Paediatrics Flashcards
How should a patient with pharyngitis and a FeverPAIN score of 2-3 be managed?
Delayed prescription of phenoxymethylpenicillin
What is a congenital diaphragmatic hernia?
A rare congenital complication in which the abdominal contents herniate through a defect in the diaphragm and occupy space within the thoracic cavity. This applies pressure on the lungs, which often fail to fully develop. They are normally identified during antenatal ultrasound scans. Once the neonate is stabilised, surgical repair will be required.
How does necrotising enterocolitis present?
Poor feeding
Rectal bleeding
Unwell, premature neonate
How is necrotising enterocolitis without bowel perforation managed?
Drip and suck
Antibiotics
Parenteral feeding
How does infant respiratory distress syndrome manifest?
Respiratory distress immediately after birth in a premature newborn
Occurs due to a deficiency of surfactant in the lungs
How does alopecia areata present?
Patchy area(s) of complete hair loss
Usually not associated with any other symptoms and most cases resolve spontaneously within 1 year
What is the first step in the active management of alopecia areata?
Topical Corticosteroids
Which non-invasive test can be used to determine whether the cause of a patient’s chronic diarrhoea is likely to be inflammatory?
Faecal Calprotectin
What is the difference between gastroschisis and omphalocele?
Gastroschisis - Defect lateral to the umbilicus. Herniated contents are NOT covered in a peritoneal membrane.
Omphalocele - Defect at the umbilicus. Herniated contents are covered in a peritoneal membrane.
How are hypospadias usually managed?
Surgical correction at 12 months
How does Duchenne muscular dystrophy manifest?
Progressive weakness that usually manifests within the first 5 years of life
Patients may demonstrate delayed motor milestones
Patients often find it difficult to walk and to stand from a seated position
What is the difference in prognosis between Duchenne muscular dystrophy and Becker muscular dystrophy?
Duchenne muscular dystrophy: ~27 years
Becker muscular dystrophy: ~45 years
How does chondromalacia patellae present?
Anterior knee pain
Generally worse when climbing the stairs or when standing from a seated position
How does osteochondritis dissecans normally present?
Pain, swelling and locking following exercise
Usually occurs in active young people
Until what age do the majority of boys have physiological phimosis?
50% at 2 years of age
10% at 11 years of age
1% at 14 years of age
What is gastro-oesophageal reflux in infants?
Condition that typically presents with frequent regurgitation within 8 weeks of birth
Caused by functional immaturity of the lower oesophageal sphincter
What is the first-line step in the management of a breastfed infant with gastro-oesophageal reflux?
Breastfeeding assessment (often a change in frequency of feeds and positioning can help resolve symptoms)
What is osteogenesis imperfecta?
Genetic condition caused by a defect in type 1 collagen
Results in the formation of very brittle bones that are at high risk of fracture
Describe the difference between diplegia, hemiplegia and quadriplegia.
Diplegia: both lower limbs affected
Hemiplegia: one upper limb and one lower limb on the same side affected
Quadriplegia: all four limbs affected
How are IQ scores interpreted in patients with learning disabilities?
Borderline Mild 70-79
Mild 50-69
Moderate 35-49
Severe 20-34
Profound < 20
How is pityriasis rosea managed?
No treatment required in the first instance (self-limiting)
Describe the presentation of mesenteric adenitis.
Non-specific abdominal pain that may localise to the right iliac fossa (thereby mimicking appendicitis)
Often preceded by an upper respiratory tract infection
Describe the presenting symptoms of Crohn’s disease
Intermittent flares of diarrhoea (may or may not be associated with bleeding) and abdominal pain
Generally unwell during these episodes
Extra-GI manifestations include oral ulcers, perianal skin tags, uveitis, arthralgia and erythema nodosum
What is the treatment of choice for Hirschsprung disease?
Anorectal Pull-Through
What test is performed next in a baby who is noted as having an abnormal newborn hearing screen result?
Auditory brainstem testing
Which rules govern which method is used to quantify hyperbilirubinaemia in babies with neonatal jaundice?
Transcutaneous Bilirubin: Jaundice develops after 24 hours of life and the baby who was born at more than 35 weeks’ gestation.
Serum Bilirubin: Jaundice develops within 24 hours of life or the baby was born at less than 35 weeks’ gestation.
How is ophthalmia neonatorum caused by chlamydia treated?
Oral erythromycin for 14 days
Which triad of features is associated with nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
(Thrombosis)
What is the investigation of choice for suspected pyloric stenosis?
Abdominal Ultrasound
How is mild croup managed?
0.15 mg/kg PO Dexamethasone STAT
How is intussusception managed?
Rectal air insufflation
Describe the presenting symptoms of epiglottitis.
Very unwell with high temperature
Worsens over hours
Intensely painful throat
Soft, inspiratory stridor and rapidly increasing respiratory difficulty
Drooling
Children often sit upright, immobile and with their mouths open to maintain their airways
What is the first-line antiepileptic treatment in a male patient with generalised tonic clonic epilepsy?
Valproate
What imaging modality is usually used in the first instance for a patient with a suspected Wilms’ tumour?
Abdominal Ultrasound
How does bronchiolitis present?
Dry cough
Breathlessness
Preceding coryzal illness
Rhinitis and nasal obstruction
Sore throat
Fine-end inspiratory crackles and wheeze on auscultation
What is the initial investigation of choice for suspected Perthes disease?
X-ray of both hips (including anteroposterior and frog leg lateral views)
How is talipes equinovarus treated?
Ponseti Method
What are the features of achondroplasia?
Short stature
Short limbs
Large head
Frontal bossing
Depression of nasal bridge
Marked lumbar lordosis
Outline the aspects of managing a sickle cell crisis.
Analgesia (usually opioids)
Oxygen
Fluids
Exchange transfusion (for acute chest syndrome, stroke and priapism)
How is idiopathic constipation with faecal impaction treated in children?
Disimpaction regimen of polyethylene glycol and electrolytes (Movicol®)
What school exclusion advice should be given to the parents of a child with mumps?
Exclude from school until 5 days after the onset of the parotid swellings
What are the main features of a candida nappy rash?
Widespread erythematous rash that involves the skin folds
May have a well-demarcated scaly border with satellite lesions
Which antibiotics are usually used in the management of meconium aspiration?
Ampicillin and Gentamicin
How should a neonate identified as having a unilateral undescended testicle during newborn examination be managed?
Re-examine at the 6-week check up
If still undescended at 4-5 months, a referral should be made to paediatric urology
How does coeliac disease tend to present in children?
Chronic diarrhoea
Failure to thrive
Fatigue
What triad of features defines nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
Which procedure is used to definitively manage biliary atresia?
Kasai Procedure
How can IgA nephropathy and post-streptococcal glomerulonephritis be clinically distinguished?
The urinary changes in IgA nephropathy occur within days of an upper respiratory tract infection whereas in post-streptococcal glomerulonephritis it happens several weeks afterwards.
How does whooping cough present?
Severe bouts of coughing with an inspiratory gasp
Bouts of coughing may be bad enough to cause vomiting
How does otitis externa present?
Ear pain (otalgia)
Red and itchy outer ear which may have some dry skin
What is the best investigation for diagnosing asthma?
Spirometry (in particular, looking at the FEV1 and the FEV1/FVC ratio)
List some clinical signs associated with pyloric stenosis
Hypochloraemic, hypokalaemia metabolic alkalosis
Visible peristalsis from left to right
Olive-like mass in the right upper quadrant
List some clinical features that are associated with ulcerative colitis more than Crohn’s disease.
Continuous lesions starting distally and progressing proximally
Rectal bleeding
Pseudopolyps
Crypt damage
What is a kerion and how does it manifest?
Area of scarring alopecia resulting from the inflammatory response to a fungal skin infection (ringworm)
The area of skin may appear boggy and inflamed.
How does Still’s disease present?
Salmon-pink rash
Arthritis
Uveitis
Systemic features (e.g. fever)
Weight loss
Myalgia
When are cleft palates usually surgically repaired?
6-12 months
How does dyskinetic cerebral palsy manifest?
Dystonia (abnormal muscle tone)
Chorea (dance-like, irregular movements)
Athetosis (slow, writing movements)
What is a caput succedaneum?
Localised, soft tissue oedema of the scalp that occurs following pressure applied on the baby’s head by the cervix during delivery
It crosses suture lines and resolves within days.
What is Ewing sarcoma and how does it present?
Rare cancer that most commonly arises in the pelvis and long bones
Patients present with severe bone pain and may suffer from pathological fractures
An X-ray may reveal an ‘onion skin’ appearance due to a multilayered periosteal reaction
What is the first step in the management of eczema?
Liberal use of emollients
Which autoantibodies are associated with coeliac disease?
Anti-tissue transglutaminase antibody
Anti-endomysial antibody
What is the first-line investigation for suspected bowel obstruction secondary to intestinal malrotation?
Upper GI Contrast Study with US Scan
How do congenital hydroceles present?
Painless, soft and fluctuant swelling around a testicle
It is possible to get above the swelling and the swelling cannot be separated from the testicle
List some clinical features that warrant immediate in-hospital review for children with bronchiolitis.
Apnoea
Central Cyanosis
Oxygen Saturation < 92%
Severe Respiratory Distress
Respiratory Rate > 70/minute
What is a useful intervention to treat malabsorption and diarrhoea in cystic fibrosis?
Pancreatic enzyme supplementation
How does acute appendicitis classically present?
Umbilical pain that moves to the right iliac fossa
Nausea and vomiting
Loss of appetite
Fever
Diarrhoea
Which gene mutation causes achondroplasia?
Fibroblast Growth Factor 3 Gene (FGFR-3) Mutation
What would you expect haemoglobin electrophoresis in a newborn with sickle cell disease to show?
HbS and HbF
Which test is useful to confirm whether a patient has had an anaphylactic reaction?
Mast Cell Tryptase
What is infant torticollis and how does it present?
Condition that is usually caused by a tumour of the sternocleidomastoid muscle.
Reduced range of neck motion
Struggle to turn head in one direction (may manifest with preferring to feed from one breast)
Palpable, non-tender nodule on sternocleidomastoid
Which vaccines are administered at 3 months?
6-in-1 (whooping cough, hepatitis B, tetanus, diphtheria, Hib, polio)
Rotavirus
Pneumococcal conjugate vaccine
How long does a child with chickenpox need to be excluded from school?
Until the vesicles have crusted over
Outline the developmental milestones that an 18-month old child should have reached.
Social, Emotional and Behavioural: Feed themselves with a spoon, drink from a cup, try to play alone and try to help with dressing
Gross Motor: Walks steadily and independently and may be able to squat
Vision and Fine Motor: Pincer grip, build a tower of 3 blocks, look at and ‘palm hit’ books, draw a scribble
Hearing, Speech and Language: 6-10 words, can follow simple instructions, points to 2-4 body parts
What is the first-line pharmacological management option for ADHD?
Methylphenidate
What is transient tachypnoea of the newborn?
Benign condition caused by a delay in the resorption of fluid from the lungs which, in turn, leads to some respiratory distress.
It usually resolves within a few hours. It is more common in infants born by C-section.
List some complications of mumps
Pancreatitis
Orchitis
CNS involvement (meningitis or encephalitis)
What important diagnosis must you consider if a child is noted to have a loss of red reflex in one eye?
Retinoblastoma
How does patellar dislocation tend to present?
Severe knee pain after trauma
Associated with sudden knee swellingand an inability to straighten the leg or walk
Patients may describe the knee ‘popping’
Describe how growing pains manifest
Bilateral pain that is present throughout the day and is worst at night
Patients are able to continue all usual activities
No limp
What is the inheritance pattern of Becker Muscular Dystrophy?
X-Linked Recessive
List some conditions that are associated with club foot.
Spina Bifida
Edward Syndrome
Oligohydramnios
Arthrogryposis Multiplex Congenita
Cerebral Palsy
What is the first-line management option for a 4-year-old child with nocturnal enuresis?
Positive reward system (e.g. star chart)
Which combinations of signs would you expect to see in testicular torsion?
Absent cremasteric reflex
Negative Prehn’s sign (no pain relief on elevation of testes)
Positive Ger sign (pitting at the testicular base)
Negative blue-dot sign (no nodule)
Positive Deming sign (abnormally elevated testes)
Positive Brunzel sign (horizontal lie of the affected testis)
What is omphalitis?
Infection and inflammation of the umbilicus and stump that is usually caused by Staphylococcal or Streptococcal organisms.
It warrants further investigation and prompt treatment because it can progress to cause more widespread tissue damage (e.g. necrotising fasciitis).
What is a secondary lesion in the context of acne?
Those that occur as a result of the primary lesion healing (e.g. excoriations from spots that have been picked)
What is Ebstein’s anomaly?
Ebstein’s anomaly is a congenital defect which involves the downward displacement of an abnormal tricuspid valve which causes the atrium to increase in size and the right ventricle to become smaller or ‘atrialise’. It is commonly associated with maternal lithium use.
What is the first-line treatment option for balanitis?
Hygiene (including under the foreskin) with saline washes and a short-course of topical 1% hydrocortisone cream is recommended.
What is the histological hallmark of a pilocytic astrocytoma?
Rosenthal Fibres
What is the most common cause of congenital adrenal hyperplasia?
21-Hydroxylase Deficiency
How should a 2.3 cm primary spontaneous pneumothorax be managed in a patient who is breathless?
Needle Aspiration (with 16-18G cannula)
What are the four types of female genital mutilation?
1: Clitoroidectomy
2: Excision
3: Infibulation
4: Other forms of genital mutilation
How should a pregnant woman who has never had chickenpox before be managed once they have had significant exposure to chickenpox?
Aciclovir
Alternative: VZIG can be given if aciclovir is poorly tolerated/contraindicated
Ref: https://assets.publishing.service.gov.uk/media/63e230638fa8f50e86ff1ae4/UKHSA-guidelines-on-VZ-post-exposure-prophylaxis-january-2023.pdf
What is the incubation period of rubella?
14-21 days
List some of the features associated with neurofibromatosis type 2.
Acoustic Neuromas
Meningiomas
Ependymomas
What biochemical results would you expect to see in osteogenesis imperfecta?
Normal Calcium, Phosphate, PTH and ALP
What is the mainstay of treating mild proctitis associated with ulcerative colitis?
Per Rectal 5-ASAs (e.g. mesalazine)
What are the presenting features of an abdominal migraine?
Paroxysmal episodes of intense acute umbilical pain which interferes with daily activities. They occur more than twice in 12 months and are associated with more than two of anorexia, vomiting, photophobia, nausea, headache and pallor.
How does intestinal malrotation present?
Often asymptomatic but can present due to internal hernias and midgut volvulus.
Volvulus can present with signs of intestinal obstruction often in the first few weeks of life and is considered a surgical emergency.
What are some of the main associated features of gastro-oesophageal reflux disease in infants?
Presenting up to 1 year of age
Crying or posturing whilst feeding
Hoarseness and/or chronic cough
Single episode of pneumonia
Unexplained feeding difficulties (e.g. refusing, gagging, choking or faltering growth)
How should infantile colic be managed?
Advice on soothing the child and parental wellbeing
What histological features would you expect to see on a full-thickness rectal biopsy in a patient with Hirschsprung disease?
Absence of ganglion cells
What are the presenting symptoms of croup?
Coryzal symptoms
Seal-like barking cough
Stridor
How is epiglottitis treated?
Urgent anaesthetic review (for consideration of intubation)
IV 3rd generation cephalosporin (e.g. ceftriaxone)
According to the NICE guidelines, what frequency of tonsillitis would warrant referral to an ENT specialist for consideration of tonsillectomy?
More than 7 episodes per year for 1 year, 5 episodes per year for 2 years or 3 episodes per year for 3 years.
What should be done first when reviewing the control of a patient’s asthma?
Review inhaler technique and compliance
What are the features of a life-threatening asthma attack?
PEFR < 33%
Oxygen Saturation < 92%
Silent Chest
Poor Respiratory Effort
Altered Consciousness
Agitation
Exhaustion
Cyanosis
Describe the presenting features of foreign body inhalation.
Short history of sudden-onset breathlessness
Associated with a focal, monophonic wheeze
CXR may reveal hyperinflation of the affected lung
What is the first-line investigation for cystic fibrosis?
Sweat test
Which organisms most commonly cause bacterial pneumonia in children?
Neonate: Group B Streptococcus, Gram-negative Enterococcus
Infants and Young Children: Streptococcus pneumoniae or Haemophilus influenzae
Children > 5 years: Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia pneumoniae
What is the first-line investigation for whooping cough?
Nasopharyngeal swab
List the topical steroids that are commonly used in eczema in order of increasing potency.
Mild: Hydrocortisone 1%
Moderate: Betamethasone Valerate 0.025% or Clobetasone Butyrate 0.05%
Potent: Betamethasone Valerate 0.1%, Mometasone
If Very Severe: Oral Steroids
How is head louse infection treated?
Wet combing
Application of malathion (chemical insecticide) or dimeticone (physical insecticide)
Describe the presenting features of guttate psoriasis
Small, scaly red lesions usually on the trunk and upper limbs occurring after a streptococcal throat infection.
Describe the classical features of Parvovirus B19 infection
Mild constitutional upset (coryzal symptoms)
Erythematous rash that is particularly prominent on the cheeks before spreading to the rest of the body
It is self-limiting but it can cause significant anaemia in patients with reduced red cell survival (e.g. sickle cell disease)
Describe the appearance of a Candida nappy rash
Well demarcated, bright red patches sparing the skin folds with satellite lesions which can become confluent
What is the next step in the management of moderate acne that is failing to respond to topical retinoids and benzoyl peroxide?
Trial of oral antibiotics (doxycycline or lymecycline)
How is molluscum contagiosum managed?
Observation (resolves spontaneously)
Describe the classical presentation of measles
Coryzal symptoms
Fever
Maculopapular rash beginning on the face and behind the ears before spreading over the trunk and limbs
Koplik spots
What are the features of an innocent murmur?
Sensitive to changes in position and breathing
Short duration (i.e. not pansystolic)
Single (i.e. no associated clicks or gallops)
Small (present in a limited area and does not radiate)
Soft (low amplitude)
Systolic
What procedure may be performed in patients with tetralogy of fallot to increase pulmonary flow ahead of definitive surgical repair?
Blalock-Taussig Shunt (aims to increase blood flow through the pulmonary circulation by, for example, creating a connection between the subclavian artery and the pulmonary artery)
What are the presenting features of transposition of the great arteries?
Usually presents within the first few days of birth as the ductus arteriosus closes
Causes profound cyanosis that does not improve with oxygen therapy
No murmurs are heard on auscultation
What are the main clinical features of tetralogy of Fallot?
It usually presents within the first month of birth with shortness of breath and cyanosis on exertion (e.g. when feeding). A murmur is often noted on neonatal examination (due to the VSD and pulmonary stenosis). A chest X-ray may reveal an enlarged, boot-shaped heart.
What is the first step in managing congenital cyanotic heart disease?
Commence a prostaglandin infusion
Outline the major and minor revised Jones criteria for acute rheumatic fever
Diagnosis requires 2 major or 1 major and 2 minor criteria
Major criteria:
Carditis
Polyarthritis
Chorea
Erythema marginatum (non-itchy, macular rash)
Subcutaneous nodules
Minor criteria:
Fever > 38.5
Arthralgia
ESR > 30 and/or CRP > 3
Prolonged PR interval on ECG
What is the first step in the management of SVT?
Vagal manoeuvres (e.g. blowing into a syringe, unilateral carotid sinus massage)
What are the main steps in the management of anaphylaxis?
IM Adrenaline
If insufficient response after 2 doses of IM adrenaline, commence the refractory anaphylaxis pathway (adrenaline infusion).
What are the main presenting features of cow’s milk protein allergy?
Irritability associated with feeds, diarrhoea and faltering growth
Urticaria and swelling of the tongue and lips may be noted in the IgE-mediated form of the disease.
What is the most common cause of encephalitis?
simplex
What are the presenting features of pneumocystis jiroveci pneumonia?
Desaturation
Respiratory distress (intercostal recession, nasal flaring)
Fever
Subtle ground-glass changes on the chest X-ray
Describe the clinical features of roseola infantum
Discrete, rose pink, maculopapular rash across the neck and trunk
Associated with high fever and febrile convulsions
Caused by HHV6B and HHV7
Which vaccines are administered at 2 months according to the UK routine childhood vaccination schedule?
5 in 1 (DTaP/IPV/Hib)
Rotavirus
Meningitis B
Which organisms are particularly associated with causing miscarriage?
Rubella
CMV
Bacterial vaginosis
HIV
Chlamydia
Gonorrhoea
Syphilis
Malaria
What school exclusion advice should be given to the parents of a child with impetigo?
Exclude until the lesions are dry and have scabbed over or until 48 hours after commencing appropriate antibiotic treatment
What is slipped upper femoral epiphysis and how does it present?
Posteroinferior displacement of the epiphysis of the femoral head due to a fracture through the growth plate
Presents gradually with hip or referred knee pain
Pain on abduction and internal rotation of the affected hip
What are the components of the APGAR score?
Appearance
Pulse
Grimace
Activity
Respiratory Effort
Which follow-up scans are required for a child under the age of 3 years with an atypical UTI?
Ultrasound Scan (in the acute setting)
DMSA in 4-6 months
What is the limit age for a mature pincer grip?
12 months
How does biliary atresia manifest?
Prolonged jaundice
Pale stool
Dark urine
Failure to gain weight
What are the respiratory red flag features according to the NICE traffic light system for identifying unwell children?
RR > 60/min
Grunting
Moderate or Severe Chest Indrawing
What is the gold-standard investigation for suspected Hirschsprung disease?
Anorectal pull-through with biopsy
How is Kawasaki disease treated?
High-Dose Aspirin
IVIG
Which vaccines are administered at 8 weeks as part of the routine childhood vaccination programme in the UK?
DTaP (diphtheria, tetanus and pertussis)
IPV (inactivated poliovirus)
Hepatitis B
Hib (Haemophilus influenzae type B)
Men B (Meningitis B)
Rotavirus
How is asymptomatic labial fusion managed?
Reassurance and follow-up
Usually resolves by puberty
How does reactive arthritis present?
Arthritis (usually an asymmetrical oligoarthritis)
Urethritis
Uveitis
Also associated with keratoderma blenorrhagicum and circinate balanitis
What is the first-line imaging modality in most cases of acute appendicitis?
Ultrasound Abdomen
What heart defect is most commonly associated with Down syndrome?
Atrioventricular Septal Defect
How does tethered spinal cord syndrome manifest?
Usually in patients with a neural tube defect
Lower back pain
Gait disturbance
Scoliosis
High-arched feet
Neurological dysfunction (bladder and bowel)
How should you treat a first episode of a UTI in a 5-year-old girl?
7-10 day course of oral cephalexin or co-amoxiclav
No imaging required if it is a first-episode and not atypical
Describe the appearance of infantile seborrhoeic dermatitis.
Well infant
Greasy rash with yellow scales primarily affecting the face and scalp
What are the components of the APGAR score?
Appearance
Pulse
Grimace
Activity
Respiratory Effort
What is Blount’s disease?
Abnormality of the medial aspect of the proximal tibial growth plate that causes progressive bowing of the legs
Outline the management of diabetic ketoacidosis.
IV Fluids
Fixed-Rate Insulin Infusion (0.1 u/kg/hr)
What is Peutz-Jegher syndrome?
Autosomal dominant disease characterised by the development of hamartomas throughout the gastrointestinal tract (predominantly the small bowel).
May present with hyperpigmented spots on the lips, hands and genitalia.
Associated with an increased risk of breast and gastrointestinal cancer (e.g. colorectal, stomach, small bowel and pancreas)
How does a thyroglossal duct cyst manifest?
Painless midline neck mass that moves when swallowing
How is idiopathic constipation with faecal impaction treated in children?
Disimpaction regimen of polyethylene glycol and electrolytes (Movicol®)
For further information:
● NICE guideline on treating constipation in children https://www.nice.org.uk/guidance/cg99/chapter/1-Guidance
Until what age is strabismus most likely to be due to refractive error and likely to resolve spontaneously?
3 Months
What are some features of a severe asthma attack in a child aged 2-5 years?
- Can’t complete sentences in one breath or too breathless to talk/feed
- SpO2 < 92%
- Peak flow 33–50% best or predicted
- Heart rate > 140/minute in children aged 1–5 years
- Respiratory rate > 40/minute in children aged 1–5 years
List some features of a life-threatening asthma attack
SpO2 < 92%
Peak flow < 33% best or predicted
Silent chest
Cyanosis
Poor respiratory effort
Hypotension
Exhaustion
Confusion
What are the clinical features of a moderate exacerbation of asthma?
Able to talk in sentences
Arterial oxygen saturation (SpO2) ≥ 92%
Peak flow ≥ 50% best or predicted
Heart rate ≤ 110/minute in children aged 12-18 years.
Respiratory rate ≤ 25/minute in children aged 12-18
Describe the otoscopy findings you would expect to see in otitis media.
Red and bulging tympanic membrane with loss of cone of light
What is the first-line management option for uncomplicated otitis media?
Simple analgesia
Most cases will resolve spontaneously within 1 week
Describe the appearance of molluscum contagiosum.
Pearly umbilicated papules
What is scabies?
Parasitic infestations caused by Sarcoptes scabiei
Presents with severe itching especially in the hands
Burrows may be visualised around the webbing of the hands
What is the first-line management option for scabies?
Permethrin (applied to the whole body and allowed to dry before being washed off 8-12 hours later. A second application must be done one week after the first.)
What is the most common cause of strabismus in children aged under 3 months?
Refractive Error
What ratio of compressions and ventilations is recommended by the paediatric advanced life support algorithm?
15 Compression
2 Ventilation Breaths
f a child goes into respiratory arrest after presenting with sudden-onset stridor and it is difficult to administer rescue breaths, what should you do next?
Open the mouth and remove any visible loose foreign bodies that may be causing the airway obstruction
Which gene mutation is associated with retinoblastoma?
Retinoblastoma gene on chromosome 13
What proportion of bilateral retinoblastomas is hereditary?
100%
Describe the classical presentation of a Wilm’s tumour (nephroblastoma).
Child presenting with macroscopic haematuria and an abdominal mass
May be associated with abdominal pain, weight loss and hypertension
How should a suspected Wilm’s tumour be managed in primary care?
Urgent referral to specialty paediatric service for review within 48 hours
What is the main consequence of severe neonatal jaundice?
Kernicterus
What are the indications for using serum bilirubin measurement as a first-line investigation for neonatal jaundice?
Jaundice developing within the first 24 hours of life
Born at or before 35 weeks’ gestation
What are the main features of primary ciliary dyskinesia?
Recurrent upper and lower respiratory tract infections
50% of patients will have complete situs inversus (in which case it is called Kartagener syndrome)
Why are pregnant women advised to avoid drinking unpasteurised milk and eating soft cheeses during pregnancy?
Risk of infection by Listeria monocytogenes
It can cross the placenta and is associated with an increased risk of miscarriage, stillbirth and neonatal sepsis
Which diseases are screened for by the heel prick test?
Sickle cell disease
Congenital hypothyroidism
Cystic Fibrosis
Phenylketonuria
MCAD deficiency
Maple syrup urine disease
Isovaleric acidaemia
Glutaric aciduria type 1
Homocystinuria
What is the median age for walking unsteadily?
15 months
Which chromosomal abnormality is strongly associated with acute myeloid leukaemia?
Trisomy 21 (Down syndrome)
What histological findings are found in ulcerative colitis?
Inflammation is confined to the submucosal layer
Crypt abscesses
Depletion of goblet cells
What is bronchopulmonary dysplasia?
Chronic lung disease in premature neonates due to a delay in lung maturation or lung damage (e..g infection, ventilation).
Neonates will have high oxygen demands and may not tolerate weaning off a ventilator.
Which immunisations are given at 12 months?
Hib/Meningitis C
PCV booster
Meningitis B booster
MMR (1st dose)
Which diseases does the heel prick test screen for?
Inherited Conditions:
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Metabolic Disorders:
Phenylketonuria (PKU)
Medium chain acyl-coA dehydrogenase deficiency (MCADD)
Maple syrup urine disease
Isovaleric acidaemia
Glutaric aciduria type 1
Homocystinuria
What are the clinical features of an abdominal migraine?
Non-specific generalised abdominal pain
Often associated with headaches and nausea
The patient may have a personal or family history of migraines
What are the main features of autism spectrum disorder?
Impaired social interaction
Speech and language disorder
Ritualistic or repetitive behaviour
Describe the appearance of pityriasis rosea.
Oval-shaped scaly patches often distributed in a fir-tree pattern
Often preceded by a larger herald patch
What are the complications of measles?
Pneumonia
Encephalitis
Subacute sclerosing panencephalitis
Immunosuppression
How is constipation with impaction in children managed?
Movicol disimpaction regimen
What are the main features of reactive arthritis?
Mono- or oligoarthritis
Urethritis
Uveitis
Usually occurring within 4 weeks of an enteric infection or sexually-transmitted infection
What are the clinical features of Henoch-Schönlein purpura?
Palpable purpuric rash (often over the extensor surfaces of the legs and buttocks)
Generalised colicky abdominal pain
Arthralgia
Self-limiting and tends to resolve within 4 weeks
What are the clinical features of diabetic ketoacidosis?
Abdominal pain
Vomiting
Drowsiness
Hyperglycaemia
Ketosis
Acidosis
What is the most common cause of early-onset neonatal sepsis?
Group B Streptococcus
Listeria monocytogenes
What is the first-line antibiotic treatment option for early-onset sepsis in the neonate?
Benzylpenicillin and gentamicin
How does epididymo-orchitis typically present?
Gradual-onset testicular pain and swelling
May be associated with dysuria and urethral discharge
Elevation of the scrotum may relieve the pain (Prehn’s sign)
What is the mainstay of managing epididymo-orchitis?
Oral Antibiotics
What clinical sign is often seen in torsion of the testicular appendage?
Blue dot sign
Which vaccine-preventable disease can cause orchitis?
Mumps
What is the first step in investigating a child with secondary enuresis?
Bladder Diary
How should uncomplicated balanitis be treated?
Wash daily with warm water and avoid soap
NOTE: antibiotics or antifungals should be prescribed if it is thought to be an infectious cause of balanitis
Which areas of skin tend to primarily be affected by eczema?
Flexor surfaces
What is possetting?
Common condition affecting infants characterised by the painless regurgitation of small amounts of feed without any faltering growth
How does constipation manifest in young children?
Abdominal discomfort
Irritability
Vomiting
What is the first-line investigation for a child with suspected coeliac disease?
Anti-tissue tranglutaminase antibody titre
Which diagnosis should be considered in a neonate with Down syndrome who has failed to pass meconium within the first 24 hours of life?
Hirschsprung Disease
What is the most common cause of infectious gastroenteritis in young children?
Rotavirus
When should a stool sample be sent for microscopy and culture in a child presenting with symptoms of gastroenteritis?
NICE guidelines state that stool microscopy and culture should be performed if any of the following are true:
- You suspect septicaemia
- There is blood and/or mucus in the stool
- The child is immunocompromised
Stool microscopy and culture should be considered if:
- There has been recent travel abroad
- The diarrhoea has not improved by day 7
- There is uncertainty about the diagnosis of gastroenteritis
What is the mainstay of managing uncomplicated gastroenteritis in children?
Oral Rehydration Solution
What do Barlow and Ortolani manoeuvres test for?
Developmental Dysplasia of the Hip
List some risk factors for developmental dysplasia of the hip.
Macrosomia
Female sex (6 times more common)
First born child
Breech presentation
Family history
Oligohydramnios
Talipes
Swaddling or limited hip abduction
How is developmental dysplasia managed if it fails to resolve spontaneously within the first few months of life?
Pavlik Harness
Which imaging should be requested in a patient with suspected slipped capital femoral epiphysis?
X-Ray Hips and Pelvis, AP and frog-leg lateral view
When should bilateral fixation be considered for a patient with slipped capital femoral epiphysis?
Obese
Males under 12.5 years
Females under 10 years
Endocrine disorders
Difficulty arranging follow-up
What is the mainstay of managing Perthes disease?
Physiotherapy and Analgesia (surgical fixation is only usually indicated in children over the age of 8 years with more than 50% of the femoral head showing signs of necrosis)
How is Osgood-Schlatter disease managed?
Analgesia (NSAIDs)
Physiotherapy
Rest
Ice
Which clinical feature can help distinguish chondromalacia patellae from other causes of knee pain in young people?
Worsening pain when climbing or descending the stairs
Which imaging modality is best at identifying osteochondritis dissecans?
MRI
What is the most appropriate imaging modality for suspected intussusception?
Abdominal Ultrasound
How is idiopathic constipation in a young child without evidence of faecal impaction managed?
Maintenance dose polyethylene glycol and electrolytes (Movicol®)
What is the main cause of meconium ileus?
Cystic Fibrosis
What are the radiographic features of Perthes disease?
Widened joint space
Asymmetrical femoral epiphyseal size
Blurred physeal plate
Radiolucency of the proximal metaphysis
What examination findings would be expected in a patient with Osgood-Schlatter disease?
Tenderness over the patellar ligament at the site of insertion into the tibial tuberosity
What is the gold standard diagnostic test for suspected acute lymphoblastic leukaemia?
Bone marrow aspiration and biopsy
Which initial investigations are useful in the diagnosis of a neuroblastoma?
Urinary Catecholamines (VMA and HVA)
This will usually be followed by abdominal ultrasound or CT imaging
How does spinal muscular atrophy present?
Usually presents before the age of 6 months
Progressive proximal weakness primarily affecting the lower limbs
How is croup diagnosed?
Primarily a clinical diagnosis
Outline how epiglottitis presents.
Septic looking child (high fever)
Drooling
Severe upper airway obstruction (stridor)
How does osteosarcoma tend to present?
Persistent bone pain and swelling (usually affecting the femur or tibia)
Pain is often worse at night and described as being dull and unremitting
What are the main features of haemolytic uraemic syndrome?
Microangiopathic Haemolytic Anaemia
Thrombocytopaenia
Renal Impairment
How is congenital hydrocephalus diagnosed?
Often diagnosed antenatally on ultrasound scans
It may be diagnosed postnatally using ultrasound, CT or MRI
How does idiopathic thrombocytopenic purpura typically present?
Isolated thrombocytopenia
Easy bruising and petechiae/purpura
Usually occurs soon after a recent viral infection
Which investigation should be requested in a child who has had their second unprovoked seizure?
EEG
Outline the immediate management of transposition of the great arteries.
Prostaglandin E1 Infusion
Balloon Atrial Septostomy
What are the main clinical features of Kawasaki disease?
Maculopapular Rash
Persistent Fever > 7 Days
Adenopathy
Strawberry Tongue
Swelling of Hands and Feet
What is the most common cause of bronchiolitis?
Respiratory Syncytial Virus (RSV)
Which inflammatory condition is associated with COVID-19 in children?
Paediatric Inflammatory Multisystem Syndrome (PIMS)
Outline the initial management of encephalitis.
IV Ceftriaxone and IV Aciclovir
How does transient synovitis present?
Mild joint pain usually occurring soon after a viral infection
It resolves spontaneously
Describe the typical presentation of viral-induced wheeze.
Wheeze and shortness of breath developing in the context of a viral-infection, typically in children under the age of 5 years
How does encephalitis usually present?
Headache
Neck stiffness
Fever
Confusion
Seizures
Describe the classical clinical features of intussusception
Intermittent abdominal pain (presenting with inconsolable crying and drawing knees up to chest)
Stool containing blood and mucus
Sausage-shaped mass in right side of abdomen
What is the first-line management option for suspected testicular torsion?
Contact local urology team urgently and arrange for emergency surgical exploration
What are the defining features of ADHD?
Inattention, hyperactivity and impulsivity that is pervasive across 2 or more important settings (e.g. school and home)
Lasts for more than 6 months
Significantly impacts psychological, educational and/or social wellbeing
How should a formula-fed infant with suspected cow’s milk protein allergy be managed?
Commence extensively hydrolysed (hypoallergenic) formula
What are the main presenting features of Kawasaki disease?
CRASH and Burn
Conjunctivitis (bilateral and non-exudative)
Rash (polymorphic and non-vesicular)
Adenopathy (cervical)
Strawberry tongue
Hands and feed involvement (oedema, erythema and desquamation)
Burn (persistent fever lasting over 5 days)
What is Sturge-Weber syndrome?
Sturge-Weber syndrome is a neurocutaneous syndrome characterised by the presence of a haemangiomatous facial lesion (port wine stain) in the distribution of the trigeminal nerve, abnormal intracranial blood vessels and eye abnormalities (e.g. glaucoma). The neurological manifestations can vary, but many patients suffer from seizures and developmental delay.
In which compartment does fluid collect in a hydrocele?
Tunica vaginalis
What are the main manifestations of congenital rubella syndrome?
Cataracts
Sensorineural hearing loss
Congenital heart disease (often PDA)
Describe the clinical manifestations of a congenital diaphragmatic hernia.
Increased work of breathing
Reduced air entry
Bowel sounds in thorax
Which abnormality detected on routine newborn examination may be suggestive of an underlying diagnosis of retinoblastoma?
Unilateral loss of red reflex
Describe the presenting features of Osgood-Schlatter disease.
Knee pain that is worse with exercise
Tenderness and swelling over the tibial tuberosity
How should nocturnal enuresis be treated in a child aged 7 years or older?
Lifestyle changes (limiting fluid intake in the evenings, positive reinforcement system)
Enuresis alarm
Desmopressin (used occasionally if short-term control is needed, e.g. for a sleepover)
What is infantile colic?
Paroxysms of inconsolable crying often with drawing up of the knees and passage of excessive flatulence in an otherwise healthy and well-fed infant.
Crying is usually present for more than 3 hours per day for more than 3 days per week for more than 3 weeks.
What is the first-line management option for a 6-year-old child with primary nocturnal enuresis?
Address toileting behaviour and fluid intake
Positive reward system
Enuresis alarm
ow should a fever in an otherwise well baby under the age of 3 months be managed?
Full septic screen (blood cultures, urine culture, stool culture, chest X-ray +/- lumbar puncture)
Empirical antibiotics
What is the most common cause of Eisenmenger syndrome?
Ventricular Septal Defect (VSD)
How does biliary atresia present?
Prolonged jaundice (> 2 weeks)
Pale stools
How is retinoblastoma treated?
If no concerning features (anterior chamber involvement, glaucoma or orbital inflammation) → Chemotherapy
If concerning features are present → Enucleation
What is the mainstay of treating a low grade and low stage Wilm’s tumour?
Surgical Resection
Vincristine
Dactinomycin
Outline the criteria for surgical fixation of fragments in osteochondritis dissecans.
Unstable lesion identified on arthroscopy
Lesion is bigger than 2 cm on MRI
Which investigation is most helpful when deciding how to treat a child with epididymo-orchitis?
Urine MC&S
Which finding would you expect to see on an abdominal X-ray of a patient with duodenal atresia?
Double bubble sign (distended stomach and proximal duodenum separated by the pyloric sphincter)
What is laryngomalacia?
Congenital softening of the supraglottic larynx. The floppiness of this structure means it partially blocks the airway and creates a harsh stridor sound during inspiration. A child usually grows out of this by the age of 2 years and it rarely causes any clinically significant consequences.
How does transient synovitis present?
Mild joint pain in the context of a recent viral infection in a well child
