Paediatrics Flashcards
What method of chest compressions is correct to use in infants?
Two-thumb circling technique
What are the most common clinical signs associated with neonatal sepsis?
Grunting and other signs of respiratory distress
At what age would the average child acquire the ability to sit without support?
6-8 months
What are the clinical signs of pyloric stenosis?
Projectile vomiting after every feed in a young baby
What investigation is diagnostic for pyloric stenosis?
Abdominal ultrasound
What is the most likely cause of ambiguous genitalia in a newborn?
Congenital adrenal hyperplasia
Describe the clinical features of idiopathic thrmbocytopenic purpura
Petechial rash in an otherwise well child
When might a bone marrow biopsy be indicated in a child presenting with idiopathic immune thrombocytopenia?
If the child is presenting with atypical signs e.g. splenomegaly, bone pain, diffuse lymphadenopathy - may suggest an underlying myoproliferative malignancy
A mother comes to surgery with her 6-year-old son. During the MMR scare she decided not to have her son immunised. However, due to a recent measles outbreak she asks if he can still receive the MMR vaccine. What is the most appropriate action?
Give MMR with repeat dose in 3 months
Describe the clinical presentation of epiglottitis
- Abrupt onset and rapid progression (within hours) of dysphagia, drooling, and distress
- Patients frequently adopt the ‘tripod’ position to maximise airway opening - patient leaning forward and extending their neck when seated
When reviewing a child with suspected bronchiolitis, what features would make you consider another diagnosis?
According to NICE, you should consider pneumonia if the child has a high fever (over 39°C) and/or persistently focal crackles
A 12-year-old female presents to her GP with bilateral knee pain, swelling and stiffness. On examination, a salmon-pink rash is noted on the legs.
What is the most likely diagnosis?
Juvanile idiopathic arthritis
What are some of the risk factors for neonatal sepsis?
- GBS infection - mother with prev. baby with GBS, colonisation identified on screening, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy
- Premature (>37 weeks)
- Low birth weight (<2.5kg)
- Evidence of maternal chorioamnionitis
Name 4 common causes of constipation in children
- Dehydration
- Anal fissure
- Hirschsprung’s disease
- Hypercalcaemia
What is the most appropriate management plan for a child with suspected whooping cough?
Prescribe azithromycin and report to Public Health (notifiable disease)
When can a child with rubella return to school?
5 days from onset of rash
When can a child with scarlet fever return to school?
24 hours after commencing antibiotics
When can a child with hand, foot and mouth return to school?
No exclusion required
What feature of tetralogy of falloy determines severity?
Degree of pulmonary stenosis (right ventricular outflow obstruction)
What is the peak incidence of bronchiolitis?
3-6 months of age
What is the rate of compressions to breaths in paediatric life support?
15:2
Describe the clinical features of Turner’s syndrome
- Short stature
- Shield chest, widely spaced nipples
- Webbed neck
- Bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
- Primary amenorrhoea
- Lymphoedema in neonates (especially feet)
- Gonadotrophin levels will be elevated
Name the cardiac murmur associated with Turner’s syndrome
Ejection systolic due to bicuspod aortic valve
What is the investigation of choice to look for renal scarring in a child with vesicoureteric reflux?
Radionuclide scan using dimercaptosuccinic acid (DMSA)
Describe the clinical features of chickenpox
- Fever initially
- Itchy, rash starting on head/trunk before spreading - initially macular then papular then vesicular
- Systemic upset is usually mild
Describe the clinical features of measles
- Prodrome: irritable, conjunctivitis, fever
- Koplik spots: white spots (‘grain of salt’) on buccal mucosa
- Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
Describe the clinical features of mumps
- Fever, malaise, muscular pain
- Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%
Describe the clinical features of rubella
- Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
- Lymphadenopathy: suboccipital and postauricular
Describe the clinical features of erythema infectiosum
- Also known as fifth disease or ‘slapped-cheek syndrome’
- Caused by parvovirus B19
- Lethargy, fever, headache
- ‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
Describe the clinical features of Scarlet fever
- Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
- Fever, malaise, tonsillitis
- ‘Strawberry’ tongue
- Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
Describe the clinical features of hand, foot and mouth disease
- Caused by the coxsackie A16 virus
- Mild systemic upset: sore throat, fever
- Vesicles in the mouth and on the palms and soles of the feet
Name one condition that children with VSD are at increased risk of
Endocarditis
What are the features of a life-threatening asthma attack?
- SpO2 <92%
- PEF <33% best or predicted
- Silent chest
- Poor respiratory effort
- Agitation
- Altered consciousness
- Cyanosis
When should you immediately refer a child with bronchiolitis for observation and oxygen therapy?
- Apnoea (observed or reported)
- Persistent oxygen saturation of <92% in air
- Inadequate oral fluid intake (<50% of normal fluid intake)
- Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
What features make up the triad of ‘shaken baby syndrome’?
Retinal haemorrhages, subdural haematoma and encephalopathy
Describe the clinical features of an umbilical granuloma
- Consist of cherry red lesions surrounding the umbilicus, they may bleed on contact and be a site of seropurulent discharge
- Infection is unusual and they will often respond favourably to chemical cautery with topically applied silver nitrate
In cases of patients with recurrent febrile seizures, what may be prescribed to be administered during febrile episodes to abort or reduce the duration of seizures?
Benzodiazepine rescue medication for recurrent febrile seizures (rectal diazepam or buccal midazolam)
What is the most common complication of measles?
Otitis media
What immunisations are given at birth?
BCG if risk factors
What immunisations are given at 2 months?
- ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
- Oral rotavirus vaccine
- Men B
What vaccinations are givenat 3 months?
- ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
- Oral rotavirus vaccine
- PCV
What vaccinations are given at 4 months?
- ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B)
- Men B
What vaccinations are given at 12-13 months?
- Hib/Men C
- MMR
- PCV
- Men B
What vaccinations are given between 2-8 years?
Flu vaccine (annual)
What vaccinations are given between 3-4 years?
- 4-in-1 pre-school booster’ (diphtheria, tetanus, whooping cough and polio)
- MMR
What vaccination is given 12-13 years?
HPV vaccination
What vaccinations are given 13-18 years?
- ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio)
- Men ACWY
What is a common complication of chickenpox?
Secondary bacterial infection of the lesion:
- Risk may be increased by NSAIDs
- Commonly manifests as a single infected lesion or small area of cellulitis, but in small number of patients invasive group A strep soft tissue infections may occur resulting in necrotizing fasciitis
What is the term used to describe the mode of inheritance for Prader-Willi syndrome?
Imprinting - phenotype depends on whether the deletion occurs on a gene inherited from the mother or father
What is the most common cause of death associated with measles?
Pneumonia
What age should a child be able to crawl?
9 months
What age should a child be able to walk unsupported? At what age would you refer a child who was unable to do this?
- Should be able to walk unsupported 13-15 months
- Should refer at 18 months
When should a child be able to hold objects in palmar grasp?
6 months
When should a child be able to point with their finger?
9 months
At what time of year is croup the most common?
Autumn months
What is a CF-specific contraindication to lung transplantation?
Chronic infection with Burkholderia cepacia
What results from a blood gas
are associated with pyloric stenosis?
Hypochloraemic, hypokalaemic alkalosis
Why is ibuprofen not recommended in chickenpox?
NSAIDs can increase the necrotising fasciitis
What is the first line management for viral-induced wheeze (episodic viral wheeze)?
Oral montelukast or inhaled corticosteroid
How is Duchenne muscular dystrophy usually diagnosed?
Genetic analysis (rather than muscle biopsy)
At what ages is the oral rotavirus vaccine given?
2 months + 3 months
What are the red flags regarding colour for the NICE paediatric system?
- Pale/mottled/ashen/blue
What are the red flags regarding activity for the NICE paediatric system?
- No response to social cues
- Appears ill to a healthcare professional
- Does not wake or if roused does not stay awake
- Weak, high-pitched or continuous cry
What are the respiratory red flags for the NICE paediatric system?
- Grunting
- Tachypnoea: respiratory rate >60 breaths/minute
- Moderate or severe chest indrawing
What are the red flags regarding hydration for the NICE paediatric system?
Reduced skin turgor
Under what age is a fever >=38°C a red flag in paeds?
< 3 months
What is the first line investigation for development dyplasia of the hip in children > 4.5 months?
X-ray
What is the most common cause of respiratory distress in the newborn? What causes this?
- Transient tachypnoea of the newborn - caused by delayed resorption of fluid in the lungs
- More common in caesarean sections
Describe the management of transient tachpnoea of the newborn
Observation and supportive care +/- oxygen
What is the cutoff for height centile which warrants a paediatric referral?
Children below 0.4th centile for height
What is a cephalhaematoma?
Swelling on the newborns head due to bleeding between the periosteum and the skull
Describe the clinical features of a cephalohaematoma
- Typically develops several hours after birth
- Most commonly in the parietal region, doesn’t cross suture lines
- May take months to resolve
What is caput succedaneum?
An extraperiosteal collection of blood present on the head of a newborn
Describe the clinical features of caput succedaneum
- Present at birth
- Typically forms over the vertex and crosses over the suture lines
- Resolves within days
Describe the clinical features of Kawasaki disease
- High fever lasting >5 days
- Red palms with desquamation
- Strawberry tongue
Describe the clinical features of roseola infantum
- Characteristic 3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever
- The fever is typically rapid onset and can often predispose to febrile convulsions
- The rash typically starts on the trunk and limbs
- HHV6 is neurotropic (attacks the nervous system) and thus a rare complication is encephalitis and febrile fits (after cessation of the fever)
Name the organism which causes roseola infantum
Human herpes virus 6
Describe the clinical features of fragile X syndrome in males
- Learning difficulties
- Large low set ears, long thin face, high arched palate
- Macroorchidism
- Hypotonia
- Autism is more common
- Mitral valve prolapse
- Macrocephaly
A child with a UTI at what age warants an immediate paediatric referral?
> 3 months
What is the difference between oligoarticular and systemic-onset juvenile idiopathic arthritis?
- Oligoarticular JIA is the most common presentation and is characterised by pain and stiffness in up to 4 (usually larger) joints, with fever and fatigue
- Other associated symptoms include rash, fever, dry or gritty eyes
- Systemic-onset juvenile idiopathic arthritis is a subset of JIA that requires the onset of joint symptoms accompanied by regular and intermittent fevers for diagnosis
What are the Kocher criteria for the diagnosis of septic arthritis?
- Fever >38.5 ℃
- Non-weight bearing
- Raised ESR (> 40 mm/hr)
- Raised WCC (> 12 10^9/L)
Each parameter is worth 1 point; estimates probability of septic arthritis (0 = very low risk, 4 = 99% probability)
At what age would the average child start to play alongside, but not interacting with, other children?
2 years
A 14-month-old girl is diagnosed as having roseola infantum. What is the most common complication of this disease?
Febrile convulsions
At what ages is the routine Men B vaccine given?
2, 4 and 12-13 months
A baby is born at term via vaginal delivery with no complications, however he is still not showing signs of breathing at one minute. Heart rate is >100bpm, but he is floppy and cyanosed. What is the most appropriate next step in management?
5 breaths of air via face mask
The mother of a 6-week-old baby girl born at 32 weeks gestation asks for advice about immunisation. What should happen regarding the first set of vaccines?
Give as per normal timetable
What is the usual management for bronchiolitis?
Supportive management only (ensuring to discharge with safety netting)
If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance, what method of feeding should be tried?
Extensive hydrolysed formula
If fails - amino acid-based formula
If a formula-fed baby is suspected of having severe (e.g. failure to thrive) cow’s milk protein intolerance, what method of feeding should be tried?
Amino acid-based formula (+ referral to paediatrician)
At what age would a child be expected to ask ‘what’ and ‘who’ questions?
3 years
At what age would a child be expected to combine two words?
2 years
At what age would a child be able to ask ‘why’, ‘when’ and ‘how’ questions?
4 years
Name 2 cardiac conditions associated with Turner’s syndrome
- Coarctation of the aorta
- Bicuspid aortic valve
When should you consider referring a child with bronchiolitis to hospital?
- A respiratory rate of over 60 breaths/minute
- Difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
- Clinical dehydration
What is the investigation of choice for stable children with suspected Meckel’s diverticulum?
Technetium scan
Describe the clinical features of Patau syndrome
- Microcephalic, small eyes
- Cleft lip/palate
- Polydactyly
- Scalp lesions
Describe the clinical features of Edward’s syndrome
- Micrognathia
- Low-set ears
- Rocker bottom feet
- Overlapping of fingers
Describe the clinical features of Noonan syndrome
- Webbed neck
- Pectus excavatum
- Short stature
- Pulmonary stenosis
Describe the clinical features of Pierre-Robin syndrome
- Micrognathia
- Posterior displacement of the tongue (may result in upper airway obstruction)
- Cleft palate
Describe the clinical features of William’s syndrome
- Short stature
- Learning difficulties
- Friendly, extrovert personality
- Elfin facies
- Transient neonatal hypercalcaemia
- Supravalvular aortic stenosis
Describe the clinical features of Prader-Willi syndrome
- Hypotonia
- Hypogonadism
- Obesity
Describe the clinical features of cri du chat syndrome
- Characteristic cry (hence the name) due to larynx and neurological problems
- Feeding difficulties and poor weight gain
- Learning difficulties
- Microcephaly and micrognathism
- Hypertelorism
Can a child under 16 refuse treatment if their parents want treatment?
No - the family law reform act of 1969 states that ‘those over 16 can consent to treatment, but cannot refuse treatment under 18 unless there is one consenting parent, even if the other disagrees
Describe the clinical features of immune thrombocytopenic purpura
- Mucosal bleeding
- Epistaxis
- Petechiae and bruising
How would you differentiate between immune thrombocytopenic purpura and acute lymphoblastic leukaemia?
Bloods - normal haemoglobin and WCC in ITP
A 35-year-old pregnant woman presents with premature labour at 30 weeks gestation. What is the most important treatment for prevention of neonatal respiratory distress syndrome?
Administer dexamethasone to the mother
What is the management of infantile colic?
Reassurance and support
What is the usual age for the presentation of intussusception?
3 months - 3 years
When is the neonatal blood spot screening test typically performed in the United Kingdom?
Between fifth and ninth day of life
What is the definition of neonatal death?
Babies dying between 0-28 days of birth
What is the definition of a stillbirth?
Babies born dead after 24 weeks
What is phimosis?
A non-retractable foreskin; may cause ballooning during micturition
Describe the management of phimosis
- Child under 2 - reassure and review, usually resolves
- Forcible retraction can result in scar formation so should be avoided
- If the child is over 2 years of age and has recurrent balanoposthitis or urinary tract infection then treatment can be considered
What is gastroschisis?
- Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord
- Abdominal contents will be outside the body, without a peritoneal covering
What is the management of gastroschisis?
- Vaginal delivery may be attempted
- Newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
What is exomphalos?
The abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum
What is the management of exomphalos?
- Caesarean section is indicated to reduce the risk of sac rupture
- A staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressure
What is the most likely causative agent of a bacterial pneumonia in children?
S. pneumoniae
What are the poor prognostic factors for acute lymphoblastic leukaemia?
- Age < 2 years or > 10 years
- WBC > 20 * 109/l at diagnosis
- T or B cell surface markers
- Non-Caucasian
- Male sex
Name the causative organism for scarlet fever?
Group A haemolytic streptococci
What treatment should be given to a child with severe croup who is experiencing significant respiratory distress?
Oxygen + nebulised adrenaline
A 14-year-old girl presents with a swollen left knee. Her parents state she suffers from haemophilia and has been treated for a right-sided haemarthrosis previously. What other condition is she most likely to have?
- Turner’s syndrome
- Haemophilia is a X-linked recessive disorder and would hence be expected only to occur in males; as patients with Turner’s syndrome only have one X chromosome however, they may develop X-linked recessive conditions
At what age would the average child be expected to run?
16 months - 2 years
At what age would the average child be expected to ride a tricycle using pedals?
3 years
What is the management of cradle cap (seborrhoeic dermatitis)?
Baby shampoo and baby oil
Describe the clinical features of chondromalacia patellae
- Softening of the cartilage of the patella
- Common in teenage girls
- Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting
- Usually responds to physiotherapy
Describe the clinical features of Osgood-Schlatter disease
- Seen in sporty teenagers
- Pain, tenderness and swelling over the tibial tubercle
If a child is seriously unwell and their parents cannot be contacted, what is the correct course of action?
GMC guidance states: you can provide emergency treatment without consent to save the life of, or prevent serious deterioration in the health of, a child or young person
Describe the clinical features of osteochondritis dissecans
- Pain after exercise
- Intermittent swelling and locking
Describe the clinical features of patellar subluxation
- Medial knee pain due to lateral subluxation of the patella
- Knee may give way
Describe the clinical features of patellar tendonitis
- More common in athletic teenage boys
- Chronic anterior knee pain that worsens after running
- Tender below the patella on examination
By 2 years, how many words would most children be able to use?
By 23-24 months most children would have a vocabulary of between 20-50 words and will be able to join 2 words with meaning
Describe the clinical presentation of Hirschsprung’s disease
- Neonatal period e.g. failure or delay to pass meconium
- Older children: constipation, abdominal distension
What is the gold-standard diagnosis for Hirschsprung’s disease?
Rectal biopsy
What is the management of Hirschsprung’s disease?
- Initially: rectal washouts/bowel irrigation
- Definitive management: surgery to affected segment of the colon
List 4 causes of jaundice the first 24 hours of life
Always pathological:
- Rhesus haemolytic disease
- ABO haemolytic disease
- Hereditary spherocytosis
- Glucose-6-phosphodehydrogenase
- Sepsis
Describe the presentation of Kawasaki disease
High fever lasting >5 days, red palms with desquamation and strawberry tongue
Describe the presentation of ALL
ALL is the most common childhood leukaemia and presents with anaemia, neutropaenia and thrombocytopaenia
What advise should you give to the household of children diagnosed with threadworms?
Household contacts of patients with threadworms should be treated even if they have no symptoms (oral mebendazole)
What is plagiocephaly?
Skull deformity producing unilateral occipital flattening, which pushes the ipsilateral forehead ear forwards producing a ‘parrallelogram’ appearance
What is the most appropriate management for plagiocephaly?
Reassurance - the vast majority improve by age 3-5 due to the adoption of a more upright posture
What babies require US screening for DDH?
- First-degree family history of hip problems in early life
- Breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
- Multiple pregnancy
A 4-year-old boy is brought to the clinic by his mother who has noticed a small lesion at the external angle of his eye. On examination there is a small cystic structure which has obviously been recently infected. On removal of the scab, there is hair visible within the lesion. What is the most likely diagnosis?
Dermoid cyst
What investigations should be performed in infants younger than 3 months with fever?
- Full blood count
- Blood culture
- C-reactive protein
- Urine testing for urinary tract infection
- Chest radiograph only if respiratory
signs are present - Stool culture, if diarrhoea is present
Describe the presentation of necrotising enterocolitis
Initial symptoms can include feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis
What is the diagnostic investigation for necrotising enterocolitis?
AXR
What is the first line management for children with mycoplasma pneumonia?
Erythromycin
Bruises at different stages of healing should raise suspicion of what?
NAI
You review a 3-year-old girl who is being treated for idiopathic constipation with Movicol Paediatric Plain. Her mother has increased the dose but unfortunately there has been no response. She remains well and examination of the abdomen is normal. What is the most appropriate next step?
Add senna
X-linked conditions are only seen in?
Males
Is male-male transmission seen in x-linked recessive conditions?
No
Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress should make you consider what diagnosis?
Congenital diaphragmatic hernia
What is the best initial management for a congenital diaphragmatic hernia?
Intubation and ventilation
What is the management for paediatric intestinal malrotation with volvulus?
Ladd’s procedure (includes division of Ladd bands and widening of the base of the mesentery)
Describe the presentation of pertussis (whooping cough)
- The initial phase presents with coryzal symptoms (runny nose, sneezing), progressing to severe bouts of coughing that can cause the child to turn red and even vomit
- This is followed by an inspiratory ‘whoop’ sound, although it may not always be present especially in infants
What is palivizumab?
Monoclonal antibody which is used to prevent respiratory syncytial virus (RSV) in children who are at increased risk of severe disease.
What chromosome is affected in Patau syndrome?
13
What is the management of whooping cough?
Azithromycin or clarithromycin if the onset of cough is within the previous 21 days
At what age would the average child start to say ‘mama’ and ‘dada’?
9-10 months
What features in bronchiolitis would suggest immediate referral to hospital?
- Apnoea (observed or reported)
- Child looks seriously unwell to a healthcare professional
- Severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
- Central cyanosis
- Persistent oxygen saturation of less than 92% when breathing air
Child aged < 5 years with asthma not controlled by a SABA + paediatric low-dose ICS. What next?
Add a leukotriene receptor antagonist
What are the features of a patent ductus arteriosus?
- Left subclavicular thrill
- Continuous ‘machinery’ murmur
- Large volume, bounding, collapsing pulse
- Wide pulse pressure
- Heaving apex beat
What are Epstein’s pearls?
- Ccongenital cyst found in the mouth
- May be mistaken for teeth
What are the risk factors for developmental dysplasia of the hip?
- Female sex: 6 times greater risk
- Breech presentation
- Positive family history
- Firstborn children
- Oligohydramnios
- Birth weight > 5 kg
- Congenital calcaneovalgus foot deformity
A 2-month-old boy is brought to the afternoon surgery by his mother. Since the morning he has been taking reduced feeds and has been ‘not his usual self’. On examination the baby appears well but has a temperature of 38.7ºC. What is the most appropriate management?
Admit to hospital
What is the most useful investigation to screen for the complications of Kawasaki disease?
Echcardiogram
Precocious puberty in males may be defined as the development of secondary sexual characteristics before what age?
9 years
Precocious puberty in females may be defined as the development of secondary sexual characteristics before what age?
8 years
What is the most common complication of measles?
Otitis media
A GP incidentally discovers a murmur in an 8-year-old girl. The murmur is described as a ‘continuous blowing noise’ heard below both clavicles.
What is the most likely type of murmur diagnosed?
Venous hum
Venous hum is a benign murmur heard in children and sounds like a continuous blowing noise heard below the clavicles
How long should a child be excluded from school when they have whooping cough?
48 hours following commencement of antibiotics
What is the management of chickenpox?
Management is through supportive measures, including calamine lotion to soothe the itch and paracetamol to control the fever
What is the recommended compression: ventilation ratio for the newborn?
3:1
At what times should you assess the APGAR scores?
NICE recommend that APGAR scores are routinely assessed at 1 and 5 minutes of age
What are the components of the APGAR score?
- Appearance (colour)
- Pulse (heart rate)
- Grimace (reflex irritability)
- Activity (muscle tone)
- Respiratory effort
What are the features of fragile x syndrome in males?
- Learning difficulties
- Large low set ears, long thin face, high
- Arched palate
- Macroorchidism
- Hypotonia
- Autism is more common
- Mitral valve prolapse
Name 3 risks associated with undescended testes
Increased risk of infertility, torsion and testicular cancer
A 16-year-old female presents with chronic left knee pain. The pain is typically felt after jogging. There is also intermittent swelling and locking of the same joint. What is the most likely diagnosis?
Chondromalacia patellae
What are the features of achondroplasia?
Short limbs (rhizomelia) with shortened fingers (brachydactyly)
Large head with frontal bossing and
Narrow foramen magnum
Midface hypoplasia with a flattened nasal bridge
‘Trident’ hands
Lumbar lordosis
What are the most common fractures in NAI?
Radial, humeral, femoral
What are the presenting features of cystic fibrosis?
Neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
Recurrent chest infections (40%)
Malabsorption (30%): steatorrhoea,
Failure to thrive
Other features: liver disease, short stature, diabetes mellitus, delayed puberty, rectal prolapse, nasal polyps, infertility/subfertility
You review a 10-year-old girl with increasing constipation over the past 4 years, having normal bowel habit beforehand. The rest of the history and examination are normal. She is on no medication at present.
What would be an appropriate next step in the management?
Osmotic laxative
When is the first dose of the MMR vaccine given routinely?
12-13 months
According to NICE guidelines on febrile seizures, when should an ambulance be called?
If a febrile convulsion lasts >5 minutes
What is the most common presenting feature of Wilms tumour?
Abdominal mass
What is the initial empirical therapy for meningitis if > 3 months of age?
IV 3rd generation cephalosporin e.g. ceftriaxone
If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance, then what should be tried?
Extensive hydrolysed formula should be tried
A newborn baby boy presents with mild abdominal distension and failure to pass meconium after 24 hours. X- Ray reveals dilated loops of bowel with fluid levels. The anus appears normally located.
What is the most likely diagnosis?
Hirschsprungs disease
What type of vaccine is rotavirus?
Oral, live attenuated vaccine
Name a late complication of Down syndrome
Alzheimer’s disease
What are the normal observations for an infant?
Healthy infants should have a respiratory rate between 30-60 breaths per minute, a regular pulse between 100-160 beats per minute in a newborn, temperature of around 37 Celsius
What examination finding is seen in SUFE?
Reduced internal rotation of the leg in flexion
You are asked to see a baby on the post-natal ward 10 hours post vaginal delivery. The midwife informs you that the mother was positive for group B streptococcus. On examination you note a yellow discolouration to the skin. What is the next most appropriate action to take?
Measure serum bilirubin within 2 hours
A 2-year-old boy is brought to the clinic by his mother who has noticed that he has developed a small mass. On examination; a small smooth cyst is identified which is located above the hyoid bone. On ultrasound the lesion appears to be a heterogenous and multiloculated mass.
What is the most likely diagnosis?
Dermoid cyst
What is the management of pyloric stenosis?
Ramstedt pyloromyotomy
A 9-year-old girl is brought to surgery as her mother is concerned that she is too fat. This has now been a problem for over two years and mum feels this is holding her back at school. What is the most appropriate method to ascertain how obese she is?
Body mass index percentile adjusted to age and gender
Describe the presentation of a cephalohaematoma
- A cephalohaematoma appears as a swelling due to bleeding between the periosteum and the skull
- It is most commonly noted in the parietal region and is associated with instrumental deliveries
- The swelling usually appears 2-3 days following delivery and does not cross suture lines
- It gradually resolves over a number of weeks
Describe the presentation of caput succadeneum
- Commonly seen in newborns immediately after birth
- It occurs due to generalised superficial scalp oedema, which crosses suture lines
- It is associated with prolonged labour and will rapidly resolve over a couple of days
A 10-year-old boy presents to the emergency department with his mother who is very concerned as she has noticed a non-blanching petechial rash on his arms and legs. The child has had a recent cold but today his observations are normal and he appears well otherwise.
What is the most likely diagnosis?
ITP
By what age should a child be able to talk in short sentences (e.g. 3-5 words)?
2-5-3 years
By what age should a child have a vocabulary of 2-6 words?
12-18 months
By what age should a child be able to respond to their own name?
9-12 months
True/ false: children with headlice should be excluded from school
False
Describe the presentation of roseola infantum
- Tharacterised by a 3-5 day high fever followed by a 2 day maculopapular rash which starts on the chest and spreads to the limbs
- This generally occurs as the fever is disappearing
What organism causes roseola infantum?
Herpes virus 6
Describe the presentation of slapped-cheek syndrome (erythema infectiosum)
Coryza and fever followed by a red rash
What organism causes slapped-cheek syndrome (erythema infectiosum)
Parvovirus B19
Where in the childhood immunisation schedule is the Meningitis B vaccine given?
2, 4, and 12 months
When can a child with scarlet fever return to school?
24 hours after commencing antibiotics
For autosomal recessive conditions, if both parents are carriers (heterozygote), what is the chance the child will be affected?
25%
What is the inheritence pattern of sickle cell disease?
Autosomal recessive
Describe the presentation of intussusception
- Intermittent, severe, crampy,
- Progressive abdominal pain
- Inconsolable crying
- During paroxysm the infant will characteristically draw their knees up and turn pale
- Vomiting
- Bloodstained stool - ‘red-currant jelly’ - is a late sign
- Sausage-shaped mass in the right upper quadrant
Describe the presentation of gonadotrophin independent precocious puberty
In gonadotrophin dependent precocious puberty (GDPP), or ‘central’ precocious puberty, the levels of the gonadotrophins LH and FSH would be high and testes would be large for age
What causes gonadotrophin dependent precocious puberty?
- In GIPP symptoms are caused by increased levels of sex hormones, for example, testosterone, leading to the suppression of LH and FSH
- Increased sex hormone secretion may be due to ovarian, testicular or adrenal causes like congenital adrenal hyperplasia. In boys, the testicular volume will tend to be normal or small
A 5-year-old child presents to the emergency department complaining of right iliac fossa pain. On examination there is no rebound tenderness or guarding. Urine dipstick and routine bloods come back as normal. The mother reports that her daughter had a viral infection a few days ago.
What’s the most likely diagnosis?
Mesenteric adenitis
Child aged 5-16 years with asthma not controlled by a SABA + paediatric low-dose ICS + leukotriene receptor antagonist
What next?
Add a LABA and stop the leukotriene receptor antagonist
What are the most common causes of cardiac arrest in children?
Respiratory
A 2-year-old boy is brought to the Emergency Department, during the autumn period, with severe dyspnoea at rest. He has been unwell for the past week with a barking cough and inspiratory stridor which are typically worse in the late evening. On examination, intercostal and subdiaphragmatic recessions are noticeable. A chest radiograph shows tapering of the upper trachea.
What is the most likely causative organism for this boy’s presentation?
Parainfluenza virus (croup)
In paediatric BLS, where are the appropriate places to check for a pulse?
Brachial and femoral arteries
How long does meconium take to pass?
Within the first 24 hours
What investigation is used to screen newborns for hearing problems?
Otoacoustic emission test
Ultrasound reveals large patent ductus arteriosus prenatally.
What is the management?
Indomethacin
How do you perform the Barlow manoeuvre?
Attempts to dislocate an articulated femoral head
How do you perform the Ortolani manoeuvre?
Attempts to relocate a dislocated femoral head
Describe the management of asymptomatic neonatal hypoglycaemia
Encourage normal feeds and monitor glucose
What is the investigation of choice for intussusception?
Ultrasound
What is the typical distribution of atopic eczema in a 10 month old child?
Face and trunk
When would you consider an enuresis alarm?
Child age > 5 and general advice has not helped
A 4-day-old girl who was diagnosed prenatally with Down’s syndrome and born at 38 weeks gestation presents with bilious vomiting and abdominal distension. She is yet to pass meconium.
What is the most likely diagnosis?
Hirschprung’s disease
A 2-year-old boy is seen by his GP with an enlarging neck swelling that has been present for the past year. On examination you note a smooth midline lesion which is round and located just below the hyoid bone. It measures 2.5 cm x 2 cm and rises on protrusion of the tongue.
What is the most likely diagnosis?
Thyroglossal cysts
What are the complications of chickenpox?
- Secondary bacterial infection of the lesions
- Pneumonia
- Encephalitis
- Disseminated haemorrhagic chickenpox
- Arthritis, nephritis and pancreatitis may very rarely be seen
Name a side effect of methylphenidate
Stunted growth
A 4-year-old boy is found collapsed and unresponsive. On examination, there is no visible airway obstruction. There are no signs of life and there is no evidence of any respiratory efforts being made. His airway has been opened and help has been called for and is on its way.
Of the options listed, what is the most appropriate next step in his management?
Give 5 rescue breaths
Prodrome is characterised by fever, irritability and conjunctivitis
What is the most likely diagnosis?
Measles
. May cause vesicles in the mouth and on the palms
What is the most likely causative organism?
Coxsackie A16
A baby is born by elective Caesarean section at 38 weeks performed due to pregnancy-induced hypertension. At one hour the female baby is noted to be grunting with mild intercostal recession. Oxygen saturations are 95-96% on air. What is the most likely cause of her respiratory distress?
Transient tachypnoea of the newborn
RDS typically presents with more severe respiratory distress, including tachypnoea, nasal flaring, and audible expiratory grunting in infants born before 37 weeks
A 3-year-old is brought by his Mum to your surgery. He has had a fever and has been refusing to eat. Mum has noticed some spots on his hands and buttocks. On examination, the child has a mild vesicular rash on the hands, buttocks, face and a few spots on his ankles. His temperature is 38.1ºC. Your records state that he had chicken pox when he was 9 months old. What is the most likely diagnosis?
Hand, foot and mouth disease
A 10-month male infant is brought to the GP by his mother with concerns over using his right hand in preference to the left.
What is the appropriate management for this patient?
Refer urgently to paediatrician
Hand preference before 12 months is abnormal - it could be an indicator of cerebral palsy
What is gastroschisis?
Describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord
Describe the management of gastroschisis
- Vaginal delivery may be attempted
- Newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
What is exomphalos?
In exomphalos (also known as an omphalocoele) the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum
Describe the management of exomphalos
- Caesarean section is indicated to reduce the risk of sac rupture
- A staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressure
A 3-week-old infant is brought to the GP by his mother who is concerned about a 5-day history of ‘sticky eyes’. On examination, the infant looks systemically well and all observations are within normal range. He has bilateral purulent discharge of the eyes and moderate conjunctival injection.
What is the appropriate management of this patient?
Should be referred for same-day ophthalmology/paediatric assessment
Ophthalmia neonatorum
Describe the presentation of bronchiolitis
Coryzal symptoms (including mild fever) precede:
- Dry cough
- Increasing breathlessness
- Wheezing, fine inspiratory crackles (not always present)
- Most common cause of a serious lower respiratory tract infection in < 1yr olds
Describe the management of bronchiolitis
Bronchiolitis does not require antibiotics, children requires supportive management only
How often should chest physiotherapy and postural drainage ideally be performed in patients with CF?
Chest physiotherapy and postural drainage should be performed at least twice daily in the chronic management of cystic fibrosis
Describe the presentation of measles
Measles is characterised by prodromal symptoms, Koplik spots, maculopapular rash starting behind the ears and conjunctivitis
Describe the presentation of biiary atresia
Patients typically present in the first few weeks of life with:
- Jaundice extending beyond the
physiological two weeks - Dark urine and pale stools
- Appetite and growth disturbance, however, may be normal in some cases
What type of bilirubin is raised in biliary atresia?
Conjugated bilirubin
A 15-year-old boy from Birmingham is brought to surgery by his mother complaining of abdominal pains for the past two days. On examination there is a clinical suspicion of appendicitis and a referral to hospital is planned. On discussing this with the patient he refuses to be admitted as he had planned to go to a party tonight. He is able to understand all information you give him and repeat it, including the serious nature of untreated appendicitis.
What is the most appropriate course of action?
His mother may overrule his wishes
Absent or weak femoral pulses at 6-8 week baby check.
What is the next step in management?
Same day discussion with paediatrics
A 7-year-old boy is brought in to the GP surgery with an exacerbation of asthma. On examination he has a bilateral expiratory wheeze but there are no signs of respiratory distress. His respiratory rate is 24 / min and PEF around 60% of normal.
What is the most appropriate action with regards to steroid therapy?
Oral prednisolone for 3 days
How do you calculate the corrected age of a premature baby?
Age minus the number of weeks he/she was born early from 40 weeks
