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Paeds Flashcards

1
Q

Which infants should routinely be referred for US for DDH?

A

Child hip problem in 1st-deg relative

Breech >= 36 wk

Multiple pregnancy

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2
Q

Barlow and Ortolani tests done when?

A

Newborn check
6-8 week check

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3
Q

Investigation of suspected DDH with US hips at age

A

<4.5 months old

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4
Q

Investigation of suspected DDH with Xray at age:

A

> 4.5 months old

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5
Q

Management of DDH with Pavlov harness at age:

A

<5 months old

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6
Q

Management of DDH with surgery at age:

A

> 5 months old

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7
Q

Neonatal blood spot screening (‘Guthrie’/’heel-prick’) is performed at..

A

Day 5-9 of life

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8
Q

Neonatal blood spot screens for..

A

Congenital hypothyroidism
Cystic fibrosis
Sickle cell disease
Phenylketonuria
Medium chain acyl-CoA dehydrogenase deficiency (MCADD)
Maple syrup urine disease (MSUD)
Isovaleric acidaemia (IVA)
Glutaric aciduria type 1 (GA1)
Homocystinuria (HCU)

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9
Q

Precocious puberty in females

A

Secondary sexual characteristics <8 yrs

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10
Q

Precocious puberty in males

A

Secondary sexual characteristics <9yrs

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11
Q

5-16y asthma - Newly-diagnosed with symptoms <3/week + no nocturnal waking

A

SABA reliever therapy alone
(salbutamol)

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12
Q

5-16y asthma - Newly-diagnosed with symptoms >=3/week +/- nocturnal waking

A

SABA + paediatric low-dose ICS
(<=200 mcg budesonide/equiv)

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13
Q

5-16y asthma -
Not controlled on:

SABA alone

A

SABA + paediatric low-dose ICS
(<=200 mcg budesonide/equiv)

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14
Q

5-16y asthma -
Not controlled on:

SABA + paediatric low dose ICS

A

SABA + paediatric low-dose ICS + LTRA

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15
Q

5-16y asthma -
Not controlled on:

SABA + paediatric low dose ICS + LTRA

A

Stop LTRA
SABA + paediatric low-dose ICS + LABA

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16
Q

5-16y asthma -
Not controlled on:

SABA + paediatric low-dose ICS + LABA

A

SABA + MART [paediatric low-dose ICS + LABA]

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17
Q

5-16y asthma -
Not controlled on:

SABA + MART [paediatric low-dose ICS + LABA]

A

SABA + MART [paediatric moderate-dose ICS + LABA]
or
SABA + paediatric moderate-dose ICS + LABA

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18
Q

5-16y asthma -
Not controlled on:

SABA + moderate-dose ICS + LABA
(fixed-dose or MART)

A

Paediatric high-dose ICS (MART/separate)
or
Theophylline/Expert advice

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19
Q

Refer for unilateral undescended testes - at what age?

A

3 months

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20
Q

Management of bilateral undescended testes

A

Same-day paediatrician review

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21
Q

Occurrence of undescended testis in newborn term male

A

2-3%

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22
Q

Croup - features prompting admission

A

Moderate/severe
<6m
Known upper airway abnormality
Uncertain diagnosis

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23
Q

Management of mild croup

A

Stat dose PO dexamethasone 150mcg/kg

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24
Q

Management of scarlet fever

A

PO Penicillin V QDS for 10/7

Notify PHE

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25
Q

Management of Scarlet Fever (pen-allergic)

A

Azithromycin OD for 5/7

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26
Q

Management of impetigo

A

Fusidic acid 2% TDS 5 days

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27
Q

Presentation of Measles

A

Irritable febrile prodrome
Conjunctivitis
Koplik spots
Rash behind ears > confluent

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28
Q

Classic presentation of Rubella

A

Maculopapular rash, from face -> whole body

Postauricular + suboccipital LN

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29
Q

Classic presentation of Mumps

A

Fever
Earache + pain on eating (unilateral -> bilateral)

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30
Q

Presentation of Erythema Infectiousum
(Fifth-disease/Slapped-cheek/Parvovirus B19)

A

Fever
Headache + lethargy
Rash from cheeks -> upper arms.

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31
Q

Scarlet fever - features
(Group A haemolytic strep toxins)

A

Fever
Tonsillitis
Strawberry tongue
Sandpaper rash + Circumoral pallor

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32
Q

HFM disease presentation
(Cocksackie A16 virus)

A

Vesicles in mouth + palms + soles
Fever, sore throat

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33
Q

Bed-wetting is considered normal up to age.

A

Age 5

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34
Q

Short-term management of bed-wetting in >7yr old (eg school trip)

A

Desmopression
Limit fluid 1hr pre - 8hr post

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35
Q

Incidence of cleft lip/palate

A

1 / 1000

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36
Q

Cleft lip usually repaired when

A

1 week - 3 months

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37
Q

Cleft palate usually repaired when

A

6 months - 1 year

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38
Q

Presentation of missed DDH in an older child

A

Trendelenberg gait + leg length discrepancy

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39
Q

1st-line management of CMPA
Formula-fed
Mild/moderate

A

eHF (extensive hydrolysed formula)

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40
Q

Management of CMPA
Formula-fed
Severe/2nd-line

A

AAF (amino acid-based formula)

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41
Q

1st-line management of CMPA- breast-fed

A

Maternal cows milk elimination
Calcium + vit D supplement

eHF milk after weaning

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42
Q

Pertussis vaccine in pregnancy

A

All offered 16-32 wks

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43
Q

Management of pertussis
>6 months old

A

Macrolide (if within 21 days onset)
Prophylactic antibiotics for household
Notify PHE

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44
Q

Complications of pertussis

A

Apnoea
Pneumonia, Bronchiectasis
Seizures
Subconjunctival haemorrhage, petechiae

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45
Q

Incidence of DDH

A

1 - 3%
(20% of which are bilateral)

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46
Q

Features of congenital Rubella

A

Sensorineural deafness
Congenital cataracts

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47
Q

Pyloric stenosis age of presentation

A

2wk - 6wk (rarely up to 4 months)

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48
Q

Definitive management of pyloric stenosis

A

Pyloromyotomy (Ramstedt or laparoscopic)

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49
Q

Presentation of pyloric stenosis

A

Projectile vomits 30min after feed
Upper abdominal mass
Constipation, dehydration, alkalosis

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50
Q

Chance of Down’s syndrome child - at maternal age 35

A

1 in 270

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51
Q

Chance of Down’s syndrome child - at maternal age 20

A

1 in 1,500

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52
Q

Chance of Down’s syndrome child - at maternal age 30

A

1 in 800

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53
Q

Chance of Down’s syndrome child - at maternal age 40

A

1 in 100

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54
Q

Chance of Down’s syndrome child - at maternal age 50

A

> =1 in 50

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55
Q

Investigation used to diagnose vesicoureteric reflux (VUR)

A

Micturating cystourethrogram

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56
Q

Investigation to look for renal scarring secondary to VUR

A

Radionuclide scan using dimercaptosuccinic acid (DMSA)

57
Q

Complications of measles

A

Otitis media
Pneumonia
Encephalitis (1-2 weeks later)
Subacute sclerosing panencephalitis (5 - 10 yr later)
Keratoconjunctivitis
Myocarditis

58
Q

Management of measles contacts

A

Offer MMR within 72hr, if not already vaccinated

59
Q

6-8 week check looks for:

A

Undescended testes
DDH
Congenital heart disease
Congenital cataract

60
Q

Diagnosis of whooping cough

A

Cough >14 days, and 1 of:

Paroxysmal cough
Inspiratory whoop
Post-tussive vomiting
Apnoea attacks

61
Q

Hip abnormality found at 6 week check - management

A

Refer specialist + US <10wks

62
Q

Roseola infantum - presentation

A

High fever, rash follows later

63
Q

Features of Patau syndrome (trisomy 13)

A

Cleft lip/palate
Polydactyly
Scalp lesions

64
Q

Features of Noonan syndrome

A

Webbed neck
Pulmonary stenosis
Pectus excavatum

65
Q

Features of Fragile X

A

Macrocephaly
Macro-orchidism
Learning difficulty

66
Q

Features of Pierre-Robin syndrome

A

Micrognathia
Posterior tongue displacement
Cleft palate

67
Q

Features of Prader-Willi syndrome

A

Obesity
Hypotonia
Hypogonadism

68
Q

Features of Edward’s syndrome (trisomy 18)

A

Rocker-bottom feet
Overlapping fingers
Low-set ears

69
Q

Features of William’s syndrome

A

Friendly and extroverted
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

70
Q

Cri du chat syndrome (chromosome 5p deletion)

A

Characteristic cry
Feeding difficulty
Hypertelorism

71
Q

Suspected meningococcal septicaemia in the community - immediate antibiotic management if < 1 year old

A

IM benzylpenicillin 300mg

72
Q

Suspected meningococcal septicaemia in the community - immediate antibiotic management if 1 - 10 years old

A

IM benzylpenicillin 600mg

73
Q

Suspected meningococcal septicaemia in the community - immediate antibiotic management if > 10 years old

A

IM benzylpenicillin 1200mg

74
Q

Limping child - indications for urgent assessment (admission)

A

< 3 years old
> 9 years + painful/restricted ROM
Unable to weight-bear
Fever / B symptoms
Severe pain / Night-awakening
Neurovascular compromise
Safeguarding concern

75
Q

Develepment - hand dominance before what age is a red flag (for cerebral palsy)

76
Q

Unexplained abdominal mass in a child - management

A

Urgent paediatric review within 48hr (possible Wilm’s tumour)

77
Q

Household contacts of threadworms

A

Stat Mebendazole - all family members on same day

78
Q

Which household members should not be treated for threadworms

A

Pregnant, breastfeeding,
< 2 years old

79
Q

Features of Kawasaki disease

A

High fever > 5 days
Conjunctival injection
Cervical LN
Red cracked lips, strawberry tongue
Red palms/sole > peel

80
Q

Management of Kawasaki disease

A

High-dose aspirin
IVIG
ECHO for coronary aneurysm

81
Q

Antibiotic treatment of whooping cough in community
(onset < 21 days) -
< 1 month old

A

Clarithromycin

82
Q

Antibiotic treatment of whooping cough in community
(onset < 21 days) -
>= 1 month old

A

Azithromycin or clarithromycin

83
Q

Antibiotic treatment of whooping cough in community
(onset < 21 days) -
pregnant woman

A

Erythromycin

84
Q

Which conditions are Autosomal Recessive

A

Metabolic conditions
Inherited ataxias

85
Q

Which conditions are Autosomal Dominant

A

Structural conditions
(+ Gilberts, hyperlipidaemia II)

86
Q

Features of Freiberg’s disease

A

Mid-foot pain, swelling + stiffness
Adolescents

87
Q

Pathology of Freibergs disease

A

Infarction > flattening of metatarsal head

88
Q

Management of Freiberg’s disease

A

Activity limitation + analgesia
Orthotics
Surgery (rare)

89
Q

Epistaxis under 2 years old

A

Fast-track referral to exclude haematological disorder

90
Q

Hearing test done as newborn

A

Otoacoustic emission test

If abnormal > Auditory brainstem response test

91
Q

Hearing test done at 6 - 9 months

A

Distraction test, by health visitor

92
Q

Hearing test done at 18 months - 2.5 years

A

Recognition of familiar objects

93
Q

Hearing test done at 2-3 years

A

Performance testing
Speech discrimination tests

94
Q

Hearing test done at school entry

A

Pure tone audiometry

95
Q

1st-line management of infantile spasm (non-tuberous sclerosis)

A

Vigabatrin or steroid (prednisolone or tetracosactide)

96
Q

EEG in Infantile spasm

A

Hypsarrhythmia

97
Q

Age of presentation - intussusception

A

6 - 18 months

98
Q

Features of intussusception

A

Paroxysmal colic, knees up, pale
Vomiting
Red-currant jelly stool
Sausage-shaped mass RUQ (25%)

99
Q

EEG findings with Benign Rolandic Epilepsy

A

Centro-temporal spikes

100
Q

Features of Benign Rolandic Epilepsy seizures

A

At night
Partial seizure
Child otherwise normal

101
Q

What age should child be competent with a spoon, and not spil with a cup

A

2 - 2.5 years

102
Q

Developmental milestone - copies square and triangle

103
Q

Developmental milestone - circular scribble

104
Q

Developmental milestone - copies vertical line

105
Q

Developmental milestone - copies circle

106
Q

Developmental milestone - copies cross

107
Q

Developmental milestone - says mama and dada

108
Q

Developmental milestone - Knows and reponds to own name

A

9 - 12 months

109
Q

Developmental milestone - knows 2-6 words

A

12 - 15 months
(Refer at 18 months)

110
Q

Developmental milestone - vocabulary of 200 words

111
Q

Developmental milestone - talks in short sentences

A

2.5 - 3 years

112
Q

Management of bruising in a non-mobile infant

A

Refer for same day paediatric assessment

113
Q

Developmental milestone - tower of 2 bricks

114
Q

Developmental milestone - tower of 3 bricks

115
Q

Developmental milestone - tower of 6 bricks

116
Q

Developmental milestone - tower of 9 bricks

117
Q

Genu valgum (knock knees) usually resolve by

118
Q

Genu varum (bow legs) usually resolve by

A

4 - 5 years

119
Q

<6m had UTI which responded to treatment - follow-up?

A

US within 6 weeks

120
Q

Child >6m
First UTI responded to treatment - follow-up

A

No imaging required
(unless suggested atypical infection)

121
Q

Features suggestive of an atypical urine infection

A

Seriously ill
Poor urine flow
Abdominal/bladder mass
Raised creatinine
Not responding to 48hr of antibiotics
Non-E.colli organism found

122
Q

Infant with GORD - 2nd line after alginate

A

omeprazole suspension 4wk trial

123
Q

Management of mild/moderate cradle cap

A

Baby shampoo + baby oils

124
Q

Management of severe cradle cap (seborrhoeic dermatitis)

A

mild topical steroid (1% hydrocortisone)

125
Q

Presentation of calcaneal apophysitis (Sever disease)

A

Bilateral heel pain in sporty child
Heel squeeze tenderness

126
Q

Features of Barter syndrome

A

Normotensive hypokalaemia
Failure to thrive

127
Q

Visible haematuria in a child

A

Paediatric review within 48hr (rule out Wilm’s tumour)

128
Q

WADR syndrome

A

Wilm’s tumour
Aniridia
Genitourinary malformation
Retardation

129
Q

General risk of a further febrile convulsion

130
Q

Management of suspected UTI in <3 month old

A

Immediate paediatrician review

131
Q

Management of lower UTI in >3 months old

A

3 days oral antibiotics (according to local guidelines)

Re-review if still unwell 24-48hr

132
Q

Migraine - 1st line acute management

133
Q

What is the average age that puberty starts in boys

134
Q

Send urine MCS before antibiotics if:

A

<3y
Pregnant
Pyelonephritis/complicated UTI
Recurrent UTI
Leucocyte/nitrite +ve only

135
Q

Management of pertussis in <6 month old

A

Admit
Prophylactic antibiotics for household
Notify PHE

136
Q

1st line management infantile spasm - tuberous sclerosis

A

Vigabatrin

137
Q

2nd line management infantile spasm - tuberous sclerosis

A

Steroid (prednisolone or tetracosactide)

138
Q

Vitamin K given to

A

All babies (3rd dose if breast-fed)

AKT (28 decks)

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