Paediatrics

Question 1

1st line management of infantile colic and by when should it resolve?

Answer 1

advice and reassurance

should resolve by 6 months of age

Question 2

What are the features of infantile colic?

Answer 2

episodes of irritability, fussing or crying that begin and end for no apparent reason and that last at least 3hrs a day on at least 3 days of the week for at least 1 week, in an infant up to 4 months of age with no e/o faltering growth
crying most often in late PM or evening and baby brings its knees up to abdomen or arching back when crying

Question 3

Children presenting with fever and any “red” features according to traffic light system should be assessed how urgently in a face to face setting if initial contact over the phone (if not immediately life threatening illness)?

Answer 3

within 2 hours

Question 4

Symptoms of iron poisioning in children?

Answer 4

usually present within 6 hrs post ingestion

vomiting, abdo pain, bloody diarrhoea, haeamtemesis, hepatic damage, tachycardia, systemic collapse.

Question 5

Cause of hand, foot and mouth disease?

Answer 5

Coxsackie virus

Question 6

Public health guidance on school exclusion for hand, foot and mouth disease?

Answer 6

no exclusion required

Question 7

If a baby is more than 24 hours old when develops jaundice, when do they require urgent admission?

Answer 7

• Jaundice 1st appears at more than 7 days of age
• Prolonged jaundice-gestational age of less than 37wks with more than 21 days of jaundice, or age 37 wks or more with more than 14 days of jaundice
• Gestational age less than 35 wks
• Unwell neonate-lethagy, fever, vomiting, irritability
• Poor feeding and/or concerns about weight
• Pale stools and dark urine

Question 8

Guidance for use of paracetamol and ibuprofen in children with a fever?

Answer 8

they should not be used simultaneously but can be alternated if a patient is distressed by their fever and this distress persists or recurs before the next dose is due

they should NOT be used for the sole aim of preventing febrile seizures

Question 9

School exclusion for child with chickenpox?

Answer 9

until all vesicles have crusted over

usually 5-6 days after onset of illness

Question 10

School exclusion for child with rubella (German Measles)?

Answer 10

4 days from onset of rash

Note risk to pregnant women

Question 11

School exclusion for child with impetigo?

Answer 11

until lesions crusted and healed, or 48hr after starting antibiotic treatment

Question 12

School exclusion for child with measles?

Answer 12

4 days from onset of rash

Question 13

School exclusion for child with rabies?

Answer 13

until had first treatment

Question 14

School exclusion for child with scarlet fever?

Answer 14

can return 24 hours after commencing appropriate antibiotic treatment

Question 15

School exclusion for child with slapped cheek (parvovirus B19/fifth disease/erythema infectiosum)

Answer 15

none once rash developed

note risk to pregnant women

Question 16

School exclusion for child with shingles?

Answer 16

exclude only if rash is weeping and cannot be covered

Question 17

School exclusion for whooping cough?

Answer 17

48 hours from starting antibiotic treatment, or 21 day from start of illness if no Abx treatment

Question 18

School exclusion for Hepatitis A?

Answer 18

exclude until 7 days after onset of jaundice (or 7 days after symptom onset)

Question 19

School exclusion for mumps?

Answer 19

for 5 days after onset of swelling

Question 20

When do umbilical herniae in a baby require surgery?

Answer 20

If persistent at 3 years.

Question 21

When should a child with a sacral dimple be r/f for lumbar US?

Answer 21

• any abnormal neurology
• any cutaneous stigmata-hair tufts or haematomas
• dimple more than 5mm in size or more than 25mm away from anus

Question 22

At what age might surgery be required for hypospadias?

Answer 22

6-12 months

Question 23

Management of baby with 1 (or both if previous referral to senior paediatrician) undescended testis at 6-8 wk check?

Answer 23

Reexamine at 4-5 months of age.
If still problem at 4-5 months child should be seen by paed surgeon by 6 months of age
Orchiodopexy performed at 6-12 months

If suspected b/l undescended testes at 6-8 weeks should be r/f for paediatric review within 2 weeks

Question 24

Height of fever classifying a child under the age of 5 as having as high risk of serious illness (red criteria)?

Answer 24

if aged under 3 months a fever of 38 or higher

if aged 3-6 months a fever of 39 or higher would classify as intermediate risk

Question 25

What is the FeverPAIN score?

Answer 25

Score to assess risk of bacterial infection in sore throat px to assess need for Abx. Score 1 for each of: -Fever -Purulence -Attend rapidly (3 days or less since onset) -Inflamed tonsils -No cough/coryza Score: 0-1 no Abx 2-3 consider delayed script 4-5 Abx

Question 26

How to measure fever in a child?

Answer 26

- if age less than 4 weeks then electronic thermometer in axilla - if age 4 weeks to 5 years then either electronic thermometer in axilla OR chemical dot thermometer in axilla OR infra-red tympanic thermometer.

Question 27

Referral pathway for suspected brain or CNS malignancy in children and young people?

Answer 27

very urgent referral (to be seen within 48hrs) if newly abnormal cerebellar or CNS function

Question 28

Referral pathway for suspected leukaemia in children?

Answer 28

Refer for immediate assessment if child has unexplained petechiae or hepatosplenomegaly Very urgent FBC (within 48hrs) if pallor/persistent fatigue/unexplained fever/persistent infection/bone pain/bruising/bleeding/generalised lymphadenopathy.

Question 29

Referral criteria for suspected Wilms tumour?

Answer 29

Consider very urgent referral (appointment within 48hrs) in children with any 1 of: palpable abdominal mass unexplained enlarged abdominal organ unexplained visible haematuria Note 1st 2 criteria same as for suspected neuroblastoma in children

Question 30

Characteristic lymphadenopathy in patients with rubella?

Answer 30

post-auricular tender lymphadenopathy patients tend to have prodrome of fever, conjunctivitis, URTI features + lymphadenopathy, then develop transient pink/light red rash that starts on face/neck then moves to trunk and limbs

Question 31

When is there documented risk to the fetus of rubella infection in pregnant woman?

Answer 31

up until 20 weeks of gestation first 16 weeks most substantial risk 16-20 weeks-minimal risk of deafness only

Question 32

Duration of rash in erythema infectiosum (parvovirus B19)?

Answer 32

biphasic: - confluent erythematous oedematous patches/plaques on cheeks, sparing of nasal bridge and peri-orbital, fade over 1-4 days. - spread to trunk and extensor extremities, lacy reticular pattern, may be itchy. Lasts 5-9 days but can recur for weeks to months afterwards with triggers e.g. emotional stress, bathing, change in temperature, exercise. Pt NOT infectious once rash appears.

Question 33

Cause of roseola?

Answer 33

HHV 6 or 7 | affects children up to 3 yrs of age

Question 34

Characteristics of rash in scarlet fever?

Answer 34

- fine, papular red rash, feels like sandpaper, as fades peeling affects fingers, toes and groin - starts on chest and stomach, rapid spread elsewhere - flushing of face and peri oral pallor - white coating on tongue, peels and leaves 'strawberry tongue'

Question 35

Abx for scarlet fever?

Answer 35

10/7 of Penicillin V

Question 36

Beyond what age is persistent strabismus significant?

Answer 36

2 months-should refer

Question 37

Most common form of glomerulonephritis in children?

Answer 37

acute post-infectious glomerulonephritis

Question 38

Time scale for testing a urine sample in children presenting with unexplained fever of 38 or higher?

Answer 38

urine should be tested within 24hrs *5% of children with unexplained fever 38 or higher will have a UTI

Question 39

Management of child with ?UTI with urine dip nitrite +ve leuc -ve?

Answer 39

start Abx and send for culture if leuc +ve nit -ve send for culture and only start Abx if good clinical e/o UTI-even if culture negative if pt clinically has a UTI and there is pyuria then Abx should be started if both +ve start Abx and send for culture if intermediate/high risk of serious illness or previous UTI

Question 40

What dx should infants and children be considered to have if T 38 or higher with bacteriuria?

Answer 40

acute pyelonephritis/upper UTI

Question 41

Which children should have an ultrasound urinary tract during an acute UTI?

Answer 41

``` -if atypical features: seriously ill poor urine flow non E coli UTI-if responding well to Abx and no other atypical features can have US at 6 weeks septicaemia raised creatinine abdo/bladder mass failure to respond to appropriate Abx within 48hrs ``` -or if recurrent infection in child under 6 months

Question 42

Definition of recurrent UTI in children?

Answer 42

2 upper UTIs 1 upper and 1 lower UTI 3 lower UTIs (or more)

Question 43

When should an US urinary tract be performed for children within 6/52 of a UTI?

Answer 43

- if under 6 months with 1st time UTI that responds to treatment - if over 6 months and recurrent UTI

Question 44

When should children have DMSA imaging 4-6months after acute UTI?

Answer 44

- if under age of 3 and atypical or recurrent UTI | - if age 3yrs or over and recurrent UTI

Question 45

Contraindications to MMR vaccine?

Answer 45

severe immunosuppression Have received another live vaccine by injection within 4 weeks allergy to neomycin pregnancy should be avoided for at least 1 month after vaccination Ig therapy within the past 3 months adverse effects: fever, malaise, rash after 1st dose, typically 5-7/7 after and lasts 2-3/7

Question 46

Definition of nocturnal enuresis?

Answer 46

involuntary d/c of urine by night in child aged 5 or older. primary-never achieved continence, secondary-child has been dry for at least 6 months before tx child under age of 7-enuresis alarm 1st line over 7-consider desmopressin 1st line

Question 47

If a child who has NOT been vaccinated against measles comes into contact with someone with measles how should they be managed?

Answer 47

offer MMR vaccine-should be given within 72hrs

Question 48

At what age can a young person be presumed to have capacity to consent?

Answer 48

16 years

Question 49

Who has parental responsibility for a child?

Answer 49

Mothers and married fathers Unmarried fathers of children registered since 01/12/2003 in England as long as the father is named on the child's birth certificate

Question 50

When do parents lose parental responsibility?

Answer 50

when the child is adopted | responsibility can be restricted by court order

Question 51

Who has parental responsibility if a child is subject to a care order?

Answer 51

local authority

Question 52

What specific documentation is needed on a prescription for children under 12?

Answer 52

their age

Question 53

Developmental red flags at 3 months?

Answer 53

poor eye contact | unable to hold head on ventral suspension

Question 54

Developmental red flags at 6 months?

Answer 54

unable to support head/chest when prone not reaching for objects-refer no vowel sounds not turning to a rattle sound

Question 55

Developmental red flags at 9 months?

Answer 55

unable to sit when supported-urgent referral at 12 months unable to transfer between hands no babbling

Question 56

Developmental red flags at 12 months?

Answer 56

no attempt to crawl or bottom shuffle (usually starts at 9 months) unable to stand holding on no response to familiar words

Question 57

Developmental red flags at 18 months?

Answer 57

not walking-urgent referral for boys girls at 2 years no meaningful single words no attempt to build a tower of blocks

Question 58

Which nutritional deficiency is associated with chronic spontaneous urticaria in children?

Answer 58

Vit D and iron

Question 59

Primary care management of breast fed baby suspected of having GORD?

Answer 59

-if sx persist despite breastfeeding assessment and advice then consider 1-2 week trial of alginate therapy e.g. gaviscon, if sx improve then continue with treatment but stop at regular intervals e.g. every 2 weeks, to see if sx improved and can stop treatment. Notes features of GORD: distress, faltering growth, feeding difficulties e.g. refusing to feed

Question 60

Stepped care approach to managing formula fed babies with suspected GORD?

Answer 60

- review feeding hx - reduce volume of feeds if excessive for child's weight (normal 150ml/kg over 24 hours with 6-8 feeds) - then offer a 1-2 week trial of smaller more frequent feeds - then offer 1-2wk trial of feed thickeners, must be endorsed by ACBS if prescribed - if unsuccessful stop the thickened formula and trial 1-2 weeks of alginate added to formula. - if sx still troublesome after alginate trial in both BF and bottle fed babies trial 4/52 of PPI-omeprazole or H2RA, if sx still persisting consider referral.

Question 61

What treatment alone may be appropriate for children with isolated delay in gross motor skills?

Answer 61

physiotherapy

Question 62

Management of a child with a squint/strabismus in primary care?

Answer 62

``` Routine referral to local paediatric eye service e.g. optometry Urgent referral to ophthalmology if: headaches nystagmus diplopia limited abduction ```

Question 63

Diagnostic criteria for developmental coordination disorders (DCD)?

Answer 63

- motor coordination during daily activities substantially below that expected for age and intelligence - resulting motor difficulties interfere with AODL/academic achievement - problems not due to general medical problem e.g. cerebral palsy, or pervasive developmental disorder - if also learning disability, motor difficulties in excess of those associated with a learning disability

Question 64

In relation to head circumference when is an urgent referral to a paediatrician advised?

Answer 64

HC above 99.6th percentile or below 0.4th centile OR HC has crossed 2 centile (up or down) OR disproportionate to parental head circumference

Question 65

What feature in relation to language development is highly specific to children with autism?

Answer 65

language regression in the 2nd year of life

Question 66

If a child is referred by primary care to social services for suspected child maltreatment, by when should the referral be confirmed in writing?

Answer 66

within 48 hours | if this referral has not been acknowledged within 3 working days social services should be contacted again

Question 67

Which children with UTI should have a MCUG?

Answer 67

if under the age of 6 months and atypical or recurrent infection used to identify VUR

Question 68

Urgency of referral for suspected lymphoma if child presents with unexplained lymphadenopathy or splenomegaly?

Answer 68

very urgent-within 48 hours

Question 69

When can non infant formula milk be introduced?

Answer 69

- infant formula milk is the only alternative to breast milk in 1st year of baby's life - after 1 year can introduce oat, soya and almond drinks - semi skimmed milk from age of 2 - skimmed milk from age of 5

Question 70

Which is the only licensed medication to treat tic disorders?

Answer 70

haloperidol

Question 71

For every child placed on the child protection register what additional number are receiving abuse and neglect and not getting support?

Answer 71

8

Question 72

Risk of a further febrile convulsion after 1 episode?

Answer 72

1 in 3 if no RFs for epilepsy, then risk of epilepsy if have febrile convulsion is 2.5%

Question 73

Fluid restriction in children on desmopressin for nocturnal enuresis?

Answer 73

must restrict from 1 hour before taking desmopressin to 8 hours after taking