Paediatrics Questions Flashcards
What is Perthe’s disease?
Self-limiting hip disorder caused by varying degrees of ischaemia and subsequent necrosis of the femoral head
Who does Perthe’s disease generally affect?
4-8 year old boys
What is the general presentation of Perthe’s disease?
Presents with pain in the hip or knee leading to a limp. There is often an effusion from associated synovitis. Antalgic gait. All movements of the hip are limited. No hx of trauma
What does Barlow’s test screen for?
Developmental dysplasia of the hip. Done during NIPE
What age should a child be referred to a paediatrician if they have not started walking?
18 months
What vitamin deficiency is associated with an increased risk of severe measles infection + why?
Vitamin A. Vitamin A deficiency impairs cell-mediated immunity and is associated with severe measles infections, particularly in developing countries. In developing countries, vitamin A should be given as part of the treatment of measles
What are the symptoms of an innocent murmur?
Soft, systolic, short, symptomless, standing/sitting
What is the management of unilateral undescended testes in a newborn? When should they be refered?
Review again at 3 months. If persistent, refer to paediatric surgeon before 6 months
What leukaemia is associated with down syndrome?
History of Down’s
What is the treatment of asymptomatic neonatal hypoglycaemia?
Encourage normal feeds and monitor glucose
What is the definition of hypoglycaemia in the newborn?
2.6 mmol/L
What are the common causes for persistent/severe hypoglycaemia in neonates?
- preterm birth (<37 weeks)
- maternal diabetes mellitus
- IUGR
- hypothermia
- neonatal sepsis
What are the possible causes of neonatal hypotonia?
Neonatal sepsis, hypothyroidism, Prader-willi
What murmur is heard with patent ductus arteriosus?
Machinery murmur at the upper left sternal edge
What is benign rolandic epilepsy? What ages does it affect?
Partial seizures occuring at night in an otherwise healthy child. Typically occurs between 4 and 12 years old
What is seen on an EEG in benign rolandic epilepsy?
Centrotemporal spikes
What is the typical presentation of necrotising enterocolitis?
Abdominal distension, feeding intolerance, bloody stool
What is a common finding in children with hypospadias?
Cryptorchidism (around 10%)
What are features of an atypical UTI?
Seriously ill, poor urine flow, abdominal or bladder mass, raised creatinine, septicaemia, failure to respond to antibiotics within 48 hours, infection with E.coli organisms
What is a common cause of hand, foot and mouth disease?
Coxsackie A16 and enterovirus
What is cephalhaematoma? Expected presentations
Swelling on a newborn’s dead. Due to bleeding between the periosteum and the skull. Parietal region most commonly affected. Doesn’t cross suture lines.
What are Chignon’s?
Birth traumas due to the use of a ventouse device
What is the rate of chest compressions in infants and children?
100-120/min.
What is indicated by hand preference before 12 months?
Abnormal. Could be an indicator of cerebral palsy
What investigation must be done and why, for infants born breech at more than 36 weeks?
USS for DDH screening; babies in the breech position have increased pressure on hip joints, increased risk
Why is normal pCO2 in an acute asthma attack an issue?
Consistent with life threatening attack; suggests exhaustion and declining respiratory effort.
What is the triad commonly seen in shaken baby syndrome?
Retinal haemorrages, subdural haematoma, encephalopathy
Where should the pulse be checked for in paediatric BLS?
Brachial and femoral arteries
What are the differentiating and similar features between Scarlet fever and Kawasaki disease?
Similar: both present as child with fever, a form of rash, strawberry tongue
Different: Scarlet Fever has fine punctuate erythmatous rash with ‘Sandpaper’ texture, sparing the mouth. Kawasaki disease has a desquamating rash and cracked lips
Name the disease: child presents with fever associated with an itchy, macular rash which becomes vesicular
Chickenpox
What rash is seen in measles?
Blanching erythematous, face and upper chest. Koplik spots
At what age can a child sit without support?
7-8 months
What rash is seen in rubella?
Pink maculopapular rash, initially on face before spreading to the whole body.
What is slapped cheek syndrome, and what causes it?
Erythema infectiosium (5th disease). Parvovirus B19
What is the typical presentation of shingles?
Elderly patient presenting with a painful, ‘burning’ rash
What bacteria causes Scarlet fever?
Group A haemolytic streptococci: S.Pyogenes
What age do children learn to turn towards sound?
3 months
Under what age should a child be referred to child protection, if they are planning to engage in sexual activity?
Under 13: this is rape under the law. You can break confidentiality
What are the 8 S’s of innocent murmurs?
- soft
- systolic
- short
- sounds (S1 and S2) normal
- symptomless
- special test normal
- standing/sitting (vary with position)
- sternal depression
What sort of murmur is never innocent in children?
Diastolic
How should SUFE be diagnosed?
Hip x-ray
What should be suspected in boys over 4 years old with a limp? Diagnostic test?
Perthes’. X-ray
What are the criteria for immediate request for CT scan of the head in children?
Loss of consciousness (>5 mins), amnesia (>5 mins), abnormal drowsiness, 3 or more discrete episodes of vomiting, post trauma seizure, GCS <14, any sign of basal skull fracture, dangerous mechanism of injury, focal neurological defect
How is patent ductus arteriosus treated?
Indomethacin or ibuprofen. Inhibits prostaglandin synthesis. Given to the neonate in the postnatal period
What is assessed using an apgar score?
Pulse, respiratory effort, colour, muscle tone, reflex irritability
What ages do febrile convulsions typically occur between?
Between 6 months and 5 years
What is distended abdomen and bilious vomiting indicative of?
Intestinal malrotation and volvulus
What is the inheritance of Prader Willi syndrome?
Imprinting
What is the causative organism of threadworms?
Enterobius vermicularis
What is the first line response if a neonate is apnoeic, floppy and blue?
Dry the baby, then reassess APGAR
What resp rate in children is a red flag (at any age)
> 60/min
If a child is under 3 months old and has a UTI, what should be immediate management?
Immediately refer to a paediatrician
What are features suggestive of hypernatraemic dehydration?
Jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness/coma
What is undigested vegetables in frequent diarrhoea a sign of?
Toddler’s diarrhoea
What is osteochondritis dissecans?
Fragment of the bone in the knee becomes detached due to lack of blood supply. Fragment and overlying cartilage can move around inside the joint, causing pain, swelling, locking. Common in sporty young adults
What is the best predictor of clinical severity of tetralogy of fallot?
Severity of the right ventricular outflow tract obstruction (pulmonary stenosis). This determines degree of cyanosis and clinical severity.
What can ritalin affect as a s/e? What should be monitored and how often?
Weight and height. Should be monitored every 6 months
What is included in the 6-in-1 vaccine?
Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type b, hepatitis B
When is the heel prick blood test done in the UK?
Between the fifth and ninth day of life
What congenital abnormalities can be caused by the use of lithium in pregnancy?
Ebstein’s abnormality
If diarrhoea persists following an episode of gastroenteritis, what is the likely cause?
Lactose intolerance
What is the triad of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma, encephalopathy
What type of bilirubin is raised in biliary atresia?
Conjugated
What is characteristic of necrotising enterocolitis? What is seen on AXR?
Characterised by inflammation and necrosis of the bowel wall. Abdominal X-rays can show dilated bowel loops, portal venous gas, as well as the pathognomonic sign of intramural gas (pneumatosis intestinalis)
What syndrome is duodenal atresia closely associated with?
Downs
What population does necrotising enterocolitis mostly affect?
Premature infants
What are the symptoms of necrotising enterocolitis?
Feeding intolerance, abdominal distension, bloody stools, abdominal discoloration, perforation, peritonitis
What is the most common cause of paediatric arrest?
Respiratory: hypoxia common (choking), hypothermnia, hypovolaemia, hypo/hyper electrolytes
