Paediatrics and Child Health

Question 1

What are the stages of childhood defined by age

Answer 1

Neonates: Birth -4 weeks

Infants: 4 weeks-<1 year

Toddlers: 1 year-2 years

Preschool: 2-4years

School: 5-16 years

Adolescence: onset of puberty-Adulthood

Question 2

What Screening and Surveillance is done during various stages of childhood?

Answer 2

Question 3

All important childhood information is recorded where?

Answer 3

The PCHR-Red Book

(PCHR: Personal Child Health record)

Question 4

What is Positional plagiocephaly and why does it occur?

Answer 4

An asymmetrically shaped head - most common: positional plagiocephaly

Occurs due to external pressure on the malleable skull

Question 5

What would you explain regarding Positional plagiocephaly to a concerned parent?

Answer 5

It is only of cosmetic significance and should becomes less noticeable once baby starts to roll and their hair grows to cover the back

Question 6

Label the image

Answer 6

Question 7

When does the anterior vs posterior fontanelle close?

Answer 7

• Anterior ~ 18 months
• Posterior ~ 2 months

Remains soft and palpable until closed

Question 8

A newborn presents with a non-pulsatile bulging fontanelle, most likley Dx

Answer 8

Raised ICP

Question 9

A newborn presents with a depressed fontanelle, most likley Dx

Answer 9

Significant dehydration

Question 10

What measurement is used to monitor head/skull growth?

Answer 10

Occipitofrontal circumference (OFC)

Question 11

What key examination of the eyes must be done on an infant?

At what age is this performed?

Answer 11

Red reflex - 6-8 weeks

Question 12

What causes an abnormal red reflex

Answer 12

Abnormal red reflex caused by anything which impedes reflection of ophthalmoscope light from vascular ocular fundus

Question 13

List the most common cause of an abnormal red reflex

Answer 13

Congenital cataracts:

• Preventable cause of blindness in children
• Requires surgical treatment in first 3 months

Question 14

A mother is concered because her 2 month old has a squint (image below)

1. What is the medical name the condition?
2. What advice would you give to Mum

Answer 14

1. Newborn strabismus
2. Transient squint (misalignment) is common upto 3 months, if squint persists beyond this age we need investigate underlying cause

Question 15

What is the most common underlying cause of a squint in a newborn

Answer 15

Refractive errors but other more serious ones need to be excluded

Question 16

Are Pre-auricular skin tags on an infant (image below) concerning?

Answer 16

Yes, newborns with this congenital anomaly are at increased risk of hearing loss

Tags may be an isolated finding or associated with part of a recognisable syndrome

Question 17

Describe the appearance of a healthy, normal eardrum

Answer 17

Appears transparent with a pinkish/grey colour and is approximately circular in shape

Inner ear bones and light reflection (shape of a cone) are easily visualised

Question 18

How would a child with Acute Otitis Media present?

Answer 18

1. Pulling of the ear in older infants
2. Purulent discharge for ear canal

These are localised signs/symptoms

Question 19

If a child with Acute Otitis Media becomes systemically unwell, how may they present?

Answer 19

1. Pyrexia
2. Irritability
3. Vomiting
4. Going off food

Question 20

You examine an infant with suspected Acute Otitis Media, list 2 indicative findings on otoscopy

Answer 20

• Red bulging ear drum
• Loss of normal light reflection

Question 21

What age group are most commonly affected by AOM?

Answer 21

6-12 months but can occur any time throughout childhood

Question 22

A mother is concerned about a lesion on her babys face, what is the Dx

Describe the progression of this lesion

Answer 22

Infantile (Strawberry) haemangioma

1. Lesion develops in first few weeks of life
2. Gradually increases in size
3. Eventually produces a raised red lesion with uneven surface (resembles a strawberry)
4. Gradually shrinks and disappears in childhood

Question 23

What is seen on the image below, what is this?

Answer 23

Pectus excavatum

Sternum is sunken so the middle of chest instead of being level with the ribs

Isolated finding OR part of a syndromic diagnosis

Question 24

What is shown on the image below?

Answer 24

Pectus carinatum, Poland syndrome

Sternum raised above the ribs, middle of chest is more prominent

Usually a number of other congenital anomalies which collectively form a recognisable Syndrome

Question 25

What is an Umbilical Granuloma?

Answer 25

Small amount of pink or lightly red tissue which remains on the navel after the umbilical cord falls off

Cause is unknown but it is related to the tissue healing process. Usually heals spontaneously, if not then salt treatment is effective

Question 26

What is the name given to the flat light/dark brown patches seen on the image below?

Answer 26

Cafe au lait spots (birthmarks)

Can be present anywhere on the body upto 2 spots are commonly seen in children

Question 27

When should we be concerned with Cafe au lait spots and why?

Answer 27

If there is 6+ (rare)

Suggestive of the Neuro-cutaneous condition → NeuroFibromatosis Type 1

Question 28

What is the medical term for webbed or conjoined fingers or toes

Answer 28

Syndactyly

In majority the affected fingers are connected only by skin

Question 29

Webbed fingers or toes may occur as an isolated finding or as part of many syndromes

What is the inherritance pattern of the isolated form?

Answer 29

Autosomal Dominant

Question 30

Image below shows a ‘sacral dimple’, what must we check to exclude a possible underlying abnormality of the spine

Answer 30

1. Is the floor of the dimple seen covered with skin?
2. Are there any other features such as a lipoma, hairy tuft, discolouration of skin adjacent to the dimple?

If skin is not intact or other features are present → possible spinal abnormality

Question 31

What is the flat blue/grey birthmark seen on the image below?

Which locations are they usually present and who do they most commonly affect?

Answer 31

Mongolian Blue Spot - no significance unless misdiagnosed as bruises

Located at the base of the spine, buttocks and occasionally on legs and arms

Commonly seen in babies with dark skin (can be present in Caucasian babies)

Question 32

What is the medical term for club foot?

Can it be treated?

Answer 32

Bilateral Congenital Talipes Equinovarus

Appropriate and timely orthopaedic and physiotherapy treatment → pain free, normal looking feet