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Passmed paeds Flashcards

1
Q

What is the first line management for enuresis?

A

Below 5 - watch and wait, reassurance.
After 5 - enuresis alarm.

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1
Q

What is the first line investigation for intussusception?

A

USS.

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2
Q

What is the triad of shaken baby syndrome?

A

Retinal haemorrhages, subdural haematoma, encephalopathy.

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3
Q

What is the triad of autism spectrum disorder?

A

Communication impairment
Impairment of social relationships
Ritualistic behaviour

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4
Q

How does congenital rubella syndrome present?

A

Sensorineural deafness
Congenital cataracts

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5
Q

What are the drugs to close and maintain the ductus arteriosus?

A

Close - indomethacin
Prevent closure - prostaglandin E1

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6
Q

What’s the most common type of diarrhoea with undigested food?

A

Toddler’s diarrhoea

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7
Q

Give a mnemonic for Scarlet fever?

A

Scarlet fever - 5 S’s - give penicillin V:

Sky-high fever
Spewing
Sore throat
Strawberry tongue
Sandpaper rash

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8
Q

What is the average presentation time for cyanotic heart disease?

A

TOF (tetra) - 4 weeks
TGA (3 letters) - first few days of life

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9
Q

When is hand preference abnormal and why?

A

Below 12 months - cerebral palsy

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10
Q

What heart conditions are associated with heart conditions?

A

Left sided heart lesions:

Bicuspid aortic valve
Coarctation of the aorta
Aortic stenosis

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11
Q

What is the number one cause of painless massive GI bleed in children aged between 1 and 2?

A

Meckel’s diverticulum

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12
Q

What is the treatment for threadworms?

A

Treat all household contacts regardless of symptoms with oral mebendazole

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13
Q

How is undescended testes managed?

A

Unilateral:
review at 3 months
refer for surgery at 6m if still undescended

Bilateral: urgent review by senior within 24h

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14
Q

What do infantile spasms look like?

A

Repeated flexion of head/arms/trunk followed by arm extension

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15
Q

What is the most common heart condition associated with Duchenne muscular dystrophy?

A

Dilated cardiomyopathy

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16
Q

What is the most common cause of stridor in children?

A

Laryngomalacia

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17
Q

What is a mnemonic for gross motor milestones?

A

Heads, shoulders, knees and toes:
3, 6, 9, 12 months
Head control, sitting up, crawling, walking

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18
Q

How may a child with missed developmental dysplasia of the hip present?

A

Trendelenburg gait and leg length discrepency

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19
Q

Describe paediatric BLS.

A

Chest compressions rate of 100-120/min, ratio of 15:2

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20
Q

What rescue medication may be given for febrile seizures?

A

Benzodiazepines:

buccal midazolam
rectal diazepam

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21
Q

What’s the age difference in Perthe’s and SUFE?

A

Perthe’s - primary school ages
SUFE - secondary school ages

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22
Q

What is the treatment for bacterial meningitis in infants under 3 months?

A

IV cefotaxime and IV amoxicillin

No corticosteroids in children under 3 months

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23
Q

What is the first line treatment for DDH?

A

Pavlik harness

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24
Q

What is used to screen newborns for hearing problems?

A

Otoacoustic emissions test

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25
Q

What is used to reduce the chances of severe brain damage in neonates with hypoxic injury?

A

Therapeutic cooling - 33-35 degrees celcius

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26
Q

What is fetal alcohol syndrome associated with?

A

Microcephaly, smooth philtrum and thin upper lip

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27
Q

What is the age range for febrile convulsions?

A

6m to 5y

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28
Q

How may infants present with pertussis?

A

With apnoeas rather than the classic whoop

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29
Q

What is the most common complication of children with roseola infantum?

A

Febrile convulsions - 10-15%

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30
Q

Which murmur does PDA present with?

A

Continuous machinery murmur at upper left sternal edge

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31
Q

What investigations are needed infants younger than 3m with fever?

A

FBC, blood culture, CRP, urinalysis, CXR (resp sx), stool culture (diarrhoea sx)

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32
Q

Mnemonic for agpar score?

A

A - Appearance (skin colour)
P - Pulse
G - Grimace (reflex irritability - cry)
A - Activity (muscle tone and movement)
R - Respiratory rate

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33
Q

What is a common electrolyte abnormality of subarachnoid haemorrhages?

A

Hyponatraemia

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34
Q

Describe roseola infantum.

A

Illness caused by HH6 or HH7.
High fever followed a few days later by rash

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35
Q

Mnemonic for Kawasaki disease?

A

CRASH and burn:

Conjunctivitis
Rash (non-vesicular)
Adenopathy (cervical lymph)
Swollen, strawberry tongue
Hand or feet swelling
Burn - fever lasts 5 more than 5 days

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36
Q

Describe hand, foot and mouth disease.

A

Mild systemic upset, oral ulcers and vesicles on palms and soles - coxsackie A16

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37
Q

What usually causes acute epiglossitis?

A

H. influenzae B

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38
Q

What causes Scarlet fever?

A

Group A haemolytic strep - mc s. pyogenes

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39
Q

What is the first line treatment for ADHD and it’s side effect?

A

Methylphenidate and stunted growth

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40
Q

What is a paediatric red flag in resp rate?

A

> 60

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41
Q

How may intestinal malrotation/volvulus present?

A

Billous vomiting, abdo pain, cramp, obstruction
Lethargy, poor appetite, infrequent bowel movements

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42
Q

What is the main difference between epileptic seizures and reflex anoxic seizures?

A

Reflex anoxic seizures - rapid recovery

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43
Q

What should be given to all children who have an asthma attack?

A

Oral prednisolone (40mg for 5 days)

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44
Q

When is APGAR stick routinely assessed?

A

1 and 5 minutes

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45
Q

What is the first sign of puberty in males and females?

A

Males - testicular growth
Females - boob growth

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46
Q

What safety net advice should be given to parents after a febrile convulsion?

A

Call ambulance if a febrile convulsion occurs for more than 5 minutes

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47
Q

What is an effective non-insecticide treatment for headlice?

A

Wet combing

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48
Q

What is a late sign of intussusception?

A

Red currant jelly stool

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49
Q

If a 2 month baby attended GP with a fever of 38.5 what do you do and why?

A

Urgent paediatric referral in hospital as a fever above 38 is a high risk of serious illness

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50
Q

What hearing test is done at school entry?

A

Pure tone audiometry

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51
Q

What is the difference between Barlow and Ortolani tests?

A

Barlow - Dislocating
Ortolani - Relocating

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52
Q

What is measles characterised by?

A

Prodromal Sx, Koplik spots, maculopapular rash starting behind ears and conjunctivitis

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53
Q

What often triggers idiopathic thrombocytopenic purpura (ITP)?

A

Self-limiting viral infection

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54
Q

What is the difference between Caput succedaneum and Cephalhaemtoma?

A

CS - Crosses suture lines
C - Don’t cross suture lines

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55
Q

What is the age of precocious puberty in males and females?

A

Males - 9
Females - 8

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56
Q

What electrolyte abnormalities are shown in pyloric stenosis?

A

Hypochloraemic hypokalaemic alkalosis

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57
Q

What is the most common signs of neonatal sepsis?

A

Grunting and other respiratory signs of distress

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58
Q

What is the main feature of benign ejection murmurs?

A

They vary with posture

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59
Q

In paediatric BLS, which pulses are palpated?

A

Brachial and femoral

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60
Q

When can’t you use anti-diarrhoea medication in children with D+V caused by gastroenteritis?

A

Below 5 years old

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61
Q

How does Perthe’s disease present?

A

Hip pain, limp and stiffness

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62
Q

When is hypospadias surgery performed?

A

Typically performed around 12 months

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63
Q

What is characteristic of JIA?

A

Salmon pink rash with arthritis

(fever, lymphadenopathy, uveitis, weight loss)

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64
Q

What is the first step of BLS?

A

After establishing there’s no breathing - give 5 rescue breaths

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65
Q

What are the signs of Edward’s syndrome?

A

Trisomy 18 - Micrognathia, low-set ears, rocker bottom feet, overlapping fingers

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66
Q

How long does it take Caput succedaneum and Cephalhaemtoma to resolve?

A

CS - few days
C - few months

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67
Q

What are life threatening features of an asthma exacerbation?

A

Sats below 92
PEF below 33
Silent chest
Agitated
Poor respiratory effort
Altered consciousness
Cyanosis
Normal pCO2

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68
Q

What is benign Rolandic epilepsy chracterised by?

A

Partial seizures at night

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69
Q

What is commonly associated with hypospadias?

A

Cryptochidism - 10%

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70
Q

Examination findings of TGA?

A

No murmur: loud single S2

Prominent RV impulse palpable

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71
Q

What is the most common cause of ambiguous genitalia?

A

Congenital adrenal hyperplasia

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72
Q

Five red flag symptoms in children?

A

Moderate/severe chest wall recession
Doesn’t awake if roused
Reduced skin turgor
Mottled or blue appearance
Grunting

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73
Q

What is a venous hum?

A

Benign murmur - like a continuous blowing noise under clavicles

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74
Q

How to manage neonate hypoglycaemia?

A

Low - encourage breastfeeding
Very low - IV 10% dextrose

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75
Q

How does congenital CMV present?

A

Hearing loss, low birth weight, petechial rash, microcephaly and seizures

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76
Q

Which maternal drug use can cause orofacial clefts?

A

Anti- epileptic drug use

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77
Q

When does infantile colic improve and resolve?

A

Improves around 3-4 months
Resolves around 6 months

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78
Q

Which condition is a girl most likely to have who has Haemophilia?

A

Turner’s syndrome - single X chromosome

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79
Q

If a newborn has an abnormal hearing test, what test is offered?

A

Auditory brainstem response

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80
Q

What are four central causes of hypotonia?

A

Cerebral palsy
Down’s syndrome
Prader-Willi syndrome
Hypothyroidism

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81
Q

Give speech and hearing milestones.

A

3m - turns towards sound
6m - double syllables (adah, erleh)
9m - mama, dada, understands no
12m - knows and responds to own name

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82
Q

Treatment of headlice in household?

A

No treatment unless affected

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83
Q

Describe the typical patient with Williams syndrome.

A

Boy with learning difficulties who is very friendly and extraverted. Short for his age and has supravalvular aortic stenosis

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84
Q

What is Rocker-Bottom feet associated with?

A

Edward’s syndrome - trisomy 18

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85
Q

What physical features is Williams syndrome associated with?

A

Elfin facies, strabismus, broad forehead, short stature

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86
Q

A child sees you in GP who is 2 months old with UTI, what do you do and why?

A

Refer immediately to hospital - infants less than 3 months

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87
Q

What is the emergency treatment for croup?

A

High-flow oxygen, nebulised adrenaline

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88
Q

What dose of dexamethasone is given to children with croup?

A

0.15mg/kg

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89
Q

What determines the severity of TOF and why?

A

RV outflow obstruction (PS) - if severe, deoxygenated blood will go through VSD and overriding aorta - more deoxygenated blood in arteries - more cyanosis

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90
Q

What is vesicouteric reflex?

A

Abnormal backflow of urine from bladder into ureter and kidney - common and predisposes to UTI

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91
Q

Investigations for vesicouteric reflex?

A

Micturating cystourethrogram
DMSA scan to look for renal scarring

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92
Q

Risk factors for DDH?

A

Fat, female, first-born, foot-first, family history

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93
Q

Management for child under 3y presenting with an acute limp?

A

Urgent paediatric assessment (to rule out septic arthritis or traumatic injury)

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94
Q

5 steps of newborn resuscitation?

A
  1. Dry baby and maintain temperature
  2. Assess tone, resp rate, heart rate
  3. Gasping or not breathing - 5 inflation breaths
  4. Reassess (chest movements)
  5. If HR not improving and <60bpm - compression/ventilation breaths at 3:1
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95
Q

When is the newborn heel prick?

A

From days 5-9:

5 weird diseases and 4 more common ones (con. hypo, sickle cell, PKU, CF)

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96
Q

What is infantile colic?

A

Common and benign set of symptoms in infants usually less than 3m - bouts of excessive crying and pulling up of legs (often worse in evening). Occurs in up to 20%

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97
Q

What is pulmonary hypoplasia and what causes it?

A

Infants with underdeveloped lungs:

-Oligohydramnios
-Congenital diaphragmatic hernia

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98
Q

What is the treatment for mycoplasma pneumoniae?

A

Macrolide - erythromycin

Mycoplasma doesn’t have a cell wall - and beta-lactams (penicillins) inhibit cell walls (useless)

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99
Q

Most common differential of a pre-term baby with blood in stool?

A

Necrotising enterocolitis

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100
Q

What is transient tachypnoea of the newborn?

A

MC cause of respiratory distress in newborn - caused by delayed resorption of fluid in lungs

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101
Q

Why is transient tachypnoea of the newborn more common in C-section babies?

A

Possibly due to fluid not being ‘squeezed out’ during the passage through the birth canal

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102
Q

What is achondroplasia?

A

Autosomal dominant disorder associated with short stature caused by abnormal FGFR-3 gene - abnormal cartilage:

-short limbs, large head with forehead bossing, lumbar lordosis, trident hands

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103
Q

Most common location of hypospadias?

A

Distal ventral surface of penis

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104
Q

When is the MMR vaccine given?

A

1234:

12 months, 3-4 years

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105
Q

What is the investigation used for stable Meckel’s diverticulum?

A

Technetium scan

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106
Q

What is oligohydramnios?

A

Decreased amniotic fluid volume for gestational age

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107
Q

What are the most common fractures associated with child abuse?

A

Radial, humeral, femoral

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108
Q

Describe newborn jaundice and it’s causes in first 24h.

A

Always pathological:

-Rhesus haemolytic disease
-ABO haemoyltic disease
-Hereditary spherocytosis
-G6PD deficiency

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109
Q

Describe neonatal jaundice in days 2-14.

A

Common and usually physiological
More commonly seen in breastfed babies

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110
Q

Describe neonatal jaundice after 14 days.

A

Described as prolonged after 14 days (or 21 if premature) - screening tests done.

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111
Q

What screening tests are performed for prolonged jaundice?

A

Bilirubin - conjugated and unconjugated
Coombs’ test
TFTs
FBC and blood film
Urine - MC+S/reducing sugars
U+Es, LFTs

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112
Q

Causes of prolonged juandice?

A

Biliary atresia
Hypothyroidism
UTI
Breastfed babies
Prematurity
Congenital infection - C,V, toxoplasmosis

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113
Q

When are immunisations given in a premature baby?

A

Same age as usual - don’t adjust

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114
Q

How are developmental milestones used in premature babies?

A

Adjust - age and weeks born from 40 weeks

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115
Q

In SUFE what movements are lost?

A

Loss of internal rotation of the leg in flexion

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116
Q

Is aciclovir given in chickenpox?

A

Only when immunocompromised - more at risk of developing complications such as meningitis/pneumonia

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117
Q

Why do VSDs put you at risk of endocarditis?

A

Blood moves quickly though VSDs - facilitates clots to stick to them, if bacteria are present they become enveloped in the clot and endocarditis may develop

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118
Q

A baby is born breech and has no hip abnormalities. Next steps?

A

Hip ultrasound 6 weeks - all breech babies at or after 36 gestation require hip US regardless of delivery

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119
Q

What is the double bubble sign for?

A

Duodenal atresia

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120
Q

Most likely cause of bilious vomiting on the first day of life?

A

Intestinal atresia

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121
Q

Inguinal hernia management in infants?

A

Urgent surgery

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122
Q

How may infants present with pertussis?

A

Apnoeas than whoops

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123
Q

In children with a fevers, how severe is it if a healthcare professional considers them to look unwell?

A

Red flag

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124
Q

What are the most common features of neonatal sepsis?

A

Grunting and other signs of respiratory distress

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125
Q

How are infantile spasms characterised?

A

Repeated flexion of head/arms/trunk followed by extension of arms

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126
Q

Describe chickenpox.

A

Prodrome of fever before rash begins on torso/face

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127
Q

How is bronchiolitis managed?

A

Supportive management only

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128
Q

What is the most common childhood leukaemia and how does it present?

A

ALL - anaemia, neutropenia, thrombocytopenia

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129
Q

What is a maternal risk factor for neonatal sepsis?

A

GBS

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130
Q

Why are diaphragmatic hernias more commonly seen on left than right side?

A

The liver plugs the hole on the right side

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131
Q

What is the first step of newborn resuscitation?

A

Dry the baby

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132
Q

Effective treatment of head lice?

A

Wet combing without insecticides

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133
Q

How may ALL present?

A

Haemorrhagic or thrombotic complications due to DIC

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134
Q

What is infantile colic?

A

When a baby a few weeks old who cries late afternoon/evening with arching of the back

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135
Q

Management of infantile colic?

A

Advise simple measures - holding, gentle motion and white noise

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136
Q

Key complication of Kawasaki disease? How is it screened for?

A

Coronary artery aneurysms - screened for via ECHO

137
Q

Common feature of SCFE?

A

Reduced internal rotation of leg in flexion

138
Q

Common patient with SCFE?

A

Obese boy aged 10 to 15 who may have had trauma

139
Q

Medications for viral gastroenteritis in children under 5 years old?

A

Don’t use antidiarrhoeal medications

140
Q

Key investigation for pyloric stenosis?

A

Ultrasound

141
Q

What is considered a normal Apgar score?

A

7+

142
Q

What is roseola infantum caused by?

A

HHV6

143
Q

If a 2 month old has a fever of 38.1C what do you do?

A

Assessed urgently in hospital

(A child aged < 3 months with a fever > 38ºC should be assessed as high risk of serious illness)

144
Q

Treatment for children with immune thrombocytopenia?

A

No treatment with petechiae/purpura only with no significant bleeding

145
Q

Management of asymptomatic neonatal hypoglycaemia?

A

Encourage normal feeding and monitor glucose

146
Q

Management of threadworm?

A

Single dose mebendazole for whole household and give hygiene advice

147
Q

Management of uncomplicated transient tachypnoea of newborn?

A

Supportive care +/- oxygen

148
Q

What is given to maintain PDA in congenital heart disease?

A

Prostaglandin E1 (alprostadil)

149
Q

What is given to close a PDA?

A

Indomethacin

150
Q

What heart condition is associated with Turner’s syndrome?

A

Aortic coarctation

151
Q

What is acute epiglottitis characterised by?

A

Stridor, rapid onset fever, drooling and tripoding

152
Q

Management of suspected ophthalmia neonatarum?

A

Urgent same-day assessment of ophthalmology/paediatric assessment

153
Q

Causes of ophthalmia neonatarum?

A

Chlamydia/gonorrhoea

154
Q

What suggests Kawasaki disease over Scarlet fever?

A

Swollen peripheries and 5+ day fever

155
Q

Which criteria is used to assess septic arthritis?

A

Kocher’s criteria

156
Q

When is the Apgar score assessed?

A

Minute 1 and 5

157
Q

What condition are nasal polyps associated with?

A

Cystic fibrosis

158
Q

What isn’t consistent with a simple febrile convulsion?

A

Drowsiness 1 hour after the seizure

159
Q

Treatment of whooping cough?

A

Azithromycin/clarythromycin within 21d of cough onset

160
Q

Admission criteria for bronchiolitis?

A

Apnoea, persistent sats below 92, less than 50% normal oral intake, persistent severe respiratory distress

161
Q

Long-term health risk of Turner’s syndrome?

A

Aortic dilatation and dissection

162
Q

Features of fragile X syndrome?

A

Learning difficulties, macrocephaly, large ears and macro-orchidism

163
Q

Most common cause of nephrotic syndrome in children?

A

Minimal change disease

164
Q

Treatment of croup?

A

Oral dexamethasone (0.15mg/kg)

165
Q

What do you do if a 2 year old presents with a limp?

A

Urgent assessment

166
Q

How is benign Rolandic epilepsy characterised?

A

Partial seizures at night

167
Q

What happens if wet combing wasn’t successful in headlice?

A

Malathion

168
Q

Which type of genetic disease is Prader-Willi syndrome?

A

Imprinting (one copy from parent is expressed and the other suppressed)

169
Q

What is the relationship between Prader-Willi syndrome and Angelman syndrome?

A

If gene deleted from father - Prader-Willi
If gene deleted from mother - Angelman

170
Q

What is elevated in biliary atresia?

A

Conjugated bilirubin

171
Q

What is used to screen newborn’s hearing?

A

Otoacoustic emission test

172
Q

What necessitates immediate referral to hospital in bronchiolitis?

A

Grunting

173
Q

Choice of investigation in intussusception?

A

US

174
Q

Turner’s syndrome and periods?

A

Primary amenorrhoea
High FSH and LH

175
Q

What is Perthe’s disease caused by? How does it present?

A

Avascular necrosis of the femoral head - progressive hip pain, limp and stiffness

176
Q

What is the classical patient on Perthe’s disease?

A

Age 4-8, more common in boys

177
Q

Mnemonic for Kawasaki disease?

A

CRASH and burn:

Conjunctivitis
Rash
Adenopathy (lymph)
Strawberry tongue
Hands and feet swelling

Burn (high fever for 5+ days)

178
Q

What is the main cause of croup?

A

Parainfluenza virus

179
Q

What is a life-threatening feature of asthma attack?

A

Normal pCO2

180
Q

Most common cause of cardiac arrest in children?

A

Respiratory

181
Q

What is Toddler’s diarrhoea and how does it present?

A

Benign condition where food passes through GI tract too fast - undigested food in poo

182
Q

What is mesenteric adenitis?

A

Inflamed mesenteric adenitis often preceded by viral illness. Self-limiting

183
Q

Cephalohaematoma vs caput succadaneum?

A

Cephalohaematoma:
-develop after birth, don’t cross suture lines

Caput succadaneum:
-can present at birth, crosses suture lines

184
Q

How does androgen insensitivity syndrome present?

A

Primary amenorrhoea without secondary sexual characteristics

185
Q

What may infants with TOF present with?

A

Hypercyanotic tet spells that can result in LOC

186
Q

If a child has a limp/hip pain with fever, what is done?

A

Urgent referral to rule out septic arthritis

187
Q

Treatment of DDH in patients under 6 months?

A

Pavlik harness

188
Q

What is the treatment for patients with cystic fibrosis who are homozygous for delta F508 mutation?

A

Lumacaftor/ivacaftor

189
Q

Features of roseola infantum?

A

Common 6m-2y
Fever followed by rash
Febrile seizures are common

190
Q

How is Duchenne muscular dystrophy diagnosed?

A

Genetic testing rather than muscle biopsy

191
Q

Most common cause of death in measles?

A

Pneumonia

192
Q

Most common complication of measles?

A

Otitis media

193
Q

Where does atopic eczema usually affect in infants?

A

Trunk and face

194
Q

How is measles characterised?

A

Prodromal symptoms, Koplik spots, maculopapular rash starting behind ears and conjunctivitis

195
Q

What may be prescribed for recurrent febrile seizures?

A

Buccal midazolam or rectal diazepam

196
Q

Which investigations are done in patients less than 3 months old with fever?

A

FBC, blood cultures, CRP, urine testing

-CXR if respiratory distress
-Stool culture if diarrhoea present

197
Q

How can Rickets present?

A

Widening of wrist joints due to excess of non-mineralised osteoid at growth plate

198
Q

Cause of spastic cerebral palsy?

A

UMN damage

199
Q

What causes slapped cheek syndrome?

A

Parvovirus B19

200
Q

How is Scarlet fever characterised?

A

Sandpaper rash

201
Q

Hand preference before 12 months?

A

Abnormal as it may be cerebral palsy

202
Q

What is neonatal hypotonia associated with?

A

Prader-Willi syndrome

203
Q

Management of biliary atresia?

A

Surgery

204
Q

What do you do if a patient aged 2 has bowed legs?

A

Nothing - normal ages <3 and usually resolves by age 4

205
Q

What is a respiratory rate red flag?

A

> 60

206
Q

What are the dietary requirements of patients with cystic fibrosis?

A

High calorie, high fat and pancreatic enzyme supplementation for each meal

207
Q

What should be given to all patients who experience an asthma attack?

A

Steroid therapy

208
Q

What is first line treatment for ADHD and what has to be monitored?

A

Methylphenidate
Monitor height and weight every 6 months

209
Q

Is whooping cough a notifiable disease?

A

Yes

210
Q

What is the most common cause of inherited neurodevelopmental delay?

A

Fragile X syndrome

211
Q

Congenital heart disease and bronchiolitis?

A

Can make bronchiolitis more severe

212
Q

What is the gold standard for diagnosing Hirchsprung’s disease?

A

Rectal biopsy

213
Q

Six risk factors for DDH?

A

Female, breech, family history, oligohydramnios, firstborn, birthweight above 5kg

214
Q

Treatment of transient synovitis?

A

Analgesia, reassurance and rest

215
Q

Which cancer are children with Down’s syndrome more at risk of?

A

Acute lymphoblastic leukaemia

216
Q

How does congenital CMV present?

A

Hearing loss, low birth weight, petechial rash, microcephaly and seizures

217
Q

Most common cause of primary headache in children?

A

Migraine

218
Q

Edward’s syndrome presentation?

A

Baby with micrognathia (undersized lower jaw), low-set ears, rocker-bottom feet and overlapping of fingers

219
Q

Triad of shaken baby syndrome?

A

Retinal haemorrhages, subdural haematoma and encephalopathy

220
Q

Management of neonatal jaundice in first 24h of life?

A

Urgently measure and record serum bilirubin within 2h as likely pathological

221
Q

Mitochondrial disease inheritance pattern?

A

Maternal

222
Q

When is the newborn blood spot screening test done?

A

Between days 5 and 9

223
Q

What is the investigation of choice for stable children with suspected Meckel’s diverticulum?

A

Technetium scan

224
Q

Treatment for meningitis if >3 months?

A

IV 3rd generation cephalosporin

225
Q

Why does cystic fibrosis cause steatorrhoea?

A

Due to fat malabsorption

226
Q

How to treat neonatal hypoglycaemia if symptomatic or very low blood glucose?

A

IV 10% dextrose

227
Q

What are undescended testicles associated with?

A

Increased risk infertility, testicular torsion and testicular cancer

228
Q

How does biliary atresia present?

A

In first few weeks of life with jaundice and appetite/growth disturbance

229
Q

In paediatric BLS, what is done if there is no signs of breathing on initial assessment?

A

Give 5 rescue breaths

230
Q

PDA murmur?

A

Machinery murmur at upper left sternal edge

231
Q

Treatment for suspected mycoplasma pneumonia?

A

Macrolides

232
Q

What is a key differential in children with petechiae and no fever?

A

ITP

233
Q

When are pregnant women offered the pertussis vaccine?

A

16-32 weeks

234
Q

How does GORD present in infants?

A

<8 weeks - milky vomit after feeds, after being laid flat, excessive crying

235
Q

What is a common neonatal feature of cystic fibrosis?

A

Meconium ileus

236
Q

In infants <3 months with bacterial meningitis do you use steroids?

A

No

237
Q

In neonates with hypoxic injury how do you reduce the chance of severe brain damage?

A

Therapeutic cooling at 33-35 degrees

238
Q

What age does the average child start smiling?

A

6 weeks

239
Q

When is the oral rotavirus vaccine given?

A

2 and 3 months

240
Q

What determines the severity of cyanosis in TOF?

A

Right ventricular outflow tract obstruction (pulmonary stenosis)

241
Q

If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance, what is tried?

A

Extensive hydrolysed formula

242
Q

Which pulses should be checked in paediatric BLS?

A

Brachial and femoral pulses

243
Q

What is the management of pyloric stenosis?

A

Ramstedt pyloromyotomy

244
Q

What sign may be seen on US in intussusception?

A

Target sign

245
Q

What may happen after bruising during birth?

A

Elevated bilirubin levels and jaundice

246
Q

What is used to prevent RSV in children with increased risk of severe disease?

A

Palivizumb (monoclonal antibody)

247
Q

Presentation of Noonan syndrome?

A

Webbed neck, pulmonary stenosis, ptosis and short stature (normal karyotype)

248
Q

Management of intestinal malrotation with volvulus?

A

Ladd’s procedure

249
Q

When does infantile colic improve and usually resolve by?

A

Improves by 3-4 months
Should resolve by 6 months

250
Q

Which heart defect is fragile X syndrome associated with?

A

Mitral valve prolapse

251
Q

In patients with chickenpox, what may NSAIDs cause?

A

Necrotising fasciitis

252
Q

When is hypospadias surgery usually performed?

A

12 months

253
Q

What can cause oro-facial clefts in newborns?

A

Maternal anti-epileptic use

254
Q

What is the number one cause of painless massive GI bleed in children aged between 1 and 2?

A

Meckel’s diverticulum

255
Q

What is a late complication of Down’s syndrome?

A

Alzheimer’s disease

256
Q

Silent chest in an asthma attack?

A

Life-threatening features that occurs due to no air entry (bronchoconstriction)

257
Q

Which murmur is Turner’s syndrome associated with?

A

Ejection systolic murmur due to bicuspid aortic valve

258
Q

What causes acute apiglottitis?

A

Haemophilius influenzae B

259
Q

What time of year is croup more common?

A

Autumn

260
Q

What is associated with increased mortality and morbidity in patients with CF?

A

Pseudomonas and Bulkholderia

261
Q

What is the initial management of Hirschsprung’s disease?

A

Rectal washouts/bowel irrigation

262
Q

What physical feature is William’s syndrome associated with?

A

Elfin facies

263
Q

What is a late sign of instussusception?

A

Red current jelly stool

264
Q

Do breech babies need hip US?

A

Yes, regardless of delivery mode after 36w gestation

265
Q

When is transient synovitis most commonly seen in children?

A

Ages 3 to 8

266
Q

What is an indicator for admission in croup?

A

Audible stridor at rest

267
Q

What is the diagnostic investigation for necrotising enterocolitis?

A

Abdominal X-RAY

268
Q

When is the peak incidence of ALL?

A

2-5y

269
Q

Cause of bilateral blowing noises below clavicles?

A

Venous hum - benign murmur

270
Q

Presentation of TOF?

A

Ejection systolic murmur at left sternal edge with cyanosis/collapse in first month of life with hypercyanotic tet spells

271
Q

Diagnosis of an infant presenting with bilious vomiting and obstruction?

A

Intestinal malrotation

272
Q

What is characteristic of Still’s disease (systematic JIA)?

A

Salmon pink rash

273
Q

When do most infants begin to crawl?

A

9 months

274
Q

What is a late sign of decompensated shock in children?

A

Hypotension

275
Q

What may be helpful in severe childhood asthma?

A

Emollient under wet bandages

276
Q

Why should patients with CF minimise contact with each other?

A

Due to risk of cross-infection

277
Q

Management for hand, foot and mouth disease?

A

Only symptomatic treatment

278
Q

Management of children under 3 months old with suspected UTI?

A

Refer to specialist paediatric services

279
Q

What are Epstein’s pearls?

A

White nodules on posterior hard palate

280
Q

What is the investigation of choice for reflux nephropathy?

A

Micturating cystography

281
Q

What is vesicouteric reflex and why is it significant?

A

Abnormal backflow from the bladder into the ureter/kidney - significant as it is relatively common and predisposes to UTI (found in 30% of children with UTI)

282
Q

Will children recover from non-IgE mediated CMPA?

A

Most will be milk tolerant by age 3

283
Q

What is a major risk factor for transient tachypnoea of the newborn?

A

Caesarean section delivery as in vaginal delivery, the narrow passage through the birth canal means fluid is squeezed out of the lungs

284
Q

How is neonatal respiratory distress syndrome prevented?

A

Administering dexamethasone to the mother

285
Q

What is scarlet fever caused by?

A

Group A strep

286
Q

If you suspect Perthe’s disease but nothing is seen on XR, what is done?

A

MRI scan

287
Q

What is Barlow’s manoeuvre?

A

Attempting to dislocate a newborns femoral head

288
Q

What may precede idiopathic thrombocytopaenic purpura?

A

Self-limiting viral infection

289
Q

Is reduced skin turgor bad?

A

Yes - red flag symptom

290
Q

When do febrile convulsions typically occur?

A

Ages 6m to 5y

291
Q

What are the views of XR when you suspect SUFE?

A

AP and frog-leg views

292
Q

What is the most common cause of stridor in children?

A

Laryngomalacia

293
Q

Presentation of Pierre-Robin syndrome?

A

Micrognathia and cleft palate

294
Q

What is the most common causative agent of bacterial pneumonia in children?

A

Strep pneumoniae

295
Q

What is a feature of a benign ejection murmur?

A

Varies with posture

296
Q

When is passing meconium a red flag?

A

After 48 hours

297
Q

Which disease does trident hands suggest?

A

Achondroplasia

298
Q

Management of babies with absent/weak femoral pulses at 6-8w check?

A

Discuss immediately with paediatrics

299
Q

What is the most common cause of ambiguous genitalia in newborns?

A

Congenital adrenal hyperplasia

300
Q

How may an older child with missed DDH present?

A

Trendelenberg gait (excessive up and down motion of the pelvis) and leg length discrepancy

301
Q

What is a poor prognostic factor for CDH?

A

Presence of liver in thoracic cavity

302
Q

Which vaccine is recommended to all new university students and why?

A

Meningitis ACWY due to outbreak of meningitis W

303
Q

When is the Meningitis B vaccine given?

A

2, 4 and 12 months

304
Q

What happens in alpha-thalassaemia?

A

Baby has hydrops fetalis and experiences fatal death in utero

305
Q

Which common condition can cystic fibrosis cause?

A

Diabetes mellitus

306
Q

Treatment of Kawasaki disease?

A

High dose aspirin and single dose IV Ig

307
Q

Four risk factors for neonatal sepsis?

A

Maternal GBS infection
Prematurity
Low birth weight
Maternal chorioamnionitis

308
Q

First line investigation in a child suspected of having DDH aged above 4.5 months?

A

X-RAY

309
Q

How does dyskinetic cerebral palsy present?

A

Athetoid movements (slow, writhing, and continuous worm-like movement of the limbs or trunk) oro-motor problems

310
Q

Which area of the brain is affected in dyskinetic cerebral palsy?

A

Basal ganglia and substantia nigra

311
Q

Timing of cephalohaemtoma and caput succadaneum?

A

Caput succadaneum - few days
Cephalohaemtoma - few weeks/months

312
Q

CPR technique in infants?

A

Two-thumb encircling technique

313
Q

CPR technique in children?

A

Compress lower half of sternum

314
Q

When should a pincer grip be good?

A

12 months

315
Q

Give four causes of pathological jaundice in first 24h.

A

Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency

316
Q

How does TGA present on examination?

A

No murmur but typically loud single S2 is audible and a prominent right ventricular impulse is palpable

317
Q

When should a child be able to hold objects with a palmar grasp and pass objects from one hand to another?

A

By 6 months

318
Q

Why do some congenital heart defects increase the risk of endocarditis?

A

High velocity blood flow across defects facilitates sticking of blood to these defects - if bacteria are in the bloodstream they become enveloped in the clot adhering to the defect and endocarditis may develop

319
Q

When is the peak incidence of bronchiolitis?

A

3-6 months

320
Q

If aged above 3 months what is the treatment of meningitis?

A

IV 3rd gen cephalosporin

321
Q

What may small testes in precocious puberty suggest?

A

Adrenal cause of symptoms

322
Q

Five steps of newborn resuscitation?

A
  1. Dry baby and maintain temperature
  2. Assess tone, respiratory rate and heart rate
  3. If gasping/not breathing give 5 inflation breaths
  4. Reassess (chest movements)
  5. If HR not improving/<60bpm start compression and ventilation breaths at 3:1
323
Q

What is a difference between reflex anoxic seizures and epileptic seizures?

A

Reflex anoxic seizures have a rapid recovery

324
Q

What may a raised immunoreactive trypsinogen on a newborn blood spot signify?

A

CF - get a sweat test

325
Q

What is the most common presenting feature of a Wilms tumour?

A

Abdominal mass

326
Q

Can parents circumcise their children while they wait for hypospadias surgery?

A

No - it is needed for the repair

327
Q

What is the most common heart lesion of DMD?

A

Dilated cardiomyopathy

328
Q

Features of retinoblastoma?

A

Absence of red-reflex (may have a white pupil), strabismus, visual problems

329
Q

What is commonly associated with malrotation?

A

Exomphaos and diaphragmatic hernia

330
Q

Treatment for SUFE?

A

Refer to orthopaedics for in situ fixation with cannulated screw

331
Q

When is the precocious puberty?

A

Females - 8
Males - 9

332
Q

Which murmur does an ASD cause and why?

A

Pulmonary systolic murmur with fixed splitting of S2 due to RV having more blood in it from ASD so takes longer to close.
Delayed closing of pulmonary valve causing a splitting sound

333
Q

What pulse does a PDA cause?

A

Large volume, bounding, collapsing

334
Q

What type of vaccine is the rotavirus vaccine?

A

Oral, live, attenuated

335
Q

What can cause Ebstein’s anomaly?

A

Lithium use in-utero

336
Q

How do you treat Scarlet fever?

A

Penicillin V

337
Q

Presentation of Patau syndrome?

A

Microcephaly, small eyes, low-set ears, cleft lip, polydactyly

338
Q

What is a significant risk factor for meconium aspiration?

A

Post-term delivery (45% of babies over 42 weeks have it)

339
Q

What needs to be considered in neonates with vague signs like poor feeding, grunting and lethargy?

A

Neonatal sepsis

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