Paediatrics

Question 1

Developmental milestones for 6 weeks old: Gross motor

Answer 1

1.) Good head control – raises head to
45o when on tummy,
2.) Stabilises head when raised to sitting
position

Question 2

Developmental milestones for 6 weeks old: Fine motor

Answer 2

1.) Tracks face/object

Question 3

Developmental milestones for 6 weeks old: Speech/language

Answer 3

1.) startles at loud noise

Question 4

Developmental milestones for 6 weeks old: Social

Answer 4

Social smile

Question 5

Developmental milestones for 6 months old: Gross motor

Answer 5

Gross Motor:
1.) Sit without support, rounded back
2.) Rolls tummy (prone) to back (supine)
. Vice versa slightly later.

Question 6

Developmental milestones for 6 months old: Fine motor skills

Answer 6

Palmer grasp
Transfer hand to hand

Question 7

Developmental milestones for 6 months old: Language and speech

Answer 7

1.) Turns head to loud sounds
2.) Understands “bye bye” / “no” (7m)
3.) Babbles (monosyllabic)

Question 8

Developmental milestones for 6 months old: Social

Answer 8

1.) Puts objects to mouth (stops at 1yr)
2.) Shakes rattle
3.) Reaches for bottle / breast

Question 9

Developmental milestones for 9 months old: Gross motor skills

Answer 9

Gross Motor:
1.) Stands holding on
2.) Sit up straight

Question 10

Developmental milestones for 9 months old: Fine motor skills

Answer 10

1.) Inferior pincer grip
2.) Object permanence

Question 11

Developmental milestones for 9 months old: Language and Speech

Answer 11

1.) Responds to own name
2.) Imitates adult sounds

Question 12

Developmental milestones for 9 months old: Social

Answer 12

Holds and bites food
Stranger fears

Question 13

Developmental milestones for 12 months old: Gross motor

Answer 13

Walks alone

Question 15

A 12-year old girl presented with palpitation for a few week and after performing an ECG was shown to have supraventricular tachycardia. What are the 3 types of SVT?

Answer 15

1) AVRT (including WPW)
2) Atrial:
-Sinus Tachycardia- Regular
-Atrial fibrillation - Irregular
-Atrial Flutter - Regular
3) AVNRT (functional) = most common SVT

Question 16

What are the measures to treat SVT (Both non-pharmacological in a stable patient, and pharmacological)

Answer 16

Non-pharmacological interventions:
Valsalva manoeuvre
Immersing face in ice water

Pharmacological:
Adenosine (first-line)
Amiodarone
Propranolol

Question 17

Describe the features of Wolff-Parkinson-White syndrome on an ECG

Answer 17

o Delta waves
o Short PR interval
o Wide QRS complex (>120 ms)

Question 18

Treatment for WPW (3)

Answer 18

1.) Vagal Manoeuvres
2.) IV Adenosine
3.) Synchronised DC Cardioversion

Question 19

What is contraindicated in WPW

Answer 19

Digoxin

Question 20

If SVT persists unrecognised how might infants present with?

Answer 20

1) pallor
2) poor feeding
3) vomiting
4) may progress to lethargy and shock

Question 21

What structural malformations are associated with SVT? (3)

Answer 21

1. Ebstein anomaly (Tricuspid valve defect)
2. Transposition of great arteries
3. Hypertrophic cardiomyopathy (heart muscles thickened)

Question 22

3 Months Boy presents with Failure to Thrive for 1 Month. What are the possible differentials?

Answer 22

Inadequate intake:
o Organic: impaired sucking, anorexia
o Non-organic: Psychosocial deprivation

Inability to retain:
o Vomiting
o severe GERD

Malabsorption:
o lactose intolerance, milk intolerance
o IBD, Celiac disease
o short gut syndrome, post necrotising enterocolitis (NEC)

Inability to utilize nutrient
o Chromosomal: Down, IUGR
o Metabolic: congenital hypothyroidism, storage disorder, amino acid disorder

Increase energy demand
o Thyrotoxicosis, malignancy, chronic infection, CHF, CRF, VSD

Question 23

Heart failure in neonates. Likely reason and causes? (4)

Answer 23

An obstructed systemic circulation
1.) Hypoplastic left heart syndrome
2.) Aortic stenosis
3.) Severe coarctation of the aorta
4.) Interruption of the aortic arch

Question 24

Heart failure in infants. Likely reason and causes? (3)

Answer 24

High pulmonary blood flow (Left-to-right shunts) - occurs when blood leaks from the systemic circulation to the pulmonary circulation

1.) Ventricular septal defect (VSD) - Hole between R and L ventricles that leads to O2 rich blood flowing back into lungs

2.) Atrioventricular septal defect (AVSD) - Hole between atrium and ventricle

3.) Large patent ductus arteriosus (PDA) - opening between a baby’s aorta and pulmonary artery is large, causing irregular blood flow and increased pressure in the lungs

Question 25

Heart failure in older children and adolescents. Likely reason and causes?

Answer 25

Right/ left heart failure

1.) Eisenmenger syndrome - congenital heart defect causes abnormal blood circulation in the lungs and heart

2.) Rheumatic heart disease - heart valves damaged by rheumatic fever

3.) Cardiomyopathy

Question 26

A 3 month old boy presents with a large VSD with Heart Failure. What are the symptoms he may present with.

Answer 26

o Respiratory distress (e.g. during feeding), dyspnea, tachypnea
o Poor feeding and feeding difficulty
o Poor weight gain
o Sweating
o Recurrent chest infection

Question 27

What are the 2 major reason for FTT in heart failure

Answer 27

o Use a lot of energy to overcome symptoms of congenital heart disease
o Reduced milk intake due to respiratory distress

Question 28

What are the Common ddx of heart failure with heart murmur in 3 months old?

Answer 28

(heart failure in infant period usually due to high pulmonary blood flow = left to right shunt)

Large VSD, AVSD, PDA

Question 29

Management for heart failure in infants

Answer 29

Supportive & Nutrition (O2, calorie input) (no fluid and salt restriction in paediatrics unless very
severe)

Pharmacological:
o Diuretics to treat pulmonary and venous congestion: furosemide, spironolactone (K
sparing)
o Inotropic support: digoxin (less used now), dobutamine
o Afterload reduction: ACEI (captopril, only syrup form), hydralazine
o Surgical (Types & Timing)
* can be done at 3-6months old to prevent pulmonary HT
* Open surgical closure
* Interventional catheterization with occlusion device

Question 30

A boy presenting with vomiting, abdominal pain and rapid breathing and acid-base results suggesting DKA
with respiratory compensation. ABG: Na 152 / K 6.2 / pO2 normal / PCO2 low / HCO3 low / BE -20

Describe the Acid-base balance abnormality

Answer 30

Metabolic acidosis with partial respiratory compensation

Respiratory acidosis we would expect an elevated PCO2 and a near normal or elevated HCO3. A near normal HCO3 would indicate no metabolic compensation while an elevated concentration would represent some level of metabolic compensation.

If the process was a metabolic acidosis, we would expect to see a declined HCO3 level and a near normal or lower PCO3. The former indicates no respiratory compensation and the latter represents some level of respiratory compensation for metabolic acidosis.

Question 31

DKA signs

Answer 31

Kussmaul breathing
Pear drop breath
Reduced skin turgor