Paediatrics

Question 1

List the 7 pregnancy and birth history questions?

Answer 1

1. Any pregnancy problems (mother and baby)
2. Gestation at birth (Normal 36-40 weeks)
3. Any birth problems?Presentation vertex (head) vs breech
4. Needed SCBU or delay going home? If SCBU- ventilation?
5. Birth weight
6. Baby checks all okay?
7. Breast fed?

Question 2

What’s an important element to ask in a paediatric history?

Answer 2

Immunisation Hx

Question 3

What are the 4 core development milestones?§

Answer 3

1. Gross motor
2. Vision and fine motor
3. Hearing and language
4. Social

Question 4

List the 7 key development questions to ask in the history?

Answer 4

1. Key milestones
2. Developmental checks in the past? Any concerns?
3. Temperament and behaviour
4. Sleep patterns
5. Eating habits
6. Bladder and bowel control
7. Do the nursery/school share the parental concerns?

Question 5

Describe the social history for paediatrics?

Answer 5

• Draw immediate family tree
• Is this genetic Dad and is he Dad for all the other children in the family/a new partner?
• If complex who does the patient live with, and does this vary through the week?
• Where do they live and what’s the home situation?
• Parental employment
• Parental habits and health-smoking, alcohol, mental illness
• School and nursery (attendance)
• Do they like nursery/school?
• Friends and social engagement?
• Academic progress?
• Sporting involvement?
• Out of School activity?
• Is there a social worker involved with the family?

Question 6

Describe the family history for paediatrics?

Answer 6

• Any relevant FH
• Health burden in the family-e.g. an autistic sibling
• Any pregnancy, neonatal or childhood deaths
• Draw the Family tree
• Consanguinity

Question 7

Describe a routine baby check?

Answer 7

• Birth weight/centile, gestational age
• Head: size, head circumference/centile, shape, presence of caput/cephalhaematoma, fontanelle & sutures palpated
• Face: dysmorphic? Downs?
• Mouth/palate: exclude cleft, Epstein’s pearls, gym cysts or teeth
• Eyes: red reflex to exclude cataracts, swollen eyelids? conjunctival haemorrhages?
• Colour/skin: plethoric/pale/jaundice? Central cyanosis on tongue? Erythema toxicum common. Capillary/cavernous haemangiomas/port wine stain? Mongolian blue spots at base of spine/buttocks?
• Arms: posture, nerve palsies?
• Hands: count fingers, examine palmar creases.
• Chest: RR & effort, resp distress? Auscultate lungs. Breast engorgement can present in newborns of either sex.
• Heart: thrill/heave? Liver edge normally palpable around 1cm below subcostal margin. Meconium? Hernia? Masses? Patent anus?
• Genitalia: normal? Passed urine? 2 Male testes in scrotum?
• Muscle: Posture, limb movements? Moro/grasp/suck reflexes?
• Back & Spine: midline defects? Sacral dimple/tuft/swelling/naevus? Mongolian blue spot?
• Hips: groin crease, leg lengths (Galeazzi sign), hip abduction symmetrical, reduced but dislocatable hip (Barlow +ve) or dislocated reducible hip (Ortolani +ve)
• Feet: count toes, posture (Talipes equino varus)

Question 8

Describe neonatal jaundice and causes?

Answer 8

• Conjugated hyperbilirubinaemia: biliary atresia. Present with pale stools and dark urine
• Unconjugated hyperbilirubirubinaemia: Physiological/ Breast milk jaundice/Haemolytic disease (Rhesus, ABO)/ Infection (UTI, sepsis)/ Congenital hypothyroidism (prolonged jaundice)
• Plot serum bili to determine Tx with phototherapy/exchange transfusion
• Tx determined by gestational age & bilirubin level

Question 9

Describe neonatal prolonged jaundice?

Answer 9

• Visible jaundice >14 days in term infant / >21 days in preterm infant
• The commonest cause of is breast feeding
• The main purpose of Ix is early identification of biliary atresia (emergency)

Question 10

What are the top 5 causes of respiratory distress in neonates?

Answer 10

1. Transient tachypnoea of the newborn (1st 8 hours)
2. Respiratory distress syndrome (surfactant deficiency)
3. Meconium aspiration
4. Pneumothorax
5. Respiratory Infection

Question 11

What are the 5 top causes of cyanosis in a neonate?

Answer 11

1. Any cause of resp distress
2. Persistent Pulmonary Hypertension of the Newborn 3. Congenital cyanotic heart disease
3. Tracheo-oesophageal fistula
4. Diaphragmatic hernia

Question 12

Describe neonatal sepsis?

Answer 12

• Most common cause of a collapsed/unwell neonate
• Risk factors: prolonged ROM, PROM, maternal infection (particularly GBS)
• Present as: collapse, apnoea, resp distress, seizures, jaundice, poor feeding, lethargy

Question 13

What does bile stained vomiting in neonates indicate?

Answer 13

Intestinal obstruction until proven otherwise

Question 14

List the 4 presentations of GI disorders in neonates?

Answer 14

1. Poor feeding
2. Vomiting
3. Delay in passage of meconium
4. Abdo distension

Question 15

List the 5 most common causes of GI disorders?

Answer 15

1. Meconium plug/ileus
2. Duodenal atresia, or other small bowel atresia
3. Oesophageal atresia
4. Malrotation with volvulus
5. Hirschsprung disease