Passmed paeds Flashcards
What is the first line management for enuresis?
Below 5 - watch and wait, reassurance.
After 5 - enuresis alarm.
What is the first line investigation for intussusception?
USS.
What is the triad of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma, encephalopathy.
What is the triad of autism spectrum disorder?
Communication impairment
Impairment of social relationships
Ritualistic behaviour
How does congenital rubella syndrome present?
Sensorineural deafness
Congenital cataracts
What are the drugs to close and maintain the ductus arteriosus?
Close - indomethacin
Prevent closure - prostaglandin E1
What’s the most common type of diarrhoea with undigested food?
Toddler’s diarrhoea
Give a mnemonic for Scarlet fever?
Scarlet fever - 5 S’s - give penicillin V:
Sky-high fever
Spewing
Sore throat
Strawberry tongue
Sandpaper rash
What is the average presentation time for cyanotic heart disease?
TOF (tetra) - 4 weeks
TGA (3 letters) - first few days of life
When is hand preference abnormal and why?
Below 12 months - cerebral palsy
What heart conditions are associated with heart conditions?
Left sided heart lesions:
Bicuspid aortic valve
Coarctation of the aorta
Aortic stenosis
What is the number one cause of painless massive GI bleed in children aged between 1 and 2?
Meckel’s diverticulum
What is the treatment for threadworms?
Treat all household contacts regardless of symptoms with oral mebendazole
How is undescended testes managed?
Unilateral:
review at 3 months
refer for surgery at 6m if still undescended
Bilateral: urgent review by senior within 24h
What do infantile spasms look like?
Repeated flexion of head/arms/trunk followed by arm extension
What is the most common heart condition associated with Duchenne muscular dystrophy?
Dilated cardiomyopathy
What is the most common cause of stridor in children?
Laryngomalacia
What is a mnemonic for gross motor milestones?
Heads, shoulders, knees and toes:
3, 6, 9, 12 months
Head control, sitting up, crawling, walking
How may a child with missed developmental dysplasia of the hip present?
Trendelenburg gait and leg length discrepency
Describe paediatric BLS.
Chest compressions rate of 100-120/min, ratio of 15:2
What rescue medication may be given for febrile seizures?
Benzodiazepines:
buccal midazolam
rectal diazepam
What’s the age difference in Perthe’s and SUFE?
Perthe’s - primary school ages
SUFE - secondary school ages
What is the treatment for bacterial meningitis in infants under 3 months?
IV cefotaxime and IV amoxicillin
No corticosteroids in children under 3 months
What is the first line treatment for DDH?
Pavlik harness
What is used to screen newborns for hearing problems?
Otoacoustic emissions test
What is used to reduce the chances of severe brain damage in neonates with hypoxic injury?
Therapeutic cooling - 33-35 degrees celcius
What is fetal alcohol syndrome associated with?
Microcephaly, smooth philtrum and thin upper lip
What is the age range for febrile convulsions?
6m to 5y
How may infants present with pertussis?
With apnoeas rather than the classic whoop
What is the most common complication of children with roseola infantum?
Febrile convulsions - 10-15%
Which murmur does PDA present with?
Continuous machinery murmur at upper left sternal edge
What investigations are needed infants younger than 3m with fever?
FBC, blood culture, CRP, urinalysis, CXR (resp sx), stool culture (diarrhoea sx)
Mnemonic for agpar score?
A - Appearance (skin colour)
P - Pulse
G - Grimace (reflex irritability - cry)
A - Activity (muscle tone and movement)
R - Respiratory rate
What is a common electrolyte abnormality of subarachnoid haemorrhages?
Hyponatraemia
Describe roseola infantum.
Illness caused by HH6 or HH7.
High fever followed a few days later by rash
Mnemonic for Kawasaki disease?
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
Describe hand, foot and mouth disease.
Mild systemic upset, oral ulcers and vesicles on palms and soles - coxsackie A16
What usually causes acute epiglossitis?
H. influenzae B
What causes Scarlet fever?
Group A haemolytic strep - mc s. pyogenes
What is the first line treatment for ADHD and it’s side effect?
Methylphenidate and stunted growth
What is a paediatric red flag in resp rate?
> 60
How may intestinal malrotation/volvulus present?
Billous vomiting, abdo pain, cramp, obstruction
Lethargy, poor appetite, infrequent bowel movements
What is the main difference between epileptic seizures and reflex anoxic seizures?
Reflex anoxic seizures - rapid recovery
What should be given to all children who have an asthma attack?
Oral prednisolone (40mg for 5 days)
When is APGAR stick routinely assessed?
1 and 5 minutes
What is the first sign of puberty in males and females?
Males - testicular growth
Females - boob growth
What safety net advice should be given to parents after a febrile convulsion?
Call ambulance if a febrile convulsion occurs for more than 5 minutes
What is an effective non-insecticide treatment for headlice?
Wet combing
What is a late sign of intussusception?
Red currant jelly stool
If a 2 month baby attended GP with a fever of 38.5 what do you do and why?
Urgent paediatric referral in hospital as a fever above 38 is a high risk of serious illness
What hearing test is done at school entry?
Pure tone audiometry
What is the difference between Barlow and Ortolani tests?
Barlow - Dislocating
Ortolani - Relocating
What is measles characterised by?
Prodromal Sx, Koplik spots, maculopapular rash starting behind ears and conjunctivitis
What often triggers idiopathic thrombocytopenic purpura (ITP)?
Self-limiting viral infection
What is the difference between Caput succedaneum and Cephalhaemtoma?
CS - Crosses suture lines
C - Don’t cross suture lines
What is the age of precocious puberty in males and females?
Males - 9
Females - 8
What electrolyte abnormalities are shown in pyloric stenosis?
Hypochloraemic hypokalaemic alkalosis
What is the most common signs of neonatal sepsis?
Grunting and other respiratory signs of distress
What is the main feature of benign ejection murmurs?
They vary with posture
In paediatric BLS, which pulses are palpated?
Brachial and femoral
When can’t you use anti-diarrhoea medication in children with D+V caused by gastroenteritis?
Below 5 years old
How does Perthe’s disease present?
Hip pain, limp and stiffness
When is hypospadias surgery performed?
Typically performed around 12 months
What is characteristic of JIA?
Salmon pink rash with arthritis
(fever, lymphadenopathy, uveitis, weight loss)
What is the first step of BLS?
After establishing there’s no breathing - give 5 rescue breaths
What are the signs of Edward’s syndrome?
Trisomy 18 - Micrognathia, low-set ears, rocker bottom feet, overlapping fingers
How long does it take Caput succedaneum and Cephalhaemtoma to resolve?
CS - few days
C - few months
What are life threatening features of an asthma exacerbation?
Sats below 92
PEF below 33
Silent chest
Agitated
Poor respiratory effort
Altered consciousness
Cyanosis
Normal pCO2
What is benign Rolandic epilepsy chracterised by?
Partial seizures at night
What is commonly associated with hypospadias?
Cryptochidism - 10%
Examination findings of TGA?
No murmur: loud single S2
Prominent RV impulse palpable
What is the most common cause of ambiguous genitalia?
Congenital adrenal hyperplasia
Five red flag symptoms in children?
Moderate/severe chest wall recession
Doesn’t awake if roused
Reduced skin turgor
Mottled or blue appearance
Grunting
What is a venous hum?
Benign murmur - like a continuous blowing noise under clavicles
How to manage neonate hypoglycaemia?
Low - encourage breastfeeding
Very low - IV 10% dextrose
How does congenital CMV present?
Hearing loss, low birth weight, petechial rash, microcephaly and seizures
Which maternal drug use can cause orofacial clefts?
Anti- epileptic drug use
When does infantile colic improve and resolve?
Improves around 3-4 months
Resolves around 6 months
Which condition is a girl most likely to have who has Haemophilia?
Turner’s syndrome - single X chromosome
If a newborn has an abnormal hearing test, what test is offered?
Auditory brainstem response
What are four central causes of hypotonia?
Cerebral palsy
Down’s syndrome
Prader-Willi syndrome
Hypothyroidism
Give speech and hearing milestones.
3m - turns towards sound
6m - double syllables (adah, erleh)
9m - mama, dada, understands no
12m - knows and responds to own name
Treatment of headlice in household?
No treatment unless affected
Describe the typical patient with Williams syndrome.
Boy with learning difficulties who is very friendly and extraverted. Short for his age and has supravalvular aortic stenosis
What is Rocker-Bottom feet associated with?
Edward’s syndrome - trisomy 18
What physical features is Williams syndrome associated with?
Elfin facies, strabismus, broad forehead, short stature
A child sees you in GP who is 2 months old with UTI, what do you do and why?
Refer immediately to hospital - infants less than 3 months
What is the emergency treatment for croup?
High-flow oxygen, nebulised adrenaline
What dose of dexamethasone is given to children with croup?
0.15mg/kg
What determines the severity of TOF and why?
RV outflow obstruction (PS) - if severe, deoxygenated blood will go through VSD and overriding aorta - more deoxygenated blood in arteries - more cyanosis
What is vesicouteric reflex?
Abnormal backflow of urine from bladder into ureter and kidney - common and predisposes to UTI
Investigations for vesicouteric reflex?
Micturating cystourethrogram
DMSA scan to look for renal scarring
Risk factors for DDH?
Fat, female, first-born, foot-first, family history
Management for child under 3y presenting with an acute limp?
Urgent paediatric assessment (to rule out septic arthritis or traumatic injury)
5 steps of newborn resuscitation?
- Dry baby and maintain temperature
- Assess tone, resp rate, heart rate
- Gasping or not breathing - 5 inflation breaths
- Reassess (chest movements)
- If HR not improving and <60bpm - compression/ventilation breaths at 3:1
When is the newborn heel prick?
From days 5-9:
5 weird diseases and 4 more common ones (con. hypo, sickle cell, PKU, CF)
What is infantile colic?
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%
What is pulmonary hypoplasia and what causes it?
Infants with underdeveloped lungs:
-Oligohydramnios
-Congenital diaphragmatic hernia
What is the treatment for mycoplasma pneumoniae?
Macrolide - erythromycin
Mycoplasma doesn’t have a cell wall - and beta-lactams (penicillins) inhibit cell walls (useless)
Most common differential of a pre-term baby with blood in stool?
Necrotising enterocolitis
What is transient tachypnoea of the newborn?
MC cause of respiratory distress in newborn - caused by delayed resorption of fluid in lungs
Why is transient tachypnoea of the newborn more common in C-section babies?
Possibly due to fluid not being ‘squeezed out’ during the passage through the birth canal
What is achondroplasia?
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
Most common location of hypospadias?
Distal ventral surface of penis
When is the MMR vaccine given?
1234:
12 months, 3-4 years
What is the investigation used for stable Meckel’s diverticulum?
Technetium scan
What is oligohydramnios?
Decreased amniotic fluid volume for gestational age
What are the most common fractures associated with child abuse?
Radial, humeral, femoral
Describe newborn jaundice and it’s causes in first 24h.
Always pathological:
-Rhesus haemolytic disease
-ABO haemoyltic disease
-Hereditary spherocytosis
-G6PD deficiency
Describe neonatal jaundice in days 2-14.
Common and usually physiological
More commonly seen in breastfed babies
Describe neonatal jaundice after 14 days.
Described as prolonged after 14 days (or 21 if premature) - screening tests done.
What screening tests are performed for prolonged jaundice?
Bilirubin - conjugated and unconjugated
Coombs’ test
TFTs
FBC and blood film
Urine - MC+S/reducing sugars
U+Es, LFTs
Causes of prolonged juandice?
Biliary atresia
Hypothyroidism
UTI
Breastfed babies
Prematurity
Congenital infection - C,V, toxoplasmosis
When are immunisations given in a premature baby?
Same age as usual - don’t adjust
How are developmental milestones used in premature babies?
Adjust - age and weeks born from 40 weeks
In SUFE what movements are lost?
Loss of internal rotation of the leg in flexion
Is aciclovir given in chickenpox?
Only when immunocompromised - more at risk of developing complications such as meningitis/pneumonia
Why do VSDs put you at risk of endocarditis?
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
A baby is born breech and has no hip abnormalities. Next steps?
Hip ultrasound 6 weeks - all breech babies at or after 36 gestation require hip US regardless of delivery
What is the double bubble sign for?
Duodenal atresia
Most likely cause of bilious vomiting on the first day of life?
Intestinal atresia
Inguinal hernia management in infants?
Urgent surgery
How may infants present with pertussis?
Apnoeas than whoops
In children with a fevers, how severe is it if a healthcare professional considers them to look unwell?
Red flag
What are the most common features of neonatal sepsis?
Grunting and other signs of respiratory distress
How are infantile spasms characterised?
Repeated flexion of head/arms/trunk followed by extension of arms
Describe chickenpox.
Prodrome of fever before rash begins on torso/face
How is bronchiolitis managed?
Supportive management only
What is the most common childhood leukaemia and how does it present?
ALL - anaemia, neutropenia, thrombocytopenia
What is a maternal risk factor for neonatal sepsis?
GBS
Why are diaphragmatic hernias more commonly seen on left than right side?
The liver plugs the hole on the right side
What is the first step of newborn resuscitation?
Dry the baby
Effective treatment of head lice?
Wet combing without insecticides
How may ALL present?
Haemorrhagic or thrombotic complications due to DIC
What is infantile colic?
When a baby a few weeks old who cries late afternoon/evening with arching of the back
Management of infantile colic?
Advise simple measures - holding, gentle motion and white noise
Key complication of Kawasaki disease? How is it screened for?
Coronary artery aneurysms - screened for via ECHO
Common feature of SCFE?
Reduced internal rotation of leg in flexion
Common patient with SCFE?
Obese boy aged 10 to 15 who may have had trauma
Medications for viral gastroenteritis in children under 5 years old?
Don’t use antidiarrhoeal medications
Key investigation for pyloric stenosis?
Ultrasound
What is considered a normal Apgar score?
7+
What is roseola infantum caused by?
HHV6
If a 2 month old has a fever of 38.1C what do you do?
Assessed urgently in hospital
(A child aged < 3 months with a fever > 38ºC should be assessed as high risk of serious illness)
Treatment for children with immune thrombocytopenia?
No treatment with petechiae/purpura only with no significant bleeding
Management of asymptomatic neonatal hypoglycaemia?
Encourage normal feeding and monitor glucose
Management of threadworm?
Single dose mebendazole for whole household and give hygiene advice
Management of uncomplicated transient tachypnoea of newborn?
Supportive care +/- oxygen
What is given to maintain PDA in congenital heart disease?
Prostaglandin E1 (alprostadil)
What is given to close a PDA?
Indomethacin
What heart condition is associated with Turner’s syndrome?
Aortic coarctation
What is acute epiglottitis characterised by?
Stridor, rapid onset fever, drooling and tripoding
Management of suspected ophthalmia neonatarum?
Urgent same-day assessment of ophthalmology/paediatric assessment
Causes of ophthalmia neonatarum?
Chlamydia/gonorrhoea
What suggests Kawasaki disease over Scarlet fever?
Swollen peripheries and 5+ day fever
Which criteria is used to assess septic arthritis?
Kocher’s criteria
When is the Apgar score assessed?
Minute 1 and 5
What condition are nasal polyps associated with?
Cystic fibrosis
What isn’t consistent with a simple febrile convulsion?
Drowsiness 1 hour after the seizure
Treatment of whooping cough?
Azithromycin/clarythromycin within 21d of cough onset
Admission criteria for bronchiolitis?
Apnoea, persistent sats below 92, less than 50% normal oral intake, persistent severe respiratory distress
Long-term health risk of Turner’s syndrome?
Aortic dilatation and dissection
Features of fragile X syndrome?
Learning difficulties, macrocephaly, large ears and macro-orchidism
Most common cause of nephrotic syndrome in children?
Minimal change disease
Treatment of croup?
Oral dexamethasone (0.15mg/kg)
What do you do if a 2 year old presents with a limp?
Urgent assessment
How is benign Rolandic epilepsy characterised?
Partial seizures at night
What happens if wet combing wasn’t successful in headlice?
Malathion
Which type of genetic disease is Prader-Willi syndrome?
Imprinting (one copy from parent is expressed and the other suppressed)
What is the relationship between Prader-Willi syndrome and Angelman syndrome?
If gene deleted from father - Prader-Willi
If gene deleted from mother - Angelman
What is elevated in biliary atresia?
Conjugated bilirubin
What is used to screen newborn’s hearing?
Otoacoustic emission test
What necessitates immediate referral to hospital in bronchiolitis?
Grunting
Choice of investigation in intussusception?
US
Turner’s syndrome and periods?
Primary amenorrhoea
High FSH and LH
What is Perthe’s disease caused by? How does it present?
Avascular necrosis of the femoral head - progressive hip pain, limp and stiffness
What is the classical patient on Perthe’s disease?
Age 4-8, more common in boys
Mnemonic for Kawasaki disease?
CRASH and burn:
Conjunctivitis
Rash
Adenopathy (lymph)
Strawberry tongue
Hands and feet swelling
Burn (high fever for 5+ days)
What is the main cause of croup?
Parainfluenza virus
What is a life-threatening feature of asthma attack?
Normal pCO2
Most common cause of cardiac arrest in children?
Respiratory
What is Toddler’s diarrhoea and how does it present?
Benign condition where food passes through GI tract too fast - undigested food in poo
What is mesenteric adenitis?
Inflamed mesenteric adenitis often preceded by viral illness. Self-limiting
Cephalohaematoma vs caput succadaneum?
Cephalohaematoma:
-develop after birth, don’t cross suture lines
Caput succadaneum:
-can present at birth, crosses suture lines
How does androgen insensitivity syndrome present?
Primary amenorrhoea without secondary sexual characteristics
What may infants with TOF present with?
Hypercyanotic tet spells that can result in LOC
If a child has a limp/hip pain with fever, what is done?
Urgent referral to rule out septic arthritis
Treatment of DDH in patients under 6 months?
Pavlik harness
What is the treatment for patients with cystic fibrosis who are homozygous for delta F508 mutation?
Lumacaftor/ivacaftor
Features of roseola infantum?
Common 6m-2y
Fever followed by rash
Febrile seizures are common
How is Duchenne muscular dystrophy diagnosed?
Genetic testing rather than muscle biopsy
Most common cause of death in measles?
Pneumonia
Most common complication of measles?
Otitis media
Where does atopic eczema usually affect in infants?
Trunk and face
How is measles characterised?
Prodromal symptoms, Koplik spots, maculopapular rash starting behind ears and conjunctivitis
What may be prescribed for recurrent febrile seizures?
Buccal midazolam or rectal diazepam
Which investigations are done in patients less than 3 months old with fever?
FBC, blood cultures, CRP, urine testing
-CXR if respiratory distress
-Stool culture if diarrhoea present
How can Rickets present?
Widening of wrist joints due to excess of non-mineralised osteoid at growth plate
Cause of spastic cerebral palsy?
UMN damage
What causes slapped cheek syndrome?
Parvovirus B19
How is Scarlet fever characterised?
Sandpaper rash
Hand preference before 12 months?
Abnormal as it may be cerebral palsy
What is neonatal hypotonia associated with?
Prader-Willi syndrome
Management of biliary atresia?
Surgery
What do you do if a patient aged 2 has bowed legs?
Nothing - normal ages <3 and usually resolves by age 4
What is a respiratory rate red flag?
> 60
What are the dietary requirements of patients with cystic fibrosis?
High calorie, high fat and pancreatic enzyme supplementation for each meal
What should be given to all patients who experience an asthma attack?
Steroid therapy
What is first line treatment for ADHD and what has to be monitored?
Methylphenidate
Monitor height and weight every 6 months
Is whooping cough a notifiable disease?
Yes
What is the most common cause of inherited neurodevelopmental delay?
Fragile X syndrome
Congenital heart disease and bronchiolitis?
Can make bronchiolitis more severe
What is the gold standard for diagnosing Hirchsprung’s disease?
Rectal biopsy
Six risk factors for DDH?
Female, breech, family history, oligohydramnios, firstborn, birthweight above 5kg
Treatment of transient synovitis?
Analgesia, reassurance and rest
Which cancer are children with Down’s syndrome more at risk of?
Acute lymphoblastic leukaemia
How does congenital CMV present?
Hearing loss, low birth weight, petechial rash, microcephaly and seizures
Most common cause of primary headache in children?
Migraine
Edward’s syndrome presentation?
Baby with micrognathia (undersized lower jaw), low-set ears, rocker-bottom feet and overlapping of fingers
Triad of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma and encephalopathy
Management of neonatal jaundice in first 24h of life?
Urgently measure and record serum bilirubin within 2h as likely pathological
Mitochondrial disease inheritance pattern?
Maternal
When is the newborn blood spot screening test done?
Between days 5 and 9
What is the investigation of choice for stable children with suspected Meckel’s diverticulum?
Technetium scan
Treatment for meningitis if >3 months?
IV 3rd generation cephalosporin
Why does cystic fibrosis cause steatorrhoea?
Due to fat malabsorption
How to treat neonatal hypoglycaemia if symptomatic or very low blood glucose?
IV 10% dextrose
What are undescended testicles associated with?
Increased risk infertility, testicular torsion and testicular cancer
How does biliary atresia present?
In first few weeks of life with jaundice and appetite/growth disturbance
In paediatric BLS, what is done if there is no signs of breathing on initial assessment?
Give 5 rescue breaths
PDA murmur?
Machinery murmur at upper left sternal edge
Treatment for suspected mycoplasma pneumonia?
Macrolides
What is a key differential in children with petechiae and no fever?
ITP
When are pregnant women offered the pertussis vaccine?
16-32 weeks
How does GORD present in infants?
<8 weeks - milky vomit after feeds, after being laid flat, excessive crying
What is a common neonatal feature of cystic fibrosis?
Meconium ileus
In infants <3 months with bacterial meningitis do you use steroids?
No
In neonates with hypoxic injury how do you reduce the chance of severe brain damage?
Therapeutic cooling at 33-35 degrees
What age does the average child start smiling?
6 weeks
When is the oral rotavirus vaccine given?
2 and 3 months
What determines the severity of cyanosis in TOF?
Right ventricular outflow tract obstruction (pulmonary stenosis)
If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance, what is tried?
Extensive hydrolysed formula
Which pulses should be checked in paediatric BLS?
Brachial and femoral pulses
What is the management of pyloric stenosis?
Ramstedt pyloromyotomy
What sign may be seen on US in intussusception?
Target sign
What may happen after bruising during birth?
Elevated bilirubin levels and jaundice
What is used to prevent RSV in children with increased risk of severe disease?
Palivizumb (monoclonal antibody)
Presentation of Noonan syndrome?
Webbed neck, pulmonary stenosis, ptosis and short stature (normal karyotype)
Management of intestinal malrotation with volvulus?
Ladd’s procedure
When does infantile colic improve and usually resolve by?
Improves by 3-4 months
Should resolve by 6 months
Which heart defect is fragile X syndrome associated with?
Mitral valve prolapse
In patients with chickenpox, what may NSAIDs cause?
Necrotising fasciitis
When is hypospadias surgery usually performed?
12 months
What can cause oro-facial clefts in newborns?
Maternal anti-epileptic use
What is the number one cause of painless massive GI bleed in children aged between 1 and 2?
Meckel’s diverticulum
What is a late complication of Down’s syndrome?
Alzheimer’s disease
Silent chest in an asthma attack?
Life-threatening features that occurs due to no air entry (bronchoconstriction)
Which murmur is Turner’s syndrome associated with?
Ejection systolic murmur due to bicuspid aortic valve
What causes acute apiglottitis?
Haemophilius influenzae B
What time of year is croup more common?
Autumn
What is associated with increased mortality and morbidity in patients with CF?
Pseudomonas and Bulkholderia
What is the initial management of Hirschsprung’s disease?
Rectal washouts/bowel irrigation
What physical feature is William’s syndrome associated with?
Elfin facies
What is a late sign of instussusception?
Red current jelly stool
Do breech babies need hip US?
Yes, regardless of delivery mode after 36w gestation
When is transient synovitis most commonly seen in children?
Ages 3 to 8
What is an indicator for admission in croup?
Audible stridor at rest
What is the diagnostic investigation for necrotising enterocolitis?
Abdominal X-RAY
When is the peak incidence of ALL?
2-5y
Cause of bilateral blowing noises below clavicles?
Venous hum - benign murmur
Presentation of TOF?
Ejection systolic murmur at left sternal edge with cyanosis/collapse in first month of life with hypercyanotic tet spells
Diagnosis of an infant presenting with bilious vomiting and obstruction?
Intestinal malrotation
What is characteristic of Still’s disease (systematic JIA)?
Salmon pink rash
When do most infants begin to crawl?
9 months
What is a late sign of decompensated shock in children?
Hypotension
What may be helpful in severe childhood asthma?
Emollient under wet bandages
Why should patients with CF minimise contact with each other?
Due to risk of cross-infection
Management for hand, foot and mouth disease?
Only symptomatic treatment
Management of children under 3 months old with suspected UTI?
Refer to specialist paediatric services
What are Epstein’s pearls?
White nodules on posterior hard palate
What is the investigation of choice for reflux nephropathy?
Micturating cystography
What is vesicouteric reflex and why is it significant?
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)
Will children recover from non-IgE mediated CMPA?
Most will be milk tolerant by age 3
What is a major risk factor for transient tachypnoea of the newborn?
Caesarean section delivery as in vaginal delivery, the narrow passage through the birth canal means fluid is squeezed out of the lungs
How is neonatal respiratory distress syndrome prevented?
Administering dexamethasone to the mother
What is scarlet fever caused by?
Group A strep
If you suspect Perthe’s disease but nothing is seen on XR, what is done?
MRI scan
What is Barlow’s manoeuvre?
Attempting to dislocate a newborns femoral head
What may precede idiopathic thrombocytopaenic purpura?
Self-limiting viral infection
Is reduced skin turgor bad?
Yes - red flag symptom
When do febrile convulsions typically occur?
Ages 6m to 5y
What are the views of XR when you suspect SUFE?
AP and frog-leg views
What is the most common cause of stridor in children?
Laryngomalacia
Presentation of Pierre-Robin syndrome?
Micrognathia and cleft palate
What is the most common causative agent of bacterial pneumonia in children?
Strep pneumoniae
What is a feature of a benign ejection murmur?
Varies with posture
When is passing meconium a red flag?
After 48 hours
Which disease does trident hands suggest?
Achondroplasia
Management of babies with absent/weak femoral pulses at 6-8w check?
Discuss immediately with paediatrics
What is the most common cause of ambiguous genitalia in newborns?
Congenital adrenal hyperplasia
How may an older child with missed DDH present?
Trendelenberg gait (excessive up and down motion of the pelvis) and leg length discrepancy
What is a poor prognostic factor for CDH?
Presence of liver in thoracic cavity
Which vaccine is recommended to all new university students and why?
Meningitis ACWY due to outbreak of meningitis W
When is the Meningitis B vaccine given?
2, 4 and 12 months
What happens in alpha-thalassaemia?
Baby has hydrops fetalis and experiences fatal death in utero
Which common condition can cystic fibrosis cause?
Diabetes mellitus
Treatment of Kawasaki disease?
High dose aspirin and single dose IV Ig
Four risk factors for neonatal sepsis?
Maternal GBS infection
Prematurity
Low birth weight
Maternal chorioamnionitis
First line investigation in a child suspected of having DDH aged above 4.5 months?
X-RAY
How does dyskinetic cerebral palsy present?
Athetoid movements (slow, writhing, and continuous worm-like movement of the limbs or trunk) oro-motor problems
Which area of the brain is affected in dyskinetic cerebral palsy?
Basal ganglia and substantia nigra
Timing of cephalohaemtoma and caput succadaneum?
Caput succadaneum - few days
Cephalohaemtoma - few weeks/months
CPR technique in infants?
Two-thumb encircling technique
CPR technique in children?
Compress lower half of sternum
When should a pincer grip be good?
12 months
Give four causes of pathological jaundice in first 24h.
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
G6PD deficiency
How does TGA present on examination?
No murmur but typically loud single S2 is audible and a prominent right ventricular impulse is palpable
When should a child be able to hold objects with a palmar grasp and pass objects from one hand to another?
By 6 months
Why do some congenital heart defects increase the risk of endocarditis?
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
When is the peak incidence of bronchiolitis?
3-6 months
If aged above 3 months what is the treatment of meningitis?
IV 3rd gen cephalosporin
What may small testes in precocious puberty suggest?
Adrenal cause of symptoms
Five steps of newborn resuscitation?
- Dry baby and maintain temperature
- Assess tone, respiratory rate and heart rate
- If gasping/not breathing give 5 inflation breaths
- Reassess (chest movements)
- If HR not improving/<60bpm start compression and ventilation breaths at 3:1
What is a difference between reflex anoxic seizures and epileptic seizures?
Reflex anoxic seizures have a rapid recovery
What may a raised immunoreactive trypsinogen on a newborn blood spot signify?
CF - get a sweat test
What is the most common presenting feature of a Wilms tumour?
Abdominal mass
Can parents circumcise their children while they wait for hypospadias surgery?
No - it is needed for the repair
What is the most common heart lesion of DMD?
Dilated cardiomyopathy
Features of retinoblastoma?
Absence of red-reflex (may have a white pupil), strabismus, visual problems
What is commonly associated with malrotation?
Exomphaos and diaphragmatic hernia
Treatment for SUFE?
Refer to orthopaedics for in situ fixation with cannulated screw
When is the precocious puberty?
Females - 8
Males - 9
Which murmur does an ASD cause and why?
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
What pulse does a PDA cause?
Large volume, bounding, collapsing
What type of vaccine is the rotavirus vaccine?
Oral, live, attenuated
What can cause Ebstein’s anomaly?
Lithium use in-utero
How do you treat Scarlet fever?
Penicillin V
Presentation of Patau syndrome?
Microcephaly, small eyes, low-set ears, cleft lip, polydactyly
What is a significant risk factor for meconium aspiration?
Post-term delivery (45% of babies over 42 weeks have it)
What needs to be considered in neonates with vague signs like poor feeding, grunting and lethargy?
Neonatal sepsis
