PAEDS

Question 1

Acute epiglottitis is caused by

Answer 1

Haemophilus influenzae type B

Question 2

features of measles

Answer 2

prodromal phase

irritable

conjunctivitis

fever

Koplik spots white spots (‘grain of salt’) on the buccal mucosa
rash

Question 3

causes of acyanotic congenital heart disease

Answer 3

ventricular septal defects (VSD) - mostcommon, accounts for 30%

atrial septal defect(ASD)

patent ductus arteriosus (PDA)

coarctation of the aorta

aortic valve stenosis

Question 4

causes of cyanotic heart disease

Answer 4

tetralogy of Fallot

transposition of the great arteries(TGA)

tricuspid atresia

Question 5

Hand, foot and mouth disease features

Answer 5

Caused by the coxsackie A16 virus
Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

Question 6

Scarlet fever features

Answer 6

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

Question 7

Erythema infectionsum features

Answer 7

known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

Question 8

Rubella features

Answer 8

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

Question 9

mumps features

Answer 9

Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

Question 10

Kawasaki features

Answer 10

high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics

conjunctival injection

bright red, cracked lips

strawberry tongue

cervical lymphadenopathy

red palms of the hands and the soles of the feet which later peel

Question 11

Roseala
infantum features

Answer 11

human herpes virus 6(HHV6). It has an incubation period of 5-15 days and typically affects children aged 6 months to 2 years.

Features

high fever: lasting a few days,followed laterby a

maculopapular rash

Nagayama spots: papular enanthem on the uvula and soft palate

febrile convulsions occur in around 10-15%

diarrhoea and cough are also commonly seen

Question 12

Patau syndrome(trisomy 13)

Answer 12

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

Question 13

Edward’s syndrome(trisomy 18)

Answer 13

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

Question 14

fragile X

Answer 14

Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism

Question 15

Noonan syndrome

Answer 15

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

Question 16

Pierre-Robin syndrome*

Answer 16

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

Question 17

Prader-Willi syndrome

Answer 17

Hypotonia
Hypogonadism
Obesity

Question 18

William’s syndrome

Answer 18

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

Question 19

Whooping cough diagnostic criteria

Answer 19

Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:

Paroxysmal cough.

Inspiratory whoop.

Post-tussive vomiting.

Undiagnosed apnoeic attacks in young infants.

Question 20

management of whooping cough

Answer 20

infants under 6 months with suspect pertussis should be admitted

in the UK pertussis is anotifiabledisease

an oralmacrolide(e.g. clarithromycin, azithromycin or erythromycin) is indicated if the onset of the cough is within the previous21 daysto eradicate the organism and reduce the spread

household contacts should be offered antibiotic prophylaxis

antibiotic therapy has not been shown to alter the course of the illness

school exclusion:48 hoursafter commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

Question 21

Measles features

Answer 21

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

Question 22

Scarlet fever features

Answer 22

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

Question 23

Which infants require routine US exam ddh risk

Answer 23

first-degree family history of hip problems in early life
breech presentation at or after 36 weeks gestation, irrespective of presentation at birth or mode of delivery
multiple pregnancy

Question 24

Risk factors for DDH

Answer 24

female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity

Question 25

Mild vs moderate vs severe croup

Answer 25

Mild croup:
Occasional barking cough with no stridor at rest
No or mild recessions
Well looking child

Moderate croup:
Frequent barking cough and stridor at rest
Recessions at rest
No distress

Severe croup:
Prominent inspiratory stridor at rest
Marked recessions
Distress, agitation or lethargy
Tachycardia

Question 26

Croup when to admit?

Answer 26

Admission to hospital is only considered for moderate or severe croup

Question 27

Croup mx

Answer 27

single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
Emergency treatment
high-flow oxygen
nebulised adrenaline

Question 28

Necrotising enterocolitis features

Answer 28

risks increased in prematurity and inter-current illness
Dilated bowel loops on AXR, pneumatosis and portal venous air

Question 29

Whooping cough cause

Answer 29

Gram-negative bacterium Bordetella pertussis

Question 30

Whooping cough mx

Answer 30

azithromycin or clarithromycin if the onset of cough is within the previous 21 days

Question 31

Undescended testicles are associated with an increased risk of

Answer 31

infertility, torsion and testicular cancer