Paeds Flashcards
(410 cards)
1
Q
Presentation of Threadworm
A
- Anal and vulval itching
- White threads in faeces
2
Q
First line treatment of Threadworm?
A
Single dose of mebendazole with hygiene measures
3
Q
Presentation of eczema
A
- Itchy, erythematous rash
- Face and trunk in infants
- Extensor surfaces in young children
- Flexor surfaces in older children
4
Q
Management of eczema
A
- Simple emollients
- Topical steroids
- Wet wrapping
- Oral ciclosporin
5
Q
Symptoms of hand, foot and mouth disease?
A
- Fever
- Anorexia
- Cough
- Abdominal pain
- Sore throat
- Mouth ulcers followed by a rash which affects hands, feet, face, buttocks, legs and genitals
6
Q
What are the 5 categories of APGAR?
A
Appearance
Pulse
Grimace
Activity - flexed arms and legs
Respiration
7
Q
APGAR scoring
A
0-3 - low
4-6 moderate
7-10 - normal
8
Q
What is the most common cause of respiratory distress in newborn period?
A
Transient Tachypnoea of the Newborn caused by delayed resorption of fluid in the lungs - often after C-section
9
Q
What are the X-ray findings of TTN?
A
- Hyperinflation of the lungs
- Fluid in the horizontal tissue
10
Q
What do bowel sounds in the respiratory exam of a neonate point towards?
A
Diaphragmatic hernia
11
Q
When might newborns have surfactant production problems?
A
< 31 weeks
12
Q
What is mesenteric adenitis?
A
Inflamed lymph nodes within the mesentery
13
Q
How does mesenteric adenitis present?
A
Similar to appendicitis - often following a viral infection but will have no abdominal tenderness or guarding
14
Q
Hirschprungs?
A
- Absence of ganglion cells from mucousa
- Full-thickness rectal biopsy to confirm
- Delayed meconium and abdominal distension
- Rectal washouts initially followed by surgery
15
Q
What is ITP?
A
An immune mediated reduction in the platelet count - a type II hypersensitivity reaction
16
Q
How does ITP present?
A
- Bruising
- Petechial/Purpuric rash
- Rarely bleeding
17
Q
Investigations for ITP?
A
- FBC
- Blood film
18
Q
Management of ITP
A
- Usually nothing
- Sometimes oral/IV corticosteroids or IV Immunoglobulins
19
Q
Presentation of Foetal alcohol syndrome
A
- Microcephaly (small head)
- Short palpebral fissures (small eye opening)
- Absent philtrum
- Cardiac abnormalities
20
Q
What happens with cigarette smoking in pregnancy?
A
- Miscarriage
- Stillbirth
- Pre-term labour
- Intrauterine growth retardation
21
Q
Risks of rubella in pregnancy?
A
- Most at risk in first 16 weeks
- Cataracts, deafness, cardiac abnormalities
- Jaundice, hepatosplenomegaly
22
Q
Risks of maternal syphillis?
A
- Rhinitis
- Saddle shaped nose
- Deafness
- Hepatosplenomegaly
23
Q
Most common cause of diarrhoea
A
- Rotavirus usually with fever and vomiting for first 2 days
24
Q
Presentation of toddlers diarrhoea?
A
- Diarrhoea with undigested food/foul smelling
- No change on growth centiles (contract to coeliac)
25
When does Cow's milk protein intolerance present?
Formula fed children in the first 3 months of life
26
Symptoms of CMPA?
- Regurgitation and vomiting
- Diarrhoea
- Urticaria, atopic eczema
- 'colic' symptoms
- Wheeze, chronic cough
27
Pyloric Stenosis
- Projectile, non-bile stained vomit at 4-6 weeks
- Test feed/USS to confirm
- Ramstedt pyloromyotomy
28
Intussusception
- Telescoping bowel
- Proximal to/at the ileocaecal valve
- 6-9 months of age
- Colicky pain, diarrhoea, sausage-shaped mass, red jelly stool
- Infant will be drawing their knees up
- US to confirm
- Treated with reduction with air insufflation
29
Intestinal malrotation
- Intestines do not twist correctly
- Features in exon-halos, diaphragmatic hernia, intrinsic duodenal atresia
- If bile stained vomit, volvulus has occured
- Upper GI contract study and USS to confirm
- Laparotomy/Ladd's procedure (if volvulus formed)
30
Meconium ileus
- Delayed meconium and abdominal distension
- Occurs with CF
- PR contract studies may dislodge meconium plug and be helpful
- Surgery needed to remove plugs
31
Biliary atresia
- Jaundice > 14 days
- Increased conjugated bilirubin
- Urgent Kasai procedure
32
Necrotising Entercolitis
- Prematurity
- Abdominal distension and bloody stools
- X-ray may show free air
- Increased risk when empirical Abx given beyond 5 days
- Total gut rest and TPN to treat with potential laparotomy if perforations
33
How do you reduce chances of severe brain damage in neonates with hypoxic injury?
Therapeutic cooling at 33-35 degrees
34
What is Atlanto-axial instability?
A complication of Downs which increases the risk of sudden neck dislocation
35
Features of Downs
- Low-set ears
- Flat occiput
- Single palmar crease
- Hypotonia
- Heart defects
- Duodenal atresia
- Hirschprungs
- Infertility
- Hypothyroidism
36
Cardiac complications of Downs
- Endocardial cushion defect
- VSD
- Tetralogy of Fallot
- Isolated PDA
37
Roseola infantum
- Herpes 6 virus
- Common in 6 months - 2 years
- Fever followed later by maculopapular rash around the trunk
- Febrile seizures common
- No treatment necessary
38
What is whooping cough
- Infectious disease caused by Bordetella pertussis
39
Immunisation of Whooping cough
- Pregnant women weeks 16-32
- Infants at 2,3,4 months and 3-5 years
40
Presentation of whooping cough
- Coryza for 2-3 days
- Coughing spouts worse at night/after feeding
- Inspiratory whoop
- Persistent coughing
- Symptoms last 10-14 weeks
41
Management of whooping cough
- Inform PHE
- Oral macrolide such as azithromycin if onset is within last 21 days
- Prophylaxis for household contacts
42
What is transient synovitis?
Hip pain following recent viral infection in 3-8 year olds?
43
What is the most common cause of hip pain in children?
Transient synovitis
44
Presentation of measles?
- Prodromal phase with irritability, fever and conjunctivitis
- Koplik spots which are white spots on buccal mucousa
- Maculopapular rash which spreads from ears to whole body
45
What is the most common deadly complication of measles?
Pneumonia
46
What is the most common complication of measles?
Otitis media
47
What is Perthes disease?
A degenerative condition affecting the hip joints of boys between 4-8 presenting with hip pain, limping and reduced ROM
48
Management of Perthes
- Conservative management
- Surgical management rarely needed for severe deformity/over 6 years old
49
Management of nocturnal enuresis (bed-wetting)
1st - Reward system
2nd - Enuresis alarm
3rd - Desmopressin
50
What is the ratio of compression for PBLS?
lay responders: 30:2
rescuers: 15 compressions: 2 breaths
51
What is the classic presentation of Scarlet fever?
- Sore throat
- Fever
- Headache
- Bright red strawberry tongue
- Coarse, red rash which starts in axillae and groins then spreads to trunk (sandpaper feel)
52
What organism accounts for majority of croup?
Parainfluenza
53
What condition does RSV cause?
Bronchiolitis
54
What is Meckel's diverticulum?
A congenital diverticulum of the small intestine which contains ectopic gastric/ileal/pancreatic mucousa
55
Presentation of Meckels Diverticulum?
- Abdominal pain
- Rectal bleeding
- Intestinal obstruction
56
What investigations should be used for MD?
- If child is stable with not severe bleeding, a 'Meckle's scan' with technetium should be used
57
What is a venous hum?
A continuous blowing noise heard just below the clavicles - due to turbulent blood flow in veins
58
What is Still's murmur?
A low-pitched sound heart at the lower left sternal edge
59
How much school should children with whooping cough miss after starting Abx?
48 HOURS
60
Signs of cerebral palsy?
- Slow to reach milestones
- Feeding difficulties
61
Signs of dyskinetic CP?
- Athetoid movements - slow movements of hands and feet and holding onto objects
- Oro-motor problems - drooling
62
What is a feature of a benign ejection systolic murmur?
Varies with posture
63
What do all breech babies born at or after 36 weeks need?
USS for DDH screening at 6 weeks
64
When is precocious puberty in males defined?
Before 9 years of age
65
What abdominal sign occurs with congenital diaphragmatic hernia?
Scaphoid abdomen (inward concavity to the abdominal wall)
66
What is the most common cause of inherited neurodevelopment delay?
Fragile X syndrome
67
What are the features of Fragile X syndrome in males?
- Mutation on X chromosome
- X-linked dominant
- Learning difficulties
- Large, low set eats with long thin face
- Hypotonia
- Autism
- Mitral valve prolapse
68
What condition is associated with congenital diaphragmatic hernia?
Pulmonary hyperplasia
69
What is mitochondrial disease inheritance?
- Only via the maternal line as the sperm contributes no cytoplasm to the zygote
- None of the children of affected male will inherit
70
How do you differentiate between epilepsy and reflex anoxia seizures?
Reflex anoxic seizures have a rapid recovery unlike epileptic
71
Key features of Osgood-Schlatter disease?
- Seen in sporty teenagers
- Pain, tenderness and swelling over the tibial tubercle
72
Key features of Chondromalacia patellae?
- Softening of the cartilage of the patella
- Common in teenage girls
- Knee pain on stairs and from prolonged sitting
73
Key features of Osteochondritis dissecans?
- Pain after excercise
- Intermittent swelling and locking
74
Key features of Patellar subluxation?
- Medial knee pain
- Knee may give way
75
Key features of Patellar tendonitis?
- More common in athletic teenage boys
- Chronic knee pain that worsens after running
- Tenderness below patella
76
Most common cause of benign, noisy breathing in infants?
Laryngomalacia
77
Which organism causes pertussis?
Bordella pertussis
78
What is the autism triad?
- Communication impairment
- Impairment of social relationships
- Ritualistic behaviour
79
What cardiac defect is associated with Turners?
Bicuspid aortic valve - ejection systolic murmur
80
What is Turner's syndrome?
One X chromosome 45, XO
81
What is the urgent management for babies with jaundice within first 24 hours of life?
Measure SBR within 2 hours
82
First line investigation for DDH in infant > 4.5 months
X-ray
83
Management of DDH in children younger than 4-5 months
Pavlov harness
84
Management of child < 3 months with temp > 38
Admit to hospital
85
Management of PDA to promote duct closure?
Indomethacin/Ibuprofen
86
What murmur is heard with PDA?
'machinery like' murmur
87
What should be given for croup regardless of severity?
0.15/kg single dose of oral dexamethasone
88
Triad of shaken baby syndrome?
- Retinal haemorrhages
- Subdural haematoma
- Encephalopathy
89
What usually precedes ITP?
A viral illness
90
How are newborns screened for hearing problems?
Automated otoacoustic emissions
91
What are exomphalos and diaphragmatic hernia associated with?
Malrotation
92
What is Osgood-Schlatter?
Pain, tenderness and swelling over the tibial tubercle seen in sporty teens
93
What is Ebstein's anomaly?
A heart defect with a low insertion of tricuspid valve resulting in large atrium and small ventricle
94
What is the most common cardiac problem associated with Duchennes?
Dilated cardiomyopathy
95
When are APGAR assessed?
1 and 5 minutes
96
What is exomphalos?
When the abdominal contents protrude through the anterior wall but are covered in an amniotic sac
97
How is exomophalos managed?
C-section to reduce risk of sac rupture
98
Abx of choice for infants < 3 months old for meningitis?
IV Amoxicillin
IV Cefotaxime
99
What vaccines do young people get between 13 and 18
Tetanus/Diptheria/Polio and Men ACWY
100
What is meningococcal septicaemia a CI to?
LP
101
What causes acute epiglottis?
H Influenzae B
102
Investigation of choice for vesicoureteric reflux?
Micturating cystourethrogram
103
Most common bacterial organism for bacterial pneumonia in children?
Strep pneumonia
104
What is used to maintain a DA for duct dependent congenital heart disease?
Prostaglandin E1
105
How can the airway be protected with acute epiglottis?
Endotracheal intubation
106
What condition is associated with intramural gas on abdominal x-ray?
Necrotising enterocolitis
107
Gold standard diagnosis for Hirschsprung disease?
Rectal biopsy
108
Which MAb is used to prevent RSV in some children?
Palivizumab
109
What organism commonly causes hand, foot mouth?
Coxsackie virus
110
What electrolyte imbalance is seen with pyloric stenosis?
Hypochloremic hypokalaemic metabolic alkalosis
111
What is a cardiac complication of Kawasaki?
Coronary artery aneurysms
112
Treatment for spasticity in cerebral palsy?
Baclofen, Oral diazepam
113
Which GI problem shows dilated loops of bowel with abdominal distension?
Hirschprung
114
What is the US finding for pyloric stenosis?
Thickened, elongated pylorus
115
Which type of epilepsy has partial seizures at night?
Benign rolandic epilepsy
116
Which condition has large volumes, bounding collapsing pulse?
PDA
117
Which condition has large volumes, bounding collapsing pulse?
PDA
118
How should children under 5 be managed with nocturnal enuresis?
Reassurance and advice
119
When is the peak incidence of bronchiolitis?
3-6 months of age
120
What should be done with children with hip/limp pain and fever?
Urgent same-day assessment
121
What should be suspected in a child with fever > 5 days?
Kawasaki disease
122
What is a poor prognostic factor for ALL?
Male sex
123
What does LP with bacterial meningitis show?
Raised WBC with predominant neutrophils and a low glucose ratio
124
Management of babies with absent/weak femoral pulses at 6-8 weeks?
Discussion with paeds immediately
125
Presentation of measles?
- Initial prodrome of cough, coryza and white spots on buccal mucousa
- Rash which starts behind ears and spreads across body
126
Most common complication of otitis media?
Measles
127
What should be done to reduce the chance of severe brain damage in neonates with hypoxic injury?
Therapeutic cooling at 33-35 degrees
128
What is neonatal hypotonia associated with?
Prader-Willi syndrome
129
What is breech presentation a risk factor for?
DDH
130
What condition is associated with cleft palate and posterior displacement of the tongue?
Pierre-Robin syndrome
131
What is gastroschisis?
A congenital defect in the anterior abdominal wall lateral to the umbilical cord
132
Risk factors associated with gastroschisis
Socioeconomic deprivation
- Maternal age < 20
- Maternal alcohol/tobacco use
133
Treatment for scarlet fever?
Oral Pen V for 10 days and return to school after 24 hours
134
Management of pyloric stenosis
Ramstedt pyloromyotomy
135
Development at 6 months?
- Palmar grasp
- Pass objects from one hand to another
136
Management of transient synovitis
Requires rest and analgesia
137
Management of phimosis in children < 2?
It is normal and will most likely resolve over time
138
Management of bruising in a non-mobile infant?
Same day paediatric assessment
139
What is the classic presentation of Edwards syndrome?
Micrognathia, rocker bottom feet and overlapping of fingers
140
What is a classic presentation of erythema infectiousum? (6th disease/Slapped Cheek)
Coryza and fever followed by red rash on cheeks caused by parvovirus b19
141
What occurs if a foetus is homozygous for alpha-thalassaemia?
Hydrops fettles
142
What is the rotavirus vaccine and when is it given?
A live attenuated vaccine given at 2 and 3 months
143
When is MMR vaccine given?
12 months and 3-4 years
144
Management of Kawasaki disease?
High dose aspirin
145
Signs of neonatal hypoglycaemia?
Irritability and jitteriness
Drowsiness and poor feeding
146
Key risk factor for neonatal hypoglycaemia
Prematurity
147
Management of unilateral undescended testicle?
Review at 3 months
148
What is neonatal death?
Death between 0-28 days of life
149
What should you not use in children < 3 months with suspected/confirmed BM?
Corticosteroids
150
What is innocent murmurs?
Soft, systolic, short, symptomless and sitting/standing (vary with position)
151
What is abnormal before 12 months?
Hand preference
152
How does congenital CMV manifest?
Hearing loss (sensoineural)
Low birth weight
Petechial rash
Seizures
Microcephaly
Visual impairment
Learning disability
Cerebral Palsy
153
When can a child with scarlet fever return to school?
24 hours after commencing Abx
154
What murmur would you see with VSD?
Pansystolic in lower left sternal edge
155
What murmur would you see with aortic coarctation?
Crescendo-descrecendo murmur in upper left sternal border
156
What murmur would you see with pulmonary stenosis?
Ejection systolic murmur in upper left sternal border
157
What is newborn compression:ventilation ratio?
3:1
158
What are the characteristic symptoms of JIA
Joint pain with salmon-pink rash
159
What is a poor prognostic indicator for congenital diaphragmatic hernia
Presence of liver in the thoracic cavity
160
What does a female with amenorrhoea and bilateral groin swelling suggests?
Undescended testes -> androgen insensitivity
161
Management of slipper upper femoral epiphysis
Internal fixation across the growth plate
162
When is the newborn blood spot screening test performed?
5th - 9th day of life
163
How long from school should a child with impetigo be excluded?
Until lesions have crusted over or 48 hours after starting Abx
164
What should be monitored when starting a child on methyphenidate?
Growth
165
What should be done with a child < 3 with acute limp?
Urgent assessment
166
What causes hand, foot mouth disease?
Coxsackie A16
167
What is the mode of inheritance of Prader-Willi syndrome?
Imprinting
168
First sign of puberty in boys?
Increase in testicular volume
169
Management of exomphalos?
C-section and staged repair
170
What kind of diet should someone with CF follow?
High calorie and high fat with pancreatic enzyme supplementation for every meal
171
What drug use during pregnancy can cause orofacial clefts?
Anti-epileptic
172
When is the MenB vaccine given?
2,4 and 12-13 months
173
What is empirical Abx treatment for meningitis if > 3 months?
3rd gen cephalosprin e.g. ceftriaxone
174
Features of Patau syndrome
- Microcephaly
- Small eyes
- Low set ears
- Polydactyly
175
What is the Abx of choice for a child with mycoplasma pneumoniae?
Erythromycin
176
Which genetic condition is associated with supravalvular aortic stenosis?
Williams Syndrome
177
What can bruising at birth lead to?
Elevated bilirubin levels
178
What is a common complication of viral gastroenteritis?
Lactose intolerance
179
Congenital cyanotic disease presenting within the first days of life?
Transposition of the great arteries
180
Congenital cyanotic disease presenting at 1-2 months of age?
Tetralogy of Fallot
181
What is the most common genetic bleeding disorder?
von Wilebrand disease - autosomal dominant
182
What blood test would be affected in someone with vWd disease?
Prolonged APTT
183
Features of Klinefelter's?
- Breast enlargement
- Infertility
- Small, firm testes
184
What would be seen on blood tests of Klinefelter's?
- Reduced inhibin B
- Elevated FSH
185
What is HSP?
Vasculitis commonly triggered by URTI/gastroenteritis
186
De-George syndrome symptoms?
Cardiac abnormalities
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcaemia/Hypoparathyroidism
22 - chromosome 22
187
Management of collapsed child if no signs of breathing?
5 rescue breaths
188
What is the risk of giving NSAIDs with chickenpox?
Necrotising Fasciitis
189
What is the normal Respiratory rate for <1?
30-40
190
What is the normal respiratory rate for 2-5 years old?
20 - 30
191
Septic arthritis vs Transient Synovitis?
SA will have refusal to weight bear, loss of passive movement, leukocytosis and raised inflammatory markers
192
What is Erb's palsy?
Damage to the C5/C6 root of the brachial plexus, usually resolves within 3 months
Associated with instrumental delivery
193
Clinical features of Erb's palsy?
- Adducted and internally rotated arm
- Forearm pronation
- Absent biceps reflex
- Normal power and hand grasp
194
What is Bartter syndrome?
A rare inherited defect of the ascending loop of Henle with hypokalaemia, alkalosis and normal/low pH.
195
How does mumps present?
- Fever
- Muscle pain
- Headache
- Fatigue
- Swelling of the parotid glands
196
What renal condition is HSP associated with?
IgA Nephritis
197
When is the 6 in 1 vaccine given to children?
8, 12 and 16 weeks of age
198
What murmur is found with Tetralogy of Fallot?
Ejection systolic murmur at left sternal edge
199
What is indomethacin used for?
Promote closure of the PDA
200
What are prostaglandins used for in the post natal period?
Keep the PDA open
201
What is venous hum?
benign murmur heard in children and sounds like a continuous blowing noise heard below the clavicles
202
What is Still's murmur?
Benign low pitched sound heart at the lower left sternal edge
203
What is Still's murmur?
Benign low pitched sound heart at the lower left sternal edge
204
What is a left subclavicular thrill indicative of?
Patent Ductus Arteriosus
205
What is patellar subluxation?
Medial knee pain - knee may give way
206
What condition is characteristic with lymphoedema in neonates?
Turners syndrome
207
What is an umbilical granuloma?
An overgrowth of tissue which occurs during the healing process of the umbilicus - most common in the first few weeks of like
208
Presentation of umbilical granuloma
- Small, red growth around the umbilicus
- Leaks small amounts of clear/yellow fluid
209
When should lochia cease postpartum?
4-6 week after
210
Vasa praevia triad?
- PROM
- Painless bleeding
- Foetal bradycardia
210
Vasa praevia triad?
- PROM
- Painless bleeding
- Foetal bradycardia
211
How long should a child with impetigo be excluded?
Until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
212
Who will inherit a mitochondrial condition?
All children of an affected mother as it is maternal line only
213
What is station in obstetrics?
Level of the head in relation to the ischial spine
214
What is recommended if HIV viral load is less than 50 copies/ml at 36 weeks?
NVD
215
Management of neonatal hypoglycaemia?
If asymptomatic: normal feeds and monitor glucose
If symptomatic: neonatal unit and IV dextrose
216
What is second line for investigating PPROM?
Ultrasound
217
Where is the damage in the brain for dyskinetic CP?
The basal ganglia and the substantia nigra
218
How to tell the difference between cephalohaematoma and caput succeadanum?
Cephalohaemtoma will not cross the suture lines
219
Complications of undescended testes?
- Infertility
- Testicular torsion
- Inguinal hernia
220
Transient synovitis vs Septic Arthritis?
Septic will have a high fever
221
What does discrepancy between the skin creases behind the right and left hips suggest?
DDH
222
What condition with hip/knee pain is associated with obese children?
Slipped capital femoral epiphysis
223
What ortho condition are Hyperactivity and short stature assoicated with?
Perthes
224
What does target sign on ultrasound suggest?
Intussception
225
What malignancies are more likely to develop in someone with Downs?
ALL and AML
226
Patau syndrome signs
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
227
Edwards syndrome signs
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
228
Noonan syndrome signs?
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
229
Pierre-Robin syndrome signs?
Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate
230
Prader-Willi syndrome signs?
Chromosome 15 - los of function on fathers copy
Hypotonia
Hypogonadism
Obesity
231
Williams syndrome signs?
Chromosome 7
Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis
232
What condition has honey-coloured crusted plaques?
Impetigo
233
What is Wardenbergs syndrome?
- Congenital
- Eyes look wider apart and different colours
234
What is Treacher Collins?
- Autosomal dominant
- Under development of the cheek bones
- Abnromal outer and middle ear with conductive loss
235
What groups might have monitored hearing?
- CF
- CMV
- Head trauma
- Downs syndrome
236
Where is the problem when there is conductive (bone > air) hearing loss?
Middle ear e.g glue ear, ear wax, infection - often resolves by themselves/operable
237
Where is the problem when there is sensorineural hearing loss?
Inner ear, nerve or brain - often is permanent and will require hearing aids
238
What is the hearing test done for babies in newborn screen?
- Otoacuoustic emission test, followed by
- Auditory brainstem response test
239
What condition has thumb sign/steeple sign on x ray?
Thumb - Epiglottitis
Steeple - Croup
240
Treatment for otitis media?
5 days of Amoxicillin
240
Treatment for otitis media?
5 days of Amoxicillin
241
What age would coeliac disease normally present in children?
9-24 months
242
When does malrotation normally present?
In the first month of life
243
Risk factors for meconium aspiration?
- Gestation > 42 weeks
- Pre-eclampsia
- Maternal diabetes
244
When does intusseption normally present?
3 months - 3 years (commonly <1)
245
What is pathological jaundice and what causes it?
Jaundice < 24 hours
- G6PD deficiency/Spherocytosis
246
What gestation can a TCB monitor for jaundice not be used?
<35 weeks
247
Complication of untreated neonatal jaundice?
Kernicterus
248
4 features of tetralogy of fallot?
- Overriding aorta
- Large VSD
- Pulmonary stenosis
- Right ventricular hypertrophy
249
Risk factors for transposition of the great arteries?
- Maternal rubella
- Diabetes
- Mum > 40
- Maternal alcohol
- Trisomy 13,18,21
250
Triad of haemolytic uraemic syndrome?
- AKI
- Thrombocytopenia
- Normocytic anaemia
251
Maculopapular, purpuritic rash in patients on amoxicillin?
Infective mononucleosis
252
What vaccines given at 8 weeks?
6 in 1
Rotavirus
Men B
253
What vaccine given at 12 weeks?
6 in 1
Rotavirus
PCV
254
What vaccines given at 16 weeks?
6 in 1
Men B
255
What vaccines give at 1 year?
- Hib/Men C
- PCV
- MMR
- Men B
256
What vaccines given at 3 year 4 months?
DTap/IPV
MMR
257
Symptoms of ALL?
- Fatigue
- Bone pain
- Anaemia
- Recurrent infections
- Fever
258
Signs of adrenal crisis (CAH)
hyponatraemia, hyperkalaemia and a metabolic acidosis
259
What is glandular fever caused by?
EBV
260
What areas of the body will chemotherapy not reach in ALL?
Testes and CNS
261
What Abx might those be given for prophylaxis in sickle cell patients?
Penicillin
262
What condition is assoicated with 'double bubble' sign on imaging?
Duodenal atresia
263
Second line for mood stabilising in bipolar?
Valproate
264
Smelly, fluid discharge and pulling at one ear?
Otitis media
265
Management of child with bruising, enlarged lymph nodes and systemic illness?
Urgent same day referral to haematology for ALL
266
First line management of unconscious child after choking?
5 rescue breaths via mouth to mouth
267
Baby getting tired quite easily and having cyanotic spells?
Echo - Tetralogy of Fallot
268
Childhood obesity, short stature, learning difficulties, hypotonia
Prader-Willi
269
Most common form of congenital heart disease in infants of diabetic mums?
Transposition of the great arteries
270
CMPA vs GORD
CMPA will have diarrhoea whereas GORD will generally have vomiting
271
Management of moderate diarrhoea with no signs of shock?
Oral rehydration solution - Diarolyte
272
Management of duodenal atresia?
Duodenoduodenostomy
273
Common complication of bronchiolitis?
Hyponatraemia
274
What is jugular foramen syndrome?
Unilateral CN 10+11 palsy
275
When will a child remain infectious until with measles?
4-5 days after rash resolves
276
What can parvovirus in first 20 weeks of pregnancy cause?
Hydrops fettles
277
Barking cough with stridor that does not resolve with treatment?
Bacterial tracheitis
278
Which consequence of artificial ventilation is routinely screened for?
Retinopathy of prematurity
279
Frequent otitis media is assoicated with which condition?
Turners
280
Frequent otitis media is assoicated with which condition?
Turners
281
What is Waterhouse-Friderichsen syndrome
Complication of meningitis associated with adrenal haemorrhage and septic shock
282
Biopsy changes for minimal change disease?
Nothing
283
What is the most common cause of proteinuria in children?
Orthostatic proteinuria - benign and self-limiting
284
Examples of live attenuated vaccines?
MMR, Rotavirus, Inhaled Influenza, Varicella
285
Gowers sign - patient uses hands and arms to walk up their body to stand up from supine?
Duchennes - X linked recessive
286
Radiological findings of rickets?
- Bowed femurs
- Widened epiphiyseal plates
287
acute bilirubin encephalopathy?
Elevated unconjugated bilirubin in the CNS
288
What pulses felt in infants/ over 1?
Infant - brachial
Over 1 - Carotid
289
ground glass pattern on x-ray in neonate?
Respiratory distress of the newborn
289
ground glass pattern on x-ray in neonate?
Respiratory distress of the newborn
290
What vitamins would someone with CF be deficient in?
ADEK - fat soluble
291
Cause of inguinal hernia?
Failure of the processes vaginalis to obliterate - more common in boy
292
HSP tetrad?
- Arthralgia
- Rash
- Abdominal pain
- Glomerulonephritis
293
Important complication of glandular fever?
Splenomegaly from white cell sequestration
294
Infant > 42 weeks who got stuck during prolonged labour?
Hepatic Ischemic Encephalopathy
295
Roseola vs Chickenpox?
Roseola will not have an itchy rash
296
Management of squint in newborns?
Referred if still present at 8 weeks
297
Incubation period of chicken pox?
21 days
298
Congenital CMV infection signs?
- Hearing loss
- Visual impairment
- Learning disability
299
Trans-illuminating scrotal swelling with non-palpable testis?
Hydrocele
300
Main differential for hydrocele and how to tell?
Inguinal hernia -> use testicular ultrasound
301
Most common cause of delayed puberty?
Constitutional delayed growth and puberty -> hand x-ray to look at bone age
302
Signs of internuclear opthalmoplegia?
- Failure to adduct on the affected side
- Nystagmus on the contralateral side
303
Risk factors for polyhydramnios?
Maternal diabetes mellitus
Foetal renal disorders
Foetal anaemia
Twin-to-twin transfusion syndrome
Oesophageal or duodenal atresia
Diaphragmatic hernia
Anencephaly
Chromosomal disorders
304
Measles complications?
pneumonia, encephalitis, immunosuppression and subacute sclerosing panencephalitis
305
Impetigo treatment?
- Hydrogen peroxide cream
- Fuscidic acid cream
306
Management of vesicoureteral reflux?
Prophylactic Abx
307
First line investigation for all children presenting with global developmental delay?
Genetic Karyotyping
308
avascular necrosis of the femoral head
Perthes disease
309
Irreversible cause of global developmental delay?
Foetal alcohol syndrome
310
What enzyme deficiency is there in congenital adrenal hyperplasia?
21-hydroxylase
311
Infant presenting with enlarged head circumference, bulging fontanelle, ditended veins on scalp?
Hydrocephalus
312
Causes of Stephen-Johnson syndrome?
- Allopurinol
- Lamotrigine
- Penicillin
- Phenytoin
313
Complications of chickenpox?
- Bacterial superinfection
- Cerebellitis
- DIC
- Progressive disseminated disease
314
Complications of chickenpox?
- Bacterial superinfection
- Cerebellitis
- DIC
- Progressive disseminated disease
315
Murmur heard loudest between the scapulae?
Aortic coarctation
316
What is raised Immunoreactive trypsinogen associated with?
CF
317
pan-systolic murmur?
VSD
318
pan systolic loudest at apex/axilla?
Mitral regurg
319
ejection systolic murmur radiating to carotids?
Aortic stenosis/Pulmonary stenosis
320
pan-systolic murmur at lower left sternal edge on inspiration?
Tricuspid regurg
321
unwell child with blisters appearing over poorly controlled eczema
eczema herpetiform? - derm emergency which needs urgent antivirals
322
Biggest risk factor for stillbirth?
Intrauterine growth restriction
323
Herpes virus 3?
Chickenpox
324
Stridor vs Wheeze?
Stridor - high pitched, heard on inspiration associated with URTI
Wheeze - high pitched, heard on expiration associated with LRTI
325
Risk factors for Bronchiolitis?
Smoke exposure
Premature babies
Babies with heart defects/existing lung conditions
Immunodeficiency
326
What is the vaccine given for bronchiolitis and who gets it?
Palavizumab
- Chronic lung disease of prematurity
- Congenital heart defects
- Immunocompromised
327
Conditions on the Newborn Spot Test?
- Sickle cell
- Cystic Fibrosis
- Congenital Hypothyroidism
- PKU
- Maple Syrup Urine Disease
- Homocystinuria
- MCADD
- GA1
- IVA
328
Signs of atypical UTI in children?
Poor urine flow
Abdominal mass
Raised creatinine
Sepsis
Failing to respond to Abx within 48 hours
Infection with non E coli organisms
329
Most common cause of cerebral palsy?
Antenatal - vascular occlusion, structural maldevelopment, cortical degeneration
330
Which type of cerebral palsy is associated with increased tone, all 4 limbs and seizures?
Spastic
331
Ix of choice for CP?
MRI
332
Indications for botox with children with CP?
Focal spasticity of upper/lower limbs with pain/disturbed sleep/impaired motor function
333
Indications for botox with children with CP?
Focal spasticity of upper/lower limbs with pain/disturbed sleep/impaired motor function
334
Risk of not managing squints?
Permanent loss of visual acuity - occipital cortex does not develop
335
Why should you not build up feeds too quickly in preterm infants?
Risk of Nec Ent
336
Pink rash which begins on face and then spreads with lymphadenopathy?
Rubella
337
Management of recurrent UTI?
Request an ultrasound scan within 6 weeks and a DMSA scan 4-6 months later
338
ECG changes associated with ASD?
- P pulmonale
- RBBB
- Right axis deviation
- QT prolongation
339
What is Jones criteria and what are the components of it?
Used to assess rheumatic fever
J = Joints arthritis (Migratory)
♥ = Pancarditis
N = Nodules (subcutaneous)
E = Erythema marginatum
S = Sydenham chorea
340
Asthma management steps?
Step 1: SABA PRN - Salbutamol
Step 2: ICS Preventer therapy - Beclomethasone
Step 3: <5 - add LTRA
>5 - add LTRA/LABA
Step 4: Stop LABA if no response: increase ICS dose
Step 5: Referral - consider increased ICS dose
341
Management of acute asthma exacerbation?
- O2 if sats low
- Nebulised Salbutamol/Iptratropium
- Steroids
- IV Salbutamol
- IV Mag Sulphate
- IV Aminophylline
- ITU
342
What kind of shunt in VSD?
Left - Right
343
What is glue ear?
- Otitis media with effusion
- Narrowed/Block Eustachian tube
- Conservative management with potential Grommets
344
What is Esotropia?
inward position squint -> affected eye deviated towards the nose
345
What is Exotropia?
outward position squint -> affected eye deviated towards the ear
346
Hyertropia vs Hypotropia?
Hyper - upward moving affected eye
Hypo - downward moving affected eye
347
Most common childhood arrhythmia?
- SVT
- HF symptoms in neonates/infants
- Narrow complex tachycardia on ECG
- Carotid sinus massage/IV adenosine
- Cardioversion if above fails
348
What is Hypospadias and Tx?
- Urethral meatus is abnormally displaced on the underside
- Surgery after 3-4 months of age
- Never retract foreskin!
349
Management of constipation?
- Laxatives such as Movicol
- Disimpaction regiment may be needed with high dose at start then half dose for maintenance
350
Crohns signs?
N- no blood or mucus
E - entire GI tract
S - skip lesions on endoscopy
T - Terminal ileum and transmural inflammation
S - Smoking is risk factor
351
UC signs?
C - continuous inflammation
L - limited to colon and rectum
O - only superficial mucosa affected
S - smoking is protective
E - excrete blood and mucus
U - use aminosalicylates
P - primary sclerosing cholangitis
352
What is Marasumus?
- Undernutrition
- Wasted appearance and low weight/height
- Withdrawn and apathetic child
- Tx with correction of electrolytes and micronutrients
353
What is Kawshiokor?
- Severe protein malnutrition
- Distended abdomen, flaky paint skin rash
- Tx with correction of electrolytes and micronutrients
354
What are choledochal cysts?
- Cystic dilatations of extrahepatic biliary stsem
- Cholestasis - treated with removal of cyst
355
Treatment of Steve-Johnson?
- Steroids/Immunoglobulins
- Supportive care
356
How to tell candida from nappy rash?
- Rash extending into the skin folds
- Large red macules which is moist
357
What is Scalded skin syndrome?
- S aureus rash with tenderness, erythema and fever
- Tx with Flucloxacillin/Analgesia
358
What is Angelman?
- Loss of function of copy of gene from mother due to deletion of Chrm 15
- Developmental delay
- Fascination with water, happy
- Fair skin, light hair and blue eyes
- Widely spaced teeth
- ADHD/Epilepsy
359
Leading cause of childhood cancer death in the UK?
Brain tumours
360
Osteosarcoma?
- Most common primary bone cancer
- Adolescent males
- Warm, painful swelling at knee
- Sunburst and Codman's triangle on X-ray
361
Ewings sarcoma?
- Adolscents
- Painful, warm, enlarging mass
- Systemic symptoms
- X-ray shows Onion skin periosteal reaction
362
Retinoblastoma
- Presents in first 3 years of life
- White reflex replaces red
- Squint
- MRI to diagnose with chemo
363
Osteogenesis Imperfecta?
- AD condition with recurrent fractures due to collagen formation issue
- Triangular face/Deafness/Bone deformities
- Bisphosphonates/Vit D
364
Oligoarticular vs Polyarticular JIA?
O - 4 joints or less, more common in girls under 6 with anterior uveitis and no systemic symptoms
P - 5 joints or more with symmetrical pattern and minimal systemic symptoms
365
What can slapped-cheek trigger in someone with sickle cell crisis?
Aplastic crisis - significant anaemia and needs blood transfusions
366
Respiratory distress of the newborn?
- Premature neonates < 32
- Inadequate surfactant -> lung collapse and hypoxia
- Artifical surfactant via ET tube/CPAP
367
Kallman syndrome?
- Delayed puberty - lack of testicle development/ameorrhoea
- Low LH, FSH, Oestrogen, Progesterone
- Lack/Reduced sense of smell
- Cleft palate
- Tx is HRT
368
What makes up 6 in 1 vaccines?
Parents will immunise toddlers because death
- Polio
- Whooping Cough
- Influenzae - Haem Inf
- Tetanus
- B Hep
- Diptheria
369
Most common cause of late-onset neonatal sepsis (after 72 h of life)
S aureus
370
Complications of Nephrotic syndrome?
- Hypercholesterolaemia
- Hypovolaemic shock
- Infections
- Thrombosis
- Relapses
371
What is Milia?
White pimples on nose/cheek - self-limiting
372
What are Mongolian blue spots?
blue/black macular discolouration at the
base of the spine and on the buttocks
373
What type of laxative is Movicol?
Macrogol laxative
374
What is Swenson procedure used for?
Hirschprungs
375
What is Hydrops fetalis?
abnormal accumulation of serous fluid in 2+ fetal compartments (pleural/ pericardial
effusions, ascites, skin oedema, polyhydramnios or placental oedema)
376
Causes of hydrops fetalis?
- Rhesus incompatiability
- Severe anaemia – congenital parvovirus B19 infection, alpha thalassaemia major, massivematerno-feto haemorrhage
● Cardiac abnormalities
● Chromosomal – Trisomy 13, 18, 21, or Turners
● Infection – toxoplasmosis, rubella, CMV, varicella
● Twin- Twin transfusion syndrome (in the recipient twin)
● Chorioangioma
377
Which genetic condition has disruption to the aortic arch?
DiGeorge syndrome
378
Fragile X signs?
A long face
Large, protruding ears
Intellectual impairment
Macroorchidism (large testes) - post-pubertal
Social anxiety
Autistic spectrum features
379
What condition are infants who drink lots of cow milk/under1s who drink cows milk at risk of?
Iron deficiency anaemia
380
When should Moro reflex have disappeared by?
6 months
381
Most common ECG findings of paeds cardiac arrest?
Asystole
382
First line investigation for asthma?
Spirometry and BDR (bronchodilator reversibility)
383
Investigation of choice to confirm Reyes?
Liver biopsy which shows hepatocyte microvesicular steatosis
384
Imaging of choice for Slipped Upper Femoral epiphysis?
Plain radiograph of the pelvis in AP and frog-leg views
385
Preseptal cellulitis vs orbital cellulitis?
Preseptal will not have visual symptoms
386
Where is the damage in spastic CP?
Upper motor neurons in the periventricular white matter
387
Risk factors for DDH?
female sex
breech presentation
positive family history
firstborn children
oligohydramnios
birth weight > 5 kg
388
Rash affecting child in first few weeks of life around scalp ('Cradle cap'), nappy area, face and limb flexures.
Sebhorreic Dermatitis
389
Management of seborrheic dermatitis?
Mild - baby shampoo and oil
Severe - 1% hydrocortisone
390
What cancers are increased risk in coeliac?
- Lymphoma
- Small bowel adenocarcinoma
391
grey-white coloured membrane covering his tonsils.
Diptheria
392
What age do febrile convulsions normally stop?
5 years old
393
Risk factors for sudden infant death syndrome?
prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity
394
Complication of aortic coarctation?
Cerebral aneurysms
395
Congenital toxoplasmosis signs?
Cerebral calcification
Chorioretinitis
Hydrocephalus
Anaemia
Hepatosplenomegaly
Cerebral palsy
396
Foetal varicella signs?
skin scarring
microcephaly
eye defects (microphthalmia)
limb hypoplasia
learning disabilities
397
Colic vs Infantile spasms?
In infantile spasms the child will become distressed between spasms, whereas in colic the child will become distressed during the 'spasms'
398
Features of achondroplasia?
short limbs (rhizomelia) with shortened fingers (brachydactyly)
large head with frontal bossing and narrow foramen magnum
midface hypoplasia with a flattened nasal bridge
'trident' hands
lumbar lordosis
399
When do you review undescended testes?
3 months
400
Anal fissures and recurrent UTIs in children can indicate what?
Sexual abuse
401
BLS of under 1s?
2 thumb-circling technique
402
prominent right ventricular impulse palpable on examination?
Transposition of great arteries
403
What should you not use in children younger than 3 months with suspected or confirmed bacterial meningitis
Corticosteroids
404
Severe asthma signs?
PEFR 33–50% best or predicted <50 in children
RR > 25 adults, >30 5-12, >40 2-5
HR >110, >125 5-12, >140 2-5
Cannot talk in full sentences
Accessory muscle use
Not feeding - infants
405
Life-threatening asthma signs?
PEFR <33
Sats <92
altered consciousness/exhaustion
Arrythmias
Hypotension
Cyanosis
Silent chest
Normal pC02
406
Red flag signs in children NICE?
<3 and temp >38
Grunting
Mod/Severe recessions
Mottled/pale
Appears withdrawn
RR > 60
Rash, seizures, bulging fontanelle, neck stiffness
407
Indications for head CT in children?
- Loss of consciousness lasting more than 5 minutes (witnessed)
- Amnesia (antegrade or retrograde) lasting more than 5 minutes
- Abnormal drowsiness
- Three or more discrete episodes of vomiting
- Post-traumatic seizure but no history of epilepsy
- Suspicion of open or depressed skull injury or tense fontanelle
- Any sign of basal skull fracture (haemotympanum, panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign)
- If under 1 year, presence of bruise, swelling or laceration of more than 5 cm on the head
