paeds

Question 1

Features of life threatening asthma

Answer 1

The features of life-threatening asthma can be remembered using the mnemonic 33,92 CHEST. Any one of the following:
PEF <33%
SO2 <92% or PO2 <8
Cyanosis
Hypotension
Exhaustion, altered consciousness
Silent chest
Tachyarrhythmias

Question 2

respiratory distress in 4 month old baby presentation and common cause and findings

Answer 2

Bronchiolitis is the most likely cause of respiratory distress in this age group 4 months. It often presents with laboured breathing (accessory muscles). Intermittent apnoea is a relatively common finding and a clear CXR doesn not rule bronchiolitis out. non atopic wheeze usually viral LRTI

Question 3

ADHD meds monitoring

Answer 3

= height every 6 months. Methylphenidate (also known as Ritalin)

Question 4

croup features

Answer 4

This patient has mild croup (evidenced by the lack of stridor and respiratory distress, and normal vital signs), which is managed with a single dose of oral Dexamethasone 0.15mg/kg.

Croup or acute laryngotracheobronchitis affects young children between 6 months and 2 years of age.

It is an upper respiratory tract infection causing oedema in the larynx due to the parainfluenza virus. It presents with a characteristic barking cough, inspiratory stridor and respiratory distress, mainly during winter. A chest X-ray shows a ‘steeple sign’ due to subglottic narrowing. It usually improves in less than 48 h and responds well to treatment with steroids, particularly dexamethasone.

Question 5

imaginary play vs parallel play

Answer 5

imaginary play can be a part of typical social development, having imaginary friends is more common among slightly older children, around the ages of 4 to 6. At 2 and a 1/2 years old, a child is more likely to engage in parallel play alongside other children.

Question 6

moderate acute asthma

Answer 6

NICE defines the criteria for moderate acute asthma as able to speak in full sentences, oxygen saturations >92% on room air, peak flow >50% of best/ predicted, heart rate <140 (children aged 1-5 ) or <125 (children aged >5) and respiratory rate <40 (children aged 1-5) or <30 (children aged >5).

Question 7

fraser guidelines

Answer 7

The Fraser guidelines state that the patient should understand the clinician’s advice, they cannot be persuaded to discuss the situation with their parents, are likely to continue having intercourse without treatment, are likely to suffer (mentally or physically) without treatment, and that it is in the patient’s best interests to provide the prescription. For 16 or below

Question 8

AGPAR 3 management

Answer 8

This is a seriously ill neonate with an APGAR score of 3 (1 for flexed limbs, 1 for slow, irregular breathing and 1 for a heart rate below 100bpm). Therefore, they need urgent resuscitation and according to the Resus council this involves first giving the neonate five inflation breaths. It is important to recognise, that unlike adults, the most common cause of an arrest in neonates is due to a respiratory arrest.

Question 9

NAI first line investigation

Answer 9

The later presentation, vague history, and unlikely pattern of injuries make non-accidental injury the most likely, and important, diagnosis. An urgent investigation however to carry out in any child with unexplained bruising is an FBC, to rule out other sinister causes of unexplained bruising such as a haematological malignancy.Skeletal survey takes time to arrange and is not done acutely

Question 10

causative organisms for bronchiolitis, croup and epiglottitis

Answer 10

Respiratory syncytial virus (RSV) = bronchiolitis
parainfluenza virus = croup
haemophilus influenza = epiglottitis

Question 11

features of soya based formula

Answer 11

Soya-based formula

These can be used in infants over 6 months; however, they are not recommended in infants under 6 months due to potential risk of isoflavones which may have oestrogenic action. The patient is 7-weeks old, therefore this is not suitable.

Question 12

features of baby allergy to milk

Answer 12

This baby is likely to have cows’ milk protein allergy. This is a common condition mainly affecting formula-fed infants. The time course of his symptoms matches the change from breastfeeding to the introduction of formula feeds. Cows’ milk protein allergy can present with an urticarial rash or atopic eczema. There may also be regurgitation, vomiting and diarrhoea. If it is a very severe allergy, there can be breathing difficulties and even anaphylaxis. NICE guidelines suggest a trial of extensively hydrolysed formula to see if that helps with symptoms. These are whey- or casein-based peptide feeds so are usually better tolerated.

Question 13

vocal milestones

Answer 13

• Infants can say 1 - 2 words by 12 month
• At age 18 months the infant should have a vocabulary of 6 - 10 words
• A 2 year old would be expected to join 2-3 words, have a vocabulary of 50 words and be able to follow a two-stage command
  -A 3 year old would be expected to use 3 or 4 word sentences frequently and have a vocabulary of at least 200 words. They should also be able to name one colour and answer when asked their name, age and gender

Question 14

cup and spoon to feed themselves and remove shoes and socks age

Answer 14

18 months

Question 15

bronchiolitis obliterates commonly associated with

Answer 15

Whilst bronchiolitis obliterans is a relatively rare complication of bronchiolitis, it is most commonly associated with adenovirus infection

Question 16

asthma hypersensitivity features

Answer 16

Acute allergic asthma is a type I (immediate type) hypersensitivity and its mechanism is shared with anaphylaxis and allergy: First contact with allergens trigger formation of IgE antibodies, which fix to mast cells. Subsequent contact with allergens triggers the mast cells to degranulate, releasing mediators and vasoactive substances within minutes

Question 17

RDS X ray

Answer 17

RDS = ground glass appearance

Question 18

A mother attends the emergency department with a 26-day old boy. The boy is breastfed, but shows poor weight gain. He is jaundiced and lethargic, and is passing dark urine and pale stool.

Answer 18

= biliary atresia

Question 19

squint

Answer 19

squint = refer if 8 weeks still there

Question 20

Prader-Willi inheritance

Answer 20

Prader-Willi syndrome is a genetic condition inherited by genomic imprinting, where gene expression is influenced by whether the gene was inherited from the mother or father

Question 21

baby with prolonged jaundice (>14 days) with pale stools, dark urine and a conjugated hyperbilirubinaemia ….

Answer 21

This baby with prolonged jaundice (>14 days) with pale stools, dark urine and a conjugated hyperbilirubinaemia is highly suspicious for obstructive jaundice. The ultrasound findings of echogenic hepatic fibrosis suggest biliary atresia. Biliary atresia is definitively diagnosed with cholangiography, which will fail to show the biliary tree

Question 22

Steroid usage asthma acute

Answer 22

Systemic corticosteroids should be used in conjunction with nebulised short acting bronchodilators in the management of acute asthma exacerbations. NICE recommends that they are started early in treatment. Oral steroids are given if possible, as there is no clinical benefit to giving IV unless unable to tolerate the oral form. The doe of prednisolone given is 20mg (ages 2-5) or 30-40mg (ages >5)

Question 23

neonatal vs children

Answer 23

Chest compressions should be given at a rate of 3 compressions to 1 breath in neonatal resuscitation, using two thumbs over the lower third of the sternum. This should only be attempted in a newborn with a heart rate of <60 bpm once the airway has been optimised and 5 inflation breaths have been attempted twice, as well as administering oxygen. It is vital to ensure the lungs have been properly aerates prior to commencing chest compressions. During chest compressions, heart rate should be re-assessed every 30 seconds. If despite compressions heart rate remains poor, venous access should be gained and administration of drugs considered.

Infants and children 15:1

Question 24

2 month old with temp mx

Answer 24

All children under three months with even a single temperature warrant a medical assessment. Part of their septic initial septic screen should include blood cultures, urine cultures and CSF cultures - as well as microbiological sampling from any other site relevant to that case which may be cause for infection

Question 25

Jaundice within 24 hrs

Answer 25

Jaundice developing within the first 24 h of life is always pathological. Testing conjugated and unconjugated bilirubin levels will help determine where the excess bilirubin is coming from. This will ultimately help guide the further management of the patient

Question 26

most common cause of late-onset neonatal sepsis

Answer 26

S. aureus is the most common cause of late-onset neonatal sepsis (after 72 h of life).

Question 27

biggest risk factor for stillbirth.

Answer 27

IUGR is the biggest risk factor for stillbirth.

Question 28

startle reflex

Answer 28

The Moro reflex, or startle reflex, usually disappears around 3–4 months, and should no longer be elicited past 6 months of age.

Question 29

when do you need Ambulance for bronchiolitis

Answer 29

bronchiolitis- NICE recommend immediate referral by ambulance if there is: apnoea (observed or reported), severe respiratory distress, central cyanosis, oxygen saturations < 92% on air, or if the child looks seriously unwell to a healthcare professional. The child’s low oxygen saturations make this option the correct answer. They will most likely receive humidified oxygen via a head box, and may require nasogastric feeding as they have been off their feeds

Question 30

stillbirth definition

Answer 30

stillbirth = Death of a baby after 24 weeks gestation, before or during birth

Question 31

Fraser guidelines vs gilick

Answer 31

The Fraser guidelines may be confused with Gillick competency. Gillick competency can be applied in the wider context of medical treatment of under 16s, whereas the Fraser guidelines are specific to sexual health.

Question 32

6wks vs 6 months

Answer 32

Six weeks: Good head control - raises head to 45 degrees when on tummy
Six months: Sit without support - rounded back; rolls tummy (prone) to back (supine) - vice versa slightly later.

Question 33

when do you correct for gestational age

Answer 33

Correction for gestational age: Age (w) – (40 – gestational age (w)) is required for babies born younger than 30 weeks of gestation and is usually used until the child is 2 years old,

Question 34

croup mx nebuliser

Answer 34

croup - nebulised adrenaline is most likely to produce a quick positive response and so should be given first.

Question 35

management for LOC after hitting head but feeling fine

Answer 35

The patient does not meet the criteria for immediate CT head as he has only 1 risk factor (loss of consciousness), whereas more than 1 is needed to proceed to CT head. They should therefore be observed for 4 hours in a unit that could deal with any deterioration.

Question 36

chronic tic vs tourettes

Answer 36

A chronic tic disorder can be distinguished from Tourette’s Syndrome by the presence of either a motor of phonic tic, but not both.

Question 37

blood group incompatibility jaundice onset

Answer 37

Blood group incompatibility can cause jaundice within the first 24 h of life. However, in this scenario, late onset of jaundice, normal blood results and a negative Coombs test make ABO incompatibility unlikely.

Question 38

What is a red flag symptom that indicates a delay in reaching fine motor milestones at 12 months of age?

Answer 38

no pincer grip

Question 39

epiglottis immediate mx

Answer 39

The correct management for a case highly suspicious of epiglottitis is to urgently secure the airway. Epiglottitis can rapidly progress to complete airway obstruction, and the child should be intubated in a controlled environment, such as an operating room, by an experienced anaesthetist or ENT doctor.

Question 40

acute epiglottis presentation and cause

Answer 40

This is the correct answer. This child is presenting with acute epiglottitis, suggested by the high fever, drooling and soft inspiratory stridor. It is most commonly caused by Haemophilus influenzae type B, and should be considered in children from overseas who may not be up to date on their immunisations. Since the introduction of its vaccine, it is rare in the UK

Question 41

most common congenital heart defect associated with Turner syndrome.

Answer 41

Bicuspid aortic valve is the most common congenital heart defect associated with Turner syndrome. This condition involves the aortic valve having only two leaflets instead of the normal three, which can lead to aortic stenosis or regurgitation over time

Question 42

Hyper-inflated lungs and a fluid level in a newborn plus respiratory symptoms

Answer 42

Hyper-inflated lungs and a fluid level in a newborn is the characteristic presentation of transient tachypnoea in the newborn, especially in caesarean section deliveries

Question 43

boy with cancer what vaccine can he not have

Answer 43

Live attenuated vaccines are contraindicated in immunosuppressed patients. Live attenuated vaccinations include the MMR vaccine (measles, mumps and rubella)

Question 44

insufficient surfactant production v unlikely at

Answer 44

term

Question 45

transient tachypnoea of newborn =

Answer 45

Delayed resorption of the lung fluid due to suboptimal epithelial clearance

Question 46

ibuprofen and breast feeding

Answer 46

Ibuprofen is considered safe for breastfeeding infants as only very small quantities appear to be excreted into breast milk after maternal ingestion. Furthermore, it is considered to be one of the analgesics of choice in breastfeeding mothers

Question 47

A young couple are planning to start a family in the near future and have come in to discuss their risk of having a child with cystic fibrosis as the woman was diagnosed with cystic fibrosis as a child and her partner has recently been screened. The result of his screening have unfortunately shown him to be a carrier for the cystic fibrosis gene.
What is the likelihood of their first child being affected by cystic fibrosis?

Answer 47

50%

As cystic fibrosis is inherited in an autosomal recessive pattern the female must carry 2 copies of the gene. The male partner is a carrier so therefore only carries 1 copy of the CF gene. So whilst there is a 100% chance any baby will inherit 1 CF gene from their mother there is only a 50% chance they will inherit the gene from their father. Then to confirm the odds we multiply 100% by 50% which leaves us with a 50% chance that their baby would inherit 2 faulty copies of the CF gene

Question 48

CXR in asthma

Answer 48

Chest x-rays do not show any specific characteristics of asthma and are most likely to show hyperinflation only

Question 49

Bordetella pertussis.

Answer 49

Gram-negative coccobacillus

Question 50

6-12 age anaphylaxis mx

Answer 50

6-12, where the correct dose of adrenaline is 300 micrograms 1:1000 IM adrenaline

Question 51

CF common pathogen in children

Answer 51

pseudomonas

Question 52

fragile X

Answer 52

This teenager with learning difficulties and epilepsy, social anxiety, poor eye contact, echolalia (repeating your speech), mitral valve prolapse and prominent ears and jaw with a long thin face most likely has a diagnosis of fragile X syndrome. The underlying genetic defect in fragile X syndrome is a trinucleotide repeat in the FMR1 (familial mental retardation 1) gene

Question 53

You are called to assess a 2-day old neonate on the postnatal ward because the baby had a fit. The baby put her arms back into an abnormal position, went stiff and had some jerking movements and lip smacking for a couple of minutes. She also appeared blue during this period. The baby has otherwise been irritable since delivery and the mother has not had much success with breastfeeding. When you arrive 15 minutes later, the baby appears pink in air but is irritable.
On examination, the baby is very floppy. She has another similar seizure while you are there.
Which of the following could have caused this neonate’s condition?

Answer 53

This neonate, with poor feeding, hypotonia and seizures most likely has a diagnosis of hypoxic ischaemic encephalopathy. This irreversible brain damage is caused by any condition or situation that causes a lack of oxygen to the brain either ante- or peri-natally. Of the answer options, the only cause of hypoxia is umbilical cord compression

Question 54

CF vitamin deficiency

Answer 54

This girl, with a long history of cough, wheeze and steatorrhoea with nasal polyps and poor growth most likely has a diagnosis of cystic fibrosis. Reduced pancreatic enzyme secretion impairs fat digestion. Therefore, children with cystic fibrosis are vulnerable to deficiency of fat soluble vitamins (A, D, E and K)

Question 55

cf heel prick

Answer 55

At birth, the heel prick test screening for cystic fibrosis shows a high immunoreactive trypsinogen level

Question 56

hydrocephalus investigation

Answer 56

cranial USS

Question 57

Corticosteroid therapy asthmatics offered what vaccine

Answer 57

Influenza

Question 58

Most common Down syndrome cause

Answer 58

Meiotic non dysfunction

Question 59

Mx for acute epiglottis

Answer 59

Endotracheal intubation

Question 60

Refusal to speak and protruding tongue

Answer 60

Epiglottitis

Question 61

Do you add weeks for pre term babies with regard to vaccines

Answer 61

No

Question 62

Constipation in paeds red flags

Answer 62

Present from birth, not passed meconium, any neurological signs

Question 63

Raised perinatal AFP could indicate

Answer 63

Omphaloceoele

Question 64

Risk factors for ASD

Answer 64

Maternal diabetes, alcohol use, FH, treacher Collins, downs, maternal rubella

Question 65

Developmental hip dysplasia RF

Answer 65

Breech, oligohydramnios, female, macrosomia

Question 66

Male or female more likely to get croup

Answer 66

Male

Question 67

Peak croup incidence

Answer 67

2 yrs

Question 68

You are asked to attend a delivery of a primiparus women. She is 25 and unmarried and has been attempting to hide her pregnancy from her family. You assess the child and find a large baby with a neural tube defect. The child is hypoglycaemic and the obstetric team are concerned about a heart defect. What is the likely maternal condition?

Answer 68

Diabetes

Question 69

What is the benefit of giving magnesium sulphate antenatally to babies at risk of being born prematurely?

Answer 69

Neuroprotective- reduces cerebral palsy

Question 70

In a NIPE a newborn boy is found to have a soft, swelling which you are not able to separate from the testes, though you can get above it.

Answer 70

Epididymal cyst

Question 71

Turner’s syndrome hypertension cause

Answer 71

Coarctation of the aorta

Question 72

Knife and fork age

Answer 72

5

Question 73

Rubella effect on baby

Answer 73

Mother most likely had a rubella infection during pregnancy: the features include purpuric ‘blueberry muffin’ rash, cardiac, ocular, and hearing defects

Question 74

Edward’s syndrome

Answer 74

Clinical features of Edwards syndrome include: flexed, overlapping fingers, low birthweight, prominent occiput, small mouth and chin, short sternum, cardiac and renal malformations and “Rocker-bottom” feet.

Question 75

Jaundice stats

Answer 75

60% of term neonates develop jaundice and 80% of preterm neonates develop jaundice

Question 76

Pyloric stenosis blood gas

Answer 76

Hypochloraemic hypokalaemia metabolic alkalosis

There is loss of hydrochloric acid during vomiting, leading to hypochloraemia and metabolic alkalosis. In an attempt to compensate the kidneys exchange potassium for protons, resulting in hypokalaemia.

Question 77

Asthma cell

Answer 77

The activation of Th-2 t-cells leads to the inflammatory cascade

Question 78

Cyanotic heart defect

Answer 78

Tricuspid atresia

Question 79

What suggests bacterial resp disease

Answer 79

Grunting

Question 80

Primary ciliary dyskinesia presentation

Answer 80

Primary ciliary dyskinesia presents with bronchiectasis, sinusitis, hearing difficulties and recurrent chest infections.

Question 81

Bronchiolitis urgent hospital referral

Answer 81

Indications for urgent referral to hospital are severe respiratory distress, apnoeas, saturations <92% and if the child looks seriously unwell.