paediatrics

Question 1

whooping cough mgt

Answer 1

azithromycin/ clarithromycin if onset of sx within past 21 days

Question 2

fragile X syndrome
cardiac issue

Answer 2

mitral valve prolapse

Question 3

Patau syndrome (trisomy 13) features (4)

Answer 3

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

Question 4

Edward’s syndrome (trisomy 18)
features (4)

Answer 4

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

Question 5

Noonan syndrome (4)

Answer 5

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

Question 6

Prader-Willi syndrome (6)

Answer 6

ch 15

short stature
Hypotonia
Hypogonadism
Obesity + hyperphagia
almond shaped eyes
LD + behavioural issues

Question 7

William’s syndrome (5)

Answer 7

Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

Question 8

Turner’s syndrome cardiac features:

Answer 8

bicuspid aortic valve (15%)
coarctation of the aorta (5-10%)

Question 9

causes of neonatal jaundice in 1st 24hrs

Answer 9

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

Question 10

causes of prolonged jaundice (after 24hrs)

Answer 10

biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
jaundice is more common in breastfed babies
mechanism is not fully understood but thought to be due to high concentrations of beta-glucuronidase → increase in intestinal absorption of unconjugated bilirubin
prematurity
due to immature liver function
increased risk of kernicterus
congenital infections e.g. CMV, toxoplasmosis

Question 11

chickenpox features

Answer 11

initially: fever

itchy rash
- starts on head/ trunk then spreads
- macular, then papular, then vesicular MPV

systemic upset = mild

Question 12

measles feature:

Answer 12

Prodrome:
irritable, conjunctivitis, fever

Koplik spots:
white spots (‘grain of salt’) on buccal mucosa

Rash:
starts behind ears then to whole body, discrete maculopapular rash becoming blotchy & confluent

Question 13

measles cx

Answer 13

otitis media (= most common)
pneumonia (=most common cause of death)

encephalitis: typically occurs 1-2 weeks following the onset of the illness)
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis

Question 14

mumps features:

Answer 14

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

Question 15

rubella features:

Answer 15

Rash:
pink maculopapular
initially face, then spreads to whole body
usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

Question 16

erythema infectiosum
i. causative organism
ii. other name

Answer 16

i. parvovirus B19
ii. slapped cheek - then spreads to proximal arms and under extensor surfaces

Question 17

scarlet fever

cause

Answer 17

Reaction to erythrogenic toxins produced by Group A haemolytic streptococci

Question 18

scarlet fever
features

Answer 18

Fever, malaise, tonsillitis
‘Strawberry’ tongue
Rash - fine punctate erythema sparing the area around the mouth (circumoral pallor)

Question 19

scarlet fever mgt

Answer 19

penicillin V PO (10 days)

Question 20

scarlet fever cx

Answer 20

otitis media
rheumatic fever
acute glomerulonephritis
invasive cx - bacteraemia, meningitis, nec fasc

Question 21

hand, foot and mouth
causative organism

Answer 21

coxsackie A16 virus

Question 22

hand, foot and mouth
features

Answer 22

Mild systemic upset: sore throat, fever
Vesicles in the mouth and on the palms and soles of the feet

Question 23

roseola infantum

i. casuative organism
ii. other name

do we need school exclusion

Answer 23

i. HHV6
ii. sixth disease

NO

Question 24

roseola infantum

features:

Answer 24

high fever for few days
then maculopapular rash

Nagayama spots - papular enanthem on uvula + soft palate

febrile convulsions
diarrhoea and cough

Question 25

Kawasaki disease features:

Answer 25

high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics conjunctival injection bright red, cracked lips strawberry tongue cervical lymphadenopathy red palms of the hands and the soles of the feet which later peel

Question 26

Kawasaki disease cx

Answer 26

coronary a. aneurysms

Question 27

most common cause of nephrotic syndrome in children

Answer 27

minimal change disease

Question 28

benpen doses for initial mgt of meningitis in community

Answer 28

<1 year 300mg 1-10yrs 600mg >10yrs 1200mg

Question 29

pyloric stenosis electrolyte derangement

Answer 29

hypochloraemic, hypokalaemic metabolic alkalosis (due to persistent vomiting)

Question 30

tetralogy of fallot features:

Answer 30

1. VSD 2. RV hypertrophy 3. RV outflow obstruction/ pulmonary stenosis 4. overrriding aorta

Question 31

tetralogy of fallot on XR

Answer 31

boot shaped heart

Question 32

Perthes disease what is it?

Answer 32

AVN of femoral head

Question 33

Perthes disease age of onset

Answer 33

4-8 yrs

Question 34

most common cause of cyanotic congenital heart disease: i. at birth ii. overall

Answer 34

i. TGA ii. tetralogy of Fallot (usually present at 1-2 months)

Question 35

most common cause of acyanotic congenital heart disease:

Answer 35

VSD

Question 36

juvenile idiopathic arthritis features:

Answer 36

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

Question 37

juvenile idiopathic arthritis ix

Answer 37

ANA +ve (especially in oligoarticular JIA) RF -ve

Question 38

patent ductus arteriosus features:

Answer 38

left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat

Question 39

patent ductus arteriosus mgt

Answer 39

indomethacin / ibuprofen

Question 40

paediatric asthma mgt:

Answer 40

1. SABA 2. SABA +ICS (start at this step if new dx + sx >3x weekly or night-time wakening) 3. SABA + ICS+ LTRA 4. SABA +ICS+ LABA ...

Question 41

DDH RF: (7)

Answer 41

- female - breech - FH - prim - oligiohydramnios - birth weight >5kg - congenital calcaneovalgus foot deformity

Question 42

tuberous sclerosis i. inheritance ii. features

Answer 42

i. AD ii. hypomelanotic macules (ash leaf spots) seizures developmental delay angiofibroma renal and cardiac cx