Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Y4 Exam Practice > Child Health SAQs and SBAs > Flashcards

Child Health SAQs and SBAs Flashcards

(84 cards)

Start Studying
1
Q

What investigations should be considered in a well child with suspected ADHD?

A

none needed

Blood testing can be considered once a patient has been diagnosed with ADHD and the management plan is to start stimulant medication. The side-effects of stimulant medication can lead to leucopoenia, pancytopenia and hepatic coma, and so it can be useful to show baseline normal function (FBC, LFTs).

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

3 main impairments in ADHD?

A

Attention deficit, hyperactivity and impulsivity

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

Give some screening tools that can be used in the assessment of ADHD

A

Conners Questionnaire
Dundee Difficult Times of the Day Scale (D- DTODS)
SNAP – IV
Strengths and Difficulties questionnaire

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

If this patient had a family history sudden death in a first-degree relative under 40 years of age suggesting a cardiac disease, what would you do prior to starting possible ADHD medication?

A

24-hour ECG tape monitoring, ECG with calculation of QTc
Blood pressure measurement
Echocardiogram

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

What should be monitored in a child on stimulant medication?

A

height, weight, pulse and BP

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

What clinical features suggets a bacterial cause of CAP?

A

Age < 2 years
Absence of rhinorrhoea
Absence of wheeze
Temperature > 38.5°C
Presence of localised pain

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

What features suggest severe CAP in an infant?

A

RR > 70/min
CRT > 2 sec
Nasal flaring
Intermittent apnoea
Grunting
Unable to feed

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

What features suggest severe CAP in an older child?

A

RR >50/min
CRT > 2 sec
Unable to complete sentences
Severe recessions
Nasal flaring
Signs of dehydration

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

Spot diagnosis: young infant child with acute onset cough and respiratory distress following a short coryzal prodrome (runny nose) and with clinical signs of fine crepitations audible in all areas

A

bronchiolitis

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

Evidence based tx options for bronchiolitis?

A

supplemental oxygen where needed (SpO2 ≤ 93%) and help with feeds/fluids (NG feeds or IV fluids).

Nebulised 3% saline may improve symptoms of mild to-moderate bronchiolitis and reduce hospital stay.

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

An acute onset of CAP (without a coryzal prodrome) in a toxic child suggests what?

A

bacterial origin

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

Give 3 causes of acute onset stridor

A

anaphylaxis
epiglottitis
inhaled foreign body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is epiglottitis decreasing in prevalence in the UK?

A

due to widespread uptake of the Hemophilus influenzae vaccine

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

Besides nephrotic syndrome, what can cause oedema in kids?

A
  1. Increased hydrostatic pressure from sodium and water retention – heart failure, renal failure, acute glomerulonephritis and drugs (antihypertensives).
  2. Increased capillary pressure from obstruction - venous obstruction, cirrhosis
  3. Decreased capillary oncotic pressure – protein malnutrition, protein losing enteropathy
  4. Lymphatic obstruction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What baseline investigations may be done for suspected minimal change disease?

A

Urinalysis for blood and protein
Protein:creatinine ratio
(early morning sample if possible)

Full blood count
Electrolytes, urea and creatinine
Bone profile (including albumin)
Varicella zoster immunity status

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

Give 3 steps in the mx of an acutely oedematous child with nephrotic syndrome

A
  1. Admit to paeds ward
  2. Prescribe oral penicillin V prophylaxis to protect against pneumococcal infection
  3. oral prednisolone to induce remission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give 2 recognised complications of nephrotic syndrome

A

Peritonitis : Depressed immunity predisposes children with NS to infections with encapsulated bacteria such as streptococcus pneumonia. Antibiotic prophylaxis and pneumococcal vaccination are recommended.

Thrombosis: hypercoagulable state due to urinary loss of antithrombin III, exaggerated by steroid therapy and increased blood viscosity from the raised haematocrit

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

Give the criteria for renal USS in a child with a UTI

A

Criteria for renal ultrasound are as follows:

  1. Infant <6 months old. Renal US within 6 weeks
  2. Atypical UTI as defined by:
    * Seriously ill.
    * Poor urine flow.
    * Abdominal/bladder mass.
    * Raised creatinine.
    * Septicaemia.
    * Failure to respond to antibiotics within 48 hours.
    * Infection with non-E. coli organism
  3. Recurrent UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How will you monitor the efficacy of a new asthma treatment in a 4 year old?

A

Clinic review after 6 weeks, symptom diary

spirometry and peak flow measurements are unreliable in children under 5 years old and can therefore not be used to monitor asthma management

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

What should you do for an asthmatic child with a new night-time cough despite previously being well-controlled?

A

Check concordance
Check inhaler technique
Exclude other concomitant cause of cough
Increase asthma preventer treatment

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

The risk factors for severe (or life-threatening) asthma are:

A

Previous near-fatal asthma e.g. previous ventilation or respiratory acidosis

Previous admissions for asthma, especially in the last year

Repeated ED attendance for asthma care, especially in the past year

Requiring three or more classes of asthma medication

Heavy use of SABA

Brittle asthma

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

A 11-year-old boy presents to ED because his urine has changed colour (now rusty like CocaCola). He has no other urinary symptoms, nor any associated fever, rash, abdominal pain or weight loss. He was previously well although did have peri-oral impetigo about 3 weeks ago. There is no family history of medical significance.

On examination the only abnormal findings are an elevated blood pressure and oedema of his feet and ankles. His urine dipstick shows 3+ of protein and 4+ of blood.

Which is the most likely diagnosis? What test would help to confirm this?

A

Post-streptococcal glomerulonephritis

Anti-streptolysin O titre (ASOT)

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

What would suggest a glomerular cause of haematuria?

A

Red cell casts visible on urine microscopy

Rusty coloured urine - secondary to red cell damage by glomerular filtration

Raised blood pressure - as a consequence of decreased glomerular filtration and sodium and water retention.

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

If haematuria is associated with abdominal pain, which conditions should be considered in the differential diagnosis?

A

Henoch-Schonlein purpura

Nephrolithiasis: Renal stones or calculi are uncommon in children, but should be considered in those with abdominal pain, loin pain and haematuria. Renal ultrasound is the first investigation

Urinary tract infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Define CKD in children
1. Structural abnormalities of the kidney seen on imaging, 2. Functional abnormalities within the kidney e.g. elevated urea or creatinine. 3. Abnormal GFR (<60ml/min/1.73m2)
26
Give complications of CKD in children
Anaemia: due to decreased erythropoietin production by the kidneys (normocytic normochromic) Hyperuricaemia: due to decreased urinary excretion. Raised levels are also independent risk factor for the progression of the disease Bleeding tendency: increase in urea results in abnormal platelet adhesion and aggregation Electrolyte abnormalities. Metabolic acidosis with low sodium and increased potassium Intellectual impairment, Growth impairment Cardiovascular disease. Due to the presence of dyslipidaemia and hypertension
27
What questionnaire can be used to assess for autism?
GARS questionnaire
28
What additional information might be helpful when considering a diagnosis of autism?
Family history of Autism Parental views about a diagnosis School report Speech and language therapy assessment Educational psychology assessment
29
What other co-morbid issues can be associated with having a diagnosis of Autism?
ADHD Anxiety issues Epilepsy Learning difficulties Sleep problems
30
What is the rule of 2's for lymphadenopathy?
Investigate if: >2 LN palpable for >2 weeks >2cm in size 2 or more regions affected
31
What is the general approach to supraclavicular lymphadenopathy?
it often reflects mediastinal disease and should always prompt investigation
32
Lymph nodes of variable size and consistency should make you consider what?
TB
33
Red flags sxs with lymphadenopathy?
Fever, weight loss and night sweats with lymphadenopathy should trigger prompt referral for early biopsy
34
Which areas are essential in your examination of a child with a limp?
Abdomen - Abdominal pathology like appendicitis can cause referred hip pain Axilla and groin - lymphadenopathy, hepatosplenomegaly Hips - Knee pain can be referred from the hip, and thigh pain can be referred from the spine or sacroiliac joints Scrotum Spine
35
What are common pitfalls and missed diagnoses in the assessment of hip pain?
Failure to recognise previous limping issues suggestive of chronic rather than acute disease - DDH, Perthes disease and JIA Not correctly localising the source of the pain e.g. incorrectly diagnosing knee pain rather than hip pain - SUFE Not identifying bone pain as source of pain or tenderness - haematological or bone tumours Not checking for lymphadenopathy or hepatosplenomegaly - cancer Not examining the abdomen - Appendicitis Not examining the scrotum - testicular torsion
36
A 12 year old boy who is systemically well presents with an acute onset limp. What are the likely ddx?
SUFE Trauma transient synovitis (irritable hip) and Perthe's disease affect younger children JIA and septic arthritis would cause the child to be systemically unwell
37
How can slipped upper femoral epiphysis be investigated?
X-ray of the hip Klein’s line is drawn along the superior border of the femoral neck and should intersect with the growth plate. Failure to do so suggests early SUFE.
38
A boy aged 3 years, presents to ED. He woke this morning complaining of pain in his right leg. He was able to walk but with a limp, but now is refusing to stand and weight bear or sit down preferring to lie. His presentation is consistent with a diagnosis of either transient synovitis or acute septic arthritis. Which clinical features are more suspicious of septic arthritis?
fever >38.5°C, inability to weight bear, ESR >40 and white cell count >12x109/L
39
Which investigations are recommended for suspected septic arthritis of the hip?
Bloods- WCC, ESR, CRP Blood culture USS - helps to identify joint effusion X-ray - always done as a baseline
40
What is a limp?
used to describe a shortened’ stance phase’ in the gait cycle where an individual ‘hurries’ off one leg to offload a source of pain – better described as an antalgic gait.
41
Which conditions are associated with haemolytic anaemia in children?
G6PD deficiency Beta-thalassaemia trait Megaloblastic anaemia Sickle cell disease
42
What is a Direct Coombs test (DCT)?
used to determine whether the haemolysis is immune (positive - mediated by antibodies IgM or IgG) or non-immune (negative) It must be requested in patients who present with haemolysis
43
Apart from G6PD, name 2 conditions associated with haemolytic anaemia that present with a negative DCT.
Disseminated Intravascular Coagulation Haemolytic Uraemic Syndrome
44
Outline the pathophysiology of DIC
DIC is a microangiopathic haemolytic anaemia. The endothelial layer of small vessels is damaged with resulting fibrin deposition and platelet aggregation. As red blood cells travel through these damaged vessels, they are fragmented resulting in intravascular haemolysis. The resulting schistocytes are also increasingly targeted for destruction by the reticuloendothelial system in the spleen
45
Outline the pathophysiology of haemolytic uraemic syndrome
HUS is a microangiopathic haemolytic anaemia. The Shiga toxin which is produced by Escherichia coli results in damage of the small vessels and haemolytic anaemia. Associated features include low platelets and renal failure with raised blood pressure
46
Give some non-immune (DCT negative) causes of haemolytic anaemia
Abnormal Hb: Sickle-cell, thalassaemias Red cell enzyme defects: G6PD deficiency, pyruvate kinase deficiency Red cell membrane defects: Hereditary spherocytosis, elliptocytosis HUS Thrombotic thrombocytopaenic purpura Micro-angiopathic anaemias: prosthetic valves, haemangiomas, DIC
47
Give some Immune (DCT positive) causes of haemolytic anaemia
Rhesus incompatibility ABO incompatibility Autoimmune (warm, cold antibody) SLE, Rheumatoid arthritis Infections: mycoplasma, CMV, EBV Drugs, malignancy Paroxysmal cold haemoglobinuria
48
Most common cause of macrocytic anaemia in children?
use of certain medication, such as anticonvulsants, zidovudine and immunosuppressant medications
49
Give 5 causes of macrocytosis in children
Aplastic anaemia Blackfan-Diamond syndrome Hypothyroidism Liver disease Vitamin B12 deficiency
50
Give some causes of microcytic anaemia
TAILS Thalassemia Anaemia of chronic disease IDA Lead poisoning Sideroblastic anaemia
51
Presence of jaundice and pallor is typical of what type of anaemia?
haemolytic anaemia
52
In what conditions would you find target cells?
post-splenectomy, haemoglobinopathy, severe iron deficiency
53
In what conditions would you find Anisocytosis (different sized RBCs) ?
iron deficiency anaemia, beta-thalassaemia, megaloblastic anaemia
54
In what conditions would you find Howell-Jolly bodies?
Beta-thalassaemia, megaloblastic anaemia, post-splenectomy
55
In what conditions would you find Poikilocytosis?
Beta-thalassaemia, severe iron deficiency
56
In what conditions would you find Heinz bodies?
Red cell enzyme defects
57
In what conditions would you find spherocytes?
Hereditary spherocytosis, immune haemolytic anaemia, severe burns, post transfusion
58
In what conditions would you see Basophilic stippling?
Lead poisoning, beta-thalassaemia
59
What would you see on blood film post splenectomy?
Howell-Jolly bodies, acanthocytes, target cells, schistocytes
60
What are the contraindications to a child receiving a live vaccine?
Previous anaphylaxis to a vaccine or vaccine component (e.g. neomycin, gelatine) Primary or acquired immunodeficiency Immunosuppressive therapy Contact with individuals with immunodeficiency or current/recent immunosuppressive therapy
61
When might a vaccine be temporarily deferred?
Acutely unwell e.g. with fever >38.5°C - postpone immunisation until well Immunoglobulin therapy - may interfere with immune response of live vaccines
62
Which of the routine vaccines in the UK are live?
rotavirus, MMR, nasal flu ± BCG
63
Adverse events following immunisation (AEFI) are common - true or false?
true - 1/10 children
64
AEFIs are more likely where there is a family history of AEFIs - true or false?
false
65
AEFI can be vaccine specific and differ between individual vaccines - true or false?
true
66
Systemic AEFIs like fever and irritability do not contraindicate further vaccination - true or false?
true
67
‘Vaccine hesitancy’ or ‘delay or refusal to vaccinate in the presence of services’ is the main reason for children being under vaccinated. True or false?
false
68
Which children are at risk of undervaccination?
Children in large families Children with single parents Looked after children Children in mobile families Migrant/asylum seeking children. Children with disabling or chronic conditions Children in ethnic minority groups.
69
Causes of a waddling gait?
Hip pain e.g. DDH, SUFE, Perthes disease Proximal myopathy e.g. Duchenne MD
70
Give some causes of a foot drop ' high steppage' gait?
Common peroneal nerve palsy Peripheral neuropathy
71
How can a child with suspected cerebral palsy be investigated?
An MRI Brain and spine would be needed to identify any obvious underlying insults of the child’s brain. In a child born very prematurely with a difficult neonatal course and clinical signs of possible cerebral palsy, a common finding is of periventricular leukomalacia (PVL), an abnormality of the white matter of the brain.
72
A child with cerebral palsy is provided with insoles, splints and supportive footwear but still continues to encounter difficulties due to the position of his feet. This is adversely affecting his gait, causing pain and localised friction from his splints. What are your options now?
Analgesia Contact orthotics to review splints Refer to orthapaedics: Botox therapy Serial casting
73
A baby is born a 28-weeks’ gestation. The pregnancy was unremarkable until spontaneous rupture of membranes at 28-weeks’ gestation. At this gestational age the baby is at high risk of respiratory distress syndrome because of surfactant deficiency. Which antenatal treatment (administered to the mother) would be the best option to help the baby?
Antenatal steroids followed by infusion of magnesium during labour Magnesium now given as routine in preterm deliveries to improve the neurodevelopmental outcome of the baby
74
Is saturations of 91% at one minute a sign of RDN?
not necessarily - Oxygen saturations can take up to 10 minutes to achieve adult levels
75
What would be the best intervention to start in a baby with RDN?
CPAP has been shown to improve the outcome if started early
76
What is the prognosis of tension pneumothorax following RDN?
Approx. 80% chance of survival. Chance of moderate disability around 10%
77
With regards to bruising, which of the following scenarios would cause you to be suspicious of non-accidental injury (NAI)? Bruising on the elbows Bruising on the face Bruising on the pinna of the ear Bruising on the shins Circular bruising on the chest
Bruising on the face Bruising on the pinna of the ear Circular bruising on the chest
78
Give some risk factors for child abuse
1. Child disabled, ‘wrong’ gender, ‘difficult’ child. born after rape or commercial sex 2. Parent/carer mental health problems alcohol, drug abuse 3. Family young parental age multiple/closely spaced births step-parents domestic violence social isolation or lack of social support poverty, poor housing
79
Give 4 fractures that raise suspicion of NAI
Metaphyseal corner fractures Posterior rib fractures Spiral fracture of the humerus Spiral fracture of the femur
80
Give some investigations are considered first-line in a child who presents with a fracture due to suspected NAI?
FBC - malabsorption disorders that reduce bone strength Alkaline phosphatase Calcium and phosphate Skeletal survey
81
What is the genetic abnormality that causes Down's syndrome?
Non-disjunction trisomy 21
82
Give 3 risk factors for Down's syndrome
A parent with a translocation mutation of chromosome 14 and 21 Advancing maternal age Having already had a child with DS
83
A baby girl with DS is kept in hospital for a couple of days under the paediatric team to complete some important screening investigations before she is discharged. Which screening investigations should be completed before discharge?
FBC TFT Hearing screen
84
Which cardiac abnormality is commonest in DS?
Atrioventricular septal defect

Y4 Exam Practice (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions