Paediatrics 2

Question 1

Jaundice
Pathological
Physiological
Prolonged

Answer 1

In the first 24 hours
2-14 days
> 14 days

Question 2

Causes of pathological jaundice (4)

Answer 2

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
G6PD

Question 3

Causes of prolonged jaundice

Answer 3

biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
congenital infections e.g. CMV, toxoplasmosis

Question 4

Tests for prolonged jaundice

Answer 4

conjugated and unconjugated bilirubin
direct antiglobulin test (Coombs' test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs

Question 5

Raised conjugated bilirubin could indicate which condition?

Mx

Answer 5

biliary atresia –> urgent surgery

Question 6

Juvenile idiopathic arthritis (JIA)
Definition

Pauciarticular JIA definition
Antibody
Associated with which extrarticular issue?

Answer 6

arthritis occurring in someone who is less than 16 years old that lasts for more than 6 weeks

4 or less joints are affected
ANA
Anterior uveitis

Question 7

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 =

Mx

Complication
Ix for screening

Answer 7

Kawasaki

1. High dose aspirin
2. IV IG

Coronary artery spasm
ECHO as screening

Question 8

Limping child
Name the condition
Limp may be painless

Answer 8

Juvenile arthritis

Question 9

Limping child
Name the condition
Usually detected in neonates
6 times more common in girls

Answer 9

Development dysplasia of the hip

Question 10

AP mimicking appendicitis
Rectal bleeding
Obstruction
Mx Surgery

Answer 10

Meckel’s diverticulum

Question 11

Meningitis

Contraindications for LP

Answer 11

focal neurological signs
papilloedema
significant bulging of the fontanelle
DIC
signs of cerebral herniation
meningococcal septicaemia

Question 12

Meningitis

Mx

Answer 12

< 3 months: IV amoxicillin + IV cefotaxime

> 3 months: IV cefotaxime (or ceftriaxone)

Question 13

Meningitis

When would you give dexamethasone?

Answer 13

frankly purulent CSF
CSF white blood cell count > 1000
raised CSF white blood cell count with protein conc >1
bacteria on Gram stain

Question 14

Meningitis
Common organisms
Neonatal to 3 months (3)

Answer 14

Group B Strep
(E. coli
Listeria)

Question 15

Meningitis
Common organisms
1 month to 6 years (3)

Answer 15

Neisseria meningitidis
(Streptococcus pneumoniae
Haemophilus influenzae)

Question 16

Meningitis
Common organisms
Greater than 6 years (3)

Answer 16

Neisseria meningitidis

Streptococcus pneumoniae

Question 17

Common age of achieving day and night time continence

Answer 17

3-4yo

Question 18

Nocturnal enuresis

Mx

Answer 18

Look for underlying causes
Advice of diet, fluid intake, star charts etc
< 7yo - enuresis alarm
> 7yo - desmopressin

Question 19

Meningococcal septicaemia 
Mx
Dosages
<1yo 
1-10yo 
>10yo

Answer 19

IV benpen

300mg, 600mg, 1200mg

Question 20

Umbilical cord contains?

How many arteries and how many veins?

Answer 20

two umbilical arteries and one umbilical vein

Question 21

Mx umbilical hernia versus paraumbilical

Answer 21

likely resolve on its own by 1-3yo

unlikely with paraumbilical

Question 22

cherry red lesions surrounding the umbilicus
may bleed on contact and be a site of seropurulent discharge
=

Mx

Answer 22

Umbilical granuloma

chemical cautery with topically applied silver nitrate

Question 23

urinary discharge from the umbilicus

associated with other urogenital abnormalities.

Answer 23

Persistent urachus

Question 24

umbilical discharge that discharges small bowel content

Answer 24

Persistent vitello-intestinal duct

Question 25

``` left subclavicular thrill continuous 'machinery' murmur large volume, bounding, collapsing pulse wide pulse pressure heaving apex beat = ``` Mx If needing to keep it open give?

Answer 25

PDA indomethacin or ibupofen to inhibit PG synthesis to help close it PGE1

Question 26

hip pain: develops progressively over a few weeks limp stiffness and reduced range of hip movement x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening More common in boys than girls 4-8yo

Answer 26

Perthes

Question 27

What is the Caterall staging?

Answer 27

Staging for Perthes Stage 1 Clinical and histological features only Stage 2 Sclerosis with or without cystic changes and preservation of the articular surface Stage 3 Loss of structural integrity of the femoral head Stage 4 Loss of acetabular integrity

Question 28

Perthes disease | Mx

Answer 28

Management To keep the femoral head within the acetabulum: cast, braces If less than 6 years: observation Older: surgical management with moderate results Operate on severe deformities Prognosis Most cases will resolve with conservative management.

Question 29

usually presents by 6 months e.g. with developmental delay child classically has fair hair and blue eyes learning difficulties seizures, typically infantile spasms eczema 'musty' odour to urine and sweat* = AD/AR Chrm Diagnosed through which investigations?

Answer 29

PKU AR Chrm 12 Guthrie test (heel prick) hyperphenylalaninaemia phenylpyruvic acid in urine

Question 30

Define precocious puberty

Answer 30

'development of secondary sexual characteristics before 8 years in females and 9 years in males'

Question 31

What does thelarche mean? | What does adrenarche mean?

Answer 31

thelarche (the first stage of breast development) | adrenarche (the first stage of pubic hair development)

Question 32

Precocious puberty | Classification

Answer 32

1. Gonadotrophin dependent due to premature activation of the hypothalamic-pituitary-gonadal axis FSH & LH raised 2. Gonadotrophin independent due to excess sex hormones FSH & LH low