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Medicine > Paediatrics > Flashcards

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

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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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

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13
Q

At what age would you be concerned that a child did not have visual fixation?

A

2 months

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14
Q

At what age would you be concerned that a child had not vocalised by?

A

6 months

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15
Q

At what age would you be concerned that a child was not sitting without support by?

A

9-10 months

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16
Q

At what age would you be concerned that a child was not standing alone?

A

16 months

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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

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18
Q

By what age would you be concerned if they were not showing any signs of imaginative play?

A

3 years

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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
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20
Q

When is the blood spot test carried out and when do parents get the results?

A

5 days old

6-8 weeks

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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
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22
Q

What is the most common cause of early onset severe infection in new borns?

A

group B strep

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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

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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)
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25
Q

What is the normal range of HR, BP and RR for a Infant (<1)

A

110-160 HR
40 RR
70-110 systolic

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26
Q

What is the normal range of HR and RR for a Toddler (1-2yrs)?

A

100-150 HR

35 RR

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27
Q

What is the normal range of HR and RR for a pre school child (3-4 yrs)?

A

96-140 HR

30 RR

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28
Q

What is the normal range of HR and RR for a School child (5-11 yrs)?

A

80-120 HR

25 RR

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29
Q

What antibiotic is used as a ‘super’ gram positive antibiotic?

A

Vancomycin

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30
Q

What antibiotic is used as a ‘super’ gram negative antibiotic?

A

Gentamicin

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31
Q

What are 2 examples of 3rd generation cephalosporins? What is the difference between daily dosing?

A

Cefotaxime - 3 times a day administration

Ceftriaxone - 1 time a day administration

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32
Q

Why would you want to check the ears of a patient with neutropenic sepsis?

A

The high temperature puts them at a increased risk to develop a ear infection

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33
Q

What 10 medical conditions are patients with autism more at risk of?

A 
ADHD
OCD 
Bipolar 
Depression 
Anxiety 
Epilepsy 
Schizophrenia 
Disrupted sleep 
GI problems - chronic constipation, abdominal pain, GORD  
Feeding problems
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34
Q

What is the definition of neutropenic sepsis?

A

Temperature over 38°C (or signs/symptoms of sepsis) and a neutrophil count of 0.5x10⁹/L

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35
Q

What are the 4 defects of tetralogy of fallot?

A

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

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36
Q

What is the treatment of Tetralogy of fallot?

A

Surgery soon after the child is born§

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37
Q

What type of bilirubin builds up in physiological jaundice and at what age would you expect this form of jaundice to occur?

A

unconjugated bilirubin

2 days –> 14 days

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38
Q

What are the 3 main causes for physiological jaundice?

A

Shorted RBC lifespan = increased haemolysis
immature liver
Increased β-glucuronidase in SI (increased conversion back to unconjugated.

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39
Q

What 3 factors can increase a babies risk of developing physiological jaundice?

A

Preterm
Breast fed - unsure why but think there is a enzyme that increases unconjugated bilirubin
Bruising (cephalohematoma) - increased RBC breakdown

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40
Q

When would you think jaundice in a neonate could be pathological?

A

first 24 hours or after 14 days.

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41
Q

What are the 3 main (broad topics) causes of unconjugated pathological jaundice?

A

Sepsis
Haemolysis
endocrine/metabolic

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42
Q

What diseases causing haemolysis can cause unconjugated pathological jaundice? (neonate)

A

disease of newborn - maternal rhesus or ABO antibodies
spherocytosis - decreased RBC lifespan
G6PD - RBC increased oxidative damage

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43
Q

What diseases of endocrine/metabolic can cause unconjugated pathological jaundice?

A

Gilbert’s syndrome

Congenital hypothyroidism

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44
Q

What are the 3 possible causes of conjugated pathological jaundice? (neonate)

A

Biliary atresia
Neonatal hepatitis
Galactosaemia

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45
Q

What is the treatment for unconjugated physiological jaundice in a neonate?

A

Based on threshold charts
Phototherapy - moderate (turns into lumirubin)
Exchange transfusion - severe

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46
Q

What are the 4 causes of HIE?

A

Placental abruption
Uterine rupture
Prolonged labour
shoulder dystocia

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47
Q

How would you treat moderate/severe HIE?

A

Therapeutic hypothermia

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48
Q

What are the 6 reflexes you would expect in a baby?

A 
Rooting 
Sucking 
Moro 
Tonic neck 
Stepping 
Grasp
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49
Q

What is the rooting reflex and when you expect to elicit it until?

A

stroke babies side of mouth and they should turn their head in that direction with mouth open
Elicited until 4 months

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50
Q

What is the sucking reflex and when you expect to elicit it until?

A

Touch top of babies lips and their mouth should open and begin to suck.
Until 3-4 months.

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51
Q

What is the moro reflex and when you expect to elicit it until?

A

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

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52
Q

What is the tonic neck reflex and when you expect to elicit it until?

A

Turn babies head to side - arm of that side should then extend whilst the other leg becomes flexed (fencing position)
Until 5-7 months

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53
Q

What is the grasp reflex and when you expect to elicit it until?

A

Stroke babies palm and their fingers should grasp around yours. (can occur in feet also)
Until 5-6 months

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54
Q

What is the stepping reflex and when you expect to elicit it until?

A

Hold baby up with their feet on solid surface and they should start to walk/dance.
Until 2 months of age

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55
Q

What is the vaccine for RSV?

A

Palivizumab

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56
Q

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?

A

Ventricular septal defect

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57
Q

What does clonic mean?

A

Rhythmic contractions followed by a slower relaxation phase

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58
Q

What does myoclonic mean?

A

Isolated brief, fast contractions followed by a complete muscle relaxation

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59
Q

What does spasm mean?

A

slightly longer phase of sustained contraction occurring in runs

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60
Q

What does tonic mean?

A

prolonged period of contraction of 1 + muscle groups

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61
Q

What does atonic mean?

A

sudden loss of muscle tone. Child will slump to the ground

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62
Q

What does absence mean?

A

brief arrest of speech and activity. Lip smacking, eye fluttering. Lasts <5 seconds

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63
Q

What does focal mean?

A

impaired awareness and unresponsiveness. Lasts >30 seconds but is less frequent than absences

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64
Q

What is the age of onset of infantile spasms?

A

4-12 months

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65
Q

What is the clinical picture of infantile spasms?

A

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

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66
Q

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?

A

Benign Rolandic Epilepsy

Carbamazepine

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67
Q

What is the function of EEG’s in the diagnosis of epilepsy?

A

Epilepsy diagnosis is based on history mainly.

EEG helps to decide what form of epilepsy it is and the most appropriate treatment and prognosis.

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68
Q

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?

A

Infantile spasms

Prednisolone or vigabatrin.

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69
Q

What is the difference between the symptomatic and idiopathic infantile spasms? (meaning of them)

A

Symptomatic - can be a sign of something more serious.

  • HIE
  • Tuberous sclerosis
  • Infection
  • Haemorrhage
  • hypoglycaemia.

Idiopathic = random.

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70
Q

How is the diagnosis of febrile convulsions made?

A

Diagnosis of exclusion

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71
Q

How would a febrile convulsion present?

A 
child 6 months --> 6 years 
2-3 minute seizure 
Tonic clonic (generalised) 
Complete recovery within a hour 
FH or previous febrile seizures.
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72
Q

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?

A

Dravet’s syndrome

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73
Q

Why are young children more likely to have a wheeze?

A

Children have smaller airways anyway therefore when they inflamed and swell there is a bigger impact on the diameter

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74
Q

What is the primary treatment for viral wheeze?

A

Blue salbutamol reliever

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75
Q

What are the differential diagnosis when a child has a wheeze and how would you differentiate?

A

Common cold - stuffy nose, sneezing, low grade fever
Pharyngitis - sore throat
Otitis media - earache
Croup - barking cough

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76
Q

What is the difference between viral wheeze and bronchiolitis?

A

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.

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77
Q

What are the symptoms of bronchiolitis?

A 
Dry raspy cough 
difficulty eating 
low grade fever 
wheezing
stuffy nose
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78
Q

What are the symptoms of bronchitis?

A 
Coughing - thick mucous. 
SOB 
Fatigue and malaise 
Runny nose/post nasal drip
sore throat 
headache 
chest pressure
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79
Q

What are the 2 viruses which primarily cause Croup?

A

Parainfluenza and RSV

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80
Q

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?

A

Croup

Epiglottitis
Upper airway abscess
foreign body inhalation

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81
Q

What is the main treatment for mild/moderate croup?

A

Oral dexamethasone

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82
Q

What would you give for severe croup?

A

Nebulised adrenaline

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83
Q

What are the 3 benign heart murmurs that can be found in infants?

A

Venous hum
Still’s vibratory
Pulmonary flow

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84
Q

What 3 factors have to be true for a murmur to be classed as innocent?

A

No symptoms
Single site
S2 variably split

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85
Q

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?

A

Venous hum

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86
Q

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?

A

Still’s Vibratory

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87
Q

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?

A

Pulmonary flow

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88
Q

Why is it important to feel the femoral pulses of a child?

A

Coarctation of the aorta.

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89
Q

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?

A 
Aortic = right 2nd ICS
Pulmonary = Left 2nd ICS 
Tricuspid = Left lower sternal border (5th rib) 
Mitral = Left midclavicular 5th ICS.
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90
Q

What are the 5 main systolic murmurs?

A 
Aortic stenosis 
Pulmonary stenosis 
Mitral regurgitation 
Tricuspid regurgitation 
Ventricular septal defect
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91
Q

Where does aortic stenosis radiate to?

A

Neck and apex

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92
Q

Where does pulmonary stenosis radiate to?

A

Back

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93
Q

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?

A

Patent ductus arteriosus

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94
Q

What are the pansystolic murmurs?

A

VSD

Mitral/tricuspid regurgitation

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95
Q

What are the crescendo decrescendo murmurs?

A

Aortic and pulmonary stenosis

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96
Q

What genetic condition is a bicuspid aortic valve related with?

A

Turners syndrome (XO)

97
Q

What are the 6 points to recognise when listening to a murmur?

A 
Geography 
Timing 
Shape 
Variation 
Quality 
Loudness
98
Q

Atrial septal defect.
What shunting occurs?
What happens to the apex beat/right ventricle?
Where is the murmur most likely to be heard?

A

Left to right shunt
RVH = apex is further out
Pulmonary outflow tract.

99
Q

What type of murmur would ventricular septal defect be heard as? (where, when)

A

Pan systolic

Left sternal edge

100
Q

What way does the shunt in VSD go? and how come it goes this way?

A

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
Q

What is the effect of the left to right shunt in VSD and why?

A

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
Q

What is the consequence of a heart murmur not being fixed in childhood and what is it?

A

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
Q

What is the treatment for eisenmenger disease?

A

Heart and lung transplant

104
Q

How can VSD lead to heart failure in infants?

A

on chart.

105
Q

If a child has jaundice in the first 24 hours of life what are the 2 main causes that you need to think about?

A

Rhesus - haemolysis

SEPSIS

106
Q

What do you give to a mum who is rhesus negative whilst a baby is rhesus positive?

A

Anti-D to prevent rhesus disease

107
Q

What is the importance of red cell distribution width?

A

Number is based on the uniformity of red blood cells. The more uniform the cells are the lower this figure will be.

108
Q

What does the reticulocyte count tell you?

A

Are RBCs being produced

109
Q

At what age does the fontanelle close?

A

1 year

110
Q

How can meningitis lead to raised intracranial pressure?

A

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
Q

How do you manage a raised ICP?

A

ABCDE

Ventricular peritoneal shunt (fitted permenantly)

112
Q

What sign do you try and ellicit in a suspected meningitis case?

A

Kernig’s sign - in over 5s

113
Q

What are the most likely causes of meningitis in a baby. 1 gram negative, positive and viral?

A

Gram negative = E. coli
Gram positive = Group B strep
Viral = Herpes simplex virus

114
Q

What are the most likely causes of meningitis in a child. 2 gram negative, positive and atypical?

A

Gram negative = meningococcal pneumoniae and haemophilus influenzae B
Gram positive = Staph aureus and streptococcus pneumoniae
Atypical = TB and Mycoplasma pneumoniae

115
Q

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?

A

Bacterial.

116
Q

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?

A

Viral

117
Q

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?

A

TB

118
Q

What are the eye signs that may be seen in a patient with raised intracranial pressure?

A

Sunset eye sign and pupils blown due to CN 3 and 6 being affected.
Papilledema - using ophthalmoscope

119
Q

What is cushing’s triad and what does it signify?

A

Decreased consciousness
Increased BP
Decreased HR
Signifies increased intracranial pressure

120
Q

When might a headache signify raised intracranial pressure - what features would you be looking for?

A

headache that is worse on lying down and can come with vomiting.

121
Q

What is very important to do when assessing someone for raised ICP?

A

Plotting their growth and head circumference.

122
Q

What is the treatment for bacterial meningitis?

A

Antibiotics - 3rd generation cephalosporin (cefotaxime or ceftriaxone)

123
Q

A febrile child comes into CAU, what are the 7 differential diagnoses to consider?

A 
Meningitis 
Kawasaki disease
Meningococcal disease (sepsis) 
Herpes simplex encephalitis 
Pneumonia 
Septic arthritis 
UTI
124
Q

A child reports having diarrhoea that looks like red currant jelly, what is the most common cause of this?

A

Intussusception

125
Q

What is the 1st line treatment for a baby with VSD and signs of cardiac failure?

A

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
Q

What is the most likely cause of pneumonia in a young child/infant?

A

RSV

127
Q

What is the most likely cause of pneumonia in a older child?

A 
1st = Streptococcus pneumoniae 
2nd = Mycoplasma
128
Q

What is a common gram negative cause for neonatal pneumonia?

A

E.coli

129
Q

What is a common gram negative cause for pneumonia in a infant/adolescent?

A

Haemophilus influenzae

Mycoplasma

130
Q

What’s the most common gram positive cause of neonatal pneumonia?

A

GBS

131
Q

What are the 2 most common gram positive causes of pneumonia in children?

A

Staph aureus

Strep pneumoniae

132
Q

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?

A

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
Q

What symptoms would make you think of a lower UTI in a child under 3 months?

A 
Fever 
Vomiting 
irritable 
poor feeding 
failure to thrive 
lethargy
134
Q

What symptoms would make you think of a lower UTI in a child over 3 months?

A 
Fever 
increased frequency 
Pain on urination 
abdominal pain 
Loin tenderness 
vomiting 
poor feeding 
dysfunctional voiding 
changes in continence
135
Q

A child comes in with suspected UTI symptoms - fever, increased frequency, abdominal pain and poor feeding. What are the differential diagnosis? (6)

A

Interstitial cystitis - relief on voiding
Sepsis
Meningitis
Kawasaki disease - rash, lymph node swelling
Nephrolithiasis - colicky pain
Urethritis

136
Q

What is the main concern when dealing with a child with vomiting or diarrhoea?

A

Dehydration

137
Q

What is the triad of symptoms for haemolytic uraemic syndrome?

A

AKI
Haemolytic anaemia
Thrombocytopenia

138
Q

What happens to urea in case of dehydration?

A

It increases - best measure of dehydration

139
Q

What are the 4 pathophysiological causes for vomiting?

A

Emetic response - irritation of gastric mucosa
Extra GI irritation
Chemoreceptor trigger zone stimulation
Increased ICP = vomiting activation

140
Q

What are the 4 main differential diagnoses for vomiting in a newborn?

A

Pyloric stenosis
Duodenal atresia
Intestinal malrotation
Tracheoesophageal fistula

141
Q

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?

A

Pyloric stenosis

Hypochloremic and hypokalemic metabolic acidosis

142
Q

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?

A

Duodenal atresia

Double bubble sign

143
Q

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?

A

Fistula

Tracheoesophageal fistula

144
Q

Intestinal malrotation is a surgical emergency and a newborn what are the likely symptoms and signs of this that would make you worry?

A

Intermittent bilious vomiting

Abdominal distension after feeding

145
Q

What is the most common age for child to present with gastro-oesophageal reflux’s?

A

One to 3 months

146
Q

what are the symptoms of normal gastro-oesophageal reflux’s?

A

Frequent small regurgitation of feeds
irritable when fed
irritable when lying supine

147
Q

what are the three possible symptoms that would make you think that this is gastro-oesophageal reflux disease instead just gastro-oesophageal reflux ?

A

Failure to thrive
Aspiration
Oesophagitis

148
Q

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?

A

Intussusception

149
Q

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?

A

Allergies want to be checking for coeliac, IBS as well as cows milk allergy and others

150
Q

What are the symptoms/signs/description of eosinophilic oesophagitis? and what is common in the PMH that would add up with that?

A

Past medical history of Atopy

Describe it as food sticking in food pipe

151
Q

what are the five infectious causes of vomiting in children?

A 
Gastroenteritis
UTI 
pyelonephritis 
meningitis 
sepsis
152
Q

are you most concerned about in a child with vomiting from gastroenteritis especially in younger children?

A

Dehydration and subsequent electrolyte disturbances

153
Q

what are the three causes of neurological vomiting and was the general principle behind these?

A

Hydrocephalus
Intracranial Neoplasm
Migraine

Generally due to increased Intracranial pressure

154
Q

for the three main symptoms you’d want to check for when assessing for increased intracranial pressure?

A

Morning headaches
focal neuro deficit
vision change such as papilloedema

155
Q

What are the three main causes of metabolic and endocrine vomiting in a child?

A

DKA
Congenital adrenal hyperplasia
Inborn errors of metabolism

156
Q

What is post-tussive emeisis?

A

Vomiting after prolonged forceful cough

157
Q

What 3 medications can cause vomiting in children?

A

Opioids
Anti-convulsants
Aspirin

158
Q

What is Leukaemia a cancer of?

A

Cancer of immature white blood cells

159
Q

How does acute lymphoblastic leukaemia happen?

A

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
Q

What is one of the biggest concerns with Acute Lymphoblastic Leukaemia?

A

Pancytopenia

Can lead to neutropenia and neutropenic sepsis

161
Q

What 3 tests can be used to diagnose Acute Lymphoblastic Leukaemia ?

A

Blood film
Bone Marrow
Flow

162
Q

What is immune thrombocytopenia?

A

Self limiting post viral illness or post immunisation. Self limiting and normally resolve in 3 months.

163
Q

What do you want to rule out before diagnosing Immune thrombocytopenia?

A

Leukaemia

Bleeding disorder

164
Q

What are petichiae?

A

Pinpoint round spots as a result of bleeding

165
Q

What are purpura?

A

Red or purple non-blanching spots due to blood vessel haemorrhage
(larger than petechiae)

166
Q

What are the symptoms of leukaemia?

A 
Fatigue and malaise 
Bone and joint pain 
Dyspnoea 
Dizziness and palpitations 
Recurrent or severe infections 
Fevers 
Thrombocytopenia (bleeding tendency)
167
Q

What may be found on examination of a patient with suspected leukaemia?

A 
Weight loss 
Pallor , petechial rash, bruising 
Tachycardia 
flow murmur 
abdominal distension 
Hepatosplenomegaly 
Lymphadenopathy
168
Q

What are the 3 main symptoms of haemophilia?

A

Bruising
Excessive bleeding
Joint effusion

169
Q

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?

A

2 months

170
Q

At 6 months what 3 gross motor signs would you expect a child to be exhibiting?

A

Sitting without support
Roll from back to tummy
Beginning to crawl (rocking)

171
Q

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?

A

9 months

172
Q

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?

A

1 year

173
Q

What gross motor signs would you expect a 18 month year old to be doing?

A 
Walking alone (red flag if not) 
Walk up stairs
174
Q

What 4 questions would you be asking to determine if a child is at the gross motor development of a 2 year old?

A

Can they jump?
Can they kick a ball?
Are they running?
Can they climb up and down furniture?

175
Q

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?

A

3 years

176
Q

What 3 gross motor things would you expect a 4 year old to be able to do?

A

Hop
Stand on 1 foot for 2 seconds
Throw, catch and kick a ball

177
Q

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?

A

5 years

178
Q

what fine motor/vision sign would you expect a 2 month old be able to do?

A

Following moving object of face - fixing and following

179
Q

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?

A

4 months

180
Q

What 2 fine motor signs would you expect a 6 month old to be able to do?

A

Hold a toy with both hands

Pass a toy between hands

181
Q

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?

A

12 months

182
Q

How many blocks would you expect a 18 month old to stack and what other fine motor signs would you expect them to do?

A

blocks of 3
Pull toys whilst walking
Drink from a cup and eat from a spoon
turn pages of a book

183
Q

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?

A

2 years

184
Q

Fine motor age - what specific block building and drawing would you expect of a 3 year old?

A

Build a bridge from a model

Draw a circle and a cross

185
Q

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?

A

4 years

186
Q

What fine motor would you expect of a 5 year old child?

A

Get undressed/dress themselves
Draw a triangle
Print some letters and numbers

187
Q

What would signify to you that a newborn could hear?

A

Startle to loud noises

188
Q

What communication would you expect a 2 month old to be making?

A

Cooing sounds
sounds when spoken back to
cries when wants something
turn head to voices

189
Q

Chuckles softly and laughs as well as making high pitched squeals would put a child at communication age of?

A

4 months

190
Q

A child is now copying simple sounds, making babbling sounds (mamma) and responds to commands. What age would you expect them to be?

A

9 months

191
Q

What communication would you expect of a 6 month old?

A

Dada, gaga

Squeals and laughs

192
Q

What communication would you expect a 1yr old to be making?

A

Respond to their own name

Makes more meaningful sounds - mamma, dadda

193
Q

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?

A

18 months

194
Q

What communication would you expect a 2 year old to do?

A

name well known objects
Use I, mine, you
able to put 2-3 words together

195
Q

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?

A

3 years

196
Q

At what age would you expect a child to be able to sing nursery rhymes?

A

4 years

197
Q

At 5 years old what would you expect their communication to be like?

A

Speech is clear

can say name, address and age

198
Q

What would you expect a 2 month old to do socially?

A

smile responsively

maintain eye contact

199
Q

A child smiles at themselves in the mirror, gets excited to see people they know. What social age would you put them at?

A

4 months

200
Q

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?

A

6 months

201
Q

What 3 features would you expect of social development for a 9 month old?

A

recognise family members
clingy to familiar adults
has a favourite toy

202
Q

A child points at objects and holds out foot/arm to help dressing. What social age would this put them at?

A

12 months

203
Q

What features would you expect for a 2 year old socially?

A

Pretends and likes role play
toilet trained
pulls off some clothing

204
Q

A child now plays with other children and takes turns. What age would this put them at socially?

A

3 years

205
Q

What would you expect a 4 year old to be like socially?

A

Likes to listen to and make up stories
asks a lot of questions
takes turns and shares
shows sympathy to friends when upset.

206
Q

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?

A

5 years

207
Q

At what age would you expect a child to have a pincer grip?

A

10 months

208
Q

At what age would you expect a child to have a pincer grip?

A

10 months/12 months

209
Q 
what are the ages for drawing a: 
line 
circle  
cross   
square 
triangle
A 
line = 2 years 
circle = 3 years 
cross  = 4 years 
square = 4.5 years 
triangle = 5 years
210
Q

If a child is not walking by age of 18 months what conditions would you be concerned about?

A

Duchennes muscular dystrophy (gowers positive)
Cerebral palsy
Hip problems

210
Q

If a child is not walking by age of 18 months what conditions would you be concerned about?

A

Duchennes muscular dystrophy (gowers positive)
Cerebral palsy
Hip problems

211
Q

If a child is not walking by age of 18 months what conditions would you be concerned about?

A

Duchennes muscular dystrophy (gowers positive)
Cerebral palsy
Hip problems

212
Q

At what age can they do stairs in a alternate fashion?

A

3 years

213
Q

At what age can they do stairs - 1 step at a time?

A

2 years

214
Q

At what age can they understand verbs - what do you eat with?

A

2 years

215
Q

At what age can they understand negatives (which is not a animal) and understand adjectives (what is the colour red)?

A

3 years

216
Q

At what age can they understand comparatives - who is this boy bigger than?

A

3.5 years

217
Q

At what age can they follow complex instructions (take x to y but before that pick up m) ?

A

4 years

218
Q

At what age can they drink from a beaker with a lid?

A

12 months

219
Q

At what age can they eat with a spoon skilfully?

A

2.5 years

220
Q

At what age can they eat with a fork and spoon?

A

3 years

221
Q

At what age should they have bowel control?

A

3 years

222
Q

At what age should they have bladder control?

A

4.5 years

223
Q

at what age should they start sharing toys?

A

3 years

224
Q

At what age should they have a best friend?

A

4 years

225
Q

At what age can they dress/undress on their own?

A

4 years

226
Q

At what age can they hop on the spot?

A

3 years

227
Q 
A baby is born with the following symptoms: 
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
What is the most likely diagnosis?
A

Patau Syndrome (trisomy 13)

228
Q 
A baby is born with the following symptoms: 
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
What is the most likely diagnosis?
A

Edwards Syndrome (Trisomy 18)

229
Q 
A baby is born with the following symptoms: 
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
What is the most likely diagnosis?
A

Fragile X

230
Q 
A baby is born with the following symptoms: 
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
What is the most likely diagnosis?
A

Noonan Syndrome

231
Q

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?

A

Pierre Robin Syndrome

232
Q 
A baby is born with the following symptoms: 
Hypotonia
Hypogonadism
Obesity
What is the most likely diagnosis?
A

Prader Willi Syndrome

233
Q 
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?
A

Williams Syndrome

234
Q

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?

A

Cri Du Chat syndrome

235
Q

What is the first line treatment for west syndrome/infantile spasms?

A

Vigabatrin

236
Q

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.

A

West syndrome aka infantile spasms

237
Q

Surgery is the ultimate management for hirschsprungs disease but what should be done before surgery to prevent the risk of entercolitis?

A

rectal washouts and bowel irrigation

Medicine (26 decks)

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