past paper stuff Flashcards
How do you manage testicular torsion
exploratory laparotomy
what mechanism does semi circular bruises occur to
non accidental injury
inverted ankles and plantar flexed sign
talipes equinovarus
kid with speech problems, who do you refer to?
Speech and language therapy (SALT)
child development team
12 year old and 13 year old having sex, who do you refer to
safeguarding lead
- Kid with diarrhoea for the last few months with pieces of vegetables undigested, otherwise healthy
Toddler’s diarrhoea
6 year old kid with Down’s syndrome with bilious vomiting and distended abdomen, patent anus. what is the diagnosis
duodenal atresia
- Girl goes to Pakistan. Develops macular rash. High fever for 5 days. HR was 70bpm. Cause?
typhoid
- Cannot examine ear directly, lump behind ear causing ear to stick out
mastoiditis
- Kid with 2cm mass (inframandibular) on left side, painful – blood film shows: toxic left shift with reactive neutrophilia.
lymphadenitis
not glandular fever as the mass would not be painful
- Child with 6 month history of loose stools. Passed one hard blood streaked stool 10 days ago. What investigation?
Colonoscopy, stool mc&s, anti TTG, No investigation needed
Anti TTG
- Girl with abdominal pain only when going to school, not weekends
functional abdominal pain
What is molluscum contagiosum and how do you manage
reassure
- You are in GP, Child with mild croup comes in?
dexamethasone + reassess in 48 hours
What murmur do you hear in TOF
harsh systolic ejection murmur on left sternal border
what does crescendo-decrescendo mean
ejection
- How should you give influenza vaccine to kid who is allergic to eggs?
hospital IM injection
- Sickle cell anaemia patient with Hb of 40 and low reticulocyte count with Howell-Jolly bodies
aplastic crisis - parvovirus B19
- Kid take medication for UTI, becomes anaemic and jaundiced, irregularly contracted cells and polychromasia
G6PD deficiency
triggers haemolysis
- Maternal T1DM increases risk of what condition in newborn?
neonatal hypoglycaemia
in acute asthma attack, how much salbutamol do you give
1 puff every 30-60 seconds up to 10 puffs
definitive diagnosis for cystic fibrosis
sweat chloride test
- Kid with pellet stools, and loose stool sometimes
Overflow diarrhoea secondary to constipation
- Maintenance fluid to give to kid with diabetes mellitus
In DKA: 0.9% saline, not in DKA: 0.9% saline with 5% dextrose
spiral fracture is a sign of waht
NAI
- Kid given dexamethasone for croup 12 hours ago by GP, was stable and well with good sats but still mild stridor. What else do you give?
repeat steroids
- Kid with episodes of stiffening of hands and limbs, accompanied by screaming and sweating
infantile spasms
- Kid with impaired taste stuff, then awareness and then goes to sleep for like an hour and back to normal. No memory of event. Focal seizure, atypical migraine, Absence seizure, Epilepsy, narcolepsy
focal seizure
kid that would fall down and scream and stuff but was completely fine afterwards
temper tantrum
- Kid with yellow and grey stools and was like 4 weeks old or something. What do you test for? Conjugated bilirubin levels, G6PD, Coombs Test
conjugated bilirubin levels
should always do first if signs of jaundice
- 7 year old kid headache and secondary nocturnal enuresis. He’s lost 1.5kg. Urine dipstick normal (i.e. no glucose, proteins, blood. Urine specific gravity 1.010 to 1.030) What is the likely diagnosis? Diabetes insipidus, diabetes mellitus, behavioural enuresis, constipation
Diabetes insipidus
- Voraciously hungry kid, hypotonia and feeding difficulties as a neonate, and almond eyes what was the diagnosis?
prader willi
- Another case with an unwell child where chest was clear, had a fever. Lost weight recently. What do you do next? Glucose. CXR, urine dip, ABG
urine dip
- 14 year old kid who thieves, got into fights (basically conduct disorder). What is 1st Mx? Multisystemic (family) therapy, CBT, DBT, psychodynamic therapy
Multisystemic (family) therapy
- Uncle gets TB, kid lives with him, Mantoux test showed a number between 10-14mm for the result. What should you do? Watch and wait, give Isoniazid prophylaxis, Start anti-TB treatment, give BCG vaccine, prophylactic isoniazid
(the kid has TB with those diameters and risk factor of living with someone with TB, plus his age if he’s under 4)
Start anti TB treatment
- Precocious puberty (5yo and has sparse axillary and pubic hair as well as breast bud development) and high centile growth parents are along some lower centile. What definitive diagnostic test do you do? Bone age, Gonadotropin stimulation test, MRI scan of pituitary fossa
Gonadotrophin stimulation test
- Fussy eater who drinks a lot of cows milk and was tired. What is the cause?
IDA
- Newborn with purple spot on face, what is the best approach? Discharge to Gp follow up, Medical photography, Clotting studies, Send urgently to A&E
discharge
- Kid needs fluids, but you can’t get standard IV access. Where do you go? Jugular, brachial, carotid, Intraosseous
intraosseus
- Kid with symptoms of nephrotic syndrome – 1st line treatment?
steroids
- 3 months old baby with signs of HF, systolic murmur that radiates over the praecordium
VSD
What type of murmur do you see in VSD
A systolic murmur that radiates over the praecordium is characteristic of a VSD. The murmur is typically holosystolic (present throughout systole) and best heard at the left lower sternal border.
- What is the most important thing to look at in follow up of HSP? ESR, FBC, urine protein and RBCs, platelets
urine protein and RBC
What is henoch-schonlein purpura
small vessel vasculitis that commonly affects children and can involve the skin, joints, gastrointestinal tract, and kidneys.
need to check urine protein and RBC to assess kidney damage + blood pressure
seen following an infection
- 15 year old boy with short stature. Passing urine 10 times a day with no dysuria. Pale with heart rate at 78bpm, blood pressure at 158/88 and respiratory rate at 14. What is the likely diagnosis? Chronic renal failure, diabetes mellitus, nephroblastoma, acute pyelonephritis, urinary tract infection
chronic renal failure
- 6 year old child with 24 hour history of left peri-orbital swelling. Had an upper respiratory tract infection last week. Left proptosis, visual acuity was normal and had a fever of 38.9. What is the best diagnostic investigation? CT of nasal orbits, USS of nasal orbits, nasal endoscopy, intraocular pressure measurement, plain x-ray of nasal sinus
CT
could be orbital cellulitis
- Child with fever, white exudate on one tonsil, diagnosis? Tonsillitis, Quinsy, diphtheria
tosillitis
- Baby is almost a month old and jaundiced. Parents say has been jaundiced since day 2. Stools are grey or white. Diagnosis?
biliary atresia
- Kid with temp of 39, cap refill 6s, generally unwell + bulging fontanelles, no description of rash.
meningococcal septicaemia
- Unwell kid with indentable mass in left iliac fossa?
constipation
- Nappy rash flexure sparing
Zinc and castor oil barrier cream (eczema or irritant)
- Nappy rash with satellite lesions
Clomitrazole (candidiasis)
- Scabies treatment
permethrin
Posterior rib fractures
NAI
Child with Downs has an NJ tube at home. It comes out and needs rehinserting. Who should put it back in?
Community paeds nurse
Community Paediatrician
Hospital Nursing staff
GP
Healthworker
hospital nursing staff
management of severe asthma
OSHIMA- O2, salbutamol back to back nebulised or via spacer, hydrocortisone, ipratoprium bromide, mag sulf, aminophylline
Impetigo measuring 8mm treatment
fusidic acid
Kids in the creche all get diarrhoea at around the same time?
norovirus
- Child w Hx of eczema, who now has a painful rash. Picture of eczema herpeticum, what would your Mx be? oral aciclovir, topical fusidic acid, oral flucloxacillin, send to A&E
aciclovir
A 9-year-old boy is brought to see his GP by his mother after complaining of a sore throat over the last 2 days. He has also had a low-grade temperature of around 37.5-38.0°C. He does not have a cough and, on examination, his left tonsil appears slightly inflamed with no exudate. The child is otherwise well and is able to eat and drink with minimal discomfort. His mother explains that he has had similar symptoms three times this year.
What is the most appropriate management option?
A
Immediately send patient to A&E
B
Refer to ENT Specialist
C
Amoxicillin 500 mg BD starting today and refer to ENT
D
Phenoxymethylpenicillin 250 mg QDS starting today and refer to ENT
E
Delayed prescription of Phenoxymethylpenicillin 250 mg QDS
E
This child has presented with pharyngitis which is most likely to be viral. It can sometimes be difficult to distinguish bacterial and viral pharyngitis so scoring systems like the Centor score and FeverPAIN score can be used to determine the likelihood of streptococcal pharyngitis. NICE recommends using the FeverPAIN Scoring System to calculate the probability of a bacterial infection and, therefore, the need for antibiotics.
Fever in past 24 hours Yes +1
Absence of cough or coryza Yes +1
Symptom onset ≤3 days Yes +1
Purulent tonsils Yes +1
Severe tonsil inflammation Yes +1
A score of < 2 is likely not bacterial thus no antibiotics are needed.
A score of 2-3 is potentially bacterial thus a delayed antibiotic prescription should be considered.
A score of 4-5 is likely a bacterial infection and antibiotics should be considered now.
This patient has a FeverPAIN score of 3 so should be given a delayed antibiotic prescription.
What are the Centor criteria
The Centor criteria are: score 1 point for each (maximum score of 4)
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
3 or more means antibiotics
What antibiotics do you give for sore throat (pharyngitis, tonsilitis, laryngitis)
penhoxymethylpenicllin or clarithromycin
When would you refer to ENT if someone presents with tonsillitis
more than 7 episodes of tonsillitis per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms.
bilateral diffuse granular opacities with air bronchograms
RDS
What does alopecia areata present with and how do you manage
patchy areas of complete hair loss. There are usually no other symptoms, however, it is sometimes associated with nail changes such as onycholysis and pitting. In most cases, the hair will regrow within 1 year without intervention
watchful waiting unless its >50% hair loss or patient is distressed -> topical corticosteroid
what is Trichotillomania
compulsive hair pulling
What is vitiligo
autoimmune condition characterised by depigmentation of the skin
A 16-year-old boy presents to his GP with a 6-month history of worsening abdominal pain and diarrhoea that has occasionally been mixed with fresh red blood. He says that he has lost about 4 kg over the last year despite there being no changes to his diet. On examination, he has mild lower abdominal tenderness and rectal examination is normal.
Which of the following is the most appropriate test to be requested by the GP?
Choose only ONE best answer.
A
Stool Culture
B
MRI Pelvis
C
Anti-Tissue Transglutaminase
D
Faecal Calprotectin
E
Abdominal Ultrasound
Faecal Calprotectin
This patient has presented with a chronic history of diarrhoea (that is sometimes bloody) associated with weight loss. This should raise suspicion of a diagnosis of inflammatory bowel disease. Faecal calprotectin is a non-invasive test that is performed on a stool sample. A raised faecal calprotectin is suggestive of intestinal inflammation (i.e. inflammatory bowel disease).
What is tricuspid atresia
Tricuspid atresia describes a condition where the tricuspid valve does not develop resulting in no blood flow to the right ventricle. This then leads to a small non-functional right ventricle (resulting in left axis deviation). Blood flows between the left and right sides of the heart via atrial and ventricular septal defects and there is minimal flow through the pulmonary circulation. Newborns often develop significant respiratory distress. It is usually managed acutely with a surgical intervention (e.g. Blalock-Taussig shunt insertion).
What are features of osteogenesis imperfecta
Osteogenesis imperfecta is a genetic condition caused by a mutation in the type 1 collagen. It is characterised by the formation of very brittle bones that are at very high risk of fracture. Blue sclerae are another clinical feature associated with osteogenesis imperfecta. The management usually involves analgesia and physiotherapy.
What is gold standard for CP
MRI
‘double bubble’ sign on XRay
duodenal atresia
Why do people with duchennes live shorter
respiratory and cardiac problems
life expectancy around 20 years
How are IQ tests interpretted
Borderline Mild
70-79
Mild
50-69
Moderate
35-49
Severe
20-34
Profound
< 20
What are features of pityriasis rosea
self-limiting skin condition that usually begins with the appearance of a large oval macule followed by the development of a more widespread rash across the torso. It usually occurs soon after a viral infection. It resolves spontaneously and no active treatment is required in the first instance.
Features of mesenteric adenitis
the abdominal lymph nodes become inflamed, causing non-specific abdominal pain. The pain is less severe than in acute appendicitis, may or may not localise to the right iliac fossa and resolves within 24-48 hours. Mesenteric adenitis is often preceded by an upper respiratory tract infection (URTI), with cervical lymphadenopathy. The condition usually resolves spontaneously; parents should be reassured that it is self-limiting.
How do you differentiate between crohns and UC
UC has an absence of extra colonic features such as oral lesions
What surgical treatment do you do for hirschsprungs
anorectal pull through
When would you do serum bilirubin vs transcutaneous bilirubinometer measurement
A serum measurement is appropriate when the jaundice has developed within the first 24 hours of life, or when the baby was born before 35 weeks’ gestation. If jaundice develops after the first 24 hours, or the gestational age is more than 35 weeks, transcutaneous bilirubinometery is appropriate. If the transcutaneous bilirubinometer records a measurement of more than 250 µmol/l, serum bilirubin measurement is indicated.
in ophthalmia neonatorum, how do you differentiate between chlamydia and gonorrhoea being the cause
Chlamydia is more common and presents between 5 days and 2 weeks after birth, whereas gonococcal conjunctivitis presents within the first 24 hours and up to 5 days after birth.
What do you use to rank Croup severity
Westley Croup Severity Score
What is first line treatment for generalised seizures
sodium valproate
What is first line for focal seziures
lamotrigine or carbamazepine
What is first line for absence seizures
ethosuximide or sodium valproate
What are features of Wilms TUmour
a large, non-tender abdominal mass in an otherwise well child, haematuria and hypertension
How do you diagnose Wilms Tumour
US with doppler studies
What is the management for Talipes Equinovarus
Ponseti Method
How do you manage hand-foot syndrome and acute chest crisis - sickle cell crisis
HF - opioids for analgesia
ACC - exchange transfusion
WHat is movicol
polyethene glycol
Cheek glands
parotid glands
Which of the following congenital syndromes is associated with normal intelligence?
Choose only ONE best answer.
A
Down Syndrome
B
Prader-Willi Syndrome
C
Turner Syndrome
D
DiGeorge Syndrome
E
Edwards Syndrome
Turner
treatment for meconium aspiration
IV gentamicin + ampicillin
How do you differentiate between IgA nephropathy and post streptococcal glomerulonephritis
IgA days after
post strep is weeks after
How do you diagnose asthma
FEV1
olive-like mass in left upper quadrant
pyloric stenosis
What are features of tinea capitis
There is a small, circular area where there is no hair growth. The underlying skin appears mildly scarred. On closer inspection, it is boggy, raised and pustular. There was no injury to the area reported.
What is cleft lip
an opening in the upper lip as facial structures fail to fuse together correctly during week 4-7 of pregnancy
what is cleft palate
a condition in which the palatal shelves in the roof of the mouth fail to join together so part of the palate remains open. This should be formed between week 6-9 of pregnancy
when does a cleft palate/lip get fixed
lip-first 3 months of life
palate-6-12months
which of the following is a poor prognostic factor for ALL?
A
Age 2-10 years at diagnosis
B
Caucasian
C
Received MMR Vaccine
D
White cell count < 20 x 109/L at diagnosis
E
T Cell Surface Markers
T cell surface markers
Test for malrotation
Upper GI Contrast Study with US Scan
An 11-month-old boy is brought to see his GP because of a painless, scrotal swelling.
On examination, the mass is soft and non-tender and confined to the scrotum. It is possible to get above the mass and it transilluminates.
hydrocoele
Features of inguinal hernia
you cannot get above them and they do not transilluminate. The contents protrude through the processus vaginalis which is patent but usually closes when the testes have descended
A newborn baby boy is identified as having sickle cell disease following routine newborn screening. The parents are unaffected and are not sure whether anyone in their families had suffered from the condition.
Which of the following would you expect to see on haemoglobin electrophoresis?
A
HbA and HbS
B
HbSS
C
HbS and HbF
D
HbAA
E
HbA and HbF
HbS and HbF
What causes TTN
a delay in the resorption of fluid from the lungs which, in turn, leads to some respiratory distress.
Which of the following is a post-viral complication associated with mumps?
A
Visual Loss
B
Gastritis
C
Hepatitis
D
Pancreatitis
E
Myositis
Pancreatitis
What are the two main signs of torsion
loss of the cremasteric reflex and negative Prehn’s sign. pregn’s sign refers to relief of scrotal pain upon elevation of the testicles (it is negative in testicular torsion and positive in epididymitis).
What is omphalitis
Omphalitis is a rare condition in which the umbilicus and surrounding tissues become infected and inflamed (usually caused by Staphylococcus sp. and Streptococcus sp.). The umbilicus and stump may appear red and warm and be discharging pus. This can quickly progress to a more widespread infection (e.g. necrotising fasciitis) as it makes its way across the abdominal wall.
What is ebsteins anomaly
downward displacement of an abnormal tricuspid valve which causes the atrium to increase in size and the right ventricle to become smaller or ‘atrialise’.
causes tricuspid regurg
Rosenthal fibres
pilocytic astrocytoma
soft, early diastolic decrescendo murmur. This is heard best on end expiration when the patient is sitting up
aortic regurg - marfans
- Kid fighting with brother, sustains injury where elbow is flexed and pronated, pain on supination. What is the injury? Subluxation of the radial head, olecranon bursitis, olecranon fracture, supracondylar fracture of humerus
subluxation of radial head
- Bilateral undescended testes in a phenotypically male newborn examination, most likely dx? Klinefelter’s, retractile testes, androgen insensitivity syndrome, increased oestrogen exposure in utero
androgen insensitivity syndrome
- Most common allergen in perennial rhinitis?
house dust mites
- Baby born to a mother with SLE has bradycardia. What is the most likely diagnosis?
Neonatal Lupus with Congenital Heart Block
- Girl (pre-pubertal) with offensive vaginal discharge. What is the most common cause of this?
foreign body
