Paeds

Question 1

Milestone: mature pincer grip

Answer 1

9-12 months

Question 2

Milestone: walking

Answer 2

18mo (red flag age)

Question 3

Which food comes with a risk of infant botulism and therefore should be avoided before 12months?

Answer 3

Honey

Question 4

Milestone: hop

Answer 4

4yr

Question 5

Symptoms of lactose intolerance

Answer 5

Loose stools which can be foamy or watery
Painful poos - burn due to acidity
Abdominal bloating
Gurgling stomach

Question 6

Characteristics and genetics of Kleinfelters

Answer 6

47XXY

Tall stature
Sparse facial/body hair
Gynaecomastia
Infertility
Learning difficulties
Small testicles (due to hypogonadism)

Question 7

Vaccines at 8 weeks

Answer 7

6 in 1: DTaP, polio, HiB, hepatitis B
Meningitis B
Pneumococcal conjugate (PCV)
Rotavirus (oral)

Question 8

Vaccines at 12 weeks

Answer 8

6 in 1: DTaP, polio, HiB, hepatitis B

Rotavirus (oral)

Question 9

Vaccines at 16 weeks

Answer 9

6 in 1: DTaP, polio, HiB, hepatitis B
Pneumococcal (PCV)
Meningitis B

Question 10

Vaccines at 1 yr

Answer 10

HiB and MenC
Pneumococcal (PCV)
MMR
Meningitis B booster

Question 11

Vaccines at 3yr 4mo

Answer 11

DTaP + polio

MMR

Question 12

Vaccines at 14yr

Answer 12

Diphtheria, tetanus and polio

MenACWY

Question 13

Vaccines offered to 65yr

Answer 13

Influenza - inactivated

Pneumococcal polysaccharide vaccine (PPV)

Question 14

Vaccines offered at 70yo

Answer 14

Shingles

Question 15

Two types of pneumococcal vaccine and when they are given

Answer 15

Pneumococcal conjugate vaccine (PCV) - 8wk, 16wk, 1yr

Pneumococcal polysaccharide vaccine (PPV) - 65yr

Question 16

Contents of 6-in-1 vaccine and when it is given

Answer 16

DTaP - diphtheria, tetanus and pertussis
Polio
Hepatitis B
HiB

given at 8wk, 12wk, 16wk

Question 17

When is temperature concerning in children?

Answer 17

> 38 degrees in <3mo
3-6mo and >39 degrees
Temperature for more than 5 days
Temperature under 36 degrees and checked 3 times

Question 18

Age range most affected by croup?

Answer 18

6mo-6yr

Question 19

Acute Epiglottitis age range

Answer 19

1-6yr

Question 20

FeverPAIN score components and interpretation

Answer 20

Fever - in past 24h
Purulent Tonsils 
Attend within 3 days 
Inflamed tonsils
No cough/coryza

1 for each
0-1 = no abx
2-3 = consider delayed prescription
4-5 = consider ab

Question 21

3 drugs used in anaphylaxis

Answer 21

Adrenaline
Chlorphenamine
Hydrocortisone

Question 22

2 tests for DDH

Answer 22

Barlow’s test = flex hip and knee, push posteriorly to dislocate
Ortolani test = attempt to reduce the dislocation

Question 23

Newborn exam: describe findings that may be present when examining the genitalia

Answer 23

Female = clitoromegaly in congenital adrenal hyperplasia

Male - epispadia = defect on dorsal surface, hypospadia = defect on the ventral surface
Undescended testes

Question 24

Craniofacial abnormalities in Down’s Syndrome

Answer 24

Round face
Epicanthic folds
Flat nasal bridge
Flat occiput and third fontanelle
Upslanted palpebral fissures
Small ears
Brushfield spots in the iris
Protruding tongue

Question 25

Non-craniofacial abnormalities in Down's Syndrome

Answer 25

``` Short neck Single palmar creases Incurved and short 5th finger Sandal gap between 1st and 2nd toe Congenital heart defects Duodenal atresia ```

Question 26

Most common pathogens in neonatal sepsis

Answer 26

<5 days = maternal floria e.g. E.coli, GBS | >5 days = above plus S. aureus

Question 27

Define early and late neonatal sepsis

Answer 27

Early - 0-7 days | Late - 7-28 days

Question 28

Management of neonatal sepsis

Answer 28

<5 days = benzypenicillin (covers GBS), gentamicin (covers E. coli) > 5 days = as above but plus flucloxacillin for s aureus

Question 29

Stages of HIE

Answer 29

Stage 1 / Mild --> irritability, hyperventilation, overstimulated, hypertonic Stage 2 / Moderate --> movement abnormalities, hypotonia, seizures Stage 3 / Severe --> no spontaneous movements, fluctuating hypo/hypertonia, seizures, multi-organ failure

Question 30

Management of HIE

Answer 30

Resuscitation Anticonvulsant Cooling - to reduce brain damage, especially for moderate-severe HIE

Question 31

Which babies are at risk of intraventricular haemorrhage?

Answer 31

Preterm babies, especially <30 weeks

Question 32

How does intraventricular haemorrhage lead to hydrocephalus?

Answer 32

``` Bleeding into ventricles Ventriculomegaly Blood products block the arachnoid granulations Build up of fluid Hydrocephalus ```

Question 33

Aetiology of ARDS

Answer 33

Surfactant deficiency as this is not made until 34 weeks gestation, so significantly preterm babies are affected Leads to alveolar collapse and prevents gas exchange

Question 34

Diagnosis of ARDS

Answer 34

Clinical signs | Ground glass CXR

Question 35

Management of ARDS

Answer 35

Respiratory support e.g. CPAP Surfactant therapy Maternal steroids before delivery - prevention

Question 36

Which babies are affected by transient tachypnoea of the newborn

Answer 36

- C sectioned babies - Fast delivery This is due to reduced stress hormones during the delivery which are needed to help the baby clear its lungs

Question 37

Diagnosis of TTN

Answer 37

Tachypnoea - >60breaths/min | CXR - lung hyperinflation, fluid in horizontal fissure of R lung

Question 38

When should TTN resolve by?

Answer 38

Within 3 days

Question 39

Clinical features of necrotising enterocolitis

Answer 39

- Intolerance to feeding - Vomiting bile - Bloody stools - Shiny distended abdomen - Shock

Question 40

Maintenance fluid in children

Answer 40

100ml/kg for first 10kg 50ml/kg for next 10kg 20ml/kg for every kg after 0.9% saline with 5% glucose +/- 20mmol/L KCl

Question 41

Deficit/replacement fluid calculation in children

Answer 41

Weight x % dehydration x 10

Question 42

Fluid bolus calculation in children

Answer 42

20ml/kg - sepsis/shock 10ml/kg trauma /DKA

Question 43

Genetic pattern and pathophysiology of Duchennes muscular dystrophy

Answer 43

X-linked recessive (so mainly affects men) mutation of dystrophin gene which forms part of muscle cell cytoskeleton, leading to myofibre necrosis (hence raised CK)

Question 44

Symptoms and signs of Duchennes muscular dystrophy

Answer 44

``` Waddling gait Slow running Delayed walking Pseudohypertrophy if calves Learning difficulties ``` Growers sign - difficulty getting up from floor, children roll prone and walk up their legs

Question 45

Diagnosis of Duchennes

Answer 45

- CK raised - should be done on every boy not walking by 18 months - genetic testing

Question 46

Heelprick test is for...

Answer 46

1. Sickle cell disease 2. Cystic fibrosis 3. Congenital hypothyroidism Then 6 inherited metabolic disorders 1. Phenylketonuria 2. MCADD 3. Maple syrup urine disease 4. Isovaleric acidaemia (IVA) 5. Glutaric Aciduria type 1 (GA1) 6. Homocysteinuria