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Paeds Flashcards

1
Q

What does the placenta provide for the fetus in the blood?

A

Oxygen and nutrients

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2
Q

what is disposed of via the placenta (fetal->mother)

A

C02, lactate

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3
Q

what are the 3 fetal shunts?

A

Ductus Venosus
Ductus Arteriosus
Foramen Ovale

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4
Q

What 2 structures are connected by Ductus Venosus and what does it enable in fetal supply?

A

Umbilical vein - IVC

Enables blood to bypass the liver

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5
Q

What structures are connected by ductus arteriosus and what does this enable in fetal supply?

A

Pulmonary artery with aorta

Enables bypass of pulmonary circulation

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6
Q

what structures are connected by the foramen ovale and what does this enable in fetal supply?

A

R to L atria

Enables the bypass of the pulmonary circulation

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7
Q

What does the first breath lead to after birth re the foramen ovale?

A

expands the alveoli, decreases pulmonary vascular resistance>fall in pressure in RA > squash atrial septum - closure of Foramen Ovale.

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8
Q

What does the foramen ovale become after shutting

A

Fossa ovalis

After a few weeks

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9
Q

What causes the closure of the Ductus Arteriosus?

A

Increased blood oxygenation > drop in circulating prostaglandins > closure of DA -> ligamentum arteriosum

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10
Q

What causes the ductus venosus to stop functioning?

A

after birth, umbilical cord clamped - no flow in umbilical veins > structurally closes > ligamentum venosum

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11
Q

What are innocent murmurs?

What are they caused by?

A

Flow murmurs

Caused by fast blood flow through the heart during systole

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12
Q

What are the features of innocent murmurs (S)?

A 
Soft
Short
Systolic
symptomless
situation dependent
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13
Q

Which features of a murmur would prompt referral to paeds cardio?

A

murmur louder than 2/6
diastolic murmur
louder on standing
failure to thrive, feeding difficulty, cyanosis, SOB

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14
Q

Investigating murmur in children:

A

CXR
ECG
Echocardiogram

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15
Q

What is split second heart sound?

A

Inspiration>chest wall/diaphragm pull lungs + heart open > negative intra-thoracic pressure > RA fills faster pulling blood from venous system > RV takes longer to empty > delay in closure of pulmonary valve - split sound

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16
Q

Atrial septal defect murmur?

A

mid-systolic crescendo-decrescendo at upper L sternal border

Fixed split second heart sound (insp and exp)

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17
Q

Patent Ductus Arteriosus murmur?

A

If significant - normal HS 1 + continuous crescendo-decrescendo machinery murmur - obscuring HS2

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18
Q

Tetralogy of Fallot murmur?

A

Pulmonary stenosis > ejection systolic murmur at pulmonary area

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19
Q

What is a Patent Ductus Arteriosus

A

DA fails to close after 2-3/52 life.

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20
Q

What causes PDA?

A

Genetic or maternal infection - rubella

Prematurity = RF

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21
Q

Presentation PDA

A

Mostly asymptomatic in children, especially if small PDA

Can present as heart failure in young adults

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22
Q

Pathophysiology PDA

A

L>R shunt (acyanotic)
Pulmonary HTN
RV hypertrophy
LV hypertrophy

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23
Q

When might a PDA be heard?

A

Newborn examination

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24
Q

How will PDA be picked up?

A 
Murmur
SOB
difficulty feeding
poor weight gain 
LRTIs
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25
How is PDA Dx?
Echocardiogram
26
Mx PDA?
Monitored using echo <1yr After 1yo, unlikely to spontaneously close trans-catheter/surgical closure
27
In which part of the atrial septum lies the foramen ovale?
Septum secondum
28
What happens in an atrial septum defect?
Shunt - LA>RA (pressure gradient) -> right sided overeload, RH strain RHF Pulmonary HTN
29
Following an ASD what can pulmonary HTN eventually lead to?
Eisenmenger syndrome
30
What is Eisenmenger syndrome?
Pulmonary P > systemic P Shunt reversal - R->L shunt Cyanosis
31
Types of ASD
Ostium secondum Patent Foramen Ovale Oostium Prinum (->AVSD - cyanosis)
32
Complications of ASD
stroke due to VTE atrial fibrilation / atrial flutter Pulmonary HTN Eisenmenger syndrome
33
How does ASD affect common DVT?
Commonly with DVT, embolises>travels to R side of heart and causes PE With ASD - embolises>RA then LA then brain - stroke
34
How do ASDs commonly present
Antenatal scan / newborn examination
35
Presentation Atrial Septal Defect:
May be asymptomatic in childhood, present with dyspnoea/HF/stroke in adulthood
36
Symptoms Atrial Septal Defect childhood:
``` SOB difficulty feeding poor weight gain LRTIs acyanotic as L>R shunt ```
37
Mx of ASD
refer to paeds cardio Asx -> watch and wait Surgical closure - transvenous catheter closure Open heart surgery
38
How to reduce the risk of cx of Atrial Septal Defects in adults
Anticoagulation - NOAC, aspirin, warfarin
39
which genetic conditions are VSDs commonly associated with ?
Down's syndrome | Turner's syndrome
40
What happens with VSD over time?
L>R shunting, right sided overload, RHF, Pulmonary hypertension shunt reversal - Eisenmenger - cyanosis
41
How might VSD be picked up
Antenatal scan newborn examination may present in adulthood
42
VSD Symtpoms
``` poor feeding dyspnoea tachypnoea failure to thrive acyanotic as L>R shunt ```
43
VSD murmur?
Pan-systolic | systolic thrill on palpitation
44
causes of pan-systolic murmur?
Ventricular Septal Defect Mitral regurgitation Tricuspid regurgitation
45
Tx Ventricular Septal Defect?
Paeds cardio referral Asx - w&w - spontaneous closure Sx - transvenous catheter closure, open heart surgery diuretics
46
What is there an increased risk of in Ventricular Septal Defect patients?
Infective endocarditis | Offer prophylactic Abx pre-surgery
47
When can Eisenmenger's present?
1-2yo - large shunts adulthood - small shunts exacerbated by pregnancy
48
How does eisenmenger present?
Cyanosis
49
What does the cyanosis lead to in eisenmengers?
Bone marrow responds to low oxygen sats by producing more RBCs + Hb -> polycythaemia
50
What causes a plethoric complexion in eisenmenger's?
Polycythaemia
51
Examination findings for eisenmenger's?
RV heave Loud HS2 Raised JVP Peripheral oedema
52
Ex findings related to the chronic hypoxia of eisenmenger's?
Cyanosis Clubbing Dyspnoea Plethoric complexion
53
Mx Eisenmenger
Correct underlying abnormality | Once the pulmonary P>systemic P, not possible to medically reverse - Heart and Lung transplant
54
Supportive tx eisenmengers?
``` O2 Sildenafil - Pulm HTN Venesection - polycythaemia Anticoagulation - thrombosis prophylactic Abx - infective endocarditis ```
55
What is coarctation of aorta?
Congenital condition, narrowing of aortic arch around the ductus arteriosus
56
What underlying condition is coarctation of aorta commonly associated with ?
Turner's syndrome
57
what is the effect on the arteries distal to the narrowing in coarctation of aorta?
reduced pressure to these arteries
58
Where will there be increased P in coarctation of aorta?
In the arteries proximal to the narrowing, commonly the heart and the first three branches
59
Presentation of coarctation of aorta?
weak femoral pulses
60
Ix Coarctation of aorta:
4 limb BP - high P in limbs supplied from arteries before the narrowing (arms), reduced P in limbs supplied from arteries after the narrowing Systolic murmur
61
Coarctation signs in infancy
``` tachypnoea, increased wob poor feeding grey/floppy baby LV heave - (LV hypertrophy) underdeveloped L arm, legs acyanotic ```
62
Mx coarctation
most can live sx free until adulthood severe cases - emergency surgery after birth Sx - correct the narrowing, ligate the DA
63
While waiting for emergency surgery for coarctation correction, what tx can be given straight after birth?
Prostaglandin E - keeps DA open
64
How many leaflets make up the pulmonary valve normally?
3
65
In pulmonary valve stenosis, what happens?
leaflets form abnormally -> fusion/thickening -> narrow opening between RA and pulmonary artery
66
Pulmonary valve stenosis presentation:
mostly asx murmur - newborn exam fatigue on exertion, SOB, dizziness, fainting
67
Signs Pulmonary valve stenosis:
Ejection systolic murmur - pulmonary area palpable thrill - pulmonary area RV heave - RV hypertrophy JVP up - giant a waves
68
Mx Pulmonary valve stenosis :
Paeds cardio Asx - w&w Sx - surgery - balloon valvuloplasty (via venous catheter) Open heart surgery
69
Gold standard Ix Pulmonary valve stenosis:
Echocardiogram
70
pathologies coexisting in Tetralogy of Fallot:
VSD Overriding Aorta Pulmonary Valve stenosis RV hypertrophy
71
What does overriding aorta mean:
Aortic valve enterance is displaced further to the right than normal, above the VSD When RV contracts, greater proportion deoxygenated blood enters aorta
72
What symptom do overriding aorta and Pulmonary valve stenosis cause in ToF?
Cyanosis
73
Which way is the shunt in ToF?
R>L causes cyanosis degree depends on severity of Pulmonary valve stenosis
74
Risk factors for ToF
Rubella infection maternal age>40 alcohol consumption in pregnancy DM mother
75
Ix ToF
Echocardiogram
76
What shape is the heart in ToF on CXR?
Boot shaped - characteristic (due to RV thickening)
77
Presentation of ToF:
Antenatal checks Newborn exam - ejection systolic murmur due to Pulmonary valve stenosis HF<1yo can present older
78
Signs and symptoms ToF:
``` Cyanosis Clubbing Poor feeding poor weight gain ejection systolic murmur Tet spells ```
79
What are Tet spells
During ToF, some infants have deep blue skin, nails, lips when agitated, increased CO2 causes this. Also can lead to LOC, seizures, death
80
Tet spell - what can children do to help and why?
squatting in older children/knees to chest in younger - increases systemic vascular resistance - encourage blood to pulmonary vessels
81
Tet spell mx
``` Involve senior paediatrician supplementary O2 BBs IV fluids Morphine Sodium bicarbonate - met acidosis phenylpherine infusion - systemic vascular resistance up ```
82
Mx ToF neonates
Prostaglandin E infusion - maintain DA | total surgical repair - OHS
83
What is ebstein's anomaly?
Congenital heart defect where tricuspid valve set lower in R side of heard (towards apex) + incompetent > larger RA, smaller RV This leads to poor flow from RA>RV>pulmonary vessels
84
Which shunt is Ebstein's anomaly associated with?
R>L shunting across atria via an ASD | Leads to cyanosis
85
Which other syndrome is Ebstein's anomaly associated?
Wolff-Parkinson-White
86
How does Ebstein's anomaly commonly present
``` Like HF - oedema Gallop rhythm heard on auscultation, +HS3+HS4 Cyanosis SOB, tachypnoea poor feeding collapse/cardiac arrest ```
87
how would ebstein's anomaly present with an ASD
cyanosis and symtomatic a few days after birth - when DA (which has been compensating) closes
88
Ebstein's anomaly: Ix
ECG - arrhythmias, RA enlargement, RBBB, left axis deviation CXR - cardiomegaly, RA enlargement Echo- Dx, severity
89
Medical management of Ebstein's anomaly
tx arrhythmias, HF prophylactic Abx for infective endocarditis Definitive sx mx to correct underlying abnormality
90
What is transposition of the great arteries?
attachments of aorta and pulmonary trunk to the heart are swapped (transposed) RV>aorta LV>pulmonary vessels
91
In transposition of great arteries, which side of heart does systemic circulation flow?
Right
92
In transposition of great arteries, which circulation flows through L side of heart?
Pulmonary
93
which conditions are associated with transposition of great arteries?
VSD Coarctation Pulmonary stenosis
94
When is transposition of great arteries a problem?
Immediately after birth - no connection between systemic and pulmonary circulation > cyanosed baby loud S2 is audible and a prominent right ventricular impulse is palpable
95
On what does immediate survival depend in ToGA?
Shunt between systemic>pulmonary circulation via PDA, VSD, ASD
96
How is ToGA usually diagnosed?
Antenatal USS
97
If doesn't present at birth, what sx ToGA
``` cyanosis RDS Tachycardia poor feeding poor weight gain sweating ```
98
Mx ToGA
VSD enables time to plan definitive tx Prostaglandin infusion - maintain PDA Balloon septostomy - catheter Foramen Ovale via umbilicus to create an ASD Definitive - OHS - arterial switch + correct other heart defects
99
what are causes of constipation in children?
Idiopathic or functional
100
secondary causes constipation paeds?
``` Hirschprung's disease CF Hypothyroid disease SC lesions sex abuse intestinal obstruction anal stenosis cows milk intolerance ```
101
what is the effect of breastfeeding on stools passed?
Variable - can be as little as one stool/week passed in breast fed babies
102
constipation sx:
``` <3 stools/week hard stools - difficult to pass rabbit droppings straining and painful passage abdo pain loss of sensation of needing to go ```
103
What posture may be seen in constipation?
Relentive posturing - holding abdo posture
104
What causes overflow soiling?
Faecal impaction - loose smelly stools
105
Examination of constipated child:
palpable hard stools in abdomen
106
lifestyle factors leading to constipation?
``` habitually not opening the bowels low fibre diet dehydration sedentary lifestyle psychosocial (safeguarding) ```
107
red flags constipation:
``` not passing meconium neuro sx vomiting ribbon stool abnormal anus/lower back failure to thrive acute severe abdo pain/bloating ```
108
what causes failure to pass meconium?
Hirschprungs (associated with downs) | CF
109
Meconium - when should it be passed and how does it look?
Before 48 hours (ideally in first 24 hours) | green n gross
110
Meconium aspiration
green liquor neonatal distress neonatal pneumonia Seen in late babies >42/40
111
management meconium aspiration
suction | ?Abx for pneumonia
112
Ribbon stool seen in?
Anal stenosis
113
Cx constipation:
``` pain reduced sensation haemorrhoids overflow/soiling psychological impact ```
114
Mx constipation in child
exclude red flags lifestyle factors/diet Movicol - first line disempaction regimen - high dose laxatives at first psych - schedule visits, bowel diary, star charts
115
What is GOR?
Gastro-oesophageal reflux is where stomach contents reflux into oesophagus, throat and mouth via the lower oesophageal sphincter
116
What is important about babies and the lower oesophageal sphincter?
It is immature in babies up to 1yr
117
presentation GOR in children under 1:
``` chronic cough hoarse cry distressed/crying/unsettled after feeding reluctance to feed pneumonia poor weight gain ```
118
In children over 1 how may GOR present
Similar to adults - heartburn, acid regurgitation, retrosternal/epigastric pain, bloating, nocturnal cough
119
vomiting causes paeds:
``` over-feeding GOR pyloric stenosis (projectile) gastroenteritis appendicitis UTI/tonsilitis/meningitis Intestinal obstruction BN ```
120
red flags vomiting child:
``` Not keeping any food down projectile/forceful vomiting bile-stained/green haematemesis/melaena abdo distension reduced consciousness/bulging fontanelle/ neuro sx resp sx blood in stool sx infection rash apnoea ```
121
Mx GOR paeds
``` conservative - reassurance small meals burping regularly not overfeeding upright posture after feed ```
122
Medical mx GOR
gaviscon with feeds thickened milk/formula ranitidine Omeprazole
123
If needed further Ix with GOR, what would you do?
barium meal endoscopy Sx fundoplication if severe
124
Sandifer's syndrome - what is this?
Brief episodes of abnormal movements associated with GOR in infants Torticollis Dystonia - back arching
125
What is torticollis?
Forceful contraction of neck muscles > twisting of neck
126
West syndrome - what is key feature?
Infantile spasms, Interictal EEG - hypsarrhythmia mental retardation
127
Mx Sandifer's?
Sx improve as GOR improves | Refer to specialist
128
What is pyloric stenosis?
Hypertrophy>narrowing of pyloric sphincter - prevents food travelling stomach>duodenum
129
Where is the pyloric sphincter?
Ring of smooth muscle forms the canal between the stomach and duodenum
130
What is paathophysiology of pyloric stenosis?
after feeding>powerful peristalsis of stomach>due to stenosis food>oesophagus>mouth>projectile
131
when does pyloric stenosis present?
First few weeks of life | Hungry, thin baby
132
features pyloric stenosis
failure to thrive | projectile vomiting
133
Ex/Ix Pyloric stenosis
Large olive felt in upper abdomen - peristalsis | Hypochloric metabolic alkalosis
134
Dx and Mx pyloric stenosis
USS for dx- thickened and elongated pylorus | Sx tx - laparoscopic pyloromyotomy (Ramstedt's)
135
Presentation gastroenteritis
D/V/N | from stomach to intestines
136
ddx gastroenteritis
``` IBD Lactose intollerance Coeliac CF Toddler's diarrhoea IBS Iatrogenic - Abx ```
137
common viral causes gastroenteritis
Rotavirus Norovirus Adenovirus
138
E. coli as cause of Gastroenteritis?
faecal contact 0157>shiga toxin> haemolytic uraemic syndrome (HUS) No Abx!!!
139
Traveller's diarrhoea cause? Cure?
Campylobacter jejeni gram -ve ingestion Azithromycin/ciprofloxacin
140
If gatroenteritis with a history of swimming pools, drinking water contamination?
Shigella Shiga toxin>HUS Azithromycin/ciprofloxacin
141
raw eggs/poultry/food contamination leading to gastroenteritis?
Salmonella | Abx if severe - culture dependent
142
CF diet mx
High calorie, high fat, pancreatic enzyme supplement with each meal
143
what is a poor prognostic factor in congenital diaphragmatic hernia?
Presence of liver in thoracic cavity | Lung:head <1
144
is there a risk of recurrence of CDH?
yes - depending on severity
145
which side is CDH more common?
Left (85%)
146
risks of CDH in future? (cx)
Pulmonary HTN | future children with CDH
147
Limping child, acute onset, viral infections ass., mild fever, well child, boys age 2-12
Transient synovitis
148
Limping child, very unwell, high fever holding leg flexed, abducted and externally rotated pain! warm jt to palpate
septic arthritis/osteomyelitis
149
painless limp indicates
JIA
150
neonate girl with disparity in skin creases behind L/R hips
Developmental dysplasia of hip
151
What is Perthe's disease?
Avascular necrosis of femoral head | 4-8yo
152
obese child, 10-15 years, 2/52 hx stiff hip/knee pain - no trauma
Slipped Upper Femoral Epiphysis | ix - 2 view both hips XR
153
Epistaxis in children causes:
nose picking foreign body URTI Allergic rhinitis
154
Above what age are nose bleeds considered less sinister?
2yo
155
high fever lasting >5 days, strawberry tongue, red palms with desquamation, conjunctive infection, lymphadenopathy is:
Kawasaki's disease
156
What type of disease is Kawasaki
Vasculitis | clinical dx
157
Mx kawasaki?
Aspirin - high dose IV IG ECHO
158
Main cardiac cx Kawasaki?
Coronary artery aneurysm
159
Normal social smile response at how many weeks old for normal milestones?
6-8/52 | if prem + weeks prem on
160
Normal milestone: laughs?
3/12
161
When do babies become shy and take everything to their mouth (normal milestone)?
9/12
162
Milestone: puts hand on cup to drink
6/12
163
milestone: drinks from cup + uses spoon
12-15/12 up to complete competencty age 2
164
milestone: spoon + fork
3yo
165
milestone: knife and fork
5yo
166
helps get self dressed/undressed
12-15/12
167
removes shoe/hat
18/12
168
puts on shoes/hat
2yo
169
dresses independently apart from buttons/laces
4yo
170
Plays peekaboo milestone:
9/12
171
waves byebye and plays patacake
12/12
172
plays happily alone
18/12
173
plays near/not with other children:
2yo
174
plays with other children:
4yo
175
Causes of neonatal hypotonia?
neonatal sepsis Wednig-Hoffman (spinal muscular atrophy 1) hypothyroid Prader-Willi syndrome Down's syndrome cerebral palsy (hypotonia may precede the development of spasticity)
176
maternal causes neonatal hypotonia?
benzos | maternal MG
177
Haemophilia A: what type of genetic disorder is this?
X-linked recessive | factor VIII deficiency compared to HaemB IX def
178
What is the transmission rate of X linked if: | male has the disease, female is not even a carrier
0% chance | No male-male transmission as males always give Y to their sons
179
What is intussusception?
invagination of one portion of bowel into the lumen of the adjacent bowel
180
Clinical features: intussuseption:
``` paroxysmal abdo colic pain during paroxysm infant knees up, pale Vomiting blood stool - redcurrent jelly sausage shaped mass RUQ ```
181
Ix: intussusception?
USS - target shaped mass
182
Mx intussusception:
reduction by air insufflation under radiological control Sx if peritonism (pneumatic reduction under fluoroscopic guidance)
183
asthma mx: step 2 difference in <5, >5?
moderate paeds dose ICS <5, | low paeds dose ICS >5
184
Asthma management >5 steps:
1. SABA 2. low dose ICS 3. LTRA 4. LABA -LTRA 5. switch ICS/LABA for MART 6. moderate dose ICS MART 7. high dose ICS, theophylline, expert
185
Transient tachypnoea of newborn: what increases the risk ?
Delayed reabsoprtion of fluid in lungs | CS increases risk
186
Ix/Mx TTN?
Ix - CXR - hyperinflation of lungs horizontal fissure | Mx - supplemental O2, usually resolves after 1-2 days
187
what disease makes children more likely to snore?
Down's syndrome - sleep apnoea | due to low muscle tone of upper airways due to large tongue/adenoids
188
causes of snoring in children:
``` obesity nasal problems - polyps, deviated septum, hypertrophic nasal turbinates recurrent tonsilitis Down's syndrome hypothyroidism ```
189
which congenital heart defect is linked to taking Lithium in pregnancy>
Ebstein's anomaly
190
Hirschprung's disease: Dx test
rectal biopsy - full thickness | absence of ganglion cells from mysenteric and submucosal plexuses
191
If parents do not give consent, but intelligent and able under 16 wants sx, which you deem in her best interests, what can you do and who's guidelines do you reference?
Gillick competency If stable - written consent will do If urgent - verbal consent ok
192
Which disease commonly presents as primary amenorrhoea? WITH GROIN SWELLINGS
Androgen insensitivity
193
What is the genotype of Turner syndrome?
45, X0
194
Short stature, shield chest and webbing of the neck is a presentation of?
Turner syndrome
195
Kleinfelter syndrome karyotype?
47 XXY
196
what is another way of describing primary hypogonadism?
Kleinfelter
197
Kleinfelter sx:
``` taller than average lack secondary sex characteristics small, firm testes infertile, gynaecomastia (risk male br ca) elevated Gonadotrophin levels ```
198
Kallman's syndrome sx:
``` delayed puberty hypogonadism, cryptorchidism anosmia sex hormone levels low LH/FSH levels v low/normal normal/tall height ```
199
why is there delayed puberty in Kallman's syndrome?
hypogonadotrophic hypogonadism
200
How is Kallman's inherited?
X-linked recessive
201
type of vaccine in rotavirus?
Oral live attenuated
202
if mycoplasma pneumonia suspected as childhood pneumonia cause - what Abx?
erythromycin
203
cerebral palsy definition?
disorder of movement and posture due to non-progressive lesion of the motor pathways in the developing brain
204
commonest cause of Cerebral Palsy?
antenatal (80%) - cerebral malformation, congential infection (rubella, toxoplasmosis, CMV)
205
name some intrapartum causes of CP?
birth asphyxia / trauma
206
postpartum causes CP?
Intraventricular haemorrhage meningitis head trauma
207
clinical manifestation of CP?
abnormal tone in early development not meeting motor milestones abnormal gait feeding difficulty
208
CP associated non-motor symptoms?
``` learning difficulties (60%) epilepsy (30%) squints (30%) hearing impairments (20%) ```
209
classes/types of CP?
spastic (70%) - hemiplegia, diplegia, quadraplegia dyskinetic ataxic mixed
210
Mx CP?
MDT
211
tx spasticity in CP?
``` oral diazepam oral/intrathecal baclofen botulinim toxin type A orthopaedic sx selective dorsal rhizotomy ```
212
should children be excluded from school for head lice until tx starts?
no | do not treat household contacts unless they have it
213
other names for head lice
pediculosis capitis | nits
214
Mx nits?
malathian, wet combing dimeticone, isopropyl myristate, cyclomethicone
215
which rash is characterised by a 3-5day high fever followed by a maculopapular rash starting on CHEST and spreads to limbs
Roseola Infantum | Herpes Virus 6
216
when does roseola infantum rash occur?
as fever is disappearing
217
'slapped cheek syndrome' - rash starts on cheeks then spreads - which rash?
Parvovirus B19
218
Group A strep - skin features?
cellulitis erysipelas impetigo
219
which cause of rash commonly leads to Koplik's spots?
Measles
220
What is a: skull deformity producing unilateral occipital flattening, which pushes the ipsilateral forehead ear forwards producing a 'parrallelogram' appearance
Plagiocephaly
221
Mx plagiocephaly?
reassurance | normally resolves between 3-5
222
epistaxis, bruising, increased PT time ->
Acute Lymphoblastic Leukaemia
223
which diseases may show lowered erythrocytes and platelets?
Aplastic anaemia | Myelodysplasia
224
what is the commonest malignancy affecting children?
ALL | 80% all childhood leukaemia
225
features of ALL caused by bone marrow failure:
anaemia (lethargy, pallor) neutropenia (frequent, severe infections) thrombocytopaenia (frequent bruising, petechiae)
226
other features of ALL:
bone pain hepatosplenomegaly fever, night sweats, wt loss, fatigue testicular swelling
227
types of ALL:
common ALL - CD10 present, pre-B phenotype T-cell (20%) B-cell (5%)
228
poor prognostic factors for ALL:
``` age < 2 years or > 10 years WBC > 20 * 109/l at diagnosis T or B cell surface markers non-Caucasian male sex ```
229
what does genetic anticipation mean?
hereditary diseases have younger onset in each successive generation
230
give two examples of diseases with genetic anticipation?
Huntington's disease | Myotonic dystrophy
231
what causes genetic anticipation?
trinucleotide repeats
232
name some examples of trinucleotide repeats?
``` Fragile X HD myotonic dystrophy spinocerebellar ataxia spinobulbar muscular atrophy dentatorubral pallidoluysian atrophy ```
233
Mx: croup
PO Dexamethasone | Pred if not availalbe
234
emergency croup tx?
high flow O2 | nebulised adrenaline
235
croup also known as:
laryngeotracheobronchitis
236
eneuresis definition?
involuntary discharge of urine by day/night/both
237
eneuresis Mx
look for underlying causes reward good behavior alarm <7 desmopressin 7<
238
if newborn hearing screening abnormal, which test do they go on to have and when?
Auditory brainstem response test as newborn/infant
239
how is hearing assessed as part of the newborn hearing screening assessment?
Otoacoustic emmision testing
240
slipped upper femoral epiphysis (SUFE) Mx;
Sx: internal fixation across the growth plate
241
what does the Pontesi method tx?
Clubfoot
242
WHat does a Pavlik harness treat?
Developmental dysplasia of the hip
243
Risk with SUFE?
avascular necrosis of femoral neck
244
4 week old child comes with red rash on her scalp + yellow flakes - dx?
seborrhoeic dematitis
245
Mx of seborrhoeic dermatitis
baby shampoo/oils if mild | if severe - topical steroids - hydrocortisone 1%
246
why do children with CF get foul smelling stools?
steatorrhoea caused by pancreatic insufficiency
247
if there are 2+ responders to a paediatric life support emergency, how many chest compressions:ventilations
15:2
248
If on own, how many chest compressions:ventilations in paeds
30:2
249
how many rescue breaths are given in resus?
5
250
what is major risk factor for TTN?
CS
251
What is major risk factor for apsiration pneumonia?
meconium staining of amniotic fluid
252
major risk factor for Neonatal Respiratory Distress Syndrome?
Prematurity
253
what is linked with NRDS?
surfactant deficiency lung disease
254
Hirschprung's disease presentation:
bilious vomiting, abdo distension constipation failure to pass meconium first 2 days
255
first sign of puberty in girls:
breast development 11.5years
256
male first sign puberty?
testicular growth 12 years
257
``` SpO2<92% PEF<33% predicted silent chest poor respiratory effort agitation altered consciousness cyanosis ```
Life threatening asthma
258
Severe asthma sx:
``` SpO2<92% PEF 33-50% too breathless to talk/feed HR>125 >5yo HR>140 <5yo RR>30/40 o5/u5 use accessory muscles ```
259
coryzal symptoms (including mild fever) precede: dry cough increasing breathlessness wheezing, fine end inspiratory crackles feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission Dx?
Bronchiolitis RSV tx - supportive
260
when is peak incidence bronchiolitis?
3-6month
261
what causes orofacial clefts during pregnancy?
maternal anti-epileptics use
262
What tests are used to diagnose developmental dysplasia of hip in early childhood?
Barlow and Ortalani test
263
what is breech delivery a risk factor for in terms of gait abnormalities?
DDH
264
what type of pulse is associated with PDA?
collapsing | large volume, bounding
265
``` Left subclavicular thrill continuous machinery murmur large vol, bounding collapsing pulse wide pulse pressure having an apex beat present acyanotic ALL features of? ```
features of PDA
266
Mx PDA - medical?
Indomethacin - prostaglandin inhibitor closes the hole in most cases surgical repair if failss
267
commonest cause of croup?
Parainfluenza virus
268
chest compressions for children of all ages should be at what rate?
100-120bpm
269
which murmur will change on variation of posture?
Benign ejection systolic murmur
270
which murmur is heard at lower Left sternal edge?
Still's murmur | low-pitched
271
which murmur is heard as a continuous blowing out sound just below the clavicles?
Venous hums - turbulent flow in great veins returning blood to heart
272
risk factors for SIDS?
``` prone sleeping parental smoking bed sharing hyperthermia / head covering prematurity ```
273
``` jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma ```
hypernatraemic dehydration
274
``` Learning difficulties - ASD Macrocephaly Long face Large low set ears Macro-orchidism ``` Syndrome?
Fragile X
275
``` Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions Syndrome?? ```
Patau syndrome
276
Which chromosome is Patau syndrome and what is the cause?
trisomy 13
277
Micrognathia Low-set ears Rocker bottom feet Overlapping of fingers
Edward syndrome | Trisomy 18
278
Webbed neck Pectus excavatum Short stature Pulmonary stenosis
Noonan syndrome
279
Micrognathia Posterior displacement of the tongue (may result in upper airway obstruction) Cleft palate
Pierre - Robbins Or Treacher- Collins
280
Differentiating between Pierre-Robin and Treacher-Collines
TC is AD so FHx positive
281
Hypotonia Hypogonadism Obesity
Prader-Willi | Ch15
282
What causes the problem in Prader-Willi?
loss of the paternal locus from Ch15 | get most of their Ch15 from mother
283
What causes problem in Angelmann?
Loss of maternal locus from ch15 | get most of their ch15 from dad
284
``` Short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis elfin faces Syndrome? ```
William's syndrome
285
Characteristic cry due to larynx and neurological problems Feeding difficulties and poor weight gain Learning difficulties Microcephaly and micrognathism Hypertelorism
Cri du chat syndrome
286
genetic cause of cri du chat ?
ch5 p deletion
287
Micrognathism?
undersiezed jaw | small chin
288
hypertelorism
increased distance between two organs, typically refers to eyes
289
what is gastrochisis?
intestinal loops protruding through a hole in the abdomen to the left of the umbilicus.
290
Omphalocele?
intestinal loops protruding through a hole in the abdomen - through the umbilicus.
291
what is gastrochisis associated with ?
low socioeconomic | mat age<20, smoking, alcohol use
292
what is first line type of laxative in childhood constipation?
osmotic laxative
293
when is stimulant laxative used in constipation mx?
2nd line
294
commonest cause of hypothyroidism in UK?
autoimmune thyroiditis
295
3yo boy, 6/12 hx of chronic diarrhoea- 5-7 loose stools/day. contain 'carrots, peas and sweet corn' and generally undigested food. growing well, stable on the 75th percentile on the growth chart for weight, height and head circumference. Otherwise well
Toddler's diarrhoea
296
stools containing carrots and peas ->
Toddler's diarrhoea
297
commonest cause diarrhoea in developed world
Cows milk intolerance
298
moderate vs severe croup differentiation?
``` severe: expiratory stridor marked sternal wall retractions severe agitation tachycardia cyanosis <1yo ```
299
Mx croup regardless of severity:
PO dexamethasone
300
if severe croup, what also can be mx:
nebulised o2, pred
301
On examination you note multiple vesicles over both palms and around the mouth. She is also pyrexial. Disease?
Hand foot and mouth disease
302
What type of disease is hand foot and mouth?
Self-limiting viral illness
303
Mx hand foot and mouth?
Requires symptomatic treatment only
304
when might someone get Stevens-Johnson syndrome?
severe drug sensitivity reaction?
305
chickenpox school exlusion criteria - until when?
should be excluded until all lesions have crusted over (usually about 5 days)
306
mx chickenpox in children:
calamine cream
307
ADHD meds started in children: what needs monitoring?
height and weight 6/12
308
what is first line ADHD drug in children?
Methylphenidate
309
what are all ADHD drugs toxic?
cardiotoxic | baseline ECG
310
differentiate between epilepsy and reflex anoxic seizure?
rapid recovery RAS
311
why might neonate be jaundiced benign?
higher number of RBCs shorter RBC lifespan slower liver conjugation
312
why can unconjugated bilirubin pass the blood brain barrier?
lipid-soluble
313
what causes kernicterus?
deposition and accumulation of unconjugated bilirubin in the brain (BG)
314
how does kernicterus manifest?
hearing loss irreversible brain damage, cerebral palsy death
315
risk factors for abnormal bilirubin levels in neonatets?
- RBC breakdown | - acidosis
316
if a newborn develops jaundice in first 24 hours of life or has abnormally high unconjugated bilirubin levels, what should you do to mx?
Sepsis screen blood group incompatibility (both these increase RBC breakdown)
317
causes of jaundice linked to the liver's ability to cocnjugate bilirubin?
G6PD deficiency hypoxic liver injury dehydration from poor feeding intestinal pathologies/obstructions
318
Tx for hyperbilibrubinaemia?
Phototherapy - light to conjugate the free bilirubin and increase it's secretion
319
if severe hyperbilirubinaemia, how do you treat?
exchange transfusion
320
episodic viral wheeze mx:
1. symptomatic only 2. SABA 3. LTRA / PO ICS / both
321
up to what time period after a febrile convulsion is normal for a child to be drowsy?
1 hour | beyond this is not simple febrile convulsion
322
when do febrile convulsions normally occur?
early on in viral infection
323
how long do seizures last in febrile convulsion normally?
usually brief <5 mins
324
how would seizures in febrile convulsions typically be described>
Tonic clonic
325
which condition should you never do an airway examination if suspect:
Croup | can cause airway to obstruct
326
breastfed first 2/52 life before switched to formula. 6/52 hx regurgitation, vomiting, diarrhoea and eczema
cows milk protein intolerance
327
IX test for cows milk protein intolerance?
skin prick/patch testing | total IgE and specific IgE (RAST) for cow's milk protein
328
in children with IgE-mediated CMPI - when will most children be tolerant?
55% by 5 years will be milk tolerant
329
In children with non-IgE-mediated CMPI - when will most children be tolerant?
3 years old
330
if want to perform a milk challenge in CMPI, where do you do this? why?
in hospital - risk of anaphylaxis
331
what should mothers who are breastfeeding child with CMPI do?
avoid dairy
332
what must you do as part of mx for whooping cough?
Notify Public Health England | household prophylaxis
333
Tx whooping cough?
if onset cough <21/7 PO macrolide eg clarithromycin, azithromycin or erythromycin
334
complications of pertussis:
subconjunctival haemorrhage pneumonia bronchiectasis seizures
335
jittery and hypotonic baby may suggest?
neonatal hypoglycaemia
336
what is a maternal risk factor for neonatal hypoglycaemia?
Maternal labetolol for pre-eclampsia
337
neonatal hypoglycaemia causes?
``` maternal diabetes mellitus prematurity IUGR hypothermia neonatal sepsis inborn errors of metabolism nesidioblastosis Beckwith-Wiedemann syndrome ```
338
attempts to dislocate an articulated femoral head describes which neonatal examination?
Barlow test for DDH
339
DDH risk factors:
``` female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity ```
340
attempts to relocate a dislocated femoral head describes which neonatal exam?
Ortaloni test DDH
341
Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress should make you consider?
Diaphragmatic hernia
342
initial mx of diaphragmatic hernia in RDS resus?
intubate and ventilate | NG to keep air out of bowel
343
karyotype: Turner's syndrome? | Is it an inherited condition?
X0, 45X | not inherited, random monosomy
344
``` short stature shield chest, widely spaced nipples webbed neck bicuspid aortic valve (15%), coarctation of the aorta (5-10%) primary amenorrhoea cystic hygroma (often diagnosed prenatally) high-arched palate short fourth metacarpal multiple pigmented naevi lymphoedema in neonates (especially feet) gonadotrophin levels will be elevated hypothyroidism horseshoe kidney ```
Turner's syndrome
345
<16yo understands the professional's advice <16yo cannot be persuaded to inform their parents or allow the professional to contact them <16yo likely to begin, or continue having, sexual intercourse with or without contraceptive treatment unless they receives contraceptive treatment, their physical or mental health, or both, is likely to suffer the young person's best interests require them to receive contraceptive advice or treatment with or without parental consent
Fraser guidelines
346
precocious puberty is the onset of 2nd sex charas before what ages in m and f?
9m | 8f
347
commonest occular malignancy of childhood?
retinoblastoma
348
absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom strabismus visual problems
retinoblastoma
349
mx retinoblastoma:
enucleation (removal of eye) - not only option | external beam radiation/chemo/photocoagulation
350
prognosis : retinoblastoma:
excellent, 90% live to adulthood
351
puffy swelling that usually occurs over the presenting part and crosses suture lines
Caput succedaneum
352
Caput succedaneum tx:
no tx | manage conservatively - resolves within days
353
``` Premature baby Intolerant to feeds Generally unwell Tender abdomen Absent bowel sounds Distended abdomen Blood in stools Peritonitis and shock ```
Necrotising enterocolitis
354
AXR: dilated bowel loops (asymmetrical) bowel wall oedema pneumatosis intestinalis (intramural gas) portal venous gas pneumoperitoneum (from perforation) air inside and outside of the bowel wall (Rigler sign) air outlining the falciform ligament (football sign)
necrotising enterocolitis
355
when is MenB vaccines given?
2,4,12 months
356
what often preceeds ITP?
viral illness
357
schistocytes are often seen on blood smears?
Thrombotic Thrombocytopaenia Purpura
358
how many episodes vomiting before CT in children following a head injury?
3
359
Criteria for immediate request for CT scan of the head (children):
* LOC>5min witnessed * Amnesia> 5 min * Abnormal drowsiness * Three + episodes of vomiting * Clinical suspicion NAI * Post-traumatic seizure, no Hx epilepsy * GCS <14, or < 1 year GCS< 15 * Suspicion of open/depressed skull injury/tense fontanelle * Any sign of basal skull fracture (haemotympanum, panda' eyes, CSF leak from the ear or nose, Battle's sign) * Focal neurological deficit * <1 year, presence of bruise, swelling/laceration of >5 cm on the head * Dangerous mechanism of injury (high-speed RTA either as pedestrian, cyclist or vehicle occupant, fall from a height >3 m, high-speed injury from a projectile or an object)
360
systemic onset JIA also known as?
Still's disease
361
still's disease/JIA has characteristic rash?
Salmon-pink rash
362
JIA dx criteria (age and time course):
<16yo, >6wks
363
features of systemic JIA:
``` pyrexia salmon-pink rash lymphadenopathy arthritis uveitis anorexia and weight loss ```
364
Ix: JIA
ANA may be positive, especially in oligoarticular JIA (<4jts) rheumatoid factor is usually negative
365
if a baby is born >36 wks with breech presentation, what follow up imaging does it need and for what?
USS 6 weeks, for DDH
366
itchy bottom but no other sx: what is wrong?
Threadworm infection
367
management of threadworm infection:
hygiene measures and single dose of mebendazole for all family
368
Dx: threadworms
sellotape attatched to perianal area to catch eggs and send for microscopy
369
what are trident hand deformity indicative of?
Achondroplasia
370
short limbs (rhizomelia), lumbar lordosis and midface hypoplasia macrocephaly with frontal bossing - which congential abnormality?
achondroplasia
371
sandle-gap in which syndrome?
downs
372
Achondroplasia inheritance?
AD
373
mutuation of FGFR3 gene causes?
achondroplasia
374
microcephaly causes?
normal variation e.g. small child with small head familial e.g. parents with small head congenital infection perinatal brain injury e.g. hypoxic ischaemic encephalopathy fetal alcohol syndrome syndromes: Patau craniosynostosis
375
what age says 'mama' 'dada'
9-10/12
376
double syllable word milestone?
6/12
377
when will child know and respond to own name?
12/12
378
repeated flexion of head/arms/trunk followed by extension of arms repeated 50x is classical chracteristics of?
Infantile spasms
379
what is West syndrome?
Infantile spasms - salaam attacks | type of epilepsy
380
when is west syndrome commonly seen?
4-8/12
381
EEG: West syndrome
Hypsarrhythmia
382
West syndrome: mx and px
1. vigabratin ACTH also used poor prognosis
383
Perthe's disease in u6yo mx:
observations
384
Perthe's disease in over 6 mx
surgical repair
385
hip pain: develops progressively over a few weeks limp stiffness and reduced range of hip movement x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening DX?
Perthe's disease
386
Perthe's disease cx?
osteoarthritis | premature fusion of the growth plates
387
What is the most important treatment for prevention of neonatal respiratory distress syndrome?
Administer Dexamethasone to mother
388
MMR how long wait between vaccines?
3 months to maximise uptake, if >10yo 1 month enough
389
If DDH suspected, what ix:
USS
390
A child aged < 3 months with a fever > 38ºC - initial mx step?
Refer for paeds assessment same day
391
Small testes in precocious puberty indicate :
adrenal cause | eg. adrenal hyperplasia
392
unilateral testes growth in precocious puberty indicate
gonadal tumour
393
bilateral enlargement testes in precocious puberty indicates:
gonadotropin release from IC lesion
394
advanced development in all areas and would be associated with a history of sexual aggression during childhood ??
testotoxicosis
395
talks in short sentences:
2.5-3yrs
396
vocab of 2-6 words:
12-18 months
397
Mx: Hirschprungs (definitive)
bowel ressection
398
eczema: first line tx:
topical emolients
399
what comes after topical emolients in step-wise mx of eczema?
topical steroids
400
If premature baby: wht is the timetable on vaccines?
give as normal, do not correct for gestational age
401
walks unsupported: age?
13-15/12
402
small umbilical hernia mx:
in under 1s, normall resove by 12/12 so watch and wait
403
what sx should parents be told about during watch and wait for umbilical hernia to seek medical attention if they see?
vomiting, pain and being unable to push the hernia in
404
newborn resus chest compression:ventilation ratio
3:1
405
if bronchiolitis sx but really high temp >39 - what should you consider?
pneumonia
406
``` short ­palpebral fissure thin vermillion border/hypoplastic upper lip smooth/absent filtrum learning difficulties microcephaly growth retardation epicanthic folds cardiac malformations ```
Fetal Alcohol syndrome
407
ask what and who questions?
3 years
408
Ask when and how questions?
4 years
409
combine 2 words: milestones
2 years
410
small cystic structure which has obviously been recently infected. On removal of the scab, there is hair visible within the lesion, what type of cyst?
Dermoid
411
where do dermoid cysts occur>
at sites of embryonic fusion
412
which cells do dermoid cysts contain?
multiple cell types - includes hair
413
Hirschprung's disease AXR findings:
dilated loops of bowel with fluid levels. The anus appears normally located.
414
premature infant (30-week gestation) presents with distended and tense abdomen. She is passing blood and mucus per rectum, and she is also manifesting signs of sepsis.
Necrotising enterocolitis
415
newborn baby boy presents with gross abdominal distension. He is diagnosed with cystic fibrosis and his abdominal x ray shows distended coils of small bowel, but no fluid levels.
Meconium ileus
416
Lower UTI tx paeds
3/7 course Abx per local policy
417
what would clean catch sample show for a child with a suspected UTI?
positive for leukocytes and nitrates
418
Upper UTI tx paeds?
10/7 course Co-amoxiclav
419
what is commonest cause of cardiac arrest in paeds?
respiratory - hypoxia
420
causative organisms of meningitis in neonates-3months old?
GBS E.Coli Listeria
421
causative organisms of meningitis in 1/12-6yo ?
neisseria meningitidis strep pneumo haemophilus influenzae
422
causative organisms meningitis over 6yo?
neisseria meningitidis | strep pneumo
423
Bow legs in a child < 3 mx?
reassurance, likely to resolve in <4yos
424
what would blood gas of child with ?pyloric stenosis classically show?
elevated bicarbinate, hypochloraemia, hypokalaemia
425
causative organism acute epiglottitis?
Hib - thumb sign
426
2/12 old gradually worsening noisy breathing, worse on eating. lower centile for weight and poor food intake:
Laryngomalacia
427
never present at the start of the day after the child has woken no limp no limitation of physical activity systemically well normal physical examination motor milestones normal symptoms are often intermittent and worse after a day of vigorous activity
growing pains
428
rare cx of chickenpox?
pneumonia encephalitis (cerebellar involvement may be seen) disseminated haemorrhagic chickenpox arthritis, witis and pancreatitis may very rarely be seen
429
Vesicoureteric reflux: Ix:
micturating cystourethrogram - to dx | DMSA to look for renal scarring
430
in newborn exam, white-coloured nodule at the roof of the mouth. Dx:
epstein's pearl
431
what is an epstein's pearl?
congential cyst found in the mouth - no tx needed
432
when does heel prick test of newborns occur?
day 5
433
what does heel prick test test for?
CF, congenital hypothyroidism, sickle cell disease, other metabolic diseases - phenylketonuria
434
for CF, what does the heel-prick test look for?
raised IRT (immunoreactive trypsinogen)
435
if heelprick shows raised IRT, what test should next be done?
sweat test to confirm for CF | >60
436
commonest cx of roseola infantum?
febrile convulsions
437
what can epstein's pearls be mistaken for?
neonatal teeth
438
cx of undescended testes?
infertility torsion testicular cancer psychological
439
mx undescended testes?
review at 3/12 old and refer to paediatric surgeon | orchidopexy
440
when will average child sit without support
6-8/12
441
nappy rash: in iritant dermatitis, where is characteristically spared?
creases/flexors
442
Typically an erythematous rash which involve the flexures and has characteristic satellite lesions
candida dermatitis
443
commonest cause nappy rash?
irritant dermatitis
444
mx nappy rash:
disposable nappies are preferable to towel nappies expose napkin area to air when possible apply barrier cream (e.g. Zinc and castor oil) mild steroid cream (e.g. 1% hydrocortisone) in severe cases
445
mx nappy rash if ?candida dermatitis
topical imidazole, | no barrier cream
446
commonest cause of ambiguous genetalia in newborns?
congenital adrenal hyperplasia
447
which gender is phenotype in androgen insensitivity syndrome?
female
448
what underlying condition, dx in childhood could cause DM in teenager?
CF
449
when is first dose MMR given in UK
12-13/12
450
when is the second dose MMR given UK?
3-4 years | pre-school booster
451
Autosomal recessive conditions are generally affecting?
metabolic
452
Autosomal dominant conditions are generally?
structural
453
The abdominal film demonstrates a large soft tissue opacity ('sausage-shaped') in the left upper quadrant.
intussusception
454
Perthe's disease more common boys/girls?
boys x5
455
1 month old baby girl presents with bile stained vomiting. She has an exomphalos and a congenital diaphragmatic hernia - ?
malrotation
456
risk of 40yo mother giving birth to a Down syndrome baby?
1/100
457
risk of 45yo giving birth to a down syndrome baby>
1/50
458
measles - immediate aftermath cx?
``` otoitis media pneumonia encephalitis febrile convulsion ketaroconjunctivitis diarrhoea appendicitis myocarditis ```
459
what cx might be seen 5-10 years after a measles infection?
subacute sclerosing panencephalitis
460
commonest presenting feature of a Wilm's tumour?
abdominal mass RUQ when lying down smooth, non-tender
461
``` abdominal mass (most common presenting feature) painless haematuria no lymphadenopathy flank pain other features: anorexia, fever unilateral in 95% of cases ```
Wilm's tumour
462
where does Wilm's tumour most commonly metastasise to ?
lung (20%)
463
Mx : wilm's tumour
nephrectomy | Chemo/RT
464
prognosis : Wilm's tumour
good, 80% cure rate
465
what causes RDS in neonate with CDH?
pulmonary hypoplasia and hypertension
466
when should APGAR scores be tested for (eg. after CS for macrosomia)?
1, 5, 10 mins
467
APGAR score refers to ?
``` Appearance (colour) Pulse (heart rate) Grimace (reflex irritability) Activity (muscle tone) Respiratory effort ```
468
exomphalos?
protruding bowel | plan C-S 37/40 (within a membrane) - staged repair
469
optimal tx of protruding bowel?
staged closure immediately with completion at 6-12/12
470
why is there a gradual repair in exophalos?
to prevent respiratory cx
471
mx gastrochitis?
urgent correction (sx)
472
Osgood-Schlatter disease. | This condition occurs as a result of inflammation at which bony prominence?
Tibial tuberosity
473
commonest cardiac cx of Turner syndrome?
bicuspid aortic valve | this is commoner than coarctation of aorta
474
roseola school exclusion?
0 days
475
d/v school exclusion?
48 hours from symptoms ending
476
whooping cough school exclusion?
2 days after starting Abx or 3 weeks if no Abx given
477
scarlet fever school exclusion?
24 hours post Abx given
478
school exclusion - measles and rubella?
4 days from onset of rash
479
type of rash in hand foot and mouth disease?
25 mm scattered erythematous macules and papules, often with a central greyish vesicle.
480
which vaccine should be offered to babies with family history of TB or from high risk region/country with TB (defined as >40 cases/100000) as defined by WHO?
BCG vaccine for TB
481
which condition are nasal polyps associated with?
CF
482
peak incidence ALL?
2-5yo
483
RDS in prematurity - Cx?
retinopathy of prematurity | renal failure
484
what screening is part of the core Child Health Promotion Program as outlined in the Children's National Service Framework?
newborn clinical exam, newborn hearig test 5-day heel prick test GP exam 6-8/52
485
can 14yo refuse tx?
no
486
what prodrome of raised temperature before the rash begins on the torso and face
chickenpox
487
when and how is vit K given to newborn?
soon after birth, PO/IM injection as a one off
488
hereditary sensorineural deafness children?
Usher syndrome, Pendred syndrome, Jervell-Lange-Nielson syndrome, Wardenburg syndrome
489
average child crawls:
6/12
490
average age: good pincer grip?
12 months
491
If no changes on ?Perthe's disease - which is second line Ix?
MRI
492
Turner syndrome: murmur commonest?
ejection systolic heard loudest over aortic valve
493
when is Men C vaccine given?
12-15monthss
494
when is pneumococcal conjugate vaccine given?
3, 12 months | PCV
495
what vaccines are given at 2/12:
6-1 (dip, tetanus, pertussis, polio, Hib, Hep B) PO rotavirus PCV MenB
496
cysts are usually multiloculated and heterogeneous. Most are located above the hyoid
Dermoid cyst
497
which neck masses are soft and transilluminate. Most are located in the posterior triangle?
cystic hygroma
498
which cysts are usually located laterally and derived from the second branchial cleft. Unless infection has occurred they will usually have an anechoic appearance on ultrasound?
brachial cysts
499
commonest cause of stridor in neonates?
laryngomalacia
500
what is a common complication of viral gastroenteritis?
lactose intolerance
501
haemorrhage mostly affects pre-term infants and can be diagnosed by ultrasound examinations.? also causes seizures?
Intraventricular haemorrhage
502
what type of haemorrhage can follow the use of forcepts?
subdural
503
haemorrhages are common and may cause irritability and even convulsions over the first 2 days of life.?
subarachnoid
504
scaphoid abdomen
CDH
505
'atrialisation' of the right ventricle
ebstein's anomaly
506
scarlet fever: causative organism?
group A haemolytic strep
507
``` fever: typically lasts 24 to 48 hours malaise, headache, nausea/vomiting sore throat 'strawberry' tongue rash - fine punctate erythema ('pinhead') which generally appears first on the torso and spares the palms and soles. Children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures. It is often described as having a rough 'sandpaper' texture. Desquamination occurs later in the course of the illness, particularly around the fingers and toes ```
scarlet fever
508
if suspected NAI and mother is staying on the ward, what do you do?
listen to her concerns and share with her your concerns
509
Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of
shaken baby syndrome
510
left sided haematoma over the parietal bone. It does not extend beyond the margins of the parietal bone and is soft to touch
cephalhaematoma
511
what may develop as a cx of cephalhaematoma?
jaundice
512
mx: necrotising enterocolitis
broad spec Abx | cefotaxime, vancomycin
513
The initial management in Hirschprung's disease
rectal washouts/bowel irrigation
514
blue-purple birthmark, often confused for bruising, that may be seen in children with darker skin tones
Mongolian blue spot
515
other name for mongolian blue spot?
congenital dermal melanocytosis
516
commonest cause of nephrotic syndrome in children?
minimal change glomerulonephritis (80%)
517
mx minimal change glomerulonephritis?
steroids
518
Nephrotic syndrome is classically defined as a triad of | :
``` proteinuria >1g/m2/24hrs hypoalbuminaemia <25g oedema frothy urine also hyperlipidaemia likely ```
519
to suggest septic arthritis, WCC and ESR would be:
WCC>12 | ESR>40
520
what test is contraindicated in meningococcal septecaemia?
LP
521
name two examples of diseases caused by genetic imprinting?
Prader-Willi | Angelmann
522
umbilical hernia mx:
usually self resolve by 1, but if large or symptomatic, perform elective age 2/3 if small and aysmptomatic elective reapir 4/5 yo
523
``` regurgitation and vomiting diarrhoea urticaria, atopic eczema 'colic' symptoms: irritability, crying wheeze, chronic cough rarely angioedema and anaphylaxis may occur Dx? ```
cows milk protein allergy
524
10 hours post vaginal delivery. The midwife informs you that the mother was positive for group B streptococcus. On examination you note a yellow discolouration to the skin. What is the next most appropriate action to take?
within 2 hours take bilirubin serum level
525
what causes jaundice in first 24 hours?
rhesus haemolytic disease ABO haemolytic disease hereditary spherocytosis glucose-6-phosphodehydrogenase
526
how is jaundice described within 2-14 days?
physiological
527
what is prolonged causes of jaundice (>14 days old)
``` biliary atresia hypothyroidism galactosaemia urinary tract infection breast milk jaundice congenital infections e.g. CMV, toxoplasmosis ```
528
not showing signs of breathing at one minute. Heart rate is >100bpm, but he is floppy and cyanosed. What is the most appropriate next step in management?
5 rescue breaths via facemask
529
child < 3 years presenting with an acute limp: mx
urgent hospital assessment
530
when is Men ACWY given?
13-18 years
531
do antipyretics prevent further convulsions?
no
532
in which gender only do x-linked recessive diseases manifest?
males
533
what is important to remember about transmission in X-linked recessive diseases?
cannot be male-male (as father passes his Y-ch to son)
534
which diseases follow a maternal pattern?
mitochondrial - if male - no chance of passing it on
535
what type of disease is leber's optic atrophy?
mitochondiral
536
In an infant, the appropriate places to check for a pulse are the
brachial and femoral arteries
537
G6PD deficiency - type of inheritance?
x-linked recessive
538
when a child with LD lacks capacity to consent, and treatment is in her best interest - how many parents need to consent?
1
539
first step in newborn resus for RDS as a fetus?
dry the baby | maintain temp and start the clock
540
why can bruising at birth lead to raised bilirubin?
haemolysis
541
when is jaundice always pathological?
in first 24 hours of life
542
in england, what rights to parents have regarding their children's treatment:
can overule to consent to treatment in patient's best wishes, cannot demand or refuse treatment
543
which heart defect is associated with fragile X?
mitral valve prolapse
544
Fragile X cx:
``` mitral valve prolapse, pes planus, autism, ADHD memory problems speech disorders ```
545
which lung disease is associated with Kartagener's syndrome?
bronchiectasis
546
what can G6PD deficiency do to gallstones?
pigmented
547
where does measles rash start?
behind ears
548
11/12m ED - rash started 2 days ago, initially behind the ears but spread. Pre-rash coryzal sx. Irritable, has white spots in his mouth and his eyes appear inflamed.
measles | Koplik spots
549
10yom R knee pain. Past three months and lasts for several hours at a time. Antalgic gait and has apparent right leg shortening. What is the most likely diagnosis?
Perthes disease
550
Cyanosis or collapse in first month of life, hypercyanotic spells. Ejection systolic murmur at left sternal edge
ToF
551
early onset puberty in male where LH and FSH low:
gonadotrophin independent | eg. adrenal hyperplasia
552
parents should call ambulance if febrile convulsion lasts?
>5mins
553
2/52 slow to establish on feeds. Past 7 hours he has been vomiting and the vomit is largely bile stained. On examination, he has a soft, scaphoid abdomen.
intestinal malroatation
554
scaphoid abdomen and bilious vomiting is highly suggestive of
intestinal malrotation and volvulus
555
1-day old emergency CS for RDS. Decreased air entry on L and displaced apex beat. scaphoid abdomen
CDH
556
Displaced apex beat and decreased air entry are suggestive of
CDH
557
before what age is hand preference abnormal?
12/12
558
what does early hand dominance suggest?
CP
559
what time period has to elapse before a child has another live vaccine after having one?
4 weeks
560
CI to MMR:
severe immunosuppression allergy to neomycin received another live vaccine by injection within 4 weeks pregnancy should be avoided for at least 1 month following vaccination immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)
561
if ?child abuse - what is likely RFs?
``` frequent A/E attenders - see different doc each time late presentation after injury hx child abuse in family torn frenulum poor weight gain ```
562
scarlet fever tx:
PO Penecillen 10/7 | azithromycin
563
What is the most appropriate way to confirm a diagnosis of pertussis
Per nasal swab
564
Cyanotic congenital heart disease presenting within the first days of life is
TGA
565
Cyanotic congenital heart disease presenting at 1-2 months of age is
TOF
566
At what age do the majority of children achieve day and night time urinary continence?
3-4yo
567
if find abdo mass in GP OE, what is appropriate mx?
refer to local paeds department
568
6/52. term. has difficulty feeding due to increased wob. As the on-call doctor, you are called to review this baby. You witness the baby feeding and note she is pink and well perfused but sweating with an increased respiratory rate. On examination, you hear a soft pan-systolic murmur at the lower left sternal border. What is the most likely underlying pathology? (general)
heart failure
569
neonate needing resus team input:
``` RR>60 grunting HR< 100 / >160 CRT> 3 seconds 38°C or above, or 37.5°C on 2 occasions 30 minutes apart sats below 95% presence of central cyanosis ```
570
do people with CMP allergy normally resolve?
55% IgE mediated resolve by 5yo
571
what needs monitoring every 6/12 in ADHD pts on methylphenydate?
height and weight
572
electrolyte abnormality seen in pyloric stenosis?
hypochloremic hypokalaemic metabolic alkalosis
573
APGAR score for newborns: 2 points for:
``` HR>100 Resp effort - strong, crying Colour- pink muscle tone - active movement reflex irritability - cries on stim/sneezes/cough ```
574
APGAR score: 1 point
``` HR<100 Resp effort - weak, irregular colour - body pink, extremities blue muscle tone - limb flexion reflex irritability - grimace ```
575
APGAR refers to:
``` Appearance Pulse rate Grimace? Activity Reflex irritability ```
576
what condition is Down's syndrome commonly associated with ?
hypothyroidism lesser risk of hyper risk of T1DM
577
2-yom - not growing at the same rate as the other children. Foul-smelling diarrhoea about 4-5 times a week, abdo pain. Bloated abdomen and wasted buttocks. He has dropped 2 centile lines and now falls on the 10th centile. Dx?
coeliac
578
coeliac Ix:
IgA TTG Abs
579
which vaccines at 12/12?
Hib/Men C + MMR + PCV + Men B
580
when is croup presentation more common (season)?
autumn months
581
UTI mx: infant <3/12
refer immediately to paediatrician
582
UTI: infant >3/12 mx:
admission to hospital
583
which pathogen commonly causes hand foot and mouth disease?
coxsackie a16 | enterovirus 71
584
mild systemic upset: sore throat, fever oral ulcers followed later by vesicles on the palms and soles of the feet
hand foot and mouth
585
in phimosis, what should be avoided in younger children?
forcible retraction of the foreskin
586
in children <2, mx phimosis?
reassure and review in 6/12 | in children this young this is normal and will commonly resolve on own
587
when does moro reflex typically disappear?
4/12
588
when does grasp reflex disappear?
5/12
589
when does rooting reflex (helps during breastfeeding) disappear?
4/12
590
when does stepping/walking reflex disappear?
2/12
591
why may people with Turner's syndrome get X-linked recessive disorders?
only have 1 X Ch
592
what is Palivizumab and why is it sometimes given to prem babies?
Monoclonal Ab used to prevent RSV (bronchiolitis)
593
15yom knee pain | relieved by rest and made worse by kneeling and sports activities?
Osgood-schlatter
594
diagnostic Ix for NEC?
AXR | pathognomonic pneumatosis intestinalis (gas in gut wall)
595
healthy infant - 1 week old | what ranges should RR and HR be
RR: 30-60 HR: 100-160
596
which childhood infection has a prodrome characterised by fever, irritability and conjunctivitis?
measles
597
commonest cause of headache in children?
migraine
598
if 9/52 infant otitis media infection and temp >38 - mx
admit for paeds assessment
599
risk factors: red light for feverish child
* Pale/mottled/ashen/blue * No response to social cues * Appears ill to a healthcare professional * Does not wake or if roused does not stay awake * Weak, high-pitched or continuous cry * Grunting * Tachypnoea: respiratory rate >60 breaths/minute * Moderate or severe chest indrawing * Reduced skin turgor * Age <3 months, temperature • >=38°C * Non-blanching rash * Bulging fontanelle * Neck stiffness * Status epilepticus * Focal neurological signs * Focal seizures
600
if amber lights in feverish child: Mx:
safety net
601
distribution of eczema rash in 10/12 old:
face and trunk
602
homocystinuria: inheritance?
recessive
603
how to mx transient hypoglycaemia in hours after birth?
observe and encourage early feeding
604
which ix in <3/12 with fever :
Full blood count Blood culture C-reactive protein Urine testing for urinary tract infection Chest radiograph only if respiratory signs are present Stool culture, if diarrhoea is present
605
what needs to be screened for in children with Downs who play sports?
atlanto-axial instability > neck dislocation
606
The oral rotavirus vaccine is given:
2+3 months
607
4M -ED. Limping for the past 48 hours and pain in his right leg. He is normally fit and well, although has recently recovered from URTI. His BMI ‘healthy’ range and there is no history of trauma. dx?
transient synovitis
608
undescended testicle - how long wait before referral?
6/12
609
if medical mx of NEC but deteriorates - sx mx?
laparotomy
610
Mx: meningitis in <3/12:-
IV amoxicillin and IV cetotaxime (not ceftriaxone in this age) (covers for listeria)
611
Mx:meningitis >3/12:-
IV Cefotaxime
612
enlarging neck swelling that has been present for the past year. On examination you note a smooth midline lesion which is round and located just below the hyoid bone. It measures 2.5 cm x 2 cm and rises on protrusion of the tongue.
Thyroglossal cyst
613
ocated in the anterior triangle, and are usually in the midline and below the hyoid. Typically, the cyst rises on protrusion of the tongue as well as on swallowing.
thyroglossal
614
maternal steroid use in pregnancy increases the risk of:
DDH
615
belly button is always wet and leaks out yellow fluid. On examination, you note a small, red growth of tissue in the centre of the umbilicus, covered with clear mucus. Dx?
umbilical granuloma
616
umbilical granuloma mx:
occurs in 1/5 babies resolves by 2yo
617
If constipation - chronic, tried movicol, next step?
add senna
618
X-linked recessive condition: mother is carrier, chances of passing it on?
50%
619
risk factors for surfactant deficiency lung disease?
male sex diabetic mothers Caesarean section second born of premature twins
620
alpha-thalassaemia
deficiency in alpha chains of Hb
621
how many alpha globulin genes are located on the chromosome coding for them and which Ch is this?
Ch16 | 2 genes on each ch16
622
a-thalassaemia: If 1 or 2 alpha globulin alleles are affected then
hypochromic and microcytic, but the Hb level would be typically normal. 'trait'
623
a-thalassaemia: if 3alpha globulin alleles are affected
hypochromic microcytic anaemia with splenomegaly. This is known as Hb H disease. jaundice
624
a-thalassaemia: if 4 alpha globulin alleles are affected:
(i.e. homozygote) then death in utero (hydrops fetalis, Bart's hydrops)
625
ADHD: dietary advice?
normal balanced diet | unless food diary shows relationship
626
16-m - groin pain 3hrs. n+vomited x3. He recently had unprotected vaginal sex. Tenderness and swelling of the scrotum and left testicle, with absence of the cremaster reflex on the left side. Elevation of the affected testicle causes increased pain.
testicular torsion
627
phren's sign postitive??
epididymitis - elevation of the testicle relieves the pain
628
newborn baby check shows jaundice - next appropriate step?
blood film
629
autism: epidemiology - sex and onset age?
males 75% | <3 yo
630
autism triad:
global impairment of language and communication impairment of social relationships ritualistic and compulsive phenomena most children have reduced IQ
631
associated conditions of Autism:
fragile X | Rett's syndrome
632
what needs measuring in jaundiced child urgently?
serum bilirubin level
633
how to measure obesity in children?
BMI percentile adjusted for age and gender
634
when can child use the palmar grasp?
5-6/12
635
when can child draw circle?
3yo
636
when can child stack tower of blocks 3-4 high?
18/12
637
6/12 from Bangladesh. 1/52 coryzal symptoms. Not been feeding well for the past two days and started to vomit today. Coughing bouts so severe he turns red. No inspiratory or expiratory noises are noted. Clinical examination reveals an apyrexial child with a clear chest. What is the most likely diagnosis?
Pertussis
638
hand foot mouth school exclusion?
no need
639
13yof. Her systolic blood pressure is <100mmHg, and her respiratory rate is raised. She has a suspected source of this infection (respiratory tract). pyrexial - 39. With these vital signs, ->
?sepsis
640
The most common fractures associated with child abuse are:
- Radial - Humeral - Femoral
641
5-year-old child presents to the emergency department complaining of right iliac fossa pain. On examination there is no rebound tenderness or guarding. Urine dipstick and routine bloods come back as normal. The mother reports that her daughter had a viral infection a few days ago.
mesenteric adenitis
642
what is mesenteric adenitis and how mx?
inflamed lymph nodes within the mesentery. Similar sx to appendicitis. It often follows a recent viral infection and needs no treatment
643
average child runs at what age?
16-24/12
644
average child rides a tricycle:
3 years
645
features of atypical UTI:
``` Seriously ill Poor urine flow Abdominal or bladder mass Raised creatinine Septicaemia Failure to respond to abx by 48 hours Infection with non-E. coli organisms. ```
646
4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face
scarlet fever
647
3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted
rubella
648
death is defined as babies dying between 0-28 days of birth?
neonatal death
649
Puerperal death
maternal death within the puerperal period <6/52
650
Perinatal death
deaths that are a result of obstetric events, the term encompasses stillbirths and deaths within the first week of life
651
An 8-M -> ED severely short of breath and wheezy. He is extremely short of breath and cannot complete sentences fully. His peak expiratory flow rate is 300 l/min (40% of normal). His oxygen saturations are 93%. His pCO2 is 4.9 kPa. Which of the above is most concerning?
normal pCo2 in an acute asthma attack is life-threatening
652
Life threatening asthma sx:
``` Cyanosis Poor respiratory effort Peak expiratory flow rate < 33% Silent chest Altered level of consciousness ```
653
Pain after exercise | Intermittent swelling and locking
Osteochondritis dissecans
654
transient synovitis mx:
analgesia and rest - it is self-limiting
655
cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?
Meckel's diverticulum
656
describe Meckel's diverticulum:
congenital diverticulum of the small intestine remnant of the omphalomesenteric duct contains ectopic ileal, gastric or pancreatic mucosa
657
mx: meckel's diverticulum:
sx
658
Patients with cystic fibrosis should follow which lifestyle related rule??
minimize contact with eachother to decrease the risk of cross-infection
659
``` usually presents in childhood, e.g. Failure to thrive polyuria, polydipsia hypokalaemia normotension weakness ```
Barrter's syndrome | AR
660
acute exacerbation of asthma: tx:
oral pred 3-5/7
661
Idiopathic thrombocytopenic purpura may be preceded by
a self-limiting viral infection (eg glandular fever)
662
addisons?
primary adrenal insufficiency | hypocortisolism
663
children below which centile for height should be referred to a paediatrician?
0.4th
664
most likely causative agent of a bacterial pneumonia in children
streptococcus pneumoniae
665
vocabulary of between 20-50 words and will be able to join 2 words with meaning. age?
24/12
666
4 week old formula fed infant to the short stay paediatric ward. They are concerned because he has persistent non-bilious vomiting and is becoming increasingly lethargic. Despite this, his appetite is substantial. On examination, he appears pale and you can see visible peristalsis in the left upper quadrant. What is the most likely diagnosis?
pyloric stenosis
667
14-month-old girl present to their GP. They have noticed that in some photos there is no 'red eye' on the left hand side. When you examine the girl you notice an esotropic strabismus and a loss of the red-reflex in the left eye. There is a family history of a grandparent having an enucleation as a child. What is the most likely diagnosis?
retinoblastoma
668
Retinoblastoma features:
absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom strabismus visual problems
669
Mx: retinoblastoma:
enucleation external beam RT chemo photocoagulation
670
average child hops on one leg?
3-4yrs
671
average child pulls to standing?
8-10/12
672
squats to pick up ball average age?
18/12
673
episodes of cyanosis are usually worst during feeding. Improvement may be seen when the baby cries
choanal atresia
674
choanal atresia:
Posterior nasal airway occluded by soft tissue or bone. Associated with other congenital malformations e.g. coloboma Babies with unilateral disease may go unnoticed. Babies with bilateral disease will present early in life as they are obligate nose breathers. Treatment is with fenestration procedures designed to restore patency.
675
what can cause bronchiolitis to be more severe?
underlying congenital heart condition (VSD)
676
what is worth being aware of re sats in first 10 mins of life?
often innacurate
677
DDH in a child >4.5 months: first line ix:
XRay
678
definition of short stature?
standing below the 2nd centile height for age
679
2 endocrine conditions that cause short stature?
hypothyroid | cushings
680
2 risk factors for prematurity?
Multiple pregnancy, pre-eclampsia, cervical insufficiency, uterine growth insufficiency, low socioeconomic status, APH
681
what criteria for child with special educational needs? (2)
physical disability preventing them from accessing education facilities significant congnition difficulty in learning compared to majority of children their age
682
first trimester test for downs syndrome?
combined test
683
a 6-year-old child with a vesicular skin lesion underneath his nose with a honey coloured crust. During the consultation, the child rubs it and a lesion ruptures and fluid exudates. Dx and causative organism?
Impetigo | saureus/srep pyogenes
684
impetigo school exclusion?
until 48 hours after abx started or until the lesions have crusted over - incredibly infectious
685
impetigo abx?
topical fusidic acid is first-line | topical retapamulin is used second-line if fusidic acid has been ineffective or is not tolerated
686
if impetigo extensive disease, which abx?
flucloxacillin
687
HIV related organism pneumonia ?
pneumocystis jiroveci
688
how will bacterial meningitis show in CSF?
turbid neutrophils protein +++ glucose low ---
689
viral CSF analysis?
clear lymphocytes normal or raised protein normal or low glucose
690
causes of meningitis in newborns:
listeria monocytogenes, Ecoli GBS
691
causes of meningitis older children:
neisseria meningitdis Hib Strep pneumo
692
causes meningitis adults:
neisseria meningitidis strep pneumo listeria monocytogenes
693
if suspect bacterial meningitis in community: immediate mx?
IM benpen
694
which antibiotic prophylaxis for household contacts of bacterial meningitis patients?
Rifampicin | Ciprofloxacin
695
JIA mx:
``` NSAIDs MTX, sulfasalazine - DMARDS Atalidimab, Retuximab Steroids (cx) Joint injections ```
696
commonest cause of septic arthritis:
saureus | gonorrhoea (if sexually active)
697
Maculopapular rash ddx:
measles, rubella, scarlet fever, kawasaki
698
petechial rash ddx (non-blanching):
meningococcal Henoch-schurlein purpura thrombocytopaenia
699
pustular (hemispherical lesions, purulent fluid) ddx:
impetigo | scalded skin
700
what is a potential cause of aspirin in children ??
Reye's syndrome
701
rash + vom -> | or blood in stool + vom ->
think CMPI
702
DKA sx:
``` abdo pain vomiting loss GCS polyuria hypokalaemia ```
703
Stridor: URTI?
yes
704
Wheeze: LRTI/URTI?
LRTI
705
risk factors for bronchiolitis?
prematurity congenital heart defect smoke, bottle fed, high exposure to other children in nursery
706
CF bacteria infections:
saureus pseudomonas auriginosa aspergillus
707
CF sx:
``` meconium ilius fail to thrive recurrent infections steatorrhoea neonatal jaundice bronchiectasis rectal prolapse ```
708
UTI in children causes:
ecoli proteus pseudomonas
709
UTI (lower) >3/12: mx:
trimethoprim, nitrofurantoin, cephalosporin or amoxicillin
710
causes of proteinuria in children:
nephrotic syndrome DM1 infetions
711
4 areas of development:
gross motor fine motor and vision speech language and hearing social and play
712
when and how do you image to assess CP lesion?
MRI age 2
713
which abx would you give all premature babies in neonatal unit and what are you concerned about?
Benzylpenecillin - GBS -> neonatal sepsis
714
hypoglycaemic premature baby tx:
dextrose 10% + fluids | parenteral nutrition
715
how to assess jaundice in newborn?
SBR score
716
biliary atresia? when will it present and what type of bilirubin and what mx?
>14 days - jaundice, appetite, growth disturbance conjugated bilirubin Kasai procedure
717
if Rh + baby born to a Rh - mother: blood is taken from the cord to sample for:
FBC Blood group Direct coomb's test: - looking for Rh Ags on RBCs
718
if blue sclera and many fractures in childhood ->???
osteogenesis imperfecta
719
wha is inheritance of OG imperfecta?
AD
720
what is childhood version of osteomalacia?
Ricket's - vit D def
721
initial mx of the congenital heart condition hypoplastic left heart syndrome?
Alprostadil
722
2/7 hx fever, sore joints migrants post-viral illness pain, swelling moves jt-jt radnomly
Rheumatic fever | Group A strep
723
what does anal fibroids and recurrent utis suggest in child?
child sex abuse
724
NF1: inheritance?
autosomal dominant
725
cafe-au-lait patches? 6+?
NF1
726
Tubular sclerosis inheritance?
autosomal dominant
727
ash leaf and shagreen patches in which condition?
tubular sclerosis
728
duchenne muscular dystrophy inheritance?
x-lined recessive But female carriers can be symptomatic if lyonisation test CK (associated with dilated cardiomyopathy)
729
``` single palmar crease upslanting eyes flat nasal bridge large saddle gap. dx? ```
downs
730
abdo pain, purpuric (non-blanching rash), clinically well. rash on leg and buttocks. some arthralgia. dx?
HSP
731
thalassaemia iheritance:
recessive
732
complication of bacterial otitis media?
mastoiditis
733
rules for tonsilectomy?
>7 /yr >5 /2yr >3 subsequent 3 yr
734
paeds acute asthma mx:
``` O SHImT o2 salbutamol Hydrocortisone / pred Ipratropium nebs Mg So4 Tube - intubate - anaes ```
735
inguinal hernia in 4/12M - mx?
surgical reduction <2/52 < 6 weeks old = correct within 2 days < 6 months = correct within 2 weeks < 6 years = correct within 2 months
736
A 1-day-old neonate is noticed to have non-projectile bilious vomiting. They were born at 39 weeks to a 47-year-old mother. At the 11-week scan the nuchal thickness was 4mm. What is the most likely underlying diagnosis?
bilious vomiting on day 1 = duodenal atresia trisomy 21 AXR: double bubble sign
737
A male infant is born by spontaneous vaginal delivery at 39 weeks gestation. He is well after the birth, established on bottle feeding and discharged home. His parents are concerned because he subsequently becomes unwell and vomits a large quantity of bile stained vomit approximately 2 days after discharge home. Looks ill and his abdomen is soft and non distended. dx?
intestinal malrotation
738
A 2-year-old has a history of rectal bleeding. The parents notice that post defecation, a cherry red lesion is present at the anal verge. dx?
juvenile polyps
739
Start IV fluid resuscitation in children or young people with a bolus of?
20ml/kg <10mins
740
how to reduce the chances of severe brain damage in neonates with hypoxic injury?
therapeutic coolin 33-35 degrees
741
what is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis?
chickenpox
742
should be considered in infants with vague signs such as poor feeding, grunting, lethargy?
neonatal sepsis
743
most common presentation of neonatal sepsis?
grunting and other respiratory distress sx
744
children under 5 years old with diarrhoea and vomiting caused by gastroenteritis??
ors - never anti-diarrhoeals -> hus
745
steroids in <3/12 -
NO

3a (7 decks)

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