Paeds 7B

Question 1

At what point in a child’s life would a squint be considered pathological?

Answer 1

3 months

Usually due to a refractive error

Question 2

What are the limit ages for:
Head control 
Sits unsupported 
Stands independently 
Walks independently

Answer 2

Head control - 4 months
Sits unsupported - 9 months
Stands independently - 12 months
Walks independently - 18 months

Question 3

What are the limit ages for:
Fixes and follows
Pincer grip

Answer 3

Fixes and follows - 3 months

Pincer grip - 12 months

Question 4

What are the limit ages for:
Saying 6 words with meaning
Joining words
3-word sentences

Answer 4

Saying 6 words with meaning - 18 months
Joining words - 2 years
3-word sentences - 2.5 years

Question 5

Name the primitive reflexes.

Answer 5

Moro
Grasp
Rooting 
Stepping
Asymmetrical tonic neck reflex

NOTE: these will be replaced by postural reflexes (e.g. parachute)

Question 6

Which intelligence tests may be used in children?

Answer 6

WPPSI (2-7 years)

WISC (6-16 years)

Question 7

How is meconium ileus treated?

Answer 7

Gastrograffin enema (or N-acetylcysteine)

Question 8

How should a congenital diaphragmatic hernia be managed?

Answer 8

Insert a large NG tube and apply suction to prevent distension of the intrathoracic bowel

Question 9

How should neonatal hypoglycaemia be managed?

Answer 9

Early and frequent milk feeding
IV dextrose in refractory cases (and consider glucagon and hydrocortisone)
Aim for blood glucose > 2 mmol/L

Question 10

How is a Meckel’s diverticulum diagnosed?

Answer 10

Technetium 99 pertechnetate scan

Question 11

Which causes of gastroenteritis should be reported to the health protection unit?

Answer 11

• Campylobacter
• Listeria
• Shigella
• Salmonella

Question 12

Which blood tests may be considered at a coeliac disease review

Answer 12

Coeliac serology
FBC 
TFT
LFT
Vitamin D, B12, folate and serum calcium
U&E

Question 13

Describe the clinical features of congenital varicella syndrome.

Answer 13

Dermatomal skin scarring 
Neurological defects 
IUGR
Limb hypoplasia 
Hydrops fetalis

Question 14

Describe the clinical features of congenital CMV infection.

Answer 14

Mental handicap
Visual impairment
Progressive hearing loss
Psychomotor retardation

At birth: hydrops, IUGR, exomphalos, microcephaly, hydrocephalus, hepatosplenomegaly, thrombocytopaenia

Question 15

Which organism most commonly causes septic arthritis in children?

Answer 15

Staphylococcus aureus

NOTE: in sickle cell patients, salmonella is also common but S. aureus is still the most common

Question 16

What is the most common site of septic arthritis in children?

Answer 16

Hip

NOTE: plain film changes are apparent after 2-3 weeks

Question 17

At what age can babies roll over?

Answer 17

4 months

Question 18

What does the child protection team do once they have been informed about a case of suspected NAI?

Answer 18

Convene a case conference (includes parents, police officer, paediatrician, GP, health visitor and social worker)

Place the child’s name on the child protection register

Give support to the parents

Ensure regular monitoring by health visitor/social worker

Arrange regular follow-up with paediatrician (especially growth and development)

Question 19

What is the most common site of osteomyelitis in children?

Answer 19

Lower femur or upper tibia (around the knee)

Tends to affect the metaphysis

Question 20

When should an MCUG and DMSA be performed in a child who has had an atypical UTI?

Answer 20

MCUG can be done as soon as the current infection is under control
DMSA should be performed 3-4 months after the infection

Question 21

Outline the definitive management of VUR.

Answer 21

Often improves with time
May require surgical corrections
Patients may receive prophylactic antibiotics

Question 22

Which investigations are used to identify DDH?

Answer 22

< 5-6 months = ultrasound

> 6 months = X-ray

Question 23

What is the typical blood gas picture that is seen in congenital cyanotic heart disease?

Answer 23

Metabolic acidosis

Hypoxia

Question 24

Describe the appearance of a rash caused by parvovirus in adults.

Answer 24

Lacey rash

Question 25

What is Gaucher disease?

Answer 25

Glycogen storage disease that is prevalent in Ashkanazi jews

NOTE: Tay Sachs is also common in this population