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Year 3 > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is the most common defect in hereditary spherocytosis?

  • iron deficiency
  • spectrin deficiency
  • folic acid deficiency
  • vitamin D deficiency
A
  • spectrin deficiency
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2
Q

What crises are associated with hereditary spherocystosis? (2)

A
  • haemolytic crisis
  • aplastic crisis
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3
Q

8 y.o. pain in R knee
Pain started spontaneously 2 days ago, no history of trauma
Increased pain during weight-bearing
Feels otherwise well, no fever

Exam: appears well at rest, normal BMI, vital signs
Gait: limb
Exam R knee: unremarkable
R hip: reduced range of motion particularly internal rotation + abduction

What is the most likely diagnosis?

  • slipped upper femoral epiphysis (SUFE)
  • Perthes disease
  • iliotibial tract syndrome
  • septic arthritis
  • patellofemoral pain syndrome
A
  • Perthes disease

(SUFE - more common in obese children)

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4
Q

6 y.o boy
2 day history of limping, severe pain in L leg whenever weight bears
Several infections recently
Fever over last week and general fatigue
No other PMHx, is up to date with his immunisations and takes no regular medication
Clinical examination: pallor, generalised lymphadenopathy + splenomegaly, significant tenderness over the mid-shaft of the L femur on palpation, but normal range of motion in all joints and an antalgic gait. Vital signs reveal fever and tachycardia

  • slipped upper femoral epiphysis (SUFE)
  • Perthes disease
  • iliotibial tract syndrome
  • septic arthritis
  • acute lymphoblastic leukaemia (ALL)
A
  • acute lymphoblastic leukaemia (ALL)
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5
Q

9 y.o. boy
2 day history of pain in R low abdomen
Viral infection last week
Bowel habit is normal and no vomiting
On exam: mild lower abdo tenderness in R iliac fossa, with no associated guarding. No palpable abdom masses
Cervical + submandibular lymphadenopathy and inflmaed tonsils with no exudate
Vital signs are unremarkable
WBC and CRP are only mildly elevated
Urine dip unremarkable
Abdominal USS - unremarkable

  • appendicitis
  • mesenteric lymphadenitis
  • abdominal migraine
  • Crohn’s disease
  • Intussuception
A
  • mesenteric lymphadenitis

(got to rule out appendicitis first)

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6
Q

6 y.o. boy admitted on paediatric ward
7 days history of high fevers and irritability
Mouth-sore and desquamated, with ‘strawberry tongue’ appearance
Feet noted oedematous and red
Polymorphous rash widespread

Which medication is most likely to reduce the risk of complications associated with this disease?

  • ibuprofen
  • amoxicillin
  • IV immunoglobulin
  • paracetamol
  • dexamethasone
A
  • IV immunoglobulin

(diagnosis: Kawasaki disease)

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7
Q

Most serious complication of Kawasaki disease?

A

= coronary artery aneurysms

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8
Q

Why is Aspirin givin in Kawasaki disease?

A

= protect against coronary artery aneurysms

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9
Q

4 y.o. in ED
Has had a runny nose and a strange noisy/ barking cough for a few days
This evening breathing became more laboured
She has a RR of 35/ min, SpO2 of 96% on room air, a pulse of 95 bpm and a temp of 37.7oc
On exam: mild intercostal recession and mildly reduced air entry on ausculatation

What is the most appropriate initial management?

  • obtain IV access
  • nebulised adrenaline
  • penicillin V
  • nebulised salbutamol
  • oral dexamethasone
A
  • oral dexamethasone
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10
Q

Most common cause of croup?

A

Viral - parainfluenza

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11
Q

When do you expect a child to sit up supported?

A

= approx. 6 months

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12
Q

What is acute epiglottitis?

A

= rapidly progressive infection that leads to inflammation of the epiglottis and adjacent tissues

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13
Q

Cause of acute epiglottitis?

A

= Haemophilus influenza B (Hib)

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14
Q

How is acute epiglottitis diagnosed?

A

= direct visualisation of the inflamed epiglottis - typically done using laryngoscopy after securing airway

(do not examine or upset child without senior support)

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15
Q

Management of acute epiglottitis? (2)

A
  • secure airway, possibly through endotracheal intubation (as first priority)
  • administer IV antibiotics, typically cefuroxime
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16
Q

What is an APGAR score?

A

= is a method of assessing the state of a neonate quickly after birth

The score is intended as a quick assessment of current status, and is not a long-term prognostic indicator

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17
Q

What components make up the APGAR score? (5)

A

A - appearance
P - pulse
G - grimace
A - activity
R - respiration

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18
Q

When does NICE adivse to calculate the APGAR score? (2)

A
  • 1 minute, AND
  • 2 minutes of life
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19
Q

Most common cancer in children?

A

= acute lymphocytic leukaemia (ALL)

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20
Q

What is acute lymphocytic leukaemia (ALL)?

A

= a malignant condition that arises from the uncontrolled proliferation of genetically altered lymphoid progenitor cells

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21
Q

How is acute lymphocytic leukaemia (ALL) definatively diagnosed?

A

= bone marrow biopsy

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22
Q

Acute exacerbation of asthma can be triggered by? (4)

A
  • Allergens: dust pollution, animal hair, smoke
  • Respiratory infections: viruses such as common cold
  • Exercise: especially in cold weather
  • Emotional stress: can lead to hyperventilation and symptoms of an asthma attack
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23
Q

Signs of severe acute episode of asthma? (3)

A
  • Respiratory distress – use of accessory muscles of respiration, breathlessness resulting in inability to complete sentences, tachypnoea with a RR > 30/min if over 5, >40 if under 5
  • HR > 125/min if over 5, >140/min if under 5
  • Peak expiratory flow rate 33-50% of predicted
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24
Q

Life-threatning features of acute exacerbation of asthma in a child? (7)

A
  • peak expiratory flow rate < 33% predicted
  • oxygen saturations < 92%
  • silent chest on auscultation
  • weak or no respiratory effort
  • hypotension
  • exhaustion
  • confusion/ altered conscious level
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25
Q

What is acute otitis media?

A

= a prevalent infection that leads to inflammation of the middle ear

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26
Q

Primary cause of otitis media?

A

= bacterial infection

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27
Q

When would you admit a child with otitis media? (2)

A
  • if < 3 monhts with temp of 38, OR with suspected complications
  • consider if systemically unwell
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28
Q

What can be used to treat pain + fever in acute otitis media? (2)

A
  • parcetamol
  • ibuprofen
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29
Q

Anaemia: causes of reduced red cell production? (6)

A
  • iron deficiency
  • folic acid deficiency
  • B12 deficiency
  • red cell aplasia
  • chronic renal failure
  • chronic inflammation
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30
Q

Anaemia: causes of increased erythrocyte destruction? (5)

A
  • G6PD deficiency
  • hereditary spherocytosis
  • sickle cell disease
  • thalassemia
  • haemolytic disease of the new-born
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31
Q

What type of hypersensitivity reaction is anaphylaxis?

A

= type I hypersensitivity reaction

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32
Q

Primary investigation in paediatric anaphylaxis?

A

= serum levels of mast cell tryptase

(rises within 1 hour of onset + can confirm diagnosis)

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33
Q

What position is best to put a child in anaphylaxis?

A

= supine position and raise their legs

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34
Q

How long should paediatric patients be monitored post-anaphylaxis? why?

A

= 6-12 hours, in case of rebound episode

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35
Q

How many adrenaline auto-injectors are given to newly diagnosed paediatric patients after an anphylaxis episode?

A

= 2

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36
Q

What is asthma?

A

= long-term inflammatory disease of the airways, characterised by reversible airway obstruction and bronchospasm

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37
Q

Investigations to do in a child with asthma (5)

A
  • detailed history
  • serial peak flow readings, to indicate reversible airflow obstruction
  • spirometry, to measure airflow capacity
  • trial of a SABA
  • FeNO testing where cases are unclear
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38
Q

What is an atrial septal defect (ASD)?

A

= cardiac malformation where a hole exists between the L and R atria. This is due to a defect in the septum secundum during cardiac embryonic development

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39
Q

Is atrial septal defect more common in females or males?

A

= females

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40
Q

Signs and symptoms of atrial septic defects? (3)

A
  • often asymptomatic
  • ejection sysolic murmur on auscultation (incidental finding), loudest on lower L sternal edge
  • in decompensated patients: HF with SOB, fatigue, oedema, rapid HR
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41
Q

How are atrial septal defects diagnosed?

A

= echocardiogram

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42
Q

Management options for atrial septal defects? (2)

A

Depends on severity of lesion:
- most managed conservatively
- surgical closure for larger defects

(routine echocardiograms used to monitor ASDs for changes over time)

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43
Q

Complications associated with atrial septal defects? (2)

A
  • heart failure
  • paradoxical embolisms, can cause stroke
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44
Q

What is ADHD?

A

= attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by persistent patterns of inattention, impulsivity, and hyperactivity that are inappropriate for the individual’s developmental level

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45
Q

2 main symptoms in ADHD?

A
  • inattention
  • hyperactivity/ impulsivity
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46
Q

How long do symptoms need to be present for ADHD diagnosis according to DSM-5 criteria?

A

= 6 months

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47
Q

What is used to help diagnose ADHD?

A

= clinical criteria set by DSM-5

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48
Q

Conservative management options for ADHD? (2)

A
  • behavioural techniques: CBT, behaviour therapy, psychoeducation, social skill training
  • extra support at home
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49
Q

Does ADHD affect intellectual ability?

A

= no

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50
Q

Medical management of ADHD?

A

= stimulant medications (such as methylphenidate or amphetamines)

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51
Q

What do the medications used in ADHD do?

A

= have activity in frontal lobe, thus increasing executive function, attention, and reducing impulsivity

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52
Q

What are autistic spectrum disorders (ASD)?

A

= set of complex neurodevelopmental disorders, characterised by a spectrum of social, language, and behavioural deficits

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53
Q

Are males of females more likely to be diagnosed with an autism spectrum disorder?

A

= males (approx. 4:1)

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54
Q

Risk factors for autistic spectrum disorder? (3)

A
  • advanced parental age at time of conception
  • genetic mutations
  • maternal exposure to specific drugs during pregnancy
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55
Q

What sort of SOCIAL interactions problems can children with an autism spectrum suffer from? (3)

A
  • prefer to play alone
  • avoid eye contact
  • lack ‘theory or mind’ - don’t think about others perspectives
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56
Q

What sort of LANGUAGE problems can children with an autism spectrum disorder suffer from? (4)

A
  • speech + language delay
  • monotomous tone of voice
  • difficulty using pronours
  • interpret speech literally
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57
Q

What sort of BEHAVIOURAL problems can children with an autism spectrum disorder suffer from? (3)

A
  • narrow interests (e.g., trains)
  • ritualistic behaviours that rely heavily on routine
  • sterotypes movements (e.g., rocking, flapping hand movements)
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58
Q

What % of children with autism may also experience seizures?

A

= about 25%

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59
Q

Key strategies used in managing autism spectrum disorders? (2)

A
  • behavioural management
  • family support, due to chronic nature of disorder
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60
Q

Prognosis of autistic spectrum disorder: what % of children with ASD will be able to live independently as adults?

A

= less than 10%

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61
Q

What is bacterial tracheitis?

A

= severe, potentially fatal condition in the paediatric population

Characterised by high fever, and rapidly progressive airway obstruction due to accumulation of copious, thick airway secretions

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62
Q

Bacterial tracheitis vs croup?

A

= may present similarly but bacterial tracheitis tends to be more severe and rapidly progressive

Croup presents typically with a low grade fever compared to a high fever in bacterial tracheitis

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63
Q

Most common causative agent of bacterial tracheitis?

A

= Staphylococcus aureus

(usually follows a viral upper respiratory tract infection)

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64
Q

Management of bacterial tracheitis? (4)

A
  • IV antibiotics (broad-spectrum until the causative organism is identified)
  • intubation in severe cases

To help clear secretions:
- airway humidication
- chest physiotherapy

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65
Q

What is biliary atresia?

A

= rare but serious condition where the bile ducts in a new-born’s liver undergo progressive fibrosis + destruction

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66
Q

Signs and symptoms of biliary atresia? (2)

A
  • prolonged jaundice (persisting beyond 14 days of life)
  • dark urine and pale or chalky white stool (signs of biliary obstruction)
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67
Q

What type of bilirubin is raised in biliary atresia?

A

= conjugated bilirubin

(+ deranged LFTs)

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68
Q

Definitive diagnositc test for biliary atresia?

A

= cholangiography

(= imaging of bile duct by x-ray + an injection of contrast medium)

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69
Q

What is cholangiography?

A

= imaging of the bile duct by x-ray + injection of contrast medium

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70
Q

Management for biliary atresia?

A

= surgical intervention - hepatoprotoenterostomy

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71
Q

What is a hepatoprotoenterostomy? what is it used to treat?

A

= this surgery creates a new pathway from the liver to the gut to bypass the fibrosed bile ducts

Carried out to treat biliary atresia

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72
Q

A ependymoma is a brain tumour originating from the cells of the

  • ventricular system
  • pituitary gland
A
  • ventricular system
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73
Q

A craniopahyngioma is a brain tumour originating from the cells of the

  • ventricular system
  • pituitary gland
A
  • pituitary gland
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74
Q

Most common solid-organ malignancy?

A

= brain tumour

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75
Q

Inherited genetic conditions which may increase a child’s risk of developign a brain tumour? (2)

A
  • neurofibromatosis
  • Li-Fraumeni syndrome
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76
Q

What is a branchial cyst?

A

= a congenital malformation that arises from an embryonic remnant. A painless, cystic mass located anterior to the sternocleidomastoid muscle just below the ear

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77
Q

Management options for a branchial cyst (conservative + active)

A

Conservative options: observation + antibiotics for infection

Active options: involves surgical excision of the cyst

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78
Q

What are reflex anoxic seizures (RAS)?

A

= paroxysmal, non-epileptic events seen in young children, which result from a temporary decrease in cerebral blood flow due to a reflex asystole or bradycardia

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79
Q

Are breath holding attacks and reflex anoxic seizures harmful?

A

= no, they are usually benign

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80
Q

Management of reflex anoxic seizures (RAS) and breath holding attacks? (2)

A
  • reassurance about benign nature of these events
  • avoid triggers

In very severe cases or frequent cases, referral to paediatric neurologist or cardiology may be necessary

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81
Q

How are breath holding attacks and reflex anoxic seizures diagnosed? (/2)

A

= primarily clinical

  • can do ECG if cardiac cause suspected
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82
Q

What is bronchiolitis?

A

= = widespread chest infection, predominately affecting infants aged 1-12 months

This lower respiratory tract disease targets the bronchioles, causing inflammation and congestion

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83
Q

Most common cause of bronchiolitis?

A

= respiratory syncytial virus (RSV)

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84
Q

How it bronchiolitis diagnosed?

A

= primarily clinical diagnosis

(CXR can be consiered in severe cases)

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85
Q

What can be given as prophylaxis for bronchiolitis in high-risk patients?

A

= Palivizumab

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86
Q

Bronchiolitis: what can be used in severe cases?

A

= antiviral therapy (e.g., Ribavirin)

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87
Q

Complications of bronchiolitis?

A

= bronchiolitis obliterans aka, popcorn lung

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88
Q

What is bronchiolitis obliterans also known as?

A

= popcorn lung

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89
Q

What occurs in bronchiolitis obliterans (popcorn lung)?

A

= bronchioles are injured due to infection or inhalation of a harmful substance, leading to an overactive cellular repair process and subsequent build-up of scar tissue

The scar tissue obstructs the bronchioles, impairing oxygen absorption in the body. The scarring and narrowing of the bronchioles may continue to worsen over time, potentially leading to respiratory failure

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90
Q

What is bronchiolitis obliterans?

A

= pathological condition characterised by permanent obstruction of the bronchioles, the smallest airways in the lungs

This obstruction results from chronic inflammation that leads to the formation of scar tissue within these airways

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91
Q

Causes of bronchiolitis? (2)

A
  • viral, most freuqnt Adenovirus
  • complication following bone marrow or lung transplants
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92
Q

Most common viral cause of bronchiolitis obliterans?

A

= adenovirus

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93
Q

Investigations used in bronchiolitis obliterans? (4)

A
  • CXR (can be normal)
  • CT scan - detect early lung changes
  • lung biopsy - confirm diagnosis
  • pulmonary function tests
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94
Q

What is observed in FEV1 in patients with bronchiolitis obliterans?

A

= a significantly reduced FEV1 (16-21%) is often observed in bronchiolitis obliterans

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95
Q

Management of bronchiolitis obliterans? (2)

A

= primarily supportive

  • can use immunosuppressive agents
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96
Q

What is caput seccedaneum?

A

= a neonatal condition that occurs as a result of the pressure exerted by the top of the infant’s skull against the dilating cervix during labour

It is characterised by a subcutaneous serosanguineous fluid collection superficial to the cranium but beneath the skin

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97
Q

Cause of caput seccedaneum?

A

= primary cause is sustained pressure from the dilating cervix, birth canal, or forceps on the infant’s head during labour

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98
Q

In caput seccedaneum - can the swelling cross cranial suture lines?

A

= yes

(unlike cephalohematoma)

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99
Q

Caput seccedaneum: imaging to help confirm diagnosis?

A

= USS

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100
Q

Management of caput seccedaneum?

A

= generally, self-resolving

Observe + reassure

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101
Q

How is caput seccedaneum diagnosed?

A

= primarily clinical

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102
Q

What is cerebral palsy?

A

= refers to a group of permanent movement disorders that appear in early childhood

This condition occurs due to damage to a child’s central nervous system (CNS), particularly areas involved in motor control. The lesions incurred is non-progressive

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103
Q

Which of the following categories of motor disorders associated with cerebral palsy is due to damage to pyramidal pathways?

  • spastic
  • dyskinetic/athetoid
  • ataxic
A
  • spastic
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104
Q

Which of the following categories of motor disorders associated with cerebral palsy is due to damage to the basal ganglia pathways?

  • spastic
  • dyskinetic/athetoid
  • ataxic
A
  • dyskinetic/athetoid
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105
Q

Which of the following categories of motor disorders associated with cerebral palsy is due to damage to cerebellar pathways?

  • spastic
  • dyskinetic/athetoid
  • ataxic
A
  • ataxic
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106
Q

Describe ‘clasp-knife’ spasticity?

A

= initial resistance when attempting passive movement, followed by rapid decrease in resistance

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107
Q

Imaging used in investigating suspected cerebral palsy?

A

= MRI - to visulise extent + nature of brain lesions

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108
Q

Medical options used in cerebral palsy (2)

A
  • Baclofen, to manage muscle spasms
  • Botox injection, to help with contractures
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109
Q

What is Baclofen used for in cerebral palsy?

A

= can be used to manage muscle spasms

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110
Q

What is chickenpox?

A

= = acute infectious disease caused by the varicella-zoster virus (VZV), a member of the herpes virus family

This highly contagious illness, predominantly seen in children, is characterised by a vesicular rash, mild fever and malaise

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111
Q

Cause of chickenpox?

A

= varicella-zoster virus (aka, human herpes virus 3 (HHV3))

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112
Q

Peak infectivity in chickenpox

(from when to when, days)

A
  • 1-2 days before the rash appears until 5 days after the rash
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113
Q

How is chickenpox diagnosed?

A

= clinical, due to characteristic nature of rash and hx of exposure

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114
Q

What treatment is available for immunocompromised patients, previously unexposed pregnant women or neonate with peripartum exposure to chickenpox? (2)

A
  • IV Aciclovir
  • human varicella-zoster immunoglobulin (VZIG)
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115
Q

Management strategies/ advise for those suffering from chickenpox? (4)

A
  • keep fingernails short to prevent iching + infection
  • loose, long-sleeve clothing to limit skin exposure + scratching
  • cooling measures like oatmeal baths or calamine lotion to reduce itching
  • analgesics + antipyretics for symptom relief
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116
Q

What is coarctation of aorta?

A

= = congenital heart condition characterised by a narrowing of the aorta

This narrowing typically occurs just before the ductus arteriosus

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117
Q

Coarctation of the aorta is associated with which genitic condition?

A

= Turner Syndrome

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118
Q

Radio-femoral delay is suggestive of?

A

= coarctation of the aorta

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119
Q

How is coarctation of aorta diagnosed and monitored?

A

= echocardiography

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120
Q

Coarctation of aorta: what can be given to keep the ductus arteriosis patent until the defect can be corrected?

A

= prostaglandins

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121
Q

What is kernicterus?

A

= bilirubin encephalopathy, is bilirubin-induced neurological damage, which is most commonly seen in infants

It occurs when the unconjugated bilirubin (indirect bilirubin) levels cross 25 mg/dL in the blood from any event leading to decreased elimination and increased production of bilirubin

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122
Q

Cyanotic congenital heart disease (R>L)

(5T’s with 1-5 mnemonic)

A
  • Truncus arteriosus - vessels join to make 1
  • Transposition of great vessels - 2 major vessels switched
  • Tricuspid atresia - 3 (tricuspid)
  • Tetralogy of Fallot - 4 defects
  • Total anomalous pulmonary vascular return, 5 letters (TAPVR)
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123
Q

What cells produce surfactant?

A

= type II alveolar cells

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124
Q

What is lung compliance?

A

= a measure of the lungs ability to stretch and expand

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125
Q

At which week gestation fo the alveolar cells become mature enough the start producing surfactant? (range)

A

= between 24-34 weeks gestation

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126
Q

Which 2 hormones are released in response to stress of labour which help stimulate respiratory effort?

A
  • adrenalin
  • cortisol
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127
Q

What is the foramen ovale?

A

= hole between the L and R atria of the heart

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128
Q

What keeps the ductus arteriosus open?

A

= prostaglandins

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129
Q

How does a babys first breath cause the functional closure of the foramen ovale?

A

First breaths baby takes expand alveoli -> decreasing pulmonary vascular resistance -> this causes a fall in pressure in the R atrium -> at this point L atrial pressure greater R atrial pressure -> this squashes the atrial septum and causes functional closure of the foramen ovale -> this structurally closes and becomes fossa ovalis

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130
Q

What is the ductus arteriosus?

A

= a blood vessel that connects the pulmonary artery to the aorta

This conncection is present un all babies in the womb, but should close shortly after birth

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131
Q

Increased blood oxygenation causes

  • a drop in prostaglandins
  • an increase in prostaglandins
A
  • a drop in prostaglandins
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132
Q

What does extended hypoxia to the brain in a neonate cause?

A

= hypoxia-ischaemic encephalopathy (HIE)

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133
Q

What can stimuate breathing in a neonate?

A

= vigorous drying

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134
Q

How are babies < 28 weeks kept warm?

A

= in a plastic bag, still wet, managed under a heat lamp

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135
Q

When is the APGAR score meant to be done? (3)

A

= 1, 5, and 10 minutes

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136
Q

In babies were there is suspected HIE (hypoxia-ischaemic encephalopathy), what may they benefit from?

A

= active cooling

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137
Q

Negative effect of delayed cord clamping?

A

= increase in neonatal jaundice

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138
Q

Benefits of delayed cord lamping (5)

A
  • improved hb
  • improved iron stores
  • improved BP
  • reduction in intraventricular haemorrhage
  • reduction in necrotising enterocolitis
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139
Q

WHO recommends uncompromised neonates to have a delay in cord clamping of how long?

A

= at least 1 minute

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140
Q

What is given to babies as standard practice shortly after birth?

A

= vitamin K

(babies are born with deficiency of vitamin K)

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141
Q

Within how many days does the newborn exmaination need to be done?

A

= within 3 days (72 hours)

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142
Q

When is blood spot screening done? when is the latest it can be done?

A

= taken on day 5, day 8 at the latest

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143
Q

How many drops are required for the blood spot screening?

A

= 4 seperate drops

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144
Q

Which congenital conditions does the blood spot screening test for? (9)

A
  • sickle cell anaemia
  • cystic fibrosis
  • congenital hypothyroidism
  • phenylketonuria
  • medium-chain-acyl-CoA
  • dehydrogenase deficiency (MCAAD)
  • maple syrup urine disease (MSUD)
  • isovaleric acidaemia (IVA)
  • glutaric aciduria type 1 (GA1)
  • homocystin
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145
Q

3 questions to ask before doing newborn examination

A
  • has the baby passed meconium?
  • baby feeding okay?
  • is there a family history of congenital heart, eye, or hip problems?
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146
Q

How might a duct-dependent congeintal heart condition be picked up in the newborn examination?

A

= difference in pre-ductal and post-ductal saturations

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147
Q

Newborn check: where can be pre-ductal and post-ductal saturations be measured?

A

Pre-ductal: measured in baby’s R hand

Post-ductal: measured in either foot

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148
Q

Describe Barlow’s + Ortolani manoeuvres

A

Barlow’s manoeuvre = guiding the hips into mild adduction and applying a slight forward pressure with the thumb

Ortolani manoeuvre = hip is abducted and gentle pressure is applied to the proximal thigh from behind. Here, the examiner attempts to relocate an already dislocated femoral head back into the acetabulum. If the joint is dislocated, a palpable “clunk” is noticed as the head slides back into place

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149
Q

Newborn check: what is the moro reflex?

A

= when rapidly tipped backwards arms and legs will extend

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150
Q

Newborn check: what is the rooting reflex?

A

= tickling cheek will cause them to turn towards the stimulus

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151
Q

What is talipes?

A

= aka, clubfoot. Where the ankles are in a supinated position, rolled inwards

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152
Q

Positional vs structural talipes?

A

Positional talipes = where muscles are slightly tight around the ankle but the bones are unaffected. Foot can still be moved into normal position. Requires physiotherapy

Structural talipes = involves the bones of the foot and ankle, and requires referral to an orthopaedic surgeon

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153
Q

What is given to treat haemangiomas?

A

= beta-blocker (i.e., Propanolol)

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153
Q

Common causative organisms in neonatal sepsis (5)

A
  • group B streptococcus
  • e.coli
  • listeria
  • klebsiella
  • staphylococcus aureus
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154
Q

First-line antibiotics in neonatal sepsis? (2)

A

= NICE recommends Benzylpenicillin + Gentamycin

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155
Q

What is hypoxic-ischaemic encephalopathy (HIE)?

A

= some hypoxia is normal during birth, however prolonged or severe hypoxia leads to ischaemic brain damage

HIE can lead to permanent damage to the brain, causing cerebral palsy. Severe HIE can result in death

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156
Q

What is Sarnat staging used to grade in neonates?

A

= hypoxic-ischaemic encephalopathy grades

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157
Q

Management of hypoxic-ischemic encephalopathy (2)

A
  • supportive care
  • therapeutic hypothermia
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158
Q

RBCs contain:
- conjugated bilirubin
- unconjugated bilirubin

A
  • unconjugated bilirubin
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159
Q

When is jaundice classed as ‘pathological’ in a neonate?

A

= in the first 24 hours of life

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160
Q

What is haemolytic disease of the newborn?

A

= incompatibility between rhesus antigens on the surface of the RBCs of the mother and foetus. Causes haemolysis + jaundice in the neonate

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161
Q

What is classified as ‘prolonged jaundice’? (2)

(in days, term + premature)

A

At term: > 14 days
In premature babies: > 21 days

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162
Q

Treatment of neonatal jaundice?

A

= phototherpay

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163
Q

What is apnoea of prematurity?

A

= defined as periods where breathing stops spontaneously for > 20 seconds, or shorter periods with oxygen desaturation or bradycardia

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164
Q

Management of apnoea of prematurity (2)

A
  • tactile stimulation (apnoea monitor can beep when apnoea is occuring)
  • IV caffeine - prevents apnoea + bradycardia
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165
Q

Describe how retinopathy of prematurity occurs? How is it associated with hypoxia?

A

= vessel formation is stimulated by hypoxia, which is a normal condition in the retina during pregnancy. When the retina is exposed to higher oxygen concentrations in a preterm baby, particularly with supplementary oxygen during medical care, the stimulant for normal blood vessel development is removed

When the hypoxic environment recurs, the retina responds by producing excessive blood vessels (neovascularisation) as well as scar tissue. These abnormal blood vessels regress and leave the retina without a blood supply. The scar tissue may cause retinal detachment

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166
Q

First-line management in retinopathy of prematurity?

A

= transpupillary laser photocoagulation, to halt and reverse neovascularisation

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167
Q

What is respiratory distress in a newborn usually from?

A

= premature neonates, born before the lungs start producing adequate surfactant

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168
Q

‘Ground-glass’ appearance on CXR in a newborn is suggestive of..?

A

= respiratory distress syndrome

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169
Q

What is necrotising enterocolitis?

A

= disorder affecting premature neonates, parts of the bowel become necrotic - life-threatening emergency

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170
Q

Risk factors for necrotising enterocolitis (5)

A
  • low birth weight, premature
  • formula feeds
  • respiratory feeds
    respiratory distress + assisted ventilation
  • sepsis
  • patent ductus arteriosis and other congenital heart disease
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171
Q

Imaging used to diagnose necrotising enterocolitis?

A

= abdominal x-ray

(supine position)

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172
Q

Management options in necrotising enterocolitis (5)

A
  • nil by mouth
  • IV fluids
  • antibiotics
  • total parenteral nutrition (TPN)
  • surgical intervention, to remove dead bowel disease
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173
Q

What is neonatal abstinence syndrome?

A

= refers to withdrawal of symptoms that happens in neonates of mothers that used substances in pregnancy

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174
Q

True or false: SSRI withdrawal typically benefits from medical treatment

A

= false

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175
Q

What is coeliac disease?

A

= t cell-mediated inflammatory autoimmune disease that impacts the small bowel

Occurs when sensitivity to prolamin results in villous atrophy in the lining of the small intestine and malabsorption

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176
Q

What proteins are people with coeliac disease sensitive to?

A

= prolamin

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177
Q

Is coeliac disease more common in males or females?

A

= females

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178
Q

What is dermatitis herpetiformis associated with?

A

= coeliac disease - dermatological manifestation

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179
Q

Serological testing for coeliac disease (3)

A
  • anti-TTG IgA antibodies
  • IgA levels
  • anti-TTG IgG (useful in those with IgA deficiency)
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180
Q

When might ‘anti-TTG IgG’ be useful in diagnosing coeliac disease?

A

= in those with an IgA deficiency

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181
Q

Gold-standard diagnostic test in those with suspected coeliac disease?

A

= oesophagogastroduodenoscopy (OGD) with duodenal/ jejunal biopsy

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182
Q

Presence of HLA-DQ2 allele is associated with what condition?

A

= coeliac disease

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183
Q

Mainstay management for coeliac disease?

A

= implementation of lifelong gluten-free diet + education

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184
Q

What is conduct disorder?

(age <)

A

= psychological diagnosis given to patients < 18 years of age who consistently exhibit behaviours and attitudes that disrespect and violate the rights of others, often breaching societal norms and rules

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185
Q

Is conduct disorder more common in males of females?

A

= males

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186
Q

Signs and symptoms of conduct disorder? (4)

A
  • persistent + serious violation of rules
  • physical aggression
  • destructive behaviour
  • decitfulness
187
Q

Is prognosis of conduct disorder generally good or bad?

A

= generally poor

188
Q

Management of conduct disorder (4)

A
  • psychotherapy, CBT
  • family therapy
  • pharmacological treatment, used to manage comorbid conditions
  • school-based interventions
189
Q
A
190
Q

Around what % of children with conduct disorder develop antisocial personality disorder or develop substance misuse issues?

A

= around 50%

191
Q

What is congenital adrenal hyperplasia?

A

= represents a collection of autosomal recessive disorders characterised by impaired steroid hormone synthesis within the adrenal cortex due to enzyme defects

192
Q

Most common type of congenital adrenal hyperplasia?

  • deficiency in 18-hydroxylase
  • deficiency in 21-hydroxylase
  • deficiency in 30-hydroxylase
A
  • deficiency in 21-hydroxylase
193
Q

What diagnosis might the following symptoms suggest…

  • ambiguous genitalia
  • hypotension
  • salt-wasting crises
  • vomiting
  • virilisation (=development of masculine secondary sexual characteristics)
A

= congenital adrenal hyperplasia

194
Q

What occurs to the following hormones in a child with congenital adrenal hyperplasia?

  • 17-hydroxyprogesterone
  • ACTH
  • crotisol
A
  • 17-hydroxyprogesterone, elevated
  • ACTH, elevated
  • crotisol, low
195
Q

Acute treatment of congenital adrenal hyperplasia? (2)

A
  • IV fluids
  • hydrocortisone (for its glucocorticoid + mineralocorticoid effects)
196
Q

What 2 medications are usually given to provide hormonal replacement in those with congenital adrenal hyperplasia?

A
  • hydrocortisone
  • fludrocortisone

(as needed)

197
Q

What can be seen on ECG in congenital heart block?

A

= complete dissociation between p waves (representing atrial contraction), and QRS complexes (representing ventricular contraction)

198
Q

What is congenital heart block associated with? (maternal/ 2)

A
  • SLE
  • anti-Ro and anti-La (sjogren’s syndrome)
199
Q

Signs and symptoms seen in congential heart block (2)

A

Neonates: bradycardia, or circulatory shock

Older children: pre-/ syncope

200
Q

Primary investigation in congenital heart block?

A

= ECG

201
Q

Management of congential heart block? (2)

A

If asymptomatic = close monitoring

Symptomatic = implantation of pacemaker

202
Q

What is congenital hypothryroidism?

A

= paediatric endocrine disorder characterised by insufficient production of thyroid hormones at birth, leading to potential physical and neurodevelopmental complications if not promptly treated

203
Q

Primary vs secondary congential hypothyroidism

A

Primary: thyroid dysgensis ( defect in thyroid gland development), or dyshormonogenesis (defect of thyroid hormone biosynthesis) - incldes thyroid agenesis, ectopic thyroid tissue and hypoplastic thyroid gland

Secondary: defects in hypothalamus or pituitary gland, leading to low TSH secretion

204
Q

Neonate presents with large anterior fontanel, an umbilical hernia and distended abdomen, macroglossia (=large tongue) and weight gain.

What is the diagnosis?

A

= congenital hypothyroidism

205
Q
A
206
Q
A
207
Q
A
208
Q

Confirmatory tests for investigating congenital hypothyroidism (TSH + T4)

A

TSH: elevated
free T4: low

209
Q

Scan to investigate congenital hypothyroidism (2)

A
  • thyroid USS
  • radionuclide scan (to identidy thyroid dysgenesis)
210
Q

Management of congenital hypothryroidism? (2)

A
  • Levothyroxine (thyroid hormone replacement therapy)
  • regular monitoring for dose adjustments (TSH + T4 levels)
211
Q

Paediatrics: what is constipation defined as?

A

= clinical condition wherein the child defaecates fewer than 3 times per week, or experiences significant difficulty passing stool

212
Q

Most common cause of chronic constipation in children?

A

= dietary factors

(low fibre, avoidance using toilet, pain upon passing due to anal fissure, unrecognised sensation of needing to pass stool)

213
Q

How is constipation in a child investigated?

A
  • history
  • palpation of impacted faeces (hard, depressible masses) on abdominal examination
214
Q

Initial treatment for constipation in a child?

A

= Movicol disimpaction regimen

215
Q

What is Hirschsprung’s disease?

A

= a birth defect in which some nerve cells are missing in the large intestine, so a child’s intestine can’t move stool and becomes blocked

216
Q

How is Hirschsprung’s disease diagnosis confirmed?

A

= rectal suction biopsy (= removal of tiny pieves of tissue from the rectal area)

217
Q

Definitive management in Hirschsprung’s disease?

A

= surgical removal of the section of the aganglionic colon

The healthy bowel is then pulled out

218
Q

What is laryngotracheobronchitis also known as?

A

= croup

219
Q

What is croup?

A

= an acute respiratory syndrome which affects the larynx, trachea, and bronchi

It is characterised by inflammation and swelling that results in partial obstruction of the upper airway

220
Q

Primary aetiological agent in croup?

A

= parainfluenza virus

221
Q

Barking or seal-like cough in a child < 3 is suggestive of?

A

= croup

222
Q

X-ray of the neck shows classic ‘steeple sign’ - what is this suggestive of?

A

= croup, indicative of subglottic narrowing in severe or atypical cases

223
Q

What can be given in mild cases of croup in primary care?

A

= single dose of Dexamethasone

224
Q

If child is admitted to hospital for croup, what treatment is usually given? (3)

A
  • monitoring
  • ocygen supplementation
  • nebulised budesonide (=corticosteroid)
225
Q

In a child with croup, if there are high concerns about airway patency what can be given?

A

= nebulised adrenaline

226
Q

Example of congenital cyanotic heart defects (3)

A
  • transposition of the great arteries
  • pulmonary + tricuspid atresias
  • tetralogy of fallot
227
Q

What is cyanotic heart disease?

A

= encompasses a range of congenital heart defects resulting in a R to L shunt, which leads to systemic arterial desaturation and subsequent cyanosis

228
Q

What might suggest cyanotic heart disease in a newborn?

A

= appears cyanotic

229
Q

How is cyanotic heart disease diagnosed? (2)

A
  • often antenatally during routine USS scans
  • echocardiography - used to characterise the anatomy and heart function
230
Q

Definitive management options in cyanotic heart disease?

A
  • surgical correction
  • if not correctable, heart transplant may be considered
231
Q

What can be given in a child with cyanotic heart disease whilst awaiting definitive correction?

A

= prostaglandin E

(to maintain patency of the ductus arterioles, which can provide temporary relief from cyanosis)

232
Q

Cystic fibrosis is…

  • autosomal dominant
  • autosomal recessive
A
  • autosomal recessive
233
Q

What is cystic fibrosis?

A

= progressive, autosomal recessive disorder that causes persistent lung infections and limits the ability to breathe over time

234
Q

Mutation in the CFTR protein is associated with which condition?

A

= cystic fibrosis

235
Q

Most common mutation associated with cystic fibrosis?

A

= Delta-F508

236
Q

A sign of cystic fibrosis in neonate?

A

= meconium ileus, due to viscous meconium that causes a delay in passing and possible GI obstruction

237
Q

Defintive diagnosis test for cystic fibrosis?

A

= sweat test

238
Q

Cystic fibrosis: What does the sweat test measure?

A

= measures concentration of chloride in excreted sweat

239
Q

Prophylactic medications taken in cystic fibrosis (3)

A
  • antibiotics
  • bronchodilators
  • medicaitons to thin secreations
240
Q

What is dornase alfa used for, what does it do?

A

= used in cystic fibrosis, thins secretions

241
Q

Which regular immunisations are recommended for those with cystic fibrosis? (2)

A
  • penumococcal vaccines
  • influenza vaccines
242
Q

What is delayed puberty defined as? (2)

A

Absence of any signs of pubertal development by the age of

  • 14 in boys
  • 13 in girls
243
Q

Most common cause of delayed puberty?

A

= constutitional delay of growth and puberty

244
Q

How is constitutional delay of growth and puberty confirmed?

A

= hand-wrist- x-ray to assess bone age

(delated in contitutional bone delay due to late fusion of the epiphyseal plates)

245
Q

Investigations in delayed puberty (3)

A
  • hand-wrist x-ray
  • endocrine function tests
  • genetic testing
246
Q

Management in delayed puberty (2)

A
  • observational, with reassurance that puberty will eventually occur
  • hormone therapy might be considered
247
Q

The following features are associated with which condition?

  • lack of breast development
  • shield chest
  • widely spaces nipples
  • webbed kneck
  • cubital valgus
  • coarctation of the aorta
A

= Turners syndrome (XO)

248
Q
A
249
Q

What is developmental dysplasia of the hip (DDH)?

A

= congenital abnormality of the hip joint in which the ball of the femur (femoral head) and the socket of the pelvis (acetabulum) do not articulate approximately

This malalignment can result in the joint dislocating easily and continuing to develop abnormally

250
Q

Development dysplasia of the hip (DDH): Risk factors, 5 Fs?

A
  • female
  • firstborn
  • family history
  • frank breech presentation
  • fluid, oligohydramnios
251
Q
A
252
Q
A
253
Q
A
254
Q
A
255
Q

Which of the following tests for developmental dysplasia of the hip, tests for posterior dislocation?

  • Barlows
  • Ortolani
A
  • Barlows

(Barlow, take that)

255
Q

Which of the following tests for developmental dysplasia of the hip, tests for relocation on hip abduction?

  • Barlows
  • Ortolani
A
  • Ortolani
256
Q

Imaging used to help confirm developmental dysplasia of the hip?

A

= hip ultrasonography

256
Q

What is a pavlik harness used for?

A

= keeps hips in a flexed and abducted position, used in developmental dysplasia of the hip (DDH)

257
Q

What is Downs syndrome?

A

= Trisomy 21, is a genetic condition resulting from the presence of 3 copies of chromosome 21, rather than the typical 2

258
Q

Facial features associated with Downs syndrome (7)

A
  • upward-slanting palpebral fissures
  • epicanthic folds
  • protruding tongue
  • small low-set ears with adherent earlobes
  • hypoplastic nasal bridge
  • broad, flat + small oral cavity
  • single transverse palmar crease
259
Q

What conditions is Downs syndrome associated with?

A
  • learning difficulties
  • congenital heart defects
260
Q

What is eidenmenger syndrome?

A

= = pathological medical condition where in a congenital L to R heart shunt reverses into a R to L shunt

This reversal is typically secondary to pulmonary HTN and is associated with R ventricular hypertrophy

261
Q

What causes Eisenmenger syndrome?

A

= increased pulmonary pressures

262
Q

Signs and symptoms of Eidenmenger syndrome

A
  • usually presents in late teens
  • main feature is cyanosis
263
Q

Gold standard investigation for diagnosis of Eisenmenger

A

= cardiac catheterization

264
Q

Management for patient with Eisenmenger syndrome (2)

A
  • heart-lung transplant

If not feasible: palliative care

265
Q

What is duodenal atresia?

A

= congenital malformation characterised by the presence of a blind-ending duodenum, which is not patent

This abnormality leads to an obstruction of the GI tract, with resulting clinical implications

266
Q

What condition is duodenal atresia associated with?

A

= down’s syndrome

267
Q

Antenatal signs of duodenal atresia?

A

= polyhydraminos

(due to inadequate ingestion of amniotic fluid by foetus)

268
Q

Postnatal sign of duodenal atresia? (2)

A
  • distended abdomen
  • vomiting
269
Q

What does the ‘double bubble’ sign on abdominal x-ray suggest?

A

= duodenal atresia

(1 gas bubble visible in the stomach, and another in the proximal, patent part of the duodenum prior to the atresia)

270
Q

Primary management option for patient with duodenal atresia?

A

= surgical repair - duodenoduodenostomy

(procedure involves reconnecting the closed proximal and distal segments of the duodenum to alleviate the obstruction)

271
Q

What is DKA characterised by? (3)

A
  • hyperglycaemia
  • acidosis
  • ketonaemia
272
Q

Is a high temperature usually a symptoms of DKA?

A

= no - could indicate an underlying infection that has triggered the DKA

273
Q

DKA: If patient is alert, and not significantly dehydrated, how would you manage? (2)

(assume can swallow)

A
  • encourage oral fluid intake
  • aminister SC insulin
274
Q

DKA: If pateint vomiting, confused, or significantly dehydrated, how would you manage? (2)

A
  • IV fluids (initial bolus of 10ml/kg 0.9% NaCl, then discuss with senior) - if evidence of shock, initial bolus should be 20ml/kg
  • insulin infusion (at 0.1 units/kg/hour 1 hour after starting IV fluids)
275
Q

Major complications of DKA management?

A

= cerebral oedema

276
Q

How are enteroviruses usually spread? (2)

A
  • faecal-oral route OR,
  • droplet transmission
277
Q

Enteroviruses: Which of the following commonly causes hand foot-and-mouth disease?

  • coxsackie A virus
  • coxsackie B virus
  • poliovirus
  • echoviruses
A
  • coxsackie A virus
278
Q

Enteroviruses: Which of the following commonly causes myocarditis?

  • coxsackie A virus
  • coxsackie B virus
  • poliovirus
  • echoviruses
A
  • coxsackie B virus
279
Q

Enteroviruses: Which of the following commonly causes poliomyelitis?

  • coxsackie A virus
  • coxsackie B virus
  • poliovirus
  • echoviruses
A
  • poliovirus
280
Q

Enteroviruses: Which of the following commonly causes aseptic meningitis?

  • coxsackie A virus
  • coxsackie B virus
  • poliovirus
  • echoviruses
A
  • echoviruses
281
Q

Key investigations for diagnosing enteroviral infections (3)

A
  • stool cultures
  • throat cultures
  • CSF analysis (in cases of suspected CNS involvement)
282
Q

How are enteroviral infections typically managed?

A

= supportive treatment

(analgesia, hydration, antipyretics, ventilatory support, vaccination against polio)

283
Q

What is Ewing’s sarcoma?

A

= malignant, small round cell tumour that primarily involves the bone but can also arise in soft tissues

284
Q

Second most prevalent bone cancer in children + adolescents?

A

= Ewing’s sarcoma

285
Q

Defintive diagnosis for Ewing’s sarcoma is established how?

A

= bone biopsy, which is examined histologically and genetically

286
Q

How is Ewing’s sarcoma managed? (3)

A
  • surgery, to remove primary tumour + metastatic disease
  • chemotherapy, reduce tumour size
  • radiotherapy, used as adjuvant therapy or when surgery is not feasible
287
Q

What are innocent murmurs in children?

A

= often referred to as functional or physiological murmurs, are benign heart sounds that can be detected in a significant proportion of healthy children

288
Q

How common are innocent murmurs in children?

A

= very common, up to 1/3 of children will have one at some point during their childhood

289
Q

6 S’s - features of innocent heart murmurs in a child?

A
  • Soft, faint not loud
  • Systolic (NOTE: all diastolic murmurs are pathological)
  • Sensitive – murmur’s intensity changes with child’s position or alongside respiration
  • Short: not holosystolic (does not last for the entire systolic phase)
  • Single: no additional sounds accompanying the murmur
  • Small: murmur localised and does not radiate to other areas
290
Q

True or false: soft, diastolic murmur with no other added sounds is suggestive of an innocent heart murmur in a child?

A

= false, all diastolic murmurs are pathological

291
Q

Innocent heart murmur in a child: If the murmur persists, or does not have typical features of an innocent murmur, what further investigations may be done? (3)

A
  • ECG
  • echocardiogram
  • CXR
292
Q

What is a febrile convulsion?

A

= = type of seizure that occur in association with a fever, without evidence of intracranial infection, or defined cause

These seizures are typically short-lived, lasting < 15 minutes, and are tonic-clonic in nature

293
Q

Features of a simple febrile convulsion (3)

A
  • short-lived, < 15 minutes
  • tonic-clonic in nature
  • associated with fever
294
Q

Features of a complex febrile convulsion (3)

A
  • partial or focal seizures
  • last > 15 minutes
  • occur multiple times during same febrile illness
295
Q

What are the chances of a child having another febrile convulsion after the first one?

A

= 1/3

296
Q

Are febrile convulsions known to cause any lasting damage?

A

= no

297
Q

What are the risks of developing epilepsy

  • for general population
  • after simple febrile convulsion
  • after complex febrile convulsion
A

General population: 1.8%
Simple febrile convulsion: 2-7.5%
Complex febrile convulsion: 10-20%

298
Q

What is foetal alcohol syndrome (FAS)?

A

= represents a set of physical and mental birth defects associated with prenatal exposure to alcohol

299
Q

Facial features associated with foetal alcohol syndrome (FAS) (3)

A
  • short palpebral fissures (= small eyes, small eyelid width)
  • smooth philtrum (= groove under nose + above lip)
  • thin upper lip
300
Q

Can you cure foetal alcohol syndrome (FAS)?

A

= no, supportive management

301
Q

What is fragile X syndrome?

A

= genetic disorder that leads to a range of developmental problems including learning disabilities and cognitive impairment

It is caused by a mutation in the FMR1 gene, which usually makes a protein needed for brain development.

302
Q

Mutation of the FMR1 gene results in the development of which condition?

A

= fragile X syndrome

(FMR1gene located on x-chromosome - CGG trinucleotide repeat expansion)

303
Q
  • long face
  • protruding ears
  • intellectual impairment
  • large testes
  • social anxiety
  • autistic spectrum features

Are all associated with what genetic condition?

A

= fragile x-syndrome

304
Q

What is the most common inherited form of learning disabilities?

A

= fragile x syndrome

305
Q

What are fraser guidelines used for?

A

= set of criteria that must be met for a health professional to give advice to a child < 16 regarding contraception and sexual health without breaking confidentiality

306
Q

Fraser guidelines (5)

A
  • can understand nature of implications of proposed treatment
  • cannot be persuaded to tell their parents
  • likely to continue having sexual intercourse
  • physical or mental health likely to suffer
  • in person’s best interest

[if all of the above criteria are met, the child is deemed to be ‘Fraser competent’ and can therefore receive advice without breaking confidentiality]

307
Q

Why is GORD commonly seen in babies?

A

= due to immaturity of the lower oesophageal sphincter, allowing contents to pass freely into the oesophagus from the stomach

308
Q

First-line management of GORD in children

A

= reassurance + practical advice

  • small frequent meals
  • burping regularly
  • not over-feeding
  • keep baby upright
309
Q

What is gastroenteritis?

A

= inflammation of the GI tract, predominantly involving the stomach + small intestines, characterised by diarrhoea and vomiting

310
Q

Most common cause of viral gastroenteritis in infants?

  • adenovirus
  • norovirus
  • rotavirus
A
  • rotavirus
311
Q

Most common cause of viral gastroenteritis across all ages?

  • adenovirus
  • norovirus
  • rotavirus
A
  • norovirus
312
Q

Gastroenteritis: Which of the following is found in cooked meats + cream products?

  • staphylococcus aureus
  • bacillus cereus
  • clostridium perfringens
  • campylobacter
  • e. coli
A
  • staphylococcus aureus
313
Q

Gastroenteritis: Which of the following is associated with reheated rice?

  • staphylococcus aureus
  • bacillus cereus
  • clostridium perfringens
  • campylobacter
  • e. coli
A
  • bacillus cereus
314
Q

Gastroenteritis: Which of the following is commonly found in reheated meat dishes or cooked meats?

  • staphylococcus aureus
  • bacillus cereus
  • clostridium perfringens
  • campylobacter
  • e. coli
A
  • clostridium perfringens
315
Q

Investigations for gastroenteritis (2)

A
  • usually clinical
  • may include stool cultures + microscopy
316
Q

Management of gastroenteritis (2)

A

= primarily supportive

  • fluid replacement
  • antibiotics (if indicated - systemically unwell, immunosuppressed, elderly)
317
Q

Gastroenteritis: Which of the following antibiotics is used against Salmonella + Shigella?

  • Ciprofloxacin
  • Amoxicilin
  • Erythromycin
  • Tetrocycline
A
  • Ciprofloxacin
318
Q

Gastroenteritis: Which of the following antibiotics is used against Campylobacter?

  • Ciprofloxacin
  • Amoxicilin
  • Erythromycin
  • Tetrocycline
A
  • Erythromycin (macrolide)
319
Q

Gastroenteritis: Which of the following antibiotics is used against Cholera?

  • Ciprofloxacin
  • Amoxicilin
  • Erythromycin
  • Tetrocycline
A
  • Tetrocycline (used to reduce transmission)
320
Q

Is food poisoning a notifiable disease in the UK?

A

= yes

321
Q

Gastroenteritis: How to prevent norovirus outbreak?

A

= handwahsing with soap + warm water

322
Q

What is glandular fever?

A

= viral infection primarily caused by the Epstein Barr virus

This infectious disease is characterised by symptoms such as
- Fever
- Fatigue
- Sore throat
- Possible hepatomegaly or splenomegaly

323
Q

What is glandular fever also known as? (2)

A
  • infectious mononucleosis
  • ‘kissing disease’
324
Q

Primary cause of glandular fever (infetious mononucleosis)?

A

= Epstein Barr virus

325
Q

How is gladular fever transmitted?

A

= saliva, which is why it is referred to as the ‘kissing disease’

However, virus can be spread through items such as eating utensils, and toothbrushes

326
Q

What does a positive heterophile antibody ‘Paul Bunnell’ test suggest?

A

= glandular fever/ infectious mononucleosis

327
Q

Why are patients with glandular fever recommended to avoid contact sport + heavy lifting for a minimum of 1 month?

A

= to minimise the risk of splenic rupture

328
Q

Management of glandular fever?

A

= supportive - rest, OTC medicaiton for fever + sore throat

329
Q

What is henoch schonlein purpura (HSP)/ IgA vasculitis ?

A

= is an immune-mediated small vessel vasculitis

It predominately affects children, especially those aged 3-5 years

330
Q

Most common vasculitis in children?

A

= henoch schonlein purpura/ IgA vasculitis

331
Q

Which vasculitis is associated with a Hx of a recent upper respiratory tract infection?

A

= henoch schonlein purpura/ IgA vasculitis

332
Q

3 year old patient presents with purpura on lower limbs, abdominal pain, arthritis, + haematuria, 2 weeks ago he suffered from an upper respiratory tract infection.

What is the diagnosis?

A

= henoch schonlein purpura/ IgA vasculitis

333
Q

Is henoch schonlein purpura more common in males or females?

A

= slightly more common in males

334
Q

Following an episodes of henoch schonlein purpura, how long should the patient have regular urine tests to monitor for potential renal impairment?

A

= 12 months

335
Q

What are the chances of recurrence of HSP?

A

= seen in 1/3 pateints

336
Q

What is hodgkin’s lymphoma?

A

= malignant lymphoma characterised by presence of Reed-Sternberg cells

337
Q

B symptoms

A
  • fever
  • weight loss
  • night sweats
338
Q

4 types of Hodgkin’s lymphoma

A
  • lymphocyte predominant
  • nodular sclerosis
  • mixed picture
  • lymphocyte deplated
339
Q

What was ‘ann arbor staging system’ used to stage?

A

= Hodgkin’s lymphoma

340
Q

The presence of which cells on blood film is suggestive of Hodgkin’s lymphoma?

A

= Reed-Sternberg cells

341
Q

Scans which can be used to stage Hodgkin’s lymphoma (2)

A
  • CT scan
  • PET scan
342
Q

What does a high LDH on bloods suggest?

A

= indicates organ or tissue damage

343
Q

How is Hodgkin’s lymphoma treated?

A

= chemoradiotherapy

344
Q

Hodgkin’s lymphoma: Which of the following type is associated with a better prognosis?

  • lymphocyte-predominant
  • lymphcyte-deplete
A
  • lymphocyte-predominant
345
Q

What is a hydrocele?

A

= = pathological accumulation of serous fluid in a sac-like cavity specifically around the testicle

Typically presents as an enlarged scrotum

346
Q

Primary hydrocele vs secondary hydrocele?

A

PRIMARY HYDROCELE = the processus vaginalis should typically obliterate after the descent. If it doesn’t close completely, fluid from the abdomen can gradually accumulate in the scrotum, causing a hydrocele

SECONDARY HYDROCELE = can develop at any time, occur when there is excessive fluid produced within tunica vaginalis

347
Q

Primary diagnostic tool in a suspected hydrocele?

A

= USS

348
Q

Management options for a hydrocele (2)

A
  • observation, many resolve by 12 months of age
  • if persists 2 years, or causes discomfort - surgical correction
349
Q

What is hydrocephalus?

A

= neurological disorder caused by the excessive accumulation of the CSF within the ventricular system of the brain

350
Q

2 types of hydrocephalus

A
  • communicating hydrocephalus
  • non-communicating hydrocephalus
351
Q

What does the following signs in a child suggest

  • enlarged head
  • bulging anterior fontanelle
  • distension of scalp veins
  • ‘sunsetting’ of the eyes
A

= hydrocephalus

352
Q

How do you investigate a child with susepcted hydrocephalus?

A
  • primarily imaging, cranial USS firstly
  • MRI or CT brain for more detailed images
353
Q

What is a ventricularoperitoneal shunt used for? in which condition?

A

= commonly inserted to divert excess CSF from brain

Used in the treatment of hydrocephalus

354
Q

What is hypoxic ischaemic encephalopathy?

A

= condition characterised by brain damage resulting from antenatal or perinatal hypoxia

355
Q

What is hypoxic ischaemic encephalopathy caused by?

A

= lack of oxygen in foetal circulation > leads to insufficient oxygen supply to the brain

356
Q

Imaging used to assess extent of brain injury in hypoxic ischaemic encephalopathy

A

= mutiple MRI brain scans

357
Q

What can be used to prevent further brain damage from secondary reperfusion injury in hypoxic ischaemic encephalitis?

A

= cooling therapy

358
Q

What is immune thrombocytopenic purpura (ITP)?

A

= autoimmune condition, characterised by a reduction in the number of circulating platelets

It is a type II hypersensitivity reaction whereby the spleen produced antibodies are directed against the glycoprotein IIb/ IIIa or Ib-V-IX complex

359
Q

What type of hypersensitivity reaction is immune thrombocytopenic purpura (ITP)?

A

= type II hypersensitivity reaction

360
Q

ITP: In children, often presents as:

  • self-limiting disease following a viral infection
  • chronic disease, with relapsing course
A
  • self-limiting disease following a viral infection
361
Q
A
362
Q
A
363
Q

ITP: In adults, often presents as:

  • self-limiting disease following a viral infection
  • chronic disease, with relapsing course
A
  • chronic disease, with relapsing course
364
Q

Immune thrombocytopenic purpura (ITP): How is it managed?

A

= generally conservative, watch-and-wait approach

(high risk of spontaneous remission)

365
Q

Immune thrombocytopenic purpura (ITP): Are platelet transfusions recommended?

A

= no, can increase rate of platelet destruction

366
Q

Immune thrombocytopenic purpura (ITP): pharmacological management options for persistent cases (2)

A
  • steroids
  • IVIG (IV immune globulin)
367
Q

Immune thrombocytopenic purpura (ITP): what may be considered in refractory cases?

A

= spelenctomy

368
Q

What is impetigo?

A

= highly contagious superficial epidermal infection of the skin

Primarily caused by Staphyloccus and Streptococcal bacteria

369
Q

Main causative agents in impetigo (2)

A

= mainly bacterial

  • Staphylococcus aureus
  • Group A Streptococcus
370
Q

What skin condition presents with a charactersitic golden crust and is highly infectious?

A

= impetigo

371
Q

Patient with impetigo has been advised to start Abx however, is allergic to penicillin, which of the following can be used instead?

  • Flucloxacillin
  • Clarithromycin
  • Erythromycin
A
  • Clarithromycin
372
Q

Patient with impetigo has been advised to start Abx however, is pregnant, which of the following can be used instead?

  • Flucloxacillin
  • Clarithromycin
  • Erythromycin
A
  • Erythromycin
373
Q

What cream can be used to treat localised non-bullous impetigo?

A

= hydrogen peroxide 1% cream

(apply 2 or 3 times daily for 5 days)

374
Q

What is intussusception?

A

= refers to the invagination (telescoping) of a segment of the proximal bowel into a distal bowel segment

375
Q

Child presents with being off his feeds, abdominal distention and ‘recurrent jelly’ stool.

What is the likely diagnosis?

A

= intussusception

376
Q

Primary investigation in intussusception?

A

= abdominal USS

377
Q

What does the ‘target sign’ on USS suggest?

A

= intussusception

378
Q

Initial management of intussusception (if child is stable vs. not) (2,1)

A
  • rectal air insufflation
  • contrast enema

If child not stable:
- operative reduction

379
Q

What is juvenile dermatomyositis (JDM)?

A

= paediatric variant of dermatomyositis, a systemic autoimmune disease primarily affecting the skin and muscles

380
Q

What can be given for acute flate of juvenile dermatomysositis?

A

= steroids

381
Q

What is juvenile idiopathic arthritis (JIA)?

A

= collective term used to describe a group of arthritis’s that affect children and young individuals < 16, where the aetiology is unknown. It is a diagnosis of exclusion characterised by persistent joint swelling that lasts > 6 weeks

382
Q

How is juvenile idiopathic arthritis managed? (4)

A

Emotional + psychological support crucial - as extremelly debilitating

Pharmacological:
- NSAIDs - symptoms control
- Steroids - inflammation
- steroid-sparing agents (Methotrexate or TNF-alpha inhibitor) may be used to minimise long-term steroid use

383
Q

What is kawasaki disease?

A

= medium-vessel vasculitis predominately affecting children

384
Q

Kawasaki disease diagnostic criteria? (1,5)

A

Based on presence of high-grade fever persisting > 5 days

Accompanied by 4/5 of the following features (‘CREAM’)

C - conjuncitivits
R - rash (any non-bullous rash)
E - oedema/ erythema of hands + feet
A - adenopathy/ lymphadenopathy (usually unilateral + non-tender)
M - mucosal involvement (strawbery tongue, oral fissures)

385
Q

Primary investigation in kawasaki disease?

A

= echocardiogram, due to risk of coronary aneurysm

386
Q

Complication associated with kawasaki disease

A

= coronary aneurysms

387
Q

Management of kawasaki disease (3)

A
  • intravenous immunoglobulins (IVIg)
  • high-dose aspirin

Regular echocardiograms
Close monitoring as recovery can take several weeks

388
Q

Long QT-syndrome (LQTS) can increase the chances of what complications in young people?

A

= sudden cardiac death

(increased risk of ventricular fibrilation + cardiac arrest)

389
Q

Main manifestation of long QT-syndrome?

A

= syncope, usually following exertion, emotional stress or during sleep

390
Q

What is the cut-off for a pathological QT interval?

A

= interval > 480ms is considered pathological

391
Q

What may be used in patients with a high risk, with long QT-syndrome?

A

= implanatable defibrillator

392
Q

What is malrotation?

A

= congenital anomaly in which the midgut undergoes abnormal rotation and fixation during embryogenesis

The misplacement of the gut makes it susceptible to volvulus

393
Q

Common complication of malrotation?

A

= volvulus

394
Q

How might a neonate with malrotation present?

A

= bilious vomiting occuring within the first day of life

395
Q

Gold-standard investigation for diagnosing malrotation?

A

= upper GI contrast study

396
Q

How is malrotation managed?

A

= urgent surgical intervention to relieve obstruction, and correct anatomical abnormality

397
Q

What is measles?

A

= highly contagious disease caused by the measles morbillivirus. It is transmitted via droplets from the nose, mouth, or throat of infected persons

398
Q

What are ‘koplik spots’, and what are they pathognomonia for?

A

= small grey discolorations of the mucosal membranes in the mouth

Pathognomonic for measles

399
Q

First line investigation for measles?

A

= measles-specific IgM and IgG serology (ELISA)

Most sensitive 2-14 days after onset of the rash

400
Q

Management of measles

A

= mostly supportive care

401
Q

What is important to give children < 2 with measles?

A

= vitamin A

402
Q

Complications of measles (3)

A
  • acute otitis media
  • bronchopneumonia
  • encephalitis
403
Q

What is meckel’s diverticulum?

A

= small outpouching extending from the wall of the intestine and located in the lower portion of the asmall intestine

404
Q

What is the ‘rule of 2s’, in relation to Meckel’s diverticulum? (4)

A
  • 2:1 (M:F)
  • 2 inches long
  • 2 feet proximal to caecum
  • affects 2% of population
405
Q

What scan is used to investigate a suspected Meckel’s diverticulum?

A

= CT scan

406
Q

Meckle’s diverticulum: What is a 99mTC scan used to identify?

A

= ectopic gastric mucosa

407
Q

Management of Meckle’s diverticulum?

A

= surugical resection (either wedge excision or small bowel resection and anastomosis)

408
Q

Complciations of Meckle’s diverticulum? (3)

A
  • intussusception
  • obstruction
  • ulceration and perforation
409
Q

What is meconium aspiration syndrome (MAS)?

A

= triggered by the passage of meconium from the amniotic fluid into the foetal lungs, leading to blockage and inflammation of the airways

410
Q

What is meconium ileus?

A

= condition characterised by the thickening of meconium causing obstruction in the neonatal bowel

411
Q

Meconium ileus can be an early indicator of what condition?

A

= cystic fibrosis

412
Q

What % of meconium ileus cases are linked to cystic fibrosis?

  • 30%
  • 50%
  • 90%
A
  • 90%
413
Q

Investigation for suspected meconium ileus?

A

= abdominal x-ray

414
Q

Abdominal x-ray: ‘bubbly’ appearance of the intestines without air-fluid levels is indicative of what condition?

A

= meconium ileus

415
Q

Meconium ileus: What does ‘drip and suck’ entail? (2)

A
  • IV fluids
  • stomach decompression w/ Ryles tube
416
Q

What is meningitis?

A

= an inflammatory condition involving the meninges, which are the protective membranes covering the brain and spinal cord

417
Q

Patient presents with fever, severe headache, neck stiffness, photophobia and confusion, what is the likely diagnosis?

A

= meningitis

418
Q

Investigations for meningitis (3)

A
  • lumbar puncture + CSF analysis
  • blood cultures
  • neuroimaging (CT or MRI)
419
Q

Management of meningitis? (4)

A
  • broad-spectrum antmicrobias
  • antivirals (if viral cause)
  • corticosteroids, reduce inflammation
  • supportive management
420
Q

What is a meningococcal infection?

A

= disease caused by Neisseria meningitidis bacterium, a gram-negative intracellular diplococcus

It resides in the nasopharynx of many children + young adults, with some strains having the potential to invade the bloodstream and cause fatal septicaemia

421
Q

What is waterhouse-friedrichsen syndrome? and what is it associated with?

A

= rare, but life threatening disorder assocaited with bilateral adrenal haemorrhage

Associated with meningococcal infection

422
Q

How is meningococcal infection investigated? (2)

A
  • cultures, blood and CSF
  • PCR testing for Neisseria meningitidis (highly sensitive)
423
Q

Causative agent in meningococcal infection?

A

= Neisseria meningitidis

424
Q

Is meningococcal infection a notifiable disease?

A

= yes

425
Q

What is mesenteric adenitis?

A

= reactive inflammatory condition that primarily involves the mesenteric lymph nodes in the abdomen

Usually occurs after initial infection has resolves

Is a common mimic of appendicitis

426
Q

Mesenteric adenitis is

  • active inflammation of the lymph nodes
  • a reactive process which usually occurs after initial infection has resolved
A
  • a reactive process which usually occurs after initial infection has resolved
427
Q

What is mesenteric adenitis commonly confused for?

A

= appendicitis

428
Q

What imaging can help diagnose mesenteric adenitis?

A

= USS abdomen

(revelas enlarged mesenteric lymph nodes and a normal appendix)

429
Q

Management of mesenteric adenitis?

A

= self-limiting, observe and reassure

430
Q

What is minimal change disease?

A

= condition that primarily affects the kidneys. Despite causing significant clinical symptoms, the disease is marked by minimal or no changes visible under light microscopy in nephrological structures

(however, more subtle changes can be detected using electron microscopy)

431
Q

Most common cause of nephrotic syndrome in children?

A

= minimal change disease

432
Q

5 year old child presents with facial swelling, fatigue, and has noticed his urine is more fronthy then usual. He had a viral upper viral respiratory infection 2 weeks ago.

What is the likely diagnosis?

A

= minimal change disease

(most common cause of nephrotic syndrome in a child)

433
Q

First-line pharacological treatment in minimial change disease?

A
  • corticosteroid therapy, Prednisolone

+ fluid restriction

434
Q

What can be given in severe cases of minimal change disease with significant fluid overload? (2)

A
  • human albumin
  • furosemide
435
Q

Prognosis of minimal change disease (1/3,1/3,1/3)

A

1/3: resolve completely
1/3: relapses requiring additional steroid treatment
1/3: dependent on continued steroid/ immunosuppression therapy

436
Q

What is muscular dystrophy?

A

= refers to a group of inherited genetic disorders characterised by the progressive degeneration and weakening of the body’s muscles

437
Q

2 most common types of muscular dystrophy?

A
  • Duchenne’s muscular dystrophy
  • Becker muscular dystrophy
438
Q

Muscular dystrophy is

  • autosomal dominant
  • automomal recessive
  • x-linked recessive disorder
  • x-linked dominant disorder
A
  • x-linked recessive disorder

(predominantly males affected)

439
Q

Which protein is affected in muscular dystrophy?

A

= dystrophin gene

440
Q

Which of the following types of muscular dystrophy presents in early childhood?

  • Duchenne’s MD
  • Becker’s MD
A
  • Duchenne’s MD
441
Q

Which of the following types of muscular dystrophy is associated with dystrophin gene expressed at lower levels, and dysfunctional?

  • Duchenne’s MD
  • Becker’s MD
A
  • Becker’s MD

(in DMD, protein is virtually absent)

442
Q

What is a positive Gower’s manoeuvre a sign of?

A

= duchenne’s muscular dystrophy

443
Q

Describe a positive Gower’s manoeuvre

A
  • gets into prone position
  • forms a triangle
  • climbs on own thighs to stand up

(due to proximal muscule weakness)

444
Q

Gold-standard test for diagnosing muscular dystrophy?

A

= genetic testing

445
Q

Apart from genetic test, what can be used as a first-line screening tool for muscular dystrophy?

A

= creatinine kinase (CK)

Levels significantly high

446
Q

Muscular dystrophy: what medical management can be used to help slow muscle degeneration?

A

= glucocorticoids

447
Q

What is nocturnal enuresis also known as?

A

= bedwetting

448
Q

What is nocturnal enuresis?

A

= also referred to as bedwetting, condition in which an individual, usually a child, involuntarily urinates during sleep

considered to be a typical part of development until the age of 5

449
Q

Up to what age is nocturnal enuresis typical of normal development?

A

= up to the age of 5

450
Q

Primary vs secondary nocturnal enuresis?

A

Primary: involves children who have never achieved urinary continence overnight

Secondary: refers to children who have previously achieved night-time continence but have subsequently lost it

451
Q

Investigations for primary nocturnal enuresis? (3)

A
  • history
  • examination
  • urine dip
452
Q

1st line management option for nocturnal enuresis?

A

= nocturesis alarm

453
Q

What is a nocturesis alarm, what does it do?

A

= device that detects moisture in underwear, activating ana alarm and alerting child to wake up and go to the bathroom

These alarms are generally effective in training children

454
Q

Apart from nocturesis alarm what can be useful in managing nocturnal enuresis?

A

= star charts - rewarding positive behaviours

455
Q

For children > 7 with nocturnal enuresis that have not responded to the alarm, what can be prescribed?

A

= DDACP (synthetic ADH), reduced urine production overnight

456
Q

What is non-accidental injury?

A

= any physical harm in a child that is deliberately inflicted or results from the failure of a caregiver to prevent such harm

457
Q

What investigations may be done if non-accidental injury is suspected?(2)

A
  • radiology, skeletal survey
  • bloods, rule-out clotting disorders or haematological malignancies
458
Q

If non-accidental injury is suspected what is imporant to rule out that would be an alternative cause of bruising? (2)

A
  • clotting disorders
  • haematological malignancies
459
Q

Management in suspected non-accidental injury? (5)

A
  • report suspcions to senior
  • safeguarding measures to admit child whilst investigations continue
  • appropriate medical management
  • documentation (clear and thorough)
  • social care liaison (to make their own investgation)
460
Q

What is oesophageal atresia?

A

= refers to congenital disorder in which the oesophagus terminates in a blind-ended pouch rather than connecting to the stomach

461
Q

What is a tracheo-oesophageal fistula?

A

= an abnormal communication between the trachea and the oesophagus

462
Q

Signs and symptoms of oesophageal atresia? (antenatal 1, postnatal 4)

A

(antenatal)
- polyhydramnios

(postnatal)
- respiratory distress
- distended abdomen
- choking or problems with swallowing
- difficulty in pass a NG tube

463
Q

Radiological finding in oesophageal atresia (NG tube)

A

= typically involved in a coiled NG tube on an anterioposterior chest radiograph

464
Q
A

Year 3 (10 decks)

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