Paediatrics Flashcards
1
Q
A 14 month year old presents with a week history of feeling unwell (fever, decreased appetite and irritable) this has now stopped however he has now got erythematous lesions on face, trunk and limbs. What is the most likely diagnosis?
A
Erythema Infectiosum
2
Q
A 5 yr old boy comes in to see you as he is experiencing falls and finding it difficult to walk. You notice that he requires his arms to stand up and that his calf muscles are beginning to atrophy. What is the name of this sign and what condition does it indicate?
A
Gower’s sign - require use of their hands and arms as their thigh and hip muscles are not strong enough to carry their weight.
Duchenne Muscular Dystrophy
3
Q
A baby comes in for a developmental check. They can turn their head to the side and wave their arms and legs and wiggle when laid down. They also respond to noises. How old would they be based on these movements?
A
2 months
4
Q
What are the physical (motor) signs that a child is around 4 months old?
A
Hold head when lying on tummy
hold head steady without support
Reach for toys nearby and play with toys
5
Q
What are the communication signs that a child is around 4 months old?
A
smile or coo
chuckle
high pitched squeals
get excited to see people
6
Q
A child can roll from back onto tummy, sit up without support and have started to get into the crawling position. When playing with toys they grasp them with both hand s. What age would you guess they were?
A
6 months
7
Q
A child has started reaching up to a parent to be lifted up, making ga, da, ka sounds and laughing more. What age would you guess they were at?
A
6 months
8
Q
What development would you expect of a 9 month old child?
A
Sit without support and can sit from lying down. Stand and can take their weight on feet. May be crawling and can roll over both ways.
9
Q
A child is sitting well on their own. Can pull up to stand up and walk around furniture as well as being able to stand alone. They can turn the pages of a book and have a pincer grip. How old would you expect them to be?
A
12 months
10
Q
A child is responding to their own name, pointing at objects and making more meaningful sounds. What age are they likely to be?
A
12 months
11
Q
A child is beginning to walk well, can stack blocks and is able to feed themselves. As well as saying several words and can obey simple commands. What age would this put them at developmentally?
A
18 months
12
Q
A child is now running and jumping. They are able to hold a pencil and drink from a cup with no lid. They do role play, can name well known objects and can put 2-3 words together. What age developmentally would this put them at?
A
2 years old
13
Q
At what age would you be concerned that a child did not have visual fixation?
A
2 months
14
Q
At what age would you be concerned that a child had not vocalised by?
A
6 months
15
Q
At what age would you be concerned that a child was not sitting without support by?
A
9-10 months
16
Q
At what age would you be concerned that a child was not standing alone?
A
16 months
17
Q
At what age would you be concerned that a child had not spoken any single words or started walking yet?
A
18 months
18
Q
By what age would you be concerned if they were not showing any signs of imaginative play?
A
3 years
19
Q
What 9 conditions does the guthrie (blood spot) test for?
only need to say 3 and then 2 examples of the 4th. Extra point for a condition that is tested in some areas of england.
A
Sickle cell disease Cystic Fibrosis Congenital Hypothyroidism Inherited Metabolic Diseases (PKU, MCADD) SCID
20
Q
When is the blood spot test carried out and when do parents get the results?
A
5 days old
6-8 weeks
21
Q
What are the signs of respiratory distress in a new-born baby? (6)
A
Tachypnoea >50/60 RR Recessions Nasal Flaring Grunting Tachycardia Poor feeding
22
Q
What is the most common cause of early onset severe infection in new borns?
A
group B strep
23
Q
Benefits of breastfeeding for a infant?
A
Protection from infection - natural antibodies
Vitamins and nutrition
SIDS and childhood leukaemia protection
Long term health benefits
24
Q
Benefits of breastfeeding for the mother ?
A
Uterus returns to normal size Bonding with the baby Long term health protection - ovarian cancer Burns calories (300 a day)
25
What is the normal range of HR, BP and RR for a Infant (<1)
110-160 HR
40 RR
70-110 systolic
26
What is the normal range of HR and RR for a Toddler (1-2yrs)?
100-150 HR
| 35 RR
27
What is the normal range of HR and RR for a pre school child (3-4 yrs)?
96-140 HR
| 30 RR
28
What is the normal range of HR and RR for a School child (5-11 yrs)?
80-120 HR
| 25 RR
29
What antibiotic is used as a 'super' gram positive antibiotic?
Vancomycin
30
What antibiotic is used as a 'super' gram negative antibiotic?
Gentamicin
31
What are 2 examples of 3rd generation cephalosporins? What is the difference between daily dosing?
Cefotaxime - 3 times a day administration
| Ceftriaxone - 1 time a day administration
32
Why would you want to check the ears of a patient with neutropenic sepsis?
The high temperature puts them at a increased risk to develop a ear infection
33
What 10 medical conditions are patients with autism more at risk of?
```
ADHD
OCD
Bipolar
Depression
Anxiety
Epilepsy
Schizophrenia
Disrupted sleep
GI problems - chronic constipation, abdominal pain, GORD
Feeding problems
```
34
What is the definition of neutropenic sepsis?
Temperature over 38°C (or signs/symptoms of sepsis) and a neutrophil count of 0.5x10⁹/L
35
What are the 4 defects of tetralogy of fallot?
Ventricular septal defect
Pulmonary stenosis
Right ventricular hypertrophy
Misplaced aortic valve - sits on top of VSD allowing blood from LV+RV to move out of the aorta
36
What is the treatment of Tetralogy of fallot?
Surgery soon after the child is born§
37
What type of bilirubin builds up in physiological jaundice and at what age would you expect this form of jaundice to occur?
unconjugated bilirubin
| 2 days --> 14 days
38
What are the 3 main causes for physiological jaundice?
Shorted RBC lifespan = increased haemolysis
immature liver
Increased β-glucuronidase in SI (increased conversion back to unconjugated.
39
What 3 factors can increase a babies risk of developing physiological jaundice?
Preterm
Breast fed - unsure why but think there is a enzyme that increases unconjugated bilirubin
Bruising (cephalohematoma) - increased RBC breakdown
40
When would you think jaundice in a neonate could be pathological?
first 24 hours or after 14 days.
41
What are the 3 main (broad topics) causes of unconjugated pathological jaundice?
Sepsis
Haemolysis
endocrine/metabolic
42
What diseases causing haemolysis can cause unconjugated pathological jaundice? (neonate)
disease of newborn - maternal rhesus or ABO antibodies
spherocytosis - decreased RBC lifespan
G6PD - RBC increased oxidative damage
43
What diseases of endocrine/metabolic can cause unconjugated pathological jaundice?
Gilbert's syndrome
| Congenital hypothyroidism
44
What are the 3 possible causes of conjugated pathological jaundice? (neonate)
Biliary atresia
Neonatal hepatitis
Galactosaemia
45
What is the treatment for unconjugated physiological jaundice in a neonate?
Based on threshold charts
Phototherapy - moderate (turns into lumirubin)
Exchange transfusion - severe
46
What are the 4 causes of HIE?
Placental abruption
Uterine rupture
Prolonged labour
shoulder dystocia
47
How would you treat moderate/severe HIE?
Therapeutic hypothermia
48
What are the 6 reflexes you would expect in a baby?
```
Rooting
Sucking
Moro
Tonic neck
Stepping
Grasp
```
49
What is the rooting reflex and when you expect to elicit it until?
stroke babies side of mouth and they should turn their head in that direction with mouth open
Elicited until 4 months
50
What is the sucking reflex and when you expect to elicit it until?
Touch top of babies lips and their mouth should open and begin to suck.
Until 3-4 months.
51
What is the moro reflex and when you expect to elicit it until?
Startle reflex - loud noises or sudden movements
Babies arms and legs extend and then are brought into their body. head is thrown back.
Until 2 months
52
What is the tonic neck reflex and when you expect to elicit it until?
Turn babies head to side - arm of that side should then extend whilst the other leg becomes flexed (fencing position)
Until 5-7 months
53
What is the grasp reflex and when you expect to elicit it until?
Stroke babies palm and their fingers should grasp around yours. (can occur in feet also)
Until 5-6 months
54
What is the stepping reflex and when you expect to elicit it until?
Hold baby up with their feet on solid surface and they should start to walk/dance.
Until 2 months of age
55
What is the vaccine for RSV?
Palivizumab
56
A 6 week child presents with a pansystolic murmur heard best at the lower left sternal border. Hepatomegaly is present as well as a thrill. What is the mostly likely hear defect present?
Ventricular septal defect
57
What does clonic mean?
Rhythmic contractions followed by a slower relaxation phase
58
What does myoclonic mean?
Isolated brief, fast contractions followed by a complete muscle relaxation
59
What does spasm mean?
slightly longer phase of sustained contraction occurring in runs
60
What does tonic mean?
prolonged period of contraction of 1 + muscle groups
61
What does atonic mean?
sudden loss of muscle tone. Child will slump to the ground
62
What does absence mean?
brief arrest of speech and activity. Lip smacking, eye fluttering. Lasts <5 seconds
63
What does focal mean?
impaired awareness and unresponsiveness. Lasts >30 seconds but is less frequent than absences
64
What is the age of onset of infantile spasms?
4-12 months
65
What is the clinical picture of infantile spasms?
sudden jerks of the neck, trunk or limbs then tonic posturing. Related to sleep.
Tend to be in clusters and then causes the child to cry.
Insidious onset with subtle worsening spasms overtime. Loss of alertness and smile
66
A 10 year old boy comes into the CAU after suffering from 1 minute of left sided tonic-clonic convulsions in which he had tingling of his lips. He did not lose consciousness. It occurred just after he had woken up. What is the most likely form of epilepsy and what is the drug of choice to control this?
Benign Rolandic Epilepsy
Carbamazepine
67
What is the function of EEG's in the diagnosis of epilepsy?
Epilepsy diagnosis is based on history mainly.
EEG helps to decide what form of epilepsy it is and the most appropriate treatment and prognosis.
68
A 6 month year old comes into the CAU after having a seizure. The mum describes it as huge contractions of the babies body with about 6 occuring in a row. What is the most likely diagnosis and how would you treat?
Infantile spasms
Prednisolone or vigabatrin.
69
What is the difference between the symptomatic and idiopathic infantile spasms? (meaning of them)
Symptomatic - can be a sign of something more serious.
- HIE
- Tuberous sclerosis
- Infection
- Haemorrhage
- hypoglycaemia.
Idiopathic = random.
70
How is the diagnosis of febrile convulsions made?
Diagnosis of exclusion
71
How would a febrile convulsion present?
```
child 6 months --> 6 years
2-3 minute seizure
Tonic clonic (generalised)
Complete recovery within a hour
FH or previous febrile seizures.
```
72
A child presents with severe myoclonic seizure episodes. The first one came with a temperature and was very long. As the seizures have continued absence has developed. The child however is developing normally. What is the most likely diagnosis?
Dravet's syndrome
73
Why are young children more likely to have a wheeze?
Children have smaller airways anyway therefore when they inflamed and swell there is a bigger impact on the diameter
74
What is the primary treatment for viral wheeze?
Blue salbutamol reliever
75
What are the differential diagnosis when a child has a wheeze and how would you differentiate?
Common cold - stuffy nose, sneezing, low grade fever
Pharyngitis - sore throat
Otitis media - earache
Croup - barking cough
76
What is the difference between viral wheeze and bronchiolitis?
Bronchiolitis is more common in under 12 months and leads to hypoxia and breathlessness. It is similar to VIW however as they are younger the effect of the narrowing of the airways is more severe.
77
What are the symptoms of bronchiolitis?
```
Dry raspy cough
difficulty eating
low grade fever
wheezing
stuffy nose
```
78
What are the symptoms of bronchitis?
```
Coughing - thick mucous.
SOB
Fatigue and malaise
Runny nose/post nasal drip
sore throat
headache
chest pressure
```
79
What are the 2 viruses which primarily cause Croup?
Parainfluenza and RSV
80
A 18 month child presents with a barking cough. They have a hoarse voice when speaking and uyou otice they are in respiratory distress when they start to cry. They have a fever as well as coryzal. Intercostal recession is present on examination. What is the most likely diagnosis as well as 3 differential diagnosis?
Croup
Epiglottitis
Upper airway abscess
foreign body inhalation
81
What is the main treatment for mild/moderate croup?
Oral dexamethasone
82
What would you give for severe croup?
Nebulised adrenaline
83
What are the 3 benign heart murmurs that can be found in infants?
Venous hum
Still's vibratory
Pulmonary flow
84
What 3 factors have to be true for a murmur to be classed as innocent?
No symptoms
Single site
S2 variably split
85
A murmur is heard on a 1yr old boy, he has no symptoms and his S2 sound is variably split. It was heard as a rumbling murmur at the right 2nd intercostal space only. It was a continuous murmur heard louder when he was sat up. What is the most likely murmur?
Venous hum
86
A systolic murmur is heard on a 6 month old at the left sternal edge. You describe it as a twangy sound. You listen when he is laying down however when he is sat up on mums lap you can no longer hear a murmur. What is the most likely murmur?
Still's Vibratory
87
A soft systolic murmur is heard on a 3 year old. There are no symptoms mentioned and the S2 sound is variably split. You hear it at the left 2nd intercostal space and notice it is louder on inspiration. What is the most likely murmur?
Pulmonary flow
88
Why is it important to feel the femoral pulses of a child?
Coarctation of the aorta.
89
You feel for the apex beat which is present at the midclavicular line 5th intercostal space. Based on this where are the 4 valve areas on the chest?
```
Aortic = right 2nd ICS
Pulmonary = Left 2nd ICS
Tricuspid = Left lower sternal border (5th rib)
Mitral = Left midclavicular 5th ICS.
```
90
What are the 5 main systolic murmurs?
```
Aortic stenosis
Pulmonary stenosis
Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect
```
91
Where does aortic stenosis radiate to?
Neck and apex
92
Where does pulmonary stenosis radiate to?
Back
93
A murmur is heard on a infant. This murmur is continuous and is a machinery type murmur. It is best heard upper left sternal border. What is the most likely to be?
Patent ductus arteriosus
94
What are the pansystolic murmurs?
VSD
| Mitral/tricuspid regurgitation
95
What are the crescendo decrescendo murmurs?
Aortic and pulmonary stenosis
96
What genetic condition is a bicuspid aortic valve related with?
Turners syndrome (XO)
97
What are the 6 points to recognise when listening to a murmur?
```
Geography
Timing
Shape
Variation
Quality
Loudness
```
98
Atrial septal defect.
What shunting occurs?
What happens to the apex beat/right ventricle?
Where is the murmur most likely to be heard?
Left to right shunt
RVH = apex is further out
Pulmonary outflow tract.
99
What type of murmur would ventricular septal defect be heard as? (where, when)
Pan systolic
| Left sternal edge
100
What way does the shunt in VSD go? and how come it goes this way?
Left to right. As the pulmonary arteries have less resistance than the aorta therefore the blood moves into the RV to go to the pulmonary circulation.
101
What is the effect of the left to right shunt in VSD and why?
Left ventricular dilation/hypertrophy
Due to more blood going to the right ventricle however this then does get pumped into the LA --> LV. Therefore there is increased filling in the LV during diastole causing hypertrophy.
102
What is the consequence of a heart murmur not being fixed in childhood and what is it?
Eisenmenger disease.
- Pulmonary arteriolar hyperplasia due to the lungs increasing resistance in order to balance the resistance to cancel out the left to right shunting. However if they become ill (chesty) resistance in the lungs increases therefore a right to left shunt occurs = hypoxia/cyanotic due to mixing of oxygenated and deoxygenated blood going to the body.
103
What is the treatment for eisenmenger disease?
Heart and lung transplant
104
How can VSD lead to heart failure in infants?
on chart.
105
If a child has jaundice in the first 24 hours of life what are the 2 main causes that you need to think about?
Rhesus - haemolysis
| SEPSIS
106
What do you give to a mum who is rhesus negative whilst a baby is rhesus positive?
Anti-D to prevent rhesus disease
107
What is the importance of red cell distribution width?
Number is based on the uniformity of red blood cells. The more uniform the cells are the lower this figure will be.
108
What does the reticulocyte count tell you?
Are RBCs being produced
109
At what age does the fontanelle close?
1 year
110
How can meningitis lead to raised intracranial pressure?
Meningitis leads to increased proteins in the CSF which get stuck through the canals in the brain as it makes its way down the spine. As these get stuck there is a build up of CSF in the brain causing raised ICP.
111
How do you manage a raised ICP?
ABCDE
| Ventricular peritoneal shunt (fitted permenantly)
112
What sign do you try and ellicit in a suspected meningitis case?
Kernig's sign - in over 5s
113
What are the most likely causes of meningitis in a baby. 1 gram negative, positive and viral?
Gram negative = E. coli
Gram positive = Group B strep
Viral = Herpes simplex virus
114
What are the most likely causes of meningitis in a child. 2 gram negative, positive and atypical?
Gram negative = meningococcal pneumoniae and haemophilus influenzae B
Gram positive = Staph aureus and streptococcus pneumoniae
Atypical = TB and Mycoplasma pneumoniae
115
There is a suspected meningitis case so a lumbar puncture is carried out. The WCC is raised moderately with the main increase in neutrophils. Protein is also raised moderately whilst the glucose is below 50% of the serum glucose. Based on this what is the most likely form of meningitis?
Bacterial.
116
There is a suspected meningitis case so a lumbar puncture is carried out. The WCC is raised mildly with the main increase in lymphocytes. Protein is also raised mildly whilst the glucose is at 50% of the serum glucose. Based on this what is the most likely form of meningitis?
Viral
117
There is a suspected meningitis case so a lumbar puncture is carried out. The WCC is raised severely with the main increase in neutrophils. Protein is also raised severely whilst the glucose is below 50% of the serum glucose. Based on this what is the most likely form of meningitis?
TB
118
What are the eye signs that may be seen in a patient with raised intracranial pressure?
Sunset eye sign and pupils blown due to CN 3 and 6 being affected.
Papilledema - using ophthalmoscope
119
What is cushing's triad and what does it signify?
Decreased consciousness
Increased BP
Decreased HR
Signifies increased intracranial pressure
120
When might a headache signify raised intracranial pressure - what features would you be looking for?
headache that is worse on lying down and can come with vomiting.
121
What is very important to do when assessing someone for raised ICP?
Plotting their growth and head circumference.
122
What is the treatment for bacterial meningitis?
Antibiotics - 3rd generation cephalosporin (cefotaxime or ceftriaxone)
123
A febrile child comes into CAU, what are the 7 differential diagnoses to consider?
```
Meningitis
Kawasaki disease
Meningococcal disease (sepsis)
Herpes simplex encephalitis
Pneumonia
Septic arthritis
UTI
```
124
A child reports having diarrhoea that looks like red currant jelly, what is the most common cause of this?
Intussusception
125
What is the 1st line treatment for a baby with VSD and signs of cardiac failure?
Want to keep feeds up as to enable the baby to grow well so they can be ready for surgery later in life.
Therefore usually use diuretics (spironolactone and furosemide) to reduced cardiac output
126
What is the most likely cause of pneumonia in a young child/infant?
RSV
127
What is the most likely cause of pneumonia in a older child?
```
1st = Streptococcus pneumoniae
2nd = Mycoplasma
```
128
What is a common gram negative cause for neonatal pneumonia?
E.coli
129
What is a common gram negative cause for pneumonia in a infant/adolescent?
Haemophilus influenzae
| Mycoplasma
130
What's the most common gram positive cause of neonatal pneumonia?
GBS
131
What are the 2 most common gram positive causes of pneumonia in children?
Staph aureus
| Strep pneumoniae
132
A 5 day old baby is brought to clinic with mum who is concerned as he is losing weight. He is breast fed and mum says he is feeding well. On plotting him on growth chart it appears he has lost just under 10% of his weight. What would you tell the mum?
It is normal for a baby to lose up to 10% of their birth weight in the first week. After the first week you would then expect them to gain an ounce a day.
133
What symptoms would make you think of a lower UTI in a child under 3 months?
```
Fever
Vomiting
irritable
poor feeding
failure to thrive
lethargy
```
134
What symptoms would make you think of a lower UTI in a child over 3 months?
```
Fever
increased frequency
Pain on urination
abdominal pain
Loin tenderness
vomiting
poor feeding
dysfunctional voiding
changes in continence
```
135
A child comes in with suspected UTI symptoms - fever, increased frequency, abdominal pain and poor feeding. What are the differential diagnosis? (6)
Interstitial cystitis - relief on voiding
Sepsis
Meningitis
Kawasaki disease - rash, lymph node swelling
Nephrolithiasis - colicky pain
Urethritis
136
What is the main concern when dealing with a child with vomiting or diarrhoea?
Dehydration
137
What is the triad of symptoms for haemolytic uraemic syndrome?
AKI
Haemolytic anaemia
Thrombocytopenia
138
What happens to urea in case of dehydration?
It increases - best measure of dehydration
139
What are the 4 pathophysiological causes for vomiting?
Emetic response - irritation of gastric mucosa
Extra GI irritation
Chemoreceptor trigger zone stimulation
Increased ICP = vomiting activation
140
What are the 4 main differential diagnoses for vomiting in a newborn?
Pyloric stenosis
Duodenal atresia
Intestinal malrotation
Tracheoesophageal fistula
141
A 2 week baby comes in with projectile nonbilious vomiting after feeds. This has happened since they were born and there is a family history of similar. On examination a mass is felt around the umbilicus. what is the most likely diagnosis and what would you expect to find on a blood test?
Pyloric stenosis
Hypochloremic and hypokalemic metabolic acidosis
142
A newborn child has come in with vomiting it is bilious and they have no distension what would be the expected sign on an x-ray and what is your most likely diagnosis?
Duodenal atresia
Double bubble sign
143
A newborn comes into your GP with a cough when they are feeding they appear to go blue and have had a previous felt of pneumonia what is a likely diagnosis and where is the most likely cause of the pathology?
Fistula
Tracheoesophageal fistula
144
Intestinal malrotation is a surgical emergency and a newborn what are the likely symptoms and signs of this that would make you worry?
Intermittent bilious vomiting
| Abdominal distension after feeding
145
What is the most common age for child to present with gastro-oesophageal reflux's?
One to 3 months
146
what are the symptoms of normal gastro-oesophageal reflux's?
Frequent small regurgitation of feeds
irritable when fed
irritable when lying supine
147
what are the three possible symptoms that would make you think that this is gastro-oesophageal reflux disease instead just gastro-oesophageal reflux ?
Failure to thrive
Aspiration
Oesophagitis
148
a one year old child comes in with intermittent progressive abdominal pain and on examination there was a sausage like mass in the abdomen and when you ask about stools the mum says that recently today she has noticed some redcurrant like jelly stools what is the most likely diagnosis?
Intussusception
149
what is a common cause of vomiting in older children that occurs especially when the type of food and what are the most likely causes of this?
Allergies want to be checking for coeliac, IBS as well as cows milk allergy and others
150
What are the symptoms/signs/description of eosinophilic oesophagitis? and what is common in the PMH that would add up with that?
Past medical history of Atopy
Describe it as food sticking in food pipe
151
what are the five infectious causes of vomiting in children?
```
Gastroenteritis
UTI
pyelonephritis
meningitis
sepsis
```
152
are you most concerned about in a child with vomiting from gastroenteritis especially in younger children?
Dehydration and subsequent electrolyte disturbances
153
what are the three causes of neurological vomiting and was the general principle behind these?
Hydrocephalus
Intracranial Neoplasm
Migraine
Generally due to increased Intracranial pressure
154
for the three main symptoms you'd want to check for when assessing for increased intracranial pressure?
Morning headaches
focal neuro deficit
vision change such as papilloedema
155
What are the three main causes of metabolic and endocrine vomiting in a child?
DKA
Congenital adrenal hyperplasia
Inborn errors of metabolism
156
What is post-tussive emeisis?
Vomiting after prolonged forceful cough
157
What 3 medications can cause vomiting in children?
Opioids
Anti-convulsants
Aspirin
158
What is Leukaemia a cancer of?
Cancer of immature white blood cells
159
How does acute lymphoblastic leukaemia happen?
Abnormal proliferation and failed differentiation of B or T lymphoid progenitor cells. Uncontrolled proliferation within bone marrow prevents normal hematopoiesis and can spread to infiltrate other organs.
160
What is one of the biggest concerns with Acute Lymphoblastic Leukaemia?
Pancytopenia
| Can lead to neutropenia and neutropenic sepsis
161
What 3 tests can be used to diagnose Acute Lymphoblastic Leukaemia ?
Blood film
Bone Marrow
Flow
162
What is immune thrombocytopenia?
Self limiting post viral illness or post immunisation. Self limiting and normally resolve in 3 months.
163
What do you want to rule out before diagnosing Immune thrombocytopenia?
Leukaemia
| Bleeding disorder
164
What are petichiae?
Pinpoint round spots as a result of bleeding
165
What are purpura?
Red or purple non-blanching spots due to blood vessel haemorrhage
(larger than petechiae)
166
What are the symptoms of leukaemia?
```
Fatigue and malaise
Bone and joint pain
Dyspnoea
Dizziness and palpitations
Recurrent or severe infections
Fevers
Thrombocytopenia (bleeding tendency)
```
167
What may be found on examination of a patient with suspected leukaemia?
```
Weight loss
Pallor , petechial rash, bruising
Tachycardia
flow murmur
abdominal distension
Hepatosplenomegaly
Lymphadenopathy
```
168
What are the 3 main symptoms of haemophilia?
Bruising
Excessive bleeding
Joint effusion
169
A child is raising their head when lying on their tummy. On their back they wiggle and move arms and legs as well as being able to turn their head to the side. How old are they?
2 months
170
At 6 months what 3 gross motor signs would you expect a child to be exhibiting?
Sitting without support
Roll from back to tummy
Beginning to crawl (rocking)
171
A child is sitting without support, crawling, is able to roll over both ways and has started to stand up whilst holding onto something. What age would you expect them to be for their gross motor?
9 months
172
A child is cruising around furniture, standing on their own and beginning to walk unaccompanied. What age would you expect them to be at based on their gross motor?
1 year
173
What gross motor signs would you expect a 18 month year old to be doing?
```
Walking alone (red flag if not)
Walk up stairs
```
174
What 4 questions would you be asking to determine if a child is at the gross motor development of a 2 year old?
Can they jump?
Can they kick a ball?
Are they running?
Can they climb up and down furniture?
175
A child is now able to walk up and down stairs with alternate feet. As well as being able to ride a tricycle and can go on their tiptoes. What gross motor age are they?
3 years
176
What 3 gross motor things would you expect a 4 year old to be able to do?
Hop
Stand on 1 foot for 2 seconds
Throw, catch and kick a ball
177
A child can stand on 1 foot for 10 seconds and are able to skip and dance. What gross development age would this be descriptive of?
5 years
178
what fine motor/vision sign would you expect a 2 month old be able to do?
Following moving object of face - fixing and following
179
A child is reaching out and holding toys. They are bringing the toy and putting it in their mouth. What fine motor development would that be suggestive of?
4 months
180
What 2 fine motor signs would you expect a 6 month old to be able to do?
Hold a toy with both hands
| Pass a toy between hands
181
A child can now pick up a pencil (mature pincer grip) and can turn pages of a book. What age would you think they are?
12 months
182
How many blocks would you expect a 18 month old to stack and what other fine motor signs would you expect them to do?
blocks of 3
Pull toys whilst walking
Drink from a cup and eat from a spoon
turn pages of a book
183
A child can stack blocks to a tower of 6, hold a pencil and draw a line as well as being able to thread macaroni onto string. What would you expect their fine motor age to be?
2 years
184
Fine motor age - what specific block building and drawing would you expect of a 3 year old?
Build a bridge from a model
| Draw a circle and a cross
185
A child can build steps, draw a square and a person as well as now being able to eat and drink by themselves. What fine motor age would you expect them to be?
4 years
186
What fine motor would you expect of a 5 year old child?
Get undressed/dress themselves
Draw a triangle
Print some letters and numbers
187
What would signify to you that a newborn could hear?
Startle to loud noises
188
What communication would you expect a 2 month old to be making?
Cooing sounds
sounds when spoken back to
cries when wants something
turn head to voices
189
Chuckles softly and laughs as well as making high pitched squeals would put a child at communication age of?
4 months
190
A child is now copying simple sounds, making babbling sounds (mamma) and responds to commands. What age would you expect them to be?
9 months
191
What communication would you expect of a 6 month old?
Dada, gaga
| Squeals and laughs
192
What communication would you expect a 1yr old to be making?
Respond to their own name
| Makes more meaningful sounds - mamma, dadda
193
A child says single words, recognises and can point to body parts, enjoys nursery rhymes and obeys simple commands. What communication age would this put them at?
18 months
194
What communication would you expect a 2 year old to do?
name well known objects
Use I, mine, you
able to put 2-3 words together
195
A child can say their own name, age and sex. Count up to 10. Talks constantly and can join words and commands together. what communication age would that put them at?
3 years
196
At what age would you expect a child to be able to sing nursery rhymes?
4 years
197
At 5 years old what would you expect their communication to be like?
Speech is clear
| can say name, address and age
198
What would you expect a 2 month old to do socially?
smile responsively
| maintain eye contact
199
A child smiles at themselves in the mirror, gets excited to see people they know. What social age would you put them at?
4 months
200
A child now holds their hands up to be lifted and likes to look at themselves in the mirror. What age would this put them at?
6 months
201
What 3 features would you expect of social development for a 9 month old?
recognise family members
clingy to familiar adults
has a favourite toy
202
A child points at objects and holds out foot/arm to help dressing. What social age would this put them at?
12 months
203
What features would you expect for a 2 year old socially?
Pretends and likes role play
toilet trained
pulls off some clothing
204
A child now plays with other children and takes turns. What age would this put them at socially?
3 years
205
What would you expect a 4 year old to be like socially?
Likes to listen to and make up stories
asks a lot of questions
takes turns and shares
shows sympathy to friends when upset.
206
A child now has a best friend, is getting a sense of humour. Likes telling and hearing stories and is showing independence. How old would you put this child at?
5 years
207
At what age would you expect a child to have a pincer grip?
10 months
208
At what age would you expect a child to have a pincer grip?
10 months/12 months
209
```
what are the ages for drawing a:
line
circle
cross
square
triangle
```
```
line = 2 years
circle = 3 years
cross = 4 years
square = 4.5 years
triangle = 5 years
```
210
If a child is not walking by age of 18 months what conditions would you be concerned about?
Duchennes muscular dystrophy (gowers positive)
Cerebral palsy
Hip problems
210
If a child is not walking by age of 18 months what conditions would you be concerned about?
Duchennes muscular dystrophy (gowers positive)
Cerebral palsy
Hip problems
211
If a child is not walking by age of 18 months what conditions would you be concerned about?
Duchennes muscular dystrophy (gowers positive)
Cerebral palsy
Hip problems
212
At what age can they do stairs in a alternate fashion?
3 years
213
At what age can they do stairs - 1 step at a time?
2 years
214
At what age can they understand verbs - what do you eat with?
2 years
215
At what age can they understand negatives (which is not a animal) and understand adjectives (what is the colour red)?
3 years
216
At what age can they understand comparatives - who is this boy bigger than?
3.5 years
217
At what age can they follow complex instructions (take x to y but before that pick up m) ?
4 years
218
At what age can they drink from a beaker with a lid?
12 months
219
At what age can they eat with a spoon skilfully?
2.5 years
220
At what age can they eat with a fork and spoon?
3 years
221
At what age should they have bowel control?
3 years
222
At what age should they have bladder control?
4.5 years
223
at what age should they start sharing toys?
3 years
224
At what age should they have a best friend?
4 years
225
At what age can they dress/undress on their own?
4 years
226
At what age can they hop on the spot?
3 years
227
```
A baby is born with the following symptoms:
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
What is the most likely diagnosis?
```
Patau Syndrome (trisomy 13)
228
```
A baby is born with the following symptoms:
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
What is the most likely diagnosis?
```
Edwards Syndrome (Trisomy 18)
229
```
A baby is born with the following symptoms:
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
What is the most likely diagnosis?
```
Fragile X
230
```
A baby is born with the following symptoms:
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
What is the most likely diagnosis?
```
Noonan Syndrome
231
A baby is born with the following symptoms:
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
What is the most likely diagnosis?
Pierre Robin Syndrome
232
```
A baby is born with the following symptoms:
Hypotonia
Hypogonadism
Obesity
What is the most likely diagnosis?
```
Prader Willi Syndrome
233
```
A baby is born with the following symptoms:
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
What is the most likely diagnosis?
```
Williams Syndrome
234
A baby is born with the following symptoms:
Characteristic cry (hence the name) due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism
What is the most likely diagnosis?
Cri Du Chat syndrome
235
What is the first line treatment for west syndrome/infantile spasms?
Vigabatrin
236
A child is having multiple (up to 20 a day) 'attacks' the mum says they look like she is having colic and they only last a few seconds. She is also developmentally behind. What is the most likely diagnosis.
West syndrome aka infantile spasms
237
Surgery is the ultimate management for hirschsprungs disease but what should be done before surgery to prevent the risk of entercolitis?
rectal washouts and bowel irrigation
