Paeds

Question 1

What gross and fine motor skills should a child of 6 months be able to achieve?

Answer 1

Pushes up on arms in prone, can roll from front to back / transfers objects using palmar grasp

Question 2

A weight on what centile corresponds to a child being obese?

Answer 2

98th centile

Question 3

Which formula is best- whey or casein based?

Answer 3

Whey

Question 4

What gross and fine motor skills should a child of 18 months be able to achieve?

Answer 4

Runs, climbs onto adult chair / builds tower of 3-4 blocks, develops hand preference

Question 5

Other than general inspection, what should you do during assessement of the back and CNS in a newborn examination?

Answer 5

Palpate down the spine

Listen to the mid-scapular area

Check the anus is patent

Check the Moro and grasp reflexes

Question 6

What defines precocious puberty in girls and boys?

Answer 6

< 8 years in girls, < 9 years in boys

Question 7

What are some potential underlying causes of a delay in social skills?

Answer 7

Autism

Secondary to abuse or neglect

Question 8

Other than general inspection, what additional test should you do during assessment of the legs and hips in a newborn examination?

Answer 8

Barlow and Ortolani’s test

Question 9

What are some good ways to tell that a baby is taking enough milk during feeds?

Answer 9

They are gaining weight

They are having 6 wet nappies per day

They are passing 2 yellow stools per day

Question 10

When is calculation of a child’s BMI required?

Answer 10

If the weight is above the 75th centile or if the weight and height centiles differ

Question 11

What social skills should a child of 9 months be able to achieve?

Answer 11

Anxious around strangers

Question 12

From 4 years to puberty, how much should a child’s height increase by each year?

Answer 12

5cm

Question 13

What extra things should you always enquire about in a paediatric history?

Answer 13

Birth history, growth and developmental history, vaccination history

Question 14

Explain how the grimace in response to plantar stimulation section of APGAR is scored?

Answer 14

Absent = 0

Grimace/feeble cry = 1

Strong cry/pull away when stimulated = 2

Question 15

What language skills should a child of 24 months be able to achieve?

Answer 15

Joins two words together, follows simple instructions

Question 16

What are some potential underlying causes of a fine motor/visual delay?

Answer 16

Squint

Refractory error

Cataract

Glaucoma

Question 17

What happens to a baby’s weight in the first week after birth?

What is the reason for this?

Answer 17

The baby will lose 5-10% of its birthweight

Loss of extracellular fluid

Question 18

What social skills should a child of 12 months be able to achieve?

Answer 18

Waves bye-bye, drinks from a cup

Question 19

By what age should the majority of children have achieved day and night time continence?

Answer 19

3-4 years

Question 20

What are some specific symptoms to ask about in a paediatrics systemic enquiry?

Answer 20

Cough/cold symptoms/difficulty breathing, vomiting, rashes, fever, any evidence of pain

Question 21

When should routine examination of the newborn take place?

Answer 21

Ideally within 24 hours of birth, must be within 72 hours

Question 22

What growth variables are plotted in children aged < 2 years?

Answer 22

Head circumference, length and weight

Question 23

At what ages are childhood vaccinations usually given?

Answer 23

2, 3 and 4 months

12-13 months

3 years 4 months

Question 24

What are some risk factors for child abuse that you should try to address in a history where this is suspected?

Answer 24

Was the child premature or does it have any physical/mental disability?

Are there any mental health or substance misuse issues with the parents?

Is there domestic violence or social deprivation?

Question 25

Exclusive breastfeeding is recommended for how long?

Answer 25

6 months

Question 26

A weight on what centile corresponds to a child being overweight?

Answer 26

91st centile

Question 27

What social skills should a child of 6 months be able to achieve?

Answer 27

Friendly with strangers, plays with their feet

Question 28

Explain how the activity (tone) section of APGAR is scored?

Answer 28

Absent = 0 Some flexion = 1 Flexed arms and legs that resist extension = 2

Question 29

Explain how the pulse section of APGAR is scored?

Answer 29

No pulse = 0 \< 100 = 1 \> 100 = 2

Question 30

What gross and fine motor skills should a child of 12 months be able to achieve?

Answer 30

Cruising, walking / bangs toys together

Question 31

What extra question should you always ask in a social history in paediatrics?

Answer 31

Has social work ever been involved with the child?

Question 32

A baby's weight should double by when?

Answer 32

4-6 months

Question 33

What are some potential underlying causes of a speech delay?

Answer 33

Hearing impairment Autism Part of a wider global developmental delay

Question 34

What social skills should a child of 3 years be able to achieve?

Answer 34

Vivid pretend play, understands sharing

Question 35

If a child who is in or completing puberty has a height measurement plotted within the shaded area, what action is required?

Answer 35

Referral to paediatrics (below 0.4th centile)

Question 36

If a child who is pre-pubertal has a height measurement plotted within the shaded area, what intervention is required?

Answer 36

Compare with the mid-parental height- only consider referral to paediatrics if there is a significant discrepancy

Question 37

At what age can a child drink full fat cow's milk?

Answer 37

12 months

Question 38

How do you gestationally correct on a growth chart?

Answer 38

Plot the measurements at the child's chronological age, then draw a line back the number of weeks the infant was preterm

Question 39

What language skills should a child of 3 years be able to achieve?

Answer 39

Knows name and sex, asks lots of questions

Question 40

What are three questions to always ask as part of your systemic enquiry in paediatrics?

Answer 40

Is the child eating/drinking normally? Is the child still having wet/dirty nappies or going to the toilet as normal? Is the child acting like their normal self or are they out of character?

Question 41

Short stature is defined as a height below what centile? Tall stature is defined as height above what centile?

Answer 41

2.5th centile 98th centile

Question 42

What language skills should a child of 12 months be able to achieve?

Answer 42

Responds to name, jargons

Question 43

What are some investigations you may want to do in a situation where child abuse is suspected?

Answer 43

Blood tests Skeletal survey Head CT Fundoscopy Medical photography

Question 44

How long should milestones and growth charts be corrected for premature babies?

Answer 44

2 years

Question 45

What social skills should a child of 6 weeks be able to achieve?

Answer 45

Social smile

Question 46

When do the primitive reflexes typically disappear?

Answer 46

5-6 months

Question 47

How should you plot growth for a baby who was \< 32 weeks premature?

Answer 47

Use an infant and neonatal close monitoring chart

Question 48

What language skills should a child of 6 weeks be able to achieve?

Answer 48

Stills to voice

Question 49

What social skills should a child of 24 months be able to achieve?

Answer 49

Puts on hat and shoes, developing symbolic play

Question 50

Explain how the respiratory effort section of APGAR is scored?

Answer 50

No effort = 0 Weak, slow gasps = 1 Strong cry = 2

Question 51

What are the 5 features of APGAR?

Answer 51

Appearance (colour) Pulse Grimace (response to stimulation) Activity (tone) Respiratory effort

Question 52

A baby's head circumference should treble by when?

Answer 52

One year

Question 53

How should head circumference be measured?

Answer 53

Above the child's ears, measure the head from midway between the eyebrows and hairline to the occipital prominence

Question 54

What is one of the most important things to ask about in a history where abuse is suspected, in order to be safe?

Answer 54

Ask if there are any other children at home

Question 55

A baby's weight should treble by when?

Answer 55

1 year

Question 56

What is the target height for a child based on mid-parental height?

Answer 56

Within two centile spaces above or below the mid-parental height

Question 57

After the first few days of life, how much milk should babies be consuming? How many feeds should this be spread over?

Answer 57

150ml/kg/day spread over 4-6 feeds

Question 58

What are some things to ask for in a family history of a child where abuse is suspected to rule out potential differentials?

Answer 58

Bleeding disorders, ostoegenesis imperfecta

Question 59

At what age should a baby begin to be weaned onto solid foods?

Answer 59

6 months

Question 60

Describe how to perform Ortolani's test?

Answer 60

Flex the hips and knees of the infant, place your index finger on the greater trochanter and apply pressure while abducting the hip- this relocates a dislocated hip

Question 61

What social skills should a child of 4 years be able to achieve?

Answer 61

Dresses and undresses, understands turn-taking

Question 62

When should a child have their length measured in a supine position as opposed to standing height?

Answer 62

If they are \< 2 years old or they are unable to stand

Question 63

When are APGAR scores calculated?

Answer 63

Routinely at 1 and 5 minutes after birth Additional checks every 5 minutes until the score is \> 6

Question 64

What gross and fine motor skills should a child of 3 years be able to achieve?

Answer 64

Stairs with alternating feet, rides tricycle / copies a circle, cuts with scissors

Question 65

How accurate is the adult height predictor section of growth charts?

Answer 65

4/5 children will be within +/- 6cm of this value

Question 66

What gross and fine motor skills should a child of 4 years be able to achieve?

Answer 66

Runs up and down stairs / threads beads, draws man

Question 67

What is a good way of explaining that you are going to refer their child to social services for assessment?

Answer 67

All children with these injuries are referred for further assessment. Some injuries like this are not accidental and it can be very difficult to tell, so we have to refer all cases in order to be safe. (Explain the process and emphasise that you are doing this to keep the child safe and protected)

Question 68

What are some specific milestones that are useful to ask about?

Answer 68

When did the child start to walk and talk?

Question 69

What gross and fine motor skills should a child of 3 months be able to achieve?

Answer 69

No head lag / regards hands held in midline

Question 70

What language skills should a child of 3 months be able to achieve?

Answer 70

Laughs and coos

Question 71

What gross and fine motor skills should a child of 9 months be able to achieve?

Answer 71

Crawls, stands holding onto furniture / picks up objects between thumb and hand, points with index finger

Question 72

What is the definition of faltering growth (failure to thrive)?

Answer 72

A sustained drop down 2 centiles on a growth chart

Question 73

Before performing a newborn examination, what information should you obtain?

Answer 73

Information about the maternal health, pregnancy and delivery, family history

Question 74

What would be your immediate management for a case where child abuse was suspected?

Answer 74

Admit to paediatrics for further investigation Contact your senior and contact safeguarding lead Refer to social services

Question 75

Between the ages of 1 and 5, the average child should gain how much weight per year?

Answer 75

2kg

Question 76

What are some potential underlying causes of a gross motor delay?

Answer 76

Cerebral palsy Muscular dystrophy Part of a wider global developmental delay

Question 77

What language skills should a child of 9 months be able to achieve?

Answer 77

Polysyllabic babble, imitates adult sounds

Question 78

For children up to the age of 5 who are walking, how much exercise should they be doing in a day? For children aged 5-18 years, how much exercise should they be doing in a day?

Answer 78

180 minutes 60 minutes of moderate-vigorous intensity exercise

Question 79

What is the triad of symptoms that forms shaken baby syndrome?

Answer 79

Retinal haemorrhages, subdural haematoma, encephalopathy

Question 80

How should you plot growth for a baby that was premature, but more than 32 weeks gestation at birth?

Answer 80

Plot measurements on the preterm section until 42 weeks' gestation After this, plot on the 0-1 chart at the chronological age but with gestational correction

Question 81

What should you do during assessment of the abdomen and external genitalia in a newborn assessment?

Answer 81

Check the umbilical stump and feel the abdomen, softly then firmly Palpate the testes and inspect for hypospadias (boys) Check the labia and introitus and warn patients to expect some spotting (girls)

Question 82

What growth variables are plotted in children aged \> 2 years?

Answer 82

Weight, height +/- BMI

Question 83

What gross and fine motor skills should a child of 6 weeks be able to achieve?

Answer 83

Head control in vertical / follows torch with eyes

Question 84

What are some benefits of breastfeeding to the mother?

Answer 84

Decreased risk of breast and ovarian cancer Decreased risk of cardiovascular disease Helps with post-natal weight loss Improves bonding More affordable

Question 85

What defines pubertal delay in boys and girls?

Answer 85

13+ for girls, 14+ for boys

Question 86

If a teenage child's height is plotted in the shaded area, what further information do you need to acquire?

Answer 86

Pubertal status and mid-parental height centil

Question 87

What are some benefits of breastfeeding to the child?

Answer 87

More proteins, antibodies and probiotics to prevent infection Decreases risk of type 1 diabetes, obesity, SUDI and cardiovascular disease in adulthood

Question 88

When should a skeletal survey be repeated?

Answer 88

After 11-14 days

Question 89

What language skills should a child of 18 months be able to achieve?

Answer 89

5-20 words, points to body parts

Question 90

A baby's head circumference should double by when?

Answer 90

4-6 months

Question 91

What language skills should a child of 6 months be able to achieve?

Answer 91

Screams when annoyed, babbles tunefully

Question 92

What is the average age of puberty in boys and girls?

Answer 92

10 years in girls, 11 years in boys

Question 93

What gross and fine motor skills should a child of 24 months be able to achieve?

Answer 93

Stairs two feet at a time / builds tower of 6-7 blocks, circular scribble

Question 94

What does dropping centiles on a chart actually correlate to in terms of growth?

Answer 94

The child isn't growing

Question 95

What should be done as part of assessment of the head and skull during the newborn examination?

Answer 95

Examine the size and shape of the skull Feel the fontanelles Measure the head circumference

Question 96

What should you do during assessment of the heart and peripheral pulses in the newborn examination?

Answer 96

Feel the femoral pulses (normally 110-160 bpm) Palpate the four areas with bell and diaphragm Feel for the apex beat and any heaves/thrills

Question 97

Other than general inspection, what are some additional things you should do during the assessment of the face, eyes, ears, mouth during the newborn examination?

Answer 97

Check the red reflex Feel the palate while assessing for the suckling reflex

Question 98

What should you do during assessment of the lungs in the newborn examination?

Answer 98

Assess the respiratory rate (30-60) and pattern of breathing Listen to air entry

Question 99

What APGAR score would be considered normal?

Answer 99

8-10

Question 100

What language skills should a child of 4 years be able to achieve?

Answer 100

Recount stories of recent experiences

Question 101

What social skills should a child of 18 months be able to achieve?

Answer 101

Feeds with a spoon, imitates adult activities

Question 102

From 1 to 4 years, how much should a child's length increase by each year?

Answer 102

25cm

Question 103

Explain how the 'appearance' section of APGAR is scored?

Answer 103

Blue/pale = 0 Pink body with blue extremities = 1 Pink = 2

Question 104

A specialised growth chart is required for children with what condition?

Answer 104

Down's syndrome

Question 105

Before performing a newborn examination you should ask whether the baby has peed or pood- within what timeframe should each of these events occur?

Answer 105

Should urinate within the first 24 hours and pass meconium within the first 48 hours

Question 106

Describe how to perform Barlow's test?

Answer 106

Adduct the hip and apply posterior pressure through the knee, this may dislocate a hip (positive test)

Question 107

What social skills should a child of 3 months be able to achieve?

Answer 107

React pleasurably to familiar situations