizures.
* Avoid dangerous activities.

ECG – Identify cardiac-related conditions.

1005
Q

What is the diagnostic test for epilepsy?

A

Routine EEG

1006
Q

What is the management for generalised tonic clonic seizures for boys?

A

Sodium valproate

1007
Q

What is the alternative to sodium valproate for the management of tonic clonic seizures?

A

Lamotrigine

1008
Q

What is the first line drug for focal seizures?

A

Lamotrigine or levetiracetam as first line.

1009
Q

What is the first line drug for absence seizures?

A

Ethosuximide

1010
Q

Which drug should be avoided for absence seizures?

A

(AVOID carbamazepine).

1011
Q

Which drug exacerbates myoclonic seizures?

A

Lamotrigine

1012
Q

What is the rescue therapy for a prolonged seizure?

A

Buccal midazolam

1013
Q

What is status epilepticus?

A

1 Epileptic seizure lasting >5 minutes OR >2 within a 5-minute period without the person returning to normal between them; Or 1 febrile seizure lasting >30 minutes?

1014
Q

What is the first line agent for status epilepticus?

A

Midazolam buccal or IV lorazepam

1015
Q

Afer 5-10 minutes which drug is given to resolve a Status Epilepticus, despite initial loading dose of benzodiazepine?

A

IV lorazepam

1016
Q

What is the dose of lorazepam given for Status Epilepticus?

A

0.1 mg/kg IV infusion

1017
Q

What is the next intervention to terminate Status Epilepticus despite 2 doses of lorazepam?

A

Levitracetam, phenytoin or phenobarbital

1018
Q

What is the main difference in terms of headache character between tension and migraine?

A

Non-throbbing headache in TTH

1019
Q

What is the most frequent type of primary headache in a child?

A

Tension headache

1020
Q

What is the ICD-3 criteria for diagnosing a tension type headache?

A

At least 10 episodes of headache lasting for 30 minutes to seven days

1021
Q

What is the management for tension type headaches?

A

simple analgesia

1022
Q

Which type of haemorrhage is associated with non-accidental injury?

A

Subdural Haemorrhage

1023
Q

On brain imaging, what is seen for a subdural haemorrhage?

A

Concave

1024
Q

What is the surgical management for a subdural haemorrhage?

A
  • Craniotomy/craniectomy in acute.
  • Burr-hole
1025
Q

What is the neurosurgical management for a subarachnoid haemorrhage?

A

Endovascular clipping and coil embolisation

1026
Q

What predisposes patients to a subarachnoid haemorrhage?

A

Ruptured saccular aneurysm.
* Arteriovenous malformations/fistulae

1027
Q

What is the inheritance pattern for DMD?

A

X-linked recessive

1028
Q

Which gene is implicated in DMD?

A

Dystrophin gene

1029
Q

The deletion of the dystrophin gene in DMD results in the influx of whcih ion within cells?

A

Calcium influx results in calmodulin breakdown - free radical release - myofibre necrosis

1030
Q

Pseudohypertrophy of the calves = what?

A

DMD

1031
Q

What is Gower’s sign?

A

Hand support to push themselves to an upright position.

1032
Q

What serum investigation is raised in duchenne dystrophy?

A

Serum creatine kinase (CK) level

1033
Q

What is the diagnostic test for DMD?

A

Genetic analysis: The DMD gene is identified

1034
Q

Which drug forms part of the management of DMD?

A

Glucocorticoids (prednisolone):
* Improve motor function and pulmonary function.
- Reduce the risk of scoliosis.

1035
Q

Communicating hydrocephalus occurs because of what?

A

impaired reabsorption of CSF in the subarachnoid space - due to inflammation of the subarachnoid villi

1036
Q

What is the main cause of communicating hydrocephalus?

A

Meningitis

1037
Q

What is the main cause of non-communicating hydrocephalus?

A

Obstructive e.g., Aqueduct stenosis, Dandy-walker formation and chiari formation

1038
Q

What is the most common cause of hydrocephalus in a child?

A

Obstructive - aqueduct stenosis between the 3rd and fourth ventricle

1039
Q

What characteristic sign is seen in hydrocephalus?

A

Sunset sign - the appearance of the sclera above the iris

1040
Q

What is the definitive management for hydrocephalus?

A

Ventriculoperitoneal shunt

1041
Q

What investigation is performed to visualise ventriculomegaly in hydrocepahlus?

A

Cranial Ultrasonography

1042
Q

A throbbing primary headache with a bilateral presentation is associated with what?

A

Migraine

1043
Q

What is the first line symptomatic management for migraines?

A

Simple analgesia

1044
Q

What is the second line migraines management for migraines?

A

Nasal triptans

1045
Q

What is the prophylaxis drug for migraines?

A
  • Propranolol OR topiramate
1046
Q

How long should a headache diary be performed for, for migraines?

A

Minimum of 8 weeks

1047
Q

Which chromosomal syndrome is associated with cleft palate, polydactyly and scalp lesions?

A

Trisomy 13

1048
Q

Which chromosomal syndrome is associated with low-set ears, micrognathia, rocker bottom feet and overlapping of fingers?

A

Trisomy 18

1049
Q

Which genetic syndrome is associated with a CGG trinucleotide repeat?

A

Fragile X

1050
Q

Macrocephaly and macro-orchidism is associated with which genetic disorder?

A

Fragile x

1051
Q

Pulmonary stenosis, webbed neck and pectus excavatum is associated with what?

A

Noonan syndrome

1052
Q

What is the inheritance pattern for Noonan syndrome?

A

Autosomal dominant

1053
Q

Which genetic disorder is associated with micrognathia and glossoptosis and cleft palate?

A

Pierre–Robin Syndrome

1054
Q

What is the genetic mechanism for Prader Willi syndrome?

A

Genetic imprinting

1055
Q

Which genetic disorder is associated with epicanthal folders, almond shaped eyes, obesity and learning disablity>

A

Prader Willi Syndrome

1056
Q

Which syndrome is associated with supravalvular aortic stenosis?

A

William’s syndrome

1057
Q

Which chromosomal disorder is associated with hypertelorism, feeding difficulties and poor weight gain?

A

Cri du Chat Syndrome

1058
Q

Which drug can cause a cleft lip/palate?

A

Folate antagonists e.g., phenytoin, sodium valproate, carbmazepine,

1059
Q

What maternal environmental factor can result in cleft lip/palate?

A
  • Foetal alcohol syndrome
  • Cigarette smoking
1060
Q

When is the primary closure of the cleft lip peformed?

A

3 months

1061
Q

When is the primary closure of cleft palate?

A

6-12 months

1062
Q

Which neurological disorder is associated with ‘Waiter’s tip sign’?

A

Erbs’s palsy

1063
Q

Erb’s palsy involves which cervical spinal nerves?

A

C5 -C6

1064
Q

What is the most common cause associated with ERB’s palsy?

A

Shoulder dystocia and macrosomia

1065
Q

What is the characteristic sign seen in Erb’s palsy?

A

Waiter’s tip sign

1066
Q

What is the medical management for treating contractures in Erb’s palsy?

A

Botulinum toxin

1067
Q

What are the indications for an immediate CT head in a child within 1 hour of a risk factor?

A

NAI
post-traumatic seizure
GCS <14
Open or depressed skull injury or tense fontanelle
Sign of basal skull fracture e..g, panda eyes, csf leakage, or battle sign
For children <1 with a bruise or laceration >5 cm
Focal neurological deficit

1068
Q

Which factors indicate a need for a minimum of 4 hour observation following head injury?

A

Witnessed loss of consciousness >5 minutes
Abnormal drowsiness
Dangerous mechanism of injury, fall of >3 m
Amnesia
3 or more episodes of vomiting

1069
Q

What is the histology of neuroblastoma?

A

Small round pale blue cells - Homer-wright Pseudorosettes

1070
Q

What is the characteristic sympathetic nervous system sign of neuroblastoma?

A
  • Horner syndrome (triad of ptosis, miosis, and anhidrosis) – involvement of superior cervical ganglia.
  • Spinal cord compression
  • Paraplegia
1071
Q

What is the investigation for suspected neuroblastoma?

A
  • HVA and VMA
1072
Q

What is the inheritance pattern for tuberous sclerosis?

A

Autosomal dominant

1073
Q

Which gene is implicated in tuberous sclerosis?

A

TSC1 or TSC2, encodes for hamartin and tuberin

1074
Q

What is the characteristic features of tuberous sclerosis in infancy?

A

eizures, hypomelanotic macules, and cardiac rhabdomyoma.

1075
Q

What is Shagreen patch associated with?

A

Tuberous sclerosis

1076
Q

What are Ash-leaf shaped macules and angiofibromas associated with?

A

Tuberous sclerosis

1077
Q

What are the major diagnostic for tuberous sclerosis?

A
  • Angiofibromas (≥3) or fibrous cephalic plaque
  • Hypomelanotic macules (≥3 lesions, each ≥5 mm in diameter); Ash leaf-shaped white macules.
  • Shagreen patch.
  • Subependymal nodules
  • Subependymal giant cell tumour
  • Retinal nodular hamartomas
  • Cardiac rhabdomyoma
  • Lymphangiomyomatosis
  • Renal angiomyolipomas (≥2)
  • Nontraumatic ungual or periungal fibroma
  • Cortical dysplasias
1078
Q

What is the Vogt diagnostic triad for tuberous sclerosis?

A

Seizures
Intellectual disability
Facial angiofibromas

1079
Q

Which autosomal disorder is characterised by cafe au lait spots?

A

Neurofibromatosis Type 1

1080
Q

Which optic manifestations are associated with Neurofibromatosis Type 1?

A

Lisch nodules
Optic pathway glioma

1081
Q

Which disorder is associated with peripheral precocious puberty?

A

McCune–Albright syndrome

1082
Q

What is the triad of McCune–Albright syndrome?

A

Polyosotic fibrous dysplasia
Cafe aut lait macules
Endocrine hyperactivity

1083
Q

What is the management of McCune–Albright syndrome?

A

Aromatase inhibitors e.g., letrozole to reduce heightened oestrogen exposure

1084
Q

When is nocturnal enuresis not considered normal?

A

Over the age of 5 years old

1085
Q

What are the risk factors associated with nocturnal enuresis?

A

Positive family history, male gender (2:1 ratio), developmental delay, constipation, faecal incontinence, day-time urinary incontinence, and behavioural disorder e.g., ADHD, ASD, anxiety, and conduct disorders

1086
Q

What is the first line investigation for a patient presenting with nocturnal enuresis?

A

Urine dipstick

1087
Q

What is the first line management for nocturnal enuresis?

A

Dietary and lifestyle advice with positive reward systems + enuresis alarm

1088
Q

How does an enuresis alarm work?

A

A sensor is typically inserted in the child’s underwear, whereby an alarm is triggered upon exposure to fluid – as such waking the child and prompting them to pass urine in the toilet

1089
Q

Minimum duration for enuresis alarm until desmopressin?

A

3 months (if complete dryness has not been achieved)

1090
Q

What is the second-line intervention for a patient with nocturnal enuresis?

A

Low dose of oral desmopressin

1091
Q

What is the management indicated for the short-term resolution of nocturnal enuresis in a child?

A

Desmopressin

1092
Q

What class of drug is desmopressin?

A

8-arginine vasopressin

1093
Q

How long should desmopressin be continued for?

A

3 months followed by a 1-week cessation period to assess for complete dryness

1094
Q

When is desmopressin administered before bedtime?

A

60 minutes before bed-time

1095
Q

What are the referral criteria for nocturnal enuresis?

A

Referral to a paediatric urologist or an enuresis-specialist (e.g., developmental-behavioural paediatrician, child psychologist) is indicated in the following circumstances for further evaluation and assessment for underlying causes:
* Daytime incontinence, urgency, holding measures, increased ((≥8 times/day), or decreased (≤3 times/day) voiding frequency.
* Weak stream, use of abdominal pressure, continuous incontinence, micturition in more than one phase.
* Proteinuria, nausea, weight loss, or fatigue
* Behavioural or emotional problems
* Developmental, attentional or learning difficulties
* Excessive thirst, nocturnal polydipsia.
* Refractory enuresis (despite two courses of treatment)

1096
Q

What is the biggest risk factor for sudden infant death syndrome?

A

Bed-sharing

1097
Q

Name 3 protective factors of sudden infant death syndrome:

A
  • Breastfeeding
  • Room sharing (not bed sharing)
  • Use of dummies (pacifiers)
1098
Q

What is the characteristic presentation of Rett synrome?

A

Developmental regression and stereotypic hand movements e.g., wringing, clapping and twisting

1099
Q

What squint term describes eyes turning in?

A

Esotropia

1100
Q

What is exotropia?

A

Eyes turning out

1101
Q

Which type of strabismus is most common?

A

Convergent (esotropia)

1102
Q

What are the two tests to assess for squint?

A

Hirschberg Test – Corneal Light Reflex Test
Cover Test

1103
Q

What are the major complications associated with strabismus?

A

Ambylopia

1104
Q

Which benign oedema of the scalp crosses suture lines?

A

Caput Succedaneum

1105
Q

Which is the commonest risk factor for Caput Succedaneum?

A

Vacuum-assisted delivery

1106
Q

Caput Succedaneum is an accumulation of fluid above which layer?

A

Superior to the periosteum

1107
Q

What is the management for Caput Succedaneum?

A

Observational - self-resolve within 48 hours

1108
Q

Cephalohaematoma occurs when?

A

Delayed within 1-3 days of birth

1109
Q

Cephalohaematoma occurs between which two layers?

A

inferior to the periosteum and above the bone

1110
Q

What are the risk factors for Cephalohaematoma?

A
  • A prolonged second stage of labour
  • Macrosomia
  • Weak or ineffective. Uterine contractions
  • Abnormal fetal presentation
  • Instrument-assisted deliver
1111
Q

What is the characteristic presentation of Cephalohaematoma?

A

Does not cross suture lines

1112
Q

What is the management for a subagaleal haemorrhage?

A

Fresh-frozen plasma to correct hypovolaemia

1113
Q

What is the investigation for an intraventricular haemorrhage?

A

Transcranial US Doppler Screening

1114
Q

Another term for HSP?

A

IgA Vasculitis

1115
Q

what is the tetrad of symptoms associated with HSP?

A
  1. Palpable purpura
  2. GI symptoms (colicky abdominal pain, GI bleed)
  3. Renal disease
  4. Arthritis/Arthralgia
1116
Q

What is the major triggers for HSP?

A

URTI

1117
Q

Where is the characteristic appearance of HSP rash (site and location)?

A
  • Palpable purpura
  • Lower extremities (palms and soles) and areas subjected to pressure – buttocks.
  • Extensor surface
  • Urticarial  Maculopapular, spares trunk
1118
Q

What are the investigations of choice associated with HSP?

A
  • Urinalysis
1119
Q

What is the management for HSP (normal GFR)?

A

Oral corticosteroid
* Prednisolone
o IV corticosteroids are recommended in patients with nephrotic-range proteinuria and those with declining renal function.

1120
Q

what is the management for rapidly progressive nephritis?

A

IV corticosteroids + oral prednisolone + cylcophosphamide

1121
Q

what is the triad of symptoms associated with. haemolytic uraemic syndrome?

A

Microangiopathic haemolytic anaemia

AKI

Thrombocytopenia

1122
Q

What is the most common causative pathogen implicated in HUS?

A

Shiga toxin-producing Escherichia coli (STEC) 0157:H7

1123
Q

What is the pro-drome phase associated with HUS?

A

Precedes the development of HUS by 5 to 10 days.
* Abdominal pain
* Vomiting
* Diarrhoea
- Bloody – E. coli.

1124
Q

What is the peripheral blood smear results associated with HUS?

A
  • Schistocytes and helmet cells
1125
Q

What is the management for atypical HUS?

A

Eculizumab (A C5 inhibitor monoclonal antibody) – plasma exchange in atypical HUS.

1126
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

1127
Q

What are the three major factors for nephrotic syndrome?

A
  1. Nephrotic range proteinuria 40 mg/hr/m2 in a 24-hour urine collection.
  2. Hypoalbuminaemia
  3. Oedema
1128
Q

What are the clinical manifestations of minimal change diseae?

A
  • Facial or generalised oedema
  • Periorbital – misdiagnosed as asn allergy.
  • Age >1 year <8 years.
  • Normal BP
  • Absence of haematuria
1129
Q

What is the first line investigation for minimal change disease?

A

Urinalysis with microscopy
- Protein: 3+ to 4+; no significant haematuria

1130
Q

What is seen on renal electron microscopy for minimal change disease?

A

Podocyte effacement

1131
Q

What is the first line management implicated in nephrotic syndrome?

A

Prednisolone

1132
Q

Why is there a hypercoagulable state in nephrotic syndrome (what is lost in the urine)?

A

Anti-thrombin 3

1133
Q

What is the most common cause of nephritic syndrome in a child?

A

Post-streptococcal glomerulonephritis

1134
Q

Which bacteria is associated with nephritic syndrome?

A

Group A beta-haemolytic streptococcus.

1135
Q

When does PSGN arise following GAS pharyngitis?

A

1-3 weeks

1136
Q

What is the characteristic colour of urine for PSGN?

A

Red cola-coloured

1137
Q

Which antibiotic is prescribed for PSGN?

A

Phenoxymethylpenicillin

1138
Q

What is the most common causative organism of epidimytis and orchitis?

A

Neisseria gonorrhoea and chlamydia trachomatis

1139
Q

Which deformity predisposes children to testicular torsion?

A

Bell-clapper deformity

1140
Q

Which reflex is absent in testicular torsion?

A

Cremasteric reflex

1141
Q

What is Prehn’s sign in testicular torsion?

A

Elevation of the testis does not ease the pain.

1142
Q

What is the first line investigation for testicular torsion?

A

Power/colour Doppler Ultrasound

And immediate scrotal exploration

1143
Q

Which ABx is prescribed in patients with epdidymiytis?

A
  • Ceftriaxone 1g IM single dose PLUS
  • Doxycycline
1144
Q

Hypospadias affects what part of the penis?

A

Abnormal ventral placement of the urethral opening

1145
Q

What is a risk factor associated with hypospadias?

A

Cryptorchidism

1146
Q

Which type of hypospadias is associated with a more severe presentation?

A

Penoscrotal

1147
Q

When is surgical correction performed for hypospadias?

A

3 months

1148
Q

What term describes this:

‘A testis that is not within the scrotum and does not descend spontaneously by four months of age’.

A

Cryptorchidism

1149
Q

What term describes the following:

Normally descended testes that can be pulled into a suprascrotal position by the cremasteric reflex.

A
  • Retractile testes
1150
Q

Name three main risk factors for cryptorchidism?

A
  • Prematurity = ~30% of premature male infants are born with an undescended testis – the majority (~70%) resolve spontaneously by one year.
  • Small gestational weight
  • Low birth weight <2.5 kg
1151
Q

Which side is mainly affected by cryptorchidism?

A

Left side- unilateral presentation

1152
Q

cryptorchidism is associated with which main complication?

A

Increased risk of testicular cancer

1153
Q

What are the associated conditions associated with cryptorchidism?

A

Abdominal wall defects (Eagle-Barret syndrome), neural tube defects, cerebral palsy, mixed gonadal dysgenesis, Kallmann syndrome, Klinefelter syndrome, Prader-Willi Syndrome or androgen insensitivity.

1154
Q

What is the management for retractile testicles?

A

Annual follow-up examination

1155
Q

What is the management for bilateral Cryptorchidism at birth?

A

24-hour hour referral (ensure child is seen by 6 months)

1156
Q

What is the management for bilateral Cryptorchidism presenting at 6-8 weeks?

A

2-week referral

1157
Q

When should unilateral Cryptorchidism be re-examined?

A

Re-examine at 6-8 weeks and 4-5 months - refer to paediatric surgery

1158
Q

Which gender is most affected by indirect inguinal hernias?

A

boys 3-4 x

1159
Q

Which conditions are associated with indirect inguinal hernias?

A

Abdominal wall defects (E.g., Eagle-Barret syndrome) and connective tissue defects (e.g., Ehlers-Danlos syndrome).

1160
Q

Highest incidence of indirect inguinal hernia at what age?

A

1 year

1161
Q

What is the management for inguinal hernias?

A

Urgent surgical correction (within 2 days if <6 weeks, 2 weeks for under 6 months, and 2 months for under 6 years

1162
Q

Which defect is associated with a full thickness abdominal wall defect with evisceration of the bowel?

A

Gastroschisis

1163
Q

What is the management for Gastroschisis?

A

1st line: Cover with transparency occlusive wrap (Delivery = vaginal).
Definitive = Surgical primary closure (within four hours)

1164
Q

Omphalocele is covered by three layers of what?

A

amnion, Wharton’s jelly and peritoneum

1165
Q

Which midline abdominal wall defect is associated with a three-layer covered?

A

Omphalocele

1166
Q

What is the first line management for Omphalocele?

A

Placement of nasogastric tube, IV Abx, and covering the sac with a damp gauze before wrapping the abdomen in clingfilm.

1167
Q

What is the definitive management for omphalocele?

A
  • Definitive = Surgical closure (staged repair over 12 months) – allows the sac to granulate over months.
1168
Q

Mode of delivery for detected omphalocele?

A

Caesarean section to reduce the risk of sac rupture.

1169
Q

What are the genetic associations with omphalocele?

A

Trisomy 13 (Patau’s), 18 (Edward’s), 21 (Down’s); Turner’s.

1170
Q

When is congenital hypothyroidism assessed?

A

newborn Guthrie test at 5 days

1171
Q

What is the most common cause of congenital hypothyroidism?

A
  • Thyroid dysgenesis
1172
Q

What is a cause of transient hypothyroidism?

A

Transient hypothyroidism – Resolves during the first few months or years of life – due to iodine deficiency.
* Maternal antithyroid drugs (carbimazole) during pregnancy
* Maternal antibiotics (Hashimoto’s)
* Iodine exposure during gestation
* ‘Gland in situ’

1173
Q

What is the management of congenital hypothyroidism?

A

Oral levothyroxine

1174
Q

What is the complication associated with untreated congenital hypothyriodism?

A

Short stature (cretinism) and intellectual disability

1175
Q

What is the most common acquired cause of hypothyroidism?

A

Hashimoto’s autoimmune thyroiditis.

1176
Q

What is the blood glucose threshold for a diagnosis of DKA?

A

> 11 mmol/L

1177
Q

What is the venous pH threshold for DKA?

A

<7.3 or bicarbonate <15 mmol/L

1178
Q

What is the level of ketones in the blood for DKA?

A

> 3 mmol/L

1179
Q

What is Kussmaul respiration?

A

Deep hyperventilation
- Respiratory compensation for metabolic acidosis

1180
Q

What is the first line management for DKA?

A

Emergency fluid resuscitation.

1181
Q

What fluid bolus is given for DKA?

A
  • 10 mL/kg of 0.9% NaCl over 60 minutes if NO shock.
1182
Q

What is the fluid deficit calculation for DKA?

A

[Body weight (kg) x % dehydration x 10] – [Initial bolus if NOT SHOCKED] - Replace over 48 hours.

1183
Q

What is mild dehydration in terms of venous pH and bicarbonate?

A

<7.2 - 7.29 HCO3 <15

5% dehydration

1184
Q

What is moderate dehydration in terms of venous pH and bicarbonate?

A

7% dehydration – Venous pH 7.1 – 7.19 or bicarbonate <10 mmol/L

1185
Q

What is severe dehydration in terms of venous pH and bicarbonate?

A

10% dehydration – Venous pH <7.1 or bicarbonate <5 mmol/L

1186
Q

What is the maintenance requirement in terms of the first 10kg?

A

100 mL/kg/24 hours

1187
Q

What is the maintenance requirement in terms of the next 10kg?

A

+ 50 mL/kg/24 hours

1188
Q

What is the maintenance requirement in terms of the >20kg?

A

+ 20 mL/kg/24 hours

1189
Q

Once plasma glucose drops below 14 mmol/L what type of fluid should be given?

A
  • Change to 0.9% saline + 5% glucose
1190
Q

What is co-administered if potassium is <5.5 in DKA?

A

40 mmol/L potassium chloride

1191
Q

After fluid therapy is initiated in DKA, what dose of insulin is given?

A
  • 0.05-0.1 units/kg/hour – Soluble insulin infusion
1192
Q

What is the most common cause of delayed puberty in boys?

A

Constitutional delay

1193
Q

When should you make a faltering growth referral in a child >75th centile?

A

if it falls by more than 3 centiles

1194
Q

When should you make a faltering growth referral in a child 25-75th centile?

A

If it falls by more than 2 centiles

1195
Q

When should you make a faltering growth referral in a child <25th centile?

A

If it falls by more than 1 centile

1196
Q

What is the threshold in terms of age for delayed puberty in boys?

A

No testicular development (volume <4 mL) by age 14 years.

1197
Q

What is the threshold in terms of age for delayed puberty in girls?

A

No breast development by age 13 years OR no periods by age 15 years.

1198
Q

What are the features of constitutional delay of growth and puberty?

A

Low bone age, no puberty signs, no organic causes.

1199
Q

What are the common hypogonadotrophic causes of hypogonadism?

A
  • Hypothalamic-pituitary disorders – panhypopituitarism, intracranial tumours
  • Kalman’s syndrome: LHRH deficiency and ANOSMIA)
  • Prader–Willi Syndrome.
1200
Q

What are the common hypergonadotrophic causes of hypogonadism?

A
  • Congenital: Cryptorchidism, Klinefelter’s syndrome (47 XXY), Turner’s syndrome (45 XO)
  • Acquired – Testicular torsion, chemotherapy, infection (mumps), trauma, autoimmune.
1201
Q

What tool is used to assess testicular volume for boys?

A
  • Prader’s orchidometer
1202
Q

What imaging modality is used to assess bone age?

A

Wrist X-ray

1203
Q

What is the diagnosis for a ‘girl’ with delayed puberty with bilateral groin swellings?

A

Androgen insensitivity syndrome

1204
Q

What is the management for constitutional delay of growth and puberty?

A

Reassurance and offer observation

consider short course sex hormone therapy as second line

1205
Q

What is the course of testosterone that is prescribed for delayed puberty in boys?

A

Short course IM testosterone or oxandrolone

1206
Q

What is the course of oestrogen that is prescribed for delayed puberty in girls?

A
  • Girls  Transdermal oestrogen (6 months)  Cyclical progesterone once established.
1207
Q

What is the early puberty range for girls?

A
  • Girls = 8 < age <10
1208
Q

What is the early puberty range for boys?

A
  • Boys = 9 < age <12
1209
Q

What is the threshold age for precocious puberty for girls?

A

8 years old

1210
Q

What is the threshold age for precocious puberty in boys?

A

9 years old

1211
Q

What is puberty determined by in girls?

A

Tanner Breast Development Stages

1212
Q

What is the threshold for testicular volume in boys with precocious puberty?

A

> 4 mL

1213
Q

What type of precocious puberty is associated with bilateral testicular enlargement?

A

Gonadotrophin-dependent (intracranial lesion)

1214
Q

What type of precocious puberty is associated with unilateral testicular enlargement?

A

Gonadal tumour

1215
Q

Which cell in boys produced testosterone?

A

Leydig cell tumour

1216
Q

What happens to testes size in adrenal related causes of precocious puberty?

A

Small testes

1217
Q

What is the gold-standard investigation for confirming precocious puberty?

A

GnRH stimulation test – Suppressed LH/FSH if G-independent.
* FSH, LH low = GIPP
* FSH, LH high = GDPP

1218
Q

What is the management for Gonadotrophin-dependent precocious puberty?

A
  • GnRH agonist (e.g., leuprolide) + GH therapy.

Agonists overstimulate pituitary and arrest GnRH release.

1219
Q

What class of drug is cyproterone?

A

Anti-androgen

1220
Q

What is the management for McCune Albright syndrome?

A

1st: Ketoconazole, or cyproterone, 2nd: Aromatase inhibitors.

1221
Q

Name three ACTH-dependent causes of Cushing’s syndrome?

A
  • Cushing disease (pituitary hypersecretion of ACTH) – pituitary adenoma.
  • Solitary neoplasm
  • Ectopic ACTH (SCLC)
1222
Q

What are the ACTH-independent causes?

A
  • Exogenous administration of glucocorticoids (adrenal glands are atrophic).
  • Adrenal hyperplasia/tumours – Common in children.
1223
Q

What is the confirmatory investigation for Cushing’s?

A

Inferior Petrosal Sinus Sampling

1224
Q

What is the first line management for an adrenal causing Cushing’s?

A

Adrenal Mass - Adrenalectomy

1225
Q

What syndrome occurs following a bilateral Adrenalectomy ?

A

Nelson’s Syndrome

1226
Q

Management for ectopic Cushing’s? (drug)

A

Ketoconazole, metyrapone

1227
Q

Fasting blood glucose threshold for diagnosis of DM?

A

o Fasting plasma glucose >7.0 mmol/L

1228
Q

What is the threshold for diagnosis of diabetes mellitus on a 2-hour plasma glucose test?

A

> 11.1 mmol/L

1229
Q

What is the first line management for type 1 diabetes mellitus?

A

Basal-bolus insulin regimen

1230
Q

What is the first-line drug for T2DM?

A

Metformin

1231
Q

What class of drug is acarbose?

A

A-glucosidase inhibitor

1232
Q

What is the threshold for obesity regarding BMI?

A

> 30

1233
Q

What is the management for infantile Haemangioma?

A

Medical photography + review in 3 months

1234
Q

What is the management for infantile Haemangioma (near the eyes, nappy area, lips and nasal tip)?

A

Topical timolol

1235
Q

Which scoring criteria is used for urticaria?

A

Urticaria Activity Score (USA7)

1236
Q

What is the first line management for urticaria?

A

Second-generation, non-sedating antihistamines (Cetirizine, fexofenadine) for up to 6 weeks.

1237
Q

What is the main cause of impetigo?

A

Staphylococcus aureus

1238
Q

Bullous impetigo is caused by which toxins?

A

exfoliative toxins (A and B)

1239
Q

Which type of impetigo is associated with a characteristic golden crust?

A

Non-bullous impetigo

1240
Q

Which type of impetigo is associated with large flaccid bullae which rupture?

A

Bullous impetigo

1241
Q

What is the first line drug for non-bullous impetigo?

A

o Hydrogen peroxide 1% cream consider topical fusidic acid

1242
Q

What is the second line management for non-bullous impetigo?

A

offer 5 days of topical fusidic acid 2% or mupirocin 2%

1243
Q

What is the management for bullous impetigo?

A

o Oral flucloxacillin (or clarithromycin if penicillin allergic)

1244
Q

Which gene is involved with the pathogenesis of atopic dermatitis?

A
  • Filaggrin gene
1245
Q

What is the common affected site for atopic dermatitis?

A

Face and trunk.

1246
Q

What is the management for eczema herpeticum?

A

IV acyclovir and immediate referral

1247
Q

Which virus is the commonest cause of eczema herpticum?

A

HSV-1

1248
Q

What is the characteristic appearance of eczema herpeticum?

A

punched-out erosions

1249
Q

What is the first line corticosteroid choice for mild eczema?

A

Topical 1% hydrocortisone

1250
Q

What is the first line corticosteroid choice for moderate eczema?

A
  • 0.025% betamethasone valerate or 0.05% clobetasone butyrate)
1251
Q

What is the management for severe eczema (widespread)?

A

Occlusive dressings of dry bandages are used in acutely flared or lichenified skin.

1252
Q

What is the second line drug for eczema despite steroid use?

A

Topical calcineurin inhibitors (tacrolimus).

1253
Q

What 12-week course is indicated for the management of mild to moderate acne?

A
  • Fixed combination of topical adapalene + topical benzoyl peroxide.
    OR
  • Fixed combination of topical tretinoin + topical clindamycin.
  • Fixed combination of topical benzoyl peroxide + topical clindamycin.
1254
Q

Management for moderate to severe acne?

A
  • A fixed combination of topical adapalene + topical benzoyl peroxide OD in the evening (together with either oral lymecycline 408 mg or oral doxycycline 100 mg).
  • Topical azelaic acid (15% or 20%) for a maximum of 3 months– TDS + oral lymecycline or doxycycline.
1255
Q

Which antibiotic is used to manage moderate to severe eczema?

A

oral lymecycline 408 mg or oral doxycycline 100 mg

1256
Q

What drug is the management for severe acne?

A

isotretinoin

1257
Q

When is the first review for acne?

A

12 weeks

1258
Q

What neonatal birth mark is associated with grey-blue discolouration?

A

Mongolian spot

1259
Q

What is the management for Mongolion spot?

A

Commonly fades within 1 year. Lesions on the buttocks typically resolve by 5 years.

1260
Q

What capillary malformation is associated with unilateral pink or red discolouration of the skin?

A

Port wine stain

1261
Q

Which mutation is associated with port wine stains?

A

GNAQ mutation

1262
Q

Which syndrome is associated with port wine stain distributed along the trigeminal nerve?

A

Sturge–Weber Syndrome

1263
Q

What congenital rash is associated with a self-limiting evanescent eruption?

A

Erythema toxicum

1264
Q

Which neonatal rash is associated with supepidermal keratin cysts?

A

Milia

1265
Q

What is the cause of molluscum contagiosum?

A

DNA poxvirus

1266
Q

What is the pathogen implicated for guttate psoriasis?

A

streptococcus pyogenes

1267
Q

What is the first line management for guttate psoriasis?

A

Phototherapy

1268
Q

What is the management for congenital melanocytic naevi?

A

prompt referral to the paediatric dermatologist and plastic surgeon (consideration of excision).

1269
Q

First line management for cradle cap?

A

Topical emollient

1270
Q

What investigation is used to diagnose ringworm?

A

Woods light

microscopic examination of the skin scrapings

1271
Q

What is the diagnostic criteria to confirm head lice?

A

Detection combing: Confirmed by visualisation of live lice on wet or dry hair. - a live louse must be found

1272
Q

What is the first line management for head lice?

A

Wet combing - four sessions spaced over 2 weeks

1273
Q

When is the 5th detection session for head lice?

A

day 17

1274
Q

Which lotion is indicated in the management for head lice?

A
  • Dimeticone 4% lotion
1275
Q

When should a child be expected to stand unsupported?

A

12 months

1276
Q

How many blocks can be stacked by 18 months?

A

3

1277
Q

What is the moro reflex?

A

Sudden head drop - Arms outstretched

1278
Q

Average age of onset for palmar grasp?

A

6 months

1279
Q

Average age of onset for pincer?

A

10 months

1280
Q

What is the average of onset for head control?

A

1 month

1281
Q

What is the average age of onset for sitting unsupported?

A

6-8 months

1282
Q

Age of drawing vertical straight line?

A

2 years

1283
Q

Age of onset for circle?

A

3 years

1284
Q

Age of onset for square?

A

4 years

1285
Q

Age of onset for cross?

A

3.5 years

1286
Q

Age of onset for crawling?

A

8-9 months

1287
Q

Age of onset for waling steadily?

A

12-15 months

1288
Q

Age of onset for transferring toys from one hand to another?

A

7 months

1289
Q

Age of onset to make a bridge?

A

3 years

1290
Q

Age of onset for 6 block tower?

A

2 years

1291
Q

Age of onset to saying dad mama?

A

9 months

1292
Q

age of onset to saying 2-3 words?

A

12 months

1293
Q

Age of onset to saying 6-10 words?

A

18 months

1294
Q

age of onset to responding to name

A

12 months

1295
Q

Age of onset for 2-word sentences?

A

2 years

1296
Q

What is the limit age for saying 6 words with meaning?

A

18 months

1297
Q

Age of onset for smiling?

A

6 weeks

1298
Q

Age of onset for interactive play?

A

2.5 to 3 years

1299
Q

What is the threshold for concern for children not being able to walk?

A

18 months

1300
Q

When can a child kick a ball?

A

2.5 years

1301
Q
A
1302
Q

Which 3 vaccines are administered at 2 months?

A

6 in 1 vaccine
Men B
Rotavirus

1303
Q

Which 3 vaccines are administered at 3 months?

A

6 in 1 vaccine
Rotavirus
PCV

1304
Q

Which 2 vaccine are administered at 4 months?

A

6 in 1
Men B

1305
Q

Which 4 vaccines are given at one year?

A

MMR
Men B booster
PCV
Hib/MenC

1306
Q

When is the HPV vaccine given?

A

at 12-13 years

1307
Q

When is the Men ACWY given?

A

14 years

1308
Q

What % of weight loss is normal?

A

10% of birth weight - restored by 3 weeks of age