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Oishi's 5th year flashcards > Paeds hard to recall > Flashcards

Paeds hard to recall Flashcards

1
Q

What abx do you start immediately in suspected sepsis?

Neonates

Children 72hrs - 1 month

Children >1 month

A

neonates: benzylpenicillin 25mg/kg 12 hourly + gentamicin 5mg/kg
children 72 hours - 1 month: ampicillin 200mg/kg/day + gentamicin 5mg/kg
children >1 month: cefotaxime 200mg/kg/day OR ceftriaxone 100mg/kg/day (use piptaz if neutropenic)

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2
Q

CXR findings of TGA?

A

Egg on side appearance of heart shadow Narrow mediastinum

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3
Q

What is Eisenmenger syndrome, when does it present and why does it occur?

A

Cyanotic heart lesion (usually VSD) Later in life (20-40yrs) RV hypertrophy causes reversal of flow across VSD so it becomes right to left

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4
Q

Causes of true precocious puberty? What is the main feautre?

A

It is gonadotrophin dependent: Idiopathic Intracranial pathology - tumours, haemorrhage, hydrocephalus, NF, CP and primary hypothyroidism

Consonant i.e. follows normal sequence of puberty

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5
Q

Causes of pseudo precocious puberty? Main feature and who is it usually pathological in?

A

Gonadotrophin independent - dissonant i.e. follows abnormal sequence - often pathological in boys:

  • CAH
  • Adrenal virilising tumours
  • Cushing syndrome
  • Testicular/ovarian malignancy
  • Gonadotrophin-secreting tumours (hepatoblastoma)
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6
Q

Features of McCune Albright syndrome?

A

Precocious puberty (primary ovarian cysts) Cafe-au-lait spots Polyostotic fibrous dysplasia

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7
Q

Define premature pubarche

A

Pubic hair with no other signs of puberty

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8
Q

Define premature thelarche

A

Breast tissue appearance without darkening or thickening of areola with no other signs of puberty

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9
Q

How to differentiate between mild and moderate dehydration?

A

In moderate you will have the following features: Tachycardia May be slightly cool peripherally Orthostatic hypotension Slightly reduced skin turgor Dry mucous membranes Oliguria

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10
Q

Define an effective cough in a child who is choking on an inhaled foreign object

A

If child is able to speak/cry/take breaths between coughs

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11
Q

What vitamin supplements are breastfeeding women recommended to take?

A

Vit D

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12
Q

What type of disorder are petechiae more suggestive of?

A

Platelet disorders e.g. ITP

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13
Q

Criteria for JIA?

A

Occurs before 16 years old

Symptoms last at least 6 weeks

Other known conditions excluded

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14
Q

Types of JIA?

Which is most common?

A

Monoarticular (single joint)

Oligoarticular aka pauciarticular (<4 joints) - MOST COMMON

Polyarticular (4+ joints) - seronegative or seropositive

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15
Q

Difference between oligoarticular and polyarticular JIA?

A

Oligoarticular: <4 joints, asymmetrical, Elbows, knees, ankles and wrists, Anterior uveitis, strong ANA association, Under 6yrs

Polyarticular: 4+ joints, symmetrical, Small joints of hands and feet, cervical and TMJ, RF positive, Older girls

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16
Q

Systemic JIA features aka Still’s disease?

A

Quotidian fever for 2 weeks

Salmon pink rash on trunk and proximal limbs

Splenomegaly

Hepatomegaly

Lymphadenopathy

Serositis (pericarditis and pleurisy)

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17
Q

Triad in HUS?

A

MAHA Thrombocytopenia Acute renal failure

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18
Q

What does the Guthrie test screen for?

A

PKU Congenital Hypothyroidism CF Sickle cell disease Thalassaemia MCADD

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19
Q

Cardinal features of galactosaemia?

A

Hepatomegaly Cataracts Jaundice

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20
Q

When is C-spine immobilisation appropriate for a head injury?

A

GCS <15 Neck tenderness/pain Focal neurological deficit Paraesthesia Clinical suspicion of injury

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21
Q

Solo Indications for CT head within 1 hour following head injury in under 16s?

A

Suspected NAI Post-traumatic seizure but no epilepsy GCS <14 in ED GCS <15 2 hours after injury Raccoon eyes Battle’s sign Haemotympanum Sign of basal skull fracture CSF from nose or ears Focal neuro deficit

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22
Q

Indications for CT head following head injury in under 1s?

A

GCS <15 in ED Presence of bruise, swelling or laceration >5cm on head

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23
Q

When to consider abx in acute otitis media?

A

Children <2 years with bilateral AOM Perforation or discharge in ear canal

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24
Q

How long should a course of abx be in acute otitis media?

A

5 days

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25
Q

Glucose targets pre-prandially and post-prandially?

A

Pre: 4-8mmol/L Post: 10mmol/L

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26
Q

What type of inguinal hernia is more common in children and why?

A

Indirect Due to a patent processus vaginalis

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27
Q

Syndromes leading to hypotonia in newborns?

A

Hypothyroidism Prader-Willi

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28
Q

Features of babies with fetal alcohol syndrome?

A

Microcephaly

Thin top lip

Short nose

Small eyes

Hypertelorism (wide gap between eyes)

Smooth philtrum

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29
Q

What type of gait is seen in diplegic cerebral palsy?

A

Scissor gait Tip toe walking Equinovarus feet (plantar flexed and turned inwards)

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30
Q

What may be seen on MRI head of kids with diplegic CP?

A

Periventricular leukomalacia

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31
Q

Features of growth hormone deficiency?

A

Neonatal hypoglycaemia Jaundice Doll-like face Delayed bone age Normal growth rate until 6-12 months then tails off

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32
Q

Syndromes associated with short stature?

A

Turner Prader Willi Noonan’s Down’s Russel Silver Achondroplasia Spondyloepiphysial dysplasia

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33
Q

How should salbutamol be adminstered during a moderate asthma attack?

A

Via spacer

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34
Q

What does coeliac disease increase the risk of?

A

Enteropathy associated T cell lymphoma (EATL) Non-hodgkin lymphoma Vitiligo Thyroid disease

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35
Q

Describe the grading of heart murmurs

A
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36
Q

What syndromes is pulmonary stenosis associated with?

A

Noonan

Alagille syndrome

TOF

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37
Q

Features of Alagille syndrome?

A

Jaundice

Xanthomas

Congenital heart defects

Butterfly-shaped vertebrae

Dysmorphic faecies

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38
Q

Why does constitutional delay cause a delay in puberty?

A

Due to low gonadotrophin release (LH and FSH)

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39
Q

What is Prehn’s sign?

A

Helps to differentiate between epididymitis and testicular torsion.

You lift the testes and in epididymitis it will decrease the pain but in testicular torsion it will increase the pain

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40
Q

What is torsion of the hydatid of Morgagni?

A

Torsion of a small embryological remnant at upper lobe of the testes

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41
Q

Which age group is testicular torsion more common in and which group is torsion of hydatid of morgagni?

Which is more painful

A

Testicular - adolescents

Hydatid of morgagni - boys aged 7-12 years

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42
Q

Features of torsion of hydatid of morgagni?

A

Pain onset over a few days

Pain localised to upper pole of testes

Cremasteric reflex preserved

Blue dot may be visible when scrotum is transilluminated

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43
Q

Mx of testicular torsion

A

Surgical exploration and untwisting of testicle

Bilateral fixation of testes to tunica vaginalis

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44
Q

What is AML associated with?

A

Down syndrome

Bloom syndrome

NF

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45
Q

Features of benign rolandic epilepsy?

A

Age 7-10 years

Male

Partial seizures in early morning

High amplitude spikes in left centrotemporal region on EEG

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46
Q

Describe a rolandic seziure

What do you see on EEG?

A

Usually nocturnal

Involve mouth and face but can progress to generalised seizure

Twitching of mouth and then rest of ipsilateral face - can be drooling, grunting and slurred speech

EEG: centrotemporal spikes

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47
Q

When does juvenile myoclonic epilepsy typically start and what can precipitate it?

When might they occur?

A

Puberty

Precipitated by alcohol

Typically occur on waking

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48
Q

What age and who typically gets absence seizures?

A

Girls aged 2-10 years

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49
Q

EEG of absence seizures?

A

3 spike-wave complexes per second

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50
Q

Features of Lennox-Gastaut type epilepsy? What would you see on EEG?

A

Presents between 1-4 years

Daily seizures

Status epilepticus

Slow psychomotor development

Behavioural disorders

Slow abnormal spike waves

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51
Q

In a split bilirubin what are you looking at?

A

Conjugated and total bilirubin levels

>20% (18 micromol/l) means referral to paediatric liver centre is needed

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52
Q

UTI tx in under 3 months?

A

IV abx and admit

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53
Q

What usually triggers guttate psoriasis?

A

Strep infection

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54
Q

Steps of movicol disimpaction regime?

A
  1. 2 sachets on day 1
  2. Increase no. of sachets by 2 every 2 days
  3. Until max 8 sachets per day
  4. Continue until impaction has resolved or for max 7 days

NB. If it doesn’t work after 2 weeks add senna

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55
Q

How to differentiate between alpha and beta thalassaemia trait?

A

Beta trait shows increase in HbA2 and HbF whereas alpha trait does not

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56
Q

During a sickle cell crisis what are the first things you should do?

A
  1. Remove the precipitant stress e.g. hypoxia
  2. Opioid and non-opioid analgesia within 30mins of arrival
  3. Fluid balance chart
  4. If infection suspected then start on broad spectrum abx
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57
Q

3 core symptoms of ADHD?

A

Inattention

Impulsivity

Hyperactivity

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58
Q

How long must symptoms be present for an ADHD diagnosis?

A

6 months

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59
Q

Non-core criteria for ADHD diagnosis?

A

The behaviour should have persisted for at least 6 months

The behaviour should be inconsistent with the child’s developmental age

There must be clinically significant impairment in social or academicdevelopment

The symptoms should occur in more than one setting

There should be no other explanation for the symptoms

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60
Q

Causes of cranial DI?

A

Meningitis

Head injury/surgery

Sarcoidosis

DIDMOAD syndrome

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61
Q

Features of DIDMOAD syndrome

A

DM

Diabetes insipidus

Optic atrophy

Deafness

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62
Q

Causes of nephrogenic DI?

A

Hypokalaemia

Hypercalcaemia

Lithium

Demeclocycline

Genetic defects

Heavy metal poisoning

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63
Q

In bacterial meningitis what would you expect to see in CSF glucose readings?

A

<50% of blood glucose levels

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64
Q

What score is used to assess severity of croup and what defines them?

A

Westley croup score

Mild <3

Moderate 3-6

Severe >6

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65
Q

What are the best predictors of long-term function in autism?

A

Language skills and IQ

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66
Q

In a pH study for GORD what is suggestive of reflux?

A

pH <4 for more than 4 hours

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67
Q

Causes of erythema multiforme?

A

Infection - HSV (MOST CASES), mycoplasma, coxsackie

Drugs - NSAIDs, antiepileptics, sulphonamides, penicillins, barbiturates

Pregnancy

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68
Q

Which vaccines should children with HIV not receive?

A

Yellow fever

BCG

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69
Q

Hypersensitivity to egg is a contraindication for which vaccines?

A

Influenza

Yellow fever

Tick-borne encephalitis

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70
Q

How long are kids treated with high dose steroids immunocompromised for?

A

3 months

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71
Q

Diagnostic criteria for kawasaki?

A

5 day+ fever & 4/5 of the following:

Bilateral conjunctival injection

Oral mucosal erythema

Polymorphous rash

Extremity changes: peripheral oedema/erythema and periungual desquamation

Cervical lymphadenopathy

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72
Q

For a child with T1DM, which regimen allows them to get tight control but not inject in school?

A

Three times daily injection

Mixed insulin in morning

Rapid acting at dinner time

Long-acting at night

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73
Q

RF for severe bronchiolitis?

A

Premature

Age <12 weeks

Chronic lung disease

CHD

Structural defects in airways

Immunodeficiency

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74
Q

Which organisms are children with nephrotic syndrome at higher risk from and why?

A

Encapsulated bacteria e.g. pneumococcus

Due to renal loss of IgG

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75
Q

Tx of minimal change disease?

A

prednisolone: 60 mg/square metre of body surface area/day orally for 6 weeks, followed by 40 mg/square metre of body surface area/day orally on alternate days for 6 weeks

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76
Q

First line Ix for global developmental delay?

A

Chromosomal testing

fragile-X testing

CK

U&Es

TFTs

lead level

FBC and ferritin

biotinidase

urate

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77
Q

Features of Landau-Kleffner syndrome?

A

Sudden or gradual aphasia

abnormal EEG

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78
Q

Causes of erythema nodosum?

A

Infection - group A strep, TB

Drugs - sulphonamides, OCP, barbiturates

IBD

SLE

Sarcoid

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79
Q

2 most important reasons to perform orchidopexy for cryptorchidism?

A

Psychological impact

Prevention and early detection/tx of testicular cancer

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80
Q

What Ix should all children who have a non-febrile seizure have?

A

ECG - exclude a prolonged QTc interval

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81
Q

Indications for MRI in non-febrile convulsive seizure?

A

Child <2 years

Focal seizure

Seizures continuing despite meds

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82
Q

SE of valproate?

A

Transient hair loss

Weight gain

Liver damage

Blood dyscrasias

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83
Q

SE of carbamazepine?

A

Allergic skin reactions

Blurred vision

Ataxia

Nausea

Hepatic enzyme inducer

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84
Q

SE of phenytoin?

A

Gum hyperplasia

Hirsutism

Coarse facial features

Ataxia

Slurred speech

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85
Q

Septic arthritis immediate Mx?

A

Joint aspiration followed by 4-6 weeks IV abx

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86
Q

Recommended imaging in kids <6 months with UTI?

A

Simple UTI which responds to abx: outpatient USS in 6 weeks –> if abnormal then MCUG

Atypical/recurrent UTI: inpatient USS and outpatient DMSA and MCUG

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87
Q

Recommended imaging in kids 3 months - 3 years with UTI?

A

Only if atypical: urgent USS followed by outpatient DMSA

If recurrent UTI: USS within 6 weeks followed by outpatient DMSA

MCUG indicated if: recurrent/atypical UTI in <6 month old

Consider MCUG if: dilation on USS, non E. coli, poor urine flow, FH of VUR

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88
Q

Recommended imaging in kids >3 years with UTI?

A

Atypical UTI: inpatient USS

Recurrent: Outpatient USS and DMSA

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89
Q

What is seen on xray of Perthes?

A

Collapsed, irregular and sclerotic femoral head

Increased joint space

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90
Q

Ix for primary enuresis?

A

LL neuro exam - rule out spina bifida and CP

BP - if elevated may indicate renal disease

Urinanalysis not needed unless indicated

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91
Q

Define polycythaemia in a baby?

A

Central venous HCT >0.65

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92
Q

What is the nitrogen washout test?

A
  1. Take a preductal ABG
  2. Repeat after 10-15mins of 100% oxygen therapy

PaO2 <20kPa suggests fixed right to left shunt

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93
Q

What period of time should a child with DKA be rehydrated?

A

48 hours

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94
Q

Features of C1 esterase deficiency?

A

Random episodes of urticaria not precipitated by things

May be FH

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95
Q

Which antibodies can be transferred in the breast milk?

A

IgG

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96
Q

Typical features on EEG of absence seizures?

A

3 spike waves per second activity in all leads

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97
Q

Complications of GOR?

A

Apnoeas

Failure to thrive

Oesophagitis

Aspiration

Sandifer’s syndrome (dystonic movements of head and neck that resemble seizures)

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98
Q

What are wormian bones and what condition are they seen in?

A

Osteogenesis imperfecta

Irregular isolated bones found within skull sutures

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99
Q

Features of osteogenesis imperfecta?

A

Recurrent fractures

Blue sclera

Conductive hearing loss

Aortic regurgitation

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100
Q

3 year old with 2 day history of fevers at 38.3. She is drowsy and has a seizure causing twitching of the right side of her body for 4 mins. RR = 30 and sats 98%. What is the diagnosis?

A

Viral encephalitis

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101
Q

What does a young child with fever who is refusing to walk suggest?

A

Osteomyelitis or septic arthritis

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102
Q

Features of Prader Willi in neonatal period?

A

Hypotonia

Poor feeding

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103
Q

Features of prader willi when older?

A

Hyperphagia

Obesity

Hypogonadism

Strabismus

Low IQ

Face - narrow forehead, olive eyes, anti-mongoloid slant, carp-shaped mouth

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104
Q

Features of Laurence-Moon-Biedl syndrome?

A

Learning difficulties

Progressive visual impairment

Polydactyl, syndactyl

Hypogenitalism

Nephropathy

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105
Q

Murmur in VSD?

A

LLSE pansystolic

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106
Q

Most common cause of mitral stenosis?

A

Rheumatic fever

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107
Q

Causes of splenic atrophy in children? What would you see on blood film?

A

Surgical removal

Sickle cell disease

Coeliac

Howell Jolly bodies

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108
Q

Which malignancy are patients with Down’s most at risk of?

A

AML

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109
Q

What day is bronchiolitis worst?

A

Day 4

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110
Q

Which inotrope should be used for cold shock vs warm shock?

A

Cold shock: Adrenaline

Warm shock: noradrenaline

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111
Q

Which neonates should not receive ceftriaxone for suspected sepsis/meningitis?

A

Premature

Jaundice

Acidotic

Hypoalbuminaemia

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112
Q

Tx for group B strep meningitis?

A

IV cefotaxime for 14 days

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113
Q

Tx for l monocytogenes meningitis?

A

IV amoxicillin/ampicillin for 21 days

Gentamicin for 7 days

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114
Q

Bacterial meningitis due to gram -ve bacilli tx?

A

IV cefotaxime for minimum 3 weeks

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115
Q

Tx for strep throat?

A

Penicillin V

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116
Q

How much milk should infants take per day?

A

150-180ml/kg/day

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117
Q

How is duodenal atresia diagnosis confirmed?

A

Double bubble on abdo xray

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118
Q

Meckel’s diverticulum rule of 2s?

A

found 2 feet proximal to iliocaecal junction

2 inches in length

occurs in 2% of population

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119
Q

List 2 pathological causes of genu varus

A

Ricket’s

Blount’s disease

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120
Q

Most likely diagnosis in a child <3 years with fever and RR >50?

A

Pneumonia

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121
Q

Which syndrome presents with swollen hands and feet in the newborn?

A

Turner’s

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122
Q

Complications of JIA?

A

Chronic anterior uveitis

Flexion contraction of joints

Amyloidosis

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123
Q

Features of enteropathic arthritis

A

Asymmetrical oligarticular arthritis

Mainly large joints in lower limbs

Occurs with underlying IBD

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124
Q

Most important diagnosis to rule out in a neonate with pale stools and jaundice? How would confirm this diagnosis?

A

Biliary atresia

USS

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125
Q

Complications of chicken pox?

A

Secondary bacterial infection

Pneumonitis

Conjunctival lesions

Post-infectious ataxia

Purpura fulminans

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126
Q

What infection causes a rash and fever which start on the same day?

A

Chicken pox

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127
Q

Complications of measles?

A

Otitis media

Pneumonitis

Mycocarditis

Encephalitis

subacute sclerosing panencephalitis (5-10 years later)

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128
Q

Complications of coxsackie virus?

A

pericarditis/myocarditis

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129
Q

Complications of parvovirus B19?

A

Arthralgia

Aplastic anaemia

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130
Q

How to diagnose giardiasis?

A

Motile trophozoites and villous atrophy of duodenal biopsy

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131
Q

When does stress haematuria occur?

A

After vigorous exercise

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132
Q

Causes of glomerulonephritis?

A

post infectious glomerulonephritis

IgA nephropathy

Alport’s syndrome

HUS

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133
Q

Features of Alport’s syndrome?

A

GBM degeneration

Sensorineural deafness

Ocular abnormalities

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134
Q

What suggests nephritic rather than nephrotic syndrome in a child?

A

Haematuria

HTN

May be oliguria

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135
Q

Blood findings with lead poisoning?

A

Microcytic hypochromic anaemia

Basophilic stippling

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136
Q

Tx of lead poisoning?

A

EDTA chelation

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137
Q

What is pica and what can it be a sign of or cause for?

A

Eating non-nutritive substances

Lead poisoning

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138
Q

Mx of meconium ileus in infants with CF?

A

Gastrograffin enema

Prophylactic fluclox

If peritonitic: laparotomy and bowel resection

Sweat test at 6 weeks

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139
Q

amino acid substitution in sicke cell?

A

Glutamine –> valine

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140
Q

When can a baby follow an object through a horizontal plane for 180 degrees?

A

3 months

90 degrees at 6 weeks

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141
Q

Tx of nephrotic syndrome?

A

Prednisolone

Salt restriction

Fluid replacement

Human albumin solution

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142
Q

Tx of salt losing crisis?

A

IV fluid resuscitation

IV hydrocortisone

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143
Q

SIADH tx?

A

Fluid restriction

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144
Q

What can frequent yawning in a newborn be a sign of?

A

Withdrawal after maternal drug use

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145
Q

How to differentiate between a hernia and a hydrocele?

A

Hernia transmits a cough impulse

You can get above a hydrocele

A hydrocele transilluminates

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146
Q

Tx of epididymo-orchitis?

A

Bed rest

6 weeks oral ciprofloxacin

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147
Q

Skin lesions of TB?

A

Erythema nodosum

Lupus vulgaris

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148
Q

Which conditions have an inheritance of uniparental disomy?

A

Prader willi

Angelman

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149
Q

Which conditions arise from microdeletions?

A

William’s Syndrome

DiGeorge

Cri-du-chat

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150
Q

Tx for labial adhesions?

A

Topical oestrogen

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151
Q

Why is cipro generally avoided in kids?

A

Risk of arthropathy

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152
Q

Phimosis vs paraphimosis?

A

Phimosis = inability to retract prepuce - no mx usually

Paraphimosis = retraction of tight foreskin over glans causing oedema of glans - formal circumcision needed

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153
Q

GH deficiency features?

A

Neonatal hypoglycaemia and prolonged jaundice

Short stature/failure to thrive

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154
Q

Features of congenital hypothyroidism?

A

Large tongue

Umbilical hernia

Prolonged jaundice

Feeding difficulties

Lethargy

Constipation

Floppy

Large fontanelle

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155
Q

Pathophys of ITP?

A

Auto-Ab to glycoprotein IIb/IIIa

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156
Q

Features of Wiskott-Aldrich syndrome?

A

Thrombocytopenia

Immunodeficiency

Eczema

Predisposed to haem malignancies

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157
Q

Features of Fanconi anaemia?

A

Aplastic anaemia

Short stature

Skeletal abnormalities

Predisposed to haem malignancies

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158
Q

Best marker of DIC?

A

Fibrinogen

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159
Q

Ix for gynaecomastia in a teenage boy?

A

Nothing if other signs of puberty present - transient gynaecomastia is a normal finding

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160
Q

Features of galactosaemia?

A

Occurs with lactose-containing milks:

Vomiting

Cataracts

Recurrent E. coli sepsis

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161
Q

How does myotonic dystrophy present most commonly?

A

Muscle weakness and wasting starting in adulthood

Congenital form can present with hypotonia from birth centrally and peripherally

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162
Q

Features of VACTERL?

A

Vertebral malformation

Anal imperforation

Cardiac problems

Tracheo-oesophageal fistula

Renal abnormalities

Limb abnormalities

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163
Q

Features of CHARGE syndrome?

A

Coloboma

Heart defects

Atresia choanae

Retardation of growth and development

Genitourinary abnormalities

Ear anomalies

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164
Q

Causes of asymmetrical IUGR?

A

Placental insufficiency

Maternal DM

Pre-eclampsia

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165
Q

Causes of symmetrical IUGR and low birth weight?

A

Chromosomal anomaly

Maternal smoking

Congenital infection

Maternal alcohol use

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166
Q

Mx of Hep A if child is well?

A

Supportive

Try not to admit them to reduce chance of spread

Report to Health Protection Agency

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167
Q

Best way to detect DiGeorge microdeletion?

A

FISH

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168
Q

2 examples of encapsulated bacteria children with asplenia or SCD are at risk from?

A

Strep pneumoniae

H. influenzae

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169
Q

Children with C5-9 complement deficiency are most at risk from which organism?

A

Neisseria meningitides

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170
Q

Most common causative organism of pneumonia in 1-4 year olds?

A

Strep pneumoniae

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171
Q

Most common causative organism of pneumonia in >4 year olds?

A

Mycoplasma pneumoniae

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172
Q

Complications of PCD?

A

Infertility

Sinusitis

Bronchiectasis

Dextrocardia

Situs inversus

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173
Q

Define chronic lung disease

A

Oxygen requirement at 36 weeks corrected gestation OR at 28 days post term

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174
Q

Which lobe of the lung is most likely to be the location of foreign body inhalation?

A

Right middle lobe

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175
Q

What does the Guthrie test for to detect CF? and what happens if it is positive?

A

Immune reactive trypsin

Sent for genetic analysis to identify mutation

Child then receives confirmatory sweat test

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176
Q

Blood gas findings if a child has increased work of breathing and has begun to tire?

A

Type 2 respiratory failure

Hypoxia

Hypercapnia

Respiratory acidosis

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177
Q

What pattern of respiratory disease is seen in muscular dystrophy?

A

Restrictive picture - low FVC, normal FEV1/FVC ratio

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178
Q

What pattern of respiratory disease is seen in asthma?

A

Obstructive picture:

Normal FVC

Low FEV1/FVC ratio

Morning dips

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179
Q

What conditions would you expect to see a flattened diaphragm in?

A

Hyperinflation and air trapping e.g. bronchiolitis

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180
Q

Most common congenital heart defects in order

A
  1. VSD
  2. PDA
  3. ASD/coarctation/TOG
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181
Q

Steps for cardioverting a child?

A
  1. Vagal manouvres
  2. Adenosine
  3. Sedated synchronised cardioversion
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182
Q

How would Eisenmenger’s present?

A

Teenagers: right to left shunt

Cyanotic and breathless

Pulmonary hypertension

Bi-basal fine creps

Soft pansystolic murmur

Displaced apex

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183
Q

What is required for a definitive dx of UTI?

A

Urine culture growing >105 colony forming units per mm of a single organism

I.e. in a baby with leukocytes in the urine you still need to do a full septic screen in case

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184
Q

Causes of HTN in children?

A
  • Essential
  • Renal - renal artery stenosis, CKD, Wilm’s
  • Cardiac - coarctation of aorta
  • Endocrine - Cushing’s, phaeo, neuroblastoma
  • Metabolic - hyperaldosteronism, CAH
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185
Q

Features of henoch schonlein purpura?

A

Few weeks after viral infection

Arthralgia

Purpuric rash behind legs

Abdo pain

Renal involvement (nephrotic syndrome)

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186
Q

Best imaging modality for posterior urethral valves? What would you see?

A

Micturating cystourethrogram

Dilated and elongated posterior urethra

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187
Q

2 types of polycystic kidney disease and their features?

A

Autosomal recessive:

  • Presents in childhood
  • Bilateral renal masses
  • Pulmonary hypoplasia
  • Congenital hepatic fibrosis

Autosomal dominant:

  • Presents in older children/adults
  • Renal, liver and cerebral vasculature has cysts
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188
Q

Why do you usually not give platelets in ITP unless life threatening bleed?

A

Platelet infusion will be destroyed by immune system too

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189
Q

Inheritance of vWD?

A

AD

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190
Q

Features of Sturge Weber?

A

Port wine stain

Seizures (secondary to vascular malformation)

Developmental problems

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191
Q

When do strawberry naevi or cavernous haemangiomas appear?

A

After first month of life

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192
Q

Appearance of erythema toxicum?

A

Erythematous rash with small pustules

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193
Q

Why might a child with congenital hypothyroidism test negative on the Guthrie test?

A

Guthrie tests for high TSH but in kids with panhypopituitarism there is a low TSH and hence a low thyroxine

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194
Q

Features of Marfan’s?

A

High arched palate

Myopia

Lens dislocation

Arachnodactyl

Arm span > height

Hypermobility

Aortic arch abnormalities

Mitral valve prolapse

Chest wall deformity

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195
Q

What Ix is most important if a child presents with Addisonian crisis?

A

Kidney function with U&Es to asses hyponatraemia and hyperkalaemia

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196
Q

Most common surgical mx of SUFE?

A

Internal fixation

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197
Q

Difference between a torus fracture and a greenstick fracture?

A

Torus = cortex buckles on one side of long bone only

Greenstick = cortex buckles on one side of long bone and cortex is interrupted on the opposite side

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198
Q

What is a salter-harris fracture?

A

Fracture through the growth plate

199
Q

Most appropriate mx if a baby is positive for DDH on ortolani and barlow’s?

A

Outpatient USS at 6 weeks of age

200
Q

MRI findings of osteomyelitis?

A

Periosteal reactions

Soft tissue swelling

201
Q

When must you always rule out meningitis in a febrile convulsion?

A

Children <1 year old

202
Q

Differences between moderate and mild HIE?

A

Moderate has seizures and altered tone movement in addition to mild: irritability, startle responses, poor feeding and hyperventilation

203
Q

MRI findings in MS?

A

Multiple hyperintense, inflammatory white matter lesions

204
Q

MRI findings in tuberous sclerosis?

A

Subependymal calcifications

Hypointense white matter lesions/tubers

205
Q

Features of neurofibromatosis type 1?

A

6 or more café-au-lait macules — flat light brown birthmarks

Freckling in skin folds

Lisch nodules in the iris of the eye

Optic gliomas

Multiple neurofibromas — tumours that hang off the skin

Sphenoid dysplasia

206
Q

Features of NF2?

A

Bilateral acoustic neuromas and schwannomas

Meningiomas

Spinal cord ependymomas

207
Q

What are slow relaxing reflexes a sign of?

A

LMN lesions - Guillain Barre

Hypothyroidism

208
Q

Eye signs of raised ICP?

A

Papilloedema

Sunset eyes

209
Q

Causes of West syndrome?

A

trauma

brain malformations such as hemimegalencephaly or cortical dysplasia

infections

Down syndrome

tuberous sclerosis (MOST COMMON)

Sturge Weber

PKU

Maple syrup urine disease

210
Q

Skin manifestations of tuberous sclerosis?

A

Ash leaf macules

Shagreen patches (rough skin over lumbar spine)

Angiofibromata in butterfly distribution over nose and cheeks

Fibromas under nail beds

211
Q

Features of Tay-Sach’s?

A

seizures

developmental regression

deafness

progressive loss of motor
function and increased tone

Ashkenazi Jews

212
Q

What is a toddler’s fracture and how does it happen?

A

aka childhood accidental spiral tibial fracture or CAST fracture

caused by a twisting injury while tripping, stumbling, or falling.

213
Q

What are the 3 types of incomplete fracture seen in children?

A

Buckle (torus)

Greenstick

Bowing

214
Q

How are fractures through the growth plate classified?

A

Salter-Harris classification

215
Q

Mnemonic to remember salter-harris classification?

A

SALTER:

S – straight across the joint (type I)

A – above the joint (type II)

L – lower (type III)

TE – through everything (type IV)

R – ruined or rammed (type V)

216
Q

Which type of salter harris fracture is most common?

A

Type 2

217
Q

Which type of fractures may lead to limb length discrepancies, progressive angular deformities or joint incongruity?

A

Growth plate (physeal) injuries

218
Q

1st line Tx for localised impetigo?

A

Topical fusidic acid

219
Q

Which abx for whooping cough and when does it help?

A

Macrolide e.g. azithromycin

Within 21 days of symptoms

220
Q

3 main complications of minimal change disease?

A

Increased risk of thrombosis

Increased infection risk

Hypercholesterolaemia

221
Q

Symptoms of chondromalacia patellae? Who is it common in?

A

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

Extension produces a grating feeling

Crepitus or small effusion may be palpable

Common in teenage girls

222
Q

What does the WHO recommend for clinical dehydration without shock?

A

Rehydration with ORS at 75ml/kg every 4 hours

223
Q

Caput succedaneum vs cephalohaematoma?

A

Caputs cross sutures (subcut fluid in scalp)

Resolves in a few days

Cephalohaematomas do not (haemorrhage between periosteum and skull)

Resolves in a few months

224
Q

Where is the bleeding in a subgaleal haemorrhage?

A

Between scalp aponeurosis and periosteum

225
Q

DDH ix?

A

Newborn and 6 week check: screen with ortolani + barlow –> then USS

6 weeks - 6month: USS

6 months and older: X-ray

226
Q

What is bronchopulmonary dysplasia?

A

Pathological lung changes in infants following prolonged artificial ventilation

227
Q

Where is the lesion in dyskinetic CP and features?

A

Basal ganglia

Variable muscle tone

Chorea

Athetosis

Dystonia

228
Q

Where is the lesion in ataxic CP and features?

A

Cerebellum

Lack of voluntary coordination of muscle movements

Intention tremor

Ataxic gait

Speech abnormalities

229
Q

Where is the lesion in spastic CP?

A

Motor cortex

230
Q

Features of TTP?

A

MAHA

AKI

Thrombocytopenia

Fever

Neurological symptoms

231
Q

How to tell the difference between HSP and IgA nephropathy?

A

IgA nephropathy presents 1-2 days after URTI

HSP presents 1-3 weeks after strep throat

232
Q

What type of hypogonadism is Klinefelter’s?

A

hypergonadotrophic hypogonadism

233
Q

Which influenza vaccine should kids with asthma or T1DM be offered?

A

IM influenza vaccine

234
Q

Ix for neuroblastoma?

A

Urinary catecholamines and HVA and VMA high

Biopsy for definitive dx

MIBG scan for mets

235
Q

What is the most common primary bone malignancy of childhood? What is the second most common?

A
  1. Osteosarcoma
  2. Ewing sarcoma
236
Q

Which diarhhoeal diseases in children should be reported to the local health authority?

A

Campylobacter jejuni

Listeria

E coli

Shigella

Salmonella

237
Q

3 stages of Rett syndrome?

A
  1. Develop normally for first 6-12 months then regression
  2. Plateau
  3. Movement deterioration - scoliosis, weakness, spasticity and loss of ability to walk
238
Q

Features of atypical UTI?

A

Poor urine flow

Abdo or bladder mass

Raised creatinine

Sepsis

Failure to respond to abx within 48 hours

Non E. coli organism

239
Q

Recommended imaging in kids >3 years with UTI?

A

USS during acute infection only if atypical UTI

USS within 6 weeks if recurrent

DMSA if recurrent

MCUG not indicated in this age group

240
Q

Define recurrent UTI?

A

2 or more episodes of UTI with acute pyelonephritis/upper urinary tract infection, or

1 episode of UTI with acute pyelonephritis/upper urinary tract infection plus one or more episode of UTI with cystitis/lower urinary tract infection, or

3 or more episodes of UTI with cystitis/lower urinary tract infection

241
Q

In boys with precocious puberty what does examination of testes suggest?

A

Bilateral enlargement = Gonadotrophin dependent

Atrophic testes = gonadotrophin independent

Unilateral enlargement = tumour

242
Q

What is an appendicular mass?

A

A complication of appendicitis

Inflamed appendix had adherent covering of omentum and small bowel

Presents like appendicitis but more gradual and might be RIF mass on palpation

243
Q

Tx for tinea capitis vs mild ring worm?

A

Mild ring worm = topical terbinafine/itraconazole

Tinea capitis = oral terbinafine

244
Q

What is herpangina and what is it caused by?

A

Prominent fever and painful ulcers on soft palate, tonsils, uvula and pharynx

Cause = Coxsackie A16

245
Q

What are nagayama spots?

A

Rash on soft palate in HHV6

246
Q

Mx of acute crisis in SCD?

A

Analgesia within 30 mins

Oxygen therapy if sats <95%

247
Q

When does post-infectious IBS most commonly occur?

A

After gastroenteritis with Campylobacter jejuni

248
Q

Which bug is mesenteric adenitis most commonly associated with?

A

Yersinia enterocolitica

249
Q

Description of eczema herpeticum?

A

Widespread blisters and punched-out erosions

250
Q

Metabolic features of a salt losing crisis in CAH?

A

Hyponatraemia

Hyperkalaemia

Hypoglycaemia

Metabolic acidosis (in proximal convoluted tubule, sodium is secreted in exchange for hydrogen ions)

251
Q

Most common causative organisms of reactive arthritis?

A

GI - campylobacter

Urogenital - chlamydia

252
Q

Definitive dx in G6PD deficiency and when can it be done?

A

Enzyme assay

2-3 months after a crisis

253
Q

Features of diamond blackfan anaemia?

A

AD

Presents at 2-3 months - red cell aplasia causes low RBCs and reticulocytes

Microcephaly

Absent thumbs

Cleft palate

254
Q

3 cardinal features of macrophage activation syndrome?

A

Cytopenia

Liver dysfunction

Coagulopathy

255
Q

What is macrophage activation syndrome a complication of?

A

Any rheumatic disease

Systemic JIA

Kawasaki disease

256
Q

Main cause of recurrent intussusception and how can you investigate it?

A

Meckel’s diverticulum

Technetium-99m scan

257
Q

Where does erythema multiforme typically start?

A

Hands and feet then spreads up limbs to torso

258
Q

1st line ix in suspected testicular torsion?

A

doppler USS to assess testicular bloow flow

259
Q

Tx for talipes equinovarus?

A

Ponseti method

Fixing feet into correct position with a cast - repeat every week for 5-8 weeks

Followed by minor operation to loosen Achilles tendon

260
Q

What is pes planus associated with?

A

CP

SPina bifida

Muscular dystrophy

261
Q

What is pes cavus associated with?

A

charcot-marie-tooth

262
Q

Another name for vertical talus?

A

Rocker bottom feet

263
Q

What is Sandifer syndrome and features?

A

Spasmodic condition associated with GOR

Torticollis of neck and arching of back

264
Q

Topical steroids for eczema mild, moderate, potent and very potent?

A

Mild

  • Hydrocortisone 1%

Moderate

  • Betamethasone valerate 0.025%
  • Clobetasone butyrate 0.05%

Potent

  • Betamethasone valerate 0.1%
  • Mometasone furoate 0.1%

Very potent

  • Clobetasone proprionate 0.1%
265
Q

Blood film findings in EBV in children >12 years in second week of illness?

A

>20% atypical lymphocytes

266
Q

Tx of scabies?

A

Permethrin 5% cream

267
Q

Head lice Tx?

A
  • Wet combing 5 times over 3 weeks
  • Dimeticone 4% or malathion 0.5% applied twice, 7 days apart
  • Check at the end with wet combing for both
268
Q

Most common cause of pneumonia in under 1 year olds?

A

RSV

269
Q

When to admit a child with pneumonia?

A

Oxygen sats <92%

Grunting, marked chest recession, cyanosis

RR >60

270
Q

1st line tx in pneumonia?

A

Amoxicillin

If no response add a macrolide

271
Q

Surgical mx for OME?

A

Myringotomy followed by insertion of grommets which stay in for 6-12 months

272
Q

OME mx?

A

Actively observe for 6-12 weeks

2x hearing tests with pure tone audiometry and tympanometry during this time

Refer to ENT if persistent

273
Q

Typical presentation of spina bifida occulta?

A

Insidious onset

Lower back pain that worsens with activity

Gait disturbance

Scoliosis

High-arched feet

Neuro dysfunction - numb/weak, bladder and bowel dysfunction

274
Q

Causes of macrocephaly?

A

Fragile X

NF type 1

Tuberous sclerosis

275
Q

What head shape is:

Plagiocephaly

Brachycephaly

Craniosynostosis?

A

Plagiocephaly - unilateral occipital flattening

Brachycephaly - bilateral occipital flattening

Craniosynostosis - premature fusion of cranial sutures leads to distortion

276
Q

What fluids to use in DKA resuscitation?

A

0.9% saline + 40mmol/L KCl

Once glucose <14 add 5% dextrose

277
Q

Tx for umbilical stump infection?

A

IV flucloxacillin + gentamicin

278
Q

What is blount’s disease? 2 types?

A

Abnormality of medial proximal tibial growth plate - bowed legs

Type 1: infantile + bilateral

Type 2: adolescent + unilateral + femur

279
Q

Newborn hearing tests?

A

Automated otoacoustic emission test

If abnormal then automated auditory brainstem response test

280
Q

What test is used to assess hearing with otitis media with effusion?

A

Tympanometry

281
Q

HTN in Turner’s why?

A

Co-arctation of aorta

282
Q

What is bronchomalacia and how does it present?

A

Cartilage supporting bronchi is weak

Presents in first few weeks of life with a wheeze

Most outgrow it by age 2 years

283
Q

Acne mx?

A
  1. Benzoyl peroxide, adapalene or azelaic acid
  2. PO abx for 3 months - lymocycline/doxycycline
  3. Alternative abx
  4. Isotretinoin
284
Q

What does a prolonged jaundice screen involve? When to do it?

A

If jaundice lasts >14 days and serum bilirubin >100

  • FBC
  • Conjugated bilirubin level
  • Group and save
  • Coomb’s
  • Urine culture
  • Metabolic screen
285
Q

In BLS where should the pulse be felt in an under 1?

A

Femoral or brachial

286
Q

What is epstein’s pearl?

A

A congenital cyst found in the mouth

Usually on the hard palate but can be on gums

Resolves spontaneously within a few weeks

287
Q

Features of hypernatraemic dehydration?

A

jittery movements

increased muscle tone

hyperreflexia

convulsions

drowsiness or coma

288
Q

When should you do a stool culture?

A

you suspect septicaemia or

there is blood and/or mucus in the stool or

the child is immunocompromised

the child has recently been abroad or

the diarrhoea has not improved by day 7 or

you are uncertain about the diagnosis of gastroenteritis

289
Q

Mx for clinical dehydration?

A

give 50 ml/kg low osmolarity oral rehydration solution (ORS) solution over 4 hours, plus ORS solution for maintenance, often and in small amounts

290
Q

Mx if exomphalos diagnosed antenatally?

What happens once born?

A

Elective C section

Staged closure starting at birth with completion at 6-12 months

291
Q

Common referral points for developmental milestones?

A

doesn’t smile at 10 weeks

cannot sit unsupported at 12 months

cannot walk at 18 months

cannot say 2-6 words at 18 months

292
Q

How are cyanotic spells in TOF managed?

A

b-blockers (to reduce infundibular spasm and thus prevent worsening of RV outflow obstruction)

293
Q

What murmur is usually heard in TOF?

A

ejection systolic murmur due to pulmonary stenosis (the VSD doesn’t usually cause a murmur)

294
Q

Muscle biopsy findings of mitochondrial diseases?

A

‘red, ragged fibres’ due to increased number of mitochondria

295
Q

Most common fractures associated with child abuse?

A

Radial

Humeral

Femoral

296
Q

How does TOG present on ausculation?

A

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

297
Q

Features of androgen insensitivity syndrome?

A

X-linked recessive condition due to end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype

‘primary amenorrhoea’

undescended testes causing groin swellings

breast development may occur as a result of conversion of testosterone to oestradiol

298
Q

When can transcutaneous bilirubinometer not be used?

A

<24 hours old

299
Q

Features of Osteochondritis dissecans?

A

Pain after exercise
Intermittent swelling and locking

300
Q

Features of Patellar subluxation?

A

Medial knee pain due to lateral subluxation of the patella
Knee may give way

301
Q

Features of Patellar tendonitis?

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

302
Q

Tx for spasticity in CP?

A

oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopaedic surgery and selective dorsal rhizotomy

303
Q

What CO2 level is a life-threatening sign of asthma?

A

Normal pCO2 of 4.8-6 kPa

304
Q

Indications for dexamethasone in meningitis?

A

Not used if <3 months

Dexamethasone may be given if the following are seen on CSF analysis:

  • Frankly purulent CSF
  • CSF WBC > 1000/µL
  • Raised CSF WBC + protein concentration > 1 g/L
  • Bacteria on Gram stain

NOTE: steroids should NOT be used in meningococcal septicaemia, unless ICU says so

305
Q

Symptoms of posterior urethral valves?

A

In utero: oligohydramnios and lung hypoplasia

Recurrent UTI

Bilateral hydronephrosis

306
Q

Tx for posterior urethral valves?

A

Transurethral catheter ablation

307
Q

What neurodevelopmental condition is fragile X associated with? What heart problem?

A

Autism

Mitral valve prolapse

308
Q

Mx of hypoglycaemia in a neonate?

A

asymptomatic:

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

symptomatic or very low blood glucose (<1mmol/L)

  • admit to the neonatal unit
  • intravenous infusion of 10% dextrose
309
Q

When can hypoglycaemia protocols be stopped in babies born to mother’s with DM?

A

at least 3 blood glucose values >2.5 mmol/L and are feeding appropriately

310
Q

Approximate definition of neonatal hypoglycaemia?

A

<2.6mmol/L

311
Q

When do NICE suggest a dx of pneumonia should be considered?

A

high fever (over 39°C) and/or

persistently focal crackles.

312
Q

Mx of umbilical hernia?

A

Usually self-resolve, but if large or symptomatic perform elective repair at 2-3 years of age

If small and asymptomatic peform elective repair at 4-5 years of age.

313
Q

Causes of HTN in children?

A
  • renal parenchymal disease
  • renal vascular disease
  • coarctation of the aorta
  • phaeochromocytoma
  • congenital adrenal hyperplasia
  • essential or primary hypertension (becomes more common as children become older)
314
Q

What prophylaxis is preferred for meningococcal septicaemia contacts?

A

Ciprofloxacin over rifampicin

315
Q

Mx for bilateral undescended testes?

A

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

316
Q

Peak incidence of bronchiolitis?

A

3-6 months

317
Q

Features O/E of PDA?

A

large volume, bounding, collapsing pulse

wide pulse pressure

machinery continuous murmur

heaving apex

left subclavicular thrill

318
Q

What rash is associated with being in the sun? What does it look like? tx?

A

Pityriasis versicolor

large number of light brown macules and confluent patches affecting most of his back and chest

Ketoconazole 2% shampoo

319
Q

Which rash has a herald patch?

A

pityriasis rosea

320
Q

When are babies at risk of meconium aspiration?

A

Thick/lumpy meconium - monitor until 12 hours postnatal

Thin meconium - monitor baby at 1 and 2 hours postnatally

321
Q

Mx of perthes?

A
  • <6 years: reassure and follow up
  • >6 years/severe deformity of limb or joint: surgery
322
Q

Perthes staging?

A

Caterall staging

323
Q

When do NICE recommend admitting a child with croup?

A
  • Signs of moderate/severe disease
  • < 6 months of age
  • Known upper airway abnormalities (e.g. Laryngomalacia, Down’s syndrome)
  • Uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
324
Q

Causes of cleft palate?

A

events in pregnancy: smoking, BDZ use, anti-epileptic use, rubella infection

syndromic disorders affecting baby: trisomies 18, 13 and 15

325
Q

Hypospadias mx?

A

once hypospadias has been identified, infants should be referred to specialist services

corrective surgery is typically performed when the child is around 12 months of age

it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure

326
Q

Definitions of low dose and moderate dose ICS in children?

A
  • <= 200 micrograms budesonide or equivalent = paediatric low dose
  • 200 micrograms - 400 micrograms budesonide or equivalent = paediatric moderate dose
  • > 400 micrograms budesonide or equivalent= paediatric high dose
327
Q

What 2 things is prognosis of congenital diaphragmatic hernia based off?

A
  1. Liver position
  2. Lung-to-head ratio (>1 is good prognostically)
328
Q

Most common cardiac abnormalities in Turner’s in order?

A
  1. Bicuspid aortic valve
  2. Aortic root dilatation
  3. Coarctation of the aorta
329
Q

Electrolyte results in pyloric stenosis?

A

High bicarb

Low chloride

Low potassium

330
Q

3 types of biliary atresia and which is most common?

A
  • Type 1: The proximal ducts are patent, however, the common duct is obliterated
  • Type 2: There is atresia of the cystic duct and cystic structures are found in the porta hepatis
  • Type 3: There is atresia of the left and right ducts to the level of the porta hepatis, this occurs in >90% of cases of biliary atresia
331
Q

Initial Tx for Hirschprung’s?

A

rectal washouts/bowel irrigation

332
Q

Midline cyst below hyoid bone and moves up on tongue protrusion?

A

Thyroglossal cyst

333
Q

Cyst located anterior to the sternocleidomastoid near the angle of the mandible?

A

Branchial cyst

334
Q

Normal value for sweat test? What value indicates CF?

A

normal value < 40 mEq/l

CF indicated by > 60 mEq/l

335
Q

What conditions are patients with Turner’s at risk of?

A

X linked (since only one X chromosome)

336
Q

Average age of dx for retinoblastoma? Most common presentation? Prognosis?

A

18 months

Leukocoria

>90% children survive to adulthood

337
Q

Mx of retinoblastoma?

A

Enucleation

depending on how advanced the tumour is other options include external beam radiation therapy, chemotherapy and photocoagulation

338
Q

Red flag RR needing immediate hospital assessment?

A

RR>60

339
Q

When to assess APGARs?

A

1, 5 and 10 mins

340
Q

Bronchiolitis immediate referral to hospital vs consider referral to hospital?

A

Immediate:

  • apnoea (observed or reported)
  • child looks seriously unwell to a healthcare professional
  • severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
  • central cyanosis
  • Sats <92% in air

Consider:

  • RR >60 breaths/minute
  • difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
  • clinical dehydration
341
Q

What organism is likely to cause superimposed infection of chicken pox lesions?

A

Group A strep causing nec fasciitis

342
Q

Biggest cause of massive painless bleeding needing a transfusion in children aged 1-2 years?

A

Meckel’s diverticulum

343
Q

Heart abnormalitis in Turner’s?

A

bicuspid aortic valve (15%)

coarctation of the aorta (5-10%)

344
Q

What is the Ponseti method?

A

process of serial manipulation and casting over a few weeks used to treat clubfoot

345
Q

SUFE surgical mx?

A

Internal fixation across growth plate

346
Q

How to remember primitive reflexes and when they disappear?

A

Some - Stepping - 2m
Meaningless - moro -3-4m
Reflexes - rooting - 4m
Go - grasp 4-5

347
Q

Umbilical granuloma presentation and mx?

A

Presentation:

  • First few weeks of life - small, red growth of tissue seen in centre of umbilicus –> usually wet and leaks small amounts of clear or yellow fluid

Mx:

  • Regular application of salt
  • Cauterise with silver nitrate
348
Q

RFs for neonatal hypoglycaemia?

A
  • preterm birth (< 37 weeks)
  • maternal diabetes mellitus
  • maternal labetalol use
  • IUGR
  • hypothermia
  • neonatal sepsis
  • inborn errors of metabolism
  • nesidioblastosis
  • Beckwith-Wiedemann syndrome
349
Q

Triad in shaken baby syndrome?

A

Retinal haemorrhages

Subdural haematoma

Encephalopathy

350
Q

Tx for biliary atresia?

A

Kasai procedure - the blocked bile ducts are removed and replaced with a segment of the small intestine. This restores bile flow from the liver to the proximal small bowel.

351
Q

How to determine cause of precocious puberty in boys by testes size?

A
  • bilateral enlargement = gonadotrophin release from intracranial lesion
  • unilateral enlargement = gonadal tumour
  • small testes = adrenal cause (tumour or adrenal hyperplasia)
352
Q

How to differentiate between thyroglossal and dermoid cyst?

A

Both usually above hyoid bone

USS of dermoid: heterogenous and multiloculated mass

USS of thyroglossal: Thin walled and anechoic

353
Q

If MMR missed in normal vaccine schedule when can you give it?

A

Any time - give 3 months in between doses

A period of 1 month is considered adequate if the child is greater than 10 years of age. In an urgent situation (e.g. an outbreak at the child’s school) then a shorter period of 1 month can be used in younger children.

354
Q

What condition is trident hand deformity seen in?

A

Achondroplasia

355
Q

Kocher’s criteria septic arthritis?

A
  • temperature >38.5C,
  • refusal to bear weight on affected limb
  • raised inflammatory markers (erythrocyte sedimentation rate >40 mm/hour and CRP > 20.0 mg/litre)
  • a peripheral white cell count of > 12.0 x 109 (normal range 3.5 – 10.5 x 109 cells per cubic litre)
356
Q

Most common type of headache in children?

A
  1. Migraine
  2. Tension type headache
357
Q

When to admit child with UTI?

A
  • infants <3 months old - refer immediately to a paediatrician
  • children >3 months old with an upper UTI -consider for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days
  • children >3 months old with a lower UTI - oral antibiotics for 3 days (trimethoprim, nitrofurantoin, cephalosporin or amoxicillin) Parents should be asked to bring the children back if they remain unwell after 24-48 hours
358
Q

What conditions are associated with malrotation/volvulus?

How might it present?

A

exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia

scaphoid abdomen in early stages which becomes distended and bilious vomiting

359
Q

What is the recommended compression: ventilation ratio for the newborn?
And for a child?

A

Newborn: 3:1

Child:15:2

360
Q

Effect of growth hormone deficiency in kids?

A

Obesity

361
Q

Mx for recurrent nosebleeds and no indication of bleeding disorder?

A

Topical treatment with an antiseptic preparation to reduce crusting and vestibulitis.
Prescribe Naseptin® (chlorhexidine and neomycin) cream to be applied to the nostrils four times daily for 10 days. If compliance is a problem, advise that it can be used twice daily for up to 2 weeks.

362
Q
A
363
Q

What should you do if a child <3 years presents with a limp?

A

Urgent hospital assessment

364
Q

most common presentation of neonatal sepsis?

A

Grunting and other signs of respiratory distress

365
Q

List the women who need a 5mg dose of folic acid

A

Previous child with NTD

Diabetes mellitus

Women on antiepileptic

Obese (body mass index >30kg/m²)

HIV +ve taking co-trimoxazole

Sickle cell

366
Q

What diet may be advised in children with drug-resistant epilepsy?

A

High-fat ketogenic diet

367
Q

Define epilepsy

A

Two or more seizures unprovoked by any immediately identifiable cause

368
Q

1st line tx for generalised seizures?

A

sodium valproate

369
Q

1st line tx for focal/partial seizures?

A

Carbamezapine or Lamotrigine

370
Q

Which syndrome is associated with supravalvular aortic stenosis?

A

William’s syndrome

371
Q

Examination findings TOG?

A

a loud single S2 is audible and a prominent right ventricular impulse

372
Q

Indicators of life threatening asthma attack?

A

Cyanosis

Poor respiratory effort (PCO2 in normal range)

Peak expiratory flow rate < 33%

Silent chest

Altered level of consciousness

373
Q

Acne Tx?

A

Mild:

  • Topical retinoid - adapalene
  • Benzoyl peroxide
  • Azeleic acid

Moderate:

    • PO abx - doxycycline or lymecycline for 3 month
  • COCP

Severe:

  • Isotretinoin
374
Q

How long should acne tx be continued if successful?

A

at least 12 weeks

375
Q

Tx for nappy rash with flexural sparing?

A

Zinc barrier cream

376
Q

Tx for impetigo?

A
  1. Topical hydrogen peroxide 1% (localised)
  2. Topical fusidic acid 2%
  3. PO flucloxacillin
377
Q

Diagnostic tools for autism?

A
  • Autism Diagnosis Interview – Revised (ADI-R): 18 months & above
  • Autism Diagnostic Observation Schedule – Generic
  • Childhood Autism Rating Scale (CARS): 2 years & above
378
Q

When to carry out autism diagnostic assessment? I.E refer directly to autism team

A

if there is regression in language or social skills in a child younger than 3 years

379
Q

Factors associatd with increased prevalence of autism?

A
  • Sibling with autism
  • CNS Birth defects including cerebral palsy
  • Gestational age <35 weeks
  • Parental schizophrenia-like psychosis or affective disorder
  • Sodium valproate in pregnancy
  • Learning (intellectual) disability
  • ADHD
  • Neonatal encephalopathy or epileptic encephalopathy, including infantile spasms
  • Chromosomal disorders - Down’s syndrome
  • Genetic disorders - fragile X
  • Muscular dystrophy
  • Neurofibromatosis
  • Tuberous sclerosis
380
Q

When to refer to first to a paediatrician or paediatric neurologist in suspected ASD?

A

older than 3 years with regression in language

of any age with regression in motor skills.

381
Q

What signs are you looking for in particular on physical exam of a kid with ?ASD

A

skin stigmata of neurofibromatosis or tuberous sclerosis using a Wood’s light

signs of injury, for example self-harm or child maltreatment

congenital anomalies and dysmorphic features including macrocephaly or microcephaly

382
Q

Who should be screened for retinopathy of prematurity? How often?

A

All babies less than 32 weeks gestational age (up to 31 weeks and 6 days) or less than 1501g birthweight

Every week/2 weeks

383
Q

1st line Tx for ROP?

A

Transpupillary diode laser therapy

384
Q

Murmur in coarctation of aorta?

A

ejection systolic murmur is often present at the upper left sternal border

Loudest at left interscapular area

385
Q

Ix to confirm oesophageal atresia +/- tracheo/oesophageal fistula?

How can you check clinically before doing this ix?

A

Gastrograffin swallow

Pass an NG tube into stomach and try to aspirate contents

386
Q

What is the most comon form of oesophageal atresia?

A

Atresia with lower pouch tracheal fistula

387
Q

Mx of haemangioma?

A
  1. Photograph and reassess in 3 months
  2. PO beta-blocker e.g. propranolol
  3. Topical/intralesional steroids
  4. Surgery
388
Q

Presentation of haemangioma?

A

Appear shortly after birth (peak 4-6 weeks)

Grow fast for first 3 months

Regress by 5 months

Red, raised well demarcated firm papule with a pale halo

389
Q

What are you worried about if a haematoma crosses the sutures in a newborn? What would you do?

A

Subgaleal haemorrhage

Cranial USS

390
Q

How does a congenital bile duct cyst present?

A

Jaundice (conjugated bilirubin)

Abdo pain

Abdo mass

391
Q

Define acute otitis media and its most common causes?

A

Acute inflammation of middle ear <3 weeks

Hib

Strep pneumonia

RSV

392
Q

Where do Ewing’s sarcoma usually affect and what do you see on Xray?

A

Diaphysis/metaphysis of long bones

onion skinning of perioesteum

subperiosteal new bone formation

areas of bone destruction

393
Q

Characteristics facies of diGeorge?

A

High and broad nasal bridge

Narrow palpebral fissures

Micrognathia

Microcephaly

Long face

Cleft palate

394
Q

How is DiGeorge diagnosed?

A

FISH - TUPLE1 gene looking for 11.22.2 chromosome deletion

395
Q

Features of congenital CMV

A

90% asymptomatic

Jaundice

Thrombocytopenia

Microcephaly

Periventricular calcification

396
Q

Features of congenital toxoplasmosis?

A

Classic triad = hydrocephalus + chorioretinitis + intracranial calcifications (tram-like)

IUGR

Jaundice

Hepatosplenomegaly

Hydrocephalus

Microcephaly

Seizures

Rashes

397
Q

Features of congenital syphilis?

A

Miscarriage/stillbirth

Rash

Blood stained rhinitis

Hepatosplenomegaly

Glomerulonephritis

Meningitis

OSteochondritis

Hutchinson’s teeth

Frontal bossing of skull

Saddle nose

Saber shins

Clutton’s joints

398
Q

What is Gaucher disease?

A

inherited metabolic disorder in which deficiency of the enzyme glucocerebrosidase results in the accumulation of harmful quantities of certain lipids (glucocerebroside) throughout the body especially within the bone marrow, spleen and liver

399
Q

Which empirical abx for child with leukaemia with febrile neutropenia?

A

IV Tazocin

400
Q

Features of congenital cmv?

A

LBW

jaundice

microcephaly

sensorineural deafness

seizures

401
Q

What to do if down’s child with AOM with effusion?

A

Refer to ENT

402
Q

Complications of pavlik harness?

A

Avascular necrosis of femoral head

Temporary femoral nerve palsy

403
Q

Presentation of Tay Sach’s and where is the deficiency?

A

Cherry red spot on macula

Progressive neurodegeneration

Hexosaminidase A deficiency

404
Q

Tx in haemophilia?

A

Acute mild-moderate bleed: Desmopressin

Acute severe bleed: Recombinant Factor VIII or IX (if recurrent can also give as prophylaxis)

405
Q

CXR findings in surfactant deficiency?

A

ground glass

406
Q

CXR on meconium aspiration?

A

hyperinflated lungs, asymmetric patchy pulmonary opacities, pleural effusions, multifocal consolidation, pneumothorax

407
Q

What is Congenital diaphragmatic hernia associated with in utero?

A

Polyhydramnios

408
Q

Ix for biliary atresia

A
  1. USS
  2. Liver biopsy = GOLD STANDARD
409
Q

Features of mastoiditis?

A

Fever

Otalgia

Hearing loss

Forward displacement of ear

410
Q

When to temporarily defer vaccines?

A

Acutely unwell (fever >38.5)

If another live vaccine given within 4 weeks

Immunoglobulin tx (wait 3 months)

411
Q

1st and 2nd line for procedural sedation?

A
  1. PO or intranasal midazolam/inhaled NO
  2. Ketamine
412
Q

CXR findings with coarctation of aorta?

A

Rib notching

413
Q

When should children be given VZIG after exposure?

A
  1. Neonates born to mothers who were infected 1 week before - 1 week after delivery
  2. Neonates born to mothers with negative varicella immune status
  3. Prem born at <28 weeks
  4. LBW
  5. Children on immunosuppressants
414
Q

Most common intracranial tumour in kids?

A

Cerebellar astrocytoma

Ependymoma

415
Q

Most common extracranial solid tumour in kids?

A

neuroblastoma

416
Q

2 X ray views needed for NEC diagnosis?

A

AP

left lateral decubitus

417
Q

Staging system used for NEC tx?

A

Bell staging

418
Q

What are the 3 main categories of unconjugated hyperbilirubinemia associated with breastfeeding?

A

Physiologic jaundice: occurs between 1 and 7 days of life and peaks at 3–5 days.

Breastfeeding jaundice (BFJ): exaggerated physiologic jaundice associated with inadequate milk intake.

Breast milk jaundice (BMJ): occurs between 1 and 12 weeks in thriving breast milk–fed infant.

419
Q

Important differential for babies who are difficult to wean off ventilators?

A

PDA

420
Q

Multiple indications (2+) for CT head within 1 hour after head injury?

A

LOC >5 mins

Abnormal drowsiness

3+ vomits

High impact/dangerous mechanism

Amnesia >5 mins

421
Q

Head injury but no CT head indicated immediately?

A

Observe 4 hours minimum

422
Q

Features of hyper IgE syndrome?

A

Recurrent respiratory infections (staph/haemophilus)

Chronic eczema

Cold abscesses

Mucocutaneous candidiasis

Coarse facial features

423
Q

Duchenne Muscular dystrophy vs Becker muscular dystrophy?

A

Duchenne is a frameshift mutation - both binding sites on dystrophin protein lost

Becker - non-frameshift insertion in the dystrophin gene resulting in both binding sites being preserved leading to a milder form

Duchenne develops at 5 years, Becker at 10 years

Intellectual impairment in 30% of Duchenne

424
Q

Features of glycogen storage diseases? Give an example

A

Muscle cramps and weakness after first few minutes of exercise

After 10mins of ongoing exercise might get ‘second wind’ of energy

Myoglobinuria after exercise

McArdle disease or Von Gierke’s

425
Q

What would you see on CXR of inhaled foreign object?

A

Hyperinflated lung in lung affected

426
Q

Clinical presentation of G6P deficiency?

A

Presents at 3-4 months

Hypoglycaemia + poor tolerance to fasting

Hepatomegaly

Growth retardation

Tendency to infection

427
Q

What does finding reducing substances in the urine suggest?

A

Galactosaemia

428
Q

What is an arterial partial pressure of oxygen <50mmHg after administration of 100% oxygen consistent with?

A

Cyanotic congenital heart lesion

429
Q

Most common cause of trisomy 21?

A

Meiotic non-dysjunction

430
Q

RFs for significant hyperbilirubinaemia in a neonate? What should you do if they don’t reach treatment threshold? What should you do if they don’t have these RFs?

A

Exclusively breast fed

Gestational age <38 weeks

Previous sibling needing phototherapy

Visible jaundice within 24 hours of life

Recheck within 18 hours

If no RFs recheck in 24 hours

431
Q

DKA diagnostic values?

A

Ketonaemia: 3mmol/L and over

Blood glucose over 11mmol/L

Bicarbonate below 15mmol/L or venous pH less than 7.3

432
Q

CENTOR criteria for tonsillitis?

A

Tonsillar exudate

Tender anterior cervical lymphadenopathy

Fever over 38

Absence of cough

433
Q

Mx of bacterial tonsillitis?

A

A Centor criteria score of 3/4 would warrant prescribing antibiotics or evidence of systemic upset/immunosuppression would warrent a course of antibiotics:

1st line: Penicillin V 500mg PO QDS for 5-10 days

Alternative in pen allergy: Clarithromycin/Erythromycin 250-500mg PO BD for 5 days

434
Q

Incubation period for chicken pox?

A

Up to 3 weeks

435
Q

RFs for sepsis?

A

Age less than 1 year

Impaired immune function (e.g. diabetes, splenectomy, immunosuppressant medication, cancer treatment)

Recent surgery in the last six weeks

Breach of skin integrity (burns/cuts/skin infections)

Presence of an indwelling catheter or line

436
Q

NICE criteria that children are at increased risk of death from sepsis?

A

If a child is not rousable, or does not stay awake when roused

Bradycardia or tachycardia for age

Bradypnoea or tachypnoea for age

Mottled skin

Peripheral or central cyanosis

Non-blanching rash

437
Q

Mx of meconium aspiration syndrome?

A

Admission to NICU for oxygen and abx

438
Q

Tanner Staging girls breasts?

A

B1 Prepubertal

B2 Breast bud

B3 Juvenile with smooth contour

B4 Areola and papilla project above breast

B5 Adult

439
Q

Tanner staging boys genitals?

A

G1 Prepubertal, testicular volume <1.5ml

G2 Penis grows in length only, testicular volume 1.5-6ml

G3 Penis grows further in length and circumference, testicular volume 6-12ml

G4 Development of glans penis, darkening of scrotal skin, testicular volume 12-20ml

G5 Adult genitalia, testicular volume >20ml

440
Q

Tanner staging pubic hair?

A

PH1 Pre-adolescent no sexual hair

PH2 Sparse, pigmented, long, straight, mainly along labia or at base of penis

PH3 Dark, coarser, curlier

PH4 Filling out towards adult distribution

PH5 Adult in quantity and type with spread to medial thighs in males

441
Q

RFs for SUFE?

A

Onset of puberty

Obesity

Endocrine disorders: hypothyroidism, panhypopituitarism, renal osteodystrophy, and growth hormone deficiency are all associated with SCFE.

Male gender

Afro-Caribbean or Hispanic ethnicity

Previous radiotherapy

442
Q

Testicular torsion mx plan?

A
  1. Contact urology for urgent surgical exploration
  2. Doppler USS (can be delayed as long as urology have been contacted)
443
Q

What is Autoimmune encephalitis? Symptoms?

A

noninfectious neuroinflammation that has become an increasingly recognized cause of acute/subacute progressive mental status change

confusion, seizures, movement disorders, behavioural changes, emotional lability, psychosis, cognitive impairment and reduced conscious level in young people

444
Q

What does partial closure of the vitelline duct cause?

A

Meckel’s diverticulum

445
Q

What is a tumour of Rathke’s pouch and what symptoms does it cause?

A

Craniopharyngioma

Bitemporal hemianopia

Growth failure

446
Q

Causes of HIE?

A

Failure of gas exchange across the placenta (excessive or prolonged uterine contractions, placental abruption, ruptured uterus)

Interruption of umbilical blood flow (e.g. cord compression including shoulder dystocia, cord prolapse)

Inadequate maternal placental perfusion, maternal hypotension and hypertension

Compromised foetus (anaemia, IUGR)

Failure of cardiorespiratory adaptation at birth (failure to breathe)

447
Q

Eligibility criteria for therapeutic cooling in HIE?

A
  • Gestational age ≥ 36 weeks and ≤6 hours of age
  • Metabolic or mixed acidosis with a pH of ≤7.0 or a base deficit of ≥ 16mmol/L in a sample of umbilical cord blood or any blood obtained within first hour after birth
  • One of the following:
    • 10 minute Apgar score of ≤ 5
    • Ongoing resuscitation initiated at birth and continued for at least 10 minutes
  • Moderate to severe encephalopathy on clinical examination
448
Q

Most common cardiac defect in mothers with T1DM and T2DM?

A

TGA

449
Q

Different types of spastic CP?

A

Spastic hemiplegia: Arm>leg, early hand preference

Spastic quadriplegia: Most severe, Associated with seizures, leg>arm

Spastic monoplegia: paralysis of 1 limb, usually an arm

Spastic diplegia: Associated with periventricular damage and scissor walking

450
Q

Risks of ceftriaxone tx in neonate?

A

Biliary sludging

Kernicterus

451
Q

How to monitor response to sepsis tx?

A

CRP 18-24 hours after abx started

452
Q

When to do an LP in a child with sepsis?

A
  • infants younger than 1 month
  • all infants aged 1–3 months who appear unwell
  • infants aged 1–3 months with a white blood cell count less than 5×109 /litre or greater than 15×109 /litre
453
Q

When should immediate IV abx be given in a child presenting with a fever?

A

Shocked

Unrousable

Signs of meningococcal disease

454
Q

Time frame for adminstering abx in suspected sepsis?

A

1 hour

455
Q

When to consider UTI in a child with a fever <3 months?

When to consider it in a child over 3 months?

A

Always in under 3 months

In a child >3 months:

  • vomiting
  • poor feeding
  • lethargy
  • irritability
  • abdominal pain or tenderness
  • urinary frequency or dysuria
456
Q

Physiological murmur findings:

A

Soft

Systolic

Short

S1 and S2 normal

Symptomless

Sitting/standing (vary with position)

457
Q

Common causative organisms of pneumonia in CF?

A

Pseudomonas

Staph aureus

Haemophilus influenza

458
Q

AVSD murmur?

A

Pan-systolic LLSE

459
Q

Murmur in ASD?

A

Ejection systolic with fixed split S2

460
Q

Bloods in post strep glomerulonephritis?

A

Low C3

High ASOT

461
Q

What do you see on CT chest/abdo in a wilm’s tumour?

A

Claw sign

462
Q

Tx for steroid sensitive nephrotic syndrome?

A

60mg/m2 per day of prednisolone for 4 weeks

4 further weeks of reducing dose

463
Q

What is seen on electron microscopy of minimal change disease?

A

Fusion of epithelial podocytes

464
Q

HSP follow up

A

Patients should be followed for at least 6 months with periodic urinalysis and BP monitoring.[24] An abnormality on urinalysis should be followed by a serum creatinine to assess renal function.

465
Q

Diagnostic ix in periorbital cellulitis?

A

CT sinus and orbits with contrast medium

466
Q

When to refer a neonate with a squint?

A

Fixed squint

Persists beyond 8 week baby check

467
Q

Symptoms of salbutamol toxicity?

A

tremor, tachycardia, agitation, metabolic acidosis, hyperglycaemia, and hypokalaemia –> arrhythmia

468
Q

Indications to not give ceftriaxone in a child?

A

Cholestatic jaundice

Acidosis

Hypoalbuminaemia

469
Q

How can the weight of children between the ages of 1 and 10 years can be safely estimated?

A

weight=2 × (age +4)

470
Q

Depth of chest compressions in resuscitation?

A

One third of depth of chest

471
Q

What does a wall to wall heart on CXR suggest?

A

Ebstein’s anomaly

472
Q

Murmur in ebstein’s anomaly?

A

Pansystolic due to tricuspid regurge

473
Q

What does a figure of 3 sign of cxr suggest?

A

CoArctation of the aorta

474
Q

Which heart defect is associated with Edward’s syndrome?

A

VSD

475
Q

Mx of atrial septal defect?

A

closure at 3-5 years, 90% device closure in catheter laboratory or uncommonly surgical closure if very large

476
Q

Mx of VSD?

A

Small VSDs are managed conservatively with regular echocardiograms

Large VSDs are usually treated with medical therapy – diuretics, captopril and added calories

477
Q

Minor criteria in revised Jones criteria for rheumatic fever

A

Minor criteria:

  1. fever > 38.5
  2. Arthralgia
  3. ESR > 30 and/or CRP > 3
  4. prolonged PR interval
478
Q

Revised Jones criteria for rheumatic fever?

A
  • 2 major criteria or 1 major criterion + 2 minor criteria
    • evidence of preceding streptococcal infection
479
Q

Formal indications for tonsillectomy?

A

An episode frequency of:

> 7 / year

> 5 / year in each of the previous 2 years

>/= 3 / year in each of the previous 3 years

480
Q

painless otorrhoea > 6 weeks causes in an adolescent? What is the pathophsy and what might be seen on examination?

A

chronic suppurative otitis media (CSOM)

Pathophys: recurrent AOM or trauma perforates tympanic membrane with subsequent bacterial infection

O/E: perforated tympanic membrane +/- cholesteatoma

481
Q

What does retraction of tympanic membrane with bright white calcification o/e suggest?

A

Tympanosclerosis – can cause significant hearing loss but unlikely to be associated with discharge

482
Q

What rash does a strep infection precipitate?

A

Guttate psoriasis

483
Q

Which rash may precede an URTI?

A

Pityriasis rosea

484
Q

Normal feeding requirements of a newborn?

A

Normal feeding requirements of a newborn

  • Day 1: 60ml/kg/day
  • Day 2: 90ml/kg/day
  • Day 3: 120ml/kg/day
  • Day 4 onwards: 150ml/kg/day
485
Q

What is a MAG3 scan used for and in who?

A

Radionucleotide scan used in children >2 years old (instead of MCUG in young kids)

486
Q

What is seen on AXR of meconium ileus?

A

Ground glass shadowing

Dilated bowel loops

487
Q

In children and young people with suspected meningitis or suspected meningococcal disease, perform a lumbar puncture unless any of which contraindications are present?

A

signs suggesting raised intracranial pressure:

  • reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 or more)
  • relative bradycardia and hypertension
  • focal neurological signs
  • abnormal posture or posturing
  • unequal, dilated or poorly responsive pupils
  • papilloedema
  • abnormal ‘doll’s eye’ movements

shock

extensive or spreading purpura

after convulsions until stabilised

coagulation abnormalities:

  • coagulation results (if obtained) outside the normal range
  • platelet count below 100 x 109/litre
  • receiving anticoagulant therapy

local superficial infection at the lumbar puncture site

respiratory insufficiency (lumbar puncture is considered to have a high risk of precipitating respiratory failure in the presence of respiratory insufficiency)

488
Q

Innocent murmurs in children? Where and when are they heard?

A
  1. Still’s murmur - short soft midsystolic murmur with a characteristic buzzing quality LLSE (gets quiet on standing)
  2. Pulmonary flow murmur - soft systolic murmur but harsher and higher pitched than Still’s (disappears on Valsava and loudest on back)
  3. Venous hum - continuous murmur heard beneath the clavicles (still heard on standing)
489
Q

What is the most common cause of heart failure in neonates? (2 days of life)

A

Obstructed systemic circulation e.g. hypoplastic left heart, critical aortic valve stenosis, severe coarctation

490
Q

What is the most common cause of heart failure in infants? (age 1-12 months)

A

Left-to-right shunt e.g. VSD, AVSD, large PDA.

491
Q

What is the definitive treatment for partial atrioventricular septal defect (pAVSD)?

A

Surgery, usually at 3-5y old.

492
Q

In term infants, what is the normal range for haemoglobin at birth?

A

145-215 g/L

493
Q

What is the definition of anaemia in a neonate?

A

<140 g/L

Oishi's 5th year flashcards (8 decks)

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