Paediatrics

Question 1

Ill neonate - consider…

3

Answer 1

1. Sepsis (infection screen including LP)
2. Hypoglycaemia
3. Metabolic disturbances

Question 2

Feeding difficulty causes in neonates

4

Answer 2

1. Sepsis
2. Prematurity
3. Heart failure
4. Congenital abnormalities (e.g. cleft palate)

Question 3

Neonatal jaundice - when to admit…

2

Answer 3

• Within 2 hours - jaundice occurs in first 24 hours of life

- Within 6 hours:
FIRST occurs after 7 days
Prolonged jaundice
Unwell
Gestational age <35/40
Pale stool and dark urine
Poor feeding

Question 4

Physiological jaundice

=

Answer 4

Day 2 - 10 (increased BR load)

Question 5

Breast-milk jaundice

=

Answer 5

Day 2 - several weeks

= prolongation of physiological jaundice in breastfed babies, baby well

Question 6

Pathological jaundice

causes - many, eg of 4

Answer 6

Many causes, eg.

• blood group incompatibility
• sepsis
• metabolic disorders
• biliary atresia

Question 7

Failure to thrive

=

Answer 7

= significant drop in expected rate of growth compared with other children of similar age/sex

—> use centile/growth charts to track
(Normal to lose 10% bodyweight in first few days of life)

Question 8

Failure to thrive - prenatal causes

4

Answer 8

1. Prematurity
2. Maternal malnutrition
3. IUGR
4. Maternal smoking/alcohol

Question 9

Failure to thrive - postnatal causes

5

Answer 9

1. Feeding problems, e.g. cleft palate
2. Reflux
3. GI disorders, e.g. malabsorption
4. Organ failure
5. Neglect

Question 10

Management of FTT

4

Answer 10

1. Dietary input
2. Social worker input
3. Paediatric input
4. Treat underlying cause

Question 11

Numerical examples of paeds chromosomal abnormalities

3

Answer 11

DEP

1. Down’s - trisomy 21
2. Edwards - trisomy 18
3. Patau’s - trisomy 13

Question 12

Sex chromosome abnormalities

2

Answer 12

1. Klinefelter’s - 47 XXY

2. Turner’s - 45 XO

Question 13

Down’s syndrome

Features (5)

Associations (4)

Answer 13

Features:

1. Smaller ears
2. Flat nasal bridge
3. Brushfield spots
4. Epicanthic folds
5. Wide space between 2nd/3rd toes

Associations:

1. ALL
2. Congenital heart disease
3. Hirschprung’s
4. Duodenal atresia

Question 14

Signs of congenital heart abnormalities

4

Answer 14

1. FTT
2. Murmur
3. Poor feeding
4. Heart failure symptoms

Question 15

Congenital abnormalities - broad headings

3

Answer 15

1. Heart
2. Gut
3. Neurological

Question 16

Congenital heart abnormalities -

Acyanotic v Cyanotic

(4) v (4)

Answer 16

Acyanotic:

1. ASD
2. VSD
3. PDA
4. Aortic coarctation

Cyanotic:

1. Fallot’s tetralogy
2. TGA (transposition of great arteries)
3. Pulmonary stenosis
4. Tricuspid atresia

Question 17

Gut congenital abnormalities

3 + info

Answer 17

1. Hirschprung’s = development failure of parasympathetic plexus —> constipation.
   Mx = surgical removal of affection section
2. Pyloric stenosis - projectile vomiting approx 3-4 weeks; sometimes visible peristalsis.
   Mx = Ramstedt’s pyloromyotomy
3. TOF = connection between trachea and oesophagus —> higher incidence of aspiration pneumonia.
   Mx = surgical correction

Question 18

Neuro congenital abnormalities

2

Answer 18

1. Cerebral palsy

2. Spina bifida

Question 19

SPINA BIFIDA

Def
Types
Dx
Ix
Mx

Answer 19

= NTD - vertebral arch of spinal column absent or incomplete

Can be occulta (overlying skin intact, no protrusion of spinal cord) or cystica (open - visible cystic mass on back, e.g. meningocele)

Dx - prenatally: AFP, anomaly scan, amniocentesis

Ix - full spine examination & check for other abnormalities

Mx - can be treated surgically (in utero or post-natally) to prevent complications, e.g. meningitis

Question 20

CEREBRAL PALSY

Defn
Cause
Features
Mx

Answer 20

= group of conditions permanently affecting motor (movement) and coordination

Caused by damage to brain before, during or soon after birth

Features - include high or low muscle tone, delayed milestones, etc

Mx - MDT approach, e.g. physio, speech therapy, etc

Question 21

Talipes equinovarus (club foot)

Answer 21

Foot can’t be placed on ground

Conservative Mx - e.g. ponseti method of stretching/casting
Or surgical, e.g. if fixed deformity

Question 22

PERTHES

Defn
Demo
So
Mx

Answer 22

= avascular necrosis of femoral head epiphysis

M>F, age 5-10

May have limp, pain in knee/hip

Non-surgical, e.g. analgesia
VS surgical when persists

Question 23

SUFE

Defn
Demo
Sx
Mx

Answer 23

Epiphysis ‘slipped’ down and back

M>F, age 10-15

May have Iimp, pain in knee/hip/groin

Surgery as may lead to avascular necrosis of femoral head

Question 24

Irritable hip

Answer 24

Pain and limp eg following infection

Admit if other causes in doubt. Rest and analgesia

Question 25

JIA (Still’s disease) Defn Ix Mx

Answer 25

Chronic arthritis in <16yo, similar features to adults Raised inflammatory markers, HLA-B27 may be positive Mx - physio, med (e.g. aspirin, methotrexate), surgery, urgent ophthalmology review for uveitis

Question 26

Pulled elbow

Answer 26

Usually under 5’s Dislocation of radial head Needs manual reduction

Question 27

ADHD Defn Mx

Answer 27

Triad of 1. Inattention 2. Hyperactivity 3. Impulsiveness At least more than 1 situation, impairing function, usually under age 7 Rx - methylphenidate (Ritalin)

Question 28

AUTISM Dx Mx

Answer 28

3 essential diagnostic features 1. Social impairment (no interest, eye contact, few friends) 2. Abnormal behaviour (lack of imagination, stereotyped play) 3. Communication impairment (speech, non-verbal) If high suspicion needs referral, e.g. autism team/CAMHS

Question 29

ENURESIS ``` Types (3) Considerations Physical causes? (6) Mx (5) Referral (4) ```

Answer 29

Types: 1. Primary enuresis with day symptoms 2. Primary enuresis without day symptoms 3. Secondary enuresis (after being dry 6 months) Consider - fluid intake, volume of urine, access to toilet, home & school issues. Normal up to age 5, common up to age 10. Physical cause? 1. Overactive bladder 2. Diabetes 3. UTI 4. Chronic constipation 5. Neuro disorders 6. Child maltreatment Mx: (depending on stage and type) 1. Reassured if appropriate 2. Potty by bed for access, encourage pre-sleep urination 3. Rewards system e.g. star charts 4. Enuresis alarm (£50-100) 5. Desmopressin (can be short term or long term use) - usually age 7 and above, oral or sublingual —>mimics ADH (so reduces urine production). HypoNa can happen therefore fluid restrict with only sips from 1 hour before taking to 8 hours after taking. No evidence of adverse effects if taken long term Referral more likely (e.g. enuresis clinic) if: 1. Daytime wetting 2. Secondary enuresis 3. Recurrent UTIs 4. Physical cause

Question 30

MEASLES Org Sx (2) Mx Notify?

Answer 30

Rubeola virus 1. Erythematous maculopapular rash 2. Koplik spots Supportive treatment Notify - Y

Question 31

MUMPS Org Sx Mx Notify?

Answer 31

Mumps virus 1. Parotitis 2. Epididymio-orchitis/oophoritis Supportive treatment Notify - Y

Question 32

RUBELLA (German measles) Org Sx Mx Notify?

Answer 32

Rubivirus 1. Rash starts behind ears 2. Arthritis/arthralgia Supportive treatment Notify - Y

Question 33

SCARLET FEVER Org Sx Mx Notify?

Answer 33

Streptococcus pyogenes 1. Strawberry tongue 2. Sandpaper rough rash Penicillin V qds 10/7 Notify - Y

Question 34

SLAPPED CHEEK SYNDROME Org Sx Mx Notify?

Answer 34

Parvovirus B19 Erythematous facial rash Supportive treatment Notify - N

Question 35

CHICKENPOX Org Sx Mx Notify?

Answer 35

Varicella zoster Macules, papules, clear vesicles, pustules Supportive treatment Notify - N

Question 36

HAND, FOOT & MOUTH DISEASE Org Sx Mx Notify?

Answer 36

Coxsackie A16 1. Ulcers in mouth 2. Macules/papules on hands/feet Supportive treatment Notify - N

Question 37

WHOOPING COUGH Org Sx Mx Notify?

Answer 37

Bordetella Pertussis 1. Coughing fits 2. Whooping 3. Vomiting —> Clarithromycin if <1mo —> Azithromycin/clarithromycin if >1mo (non-pregnant) Notify - Y

Question 38

ANAPHYLAXIS Mx

Answer 38

Adults & >12: 0.5mg (0.5ml of 1 in 1000) adrenaline IM >12 (small): 0.3mg (0.3ml of 1 in 1000) 6-12y: 0.3mg (0m3ml of 1 in 1000) Up to 6y: 0.15mg (0.15ml of 1 in 1000)

Question 39

MENINGITIS Mx

Answer 39

Adults & >10: 1.2g Benzylpenicillin IM/IV 1-9y: 600mg <1y: 300mg

Question 40

CHILD MALTREATMENT | 4 types & when to suspect

Answer 40

``` 1. PHYSICAL Bruising/lacerations/thermal injury/fracture when not mobile, Bruising on non-bony areas, Bruising in clusters, Lacerations on areas usually covered, Human bite mark, Delayed presentation ``` 2. EMOTIONAL Persistent punishing (e.g. for bedwetting) Persistent rejection/scapegoating Persistent inappropriate threats/discipline 3. SEXUAL Genital/anal/perianal injury without explanation STI/pregnancy in <13 Sexualised behaviour in pre-pubertal child 4. NEGLECT Failure to seek appropriate medical care Persistently smelly/dirty

Question 41

Child safeguarding measures | 4

Answer 41

1. Child protection register (Confidential details of children who are at risk of abuse/neglect) 2. Child protection plan (Assesses likelihood of harm/Goals to reduce risk/Assigns responsibility and actions/Outline ongoing monitoring) 3. Local safeguarding children boards (In every local authority - responsible for multi-agency co-ordination and monitoring) 4. Serious case reviews (Undertaken where abuse or neglect has taken place/suspected and where death or serious harm has taken place)