Past paper questions Flashcards
A 3-year-old boy is brought to the paediatric emergency department by his father. His father is concerned as he has developed a pinprick purple rash on the back of his legs and has been complaining of stomach and knee pain for the last few days. Prior to this, he had a cold.
His vital signs are normal.
Which of the following is the next most appropriate step of management?
Steroids
Non-steroidal anti-inflammatory drugs (NSAIDs)
Antibiotics
Anti-hypertensives
Intravenous Fluids
Non-steroidal anti-inflammatory drugs (NSAIDs)
This is a case of Henoch-Schonlein purpura (HSP). It commonly presents with a triad of purpura/petechiae on the buttocks and lower limbs, abdominal pain and arthralgia. Other features include haematuria, proteinuria, pyrexia and hypertension.
The majority of HSP cases are self-limiting and resolve completely. Therefore, simple analgesia such as NSAIDs and/or paracetamol can be used. In severe cases, steroids may be indicated. If hypertension is present, antihypertensives may also be indicated.
A 3 year old girl is brought to the GP by her mother. She has had a cold for the last few days, but now developed a rash on her chin. It blanches under pressure, but her mother remains worried about the cause. She was previously well and is up to date with all scheduled immunisations. On examination the girl has a fever of 38.5 degrees Celsius, with a maculopapular rash around her mouth, ulcerations on her tongue and blisters on the palms of her hands and the soles of her feet. There are no signs of excoriation.
Which of the following is the most likely cause of her symptoms?
Hand, foot and mouth disease
Scarlet fever
Slapped cheek syndrome
Meningococcal septicaemia
Measles
hand foot and mouth
A 3-day-old neonate presents to paediatric A&E with his concerned parents. He was born at 39+2 weeks following spontaneous vaginal delivery, and was discharged from hospital yesterday evening after being established on bottle feeding. His parents are worried as this morning he vomited a large quantity of bile stained vomitus. He is still yet to pass meconium. On examination of the abdomen, distension is noted, but there are no palpable masses.
Which of the following is the most likely diagnosis?
Meconium Ileus
Pyloric Stenosis
Necrotising Enterocolitis
Intestinal Malrotation
Viral Gastroenteritis
Meconium Ileus
This is the correct answer. Meconium ileus typically presents in the first few days of life as a delay in passing meconium (> 48 hours) and features of bowel obstruction (bilious vomiting). Diagnosis is confirmed with abdominal x-ray which shows characteristic findings of a ‘bubbly’ appearance of the intestines and lack of air-fluid levels
A 3-day-old neonate presents to paediatric A&E with his concerned parents. He was born at 39+2 weeks following spontaneous vaginal delivery, and was discharged from hospital yesterday evening after being established on bottle feeding. His parents are worried as this morning he vomited a large quantity of bile stained vomitus. He is still yet to pass meconium. On examination of the abdomen, distension is noted, but there are no palpable masses.
Which of the following is the most likely diagnosis?
Meconium Ileus
Pyloric Stenosis
Necrotising Enterocolitis
Intestinal Malrotation
Viral Gastroenteritis
Meconium Ileus
This is the correct answer. Meconium ileus typically presents in the first few days of life as a delay in passing meconium (> 48 hours) and features of bowel obstruction (bilious vomiting). Diagnosis is confirmed with abdominal x-ray which shows characteristic findings of a ‘bubbly’ appearance of the intestines and lack of air-fluid levels
A 3 year old boy is brought to the GP because he has a rash and red eyes.
His mother says her son developed a non-productive cough, runny nose and red eyes about 4 days ago, and this morning he woke up with a red blotchy rash over his head and face which has since spread onto his chest and arms. His mother also noted white spots in his mouth a few days ago. He is normally healthy. He takes no medicines and has never had any vaccinations, as his parents do not think they are safe.
On examination, the boy appears unhappy but well. His saturations are 99% in air, respiratory rate is 20, heart rate is 82 and capillary refill time is 2 seconds. His temperature is 39.5 degrees. There is an erythematous maculopapular rash across his head, neck, torso and limbs.
What kind of vaccine would have prevented this child’s infection?
Toxoid vaccine
Live attenuated vaccine
Killed vaccine
Conjugate vaccine
Polysaccharide vaccine
Live attenuated vaccine
This unvaccinated child with cough, coryza and conjunctivitis, white spots in the mouth and a rash should raise suspicion for measles infection. Measles is routinely vaccinated against with the MMR, which is a live attenuated vaccine
A 27 year old lady who is 32 weeks pregnant visits her GP concerned about breastfeeding. Which of the following situations would be acceptable for her to breastfeed?
Taking ibuprofen for back pain
Neonatal galactosaemia
Herpes simplex lesions on the mother’s breasts
Maternal HIV infection (viral load undetectable)
Maternal multi-drug resistant tuberculosis infection
Taking ibuprofen for back pain
Ibuprofen is considered safe for breastfeeding infants as only very small quantities appear to be excreted into breast milk after maternal ingestion. Furthermore, it is considered to be one of the analgesics of choice in breastfeeding mothers
methylphenidate same as
ritalin
A 10 year old boy with a diagnosis of attention-deficit hyperactivity disorder (ADHD) attends the outpatient psychiatry clinic for review. He was recently started on Methylphenidate to control his symptoms. His behaviour has improved, however, he has developed facial tics which he finds distressing.
Which of the following is the most appropriate drug to switch to for long-term management of his condition?
Melatonin
Sertraline
Ritalin
Risperidone
Atomoxetine
Atomoxetine
Atomoxetine is another stimulant medication. It is recommended for ADHD refractory to Methylphenidate or in those who it is not appropriate due to risk factors or development of side effects. Development of facial tics is an indication to change medications
An eight year old girl is brought into the emergency department by ambulance. She was found by her mother minimally responsive and with vomit in her mouth. On examination, she is somnolent but rousable, with a GCS of nine. Observations were normal. Her mother reports that she had been unwell with a ‘cold’ over the last three days, and her mother had given her aspirin and ibuprofen for her headache and fever. Blood tests showed a mild anaemia, a transaminitis, raised bilirubin, a prolonged international normalised ratio, raised lactate and a raised C-reactive protein. A toxicology screen is negative. What is the most likely diagnosis?
Viral encephalitis
Reye’s syndrome
Unintentional overdose
Meningococcal meningitis
Head injury
Reye’s syndrome
Aspirin should not be given to children under 12 years old because of its association with Reye’s syndrome. Reye’s syndrome is acute liver failure and non-inflammatory hepatic encephalopathy which occurs in children under 12 who are given aspirin during the acute phase of a viral infection. Liver biopsies show microvesicular steatosis and venous collapse. Treatment is supportive, and often requires ITU admission. Lactulose can be used to lower ammonia levels
when is jaundice normal in neonates
- after 24 hours
- jaundice is not normal if apparent within the first 24 hours of life
Neonatal jaundice is common. Most cases are physiological, however it is important not to miss serious pathology. Any jaundice in the first 24 hours of life is always pathological.
causes of jaundice in <24hrs
- Haemolytic disorders (Rhesus incompatibility, ABO incompatibility, G6PD, spherocytosis)
- Congenital infection (TORCH screen is indicated)
- Sepsis
causes of jaundice in >24hrs
Physiologic jaundice
Breast milk jaundice
Dehydration
Infection, including sepsis
Haemolysis
Bruising
Polycythaemia
Crigler-Najjar Syndrome
causes of jaundice >14 days
Physiologic jaundice
Breast milk jaundice
Infection
Hypothyroidism
Bililary obstruction (incl. biliary atresia)
Neonatal hepatitis
A 2-week old neonate, born prematurely at 30 weeks’ gestationn, has had 2 days of vomiting and 1 day of bloody stools. The vomiting has occasionally been streaked with green, and occurs particularly after feeding with expressed breast milk. The stool has also been streaked with fresh red blood.
The baby has also significantly deteriorated over the last few days, and has required IV fluids and has just been re-intubated for the first time since day 2 of life.
On examination, the baby’s abdomen is significantly distended. An abdominal X-ray shows distended loops of bowel with thin black lines within the white bowel walls.
What is the most appropriate management for this condition?
Cow’s milk formula
Cooling to 34 degrees
Retinal laser therapy
Broad spectrum antibiotics and parenteral nutrition
Surgical resection of ectopic gastric mucosa
necrotising enterocolitis
Broad spectrum antibiotics and parenteral nutrition
This premature infant with bile-streaked vomiting, blood-streaked stool, abdominal distention and intramural air on abdominal x-ray has necrotising enterocolitis. The best initial management of necrotising enterocolitis is broad spectrum antibiotics and parenteral nutrition to prevent infection and rest the bowel
A 13 year old boy presents to the GP because his mum is worried that he has recently been ‘going blue’. Friends and family have commented that he looks a bit blue. On questioning, he reports feeling a little short of breath when playing football, but otherwise reports feeling well. His mother says he has no known conditions apart from a hole in the heart that was mentioned early on but was never followed up on.
On examination, he appears moderately cyanotic. He has clubbing of the fingernails. There is a harsh holosystolic murmur loudest at the lower left sternal edge. The lung fields are clear to auscultation. His oxygen saturations are 93%, respiratory rate is 18, heart rate is 80, and temperature is 36.8.
What is the most likely underlying cause of this patient’s colour change?
Reversal of direction of cardiac shunting
Narrowing of the aorta
Lead exposure
Reversible constriction of bronchioles
Abnormal insertion of the pulmonary veins
Reversal of direction of cardiac shunting
Eisenmenger syndrome describes the reversal of a left-to-right shunt (patent ductus arteriosus, atrial septal defect, or ventricular septal defect) to a right-to-left shunt
A neonate is delivered by emergency caesarean section at 32 weeks gestation after preterm premature rupture of membranes. At 1 minute after birth, the neonate appears blue at the fingers and around the mouth and has a poor respiratory effort. The baby is resuscitated, intubated and stabilized before transfer to the neonatal intensive care.
At 48 hours after delivery, the baby appears moderately cyanotic and is grunting on inspiration. The baby has a raised respiratory rate, nasal flaring and subcostal recessions. A chest X-ray shows a ground glass appearance to the lung field bilaterally.
Which of the following medicines given to the mother prior to delivery could help reduce the severity of this neonatal condition?
Dexamethasone
Misoprostol
Pethidine
Magnesium sulphate
Prostin gel
Dexamethasone
This preterm baby with signs of respiratory distress including cyanosis, grunting, tachypnoea, nasal flaring and subcostal recessions with a ground glass appearance on chest x-ray has neonatal respiratory distress syndrome. If preterm delivery is suspected, maternal intramuscular steroid injection, such as dexamethasone, can help to boost foetal surfactant production and thus reduce the likelihood of developing neonatal respiratory distress syndrome
A 6 month old baby boy is an inpatient on a paediatric hospital ward for a chest infection. He has been sleeping quietly in his cot but when a nurse checks on him, he is unresponsive and looks blue. The nurse ensures that it is safe to approach him, calls for help and keeps his airway in a neutral position. The nurse looks for chest movements and listens for breath sounds, observing infrequent, noisy gasps, less than once every 3 seconds. She cannot feel a pulse.
Which of the following is the most appropriate action for the nurse to take?
Give 15 chest compressions followed by 2 rescue breaths
Give 5 rescue breaths followed by 15 chest compressions
Feel longer for a pulse
Observe in case he stops breathing
Give 2 rescue breaths followed by 15 chest compressions
Give 5 rescue breaths followed by 15 chest compressions
In paediatric resuscitation, 5 rescue breaths are given initially. As opposed to adult basic life support, rescue breaths are given before chest compressions in children and this is one of the key differences to increase the amount of circulating oxygen in the body
A 6 week old baby boy is brought to A&E as a GP referral because he is still yellow.
He has been getting progressively more yellow for the last 3 weeks. His mum says his poo has also changed from thick black when he was born to mustardy to chalky. His wee has also turned a dark yellow. Otherwise, he has been breastfeeding well and is growing along his centiles. He was born at 39+6 by spontaneous vaginal delivery after a normal pregnancy. Antenatal screening and scans showed no abnormalities.
On examination, the baby appears well. His abdomen is soft and a liver edge is palpable 2cm below the costal margin. Antenatal screening and scans were all normal. Blood tests show a significantly raised ALT, ALP and bilirubin (predominantly conjugated).
What is the most likely underlying cause of this baby’s presentation?
Haemolysis from enzyme deficiency
Maternal antibody
Liver viral infection
Fibrosis of biliary tree
Abnormal erythrocyte membrane
Biliary fibrosis - biliary atresia
This infant with prolonged jaundice, dark urine, chalky-white stool and conjugated hyperbilirubinaemia is suspicious for an obstructive cause of jaundice. The results of the hepatic scintigraphy radioisotope scan (highlights the liver and not the bowel) is suspicious for biliary atresia. Biliary atresia is characterized by progressive fibrosis and destruction of the biliary tree
A 15 month old child has a history of epilepsy and has difficulty walking. The gait of the child is ‘scissor walking’. The mother reports that the labour was complicated by shoulder dystocia. The APGAR score at birth was 4 and the neonate required a stay in the neonatal intensive care unit (NICU) for a few days. What is the most likely location for the pathology seen in this presentation?
Hip injury at delivery
Cervical nerves
Periventricular
Basal ganglia
Congenital developmental dysplasia of the hip
Periventricular
Periventricular damage (due to a hypoxic ischaemic event during a prolonged delivery due to the baby getting stuck) is the aetiology behind spastic diplegia. The gait is classically termed as scissor walking
A 3 year old girl is brought to the GP by her mother. She has had a cold for the last few days, but now developed a rash on her chin. It blanches under pressure, but her mother remains worried about the cause. She was previously well and is up to date with all scheduled immunisations. On examination the girl has a fever of 38.5 degrees Celsius, with a maculopapular rash around her mouth, ulcerations on her tongue and blisters on the palms of her hands and the soles of her feet. There are no signs of excoriation.
Which of the following options is the most likely pathogen responsible for her symptoms?
Measles virus
Parvovirus B19
Coxsackie virus A16
Streptococcus pyogenes
Staphylococcus aureus
Coxsackie virus A16
This girl presents with features in keeping with hand, foot and mouth disease, most commonly caused by enteroviruses such as Coxsackie virus A16
A 2-year-old girl comes to the GP with her parents. Her parents are concerned she is having difficulty growing. They say that over the past month she has felt tired and lethargic, and has intermittent diarrhoea. His growth chart shows she has dropped from the 75th centile for height and weight to the 25th centile in the last 6 months. On examination there is a vesicular rash on the child’s knees. Her doctor suspects coeliac disease.
Which of the following would be the next most appropriate investigation?
Duodenal biopsy
Faecal calprotectin
Anti-gliadin antibody
Endomyseal antibodies
Tissue transglutaminase (TTG) antibodies and total IgA
Tissue transglutaminase (TTG) antibodies and total IgA
This is correct. The growth difficulties along with abdominal distension and diarrhoea are suggestive of coeliac disease. The rash described is most likely dermatitis herpetiformis, which is strongly associated with the condition. The next best investigation would be to look measure anti-TTG levels (raised in coeliac disease), as well as total IgA, because IgA deficiency could lead to a false negative result
A 10-year-old girl was admitted to a paediatric ward 3 days ago due to an acute exacerbation of asthma. At the time of admission, she is very short of breath and could not complete sentences fully. On auscultation, a silent chest is noted. Her peak expiratory flow rate was 100 l/min (35% of normal), and oxygen saturations were 93%.
Which of the following features make this a life-threatening acute exacerbation of asthma?
Inability to complete sentences
Silent chest
Her peak expiratory flow rate
Shortness of breath
Her oxygen saturations
Silent chest
This is correct. Silent chest occurs because of bronchoconstriction so severe that there is not enough air movement to produce even an audible wheeze. This is a life-threatening sign and the child must be taken to hospital immediately. Other signs of a life-threatening attack include cyanosis, poor/no respiratory effort, peak expiratory flow rate <33%, hypotension and an altered level of consciousness
A 14-year-old girl with Turner syndrome is found to have an ejection systolic murmur heard loudest posteriorly between the shoulders.
Given the most likely diagnosis, which of the following signs would most likely be seen on examination?
Radio-femoral delay
Cyanosis
Palpable thrill
Tachypnoea
Malar flush
Radio-femoral delay
This patient likely has coarctation of the aorta, due to the typical murmur and the association with Turner syndrome. Radio-femoral delay is caused by the collateral circulation via the chest wall delaying bloodflow to the lower extremities.
An 11 year old boy presents to his GP complaining of a three day history of right hip pain. There is no history of trauma. His mother reports that the family is recovering from a common cold. On examination, there is restricted internal rotation and extension of the right hip. He does not have a temperature and his past medical history is unremarkable. His height and weight are at the 50th percentile for his age and his immunisations are up to date. What is the most likely diagnosis?
Hip fracture
Slipped femoral epiphysis
Transient synovitis
Tuberculosis arthritis
Perthe’s disease
Transient synovitis
Transient synovitis is an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight. This occurs in pre-pubescent children and is the most common cause of hip pain. It occurs when a viral infection, such as an upper respiratory infection, moves to and settles in the hip joint. Limited range of motion, specifically extension and internal rotation of the hip can be found. It is confirmed using a hip x-ray (which will be normal) and ultrasound which shows synovitis. It is treated using NSAIDs and bedrest for up to 6 weeks
Perthe’s disease
Perthe’s disease is most common in children from 3-11 years of age. It presents as a progressive reduction in movements in all ranges over a period of months. It is confirmed using x-rays of the hip, which show reduction of joint space and decreased size of the femoral head. An ultrasound can show synovial thickening. Management involves NSAIDs, analgesics and physiotherapy. Surgery may be needed to correct the femoral head defect
Perthe’s disease
Perthe’s disease is most common in children from 3-11 years of age. It presents as a progressive reduction in movements in all ranges over a period of months. It is confirmed using x-rays of the hip, which show reduction of joint space and decreased size of the femoral head. An ultrasound can show synovial thickening. Management involves NSAIDs, analgesics and physiotherapy. Surgery may be needed to correct the femoral head defect
Slipped femoral epiphysis
Slipped femoral epiphysis most commonly presents in obese adolesent children with pain over the front of the thigh, knee and groin, evolving over minutes to weeks. There is limitation of flexion, abduction and medial rotation. Pain is associated with exercise. Investigations include a lateral x-ray of the hip, looking for displacement of the growth plate. Management includes treatment of the underlying condition, most commonly primary hypothyroidism. In this case the patient is slightly young and not obese which makes SUFE less likely
A mother brings in her 12-year-old son to paediatric A&E because he has been complaining of a headache since this morning. He complains that the lights in the hospital are hurting his eyes and says his neck feels stiff. On examination there is a purpuric rash across the child’s chest and torso. His temperature is 38.0ºC, he has a heart rate of 120/min, a respiratory rate of 26, and a blood pressure of 90/65 mmHg. Which of the following is the most likely diagnosis?
Meningococcal septicaemia
Henoch-Schonlein Purpura
Tension-type headache
Migraine
Measles
Meningococcal septicaemia
This is correct. This child has presented with classic symptoms of meningitis (neck stiffness, photophobia, headache) as well as sepsis (tachycardia, tachypnoea, hypotension, petechial rash), known as meningococcal septicaemia. This patient requires urgent intravenous antibiotics
A 3-year-old girl is brought to the GP by her parents. For the past four days she has had a fever, runny nose, cough and non-bloody diarrhoea. Last night, her parents noticed that she had developed a pink rash on her legs and arms. She is normally fit and well and is up to date with all her vaccinations. On examination, a pink lace-like rash is visible on all four of her limbs, along with erythematous patches on her cheeks which feel hot to touch.
Which of the following is the most likely pathogen causing her symptoms?
Rhinovirus
Coxsackie Virus A16
Measles
Parvovirus B19
Human Herpes Virus 6 (HHV6)
Parvovirus B19
This is the correct answer. This child has presented with a prodrome of fever, coryzal symptoms and diarrhoea, followed by the onset of a diffuse ‘lace-like’ rash across the body and characteristic bright red cheeks. This presentation makes parvovirus B19, aka slapped-cheek syndrome, the most likely diagnosis
A 9-week-old boy is seen in the Paediatric Assessment Unit with a 2-week history of worsening projectile vomiting after feeds.
On examination, there is a smooth spherical mass in the left upper abdomen, approximately the shape of an olive.
Which of the following acid–base abnormalities would most likely be seen on a blood gas?
Hyponatraemia
Hypokalaemia
Hyperchloraemia
Metabolic acidosis
Respiratory alkalosis
Hypokalaemia
Severe pyloric stenosis can lead to hypochloraemic hypokalaemic metabolic alkalosis due to excessive vomiting - so hypokalaemia may be present.
A 7-year-old boy presents to the Emergency Department with increasing fatigue and drowsiness, on a background of 5 days of diarrhoea and vomiting. There is no blood or mucous in his stool, but his urine has become significantly darker. His mother notes that in the last 24 hours he has been unable to eat any solid food, but, he can tolerate small amounts of fluid.
He is diagnosed with gastroenteritis and his dehydration deficit is calculated to be 5%. His healthy weight is approximately 25kg.
Which of the following is the correct volume of total fluids to prescribe over 24 hours?
1600 ml
3200 ml
1250 ml
2850 ml
750 ml
2850 ml
This is the correct answer. Using the paediatric fluid formula (10 x 100) + (10 x 50) + (5 x 20), the maintenance fluid required for this 25kg child is 1600ml over 24 hours.
The deficit that needs to be replaced is calculated using the formula weight (kg) x 10 x % dehydration (5%), which comes to 1250ml.
1600ml + 1250ml = 2850 ml.
A 5 year old boy is brought to the GP by his mother. He has been feeling generally unwell over the last 2 days with lethargy, headache, sore throat, runny nose and fever. He was previously well and is up to date with all scheduled immunisations. He has developed an erythematous rash on his torso and both cheeks, which blanches under pressure. His tongue and buccal mucosa appear normal.
Which of the following is the most appropriate advice to give his mother about the risk of passing the infection to other children?
He may still be infectious after several weeks and should be not return to school
He will remain infectious until 4 days after the rash resolves
He will remain infectious until the rash has crusted over
He is no longer infectious and can return to school
He will remain infectious until 24 hours after the first dose of antibiotics
He is no longer infectious and can return to school
This boy presents with features in keeping with slapped cheek syndrome. Once the rash appears, children are no longer infectious
A 13-year-old patient attends a Child and Adolescent Mental Health Service (CAMHS) clinic with symptoms of low mood, reduced energy levels and anhedonia over the past year. There are no features of psychosis and the patient denies any thoughts of deliberate self harm.
Alongside talking therapies and lifestyle changes, which of the following antidepressants is most appropriate to prescribe?
Venlafaxine
Citalopram
Sertraline
Fluoxetine
Mirtazapine
Fluoxetine
Fluoxetine, a selective-serotonin-reuptake inhibitor, is the only antidepressant medication licensed for children and has the best evidence base for use in children.
A junior doctor is asked to review a neonate on the postnatal ward. He was born 10 hours ago and has suddenly turned blue and developed an increased work of breathing. Upon examination, he has central cyanosis, he is not tachypnoeic, there are no additional breath sounds, and on auscultation of the heart there are no murmurs. A chest x-ray shows cardiomegaly. He has been given Oxygen by the nurses but this has not improved the cyanosis.
Which of the following is the next best step in the management of this patient?
Alprostadil
Indomethacin
Echocardiogram
Furosemide
Insert nasogastric tube for feeding
Alprostadil
This is the correct answer. This is a case of duct dependent congenital heart disease, which is managed with prostaglandins. This is to promote patency of the ductus arteriosus, which begins to close shortly after birth and is the cause of cyanosis in this situation. This will allow the infant to survive long enough to allow investigations to confirm the diagnosis, which is most likely transposition of the great arteries, and thus surgical correction
maculopapular rashes
roseola infantum
slapped cheek
meqsles (cough, coryza, conjuncitvitis)
scarlet fever
vesicular rahses
chicken pox - herpes varicella zoster
hand foot and mouth disease
herpes simplex virus- herpes 1
erythema multiform- herpes 1
petechial (<2mm)/ pupuric (>2mm) rash
Non blanching
- meningococcal
- Henoch-Schönlein purpura (HSP) - lower limbs due to gaviravity
paediatric sepsis six
management of possible sepsis
management of possible sepsis
kawasaki
- One of the most common vasculitides in children; also occurs in adults.
- Acute self-limiting an acute self-limiting inflammatory disorder affecting predominantly medium sized arteries, particularly coronary arteries causing aneurysms in 15-25% if untreated.
- Commonest causes of acquired heart disease in children in developed countries.
Presentation
CRASH AND BURN
Management: (no laboratory investigation included in diagnostic criteria):
Systemic inflammation with mild anaemia, leucocytosis with left shirt and thrombocytosis (end of week 2).
Raised ferritin (acute phase reactant). Needs ECG, CXR and cardiac ECHO.
Treatment: IV Ig; Aspirin - high dose in acute phase followed by low dose maintenance.
viral vs bacterial meningitits
viral:
- entervorus
- herpes virus
bacterial
- younger: Neisseria meningiditis (meningococcal), E.coli, Group B strep
- adults: Haemophilus influnzae and streptococcus pneumoniae
cough type. andspecific causes summary
summary of LRTI management
UTI urine dipstix and MCS findings
management of UTI
Kocher Criteria for Septic Arthritis
transient synovitis vs septic arthritis
differential diagnosis of an autrauamtic limp
antibiotic prescribing
antibiotic prescribing
differentials for wheeze
examples of chronic asthma treatment drugs
LTRA- suidical ideation
theophylline- awful drug
causes of central cyanosis in neonates
Airway obstruction
- choanal atresia
- larygomalacia
- macroglossia
- micrognathia or rethrognathia (Pierre-Robin syndrome)
**Pulmonary
- alveolar capillary dysplasia
- lobar emphysema
- pneumonoa/PE/ pneumo
- perissdtent pulmonary hypertension of newborn
- pulmonary hypoplasia
- resp distress syndrome
- transient tachypnoea of the newborn
chonal atresia
laryngomalacia
micrognathia (pairee robin sequence)
congential lobar emphysema
congenital diaphragmatic hernia
congenital heart disease presentations at birth
heart murmurs
intussusception
red flags for constipation
constipation summary
: <3 complete stools/week.
Large, infrequent stools (Bristol 3/4).
‘Rabbit droppings’ (Bristol 1)
Overflow soiling: very loose/smelly.
unaware passed.
dehyration summary
