Paediatrics Flashcards
1
Q
Median age and Limit age for walking
A
Median age: 12 months
Limit age: 18 months
2
Q
Child appears to be developing normally and hitting their milestones for the first year but then they lose their skills (regression). Which condition is this associated with?
A
Rett’s syndrome
3
Q
How do you diagnose global developmental delay
A
Significant delay in 2 or more of
- Gross/fine motor
- Speech/language
- Cognition
- Social/personal
- ADL
4
Q
What 3 things make up the autistic triad
A
Social interaction
Communication
Flexibility of thought/imagination
5
Q
In which condition is grower’s manouvre seen in ?
A
Duchenes muscular dystrophy
6
Q
MMR is live/inactivated vaccine
A
Live
7
Q
Whooping cough vaccine is live/inactivated?
A
Inactivated
8
Q
Diphtheria vaccine is live/inactivated?
A
inactivated
9
Q
Which 2 vaccines cannot be given to anyone with an egg allergy ?
A
Flu
Yellow fever
10
Q
5 in 1 childhood vaccine - what are the 5 things
A
Diphtheria Tetanus Polio Pertussis Haemophilus influenza B
11
Q
What is normal pulse range for a child less than 11 months
A
110-160 bpm
12
Q
What is normal pulse range for a child 12-24 months
A
100-150 bpm
13
Q
What is normal pulse range for child 2-4y
A
90-140 bpm
14
Q
What is normal pulse range for child 5-11y
A
80-130 bpm
15
Q
What is normal pulse range for child over 12
A
70-110 bpm
16
Q
What is normal resp rate for child less than 11 months
A
30-50
17
Q
Paediatric BLS algorithm - what do you do initially if patient is unresponsive / not breathing / only occasional gasps
A
Danger
Responsiveness (unresponsive)
Shout for help (call resus team)
5 rescue breaths
18
Q
If you give unresponsive child 5 rescue breaths and they do not respond, what do you do?
A
15 chest compressions -> 2 rescue breaths and so on
19
Q
If during CPR, you attach a defibrillator to the patient and it shows shockable rhythm, what do you do?
A
Administer shock then resume CPR for 2 mins until rhythm is assessed again
20
Q
What is the most common disease of the lower respiratory tract during the first year of life
A
Bronchiolitis
21
Q
What is the likley diagnosis?
few day Hx corzyal symptoms, persistent cough with increased work of breathing, often affects a child’s ability to feed.
On examination: wheeze / crackles on auscultation
A
Bronchiolitis
22
Q
You should routinely perform a chest X‑ray in children with bronchiolitis. True or false?
A
False
- often looks like a pneumonia
23
Q
coryzal prodrome lasting 1 to 3 days, followed by:
persistent cough and
either tachypnoea or chest recession (or both) and
either wheeze or crackles on chest auscultation (or both)
What is likelly diagnosis
A
Bronchiolitis
24
Q
How should bronchiolitis (in the hospital) be managed
A
O2 for patients with O2 sats less than 92%
Fluids - if patient is dehydrated
25
sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory), hoarse voice, and respiratory distress due to upper-airway obstruction. Symptoms are usually worse at night. There may be a fever.
What is likely diagnosis?
Can this be managed at home or in hospital?
Croup (severe, needs hospitlisation)
26
Bronchiolitis typically affects which age
Under 2
27
Croup typically affects which age
6 months -> 6 years
28
What treatment should child with croup receive
Oral dexamethasone (single dose)
29
Croup is viral or bacterial?
| Upper or lower RTI?
Viral (typically parainfluenza virus types 1 or 3)
| Upper RTI
30
first line antibiotic in child with CAP
amoxicillin, 5 days
31
if child has severe CAP what is first line treatment
Co-amoxiclav
32
Where should you routinely measure body temperature in children age 0-5
Axilla / ear
33
5 signs of dehydration in a child
```
Dry mucous membranes
Reduced skin turgor
Prolonged cap refill time
Weak pulse
Cold extremities
```
34
Tachypnoea, crackles in the chest, nasal flaring, chest indrawing, cyanosis, oxygen saturation of 95% or less when breathing air. What does this make you think or?
Pneumonia
35
If a child has suspected/proven infection and at least 2 of the following:
temp <36 or >38
inappropriate tachycardia
altered mental state (sleepy/irritable/floppy)
reduced peripheral perfusion / prolonged cap refill
What do you think is going on and how do you manage?
SEPSIS
| initiate sepsis 6
36
Bacterial tonsillitis confirmed and high centor score. What antibiotic is used
Phenoxymethylpenicillin
37
Antibiotics are usually required to treat acute ottitis media. True or false?
False
38
If an antibiotic is required to treat acute ottitis media, Which antibiotic is prescribed?
Amoxicillin
39
What is the bst indicator or UTI
+ve leukocyte esterase OR
+ve nitrites
+ve nitrites
40
For infants younger than 6 months with first-time UTI that responds well to treatment....do they require follow up investigation?
Yes, US within 6 weeks
41
For infants younger than 6 months with atypical UTI...d they require investigation? If so, what and when?
Yes
| - acute US investigation
42
For infants older than 6 months with first-time UTI that responds well to treatment....do they require follow up investigation?
NO
43
Wheezing occurs during inspiration.expiration?
Expiration
44
What is the most common inhaler used in children?
pressurised meter dose inhaler (pMDI)
45
pressurised meter dose inhaler (pMDI) MUST be used with a spacer in children. True or false?
True
46
Name 2 examples of DPI (dry power inhaler)
Ellipta
| Accuhaler
47
If you use an inhaler that contains steroids, what should you do afterward?
Rinse your mouth out with water
48
How do you instruct someone to use a pMDI
```
Open cap
Shake inhaler
breathe out fully
ensure good seal of inhaler around mouth and breathe in slowly and deeply
Count to 10 before breathing out
```
49
How do you instruct someone to use a DPI ?
Open cap
Hold inhaler horizontally
Load the device by pushing back the lever
breathe out fully
ensure good seal of inhaler around mouth and breathe in as hard and fast as possible
Count to 10 before breathing out
50
Spacer for pMDI for pre-school child
Yellow aerochamber with mask or volumatic with mask
51
Spacer for pMDI for school aged children
Blue aerochamber or volumatic without mask
52
What kind of inhaler is a symbicort and what drugs are in it
Combination of ICS + LABA
| Budesonide + formoterol
53
What kind of inhaler is a seretide and what drugs are in it
Combination of ICS + LABA
| Fluticasone + salmeterol
54
Management of severe croup
Oral dexamethasone
| Nebulised adrenaline with oxygen
55
Which organism causes bacterial tracheitis ?
Staph aureus
56
Which organism causes acute epiglottitis?
Haemophilus influenzae type B
57
Acute onset
high fever in an ill, toxic-looking child
• an intensely painful throat that prevents the child
from speaking or swallowing; saliva drools down
the chin
• soft inspiratory stridor and rapidly increasing
respiratory difficulty over hours
• the child sitting immobile, upright, with an open
mouth to optimise the airway.
what does this make you think
Acute epiglottitis
58
What is the prophylaxis for whooping cough
Erythromycin
59
What is laryngomalacia
Recurrent or continuous stridor since birth
60
Fever, poor feeding, cough, lethargy, cyanosis
• Tachypnoea, nasal flaring, chest recession, wheeze
and end-inspiratory coarse crackles over the
affected area
• O2 saturation may be decreased
What does this most likely suggest?
Pneumonia
61
What are 2 risk factors for transient early wheezing
Maternal smoker
Prematurity
Resolves by age 5, associated with viral illnesses
62
Name 2 SABAs (relievers)
| How long are they effective for?
Salbutamol
Terbutaline
Effective for 2-4 hrs
They are used PRN
63
Name 2 LABAs
| How long are they effective for?
Salmeterol
Formoterol
Effective for 12 hrs
64
tracheal tug (looks like trachea is touching back of c-spine), sternal recession suggests
Upper airway obstruction
65
reduced air entry is often associated with? and what investigation should be carried out?
empyema
| US
66
Management of acute mild asthma attack
10 puff salbutamol via spacer
| oral prednisolone
67
Management of acute moderate asthma attack
10 puff salbutamol via spacer (re-assess every hour)
| may need to go nebulised -> life threatening
68
Management of acute severe/life threatening asthma attack
```
Oxygen
Salbutamol (nebuliser)
IV hydrocortisone
Ipatroprium bromide (nebs)
IV magnesium sulphate
Oral theophyline / IV aminophiline
```
69
Sat upright, hyperextended neck, looks really unwell, drooling
Epiglottitis
70
Management of severe croup
Oral dexamethasone
| Nebulised adrenaline
71
Management of severe croup
Oral dexamethasone
| Nebulised adrenaline
72
commonest cause of bloody diarrhoea and dehydration?
E. coli 0157 (HUS)
73
What will you see in a blood film of HUS?
red cell breakdown
74
Treatment of HUS
establish IV access
get bloods
urinalysis
IV fluids -> keep checking bloods
75
How would you describe billious vomiting?
| what does it suggest?
dark green
| suggests mechanical obstruction
76
```
7 year old female, central abdo pain for 2 days now radiating to right, abdo soft
Preceding cold/viral infection
neck lymphadenopathy
Observations fine
What is likely diagnosis?
```
Mesenteric adenitis
77
Domperidone - side effects (2)
Long QT
Brugada syndrome
Need ECG every 3 months
78
bilious vomiting, very hungry baby, every time they feed they vomit, big head little body
diagnosis?
Management?
diagnosis: Pyloric stenosis
Management: correct electrolytes -> surgery
79
bilious vomiting, very hungry baby, every time they feed they vomit, big head little body
diagnosis?
Management?
diagnosis: Pyloric stenosis
Management: correct electrolytes -> surgery
80
Heavy child (weight above 90th centile) , 9-11 year, mainly male, atraumatic limp, antalgic gait, leg length discrepancy. Suggest diagnosis? suggest investigation?
```
SUFE
XR pelvis (AP and lateral)
```
81
Hot swollen joints, often more than one, cyclical temps, fluid filled joints, normal inflammatory markers. Child otherwise well. What is likely diagnosis?
juvenile idiopathic arthritis
82
```
Less than 5
more common in baby boy
affects hip (more common) / knee
preceded by viral illness
Suggest diagnosis?
```
Transient synovitis
83
between 3-9 y/o
more common in boys
present with leg length discrepancies
Perthes disease
84
Kid with recent chicken pox / insect bite.
Vomiting, lethargy, fever, red hot swollen joint (knee).
very severe pain.
think about?
investigation?
Septic arthritis
Ix: joint aspiration
involve orthopaedics early
85
4 yo girl presents with "sore knee" lasts 2 days. Not getting better with calpol. Walking with a limp no Hx of trauma.
Obs: normal, afebrile
OE: slightly antalgic gait, no swollen or red joints
Transient synovitis
86
Infected rash give
Antibiotics
87
Non blanching rash differentials
```
Meningococcal
HSP
ITP
Acute leukaemia
HUS
```
88
Non blanching rash differentials
```
Meningococcal
HSP
ITP
Acute leukaemia
HUS
```
89
Rash in SVC distribution. does this make it more/less severe?
Less
| - this rash is due to coughing / vomiting
90
Dry rash give
Emollients
91
5 week old girl. Unsettled for last week. crying after feeds, vomiting, initial weight loss, now following 50th centile.
Obs: normal, afebrile
OE: examines well, no rashes, soft fontanella, well hydrated.
What is likely diagnosis?
GORD
| Tx: conservative
92
Allergy vs Intolerance
allergy - hypersensitivity reaction (involved immune system)
Intolerance - direct effect from the food (bloating/loose stools/sore stomach), no involvement of immune system
93
2 types of food allergy
Immediate hypersensitivity reaction (IgE mediated)
| Delayed hypersensitivity reaction (type IV)
94
first line treatment of eczema
Steroid creams and emollients
95
Atopic individuals are more likely to have
Immediate hypersensitivity reaction (IgE mediated)
Delayed hypersensitivity reaction
Immediate
96
IgE mediated food allergy
Tingling in mouth
Swelling
Urticarial rash
Angioedema
97
Urticarial type rash with dot in the middle. What is likely
Erythema murtiforme
98
Investigating IgE mediated food allergy
```
Blood tests (IgE)
Skin prick
```
99
When would you get an epipen?
Wheezy
| Peanut allergy
100
Treatment of food allergy
Avoidance of trigger
Anti-histamine +/- steroids
Adrenaline
Immunotherapy - give you small doses of what you're allergic to
101
Sore tummy, lose poos, blood in poo in children under 1
Cows milk protein allergy/intolerance
102
What do you do if you have a bottle fed baby with cows milk protein allergy/intolerance, step 1
Hydrolysed formula milk
103
What do you do if you have a bottle fed baby with cows milk protein allergy/intolerance if hydrolysed formula milk doesn't work?
Amino acid based formula milk
104
If you have an exclusively breast feeding mother but the baby has cows milk protein allergy/intolerance. What do you do?
Make sure mum is dairy free and also soy free.
| Why soy free? Has increased plant oestrogens in soya milk
105
Children of any age can get pMDI / DPI ?
pMDI
106
Overview of management of acute severe stridor
Identify underlying cause
- eg croup, epiglottitis, foreign body, anaphylaxis
Combined nebulisers
- oxygen
- steroid (dexamethasone)
- adrenaline
107
Which hormone is responsible for the let down reflex in breast feeding?
Oxytocin
108
Children on cow's milk should receive full fat milk / semi skimmed milk?
Full fat milk - up until the age of 5
109
What is the protein in a cows milk based formula?
Lactose
110
Solid foods are recommended to be introduced after X months?
6 months
111
How many wet nappies should a baby have in 24 hours?
At least 3
112
What is the significance of a fever lasting for 5 or more days?
think about Kawasaki disease
113
When administering adrenaline in anaphylaxis, what position should the patient be in?
lie down with legs up
114
In an adult / child over 12, what dose of adrenaline should be given for anaphylaxis?
500mcg (5ml 1 in 1000)
115
In a child 6-12 years, what dose of adrenaline should be given for anaphylaxis?
300mcg (3ml 1 in 1000)
116
In a child under 6, what dose of adrenaline should be given for anaphylaxis?
150mcg (0.15ml 1 in 1000)
117
Which 3 drugs are important in anaphylaxis
Adrenaline
Hydrocortisone
Chlorphenamine (anti-histamine)
118
'projectile' vomiting, typically 30 minutes after a feed
constipation and dehydration may also be present
a palpable mass may be present in the upper abdomen
hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
most common in 2nd-4th week of life.
What is the suggested diagnosis here?
Pyloric stenosis
119
What is the definitive investigation in allergy testing?
Eat the food - be exposed to the allergen
120
if you're going to do allergy testing (skin prick / bloods for IgE levels) when should you NOT do them?
Within 4-6 weeks of an allergic reaction
| - wait until after this time
121
Before doing skin prick test, how long does child need to be off anti-histamine?
3 days
122
Children under X age don't get soy milk?
Children under 6 months
123
Which antihistamine is used in anaphylaxis
Chlorphenamine
124
Treatment of acute allergic reaction (not anaphylaxis) what is first line
Chlorphenamine
125
Where is IM adrenaline injected into
Anterolateral aspect of thigh
126
Latent TB treatment
3 months of isoniazid
127
Which medication may be used for an infant with GORD
Gaviscon
128
5 year old girl referred with failure to gain weight and possible weight loss.
Daily abdominal pain and bloating
Loose stools x 4 daily.
What is the likely diagnosis?
and what initial investigations should you do?
Coeliac disease or crohns
TTG
Anti-endomesial antibodies (EMA)
129
What is the gold standard investigation for diagnosis of coeliac disease
Endoscopy with duodenal biopsy
130
Explosive passing of stool after PR exam suggests which diagnosis
Hirschsprung’s disease
131
12 year old boy referred from general paediatric clinic with abdominal pain and weight loss.
Treated for irritable bowel syndrome for 2 years.
Now loosing weight and passing blood PR.
Stool cultures normal.
What is likely diagnosis?
Ulcerative colitis
132
Projectile vomiting in first few weeks of life and hunger after vomiting makes you think
Pyloric stenosis
133
Children with gord are usually
- gaining weight normally
- failing to thrive
Gaining weight normally
134
Pyloric stenosis is more common in boys/girls?
Boys (4:1)
135
Management of pyloric stenosis
correct any fluid and electrolyte disturbance with intravenous fluids
then pyloromyotomy
136
Abdominal pain accompanied with viral infection with lymphadenopathy. What is likely diagnosis?
Mesenteric adenitis
137
What is the commonest cause of intestinal obstruction in infants after the neonatal period
Intusucception
138
1 year old with paroxysmal, colicky pain
with pallor, abdominal mass, redcurrant jelly
stool, draws legs up. what is likely diagnosis?
Intusucception
139
When in a childs life does malrotation usually present?
First 3 days of life
140
What is the most common bacterial cause of gastroenteritis
Campylobacter
141
Mesalazine is used in crohns / UC ?
UC
142
Which types of medications may be used in constipation
```
Stool softener (laxitive)
Stimulant laxative (senna)
```
143
Which is worst
- right to left cardiac shunt
- left to right cardiac shunt
Right to left cardiac shunt
144
Transposition of the great arteries and tetralogy of fallot are both
- R to L shunt
- L to R shunt
R to L shunt
145
In the foetus, the RIGHT/LEFT atrium has higher pressure?
Right atrium
146
When a baby takes its first breaths, volume in the right atrium increases/decreases and the volume in the left atrium increases/decreases
R atrium - decreases
| L atrium - increases
147
Name 3 L to R shunts
ASD
VSD
Persistent ductus arteriosus
148
ASD murmur type
- systolic / diastolic
- ejection / pan / holi
Ejection systolic
149
VSD murmur type and heart sound
Pan systolic murmur
| Quiet second heart sound
150
continuous murmur beneath the left clavicle
| collapsing or bounding pulse
patent ductus arteriosus
151
Cyanosis within the first week of life think either (2)
Tetrallogy of fallot
| Transposition of the great vessels
152
• A large VSD
• Overriding of the aorta with respect to the
ventricular septum
• Subpulmonary stenosis causing right ventricular
outflow tract obstruction
• Right ventricular hypertrophy as a result.
Tetralogy of fallot
153
Seritide is twice as potent as clenile modulate inhaler. True or false?
True
154
An 11 year old is very stable and needs to step down their asthma treatment. They are currently taking Seretide 125 Evohaler 2 puffs twice daily. What is the safest step down option?
Seretide 125 Evohaler 1 puff twice daily
Clenil Modulite 100mcg 1 puff twice daily
Seretide 50 Evohaler 2 puffs twice daily
No change
Seretide 50 Evohaler 2 puffs twice daily
- Seretide is a combination inhaler of Fluticasone and Salmeterol. This steps down from 1000mcg/day to 400 mcg/day by using the lower strength inhaler, but crucially, this doesn't change the daily Salmeterol dose. Patients may be more likely to manage as the "2 puffs twice a day" instructions are also the same. If patients need to move in smaller steps, you can exchange individual puffs of Seretide 125 with Seretide 50 to bring the dose in a series of smaller steps, but that's more fiddly and needs the family to have clear instructions!
155
Which medication can be used to help keep cardiac duct open?
Prostaglandin
156
What may a single palmar crease be a sign of?
Downs syndrome
157
For how long should gestational correction be continued for premature infants born at 32-36 weeks gestation?
1 year
158
For how long should gestational correction be continued for premature infants born at 28-32 weeks gestation?
2 years
159
Common organism causing sepsis in neonate ?
Group B strep
160
- usually after recovering from RDS
- early signs: lethargy and gastric residuals
- Bloody stool, temperature instability, apnoea and bradycardia
What does this suggest?
Necrotising enterocolitis (NEC)
161
If you stroke both carotids at the same time, what can happen?
Make someone faint
| - baroreceptor reflexes firing
162
In the womb, where do you get oxygen from?
PLacneta
163
Where is the foramen ovale
Right atrium to transfer blood from RA --> LA
164
What medication is used for strawberry haemangioma to help them shrink
propranolol
165
Rash on baby, comes up a couple of days after birth, completely benign, baby is otherwise well, what is it?
Erythema toxicum
166
Papsule with punctum in the middle makes you think
Molluscum contagiosum
167
What causes molluscum contagiosum
Pox virus
168
Coryza symptoms, swollen red cheeks, what is the syndrome and what virus causes it?
Slapped cheek syndrome
| Virus: parovirus
169
Slapped cheek syndrome affects
- platelets
- red blood cells
- white blood cells
Red blood cells
170
Scarlet fever treatment
IV penicillin
| - since it is group A strep
171
White strawberry tongue, peeling of fingers of toes, erythematous, rough rash, perioral palor. What is likely diagnosis?
Scarlet fever
172
Yellow gold crusted lesion on face - what is it? and what organism?
Impetigo
| Staph aureus
173
Child presents with around 10 loose stools per day, otherwise well and thriving. What is likely diagnosis?
Toddler's diarrhoea
| - likely grow out of it
174
3 month old boy referred to outpatient clinic with persistent vomiting.
Growing well on centile chart.
Bottle feeding
What is likely going on?
GORD
175
In children, you can diagnose coeliac disease on blood tests alone (ie you don't have to do endoscopy). True or false?
True
- if ttG >10 times the upper limit of normal
- if classical symptoms present
176
What is the target blood sugar level for a diabetic before meals?
4-7
177
What si the target blood sugar level for a diabetic 2 hours after meals?
5-9
178
Lantis (glargine) is long acting or short acting
Long acting
179
Outline the management of DKA
Oxygen if required
IV access
- IV fluids (first)
- IV insulin
180
```
Polyuria
Polydypsia
Tiredness
Tummy pain
Weight loss
```
Diabetes
181
decreased/increased skin tugor is a sign of dehydration
Decreased
182
There is a risk of what with DKA?
Cerebral oedema
183
Converting IV to sub cut
0. 05 units / kilo
- half their weight
- half again for lantis
- and thirds for novorapid
184
Surfactant deficiency CXR findings
Small volume lungs
diffuse granular opacification
bubbly lungs
pneumothorax
185
TTN definition
Slow clearing of pulmonary fluid
| onset within 24 hours of birth
186
Normal or hyperinflated lungs
interstitial lines
fluid in the fissures
air space oppacification
TTN
187
Distress during delivery
over inflated lungs (air trapping)
air leaks
Meconium aspiration
188
patchy opacities
over infaltion
atelectasis
what do you suspect
Pneumonia
189
endotracheal tube goes into right main bronchus. what can happen to the left lung?
L lung can collapse
| - since it is unventilated
190
children under 6 months - UTI imaging required ?
US
If abnormal
- VCUG and renogram
191
What does DMSA scan look at
Renal function
| done 4-6 months post complicated UTI to assess relative renal function and scarring
192
Buldging fontanelles suggests
Raised ICP
193
Spiral long bone fractures in a child suggests
NAI
194
Posterior or lateral rib fractures. What does this suggest?
NAI
195
Fracture
| - broken on one side but bowing on the other (ie other side intact) . What is this called?
greenstick fracture
196
Which classification system is used to classify growth plate injuries
Salter harris classification
- 1-5
2 is most common
197
Fixed split S2 - which heart defect
ASD
| - think A split double (splitting of 2nd heart sound)
198
Which type of murmur do you get in VSD?
holosystolic murmur
199
Which medications would you give in coarctation of the aorta to keep the ductus arteriosus open?
prostaglandin E
200
Which medications would you give in patent ductus arteriosus to promote duct closure?
Indomethacin
| Ibuprofen
201
transposition of the great arteries can be diagnosed on antenatal US. True or false?
True
202
What is the most common cyanotic heart defect in paeds
tetralogy of fallot
203
Loud harsh ejection systolic murmur in which heart defect
Tetralogy of fallot
204
Is tetrallogy of fallot cyanotic?
Yes
205
Spots -> fluid filled blisters (vesicles -> crust over. On skin. what is this?
Chickenpox
206
How is chickenpox spread?
Droplets (coughs, sneezes)
207
Blue mark on bum
mongolian blue spot
208
If someone has talipes....what should you to?
Try and straighten it out to see if it is fixed or not
209
If talipes does't straighten out, what should you do?
Refer to orthopaedics for splinting
210
Lumps on babys head differential
Caput
| Cephalohaematoma
211
How do you tell the difference between caput and cephalohaematoma?
Cephalohaematoma doesn't cross the suture lines
212
Physiological jaundice (3 causes)
Breast feeding
| foetal haemoglobin
213
2 potentially pathological causes of jaundice
Prolonged - over 14 days
| Immediately after birth - in first 24 hours
214
PDA is a shunt from right/left -> right/left
Left -> Right
215
Extreme preterm
Very preterm
Moderate-late preterm
ranges
Extreme preterm: before 28 weeks
Very preterm: 28-32 weeks
Moderate-late preterm: 32-36 weeks
216
Preterm baby doesn't get formula milk. True or false?
True
- breast milk
- donor expressed breast milk
217
What is RDS commonly due to
Lack of surfactant
| Structural immaturity of lung tissue
218
Who is most likely to get TTN
Babies delivered by C section
219
Over reaction to mistakes
Thumb sucking when older
Self mutilation
Sudden speech disorders
What kind of abuse does this suggest?
Emotional abuse
220
If you recognise potential child abuse at work, normal office hours, who do you report to
Senior colleague
| Child protection team
221
Which types of injuries/bruising makes you concerned about child abuse
Bruising on a child who can't mobilise yet
Bruising at ears
Bruising at upper arm / outer thigh
222
Fractures suggesting NAI
Fractures of different ages
Spiral femoral fracture
C spine fracture (shaking)
223
Surfactant is pig extract. True or false?
True
224
Why is vitamin K given at birth
To prevent bleeding disorders
225
Pre-term neonate
bilious vomiting, bloody stool, abdo distention
What is this likely to be
NEC
226
Risk factors for NEC
Preterm
Formula feeding
IUGR
227
When prescribing an inhaler, what should you remember
include strength and types of inhaler
| Prescribe in number of puffs
228
Dextrocardia + bronchiectasis + chronic sinusitis suggests
Kartagener syndrome
229
First time AF, lasted longer than 48 hours. Patient doing ok.
How do you manage?
Do you want to cardiovert and if so either
- pharmacological
- elecrical
Bisoprolol and anticoagulation for 3 weeks
Then electrical cardioversion
230
Red patchy rash in first week of life. What is it and how do you treat?
Erythema toxicum
| Self limiting
231
Measles and rubella have which type of rash
Maculopapular
232
Which type of rash is seen in chicken pox
Vesicular
233
Purpura and petichiae are associated with which infection
Meningitis
234
Target lesions are associated with which rash
Steven Johnson syndrome
235
In HSP, the child will be well / unwell
Well
236
The rash between HSP and which other condition looks similar?
Meningitis
237
Why do babies with respiratory distress grunt
trying to increase alveolar pressure
238
Chest x-ray of respiratory distress syndrome will show
Ground glass opacification
239
What is RDS caused by
Relative surfactant deficiency
240
How is production of surfactant stimulated
By steroids
241
How to manage a tension pneumothorax
Needle decompression
| Chest drain
242
Babies at risk of RSV, what do you give them?
Pavalizumab - this is IgG to RSV
243
Term baby, especially delivered by c-section, what respiratory problem do you risk?
TTN
| - lungs filled with amniotic fluid
244
What gestation do babies learn to suck?
32 weeks gestation
245
Treatment of neonatal acne?
Nothing
246
First line oral acne for teenager?
Tetracycline
247
Why should you never give a baby tetracycline?
affects bones / teeth in babies
248
Jaundice that appears before 24 hours old, what are you worried about ?
Haemolytic disease
- ABO
- rhesus disease
249
All pregnant mkthers get antiD. True or false?
True
250
Prolonged jaundice - what are you worrying about
Biliary atresia
251
Pale stools and dark urine - is this conjugated / unconjugated jaundice?
Conjugated
252
Day 6 we get gurthrie teat
Screened for thyroid function
253
Why treat jaundice with light therapy
if your level is too high, can cross the BBB, can cause cererbal palsy - kernicterous
254
How does light therapy work for babies with high unconjugated jaundice
change bilirubin from fat soluble to water soluble isomer
255
Erbs palsy involves which nerves?
C5, C6
256
Klumpke's palsy involves which nerves?
C8, T1
257
AXR - air/gas in the gut wall. What does this make you think?
NEC
258
```
4-6 week age group
Distention of stomach
Baby vomits towards end of / just after feed
PROJECTILE vomit
What is the likely diagnosis
```
Pyloric stenosis
259
Colicky pain, young child, mass may be felt in abdomen.
| What is the likely diagnosis?
Insusception
260
True bilous vomiting suggests
Intestinal obstruction
261
What are the 4 features of tetralogy of fallot?
Right ventricular hypertrophy
Pulmonary stenosis
Ventricular septal defect
Overriding aorta
262
Rash: Small, pearly papules with central umbilication
molluscum contagiosum
263
What is the treatment of molluscum contagiosum
Self limiting
264
Failure to pass meconium in first 24-48 hours after birth, vomiting and abdominal distension makes you think?
Hirshprung's disease
265
What investigation is needed for the definitive diagnosis of Hirshprung's disease?
Suction assisted full thickness rectal biopsies
266
Most common site of aspiration
- right main bronchus
- left main bronchus
Right main bronchus
267
Acute glomerulonephritis often follows a sore throat / URTI. True or false?
True
268
Which age group is most common for intussception
9-12 months
269
Convulsing child in hospital. Episode has been lasting over 5 mins and you have vascular access. What do you give?
IV Lorazepam
270
Convulsing child in hospital. Episode has been lasting over 5 mins and you DO NOT have vascular access. What do you give?
Buccal midazolam / rectal diazepam
271
Convulsing child in hospital. Episode has been lasting over 10 mins and you have vascular access. At 5 mins you gave lorazepam IV. What do you do at 10 mins?
Give IV lorazepam
272
3 triggers for reflex anoxic seizures
Pain
Fear
Anxiety
273
When should a child be able to sit unsupported?
6 months
274
When should child be able to walk?
12 months
275
When should child be able to transfer objects between hands?
6 months
276
When should child be able to develop pincer grip?
9 months
277
What age to draw a circle?
Age 3
278
Can't run by X months is classified as delayed?
24
279
Hand dominance prior to X months is a red flag?
18 months
280
Primitive reflexes are usually lost by X months?
12 months
281
Describe the rooting reflex
Stroke a baby's cheek causes baby to turn and open mouth
282
At 12 months of age, a child has persistence of primitive reflexes. Does this indicate:
- normal finding for this age
- UMN lesion
- LMN lesion
UMN lesion
283
HSP rash is blanching or non-blanching?
Non-blanching
284
HSP commonly involves which organ?
Kidneys
285
If someone is in status epilepticus, begin to intervene after X mins
5
286
Tried lorazepam for status epilepticus but not controlling seizure, what can you use?
phenytoin
287
How must you give phenytoin
Slowly over an infusion
288
Which age do febrile convulsions usually stop?
By age 6
289
18 month old male, not walking. What will you check?
CK levels for ?Duchenes muscular dystrophy
290
Sensory issues
Repetitive behaviour
Deficits in social communication and interaction
ASD
291
Cerebral palsy
- UMN lesion
- LMN lesion
UMN lesion
292
```
Prominent forehead
Long, thin face
High arch palate
Dental overcrowding
Pectus excuvatum
Delayed gross motor milestones
Dysmorphic features present
```
Fragile X
293
Main complication of chicken pox
Encephalitis
294
When will the anterior fontanelle have disappeared (roughly)?
Around 18 months
295
newborn with abdominal contents protruding through anterior abdominal wall but are covered in an amniotic sac. what is this likely to be?
Exopthalmos
296
What is the key investigation in pyloric stenosis?
US
297
What are the 2 treatments used in kawasaki disease
Aspirin
| single dose IVIg
298
3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever - what does this suggest?
HHV6
| roseola infantum
299
Coarctation of the aorta and PDA have SYSTOLIC murmurs. True or false?
False
300
SUFE
- painless / painful limp
- age group
Painful limp
| Teenagers
301
Perthes disease
- painless / painful limp
- age group
Painless limp
Longer history (weeks / months)
Children 4-8y
302
Commonest brain tumour in young children
Medulloblastoma
303
Child 4 years old with PDA. What is the management?
Early operative closure is recommended in any patient where the defect has persisted beyond 6 months of age.
304
Which of the following is a child with recurrent upper urinary tract infections most likely to show?
Horseshoe kidney
Neurogenic bladder
Renal and ureteric calculi
Vesicoureteric reflux
Vesicoureteric reflux
305
What is the likely diagnosis here:
A 5-year-old boy is referred to a paediatrician after his parents notice frank haematuria. On examination an abdominal mass is palpable. An intravenous urogram shows dilation of the pelvicalyceal system.
Wilms tumour
306
A 2-year-old child presents to the Emergency department with fever, left loin pain and offensive smelling urine.
He is pyrexial at 38.5°C. A clean catch urine is positive for blood, protein and nitrites.
What is most appropriate initial antibiotic therapy?
Co-amoxiclav
307
Name 3 causes of prolonged jaundice in the neonate
Biliary atresia
Hypothyroidism
G6PD deficiency
308
What does direct coombs test check for
Haemolysis
309
What is kernicterus
| How does it present
A type of brain damage caused by excessive bilirubin levels
less responsive, floppy, drowsy baby with poor feeding. The damage to the nervous system is permeant, causing cerebral palsy, learning disability and deafness
310
CXR in RDS
Ground glass appearance
311
What is th investigation of choice for NEC
Abdominal XRay
312
Immediate management of NEC
nil by mouth with IV fluids, total parenteral nutrition (TPN) and antibiotics to stabilise them. A nasogastric tube can be inserted to drain fluid and gas from the stomach and intestines.
