Paeds Key Concepts Flashcards
1
Q
If a newborn has hypoglycaemia in the hours after birth what should you do and why?
A
Transient hypoglycaemia in the first 24 hours is common
Asymptomatic - encourage normal feeding (breast/bottle), monitor blood glucose
Symptomatic - admit to neonatal unit and IV 10% dextrose
2
Q
What are the key features of patent ductus arteriosus?
A
Left subclavicular thrill Continuous 'machinery' murmur Large volume, bounding, collapsing pulse Wide pulse pressure Heaving apex beat
3
Q
How is patent ductus arteriosus managed?
A
Indomethacin or ibuprofen (inhibits prostaglandin synthesis and promotes duct closure)
4
Q
What are the main features of acute lymphoblastic leukaemia?
A
Bone marrow failure
- anaemia (lethargy and pallor)
- neutropaenia (frequent/severe infections)
- thrombocytopaenia (easy bruising, petechiae)
Bone pain
Spleno/hepatomegaly
Fever (either representing infection or constitutional symptom)
Testicular swelling
5
Q
What are main common sign + symptom of anaemia?
A
Soft systolic murmur
Shortness of breath on exertion
6
Q
What is the management for whooping cough?
A
Azithromycin or clarithromycin if onset of cough within previous 21 days
7
Q
What are the 3 phases of whooping cough?
A
Catarrhal (getting worse)
Paroxysmal (v bad)
Convalescent (getting better)
8
Q
What are the main features of whooping cough?
A
Initial mild illness with coryzal symptoms, fever, mild cough that then progresses to clusters of lots of rapid coughs + long inspiratory effort + ‘whoop’ at end of cough clusters + cyanosis + vomiting (frequently post-cough cluster)
Unvaccinated kids
9
Q
When are children usually vaccinated against whooping cough?
A
2, 3, 4 months
3-5 years
10
Q
What is the management for croup?
A
A single immediate dose of oral dexamethasone (0.15mg/kg)
11
Q
When do most children achieve day and night time continence?
A
3-4 years old
12
Q
What is the management for noctural enuresis in children under 5?
A
Reassurance that this is normal and advice about fluid intake and encouraging to empty bladder regularly during day and before sleep
13
Q
What 4 things should be recorded in all febrile children?
A
Temperature
HR
RR
Cap refill
14
Q
What are the 3 risk classes for children with fever?
A
Green
Amber
Red
15
Q
What is the management for green, amber, and red risk class febrile children?
A
Green - manage at home with appropriate care advice + when to seek more help
Amber - safety net advice (advice on warning symptoms/a follow-up appointment/liaison with other HCPs)
Red - refer child urgently to paediatric specialist
16
Q
What are the 3 month motor development milestones?
A
Little or no head lag on being pulled to sit
Lying on abdomen, good head control
Held sitting, lumbar curve
17
Q
What are the 6 month motor development milestones?
A
Lying on abdomen, arms extended Lying on back, lifts and grasps feet Pulls self to sitting Held sitting, back straight Rolls front to back
18
Q
What is the 6-8 month motor development milestones?
A
Sits without support (refer at 12 months)
19
Q
What are the 9 month motor development milestones?
A
Pulls to standing
Crawls
20
Q
What are the 12 month motor development milestones?
A
Cruises
Walks with one hand held
21
Q
What is the 13-15 month motor development milestone?
A
Walks unsupported (refer at 18 months)
22
Q
What is the 18 month motor development milestone?
A
Squats to pick up a toy
23
Q
What are the 2 years motor development milestones?
A
Runs
Walks upstairs and downstairs holding onto rail
24
Q
What are the 3 years motor development milestones?
A
Rides a tricycle using pedals
Walks up stairs without holding onto rail
25
What is the 4 years motor development milestone?
Hops on one leg
26
When is neonatal hypoglycaemia severe enough to warrant admission and what do you do on admission?
- Symptomatic
- very low blood glucose (<1mmol/L)
IV 10% dextrose on admission
27
What is first-line treatment for idiopathic constipation in children?
Movicol Paediatric Plan (polyethylene glycol 3350 + electrolytes) on escalating dose regimen
28
What should you do if first-line treatment for idiopathic constipation in children does not lead to disimpaction within 2 weeks?
Stimulant laxative (senna)
29
What does short stature and primary amenorrhoea suggest?
Turner's Syndrome
30
What is Turner's Syndrome?
Primary amenorrhoea (amongst other issues) caused by presence of only 1 X chromosome or deletion of short arm of one of the X chromosomes
31
When a child lacks capacity, what consent is required to administer treatment if it's in the best interests of the child?
Consent from one parent (as long as it's in best interests)
32
When is jaundice always pathological in newborns?
In the first 24 hours
33
What are 4 causes of jaundice in the first 24 hours of life?
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
Glucose-6-phosphodehydrogenase
34
How does seborrhoeic dermatitis (cradle cap) usually present in children?
Erythematous rash + coarse yellow scales
| V young child
35
How is seborrhoeic dermatitis managed?
Mild-moderate - baby shampoo and baby oils
Severe - mild topical steroids e.g. 1% hydrocortisone
36
What is the first sign of puberty in boys?
Increase in testicular volume
37
What does erythematous rash, poorly demarcated, and covering 10% of total body area with no history of common allergen contact or new skincare products + Hx of familial atopy suggest?
Atopic dermatitis (eczema)
38
When does idiopathic thrombocytopenic purpura need treated?
If platelets <10*10^9/L
OR
Significant bleeding
- otherwise it resolves 80% of the time within 6 months with/without treatment
39
How is Prader-Willi syndrome inherited?
Imprinting - Prader-Willi gene deleted from father
40
What are the murmur findings for ventricular septal defect?
Pansystolic murmur in lower left sternal border
41
What are the murmur findings for coarctation of the aorta?
Crescendo-decrescendo murmur in upper left sternal border
42
What are the murmur findings for patent ductus arteriosus?
Diastolic machinery murmur in the upper left sternal border
43
Ejection systolic murmur in the upper left sternal border
Pulmonary Stenosis
44
When are bow legs in a child normal and what is the management?
<3 years old
| Usually resolves by 4 y/o so just reassure patients
45
What is the most common cause of primary headache in children?
Migraine
46
What are the features of hand, foot, and mouth disease?
Mild systemic upset
Oral ulcers
FOLLOWED by vesicles on palms and soles
47
How does congenital cytomegalovirus (passing of CMV from mum to baby during pregnancy) present?
```
Child with:
Hearing loss
Low birth weight
Petechial rash
Microcephaly
Seizures
```
48
When can a child with scarlet fever return to school?
24 hours after commencing antibiotics
49
What are the presenting features of scarlet fever?
Blanching, red, punctate, rough sandpaper-like texture rash on torso
Fever, sore throat
Throat red with petechiae on hard and soft palate
Tongue covered in white coat + red papillae
50
What is the management of scarlet fever?
Oral penicillin V for 10 days (azithromycin in case of allergy)
Can return to school 24 hrs after starting abx
SF is a notifiable disease
51
Why should a child with limp/hip pain and fever be referred for same-day assessment?
Want to rule out septic arthritis due to poor outcomes
| - likely to be transient synovitis but must make sure first
52
How should UTI in the 3 brackets of children be managed?
<3 months - Immediate referral to paediatrician
>3 months upper UTI - consider admission, oral cephalosporin or co-amoxiclav for 7-10 days
>3 months lower UTI - oral abx 3 days (trimethoprim, nitrofurantoin, cephalosporin, amoxicillin) + bring child back if still unwell after 24-48 hrs
Consider prophylactic abx if recurrent UTIs
53
What is plagiocephaly and what is the prognosis?
Skull deformity - unilateral occipital flattening due to campaign around prevent SIDS
Vast majority of children improve by age 3-5 due to adoption of upright posture. Can also put child on tummy in day, supervised supported sitting during day.
54
What is the characteristic presentation of measles?
Fever + myalgia + painful eyes
Conjunctivitis
Clusters of white lesions on buccal mucosa (Koplik spots)
55
Main risk factor for transient tachypnoea of the newborn
C-section (risk factor for?)
56
Transient tachypnoea of the newborn CXR appearance
Appearance on CXR
- Hyperinflation of the lungs
- Fluid in horizontal tissue
57
Threadworm treatment
Mebendazole single dose + hygiene advice/measures for whole household
58
Clinical features of ASD
Impaired social communication/interaction
Repetitive behaviours, interests, activities
Intellectual/language impairment
59
Management of ASD
Early educational/behavioural interventions (ABA, ASD preschool, TEACCH, ESDM, JASPER)
SSRIs - symptom relief for anxiety, aggression, repetitive behaviour
Antipsychotics - symptom relief for aggression, self-injury
Methylphenidate - ADHD
Family support/counselling
60
Causes of stridor in children
Croup - 6 months-3 years (+barking cough, fever, coryzal sx)
Acute epiglottitis - 2-6 years (+rapid onset, unwell/toxic child, drooling)
Inhaled FB - choking, coughing, vomiting
Laryngomalacia - congenital abnormality of larynx, 4-8 weeks
61
Normal basic obs for infants
RR 30-60
HR 100-160
T 37c
62
Turner's syndrome complication --> crescendo/decrescendo murmur UR sternal border radiating carotids
Bicuspid aortic valve (complication of + description)
63
Investigations for developmental dysplasia of the hip (DDH)
Ultrasound
| >4.5mths then X-ray
64
Risk factors for DDH
Female sex - 6x greater
| Breech presentation
65
Routine US exam for infants in these categories
1st degree FHx of hip problems in early life
Breech presentation ≥36w gestation
Multiple pregnancy
66
Barlow test
Test that attempts to dislocate an articulated femoral head
| - checks for DDH
67
Investigation for vesicoureteric reflux
Micturating cystourethrogram
68
≤3m old infant
| Irritability, general lethargy, poor feeding, fevers +/- seizures.
Meningitis presentation in infants
69
Treatment for meningitis in children <3m
```
IV amoxicillin
IV cefotaxime (cover Listeria)
```
70
Congenital diaphragmatic hernia prognostic factors
```
Liver position (liver in chest is bad)
Lung-to-head ratio (estimates foetal lung size, >1.0 is good)
```
71
IV fluid resus amount in children/young people
20ml/kg over <10 mins (0.9% NaCl bolus)
72
Daily fluid calculation method in children
Maintenance = 100ml/kg for first 10kg, 50ml/kg for next 10kg, 40ml/kg for next 20kg
Replacement = 100ml/kg/day
73
Foetal alcohol syndrome key feature
Microcephaly (+/- smooth philtrum, hypoplastic upper lip, epicanthic folds)
74
Innocent murmurs in children characteristics
Characteristics
```
Soft-blowing murmur in pulmonary area
Short buzzing murmur in aortic area
May vary with posture
Localised, no radiation
No diastolic component
No thrill
No added sounds (e.g. clicks)
Asymptomatic child
No other abnormality
```
75
3 years to acquire tolerance
Common milestone to achieve milk tolerance (esp post-milk ladder)
76
Investigation used for diagnosis AND grading of severity in vesicoureteral reflux (a.k.a reflux nephropathy)
Micturating cystography
77
Red flag symptoms/signs in child with fever
Colour - Pale/mottled/ashen/blue
Activity - no response to social cues, appears ill to a HCP, doesn't wake or doesn't stay awake if roused, weak/high-pitched/continuous cry
Respiratory - grunting, RR >60, moderate/severe chest indrawing
Circulation or hydration - reduced skin turgor
Other - age <3m + temp ≥38. Non-blanching rash. Bulging fontanelle. Neck stiffness. Status epilepticus. Focal neurological signs. Focal seizures.
78
Definition + description of hypospadias + 2 associated conditiosn
Congenital abnormality of the penis - ventral urethral meatus, hooded prepuce, chordee (ventral curvature of penis) in more severe.
Associated with cryptorchidism (present in 10%) and inguinal hernia
79
Management of hypospadias
Refer to specialist services
Corrective surgery at 12 months, don't circumcise before
If very distal don't treat
80
Pulses to check in infant BLS
Brachial and femoral arteries
81
Pathogen for bronchiolitis
Respiratory synctial virus (RSV) (75-80%
Also mycoplasma, adenoviruses or secondary bacterial infection
82
Conditions likely to make bronchiolitis more severe
Bronchopulmonary dysplasia (e.g. if premature)
Congenital heart disease
CF
83
Examination findings for transposition of the great arteries
Loud single S2 sound
Prominent right ventricular impulse palpable
NO murmur
84
Pierre-Robin syndrome presentation
Baby with micrognathia (small lower jaw), posterior tongue, cleft palate with no FHx
85
Obese boy + groin/thigh/knee pain =
?slipped capital femoral epiphysis
86
Perthes' disease prognosis if present <6y + management
Good prognosis <6y
| Requires only observation
87
Course of action for unilateral undescended testicle
Review at 3 months
| If persistent then refer
88
Indication for bone marrow exam in children with immune thrombocytopenia (ITP)
Only required if there are atypical features
89
Transposition of great arteries cyanotic or non-cyanotic?
Cyanotic
90
'Tripod' position + condition
Leaning forward with neck extended while seated
| Acute epiglottitis
91
Ebstein's anomaly findings on exam + Ix
Systolic murmur
| Echo - right atrial hypertrophy + septal and posterior leaflet of the tricuspid valve attached to right ventricle
92
Management of unborn with exomphalos (intestine outside abdomen, developmental issue)
C-section to reduce risk of sac rupture
93
SpO2 readings expected from healthy neonate
Suboptimal SpO2 readings expected in first 10 mins of life (like 70% and above)
94
Chickenpox risk factor for what kind of soft tissue infections
Invasive group A strep soft tissue infections
| including NECROTISING FASCIITIS
95
Commonest benign cause of noisy breathing in infants
Laryngomalacia
96
Treatment of uncomplicated transient tachypnoea of the newborn
Observation + supportive care +/- oxygen
97
Ventricular septal defect increases the risk of...
Endocarditis
98
What is fragile X syndrome?
A trinucleotide repeat disorder
99
Childhood disorders associated with fragile X syndrome
Learning difficulties
Autistic spectrum disorder
- particularly in males
100
Genetic anticipation definition
Hereditary diseases that have an earlier age of onset through successive generations
101
Types of hereditary disorders (+2 examples) that exhibit genetic anticipation
Trinucleotide repeat disorders
- Huntington's disease
- Myotonic dystrophy
102
Differentiation between bronchiolitis and pneumonia in a child
Bronch - low-grade fever
| Pneumonia - high-grade fever (>39) and/or persistently focal crackles
103
Head injury red flags for immediate CT in children
```
Loss of consciousness >5 mins
Amnesia >5 mins
Abnormal drowsiness
3+ vomits
Suspected non-accidental injury
Post-traumatic seizure without epilepsy
GCS <14
Suspected open/depressed skull injury/tense fontanelle
```
104
How long can transient hypoglycaemia last in the newborn
First hours to days
105
Key risk factor for neonatal hypoglycaemia
Preterm birth (<37 wks)
106
Most common signs of neonatal sepsis
Grunting and other signs of respiratory distress
107
Hirschsprung's disease diagnostic test
Rectal biopsy to examine under microscope for absence of ganglionic cells
108
Definition of Kawasaki's disease
Fever for 5+ days with 4 of:
- dry cracked lips
- bilateral conjunctivitis
- peeling of skin on fingers and toes
- cervical lymphadenopathy
- red rash over trunk
109
Characteristic rash of systemic-onset juvenile idiopathic arthritis/Still's disease
Salmon-pink
110
Passage of meconium normal time + red flag time (and associated condition)
Normally in first 24 hours
| Red flag is >48 hours (delayed passage, Hirschsprung's disease)
111
Large volume, bounding, collapsing pulse
Patent ductus arteriosus
112
Organism responsible for majority of croup cases
Parainfluenza virus
113
Boy with learning difficulties, extremely friendly + extroverted. Short for his age + supravalvular aortic stenosis
William's syndrome
114
Poor prognostic factors for ALL
Presenting <2 or >10 years
Having B or T cell surface markers
Having WCC >20x10^9/L at diagnosis
Male
115
Treatment of pyloric stenosis
Ramstedt pyloromyotomy
116
Investigation for stable children ?Meckel's diverticulum
Technetium scan
117
Episodic hypercyanotic spells sometimes resulting in loss of consciousness in infants - name of spells + condition associated
'tet' spells
| Tetralogy of Fallot
118
Don't do this on examination of croup patient
Don't do THROAT examination - airway obstruction risk (also in acute epiglottitis)
119
Next management step in 5-16y with asthma not controlled by SABA (salbutamol)
Add low-dose corticosteroid inhaler (beclometasone)
120
Paediatric basic life support ratio of chest compressions to rescue breaths
15:2
121
Chickenpox school exclusion protocol
Exclude until:
- lesions are dry
- lesions have crusted over (usually about 5 days after rash onset)
122
Major complication of Kawasaki disease + investigation
Coronary artery aneurysm
| - echocardiogram
123
Inheritance chance of autosomal dominant disease if 1 parent has it and other parent doesn't have it
50%
124
Asthma in child <5 not controlled with SABA and low-dose ICS - next step?
Add leukotriene receptor antagonist (montelukast)
125
Asthma not controlled by SABA, ICS, leukotriene receptor antagonist - next step?
```
Stop leukotriene receptor antagonist
Add LABA (long-acting beta-agonist)
```
126
Management of VZV exposure if immunosuppressed
VZIG
127
Causes of snoring in children
```
Obesity
Nasal problems
Recurrent tonsillitis
Down's
Hypothyroidism
```
128
What is Kallman's syndrome
Delayed puberty secondary to hypogonadotrophic hypogonadism
129
Management step after general advice and rewards systems
Enuresis alarm
130
Management of DDH
Most spontaneously stabilise by 3-6 wks
Pavlik harness if <4-5 mths
Older children may require surgery
131
Pavlik harness description
Dynamic flexion-abduction orthosis
132
Test if neonate has abnormal hearing test at birth
Offered auditory brainstem response test as a newborn/infant
133
Investigation of choice in ?intussusception
Ultrasound
134
Pain in legs with no obvious cause or worrying features. Diagnosis?
Growing pains
135
Management of appendicitis
Appendicectomy
136
Management of necrotising enterocolitis
Medical management
| Laparotomy if deteriorates
137
Management of intussusception
Pneumatic reduction under fluoroscopic guidance
138
Most common childhood leukaemia + triad of presenting symptoms/signs
Acute lymphoblastic leukaemia
Anaemia + neutropenia + thrombocytopenia
139
Management of exomphalos vs gastroschisis
Exomphalos - gradual repair (staged closure starting immediately with completion at 6-12 mths)
Gastroschisis - URGENT correction required
140
Achondroplasia inheritance pattern + outcomes for potential children
Autosomal dominant
25% normal
50% affected heterozygous
25% affected homozygous (die in first months)
141
Investigation for ?slipped upper femoral epiphysis
Hip x-ray
142
Investigation for ?DDH
US hip
143
?Perthe's disease investigation
MRI scan
144
When should parents call an ambulance in the event of a febrile child's seizure
If convulsion (febrile remember) lasts >5 MINS
145
Hirschsprung's disease management
Rectal washouts/bowel irrigation
146
Neurological disease Down syndrome associated with later in life
Alzheimer's disease
147
Management of umbilical hernias in children
Usually self-resolve
If large + symptomatic = elective repair at 2-3 y/o
If small + asymptomatic = elective repair at 4-5 y/o
148
Characteristic clinical progression of roseola infantum
Fever FOLLOWED BY rash (fever can start resolving before rash appearance)
149
Number 1 cause of massive PAINLESS GI bleeding in children between 1-2y/o + management
Meckel's diverticulum
| Requires transfusion
150
Advice to give CF patients concerned about recurrent infections
Avoid other CF patients
151
Androgen insensitivity classic presentation
Primary amenorrhoea but secondary sexual characteristics have started
152
Triad of shaken baby syndrome
Retinal haemorrhages
Subdural haematoma
Encephalopathy
153
Triad of ALL
Anaemia
Neutropenia
Thrombocytopenia
154
Commonest red flag in children with a fever
Moderate to severe intercostal recession
155
Chest compression technique in infants and children aged 1-puberty
Infants - 2 thumb circling technique
| 1-puberty - 1 hand on lower half of sternum
156
Perthes disease aetiology + triad
Avascular necrosis of femoral head
| Progressive hip pain, limp, stiffness
157
Initial management of duct dependent congenital heart disease
Prostaglandins to keep ductus arteriosus open
158
Management of patent ductus arteriosus with no other cardiac defects
Indomethacin given to neonate postnatally to close the duct (not to mother during antenatal)
159
Most common CO for early-onset (<48 hrs post-birth) neonatal sepsis
GBS
160
Diagnostic investigation for necrotising enterocolitis
Abdo XR
161
Inherited disease associated with neonatal hypotonie
Prader-Willi syndrome
162
Sites prone to dermoid cyst formation
Sites of embryonic fusion
163
CF can cause...
Diabetes mellitus
164
FSH/LH levels in gonadotrophin independent precocious puberty
Both LOW
165
School attendance advice for child with impetigo
Exclude from school until lesions are crusted and healed
or
48 hours after commencing ABx treatment
166
Age at which autism normally apparent
3 years
167
Diet advice in CF
High calorie + high fat + pancreatic enzyme supps EVERY meal
168
10 years old with constipation, management
Likely dietary cause so dietary advice (increase fibre + fluids)
Laxative - osmotic to soften then stimulant to pass stool
169
Rocker-bottom feet feature of which trisomy
Edward's syndrome/trisomy 18
170
Necrotising fasciitis CO
Beta-haemolytic GAS
171
Additional scan required for all babies breech at 36+ wks regardless of delivery method + what date post-birth
USS for DDH screening at 6 wks
172
LFT raised in biliary atresia
Conjugated bilirubin
173
When not to use antidiarrhoeal meds in children
Don't use if <5 with D&V caused by gastroenteritis
174
Rotavirus vaccine type of vaccine
Oral + live + attenuated vaccine
175
Most common complication of measles
Otitis media
176
Investigation for ?SUFE (slipped upper femoral epiphysis)
AP + frog-leg view x-ray
177
General trend for types of conditions inherited in an autosomal recessive/dominant manner (AR/AD)
Metabolic - AR
| Structural - AD
178
Steps in eczema management
Topical emollient
Topical steroid
Wet wrapping
Oral ciclosporin
179
Cause of Ebstein's anomaly
Use of lithium in pregnancy
180
Heart murmur in Ebstein's anomaly
Pan-systolic murmur + mid-diastolic murmur
181
Features of atypical UTI in infants <6mths
```
Seriously ill
Poor urine flow
Abdo/bladder mass
Raised creatinine
Septicaemia
Failure to respond to suitable abx in 48 hours
Infx with non-e.coli CO
```
182
Newborn resus algorithm
Dry baby + start clock
Assess tone, breathing, HR
If gasping/not breathing give 5 inflation breaths
Reassess for increase in HR (want this, if no increase then give better inflation breaths)
If chest not moving get 2 people.
If chest moving but no HR then chest compressions 3:1 to 1 inflation breath
Reassess HR every 30 secs
183
FAP inheritance pattern
Autosomal dominant
184
Heel prick test date + diseases tested for
Day 5 of life
| CF, congenital hypothyroid, sickle cell disease, other metabolic diseases
185
Positive heel prick test result for CF
Raised immunoreactive trypsinogen (IRT)
186
Next step if positive heel prick test for CF
Sweat test (high in CF)
187
Key feature of irritant dermatitis (nappy rash)
Flexural sparing
188
Factors in CF associated w/increased morbidity + mortality
Chronic infections with Pseudomonas and Burkholderia species
189
Exacerbation of asthma treatment in child
Oral prednisolone for 3 days
190
Elfin facies, strabismus, broad forehead, short stature
William's syndrome
191
Bowel sounds (tinkling when listening to chest) on RESP exam of neonate = ?
Congenital diaphragmatic hernia
192
Commonest CO of bacterial pneumonia in children
Strep pneumoniae
193
Triad seen in tetralogy of fallot
Cyanosis/collapse in 1st month of life
Hypercyanotic spells
Ejection systolic murmur at left sternal edge
194
Investigation if ?West syndrome/infantile spasms
EEG - hypsarrhythmia
195
Caput succedaneum features + prognosis
Soft, puffy swelling of the scalp due to localised oedema. Crosses suture lines
No treatment needed - resolves in a few days
196
Cause of caput succedaneum
May be due to mechanical trauma to initial portion of scalp pushing through cervix in prolonged delivery or if VACUUM used (ventouse delivery)
197
Gender split for Perthes' disease
5: 1
boys: girls
198
Sandpaper rash = ?
Scarlet fever
199
Treatment for Kawasaki disease
High dose aspirin
| Single dose of IV Ig
200
Vaccines given at 2 months
6-1
Men B
Rotavirus
201
Components of 6-1 vaccine
```
Diphtheria
Tetanus
Whooping cough
Polio
Hib
Hep B
```
202
Vaccines at 12-13 months
Hib/Men C
MMR
PCV
Men B
203
Loss of red reflex in child + FHx of enucleation
Retinoblastoma
204
Vaccines offered to women 16-32 wks pregnant
Pertussis + influenza vaccine
205
Features of a LIFE-THREATENING asthma attack (6)
```
Cyanosis
Poor resp effort
PEF <33% of normal
Silent chest
Altered level of consciousness
PO2 <92%
```
206
Indication of poor resp effort in life-threatening asthma attack
NORMAL pCO2 (4.8-6)
207
Treatment for ?bacterial meningitis in children
<3mths - IV cefotaxime + amox/amp
| >3mths - IV ceftriaxone (add vanc if recent travel)
208
RFs for infants to develop RSV
Prematurity
Lung or heart abnormalities
Immunocompromise
209
Treatment for prevention of RSV in infants (with RFs for severe disease)
Palivizumab (monoclonal ab for RSV prevention)
210
Dates for Men B vaccine admin
2, 4, 12-13 months
211
Small chin (micrognathia), posterior displacement of tongue, cleft palate
Pierre-Robin syndrome
212
3M, learning difficulties, supravalvular aortic stenosis
William's syndrome
213
Micrognathia (small chin) + rocker-bottom feet
Edward's syndrome
214
Baby jittery + hypotonic = ?
?Neonatal hypoglycaemia
215
RF for neonatal hypoglycaemia + management
Maternal labetalol use
| Measure blood glucose
216
Vaccine at 12-13 years
HPV for boys AND girls
217
Difference between early and late shock in children
Early = compensated = reversible
Late = decompensated = (may be) irreversible
Difference lies in BLOOD PRESSURE - low = decomp
218
Visible LUQ peristalsis in unwell child
Pyloric stenosis
219
LP findings = bacterial meningitis
Non-turbid
High protein
High WBC
Gram-positive organism
220
Teenage (13-18) vaccines
Men ACWY
| 3-1 (tetanus, diphtheria, polio)
221
Painless haematuria + palpable non-tender mass + reduced appetitie + distended abdomen
Wilms' tumour
222
Management of child with limp + hip pain + fever in GP
Refer for same-day hospital assessment
| - ?transient synovitis
223
Age 3-8 with hip pain after being unwell recently
Transient synovitis
224
4 core components in Child Health Promotion Program (early life checkups)
Newborn clinical exam
Newborn hearing test
Heel prick 5-9 days
GP exam 6-8 weeks
225
Treatment for biliary atresia (child + conjugated hyperbilirubinaemia)
Early surgical treatment
226
RIF pain differentials + dist features
Appendicitis - abdo tenderness + guarding
Pyelonephritis - positive urine dip
Intussusception - <9mths + colic pain
Mesenteric adenitis - no abdo tenderness/guarding + post-viral infx
Meckel's diverticulum - like appendicitis but with severe pain + around 2yo
227
Criteria for admission in ?bronchiolitis
Apnoea (observed/reported)
Persistent O2 sats <92%
<50% normal fluid intake
Resp distress (grunting, marked chest recession, RR >70)
228
Height centile for referral to paediatrician
≤0.4th height centile
229
Investigation of jaundice in first 24hrs of life
Urgent serum bilirubin
230
Features of growing pains
Not present start of day
No limp or limitation of physical activity
Systemically well
Normal O/E
Motor milestones normal
Sx often intermittent + worse after day of vigorous exercise
231
Children of affected males in x-linked recessive inheritance patterns
Unaffected sons
| Carrier daughters
232
Children of heterozygous female carrier of x-linked recessive inheritance patterns
Males - 50% chance of being affected
| Females - 50% chance of being a carrier
233
Commonest cause of cardiac arrest in children
Respiratory - hypoxic cardiac arrest (choking v common)
234
Management of PDA in cyanotic and acyanotic congenital heart disease
Cyanotic - prostaglandin E1 (maintain PDA to allow oxygenated blood to reach systemic circulation)
Acyanotic - indomethacin to close PDA
235
Name of newborn hearing test
Otoacoustic emission test
236
Management of hand, food, and mouth disease
Symptomatic treatment only
237
Scenarios where vaccinations are delayed or given in a different setting
Vaccines delayed if FEBRILE illness/intercurrent infection
| Vaccines given in hospital if born <28 weeks (risk of apnoea)
238
Infantile spasms/West syndrome prognosis
Poor prognosis
239
Management of child <3 y/o with acute limp
Urgent hospital assessment (risk of septic arthritis or maltreatment)
240
Differentials for jaundice in first 24hrs of life
Rhesus haemolytic disease
ABO incompatibility
G6PD deficiency
Hereditary spherocytosis
241
Investigation in jaundice in first 24 hrs of life
Blood film analysis
242
Triad for biliary atresia
Presents in FIRST few weeks of life
- jaundice
- appetite disturbance
- growth disturbance
243
Chance of male-to-male transmission of X-linked recessive conditions
0% (inherit the unaffected Y chromosome)
244
Webbed neck + pectus excavatum
Noonan syndrome
245
Small eyes + polydactyly
Patau syndrome
246
Learning difficulties + macrocephaly
Fragile X
247
Management of GORD in children
2 week trial of thickened formula or alginate therapy (Gaviscon)
4 week trial of PPI if refractory
248
Murmur in Turner's
Ejection systolic (bicuspid aortic valve)
249
Management of acute epiglottitis
Involve seniors
Endotracheal intubation to protect airway
O2
IV abx
250
Management of viral-induced wheeze
Symptomatic first-line
Short-acting beta 2 agonists (salbutamol) via spacer
Intermittent leukotriene receptor antagonist (montelukast) or corticosteroids
251
Management of any acute asthma attack
Bronchodilator + steroids
- inhaled broncho via spacer or mask if <3 (refer to hosp if beta-2 agonist doesn't control)
- oral steroids for 3-5 days
252
Oral prednisolone dosage for acute asthma attack in children
```
2-5y = 20mg OD or 1-2mg/kg OD (max 40mg)
>5y = 30-40mg OD or 1-2mg/kg OD (max 40mg)
```
253
Jelly-like stool
Intussusception
254
Strawberry tongue + cracked red lips
Kawasaki disease
255
Do antipyretics prevent febrile convulsions?
No
256
Criteria for considering hospital referral in ?bronchiolitis
RR >60
Decreased oral/fluid intake 50-75% normal
Clinical dehydration
257
RF for meconium aspiration
Post-term delivery
258
Scarlet Fever CO
Group A haemolytic strep
259
When to admit child with croup
Moderate or severe croup
<6mths old
Laryngomalacia/Down's
Uncertain about diagnosis
260
Ix + ?Dx if child with calf hyperplasia + positive Gowers test
Genetic analysis
| MLDx - Duchenne muscular dystrophy
261
Key side-effects of methylphenidate (ADHD treatment)
```
Stunted growth
Insomnia
WL
Anxiety
Nausea
Pain
```
262
Pain character in Osgood-Schlatter disease
Unilateral (30% bilateral)
Gradual onset + progressive
Pain relieved at rest and made worse by kneeling/activity
263
3d fever + new rash now afebrile MLDx + CO
Roseola infantum
| HHV6
264
H F &M disease CO
Coxsackie A16
265
Potential cause of elevated bilirubin at birth
Bruising (forceps delivery)
266
Difference between gastroschisis and omphalocele
Gastroschisis - lateral to umbilicus
| Omphalocele - umbilicus
267
Gastroschisis lifestyle association
Socioeconomic deprivation - maternal age <20 + alcohol/tobacco use
268
Most common location of urethral location in hypospadias
Distal ventral surface of penis
269
Neonate w/poor feeding + grunting + lethargy =
Neonatal sepsis!!
270
Chest comp:ventilations ratio for paeds BLS + rate of chest comp
30:2 if lay person
15:2 if 2+ qualified rescuers
Give 100-120 comps per min
271
Rule for disclosing information about sexual activity in children <13
if <13 then share - considered not able to consent
272
Phenotype + genetic in androgen insensitivity syndrome
Female despite genetically XY
273
Masses palpable in androgen insensitivity syndrome
Undescended testes
274
Difference between meconium ileus and Hirschsprung's disease
Meconium ileus - ABDO DISTENSION
275
Common neonatal feature of CF
Meconium ileus (abdo distension + bil vomiting)
276
2 main features of congenital rubella syndrome
Sensorineural deafness
| Congenital cataracts
277
Protocol for review of undescended testicle
Review 6-8 wks after birth
Review at 3 months
Refer to paed surgeon if still present at 3 months
278
Preceding factor for idiopathic thrombocytic purpura
Self-limiting viral infection (e.g. glandular fever)
279
CO for erythema infectiosum/slapped cheek syndrome
Parvovirus B19
280
Most common presenting feature of Wilms tumour
Painless palpable abdominal mass
281
If need to provide emergency treatment for a child, what consent do you need?
None - 'you can provide emergency treatment without consent to save the life of, or prevent serious deterioration int he health of, a child or young person'
So do it if absolutely necessary and in their best interests
282
Intramural gas/pneumatosis intestinalis on AXR =
Necrotising enterocolitis
283
Initial intervention to reduce brain daamge in neonates with hypoxic injury
Therapeutic COOLING
- 33-34 for whole body
- 34-35 for selective head
284
Seizures that happen at night, usually affect the face, in a child otherwise normal
Benign rolandic epilepsy
285
Leukaemia Down's patients are most at risk of
ALL
286
Diarrhoea with undigested food in a toddler =
Toddlers diarrhoea or 'chronic nonspecific diarrhoea'
287
Pulmonary hypoplasia associated with...
Congenital diaphragmatic hernia
288
Management of febrile convulsions at home
Remove excess clothing, give fluids, and give antipyretics ONLY if child is uncomfortable (no active cooling)
289
Investigation in ?pyloric stenosis
Abdominal ultrasound
290
6in1 vaccine dates
2,3,4 months (8,12,16 weeks)
291
5 S's of innocent murmurs in children
```
Soft
Systolic
Short
Symptomless
Standing/Sitting (vary with position)
```
292
Continuous blowing noise just below clavicles
Venous hum (innocent murmur)
293
Low-pitched sound heard at lower left sternal edge
Still's murmur (innocent murmur)
294
Diagnostic test for Coeliac disease
IgA TTG antibodies
295
CF inheritance pattern
Autosomal recessive
296
Emergency treatment for croup (sats <90)
O2 + Neb adrenaline
297
School exclusion for whooping cough
2 days post-antibiotic start
| 21 days post-symptom start
298
School exclusion for roseola
No exclusion
299
Infant vs child presentation of whooping cough
Infants - cyanotic apnoeic periods instead of the "whoop" inspiration
300
Cyanotic congenital heart disease - TGA vs TOF
```
TGA = CCHD presenting in 1st DAYS of life
TOF = CCHD presenting in 1-2 MONTHS of life
```
301
1st-line for ADHD
Methylphenidate
302
Definition of precocious puberty
Development of secondary sexual characteristics before 8 years in females and 9 years in males
(more common in females)
303
Thelarche =
First stage of breast development
304
Adrenarche =
First stage of pubic hair development
305
Management of transient synovitis in otherwise well patient
Recommend rest + analgesia
306
Roseola infantum CO
Human herpes virus 6
307
Distinguishing feature between epilepsy and reflex anoxic seizures
RA seizures = QUICK recovery
| Epileptic seizures typically have a prolonged recovery
308
Most common heart lesion associated with Duchenne muscular dystrophy
Dilated cardiomyopathy
309
Corrected age calculation for premature babies (wrt development milestones)
Age minus the number of weeks born early from 40 weeks
| e.g. 32 weeks gestation you add 8 weeks to all the development milestones
310
Inheritance pattern of haemophilia
X-linked recessive (only occurs on X chromosomes and is recessive)
311
Investigation for renal scarring in vesicoureteric reflux
Radionuclide scan using dimercaptosuccinic acid (DMSA)
312
Cardiac abnormality potential in Fragile X syndrome
Mitral valve prolapse
313
Most common presentation of juvenile idiopathic arthritis + definition
Pauciarticular/oligoarticular arthritis
| - defined as affecting up to 4 different joints (typically larger ones elbows knees etc)
314
Surfactant deficiency preterm or late?
PRETERM - prematurity
315
Initial management of congenital diaphragmatic hernia
Insertion of NG tube to keep air out of the gut
Intubation + ventilation
Surgical repair of diaphragm (DEFINITIVE Mx)
316
When are babies screened for DDH
Newborn check + 6 week check with Barlow and Ortolani tests
317
Ortolani test
Attempts to relocate a dislocated femoral head
| - DDH
318
Other than Barlow/Ortolani tests, important tests for DDH
Leg length symmetry
Level of knees when hips + knees bilaterally flexed
Restricted abduction of hip in flexion
319
Screen for what instability in Down's
Atlanto-axial instability (if child participating in sports placing them at risk of neck dislocation)
320
What to monitor and when in Methylphenidate pt
Height + weight every 6 months
321
Definitive management of slipped capital/upper femoral epiphysis
In situ fixation with cannulated screw (ortho referral if primary care)
322
Commonest cause of nephrotic syndrome in children + aetiology + management
Minimal change glomerulonephritis
Accounts for 80% cases in children and 25% in adults with the majority of cases being idiopathic
Responds well to STEROIDS
323
Disease with prodrome of fever, irritability, and conjunctivitis
MEASLES
324
CENTRAL causes of hypotonia in children
Down's
Prader-Willi
Hypothyroidism
Cerebral palsy (hypotonia then spasticity)
325
Head swelling occurring several hours after birth, doesn't cross suture lines, takes months to resolve
Cephalohaematoma
326
Commonest cause of childhood hypothyroidism in UK
AI thyroiditis
327
Criteria used to assess probability of septic arthritis in children
Kocher's criteria
328
Hip pain in short child + hyperactivity between 3-8 years
Perthes disease
329
Child can consent to treatment but not...
REFUSE treatment
330
Causes of obesity in children
```
GH deficiency
Hypothyroidism
Down's
Cushing's
Prader-Willi
```
331
Motor neurons damaged in cerebral palsy
Upper motor neurones in periventricular white matter
332
Inheritance pattern in disease where all familial females are affected and inheritance stops abruptly in men (children of these men unaffected)
MITOCHONDRIAL inheritance (affected man can't pass this on to kids)
333
Lumbar puncture contraindicated in...
Meningococcal septicaemia
334
Commonest child abuse fractures
Radial, humeral, femoral
335
Management of phimosis (foreskin swelling + inability to retract)
<2 - reassure normal and may resolve over time
| >2 - if recurrent + UTI or balanoposthitis then treat
336
Atrialisation of the right ventricle
Ebstein's anomaly (small RV + large RA)
337
Osteochronditis caused by inflammation (apophysitis) at tibial tuberosity
Osgood-Schlatter disease
338
Fever + stridor + SoB caused by haemophilus influenzae B
Acute epiglottitis
339
Cyanosis/collapse in 1ST MONTH of life + ejection systolic murmur
Tetralogy of Fallot
340
White nodules on posterior hard palate/roof of mouth along the midline commonly mistaken for neonatal teeth
Epstein's pearls (no tx required)
341
Congenital infection, perinatal brain injury, fetal alcohol syndrome, Patau syndrome, craniosynostosis, familial, normal variation
MICROcephaly causes
342
Childhood infection commonly associated with pneumonia developing immediately after initial infection
Measles
343
Slight forward lean + normal RR + fever
?Acute epiglottitis
344
Childhood disease indicated for Echocardiogram + why
Kawasaki disease
| - coronary artery aneurysms are a complication need to be screened for
345
Commonest cause of ambiguous genitalia in newborns
Congenital adrenal hyperplasia
346
Commonest cause of overgrowth of tissue in umbilicus in first weeks of life
Umbilical granuloma
347
Tx for overgrowth of tissue that occurs during healing process of umbilicus
Regular application of salt to wound or cauterisation with silver nitrate
- umbilical granuloma
348
Drug risk in chickenpox
NSAIDs - necrotising fasciitis
349
Term for death in first 28 days of life
Neonatal death
(early = <7 days)
(late = >7 days)
350
Term for maternal death in first 6 weeks after birth
Puerperal death
351
Best practice administration of vit K to newborns
Once-off IM injection
352
Age bracket of febrile convulsion incidence (+ typical age of stopping)
6mths to 5 years
| Usually stop having these at 5 years
353
Minutes of age APGAR assessed
1, 5, 10 mins of age
354
Management of palpable painless abdominal mass in child <5 yrs, typically around 3 yrs
Speak to local paediatrician as could be Wilm's tumour
355
Unexplained lump/swelling + unexplained bone pain
?Osteosarcoma (rare)
356
Precocious puberty + small testes = ?
Adrenal cause of symptoms (i.e. adrenal hyperplasia)
357
Trident hands in child = ?
Achondroplasia
358
Clinical findings suggestive of child sexual abuse
Anal fissures
| Recurrent UTIs
359
Condition associated with nasal polyps + recurrent respiratory infections requiring hospitalisation
Cystic Fibrosis
360
Necessary investigation in newborn <24hrs with jaundice + high risk for hyperbilirubinaemia
Measure SERUM BILIRUBIN within 2 hours
361
Management of ADHD
10 wks watch and wait
If persist then secondary care referral
Educate on normal balanced diet (no need for special foods if food diary has not demonstrated a link between those foods and behaviour)
Methylphenidate if unsuccessful
362
When are BCG, Men ACWY, yellow fever, and Hep A vaccines offered to children?
BCG - given to <1yrs born in area of UK with high TB rate or parents/grandparents born in country with high rates of TB
Men ACWY - teenagers going uni for first time
Yellow fever - given to >1yrs arriving from sub-Saharan Africa or tropical South America
Hep A - given to >1yrs travelling to Africa, Asia, Central/South America
363
Investigations in fever <3mth child workup
```
FBC
Blood culture
CRP
Urine dip for UTI
CXR if resp signs present
Stool culture if diarrhoea present
```
364
Mass in anterior triangle of neck in midline below hyoid. Rises on protrusion of tongue + swallowing
Thyroglossal cyst
365
Syndrome that's the commonest cause of inherited neurodevelopmental delay and is associated with ADHD. Presents around puberty
Fragile X syndrome
366
Drug use in pregnancy that can cause orofacial clefts
Anti-epileptics
367
Peak incidence of ALL
2-5yrs
368
Major RFs for sudden infant death syndrome
```
Prone sleeping
Parental smoking
Bed sharing
Hyperthermia and head covering
Prematurity
```
