Paeds: crib list

Question 1

Respiratory distress

Answer 1

Vitals - RR, SpO2 (likely if on oxygen), HR
Inspection (and A-E) - recessions, nasal flaring, cyanosis, tiring, drowsiness,
Auscultation - grunting, silent chest, crackles, (stridor, wheeze)

Question 2

Reflexes

a) Primitive (MRS BAPS) - up to ~ 6 months
b) Postural (LLPP)

Answer 2

a) Moro, rooting, sucking, Babinksi, ATNR, palmar grasp, stepping
b) Landau, Lateral propping, parachute, positive support

Question 3

Causes of short stature

a) 4 categories
b) ABCDEFG

Answer 3

a) Reduced intake, malabsorption, increased requirement, dysregulation
b) Alone (neglect), Bone dysplasia, Chromosomal (Turner, Down), Endocrine (GH, T4), Familial (genetics, constitutional delay), Gastro (coeliac, IBD, CF)

Question 4

Congenital hypothyroidism: features

a) Vitals
b) Appearance/signs on examination
c) Symptoms

Answer 4

a) Bradycardia, low temperature
b) Jaundice, hypotonia, large fontanelles, Myxoedema (coarse features), Macroglossia, Umbilical hernia, Goitre, SHORT STATURE
c) Feeding difficulties, Somnolence, Lethargy, Low frequency of crying, Constipation, cretinism

Question 5

Puberty:

a) Girls - normal, precocious, delayed
b) Boys - normal, precocious, delayed
c) Causes of precocious
d) Causes of delay

Answer 5

a) Normal (8-13)
- Precocious (<8)
- Delayed (>13 without breast development or >15 amenorrhoea with normal breasts)

b) Normal (9-14)
- Precocious (<9)
- Delayed (>14 without testicular development)

c) Usually idiopathic (in girls), CAH
d) CDGP, chronic disease, gonadal dysgenesis

Question 6

Neonatal jaundice:

a) What 3 groups to screen (timing, duration)
b) Screening tests (BLITH)

Answer 6

a) Onset <24h, onset >2 weeks, duration > 10 days

b) Bilirubin (serum if <24h, transcutaneous otherwise)
Liver function tests
Infection screen (TORCH, surface swabs, septic screen)
Thyroid function test
Haemolytic tests (FBC, Blood group and Rh, Reticulocyte count., Coombs, blood film, Hb electrophoresis and red cell enzyme essays for G6PD deficiency, pyruvate kinase deficiency)
Imaging USS if required

Question 7

Heart murmurs:

a) Innocent characteristics
b) VSD - characteristics, other features, Ix
c) VSD investigations
d) VSD management

Answer 7

a) Soft, Systolic, Short, Symptomless (no WOB, no HF, no cyanosis, normal femorals), Small (no radiation), Single (no associated sounds), Sensitive (varies with posture)
b) Harsh pansystolic, LLSB, signs of heart failure
c) Investigate using CXR, ECG, Echo (diagnostic).
d) Treat with high energy feeds, diuretics, ACE +/-digoxin

Question 8

Cyanotic CHD

• 1, 2, 3, 4, 5
• Caused by…?

Answer 8

1 - Persitent truncus arteriosus
2 - TGA
3 - Tricuspid atresia
4 - ToF
5 - TAPVR (oxygenated blood returns into R atrium, rather than L atrium)

Caused by mixing of ox/deox blood (right to left shunts) causing deox blood to be pumped to the body

Question 9

Duct-dependent lesions:

a) Explain the 2 basic types
b) Presentation
c) DDx: cardiac and non-cardiac
d) How to differentiate cardiac vs pulmonary causes
e) Ix
f) Rx

Answer 9

a) - Duct-dependent systemic lesions: systemic circulation dependent on R-L flow through patent DA
- Duct-dependent pulmonary lesions: pulmonary blood flow is dependent on L-R shunting from the aorta to the pulmonary arteries through the patent DA

(DA closure in both cases can be catastrophic)

b) Difficulty feeding, SOB, Cyanosis, Acute cardiorespiratory collapse with shock (weak femorals).

c) Cardiac.
- Duct-dependent systemic circulation: critical AS, hypoplastic left heart, CoA
- Duct-dependent pulmonary circulation: pulmonary atresia, Critical pulmonary stenosis, TGA, Tricuspid atresia, ToF

Non Cardiac.
- Persistent Pulmonary Hypertension of
the Newborn (PPHN)
- Primary pulmonary disease (Lobe collapse, pneumothorax, IRDS, etc.)
- Sepsis, Metabolic disorders

d) Hyperoxic test (if improved oxygenation: respiratory)
e) CXR, ECG, Echo
f) - ABDCE (airway, oxygen and breathing support, monitor pre+post-ductal sats, fluid resuscitation if needed, dopamine if needed, monitor BP in all 4 limbs)
- PGE2 to keeps duct open - give before oxygen as oxygen is a systemic vasoconstrictor

Question 10

Classifying babies with suspected CHD

a) Blue, femoral pulses present, murmur - 4 DDs
b) Blue, femoral pulses present, NO murmur - 3 DDs
c) Blue/pink, femoral pulses ABSENT
d) Pink, femorals present

Answer 10

a) Cyanotic CHD: ToF, AVSD, TA

b) - Cyanotic CHD: TGA, TAPVR
- Persistent pulmonary HTN

c) Duct-dependent systemic lesions: CoA, critical AS, hypoplastic left heart, interrupted arch
d) VSD, ASD, AS

Question 11

Persistent pulmonary hypertension of the newborn

a) Pathophys
b) Causes
c) Presentation
d) Ix
e) Rx

Answer 11

a) Normally - first breath leads to pulmonary vasodilatation and reduction in pulmonary blood pressure.
- In PPHN, this doesn’t happen, causing persisting pulmonary hypertension

b) Meconium aspiration, infection, diaphragmatic hernia
c) Blue baby, normal femorals, hypoxic, respiratory distress, poor feeding
d) CXR, ECG, Echo, pre+post-ductal sats

e) ABC (oxygen and ventilation, feeding support, fluids and antibiotics, dopamine if necessary),
- Nitric oxide (NO) may be useful as a vasodilator

Question 12

Asthma vs. viral wheeze

DR BANT

Answer 12

Dry cough
Recurrent/persistent
Bronchodilator response
Atopy
Nocturnal symptoms
Triggers

Question 13

Asthma/wheeze management

a) Indications for step-up asthma management (3)
b) Management of exacerbation: O SHIT ME
c) Step-wise (< 5 years)
d) Step-wise (> 5 years) - differences

Answer 13

a) Salbutamol (>2/week), sleep disturbance (1/week), Exacerbation in previous 2 years requiring admission
b) Oxygen, Salbutamol, Hydrocortisone (or pred), Ipratroprium, Theophylline, Magnesium, Escalate
c) Conservative (triggers, diet, exercise, educate, monitor, review, asthma action plan), Step 1 (B2 agonist), Step 2 (Preventer ICS or LTRA), Step 3 (ICS and LTRA), Step 4 (referral to paeds, note: refer under 2s at step 3)

d) Step 3: add LABA, or increase ICS. If still not controlled, add LTRA or theophylline
Step 4: increase ICS again. Step 5 (requiring regular oral steroids): refer to paeds)

Question 14

Fluids and resus and traffic light system

Answer 14

Covered in separate deck

Question 15

Collapsed child

WET FLAG

Answer 15

Weight: (age + 4) x 2
Energy: (age/4) + 4
Tube (NG)
Fluids - 20ml/kg (or 10 - neonates, DKA, trauma)
Lorazepam
Adrenaline/dopamine (and escalate)
Glucose

Question 16

Development

a) By age 6m
b) By 1 year
c) By 18m
d) By 2 years
e) By 3 years
f) By 4 years
g) By 5 years

Answer 16

a) Sit without support, roll onto back, palmar grasp, reach for toys, babbling, put food in mouth
b) First steps, pincer grip, transfer objects, scribble, one word sentences, drink from a cup
c) Walking confidently, tower of 2 cubes
d) Walk up two steps, tower of 6 cubes, draw line, 2-word sentences, cooperates with dressing
e) Jump, tower of 8 cubes, draw circle, speech mostly understandable, names a friend
f) Hop and skip, draw square, knows colours, dress without help, toileting
g) Ride bike, knows meaning of words

Question 17

Developmental red flags

Answer 17

Gross Motor

• Not sitting by 1 year
• Not walking at 18 months

Fine Motor
- Hand preference before 18 months

Speech and language

• Not smiling by 3 months
• No clear words by 18 months

Social development

• No response to carers interactions by 8 weeks
• Not interested in playing with peers by 3 years

Question 18

THE MISFITS

- the main 4

Answer 18

Trauma
Heart
Endocrine
Metabolic
Inborn errors
Seizures/neuro
Formula
Intestinal
Toxins
Sepsis

Main 4:

• Sepsis
• CHD
• NAI
• Metabolic

Question 19

Septic screen

a) Under 1 month
b) 1 - 3 months
c) Over 3 months - green, amber, red

Answer 19

a) FUCC LP (FBC, Urine, CRP, Culture, LP)
b) FUCC (only add LP if unwell/raised WCC)

c) - Green (urine)
- Amber (FUCC, + LP if under 1 year, + CXR if fever and raised WCC)
- Red (FUCC + LP + Gas + CXR depending on clinical picture)

Question 20

Immunisation schedule

a) Four at 8, 12 and 16 weeks (largely the same)
b) Four at 1 year
c) Two at 3 years (pre-school)
d) Seasonal for 2 - 8 year olds
e) 3 for teenage girls (2 for teenage boys)
f) Optional/at-risk groups

Answer 20

a) 6-in-1 (Dip, polio, tetanus, pertussis, Hib, Hep B),
PCV, Rotavirus, Men B

b) MMR, PCV, Men B, Hib/Men C
c) MMR booster, 4-in-1 pre-school booster (DTaPP)
d) Nasal flu vaccine
e) HPV, 3-in-1 teenage booster (DTaP), Men ACWY
f) Flu, BCG, Chickenpox, Hep B

Question 21

Paediatric sepsis 6

a) Suspect in patients with 2 or more of what 4 features? (PATT)
b) Lower threshold in what groups?
c) 6 actions

Answer 21

a) Poor peripheral perfusion/increased CRT, Altered mental state, Tachycardia, Temperature <36/ >38.5C
b) < 3 months, recent surgery, ID

c) - Administer high-flow oxygen
- IV/IO access and do septic screen (FUCC, blood gas and lactate)
- Administer IV/IO antibiotics
- Consider fluid resuscitation (20ml/kg)
- Involve senior support
- Give 2nd and 3rd fluid bolus then inotropes
- HDU/ICU (invasive monitoring, dialysis, mechanical ventilation, etc.)

Question 22

Kawasaki

• Fever for 5 days + at least 4 out of…HEART
• other features

Answer 22

H - Hands and feet erythema, oedema and desquamation
E - eye (bilateral conjunctival injection without exudate)
A - adenopathy (15mm cervical, usually unilateral)
R - rash polymorphic
T - tongue strawberry and chapped lips

Coronary artery aneurysms - do an ECHO
Increased ESR and platelet count
Treat with aspirin and IVIG

Question 23

UTI in children

a) Atypical
b) Recurrent
c) Urine dip vs MSU

Answer 23

a) Seriously unwell/septic, reduced urine output, abdominal mass, non-e.coli, raised serum creatinine, poor response to ABx in 48 hours
b) 2 or more Upper UTIs. 3 or more lower UTIs

c) < 3 months (MSU only)
- 3m - 3y (Dip: treat if leukocyte or nitrite positive, send for culture)
- >3y (Dip: treat only if nitrite positive, send for culture if leukocyte positive)

Question 24

UTI imaging in children

a) MCUG - only needed in…?
b) USS during infection
c) USS within 6 weeks (1 group only)
d) DMSA

Answer 24

a) < 6 months if atypical/recurrent UTI or abnormality on USS in normal UTI
b) Atypical at any age, recurrent < 6 months
c) Normal UTI in < 6 months
d) Recurrent UTI at any age, atypical UTI < 3 years

Question 25

Treatment for: a) Early-onset neonatal sepsis b) Empirical sepsis under 3 months c) Empirical sepsis over 3 months d) Suspected meningococcus in GP surgery e) Suspected meningitis over 3 months f) Intrapartum antibiotic prophylaxis for women with confirmed GBS/previous baby with GBS

Answer 25

a) Benpen + Gent b) Cef + Amox c) Cef d) Benpen e) Cef + dexamethasone f) IV Benpen (mother)

Question 26

``` Meningitis on CSF (Opening pressure, colour, cells, gram stain, protein, glucose): a) Viral b) Bacterial c) TB/Fungal ```

Answer 26

a) Normal pressure, clear, lymphocytes, normal protein, normal glucose b) Increased pressure, turbid, neutrophils, raised protein, low glucose (< 50% serum glucose) c) Normal pressure, mainly lymphocytes, raised protein, low glucose (< 50% serum)

Question 27

Safety-netting a) General b) Dehydration c) Infection (e.g. gastroenteritis) prevention

Answer 27

a) Recognising red flag symptoms, How to get help, Follow-up b) - Continue breast-feeding/eating and drinking, - Discourage juices/carbonated drinks, ORS supplements PRN - Red flags (thirsty, tired, sunken fontanelle, dry mouth, pale, SOB, drowsy, confused) c) Hand-washing (especially before/ after contact, if in contact with stool/secretions, before and after food), Wash and don't share towels, Keep from school until clear of D&V for 48 hours, barriers

Question 28

Monitoring renal function | a) 3 main tests

Answer 28

a) BP, urinalysis, eGFR

Question 29

Febrile convulsions: a) Requirements - age, cause, temperature b) Emergency treatment - explain c) 2 reasons to LP d) If home care - advice for parents

Answer 29

a) Occur in 6 months to 5 years, associated with fever, without other underlying cause such as CNS infection or electrolyte imbalance (if suspected meningitis: treat with cefotaxime) b) ABCD (airway, breathing, circulation, glucose check) If > 5 mins, rectal diazepam ``` c) Under the age of 18 months. Complex seizure. Severe infection (red flags, e.g. reduced GCS) ``` d) Educate, how to treat fever, spotting red flags (rash, drowsiness, dehydration, not eating/drinking, fever > 5 days), call 999 if longer than 5 minutes seizure or any red flags

Question 30

Dysmorphic features | JT SMELSS

Answer 30

``` Jaw small Thin upper lip Smooth philtrum Microcephaly Epicanthic folds Low nasal bridge Short nose Short stature ```

Question 31

Downs features a) Eyes - 3 b) Face - 4 c) Body - 4 d) Diseases

Answer 31

a) Epicanthic folds, oblique palpebral fissures, Brushfield spots (iris speckles) b) Protruding tongue, high arched palate, brachcephaly, low set ears, flat nasal bridge c) Sandal gap, single palmar crease, short and incurved little finger, short hands, hypotonia, hyperflexibility d) Leukaemias (ALL especially), duodenal atresia, hypothyroidism, AVSD, Alzheimer's, myelodisplasia

Question 32

If child has a breath-holding spell (blue or reflex anoxic), what treatment may help?

Answer 32

Iron supplements

Question 33

Limping child: a) Kocher's criteria b) Differentials c) SALTR

Answer 33

a) Fever > 38.5C, ESR > 40, WCC > 12,000, unable to weight bear (3 or 4: Septic Arthritis very likely) b) Transient synovitis (3-8), septic arthritis, Perthes (5-10), SCFE (10-13), malignancy (ALL, osteo, Ewing's), JIA, OM, Osgood-Schlatter, growing pains (exclusion), TB c) Slipped, Above, Lower, Through, Rammed

Question 34

Centor criteria

Answer 34

Temp > 38C Anterior cervical nodes swollen/tender Cough absent Tonsils swollen/exudative

Question 35

IRDS. a) Management (SOS CpAp) b) Appearance on CXR

Answer 35

a) - Surfactant via ETT - Oxygen (target sats: 91 - 95%) - Supportive care: nutrition (NG feed), temperature, glucose and hydration control - CPAP (non-invasive) or IPPV (invasive) - Antibiotics to cover for infection (discontinue if cultures negative) b) Ground glass appearance

Question 36

Cyanosed neonate. - What features would help to give diagnosis? - What examinations would you do? - What investigations would you do?

Answer 36

- SOB, recessions, cough, fever, scaphoid abdomen (diaphragmatic hernia - may cause PPHN) - Vitals: SpO2 (pre and post ductal), HR, RR, - CV (hepatomegaly, femorals, cool peripheries), resp (crackles, wheeze) - Ix: hyperoxic test, CXR, ECG, Echo, blood gas (lactic acidosis in CHD and sepsis)

Question 37

Collapsed neonate: how would you manage...? a) General b) Duct-dependent cardiac lesion c) TGA operation

Answer 37

a) Airway and breathing (intubate, ventilate, NG tube) circulation (IV/IO access, fluid bolus 10ml/kg, inotropes), disability (glucose 10%, prevent hypothermia). b) Prostaglandin infusion c) Atrial septostomy

Question 38

Investigations and management of: a) Volvulus b) Intusussception c) NEC d) Pyloric stenosis e) HSP f) Hirschsprung's

Answer 38

a) - UGI contrast studies - Rx: ABC, correct any fluid and electrolyte imbalance - Surgical Rx: Ladd's procedure b) - USS (donut sign) and barium enema - Rx: NG tube and IV fluids (drip and suck), followed by air enema reduction. - Laparotomy if 5 Ps (peritonitis, perf, prolonged, poor response to enema, pathological lead point likely) c) - Bloods (to indicate severity via Bells staging criteria): lactic acidosis, thrombocytopenia, coagulopathy - AXR (loops of bowel, Football sign, thickened bowel wall, intramural gas) - Rx: ABC (intubate, ventilate, fluids and inotropes if shocked), NBM and TPN feeding, drip and suck - Antibiotics (gentamicin and metronidazole) - Surgery if air under the diaphragm/necrotic bowel d) - Blood gas (metabolic alkalosis) - UEs (hypokalaemia, hypochloraemia) - USS to confirm. (also olive shaped mass in epigastrium) - Rx: correct fluid/electrolyte imbalance and... - Pyloromyotomy e) - Monitor for renal involvement - Urinalysis (haematuria and proteinuria) - U+E and creatinine, eGFR, Blood pressure. - If nephrotic: fluid and salt restrict, diuretics, penicillin V prophylaxis and PCV vaccine. - If suspect intussusception, manage as above f) - Bloods (WCC raised in enterocolitis - fever, foul smelling and bloody diarrhoea), - AXR (obstruction), anal manometry, rectal biopsy (definitive) - Rx in acute obstruction (NBM, drip and suck) - Rx in enterocolitis (broad spec ABx) - Surgical Rx: resection and end-to-end anastamosis

Question 39

Management of: a) Bronchiolitis b) Croup

Answer 39

a) Supportive: fluids, feeding (NG if necessary), temperature control, high-flow oxygen +/- CPAP b) Oral dexamethasone (+ 2nd dose if needed after 12 hours), keep child calm, don't examine throat - Nebulised adrenaline if severe. - General: fluids, temperature control, adequate nutrition, oxygen if required

Question 40

DKA: immediate management (ABCDE)

Answer 40

Airway: - intubate and pass NG tube if necessary Breathing: - Kussmaul resps, - ventilate if necessary, 100% high-flow oxygen Circulation: - IV access and take bloods (glucose, ketones, blood gas, electrolytes), - fluid bolus 10ml/kg 0.9% NaCl (may give 3 max), - attach cardiac monitor, - maintenance fluids of 0.9% NaCl with 20 mmol KCl Disability: - AVPU/GCS, pupils, temperature control, fundoscopy Exposure

Question 41

DKA: further management (glycaemic control)

Answer 41

- After 1 - 2 hours of 0.9% NaCl with 20 mmol KCl, you can add IV insulin (0.1 U/kg/hour). - Once BM = 12 - 15, swap fluid from 0.9% NaCl to 0.45% NaCl and 5% glucose (still include 20 mmol KCl) - If glucose rises, reduced dextrose and increase insulin if necessary - Once BM < 14 or pH > 7.3, can reduce insulin dose (but don't stop till clinically well)

Question 42

DKA: further management (monitoring) | - if cerebral oedema suspected?

Answer 42

``` Vitals and ABCD (including GCS) Fluid input and output ECG Blood glucose, ketones and electrolytes Blood gas (acidosis) ``` Cerebral oedema - mannitol, ICU transfer, intubate and ventilate as necesary

Question 43

CAH: investigations and management

Answer 43

UEs (hyponatraemia, hyperkalaemia) Glucose (hypoglycaemia) Blood gas (met alkalosis) 17-hydroxyprogesterone raised in serum Management: - A-E (including glucose correction, fluid bolus if shocked 10ml/kg 0.9% NaCl, IV/IO access and bloods as above, IV antibiotics) - IV hydrocortisone acute - Fludrocortisone long-term - NaCl supplements (first 6 - 12 months)

Question 44

Pavalizumab - Who? (3 groups) - How and when?

Answer 44

CLD of prematurity CHD SCID IM monthly injections during winter season

Question 45

CF diagnosis a) Measured on newborn heelprick b) If raised, what 2 tests?

Answer 45

a) IRT | b) Genetic testing and sweat test (raised chloride with chloride higher than sodium on 2 occasions)

Question 46

Nephrotic syndrome: investigations and management a) Ix b) Rx

Answer 46

a) Urine dipstick and 24h urine collection FBC, UEs, CRP, albumin and total protein levels (calculate albumin: creatinine ratio) ASOT, glucose, IGs, auto-antibodies Lipids, clotting screen b) - Fluid restrict, diuretics - Corticosteroids (If resistant: tacrolimus, cyclophosp) - Consider: Penicillin V (not routinely recommended) and PCV jab

Question 47

Cerebral palsy: investigations | Note: clinical diagnosis

Answer 47

To exclude differentials: - Thyroid studies - Chromosomal analysis - Pyruvate and lactate levels (mitochondrial) - Amino acid and organic acid levels (inborn errors) To confirm diagnosis/damage if unclear: - CT/MRI head - EEG For complications: - Audiology - Ophthalmology

Question 48

HCPs involved in CP management

Answer 48

Child developmental services Multidisciplinary and Multiagency working Community Paediatrician +/- Neurologist/ Specialists Specialist Nurse-epilepsy Physiotherapist/Occupational therapist/Psychologist/Dietician Ophthalmology/ Audiology/ENT/SALT Orthopaedic surgeon Social services Education

Question 49

Anatomical landmark in GI tract determining bilious or non-bilious vomiting

Answer 49

Ampulla of vater

Question 50

Signs of NEC on AXR

Answer 50

Football sign Thickened bowel wall Intramural gas Dilated loops of bowel

Question 51

Differentials for... a) Bilious vomiting b) Projectile vomiting

Answer 51

a) Volvulus, NEC, duodenal atresia, meconium ileus (all distal to ampulla of vater) b) Pyloric stenosis

Question 52

Patau syndrome - feature

Answer 52

Polydactyly

Question 53

VACTERL association

Answer 53

``` Vertebral defects Anorectal anomalies Cardiac defects Tracheo-oesphageal fistula/oesophageal atresia Renal abnormalities Limb abnormalities ```

Question 54

CHARGE association

Answer 54

``` Colomboma (pupil defect) Heart defect Choanal Atresia (blockage of nasal passage) Retardation of growth / development Genital hypoplasia Ear anomalies ```

Question 55

Cleft lip/palate complications

Answer 55

Poor feeding, milk aspiration, speech delay, conductive hearing loss

Question 56

DDH: tests

Answer 56

``` Barlow’s = dislocation Ortolini = relocation ``` (Orto - relocates, because Ortho is all about relocating and fixing things)

Question 57

Hemiplegic vs. diplegic CP

Answer 57

Diplegic: Bilateral leg > arm spasticity, knock-knee gait, most common CP phenotype Hemiplegic: Unilateral arm > leg spasticity, tiptoe gait and dystonic posture

Question 58

NAI a) History b) Injuries

Answer 58

a) History incompatible with injury / unclear history, delay seeking medical attention b) Multiple fractures (Metaphyseal corner fracture!!!) Retinal haemorrhage, torn frenulum Injury in a non-ambulatory / totally dependent child

Question 59

Neuroblastoma: a) Presentation - 4 common symptoms, 4 common signs b) Possible eye abnormality c) Investigations - bloods? Urine? Imaging? d) Metastases common to where? Scan indicated? e) Management - low-risk? High-risk? f) Complications

Answer 59

a) - Loss of appetite, vomiting, weight loss, abdominal pain, periorbital bruising; - Signs - abdominal distention, Horner's, hypertension, fever, blueberry muffin baby b) Opsoclonus-myoclonus c) - Raised ESR, raised LFTs; - urinary catecholamine metabolites; - CT TAP (or MRI if worried about cord compression) d) Bone - MIBG bone scan e) Resection; adjuvant chemoradiotherapy f) Cord compression, hypertension, renal failure

Question 60

Osteosarcoma a) Most common sites b) Metastasises rapidly to...? c) XR appearance d) Management

Answer 60

a) Around the knee (75%) and humeral shaft b) Lungs c) Bone destruction and formation (Sunburst appearance) d) Surgery + chemo

Question 61

Ewing's sarcoma a) Tumour type b) Presentation - main symptom? Other symptoms? c) Imaging d) On bloods - what 2 things indicate mets and poor prognosis? e) Treatment

Answer 61

a) PNET b) Mass or swelling in long bones of the arms and legs, pelvis or chest but also in the skull and flat bones of the trunk. Other: pain, redness, malaise, anorexia, weight loss, fever, cord compression symptoms (e.g. weakness, tingling, incontinence) c) XR: onion-skin appearance of bone formation. Also do bone scintigraphy and CT to assess spread d) Anaemia and raised LDH e) Chemotherapy: vincristine, ifosfamide, doxorubicin and etoposide (VIDE). - Also combine with radiotherapy and surgery

Question 62

Wilms tumour a) May coexist with what syndromes (in 10%) b) Onset - age, site c) Presentations d) Management

Answer 62

a) Overgrowth syndromes (macroglossia, nehpromegaly) or non-overgrowth (WAGR, Edwards) b) 95% unilateral, 97% under age of 5 c) Asymptomatic abdominal mass. - Others: abdo pain, haematuria, UTIs d) Nephrectomy + chemo (e.g. vincristine, dactinomycin and doxorubicin, cyclophosphamide) +/- RT