Paeds Flashcards

1
Q

Commonest cause of neck lump in children

A

Lymphadenopathy, history of local infection or general illness

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2
Q

Lymphoma characteristics

A

Rubbery, painless lymphadenopathy. Associated night sweats and splenomegaly.

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3
Q

Thyroid cyst appearance

A

Midline between isthmus and hyoid bone, moves upward on protrusn of the tongue. If infected can be painful

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4
Q

What is a cystic hygroma

A

Congenital lymphatic lesion typically found in the neck

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5
Q

Brachial cyst presentation

A

Oval, mobile cyst that develops between sternocleidomastoid muscle and the pharync.

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6
Q

What is cervical rib

A

More common in adult females, cause of thoracic outlet syndrome

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7
Q

Hodgkin lymphoma summary

A

Reed-Sternberg cell, painless lymphadenopathy (large), B symptoms often uncommon

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8
Q

Diagnosis of Hodgkin lymphoma

A

Biopsy

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9
Q

Management of Hodgkin lymphoma

A

Chemo +/- radiotherapy 80% cured

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10
Q

Non-Hodgkin lymphoma summary

A

May affects B or T cells. Much more common and more common in elderly, may cause vena cava obstruction (facial flushing/swelling)

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11
Q

What is Burkitt’s lymphoma

A

High-grade B-cell neoplasm, usually in African, malaria endemic areas. Tumour of facial bones

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12
Q

What virus is associated with Burkitt’s lymphoma

A

EBV - found in almost all cases. Chronic malaria is thought to reduce resistance to this

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13
Q

Peak incidence of ALL

A

2-5 years old, boys slightly more affected, 80% of childhood leukaemias

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14
Q

Features of ALL

A

Anaemia (lethargy and pallor)
Neutropaenia (frequent infection)
Thrombocytopaenia (easy bruising, petechiae)

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15
Q

Other features of ALL

A
Bone pain (secondary to bone marrow infiltration)
Splenomegaly
Hepatomegaly
Fever
Testicular swelling
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16
Q

Investigations in ALL

A
Low Hb
Thrombocytopenia
Circulating leukaemic BLAST CELLS ON BLOOD SMEAR
DIC
LP
CXR - mediastinal maas (T cell disease)
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17
Q

How is ALL diagnosed

A

Bone marrow biopsy

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18
Q

What is Wilms tumour

A

Renal tumour, usually present before 5 with large abdominal mass and haematuria.

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19
Q

Quick retinoblastoma summary

A

Autosomal dominant, most within first 3 years of life, white pupillary reflex replacing red. May have squint

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20
Q

Glucose-6-dehydrogenase deficiency

A

Neonatal jaundice, haemolysis causing fever, malaise, abdo pain and dark urine. Precipitated by infection, broad beans and drugs. X-linked recessive

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21
Q

Hereditary spherocytosis summary

A

Sphere RBCs, commonly presents as neonatal jaundice, anaemia, splenomegaly, aplastic crisis (caused by parvovirus B19). Oral folic acid needed

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22
Q

Most common causative organism for UTI in children

A

E.coli (80%), proteus, pseudomonas

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23
Q

Predisposing factors for UTI

A

Infrequent voiding, hurried micturition, neuropathic bladder, vesicoureteric reflux, poor hygiene, STRUCTURAL ABNORMALITY

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24
Q

Presentation of UTI in childhood

A

Infants - poor feeding, vomiting, irritability
Younger children - abdo pain, fever, dysuria
Older children - dysuria, frequency, haematuria

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25
Q

What features would suggest an upper UTI

A

Fever >38, loin pain/tenderness

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26
Q

Management of UTI in children

A

<3 months - referred immediately to paediatrician
Upper UTI admit to hospital (cephalosporin/co-amox for 7-10 days)
>3 months lower UTI - trimethoprim or nitrofuratonin

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27
Q

What is the triad of haemolytic uraemic syndrome

A

Acute kidney injury
Microangiopathic haemolytic anaemia
Thrombocytopenia

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28
Q

What is the commonest cause of haemolytic uraemic syndrome

A

E.coli (Shiga toxin producing type)

Also: HIV, pneumococcal infection, SLE

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29
Q

Management of haemolytic uraemic syndrome

A

Fluids, blood transfusion/dialysis if needed.

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30
Q

Which cranial nerve is most likely to be affected by raised ICP

A

Abducens VI because it has a very long intracranial course

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31
Q

Red flag symptoms for headache

A

Growth failure, new onset squint, worse in mornings, torticollis, ataxia, papilloedema, abnormal gait

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32
Q

Prophylactic treatment for migraine

A

sodium channel blockers (valproate), propranolol

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33
Q

What is a generalised epileptic attack

A

Arrises from both hemispheres

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34
Q

Investigations for epilepsy

A

ECG is recommended in all as don’t want to miss long-QT syndrome. EEG if epilepsy suspected

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35
Q

What is West syndrome

A

Infantile spasms - flexion of head and trunk followed by extension of the arms often on waking

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36
Q

Side effects of valproate

A

Weight gain, hair loss, teratogenic

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37
Q

Side effects of carbamazepine

A

Rash, hyponatraemia, ataxia

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38
Q

Side effects of lamotrigine

A

Rash, insomnia, ataxia

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39
Q

What diet can be used in epilepsy

A

Ketogenic (high fat, low carb)

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40
Q

Types of muscular dystrophies

A

Duchenne, Becker, congenital

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41
Q

Features of Duchenne muscular dystrophy

A

X-linked recessive, deletion of dystrophin gene. Present with waddling gait at around 5 years. Corticosteroids help, CPAP overnight.

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42
Q

What is Becker muscular dystrophy

A

Same gene as Duchenne, a less severe form and presents later

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43
Q

Brain haemorrhage in children

A

Most common extradural from injury - lucid interval where seem okay.
Subdural indicates shaken baby syndrome
SAH very rare

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44
Q

Conditions tested for in newborn screening

A

Cystic fibrosis, sickle cell disease, congenital hypothyroidism, phenylketonuria, galactosaemia, homocytinuria

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45
Q

5 Signs of kernicterus

A

Irritability, poor feeding, seizures, coma, opisthotonus (muscle spasm)

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46
Q

Diseases associated with Down’s syndrome

A

Atrioventricular septal defect, duodenal atresia, Hirschprung’s disease, hypothyroidism, coeliac disease, apnoea, leukaemia, Alzheimer’s

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47
Q

What chromosome abnormality is Edwards syndrome

A

Trisomy 18

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48
Q

What chromosome abnormality is Patau syndrome

A

Trisomy 13

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49
Q

What chromosome abnormality is Turner’s syndrome

A

45 X

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50
Q

3 signs of Turner’s syndrome on foetal ultrasound

A

Foetal oedema of neck hands and feet
Cystic hygroma
Structural heart/kidney defects

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51
Q

What chromosome abnormality is fragile X

A

X-linked recessive - trinucleotide repeat

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52
Q

What blood test result would indicate Duchenne’s muscular dystrophy

A

Raised creatinine kinase

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53
Q

Duchenne’s muscular dystrophy mode of inheritance

A

X-linked recessive

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54
Q

Features of congenital adrenal hyperplasia

A

Low mineralocorticoids - vomiting, dehydration, weight loss. Loow cortisol - hypoglycaemia, clitoral hypertrophy, penis enlargement

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55
Q

What is the risk of treating hyponatraemia quickly

A

Cerebral oedema causing damage to myelin sheath in brainstem (pons). Can cause paralysis, dysphagia and dysarthria

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56
Q

X-ray finding for tetralogy of Fallot

A

Boot-shaped heart, right sided aortic arch

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57
Q

4 causes of heart failure in the neonate

A

Severe coarctation of the aorta
Critical aortic valve stenosis
Hypoplastic left heart syndrome
Interruption of the aortic arch

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58
Q

3 causes of heart failure in infant

A

(due to L-R shunt)
VSD
ASD
Patent ductus arteriosus

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59
Q

3 causes of heart failure in older child

A

Eisenmenger syndrome
Rheumatic heart disease
Cardiomyopathy

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60
Q

3 factors which contribute to airway narrowing in asthma

A

Bronchial muscle contraction
Mucosal inflammation
Increased mucous production

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61
Q

Severe asthma attack features

A

Inability to complete sentences
Pulse >140
RR >40 (>5yrs)
Peak flow 35-50% predicted

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62
Q

Features of life threatening asthma attack

A
Silent chest
LOC/exhaustion
Cyanosis
Peak flow <33% predicted
Poor respiratory effort
Normal or raised PaCO2
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63
Q

Features of ADHD

A
INATTENTION
HYPERACTIVITY
IMPULSIVENESS
impaired concentration
distractibility
difficulty taking turns
fidgety
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64
Q

Treatment for ADHD

A

CBT, methylphenidate (stimulant medicine - increase dopamine)

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65
Q

Side effects of methylphenidate

A

Dry mouth
Loss of appetite
Insomnia

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66
Q

Erythema multiforme and causes

A

Rash with target lesions

Penicillin, NSAIDs, phenytoin, HSV!

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67
Q

Name 2 complications of eczema

A
Cellulitis (gram positive cocci) - treat with flucloxacillin
Eczema Herpeticum (herpes simplex) - acyclovir
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68
Q

Complications of chicken pox

A

Secondary bacterial infection - toxic shock syndrome
Encephalitis/cerebellitis
DIC
Purpura fulminans

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69
Q

What are Fraser guidelines used for

A

To give contraception to under 16s

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70
Q

Conditions of Fraser guidelines

A
Understands professionals advice
Cannot be persuaded to inform their parents
Likely to continue without contraception
Physical or mental health will suffer
In best interests
71
Q

What is Gillick Competence

A

Child <16 must be able to understand advice given

72
Q

3 causative organisms of meningitis <3

A

Group B strep
E.coli
Listeria

73
Q

4 features of an innocent murmur

A

aSymptomatic
Soft blowing
Systolic murmur
Left Sternal edge

74
Q

3 symptoms of toxic shock syndrome

A

Fever >39
Hypotension
Diffuse erythematous macular rash

75
Q

Treatment of toxic shock syndrome

A

Ceftriaxone, Intravenous immunoglobulin

76
Q

Causes of sensorineural hearing loss

A

Congenital rubella, HIE, meningitis

77
Q

5 causes of stridor

A
Croup
Epiglottitis
Laryngomalacia
Bacterial tracheitis
Foreign body
78
Q

What is the triad of Henoch-Schonlein Purpura

A

Purpura (buttocks/extensor surfaces)
Arthritis
Abdominal pain

79
Q

What is the first sign of puberty

A

Breast development

Testicular enlargement

80
Q

Signs of ASD on asucultation

A

Ejection systolic murmur at the left sternal edge.

Splitting of the second heart sound

81
Q

What murmur is heard in VSD

A

Pansystolic murmur at lower left sternal edge

reverse correlation to noise volume

82
Q

Signs of PDA

A

Continuous machinery murmur

Increased pulse pressure, collapsing pulse

83
Q

Features of growing pains

A
Never present at start of day
No limp
No limitation of movement
Systemically well
Normal examination
Worse after a day of vigorous activity
84
Q

What can cause erythrocytosis

A

smoking, alcohol or polycythaemia vera

85
Q

Cause of neutrophilia

A

cancer or result of chemotherapy, viral infection such as hepB/C or HIV, medications (antipsychotics, carbimazole) or autoimmune disorders

86
Q

What liver enzyme may be raised in osteomalacia, rickets, vit D deficiency or primary bone tumours

A

raised ALP

87
Q

Infectious mononucleosis need to knows

A

a maculopapular rash develops in 99% who take amoxicillin whilst they have infectious mononucleosis (note amox not treatment for mono)

88
Q

What electrolyte imbalance does congenital adrenal hyperplasia cause

A

Hyponatraemia (low aldosterone), hyperkalaemia, metabolic acidosis

89
Q

What areas are protected from chemotheraputic agenst

A

CNS and testes

90
Q

What is penacillamine and what is it used for

A

Copper chelating agent, used in Wilson’s disease

91
Q

What therapy can be given to those with sickle cell disease

A

Hydroxycarbamide - prevents vaso-occlusive complications
blood transfusions
prophylactic penicillin - as have splenectomy
bone marrow transplant - curative but risky

92
Q

Which clotting factor deficiency is haemophilia A

A

VIII

93
Q

What clotting factor deficiency is haemophilia B

A

IX

94
Q

What is the final product of the coagulation cascade

A

fibrin

95
Q

Symptoms of septic arthritis

A

Single swollen joint, severe pain, pyrexia, no tolerate passive movement, cannot weight bear

96
Q

What scan can be used to show effectiveness of lymphoma treatment

A

PET scan - uses a radioactive tracer to show areas of high uptake (cancer)

97
Q

age group of Perthes disease

A

5-10 years

98
Q

Causes of limp in children 1-3 years

A

missed DDH, septic arthritis, transient synovitis, leukaemia

99
Q

Causes of limp in children 11-16

A

slipper upper femoral epiphysis (obesity RF), reactive arthritis and sports injuries

100
Q

What does a double bubble sign on abdominal x-ray indicate

A

duodenal atresia

101
Q

What defects can lead to Eisenmenger syndrome

A

ASD
VSD
PDA

102
Q

Physiology of Eisenmenger’s

A

High pressure in pulmonary artery due to left to right shunt causes changes in pulmonary microvasculature leading to pulmonary hypertension and subsequent reversal of the shunt

103
Q

Features of Eisenmenger’s

A
Original murmur disappear
cyanosis
clubbing
right ventricular failure
(lack of oxygen causes polycythemia)
Polycythaemia leads to haemoptysis and embolism
104
Q

What is the treatment for Eisenmenger’s

A

heart-lung transplantation

105
Q

What should be given first for moderate DKA

A

IV fluids (0.9 saline) and 1 hour later SC insulin at 0.1units/kg/hr (over 48 hours)

106
Q

What blood results would you see in DKA

A
Hyperglycaemia
acidosis
ketonaemia
mildly raised creatinine
low bicarbonate
107
Q

What is the progression of a chickenpox rash

A

papules>vesicles>papules>crusts

108
Q

Features of Turner’s syndrome

A
hypothyroidism
congenital heart defects
coarctation of the aorta
bicuspid aortic valve
webbed neck
short stature
widely spaced nipples
109
Q

JIA summary

A

Most common chronic inflammatory joint disease in children.
Defined as persistent joint swelling >6 weeks duration before the age of 16.
95% have disease separate from RA

110
Q

Complications of JIA

A
Chronic anterior uveitis
Flexion contractures of the joints
growth failure
anaemia
osteoporosis
amyloidosis
111
Q

Presentation of JIA

A

Most are oligoarthritis affecting 1-4 joints (mostly knee, ankle or wrist) associated with uveitis.
Other presentations are enthesitis, psoratic, systemic

112
Q

Systemic JIA presentation

A
(around 9% of JIA)
pyrexia
salmon-pink rash
lymphadenopathy
arthritis
uveitis
anorexia
113
Q

Management of JIA

A
NSAID/analgesic
steroid joint injection
methotrexate
systemic corticosteroids
TNF-alpha/inteleukin
114
Q

Common causes of Stephen-Johnson syndrome

A
penicillin
phenytoin
lamotrigine
allopurinol
sulphonamides
carbamazepine
NSAIDs
OCP
mumps
flu
HSV
EBV
115
Q

Symptoms of Steven-johnson syndrome

A

Maculopapular rash with target lesions being characteristic
Mucosal incolvement
fever
arthralgia

116
Q

Lennox-Gastaut summary

A

extension of infantile spasms
1-5yrs
abscences, falls jerks
90% moderate-severe mental handicap

117
Q

Typical juvenile myoclonic apilepsy

A

infrequent generalized seizures often in morning
daytime absence seizure
sudden myoclonic seizure

118
Q

Characteristic features of fragile-X

A
learning difficulties
global developmental delay
large head
long face
large ears
prominent mandible
mitral valve prolapse
poor muscle tone
119
Q

Features of Kallmann syndrome

A
delayed puberty
small penis
small testes
no body hair
reduced sense of smell
poor balance
learning difficulties
120
Q

What is Klinefelter syndrome

A

delayed puberty
lack of secondary sexual characteristics
tall stature
learning difficulties

121
Q

rash of dermatitis herpetiformis

A

itchy bullous rash affecting extensor surfaces

122
Q

What does cholesterol correlate with

A

inversely with albumin

123
Q

Complications of nephrotic syndrome

A
frequent relapses
hypercholesterolaemia
hypovolaemia
infection
thrombosis
124
Q

what is the most common cause of nephrotic syndrome in children

A

minimal change disease

125
Q

distribution of rash in henoch-scholen purpura

A

symmetrically distributed over buttocks and extensor surfaces of arms, legs and ankle

126
Q

symptoms of henoch-schonlen purpura

A
rash
joint pain
abdominal pain
glomerulonephritis
fever
127
Q

what is alginate therapy

A

feed thickeners/gaviscon

128
Q

what does ottitis media look like on otoscope

A

red, bulging and tender tympanic membrane

129
Q

what does ottitis media with effusion look like on otoscope

A

grey tympanic membrane, loss of cone of light reflex and a visible fluid level behind the membrane.
You would also expect hearing loss

130
Q

What are some serious complications of ottitis media

A

acute mastoiditis

intracranial abscess

131
Q

what is the feverpain score used for

A

to assess whether pharyngitis is due to a bacterial infection and hence whether it needs antibiotics

132
Q

fever pain scoring

A

Everything 1 point, max 5

  1. fever in past 24 hours
  2. absence of cough or coryza
  3. symptom onset <3 days
  4. purulent tonsils
  5. severe tonsil inflammation
133
Q

at what score on feverpain would you consider delayed antibiotics

A

2-3

134
Q

at what score on the feverpain would you give antibiotics

A

4-5

135
Q

what is naevus flammeus

A

port wine stain - congenital and on face

136
Q

treatment of faecal impaction

A

disimpaction regimen:

osmotic laxative

137
Q

ITP need to knows

A

it is typically benign and resolves spontaneously after 6-8 weeks
NSAIDs should be avoided
contact sports should be avoided

138
Q

ITP presentation

A

petechiae following a viral illness

low platelets

139
Q

when would you prescribe antibiotics for otitis media

A

under 2 years with bilateral infection

140
Q

antibiotic of choice for otitis media

A

amoxicillin

141
Q

what is the name of the surgical treatment for Hirschprungs

A

Swenson procedure

142
Q

which syndrome has microganthia (small lower jaw)

A

Edward’s syndrome

143
Q

which syndrome has polydactyly

A

Patau’s

144
Q

which syndrome has pectus excavatum

A

Noonans

145
Q

whichh syndrome has macrocephaly

A

fragile x

146
Q

what is second line to methylphenidate for ADHD

A

lisdexamfetamine

147
Q

what is given for viral induced wheeze

A

salbutamol via a spacer

steroids are not helpful in viral induced wheeze!

148
Q

common signs/symptoms of nec

A
abdominal distension
vomiting
visible intestine loops
rectal bleeding
lethargy
feeding intolerance
149
Q

how is nec diagnosed

A

abdominal xray show
dilated bowel loops
bowel wall oedema
gas within wall of intestine.

150
Q

what heart defect is William’s syndrome associated with

A

supravalvular aortic stenosis (not cyanotic)

151
Q

what can be used for acute asthma attack

A

nebulised salbutamol/ipratropium, high flow o2, corticosteroids.
Second line for severe attacks would be IV treatments

152
Q

treatment for impetigo

A

if small a short course of hydrogen peroxide may be used. Otherwise topical antibiotics (fusic acid) or oral flucloxacillin may be used

153
Q

what is cryptorchidism

A

undescended testes:
1 retractile (can be pulled into scrotum)
2 palpable
3 impalpable (may be in inguinal canal, abdominally or absent)

154
Q

when to refer for undescended testes

A

bilateral - 6-8 weeks (to be seen within 2 weeks)

unilateral - refer at 4-5 months

155
Q

when should orchidopexy be performed

A

around 12 months

156
Q

what is the treatment of choice for intussusception

A

rectal air insufflation

157
Q

when would antibiotics be required for gastroenteritis

A

if suspicious of sepsis, immunocompromised or spread of infection

158
Q

eczema treatments

A

1st line emolients
non-sedating antihistamine (cetirizine) with severe itching
topical corticosteroids if persistent

159
Q

what is the commonest presentation of a varicocele

A

asymptomatic!

may have a dull ache

160
Q

what does a red swollen warm testicle indicate

A

epididymitis or orchiditis

BUT CONSIDER TORSION

161
Q

what does severe sharp pain in scrotum indicate

A

torsion but suspect with any abdo pain

162
Q

some causes of jaundice <2 weeks

A

polycythemia
infection
physiological
rhesus incompatibility

163
Q

how to correct acidosis due to DKA in children

A

fluids, DO NOT use sodium bicarbonate (but this can be used in adults)

164
Q

side effects of topical corticosteroids

A

acne
striae
telangiectasia
thinning of skin

165
Q

definition of JIA

A

a child presenting with joint swelling of >6 weeks duration in the absence of infection or any other defined cause
more common in girls

166
Q

secondary care for JIA

A

refer to ophthalmology as at risk of anterior uveitis which can lead to blindness!

167
Q

what type of seiures are febrile convulsions

A

tonic clonic

168
Q

slapped cheek syndrome cause

A

parvovirus B19

169
Q

treatment for croup not responsing to dexamethasone

A

oxygen + nebulised adrenaline

170
Q

histology in coeliac disease

A

intraepithelial lymphocytes
normal thickness mucosa
villous atrophy
crypt hyperplasia

171
Q

what disease has a cobblestone appearance

A

Crohn’s disease

172
Q

does toddlers diarrhoea cause faltering growth

A

no

173
Q

does vomiting cause faltering growth

A

can do