Peads Mock Flashcards
Components of an APGAR Score
- Appearance/colour
- Pulse
- Grimace/reflex irritability
- Activity/muscle tone
- Respiratory effort
An absence of fundal reflex could be indicative of what ?
- Congenital cataracts, retinal detachment, vitreous haemorrhage, retinoblastoma
How is developmental dysplasia of the hip investigated ?
- Hip USS
- Paediatric orthopedics is done if abnormal
RFs for DDH ?
- Female sex
- FHx
- Breech presentation after 36 weeks
- Multiple pregnancy where other foetus was breech after 36 weeks
- Firstborn child
- Oligohydramnios
- Macrosomic baby
What is the pathophysiology of pyloric stenosis ?
- Hypertrophy of the pyloric sphincter resulting in narrowing of the pyloric canal
What would an ABG of a child with pyloric stenosis show ?
- Hypochloremia metabolic alkalosis
What is definitive management of pyloric stenosis ?
- Laparoscopic pyloromyotomy (Ramstedt’s pyloromyotomy)
How does Bronchiolitis present ?
- Coryzal symptoms
- Signs of respiratory distress
- Dyspnoea
- Tachypnoea
- Poor feeding
- Mild fever
- Apnoeas
- Wheeze and crackles
- Dry cough
How does viral induced wheeze present ?
- SOB
- Signs of respiratory distress
- Expiratory wheeze throughout the chest
What are the differences between bronchiolitis and viral induced wheeze ?
- Bronchiolitis will present with coryzal symptoms and mild fever
- Crackles on auscultation
- Dry cough
Red flag symptoms for bronchiolitis ?
- Observed/reported apnoea
- RR > 70
- Grunting
- Central cyanosis
- O2 sat < 92%
- Looks unwell to a HCP
What dietary advice would you give to a child with CF ?
- High calorie diet with high fat content and pancreatic enzyme supplementation for every meal
How could congenital adrenal hyperplasia present in females ?
- Tall for their age
- Facial hair
- Absent periods
- Deep voice
- Early puberty
- Hyperpigmentation
How could congenital adrenal hyperplasia present in males ?
- Tall for their age
- Deep voice
- Large penis
- Small testicles
- Early puberty
- Hyperpigmentation
Why does hyperpigmentation occur in congenital adrenal hyperplasia ?
- 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
Name electrolyte abnormalities that present with congenital adrenal hyperplasia ?
- Hyponatremia
- Hyperkalaemia
- Metabolic acidosis
- Hyperglycaemia
What is the mode of inheritance of congenital adrenal hyperplasia ?
- Autosomal recessive
What is the most common cause of congenital adrenal hyperplasia ?
- 21-hydroxylase deficiency
How would you treat congenital adrenal hyperplasia ?
- IV fluids, dextrose, hydrocortisone
What are the components of TOF ?
- Overarching aorta
- VSD
- Pulmonary hypertension
- Right ventricular hypertrophy
What are tet spells and how do they present ?
- 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.
What is the mechanism for how TOF can lead to heart failure ?
- 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.
How does measles present ?
- Erythematous maculopapular rash that starts on the face and spreads to the trunk
- Fever
- Koplik spots
- Conjunctivitis
- Rhinorrhoea/nasal discharge
- Who should be notified of a measles outbreak ?
- The local health protection team
- What are complications of measles ?
- Otitis media
- Pneumonia
- Encephalitis
- Diarrhoea
What are the 2 main features of ADHD ?
- Inattention
- Hyperactivity
What is first line medication for ADHD ?
- Methylphenidate
How and how often should the side effects of methylphenidate be monitored ?
- BMI
- Every 6 months
What is the mode of inheritance of muscular dystrophy ?
- X linked recessive
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
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.
Give options for MDT management of muscular dystrophy ?
- Medical – corticosteroids
- Surgical – Scoliosis surgery
- Respiratory ventilation
- Physiotherapy
- Exercise
- Education
- Counselling
- Palliative care
At what time does physiological jaundice typically resolve in a pre-term and term baby ?
- At term = 14 days
- Preterm = 21 days
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
What are the 2 main management options for jaundice in neonates ?
- Phototherapy
- Exchange transfusion
What is the surgical procedure used to treat biliary atresia?
- Kasai procedure
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
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
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.
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
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
What cardiovascular abnormalities is the patient at risk of ?
- Pulmonary stenosis
- Hypertrophic cardiomyopathy
- ASD
- What cancers do patients with Noonan’s have a increased risk of developing ?
- Leukaemia
- Neuroblastoma
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
A patient has been given ABs for a UTI and they have not worked. How do you follow up ?
- Ultrasound of the urinary tract
How do you investigate a child who has recurrent UTIs ?
- DMSA (dimercaptosuccinic acid scintigraphy) scan
What is the MCC of a UTI in children ? What are less common causes ?
- E.coli
- Proteus
- Klebsiella
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.
What is vesicoureteral reflux ?
- Abnormal backflow of urine from the bladder into the ureter/kidney
RFs for UTIs in children
- Female sex
- Sexual abuse
- Immunosuppressed
- Malnourishment
- Age < 1 year
Not breast fed
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
What is the initial management of a child with a new onset limp ?
- Refer to pediatrics for urgent specialist review
What red flags could indicate septic arthritis
- Fever > 38 degrees
- Non-weight bearing
- Raised ESR
- Raised CRP
- Swollen red joint
What is a toddler’s facture ?
- Spiral fracture of the tibia
