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Y4 > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Median age and Limit age for walking

A

Median age: 12 months

Limit age: 18 months

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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

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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
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4
Q

What 3 things make up the autistic triad

A

Social interaction
Communication
Flexibility of thought/imagination

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5
Q

In which condition is grower’s manouvre seen in ?

A

Duchenes muscular dystrophy

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6
Q

MMR is live/inactivated vaccine

A

Live

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7
Q

Whooping cough vaccine is live/inactivated?

A

Inactivated

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8
Q

Diphtheria vaccine is live/inactivated?

A

inactivated

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9
Q

Which 2 vaccines cannot be given to anyone with an egg allergy ?

A

Flu

Yellow fever

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10
Q

5 in 1 childhood vaccine - what are the 5 things

A 
Diphtheria 
Tetanus 
Polio 
Pertussis 
Haemophilus influenza B
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11
Q

What is normal pulse range for a child less than 11 months

A

110-160 bpm

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12
Q

What is normal pulse range for a child 12-24 months

A

100-150 bpm

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13
Q

What is normal pulse range for child 2-4y

A

90-140 bpm

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14
Q

What is normal pulse range for child 5-11y

A

80-130 bpm

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15
Q

What is normal pulse range for child over 12

A

70-110 bpm

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16
Q

What is normal resp rate for child less than 11 months

A

30-50

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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

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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

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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

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20
Q

What is the most common disease of the lower respiratory tract during the first year of life

A

Bronchiolitis

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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

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22
Q

You should routinely perform a chest X‑ray in children with bronchiolitis. True or false?

A

False

- often looks like a pneumonia

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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

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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

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25
Q

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?

A

Croup (severe, needs hospitlisation)

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26
Q

Bronchiolitis typically affects which age

A

Under 2

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27
Q

Croup typically affects which age

A

6 months -> 6 years

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28
Q

What treatment should child with croup receive

A

Oral dexamethasone (single dose)

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29
Q

Croup is viral or bacterial?

Upper or lower RTI?

A

Viral (typically parainfluenza virus types 1 or 3)

Upper RTI

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30
Q

first line antibiotic in child with CAP

A

amoxicillin, 5 days

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31
Q

if child has severe CAP what is first line treatment

A

Co-amoxiclav

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32
Q

Where should you routinely measure body temperature in children age 0-5

A

Axilla / ear

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33
Q

5 signs of dehydration in a child

A 
Dry mucous membranes 
Reduced skin turgor
Prolonged cap refill time 
Weak pulse
Cold extremities
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34
Q

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?

A

Pneumonia

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35
Q

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?

A

SEPSIS

initiate sepsis 6

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36
Q

Bacterial tonsillitis confirmed and high centor score. What antibiotic is used

A

Phenoxymethylpenicillin

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37
Q

Antibiotics are usually required to treat acute ottitis media. True or false?

A

False

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38
Q

If an antibiotic is required to treat acute ottitis media, Which antibiotic is prescribed?

A

Amoxicillin

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39
Q

What is the bst indicator or UTI
+ve leukocyte esterase OR
+ve nitrites

A

+ve nitrites

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40
Q

For infants younger than 6 months with first-time UTI that responds well to treatment….do they require follow up investigation?

A

Yes, US within 6 weeks

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41
Q

For infants younger than 6 months with atypical UTI…d they require investigation? If so, what and when?

A

Yes

- acute US investigation

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42
Q

For infants older than 6 months with first-time UTI that responds well to treatment….do they require follow up investigation?

A

NO

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43
Q

Wheezing occurs during inspiration.expiration?

A

Expiration

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44
Q

What is the most common inhaler used in children?

A

pressurised meter dose inhaler (pMDI)

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45
Q

pressurised meter dose inhaler (pMDI) MUST be used with a spacer in children. True or false?

A

True

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46
Q

Name 2 examples of DPI (dry power inhaler)

A

Ellipta

Accuhaler

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47
Q

If you use an inhaler that contains steroids, what should you do afterward?

A

Rinse your mouth out with water

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48
Q

How do you instruct someone to use a pMDI

A 
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
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49
Q

How do you instruct someone to use a DPI ?

A

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

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50
Q

Spacer for pMDI for pre-school child

A

Yellow aerochamber with mask or volumatic with mask

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51
Q

Spacer for pMDI for school aged children

A

Blue aerochamber or volumatic without mask

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52
Q

What kind of inhaler is a symbicort and what drugs are in it

A

Combination of ICS + LABA

Budesonide + formoterol

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53
Q

What kind of inhaler is a seretide and what drugs are in it

A

Combination of ICS + LABA

Fluticasone + salmeterol

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54
Q

Management of severe croup

A

Oral dexamethasone

Nebulised adrenaline with oxygen

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55
Q

Which organism causes bacterial tracheitis ?

A

Staph aureus

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56
Q

Which organism causes acute epiglottitis?

A

Haemophilus influenzae type B

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57
Q

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

A

Acute epiglottitis

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58
Q

What is the prophylaxis for whooping cough

A

Erythromycin

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59
Q

What is laryngomalacia

A

Recurrent or continuous stridor since birth

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60
Q

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?

A

Pneumonia

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61
Q

What are 2 risk factors for transient early wheezing

A

Maternal smoker
Prematurity
Resolves by age 5, associated with viral illnesses

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62
Q

Name 2 SABAs (relievers)

How long are they effective for?

A

Salbutamol
Terbutaline

Effective for 2-4 hrs
They are used PRN

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63
Q

Name 2 LABAs

How long are they effective for?

A

Salmeterol
Formoterol

Effective for 12 hrs

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64
Q

tracheal tug (looks like trachea is touching back of c-spine), sternal recession suggests

A

Upper airway obstruction

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65
Q

reduced air entry is often associated with? and what investigation should be carried out?

A

empyema

US

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66
Q

Management of acute mild asthma attack

A

10 puff salbutamol via spacer

oral prednisolone

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67
Q

Management of acute moderate asthma attack

A

10 puff salbutamol via spacer (re-assess every hour)

may need to go nebulised -> life threatening

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68
Q

Management of acute severe/life threatening asthma attack

A 
Oxygen 
Salbutamol (nebuliser)
IV hydrocortisone 
Ipatroprium bromide (nebs) 
IV magnesium sulphate 
Oral theophyline / IV aminophiline
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69
Q

Sat upright, hyperextended neck, looks really unwell, drooling

A

Epiglottitis

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70
Q

Management of severe croup

A

Oral dexamethasone

Nebulised adrenaline

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71
Q

Management of severe croup

A

Oral dexamethasone

Nebulised adrenaline

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72
Q

commonest cause of bloody diarrhoea and dehydration?

A

E. coli 0157 (HUS)

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73
Q

What will you see in a blood film of HUS?

A

red cell breakdown

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74
Q

Treatment of HUS

A

establish IV access
get bloods
urinalysis
IV fluids -> keep checking bloods

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75
Q

How would you describe billious vomiting?

what does it suggest?

A

dark green

suggests mechanical obstruction

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76
Q 
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?
A

Mesenteric adenitis

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77
Q

Domperidone - side effects (2)

A

Long QT
Brugada syndrome

Need ECG every 3 months

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78
Q

bilious vomiting, very hungry baby, every time they feed they vomit, big head little body
diagnosis?
Management?

A

diagnosis: Pyloric stenosis

Management: correct electrolytes -> surgery

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79
Q

bilious vomiting, very hungry baby, every time they feed they vomit, big head little body
diagnosis?
Management?

A

diagnosis: Pyloric stenosis

Management: correct electrolytes -> surgery

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80
Q

Heavy child (weight above 90th centile) , 9-11 year, mainly male, atraumatic limp, antalgic gait, leg length discrepancy. Suggest diagnosis? suggest investigation?

A 
SUFE 
XR pelvis (AP and lateral)
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81
Q

Hot swollen joints, often more than one, cyclical temps, fluid filled joints, normal inflammatory markers. Child otherwise well. What is likely diagnosis?

A

juvenile idiopathic arthritis

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82
Q 
Less than 5
more common in baby boy 
affects hip (more common) / knee 
preceded by viral illness 
Suggest diagnosis?
A

Transient synovitis

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83
Q

between 3-9 y/o
more common in boys
present with leg length discrepancies

A

Perthes disease

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84
Q

Kid with recent chicken pox / insect bite.
Vomiting, lethargy, fever, red hot swollen joint (knee).
very severe pain.
think about?
investigation?

A

Septic arthritis
Ix: joint aspiration
involve orthopaedics early

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85
Q

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

A

Transient synovitis

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86
Q

Infected rash give

A

Antibiotics

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87
Q

Non blanching rash differentials

A 
Meningococcal 
HSP 
ITP 
Acute leukaemia 
HUS
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88
Q

Non blanching rash differentials

A 
Meningococcal 
HSP 
ITP 
Acute leukaemia 
HUS
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89
Q

Rash in SVC distribution. does this make it more/less severe?

A

Less

- this rash is due to coughing / vomiting

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90
Q

Dry rash give

A

Emollients

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91
Q

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?

A

GORD

Tx: conservative

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92
Q

Allergy vs Intolerance

A

allergy - hypersensitivity reaction (involved immune system)
Intolerance - direct effect from the food (bloating/loose stools/sore stomach), no involvement of immune system

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93
Q

2 types of food allergy

A

Immediate hypersensitivity reaction (IgE mediated)

Delayed hypersensitivity reaction (type IV)

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94
Q

first line treatment of eczema

A

Steroid creams and emollients

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95
Q

Atopic individuals are more likely to have
Immediate hypersensitivity reaction (IgE mediated)
Delayed hypersensitivity reaction

A

Immediate

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96
Q

IgE mediated food allergy

A

Tingling in mouth
Swelling
Urticarial rash
Angioedema

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97
Q

Urticarial type rash with dot in the middle. What is likely

A

Erythema murtiforme

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98
Q

Investigating IgE mediated food allergy

A 
Blood tests (IgE) 
Skin prick
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99
Q

When would you get an epipen?

A

Wheezy

Peanut allergy

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100
Q

Treatment of food allergy

A

Avoidance of trigger
Anti-histamine +/- steroids
Adrenaline
Immunotherapy - give you small doses of what you’re allergic to

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101
Q

Sore tummy, lose poos, blood in poo in children under 1

A

Cows milk protein allergy/intolerance

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102
Q

What do you do if you have a bottle fed baby with cows milk protein allergy/intolerance, step 1

A

Hydrolysed formula milk

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103
Q

What do you do if you have a bottle fed baby with cows milk protein allergy/intolerance if hydrolysed formula milk doesn’t work?

A

Amino acid based formula milk

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104
Q

If you have an exclusively breast feeding mother but the baby has cows milk protein allergy/intolerance. What do you do?

A

Make sure mum is dairy free and also soy free.

Why soy free? Has increased plant oestrogens in soya milk

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105
Q

Children of any age can get pMDI / DPI ?

A

pMDI

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106
Q

Overview of management of acute severe stridor

A

Identify underlying cause
- eg croup, epiglottitis, foreign body, anaphylaxis

Combined nebulisers

  • oxygen
  • steroid (dexamethasone)
  • adrenaline
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107
Q

Which hormone is responsible for the let down reflex in breast feeding?

A

Oxytocin

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108
Q

Children on cow’s milk should receive full fat milk / semi skimmed milk?

A

Full fat milk - up until the age of 5

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109
Q

What is the protein in a cows milk based formula?

A

Lactose

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110
Q

Solid foods are recommended to be introduced after X months?

A

6 months

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111
Q

How many wet nappies should a baby have in 24 hours?

A

At least 3

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112
Q

What is the significance of a fever lasting for 5 or more days?

A

think about Kawasaki disease

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113
Q

When administering adrenaline in anaphylaxis, what position should the patient be in?

A

lie down with legs up

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114
Q

In an adult / child over 12, what dose of adrenaline should be given for anaphylaxis?

A

500mcg (5ml 1 in 1000)

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115
Q

In a child 6-12 years, what dose of adrenaline should be given for anaphylaxis?

A

300mcg (3ml 1 in 1000)

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116
Q

In a child under 6, what dose of adrenaline should be given for anaphylaxis?

A

150mcg (0.15ml 1 in 1000)

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117
Q

Which 3 drugs are important in anaphylaxis

A

Adrenaline
Hydrocortisone
Chlorphenamine (anti-histamine)

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118
Q

‘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?

A

Pyloric stenosis

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119
Q

What is the definitive investigation in allergy testing?

A

Eat the food - be exposed to the allergen

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120
Q

if you’re going to do allergy testing (skin prick / bloods for IgE levels) when should you NOT do them?

A

Within 4-6 weeks of an allergic reaction

- wait until after this time

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121
Q

Before doing skin prick test, how long does child need to be off anti-histamine?

A

3 days

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122
Q

Children under X age don’t get soy milk?

A

Children under 6 months

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123
Q

Which antihistamine is used in anaphylaxis

A

Chlorphenamine

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124
Q

Treatment of acute allergic reaction (not anaphylaxis) what is first line

A

Chlorphenamine

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125
Q

Where is IM adrenaline injected into

A

Anterolateral aspect of thigh

126
Q

Latent TB treatment

A

3 months of isoniazid

127
Q

Which medication may be used for an infant with GORD

A

Gaviscon

128
Q

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?

A

Coeliac disease or crohns

TTG
Anti-endomesial antibodies (EMA)

129
Q

What is the gold standard investigation for diagnosis of coeliac disease

A

Endoscopy with duodenal biopsy

130
Q

Explosive passing of stool after PR exam suggests which diagnosis

A

Hirschsprung’s disease

131
Q

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?

A

Ulcerative colitis

132
Q

Projectile vomiting in first few weeks of life and hunger after vomiting makes you think

A

Pyloric stenosis

133
Q

Children with gord are usually

  • gaining weight normally
  • failing to thrive
A

Gaining weight normally

134
Q

Pyloric stenosis is more common in boys/girls?

A

Boys (4:1)

135
Q

Management of pyloric stenosis

A

correct any fluid and electrolyte disturbance with intravenous fluids
then pyloromyotomy

136
Q

Abdominal pain accompanied with viral infection with lymphadenopathy. What is likely diagnosis?

A

Mesenteric adenitis

137
Q

What is the commonest cause of intestinal obstruction in infants after the neonatal period

A

Intusucception

138
Q

1 year old with paroxysmal, colicky pain
with pallor, abdominal mass, redcurrant jelly
stool, draws legs up. what is likely diagnosis?

A

Intusucception

139
Q

When in a childs life does malrotation usually present?

A

First 3 days of life

140
Q

What is the most common bacterial cause of gastroenteritis

A

Campylobacter

141
Q

Mesalazine is used in crohns / UC ?

A

UC

142
Q

Which types of medications may be used in constipation

A 
Stool softener (laxitive) 
Stimulant laxative (senna)
143
Q

Which is worst

  • right to left cardiac shunt
  • left to right cardiac shunt
A

Right to left cardiac shunt

144
Q

Transposition of the great arteries and tetralogy of fallot are both

  • R to L shunt
  • L to R shunt
A

R to L shunt

145
Q

In the foetus, the RIGHT/LEFT atrium has higher pressure?

A

Right atrium

146
Q

When a baby takes its first breaths, volume in the right atrium increases/decreases and the volume in the left atrium increases/decreases

A

R atrium - decreases

L atrium - increases

147
Q

Name 3 L to R shunts

A

ASD
VSD
Persistent ductus arteriosus

148
Q

ASD murmur type

  • systolic / diastolic
  • ejection / pan / holi
A

Ejection systolic

149
Q

VSD murmur type and heart sound

A

Pan systolic murmur

Quiet second heart sound

150
Q

continuous murmur beneath the left clavicle

collapsing or bounding pulse

A

patent ductus arteriosus

151
Q

Cyanosis within the first week of life think either (2)

A

Tetrallogy of fallot

Transposition of the great vessels

152
Q

• 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.

A

Tetralogy of fallot

153
Q

Seritide is twice as potent as clenile modulate inhaler. True or false?

A

True

154
Q

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

A

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
Q

Which medication can be used to help keep cardiac duct open?

A

Prostaglandin

156
Q

What may a single palmar crease be a sign of?

A

Downs syndrome

157
Q

For how long should gestational correction be continued for premature infants born at 32-36 weeks gestation?

A

1 year

158
Q

For how long should gestational correction be continued for premature infants born at 28-32 weeks gestation?

A

2 years

159
Q

Common organism causing sepsis in neonate ?

A

Group B strep

160
Q
  • usually after recovering from RDS
    - early signs: lethargy and gastric residuals
    - Bloody stool, temperature instability, apnoea and bradycardia
    What does this suggest?
A

Necrotising enterocolitis (NEC)

161
Q

If you stroke both carotids at the same time, what can happen?

A

Make someone faint

- baroreceptor reflexes firing

162
Q

In the womb, where do you get oxygen from?

A

PLacneta

163
Q

Where is the foramen ovale

A

Right atrium to transfer blood from RA –> LA

164
Q

What medication is used for strawberry haemangioma to help them shrink

A

propranolol

165
Q

Rash on baby, comes up a couple of days after birth, completely benign, baby is otherwise well, what is it?

A

Erythema toxicum

166
Q

Papsule with punctum in the middle makes you think

A

Molluscum contagiosum

167
Q

What causes molluscum contagiosum

A

Pox virus

168
Q

Coryza symptoms, swollen red cheeks, what is the syndrome and what virus causes it?

A

Slapped cheek syndrome

Virus: parovirus

169
Q

Slapped cheek syndrome affects

  • platelets
  • red blood cells
  • white blood cells
A

Red blood cells

170
Q

Scarlet fever treatment

A

IV penicillin

- since it is group A strep

171
Q

White strawberry tongue, peeling of fingers of toes, erythematous, rough rash, perioral palor. What is likely diagnosis?

A

Scarlet fever

172
Q

Yellow gold crusted lesion on face - what is it? and what organism?

A

Impetigo

Staph aureus

173
Q

Child presents with around 10 loose stools per day, otherwise well and thriving. What is likely diagnosis?

A

Toddler’s diarrhoea

- likely grow out of it

174
Q

3 month old boy referred to outpatient clinic with persistent vomiting.
Growing well on centile chart.
Bottle feeding
What is likely going on?

A

GORD

175
Q

In children, you can diagnose coeliac disease on blood tests alone (ie you don’t have to do endoscopy). True or false?

A

True

  • if ttG >10 times the upper limit of normal
  • if classical symptoms present
176
Q

What is the target blood sugar level for a diabetic before meals?

A

4-7

177
Q

What si the target blood sugar level for a diabetic 2 hours after meals?

A

5-9

178
Q

Lantis (glargine) is long acting or short acting

A

Long acting

179
Q

Outline the management of DKA

A

Oxygen if required
IV access
- IV fluids (first)
- IV insulin

180
Q 
Polyuria 
Polydypsia 
Tiredness
Tummy pain 
Weight loss
A

Diabetes

181
Q

decreased/increased skin tugor is a sign of dehydration

A

Decreased

182
Q

There is a risk of what with DKA?

A

Cerebral oedema

183
Q

Converting IV to sub cut

A
  1. 05 units / kilo
    - half their weight
    - half again for lantis
    - and thirds for novorapid
184
Q

Surfactant deficiency CXR findings

A

Small volume lungs
diffuse granular opacification
bubbly lungs
pneumothorax

185
Q

TTN definition

A

Slow clearing of pulmonary fluid

onset within 24 hours of birth

186
Q

Normal or hyperinflated lungs
interstitial lines
fluid in the fissures
air space oppacification

A

TTN

187
Q

Distress during delivery
over inflated lungs (air trapping)
air leaks

A

Meconium aspiration

188
Q

patchy opacities
over infaltion
atelectasis
what do you suspect

A

Pneumonia

189
Q

endotracheal tube goes into right main bronchus. what can happen to the left lung?

A

L lung can collapse

- since it is unventilated

190
Q

children under 6 months - UTI imaging required ?

A

US
If abnormal
- VCUG and renogram

191
Q

What does DMSA scan look at

A

Renal function

done 4-6 months post complicated UTI to assess relative renal function and scarring

192
Q

Buldging fontanelles suggests

A

Raised ICP

193
Q

Spiral long bone fractures in a child suggests

A

NAI

194
Q

Posterior or lateral rib fractures. What does this suggest?

A

NAI

195
Q

Fracture

- broken on one side but bowing on the other (ie other side intact) . What is this called?

A

greenstick fracture

196
Q

Which classification system is used to classify growth plate injuries

A

Salter harris classification
- 1-5
2 is most common

197
Q

Fixed split S2 - which heart defect

A

ASD

- think A split double (splitting of 2nd heart sound)

198
Q

Which type of murmur do you get in VSD?

A

holosystolic murmur

199
Q

Which medications would you give in coarctation of the aorta to keep the ductus arteriosus open?

A

prostaglandin E

200
Q

Which medications would you give in patent ductus arteriosus to promote duct closure?

A

Indomethacin

Ibuprofen

201
Q

transposition of the great arteries can be diagnosed on antenatal US. True or false?

A

True

202
Q

What is the most common cyanotic heart defect in paeds

A

tetralogy of fallot

203
Q

Loud harsh ejection systolic murmur in which heart defect

A

Tetralogy of fallot

204
Q

Is tetrallogy of fallot cyanotic?

A

Yes

205
Q

Spots -> fluid filled blisters (vesicles -> crust over. On skin. what is this?

A

Chickenpox

206
Q

How is chickenpox spread?

A

Droplets (coughs, sneezes)

207
Q

Blue mark on bum

A

mongolian blue spot

208
Q

If someone has talipes….what should you to?

A

Try and straighten it out to see if it is fixed or not

209
Q

If talipes does’t straighten out, what should you do?

A

Refer to orthopaedics for splinting

210
Q

Lumps on babys head differential

A

Caput

Cephalohaematoma

211
Q

How do you tell the difference between caput and cephalohaematoma?

A

Cephalohaematoma doesn’t cross the suture lines

212
Q

Physiological jaundice (3 causes)

A

Breast feeding

foetal haemoglobin

213
Q

2 potentially pathological causes of jaundice

A

Prolonged - over 14 days

Immediately after birth - in first 24 hours

214
Q

PDA is a shunt from right/left -> right/left

A

Left -> Right

215
Q

Extreme preterm
Very preterm
Moderate-late preterm
ranges

A

Extreme preterm: before 28 weeks
Very preterm: 28-32 weeks
Moderate-late preterm: 32-36 weeks

216
Q

Preterm baby doesn’t get formula milk. True or false?

A

True

  • breast milk
  • donor expressed breast milk
217
Q

What is RDS commonly due to

A

Lack of surfactant

Structural immaturity of lung tissue

218
Q

Who is most likely to get TTN

A

Babies delivered by C section

219
Q

Over reaction to mistakes
Thumb sucking when older
Self mutilation
Sudden speech disorders

What kind of abuse does this suggest?

A

Emotional abuse

220
Q

If you recognise potential child abuse at work, normal office hours, who do you report to

A

Senior colleague

Child protection team

221
Q

Which types of injuries/bruising makes you concerned about child abuse

A

Bruising on a child who can’t mobilise yet
Bruising at ears
Bruising at upper arm / outer thigh

222
Q

Fractures suggesting NAI

A

Fractures of different ages
Spiral femoral fracture
C spine fracture (shaking)

223
Q

Surfactant is pig extract. True or false?

A

True

224
Q

Why is vitamin K given at birth

A

To prevent bleeding disorders

225
Q

Pre-term neonate
bilious vomiting, bloody stool, abdo distention
What is this likely to be

A

NEC

226
Q

Risk factors for NEC

A

Preterm
Formula feeding
IUGR

227
Q

When prescribing an inhaler, what should you remember

A

include strength and types of inhaler

Prescribe in number of puffs

228
Q

Dextrocardia + bronchiectasis + chronic sinusitis suggests

A

Kartagener syndrome

229
Q

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

A

Bisoprolol and anticoagulation for 3 weeks

Then electrical cardioversion

230
Q

Red patchy rash in first week of life. What is it and how do you treat?

A

Erythema toxicum

Self limiting

231
Q

Measles and rubella have which type of rash

A

Maculopapular

232
Q

Which type of rash is seen in chicken pox

A

Vesicular

233
Q

Purpura and petichiae are associated with which infection

A

Meningitis

234
Q

Target lesions are associated with which rash

A

Steven Johnson syndrome

235
Q

In HSP, the child will be well / unwell

A

Well

236
Q

The rash between HSP and which other condition looks similar?

A

Meningitis

237
Q

Why do babies with respiratory distress grunt

A

trying to increase alveolar pressure

238
Q

Chest x-ray of respiratory distress syndrome will show

A

Ground glass opacification

239
Q

What is RDS caused by

A

Relative surfactant deficiency

240
Q

How is production of surfactant stimulated

A

By steroids

241
Q

How to manage a tension pneumothorax

A

Needle decompression

Chest drain

242
Q

Babies at risk of RSV, what do you give them?

A

Pavalizumab - this is IgG to RSV

243
Q

Term baby, especially delivered by c-section, what respiratory problem do you risk?

A

TTN

- lungs filled with amniotic fluid

244
Q

What gestation do babies learn to suck?

A

32 weeks gestation

245
Q

Treatment of neonatal acne?

A

Nothing

246
Q

First line oral acne for teenager?

A

Tetracycline

247
Q

Why should you never give a baby tetracycline?

A

affects bones / teeth in babies

248
Q

Jaundice that appears before 24 hours old, what are you worried about ?

A

Haemolytic disease

  • ABO
  • rhesus disease
249
Q

All pregnant mkthers get antiD. True or false?

A

True

250
Q

Prolonged jaundice - what are you worrying about

A

Biliary atresia

251
Q

Pale stools and dark urine - is this conjugated / unconjugated jaundice?

A

Conjugated

252
Q

Day 6 we get gurthrie teat

A

Screened for thyroid function

253
Q

Why treat jaundice with light therapy

A

if your level is too high, can cross the BBB, can cause cererbal palsy - kernicterous

254
Q

How does light therapy work for babies with high unconjugated jaundice

A

change bilirubin from fat soluble to water soluble isomer

255
Q

Erbs palsy involves which nerves?

A

C5, C6

256
Q

Klumpke’s palsy involves which nerves?

A

C8, T1

257
Q

AXR - air/gas in the gut wall. What does this make you think?

A

NEC

258
Q 
4-6 week age group 
Distention of stomach 
Baby vomits towards end of / just after feed 
PROJECTILE vomit 
What is the likely diagnosis
A

Pyloric stenosis

259
Q

Colicky pain, young child, mass may be felt in abdomen.

What is the likely diagnosis?

A

Insusception

260
Q

True bilous vomiting suggests

A

Intestinal obstruction

261
Q

What are the 4 features of tetralogy of fallot?

A

Right ventricular hypertrophy
Pulmonary stenosis
Ventricular septal defect
Overriding aorta

262
Q

Rash: Small, pearly papules with central umbilication

A

molluscum contagiosum

263
Q

What is the treatment of molluscum contagiosum

A

Self limiting

264
Q

Failure to pass meconium in first 24-48 hours after birth, vomiting and abdominal distension makes you think?

A

Hirshprung’s disease

265
Q

What investigation is needed for the definitive diagnosis of Hirshprung’s disease?

A

Suction assisted full thickness rectal biopsies

266
Q

Most common site of aspiration

  • right main bronchus
  • left main bronchus
A

Right main bronchus

267
Q

Acute glomerulonephritis often follows a sore throat / URTI. True or false?

A

True

268
Q

Which age group is most common for intussception

A

9-12 months

269
Q

Convulsing child in hospital. Episode has been lasting over 5 mins and you have vascular access. What do you give?

A

IV Lorazepam

270
Q

Convulsing child in hospital. Episode has been lasting over 5 mins and you DO NOT have vascular access. What do you give?

A

Buccal midazolam / rectal diazepam

271
Q

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?

A

Give IV lorazepam

272
Q

3 triggers for reflex anoxic seizures

A

Pain
Fear
Anxiety

273
Q

When should a child be able to sit unsupported?

A

6 months

274
Q

When should child be able to walk?

A

12 months

275
Q

When should child be able to transfer objects between hands?

A

6 months

276
Q

When should child be able to develop pincer grip?

A

9 months

277
Q

What age to draw a circle?

A

Age 3

278
Q

Can’t run by X months is classified as delayed?

A

24

279
Q

Hand dominance prior to X months is a red flag?

A

18 months

280
Q

Primitive reflexes are usually lost by X months?

A

12 months

281
Q

Describe the rooting reflex

A

Stroke a baby’s cheek causes baby to turn and open mouth

282
Q

At 12 months of age, a child has persistence of primitive reflexes. Does this indicate:

  • normal finding for this age
  • UMN lesion
  • LMN lesion
A

UMN lesion

283
Q

HSP rash is blanching or non-blanching?

A

Non-blanching

284
Q

HSP commonly involves which organ?

A

Kidneys

285
Q

If someone is in status epilepticus, begin to intervene after X mins

A

5

286
Q

Tried lorazepam for status epilepticus but not controlling seizure, what can you use?

A

phenytoin

287
Q

How must you give phenytoin

A

Slowly over an infusion

288
Q

Which age do febrile convulsions usually stop?

A

By age 6

289
Q

18 month old male, not walking. What will you check?

A

CK levels for ?Duchenes muscular dystrophy

290
Q

Sensory issues
Repetitive behaviour
Deficits in social communication and interaction

A

ASD

291
Q

Cerebral palsy

  • UMN lesion
  • LMN lesion
A

UMN lesion

292
Q 
Prominent forehead
Long, thin face
High arch palate 
Dental overcrowding 
Pectus excuvatum 
Delayed gross motor milestones 
Dysmorphic features present
A

Fragile X

293
Q

Main complication of chicken pox

A

Encephalitis

294
Q

When will the anterior fontanelle have disappeared (roughly)?

A

Around 18 months

295
Q

newborn with abdominal contents protruding through anterior abdominal wall but are covered in an amniotic sac. what is this likely to be?

A

Exopthalmos

296
Q

What is the key investigation in pyloric stenosis?

A

US

297
Q

What are the 2 treatments used in kawasaki disease

A

Aspirin

single dose IVIg

298
Q

3 day fever and then emergence of a maculopapular rash on the 4th day, following the resolution of the fever - what does this suggest?

A

HHV6

roseola infantum

299
Q

Coarctation of the aorta and PDA have SYSTOLIC murmurs. True or false?

A

False

300
Q

SUFE

  • painless / painful limp
  • age group
A

Painful limp

Teenagers

301
Q

Perthes disease

  • painless / painful limp
  • age group
A

Painless limp
Longer history (weeks / months)
Children 4-8y

302
Q

Commonest brain tumour in young children

A

Medulloblastoma

303
Q

Child 4 years old with PDA. What is the management?

A

Early operative closure is recommended in any patient where the defect has persisted beyond 6 months of age.

304
Q

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
A

Vesicoureteric reflux

305
Q

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.

A

Wilms tumour

306
Q

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?

A

Co-amoxiclav

307
Q

Name 3 causes of prolonged jaundice in the neonate

A

Biliary atresia
Hypothyroidism
G6PD deficiency

308
Q

What does direct coombs test check for

A

Haemolysis

309
Q

What is kernicterus

How does it present

A

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
Q

CXR in RDS

A

Ground glass appearance

311
Q

What is th investigation of choice for NEC

A

Abdominal XRay

312
Q

Immediate management of NEC

A

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.

Y4 (23 decks)

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