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Medical Finals 2020 > Paediatrics > Flashcards

Paediatrics Flashcards

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USMLE® Step 1 flashcards
1
Q

How do you calculate weight in paediatrics?

A

(Age + 4) x 2 = weight in kg

Now generally not considered accurate

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2
Q

What is the formula for prescribing fluids in a child?

A

100mls/kg for first 10kg
50mls/kg for second 10kg
20mls/kg for further weight

Dehydrated 50mls/kg extra
Shocked 100mls/kg extra + 20mls/kg fluid bolus

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3
Q

Which out of caput succundum and cepalohematoma cross suture lines?

A

Caput succundum

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4
Q

What are some features of foetal alcohol syndrome?

A

Flattened philtrum
Thin upper lip
Microcephaly

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5
Q

What is an omphalocele as opposed to a gastochisis?

A

Omphalocele - defect in the umbilicus

Gastroschisis - bowel develops outside of abdomen, next to umbilicus

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6
Q

What are the five main features of autism?

A
  • social impairment
  • stereotypes behaviours
  • repeated movements
  • impaired communications
  • sensory difficulty
  • emotional lability
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7
Q

What is included in the Guthrie blood spot test?

A
  • CF
  • MSUD
  • PCK
  • SCF
  • thalassaemia
  • HT
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8
Q

What are some features of fragile X syndrome?

A
  • learning difficulties
  • large low set ears
  • long thin face
  • hypertonic
  • mitral valve prolapse
  • macroorchidism
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9
Q

What murmur is heard in PDA?

A

Machine-like murmur, heard under the left clavicle

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10
Q

What are the typical features of a Wilm’s Tumour?

A

Abdominal mass
Painless haematuria
Flank pain

This is a nephroblastoma, a common childhood malignancy

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11
Q

What are some differentials of noisy breathing in babies?

A 
Foreign body (acute onset)
Cystic fibrosis (associated with faltering growth, meconium ileus)
Laryngomalacia (congenital softening of the larynx cartilage, usually self-resolves)
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12
Q

What is bronchopulmonary dysplasia and when does it occur?

A

Preterm infants treated with supplemental oxygen and ventilation

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13
Q

What is the difference between a cephalhaematoma and a caput succedaneum?

A

Caphalhaematoma - usual develops after birth, doesn’t cross the suture lines, blood confined between skull and periosteum
Caput succedaneum - extraperiosteal blood collection, can cross suture lines, can be persent at birth

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14
Q

What are the steps for newborn resuscitation?

A 
Dry the baby, maintain temperature
Assess tone, breathing, HR
Open airway, 5 inflation breaths
Assess HR, check chest movement
If HR => start compressions 3:1 (breath)
If no HR => repeat inflation breaths
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15
Q

What extra vaccinations should be given other than the usual set?

A

BCG if at risk, Flu if at risk, Men ACWY going to university, varicella zoster if at risk of transmission, HPV 14 year old girls, DPT booster at 14

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16
Q 
What vaccinations are given at:
8 weeks/2 months (three + PO)
12 weeks/3 months (one + PO)
16 weeks/4 months (three)
12 months (four)
3 years, 4 months (two)
A

HiB/D/T/P/P/HepB (6-in-one), PCV, Men B, Rotavirus

D/P/HiB/HepB/P (6-in-one), Rotavirus

D/P/HiB/T/HepB/P (6-in-one), PCV, Men B

Men B, HiB/MenC, MMR, PCV
MMR, D/T/P/P (4-in-one)

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17
Q

Describe the features of foetal alcohol syndrome.

A

IUGR, microcephaly, midfacial hypoplasia, micrognathia, smooth philtrum, microphthalmia, thin upper lip, irritability

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18
Q

What are the pharmacological treatments in ADHD?

A

Methylphenidate (1st line, monitor growth), lisdexamfetamine, all drugs are cardiotoxic, perform a baseline ECG prior to starting treatment

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19
Q

Name the 5 key symptom groups for autism

A

Social impairment, impaired communications, sensory difficulties, emotional lability, restricted, repetitive and stereotyped behaviour

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20
Q

What are the 3 key symptoms for ADHD?

A

Hyperactivity, inattention, impulsivity

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21
Q

Give some possible consequences of ADHD in later life.

A

Poor education and school performance. Higher risk of drug and alcohol abuse. Employment difficulty.

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22
Q

How is ADHD assessed?

A

Clinical assessment (interview, behavioural observation)

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23
Q

How is ADHD managed?

A

Education, school support, methylphenidate (Ritalin/Equasym, Melatonin for sleep)

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24
Q

What age should a child learn to hop on 1 leg?

A

4 years

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25
Q

What are the 4 domains of development?

A

Gross motor, fine motor and vision, speech and social interactions

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26
Q

How does block building progress?

A

2 years = 6 blocks, 18 months = 8 blocks and train

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27
Q

What indicates abnormality in development?

A

Persistence of primitive reflexes

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28
Q

Describe some common features of Down’s Syndrome

A

Round face, epicanthal folds (skin folds of the upper eyelid covering the inner corner of the eye), single palmar creases, small ears, short neck, hypotonia

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29
Q

What congenital cardiac problems are associated with Down’s Syndrome?

A

ABSD, ASD, VSD, TOF, [Coarctation and AS is Turner’s]

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30
Q

What congenital bowel problems occur in Down’s Syndrome?

A

Duodenal atresia, imperforate anus

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31
Q

What syndrome is trisomy 18 and what are the features of it?

A

Edward’s Syndrome, congenital heart defects, rocker bottom feet, low set ears, overlapping of fingers, micrognathia

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32
Q

What are some structural problems in Patau’s Syndrome?

A

Microcephaly, small eyes, cleft lip/palate, polydactyl, scalp lesions

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33
Q

Name some other chromosomal based syndromes

A

Angelman’s (15), Noonans (webbed neck, pectus excavatum, PS, short stature), Fragile X (learning difficulties, macrocephaly, long face, large ears, large testicle size),

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34
Q

How do you estimate a child’s weight?

A

(Age + 4) / 2

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35
Q

List 5 signs of dehydration in a child

A

Sunken fontanelle, dry mucous membranes, reduced urine output, thread tachycardic pulse, prolonged CRT, cool peripheries, lethargy

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36
Q

How much fluid over 24 hours would you give a 14-year-old dehydrated septic child, weight unknown?

A

Estimated weight = 36. 1000+500+120+(50x36)

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37
Q

What does the newborn screening test (Guthrie’s test) measure in regards to CF?

A

Immunoreactive trypsinogen

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38
Q

What is tested for in the newborn heel prick test?

A

CF, SCD, CHT, IMD (MCADD, MSUD)

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39
Q

What do you give in a cardiac arrest?

A

IM adrenaline 200microgram 1:10,000

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40
Q

What are red flags in the NICE traffic light guidelines for a sick child?

A

RR>60bpm, grunting, HR below 100 or above 160 bpm, CRT>3 seconds, Temp >38, SpO2<95%, central cyanosis

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41
Q

How many resuscitation breaths to chest compression should be performed in a sick child?

A

15:2

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42
Q

What is Reye’s Syndrome?

A

This is swelling of the liver and brain occurring in children given aspirin. It is a classic acute encephalopathy. There is elevated ammonia, ALT/AST and prolonged PT. Treatment is supportive care, correction of metabolic abnormalities and ICP control.

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43
Q

What is distributive shock?

A

This is when there is leakage of capillary fluid causing oedema and closing the airway.

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44
Q

What is sepsis?

A

Sepsis is a disseminated immune reaction leading to end-organ damage.

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45
Q

What are signs of an iron overdose?

A

Initial vomiting, potentially black stools, later liver failure and drowsiness

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46
Q

When should a head tilt be performed – in an infant or a child?

A

Infant, a child should ‘sniff the morning air’

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47
Q

What is the most common childhood leukaemia?

A

ALL

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48
Q

What are the potential presenting complaints of leukaemia?

A 
Pallor
Fatigue
Bone pain
Bruising
Lymphadenopathy
Hepatosplenomegaly
Frequent infections
Testicular swelling
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49
Q

What tests should be done in suspected ALL?

A

FBC (low Hb, raised WCC, low platelets)
Blood film (auer rods for AML, large blast cells in ALL)
Serum electrolytes
CXR (mediastinal widening)

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50
Q

What courses of chemotherapy do you give in leukaemia?

A 
Induction
Consolidation
Interim Maintenance
Delayed Intensification
Continued Maintenance
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51
Q

What aggressive forms of sarcoma are seen in children?

A

Osteosarcoma

Ewing’s

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52
Q

What are some symptoms of lymphoma

A

Painless lymphadenopathy, sweating, weight loss, fever, compression syndrome. Ix: CXR, CT scan, bone marrow, lymph node biopsy, FBC, blood film, cytogenetics. Mx: chemotherapy, bone marrow transplant, radiotherapy, rituximab

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53
Q

What is the classical feature of retinoblastoma?

A

Loss of red reflex in the eye

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54
Q

Give five investigations you would do in Wilms’ tumour

A

Abdominal US, CT abdomen (claw sign in kidney), CXR/CT, urine catecholamine

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55
Q

Give 5 presenting features of nephro and neuroblastoma

A

Nephroblastoma – mass, haematuria, fever, association with aniridia and genital abnormalities (Down’s), Neuroblastoma – loss of skills in childhood, abdominal mass, proptosis if orbital involvement, bone pain, early morning vomiting, periorbital bruising, fever

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56
Q

What is WAGR complex?

A

Wilms’ Tumour, Aniridia, Genital Abnormalities, Mental Retardation

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57
Q

Why is a urine catecholamine test done?

A

Neuroblastomas produce breakdown products of adrenaline that end up the urine, it differentiates abdominal masses between neuro and nephroblastoma

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58
Q

What is the different between abdominal masses in neuro and nephroblastoma?

A

Neuroblastomas cross the midline, nephroblastoma do no cross the midline

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59
Q

What kind of cancer is a neuroblastoma?

A

Blue cell cancer, solid extracranial tumour

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60
Q

What is ITP?

A

Idiopathic thrombocytopenic purpura is often preceded by a viral illness. It is an immune-mediated reduction in platelet count, usually self-limiting.

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61
Q

What is typically the first sign of puberty in females?

A

Breast budding

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62
Q

What are the two tests done in the newborn hearing test?

A

Evoked emission and auditory brainstem response

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63
Q

Name some behavioral audiology tests?

A

Distraction testing
Visual reinforcement audiometry
Speech discrimination testing

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64
Q

How does hearing develop in an infant?

A

Initially startles at loud sounds, then turns towards voices and prolonged sound, 4-month smiles to voice, 7 months hears room entry, 9 months babbles

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65
Q

What are the symptoms of otitis media in a child?

A

Ear tugging, fever, crying, irritable, red ear drum

66
Q

How is OM treated?

A

Amoxicillin

67
Q

What antibiotics are given in tonsillitis?

A

Penicillin

68
Q

What is an exotropia stabismus?

A

An outward looking squint

69
Q

What are other kind of strabismus?

A

Esotropia - inward looking

Hypertrophic - vertical

70
Q

How do you test for a squint?

A

Cover test

Corneal red-light reflex test

71
Q

What is your management for a squint?

A

Refer to paeds
Conservative (optical or prism correction)
Surgery
Botox injection

72
Q

What is amblyopia?

A

When lack of vision during development of the visual cortex leads to a stunting of the visual cortex

73
Q
  1. A 9 months old presents with 24 hr history of drowsiness, irritability. On examination he is a bit floppy and has red rash in armpit, groin and neck which are starting to peel.

What is the problem and what is your initial management?

A

Scalded skin syndrome

Caused by staph aureus exotoxin that binds to the skin and causes it to lose formation

74
Q

A 8.5kg 9 month child is 5% dehydrated and required fluid - how much should be prescribed for the next 24 hours?

A

37.5ml/hr over 24hr - not including dehydration

53ml/hr over 24hr - including dehydration

75
Q

What is the investigation of choice in Hirshsprung’s Disease?

A

Rectal biopsy

76
Q
  1. A 3-week-old presents with prolonged jaundice. Onset was at day 3 of life, exclusive breast fed. Initially slow to regain birth weight but now happily gaining weight. O/E clinically jaundiced, afebrile and happy. Stools are yellow-green. Investigations show grossly raised unconjugated bilirubin. Conjugated bilirubin is within normal ranges. LFTs and various others are normal. Dx?
A

Breast milk jaundice

77
Q

How might a young girl become infected with trichomonas?

A

Shared towels

78
Q

What is on the Newborn Bloodspot screening test? Give 5

A

SCD, MSUD, PKD, Hypothyroidism, Thalassaemia, CF, G6PD deficiency, Inherited metabolic diseases, Medium-chain acyl-CoA dehydrogenase deficiency MCADD, HCU Homocystinuria

79
Q

What are the diagnoses to the following typical presentations in a child?

  • Bilious projectile vomiting in a child
  • machine-like murmur under the left clavicle
  • redcurrent jelly stool
  • blue sclera
  • immobile infant with a femur fracture
  • white/clay coloured stool
  • ‘walking up’ legs to standing position
A
  • Bilious projectile vomiting in a child - pyloric stenosis
  • machine-like murmur under the left clavicle - Patent Ductus Arteriosis
  • redcurrent jelly stool - intusseption
  • blue sclera - osteogenesis imperfecta
  • immobile infant with a femur fracture - NAI
  • white/clay coloured stool - biliary atresia
  • ‘walking up’ legs to standing position - Duchene’s muscular dystrophy
80
Q

What causes cerebral palsy?

A

Hypoxia-ischaemic event, infection and inflammation, trauma during birth, neonatal encephalopathy

81
Q

What are potential causes of neurodevelopmental disorders?

A

Chromosomal, foetal hypoxia, congenital infection (CMV, HIV, alcohol), prematurity, brain injury

82
Q

What are different kinds of CP and what part of the brain does each one affect? Are there further ways to classify cerebral palsy?

A

Spastic (cortex problem, rigidity, tip-toe walking)
Ataxic (wide gait, hypotonic, balance disturbance)
Dyskinetic (basal ganglia)
Mixed, can further classify it as quadriplegic, hemiplegic or paraplegic

83
Q

How is cerebral palsy managed? What teams are involved in their care?

A

OT/PT, SALT, Medical Team, Baclofen, Botox injections, Orthopaedic input, MDT

84
Q

What are the 4 types of generalised seizures and their appearance?

A

Absence, Myoclonic, Generalised, Atonic

85
Q

What is a focal onset seizure?

A

A seizure without loss of consciousness

86
Q

Define status epilepticus and how it is treated?

A

A seizure with no threshold resulting in uncontrolled fitting for >5 minutes. Treat with benzos twice and then phenytoin

87
Q

How do you treat absence seizures?

A

Valproate, ethosuximide

88
Q

What is post-ictal weakness called?

A

Todd’s Palsy

89
Q

Describe the circulatory changes that occur around birth in the foetus

A

The baby breaths, decreasing pressure in pulmonary circulation and consequently in the right side of the heart. Previously the right side had higher pressure with a R=>L shunt, but as pressure drops, this reverses to a L=>R which forces closure of the FO. LA pressure also increases due to increased return of blood from the PA. The DA also closes.

90
Q

A well-baby is found to have a systolic murmur at the upper left sternal edge. What are your differentials?

A

ASD - asymptomatic patient, soft blowing murmur, systolic only left sternal edge, wide-splitting of the second heart sound

91
Q

A loud pansystolic murmur in an asymptomatic child is usually…?

A

VSD (the smaller the louder, it closes spontaneously)

92
Q

What are your differentials in a cyanotic baby presenting with a murmur, blue and breathless in the first few days of life?

A

Tetralogy of Fallot, Transposition of the Great Arteries (AVSD is mixed so baby is blue and breathless)

93
Q

How do you maintain the patency of a shunt and why would you do this?

A

Prostaglandins, to allow oxygen to be routed around the heart if baby is cyanotic

94
Q

What can force the closure of a patent ductus arteriosus?

A

Prostaglandin inhibitors – NSAIDs, IV indomethacin or ibuprofen

95
Q

What s the difference in presentation between a L=>R shunt and R=> shunt and name what defects are classified as which?

A

L=>R, baby is pink, breathless, acyanotic (VSD, ASD, PDA) can be outflow obstructions (coarctation in a sick child, PS in a well child). Cyanotic – unwell, blue, if put in 100% o2 will stay blue, (TGA and TOF)

96
Q

What genetic diseases might result in a congenital heart defect?

A

Edward’s (18), Down’s, Patau, Noonan’s, DiGeorge. Other causes include maternal disorders (rubella), maternal drugs (warfarin, foetal alcohol)

97
Q

What is TGA?

A

Transposition of the Great Arteries, the pulmonary artery and aorta are switched

98
Q

What outflow obstructions result in breathlessness?

A

Coarctation of the aorta and Pulmonary stenosis

99
Q

What is the commonest childhood arrythmia

A

Supraventricular tachycardia

100
Q

What are the 4 features of Tetralogy of Fallot?

A

Overriding Aorta, Right Ventricular Hypertrophy, Pulmonary Stenosis, Ventricular Septal Defect – cyanosis, on x-ray – boot shape heart, surgery at 6 months to treat (BT shunt)

101
Q

What murmur is heart on transposition of the great arteries?

A

There is no murmur, there is a cyanotic baby that is failing to thrive.

102
Q

What is indomethacin?

A

An NSAID used to close the PDA. Prostaglandins keep it open.

103
Q

What congenital cardiac diseases are associated with each of the following syndromes?
Down’s Syndrome
Turner’s Syndrome
Noonans

A

Down’s Syndrome – AVSD, VSD, TOF, ASD
Turner’s Syndrome – atrial stenosis, coarctation
Noonans – tricuspid stenosis, septal defects

104
Q

What are some potential worries in people with short stature?

A

Psychosocial deprivation - abuse or neglect

Chromosomal disorders and associated health problems

105
Q

What are causes of tall stature?

A

Obesity
Secondary to… hyperthyroidism, precocious puberty, gigantism, congenital adrenal hyperplasia
Syndromes… Marfan’s, Klinefelter, maternal diabetes

106
Q

What can cause abnormalities in head growth?

A

Tall stature, familial macrocephaly, raised ICP, tumour

107
Q

What is 45 XO and how does it present?

A

Turner’s Syndrome

Oedema of the hand dorsa, feet and loose skinfolds at the nape of the neck
Low posterior hairline, prominent ears
Small mandible, high arched palette
Broad chest
Short stature, 1.5m
Aortic arch rupture, horseshoe kidney, recurrent otitis media

108
Q

What is Kallmann Syndrome?

A

Failure of GnRH neurons, more common in males
Anosmia - loss of smell
Can cause primary amenorrhoea

109
Q

What is hypogonadotropic hypogonadism?

A

Primary gonadal failure leading to lack of negative feedback so increase in GnRH, LH and FSH

110
Q

What is the difference between gonadotropin dependent and independent precocious puberty?

A

Gonadotropin dependent - increased LH and FSH while independent has low FSH and LH and is due to adrenal or gonadal disorders

111
Q

How does a DKA present and how is it treated?

A

Vomiting, acute illness, acidosis
Treat with immediate fluids and insulin
Monitor BMs and electrolyes

112
Q

What does a high TSH and low T4 indicate? In what disease does this occur and how does it present?

A

Primary hypothyroidism

Congenital or due to iodine deficiency in mother

113
Q

How do you estimate how tall a girl will be fully grown?

A

Mother’s height + (FH-7.5cm)/2

114
Q

What are some causes of delayed growth?

A

Neglect
Failure to thrive
Actual weight loss (over 2 centiles)

115
Q

What counts as a delayed puberty?

A

Boys - early is <8, late is >13

Girls - early is <9, late is >14

116
Q

In a baby with clitoral hypertrophy what are the risks? How will males present? What is the lifelong treatment?

A

CAH
Abnormal hormone synthesis, low cortisol results in ACTH increase
Virilisation
Failure of aldosterone
Males present with enlarged penis and pigmented scrotum
Adrenal crisis in males, salt loss, 1-3 weeks old presentation with vomiting, weight loss, floppiness and circulatory collapse

117
Q

What are some advantages and disadvantages of breast feeding?

A

Advantages – improved bond between mother and baby, improved immunity against infection, maternal risk of breast cancer decreases, decreased risk of NEC.
Disadvantages – difficult in multiple births, difficult to know exactly how much baby is having, requires mother to always be around

118
Q

What alternatives to breast milk exist?

A

Formula milk (based on cow’s, removal of protein and extra iron and mineral content), Cow’s Milk (requires vitamin and iron supplements), Soya Milk

119
Q

Give some organic and non-organic causes of FTT?

A

Non-organic – neglect, poverty, maternal depression, inadequate food availability. Organic – cleft lip/palate, congenital heart disease, GORD, malabsorption

120
Q

What % weight loss is concerning in children?

A

10% weight loss or a drop of 2 major centiles

121
Q

How do you investigate cow’s milk protein allergy?

A

Skin prick, IgE blood test, coeliac screen, FBC, BM, stool sample

122
Q

Why symptoms occur in CF?

A 
Sweat loss
Neuropathy
Atrophy of vas deference
Malabsorption
Steatorrhoea
FTT
Meconium ileus
Recurrent infections
123
Q

How is CF investigated and managed?

A

Sweat Test
Serum IRT (immunoreactive trypsin)
Faecal elastase - low in pancreatic insufficiency

124
Q

What treatment is used for a viral induced wheeze?

A

Inhaled steroids - brief high dose

Bronchodilators - Beta agonist

125
Q

What are the different types of brittle asthma?

A

Type 1 - daily periods of breathlessness and sudden frequent attacks
Type 2 - well-controlled, occasional severe attacks requiring emergency care

126
Q

What metabolic abnormality is found in pyloric stenosis?

A

Hypochloraemia, hypokalaemia metabolic acidosis

127
Q

What is the most likely causative organism for tonsillitis?

A

RSV??

128
Q

Can bile be present in pyloric stenosis?

A

No, it occurs above the ampulla of vater

129
Q

What is the most likely age pyloric stenosis presents?

A

2-8 weeks

130
Q

What is your management for pyloric stenosis?

A

Stop oral feeds
IV fluids
Atropin
Pyloromyotomy

131
Q

What is Hirshsprung’s Disease and how does it present in children?

A

This is a lack of ganglions in the rectal, presents with constipation in young children, failure to pass meconium, distended abdnomen, inflamed bowel. Treat with surgical resection and enema

132
Q

What is NEC and how can it occur and present? What are the signs seen on x-ray?

A

Necrotising Enterocolitis is ischaemic reperfusion injury of the gut caused by infection and inflammation of bacterial invasion of mucosa. Signs include vomiting, infectious signs, abdominal distention, poor food tolerance. It is managed by surgical excision, NBM, antibiotics (gentamycin/metronidazole)

133
Q

At what age is interssuption most common and how does it present?

A

Telescoping of the bowel, most common at ileo-caecal junction, fixed with air enema, fluoroscopy for diagnosis, common at 6m to 6 years

134
Q

What do you treat bronchiolitis with?

A

Supportive treatment

If severe O2, resp support, CPAP, inpatient care

135
Q

What can cause stridor?

A

Epiglottis

Croup

136
Q

A 15-year old post-pubertal girl with diarrhoea and weight loss is suspected of IBD. Name 3 intestinal and 3 extraintestinal signs of IBD.

A

Oral granulomatosis, arthritis, uveitis, erythema nodosum, diarrhoea, haematemesis, perianal lesions, clubbing, malnutrition, mouth ulcers, palpable masses, abdominal tenderness

137
Q

A young girl undergoes colonoscopy and is diagnosed with Crohn’s. Name 3 histological findings on biopsy of Crohn’s.

A

Epithelioid granulomas, transmural inflammation, skip lesions, perianal lesions, discontinuous inflammation

138
Q

A Crohn’s patient is treated with prednisolone. Name 4 side-effects relevant to a teenage girl.

A

Weight gain. Menstrual cycle irregularities. Skin reactions. Mood alteration. Growth retardation.

139
Q

What is a football sign and in what condition do you see it?

A

NEC – air collecting in abdomen, seen on X-Ray, collects anteriorly to abdominal viscera

140
Q

A 1-year old child presents to their GP with bile-stained vomit with intermittent crying in pain and drawing up of legs to chest area. What is the most likely differential diagnosis?

A

Introsusception

141
Q

Where in the bowel is the most common site of introsusception? What signs would you see on examination and USS?

A

Terminal ileum/ileo-coecal valve
Tender, red currant jelly stool, sausage shaped mass in abdomen
Doughnut shape/target sign

142
Q

What are complications of introsusception?

A

Necrosis, bowel perforation, peritonitis

143
Q

An 8-month-old child presents with bilious vomiting – what are your differentials?

A

Pyloric stenosis, malrotation with volvulus., NEC

144
Q

What is your investigation of choice in pyloric stenosis and what would you see?

A

USS

US will show hypertrophy of circular pylorus muscle – projectile vomiting

145
Q

What kind of pulse do you get in ductus arteriosis?

A

Collapsing pulse

146
Q

What is your investigation of choice for NEC and what might you see on it?

A 
Abdo X-Ray
Dilated bowel loops (often asymmetrical)
Bowel wall oedema
Pneumoperitoneum
Portal venous gas
Intramural gas
Football sign (air around falciform ligament)
Rigler sign (air inside and outside bowel wall)
147
Q

What is the charicteristic hallmark of intussception on examination?

A

Sausage shaped mass in right hypochonrium and emptiness in right lower quadrant (Dance’s sign)

148
Q

How does necrotising enterocolitis present?

A

Initial symptoms can include feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis.

149
Q

Name 5 features of Turner’s Syndrome?

A 
Webbed neck
Short stature
Lymphoedema of hands and feet
Low set ears and low posterior hair line
Wide carrying angle
150
Q

Name a sign of Turner’s Syndrome at antenatal foetal ultrasound scan?

A

Foetal oedema of the neck, hands and feet
Cystic hygroma
Structure defects of the heart (Coarctation of the aorta, Aortic stenosis, Bicupsid aortic valve), kidneys (horseshoe kidneys)

151
Q

What are signs of Kleinfelter’s Syndrome?

A 
47 XXY
Hypogonadism
Small firm testes
Tall
Behavioural Problems
152
Q

What are 3 signs of cystic fibrosis on examination?

A 
Hyperinflation
Coarse inspiratory creps
Expiratory wheeze
Finger clubbing
Cyanosis
153
Q

What does Congenital Adrenal Hyperplasia present as?

A

Salt-losing crisis – vomiting, dehydration, weight loss, floppiness, collapse – due to low cortisol
High androgens – virilisation of external genitalia in female infants, in males penis can be enlarged, scrotum pigmented
Precocious puberty

154
Q

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

A

Mineral change disease - glomerulonephritis

155
Q

List 4 clinical features of Down’s Syndrome?

A

Intellectual impairment/mental retardation, congenital heart disease, stunted growth, leukaemia

156
Q

Which 3 Biochemical Markers are measured in the Triple Test for Down’s Screening?

A

βHCG, αFetoProtein, Free Unconjugated Oestriol

157
Q

Which finding on Ultrasound Scan is indicative of Down’s Syndrome?

A

Nuchal Translucency

158
Q

Give the main risk factor for the development of Down’s?

A

Increasing Maternal Age

159
Q

What are 6 signs you might see in a child with Down’s Syndrome?

A 
Epicanthal folds
Single palmar creases
Small ears
Round face
Flat nasal bridge
Flat occiput
Sandal gap between toes
160
Q

What should you council parents of a Down’s baby about?

A

Future prognosis

Risk of future Down’s babies

Medical Finals 2020 (25 decks)

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