Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3a > Paeds > Flashcards

Paeds Flashcards

1
Q

What does the placenta provide for the fetus in the blood?

A

Oxygen and nutrients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is disposed of via the placenta (fetal->mother)

A

C02, lactate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 3 fetal shunts?

A

Ductus Venosus
Ductus Arteriosus
Foramen Ovale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What 2 structures are connected by Ductus Venosus and what does it enable in fetal supply?

A

Umbilical vein - IVC

Enables blood to bypass the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What structures are connected by ductus arteriosus and what does this enable in fetal supply?

A

Pulmonary artery with aorta

Enables bypass of pulmonary circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what structures are connected by the foramen ovale and what does this enable in fetal supply?

A

R to L atria

Enables the bypass of the pulmonary circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the first breath lead to after birth re the foramen ovale?

A

expands the alveoli, decreases pulmonary vascular resistance>fall in pressure in RA > squash atrial septum - closure of Foramen Ovale.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does the foramen ovale become after shutting

A

Fossa ovalis

After a few weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What causes the closure of the Ductus Arteriosus?

A

Increased blood oxygenation > drop in circulating prostaglandins > closure of DA -> ligamentum arteriosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes the ductus venosus to stop functioning?

A

after birth, umbilical cord clamped - no flow in umbilical veins > structurally closes > ligamentum venosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are innocent murmurs?

What are they caused by?

A

Flow murmurs

Caused by fast blood flow through the heart during systole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the features of innocent murmurs (S)?

A 
Soft
Short
Systolic
symptomless
situation dependent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which features of a murmur would prompt referral to paeds cardio?

A

murmur louder than 2/6
diastolic murmur
louder on standing
failure to thrive, feeding difficulty, cyanosis, SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Investigating murmur in children:

A

CXR
ECG
Echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is split second heart sound?

A

Inspiration>chest wall/diaphragm pull lungs + heart open > negative intra-thoracic pressure > RA fills faster pulling blood from venous system > RV takes longer to empty > delay in closure of pulmonary valve - split sound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Atrial septal defect murmur?

A

mid-systolic crescendo-decrescendo at upper L sternal border

Fixed split second heart sound (insp and exp)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Patent Ductus Arteriosus murmur?

A

If significant - normal HS 1 + continuous crescendo-decrescendo machinery murmur - obscuring HS2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tetralogy of Fallot murmur?

A

Pulmonary stenosis > ejection systolic murmur at pulmonary area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a Patent Ductus Arteriosus

A

DA fails to close after 2-3/52 life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What causes PDA?

A

Genetic or maternal infection - rubella

Prematurity = RF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Presentation PDA

A

Mostly asymptomatic in children, especially if small PDA

Can present as heart failure in young adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pathophysiology PDA

A

L>R shunt (acyanotic)
Pulmonary HTN
RV hypertrophy
LV hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When might a PDA be heard?

A

Newborn examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How will PDA be picked up?

A 
Murmur
SOB
difficulty feeding
poor weight gain 
LRTIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is PDA Dx?

A

Echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Mx PDA?

A

Monitored using echo <1yr
After 1yo, unlikely to spontaneously close
trans-catheter/surgical closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In which part of the atrial septum lies the foramen ovale?

A

Septum secondum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What happens in an atrial septum defect?

A

Shunt - LA>RA (pressure gradient) -> right sided overeload, RH strain
RHF
Pulmonary HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Following an ASD what can pulmonary HTN eventually lead to?

A

Eisenmenger syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is Eisenmenger syndrome?

A

Pulmonary P > systemic P
Shunt reversal - R->L shunt
Cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Types of ASD

A

Ostium secondum
Patent Foramen Ovale
Oostium Prinum (->AVSD - cyanosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Complications of ASD

A

stroke due to VTE
atrial fibrilation / atrial flutter
Pulmonary HTN
Eisenmenger syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does ASD affect common DVT?

A

Commonly with DVT, embolises>travels to R side of heart and causes PE
With ASD - embolises>RA then LA then brain - stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How do ASDs commonly present

A

Antenatal scan / newborn examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Presentation Atrial Septal Defect:

A

May be asymptomatic in childhood, present with dyspnoea/HF/stroke in adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Symptoms Atrial Septal Defect childhood:

A 
SOB
difficulty feeding
poor weight gain
LRTIs
acyanotic as L>R shunt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Mx of ASD

A

refer to paeds cardio
Asx -> watch and wait
Surgical closure - transvenous catheter closure
Open heart surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How to reduce the risk of cx of Atrial Septal Defects in adults

A

Anticoagulation - NOAC, aspirin, warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

which genetic conditions are VSDs commonly associated with ?

A

Down’s syndrome

Turner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What happens with VSD over time?

A

L>R shunting, right sided overload, RHF, Pulmonary hypertension
shunt reversal - Eisenmenger - cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How might VSD be picked up

A

Antenatal scan
newborn examination
may present in adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

VSD Symtpoms

A 
poor feeding
dyspnoea
tachypnoea
failure to thrive
acyanotic as L>R shunt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

VSD murmur?

A

Pan-systolic

systolic thrill on palpitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

causes of pan-systolic murmur?

A

Ventricular Septal Defect
Mitral regurgitation
Tricuspid regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Tx Ventricular Septal Defect?

A

Paeds cardio referral
Asx - w&w - spontaneous closure
Sx - transvenous catheter closure, open heart surgery
diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is there an increased risk of in Ventricular Septal Defect patients?

A

Infective endocarditis

Offer prophylactic Abx pre-surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When can Eisenmenger’s present?

A

1-2yo - large shunts
adulthood - small shunts
exacerbated by pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How does eisenmenger present?

A

Cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What does the cyanosis lead to in eisenmengers?

A

Bone marrow responds to low oxygen sats by producing more RBCs + Hb -> polycythaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What causes a plethoric complexion in eisenmenger’s?

A

Polycythaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Examination findings for eisenmenger’s?

A

RV heave
Loud HS2
Raised JVP
Peripheral oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Ex findings related to the chronic hypoxia of eisenmenger’s?

A

Cyanosis
Clubbing
Dyspnoea
Plethoric complexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Mx Eisenmenger

A

Correct underlying abnormality

Once the pulmonary P>systemic P, not possible to medically reverse - Heart and Lung transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Supportive tx eisenmengers?

A 
O2
Sildenafil - Pulm HTN
Venesection - polycythaemia 
Anticoagulation - thrombosis
prophylactic Abx - infective endocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is coarctation of aorta?

A

Congenital condition, narrowing of aortic arch around the ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What underlying condition is coarctation of aorta commonly associated with ?

A

Turner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

what is the effect on the arteries distal to the narrowing in coarctation of aorta?

A

reduced pressure to these arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Where will there be increased P in coarctation of aorta?

A

In the arteries proximal to the narrowing, commonly the heart and the first three branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Presentation of coarctation of aorta?

A

weak femoral pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Ix Coarctation of aorta:

A

4 limb BP - high P in limbs supplied from arteries before the narrowing (arms), reduced P in limbs supplied from arteries after the narrowing
Systolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Coarctation signs in infancy

A 
tachypnoea, increased wob
poor feeding
grey/floppy baby 
LV heave - (LV hypertrophy)
underdeveloped L arm, legs
acyanotic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Mx coarctation

A

most can live sx free until adulthood
severe cases - emergency surgery after birth
Sx - correct the narrowing, ligate the DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

While waiting for emergency surgery for coarctation correction, what tx can be given straight after birth?

A

Prostaglandin E - keeps DA open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How many leaflets make up the pulmonary valve normally?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

In pulmonary valve stenosis, what happens?

A

leaflets form abnormally -> fusion/thickening -> narrow opening between RA and pulmonary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Pulmonary valve stenosis presentation:

A

mostly asx
murmur - newborn exam
fatigue on exertion, SOB, dizziness, fainting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Signs Pulmonary valve stenosis:

A

Ejection systolic murmur - pulmonary area
palpable thrill - pulmonary area
RV heave - RV hypertrophy
JVP up - giant a waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Mx Pulmonary valve stenosis :

A

Paeds cardio
Asx - w&w
Sx - surgery - balloon valvuloplasty (via venous catheter)
Open heart surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Gold standard Ix Pulmonary valve stenosis:

A

Echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

pathologies coexisting in Tetralogy of Fallot:

A

VSD
Overriding Aorta
Pulmonary Valve stenosis
RV hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What does overriding aorta mean:

A

Aortic valve enterance is displaced further to the right than normal, above the VSD
When RV contracts, greater proportion deoxygenated blood enters aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What symptom do overriding aorta and Pulmonary valve stenosis cause in ToF?

A

Cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Which way is the shunt in ToF?

A

R>L
causes cyanosis
degree depends on severity of Pulmonary valve stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Risk factors for ToF

A

Rubella infection
maternal age>40
alcohol consumption in pregnancy
DM mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Ix ToF

A

Echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What shape is the heart in ToF on CXR?

A

Boot shaped - characteristic (due to RV thickening)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Presentation of ToF:

A

Antenatal checks
Newborn exam - ejection systolic murmur due to Pulmonary valve stenosis
HF<1yo
can present older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Signs and symptoms ToF:

A 
Cyanosis
Clubbing
Poor feeding
poor weight gain
ejection systolic murmur
Tet spells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are Tet spells

A

During ToF, some infants have deep blue skin, nails, lips when agitated, increased CO2 causes this.
Also can lead to LOC, seizures, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Tet spell - what can children do to help and why?

A

squatting in older children/knees to chest in younger - increases systemic vascular resistance - encourage blood to pulmonary vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Tet spell mx

A 
Involve senior paediatrician 
supplementary O2
BBs
IV fluids
Morphine
Sodium bicarbonate - met acidosis
phenylpherine infusion - systemic vascular resistance up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Mx ToF neonates

A

Prostaglandin E infusion - maintain DA

total surgical repair - OHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is ebstein’s anomaly?

A

Congenital heart defect where tricuspid valve set lower in R side of heard (towards apex) + incompetent > larger RA, smaller RV
This leads to poor flow from RA>RV>pulmonary vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Which shunt is Ebstein’s anomaly associated with?

A

R>L shunting across atria via an ASD

Leads to cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Which other syndrome is Ebstein’s anomaly associated?

A

Wolff-Parkinson-White

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

How does Ebstein’s anomaly commonly present

A 
Like HF - oedema 
Gallop rhythm heard on auscultation, +HS3+HS4
Cyanosis
SOB, tachypnoea
poor feeding
collapse/cardiac arrest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

how would ebstein’s anomaly present with an ASD

A

cyanosis and symtomatic a few days after birth - when DA (which has been compensating) closes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Ebstein’s anomaly: Ix

A

ECG - arrhythmias, RA enlargement, RBBB, left axis deviation
CXR - cardiomegaly, RA enlargement
Echo- Dx, severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Medical management of Ebstein’s anomaly

A

tx arrhythmias, HF
prophylactic Abx for infective endocarditis
Definitive sx mx to correct underlying abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is transposition of the great arteries?

A

attachments of aorta and pulmonary trunk to the heart are swapped (transposed)
RV>aorta
LV>pulmonary vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

In transposition of great arteries, which side of heart does systemic circulation flow?

A

Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

In transposition of great arteries, which circulation flows through L side of heart?

A

Pulmonary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

which conditions are associated with transposition of great arteries?

A

VSD
Coarctation
Pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

When is transposition of great arteries a problem?

A

Immediately after birth - no connection between systemic and pulmonary circulation > cyanosed baby
loud S2 is audible and a prominent right ventricular impulse is palpable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

On what does immediate survival depend in ToGA?

A

Shunt between systemic>pulmonary circulation via PDA, VSD, ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How is ToGA usually diagnosed?

A

Antenatal USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

If doesn’t present at birth, what sx ToGA

A 
cyanosis
RDS
Tachycardia
poor feeding
poor weight gain
sweating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Mx ToGA

A

VSD enables time to plan definitive tx
Prostaglandin infusion - maintain PDA
Balloon septostomy - catheter Foramen Ovale via umbilicus to create an ASD
Definitive - OHS - arterial switch + correct other heart defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

what are causes of constipation in children?

A

Idiopathic or functional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

secondary causes constipation paeds?

A 
Hirschprung's disease
CF
Hypothyroid disease
SC lesions
sex abuse
intestinal obstruction
anal stenosis
cows milk intolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

what is the effect of breastfeeding on stools passed?

A

Variable - can be as little as one stool/week passed in breast fed babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

constipation sx:

A 
<3 stools/week
hard stools - difficult to pass
rabbit droppings 
straining and painful passage
abdo pain
loss of sensation of needing to go
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What posture may be seen in constipation?

A

Relentive posturing - holding abdo posture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What causes overflow soiling?

A

Faecal impaction - loose smelly stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Examination of constipated child:

A

palpable hard stools in abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

lifestyle factors leading to constipation?

A 
habitually not opening the bowels
low fibre diet
dehydration
sedentary lifestyle
psychosocial (safeguarding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

red flags constipation:

A 
not passing meconium 
neuro sx
vomiting 
ribbon stool
abnormal anus/lower back
failure to thrive
acute severe abdo pain/bloating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what causes failure to pass meconium?

A

Hirschprungs (associated with downs)

CF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Meconium - when should it be passed and how does it look?

A

Before 48 hours (ideally in first 24 hours)

green n gross

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Meconium aspiration

A

green liquor
neonatal distress
neonatal pneumonia
Seen in late babies >42/40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

management meconium aspiration

A

suction

?Abx for pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Ribbon stool seen in?

A

Anal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Cx constipation:

A 
pain 
reduced sensation
haemorrhoids 
overflow/soiling
psychological impact
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Mx constipation in child

A

exclude red flags
lifestyle factors/diet
Movicol - first line
disempaction regimen - high dose laxatives at first
psych - schedule visits, bowel diary, star charts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is GOR?

A

Gastro-oesophageal reflux is where stomach contents reflux into oesophagus, throat and mouth via the lower oesophageal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is important about babies and the lower oesophageal sphincter?

A

It is immature in babies up to 1yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

presentation GOR in children under 1:

A 
chronic cough
hoarse cry
distressed/crying/unsettled after feeding
reluctance to feed
pneumonia 
poor weight gain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

In children over 1 how may GOR present

A

Similar to adults - heartburn, acid regurgitation, retrosternal/epigastric pain, bloating, nocturnal cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

vomiting causes paeds:

A 
over-feeding
GOR
pyloric stenosis (projectile)
gastroenteritis 
appendicitis 
UTI/tonsilitis/meningitis
Intestinal obstruction
BN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

red flags vomiting child:

A 
Not keeping any food down 
projectile/forceful vomiting
bile-stained/green
haematemesis/melaena
abdo distension 
reduced consciousness/bulging fontanelle/ neuro sx
resp sx
blood in stool 
sx infection
rash
apnoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Mx GOR paeds

A 
conservative - reassurance
small meals
burping regularly 
not overfeeding
upright posture after feed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Medical mx GOR

A

gaviscon with feeds
thickened milk/formula
ranitidine Omeprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

If needed further Ix with GOR, what would you do?

A

barium meal
endoscopy
Sx fundoplication if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Sandifer’s syndrome - what is this?

A

Brief episodes of abnormal movements associated with GOR in infants
Torticollis
Dystonia - back arching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What is torticollis?

A

Forceful contraction of neck muscles > twisting of neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

West syndrome - what is key feature?

A

Infantile spasms,
Interictal EEG - hypsarrhythmia
mental retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Mx Sandifer’s?

A

Sx improve as GOR improves

Refer to specialist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is pyloric stenosis?

A

Hypertrophy>narrowing of pyloric sphincter - prevents food travelling stomach>duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Where is the pyloric sphincter?

A

Ring of smooth muscle forms the canal between the stomach and duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What is paathophysiology of pyloric stenosis?

A

after feeding>powerful peristalsis of stomach>due to stenosis food>oesophagus>mouth>projectile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

when does pyloric stenosis present?

A

First few weeks of life

Hungry, thin baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

features pyloric stenosis

A

failure to thrive

projectile vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Ex/Ix Pyloric stenosis

A

Large olive felt in upper abdomen - peristalsis

Hypochloric metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Dx and Mx pyloric stenosis

A

USS for dx- thickened and elongated pylorus

Sx tx - laparoscopic pyloromyotomy (Ramstedt’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Presentation gastroenteritis

A

D/V/N

from stomach to intestines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

ddx gastroenteritis

A 
IBD
Lactose intollerance
Coeliac
CF
Toddler's diarrhoea 
IBS 
Iatrogenic - Abx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

common viral causes gastroenteritis

A

Rotavirus
Norovirus
Adenovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

E. coli as cause of Gastroenteritis?

A

faecal contact
0157>shiga toxin> haemolytic uraemic syndrome (HUS)
No Abx!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Traveller’s diarrhoea cause? Cure?

A

Campylobacter jejeni
gram -ve
ingestion
Azithromycin/ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

If gatroenteritis with a history of swimming pools, drinking water contamination?

A

Shigella
Shiga toxin>HUS
Azithromycin/ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

raw eggs/poultry/food contamination leading to gastroenteritis?

A

Salmonella

Abx if severe - culture dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

CF diet mx

A

High calorie, high fat, pancreatic enzyme supplement with each meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

what is a poor prognostic factor in congenital diaphragmatic hernia?

A

Presence of liver in thoracic cavity

Lung:head <1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

is there a risk of recurrence of CDH?

A

yes - depending on severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

which side is CDH more common?

A

Left (85%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

risks of CDH in future? (cx)

A

Pulmonary HTN

future children with CDH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Limping child, acute onset, viral infections ass., mild fever, well child, boys age 2-12

A

Transient synovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Limping child, very unwell, high fever
holding leg flexed, abducted and externally rotated
pain! warm jt to palpate

A

septic arthritis/osteomyelitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

painless limp indicates

A

JIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

neonate girl with disparity in skin creases behind L/R hips

A

Developmental dysplasia of hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

What is Perthe’s disease?

A

Avascular necrosis of femoral head

4-8yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

obese child, 10-15 years, 2/52 hx stiff hip/knee pain - no trauma

A

Slipped Upper Femoral Epiphysis

ix - 2 view both hips XR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Epistaxis in children causes:

A

nose picking
foreign body
URTI
Allergic rhinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Above what age are nose bleeds considered less sinister?

A

2yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

high fever lasting >5 days, strawberry tongue, red palms with desquamation, conjunctive infection, lymphadenopathy is:

A

Kawasaki’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What type of disease is Kawasaki

A

Vasculitis

clinical dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Mx kawasaki?

A

Aspirin - high dose
IV IG
ECHO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Main cardiac cx Kawasaki?

A

Coronary artery aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Normal social smile response at how many weeks old for normal milestones?

A

6-8/52

if prem + weeks prem on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Normal milestone: laughs?

A

3/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

When do babies become shy and take everything to their mouth (normal milestone)?

A

9/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Milestone: puts hand on cup to drink

A

6/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

milestone: drinks from cup + uses spoon

A

12-15/12 up to complete competencty age 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

milestone: spoon + fork

A

3yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

milestone: knife and fork

A

5yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

helps get self dressed/undressed

A

12-15/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

removes shoe/hat

A

18/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

puts on shoes/hat

A

2yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

dresses independently apart from buttons/laces

A

4yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Plays peekaboo milestone:

A

9/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

waves byebye and plays patacake

A

12/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

plays happily alone

A

18/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

plays near/not with other children:

A

2yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

plays with other children:

A

4yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Causes of neonatal hypotonia?

A

neonatal sepsis
Wednig-Hoffman (spinal muscular atrophy 1)
hypothyroid
Prader-Willi syndrome
Down’s syndrome
cerebral palsy (hypotonia may precede the development of spasticity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

maternal causes neonatal hypotonia?

A

benzos

maternal MG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

Haemophilia A: what type of genetic disorder is this?

A

X-linked recessive

factor VIII deficiency compared to HaemB IX def

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What is the transmission rate of X linked if:

male has the disease, female is not even a carrier

A

0% chance

No male-male transmission as males always give Y to their sons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

What is intussusception?

A

invagination of one portion of bowel into the lumen of the adjacent bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Clinical features: intussuseption:

A 
paroxysmal abdo colic pain
during paroxysm infant knees up, pale
Vomiting
blood stool - redcurrent jelly
sausage shaped mass RUQ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Ix: intussusception?

A

USS - target shaped mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

Mx intussusception:

A

reduction by air insufflation under radiological control
Sx if peritonism
(pneumatic reduction under fluoroscopic guidance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

asthma mx: step 2 difference in <5, >5?

A

moderate paeds dose ICS <5,

low paeds dose ICS >5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

Asthma management >5 steps:

A
  1. SABA
  2. low dose ICS
  3. LTRA
  4. LABA -LTRA
  5. switch ICS/LABA for MART
  6. moderate dose ICS MART
  7. high dose ICS, theophylline, expert
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Transient tachypnoea of newborn: what increases the risk ?

A

Delayed reabsoprtion of fluid in lungs

CS increases risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Ix/Mx TTN?

A

Ix - CXR - hyperinflation of lungs horizontal fissure

Mx - supplemental O2, usually resolves after 1-2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

what disease makes children more likely to snore?

A

Down’s syndrome - sleep apnoea

due to low muscle tone of upper airways due to large tongue/adenoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

causes of snoring in children:

A 
obesity 
nasal problems - polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsilitis 
Down's syndrome
hypothyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

which congenital heart defect is linked to taking Lithium in pregnancy>

A

Ebstein’s anomaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

Hirschprung’s disease: Dx test

A

rectal biopsy - full thickness

absence of ganglion cells from mysenteric and submucosal plexuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

If parents do not give consent, but intelligent and able under 16 wants sx, which you deem in her best interests, what can you do and who’s guidelines do you reference?

A

Gillick competency
If stable - written consent will do
If urgent - verbal consent ok

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

Which disease commonly presents as primary amenorrhoea? WITH GROIN SWELLINGS

A

Androgen insensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

What is the genotype of Turner syndrome?

A

45, X0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

Short stature, shield chest and webbing of the neck is a presentation of?

A

Turner syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Kleinfelter syndrome karyotype?

A

47 XXY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

what is another way of describing primary hypogonadism?

A

Kleinfelter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Kleinfelter sx:

A 
taller than average
lack secondary sex characteristics
small, firm testes
infertile, 
gynaecomastia (risk male br ca)
elevated Gonadotrophin levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Kallman’s syndrome sx:

A 
delayed puberty
hypogonadism, cryptorchidism
anosmia
sex hormone levels low
LH/FSH levels v low/normal
normal/tall height
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

why is there delayed puberty in Kallman’s syndrome?

A

hypogonadotrophic hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

How is Kallman’s inherited?

A

X-linked recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

type of vaccine in rotavirus?

A

Oral live attenuated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

if mycoplasma pneumonia suspected as childhood pneumonia cause - what Abx?

A

erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

cerebral palsy definition?

A

disorder of movement and posture due to non-progressive lesion of the motor pathways in the developing brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

commonest cause of Cerebral Palsy?

A

antenatal (80%) - cerebral malformation, congential infection (rubella, toxoplasmosis, CMV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

name some intrapartum causes of CP?

A

birth asphyxia / trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

postpartum causes CP?

A

Intraventricular haemorrhage
meningitis
head trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

clinical manifestation of CP?

A

abnormal tone in early development
not meeting motor milestones
abnormal gait
feeding difficulty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

CP associated non-motor symptoms?

A 
learning difficulties (60%)
epilepsy (30%)
squints (30%)
hearing impairments (20%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

classes/types of CP?

A

spastic (70%) - hemiplegia, diplegia, quadraplegia
dyskinetic
ataxic
mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

Mx CP?

A

MDT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

tx spasticity in CP?

A 
oral diazepam
oral/intrathecal baclofen
botulinim toxin type A
orthopaedic sx
selective dorsal rhizotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

should children be excluded from school for head lice until tx starts?

A

no

do not treat household contacts unless they have it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

other names for head lice

A

pediculosis capitis

nits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

Mx nits?

A

malathian, wet combing
dimeticone,
isopropyl myristate,
cyclomethicone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

which rash is characterised by a 3-5day high fever followed by a maculopapular rash starting on CHEST and spreads to limbs

A

Roseola Infantum

Herpes Virus 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

when does roseola infantum rash occur?

A

as fever is disappearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

‘slapped cheek syndrome’ - rash starts on cheeks then spreads - which rash?

A

Parvovirus B19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

Group A strep - skin features?

A

cellulitis
erysipelas
impetigo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

which cause of rash commonly leads to Koplik’s spots?

A

Measles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

What is a: skull deformity producing unilateral occipital flattening, which pushes the ipsilateral forehead ear forwards producing a ‘parrallelogram’ appearance

A

Plagiocephaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

Mx plagiocephaly?

A

reassurance

normally resolves between 3-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

epistaxis, bruising, increased PT time ->

A

Acute Lymphoblastic Leukaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

which diseases may show lowered erythrocytes and platelets?

A

Aplastic anaemia

Myelodysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

what is the commonest malignancy affecting children?

A

ALL

80% all childhood leukaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

features of ALL caused by bone marrow failure:

A

anaemia (lethargy, pallor)
neutropenia (frequent, severe infections)
thrombocytopaenia (frequent bruising, petechiae)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

other features of ALL:

A

bone pain
hepatosplenomegaly
fever, night sweats, wt loss, fatigue
testicular swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

types of ALL:

A

common ALL - CD10 present, pre-B phenotype
T-cell (20%)
B-cell (5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

poor prognostic factors for ALL:

A 
age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

what does genetic anticipation mean?

A

hereditary diseases have younger onset in each successive generation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

give two examples of diseases with genetic anticipation?

A

Huntington’s disease

Myotonic dystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

what causes genetic anticipation?

A

trinucleotide repeats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

name some examples of trinucleotide repeats?

A 
Fragile X
HD
myotonic dystrophy
spinocerebellar ataxia 
spinobulbar muscular atrophy
dentatorubral pallidoluysian atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

Mx: croup

A

PO Dexamethasone

Pred if not availalbe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

emergency croup tx?

A

high flow O2

nebulised adrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

croup also known as:

A

laryngeotracheobronchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

eneuresis definition?

A

involuntary discharge of urine by day/night/both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

eneuresis Mx

A

look for underlying causes
reward good behavior
alarm <7
desmopressin 7<

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

if newborn hearing screening abnormal, which test do they go on to have and when?

A

Auditory brainstem response test as newborn/infant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

how is hearing assessed as part of the newborn hearing screening assessment?

A

Otoacoustic emmision testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

slipped upper femoral epiphysis (SUFE) Mx;

A

Sx: internal fixation across the growth plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

what does the Pontesi method tx?

A

Clubfoot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
242
Q

WHat does a Pavlik harness treat?

A

Developmental dysplasia of the hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
243
Q

Risk with SUFE?

A

avascular necrosis of femoral neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
244
Q

4 week old child comes with red rash on her scalp + yellow flakes - dx?

A

seborrhoeic dematitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
245
Q

Mx of seborrhoeic dermatitis

A

baby shampoo/oils if mild

if severe - topical steroids - hydrocortisone 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
246
Q

why do children with CF get foul smelling stools?

A

steatorrhoea caused by pancreatic insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
247
Q

if there are 2+ responders to a paediatric life support emergency, how many chest compressions:ventilations

A

15:2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
248
Q

If on own, how many chest compressions:ventilations in paeds

A

30:2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
249
Q

how many rescue breaths are given in resus?

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
250
Q

what is major risk factor for TTN?

A

CS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
251
Q

What is major risk factor for apsiration pneumonia?

A

meconium staining of amniotic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
252
Q

major risk factor for Neonatal Respiratory Distress Syndrome?

A

Prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
253
Q

what is linked with NRDS?

A

surfactant deficiency lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
254
Q

Hirschprung’s disease presentation:

A

bilious vomiting,
abdo distension
constipation
failure to pass meconium first 2 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
255
Q

first sign of puberty in girls:

A

breast development 11.5years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
256
Q

male first sign puberty?

A

testicular growth 12 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
257
Q 
SpO2<92%
PEF<33% predicted
silent chest
poor respiratory effort
agitation 
altered consciousness
cyanosis
A

Life threatening asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
258
Q

Severe asthma sx:

A 
SpO2<92%
PEF 33-50%
too breathless to talk/feed
HR>125 >5yo
HR>140 <5yo
RR>30/40 o5/u5
use accessory muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
259
Q

coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine end inspiratory crackles
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
Dx?

A

Bronchiolitis

RSV

tx - supportive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
260
Q

when is peak incidence bronchiolitis?

A

3-6month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
261
Q

what causes orofacial clefts during pregnancy?

A

maternal anti-epileptics use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
262
Q

What tests are used to diagnose developmental dysplasia of hip in early childhood?

A

Barlow and Ortalani test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
263
Q

what is breech delivery a risk factor for in terms of gait abnormalities?

A

DDH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
264
Q

what type of pulse is associated with PDA?

A

collapsing

large volume, bounding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
265
Q 
Left subclavicular thrill
continuous machinery murmur
large vol, bounding collapsing pulse 
wide  pulse pressure
having an apex beat present
acyanotic
ALL features of?
A

features of PDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
266
Q

Mx PDA - medical?

A

Indomethacin - prostaglandin inhibitor closes the hole in most cases
surgical repair if failss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
267
Q

commonest cause of croup?

A

Parainfluenza virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
268
Q

chest compressions for children of all ages should be at what rate?

A

100-120bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
269
Q

which murmur will change on variation of posture?

A

Benign ejection systolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
270
Q

which murmur is heard at lower Left sternal edge?

A

Still’s murmur

low-pitched

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
271
Q

which murmur is heard as a continuous blowing out sound just below the clavicles?

A

Venous hums - turbulent flow in great veins returning blood to heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
272
Q

risk factors for SIDS?

A 
prone sleeping
parental smoking
bed sharing
hyperthermia / head covering
prematurity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
273
Q 
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
A

hypernatraemic dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
274
Q 
Learning difficulties - ASD
Macrocephaly
Long face
Large low set ears
Macro-orchidism

Syndrome?

A

Fragile X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
275
Q 
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Syndrome??
A

Patau syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
276
Q

Which chromosome is Patau syndrome and what is the cause?

A

trisomy 13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
277
Q

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

A

Edward syndrome

Trisomy 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
278
Q

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

A

Noonan syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
279
Q

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

A

Pierre - Robbins

Or Treacher- Collins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
280
Q

Differentiating between Pierre-Robin and Treacher-Collines

A

TC is AD so FHx positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
281
Q

Hypotonia
Hypogonadism
Obesity

A

Prader-Willi

Ch15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
282
Q

What causes the problem in Prader-Willi?

A

loss of the paternal locus from Ch15

get most of their Ch15 from mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
283
Q

What causes problem in Angelmann?

A

Loss of maternal locus from ch15

get most of their ch15 from dad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
284
Q 
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
elfin faces
Syndrome?
A

William’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
285
Q

Characteristic cry due to larynx and neurological problems
Feeding difficulties and poor weight gain
Learning difficulties
Microcephaly and micrognathism
Hypertelorism

A

Cri du chat syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
286
Q

genetic cause of cri du chat ?

A

ch5 p deletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
287
Q

Micrognathism?

A

undersiezed jaw

small chin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
288
Q

hypertelorism

A

increased distance between two organs, typically refers to eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
289
Q

what is gastrochisis?

A

intestinal loops protruding through a hole in the abdomen to the left of the umbilicus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
290
Q

Omphalocele?

A

intestinal loops protruding through a hole in the abdomen - through the umbilicus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
291
Q

what is gastrochisis associated with ?

A

low socioeconomic

mat age<20, smoking, alcohol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
292
Q

what is first line type of laxative in childhood constipation?

A

osmotic laxative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
293
Q

when is stimulant laxative used in constipation mx?

A

2nd line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
294
Q

commonest cause of hypothyroidism in UK?

A

autoimmune thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
295
Q

3yo boy, 6/12 hx of chronic diarrhoea- 5-7 loose stools/day. contain ‘carrots, peas and sweet corn’ and generally undigested food.
growing well, stable on the 75th percentile on the growth chart for weight, height and head circumference. Otherwise well

A

Toddler’s diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
296
Q

stools containing carrots and peas ->

A

Toddler’s diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
297
Q

commonest cause diarrhoea in developed world

A

Cows milk intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
298
Q

moderate vs severe croup differentiation?

A 
severe:
expiratory stridor 
marked sternal wall retractions
severe agitation 
tachycardia
cyanosis 
<1yo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
299
Q

Mx croup regardless of severity:

A

PO dexamethasone

300
Q

if severe croup, what also can be mx:

A

nebulised o2, pred

301
Q

On examination you note multiple vesicles over both palms and around the mouth. She is also pyrexial.
Disease?

A

Hand foot and mouth disease

302
Q

What type of disease is hand foot and mouth?

A

Self-limiting viral illness

303
Q

Mx hand foot and mouth?

A

Requires symptomatic treatment only

304
Q

when might someone get Stevens-Johnson syndrome?

A

severe drug sensitivity reaction?

305
Q

chickenpox school exlusion criteria - until when?

A

should be excluded until all lesions have crusted over (usually about 5 days)

306
Q

mx chickenpox in children:

A

calamine cream

307
Q

ADHD meds started in children: what needs monitoring?

A

height and weight 6/12

308
Q

what is first line ADHD drug in children?

A

Methylphenidate

309
Q

what are all ADHD drugs toxic?

A

cardiotoxic

baseline ECG

310
Q

differentiate between epilepsy and reflex anoxic seizure?

A

rapid recovery RAS

311
Q

why might neonate be jaundiced benign?

A

higher number of RBCs
shorter RBC lifespan
slower liver conjugation

312
Q

why can unconjugated bilirubin pass the blood brain barrier?

A

lipid-soluble

313
Q

what causes kernicterus?

A

deposition and accumulation of unconjugated bilirubin in the brain (BG)

314
Q

how does kernicterus manifest?

A

hearing loss
irreversible brain damage, cerebral palsy
death

315
Q

risk factors for abnormal bilirubin levels in neonatets?

A
  • RBC breakdown

- acidosis

316
Q

if a newborn develops jaundice in first 24 hours of life or has abnormally high unconjugated bilirubin levels, what should you do to mx?

A

Sepsis screen
blood group incompatibility

(both these increase RBC breakdown)

317
Q

causes of jaundice linked to the liver’s ability to cocnjugate bilirubin?

A

G6PD deficiency
hypoxic liver injury
dehydration from poor feeding
intestinal pathologies/obstructions

318
Q

Tx for hyperbilibrubinaemia?

A

Phototherapy - light to conjugate the free bilirubin and increase it’s secretion

319
Q

if severe hyperbilirubinaemia, how do you treat?

A

exchange transfusion

320
Q

episodic viral wheeze mx:

A
  1. symptomatic only
  2. SABA
  3. LTRA / PO ICS / both
321
Q

up to what time period after a febrile convulsion is normal for a child to be drowsy?

A

1 hour

beyond this is not simple febrile convulsion

322
Q

when do febrile convulsions normally occur?

A

early on in viral infection

323
Q

how long do seizures last in febrile convulsion normally?

A

usually brief <5 mins

324
Q

how would seizures in febrile convulsions typically be described>

A

Tonic clonic

325
Q

which condition should you never do an airway examination if suspect:

A

Croup

can cause airway to obstruct

326
Q

breastfed first 2/52 life before switched to formula. 6/52 hx regurgitation, vomiting, diarrhoea and eczema

A

cows milk protein intolerance

327
Q

IX test for cows milk protein intolerance?

A

skin prick/patch testing

total IgE and specific IgE (RAST) for cow’s milk protein

328
Q

in children with IgE-mediated CMPI - when will most children be tolerant?

A

55% by 5 years will be milk tolerant

329
Q

In children with non-IgE-mediated CMPI - when will most children be tolerant?

A

3 years old

330
Q

if want to perform a milk challenge in CMPI, where do you do this? why?

A

in hospital - risk of anaphylaxis

331
Q

what should mothers who are breastfeeding child with CMPI do?

A

avoid dairy

332
Q

what must you do as part of mx for whooping cough?

A

Notify Public Health England

household prophylaxis

333
Q

Tx whooping cough?

A

if onset cough <21/7
PO macrolide
eg clarithromycin, azithromycin or erythromycin

334
Q

complications of pertussis:

A

subconjunctival haemorrhage
pneumonia
bronchiectasis
seizures

335
Q

jittery and hypotonic baby may suggest?

A

neonatal hypoglycaemia

336
Q

what is a maternal risk factor for neonatal hypoglycaemia?

A

Maternal labetolol for pre-eclampsia

337
Q

neonatal hypoglycaemia causes?

A 
maternal diabetes mellitus
prematurity
IUGR
hypothermia
neonatal sepsis
inborn errors of metabolism
nesidioblastosis
Beckwith-Wiedemann syndrome
338
Q

attempts to dislocate an articulated femoral head describes which neonatal examination?

A

Barlow test for DDH

339
Q

DDH risk factors:

A 
female sex: 6 times greater risk
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
congenital calcaneovalgus foot deformity
340
Q

attempts to relocate a dislocated femoral head describes which neonatal exam?

A

Ortaloni test DDH

341
Q

Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress should make you consider?

A

Diaphragmatic hernia

342
Q

initial mx of diaphragmatic hernia in RDS resus?

A

intubate and ventilate

NG to keep air out of bowel

343
Q

karyotype: Turner’s syndrome?

Is it an inherited condition?

A

X0, 45X

not inherited, random monosomy

344
Q 
short stature
shield chest, widely spaced nipples
webbed neck
bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
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
horseshoe kidney
A

Turner’s syndrome

345
Q

<16yo understands the professional’s advice
<16yo cannot be persuaded to inform their parents or allow the professional to contact them
<16yo likely to begin, or continue having, sexual intercourse with or without contraceptive treatment
unless they receives contraceptive treatment, their physical or mental health, or both, is likely to suffer
the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent

A

Fraser guidelines

346
Q

precocious puberty is the onset of 2nd sex charas before what ages in m and f?

A

9m

8f

347
Q

commonest occular malignancy of childhood?

A

retinoblastoma

348
Q

absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems

A

retinoblastoma

349
Q

mx retinoblastoma:

A

enucleation (removal of eye) - not only option

external beam radiation/chemo/photocoagulation

350
Q

prognosis : retinoblastoma:

A

excellent, 90% live to adulthood

351
Q

puffy swelling that usually occurs over the presenting part and crosses suture lines

A

Caput succedaneum

352
Q

Caput succedaneum tx:

A

no tx

manage conservatively - resolves within days

353
Q 
Premature baby
Intolerant to feeds
Generally unwell
Tender abdomen
Absent bowel sounds
Distended abdomen
Blood in stools
Peritonitis and shock
A

Necrotising enterocolitis

354
Q

AXR:
dilated bowel loops (asymmetrical)
bowel wall oedema
pneumatosis intestinalis (intramural gas)
portal venous gas
pneumoperitoneum (from perforation)
air inside and outside of the bowel wall (Rigler sign)
air outlining the falciform ligament (football sign)

A

necrotising enterocolitis

355
Q

when is MenB vaccines given?

A

2,4,12 months

356
Q

what often preceeds ITP?

A

viral illness

357
Q

schistocytes are often seen on blood smears?

A

Thrombotic Thrombocytopaenia Purpura

358
Q

how many episodes vomiting before CT in children following a head injury?

A

3

359
Q

Criteria for immediate request for CT scan of the head (children):

A
  • LOC>5min witnessed
  • Amnesia> 5 min
  • Abnormal drowsiness
  • Three + episodes of vomiting
  • Clinical suspicion NAI
  • Post-traumatic seizure, no Hx epilepsy
  • GCS <14, or < 1 year GCS< 15
  • Suspicion of open/depressed skull injury/tense fontanelle
  • Any sign of basal skull fracture (haemotympanum, panda’ eyes, CSF leak from the ear or nose, Battle’s sign)
  • Focal neurological deficit
  • <1 year, presence of bruise, swelling/laceration of >5 cm on the head
  • Dangerous mechanism of injury (high-speed RTA either as pedestrian, cyclist or vehicle occupant, fall from a height >3 m, high-speed injury from a projectile or an object)
360
Q

systemic onset JIA also known as?

A

Still’s disease

361
Q

still’s disease/JIA has characteristic rash?

A

Salmon-pink rash

362
Q

JIA dx criteria (age and time course):

A

<16yo, >6wks

363
Q

features of systemic JIA:

A 
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia and weight loss
364
Q

Ix: JIA

A

ANA may be positive, especially in oligoarticular JIA (<4jts)
rheumatoid factor is usually negative

365
Q

if a baby is born >36 wks with breech presentation, what follow up imaging does it need and for what?

A

USS 6 weeks, for DDH

366
Q

itchy bottom but no other sx: what is wrong?

A

Threadworm infection

367
Q

management of threadworm infection:

A

hygiene measures and single dose of mebendazole for all family

368
Q

Dx: threadworms

A

sellotape attatched to perianal area to catch eggs and send for microscopy

369
Q

what are trident hand deformity indicative of?

A

Achondroplasia

370
Q

short limbs (rhizomelia), lumbar lordosis and midface hypoplasia
macrocephaly with frontal bossing
- which congential abnormality?

A

achondroplasia

371
Q

sandle-gap in which syndrome?

A

downs

372
Q

Achondroplasia inheritance?

A

AD

373
Q

mutuation of FGFR3 gene causes?

A

achondroplasia

374
Q

microcephaly causes?

A

normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis

375
Q

what age says ‘mama’ ‘dada’

A

9-10/12

376
Q

double syllable word milestone?

A

6/12

377
Q

when will child know and respond to own name?

A

12/12

378
Q

repeated flexion of head/arms/trunk followed by extension of arms repeated 50x is classical chracteristics of?

A

Infantile spasms

379
Q

what is West syndrome?

A

Infantile spasms - salaam attacks

type of epilepsy

380
Q

when is west syndrome commonly seen?

A

4-8/12

381
Q

EEG: West syndrome

A

Hypsarrhythmia

382
Q

West syndrome: mx and px

A
  1. vigabratin
    ACTH also used
    poor prognosis
383
Q

Perthe’s disease in u6yo mx:

A

observations

384
Q

Perthe’s disease in over 6 mx

A

surgical repair

385
Q

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

DX?

A

Perthe’s disease

386
Q

Perthe’s disease cx?

A

osteoarthritis

premature fusion of the growth plates

387
Q

What is the most important treatment for prevention of neonatal respiratory distress syndrome?

A

Administer Dexamethasone to mother

388
Q

MMR how long wait between vaccines?

A

3 months to maximise uptake, if >10yo 1 month enough

389
Q

If DDH suspected, what ix:

A

USS

390
Q

A child aged < 3 months with a fever > 38ºC - initial mx step?

A

Refer for paeds assessment same day

391
Q

Small testes in precocious puberty indicate :

A

adrenal cause

eg. adrenal hyperplasia

392
Q

unilateral testes growth in precocious puberty indicate

A

gonadal tumour

393
Q

bilateral enlargement testes in precocious puberty indicates:

A

gonadotropin release from IC lesion

394
Q

advanced development in all areas and would be associated with a history of sexual aggression during childhood ??

A

testotoxicosis

395
Q

talks in short sentences:

A

2.5-3yrs

396
Q

vocab of 2-6 words:

A

12-18 months

397
Q

Mx: Hirschprungs (definitive)

A

bowel ressection

398
Q

eczema: first line tx:

A

topical emolients

399
Q

what comes after topical emolients in step-wise mx of eczema?

A

topical steroids

400
Q

If premature baby: wht is the timetable on vaccines?

A

give as normal, do not correct for gestational age

401
Q

walks unsupported: age?

A

13-15/12

402
Q

small umbilical hernia mx:

A

in under 1s, normall resove by 12/12 so watch and wait

403
Q

what sx should parents be told about during watch and wait for umbilical hernia to seek medical attention if they see?

A

vomiting, pain and being unable to push the hernia in

404
Q

newborn resus chest compression:ventilation ratio

A

3:1

405
Q

if bronchiolitis sx but really high temp >39 - what should you consider?

A

pneumonia

406
Q 
short ­palpebral fissure
thin vermillion border/hypoplastic upper lip
smooth/absent filtrum
learning difficulties
microcephaly
growth retardation
epicanthic folds
cardiac malformations
A

Fetal Alcohol syndrome

407
Q

ask what and who questions?

A

3 years

408
Q

Ask when and how questions?

A

4 years

409
Q

combine 2 words: milestones

A

2 years

410
Q

small cystic structure which has obviously been recently infected. On removal of the scab, there is hair visible within the lesion, what type of cyst?

A

Dermoid

411
Q

where do dermoid cysts occur>

A

at sites of embryonic fusion

412
Q

which cells do dermoid cysts contain?

A

multiple cell types - includes hair

413
Q

Hirschprung’s disease AXR findings:

A

dilated loops of bowel with fluid levels. The anus appears normally located.

414
Q

premature infant (30-week gestation) presents with distended and tense abdomen. She is passing blood and mucus per rectum, and she is also manifesting signs of sepsis.

A

Necrotising enterocolitis

415
Q

newborn baby boy presents with gross abdominal distension. He is diagnosed with cystic fibrosis and his abdominal x ray shows distended coils of small bowel, but no fluid levels.

A

Meconium ileus

416
Q

Lower UTI tx paeds

A

3/7 course Abx per local policy

417
Q

what would clean catch sample show for a child with a suspected UTI?

A

positive for leukocytes and nitrates

418
Q

Upper UTI tx paeds?

A

10/7 course Co-amoxiclav

419
Q

what is commonest cause of cardiac arrest in paeds?

A

respiratory - hypoxia

420
Q

causative organisms of meningitis in neonates-3months old?

A

GBS
E.Coli
Listeria

421
Q

causative organisms of meningitis in 1/12-6yo ?

A

neisseria meningitidis
strep pneumo
haemophilus influenzae

422
Q

causative organisms meningitis over 6yo?

A

neisseria meningitidis

strep pneumo

423
Q

Bow legs in a child < 3 mx?

A

reassurance, likely to resolve in <4yos

424
Q

what would blood gas of child with ?pyloric stenosis classically show?

A

elevated bicarbinate, hypochloraemia, hypokalaemia

425
Q

causative organism acute epiglottitis?

A

Hib - thumb sign

426
Q

2/12 old gradually worsening noisy breathing, worse on eating. lower centile for weight and poor food intake:

A

Laryngomalacia

427
Q

never present at the start of the day after the child has woken
no limp
no limitation of physical activity
systemically well
normal physical examination
motor milestones normal
symptoms are often intermittent and worse after a day of vigorous activity

A

growing pains

428
Q

rare cx of chickenpox?

A

pneumonia
encephalitis (cerebellar involvement may be seen)
disseminated haemorrhagic chickenpox
arthritis, witis and pancreatitis may very rarely be seen

429
Q

Vesicoureteric reflux: Ix:

A

micturating cystourethrogram - to dx

DMSA to look for renal scarring

430
Q

in newborn exam, white-coloured nodule at the roof of the mouth. Dx:

A

epstein’s pearl

431
Q

what is an epstein’s pearl?

A

congential cyst found in the mouth - no tx needed

432
Q

when does heel prick test of newborns occur?

A

day 5

433
Q

what does heel prick test test for?

A

CF,
congenital hypothyroidism,
sickle cell disease,
other metabolic diseases - phenylketonuria

434
Q

for CF, what does the heel-prick test look for?

A

raised IRT (immunoreactive trypsinogen)

435
Q

if heelprick shows raised IRT, what test should next be done?

A

sweat test to confirm for CF

>60

436
Q

commonest cx of roseola infantum?

A

febrile convulsions

437
Q

what can epstein’s pearls be mistaken for?

A

neonatal teeth

438
Q

cx of undescended testes?

A

infertility
torsion
testicular cancer
psychological

439
Q

mx undescended testes?

A

review at 3/12 old and refer to paediatric surgeon

orchidopexy

440
Q

when will average child sit without support

A

6-8/12

441
Q

nappy rash: in iritant dermatitis, where is characteristically spared?

A

creases/flexors

442
Q

Typically an erythematous rash which involve the flexures and has characteristic satellite lesions

A

candida dermatitis

443
Q

commonest cause nappy rash?

A

irritant dermatitis

444
Q

mx nappy rash:

A

disposable nappies are preferable to towel nappies
expose napkin area to air when possible
apply barrier cream (e.g. Zinc and castor oil)
mild steroid cream (e.g. 1% hydrocortisone) in severe cases

445
Q

mx nappy rash if ?candida dermatitis

A

topical imidazole,

no barrier cream

446
Q

commonest cause of ambiguous genetalia in newborns?

A

congenital adrenal hyperplasia

447
Q

which gender is phenotype in androgen insensitivity syndrome?

A

female

448
Q

what underlying condition, dx in childhood could cause DM in teenager?

A

CF

449
Q

when is first dose MMR given in UK

A

12-13/12

450
Q

when is the second dose MMR given UK?

A

3-4 years

pre-school booster

451
Q

Autosomal recessive conditions are generally affecting?

A

metabolic

452
Q

Autosomal dominant conditions are generally?

A

structural

453
Q

The abdominal film demonstrates a large soft tissue opacity (‘sausage-shaped’) in the left upper quadrant.

A

intussusception

454
Q

Perthe’s disease more common boys/girls?

A

boys x5

455
Q

1 month old baby girl presents with bile stained vomiting. She has an exomphalos and a congenital diaphragmatic hernia - ?

A

malrotation

456
Q

risk of 40yo mother giving birth to a Down syndrome baby?

A

1/100

457
Q

risk of 45yo giving birth to a down syndrome baby>

A

1/50

458
Q

measles - immediate aftermath cx?

A 
otoitis media 
pneumonia
encephalitis 
febrile convulsion
ketaroconjunctivitis
diarrhoea
appendicitis 
myocarditis
459
Q

what cx might be seen 5-10 years after a measles infection?

A

subacute sclerosing panencephalitis

460
Q

commonest presenting feature of a Wilm’s tumour?

A

abdominal mass
RUQ when lying down
smooth, non-tender

461
Q 
abdominal mass (most common presenting feature)
painless haematuria
no lymphadenopathy
flank pain
other features: anorexia, fever
unilateral in 95% of cases
A

Wilm’s tumour

462
Q

where does Wilm’s tumour most commonly metastasise to ?

A

lung (20%)

463
Q

Mx : wilm’s tumour

A

nephrectomy

Chemo/RT

464
Q

prognosis : Wilm’s tumour

A

good, 80% cure rate

465
Q

what causes RDS in neonate with CDH?

A

pulmonary hypoplasia and hypertension

466
Q

when should APGAR scores be tested for (eg. after CS for macrosomia)?

A

1, 5, 10 mins

467
Q

APGAR score refers to ?

A 
Appearance (colour)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
468
Q

exomphalos?

A

protruding bowel

plan C-S 37/40 (within a membrane) - staged repair

469
Q

optimal tx of protruding bowel?

A

staged closure immediately with completion at 6-12/12

470
Q

why is there a gradual repair in exophalos?

A

to prevent respiratory cx

471
Q

mx gastrochitis?

A

urgent correction (sx)

472
Q

Osgood-Schlatter disease.

This condition occurs as a result of inflammation at which bony prominence?

A

Tibial tuberosity

473
Q

commonest cardiac cx of Turner syndrome?

A

bicuspid aortic valve

this is commoner than coarctation of aorta

474
Q

roseola school exclusion?

A

0 days

475
Q

d/v school exclusion?

A

48 hours from symptoms ending

476
Q

whooping cough school exclusion?

A

2 days after starting Abx or 3 weeks if no Abx given

477
Q

scarlet fever school exclusion?

A

24 hours post Abx given

478
Q

school exclusion - measles and rubella?

A

4 days from onset of rash

479
Q

type of rash in hand foot and mouth disease?

A

25 mm scattered erythematous macules and papules, often with a central greyish vesicle.

480
Q

which vaccine should be offered to babies with family history of TB or from high risk region/country with TB (defined as >40 cases/100000) as defined by WHO?

A

BCG vaccine for TB

481
Q

which condition are nasal polyps associated with?

A

CF

482
Q

peak incidence ALL?

A

2-5yo

483
Q

RDS in prematurity - Cx?

A

retinopathy of prematurity

renal failure

484
Q

what screening is part of the core Child Health Promotion Program as outlined in the Children’s National Service Framework?

A

newborn clinical exam,
newborn hearig test
5-day heel prick test
GP exam 6-8/52

485
Q

can 14yo refuse tx?

A

no

486
Q

what prodrome of raised temperature before the rash begins on the torso and face

A

chickenpox

487
Q

when and how is vit K given to newborn?

A

soon after birth, PO/IM injection as a one off

488
Q

hereditary sensorineural deafness children?

A

Usher syndrome, Pendred syndrome, Jervell-Lange-Nielson syndrome, Wardenburg syndrome

489
Q

average child crawls:

A

6/12

490
Q

average age: good pincer grip?

A

12 months

491
Q

If no changes on ?Perthe’s disease - which is second line Ix?

A

MRI

492
Q

Turner syndrome: murmur commonest?

A

ejection systolic heard loudest over aortic valve

493
Q

when is Men C vaccine given?

A

12-15monthss

494
Q

when is pneumococcal conjugate vaccine given?

A

3, 12 months

PCV

495
Q

what vaccines are given at 2/12:

A

6-1 (dip, tetanus, pertussis, polio, Hib, Hep B)
PO rotavirus
PCV
MenB

496
Q

cysts are usually multiloculated and heterogeneous. Most are located above the hyoid

A

Dermoid cyst

497
Q

which neck masses are soft and transilluminate. Most are located in the posterior triangle?

A

cystic hygroma

498
Q

which cysts are usually located laterally and derived from the second branchial cleft. Unless infection has occurred they will usually have an anechoic appearance on ultrasound?

A

brachial cysts

499
Q

commonest cause of stridor in neonates?

A

laryngomalacia

500
Q

what is a common complication of viral gastroenteritis?

A

lactose intolerance

501
Q

haemorrhage mostly affects pre-term infants and can be diagnosed by ultrasound examinations.?
also causes seizures?

A

Intraventricular haemorrhage

502
Q

what type of haemorrhage can follow the use of forcepts?

A

subdural

503
Q

haemorrhages are common and may cause irritability and even convulsions over the first 2 days of life.?

A

subarachnoid

504
Q

scaphoid abdomen

A

CDH

505
Q

‘atrialisation’ of the right ventricle

A

ebstein’s anomaly

506
Q

scarlet fever: causative organism?

A

group A haemolytic strep

507
Q 
fever: typically lasts 24 to 48 hours
malaise, headache, nausea/vomiting
sore throat
'strawberry' tongue
rash - fine punctate erythema ('pinhead') which generally appears first on the torso and spares the palms and soles. Children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures. It is often described as having a rough 'sandpaper' texture. Desquamination occurs later in the course of the illness, particularly around the fingers and toes
A

scarlet fever

508
Q

if suspected NAI and mother is staying on the ward, what do you do?

A

listen to her concerns and share with her your concerns

509
Q

Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of

A

shaken baby syndrome

510
Q

left sided haematoma over the parietal bone. It does not extend beyond the margins of the parietal bone and is soft to touch

A

cephalhaematoma

511
Q

what may develop as a cx of cephalhaematoma?

A

jaundice

512
Q

mx: necrotising enterocolitis

A

broad spec Abx

cefotaxime, vancomycin

513
Q

The initial management in Hirschprung’s disease

A

rectal washouts/bowel irrigation

514
Q

blue-purple birthmark, often confused for bruising, that may be seen in children with darker skin tones

A

Mongolian blue spot

515
Q

other name for mongolian blue spot?

A

congenital dermal melanocytosis

516
Q

commonest cause of nephrotic syndrome in children?

A

minimal change glomerulonephritis (80%)

517
Q

mx minimal change glomerulonephritis?

A

steroids

518
Q

Nephrotic syndrome is classically defined as a triad of

:

A 
proteinuria >1g/m2/24hrs
hypoalbuminaemia <25g
oedema
frothy urine 
also hyperlipidaemia likely
519
Q

to suggest septic arthritis, WCC and ESR would be:

A

WCC>12

ESR>40

520
Q

what test is contraindicated in meningococcal septecaemia?

A

LP

521
Q

name two examples of diseases caused by genetic imprinting?

A

Prader-Willi

Angelmann

522
Q

umbilical hernia mx:

A

usually self resolve by 1, but if large or symptomatic, perform elective age 2/3
if small and aysmptomatic elective reapir 4/5 yo

523
Q 
regurgitation and vomiting
diarrhoea
urticaria, atopic eczema
'colic' symptoms: irritability, crying
wheeze, chronic cough
rarely angioedema and anaphylaxis may occur
Dx?
A

cows milk protein allergy

524
Q

10 hours post vaginal delivery. The midwife informs you that the mother was positive for group B streptococcus. On examination you note a yellow discolouration to the skin. What is the next most appropriate action to take?

A

within 2 hours take bilirubin serum level

525
Q

what causes jaundice in first 24 hours?

A

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

526
Q

how is jaundice described within 2-14 days?

A

physiological

527
Q

what is prolonged causes of jaundice (>14 days old)

A 
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
congenital infections e.g. CMV, toxoplasmosis
528
Q

not showing signs of breathing at one minute. Heart rate is >100bpm, but he is floppy and cyanosed. What is the most appropriate next step in management?

A

5 rescue breaths via facemask

529
Q

child < 3 years presenting with an acute limp: mx

A

urgent hospital assessment

530
Q

when is Men ACWY given?

A

13-18 years

531
Q

do antipyretics prevent further convulsions?

A

no

532
Q

in which gender only do x-linked recessive diseases manifest?

A

males

533
Q

what is important to remember about transmission in X-linked recessive diseases?

A

cannot be male-male (as father passes his Y-ch to son)

534
Q

which diseases follow a maternal pattern?

A

mitochondrial - if male - no chance of passing it on

535
Q

what type of disease is leber’s optic atrophy?

A

mitochondiral

536
Q

In an infant, the appropriate places to check for a pulse are the

A

brachial and femoral arteries

537
Q

G6PD deficiency - type of inheritance?

A

x-linked recessive

538
Q

when a child with LD lacks capacity to consent, and treatment is in her best interest - how many parents need to consent?

A

1

539
Q

first step in newborn resus for RDS as a fetus?

A

dry the baby

maintain temp and start the clock

540
Q

why can bruising at birth lead to raised bilirubin?

A

haemolysis

541
Q

when is jaundice always pathological?

A

in first 24 hours of life

542
Q

in england, what rights to parents have regarding their children’s treatment:

A

can overule to consent to treatment in patient’s best wishes, cannot demand or refuse treatment

543
Q

which heart defect is associated with fragile X?

A

mitral valve prolapse

544
Q

Fragile X cx:

A 
mitral valve prolapse, 
pes planus, 
autism, 
ADHD
memory problems 
speech disorders
545
Q

which lung disease is associated with Kartagener’s syndrome?

A

bronchiectasis

546
Q

what can G6PD deficiency do to gallstones?

A

pigmented

547
Q

where does measles rash start?

A

behind ears

548
Q

11/12m ED - rash started 2 days ago, initially behind the ears but spread.
Pre-rash coryzal sx.
Irritable, has white spots in his mouth and his eyes appear inflamed.

A

measles

Koplik spots

549
Q

10yom R knee pain. Past three months and lasts for several hours at a time. Antalgic gait and has apparent right leg shortening. What is the most likely diagnosis?

A

Perthes disease

550
Q

Cyanosis or collapse in first month of life, hypercyanotic spells. Ejection systolic murmur at left sternal edge

A

ToF

551
Q

early onset puberty in male where LH and FSH low:

A

gonadotrophin independent

eg. adrenal hyperplasia

552
Q

parents should call ambulance if febrile convulsion lasts?

A

> 5mins

553
Q

2/52 slow to establish on feeds. Past 7 hours he has been vomiting and the vomit is largely bile stained. On examination, he has a soft, scaphoid abdomen.

A

intestinal malroatation

554
Q

scaphoid abdomen and bilious vomiting is highly suggestive of

A

intestinal malrotation and volvulus

555
Q

1-day old emergency CS for RDS. Decreased air entry on L and displaced apex beat. scaphoid abdomen

A

CDH

556
Q

Displaced apex beat and decreased air entry are suggestive of

A

CDH

557
Q

before what age is hand preference abnormal?

A

12/12

558
Q

what does early hand dominance suggest?

A

CP

559
Q

what time period has to elapse before a child has another live vaccine after having one?

A

4 weeks

560
Q

CI to MMR:

A

severe immunosuppression
allergy to neomycin
received another live vaccine by injection within 4 weeks
pregnancy should be avoided for at least 1 month following vaccination
immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)

561
Q

if ?child abuse - what is likely RFs?

A 
frequent A/E attenders - see different doc each time
late presentation after injury
hx child abuse in family
torn frenulum
poor weight gain
562
Q

scarlet fever tx:

A

PO Penecillen 10/7

azithromycin

563
Q

What is the most appropriate way to confirm a diagnosis of pertussis

A

Per nasal swab

564
Q

Cyanotic congenital heart disease presenting within the first days of life is

A

TGA

565
Q

Cyanotic congenital heart disease presenting at 1-2 months of age is

A

TOF

566
Q

At what age do the majority of children achieve day and night time urinary continence?

A

3-4yo

567
Q

if find abdo mass in GP OE, what is appropriate mx?

A

refer to local paeds department

568
Q

6/52. term. has difficulty feeding due to increased wob. As the on-call doctor, you are called to review this baby. You witness the baby feeding and note she is pink and well perfused but sweating with an increased respiratory rate. On examination, you hear a soft pan-systolic murmur at the lower left sternal border.

What is the most likely underlying pathology? (general)

A

heart failure

569
Q

neonate needing resus team input:

A 
RR>60
grunting
HR< 100 / >160 
CRT> 3 seconds
38°C or above, or 37.5°C on 2 occasions 30 minutes apart
sats below 95%
presence of central cyanosis
570
Q

do people with CMP allergy normally resolve?

A

55% IgE mediated resolve by 5yo

571
Q

what needs monitoring every 6/12 in ADHD pts on methylphenydate?

A

height and weight

572
Q

electrolyte abnormality seen in pyloric stenosis?

A

hypochloremic hypokalaemic metabolic alkalosis

573
Q

APGAR score for newborns: 2 points for:

A 
HR>100
Resp effort - strong, crying
Colour- pink
muscle tone - active movement
reflex irritability - cries on stim/sneezes/cough
574
Q

APGAR score: 1 point

A 
HR<100
Resp effort - weak, irregular
colour - body pink, extremities blue
muscle tone - limb flexion
reflex irritability - grimace
575
Q

APGAR refers to:

A 
Appearance 
Pulse rate
Grimace?
Activity
Reflex irritability
576
Q

what condition is Down’s syndrome commonly associated with ?

A

hypothyroidism
lesser risk of hyper
risk of T1DM

577
Q

2-yom - not growing at the same rate as the other children.
Foul-smelling diarrhoea about 4-5 times a week, abdo pain.
Bloated abdomen and wasted buttocks. He has dropped 2 centile lines and now falls on the 10th centile.
Dx?

A

coeliac

578
Q

coeliac Ix:

A

IgA TTG Abs

579
Q

which vaccines at 12/12?

A

Hib/Men C + MMR + PCV + Men B

580
Q

when is croup presentation more common (season)?

A

autumn months

581
Q

UTI mx: infant <3/12

A

refer immediately to paediatrician

582
Q

UTI: infant >3/12 mx:

A

admission to hospital

583
Q

which pathogen commonly causes hand foot and mouth disease?

A

coxsackie a16

enterovirus 71

584
Q

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

A

hand foot and mouth

585
Q

in phimosis, what should be avoided in younger children?

A

forcible retraction of the foreskin

586
Q

in children <2, mx phimosis?

A

reassure and review in 6/12

in children this young this is normal and will commonly resolve on own

587
Q

when does moro reflex typically disappear?

A

4/12

588
Q

when does grasp reflex disappear?

A

5/12

589
Q

when does rooting reflex (helps during breastfeeding) disappear?

A

4/12

590
Q

when does stepping/walking reflex disappear?

A

2/12

591
Q

why may people with Turner’s syndrome get X-linked recessive disorders?

A

only have 1 X Ch

592
Q

what is Palivizumab and why is it sometimes given to prem babies?

A

Monoclonal Ab used to prevent RSV (bronchiolitis)

593
Q

15yom knee pain

relieved by rest and made worse by kneeling and sports activities?

A

Osgood-schlatter

594
Q

diagnostic Ix for NEC?

A

AXR

pathognomonic pneumatosis intestinalis (gas in gut wall)

595
Q

healthy infant - 1 week old

what ranges should RR and HR be

A

RR: 30-60
HR: 100-160

596
Q

which childhood infection has a prodrome characterised by fever, irritability and conjunctivitis?

A

measles

597
Q

commonest cause of headache in children?

A

migraine

598
Q

if 9/52 infant otitis media infection and temp >38 - mx

A

admit for paeds assessment

599
Q

risk factors: red light for feverish child

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
600
Q

if amber lights in feverish child: Mx:

A

safety net

601
Q

distribution of eczema rash in 10/12 old:

A

face and trunk

602
Q

homocystinuria: inheritance?

A

recessive

603
Q

how to mx transient hypoglycaemia in hours after birth?

A

observe and encourage early feeding

604
Q

which ix in <3/12 with fever :

A

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

605
Q

what needs to be screened for in children with Downs who play sports?

A

atlanto-axial instability > neck dislocation

606
Q

The oral rotavirus vaccine is given:

A

2+3 months

607
Q

4M -ED. Limping for the past 48 hours and pain in his right leg. He is normally fit and well, although has recently recovered from URTI. His BMI ‘healthy’ range and there is no history of trauma. dx?

A

transient synovitis

608
Q

undescended testicle - how long wait before referral?

A

6/12

609
Q

if medical mx of NEC but deteriorates - sx mx?

A

laparotomy

610
Q

Mx: meningitis in <3/12:-

A

IV amoxicillin and IV cetotaxime (not ceftriaxone in this age)
(covers for listeria)

611
Q

Mx:meningitis >3/12:-

A

IV Cefotaxime

612
Q

enlarging neck swelling that has been present for the past year. On examination you note a smooth midline lesion which is round and located just below the hyoid bone. It measures 2.5 cm x 2 cm and rises on protrusion of the tongue.

A

Thyroglossal cyst

613
Q

ocated in the anterior triangle, and are usually in the midline and below the hyoid. Typically, the cyst rises on protrusion of the tongue as well as on swallowing.

A

thyroglossal

614
Q

maternal steroid use in pregnancy increases the risk of:

A

DDH

615
Q

belly button is always wet and leaks out yellow fluid. On examination, you note a small, red growth of tissue in the centre of the umbilicus, covered with clear mucus.
Dx?

A

umbilical granuloma

616
Q

umbilical granuloma mx:

A

occurs in 1/5 babies resolves by 2yo

617
Q

If constipation - chronic, tried movicol, next step?

A

add senna

618
Q

X-linked recessive condition: mother is carrier, chances of passing it on?

A

50%

619
Q

risk factors for surfactant deficiency lung disease?

A

male sex
diabetic mothers
Caesarean section
second born of premature twins

620
Q

alpha-thalassaemia

A

deficiency in alpha chains of Hb

621
Q

how many alpha globulin genes are located on the chromosome coding for them and which Ch is this?

A

Ch16

2 genes on each ch16

622
Q

a-thalassaemia: If 1 or 2 alpha globulin alleles are affected then

A

hypochromic and microcytic, but the Hb level would be typically normal. ‘trait’

623
Q

a-thalassaemia: if 3alpha globulin alleles are affected

A

hypochromic microcytic anaemia with splenomegaly. This is known as Hb H disease. jaundice

624
Q

a-thalassaemia: if 4 alpha globulin alleles are affected:

A

(i.e. homozygote) then death in utero (hydrops fetalis, Bart’s hydrops)

625
Q

ADHD: dietary advice?

A

normal balanced diet

unless food diary shows relationship

626
Q

16-m - groin pain 3hrs. n+vomited x3. He recently had unprotected vaginal sex. Tenderness and swelling of the scrotum and left testicle, with absence of the cremaster reflex on the left side. Elevation of the affected testicle causes increased pain.

A

testicular torsion

627
Q

phren’s sign postitive??

A

epididymitis - elevation of the testicle relieves the pain

628
Q

newborn baby check shows jaundice - next appropriate step?

A

blood film

629
Q

autism: epidemiology - sex and onset age?

A

males 75%

<3 yo

630
Q

autism triad:

A

global impairment of language and communication
impairment of social relationships
ritualistic and compulsive phenomena

most children have reduced IQ

631
Q

associated conditions of Autism:

A

fragile X

Rett’s syndrome

632
Q

what needs measuring in jaundiced child urgently?

A

serum bilirubin level

633
Q

how to measure obesity in children?

A

BMI percentile adjusted for age and gender

634
Q

when can child use the palmar grasp?

A

5-6/12

635
Q

when can child draw circle?

A

3yo

636
Q

when can child stack tower of blocks 3-4 high?

A

18/12

637
Q

6/12 from Bangladesh. 1/52 coryzal symptoms. Not been feeding well for the past two days and started to vomit today. Coughing bouts so severe he turns red. No inspiratory or expiratory noises are noted. Clinical examination reveals an apyrexial child with a clear chest. What is the most likely diagnosis?

A

Pertussis

638
Q

hand foot mouth school exclusion?

A

no need

639
Q

13yof. Her systolic blood pressure is <100mmHg, and her respiratory rate is raised. She has a suspected source of this infection (respiratory tract). pyrexial - 39. With these vital signs, ->

A

?sepsis

640
Q

The most common fractures associated with child abuse are:

A
  • Radial
  • Humeral
  • Femoral
641
Q

5-year-old child presents to the emergency department complaining of right iliac fossa pain. On examination there is no rebound tenderness or guarding. Urine dipstick and routine bloods come back as normal. The mother reports that her daughter had a viral infection a few days ago.

A

mesenteric adenitis

642
Q

what is mesenteric adenitis and how mx?

A

inflamed lymph nodes within the mesentery. Similar sx to appendicitis. It often follows a recent viral infection and needs no treatment

643
Q

average child runs at what age?

A

16-24/12

644
Q

average child rides a tricycle:

A

3 years

645
Q

features of atypical UTI:

A 
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to abx by 48 hours
Infection with non-E. coli organisms.
646
Q

4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face

A

scarlet fever

647
Q

3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted

A

rubella

648
Q

death is defined as babies dying between 0-28 days of birth?

A

neonatal death

649
Q

Puerperal death

A

maternal death within the puerperal period <6/52

650
Q

Perinatal death

A

deaths that are a result of obstetric events, the term encompasses stillbirths and deaths within the first week of life

651
Q

An 8-M -> ED severely short of breath and wheezy. He is extremely short of breath and cannot complete sentences fully. His peak expiratory flow rate is 300 l/min (40% of normal). His oxygen saturations are 93%. His pCO2 is 4.9 kPa.
Which of the above is most concerning?

A

normal pCo2 in an acute asthma attack is life-threatening

652
Q

Life threatening asthma sx:

A 
Cyanosis
Poor respiratory effort
Peak expiratory flow rate < 33%
Silent chest
Altered level of consciousness
653
Q

Pain after exercise

Intermittent swelling and locking

A

Osteochondritis dissecans

654
Q

transient synovitis mx:

A

analgesia and rest - it is self-limiting

655
Q

cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?

A

Meckel’s diverticulum

656
Q

describe Meckel’s diverticulum:

A

congenital diverticulum of the small intestine
remnant of the omphalomesenteric duct
contains ectopic ileal, gastric or pancreatic mucosa

657
Q

mx: meckel’s diverticulum:

A

sx

658
Q

Patients with cystic fibrosis should follow which lifestyle related rule??

A

minimize contact with eachother to decrease the risk of cross-infection

659
Q 
usually presents in childhood, e.g. Failure to thrive
polyuria, polydipsia
hypokalaemia
normotension
weakness
A

Barrter’s syndrome

AR

660
Q

acute exacerbation of asthma: tx:

A

oral pred 3-5/7

661
Q

Idiopathic thrombocytopenic purpura may be preceded by

A

a self-limiting viral infection (eg glandular fever)

662
Q

addisons?

A

primary adrenal insufficiency

hypocortisolism

663
Q

children below which centile for height should be referred to a paediatrician?

A

0.4th

664
Q

most likely causative agent of a bacterial pneumonia in children

A

streptococcus pneumoniae

665
Q

vocabulary of between 20-50 words and will be able to join 2 words with meaning. age?

A

24/12

666
Q

4 week old formula fed infant to the short stay paediatric ward. They are concerned because he has persistent non-bilious vomiting and is becoming increasingly lethargic. Despite this, his appetite is substantial. On examination, he appears pale and you can see visible peristalsis in the left upper quadrant. What is the most likely diagnosis?

A

pyloric stenosis

667
Q

14-month-old girl present to their GP. They have noticed that in some photos there is no ‘red eye’ on the left hand side. When you examine the girl you notice an esotropic strabismus and a loss of the red-reflex in the left eye. There is a family history of a grandparent having an enucleation as a child. What is the most likely diagnosis?

A

retinoblastoma

668
Q

Retinoblastoma features:

A

absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
strabismus
visual problems

669
Q

Mx: retinoblastoma:

A

enucleation
external beam RT
chemo
photocoagulation

670
Q

average child hops on one leg?

A

3-4yrs

671
Q

average child pulls to standing?

A

8-10/12

672
Q

squats to pick up ball average age?

A

18/12

673
Q

episodes of cyanosis are usually worst during feeding. Improvement may be seen when the baby cries

A

choanal atresia

674
Q

choanal atresia:

A

Posterior nasal airway occluded by soft tissue or bone.
Associated with other congenital malformations e.g. coloboma
Babies with unilateral disease may go unnoticed.
Babies with bilateral disease will present early in life as they are obligate nose breathers.
Treatment is with fenestration procedures designed to restore patency.

675
Q

what can cause bronchiolitis to be more severe?

A

underlying congenital heart condition (VSD)

676
Q

what is worth being aware of re sats in first 10 mins of life?

A

often innacurate

677
Q

DDH in a child >4.5 months: first line ix:

A

XRay

678
Q

definition of short stature?

A

standing below the 2nd centile height for age

679
Q

2 endocrine conditions that cause short stature?

A

hypothyroid

cushings

680
Q

2 risk factors for prematurity?

A

Multiple pregnancy, pre-eclampsia, cervical insufficiency, uterine growth insufficiency, low socioeconomic status, APH

681
Q

what criteria for child with special educational needs? (2)

A

physical disability preventing them from accessing education facilities
significant congnition difficulty in learning compared to majority of children their age

682
Q

first trimester test for downs syndrome?

A

combined test

683
Q

a 6-year-old child with a vesicular skin lesion underneath his nose with a honey coloured crust. During the consultation, the child rubs it and a lesion ruptures and fluid exudates. Dx and causative organism?

A

Impetigo

saureus/srep pyogenes

684
Q

impetigo school exclusion?

A

until 48 hours after abx started or until the lesions have crusted over - incredibly infectious

685
Q

impetigo abx?

A

topical fusidic acid is first-line

topical retapamulin is used second-line if fusidic acid has been ineffective or is not tolerated

686
Q

if impetigo extensive disease, which abx?

A

flucloxacillin

687
Q

HIV related organism pneumonia ?

A

pneumocystis jiroveci

688
Q

how will bacterial meningitis show in CSF?

A

turbid
neutrophils
protein +++
glucose low —

689
Q

viral CSF analysis?

A

clear
lymphocytes
normal or raised protein
normal or low glucose

690
Q

causes of meningitis in newborns:

A

listeria monocytogenes,
Ecoli
GBS

691
Q

causes of meningitis older children:

A

neisseria meningitdis
Hib
Strep pneumo

692
Q

causes meningitis adults:

A

neisseria meningitidis
strep pneumo
listeria monocytogenes

693
Q

if suspect bacterial meningitis in community: immediate mx?

A

IM benpen

694
Q

which antibiotic prophylaxis for household contacts of bacterial meningitis patients?

A

Rifampicin

Ciprofloxacin

695
Q

JIA mx:

A 
NSAIDs
MTX, sulfasalazine - DMARDS
Atalidimab, Retuximab
Steroids (cx)
Joint injections
696
Q

commonest cause of septic arthritis:

A

saureus

gonorrhoea (if sexually active)

697
Q

Maculopapular rash ddx:

A

measles, rubella, scarlet fever, kawasaki

698
Q

petechial rash ddx (non-blanching):

A

meningococcal
Henoch-schurlein purpura
thrombocytopaenia

699
Q

pustular (hemispherical lesions, purulent fluid) ddx:

A

impetigo

scalded skin

700
Q

what is a potential cause of aspirin in children ??

A

Reye’s syndrome

701
Q

rash + vom ->

or blood in stool + vom ->

A

think CMPI

702
Q

DKA sx:

A 
abdo pain
vomiting
loss GCS
polyuria
hypokalaemia
703
Q

Stridor: URTI?

A

yes

704
Q

Wheeze: LRTI/URTI?

A

LRTI

705
Q

risk factors for bronchiolitis?

A

prematurity
congenital heart defect
smoke, bottle fed, high exposure to other children in nursery

706
Q

CF bacteria infections:

A

saureus
pseudomonas auriginosa
aspergillus

707
Q

CF sx:

A 
meconium ilius
fail to thrive
recurrent infections
steatorrhoea 
neonatal jaundice
bronchiectasis 
rectal prolapse
708
Q

UTI in children causes:

A

ecoli
proteus
pseudomonas

709
Q

UTI (lower) >3/12: mx:

A

trimethoprim, nitrofurantoin, cephalosporin or amoxicillin

710
Q

causes of proteinuria in children:

A

nephrotic syndrome
DM1
infetions

711
Q

4 areas of development:

A

gross motor
fine motor and vision
speech language and hearing
social and play

712
Q

when and how do you image to assess CP lesion?

A

MRI age 2

713
Q

which abx would you give all premature babies in neonatal unit and what are you concerned about?

A

Benzylpenecillin - GBS -> neonatal sepsis

714
Q

hypoglycaemic premature baby tx:

A

dextrose 10% + fluids

parenteral nutrition

715
Q

how to assess jaundice in newborn?

A

SBR score

716
Q

biliary atresia? when will it present and what type of bilirubin and what mx?

A

> 14 days - jaundice, appetite, growth disturbance
conjugated bilirubin
Kasai procedure

717
Q

if Rh + baby born to a Rh - mother: blood is taken from the cord to sample for:

A

FBC
Blood group
Direct coomb’s test:
- looking for Rh Ags on RBCs

718
Q

if blue sclera and many fractures in childhood ->???

A

osteogenesis imperfecta

719
Q

wha is inheritance of OG imperfecta?

A

AD

720
Q

what is childhood version of osteomalacia?

A

Ricket’s - vit D def

721
Q

initial mx of the congenital heart condition hypoplastic left heart syndrome?

A

Alprostadil

722
Q

2/7 hx fever, sore joints
migrants
post-viral illness
pain, swelling moves jt-jt radnomly

A

Rheumatic fever

Group A strep

723
Q

what does anal fibroids and recurrent utis suggest in child?

A

child sex abuse

724
Q

NF1: inheritance?

A

autosomal dominant

725
Q

cafe-au-lait patches? 6+?

A

NF1

726
Q

Tubular sclerosis inheritance?

A

autosomal dominant

727
Q

ash leaf and shagreen patches in which condition?

A

tubular sclerosis

728
Q

duchenne muscular dystrophy inheritance?

A

x-lined recessive
But female carriers can be symptomatic if lyonisation
test CK
(associated with dilated cardiomyopathy)

729
Q 
single palmar crease
upslanting eyes
flat nasal bridge
large saddle gap. 
dx?
A

downs

730
Q

abdo pain, purpuric (non-blanching rash), clinically well. rash on leg and buttocks. some arthralgia. dx?

A

HSP

731
Q

thalassaemia iheritance:

A

recessive

732
Q

complication of bacterial otitis media?

A

mastoiditis

733
Q

rules for tonsilectomy?

A

> 7 /yr
5 /2yr
3 subsequent 3 yr

734
Q

paeds acute asthma mx:

A 
O SHImT
o2
salbutamol
Hydrocortisone / pred
Ipratropium nebs 
Mg So4
Tube - intubate - anaes
735
Q

inguinal hernia in 4/12M - mx?

A

surgical reduction <2/52
< 6 weeks old = correct within 2 days
< 6 months = correct within 2 weeks
< 6 years = correct within 2 months

736
Q

A 1-day-old neonate is noticed to have non-projectile bilious vomiting. They were born at 39 weeks to a 47-year-old mother. At the 11-week scan the nuchal thickness was 4mm. What is the most likely underlying diagnosis?

A

bilious vomiting on day 1 = duodenal atresia
trisomy 21
AXR: double bubble sign

737
Q

A male infant is born by spontaneous vaginal delivery at 39 weeks gestation. He is well after the birth, established on bottle feeding and discharged home. His parents are concerned because he subsequently becomes unwell and vomits a large quantity of bile stained vomit approximately 2 days after discharge home. Looks ill and his abdomen is soft and non distended. dx?

A

intestinal malrotation

738
Q

A 2-year-old has a history of rectal bleeding. The parents notice that post defecation, a cherry red lesion is present at the anal verge. dx?

A

juvenile polyps

739
Q

Start IV fluid resuscitation in children or young people with a bolus of?

A

20ml/kg <10mins

740
Q

how to reduce the chances of severe brain damage in neonates with hypoxic injury?

A

therapeutic coolin 33-35 degrees

741
Q

what is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis?

A

chickenpox

742
Q

should be considered in infants with vague signs such as poor feeding, grunting, lethargy?

A

neonatal sepsis

743
Q

most common presentation of neonatal sepsis?

A

grunting and other respiratory distress sx

744
Q

children under 5 years old with diarrhoea and vomiting caused by gastroenteritis??

A

ors - never anti-diarrhoeals -> hus

745
Q

steroids in <3/12 -

A

NO

3a (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions