Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PM > Paeds > Flashcards

Paeds Flashcards

1
Q

List conditions associated with Down’s syndrome (2)

A

Hypothyroidism > hyperthyroidism
T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Threshold for hypoglycaemia

A

<2.6mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of persistent/severe hypoglycaemia in neonates

A

Preterm birth (<37wks), IUGR
Hypothermia, neonatal sepsis, inborn errors of metabolism, nesidioblastosis, Beckwith-Wiedemann syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of neonatal hypoglycaemia (4)

A

May be asymptomatic
Hypoglycaemia (changes in neural sympathetic discharge): jitteriness, irritable, tachypnoea, pallor
Neuroglycopenic (shortage of glucose in the brain): poor feeding/sucking, weak cry, drowsy, hypotonia, seizures
Others: apnoea, hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of neonatal hypoglycaemia

A

Asymptomatic: encourage normal breastfeeding, monitor glucose
Symptomatic (<2) or very low glucose (<1): admit to neonatal unit, IV infusion of 10% dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Features of benign rolandic epilepsy (7)

A

Partial seizures occurring at night
Hemifacial paraethesias
Secondary generalisation to tonic-clonic seizures
Oropharyngeal manifestation (strange noises), hypersalivation
FHx
Otherwise normal, good prognosis, usually stops by adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

EEG manifestation of benign rolandic epilepsy

A

Centrotemporal spikes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Empirical Mx for bacterial meningitis (5)

A
  1. Abx
    <3m : IV amoxicillin/ ampicillin + IV cefotaxime
    >3m : IV cefotaxime/ ceftriaxone
  2. Steroids (AVOID corticosteroids in babies <3m)
    Dexamethasone
    if LP: purulent CSF, CSF WCC >1000/microlitre, raised CSF WCC with protein conc >1g/L, bacteria on gram stain
  3. Fluids
    Treat any shock e.g. with colloid
  4. Cerebral monitoring
    Mechanical ventilation if resp impairment
  5. Public health notification and ABx prophylaxis of contacts
    Ciprofloxacin&raquo_space; rifampicin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms of cystic fibrosis (7)

A

Recurrent chest infections
Malabsorption: steatorrhoea (due to pancreatic insufficiency, malabsorption of fats), failure to thrive (short stature, delayed puberty)
Meconium ileus
Liver disease, DM
Rectal prolapse
Nasal polyps
Male infertility, female subfertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List causes of constipation in children (6)

A

Idiopathic
SECONDARY TO ANXIETY
Dehydration, low fibre diet
Medication: opiates
Anal fissure
Over-enthusiastic potty training
Hypothyroidism, Hirschsprung’s disease, hypercalcaemia, learning disabilities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What should be assessed before starting treatment for constipation?

A

Check for faecal impaction: Sx of severe constipation, overflow soiling, faecal mass palpable in the abdomen (DRE only by specialist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment plan if faecal impaction is present

A
  1. Osmotic laxative, escalating dose
  2. Add stimulant if no disimpaction after 2 weeks
  3. Inform families that disimpaction therapy may lead to increase in soiling and abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common fractures associated with child abuse

A

Radial, humeral, femoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Paediatrics constipation maintenance therapy

A

MSO
Movicol Paediatric Plan (polyethylene glycol 3350 + electrolytes)
Senna (stimulant)
Osmotic (lactulose) if stools are hard despite the top two meds
Continue the maintenance therapy for several weeks after regular bowel habit is established

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why should evidence of exomphalos in an antenatal scan indicate elective C-section?

A

To reduce risk of sac rupture, infection and atresia secondary to injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Difference between gastroschisis and exomphalos

A

In exomphalos (omphalocele), the abdominal contents protrude through anterior abdominal wall but it’s covered in an amniotic sac formed by amniotic membrane and peritoneum. C-section is indicated to reduce risk of sac rupture, staged closure can be undertaken as primary closure may be difficult due to high intra-abdominal pressure/lack of space.

In Gastroschisis the contents are not in a peritoneal covering. Vaginal delivery can be trialled, neonate should be taken to surgery after delivery within 4 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define scarlet fever

A

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci (strep pyogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Epidemiology of scarlet fever

A

Common in children aged 2-6yo with peak incidence at 4yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Route of transmission of scarlet fever

A

Respiratory route by inhaling/ingesting respiratory droplets or by direct contact with nose and throat discharges esp during coughing and sneezing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

S+Sx of scarlet fever

A

Incubation time of 2-4days
Fever lasting 24-48hrs
Malaise, headache, n&v
Sore throat
Strawberry tongue, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the rash present in scarlet fever

A

Fine punctuate erythema (pinhead), generally appearing first on the torso, sparing the palms and soles, more prominent in flexures. Rough, sad-paper texture.
Flushed appearance with circumoral pallor.
Desquamination occurs later in the course of illness, esp around fingers and toes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ix for scarlet fever

A

Throat swab but start Abx treatment STAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Mx for scarlet fever

A

Oral penicillin V for 10 days or azithromycin if penicillin allergy.
Children can return to school after 24hrs of starting Abx.
Notifiable disease!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most common complication of scarlet fever

A

Otitis media!!

Others: rheumatic fever (around 20days post infection), acute glomerulonephritis
Rare: invasive complications e.g. bacteraemia, meningitis, necrotizing fasciitis are rare but present with acutely life-threatening illness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

4 signs of Noonan syndrome

A

Webbed neck, pectus excavatum, short stature, pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

4 signs of Patau syndrome (trisomy 13)

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

5 signs of Fragile X syndrome

A

Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are febrile convulsions and what age range is it normally seen?

A

Seizures provoked by fever in otherwise normal children. Most common in 6months-5yo (3%).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Key features of febrile convulsions (3)

A

Occur early after viral infection as temp rises rapidly. Seizures usually brief, lasting 5mins. Most tonic clonic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Types of febrile convulsions

A

Simple: <15mins, generalised seizure, complete resolves in 24hrs, no recurrence
Complex: 15-30mins, focal seizure, may have repeat seizures within 24hrs
Focal status epilepticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Mx following a seizure

A

If first ever seizure/ complex, admit to paediatrics ASAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Ongoing Mx for febrile convulsions / seizure

A
  1. If seizure lasts >5mins, call ambulance
  2. Regular antipyretics have not been shown to reduce chance of febrile convulsions
  3. If recurrent febrile convulsions occur, BDZ rescue medication should be considered: rectal diazepam/buccal midazolam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What medication should you avoid in chickenpox?

A

NSAID e.g. ibuprofen due to increase in secondary bacterial infection of the lesions (necrotising fasciitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is chickenpox and shingles?

A

Chickenpox is primary infection with varicella zoster virus. Shingles is reactivation of the dormant virus in the dorsal root ganglion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How infective is chickenpox?

A

Via respiratory route. Can be caught from someone with shingles. Incubation period of 10-21 days. Infectivity occurs 4 days before onset of rash and 5days after rash appears.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

S+Sx of chickenpox

A

Initial fever
Itchy rash, starting on head/trunk before spreading. Macular –> papular –> vesicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Mx of chickenpox

A

Keep cool, trim nails
Calamine lotion
Exclusion from school until end of infectivity period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Rare complications of chickenpox

A

Pneumonia, encephalitis, disseminated haemorrhagic chickenpox
Arthritis, nephritis, pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Action for child <3yo presenting with acute limp

A

Urgent specialist assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

DDx for limping child

A

Transient synovitis: acute, viral infection, mild fever, M>F, 2-12yo
Septic arthritis/osteomyelitis: unwell, high fever
Juvenile idiopathic arthritis: painless limp
Trauma: Hx diagnostic
Development of dysplasia of hip: detected in neonates, 6x more common in girls
Perthes disease: 4-8yo, due to avascular necrosis of the femoral head
Slipped upper femoral epiphysis: 10-15yo, displacement of femoral head epiphysis postero-inferiorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the purpose of traffic light system for fever in child?

A

Risk stratification for children <5yo.
Includes colour, activity, respiratory , circulation and hydration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Red flag signs for feverish child

A

Pale, blue
No response, does not wake, weak high-pitched/ continuous cry, grunting, chest retraction, RR>60, REDUCED SKIN TURGOR, age<3months, non blanching rash, bulging fontanelle, neck stiffness, focal neurological signs, focal seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Define precocious puberty

A

Development of secondary characteristics before age 8 in female and age 9 in male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Define thelarche

A

First stage of breast development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Define adrenarche

A

First stage of pubic hair development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is Osgood-Schlatter disease?

A

Inflammation of growth plate at the tibial tuberosity causing anterior knee pain in adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which demographic is mostly affected by slipped capital femoral epiphysis?

A

Obese, boys, 10-15yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

S+Sx of slipped capital femoral epiphysis

A

Hip, groin, medial thigh/knee pain
Loss of internal rotation of leg in flexion, bilateral slip in 20% cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Ix for slipped capital femoral epiphysis

A

AP + lateral (typically frog leg) views are diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Mx of slipped capital femoral epiphysis

A

Internal fixation: a single cannulated screw placed in centre of epiphysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Complications of slipped capital femoral epiphysis

A

Osteoarthritis, avascular necrosis of femoral head, chondrolysis, leg length discrepency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Key features of Down’s syndrome

A

Upslanting palpebral fissures, epicantic folds, Brushfield spots in iris, protrudng tongue, small low-set ears, round/flat face
Flat occiput
Single palmar crease, sandal gap between big and first tow
Hypotonia
Congenital heart defects
Duodenal atresia
Hirschsprung’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

List 4 features of Trisomy 18 (Edward’s syndrome)

A

Micrognathia, low-set ears, rocker bottom feet, overlapping of fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Define nocturnal enuresis

A

Involuntary discharge of urine by day/night/both, in a child aged 5 years or older, in the absence of congenital/acquired defects of the nervous system/urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Difference between primary and secondary nocturnal enuresis

A

Primary: child has never achieved continence
Secondary: child has been dry for at least 6m before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

List the Mx options for nocturnal enuresis

A
  1. Look for possible underlying cause: constipation, DM, UTI if acute
  2. General advice: reduce fluid intake before night, encourage bladder emptying regularly during the day and before sleep, starting a reward system for agreed behaviour (star charts) rather than dry nights e.g. using toilet to pass urine before sleep
  3. Enuresis alarm: have sensor pads that sense wetness (high success rate)
  4. Desmopressin for short-term control/ enuresis alarm as been ineffective/not acceptable to family
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What organism causes necrotising fasciitis in a patient with chickenpox?

A

Group A streptococcal soft tissue infections affecting soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

List causes of chronic diarrhoea (4)

A

Cow’s milk intolerance
Toddler diarrhoea
Coeliac disease
Post-gastroenteritis lactose intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

When is ultrasound screening of the hip conducted?

A

6 weeks of age for newborns with specific risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is developmental dysplasia of the hip (DDH)?

A

Congenital dislocation of the hip, affecting 1-3% of newborns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

List 7 risk factors for DDH

A

F>M (6x)
Breech presentation, oligohydraminos
Positive FHx
Firstborn children
Birthweight >5kg
Calcaneovalgus foot deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Which side is more commonly affected in DDH?

A

Left. Around 20% of cases are bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

List three RFs that indicate a routine US examination for DDH

A

First degree FHx of hip problems in early life
Breech presentation at or after 36wks gestation irrespective of birth or mode of delivery
Multiple pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Clinical examination of DDH

A

Barlow test: attempt dislocation of articulated femoral head
Ortolani test: attempt relocation of dislocated femoral head
Other factors: symmetry of leg length, level of knees when hips and knees are bilaterally flexed, restricted abduction of hip in flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Imaging used for DDH

A

??clinically suspected, confirm diagnosis –> USS

If >4.5m, FIRST LINE IS XRAY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Mx of DDH

A

Most unstable hips stabilise by 3-6wks of age
Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5m
Older children may require surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Define Perthes’ Disease

A

Degenerative condition affecting hip joints of children, due to avascular necrosis of femoral head, specifically the femoral epiphysis (impaired blood supply causes infarction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

S+Sx of Perthes’ disease

A

Hip pain: progressively over a few weeks
Limp
Stiffness and reduced range of hip movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

X-ray features of Perthes’ disease

A

Early changes include widening of joint space, later changes include decreased femoral head size/flattening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Ix for Perthes’ disease

A

Plain X-ray
Technetium bone scan or MRI if normal X-ray and Sx persist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Complications of Perthes’ disease

A

Osteoarthritis
Premature fusion of growth plates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Define reflex anoxic seizures

A

Syncopal episode (presyncope) that occurs in response to pain or emotional stimuli. Thought to be caused by neurally-mediated transient asystole in children with very sensitive vagal cardiac reflexes. Most common in 6m-3yo.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

List 4 S+Sx of reflex anoxic seizures

A

Pale, falls to floor
Stiffness
Rapid recovery (key difference to epilepsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Tx and prognosis of reflex anoxic seizures

A

No specific treatment, prognosis is excellent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Name a common side effect of ventouse delivery

A

Caput succedaneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is Caput succedaneum?

A

Oedema of the scalp at the presenting part of the head, typically at the vertex. May be due to mechanical trauma of the initial portion of scalp pushing through cervix in a prolonged delivery or secondary to use of ventouse (vacuum) delivery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

S+Sx of necrotising fasciitis

A

Feeding intolerance
Abdominal distension, bloody stools
Abdominal discolouration, perforation, peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Signs on AXRs that indicate necrotising enterocolitis (7)

A

Asymmetrical dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis (intramural gas)
Portal venous gas
Pneumoperitoneum from perforation
Air both inside and outside of bowel wall (Rigler sign)
Air outlining the falciform ligament (football sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Pathogen responsible for bronchiolitis (in 75-80% of cases)

A

RSV respiratory syncytial virus

Other causes: mycoplasma, adenoviruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Epidemiology of bronchiolitis

A

Most common cause of serious low respiratory tract infection in <1yo, peach incidence at 3-6m olds.
Higher incidence during the winter.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

S+Sx of bronchiolitis (5)

A

Coryzal Sx including mild fever precede:
Dry cough
Increase breathlessness
Wheezing, fine inspiratory crackles
Feeding difficulties associated with increasing dyspnoea (often the reason for admission)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What should warrant an urgent referral (999) for bronchiolitis (5)?

A

Apnoea (observed/reported)
Child looks seriously unwell to a healthcare professional
Severe respiratory distress: grunting, marked chest recession, RR<70breaths/min
Central cyanosis
Persistent O2 sats of <92% when breathing air

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

When should you consider referring a suspected bronchiolitis child to hospital (4)?

A

RR >60
Difficulty breastfeeding or inadequate oral fluid intake
Clinical dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Ix for bronchiolitis

A

Immunofluorescence of nasopharyngeal secretions may show RSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Mx of bronchiolitis

A

Largely supportive
Humidified O2 given via head box and is typically recommended if O2 sats are persistently <92%
Nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
Suction is sometimes used for excessive upper airway secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is Hirschsprung’s disease?

A

Aganglionic segment of bowel due to developmental failure of parasympathetic Auerback and Meissner plexuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

How common is Hirschprung’s disease?

A

1 in 5,000 births RARE but an important Dx for constipation in childhood
More common in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

S+Sx of Hirschsprung’s disease

A

Neonatal period e.g. failure or delay to pass meconium
Other children: constipation, abdominal distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Ix for Hirschsprung’s disease

A

AXR
Rectal biopsy : GOLD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Mx of Hirschsprung disease

A

Initially: rectal washouts/bowel irrigation
Definitive Mx: surgery to affected segment of colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Describe the rash in ezcema

A

Itchy, erythematous rash
Repeated scratching may exacerbate the affected areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Describe the distribution of ezcema in infants, younger children, older children

A

Infants : face and trunk
Younger children : eczema on extensor surfaces
Older children : flexor surfaces affected and creases of the face and neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Mx of eczema

A

Avoid irritants
Simple emollients: large quantities prescribed (250g/week), apply emollient 30mins before applying the steroid, creams soak into skin faster than ointments, emollients can become contaminated with bacteria (fingers should not be inserted into pots, many have pump dispensers)
Topical steroids
Wet wrapping: large amounts of emollient (sometimes topical steroids) applied under wet bandages
In severe cases, oral ciclosporin may be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Characteristics of infantile colic (4)

A

Typical in infants <3m
Excessive crying
Pulling up of legs
Often worse in evenings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is NOT recommended for infantile colic?

A

Simeticone/lactase drops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Epidemiology of ALL

A

Peak incidence 2-5yo
M>F
Most common malignancy affecting children
Not a strong family correlation (although Down’s increase likelihood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Key features of ALL

A

Anaemia : pallor, lethargy
Neutropenia : frequent/severe infections
Thrombocytopenia : easy bruising, petechiae
Bone pain (secondary to bone marrow infiltration), splenomegaly, hepatomegaly, fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Poor prognostic factors of ALL

A

Age <2yo or >10
WBC >20X10^9/l at Dx
T/B cell surface markers
Non-Caucasian
Male sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

School exclusion rules for chicken pox

A

Until all the lesions have crusted over, which occur 5 days after onset of rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Areas affected by seborrhoeic dermatitis

A

Scalp, nappy area, face, limb flexures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Early sign of seborrhoeic dermatitis

A

Early sign that develops in the first few weeks of life, erythematous rash with coarse yellow scales

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Mx of seborrhoeic dermatitis

A

Reassure that it doesn’t affect baby and usually resolves within few weeks (tends to resolve around 8m of age)
Massage topical emollient onto the scalp to loosen scales, brush gently with soft brush and wash off with shampoo
If severe/persistent a topical imidazole cream may be tried

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Triad for shaken baby syndrome

A

Retinal haemorrhages, subdural haematoma, encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What causes shaken baby syndrome?

A

Caused by intentional shaking of a child 0-5yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is Meckel’s diverticulum?

A

Congenital diverticulum of the small intestine. It is a remnant of the omphalomesenteric duct containing ectopic ileal, gastric or pancreatic mucosa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Rule of 2s for Meckel’s diverticulum

A

Occurs in 2% of population
2 feet from the ileocaecal valve
2 inches long

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

S+Sx of Meckel’s diverticulum (3)

A

Usually asymptomatic

Abdominal pain (mimik appendicitis)
Rectal bleeding (MOST COMMON CAUSE OF MASSIVE PAINLESS GI BLEEDING requiring transfusion in children between ages of 1-2yo)
Intestinal obstruction secondary to an omphalomesenteric band, volvulus, intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Ix for Meckel’s diverticulum

A

If child is haemodynamically stable with less severe of intermittent bleeding then a Meckel’s scan should be considered

Mesenteric arteriography also may be used in more severe cases e.g. transfusion is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Mx of Meckel’s diverticulum

A

Removal if narrow neck or symptomatic
Either wedge excision or formal small bowel resection and anastomosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Mx of Perthes’ disease

A

Keep femoral head within the acetabulum: cast, braces
If less than 6yo: observation
If older: surgical Mx with moderate results
Operate on severe deformities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Prognosis of Perthes’ disease

A

Most cases resolve with conservative Mx, early Dx improves outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Define neonatal sepsis

A

Serious bacterial/viral infection in the blood affecting babies within the first 28days of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Difference between early onset and late onset sepsis

A

Early onset : within 72hrs of birth
Late onset : between 7-28days of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Cause of EOS

A

GBS infection (75%) usually due to transmission of pathogens from the mother to the neonate during delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Cause of LOS

A

Staphylococcus epidermis
Pseudomonas aeruginosa
Klebsiella and Enterobacter
Due to transmission of pathogens from environment post delivery, from parents/healthcare workers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

RFs for neonatal sepsis

A

Mother with previous GBS infection, intrapartum temp >=38deg, membrane rupture >=18hrs, current infection during preg
Premature birth (<37wks)
Low birth weight (<2.5kg)
Evidence of maternal chorioamnionitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Ix for neonatal sepsis

A

Blood culture to obtain Dx
FBC to exclude healthy neonates
CRP guide Mx and patient progress during treatment
Blood gas : metabolic acidosis, BE -10>=
Urine microscopy, culture, sensitivity (?UTI? for LOS)
LP ?meningitis, or part of septic screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Mx of neonatal sepsis

A

Main aim: improve outcomes by early identification and Tx

Use IV benzylpenicillin + gentamicin as first-line regimen for suspected/confirmed
Measure CRP 18-24hrs after Abx to monitor progress and guide duration of therapy
Cease Abx in neonates CRP <10mg/L and negative blood culture at presentation and at 48hrs

Maintain O2, normal fluid and electrolyte status
Monitor body weight for assessment of fluid status
Prevent and manage hypoglycaemia and metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is Kawasaki disease?

A

Type of vasculitis predominantly seen in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Name a serious complication of Kawasaki disease

A

Coronary artery aneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

S+Sx of Kawasaki disease

A

High grade fever (lasting >5days, RESISTANT TO ANTIPYRETICS)
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Cervical lymphadenopathy
Red palms of the hands and soles of feet which later peel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Dx test of Kawasaki disease

A

No specific diagnostic test, it is clinically diagnosed!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Mx of Kawasaki disease

A

High dose aspirin
IV immunoglobulin
Echocardiogram used as an initial screening test for coronary artery aneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

S+Sx of measles

A

Prodromal phase : irritable, conjunctivitis, fever
Koplik spots : typically develop before the rash, white spots (grain of salt) on the buccal mucosa
Rash : starts behind ears then to the whole body, discrete maculopapular rash becoming blotchy and confluent, desquamination that typically spares the palms and soles may occur after a week
Diarrhoea around 10% of patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Ix for measles

A

IgM Abs detected within a few days of rash onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Mx of measles

A

Supportive
Admission if immunosuppressed/ pregnant
Notifiable disease –> public health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Main complication of measles (3)

A

Otitis media : most common
Pneumonia : most common cause of death
Encephalitis : typically occurs 1-2wks following onset of illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Mx of a child that came into contact with measles

A

MMR vaccine induced Abs develops more rapidly than that following infection
Give within 72hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What is the commonest cause of vomiting in infancy?

A

GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

RFs of GORD

A

Preterm delivery, neurological disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Features of GORD in children (3)

A

Typically develops before 8wks
Vomiting/regurg (milky vomit after feeds, may occur after being laid flat)
Excessive crying, especially while feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Dx of GORD

A

Made clinically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Mx of GORD

A
  1. Advice regarding position during feeds : 30deg head-up
  2. Infants should sleep on their backs to reduce risk of cot death
  3. Make sure infant is not being overfed : trial smaller feeds/ more frequent
  4. Trial of thickened formula : rice starch, cornstarch
  5. Trial alginate therapy e.g. Gaviscon NOT with thickening agents
  6. PPI if 1 applies : unexplained feeding difficulties (refuse feeds, gag, choke), distressed behaviour, faltering growth
  7. Prokinetic agents e.g. metoclopramide should be used with specialist advice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Complications of GORD in infants (5)

A

Failure to thrive
Distress
Aspiration
Frequent otitis media
In older children, dental erosion may occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What to do with severe complications of GORD?

A

If medical Tx is ineffective, consider fundoplication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Define intussusception

A

Invagination of one portion of the bowel into the lumen of the adjacent bowel, most commonly around the ileocaecal region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Epidemiology of intussusception

A

6-18months old
M>F (x2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

S+Sx of intussusception (6)

A

Intermittent, severe, crampy, progressive abdo pain
Inconsolable crying
During paroxysm the infant will characteristically draw their knees up and turn pale
Vomiting
Blood stained stool - red current jelly (LATE sign)
Sausage shaped mass in the RUQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Ix for intussusception

A

USS may show target like mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Mx of intussusception

A

Tx with reduction by air insufflation under radiological control, widely used first-line compared to traditional barium enema
If this fails/peritonitis –> surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Inheritance pattern of achondroplasia

A

AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

S+Sx of achondroplasia (5)

A

Short limbs (rhizomelia), shortened fingers (brachydactyly)
Large head with frontal bossing and narrow foramen magnum
Midface hypoplasia with flattened nasal bridge
Trident hands
Lumbar lordosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

RFs for achondroplasia

A

70% due to sporadic mutation
Advanced paternal age at the time of conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Tx for achondroplasia

A

No specific therapy, but some benefit from limb lengthening procedures - application of llizarov frames and targeted bone fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

What should be screened for Down’s syndrome infant taking part in excercise?

A

Atlanto-axial instability due to high risk of neck dislocation
(a complication of DS is atlanto-axial instability)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is congenital diaphragmatic hernia?

A

Occurs 1 in 2,000 newborns, characterised by herniation of abdominal viscera into chest cavity due to incomplete formation of diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Most common type of CDH

A

Left sided posterolateral Bochdalek hernia for around 85% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Prognosis of CDH

A

50% of newborns survive despite modern medical intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

S+Sx of CDH

A

Pulmonary hypoplasia and HTN causes respiratory distress shortly after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Define croup

A

Form of upper respiratory tract infection in infants and toddlers, characterised by stridor caused by combination of laryngeal oedema and secretions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Epidemiology of croup

A

6m-3yo, more common in autumn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

S+Sx of croup (4)

A

Stridor
Barking cough
Fever
Coryzal Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

When should a child with croup be admitted?

A

Moderate-severe
OR
* if <6mo / known upper airway abnormality / uncertainty about Dx –> admit!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

X-ray sign of croup

A

Steeple sign : PA view showing subglottic narrowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Mx of croup

A

Regardless of severity
Single dose of oral dexamethasone 0.15mg/kg STAT (prednisolone alternatively)
High flow O2, nebulised adrenaline if emergency!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Test done as part of Newborn Hearing Screening Programme

A

Otoacoustic emission test - done prior to being discharged from hospital.
Soft ear piece placed in baby’s ear and quiet clicking noises are played through it. Earpiece picks up the response from the inner ear and computer analyses it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Test done if otoacoustic test is abnormal

A

Auditory Brainstem Response (3 sensors placed on head and neck; soft headphones used to play quiet clicking sounds; sensors detect how baby’s brain and hearing nerves respond to sound and computer analyses results)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

List factors that point towards child abuse (4)

A

Story inconsistent with injuries
Repeated attendances at A&E departments
Delayed presentation
Child with a frightened, withdrawn appearance - ‘frozen watchfulness’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Possible physical presentations of child abuse (6)

A

Bruising
Fractures: multiple at different stages of healing, posterior rib fractures
Burns and scalds
Failure to thrive
STIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Define microcephaly

A

Occipital-frontal circumference <2nd centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

List causes of micocephaly (7)

A

Normal variation
Familial e.g. parents have small head
Congenital infarction
Perinatal brain injury e.g. hypoxic ischaemic encephalopathy
Fetal alcohol syndrome
Patau syndrome
Craniosynostosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Mx for child presenting with ADHD

A
  1. Watch and wait period of 10wks
  2. If persists, refer to paediatrician/CAMHS
  3. Drug therapy seen as last resort for >5yo
    Methylphenidate FIRST LINE 6wk trial
    If inadequate, switch to lisdexamfetamine but if this causes SEs give dexamfetamine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

SEs of methylphenidate (ADHD first line) in children

A

Abdo pain, nausea, dyspepsia

Note: weight and height should be monitored every 6m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

How harmful are ADHD drugs and what should be monitored?

A

These are cardiotoxic drugs, so perform baseline ECG before starting and refer to cardiologist if there is significant PMHx, FHx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Define vesicoureteric reflux (VUR)

A

Abnormal backflow of urine from bladder into ureter and kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Epid of VUR

A

Common abnormality of urinary tract in children and predisposes to UTI (30% of UTI have VUR) and 35% develop renal scarring so it is important to Ix for VUR following UTI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

List presentations of VUR (3)

A

Antenatal period : hydronephrosis of USS
Recurrent childhood UTI
Reflux nephropathy : term used to describe chronic pyelonephritis secondary to VUR, commonest cause of chronic pyelonephritis, renal scar may produce increased quantities of renin causing HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Ix for VUR (2)

A

Micturating cystourethrogram
DMSA scan may be used to look for renal scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

List 5 grades of VUR

A
  1. Reflux into ureter only, no dilatation
  2. Reflux into renal pelvis on micturition, no dilatation
  3. Mild/moderate dilatation of ureter, renal pelvis and calyces
  4. Dilation of renal pelvis and calyces with moderate ureteral tortuosity
  5. Gross dilatation of ureter, pelvis, calyces with ureteral tortuosity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Epid of growing pains

A

M=F
3-12yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

S+Sx of growing pains (7)

A

Never present at the start of day
No limp, no limitation of physical activity
Systemically well, normal examination
Motor milestones normal
Sx intermittent and worse after a day of vigorous activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

List causes of jaundice in the first 24hrs (4)

A

ALWAYS PATHOLOGICAL
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
Glucose-6-phosphodeydrogenase

Measure serum bilirubin urgently!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Causes of jaundice in neonates from 2-14days

A

Common (up to 40%)
Usually physiological (more RBCs, less developed liver function)
More common in breastfed babies (?? high conc of beta-glucuronidase –> increase in intestinal absorption of unconjugated bili)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

List Ix for jaundice after 14days (prolonged, or 21days in premature)

A

Conjugated and unconjugated bilirubin (? biliary atresia requires urgent surgical intervention)
Direct antiglobulin test
TFTs
FBC and blood film
Urine for MC&S and reducing sugars
U&Es and LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

List causes of prolonged jaundice (7)

A

Biliary atresia
Hypothyroidism
Galactosaemia
UTI
Breast milk jaundice
Prematurity (immature liver function, increased risk of kernicterus)
Congenital infections e.g. CMV, toxoplasmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

Classical S+Sx of slipped upper femoral epiphysis (SUFE)

A

Obese, young boys (10-15yo) (displacement of femoral head epiphysis posteriorinferiorly)
Hip, groin, medial thigh +/- knee pain. Loss of internal rotation of leg, whilst flexion may be seen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

Presentation of UTI in childhood (infants, younger children, older children)

A

Infants: poor feeding, vomiting, irritability
Younger children: abdominal pain, fever, dysuria
Older children: dysuria, frequency, haematuria
Fts of upper UTI: temp ?38deg, loin pain/tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

List 3 scenarios of when a child’s urine sample should be obtained

A

Sx/S of UTI
Unexplained fever of 38deg + (test urine after24hrs the latest)
With an alternate site of infection but remains unwell (consider urine test after 24hrs at the latest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

3 different ways of collecting urine from children

A

Preferred method: clean catch
Urine collection pads
Don’t use cotton balls, gauze, sanitary towels
Invasive methods e.g. suprapubic aspiration should only be used if non-invasive methods are not possible

180
Q

Mx of UTI

A

<3m should be referred immediately to paediatrician
>3m + upper UTI consider admission to hospital / if not admitted, five oral e.g. cephalosporin/co-amoxiclav for 7-10days
>3m + lower UTI Tx with Abx for 3days according to local guidelines e.g. trimethoprim, nitrofurantoin, cephalosporin, amox)
Bring child back if unwell for 24-48hrs
Abx prophylaxis considered with recurrent UTIs

181
Q

Define meconium aspiration syndrome

A

Resp distress in newborn as a result of meconium in trachea

182
Q

RFs of meconium aspiration syndrome

A

Post-term deliveries (44% in babies born after 42wks)
Maternal HTN, pre-eclampsia, chorioamnionitis, smoking/substance abuse

183
Q

Causes of hypotonia (7)

A

Down’s syndrome
Prader Willi syndrome
Hypothyroidism
Cerebral palsy (hypotonia may precede development of spasticity)

Spinal muscular atrophy
GBS
MG

184
Q

Name the most common congenital infection in the UK

A

CMV, rubella, toxoplasmosis

185
Q

List S+Sx of congenital CMV infection

A

Low birth weight
Petechial rash
Sensorineural deafness
Seizure
Jaundice
Microcephaly
Learning disability

186
Q

Two prognostic factors of CDH

A

Liver position : if liver has herniated to the chest, disease is more severe and lower chance of survival
lung-to-head ratio : >1.0 reflects better outcome

187
Q

When does a baby start to smile?

A

6wks

188
Q

Organisms causing meningitis in neontal-3m

A

Group B strep (acquired from mother at birth), E coli, Listeria monocytogenes

189
Q

Organisms causing meningitis in 1m to 6m

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

190
Q

Organisms causing meningitis in >6yrs

A

Neisseria meningitidis
Streptococcus pneumoniae

191
Q

When is Meningitis B vacc given?

A

2m, 4m, 12-13m

192
Q

Cause of hand, foot and mouth disease

A

Coxsackie A16 and enterovirus 71 (contagious, typically outbreaks in nursery)

193
Q

S+Sx of Coxsackie A16 disease (3)

A

Mild systemic upset : sore throat, fever
Oral ulcers
Followed later by vesicles on palms and soles of feet

194
Q

Mx of Coxsackie infection (3)

A

Sx Tx ONLY : general advice about hydration and analgesia
Reassurance there is no link to cattle
No exclusion from school : stay home until they feel better, contact HPA if there is a large outbreak

195
Q

Define therapeutic cooling

A

Deliberate lowering of patient’s body temperature to prevent brain damage

196
Q

Prognosis of HIE

A

10-60% die during neonatal period, 25% suffer from long term neurological impairment including epilepsy, mental retardation/ cerebral palsy.

197
Q

When should therapeutic cooling be started?

A

Within 6hrs of birth and continued for 72hrs ; then cooling rewarming should be carried out slowly 0.5deg over a period of 6-12hrs

198
Q

Define phimosis

A

Non-retractable foreskin +/- ballooning during micturition

199
Q

Mx of phimosis

A

<2 - expectant approach
Avoid forcible retraction as it can cause scar formation
Ensure personal hygiene
Consider Tx if >2, recurrent UTI, recurrent balanoposthitis

200
Q

When to refer for developmental problems (3)

A

No smile at 10wks
Cannot sit unsupported at 12m
Cannot walk at 18m

201
Q

Define Roseola infantum

A

Common disease of infancy, caused by HHV6. Incubation period of 5-15days and typically affects children aged 6m-2yo

202
Q

S+Sx of roseola infantum (5)

A

High fever: last few days followed LATER BY A
Maculopapular rash
Nagayama spots : papular enanthem on uvula and soft palate
Febrile convulsions occur around 10-15%
Diarrhoea and cough commonly seen

203
Q

List 3 consequences of HHV6 infection

A

Roseola infantum
Aseptic meningitis
Hepatitis

204
Q

School exclusion for roseola infantum?

A

No

205
Q

What is Duchenne muscular dystrophy?

A

X-linked recessive disorder due to a problem in the dystrophin gene required for normal muscular function

206
Q

S+Sx of Duchenne muscular dystrophy (4)

A

Progressive proximal muscle weakness from 5yrs
Calf pseudohypertrophy
Gower’s sign: child uses arms to stand up from a squatted position
30% of patients have intellectual impairment

207
Q

Ix for Duchenne muscular dystrophy

A

Raised Cr kinase
DEFINITIVE DX: genetic testing

208
Q

Mx of Duchenne muscular dystrophy

A

Largely supportive as there is currently no effective Tx

209
Q

Prognosis of Duchenne muscle dystrophy

A

Most children cannot walk by age 12
Patients typically survive to 25-30yo
Associated with dilated cardiomyopathy

210
Q

RFs of RDS (5)

A

Premature (<28wks)
C-section
Male
Second born of premature twins

211
Q

S+Sx of RDS

A

Tachypnoea, intercostal recession, expiratory grunting and cyanosis

212
Q

Ix of RDS

A

Ground-glass appearance with indistinct heart border

213
Q

Mx of RDS

A

Prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
O2
Assisted ventilation
Exogenous surfactant given via endotracheal tube

214
Q

Mx of hypospadias

A
  1. Refer to specialist services
  2. Corrective surgery conducted when around 12m of age
  3. Essential child is not circumcised prior to surgery
  4. In boys with very distal disease, no Tx may be needed
215
Q

List 4 key features of hypospadias

A

Ventral urethral meatus
Hooded prepuce
Chordee (ventral curvature of penis)
Urethral meatus may open more proximally in more severe variants

216
Q

Define (periarticular) juvenile idiopathic arthritis

A

Arthritis occurring in someone who is <16yo that lasts >6wks
Periarticular JIA = <=4 joints affected (60%)

217
Q

S+Sx of periarticular JIA (3)

A

Joint pain and swelling: usually medium sized joint e.g. knees, ankles, elbows
Limp
ANA may be positive - associated with anterior uveitis

218
Q

Define biliary atresia

A

Obstruction/discontinuity within extrahepatic biliary system which results in cholestasis in the first weeks of life

219
Q

S+Sx of biliary atresia

A

Jaundice extending from the physiological 2wks
Dark urine, pale stools
Appetite and growth disturbance
Hepatomegaly, splenomegaly, abnormal growth, cardiac murmurs

220
Q

Ix of biliary atresia (6)

A

Serum bilirubin (conjugated»unconjugated)
LFTs (raised but cannot differentiate biliary atresia and other causes of neonatal jaundice)
Serum alpha-1-antitrypsin: neonatal cholestasis
Sweat chloride test: cystic fibrosis
US of biliary tree and liver: ?distension
Percutaneous liver biopsy with intraoperative cholangioscopy

221
Q

Mx of biliary atresia

A

ONLY DEFINITIVE - Kasai portoenterostomy:
Abx coverage and bile enchancers after pregnancy

222
Q

Complications of biliary atresia (3)

A

Unsuccessful anastomosis formation, progressive liver disease, cirrhosis with eventual hepatocellular carcinoma

223
Q

Mx of threadworms

A

Anthelmintic with hygiene measures for all members of household (mebendazole FIRST LINE for >6mo SINGLE DOSE unless infestation persists)

224
Q

Most common place affected by cephalohaematoma

A

Parietal

225
Q

Caput succedaneum vs cephalohaematoma

A

Caput succadaneum
present at birth, forms over vertex and CROSS SUTURE LINES, resolve within a few days

Cephalohaematoma
Several hrs after birth, parietal region, DOESNT CROSS SUTURE LINES, may take months to resolve

Similarities
Swelling on the head, prolonged difficult deliveries, Mx conservative

226
Q

Paediatric GI disorders

A

Pyloric stenosis: projectile vomiting
Acute appendicitis
Mesenteric adenitis: central abdo pain, URTI
Intussusception: telescoping bowel, colicky pain, d&v, red jelly stool
Intestinal malrotation, feature in exomphalos, CDH
Hirschprung’s disease: delayed passage of meconium, abdo distension
Biliary atresia: jaundice >14days, increased conjug bili
Oesophageal atresia
Necrotising enterocolitis: prematurity RF, abdo distension, bloody stool

227
Q

Vaccination at 12-13yo

A

HPV

228
Q

Define Epstein’s pearl

A

Congenital cyst found in mouth, common on hard palate, commonly mistaken for tooth

229
Q

Tx of Epstein’s pearl

A

No Tx required as they tend to spontaneously resolve over course of a few weeks

230
Q

S+Sx of PDA (5)

A

Left subclavicular thrill
Continuous machinery murmur
Large volume, bounding, collapsing pulse
Wide pulse pressure
Apex beat

231
Q

Mx of PDA

A

Indomethacin/ibuprofen inhibits PG synthesis given to neonate
note: if associated with another congenital heart defect amenable to surgery then prostaglandin E1 is useful to keep the duct open until after surgical repair

232
Q

S+Sx of bronchiolitis

A

Poor feeding, cough, fever
Crackles, wheezing, increased resp effort

233
Q

What condition do the majority of meconium ileus patients have?

A

Cystic fibrosis

234
Q

Epidemiology of Tetralogy of Fallot

A

Most common cause of cyanotic congenital heart disease. Presents 1-2m, not picked up until baby is 6m old.

235
Q

4 features of TOF

A

Ventricular septal defect (VSD)
Right ventricular hypertrophy
Right ventricular outflow obstruction, pulmonary stenosis
Overriding aorta

236
Q

What determines degree of cyanosis and clinical severity of TOF

A

Severity of right ventricular outflow obstruction

237
Q

Other S+Sx of TOF

A

Cyanosis: hypercyanotic tet spells (tachypnoea, severe cyanosis), right-left shunt, right-sided aortic arch, CXR showing boot-shaped heart, ECG showing right ventricular hypertrophy

238
Q

Mx of TOF

A

Surgical repair undertaken in two parts
Cyanotic episodes helped by BB to reduce infundibular spasm

239
Q

Features of Pierre-Robin syndrome (3)

A

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

240
Q

Name the hearing test done on children at >3yo

A

Pure tone audiometry (school entry in UK) - headphones on and raise hand when they hear a bleep

241
Q

Mx for bronchiolitis

A

Humidified O2 via headbox, recommended if O2 sats persistently <92%
Nasogastric feed if children cannot take enough fluid/feed by mouth
Suction is sometimes used for excessive upper airway secretions

242
Q

In paediatric BLS, where should you check the pulse (in an infant and child)?

A

Brachial, femoral in an infant
Femoral in a child

243
Q

What is infantile spasms?

A

Type of childhood epilepsy presents in first 4-8m of life, more common in female infants.

244
Q

S+Sx of infantile spasms (3)

A

Characteristic ‘salaam’ attacks: flexion of head, trunk, arms followed by extension of arms
Only lasts 1-2secs but may be repeated up to 50 times
Progressive mental handicap

245
Q

Ix for infantile spasms

A

EEG: shows hypsarrythmia in 2/3rds infants
CT shows diffuse/localised brain disease in 70%

246
Q

Mx of infantile spasms

A

Poor prognosis
Vigabatrin FIRST-LINE
ACTH also used

247
Q

What condition is pneumatosis intestinalis a hallmark feature of?

A

It is presence of intramural gas

Necrotising enterocolitis (inflammation and necrosis of the bowel wall!)

248
Q

Paediatrics BLS outline

A

Unresponsive?
Call for help
Open airways. look, listen, feel for breathing.
Give 5 rescue breaths
Check for signs of circulation
15 chest compressions:2 rescue breaths (100/120CP per min)

249
Q

How should chest compressions be administered in infants and children?

A

In infants: use two-thumb encircling technique
In children (>1yo): compress the lower half of sternum with one hand

250
Q

Describe the difference in clinical severity of alpha-thalassaemia

A

There are two separate alpha globulin genes in each chromosome.

If 1/2 alleles are affected: hypochromic, microcytic normal Hb level

If 3 alpha globulin alleles affected: hypochromic, microcytic anaemia with splenomegaly (HbH disease)

If 4 alpha globulin alleles are affected: death in utero (hydrops fetalis, Bart’s hydrops)

251
Q

Guideline on asthma treatment in 5-16yo

A
  1. Newly diagnosed: SABA
  2. Not controlled/newly Dx asthma with Sx >=3/wk/nighttime waking: SABA + low dose ICS (beclomethasone)
  3. SABA + low dose ICS + LTRA
  4. SABA + low dose ICS + LABA
  5. SABA + switch ICS/LABA with MART
  6. SABA + switch moderate dose ICS with MART
  7. SABA +
    increase ICS to paediatric high dose
    trial additional drug (theophylline)
    seek advice from HCP with expertise is asthma
252
Q

When is the rotavirus immunisation given?

A

2 doses, first at 2m and then second at 3m

253
Q

Two types of pre-school wheeze

A

Episodic viral wheeze: only when there is viral URTI and Sx free between episodes
Multiple trigger wheeze e.g. exercise, allergens and cirgarette smoke

254
Q

Advice given to parents who has a child with pre-school wheeze

A

STOP SMOKING

255
Q

Mx of episodic viral wheeze(3)

A
  1. Tx is symptomatic only
  2. FIRST LINE - SABA (Salbutamol)/ anticholinergic via spacer
  3. Intermittent LTRA, intermittent inhaled CS, both
256
Q

Mx of multiple trigger wheeze

A

Trial of either inhaled CS or LTRA (montelukast) typically for 4-8wks

257
Q

List 5 major RFs of SIDS

A

Prone sleeping
Parental smoking
Bed sharing
Hyperthermia, head covering
Prematurity

Others: male, multiple birth, social classes IV+V, maternal drug use, incidence increase in winter

258
Q

List three protective factors for SIDS

A

Breastfeeding
Room sharing (NOT BED SHARING)
Use of dummies (pacifiers)

259
Q

Mx of Hirschprungs disease

A

Initially, rectal washouts, bowel irrigation. Then surgical Mx is DEFINITIVE, done to the affected segment of the bowel.

260
Q

S+Sx of fetal alcohol syndrome

A

Acutely, may show alcohol withdrawal Sx (hypotonia, irritable, tremors)
Features: small palpebral fissures, thin vermillion border, smooth filtrum, learning difficulties, microcephaly

261
Q

Most common cause of pneumonia in children

A

S pneumoniae

262
Q

Mx of pneumonia

A

FIRST LINE is amoxicillin, but if mycoplasma/chlamydia suspected –> erythromycin or add it if no improvement with amox

If pneumonia associated with influenza is co-amoxiclav

263
Q

Ix for bacterial meningitis

A

LP (avoid if any sign of increased ICP)

264
Q

Signs of increased ICP (hence CI to LP)

A

Focal neurological signs
Papilloedema
Significant budging of fontanelle
DIC
Signs of cerebral herniation

265
Q

S+Sx of Fragile X syndrome

A

Learning difficulties
Large low set ears, long thin face, high arched palate
Macroorchisim
Hypotonia
Autism more common
Mitral valve prolapse

266
Q

Dx of Fragile X syndrome

A

Made antenatally by chorionic villus sampling/ aminocentesis
Analysis of no. of CGG repeats using restriction endonuclease digestion and Southern blot analysis

267
Q

CF should minimise contact with … to prevent cross infection

A

Burkholderia cepacia complex and pseudomonas aeruginosa

268
Q

Key features of Kawasaki disease

A

High grade fever resistant to anti-pyretics (>5days fever)
Strawberry tongue, cervical lymphadenopathy
Red palms of hand and soles of feet that later peel
Bright red, cracked lips

269
Q

School exclusion rules for D&V

A

Until Sx have settled for 48hrs

270
Q

School exclusion rules for whooping cough

A

2 days after commencing Abx (or 21days from onset of Sx if no Abx)

271
Q

Define cerebral palsy

A

Non-progressive lesion present in motor pathways in developing brain (most common cause of major motor impairment)

272
Q

List 4 features of cerebral palsy

A

Abnormal tone early infancy
Delayed motor milestones
Abnormal gait
Feeding difficulties
Learning difficulties, epilepsy, squints, hearing impairments

273
Q

Classification of different types of cerbral palsy (4)

A

Spastic
Dyskinetic
Ataxic
Mixed

274
Q

Mx of cerebral palsy

A

MDT required as this is a CHRONIC condition
Tx for spasticity: oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery and selective dorsal rhizotomy
Anticonvulsants, analgesia as required

275
Q

What is in 6 in 1 vaccine?

A

Diptheria, tetanus, whooping cough, polio, Hib, hepB

276
Q

What vaccines are given at 2m?

A

6-in-1 vaccine, one dose of Men B, one dose of Rotavirus vaccine

277
Q

Mx of asthma in <5yo

A
  1. SABA
  2. SABA + 8wk trial of moderate dose inhaled CS
  3. SABA + paediatric low dose CS + LTRA
  4. Stop LTRA and refer to an paediatric asthma specialist
278
Q

What is MART?

A

Form of combined ICS and fast-acting LABA treatment (formoterol)

279
Q

What constitutes a low, moderate, high dose ICS?

A

LOW : <=200micrograms budesonide
MODERATE : 200micrograms-400micrograms budesonide
HIGH : >400micrograms budesonide

280
Q

Cause of acute epiglottitis

A

Haemophilus influenzae type B

281
Q

S+Sx of acute epiglottitis

A

Rapid onset
High temp, generally unwell
Stridor
Drooling of saliva
Tripod position = easier to breathe if leaning forward and extending in a seated position

282
Q

When should children be able to sit without support?

A

7-8m

283
Q

Developmental milestones at 3yo

A

Ride a tricycle using pedals, walks upstairs without holding onto rail

284
Q

S+Sx of dyskinetic cerebral palsy

A

ATHETOID MOVEMENTS AND ORO-MOTOR PROBLEMS
Slow writhing movements of hands and feet, difficulty holding onto objects
Drooling

285
Q

Following birth of a baby, what should you ensure you do?

A
  1. Dry the baby, maintain temperature, start clock
  2. Assess tone, breathing and HR
  3. If gasping/not breathing –> give 5 inflation breaths
  4. Reassess HR , if no increase ensure adequate breaths are being given by checking chest movement
  5. If chest not moving you assume inflation breaths are inadequate –> recheck head position, consider 2-person airway control and repeat inflation breaths and look for response
  6. If chest moving but HR undetectable/<60, start chest compression at ratio of 3compressions to 1inflation breaths
  7. Reassess HR every 30secs, if slow or undetectable, consider IV access and drugs
286
Q

List 5 acyanotic congenital heart diseases

A

VSD (increase risk of endocarditis)
ASD
PDA
Coarctation of the aorta
Aortic valve stenosis

287
Q

Koplik spots (small white lesions on buccal mucosa) pathognomonic for…

A

Measles

288
Q

What is APGAR score?

A

Assess health of baby, conducted at 1mins and 5mins of life. If the score is low, it is repeated every 10mins.

289
Q

What does the APGAR score suggest?

A

0-3 = very LOW
4-6 = moderate low
7-10 = good state

290
Q

What is intraventricular haemorrhage?

A

Haemorrhage that occurs in the ventricular system of the brain. Occurs in premature neonates spontaneously. The blood may clot and occlude CSF flow and result in hydrocephalus.

291
Q

Tx of intraventricular haemorrhage

A

Largely supportive
Hydrocephalus and rising ICP: indication for shunting

292
Q

When does transient tachypnoea of newborn usually settle?

A

Within 1-2days

293
Q

Name a late complication of Down’s syndrome

A

AD

294
Q

List three key Sx of bronchiolitis

A

Mild fever, persistent cough, wheeze

295
Q

Mx of achondroplasia

A

No specific therapy. Some benefit from limb lengthening procedures.

296
Q

RFs of achondroplasia

A

70% sporadic mutation
Advancing parental age at the time of conception

297
Q

Pattern of inheritance of achondroplasia

A

Autosomal dominant

298
Q

ALL breech babies at/after 36wks require what screening?

A

DDH - ultrasound scan of the pelvis

299
Q

What murmur is found in TOF?

A

Ejection systolic murmur due to pulmonary stenosis

300
Q

Explain what the phenomenon of anticipation means in Huntington’s disease

A

Earlier onset and increased severity of disease

301
Q

List 3 S+Sx of androgen insensitivity syndrome

A

Primary amenorrhoea
Undescended tests causing groin swellings
Breast development may occur as a result of conversion of testosterone to oestradiol

302
Q

What is androgen insensitivity syndrome?

A

X-linked recessive condition due to end-organ resistance to testosterone causing a genotypically 46XY to have a female phenotype.

303
Q

Mx of androgen insensitivity syndrome

A

Counselling: raise child as female
Bilateral orchidectomy (increased risk of testicular Ca due to undescended testes)
Oestrogen therapy

304
Q

Ix for androgen insensitivity syndrome

A

Buccal smear or chromosomal analysis to reveal 46XY genotype

305
Q

When is MenB vaccination given?

A

2m, 4m and 12-13m

306
Q

What are venous hums?

A

Continuous blowing noise heard just below the clavicles due to turbulent blood flow in the great veins returning to the heart.

307
Q

Surgical Mx of biliary atresia

A

The only DEFINITIVE TX
Hepatoportoenterostomy (aka Kasai portoenterostomy) = blocked bile ducts are removed and replaced with a segment of the small intestine. Restores bile flow from liver to proximal small bowel.
If there are signs of end-stgae disease/progressive cholestasis/hepatocellular decompensation, development of severe portal HTN.

308
Q

Mx of scarlet fever

A

Oral penicillin V 10 days
Note: if allergy to penicillin, give azithromycin

309
Q

S+Sx of neonatal sepsis

A

Resp distress (85%): grunting, nasal flaring, use of accessory resp muscles, tachypnoea
Tachycardia
Apnoea, jaundice, change is mental status/lethargy

310
Q

S+Sx of benign rolandic seizures

A

Night-time, partial seizures (possible secondary generalisation), otherwise normal

311
Q

Name a neck mass that rises on protrusion of the tongue

A

Thyroglossal cyst

312
Q

Cardiac abnormalities in Turner’s syndrome

A

Ejection systolic murmur from bicuspid aortic valve
Coarctation of the aorta

313
Q

Mneumonic for Kawasaki disease presentation

A

Need at least 5 of the Sx (also more common in <5yo)
CRASH BURN
Conjunctival infection
Rash
Adenopathy (lymph)
Strawberry tongue
Hands (swelling/erythema of hands/feet)
BURN - fever >5days

314
Q

Mx of pyloric stenosis

A

Ramstedt pyloromyotomy

315
Q

Child presenting with acute limp <3yo

A

Refer for urgent paediatric assessment to rule out trauma, septic arthritis

316
Q

Ix for Hirschprung’s disease

A

Full-thickness rectal biopsy

317
Q

Limp + fever in a child Mx

A

Must differentiate between septic arthritis and other serious causes
–> fever is a RED flag, so need urgent specialist assessment
–> if child is 3-9yo, well, febrile, limping, Sx<72hrs, then can be monitored in primary care

318
Q

When is DMSA used?

A

Assess renal scarring due to vesicoureteric reflux

319
Q

Bronchiolitis vs VIW

A

Bronchiolitis: less than 12m old, wheeze + FINE CRACKLES
VIW: 1-7yo, wheeze

Asthma is usually >5yo

320
Q

List 5 red flags in a child with a fever

A

Moderate/severe chest wall recession
Does not wake if aroused
Reduced skin turgor
Mottled/blue appearance
Grunting

321
Q

Why is IV amoxicillin given to babies with cefotaxime?

A

To cover for Listeria

322
Q

Most common location of urethral opening in boys suffering from the condition?

A

On the distal ventral surface of the penis

323
Q

Define nephrotic syndrome

A

Triad of proteinuria (>1g/m2 per 24hrs)
Hypoalbuminaemia (<25g/L)
Oedema

324
Q

Most common cause of nephrotic syndrome in children

A

80% due to minimal change glomerulonephritis

325
Q

When should you consider prostaglandin E1 for PDAs?

A

This works differently to indomethacin/ibuprofen as it keeps the patent duct open.
It is used whilst awaiting surgery if PDA is associated with another congenital heart defect amenable to surgery.

326
Q

Ix of choice for intersussception

A

USS - may show target like mass

327
Q

Define retinoblastoma

A

Malignant tumour of retinal cells, accounts for 5% of severe visual impairment of children

328
Q

S+Sx of retinoblastoma

A

Absence of red reflex, replaced by white pupil (leukocoria) - most common
Stabismus
Visual problems

329
Q

Mx of retinoblastoma

A

Enucleation
For advanced disease: chemotherapy (bilateral) + laser treatment to retina ± chemotherapy (advanced disease)

330
Q

Cause of retinoblastoma

A

Unilateral (80% spontaneous), bilateral (100% hereditary)
AD, chromosome 13 encoding pRB (protein retinoblastoma)

331
Q

Average age of Dx of retinoblastoma

A

18m

332
Q

Prognosis of retinoblastoma

A

Most cured, some may be visually impaired (>90% survive to childhood)
Risk of secondary malignancy (sarcoma) in survivors of hereditary retinoblastoma

333
Q

Define central cyanosis

A

Conc of reduced Hb in blood exceeds 5g/dl

334
Q

What is the nitrogen washout test?

A

Used to differentiate cardiac from non-cardiac causes
1. Give infant 100% O2 for 10mins
2. Take ABG
3. pO2 <15kPa&raquo_space; cyanotic congenital heart disease

335
Q

List 3 causes of cyanotic congenital heart disease

A

Tetralogy of Fallot (TOF)
Transposition of great arteries (TGA)
Tricuspid atresia

336
Q

Initial Mx of cyanotic congenital heart disease (2)

A
  1. Supportive care
  2. Prostaglandin E1 e.g. alprostadil - used to maintain PDA if the congenital heart defect depends on the patent duct
337
Q

Define acrocyanosis

A

Peripheral cyanosis around mouth and extremities (hands and feet) in healthy newborns persists 24/48hrs

338
Q

Child can walk unsupported by…

A

13-15m

339
Q

List 5 causes of nappy (napkin) rash

A

Irritant dermatitis - most common cause, due to irritant effect of urinary ammonia and faeces, spares creases
Candida dermatitis - erythematous rash with involve the flexures and characteristic satellite lesions
Seborrhoeic dermatitis - erythematous rash with flakes, may coexist with scalp rash
Psoriasis - erythematous scaly rash but rare cause
Atopic eczema - extensor

340
Q

General Mx of nappy rash

A

Disposable nappies are preferable to towel nappies
Expose napkin area to air when possible
Apply barrier cream (e.g. Zinc and castor oil)
Mild steroid cream (1% hydrocortisone) in severe cases

341
Q

Mx of suspected candidal nappy rash

A

Topical imidazole
Stop the use of barrier cream until candida has settled

342
Q

Define Ebstein’s anomaly

A

Congenital heart defect characterised by low insertion of tricuspid valve resulting in large atrium

343
Q

What is in the Kocher criteria to differentiate between transient synovitis and septic arthritis?

A

Temp >38.5
Unable to weight-bear on affected limb
ESR > 40
WCC > 12

(very low, 3%, 40%, 93%, 99%)

344
Q

When is it ‘normal’ to have neonatal hypoglycaemia?

A

First 24hrs of life, but does not have any negative consequences as they can utilise alternate fuels like ketones and lactate

345
Q

List 2 conditions associated with hypospadias

A

Cryptorchidism and inguinal hernia

346
Q

5 steps of newborn resus

A
  1. Dry baby and maintain temp
  2. Assess tone, RR, HR
  3. If gasping/ not breathing give 5 inflation breaths
  4. Reassess (chest movements)
  5. If HR not improving and <60bpm start compression and ventilation (3:1)
347
Q

State the risk of further febrile convulsions and RFs

A

1 in 3
RFs for further seizures : age of onset <18m, fever <39, shorter duration of fever before seizure, FHx febrile convulsions

348
Q

What is the risk of child developing epilepsy if they have had a febrile convulsion?

A

RFs for developing epilepsy: FHx, complex febrile seizures, background of neurodevelopmental disorder
Children with NO RFs: 2.5% risk
Children with all 3 RFs: higher risk of 50%

349
Q

How to manage a child with a limp + fever?

A

Even if the Dx of transient synovitis is likely, fever is a red flag –> need urgent specialist assessment

350
Q

Define ITP (IDIOPATHIC THROMBOCYTOPENIC PURPURA)

A

Immune-mediated reduction in platelet count

351
Q

S+Sx of ITP

A

Bruising
Petechial/ purpuric rash
Bleeding is less common and typically presents as epistaxis/gingival bleeding

352
Q

Ix for ITP (3)

A

FBC: isolated thrombocytopenia
Blood film
Bone marrow examinations only required if there are atypical features e.g. lymph node enlargement/splenomegaly, high/low WCC, failure to resolve/respond to Tx

353
Q

What do patients with ITP tend to develop?

A

Viral infection

354
Q

Mx of ITP (3)

A
  1. Usually no Tx required (resolves in 80% of children with 6m +/- Tx)
  2. Advice to avoid activities that may result in trauma e.g. team sports
  3. If platelet count is very low (<10x10^9/L)/ significant bleeding: oral/IV CS, IV Ig, platelet transfusion used in emergency (e.g. active bleeding) but are only a temporary measure as they are soon destroyed by circulating Abs
355
Q

List 5 conditions that result in obesity in children

A

GH def
Hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prader Willi syndrome

356
Q

List the consequences of obesity in children

A

Orthopaedic issues: slipped upper femoral epiphyses, Blount’s disease, MSK pain
Psychological: poor self-esteem, bullying
Sleep apnoea
Benign intracranial HTN
Long-term consequences: increased incidence. ofT2DM, HTN, IHD

357
Q

When should you suspect whooping cough?

A

Acute cough lasting more than 14days + without another apparent cause and has 1/+ of these features: paroxysmal cough, inspiratory whoop, post-tussive vomiting, undiagnosed apnoeic attacks in young infants

358
Q

Name 3 Abx for whooping cough and its indication

A

Oral macrolide (e.g. clarithromycin, azithromycin, erythromycin) indicated if cough is within the previous 21 days to eradicate the organism and reduce spread

359
Q

List 2 conditions for which throat Ex is contraindicated

A

Croup and acute epiglottitis

360
Q

Define juvenile idiopathic arthritis (JIA)

A

Arthritis occurring in <16yo that lasts for >6wks

361
Q

S+Sx of JIA (7)

A

Pyrexia
Salmon-pink rash
Lymphadenopathy
Arthritis, uveitis
Anorexia, weight loss

362
Q

Ix for JIA

A

ANA positive , esp in JIA
Rheumatoid factor negative

363
Q

Difference between early and late shock

A

Early shock: normal BP, tachycardia, tachypnoea, pale/mottled, reduced

Late shock: hypotension, bradycardia, acidotic (Kussmaul), blue, absent

364
Q

Typical presentation of laryngomalacia

A

Congenital abnormality of the larynx, very common benign cause of noisy breathing infants
Stridor at 4wks of age

365
Q

Vaccinations given 13-18yo

A

3 in 1 teen booster (tet, diphtheria, polio)
Men ACWY

366
Q

Venous hums

A

Innocent murmur, due to turbulent blood flow in great veins returning to heart - continuous blowing noise heard below clavicles

367
Q

Still’s murmur

A

Innocent murmur, low-pitched sound heard at lower left sternal edge

368
Q

List characteristics of an innocent ejection murmur

A

Soft-blowing murmur in pulmonary area/ short buzzing in aortic area
May vary with posture
Localised with no radiation
No diastolic component, thrill, added sounds (clicks)
Asymptomatic
No other abnormality

369
Q

What organism acute epiglottitis?

A

Haemophilus influenzae type B

370
Q

Where can lesions of hand, foot, mouth disease be found?

A

Lesions on hands and feet, groin/buttocks

371
Q

Characterise the rash found in hand, foot. andmouth disease

A

25mm scattered erythematous macules and papules, often with central greyish vesicle

372
Q

State the 4Ts and 4Hs - reversible causes of cardiac arrest

A

Hypoxia, hypothermia, hypovolaemia (hypotension), hypo/hyper - kalaemia, glycaemia, calcaemia

Tension pneumothorax, tamponade, thromboembolism, toxicity

373
Q

What is defined as a moderate asthma attack in children 2-5 and >5yo?

A

SpO2 > 92%

+ in >5yo, PEF >50%

No clinical features of severe asthma

374
Q

Mx of mild-moderate asthma attack in children

A

Bronchodilator therapy: beta-2-agonist via spacer (for child <3yo, use close-fitting mask), give 1 puff every 30-60secs up to a max of 10puffs, one puff every 30-60secs up to max 10 puffs, if Sx not controlled, repeat beta-2-agonist and refer to hospital

All asthma exacerbation: oral prednisolone (steroid) for 3-5days (20mg od // 30-40mg od)

375
Q

List three characteristics of children associated with Perthes disease

A

Short, hyperactivity (disruptive behaviour), primary school kids

376
Q

When is the first MMR vaccine given?

A

12-13m

Then 3-4yo

377
Q

First sign of puberty in males

A

Testicular growth at around 12yo (10-15yo), >4ml of testicular volume indicates puberty

378
Q

First sign of puberty in females

A

Breast development around 11.5yo (9-13yo)

379
Q

Immunisations given at 12-13m

A

Hib/MenC, MMR, PCV, Men B

380
Q

What is CHD associated with?

A

Pulmonary hypoplasia (as part of a sequence alongside hernial development rather than direct compression of lungs by the herniated viscera)

381
Q

Define pulmonary hypoplasia

A

Newborn infants with underdeveleped lungs

382
Q

List 2 causes of pulmonary hypoplasia

A

Oligohydraminos, CHD

383
Q

Mx of umbilical hernias

A

Typically resolve by 4-5 years of age
If large/symptomatic perform elective repair at 2-3yo
If small and asymptomatic, perform elective repair at 4-5yo

384
Q

List 3 factors associated with umbilical hernias

A

Afro-Caribbean infants
Down’s syndrome
Mucopolysaccharide storage disease

385
Q

Ix of choice for intussusception

A

Ultrasound scan

386
Q

List 6 S+Sx of cow’s milk protein intolerance

A

Regurg, vomiting
Diarrhoea
Urticaria, atopic eczema
Colic Sx: irritability, crying
Wheeze, chronic cough
Rarely angioedema, anaphylaxis may occur

387
Q

Ix for cow’s milk protein intolerance

A

Usually clinical (cow’s milk protein elimination)
Others: Skin prick/patch testing, total IgE and specific IgE RAST for cow’s milk protein

388
Q

Mx if severe cow’s milk protein intolerance Sx (failure to thrive)

A

Refer to a paediatrician

389
Q

Mx of cow’s milk protein intolerance if formula-fed

A

Extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with ild-moderate symptoms
Amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF
Around 10% of infants are also intolerant to soya milk

390
Q

Mx of cow’s milk protein intolerance if breastfed

A

Continue breastfeeding
Eliminate cow’s milk protein from maternal diet. Consider prescribing calcium supplements for breastfeeding mothers whose babies have, or are suspected to have, CMPI, to prevent deficiency whilst they exclude dairy from their diet
Use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months

391
Q

Prognosis of CMPR

A

In children with IgE mediated intolerance around 55% will be milk tolerant by the age of 5 years
In children with non-IgE mediated intolerance most children will be milk tolerant by the age of 3 years
A challenge is often performed in the hospital setting as anaphylaxis can occur

392
Q

List key features of rubella

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

393
Q

Diagnostic Ix for pyloric stenosis

A

US Abdomen

394
Q

Presentation of laryngomalacia

A

Congenital abnormality of the larynx. Infants typically present at 4wks of age with stridor.

395
Q

List 4 DDx of stridor

A

Croup
Acute epiglottitis
Inhaled foreign body
Laryngomalacia

396
Q

What is transient synovitis referred to as?

A

Irritable hip

397
Q

List 6 Ix for fever in <3m

A

FBC
Blood culture
CRP
Urine test for UTI
CXR if resp signs present
Stool culture if diarrhoea present

398
Q

Describe the rash that presents with Parvovirus B19

A

Slapped cheek syndrome, where the rash starts on the cheeks and then spreads

399
Q

What electrolyte disturbance is caused by pyloric stenosis?

A

Hypochloraemic, hypokalaemic metabolic alkalosis

400
Q

RFs of meconium aspiration syndrome

A

Post-term born after 42wks (44%)
Maternal HTN, pre-eclampsia, chorioamnionitis, smoking, substance abuse

401
Q

School exclusion criteria for scarlet fever

A

24hrs after starting Abx

402
Q

True or false: ITP is often preceded by viral illness

A

True

403
Q

If a baby fits the screening criteria for DDH, when should they be screened using USS?

A

6wks

404
Q

Pain after exercise, intermittent swelling and locking of knees

A

Osteochondritis dissecans

A joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.

405
Q

First sign of puberty in girls

A

Breast development around 11.5yo of age (9-13)

406
Q

RR and HR of healthy infants

A

RR of 30-60 breaths per min
Regular pulse of 100-160bpm

407
Q

Murmur for VSD

A

Pansystolic murmur in lower left sternal border

408
Q

Murmur for coarctation of aorta

A

Cresendo-decrescendo murmur in upper left sternal border

409
Q

Murmur for PDA

A

Diastolic machinery murmur in the upper left sternal border

410
Q

Murmur for pulmonary stenosis

A

Ejection systolic murmur in upper left sternal border

411
Q

Mx of Perthes disease

A

Keep femoral head within acetabulum: cast, braces
If less than 6yo, observation
Older: surgical Mx with moderate results
Operate on severe deformities

412
Q

Prognosis of Perthes disease

A

Most cases resolve with conservative Mx, early Dx improves outcomes.

413
Q

When should you admit the child for bronchiolitis?

A

Usually self-limiting, but important to deteriorate in the first 72hrs of illness:
Apnoea, persistent O2 sats of <92%
Inadequate fluid intake (<50% of normal fluid intake), persisting severe resp distress e.g. grunting, marked chest recession, resp rate >70breaths/min

414
Q

Murmur for bicuspid aortic valves

A

Ejection systolic murmurs

415
Q

Organism accountable for croup?

A

Parainfluenza virus

416
Q

Organism accountable for bronchiolitis?

A

RSV

417
Q

Organism accountable for whooping cough

A

Bordetella pertussis

418
Q

What is transposition of the great arteries?

A

Aorta leaves the right ventricle, pulmonary trunk leaves the left ventricle

419
Q

S+Sx of transposition of the great arteries

A

Cyanosis, tachypnoea, loud single S2, prominent right ventricular impulse, egg-on-side appearance on CXR

420
Q

Mx of transposition of the great artiers

A

Maintenance of the ductus arteriosus with prostaglandins, surgical correction is definite

421
Q

Immediate Mx of CDH in a neonate

A

Immediately intubate and ventilate

422
Q

Mx of immune thrombocytopenia (idiopathic thrombocytopenia)

A

Usually no Tx required. Normally resolves in around 80% of children with 6m. If platelet count is <10x10^9/L / sig bleeding, then oral/IV CS or Ig, platelet transfusion used in an emergency but only a temp measure as they are soon destroyed by circulating Abs.

423
Q

Hand preference abnormality

A

Hand preference before age of 12m&raquo_space; cerebral palsy

424
Q

Name the hearing test conducted at >3yo

A

Pure tone audiometry

425
Q

Mx of UTI in >3m

A

Treat with oral Abx for 3days according to local guidelines, usually trimetoprim, niturofurantoin, cephalosporin, amoxicillin

426
Q

Key features of Osgood-Schlatter disease

A

Seen in sporty teens. Pain, tenderness and swelling over tibial tubercle.

427
Q

Cause of roseola infantum

A

HHV6

428
Q

List features of atypical UTIs

A

Seriously ill, poor urine flow, abdo/bladder mass, raised Cr, septicaemia, failure to respond to Tx with suitable Abx within 48hrs, infection with non-E.coli organisms

429
Q

Pattern of inheritance of hereditary haemochromatosis

A

Autosomal recessive

430
Q

List 3 features of Pierre-Robin syndrome

A

Micrognathia, posterior displacement of the tongue (may result in upper airway obstruction), cleft palate

431
Q

When do you give oral macrolide for whooping cough?

A

If the onset of cough is within previous 21days to eradicate the organism and reduce the spread

432
Q

When is rotavirus vaccine given?

A

2 doses - 2m and 3m

433
Q

When should you not give rotavirus?

A

1st dose after 14+6
2nd dose 23+6 due to theoretical risk of intussusception

434
Q

Classic presentation of chickenpox

A

Increased temp of 2days before developing erythematous vesicles affecting predominantly the torso and face

435
Q

When is the infectious period of chicken pox?

A

1-2days before the rash appears, infectivity continues until all the lesions are dry and have crusted over (5days after onset of rash)

436
Q

Mx of a child below 0.4th centrile for height

A

Referral to paediatric outpatients clinic

437
Q

Mx of a child below 2nd centile for height

A

Review by GP

438
Q

Mx of CF patients

A

MDT approach

  1. Regular (at least 2 times a day) chest physiotherapy and postural drainage, deep breathing exercises
  2. High calorie diet, high fat intake with pancreatic enzyme supplementation for every meal
  3. Minimise contact with each other to prevent cross infection with Burukholderia cepacia complex and pseudomonas aeruginosa
  4. Vitamin supplementation
  5. Lung transplantation - CI in patients with crhonic Burkholderia cepacia
439
Q

Triad of features of Shaken Baby Syndrome

A

Retinal haemorrhages, subdural haematoma, encephalopathy

440
Q

When are bone marrow ex required for ITP?

A

When there are atypical features e.g. lymph node enlargement/splenomegaly, high/low WCC, failure to resolve/ respond to Tx

441
Q

When is the heel prick test conducted?

A

5 and 9 days of life

442
Q

What causes CROUP?

A

Parainfluenza VIRUS

443
Q

Most common complication of roseola infantum

A

FEBRILE CONVULSIONS

444
Q

Mx for child presenting with ?transient synovitis

A

Urgent paeds referral for assessment

445
Q

Characteristics of toddler’s diarrhoea

A

Stool varying in consistency, may contain undigested food

PM (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions