Paediatrics Flashcards
1
Q
Name the infection that the following organisms commonly cause:
1. Parvovirus B19
- Coxsackie virus A
- Group A Strep
- RSV (2)
- Parainfluenza virus
A
- Slapped cheek
- Hand, foot & mouth
- Scarlet fever
- Bronchiolitis, viral induced wheeze
- Croup
2
Q
What skills would you expect to see from each developmental domain in an 18m toddler?
- Gross motor (2)
- Fine motor (2)
- Language (1)
- Social (2)
- Self help (1)
A
- *Gross motor:** 1) walks up/down stairs unsupported
2) kicks a ball - *Fine motor:** 1) scribbles with crayon
2) builds towers with 4+ bricks
Language: 1) starts to join words into sentences
- *Social**: 1) early pretend play
2) says no when interfered with
Self help: 1) eats with fork
3
Q
What type of bilirubin is always abnormal in infants?
When ordering LFT’s, what should you order specificially to determine the cause of jaundice?
What would you expect the stools of a baby with biliary atresia (obstruction of bile flow) to look like?
A
Conjugated bilirubin!!
Split bilirubin
Pale, chalky white stools
4
Q
A 3-week-old boy presents to paediatric A&E with persistent vomiting. The mother reports that vomiting always occurs soon after feeds and often hits the kitchen walls.
On abdominal examination, there are no peritonitic features, but, a small, firm, olive shaped mass is palpable in the epigastric area.
What is the likely diagnosis?
What is the investigation of choice?
What is the definitive management?
A
Pyloric stenosis
Abdominal US
Management: surgery (laparoscopic pyloromyotomy)
5
Q
What skills would you expect to see from each developmental domain in an 24m toddler?
- Gross motor (1)
- Fine motor (1)
- Language (1)
- Social (1)
- Self help (1)
A
Gross motor: climbs on play equipment (eg, slides)
Fine motor: scribbles with circular motion
Language: vocabulary of 30-50 words
Social: helps with simple household tasks
Self help: opens door by turning knob
6
Q
What are an Exomphalus and Gastroschisis? - whats the difference between them?
A
Exomphalus = herniation of abdominal contents at birth which ARE COVERED by the peritoneal membrane
Gastroschisis = herniation of abdominal contents at birth which AREN’T COVERED by the peritoneal membrane!
7
Q
What are the 6 components of sepsis 6?
~ state the order you would do these in
(take 3, give 3)
A
1) Give O2 if sats are below 94%
2) Take blood cultures
3) Give IV antibiotics
4) Fluid challenge (give IV fluids)
5) Measure blood lactate
6) Measure urine output
8
Q
A one-year old girl presents to the Emergency department with intermittent abdominal pain. Her father explains that during these episodes the child becomes irritable, pale, and draws her legs up towards her abdomen. There has been no vomiting, but the child has refused feeds for two days. The abdomen is soft, but there is a palpable, sausage shaped mass in the right flank.
What is the likely diagnosis?
What other buzz word would indicate this diagnosis? (common in later presentations)
What is the 1st line investigation & management of this conditon?
If the child had been vomiting & there was abdominal distension, what does this suggest?
A
Intussusception
Redcurrent jelly stool
Investigation: abdominal US
Management: Enema (commonly air enema)
Obstruction!
9
Q
What would you hear when ascultating someone with an atrial septal defect? (2)
Explain why you would hear these things!
A
Fixed, split 2nd heart sound → as blood is being shunted from L→R atria, there is more blood to flow through the pulmonary valve. This causes a delay in the valve closing compared to closing of aortic valve = split 2nd heart sound
Pulmonary flow murmur (ejection systolic murmur) → due to increased blood flowing through the valve
10
Q
What is Croup?
What is the commonest causative organism?
What are the common presenting features of croup? (6)
How long does croup usually last for?
What is the management of croup?
A
An URTI causing oedema & swelling of the larynx.
Parainfluenza virus
~ Increased work of breathing
~ Barking cough (sounds like a seal)
~ cold symptoms
~ hoarse voice
~ +/- stridor
~ +/- mild fever
1 - 2 days
Oral dexamethasone
11
Q
If someone is cyanotic, but their SATs are normal (99-100%), what is the likley underlying cause?
A
Carbon monoxide poisoning
12
Q
What is Kawasaki disease?
What are the 6 common features of Kawasaki disease? CREAM
What is the main complication of Kawasaki disease? - What investigation is done to screen for this?
What is the treatment of Kawasaki disease?
A
A systemic medium vessel vasculitis
- *Fever for 5+ days** PLUS
- *C** - conjunctivitis (red eyes)
- *R** - rash
- *E** - oedema/ erythema of hands & feet
- *A** - adenopathy (usually cervical)
- *M** - mucosal invovlement (strawberry tongue, cracked lips)
Coronary artery aneurysm - ECHO
Treatment: aspirin (to reduce risk of thrombosis) & IV immunoglobulins IVIg) (to reduce risk of coronary artery aneurysms)
13
Q
What condition would be indicated by: “a child with a 3 day history of vomiting & diarrhoea”
What is the investigation of this condition?
If the diarrhoea was bloody, what would be the likely causative organism?
This organism increases the risk of developing what condition?
What are the 3 characteristic features of this condition?
What is the management of this condition?
A
Gastroenteritis
Stool sample sent for microscopy, culture & sensitivies (MCS)
E. Coli
Haemolytic Uraemic Syndrome (HUS)
1) Haemolytic anaemia
2) Thrombocytopenia
3) AKI
Supportive management as it self resolves - monitor fluid balance to detect a worsening AKI
14
Q
Ventricular-septal defects are associated with which 2 genetic conditions?
What type of murmur is heard when there is a ventricular-septal defect?
A
Down syndrome, Turner’s syndrome
Pan-systolic murmur
15
Q
What is the treatment of hydrocephalus in children?
List some complications of this treatment:
A
VP shunt (ventriculoperitoneal shunt)
Complications:
• infection
• excessive CSF drainage
• shunt can become blocked
• intraventricular haemorrhage *during the surgery*
••• Children outgrow the shunt, so it will need replacing •••
16
Q
List some common symptoms of asthma: (3)
A
- Wheeze
- Cough (worse at night)
- SOB
17
Q
What is the treatment of aortic / pulmonary valve stenosis in children?
What is a common complication of this procedure?
A
Balloon valvoplasty
Valve regurgitation due to damage of the cusps of the valve
18
Q
What is the commonest causative organism of bronchiolitis?
~ what is the treatment?
What is the commonest causative organism of viral induced wheeze?
~ what is the treatment?
What is the commonest causative organism of bacterial/ viral pneumonia?
~ what is the treatment for each?
What is the commonest causative organism of croup?
~ what is the treatment?
What is the commonest causative organism of epiglottitis?
~ what is the treatment?
What is the commonest causative organism of whooping cough?
~ what is the treatment?
A
Bronchiolitis: RSV
~ supportive treatment (viral infection - self resolves)
Viral induced wheeze: RSV
~ 10 puffs of salbutamol +/- O2 if needed
- *Bacterial pneumonia:** Strep pneumonia - amoxicillin
- *Viral pneumonia:** RSV (supportive treatment)
Croup: parainfluenza virus
~ dexamethasone
Epiglottitis: H.influenza B
~ secure airways, ceftriaxone & dexamethasone
Whooping cough: Bordetella pertussis
~ supportive management
19
Q
What is the most likely diagnosis of the following:
Unvaccinated child presents with a fever, sore throat & difficulty swallowing. The child is sitting forward and drooling.
What is the management of this?
A
Epiglottitis
1) Secure airway!!!!!
2) IV antibiotics (ceftriaxone) + Steroids (dexamethasone)
20
Q
What is Tetralogy of Fallot also known as by leymans?
Physiologically, what is it & what are the 4 components to it?
A
“Hole in the heart”
A congenital heart condition that has 4 components:
1. Ventricular septal defect
- Pulmonary valve stenosis
- Right ventricular hypertrophy
- “Over-riding aorta” - aorta arises from both ventricles
21
Q
What are the 4 abnormalities seen in Tetralogy of Fallot?
What xray finding is seen in this condition?
What clinical sign may be seen on examination? - Why does this happen?
What is the definitive treatment and when does it occur?
A
1) Pulmonary valve stenosis
2) R ventricle hypertrophy
3) Ventricularseptal defect
4) Overriding aorta (L & R ventricle drain into aorta)
Boot shaped heart seen on xray
Central cyanosis - high pressure in R ventricle due to hypertrophy causes R→L shunt through ventricularseptal defect - less oxygenated blood enters systemic circulation
Surgical correction: performed when baby is 5kg (~ 6 months)
22
Q
A 3m girl is brought to the GP as her parents are worried about a skin lump that has appeared on her neck. It is non-tender and isn’t bothering her, but it is growing in size.
On examination there is a 2 x 2cm firm, well demarcated lesion with visible telangiectasia. There are no other skin lesions.
What is the likely diagnosis? - what is this?
What would the treatment be here?
What would the treatment be if the lesion was near the eyes/ rapidly enlarging or was ulcerating?
A
Haemangioma - a vascular birth mark that isnt present at birth but appears from 6 weeks onwards. It will proliferate & grow up until 8m and then self resolve.
Treatment if asymptomatic: nothing - they will self resolve (involute)
Treatment if problematic: Oral propanolol
23
Q
List the distinguishing features that differentiate IgA nephropathy from post-streptococcal glomerulonephritis: (2)
A
IgA Nephropathy:
~ 1-2 days post URTI
~ Renal biopsy: IgA immune complex deposits in the glomerulus
Post-strep GN:
~ 1-3 weeks post URTI (usually strep throat)
~ Renal biopsy: IgG immune complex deposits in the glomerulus
24
Q
What changes occur at birth regarding the foetal circulation? (6)
A
1) foramen ovale closes
2) ductus arteriosus closes
3) ductus venosus closes (blood vessel connecting umbilical vein→IVC)
4) Pulmonary vascular resistance falls
5) Pulmonary blood flow increases
6) Systemic vascular resistance increases
25
What skills would you expect to see from each developmental domain in a 3y?
* Gross motor (1)
* Fine motor (1)
* Language (2)
* Social (1)
* Self help (1)
**Gross motor:** 1) Rides a tricycle
**Fine motor:** 1) Draws/ copies a complete circle
* *Language**: 1) Identifies 4+ colours
2) Asks questions: 'why' 'how'
**Social**: 1) Gives directions to other children
**Self help:** 1) Toilet trained (may still need help with wiping)
26
What is Hirschprung's Disease?
What is a common presentation of it?
What investigation is done? - what is used to confirm the diagnosis?
What is the definitive management?
Congenital condition in which nerves of the distal bowel & rectum are absent (*myenteric plexus*)
24h neonate hasnt passed meconium, distended abdomen and vomiting!
Rectal exam (forecful evacuation of stool will occur!!!) - confirmation is made by **suction rectal biopsy**
**Definitive management:** surgical removal of aganglionic bowel
27
State the 3 vaccines that are live, attenuated:
**Live attenuated:**
• MMR
• Rotavirus
• Nasal flu vaccine
28
What is Kawasaki disease?
What are the 6 common features of Kawasaki disease? CREAM
What is the main complication of Kawasaki disease? - What investigation is done to screen for this?
What is the treatment of Kawasaki disease?
A systemic medium vessel vasculitis
* *Fever for 5+ days** PLUS
* *C** - conjunctivitis (red eyes)
* *R** - rash
* *E** - oedema/ erythema of *hands & feet*
* *A** - adenopathy (usually cervical)
* *M** - mucosal invovlement (strawberry tongue, cracked lips)
Coronary artery aneurysm - ECHO
Treatment: **aspirin** (to reduce risk of thrombosis) & **IV immunoglobulins IVIg)** (to reduce risk of coronary artery aneurysms)
29
What is the management of a baby with symptomatic patent ductus arteriosus? - what is the mechanism behind this?
When would this management not be used and why?
In these babies, what would the management be? - what is the timeframe for this?
Indomethacin (an NSAID) - it is a prostagland inhibitor so causes closure of ductus arteriosus
Not used in **term** babies as their patent ductus arteriosus isnt prostaglandin sensitive!
Watch & wait - most will close spontaneously within 1y. IF symptomatic, can be surgically ligated
30
What is SUFE?
What age group & sex is it most common in?
What is the biggest RF for SUFE?
List some features seen in someone with SUFE: (3)
It's when the head of femur is displaced along the growth plate (it looks like it has slipped off)
Teenage boys
Obesity
~ Hip/ groin/ knee pain with **insidious** onset
~ Restricted ROM of hip
~ Painful limp
31
What is **osteomyelitis?**
What is the commonest causative organism?
List some investigations usually performed if osteomyelitis is suspected: (3)
An infection of the bone and bone marrow.
**Staph aureus**
1. Xray of the bone (it may be normal - MRI is the best for a diagnosis)
2. Bloods (raised CRP, ESR, WBC)
3. Blood cultures (bone marrow aspirate/biopsy is sometimes required)
32
What skills would you expect to see from each developmental domain in an 24m toddler?
* Gross motor (1)
* Fine motor (1)
* Language (1)
* Social (1)
* Self help (1)
**Gross motor:** climbs on play equipment (eg, slides)
**Fine motor:** scribbles with circular motion
**Language**: vocabulary of 30-50 words
**Social**: helps with simple household tasks
**Self help:** opens door by turning knob
33
What skills would you expect to see from each developmental domain in a 12m toddler?
* Gross motor (2)
* Fine motor (2)
* Language (2)
* Social (1)
* Self help (2)
* *Gross motor:** 1) stands without support
2) starts to walk without help (by 18m)
* *Fine motor:** 1) stacks 2+ blocks
2) picks up 2+ toys in 1 hand
* *Language**: 1) know's the meaning of 1 or 2 words
2) uses mama / dada specifically for parents
**Social**: 1) points to things of interest
* *Self help:** 1) feeds themself with spoon
2) lifts cup to mouth and drinks
34
What is the 1st line treatment of **atonic seizures** in children?
**Sodium valproate**
35
A 7y old boy is brought in because parents are concerned that he **still** wets the bed most nights (dry throughout the day).
He has no fever and abdominal/ spinal/ neuro examination is normal.
What is the likely diagnosis? - how does this differ if the boy had previously been continent at night?
What is the diagnosis if urinary incontinence occurs throughout the day too?
What is the management of this boys condition?
* *Primary nocturnal enuresis**
* - Secondary* notcurnal enuresis
Diurenal enuresis
**Management:** identify underlying cause & treat!
~ eg, reduce fluid intake in evenings
~ eg, check for UTI
36
What is **cerebral palsy** & what causes it?
**Cerebral palsy:** a group of permanent neurological problems (deficits) that present in early childhood
**Cause:** damage to the brain around the time of birth (commonly hypoxic brain injury during birth)
37
Describe what coarctation of the aorta is:
List the clinical signs/ symptoms of coarctation of aorta: (3)
How would a child with coarctation of aorta usually present?
What congenital condition is associated with coarctation of the aorta?
Narrowing of the descending aorta
1) Weak/ absent femoral pulse
2) Radio-femoral delay
3) Systolic murmur that's loudest at the back
Presentation: sudden deterioration & collapse
**Turner's syndrome**
38
Anaphylaxis is what type of hypersensitivity reaction?
This type of reaction is mediated by what?
Type 1 hypersensitivity reaction
IgE mediated mast cell degranulation
39
What is Croup?
What is the commonest causative organism?
What are the common presenting features of croup? (6)
How long does croup usually last for?
What is the management of croup?
An URTI causing oedema & swelling of the larynx.
Parainfluenza virus
~ Increased work of breathing
~ Barking cough (sounds like a seal)
~ cold symptoms
~ hoarse voice
~ +/- stridor
~ +/- mild fever
1 - 2 days
Oral dexamethasone
40
**Erb's palsy** results in damage to what nerves of the brachial plexus?
What obstetric emergency can result in **Erb's palsy?**
**C5 & C6**
Shoulder dystocia
41
When would **baby blues** typically present?
When would **postnatal depression** typically present?
**Baby blues**: Within 2 weeks of delivery
**Postnatal depression:** several weeks after delivery up to 1y
42
A 5y old boy complains of difficulty in hearing. He has had several fractures following minor falls. O/E his legs appear short & deformed and his sclera have a blue tinge.
What is the likely diagnosis?
**Osteogenesis imperfecta** (brittle bone disease)
43
What direction is blood shunted in a ventricular-septal defect?
What pathology can occur over time if a ventricular-septal defect isnt corrected? What causes this?
What condition does this result in and why?
What clinical sign will be seen when this happens?
L→R ventricle
Increased blood in R ventricle → increased blood (and thus pressure) in pulmonary circulation → **pulmonary hypertension**
Pulmonary hypertension causes **Eisenmenger syndrome:** pressure in R ventricle is higher than L which causes blood to be shunted from R→L
Central cyanosis (more blood is bypassing the lungs)
44
What is the commonest type of headache in children?
**Tension type** headaches
45
What are the 2 criteria's/ tools that GP's often use to determine a bacterial or viral cause of a sore throat?
CENTOR & feverPAIN
46
What is Perthes disease? (Legg-Calve-Perthes)
What age group is it most common in?
What is the typical presentation of someone with Legg-Calve-Perthes disease?
Avascular necrosis of the femoral head in children which is caused by disruption to the blood flow of the femoral head
Ages 4-10y
• Gradual\* onset limb & hip pain
• Referred pain to the knee
• Pain persists for \>4 weeks
\* Gradual due to the femoral head becoming increasingly ischaemic
47
The following would be red flags in a child's development if they hadn't achieved them by what age?
1) Social smile
2) Sitting unsupported
3) Walking unsupported
4) Words
1) No social smile by **2** months
2) Not sitting unsupported by **9** months
3) Not walking unsupported by **18** months
4) No words by **2** years
48
What is **Talipes** (clubfoot)?
What is the *non-surgical* treatment & what does this involve?
A fixed abnormal ankle position that is present at birth
* *Ponseti method**: The foot is manipulated towards the normal position & a cast is applied to hold it in this position. This is repeated until the feet are in the correct position. Once in corrected position, a brace is applied until the child starts walking (looks like a skateboard)
* ~ At some point an achilles tenotomy is done to release tension in the achilles tendon*
49
What is septic arthritis?
Which 2 joints are most commonly affected?
What is the commonest causative organism?
What is the immediate initial investigation is septic arthritis is suspected?
Infection inside a joint
Hip & Knee
**Staph aureus**
**Joint aspiration** for culture and sensitivities
50
A 3y old boy presents with 5 days of **vomiting** and **bloody** **diarrhoea**. He is tolerating oral fluids and recently visited a petting zoo.
Examination showed no fever, HR 100, RR 25, no skin changes and mild general abdo discomfort.
What is the likely diagnosis? - likely causative organism?
What is a complication of this?
~ List the triad of features with this condition
What is the management of this boys condition?
**Gastroenteritis** - E.coli
**Haemolytic uraemic syndrome:**
• haemolytic anaemia (causing jaundice)
• AKI (causing high urea levels)
• thrombocytopenia
***Conservative***: encourage fluids
51
What is the 1st line treatment of **tonic-clonic seizures** in children?
**Sodium valproate**
52
When palpating the anterior & posterior fonatelles on vaginal examination during delivery, what shapes do they typically have?
* *Anterior fontanelle:** diamond
* *Posterior fontanelle:** triangle
53
What age group is classed as **adolescence?**
Which area of the brain changes the most during this period?
~ what 3 things is this brain area involved in?
11-25y
**Prefrontal cortex**
~ planning
~ social interaction & self-awareness
~ risk taking
54
Very high levels of bilirubin in infants can cause what serious condition?
What type of bilirubin causes this condition & why?
What is the treatment of raised unconjugated bilirubin levels?
If untreated, what can this result in?
**Kernicterus**
Unconjugated bilirubin - it's fat soluble so can cross the BBB whereas conjugated bilirubin is water soluble so cannot cross the BBB
Phototherapy (babies are placed under blue light)
Encephaloptahy (seizures)/ cerebral palsy
55
State the diagnosis & commonest causative organism of **a-e**:
**a)** Child presents with rapdly-developing non-blanching purpuric skin rash, lethargy, headache, fever, vomting.
**b)** Child presents with mild fever, runny nose, lethargy and an itchy lace like rash on the body, which is bright red over the cheeks.
**c)** Unvaccinated child with a 4day history of cough, fever, lethargy has now developed a rash all over his body with a few grey spots inside his cheeks.
**d)** Child presents with a course red rash on his trunk that has a sandpaper texture, as well as a fever, sore throat and bright red tongue.
**e)** Child presents with an itchy, widespread, erythematous, vasicular rash that started on their face/ trunk & has quickly spread to their whole body. Child also has a fever and Mum noticed that the rash has started to crust over.
**f)** Child presents with lethargy, fever, cough & sore throat with new ulcers around their mouth and blistering red spots on their hands & feet.
a) Meningitis - Neisseria meningitidis
b) Slapped cheek - Parvovirus B19
c) Measles - Measles virus
d) Scarlet fever - Group A **STREP**
e) Chickenpox - Varicella Zooster virus
f) Hand, foot & mouth disease - Coxsackie A virus
56
What skills would you expect to see from each developmental domain in a 3y?
* Gross motor (1)
* Fine motor (1)
* Language (2)
* Social (1)
* Self help (1)
**Gross motor:** 1) Rides a tricycle
**Fine motor:** 1) Draws/ copies a complete circle
* *Language**: 1) Identifies 4+ colours
2) Asks questions: 'why' 'how'
**Social**: 1) Gives directions to other children
**Self help:** 1) Toilet trained (may still need help with wiping)
57
An 18m boy presents with a 4h history of **barking** **cough** (seal) and noisy breathing having been well the day before.
Examination shows a runny nose, loud **stridor**, tracheal tug, sub-costal recession, well perfused peripheries and temp of 37.8c
What is the likely diagnosis?
What is the commonest causative organism?
What age group is it most common in?
How long does it usually last for?
What is the management?
**Croup**
Parainfluenza
Commonest in **6m - 2y**
Lasts for up to 48h
Management: **steroids!** (dexamethasone)
58
A 1 year old girl is brought in to A/E by her parents as they are concerned about her breathing. She has been feeling unwell with the flu over the last few days. The parents describe a barking cough. They think she has had all her immunisations. She has a high grade fever. A constant high-pitched sound on inspiration can be heard and she has a hoarse voice.
Humidified oxygen, dexamethasone and nebulised adrenaline is given. The symptoms do not improve.
What is the most likely diagnosis?
**Bacterial Tracheitis**
*Always consider bacterial tracheitis in a barking cough with continuous stridor that does not resolve.*
59
What is **rickets?**
~ What is the name for this condition if it presents in adults?
What deficiency results in rickets?
Soft & deformed bones due to defective mineralisation of the bone
~ In adults = *osteomalacia*
## Footnote
**Calcium / vitamin D**
60
What are 3 commonest pathogens responsible for causing neonatal sepsis?
What antibiotics are used in the 1st line management of neonatal sepsis?
1) Group-B strep
2) E.Coli
3) Listeria
IV penicillin & gentamicin
61
List some signs of hydrocephalus in babies: (4)
* Bulging anterior fontanelle
* Rapidly increasing occipito-frontal circumference (due to sutures not being fused so the skull expands)
* Poor feeding/ vomiting
* Sleepiness
62
A 7m old child presents with recurrent milky vomiting and low weight for age. On further questioning of the primigravida mother, she informs you that the child was born prematurely and she has noticed that the child has a chronic cough and hoarse cry. Examination is unremarkable.
What is the likely diagnosis?
What is the cause of this in infants? - what age does it usually resolve by?
What is the **management** if:
a) no effect on growth
b) effect on growth
**GORD**
Immaturity of the lower oesophageal sphincter - age 1y
* *Management:**
* No effect on growth:* conservative advice
* Effect on growth:* gaviscon mixed with feeds/ omeprazole!
63
List some features of **nephrotic** syndrome: (4)
List some features of **nephritis** syndrome: (3)
**Nephrotic syndrome:**
• proteinuria (+++)
• oedema
• hypoalbuminaemia
• hyperlipidaemia
**Nephritic syndrome:**
• haematuria
• hypertension
• proteinuira (+)
64
An ejection systolic murmur in the upper left sternal border & radiates to the back indicates what type of valvular condition?
An ejection systolic murmur in the upper right sternal border & radiates to the carotids indicates what type of valvular condition?
**Pulmonary stenosis**
**Aortic stenosis**
65
**Erb's palsy** results in damage to what nerves of the brachial plexus?
What obstetric emergency can result in **Erb's palsy?**
**C5 & C6**
Shoulder dystocia
66
What is haemolytic uraemic syndrome (HUS)?
What disease does HUS usually follow from?
What is the commonest organism that causes HUS & what investigation is used to identify it's presence?
What are the characteristic triad of features seen with HUS?
→ What invstigations would be done for each feature to identify them?
HUS occurs when there is thrombosis in small blood vessels throughout the body
Gastroenteritis
E.coli - stool sample will identify it
1) Haemolytic anaemia → FBC, blood film
2) AKI → U&E's to measure serum urea
3) Thrombocytopenia → FBC
67
What part of the GIT does coeliacs disease affect & what is the main histological finding seen?
List some clinical features seen in coeliac disease: (6)
What condition is closely associated with coeliac disease?
Small bowel (esp jejenum) - villous atrophy
* Failure to thrive (in children)
* Diarrhoea
* Weight loss
* Fatigue
* Dermatitis herpetiformis (itchy rash, usually on abdomen)
* Malabsorption
**Type 1 diabetes** (as well as other autoimmune conditions)
68
If a split bilirubin shows high levels of conjugated bilirubin, what underlying problem does this indicate?
What is **biliary atresia?** - what investigation would you do (other than split bilirubin)
What 3 features might biliary atresia present with?
What is the management of biliary atresia?
Biliary tree obstruction (bile is unable to be transported to the bowel)
Congenital condition in which there is *absent* / *stenoised* bile duct - prevents bile (and conjugated bilirubin) being transported to bowel
*~ abdominal US*
1) Jaundice
2) Pale, chalky white stools
3) Hepatosplenomegaly
Surgery - **kasai portoenterostomy** (small intestine is attached directly to the liver)
69
What epileptic medication is **teratogenic?**
This medication should be avoided in which patients?
**Sodium valproate**
Should be avoided in **girls** unless there is no other effective medication/ they are on contraceptives
70
What is haemolytic uraemic syndrome (HUS)?
What disease does HUS usually follow from?
What is the commonest organism that causes HUS & what investigation is used to identify it's presence?
What are the characteristic triad of features seen with HUS?
→ What invstigations would be done for each feature to identify them?
HUS occurs when there is **thrombosis** in **small blood vessels** throughout the body
Gastroenteritis
E.coli - stool sample will identify it
1) Haemolytic anaemia → FBC, blood film
2) AKI → U&E's to measure serum urea
3) Thrombocytopenia → FBC
71
What is the 1st line treatment of **focal seizures** in children?
**Carbamazepine**
72
Between which ages is jaundice **more likely** to be pathological?
What causes **physiological** jaundice? - what type of bilirubin will be elevated?
What type of bilirubin will be elevated in **breast-milk** jaundice?
Before 24h, after 2 weeks (3 weeks if pre-term)
**Physiological jaundice:**
• HbF has shorter life span & liver function is immature so cannot conjugate as quick as is needed with the excess haemolysis
• Bilirubin = *unconjugated*
**Breast-milk jaundice:** *unconjugated* bilirubin
73
What skills would you expect to see from each developmental domain in a 6m infant?
* Gross motor (2)
* Fine motor (2)
* Language (2)
* Social (2)
* Self help (1)
* *Gross motor:** 1) rolls over
2) starts to sit without support
* *Fine motor:** 1) uses 2 hands to pick up large objects
2) transfers toy from 1 hand to another
* *Language**: 1) responds to name
2) 2 syllable babble
* *Social**: 1) reaches for familiar people
2) pushes things they don't want away
**Self help:** 1) feeds self small food
74
A low birth weight is considered below what?
A large baby is considered as weight what at birth?
**2500g** (2.5kg)
## Footnote
**4.5kg**
75
What is **hydrocephalus?**
Why does this occur? (2)
List some *congenital* causes of hydrocephalus: (3)
A build up of **CSF** within the brain/ spinal cord
1. Over production of CSF
2. Problemn with draining/ re-absorbing CSF
**Congenital causes:**
• aqueductal stenosis (narrowed cerebral aqueduct connecting 3rd and 4th ventricles)
• arachnoid cysts
• arnold-chiari malformation (cerebellum herniates down through the foramen magnum, blocking outflow of CSF)
76
Why are children's bones more flexible, but weaker?
What type of # is more likely in children due to this?
They contain more **cancellous bone** than adults (this is spongey, highly vascular bone in the centre of long bones)
**Greenstick #** - one side of the bone breaks whilst the other side stays intact
77
What is **status epilepticus?**
Seziures lasting **more than 5 minutes** *or* **more than 3 seizures in one hour**
78
What pathology is seen in the condition: "**transposition of the great arteries"**?
What needs to occur postnatally to make it temporarily compatible with life? - Give examples of 3 things that could occur:
This condition is usually detected antenatally. What is given immediately after birth before the baby is transferred for surgical correction? - What does this do?
The pulmonary artery arises from the left ventricle & the aorta arises from the right ventricle (they've swapped)
There needs to be a shunt between R & L ventricles so that oxygenated blood goes to systemic circulation
1) patent ductus arteriosus (connection between pulmonary trunk & aorta)
2) atrioseptal defect
3) ventriculoseptal defect
**Prostaglandin E** is given - prevents the ductus arteriosus from closing
79
What type of formula is used to treat CMPA?
If the child still can't tolerate this formula, what would they be swapped to?
Hydrolysed formula
An amino acid formula
80
What are the 5 domains of development?
1) Gross motor skills
2) Fine motor skills
3) Speech & language skills
4) Social & self help skills
5) Hearing & vision
81
Regarding pO2 & pCO2, what would be seen on a blood gas in:
a) type 1 respiratory failure
b) type 2 respiratory failure
**Type 1 resp failure:** low O2, normal CO2
**Type 2 resp failure:** low O2, high CO2 - respiraoty acidosis
82
An 8 year old boy is referred with behavioural problems to the child Psychiatry Department. He is always active at home and moves from task to task. He finds it difficult to concentrate to read or watch TV. He often puts himself into dangerous situations like climbing onto high roofs. His performance at school is poor where he is distractible and causes distractions to others.
What is the most likely diagnosis?
ADHD
83
List some common causes of bilious vomiting: (4)
What is the 1st line investigation to identify a cause of bilious vomiting?
**Intestinal obstruction:**
• Malrotation
• Intusussecption
• Ileus
• Duodenal atresia
## Footnote
**Abdominal Xray**
84
What is a:
1. *Simple febrile convulsion*
2. *Complex febrile convulsion*
**Simple febrile convulsion:** *Generalised tonic-clonic seizure* lasting no more than 15 minutes and occuring only *once* during the febrile illness
**Complex febrile convulsion:** *Partial / focal seizure* lasting more than 15 minutes *or* occuring multiple times during the febrile illness
85
**Sodium valproate** is the 1st line medication for all types of seizures, *except for?*
Focal seizures (1st line = carbamazepine)
86
A 14 month old girl presents with 12h of increasing wheeze and respiratory effort and a 3d history of runny nose and cough.
Examination shows **bilateral** **wheeze**, no creps and sub-costal recession, a pink throat and red ears. Resp rate of 60 and temperature 37.5c
What is the likely diagnosis?
Under what age is it commonest in?
What is the management?
**Viral induced wheeze**
Commonest under 5s (especially under 3y)
Management: **salbutamol** (10 puffs!)
87
What is the *gold standard* investigation for suspected vesico-uteric reflux in children?
What investigation is used to look for any kidney scarring/ function of the kidney?
What investigation is used to look at the structure (size & shape) of the kidney?
MCUG (micturicting urogram)
DMSA
US KUB
88
What classification is used to grade # through the growth plate?
What are the types of growth plate #'s according to the above classification? (*SALTR*)
**Salter-Harris classification**
* *Type 1: S**traight accross the growth plate
* *Type 2: A**bove the growth plate
* *Type 3:** Be**L**ow the growth plate
* *Type 4: T**hrough the growth plate
* *Type 5:** C**R**ushing of the growth plate
89
What skills would you expect to see from each developmental domain in a 12m toddler?
* Gross motor (2)
* Fine motor (2)
* Language (2)
* Social (1)
* Self help (2)
* *Gross motor:** 1) stands without support
2) starts to walk without help (by 18m)
* *Fine motor:** 1) stacks 2+ blocks
2) picks up 2+ toys in 1 hand
* *Language**: 1) know's the meaning of 1 or 2 words
2) uses mama / dada specifically for parents
**Social**: 1) points to things of interest
* *Self help:** 1) feeds themself with spoon
2) lifts cup to mouth and drinks
90
What is SUFE?
What age group & sex is it most common in?
What is the biggest RF for SUFE?
List some features seen in someone with SUFE: (3)
It's when the head of femur is displaced along the growth plate (it looks like it has slipped off)
Teenage boys
**Obesity**
~ Hip/ groin/ knee pain with *insidious* onset
~ Restricted ROM of hip
~ Painful limp
91
Delayed puberty & *anosmia* (lack of smell) would suggest what condition?
What is the physiological cause behind delayed puberty in this condition?
Kallmann's syndrome
**Hypogonadotropic hypogonadism:** hypothalamus doesn't secrete enough GnRH to stimulate anterior pituitary to secrete LH & FSH → little testosterone/ oestrogen secreted
92
If a child presents with hip pain, no fever (or other systemic illness) and has recently had a viral URTI, what is the *most likely diagnosis*?
What is the management of this?
If the child *also* has a **fever,** what is the most likely diagnosis?
**Transient synovitis**
Management: *symptomatic* (eg analgesia for pain)
**Septic arthritis**
93
What is **muscular dystrophy?**
*An umbrella term* for genetic conditions that cause **gradual weakening & wasting of muscles.**
94
What is a **febrile convulsion?**
What age group are these seen in?
**Febrile convulsion:** seizures that occur in children whilst they have a fever (*not caused by epilepsy or any other neurological pathology)*
Occur in children **up to 5y**
95
What skills would you expect to see from each developmental domain in a 6m infant?
* Gross motor (2)
* Fine motor (2)
* Language (2)
* Social (2)
* Self help (1)
* *Gross motor:** 1) rolls over
2) starts to sit without support
* *Fine motor:** 1) uses 2 hands to pick up large objects
2) transfers toy from 1 hand to another
* *Language**: 1) responds to name
2) 2 syllable babble
* *Social**: 1) reaches for familiar people
2) pushes things they don't want away
**Self help:** 1) feeds self small food
96
What type of tissue are epiphyseal growth plates composed of?
After fusion of the growth plates during puberty, what do they become?
Hyaline cartilage
The epiphyseal lines
97
What skills would you expect to see from each developmental domain in an 18m toddler?
* Gross motor (2)
* Fine motor (2)
* Language (1)
* Social (2)
* Self help (1)
* *Gross motor:** 1) walks up/down stairs unsupported
2) kicks a ball
* *Fine motor:** 1) scribbles with crayon
2) builds towers with 4+ bricks
**Language**: 1) starts to join words into sentences
* *Social**: 1) early pretend play
2) says no when interfered with
**Self help:** 1) eats with fork
98
Describe what you might see in the following seizures:
a) Tonic-clonic seizure
b) Myoclonic seizure
c) Absence seizure
d) Atonic seizure
**Tonic-clonic seizure:** Muscles stiffen (go rigid = tonic) before generalised jerking of limbs (clonic)
**Myoclonic seizure:** Sudden jerking of one limb - patient may be conscious!
**Absence seizure:** Patient 'pauses' for a few seconds before restarting activity - patient often has no recollection
**Atonic seizure:** Muscles suddenly loose all tone - patient falls over
99
If a woman is \*Rh- and is carrying a Rh+ baby and there is no intervention, what will happen during delivery/ when there is mixing of blood?
Why does this happen?
When should this be checked for during pregnancy?
What can be given as prophylaxis for this?
\*Rh = rhesus
The women will start developing anti-D antibodies after any sensitising event (commonly giving birth)
If someone is rhesus negative, they don't have the D antigen on their RBC's so if their blood comes into contact with someone that is rhesus positive then their blood will start producing antibodies against the foreign antigens.
Rh status of mother & baby is checked at the booking appointment (week 10)
If mother is negative & baby is positive, prophylaxis = anti D injection at 28 weeks gestation PLUS immediately after any sensitising events
100
What antibodies are present in coeliac disease?
What type of Ig are these antibodies?
When testing for these antibodies, what do you also need to test for to avoid a false negative result?
Anti-tissue transglutaminase (**anti-TTG**) & anti-endomysial (anti-EMA)
**IgA antibodies**
Total IgA levels - some people are IgA deficient so their total IgA will be low, even if they have coeliacs
101
What age group is Perthes disease most common in?
Children aged 4-10y
102
What investigation is **essential** in order to diagnose meningitis in children?
~ What would be an absolute contraindictation to this?
**Lumbar puncture**
~ signs of raised ICP
103
What is otitis media?
List some symptoms of otitis media: (4)
What will you see on examination?
What is the 1st line management?
What is a concerning complication of otitis media?
Infection of the middle ear
~ ear pain (young children may tug at their ear)
~ reduced hearing in affected ear
~ URTI symptoms: fever, cough, sore throat, blocked nose (otitis media commonly follows from an URTI)
~ discharge if tympanic membrane perforates
~ bulging, red, inflammed tympanic membrane
~ if perforation: discharge & hole in the tympanic membrane
Simple analgesics
Mastoiditis
104
What is **developmental dysplasia of the hip**? (DDH)
List some risk factors for DDH: (3)
What 2 examination tests are performed if DDH is suspected?
What investigation is used to confirm DDH diagnosis?
What is the management of DDH in children:
1. Under 6 months
2. Over 6 months
Abnormal development of the fetal hip/pelvic bones during pregnancy results in structural abnormalities of the femoral head & acetabulum ***→ dislocation of the hip***
1. FH
2. Breech presentation
3. Multiple pregnancy
* *Ortolani test:** hips are abducted & femur is pushed forward to check for anterior dislocation
* *Barlows test:** hips are adducted & flexed to 90 degrees; downward presure applied to knees/femur to check for posterior dislocation
**US of hip**
* *Management:**
1. Pavlik harness
2. Surgery
105
What is the 1st line treatment of **myoclonic seizures** in children?
**Sodium valproate**
106
A 2y old child presents with 4 month history of passage of foul smelling explosive stools 3-4/day, tiredness, pallor & poor weight gain. They have just developed an itchy rash on their abdomen.
What is the likely diagnosis? - name of the rash?
What investigations would you do to confirm this condition?
What is the gold standard investigation to **confirm** the diagnosis?
**Coeliac's disease** - dermatitis herpetiformis
* *Antibodies:**
1) Anti-TTG *plus* total IgA
2) Anti-EMA (if anti-TTG were positive)
**Duodenal biopsy** (via endoscopy)
107
What investigation is used to diagnose coarctation of aorta?
What is the initial management of coarctation of aorta? What does this do physiologically to help?
What are the 2 definitive managements of coarctation of aorta?
***ECHO***
Give **prostaglandin E** - this reopens the ductus arteriosis which increases cardiac ouput & relieves the strain on the L ventricle
Surgical repair (narrowed part is resected and the 2 ends are anastamosed together) or stent insertion
108
What is the 1st line treatment of **absence seizures** in children?
**Sodium valproate**
109
What age are the first immunisations given at in the UK?
What immunisations would you expect a **4month** old to have had? (4)
What additional immunisations would you expect a **12month** old to have had? (2)
What additional immunisation is given at age **13-14y**? (1)
What additional immunisation is given at age **14y**? (1)
2 months old
**Up to 4 months:**
• Diphtheria, tetanus, polio, pertussis, HepB, H.influenza B
• Pneumococcal disease
• Meningococcal B
• Rotavirus
**12 months:**
• Meningococcal C
• Measles, mumps & rubella
**13-14y:**
• HPV vaccine (cervical cancer)
**14y:**
• Meningococcal ACWY
110
A 16y boy presents with central abdominal pain & haematuria for 1 week. He also complains of pain in both knees. Examination reveals a non-blanching purpuric rash on his legs & buttocks. Urine dip shows blood ++ & protein +, kidney function is abnormal.
What is the most likely diagnosis? - what is this?
List the 4 common presenting features of this condition:
What is the management of this condition?
What monitoring needs to be done? (2)
**Henoch-Schonlein Purpura** - A type of IgA vasculitis
* Purpura (rash on legs → buttocks)
* Joint pain (commonly knee's & ankles)
* Abdominal pain
* Renal impairment
**Management:** supportive (analgesia, rest, hydration)
~ most usually resolve within 4-6 weeks.
**Monitoring**: needed whilst the disease is still active:
• urine dipstick (to monitor renal impairment)
• blood pressure (to monitor for hypertension)
111
What is the 1st line investigation in SUFE?
What is the management of SUFE?
**Xray of hip**
Surgery: correction of femoral head positon PLUS screw fixation
~ Prophylactic fixation of contralateral hip may be done
112
A 14-year-old presents to her GP with her mother who is concerned that she is tired all the time and failing to meet deadlines for school projects. She is slightly overweight, but examination is otherwise normal. Urinalysis, FBC, U&Es, LFTs, TFTs and blood glucose are all normal. What would be the most appropriate next step?
* Advise her that everything is normal and to seek further review if new symptoms develop
* Advise her that the tests are normal and suggest seeking additional educational support
* Discuss her lifestyle including sleep patterns and diet
* Refer her to paediatrics for further investigation
* Repeat the blood tests in case something has changed
**Discuss her lifestyle including sleep patterns and diet**
*Repeating normal tests after a very short time scale is unlikely to provide new information. The history and initial examination/investigation suggest that lifestyle factors are likely to be the cause, so this needs to be explored and advice given accordingly.*
113
Match the congenital defect with genetic condition:
Ventricular septal defect
Aortic arch defect
Coarctation of the aorta
Pulmonary valve stenosis
Tetralogy of Fallot
Supravalvular aortic stenosis
Williams syndrome
Down's syndrome
DiGeorge syndrome
Noonan syndrome
Turner's syndrome
**Downs syndrome**: Ventricular septal defect, tetralogy of Fallot
**DiGeorge syndrome:** Aortic arch defect
**Turner syndrome:** Coarctation of the aorta
**Noonan syndrome:** Pulmonary valve stenosis
**Williams syndrome:** Supravalvular aortic stenosis
114
If a woman is found to be **GroupB** **strep** positive during pregnancy, how would this be managed to **avoid transmission** to the **newborn**?
Intrapartum IV Benzylpenicillin
