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Paeds Flashcards

1
Q

does malrotation of the gut present with non-bilious or bilious vomiting?

A

bilious

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2
Q

what is a patient education measure that can be advised to prevent gastroenteritis in bottle-fed infants?

A

proper sterilisation for the bottle caps

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3
Q

what is a serious complication of gastro-oesophageal reflux?

A

aspiration - chronic cough, pneumonia

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4
Q

what are the management steps for GOR?

A

Conservative - positioning tips while feeding, feed thickeners

Medical - prokinetics (erythromycin), antacids, H2 antagonist, PPIs

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5
Q

what is recommendation for volume of milk to be taken every day for infants?

A

150 - 180 mL/kg/day

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6
Q

what should be counciled and investigated upon discovery of duodenal atresia?

A

Down’s syndrome. 1/3rd of DA have trisomy 21

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7
Q

what is the diagnostic test for Meckel’s diverticulum and how does it work?

A

technetium-99m scan

radiolabel only taken up by gastric type mucosa. Meckel’s diverticulum has ectopic gastric and pancreatic tissue, so a signal will alight in the right illiac fossa confirming the diverticular tissue

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8
Q

what is the treatment for lead poisoning?

A

ETDA chelation of lead

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9
Q

what is missing is Hirschprung disease?

A

the parasympathetic myenteric nervous plexus from a portion of the bowel

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10
Q

an infant with CF has not passed stool within 48 hours of birth.

what is the diagnosis and treatment?

A

meconium ileus

gastrograffin enema initially, then the rest of CF treatment under specialist

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11
Q

what is the link between temperature and likelihood of fits in febrile convulsions?

A

lowering temperatures does not prevent seizures

HOWEVER still advise to keep temperatures down for wellbeing/comfort of child

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12
Q

what safety precautions should be given to parents of children with febrile convulsions?

A

Advise to call 999 if seizure lasts >5 minutes

rescue therapy with rectal diazepam or buccal midazolam can be supplied.

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13
Q

what is the relationship between febrile convulsions and epilepsy?

A

same background risk of developing epilepsy (1-2%) but increased if they become complex seizures (4-12%)

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14
Q

what are the differential diagnoses to consider with headache in children?

A

migraine, tension, SOL, medication induced, infection (meningitis, encephalitis)

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15
Q

what are the red flags for headache?

A
  • Sudden onset, severe headache
  • Headache lasting several days or progressing in severity
  • Weight loss
  • Associated with straining, e.g. coughing, or increased by lying down
  • Morning headache, especially associated with vomiting
  • Seizures or focal neurology
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16
Q

define status epilepticus

A

seizure lasting for more than 30 minutes or repeated fits without resolution of post-ictal state for more than 30 minutes

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17
Q

what is the prescription for BZDs to terminate a seizure?

A

at 5 mins without spontaneous resolution

PO lorazepam 0.1 mg/kg or buccal midazolam 0.3 mg/kg

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18
Q

after how long of a seizure do you move onto phenytoin?

A

15 mins

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19
Q

what is a common complication of resolving bacterial meningitis?

A

deafness as pus drains through the auditory meatus and damages CN VIII

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20
Q

what is a prophylactic medication given to children with recurrent brochiolitis?

A

pavilizumab, biological anti-RSV

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21
Q

what symptoms should you advise parents to look out for as safety net on discharge after bronchiolitis?

A
  • ^WOB
  • fluid intake 50–75% of normal/no wet nappy for 12 hours
  • apnoea or cyanosis
  • exhaustion (e.g wakes only with prolonged stimulation)
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22
Q

what is the bug implicated in croup?

A

parainfluenza virus

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23
Q
  • Upper respiratory tract infection (coryza, fever) 2 days before onset of cough
  • Characteristic barking cough (‘sea lion’)
  • Stridor (subglottic inflammation and oedema)
  • Symptoms start, and are worse at night.

what is the diagnosis?

A

croup

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24
Q

what are three dangerous differentials to rule out in croup/URTI history?

A

epiglottitis

inhaled foreign body

anaphylaxis

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25
Q

what is the management of mild croup?

A

outpatient, single dose PO dexamethasone 0.15 mg/kg

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26
Q

what is the medical management of moderate/severe croup?

A

PO/IV dexamethasone 0.15 mg/kg single dose

or

PO prednisone 1-2 mg/kg single dose

once arrived at hospital - nebs budesonide 2 mg

after 30 mins if further medication required
nebs adrenaline 0.4 mg/kg of 1:1000; max 5 mg

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27
Q

what steps should be taken if an inhaled foreign body is seen in the back of the oropharynx that causes respiratory distress?

A

CALL FOR SENIOR HELP IMMEDIATELY and prepare instruments for cricothyroidotomy. Do not put your fingers in their mouth.

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28
Q

what are the PEF thresholds for moderate, severe, life threatening asthma exacerbations?

A

>50 % - moderate

<50 % - severe

<33 % - life threatening

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29
Q

in under 5 year olds with SpO2 <92 %, what clinical features suggest life threatening asthma exacerbation?

A
  • silent chest
  • poor respiratory effort
  • agitation
  • altered consciousness
  • cyanosis
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30
Q

what is the medical therapy for asthma exacerbation?

A
  • Nebulised salbutamol back to back
    • Consider ipratropium bromide if unresponsive
    • Consider malgnesium sulfate if presenting with sats <92%
  • Steroid therapy for 3 days
  • Consider IV salbutamol in severe asthma if no response
  • Consider aminophylline in severe to life threatening if unresponsive
  • Discharge when stable, PEF >75% and sats >99%
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31
Q

what is the management of dehydration following diarrhoea or vomiting?

not shock

A

<5yrs give 50 ml/kg low osmolarity ORS over 4 hours, + ORS solution for maintenance

>5yrs 200ml ORS after each loose stool + Normal fluid intake

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32
Q

what cheap stool test will inform you about post-gastroenteritis lactose intolerance?

A

stool pH <6.0

or

reducing sugars

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33
Q

what differentials should be considered in a child with metabolic acidosis?

A
  1. DKA
  2. HONK/HHS
  3. lactic acidosis
  4. starvation ketosis
  5. uraemic acidosis
  6. ethylene glycol/methanol poisoning
  7. salicylate poisoning
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34
Q

what is the bolus fluid challenge given for children with DKA?

A

IV 0.9 % saline 10 ml/kg

up to 3x as directed by specialist

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35
Q

what is the equation for fluid requirement in children?

A

Fluid req = maintenance + estimated deficit - bolus given

(100/50/20 ml/kg in 24hrs) + (% dehydration x weight)*1000 - (20/10 mg/kg)

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36
Q

what is the potassium chloride requirement for normal fluid maintenance?

A

20 mL KCl in 500 mL fluids

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37
Q

what is the insulin requirement IV for a patient in DKA until stable?

when do you start and stop IV insulin?

A

0.1 U/kg/hr

Start after 1 hour of IV fluids have run

Do not stop until 1 hour after subcut insulin begins

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38
Q

what is the electrolyte abnormality from vomiting you would expect?

A

hypochloraemic, hypokalaemic metabolic alkalosis

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39
Q

what is the diagnostic, supportive and definitive management of pyloric stenosis

A

Diagnosis is made on USS

Initially correct dehydration

Definitive treatment with Ramstedt’s pyloromyotomy

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40
Q

what are the common causes of constipation in children (>6 months)

A
  • Simple constipation
  • Short-segment Hirschprung’s diseae (can present late)
  • Neuromuscular disorders (e.g. cerebral palsy)
  • Hypothyroidism
  • Coeliac disease
  • Food allergies (non-IgE mediated)
  • Anal fissure
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41
Q

what are the red flag symptoms of constipation?

A
  • Symptoms started within first few weeks of life
  • Passage of meconium >24h
  • Faltering growth
  • Delayed walking or lower limb abnormal neurology (cerebral palsy)
  • Distension of abdomen and or vomiting
  • Child protection concerns
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42
Q

what are the steps in acute management of constipation?

A
  1. osmotic laxative - movicol//lactulose/docusate
  2. stimulant laxative - senna
  3. phosphate enema - traumatic, avoid in under 2 y/o
  4. super specialist surgical referral
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43
Q

what are the differentials for a slow walker? (20 months)

A

constitutional delay

global delay

motor cortex injury

neuromuscular disorder

spinal cord lesions (spina bifida)

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44
Q

what causes for limp are considered between 0 - 3 years?

A

trauma

infection: septic and reactive, osteomyelitis, discitis

malignancy

developmental dysplasia of the hip

NMD

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45
Q

what causes for limp are considered between 4 - 10 years?

A

Trauma

specials: transient synovitis, Perthe’s disease, JIA
infection: septic and reactive, osteomyelitis, discitis
malignancy: Ewing, osteosarcoma, lymphoma

NMD

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46
Q

what causes for limp are considered between 10-18 years?

A

Trauma

specials: SUFE, JIA
malignancy: Ewing, osteogenic sarcoma
infection: septic and reactive, osteomyelitis, discitis

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47
Q

when is Perthes disease most common?

A

4-8 years old

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48
Q

monoarthralgia + fever and severely reduced ROM

A

septic arthritis

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49
Q

monoarthralgia + recent cold

A

reactive arthritis

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50
Q

monoarthralgia + easy bruising

A

haemophilia

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51
Q

monoarthralgia + chronic pain and swelling

A

juvenile idiopathic arthritis

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52
Q
A
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53
Q

what skin condition is associated with COCP use?

A

erythema nodosum

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54
Q

what is the most common aetiology for erythema multiforme?

A

infection

mycoplasma, coxsackievirus, echovirus, , adenovirus, herpes (HSV-1/2, VZV, EBV, CMV) viral hepatitis, HIV, salmonella, TB, typhoid, dermatophytes

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55
Q

how do you best tell Noonan syndrome from Turner syndrome?

A

pulmonary stenosis and mental retardation (present in Noonan)

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56
Q

egg hypersensitivity is a contraindicaiton to what vaccines?

A

influenza and yellow fever

MMR may still be given

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57
Q

what is the minimum CD4+ count for children with HIV to receive live attenuated MMR vaccine?

<6 years old and >6 years old

A

<6 = 500/mcL

>6 = 200/mcL

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58
Q

what is the diagnostic criteria for Kawasaki disease?

A

>5 days fever

+ at least four of:

  1. conjunctivitis
  2. orocutaneous erythema
  3. peripheral skin involvement (palms and soles)
  4. cervical lymphadenopathy
  5. polymorphous rash

+ absence of another diagnosis that could explain findings

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59
Q

jaundice does not have to be investigated when what criteria are met?

A
  1. no jaundice in the first 24 hours of life
  2. baby is clinically well
  3. bilirubin remains under treatment level
  4. jaundice resolves by 14 days
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60
Q

what investigation is needed following a non-febrile seizure in a child?

A

12-lead ECG

MRI only indicated in repeat seizures, refractory epilepsy or evidence of focal neurology

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61
Q

what are the first line treatments for absence seizures in the UK?

A

valproate and lamotrigine

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62
Q

what are the causal organisms of septic arthritis in children?

A

staph aureus, strep spp. HiB

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63
Q

what are some factors that increase or decrease the likelihood of surfactant deficiency in preterm babies?

A

increases the likelihood

  • male gender
  • maternal diabetes
  • second twin
  • elective CS

Decreases the likelihood

  • female gender
  • prolonged ROM
  • maternal opiate use
  • IUGR
  • antenatal steroids
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64
Q

which vaccines should and should not be given in HIV?

A

SHOULD give - MMR, 5 in 1

SHOULD NOT give - yellow fever, BCG

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65
Q

what vaccinations are given at 8 weeks?

A

5 in 1

PCV

Men B

Rotavirus

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66
Q

what vaccinations are given at 12 weeks?

A

5 in 1

Rotavirus

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67
Q

what vaccines are given at 16 weeks?

A

5 in 1

PCV

MenB

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68
Q

what vaccines are given at 1 year?

A

MMR

Hib booster

PCV booster

MenB/C

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69
Q

what vaccines are given at 3 years 4 months?

A

MMR

DTaP/IPV

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70
Q

what vaccines are given at 12-13 years old?

A

HPV quadravalent

repeated 6-24 months apart

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71
Q

what vaccines are given at 14 years?

A

tetanus, diptheria and polio (Td/IPV)

MenAWCY

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72
Q

what is the timeline for undescended testicle management?

A

<3 months old - review at 3 months old

3 months old - if undescended, refer to paediatric surgeon

must be reviewed by specialist before 6 months old

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73
Q

what are the first steps in management of nocturnal enuresis for all children?

A
  • look for possible underlying causes/triggers (e.g. Constipation, diabetes mellitus, UTI if recent onset)
  • advise on fluid intake, diet and toileting behaviour
  • reward systems (e.g. Star charts). NICE recommend these ‘should be given for agreed behaviour rather than dry nights’ e.g. Using the toilet to pass urine before sleep
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74
Q

following initial management, what is the next step for nocturnal enuresis in children younger than 7 years old?

A

always try enuresis alarm

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75
Q

at what age is nocturnal enuresis supposed to be normal until?

A

5 years old

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76
Q

episodic crying and drawing of the legs towards the chest

suggests what?

A

intussusception

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77
Q

what is the natural history of HHV-6, roseola infantum?

A

3-5 days high fever

2 days maculopapular rash

rash starts on chest and spreads to arms and legs

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78
Q

risk factors for NRDS besides prematurity

(4)

A
  • male sex
  • diabetic mothers
  • Caesarean section
  • second born of premature twins
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79
Q

what are the signs of ‘moderate croup’ that would prompt admission for observation?

A
  • Frequent barking cough
  • Easily audible stridor at rest
  • Suprasternal and sternal wall retraction at rest
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80
Q

what layer is filled with fluid in a hydrocele?

A

tunica vaginalis

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81
Q

what investigation is indicated in hydrocele?

A

USS testicle to make sure the hydrocele isn’t secondary to any underlying pathology

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82
Q

how do you diagnose varicocele?

A

USS - venous dilatation of pampiniform plexus >2 mm

83
Q

what is the treatment of varicocele?

A

conservative - supportive underwear

interventional - radiological ablation of testicular vein

surgical - ligation and division of testicular veins

84
Q

what is Prehn sign?

A

relief of pain on elevation of the testes - clinical diagnosis of epididymo-orchitis

85
Q

what is the treatment of epididymo-orchitis

A

abx - oral ciprofloxacin for 6 weeks

86
Q

pitted teeth and metabolic alkalosis…

diagnosis?

A

bulimia

87
Q

what is the treatment of quincy?

A

peritonsillar abscess caused after tonsilitis

abx - penicillin

6 weeks after resolution should perform tonsillectomy

88
Q

what antifungals can you use to treat oral/oesophageal candidiasis?

A

fluconazole, nystatin or amphotericin

89
Q

what are the skin lesions of TB?

A

erythema nodosum

lupus vulgaris (nodular, painful, disfiguring lesions, primarily on the face)

90
Q

what is the treatment of pyelonephritis in children?

A

sepsis six, sending blood cultures before beginning treatment

7-10 days oral cephalosporin if they are able to take oral meds

if not, start on IV meds then switch to oral when possible

91
Q

what is the treatment of cysitis in a child?

A

MSU MC&S

Urine dip

3 days of oral cephalosporin, trimethoprim, co-amoxiclav

92
Q

Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild

A

chickenpox

93
Q

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

A

measles

94
Q

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

A

mumps

‘earache’ is actually parotitis

95
Q

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

A

rubella

96
Q

Lethargy, fever, headache
facial rash spreading to proximal arms and extensor surfaces

A

parvovirus B19 - fifth disease - erythema infectiosum

97
Q

Fever, malaise, tonsillitis
‘Strawberry’ tongue
fine punctate erythema sparing face

A

scarlet fever

98
Q

Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

A

coxsackie A16 - hand, foot and mouth

99
Q

what are the centor criteria?

A
  1. exudate
  2. no cough
  3. fever
  4. tender cervical lymphadenopathy/lymphadenitis

if 3-4 is scored, 50% chance of GABHS tonsilitis. treat

100
Q

what are the antibiotic treatment options for GABHS tonsilitis?

A

analgesia with paracetamol regular

abx phenoxymethylpenicillin/clarithromycin if pen-allergic

101
Q

what are the infection control steps of scarlet fever?

A

notifiable disease

children should return to school 24 hours after starting abx

102
Q

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

A

Pierre Robin syndrome

103
Q

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

A

Noonan syndrome

104
Q

Hypotonia
Hypogonadism
Obesity

A

Prader-Willi syndrome

105
Q

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

A

William’s syndrome

106
Q

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Cutis aplasia

A

Patau syndrome

107
Q

what is the ratio of compressions to ventilation in neonatal resus?

A

give 5 ventilation breaths at first then reasses

if heartrate is not picking up/spontaneous return of breathing…

3 to 1 (compressions to ventilation)

108
Q

what are the components of Apgar score?

A

pulse, respiratory effort, colour, muscle tone, reflex irritability

109
Q

apgar score

pulse breakdown

A

>100 = 2

<100 = 1

pulseless = 0

110
Q

apgar score

respiratory effort breakdown

A

strong, crying = 2

weak, irregular = 1

nil = 0

111
Q

apgar score

colour breakdown

A

pink all over = 2

body pink, extremities blue = 1

blue all over = 0

112
Q

apgar score

muscle tone breakdown

A

active movement = 2

limb flexion = 1

flaccid = 0

113
Q

apgar score

reflex irritability breakdown

A

cries/sneezes/coughs on stimulation = 2

grimace = 1

nil = 0

114
Q

what is the most common age to get croup?

A

6 months - 3 years

115
Q

what should always be done for an infant younger than 3 months old with a fever?

A
  • refer to specialist
  • blood culture
  • FBC
  • CRP
  • urine dip, MC&S
  • CXR if chest signs
  • stool culture if diarrhoea
116
Q

what are the different antibiotic options for hospital aquired pneumonia?

A

Within 5 days of admission: co-amoxiclav or cefuroxime

More than 5 days after admission: piperacillin with tazobactam OR a broad-spectrum cephalosporin (e.g. ceftazidime) OR a quinolone (e.g. ciprofloxacin)

117
Q

what is the visual field defect in craniopharyngioma?

A

bitemporal inferior quadrantanopia

118
Q

what is the finding for NEC on AXR?

A

gas cysts in bowel wall

119
Q

3 main differences between mild and moderate croup

A

stridor at rest

little distress but can be placated with toys

suprasternal/intercostal recessions

120
Q

what is the difference in management between mild or moderate croup?

A

none - all children get single dose 0.15 mg/kg dexamethasone PO regardless of severity

121
Q

what is the treatment for nephrogenic DI?

A

thiazide diuretic

122
Q

what are the admission criteria for bronchiolitis?

A

apnoea (witnessed or reported)

off oral fluid intake >50%

RR >60

SpO2 <92%

123
Q

allergy to neomycin is a contraindication to which vaccines?

A

MMR

124
Q

what type of bilirubin can cause kernicterus?

what are the consequences of kernicterus?

A

only unconjugated

deafness, chorioathetoid cerebral palsy

125
Q

what is Kasai procedure?

A

indicated in biliary atresia

protoenterostomy - joining CBD/hepatic duct to the duodenum allowing drainage of bile

126
Q

neonatal intraventricular haemorrhage is most associated with which type of cerebral palsy?

A

spastic diplegic

127
Q

managing UTI

infant <3/12

A

refer to hospital immediately

128
Q

managing UTI

upper UTI, child >3/12

A

consider admission

if not, oral abx such as cephalosporin or co-amoxiclav for 7-10 days

129
Q

managing UTI

child >3/12, lower tract UTI

A

oral antibiotics such as trimethoprim, nitrofurantoin, cephalosporin or amoxicillin for 3 days

safety net by telling parents to retun in 24-48 hours if the child doesn’t feel better

130
Q

after how many childhood UTIs do you consider giving antibiotic prophylaxis?

A

after the 2nd

131
Q

what dietary advice would you give to help in uncontrollable childhood epilepsy?

A

Ketogenic diet

low carb, high protein, high fat

132
Q

what other conditions are linked to epilepsy?

A

cerebral palsy (30% will have epilepsy)

mitochondrial disorders

tuberous sclerosis

133
Q

A 2-month-old baby girl is admitted to hospital with suspected meningitis. Her parents describe her becoming pyrexial and drowsy over the past 24 hours. On examination her temperature is 39.2ºC, heart rate is 160/min and respiratory rate is 50.min. Her anterior fontanelle is bulging. No petechial rash is seen. In addition to cefotaxime, what antibiotic should be given intravenously?

A

amoxicillin to cover Listeria

134
Q

what are the antibiotics are indicated for bordetella pertussis?

A

macrolides (clarithromycin, azithromycin)

135
Q

what is the does of IM adrenaline to give to children of different ages in anaphylaxis?

A

0-6 months = 0.15 mL of 1 in 1,000

6 mo-6 years = 0.15 mL of 1 in 1,000

6-12 years = 0.3 mL of 1 in 1,000

adult and >12 years = 0.5mL of 1 in 1,000

136
Q

what is the name for a low-pitched murmur heard at the lower left sternal border in children?

A

still’s murmur

137
Q

what is the name for the continuous blowing sounds heard below the clavicles in children on auscultation?

A

venous hums

138
Q

at what age do you usually get Perthe’s disease?

A

4-8 years old

139
Q

what diseases are screened for on the heel-prick test?

when does this happen?

A

5-9 days old

PKU, hypothyroidism, MCADD, cystic fibrosis, inherited metabolic diseases

140
Q

IgA nephropathy (Berger’s disease) is nephritic or nephrotic syndrome?

A

nephritic, similar presentation to RPGN/alport syndrome

141
Q

which are the live attenuated vaccines?

A

MMR

BCG

oral polio

yellow fever

oral typhoid

142
Q

what is laryngomalacia?

A

congenital malformaiton of the epiglottis

presents at 2-4 weeks old with stridor and poor feeding

should resolve on its own but if stridor is bad and breathing difficult then surgery may be performed to improve the airway

143
Q

a mother is given labetalol for high BP

what should be monitored in the baby after it is born?

A

measure BM, baby at increased risk for neonatal hypoglycaemia

144
Q

at what age do children start to respond to their own name when called?

A

12-15 months

145
Q

at what age to children begin to talk in full sentances (3-6 words)?

A

3 years old

146
Q

what is the treatment for mesenteric adenitis?

A

reassurance and discharge

147
Q

what are the causative organisms for bacterial conjunctivitis in children?

A
  • haemophilus influenzae*
  • streptococcus pneumoniae*
148
Q

what advice do you give for staying off school for children with hand, foot and mouth disease

A

no need to stay off school if the child feels well

149
Q

what are the outcome statistics for enuresis alarms?

A

2/3rd children acheive cure within 3-5 months

50% remain cured after stopping the alarm

can always bring the alarm back

150
Q

what are the medical explanations for childhood obesity? (5)

other than lifestyle factors, which are by far the most common reasons

A

growth hormone deficiency

down’s syndrome

hypothyroidism

prader-willi

cushing’s syndrome

151
Q

no earlier than ______ should hand preference develop

A

12 months

152
Q

what is the treatment and prognosis of HSP?

A

analgesia for the arthralgia

steroids/immunosuppression have inconsistent evidence

prognosis excellent - generally self-limiting disease

caution in children with pre-existing renal disease

around 1/3rd will relapse

153
Q

school exclusion for whooping cough?

A

5 days from starting antibiotics

154
Q

school exclusion for roseola infantium?

A

no exclusion

155
Q

school exclusion for D&V?

A

until symptoms have settled for 12 hours

156
Q

what is the advice for newborn children with conjunctivitis with exudate, other than possible antibiotic therapy?

A

wash out the eyes with cooled, boiled tap water 4 times per day

157
Q

what is the definition of JIA?

what are the classifications of JIA?

A

arthritis before age 16, persisting for >6 weeks with no other cause identified

  • systemic JIA
  • oligoarticular JIA
  • polyarticular JIA
  • enthesitis-related JIA
  • psoriatic arthritis
158
Q

what is the criteria for oligoarticular JIA?

A

=<4 joints affected, RF-negative

associated with high ANA and risk of uveitis

159
Q

what are the features of polyarticular JIA?

A

>4 joints affected, older girls, RF-positive

C spine and temporomandibular joints often affected

160
Q

at what GCS must a CT head be ordered for children >1 year old and <1 year old (paediatric GCS)?

A

>1 year old - <14…

<1 year old (infant) - <15…

…on assessment in A&E
After 2 hours, if GCS is <15 in either then send for CT

161
Q

what signs of trauma in the head would prompt CT scan? (5)

A

racoon eyes/Battle sign

skull bone depression

tense fontanelle

haemotympanum

CSF drip from nose or ear

162
Q

what is this?

A

Battle sign - indication of basal skull #

send for CT w/o contrast

163
Q

how many episodes of vomiting after head trauma is an amber flag for CT head?

A

3 or more discrete episodes

164
Q

what duration of amnesia should be an amber flag for CT head?

A

>5 minutes

anterograde or retrograde

165
Q

what duration of loss of consciousness should be an amber flag for head CT?

A

>5 minutes

166
Q

what are the indications for antibiotic use in acute otitis media?

A

child <2 years old

associated perforation of ear drum, otorrhoea/discharge

167
Q

roughly at what age can children be asked to do a PEFR?

A

about 5

168
Q

what are Brushfield spots?

A

white spots seen in the iris of Downs sydnrome patients

169
Q

what is hypertelorism and in what condition is it mostly seen?

A

increased space between the eyes

foetal alcohol syndrome

170
Q

other than short stature, what are the features of growth hormone deficiency?

A

doll-like face

neonatal hypoglycaemia and jaundice

delayed bone age

growth restriction does not present until 6-12 months old

171
Q

what is the mechanism of short stature in Cushing disease?

A

premature fusion of the growth plates/advanced bone age

172
Q

how do you get a bone age?

A

radiograph of carpal bones, scoring the ossification centres and caculating the age

173
Q

what are the components of the traffic light system of identification in children with fever?

A

colour

activity

breathing

circulation/hydration

other

174
Q

what is the definition of delayed puberty in boys and girls?

A

boys - >14 years

girls - >13 years

OR - failure to progress for >2 years

175
Q

how do you classify the causes of pubertal delay?

A

hyper-/hypo-gonadotrophic

176
Q

what are some examples of hypergonadotrophic hypogonadism?

A

turner syndrome/kleinfelter syndrome

surgery, radiation, chemotherapy damaging the gonads

androgen/oestrogen resistance

177
Q

what are some examples of hypogonadotrophic hypogonadism?

A

kallmann syndrome (with anosmia and developmental delay)

chronic illness (CF, asthma, Crohn’s, anorexia)

HPA damage - panhypopituitism, hypothyroidism, CNS tumour

178
Q

describe benign rolandic epilepsy

A

7-10 years old

male

twitch at corner of mouth, spreads to ipsilateral cheek and face

drooling, grunting and slurred speech

mostly happens at night

will grow out of it by adolescence

179
Q

a symmetrical jerking of arms and legs in teenagers

most likely in the morning

precipitated by alcohol

progress to generalised seizures

A

juvenile myoclonic epilepsy

180
Q

what pharmacotherapy is used in congenital heart disease in infancy?

what is the purpose of medical management?

A

thiazide diuretics and ACE-I

improve outcome by limiting growth restriction until child is big enough to tolerate surgery

181
Q

what age do children frequently get breath holding attacks?

A

as toddlers

start: 6-18 months
finish: 4-5 years

182
Q

what is the frequency of acute renal failure in HSP?

A

1%

183
Q

a rash develops after streptococcal infection

what are the two differentials to be considered?

A

scarlet fever

guttate psoriasis

184
Q

what antiepileptic medication should be avoided in absence seizures?

A

carbamazapine

185
Q

what are the ages for children to build block towers of:

2

3

6

9

.. blocks?

A

2 - 15 mo

3 - 18 mo

6 - 2 years

9 - 3 years

186
Q

what %age of retinoblastoma cases are hereditary?

A

10%

187
Q

what are the age definitions of precocious puberty?

A

8 for girls

9 for boys

188
Q

first line treatment for intussusception?

A

rectal air insufflation, followed by surgical correction if that doesn’t work

189
Q

what are the side effects of carbamazepine?

A

senses - diplopia, dizziness & ataxia

neuro - headache, drowsiness

systemic - SJS, leukopenia, agranulocytosis, SIADH, enzyme inducer

190
Q

what is the maintenance fluid eqn for children?

what is a suitable fluid?

A

100 mL/kg for first 10 kg;

50 mL/kg for 2nd 10 kg;

20 mL/kg thereafter

0.45% normal saline and 5% dextrose

191
Q

what is the prognosis for Peutz-Jaghers syndrome?

A

50% die from CRC before age 60

192
Q

in what proportion of patients with roseola infantum do febrile convulsions develop?

A

10-15%

193
Q

what are the treatment options for spasticity in cerebral palsy?

A

oral diazepam

oral/intrathecal baclofen

botox A

surgery (orthopaedic) or selective dorsal rhizotomy

194
Q

what is the prevalence of cows milk protein intolerance?

A

3-6% of all bottle fed infants

rarely seen in exclusively breastfed infants too

195
Q

what is the management for meconium ileus?

A

think CF

gastrograffin enema is both therapeutic and diagnostic. if peritonitic, send to theatre for laparotomy

sweat test at 6 weeks to confirm

prophylactic flucloxacillin

196
Q

to confirm a diagnosis, what investigation is suitable for a girl with microcytic monochromic anemia, fussy eater, presenting to hospital today with acute UTI?

A

nothing at the moment

have to measure ferritin to confirm IDA but is an acute phase reactant, so must wait until she’s better then you can measure

197
Q

developmental milestones for fix and follow (90 deg and 180 deg)

A

90 deg = 6 weeks

180 deg = 3 months

198
Q

management of SIADH

mild, moderate and severe

A

mild: fluid restriction & treat underlying cause

moderate: consider ADH antagonist (tolvaptan)

severe: + IV hypertonic saline & IV furosemide

199
Q

are growing pains worst in the morning or at night?

A

at night.

by definition, never present in the morning after the child is woken

200
Q

how would you bring on an absence seizure?

A

hyperventilation or stress

201
Q
  • failure to thrive
  • polyuria, polydipsia
  • hypokalaemia
  • normotension
  • weakness

diagnosis?

A

Bartter’s syndrome

202
Q

what age do the primitive reflexes disappear? roughly in what order?

A

4 months

stepping, moro, rooting then grasping

203
Q

other than prematurity, what are the risk factors for NRDS?

A

male sex

caesarean delivery

diabetic mother

second of twins

Specialty PACES (3 decks)

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