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3a PTS - PM - ZTF > Paeds > Flashcards

Paeds Flashcards

1
Q

HUS triad

A
  1. Low platelet count (thrombocytopenia)
    - consumption of platelets for blood clots
  2. Haemolytic anaemia (normocytic - HHAAA)
    - blood clots within the small vessels chop up the red blood cells as they pass by (haemolysis), causing anaemia
  3. Acute kidney injury
    - blood flow through the kidney is affected by the clots and damaged red blood cells, leading to acute kidney injury
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2
Q

HUS presentation

A

Brief gastroenteritis (bloody diarrhoea)

5 days after:
Reduced urine output
Haematuria
Abdominal pain
Lethargy and irritability
Confusion
Hypertension
Bruising

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3
Q

Causes of HUS

A

Most common cause: toxin produced by E.coli called the shiga toxin
- shigella also produces this toxin and can cause HUS

The use of antibiotics and anti-motility medications such as loperamide to treat the gastroenteritis INCREASE THE RISK of developing HUS

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4
Q

Infective mononucleosis causative organism

A

Epstein Barr Virus (EBV)

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5
Q

Features of infectious mononucleosis

A

Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar enlargement with white coating
Splenomegaly (and in rare cases splenic rupture)

intensely itchy maculopapular rash in response to AMOXICILLIN or cefalosporins in 99% of patients

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6
Q

Infectious mononucleosis tests

A

‘Mono spot test’ for heterophile antibodies (produced in response to EBV infection)
- can take up to 6 weeks for these antibodies to be produced

Anti-viral capsid antigen (VCA) antibody test
- IgM antibody: rises early and suggests acute infection
- IgG antibody: persists after the condition and suggests immunity

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7
Q

5 signs of leukaemia

A

Failure to thrive
Pallor (anaemia)
Neutropenia (infection)
Petechiae + abnormal bleeding/bruising (secondary to thrombocytopenia)
Lymphadenopathy
Hepatosplenomegaly

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8
Q

Main investigations leukaemia

A

FBC - 1st line
Bone marrow biopsy - diagnostic
Blood film - to look for abnormalities

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9
Q

Leukaemia associated with Down’s syndrome

A

ALL

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10
Q

4 complications of chemotherapy

A
  1. Stunted growth and development in children
  2. Infertility
  3. Neurotoxicity
  4. Tumour lysis syndrome
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11
Q

Explain the pathophysiology of congenital adrenal hyperplasia

A
  1. Deficiency of 21-hydroxylase enzyme
  2. 21-hydroxylase enzyme usually converts progesterone into aldosterone and cortisol = underproduction of aldosterone and cortisol
  3. unconverted progesterone = converted into testosterone = overproduction of androgens
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12
Q

Why does hypoglycaemia, hyponatraemia and hyperkalaemia occur in CAH

A

Low cortisol = Hypoglycaemia
Low aldosterone = Hyponatraemia, Hyperkalaemia

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13
Q

Why does skin hyperpigmentation occur in CAH

A

Anterior pituitary responds to low cortisol by increasing ACTH
By product of ACTH = melanocyte stimulating hormone

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14
Q

Characteristics of CAH in cases presenting later in childhood

A

Tall for age
Deep voice
Early puberty
Females: absent periods, facial hair
Males: large penis, small testicles

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15
Q

CAH management

A

Corticosteroids:
Hydrocortisone (CORTISOL replacement)
Fludrocortisone (ALDOSTERONE replacement)

Female patients with virilised genitalia may require corrective surgery

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16
Q

Risk factors for further febrile convulsions

A

Age of onset < 18 months
Fever < 39
Shorter duration of fever before the seizure
FHx of febrile convulsions

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17
Q

Features of a simple febrile seizure

A

Generalised tonic clonic seizure
Lasts less than 15 mins
Only occur once during a single febrile illness

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18
Q

management following febrile convulsion

A

Treat underlying cause (usually viral or bacterial infection)
Reassurance and parental education
Complex - further investigation

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19
Q

Eye muscle controlled by cranial nerve 6 (abducens) and action

A

Lateral rectus

‘ABDuction’ = “out”

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20
Q

Eye muscles controlled by cranial nerve 3 (oculumotor) and action

A

Medial rectus - adduction
Superior rectus - elevates + turns medially
Inferior rectus - depresses + turns medially
Inferior oblique - elevates + turns laterally

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21
Q

Eye muscle controlled by cranial nerve 4 (trochlear) and action

A

Superior oblique

Depresses :( and turns laterally “down” :(

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22
Q

Other than “down and out” in a third nerve palsy, name 2 other presentations (usually indicating a ‘surgical’ cause of compression against the 3rd nerve)

A

Ptosis (levetor palpebrae superioris is not innervated)

Dilated fixed (non-reactive) pupil (parasympathetic nerves of iris sphincter not innervated)

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23
Q

Name 4 causes of a third nerve (oculomotor) palsy

A

Microvascular (diabetes, HTN, ischaemia)
Tumour
Cavernous sinus thrombosis
Posterior communicating artery aneurysm

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24
Q

Types of microcytic anaemia

A

TAILS

Thalassaemia
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning
Sideroblastic anaemia

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25
Q

Types of normocytic anaemia (3)

A

Increased reticulocyte count:
Acute blood loss
Haemolytic anaemia

Decreased reticulocyte count:
Aplastic anaemia

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26
Q

Causes of megaloblastic (impaired DNA synthesis) macrocytic anaemia

A

B12 deficiency
Folate deficiency

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27
Q

4 causes of normoblastic macrocytic anaemia

A

Drugs
Alcohol
Hypothyroidism
Liver disease

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28
Q

Causes of anaemia in infancy

A

Physiological (most common cause)
Anaemia of prematurity
Blood loss
Haemolysis
Twin-twin transfusion (shared placenta)

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29
Q

Test for haemolytic disease of the newborn

A

Direct coombs test (DCT)

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30
Q

Investigations show increased reticulocytes - 2 differentials

A

Haemolysis
Blood bloss

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31
Q

Causes of anaemia in older children

A

Iron deficiency anaemia secondary to dietary insufficiency (most common cause)
Blood loss e.g. menstruation in older girls

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32
Q

Four general symptoms of anaemia

A

Fatigue
Shortness of breath
Headache
Dizziness

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33
Q

Four general signs of anaemia

A

Pale skin
Conjunctival pallor
Tachycardia
Increased resp rate

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34
Q

Specific symptoms of iron deficiency anaemia

A

Pica (dirt cravings)
Hair loss

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35
Q

Specific signs of iron deficiency anaemia

A

Koilonychia (spoon shaped nails)
Angular chelitis (inflammation around mouth)
Atrophic glossitis (smooth tongue)
Brittle hair and nails

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36
Q

Inheritance pattern sickle cell anaemia

A

Autosomal recessive

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37
Q

When is sickle cell anaemia screened for (2)

A

High risk pregnant women are offered testing during pregnancy
Newborn screening heel prick test at 5 days of age

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38
Q

General management of sickle cell anaemia

A

Antibiotic prophylaxis (penicillin V) - due to splenectomy

Hydroxycarbamide (stimulates production of HbF) - prevents vaso-occlusive complications

Blood transfusion (for severe anaemia)

Bone marrow transplant (curative but high risk)

Avoid NSAIDs in complications of CKD

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39
Q

Name the four sickle cell crises

A

Vaso-occlusive crisis (> priapism)
Splenic sequestration crisis (> hypovolaemic shock)
Aplastic crisis (+ triggered by parvovirus B19)
Acute chest syndrome (= fever or resp symptoms WITH new infiltrates on CXR)

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40
Q

Factor deficiency in Haemophilia A and Haemophilia B

A

A = VIII (8)
B = IX (9)

8 is B and it’s the opposite way round

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41
Q

Presentation of haemophilia

A

Neonatal intracranial haemorrhage, haematomas + cord bleeding
Spontaneous bleeding into joints + muscles = joint damage and deformity, bruising

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42
Q

1st line investigation haemophilia

A

Clotting screen:
PT
APTT
fibrinogen

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43
Q

Management of haemophilia

A

IV infusion replacement of clotting factors (prophylactic or in response to bleeding)

In acute settings:
- IV infusion
- Desmopressin (to stimulate VWF)
- Antifibrinolytics e.g. tranexamic acid

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44
Q

APGAR score

A

Appearance
Pulse
Grimace
Activity
Respiratory

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45
Q

Presentation of biliary atresia (4)

A

prolonged jaundice (present > 14 days of age)
Dark urine and pale stools
hepatomegaly
splenomegaly
Appetite and abnormal growth

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46
Q

Investigatory blood test for biliary atresia

A

Serum bilirubin: total bilirubin may be normal with abnormally high conjugated bilirubin

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47
Q

Ebstein’s anomaly definition

A

congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle

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48
Q

Hirschprung’s disease definition

A

aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses

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49
Q

Definitive management Hirschsprung’s

A

surgery to affected segment of the colon (Swenson procedure)

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50
Q

3 bronchiolitis red flag signs

A

Severe respiratory distress e.g. grunting
Central cyanosis
Apnoea

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51
Q

Thalassaemia definition

A

Genetic defect in the protein chains of haemoglobin (alpha or beta)

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52
Q

Thalassaemia inheritance pattern

A

Autosomal recessive

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53
Q

Three key presentations of thalassaemia

A

Splenomegaly: fragile RBCS break down and collect in the spleen

Pronounced forehead and malar eminences + susceptibility to fractures: bone marrow expands to produce extra RBC to compensate

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54
Q

Diagnostic testing thalassaemia (3) + who is offered screening?

A

FBC: Microcytic anaemia
Haemoglobin electrophoresis: globin abnormalities
DNA testing: genetic abnormalities

Pregnant women are offered screening

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55
Q

A complication of thalassaemia (and recurrent infusions) + management of the complication

A

Iron overload

Management:
- serum ferritin monitoring
- limit transfusions
- iron chelation

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56
Q

Management of alpha thalassamia and beta thalassaemia major (4)

A

Regular blood transfusions
Iron chelation due to iron overload in transfusions
Splenectomy
Bone marrow transplant

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57
Q

Most likely demographic of patient with Kawasaki disease

A

Under 5 years old
Japanese or Korean
Male

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58
Q

Key complication of Kawasaki disease

A

Coronary artery aneurysm

Ix = transthoracic echocardiogram

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59
Q

Clinical features of Kawasaki disease

A

CRASH & BURN

Conjunctivitis (bilateral) 👀
Rash (widespread erythematous maculopapular)📍📍📍
Adenopathy (cervical lymphadenopathy)
Strawberry tongue 🍓
Hands: desquamation (skin peeling) on palms and soles

BURN (Persistent fever: >39c for >5 days 🥵)

Diagnostic criteria: fever for > 5 days PLUS 4 out of 5 of CRASH

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60
Q

Management Kawasaki disease

A

High dose aspirin (to reduce risk of thrombosis)
AND
IV immunoglobulins (to reduce risk of coronary artery aneurysm)

Close follow up using echocardiograms

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61
Q

Why is aspirin not usually used in the treatment of children?

A

Risk of Reye’s syndrome (acute increase in pressure within the brain)

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62
Q

Patient age group most likely to get septic arthritis

A

< 4 years old

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63
Q

Presentation of septic arthritis

A

Usually a single joint (often knee or hip)

Rapid onset:
- hot, red, swollen, painful joint
- refusing to weight bear
- stiffness and reduced range of motion
- systemic symptoms E.g. fever, lethargy, sepsis

usually results from haematological spread from a bacterial infection
elsewhere in the body, although it can occur following a skin wound such as chickenpox scar

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64
Q

Most common causative bacteria of sepsis arthritis

A

Staph aureus

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65
Q

Differential diagnosis septic arthritis

A

Transient sinovitis
Perthes disease
SUFE
Juvenile idiopathic arthritis

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66
Q

Management of septic arthritis

A

Aspiration: gram staining, crystal microscopy, culture, antibiotic sensitivities,
- joint fluid may be purulent

Empirical Abx given until microbial sensitivities known (Abx given 3-6 wks)

Severe cases = surgical drainage + washout

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67
Q

Bimodal age distribution in Hodgkin’s lymphoma

A

20 + 75

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68
Q

Risk factors for Hodgkin’s lymphoma

A

HIV
EBV
Autoimmune conditions (RA/sarcoidosis)
FHx

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69
Q

Describe the lymphadenopathy seen in Hodgkin’s (key presentation)

A

Cervical / Axilla / Inguinal
Non tender + “rubbery”
Pain when drinking alcohol

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70
Q

Hodgkin’s B symptoms

A

Unexplained Fever
Unexplained Weight loss
Drenching Night sweats

‘B’ symptoms = associated with B-cell abnormalities

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71
Q

Investigations Hodgkin’s lymphoma

A

Lactate dehydrogenase (LDH) = raised but not specific

Lymph node biopsy = diagnostic
- Reed Sternberg cells

CT/MRI/PET = diagnosing + staging

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72
Q

Ann Arbor staging

A

S1: one region of lymph nodes
S2: more than one region but same side of diaphragm
S3: above + below
S4: non-lymphatic (lungs/liver etc)

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73
Q

Management of Hodgkin’s lymphoma and risks of management options

A

Chemo: risk of leukaemia + infertility

Radiotherapy: risk of cancer, damage to tissues + hypothyroidism

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74
Q

Name 3 Non-Hodgkin lymphomas

A

Burkitt lymphoma
MALT lymphoma
Diffuse large B cell lymphoma

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75
Q

Non-Hodgkin management options

A

Watchful waiting
Chemo
Monoclonal antibodies E.g. rituximab
Radiotherapy
Stem cell transplant

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76
Q

Perthe’s disease definition

A

Avascular necrosis of the femoral head

It is idiopathic

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77
Q

Most common gender / age of onset Perthes disease

A

Boys aged 5-10

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78
Q

Presentation of Perthes disease

A

Younger than 10

Slow onset of:
- Pain in the hip or groin
- Limp
- Restricted in hip movements
- Possible referred pain to knee

No history of trauma (SUFE more likely if minor trauma history)

Associated with hyperactivity and short stature

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79
Q

Investigations for Perthes disease

A

1st line: X Ray (can appear normal)

Other:
- Blood tests (typically normal - useful for DDx)
- Technetium bone scan
- MRI scan

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80
Q

Four conservative management option for a Perthes disease patient who is under 6 years old/less severe disease

A

Bed rest
Traction
Crutches
Analgesia

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81
Q

Slipped upper femoral epiphysis definition

A

Head of the femur is displaced (slips) along the growth plate

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82
Q

Typical patient presentation of SUFE

A

Obese 12 year old boy undergoing growth spurt and may be history of minor trauma that triggers onset

Bilateral (75%)

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83
Q

Investigations for SUFE

A

1st line: X ray

Other:
- Bloods (typically normal - useful for DDx)
- Technetium bone scan
- CT scan
- MRI scan

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84
Q

Management of SUFE

A

Surgery to correct position and fix it in place

Surgery: Internal fixation across the growth plate

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85
Q

Developmental dysplasia of the hip definiton

A

Structural abnormality in the hips caused by abnormal development of the fetal bones during pregnancy - causes instability in the hips and a tendency for dislocation

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86
Q

Risk factors for DDH

A

Fs

Family history (1st degree)
Female
First born children
Feet first (Birth in breech position from 28 weeks onward)
Fat (high birth weight)
Fluid (oligohydramnios)

+ prematurity

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87
Q

What two tests are done in the NIPE to check for DDH

A

Barlow test (dislocation of an articulated femoral head / adduction and downward pressure)

Ortoloni test (relocation of a dislocated femoral head / abduction and upward pressure)

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88
Q

Diagnostic investigation of DDH in < 4.5 months

A

Ultrasound

>4.5 months = X-ray

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89
Q

Management of DDH

A

Pavlik harness if presentation <6 months (flexed and abducted)

Surgery if >6 months or if harness fails

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90
Q

Associated genetic condition of duodenal atresia

A

Down’s syndrome

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91
Q

Name 5 causes of intestinal obstruction

A

Intussusception
Meconium ileus
Hirschsprung’s disease
Oesophageal atresia
Duodenal atresia

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92
Q

X ray sign of duodenal atresia

A

Double bubble

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93
Q

Name 4 dysmorphic features of Down’s syndrome

A

Hypotonia
Brachycephaly
Prominent epicanthic folds
Upslanted palpebral fissures
Small ears + round face
Brushfield spots in the iris

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94
Q

Name 5 complications of Down’s syndrome

A

Learning disability
Visual problems (myopia, cataracts)
Recurrent otitis media
Deafness (eustachian tube abnormality)
Obstructive sleep apnoea
Cardiac defects (1 in 3): ASD, VSD, PDA, Tet of F

brain > eyes > ears > mouth > heart

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95
Q

How is Down’s syndrome primarily screened for

A

Combined test: ultrasound + maternal blood test

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96
Q

How is Down’s syndrome diagnosed prenatally (2)

A

Week 9 to 11: chorionic villus sampling

Week 14 to 18: amniocentesis

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97
Q

What is intussusception

A

The bowel telescopes into itself which thickens the overall size of the bowel and narrows the lumen

This causes a palpable mass + obstruction

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98
Q

Typical presentation of a patient with intussusception

A

More common in boys and typically 6 months - 2 years

Recent viral upper respiratory tract infection
Pale, lethargic and unwell
Features of intestinal obstruction (vomiting, absolute constipation, abdo distention)
Drawing legs up to abdomen
Redcurrant jelly stool
RUQ palpable mass (sausage shaped)

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99
Q

Key Investigation for intussusception

A

Ultrasound abdomen: shows ‘target sign’ or ‘doughnut sign’ which confirms diagnosis

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100
Q

Management of intussusception

A

Therapeutic enema/rectal air insufflation: force the folded bowel out

If therapeutic enema fails or if there is gangrenous bowel or perforation = surgical reduction

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101
Q

4 complications of intussusception

A

Obstruction
Gangrenous bowel
Perforation
Death

as the obstruction worsens, mesentery is stretched leading to venous obstruction. This then causes strangulation of the bowel, leading to necrosis of the bowel, generalised peritonitis and shock over time

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102
Q

Hirschsprung’s definition

A

Congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel + rectum

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103
Q

Pathophysiology of Hirschsprung’s

A

Absence of parasympathetic ganglion cells in the myenteric plexus

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104
Q

What increases the risk of Hirschsprung’s

A

Family history

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105
Q

Presentation of Hirschsprung’s associated enterocolitis

A

20% of neonates with Hirschsprung’s get HEC
2-4 weeks after birth

Fever, abdominal distention, diarrhoea with blood + septic features

LIFE THREATENING

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106
Q

Investigation of Hirschsprung’s

A

Diagnostic: full thickness suction rectal biopsy (shows absence of ganglion cells in mesenteric plexus)

Abdominal X-Ray can be used in addition to diagnose intestinal obstruction + HAEC: dilated loops of bowel with fluid levels

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107
Q

Definitive management of Hirschsprung’s

A

Surgical removal of the aganglionic section of bowel

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108
Q

How does NEC lead to death

A

Death of bowel tissue > perforation > peritonitis > shock > death

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109
Q

Presentation of NEC

A

first 2 weeks of life in neonates
Intolerance to feeds
Vomiting (milk from feeding particularly w/ green bile)
Distended, tender abdomen
Visible intestine loops lacking peristalsis
Absent bowel sounds
Blood in stools
Generally unwell/lethargic

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110
Q

Initial Investigations NEC

A

Bloods:
- FBC (thrombocytopenia + neutropenia)
- CRP
- capillary blood gas (to determine metabolic acidosis)
- blood culture (sepsis)

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111
Q

Diagnostic investigation NEC

A

Abdominal X-Ray
- dilated loops of bowel
- bowel wall oedema (thickened)
- pneumatosis intestinalis (intramural gas) = pathognomonic

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112
Q

Management of NEC

A

Suspected NEC: Nil by mouth with IV fluids, TPN + broad spectrum antibiotics to stabilise
- a nasogastric tube can be inserted to drain fluid + gas from the stomach intestines

SURGICAL EMERGENCY 🚨

May be left with a temporary stoma if significant bowel is removed

Risk: short bowel syndrome

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113
Q

Where is unconjugated bilirubin found

A

RBCs

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114
Q

Where is unconjugated bilirubin conjugated

A

Liver

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115
Q

How is conjugated bilirubin excreted

A
  1. Via the biliary system into the GI tract / stool
  2. urine
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116
Q

Common presentation of Hirschsprung’s in neonates

A

Failure or delay in passing meconium within 48 hours

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117
Q

Vaccines: 2 months

A

6 in 1 (1st)
Rotavirus (1st)
Men B (1st)

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118
Q

Vaccines: 3 months

A

6 in 1 (2nd)
Rotavirus (2nd)
Pneumococcal

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119
Q

Vaccines: 4 months

A

6 in 1 (3rd)
Men B (2nd)

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120
Q

Vaccines: 1 year

A

Pneumococcal (2nd)
Men B (3rd)
Hib/Men C (1st)
MMR (1st)

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121
Q

Vaccines: 3 years + 4 months

A

MMR (2nd)
4 in 1 pre-school booster

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122
Q

Inheritance pattern of Haemophilia

A

X-linked recessive disorder = only boys develop it and can only get it from their mother’s being carriers

von Willebrand = Women too

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123
Q

commonest lymphoma in childhood

A

non-Hodgkin

Hodgkin more common in adolescence

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124
Q

Most important differential diagnoses of limp in children 1-3 years

A

developmental dysplasia of the hip
septic arthritis
transient synovitis
trauma
leukaemia

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125
Q

Most important differential diagnoses of limp in children 11-16 years (3)

A

slipped upper femoral epiphysis (SUFE)
reactive arthritis
mechanical/overuse injuries (sports related)

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126
Q

3 causes of bilious vomiting in neonates

A

bilious vomiting = intestinal obstruction

Duodenal atresia
Meconium ileus
NEC

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127
Q

Meconium ileus presentation

A

Thick and sticky stool that causes obstruction

Typically presents 24-48 hours after birth with bilious vomiting and abdo distention

Associated with cystic fibrosis

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128
Q

Hirschprung’s disease associations (2)

A

3 times more common in males
Down’s syndrome

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129
Q

DKA triad

A

Hyperglycaemia i.e. blood glucose > 11mmol/l
Ketonaemia i.e. blood ketones > 3 mmol/l
Acidosis i.e. pH < 7.3

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130
Q

DKA key signs and symptoms

A

Fruity-smelling breath (due to presence of acetone)
Vomiting
Dehydration (due to glucose taking fluid out in urine)
Abdominal pain
Kussmaul respiration
Altered mental status (drowsiness/coma)

signs of DM e.g. weight changes, polyuria, polydipsia before DKA starts

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131
Q

DKA investigations

A

Blood glucose >11.1
Blood ketones >3
Urinary glucose + ketones
Bicarbonate < 15
Blood gas analysis (pH < 7.3)
Blood cultures (if infection is suspected)
U&Es (high potassium due to acidosis/lack of insulin)
Creatinine (mildly raised in dehydration)

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132
Q

Management of DKA: alert patient, not significantly dehydrated and can tolerate oral intake w/o vomiting

A

Encourage oral intake of fluids
Administer subcutaneous insulin

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133
Q

Major complication of treating DKA

A

Cerebral oedema caused by rapid correction of dehydration with IV fluids

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134
Q

Common precipitating factors causing DKA

A

Untreated type 1 diabetes
Infection
Dehydration
Myocardial infarction
Fasting

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135
Q

Management of DKA: patient is vomiting, confused, or significantly dehydrated

A

IV fluids (initial bolus of 10ml/kg 0.9% NaCl)

1 hour after starting IV fluids: Insulin infusion (0.1 units/kg/hour)

Once blood glucose falls below 14mmol/l: IV 10% dextrose at 125 mls/hour

correct dehydration evenly over 48 hours to reduce risk of cerebral oedema

monitor and correct hypokalaemia + cardiac signs after insulin administration

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136
Q

Does regular insulin treatment continue in the management of DKA

A

Long acting insulin should be continued
Short acting insulin should be stopped

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136
Q

DKA pathophysiology

A

uncontrolled lipolysis which results in an excess of free fatty acids that are ultimately converted to ketone bodies

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137
Q

DKA resolution defined values

A

pH > 7.3
Blood ketones < 0.6
Bicarbonate > 15

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138
Q

How soon should DKA be resolved

A

within 24 hours or a senior review is needed from an endocrinologist

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139
Q

Does insulin transport potassium into or out of cells

A

Into cells

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140
Q

pathognomonic sign for measles

A

Koplik spots on oral mucosal membranes

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141
Q

measles features

A

incubation period: 10-14 days

prodrome: irritable, conjunctivitis, fever

2 days after fever: koplik spots

3-15 days after fever: rash starts behind ears and spreads downwards

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142
Q

management of measles

A

self-resolving after 7-10 days of symptoms

children should be isolated until 4 days after symptoms resolve

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143
Q

most common complication of measles infection

A

Otitis media

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144
Q

most common cause of death in measles infection

A

pneumonia

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145
Q

4 complications of measles infection

A

otitis media
pneumonia
encephalitis (1-2 weeks after)
subacute sclerosing panencephalitis (5-10 years after)

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146
Q

1st investigation for suspected measles

A

measles-specific IgM and IgG serology

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147
Q

scarlet fever associated bacterial infection

A

group A streptococcus (streptococcus pyogenes)

usually tonsilitis

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148
Q

scarlet fever features

A

red-pink, blotchy, rough sandpaper rash that starts on the trunk and spreads outwards

strawberry tongue
lymphadenopathy
sore throat
fever

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149
Q

management of scarlet fever/strep throat

A

phenoxymethylpenicillin (penicillin V) for 10 days

children should be kept off school until 24 hours after starting antibiotics

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150
Q

2 complications of scarlet fever

A

otitis media
post-streptococcal glomerulonephritis (typically 10 days after infection)
acute rheumatic fever (typically 20 days after infection)

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151
Q

rubella 2 key features

A

rash lasting 3 days

lymphadenopathy behind the ears and back of the neck

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152
Q

management of rubella

A

supportive/self-limiting

children should stay off school for at least 5 days after the rash appears

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153
Q

congenital rubella syndrome triad

A

deafness, blindness, congenital heart disease

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154
Q

parvovirus b19 presentation

A

prodrome (mild fever, coryzal)

rash appears 2-5 days after symptoms begin: diffuse bright red rash on both cheeks and a few days later a reticular rash on trunk and limbs

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155
Q

when is parvovirus b19 infectious

A

until the rash appears

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156
Q

3 groups at risk of complications from parvovirus b19

A

immunocompromised
pregnant women
sickle cell anaemia (cause of aplastic crisis)

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157
Q

roseola infantum causative virus

A

human herpes virus 6

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158
Q

roseola infantum presentation

A

Most common in children 6 months - 2 years

high fever that comes on suddenly, lasts for 3-5 days then suddenly disappears

followed by mild non-itchy maculopapular lace-like rash on the trunk for 1-2 days

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159
Q

roseola infantum key complication

A

febrile convulsions due to high temperature

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160
Q

1st feature of chickenpox infection

A

pyrexia

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161
Q

stages of chickenpox lesions

A

papules > vesicles > pustules > crusts

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162
Q

Henoch-schoenlein purpura (HSP) patho

A

IgA mediated small vessel vasculitis

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163
Q

4 features of HSP

A

Palpable purpuric rash (with localised oedema) over buttocks and extensor surfaces of arms and legs
Joint pain
Abdominal pain
Renal involvement

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164
Q

Turner syndrome chromosomal abnormality

A

Female with single X chromosome (45 XO)

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165
Q

presentation of Turner’s syndrome (4)

A

Short stature
Primary amenorrhoea
Widely spaced nipples
Webbed neck

+ Infertility later in life due to underdeveloped ovaries

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166
Q

sign of Turner’s syndrome in neonates

A

lymphoedema

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167
Q

which hormones are elevated in Turner’s (1)

A

Gonadotrophins (LH and FSH)

(Caused by low levels of osteogen = negative feedback)

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168
Q

Hypo or hyper thyroidism in Turner’s

A

Hypothyroidism

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169
Q

Most common cardiac defect seen in Turner’s

A

Bicuspid aortic valve (15%) = ejection systolic murmur

Turner’s is also associated with coarctation of the aorta but it is not as common

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170
Q

Major long-term health complication in Turner’s syndrome

A

Aortic dilation and dissection

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171
Q

Rocker bottom feet sign (2 disorders)

A

Soles of the feet are convex

Patau syndrome (trisomy 13)
Edwards syndrome (trisomy 18)

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172
Q

Patau’s syndrome presentation

A

Holoprosencephaly (failure of the cerebral hemispheres to divide)
Microcephaly
Cleft lip and palate
Polydactyly (extra digits)
Congenital heart disease

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173
Q

Edward’s syndrome presentation

A

Low-set ears
Macrognathia (undersized jaw)
Microcephaly
Overlapping 4th and 5th fingers
Rocked bottomed feet
Congenital heart disease

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174
Q

Klinefelter’s syndrome karyotype

A

47, XXY

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175
Q

Klinefelter’s syndrome characteristics

A

often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia
elevated gonadotrophin levels but low testosterone

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176
Q

Rash for > 5 days non-infective differentials

A

Kawasaki disease
Still’s disease
Rheumatic fever
Leukaemia

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177
Q

Juvenile idiopathic arthritis

A

Chronic autoimmune disease that causes arthritis < 16 years old for > 6 weeks

Joint pain, swelling, stiffness

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178
Q

Still’s disease

A

Systemic onset JIA

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179
Q

Features of systemic onset JIA/Still’s disease

A

Intermittent febrile episodes
salmon-pink rash
lymphadenopathy
arthritis
uveitis
Reduced appetite and weight loss

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180
Q

Most common subtype of JIA

A

oligoarticular JIA (4 or less joints affected) accounts for 60% of cases

most frequently occurs in girls under the age of 6 years

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181
Q

Classic associated feature of oligoarticular JIA

A

chronic anterior uveitis (eye redness, pain, vision loss)

seen in 1/3 of children with JIA

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182
Q

Joints affected in JIA

A

large joints e.g. knee, ankle, wrist

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183
Q

5 key onset subtypes of JIA

A

Systemic
polyarticular > 4 joints
oligoarticular < 4 joints
enthesitis related (key complication: anterior uveitis)
juvenile psoriatic (nail pitting, plaques of psoriasis, dactylitis)

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184
Q

Still’s disease investigations

A

ANA negative
rheumatoid factor negative
Raised inflammatory markers (raised CRP, ESR, platelets, and serum ferritin)

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185
Q

Key complication of Still’s disease

A

Macrophage activation syndrome (acutely unwell child with DIC, anaemia, thrombocytopenia, bleeding, non-blanching rash)

Key investigation finding: low ESR

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186
Q

Medical management of JIA

A

NSAIDs e.g. ibuprofen
Steroids (oral, intramuscular, or intra-articular in oligoarthritis)
Disease modifying anti-rheumatic drugs (DMARDs) e.g. methotrexate, hydroxychloroquine
Biologic therapy e.g. anti-TNFa e.g. infliximab

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187
Q

1st line treatment for oligoarticular JIA

A

intra-articular steroid injection

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188
Q

Stephen-Johnson syndrome

A

flu-like symptoms followed by a red/purple target-like rash that spreads and forms blisters

triggered by viral infection (mumps, flu, HSV, EBV) or reaction to medicines

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189
Q

4 medications that can cause stephen-johnson syndrome

A

Penicillin
Lamotrigine
Phenytoin
Allopurinol

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190
Q

Red flags in developmental milestone assessment

A

Not able to hold an object at 5 months
Not sitting unsupported at 12 months
Not standing independently at 18 months
No words at 18 months
No interest in others at 18 months
Not walking independently at 2 years
Not running at 2.5 years

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191
Q

Four major domains of child development

A

Gross motor and Fine motor
Language and communication
Cognitive
Personal and social

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192
Q

milestones in gross motor development:
4 months
9 months
12 months
15 months

A

head downwards

4 months: support their head
7-8 months months: sit unsupported, crawling
12 months: cruising
15 months: walk unaided

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193
Q

milestones in fine motor development:
8 weeks
6 months
9 months
12 months

A

8 weeks: fixes their eyes on an object
6 months: palmar grasp
9 months: scissor grasp (squashes it between thumb and forefinger)
12 months: pincer grasp (with the tip of the thumb and forefinger)

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194
Q

what age should a baby be able to say single words in context e.g. mama

A

12 months

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195
Q

at what age should a baby smile responsively

A

6 weeks

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196
Q

West syndrome

A

Infantile spasms starting at around 6 months of age (repeated flexion of head/arms/trunk followed by extension of arms)
More common in male infants
Poor prognosis

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197
Q

Juvenile myoclonic epilepsy

A

Bilateral myoclonic jerks in upper and lower limbs often in the morning/following sleep deprivation
periods of absence
Age of onset: 10-20 years

If left untreated, may progress to generalised tonic-clonic seizures

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198
Q

Lennox-Gastaut syndrome

A

atypical absences, falls, jerks
90% moderate-severe mental handicap
onset: 1-5 years

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199
Q

Absence seizures management

A

1st line in men: sodium valproate
Girls: ethosuximide, lamotrigine

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200
Q

Management of general tonic-clonic seizures

A

1st line: sodium valproate

2nd line: lamotrigine or carbamazepine

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201
Q

Management of focal seizures

A

remember opposite to general tonic-clonic

1st line (for men and women): carbamezepine or lamotrigine
2nd line: sodium valproate

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202
Q

1st line investigation after 2nd seizure

A

electroencephalogram (EEG)

categorises epilepsy type and aids diagnosis before deciding which anti-epileptic would be appropriate

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203
Q

when would an MRI be indicated in epilepsy diagnosis

A

Unclear history/atypical features
1st seizure in child under 2 years
Focal seizures

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204
Q

Hand foot and mouth disease virus

A

coxsackie A

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205
Q

Wilms’ tumour

A

Nephroblastoma

One of the most common childhood malignancies

Typically presents under 5 years old (median age 3)

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206
Q

WAGR syndrome

A

Wilms’ tumour
Aniridia
Genitourinary malformations
mental Retardation

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207
Q

Wilms’ tumour features

A

unilateral in 95% of cases
Palpable abdominal mass (most common presenting feature)
painless haematuria
flank pain

Unexplained enlarged abdo mass in a child = arrange paediatric review within 48 hours

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208
Q

Fragile X syndrome features

A

MALES are always affected (X-linked)
learning difficulties
large ears, long thin face, high-arched palate
macrocephaly
macroorchidism
autism
ADHD
hypotonia
mitral valve prolapse

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209
Q

Prader-Willi syndrome

A

hypotonia
faltering growth
developmental delay
learning difficulties

facies: almond shaped eyes, narrow bridge of nose, narrowing of forehead at temples, thin upper lip

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210
Q

Noonan syndrome

A

mild learning difficulties
short webbed neck
pectus excavatum (ribs + sternum grow inwards)
pulmonary stenosis
short stature
congenital heart disease

facies: broad forehead, drooping eyelids, wide distance between eyes

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211
Q

Williams syndrome

A

short stature
congenital heart disease (supravalvular aortic stenosis)
mild-moderate learning difficulties

facies: broad forehead, short nose, full cheeks, wide mouth

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212
Q

Kallman syndrome

A

genetic condition causing delayed puberty secondary to hypogonadotropic hypogonadism

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213
Q

Kallman syndrome features

A

‘delayed puberty’
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
LH, FSH levels are inappropriately low/normal

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214
Q

Hypogonadotropic Hypogonadism

A

deficiency of LH and FSH (hypogonadotropic)

leads to a deficiency of the sex hormones testosterone and oestrogen (hypogonadism)

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215
Q

Hypergonadotropic Hypogonadism

A

gonads fail to respond to stimulation from the gonadotrophins (LH and FSH) (hypogonadism)

no negative feedback from the sex hormones (testosterone and oestrogen), therefore the anterior pituitary produces increasing amounts of LH and FSH (hypergonadtropic)

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216
Q

2 chromosomal abnormalities that cause hypergonadotropic hypogonadism

A

Kleinfelter’s Syndrome (XXY)
Turner’s Syndrome (XO)

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217
Q

Impetigo rash

A

small pustules that develop a honey-coloured crusted plaques
usually begins on face
no surrounding erythema
often not itchy

the rash starts as erythematous macules that progress to vesicles, pustules or bullae. rupture of these causes the crusting over plaques

highly contagious, children should stay off school until the lesions have dried out

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218
Q

Status epilepticus management

A

ABCDE (rule out hypoxia and hypoglycaemia) then benzodiazepine

Benzodiazepine indication:

pre-hospital: buccal midazolam or PR diazepam

IV access: lorazepam (max 2 doses) if still no response IV phenytoin

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219
Q

Status epilepticus definition

A

a single seizure lasting >5 minutes
or
>2 seizures within a 5-minute period without the person returning to normal between them

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220
Q

Nephrotic syndrome triad

A

Proteinuria (> 3g / 24 hr)
causing
Hypoalbuminaemia
and
Oedema

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221
Q

complications of nephrotic syndrome (6)

A

Hypercoagulable state (increased risk of VTE): Prophylactic LMWH required - due to loss of antithrombin-III

Hyperlipidaemia (increased risk of ACS, stroke)

Hypovolaemia (during initial phase of oedema formation)

Hypocalcaemia (vit D and binding protein lost in urine)

Chronic kidney disease

Infection (due to urinary immunoglobulin loss)

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222
Q

which condition causes 80% of nephrotic syndrome cases in children

A

Minimal change glomerulonephritis

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223
Q

Treatment nephrotic syndrome

A

High dose oral corticosteroids e.g. prednisolone

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224
Q

how many cases of nephrotic syndrome will have frequent relapses

A

1/3

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225
Q

pathophysiology minimal change disease

A

foot process effacement causes proteins to pass through the glomerular membrane

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226
Q

SUFE presenting features (3)

A

Hip, groin, thigh or knee pain
Restricted range of hip movement (particularly internal rotation in flexion)
Painful limp

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227
Q

commonest cause of vomiting in infancy

A

GORD (can be physiological)

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228
Q

Risk factors for GORD in infancy

A

Preterm delivery
Neurological disorders e.g. cerebral palsy
Down syndrome

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229
Q

Features of GORD in infancy

A

typically develops before 8 weeks
vomiting/regurgitation (milky vomits after feeds, after being laid flat)
excessive crying esp. while feeding
Aspiration/hoarseness/wheezing

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230
Q

complications of GORD in children

A

distress
failure to thrive
Iron deficiency anaemia
Oesophagitis
recurrent pulmonary aspiration
frequent otitis media
in older children dental erosion may occur
Sandifer syndrome (unusual movements)

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231
Q

1st line treatment for GORD in infancy

A

1st for Breast- fed baby: Gaviscon (alginate therapy)
1st for Bottle-fed baby: Feed thickener e.g. Carobel

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232
Q

When should a PPI be used to treat GORD in infancy

A

where the child doesn’t respond to alginates/thickened feeds and:

  1. unexplained feeding difficulties (for example, refusing feeds, gagging or choking)
    Or
  2. distressed behaviour
    Or
  3. faltering growth
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233
Q

Scoring system for likelihood of strep throat

A

FeverPAIN

Fever in past 24 hours
Purulent tonsils
Attend rapidly (under 3 days)
Inflamed tonsils
No cough or coyza

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234
Q

Common causes of bacterial otitis media

A

Streptococcus pneumonaie
Haemophilus influenzae
Moraxella catarrhalis
Streptococcus pyogenes

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235
Q

Features of otitis media

A

Otalgia (tug or rubbing ear)
fever (50%)
hearing loss
recent viral URTI symptoms are common
ear discharge (if tympanic membrane perforates)

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236
Q

Otoscopy findings in otitis media

A

bulging tympanic membrane → loss of light reflex
opacification or erythema of the tympanic membrane
perforation with purulent otorrhoea

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237
Q

Diagnostic criteria otitis media (3)

A
  1. acute onset of symptoms (otalgia or ear tugging)
  2. presence of a middle ear effusion (bulging of the tympanic membrane, or
    otorrhoea, decreased mobility on pneumatic otoscopy)
  3. inflammation of the tympanic membrane i.e. erythema
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238
Q

Management of otitis media if antibiotics are not indicated

A

majority of patients do not require an antibiotic prescription

Analgesia

Safety net: seek medical help if symptoms worsen or do not improve after 3 days

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239
Q

Indications for the use of antibiotics in otitis media (5)

A
  1. Symptoms lasting more than 4 days or not improving
  2. Systemically unwell but not requiring admission
  3. Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
  4. Younger than 2 years with bilateral otitis media
  5. Otitis media with perforation and/or discharge in the canal
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240
Q

1st line antibiotic for otitis media

A

5-7 day course of amoxicillin

penicillin allergy: erythromycin, clarithromycin

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241
Q

chronic suppurative otitis media (CSOM)

A

perforation of the tympanic membrane with otorrhoea for >6 weeks

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242
Q

4 complications of otitis media

A

complications are rare

mastoiditis
meningitis
brain abscess
facial nerve paralysis

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243
Q

presentation of acute mastoiditis

A

presence of a tender boggy swelling behind the pinna with loss of the post-auricular sulcus & auricular proptosis

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244
Q

presentation of otitis media with effusion/glue ear on otoscopy

A

grey tympanic membrane
loss of cone of light reflex
visible fluid level behind the tympanic membrane

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245
Q

Naevus flammeus birth mark

A

Port wine stain
present from birth and grows with infant

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246
Q

Cavernous haemangioma

A

Strawberry naevus birth mark
often not present at birth but appears in the first month of life

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247
Q

Erythema toxicum

A

(neonatal urticaria)
common rash appearing at 2-3 days of age, consisting of white pinpoint papules at the centre of an erythematous base, concentrated on the trunk

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248
Q

Mongolian blue spots

A

blue/black macular discolouration at the base of the spine and on the buttocks
these can be misdiagnosed as bruises

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249
Q

Management of constipation in children (disimpaction regimen)

A

1st line: Movicol Paediatric Plain (Macrogol laxative e.g. polyethylene glycol + electrolytes)

If a macrogol laxative is not tolerated: osmotic laxative e.g. lactulose

2nd line (if no improvement after 2 weeks): stimulant laxative e.g. senna can be added

ensure adequate fluid + fibre intake

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250
Q

Secondary causes of constipation in children

A

Hirschsprung’s
Cystic fibrosis
Hypothyroidism

251
Q

Red / amber flags constipation

A

Reported from birth or first few weeks of life
> 48 hours (CF / Hirschsprung’s)
Faltering growth (hypothyroidism, coeliac)
‘ribbon’ stools (anal stenosis)
Previously unknown or undiagnosed weakness in legs/locomotor delay (cerebral palsy)
Distention (obstruction or intussusception)
Disclosure or evidence that raises concerns (child abuse)

252
Q

Immune (idiopathic) thrombocytopenia purpura (ITP) management

A

typically runs a benign course and 80% of cases will have resolved spontaneously after 6-8 weeks

If the platelet counts needs to be raised: prednisolone

Chronic and unremitting ITP for 12-24 months with severe symptoms: splenectomy

253
Q

What should be avoided in ITP

A

NSAIDs and aspirin
Contact sports

254
Q

What kind of hypersensitivity reaction is ITP

A

Type II

immune-mediated reduction in the platelet count (usually following infection). Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex

255
Q

Major differential in child presenting with petechiae, purpura (non-blanching) and no fever

A

ITP

256
Q

When would a bone marrow examination be indicated in ITP

A

Atypical features
- lymph node enlargement
- splenomegaly
- high/low WCC
- failure to resolve/respond to treatment

257
Q

Most common cause of bronchiolitis

A

Respiratory Syncytial virus (80%)

258
Q

Age of onset bronchiolitis

A

90% are 1-9 months (peak incidence 3-6 months)

259
Q

3 conditions where bronchiolitis is more complicated

A

Bronchopulmonary dysplasia e.g. premature
Congenital heart disease
Cystic fibrosis

260
Q

Key symptom that leads to hospital admission in bronchiolitis

A

Feeding difficulties associated with increasing dyspnoea

261
Q

signs of respiratory distress

A

grunting
marked chest recession
resp rate of > 70 breaths/min
SpO2 <94%
nasal flaring
cyanosis
fluid intake <50%

262
Q

Bronchiolitis investigation

A

immunofluorescence of nasopharyngeal secretions may show RSV

263
Q

Management bronchiolitis

A

supportive

264
Q

Pyloric stenosis presentation

A

2-4 weeks of age
4 times more common in males
Non-bilious projectile vomiting (typically 30 mins after a feed)
Palpable mass in the upper abdomen, visible peristalsis as stomach pushes contents past obstruction
hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

265
Q

Meckel’s diverticulum

A

congenital abnormality of the small intestine caused by incomplete obliteration of the vitelline (omphalomesenteric) duct

266
Q

most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years

A

Meckel’s diverticulum

267
Q

Management Meckel’s diverticulum

A

wedge excision or small bowel resection and anastomosis

268
Q

Most common cause of cyanotic congenital heart disease

A

Tetrology of fallot

269
Q

4 characteristic features of ToF

A

Right ventricular outflow tract obstruction (pulmonary stenosis) determines the degree of cyanosis
VSD
Overriding aorta
Right ventricular hypertrophy

= R to L shunt

270
Q

CXR sign of T of F

A

Boot shaped heart (due to right ventricular thickening)

271
Q

1 symptom and 1 sign of Tet of F

A

Hypercyanotic ‘Tet’ spells (usually after crying etc.)
Ejection systolic murmur due to pulmonary stenosis

cyanotic episodes can be helped by beta-blockers

272
Q

4 risk factors for Tet of F

A

Rubella infection
Increased age of the mother (over 40 years)
Alcohol consumption in pregnancy
Diabetic mother

273
Q

What can be given to maintain the ductus arteriosus

A

Prostaglandin infusion

274
Q

when does TOF generally present

A

1-2 months

275
Q

Atrial septal defect

A

Acyanotic (left to right shunt)
2 types: secundum ASD and partial AVSD

276
Q

Coarctation of the aorta

A

Acyanotic
narrowing of the aorta in the region of the ductus arteriosus (proximal, distal or at DA)

277
Q

Patent ductus arteriosis

A

Acyanotic

persistence of the connection between the aorta and pulmonary artery which would normally close physiologically after birth

if uncorrected can become cyanotic

278
Q

Commonest congenital heart disease

A

Ventricular septal defect

279
Q

VSD murmur

A

loud, hard pansystolic murmur best heard at the lower left sternal border

(High to low pressure)

280
Q

ASD murmur

A

ejection systolic

281
Q

Guthrie test

A

Heel prick test

Newborn screening test to identify 9 potentially life threatening genetic conditions (including sickle cell anaemia and cystic fibrosis

282
Q

Immediate first step when a child presents in respiratory distress

A

Acute emergency: ABCDE

283
Q

Which viruses account for the majority of croup cases

A

Parainfluenza viruses

284
Q

Croup peak incidence

A

6 months - 3 years
More common in autumn

285
Q

4 features of croup

A

Stridor
Barking cough (worse at night)
Fever
Coryzal symptoms

286
Q

Audible stridor at rest in a child management

A

Admission to hospital

admit any child with moderate or severe croup

287
Q

Medical management croup

A

Single dose oral dexamethasone to all children regardless of severity

Alternative: prednisolone

Severe/no response to steroids: high-flow oxygen, nebulised adrenaline

288
Q

ADHD defining criteria

A

6 x diagnostic features

Symptoms present before age 12
Clear impact on function
Developmentally inappropriate

289
Q

Management after initial presentation of ADHD

A

10 week watch and wait before being referred to a specialist

290
Q

Medical management of ADHD

A

Drug therapy is a last resort, after parental educational training etc, and is only available to those ages 5+

1st line: Methylphenidate (given on 6 week trial bias)
2nd line: Lisdexamfetamine
3rd line: Dexamfetamine (if the child benefited from Lisdexamfetamine but couldn’t tolerate the side effects)

All of these drugs are cardiotoxic - perform baseline ECG
Measure height and weight

291
Q

Methylphenidate mechanism of action

A

CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor

292
Q

Anaphylaxis definition

A

ABC
A - airway (swelling of throat and tongue = hoarse voice and stridor)
B - breathing (respiratory wheeze and dyspnoea)
C - circulation (hypotension and tachycardia)

293
Q

Most important drug given in anaphylaxis

A

Intramuscular adrenaline

Repeated every 5 minutes if necessary
Best site = anterolateral aspect of the middle third of the thigh

294
Q

Why is discharge risk-stratified in anaphylaxis

A

20% of patients experience bisphasic reactions

295
Q

Management of a child with dehydration without shock

A

Give low osmolarity oral rehydration solution (ORS) over 4 hours
Continue breastfeeding (if relevant)

296
Q

Signs of hypernatraemic dehydration

A

jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma

297
Q

Most common cause of gastroenteritis in children in the UK

A

Rotavirus

298
Q

Most common cause of obstruction in infants after the neonatal period

A

Intussusception

299
Q

Causes of cerebral palsy

A

antenatal (80%): e.g. cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV)
intrapartum (10%): birth asphyxia/trauma, prematurity
postnatal (10%): intraventricular haemorrhage, meningitis, head-trauma, kernicterus

300
Q

4 signs cerebral palsy

A

abnormal tone early infancy
delayed motor milestones
abnormal gait
feeding difficulties

301
Q

4 classifications of cerebral palsy

A

spastic (70%)
subtypes include hemiplegia, diplegia or quadriplegia

dyskinetic
+/- dystonia, +/- athetosis
athetoid movements and oro-motor problems

ataxic
caused by damage to the cerebellum with typical cerebellar signs

mixed

302
Q

Viral induced wheeze vs asthma

A

Presenting before 3 years of age
No atopic history
Only occurs during viral infections

both will present with wheeze throughout the chest, a focal wheeze could indicate blockage

303
Q

Life threatening sign in acute asthma

A

silent chest (e.g. no wheezing or coughing heard on ausculation)

304
Q

Severe acute asthma attack features

A

Peak flow < 50 % predicted
Saturations < 92%
Unable to complete sentences in one breath
Signs of respiratory distress
RR > 40 in 1-5, > 30 in > 5
HR > 140 in 1-5, > 125 in > 5

305
Q

Life threatening acute asthma attack features

A

Peak flow < 33 % predicted
Saturations < 92 %
Exhaustion and poor respiratory effort
Normal pCO2 = no longer compensating
Hypotension
Silent chest
Cyanosis
Altered consciousness/confusion

306
Q

medical management options in viral induced wheeze (3)

A

If sats <94% = Supplementary oxygen
1. short acting bronchodilators e.g. salbutamol
2. leukotriene receptor antagonist e.g. montelukast or inhaled corticosteroids

307
Q

stepwise management in moderate to severe cases of acute asthma

A
  1. Salbutamol inhaler via spacer
  2. Inhaled or nebulised salbutamol or ipratropium bromide
  3. Oral prednisolone
  4. IV hydrocortisone
  5. IV magnesium sulphate
  6. IV salbutamol
  7. IV aminophylline
308
Q

Red flags for acute asthma or viral induced wheeze

A

Central cyanosis
Child becoming floppy
Tracheal tug
Costal recession
Too breathless to feed/finish a sentence

309
Q

What is not recommended whilst awaiting surgery for a strangulated inguinal hernia

A

Manually reducing the strangulated hernia as this can cause more generalised peritonitis

310
Q

Strangulated hernia symptoms

A

Pain (as apposed to unpainful incarcerated)
Fever
Increase in the size of a hernia or erythema of the overlying skin
Peritonitic features such as guarding and localised tenderness
Bowel obstruction e.g. distension, nausea, vomiting
Bowel ischemia e.g. bloody stools

311
Q

Incarcerated hernia definition

A

where a hernia cannot be reduced

312
Q

Stepwise 1-3 chronic asthma management for all paediatric ages

A

1 (newly diagnosed): SABA
2 (not controlled or newly diagnosed with symptoms 3/week or night time waking): SABA + paediatric dose ICS (8 week trail if under 5)
3: SABA + ICS + LTRA e.g. monteleukast
4. SABA + ICS + LABA e.g. salmeterol

313
Q

Which causal organism is impetigo normally caused by

A

Staph aureus

May also be caused by Group A strep

314
Q

Impetigo management

A

Localised/non-bullous lesions: short course of hydrogen peroxide cream or topical antibiotic creams

Widespread/non-bullous lesions: 1st line topical or oral antibiotics

Bullae/unwell child/risk of complications: 1st line oral antibiotics e.g. flucloxacillin

bullae = raised, clear fluid-filled lesions > 0.5 cm

315
Q

3 types of cryptorchidism

A

Retractile (not present in the scrotum but can be manipulated back before retracting again)
Palpable (palpated in the groin but cannot be manipulated back)
Impalpable (no testis can be felt)

316
Q

Why is cryptorchidism more common in premature infants

A

descent occurs in the 3rd trimester

317
Q

When would referral be needed in an infant with cryptorchidism

A

If the testes are still undescended at 3 months of age

318
Q

When would hormonal testing and karyotyping be done in undescended testes

A

Bilateral impalpable testes

319
Q

Benefits of an orchidopexy in cryptorchidism

A

Orchidopexy = surgical placement of the testis in the scrotum

  1. Improving fertility
  2. Potential reduced risk of malignancy
  3. Cosmetic and psychological benefits
320
Q

Volvulus definition

A

Loop of intestine twists around itself and the mesentery that supplies it, causing bowel obstruction

Most commonly presents in the first few days of life

321
Q

First sign of puberty in males

A

Testicular growth (around 12 years of age)

322
Q

First sign of puberty in males

A

Testicular growth (around 12 years of age)

323
Q

First sign of puberty in females

A

Breast development (around 11.5)

324
Q

4 causes of jaundice in the first 24 hours of life

A

first 24 hours = always pathological + always a haemolytic disorder:

  1. Rhesus haemolytic disease
  2. ABO haemolytic disease
  3. Hereditary spherocytosis
  4. Glucose-6-phosphodehydrogenase
325
Q

Physiological jaundice

A

Jaundice between 2-14 days (caused by more RBCs, more fragile RBCs, less developed liver function)

more commonly seen in breastfed babies

326
Q

Causes of prolonged jaundice (after 14 days)

A

Hypothyroidism
Breast milk jaundice
Prematurity
Congenital infections
Biliary atresia

327
Q

Measles causative organism

A

RNA paramyxovirus

328
Q

Gillick competence

A

A young person is able to make decisions regarding their medical treatment if they are deemed to be mentally competent

Used in cases where they don’t want their parents involved, or they can’t be involved

Fraser = specifically relating to contraception and sexual health

329
Q

Pyloric stenosis on examination

A

Olive sized mass

330
Q

Varicocele

A

Dilated testicular veins which causes scrotal swelling

331
Q

Most common presentation of varicocele

A

Asymptomatic

332
Q

Causes of jaundice 24h-14d

A

Physiological/breastfeeding
Polycythaemia
Haemolysis
Infection

333
Q

4 side effects of topical steroids

A

Acne
Striae
Telangiectasia
Thinning of the skin

334
Q

Coeliac presentation

A

Chronic or intermittent diarrhoea
Failure to thrive or faltering growth (in children)
GI symptoms including nausea and vomiting
Prolonged fatigue (‘tired all the time’)
Recurrent abdominal pain, cramping or distension
Sudden or unexpected weight loss
Anaemia

335
Q

4 key drivers for failure to thrive

A
  1. Inadequate intake: can be caused by issues with feeding and may be associated with maternal depression and socio-economic background
  2. Inadequate retention: including vomiting or severe GORD
  3. Malabsorption: diseases such as coeliac disease
  4. Increased requirements: thyrotoxicosis, congenital heart failure or malignancy
336
Q

Coeliac biopsy findings

A

atrophy of the villi with flat mucosa and marked crypt hyperplasia and Intraepithelial lymphocytosis

337
Q

ADHD triad

A

Hyperactivity, impulsivity and inattentiveness

338
Q

Modified Kocher criteria septic arthritis

A

Fever > 38 .5
Inability to weight bear
CRP > 20
WBC > 12

339
Q

Transient synovitis of the hip typical age group

A

3-8 years

340
Q

Transient synovitis presentation (1)

A

Acute hip pain following recent viral infection

341
Q

Commonest cause of hip pain in children

A

Transient synovitis

342
Q

Management transient synovitis

A

Self-limiting (rest and analgesia)

343
Q

Causative organism epiglottis

A

Haemophilus influenza B

344
Q

Whooping cough causative organism

A

Bordatella pertussis

Gram-negative

345
Q

Pyloric stenosis definitive management

A

Ramstedt pyloromyotomy

346
Q

Pyloric stenosis diagnostic investigation

A

Ultrasound

347
Q

Pyloric stenosis U&E / ABG

A

Blood gas values:
- raised bicarbonate (metabolic)
- high pH (alkalosis)
- raised CO2 (partial compensation as still alkalosis)

Electrolyte values:
- Low Cl- (hypochloraemic)
- Low K+ (hypokalaemic)

due to persistent vomiting

348
Q

Duchenne and Becker muscular dystrophy inheritance patter

A

X-linked recessive

Dystrophinopathies

349
Q

Duchenne muscular dystrophy features

A

Progressive proximal muscle weakness from 5 years old - most children cannot walk by 12 years old and will need a wheelchair
Calf pseudohypertrophy (fat + fibrosis)
Gower’s sign: child uses arms to stand up from a squatted position
30% have intellectual impairment
Dilated cardiomyopathy

Survival = 25-30 years

350
Q

Investigations Duchenne muscular dystrophy

A

Diagnostic: genetic testing for dystrophin mutations

Other: Raised CK

351
Q

Duchenne vs Becker

A

Becker develops after the age of 10 (Duchenne is earlier from 5) and intellectual impairment is much less common in Becker

352
Q

Treatments for spasticity in cerebral palsy (4)

A

Oral diazepam
Oral and Intrathecal Baclofen
Botulinum toxin type A
Orthopaedic surgery

353
Q

Most common causative organism of early onset neonatal sepsis (within 72 hours of birth)

A

GBS infection

354
Q

Most common causative organisms of late-onset sepsis (between 7-28 days of life)

A

Staphylococcus epidermidis
Pseudomonas aeruginosa
Klebsiella
Enterobacter

355
Q

Risk factors for neonatal sepsis

A
  1. INFECTION: Previous baby with GBS infection, current GBS colonisation from prenatal screening, current bacteruria, intrapartum temp >38, membrane rupture >18 hours, or current infection throughout pregnancy
  2. Premature (<37 weeks) - 85% of cases
  3. Low birth weight (<2.5kg) - 80% of cases
356
Q

Most common presenting feature of neonatal sepsis

A

Respiratory distress (grunting, nasal flaring, use of accessory resp muscles, tachypnoea)

357
Q

1st line treatment neonatal sepsis

A

IV Benzylpenicillin with gentamicin

CRP should be re-measured 18-24 hours after presentation

358
Q

Transient tachypnoea of the new born (TTN)

A

Delayed resorption of fluid in the lungs

More common following C-sections possibly due to lung fluid not being ‘squeezed out’ during birth canal passage

Commonest cause of respiratory distress in the newborn period

359
Q

CXR in transient tachypnoea of the newborn

A

Hyperinflation of the lungs and fluid in the horizontal fissure

360
Q

Management transient tachypnoea of the newborn

A

Supportive care (usually settles within 1-2 days)

361
Q

5 non-lifestyle causes of obesity in children

A

GH deficiency
Hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prayer-Willi syndrome

362
Q

Cystic fibrosis inheritance pattern

A

Autosomal recessive

363
Q

Genetic defect seen in cystic fibrosis

A

Delta F508 in chromosome 7 causes a defect in the Cystic fibrosis transmembrane conductance regulator gene (CFTR)

364
Q

4 organisms that may colonise CF patients

A

Staph aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergillus

365
Q

3 presenting features of cystic fibrosis

A

Meconium ileus
Recurrent chest infections
Malabsorption (steatorrhoea, failure to thrive)

366
Q

features of cystic fibrosis that may present later in childhood/adulthood

A

Short stature
Diabetes Mellitus
Delayed puberty
Rectal prolapse
Nasal polyps
Male infertility

367
Q

Diagnostic test for cystic fibrosis

A

Sweat test

368
Q

Management cystic fibrosis

A
  1. Chest physiotherapy and postural draining (x2/day)
  2. High calorie, high fat diet
  3. minimise contact with other CF patients to prevent cross infection with Burkholderia cepacia and Pseudomonas aeruginosa
  4. Vitamin supplements
  5. Pancreatic enzyme supplements
  6. Lung transplantation (chronic infection with Burkholderia is a C/I)
369
Q

Which medication can be used for cystic fibrosis in patients who are homozygous for the delta F508 mutation

A

CFTR modulators i.e. Lumacaftor + Ivacaftor

370
Q

Most causative organism of pneumonia in children

A

Strep pneumoniae

371
Q

Treatment of pneumonia in children

A

1st line: Amoxicillin

2nd line: Macrolides if no response or if mycoplasma or chlamydia is suspected

Pneumonia associated with influenza: co-amoxiclav

372
Q

Features of acute epiglottis

A

Rapid onset
High temperature
Stridor
Saliva drooling
Tripod position (easier to breathe by leaning forward in seated position)

373
Q

Diagnosis of epiglottis

A

Direct visualisation by airway trained staff

374
Q

Management of acute epiglottis

A

Endotracheal intubation
Do not examine the throat (risk of acute airway obstruction)
Oxygen
IV antibiotics

375
Q

Features of CMPA

A

Regurgitation and vomiting
Diarrhoea
Urticaria, atopic eczema
‘Colic’ symptoms (irritability, crying)
Wheeze, chronic cough

376
Q

Diagnosis CMPA

A

Often clinical i.e. improvement with cows milk protein elimination

Other investigations:
Skin prick/patch testing
Total IgE and specific IgE (RAST) for cows milk protein

377
Q

Management CMPA

A

Failure to thrive = refer to paediatrician

1st line replacement for mild-moderate symptoms: extensively hydrolysed formula

Severe or no response to eHF: amino acid-based formula

378
Q

Prognosis of CMPA

A

IgE mediated intolerance: tolerant by age 5
Non-IgE mediated intolerance: tolerant by age 3

379
Q

Causes of snoring in children

A

Obesity
Nasal problems e.g. polyps
Recurrent tonsillitis
Down’s syndrome
Hypothyroidism

380
Q

Threadworm organism

A

Enterobius vermicularis

381
Q

How does transmission occur of threadworms

A

Swallowing eggs that are present in the environment

382
Q

Features of threadworms

A

Asymptomatic (90%)
Perianal itching (particularly at night)
Girls may have vulval symptoms

383
Q

Management of threadworms

A

Combination of anthelmintic with hygiene measures for all members of the household

Children over 6 months = 1st line anthelmintic is mebendazole

384
Q

Who requires a routine ultrasound examination at 6 weeks to screen for DDH (3)

A
  1. 1st degree family history of hip problems in early life
  2. Breech presentation at or after 36 weeks gestation (regardless of birth)
  3. Multiple pregnancy
385
Q

Rovsing’s sign

A

Appendicitis: Palpation in the LIF causes pain in the RIF

386
Q

Diagnosis of appendicitis

A

Raised inflammatory markers coupled with compatible history and examination findings
+ neutrophil-predominant leucocytosis

387
Q

Management appendicitis

A

Laparoscopic appendicectomy

Prophylactic IV antibiotics reduces wound infection rates

388
Q

Periorbital cellulitis + epidemiology

A

Infection of the soft tissues anterior to the orbital septum (includes the eyelids, skin and subcutaneous tissue of the face but not the contents of the orbit)

Infection spreads from nearby sites e.g. breaks in the skin or local infections (sinusitis, URTIs)

80% of patients are under 10 (peak 21 months)

More common in the winter (due to increased URTIs)

389
Q

Most frequent causative organisms of periorbital/preseptal cellulitis

A

Staph aureus
Staph epidermidis
Streptococci

390
Q

Presentation of periorbital cellulitis

A

Erythema and oedema of the eyelids which can spread to surrounding skin
Partial or complete ptosis of the eye due to swelling
ABSENT: Orbital signs (pain on movement etc.) if these are present it would indicate orbital cellulitis

391
Q

Investigations periorbital cellulitis

A
  1. Raised inflammatory markers
  2. Swab of any discharge present
  3. Contrast CT for orbital cellulitis differential diagnosis
392
Q

Management of periorbital cellulitis

A
  1. Oral antibiotics - usually co-amoxiclav
  2. All cases should be referred to secondary care for assessment
393
Q

Squint (strabismus)

A

Imbalance in extraocular muscles of one eye

Convergent is more common than divergent

394
Q

How can a squint be detected

A

Hirschberg test: Corneal light reflection test (holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils)

Cover test

395
Q

Management of squint in GP setting

A

Refer to ophthalmology

396
Q

Squint definition

A

Misalignment of the eyes which causes double vision

397
Q

Amblyopia

A

The affected eye in a squint becomes passive and has reduced function compared to the dominant eye

If uncorrected, becomes a lazy eye

398
Q

Squint treatment options (2)

A

Occlusive patch over good eye
Atropine drops in good eye

399
Q

Presentation of UTI infants

A

Poor feeding, vomiting, irritability

400
Q

Presentation of UTI in younger children

A

Abdominal pain, fever, dysuria

401
Q

Presentation of UTI in older children

A

Dysuria, frequency, haematuria

402
Q

Features of pylonephritis

A

Temperature > 38, loin pain/tenderness

403
Q

NICE criteria for checking urine sample in a child

A
  1. Any symptoms or signs of UTI
  2. Unexplained fever of 38 or higher (test urine within 24 hours)
  3. Alternative site of infection but remain unwell (test urine within 24 hours)
404
Q

Urine collection method for children

A

1st: Clean catch
2nd: urine collection pads

If non-invasive methods are not possible: suprapubic aspiration

405
Q

Management of infant less than 3 months old with UTI

A

Immediate referral to paediatrician

IV cefotaxime and urine sample for urgent microscopy and culture

406
Q

Management child over 3 months with pyelonephritis

A

Consider admission to hospital

Start oral antibiotics e.g. cefotaxime or co-amoxiclav for 7-10 days

407
Q

Management of child over 3 months old with lower UTI

A

Oral antibiotics for 3 days:
1st: trimethoprim or nitrofurantoin
2nd: cefalexin or amoxicillin

Advise parents to bring child back if they remain unwell after 24-48 hours

408
Q

Enuresis definition (4)

A
  1. Involuntary discharge of urine
  2. Day/night/both
  3. Child aged 5 years or older
  4. Absence of congenital or acquired defects of the nervous system or urinary tract
409
Q

Primary nocturnal enuresis

A

The child has never achieved continence

410
Q

Secondary nocturnal enuresis

A

The child has been dry for at least 6 months before

411
Q

Management options for nocturnal enuresis

A

1st line: Enuresis alarm

2nd line: desmopressin (particularly useful for short-term control e.g. sleepover)

+ Reward systems e.g. star charts (give for agreed behaviour e.g. using the toilet before bedtime rather than dry nights)

412
Q

Nephritic syndrome / glomerulonephritis presentation

A

inflammation within the glomeruli

  • haematuria
  • renal impairment
  • hypertension
  • variable proteinuria
413
Q

Commonest cause of glomerulonephritis worldwide

A

IgA nephropathy

414
Q

Classical presentation of IgA nephropathy / Bergers disease

A

Recurrent episodes of macroscopic haematuria in a young boy following URTI

nephrotic range proteinuria is rare

415
Q

Pathophysiology of IgA nephropathy

A

Mesangial deposition of IgA immune complexes
- considerable overlap with Henoch-Schoenlein purpura (IgA vasculitis)

416
Q

IgA nephropathy vs Post-streptococcal glomerulonephritis

A

Post-strep = low complement levels
Main symptom of post-strep = proteinuria (although haematuria can occur)
Post strep has an interval between URTI and onset of renal problems

417
Q

Management of IgA nephropathy

A

Minimal proteinuria or normal GFR: no treatment needed other than follow-up

Persistent proteinuria: ACE inhibitors

Active disease e.g. falling GFR or no response to ACEi: Immunosuppression with corticosteroids

418
Q

Poor prognosis indicators of IgA nephropathy

A

Male gender
Proteinuria
Hypertension
Hyperlipidaemia

419
Q

Phimosis

A

Inability to retract the foreskin

420
Q

Age dependent management of phimosis

A

Under 2: expectant approach
Over 2 with recurrent balanoposthitis or UTI: consider treatment e.g. circumcision

421
Q

Most common inherited bleeding disorder

A

Von Willebrand’s disease

422
Q

Inheritance pattern of Von Willebrands (type 1 and 2)

A

Autosomal dominant

423
Q

2 common features of vWD

A

Epistaxis
Menorrhagia

424
Q

Investigation results vWD (3)

A

Prolonged bleeding time
APTT may be prolonged (intrinsic pathway)
Factor VIII levels may be moderately reduced

425
Q

Management of vWD (3)

A
  1. Transexamic acid for mild bleeding
  2. Desmopressin (raises levels of vWF)
  3. Factor VIII concentrate
426
Q

What age does atopic eczema in children usually present by

A

Before the age of 2 years

Clears in around 50% of children by 5 years and 75% by 10 years

427
Q

Features of eczema (by age)

A

Itchy, erythematous rash

Infants: face and trunk
Younger children: extensor surfaces
Older children: more typical distribution of flexor surfaces and creases of face and neck

428
Q

Management of eczema in children

A

Avoid irritants
Simple emollients (apply before topical steroid if using one)
Topical steroids
Wet wrapping (large amounts of emollient under wet bandages)
Severe cases: oral ciclosporin

429
Q

Management of allergic rhinitis (hayfever)

A

Allergen avoidance

Mild to moderate intermittent: oral or intranasal antihistamines

Moderate to severe persistent: intranasal corticosteroids

430
Q

4 features of allergic rhinitis

A

Sneezing
Clear nasal discharge
Nasal pruritis
Post nasal drip

431
Q

Urticaria features

A

Pale, pink raised skin
Pruritic

432
Q

Management of urticaria

A

1st line: non-sedating anti-histamines
Severe or resistant episodes: prednisolone

433
Q

Neuroblastoma

A

Tumour which arises from neural crest tissue of the adrenal medulla (most common site) and abdominal sympathetic chain

Median age of onset: 20 months (most common cancer in children under 1)

434
Q

Features of neuroblastoma

A

Abdominal mass
Pallor, weight loss
Bone pain, limp
Hepatomegaly
Paraplegia
Proptosis

435
Q

Neuroblastoma investigations

A

Urinalysis (vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels)
Calcification on abdominal X-Ray
Biopsy

436
Q

Most common ocular malignancy found in children

A

Retinoblastoma

Average age of diagnosis: 18 months

437
Q

Hereditary cases of retinoblastoma inheritance pattern

A

Autosomal dominant

RB1 gene

438
Q

Features of retinoblastoma

A

Absence of red-reflex, replaced by white pupil (leukocoria) most common presenting symptom

Strabismus/squint
Visual problems

439
Q

Most common primary brain tumour in children

A

Astrocytoma (develop from glial cells)

440
Q

3 risk factors for CNS malignancies

A

Neurofibromatosis 1 and 2
Tuberous sclerosis 1 and 2
Personal or family history of brain tumour, leukaemia

441
Q

Red flags of brain tumours in children

A
442
Q

Most common bone affected in osteosarcoma

A

Femur

(Other sites are tibia and humerus)

443
Q

Main presenting feature osteosarcoma

A

Persistent bone pain worse at night time

444
Q

Osteosarcoma associations

A

Retinoblastoma (Rb gene)
Paget’s disease of the bone
Radiotherapy

445
Q

Ewing’s sarcoma

A

Small round blue cell tumour occurring most frequently in the pelvis and long bones

Causes severe pain

X-ray: onion-skin appearance

446
Q

Causes of non-transient/severe hypoglycaemia

A

Preterm birth (<37 weeks)
Maternal DM
IUGR
Hypothermia
Neonatal sepsis

447
Q

Features of neonatal hypoglycaemia

A

May be asymptomatic

Autonomic: jitteriness, irritable, tachypnoea, pallor

Neuroglycopenic: poor feeding/sucking, weak cry, drowsy, hypotonia, seizures

448
Q

Asymptomatic management of neonatal hypoglycaemia

A

Encourage normal feeding (breast or bottle)
Monitor blood glucose

449
Q

Symptomatic/severe neonatal hypoglycaemia management

A

Admit to neonatal unit
IV infusion of 10% dextrose

450
Q

Acute respiratory distress syndrome pathology

A

Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli i.e. non-cardiogenic pulmonary oedema

Mortality = 40% / significant morbidity in those who survive

451
Q

Causes of ARDS

A

Acute pancreatitis
Infection (sepsis, pneumonia)
Massive blood transfusion
Trauma
Smoke inhalation
Covid-19
Cardio-pulmonary bypass

452
Q

4 ARDS features typical of acute and severe onset

A
  1. Dyspnoea
  2. Elevated respiratory rate
  3. Bilateral lung crackles
  4. Low oxygen saturations
453
Q

2 key investigations ARDS

A

Chest X-ray = pulmonary oedema (bilateral infiltrates)
Arterial blood gas = low pO2

454
Q

Diagnostic criteria ARDS

A

Clinical (acute onset within 1 week of a known risk factor) + CXR (pulmonary oedema) + low pO2 + exclude cardiogenic causes

455
Q

Management of ARDS

A

ITU management
Oxygenation/ventilation to treat hypoxaemia
General organ support e.g. vasopressors
Treat underlying cause e.g. Abx for sepsis

456
Q

Newborn resuscitation

A
  1. Dry baby and maintain temperature
  2. Assess tone, respiratory rate, heart rate
  3. If gasping or not breathing give 5 inflation breaths
  4. Reassess (chest movements)
  5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
457
Q

Meconium aspiration syndrome

A

Respiratory distress in the newborn as a result of meconium in the trachea (occurs in the immediate neonatal period)

458
Q

When do most cases of meconium aspiration syndrome occur

A

In post-term deliveries (after 42 weeks)

459
Q

Risk factors meconium aspiration syndrome

A

Maternal hypertension
Pre-eclampsia
Chorioamnionitis
Smoking
Substance abuse

460
Q

Signs of meconium aspiration syndrome

A

Dark green streaks in amniotic fluid (meconium staining)
Cyanosis
Grunting
Limpness
Bradycardia

461
Q

Kernicterus

A

Brain damage (cerebral palsy, learning disability, deafness) resulting from untreated jaundice in babies

462
Q

Risk factors for haematogenous osteomyelitis resulting from bacteraemia (most common form in children)

A

Sickle cell anaemia
Immunosuppression
Infective endocarditis

463
Q

Most common causative organism of osteomyelitis

A

Staph aureus except in sickle cell patients where Salmonella species predominates

464
Q

Gold standard imaging modality for osteomyelitis

A

MRI

465
Q

Management osteomyelitis

A

Flucoxacillin for 6 weeks

Clindamycin if penicillin-allergic

466
Q

Osteogenesis imperfecta

A

brittle bone disease

Group of disorders of collagen metabolism resulting in bone fragility and fractures

467
Q

Inheritance pattern osteogenesis imperfecta

A

Autosomal dominant

468
Q

Features of osteogenesis imperfecta

A

Fractures following minor trauma
Blue sclera
Deafness secondary to otosclerosis
Dental imperfections

469
Q

Investigations osteogenesis imperfecta

A

Normal calcium, phosphate, parathyroid hormone and ALP results

470
Q

Rickets definition

A

Inadequately mineralised bone in developing and growing bones resulting in soft and easily deformed bones

Usually due to vitamin D deficiency

In adults it is termed osteomalacia

471
Q

Predisposing factors for rickets (4)

A
  1. Dietary deficiency of calcium e.g. in developing countries
  2. Prolonged breastfeeding
  3. Unsupplemented cow’s milk formula
  4. Lack of sunlight
472
Q

Features of rickets

A

Aching bones and joints
Lower limb abnormalities: toddlers = genu varum (bow legs), older children = genu valgum (knock knees)
‘Rickety rosary’ - swelling at the costochondral junction causing widening of the wrist joints

473
Q

Rickets investigations

A

Low Vit D levels
Reduced serum calcium (symptoms may result from hypocalcaemia)
Raised alkaline phosphatase

474
Q

Management of rickets

A

Oral vitamin D

475
Q

6 in 1 vaccine

A

Diphtheria
Hepatitis B
Haemophilus influenzae type B
Polio
Tetanus
Whooping cough

476
Q

Features of whooping cough

A

1-2 weeks: URTI symptoms

2-8 weeks:
1. cough increases in severity, usually worse at night and after feeding, associated vomiting and central cyanosis
2. inspiratory whoop (not always present, caused by forced inspiration against a closed glottis) instead may have spells of apnoea

477
Q

Diagnostic criteria whooping cough

A

Acute cough lasting for 14 days or more without another apparent cause and one or more of the following features:
- Paroxysmal cough
- Inspiratory whoop
- Post-tussive vomiting
- Undiagnosed apneoic attacks

478
Q

Diagnosis whooping cough

A

Nasal swab culture for Bordetella pertussis + PCR

479
Q

Management of whooping cough (5)

A
  1. Infants under 6 months should be admitted
  2. Onset within last 21 days: Oral macrolide e.g. clarithromycin or azithromycin
  3. Household contacts should be offered antibiotic prophylaxis
  4. School exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms)
  5. Notifiable disease
480
Q

Complications of whooping cough

A

Subconjunctival haemorrhage
Pneumonia
Bronchiectasis
Seizures

481
Q

When should pregnant women be offered the pertussis vaccine

A

16-32 weeks pregnant

482
Q

Testicular torsion features

A

Pain usually severe and sudden onset - may refer to lower abdomen
Nausea + vomiting
O/E: swollen, tender testis retracted upwards, reddened skin
Stroking the thigh does not raise the ipsilateral testicle (Cremasteric reflex is lost)
Elevation of the testis does not ease the pain (Prehn’s sign is lost)

483
Q

Management testicular torsion

A

SURGICAL EMERGENCY - urgent surgical exploration and both testis should be fixed

484
Q

Total fluid requirement

A

First 10kg: 100ml/kg/day
Second 10kg - 50ml/kg/day
Over 20kg - 20ml/kg/day

485
Q

Most common cause of admissions to child and adolescent psychiatric wards

A

Anorexia nervosa

486
Q

DSM-5 diagnostic criteria for anorexia nervosa (3)

A
  1. Restriction of energy intake relative to requirement leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
  2. Intense fear of gaining weight or becoming fat, even though underweight
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
487
Q

1st line treatment for children and young people with anorexia nervosa

A

Anorexia focused family therapy

2nd line = CBT

488
Q

DSM-5 diagnostic criteria of bulimia nervosa (6)

A
  1. Recurrent episodes of binge eating
  2. Sense of lack of control over eating during the episode
  3. Recurrent inappropriate compensatory behaviour in order to prevent weight gain e.g. self induced vomiting
  4. Binge eating + compensatory behaviour occur at least once a week for 3 months
  5. Self evaluation is unduly influenced by body shape and weight
  6. The disturbance does not occur exclusively during episodes of anorexia nervosa
489
Q

Signs of recurrent vomiting in bulimia nervosa

A

Erosion of teeth
Russell’s sign (calluses on the knuckles or back of the hand)

490
Q

Bacteria that contributes to development of acne

A

Propionibacterium acnes

491
Q

1st line treatment of mild to moderate acne

A

12 week course of topical combination therapy e.g. retinoids, benzoyl peroxide, topical clindamycin

492
Q

1st line treatment for moderate-severe acne

A

12 week course of topicals +/- oral antibiotics i.e. oral lymecycline or oral doxycycline

493
Q

What can be used instead of tetracyclines in pregnancy

A

Erythromycin

494
Q

management to prevent antibiotic resistant developing in acne

A

Topical retinoid or benzoyl peroxide should always be co-prescribed (never monotherapy)
Topic and oral antibiotics should not be used in combination

495
Q

Alternative option for women wanting acne medication

A

COC

496
Q

Contraindication to topical and oral retinoid treatment

A

Pregnancy

497
Q

When should referral for acne be considered

A

Non-responders
Scarring
Persistent pigment are changes
Persistent psychological distress caused by acne

498
Q

4 viral causes of otitis media

A

RSV
Rhinovirus
Adenovirus
Influenza virus

499
Q

Commonest cause of conductive hearing loss in childhood

A

Glue ear

500
Q

Treatment for glue ear

A

Grommet insertion

501
Q

Seizure definition

A

Transient episodes of abnormal electrical activity in the brain

502
Q

Advice after first seizure

A

Shower rather than bath
Take caution when swimming
Take caution with heights
Record any further episodes
If > 5 minutes ring 999

503
Q

Follow up after first seizure

A

Paediatric neurologist 2 week urgent referral

504
Q

2 factors to monitor when a patient is admitted with life threatening asthma

A

Oxygen saturations
PEFR

505
Q

Features of a complex febrile seizure

A

partial or focal, >15 mins, can occur multiple times during same febrile illness

506
Q

Phototherapy

A

Converts unconjugated bilirubin into isomers that can be excreted in the bile and urine without requiring conjugation in the liver

507
Q

Treatment threshold charts for neonatal jaundice

A

Age of baby x Total bilirubin level

Phototherapy usually adequate for correction
Extremely high levels = exchange blood transfusion

508
Q

Fluid deficit calculation for a dehydrated patient

A

% dehydration x weight (kg) x 10

509
Q

How to calculate amount of fluids for dehydrated patient without signs of shock

A

Work out maintenance
Work out fluid deficit
Maintenance + fluid deficit = hourly rate

510
Q

TORCH infection

A
511
Q

When is a childs hearing first formally tested

A

Newborn hearing screening programme

Test: Otoacoustic emission test

512
Q

features of growing pains in a child

A

never present at the start of the day
no limp
no limitation of physical activity
systemically well
normal physical exam
intermittent symptoms, worse after a day of vigorous activity

513
Q

Rumination

A

Frequent regurgitation of ingested food that is largely behavioural

514
Q

Regurgitation

A

Effortless expulsion of gastric contents e.g. in healthy infants

515
Q

Possetting

A

Small volume vomiting during or between feeds in an otherwise well child

516
Q

Intestinal atresia presentation

A

Delayed passage of meconium
Bilious vomiting
Abdominal distention

517
Q

3 signs of food intolerance

A

Vomiting
Stool changes
Eczema

518
Q

Presentation of appendicitis in older child

A

Anorexia
Central abdominal pain migrating to RIF
Vomiting fever

519
Q

Precocious puberty diagnosis

A

Before age 8 in girls
Before age 9 in boys

520
Q

Stimulation of puberty

A

High amplitude pulses of GnRH

521
Q

Pseudopuberty

A

Gonadotropin-independent puberty / low FSH and LH

CAH, tumours of the adrenals, ovaries, McCune Albright syndrome (cafe au last spots)

522
Q

Score for acute presentation of perinatal mental illness

A

Mental state examination

523
Q

Testes signs in precocious puberty (bilateral, unilateral, small)

A

bilateral enlargement = gonadotrophin release from intracranial lesion
unilateral enlargement = gonadal tumour
small testes = adrenal cause (tumour or adrenal hyperplasia)

524
Q

Vesicoureteric reflux

A

Abnormal back flow of urine from the bladder into the ureter and kidney

Causes UTIs

525
Q

Investigation vesicoureteric reflux

A

Micturating cystourethrogram

526
Q

Management of mild to moderate acute asthma (exacerbation)

A

Bronchodilator therapy (salbutamol via spacer)
Steroid therapy (give to all children with asthma exacerbation for 3-5 days)

527
Q

4 features which may be present in a sexually abused child

A

STIs, recurrent UTIs
Anal fissure, bruising
Enuresis
Behavioural problems, self harm

528
Q

Autosomal recessive condition
Both parents carriers
Chance of affected child ?
Chance of carrier child ?
Chance of unaffected child ?

A

25% homozygous affected child
50% heterozygous carrier child
25% unaffected genotypical child

529
Q

Fetal alcohol syndrome features

A

Short palpebral fissure
Smooth philtrum
Hypoplastic upper lip
Learning difficulties
Microcephalic
Cardiac malformations
Epicanthic folds

530
Q

Paediatric BLS

A

5 rescue breaths
Circulation check (infants use brachial or femoral, children use femoral)
15:2 chest compressions:rescue breaths (100-120/min)
- children: compress lower half of sternum
- infants: two-thumb encircling technique

531
Q

Risk of using NSAIDs in chickenpox

A

Risk of necrotising fasciitis

532
Q

All the milestones in gross motor development (grid)

A
533
Q

4 indications for immediate CT scan (within 1 hour) of a child with head injury

A

LOC > 5 minutes
3 or more vomiting episodes
Amnesia > 5 minutes
Seizure with no history of epilepsy

534
Q

Initial treatment of suspected cyanosis congenital heart disease

A

Prostaglandin E1 e.g. alprostadil (maintains patent duct arteriosus)

535
Q

Test to differentiate cardiac from non-cardiac causes in a cyanosed baby

A

Nitrogen washout test (100% oxygen then ABG)

536
Q

2 signs that point to pneumonia in a child

A

High fever (over 39C)
Persistently focal crackles

537
Q

Features of bronchiolitis

A

Corzyal symptoms / mild fever preceding:
Dry cough
Increased breathlessness
Wheezing, fine inspiratory crackles
Feeding difficulties (associated with dyspnoea)

538
Q

How may an older child (2-3 yrs) with missed DDH present

A

Trendlenberg gait
Leg length discrepancy

539
Q

Osgood-Schlatter disease

A

Aged 10-15
Unilateral inflammation/swelling of the area below the knee which can be exacerbated by exercise and relieved by rest
Gradual in onset and can become severe
Self-resolving

540
Q

Steroid treatment in meningitis

A

> 3 months = dexamethasone if high WCC
< 3 months = do not give steroids!

541
Q

Chickenpox school exclusion

A

Until all the lesions are dry and have crusted over

542
Q

Definitive treatment biliary atresia

A

Surgical intervention

543
Q

Intestinal malrotation

A

High caecum at the midline

Presents with: bilious vomiting, abdominal distention

Associated with: exomphalos (below pic), congenital diaphragmatic hernia, intrinsic duodenal atria

Complications: volvulus

Urgent upper GI contrast study and ultrasound

544
Q

Reflex anoxic seizures typical features

A

child goes very pale
falls to floor
secondary anoxic seizures are common
rapid recovery

545
Q

Later complications of Down’s syndrome

A

Alzheimer’s disease
Hypothyroidism
ALL
Repeated respiratory infections
Subfertility

546
Q

Management of chickenpox

A

Supportive
Calamine lotion

547
Q

Common complication of chickenpox infection

A

Secondary bacterial infection of the lesions
NSAIDs may increase this risk
Invasive group A strep soft tissue infections can occur resulting in necrotising fasciitis

548
Q

GORD investigations

A

PH testing
Barium swallow and meal
Endoscopy

549
Q

2 components of milk that cause CMPA

A

Casein and whey

550
Q

Encopresis

A

Involuntary faecal soiling or incontinence secondary to chronic constipation

551
Q

Functional constipation

A

Withhold from going to the toilet because defecation is painful but this only increases pain

552
Q

Clinical signs of dehydration

A

Prolonged capillary refill time
reduced skin turgor
Thirst
Sunken eyes
Irritability
lethargy

553
Q

Chronic diarrhoea definition

A

> 2 weeks

554
Q

3 features more typical of functional abdominal pain than organic

A

Stressful life event
Vague pain with gradual onset
Prolonged duration with few effective interventions

555
Q

3 subgroups of children at increased risk of developing cancer

A

Neurofibromatosis 1
Down’s syndrome
Immunocompromised

556
Q

Features of CNS tumour

A

Headache worse lying down
Early morning vomiting
Papilloedema
Squint
Nystagmus
Ataxia
Personality or behaviour change

557
Q

Features that would indicate head scan for child with headaches

A

< 3 y/o
Underlying risk factors e.g. NF1
Presence of any CNS tumour red flag symptoms

558
Q

5 requirements for Fraser guidelines

A

Understands the advice
Understands the implications of treatment
Likely to have sex regardless
Likely to suffer physically or mentally without treatment
It is in their best interests to receive advice and treatment without consent

559
Q

National child measurement programme

A

Measures BMI in children in reception and year 6

560
Q

Mild, moderate, severe DKA

A

pH under 7.3 or BiC under 15
PH under 7.2 or BiC under 10
pH under 7.1 or BiC under 5

561
Q

Grams of carb per unit insulin

A

15g

562
Q

Management of mild-moderate hypoglycaemia

A

Check BG to confirm hypo
Give glucose tablet, gel, food or drink
Check BG in 15 mins
Follow up with longer acting carb e.g. bread

563
Q

Top 2 GI emergencies in babies

A

Sepsis - antibiotics
Malrotation - upper GI contrast (barium meal)

564
Q

4 most common causes of vomiting in a 4 week old baby

A

Overfeeding
GORD
Sepsis
Pyloric stenosis

565
Q

Top 3 differential diagnoses for intussusception

A

Infantile colic, gastroenteritis, sepsis

566
Q

Red flags NICE paeds traffic light system

A

Abnormal skin colour
Appears ill to a healthcare professional
Grunting
RR > 60
Intercostal recession
Reduced skin turgor
Age < 3 months with temp > 38
Signs of meningitis

Management: ADMIT/REFER URGENTLY TO PAEDIATRIC SPECIALIST

567
Q

CF infection with pseudomonas aeruginosa Abx

A

Oral ciprofloxacin

568
Q

1st line management of jaundiced newborn in first 24 hours

A

Measure and record serum bilirubin level

569
Q

What age does persistence of primitive reflexes become concerning

A

6 months e.g. cerebral palsy

570
Q

Vesicoureteric reflux risk factor

A

Family Hx
White
Female
Spina bifida

571
Q

3 investigations minimal change disease

A

Urinalysis
24 hour urinary protein
Serum albumin

572
Q

CAH ABG

A

Metabolic acidosis

573
Q

Cause of purpura in meningococcal septicaemia

A

disseminated intravascular coagulation

574
Q

Differential diagnoses for an unwell neonate

A

Infective: Sepsis
Cardiac: Congenital heart disease
NAI
Metabolic: Hypoglycaemia, Congenital adrenal hyperplasia
Surgical: Hirschsprungs, Necrotising enterocolitis, pyloric stenosis

575
Q

Stridor definition

A

high-pitched respiratory sound produced by irregular airflow in a narrowed airway during the inspiration phase

DDx wheeze = expiratory

576
Q

Patent ductus arteriosus murmur

A

machinery murmur (continuous crescendo-decrescendo) at the upper left sternal edge

577
Q

2 risk factors for PDA

A

rubella infection
Prematurity

578
Q

4 presentations of PDA

A

Shortness of breath
Difficulty feeding
Poor weight gain
LRTI

579
Q

PDA investigation

A

Echocardiogram: right + left hypertrophy

monitored with echos until 1 year - resolves spontaneously or need surgery

580
Q

PDA medications

A

IV indomethacin or ibuprofen

581
Q

5 causes of failure to thrive

A

Inadequate nutritional intake e.g. iron deficiency anaemia, neglect
Difficulty feeding e.g. cerebral palsy, pyloric stenosis
Malabsorption e.g. cystic fibrosis, coeliac, CMPA
Increased energy requirements e.g. hypothyroidism, infection
Inability to process nutrients e.g. T1DM

582
Q

2 key investigations failure to thrive

A

Urine dipstick for UTI
Coeliac screen (anti-TTG)

583
Q

Neonatal respiratory distress syndrome

A

Surfactant deficiency

Key signs: rapid, laboured breathing, ground class on CXR

Management: corticosteroids pre-delivery, artificial surfactant via intratracheal instillation, high pressure oxygen

584
Q

4 causes of diarrhoea in infants/children

A

Infection (gastroenteritis)
Cow milk intolerance
Toddler’s diarrhoea
Coeliac
Post-gastro lactose intolerance
Antibiotic treatment
Anxiety/stress
IBD

585
Q

Fecal impaction

A

Constipation and overflow diarrhoea (loose, watery stool comes around the stuck fetal matter), often affects the child’s ability to sense and respond to the presence of stool in the rectum

586
Q

Cerebral palsy is a clinical diagnosis, what further investigations could you do?

A

MRI brain

587
Q

Professionals involved in care of cerebral palsy

A

Occupational therapy
Physiotherapy
Speech therapy
GP
Neurology

588
Q

3 indications for Botox prescription in cerebral palsy

A

Salivary glands to stop drooling
Bladder in overactive bladder
Lower limb spasticity and dystonia

589
Q

Differential diagnoses Neonatal RDS

A

Meconium aspiration
Sepsis
Pneumothorax

590
Q

Complication of building up feeds too quickly in neonatal hypoglycaemia

A

Necrotising enterocolitis

591
Q

Severe complications of neonatal hypoglycaemia (4)

A

Retinopathy of prematurity
Sensorineural hearing loss
Chronic lung disease
Cerebral palsy

592
Q

rhesus disease of the newborn

A

1st baby: rhesus D negative, 2nd baby: rhesus D positive

Mothers anti-D antibodies from 1st pregnancy cross the placenta into the rhesus D positive 2nd baby = haemolysis (anaemia + jaundice)

593
Q

What condition can maternal antenatal labetalol use increase the risk of

A

Neonatal hypoglycaemia

594
Q

investigations in infants younger than 3 months with fever

A

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

595
Q

Management of child < 3 years with acute limp

A

Urgent specialist assessment

596
Q

One parent has an autosomal dominant disease (Aa or AA)
One parent does not have the disease (aa)
Chance of the patient’s children inheriting the disease?

A

50%

597
Q

Parallel play milestone

A

2 years

598
Q

Corrected age of a premature baby

A

Age minus the number of weeks born early from 40 weeks

599
Q

Intestinal obstruction e.g. meconium ileus X-ray

A

Dilated bowel loops proximal to impaction

600
Q

Shaken baby syndrome triad

A

Retinal haemorrhages
Subdural haematoma
Encephalopathy

601
Q

4 delayed motor milestones that should elicit urgent referral for cerebral palsy if there are risk factors e.g. low birth weight

A

Not sitting by 8 months
Not walking by 18 months
Early asymmetry of hand function before 12 months
Persistent toe-walking

602
Q

Otherwise well infant with inspiratory strider

A

Laryngomalacia

Congenital softening of the cartilage of the larynx, causing collapse during inspiration

Usually self-resolves before 2 years of age

603
Q

Cystic fibrosis positive heel prick test results

A

Raised level of immunoreactive trypsinogen (IRT)

604
Q

Duchenne muscular dystrophy associated cardiac pathology

A

Dilated cardiomyopathy

605
Q

Toddler’s diarrhoea

A

Stools vary in consistency and often contain undigested food

606
Q

Cephalohaematoma (DDx from caput)

A

Typically develops several hours after birth
Most commonly in parietal region
Doesn’t cross the suture lines
May take months to resolve

607
Q

Caput succedaneum (DDx from cephalohaematoma)

A

Present at birth
typically forms over the vertex and crosses suture lines
Resolves within days

608
Q

Caput succedaneum + Cephalohaematoma (3 similarities)

A

Swelling on the head of a newborn
more common following prolonged, difficult deliveries
Managed conservatively

609
Q

Major risks for sudden infant death syndrome

A

Prone sleeping (face down)
Parental smoking
Bed sharing
Hyperthermia and head covering
Prematurity

610
Q

Smooth midline lesion, round, located just below the hyoid bone
Rises on protrusion of the tongue

A

Thyroglossal cyst

611
Q

Cause of spastic cerebral palsy

A

increased tone resulting from damage to upper motor neurons

612
Q

Cause of dyskinetic cerebral palsy

A

damage to the basal ganglia and the substantia nigra

613
Q

Mesenteric adenitis

A

Inflamed lymph nodes within the mesenteric

Often follows a recent viral infection

DDx: appendicitis

614
Q

Congenital diaphragmatic hernia O/E

A

Displaced apex beat and decreased air entry
Scaphoid abdomen

615
Q

Vitamin K in neonates

A

Offered by IM route as a once-off injection shortly after birth

616
Q

Neonatal death definition

A

Between 0-28 days of birth

617
Q

3 complications of undescended testis

A

Infertility
Torsion
Testicular cancer

618
Q

2 options for head lice management

A

Treatment is only indicated if living lice are found when combing inc household contacts unless they are affected

  1. Malathion
  2. Wet combing
619
Q

Premature baby vaccinations: gestational or chronological age?

A

Chronological age

620
Q

Antibiotic whooping cough

A

Onset within last 21 days: Oral macrolide e.g. clarithromycin or azithromycin

621
Q

Congenital diaphragmatic hernia

A

Herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm

= pulmonary hypoplasia and hypertension resulting in respiratory distress shortly after birth

622
Q

What should be prescribed for all patients presenting with an asthma attack for 5 days

A

Prednisolone

623
Q

Myoclonic Tx

A

Levetiracitam

624
Q

complication minimal change disease

A

Hypovolaemia
Thrombosis
Infection

3a PTS - PM - ZTF (8 decks)

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