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Paediatrics Flashcards

1
Q

What are the normal ranges for heart rate in the following age ranges?

  • <1
  • 1-2
  • 2-5
  • 5-12
  • > 12
A 
<1: 110-160
1-2: 100-150
2-5: 90-140
5-12: 80-120
>12: 60-100
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2
Q

What are the normal ranges for respiratory rate in the following age ranges?

  • <1
  • 1-2
  • 2-5
  • 5-12
  • > 12
A 
<1: 30-40
1-2: 25-35
2-5: 25-30
5-12: 20-25
>1: 15-20
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3
Q

What would recurrent respiratory infections and weight loss in a child suggest?
What are some other features of this disorder or disease?

A

Cystic fibrosis

Features:

  • Short statue
  • DM
  • Delayed puberty
  • Rectal prolapse (2 to bulky stools)
  • Nasal polyps
  • Male infertility
  • Female subfertility
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4
Q

In meningitis when is LP contraindicated?

A

Meningococcal septicaemia (raised ICP_

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5
Q

What is the Abx of choice in meningitis?
<3 months
>3 months

A

<3 months: IV amox + IV cefotaxime
>3 months: IV cefotaxime

If >1 month and H. influenzae then also give dexamethasone.

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6
Q

What is used for antibiotic prophylaxis of meningitis contacts?

A

Ciprofloxacin

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7
Q

What test would you order in an infant with jaundice lasting >14 days?

A

Coomb’s test (direct antiglobulin)

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8
Q

What is fragile X syndrome?

What are its features?

A

Trinucleotide repeat disorder

Features in males:

  • Learning difficulties
  • large low set ears, long thin face, high arched palate
  • macroorchidism
  • hypotonia
  • autism is more common
  • mitral valve prolapse

Females (heterozygous), may be normal/mild symptoms

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9
Q

How is Fragile X diagnosed?

A

Antenatally: CVS or amnio

CGG repeats analysis using endonuclease digestion and southern blot analysis.

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10
Q

What is palivizumab?

When is it used?

A

Monoclonal antibody used to prevent RSV in children at risk of severe disease - Premature infants, those with lung or heart abnormalities, immunocompromised

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11
Q

What is the most common ocular malignancy in children?

A

Retinoblastoma

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12
Q

What is the pathophysiology of retinoblastoma? Is it hereditary?
What is the prognosis?

A

LOF of retinoblastoma tumour suppressor gene on chromosome 13
10% hereditary

Prognosis is excellent, with >90% surviving into adulthood

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13
Q

What are the presenting features of retinoblastoma?

How is it managed?

A
  • Absence of red-reflex (most common)
  • Strabismus
  • Visual problems

Mx:
- Enucleation, external beam radiation therapy, chemo, photocoagulation

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14
Q

What is the most common causative organism in Scarlet fever? What specifically causes the reaction?

A

Group A haemolytic streptococci (usually Streptococcus pyogenes).

Reaction is to the erythrogenic toxins.

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15
Q

When are the two doses of MMR vaccine given?

What are the potential SE?

A

12-15 months, then 3-4 years.

May have an episode of malaise, fever and rash after first dose, typically after 5-10 days, lasting 2-3 days.

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16
Q

What are the contraindications to MMR?

A
  • severe immunosuppression
  • allergy to neomycin
  • children who have received another live vaccine by injection within 4 weeks
  • pregnancy should be avoided for at least 1 month following vaccination
  • immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)
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17
Q

In ADHD when would you advise avoiding certain foods/ using fatty acid supplements?

A

Only after a food diary has shown a link between diet and behaviour - Use an MDT approach including a dietitian.

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18
Q

What are the side effects of methylphenidate (ritalin)?

What monitoring is needed?

A

Abdo pain, nausea, dyspepsia

Monitor growth every 6 months (not usually affected), monitor for psychiatric disorders and check blood pressure/pulse every 6 months

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19
Q

What are the cardiac associations with Turner’s syndrome?

A
  • Bicuspid aortic valve
  • Aortic root dilatation
  • Coarctation of the aorta
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20
Q

What is Mesenteric adenitis?

What is the Mx?

A

Inflamed lymph nodes within the mesentery.

It can cause similar symptoms to appendicitis. It often follows a recent viral infection and needs no treatment

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21
Q

When is the neonatal blood spot screening carried out?

What does it screen for?

A

= Guthrie test/heel-prick test
5-9 days of life.

Screens for:

  • Congenital hypothyroidism
  • CF
  • Sickle
  • Phenylketonuria
  • Medium chain acyl-CoA dehydrogenase deficiency (MCADD)
  • Maple syrup urine disease (MSUD)
  • Isovaleric acidaemia (IVA)
  • Glutaric aciduria type 1 (GA1)
  • Homocystinuria (pyridoxine unresponsive) (HCU)
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22
Q

What is Bartter’s syndrome?

Features?

A

Inherited (autosomal recessive) severe hypokalaemia due to defective chloride absorption at the Na+ K+ 2Cl- cotransporter in the ascending loop of Henle.

NORMOtension

  • Usually presents in childhood with failure to thrive
  • Hypokalaemia
  • Polyuria, polydypsia
  • Weakness
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23
Q

What are the causes of a false negative CF sweat test?

A
  • Skin oedema (most common - often due to hypoalbuminaemia/ hypoproteinaemia secondary to pancreatic exocrine insufficiency.)
  • Poor technique
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24
Q

What are the causes of a false positive CF sweat test?

A
  • malnutrition
  • adrenal insufficiency
  • glycogen storage diseases
  • nephrogenic diabetes insipidus
  • hypothyroidism, hypoparathyroidism
  • G6PD
  • ectodermal dysplasia
  • atopic eczema
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25
Q

What is the initial emergency management of a unresponsive child that has arrested?

A
  • unresponsive?
  • shout for help
  • open airway
  • look, listen, feel for breathing
  • give 5 rescue breaths
  • check for signs of circulation
  • IF 2+ MEDICAL RESCUERS: 15 chest compressions:2 rescue breaths
    Lay rescuers should use 30:2
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26
Q

What are the developmental speech milestones at 3 months?

A
  • Quietens to parents voice
  • Turns towards sound
  • Squeals
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27
Q

What are the developmental speech milestones at 6 months?

A
  • Double syllable mumbles
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28
Q

What are the developmental speech milestones at 9 months?

A

Says ‘mama’ and ‘dada’

Understands ‘no’

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29
Q

What are the developmental speech milestones at 12 months?

A

Knows and responds to name

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30
Q

What are the developmental speech milestones at 12-15 months?

A

Knows about 2-6 words (refer at 18 months)

Understands simple commands

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31
Q

What are the developmental speech milestones at 2 years?

A

Combine two words

Points to parts of the body

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32
Q

What are the developmental speech milestones at 2.5 years?

A

Vocabulary of 200 words

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33
Q

What are the developmental speech milestones at 3 years?

A

Talks in short sentences (3-5 words)
Asks ‘what’ and ‘who’ questions
Identifies colours
Counts to 10

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34
Q

What are the developmental speech milestones at 4 months?

A

Asks ‘why’, ‘when’ and ‘how’ questions

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35
Q

What is toddler’s diarrhoea?

What would you do to exclude underlying conditions?

A

Benign condition causing no problems to child. Due to fast transit through digestive system. Often contains undigested food. No pain/bloating.

Plot height and weight to exclude underlying coeliac etc.

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36
Q

What are the physical features of foetal alcohol syndrome?

A
  • short ­palpebral fissure
  • thin vermillion border/hypoplastic upper lip
  • smooth/absent filtrum
  • learning difficulties
  • microcephaly
  • growth retardation
  • epicanthic folds
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37
Q

What is Beckwith-Wiedemann syndrome?

Features?

A

An overgrowth disorder, usually present at birth. Characterised by an increased risk of childhood cancer - particularly Wilms tumours (kidneys) and hepatoblastoma (liver).

  • Foetal macrosomia
  • Macroglossia
  • Hypoglycaemia
  • Omphalocele
  • Umbilical hernia
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38
Q

At what times should you assess the APGAR scores?

A

0, 1 and 5 minutes

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39
Q

What gross motor milestones would you expect a child to reach by 3 months?

A
  • Little or no head lag on being pulled to sit
  • Lying on abdomen, good head control
  • Held sitting, lumbar curve
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40
Q

What gross motor milestones would you expect a child to reach by 6 months?

A
  • Lying on abdomen, arms extended
  • Lying on back, lifts and grasps feet
  • Pulls self to sitting
  • Held sitting - back straight
  • Rolls front to back
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41
Q

What gross motor milestones would you expect a child to reach by 7-8 months?

A

Sits without support (refer at 12 months)

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42
Q

What gross motor milestones would you expect a child to reach by 9 months?

A

Pulls to standing

Crawls

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43
Q

What gross motor milestones would you expect a child to reach by 12 months?

A

Cruises

Walks with one hand held

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44
Q

What gross motor milestones would you expect a child to reach by 13-15 months?

A

Walks unsupported (refer at 18 months)

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45
Q

What gross motor milestones would you expect a child to reach by 18 months?

A

Squats to pick up a toy

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46
Q

What gross motor milestones would you expect a child to reach by 2 years?

A

Runs

Walks upstairs and downstairs holding on to rail

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47
Q

What gross motor milestones would you expect a child to reach by 3 years?

A

Rides a tricycle using pedals

Walks up stairs without holding on to rail

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48
Q

What gross motor milestones would you expect a child to reach by 4 years?

A

Hops on one leg

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49
Q

What is the most likely organism to cause croup?

A

Parainfluenza virus

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50
Q

What is the most likely organism to cause whopping cough?

A

Bordetella pertussis

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51
Q

What does the Barlow test do?

A

Attempts to dislocate an articulated femoral head

B - back

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52
Q

What does the Ortolani test do?

A

Attempts to relocate a dislocated femoral head

oRto - relocate

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53
Q

What is the screening test for childhood strabismus (squint)?

A

Corneal light reflection test - hold a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils

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54
Q

Having identified strabismus, how would you identify its nature?

A
  • ask the child to focus on a object
  • cover one eye
  • observe movement of uncovered eye
  • cover other eye and repeat test
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55
Q

What causes a concomitant squint? What are the two types?

A

Imbalance in extra-ocular muscles
Convergent and divergent.
Convergent is more common.

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56
Q

What are the two types of strabismus?

A

Concomitant (common)

Paralytic (rare)

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57
Q

What type of haemorrhage may occur spontaneously in premature infants?
What may happen in the blood clots?
What is the treatment? When would shunt be indicated?

A

Intraventricular - occurs in the first 72 hours ?due to birth trauma and cellular hypoxia, together the with the delicate neonatal CNS.

Blood clots may occlude CSF flow and result in hydrocephalus.

Mx is supportive.

Shunt if hydrocephalus and rising ICP

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58
Q

What is the step-wise mx of nocturnal enuresis?

A

1: Look for triggers (UTI, DM, constipation)
2: Reduce fluid intake and try toiletting before bed
3: Reward systems
4: If under 7 enuresis alarm is first line, if over 7 use desmopressin, particularly if short-term control is required on enuresis alarm ineffective/not acceptable to family.

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59
Q

Before what age is hand preference abnormal?

What might this indicate?

A

12 months

Cerebral palsy

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60
Q

What book milestones would you expect at the following ages?:
15 months
18 months
2 years

A

15 months: Looks at book, pats page
18 months: Turns pages, several at time
2 years: Turns pages one at time

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61
Q 
A tower of how many bricks should be able to be built at?:
15 months
18 months
2 years
3 years
A

15 months: Tower of 2
18 months: Tower of 3
2 years: Tower of 6
3 years: Tower of 9

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62
Q

What fine motor and vision milestones would you expect at 3 months?

A
  • Reaches for object
  • Holds rattle briefly if given to hand
  • Visually alert, particularly human faces
  • Fixes and follows to 180 degrees
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63
Q

What fine motor and vision milestones would you expect at 6 months?

A
  • Holds in palmar grasp
  • Pass objects from one hand to another
  • Visually insatiable, looking around in every direction
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64
Q

What fine motor and vision milestones would you expect at 9 months?

A
  • Points with finger

- Early pincer

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65
Q

What fine motor and vision milestones would you expect at 12 months?

A
  • Good pincer grip

- Bangs toys together

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66
Q

What drawing milestones would you expect at 18 months?

A

Circular scribble

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67
Q

What drawing milestones would you expect at 2 years?

A

Copies vertical line

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68
Q

What drawing milestones would you expect at 3 years?

A

Copies circle

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69
Q

What drawing milestones would you expect at 4 years?

A

Copies cross

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70
Q

What drawing milestones would you expect at 5 years?

A

Copies square and triangle

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71
Q

What Ix would you undertake if you suspected an atypical UTI in an infant under 6 months?
What would be the suspicious features?

A

Ultrasound

Features of atypical UTI:

  • Seriously ill
  • Poor urine flow
  • Abdominal or bladder mass
  • Raised creatinine
  • Septicaemia
  • Failure to respond to treatment with suitable antibiotics within 48 hours
  • Infection with non-E. coli organisms.
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72
Q

At what age would a UTI warrant immediate referral to paeds?

A

<3 months

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73
Q

What are the key physical features of patau syndrome (Trisomy 13)?

A
  • Microcephalic, small eyes
  • Cleft lip/palate
  • Polydactyly
  • Scalp lesions
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74
Q

What are the key physical features of Edward’s syndrome (Trisomy 18)?

A
  • Micrognathia
  • Low-set ears
  • Rocker bottom feet
  • Overlapping of fingers
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75
Q

What are the key physical features of Fragile X syndrome?

A
  • Macrocephaly
  • Long face
  • Large ears
  • Macro-orchidism
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76
Q

What are the key physical features of Noonan syndrome?

A
  • Webbed neck
  • Pectus excavatum
  • Short stature
  • Pulmonary stenosis
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77
Q

What are the key physical features of Pierre-Robin syndrome?

How might you distinguish it from Treacher-Collins?

A
  • Micrognathia
  • Posterior displacement of the tongue (may -> upper airway obstruction)
  • Cleft palate

TCS is AD, so usually a family history of similar problems.

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78
Q

What are the key physical features of Prader-Willi syndrome?

A
  • Hypotonia
  • Hypogonadism
  • Obesity
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79
Q

What are the key physical features of William’s syndrome?

A
  • Short stature
  • Friendly, extrovert personality
  • Transient neonatal hypercalcaemia
  • Supravalvular aortic stenosis
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80
Q

What is the Mx of threadworms?

A

Single dose of mebandazole (an anthelmintic) for whole household and hygiene advice.
Repeat dose if infection persists.

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81
Q

What is intussusception?

Features? Mx?

A

Telescoping bowel, proximal to or at the level of the ileocaecal valve.
6-9 months age

Colicky pain, diarrhoea and vomiting. Sausage-shaped mass, red jelly stool.

Target sign on US (side-on view of multiple layers bowel wall)

Mx: Pneumatic reduction (air insufflation) under fluoroscopic guidance.

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82
Q

What is Hirschsprung’s disease?

Features? Mx?

A

Absence of ganglion cells from myenteric and submucosal plexuses
Occurs in 1/5000 births.
- Delayed passage of meconium and abdominal distension

Full thickness rectal biopsy for diagnosis. Plain abdo X-ray will show dilated loops of bowel with fluid levels.

Mx: rectal washouts initially, thereafter an anorectal pull thorugh procedure

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83
Q

What is Meconium ileus?
What condition is associated with this?
Presentation? X-ray findings?
Mx:

A

= Distal small bowel obstruction secondary to abnormal bulky and viscid meconium. (1/15k)
90% have CF.

Presents in first days of life with gross abdo distention and bilious vomiting.

X-ray: Distended coils of bowel with ‘mottled ground glass’ appearance. No fluid levels.

Mx: PR contrast studies - may dislodge meconium plugs. + NG N-acetyl cysteine.
If unresponsive - surgery.

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84
Q

What is the mutation in achondroplasia?

How is it inherited?

A

Mutation is in the fibroblast growth factor receptor 3 (FGFR-3) gene. This results in abnormal cartilage.

Approx 70% sporadic (RF advancing parental age) mutation, once present AD.

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85
Q

When would you expect a child to start smiling? When would you refer if not?

A

6 weeks.

Refer at 10 weeks.

86
Q

At what age would you expect a child to:

  • Play contentedly alone?
  • Play near others, not with them?
  • Play with other children?
A

Alone: 18 months
Near others: 2 years
With others: 4 years

87
Q

At what ages would you expect a child to be able to:

  • Put hand on bottle when being fed?
  • Drink from cup and use a spoon?
  • Be competent with spoon, not spill a cup?
  • Use a spoon and fork?
  • Use and knife and fork?
A

Hand on bottle: 6 months
Drink from cup and use spoon: 12-15 months
Competent with spoon, no cup spills: 2 years
Use spoon and fork: 3 years
Use knife and fork: 5 years

88
Q

What is an umbilical granuloma?

Mx?

A

= overgrowth of tissue, occurs during the healing process of the umbilicus.
Most common in the first few weeks of life.

On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.

Mx: regular application of salt to the wound.
If ineffective then can cauterise with silver nitrate.

89
Q

What is the most common cause of napkin ‘nappy’ rash?

A 
Irritant dermatitis (irritant effect of urinary ammonia and faeces).
Characteristically spares the creases.
90
Q

What would a erythematous nappy rash, involving the flexures with characteristic satellite lesions indicate?

A

Candida dermatitis

91
Q

What would an erythematous nappy rash with flakes indicate?

A

Seborrhoeic dermatitis

NB. May be coexistent scalp rash

92
Q

What type of vaccine is rotavirus?

When is it given?

A

Oral, live attenuated.

2 doses:

  • 2 months
  • 3 months
93
Q

Why are neonates given vitamin K?

How is it given?

A

To prevent haemorrhagic disease of the newborn (breast feeding and maternal use of antiepileptics puts babies particularly at risk)

Given as a once-off IM injection shortly after birth.
Can also be given orally but not recommended for healthy neonates - risk of insufficient dosing (forgetting doses or vomiting)

94
Q

What 6 common conditions would not warrant school exclusion?

A 
Conjunctivitis
Fifth disease
Roseola
Infectious mononucleosis 
Head lice
Threadworms
95
Q

How long should children with scarlet fever be excluded from school?

A

24 hours after commencing abx

96
Q

How long should children with whooping cough be excluded from school?

A

2 days after abs or 21 days from onset of symptoms if no abx

97
Q

How long should children with measles or rubella be excluded from school?

A

4 days from onset of rash

98
Q

How long should children with chicken pox be excluded from school?

A

5 days from onset of rash

99
Q

How long should children with mumps be excluded from school?

A

5 days from onset of swollen glands

100
Q

How long should children with D+V be excluded from school?

A

Until symptoms have settled for 48 hours

101
Q

How long should children with impetigo be excluded from school?

A

Until lesions have crusted over

102
Q

How long should children with scabies be excluded from school?

A

Until treated

103
Q

How long should children with influenza be excluded from school?

A

Until recovered.

104
Q

What causes Roseola infantum?

Features?

A

(=exanthem subitum, sixth disease)

Common disease of infancy caused by the human herpes virus 6 (HHV6).
Incubation period: 5-15 days and typically affects children aged 6 months to 2 years.

Features

  • high fever: lasting a few days, followed by:
  • maculopapular rash
  • febrile convulsions occur in around 10-15%
  • diarrhoea and cough are also commonly seen
105
Q

What is the Mx of Whooping cough?

A

If the onset of cough is within the previous 21 days:
<1 month: Clarithromycin
>1 month/Non-pregnant adults: Azithromycin/Clarithromycin
Pregnant adults: Erythromycin

106
Q

What is Ebstein’s anomaly?

RF?

A

Congenital heart defect:

  • Right atrial hypertrophy, small ventricle
  • Triscuspid valve leaflets attach to wall and septum of right ventricle
  • May lead to tricuspid regurgitation (pan-systolic, giant V waves JVP), 50% have Wolff-Parkinson-White.

RF: Mother taking lithium during first trimester.

107
Q

What are the features of pyloric stenosis?
Diagnosis?
Mx?

A

Features:

  • ‘projectile’ vomiting, typically 30 minutes after a feed
  • constipation and dehydration may also be present
  • a palpable mass may be present in the upper abdomen
  • hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

Dx: US
Mx: Ramstedt pyloromyotomy (LT incision in hypertrophied muscle)

108
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease (80%) (- give high dose oral steroids)

109
Q

What is the triad of nephrotic syndrome?

A
  • Proteinuria
  • Hypoalbuminaemia
  • Oedema
110
Q

What is the risk of surfactant deficient lung disease at:
26-28 weeks?
30-31 weeks?

Give 4 other risk factors?

A

26-28 weeks: 50%
30-31 weeks: 25%

RF:

  • Male sex
  • Maternal DM
  • CS
  • Second born of premature twins
111
Q

What are the characteristic x-ray findings of surfactant deficient lung disease?

A

‘Ground-glass’ appearance, with an indistinct heart border.

112
Q

What is the most common cause of juvenile hypothyroidism?

Give 2 other causes?

A

Autoimmune thyroiditis

Other causes:

  • post total-body irradiation (e.g. in a child previous treated for acute lymphoblastic leukaemia)
  • iodine deficiency (the most common cause in the developing world)
113
Q

What is the stepwise Mx of asthma in children under 5?

A

1: SABA
2: + 8-week trial moderate dose ICS - review and consider alternative diagnosis if no effect, if resolved then reoccurs:
- if within 4 weeks then restart ICS at low dose maintainance
- if after 4 weeks repeat 8-week trial

3: + leukotriene reception antagonist
4: stop LTRA and refer to paeds

114
Q

What is the stepwise Mx of asthma in children 5-16?

A

1: SABA
2: + low-dose ICS
3: + LTRA
4: Stop LTRA, start LABA
5: Switch LCS and LABA for maintenance and reliever therapy (MART) that includes low-dose ICS
6: Swap to mod-dose ICS MART
7: SABA + one of the following options:
- increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MART
- a trial of an additional drug (for example theophylline)
- seeking advice from a healthcare professional with expertise in asthma

115
Q

At what age would you expect a child to have adult visual acuity?

A

2 years

116
Q

At what age do most children achieve day and night-time urinary continence?

A

3-4 years

117
Q

What is Li-Fraumeni Syndrome?

What malignancies is it associated with?

A

AD germline mutations to p53 tumour suppressor gene

  • Sarcomas and leukaemias
118
Q

What chromosomes are BRCA1 and 2 carried on?

A

1: 17
2: 13

119
Q

What is Lynch syndrome?

What criteria are used to identify high-risk individuals?

A

= Hereditary nonpolyposis colorectal cancer (HNPCC)
Autosomal dominant

Develop colonic cancer and endometrial cancer at young age

80% of affected individuals will get colonic and/ or endometrial cancer

High risk individuals may be identified using the Amsterdam criteria

120
Q

What is the Amsterdam criteria?

A

Used to identify individuals at high risk of Lynch Syndrome

  • 3+ family members with confirmed diagnosis of colorectal ca, one of whom is a first-degree relative of the other two
  • One or more colon cancers diagnosed under age 50
  • Familial adenomatous polyposis has been excluded
121
Q

What is Gardner’s syndrome?

Features?

A

AD familial colorectal polyposis, due to mutation of APC gene located on chromosome 5.

Features:

  • Multiple colonic polyps
  • Extra-colonic diseases: skull osteoma, thyroid ca and epidermal cysts
  • 15% have desmoid tumours
  • Most patients undergo colectomy to reduce risk of colorectal ca.
122
Q

What is the risk of Down’s syndrome at the following maternal ages?

  • 20
  • 30
  • 35
  • 40
  • 45
A
  • 20: 1 in 1500
  • 30: 1 in 800
  • 35: 1 in 270
  • 40: 1 in 100
  • 45: 1 in 50/greater

NB. Can roughly remember this by starting at 1/1,000 at 30 years and then dividing the denominator by 3 (i.e. 3 times more common) for every extra 5 years of age

123
Q

What are the characteristic sequelae of congenital rubella infection?

A
  • Sensorineural deafness
  • Congenital cataracts
  • CHD
  • Glaucoma
124
Q

What are the characteristic sequelae of congenital toxoplasmosis infection?

A
  • Cerebral calcification
  • Chorioretinitis
  • Hydrocephalus
125
Q

What are the characteristic sequelae of congenital CMV infection?

A
  • Growth retardation

- Purpuric skin lesions

126
Q

What is the most common congenital infection in the UK?

A

CMV

Maternal infection is usually asymptomatic

127
Q

What is the Mx of seborrhoeic dermatitis in children?

A

Mild-mod: Baby shampoo and baby oils
Severe: Mild topical steroids e.g. 1% hydrocortisone

NB. Tends to resolve spontaneously around 8 months.

128
Q

What are the features of Kawasaki disease?
How is it diagnosed?
Complications?

A

= Uncommon type of vasculitis, pred in children.

Features:
- high-grade fever which lasts for > 5 days, characteristically resistant to antipyretics
- conjunctival injection
- bright red, cracked lips
- strawberry tongue
- cervical lymphadenopathy
- red palms of the hands and the soles of the feet which later peel
Diagnosis is clinical, no specific test.
129
Q

What is the Mx of Kawasaki disease?

What is the potential complication? How is this screened for?

A

High dose aspirin
IV immunoglobulin

Complication: Coronary artery aneurysm. Echo to screen for.

130
Q

What is the most common cause of headaches in children?

A

Migraine (without aura)

131
Q

What are the recommended immunisations at birth?

A

BCG/Hep B if risk factors

132
Q

What are the recommended immunisations at 2 months?

A

‘6-1’: Diptheria, Tetanus, Whooping Cough, Polio, HiB, Hep B

  • Oral rotavirus vaccine
  • Pneumococcal conjugate vaccine
  • Men B
133
Q

What are the recommended immunisations at 3 months?

A

‘6-1’

Oral rotavirus

134
Q

What are the recommended immunisations at 4 months?

A

‘6-1’
PCV
Men B

135
Q

What are the recommended immunisations at 12-13 months?

A

HiB/Men C
MMR
PCV
Men B

136
Q

At what ages is an annual flu vaccine recommended?

A

2-8

137
Q

What are the recommended immunisations at 3-4 years?

A

‘4-1 pre-school booster’: Diptheria, tetanus, Whooping Cough and Polio
MMR

138
Q

What are the recommended immunisations at 12-13 years in girls?

A

HPV

139
Q

What are the recommended immunisations at 13-18 years?

A

‘3-1 teenage booster’ Tetanus, Diptheria and Polio

Men ACWY

140
Q

When are the Men B vaccines given?

A

3 doses:

  • 2 months
  • 4 months
  • 12-13 months
141
Q

When are the ‘6-1’ vaccines given?

A

3 doses:

  • 2 months
  • 3 months
  • 4 months
142
Q

When are the oral rotavirus vaccines given?

A

2 doses:

  • 2 months
  • 3 months
143
Q

When are the PCV vaccines given?

A

2 doses:

  • 4 months
  • 12-13 months
144
Q

When is meconium aspiration syndrome most common?

Maternal RF?

A

In post-term deliveries, rates up to 44% reported in babies born after 42 weeks

RF:

  • HTN
  • Pre-eclampsia
  • Chorioamnionitis
  • Smoking
  • Substance abuse
145
Q

What are the 7 features of a life-threatening asthma attack?

A 
Sp02 <92%
PEF <33% best or predicted
Silent chest
Poor respiratory effort
Agitation
Altered consciousness
Cyanosis
146
Q

What are the 4 characteristic features of TOF?

A
  • VSD
  • Right ventricular hypertrophy
  • Right ventricular outflow tract obstruction, pulmonary stenosis
  • Overriding aorta
147
Q

What would a crescendo-decrescendo murmur in the upper left sternal border suggest?

A

Coartaction of aorta

148
Q

What would a pansystolic murmur in the lower left sternal border suggest?

A

VSD

149
Q

What would a continuous machinery murmur in the upper left sternal border suggest?

A

PDA

150
Q

What would an ejection systolic murmur in the upper left sternal border suggest?

A

Pulmonary stenosis

151
Q

What would a systolic murmur in the upper left sternal border with a fixed splitting to the second heart sound suggest?

A

Atrial septal defect.

152
Q

What hip disorder is associated with short stature and hyperactivity?

A

Perthes

153
Q

What is the stepwise Mx of constipation if faecal impaction is present?

A

1: Polyethylene glycol 3350 + electrolytes (Movicol paed plain)
2: Stimulant laxative (Senna) if no disimpaction after 2 weeks

NB. Substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose if Movicol not tolerated.

154
Q

Give 5 causes of snoring in children?

A
  • Obesity
  • Nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
  • Recurrent tonsillitis
  • Down’s syndrome
  • Hypothyroidism
155
Q

What is Kallman’s syndrome?

A

Delayed puberty secondary to hypogonadotrophic hypogonadism

156
Q

Give 8 causes of neonatal hypoglycaemia?

A
  • Maternal diabetes
  • Prematurity
  • IUGR
  • Hypothermia
  • Neonatal sepsis
  • Inborn errors of metabolism
  • Nesidioblastosis
  • Beckwith-Wiedemann syndrome
157
Q

What is the major risk factor for neonatal respiratory distress syndrome?

A

Prematurity

158
Q

What is the major risk factor for tachypnoea of the newborn?

A

CS

159
Q

What is the causative organism in acute epiglottitis?

Features?

A

H. influenzae type B. (HiB vaccine at 12-13 months)

Features:

  • Rapid onset
  • High temperature, generally unwell
  • Stridor
  • Drooling of saliva
160
Q

When would you refer a child with an undescended testes?

A

3 months (should be seen before 6 months of age)

161
Q

What is the antibody in coeliac disease?

A

IgA TTG

162
Q

Jaundice in the first 24 hours is always pathological, what are 4 causes?

A
  • Rhesus haemolytic disease
  • ABO haemolytic disease
  • Hereditary spherocytosis
  • G6PD
163
Q

Jaundice in neonates 2-14 days is usually physiological and more commonly seen in breast fed babies. If there are still signs of jaundice after this time do a prolonged jaundice screen. What does this include?

A
  • Conjugated and unconjugated bilirubin
  • Direct antiglobulin test (Coombs)
  • TFTs
  • FBC and blood film
  • Urine for MC&S and reducing sugars
  • U&E and LFTs
164
Q

What might a raised conjugated bilirubin in a neonate indicate?

A

Biliary atresia

165
Q

What are the 5 S’s of innocent murmurs?

A 
Soft
Systolic
Short
Symptomless
Standing/sitting (vary with position)
166
Q

What is the investigation of choice for vesicoureteric reflux?

A

Micturating cystourethrogram

167
Q

What is the pathophysiology of vesicoureteric reflux?
What does it predispose to?
What is the complication of this?

A

= Abnormal back flow of urine from bladder into the ureter and kidney.

  • Ureters are displaced laterally, entering the bladder more perpendicularly
  • Shortened intramural course of ureter
  • Vesicoureteric junction cannot therefore function adequately

Predisposes to UTI (found in around 30% children presenting with UTI)

Complication: Renal scarring (in around 35%)

168
Q

What is the most common cause of painless, massive GI bleeding in children aged 1-2?

A

Meckels diverticulum.

169
Q

What is Meckel’s diverticulum?

What is the rule of 2s?

A

A congenital diverticulum of the small intestine (remnant of the omphalomesenteric duct)

Rule of 2s:

  • Occurs in 2% pop
  • 2 feet from the ileocaecal valve
  • 2 inches long
170
Q

What is the abx mx of meningitis?

A

<3 months: IV amox (cover for listeria) + IV cef

>3 months: IV cef

171
Q

What is the most common childhood malignancy?

Features? (think bone marrow failure)

A

ALL

2-5 year old

  • Anaemia: Lethargy and pallor
  • Neutropaenia: Frequent/severe infections
  • Thrombocytopenia: Easy bruising, petechiae

Plus:

  • Bone pain (infiltration)
  • Hepatosplenomegaly
  • Testicular swelling
172
Q

If the newborn otoacoustic emission test is abnormal what test should be undertaken?

A

Auditory brainstem response test (as a newborn/infant)

173
Q

What is Osgood-Schlatter disease? Features?

A

= Tibial apophysitis
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle.

174
Q

What are the features of osteochondritis dissecans?

A

Pain after exercise

Intermittent swelling and locking

175
Q

What might a soft, scaphoid abdomen (concave, depressed) and bilious vomiting suggest?
How would you investigate?

A

Intestinal malrotation and volvulus

Urgent upper GI contrast study and US.

176
Q

How is precocious puberty defined?

A

Development of secondary sexual characteristics before 8 years in F and 9 years in M.

177
Q

What is the most appropriate way to confirm a diagnosis of pertussis?

A

Per nasal swab. (Or PCR/serology)

178
Q

How long should abx be given in:
UUTI?
LUTI?

A

Upper: 7-10 days
Lower: 3 days

179
Q

What is erythema infectiosum caused by?

Typical features?

A

Parvovirus B19
(Also known as fifth disease or ‘slapped-cheek syndrome’)

  • Lethargy, fever, headache
  • ‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
180
Q

What is first and second line mx for viral-induced wheeze?

A

1: SABA
2: Oral montelukast/ ICS

181
Q

What is Laryngomalacia?
Typical presentation?
Prognosis?

A

A very common congenital abnormality of the larynx - softening of the cartilage.
Typically an otherwise well infant with inspiratory stridor.
If stridor becomes severe with respiratory distress or FTT then surgery recommended.
Usually self-resolves before 2 years.

182
Q

What is the triad of shaken baby syndrome?

A
  • Retinal haemorrhages
  • Subdural haematoma
  • Encephalopathy
183
Q

When would you consider a diagnosis of pneumonia rather than bronchiolitis?

A
  • High fever (>39) and/or

- Persistently focal crackles

184
Q

What is the most common complication of chickenpox?

What are the rare complications?

A

Most common: secondary bacterial infection

Rare:

  • Pneumonia
  • Encephalitis
  • Disseminated haemorrhagic chickenpox
  • Arthritis, nephritis and pancreatitis
185
Q

What is gastroschisis?

Maternal associations?

A

A congenital defect in the anterior abdominal wall just lateral to the umbilical cord, allows intestines to protrude

  • Maternal age <20
  • Maternal alcohol/tobacco use
186
Q

What 2 factors determine the prognosis of congenital diaphragmatic hernias?
What is the overall survival rate?

A
  • Liver position
  • Lung-to-head ration

Around 50%

187
Q

What kind of diet should patients with CF have?

A

High calorie
High fat
Pancreatic enzyme supplements taken with every meal.

188
Q

What electrolyte abnormalities would you expect in an infant with pyloric stenosis?

A

Hypochloraemic, hypokalaemia alkalosis

189
Q

What type of inheritance is Prader-Willi?

A

Imprinting - gene deletion from father, chromosome 15 (NB. gene deletion from mother -> Angelman syndrome)

190
Q

What is a common complication of viral gastroenteritis?

A

Transient lactose intolerance

191
Q

Following a febrile convulsion, what is the risk of further convulsions?

A

30%

192
Q

What is the first sign of puberty in males?

A

testicular growth, volume >4ml indicates onset of puberty

193
Q

In hypospadias, where is the urethral opening most commonly located?

A

Distal, ventral surface of the penis

194
Q

What is the most common complication of roseola infantum? How likely is this?

A

Febrile convulsions.

10-15%

195
Q

What is the emergency treatment of a child with severe croup?

A

Oxygen and nebs adrenaline

+ Oral dex if able to take.

196
Q

When does the moro reflex typically disappear?

A

3-4 months

197
Q

When does the grasp reflex typically disappear?

A

4-5 months

198
Q

When does the rooting reflex typically disappear?

A

4 months

199
Q

When does the stepping reflex typically disappear?

A

2 months

200
Q

What are the characteristic features of infantile spasms/west syndrome?
Prognosis? Why?

A

= Childhood epilepsy presenting in first 4-8 months. More common in male infants.

  • Characteristic ‘salaam’ attacks: flexion of the head, trunk and arms, followed by arm extension.
  • Lasts 1-2 seconds but may be repeated up to 50 times

Often associated with a serious underlying condition - poor prognosis

201
Q

What investigations would you undertake in suspected infantile spasms? What would they show?
Mx?

A

EEG: Hysparrhythmia in 2/3
CT: Diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)

Vigabatrin is first-line.
ACTH also used

202
Q

What are the 4C’s of the measles prodrome?

A

Coryza
Cranky
Conjunctivitis
Cough

203
Q

What causes hand, foot and mouth disease?

A

Coxsackie A16 virus

204
Q

What are the complications of measles infection?

A
  • encephalitis: typically occurs 1-2 weeks following the onset of the illness
  • subacute sclerosing panencephalitis: very rare, may present 5-10 years later
  • febrile convulsions
  • giant cell pneumonia
  • keratoconjunctivitis, corneal ulceration
  • diarrhoea
  • appendicitis
  • myocarditis
205
Q

If a non-immunised child comes into contact with measles what do you do?

A

Give MMR within 72 hours (vaccine-induced antibody develops more rapidly than natural infection)

206
Q

What Ix would you do ton look for renal scarring in a child with vesicoureteric reflux?

A

Radionuclide scan using dimercaptosuccinic acid (DMSA)

207
Q

What is an Epstein’s pearl?
Where are they seen?
Mx?

A

A congenital cyst, found in the mouth. Most common on the hard palate but can also be seen on the gums.
No treatment, spontaneously resolve over a few weeks.

208
Q

What is the step-wise management of reflux in infants?

A
  • Simple advice: feed 30 degree head up, ensure not being overfed, consider trial of smaller and more frequent feeds
  • Trial thickened formula OR alginate therapy (Gaviscon)
  • Trial PPI or H2RA, but only if regurgitation associated with:
    → unexplained feeding difficulties (for example, refusing feeds, gagging or choking)
    → distressed behaviour
    → faltering growth

Prokinetics e.g metoclopramide should only be used with specialist advice (dystonia risk)

209
Q

What is choanal atresia?
Presentation?
Mx?

A

Congenital disorder (1 in 7k), where the posterior nasal airway is occluded by soft tissue or bone.

May be bilateral or unilateral. Unilateral may go unnoticed, bilateral will present early in life (obligate mouth breathers) with cyanosis, worse during feeding and may improve when the baby cries.

Mx: Fenestration procedures to restore patency

210
Q

What is the ratio of chest compressions to ventilation in newborn resuscitation?

A

3:1

211
Q

What is chondromalacia patellae?
Typical presentation?
Mx?

A

Softening of the cartilage of the patella.

Common in teenage girls. Characteristically anterior keen pain on walking up and down stairs and on rising from prolonged sitting.

Mx: Physio

Specialities (12 decks)

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