paediatrics

Question 1

childhood seizures- flexion of the head, trunk, and limbs, followed by extension of the arms (known as Salaam attacks).

Answer 1

infantile spasms

first 4-6 months of life

An EEG would show hypsarrhythmia

Question 1

childhood seizures- aged 6 months to 5 years, temperature, tonic clonic

Answer 1

febrile seizures

still need the same safety netting and treatment as usual seizures but unlikely to cause epilepsy

Question 2

childhood epilepsy syndromes - partial seizures at night time. usually upper limb and face

Answer 2

Benign rolandic epilepsy

unilateral

no loss of consciousness

between 4-12 years of age

centrotemporal spikes confirms the diagnosis

seizures originate from the central sulcus of the brain in a region called the Rolandic fissure

Excellent prognosis- most children outgrow it

Question 3

childhood seizures- in adolescence actually and characterised by infrequent generalised myoclonic seizures in the morning or following sleep deprivation.

Answer 3

Juvenile myoclonic epilepsy

lack of consciousness

Question 4

haemolytic anaemias - what age do they present and what conditions do they encompass and what are the key symptoms

Answer 4

sickle cell, thalasemmia, hereditary spherocytosis
pale, jaundice, sob, spleenomegaly or splenectomy /infarction. +/- dark urine, gall stones, high ferritin and limb ischaemia.
around 6 months

Question 5

when is TOF repaired and what is given in the meantime?

Answer 5

presents at around 1-2 months- tet spellls, blue lips, not feeding and ejection systolic murmur.
wait until their heart grows to be able to do adequate surgery - around 6-months of age

cyanotic spells are managed with b-blockers (to reduce infundibular spasm and thus prevent worsening of RV outflow obstruction).

Question 6

six diagnostic criteria for Kawasaki disease

Answer 6

The hallmark of KD is fever lasting 5 days or more, counting the day of fever onset as day in addition to 4 or 5 of the principal clinical criteria

1. cracking of lips or strawberry tongue
2. nonpurulent conjunctivitis
3. rash
4. erythema and edema of the hands and feet
5. large ≥1.5cm usually unilateral cervical lymphadenopathy

Question 7

high head big ears big balls

Answer 7

fragile X

Question 8

3 innocent heart murmurs in children

Answer 8

Venous hum= turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles
Stills murmur = left lower sternal edge, due to turbulent flow - exaccerbated by anxiety exercise or stress. often described as a string being plucked on a violin, ejection systolic.
Pulmonary flow murmur = a high-pitched, harsh heart murmur that indicates a disturbance in blood flow to the lungs, probably what you had. radiates to axilla and back. Loudest when the child is supine. May be caused by increased flow from anemia, pyrexia, or exercise

Question 9

rate of fluid resus for shock in children ?

Answer 9

Start IV fluid resuscitation in children or young people with a bolus of 10 ml/kg over less than 10 minutes

Question 10

duodenal atresia and hirsprungs both cause constipation and bilious vomitting. both associated with down syndrome, how to distinguish without imaigng?

Answer 10

TIMING

Duodenal atresia often shows up on antenatal screening. It presents with bilious vomiting hours after birth. They can still pass meconium +/- some other stool that is made up of the various GI secretions and sloughing.

hirsprungs will show up with bilious vomitting after a few days (back up of poo).

STOMACH APPEARANCE
In duodenal atresia you get a characteristic flat abdomen.

Hirsprungs- distended abdomen, full of shit and gas

Question 11

NSAIDs can increase the risk of what in patients with chicken pox

Answer 11

NSAIDs can increase the risk of necrotising fasciitis in patients with chicken pox

Question 12

boney pain at night, tenderness and fever in the lower femur, upper tibia differnetials in a 10 year old. why is this site common?

Answer 12

osteomyelitis (commonest site)
osteosarcoma and osteoid osteoma
benign nocturnal limb pain of childhood (without fever)

more suspicious if unilateral.
Approach - examine for lumps, bloods and blood cultures, XR (will show osteosarcoma but will not show osteomyelitis or benign nocturnal limb pain of childhood) so MRI may be better and is less radiation!

+/- juvenille arthritis but less likely to present this way and usually morning fever and systemic symptoms such as uveitis, and other joints are also affected.

why is this site common?
1. vascular = so more risk of infection
2. metaphysis is where growth occurs = increased cell turnover makes cancer more likely
3. where muscles attach = making DOMS (part of BNIPC more common)

Question 13

kocher criteria?

Answer 13

for septic arthritis
predicts probability of septic arthritis
The probability of septic arthritis increases with the total number of points: 0 points: <0.2, 1 point: 3, 2 points: 40, 3 points: 93, and 4 points: 97

1. ESR >40mm/hr
2. Fever >38.5
3. Cant weight bare
4. Raised WCC

Question 14

management approach for ?fractures in kids and adults…

Answer 14

5Rs
reduce and assess VAN
resus
retain
reassess
rehabilitate

Question 15

minimal change disease presentation and risks.

Answer 15

• MASSIVE proteinuria, hypoalbuminemia, edema, and HYPERLIPIDEMIA
• Clinically this shows up as periorbital edema and pitting edema of the lower extremities (remember person in Bangor!)
• Risk of infections due to urinary loss of immunoglobulins, thromboembolism, and, in rare cases, progression to chronic kidney disease.
  *corticosteroids first line

Question 16

Hydronephrosis symptoms

Answer 16

Usually asymptomatic unless bilateral!
*clues may be the cause i.e., PUV, UPJ, VUR !