stuff Flashcards

1
Q

What are causes of neonatal hypotonia

A

neonatal sepsis
Werdnig-Hoffman disease (spinal muscular atrophy type 1)
hypothyroidism
Prader-Willi

maternal drugs e.g. benzodiazepines
maternal myasthenia gravis

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2
Q

What is craniosynostosis

A

premature fusion of skull bones

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3
Q

Limp + fever what do you do

A

admit urgently

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4
Q

What is enuresis defined as

A

‘involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract’

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5
Q

How do you treat infantile spasms

A

poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used

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6
Q

What can cause snoring in children

A

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

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7
Q

What are features of acute epiglottis

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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8
Q

Pansystolic murmur in lower left sternal border

A

VSD

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9
Q

How do you diagnose whooping cough

A

per nasal swab culture for Bordetella pertussis - may take several days or weeks to come back
PCR and serology are now increasingly used as their availability becomes more widespread

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10
Q

What is the cause of bronchioloitis

A

RSV - Respiratory syncytial virus

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11
Q

How do you treat CP

A

mdt approach
spasticity - oral diazepam. oral and intrathecal baclofen
Anticonvulsants and analgesia when required

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12
Q

What are 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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13
Q

How do you manage hypospadias

A

referral to specialist services
corrective surgery performed at 12 months
do not circumcise

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14
Q

How do you manage ADHD

A

education/training programs
methylphenidate

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15
Q

What is epsteins pearl

A

congenital cyst found in the mouth. They are common on the hard palate, but may also be seen on the gums where the parents may mistake it for an erupting tooth

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16
Q

What are the tow types of innocent murmur

A

venous hums
stills murmur

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17
Q

what heart condition is linked to duchennes

A

dilated cardiomyopathy

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18
Q

Do you need exclusion for diarrhoea and vomiting

A

until symptoms have settled for 48 hours

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19
Q

what is exomphalos (omphalocoele) and how is is treated

A

In exomphalos (also known as an omphalocoele) the abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.

caesarean section is indicated to reduce the risk of sac rupture
a staged repair may be undertaken as primary closure may be difficult due to lack of space/high intra-abdominal pressure

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20
Q

Do you need exclusion for scabies

A

until treated

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21
Q

What is the main risk factor for aspiration pneumonia

A

meconium staining

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22
Q

What are features of kallmans

A

‘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

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23
Q

outline paeds bls

A

unresponsive?
shout for help
open airway
look, listen, feel for breathing
give 5 rescue breaths
check for signs of circulation
infants use brachial or femoral pulse, children use femoral pulse

15 chest compressions:2 rescue breaths
chest compressions should be 100-120/min for both infants and children
depth: depress the lower half of the sternum by at least one-third of the anterior-posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child)
in children: compress the lower half of the sternum
in infants: use a two-thumb encircling technique for chest compression

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24
Q

How do you manage diaphragmatic hernia

A

insertion of nasogastric tube (intubation and ventilation)
surgical repair

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25
What is Kochers criteria used for and what is the criteria
Non-weight bearing Fever >38.5ºC WCC >12 * 109/L ESR >40mm/hr
26
What is the main difference between cephalohaematoma and caput succedaneum
C S crosses suture lines
27
What causes roseola infantum
human herpes virus 6
28
What do you see on muscle biopsy of mitochondrial diseases
red ragged fibres
29
How do you screen for DDH
breech presentation or multiple pregnancy - ultrasound - 6 weeks newborn check and 6 week check - barlow and ortolani test if >4.5months do xray
30
What is a contraindication for lung transplant in CF
chronic infection with Burkholderia cepacia is an important CF-specific contraindication to lung transplantation
31
What is asthma management for 5-16 year olds
1 - SABA 2 - SABA+low dose ICS 3 - SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA) 4 - SABA + paediatric low-dose ICS + long-acting beta agonist (LABA) 5 - SABA + switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a paediatric low-dose ICS 6 - SABA + paediatric moderate-dose ICS MART OR consider changing back to a fixed-dose of a moderate-dose ICS and a separate LABA 7 - SABA + one of the following options: increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MART a trial of an additional drug (for example theophylline) seeking advice from a healthcare professional with expertise in asthma
32
What is precocious puberty defined as
'development of secondary sexual characteristics before 8 years in females and 9 years in males'
33
How do you manage nocturnal enuresis
look for causes eg constipation, DM, UTI general advice eg fluid Reward system enuresis alarm (first line) desmopressin - short term beenfit too
34
What is the main risk factor for transient tachypnoea of the newborn
C section
35
Is whooping cough a notifiable disease
yes
36
How do you manage PDA
indomethacin
37
What are features of cystic fibrosis
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
38
what do you see on xray for NE? what is signs do you see?
dilated bowel loops (often asymmetrical in distribution) 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)
39
What is a cephalohaematoma
swelling on the newborns head. It typically develops several hours after delivery and is due to bleeding between the periosteum and skull. The most common site affected is the parietal region
40
What are features of Turners + what is the most common renal abnormality
short stature shield chest, widely spaced nipples webbed neck bicuspid aortic valve (15%), coarctation of the aorta (5-10%) an increased risk of aortic dilatation and dissection are the most serious long-term health problems for women with Turner's syndrome regular monitoring in adult life for these complications is an important component of care primary amenorrhoea cystic hygroma (often diagnosed prenatally) high-arched palate short fourth metacarpal multiple pigmented naevi lymphoedema in neonates (especially feet) gonadotrophin levels will be elevated hypothyroidism is much more common in Turner's horseshoe kidney: the most common renal abnormality in Turner's syndrome
41
What are features of androgen insensitivity syndrome
'primary amenorrhoea' undescended testes causing groin swellings breast development may occur as a result of conversion of testosterone to oestradiol
42
what complications are there for downs
subfertility short stature repeated respiratory infections (+hearing impairment from glue ear) acute lymphoblastic leukaemia hypothyroidism Alzheimer's disease atlantoaxial instability
43
What are the causes of acyanotic congenital heart disease
ventricular septal defects (VSD) - most common, accounts for 30% atrial septal defect (ASD) patent ductus arteriosus (PDA) coarctation of the aorta aortic valve stenosis
44
What should you not do in acute epiglottis
Do not examine the throat
45
What are risk factors for DDH
female sex: 6 times greater risk breech presentation positive family history firstborn children oligohydramnios birth weight > 5 kg congenital calcaneovalgus foot deformity
46
What are features of pierre-robin syndrome
Micrognathia Posterior displacement of the tongue (may result in upper airway obstruction) Cleft palate
47
What are features of intestinal malrotation + how do you diagnose and treat
High caecum at the midline Feature in exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia May be complicated by the development of volvulus, an infant with volvulus may have bile stained vomiting Diagnosis is made by upper GI contrast study and USS Treatment is by laparotomy, if volvulus is present (or at high risk of occurring then a Ladd's procedure is performed (includes division of Ladd bands and widening of the base of the mesentery)
48
What causes threadworms
Enterobius vermicularis
49
What is gastroschisis
Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord
50
What is pulmonary hypoplasia and what causes it
Pulmonary hypoplasia is a term used for newborn infants with underdeveloped lungs Causes include oligohydramnios congenital diaphragmatic hernia
51
What would you do if you had ITP with lymphadenopathy
bone marrow examinations is only required if there are atypical features e.g. lymph node enlargement/splenomegaly, high/low white cells failure to resolve/respond to treatment
52
What cardiac problems are seen in downs
multiple cardiac problems may be present endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects) ventricular septal defect (c. 30%) secundum atrial septal defect (c. 10%) tetralogy of Fallot (c. 5%) isolated patent ductus arteriosus (c. 5%)
53
What are features of chickenpox
fever initially itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular systemic upset is usually mild
54
What genetic pattern is seen in prader willi
imprinting
55
What would hemiplegic CP look like
involve one side of the patient's body
56
do you need to exclude for hand foot and mouth disease
No
57
What is laryngomalacia
Congenital abnormality of the larynx. Infants typical present at 4 weeks of age with: stridor
58
What is whooping cough caused by
Bordetella pertussis
59
What are features of impetigo
'golden', crusted skin lesions typically found around the mouth very contagious
60
How do you treat pneumonia in a child
amoxicillin first line add a macrolide if this doesnt work use a macrolide if you suspect mycoplasma or chlamydia if associated with influenza, use coamoxiclav
61
What is the main cause of gastroenteritis in children
rotavirus
62
what are complications of whooping cough
subconjunctival haemorrhage pneumonia bronchiectasis seizures
63
What is group b strep specifically known as
Streptococcus agalactiae
64
what are features of duchenne muscular dystrophy + what sign is shown + what mode of inheritance
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 X linked recessive
65
What is management of SUFE
internal fixation across the growth plate
66
What features do you see in achondroplasia
short limbs (rhizomelia) with shortened fingers (brachydactyly) large head with frontal bossing and narrow foramen magnum midface hypoplasia with a flattened nasal bridge 'trident' hands lumbar lordosis
67
What are high risk features sepsis
Pale/mottled/ashen/blue No response to social cues * Appears ill to a healthcare professional * Does not wake or if roused does not stay awake * Weak, high-pitched or continuous cry Grunting * Tachypnoea: respiratory rate >60 breaths/minute * Moderate or severe chest indrawing Reduced skin turgor * Age <3 months, temperature >=38°C * Non-blanching rash * Bulging fontanelle * Neck stiffness * Status epilepticus * Focal neurological signs * Focal seizures
68
Is there exclusion for roseola infantum
No
69
What does VSD increase the risk of
endocarditis
70
What are features of Osgood-Schlatter disease (tibial apophysitis)
Seen in sporty teenagers Pain, tenderness and swelling over the tibial tubercle
71
How do you manage whooping cough
<6months - admit Notifiable disease oral macrolide if onset of cough is in last 21 days prophylaxis for household members
72
What needs to be monitored with methylphenidate usage
monitor ECG before starting - drugs are cardiotoxic weight and height every 6 months
73
How do you work out apgar scores
74
When in the year is croup more common
autumn
75
how do you treat headlice
malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone household contacts of patients with head lice do not need to be treated unless they are also affected
76
Whata re features of oesophageal atresia
Associated with tracheo-oesophageal fistula and polyhydramnios May present with choking and cyanotic spells following aspiration VACTERL associations
77
What are features of rickets
aching bones and joints lower limb abnormalities: in toddlers genu varum (bow legs) in older children - genu valgum (knock knees) 'rickety rosary' - swelling at the costochondral junction kyphoscoliosis craniotabes - soft skull bones in early life Harrison's sulcus
78
What LH and testosterone do you see in Klinefelters, Kallmans, androgen insensitivity syndrome and a testerone secreting tumour
79
What is meant by genetic anticipation
earlier onset in successive generations
80
Where does bile enter the GI tract (and therefore when bilious vomiting occurs)
second part of duodenum
81
What are features of measles
prodromal phase irritable conjunctivitis fever Koplik spots typically develop before the rash white spots ('grain of salt') on the buccal mucosa rash starts behind ears then to the whole body discrete maculopapular rash becoming blotchy & confluent desquamation that typically spares the palms and soles may occur after a week diarrhoea occurs in around 10% of patients
82
management of neonatal hypoglycaemia
asymptomatic encourage normal feeding (breast or bottle) monitor blood glucose symptomatic or very low blood glucose admit to the neonatal unit intravenous infusion of 10% dextrose
83
What are features of Mumps
Fever, malaise, muscular pain Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%
84
Asthma management in kid <5 years
1 - Short-acting beta agonist (SABA) 2 - SABA + an 8-week trial of paediatric MODERATE-dose inhaled corticosteroid (ICS) After 8-weeks stop the ICS and monitor the child's symptoms: if symptoms did not resolve during the trial period, review whether an alternative diagnosis is likely if symptoms resolved then reoccurred within 4 weeks of stopping ICS treatment, restart the ICS at a paediatric low dose as first-line maintenance therapy if symptoms resolved but reoccurred beyond 4 weeks after stopping ICS treatment, repeat the 8-week trial of a paediatric moderate dose of ICS 3 - SABA + paediatric low-dose ICS + leukotriene receptor antagonist (LTRA) 4 - Stop the LTRA and refer to an paediatric asthma specialist
85
if neonatal hypoglycaemia is <1mmol what do you do
IV 10% dextrose
86
what is ophthalmia neonatum
infection of the eye usually conjunctivitis - discharge
87
What are characteristics of an innocent murmur
soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area may vary with posture localised with no radiation no diastolic component no thrill no added sounds (e.g. clicks) asymptomatic child no other abnormality
88
what do you see on xray with TTN
heart failure type pattern (e.g. interstitial oedema and pleural effusions) but key distinguishing features from congenital heart disease are a normal heart size and rapid resolution of the failure type pattern within days.
89
What are the causes of precocious puberty in males
Testes bilateral enlargement = gonadotrophin release from intracranial lesion unilateral enlargement = gonadal tumour small testes = adrenal cause (tumour or adrenal hyperplasia)
90
How do you manage eczema
avoid irritants simple emolients topical steroids wet wrapping oral ciclosporin in severe cases
91
What are features of downs syndrome
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
92
What are features of Scarlet Fever + what causes it
Reaction to erythrogenic toxins produced by Group A haemolytic streptococci Fever, malaise, tonsillitis 'Strawberry' tongue Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)
93
What do you do with acute epiglottis when medical therapy is not enough
endotracheal intubation
94
How do you investigate meckels diverticulum
if the child is haemodynamically stable with less severe or intermittent bleeding then a 'Meckel's scan' should be considered uses 99m technetium pertechnetate, which has an affinity for gastric mucosa mesenteric arteriography may also be used in more severe cases e.g. transfusion is required
95
How do you treat NE
laporotomy
96
investigation for NE
abdominal xray
97
What is Meckels diverticulum
congenital diverticulum of the small intestine. It is a remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric or pancreatic mucosa.
98
What is management for constipation
polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) add a stimulant laxative if Movicol Paediatric Plain does not lead to disimpaction after 2 weeks maintenance therapy: first-line: Movicol Paediatric Plain add a stimulant laxative if no response
99
What do you see on EEG in benign rolandic epilepsy
centrotemporal strikes
100
What are the differences between early (compensated) shock and late (decompensated) shock
101
What is the cause of croup
parainfluenza virus
102
What age does bronchiolitis typically impact
<1-2 year
103
what staging system is used for perthes
Catterall staging
104
What causes homocystinuria
deficiency of cystathionine beta synthase
105
What signs are there for biliary atresia
Jaundice Hepatomegaly with splenomegaly Abnormal growth Cardiac murmurs if associated cardiac abnormalities present
106
how is pyloric stenosis managed
Ramstedt pyloromyotomy.
107
What is the criteria for an immediate CT if a child has hit their head
Loss of consciousness lasting more than 5 minutes (witnessed) Amnesia (antegrade or retrograde) lasting more than 5 minutes Abnormal drowsiness Three or more discrete episodes of vomiting Clinical suspicion of non-accidental injury Post-traumatic seizure but no history of epilepsy GCS less than 14, or for a baby under 1 year GCS (paediatric) less than 15, on assessment in the emergency department Suspicion of open or depressed skull injury 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 If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head Dangerous mechanism of injury (high-speed road traffic accident either as pedestrian, cyclist or vehicle occupant, fall from a height of greater than 3 m, high-speed injury from a projectile or an object)
108
How do you investigate \hirschprungs
rectal biopsy
109
What are features of Rubella
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day Lymphadenopathy: suboccipital and postauricular
110
What are features of Dyskinetic CP
caused by damage to the basal ganglia and the substantia nigra athetoid movements and oro-motor problems involuntary movements, commonly affecting the hands and feet. The excessive salivation and mastication difficulties observed are indicative of compromised control over facial muscles
111
What classes severity of alpha thalassemia and what are typical findings
If 1 or 2 alpha globulin alleles are affected then the blood picture would be hypochromic and microcytic, but the Hb level would be typically normal If are 3 alpha globulin alleles are affected results in a hypochromic microcytic anaemia with splenomegaly. This is known as Hb H disease If all 4 alpha globulin alleles are affected (i.e. homozygote) then death in utero (hydrops fetalis, Bart's hydrops)
112
What are features of osteochondritis dissecans
Pain after exercise Intermittent swelling and locking
113
What are features of Patellar tendonitis
More common in athletic teenage boys Chronic anterior knee pain that worsens after running Tender below the patella on examination
114
What are features of hand foot and mouth disease
mild systemic upset: sore throat, fever oral ulcers followed later by vesicles on the palms and soles of the feet
115
What causes impetigo
staph/strep
116
How is pyloric stenosis diagnosed
ultrasound
117
Which disorders show genetic anticipation
Trinucleotide repeat disorders: Fragile X (CGG) Huntington's (CAG) myotonic dystrophy (CTG) Friedreich's ataxia* (GAA) spinocerebellar ataxia spinobulbar muscular atrophy dentatorubral pallidoluysian atrophy *Friedreich's ataxia is unusual in not demonstrating anticipation
118
What chromosome trisomies are linked to congenital disorders eg downs
patau 13 edwards 18 downs 21
119
What are features of reflex anoxic seizures
child goes very pale falls to floor secondary anoxic seizures are common rapid recovery
120
How do you grade VUR
121
How do you manage perthes
To keep the femoral head within the acetabulum: cast, braces If less than 6 years: observation Older: surgical management with moderate results Operate on severe deformities
122
123
How do you manage meckels diverticulum
Management removal if narrow neck or symptomatic options are between wedge excision or formal small bowel resection and anastomosis
124
What are features of JIA
joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows limp ANA may be positive in JIA - associated with anterior uveitis
125
What are features of edwards syndrome
Micrognathia Low-set ears Rocker bottom feet Overlapping of fingers
126
What is headlice caused by
Pediculus capitis
127
What is Vesicoureteric reflux
abnormal backflow of urine from the bladder into the ureter and kidney. It is a relatively common abnormality of the urinary tract in children and predisposes to urinary tract infection (UTI)
128
What is the barlow and ortolani test
Barlow test: attempts to dislocate an articulated femoral head Ortolani test: attempts to relocate a dislocated femoral head
129
How do threadworms manifest
perianal itching, particularly at night girls may have vulval symptoms
130
How do you manage ophthalmia neonatum
refer same day
131
What are features of TGA + what sign + what heart sound
cyanosis tachypnoea loud single S2 prominent right ventricular impulse 'egg-on-side' appearance on chest x-ray
132
When are you infectious with chickenpox
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).
133
what are features of ITP
bruising petechial or purpuric rash bleeding is less common and typically presents as epistaxis or gingival bleeding
134
What are features of whooping cough
catarrhal phase symptoms are similar to a viral upper respiratory tract infection lasts around 1-2 weeks paroxysmal phase the cough increases in severity coughing bouts are usually worse at night and after feeding, may be ended by vomiting & associated central cyanosis inspiratory whoop: not always present (caused by forced inspiration against a closed glottis) infants may have spells of apnoea persistent coughing may cause subconjunctival haemorrhages or even anoxia leading to syncope & seizures lasts between 2-8 weeks convalescent phase the cough subsides over weeks to months
135
What are risk factors for neonatal sepsis
Mother who has had a previous baby with GBS 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
136
What are the most common fractures associated with child abuse
- Radial - Humeral - Femoral
137
What causes ophthalmia neonatum
chlamydia gonorrhoea
138
What are features of fragile x
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
139
What is ebsteins anomaly + what features + heart defects
caused by the use of lithium in pregnancy. It occurs when the posterior leaflets of the tricuspid valve are displaced anteriorly towards the apex of the right ventricle. The creates tricuspid regurgitation (pan-systolic murmur) and tricuspid stenosis (mid-diastolic murmur). There is also enlargement of the right atrium. 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
140
What are features of intussusception
intermittent, severe, crampy, progressive abdominal pain inconsolable crying during paroxysm the infant will characteristically draw their knees up and turn pale vomiting bloodstained stool - 'red-currant jelly' - is a late sign sausage-shaped mass in the right upper quadrant
141
What can you give to help with recurrent febrile convulsions
rectal diazepam or buccal midazolam
142
How do you investigate duchennes
raised creatinine kinase genetic testing has now replaced muscle biopsy as the way to obtain a definitive diagnosis
143
What time intervals do you measure apgar score
1,5 minutes, if low, repeat every 10
144
What is infantile colic
Excessive crying and pulling up of legs, often worse in evenings Reassurance and support <3 months old
145
What are features of lymphatic malformations
Usually located posterior to the sternocleidomastoid Cystic hygroma result from occlusion of lymphatic channels The painless, fluid filled, lesions usually present prior to the age of 2 They are often closely linked to surrounding structures and surgical removal is difficult They are typically hypoechoic on USS
146
When should a PPI be used in GORD
PPI should be trialled in infants with GORD who do not respond to alginates/thickened feeds and who have 1. feeding difficulties, 2. distressed behaviour or 3. faltering growth
147
What investigations do you do for infantile spasms + what do you see
the EEG shows hypsarrhythmia in two-thirds of infants CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)
148
limp <3 years old
admit
149
When does immune thrombocytopenia present
after infection/vaccine
150
how do you manage ddh
pavlik harness if <4/5 months
151
What mode of inheritance is achondroplasia + what is mutation
autosomal dominant mutation in FGFR-3 gene
152
What are life threatening features of asthma attack
SpO2 <92% PEF <33% best or predicted Silent chest Poor respiratory effort Agitation Altered consciousness Cyanosis
153
What would monoplegic CP look like
impacts a single limb
154
Diastolic machinery murmur in the upper left sternal border
PDA
155
How do you manage NRDS
prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation oxygen assisted ventilation exogenous surfactant given via endotracheal tube
156
What causes Scarlet Fever
Group A haemolytic streptococci
157
What are features of a wilms tumour
abdominal mass (most common presenting feature) painless haematuria flank pain other features: anorexia, fever unilateral in 95% of cases metastases are found in 20% of patients (most commonly lung)
158
How do you manage meningitis
< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime > 3 months: IV cefotaxime (or ceftriaxone)
159
What is plagiocephaly
parallelogram shaped head the incidence of plagiocephaly has increased over the past decade. This may be due to the success of the 'Back to Sleep' campaign
160
When is heel prick test done
5-9 days
161
What are features of Erythema infectiosum (Slapped cheek syndrome) + what causes it
Also known as fifth disease or 'slapped-cheek syndrome' Caused by parvovirus B19 Lethargy, fever, headache 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
162
Crescendo-decrescendo murmur in the upper left sternal border
coarctation of the aorta
163
At what age do you typically get intussusception
6-18 months
164
Where does atopic eczema typically effect infants
nappy area and trunk
165
what is the first sign of puberty in women
breast development
166
How do you manage CMPI/A
if formula fed: extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptoms amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF if breastfeeding: continue breastfeeding eliminate cow's milk protein from maternal diet. Consider prescribing calcium supplements for breastfeeding mothers use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months
167
When does infantile colic typically stop
6 months
168
What are causes of jaundice in first 24 hours
PATHOLOGICAL rhesus haemolytic disease ABO haemolytic disease hereditary spherocytosis glucose-6-phosphodehydrogenase
169
What are features of noonan syndrome
Webbed neck Pectus excavatum Short stature Pulmonary stenosis
170
Where are the alpha globulin genes in alpha thalaessemia found
ch16
171
What is perthes disease
degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years. It is due to avascular necrosis of the femoral head, specifically the femoral epiphysis. Impaired blood supply to the femoral head causes bone infarction.
172
What are cardiac defects associated with Turners syndrome
Bicuspid aortic valve (most common) Aortic root dilatation Coarctation of the aorta
173
What are features of patella subluxation
Medial knee pain due to lateral subluxation of the patella Knee may give way
174
What do you see on imaging of intussusception
abdominal film xray - sausage shaped mass ultrasound - target sign
175
What are features of Cri du chat syndrome (chromosome 5p deletion syndrome)
Characteristic cry (hence the name) due to larynx and neurological problems Feeding difficulties and poor weight gain Learning difficulties Microcephaly and micrognathism Hypertelorism
176
in peads bls, what ratio of compressions do you do
15:2 if there are 2 people, one LAY person - 30:2
177
What do you see on xray for croup
a posterior-anterior view will show subglottic narrowing, commonly called the 'steeple sign' in contrast, a lateral view in acute epiglottis will show swelling of the epiglottis - the 'thumb sign'
178
what is a venous hum
Due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles
179
What are complications of undescended testes
infertility torsion testicular cancer psychological
180
what is a reflex anoxic seizure
a syncopal episode (or presyncope) that occurs in response to pain or emotional stimuli
181
What causes Erythema infectiosum
Parvovirus B19
182
What are features of prader willi
hypotonia during infancy dysmorphic features short stature hypogonadism and infertility learning difficulties childhood obesity behavioural problems in adolescence willi - willy - floppy
183
When should you admit for croup
<3months moderate or severe croup known upper airway abnormalities (e.g. Laryngomalacia, Down's syndrome) uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
184
What are complications of measles
otitis media: the most common complication pneumonia: the most common cause of death encephalitis: typically occurs 1-2 weeks following the onset of the illness) subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness febrile convulsions keratoconjunctivitis, corneal ulceration diarrhoea increased incidence of appendicitis myocarditis
185
how does biliary atresia present
FIRST FEW WEEKS OF LIFE Jaundice extending beyond the physiological two weeks Dark urine and pale stools Appetite and growth disturbance, however, may be normal in some cases
186
What is management of chickenpox
calamine lotion school exclusion: NICE Clinical Knowledge
187
How do you manage acute epiglottis
Senior involvement - emergency Intubate if necessary oxygen if needed IV ABx
188
Typical paediatric vitals (HR and RR)
189
What should you do if a neonate presents with jaundice
measure serum bilirubin urgently
190
How is JIA defined
occurring in someone who is less than 16 years old that lasts for more than 6 weeks. Pauciarticular JIA refers to cases where 4 or less joints are affected. It accounts for around 60% of cases of JIA
191
What is a common deficiency in newborns
vit k can lead to haemorrhagic disease antiepileptics increases risk offer vit k orally or IM
192
What incerases risk of having a child with TGA
diabetets
193
How do you diagnose CF
immue reactive trypsinogen sweat testW
194
What is the first sign of puberty in males
testicular growth
195
What is the difference of timing between NRDS and TTN
Neonates with NRDS usually present with respiratory distress shortly after birth which usually worsens over the next few days. In contrast, TTN usually presents with tachypnoea shortly after birth and often fully resolves within the first day of life
196
What is the main riks factor for neonatal respiratory distress syndrome
prematurity
197
What are features of Measles
Prodrome: irritable, conjunctivitis, fever Koplik spots: white spots ('grain of salt') on buccal mucosa Rash: starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent
198
What are features of infantile haemangioma
May present in either triangle of the neck Grow rapidly initially and then will often spontaneously regress Plain x-rays will show a mass lesion, usually containing calcified phleboliths As involution occurs the fat content of the lesions increases
199
How do you diagnose vesicoureteric reflux
micturating cystourethrogram
200
What are the features of TOF + what murmur + what on xray
ventricular septal defect (VSD) right ventricular hypertrophy right ventricular outflow tract obstruction, pulmonary stenosis overriding aorta cyanosis unrepaired TOF infants may develop episodic hypercyanotic 'tet' spells due to near occlusion of the right ventricular outflow tract features of tet spells include tachypnoea and severe cyanosis that may occasionally result in loss of consciousness they typically occur when an infant is upset, is in pain or has a fever **causes a right-to-left shunt** **ejection systolic murmur** due to pulmonary stenosis (the VSD doesn't usually cause a murmur) a right-sided aortic arch is seen in 25% of patients chest x-ray shows a '**boot-shaped**' heart, ECG shows right ventricular hypertrophy
201
what is a stills murmur
Low-pitched sound heard at the lower left sternal edge
202
What are features of febrile convulsion
usually occur early in a viral infection as the temperature rises rapidly seizures are usually brief, lasting less than 5 minutes are most commonly tonic-clonic
203
How do you manage impetigo
hydrogen peroxide cream 1%
204
what can chickenpox + group A strep result in
necrotizing fasciitis
205
What are features of patau syndrome
Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions
206
How is acute epiglottis diagnosed
Diagnosis is made by direct visualisation (only by senior/airway trained staff, see below). However, x-rays may be done
207
What are features of williams syndrome + what heart condition
short stature Learning difficulties Friendly, extrovert personality Transient neonatal hypercalcaemia Supravalvular aortic stenosis elfin facies
208
What are contraindications to LP in suspected meningitis
focal neurological signs papilloedema significant bulging of the fontanelle disseminated intravascular coagulation signs of cerebral herniation
209
what is the most common cause of ambiguous genitalia
congenital adrenal hyperplasia
210
How do you manage scarlet fever
oral penicillin V (phenoxymethylpenicillin) 10 days azithromycin if allergy
211
What are causes of prolonged jaundice
biliary atresia hypothyroidism galactosaemia urinary tract infection breast milk jaundice jaundice is more common in breastfed babies prematurity due to immature liver function increased risk of kernicterus congenital infections e.g. CMV, toxoplasmosis
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When do you offer the whooping cough vaccine in pregnancy
16-32 weeks
213
What are features of infantile spasms
characteristic 'salaam' attacks: flexion of the head, trunk and arms followed by extension of the arms this lasts only 1-2 seconds but may be repeated up to 50 times progressive mental handicap
214
risk factors for neonatal hypoglycaemia
preterm birth (< 37 weeks) maternal diabetes mellitus IUGR hypothermia neonatal sepsis inborn errors of metabolism nesidioblastosis Beckwith-Wiedemann syndrome
215
How do you treat intestnal malrotation
Ladds procedure
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When are will children with non-IgE mediated intolerance become tolerant
3 years
217
How are immunisations and developmental stages affected by prematurity
dont adjust immunisations adjust developmental - add difference from week 40
218
What is mesenteric adenitis
similar presntation to appendicitis but follows after infection
219
What classes as neonatal hypoglycaemia
<2.6
220
What are features of perthes disease
hip pain: develops progressively over a few weeks limp stiffness and reduced range of hip movement x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
221
Is there exclusion for whooping cough
school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )
222
How do you manage a wilms tumour
nephrectomy chemotherapy radiotherapy if advanced disease
223
do you need exclusion for influenza
until recovered
224
how do you manage intussuscpetion
reduction by air insufflation if this fails, or signs of peritonitis -> surgery
225
What are features of GORD
typically develops before 8 weeks vomiting/regurgitation milky vomits after feeds may occur after being laid flat excessive crying, especially while feeding
226
hypoglycaemia seen hours after birth
Transient hypoglycaemia in the first hours after birth is common.
227
What does maternal antiepleptic use increase chances of
orofacial defects eg cleft palate
228
How do you manage gastroschisis
vaginal delivery may be attempted newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours
229
What are the criteria of severity for croup
230
How do you diagnose headlice
fine-toothed combing of wet or dry hair
231
When do febrile convulsions occur
6months-3years
232
What increases the chances of secondary bacterial infection with chickenpox
nsaids
233
What are features of eczema
itchy, erythematous rash repeated scratching may exacerbate affected areas in infants the face and trunk are often affected in younger children, eczema often occurs on the extensor surfaces in older children, a more typical distribution is seen, with flexor surfaces affected and the creases of the face and neck
234
ejection systolic murmur and fixed splitting of the second heart sound
ASD
235
What are features of klinefelters
often taller than average lack of secondary sexual characteristics small, firm testes infertile gynaecomastia - increased incidence of breast cancer elevated gonadotrophin levels
236
What are the types of biliary atresia
Type 1: The proximal ducts are patent, however, the common duct is obliterated Type 2: There is atresia of the cystic duct and cystic structures are found in the porta hepatis Type 3: There is atresia of the left and right ducts to the level of the porta hepatis, this occurs in >90% of cases of biliary atresia
237
Do you need exclusion for impetigo
Until lesions are crusted and healed, or 48 hours after commencing antibiotic treatment
238
How do you manage CF + what drugs
twice daily chest physio and postural drainage high calorie high fat diet minimise contact with other CF vitamin supplements pancreatic enzyme supplements with meals Lumacaftor/Ivacaftor (Orkambi) is used to treat cystic fibrosis patients who are homozygous for the delta F508 mutation lumacaftor increases the number of CFTR proteins that are transported to the cell surface ivacaftor is a potentiator of CFTR that is already at the cell surface, increasing the probability that the defective channel will be open and allow chloride ions to pass through the channel pore
239
What are features of Kawasaki disease
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics conjunctival injection bright red, cracked lips strawberry tongue cervical lymphadenopathy red palms of the hands and the soles of the feet which later peel
240
When would you consider pneumonia in a bronchiolitis picture
fever >39 persistently focal crackles
241
What are features of pyloric stenosis
'projectile' vomiting, typically 30 minutes after a feed constipation and dehydration may also be present a palpable mass may be present in the upper abdomen hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
242
management for hirschprungs
rectal washouts/bowel irrigation initially surgery to affected segment of colon
243
what are features of necrotising enterocolitis
feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis.
244
How do you manage umbilical hernia
Usually self-resolve, but if large (>1.5cm) or symptomatic perform elective repair at 2-3 years of age. If small and asymptomatic perform elective repair at 4-5 years of age.
245
How do you look at scarring for vesicoureteric reflux
DMSA scan
246
What murmur is linked to turners
ejection systolic
247
What are features of croup
cough barking, seal-like worse at night stridor remember, the throat should be not examined due to the risk of precipitating airway obstruction fever coryzal symptoms increased work of breathing e.g. retraction
248
When is bowed legs in a child normal
<3 years
249
what are features of meckels diverticulum
abdominal pain mimicking appendicitis rectal bleeding Meckel's diverticulum is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years intestinal obstruction secondary to an omphalomesenteric band (most commonly), volvulus and intussusception
250
What emergency teratment is there for croup
high-flow oxygen nebulised adrenaline
251
What is the triad of shaken baby syndrome
Retinal haemorrhages, subdural haematoma and encephalopathy
252
What can cause a false positive sweat test
malnutrition adrenal insufficiency glycogen storage diseases nephrogenic diabetes insipidus hypothyroidism, hypoparathyroidism G6PD ectodermal dysplasia
253
outline newborn resuscitation
1. Dry baby and maintain temperature 2. Assess tone, respiratory rate, heart rate 3. If gasping or not breathing give 5 inflation breaths* 4. Reassess (chest movements) 5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
254
how do you manage croup
single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
255
What is acute epiglottis caused by
Haemophilus influenzae type B
256
How do you manage threadworms
hygiene measures for everyone in house single dose mebendazole is used first-line for children > 6 months old and to household
257
What are features of a brachial cyst
Six branchial arches separated by branchial clefts Incomplete obliteration of the branchial apparatus may result in cysts, sinuses or fistulae 75% of branchial cysts originate from the second branchial cleft Usually located anterior to the sternocleidomastoid near the angle of the mandible Unless infected the fluid of the cyst has a similar consistency to water and is anechoic on USS
258
What are features of sexual abuse
pregnancy sexually transmitted infections, recurrent UTIs sexually precocious behaviour anal fissure, bruising reflex anal dilatation enuresis and encopresis behavioural problems, self-harm recurrent symptoms e.g. headaches, abdominal pain
259
What do you do if a hernia incarcerates
it should be manually reduced with pressure and surgically repaired within 24 hours. If it can't be reduced, an emergency operation is required. His hernia has not incarcerated and hence does not require an emergency operation.
260
What is the difference between Cows milk protein intolerance and allergy
Both immediate (IgE mediated) and delayed (non-IgE mediated) reactions are seen. The term CMPA is usually used for immediate reactions and CMPI for mild-moderate delayed reactions.
261
What genetic condition is associated with intussusception
downs
262
What anatomical changes do you see in TGA
aorta leaves the right ventricle pulmonary trunk leaves the left ventricle
263
What are features of spastic CP
subtypes include hemiplegia, diplegia or quadriplegia increased tone resulting from damage to upper motor neurons in periventricular white matter hypertonia resulting in muscular stiffness
264
What is the main complication of scarlet fever
otitis media can cause invasive features eg bacteraemia or necrotising fasciitis
265
What are the 3 types of cerebral palsy
Spastic 70% Dyskinetic Ataxic Mixed
266
What is management of neonatal sepsis
IV benzylpenicillin + gentamicin
267
What are symptoms of hypernatraemia due to dehydration
jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma
268
What is CPAP used in
sleep apnoea
269
What conditions are associated with hypospadias
cryptorchidism inguinal hernia
270
How do you manage undescended testes + what is the name of the procedure
unilateral - refer at 3 months, ideally have a surgeon by 6 months Orchidopexy bilateral - urgent review within 24 hours
271
How does perthes usually present
Hip pain (may be referred to the knee) usually occurring between 5 and 12 years of age. Bilateral disease in 20%.
272
What do you see on xray with NRDS
diffuse ground glass lungs with low volumes and a bell-shaped thorax indistinct heart border
273
What do you see on xray of acute epiglottis
a lateral view in acute epiglottis will show swelling of the epiglottis - the 'thumb sign' in contrast, a posterior-anterior view in croup will show subglottic narrowing, commonly called the 'steeple sign'
274
What is benign rolandic epilepsy
occurs between 4-12 seizures characteristically occur at night seizures are typically partial (e.g. paraesthesia affecting the face) but secondary generalisation may occur (i.e. parents may only report tonic-clonic movements) the child is otherwise normal
275
What hearing tests are done for kids and when
Newborn - otoacoustic emission test -> auditory brainstem response if abnormal 6-9 months - distraction test 18months-2.5years - recognition of familiar objects >2.5 years - perforamnce test and speech discrimination tests >3 years - Pure tone audiometry - done at school
276
What causes Hand foot and mouth disease
Coxsackie A16 virus or enterovirus 71
277
What are causes of obesity in children
growth hormone deficiency hypothyroidism Down's syndrome Cushing's syndrome Prader-Willi syndrome
278
What is diagnostic criteria for whooping cough
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.
279
What are features of roseola infantum and what complication is there
high fever: lasting a few days, followed later by a maculopapular rash Nagayama spots: papular enanthem on the uvula and soft palate febrile convulsions occur in around 10-15% diarrhoea and cough are also commonly seen
280
What are features of fragile x
learning difficulties large low set ears, long thin face, high arched palate macroorchidism hypotonia autism is more common mitral valve prolapse
281
What type of vaccine is the rotavirus
oral live attenuated vaccine
282
What significant complication is associated with kawasaki disease
coronary artery aneurysms do echo
283
Do you need exclusion for slapped cheek
no
284
What is the most common cause of pneumonia in children
strep pne
285
What are features of retinoblastoma + what is mode of inheritance
autosomal dominant most common ocular malignancy in children absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom strabismus visual problems
286
What is the most common cyanotic congenital heart disease
TOF, but TGA is more common at birth
287
How does SUFE present
Typically seen in obese male adolescents. Pain is often referred to the knee. Limitation to internal rotation is usually seen. Knee pain is usually present 2 months prior to hip slipping. Bilateral in 20%.
288
What types of febrile convulsion can you get and what are features
289
What shoudl you do with someone <6months with atypical UTI
ultrasound
290
features of neonatal hypoglycaemia
autonomic (hypoglycaemia → changes in neural sympathetic discharge) 'jitteriness' irritable tachypnoea pallor neuroglycopenic poor feeding/sucking weak cry drowsy hypotonia seizures other features may include apnoea hypothermia
291
What are features of Hand, Foot and Mouth disease
Caused by the coxsackie A16 virus Mild systemic upset: sore throat, fever Vesicles in the mouth and on the palms and soles of the feet
292
What are features of foetal alcohol syndrome
Baby may show symptoms of alcohol withdrawal at birth e.g. irritable, hypotonic, tremors Features short ­palpebral fissure thin vermillion border/hypoplastic upper lip smooth/absent filtrum learning difficulties microcephaly growth retardation epicanthic folds cardiac malformations
293
How do you manage biliary atresia
Surgical intervention is the only definitive treatment for biliary atresia: Intervention may include dissection of the abnormalities into distinct ducts and anastomosis creation Medical intervention includes antibiotic coverage and bile acid enhancers following surgery
294
How do you diagnose perthes
x ray
295
how do you manage acute asthma
Bronchodilator therapy give a beta-2 agonist via a spacer (for a child < 3 years use a close-fitting mask) give 1 puff every 30-60 seconds up to a maximum of 10 puffs if symptoms are not controlled repeat beta-2 agonist and refer to hospital Steroid therapy should be given to all children with an asthma exacerbation treatment should be given for 3-5 days
296
Ejection systolic murmur in the upper left sternal border
pulmonary stenosis
297
How do you manage GORD
advice - positioning (30 degrees up), dont overfeed, sleep on back trial of thickened formula (if bottle fed) trial of alginate therapy eg gaviscon (dont use at same time as thickened formula)
298
What are features of chickenpox
Fever initially Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular Systemic upset is usually mild
299
Why do you not give aspirin to children
Reye syndrome
300
Do you need exclusion for infectious mononucleosis
no
301
What investigation results do you see with biliary atresia
Total bilirubin may be normal, whereas conjugated bilirubin is abnormally high
302
what determines the degree of cyanosis and severity in TOF
The severity of the right ventricular outflow tract obstruction
303
What are features of dermoid cysts
Derived from pleuripotent stem cells and are located in the midline Most commonly in a suprahyoid location They have heterogeneous appearances on imaging and contain variable amounts of calcium and fat
304
What is the most common cause of hypothyroidism in kids
autoimmune thyroiditis
305
Do you need exclusion for rubella
5 days after rash
306
What are features of a thyroglossal cyst
Located in the anterior triangle, usually in the midline and below the hyoid (65% cases) Derived from remnants of the thyroglossal duct Thin walled and anechoic on USS (echogenicity suggests infection of cyst)
307
What is hypospadias
a ventral urethral meatus a hooded prepuce chordee (ventral curvature of the penis) in more severe forms the urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.
308
How do you treat biliary atresia
Kasai procedure
309
What are features of CMPI/A
regurgitation and vomiting diarrhoea urticaria, atopic eczema 'colic' symptoms: irritability, crying wheeze, chronic cough rarely angioedema and anaphylaxis may occur
310
What are features of McCune-Albright syndrome
somatic mutation in the GNAS gene. Features precocious puberty cafe-au-lait spots polyostotic fibrous dysplasia short stature
311
how do you investigate hirschsprungs
rectal biopsy
312
Do you need exclusion for mumps
5 days after onset of swollen glands
313
How do you manage kawasaki
high dose aspirin IV IG echo
314
What are features of PDA
left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat
315
What are features of prader willi syndrome
Hypotonia Hypogonadism Obesity
316
What are features of chondromalacia patellae
Softening of the cartilage of the patella Common in teenage girls Characteristically anterior knee pain on walking up and down stairs and rising from prolonged sitting Usually responds to physiotherapy
317
What is patent ductus arteriosus
connection between the pulmonary trunk and descending aorta usually, the ductus arteriosus closes with the first breaths due to increased pulmonary flow which enhances prostaglandins clearance more common in premature babies, born at high altitude or maternal rubella infection in the first trimester
318
What investigation do you do for intussusception
ultrasound
319
What are risk factors for sudden infant death syndrome
prone sleeping parental smoking bed sharing hyperthermia and head covering prematurity
320
How does DDH present
Usually diagnosed in infancy by screening tests. May be bilateral, when disease is unilateral there may be leg length inequality. As disease progresses child may limp and then early onset arthritis. More common in extended breech babies.
321
What are features of Ataxic CP
caused by damage to the cerebellum with typical cerebellar signs poor coordination and balance
322
Do you need exclusion for measles
4 days after rash
323
What do you see in congenital CMV
Low birth weight Purpuric skin lesions Sensorineural deafness Microcephaly Visual impairment Learning disability Encephalitis/seizures Pneumonitis Hepatosplenomegaly Anaemia Jaundice Cerebral palsy
324
What do you see in conegnital toxoplasmosis
Cerebral calcification Chorioretinitis Hydrocephalus Anaemia Hepatosplenomegaly Cerebral palsy
325
Is there exclusion for scarlet fever
return 24 hours after starting antibiotics
326
When does TOF present
1-2 months but sometimes not picked up till 6 months