Paeds Flashcards

Question

Types of normocytic anaemia (3)

Answer 1

Increased reticulocyte count: Acute blood loss Haemolytic anaemia Decreased reticulocyte count: Aplastic anaemia

Answer 2

B12 deficiency Folate deficiency

Answer 3

Drugs Alcohol Hypothyroidism Liver disease

Answer 4

Physiological (most common cause) Anaemia of prematurity Blood loss Haemolysis Twin-twin transfusion (shared placenta)

Answer 5

Direct coombs test (DCT)

Answer 6

Haemolysis Blood bloss

Answer 7

Iron deficiency anaemia secondary to dietary insufficiency (most common cause) Blood loss e.g. menstruation in older girls

Answer 8

Fatigue Shortness of breath Headache Dizziness

Answer 9

Pale skin Conjunctival pallor Tachycardia Increased resp rate

Answer 10

Pica (dirt cravings) Hair loss

Answer 11

Koilonychia (spoon shaped nails) Angular chelitis (inflammation around mouth) Atrophic glossitis (smooth tongue) Brittle hair and nails

Answer 12

Autosomal recessive

Answer 13

**High risk pregnant women** are offered testing during pregnancy **Newborn screening heel prick test** at 5 days of age

Answer 14

**Antibiotic prophylaxis** (penicillin V) - due to splenectomy **Hydroxycarbamide** (stimulates production of HbF) - prevents vaso-occlusive complications **Blood transfusion** (for severe anaemia) **Bone marrow transplant** (*curative* but high risk) Avoid NSAIDs in complications of CKD

Answer 15

Vaso-occlusive crisis (> priapism) Splenic sequestration crisis (> hypovolaemic shock) Aplastic crisis (+ triggered by parvovirus B19) Acute chest syndrome (= fever or resp symptoms WITH new infiltrates on CXR)

Answer 16

A = VIII (8) B = IX (9) 8 is B and it’s the opposite way round

Answer 17

Neonatal intracranial haemorrhage, haematomas + cord bleeding Spontaneous bleeding into joints + muscles = joint damage and deformity, bruising

Answer 18

**Clotting screen:** PT APTT fibrinogen

Answer 19

IV infusion replacement of clotting factors (prophylactic or in response to bleeding) In acute settings: - IV infusion - Desmopressin (to stimulate VWF) - Antifibrinolytics e.g. tranexamic acid

Answer 20

Appearance Pulse Grimace Activity Respiratory

Answer 21

prolonged jaundice (present > 14 days of age) Dark urine and pale stools hepatomegaly splenomegaly Appetite and abnormal growth

Answer 22

Serum bilirubin: total bilirubin may be normal with abnormally high **conjugated bilirubin**

Answer 23

congenital heart defect characterised by low insertion of the tricuspid valve resulting in a large atrium and small ventricle

Answer 24

aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses

Answer 25

surgery to affected segment of the colon (**Swenson procedure**)

Answer 26

Severe respiratory distress e.g. grunting Central cyanosis Apnoea

Answer 27

Genetic defect in the protein chains of haemoglobin (alpha or beta)

Answer 28

Autosomal recessive

Answer 29

**Splenomegaly**: *fragile RBCS break down and collect in the spleen* **Pronounced forehead** and **malar eminences** + **susceptibility to fractures**: *bone marrow expands to produce extra RBC to compensate*

Answer 30

FBC: **Microcytic anaemia** Haemoglobin electrophoresis: **globin abnormalities** DNA testing: **genetic abnormalities** Pregnant women are offered screening

Answer 31

Iron overload Management: - serum ferritin monitoring - limit transfusions - iron chelation

Answer 32

Regular blood transfusions Iron chelation *due to iron overload in transfusions* Splenectomy Bone marrow transplant

Answer 33

Under 5 years old Japanese or Korean Male

Answer 34

Coronary artery aneurysm *Ix = transthoracic echocardiogram*

Answer 35

CRASH & BURN **C**onjunctivitis (bilateral) 👀 **R**ash (widespread erythematous maculopapular)📍📍📍 **A**denopathy (cervical lymphadenopathy) **S**trawberry tongue 🍓 **H**ands: desquamation (skin peeling) on palms and soles **BURN** (Persistent fever: >39c for >5 days 🥵) Diagnostic criteria: fever for > 5 days **PLUS** 4 out of 5 of CRASH

Answer 36

High dose aspirin (to reduce risk of thrombosis) AND IV immunoglobulins (to reduce risk of coronary artery aneurysm) Close follow up using echocardiograms

Answer 37

Risk of Reye’s syndrome (acute increase in pressure within the brain)

Answer 38

< 4 years old

Answer 39

Usually a single joint (often knee or hip) Rapid onset: - hot, red, swollen, painful joint - refusing to weight bear - stiffness and reduced range of motion - systemic symptoms E.g. fever, lethargy, sepsis *usually results from haematological spread from a bacterial infection elsewhere in the body, although it can occur following a skin wound such as chickenpox scar*

Answer 40

Staph aureus

Answer 41

Transient sinovitis Perthes disease SUFE Juvenile idiopathic arthritis

Answer 42

Aspiration: gram staining, crystal microscopy, culture, antibiotic sensitivities, - joint fluid may be purulent Empirical Abx given until microbial sensitivities known (Abx given 3-6 wks) Severe cases = surgical drainage + washout

Answer 43

HIV EBV Autoimmune conditions (RA/sarcoidosis) FHx

Answer 44

Cervical / Axilla / Inguinal Non tender + “rubbery” Pain when drinking alcohol

Answer 45

Unexplained Fever Unexplained Weight loss Drenching Night sweats *‘B’ symptoms = associated with B-cell abnormalities*

Answer 46

Lactate dehydrogenase (LDH) = raised but not specific **Lymph node biopsy = diagnostic - Reed Sternberg cells** CT/MRI/PET = diagnosing + staging

Answer 47

S1: one region of lymph nodes S2: more than one region but same side of diaphragm S3: above + below S4: non-lymphatic (lungs/liver etc)

Answer 48

Chemo: risk of leukaemia + infertility Radiotherapy: risk of cancer, damage to tissues + hypothyroidism

Answer 49

Burkitt lymphoma MALT lymphoma Diffuse large B cell lymphoma

Answer 50

Watchful waiting Chemo Monoclonal antibodies E.g. rituximab Radiotherapy Stem cell transplant

Answer 51

Avascular necrosis of the femoral head It is idiopathic

Answer 52

Boys aged 5-10

Answer 53

Younger than 10 Slow onset of: - Pain in the hip or groin - Limp - Restricted in hip movements - Possible referred pain to knee No history of trauma (SUFE more likely if minor trauma history) Associated with hyperactivity and short stature

Answer 54

1st line: X Ray (can appear normal) Other: - Blood tests (typically normal - useful for DDx) - Technetium bone scan - MRI scan

Answer 55

Bed rest Traction Crutches Analgesia

Answer 56

Head of the femur is displaced (slips) along the growth plate

Answer 57

Obese 12 year old boy *undergoing growth spurt* and may be history of **minor trauma** that triggers onset **Bilateral** (75%)

Answer 58

**1st line: X ray** Other: - Bloods (typically normal - useful for DDx) - Technetium bone scan - CT scan - MRI scan

Answer 59

**Surgery** to correct position and fix it in place *Surgery: Internal fixation across the growth plate*

Answer 60

Structural abnormality in the hips caused by abnormal development of the fetal bones during pregnancy - causes instability in the hips and a tendency for dislocation

Answer 61

Fs Family history (1st degree) Female First born children Feet first (Birth in breech position from 28 weeks onward) Fat (high birth weight) Fluid (oligohydramnios) + prematurity

Answer 62

Barlow test (dislocation of an articulated femoral head / adduction and downward pressure) Ortoloni test (relocation of a dislocated femoral head / abduction and upward pressure)

Answer 63

Ultrasound *>4.5 months = X-ray*

Answer 64

Pavlik harness if presentation <6 months (flexed and abducted) Surgery if >6 months or if harness fails

Answer 65

Down’s syndrome

Answer 66

Intussusception Meconium ileus Hirschsprung’s disease Oesophageal atresia Duodenal atresia

Answer 67

Double bubble

Answer 68

Hyp*o*tonia Brachycephaly Prominent epicanthic folds Upslanted palpebral fissures Small ears + round face Brushfield spots in the iris

Answer 69

Learning disability Visual problems (myopia, cataracts) Recurrent otitis media Deafness (eustachian tube abnormality) Obstructive sleep apnoea Cardiac defects (1 in 3): ASD, VSD, PDA, Tet of F *brain > eyes > ears > mouth > heart*

Answer 70

Combined test: ultrasound + maternal blood test

Answer 71

Week 9 to 11: chorionic villus sampling Week 14 to 18: amniocentesis

Answer 72

The bowel telescopes into itself which thickens the overall size of the bowel and narrows the lumen This causes a palpable mass + obstruction

Answer 73

More common in boys and typically 6 months - 2 years Recent viral upper respiratory tract infection Pale, lethargic and unwell Features of intestinal obstruction (vomiting, absolute constipation, abdo distention) Drawing legs up to abdomen Redcurrant jelly stool RUQ palpable mass (sausage shaped)

Answer 74

**Ultrasound abdomen**: shows ‘target sign’ or ‘doughnut sign’ which confirms diagnosis

Answer 75

Therapeutic enema/rectal air insufflation: force the folded bowel out *If therapeutic enema fails or if there is gangrenous bowel or perforation* = surgical reduction

Answer 76

Obstruction Gangrenous bowel Perforation Death *as the obstruction worsens, mesentery is stretched leading to venous obstruction. This then causes strangulation of the bowel, leading to necrosis of the bowel, generalised peritonitis and shock over time*

Answer 77

Congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel + rectum

Answer 78

Absence of parasympathetic ganglion cells in the myenteric plexus

Answer 79

Family history

Answer 80

20% of neonates with Hirschsprung’s get HEC 2-4 weeks after birth Fever, abdominal distention, diarrhoea with blood + septic features LIFE THREATENING

Answer 81

**Diagnostic**: full thickness suction rectal **biopsy** (shows absence of ganglion cells in mesenteric plexus) Abdominal X-Ray can be used *in addition* to diagnose intestinal obstruction + HAEC: dilated loops of bowel with fluid levels

Answer 82

Surgical removal of the aganglionic section of bowel

Answer 83

Death of bowel tissue > perforation > peritonitis > shock > death

Answer 84

first 2 weeks of life in neonates **Intolerance to feeds** **Vomiting (milk from feeding particularly w/ green bile)** **Distended, tender abdomen** Visible intestine loops lacking peristalsis Absent bowel sounds Blood in stools Generally unwell/lethargic

Answer 85

Bloods: - FBC (thrombocytopenia + neutropenia) - CRP - capillary blood gas (to determine metabolic acidosis) - blood culture (sepsis)

Answer 86

**Abdominal X-Ray** - dilated loops of bowel - bowel wall oedema (thickened) - pneumatosis intestinalis (**intramural gas**) = **pathognomonic**

Answer 87

Suspected NEC: Nil by mouth with IV fluids, TPN + **broad spectrum antibiotics** to stabilise - a nasogastric tube can be inserted to drain fluid + gas from the stomach intestines SURGICAL EMERGENCY 🚨 *May be left with a temporary stoma if significant bowel is removed* *Risk: short bowel syndrome*

Answer 88

1. Via the biliary system into the GI tract / stool 2. urine

Answer 89

Failure or delay in passing meconium within 48 hours

Answer 90

6 in 1 (1st) Rotavirus (1st) Men B (1st)

Answer 91

6 in 1 (2nd) Rotavirus (2nd) Pneumococcal

Answer 92

6 in 1 (3rd) Men B (2nd)

Answer 93

Pneumococcal (2nd) Men B (3rd) Hib/Men C (1st) MMR (1st)

Answer 94

MMR (2nd) 4 in 1 pre-school booster

Answer 95

**X-linked recessive disorder** = only boys develop it and can only get it from their **mother’s being carriers** *von **W**illebrand = **W**omen too*

Answer 96

non-Hodgkin *Hodgkin more common in adolescence*

Answer 97

developmental dysplasia of the hip septic arthritis transient synovitis trauma leukaemia

Answer 98

slipped upper femoral epiphysis (SUFE) reactive arthritis mechanical/overuse injuries (sports related)

Answer 99

*bilious vomiting = intestinal obstruction* Duodenal atresia Meconium ileus NEC

Answer 100

Thick and sticky stool that causes obstruction Typically presents 24-48 hours after birth with **bilious vomiting and abdo distention** Associated with cystic fibrosis

Answer 101

3 times more common in males Down's syndrome

Answer 102

Hyperglycaemia i.e. blood glucose > 11mmol/l Ketonaemia i.e. blood ketones > 3 mmol/l Acidosis i.e. pH < 7.3

Answer 103

**Fruity-smelling breath (due to presence of acetone)** Vomiting Dehydration (due to glucose taking fluid out in urine) **Abdominal pain** Kussmaul respiration Altered mental status (drowsiness/coma) *signs of DM e.g. weight changes, polyuria, polydipsia before DKA starts*

Answer 104

Blood glucose >11.1 Blood ketones >3 Urinary glucose + ketones Bicarbonate < 15 Blood gas analysis (pH < 7.3) Blood cultures (if infection is suspected) U&Es (high potassium due to acidosis/lack of insulin) Creatinine (mildly raised in dehydration)

Answer 105

Encourage **oral intake of fluids** Administer **subcutaneous insulin**

Answer 106

Cerebral oedema caused by rapid correction of dehydration with IV fluids

Answer 107

Untreated type 1 diabetes Infection Dehydration Myocardial infarction Fasting

Answer 108

**IV fluids** (initial bolus of 10ml/kg 0.9% NaCl) 1 hour after starting IV fluids: **Insulin infusion** (0.1 units/kg/hour) Once blood glucose falls below 14mmol/l: **IV 10% dextrose** at 125 mls/hour **correct dehydration evenly over 48 hours to reduce risk of cerebral oedema** *monitor and correct **hypokalaemia** + cardiac signs after insulin administration*

Answer 109

Long acting insulin should be *continued* Short acting insulin should be *stopped*

Answer 110

uncontrolled lipolysis which results in an excess of free fatty acids that are ultimately converted to ketone bodies

Answer 111

pH > 7.3 Blood ketones < 0.6 Bicarbonate > 15

Answer 112

within 24 hours or a senior review is needed from an endocrinologist

Answer 113

*Into* cells

Answer 114

Koplik spots on oral mucosal membranes

Answer 115

incubation period: 10-14 days *prodrome:* irritable, conjunctivitis, fever *2 days after fever:* koplik spots *3-15 days after fever:* rash starts behind ears and spreads downwards

Answer 116

**self-resolving** after **7-10 days of symptoms** children should be isolated until **4 days after symptoms** resolve

Answer 117

Otitis media

Answer 118

otitis media pneumonia encephalitis (1-2 weeks after) subacute sclerosing panencephalitis (5-10 years after)

Answer 119

measles-specific IgM and IgG serology

Answer 120

group A streptococcus (streptococcus pyogenes) *usually **tonsilitis***

Answer 121

red-pink, blotchy, rough **sandpaper** rash that starts on the trunk and spreads outwards strawberry tongue lymphadenopathy sore throat fever

Answer 122

phenoxymethylpenicillin (penicillin V) for 10 days children should be kept off school until **24 hours after starting antibiotics**

Answer 123

otitis media post-streptococcal glomerulonephritis (typically 10 days after infection) acute rheumatic fever (typically 20 days after infection)

Answer 124

rash lasting **3 days** lymphadenopathy behind the ears and back of the neck

Answer 125

supportive/self-limiting children should stay off school for at least **5 days** after the rash appears

Answer 126

deafness, blindness, congenital heart disease

Answer 127

prodrome (mild fever, coryzal) rash appears 2-5 days after symptoms begin: diffuse bright red rash on both cheeks and a few days later a reticular rash on trunk and limbs

Answer 128

until the rash appears

Answer 129

immunocompromised pregnant women sickle cell anaemia (cause of aplastic crisis)

Answer 130

human herpes virus 6

Answer 131

Most common in children 6 months - 2 years high fever that comes on suddenly, lasts for 3-5 days then suddenly disappears **followed by** mild non-itchy maculopapular lace-like rash on the trunk for 1-2 days

Answer 132

febrile convulsions due to high temperature

Answer 133

papules > vesicles > pustules > crusts

Answer 134

IgA mediated small vessel vasculitis

Answer 135

Palpable purpuric rash (with localised oedema) over buttocks and extensor surfaces of arms and legs Joint pain Abdominal pain Renal involvement

Answer 136

Female with single X chromosome (45 XO)

Answer 137

Short stature Primary amenorrhoea Widely spaced nipples Webbed neck + Infertility later in life due to underdeveloped ovaries

Answer 138

lymphoedema

Answer 139

Gonadotrophins (LH and FSH) (Caused by **low** levels of osteogen = negative feedback)

Answer 140

Hypothyroidism

Answer 141

Bicuspid aortic valve (15%) = ejection systolic murmur *Turner’s is also associated with coarctation of the aorta but it is not as common*

Answer 142

Aortic dilation and dissection

Answer 143

*Soles of the feet are convex* Patau syndrome (trisomy 13) Edwards syndrome (trisomy 18)

Answer 144

Holoprosencephaly (failure of the cerebral hemispheres to divide) Microcephaly Cleft lip and palate Polydactyly (extra digits) Congenital heart disease

Answer 145

Low-set ears Macrognathia (undersized jaw) Microcephaly Overlapping 4th and 5th fingers Rocked bottomed feet Congenital heart disease

Answer 146

often taller than average lack of secondary sexual characteristics small, firm testes infertile gynaecomastia elevated gonadotrophin levels but low testosterone

Answer 147

Kawasaki disease Still's disease Rheumatic fever Leukaemia

Answer 148

Chronic autoimmune disease that causes arthritis < 16 years old for > 6 weeks Joint pain, swelling, stiffness

Answer 149

Systemic onset JIA

Answer 150

**Intermittent** febrile episodes **salmon-pink rash** lymphadenopathy arthritis uveitis Reduced appetite and weight loss

Answer 151

oligoarticular JIA (4 or less joints affected) *accounts for 60% of cases* *most frequently occurs in girls under the age of 6 years*

Answer 152

**chronic anterior uveitis** (eye redness, pain, vision loss) *seen in 1/3 of children with JIA*

Answer 153

large joints e.g. knee, ankle, wrist

Answer 154

Systemic polyarticular > 4 joints oligoarticular < 4 joints enthesitis related (key complication: anterior uveitis) juvenile psoriatic (nail pitting, plaques of psoriasis, dactylitis)

Answer 155

ANA **negative** rheumatoid factor **negative** Raised inflammatory markers (raised CRP, ESR, platelets, and serum ferritin)

Answer 156

Macrophage activation syndrome (acutely unwell child with DIC, anaemia, thrombocytopenia, bleeding, non-blanching rash) Key investigation finding: **low ESR**

Answer 157

NSAIDs e.g. ibuprofen Steroids (oral, intramuscular, or intra-articular in oligoarthritis) Disease modifying anti-rheumatic drugs (DMARDs) e.g. methotrexate, hydroxychloroquine Biologic therapy e.g. anti-TNFa e.g. infliximab

Answer 158

intra-articular steroid injection

Answer 159

flu-like symptoms followed by a red/purple target-like rash that spreads and forms blisters triggered by viral infection (mumps, flu, HSV, EBV) or reaction to medicines

Answer 160

Penicillin Lamotrigine Phenytoin Allopurinol

Answer 161

Not able to **hold an object** at **5 months** Not **sitting unsupported** at **12 months** Not **standing independently** at **18 months** No **words** at **18 months** No **interest in others** at **18 months** Not **walking independently** at **2 years** Not **running** at **2.5 years**

Answer 162

Gross motor and Fine motor Language and communication Cognitive Personal and social

Answer 163

**head downwards** 4 months: support their head 7-8 months months: sit unsupported, crawling 12 months: cruising 15 months: walk unaided

Answer 164

8 weeks: fixes their eyes on an object 6 months: palmar grasp 9 months: scissor grasp (squashes it between thumb and forefinger) 12 months: pincer grasp (with the tip of the thumb and forefinger)

Answer 165

Infantile spasms starting at around 6 months of age (repeated flexion of head/arms/trunk followed by extension of arms) More common in male infants Poor prognosis

Answer 166

Bilateral myoclonic jerks in upper and lower limbs often in the morning/following sleep deprivation periods of absence Age of onset: 10-20 years If left untreated, may progress to generalised tonic-clonic seizures

Answer 167

atypical absences, falls, jerks 90% moderate-severe mental handicap onset: 1-5 years

Answer 168

1st line in men: sodium valproate Girls: **ethosuximide**, lamotrigine

Answer 169

1st line: sodium valproate 2nd line: lamotrigine or carbamazepine

Answer 170

*remember opposite to general tonic-clonic* 1st line (for men and women): carbamezepine or lamotrigine 2nd line: sodium valproate

Answer 171

electroencephalogram (EEG) *categorises epilepsy type and aids diagnosis before deciding which anti-epileptic would be appropriate*

Answer 172

Unclear history/atypical features 1st seizure in child under 2 years Focal seizures

Answer 173

coxsackie A

Answer 174

**Nephroblastoma** One of the most common childhood malignancies Typically presents under 5 years old (median age 3)

Answer 175

**W**ilms' tumour **A**niridia **G**enitourinary malformations mental **R**etardation

Answer 176

unilateral in 95% of cases Palpable abdominal mass **(most common presenting feature)** **painless** haematuria flank pain **Unexplained enlarged abdo mass in a child = arrange paediatric review within 48 hours**

Answer 177

MALES are *always* affected (X-linked) learning difficulties large ears, long thin face, high-arched palate macrocephaly macroorchidism autism ADHD hypotonia mitral valve prolapse

Answer 178

hypotonia faltering growth developmental delay learning difficulties facies: almond shaped eyes, narrow bridge of nose, narrowing of forehead at temples, thin upper lip

Answer 179

mild learning difficulties short webbed neck pectus excavatum (ribs + sternum grow inwards) pulmonary stenosis short stature congenital heart disease facies: broad forehead, drooping eyelids, wide distance between eyes

Answer 180

short stature congenital heart disease (supravalvular aortic stenosis) mild-moderate learning difficulties facies: broad forehead, short nose, full cheeks, wide mouth

Answer 181

genetic condition causing delayed puberty secondary to hypogonadotropic hypogonadism

Answer 182

'delayed puberty' hypogonadism, cryptorchidism **anosmia** sex hormone levels are low LH, FSH levels are inappropriately low/normal

Answer 183

deficiency of LH and FSH (hypogonadotropic) leads to a deficiency of the sex hormones testosterone and oestrogen (hypogonadism)

Answer 184

gonads fail to respond to stimulation from the gonadotrophins (LH and FSH) (hypogonadism) no negative feedback from the sex hormones (testosterone and oestrogen), therefore the anterior pituitary produces increasing amounts of LH and FSH (hypergonadtropic)

Answer 185

Kleinfelter’s Syndrome (XXY) Turner’s Syndrome (XO)

Answer 186

small pustules that develop a honey-coloured crusted plaques usually begins on face no surrounding erythema often not itchy *the rash starts as erythematous macules that progress to vesicles, pustules or bullae. rupture of these causes the crusting over plaques* **highly contagious, children should stay off school until the lesions have dried out**

Answer 187

**ABCDE (rule out hypoxia and hypoglycaemia) then benzodiazepine** *Benzodiazepine indication:* pre-hospital: **buccal midazolam** or **PR diazepam** IV access: **lorazepam (max 2 doses)** if still no response **IV phenytoin**

Answer 188

a single seizure lasting **>5 minutes** or **>2 seizures** within a 5-minute period **without the person returning to normal between them**

Answer 189

Proteinuria (> 3g / 24 hr) *causing* Hypoalbuminaemia *and* Oedema

Answer 190

Hypercoagulable state (increased risk of VTE): **Prophylactic LMWH required** - due to loss of antithrombin-III Hyperlipidaemia (increased risk of ACS, stroke) Hypovolaemia (during initial phase of oedema formation) Hypocalcaemia (vit D and binding protein lost in urine) **Chronic** kidney disease Infection (due to urinary immunoglobulin loss)

Answer 191

Minimal change glomerulonephritis

Answer 192

High dose oral corticosteroids e.g. prednisolone

Answer 193

foot process effacement causes proteins to pass through the glomerular membrane

Answer 194

Hip, groin, thigh or knee pain Restricted range of hip movement (particularly **internal rotation** in **flexion**) Painful limp

Answer 195

GORD *(can be physiological)*

Answer 196

Preterm delivery Neurological disorders e.g. cerebral palsy Down syndrome

Answer 197

typically develops before 8 weeks vomiting/regurgitation (milky vomits after feeds, after being laid flat) excessive crying esp. while feeding Aspiration/hoarseness/wheezing

Answer 198

distress failure to thrive Iron deficiency anaemia Oesophagitis recurrent pulmonary aspiration frequent otitis media in older children dental erosion may occur Sandifer syndrome (unusual movements)

Answer 199

1st for Breast- fed baby: Gaviscon (alginate therapy) 1st for Bottle-fed baby: Feed thickener e.g. Carobel

Answer 200

where the child doesn’t respond to alginates/thickened feeds *and*: 1. **unexplained feeding difficulties** (for example, refusing feeds, gagging or choking) Or 2. **distressed** behaviour Or 3. **faltering growth**

Answer 201

**FeverPAIN** **Fever** in past **24 hours** **Purulent** tonsils Attend rapidly (**under 3 days**) Inflamed tonsils **No cough** or coyza

Answer 202

Streptococcus pneumonaie Haemophilus influenzae Moraxella catarrhalis Streptococcus pyogenes

Answer 203

Otalgia (tug or rubbing ear) fever (50%) hearing loss recent viral URTI symptoms are common ear discharge (if tympanic membrane perforates)

Answer 204

bulging tympanic membrane → loss of light reflex opacification or erythema of the tympanic membrane perforation with purulent otorrhoea

Answer 205

1. **acute onset of symptoms** (otalgia or ear tugging) 2. **presence of a middle ear effusion** (bulging of the tympanic membrane, or otorrhoea, decreased mobility on pneumatic otoscopy) 3. **inflammation of the tympanic membrane** i.e. erythema

Answer 206

*majority of patients do not require an antibiotic prescription* Analgesia Safety net: seek medical help if symptoms worsen or do not improve after **3 days**

Answer 207

1. Symptoms lasting **more than 4 days** or not improving 2. **Systemically unwell** but not requiring admission 3. **Immunocompromise** or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease 4. **Younger than 2 years** with **bilateral** otitis media 5. Otitis media **with perforation and/or discharge in the canal**

Answer 208

5-7 day course of amoxicillin *penicillin allergy:* erythromycin, clarithromycin

Answer 209

perforation of the tympanic membrane with otorrhoea for >6 weeks

Answer 210

*complications are rare* **mastoiditis** meningitis brain abscess facial nerve paralysis

Answer 211

presence of a tender boggy swelling behind the pinna with loss of the post-auricular sulcus & auricular proptosis

Answer 212

grey tympanic membrane loss of cone of light reflex visible fluid level behind the tympanic membrane

Answer 213

Port wine stain *present from birth and grows with infant*

Answer 214

Strawberry naevus birth mark *often not present at birth but appears in the first month of life*

Answer 215

(neonatal urticaria) common rash appearing at 2-3 days of age, consisting of white pinpoint papules at the centre of an erythematous base, concentrated on the trunk

Answer 216

blue/black macular discolouration at the base of the spine and on the buttocks *these can be misdiagnosed as bruises*

Answer 217

1st line: **Movicol Paediatric Plain** (Macrogol laxative e.g. polyethylene glycol + electrolytes) If a ***macrogol laxative** is not tolerated: **osmotic laxative** e.g. lactulose* 2nd line *(if no improvement after 2 weeks)*: **stimulant laxative** e.g. senna can be **added** *ensure adequate fluid + fibre intake*

Answer 218

Hirschsprung's Cystic fibrosis Hypothyroidism

Answer 219

Reported from birth or first few weeks of life > 48 hours (CF / Hirschsprung's) Faltering growth (hypothyroidism, coeliac) 'ribbon' stools (anal stenosis) Previously unknown or undiagnosed weakness in legs/locomotor delay (cerebral palsy) Distention (obstruction or intussusception) Disclosure or evidence that raises concerns (child abuse)

Answer 220

**typically runs a benign course and 80% of cases will have resolved spontaneously after 6-8 weeks** If the platelet counts needs to be raised: *prednisolone* Chronic and unremitting ITP for 12-24 months with severe symptoms: *splenectomy*

Answer 221

NSAIDs and aspirin Contact sports

Answer 222

Type II *immune-mediated reduction in the platelet count (usually following infection). Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex*

Answer 223

Atypical features - lymph node enlargement - splenomegaly - high/low WCC - failure to resolve/respond to treatment

Answer 224

Respiratory Syncytial virus (80%)

Answer 225

90% are 1-9 months (**peak incidence 3-6 months**)

Answer 226

Bronchopulmonary dysplasia e.g. premature Congenital heart disease Cystic fibrosis

Answer 227

Feeding difficulties associated with increasing dyspnoea

Answer 228

grunting marked chest recession resp rate of > 70 breaths/min SpO2 <94% nasal flaring cyanosis fluid intake <50%

Answer 229

immunofluorescence of nasopharyngeal secretions may show RSV

Answer 230

supportive

Answer 231

2-4 weeks of age 4 times more common in males Non-bilious projectile vomiting (typically 30 mins after a feed) Palpable mass in the upper abdomen, visible peristalsis as stomach pushes contents past obstruction hypochloraemic, hypokalaemic alkalosis due to persistent vomiting

Answer 232

congenital abnormality of the small intestine caused by incomplete obliteration of the vitelline (omphalomesenteric) duct

Answer 233

Meckel's diverticulum

Answer 234

wedge excision or small bowel resection and anastomosis

Answer 235

Tetrology of fallot

Answer 236

Right ventricular outflow tract obstruction (pulmonary stenosis) *determines the degree of cyanosis* VSD Overriding aorta Right ventricular hypertrophy = **R to L shunt**

Answer 237

Boot shaped heart (due to right ventricular thickening)

Answer 238

Hypercyanotic 'Tet' spells (usually after crying etc.) Ejection systolic murmur due to pulmonary stenosis *cyanotic episodes can be helped by beta-blockers*

Answer 239

Rubella infection Increased age of the mother (over 40 years) Alcohol consumption in pregnancy Diabetic mother

Answer 240

Prostaglandin infusion

Answer 241

1-2 months

Answer 242

**Acyanotic** (left to right shunt) 2 types: secundum ASD and partial AVSD

Answer 243

**Acyanotic** narrowing of the aorta in the region of the ductus arteriosus (proximal, distal or at DA)

Answer 244

**Acyanotic** persistence of the connection between the aorta and pulmonary artery which would normally close physiologically after birth *if uncorrected can become cyanotic*

Answer 245

Ventricular septal defect

Answer 246

loud, hard pansystolic murmur best heard at the lower left sternal border (High to low pressure)

Answer 247

ejection systolic

Answer 248

**Heel prick test** Newborn screening test to identify 9 potentially life threatening genetic conditions (including **sickle cell anaemia** and **cystic fibrosis**

Answer 249

Acute emergency: ABCDE

Answer 250

Parainfluenza viruses

Answer 251

6 months - 3 years More common in autumn

Answer 252

Stridor Barking cough (worse at night) Fever Coryzal symptoms

Answer 253

Admission to hospital *admit any child with moderate or severe croup*

Answer 254

**Single dose oral dexamethasone to all children regardless of severity** Alternative: prednisolone Severe/no response to steroids: **high-flow oxygen, nebulised adrenaline**

Answer 255

6 x diagnostic features Symptoms present before age 12 Clear impact on function Developmentally inappropriate

Answer 256

10 week watch and wait before being referred to a specialist

Answer 257

***Drug therapy is a last resort, after parental educational training etc, and is only available to those ages 5+*** 1st line: **Methylphenidate** (given on 6 week trial bias) 2nd line: Lisdexamfetamine 3rd line: Dexamfetamine (if the child benefited from Lisdexamfetamine but couldn’t tolerate the side effects) **All of these drugs are cardiotoxic - perform baseline ECG** **Measure height and weight**

Answer 258

CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor

Answer 259

ABC A - airway (swelling of throat and tongue = hoarse voice and stridor) B - breathing (respiratory wheeze and dyspnoea) C - circulation (hypotension and tachycardia)

Answer 260

**Intramuscular** adrenaline *Repeated every 5 minutes if necessary* *Best site = anterolateral aspect of the middle third of the thigh*

Answer 261

20% of patients experience **bisphasic** reactions

Answer 262

Give low osmolarity oral rehydration solution (ORS) over 4 hours *Continue breastfeeding (if relevant)*

Answer 263

jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma

Answer 264

Intussusception

Answer 265

antenatal (80%): e.g. cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV) intrapartum (10%): birth asphyxia/trauma, prematurity postnatal (10%): intraventricular haemorrhage, meningitis, head-trauma, kernicterus

Answer 266

abnormal tone early infancy delayed motor milestones abnormal gait feeding difficulties

Answer 267

**spastic (70%)** subtypes include hemiplegia, diplegia or quadriplegia **dyskinetic** +/- dystonia, +/- athetosis athetoid movements and oro-motor problems **ataxic** caused by damage to the cerebellum with typical cerebellar signs **mixed**

Answer 268

Presenting before 3 years of age No atopic history Only occurs during viral infections *both will present with wheeze **throughout the chest**, a focal wheeze could indicate blockage*

Answer 269

silent chest (e.g. no wheezing or coughing heard on ausculation)

Answer 270

Peak flow < 50 % predicted Saturations < 92% Unable to complete sentences in one breath Signs of respiratory distress RR > 40 in 1-5, > 30 in > 5 HR > 140 in 1-5, > 125 in > 5

Answer 271

Peak flow < 33 % predicted Saturations < 92 % Exhaustion and poor respiratory effort Normal pCO2 = no longer compensating Hypotension Silent chest Cyanosis Altered consciousness/confusion

Answer 272

If sats <94% = **Supplementary oxygen** 1. **short acting bronchodilators** e.g. salbutamol 2. **leukotriene receptor antagonist** e.g. montelukast or **inhaled corticosteroids**

Answer 273

1. Salbutamol inhaler via spacer 2. Inhaled or nebulised salbutamol or ipratropium bromide 3. Oral prednisolone 4. IV hydrocortisone 5. IV magnesium sulphate 6. IV salbutamol 7. IV aminophylline

Answer 274

Central cyanosis Child becoming floppy Tracheal tug Costal recession Too breathless to feed/finish a sentence

Answer 275

Manually reducing the strangulated hernia as this can cause more generalised peritonitis

Answer 276

Pain (as apposed to unpainful incarcerated) Fever Increase in the size of a hernia or erythema of the overlying skin Peritonitic features such as guarding and localised tenderness Bowel obstruction e.g. distension, nausea, vomiting Bowel ischemia e.g. bloody stools

Answer 277

where a hernia cannot be reduced

Answer 278

1 (newly diagnosed): SABA 2 (not controlled or newly diagnosed with symptoms 3/week or night time waking): SABA + paediatric dose ICS (8 week trail if under 5) 3: SABA + ICS + LTRA e.g. monteleukast 4. SABA + ICS + LABA e.g. salmeterol

Answer 279

Staph aureus *May also be caused by Group A strep*

Answer 280

Localised/non-bullous lesions: short course of **hydrogen peroxide cream** or **topical antibiotic creams** Widespread/non-bullous lesions: **1st line topical or oral antibiotics** Bullae/unwell child/risk of complications: **1st line oral antibiotics e.g. flucloxacillin** *bullae = raised, clear fluid-filled lesions > 0.5 cm*

Answer 281

Retractile (not present in the scrotum but can be manipulated back before retracting again) Palpable (palpated in the groin but cannot be manipulated back) Impalpable (no testis can be felt)

Answer 282

descent occurs in the 3rd trimester

Answer 283

If the testes are still undescended at 3 months of age

Answer 284

Bilateral impalpable testes

Answer 285

*Orchidopexy = surgical placement of the testis in the scrotum* 1. Improving fertility 2. Potential reduced risk of malignancy 3. Cosmetic and psychological benefits

Answer 286

Loop of intestine twists around itself and the mesentery that supplies it, causing bowel obstruction *Most commonly presents in the first few days of life*

Answer 287

Testicular growth (around 12 years of age)

Answer 288

Testicular growth (around 12 years of age)

Answer 289

Breast development (around 11.5)

Answer 290

**first 24 hours = always pathological + always a haemolytic disorder**: 1. Rhesus haemolytic disease 2. ABO haemolytic disease 3. Hereditary spherocytosis 4. Glucose-6-phosphodehydrogenase

Answer 291

Jaundice between 2-14 days (caused by more RBCs, more fragile RBCs, less developed liver function) more commonly seen in breastfed babies

Answer 292

Hypothyroidism Breast milk jaundice Prematurity Congenital infections Biliary atresia

Answer 293

RNA paramyxovirus

Answer 294

A young person is able to make decisions regarding their medical treatment if they are deemed to be mentally competent Used in cases where they don’t want their parents involved, or they can’t be involved *Fraser = specifically relating to contraception and sexual health*

Answer 295

Olive sized mass

Answer 296

Dilated testicular veins which causes scrotal swelling

Answer 297

Asymptomatic

Answer 298

Physiological/breastfeeding Polycythaemia Haemolysis Infection

Answer 299

Acne Striae Telangiectasia Thinning of the skin

Answer 300

Chronic or intermittent diarrhoea Failure to thrive or faltering growth (in children) GI symptoms including nausea and vomiting Prolonged fatigue ('tired all the time') Recurrent abdominal pain, cramping or distension Sudden or unexpected weight loss Anaemia

Answer 301

1. **Inadequate intake**: *can be caused by issues with feeding and may be associated with maternal depression and socio-economic background* 2. **Inadequate retention**: *including vomiting or severe GORD* 3. **Malabsorption**: *diseases such as coeliac disease* 4. **Increased requirements**: *thyrotoxicosis, congenital heart failure or malignancy*

Answer 302

atrophy of the villi with flat mucosa and marked crypt hyperplasia and Intraepithelial lymphocytosis

Answer 303

Hyperactivity, impulsivity and inattentiveness

Answer 304

Fever > 38 .5 Inability to weight bear CRP > 20 WBC > 12

Answer 305

Acute hip pain following recent viral infection

Answer 306

Transient synovitis

Answer 307

Self-limiting (rest and analgesia)

Answer 308

Haemophilus influenza B

Answer 309

Bordatella pertussis **Gram-negative**

Answer 310

Ramstedt pyloromyotomy

Answer 311

Ultrasound

Answer 312

Blood gas values: - raised bicarbonate (**metabolic**) - high pH (**alkalosis**) *- raised CO2 (partial compensation as still alkalosis)* Electrolyte values: - Low Cl- (**hypochloraemic**) - Low K+ (**hypokalaemic**) **due to persistent vomiting**

Answer 313

X-linked recessive *Dystrophinopathies*

Answer 314

Progressive proximal muscle weakness from 5 years old - most children cannot walk by 12 years old and will need a wheelchair Calf pseudohypertrophy (fat + fibrosis) Gower’s sign: child uses arms to stand up from a squatted position 30% have intellectual impairment Dilated cardiomyopathy *Survival = 25-30 years*

Answer 315

Diagnostic: genetic testing for dystrophin mutations Other: Raised CK

Answer 316

Becker develops after the age of 10 (Duchenne is earlier from 5) and intellectual impairment is much less common in Becker

Answer 317

Oral diazepam Oral and Intrathecal Baclofen Botulinum toxin type A Orthopaedic surgery

Answer 318

GBS infection

Answer 319

Staphylococcus epidermidis Pseudomonas aeruginosa Klebsiella Enterobacter

Answer 320

1. INFECTION: Previous baby with GBS infection, current GBS colonisation from prenatal screening, current bacteruria, intrapartum temp >38, membrane rupture >18 hours, or current infection throughout pregnancy 2. Premature (<37 weeks) - 85% of cases 3. Low birth weight (<2.5kg) - 80% of cases

Answer 321

Respiratory distress (grunting, nasal flaring, use of accessory resp muscles, tachypnoea)

Answer 322

IV Benzylpenicillin with gentamicin *CRP should be re-measured 18-24 hours after presentation*

Answer 323

Delayed resorption of fluid in the lungs More common following **C-sections** possibly due to lung fluid not being ‘squeezed out’ during birth canal passage Commonest cause of respiratory distress in the newborn period

Answer 324

Hyperinflation of the lungs and fluid in the horizontal fissure

Answer 325

Supportive care (usually settles within 1-2 days)

Answer 326

GH deficiency Hypothyroidism Down’s syndrome Cushing’s syndrome Prayer-Willi syndrome

Answer 327

Autosomal recessive

Answer 328

Delta F508 in chromosome 7 causes a defect in the Cystic fibrosis transmembrane conductance regulator gene (CFTR)

Answer 329

Staph aureus Pseudomonas aeruginosa Burkholderia cepacia Aspergillus

Answer 330

Meconium ileus Recurrent chest infections Malabsorption (steatorrhoea, failure to thrive)

Answer 331

Short stature **Diabetes Mellitus** Delayed puberty Rectal prolapse Nasal polyps Male infertility

Answer 332

Sweat test

Answer 333

1. Chest physiotherapy and postural draining (x2/day) 2. **High calorie**, **high fat** diet 3. minimise contact with other CF patients to prevent cross infection with Burkholderia cepacia and Pseudomonas aeruginosa 4. Vitamin supplements 5. **Pancreatic enzyme supplements** 6. Lung transplantation (chronic infection with Burkholderia is a C/I)

Answer 334

CFTR modulators i.e. Lumacaftor + Ivacaftor

Answer 335

Strep pneumoniae

Answer 336

1st line: **Amoxicillin** 2nd line: **Macrolides** *if no response or if mycoplasma or chlamydia is suspected* Pneumonia associated with influenza: **co-amoxiclav**

Answer 337

Rapid onset High temperature Stridor Saliva drooling Tripod position (easier to breathe by leaning forward in seated position)

Answer 338

Direct visualisation by airway trained staff

Answer 339

Endotracheal intubation Do **not** examine the throat (risk of acute airway obstruction) Oxygen IV antibiotics

Answer 340

Regurgitation and vomiting Diarrhoea Urticaria, atopic eczema ‘Colic’ symptoms (irritability, crying) Wheeze, chronic cough

Answer 341

Often clinical i.e. **improvement with cows milk protein elimination** Other investigations: Skin prick/patch testing Total IgE and specific IgE (RAST) for cows milk protein

Answer 342

Failure to thrive = refer to paediatrician 1st line replacement for mild-moderate symptoms: **extensively hydrolysed formula** Severe or no response to eHF: **amino acid-based formula**

Answer 343

IgE mediated intolerance: tolerant by age 5 Non-IgE mediated intolerance: tolerant by age 3

Answer 344

Obesity Nasal problems e.g. polyps Recurrent tonsillitis Down’s syndrome Hypothyroidism

Answer 345

Enterobius vermicularis

Answer 346

Swallowing eggs that are present in the environment

Answer 347

Asymptomatic (90%) Perianal itching (particularly at night) Girls may have vulval symptoms

Answer 348

Combination of anthelmintic with hygiene measures for all members of the household Children over 6 months = 1st line anthelmintic is **mebendazole**

Answer 349

1. 1st degree family history of hip problems in early life 2. Breech presentation at or after 36 weeks gestation (regardless of birth) 3. Multiple pregnancy

Answer 350

Appendicitis: Palpation in the LIF causes pain in the RIF

Answer 351

Raised inflammatory markers coupled with compatible history and examination findings + neutrophil-predominant leucocytosis

Answer 352

Laparoscopic appendicectomy Prophylactic IV antibiotics reduces wound infection rates

Answer 353

Infection of the soft tissues anterior to the orbital septum (includes the eyelids, skin and subcutaneous tissue of the face but not the contents of the orbit) Infection spreads from nearby sites e.g. breaks in the skin or local infections (sinusitis, URTIs) 80% of patients are under 10 (peak 21 months) More common in the winter (due to increased URTIs)

Answer 354

Staph aureus Staph epidermidis Streptococci

Answer 355

Erythema and oedema of the eyelids which can spread to surrounding skin Partial or complete ptosis of the eye due to swelling **ABSENT:** Orbital signs (pain on movement etc.) if these are present it would indicate **orbital cellulitis**

Answer 356

1. Raised inflammatory markers 2. Swab of any discharge present 3. Contrast CT for orbital cellulitis differential diagnosis

Answer 357

1. Oral antibiotics - usually **co-amoxiclav** 2. All cases should be referred to **secondary care for assessment**

Answer 358

Imbalance in extraocular muscles of one eye Convergent is more common than divergent

Answer 359

Hirschberg test: Corneal light reflection test (holding a light source 30cm from the child’s face to see if the light reflects symmetrically on the pupils) Cover test

Answer 360

Refer to ophthalmology

Answer 361

Misalignment of the eyes which causes double vision

Answer 362

The affected eye in a squint becomes passive and has reduced function compared to the dominant eye If uncorrected, becomes a lazy eye

Answer 363

Occlusive patch over good eye Atropine drops in good eye

Answer 364

Poor feeding, vomiting, irritability

Answer 365

Abdominal pain, fever, dysuria

Answer 366

Dysuria, frequency, haematuria

Answer 367

Temperature > 38, loin pain/tenderness

Answer 368

1. Any **symptoms or signs of UTI** 2. **Unexplained fever** of 38 or higher (test urine within 24 hours) 3. Alternative site of infection but **remain unwell** (test urine within 24 hours)

Answer 369

1st: Clean catch 2nd: urine collection pads *If non-invasive methods are not possible: suprapubic aspiration*

Answer 370

Immediate referral to paediatrician *IV cefotaxime and urine sample for urgent microscopy and culture*

Answer 371

Consider **admission to hospital** Start oral antibiotics e.g. **cefotaxime** or **co-amoxiclav** for 7-10 days

Answer 372

Oral antibiotics for **3 days**: 1st: **trimethoprim or nitrofurantoin** 2nd: cefalexin or amoxicillin *Advise parents to bring child back if they remain unwell after 24-48 hours*

Answer 373

1. Involuntary discharge of urine 2. Day/night/both 2. Child aged **5 years or older** 3. Absence of congenital or acquired defects of the nervous system or urinary tract

Answer 374

The child has never achieved continence

Answer 375

The child has been dry for at least 6 months before

Answer 376

1st line: Enuresis alarm 2nd line: desmopressin (particularly useful for short-term control e.g. sleepover) + Reward systems e.g. star charts (give for agreed behaviour e.g. using the toilet before bedtime rather than dry nights)

Answer 377

inflammation within the glomeruli * haematuria * renal impairment * hypertension * variable proteinuria

Answer 378

IgA nephropathy

Answer 379

Recurrent episodes of macroscopic haematuria in a young boy following URTI *nephrotic range proteinuria is rare*

Answer 380

Mesangial deposition of IgA immune complexes - considerable overlap with Henoch-Schoenlein purpura (IgA vasculitis)

Answer 381

Post-strep = low complement levels Main symptom of post-strep = **proteinuria** (although haematuria can occur) Post strep has an **interval** between URTI and onset of renal problems

Answer 382

Minimal proteinuria or normal GFR: no treatment needed other than follow-up Persistent proteinuria: **ACE inhibitors** Active disease e.g. falling GFR or no response to ACEi: **Immunosuppression with corticosteroids**

Answer 383

Male gender Proteinuria Hypertension Hyperlipidaemia

Answer 384

Inability to retract the foreskin

Answer 385

Under 2: expectant approach Over 2 with recurrent balanoposthitis or UTI: consider treatment e.g. **circumcision**

Answer 386

Von Willebrand’s disease

Answer 387

Autosomal dominant

Answer 388

Epistaxis Menorrhagia

Answer 389

Prolonged bleeding time APTT may be prolonged (intrinsic pathway) Factor VIII levels may be moderately reduced

Answer 390

1. **Transexamic acid** for mild bleeding 2. **Desmopressin** (raises levels of vWF) 3. **Factor VIII** concentrate

Answer 391

Before the age of 2 years *Clears in around 50% of children by 5 years and 75% by 10 years*

Answer 392

Itchy, erythematous rash Infants: face and trunk Younger children: extensor surfaces Older children: more typical distribution of flexor surfaces and creases of face and neck

Answer 393

Avoid irritants Simple emollients (apply before topical steroid if using one) Topical steroids Wet wrapping (large amounts of emollient under wet bandages) Severe cases: oral ciclosporin

Answer 394

Allergen avoidance Mild to moderate intermittent: oral or intranasal antihistamines Moderate to severe persistent: intranasal corticosteroids

Answer 395

Sneezing Clear nasal discharge Nasal pruritis Post nasal drip

Answer 396

Pale, pink raised skin Pruritic

Answer 397

1st line: non-sedating anti-histamines Severe or resistant episodes: prednisolone

Answer 398

Tumour which arises from neural crest tissue of the **adrenal medulla** (most common site) and abdominal sympathetic chain Median age of onset: **20 months** (most common cancer in children under 1)

Answer 399

Abdominal mass Pallor, weight loss Bone pain, limp Hepatomegaly Paraplegia Proptosis

Answer 400

**Urinalysis** *(vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels)* Calcification on **abdominal X-Ray** **Biopsy**

Answer 401

Retinoblastoma *Average age of diagnosis: 18 months*

Answer 402

Autosomal dominant *RB1 gene*

Answer 403

Absence of red-reflex, replaced by white pupil (leukocoria) ***most common presenting symptom*** Strabismus/squint Visual problems

Answer 404

Astrocytoma (develop from glial cells)

Answer 405

Neurofibromatosis 1 and 2 Tuberous sclerosis 1 and 2 Personal or family history of brain tumour, leukaemia

Answer 406

Femur (Other sites are tibia and humerus)

Answer 407

Persistent bone pain worse at night time

Answer 408

Retinoblastoma (Rb gene) Paget’s disease of the bone Radiotherapy

Answer 409

Small round blue cell tumour occurring most frequently in the pelvis and long bones Causes severe pain X-ray: onion-skin appearance

Answer 410

Preterm birth (<37 weeks) Maternal DM IUGR Hypothermia Neonatal sepsis

Answer 411

May be asymptomatic Autonomic: **jitteriness, irritable, tachypnoea, pallor** Neuroglycopenic: **poor feeding/sucking, weak cry, drowsy, hypotonia, seizures**

Answer 412

Encourage normal feeding **(breast or bottle)** Monitor blood glucose

Answer 413

Admit to neonatal unit IV infusion of 10% dextrose

Answer 414

Increased permeability of alveolar capillaries leading to fluid accumulation in the alveoli i.e. non-cardiogenic pulmonary oedema *Mortality = 40% / significant morbidity in those who survive*

Answer 415

Acute pancreatitis Infection (sepsis, pneumonia) Massive blood transfusion Trauma Smoke inhalation Covid-19 Cardio-pulmonary bypass

Answer 416

1. Dyspnoea 2. Elevated respiratory rate 3. Bilateral lung crackles 4. Low oxygen saturations

Answer 417

Chest X-ray = pulmonary oedema (bilateral infiltrates) Arterial blood gas = low pO2

Answer 418

Clinical (acute onset within 1 week of a known risk factor) + CXR (pulmonary oedema) + low pO2 + exclude cardiogenic causes

Answer 419

ITU management Oxygenation/ventilation to treat hypoxaemia General organ support e.g. vasopressors Treat underlying cause e.g. Abx for sepsis

Answer 420

1. Dry baby and maintain temperature 2. Assess tone, respiratory rate, heart rate 3. If gasping or not breathing give 5 inflation breaths 4. Reassess (chest movements) 5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1

Answer 421

Respiratory distress in the newborn as a result of meconium in the trachea (occurs in the immediate neonatal period)

Answer 422

In post-term deliveries (after 42 weeks)

Answer 423

Maternal hypertension Pre-eclampsia Chorioamnionitis Smoking Substance abuse

Answer 424

Dark green streaks in amniotic fluid (meconium staining) Cyanosis Grunting Limpness Bradycardia

Answer 425

Brain damage (cerebral palsy, learning disability, deafness) resulting from **untreated jaundice** in babies

Answer 426

Sickle cell anaemia Immunosuppression Infective endocarditis

Answer 427

**Staph aureus** *except in sickle cell patients where **Salmonella** species predominates*

Answer 428

**Flucoxacillin** for 6 weeks *Clindamycin if penicillin-allergic*

Answer 429

*brittle bone disease* Group of disorders of collagen metabolism resulting in bone fragility and fractures

Answer 430

Autosomal dominant

Answer 431

Fractures following minor trauma Blue sclera Deafness secondary to otosclerosis Dental imperfections

Answer 432

**Normal** calcium, phosphate, parathyroid hormone and ALP results

Answer 433

Inadequately mineralised bone in developing and growing bones resulting in soft and easily deformed bones Usually due to vitamin D deficiency *In adults it is termed osteomalacia*

Answer 434

1. Dietary deficiency of calcium e.g. in developing countries 2. Prolonged breastfeeding 3. Unsupplemented cow’s milk formula 4. Lack of sunlight

Answer 435

Aching bones and joints Lower limb abnormalities: toddlers = genu varum (bow legs), older children = genu valgum (knock knees) ‘Rickety rosary’ - swelling at the costochondral junction causing widening of the wrist joints

Answer 436

Low Vit D levels Reduced serum calcium (symptoms may result from hypocalcaemia) Raised alkaline phosphatase

Answer 437

Oral vitamin D

Answer 438

Diphtheria Hepatitis B Haemophilus influenzae type B Polio Tetanus Whooping cough

Answer 439

1-2 weeks: URTI symptoms 2-8 weeks: 1. cough increases in severity, usually worse at night and after feeding, associated vomiting and central cyanosis 2. **inspiratory whoop** (not always present, caused by forced inspiration against a closed glottis) instead may have spells of **apnoea**

Answer 440

Acute cough lasting for **14 days or more** without another apparent cause and one or more of the following features: - Paroxysmal cough - Inspiratory whoop - Post-tussive vomiting - Undiagnosed **apneoic attacks**

Answer 441

Nasal swab culture for Bordetella pertussis + **PCR**

Answer 442

1. Infants **under 6 months** should be **admitted** 2. Onset **within last 21 days**: Oral macrolide e.g. **clarithromycin** or **azithromycin** 3. Household contacts should be offered **antibiotic prophylaxis** 4. School exclusion: **48 hours after commencing antibiotics** (or 21 days from onset of symptoms) 5. **Notifiable disease**

Answer 443

Subconjunctival haemorrhage Pneumonia Bronchiectasis Seizures

Answer 444

16-32 weeks pregnant

Answer 445

Pain usually **severe** and **sudden onset** - may refer to lower abdomen Nausea + vomiting O/E: **swollen, tender testis** retracted upwards, **reddened skin** Stroking the thigh does not raise the ipsilateral testicle (Cremasteric reflex is lost) Elevation of the testis does not ease the pain (Prehn’s sign is lost)

Answer 446

SURGICAL EMERGENCY - urgent surgical exploration and both testis should be fixed

Answer 447

First 10kg: 100ml/kg/day Second 10kg - 50ml/kg/day Over 20kg - 20ml/kg/day

Answer 448

Anorexia nervosa

Answer 449

1. **Restriction of energy intake** relative to requirement leading to a **significantly low body weight** in the context of age, sex, developmental trajectory, and physical health 2. **Intense fear of gaining weight** or becoming fat, even though underweight 3. **Disturbance in the way in which one’s body weight or shape is experienced**, undue influence of body weight or shape on self-evaluation, or **denial of the seriousness of the current low body weight**

Answer 450

Anorexia focused family therapy *2nd line = CBT*

Answer 451

1. Recurrent episodes of binge eating 2. Sense of lack of control over eating during the episode 3. Recurrent inappropriate compensatory behaviour in order to prevent weight gain e.g. self induced vomiting 4. Binge eating + compensatory behaviour occur at least once a week for 3 months 5. Self evaluation is unduly influenced by body shape and weight 6. The disturbance does not occur exclusively during episodes of anorexia nervosa

Answer 452

Erosion of teeth Russell’s sign (calluses on the knuckles or back of the hand)

Answer 453

Propionibacterium acnes

Answer 454

12 week course of topical combination therapy e.g. retinoids, benzoyl peroxide, topical clindamycin

Answer 455

12 week course of topicals +/- oral antibiotics i.e. oral lymecycline or oral doxycycline

Answer 456

Erythromycin

Answer 457

Topical retinoid or benzoyl peroxide should always be co-prescribed (never monotherapy) Topic and oral antibiotics should not be used in combination

Answer 458

Non-responders Scarring Persistent pigment are changes Persistent psychological distress caused by acne

Answer 459

RSV Rhinovirus Adenovirus Influenza virus

Answer 460

Grommet insertion

Answer 461

Transient episodes of abnormal electrical activity in the brain

Answer 462

Shower rather than bath Take caution when swimming Take caution with heights Record any further episodes If > 5 minutes ring 999

Answer 463

Paediatric neurologist 2 week urgent referral

Answer 464

Oxygen saturations PEFR

Answer 465

partial or focal, >15 mins, can occur multiple times during same febrile illness

Answer 466

Converts unconjugated bilirubin into isomers that can be excreted in the bile and urine without requiring conjugation in the liver

Answer 467

Age of baby x Total bilirubin level Phototherapy usually adequate for correction Extremely high levels = exchange blood transfusion

Answer 468

% dehydration x weight (kg) x **10**

Answer 469

Work out maintenance Work out fluid deficit Maintenance + fluid deficit = hourly rate

Answer 470

Newborn hearing screening programme Test: Otoacoustic emission test

Answer 471

never present at the start of the day no limp no limitation of physical activity systemically well normal physical exam intermittent symptoms, worse after a day of vigorous activity

Answer 472

Frequent regurgitation of ingested food that is largely behavioural

Answer 473

Effortless expulsion of gastric contents e.g. in healthy infants

Answer 474

Small volume vomiting during or between feeds in an otherwise well child

Answer 475

Delayed passage of meconium Bilious vomiting Abdominal distention

Answer 476

Vomiting Stool changes Eczema

Answer 477

Anorexia Central abdominal pain migrating to RIF Vomiting fever

Answer 478

Before age 8 in girls Before age 9 in boys

Answer 479

High amplitude pulses of GnRH

Answer 480

Gonadotropin-independent puberty / **low** FSH and LH CAH, tumours of the adrenals, ovaries, McCune Albright syndrome (cafe au last spots)

Answer 481

Mental state examination

Answer 482

bilateral enlargement = **gonadotrophin release** from intracranial lesion unilateral enlargement = **gonadal tumour** small testes = **adrenal cause** (tumour or adrenal hyperplasia)

Answer 483

Abnormal back flow of urine from the bladder into the ureter and kidney Causes UTIs

Answer 484

Micturating cystourethrogram

Answer 485

Bronchodilator therapy (salbutamol via spacer) Steroid therapy (give to all children with asthma exacerbation for 3-5 days)

Answer 486

STIs, recurrent UTIs Anal fissure, bruising Enuresis Behavioural problems, self harm

Answer 487

25% homozygous affected child 50% heterozygous carrier child 25% unaffected genotypical child

Answer 488

Short palpebral fissure Smooth philtrum Hypoplastic upper lip Learning difficulties Microcephalic Cardiac malformations Epicanthic folds

Answer 489

5 rescue breaths Circulation check (infants use brachial or femoral, children use femoral) 15:2 chest compressions:rescue breaths (100-120/min) - children: compress lower half of sternum - infants: two-thumb encircling technique

Answer 490

Risk of necrotising fasciitis

Answer 491

LOC > 5 minutes 3 or more vomiting episodes Amnesia > 5 minutes Seizure with no history of epilepsy

Answer 492

Prostaglandin E1 e.g. alprostadil (maintains patent duct arteriosus)

Answer 493

Nitrogen washout test (100% oxygen then ABG)

Answer 494

High fever (over 39C) Persistently focal crackles

Answer 495

Corzyal symptoms / mild fever preceding: Dry cough Increased breathlessness Wheezing, fine inspiratory crackles Feeding difficulties (associated with dyspnoea)

Answer 496

Trendlenberg gait Leg length discrepancy

Answer 497

Aged 10-15 Unilateral inflammation/swelling of the area below the knee which can be **exacerbated by exercise** and **relieved by rest** Gradual in onset and can become severe Self-resolving

Answer 498

> 3 months = dexamethasone **if** high WCC < 3 months = do not give steroids!

Answer 499

Until all the lesions are dry and have crusted over

Answer 500

Surgical intervention

Answer 501

High caecum at the midline Presents with: **bilious vomiting, abdominal distention** Associated with: exomphalos (below pic), congenital diaphragmatic hernia, intrinsic duodenal atria Complications: volvulus Urgent upper GI contrast study and ultrasound

Answer 502

child goes very pale falls to floor secondary anoxic seizures are common rapid recovery

Answer 503

Alzheimer’s disease Hypothyroidism ALL Repeated respiratory infections Subfertility

Answer 504

Supportive Calamine lotion

Answer 505

Secondary bacterial infection of the lesions **NSAIDs may increase this risk** **Invasive group A strep soft tissue infections can occur resulting in necrotising fasciitis**

Answer 506

PH testing Barium swallow and meal Endoscopy

Answer 507

Casein and whey

Answer 508

Involuntary faecal soiling or incontinence secondary to chronic constipation

Answer 509

Withhold from going to the toilet because defecation is painful but this only increases pain

Answer 510

Prolonged capillary refill time reduced skin turgor Thirst Sunken eyes Irritability lethargy

Answer 511

Stressful life event Vague pain with gradual onset Prolonged duration with few effective interventions

Answer 512

Neurofibromatosis 1 Down’s syndrome Immunocompromised

Answer 513

Headache worse lying down Early morning vomiting Papilloedema Squint Nystagmus Ataxia Personality or behaviour change

Answer 514

< 3 y/o Underlying risk factors e.g. NF1 Presence of any CNS tumour red flag symptoms

Answer 515

Understands the advice Understands the implications of treatment Likely to have sex regardless Likely to suffer physically or mentally without treatment It is in their best interests to receive advice and treatment without consent

Answer 516

Measures BMI in children in reception and year 6

Answer 517

pH under 7.3 or BiC under 15 PH under 7.2 or BiC under 10 pH under 7.1 or BiC under 5

Answer 518

Check BG to confirm hypo Give glucose tablet, gel, food or drink Check BG in 15 mins Follow up with longer acting carb e.g. bread

Answer 519

Sepsis - antibiotics Malrotation - upper GI contrast (barium meal)

Answer 520

Overfeeding GORD **Sepsis** Pyloric stenosis

Answer 521

Infantile colic, gastroenteritis, sepsis

Answer 522

Abnormal skin colour Appears ill to a healthcare professional Grunting RR > 60 Intercostal recession Reduced skin turgor Age **< 3 months** with **temp > 38** Signs of meningitis Management: **ADMIT/REFER URGENTLY TO PAEDIATRIC SPECIALIST**

Answer 523

Oral ciprofloxacin

Answer 524

Measure and record serum bilirubin level

Answer 525

6 months e.g. cerebral palsy

Answer 526

Family Hx White Female Spina bifida

Answer 527

Urinalysis 24 hour urinary protein Serum albumin

Answer 528

Metabolic acidosis

Answer 529

disseminated intravascular coagulation

Answer 530

Infective: Sepsis Cardiac: Congenital heart disease NAI Metabolic: Hypoglycaemia, Congenital adrenal hyperplasia Surgical: Hirschsprungs, Necrotising enterocolitis, pyloric stenosis

Answer 531

high-pitched respiratory sound produced by irregular airflow in a narrowed airway during the inspiration phase *DDx wheeze = expiratory*

Answer 532

machinery murmur (continuous crescendo-decrescendo) at the upper left sternal edge

Answer 533

rubella infection Prematurity

Answer 534

Shortness of breath Difficulty feeding Poor weight gain LRTI

Answer 535

Echocardiogram: right + left hypertrophy *monitored with echos until 1 year - resolves spontaneously or need surgery*

Answer 536

IV indomethacin or ibuprofen

Answer 537

Inadequate nutritional intake e.g. iron deficiency anaemia, neglect Difficulty feeding e.g. cerebral palsy, pyloric stenosis Malabsorption e.g. cystic fibrosis, coeliac, CMPA Increased energy requirements e.g. hypothyroidism, infection Inability to process nutrients e.g. T1DM

Answer 538

Urine dipstick for UTI Coeliac screen (anti-TTG)

Answer 539

Surfactant deficiency Key signs: rapid, laboured breathing, ground class on CXR Management: corticosteroids pre-delivery, artificial surfactant via intratracheal instillation, high pressure oxygen

Answer 540

Infection (gastroenteritis) Cow milk intolerance Toddler’s diarrhoea Coeliac Post-gastro lactose intolerance Antibiotic treatment Anxiety/stress IBD

Answer 541

Constipation and overflow diarrhoea (loose, watery stool comes around the stuck fetal matter), often affects the child’s ability to sense and respond to the presence of stool in the rectum

Answer 542

Occupational therapy Physiotherapy Speech therapy GP Neurology

Answer 543

Salivary glands to stop drooling Bladder in overactive bladder Lower limb spasticity and dystonia

Answer 544

Meconium aspiration Sepsis Pneumothorax

Answer 545

Necrotising enterocolitis

Answer 546

Retinopathy of prematurity Sensorineural hearing loss Chronic lung disease Cerebral palsy

Answer 547

1st baby: rhesus D negative, 2nd baby: rhesus D positive Mothers anti-D antibodies from 1st pregnancy cross the placenta into the rhesus D positive 2nd baby = haemolysis (anaemia + jaundice)

Answer 548

Neonatal hypoglycaemia

Answer 549

Full blood count Blood culture C-reactive protein Urine testing for urinary tract infection Chest radiograph only if respiratory signs are present Stool culture, if diarrhoea is present

Answer 550

Urgent specialist assessment

Answer 551

Age minus the number of weeks born early from 40 weeks

Answer 552

Dilated bowel loops proximal to impaction

Answer 553

Retinal haemorrhages Subdural haematoma Encephalopathy

Answer 554

Not sitting by 8 months Not walking by 18 months Early asymmetry of hand function before 12 months Persistent toe-walking

Answer 555

Laryngomalacia Congenital softening of the cartilage of the larynx, causing collapse during inspiration Usually self-resolves before 2 years of age

Answer 556

Raised level of immunoreactive trypsinogen (IRT)

Answer 557

Dilated cardiomyopathy

Answer 558

Stools vary in consistency and often contain undigested food

Answer 559

Typically develops several hours after birth Most commonly in parietal region Doesn’t cross the suture lines May take months to resolve

Answer 560

Present at birth typically forms over the vertex and crosses suture lines Resolves within days

Answer 561

Swelling on the head of a newborn more common following prolonged, difficult deliveries Managed conservatively

Answer 562

Prone sleeping (face down) Parental smoking Bed sharing Hyperthermia and head covering Prematurity

Answer 563

Thyroglossal cyst

Answer 564

increased tone resulting from damage to upper motor neurons

Answer 565

damage to the basal ganglia and the substantia nigra

Answer 566

Inflamed lymph nodes within the mesenteric Often follows a recent viral infection DDx: appendicitis

Answer 567

Displaced apex beat and decreased air entry Scaphoid abdomen

Answer 568

Offered by IM route as a once-off injection shortly after birth

Answer 569

Between 0-28 days of birth

Answer 570

Infertility Torsion Testicular cancer

Answer 571

**Treatment is only indicated if living lice are found when combing inc household contacts unless they are affected** 1. Malathion 2. Wet combing

Answer 572

Chronological age

Answer 573

Onset **within last 21 days**: Oral macrolide e.g. **clarithromycin** or **azithromycin**

Answer 574

Herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm = pulmonary hypoplasia and hypertension resulting in **respiratory distress** shortly after birth

Answer 575

Prednisolone

Answer 576

Levetiracitam

Answer 577

Hypovolaemia Thrombosis Infection

Paeds Flashcards

(625 cards)