Paediatrics

Question 1

When should a babby be able to raise their head to 45 degrees when in prone position?

Answer 1

6-8 weeks

Question 2

When should a baby be able to sit without support? When should it be able to crawl?

Answer 2

6-8 months to sit

8-9 months to crawl

Question 3

When should a baby be walking unsteady by?

Answer 3

should start at 12 months

>18 months is abnormal

Question 4

When should a child be able to walk steady? when for run and jumping?

Answer 4

steady walking should be around 15months

running and jumping at 2.5 years

Question 5

Describe 3 of the vision and fine motor development milestones

Answer 5

• at 6 weeks should follow objects/ face by turning head
• at 4 months should reach out for toys
• palmar grasp at 4-6 months
• pincer grip at 10 months

Question 6

many many bricks should a 1.5,2 and 2.5 year old be able to stack?

Answer 6

3 bricks- 18 months
6 bricks- 2 years
8 bricks- 2.5 years
3 year old should be able to build a bridge from a model

Question 7

How is a childs fine motor development assessed from ages 2-4?

Answer 7

Drawing
line= 2 yrs 
circle= 3 yrs
cross= 3.5 yrs
square= 4 years

Question 8

When should a baby start making noises?

Answer 8

3-4 months

Question 9

When should the child start saying words like mamma and dadda

Answer 9

7-10 months

Question 10

when should a child be able to make simple phrases? eg ‘give me teddy’

Answer 10

20-24 months

Question 11

What is are the 4 main things drs are looking for in the 6 week baby check?

Answer 11

• congential heart disease (cyanosis, head, resp distress, murmers)
• developmental dysplasia of the hip (length discrepancy, barlow test)
• congenital cateracts (external exam, red reflex)
• undescended testes
• a general abdo, resp, growth, tone–> bruises SAFEGUARDING

Question 12

What are the 4 categories of child abuse?

Answer 12

• physical abuse
• emotional abuse
• sexual abuse
• neglect

Question 13

Give 4 signs of child neglect

Answer 13

• absent from school frequently
• lacks needed medical care, denal care, immunisations or glasses
• consistantly dirty or poor body odour
• complain of hunger and looks malnourished

Question 14

Give 2 signs of emotional abuse

Answer 14

• extremes in behaviour
• delayed physical, emotional or intellectual development
• finds it hard making friends
• bed wetting or soiling in school age
• seem gloomy or depressed

Question 15

What is the normal resp rate for a 1 year old?

Answer 15

<40 breaths per min

<60 for 0-5 months and <50 for 6-12 months

Question 16

What is normal HR for child <1, 1-2 and 2-4?

Answer 16

<1= <160 bpm
1-2= <150bpm
2-4= <140bpm

Question 17

What are signs of meningitis in child?

Answer 17

• fever
• neck stiffness
• bulging frontanelle
• decrease consciousness
• epilepsy
• non blanching rash
• prolonged cap refill
• signs other than fever may not be present in infants

Question 18

What tool can be used for assessment of feverish child with no localising symptoms? How does the system work?

Answer 18

Traffic light system

• if no amber or red signs they are not at high risk of serious illness
• if they do they should be sent straight to hospital

Question 19

Describe amber signs on the traffic light system for a feverish child? (Give 5)

Answer 19

• pallor
• not responding normally to social queues, not smiling, wakes with only prolonged stimulation, decreased activity
• nasal flaring, highresp rate for age, sats less than 95%
• high hr for age, cap refill longer than 3
• dry mucous membranes, reduced urine output
• age 3-6 months temp >39
• fever >5 days
• joint or limb swelling
• other localising symptoms and signs

Question 20

Give 5 high risk signs for a feverish child

Answer 20

• pale/ mottled/ ashen/ blue
• no response to social cues
• appears ill
• does not wake
• weak high pitches continious cry
• grunting
• rr>60
• moderate or severe chest indrawing
• reduced skin turgor
• age more than 3 months with fever greater than 38
• non blanching rash
• bulging frontanelles
• neck stiffness
• status epilepticus
• focal neuro signs or seizures

Question 21

How should you measure the temperature of a child younger than 4 weeks?

Answer 21

Electronic thermometer in axilla

Question 22

How does infectious mononucleosis present?

Answer 22

• usually in college age students
• low grade fever
• fatigue and prolonged malaise (can persist for months after acute infection)
• sore throat: tonsils enlargement with exudate, palatial petechia and uvulas odema
• fine macular and non pruritic rash which rapidly dissapears
• lyphadenopathy common
• later signs inc mild hepatomegaly and splenomegaly and jaundice (

Question 23

How can infective mononucleosis be diagnosed?

Answer 23

IM heterophile antibodies on blood test- monospot test

EBV specific antibodies if suspect false negative heterophile antibody test

Question 24

What disease are associated with infectious mononucleosis

Answer 24

• burkitts lymphoma
• b cell lymphomas in immunosurpressed pts
• undifferentiated carcinomas
• Duncan’s syndrome
• multiple sclerosis

Question 25

How is infectious mononucleosis managed?

Answer 25

Avoid contact sports for 3 weeks
Avoid alcohol
Paracetamol for analgesia and fever control
Can go to school/ work
Steroids can be used if develop haemolytic anaemia, CNS involvement or extreme tonsillar enlargement
Send to hospital if need iv fluids

Question 26

Give 3 complications of infectious mononucleosis

Answer 26

Extreme tonsillar enlargement blocking airway
Myocarditis 
Splenic rupture 
Haemolytic anaemia 
Thrombocytopenia 
ATN and GN
prolonged fatigue and depression