Peadiatrics

Question 1

Red currant jelly poo in baby

Answer 1

Intussusception
- screaming and pallor
-vomiting
- red currant jelly stool (blood, mucus and mucosa)
- sausage shaped palpable mass on RHS abdo 
Emergency 
<1 mostly
Associated with HSP, CF, Haemophilia.
D: ultrasound 
T: enema or surgery - removal

Question 2

Tetralogy of fallot

Answer 2

Pulmonary stenosis / Right ventricular outflow tract obstruction (RVOT)
Right ventricular hypertrophy
VSD
Overriding displaced aorta 
Usually 1-2 months of age

Question 3

Acute, febrile, multi-system disease
3 yo, fever, cervical lymph nodes, conjunctival congestion, red lips and palms, desquamation of fingertips, erythema of oral cavity.
Suddenly dies 2 weeks later after Sx resolve
Autopsy - vasculitis of coronary arteries and aneurysm.

Answer 3

Kawasaki’s disease 
Mucocutaneous lymph node syndrome 
Mostly <5 yo
No pus (non-suppurative) revival adenitis 
Changes in skin and mucus membranes 
Generally benign - 25% coronary artery aneurysms 
Fatality 0.5-2.8%
Platelet count abnormally ELEVATED
Complications generally 3-4 weeks 
T: High dose IVIG 2g/kg with aspirin

Question 4

4 yo boy acute painful right hip 
Cannot weight bear 
Had URTI last week 
Temp of 37.1
Restricted movement on hip and pain on flexion and internal rotation. 
X-ray and bloods is normal 
Ultra sound shows small joint effusion

Answer 4

Transient synovitis
Diagnosis of exclusion.
Most common cause of hip pain in pre pubescent children.
Infection (viral often) moves and settles in joint.
Normal investigations.

Question 5

5 yo boy with limp with not pain. (Or knee pain)
Started 3 weeks ago and worsening.
Misdiagnosis
Short stature

Answer 5

Perthes disease - self limiting femoral head comprising necrosis collapse and repair. More common in <10 and in boys.
Typically 4-8 yo presentation
Often Hx of short stature
Passive smoking in home, and low economic status
X-ray - femoral head collapse, fragmentation, subchondral fracture
Normal FBC
May have slightly raised sedimentation rate and CRP
Bone scintigraphy - diagnose ischemic stage in normal xrays. Cold spots indicate early disease.

Question 6

Septic arthritis

Answer 6

Acute onset 
Systemic Sx
Unilateral 
Acute pain in hip 
Marked restriction in movement 
Elevated WBC 
Positive blood cultures
X-ray shows widened joint space
 Joint effusion on ultrasound 
Aspiration confirms infection

Question 7

8 week Immunisations

Answer 7

DTaP/ IPV/ Hib/ HepB

• Diphtheria, tetanus, pertussis (whooping cough)
• Polio
• Haemophilus influenza B
• hepatitis B

Meningococcal group B
Rotavirus
Pneumoccocal (13 subtypes) PCV

Question 8

12 week immunisations

Answer 8

DTaP / IPV / Hib / HepB - second dose

Rotavirus - second dose

Question 9

16 week immunisations

Answer 9

DTaP / IPV/ Hib/ HepB - third dose
Men B - second dose
PCV - second dose

Question 10

1 year immunisations

Answer 10

Hib and Men C
Pneumoccocal (PCV) booster - third dose
MMR
MenB Booster - third dose

Question 11

3yrs 4months immunisations

Answer 11

DTaP / IPV

MMR - second dose

Question 12

12/13 years old immunisation

Answer 12

HPV - two doses 6-24 months apart
cancer - 16/18
Genital warts - 6/11

Question 13

14 yo immunisations

Answer 13

Td/ IPV (check MMR status)
- tetanus, Diphtheria and polio

MenACWY - meningococcal groups