Paediatrics Flashcards

Question

What is observed on HRCT in bronchiectasis?

Answer 1

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

Answer 2

Obstructive pattern (Reduced FEV1, normal FVC)

Answer 3

Obstructive pattern (Reduced FEV1, normal FVC)

Answer 4

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

Answer 5

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

Answer 6

Amoxicillin or Clarithromycin

Answer 7

Doxycycline

Answer 8

Co-amoxiclav Pipieracillin and tazobactam

Answer 9

Chest physiotherapy Antibiotic therapy Inhaled hypertonic saline for high sputum load

Answer 10

Streptococcus pneumonia Seasonal influenza

Answer 11

Inflammation of the epiglottis and adjacent supraglottic structures It is a life-threatening obstruction

Answer 12

Haemophilusinfluenzae type B

Answer 13

Hot potato voice - muffled

Answer 14

Epiglottitis

Answer 15

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

Answer 16

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

Answer 17

Thumb sign

Answer 18

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

Answer 19

Rifmapicin

Answer 20

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.

Answer 21

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

Answer 22

Immunofluorescence of nasopharyngeal secretions --> RSV

Answer 23

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

Answer 24

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

Answer 25

palivizumab

Answer 26

Pyloric stenosis

Answer 27

Hypercholraemic alkalosis - due to a loss of gastric acid

Answer 28

Olive-like mass

Answer 29

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

Answer 30

Surgical pyloromyotomy (Ramstedt) - Can be open or laparoscopic

Answer 31

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

Answer 32

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

Answer 33

6 in 1 Vaccine Oral rotavirus vaccine Men B

Answer 34

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

Answer 35

6 in 1 Men B

Answer 36

Hib/Men C MMR PCV Men B

Answer 37

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

Answer 38

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

Answer 39

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

Answer 40

Choleretics - Ursodeoxycholic acid - to promote bile flow. Nutritional supplementation - medium chain triglyceride formula Fat-soluble vitamin

Answer 41

IV amoxicillin + cefotaxime

Answer 42

IV Ceftriaxone

Answer 43

IM Benzylpenicillin + arrange emergency transfer to secondary care centre.

Answer 44

Auditory assessment within 4 weeks after discharge

Answer 45

Ciprofloxacin

Answer 46

Bordetella pertussis (Gram-negative)

Answer 47

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

Answer 48

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

Answer 49

Coughing spells increase in severity Gagging, breathlessness Sweating episodes between paroxysms Bothersome at night

Answer 50

Nasal swab culture for Bordetella pertussis - nasopharyngeal aspirate or swab (Suitable for all age groups <21 days of cough duration)

Answer 51

PCR and serological testing

Answer 52

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

Answer 53

< 6 months

Answer 54

Macrolide (cough within 21 day duration).

Answer 55

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

Answer 56

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

Answer 57

- Less than 28 weeks’ gestation - IUGR infants - Chorioamnionitis – Increases risk of developing a systemic inflammatory response.

Answer 58

* Breathing difficulties and is oxygen-dependent. * Poor growth * Feeding problems

Answer 59

Hyperinflation, cystic changes and streaky infiltrates

Answer 60

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

Answer 61

High flow oxygen via a nasal cannula or if >2L/min - humidified oxygen CPAP Invasive ventilation + prescribe surfactant

Answer 62

* 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

Answer 63

If >8 days and on ventilator

Answer 64

In preterm and apnoeic patients OR <30 weeks corrected gestational age

Answer 65

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.

Answer 66

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

Answer 67

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

Answer 68

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

Answer 69

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

Answer 70

Echocardiography

Answer 71

* 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.

Answer 72

* Caesarean section * Maternal diabetes * Maternal asthma

Answer 73

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.

Answer 74

Between time of birth and two hours post-delivery

Answer 75

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

Answer 76

Fluid in horizontal fissure + hyperinflation

Answer 77

12-24 hours

Answer 78

RR is 60-80 breaths per minute

Answer 79

If tachypnoea persists >4-6 hours

Answer 80

Ampicillin + gentamicin

Answer 81

Thumb sign

Answer 82

* 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

Answer 83

Immunofluorescence of nasopharyngeal secretions  RSV - + Rapid antigen testing

Answer 84

Epstein-Barr virus

Answer 85

Reed-Sternberg Cells

Answer 86

Nodular Sclerosis

Answer 87

2-5 years of age

Answer 88

>2 X 109/L at diagnosis

Answer 89

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

Answer 90

Lymphoid progenitor cells

Answer 91

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

Answer 92

FBC with differential Peripheral blood smear

Answer 93

Bone marrow aspiration and trephine biopsy

Answer 94

>20% lymphoblasts

Answer 95

MYC gene on chromosome 8

Answer 96

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

Answer 97

1. Endemic 2. Sporadic

Answer 98

* Jaw or facial bone tumour - Involves the mandible or maxilla * Extranodal sites: Mesentery, ovary, testis, kidney, breast and meninges.

Answer 99

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

Answer 100

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

Answer 101

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

Answer 102

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

Answer 103

CSF - Filgrastim

Answer 104

Blood transfusions

Answer 105

Allopurinol Rasburicase

Answer 106

Intrathecal methotrexate

Answer 107

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

Answer 108

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

Answer 109

Type 2 hypersensitivity

Answer 110

* 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

Answer 111

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

Answer 112

Intermittent painless lower GI bleeding

Answer 113

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

Answer 114

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)

Answer 115

Bilious vomiting - dark green.

Answer 116

Upper GI contrast study

Answer 117

Right-sided duodenum Bird-beak cut-off Corkscrew

Answer 118

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

Answer 119

Ladd's procedure

Answer 120

McBurney's point

Answer 121

Leuckocytosis

Answer 122

PAS > 7 or 8 - high risk - surgical consultation

Answer 123

Abdominal ultrasound

Answer 124

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

Answer 125

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

Answer 126

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.

Answer 127

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.

Answer 128

Abdominal ultrasound

Answer 129

- Absence of gallbladder, irregular morphology, polysplenia - Triangular cord sign

Answer 130

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.

Answer 131

Ileocolic Intussusception

Answer 132

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

Answer 133

Redcurrant jelly stools

Answer 134

Sausage-shaped abdominal mass

Answer 135

3-12 months

Answer 136

Ultrasound

Answer 137

Target sign

Answer 138

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

Answer 139

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

Answer 140

3-6 week old infants MALES 5:1

Answer 141

* 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

Answer 142

* Hypochloraemic alkalosis

Answer 143

Olive-like mass

Answer 144

Surgical pyloromyotomy (Ramstedt) - Can be open or laparoscopic

Answer 145

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.

Answer 146

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

Answer 147

Nephroblastoma (Wilm's tumour)

Answer 148

Beckwith-Wiedemann Syndrome

Answer 149

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

Answer 150

Arrange a paediatric review within 48 hours

Answer 151

Surgical excision or biopsy - histological confirmation

Answer 152

Abdominal ultrasound

Answer 153

Nephrectomy

Answer 154

Necrotising enterocolitis

Answer 155

* 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.

Answer 156

Intramural gas - pneumatosis intestinalis

Answer 157

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

Answer 158

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

Answer 159

- Ampicillin + Gentamicin + metronidazole.

Answer 160

Resolves by 2 years

Answer 161

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

Answer 162

* 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.

Answer 163

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

Answer 164

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

Answer 165

Feed thickeners

Answer 166

Consider 1–2-week trial of alginate therapy.

Answer 167

4 weeks of PPI – Omeprazole suspension

Answer 168

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

Answer 169

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

Answer 170

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

Answer 171

Intravenous immunoglobulin + platelet transfusion Antifibrinolytics

Answer 172

An ACQUIRED syndrome characterised by systemic activation of coagulation - Haemorrhage and thrombosis.

Answer 173

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

Answer 174

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

Answer 175

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

Answer 176

Platelet transfusion, FFP an cryoprecipitate transfusions.

Answer 177

Protein C concentrates

Answer 178

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

Answer 179

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

Answer 180

Parent training in behaviour management

Answer 181

methylphenidate or amphetamine + psychoeducation

Answer 182

Abdominal pain, nausea, and dyspepsia. Weight and height - stunted growth

Answer 183

Height and Weight

Answer 184

Guanfacine or clonidine.

Answer 185

lisdexamfetamine

Answer 186

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

Answer 187

6 months to 6 years

Answer 188

Approximately 2-3 minutes (<5 minutes)

Answer 189

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

Answer 190

High fever Viral infection Recent immunisation Family history

Answer 191

Human herpes simplex virus 6 (HH6) in Roseola.

Answer 192

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

Answer 193

Buccal midazolam

Answer 194

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,

Answer 195

Do not try and cool the child Regular paracetamol and ibuprofen Adequate fluid intake Seek advice if prolonged fever

Answer 196

* 15-30 minutes * Focal seizure * Repeat seizures within 24 hours

Answer 197

Trisomy 21 - meiotic nondisjunction

Answer 198

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

Answer 199

Brush field spots on the iris

Answer 200

* 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.

Answer 201

AV Canal defect VSD ASD TOF PDA Pulmonary HTN

Answer 202

Duodenal atresia Hirshprung's disease Omphalocele

Answer 203

Atlantoaxial instability

Answer 204

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

Answer 205

Nuchal translucency measurement - Serum B-HCG - raised -Pregnancy-associated plasma protein (PAAP-A reduced).

Answer 206

Pregnancy-associated plasma protein

Answer 207

AFP, Unconjugated oestriol, HCG, and inhibin A

Answer 208

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

Answer 209

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

Answer 210

CORE SYMPTOM 1: Impaired social communication and interaction CORE SYMPTOM 2: Restricted and repetitive behaviour, interests, and activities Stereotyped behaviours

Answer 211

Autism diagnostic observational schedule DISCO SCQ, CAST, CARS, SRS, ASQ

Answer 212

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

Answer 213

Breast-fed babies - poor source of vitamin K + Maternal use of anti-epileptic drugs

Answer 214

Once-off Intramuscular injection of vitamin K

Answer 215

A venous hum

Answer 216

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

Answer 217

Inferior to both clavicles

Answer 218

Low-pitched sound heard at the lower left sternal edge

Answer 219

At the lower left sternal edge

Answer 220

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

Answer 221

High-dose aspirin and intravenous immunoglobulin

Answer 222

Echocardiogram to detect coronary artery aneurysm

Answer 223

Fifth disease - Parvovirus B19 infection - Erythema infectiosum

Answer 224

Infantile spasms - characterised by hypsarrythmia on an EEG

Answer 225

Hypsarrhythmia

Answer 226

vigabatrin

Answer 227

'salaam' attacks

Answer 228

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

Answer 229

Tetralogy of Fallot Transposition of great arteries (TGA Tricuspid atresia

Answer 230

Haemophilus influenzae type B

Answer 231

Encourage normal feeding and monitor glucose

Answer 232

<2.6 mmol/L

Answer 233

Jitteriness Irritabile Tachypnoea Pallor + neuroglycopenic symptoms - poor feeding, weak cry, drowsy, hypotonia, seizures

Answer 234

GBS and Escherichia coli, L. monocytogenes

Answer 235

Intravenous infusion of 10% dextrose

Answer 236

Autosomal recessive

Answer 237

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

Answer 238

Boot shaped heart

Answer 239

Right ventricular hypertrophy

Answer 240

Oral Penicillin V for 10 days

Answer 241

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

Answer 242

Streptococcus pyogenes (group A)

Answer 243

Otitis media

Answer 244

Intussusception

Answer 245

Abdominal ultrasound revealing target sign

Answer 246

Air insufflation under radiographic guidance or barium enema

Answer 247

Otoacoustic emissions

Answer 248

Auditory brainstem response test

Answer 249

Varicella zoster immunoglobulin

Answer 250

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

Answer 251

Desmopressin

Answer 252

Dry the baby followed by 5 inflation breaths

Answer 253

Pierre-Robin Syndrome

Answer 254

William's Syndrome

Answer 255

Edward's syndrome

Answer 256

Cryptorchidism

Answer 257

Parainfluenza virus

Answer 258

Observation

Answer 259

In situ screw fixation

Answer 260

Cystic fibrosis

Answer 261

The presence of the liver in the thoracic cavity

Answer 262

>60 breaths per minute

Answer 263

Rectal washout/bowel irrigation

Answer 264

Rectal biopsy

Answer 265

10-15 years

Answer 266

10-15 Year olds Boys Obese

Answer 267

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.

Answer 268

Displacement of the femoral head epiphysis postero-inferiorly

Answer 269

Bilateral AP X-rays Lateral (frog-leg X-rays)

Answer 270

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

Answer 271

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

Answer 272

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

Answer 273

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%

Answer 274

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

Answer 275

Technetium bone scan

Answer 276

Analgesia + supportive (protective pad over tibial tubercule)

Answer 277

Mobilisation and monitoring

Answer 278

Surgical containment - keep femoral head within the acetabulum.

Answer 279

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.

Answer 280

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

Answer 281

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

Answer 282

FBC - WCC within normal range (Raised = septic arthritis). X-ray - Exclude Perthe's disease (normal in TS)

Answer 283

Symptomatic relief – ibuprofen, naproxen or paracetamol.

Answer 284

Osgood-Schlatter Disease

Answer 285

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

Answer 286

* 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.

Answer 287

Separation and fragmentation of the upper tibial epiphysis

Answer 288

* 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

Answer 289

10 to 15 minutes up to 3 times per day

Answer 290

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

Answer 291

Staphylococcus aureus

Answer 292

Salmonella

Answer 293

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

Answer 294

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

Answer 295

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

Answer 296

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

Answer 297

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

Answer 298

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

Answer 299

Kocher criteria

Answer 300

* Fever >38.5 * Non-weight bearing * Raised ESR * Raised WCC

Answer 301

IV cefotaxime + amoxicillin

Answer 302

- IV ceftriaxone - Penicillin allergic – Clindamycin

Answer 303

- IV flucloxacillin o Allergic - Clindamycin o MRSA - Vancomycin o Gram-negative - Cefotaxime

Answer 304

13-16 years of age - coincides with adolescent growth spurt - occurs at an earlier age in children - more frequently in black children

Answer 305

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

Answer 306

Gardner Syndrome, Li-Fraumeni, NFT1, Retinoblastoma

Answer 307

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

Answer 308

* 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.

Answer 309

Plain conventional radiograph

Answer 310

Urgent direct access X-ray within 48 hours

Answer 311

Codman's triangle - Elevated periosteum Sunburst appearance - soft tissue calcification

Answer 312

Elevated periosteum

Answer 313

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

Answer 314

Resection and reconstruction

Answer 315

Complete surgical resection of the primary tumour

Answer 316

POOR 60% - 5 year survival rate

Answer 317

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)

Answer 318

* 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.

Answer 319

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

Answer 320

Small round blue cells

Answer 321

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.

Answer 322

Female infants are at a higher risk 9:1 ratio

Answer 323

Breech presentation (>34 weeks) Firstborn child Oligohydramnios Positive family history Macrosomia (birth weight >5kg) Congenital calcaneovulagus foot deformity

Answer 324

- Attempts to dislocate an articulated femoral head.

Answer 325

- 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

Answer 326

* Limb-length discrepancy (Galeazzi sign – baby on back, legs together and knees flexed)

Answer 327

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

Answer 328

* 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

Answer 329

Avascular necrosis Temporary femoral nerve palsy

Answer 330

High dose IV empirical antibiotics - - Flucloxacillin

Answer 331

Distal femur and proximal tibia.

Answer 332

Cienry-Mader classification

Answer 333

* 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.

Answer 334

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

Answer 335

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

Answer 336

Rib or long bone fractures

Answer 337

* 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.

Answer 338

Under the age of 13 - suspected sexual abuse

Answer 339

anogenital warts

Answer 340

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

Answer 341

Factor VIII

Answer 342

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

Answer 343

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

Answer 344

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

Answer 345

Community - IM benzylpenicillin Hospital - IV cefotaxime

Answer 346

IV meropenem + amikacin + ampicillin

Answer 347

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

Answer 348

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

Answer 349

Femoral , brachial

Answer 350

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

Answer 351

15 over 30s

Answer 352

First minute and 5 minutes post-delivery

Answer 353

Appearance Pulse Grimace Activity Respiration

Answer 354

Trisomy 13

Answer 355

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

Answer 356

Edward's syndrome

Answer 357

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

Answer 358

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

Answer 359

Noonan Syndrome

Answer 360

Noonan syndrome

Answer 361

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

Answer 362

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

Answer 363

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

Answer 364

chromosome 15

Answer 365

CGG trinucleotide repeat expansion of the FMR1 gene.

Answer 366

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

Answer 367

Mitral Valve prolapse

Answer 368

Foetal alcohol syndrome

Answer 369

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

Answer 370

Autosomal dominant

Answer 371

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

Answer 372

Ejection systolic murmur secondary to biscspid aortic valve

Answer 373

Cystic hygroma

Answer 374

Growth hormone replacement therapy - plot growth and height charts Oestrogen replacement at the time of puberty for the development of secondary sexual characteristics

Answer 375

Meiotic non-disjunction

Answer 376

Congenital heart defects - AVSD Duodenal atresia Hirschprung's disease Omphalocele

Answer 377

Secretory otitis media Learning difficulty Short stature Delayed developmental milestones OSA ALL

Answer 378

ALL Hypothyroidism and Coeliac's disease Epilepsy Early-onset Alzheimer's disease Joint laxity - screen for atlantoaxial instability

Answer 379

Evoke otoacoustic emission testing

Answer 380

Automated auditory brainstem repsonse audiometry

Answer 381

Pure tone audiometry

Answer 382

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

Answer 383

Ponsetti method - plaster casting and bracing

Answer 384

Trisomy 13

Answer 385

Edward's syndrome

Answer 386

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

Answer 387

High flow oxygen followed by CPAP

Answer 388

Stimulates respiratory effort

Answer 389

Paliviziumb

Answer 390

Refer to the cleft lip and palate MDT team - EARLY REFERRAL Speech and language therapy input for long-term Definitive surgical closure

Answer 391

6-12 months

Answer 392

Dental plates, specially shaped bottles, teats

Answer 393

Urine or saliva PCR testing within the first 2 weeks.

Answer 394

Oral valgancilovir or IV ganciclovir (if oral not tolerated) + Barrier nursing (CMV is shed in the urine and body secretions).

Answer 395

Elective c-section

Answer 396

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

Answer 397

Within 48 to 72 hours

Answer 398

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

Answer 399

Oral erythromycin Treat partner and mother

Answer 400

Single dose of parenteral (IV or IM) cefotaxime/ceftriaxone Treat partner and mother

Answer 401

Hypothyroidism Duodenal atresia Hirschprung's disease Coeliac disease Epilepsy Atlantoaxial instability

Answer 402

At birth, 6 months, 1 year and annual surveillance

Answer 403

Down's syndrome association

Answer 404

Intrapartum benzylpenicillin (or vancomyin if allergic)

Answer 405

Previous baby born with invasive group B streptococcal infection Group B colonisation, bacteriuria, or infection Are in pre-term labour

Answer 406

Penicillin (IV benzylpenicillin) and gentamicin

Answer 407

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

Answer 408

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

Answer 409

Monovalent Hepatitis B vaccine within 24 hours of birth (and at 4 weeks + 1 year) 6 in 1 vaccine at 8,12,16 weeks

Answer 410

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

Answer 411

Prophylactic regular aciclovir is given from 36 weeks onwards Vaginal delivery if asymptomatic and >6 weeks after initial infection

Answer 412

Symptomatic presentation

Answer 413

C-section + acyclovir

Answer 414

Sarnat grading - classifies into 3 stages

Answer 415

A-E resuscitation -Therapeutic hypothermia within neonatal ICU

Answer 416

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.

Answer 417

Amoxicillin and gentamicin

Answer 418

Meconium aspiration

Answer 419

Observation

Answer 420

IV ampicilllin and gentamicin Oxygen and non-invasive ventilation

Answer 421

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

Answer 422

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

Answer 423

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

Answer 424

Confirm hypoglycaemia via blood glucose assay. - Support breastfeeding technique; consider supplement breast milk substitute or IV glucose Remeasure glucose every 1 hour

Answer 425

Symptomatic OR Pre-feed glucose <2 mmol/L

Answer 426

2 ml/Kg of 10% glucose infusion

Answer 427

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

Answer 428

Transcutaneous bilirubin

Answer 429

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

Answer 430

Reassurance

Answer 431

Phototherapy

Answer 432

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

Answer 433

Intensified phototherapy and adjuncts (IVIG)

Answer 434

Exchange transfusion

Answer 435

Biliary atresia

Answer 436

Eye protection

Answer 437

NHS choices neonatal jaundice factsheet The breastfeeding network Bliss (for premature and sick babies)

Answer 438

Oxygen Ventilation Surfactant Suction of secretions from ETT Inhaled nitric oxide

Answer 439

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

Answer 440

Chest drain insertion

Answer 441

Antenatal corticosteroids - increases foetal lung maturation

Answer 442

Refer to paediatric infectious diseases -Pyrimethamine + Sulfadiazine + Folinic acid Continue all 3 for 1 year

Answer 443

Prednisolone

Answer 444

Ophthalmology and audiology assessment

Answer 445

Stabilisation and gastrostomy + replacement

Answer 446

Suction catheter and surgical correction

Answer 447

NBM and surgical division of the fistula

Answer 448

Nutritional support - NGT or TPN

Answer 449

Respiratory rate 60-80 breaths/minute

Answer 450

Echocardiogram

Answer 451

Percutaneous balloon aortic valvuloplasty OR Transcatheter aortic valve replacement (TAVR) or surgical valvotomy

Answer 452

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

Answer 453

Ostium secondum

Answer 454

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

Answer 455

Transcatheter closure after 2 years. of age in asymptomatic patients

Answer 456

Open heart surgery

Answer 457

Right heart enlargement Symptomatic pulmonary over circulation Evidence of substantial left-to-right shunting (ratio of pulmonary to systematic blood flow >1.5)

Answer 458

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

Answer 459

Prostaglandin E1 infusion - to maintain duct patency

Answer 460

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

Answer 461

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

Answer 462

Prostaglandin E1 infusion

Answer 463

Diuretics Furosemide Venous dilators - Nitroglycerin

Answer 464

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

Answer 465

Oral ACE inhibitors IV agents (e.g., hydralazine, nitroprusside, alprostadil)

Answer 466

Beta-blockers (e.g., carvedilol)

Answer 467

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

Answer 468

Bacterial endocarditis Pulmonary vascular disease

Answer 469

IV indomethacin - 1st line

Answer 470

Prostacyclin synthetase inhibitor

Answer 471

Surgical ligation or percutaneous catheter device closure

Answer 472

Transcatheter balloon dilatation Surgical valvuloplasty (2nd line)

Answer 473

Benzathine penicillin every 3-4 weeks

Answer 474

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

Answer 475

NSAIDs (naproxen/ibuprofen) Anti-streptococcal antibiotics

Answer 476

Jones criteria

Answer 477

ACE inhibitors and diuretics

Answer 478

Vagal manoeuvres

Answer 479

DC cardioversion, amiodarone, procainamide, flecainide

Answer 480

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

Answer 481

Prostaglandin E1 infusion Blalock-Taussing Shunt

Answer 482

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

Answer 483

Right ventricular outflow tract obstruction

Answer 484

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

Answer 485

Place the patient in the knee-to-chest position Supplementary oxygen IV fluids Beta-blockers Morphine Sodium bicarbonate Phenylphrine infusion

Answer 486

Severe systemic infection Complications e.g. meningitis, mastoiditis, facial nerve palsy Children <3 months with a temperature >38 degrees

Answer 487

Haemophilus influenzae Streptoccous pneumoniae Moraxella catarrhalis

Answer 488

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

Answer 489

* Ear pain (otalgia) – rapid-onset

Answer 490

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.

Answer 491

Otoscopic examination

Answer 492

* 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

Answer 493

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

Answer 494

AOM spontaneously resolves within 3 days; provide symptom relief with analgesia Provide back-up antibiotic prescription

Answer 495

* 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).

Answer 496

Amoxicillin or clarithryomycmocyin for 5-7 days.

Answer 497

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.

Answer 498

Acute otitis media with effusion - Glue ear

Answer 499

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

Answer 500

Conductive hearing loss

Answer 501

Pneumatic otoscopy

Answer 502

* 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.

Answer 503

1. Auditory brainstem response 2. Tympanometry

Answer 504

3 month period - audiology + speech and language assessment

Answer 505

Hearing aids

Answer 506

Myringotomy and insertion of grommets

Answer 507

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

Answer 508

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

Answer 509

12 to 35 days

Answer 510

* 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.

Answer 511

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.

Answer 512

* Malaria chemoprophylaxis * Precautions against biting insects * Travel immunisations.

Answer 513

Microscopy of thick and thin films with Giemsa staining

Answer 514

* Artemisinin combination therapy (artemether with lumefantrine or artenimol with piperaquine phosphate).

Answer 515

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

Answer 516

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

Answer 517

* 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.

Answer 518

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

Answer 519

Blantyre Coma scale 2 or less - coma

Answer 520

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*

Answer 521

>60 breaths per minute

Answer 522

Group B Streptococcus Listeria monocytogenes E coli

Answer 523

Coagulase-negative staphylococcus (CoNS)

Answer 524

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

Answer 525

Within 72 hours of birth

Answer 526

Black ethnicity

Answer 527

* 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

Answer 528

IV cefotaxime + amikacin + ampicillin.

Answer 529

IV meropenem + amikacin + ampicillin

Answer 530

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

Answer 531

* 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

Answer 532

paramyxovirus

Answer 533

Respiratory droplets, fomites, or saliva.

Answer 534

16-18 days

Answer 535

1-2 days before onset of symptoms

Answer 536

* 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.

Answer 537

Bilateral parotid swelling

Answer 538

Epidiymo-orchitis - diminished sperm count and infertility

Answer 539

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

Answer 540

Yes - notify HPU

Answer 541

Saliva sample to detect IgM mumps antibody

Answer 542

Serum amylase

Answer 543

5 days after the development of parotitis

Answer 544

Retinopathy of prematurity

Answer 545

Thyroglossal cyst

Answer 546

Transcutaneous bilirubin

Answer 547

Serum bilirubin

Answer 548

Split bilirubin, TFTs and LFTs

Answer 549

Kernicterus

Answer 550

dyskinetic cerebral palsy

Answer 551

Phototherapy + IVIG or exchange transfusion.

Answer 552

Unconjugated bilirubin

Answer 553

Once BR >50 umol/L

Answer 554

>450 total serum bilirubin

Answer 555

350-450 total serum BR

Answer 556

Immedaite ventilation and intubation

Answer 557

Routine antenatal scans

Answer 558

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

Answer 559

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

Answer 560

* Type A: OA without TOF (6%)

Answer 561

* Type B: OA with a TOF to the proximal oesophageal segment (5%)

Answer 562

* Type C: OA with a TOF to the distal oesophageal segment (84%) - Mx: Stabilisation and surgical correction.

Answer 563

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

Answer 564

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

Answer 565

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

Answer 566

Chest X-ray

Answer 567

Surfactant deficiency

Answer 568

At 20 weeks' gestation

Answer 569

24-34 weeks'

Answer 570

Ground-glass reticulo-grannular appearance

Answer 571

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

Answer 572

Benzylpenicillin and gentamicin

Answer 573

Berlin criteria

Answer 574

Delta f508

Answer 575

Autosomal recessive

Answer 576

Meconium ileus

Answer 577

Cystic fibrosis, followed by primary ciliary dyskinesia

Answer 578

Immunoreactive trypsinogen

Answer 579

Sweat chloride test >60 mmol/L

Answer 580

rhDNase (dornase alfa)

Answer 581

- Flucloxacillin

Answer 582

Pseudomonas aeuroginosa

Answer 583

ceftrizaide, ciprofloxacin followed by chronic azithromycin therapy

Answer 584

* High-calorie diet

Answer 585

Call for Help, remove trigger and lie the patient flat

Answer 586

Anterolateral aspect - middle third of the thigh

Answer 587

IM adrenaline

Answer 588

150 micrograms

Answer 589

300 micrograms

Answer 590

Repeat dose of adrenaline and administer a fluid bolus

Answer 591

C1 esterase deficiency

Answer 592

1. Cutaneous attacks 2. Gastrointestinal attacks 3. Upper airway attacks

Answer 593

Viral induced wheeze

Answer 594

* Harrison’s sulci

Answer 595

Spirometry testing + bronchodilator reversibility and PEFR variability

Answer 596

Restrictive pattern FEV1/FVC <70%

Answer 597

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

Answer 598

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

Answer 599

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

Answer 600

Short-course of oral prednisolone for 3-5 days

Answer 601

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

Answer 602

3 every 20 minutes

Answer 603

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

Answer 604

Prednisolone and IV hydrocortisone

Answer 605

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

Answer 606

More than 3 exacerbations a week

Answer 607

low-dose inhaled corticosteroid

Answer 608

Leukotriene receptor antagonist

Answer 609

4. Stop LTRA and add a LABA

Answer 610

5. Switch ICS and LABA to a MART regimen with a paediatric low-dose ICS.

Answer 611

* Flexible fibreoptic laryngoscopy

Answer 612

Observation and reassure; consider GORD therapy

Answer 613

Streptococcus pneumonia

Answer 614

Group B streptococcus

Answer 615

RSV (influenza).

Answer 616

<92% saturations

Answer 617

Respiratory symptoms do not interfere with normal activity.

Answer 618

Amoxicillin (or clarithromycin)

Answer 619

Group A streptococcus

Answer 620

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

Answer 621

Optional rapid strep testing and/or culture

Answer 622

Throat culture or a rapid streptococcal antigen test

Answer 623

Phenoxymethylpenicillincilin, 10 days, QDS

Answer 624

Can cause widespread maculopapular rash if due to infectious mononucleosis

Answer 625

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

Answer 626

* Adenotonsillar hypertrophy , obesity

Answer 627

STOP-bang questionnaire or Epworth Sleepiness Scale.

Answer 628

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

Answer 629

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

Answer 630

Immediate needle decompression

Answer 631

Chest drain

Answer 632

patches of collapse and consolidation.

Answer 633

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

Answer 634

* Anterior rhinoscopy

Answer 635

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

Answer 636

If symptoms >10 days

Answer 637

If symptoms do not improve within 7 days or rapidly worsen

Answer 638

House dust mites

Answer 639

Skin-prick testing or measuring serum IgE

Answer 640

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

Answer 641

Intranasal corticosteroids and oral antihistamines

Answer 642

Clinical diagnosis

Answer 643

Oral miconazole, consider nystatin suspension in a child

Answer 644

Candida albicans

Answer 645

Irritant contant dermatitis

Answer 646

No (skin-fold sparing)

Answer 647

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

Answer 648

* 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.

Answer 649

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

Answer 650

Purulent discharge

Answer 651

* Requires immediate ophthalmologic referral.

Answer 652

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

Answer 653

* 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

Answer 654

lesions present at the tip of the nose.

Answer 655

Haemophilus Influenza Streptococcus pneumoniae Moraella cararrhalis

Answer 656

Adenovirus, enterovirus

Answer 657

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

Answer 658

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

Answer 659

than 3 - four

Answer 660

- Chloramphenicol or neomycin

Answer 661

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

Answer 662

* Chlamydia

Answer 663

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

Answer 664

Streptococcus pyogenes (Group A beta-haemolytic streptococci)

Answer 665

ERON classification

Answer 666

Oral flucloxacillin

Answer 667

* Admit + Oral/IV Co-amoxiclav, clindamycin, cefuroxime, or ceftriaxone

Answer 668

Staphylococcus aureus, streptococcus pneumoniae, haemophilus influenzae.

Answer 669

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

Answer 670

CT or MRTI scan of the orbits and refer

Answer 671

High dose ceftriaxone

Answer 672

Otitis media

Answer 673

24 hours after commencing antibiotics and notify HPU

Answer 674

Penicillin V for 10 days

Answer 675

Koplik spots

Answer 676

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

Answer 677

Otitis Media – Common Pneumonia – Common cause of mortality Encephalitis - 1-2 weeks post-onset Subacute sclerosing panencephalitis - Rare

Answer 678

Forchheimer spots

Answer 679

Human herpesvirus 6

Answer 680

* Nagayama spots – papular enanthem on the uvula and soft palate.

Answer 681

Febrile convulsions

Answer 682

Slapped-cheek

Answer 683

Parvovirus b19

Answer 684

Sexual abuse - begin safeguarding protocol

Answer 685

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

Answer 686

- Haemophilus influenzae - S pneumoniae - Moraxella catarrhalis

Answer 687

Ear pain - rapid onset

Answer 688

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.

Answer 689

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

Answer 690

* Regular doses of paracetamol or ibuprofen for pain (oral or rectal).

Answer 691

* 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).

Answer 692

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.

Answer 693

Down syndrome

Answer 694

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

Answer 695

Conductive hearing loss

Answer 696

Pneumatic otoscopy

Answer 697

Hearing loss - Auditory brainstem response and tympanometry

Answer 698

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

Answer 699

Reassurance and monitor

Answer 700

Patients with hearing loss and persistent bilateral OME

Answer 701

* 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.

Answer 702

* Artemisinin combination therapy

Answer 703

1. GBS and E. coli, listeria monocytogenes

Answer 704

2. Coagulase-negative staphylococcus (CoNS) – Late-onset neonatal sepsis - Staphylococcus epidermis

Answer 705

Within 72 hours of birth

Answer 706

IV cefotaxime + amikacin + ampicillin.

Answer 707

IV meropenem + amikacin + ampicillin

Answer 708

* 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

Answer 709

Methiccillin-suspectible S. aureus

Answer 710

TSST-1 exotoxin.

Answer 711

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

Answer 712

Necrotising fasciitis

Answer 713

Group A streptococcus or S. aureus.

Answer 714

Surgical debridement of necrotic tissue

Answer 715

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

Answer 716

* Interferon-gamma release assays

Answer 717

* Tuberculin skin test (Mantoux test)

Answer 718

Mantoux test

Answer 719

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

Answer 720

* Rifampicin

Answer 721

* Isoniazid

Answer 722

pyridoxine) – Vitamin B6

Answer 723

* Pyrazinamide

Answer 724

* Optic neuritis.

Answer 725

<6 months (recurrent or atypical)

Answer 726

>6 months and recurrent <6 month and typical

Answer 727

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

Answer 728

Micturating urethrogram

Answer 729

Positive leucocyte esterase and nitrite

Answer 730

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

Answer 731

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

Answer 732

Oral ABx (trimethoprim, nitrofurantoin), 3 days.

Answer 733

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

Answer 734

Loin pain and tenderness

Answer 735

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

Answer 736

Faecal-oral route

Answer 737

IV drug user - blood products and vertical transmission

Answer 738

Peiginterferon alpha 2b

Answer 739

* Glecaprevir/Pibrentasvir * Sofosbuvir/velpatasvir.

Answer 740

immediate monovalent hepatis B vaccine within 24 hours at birth

Answer 741

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

Answer 742

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

Answer 743

Streptococcus pneumoniae

Answer 744

N. meningitides

Answer 745

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

Answer 746

2. Brudzinski sign

Answer 747

High blood pressure Low heart rate Irregular respiratory rate

Answer 748

IM benzylpenicillin

Answer 749

o IV cefotaxime AND IV amoxicillin/ampicillin.

Answer 750

o IV Ceftriaxone

Answer 751

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.

Answer 752

ciprofloxacin

Answer 753

* Coxsackie Group B, Echovirus

Answer 754

Haemagglutinin

Answer 755

neuraminidase

Answer 756

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

Answer 757

oseltamivir

Answer 758

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

Answer 759

Secondary pneumonia by staph aureus

Answer 760

HSV type 1

Answer 761

Lumbar puncture

Answer 762

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

Answer 763

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.

Answer 764

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

Answer 765

* Secondary infections – bacterial pneumonia (superinfection) – if using NSAIDs (increased risk of necrotising fascititis).

Answer 766

Sensory nerve root ganglia - reactivtion - shingles

Answer 767

* Topical calamine lotion to alleviate itch. * Chlorphenamine for treating itching - >1 years.

Answer 768

Oral acyclovir 700 mg 5 times a day for 7 days

Answer 769

Sarcoptes scabiei

Answer 770

Skin to skin contact

Answer 771

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.

Answer 772

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

Answer 773

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.

Answer 774

Type IV hypersensitivity

Answer 775

serpiginous lines

Answer 776

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

Answer 777

5% permethrin cream

Answer 778

Crotamiton 10% cream

Answer 779

* 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.

Answer 780

Epstein–Barr virus (HHV-4)

Answer 781

Contact with saliva

Answer 782

15 and 24 years

Answer 783

Fever Tonsillar pharyngitis Severe sore throat characterised by whitewash tonsillar exudate Lymphadenopathy

Answer 784

Splenomegaly - risk of splenic rupture

Answer 785

EBV serology

Answer 786

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

Answer 787

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

Answer 788

Within the second week of illness

Answer 789

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

Answer 790

Reviewed within 24 hours - indicates Klinefelters or genetic cause

Answer 791

Coxsackie A16 virus.

Answer 792

Not required

Answer 793

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.

Answer 794

Otoacoustic emission test

Answer 795

Auditory brainstem response test

Answer 796

Distraction test (Requires 2 trained staff).

Answer 797

Pure Tone Audiometry

Answer 798

Steeple sign

Answer 799

<2.6 mmol/L

Answer 800

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

Answer 801

- Jitteriness - Irritable - Tachypnoea - Pallor

Answer 802

- Poor feeding/sucking - Weak cry - Drowsy - Hypotonia - Seizures

Answer 803

Feed baby within 30 minutes of birth

Answer 804

<1.5 mmol/L or if there are symptoms

Answer 805

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

Answer 806

Secondum ASD (70%)

Answer 807

Primum ASD

Answer 808

1. Female sex 2. Maternal alcohol consumption

Answer 809

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

Answer 810

Referred to paediatric cardiology for management.

Answer 811

Echocardiography demonstrating left to right shunting

Answer 812

2 years of age

Answer 813

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.

Answer 814

Transcatheter approach

Answer 815

Open heart surgery - direct repair

Answer 816

* Holt-Oram Syndrome

Answer 817

Ventricular septal defect

Answer 818

* Down’s syndrome * Edward’s syndrome * Patau syndrome * Cri-du-chat syndrome

Answer 819

Loud pan systolic murmur at the lower eft sternal edge

Answer 820

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

Answer 821

Egg on string’ appearance.

Answer 822

Echocardiography

Answer 823

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

Answer 824

1. Blalock–Taussig shunt insertion

Answer 825

Within 2 weeks of life

Answer 826

Balloon atrial septostomy

Answer 827

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

Answer 828

right ventricular outflow tract obstruction

Answer 829

Tet spells

Answer 830

Ejection systolic murmur

Answer 831

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

Answer 832

Boot-shaped heart

Answer 833

Right ventricular hypertrophy

Answer 834

1. Prostaglandin E1 infusion

Answer 835

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

Answer 836

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

Answer 837

left subclavian artery

Answer 838

ductus arteriosus

Answer 839

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

Answer 840

* Systolic apical click

Answer 841

* Blood pressure – Lower systolic blood pressure in the lower extremities < Upper extremities. * Upper extremity hypertension. - Radio-femoral delay. and rib notching

Answer 842

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

Answer 843

Coarctation of the aorta

Answer 844

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

Answer 845

- NO diastolic component

Answer 846

Innocent murmurs

Answer 847

Heard as a continuous blowing noise heard infraclavicular.

Answer 848

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

Answer 849

Eisenmenger Syndrome

Answer 850

Rubella infection

Answer 851

Bacterial endocarditis

Answer 852

Continuous ‘machine-like’ murmur

Answer 853

indomethacin to neonate.

Answer 854

* Prostacyclin synthetase inhibitor

Answer 855

percutaneous catheter device closure.

Answer 856

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

Answer 857

5 inflation breaths

Answer 858

Femoral and brachial

Answer 859

Ventilate for 30s 15 over 30s

Answer 860

Appearance, Pulse, Grimace, Activity, Respiration.

Answer 861

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

Answer 862

two thumb or two fingers

Answer 863

Group A streptococcus (GAS) Lancefield group

Answer 864

* 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

Answer 865

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

Answer 866

Jones criteria

Answer 867

Pen V, or amoxicillin or benzylpenicillin

Answer 868

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)

Answer 869

* Prenatal – 80% - Cortical migration disorders or structural maldevelopment during gestation - Cerebrovascular haemorrhage or ischaemia - Rubella, CMV or toxoplasmosis

Answer 870

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

Answer 871

- Meningitis/encephalitis/encephalopathy - Head trauma from NAI

Answer 872

Spastic cerebral palsy

Answer 873

Pyramidal or corticospinal tract

Answer 874

Basal ganglia and the substantia nigra

Answer 875

HIE or kernicterus

Answer 876

Dyskinetic cerebral palsy

Answer 877

- 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

Answer 878

Diazepam, baclofen

Answer 879

SCOPE disability charity

Answer 880

Sarant staging

Answer 881

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

Answer 882

2. 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.

Answer 883

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

Answer 884

Therapeutic hypothermia

Answer 885

Pilocytic astrocytoma

Answer 886

Rosenthal fibres

Answer 887

Medulloblastoma

Answer 888

* 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

Answer 889

Piloid hairy cell

Answer 890

BRAF mutation

Answer 891

Focal neurological deficits, seizures, personality change.

Answer 892

Cerebellar ataxia, long tract signs, cranial nerve palsies

Answer 893

Maximal safe resection

Answer 894

Retinoblastoma

Answer 895

RB1 on chromosome 13

Answer 896

Autosomal dominant

Answer 897

* Leukocoria (<3 years) - White reflex or white pupil

Answer 898

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

Answer 899

Consider an urgent referral within 2 weeks for assessment

Answer 900

Enucleation

Answer 901

Systemic chemotherapy

Answer 902

Hypsarrhythmia

Answer 903

- Age of onset – 3 and 12 months.

Answer 904

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

Answer 905

o ‘Salaam attacks’

Answer 906

With waking or before sleeping

Answer 907

* Vigabatrin

Answer 908

centrotemporal spikes

Answer 909

perisylvian sensorimotor cortex

Answer 910

Benign Rolandic Seizures

Answer 911

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

Answer 912

Focal motor seizures

Answer 913

Tonic-clonic

Answer 914

Juvenile myoclonic epilepsy

Answer 915

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.

Answer 916

Routine EEG

Answer 917

Sodium valproate

Answer 918

Lamotrigine

Answer 919

Lamotrigine or levetiracetam as first line.

Answer 920

Ethosuximide

Answer 921

(AVOID carbamazepine).

Answer 922

Lamotrigine

Answer 923

Buccal midazolam

Answer 924

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?

Answer 925

Midazolam buccal or IV lorazepam

Answer 926

IV lorazepam

Answer 927

0.1 mg/kg IV infusion

Answer 928

Levitracetam, phenytoin or phenobarbital

Answer 929

Non-throbbing headache in TTH

Answer 930

Tension headache

Answer 931

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

Answer 932

simple analgesia

Answer 933

Subdural Haemorrhage

Answer 934

- Craniotomy/craniectomy in acute. - Burr-hole

Answer 935

Endovascular clipping and coil embolisation

Answer 936

Ruptured saccular aneurysm. * Arteriovenous malformations/fistulae

Answer 937

X-linked recessive

Answer 938

Dystrophin gene

Answer 939

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

Answer 940

Hand support to push themselves to an upright position.

Answer 941

Serum creatine kinase (CK) level

Answer 942

Genetic analysis: The DMD gene is identified

Answer 943

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

Answer 944

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

Answer 945

Meningitis

Answer 946

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

Answer 947

Obstructive - aqueduct stenosis between the 3rd and fourth ventricle

Answer 948

Sunset sign - the appearance of the sclera above the iris

Answer 949

Ventriculoperitoneal shunt

Answer 950

Cranial Ultrasonography

Answer 951

Simple analgesia

Answer 952

Nasal triptans

Answer 953

* Propranolol OR topiramate

Answer 954

Minimum of 8 weeks

Answer 955

Trisomy 13

Answer 956

Trisomy 18

Answer 957

Noonan syndrome

Answer 958

Autosomal dominant

Answer 959

Pierre–Robin Syndrome

Answer 960

Genetic imprinting

Answer 961

Prader Willi Syndrome

Answer 962

William's syndrome

Answer 963

Cri du Chat Syndrome

Answer 964

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

Answer 965

- Foetal alcohol syndrome - Cigarette smoking

Answer 966

6-12 months

Answer 967

Erbs's palsy

Answer 968

Shoulder dystocia and macrosomia

Answer 969

Waiter’s tip sign

Answer 970

Botulinum toxin

Answer 971

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

Answer 972

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

Answer 973

Small round pale blue cells - Homer-wright Pseudorosettes

Answer 974

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

Answer 975

* HVA and VMA

Answer 976

Autosomal dominant

Answer 977

TSC1 or TSC2, encodes for hamartin and tuberin

Answer 978

eizures, hypomelanotic macules, and cardiac rhabdomyoma.

Answer 979

Tuberous sclerosis

Answer 980

Tuberous sclerosis

Answer 981

* 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

Answer 982

Seizures Intellectual disability Facial angiofibromas

Answer 983

Neurofibromatosis Type 1

Answer 984

Lisch nodules Optic pathway glioma

Answer 985

McCune–Albright syndrome

Answer 986

Polyosotic fibrous dysplasia Cafe aut lait macules Endocrine hyperactivity

Answer 987

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

Answer 988

Over the age of 5 years old

Answer 989

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

Answer 990

Urine dipstick

Answer 991

Dietary and lifestyle advice with positive reward systems + enuresis alarm

Answer 992

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

Answer 993

3 months (if complete dryness has not been achieved)

Answer 994

Low dose of oral desmopressin

Answer 995

Desmopressin

Answer 996

8-arginine vasopressin

Answer 997

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

Answer 998

60 minutes before bed-time

Answer 999

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)

Answer 1000

Bed-sharing

Answer 1001

* Breastfeeding * Room sharing (not bed sharing) * Use of dummies (pacifiers)

Answer 1002

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

Answer 1003

Eyes turning out

Answer 1004

Convergent (esotropia)

Answer 1005

Hirschberg Test – Corneal Light Reflex Test Cover Test

Answer 1006

Caput Succedaneum

Answer 1007

Vacuum-assisted delivery

Answer 1008

Superior to the periosteum

Answer 1009

Observational - self-resolve within 48 hours

Answer 1010

Delayed within 1-3 days of birth

Answer 1011

inferior to the periosteum and above the bone

Answer 1012

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

Answer 1013

Does not cross suture lines

Answer 1014

Fresh-frozen plasma to correct hypovolaemia

Answer 1015

Transcranial US Doppler Screening

Answer 1016

IgA Vasculitis

Answer 1017

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

Answer 1018

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

Answer 1019

* Urinalysis

Answer 1020

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

Answer 1021

IV corticosteroids + oral prednisolone + cylcophosphamide

Answer 1022

Microangiopathic haemolytic anaemia AKI Thrombocytopenia

Answer 1023

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

Answer 1024

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

Answer 1025

- Schistocytes and helmet cells

Answer 1026

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

Answer 1027

Minimal change disease

Answer 1028

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

Answer 1029

* Facial or generalised oedema - Periorbital – misdiagnosed as asn allergy. * Age >1 year <8 years. * Normal BP * Absence of haematuria

Answer 1030

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

Answer 1031

Podocyte effacement

Answer 1032

Prednisolone

Answer 1033

Anti-thrombin 3

Answer 1034

Post-streptococcal glomerulonephritis

Answer 1035

Group A beta-haemolytic streptococcus.

Answer 1036

Red cola-coloured

Answer 1037

Phenoxymethylpenicillin

Answer 1038

Neisseria gonorrhoea and chlamydia trachomatis

Answer 1039

Bell-clapper deformity

Answer 1040

Cremasteric reflex

Answer 1041

Elevation of the testis does not ease the pain.

Answer 1042

Power/colour Doppler Ultrasound And immediate scrotal exploration

Answer 1043

* Ceftriaxone 1g IM single dose PLUS * Doxycycline

Answer 1044

Abnormal ventral placement of the urethral opening

Answer 1045

Cryptorchidism

Answer 1046

Penoscrotal

Answer 1047

Cryptorchidism

Answer 1048

* Retractile testes

Answer 1049

* 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

Answer 1050

Left side- unilateral presentation

Answer 1051

Increased risk of testicular cancer

Answer 1052

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

Answer 1053

Annual follow-up examination

Answer 1054

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

Answer 1055

2-week referral

Answer 1056

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

Answer 1057

boys 3-4 x

Answer 1058

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

Answer 1059

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

Answer 1060

Gastroschisis

Answer 1061

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

Answer 1062

amnion, Wharton’s jelly and peritoneum

Answer 1063

Omphalocele

Answer 1064

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

Answer 1065

* Definitive = Surgical closure (staged repair over 12 months) – allows the sac to granulate over months.

Answer 1066

Caesarean section to reduce the risk of sac rupture.

Answer 1067

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

Answer 1068

newborn Guthrie test at 5 days

Answer 1069

* Thyroid dysgenesis

Answer 1070

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’

Answer 1071

Oral levothyroxine

Answer 1072

Short stature (cretinism) and intellectual disability

Answer 1073

Hashimoto’s autoimmune thyroiditis.

Answer 1074

>11 mmol/L

Answer 1075

<7.3 or bicarbonate <15 mmol/L

Answer 1076

Deep hyperventilation - Respiratory compensation for metabolic acidosis

Answer 1077

Emergency fluid resuscitation.

Answer 1078

* 10 mL/kg of 0.9% NaCl over 60 minutes if NO shock.

Answer 1079

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

Answer 1080

<7.2 - 7.29 HCO3 <15 5% dehydration

Answer 1081

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

Answer 1082

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

Answer 1083

100 mL/kg/24 hours

Answer 1084

+ 50 mL/kg/24 hours

Answer 1085

+ 20 mL/kg/24 hours

Answer 1086

* Change to 0.9% saline + 5% glucose

Answer 1087

40 mmol/L potassium chloride

Answer 1088

- 0.05-0.1 units/kg/hour – Soluble insulin infusion

Answer 1089

Constitutional delay

Answer 1090

if it falls by more than 3 centiles

Answer 1091

If it falls by more than 2 centiles

Answer 1092

If it falls by more than 1 centile

Answer 1093

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

Answer 1094

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

Answer 1095

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

Answer 1096

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

Answer 1097

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

Answer 1098

* Prader’s orchidometer

Answer 1099

Wrist X-ray

Answer 1100

Androgen insensitivity syndrome

Answer 1101

Reassurance and offer observation consider short course sex hormone therapy as second line

Answer 1102

Short course IM testosterone or oxandrolone

Answer 1103

* Girls  Transdermal oestrogen (6 months)  Cyclical progesterone once established.

Answer 1104

* Girls = 8 < age <10

Answer 1105

* Boys = 9 < age <12

Answer 1106

8 years old

Answer 1107

9 years old

Answer 1108

Tanner Breast Development Stages

Answer 1109

Gonadotrophin-dependent (intracranial lesion)

Answer 1110

Gonadal tumour

Answer 1111

Leydig cell tumour

Answer 1112

Small testes

Answer 1113

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

Answer 1114

- GnRH agonist (e.g., leuprolide) + GH therapy. Agonists overstimulate pituitary and arrest GnRH release.

Answer 1115

Anti-androgen

Answer 1116

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

Answer 1117

- Cushing disease (pituitary hypersecretion of ACTH) – pituitary adenoma. - Solitary neoplasm - Ectopic ACTH (SCLC)

Answer 1118

- Exogenous administration of glucocorticoids (adrenal glands are atrophic). - Adrenal hyperplasia/tumours – Common in children.

Answer 1119

Inferior Petrosal Sinus Sampling

Answer 1120

Adrenal Mass - Adrenalectomy

Answer 1121

Nelson’s Syndrome

Answer 1122

Ketoconazole, metyrapone

Answer 1123

o Fasting plasma glucose >7.0 mmol/L

Answer 1124

>11.1 mmol/L

Answer 1125

Basal-bolus insulin regimen

Answer 1126

A-glucosidase inhibitor

Answer 1127

Medical photography + review in 3 months

Answer 1128

Topical timolol

Answer 1129

Urticaria Activity Score (USA7)

Answer 1130

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

Answer 1131

Staphylococcus aureus

Answer 1132

exfoliative toxins (A and B)

Answer 1133

Non-bullous impetigo

Answer 1134

Bullous impetigo

Answer 1135

o Hydrogen peroxide 1% cream consider topical fusidic acid

Answer 1136

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

Answer 1137

o Oral flucloxacillin (or clarithromycin if penicillin allergic)

Answer 1138

- Filaggrin gene

Answer 1139

Face and trunk.

Answer 1140

IV acyclovir and immediate referral

Answer 1141

punched-out erosions

Answer 1142

Topical 1% hydrocortisone

Answer 1143

* 0.025% betamethasone valerate or 0.05% clobetasone butyrate)

Answer 1144

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

Answer 1145

Topical calcineurin inhibitors (tacrolimus).

Answer 1146

* Fixed combination of topical adapalene + topical benzoyl peroxide. OR * Fixed combination of topical tretinoin + topical clindamycin. * Fixed combination of topical benzoyl peroxide + topical clindamycin.

Answer 1147

* 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.

Answer 1148

oral lymecycline 408 mg or oral doxycycline 100 mg

Answer 1149

isotretinoin

Answer 1150

Mongolian spot

Answer 1151

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

Answer 1152

Port wine stain

Answer 1153

GNAQ mutation

Answer 1154

Sturge–Weber Syndrome

Answer 1155

Erythema toxicum

Answer 1156

DNA poxvirus

Answer 1157

streptococcus pyogenes

Answer 1158

Phototherapy

Answer 1159

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

Answer 1160

Topical emollient

Answer 1161

Woods light microscopic examination of the skin scrapings

Answer 1162

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

Answer 1163

Wet combing - four sessions spaced over 2 weeks

Answer 1164

* Dimeticone 4% lotion

Answer 1165

Sudden head drop - Arms outstretched

Answer 1166

6-8 months

Answer 1167

8-9 months

Answer 1168

12-15 months

Answer 1169

2.5 to 3 years

Answer 1170

6 in 1 vaccine Men B Rotavirus

Answer 1171

6 in 1 vaccine Rotavirus PCV

Answer 1172

6 in 1 Men B

Answer 1173

MMR Men B booster PCV Hib/MenC

Answer 1174

at 12-13 years

Answer 1175

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