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Year 5 Specialities > Paeds > Flashcards

Paeds Flashcards

1
Q

O/E Ventricular septal defect

A

Pansystolic murmur in lower left sternal border

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2
Q

O/E coarctation of the aorta

A

Crescendo-decrescendo murmur in the upper left sternal border

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3
Q

O/E patent ductus arteriosus

A

Diastolic machinery murmur in the upper left sternal border

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4
Q

O/E pulmonary stenosis

A

Ejection systolic murmur in the upper left sternal border

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5
Q

O/E atrial septal defects

A

Ejection systolic murmur in the pulmonary area and fixed splitting to the second heart sound

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6
Q

Which childhood syndrome is associated with microcephalic, small eyes, cleft lip/palate, polydactyly, and scalp lesions?

A

Patau syndrome (trisomy 13)

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7
Q

Which childhood syndrome is associated with micrognathia, low-set ears, rocker bottom feet, and overlapping of fingers?

A

Edward’s syndrome (trisomy 18)

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8
Q

Which childhood syndrome is associated with learning difficulties, macrocephaly, long face, large ears, and macro-orchidism?

A

Fragile X

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9
Q

Which childhood syndrome is associated with webbed neck, pectus excavatum, short stature, and pulmonary stenosis?

A

Noonan syndrome

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10
Q

Which childhood syndrome is associated with micrognathia, posterior displacement of the tongue, and cleft palate?

A

Pierre-Robin syndrome

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11
Q

Which childhood syndrome is associated with hypotonia, hypogonadism, and obesity?

A

Prader-Willi syndrome

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12
Q

Which childhood syndrome is associated with short stature, learning difficulties, friendly personality, transient neonatal hypercalcaemia, and supravalvular aortic stenosis?

A

William’s syndrome

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13
Q

Which childhood syndrome is associated with a distinct cry, feeding difficulties and poor weight gain, learning difficulties, microcephaly and micrognathism, and hypertelorism?

A

Cri du chat syndrome (chromosome 5p deletion syndrome)

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14
Q

Which childhood syndrome is associated with the following heart defect?

a) Supravalvular aortic stenosis
b) Bicuspid aortic valve
c) Pulmonary stenosis
d) Atrioventricular septal defect

A

a) William’s
b) Turner’s
c) Noonan
d) Down’s

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15
Q

Developmental milestone red flags at any age

A

Maternal concern
Discrepancy
Regression

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16
Q

Developmental milestone red flags at birth

A

Asymmetric moro
Absent red reflex
Failed neonatal hearing test

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17
Q

Developmental milestone red flags by 10 weeks

A

No head control

No smiles

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18
Q

Developmental milestone red flags by 6 months

A

Primitive reflex
Hand preference
Squint
Minimal response to people, toys or noise

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19
Q

Developmental milestone red flags by 12 months

A

No sitting
Double babble
Pincer grasp

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20
Q

Developmental milestone red flags by 18 months

A

Not walking
< 5 words
Mouthing
Drooling

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21
Q

Developmental milestone red flags by 36 months

A

No 2 word phrases

Not interactive

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22
Q

HEADSSS assessment

A 
Home
Environment
Education
Activities
Drugs and alcohol
Sexuality/Sex
Self-harm/suicide
Safety
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23
Q

What are common innocent murmurs?

A

Systolic ejection murmur

Venous hums

Vibratory murmur

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24
Q

Compare characteristics of innocent and pathological murmurs

A

Innocent

  • systolic
  • musical quality
  • no radiation
  • varies in intensity w posture and respiration
  • asx
  • normal peripheral pulses

Pathological

  • pansystolic or diastolic
  • harsh/long
  • thrill, radiation or cardiac sx always indicate pathological
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25
Q

What clinical features would you expect in a ventricular septal defect?

A

Loud hard pansystolic murmur at sternal border, radiating all over chest

Severe: heart failure, breathlessness on feeding and crying, failure to thrive, recurrent chest infections

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26
Q

What clinical features would you expect in an atrial septal defect?

A

Soft systolic murmur in second left intercostal space, wide fixed splitting of the second sound

High flow through pulmonary valve causes systolic murmur

Breathlessness, tiredness on exertion, recurrent chest infections

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27
Q

What clinical features would you expect in aortic stenosis?

A

Systolic ejection murmur at right upper sternal border, radiating to neck and down left sternal border

Exercise-induced dizziness

Loss of consciousness in minority of older children

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28
Q

What clinical features would you expect in coarctation of the aorta?

A

Systolic murmur over the left side of the chest, especially at the back

Absent/delayed weak femoral pulses

Hypertension in arms

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29
Q

What clinical features would you expect in pulmonary stenosis?

A

Systolic ejection murmur over the upper part of left chest anteriorly and conducted ot the back, usually preceded by an ejection click

Associated w cyanosis if > mild

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30
Q

What clinical features would you expect with patent ductus arteriosus?

A

Pansystolic murmur in neonates

Continuous murmur after 3 months of age

Collapsing pulse

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31
Q

Three ddx of syncope with normal EEG findings

A

Syncopal attacks

  • blurred vision, lightheaded, sweating, nausea
  • helps to lie down
  • prolonged standing, painful/emotional stimulus precipitates it

Hyperventilation

  • excessive deep breathing
  • breath into paper bag to resolve
  • excitement precipitates it

Hysterical seizures

  • gradual onset, asynchronous flailing movements
  • no incontinence or postictal state
  • often triggered by emotional stimulus
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32
Q

Compare the impact on the heart of the following cardiac problems:

a) atrial septal defect
b) ventricular septal defect
c) aortic stenosis
d) coarctation of the aorta
e) pulmonary stenosis
f) transposition of the great vessels
g) fallot’s tetralogy

A

a) high flow through the pulmonary valve causes systolic murmur
b) blood flows through defect to right side of heart leading to pulmonary HTN, cardiomegaly, and prominent pulmonary arteries
c) stenosis causes enlargement of the left ventricle and prominence of the ascending aorta
d) blood flow to the lower limbs is maintained through a patent ductus arteriosus
e) right ventricle hypertrophies to overcome obstruction presented by stenosis of pulmonary valve
f) pulmonary artery arises from left ventricle and aorta from the left, open ductus allows mixing of the blood
g) pulmonary stenosis, ventricular septal defect w shunt, overriding aorta, right ventricular hypertrophy

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33
Q

In which congenital lesion must strenuous activity be avoided?

A

Aortic stenosis

High risk of sudden death

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34
Q

Emergency treatment of severely cyanosed child w poor systemic circulation

A

IV prostaglandin
- maintain ductus open

Balloon septostomy
- improve mixing of blood within the heart

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35
Q

Four characteristics of Fallot’s tetralogy

A
  1. Ventricular septal defect
  2. Overriding of the aorta
  3. Infundibular pulmonary stenosis
  4. Right ventricular hypertrophy
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36
Q

Which pts are at risk of infective endocarditis?

A

Congenital heart disease

Indwelling central venous catheter

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37
Q

4 yr old with background of atrial septal defect presents with 1/52 fever and 1/7 petechiae and splinter haemorrhages

O/E changing murmur, hepatosplenomegaly

What is causing this and how should it be treated?

A

Infective endocarditis
- strep, staph main organisms

IV abx given over 4-8 weeks

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38
Q

How should a 14 year old girl presenting w syncope be managed?

A

History

  • before/during/after syncope
  • any unpleasant stimulus/prolonged standing

Cardiac examination
- including standing + lying BP

Any doubt about fall
- further ECG

Reassure very common in teenage girls due to:

  • emotional/painful stimulus
  • poor vasomotor reflexes
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39
Q

What investigations could you order for diagnosing and leg pain and what could they indicate?

A

FBC, WCC

  • leukaemia
  • infections
  • collagen vascular disease

Plasma viscosity
- infections

ESR
- collagen vascular disease

CRP

  • IBD
  • tumours

X-ray

  • bone tumours
  • infection
  • trauma
  • avascular necrosis
  • leukaemia
  • slipped capital femoral epiphysis

Bone scan

  • osteomyelitis
  • stress fractures
  • malignant tumours

Muscle enzymes
- damage to muscle cells

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40
Q

Compare characteristics in leg pain due to organic vs non-organic causes

A

Organic

  • day and night persists
  • interrupts play
  • unilateral
  • located in joint
  • limp/refuses to walk
  • systemic features
  • O/E point tenderness, redness, swelling, limited movements, muscle weakness/atrophy, fever, rash, pallor, lymphadenopathy, organomegaly

Non-organic

  • only at night
  • primarily school days
  • no interference w normal activities
  • located between joints
  • bilateral
  • normal gait
  • otherwise healthy child
  • normal exam/minor changes such as coolness/mottling of leg
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41
Q

Investigations for a child with swollen joints and their relevance

A

FBC

  • high WCC, left shift = bacterial infection
  • anaemia in collagen vascular disease, IBD, malignancy
  • haemoglobinopathy features

ESR + plasma viscosity
- elevated in bacterial infection, collagen vascular disease, IBD

Blood culture
- +ve septic arthritis

ASO titre
- indicative of strep infection = reactive arthritis

Viral titres
- viral arthritis

Rheumatoid factor, antinuclear antibodies
- -ve in most forms of juvenile chronic athritis

X ray

Joint aspiration
- microscope + culture for ?septic arthritis

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42
Q

Causes of abnormal gait

A

Common

  • flat feet
  • intoeing
  • bow legs and knock-knees
  • toe walking

Less common

  • congenital dislocation of hip
  • cerebral palsy
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43
Q

Name two paediatric forms of joint trauma

A

Pulled elbow/’nursemaid’s’ elbow

  • sudden forceful traction on arm dislocates elbow
  • toddler group, don’t complain but refuse to use arm/hold in flexed position
  • simple supinate arm fully to click head of ulnar back into place

Fracture of the growth plate

  • most vulnerable structure in joint is growth plate > ligamentous sprain
  • still present w swelling, not seen easily on X ray
  • immobilise joint for few weeks
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44
Q

6 yr old comes in w 4/7 fever and 2/7 swollen knee

O/E swelling and redness at site, temperature 37.9

IX sterile aspirate, high WCC and ESR

What likely caused this and how should we treat?

A

Osteomyelitis

  • Staph aureus
  • Haem influenzae
  • Strep pyogenes

Long bones infected, get sympathetic effusion of adjacent joint

High-dose abx for 4 weeks

Surgical exploration and drainage if no response to abx

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45
Q

Complications of osteomyelitis

A

Irreversible bone necrosis

Draining sinuses

Limb deformity

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46
Q

What clinical features would you expect in transient synovitis?

A

Sudden onset limp w hip and/or knee pain

Mild UTI/viral infection precedes sx

Limited abduction, extension + internal rotaion of hip

Lack of systemic sx

Normal WCC, ESR, hip X ray

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47
Q

Most common organisms causing septic arthritis

A

Staph aureus
Haem influenzae

blood-borne

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48
Q

What would the ix show in septic arthritis?

A

Elevated WCC, ESR, CRP

X ray shows widening of joint space due to fluid accumulation, adjacent osteomyelitis

Aspiration of joint sent for urgent microscopy + culture, fluid is purulent with organisms found on gram’s stain

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49
Q

Tx for septic arthritis

A

IV flucloxacillin + penicillin/cephalosporin

Splint joint in acute stage

Switch to oral abx as systemic sx settle

Pain subsided, physiotherapy to encourage full joint mobility + avoid joint flexion deformities

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50
Q

8 yr old boy presents w pain in left hip and limp for 1/52

X ray shows increased density, flattening and fragmentation of left capital femoral epiphysis

What this and its tx?

A

Legg-Calve-Perthes disease/avascular necrosis of femoral head

Tx includes bracing or traction and recovery may take 2-3 years

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51
Q

12 yr old obese boy presents w pain in knee, gradually increasing over last week

What is likely seen on examination and X ray?

A

O/E hip held in abduction and external rotation with limitation of internal rotation

X ray shows slipped capital femoral epiphysis

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52
Q

What are the three presentations of juvenile idiopathic arthritis?

A

Systemic (M>F)

  • large and small joints affected
  • remitting fever, variable rash, anaemia, wt loss, abdo pain, hepatosplenomegaly

Polyarticular (F>M)

  • large and small joints affected
  • morning stiffness common
  • symmetrically distributed
  • sometimes poor wt gain and mild anaemia

Pauciarticular (F>M)

  • <5 joints, usually large
  • chronic iridocyclitis
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53
Q

What ix would you see in juvenile idiopathic arthritis?

A

Elevated ESR and WCC

Anaemia

RhF negative

ANA negative in systemic

ANA positive possible in poly-, pauciarticular

X ray: soft tissue swelling, periostitis, early loss of cartilage, bone destruction + fusion

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54
Q

How do you manage juvenile idiopathic arthritis?

A

NSAIDs for inflammation

Corticosteroids for severe systemic disease (avoid repeated steroid injections into joint)

Physio- and occupational therapy

Psychosocial support for child and family

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55
Q

Causes of anaemia/pallor in childhood

A

Common

  • iron deficiency anaemia
  • thalassaemia trait

Uncommon

  • lead poisoning
  • haemolysis, i.e. thalassaemia major, sickle cell
  • chronic infection
  • chronic renal failure
  • malignancy, i.e. leukaemia
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56
Q

What ix would you do in a child with anaemia who is ill or unresponsive to iron treatment?

A 
FBC
Blood film
Ferritin
Lead level - check for toxicity
Haemoglobin electrophoresis 
U&Es
Blood and urine culture
Bone marrow aspiration
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57
Q

Why is anaemia common in toddlers?

A

Poor intake of iron-rich foods

Cow’s milk bottle feeding leads to occult GI blood loss

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58
Q

3 yr old comes in with irritability and pallor, started on iron treatment, however, has been unresponsive

Blood film shows hypochromic microcytic anaemia

X ray shows radiopaque flecks and increased density at growing ends of bone

What is this and its tx?

A

Lead poisoning

  • high lead levels would have been tested irl
  • radiopaque = foreign matter ingested
  • long bones with increased density = leadlines

Sx

  • usually subtle, irritability, decreased play, anorexia
  • acute encephalopathy rare

Tx

  • lead chelating agents
  • source must be identified and removed
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59
Q

Complication of repeated iron transfusions and how are they managed

A

Haemosiderosis

  • cardiomyopathy
  • cirrhosisd
  • diabetes
  • skin pigmentation

Chelating iron agents to mop up extra iron
- desferrioxamine, subcutaneous/IV/oral

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60
Q

How is thalassaemia diagnosed?

A

Haemoglobin electrophoresis

- beta thalassaemia = HbA1 absent, HbA2 + HbF increased

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61
Q

What would blood film of homozygous state of thalassaemia show?

A

Severe anaemia

  • hypochromia, microcytosis
  • fragmented poikilocytes
  • target cells
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62
Q

What would you see on physical examination of a child with thalassaemia major?

A 
Anaemia - pallor
Maxillary overgrowth - frontal bossing
Hepatosplenomegaly
Skin pigmentation - haemosiderosis 
Short stature and delayed puberty
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63
Q

4 yr old comes in with painful swelling of hands and feet after a bout of gastroenteritis

O/E scleritis, dactylitis, splenomegaly

What’s going on and what would you see on a blood smear?

A

Sickle cell disease, pts susceptible to acute, painful crises due to dehydration, hypoxia or acidosis

Blood smear

  • target cells
  • poikilocytes
  • irreversibly sickled cells
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64
Q

Complications of sickle cell disease

A

Chronic haemolysis
Recurrent painful crises due to ischaemic occlusions
Aplastic crises
Sequestration crises causing circulatory collapse
Pneumococcal infection due to asplenism
Osteomyelitis
Renal damage w reduced ability to concentrate urine
Gallstones
Heart failure from chronic anaemia

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65
Q

Mx of child with sickle cell disease

A

Analgesics, abx, warmth, fluids during crises

Blood transfusion if Hb low during aplastic, sequestration or haemolytic crisis

Maintain immunisations, i.e. pneumococcal

Penicillin prophylaxis to prevent pneumococcal infection

Genetic counselling for family

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66
Q

How is sickle cell diagnosed?

A

Haemoglobin electrophoresis

- HbS present, HbA absent

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67
Q

What is the main concern for children with asplenism and how are they managed?

A

Spleen responsible for filtering blood and early antibody responses so asplenic children at high risk of sepsis, particularly due to pneumococcal infection

  • prophylactic penicillin
  • maintain pneumococcal immunisation
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68
Q

10 yr old comes in with new onset rash, had viral infection 2 weeks ago, otherwise generally healthy

O/E petechial rash, superficial bruising on arms and legs

What will your ix show for most likely diagnosis?

A

Low platelet count < 40 x10^9/L

Normal WCC, Hb (anaemia only if significant blood loss occurring)

Bone marrow aspirate (to exclude aplastic/neoplastic bone marrow problems) show normal or increased megakaryocytes

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69
Q

What’s the prognosis for ITP?

A

Fantastic - 85% self-limiting course

Severe spontaneous haemorrhage and intracranial bleeding confined to initial phase of disease then majority children recover within 6 months

Children with chronic ITP face splenectomy and immunosuppressive tx

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70
Q

5 yr old comes in with increased lethargy and wt loss over last couple months. Mum mentions recent fevers and irritability. Last week been complaining about left leg pain.

O/E petechiae, mucous membranes bleeding, lymphadenopathy, splenomegaly, bone tenderness in left leg

What will ix show likely show?

A

Peripheral blood smear

  • elevated WCC
  • anaemia
  • thrombocytopenia
  • blast cells may be seen

Bone marrow
- replaced by leukaemic lymphoblasts

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71
Q

What features would you expect to see in congenital rubella infection of a newborn?

A

Characteristic features:

  • sensorineural deafness
  • congenital cataracts
  • congenital heart disease (i.e. PDA)
  • glaucoma

Other features:

  • growth retardation
  • hepatosplenomegaly
  • purpuric skin lesions
  • ‘salt and pepper’ chorioretinitis
  • microphthalmia
  • cerebral palsy
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72
Q

What would you expect to see in congenital toxoplasmosis infection of a newborn?

A

Characteristic features:

  • cerebral calcification
  • chorioretinitis
  • hydrocephalus

Other features:

  • anaemia
  • hepatosplenomegaly
  • cerebral palsy
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73
Q

What would you expect to see in congenital cytomegalovirus infection of a newborn?

A

Characteristic features:

  • growth retardation
  • purpuric skin lesions

Other features:

  • sensorineural deafness
  • encephalitis/seizures
  • pneumonitis
  • hepatosplenomegaly
  • anaemia
  • jaundice
  • cerebral palsy
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74
Q

What causes stridor?

A

Partial obstruction of the upper airway, causing an inspiratory noise

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75
Q

What causes wheeze?

A

Partial obstruction of the lower airway, causing an expiratory wheeze

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76
Q

Signs of respiratory distress

A 
SOB
Tachypnoea
Alar flaring
Intercostal and subcostal recession
Use of accessory muscles for breathing

SEVERE SIGNS
Cyanosis
Drowsiness
Inability to talk

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77
Q

What age groups do the following conditions typically occur in?

a) croup
b) epiglottis
c) foreign body
d) laryngomalacia
e) subglottic stenosis

A

a) 6-24 months
b) 2-7 years
c) 9-18 months
d) newborn
e) 0-6 months

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78
Q

What are the distinguishing features between the following conditions?

a) croup
b) epiglottis
c) foreign body
d) laryngomalacia
e) subglottic stenosis

A

They all present with stridor

a) coryzal prodrome, barking cough
b) toxicity and high fever, drooling
c) hx and sudden onset stridor
d) at birth, nosy breather worse on crying and improves w age
e) previous hx of intubation, exacerbations with URTI

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79
Q

What are the developmental warning signs at any age?

A

Maternal concern

Regression in previously acquired skilss

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80
Q

What are the developmental warning signs at 10 weeks?

A

Not smiling

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81
Q

What are the developmental warning signs at 6 months?

A

Persistent primitive reflexes
Persistent squint
Hand preference
Little interest in people, toys, noises

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82
Q

What are the developmental warning signs at 10-12 months?

A

No sitting
No double-syllable babble
No pincer grasp

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83
Q

What are the developmental warning signs at 18 months?

A

Not walking independently
Fewer than six words
Persistent mouthing and drooling

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84
Q

What are the developmental warning signs at 2.5 years?

A

No two- to three-word sentences

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85
Q

What are the developmental warning signs at 4 years?

A

Unintelligible speech

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86
Q

Causes of speech and language difficulties

A 
Speech difficulties
Stammer
Cleft lip and palate
Deafness
Maturational delay (familial) 
Environmental deprivation and neglect
Learning disabilities
Communication difficulties
Autism
Language disorder
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87
Q

Common causes of delayed walking

A 
Delayed motor maturation (familial) 
Severe learning diasabilties 
Cerebral palsya
Hypotonia of any cause
Muscular dystrophy
Other neuromuscular disorders
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88
Q

What signs may you see on physical examination of the following patients with:

a) Trisomy 21
b) Fragile X
c) Fetal alcohol syndrome
d) Inborn errors of metabolism
e) Intrauterine infections

A

a) Epicanthic folds, small palpebral fissures, flat nasal bridge, single palmar crease, Brushfield spots, hypotonia
b) Long face, prominent ears, large jaw, large testes at puberty
c) Short palpebral fissures, maxillary hypoplasia, thin upper lip, microcephaly
d) Sometimes coarse features, hepatosplenomegaly, microcephaly, failure to thrive
e) Visual or hearing deficits common, microcephaly

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89
Q

What medication is used for ADHD in children?

A

Methylphenidate

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90
Q

Character and area affected in the brain by the following types of cerebral palsy:

a) Spastic
b) Dystonic
c) Ataxic

A

Spastic

  • most common
  • damage to cerebral motor cortex/its connections
  • brisk deep tendon reflexes, clonus, hypertonia in affected limbs

Dystonic

  • damage to basal ganglia
  • irregular, involuntary movements that may be continuous/occur on voluntary movement

Ataxic

  • rare
  • damage to cerebellum
  • hypotonia, incoordination and intention tremor
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91
Q

What features may be seen in the diagnosis of cerebral palsy in a 12-month old?

A

Abnormalities of tone
- initially reduced than spasticity develops

Delays in motor development
- marked head lag and delays in sitting and rolling over usually found

Abnormal patterns of development

Persistence of primitive reflexes
- Moro, grasp, and asymmetric tonic neck reflex persist

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92
Q

State the main features of spastic hemiplegia cerebral palsy

A

One side of the body affected, arm > leg, walking delayed until 18-24 months then characteristic gait noted - walks on tiptoes, affected arm held in dystonic posture when running

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93
Q

State the main features of spastic diplegia cerebral palsy

A

Survivor of severe prematurity, both legs involved > arms, problem when baby starts to crawl and legs drag behind, when baby suspended goes into scissoring position, walking delayed and child walks on tiptoes

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94
Q

State the main features of spastic quadriplegia cerebral palsy

A

Severe due to marked motor impairment of all extremities, associated with severe LD and fits, swallowing difficulties and GO reflux common, microcephaly

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95
Q

What teams are involved with children cerebral palsy?

A 
Paediatricians 
Physiotherapists
Occupational therapists
Speech therapists
Orthopaedic surgeons 
Dieticians 
Social workers (support family) 
Special educational needs institutions (if severe)
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96
Q

Neurological signs seen in affected limbs of spastic cerebral palsy

A

Clasp-knife hypotonia
Brisk deep tendon reflexes
Ankle clonus
Babinski response (extensor plantar)

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97
Q

5 year old boy presents with a lordotic, waddling gait and difficulty climbing stairs.

O/E enlarged but weak calf muscles

What ix should you do and what would they show?

A

Elevated creatinine kinase levels

Further confirmatory ix:
EMG shows myopathic changes
Muscle biopsy

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98
Q

5 year old boy presents with a lordotic, waddling gait and difficulty climbing stairs.

O/E enlarged but weak calf muscles

What is the cause of their condition?

A

Duchenne muscular dystrophy is X-linked recessive trait

Only seen in boys

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99
Q

Mx of duchenne muscular dystrophy

A

Poor prognosis - life expectancy 20s-early 30s

Respiratory support with steroids or non-invasive breathing support overnight
Physiotherapy
Genetic counselling for future pregnancies

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100
Q

Clinical features of trisomy 21

A 
Upward sloping palpebral fissures
Epicanthal folds
Brushfield spots
Protruding tongue
Flat occiput 
Single palmar creases
Hypotonia 
Small stature
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101
Q

Complications seen in trisomy 21

A 
Cardiac anomalies (AV canal defects)
Duodenal atresia
Secretory otitis media
Strabismus
Hypothyroidism
Atlantoaxial instability
Leukaemia
Alzheimer's later in life
102
Q

Which children are at risk for hearing impairment?

A 
Severe prematurity
Hx of meningitis, recurrent otitis media
Significantly delayed/unclear speech
FHx of deafness
Parental suspicion of deagness
Children w cerebral palsy, cleft palate, absent/deformed ears
103
Q

Common conductive hearing loss seen in children

A

Glue ear

  • chronic secretory otitis media
  • result of persistent effusions in middle ear
104
Q

Surgical mx of conductive hearing loss in children

A

Grommets inserted

  • aerates middle ear and drains fluid
  • adenoidectomy may be performed at same time
  • will eventually fall out spontaneously and don’t need to be replaced as child grows out of glue ear
105
Q

Mx of sensorineural hearing loss in children

A

Hearing aids
Aid communication (sign language, lip reading)
Education by peripatetic teacher of deaf to assist in mainstream schools

106
Q

When are children’s hearing tested?

A

Within few weeks of birth

  • newborn hearing screening via automated otoacoustic emission (AOAE) test
  • if no response from 1st test goes onto have automated auditory brainstem response (AABR) test

9 months to 2.5 years old
- reviews will be asked, parental concern will lead to hearing test referrals

4 to 5 years old
- hearing tests when you start school depending on where you live

107
Q

What are ‘blindisms’?

A

Children with visual deficits develop mannerisms like eye poking, eye rubbing and rocking

Likely as it may induce pleasurable visual gratification of retinal origin

108
Q

Commonest causes of visual impairment in children

A

Optic atrophy
Congenital cataracts
Choroidoretinal degeneration

109
Q

How may development be affected in a child with visual impairment?

A

If congenital, early smiling is inconsistent and no turning towards sounds
Reaching for objects and pincer grip is delayed
Early language may be normal but complex language may be delayed

110
Q

What is diurnal enuresis?

A

Lack of bladder control during the day in a child old enough to maintain bladder continence

111
Q

Features suggestive of a neurogenic bladder

A

Distended bladder
Abnormal perianal sensation and anal tone
Abnormal neurological findings in the legs

112
Q

Features suggestive of congenital bladder anomalies

A

Primary enuresis
Continuous leakage of urine
Distended bladder
UTI in preschool years

113
Q

What urinary sx points towards a psychogenic cause?

A

If sx are absent at night, psychogenic likely (although the opposite cannot be stated)

114
Q

What ix could you do for haematuria and why?

A

Urinalysis

  • red cell casts, protein ++ indicate glomerular lesion
  • pyuria, bacteriuria indicate infection

Urine culture
- UTI

FBC
- anaemia

ASO titre and throat culture
- recent strep infection precedes acute glomerulonephritis

Serum creatinine, U&E
- elevated indicate impaired renal function

24-hour urine creatinine, protein and calcium
- Cr clearance quantify renal impairment

Serum C3 level
- low C3 specific for some glomerulonephritis

Abdo/pelvic US and intraveous pyelogram
- structural abnormalities of kidney

Renal biopsy
- if persistent haematuria with proteinuria, hypertension or impaired renal function

115
Q

Possible ddx if you find renal mass on palpation

A

Hydronephrosis
Polycystic kidneys
Wilms’ tumour

116
Q

Causative organism of UTIs in children

A

90% E coli

117
Q

When would you give IV abx for UTI in children?

A

< 3 months of age

Older children w signs of systemic illness

118
Q

1st line abx for UTI in children

A

Trimethoprim for 3 days for lower urinary tract

7-10 days if upper urinary tract involved

119
Q

Which children with UTIs require further ix?

A

< 6 months old w single confirmed UTI need USS
Atypical/recurrent UTIs any age need USS
If persistent proteinuria with sterile urine need creatinine clearance to assess renal function

120
Q

What does a DMSA do?

A

Radionuclide scan that uses dimercaptosuccinic acid (DMSA) in assessing renal morphology, structure and function

Detect renal scarring

121
Q

What does a MCUG do?

A

Micturating cystourethrogram

  • indicated < 6 months or older children when concerns about bladder neck outflow and vesicoureteric reflux
  • unpleasant procedure requiring catheterisation
122
Q

When would you do a DMSA and MCUG?

A

Atypical UTI

  • DMSA 4-6 months later
  • MCUG if < 6 months old

Recurrent UTI

  • DMSA 4-6 months later
  • MCUG if < 6 months old
123
Q

What is VUR?

A

Vesicoureteric reflux

  • reflux of urine from bladder up ureter on micturition due to incompetence of valvular mechanism at vesicoureteric junction
  • more severe VUR can reflux back into kidney
  • increased risk of renal scarring
124
Q

Complications of VUR

A

Renal scarring (> 50%)
Hypertension in adult life (10-20%)
Chronic renal failure (less common)

125
Q

Mx of VUR

A

Long-term prophylactic abx
Regular monitoring of renal growth
Surgery if severe reflux

126
Q

Mx of nocturnal enuresis

A

Fluid restriction in evenings
Lift child from bed to urinate at night
Star charts (positive reinforcement)
Enuresis alarm (reserved if child motivated/indepdenent)
Vasopressin (can be used for an occasion, i.e. sleepover)

127
Q

Smoky/cola-coloured urine is suggestive of which renal condition?

A

Acute glomerulonephritis

128
Q

Signs and sx of acute glomerulonephritis

A 
Smoky/cola-coloured urine
Malaise/headache
Loin discomfort
Throat/skin infection 2-3 weeks ago 
Oedema (periorbital, backs of hands/feet)
Hypertension
129
Q

Complications of acute glomerulonephritis

A

Renal failure
Hypertension
Seizures
Heart failure

130
Q

Pt comes in with proteinuria, hypoproteinaemia, oedema, and hyperlipidaemia

What is this?

A

Nephrotic syndrome

131
Q

What do you see in nephrotic syndrome?

A

Proteinuria, hypoproteinaemia, oedema, and hyperlipidaemia

132
Q

Most common cause of nephrotic syndrome in children

A

Minimal change disease (85% cases)

133
Q

Mx of nephrotic syndrome in children

A

Excessive fluid intake discouraged
No added salt diet
Daily weights and proteinuria
Steroids for 4-6 weeks
Prophylactic penicillin due to risk of infection (antibodies lost in urine)
Renal biopsy ONLY if child resistant to steroid tx

134
Q

What medications may you use for sx in cerebral palsy?

A

Muscle stiffness = baclofen
Constipation = movicol
Sleeping problems = melatonin
Drooling = anti-cholinergic (scopolamine: hyoscine)

135
Q

Clues to differentiate between a hydrocele, inguinal hernia, and testicular torsion

A

Hydrocele
- transilluminates, not painful, more likely in babies

Inguinal hernia
- infants (usually premature), extends to groin, not painful

Torsion
- very painful, boys under 6 usually

136
Q

Causes of scrotal swellings

A

Hydrocele
Inguinal hernia
Testicular torsion

137
Q

Causes of swelling in the groin

A

Inguinal hernia
Inguinal lymphadenopathy
Ectopic testis

138
Q

Causes of impalpable testes

A

Undescended or ectopic testes
Retractile testes
True testicular absence

139
Q

6 week baby check, undescended testes noted - when should the baby have surgery?

A

May descend spontaneously before 1 year

Must have surgery before age of 2 years to reduce complications

140
Q

What testing should be done if testes are impalpable bilaterally?

A

Chromosomal and hormonal testing

?Intersex

141
Q

What complications arise due to cryptochordism?

A

Uncorrected undescended testes can result in infertility and malignancy

142
Q

4 yr old boy comes in acute pain and swelling of the scrotum

O/E distressed, scrotum looks tender and swollen

What are the next steps?

A

Surgical exploration for testicular torsion to untwist and fix testis to scrotum

If completed within 6 hours, greater chance of testis surviving

If testicular torsion confirmed, contralateral testis must be fixed as also prone to torsion

If Hydatid of Morgagni, contralateral testis does not need to be fixed

143
Q

When is an irretractable prepuce pathological?

A

After 3 years of age it is considered true phimosis and requires surgery

144
Q

What is the most common hypospadias?

A

Meatus sited on the ventral aspect of the glans penis

145
Q

When should surgical reconstruction occur for hypospadias?

A

Before the age of 2 years

146
Q

What should parents be advised if their baby has a hypospadias?

A

Do not circumcise the child as the foreskin may be used in reconstructive surgery

147
Q

Complications of an inguinal hernia

A

Risk of strangulation of bowel and/or testis

148
Q

Features of an atypical UTI

A 
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms
149
Q

Describe a macule lesion, including examples

A

Discrete flat lesions of any size or shape that are pink/red in colour
Characteristically fade on pressure

  • rubella, roseola
150
Q

Describe a papule lesion, including example

A

Solid palpable projections above the surface of the skin

  • insect bite
151
Q

Describe a maculopapular lesion, including examples

A

Mixture of macules and papules which tend to be confluent

  • measles, drug rash
152
Q

Describe a purpura and petechiae lesion, including examples

A

Purple lesions caused by small haemorrhages in the superficial layers of skin, indicating a serious condition
Characteristically DO NOT fade on pressure
Petechiae - tiny purpuric lesions

  • meningococcal septicaemia, ITP, HSP, leukaemia
153
Q

Describe a vesicle lesion, including example

A

Raised fluid filled lesions < 0.5cm in diameter, if larger they are bullae

  • chicken pox
154
Q

Describe a wheals lesion, including example

A

Raised lesions with a flat top and pale centre of variable size

  • urticaria
155
Q

Describe a desquamation lesion, including example

A

Loss of epidermal cells producing a ‘scaly’ eruption

  • post-scarlet fever
156
Q

2 year old presents with non-blanching purpuric rash with a background of 2 days fevers of up to 39 degrees

What ix should you order?

A

Suspected meningococcal septicaemia needs urgent ix:

  • Blood cultures
  • Meningococcal PCR
  • Clotting screen
  • FBC
  • Ca profile
157
Q

2 year old presents with non-blanching purpuric rash with a background of 2 days fevers of up to 39 degrees

What mx should be given?

A

Immediate IM penicillin + urgent hospital admission with extensive ix

158
Q

Maculopapular rash starts on face then spreads downwards, what other features may you see in this child?

A

Measles

  • koplik spots
  • coryza
  • cough and conjunctivitis
  • ill child
159
Q

Tiny pink macular rash starts on face and trunk and works downwards, what other features may you see in this child?

A

Rubella

  • well child
  • lymphadenopathy sometimes
160
Q

Macular faint pink rash presents on trunk, what other features may you see in this child?

A

Roseola

- rash occurs after fever defervesces

161
Q

Fine punctuate maculopapular rash with a sandpaper feel starts to peel, what other features may you see in this child?

A

Scarlet fever

  • strawberry tongue
  • perioral pallor
  • tonsillitis
162
Q

Maculopapular lace-like rash present on arms, trunk and thighs, what other features may you see in this child?

A

Fifth disease

  • ‘slapped cheek’
  • well child
  • lasts up to weeks
163
Q

Papules, vesicles and crusts present in crops on face and trunk, what other features may you see in this child?

A

Chicken pox

- shallow ulcers of the mucous membranes

164
Q

Compare the presentations seen in HSP and ITP

A

HSP

  • purpuric
  • distributed over buttocks, thighs and legs
  • abdo pain, arthralgia, melaena, haematuria

ITP

  • petechial over body
  • bruising present
  • bleeding from other sites, i.e. gums, nose
165
Q

Common chronic skin rashes in children

A

Eczema (atopic dermatitis)
Contact dermatitis
Seborrhoeic dermatitis
Psoriasis

166
Q

What can long-term topical steroid use result in?

A

Atrophy of skin
Increase in hair growth

*particularly the fluorinated variety of steroids

167
Q

Compare the distribution of common chronic skin rashes in children

A

Atopic dermatitis
- flexures

Contact dermatitis
- at sites of contact with irritant

Seborrhoeic dermatitis
- face, neck, axillae and nappy area

Psriasis
- scalp, knees, elbows and genitalia

168
Q

Causes of nappy rash

A

Ammoniacal dermatitis
Candidiasis
Seborrhoeic dermatitis
Psoriasis

169
Q

Describe a typical ammoniacal dermatitis nappy rash

A

Erythematous +/- papulovesicular/bullous lesions, fissures and erosions
Patchy/confluent
Skin folds characteristically spared

170
Q

Describe a typical candida nappy rash

A

Bright red with sharply demarcated edge and satellite lesions
Inguinal folds involved
Oral thrush may be found

171
Q

Compare nappy rashes caused by seborrhoeic dermatitis and psoriasis

A

BOTH

  • pink, greasy lesions with yellow scale
  • often in skin folds

SD
- cradle cap may be found

Psoriasis

  • +ve FHx
  • nail pitting present
172
Q

Roughened keratotic lesion with irregular surface on finger of 8 year old

A

Wart

173
Q

Sticky, heaped-up, honey-colour crusts in flexures of 3 year old with known eczema

A

Impetigo

174
Q

Pearly, dome-shaped papules with central umbilicus on trunk of 6 year old

A

Molluscum contagiosum

175
Q

Dry scaly papule which spreads centrifugally with central clearing on 9 year old’s back

A

Tinea corporis (ringworm)

176
Q

Grouped vesicles and pustules on upper lip of 5 year old

A

Cold sore

177
Q

When could guttate psoriasis occur?

A

Post-streptococcal infection

178
Q

Mx of nappy rash

A

Regular changing and washing area
Exposure to air
Protective creams (i.e. zinc and castor oil ointment)
Consider use of mild hydrocortisone cream, anticandida creams (nystatin)

179
Q

Main pathogens responsible for impetigo

A

Group A haemolytic streptococci or staphylococci

180
Q

Mx of impetigo

A

< 5 lesions = topical abx

> 5 = oral abx (erythromycin, broad cover)

181
Q

Medication used to treat extensive ringworm

A

Griseofulvin

182
Q

Treatment for threadworms

A

Single doze mebendazole for whole household

183
Q

List potential birthmarks and what they may signify

A

Pigemented naevi = rarely malignant, appear from 2 yo

Cafe-au-lait spots = neurofibromatosis

Strawberry naevus = resolve spontaneously, only treat if affecting vision

Naevus flammeus = stork marks/salmon patch, resolve spontaneously

Mongolion spots = fade during first years of life

Port-wine stain = localised to trigeminal area, potential Sturge-Weber syndrome

184
Q

What is associated with Sturge-Weber syndrome?

A

Port-wine stain on trigeminal area of face
Underlying meningeal haemangioma
Intracranial calcification associated with fits

185
Q

Types of child abuse

A 
Physical neglect
Emotional abuse
Non-accidental injury 
Sexual abuse 
Non-organic failure to thrive
186
Q

Characteristics of non-accidental injury

A

Injuries in very young children
Explanations which do not match the appearance of the injury and sound unconvincing
Multiple types and age of injury
Injuries which are ‘classic’ in site or character
Delay in presentation
Things the child communicates during the evaluation

187
Q

Fractures associated with NAIs

A

Spiral fractures
Metaphyseal chips
Periosteal bleeds
Callus around ribs

188
Q

Clinical features of physical abuse

A 
Physical neglect
Failure to thrive
Bruises
Fractures
Burns and scalds
Bites
Ligature marks
189
Q

Ix in suspected child abuse

A

Photographs
- useful for further consultation and evidence in court

FBC, PTT, APTT
- rule out thrombocytopaenia or other haem disorders causing excessive bruising

Skeletal survey (X-rays)
- characteristic fractures and healing at various stages suggestive of NAIs

Head CT scan
- important in infants presenting with abuse, detect subdural haemorrhage which could be missed

Pregnancy test, STI screen
- in children suspected of sexual abuse, STI +ve strong corroborative evidence + needs treatment

190
Q

General mx for suspected child abuse

A

Medical care for injury
Involve social services
Admit child to place of safety if ongoing danger
Case conference
Child Protection Register
Removal from home if child remains at risk

191
Q

Triad of shaken baby syndrome

A

Retinal haemorrhages
Subdural haematoma
Encephalopathy

192
Q

Features of focal seizure of the following:

a) Temporal
b) Occipital
c) Frontal
d) Parietal

A

Temporal

  • aura including strange tastes or smells before the seizure
  • automatisms (lip smacking, plucking at clothes, aimless walking)
  • consciousness may be impaired and a feeling of deja vu has been described

Occipital
- hallucinations or visual deficits

Frontal
- may cause proximally moving clonic movements (Jacksonian march) or tonic seizures of one or both upper limbs

Parietal
- contralateral altered sensation or distorted body image

193
Q

Asthma guidelines for 5-16 year olds

A 
SABA alone
SABA + low dose ICS
SABA + low dose ICS + LTRA
SABA + low dose ICS + LABA
MART with low dose ICS
MART with moderate dose ICS OR SABA + moderate dose ICS + LABA
194
Q

What ix would you do in infants younger than 3 months with fever?

A

Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
Chest radiograph only if respiratory signs are present
Stool culture, if diarrhoea is present

195
Q

What criteria is used to assess the probability of septic arthritis in children?

A 
Kocher's criteria (1 point each):
Non-weight bearing
Fever > 38.5ºC
WCC > 12 * 109/L
ESR > 40mm/hr

0 points = very low risk
1 point = 3% probability of septic arthritis
2 points = 40% probability of septic arthritis
3 points = 93% probability of septic arthritis
4 points = 99% probability of septic arthritis

196
Q

What is the most common cause of secondary skin infection to chicken pox lesions?

A

Invasive group A streptococcal (Strep pyogenes)

- results in soft tissue infections may occur resulting in necrotizing fasciitis

197
Q

First signs of puberty

A

Boys
- testicular enlargement

Girls
- breast budding

198
Q

What are the key ages for the following in puberty?

a) Normal puberty start to completion
b) Precocious puberty
d) Delayed puberty
d) Delayed menarche

A

a) B: 11-16yo; G: 10-14yo
b) B: < 9.5yo; G: < 8.5 yo
c) B: > 14yo; G > 13 yo
d) G: > 16yo

199
Q

What pain is seen in Osgood-Schlatter disease?

A

Unilateral (but may be bilateral in up to 30% of people).

Gradual in onset and initially mild and intermittent, but may progress to become severe and continuous.

Relieved by rest and made worse by kneeling and activity, such as running or jumping.

200
Q

What’s raised in biliary atresia?

A

Conjugated bilirubin

201
Q

Amber signs in the traffic light system

A 
Nasal flaring
Lung crackles on auscultation
Not responding normally to social cues
Reduced nappy wetting
Dry mucous membranes
Pallor reported by parent or carer
202
Q

Red signs in the traffic light system

A 
Moderate or severe chest wall recession
Does not wake if roused
Reduced skin turgor
Mottled or blue appearance
Grunting
203
Q

Gross motor limit ages

A

4 months - head control
9 months - sits unsupported
12 months - stands with support
18 months - walks independently

204
Q

Vision and fine motor limit ages

A

3 months - fixes on objects and follows them visually
6 months - reaches for objects
9 months - transfers objects between hands
12 months - has developed a pincer grip

205
Q

Hearing, speech, and language limit ages

A 
7 months - polysyllabic babble
10 months - consonant babble
18 months - can say 6 words with meaning
2 years - joins words together
2.5 years - 3-word sentences
206
Q

Social behaviour limit ages

A 
8 weeks - smiles
10 months - fears strangers
18 months - can feed self with a spoon
2-2.5 years - symbolic play (e.g. pretending a wooden block is a car/ phone)
3-3.5 years - Interactive play
207
Q

What sign is seen on USS for duodenal atresia?

A

‘Double bubble’ sign

  • refers to the pockets of air in the proximal duodenum and stomach separated by the pyloric sphincter
  • distal to the point of atresia, there will be no air visible in the duodenum
208
Q

Tx in suspected meningitis

A

Antibiotics
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)

No steroids in < 3 months

Fluids

Cerebral monitoring

Public health notification + abx prophylaxis for close contacts

209
Q

When should you trial PPI in infants with GORD?

A

Trial in infants with GORD who do not respond to alginates/thickened feeds and who have:

  1. feeding difficulties
  2. distressed behaviour or
  3. faltering growth
210
Q

Signs of severe illness in a child

A 
Rashes (petechial, purpuric) 
Deep coma, can't arouse them
Dehydrated 
Respiratory distress
Stridor
Signs of injury
Large surface area of burns
211
Q

Mx of respiratory failure

A

Regular ABGs
Oxygen sat monitor and if desaturating give oxygen
If PaCO2 increasing, mechanical ventilation required on ITU
Find underlying cause: CXR
Treat underlying cause: abx, steroids, bronchodilators, remove foreign body

212
Q

Causes of upper airway obstruction

A

Intrinsic: epiglottis, croup
Extrinsic: foreign body

213
Q

What is ‘shock’?

A

Term used to describe a state where the cardiac output is insufficient to perfuse the tissues adequately

214
Q

Mx of shock

A

IV cefotaxime if meningitis suspected
Rapid IV fluid bolus 20ml/kg irrespective of cause
Blood to replace haemorrhagic loss
Monitor fluid replacement by central venous pressure line
Inotropes if cardiac performance impaired
Treat underlying cause
Monitor in ITU
Treat complications: coma, renal failure

215
Q

Clinical features of shock

A 
Restlessness
Tachycardia
Thready pulse 
Tachypnoea 
Mottled pale cold skin 
Clammy extremities 
Hypotension (late finding) 
Oliguria 
Metabolic acidosis
216
Q

Hexosaminidase A deficiency

A

Tay-Sachs disease

  • NO hepatomegaly
  • cherry-red spot on macula
  • neurodegeneration
217
Q

Alpha-galactosidase A deficiency

A

Fabry’s disease

218
Q

Alpha-L-iduronidase deficiency

A

Hurler syndrome

219
Q

Sphingomyelinase deficiency

A

Niemann-Pick’s disease

  • hepatomegaly
  • cherry-red spot on macula
  • neurodegeneration
220
Q

Glucocerebrosidase deficiency

A

Gaucher’s disease

221
Q

AVPU score

A

A: alert
V: responds to voice
P: responds to pain
U: unresponsive

222
Q

Emergency tx of convulsing child

A

Check airway
Lay child on floor in recovery position
Do not insert objects into child’s mouth
Child needs medication to abort seizure if lasts longer than 5 minutes

223
Q

Indications to perform a CT head (name six)

A

GCS < 15 at 2 hours after head injury
Suspicion of NAI
Post-traumatic seizure in absence of epilepsy
Suspected open/depressed skull fracture/tense fontanelle in bebe
Signs of basal skull fracture
< 1 years old with bruise/swelling/laceration on heard > 5cm
Focal neurological deficit
GCS < 14 or < 15 if < 1 yo on arrival to A&E
LOC lasting > 5 mins
Abnormal drowsiness
3+ discrete episodes of vomiting
Dangerous mechanism of injury (RTA)
Amnesia lasting > 5 minutes

224
Q

Risk factors for SIDS

A 
Birth weight < 2.5kg 
Socioeconomic deprivation 
Premature birth < 37 weeks
Parental smoking, esp if mother during pregnancy
Co-sleeping
High environmental temperature
Sleeping in prone position 
Bottle feeding
Non-use of pacifier
225
Q

Muco-active agents for CF

A

Lumacaftor (Potentiator)
Ivacaftor (Corrects)
*new agents

226
Q

Evidence of serious chronic lower respiratory tract disease in children

A 
Productive cough which improves with abx but quickly recurs
Restriction of activity
Failure to grow or gain weight 
Nail clubbing 
Persistent tachypnoea
227
Q

What sounds are heard with partial obstruction of the upper and lower airways?

A 
Upper = inspiratory stridor
Lower = expiratory wheeze
228
Q

What age do you see the following resp conditions?

a) Croup
b) Epiglottis
c) Foreign body
d) Laryngomalacia
e) Subglottic stenosis

A

a) 6-24 months
b) 2-7 years
c) 9-18 months
d) newborn
e) 0-6 months

229
Q

Main causes of pneumonia in children

A

Bacteria

  • Strep pneumoniae
  • Mycoplasma pneumoniae
  • Haem influenzae
  • Group B strep in newborn

Viral

  • RSV
  • Influenza/parainfluenza
  • Adenovirus
230
Q

Which conditions require no exclusion from school?

A 
Conjunctivitis
Fifth disease (slapped cheek)
Roseola
Infectious mononucleosis
Head lice
Threadworms
Hand, foot and mouth
231
Q

What are the school exclusion rules for the following conditions?

a) Scarlet fever
b) Measles
c) Rubella
d) Chickenpox
e) Mumps
f) Whooping cough
g) Influenza
h) Scabies
i) D&V

A

a) 24 hours after commencing abx
b) 4 days from onset of rash
c) 5 days from onset of rash
d) Lesions all crusted over (usually about 5 days from onset of rash)
e) 5 days from onset of swollen glands
f) 2 days after commencing abx (or 20+1 days from onset of sx if no abx)
g) until recovered
h) until treated
i) sx settled for 48 hours

232
Q

Worrying features in a vomiting child

A 
Bile-stained vomitus
Blood in vomitus
Drowsiness
Refusal to feed
Malnutrition
Dehydration
Abdominal tenderness or distension 
Abdominal mass 
Encephalopathy
Rectal bleeding
233
Q

Features of concern in a child with headache

A 
Acute onset of severe pain
Fever
Headache intensified by lying down or waking during night 
Associated nightmare
Diminished school performance or regression of developmental skills
Consistently unilateral pain
Cranial bruit
Hypertension
Papilloedema
Fall-off in growth
234
Q

Raised intracranial pressure headache features

A 
Worse on lying down
Headaches worse in mornings
Wake up at night from pain
Vomiting without nausea
High BP, irregular breathing, papilloedema, enlarging head circumference
235
Q

Notable EEG features for the following types of childhood epilepsy:

a) West Syndrome
b) Absence
c) Myoclonic
d) Centro-Temporal spike/rolandic

A

a) hypsarrhythmia
b) 3-3.5 per second spike and wave during seizure
c) polyspikes
d) spikes in ‘rolandic’ or centro-temporal spike

236
Q

O/E hydrocephalus

A 
Accelerated head growth 
Open, bulging fontanelle
Separated sutures
'Setting sun' eyes
'Cracked pot' sound on skull percussion 
Transillumination of the skull
Spasticity, clonus, brisk tendon reflexes
237
Q

When may you be concerned about a child’s growth?

A

After 2 years of age

  • crossing of two centiles
  • very short/very tall
  • discrepancy between height and weight/parental heights
  • parental/professional concern
238
Q

Signs of congenital hypothyroidism

A 
Coarse facies
Hypotonia 
Bradycardia, hypotension
Macroglossia 
Umbilical hernia
Constipation
Prolonged jaundice
Hoarse cry
Poor growth
Developmental delay
239
Q

Scenarios where health professionals must be trained in neonatal resuscitation

A 
Preterm birth
Fetal distress
Thick meconium staining of amniotic fluid 
Emergency C section
Vacuum or forceps delivery 
Major fetal abnormality
Multiple birth
240
Q

Apgar Score

A

Heart rate
- 0: absent; 1: < 100/min; 2: > 100/min

Resp rate
- 0: absent; 1: weak cry; 2: strong cry

Muscle tone
- 0: limp; 1: some flexion; 3: good flexion

Reflex irritability (suction pharynx)
- 0: no response; 1: some motion; 2: cry

Colour
- 0: pale/white; 1: blue/cold periphery; 2: pink/perfused all over

241
Q

Neonatal BLS

A

Assess
Five inflation breaths
Assess
3:1 cardiac compressions with ventilation ratio
Still no response consider venous access and administration of adrenaline as you await NICU transfer

242
Q

Reflexes assessed at neonate exam

A

Moro
Grasp
Suck
Rooting

243
Q

Risks of premature babye

A 
Hypothermia
Hypoglycaemia
Jaundice
Infection
Respiratory distress syndrome
NEC
Retinopathy of prematurity 
Intracranial haemorrhage
Feeding difficulties
244
Q

Prenatal infectiosn

A 
TORCH
Toxoplasmosis
Other (syphilis)
Rubella
CMV
Herpes
245
Q

Unconjugated hyperbilirubinaemia causes of neonatal jaundice

A 
Rhesus and ABO incompatibility 
G6PD deficiency
Bacterial infection
Excessive bruising
Internal haemorrhage
Prematurity 
Hypothyroidism
Breast-milk jaundice 
Phsyiological
246
Q

Conjugated hyperbilirubinaemia causes of neonatal jaundice

A

Neonatal hepatitis
Cystic fibrosis
Biliary atresia

247
Q

Neonate has bile-stained vomit and ‘double bubble’ seen on AXR

A

Duodenal atresia

248
Q

Anatomical abnormality causes of bowel obstruction in neonate

A

Oesophageal atresia
Duodenal atresia
Jejunal atresia
Anal atresia/imperforate anus

249
Q

Functional abnormality cases of bowel obstruction in neonate

A

Hirschsprung’s disease
Meconium ileus
Volvulus secondary to malrotation

250
Q

CXR shows air bronchogram and ground glass appearance of lung fields of a neonate

A

Respiratory distress syndrome

Year 5 Specialities (3 decks)

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