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0
Q

If using formula how much milk should an infant consume per day? (1)

A

150ml/kg/day

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1
Q

Name 3 reasons mothers give up brestfeeding? (3)

A

Pain and discomfort from mastitis, cracked nipples, breast abscess
Concerns they are not producing enough milk
Return to work, inadequate facilities, attitudes towards breastfeeding in the workplace.

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2
Q

Give 3 advantages of breastfeeding for the mother? (3)

A

Contraceptive
Bonding with baby
Practical- free, no prep, right temp
Reduce risk of PPH - oxytocin constricts uterine arteries
Reduce disease- premenopausal breast ca, ovarian ca and osteoporosis
Help get back to pre pregnancy weight

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3
Q

Give 3 advantages to child of breastfeeding. (3)

A

Bonding with mother
Immunological transfer of humoral and cellular components.
Nutritional - correct amount of protein and vitamins and minerals
Sterile
Reduces risk of GORD, IBD, NEC and lactose intolerance.

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4
Q

Name 2 contraindications to breastfeeding. (2)

A

Maternal active TB
HIV positive mother
Maternal drugs (carbimazole, methotrexate, lithium, chemo)

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5
Q

What does APGAR stand for? (5)

A 
Activity
Pulse
Grimacing/ reflex irrirability
Appearance
Respiratory effort
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6
Q

What is the significance of the APGAR score? (2)

A

7-10 is normal
4-7 may require some resuscitative measures
<3 requires immediate resuscitation

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7
Q

What is the correct term for Down’s syndrome? (1)

What is the largest risk factor for a child being affected by Down’s syndrome? (1)

A 
Trisomy 21
Extra chromosome from mother.. Increasing maternal age (esp >35)
    Age <30 risk 1:2000
    Age 30 risk 1:1300
    Age 35 risk 1:400
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8
Q

Name 4 conditions associated with Downs syndrome. (4)

A

Congenital heart disease (AVSD, ASD, VSD, PDA, tetralogy of Fallot)
GI (anal, oesophageal and duodenal atresia, Hirschprung’s disease)
Chronic secretory otitis media
Cataracts
Hypothyroidism

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9
Q

Name 5 signs you may notice during examination of a child with Down’s syndrome. (5)

A

General: neonatal hypotonia, short stature
Developmental: lowered IQ
Craniofacial: microcephaly, brachycephaly, upward slanting eyes, prominent epicanthal folds, flat nasal bridge, protruding tongue, small ears, round face, excess skin at back of neck, atlanto-axial instability
Eyes: strabismus, nystagmus, cataracts
Limbs: single palmar crease, 5th finger clinodactyly, wide gap between first and second toes, hyperflexible joints in infants
CV: murmurs, arrhythmias, chf
Gi: constipation or vomiting

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10
Q

What cancer does Down’s syndrome predispose to? (1)
How is fertility affected? (1)
Why does Down’s syndrome predispose to Alzheimers? (1)

A

Leukaemia (ALL & AML)
Reduced fertility
Most develop Alzheimers by age of 40 as gene encoding for amyloid protein found on chromosome 21.

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11
Q

What is Wilm’s tumour? (1)

How does it present? (2)

A

Nephroblastoma. Originates from embryonal renal tissue.

Large abdominal mass. *
Pallor
Weight loss
Hepatomegaly
Bone pain
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12
Q

What are the four areas of development? (4)

A

Gross motor
Fine motor and vision
Speech, Language and Hearing
Social

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13
Q

What is retinoblastoma? (1)
How does it usually present? (1)
What age is it seen by? (1)

A

Malignant tumour of retinal cells
Loss of red eye on photos, pupil can sometime look white.
Presents by age 4

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14
Q

What developmental milestones may be present in a newborn? (4)

A

GM: symmetrical movements in 4 limbs, normal muscle tone, Moro reflex
FM&V: Fixes on mothers face and rotates 90 degrees
SL&H: Cries. Undergoes newborn hearing screening tests
Social: Responds to being picked up.

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15
Q

What developmental milestones would you expect in a 6-8 week old infant? (4)

A

GM: Good head control when pulled up to sitting, when held ventrally holds head transiently in horizontal plane.
FM&V: Stares at and follows mothers face
SL&H: coos, startles to loud noises
Social: smiles in response.

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16
Q

What developmental milestones might you expect to see in a 12 month old child? (4)

A

GM: crawling and pulling to stand, 50% may be walking.
FM&V: Pincer grip, points to objects
SL&H: uses single words, understands simple commands
Social: finger feeds, waves bye, responds to name

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17
Q

What are the main primitive reflexes? (4)

A

Moro’s, Rooting, Walking, Palmar grasp.

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18
Q

What age does hand preference develop? (1)

What is the implication of a dominant hand before this age? (1)

A

18m-24m

Indicates a problem eg weakness on the non-dominant side.

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19
Q

What is TORCH screen? (1)

A 
Screen for infective agents that cause congenital intrauterine infections that may damage the growing foetus. 
Toxoplasmosis
Other- Varicella zoster, syphilis
Rubella
CMV
Herpes simplex
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20
Q

A child who is 12 hours old is noticed to have microcephaly, cataracts, hepatomegaly, splenomegaly, a petechial rash and jaundice. What is the most likely diagnosis? (1)

A

TORCH infection

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21
Q

A 16/40 pregnant woman attends GP after contracting chickenpox and wants to know if it will affect her child. When is a foetus susceptible in pregnancy? (2)
What is the infective organism? (1)

A

In first 20/40 pregnancy - 2% risk of severe skin scarring or ocular or neurological damage
If mother develops chickenpox within 5 days before or 2 days after delivery when foetus is unprotected by mothers antibodies. May develop vesicular rash , mortality up to 30%.
Varicella zoster virus.

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22
Q

A pregnant woman attends GP having been exposed to chickenpox virus.
What are the risk factors for her also becoming affected? (3)

A

Never had chickenpox in the past.
Same room as an affected person for 15 mins
Face to face conversation with someone affected.

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23
Q

When is chickenpox contagious? (2)

A

From 2 days before the rash develops until all spots have crusted over.

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24
If a pregnant lady believes she is not immune to chickenpox and has had contact with a currently affected individual, how will you manage this? (2)
Serology for VZV antibodies if unsure about immunity. | Give IgG VZV immunoglobulins if within 10 days of exposure.
25
Why do term infants have high levels of Hb (140-210g/L) at birth? (1)
Levels of HbF are high to compensate for low oxygen concentration in the foetus.
26
Name 4 causes of anaemia in a child. (4)
``` Impaired red cell production- iron deficiency*, folic acid deficiency, CRF, leukaemia, aplastic anaemia Increased haemolysis- hereditary spherocytosis, G6PD deficiency, sickle cell Blood loss (rare)- von Willebrand disease ```
27
What is pica? (1)
Child eating non-food materials eg soil
28
What is hereditary spherocytosis? (1)
Autosomal dominant caused by mutations in genes for proteins of red cell membrane. RBCs are spherical and less deformable than normal RBCs so are destroyed by the spleen.
29
Name 4 features of hereditary spherocytosis. (4) (Clue: JAPGAS) What investigation will diagnose? (1) What management is required? (2)
Jaundice, Anaemia, Pigment Gallstones, Aplastic crisis, Splenomegaly Blood film Folic acid for increase RBC production and consider splenectomy for poor growth or bad anaemia
30
How does Glucose-6-phosphate dehydrogenase deficiency cause anaemia? (1) Why are men more affected? (1) Which ethnicities are more commonly affected? (3)
G6PD is essential enzyme for preventing oxidative damage/haemolysis to RBCs. X-linked. Affects central africa, middle east, far east and mediterranean origins more commonly.
31
What is the normal composition of HbF and HbA? (2) Therefore why do β-thallesaemias and sickle cell disease not present until after 6 months of age? (1) What is the pattern of inheritance in the thallesaemias? (1)
HbF has 2 α and 2 γ components, whereas HbA has α and 2 β chains. Because iin these 2 diseases only β-chains are affected and as HbF is predominant until about 6 months of age, they do not show symptoms until HbA takes over. Autosomal recessive
32
A 6 month old child is brought to the GP with yellowing of the sclera, anaemia and splenomegaly. The child's parents are from the Caribbean. What is the most likely diagnosis? (1) What is the amino acid change that causes the production of HbS? (1)
Sickle cell disease. | Glutamine to Valine in the β-haemoglobin chain.
33
What is the difference between sickle cell anaemia and sickle cell trait? (2)
Sickle cell anaemia is HbSS (homozygous HbS) the sickle mutation in both genes means they have NO HbA. (But may prodcue some HbF to compensate) Sickle cell trait are heterozygous HbS and HbA. They are therefore asymptomatic but able to pass the HbS gene on.
34
What is the problem with irreversibly sickle shaped RBC's? (2)
The cells have a reduced lifespan and may become trapped in the microcirculation => blood vessel occlusion => ischaemia of organ or bone
35
Why are children with sickle cell disease at increased risk of infection? (1) Which organisms pose a greater threat? (1)
Hyposlenism occurs secondary to chronic sickling and microinfarction of the spleen in infancy. More at risk from encapsulated organisms eg pneumococci or Haemophilis influenzae.
36
A 10/40 african lady attends clinic, her partner has SCD (HbSS) and she wishes to know if her child may be affected. What diagnostic test can give the answer and when can it be performed? (1) What is the risk of miscarriage from this test? (1)
Chorionic villus sampling (CVS) between 10 and 13/40 (end of first trimester). Miscarriage risk is 1%.
37
How are acute vaso-occlusive crises treat? (4)
Analgesia for pain IV fluids for dehydration Oxygen is desaturated Antibiotics if infection Exchange transfusion for acute chest syndrome, stroke and priapism. If repeated hospitalisation for painful vaso-occlusive episodes or chest syndrome, then hydroxyurea can be tried to stimulate increased production of HbF.
38
How can children with SCD be protected from encapsulated viruses? (2) Why are they more prone to infections? (1) What medication can help prevent anaemia? (1)
Immunisations against pneumococcus, HiB and meningococcus and daily oral penicillin prophylactically. Functional asplenia Chronic haemolytic anaemia causes increased demand of folic acid.
39
What is a common example of a vaso-occlusive crises in infant with sickle cell disease? (2)
Hand-foot syndrome in which there is dactylitis with swelling and pain of the finger or feet from vaso-occlusion.
40
Name 3 things that can precipitate a vaso-occlusive episode in SCD? (3)
Exposure to cold, dehydration, excessive exercise, stress, hypoxia or infection.
41
What infection can cause an aplastic crises in SCD? (1)
Parvovirus infection causes complete but temporary cessation of RBC production => acute anaemia
42
Name 4 long term complications associated with sickle cell disease. (4)
Short stature and delayed puberty. Stroke Adenotonsilar hypertrophy => sleep apnoea => nocturnal hypoxaemia => vaso-occlusive crises or stroke Cardiomegaly <= increased bile pigment production Leg ulcers
43
What is the most common cause of headache in children? (1)
Migraine
44
Name 2 causes of a loss of a red reflex in photos? (2)
Cataracts | Retinoblastoma
46
Name the 3 criteria for diagnosing autism. (3)
Global impairment of language and communication Impairment of social relationships Ritualistic and compulsive behaviour
47
In emergency management of children following collapse, how is resuscitation initiated? (3)
5 rescue breaths Check signs of circulation Chest compressions 15:2
48
When do children receive the flu vaccine? (1) What type of vaccine is it? (1) How is it given? (1)
2-3 years old and annually after that Live vaccine given intranasally Nb flu vaccine given to adults in inactivated
49
What is Kawasaki disease? (1) | How is it diagnosed? (2)
Systemic vasculitis potentially affecting the coronary arteries. Diagnosis is based on clinical features of a fever >5 days and 4 of: non-purulent conjunctivitis, red mucous membranes, cervical lymphadenopathy, red/swollen palm and soles.
50
What are Koplik's spots? (2)
Grain-like white spots seen on buccal mucosa, seen on bright red background - associated with measles.
51
Describe the clinical features seen in measles. (3)
Prodrome of fever, coryza, cough, conjunctvitis and Koplik's spots. Rash occurs 3-4 days later, starts behind ears and spreads to whole body (maculopapular -> blotchy and confluent)
52
Name 3 complications associated with measles. (3)
Common - pneumonia, otitis media, diarrhoea | Rare - encephalitis and subacute sclerosing panencephalitis
53
When is MMR vaccine given? (1)
1 year old and 3 and a half years old
54
What is mumps and how does it present? (2) | name 3 complications. (3)
RNA viral illness - prodrome of fever, muscle pain, headache and malaise. Pain/swelling of one or both parotid glands. Viral meningitis, encephalitis, orchitis, oophoritis, pancreatitis and deafness
55
How does the rash progress in rubella? (2)
Maculopapular on face spreading in 24 hours to chest, upper arms, abdomen and thighs.
56
What are the doses of adrenaline in anaphylaxis in children up to 6years, 6-12years old and 12-adult? (3)
Up to 6years - 150mcg 6years to 12 years - 300mcg 12 years + 500mcg
57
You are a GP and suspect meningitis. What is the immediate treatment of suspected meningitis? (1) What is the only contrindication? (1)
IM benzylpenicillin | Only withhold if previous anaphylaxis - rash with previous penicillin is not contraindication
58
A child attends the sugery for their 3 month injections. What injections would they be expecting? (3)
5 in 1, Men C, Rotavirus
59
A child attends the sugery for their 2 month injections. What injections would they be expecting? (3)
5 in 1, PCV, Rotavirus
60
A child attends the sugery for their 4 month injections. What injections would they be expecting? (2)
5 in 1, PCV
61
What injections would a child receive from age 1-4?
12m - MMR, Men C/Hib booster, PCV Annual flu vaccine 40m - MMR, 4 in 1 preschool booster
62
What is contained in the 5 in 1 injection given at 2, 3 and 4 months of age? (5)
Diphtheria, Tetanus, HiB, Polio and Pertussis
63
When is the neonatal blood spot test performed? (1) | What is included in the screening? (4)
5th-9th day of life | Congenital hypothyroidism, PKU, SCD, CF, MCADD
64
Nem 3 live attenuated vaccines. (3)
MMR, intranasal flu, oral polio, oral rotavirus, yellow fever
65
Name 3 medical causes of obesity in children. (3)
Hypothyroidism, Cushing's disease, Prader-Willi, Down's syndrome, GH deficiency.
66
What is the best method of ascertaining wheher a child is obese? (1)
BMI percentile charts adjusted for sex and age.
67
A 15-year-old girl presents with a palpable purpuric rash over her lower limbs accompanied by polyarthralgia following a recent sore throat. What is the most likely diagnosis?
Henoch-Schloein purpura
68
What is HSP? (1) | What areas does the purpura usually affect? (3)
Small vessel IgA mediated vasculitis | Buttocks and extensor surfaces of arms and legs
69
How long should children with chicken pox be kept off school? (1) How long are they infective for? (1)
5 days after rash appeared. | 4 days before rash appears to 5 days after.
70
What is the commonest cause of death in children under 1 year old? (1) Give 3 risk factors. (3)
``` Sudden infant death syndrome Prematurity Male Bottle fed Sleeping prone Hyperthermia Multiple births Parental smoking ```
71
What is the commonest cause of death in children over the age of 1? (1)
Accidents
72
What are the chances a 35 year old woman will have a child with Down's syndrome? (1)
30 years = 1/1000 35 years = 1/300 40 years = 1/100
73
What does the mnemonic CHILD HAS PROBLEM stand for? | with regards to features of Down's syndrome.
``` CHD and cataracts Hypotonia and Hirschprung's Increased gap between 1st and 2nd toe Leukaemia risk Developmental delay Hypothyroid Alzheimer's Short stature/squint Protruding tongue Round face Occiput flat Behavioural difficulties Low nasal bridge Eyes - speckled iris, Brush field spots Mental retardation ```
74
Child is unwell and appears dehydrated, she is admitted for IV fluid management. How will you proceed? (4)
Bolus 10mg/kg (can rpt up to 30mg/kg) Calculate deficit as % dehydration of (kg x 1000) Calculate maintenance as 100mg/kg up to 10kg then 50mg/kg for 10-20kg, then 20mg/kg for extra kg's Fluid requirement = maintenance + deficit - bolus over 48 hours
75
Name 3 signs of severe dehydration (shock). (3)
Decreased consciousness, mottled/pale skin, cold extremities, tachycardia, tachypnoea, hypotension, weak peripheral pulses, prolonged CR.
76
What fluid is used in NG tubes for rehydration? (1)
Hypo-osmolarity rehydration solution (hypo-osmolar to prevent osmotic diarrhoea)
77
In what medical conditions would you replace fluids more cautiously (i.e. over 48 hours)? (2) Why? (1)
DKA or hypernatraemia | Risk of cerebral oedema
78
What is the difference between passive and active immunity? (2)
Passive - transfer of active humeral immunity in form of antibodies (e.g. mother to child) Active - antibody or cell mediated. Acquired by natural disease process or immunisations.
79
What is the most common cancer of childhood? (1) Name 3 clinical features. (3) Give 3 good prognostic factors? (3)
Acute Lymphoblastic leukaemia Anaemia, infection, bleeding, bone pain, lymphadenopathy, hepatosplenomegaly Female, young age (2-10y), WCC<50, no CNS disease
80
What is the most commonly seen solid tumour in children? (1) | What is the most commonly seen location? (1)
Brain tumours | Primary and infratentorial (55%) eg cerebellum

Paediatrics (9 decks)

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