Paediatrics

Question 1

Gross Motor Milestones

Answer 1

3 Months - head control
6 Months - rolls front to back, back straight when held sitting
7-8 Months - sits without support
9 Months - pulls to standing, crawls
12 Months - cruises, walks with one hand held
12-15 Months - walks unaided
18 Months - squats to pick things up
2 years - runs
3 years - rides a tricycle
4 years - hops on one leg

Question 2

Gross motor milestones - when to be concerned (2 things)

Answer 2

Not sitting without support by 12 months

Not walking without support by 18 months.

Question 3

Age at which continence usually achieved

Answer 3

3 to 4 years

Question 4

Management of Nocturnal Eneuresis (4 things)

Answer 4

1) rule out other causes e.g. constipation, diabetes, UTI
2) advise on fluid intake, diet, toileting behaviour
3) give rewards for agreed behaviour i.e. toileting before bed
4) failing these measures, generally enuresis alarm for children under 7 or desmopressin for children over 7 years. (depending on family needs and preferences.)

Question 5

Causes of Microcephaly

Answer 5

Normal Varient
Familial
Congenital Infection
Perinatal brain injury
FAS
syndromes e.g. Patau
craniocyntosis

Question 6

Presentation of Heart failure in Infants (4)

Answer 6

Breathlessness worse on exertion e.g. feeding
sweating
poor feeding
recurrent chest infections

Question 7

Causes of Heart Failure in Infants

Answer 7

< 2 weeks - duct dependant systemic circulations e.g. coarctation of the aorta
> 2 weeks - VSD as the pulmonary vasculature resistance falls

Question 8

Risk assessment in febrile children -colour

Answer 8

Green - normal
Amber - pallor reported by care giver
Red - pale or mottled

Question 9

Risk assessment in febrile children - Activity

Answer 9

Green - responds normally, content, easily rousable or awake, not crying or strong cry
Amber - not responding normally to social cues, no smile, takes time to wake, decreased activity
red - no response to social cues, appears ill, does not wake or does not stay awake when roused, weak, high pitched or continuous cry.

Question 10

Risk assessment in febrile children - Respiratory

Answer 10

Amber - nasal flaring, tachyponea (>50b/m in 6-12 months or >40b/p in ae >12 months), 02 sats = 95% in air, Crackles in the chest.
red - grunting, tachyponea >60 bpm, moderate or severe chest indrawing

Question 11

Risk assessment in febrile children - circulation and hydration

Answer 11

green - normal skin and eyes, moist mucous membranes
amber - tachycardia >160 b/m in <12 mnths, >150 b/m in 12-24 mnths, >140 b/m in 2-5yrs, cap refil >/= 3 secondsm dry mucous membranes, poor feeding, reduced urine output
red - reduced skin turgor

Question 12

Risk assessment in febrile children - other

Answer 12

green - no amber or red signs
amber - age 3-6 mnths temp >39 degrees, fever for 5 days or more, rigors, swelling of a joint or limb, non-weight bearing or not using an extremety.
red - age <3 months temp >38, non blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal neurology, focal seizures.

Question 13

management of febrile illness in infants

Answer 13

GREEN - supportive care at home, advice when to seek help
AMBER - safety net or paeds specialist review
RED - urgent referal to paeds specialist

Question 14

What would these parameters be in early (compensated) shock in a child? BP, HR, Resp rate, appearance, urine output

Answer 14

BP - Normal
HR - tachy
RR - tachy
appearance - pale or mottled
UP - reduced

Question 15

What would these parameters be in late (decompensated) shock in a child? BP, HR, Resp appearance, urine output

Answer 15

BP - hypo
HR - Brady
Resp - acidotic
appearance - blue
UO - absent

Question 16

Fluid Bolus in children

Answer 16

20ml/kg (15ml/kg in neonates) in 10 mins of saline

Question 17

initial management of duct dependent congenital heart disease

Answer 17

prostaglandins e.g. alprostadil as they maintain patency of the ductus arteriosus

Question 18

Red flags for constipation (5) (and two amber)

Answer 18

reported from first few weeks of life
Meconium passed later than 48 hrs post birth
‘ribbon’ stools
previously undiagnosed leg weakness or locomotor delay
abdominal distension
Amber - safeguarding concern, faltering growth

Question 19

Causes of Constipation in Children

Answer 19

Majority are Idiopathic
dehydration
low-fibre diet
opiate medication
anal fissure
over enthusiastic potty training
hypothyroidism
hirschsprung's disease
hypercalcaemia
learning disability

Question 20

what is Hirschsprung’s Disease?

Answer 20

the absence of ganglions in a segment of the bowel causing loss of peristalsis and ability to move stool through the intestine

Question 21

What is perthes’ disease and who gets it?

Answer 21

degenerative condition of the hips, typically affecting boys (5:1) aged 4 - 8 years. It is due to AVN of the femoral epiphysis.

Question 22

presentation of Perthes’

Answer 22

Hip pain, progressive over weeks
limp
stiffness and reduced ROM

Question 23

radiographical changes in perthes’

Answer 23

widening of joint space, decreased femoral head size, femoral head flattening

Question 24

management of perthes’

Answer 24

Cast and braces to keep femoral head in acetabulum

if older than 6 consider surgical management

Question 25

What is Juvenile idiopathic arthritis

Answer 25

arthritis occurring in someone less than 16 years old lasting more than 6 weeks.

Question 26

Types of JIA and their features (5)

Answer 26

Pauciarticular - most common, 4 or less joints effected, medium sized joints e.g. knees, shoulders elbows Systemic-onset JIA -anaemia, thrombocytosis, lecucytosis and rasied ESR present RF positive JIA - RF is positive, nodules on extensor surface of tendons Polyarticular JIA - 4 or more joints effected Ethesitis related JIA - inflammationof the entheses present (site of tendon and ligament insertion into bone.)

Question 27

What is plagiocephaly?

Answer 27

parallelogram shaped head - normal in infants due to sleeping on back. usually resolves between 3-5 years. Reassure and recommend moving cot/ focus of attention, encouraging supervised supported sitting out during the day and supervised tummy time.

Question 28

What is biliary atresia and when does it occur?

Answer 28

oliteration or discontinuity of the extrahepatic biliary system, resulting in obstructive jaundice. Usually presents in first few weeks of life.

Question 29

Fine motor developmental milestones - general

Answer 29

3 months - reaches for objects, holds rattle briefly 6 months - holds in palmar grasp, passess objects from one hand to the other 9 months - points with finger, early pincer 12 months - good pincer, bangs toys together

Question 30

visual developmental milestiones

Answer 30

3 months - fixes and follows to 180 degrees | 6 months - visually insatiable - looking around in every direction

Question 31

Towers of Bricks milestones

Answer 31

15 months - tower of 2 18 months - tower of 3 2 years - tower of 6 3 years - tower of 9

Question 32

drawing milestones

Answer 32

``` 18 months - circular scribble 2 years - copies vertical line 3 years - copies circle 4 years - copies cross 5 years - copies square and triangle ```

Question 33

book milestones

Answer 33

15 months - looks at pages and pats pages 18 months - turns several pages at a time 2 years - turns pages one at a time

Question 34

What is Croup

Answer 34

URTI most common in 6mnths to 3 yrs causing laryngeal oedema and secretions caused by parainfluenza viruses.

Question 35

features of croup

Answer 35

stridor barking cough fever coryzal symptoms

Question 36

severity of croup

Answer 36

mild - occasional barking cough, no stridor, no recessions, well child moderate - frequent barking cough, audible stridor at rest, some suprasternal and sternal wall retraction at rest. No or little distress, child can be placated and is interested in surroundings severe - frequent barking cough, prominent stridor, marked sternal retractions, significant distress, lethargy or restlessness, tachycardia, hypoxia

Question 37

management of Croup

Answer 37

oral dexamethasone 0.15mg/kg admit if moderate or severe, child under 6mnths old, known upper airway abnormalities, uncertain diagnosis. In emergencies give high flow oxygen and nebulised adrenaline.

Question 38

What are infantile spasms?

Answer 38

type of childhood epilepsy which typically first present in 4-8mnths. they carry a poor prognosis.

Question 39

Presentation of infantile spasms

Answer 39

'salaam' attacks - flexion of head, trunk and arms, followed by extension of the arms, lasting a few seconds but may be repeated many times. progressive learning disability.

Question 40

investigation of infantile spasms

Answer 40

CT - brain disease in 70% | EEG - hypsarrhythmmia in 66%

Question 41

management of infantile spasms

Answer 41

vigabatrin first line (prevents breakdown of GABA) | ACTH

Question 42

complications of respiratory distress syndrome at birth

Answer 42

renal failure and retinopathy of prematurity

Question 43

What is transient synovitis and how should it be managed.

Answer 43

Acute hip pain following a viral infection in 2 to 10 years. There may be a low grade fever. Rest and analgesia.

Question 44

What is Ebstein's anomaly?

Answer 44

CHD where the tricuspid valve is positioned low, in the right ventricle resulting in a large atrium and small ventricle. It is associated with tricuspid regurg and Wolff-Parkinson White and may be caused by intrauterine lithium exposure.

Question 45

Features of Turner's Syndrome (12)

Answer 45

``` short stature shield chest widely spaced nipples webbed neck bicuspid aortic valve (15%), coarctation of the aorta (5-10%) primary amenorrhoea cystic hygroma (often diagnosed prenatally) high-arched palate short fourth metacarpal multiple pigmented naevi lymphoedema in neonates (especially feet) gonadotrophin levels will be elevated ```

Question 46

5 Red flags and 2 amber flags for constipation in children

Answer 46

Present since the first few weeks of life >48hrs to meconium passage 'ribbon' stools new leg weakness or locomotor delay Abdominal distention Amber: Faltering growth and safeguarding concerns

Question 47

Epiglottitis causative organism

Answer 47

Haemophilus infleunzae type B

Question 48

``` Pyloric stenosis Who gets it? Features Diagnosis Treatment ```

Answer 48

M>F, 4-6 weeks old Projectile non bile stained vomiting Diagnosis is made by test feed or USS Treatment: Ramstedt pyloromyotomy (open or laparoscopic)

Question 49

Acute appendicitis Who gets it? Presentation

Answer 49

Uncommon under 3 years | When occurs may present atypically

Question 50

``` Intussusception What is it? Where does it usually occur? Age? Presentation? Management? ```

Answer 50

Telescoping bowel Proximal to or at the level of, ileocaecal valve 6-9 months of age Colicky pain, diarrhoea and vomiting, sausage-shaped mass, red jelly stool. Treatment: reduction with air insufflation

Question 51

``` Malrotation What is it? Associated conditions? Complications? Diagnosis? Management? ```

Answer 51

High caecum at the midline Feature in exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia May be complicated by the development of volvulus, an infant with volvulus may have bile stained vomiting Diagnosis is made by upper GI contrast study and USS Treatment is by laparotomy, if volvulus is present (or at high risk of occurring then a Ladd's procedure is performed

Question 52

``` Hirschsprung's disease What is it? Presentation Diagnosis Management ```

Answer 52

Absence of ganglion cells from myenteric and submucosal plexuses Delayed passage of meconium and abdominal distension Full-thickness rectal biopsy for diagnosis Treatment is with rectal washouts initially, after that an anorectal pull through procedure

Question 53

Oesophageal atresia Associations Presentation

Answer 53

Associated with tracheo-oesophageal fistula and polyhydramnios May present with choking and cyanotic spells following aspiration

Question 54

Meconium ileus Presentation associated diagnosis Management

Answer 54

Usually delayed passage of meconium and abdominal distension The majority have cystic fibrosis PR contrast studies may dislodge meconium plugs and be therapeutic, NG N-acetyl cysteine useful, Infants who do not respond will require surgery to remove the plugs

Question 55

Biliary atresia Presentation Investigation finding Management

Answer 55

Jaundice > 14 days Increased conjugated bilirubin Urgent Kasai procedure

Question 56

``` Necrotising enterocolitis Who gets it? Features X-ray findings Risk factor Management ```

Answer 56

Premature babies Early features include abdominal distension and passage of bloody stools X-Rays may show pneumatosis intestinalis and evidence of free air Increased risk when empirical antibiotics are given to infants beyond 5 days Treatment is with total gut rest and TPN, babies with perforations will require laparotomy

Question 57

Mesenteric adenitis | Presentation and management

Answer 57

Central abdominal pain and URTI | Conservative management

Question 58

VACTERL conditions

Answer 58

``` Vertebral defects Anal atresia Cardiac defects Tracheo-esophageal fistula Renal anomalies Limb abnormalities ```

Question 59

Management of UTI

Answer 59

Under 3 months - refer same day to paeds Over 3 months - upper UTI - refer to hospital - lower UTI - 3 days Abx and safety netting

Question 60

when to admit a child with bronchiolitis

Answer 60

RR over 60 breaths/minute difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume clinical dehydration

Question 61

``` Patau syndrome (trisomy 13) 4x features ```

Answer 61

Microcephalic, small eyes Cleft lip/palate Polydactyly Scalp lesions

Question 62

Edward's syndrome (trisomy 18) | 4x feautres

Answer 62

Micrognathia Low-set ears Rocker bottom feet Overlapping of fingers

Question 63

Fragile X | 5x features

Answer 63

``` Learning difficulties Macrocephaly Long face Large ears Macro-orchidism ```

Question 64

Noonan syndrome | 4x features

Answer 64

Webbed neck Pectus excavatum Short stature Pulmonary stenosis

Question 65

Pierre-Robin syndrome* | 3x features

Answer 65

Micrognathia Posterior displacement of the tongue (may result in upper airway obstruction) Cleft palate

Question 66

Prader-Willi syndrome | 3x features

Answer 66

Hypotonia Hypogonadism Obesity

Question 67

William's syndrome | 5x features

Answer 67

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

Question 68

Cri du chat syndrome (chromosome 5p deletion syndrome) | 5x features

Answer 68

Characteristic cry (hence the name) due to larynx and neurological problems Feeding difficulties and poor weight gain Learning difficulties Microcephaly and micrognathism Hyperteloris

Question 69

Causes of Hypertension in children (6)

Answer 69

``` Renal parenchymal disease renal vascular disease coarctation of the aorta phaeochromocytoma congenital adrenal hyperplasia essential or primary hypertension ```

Question 70

Imaging developmental dysplasia of the hip

Answer 70

newborn - ultrasound | >4.5 months - X-ray