extra

Question 1

biggest risk factor for still birth

Answer 1

foetal growth restriction

Question 2

biggest risk facotr for neonatal death

Answer 2

maternal age under 25 or over 40

Question 3

non productive cough , tachypnoea and intercostal recession in a child under 1 year of age suggestive of

Answer 3

bronchiolitis

RSV
hosp
humidified oxygen via a head box and may requrie nasogastric feeding

Question 4

what is potters syndrome

Answer 4

Potter’s sequence describes the typical physical appearance caused by pressure in utero due to oligohydramnios. The olighydramnios can occur due to a range of variety of reasons. When it is a result of bilateral renal agenesis, it is called Potter Syndrome.

It is called Potter sequence to reflect that the phenotype results due to a sequence of events resulting form the oligohydramnios:

Renal tract complications result in reduced amniotic fluid production
The lack of amniotic fluid results in foetal compression causing the characteristic facial and limb features
The lack of amniotic fluid also affects lung development, causing pulmonary hypoplasia

Question 5

signs of potters syndrome

Answer 5

Facial signs include:

Flattened ‘parrot-beaked’ nose
Recessed chin
Downward epicanthal folds
Low-set, cartilage-deficient ears (known as ‘Potter’s ears’)
Pulmonary hypoplasia can result in the baby having respiratory distress at birth.

Question 6

measles diagnostic investigation

Answer 6

PCR test for m mRNA
if after 48hr measles specific immunoglobulin M - IGm and IgG serology

Question 7

raised immuno reactive trypsinogen suggestive of what

Answer 7

cf

Question 8

baby with sleepy, jaundice, hypotonia, macroglossia, umbilical hernia, reduced feedingand constipation

Answer 8

congenital hypothyroidism

Question 9

heel prick tests for

Answer 9

congenital hypothyroidism - high TSH
CF - raised immuno-reactive trypsinogen
phenlketonuria - raised phenylalanine
maple syrup urine disease
sickle cell - Hbs
MCAD - rasied acylcarnitine level
homocysteine urea
glutaric acid urea
isovalric acidemia

Question 10

when is the heel prick test done

Answer 10

5-8 days of life

Question 11

juvenile idiopathic arthritis
under what age and swelling for how long

Answer 11

children <16 years old who have persistent joint swelling (>6 weeks)

Question 12

Intussusception describes invagination (telescoping) of proximal bowel into a distal segment (commonly ileum) passing into the caecum through the ileocaecal valve.

3 motnhs to 2 years

sx

Answer 12

May refuse feeds
Vomiting may be bile stained depending on site of intussusception
Passage of redcurrant jelly stool compromising of blood-stained mucus
Abdominal distension
Sausage-shaped mass may be palpated in the abdomen

Question 13

intersusseption what would abdo US show

Answer 13

‘target’ sign (concentric echogenic and hypoechogenic bands) and can also show complications of disease such as free-abdominal air or presence of gangrene.

Question 14

mx of intersusspetion

Answer 14

Rectal air insufflation or contrast enema (only to be performed if child is stable)
Operative reduction indicated if –
Failure of non-operative management
Peritonitis or perforation is present
Haemodynamically unstable

Question 15

delayed pubtery at age 14 what investigation is the most important

Answer 15

x ray of hamds and wrist to assess bone age which would tell you

Question 16

delayed pubtery defintion by what age in both men and women

Answer 16

Delayed puberty is classed as no pubertal development by the age of 14 in boys and 13 in girls.

Causes

Question 17

rare causes of delayed pubtery

Answer 17

Other (much less common) causes of delayed puberty include those associated with low and high gonadotrophin secretion.

Low gonadotrophin secretion induces pituitary disorders (craniopharyngiomas, Kallmann syndrome, panhypopituitarism or isolated gonadotrophin deficiency), hypothyroidism, or systemic disease (e.g. cystic fibrosis or Crohn’s).

High gonadotrophin secretion causes include chromosomal disorders (Turner’s XO, Klinefelter’s XXY), congenital adrenal hyperplasia, or acquired hypogonadism (e.g. after chemotherapy)

Question 18

What is hypoechoic area

Answer 18

Opening of the spinal cord suggestive of spinal bifida

Question 19

Is US better at looking af fluids or bone

Answer 19

Fluids - hard to look at foetal brain as bone becomes thicker

Question 20

In part of treatment for CIN what is given to help identify cells in high nuclear protein indicating cytological abnormality

Answer 20

Acetic acid

Question 21

Threatened miscarriage give mifepristone 400mg BD and progesterone given till week 16 . Incomplete m or missed m offer misoprostoo 800mg

From what week do we do MVA or surgical

Answer 21

Under 10 weeks some 14 weeks

Question 22

How much anti-D immunoglobulin do you offer as part of prophylaxis to all Theseus negative women who have a surgical procedure to manage an ectopic or miscarriage

Answer 22

250 IU or 50micrograms

Question 23

Who do you not offer anti-D immunoglobulin prophylaxis to women who

Answer 23

Receive solely medical management for an ectopic pregnancy or miscarriage or
Have a threatened miscarriage
Complete miscarriage
Pregnancy of unknown location

Do not do a kleihauer test for quantifying feto-maternal haemorrhage

Question 24

Trans placenta drugs

Answer 24

Arrhythmias - digoxin, flecanide, Sotolol, salbutamol
Carbimazole
Abx and steroids

Congenital diaphragmatic hernia , pulmonary hypoplasia - balloon placed inside trachea 27-29 weeks taken out and punctured at 34 weeks

Question 25

If a baby has high levels of conjugated hyper bilirubinaemia what do you give

Answer 25

Total parenteral nutrition TPN is a method of feeding that bypasses the GI tract

Question 26

genetic condition in which an infant is born with micrognathia (small jaw), glossoptysis (posterior tongue) and often cleft palate. As a result the infant may have breathing or feeding difficulties shortly after birth.

Answer 26

Pierre Robin sequence

Initial management involves airway management and feeding support. Physiological effects usually resolve within 3–6 months however surgical repair may be indicated, particularly in cases which co-exist with a cleft palate. Most babies with Pierre Robin sequence will grow up to lead healthy adult lives.

Question 27

recurrent Otis media what we thinking

Answer 27

turner syndrome

Question 28

orbital cellulitis linked with bacterial sinusitis what investigation should you do

Answer 28

CT orbit - depth of infection and if any abcesses or anythign like that

Question 29

indications fro tonsil removal

Answer 29

The indications for tonsillectomy in recurrent tonsillitis are seven or more episodes in a single year, five or more episodes/year in two years, or three or more episodes/year in three years

Question 30

This child presenting with a pulmonary ejection murmur and a fixed split second heart sound has an

Answer 30

Atrial septal defect

Question 31

bilous green vomit 3 day post birth and lost of crying what is it

Answer 31

Malrotation is a rare but extremely important diagnosis to make. In malrotation, early in development the midgut rotates and fixates in an abnormal position. This abnormal position makes the bowel more prone to volvulus and for the duodenum to be compressed by peritoneal bands (Ladd bands).

Question 32

dx and mx of malrotation

Answer 32

Bilious vomiting within the first day of life
Diagnosis
The diagnosis of malrotation is confirmed with an upper gastrointestinal contrast study, which will identify the point of the obstruction (as no contrast can pass distally from this location). The proximal bowel may be shaped like a corkscrew.
Management
Malrotation must be managed with urgent surgery to relieve the obstruction.

Question 33

A 15 year old girl has developed a rash on her face and hands. The rash is non-pruritic. She reports feeling weak and lethargic over the last two weeks. She has felt feverish but has not checked her temperature. She is otherwise well.

Answer 33

thinking SLE - so ANA

juvenille dermatomyossitis due to eyelid involvement - ESR

Question 34

A previously well 8 year old girl is seen at the General Practitioner following five days of dysuria. She is otherwise well, with normal observations and examination. Urine dipstick results are as follows:

Leuks: ++ Nitrites: ++ Hb: - Ket: Trace

She is commenced on antibiotics.

What additional investigation should this patient have?

Answer 34

urine microbiology

Question 35

what ssri under 18

Answer 35

Fluoxetine

Question 36

combined pill fertility how long before can seek help

Answer 36

1year and a half

nroaml 1 year

Question 37

heart failure kids what big sign

Answer 37

hepatomegaly

Question 38

what is the vesicouretteric reflux

Answer 38

Vesicoureteric reflux (VUR) is the term for the abnormal flow of urine from the bladder into the upper urinary tract.

Question 39

how is VUR diagnosed

Answer 39

Vesicouretric reflux is diagnosed by a MCUG scan. MCUG is a diagnostic test to visualise the radio-opaque dye refluxing up into the ureters +/- kidneys.

Micturating cystourethrogram

Risk Factors
Males
Neurogenic bladder
Posterior urethral valves

Classification
Urine refluxes back up the ureters as there is either a short or absent valve where the ureters enter the bladder.

Grade 1 – into ureters only
Grade 2 – into pelvis causing no dilatation
Grade 3 – into pelvis causing mild dilatation
Grade 4 - into the pelvis causing moderate dilatation
Grade 5 – through to calyces
Presentation
Recurrent UTIs
Incomplete voiding
Management
Grades 1-3 often spontaneously resolve
If VUR persists, complications arise or grade 4/5 VUR - surgery may be required
Complications
Recurrent UTIs and subsequent complications (sepsis, scarring, abscesses)
Reflux nephropathy
CKD

Question 40

A three month old boy presents to the Emergency Department with a fever and poor feeding. His urine dipstick was positive for white cells and nitrates and he was treated with intravenous antibiotics for a urinary tract infection. An ultrasound scan of the renal tract was performed after the resolution of symptoms. It showed bilateral dilated ureters and small kidneys. Given the likely diagnosis, what investigation is diagnostic?

Answer 40

vur

Question 41

roseala infantartum associated with

Answer 41

febrile conulsions

Question 42

The growth chart for head circumference of a 10 month old infant has increased to the 99th percentile from the 75th centile. His height and his weight remain on the 75th centile. His hands and feet are proportional to his body. He has been achieving his milestones with no concerns. His mother reports that he was born at 32 weeks.

He has been feeding poorly for the last few hours and he has been less active. He is febrile and has not had any seizures. His mother does not think that he has had any falls recently.

What is the most likely diagnosis?

Answer 42

Hydrocephalus

This is an important diagnosis to investigate in macrocephaly. There can be potentially life-threatening consequences of missing this. This is a condition in which there is an accumulation of cerebrospinal fluid in the brain. Acute causes include meningitis, traumatic brain injury and haemorrhage (intra-ventricular or sub-arachnoid). In this case, meningitis is hinted at in this question (febrile, poor feeding)

meningitis is by poor feeding and febrile

Question 43

A 3-month-old baby is seen for a routine review in the GP surgery. On assessment of developmental progress, the baby is able to raise head to 45° when on their tummy but is not yet able to sit. They can track objects when moved but have not yet developed a palmar grasp. They are startled by noise but not yet able to turn their head to sounds. They can smile and laugh. The baby still demonstrates the primitive Moro and grasp reflexes.

At what age would you expect the Moro reflex to have disappeared by?

Answer 43

6 months

The Moro reflex, or startle reflex, usually disappears around 3–4 months, and should no longer be elicited past 6 months of age.

Question 44

A 10-month-old girl is seen in the general paediatric clinic after being referred by her GP because her head circumference was found to be in the 99.6th percentile. She was born at 40+2 weeks via spontaneous vaginal delivery after an uneventful pregnancy. At birth, her head circumference was measured to be in the 75th percentile. Her two siblings both have normal head circumferences.

Her mother reports that she often vomits in the morning before feeds, and is very lethargic and irritable during the day. At 10 months she is still unable to sit up unsupported or grasp objects. On examination, a tense anterior fontanelle is palpable, the sclerae are visible between the iris and upper eyelid of both eyes and distended veins are visible across her scalp.

What is the most likely underlying pathology?

Answer 44

hydrocephalus

Question 45

Which of the following blood tests is most specific to bacterial sepsis?

Answer 45

Procalcitonin

Procalcitonin is an emerging blood test that shows specificity for inflammatory markers and can help detect bacterial sepsis. This boy’s presentation is in keeping with sepsis secondary to a urinary tract infection, but the source is currently unproven

Question 46

A 6-month-old boy is found to have a continuous murmur, heard best at the left sternal edge, which is consistent with a persistent patent ductus arteriosus (PDA). Which of the following abnormalities is most likely to be found in this patient?

Answer 46

collapsing pulse

Question 47

collpapsing pulse

Answer 47

PDA

Question 48

radio-femoral delay

Answer 48

coarctation

Question 49

complication of hydrocele

Answer 49

indirect inguinal hernia

Question 50

This girl with constipation, cold intolerance, weight gain, dry skin, short stature and thin hair has signs and symptoms consistent with hypothyroidism. The most common cause of hypothyroidism in children is auto-immune thyroiditis. Children with auto-immune thyroiditis are at higher risk of developing other auto-immune mediated conditions, such as type 1 diabetes, rheumatoid arthritis and

Answer 50

In vitiligo, auto-immune destruction of melanocytes causes patchy areas of complete depigmentation

Question 51

A newborn on the postnatal ward develops respiratory distress a day after birth. The delivery was an uncomplicated vaginal birth. On examination she is pyrexial, tachycardic and has laboured breathing. She also appears floppy and lethargic, but there are no dysmorphic features. The mother is distressed and confesses to eating copious amounts of Camembert cheese during the pregnancy due to cravings. Which is the most likely causative organism?

Answer 51

Listeria monocytogenes is the most likely causative pathogen as it is commonly found in unpasteurised dairy products and soft cheeses. If these foods are not avoided during pregnancy there is increased of transmission to the fetus and early onset neonatal infection

Question 52

salmonella

Answer 52

poultry or eggs

Question 53

maintainance fluid in kids

Answer 53

1st 10kg of bodyweight at 100ml/kg/day
2nd 10kg of bodyweight at 50ml/kg/day
Remaining bodyweight at 20ml/kg/day