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Paeds Flashcards

1
Q

Newborn resuscitation guidelines

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
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2
Q

Most common cause of arrest in children?

A

Respiratory - likely foreign body

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3
Q

What does this image show?

A

Pyloris stenosis - target mass on USS

Bloods will show hypochloraemic hypokalaemic metabolic alkalosis

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4
Q

causative organism of croup

A

parainfluenza

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5
Q

Other name for croup

A

Laryngeotracheobronchitis

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6
Q

Treatment of meningitis

A

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

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7
Q

Initial management of cyanotic heart disease

A

Prostaglandin E1, then surgery

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8
Q

When do cyanotic heart disease present/

A

ToF - months, weeks, days
TGA - hours
TA - minutes

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9
Q

Basic anatomical changes in TGA

A

aorta leaves the right ventricle
pulmonary trunk leaves the left ventricle

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10
Q

CXR appearance of TGA

A

‘egg-on-side’ appearance on chest x-ray

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11
Q

Murmurs heard on TGA

A

NO MURMUR
loud single S2
prominent right ventricular impulse

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12
Q

Echocardiogram sign of TGA

A

parallel aorta and pulmonary trunk

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13
Q

Prostanglandin name

A

Alloprostadil

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14
Q

Red flags that would warrant admission in bronchiolitis

A

grunting noises, cyanosis, use of accessory muscles for respiration, a respiratory rate exceeding 70 breaths per minute, oxygen saturations below 92% on room air or episodes of apnoea

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15
Q

cuase of bronchiolitis

A

RSV

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16
Q

Management of bronchiolitis

A

supportive

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17
Q

What can cause bronchiolitis to be more severe?

A

CHD

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18
Q

Monoclonal AB that can be used in RSV

A

Palivizumab

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19
Q

Neonatal hypoglycaemia cut off

A

<2.6

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20
Q

Management of neonatal hypoglycaemia

A

asymptomatic
encourage normal feeding (breast or bottle)
monitor blood glucose

symptomatic or very low blood glucose
admit to the neonatal unit
intravenous infusion of 10% dextrose

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21
Q

Most common cause of nappy rash

A

Irritant dermatitis, typically spares creases

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22
Q

Pattern of nappy rash in candida dermatitis

A

involves flexures and has satellite lesions

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23
Q

High fever lasting >5 days, red palms with desquamation and strawberry tongue

A

Kawasaki

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24
Q

Management of Kawasaki

A

high-dose aspirin
intravenous immunoglobulin
echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms

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25
Q

Complication of Kawasaki that needs screening for, how?

A

Coronary artery aneurysm, Echo

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26
Q

When should infantile colic resolve by?

A

6 months

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27
Q

Features that suggest infantile colic

A

baby’s age (colic starts in the first few weeks of life and resolves around 3-4 months of age), the timing of the crying (most often occurs in the late afternoon or evening), and arching of the back (babies often draw their knees up to their abdomen or arch their backs when crying).

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28
Q

when is APGAR score measured

A

NICE recommend that it is assessed at 1, and 5 minutes of age. If the score is low then it is again repeated at 10 minutes

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29
Q

APGAR score interpretations

A

A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state

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30
Q

Visible peristalsis in abdomen with non-bilious vomiting

A

Pyloric stenosis

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31
Q

Electrolyte abnormality in pyloric stenosis

A

Hypochloraemic Hypokalaemic Metabolic Alkalosis

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32
Q

Criteria to assess probability of septic arthritis in children, how to calculate and interpret?

A

Non-weight bearing - 1 point
Fever >38.5ºC - 1 point
WCC >12 * 109/L - 1 point
ESR >40mm/hr

The probabilities are calculated thus:
0 points = very low risk
1 point = 3% probability of septic arthritis
2 points = 40% probability of septic arthritis
3 points = 93% probability of septic arthritis
4 points = 99% probability of septic arthritis

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33
Q

Most important investigations in septic arthritis

A

joint aspiration: for culture. Will show a raised WBC
raised inflammatory markers
blood cultures

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34
Q

What should be given to all children who an asthma attack/exacerbation? How long for?

A

Oral steroids for 3-5 days

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35
Q

groin swelling and primary amenorrhoea

A

androgen insensitivity, groin swellings are undescended testis

genetically male (46XY), but phenotypically female

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36
Q

Table showing disorders of sex hormones

A
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37
Q

Cause of primary hypogonadism, give karyotype and features

A

Klinefelter’s syndrome is associated with karyotype 47, XXY

Features
often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels

Diagnosis is by chromosomal analysis

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38
Q

Cause of hypogonadotropic hypogonadism, give features

A

Kallman syndrome, X-linked

Features
‘delayed puberty’
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
LH, FSH levels are inappropriately low/normal
patients are typically of normal or above average height

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39
Q

lack of smell (anosmia) in a boy with delayed puberty

A

Kallman

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40
Q

Management of androgen insensitivity syndrome

A

counselling - raise child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy

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41
Q

When can a child with scarlet fever return to school?

A

24 hours after commencing ABx

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42
Q

When can a child with measles return to school>

A

4 days from onset of rash

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43
Q

When can child with whooping cough return to school?

A

48 hours after commencing ABxWh

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44
Q

When can child with rubella return to school?

A

5 days from onset of ras

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45
Q

When can child with D+V return to school?

A

48 hours after symptoms settled

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46
Q

causative organism of scarlet fever

A

Group A haemolytic streptococci (usually Streptococcus pyogenes)

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47
Q

sandpaper rash

A

Scarlet fever

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48
Q

Management of scarlet fever

A

oral penicillin V for 10 days
patients who have a penicillin allergy should be given azithromycin
children can return to school 24 hours after commencing antibiotics
scarlet fever is a notifiable disease

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49
Q

Most common complication of scarlet fever

A

otitis media: the most common complication

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50
Q

Child with a limp/hip pain and fever mx

A

Refer for same day assessment even if a diagnosis of transient synovitis suspected

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51
Q

Main cause of painless massive GI bleeding

A

Meckels

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52
Q

Rule of 2s for Meckles

A

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

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53
Q

How can meckels present?

A

Presentation (usually asymptomatic)

abdominal pain mimicking appendicitis

rectal bleeding
Meckel’s diverticulum is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years

intestinal obstruction
secondary to an omphalomesenteric band (most commonly), volvulus and intussusception

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54
Q

Differential for appendicitis

A

Meckels

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55
Q

Investigation for Meckels

A

99m technetium pertechnetate, which has an affinity for gastric mucosa

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56
Q

What is meckels?

A

remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa.

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57
Q

Child <3 with acute limp

A

Urgent paediatric assessment

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58
Q

Acute cough and stridor following fever and coryza in a child aged 6 months to 3 years

A

Croup

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59
Q

Barking cough

A

Croup

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60
Q

What does stridor suggest?

A

upper airway obstruction, caused by inflammation and oedema of the larynx, trachea, and bronchi

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61
Q

Croup is more common in which season

A

autumn

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62
Q

most likely result if a fetus is homozygous for alpha-thalassaemia

A

hydrops fetalis

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63
Q

what is anencephaly, cause?

A

serious birth defect in which a baby is born without parts of the brain and skull

folic acid deficiency

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64
Q

Management of formula fed cows milk protein allergy

A

extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptoms

amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF

around 10% of infants are also intolerant to soya milk

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65
Q

Management of breast fed cows milk protein allergy

A

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

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66
Q

What occurs in testicular torsion?

A

testis turns on the remnant of the processus vaginalis

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67
Q

acutely severe testicular pain often with associated nausea and vomiting

A

torsion

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68
Q

Signs associated with torsion

A

The cremaster reflex may also be absent on the affected side.

Prehn’s sign - Elevation of the testicle often results in worsening of the pain.

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69
Q

Features of Innocent murmur

A

Soft, Systolic, Short, Symptomless, Standing/Sitting (vary with position)

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70
Q

Venous hums

A

Innocent murmurs that is due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles

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71
Q

Still’s murmur

A

Innocent murmur that is a Low-pitched sound heard at the lower left sternal edge

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72
Q

murmur in aortic coarctation

A

ejection systolic murmur which can be heard through to the back

murmur does not change on position

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73
Q

Examination finding of aortic coarctation

A

Radio-femoral delay

difference between blood pressure in the arms and legs is detected

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74
Q

Murmur thats seen in VSD

A

pansystolic

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75
Q

Murmur seen in ASD

A

ejection systolic murmur but is often associated with fixed splitting of the 2nd heart sound

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76
Q

Murmur seen in pulmonary stenosis

A

ejection systolic murmur heard at the left upper parasternal edge

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77
Q

Components of APGAR score

A

Pulse Respiratory effort Colour Muscle tone Reflex irritability

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78
Q

A 5-day-old baby has her heel prick test done, and it comes back that she has a raised level of immunoreactive trypsinogen (IRT). What next?

A

Sweat test

normal value < 40 mEq/l, CF indicated by > 60 mEq/l

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79
Q

Fluid resus guidelines

A

Start IV fluid resuscitation in children or young people with a bolus of 10 ml/kg over less than 10 minutes

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80
Q

Major RF for NRDS

A

Prematurity

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81
Q

Major RF for TTN

A

C section

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82
Q

Major RF for aspiration pneumonia

A

Meconium staining

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83
Q

CXR finding on NRDS

A

diffuse ground glass lungs with low volumes and a bell-shaped thorax

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84
Q

CXR finding of TTn

A

heart failure type pattern (e.g. interstitial oedema and pleural effusions

NOTE: key distinguishing features from congenital heart disease are a normal heart size and rapid resolution of the failure type pattern within days.

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85
Q

NRDS AKA

A

Surfactant deficienct lung disease

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86
Q

Management of NRDS

A

prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
oxygen
assisted ventilation
exogenous surfactant given via endotracheal tube

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87
Q

Infant with bilious vomiting & obstruction

A

Intestinal malrotation

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88
Q

Signs of obstruction

A

distended abdomen and absent bowel sounds

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89
Q

What type of vaccine is rotavirus?

A

oral, live attenuated vaccine

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90
Q

Dose of dex to be given in croup

A

Croup - A single dose of oral dexamethasone (0.15 mg/kg) is to be taken immediately regardless of severity

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91
Q

Initial management of Hirchsprung’s

A

rectal washouts/bowel irrigation

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92
Q

Definitive management of Hirchpsrung’s

A

Anorectal pull through

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93
Q

Absence of in Hirchsprung

A

parasympathetic Auerbach and Meissner plexuses

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94
Q

Hirchsprung association

A

Down’s

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95
Q

Gold standard for Hirchsprung

A

Full thickness rectal biopsy

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96
Q

Failure or delay to pass meconium

A

Hirchsprung

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97
Q

prodrome of fever, irritability and conjunctivitis

A

Measles

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98
Q

Koplik spots

A

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

seen in measles

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99
Q

Presentation of chickenpox

A

Fever initially

Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular

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100
Q

How does rash present in measles?

A

Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

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101
Q

How does rash present in rubella?

A

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

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102
Q

How to differentiate between measles and rubella?

A

Measles has a prodrome of irrtability, conjunctivitis and fever

Rubella has Lymphadenopathy: suboccipital and postauricular

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103
Q

Complication of mumps

A

Orchitis and eventually subfertility

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104
Q

Parotitis (earache/pain on eating)

A

Mumps

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105
Q

Erythema Infectiosum AKA, cause?

A

Also known as fifth disease or ‘slapped-cheek syndrome’
Caused by parvovirus B19

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106
Q

Rash in erythema infectiosum

A

‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

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107
Q

Rash in scarlet fever

A

fine punctate erythema sparing the area around the mouth (circumoral pallor)

Sandpaper like

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108
Q

Cause of hand, foot and mouth disease

A

coxsackie A16 virus

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109
Q

Vesicles in the mouth and on the palms and soles of the feet

A

Hand, foot and mouth disease

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110
Q

Short stature + primary amenorrhoea

A

Turners

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111
Q

Karyotype of Turners

A

45,XO or 45,X.

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112
Q

Presentation of Turners

A

short stature
shield chest, widely spaced nipples
webbed neck
bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
primary amenorrhoea

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113
Q

Projectile non bile stained vomiting at 4-6 weeks of life

A

Pyloric stenosis

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114
Q

Treatment of pyloric stenosis

A

Ramstedt pyloromyotomy (open or laparoscopic)

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115
Q

Colicky pain, diarrhoea and vomiting, sausage-shaped mass, red jelly stool.

A

Intusussception

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116
Q

Treatment of intusussception

A

reduction with air insufflation

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117
Q

Treatment of volvulus

A

Ladd’s procedure

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118
Q

Associations of oesophogael atresia

A

Associated with tracheo-oesophageal fistula and polyhydramnios

VACTERL associations - vertebrae, anus, cardia, trachea, esophagus, renal and limbs

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119
Q

VACTERL associations

A

vertebrae, anus, cardia, trachea, esophagus, renal and limbs

Seen in oesophogael atresia

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120
Q

Jaundice >14 days with increased conjugated bilirubin

A

Biliary atresia

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121
Q

Management of biliary atresia

A

Kasai

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122
Q

What blood test finding in biliary atresia?

A

Increased conjugated bilirubin

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123
Q

XR finding of nec enterocolitis

A

pneumatosis intestinalis

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124
Q

abdominal distension and passage of bloody stools in a premature infant

A

Nec enterocolitis

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125
Q

meconium ileus associated with

A

CF

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126
Q

What can be done to reduce chances of severe brain damage in neonates with hypoxic injury?

A

Therapeutic cooling at 33-35 degrees

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127
Q

normal pCO2 in an acute asthma attack indicates

A

Life threatening attack

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128
Q

Features of severe astham attack

A

SpO2 < 92% (unlike in adults, SpO2 < 92% may be consistent with a ‘severe’ attack in children)

PEF 33-50% best or predicted

Too breathless to talk or feed

Heart rate
>125 (>5 years)
>140 (1-5 years)

Respiratory rate
>30 breaths/min (>5 years)
>40 (1-5 years)

Use of accessory neck muscles

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129
Q

Features of life threatening asthma attack

A

SpO2 <92%

PEF <33% best or predicted

Silent chest

Poor respiratory effort

Agitation

Altered consciousness

Cyanosis

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130
Q

Most common fractures associated with child abuse

A
  • Radial
  • Humeral
  • Femoral
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131
Q

Treatment of ITP

A

usually, no treatment is required
ITP resolves in around 80% of children with 6 months, with or without treatment

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132
Q

What type of rash in ITP

A

petechial or purpuric rash

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133
Q

Best investigation for VUR

A

micturating cystourethrogram

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134
Q

Why do a DMSA scan

A

look for renal scarring

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135
Q

Infantile spasms AKA

A

West syndrome

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136
Q

Features of West syndrome

A

characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms
this lasts only 1-2 seconds but may be repeated up to 50 times
progressive mental handicap

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137
Q

Prognosis of infantile spasms

A

BAD

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138
Q

EEG findings of West syndrome

A

hypsarrhythmia

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139
Q

1st line medication for infantile spasms

A

vigabatrin is now considered first-line therapy

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140
Q

Fever followed later by rash

A

Roseola infantum

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141
Q

Roseola infantum AKA, caused by?

A

Roseola infantum (also known as exanthem subitum, occasionally sixth disease) is a common disease of infancy caused by the human herpes virus 6 (HHV6)

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142
Q

Common association of roseola infantum

A

Febrile convulsions

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143
Q

What can NSAIDs cause in patients with chicken pox?

A

Nec fascitis

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144
Q

baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers

A

Edward’s (trisomy 18)

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145
Q

cleft lip or palate, polydactyly (extra digits), microphthalmia (small eyes), scalp defects, and congenital heart disease

A

Patau (trisomy 13)

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146
Q

elfin’ facies (distinctive facial features such as a wide mouth, small nose, and full lips), cardiovascular disease (especially supravalvular aortic stenosis), hypercalcemia (high calcium levels in the blood), intellectual disability and an outgoing personality

A

William syndrome

Deletion on chromosome 7

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147
Q

intellectual disability ranging from learning difficulties to severe cognitive impairment along with characteristic long face, large ears, hyperextensible joints especially fingers and behavioural problems like ADHD or autism spectrum disorder

A

Fragile X

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148
Q

anomalies of the facial structures leading to micrognathia (undersized jaw), glossoptosis (downward displacement or retraction of the tongue) and often cleft palate

A

Pierre-Robin syndrome

149
Q

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

A

Noonnan syndrome

150
Q

Hypotonia
Hypogonadism
Obesity

A

Prader-Willi syndrome

Deletion on chromosome 5

151
Q

Characteristic cry due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism

A

Cri du chat syndrome (chromosome 5p deletion syndrome)

THINK: CRY du chat

152
Q

Management of hand, foot and smouth disease

A

symptomatic treatment only: general advice about hydration and analgesia
reassurance no link to disease in cattle
children do not need to be excluded from school

153
Q

This child has had what was a likely viral illness in the past week and is now suffering with abdominal pain, How to differ mesenteric adenitis from other conditions?

A

He is eating and drinking normally, unlikely in appendicitis.
He is passing normal stools, unlikely in constipation.
He is not vomiting, unlikely in gastroenteritis.

154
Q

1st line laxative in constipation

A

Osmotic - polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain

Then stimulant

155
Q

children with an unexplained enlarged abdominal mass in children

A

possible Wilm’s tumour - arrange paediatric review with 48 hours

156
Q

Most common complication of measles

A

otitis media

Pneumonia also a complication

157
Q

When to start medication in whooping cough? What medication?

A

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

158
Q

Causative organism of whooping cough

A

Bordetella pertussis

159
Q

Diagnostic criteria for whooping cough

A

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.

160
Q

Diagnosis of whooping cough done via

A

per nasal swab culture for Bordetella pertussis - may take several days or weeks to come back

161
Q

Who should be admitted in whooping cough?

A

infants under 6 months with suspect pertussis should be admitted

162
Q

Is whooping cough a notifiable disease?

A

Yes

163
Q

Main complication of whooping cough

A

subconjunctival haemorrhage

164
Q

Triad of shaken baby syndrome

A

Retinal haemorrhages, subdural haematoma and encephalopathy

165
Q

Common presenting features of neonatal sepsis

A

grunting, nasal flaring, tachypnoea and the use of accessory respiratory muscles.

166
Q

Cause of early onset neonatal sepsis

A

GBS

167
Q

Cause of late onset neonatal sepsis

A

Coag negative staph e.g. satph epidermis

168
Q

1st like medication in confirmed neonatal sepsis

A

intravenous benzylpenicillin with gentamicin

169
Q

Risk of further febrile convulsion

A

1 in 3

170
Q

Management of febrile convulsions

A

parents should be advised to phone for an ambulance if the seizure lasts > 5 minutes
regular antipyretics have not been shown to reduce the chance of a febrile seizure occurring

171
Q

1st line medication for febrile convulsion that don’t teriminate

A

rectal diazepam or buccal midazolam

172
Q

Why is gestational diabetes a risk factor for NRDS?

A

insulin inhibits surfactant production and maturation of the fetal lungs.

173
Q

Rate of chest compressions in children

A

100-120 per minute

174
Q

What age should babies who were born prematurely receive their routine vaccines according to?

A

Chronological, no adjustment for gestation

175
Q

Under what centile for height should children be reviewed by a paediatrician?

A

Children below 0.4th centile for height should be reviewed by a paediatrician

176
Q

What murmur in PDA?

A

Gibson murmur - continuous machinery murmur

177
Q

Features on examination of PDA

A

left subclavicular thrill
continuous ‘machinery’ murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat

178
Q

Management of PDA

A

indomethacin or ibuprofen

179
Q

most common cardiac condition in Down’s

A

AVSD

180
Q

Associations of down’s syndrome

A

congenital heart defects - AVSD, VSD
duodenal atresia
Hirschsprung’s disease

181
Q

Complications of Down’s

A

Subfertility
Short stature
Recurrent infections
acute lymphoblastic leukaemia
hypothyroidism
Alzheimer’s disease
atlantoaxial instability

182
Q

Hand preference before when is abnormal?

A

12 months

183
Q

Presentation of ALL

A

anaemia, neutropaenia and thrombocytopaenia

184
Q

testicular swelling in a child

A

Exclude ALL

185
Q

Hepatosplenomegaly and the presence of bruising together with the symptoms of anaemia (soft systolic murmur and shortness of breath on exertion)

A

ALL

186
Q

management of unilateral undescened testicle

A

Unilateral undescended testicle - review at 3 months - if persistent refer

187
Q

Management of bilateral undescended testis

A

Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation

188
Q

when to consider a diagnosis of pneumonia over bronchiolitis?

A

high fever (over 39°C) and/or
persistently focal crackles.

189
Q

anterior knee pain on walking up and down stairs and rising from prolonged sitting

A

Chondromalacia patellae

190
Q

Pain, tenderness and swelling over the tibial tubercle

A

Osgood-Schlatter disease

191
Q

Pain after exercise
Intermittent swelling and locking

A

Osteochondritis dissecans

192
Q

Where may referred pain in the knee come from?

A

hip problems such as slipped upper femoral epiphysis

193
Q

When to admit a child with group?

A

moderate or severe croup
< 3 months of age
known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)

194
Q

child with croup and stridor at rest, mx?

A

admit as stridor at rest is a feature of moderate croup along with sternal wall retraction

195
Q

At what age would the average child acquire the ability to sit without support?

A

The answer (6-8 months) includes the 6 months as stated in the MRCPCH Development Guide.

196
Q

Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress

A

diaphragmatic hernia

197
Q

Difference in presentation of cyanotic heart disease

A

Cyanotic congenital heart disease presenting within the first days of life is TGA.
Cyanotic congenital heart disease presenting at 1-2 months of age is TOF

198
Q

After how long is passage of meconium classed as a red flag?

A

48 hours

199
Q

Cardiac compplication associated with fragile X

A

mitral valve prolapse

200
Q

Most common cardiac abnormality in Turners

A

Bicuspid aortic valve

201
Q

What condition is a contraindication to LP? How does it present?

A

Meningococcal septicaemia, purpuric rash

202
Q

Cyanotic heart disease with no murmur but typically a loud single S2 is audible and a prominent right ventricular impulse is palpable on examination

A

ToGA

203
Q

antispasmolytic used in cerebral palsy

A

Baclofen

203
Q

How to differentiate between cyanotic cardiac and respiratory causes?

A

Administer 15 mins of 100% oxygen - nitrogen (hyperoxia) test
>15 - resp e.g. TTN, meconium aspiration, NRDS
<15 –> heart e.g. TA, TOGA, ToF

204
Q

Types of cerebral palsy

A

spastic (70%)
subtypes include hemiplegia, diplegia or quadriplegia
increased tone resulting from damage to upper motor neurons

dyskinetic
caused by damage to the basal ganglia and the substantia nigra
athetoid movements and oro-motor problems

ataxic
caused by damage to the cerebellum with typical cerebellar signs

mixed

205
Q

Damage occurs where in the brain cerebral palsy

A

pyramidal tracts

206
Q

Causes of cerebral palsy

A

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

207
Q

Non-motor associations of cerebral palsy

A

learning difficulties (60%)
epilepsy (30%)
squints (30%)
hearing impairment (20%)

208
Q

At what age would the average child acquire the ability to walk unsupported

A

On average, most children start to walk unsupported between the ages of 13 and 15 months

209
Q

what age do you grow out of febrile convulsions?

A

5 years

210
Q

A boy with learning difficulties is noted to be extremely friendly and extroverted. He has short for his age and has supravalvular aortic stenosis

A

Williams

211
Q

Cardiac defect most associated with Williams

A

supravalvular aortic stenosis

212
Q

A child aged < 3 months with a fever > 38ºC, management?

A

same day paediatric assessment

213
Q

At what age would the average child start to smile?

A

6 weeks

214
Q

What position may patiennts with acute epigolittis adopt?

A

tripod position

215
Q

drooling and respiratory distress

A

acute epiglottitis

216
Q

what sign on X ray in epiglottitis

A

Thumb si

217
Q

Causative agent of acute epiglottitis

A

Hib

218
Q

Management of acute epiglottitis

A

immediate senior involvement, including those able to provide emergency airway support (e.g. anaesthetics, ENT)
endotracheal intubation may be necessary to protect the airway
if suspected do NOT examine the throat due to the risk of acute airway obstruction
oxygen
intravenous antibiotics

219
Q

most common cause of microcephaly

A

foetal alcohol syndrome

220
Q

Presentation of foetal alcohol syndrome

A

short ­palpebral fissure
thin vermillion border/hypoplastic upper lip
smooth/absent filtrum
learning difficulties
microcephaly
growth retardation
epicanthic folds
cardiac malformations

221
Q

what signs can be indicative of sexual abuse?

A

Anal fissures and recurrent UTIs in children

222
Q

Cause of slapped cheek syndrome

A

Parvovirus B19

223
Q

Distinguishing features between cephalhaematoma and caput succedaneum

A

Distinguishing features of a cephalhaematoma are that they usually develop after birth and do not cross the suture lines of the skull as the blood is confined between the skull and periosteum.

224
Q

crosses suture lines

A

caput succedcaneum

225
Q

Infant < 8 weeks, presents with milky vomits after feeds, often after being laid flat, excessive crying

A

GORD

226
Q

When is indomethacin given to child with PDA?

A

indomethacin is given to the neonate in the postnatal period, if the echo shows PDA one week after delivery

227
Q

When should a PPI be trialed in GORD?

A

PPI should be trialled in infants with GORD who do not respond to alginates/thickened feeds and who have 1. feeding difficulties, 2. distressed behaviour or 3. faltering growth

228
Q

At what age would the average child acquire the ability to crawl?

A

9 months

229
Q

In tetralogy of Fallot, what determines the degree of cyanosis and severity?

A

the severity of the right ventricular outflow tract obstruction (pulmonary stenosis) determines the degree of cyanosis and clinical severity

230
Q

Age of palmar grasp

A

5-6 months

231
Q

Age to draw a circle

A

3 years

232
Q

Age for a tower of 3-4 blokcs

A

18 months

233
Q

Most common cause of stridor in neonate

A

laryngomalacia

234
Q

greasy, yellowish rash with flaky scales, most commonly on the scalp

A

cradle cap - seborrhoeic dermatitis - malazzesia

235
Q

Management of seborrhoeic dermatitits

A

reassurance that it doesn’t affect the baby and usually resolves within a few weeks
massage a topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo.
if severe/persistent a topical imidazole cream may be tried

236
Q

At what age would the average child start to say ‘mama’ and ‘dada’?

A

9-10 months

237
Q

webbed neck, pulmonary stenosis, ptosis and short stature. The karyotype is normal

A

Noonan syndrome

238
Q

bossing of the forehead, bowing of his legs, widening of joints and significant kyphoscoliosis of the spine.

A

Rickets

239
Q

child presents in first few weeks of life with jaundice, appetite and growth disturbance

A

biliary atresia

240
Q

When is bow legs in a child normally?

A

Bow legs in a child < 3 is a normal variant and usually resolves by the age of 4 years

241
Q

Effective treatment option for head lice

A

Wet combing

242
Q

How does hypernatraemic dehydration present?

A

jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma

243
Q

Features of atypical UTI

A

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

244
Q

Emergency treatment of croup

A

high-flow oxygen
nebulised adrenaline

245
Q

Causes of jaundice in the first 24 hours

A

ALWAYS PATHOLOGICAL

Causes of jaundice in the first 24 hrs
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

246
Q

How quick should serum bilirubin be measured when jaundice occurs within the first 24 hours of life?

A

Within 2 hours

247
Q

small, red growth of tissue in the centre of the umbilicus, covered with clear mucus

A

Umbilical granuloma

248
Q

size of testes in fragile X

A

macroorchidism

249
Q

size of head in Fragile X syndrome

A

MASSIVE HEAD

250
Q

mode of inheritance in Prader willi

A

Imprinting

251
Q

loss of red reflex in eye

A

Retinoblastoma

252
Q

UTI in <3 month mx

A

Refer immediately to hospital

253
Q

atrialisation of right ventricle

A

Ebstein’s anomaly

254
Q

Associations of Ebstein’s anomaly

A

patent foramen ovale (PFO) or atrial septal defect (ASD) is seen in at least 80% of patients, resulting in a shunt between the right and left atria
Wolff-Parkinson White syndrome

255
Q

Clinical features of Ebstein’s anomaly

A

cyanosis
prominent ‘a’ wave in the distended jugular venous pulse,
hepatomegaly
tricuspid regurgitation
pansystolic murmur, worse on inspiration
right bundle branch block → widely split S1 and S2

256
Q

Commonly associated conditions with malrotation

A

Exomphalos and diaphragmatic hernia

257
Q

Is school exclusion needed for head lice?

A

No

258
Q

infrahyoid cyst that rises on protrusion of tongue

A

Thyroglossal cyst

259
Q

Palivizumab type of medication and indication

A

monoclonal antibody used to prevent RSV

260
Q

most common cause of childhood hypothyroidism in the UK

A

AI thyroiditis

261
Q

Most common cause of nephrotic syndrome in children

A

Minimal change disease

262
Q

eczema distribution in a 10 month child

A

face and trunk

263
Q

What type of pulse with PDA?

A

large volume, bounding, collapsing pulse

264
Q

What causes nec fascitis in patients with chicken pox?

A

Invasive group A Streptococcus, a β-haemolytic Streptococcus

265
Q

When is an immediate CT scan warranted in head injury?

A

Loss of consciousness lasting more than 5 minutes (witnessed)
Amnesia (antegrade or retrograde) lasting more than 5 minutes
Abnormal drowsiness
Three or more discrete episodes of vomiting
Reduced GCS

266
Q

Most common causative agent of bacterial pneumonia in children

A

S.Pneumoniae

267
Q

Sign of late decompensated shock compared to earlly

A

Hypotension in late

268
Q

Table showing differences between early and late shock

A
269
Q

Opthalmia neonatorum mx

A

referred for same-day ophthalmology/paediatric assessment.

270
Q

Causative agents of opthalmia neonatorum and how they differ

A

Chlamydia trachomatis - few weeks after birth
Neisseria gonorrhoeae - few days after birth

271
Q

When should parents be advised to call an ambulance in a febrile convulsion?

A

If it lasts>5 mins

272
Q

Healthy resp rate and pulse rate for infants

A

Healthy infants should have a respiratory rate between 30-60 breaths per minute, a regular pulse between 100-160 beats per minute in a newborn, temperature of around 37 Celsius, and pass urine and stool regularly.

273
Q

Treatment of pityriasis versiocolor

A

Ketoconazole 2% shampoo

274
Q

You are seeing a 15-year-old boy who has developed a widespread rash over the last week. It seemed to start from a single patch on his abdomen that he first noticed 10 days ago.

On examination, he has a symmetrically distributed rash consisting of discrete pink/red lesions which are 0.5-1cm in diameter. Most are flat, but some appear slightly raised. Some have fine scales along the edges. They are not painful or itchy.

He is otherwise well and his observations are normal. Dx? Mx?

A

Pityriasis rosea, supportive

275
Q

ESM and fixed splitting of second heart sound in an asymptoamtic child

A

ASD

276
Q

VSD murmur

A

Pansystolic murmur in lower left sternal border

277
Q

Coaractation of aorta murmur

A

Crescendo-decrescendo murmur in the upper left sternal border

278
Q

PDA murmur

A

Diastolic machinery murmur in the upper left sternal border

279
Q

Pulmonary stenosis murmur

A

Ejection systolic murmur in the upper left sternal border

280
Q

a ballotable mass associated with abdominal distension, Hx of passing stools every other day, mx?

A

history of constipation is not particularly convincing. A child passing a stool of normal consistency every other day is within the boundaries of normal. The key point to this question is recognising the abnormal examination finding - a ballotable mass associated with abdominal distension.

281
Q

Management of viral induced wheeze

A

treatment is symptomatic only
first-line is treatment with short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacer
next step is intermittent leukotriene receptor antagonist (montelukast), intermittent inhaled corticosteroids, or both

282
Q

What should be offered to breafeeding mothers whoa are trying to exclude calcium from their diet?

A

Calcium and vitamin D

283
Q

What is the most esrious long term health problems for women with Turner’s?

A

Aortic dilatation and dissection

284
Q

most common cause of ambiguous genitalia in newborns

A

CAH

285
Q

What can bruising cause in the newborn?

A

Jaundice due to haemolysis

286
Q

What may infants present with instead of whoops in whooping cough?

A

Periods of apnoea

287
Q

Should whooping cough be notified?

A

Yea

288
Q

Most common heart lesion associated with duchenne

A

Dilated cardiomyopathy

289
Q

A 9-week-old infant is brought to the Emergency department by her father. She has been very unsettled for the past 24 hours, high pitched crying and poorly feeding. On examination her temperature is 38.1C and her right tympanic membrane appears red and inflamed. A diagnosis of acute otitis media without effusion is made. Which one of the following is the most appropriate management in the emergency department?

A

Admit

According to the guidelines, this child has one medium risk factor (poor feeding) and two high risk factors (high pitched cry, temperature greater than 38C in an infant under 3-month-old). Any child with a high risk factor should be referred urgently to the paediatric team for assessment.

290
Q

What may be needed to protect the airway in epiglottitis?

A

Endotracheal intubation

291
Q

What test may be done in newborns if the otacoustic emission test is abnormal?

A

Auditpory brainstrem response test

292
Q

When is bow legs in a child a normal variant? When does it resolve by?

A

Bow legs in a child < 3 is a normal variant and usually resolves by the age of 4 years

293
Q

Difference between gastroschisis and omphalocele and how they present

A

Gastroschisis and omphalocele present similarly, but gastroschisis refers to a defect lateral to the umbilicus whereas omphalocele refers to a defect in the umbilicus itself.

Gastroschisis does not have a covering, omphalocele does

294
Q

How to differentiate between reflex anoxic seizures and epilepsy?

A

Reflex anoxic seizures have a rapid recovery unlike epileptic seizures

295
Q

How should impetigo be managed?

A

A child with impetigo should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

Topical hydrogen peroxide 1% cream can also be used

296
Q

When is bone marrow biopsy required in children with ITP?

A

Splenomegaly

297
Q

Inheritance of Hungtindons

A

AD

298
Q

What does VSD increase the risk of?

A

Endocarditis

299
Q

When to offer surgeries for umbilical hernias?

A

4-5 years of age

Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age. If small and asymptomatic peform elective repair at 4-5 years of age.

300
Q

Management of babies with absent or weak femoral pulses at 6-8 week baby check? Suggestive of?

A

same day discussion with paediatrics is the correct answer. Absent or weak femoral pulses are suggestive of a major defect such as coarctation of the aorta and thus would best be discussed with and referred to the appropriate paediatrics team.

301
Q

What do small testes in precocoious puberty indicate?

A

an adrenal cause of the symptoms

302
Q

A baby is noted to have micrognathia and a cleft palate. He is placed prone due to upper airway obstruction. There is no family history of similar problems

A

Pierre-Robin syndrome

303
Q

What genetic condition causes neonatal hypotonia?

A

Prader-Willi syndrome

304
Q

An older child presenting with a Trendlenberg gait and leg length discrepancy

A

missed DDH

305
Q

How to adjust development milestones if premature?

A

The corrected age of a premature baby is the age minus the number of weeks he/she was born early from 40 weeks

306
Q

What MSK condition are people with Down syndrome most at risk of? How to reduce risk =?

A

Screen for atlanto-axial instability in people with Down syndrome who participate in sports that may carry an increased risk of neck dislocation (e.g. trampolining, gymnastics, boxing, diving, rugby and horse riding)

307
Q

Next step in management of head lice following wet combing

A

malathione

308
Q

How to remember which conditions are autosomal dominant and recessive

A

Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias

Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II

309
Q

bicuspid aortic valve murmur

A

ESM

310
Q

What genetic condition are nasal polyps associated with?

A

Cystic fibrosis

311
Q

What do mitochondrial diseases follow?

A

A maternal inheritance pattern

312
Q

How does neonatal sepsis most commonly present?

A

Gruntin and other signs of respiratory distress

313
Q

What is the mainstay of treatment in unvomplicated TTN

A

Observation and supportive care +/- oxygen

314
Q

What area of brain is affected in dyskinetic cerebral palsy?

A

Basal ganglia

315
Q

What area of brain is affected in spastic cerebral palsy?

A

Pyramidal tracts

316
Q

Mx of otitis media with effusion?

A

refer to ENT - to avoid risk of delays in their development

317
Q

Who is a PDA more lilely to occur concurrently in?

A

children with hyaline membrane disease and in those with a concurrent cyanotic congenital heart condition

318
Q

What is used as the treatment for conjugated hyperbilirubinaemia in children in the neonatal period?

A

First phototherapy, then ursdeoxycholic acid

319
Q

Genetic inheritance of DMD

A

X linked recessive

320
Q

resence of hepatosplenomegaly, lymphadenopathy and new-onset bruising

A

malignancy

321
Q

anaemia, thrombocytopenia, and neutropenia

A

ALL

322
Q

Definitive diagnosis of ALL

A

bone marrow aspirate and biopsy

323
Q

How does congenital hypothyroidism cause neonatal jaundice?

A

by reducing bilirubin conjugation, gut motility, and feeding.

324
Q

What disorders can present with bleeding problems with normal haematological values?

A

Connective tissue disorders like Ehler Danlos SYndrome

325
Q

What are infants of diabetic mothers at greater risk of developing?

A

NRDS

326
Q

‘double bubble’ in the abdomen

A

Duodenal atresia

327
Q

Unilateral wheeze in a child under three years old is usually associated with

A

Inhalation of a foreign body until proven otherwise. The latter tend to lodge at the bifurcation of the right main bronchus, as it is more vertical. Foreign body inhalation explains the unilateral wheeze, as the latter results from partial or complete airway obstruction by the foreign body.

328
Q

What GI condition are those with TUrner’s at risk of?

A

Pyloric stenosis

329
Q

bony deformities, blue sclera, teeth, deafness and heart valve abnormalities.

A

osteogenesis imperfecta

330
Q

Severely dehydrated children exhibit symptoms of clinical shocks, such as? What do they require?

A

Decreased consciousness, pale or mottled skin, cold extremities, tachycardia, rapid breathing, low blood pressure, weak peripheral pulses, and prolonged CRT. Children experiencing clinical shock require immediate admission and treatment, including intravenous fluid rehydration and electrolyte supplementation to restore normal fluid balance.

331
Q

What is impetigo due to? How does it present?

A

Impetigo is a superficial infection with Staphylococcus or Streptococcus bacteria. It gives fluid-filled blisters or sores that burst to leave a yellow crust.

332
Q

waiter’s tip position

A

Erb’s palsy

333
Q

Management of Erb’s palsy

A

physiotherapy involvement, and exercises are given to the parents to help strengthen the arm. Erb’s palsy is self-resolving.

334
Q

How can coarctation of aorta be treated?

A

surgical repair or balloon angioplasty and/or stenting.

335
Q

chest X-ray may show rib notching

A

Aortic coarctation

336
Q

absent femoral pulses in a cardiac ocnditon, or radiofemoral delay

A

Aortic coarctation

337
Q

musty odour of the skin and urine. Examination reveals hypopigmentation and eczema. Genetic testing revealed an autosomal recessive genetic disorder.

A

Phenylketonuria, due to a defect in phenylalanine hydroxylase

338
Q

What is Erb’s palsy due to?

A

trauma to the upper trunk of the brachial plexus

339
Q

What is tracheoesophagael fistula associated with?

A

Polyhydramnios in pregnancy

340
Q

Potential complciations of pavlik harness

A

Avascular necrosis and temporary femoral nerve palsy

341
Q

When should CT scan be done in head injuries? If not CT scan then what?

A

f a child has more than one of the specified features such as loss of consciousness for more than five minutes, abnormal drowsiness, three or more episodes of vomiting, a dangerous mechanism of injury, or amnesia lasting more than five minutes, a CT scan should be done within one hour. If they have only one of these features, observation for a minimum of four hours is recommended.

342
Q

loss of red reflex on child

A

Retinoblastoma

343
Q

Gene and mutation of retinoblastoma

A

RB1 gene on chromosome 13

344
Q

Mx of bacterial superinfection of chicken pox

A

Fluclox and aciclovir both IV

345
Q

Most common cyanotic heart disease on first day

A

TGA

Difficult to differentiate between tricuspid atresia, TGA has no murmur. If in doubt put TGA

346
Q

How tpo differentaite between epididymitis and epididymal-orchitis? Management?

A

epididymitis. The testicles are not inflamed, and as such, this patient does not have epididymal-orchitis. This typically presents with tenderness and swelling of the scrotum, plus a gradual build-up of pain and fever. Among sexually active men, acute epididymitis is most frequently caused by Chlamydia trachomatis and Neisseria gonorrhoeae. Treatment is a single shot of ceftriaxone 1 g, followed by doxycycline 2 × 100 mg/day for two weeks.

347
Q

boot shaped heart

A

ToF

348
Q

Anatomical features of ToF

A

right ventricular hypertrophy, right ventricular outflow tract obstruction due to pulmonary stenosis, a ventricular septal defect causing the murmur, and an overriding aorta

349
Q

An unwell child with an unhealed burn must be treated for?

A

toxic shock syndrome until proven otherwise. Treatment will require management in the intensive care department with input from a paediatric consultant and the plastic surgery team. Circulatory support with cryoprecipitate may be necessary.

350
Q

Which is the most common cerebellar neoplasm of childhood?

A

Cerebellar astrocytoma is one of the commonest brain tumour in the paediatric population. They are classed as a type of glioma as they originate from astrocytes which are a type of glial cells, others being microglia and ependymal cells.

351
Q

fluid-filled cystic mass that is continuous with the spinal cana

A

meningocele due to spina bifida

352
Q

Manifestations of spina bifida and they range in severity

A

mild, as in spina bifida occulta, to severe, involving the spinal cord and meninges, as in meningomyelocele

353
Q

What is spina bifida caused by?

A

failure of the neural tube to close during development, owing to insufficient maternal folate, a vitamin necessary in nucleic acid synthesis

354
Q

What defect is associated with ToF?

A

VSD

355
Q

What do NICE guidelines say to do urgently in children younger than 6 months of age with an atypical UTI? What to do after?

A

Urgent USS is required during the acute infection, looking for any structural abnormalities in the urinary tract. Once the acute infection has resolved, 4–6 months later, a routine DMSA is performed (looking for a scar in the kidney, renal agenesis or a duplex system) and an MCUG (looking for vesico-ureteric reflux or a posterior urethral valve).

356
Q

Gene and mutation affected in achondroplasia

A

autosomal dominant inheritance, fibroblast growth factor receptor (FGFR3)

357
Q

What mutation and inheritance in Marfan syndrome?

A

Mutations in the fibrillin-1 gene cause Marfan syndrome, an autosomal dominant connective tissue disorder.

358
Q

‘egg-on-side’ appearance of the cardiac shadow

A

Transposition of the great arteries

359
Q

Biggest complication of untreated ToF

A

Eisenmenger syndrome

In ventricular septal defect (VSD), there is a shunt of blood from the left ventricle to the right ventricle caused by an opening in the membranous region of the septum (90% of cases). Newborns with a VSD will become cyanotic at a later age when the demand for oxygen increases. It is important to correct the defect because uncorrected VSD can cause compensatory pulmonary vascular hypertrophy, leading to pulmonary hypertension and shunt reversal (right to left shunt, known as Eisenmenger’s syndrome). In turn, pulmonary hypertension will lead to congestive heart failure.

360
Q

Management of a child who has made a serious attempt at committing suicide

A

admission and urgent CAMHS assessment for all children who self-harm.

361
Q

What is infantile hemangioma? How does it present?

A

benign lesion caused by abnormal blood vessel growth in the skin and deeper tissues. Hemangiomas typically appear shortly after birth, with the highest incidence around the fourth to sixth week of life. They can be superficial (red, raised areas) or affect deeper structures (bluish tinge). Most hemangiomas grow rapidly in the first three months, peak around the fifth month, and then regress.

362
Q

child with febrile nutropenia indicates what?

A

Neutropenic sepsis

363
Q

Management of neutropenic spesis

A

IV tazocin (covers for pseudomonas)

364
Q

What renal syndrome does HSP occur alongside?

A

IgA Vasculitis

Get a rash over buttocks

365
Q

A six-week-old female is taken to see the General Practitioner. She has been struggling to feed for a few days, seems to be working harder with her breathing and has not gained weight in two weeks. On examination, a parasternal heave and a loud systolic murmur are heard at the lower left sternal border. Dx?

A

VSD

366
Q

Mx of acute otitis media with perf

A

five-day course of oral amoxicillin and a review to ensure healing, which can be done in primary care.

367
Q

What is the preferred investigative method in caput succadenum?

A

Cranial US scan

368
Q

what type of biopsy is needed in Hirchsprung?

A

Suction assissted full thickness

Specialities - Things to Go Over (5 decks)

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