Paediatrics

Question 1

Infant <8 weeks , milky vomit after he feeds and excessive crying

Answer 1

GORD

Question 2

Poor feeding , vomiting and blood stools and dilated bowel loops on X-RAY + air

Answer 2

Necrotising enterocolitis
- leading cause of death in premature infants
- conservative management to rest the bowel = NG tube and fluids and antibiotics
In perforation = laparotomy

Question 3

4 week old baby + projectile vomit + non billous + mass palpable in upper abdomen
What’s the diagnosis and what would the blood gas be ?

Answer 3

Pyloric stenosis (4-6 weeks of Life )
- treatment is rehydration and Pylorotomy
Diagnosis : USS, string sign
hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

Question 4

Crampy abdominal pain and billous vomit + red current jelly stool + sausage shaped mass in abdomen + target sign on USS

Answer 4

Intussusception = telescoping bowel
- reduced by air or barium enema

Question 5

New born vomiting billous fluids few hours after birth associated with Down’s syndrome

Answer 5

Duodenal atresia
X-RAY : double bubble sign
Treatment is Duodenoduodenostomy

Question 6

Vomiting , back arching , rash , wheeze and cough when feeding

Answer 6

Cow milk protein allergy

Question 7

Hirschsprung’s disease ?

Answer 7

Delay in passing meconium for more than 2 days .
Congenital A ganglion cells in Meissners and Auerchbach’s plexus are missing
Also increase in Down’s syndrome
Resect aganglionic part

Question 8

Infantile spasms
age
movement

Answer 8

Less than 3 months old
Excessive crying and lifting the legs up towards chest
Worse in evening but child is distressed in between the spasms ,
Whereas in colic the child is distressed during the spasm

Question 9

Infantile colic

Answer 9

Begging , the child pulls up legs and is irritated. Distressed during colic .

Question 10

Biliary atresia

Answer 10

Biliary atresia is a paediatric condition involving either obliteration or discontinuity within the extrahepatic biliary system leading to cholestasis and obstruction of bile flow
+ prolonged jaundice
+ draknuring and white stool , raised CB, deranged LFTS,
Treatment= surgery = kasai procedure

Question 11

Up to 6 month old baby with hip pain
Born in breech position

Answer 11

DDH ( USS )
Wear Pavlik harnes if 4 weeks to 6 months
If older than 6 moths wear Cast

Question 12

Perthes disease

Answer 12

4-8 year old child
Short and active
Insidious limp

Avascular necrosis of femoral head

Treatment is just therapy and exercise with NSAIDS

Question 13

SUFE

Answer 13

13-15 year old boy , obese and had growth spurt

Treatment is screw into the epiphysis

Question 14

Transient synovitis

Answer 14

Low fever mild hip pain and recent URTI
1) give NSAIDS and bed rest

Question 15

How can we separate TS from septic arthritis
Features of TS :

Answer 15

WBC < 12000
ESR < 40
TS is self limiting
Fever is low grade < 38

Question 16

Knee pain in 13-15 year old associated with growth spurt and physical activity ?

Answer 16

Osgood-Schlatter disease

Question 17

Congenital CMV infection

Answer 17

Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly (small head)

Question 18

measles symptoms

Answer 18

white spots in buccal mucosa
(Kolpik spots)
Rash that starts behind the ears and progresses to around the whole body

Question 19

Mumps symptoms

Answer 19

Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

Question 20

RSV causes which infection

Answer 20

Bronchiolitis

Question 21

Kawasaki disease serious side effects

Answer 21

Coronary artery aneurysms
+ high grade fever for more than 5 days

CREAM
Conjuncitivits

Rash

Erythema - red palms and soles which later peel

Adenopathy (cervical lymphadenopathy)

Mucous membrane changes (strawberry red tongue and cracked lips)

Management :
Aspirin ( monitor for Reyes syndrome)
IvIg and regular Echo

Question 22

What is Reye syndrome ?

Answer 22

acute onset encephalopathy in children
+ fatty degeneration of the liver
due to use of aspirin in children (hence it’s normally contraindicated)

Question 23

ITP in children , what is it ?
symptoms ?

Answer 23

Immune related reduction in platelet count
bruises and rashes are common

no treatment needed but avoid contact sports
if bleeding then iV

Question 24

Whooping cough treatment

Answer 24

if onset is within 21 days then Azithromycin or clarithromycin

Question 25

TTP features
- Thrombotic TP

Answer 25

TTP mnemonic: FAT RN
Fever,
Anemia (hemolytic), Thrombocytopenia,
Renal,
Neuro

Question 26

APGAR score for new born features

Answer 26

Appearance
Pulse
Grimace
Activity = muscle tone
Respirations

7-10 is an excellent score :)

Question 27

Signs of Rubella infection

Answer 27

Cataracts + sensorineural hearing loss

Question 28

Bronchiloitis features

Answer 28

Most common cause of arrest in children

+ Poor feeding, cough and fever and the patient’s examination findings such as crackles, wheezing and increased respiratory effort

fibrosis and destruction of the bronchioles = brochiolitis obliterans

Question 29

Causes of meningitis in children

Answer 29

0-3months = GBS
1 month -6 years= Neisseria meningitidis , Streptococcus pneumoniae , Haemophilus influenzae

> 6 years = Neisseria meningitidis , Streptococcus pneumoniae

Question 30

management of jaundice in first 24hrs of life ?

Answer 30

always PATHOLOGICAL
so mature and record the serum Brb level

Question 31

whooping cough management and pathogen

Answer 31

Whoop Whoop its the sound of Pertussis
CLARITHROMYCIN TO reduce infectivity
within 21 days