Paeds

Question 1

Summarise Vit K deficiency

Answer 1

1. Ix - coag studies
2. Tx: Prophylactic IM Vit K

Question 2

Summarise APGAR scores

Answer 2

1. Used to assess state of neonate quickly after birth
2. Appearance (colour of baby)
   
   • 2 = pink
   • 1 = blue peripherally but pink centrally
   • 0 = baby blue all over
3. Pulse
   
   • 2 = >100 bpm
   • 1 = <100 bpm
   • 0 = non detectable heart rate
4. Grimace (response to stimuli)
   
   • 2 = crying on stim
   • 1 = grimace
   • 0 = no response
5. Activity
   
   • 2 = flexed limbs that resist extension
   • 1 = some flexion
   • 0 = floppy baby
6. Respiration
   
   • 2 = strong cry
   • 1 = weak cry
   • 0 = no resp. effort

Question 3

Signs + Sx of different visual impairments in children

Answer 3

1. Oculocutaneous albinism
   
   • No skin pigmentation
   • White hair
   • No pigment in the iris (red from light reflection)
   • Visual impairment
2. Retinoblastoma
   
   • White eye reflex (loss of normal red reflex)
3. Rentinopathy of prematurity
   
   • Visual impairment
4. Cataracts
   
   • Absent red reflex
5. Juvenile idiopathic arthritis
   
   • Chronic anterior uveitis
   • Visual loss

Question 4

Summarise ventricular septal defect (VSD)

Answer 4

1. Congenital cardiac defect
2. Hole in septum that separates ventricles of the heart
3. Small = often asymptomatic
4. Large VSD = HF
5. Ausc: loud, harsh, pansystolic murmur. Loudest at left lower sternal edge
6. Ix: ECHO
7. Self resolve or surgical intervention

Question 5

Summarise T1DM

Answer 5

1. Autoimmune
2. Destruction of insulin-producing pancreatic cells
3. Sx include:
   
   • Polyuria
   • Polydipsia
   • Weight loss

Question 6

Summarise Turner syndrome

Answer 6

1. 45, XO (just one X chromosome)
2. Affects women only
3. Sx include:
   
   • Short stature
   • Webbed neck
   • Primary amenorrhoea
   • Congenital cardiac defect in bicuspid aortic valve
4. Tx: HGH during childhood + oestrogen replacement

Question 7

Summarise the Trisomy disorders

Answer 7

1. 21 - Down’s
   
   • Flat facial features
   • Upward slanting eyes
   • Small ears and hands
   • Hypotonia
   • Congenital heart defect
2. 18 - Edward’s
   
   • Low set ears
   • Micrognathia (small lower jaw)
   • Microcephaly
   • Overlapping 4th and 5th finger
3. 13 - Patau’s
   
   • Holoprosencephaly (failure of cerebral hemispheres to divide)
   • Microcephaly
   • Cleft lip/palate
   • Polydactyly (extra fingers)

Question 8

Most common bacterium causing tonsillitis

Answer 8

Strep. pyogenes (Group A Strep)

Question 9

Summarise tetralogy of fallot

Answer 9

1. Cyanotic congenital heart defect
2. Ventricular septal defect
3. Overriding aorta
4. Pulmonary stenosis (RV outflow tract obstruction)
5. RV hypertrophy
6. Sx: tet spells - acute episodes of deepened cyanosis
7. Tx: O2, beta blockers, analgesia. Severe = phenylepinepherin

Question 10

Summarise testicular torsion

Answer 10

1. Twisting of testicle around spermatic cord due to inadequate tissue attachment
2. Impaired blood flow
3. Sx include:
   
   • Sudden severe unilateral testicular pain
   • High riding of testicle in scrotum
   • -ve Prehn’s sign

Question 11

Summarise Rubella

Answer 11

1. Sx include:
   
   • Fever
   • Coryza (nasaly)
   • Arthalgia
   • Rash
     
     • Begins on face and moves down trunk. LIMBS SPARED
2. Rubella in unvaccinated pregnant women -> congenital rubella syndrome (birth defects)

Question 12

Summarise roseola infantum

Answer 12

1. Human herpes virus 6
2. Macular rash as fever subsides

Question 13

Summarise rickets

Answer 13

1. Skeletal disorder
2. Prolonged lack of sufficient Vit D -> impaired calcium + phosphorus absorption
3. Sx include:
   
   • Bowed legs
   • Bone pain
   • Stunted growth
4. Ix include:
   
   • Bloods: Calcium, phosphate and alkaline phosphatase
5. Tx include:
   
   • Vit D + calcium supplement

Question 14

Summarise red flag features of vomiting in children

Answer 14

1. Projectile vomiting around 6-8w - Pyloric stenosis
2. Bile stained vomit + abdo distension - intestinal obstruction
3. Bloody stool + vomit - dysentery
4. Paroxysmal coughing to the point of vomit - whooping cough
5. Seizures +/- bulging fontanelle with vomiting - raised intracranial pressure

Question 15

Summarise pyloric stenosis

Answer 15

1. Hypertrophy of pyloric sphincter (end sphincter in stomach) in infants
2. Projectile vomiting post feeding
3. Dx: USS
4. Tx: Surgery

Question 16

Summarise epiglottitis

Answer 16

1. Rapidly progressive infection
2. Inflammation of epiglottis + surrounding tissue
3. Abrupt blockage of upper airway + potential death
4. Age 1-6
5. Preventable by Hib vaccine (H. influenza B vaccine)
6. Sx include:
   
   • Soft inspiratory stridor in upright position
7. Tx include:
   
   • Secure airway
   • Endotracheal intubation
   • IV cefuroxime

Question 17

Summarise the different rashes in children

Answer 17

1. Slapped cheek syndrome
   
   • Rash on both cheeks
   • Fever
   • URTI
2. Hand, foot and mouth disease
   
   • Blister on hands + feet
   • Grey ulceration in buccal cavity
   • Fever
   • Lethargy
3. Scarlet fever
   
   • Coarse sandpaper texture red rash on cheeks
   • Sore throat
   • Headache
   • Fever
   • Bright red tongue
4. Measles
   
   • Erythematous blanching maculopapular rash
   • Fever
   • Cough
   • Conjunctivitis
   • Koplik spots (white spots inside mouth)
5. Urticaria
   
   • Raised itchy red rashes
   • No fever
6. Chickenpox
   
   • Maculopapular vesicular rash
   • Crusts over + blister
7. Roseola
   
   • Lace like red rash across whole body
   • High fever
8. Rubella
   
   • Starts on head and spreads to trunk
   • Swollen lymph nodes behind ear

Question 18

Summarise Whooping cough

Answer 18

1. Severe URTI
2. Bordetella pertussis
3. Tx: Macrolides

Question 19

Summarise Patent Ductus Arteriosus (PDA)

Answer 19

1. DA (duct connecting aorta and pulmonary artery remains patent after 1st month of life
2. Sx: Asymptomatic or signs of HF
3. Machine-whirring continuous murmur

Question 20

Summarise paeds BLS

Answer 20

1. Open airway
2. 5 rescue breaths
3. 15 chest compressions + 2 rescue breaths:
   
   • Infant: 2 fingers (1/3 chest depth)
   • Small child: one hand
   • Large child: 2 hands (5cm)
4. Airway position
   
   • Infants: Neutral
   • Young child: Slight extension of neck
   • Older child: head tilt, chin lift

Question 21

Summarise paeds obs

Answer 21

1. Birth
   
   • 110-170bpm
   • 35-55rr
   • 50-70mmHg
2. 12m
   
   • 80-140bpm
   • 30-40rr
   • 70-100mmHg
3. 3-5y
   
   • 80-130bpm
   • 20-30rr
   • 70-110mmHg
4. 6-11y
   
   • 70-120bpm
   • 16-25rr
   • 80-120mmHg
5. 12-18y
   
   • 60-100bpm
   • 12-22rr
   • 100-120mmHg

Question 22

Summarise HEADSSSS screening for adolescent

Answer 22

1. Home
2. Education/employment
3. Activities
4. Drugs/drinking
5. Sex
6. Self-harm
7. Suicide
8. Safety
9. Sleep

Question 23

Summarise the heel prick test

Answer 23

Blood screen on day 5 of life
Conditions screened for:
1. Sickle cell
2. Congenital hypothyroidism
3. CF
4. Phenylketonuria

Question 24

State the common microbes that cause early onset neonatal sepsis

Answer 24

1. Group B Strep
2. Listeria
3. Toxoplasma
4. Rubella
5. CMV

Question 25

State the common microbes that cause late onset neonatal sepsis

Answer 25

1. Staph. aureus 2. Staph. epidermis 3. E. coli 4. Pseudomonas 5. Klebsiella

Question 26

Define neonatal sepsis

Answer 26

1. <90d age 2. Early onset - within 72h of life 3. Late onset - after 72h of life

Question 27

Summarise osteomyelitis

Answer 27

1. Bact or fungal infection of the bone 2. Sx include: - Usual - Swelling - Erythema 3. Ix include: - Bone biopsy - Blood inflammatory markers - Imaging + cultures 4. Tx include: - ABx 4-6w - Surgical debridement

Question 28

Summarise stillbirths and neonatal death

Answer 28

1. Stillbirth death after: - 24w gestation - Before or during birth 2. Neonatal death includes: - First 28d of life

Question 29

Summarise Neonatal Respiratory Distress Syndrome (NRDS)

Answer 29

1. Deficiency of surfactant -> alveolar collapse 2. Sx include: - Rapid laboured breathing - Ground glass CXR 3. Dx: clinical + CXR 4. Tx: artificial surfactant + glucocorticoids to mother of preterm delivery

Question 30

Summarise transient synovitis

Answer 30

1. Benign cause of limping child 2. Inflammation of synovial lining of hip joint 3. 3-11yrs 4. Sx incude: - Acute onset limp - Hip or referred knee pain - Low grade fever 5. Tx: supportive management

Question 31

Summarise Duchenne's muscular dystrophy

Answer 31

1. Early childhood typically male 2. Muscle wasting + weakness 3. Wheelchair-bound before puberty + resp failure by 20's (often fatal) 4. Hypertrophic calves; degen muscles replaced by fat 5. Key signs: - +ve Gower's manoeuvre: use of hands to climb up legs when rising from floor

Question 32

Summarise difference between Duchenne's and Becker's muscular dystrophy

Answer 32

1. Presents later in childhood 2. Wheelchair-bound in teens but survive into their 30's

Question 33

Summarise Juvenile Idiopathic Arthiritis (JIA)

Answer 33

1. Chronic inflammatory disorder 2. Persistent joint swelling >6w 3. Key Sx: - Fever - Malaise - Salmon pink rash - Joint pain 4. Dx: exclusion 5. Tx: - NSAIDs - Steroids - Methotrexate

Question 34

Summarise minimal change disease

Answer 34

1. Leading cause of nephrotic syndrome (increased permeability of renal glomerular basement membrane) 2. Minimal change to nephrological structures on light microscopy 3. Sx: - Oedema - Frothy urine - Follows from viral URTI 4. Ix: - Urine tests 5. Tx include: - Corticosteroids - Fluid restriction - Reduced salt

Question 35

Summarise meningitis Sx

Answer 35

1. Fever 2. Severe headache 3. Neck stiffness 4. Photophobia 5. Confusion

Question 36

Summarise meconium ileus

Answer 36

1. Meconium - first faeces by newborn, dark green 2. Meconium ileus - bowel obstruction 3. Indicates CF 4. Failure to pass meconium within 24h 5. Abdo distension 6. Bilious vomiting

Question 37

Summarise intussusception

Answer 37

1. Invagination of ileum (end of small intestine) into caecum (start of large intestine) 2. Between 3m and 2y 3. Sx: - Severe colicky pain - Vomiting - Blood stained mucus faeces - Abdo distension 4. USS - 'target' sign 5. Tx: - Rectal aur insufflation

Question 38

Summarise impetigo

Answer 38

1. Highly infectious superficial epidermal infection 2. Staph or Strep 3. Infants and school-aged children 4. Sx include: - Erythematous macules that vesiculate (fluid) or pustulate (pus) - Followed by superficial erosion + golden crust 5. Tx include: - Fusidic acid or oral flucloxacillin

Question 39

What is immune thrombocytopenic purpura (ITP)

Answer 39

1. Autoimmune disease 2. Reduction in circulating platelets

Question 40

Summarise hydrocele

Answer 40

1. Fluid collection around testicle 2. Sx include: - Scrotal swelling + discomfort 3. Dx: USS 4. Tx|: resolve by 12m otherwise surgery

Question 41

Summarise Hodgkin's lymphoma

Answer 41

1. Reed-sternberg cells 2. Young adults with cervical or supraclavicular non-tender lymphadenopathy 3. Dx: lymph node biopsy 4. Tx: Chemoradiotherapy

Question 42

Summarise glandular fever

Answer 42

1. Viral infection from EBV 2. Saliva transmittance 3. Sx include: - Fever - Sore throat - Fatigue - Hepatomegaly/splenomegaly 4. Dx: - 1. +ve Paul Bunnell test for presence of virus

Question 43

Summarise gastroenteritis

Answer 43

1. Bact, viral or parasitic infections 2. D+V 3. Normal D+V management and Ix

Question 44

Summarise GOR in babies

Answer 44

1. Immaturity of lower oesophageal sphincter 2. Common in infants under 1y 3. GORD Sx

Question 45

Summarise WETFLAG

Answer 45

1. Weight: (Age + 4) x 2 (kg) 2. Energy: 4 x weight (kg) = Joules 3. Tube size: (Age/4) + 4 (cm)= mm endotracheal tube size 4. Fluids: 10ml/kg normal saline bolus or another isotonic fluid 5. Adrenaline: 10 micrograms/kg 6. Glucose: 2ml/kg of 10% dextrose

Question 46

Summarise Ddx for vomiting in children

Answer 46

1. GORD - After meals - Large volume regurg 2. Gastroenteritis - Forceful vomit + D 3. Pneumonia - Forceful vomit - pneumonia Sx 4. Acute otitis media - Forceful vomit - Ear pain 5. Tonsilitis - Throat Sx 6. Meningitis - Forceful vomit - Meningitis Sx 7. UTI 8. Whooping cough - Vomiting + prolonged coughing 9. Testicular torsion 10. Pyloric stenosis 11. GI obstruction - Bilious vomiting 12. Appendicitis

Question 47

How is delayed puberty defined

Answer 47

1. Absence of any pubertal development by 14M and 13F

Question 48

Factors for asthma to be considered life threatening

Answer 48

33,92 CHEST. Any one of the following: PEF <33% SO2 <92% or PO2 <8 Cyanosis Hypotension Exhaustion, altered consciousness Silent chest Tachyarrhythmias