Paediatrics Flashcards
1
Q
What are the normal ranges for heart rate in the following age ranges?
- <1
- 1-2
- 2-5
- 5-12
- > 12
A
<1: 110-160 1-2: 100-150 2-5: 90-140 5-12: 80-120 >12: 60-100
2
Q
What are the normal ranges for respiratory rate in the following age ranges?
- <1
- 1-2
- 2-5
- 5-12
- > 12
A
<1: 30-40 1-2: 25-35 2-5: 25-30 5-12: 20-25 >1: 15-20
3
Q
What would recurrent respiratory infections and weight loss in a child suggest?
What are some other features of this disorder or disease?
A
Cystic fibrosis
Features:
- Short statue
- DM
- Delayed puberty
- Rectal prolapse (2 to bulky stools)
- Nasal polyps
- Male infertility
- Female subfertility
4
Q
In meningitis when is LP contraindicated?
A
Meningococcal septicaemia (raised ICP_
5
Q
What is the Abx of choice in meningitis?
<3 months
>3 months
A
<3 months: IV amox + IV cefotaxime
>3 months: IV cefotaxime
If >1 month and H. influenzae then also give dexamethasone.
6
Q
What is used for antibiotic prophylaxis of meningitis contacts?
A
Ciprofloxacin
7
Q
What test would you order in an infant with jaundice lasting >14 days?
A
Coomb’s test (direct antiglobulin)
8
Q
What is fragile X syndrome?
What are its features?
A
Trinucleotide repeat disorder
Features in males:
- Learning difficulties
- large low set ears, long thin face, high arched palate
- macroorchidism
- hypotonia
- autism is more common
- mitral valve prolapse
Females (heterozygous), may be normal/mild symptoms
9
Q
How is Fragile X diagnosed?
A
Antenatally: CVS or amnio
CGG repeats analysis using endonuclease digestion and southern blot analysis.
10
Q
What is palivizumab?
When is it used?
A
Monoclonal antibody used to prevent RSV in children at risk of severe disease - Premature infants, those with lung or heart abnormalities, immunocompromised
11
Q
What is the most common ocular malignancy in children?
A
Retinoblastoma
12
Q
What is the pathophysiology of retinoblastoma? Is it hereditary?
What is the prognosis?
A
LOF of retinoblastoma tumour suppressor gene on chromosome 13
10% hereditary
Prognosis is excellent, with >90% surviving into adulthood
13
Q
What are the presenting features of retinoblastoma?
How is it managed?
A
- Absence of red-reflex (most common)
- Strabismus
- Visual problems
Mx:
- Enucleation, external beam radiation therapy, chemo, photocoagulation
14
Q
What is the most common causative organism in Scarlet fever? What specifically causes the reaction?
A
Group A haemolytic streptococci (usually Streptococcus pyogenes).
Reaction is to the erythrogenic toxins.
15
Q
When are the two doses of MMR vaccine given?
What are the potential SE?
A
12-15 months, then 3-4 years.
May have an episode of malaise, fever and rash after first dose, typically after 5-10 days, lasting 2-3 days.
16
Q
What are the contraindications to MMR?
A
- severe immunosuppression
- allergy to neomycin
- children who have received another live vaccine by injection within 4 weeks
- pregnancy should be avoided for at least 1 month following vaccination
- immunoglobulin therapy within the past 3 months (there may be no immune response to the measles vaccine if antibodies are present)
17
Q
In ADHD when would you advise avoiding certain foods/ using fatty acid supplements?
A
Only after a food diary has shown a link between diet and behaviour - Use an MDT approach including a dietitian.
18
Q
What are the side effects of methylphenidate (ritalin)?
What monitoring is needed?
A
Abdo pain, nausea, dyspepsia
Monitor growth every 6 months (not usually affected), monitor for psychiatric disorders and check blood pressure/pulse every 6 months
19
Q
What are the cardiac associations with Turner’s syndrome?
A
- Bicuspid aortic valve
- Aortic root dilatation
- Coarctation of the aorta
20
Q
What is Mesenteric adenitis?
What is the Mx?
A
Inflamed lymph nodes within the mesentery.
It can cause similar symptoms to appendicitis. It often follows a recent viral infection and needs no treatment
21
Q
When is the neonatal blood spot screening carried out?
What does it screen for?
A
= Guthrie test/heel-prick test
5-9 days of life.
Screens for:
- Congenital hypothyroidism
- CF
- Sickle
- Phenylketonuria
- Medium chain acyl-CoA dehydrogenase deficiency (MCADD)
- Maple syrup urine disease (MSUD)
- Isovaleric acidaemia (IVA)
- Glutaric aciduria type 1 (GA1)
- Homocystinuria (pyridoxine unresponsive) (HCU)
22
Q
What is Bartter’s syndrome?
Features?
A
Inherited (autosomal recessive) severe hypokalaemia due to defective chloride absorption at the Na+ K+ 2Cl- cotransporter in the ascending loop of Henle.
NORMOtension
- Usually presents in childhood with failure to thrive
- Hypokalaemia
- Polyuria, polydypsia
- Weakness
23
Q
What are the causes of a false negative CF sweat test?
A
- Skin oedema (most common - often due to hypoalbuminaemia/ hypoproteinaemia secondary to pancreatic exocrine insufficiency.)
- Poor technique
24
Q
What are the causes of a false positive CF sweat test?
A
- malnutrition
- adrenal insufficiency
- glycogen storage diseases
- nephrogenic diabetes insipidus
- hypothyroidism, hypoparathyroidism
- G6PD
- ectodermal dysplasia
- atopic eczema
25
What is the initial emergency management of a unresponsive child that has arrested?
- unresponsive?
- shout for help
- open airway
- look, listen, feel for breathing
- give 5 rescue breaths
- check for signs of circulation
- IF 2+ MEDICAL RESCUERS: 15 chest compressions:2 rescue breaths
Lay rescuers should use 30:2
26
What are the developmental speech milestones at 3 months?
- Quietens to parents voice
- Turns towards sound
- Squeals
27
What are the developmental speech milestones at 6 months?
- Double syllable mumbles
28
What are the developmental speech milestones at 9 months?
Says 'mama' and 'dada'
| Understands 'no'
29
What are the developmental speech milestones at 12 months?
Knows and responds to name
30
What are the developmental speech milestones at 12-15 months?
Knows about 2-6 words (refer at 18 months)
| Understands simple commands
31
What are the developmental speech milestones at 2 years?
Combine two words
| Points to parts of the body
32
What are the developmental speech milestones at 2.5 years?
Vocabulary of 200 words
33
What are the developmental speech milestones at 3 years?
Talks in short sentences (3-5 words)
Asks 'what' and 'who' questions
Identifies colours
Counts to 10
34
What are the developmental speech milestones at 4 months?
Asks 'why', 'when' and 'how' questions
35
What is toddler's diarrhoea?
| What would you do to exclude underlying conditions?
Benign condition causing no problems to child. Due to fast transit through digestive system. Often contains undigested food. No pain/bloating.
Plot height and weight to exclude underlying coeliac etc.
36
What are the physical features of foetal alcohol syndrome?
- short palpebral fissure
- thin vermillion border/hypoplastic upper lip
- smooth/absent filtrum
- learning difficulties
- microcephaly
- growth retardation
- epicanthic folds
37
What is Beckwith-Wiedemann syndrome?
| Features?
An overgrowth disorder, usually present at birth. Characterised by an increased risk of childhood cancer - particularly Wilms tumours (kidneys) and hepatoblastoma (liver).
- Foetal macrosomia
- Macroglossia
- Hypoglycaemia
- Omphalocele
- Umbilical hernia
38
At what times should you assess the APGAR scores?
0, 1 and 5 minutes
39
What gross motor milestones would you expect a child to reach by 3 months?
- Little or no head lag on being pulled to sit
- Lying on abdomen, good head control
- Held sitting, lumbar curve
40
What gross motor milestones would you expect a child to reach by 6 months?
- Lying on abdomen, arms extended
- Lying on back, lifts and grasps feet
- Pulls self to sitting
- Held sitting - back straight
- Rolls front to back
41
What gross motor milestones would you expect a child to reach by 7-8 months?
Sits without support (refer at 12 months)
42
What gross motor milestones would you expect a child to reach by 9 months?
Pulls to standing
| Crawls
43
What gross motor milestones would you expect a child to reach by 12 months?
Cruises
| Walks with one hand held
44
What gross motor milestones would you expect a child to reach by 13-15 months?
Walks unsupported (refer at 18 months)
45
What gross motor milestones would you expect a child to reach by 18 months?
Squats to pick up a toy
46
What gross motor milestones would you expect a child to reach by 2 years?
Runs
| Walks upstairs and downstairs holding on to rail
47
What gross motor milestones would you expect a child to reach by 3 years?
Rides a tricycle using pedals
| Walks up stairs without holding on to rail
48
What gross motor milestones would you expect a child to reach by 4 years?
Hops on one leg
49
What is the most likely organism to cause croup?
Parainfluenza virus
50
What is the most likely organism to cause whopping cough?
Bordetella pertussis
51
What does the Barlow test do?
Attempts to dislocate an articulated femoral head
| B - back
52
What does the Ortolani test do?
Attempts to relocate a dislocated femoral head
| oRto - relocate
53
What is the screening test for childhood strabismus (squint)?
Corneal light reflection test - hold a light source 30cm from the child's face to see if the light reflects symmetrically on the pupils
54
Having identified strabismus, how would you identify its nature?
- ask the child to focus on a object
- cover one eye
- observe movement of uncovered eye
- cover other eye and repeat test
55
What causes a concomitant squint? What are the two types?
Imbalance in extra-ocular muscles
Convergent and divergent.
Convergent is more common.
56
What are the two types of strabismus?
Concomitant (common)
| Paralytic (rare)
57
What type of haemorrhage may occur spontaneously in premature infants?
What may happen in the blood clots?
What is the treatment? When would shunt be indicated?
Intraventricular - occurs in the first 72 hours ?due to birth trauma and cellular hypoxia, together the with the delicate neonatal CNS.
Blood clots may occlude CSF flow and result in hydrocephalus.
Mx is supportive.
Shunt if hydrocephalus and rising ICP
58
What is the step-wise mx of nocturnal enuresis?
1: Look for triggers (UTI, DM, constipation)
2: Reduce fluid intake and try toiletting before bed
3: Reward systems
4: If under 7 enuresis alarm is first line, if over 7 use desmopressin, particularly if short-term control is required on enuresis alarm ineffective/not acceptable to family.
59
Before what age is hand preference abnormal?
| What might this indicate?
12 months
| Cerebral palsy
60
What book milestones would you expect at the following ages?:
15 months
18 months
2 years
15 months: Looks at book, pats page
18 months: Turns pages, several at time
2 years: Turns pages one at time
61
```
A tower of how many bricks should be able to be built at?:
15 months
18 months
2 years
3 years
```
15 months: Tower of 2
18 months: Tower of 3
2 years: Tower of 6
3 years: Tower of 9
62
What fine motor and vision milestones would you expect at 3 months?
- Reaches for object
- Holds rattle briefly if given to hand
- Visually alert, particularly human faces
- Fixes and follows to 180 degrees
63
What fine motor and vision milestones would you expect at 6 months?
- Holds in palmar grasp
- Pass objects from one hand to another
- Visually insatiable, looking around in every direction
64
What fine motor and vision milestones would you expect at 9 months?
- Points with finger
| - Early pincer
65
What fine motor and vision milestones would you expect at 12 months?
- Good pincer grip
| - Bangs toys together
66
What drawing milestones would you expect at 18 months?
Circular scribble
67
What drawing milestones would you expect at 2 years?
Copies vertical line
68
What drawing milestones would you expect at 3 years?
Copies circle
69
What drawing milestones would you expect at 4 years?
Copies cross
70
What drawing milestones would you expect at 5 years?
Copies square and triangle
71
What Ix would you undertake if you suspected an atypical UTI in an infant under 6 months?
What would be the suspicious features?
Ultrasound
Features of atypical UTI:
- Seriously ill
- Poor urine flow
- Abdominal or bladder mass
- Raised creatinine
- Septicaemia
- Failure to respond to treatment with suitable antibiotics within 48 hours
- Infection with non-E. coli organisms.
72
At what age would a UTI warrant immediate referral to paeds?
<3 months
73
What are the key physical features of patau syndrome (Trisomy 13)?
- Microcephalic, small eyes
- Cleft lip/palate
- Polydactyly
- Scalp lesions
74
What are the key physical features of Edward's syndrome (Trisomy 18)?
- Micrognathia
- Low-set ears
- Rocker bottom feet
- Overlapping of fingers
75
What are the key physical features of Fragile X syndrome?
- Macrocephaly
- Long face
- Large ears
- Macro-orchidism
76
What are the key physical features of Noonan syndrome?
- Webbed neck
- Pectus excavatum
- Short stature
- Pulmonary stenosis
77
What are the key physical features of Pierre-Robin syndrome?
| How might you distinguish it from Treacher-Collins?
- Micrognathia
- Posterior displacement of the tongue (may -> upper airway obstruction)
- Cleft palate
TCS is AD, so usually a family history of similar problems.
78
What are the key physical features of Prader-Willi syndrome?
- Hypotonia
- Hypogonadism
- Obesity
79
What are the key physical features of William's syndrome?
- Short stature
- Friendly, extrovert personality
- Transient neonatal hypercalcaemia
- Supravalvular aortic stenosis
80
What is the Mx of threadworms?
Single dose of mebandazole (an anthelmintic) for whole household and hygiene advice.
Repeat dose if infection persists.
81
What is intussusception?
| Features? Mx?
Telescoping bowel, proximal to or at the level of the ileocaecal valve.
6-9 months age
Colicky pain, diarrhoea and vomiting. Sausage-shaped mass, red jelly stool.
Target sign on US (side-on view of multiple layers bowel wall)
Mx: Pneumatic reduction (air insufflation) under fluoroscopic guidance.
82
What is Hirschsprung's disease?
| Features? Mx?
Absence of ganglion cells from myenteric and submucosal plexuses
Occurs in 1/5000 births.
- Delayed passage of meconium and abdominal distension
Full thickness rectal biopsy for diagnosis. Plain abdo X-ray will show dilated loops of bowel with fluid levels.
Mx: rectal washouts initially, thereafter an anorectal pull thorugh procedure
83
What is Meconium ileus?
What condition is associated with this?
Presentation? X-ray findings?
Mx:
= Distal small bowel obstruction secondary to abnormal bulky and viscid meconium. (1/15k)
90% have CF.
Presents in first days of life with gross abdo distention and bilious vomiting.
X-ray: Distended coils of bowel with 'mottled ground glass' appearance. No fluid levels.
Mx: PR contrast studies - may dislodge meconium plugs. + NG N-acetyl cysteine.
If unresponsive - surgery.
84
What is the mutation in achondroplasia?
| How is it inherited?
Mutation is in the fibroblast growth factor receptor 3 (FGFR-3) gene. This results in abnormal cartilage.
Approx 70% sporadic (RF advancing parental age) mutation, once present AD.
85
When would you expect a child to start smiling? When would you refer if not?
6 weeks.
| Refer at 10 weeks.
86
At what age would you expect a child to:
- Play contentedly alone?
- Play near others, not with them?
- Play with other children?
Alone: 18 months
Near others: 2 years
With others: 4 years
87
At what ages would you expect a child to be able to:
- Put hand on bottle when being fed?
- Drink from cup and use a spoon?
- Be competent with spoon, not spill a cup?
- Use a spoon and fork?
- Use and knife and fork?
Hand on bottle: 6 months
Drink from cup and use spoon: 12-15 months
Competent with spoon, no cup spills: 2 years
Use spoon and fork: 3 years
Use knife and fork: 5 years
88
What is an umbilical granuloma?
| Mx?
= overgrowth of tissue, occurs during the healing process of the umbilicus.
Most common in the first few weeks of life.
On examination, a small, red growth of tissue is seen in the centre of the umbilicus. It is usually wet and leaks small amounts of clear or yellow fluid.
Mx: regular application of salt to the wound.
If ineffective then can cauterise with silver nitrate.
89
What is the most common cause of napkin 'nappy' rash?
```
Irritant dermatitis (irritant effect of urinary ammonia and faeces).
Characteristically spares the creases.
```
90
What would a erythematous nappy rash, involving the flexures with characteristic satellite lesions indicate?
Candida dermatitis
91
What would an erythematous nappy rash with flakes indicate?
Seborrhoeic dermatitis
| NB. May be coexistent scalp rash
92
What type of vaccine is rotavirus?
| When is it given?
Oral, live attenuated.
2 doses:
- 2 months
- 3 months
93
Why are neonates given vitamin K?
| How is it given?
To prevent haemorrhagic disease of the newborn (breast feeding and maternal use of antiepileptics puts babies particularly at risk)
Given as a once-off IM injection shortly after birth.
Can also be given orally but not recommended for healthy neonates - risk of insufficient dosing (forgetting doses or vomiting)
94
What 6 common conditions would not warrant school exclusion?
```
Conjunctivitis
Fifth disease
Roseola
Infectious mononucleosis
Head lice
Threadworms
```
95
How long should children with scarlet fever be excluded from school?
24 hours after commencing abx
96
How long should children with whooping cough be excluded from school?
2 days after abs or 21 days from onset of symptoms if no abx
97
How long should children with measles or rubella be excluded from school?
4 days from onset of rash
98
How long should children with chicken pox be excluded from school?
5 days from onset of rash
99
How long should children with mumps be excluded from school?
5 days from onset of swollen glands
100
How long should children with D+V be excluded from school?
Until symptoms have settled for 48 hours
101
How long should children with impetigo be excluded from school?
Until lesions have crusted over
102
How long should children with scabies be excluded from school?
Until treated
103
How long should children with influenza be excluded from school?
Until recovered.
104
What causes Roseola infantum?
| Features?
(=exanthem subitum, sixth disease)
Common disease of infancy caused by the human herpes virus 6 (HHV6).
Incubation period: 5-15 days and typically affects children aged 6 months to 2 years.
Features
- high fever: lasting a few days, followed by:
- maculopapular rash
- febrile convulsions occur in around 10-15%
- diarrhoea and cough are also commonly seen
105
What is the Mx of Whooping cough?
If the onset of cough is within the previous 21 days:
<1 month: Clarithromycin
>1 month/Non-pregnant adults: Azithromycin/Clarithromycin
Pregnant adults: Erythromycin
106
What is Ebstein's anomaly?
| RF?
Congenital heart defect:
- Right atrial hypertrophy, small ventricle
- Triscuspid valve leaflets attach to wall and septum of right ventricle
- May lead to tricuspid regurgitation (pan-systolic, giant V waves JVP), 50% have Wolff-Parkinson-White.
RF: Mother taking lithium during first trimester.
107
What are the features of pyloric stenosis?
Diagnosis?
Mx?
Features:
- 'projectile' vomiting, typically 30 minutes after a feed
- constipation and dehydration may also be present
- a palpable mass may be present in the upper abdomen
- hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
Dx: US
Mx: Ramstedt pyloromyotomy (LT incision in hypertrophied muscle)
108
What is the most common cause of nephrotic syndrome in children?
Minimal change disease (80%) (- give high dose oral steroids)
109
What is the triad of nephrotic syndrome?
- Proteinuria
- Hypoalbuminaemia
- Oedema
110
What is the risk of surfactant deficient lung disease at:
26-28 weeks?
30-31 weeks?
Give 4 other risk factors?
26-28 weeks: 50%
30-31 weeks: 25%
RF:
- Male sex
- Maternal DM
- CS
- Second born of premature twins
111
What are the characteristic x-ray findings of surfactant deficient lung disease?
'Ground-glass' appearance, with an indistinct heart border.
112
What is the most common cause of juvenile hypothyroidism?
| Give 2 other causes?
Autoimmune thyroiditis
Other causes:
- post total-body irradiation (e.g. in a child previous treated for acute lymphoblastic leukaemia)
- iodine deficiency (the most common cause in the developing world)
113
What is the stepwise Mx of asthma in children under 5?
1: SABA
2: + 8-week trial moderate dose ICS - review and consider alternative diagnosis if no effect, if resolved then reoccurs:
- if within 4 weeks then restart ICS at low dose maintainance
- if after 4 weeks repeat 8-week trial
3: + leukotriene reception antagonist
4: stop LTRA and refer to paeds
114
What is the stepwise Mx of asthma in children 5-16?
1: SABA
2: + low-dose ICS
3: + LTRA
4: Stop LTRA, start LABA
5: Switch LCS and LABA for maintenance and reliever therapy (MART) that includes low-dose ICS
6: Swap to mod-dose ICS MART
7: SABA + one of the following options:
- increase ICS to paediatric high-dose, either as part of a fixed-dose regime or as a MART
- a trial of an additional drug (for example theophylline)
- seeking advice from a healthcare professional with expertise in asthma
115
At what age would you expect a child to have adult visual acuity?
2 years
116
At what age do most children achieve day and night-time urinary continence?
3-4 years
117
What is Li-Fraumeni Syndrome?
| What malignancies is it associated with?
AD germline mutations to p53 tumour suppressor gene
- Sarcomas and leukaemias
118
What chromosomes are BRCA1 and 2 carried on?
1: 17
2: 13
119
What is Lynch syndrome?
| What criteria are used to identify high-risk individuals?
= Hereditary nonpolyposis colorectal cancer (HNPCC)
Autosomal dominant
Develop colonic cancer and endometrial cancer at young age
80% of affected individuals will get colonic and/ or endometrial cancer
High risk individuals may be identified using the Amsterdam criteria
120
What is the Amsterdam criteria?
Used to identify individuals at high risk of Lynch Syndrome
- 3+ family members with confirmed diagnosis of colorectal ca, one of whom is a first-degree relative of the other two
- One or more colon cancers diagnosed under age 50
- Familial adenomatous polyposis has been excluded
121
What is Gardner's syndrome?
| Features?
AD familial colorectal polyposis, due to mutation of APC gene located on chromosome 5.
Features:
- Multiple colonic polyps
- Extra-colonic diseases: skull osteoma, thyroid ca and epidermal cysts
- 15% have desmoid tumours
- Most patients undergo colectomy to reduce risk of colorectal ca.
122
What is the risk of Down's syndrome at the following maternal ages?
- 20
- 30
- 35
- 40
- 45
- 20: 1 in 1500
- 30: 1 in 800
- 35: 1 in 270
- 40: 1 in 100
- 45: 1 in 50/greater
NB. Can roughly remember this by starting at 1/1,000 at 30 years and then dividing the denominator by 3 (i.e. 3 times more common) for every extra 5 years of age
123
What are the characteristic sequelae of congenital rubella infection?
- Sensorineural deafness
- Congenital cataracts
- CHD
- Glaucoma
124
What are the characteristic sequelae of congenital toxoplasmosis infection?
- Cerebral calcification
- Chorioretinitis
- Hydrocephalus
125
What are the characteristic sequelae of congenital CMV infection?
- Growth retardation
| - Purpuric skin lesions
126
What is the most common congenital infection in the UK?
CMV
| Maternal infection is usually asymptomatic
127
What is the Mx of seborrhoeic dermatitis in children?
Mild-mod: Baby shampoo and baby oils
Severe: Mild topical steroids e.g. 1% hydrocortisone
NB. Tends to resolve spontaneously around 8 months.
128
What are the features of Kawasaki disease?
How is it diagnosed?
Complications?
= Uncommon type of vasculitis, pred in children.
```
Features:
- high-grade fever which lasts for > 5 days, 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
Diagnosis is clinical, no specific test.
```
129
What is the Mx of Kawasaki disease?
| What is the potential complication? How is this screened for?
High dose aspirin
IV immunoglobulin
Complication: Coronary artery aneurysm. Echo to screen for.
130
What is the most common cause of headaches in children?
Migraine (without aura)
131
What are the recommended immunisations at birth?
BCG/Hep B if risk factors
132
What are the recommended immunisations at 2 months?
'6-1': Diptheria, Tetanus, Whooping Cough, Polio, HiB, Hep B
- Oral rotavirus vaccine
- Pneumococcal conjugate vaccine
- Men B
133
What are the recommended immunisations at 3 months?
'6-1'
| Oral rotavirus
134
What are the recommended immunisations at 4 months?
'6-1'
PCV
Men B
135
What are the recommended immunisations at 12-13 months?
HiB/Men C
MMR
PCV
Men B
136
At what ages is an annual flu vaccine recommended?
2-8
137
What are the recommended immunisations at 3-4 years?
'4-1 pre-school booster': Diptheria, tetanus, Whooping Cough and Polio
MMR
138
What are the recommended immunisations at 12-13 years in girls?
HPV
139
What are the recommended immunisations at 13-18 years?
'3-1 teenage booster' Tetanus, Diptheria and Polio
| Men ACWY
140
When are the Men B vaccines given?
3 doses:
- 2 months
- 4 months
- 12-13 months
141
When are the '6-1' vaccines given?
3 doses:
- 2 months
- 3 months
- 4 months
142
When are the oral rotavirus vaccines given?
2 doses:
- 2 months
- 3 months
143
When are the PCV vaccines given?
2 doses:
- 4 months
- 12-13 months
144
When is meconium aspiration syndrome most common?
| Maternal RF?
In post-term deliveries, rates up to 44% reported in babies born after 42 weeks
RF:
- HTN
- Pre-eclampsia
- Chorioamnionitis
- Smoking
- Substance abuse
145
What are the 7 features of a life-threatening asthma attack?
```
Sp02 <92%
PEF <33% best or predicted
Silent chest
Poor respiratory effort
Agitation
Altered consciousness
Cyanosis
```
146
What are the 4 characteristic features of TOF?
- VSD
- Right ventricular hypertrophy
- Right ventricular outflow tract obstruction, pulmonary stenosis
- Overriding aorta
147
What would a crescendo-decrescendo murmur in the upper left sternal border suggest?
Coartaction of aorta
148
What would a pansystolic murmur in the lower left sternal border suggest?
VSD
149
What would a continuous machinery murmur in the upper left sternal border suggest?
PDA
150
What would an ejection systolic murmur in the upper left sternal border suggest?
Pulmonary stenosis
151
What would a systolic murmur in the upper left sternal border with a fixed splitting to the second heart sound suggest?
Atrial septal defect.
152
What hip disorder is associated with short stature and hyperactivity?
Perthes
153
What is the stepwise Mx of constipation if faecal impaction is present?
1: Polyethylene glycol 3350 + electrolytes (Movicol paed plain)
2: Stimulant laxative (Senna) if no disimpaction after 2 weeks
NB. Substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose if Movicol not tolerated.
154
Give 5 causes of snoring in children?
- Obesity
- Nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
- Recurrent tonsillitis
- Down's syndrome
- Hypothyroidism
155
What is Kallman's syndrome?
Delayed puberty secondary to hypogonadotrophic hypogonadism
156
Give 8 causes of neonatal hypoglycaemia?
- Maternal diabetes
- Prematurity
- IUGR
- Hypothermia
- Neonatal sepsis
- Inborn errors of metabolism
- Nesidioblastosis
- Beckwith-Wiedemann syndrome
157
What is the major risk factor for neonatal respiratory distress syndrome?
Prematurity
158
What is the major risk factor for tachypnoea of the newborn?
CS
159
What is the causative organism in acute epiglottitis?
| Features?
H. influenzae type B. (HiB vaccine at 12-13 months)
Features:
- Rapid onset
- High temperature, generally unwell
- Stridor
- Drooling of saliva
160
When would you refer a child with an undescended testes?
3 months (should be seen before 6 months of age)
161
What is the antibody in coeliac disease?
IgA TTG
162
Jaundice in the first 24 hours is always pathological, what are 4 causes?
- Rhesus haemolytic disease
- ABO haemolytic disease
- Hereditary spherocytosis
- G6PD
163
Jaundice in neonates 2-14 days is usually physiological and more commonly seen in breast fed babies. If there are still signs of jaundice after this time do a prolonged jaundice screen. What does this include?
- Conjugated and unconjugated bilirubin
- Direct antiglobulin test (Coombs)
- TFTs
- FBC and blood film
- Urine for MC&S and reducing sugars
- U&E and LFTs
164
What might a raised conjugated bilirubin in a neonate indicate?
Biliary atresia
165
What are the 5 S's of innocent murmurs?
```
Soft
Systolic
Short
Symptomless
Standing/sitting (vary with position)
```
166
What is the investigation of choice for vesicoureteric reflux?
Micturating cystourethrogram
167
What is the pathophysiology of vesicoureteric reflux?
What does it predispose to?
What is the complication of this?
= Abnormal back flow of urine from bladder into the ureter and kidney.
- Ureters are displaced laterally, entering the bladder more perpendicularly
- Shortened intramural course of ureter
- Vesicoureteric junction cannot therefore function adequately
Predisposes to UTI (found in around 30% children presenting with UTI)
Complication: Renal scarring (in around 35%)
168
What is the most common cause of painless, massive GI bleeding in children aged 1-2?
Meckels diverticulum.
169
What is Meckel's diverticulum?
| What is the rule of 2s?
A congenital diverticulum of the small intestine (remnant of the omphalomesenteric duct)
Rule of 2s:
- Occurs in 2% pop
- 2 feet from the ileocaecal valve
- 2 inches long
170
What is the abx mx of meningitis?
<3 months: IV amox (cover for listeria) + IV cef
| >3 months: IV cef
171
What is the most common childhood malignancy?
| Features? (think bone marrow failure)
ALL
2-5 year old
- Anaemia: Lethargy and pallor
- Neutropaenia: Frequent/severe infections
- Thrombocytopenia: Easy bruising, petechiae
Plus:
- Bone pain (infiltration)
- Hepatosplenomegaly
- Testicular swelling
172
If the newborn otoacoustic emission test is abnormal what test should be undertaken?
Auditory brainstem response test (as a newborn/infant)
173
What is Osgood-Schlatter disease? Features?
= Tibial apophysitis
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle.
174
What are the features of osteochondritis dissecans?
Pain after exercise
| Intermittent swelling and locking
175
What might a soft, scaphoid abdomen (concave, depressed) and bilious vomiting suggest?
How would you investigate?
Intestinal malrotation and volvulus
Urgent upper GI contrast study and US.
176
How is precocious puberty defined?
Development of secondary sexual characteristics before 8 years in F and 9 years in M.
177
What is the most appropriate way to confirm a diagnosis of pertussis?
Per nasal swab. (Or PCR/serology)
178
How long should abx be given in:
UUTI?
LUTI?
Upper: 7-10 days
Lower: 3 days
179
What is erythema infectiosum caused by?
| Typical features?
Parvovirus B19
(Also known as fifth disease or 'slapped-cheek syndrome')
- Lethargy, fever, headache
- 'Slapped-cheek' rash spreading to proximal arms and extensor surfaces
180
What is first and second line mx for viral-induced wheeze?
1: SABA
2: Oral montelukast/ ICS
181
What is Laryngomalacia?
Typical presentation?
Prognosis?
A very common congenital abnormality of the larynx - softening of the cartilage.
Typically an otherwise well infant with inspiratory stridor.
If stridor becomes severe with respiratory distress or FTT then surgery recommended.
Usually self-resolves before 2 years.
182
What is the triad of shaken baby syndrome?
- Retinal haemorrhages
- Subdural haematoma
- Encephalopathy
183
When would you consider a diagnosis of pneumonia rather than bronchiolitis?
- High fever (>39) and/or
| - Persistently focal crackles
184
What is the most common complication of chickenpox?
| What are the rare complications?
Most common: secondary bacterial infection
Rare:
- Pneumonia
- Encephalitis
- Disseminated haemorrhagic chickenpox
- Arthritis, nephritis and pancreatitis
185
What is gastroschisis?
| Maternal associations?
A congenital defect in the anterior abdominal wall just lateral to the umbilical cord, allows intestines to protrude
- Maternal age <20
- Maternal alcohol/tobacco use
186
What 2 factors determine the prognosis of congenital diaphragmatic hernias?
What is the overall survival rate?
- Liver position
- Lung-to-head ration
Around 50%
187
What kind of diet should patients with CF have?
High calorie
High fat
Pancreatic enzyme supplements taken with every meal.
188
What electrolyte abnormalities would you expect in an infant with pyloric stenosis?
Hypochloraemic, hypokalaemia alkalosis
189
What type of inheritance is Prader-Willi?
Imprinting - gene deletion from father, chromosome 15 (NB. gene deletion from mother -> Angelman syndrome)
190
What is a common complication of viral gastroenteritis?
Transient lactose intolerance
191
Following a febrile convulsion, what is the risk of further convulsions?
30%
192
What is the first sign of puberty in males?
testicular growth, volume >4ml indicates onset of puberty
193
In hypospadias, where is the urethral opening most commonly located?
Distal, ventral surface of the penis
194
What is the most common complication of roseola infantum? How likely is this?
Febrile convulsions.
| 10-15%
195
What is the emergency treatment of a child with severe croup?
Oxygen and nebs adrenaline
| + Oral dex if able to take.
196
When does the moro reflex typically disappear?
3-4 months
197
When does the grasp reflex typically disappear?
4-5 months
198
When does the rooting reflex typically disappear?
4 months
199
When does the stepping reflex typically disappear?
2 months
200
What are the characteristic features of infantile spasms/west syndrome?
Prognosis? Why?
= Childhood epilepsy presenting in first 4-8 months. More common in male infants.
- Characteristic 'salaam' attacks: flexion of the head, trunk and arms, followed by arm extension.
- Lasts 1-2 seconds but may be repeated up to 50 times
Often associated with a serious underlying condition - poor prognosis
201
What investigations would you undertake in suspected infantile spasms? What would they show?
Mx?
EEG: Hysparrhythmia in 2/3
CT: Diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)
Vigabatrin is first-line.
ACTH also used
202
What are the 4C's of the measles prodrome?
Coryza
Cranky
Conjunctivitis
Cough
203
What causes hand, foot and mouth disease?
Coxsackie A16 virus
204
What are the complications of measles infection?
- encephalitis: typically occurs 1-2 weeks following the onset of the illness
- subacute sclerosing panencephalitis: very rare, may present 5-10 years later
- febrile convulsions
- giant cell pneumonia
- keratoconjunctivitis, corneal ulceration
- diarrhoea
- appendicitis
- myocarditis
205
If a non-immunised child comes into contact with measles what do you do?
Give MMR within 72 hours (vaccine-induced antibody develops more rapidly than natural infection)
206
What Ix would you do ton look for renal scarring in a child with vesicoureteric reflux?
Radionuclide scan using dimercaptosuccinic acid (DMSA)
207
What is an Epstein's pearl?
Where are they seen?
Mx?
A congenital cyst, found in the mouth. Most common on the hard palate but can also be seen on the gums.
No treatment, spontaneously resolve over a few weeks.
208
What is the step-wise management of reflux in infants?
- Simple advice: feed 30 degree head up, ensure not being overfed, consider trial of smaller and more frequent feeds
- Trial thickened formula OR alginate therapy (Gaviscon)
- Trial PPI or H2RA, but only if regurgitation associated with:
→ unexplained feeding difficulties (for example, refusing feeds, gagging or choking)
→ distressed behaviour
→ faltering growth
Prokinetics e.g metoclopramide should only be used with specialist advice (dystonia risk)
209
What is choanal atresia?
Presentation?
Mx?
Congenital disorder (1 in 7k), where the posterior nasal airway is occluded by soft tissue or bone.
May be bilateral or unilateral. Unilateral may go unnoticed, bilateral will present early in life (obligate mouth breathers) with cyanosis, worse during feeding and may improve when the baby cries.
Mx: Fenestration procedures to restore patency
210
What is the ratio of chest compressions to ventilation in newborn resuscitation?
3:1
211
What is chondromalacia patellae?
Typical presentation?
Mx?
Softening of the cartilage of the patella.
Common in teenage girls. Characteristically anterior keen pain on walking up and down stairs and on rising from prolonged sitting.
Mx: Physio
