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Phase 3A > Paeds > Flashcards

Paeds Flashcards

1
Q

Presentation of Threadworm

A
  • Anal and vulval itching
  • White threads in faeces
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2
Q

First line treatment of Threadworm?

A

Single dose of mebendazole with hygiene measures

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3
Q

Presentation of eczema

A
  • Itchy, erythematous rash
  • Face and trunk in infants
  • Extensor surfaces in young children
  • Flexor surfaces in older children
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4
Q

Management of eczema

A
  • Simple emollients
  • Topical steroids
  • Wet wrapping
  • Oral ciclosporin
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5
Q

Symptoms of hand, foot and mouth disease?

A
  • Fever
  • Anorexia
  • Cough
  • Abdominal pain
  • Sore throat
  • Mouth ulcers followed by a rash which affects hands, feet, face, buttocks, legs and genitals
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6
Q

What are the 5 categories of APGAR?

A

Appearance
Pulse
Grimace
Activity - flexed arms and legs
Respiration

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7
Q

APGAR scoring

A

0-3 - low
4-6 moderate
7-10 - normal

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8
Q

What is the most common cause of respiratory distress in newborn period?

A

Transient Tachypnoea of the Newborn caused by delayed resorption of fluid in the lungs - often after C-section

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9
Q

What are the X-ray findings of TTN?

A
  • Hyperinflation of the lungs
  • Fluid in the horizontal tissue
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10
Q

What do bowel sounds in the respiratory exam of a neonate point towards?

A

Diaphragmatic hernia

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11
Q

When might newborns have surfactant production problems?

A

< 31 weeks

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12
Q

What is mesenteric adenitis?

A

Inflamed lymph nodes within the mesentery

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13
Q

How does mesenteric adenitis present?

A

Similar to appendicitis - often following a viral infection but will have no abdominal tenderness or guarding

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14
Q

Hirschprungs?

A
  • Absence of ganglion cells from mucousa
  • Full-thickness rectal biopsy to confirm
  • Delayed meconium and abdominal distension
  • Rectal washouts initially followed by surgery
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15
Q

What is ITP?

A

An immune mediated reduction in the platelet count - a type II hypersensitivity reaction

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16
Q

How does ITP present?

A
  • Bruising
  • Petechial/Purpuric rash
  • Rarely bleeding
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17
Q

Investigations for ITP?

A
  • FBC
  • Blood film
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18
Q

Management of ITP

A
  • Usually nothing
  • Sometimes oral/IV corticosteroids or IV Immunoglobulins
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19
Q

Presentation of Foetal alcohol syndrome

A
  • Microcephaly (small head)
  • Short palpebral fissures (small eye opening)
  • Absent philtrum
  • Cardiac abnormalities
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20
Q

What happens with cigarette smoking in pregnancy?

A
  • Miscarriage
  • Stillbirth
  • Pre-term labour
  • Intrauterine growth retardation
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21
Q

Risks of rubella in pregnancy?

A
  • Most at risk in first 16 weeks
  • Cataracts, deafness, cardiac abnormalities
  • Jaundice, hepatosplenomegaly
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22
Q

Risks of maternal syphillis?

A
  • Rhinitis
  • Saddle shaped nose
  • Deafness
  • Hepatosplenomegaly
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23
Q

Most common cause of diarrhoea

A
  • Rotavirus usually with fever and vomiting for first 2 days
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24
Q

Presentation of toddlers diarrhoea?

A
  • Diarrhoea with undigested food/foul smelling
  • No change on growth centiles (contract to coeliac)
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25
Q

When does Cow’s milk protein intolerance present?

A

Formula fed children in the first 3 months of life

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26
Q

Symptoms of CMPA?

A
  • Regurgitation and vomiting
  • Diarrhoea
  • Urticaria, atopic eczema
  • ‘colic’ symptoms
  • Wheeze, chronic cough
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27
Q

Pyloric Stenosis

A
  • Projectile, non-bile stained vomit at 4-6 weeks
  • Test feed/USS to confirm
  • Ramstedt pyloromyotomy
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28
Q

Intussusception

A
  • Telescoping bowel
  • Proximal to/at the ileocaecal valve
  • 6-9 months of age
  • Colicky pain, diarrhoea, sausage-shaped mass, red jelly stool
  • Infant will be drawing their knees up
  • US to confirm
  • Treated with reduction with air insufflation
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29
Q

Intestinal malrotation

A
  • Intestines do not twist correctly
  • Features in exon-halos, diaphragmatic hernia, intrinsic duodenal atresia
  • If bile stained vomit, volvulus has occured
  • Upper GI contract study and USS to confirm
  • Laparotomy/Ladd’s procedure (if volvulus formed)
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30
Q

Meconium ileus

A
  • Delayed meconium and abdominal distension
  • Occurs with CF
  • PR contract studies may dislodge meconium plug and be helpful
  • Surgery needed to remove plugs
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31
Q

Biliary atresia

A
  • Jaundice > 14 days
  • Increased conjugated bilirubin
  • Urgent Kasai procedure
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32
Q

Necrotising Entercolitis

A
  • Prematurity
  • Abdominal distension and bloody stools
  • X-ray may show free air
  • Increased risk when empirical Abx given beyond 5 days
  • Total gut rest and TPN to treat with potential laparotomy if perforations
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33
Q

How do you reduce chances of severe brain damage in neonates with hypoxic injury?

A

Therapeutic cooling at 33-35 degrees

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34
Q

What is Atlanto-axial instability?

A

A complication of Downs which increases the risk of sudden neck dislocation

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35
Q

Features of Downs

A
  • Low-set ears
  • Flat occiput
  • Single palmar crease
  • Hypotonia
  • Heart defects
  • Duodenal atresia
  • Hirschprungs
  • Infertility
  • Hypothyroidism
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36
Q

Cardiac complications of Downs

A
  • Endocardial cushion defect
  • VSD
  • Tetralogy of Fallot
  • Isolated PDA
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37
Q

Roseola infantum

A
  • Herpes 6 virus
  • Common in 6 months - 2 years
  • Fever followed later by maculopapular rash around the trunk
  • Febrile seizures common
  • No treatment necessary
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38
Q

What is whooping cough

A
  • Infectious disease caused by Bordetella pertussis
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39
Q

Immunisation of Whooping cough

A
  • Pregnant women weeks 16-32
  • Infants at 2,3,4 months and 3-5 years
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40
Q

Presentation of whooping cough

A
  • Coryza for 2-3 days
  • Coughing spouts worse at night/after feeding
  • Inspiratory whoop
  • Persistent coughing
  • Symptoms last 10-14 weeks
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41
Q

Management of whooping cough

A
  • Inform PHE
  • Oral macrolide such as azithromycin if onset is within last 21 days
  • Prophylaxis for household contacts
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42
Q

What is transient synovitis?

A

Hip pain following recent viral infection in 3-8 year olds?

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43
Q

What is the most common cause of hip pain in children?

A

Transient synovitis

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44
Q

Presentation of measles?

A
  • Prodromal phase with irritability, fever and conjunctivitis
  • Koplik spots which are white spots on buccal mucousa
  • Maculopapular rash which spreads from ears to whole body
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45
Q

What is the most common deadly complication of measles?

A

Pneumonia

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46
Q

What is the most common complication of measles?

A

Otitis media

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47
Q

What is Perthes disease?

A

A degenerative condition affecting the hip joints of boys between 4-8 presenting with hip pain, limping and reduced ROM

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48
Q

Management of Perthes

A
  • Conservative management
  • Surgical management rarely needed for severe deformity/over 6 years old
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49
Q

Management of nocturnal enuresis (bed-wetting)

A

1st - Reward system
2nd - Enuresis alarm
3rd - Desmopressin

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50
Q

What is the ratio of compression for PBLS?

A

lay responders: 30:2
rescuers: 15 compressions: 2 breaths

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51
Q

What is the classic presentation of Scarlet fever?

A
  • Sore throat
  • Fever
  • Headache
  • Bright red strawberry tongue
  • Coarse, red rash which starts in axillae and groins then spreads to trunk (sandpaper feel)
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52
Q

What organism accounts for majority of croup?

A

Parainfluenza

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53
Q

What condition does RSV cause?

A

Bronchiolitis

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54
Q

What is Meckel’s diverticulum?

A

A congenital diverticulum of the small intestine which contains ectopic gastric/ileal/pancreatic mucousa

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55
Q

Presentation of Meckels Diverticulum?

A
  • Abdominal pain
  • Rectal bleeding
  • Intestinal obstruction
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56
Q

What investigations should be used for MD?

A
  • If child is stable with not severe bleeding, a ‘Meckle’s scan’ with technetium should be used
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57
Q

What is a venous hum?

A

A continuous blowing noise heard just below the clavicles - due to turbulent blood flow in veins

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58
Q

What is Still’s murmur?

A

A low-pitched sound heart at the lower left sternal edge

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59
Q

How much school should children with whooping cough miss after starting Abx?

A

48 HOURS

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60
Q

Signs of cerebral palsy?

A
  • Slow to reach milestones
  • Feeding difficulties
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61
Q

Signs of dyskinetic CP?

A
  • Athetoid movements - slow movements of hands and feet and holding onto objects
  • Oro-motor problems - drooling
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62
Q

What is a feature of a benign ejection systolic murmur?

A

Varies with posture

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63
Q

What do all breech babies born at or after 36 weeks need?

A

USS for DDH screening at 6 weeks

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64
Q

When is precocious puberty in males defined?

A

Before 9 years of age

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65
Q

What abdominal sign occurs with congenital diaphragmatic hernia?

A

Scaphoid abdomen (inward concavity to the abdominal wall)

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66
Q

What is the most common cause of inherited neurodevelopment delay?

A

Fragile X syndrome

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67
Q

What are the features of Fragile X syndrome in males?

A
  • Mutation on X chromosome
  • X-linked dominant
  • Learning difficulties
  • Large, low set eats with long thin face
  • Hypotonia
  • Autism
  • Mitral valve prolapse
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68
Q

What condition is associated with congenital diaphragmatic hernia?

A

Pulmonary hyperplasia

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69
Q

What is mitochondrial disease inheritance?

A
  • Only via the maternal line as the sperm contributes no cytoplasm to the zygote
  • None of the children of affected male will inherit
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70
Q

How do you differentiate between epilepsy and reflex anoxia seizures?

A

Reflex anoxic seizures have a rapid recovery unlike epileptic

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71
Q

Key features of Osgood-Schlatter disease?

A
  • Seen in sporty teenagers
  • Pain, tenderness and swelling over the tibial tubercle
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72
Q

Key features of Chondromalacia patellae?

A
  • Softening of the cartilage of the patella
  • Common in teenage girls
  • Knee pain on stairs and from prolonged sitting
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73
Q

Key features of Osteochondritis dissecans?

A
  • Pain after excercise
  • Intermittent swelling and locking
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74
Q

Key features of Patellar subluxation?

A
  • Medial knee pain
  • Knee may give way
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75
Q

Key features of Patellar tendonitis?

A
  • More common in athletic teenage boys
  • Chronic knee pain that worsens after running
  • Tenderness below patella
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76
Q

Most common cause of benign, noisy breathing in infants?

A

Laryngomalacia

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77
Q

Which organism causes pertussis?

A

Bordella pertussis

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78
Q

What is the autism triad?

A
  • Communication impairment
  • Impairment of social relationships
  • Ritualistic behaviour
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79
Q

What cardiac defect is associated with Turners?

A

Bicuspid aortic valve - ejection systolic murmur

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80
Q

What is Turner’s syndrome?

A

One X chromosome 45, XO

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81
Q

What is the urgent management for babies with jaundice within first 24 hours of life?

A

Measure SBR within 2 hours

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82
Q

First line investigation for DDH in infant > 4.5 months

A

X-ray

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83
Q

Management of DDH in children younger than 4-5 months

A

Pavlov harness

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84
Q

Management of child < 3 months with temp > 38

A

Admit to hospital

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85
Q

Management of PDA to promote duct closure?

A

Indomethacin/Ibuprofen

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86
Q

What murmur is heard with PDA?

A

‘machinery like’ murmur

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87
Q

What should be given for croup regardless of severity?

A

0.15/kg single dose of oral dexamethasone

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88
Q

Triad of shaken baby syndrome?

A
  • Retinal haemorrhages
  • Subdural haematoma
  • Encephalopathy
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89
Q

What usually precedes ITP?

A

A viral illness

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90
Q

How are newborns screened for hearing problems?

A

Automated otoacoustic emissions

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91
Q

What are exomphalos and diaphragmatic hernia associated with?

A

Malrotation

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92
Q

What is Osgood-Schlatter?

A

Pain, tenderness and swelling over the tibial tubercle seen in sporty teens

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93
Q

What is Ebstein’s anomaly?

A

A heart defect with a low insertion of tricuspid valve resulting in large atrium and small ventricle

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94
Q

What is the most common cardiac problem associated with Duchennes?

A

Dilated cardiomyopathy

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95
Q

When are APGAR assessed?

A

1 and 5 minutes

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96
Q

What is exomphalos?

A

When the abdominal contents protrude through the anterior wall but are covered in an amniotic sac

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97
Q

How is exomophalos managed?

A

C-section to reduce risk of sac rupture

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98
Q

Abx of choice for infants < 3 months old for meningitis?

A

IV Amoxicillin
IV Cefotaxime

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99
Q

What vaccines do young people get between 13 and 18

A

Tetanus/Diptheria/Polio and Men ACWY

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100
Q

What is meningococcal septicaemia a CI to?

A

LP

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101
Q

What causes acute epiglottis?

A

H Influenzae B

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102
Q

Investigation of choice for vesicoureteric reflux?

A

Micturating cystourethrogram

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103
Q

Most common bacterial organism for bacterial pneumonia in children?

A

Strep pneumonia

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104
Q

What is used to maintain a DA for duct dependent congenital heart disease?

A

Prostaglandin E1

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105
Q

How can the airway be protected with acute epiglottis?

A

Endotracheal intubation

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106
Q

What condition is associated with intramural gas on abdominal x-ray?

A

Necrotising enterocolitis

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107
Q

Gold standard diagnosis for Hirschsprung disease?

A

Rectal biopsy

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108
Q

Which MAb is used to prevent RSV in some children?

A

Palivizumab

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109
Q

What organism commonly causes hand, foot mouth?

A

Coxsackie virus

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110
Q

What electrolyte imbalance is seen with pyloric stenosis?

A

Hypochloremic hypokalaemic metabolic alkalosis

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111
Q

What is a cardiac complication of Kawasaki?

A

Coronary artery aneurysms

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112
Q

Treatment for spasticity in cerebral palsy?

A

Baclofen, Oral diazepam

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113
Q

Which GI problem shows dilated loops of bowel with abdominal distension?

A

Hirschprung

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114
Q

What is the US finding for pyloric stenosis?

A

Thickened, elongated pylorus

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115
Q

Which type of epilepsy has partial seizures at night?

A

Benign rolandic epilepsy

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116
Q

Which condition has large volumes, bounding collapsing pulse?

A

PDA

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117
Q

Which condition has large volumes, bounding collapsing pulse?

A

PDA

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118
Q

How should children under 5 be managed with nocturnal enuresis?

A

Reassurance and advice

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119
Q

When is the peak incidence of bronchiolitis?

A

3-6 months of age

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120
Q

What should be done with children with hip/limp pain and fever?

A

Urgent same-day assessment

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121
Q

What should be suspected in a child with fever > 5 days?

A

Kawasaki disease

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122
Q

What is a poor prognostic factor for ALL?

A

Male sex

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123
Q

What does LP with bacterial meningitis show?

A

Raised WBC with predominant neutrophils and a low glucose ratio

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124
Q

Management of babies with absent/weak femoral pulses at 6-8 weeks?

A

Discussion with paeds immediately

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125
Q

Presentation of measles?

A
  • Initial prodrome of cough, coryza and white spots on buccal mucousa
  • Rash which starts behind ears and spreads across body
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126
Q

Most common complication of otitis media?

A

Measles

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127
Q

What should be done to reduce the chance of severe brain damage in neonates with hypoxic injury?

A

Therapeutic cooling at 33-35 degrees

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128
Q

What is neonatal hypotonia associated with?

A

Prader-Willi syndrome

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129
Q

What is breech presentation a risk factor for?

A

DDH

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130
Q

What condition is associated with cleft palate and posterior displacement of the tongue?

A

Pierre-Robin syndrome

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131
Q

What is gastroschisis?

A

A congenital defect in the anterior abdominal wall lateral to the umbilical cord

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132
Q

Risk factors associated with gastroschisis

A

Socioeconomic deprivation
- Maternal age < 20
- Maternal alcohol/tobacco use

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133
Q

Treatment for scarlet fever?

A

Oral Pen V for 10 days and return to school after 24 hours

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134
Q

Management of pyloric stenosis

A

Ramstedt pyloromyotomy

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135
Q

Development at 6 months?

A
  • Palmar grasp
  • Pass objects from one hand to another
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136
Q

Management of transient synovitis

A

Requires rest and analgesia

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137
Q

Management of phimosis in children < 2?

A

It is normal and will most likely resolve over time

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138
Q

Management of bruising in a non-mobile infant?

A

Same day paediatric assessment

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139
Q

What is the classic presentation of Edwards syndrome?

A

Micrognathia, rocker bottom feet and overlapping of fingers

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140
Q

What is a classic presentation of erythema infectiousum? (6th disease/Slapped Cheek)

A

Coryza and fever followed by red rash on cheeks caused by parvovirus b19

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141
Q

What occurs if a foetus is homozygous for alpha-thalassaemia?

A

Hydrops fettles

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142
Q

What is the rotavirus vaccine and when is it given?

A

A live attenuated vaccine given at 2 and 3 months

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143
Q

When is MMR vaccine given?

A

12 months and 3-4 years

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144
Q

Management of Kawasaki disease?

A

High dose aspirin

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145
Q

Signs of neonatal hypoglycaemia?

A

Irritability and jitteriness
Drowsiness and poor feeding

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146
Q

Key risk factor for neonatal hypoglycaemia

A

Prematurity

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147
Q

Management of unilateral undescended testicle?

A

Review at 3 months

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148
Q

What is neonatal death?

A

Death between 0-28 days of life

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149
Q

What should you not use in children < 3 months with suspected/confirmed BM?

A

Corticosteroids

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150
Q

What is innocent murmurs?

A

Soft, systolic, short, symptomless and sitting/standing (vary with position)

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151
Q

What is abnormal before 12 months?

A

Hand preference

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152
Q

How does congenital CMV manifest?

A

Hearing loss (sensoineural)
Low birth weight
Petechial rash
Seizures
Microcephaly
Visual impairment
Learning disability
Cerebral Palsy

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153
Q

When can a child with scarlet fever return to school?

A

24 hours after commencing Abx

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154
Q

What murmur would you see with VSD?

A

Pansystolic in lower left sternal edge

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155
Q

What murmur would you see with aortic coarctation?

A

Crescendo-descrecendo murmur in upper left sternal border

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156
Q

What murmur would you see with pulmonary stenosis?

A

Ejection systolic murmur in upper left sternal border

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157
Q

What is newborn compression:ventilation ratio?

A

3:1

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158
Q

What are the characteristic symptoms of JIA

A

Joint pain with salmon-pink rash

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159
Q

What is a poor prognostic indicator for congenital diaphragmatic hernia

A

Presence of liver in the thoracic cavity

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160
Q

What does a female with amenorrhoea and bilateral groin swelling suggests?

A

Undescended testes -> androgen insensitivity

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161
Q

Management of slipper upper femoral epiphysis

A

Internal fixation across the growth plate

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162
Q

When is the newborn blood spot screening test performed?

A

5th - 9th day of life

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163
Q

How long from school should a child with impetigo be excluded?

A

Until lesions have crusted over or 48 hours after starting Abx

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164
Q

What should be monitored when starting a child on methyphenidate?

A

Growth

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165
Q

What should be done with a child < 3 with acute limp?

A

Urgent assessment

166
Q

What causes hand, foot mouth disease?

A

Coxsackie A16

167
Q

What is the mode of inheritance of Prader-Willi syndrome?

A

Imprinting

168
Q

First sign of puberty in boys?

A

Increase in testicular volume

169
Q

Management of exomphalos?

A

C-section and staged repair

170
Q

What kind of diet should someone with CF follow?

A

High calorie and high fat with pancreatic enzyme supplementation for every meal

171
Q

What drug use during pregnancy can cause orofacial clefts?

A

Anti-epileptic

172
Q

When is the MenB vaccine given?

A

2,4 and 12-13 months

173
Q

What is empirical Abx treatment for meningitis if > 3 months?

A

3rd gen cephalosprin e.g. ceftriaxone

174
Q

Features of Patau syndrome

A
  • Microcephaly
  • Small eyes
  • Low set ears
  • Polydactyly
175
Q

What is the Abx of choice for a child with mycoplasma pneumoniae?

A

Erythromycin

176
Q

Which genetic condition is associated with supravalvular aortic stenosis?

A

Williams Syndrome

177
Q

What can bruising at birth lead to?

A

Elevated bilirubin levels

178
Q

What is a common complication of viral gastroenteritis?

A

Lactose intolerance

179
Q

Congenital cyanotic disease presenting within the first days of life?

A

Transposition of the great arteries

180
Q

Congenital cyanotic disease presenting at 1-2 months of age?

A

Tetralogy of Fallot

181
Q

What is the most common genetic bleeding disorder?

A

von Wilebrand disease - autosomal dominant

182
Q

What blood test would be affected in someone with vWd disease?

A

Prolonged APTT

183
Q

Features of Klinefelter’s?

A
  • Breast enlargement
  • Infertility
  • Small, firm testes
184
Q

What would be seen on blood tests of Klinefelter’s?

A
  • Reduced inhibin B
  • Elevated FSH
185
Q

What is HSP?

A

Vasculitis commonly triggered by URTI/gastroenteritis

186
Q

De-George syndrome symptoms?

A

Cardiac abnormalities
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcaemia/Hypoparathyroidism
22 - chromosome 22

187
Q

Management of collapsed child if no signs of breathing?

A

5 rescue breaths

188
Q

What is the risk of giving NSAIDs with chickenpox?

A

Necrotising Fasciitis

189
Q

What is the normal Respiratory rate for <1?

A

30-40

190
Q

What is the normal respiratory rate for 2-5 years old?

A

20 - 30

191
Q

Septic arthritis vs Transient Synovitis?

A

SA will have refusal to weight bear, loss of passive movement, leukocytosis and raised inflammatory markers

192
Q

What is Erb’s palsy?

A

Damage to the C5/C6 root of the brachial plexus, usually resolves within 3 months
Associated with instrumental delivery

193
Q

Clinical features of Erb’s palsy?

A
  • Adducted and internally rotated arm
  • Forearm pronation
  • Absent biceps reflex
  • Normal power and hand grasp
194
Q

What is Bartter syndrome?

A

A rare inherited defect of the ascending loop of Henle with hypokalaemia, alkalosis and normal/low pH.

195
Q

How does mumps present?

A
  • Fever
  • Muscle pain
  • Headache
  • Fatigue
  • Swelling of the parotid glands
196
Q

What renal condition is HSP associated with?

A

IgA Nephritis

197
Q

When is the 6 in 1 vaccine given to children?

A

8, 12 and 16 weeks of age

198
Q

What murmur is found with Tetralogy of Fallot?

A

Ejection systolic murmur at left sternal edge

199
Q

What is indomethacin used for?

A

Promote closure of the PDA

200
Q

What are prostaglandins used for in the post natal period?

A

Keep the PDA open

201
Q

What is venous hum?

A

benign murmur heard in children and sounds like a continuous blowing noise heard below the clavicles

202
Q

What is Still’s murmur?

A

Benign low pitched sound heart at the lower left sternal edge

203
Q

What is Still’s murmur?

A

Benign low pitched sound heart at the lower left sternal edge

204
Q

What is a left subclavicular thrill indicative of?

A

Patent Ductus Arteriosus

205
Q

What is patellar subluxation?

A

Medial knee pain - knee may give way

206
Q

What condition is characteristic with lymphoedema in neonates?

A

Turners syndrome

207
Q

What is an umbilical granuloma?

A

An overgrowth of tissue which occurs during the healing process of the umbilicus - most common in the first few weeks of like

208
Q

Presentation of umbilical granuloma

A
  • Small, red growth around the umbilicus
  • Leaks small amounts of clear/yellow fluid
209
Q

When should lochia cease postpartum?

A

4-6 week after

210
Q

Vasa praevia triad?

A
  • PROM
  • Painless bleeding
  • Foetal bradycardia
210
Q

Vasa praevia triad?

A
  • PROM
  • Painless bleeding
  • Foetal bradycardia
211
Q

How long should a child with impetigo be excluded?

A

Until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

212
Q

Who will inherit a mitochondrial condition?

A

All children of an affected mother as it is maternal line only

213
Q

What is station in obstetrics?

A

Level of the head in relation to the ischial spine

214
Q

What is recommended if HIV viral load is less than 50 copies/ml at 36 weeks?

A

NVD

215
Q

Management of neonatal hypoglycaemia?

A

If asymptomatic: normal feeds and monitor glucose
If symptomatic: neonatal unit and IV dextrose

216
Q

What is second line for investigating PPROM?

A

Ultrasound

217
Q

Where is the damage in the brain for dyskinetic CP?

A

The basal ganglia and the substantia nigra

218
Q

How to tell the difference between cephalohaematoma and caput succeadanum?

A

Cephalohaemtoma will not cross the suture lines

219
Q

Complications of undescended testes?

A
  • Infertility
  • Testicular torsion
  • Inguinal hernia
220
Q

Transient synovitis vs Septic Arthritis?

A

Septic will have a high fever

221
Q

What does discrepancy between the skin creases behind the right and left hips suggest?

A

DDH

222
Q

What condition with hip/knee pain is associated with obese children?

A

Slipped capital femoral epiphysis

223
Q

What ortho condition are Hyperactivity and short stature assoicated with?

A

Perthes

224
Q

What does target sign on ultrasound suggest?

A

Intussception

225
Q

What malignancies are more likely to develop in someone with Downs?

A

ALL and AML

226
Q

Patau syndrome signs

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

227
Q

Edwards syndrome signs

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

228
Q

Noonan syndrome signs?

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

229
Q

Pierre-Robin syndrome signs?

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

230
Q

Prader-Willi syndrome signs?

A

Chromosome 15 - los of function on fathers copy
Hypotonia
Hypogonadism
Obesity

231
Q

Williams syndrome signs?

A

Chromosome 7
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

232
Q

What condition has honey-coloured crusted plaques?

A

Impetigo

233
Q

What is Wardenbergs syndrome?

A
  • Congenital
  • Eyes look wider apart and different colours
234
Q

What is Treacher Collins?

A
  • Autosomal dominant
  • Under development of the cheek bones
  • Abnromal outer and middle ear with conductive loss
235
Q

What groups might have monitored hearing?

A
  • CF
  • CMV
  • Head trauma
  • Downs syndrome
236
Q

Where is the problem when there is conductive (bone > air) hearing loss?

A

Middle ear e.g glue ear, ear wax, infection - often resolves by themselves/operable

237
Q

Where is the problem when there is sensorineural hearing loss?

A

Inner ear, nerve or brain - often is permanent and will require hearing aids

238
Q

What is the hearing test done for babies in newborn screen?

A
  • Otoacuoustic emission test, followed by
  • Auditory brainstem response test
239
Q

What condition has thumb sign/steeple sign on x ray?

A

Thumb - Epiglottitis
Steeple - Croup

240
Q

Treatment for otitis media?

A

5 days of Amoxicillin

240
Q

Treatment for otitis media?

A

5 days of Amoxicillin

241
Q

What age would coeliac disease normally present in children?

A

9-24 months

242
Q

When does malrotation normally present?

A

In the first month of life

243
Q

Risk factors for meconium aspiration?

A
  • Gestation > 42 weeks
  • Pre-eclampsia
  • Maternal diabetes
244
Q

When does intusseption normally present?

A

3 months - 3 years (commonly <1)

245
Q

What is pathological jaundice and what causes it?

A

Jaundice < 24 hours
- G6PD deficiency/Spherocytosis

246
Q

What gestation can a TCB monitor for jaundice not be used?

A

<35 weeks

247
Q

Complication of untreated neonatal jaundice?

A

Kernicterus

248
Q

4 features of tetralogy of fallot?

A
  • Overriding aorta
  • Large VSD
  • Pulmonary stenosis
  • Right ventricular hypertrophy
249
Q

Risk factors for transposition of the great arteries?

A
  • Maternal rubella
  • Diabetes
  • Mum > 40
  • Maternal alcohol
  • Trisomy 13,18,21
250
Q

Triad of haemolytic uraemic syndrome?

A
  • AKI
  • Thrombocytopenia
  • Normocytic anaemia
251
Q

Maculopapular, purpuritic rash in patients on amoxicillin?

A

Infective mononucleosis

252
Q

What vaccines given at 8 weeks?

A

6 in 1
Rotavirus
Men B

253
Q

What vaccine given at 12 weeks?

A

6 in 1
Rotavirus
PCV

254
Q

What vaccines given at 16 weeks?

A

6 in 1
Men B

255
Q

What vaccines give at 1 year?

A
  • Hib/Men C
  • PCV
  • MMR
  • Men B
256
Q

What vaccines given at 3 year 4 months?

A

DTap/IPV
MMR

257
Q

Symptoms of ALL?

A
  • Fatigue
  • Bone pain
  • Anaemia
  • Recurrent infections
  • Fever
258
Q

Signs of adrenal crisis (CAH)

A

hyponatraemia, hyperkalaemia and a metabolic acidosis

259
Q

What is glandular fever caused by?

A

EBV

260
Q

What areas of the body will chemotherapy not reach in ALL?

A

Testes and CNS

261
Q

What Abx might those be given for prophylaxis in sickle cell patients?

A

Penicillin

262
Q

What condition is assoicated with ‘double bubble’ sign on imaging?

A

Duodenal atresia

263
Q

Second line for mood stabilising in bipolar?

A

Valproate

264
Q

Smelly, fluid discharge and pulling at one ear?

A

Otitis media

265
Q

Management of child with bruising, enlarged lymph nodes and systemic illness?

A

Urgent same day referral to haematology for ALL

266
Q

First line management of unconscious child after choking?

A

5 rescue breaths via mouth to mouth

267
Q

Baby getting tired quite easily and having cyanotic spells?

A

Echo - Tetralogy of Fallot

268
Q

Childhood obesity, short stature, learning difficulties, hypotonia

A

Prader-Willi

269
Q

Most common form of congenital heart disease in infants of diabetic mums?

A

Transposition of the great arteries

270
Q

CMPA vs GORD

A

CMPA will have diarrhoea whereas GORD will generally have vomiting

271
Q

Management of moderate diarrhoea with no signs of shock?

A

Oral rehydration solution - Diarolyte

272
Q

Management of duodenal atresia?

A

Duodenoduodenostomy

273
Q

Common complication of bronchiolitis?

A

Hyponatraemia

274
Q

What is jugular foramen syndrome?

A

Unilateral CN 10+11 palsy

275
Q

When will a child remain infectious until with measles?

A

4-5 days after rash resolves

276
Q

What can parvovirus in first 20 weeks of pregnancy cause?

A

Hydrops fettles

277
Q

Barking cough with stridor that does not resolve with treatment?

A

Bacterial tracheitis

278
Q

Which consequence of artificial ventilation is routinely screened for?

A

Retinopathy of prematurity

279
Q

Frequent otitis media is assoicated with which condition?

A

Turners

280
Q

Frequent otitis media is assoicated with which condition?

A

Turners

281
Q

What is Waterhouse-Friderichsen syndrome

A

Complication of meningitis associated with adrenal haemorrhage and septic shock

282
Q

Biopsy changes for minimal change disease?

A

Nothing

283
Q

What is the most common cause of proteinuria in children?

A

Orthostatic proteinuria - benign and self-limiting

284
Q

Examples of live attenuated vaccines?

A

MMR, Rotavirus, Inhaled Influenza, Varicella

285
Q

Gowers sign - patient uses hands and arms to walk up their body to stand up from supine?

A

Duchennes - X linked recessive

286
Q

Radiological findings of rickets?

A
  • Bowed femurs
  • Widened epiphiyseal plates
287
Q

acute bilirubin encephalopathy?

A

Elevated unconjugated bilirubin in the CNS

288
Q

What pulses felt in infants/ over 1?

A

Infant - brachial
Over 1 - Carotid

289
Q

ground glass pattern on x-ray in neonate?

A

Respiratory distress of the newborn

289
Q

ground glass pattern on x-ray in neonate?

A

Respiratory distress of the newborn

290
Q

What vitamins would someone with CF be deficient in?

A

ADEK - fat soluble

291
Q

Cause of inguinal hernia?

A

Failure of the processes vaginalis to obliterate - more common in boy

292
Q

HSP tetrad?

A
  • Arthralgia
  • Rash
  • Abdominal pain
  • Glomerulonephritis
293
Q

Important complication of glandular fever?

A

Splenomegaly from white cell sequestration

294
Q

Infant > 42 weeks who got stuck during prolonged labour?

A

Hepatic Ischemic Encephalopathy

295
Q

Roseola vs Chickenpox?

A

Roseola will not have an itchy rash

296
Q

Management of squint in newborns?

A

Referred if still present at 8 weeks

297
Q

Incubation period of chicken pox?

A

21 days

298
Q

Congenital CMV infection signs?

A
  • Hearing loss
  • Visual impairment
  • Learning disability
299
Q

Trans-illuminating scrotal swelling with non-palpable testis?

A

Hydrocele

300
Q

Main differential for hydrocele and how to tell?

A

Inguinal hernia -> use testicular ultrasound

301
Q

Most common cause of delayed puberty?

A

Constitutional delayed growth and puberty -> hand x-ray to look at bone age

302
Q

Signs of internuclear opthalmoplegia?

A
  • Failure to adduct on the affected side
  • Nystagmus on the contralateral side
303
Q

Risk factors for polyhydramnios?

A

Maternal diabetes mellitus
Foetal renal disorders
Foetal anaemia
Twin-to-twin transfusion syndrome
Oesophageal or duodenal atresia
Diaphragmatic hernia
Anencephaly
Chromosomal disorders

304
Q

Measles complications?

A

pneumonia, encephalitis, immunosuppression and subacute sclerosing panencephalitis

305
Q

Impetigo treatment?

A
  • Hydrogen peroxide cream
  • Fuscidic acid cream
306
Q

Management of vesicoureteral reflux?

A

Prophylactic Abx

307
Q

First line investigation for all children presenting with global developmental delay?

A

Genetic Karyotyping

308
Q

avascular necrosis of the femoral head

A

Perthes disease

309
Q

Irreversible cause of global developmental delay?

A

Foetal alcohol syndrome

310
Q

What enzyme deficiency is there in congenital adrenal hyperplasia?

A

21-hydroxylase

311
Q

Infant presenting with enlarged head circumference, bulging fontanelle, ditended veins on scalp?

A

Hydrocephalus

312
Q

Causes of Stephen-Johnson syndrome?

A
  • Allopurinol
  • Lamotrigine
  • Penicillin
  • Phenytoin
313
Q

Complications of chickenpox?

A
  • Bacterial superinfection
  • Cerebellitis
  • DIC
  • Progressive disseminated disease
314
Q

Complications of chickenpox?

A
  • Bacterial superinfection
  • Cerebellitis
  • DIC
  • Progressive disseminated disease
315
Q

Murmur heard loudest between the scapulae?

A

Aortic coarctation

316
Q

What is raised Immunoreactive trypsinogen associated with?

A

CF

317
Q

pan-systolic murmur?

A

VSD

318
Q

pan systolic loudest at apex/axilla?

A

Mitral regurg

319
Q

ejection systolic murmur radiating to carotids?

A

Aortic stenosis/Pulmonary stenosis

320
Q

pan-systolic murmur at lower left sternal edge on inspiration?

A

Tricuspid regurg

321
Q

unwell child with blisters appearing over poorly controlled eczema

A

eczema herpetiform? - derm emergency which needs urgent antivirals

322
Q

Biggest risk factor for stillbirth?

A

Intrauterine growth restriction

323
Q

Herpes virus 3?

A

Chickenpox

324
Q

Stridor vs Wheeze?

A

Stridor - high pitched, heard on inspiration associated with URTI
Wheeze - high pitched, heard on expiration associated with LRTI

325
Q

Risk factors for Bronchiolitis?

A

Smoke exposure
Premature babies
Babies with heart defects/existing lung conditions
Immunodeficiency

326
Q

What is the vaccine given for bronchiolitis and who gets it?

A

Palavizumab
- Chronic lung disease of prematurity
- Congenital heart defects
- Immunocompromised

327
Q

Conditions on the Newborn Spot Test?

A
  • Sickle cell
  • Cystic Fibrosis
  • Congenital Hypothyroidism
  • PKU
  • Maple Syrup Urine Disease
  • Homocystinuria
  • MCADD
  • GA1
  • IVA
328
Q

Signs of atypical UTI in children?

A

Poor urine flow
Abdominal mass
Raised creatinine
Sepsis
Failing to respond to Abx within 48 hours
Infection with non E coli organisms

329
Q

Most common cause of cerebral palsy?

A

Antenatal - vascular occlusion, structural maldevelopment, cortical degeneration

330
Q

Which type of cerebral palsy is associated with increased tone, all 4 limbs and seizures?

A

Spastic

331
Q

Ix of choice for CP?

A

MRI

332
Q

Indications for botox with children with CP?

A

Focal spasticity of upper/lower limbs with pain/disturbed sleep/impaired motor function

333
Q

Indications for botox with children with CP?

A

Focal spasticity of upper/lower limbs with pain/disturbed sleep/impaired motor function

334
Q

Risk of not managing squints?

A

Permanent loss of visual acuity - occipital cortex does not develop

335
Q

Why should you not build up feeds too quickly in preterm infants?

A

Risk of Nec Ent

336
Q

Pink rash which begins on face and then spreads with lymphadenopathy?

A

Rubella

337
Q

Management of recurrent UTI?

A

Request an ultrasound scan within 6 weeks and a DMSA scan 4-6 months later

338
Q

ECG changes associated with ASD?

A
  • P pulmonale
  • RBBB
  • Right axis deviation
  • QT prolongation
339
Q

What is Jones criteria and what are the components of it?

A

Used to assess rheumatic fever

J = Joints arthritis (Migratory)
♥ = Pancarditis
N = Nodules (subcutaneous)
E = Erythema marginatum
S = Sydenham chorea

340
Q

Asthma management steps?

A

Step 1: SABA PRN - Salbutamol
Step 2: ICS Preventer therapy - Beclomethasone
Step 3: <5 - add LTRA
>5 - add LTRA/LABA
Step 4: Stop LABA if no response: increase ICS dose
Step 5: Referral - consider increased ICS dose

341
Q

Management of acute asthma exacerbation?

A
  • O2 if sats low
  • Nebulised Salbutamol/Iptratropium
  • Steroids
  • IV Salbutamol
  • IV Mag Sulphate
  • IV Aminophylline
  • ITU
342
Q

What kind of shunt in VSD?

A

Left - Right

343
Q

What is glue ear?

A
  • Otitis media with effusion
  • Narrowed/Block Eustachian tube
  • Conservative management with potential Grommets
344
Q

What is Esotropia?

A

inward position squint -> affected eye deviated towards the nose

345
Q

What is Exotropia?

A

outward position squint -> affected eye deviated towards the ear

346
Q

Hyertropia vs Hypotropia?

A

Hyper - upward moving affected eye
Hypo - downward moving affected eye

347
Q

Most common childhood arrhythmia?

A
  • SVT
  • HF symptoms in neonates/infants
  • Narrow complex tachycardia on ECG
  • Carotid sinus massage/IV adenosine
  • Cardioversion if above fails
348
Q

What is Hypospadias and Tx?

A
  • Urethral meatus is abnormally displaced on the underside
  • Surgery after 3-4 months of age
  • Never retract foreskin!
349
Q

Management of constipation?

A
  • Laxatives such as Movicol
  • Disimpaction regiment may be needed with high dose at start then half dose for maintenance
350
Q

Crohns signs?

A

N- no blood or mucus
E - entire GI tract
S - skip lesions on endoscopy
T - Terminal ileum and transmural inflammation
S - Smoking is risk factor

351
Q

UC signs?

A

C - continuous inflammation
L - limited to colon and rectum
O - only superficial mucosa affected
S - smoking is protective
E - excrete blood and mucus
U - use aminosalicylates
P - primary sclerosing cholangitis

352
Q

What is Marasumus?

A
  • Undernutrition
  • Wasted appearance and low weight/height
  • Withdrawn and apathetic child
  • Tx with correction of electrolytes and micronutrients
353
Q

What is Kawshiokor?

A
  • Severe protein malnutrition
  • Distended abdomen, flaky paint skin rash
  • Tx with correction of electrolytes and micronutrients
354
Q

What are choledochal cysts?

A
  • Cystic dilatations of extrahepatic biliary stsem
  • Cholestasis - treated with removal of cyst
355
Q

Treatment of Steve-Johnson?

A
  • Steroids/Immunoglobulins
  • Supportive care
356
Q

How to tell candida from nappy rash?

A
  • Rash extending into the skin folds
  • Large red macules which is moist
357
Q

What is Scalded skin syndrome?

A
  • S aureus rash with tenderness, erythema and fever
  • Tx with Flucloxacillin/Analgesia
358
Q

What is Angelman?

A
  • Loss of function of copy of gene from mother due to deletion of Chrm 15
  • Developmental delay
  • Fascination with water, happy
  • Fair skin, light hair and blue eyes
  • Widely spaced teeth
  • ADHD/Epilepsy
359
Q

Leading cause of childhood cancer death in the UK?

A

Brain tumours

360
Q

Osteosarcoma?

A
  • Most common primary bone cancer
  • Adolescent males
  • Warm, painful swelling at knee
  • Sunburst and Codman’s triangle on X-ray
361
Q

Ewings sarcoma?

A
  • Adolscents
  • Painful, warm, enlarging mass
  • Systemic symptoms
  • X-ray shows Onion skin periosteal reaction
362
Q

Retinoblastoma

A
  • Presents in first 3 years of life
  • White reflex replaces red
  • Squint
  • MRI to diagnose with chemo
363
Q

Osteogenesis Imperfecta?

A
  • AD condition with recurrent fractures due to collagen formation issue
  • Triangular face/Deafness/Bone deformities
  • Bisphosphonates/Vit D
364
Q

Oligoarticular vs Polyarticular JIA?

A

O - 4 joints or less, more common in girls under 6 with anterior uveitis and no systemic symptoms
P - 5 joints or more with symmetrical pattern and minimal systemic symptoms

365
Q

What can slapped-cheek trigger in someone with sickle cell crisis?

A

Aplastic crisis - significant anaemia and needs blood transfusions

366
Q

Respiratory distress of the newborn?

A
  • Premature neonates < 32
  • Inadequate surfactant -> lung collapse and hypoxia
  • Artifical surfactant via ET tube/CPAP
367
Q

Kallman syndrome?

A
  • Delayed puberty - lack of testicle development/ameorrhoea
  • Low LH, FSH, Oestrogen, Progesterone
  • Lack/Reduced sense of smell
  • Cleft palate
  • Tx is HRT
368
Q

What makes up 6 in 1 vaccines?

A

Parents will immunise toddlers because death
- Polio
- Whooping Cough
- Influenzae - Haem Inf
- Tetanus
- B Hep
- Diptheria

369
Q

Most common cause of late-onset neonatal sepsis (after 72 h of life)

A

S aureus

370
Q

Complications of Nephrotic syndrome?

A
  • Hypercholesterolaemia
  • Hypovolaemic shock
  • Infections
  • Thrombosis
  • Relapses
371
Q

What is Milia?

A

White pimples on nose/cheek - self-limiting

372
Q

What are Mongolian blue spots?

A

blue/black macular discolouration at the
base of the spine and on the buttocks

373
Q

What type of laxative is Movicol?

A

Macrogol laxative

374
Q

What is Swenson procedure used for?

A

Hirschprungs

375
Q

What is Hydrops fetalis?

A

abnormal accumulation of serous fluid in 2+ fetal compartments (pleural/ pericardial
effusions, ascites, skin oedema, polyhydramnios or placental oedema)

376
Q

Causes of hydrops fetalis?

A
  • Rhesus incompatiability
  • Severe anaemia – congenital parvovirus B19 infection, alpha thalassaemia major, massivematerno-feto haemorrhage
    ● Cardiac abnormalities
    ● Chromosomal – Trisomy 13, 18, 21, or Turners
    ● Infection – toxoplasmosis, rubella, CMV, varicella
    ● Twin- Twin transfusion syndrome (in the recipient twin)
    ● Chorioangioma
377
Q

Which genetic condition has disruption to the aortic arch?

A

DiGeorge syndrome

378
Q

Fragile X signs?

A

A long face
Large, protruding ears
Intellectual impairment
Macroorchidism (large testes) - post-pubertal
Social anxiety
Autistic spectrum features

379
Q

What condition are infants who drink lots of cow milk/under1s who drink cows milk at risk of?

A

Iron deficiency anaemia

380
Q

When should Moro reflex have disappeared by?

A

6 months

381
Q

Most common ECG findings of paeds cardiac arrest?

A

Asystole

382
Q

First line investigation for asthma?

A

Spirometry and BDR (bronchodilator reversibility)

383
Q

Investigation of choice to confirm Reyes?

A

Liver biopsy which shows hepatocyte microvesicular steatosis

384
Q

Imaging of choice for Slipped Upper Femoral epiphysis?

A

Plain radiograph of the pelvis in AP and frog-leg views

385
Q

Preseptal cellulitis vs orbital cellulitis?

A

Preseptal will not have visual symptoms

386
Q

Where is the damage in spastic CP?

A

Upper motor neurons in the periventricular white matter

387
Q

Risk factors for DDH?

A

female sex
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg

388
Q

Rash affecting child in first few weeks of life around scalp (‘Cradle cap’), nappy area, face and limb flexures.

A

Sebhorreic Dermatitis

389
Q

Management of seborrheic dermatitis?

A

Mild - baby shampoo and oil
Severe - 1% hydrocortisone

390
Q

What cancers are increased risk in coeliac?

A
  • Lymphoma
  • Small bowel adenocarcinoma
391
Q

grey-white coloured membrane covering his tonsils.

A

Diptheria

392
Q

What age do febrile convulsions normally stop?

A

5 years old

393
Q

Risk factors for sudden infant death syndrome?

A

prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity

394
Q

Complication of aortic coarctation?

A

Cerebral aneurysms

395
Q

Congenital toxoplasmosis signs?

A

Cerebral calcification
Chorioretinitis
Hydrocephalus
Anaemia
Hepatosplenomegaly
Cerebral palsy

396
Q

Foetal varicella signs?

A

skin scarring
microcephaly
eye defects (microphthalmia)
limb hypoplasia
learning disabilities

397
Q

Colic vs Infantile spasms?

A

In infantile spasms the child will become distressed between spasms, whereas in colic the child will become distressed during the ‘spasms’

398
Q

Features of achondroplasia?

A

short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
‘trident’ hands
lumbar lordosis

399
Q

When do you review undescended testes?

A

3 months

400
Q

Anal fissures and recurrent UTIs in children can indicate what?

A

Sexual abuse

401
Q

BLS of under 1s?

A

2 thumb-circling technique

402
Q

prominent right ventricular impulse palpable on examination?

A

Transposition of great arteries

403
Q

What should you not use in children younger than 3 months with suspected or confirmed bacterial meningitis

A

Corticosteroids

404
Q

Severe asthma signs?

A

PEFR 33–50% best or predicted <50 in children
RR > 25 adults, >30 5-12, >40 2-5
HR >110, >125 5-12, >140 2-5
Cannot talk in full sentences
Accessory muscle use
Not feeding - infants

405
Q

Life-threatening asthma signs?

A

PEFR <33
Sats <92
altered consciousness/exhaustion
Arrythmias
Hypotension
Cyanosis
Silent chest
Normal pC02

406
Q

Red flag signs in children NICE?

A

<3 and temp >38
Grunting
Mod/Severe recessions
Mottled/pale
Appears withdrawn
RR > 60
Rash, seizures, bulging fontanelle, neck stiffness

407
Q

Indications for head CT in children?

A
  • Loss of consciousness lasting more than 5 minutes (witnessed)
  • Amnesia (antegrade or retrograde) lasting more than 5 minutes
  • Abnormal drowsiness
  • Three or more discrete episodes of vomiting
  • Post-traumatic seizure but no history of epilepsy
  • Suspicion of open or depressed skull injury or tense fontanelle
  • Any sign of basal skull fracture (haemotympanum, panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
  • If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head

Phase 3A (10 decks)

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