Peads Mock Flashcards

1
Q

Components of an APGAR Score

A
  • Appearance/colour
  • Pulse
  • Grimace/reflex irritability
  • Activity/muscle tone
  • Respiratory effort
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2
Q

An absence of fundal reflex could be indicative of what ?

A
  • Congenital cataracts, retinal detachment, vitreous haemorrhage, retinoblastoma
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3
Q

How is developmental dysplasia of the hip investigated ?

A
  • Hip USS
  • Paediatric orthopedics is done if abnormal
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4
Q

RFs for DDH ?

A
  • Female sex
  • FHx
  • Breech presentation after 36 weeks
  • Multiple pregnancy where other foetus was breech after 36 weeks
  • Firstborn child
  • Oligohydramnios
  • Macrosomic baby
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5
Q

What is the pathophysiology of pyloric stenosis ?

A
  • Hypertrophy of the pyloric sphincter resulting in narrowing of the pyloric canal
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6
Q

What would an ABG of a child with pyloric stenosis show ?

A
  • Hypochloremia metabolic alkalosis
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7
Q

What is definitive management of pyloric stenosis ?

A
  • Laparoscopic pyloromyotomy (Ramstedt’s pyloromyotomy)
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8
Q

How does Bronchiolitis present ?

A
  • Coryzal symptoms
  • Signs of respiratory distress
  • Dyspnoea
  • Tachypnoea
  • Poor feeding
  • Mild fever
  • Apnoeas
  • Wheeze and crackles
  • Dry cough
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9
Q

How does viral induced wheeze present ?

A
  • SOB
  • Signs of respiratory distress
  • Expiratory wheeze throughout the chest
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10
Q

What are the differences between bronchiolitis and viral induced wheeze ?

A
  • Bronchiolitis will present with coryzal symptoms and mild fever
  • Crackles on auscultation
  • Dry cough
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11
Q

Red flag symptoms for bronchiolitis ?

A
  • Observed/reported apnoea
  • RR > 70
  • Grunting
  • Central cyanosis
  • O2 sat < 92%
  • Looks unwell to a HCP
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12
Q

What dietary advice would you give to a child with CF ?

A
  • High calorie diet with high fat content and pancreatic enzyme supplementation for every meal
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13
Q

How could congenital adrenal hyperplasia present in females ?

A
  • Tall for their age
  • Facial hair
  • Absent periods
  • Deep voice
  • Early puberty
  • Hyperpigmentation
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14
Q

How could congenital adrenal hyperplasia present in males ?

A
  • Tall for their age
  • Deep voice
  • Large penis
  • Small testicles
  • Early puberty
  • Hyperpigmentation
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15
Q

Why does hyperpigmentation occur in congenital adrenal hyperplasia ?

A
  • The anterior pituitary glands responds to low levels of cortisol by producing increasing amounts of ACTH
  • A by-product of ACTH production is melanocyte simulating hormone which stimulates the production of melanin (pigment) within skin cells
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16
Q

Name electrolyte abnormalities that present with congenital adrenal hyperplasia ?

A
  • Hyponatremia
  • Hyperkalaemia
  • Metabolic acidosis
  • Hyperglycaemia
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17
Q

What is the mode of inheritance of congenital adrenal hyperplasia ?

A
  • Autosomal recessive
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18
Q

What is the most common cause of congenital adrenal hyperplasia ?

A
  • 21-hydroxylase deficiency
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19
Q

How would you treat congenital adrenal hyperplasia ?

A
  • IV fluids, dextrose, hydrocortisone
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20
Q

What are the components of TOF ?

A
  • Overarching aorta
  • VSD
  • Pulmonary hypertension
  • Right ventricular hypertrophy
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21
Q

What are tet spells and how do they present ?

A
  • Intermittent symptomatic periods where the right to left shunt is temporarily worsened, causing cyanosis
  • When the pulmonary vascular resistance increases or the systemic resistance decreases. E.g. if the child is physically exerting themselves they are generating a lot of Co2
  • Co2 is a vasodilator that causes systemic vasodilation and therefore reduces the systemic vascular resistance.
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22
Q

What is the mechanism for how TOF can lead to heart failure ?

A
  • Blood flow through the left-to-right shunt leads to pulmonary hypertension
  • This causes right ventricular hypertrophy and an increase in the right ventricular pressure
  • When the right ventricular pressure exceeds the left ventricular pressure, there is a reversal of blood flow, leading to a right-to-left shunt.
23
Q

How does measles present ?

A
  • Erythematous maculopapular rash that starts on the face and spreads to the trunk
  • Fever
  • Koplik spots
  • Conjunctivitis
  • Rhinorrhoea/nasal discharge
24
Q
  1. Who should be notified of a measles outbreak ?
A
  • The local health protection team
25
25. What are complications of measles ?
- Otitis media - Pneumonia - Encephalitis - Diarrhoea
26
What are the 2 main features of ADHD ?
- Inattention - Hyperactivity
27
What is first line medication for ADHD ?
- Methylphenidate
28
How and how often should the side effects of methylphenidate be monitored ?
- BMI - Every 6 months
29
What is the mode of inheritance of muscular dystrophy ?
- X linked recessive
30
Explain the pathology of muscular dystrophy ?
- Gene mutation on Xp21 - Dystrophin is absent which is important for architecture - Muscle is lost and replaced by adipose tissue
31
What is Growers sign ?
- The child assumes the hands-and-knees position and then climbs to a stand by "walking" his hands progressively up his shins, knees, and thighs.
32
Give options for MDT management of muscular dystrophy ?
- Medical – corticosteroids - Surgical – Scoliosis surgery - Respiratory ventilation - Physiotherapy - Exercise - Education - Counselling - Palliative care
33
At what time does physiological jaundice typically resolve in a pre-term and term baby ?
- At term = 14 days - Preterm = 21 days
34
What could differentials be for a child presenting with jaundice in the first 24 hours after birth ?
- Rhesus haemolytic disease - ABO haemolytic disease - Hereditary spherocytosis - Glucose-6-phosphodehydrogenase
35
What are the 2 main management options for jaundice in neonates ?
- Phototherapy - Exchange transfusion
36
What is the surgical procedure used to treat biliary atresia?
- Kasai procedure
37
A 5-year-old boy, presents to your paediatric ENT clinic with a complaint of persistent ear pain and hearing difficulties. His parents mention that he has a history of recurrent ear infections since infancy. Upon examination, you notice fluid behind both tympanic membranes and mild hearing loss. What is the most likely diagnosis ?
- Otitis media with effusion
38
RFs for recurrent ear infections in children ?
- Age 6m to 2 years (shorter eustachian tubes) - Bottle feeding when lying down - Allergies - Genetic predisposition (FHx) - Cleft palate - Respiratory infections
39
Primary treatment for recurrent ear infections ?
- Conservative measures such as nasal saline irrigation, and medical - options like antibiotics in cases of acute exacerbations. Tympanostomy tube insertion - may be considered in persistent cases.
40
What is Noonan’s syndrome ?
- Can be thought of as male Turner’s syndrome - An autosomal dominant condition associated with a normal karyotype caused by a gene defect on CH:12
41
How does Noonan’s present ?
- Webbed neck, widely spaced nipples, short stature, pectus carinatum and excavatum (similar to Turner’s) - Pulmonary valve stenosis - Ptosis - Triangular-shaped face - Low-set ears - Coagulation problems e.g. factor XI deficiency
42
What cardiovascular abnormalities is the patient at risk of ?
- Pulmonary stenosis - Hypertrophic cardiomyopathy - ASD
43
43. What cancers do patients with Noonan’s have a increased risk of developing ?
- Leukaemia - Neuroblastoma
44
Management for a 2-year-old with a UTI ?
- Nitrofurantoin or Trimethoprim - 3 days - Infant less than 3 months old should be referred immediately to a pediatrician - Upper UTI should be considered for admission
45
A patient has been given ABs for a UTI and they have not worked. How do you follow up ?
- Ultrasound of the urinary tract
46
How do you investigate a child who has recurrent UTIs ?
- DMSA (dimercaptosuccinic acid scintigraphy) scan
47
What is the MCC of a UTI in children ? What are less common causes ?
- E.coli - Proteus - Klebsiella
48
Why are UTIs more common in females ?
- The female urethra is shorter than the male urethra, so it is easier for bacteria to - enter and cause infection.
49
What is vesicoureteral reflux ?
- Abnormal backflow of urine from the bladder into the ureter/kidney
50
RFs for UTIs in children
- Female sex - Sexual abuse - Immunosuppressed - Malnourishment - Age < 1 year Not breast fed
51
DDs for a 2 year old with a new limp
- Septic arthritis - Transient synovitis - Malignancy - Fracture/sprain - Abuse - Developmental dysplasia of the HIP - Perthes’s disease - Juvenile idiopathic arthritis - ALL
52
What is the initial management of a child with a new onset limp ?
- Refer to pediatrics for urgent specialist review
53
What red flags could indicate septic arthritis
- Fever > 38 degrees - Non-weight bearing - Raised ESR - Raised CRP - Swollen red joint
54
What is a toddler’s facture ?
- Spiral fracture of the tibia