Paediatrics

Question 1

Paediatric BLS FIRST STEP

Answer 1

give 5 rescue breaths if there are no signs of breathing on initial assessment.- mitigate hypoxia first before checking for signs of circulation

Question 2

Paediatric BLS SECOND STEP

Answer 2

Start chest compressions at a ratio of 15:2

Question 3

Acute lymphoblastic leukaemia Features

Answer 3

anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae

Question 4

most common cause of headaches in children

Answer 4

Migraine is the most common cause of primary headache in children

Question 5

pneumococcal vaccination schedule?

Answer 5

The pneumococcal vaccine is routinely given at 3 months and 12-13 months

Question 6

Which vaccines are given at 4 months?

Answer 6

‘6 in 1’ vaccine is given, which includes diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B. The Men B vaccination is also given at four months old.

Question 7

Pyloric stenosis typically presentations.

Answer 7

1. presents around 2-6 weeks of age
2. Infants tend to have projectile vomiting following feeds
3. remain hungry after vomiting
4. Olive shaped mass in the right upper quadrant due to hypertrophy of the pylorus
5. ‘waves of peristalsis’ may be seen following a test feed.

Question 8

Galactosaemia ?

Answer 8

1. Autosomal recessive metabolic conditions which can present with failure to thrive and vomiting in infancy.
2. Detected by the newborn Guthrie skin-prick test, and ‘oil drop’ cataracts may be noted on examination.

Question 9

Turner’s syndrome is associated with?

Answer 9

1. where an X chromosome is missing (genotype 45, X).
2. Short stature (being in the 9th percentile of height), short fourth metacarpals, primary amenorrhoea, poorly developed secondary sexual characteristics (poor breast growth), and a high arched palate all point towards Turner’s.
3. A complication of Turner’s syndrome is a bicuspid aorta, which is present in 15% of cases. This gives an ejection systolic murmur in the aortic region (right sternal border at the 2nd intercostal space), which can be described as a crescendo-decrescendo murmur due to the steady rise and fall in sound corresponding to the force of ventricular contraction against the stenosed valve.
4. Ejection systolic murmur due to bicuspid aortic valve

Question 10

risk factor for the development of surfactant deficient lung disease in the newborn?

Answer 10

Maternal diabetes mellitus.

Surfactant deficient lung disease, also known as neonatal respiratory distress syndrome (RDS), is more common in infants born to mothers with diabetes mellitus. This is because insulin, which is increased in diabetic mothers, inhibits surfactant production and maturation of the fetal lungs.

Question 11

Maternal pregnancy-induced hypertension risk factor?

Answer 11

Lead to preterm birth which is a significant risk factor for RDS due to the immaturity of the lungs at birth.

Question 12

Risk factor for surfactant-deficient lung disease

Answer 12

caesarean section without labour increases the risk of RDS compared to vaginal delivery due to lack of exposure to stress hormones during labour which promotes lung maturation.

Question 13

past medical history of a mild non-IgE mediated egg allergy. What treatment would you recommend?

Answer 13

The egg ladder can be used to reintroduce egg in children with a non-IgE mediated allergy.

In this case, chlorpheniramine (Piriton) is an inappropriate choice as it would cause drowsiness and would only give symptomatic relief. An adrenaline pen is not indicated. Scrambled egg is high up the egg ladder, instead, start with baked egg in biscuits.

Question 14

How should his routine childhood immunisations be given in premature babies?

Answer 14

Babies who were born prematurely should receive their routine vaccinations according to chronological age; there should be no correcting for gestational age. Babies who were born prior to 28 weeks gestation should receive their first set of immunisations at hospital due to risk of apnoea.

Question 15

features consistent with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD

Answer 15

Poor concentration
Impulsiveness
Uncontrolled activity
Extreme restlessness

Question 16

Eczema

Answer 16

Atopic eczema in children typically presents before the age of 2 years.
usually involves the face and extensor surfaces of the body as opposed to its classical flexural distribution. This patient is under the age of 2, with visible dermatitis in the extensor aspects of her body, and therefore a diagnosis of atopic eczema can be made clinically.

Question 17

Features of Osteosarcoma?

Answer 17

1. unexplained lump
2. unexplained bone pain
3. unexplained swelling.

Question 18

autosomal dominant conditions?

Answer 18

Achondroplasia
Acute intermittent porphyria
Adult polycystic disease
Antithrombin III deficiency
Ehlers-Danlos syndrome
Familial adenomatous polyposis
Hereditary haemorrhagic telangiectasia
Hereditary spherocytosis
Hereditary non-polyposis colorectal carcinoma
Huntington’s disease
Hyperlipidaemia type II
Hypokalaemic periodic paralysis
Malignant hyperthermia
Marfan’s syndromes
Myotonic dystrophy
Neurofibromatosis
Noonan syndrome
Osteogenesis imperfecta
Peutz-Jeghers syndrome
Retinoblastoma
Romano-Ward syndrome
tuberous sclerosis
Von Hippel-Lindau syndrome
Von Willebrand’s disease

Question 19

Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias

Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II

Answer 19

Autosomal recessive conditions are often thought to be ‘metabolic’ as opposed to autosomal dominant conditions being ‘structural’, notable exceptions:
some ‘metabolic’ conditions such as Hunter’s and G6PD are X-linked recessive whilst others such as hyperlipidaemia type II and hypokalaemic periodic paralysis are autosomal dominant
some ‘structural’ conditions such as ataxia telangiectasia and Friedreich’s ataxia are autosomal recessive

Question 20

Basic outline of child health surveillance in the UK?

Answer 20

Newborn: Clinical examination of newborn. Newborn Hearing Screening Programme e.g. oto-acoustic emissions test
Give mother Personal Child Health Record

First month Heel-prick test day 5-9 - hypothyroidism, PKU, metabolic diseases, cystic fibrosis, medium-chain acyl Co-A dehydrogenase deficiency (MCADD)
Midwife visit up to 4 weeks*

Following months: ju’‘Health visitor input
GP examination at 6-8 weeks
Routine immunisations

Pre school National orthoptist-led programme for pre-school vision screening to be introduced

Ongoing Monitoring of growth, vision, hearing
Health professionals advice on immunisations, diet, accident prevention

Question 22

Impetigo

Answer 22

Impetigo is a bacterial infection that typically affects exposed skin areas (such as the mouth’s and nostril’s border). It results in a vesicular eruption with an erythematous border which evolves into a characteristic ‘golden crust’. This patient’s findings (symmetrical dry rash involving the extensor aspects of the limbs) are more in keeping with eczema.

Question 23

Pemphigus vulgaris

Answer 23

This autoimmune condition results in widespread blistering, which involves oral and genital mucosa. This patient’s findings (symmetrical dry rash involving the extensor aspects of the limbs) are more in keeping with eczema.

Question 24

Psoriasis

Answer 24

It is rare for psoriasis to affect infants. Psoriasis typically results in a plaque and silvery scale and maybe a differential in a child presenting with treatment-refractory seborrhoeic dermatitis. This patient’s findings (symmetrical dry rash involving the extensor aspects of the limbs) are more in keeping with eczema.

Question 25

Scabies

Answer 25

This condition is the result of mite infection. Scabies can result in a generalised, intensely pruritic eruption in infants; however, there would be evidence of linear burrowing and lesions associated with papules. Scabies also has a predilection for the volar aspect of the wrist, the periumbilical region, and the interdigital webspace. This patient’s findings (symmetrical dry rash involving the extensor aspects of the limbs) are more in keeping with eczema.

Question 26

investigation of choice for intussusception

Answer 26

Ultrasound

Question 27

intussusception

Answer 27

the invagination of a portion of the bowel into the lumen of the adjacent bowel. It typically affects infants between 6-18 months old, more commonly boys. Patients present with episodic, severe abdominal pain and inconsolable crying, with drawing up of the knees during episodes. The classic, ‘redcurrant jelly’ stool is a late sign. A sausage-shaped mass in the right upper quadrant is often palpable.

Management involves reduction by air insufflation, or surgery if this fails or the child is peritonitic.

Question 28

blood transfusion consent for treatment age?

Answer 28

Over the age of 16 a child is assumed competent to consent for treatment.

If the child were not consenting the blood could be given in best interests without her or her parents consent using the Children Act 1989 and a High Court Order. Such an order can be obtained from a judge in writing or verbally within thirty minutes.

Question 29

carrier rate of cystic fibrosis in the UK?

Answer 29

1 in 25

Question 30

initial management for duct dependent congenital heart disease?

Answer 30

Prostaglandin E1 - Maintenance of the ductus arteriosus.

given intravenously to neonates with transposition of the great arteries (TGA) to maintain the ductus arteriosus, ensuring a route of alternate blood flow. The parallel circulatory systems caused by TGA means that ductus arteriosus closure will result in profound cyanosis and circulatory failure.

Prostaglandins maintain the patency of the ductus arteriosus through dilation of vascular smooth muscle. Physiologically in the foetus, the prostaglandin-rich placenta allows the ductus arteriosus to remain open, and deprivation from this environment after delivery results in its constriction.

Therefore, administering prostaglandins after delivery will maintain the ductus arteriosus until corrective surgery can be performed.

Question 31

hypospadias - treatment prevent it worsening?

Answer 31

Corrective surgery at around 12 months of age is required and children should not be circumcised