Paediatrics

Question 1

What is the clinical estimation of dehydration (not DKA)?

Answer 1

3% = dry lips
5% = tachycardia
7.5% = increased cap refill

Question 2

What haematological malignancy is associated with down syndrome?

Answer 2

Epidemiologically, children with Down syndrome are more likely
to get AML than ALL in the first 3 years of their life, but thereafter are
more likely to get ALL, similar to those without Down syndrome.

Question 3

What is the treatment for hydrocele?

Answer 3

< 2 years (congenital hydrocoele) = most resolve spontaneously before the age of 2 –> reassure, observation + safety net

If hydrocele persists beyond 2 years consider surgical repair. Increased risk of inguinal hernia.

Question 4

Kid with speech problems, other milestones are normal, who do you do refer to?

Answer 4

SALT

Question 5

Maternal T1DM increases risk of what condition in newborn?

Answer 5

neural tube defects

Question 6

Kid with pellets, and loose stool sometimes

Answer 6

overflow diarrhoea

Question 7

How does dyskinetic cerebral palsy present?

Which part of the brain is damaged?

Answer 7

Athetoid movements and oro-motor problems

Basal ganglia and substantia nigra

Question 8

What is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.

Answer 8

Meckels diverticulum

Question 9

Feature of achondroplasia

Answer 9

Trident hands

Question 10

Hypospadias - what congenital defect is this neonate at an increased risk of also having

Answer 10

Cryptorchidism

Question 11

What drug can increase the risk of necrotising fasciitis in patients with chicken pox

Answer 11

NSAIDs

Question 12

What therapy must be given to all children after an asthma attack?

Answer 12

Steroid therapy - 3 days of oral prednisolone

Question 13

When is hypospadias surgery performed?

Answer 13

12 months

Question 14

Methotrexate causes what vitamin deficiency?

Answer 14

folate (B9)

Question 15

5% fluid deficit in mild DKA => pH
7% fluid deficit in moderate DKA => pH
10% fluid deficit in severe DKA => pH

Answer 15

pH 7.2-7.29
pH 7.1-7.19
pH < 7.1

Question 16

Over how long should the fluid deficit be replaced in a patient with DKA?

Answer 16

48 hours

Question 17

What the difference between spina bifida, meningocele, myelomeningocele?

Answer 17

1) Spina bifida: vertebral defect - no herniation of meninges or spinal cord, patch of hair/sacral dimple overlies the defect
2) Meningocele: spinal defect with protrusion of the meninges
3) Myelomeningocele: spinal defect with protrusion of the meninges and spinal cord

Question 18

What is the most common cause of erythema nodosum?

Answer 18

Herpes simplex virus

Question 19

Threadworm species

Answer 19

Enterobius vermicularis

Question 20

What is the treatment of wilson’s disease?

Answer 20

penicillamine

Question 21

Management of pyelonephritis?

Answer 21

IV ceftriaxone and gentamicin

Question 22

Alport’s syndrome

Answer 22

X linked
SBAs: Haematuria + hearing loss + hereditary
Female carriers may have haematuria

Question 23

What is a very common rash in neonates that resolves in 2 weeks and is non threatening?

Answer 23

erythema toxicum neonatorum

Question 24

What can be used to treat muscle stiffness in cerebral palsy?

Answer 24

baclofen

Question 25

What is the first sign of puberty in girls?

Answer 25

breast development

Question 26

What is the first sign of puberty in boys?

Answer 26

testicular growth at around 12 years of age (range = 10-15 years)

Question 27

What is the hearing test for children above 3 years?

Answer 27

pure tone audiometry

Question 28

You are in GP, Child with croup comes in - only seal barking cough?

Answer 28

Oral dexamethasone + review in 48 hours only send to hospital/admit if increasing stridor, increasing sternal/intercostal recession or RR>70 = basically if unwell looking

Question 29

FH of T1DM, and the kid is not gaining weight and has loose stools

Answer 29

Coeliac disease

Question 30

Maintenance fluid to give to kid with diabetes mellitus

Answer 30

0.9% saline without added glucose should be used for rehydration and maintenance until plasma glucose is < 14 mmol/L Change to 0.9% saline + 5% glucose after plasma glucose drops below 14 mmol/L ALSO all fluids (except boluses) have 40mmol/L of KCl (unless they have renal failure)

Question 31

Bilateral undescended testes in a phenotypically male newborn examination, most likely dx?

Answer 31

Klinefelters NOT androgen insensitivity syndrome because phenotypically male Bilateral (at birth) = pituitary causes

Question 32

14-year old girl presented to GP with short stature and no secondary sexual characteristics. Otherwise well. The mean parental height is on the 50th centile. What is most likely dx?

Answer 32

constitutional delay - most common cause of delayed puberty

Question 33

Itchy maculovesicular rash w fever started on chest and spread to arms, dx?

Answer 33

chicken pox

Question 34

Treatment for scarlet fever

Answer 34

Phenoxymethylpenicillin *azithromycin if allergy

Question 35

Most common allergen in perennial rhinitis?

Answer 35

House dustmite

Question 36

Definitive management of intussception

Answer 36

air insufflation

Question 37

20. Girl (pre-pubertal) with offensive vaginal discharge. What is the most common cause of this?

Answer 37

vulvovaginitis - likely caused by candida albicans

Question 38

Precocious puberty (5yo and has sparse axillary and pubic hair as well as breast bud development) and high centile growth parents are along some lower centile. What definitive diagnostic test do you do?

Answer 38

Gonadotrophin stimulation test

Question 39

Differential diagnoses for hirschprung's disease

Answer 39

Cystic fibrosis (meconium ileus) Small left colon syndrome Distal small bowel atresia or stenosis Constipation

Question 40

What is hirschprungs disease?

Answer 40

Congenital disease resulting in the absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel - results in narrow constricted segment. Extends from the rectum for variable distance to normally innervated dilated colon. Commonly affects down syndrome children

Question 41

How would you investigate hirschprungs disease

Answer 41

Full examination Rectal examination - may result in explosive bowel movement - symptomatic improvement immediately Basic observations rule out other causes of vomiting e.g. infection Urine dipstick if possible Imaging - Abdominal x-ray, contrast enema Diagnosis: Suction rectal biopsy to demonstrate the absence of ganglion cells with presence of large acetylcholinesterase positive nerve trunks. Removal of mucosa and submucosa - shouldn’t be painful and can be done at bedside. Anorectal manometry and barium studies may be useful in giving surgeon idea of length of aganglionic segment (but not useful for dx) Anorectal manometry - measures pressure in anus and rectum - uses balloon and pressure gauge Barium studies - used to image gut and can see where narrowing occurs

Question 42

How do you management hischprungs disease?

Answer 42

ABCDE approach And discuss with seniors Initial colostomy followed by anastomosing normally innervated bowel to anus - “pull through” Laparoscopic or open Older children/ if unwell: Wash out - tube inserted into child's bottom and filled with warm salt water to soften faeces and flush out from bowel Parents taught how to do it. Surgery - step approach Create stoma as temporary measure Involvement of stoma nurse Few weeks later -pull through examination

Question 43

What are the complications of hirschprungs disease?

Answer 43

Acutely: May present with hirschsprung's enterocolitis/ sepsis in first few weeks of life due to C. diff → if fever/ diarrhoea Rx: admission with abx (metronidazole) and fluids Late presentation: In later childhood may present with chronic constipation May also present with growth failure. After treatment: Constipation is common after pull through operation - may need medication incontinence/ soiling Further children may be at risk → genetics

Question 44

Management of constipation

Answer 44

Disimpaction regimen: Stool softeners, initially macrogol laxative eg polyethylene glycol + electrolytes (movicol paediatric plain) Escalating dose regimen administered over 1 -2 weeks unwin impaction results If unsuccessful add in stimulant laxative eg senna or sodium picosulphate (if polyethylene gycp; and electrolytes not tolerated osmotic laxative can be substitutes 0 Disimpactment must be followed by maintenance treatment to ensure ongoing regaur pain free defecation - often polyethylene glycol - gradually reduce over period of months Dietary interventions Explore child's concerns Star chart

Question 45

Differential diagnoses for testicular pain?

Answer 45

Torsion Hernia Epididymo-orchitis Testicular tumour

Question 46

Counsel a patient with testicular torsion

Answer 46

Testicular torsion Each testicle is connected to the rest of the body by a blood vessel called the spermatic cord. Testicular torsion happens when a spermatic cord becomes twisted, cutting off the flow of blood to the attached testicle It can be really painful and cause the twisted testicle to swell up and be tender Really important we treat it now because it is a serious matter but can be easily resolved if act quickly Risks of not treating include the testicle blood flow being blocked > testicle may die > testicular removal Treatment is a simple operation: can only be offered if 6-8 hours. During the operation a small cut is made in the skin of the scrotum (midline scrotal incision} to expose the testes. The affected testis and spermatic cord are untwisted. The testis is then stitched to the surrounding tissue and fixed so that it is unable to twist in the future. The other testis will also be fixed at the same time so it cannot twist in the future either. Risks of operation short term: general anaesthetic, infection risk, bleeding postoperatively Risk - removal of non-viable testicle If >24 hours Where the testicle is known to be non-viable because the torsion has lasted more than 24 hours, a semi-urgent orchidectomy is performed with fixation of the contralateral testicle. If a non-viable testicle is found at the time of exploration, then a scrotal orchidectomy is performed, again with fixation of the contralateral testicle.

Question 47

How could you differentiate between testicular torsion and epididymitis?

Answer 47

Ultrasound Loss of Cremasteric reflex In testicular torsion there is no improvement of the pain on elevating the scrotum, whereas the pain improves in cases of epididymitis (Prehn's sign)

Question 48

Will a 3 in 1 vaccine overload my childs immune system?

Answer 48

Given as 1 in 3 is just as safe, doesn’t ‘overload’ immune system and makes sure the baby goes through as little pain as possible 3 separate vaccines have no safety evidence Only a tiny amount of your Charles’ immune system will be used to develop a response to this vaccine, the rest will be used to fight off the many bugs they come into contact with every day! The vaccines work at different times so won’t be overloaded 6-10 days measles 2-3 weeks mumps 12-14 days rubella

Question 49

What are the differential diagnoses for persistent cough in children?

Answer 49

bronchiolitis, croup, pneumonia, TB, pertussis

Question 50

Would you see any changes on an x-ray for bronchiolitis?

Answer 50

probably not but hyperinflated lungs pneumonia would show focal areas of consolidation. If there is significant respiratory distress + fever --> carry out a CXR to help rule out pneumonia

Question 51

When would you admit a child with bronchiolitis?

Answer 51

ADMIT if: apnoea, severe resp distress, RR>70, central cyanosis, not feeding

Question 52

What are the three phases of whooping cough?

Answer 52

catarrhal phase paroxysmal convalescent