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Phase 3a > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

How does scarlet fever typically present?

A

1.Fever- 24-48 hours
2.Strawberry tongue
3.Sandpaper rash over trunk and extremities
4.Cervical lymphadenopathy
5. Pharangitis (sore throat)
6. Circumoral pallor
Headache

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2
Q

Management for scarlet fever?

A

Oral penicillin for 10 days
(Azithromycin in patients with penicillin allergy)

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3
Q

What is transient synovitis?

A

Acute hip pain following a viral infection

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4
Q

What is the typical age range for transient synovitis?

A

3-8 years

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5
Q

What is the treatment for transient synovitis?

A

Rest and analgesia

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6
Q

What causes chicken pox?

A

Varicella zoster virus

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7
Q

What are the criteria needed for diagnosis of Kawasaki disease?

A

4 of the following 5 features must be present along with a fever for >5 days:
Bilateral conjunctivitis
Cervical lymphadenopathy
Polymorphic rash
Cracked lips/strawberry tongue
Oedema/desquamation of the hands/feet

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8
Q

Why is aspirin not normally used in children?

A

Risk of Reye’s syndrome

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9
Q

What is the management for Kawasaki disease?

A

High dose aspirin
Intravenous immunoglobulin
Echocardiogram (screen for coronary artery aneurysms)

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10
Q

What is the main complication of Kawasaki disease?

A

Coronary artery syndrome

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11
Q

What is the difference between primary amenorrhoea and secondary amenorrhoea

A

Primary- never started periods
Secondary- had regular periods but have stopped

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12
Q

What is the average age of diagnosis for a retinoblastoma?

A

18 months

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13
Q

What is the most common feature of a retinoblastoma?

A

Loss of red reflex- replaced with white

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14
Q

What is the management of a retinoblastoma?

A

Enucleation
Radiation beam therapy
Chemotherapy

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15
Q

What causes precocious puberty with small testes?

A

Adrenal hyperplasia

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16
Q

What are the features of ALL in children?

A

Anaemia (lethargy), neutropenia (frequent/severe infections), thrombocytopenia (easy bruising). Bone pain, splenomegaly, hepatomegaly

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17
Q

Which virus causes hand, foot and mouth?

A

Coxsackie virus A16 and Enterovirus 71

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18
Q

What are the features of hand, foot and mouth?

A

Systemic illness and oral ulcers followed by hand and feet rash

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19
Q

What is the treatment for pyloric stenosis?

A

Ramstedt pyloromyotomy

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20
Q

When is transient tachypnoea of the newborn more common?

A

Following a caesarean section

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21
Q

What does a chest x-ray show in transient tachypnoea of the newborn?

A

Hyperinflation of the lungs and fluid in the horizontal fissure

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22
Q

What is the management of transient tachypnoea of the newborn?

A

Supportive
Supplemental oxygen if required

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23
Q

What are the features of pyloric stenosis?

A

Projectile vomiting
Olive shaped mass
Constipation, dehydration, willingness to feed, failure to thrive
Hypochloraemic, hypokalaemic alkalosis due to vomiting

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24
Q

How do you diagnose pyloric stenosis?

A

USS

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25
Q

What is the first line treatment for constipation?

A

Polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)
2nd- Add a stimulant laxative
3rd- Substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose

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26
Q

Which conditions make bronchiolitis more serious?

A

Bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis

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27
Q

What are the presenting features of CF?

A

Neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
Recurrent chest infections (40%)
Malabsorption (30%): steatorrhoea, failure to thrive
Other features (10%): liver disease

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28
Q

Name some other features of CF?

A

Short stature
Diabetes mellitus
Delayed puberty
Rectal prolapse (due to bulky stools)
Nasal polyps
Male infertility, female subfertility

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29
Q

Which vaccine do boys and girls get at 12-13 years old?

A

The HPV vaccine

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30
Q

Precocious puberty in males may be defined as the development of secondary sexual characteristics before what age?

A

9 years

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31
Q

Precocious puberty in females may be defined as the development of secondary sexual characteristics before what age?

A

8 years

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32
Q

What are the causes of jaundice within the first 24 hours of life?

A

Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
Glucose-6-phosphodehydrogenase

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33
Q

What are the causes of prolonged jaundice (present at over 14 days of life)?

A

Biliary atresia
Hypothyroidism
Galactosaemia
Urinary tract infection
Breast milk jaundice
Prematurity
Congenital infections e.g. CMV, toxoplasmosis

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34
Q

What are febrile convulsions?

A

Febrile convulsions are seizures provoked by fever in otherwise normal children.

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35
Q

Between what ages do febrile convulsions typically occur?

A

Between the ages of 6 months and 5 years

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36
Q

What urgent rescue medication should be used for febrile convulsions?

A

Rectal diazepam or buccal midazolam

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37
Q

Write out the immunisation program

A

A

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38
Q

Write out the developmental milestones

A

A

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39
Q

Where are hand, foot and mouth lesions found?

A

Mouth, hands, feet, buttocks, groin

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40
Q

What is the autism triad?

A

Communication impairment + impairment of social relationships + ritualistic behaviour

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41
Q

What is the investigation for pyloric stenosis?

A

US Abdomen

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42
Q

What investigation would you do for Kawasaki disease complications?

A

Echocardiogram for coronary artery aneurysms

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43
Q

Aspirin is normally contraindicated in children due to the risk of Reye’s syndrome, for what disease is it used?

A

Kawasaki disease

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44
Q

What is the most common complication of measles?

A

Otitis media

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45
Q

What are the features of measles?

A

Prodromal phase- irritability, conjunctivitis, fever
Koplik spots- white spots on buccal mucosa
Rash- Starts behind ears and spreads to whole body, discrete macropapular rash that becomes blotchy
Diahorroea in 10% of patients

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46
Q

What is the management of measles?

A

Supportive treatment
Admission considered in immunosuppressed patients
Notifiable disease- tell public health
MMR offered/given to contacts within 72 hours

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47
Q

What are the complications of measles?

A

Otitis media- most common complication
Pneumonia- most common cause of death
Encephalitis- 1-2 weeks after illness onset
Subacute sclerosing encephalitis- rare and presents 5-10 years after illness

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48
Q

What organism is threadworm caused by?

A

Enterobius vermicularis

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49
Q

What symptoms are indicative of threadworm?

A

Perianal itching, particularly at night- potentially affecting family members
Girls may have vulval symptoms

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50
Q

What is the management of threadworm?

A

Hygiene for household and anthelmintic- mebendazole in children over 6 months

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51
Q

What are the features of an atypical UTI?

A

Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms

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52
Q

What are the features of GORD?

A

Typically develops before 8 weeks
Vomiting/regurgitation
Excessive crying, especially while feeding

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53
Q

What is the management of GORD?

A

Advise on overfeeding and position during feeds
Trial a thickened formula
Trial alginate therapy

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54
Q

What are the features of Turner’s syndrome?

A

Short stature
Webbed neck
Bicuspid aortic valve, coarctation of the aorta
Primary amenorrhoea
Lymphoedema in neonates
Gonadotrophin levels will be elevated
Horseshoe kidney
High arched palate

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55
Q

Generally what level is neonatal hypoglycaemia?

A

<2.6 mmol/L

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56
Q

What can cause neonatal hypoglycaemia?

A

Preterm birth (< 37 weeks)
Maternal diabetes mellitus
IUGR
Hypothermia
Neonatal sepsis
Inborn errors of metabolism
Nesidioblastosis
Beckwith-Wiedemann syndrome

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57
Q

What is the management of neonatal hypoglycaemia?

A

Asymptomatic- encourage normal feeding and monitor blood glucose
Symptomatic or very low- admit to neonatal unit and administer 10% dextrose

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58
Q

What are the features of croup?

A

Stridor
Barking cough (worse at night)
Fever
Coryzal symptoms

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59
Q

What is the management of croup?

A

Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
Emergency treatment with high flow oxygen and nebulised adrenaline if necessary

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60
Q

Difference between getting prader-willi and angelman syndrome

A

Prader-Willi syndrome if gene deleted from father
Angelman syndrome if gene deleted from mother

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61
Q

Prader willi features

A

Hypotonia during infancy
Dysmorphic features
Short stature
Hypogonadism and infertility
Learning difficulties
Childhood obesity
Behavioural problems in adolescence

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62
Q

What inheritance pattern is prader willi an example of?

A

Imprinting

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63
Q

What are the features of patent ductus arteriosus?

A

Left subclavicular thrill
Continuous ‘machinery’ murmur
Large volume, bounding, collapsing pulse
Wide pulse pressure
Heaving apex beat

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64
Q

What is the management of patent ductus arteriosus?

A

Give indomethacin or ibuprofen

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65
Q

What keeps PDA open?

A

Prostoglandin E1- until surgery can be done if associated with congenital heart defects

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66
Q

What inheritance pattern is haemophillia A?

A

X linked recessive- only effects males (apart from Turners syndrome) and X always comes from mother

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67
Q

What is the triad of shaken baby syndrome?

A

Retinal haemorrhages, subdural hematoma and encephalopathy

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68
Q

What are the risk factors for neonatal sepsis?

A

Mother who has had a previous baby with GrouoBStrep infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy
Premature (<37 weeks): approximately 85% of neonatal sepsis cases are in premature neonates
Low birth weight (<2.5kg): approximately 80% are low birth weight
Evidence of maternal chorioamnionitis

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69
Q

What is the main cause of neonatal sepsis in the UK?

A

Group B Streptococcus

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70
Q

What is the presentation of neonatal sepsis?

A

Respiratory distress
Tachycardia
Apnoea
Change in mental status
Jaundice
Seizures
Poor feeding
Abdominal distention
Vomiting
Temperature

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71
Q

What are the risk factors for surfactant deficient lung disease (respiratory distress syndrome)?

A

Male
Diabetic mother
Caesarean section
Second born of premature twins

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72
Q

What does x-ray show in respiratory distress syndrome?

A

Ground glass appearance

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73
Q

What features are indicative of slipped capital femoral epiphysis (SCFE)?

A

Obesity, unilateral groin pain, trauma, loss of internal rotation of the leg in flexion

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74
Q

What bacteria causes whooping cough?

A

Bordetella pertussis

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75
Q

What are the diagnostic criteria for whooping cough?

A

(Lots of coughing fits)
Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.

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76
Q

Is whooping cough a notifiable disease?

A

Yes

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77
Q

What is the management for whooping cough?

A

Admitted if under 6 months
Notify public health
Oral macrolide (azithromycin) if onset of cough within 21 days to reduce spread
Household contacts offered antibiotic prophylaxis
Antibiotic therapy does not alter course of illness
School exclusion for 48 hours after initiation of antibiotics or for 21 days if no antibiotics

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78
Q

What are the complications of whooping cough?

A

Subconjunctival haemorrhage
Pneumonia
Bronchiectasis
Seizures

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79
Q

What are some high risk symptoms in children?

A

Pale/mottled/ashen/blue
No response to social cues
Appears ill to healthcare professional
Does not wake or if roused does not stay awake
Weak, high pitched or continuous cry
Grunting
Resp rate > 60
Moderate or severe chest indrawing
Reduced skin turgor
Under 3 month with temp over 38
Non blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures

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80
Q

What is the most common cause of cardiac arrest in children?

A

Respiratory problems (Hypoxia)

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81
Q

What is the first line management for cow’s milk protein allergy?

A

Extensive hydrolysed formula
2nd- Amino acid based formula

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82
Q

When does CMPA present?

A

Within the first 3 months

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83
Q

How does CMPA/CMPI present?

A

CMPA- immediate IgE mediated, CMPI- delayed non-IgE mediated
Regurgitation and vomiting
Diarrhoea
Urticaria, atopic eczema
Colic symptoms: irritability, crying
Wheeze, chronic cough
Rarely angioedema and anaphylaxis may occur

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84
Q

What are the components of APGAR?

A

APGAR is an mnemonic for the assessment of:
Appearance (colour)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort

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85
Q

What is the RR and HR of healthy infants?

A

RR- 30-60
HR- 100-160

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86
Q

What are the symptoms of necrotising enterocolitis?

A

Feeding intolerance, abdominal distension, bloody stools which can progress to abdominal discolouration, perforation and peritonitis

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87
Q

What is the investigation for necrotising enterocolitis and what does it show?

A

X-rays-
Dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis (intramural gas)
Portal venous gas
Pneumoperitoneum resulting from perforation
Air both inside and outside of the bowel wall (Rigler sign)
Air outlining the falciform ligament (football sign)

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88
Q

What is the treatment for ADHD?

A

Behavioural therapy

Drug therapy last resort and in those aged 5 or older

Methylphenidate or lisdexamfetamine

Both drugs are cardiotoxic so ECG before starting them

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89
Q

What is the recommended compression to ventilation ratio for a newborn?

A

3:1

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90
Q

What causes roseola infantum?

A

Human herpes virus 6

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91
Q

What are the features of roseola infantum?

A

High grade fever followed by a maculopapular rash (roses bloom from inside first)
Nagayama spots
Febrile convulsions
Diarrhoea and cough

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92
Q

What are the characteristics of a life threatening asthma attack?

A

SpO2 < 92%
PEF <33% best or predicted
Silent chest
Altered of consciousness
Cyanosis
Agitation
Poor respiratory effort

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93
Q

What is the management of cystic fibrosis?

A

Minimise contact with other CF patients to limit cross infection- Burkholderia cepacia complex and Pseudomonas aeruginosa
Physiotherapy twice daily
High calorie high fat diet
Enzyme supplements for digestion
Potential lung transplantation

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94
Q

What is the typical age range for febrile convulsions?

A

Between 6 months and 5 years

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95
Q

What type of seizure is a febrile convulsion most likely to be?

A

Tonic-clonic seizure

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96
Q

What age do infantile spasms present?

A

4-8 months

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97
Q

What are the features of infantile spasms?

A

Characteristic salaam attacks lasting 1-2 seconds and repeated up to 50 times
Looks like colic
Progressive mental handicap
Poor prognosis- vigabatrin is first line

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98
Q

What does the EEG show in infantile spasms?

A

Hypsarrythmia

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99
Q

What syndrome are infantile spasms part of?

A

West syndrome

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100
Q

What are the main causes of chronic diarrhoea in infants?

A

Cow’s milk intolerance
Toddlers diarrhoea- stools vary in consistency- often undigested food
Coeliac disease
Post-gastroenteritis lactose intolerance

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101
Q

What is the most common cause of gastroenteritis?

A

Rotavirus

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102
Q

What is the treatment for gastroenteritis?

A

Avoid dehydration
Rehydration treatment

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103
Q

What is the management of chicken pox?

A

Supportive
Keep cool, trim nails
Calamine lotion
School exclusion- Advise that the most infectious period is 1–2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash).
Immunocompromised and newborns with peripartum exposure should receive varicella zoster immunoglobulin, if chicken pox develops then IV aciclovir should be considered

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104
Q

What is the classic electrolyte balance disturbance in pyloric stenosis?

A

Hypochloremic, hypokalaemic metabolic alkalosis

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105
Q

What are the differences between caput succedaneum and cephalohaematoma?

A

https://d32xxyeh8kfs8k.cloudfront.net/images_Passmedicine/pdd913.png

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106
Q

What are the features of epiglottitis?

A

Rapid onset
High temperature, generally unwell
Stridor
Drooling of saliva
‘Tripod’ position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position

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107
Q

What are the presenting features of cystic fibrosis?

A

Neonatal period (around 20%): meconium ileus, less commonly Prolonged jaundice
Recurrent chest infections (40%)
Malabsorption (30%): steatorrhoea, failure to thrive
Other features (10%): liver disease

Short stature
Diabetes mellitus
delayed puberty
Rectal prolapse (due to bulky stools)
Nasal polyps
Male infertility, female subfertility

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108
Q

What is the combination of a distended abdomen and bilious vomiting suggestive of?

A

Intestinal malrotaion

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109
Q

What are displaced apex beat and decreased air entry suggestive of?

A

Congenital diaphragmatic hernia

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110
Q

What are undescended testes associated with?

A

Increased risk of infertility, torison and testicular cancer

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111
Q

Osgood-Schlatter disease is caused by inflammation of what?

A

The tibial tuberosity

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112
Q

What type of rash is scarlett fever?

A

Sandpaper rash (rough)

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113
Q

What causes rapid onset fever, stridor and drooling?

A

Acute epiglottis caused by Haemophilius influenzae B

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114
Q

What are the components of APGAR score?

A

Made up acronym
Appearance (colour)
Pulse rate (100+ is good)
Grimace (reflex irritability cry,cough, sneeze)
Activity (muscle tone)
Respiratory rate
Out of 10 points

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115
Q

Asthma management for under 5’s

A
  1. SABA
  2. SABA + Moderate dose ICS
  3. SABA +ICS +LTRA
  4. Stop LTRA and refer to specialist
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116
Q

Asthma management for 5-16 year olds (similar to adults)

A
  1. SABA
  2. SABA + ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA
  5. SABA + MART (which includes low dose ICS)
  6. SABA + MART (Moderate dose)
  7. SABA + either high dose ICS (can be part of MART), trial of additional drug such as theophylline or specialist advice
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117
Q

How long shoud a febrile seizure last before the ambulance is called?

A

5 minutes

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118
Q

At what age can nocturnal enuresis be diagnosed?

A

Over 5 years of age

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119
Q

What is the management of nocturnal enuresis?

A
  1. Look for causes (diabetes, constipation, UTI)
  2. General advice- fluid intake, toileting patterns
  3. Reward systems
  4. Enuresis alarm
  5. Desmopressin
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120
Q

What are the meningitis organisms in children?

A

Neonatal to 3 months:
Group B strep
E.coli
Listeria monnocytogenes

1 month to 6 years:
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

Greater than 6 years:
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)

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121
Q

What is atlantoaxial instability?

A

Unstable neck- down syndrome children more likely to dislocate neck when trampolining, gymnastics and other sports

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122
Q

What are the clinical features of downs syndrome?

A

Face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
Flat occiput
Single palmar crease,pronounced ‘sandal gap’ between big and first toe
Hypotonia
Congenital heart defects (40-50%, see below)
Duodenal atresia
Hirschsprung’s disease

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123
Q

What are the later complications of downs syndrome?

A

Subfertility: males are almost always infertile due to impaired spermatogenesis. Females are usually subfertile, and have an increased incidence of problems with pregnancy and labour
Learning difficulties
Short stature
Repeated respiratory infections (+hearing impairment from glue ear)
Acute lymphoblastic leukaemia
Hypothyroidism
Alzheimer’s disease
Atlantoaxial instability

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124
Q

Which condition will show pneumatosis intestinalis (intramural gas)?

A

Necrotising enterocolitis

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125
Q

What condition if bowel sounds heard in lung fields on respiratory examination?

A

Congenital diaphragmatic hernia

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126
Q

What is the treatment for croup?

A

A single dose of oral dexamethosone (0.15mg/kg) given to all children regardless of severity
Prednisone is an alternative
Emergency: high flow oxygen and nebulised adrenaline

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127
Q

What causes croup?

A

Parainfluenza viruses

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128
Q

What is cryptorchidism?

A

Undescended testes

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129
Q

What conditions are associated with hypospadias?

A

Cryptorchidism (undescended testes)
Inguinal hernia

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130
Q

What is the management of umbilical hernias?

A

Very common and usually resolve around 3- watch and wait
Is still present at 2 years arrange surgical referral

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131
Q

What causes acute epiglottitis?

A

Haemophilus influenzae type B

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132
Q

What are the features of acute epiglottitis?

A

Rapid onset
High temp/systemically unwell
Stridor
Tripod position
Drooling of saliva

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133
Q

How is epiglottitis diagnosed?

A

Direct visualisation by senior airway trained staff
X-rays done if foreign body concern- lateral view- thumb sign
Posterior-anterior in CROUP is steeple sign

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134
Q

How to remember the trisomys

A

Puberty Starts @ 13 –> Patau
Education Finishes @ 18 –> Edward’s
Degree Finishes @ 21 –> Down’s Syndrome

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134
Q

Epiglottitis management

A

Immediate senior involvement- airway (endotrachial intubation)
Do not examine throat (potential airway obstruction)
Oxygen
IV antibiotics

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135
Q

What could Webbed neck be?

A

In girls- Turner’s syndrome (+short stature/missed periods)
In boys- Noonan syndrome

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136
Q

What causes slapped cheek syndrome?

A

Parvovirus B19

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137
Q

Features of hand, foot and mouth?

A

Mild systemic upset: sore throat, fever
Oral ulcers
Followed by vesicles on palms and soles of the feet

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138
Q

Hand, foot and mouth treatment?

A

Symptomatic treatment
No exclusion
Reassurance no link to cattle disease

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139
Q

Treatment for threadworm?

A

Single dose of mebendazole for the whole house + hygiene advice

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140
Q

Is jaundice in the first 24 hours pathological?

A

Yes always

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141
Q

Causes of jaundice in the first 24 hours?

A

Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
Glucose-6-phosphodehydrogenase

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142
Q

Is jaundice common 2-14 days?

A

Yes

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143
Q

What do you do if jaundice still present after 14 days?

A

Prolonged jaundice screen-
Conjugated and unconjugated bilirubin (raided conjugated could indicate biliary atresia (urgent surgical intervention))
Direct antiglobulin test (Coombs’ test)
TFTs
FBC and blood film
Urine for MC&S and reducing sugars
U&Es and LFTs

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144
Q

Causes of prolonged jaundice?

A

Biliary atresia
Hypothyroidism
Galactosaemia
Urinary tract infection
Breast milk jaundice
Prematurity
Congenital infections e.g. CMV, toxoplasmosis

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145
Q

Intussusception investigation?

A

Ultrasound scan
IntUSSusception

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146
Q

What sign is seen on USS intussusception?

A

Target sign

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147
Q

Pyloric stenosis presentation

A

Projectile non-bile stained vomiting at 4-6 weeks

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148
Q

Pyloric stenosis diagnosis?

A

Test feed/USS

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149
Q

Pyloric stenosis treatment?

A

Ramstedt pyloromyotomy

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150
Q

Acute appendicitis treatment?

A

Laparoscopic appendicectomy

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151
Q

Intusussception presentationn?

A

Colicky pain, diarrhoea, vomiting, sausage shaped mass, red jelly stool

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152
Q

Age range intusussception?

A

6-18 months old

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153
Q

Investigation for intestinal malrotation?

A

Upper GI contrast study and USS

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154
Q

Intestinal malrotation treatment?

A

Lapaotomy, if volvulus present or high risk then Ladd’s procedure performed

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155
Q

Biliary atresia treatment?

A

Urgent Kasai procedure

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156
Q

Diagnosis criteria biliary atresia?

A

Jaundice>14 days
Increased conjugated bilirubin

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157
Q

Difference between gastroschisis and omphalocele?

A

Gastroschisis is a defect lateral to the umbilicus wheras an omphalocele is a defect of the umbilicus itself

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158
Q

What is omphalocele also known as?

A

Exomphalos

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159
Q

What causes rickets?

A

Malnoutrision- vitamin D deficiency

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160
Q

Rickets risk factors?

A

Dietary deficiency of calcium
Prolonged breast feeding
Lack of sunlight

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161
Q

Features of rickets?

A

Aching bones/joints
Bow legs/knock knees
Swelling at costochondral junction
Kyphoscoliosis
Soft skull bones in early life
Harrison’s sulcus

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162
Q

Rickets investigations?

A

Low vit D levels
Reduced serum calcium
Raised alkaline phosphtase

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163
Q

Rickets management?

A

Oral vit D

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164
Q

What is laryngomalacia?

A

Congenital abnormality of the larynx- typically presents at 4 weeks of age with stridor

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165
Q

What are the causes of stridor in children?

A

Croup, acute epiglottitis, inhaled foreign body, laryngomalacia

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166
Q

What is a Wilms’ tumour?

A

Nephroblastoma- common
Typically under 5- common in 3 year olds

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167
Q

Wilms’ tumour features?

A

Abdominal mass (common)
Painless haematuria
Flank pain
Anorexia, fever
Unilateral in 95%
Metastses in 20%

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168
Q

Wilms’ tumour management?

A

Nephrectomy, chemotherapy, radiotherapy

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169
Q

By what time should testes descend in males?

A

3 months- refer after 3 months- unilateral

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170
Q

Bilateral undescended testes management?

A

Reviewed by senior pediatrician within 24 hours

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171
Q

Causes of neonatal hypoglycaemia?

A

Preterm birth
Maternal DM
IUGR
Hypothermia
Neonatal sepsis
Inborn errors of metabolism

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172
Q

What are the four features of tetralogy of fallot?

A

Ventricular septal defect
Right ventricular hypertrophy
Right ventricular outflow tract obstruction
Overriding aorta

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173
Q

What are the features of TOF?

A

Cyanosis- hypercyanotic tet spells- tachypnoea, severe cyanosis, LOC- occur when upset or in pain
Right to left shunt
Ejection systolic murmur due to pulmonary stenosis
Right sided aortic arch in 25%
X-ray- boot shaped heart, ECG- right ventricular hypertrophy

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174
Q

TOF management?

A

Surgical repair
Cyanotic episodes helped with beta blockers

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175
Q

What age do TOF patients ususally present?

A

1-2 moths- transposition of great arteries more common at birth

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176
Q

Management umbilical hernias?

A

Usually self resolve
If large/symptomatic- elective surgery at 2-3
If small/asymptomatic- elective surgery at 4-5 years of age

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177
Q

What is a cephalohaematoma?

A

Develops after hours after birth, bleeding between the periosteum and the skull- may take 3 months to heal and jaundice is a complication

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178
Q

Difference between caput succedaneum and cephalohaematoma

A

Caput succedaneum- present at birth, crosses suture lines, resolves in days

Cephalohaematoma- develops after hours, more common in parietal region, doesn’t cross suture lines, months to resolve

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179
Q

Risk factors for developmental dysplasia of the hip?

A

Female sex: 6 times greater risk
Breech presentation
Positive family history
Firstborn children
Oligohydramnios
Birth weight > 5 kg
Congenital calcaneovalgus foot deformity

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180
Q

What is Ebstein’s anomaly?

A

Tricuspid valve set low so larger right atrium

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181
Q

What are the clinical features of Ebstein’s anomaly?

A

Patients often have ASD/ Wolff-Parkinson White syndrome

Cyanosis
Hepatomegaly
Tricuspid regurgitation- pansystolic murmur
RBBB

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182
Q

What is the ratio of CPR in children?

A

5 rescue breaths
15 chest compressions: 2 rescue breaths
100-120/min compressions

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183
Q

What does a bicuspid valve increase the risk of? (Turner’s)

A

Aortic dissection

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184
Q

Before what age is hand preferance abnormal?

A

12 months

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185
Q

Give some development problem milestones?

A

Referral points
doesn’t smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months

Fine motor skill problems
hand preference before 12 months is abnormal and may indicate cerebral palsy

Gross motor problems
most common causes of problems: variant of normal, cerebral palsy and neuromuscular disorders (e.g. Duchenne muscular dystrophy)

Speech and language problems
always check hearing
other causes include environmental deprivation and general development delay

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186
Q

How quickly should a child fully recover from a febrile seizure?

A

Within an hour

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187
Q

Haemophilia is X-linked, how can a girl get it?

A

Turner’s syndrome as they only have one X chromosome

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188
Q

Characteristic features of rubella?

A

Prodrome- low grade fever
Rash- maculopapular, initially on face before spreading to whole body- 3 to 5 days
Lymphadenopathy
(In question not had vaccines-MMR)

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189
Q

Which diseases require no school exclusion?

A

Conjunctivitis
Slapped cheek
Roseola
Infectious mononuleosis
Head lice
Threadworms
Hand, foot and mouth

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190
Q

Can you go to school with scarlet fever?

A

No, 24 hours after commencing antibiotics

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191
Q

Can you go to school with whooping cough?

A

2 days after commencing antibiotics (or 21 days from onset if no antibiotics)

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192
Q

Can you go to school with measles?

A

No, 4 days after onset of rash

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193
Q

Can you go to school with rubella?

A

No, 5 days after onset of rash

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194
Q

Can you go to school with chickenpox?

A

No, when all lesions crusted over

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195
Q

Can you go to school with mumps?

A

No, 5 days from onset of swollen glands

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196
Q

School with D+V?

A

No, 48 hours

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197
Q

School with impetigo?

A

No, crusted lesions or 48 hours after antibiotics

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198
Q

School with scabes?

A

No, until treated

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199
Q

School with influenza?

A

No, until recovered

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200
Q

What causes scarlet fever?

A

Group A steptococcus

201
Q

Is scarlet fever a notifiable disease?

A

Yes

202
Q

What are the complications of scarlet fever?

A

Otitis media- common
Rheumatic fever
Acute glomerulonephritis

203
Q

What is another name for infectious mononucleosis?

A

Glandular fever

204
Q

What causes infectious mononucleosis?

A

Epstein-Barr virus

205
Q

What is the triad of infectious mononucleosis?

A

Classic triad of-
Sore throat
Lymphadenopathy
Pyrexia

206
Q

Features of infectious mononucleosis?

A

Malaise, anorexia, headache
Palatal petechiae
Splenomegaly
Hepatitis
Lymphocytosis
Haemolytic anaemia
A maculopapular, pruritic rash develops in most patients who take ampicillin/amoxicillin

207
Q

What test is used to diagnose infectious mononucleosis?

A

Heterophil antibody test (monospot test)

208
Q

Management of infectious mononucleosis?

A

Rest, simple analgesia, avoid contact sports to reduce risk of spelenic rupture

209
Q

Measles features?

A

Prodromal- irritable, fever, conjunctivitis
Koplik spots
Rash- starts behind ears then whole body- discrete to blotchy
Desquamation spares palms and soles after a week
Diarrhoea in 10%

210
Q

Measles investigations?

A

IgM antibodies

211
Q

Measles management?

A

Supportive
Admission if pregnant/immunosuppressed
Notify public health
Contacts immunised within 72 hours

212
Q

Measles complications?

A

Otitis media- common
Pneumonia - common death cause
Encephalitis
Subacute sclerosing panencephalitis- rare and 5-10 years after illness

213
Q

What causes roseola infantum?

A

Human herpes virus 6

214
Q

What age range does roseola infantum affect?

A

6 month- 2 years

215
Q

What are the features of roseola infantum?

A

High fever- lasting a few days and followed by
Maculopapular rash

Nagayama spots- papular enanthem on the uvula and soft palate

Febrile convulsions 10-15%

Diarrhoea and cough

216
Q

ADHD management?

A

Period of 10 weeks observation- behavioural advice and educational programme for parents

Drug therapy last resort for age 5+
First line is methylphenidate (ritalin)
2nd- lisdexamfetamine

217
Q

What are the side effects of methylphenidate?

A

Abdo pain, nausea and dyspepsia. Weight and height monitored every 6 months

218
Q

What do you need to do before starting methylphenidate? (or ADHD drugs)

A

Perform a baseline ECG as potentially cardiotoxic

219
Q

What finding supports a diagnosis of biliary atresia in a 15 day old?

A

Raised conjugated bilirubin

220
Q

What is the presentation of biliary atresia?

A

Present in the first weeks of life with-
Jaundice
Dark urine/ pale stools
Appetite and growth disturbance (maybe normal)

Signs:
Jaundice
Hepatomegaly/splenomegaly
Abnormal growth
Cardiac murmurs

221
Q

Biliary atresia investigations?

A

Serum bilirubin- conjugated bilirubin high
LFTs

222
Q

What are the features of eczema?

A

Itchy, erythematous rash
Infants- face and trunk
Young- extensor surfaces
Older- flexor surfaces

223
Q

Eczema management?

A

Avoid irritants
Simple emollients
Topical steroids
Wet wrapping

224
Q

Features of fetal alcohol syndrome?

A

(Withdrawl symptoms at birth)
Short palpebral fissure
Hypoplastic/thin upper lop
Smooth/absent filtrum
Learning difficulties
Microcephaly
Growth retardation
Cardiac malformations

225
Q

How many days of fever for Kawasaki disease?

A

More than 5

226
Q

What are the indications for head CT within an hour in under 16s?

A

Suspicion of non-accidental injury
post-traumatic seizure

On initial emergency department assessment, a GCS score of less than 14 or, for babies under 1 year, a GCS score (paediatric) of less than 15

At 2 hours after the injury, a GCS score of less than 15

Suspected open or depressed skull fracture, or tense fontanelle

Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)

Focal neurological deficit

For babies under 1 year, a bruise, swelling or laceration of more than 5 cm on the head.

227
Q

CT head risk factors where you need more than one?

A

Loss of consciousness lasting more than 5 minutes (witnessed)

Abnormal drowsiness

3 or more discrete episodes of vomiting

Dangerous mechanism of injury (high-speed road traffic accident as a pedestrian, cyclist or vehicle occupant, fall from a height of more than 3 m, high-speed injury from a projectile or other object)

Amnesia (anterograde or retrograde) lasting more than 5 minutes (it will not be possible to assess amnesia in children who are preverbal and is unlikely to be possible in children under 5)

Any current bleeding or clotting disorder.

If only 1 observe for four hours- if further vomiting, GCS under 15 or further episode drowsiness get CT

228
Q

What immunisations are included in the 6-in-1 vaccine?

A

Diptheria, tetanus, pertussis, polio, haemophilus influenzae type b and hepatitis B

229
Q

When is the 6-in-1 vaccine given?

A

8, 12 and 16 weeks

230
Q

Which vaccines are given at birth?

A

BCG if risk factors (against TB)

231
Q

What vaccines at 2 months?

A

6-1
Oral rotavirus
Men B

232
Q

3 months

A

6-1
Oral rotavirus
PCV

233
Q

4 months

A

6-1
Men B

234
Q

12-13 months

A

Hib/Men C
MMR
PCV
MenB

235
Q

2-8 years

A

Flu vaccine annual

236
Q

3-4 years

A

4 in 1 pre school booster
MMR

237
Q

What is in the 4 in 1 pre school booster vaccine?

A

Diphtheria, tetanus, whooping cough and polio

238
Q

12-13 years

A

HPV vaccine

239
Q

13-18 years

A

3 in 1 teenage booster
Men ACWY

240
Q

What is in the 3 in 1 teenage booster

A

Tetanus, diphtheria, polio

241
Q

Roseola infantum?

A

6th disease
3 days fever
3 days rash

242
Q

What could you think of when a question has meconium ileus?

A

CF
Hirschsprung’s disease

243
Q

Gold standard investigation for Hirschsprung’s disease?

A

Rectal biopsy

244
Q

Management Hirschsprung’s disease?

A

Rectal washouts/ bowel irrigation
Surgery

245
Q

Features of slipped femoral epiphysis?

A

Hip, groin, medial thigh or knee pain

Loss of internal rotation of the leg in flexion

Bilateral slip on 20%

246
Q

What would cause you to admit a child with bronchiolitis?

A

Apnoea
Oxygen sets under 92%
Inadequate oral fluid intake
Severe respiratory distress- grunting, marked chest recession, resp rate over 70

247
Q

What type of murmur in patent ductus arteriosus?

A

Continuous ‘machinery’ murmur

248
Q

In what conditions can you find an ejection systolic murmur?

A

Aortic stenosis
Pulmonary stenosis
Atrial septal defect
Hypertrophic obstructive cardiomyopathy
Tetralogy of Fallot

249
Q

Which conditions have recurrent chest infections?

A

Cystic fibrosis
Downs syndrome

250
Q

Which conditions have overlapping of fingers?

A

Edward’s syndrome (trisomy 18)

251
Q

What causes brochiolitis?

A

Respiratory syncytial virus

252
Q

What are the acyanotic causes of CHD?

A

Ventricular septal defects (VSD) - most common

Atrial septal defect (ASD)

Patent ductus arteriosus (PDA)

Coarctation of the aorta
aortic valve stenosis

253
Q

What are the cyanotic causes of CHD?

A

Tetralogy of Fallot
Transposition of the great arteries (TGA)
Tricuspid atresia

254
Q

When do Fallot’s present compared to TGA?

A

Tetralogy of Fallot- 1-2 motnhs
TGA- at birth

255
Q

Asthma management in under 5’s?

A
  1. SABA
  2. SABA + 8 week triak moderate ICS
  3. Add LTRA
    4 Stop LTRA and refer to specialist
256
Q

Asthma management 5-16?

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + ICS + LTRA
  4. SABA + ICS + LABA
  5. SABA + switch ICS/LABA for MART
  6. SABA +moderate ICS MART
  7. SABA + either Increase ICS/ trial additional drug (theophylline)/get specialist help
257
Q

Developmental dysplasia of the hip investigation?

A

Ultrasound

258
Q

What are the features of croup?

A

Stidor
Barking cough (worse at night)
Fever
Coryzal symptoms

259
Q

Average age for croup?

A

6 months to 3 years

260
Q

What are the features of mumps?

A

Fever, malaise, muscular pain
Parotitis (earache, pain on eaing)- unilateral then becomes bilateral

261
Q

What are the names for slapped cheek syndrome?

A

Erythema infectiosum or fifth disease

262
Q

Rubella features?

A

Pink maculopapular rash, initially on face before spreading to whole body- fades in 3-5 days

Lymphadenopathy- suboccipital/ postauricular

263
Q

What is the presentation of Meckel’s diverticulum?

A

Abdo pain mimicking appendicitis

Rectal bleeding

Intestinal obstruction- secondary to an omphalomesenteric band (most common), volvulus and intussusception

264
Q

Which conditions are autosomal recessive?

A

Cystic fibrosis
Sickle cell anaemia
Haemochromatosis
Gilbert’s syndrome

265
Q

Which conditions are X-linked recessive?

A

Haemophilia A, B
Duchenne muscular dystrophy
G6PD deficiency

266
Q

What closes the patent ductus arteriosus?

A

Indomethacin
Or ibuprofen

267
Q

Features of hand, foot and mouth

A

Mild systemic upset- sore throat, fever
Oral ulcers
Followed later by vesicles on the palms and soles of the feet

268
Q

What causes scarlet fever?

A

Streptococcus pyogenes

269
Q

What are the three major congenital infections?

A

Rubella, toxoplasmosis and cytomegalovirus

Cytomegalovirus is most common and maternal infection is usually asymptomatic

270
Q

Rubella congenital infection characteristics

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease (patent ductus arteriosus)
Glaucoma

Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
‘Salt and pepper’ chorioetinitis
Microphtalmia
Cerebral palsy

271
Q

Toxoplasmosis congenital infection characteristics

A

Cerebral calcification
Chorioetinitis
Hydrocephalus

Anaemia
Hepatosplenomegaly
Cerebral palsy

272
Q

Cytomegalovirus congenital infection characteristics

A

Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly

Visual impairment
Learning disability
Encephalitis/seizures
Pneumonitis
Hepatosplenomegaly
Anaemia
Jaundice
Cerebral palsy

273
Q

What is the investigation for bronchiolitis?

A

Immunofluorescence of nasopharayngeal secretions may show RSV

274
Q

Features of bronchiolitis?

A

Coryzal symptoms (including mild fever)
Dry cough
Increasing breathlessness
Wheezing, fine inspiratory crackles
Feeding difficulties associated with dyspnoea

275
Q

Presentations of Hirschprung’s disease?

A

Neonatal period- failure or delay to pass meconium

Older children- constipation, abdominal distension

276
Q

What is the most common cause of ambiguous genitalia?

A

Androgen insensitivity syndrome

277
Q

What is the emergency treatment for croup in severe respiratory distress?

A

High flow oxygen

Nebulised adrenaline

278
Q

What are reflex anoxic seizures?

A

A syncopal episode that occurs in response to pain or emotional stimuli

279
Q

Age range for reflex anoxic seizures?

A

6 months to 3 years

280
Q

What is the most common cause of stridor in infants?

A

Laryngomalacia

281
Q

Causes of CHD, DDH, congenital cataract and spina bifida

A

Congenital heart defect- lithium (Epstein’s anomaly)
DDH- Breech presentation
Congenital cataract- congenital rubella
Spina bifida- No folic acid taken

282
Q

Causes of hypotonia in infants?

A

Down’s syndrome
Prader-Willi
Hypothyroidism
Cerebral palsy

283
Q

Mnemonic for Kawasaki?

A

CRASH and Burn
Conjunctivitis
Rash
Adenopathy (cervical lymphadenopathy)
Strawberry tongue
Hands and feet: swollen and peeling
Burn: high fever that does not respond to antipyretics

284
Q

What age does benign rolandic epilepsy occur?

A

Between 4 and 12

284
Q

What are the features of benign rolandic epilepsy?

A

Seizures at night
Partial (eg face) but secondary generalised may occur
Child otherwise normal

285
Q

When is a routine USS for DDH?

A

At 6 weeks of age, following breech delivery

286
Q

When x-ray for DDH

A

If child is over 4.5 months

287
Q

Classic signs of congenital CMV?

A

Hearing loss, low birth weight, petechial rash, microcephaly and seizures

288
Q

Classic triad of symptoms for congenital rubella?

A

Sensorineural deafness, eye abnormalities and congenital heart disease

289
Q

What are the features of gastro-oesophageal reflux in children? (GORD)

A

Develops before 8 weeks

Vomiting/regurgitation- milky vomits after feeds/may occur after being laid flat

Excessive crying, especially while feeding

290
Q

Rare complications of chicken pox?

A

Pneumonia
Encephalities
Disseminated haemorrhagic chickenpox
Arthritis, nephritis and pancreatitis

291
Q

Common complication of chickenpox?

A

Secondary bacterial infection of lesions- NSAIDs may increase this risk
In small number of patients- invasive group A step soft tissue infections causing necrotising fasciitis

292
Q

What is a contraindication of an LP?

A

Meningococcal septicaemia

293
Q

Which signs of raised ICP would contraindicate an LP?

A

Focal neurological signs
Papillodema
Significant bulging fontanelle
DIC
Signs of cerebral herniation

294
Q

Management of meningitis?

A
  1. Antibiotics-
    If under 3 months- IV amoxicillin + IV cefotaxime
    Over 3 months- IV Cefotaxime
  2. Steroids- (No corticosteroids in under 3 months)
    Dexamethasone considered if LP reveals- frankly purulent CSF, CSR WCC greater than 1000/microlitre, raised WCC with protein greater than 1g/litre
    Bacteria on gram stain
  3. Fluids
  4. Cerebral monitoing
  5. Public health notification and antibiotic prophylaxis of contacts- ciprofloxacin
295
Q

What are the four areas of developmental milestones?

A
  1. Speech and hearing
  2. Fine motor and vision
  3. Social behaviour and play
  4. Gross motor
296
Q

Causes of neonatal hypotonia?

A

Neonatal sepsis
Hypothyroidism
Prader-Willi
Werdnig-Hoffman

Maternal drugs- benzos
Maternal MG

297
Q

School exlusion with head lice?

A

No

298
Q

Head lice management?

A

Malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone

Household contacts do not need to be treated

299
Q

What should all children who have an asthma attack get?

A

Steroids

300
Q

What is Kocher’s criteria used for?

A

Probability of septic arthritis in children

301
Q

What are the 4 parameters in Kocher’s criteria?

A

Non-weight bearing- 1 point
Fever >38.5- 1 point
WCC >12 * 109/L - 1 point
ESR > 40mm/hr

302
Q

How might an older child present with DDH?

A

Trendelenberg gait and leg length discrepancy

303
Q

Difference between mitchondrial diseases vs X-linked

A

All women in family get mitochondrial, no children of men

X-linked some women won’t have it

304
Q

What does a normal pCO2 suggest in an acute asthma attack?

A

Life threatening

305
Q

What is menarche?

A

The first period

306
Q

What is Perthes’ disease and when does it present?

A

Degenerative condition in hip of children 4-8

Due to avascular necrosis of the femoral head

5x more common in boys

307
Q

What are the features of Perthes’ disease?

A

Hip pain- develops progressively over a few weeks

Limp

Stiffness and reduced range of movement

X-Ray- widening of joint space and decreased femoral head size

308
Q

Perthes’ disease diagnosis?

A

Plain x-ray

Technetium bone scan or MRI

309
Q

Perthes’ disease management?

A

Keep femoral head within acetabulum- cast, braces

Less than 6 years- observation

Older surgical management

Most cases resolve with conservative management

310
Q

When is corrective hypospadias surgery performed?

A

Around 12 months of age

Essential child not circumcised before surgery as sometimes used

311
Q

What is the triad of shaken baby syndrome?

A

Retinal haemorrhages, subdural haematoma and encephalopathy

312
Q

Which condition presents with a salmon pink rash?

A

Juvenile idiopathic arthritis

313
Q

JIA features?

A

Pyrexia
Salmon pink rash
Lymphadenopathy
Arthritis
Uveitis
Anorexia and weight loss

314
Q

JIA investigations?

A

ANA may be positive
Rheumatoid factor usually negative

315
Q

Features of a life threatening asthma attack?

A

A CHEST
Arrhythmia/ Altered conscious level
Cyanosis, PaCO2 normal
Hypotension, Hypoxia (PaO2<8kPa, SpO2 <92%)
Exhaustion
Silent chest
Threatening PEF < 33% best or predicted (in those >5yrs old)

316
Q

What is thelarche?

A

The first stage of breast development

317
Q

What is adenarche?

A

First stage of pubic hair development

318
Q

What are the two types of precocious puberty?

A

Gonadotrophin dependant- premature activation of axis- FSH and LH raised

Gonadotrophin independant- excess sex hormones- FSH and LH low

319
Q

Testes in precocious puberty?

A

Bilateral enlargement- gonadotrophin release from intracranial lesion

Unilateral enlargement- gonadal tumour

Small testes- adrenal cause

320
Q

At what rate should paediatric compressions be?

A

100-120/min

321
Q

What are you vaccinated against between 13-18 years?

A

Tetanus/diptheria/polio + MenACWY

322
Q

Risk factors for DDH?

A

The F’s-
- Female
- Feet first (breech px)
- Family Hx
- Firstborn
- Fluid (oligohydramnios)
- Fat kid (macrosomia)
- Foot deformity (congenital calcaneovalgus foot deformity)

323
Q

Management of DDH?

A

Most unstable hips stabilise by 3-6 weeks

Pavlik harness in children younger than 4-5 months

Older children require surgery

324
Q

What noise is associated with croup?

A

A barking noise

325
Q

What are the investigations for biliary atresia?

A

Serum bilirubin- total bilirubin may be normal, conjugated bilirubin is high

LFTs

Serum alpha 1-antitrypsin

Sweat chloride test

Ultrasound biliary tree and liver

326
Q

When is the oral rotavirus vaccine given?

A

At 2 and 3 months

327
Q

What is a complication of the oral rotavirus vaccine?

A

If given late, intussusception

328
Q

Tip for inheritance patterns?

A

Most structural stuff = Autosomal Dominant
Most metabolic stuff = Autosomal Recessive

329
Q

Hyperinflated lungs on x-ray and fluid in horizontal fissure?

A

Transient tachypnoea of the newborn

330
Q

Roseola infantum presentation?

A

High fever for few days followed by a maculopapular rash

331
Q

How to remember Roseola Infantum?

A

(R)oseola (I)nfantum= (R)ash when (I)mproving

332
Q

What procedure for malrotation with volvulus?

A

Ladd’s procedure and laparotomy

333
Q

What age is croup most common?

A

6 months- 3 years in the autumn

334
Q

Croup features?

A

Stridor
Barking cough
Fever
Coryzal symptoms

335
Q

X-ray signs in croup (normally clinical diagnosis)?

A

Steeple sign (subglotic narrowing)

Thumb sign (epiglottis)

336
Q

What do all children with croup get?

A

Dexamethosone

337
Q

Croup emergency treatment?

A

High flow oxygen

Nebulised adrenaline

338
Q

What features prompt admission with croup?

A

Moderate or sever croup

Under 6 months
Known airway abnormalities (laryngomalacia, Down’s syndrome)
Uncertainty about diagnosis

339
Q

What age babies class as neonatal death?

A

0-28 days after birth

340
Q

Calculate perinatal death rates?

A

Maternal mortality rate = deaths in pregnancy, labour & 6 weeks afterwards / total maternities * 1000

Stillbirth rate = babies born dead after 24 weeks / total births (live + stillborn) * 1000

Neonatal death rate = babies dying between 0-28 days / total live births * 1000

341
Q

Patau syndrome (trisomy 13) features?

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

342
Q

Edward’s syndrome (trisomy 18) features?

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

343
Q

Should you use corticosteroids in children under 3 months with bacterial meningitis?

A

No

344
Q

What condition is Hirschprung’s disease associated with?

A

Down’s syndrome

345
Q

What are children’s with Down’s prone to?

A

Snoring

346
Q

What are the presentations of UTI by age?

A

Infants: poor feeding, vomiting, irritability

Younger children: abdominal pain, fever, dysuria

Older children: dysuria, frequency, haematuria

Features which may suggest an upper UTI include: temperature > 38ºC, loin pain/tenderness

347
Q

What should happen with a child under 3 months with suspected UTI?

A

Immediate referral to a paediatrician

348
Q

What to do with unborn exomphalos?

A

Plan a cesarean insection

349
Q

Hand preference before which age is abnormal?

A

12 months

350
Q

Some key developmental referral points?

A

Doesn’t smile at 10 weeks
Cannot sit unsupported at 12 months
Cannot walk at 18 months

351
Q

Should suspected transient synovitis be reffered same day anyway?

A

Yes, to rule out septic arthritis

352
Q

Temperature over 38 under 3 months?

A

Urgent referral to paediatrics

353
Q

What is juvenile myoclonic epilepsy associated with?

A

Seizures in the morning or after sleep deprivation

354
Q

What is the definitive investigation for acute epiglottitis?

A

Flexible laryngoscopy (visualisation by a senior/airway trained staff member)

355
Q

Characteristics of an innocent ejection murmur?

A

Soft blowing murmur in the pulmonary area

May vary with posture

Localised no variation

No diastolic component

No thrill

No added sounds

Asymptomatic child

No other abnormality

356
Q

What are the investigations for myesthenia gravis?

A

CT thorax to exclude thymoma

Antibodies to acetylcholine receptors

357
Q

What is the management of a myasthenic crisis?

A

Plasmapheresis

Intravenous immunoglobulins

358
Q

How to remember levodopa side effects?

A

D - dyskinesia
O - on-off
P - Psychosis
A - Arterial BP down (hypotension)
M - Mouth dryness
I - Insomnia
N - N/V
E - Excessive daytime sleepiness

359
Q

When should APGAR be calculated?

A

1 and 5 minutes of age

If low repeat again at 10 minutes

360
Q

What do the APGAR scores mean?

A

0-3 very low

4-6 is moderate

7-10 good state

361
Q

APGAR Score specific

A

Pulse
2- >100
1- <100
0- Absent

Appearance
2- Pink
1- Pink w/blue extremities
0- Blue

Grimace
2- Cries on stimulation
1- Grimace
0- Nil

Activity
2- Active movement
1- Limb flexion
0- Flaccid

Resp effort
2- Strong, crying
1- Weak, irregular
0- Nil

362
Q

What should you not give children with chicken pox?

A

NSAIDs- risk of necrotising facialiitis

363
Q

When is the neonatal blood spot screening (heel prick test) carried out?

A

Between 5-9 days of life

364
Q

What are the conditions screened for on the neonatal blood spot screening (heel prick test)?

A

Congenital hypothyroidism

Cystic fibrosis

Sickle cell disease

Phenylketonuria

Medium chain acyl-CoA dehydrogenase deficiency (MCADD)

Maple syrup urine disease (MSUD)
Isovaleric acidaemia (IVA)

Glutaric aciduria type 1 (GA1)

Homocystinuria (pyridoxine unresponsive) (HCU)

365
Q

What type of dementia is MND associated with?

A

Frontotemporal dememntia

366
Q

What is theraputic cooling?

A

The deliberate lowering of a patient’s body temperature with the intention of cooling the brain and preventing damage

Used to limit hypoxic brain injury

367
Q

Order of puberty in girls?

A

Boobs, pubes, grow, flow

368
Q

Order of puberty in boys?

A

Grapes (testicles), drapes (hair), grow, blow

369
Q

5 T’s cyanotic heart diseases (CHD)?

A

Give prostoglandin E1 to keep the PDA open

Transposition of the great vessels (TGA)
Tetralogy of fallot
Tricuspid atresia
Total anomalous pulmonary venous return
Truncus arteriosus

370
Q

What are the two innocent murmurs?

A

Venous hums- Turbulent blood flow in the great veins- continuous blowing noise heard just below the clavicles

Still’s murmur- low pitched sound heard at the lower left sternal edge

371
Q

Key visual field defects (check passmed page)?

A

Left homonymous hemianopia means visual field defect to the left, i.e. Lesion of right optic tract
homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)
incongruous defects = optic tract lesion; congruous defects = optic radiation lesion or occipital cortex

372
Q

Caput Succedanum key features?

A

Swelling on head

Present at birth

Crosses suture lines

Resolves in days

373
Q

Cephalohematoma key features?

A

Swelling on head

Develops hours after birth

Doesn’t cross suture lines

May take months to resolve

374
Q

Investigations for child under 3 months with a fever?

A

Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
Chest radiograph only if respiratory signs are present
Stool culture, if diarrhoea is present

375
Q

What should happen to a baby with weak femoral pulses at 6-8 week baby check?

A

Same day referral to paeds

Worry about coarctation of the aorta

376
Q

What should be fulfilled to meet the fraser guidelines?

A

The young person understands the professional’s advice

The young person cannot be persuaded to inform their parents

The young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment

Unless the young person receives contraceptive
treatment, their physical or mental health, or both, are likely to suffer

The young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent

377
Q

STI tests in young people?

A

Young people should be advised to have STI tests 2 and 12 weeks after an incident of unprotected sexual intercourse (UPSI)

378
Q

Which is the LARC of choice for young people (under 20)?

A

The progesterone only implant (nexplanon)

379
Q

Which medication can you not use the implant (nexplanon)?

A

Enzyme inducers- rifampicin

380
Q

Osgood-Schlatter disease?

A

Seen in sporty teenagers

Pain and tenderness over the tibial tuberosity

381
Q

Osteochondritis dissecans?

A

Pain after exercise

Intermittent swelling and locking

382
Q

What is the management of cystic fibrosis?

A

Regular- at least twice daily- chest physiotherapy and postural drainage

High calorie, high fat diet

CF patients minimise cross infection with each other Burkholderia cepacia complex and Pseudomonas aeruginosa

Vitamin supplementation

Pancreatic enzyme taken with meals

Lung transplantation

383
Q

What is the most common cause of primary headache in children?

A

Migraine

384
Q

Cushing’s triad in raised ICP?

A

Widening pulse pressure, bradycardia and irregular breathing

385
Q

Management of paediatric migraine?

A

Acute:
Ibuprofen more effective than paracetamol
Maybe triptans in children 12 or over

Prophylaxis:
Evidence limited
Propanolol 1st

386
Q

Is pregnancy a risk factor for Bell’s Palsy?

A

YEs

387
Q

Management of Bell’s palsy?

A

Oral prednisolone within 72 hours

Maybe antivirals not 100%

Eye care important to prevent exposure keratopathy

388
Q

Distal sensory loss + tingling + absent ankle jerk/ extensor plantars + gait abnormalities/Romberg’s positive?

A

Subacute combined degeneration of the spinal cord

389
Q

What are the causes of oligohydraminos?

A

Premature rupture of the membranes

Potter sequence- (bilateral renal agenesis + pulmonary hypoplasia)

IUGR

Post-term gestation

Pre-eclampsia

390
Q

Features of an ectopic pregnancy?

A

Lower abdominal pain- may be unilateral

Vaginal bleeding

Recent history of amenorrhoea

Peritoneal bleeding can cause shoulder tip pain, pain on defecation/ urination

Dizziness, fainting or syncope

Breast tenderness

391
Q

Examination findings ectopic pregnancy?

A

Abdominal tenderness

Cervical excitation (cervical motion tenderness)

Adnexal mass- donn’t examine might rupture

Serum bHCG levels over >1500 point to diagnosis of an ectopic in pregnancy of unknown location

392
Q

Perthe’s disease boys or girls?

A

5x more common in boys

393
Q

What are the three key signs of ALL?

A

Anaemia: lethargy and pallor
Neutropaenia: frequent or severe infections
Thrombocytopenia: easy bruising, petechiae

394
Q

What is Henoch-Schonlein purpura?

A

IgA mediated small vessel vasculitis. Seen in children following an infection

395
Q

What are the features of Henoch-Schonlein purpura?

A

Palpable purpuric rash (with localized oedema)
over buttocks and extensor surfaces of arms and legs

Abdominal pain

Polyarthritis

Features of IgA nephropathy may occur e.g. haematuria, renal failure

396
Q

What is the treatment for Henoch-Schonlein purpura?

A

Analgesia for arthralgia

Treatment nephropathy generally supportive

Prognosis good- BP and urinalysis monitored to detect progressive renal involvement, can relapse

397
Q

Premature baby milestones and immunisations?

A

Immunisations - same age as usual

Developmental milestones - age + weeks born from 40 weeks

398
Q

How to find out jaundice level in newborn?

A

A transcutaneous bilirubinometer cannot be used under 24 hours

Get a serum bilirubin within 2 hours

399
Q

What can palivizumab be used for?

A

Monclonal antibody to prevent RSV

400
Q

What is seborrhoeic dermatitis?

A

Cradle cap

It typically affects the scalp (‘Cradle cap’), nappy area, face and limb flexure

Characterised by an erythematous rash with coarse yellow scales, appears in first few weeks of life

401
Q

What is the management for seborrhoeic dermatitis?

A

Reassurance that it doesn’t affect the baby and usually resolves within a few weeks

Massage a topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo.

If severe/persistent a topical imidazole cream may be tried

402
Q

Which babies need ultrasound at 6 weeks?

A

All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery

403
Q

What are the clinical tests for DDH?

A

Barlow test: attempts to dislocate an articulated femoral head

Ortolani test: attempts to relocate a dislocated femoral head

404
Q

Can a patient under 16 refuse treatment?

A

No

A patient under 16 can agree to treatment in their best interest against parental wishes but cannot refuse it if it is in their best interests

If deemed to be competent

405
Q

Kallman’s?

A

Tallman

FSH and LH Fallman

406
Q

What causes impetigo?

A

Staphylococcus aureus

Streptococcus pyogenes

407
Q

Impetigo features?

A

Face flexures and limbs not covered by clothing

Spread by direct contact with discharges of another person

‘golden’, crusted skin lesions typically found around the mouth

Very contagious

408
Q

What is the management of impetigo?

A

Hydrogen peroxide 1% cream

Topical antibiotic creams- topical fusidic acid

Extensive disease:
Oral flucloxacillin

409
Q

What is vesicoureteric reflux?

A

The abnormal backflow of urine from the bladder into the ureter and kidney

Investigation: micturating cystourethrogram

hydronephrosis on ultrasound

reccurent UTIs

410
Q

What do you do for vaccines/development in premature infants?

A

Vaccines- the same

Development- correct for gestational age

411
Q

What can cause Ebstein’s anomaly?

A

Exposure to lithium in vitro

412
Q

Features of Ebstein’s anomaly?

A

Cyanosis

Prominent ‘a’ wave in the distended jugular venous pulse,

Hepatomegaly

Tricuspid regurgitation

Pansystolic murmur, worse on inspiration
right bundle branch block → widely split S1 and S2

413
Q

Most common complication of roseola infantum?

A

Febrile convulsions

414
Q

Is breastfeeding ok with antiepileptics?

A

Yes nearly all of them

415
Q

LAMBAST mothers ceen taking

A

LAMBAST mothers ceen taking:

Lithium
Amiodarone
Methotrexate
Benzodiazepines
Aspirin
Sulphonamide
Tetracyclines

+

Carbimazole, Ciprofloxacin, Chlorampenicol

416
Q

Delayed puberty short vs normal?

A

Delayed puberty with short stature
Turner’s syndrome
Prader-Willi syndrome
Noonan’s syndrome

Delayed puberty with normal stature
polycystic ovarian syndrome
androgen insensitivity
Kallman’s syndrome
Klinefelter’s syndrome

417
Q

What is used to treat CF patients who are homozygous for the delta F508 mutation?

A

Lumacaftor/Ivacaftor (Orkambi)

418
Q

1 year milestones?

A

At their 1st birthday party…
* gross motor: walk/cruise
* fine motor: pincer grip their cake and bangs their new toys together
* social: stranger anxiety (meeting family for 1st time)
* speech and language: knows and responds to their own name + can say muma/dada

419
Q

Which condition do you get polydactyly as well as cleft lip and small eyes?

A

Patau- Trisomy 13

420
Q

Diseases causing heart problems?

A

Kawasaki- coronary artery spasms
Duchenne- dilated cardiomyopathy

421
Q

Features of duchenne muscular dystrophy?

A

Progressive proximal muscle weakness from 5 years

Calf pseudohypertrophy

Gower’s sign: child uses arms to stand up from a squatted position
30% of patients have intellectual impairment

422
Q

Ventricular septal defect murmur?

A

Pansystolic murmur in lower left sternal border

423
Q

Coarctation of the aorta murmur?

A

Crescendo-decrescendo murmur in the upper left sternal border

424
Q

Patent ductus arteriosus murmur?

A

Diastolic machinery murmur in the upper left sternal border

425
Q

Pulmonary stenosis murmur?

A

Ejection systolic murmur in the upper left sternal border

426
Q

Atrial septal defect murmur?

A

Ejection systolic murmur and fixed splitting of the second heart sound

427
Q

Snoring causes in children?

A

obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down’s syndrome
hypothyroidism

428
Q

Fragile X syndrome features?

A

Features in males
learning difficulties
large low set ears, long thin face, high arched palate
macroorchidism
hypotonia
autism is more common
mitral valve prolapse

Features in females (who have one fragile chromosome and one normal X chromosome) range from normal to mild

Diagnosis
can be made antenatally by chorionic villus sampling or amniocentesis
analysis of the number of CGG repeats using restriction endonuclease digestion and Southern blot analysis

429
Q

Hearing tests in children?

A

Newborn Otoacoustic emission test

Newborn & infants Auditory Brainstem Response test- done if otoacustic abnormal

> 3 years Pure tone audiometry- done at school entry

430
Q

Androgen insensitivity syndrome overview?

A

X-linked recessive

‘primary amenorrhoea’
little or no axillary and pubic hair
undescended testes causing groin swellings
breast development may occur as a result of the conversion of testosterone to oestradiol

buccal smear or chromosomal analysis to reveal 46XY genotype
after puberty, testosterone concentrations are in the high-normal to slightly elevated reference range for postpubertal boys

counselling - raise the child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy

431
Q

Haemolytic uraemic syndrome overview?

A

Triad of:
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia

Most commonly caused by E.Coli 0157

Investigations: FBC, U&E: acute kidney injury, Stool culture

Treatment: supportive

432
Q

What is the triad of haemolytic uraemic syndrome?

A

Acute kidney injury

Microangiopathic haemolytic anaemia

Thrombocytopenia

433
Q

What are the signs of congenital adrenal hyperplasia?

A

Reduced production of cortisol and aldoesterone

Less sodium retention and increased potassium excretion In an adrenal crisis they may present with metabolic acidosis

Hyperkalaemia, hyponatraemia, metabolic acidosis

434
Q

Nephrotic syndrome triad?

A

Proteinuria (> 1 g/m^2 per 24 hours)
Hypoalbuminaemia (< 25 g/l)
Oedema

435
Q

What is minimal change disease?

A

Most common cause of nephrotic syndrome in children

436
Q

Other features of nephrotic syndrome?

A

Hyperlipidemia, hypercoagulable state and predisposition to infection

437
Q

Nephrotic syndrome management?

A

Urine dipstick

High dose corticosteroids- prednisolone

Furosemide

438
Q

What is the triad for nephritic syndrome?

A

Inflammation within nephrons of kidney- likely after infection such as tonsilitis

Reduction in kidney function
Haematuria
Proteinuria

439
Q

Investigations/ management for nephritic syndrome?

A

Urine microscopy

Support renal failure
Diuretics and anihypertensives

440
Q

What determines the severity of TOF?

A

How bad the pulmonary stenosis is

441
Q

Pneumonia in children treatment?

A

Amoxcillin firt line

Macrolides used if no response or mycoplasma/chlamydia- erythromycin

Influenza pneumonia is co-amoxiclav

442
Q

MENINGITIS MANAGEMENT?

A

<3 months- amoxicillin and cefotaxime

> 3 months cefotaxime

Dexomethosone to over 3 months if-
purulent CSF
CSF with white cell count over 1000/microlitre
Raised CSF WCC
Bacteria on gram stain

FLUIDS

Cerebral monitoring

Notify public health- ciprofloxacin to contacts

443
Q

Edward’s syndrome features?

A

Low set ears, rocker bottom feet, overlapping of fingers and micrognathia

444
Q

Difference between CF, Hirchprung’s and NEC?

A

Muconeum ileus -> Hirschsprung or CF
Blood in stool in pre-term baby -> NEC

445
Q

Obesity causes in children?

A

Cause of obesity in children

Growth hormone deficiency
Hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prader-Willi syndrome

Assess by age adjusted BMI

446
Q

Poor prognosis factors ALL?

A

Poor prognostic factors
age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex

447
Q

When are women offered the pertussis vaccine?

A

Between 16 and 32 weeks

448
Q

Which pulses checked in infants?

A

Brachial and femoral

Children use femoral

449
Q

First line for infantile spasms?

A

Vigabatrin

450
Q

Nagayama spots are associated with which disease?

A

Roseola infantum (HHV6)

451
Q

HUS vs HSP vs ITP

A

HUS is incorrect - HUS is associated with a triad of microangiopathic haemolytic uraemia, acute kidney injury and thrombocytopenia. The symptoms are typically bloody diarrhoea, abdominal pain, fever and vomiting, and the history usually includes exposure to farm animals. The child in the question hasn’t experienced these symptoms so this diagnosis is unlikely

HSP is incorrect - Features of HSP are typically a non-blanching rash affecting the legs and buttocks, arthralgia and abdominal pain. This child has presented with a non-blanching rash but not in the distribution of HSP and has not experienced any other symptoms of HSP. The child has presented with a typical history of ITP so a diagnosis of ITP is more likely

ITP is correct - ITP is correct as it is a differential in any child presenting with petechiae and no fever and is usually preceded by a viral illness. We need blood results to confirm the diagnosis but these typically present with isolated thrombocytopenia and this low platelet count causes the classic petechial rash

452
Q

Viral induced wheeze treatment?

A

SABA

LTRA (montelukast) or ICS

Wheezy - viral induce wheeze
Crackles - bronchiolitis

453
Q

Kallman’s presentation and key feature?

A

Key feature in questions could be lack of smell

‘delayed puberty’
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
LH, FSH levels are inappropriately low/normal
patients are typically of normal or above-average height

454
Q

Risk if get rotavirus vaccine late?

A

Intussusseption

455
Q

First line investigation for coeliac disease?

A

Tissue transglutaminase (TTG) antibodies (IgA) are first-choice

Endoscopic intestinal biopsy is gold standard

456
Q

Features of growing pains?

A

Features of growing pains:

Never present at the start of the day after the child has woken
No limp
No limitation of physical activity
Systemically well
Normal physical examination
Motor milestones normal
Symptoms are often intermittent and worse after a day of vigorous activity

457
Q

What is mesenteric adenitis?

A

Mesenteric adenitis is inflamed lymph nodes within the mesentery. It can cause similar symptoms to appendicitis and can be difficult to distinguish between the two. It often follows a recent viral infection and needs no treatment

458
Q

Feverpain and centor?

A

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

The FeverPAIN criteria are: score 1 point for each (maximum score of 5)
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza

459
Q

Birth marks?

A

Naevus flammeus- port wine stain and grows with the infant

Cavernous haemangioma (strawberry naevus)- Not present at birth and appears in first month of life

460
Q

What is opthalmia neonatorum?

A

Infection of newborn eye

Same day referral

Could be chlamydia or gonorrhoea

461
Q

Most common cause of worsening neurological function within a premature infant?

A

Intraventricular haemorrhage

Most common in premature infants within 72 horus of birth

462
Q

Heart murmurs summary?

A

Cyanotic
TGA: loud S2 and prominent RV impulse
ToF: ejection systolic murmur (due to pulmonary stenosis)
Tricuspid: ejection systolic and prominent apical impulse
Acyanotic
VSD: pan systolic associated with chromosomal abnormalities e.g. Down’s
ASD: more common in adults, ejection systolic and fixed splitting S2
PDA: ‘machinery’ murmur associated with prematurity/rubella
CoA: radio-femoral delay, apical click and mid systolic

463
Q

Child under 3 with an acute lip?

A

Urgent refferal to specialist

464
Q

HSP four symptoms?

A

Rash

Joint pain

Abdo pain

Kidney involvement

465
Q

When do children normally toilet train?

A

At or after 3 months of age

466
Q

Investigation for Meckel’s diverticulum?

A

Technetium scan

467
Q

Another way of saying Turner’s syndrome?

A

Gonadal dysgenesis

468
Q

Thickened formula vs alginate therapy?

A

Breastfeeding- alginate therapy first line

Not breastfeeding- thickened formula first line

469
Q

Which type of cyst has hair in them?

A

Dermoid cyst

470
Q

Paeds red flag symptoms?

A

Red Flag Symptoms
1. Moderate or severe chest wall recession.
2. Does not awake if roused.
3. Reduce skin turgor.
4. Mottled or blue appearance.
5. Grunting

471
Q

Anaphylaxis treatment?

A

IM adrenaline- repeat after 5 mins

IV Fluids

IV adrenaline

After stabilisation:

Antihistamines

472
Q

How often chest physiotherapy in CF patients?

A

Twice daily

473
Q

Rubella starts on face and moves down to the torso but spares the limbs

A

Apparently, but remember suboccipital ad postauricular lymphadenopathy

Rash from face to rest of the body

Prodrome

474
Q

Difference between Barlow and Ortolani tests?

A

Barlow tries to dislocate

Ortolani tries to relocate

475
Q

Perthe’s disease treatment?

A

<6 observation- prognosis is good
>6 surgical repair

476
Q

Criteria to diagnose otitis media?

A

Acute onset of symptoms

Otalgia or ear tugging

Presence of a middle ear effusion

Pulging of the tympanic membrane, or
otorrhoea

Decreased mobility on pneumatic otoscopy

Inflammation of the tympanic membrane
i.e. erythema

477
Q

Treatment for otitis media?

A

Conservative and treat otalgia with analgesia

Antibiotics should be prescribed immediately if:
Symptoms lasting more than 4 days or not improving

Systemically unwell but not requiring admission
I
mmunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease

Younger than 2 years with bilateral otitis media

Otitis media with perforation and/or discharge in the canal

5-7 days amoxicillin is first line

478
Q

Biggest VSD condition complication?

A

Endocarditis

479
Q

Otitis media causes?

A

Haemophilius influenzae

Strep pneumoniae

Moraxella catarrhalis

(RSV, influenza virus, rhinovirus)

480
Q

Otitis media treatment?

A

1st- Amoxicillin

2nd- Clarithromycin

481
Q

Surfactant deficient lung disease RFs?

A

Premature infants

Male sex
Diabetic mothers
Caesarean section
Second born of premature twins

482
Q

Features of SDLD?

A

Clinical features are those common to respiratory distress in the newborn, i.e. tachypnoea, intercostal recession, expiratory grunting and cyanosis

X-ray- ground glass appearance with an indistinct heart border

483
Q

Management of SDLD?

A

Management

Prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation

Oxygen

Assisted ventilation

Exogenous surfactant given via endotracheal tube

484
Q

UTI treatment?

A

<3 months- urgent referral to Paeds

> 3 months with upper UTI- cephaloporin or co-amoxiclav

> 3 months with lower UTI- oral antibiotics- trimethoprim, nitrofurantoin

485
Q

Difference between reflex anoxic seizures and seizures?

A

Reflex anoxic seizures have a rapid recovery (syncope)

486
Q

Premature vaccines?

A

Give as normal

If under 28 weeks give first in hospital

487
Q

Simple vs complex febrile seizures?

A

Simple:
Less than 15 mins
Generalised seizure
No reccurence witin 24 hours
Complete recovery within an hour

Complex:
15-30 mins
Focal seizures
Repeat within 24 hours

Febrile status epilepticus:
>30 mins

488
Q

Remember question- girl without condition, what is chance she is a carrier?

A

2/3

Can exclude aa as know she does not have it

489
Q

PDA features?

A

Features
left subclavicular thrill
continuous ‘machinery’ murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat

490
Q

Fluids summary?

A

0-10kg- 100ml/kg
10-20kg- 50ml/kg
20+kg- 20ml/kg

Up to 2.5L

% dehydration = (well weight - ill weight) / well weight x 100
Fluid deficit (ml) = %dehydration x well weight (kg) x 10

Give over 24 hours with normal fluids

Resuscitation bolus is 10ml/kg repeat up to 40ml/kg

491
Q

Hydrocele?

A

Fluid in tunica vaginalis

Soft, non tender swelling that transilluminates

Confined to scrotum and get above the mass

USS

Repair if don’t resolve

492
Q

Varicocele?

A

Enlargement of testicular veins

Bag of worms
Subfertility

Utrasound

Conservative

493
Q

Torsion?

A

Twisting of the spermatic cord

Pain severe
N+V
Swollen, tender testis unilateral
Cremasteric reflex lost
Prehn’s sign- lift ball doesn’t ease pain

Urgent surgical exploration

494
Q

What virus is measles?

A

RNA paramyxovirus

495
Q

Chicken pox IgG, IgM?

A

IgG- got antibodies

IgM- met someone with virus

496
Q

How to look for scarring in vesicouteric reflux?

A

DMSA scan

497
Q

Clinical features of Down’s syndrome?

A

Clinical features
face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
flat occiput
single palmar crease, pronounced ‘sandal gap’ between big and first toe
hypotonia
congenital heart defects (40-50%, see below)
duodenal atresia
Hirschsprung’s disease

498
Q

Cerebral palsy causes?

A

80% congenital infections- rubella
10% birth asphixiation/trauma
10% trauma meninigits intraventricular haemorrhage

499
Q

Pierre-Robin triad?

A

Micrognathia

Cleft lip

Glossoptosis (posterior displacement of the tongue)

Phase 3a (17 decks)

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