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Y5 Passmed > Paeds Key Concepts > Flashcards

Paeds Key Concepts Flashcards

1
Q

If a newborn has hypoglycaemia in the hours after birth what should you do and why?

A

Transient hypoglycaemia in the first 24 hours is common
Asymptomatic - encourage normal feeding (breast/bottle), monitor blood glucose
Symptomatic - admit to neonatal unit and IV 10% dextrose

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2
Q

What are the key features of patent ductus arteriosus?

A 
Left subclavicular thrill
Continuous 'machinery' murmur
Large volume, bounding, collapsing pulse
Wide pulse pressure
Heaving apex beat
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3
Q

How is patent ductus arteriosus managed?

A

Indomethacin or ibuprofen (inhibits prostaglandin synthesis and promotes duct closure)

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4
Q

What are the main features of acute lymphoblastic leukaemia?

A

Bone marrow failure

  • anaemia (lethargy and pallor)
  • neutropaenia (frequent/severe infections)
  • thrombocytopaenia (easy bruising, petechiae)

Bone pain
Spleno/hepatomegaly
Fever (either representing infection or constitutional symptom)
Testicular swelling

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5
Q

What are main common sign + symptom of anaemia?

A

Soft systolic murmur

Shortness of breath on exertion

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6
Q

What is the management for whooping cough?

A

Azithromycin or clarithromycin if onset of cough within previous 21 days

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7
Q

What are the 3 phases of whooping cough?

A

Catarrhal (getting worse)
Paroxysmal (v bad)
Convalescent (getting better)

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8
Q

What are the main features of whooping cough?

A

Initial mild illness with coryzal symptoms, fever, mild cough that then progresses to clusters of lots of rapid coughs + long inspiratory effort + ‘whoop’ at end of cough clusters + cyanosis + vomiting (frequently post-cough cluster)

Unvaccinated kids

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9
Q

When are children usually vaccinated against whooping cough?

A

2, 3, 4 months

3-5 years

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10
Q

What is the management for croup?

A

A single immediate dose of oral dexamethasone (0.15mg/kg)

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11
Q

When do most children achieve day and night time continence?

A

3-4 years old

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12
Q

What is the management for noctural enuresis in children under 5?

A

Reassurance that this is normal and advice about fluid intake and encouraging to empty bladder regularly during day and before sleep

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13
Q

What 4 things should be recorded in all febrile children?

A

Temperature
HR
RR
Cap refill

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14
Q

What are the 3 risk classes for children with fever?

A

Green
Amber
Red

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15
Q

What is the management for green, amber, and red risk class febrile children?

A

Green - manage at home with appropriate care advice + when to seek more help

Amber - safety net advice (advice on warning symptoms/a follow-up appointment/liaison with other HCPs)

Red - refer child urgently to paediatric specialist

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16
Q

What are the 3 month motor development milestones?

A

Little or no head lag on being pulled to sit
Lying on abdomen, good head control
Held sitting, lumbar curve

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17
Q

What are the 6 month motor development milestones?

A 
Lying on abdomen, arms extended
Lying on back, lifts and grasps feet
Pulls self to sitting
Held sitting, back straight
Rolls front to back
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18
Q

What is the 6-8 month motor development milestones?

A

Sits without support (refer at 12 months)

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19
Q

What are the 9 month motor development milestones?

A

Pulls to standing

Crawls

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20
Q

What are the 12 month motor development milestones?

A

Cruises

Walks with one hand held

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21
Q

What is the 13-15 month motor development milestone?

A

Walks unsupported (refer at 18 months)

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22
Q

What is the 18 month motor development milestone?

A

Squats to pick up a toy

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23
Q

What are the 2 years motor development milestones?

A

Runs

Walks upstairs and downstairs holding onto rail

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24
Q

What are the 3 years motor development milestones?

A

Rides a tricycle using pedals

Walks up stairs without holding onto rail

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25
Q

What is the 4 years motor development milestone?

A

Hops on one leg

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26
Q

When is neonatal hypoglycaemia severe enough to warrant admission and what do you do on admission?

A
  • Symptomatic
  • very low blood glucose (<1mmol/L)

IV 10% dextrose on admission

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27
Q

What is first-line treatment for idiopathic constipation in children?

A

Movicol Paediatric Plan (polyethylene glycol 3350 + electrolytes) on escalating dose regimen

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28
Q

What should you do if first-line treatment for idiopathic constipation in children does not lead to disimpaction within 2 weeks?

A

Stimulant laxative (senna)

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29
Q

What does short stature and primary amenorrhoea suggest?

A

Turner’s Syndrome

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30
Q

What is Turner’s Syndrome?

A

Primary amenorrhoea (amongst other issues) caused by presence of only 1 X chromosome or deletion of short arm of one of the X chromosomes

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31
Q

When a child lacks capacity, what consent is required to administer treatment if it’s in the best interests of the child?

A

Consent from one parent (as long as it’s in best interests)

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32
Q

When is jaundice always pathological in newborns?

A

In the first 24 hours

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33
Q

What are 4 causes of jaundice in the first 24 hours of life?

A

Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
Glucose-6-phosphodehydrogenase

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34
Q

How does seborrhoeic dermatitis (cradle cap) usually present in children?

A

Erythematous rash + coarse yellow scales

V young child

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35
Q

How is seborrhoeic dermatitis managed?

A

Mild-moderate - baby shampoo and baby oils

Severe - mild topical steroids e.g. 1% hydrocortisone

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36
Q

What is the first sign of puberty in boys?

A

Increase in testicular volume

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37
Q

What does erythematous rash, poorly demarcated, and covering 10% of total body area with no history of common allergen contact or new skincare products + Hx of familial atopy suggest?

A

Atopic dermatitis (eczema)

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38
Q

When does idiopathic thrombocytopenic purpura need treated?

A

If platelets <10*10^9/L
OR
Significant bleeding
- otherwise it resolves 80% of the time within 6 months with/without treatment

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39
Q

How is Prader-Willi syndrome inherited?

A

Imprinting - Prader-Willi gene deleted from father

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40
Q

What are the murmur findings for ventricular septal defect?

A

Pansystolic murmur in lower left sternal border

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41
Q

What are the murmur findings for coarctation of the aorta?

A

Crescendo-decrescendo murmur in upper left sternal border

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42
Q

What are the murmur findings for patent ductus arteriosus?

A

Diastolic machinery murmur in the upper left sternal border

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43
Q

Ejection systolic murmur in the upper left sternal border

A

Pulmonary Stenosis

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44
Q

When are bow legs in a child normal and what is the management?

A

<3 years old

Usually resolves by 4 y/o so just reassure patients

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45
Q

What is the most common cause of primary headache in children?

A

Migraine

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46
Q

What are the features of hand, foot, and mouth disease?

A

Mild systemic upset
Oral ulcers
FOLLOWED by vesicles on palms and soles

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47
Q

How does congenital cytomegalovirus (passing of CMV from mum to baby during pregnancy) present?

A 
Child with:
Hearing loss
Low birth weight
Petechial rash
Microcephaly
Seizures
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48
Q

When can a child with scarlet fever return to school?

A

24 hours after commencing antibiotics

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49
Q

What are the presenting features of scarlet fever?

A

Blanching, red, punctate, rough sandpaper-like texture rash on torso
Fever, sore throat
Throat red with petechiae on hard and soft palate
Tongue covered in white coat + red papillae

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50
Q

What is the management of scarlet fever?

A

Oral penicillin V for 10 days (azithromycin in case of allergy)
Can return to school 24 hrs after starting abx
SF is a notifiable disease

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51
Q

Why should a child with limp/hip pain and fever be referred for same-day assessment?

A

Want to rule out septic arthritis due to poor outcomes

- likely to be transient synovitis but must make sure first

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52
Q

How should UTI in the 3 brackets of children be managed?

A

<3 months - Immediate referral to paediatrician

> 3 months upper UTI - consider admission, oral cephalosporin or co-amoxiclav for 7-10 days

> 3 months lower UTI - oral abx 3 days (trimethoprim, nitrofurantoin, cephalosporin, amoxicillin) + bring child back if still unwell after 24-48 hrs

Consider prophylactic abx if recurrent UTIs

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53
Q

What is plagiocephaly and what is the prognosis?

A

Skull deformity - unilateral occipital flattening due to campaign around prevent SIDS
Vast majority of children improve by age 3-5 due to adoption of upright posture. Can also put child on tummy in day, supervised supported sitting during day.

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54
Q

What is the characteristic presentation of measles?

A

Fever + myalgia + painful eyes
Conjunctivitis
Clusters of white lesions on buccal mucosa (Koplik spots)

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55
Q

Main risk factor for transient tachypnoea of the newborn

A

C-section (risk factor for?)

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56
Q

Transient tachypnoea of the newborn CXR appearance

A

Appearance on CXR

  • Hyperinflation of the lungs
  • Fluid in horizontal tissue
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57
Q

Threadworm treatment

A

Mebendazole single dose + hygiene advice/measures for whole household

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58
Q

Clinical features of ASD

A

Impaired social communication/interaction
Repetitive behaviours, interests, activities
Intellectual/language impairment

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59
Q

Management of ASD

A

Early educational/behavioural interventions (ABA, ASD preschool, TEACCH, ESDM, JASPER)
SSRIs - symptom relief for anxiety, aggression, repetitive behaviour
Antipsychotics - symptom relief for aggression, self-injury
Methylphenidate - ADHD
Family support/counselling

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60
Q

Causes of stridor in children

A

Croup - 6 months-3 years (+barking cough, fever, coryzal sx)

Acute epiglottitis - 2-6 years (+rapid onset, unwell/toxic child, drooling)

Inhaled FB - choking, coughing, vomiting

Laryngomalacia - congenital abnormality of larynx, 4-8 weeks

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61
Q

Normal basic obs for infants

A

RR 30-60
HR 100-160
T 37c

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62
Q

Turner’s syndrome complication –> crescendo/decrescendo murmur UR sternal border radiating carotids

A

Bicuspid aortic valve (complication of + description)

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63
Q

Investigations for developmental dysplasia of the hip (DDH)

A

Ultrasound

>4.5mths then X-ray

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64
Q

Risk factors for DDH

A

Female sex - 6x greater

Breech presentation

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65
Q

Routine US exam for infants in these categories

A

1st degree FHx of hip problems in early life
Breech presentation ≥36w gestation
Multiple pregnancy

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66
Q

Barlow test

A

Test that attempts to dislocate an articulated femoral head

- checks for DDH

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67
Q

Investigation for vesicoureteric reflux

A

Micturating cystourethrogram

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68
Q

≤3m old infant

Irritability, general lethargy, poor feeding, fevers +/- seizures.

A

Meningitis presentation in infants

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69
Q

Treatment for meningitis in children <3m

A 
IV amoxicillin
IV cefotaxime (cover Listeria)
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70
Q

Congenital diaphragmatic hernia prognostic factors

A 
Liver position (liver in chest is bad)
Lung-to-head ratio (estimates foetal lung size, >1.0 is good)
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71
Q

IV fluid resus amount in children/young people

A

20ml/kg over <10 mins (0.9% NaCl bolus)

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72
Q

Daily fluid calculation method in children

A

Maintenance = 100ml/kg for first 10kg, 50ml/kg for next 10kg, 40ml/kg for next 20kg

Replacement = 100ml/kg/day

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73
Q

Foetal alcohol syndrome key feature

A

Microcephaly (+/- smooth philtrum, hypoplastic upper lip, epicanthic folds)

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74
Q

Innocent murmurs in children characteristics

A

Characteristics

Soft-blowing murmur in pulmonary area
Short buzzing murmur in aortic area
May vary with posture
Localised, no radiation
No diastolic component
No thrill
No added sounds (e.g. clicks)
Asymptomatic child
No other abnormality
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75
Q

3 years to acquire tolerance

A

Common milestone to achieve milk tolerance (esp post-milk ladder)

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76
Q

Investigation used for diagnosis AND grading of severity in vesicoureteral reflux (a.k.a reflux nephropathy)

A

Micturating cystography

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77
Q

Red flag symptoms/signs in child with fever

A

Colour - Pale/mottled/ashen/blue

Activity - no response to social cues, appears ill to a HCP, doesn’t wake or doesn’t stay awake if roused, weak/high-pitched/continuous cry

Respiratory - grunting, RR >60, moderate/severe chest indrawing

Circulation or hydration - reduced skin turgor

Other - age <3m + temp ≥38. Non-blanching rash. Bulging fontanelle. Neck stiffness. Status epilepticus. Focal neurological signs. Focal seizures.

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78
Q

Definition + description of hypospadias + 2 associated conditiosn

A

Congenital abnormality of the penis - ventral urethral meatus, hooded prepuce, chordee (ventral curvature of penis) in more severe.

Associated with cryptorchidism (present in 10%) and inguinal hernia

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79
Q

Management of hypospadias

A

Refer to specialist services
Corrective surgery at 12 months, don’t circumcise before
If very distal don’t treat

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80
Q

Pulses to check in infant BLS

A

Brachial and femoral arteries

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81
Q

Pathogen for bronchiolitis

A

Respiratory synctial virus (RSV) (75-80%

Also mycoplasma, adenoviruses or secondary bacterial infection

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82
Q

Conditions likely to make bronchiolitis more severe

A

Bronchopulmonary dysplasia (e.g. if premature)
Congenital heart disease
CF

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83
Q

Examination findings for transposition of the great arteries

A

Loud single S2 sound
Prominent right ventricular impulse palpable
NO murmur

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84
Q

Pierre-Robin syndrome presentation

A

Baby with micrognathia (small lower jaw), posterior tongue, cleft palate with no FHx

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85
Q

Obese boy + groin/thigh/knee pain =

A

?slipped capital femoral epiphysis

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86
Q

Perthes’ disease prognosis if present <6y + management

A

Good prognosis <6y

Requires only observation

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87
Q

Course of action for unilateral undescended testicle

A

Review at 3 months

If persistent then refer

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88
Q

Indication for bone marrow exam in children with immune thrombocytopenia (ITP)

A

Only required if there are atypical features

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89
Q

Transposition of great arteries cyanotic or non-cyanotic?

A

Cyanotic

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90
Q

‘Tripod’ position + condition

A

Leaning forward with neck extended while seated

Acute epiglottitis

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91
Q

Ebstein’s anomaly findings on exam + Ix

A

Systolic murmur

Echo - right atrial hypertrophy + septal and posterior leaflet of the tricuspid valve attached to right ventricle

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92
Q

Management of unborn with exomphalos (intestine outside abdomen, developmental issue)

A

C-section to reduce risk of sac rupture

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93
Q

SpO2 readings expected from healthy neonate

A

Suboptimal SpO2 readings expected in first 10 mins of life (like 70% and above)

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94
Q

Chickenpox risk factor for what kind of soft tissue infections

A

Invasive group A strep soft tissue infections

including NECROTISING FASCIITIS

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95
Q

Commonest benign cause of noisy breathing in infants

A

Laryngomalacia

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96
Q

Treatment of uncomplicated transient tachypnoea of the newborn

A

Observation + supportive care +/- oxygen

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97
Q

Ventricular septal defect increases the risk of…

A

Endocarditis

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98
Q

What is fragile X syndrome?

A

A trinucleotide repeat disorder

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99
Q

Childhood disorders associated with fragile X syndrome

A

Learning difficulties
Autistic spectrum disorder
- particularly in males

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100
Q

Genetic anticipation definition

A

Hereditary diseases that have an earlier age of onset through successive generations

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101
Q

Types of hereditary disorders (+2 examples) that exhibit genetic anticipation

A

Trinucleotide repeat disorders

  • Huntington’s disease
  • Myotonic dystrophy
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102
Q

Differentiation between bronchiolitis and pneumonia in a child

A

Bronch - low-grade fever

Pneumonia - high-grade fever (>39) and/or persistently focal crackles

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103
Q

Head injury red flags for immediate CT in children

A 
Loss of consciousness >5 mins
Amnesia >5 mins
Abnormal drowsiness
3+ vomits
Suspected non-accidental injury
Post-traumatic seizure without epilepsy
GCS <14 
Suspected open/depressed skull injury/tense fontanelle
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104
Q

How long can transient hypoglycaemia last in the newborn

A

First hours to days

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105
Q

Key risk factor for neonatal hypoglycaemia

A

Preterm birth (<37 wks)

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106
Q

Most common signs of neonatal sepsis

A

Grunting and other signs of respiratory distress

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107
Q

Hirschsprung’s disease diagnostic test

A

Rectal biopsy to examine under microscope for absence of ganglionic cells

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108
Q

Definition of Kawasaki’s disease

A

Fever for 5+ days with 4 of:

  • dry cracked lips
  • bilateral conjunctivitis
  • peeling of skin on fingers and toes
  • cervical lymphadenopathy
  • red rash over trunk
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109
Q

Characteristic rash of systemic-onset juvenile idiopathic arthritis/Still’s disease

A

Salmon-pink

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110
Q

Passage of meconium normal time + red flag time (and associated condition)

A

Normally in first 24 hours

Red flag is >48 hours (delayed passage, Hirschsprung’s disease)

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111
Q

Large volume, bounding, collapsing pulse

A

Patent ductus arteriosus

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112
Q

Organism responsible for majority of croup cases

A

Parainfluenza virus

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113
Q

Boy with learning difficulties, extremely friendly + extroverted. Short for his age + supravalvular aortic stenosis

A

William’s syndrome

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114
Q

Poor prognostic factors for ALL

A

Presenting <2 or >10 years
Having B or T cell surface markers
Having WCC >20x10^9/L at diagnosis
Male

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115
Q

Treatment of pyloric stenosis

A

Ramstedt pyloromyotomy

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116
Q

Investigation for stable children ?Meckel’s diverticulum

A

Technetium scan

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117
Q

Episodic hypercyanotic spells sometimes resulting in loss of consciousness in infants - name of spells + condition associated

A

‘tet’ spells

Tetralogy of Fallot

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118
Q

Don’t do this on examination of croup patient

A

Don’t do THROAT examination - airway obstruction risk (also in acute epiglottitis)

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119
Q

Next management step in 5-16y with asthma not controlled by SABA (salbutamol)

A

Add low-dose corticosteroid inhaler (beclometasone)

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120
Q

Paediatric basic life support ratio of chest compressions to rescue breaths

A

15:2

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121
Q

Chickenpox school exclusion protocol

A

Exclude until:

  • lesions are dry
  • lesions have crusted over (usually about 5 days after rash onset)
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122
Q

Major complication of Kawasaki disease + investigation

A

Coronary artery aneurysm

- echocardiogram

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123
Q

Inheritance chance of autosomal dominant disease if 1 parent has it and other parent doesn’t have it

A

50%

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124
Q

Asthma in child <5 not controlled with SABA and low-dose ICS - next step?

A

Add leukotriene receptor antagonist (montelukast)

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125
Q

Asthma not controlled by SABA, ICS, leukotriene receptor antagonist - next step?

A 
Stop leukotriene receptor antagonist
Add LABA (long-acting beta-agonist)
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126
Q

Management of VZV exposure if immunosuppressed

A

VZIG

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127
Q

Causes of snoring in children

A 
Obesity
Nasal problems 
Recurrent tonsillitis
Down's
Hypothyroidism
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128
Q

What is Kallman’s syndrome

A

Delayed puberty secondary to hypogonadotrophic hypogonadism

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129
Q

Management step after general advice and rewards systems

A

Enuresis alarm

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130
Q

Management of DDH

A

Most spontaneously stabilise by 3-6 wks
Pavlik harness if <4-5 mths
Older children may require surgery

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131
Q

Pavlik harness description

A

Dynamic flexion-abduction orthosis

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132
Q

Test if neonate has abnormal hearing test at birth

A

Offered auditory brainstem response test as a newborn/infant

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133
Q

Investigation of choice in ?intussusception

A

Ultrasound

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134
Q

Pain in legs with no obvious cause or worrying features. Diagnosis?

A

Growing pains

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135
Q

Management of appendicitis

A

Appendicectomy

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136
Q

Management of necrotising enterocolitis

A

Medical management

Laparotomy if deteriorates

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137
Q

Management of intussusception

A

Pneumatic reduction under fluoroscopic guidance

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138
Q

Most common childhood leukaemia + triad of presenting symptoms/signs

A

Acute lymphoblastic leukaemia

Anaemia + neutropenia + thrombocytopenia

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139
Q

Management of exomphalos vs gastroschisis

A

Exomphalos - gradual repair (staged closure starting immediately with completion at 6-12 mths)
Gastroschisis - URGENT correction required

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140
Q

Achondroplasia inheritance pattern + outcomes for potential children

A

Autosomal dominant
25% normal
50% affected heterozygous
25% affected homozygous (die in first months)

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141
Q

Investigation for ?slipped upper femoral epiphysis

A

Hip x-ray

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142
Q

Investigation for ?DDH

A

US hip

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143
Q

?Perthe’s disease investigation

A

MRI scan

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144
Q

When should parents call an ambulance in the event of a febrile child’s seizure

A

If convulsion (febrile remember) lasts >5 MINS

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145
Q

Hirschsprung’s disease management

A

Rectal washouts/bowel irrigation

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146
Q

Neurological disease Down syndrome associated with later in life

A

Alzheimer’s disease

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147
Q

Management of umbilical hernias in children

A

Usually self-resolve
If large + symptomatic = elective repair at 2-3 y/o
If small + asymptomatic = elective repair at 4-5 y/o

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148
Q

Characteristic clinical progression of roseola infantum

A

Fever FOLLOWED BY rash (fever can start resolving before rash appearance)

149
Q

Number 1 cause of massive PAINLESS GI bleeding in children between 1-2y/o + management

A

Meckel’s diverticulum

Requires transfusion

150
Q

Advice to give CF patients concerned about recurrent infections

A

Avoid other CF patients

151
Q

Androgen insensitivity classic presentation

A

Primary amenorrhoea but secondary sexual characteristics have started

152
Q

Triad of shaken baby syndrome

A

Retinal haemorrhages
Subdural haematoma
Encephalopathy

153
Q

Triad of ALL

A

Anaemia
Neutropenia
Thrombocytopenia

154
Q

Commonest red flag in children with a fever

A

Moderate to severe intercostal recession

155
Q

Chest compression technique in infants and children aged 1-puberty

A

Infants - 2 thumb circling technique

1-puberty - 1 hand on lower half of sternum

156
Q

Perthes disease aetiology + triad

A

Avascular necrosis of femoral head

Progressive hip pain, limp, stiffness

157
Q

Initial management of duct dependent congenital heart disease

A

Prostaglandins to keep ductus arteriosus open

158
Q

Management of patent ductus arteriosus with no other cardiac defects

A

Indomethacin given to neonate postnatally to close the duct (not to mother during antenatal)

159
Q

Most common CO for early-onset (<48 hrs post-birth) neonatal sepsis

A

GBS

160
Q

Diagnostic investigation for necrotising enterocolitis

A

Abdo XR

161
Q

Inherited disease associated with neonatal hypotonie

A

Prader-Willi syndrome

162
Q

Sites prone to dermoid cyst formation

A

Sites of embryonic fusion

163
Q

CF can cause…

A

Diabetes mellitus

164
Q

FSH/LH levels in gonadotrophin independent precocious puberty

A

Both LOW

165
Q

School attendance advice for child with impetigo

A

Exclude from school until lesions are crusted and healed
or
48 hours after commencing ABx treatment

166
Q

Age at which autism normally apparent

A

3 years

167
Q

Diet advice in CF

A

High calorie + high fat + pancreatic enzyme supps EVERY meal

168
Q

10 years old with constipation, management

A

Likely dietary cause so dietary advice (increase fibre + fluids)
Laxative - osmotic to soften then stimulant to pass stool

169
Q

Rocker-bottom feet feature of which trisomy

A

Edward’s syndrome/trisomy 18

170
Q

Necrotising fasciitis CO

A

Beta-haemolytic GAS

171
Q

Additional scan required for all babies breech at 36+ wks regardless of delivery method + what date post-birth

A

USS for DDH screening at 6 wks

172
Q

LFT raised in biliary atresia

A

Conjugated bilirubin

173
Q

When not to use antidiarrhoeal meds in children

A

Don’t use if <5 with D&V caused by gastroenteritis

174
Q

Rotavirus vaccine type of vaccine

A

Oral + live + attenuated vaccine

175
Q

Most common complication of measles

A

Otitis media

176
Q

Investigation for ?SUFE (slipped upper femoral epiphysis)

A

AP + frog-leg view x-ray

177
Q

General trend for types of conditions inherited in an autosomal recessive/dominant manner (AR/AD)

A

Metabolic - AR

Structural - AD

178
Q

Steps in eczema management

A

Topical emollient
Topical steroid
Wet wrapping
Oral ciclosporin

179
Q

Cause of Ebstein’s anomaly

A

Use of lithium in pregnancy

180
Q

Heart murmur in Ebstein’s anomaly

A

Pan-systolic murmur + mid-diastolic murmur

181
Q

Features of atypical UTI in infants <6mths

A 
Seriously ill
Poor urine flow
Abdo/bladder mass
Raised creatinine
Septicaemia
Failure to respond to suitable abx in 48 hours
Infx with non-e.coli CO
182
Q

Newborn resus algorithm

A

Dry baby + start clock
Assess tone, breathing, HR
If gasping/not breathing give 5 inflation breaths
Reassess for increase in HR (want this, if no increase then give better inflation breaths)
If chest not moving get 2 people.
If chest moving but no HR then chest compressions 3:1 to 1 inflation breath
Reassess HR every 30 secs

183
Q

FAP inheritance pattern

A

Autosomal dominant

184
Q

Heel prick test date + diseases tested for

A

Day 5 of life

CF, congenital hypothyroid, sickle cell disease, other metabolic diseases

185
Q

Positive heel prick test result for CF

A

Raised immunoreactive trypsinogen (IRT)

186
Q

Next step if positive heel prick test for CF

A

Sweat test (high in CF)

187
Q

Key feature of irritant dermatitis (nappy rash)

A

Flexural sparing

188
Q

Factors in CF associated w/increased morbidity + mortality

A

Chronic infections with Pseudomonas and Burkholderia species

189
Q

Exacerbation of asthma treatment in child

A

Oral prednisolone for 3 days

190
Q

Elfin facies, strabismus, broad forehead, short stature

A

William’s syndrome

191
Q

Bowel sounds (tinkling when listening to chest) on RESP exam of neonate = ?

A

Congenital diaphragmatic hernia

192
Q

Commonest CO of bacterial pneumonia in children

A

Strep pneumoniae

193
Q

Triad seen in tetralogy of fallot

A

Cyanosis/collapse in 1st month of life
Hypercyanotic spells
Ejection systolic murmur at left sternal edge

194
Q

Investigation if ?West syndrome/infantile spasms

A

EEG - hypsarrhythmia

195
Q

Caput succedaneum features + prognosis

A

Soft, puffy swelling of the scalp due to localised oedema. Crosses suture lines
No treatment needed - resolves in a few days

196
Q

Cause of caput succedaneum

A

May be due to mechanical trauma to initial portion of scalp pushing through cervix in prolonged delivery or if VACUUM used (ventouse delivery)

197
Q

Gender split for Perthes’ disease

A

5: 1
boys: girls

198
Q

Sandpaper rash = ?

A

Scarlet fever

199
Q

Treatment for Kawasaki disease

A

High dose aspirin

Single dose of IV Ig

200
Q

Vaccines given at 2 months

A

6-1
Men B
Rotavirus

201
Q

Components of 6-1 vaccine

A 
Diphtheria
Tetanus
Whooping cough
Polio
Hib
Hep B
202
Q

Vaccines at 12-13 months

A

Hib/Men C
MMR
PCV
Men B

203
Q

Loss of red reflex in child + FHx of enucleation

A

Retinoblastoma

204
Q

Vaccines offered to women 16-32 wks pregnant

A

Pertussis + influenza vaccine

205
Q

Features of a LIFE-THREATENING asthma attack (6)

A 
Cyanosis
Poor resp effort 
PEF <33% of normal
Silent chest
Altered level of consciousness
PO2 <92%
206
Q

Indication of poor resp effort in life-threatening asthma attack

A

NORMAL pCO2 (4.8-6)

207
Q

Treatment for ?bacterial meningitis in children

A

<3mths - IV cefotaxime + amox/amp

>3mths - IV ceftriaxone (add vanc if recent travel)

208
Q

RFs for infants to develop RSV

A

Prematurity
Lung or heart abnormalities
Immunocompromise

209
Q

Treatment for prevention of RSV in infants (with RFs for severe disease)

A

Palivizumab (monoclonal ab for RSV prevention)

210
Q

Dates for Men B vaccine admin

A

2, 4, 12-13 months

211
Q

Small chin (micrognathia), posterior displacement of tongue, cleft palate

A

Pierre-Robin syndrome

212
Q

3M, learning difficulties, supravalvular aortic stenosis

A

William’s syndrome

213
Q

Micrognathia (small chin) + rocker-bottom feet

A

Edward’s syndrome

214
Q

Baby jittery + hypotonic = ?

A

?Neonatal hypoglycaemia

215
Q

RF for neonatal hypoglycaemia + management

A

Maternal labetalol use

Measure blood glucose

216
Q

Vaccine at 12-13 years

A

HPV for boys AND girls

217
Q

Difference between early and late shock in children

A

Early = compensated = reversible
Late = decompensated = (may be) irreversible
Difference lies in BLOOD PRESSURE - low = decomp

218
Q

Visible LUQ peristalsis in unwell child

A

Pyloric stenosis

219
Q

LP findings = bacterial meningitis

A

Non-turbid
High protein
High WBC
Gram-positive organism

220
Q

Teenage (13-18) vaccines

A

Men ACWY

3-1 (tetanus, diphtheria, polio)

221
Q

Painless haematuria + palpable non-tender mass + reduced appetitie + distended abdomen

A

Wilms’ tumour

222
Q

Management of child with limp + hip pain + fever in GP

A

Refer for same-day hospital assessment

- ?transient synovitis

223
Q

Age 3-8 with hip pain after being unwell recently

A

Transient synovitis

224
Q

4 core components in Child Health Promotion Program (early life checkups)

A

Newborn clinical exam
Newborn hearing test
Heel prick 5-9 days
GP exam 6-8 weeks

225
Q

Treatment for biliary atresia (child + conjugated hyperbilirubinaemia)

A

Early surgical treatment

226
Q

RIF pain differentials + dist features

A

Appendicitis - abdo tenderness + guarding
Pyelonephritis - positive urine dip
Intussusception - <9mths + colic pain
Mesenteric adenitis - no abdo tenderness/guarding + post-viral infx
Meckel’s diverticulum - like appendicitis but with severe pain + around 2yo

227
Q

Criteria for admission in ?bronchiolitis

A

Apnoea (observed/reported)
Persistent O2 sats <92%
<50% normal fluid intake
Resp distress (grunting, marked chest recession, RR >70)

228
Q

Height centile for referral to paediatrician

A

≤0.4th height centile

229
Q

Investigation of jaundice in first 24hrs of life

A

Urgent serum bilirubin

230
Q

Features of growing pains

A

Not present start of day
No limp or limitation of physical activity
Systemically well
Normal O/E
Motor milestones normal
Sx often intermittent + worse after day of vigorous exercise

231
Q

Children of affected males in x-linked recessive inheritance patterns

A

Unaffected sons

Carrier daughters

232
Q

Children of heterozygous female carrier of x-linked recessive inheritance patterns

A

Males - 50% chance of being affected

Females - 50% chance of being a carrier

233
Q

Commonest cause of cardiac arrest in children

A

Respiratory - hypoxic cardiac arrest (choking v common)

234
Q

Management of PDA in cyanotic and acyanotic congenital heart disease

A

Cyanotic - prostaglandin E1 (maintain PDA to allow oxygenated blood to reach systemic circulation)
Acyanotic - indomethacin to close PDA

235
Q

Name of newborn hearing test

A

Otoacoustic emission test

236
Q

Management of hand, food, and mouth disease

A

Symptomatic treatment only

237
Q

Scenarios where vaccinations are delayed or given in a different setting

A

Vaccines delayed if FEBRILE illness/intercurrent infection

Vaccines given in hospital if born <28 weeks (risk of apnoea)

238
Q

Infantile spasms/West syndrome prognosis

A

Poor prognosis

239
Q

Management of child <3 y/o with acute limp

A

Urgent hospital assessment (risk of septic arthritis or maltreatment)

240
Q

Differentials for jaundice in first 24hrs of life

A

Rhesus haemolytic disease
ABO incompatibility
G6PD deficiency
Hereditary spherocytosis

241
Q

Investigation in jaundice in first 24 hrs of life

A

Blood film analysis

242
Q

Triad for biliary atresia

A

Presents in FIRST few weeks of life

  • jaundice
  • appetite disturbance
  • growth disturbance
243
Q

Chance of male-to-male transmission of X-linked recessive conditions

A

0% (inherit the unaffected Y chromosome)

244
Q

Webbed neck + pectus excavatum

A

Noonan syndrome

245
Q

Small eyes + polydactyly

A

Patau syndrome

246
Q

Learning difficulties + macrocephaly

A

Fragile X

247
Q

Management of GORD in children

A

2 week trial of thickened formula or alginate therapy (Gaviscon)
4 week trial of PPI if refractory

248
Q

Murmur in Turner’s

A

Ejection systolic (bicuspid aortic valve)

249
Q

Management of acute epiglottitis

A

Involve seniors
Endotracheal intubation to protect airway
O2
IV abx

250
Q

Management of viral-induced wheeze

A

Symptomatic first-line
Short-acting beta 2 agonists (salbutamol) via spacer
Intermittent leukotriene receptor antagonist (montelukast) or corticosteroids

251
Q

Management of any acute asthma attack

A

Bronchodilator + steroids

  • inhaled broncho via spacer or mask if <3 (refer to hosp if beta-2 agonist doesn’t control)
  • oral steroids for 3-5 days
252
Q

Oral prednisolone dosage for acute asthma attack in children

A 
2-5y = 20mg OD or 1-2mg/kg OD (max 40mg)
>5y = 30-40mg OD or 1-2mg/kg OD (max 40mg)
253
Q

Jelly-like stool

A

Intussusception

254
Q

Strawberry tongue + cracked red lips

A

Kawasaki disease

255
Q

Do antipyretics prevent febrile convulsions?

A

No

256
Q

Criteria for considering hospital referral in ?bronchiolitis

A

RR >60
Decreased oral/fluid intake 50-75% normal
Clinical dehydration

257
Q

RF for meconium aspiration

A

Post-term delivery

258
Q

Scarlet Fever CO

A

Group A haemolytic strep

259
Q

When to admit child with croup

A

Moderate or severe croup
<6mths old
Laryngomalacia/Down’s
Uncertain about diagnosis

260
Q

Ix + ?Dx if child with calf hyperplasia + positive Gowers test

A

Genetic analysis

MLDx - Duchenne muscular dystrophy

261
Q

Key side-effects of methylphenidate (ADHD treatment)

A 
Stunted growth
Insomnia
WL
Anxiety
Nausea
Pain
262
Q

Pain character in Osgood-Schlatter disease

A

Unilateral (30% bilateral)
Gradual onset + progressive
Pain relieved at rest and made worse by kneeling/activity

263
Q

3d fever + new rash now afebrile MLDx + CO

A

Roseola infantum

HHV6

264
Q

H F &M disease CO

A

Coxsackie A16

265
Q

Potential cause of elevated bilirubin at birth

A

Bruising (forceps delivery)

266
Q

Difference between gastroschisis and omphalocele

A

Gastroschisis - lateral to umbilicus

Omphalocele - umbilicus

267
Q

Gastroschisis lifestyle association

A

Socioeconomic deprivation - maternal age <20 + alcohol/tobacco use

268
Q

Most common location of urethral location in hypospadias

A

Distal ventral surface of penis

269
Q

Neonate w/poor feeding + grunting + lethargy =

A

Neonatal sepsis!!

270
Q

Chest comp:ventilations ratio for paeds BLS + rate of chest comp

A

30:2 if lay person
15:2 if 2+ qualified rescuers
Give 100-120 comps per min

271
Q

Rule for disclosing information about sexual activity in children <13

A

if <13 then share - considered not able to consent

272
Q

Phenotype + genetic in androgen insensitivity syndrome

A

Female despite genetically XY

273
Q

Masses palpable in androgen insensitivity syndrome

A

Undescended testes

274
Q

Difference between meconium ileus and Hirschsprung’s disease

A

Meconium ileus - ABDO DISTENSION

275
Q

Common neonatal feature of CF

A

Meconium ileus (abdo distension + bil vomiting)

276
Q

2 main features of congenital rubella syndrome

A

Sensorineural deafness

Congenital cataracts

277
Q

Protocol for review of undescended testicle

A

Review 6-8 wks after birth
Review at 3 months
Refer to paed surgeon if still present at 3 months

278
Q

Preceding factor for idiopathic thrombocytic purpura

A

Self-limiting viral infection (e.g. glandular fever)

279
Q

CO for erythema infectiosum/slapped cheek syndrome

A

Parvovirus B19

280
Q

Most common presenting feature of Wilms tumour

A

Painless palpable abdominal mass

281
Q

If need to provide emergency treatment for a child, what consent do you need?

A

None - ‘you can provide emergency treatment without consent to save the life of, or prevent serious deterioration int he health of, a child or young person’
So do it if absolutely necessary and in their best interests

282
Q

Intramural gas/pneumatosis intestinalis on AXR =

A

Necrotising enterocolitis

283
Q

Initial intervention to reduce brain daamge in neonates with hypoxic injury

A

Therapeutic COOLING

  • 33-34 for whole body
  • 34-35 for selective head
284
Q

Seizures that happen at night, usually affect the face, in a child otherwise normal

A

Benign rolandic epilepsy

285
Q

Leukaemia Down’s patients are most at risk of

A

ALL

286
Q

Diarrhoea with undigested food in a toddler =

A

Toddlers diarrhoea or ‘chronic nonspecific diarrhoea’

287
Q

Pulmonary hypoplasia associated with…

A

Congenital diaphragmatic hernia

288
Q

Management of febrile convulsions at home

A

Remove excess clothing, give fluids, and give antipyretics ONLY if child is uncomfortable (no active cooling)

289
Q

Investigation in ?pyloric stenosis

A

Abdominal ultrasound

290
Q

6in1 vaccine dates

A

2,3,4 months (8,12,16 weeks)

291
Q

5 S’s of innocent murmurs in children

A 
Soft
Systolic
Short
Symptomless
Standing/Sitting (vary with position)
292
Q

Continuous blowing noise just below clavicles

A

Venous hum (innocent murmur)

293
Q

Low-pitched sound heard at lower left sternal edge

A

Still’s murmur (innocent murmur)

294
Q

Diagnostic test for Coeliac disease

A

IgA TTG antibodies

295
Q

CF inheritance pattern

A

Autosomal recessive

296
Q

Emergency treatment for croup (sats <90)

A

O2 + Neb adrenaline

297
Q

School exclusion for whooping cough

A

2 days post-antibiotic start

21 days post-symptom start

298
Q

School exclusion for roseola

A

No exclusion

299
Q

Infant vs child presentation of whooping cough

A

Infants - cyanotic apnoeic periods instead of the “whoop” inspiration

300
Q

Cyanotic congenital heart disease - TGA vs TOF

A 
TGA = CCHD presenting in 1st DAYS of life
TOF = CCHD presenting in 1-2 MONTHS of life
301
Q

1st-line for ADHD

A

Methylphenidate

302
Q

Definition of precocious puberty

A

Development of secondary sexual characteristics before 8 years in females and 9 years in males
(more common in females)

303
Q

Thelarche =

A

First stage of breast development

304
Q

Adrenarche =

A

First stage of pubic hair development

305
Q

Management of transient synovitis in otherwise well patient

A

Recommend rest + analgesia

306
Q

Roseola infantum CO

A

Human herpes virus 6

307
Q

Distinguishing feature between epilepsy and reflex anoxic seizures

A

RA seizures = QUICK recovery

Epileptic seizures typically have a prolonged recovery

308
Q

Most common heart lesion associated with Duchenne muscular dystrophy

A

Dilated cardiomyopathy

309
Q

Corrected age calculation for premature babies (wrt development milestones)

A

Age minus the number of weeks born early from 40 weeks

e.g. 32 weeks gestation you add 8 weeks to all the development milestones

310
Q

Inheritance pattern of haemophilia

A

X-linked recessive (only occurs on X chromosomes and is recessive)

311
Q

Investigation for renal scarring in vesicoureteric reflux

A

Radionuclide scan using dimercaptosuccinic acid (DMSA)

312
Q

Cardiac abnormality potential in Fragile X syndrome

A

Mitral valve prolapse

313
Q

Most common presentation of juvenile idiopathic arthritis + definition

A

Pauciarticular/oligoarticular arthritis

- defined as affecting up to 4 different joints (typically larger ones elbows knees etc)

314
Q

Surfactant deficiency preterm or late?

A

PRETERM - prematurity

315
Q

Initial management of congenital diaphragmatic hernia

A

Insertion of NG tube to keep air out of the gut
Intubation + ventilation
Surgical repair of diaphragm (DEFINITIVE Mx)

316
Q

When are babies screened for DDH

A

Newborn check + 6 week check with Barlow and Ortolani tests

317
Q

Ortolani test

A

Attempts to relocate a dislocated femoral head

- DDH

318
Q

Other than Barlow/Ortolani tests, important tests for DDH

A

Leg length symmetry
Level of knees when hips + knees bilaterally flexed
Restricted abduction of hip in flexion

319
Q

Screen for what instability in Down’s

A

Atlanto-axial instability (if child participating in sports placing them at risk of neck dislocation)

320
Q

What to monitor and when in Methylphenidate pt

A

Height + weight every 6 months

321
Q

Definitive management of slipped capital/upper femoral epiphysis

A

In situ fixation with cannulated screw (ortho referral if primary care)

322
Q

Commonest cause of nephrotic syndrome in children + aetiology + management

A

Minimal change glomerulonephritis
Accounts for 80% cases in children and 25% in adults with the majority of cases being idiopathic
Responds well to STEROIDS

323
Q

Disease with prodrome of fever, irritability, and conjunctivitis

A

MEASLES

324
Q

CENTRAL causes of hypotonia in children

A

Down’s
Prader-Willi
Hypothyroidism
Cerebral palsy (hypotonia then spasticity)

325
Q

Head swelling occurring several hours after birth, doesn’t cross suture lines, takes months to resolve

A

Cephalohaematoma

326
Q

Commonest cause of childhood hypothyroidism in UK

A

AI thyroiditis

327
Q

Criteria used to assess probability of septic arthritis in children

A

Kocher’s criteria

328
Q

Hip pain in short child + hyperactivity between 3-8 years

A

Perthes disease

329
Q

Child can consent to treatment but not…

A

REFUSE treatment

330
Q

Causes of obesity in children

A 
GH deficiency
Hypothyroidism
Down's
Cushing's
Prader-Willi
331
Q

Motor neurons damaged in cerebral palsy

A

Upper motor neurones in periventricular white matter

332
Q

Inheritance pattern in disease where all familial females are affected and inheritance stops abruptly in men (children of these men unaffected)

A

MITOCHONDRIAL inheritance (affected man can’t pass this on to kids)

333
Q

Lumbar puncture contraindicated in…

A

Meningococcal septicaemia

334
Q

Commonest child abuse fractures

A

Radial, humeral, femoral

335
Q

Management of phimosis (foreskin swelling + inability to retract)

A

<2 - reassure normal and may resolve over time

>2 - if recurrent + UTI or balanoposthitis then treat

336
Q

Atrialisation of the right ventricle

A

Ebstein’s anomaly (small RV + large RA)

337
Q

Osteochronditis caused by inflammation (apophysitis) at tibial tuberosity

A

Osgood-Schlatter disease

338
Q

Fever + stridor + SoB caused by haemophilus influenzae B

A

Acute epiglottitis

339
Q

Cyanosis/collapse in 1ST MONTH of life + ejection systolic murmur

A

Tetralogy of Fallot

340
Q

White nodules on posterior hard palate/roof of mouth along the midline commonly mistaken for neonatal teeth

A

Epstein’s pearls (no tx required)

341
Q

Congenital infection, perinatal brain injury, fetal alcohol syndrome, Patau syndrome, craniosynostosis, familial, normal variation

A

MICROcephaly causes

342
Q

Childhood infection commonly associated with pneumonia developing immediately after initial infection

A

Measles

343
Q

Slight forward lean + normal RR + fever

A

?Acute epiglottitis

344
Q

Childhood disease indicated for Echocardiogram + why

A

Kawasaki disease

- coronary artery aneurysms are a complication need to be screened for

345
Q

Commonest cause of ambiguous genitalia in newborns

A

Congenital adrenal hyperplasia

346
Q

Commonest cause of overgrowth of tissue in umbilicus in first weeks of life

A

Umbilical granuloma

347
Q

Tx for overgrowth of tissue that occurs during healing process of umbilicus

A

Regular application of salt to wound or cauterisation with silver nitrate
- umbilical granuloma

348
Q

Drug risk in chickenpox

A

NSAIDs - necrotising fasciitis

349
Q

Term for death in first 28 days of life

A

Neonatal death
(early = <7 days)
(late = >7 days)

350
Q

Term for maternal death in first 6 weeks after birth

A

Puerperal death

351
Q

Best practice administration of vit K to newborns

A

Once-off IM injection

352
Q

Age bracket of febrile convulsion incidence (+ typical age of stopping)

A

6mths to 5 years

Usually stop having these at 5 years

353
Q

Minutes of age APGAR assessed

A

1, 5, 10 mins of age

354
Q

Management of palpable painless abdominal mass in child <5 yrs, typically around 3 yrs

A

Speak to local paediatrician as could be Wilm’s tumour

355
Q

Unexplained lump/swelling + unexplained bone pain

A

?Osteosarcoma (rare)

356
Q

Precocious puberty + small testes = ?

A

Adrenal cause of symptoms (i.e. adrenal hyperplasia)

357
Q

Trident hands in child = ?

A

Achondroplasia

358
Q

Clinical findings suggestive of child sexual abuse

A

Anal fissures

Recurrent UTIs

359
Q

Condition associated with nasal polyps + recurrent respiratory infections requiring hospitalisation

A

Cystic Fibrosis

360
Q

Necessary investigation in newborn <24hrs with jaundice + high risk for hyperbilirubinaemia

A

Measure SERUM BILIRUBIN within 2 hours

361
Q

Management of ADHD

A

10 wks watch and wait
If persist then secondary care referral
Educate on normal balanced diet (no need for special foods if food diary has not demonstrated a link between those foods and behaviour)
Methylphenidate if unsuccessful

362
Q

When are BCG, Men ACWY, yellow fever, and Hep A vaccines offered to children?

A

BCG - given to <1yrs born in area of UK with high TB rate or parents/grandparents born in country with high rates of TB

Men ACWY - teenagers going uni for first time

Yellow fever - given to >1yrs arriving from sub-Saharan Africa or tropical South America

Hep A - given to >1yrs travelling to Africa, Asia, Central/South America

363
Q

Investigations in fever <3mth child workup

A 
FBC
Blood culture
CRP
Urine dip for UTI
CXR if resp signs present
Stool culture if diarrhoea present
364
Q

Mass in anterior triangle of neck in midline below hyoid. Rises on protrusion of tongue + swallowing

A

Thyroglossal cyst

365
Q

Syndrome that’s the commonest cause of inherited neurodevelopmental delay and is associated with ADHD. Presents around puberty

A

Fragile X syndrome

366
Q

Drug use in pregnancy that can cause orofacial clefts

A

Anti-epileptics

367
Q

Peak incidence of ALL

A

2-5yrs

368
Q

Major RFs for sudden infant death syndrome

A 
Prone sleeping
Parental smoking
Bed sharing
Hyperthermia and head covering
Prematurity

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