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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
Q

What is Kochers criteria used for and what is the criteria

A

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

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26
Q

What is the main difference between cephalohaematoma and caput succedaneum

A

C S crosses suture lines

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27
Q

What causes roseola infantum

A

human herpes virus 6

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28
Q

What do you see on muscle biopsy of mitochondrial diseases

A

red ragged fibres

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29
Q

How do you screen for DDH

A

breech presentation or multiple pregnancy - ultrasound - 6 weeks
newborn check and 6 week check - barlow and ortolani test
if >4.5months do xray

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30
Q

What is a contraindication for lung transplant in CF

A

chronic infection with Burkholderia cepacia is an important CF-specific contraindication to lung transplantation

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31
Q

What is asthma management for 5-16 year olds

A

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

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32
Q

What is precocious puberty defined as

A

‘development of secondary sexual characteristics before 8 years in females and 9 years in males’

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33
Q

How do you manage nocturnal enuresis

A

look for causes eg constipation, DM, UTI
general advice eg fluid
Reward system
enuresis alarm (first line)
desmopressin - short term beenfit too

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34
Q

What is the main risk factor for transient tachypnoea of the newborn

A

C section

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35
Q

Is whooping cough a notifiable disease

A

yes

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36
Q

How do you manage PDA

A

indomethacin

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37
Q

What are 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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38
Q

what do you see on xray for NE? what is signs do you see?

A

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)

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39
Q

What is a cephalohaematoma

A

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

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40
Q

What are features of Turners + what is the most common renal abnormality

A

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

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41
Q

What are features of androgen insensitivity syndrome

A

‘primary amenorrhoea’
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol

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42
Q

what complications are there for downs

A

subfertility
short stature
repeated respiratory infections (+hearing impairment from glue ear)
acute lymphoblastic leukaemia
hypothyroidism
Alzheimer’s disease
atlantoaxial instability

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43
Q

What are the causes of acyanotic congenital heart disease

A

ventricular septal defects (VSD) - most common, accounts for 30%
atrial septal defect (ASD)
patent ductus arteriosus (PDA)
coarctation of the aorta
aortic valve stenosis

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44
Q

What should you not do in acute epiglottis

A

Do not examine the throat

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45
Q

What are risk factors for DDH

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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46
Q

What are features of pierre-robin syndrome

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

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47
Q

What are features of intestinal malrotation + how do you diagnose and treat

A

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)

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48
Q

What causes threadworms

A

Enterobius vermicularis

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49
Q

What is gastroschisis

A

Gastroschisis describes a congenital defect in the anterior abdominal wall just lateral to the umbilical cord

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50
Q

What is pulmonary hypoplasia and what causes it

A

Pulmonary hypoplasia is a term used for newborn infants with underdeveloped lungs

Causes include
oligohydramnios
congenital diaphragmatic hernia

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51
Q

What would you do if you had ITP with lymphadenopathy

A

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

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52
Q

What cardiac problems are seen in downs

A

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%)

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53
Q

What are features of chickenpox

A

fever initially
itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
systemic upset is usually mild

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54
Q

What genetic pattern is seen in prader willi

A

imprinting

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55
Q

What would hemiplegic CP look like

A

involve one side of the patient’s body

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56
Q

do you need to exclude for hand foot and mouth disease

A

No

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57
Q

What is laryngomalacia

A

Congenital abnormality of the larynx.

Infants typical present at 4 weeks of age with:
stridor

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58
Q

What is whooping cough caused by

A

Bordetella pertussis

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59
Q

What are features of impetigo

A

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

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60
Q

How do you treat pneumonia in a child

A

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

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61
Q

What is the main cause of gastroenteritis in children

A

rotavirus

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62
Q

what are complications of whooping cough

A

subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures

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63
Q

What is group b strep specifically known as

A

Streptococcus agalactiae

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64
Q

what are features of duchenne muscular dystrophy + what sign is shown + what mode of inheritance

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

X linked recessive

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65
Q

What is management of SUFE

A

internal fixation across the growth plate

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66
Q

What features do you see in achondroplasia

A

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

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67
Q

What are high risk features sepsis

A

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
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68
Q

Is there exclusion for roseola infantum

A

No

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69
Q

What does VSD increase the risk of

A

endocarditis

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70
Q

What are features of Osgood-Schlatter disease (tibial apophysitis)

A

Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle

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71
Q

How do you manage whooping cough

A

<6months - admit
Notifiable disease
oral macrolide if onset of cough is in last 21 days
prophylaxis for household members

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72
Q

What needs to be monitored with methylphenidate usage

A

monitor ECG before starting - drugs are cardiotoxic
weight and height every 6 months

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73
Q

How do you work out apgar scores

A
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74
Q

When in the year is croup more common

A

autumn

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75
Q

how do you treat headlice

A

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

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76
Q

Whata re features of oesophageal atresia

A

Associated with tracheo-oesophageal fistula and polyhydramnios
May present with choking and cyanotic spells following aspiration
VACTERL associations

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77
Q

What are features of rickets

A

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

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78
Q

What LH and testosterone do you see in Klinefelters, Kallmans, androgen insensitivity syndrome and a testerone secreting tumour

A
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79
Q

What is meant by genetic anticipation

A

earlier onset in successive generations

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80
Q

Where does bile enter the GI tract (and therefore when bilious vomiting occurs)

A

second part of duodenum

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81
Q

What are features of measles

A

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

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82
Q

management of neonatal hypoglycaemia

A

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

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83
Q

What are features of Mumps

A

Fever, malaise, muscular pain
Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

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84
Q

Asthma management in kid <5 years

A

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

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85
Q

if neonatal hypoglycaemia is <1mmol what do you do

A

IV 10% dextrose

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86
Q

what is ophthalmia neonatum

A

infection of the eye
usually conjunctivitis - discharge

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87
Q

What are characteristics of an innocent murmur

A

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

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88
Q

what do you see on xray with TTN

A

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.

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89
Q

What are the causes of precocious puberty in males

A

Testes
bilateral enlargement = gonadotrophin release from intracranial lesion
unilateral enlargement = gonadal tumour
small testes = adrenal cause (tumour or adrenal hyperplasia)

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90
Q

How do you manage eczema

A

avoid irritants
simple emolients
topical steroids
wet wrapping
oral ciclosporin in severe cases

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91
Q

What are 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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92
Q

What are features of Scarlet Fever + what causes it

A

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)

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93
Q

What do you do with acute epiglottis when medical therapy is not enough

A

endotracheal intubation

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94
Q

How do you investigate meckels diverticulum

A

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

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95
Q

How do you treat NE

A

laporotomy

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96
Q

investigation for NE

A

abdominal xray

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97
Q

What is Meckels diverticulum

A

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.

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98
Q

What is management for constipation

A

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

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99
Q

What do you see on EEG in benign rolandic epilepsy

A

centrotemporal strikes

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100
Q

What are the differences between early (compensated) shock and late (decompensated) shock

A
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101
Q

What is the cause of croup

A

parainfluenza virus

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102
Q

What age does bronchiolitis typically impact

A

<1-2 year

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103
Q

what staging system is used for perthes

A

Catterall staging

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104
Q

What causes homocystinuria

A

deficiency of cystathionine beta synthase

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105
Q

What signs are there for biliary atresia

A

Jaundice
Hepatomegaly with splenomegaly
Abnormal growth
Cardiac murmurs if associated cardiac abnormalities present

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106
Q

how is pyloric stenosis managed

A

Ramstedt pyloromyotomy.

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107
Q

What is the criteria for an immediate CT if a child has hit their head

A

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)

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108
Q

How do you investigate \hirschprungs

A

rectal biopsy

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109
Q

What are features of Rubella

A

Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

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110
Q

What are features of Dyskinetic CP

A

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

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111
Q

What classes severity of alpha thalassemia and what are typical findings

A

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)

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112
Q

What are features of osteochondritis dissecans

A

Pain after exercise
Intermittent swelling and locking

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113
Q

What are features of Patellar tendonitis

A

More common in athletic teenage boys
Chronic anterior knee pain that worsens after running
Tender below the patella on examination

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114
Q

What are features of hand foot and mouth disease

A

mild systemic upset: sore throat, fever
oral ulcers
followed later by vesicles on the palms and soles of the feet

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115
Q

What causes impetigo

A

staph/strep

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116
Q

How is pyloric stenosis diagnosed

A

ultrasound

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117
Q

Which disorders show genetic anticipation

A

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

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118
Q

What chromosome trisomies are linked to congenital disorders eg downs

A

patau 13
edwards 18
downs 21

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119
Q

What are features of reflex anoxic seizures

A

child goes very pale
falls to floor
secondary anoxic seizures are common
rapid recovery

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120
Q

How do you grade VUR

A
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121
Q

How do you manage perthes

A

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

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122
Q
A
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123
Q

How do you manage meckels diverticulum

A

Management
removal if narrow neck or symptomatic
options are between wedge excision or formal small bowel resection and anastomosis

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124
Q

What are features of JIA

A

joint pain and swelling: usually medium sized joints e.g. knees, ankles, elbows
limp
ANA may be positive in JIA - associated with anterior uveitis

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125
Q

What are features of edwards syndrome

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

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126
Q

What is headlice caused by

A

Pediculus capitis

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127
Q

What is Vesicoureteric reflux

A

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)

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128
Q

What is the barlow and ortolani test

A

Barlow test: attempts to dislocate an articulated femoral head
Ortolani test: attempts to relocate a dislocated femoral head

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129
Q

How do threadworms manifest

A

perianal itching, particularly at night
girls may have vulval symptoms

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130
Q

How do you manage ophthalmia neonatum

A

refer same day

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131
Q

What are features of TGA + what sign + what heart sound

A

cyanosis
tachypnoea
loud single S2
prominent right ventricular impulse
‘egg-on-side’ appearance on chest x-ray

132
Q

When are you infectious with chickenpox

A

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
Q

what are features of ITP

A

bruising
petechial or purpuric rash
bleeding is less common and typically presents as epistaxis or gingival bleeding

134
Q

What are features of whooping cough

A

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
Q

What are risk factors for neonatal sepsis

A

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
Q

What are the most common fractures associated with child abuse

A
  • Radial
  • Humeral
  • Femoral
137
Q

What causes ophthalmia neonatum

A

chlamydia
gonorrhoea

138
Q

What are features of fragile x

A

Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism

139
Q

What is ebsteins anomaly + what features + heart defects

A

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
Q

What are features of intussusception

A

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
Q

What can you give to help with recurrent febrile convulsions

A

rectal diazepam or buccal midazolam

142
Q

How do you investigate duchennes

A

raised creatinine kinase
genetic testing has now replaced muscle biopsy as the way to obtain a definitive diagnosis

143
Q

What time intervals do you measure apgar score

A

1,5 minutes,
if low, repeat every 10

144
Q

What is infantile colic

A

Excessive crying and pulling up of legs, often worse in evenings
Reassurance and support
<3 months old

145
Q

What are features of lymphatic malformations

A

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
Q

When should a PPI be used in GORD

A

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
Q

What investigations do you do for infantile spasms + what do you see

A

the EEG shows hypsarrhythmia in two-thirds of infants
CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)

148
Q

limp <3 years old

A

admit

149
Q

When does immune thrombocytopenia present

A

after infection/vaccine

150
Q

how do you manage ddh

A

pavlik harness if <4/5 months

151
Q

What mode of inheritance is achondroplasia + what is mutation

A

autosomal dominant
mutation in FGFR-3 gene

152
Q

What are life threatening features of asthma attack

A

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

153
Q

What would monoplegic CP look like

A

impacts a single limb

154
Q

Diastolic machinery murmur in the upper left sternal border

A

PDA

155
Q

How do you manage NRDS

A

prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
oxygen
assisted ventilation
exogenous surfactant given via endotracheal tube

156
Q

What causes Scarlet Fever

A

Group A haemolytic streptococci

157
Q

What are features of a wilms tumour

A

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
Q

How do you manage meningitis

A

< 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime
> 3 months: IV cefotaxime (or ceftriaxone)

159
Q

What is plagiocephaly

A

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
Q

When is heel prick test done

A

5-9 days

161
Q

What are features of Erythema infectiosum (Slapped cheek syndrome) + what causes it

A

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
Q

Crescendo-decrescendo murmur in the upper left sternal border

A

coarctation of the aorta

163
Q

At what age do you typically get intussusception

A

6-18 months

164
Q

Where does atopic eczema typically effect infants

A

nappy area and trunk

165
Q

what is the first sign of puberty in women

A

breast development

166
Q

How do you manage CMPI/A

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
Q

When does infantile colic typically stop

A

6 months

168
Q

What are causes of jaundice in first 24 hours

A

PATHOLOGICAL
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

169
Q

What are features of noonan syndrome

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

170
Q

Where are the alpha globulin genes in alpha thalaessemia found

A

ch16

171
Q

What is perthes disease

A

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
Q

What are cardiac defects associated with Turners syndrome

A

Bicuspid aortic valve (most common)
Aortic root dilatation
Coarctation of the aorta

173
Q

What are features of patella subluxation

A

Medial knee pain due to lateral subluxation of the patella
Knee may give way

174
Q

What do you see on imaging of intussusception

A

abdominal film xray - sausage shaped mass
ultrasound - target sign

175
Q

What are features of Cri du chat syndrome (chromosome 5p deletion syndrome)

A

Characteristic cry (hence the name) due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism

176
Q

in peads bls, what ratio of compressions do you do

A

15:2 if there are 2 people, one LAY person - 30:2

177
Q

What do you see on xray for croup

A

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
Q

what is a venous hum

A

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
Q

What are complications of undescended testes

A

infertility
torsion
testicular cancer
psychological

180
Q

what is a reflex anoxic seizure

A

a syncopal episode (or presyncope) that occurs in response to pain or emotional stimuli

181
Q

What causes Erythema infectiosum

A

Parvovirus B19

182
Q

What are features of prader willi

A

hypotonia during infancy
dysmorphic features
short stature
hypogonadism and infertility
learning difficulties
childhood obesity
behavioural problems in adolescence

willi - willy - floppy

183
Q

When should you admit for croup

A

<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
Q

What are complications of measles

A

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
Q

how does biliary atresia present

A

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
Q

What is management of chickenpox

A

calamine lotion
school exclusion: NICE Clinical Knowledge

187
Q

How do you manage acute epiglottis

A

Senior involvement - emergency
Intubate if necessary
oxygen if needed
IV ABx

188
Q

Typical paediatric vitals (HR and RR)

A
189
Q

What should you do if a neonate presents with jaundice

A

measure serum bilirubin urgently

190
Q

How is JIA defined

A

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
Q

What is a common deficiency in newborns

A

vit k
can lead to haemorrhagic disease
antiepileptics increases risk
offer vit k orally or IM

192
Q

What incerases risk of having a child with TGA

A

diabetets

193
Q

How do you diagnose CF

A

immue reactive trypsinogen
sweat testW

194
Q

What is the first sign of puberty in males

A

testicular growth

195
Q

What is the difference of timing between NRDS and TTN

A

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
Q

What is the main riks factor for neonatal respiratory distress syndrome

A

prematurity

197
Q

What are features of Measles

A

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
Q

What are features of infantile haemangioma

A

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
Q

How do you diagnose vesicoureteric reflux

A

micturating cystourethrogram

200
Q

What are the features of TOF + what murmur + what on xray

A

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
Q

what is a stills murmur

A

Low-pitched sound heard at the lower left sternal edge

202
Q

What are features of febrile convulsion

A

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
Q

How do you manage impetigo

A

hydrogen peroxide cream 1%

204
Q

what can chickenpox + group A strep result in

A

necrotizing fasciitis

205
Q

What are features of patau syndrome

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

206
Q

How is acute epiglottis diagnosed

A

Diagnosis is made by direct visualisation (only by senior/airway trained staff, see below). However, x-rays may be done

207
Q

What are features of williams syndrome + what heart condition

A

short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
elfin facies

208
Q

What are contraindications to LP in suspected meningitis

A

focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation

209
Q

what is the most common cause of ambiguous genitalia

A

congenital adrenal hyperplasia

210
Q

How do you manage scarlet fever

A

oral penicillin V (phenoxymethylpenicillin) 10 days
azithromycin if allergy

211
Q

What are causes of prolonged jaundice

A

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

212
Q

When do you offer the whooping cough vaccine in pregnancy

A

16-32 weeks

213
Q

What are features of infantile spasms

A

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
Q

risk factors for neonatal hypoglycaemia

A

preterm birth (< 37 weeks)
maternal diabetes mellitus
IUGR
hypothermia
neonatal sepsis
inborn errors of metabolism
nesidioblastosis
Beckwith-Wiedemann syndrome

215
Q

How do you treat intestnal malrotation

A

Ladds procedure

216
Q

When are will children with non-IgE mediated intolerance become tolerant

A

3 years

217
Q

How are immunisations and developmental stages affected by prematurity

A

dont adjust immunisations
adjust developmental - add difference from week 40

218
Q

What is mesenteric adenitis

A

similar presntation to appendicitis but follows after infection

219
Q

What classes as neonatal hypoglycaemia

A

<2.6

220
Q

What are features of perthes disease

A

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
Q

Is there exclusion for whooping cough

A

school exclusion: 48 hours after commencing antibiotics (or 21 days from onset of symptoms if no antibiotics )

222
Q

How do you manage a wilms tumour

A

nephrectomy
chemotherapy
radiotherapy if advanced disease

223
Q

do you need exclusion for influenza

A

until recovered

224
Q

how do you manage intussuscpetion

A

reduction by air insufflation
if this fails, or signs of peritonitis -> surgery

225
Q

What are features of GORD

A

typically develops before 8 weeks
vomiting/regurgitation
milky vomits after feeds
may occur after being laid flat
excessive crying, especially while feeding

226
Q

hypoglycaemia seen hours after birth

A

Transient hypoglycaemia in the first hours after birth is common.

227
Q

What does maternal antiepleptic use increase chances of

A

orofacial defects eg cleft palate

228
Q

How do you manage gastroschisis

A

vaginal delivery may be attempted
newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours

229
Q

What are the criteria of severity for croup

A
230
Q

How do you diagnose headlice

A

fine-toothed combing of wet or dry hair

231
Q

When do febrile convulsions occur

A

6months-3years

232
Q

What increases the chances of secondary bacterial infection with chickenpox

A

nsaids

233
Q

What are features of eczema

A

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
Q

ejection systolic murmur and fixed splitting of the second heart sound

A

ASD

235
Q

What are features of klinefelters

A

often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels

236
Q

What are the types of biliary atresia

A

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
Q

Do you need exclusion for impetigo

A

Until lesions are crusted and healed, or 48 hours
after commencing antibiotic treatment

238
Q

How do you manage CF + what drugs

A

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
Q

What are features of Kawasaki disease

A

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
Q

When would you consider pneumonia in a bronchiolitis picture

A

fever >39
persistently focal crackles

241
Q

What are features of pyloric stenosis

A

‘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
Q

management for hirschprungs

A

rectal washouts/bowel irrigation initially
surgery to affected segment of colon

243
Q

what are features of necrotising enterocolitis

A

feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis.

244
Q

How do you manage umbilical hernia

A

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
Q

How do you look at scarring for vesicoureteric reflux

A

DMSA scan

246
Q

What murmur is linked to turners

A

ejection systolic

247
Q

What are features of croup

A

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
Q

When is bowed legs in a child normal

A

<3 years

249
Q

what are features of meckels diverticulum

A

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
Q

What emergency teratment is there for croup

A

high-flow oxygen
nebulised adrenaline

251
Q

What is the triad of shaken baby syndrome

A

Retinal haemorrhages, subdural haematoma and encephalopathy

252
Q

What can cause a false positive sweat test

A

malnutrition
adrenal insufficiency
glycogen storage diseases
nephrogenic diabetes insipidus
hypothyroidism, hypoparathyroidism
G6PD
ectodermal dysplasia

253
Q

outline newborn resuscitation

A
  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
Q

how do you manage croup

A

single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity

255
Q

What is acute epiglottis caused by

A

Haemophilus influenzae type B

256
Q

How do you manage threadworms

A

hygiene measures for everyone in house
single dose mebendazole is used first-line for children > 6 months old and to household

257
Q

What are features of a brachial cyst

A

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
Q

What are features of sexual abuse

A

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
Q

What do you do if a hernia incarcerates

A

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
Q

What is the difference between Cows milk protein intolerance and allergy

A

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
Q

What genetic condition is associated with intussusception

A

downs

262
Q

What anatomical changes do you see in TGA

A

aorta leaves the right ventricle
pulmonary trunk leaves the left ventricle

263
Q

What are features of spastic CP

A

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
Q

What is the main complication of scarlet fever

A

otitis media

can cause invasive features eg bacteraemia or necrotising fasciitis

265
Q

What are the 3 types of cerebral palsy

A

Spastic 70%
Dyskinetic
Ataxic
Mixed

266
Q

What is management of neonatal sepsis

A

IV benzylpenicillin + gentamicin

267
Q

What are symptoms of hypernatraemia due to dehydration

A

jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma

268
Q

What is CPAP used in

A

sleep apnoea

269
Q

What conditions are associated with hypospadias

A

cryptorchidism
inguinal hernia

270
Q

How do you manage undescended testes + what is the name of the procedure

A

unilateral - refer at 3 months, ideally have a surgeon by 6 months Orchidopexy
bilateral - urgent review within 24 hours

271
Q

How does perthes usually present

A

Hip pain (may be referred to the knee) usually occurring between 5 and 12 years of age. Bilateral disease in 20%.

272
Q

What do you see on xray with NRDS

A

diffuse ground glass lungs with low volumes and a bell-shaped thorax
indistinct heart border

273
Q

What do you see on xray of acute epiglottis

A

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
Q

What is benign rolandic epilepsy

A

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
Q

What hearing tests are done for kids and when

A

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
Q

What causes Hand foot and mouth disease

A

Coxsackie A16 virus
or enterovirus 71

277
Q

What are causes of obesity in children

A

growth hormone deficiency
hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prader-Willi syndrome

278
Q

What is diagnostic criteria for whooping cough

A

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
Q

What are features of roseola infantum and what complication is there

A

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
Q

What are features of fragile x

A

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

281
Q

What type of vaccine is the rotavirus

A

oral live attenuated vaccine

282
Q

What significant complication is associated with kawasaki disease

A

coronary artery aneurysms
do echo

283
Q

Do you need exclusion for slapped cheek

A

no

284
Q

What is the most common cause of pneumonia in children

A

strep pne

285
Q

What are features of retinoblastoma + what is mode of inheritance

A

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
Q

What is the most common cyanotic congenital heart disease

A

TOF, but TGA is more common at birth

287
Q

How does SUFE present

A

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
Q

What types of febrile convulsion can you get and what are features

A
289
Q

What shoudl you do with someone <6months with atypical UTI

A

ultrasound

290
Q

features of neonatal hypoglycaemia

A

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
Q

What are features of Hand, Foot and Mouth disease

A

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
Q

What are features of foetal alcohol syndrome

A

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
Q

How do you manage biliary atresia

A

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
Q

How do you diagnose perthes

A

x ray

295
Q

how do you manage acute asthma

A

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
Q

Ejection systolic murmur in the upper left sternal border

A

pulmonary stenosis

297
Q

How do you manage GORD

A

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
Q

What are features of chickenpox

A

Fever initially
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild

299
Q

Why do you not give aspirin to children

A

Reye syndrome

300
Q

Do you need exclusion for infectious mononucleosis

A

no

301
Q

What investigation results do you see with biliary atresia

A

Total bilirubin may be normal, whereas conjugated bilirubin is abnormally high

302
Q

what determines the degree of cyanosis and severity in TOF

A

The severity of the right ventricular outflow tract obstruction

303
Q

What are features of dermoid cysts

A

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
Q

What is the most common cause of hypothyroidism in kids

A

autoimmune thyroiditis

305
Q

Do you need exclusion for rubella

A

5 days after rash

306
Q

What are features of a thyroglossal cyst

A

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
Q

What is hypospadias

A

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
Q

How do you treat biliary atresia

A

Kasai procedure

309
Q

What are features of CMPI/A

A

regurgitation and vomiting
diarrhoea
urticaria, atopic eczema
‘colic’ symptoms: irritability, crying
wheeze, chronic cough
rarely angioedema and anaphylaxis may occur

310
Q

What are features of McCune-Albright syndrome

A

somatic mutation in the GNAS gene.

Features
precocious puberty
cafe-au-lait spots
polyostotic fibrous dysplasia
short stature

311
Q

how do you investigate hirschsprungs

A

rectal biopsy

312
Q

Do you need exclusion for mumps

A

5 days after onset of swollen glands

313
Q

How do you manage kawasaki

A

high dose aspirin
IV IG
echo

314
Q

What are features of PDA

A

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

315
Q

What are features of prader willi syndrome

A

Hypotonia
Hypogonadism
Obesity

316
Q

What are features of chondromalacia patellae

A

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
Q

What is patent ductus arteriosus

A

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
Q

What investigation do you do for intussusception

A

ultrasound

319
Q

What are risk factors for sudden infant death syndrome

A

prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity

320
Q

How does DDH present

A

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
Q

What are features of Ataxic CP

A

caused by damage to the cerebellum with typical cerebellar signs
poor coordination and balance

322
Q

Do you need exclusion for measles

A

4 days after rash

323
Q

What do you see in congenital CMV

A

Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly

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

324
Q

What do you see in conegnital toxoplasmosis

A

Cerebral calcification
Chorioretinitis
Hydrocephalus

Anaemia
Hepatosplenomegaly
Cerebral palsy

325
Q

Is there exclusion for scarlet fever

A

return 24 hours after starting antibiotics

326
Q

When does TOF present

A

1-2 months but sometimes not picked up till 6 months

Paeds (2 decks)

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