Pediatrics Flashcards
(501 cards)
1
Q
How does scarlet fever typically present?
A
1.Fever- 24-48 hours
2.Strawberry tongue
3.Sandpaper rash over trunk and extremities
4.Cervical lymphadenopathy
5. Pharangitis (sore throat)
6. Circumoral pallor
Headache
2
Q
Management for scarlet fever?
A
Oral penicillin for 10 days
(Azithromycin in patients with penicillin allergy)
3
Q
What is transient synovitis?
A
Acute hip pain following a viral infection
4
Q
What is the typical age range for transient synovitis?
A
3-8 years
5
Q
What is the treatment for transient synovitis?
A
Rest and analgesia
6
Q
What causes chicken pox?
A
Varicella zoster virus
7
Q
What are the criteria needed for diagnosis of Kawasaki disease?
A
4 of the following 5 features must be present along with a fever for >5 days:
Bilateral conjunctivitis
Cervical lymphadenopathy
Polymorphic rash
Cracked lips/strawberry tongue
Oedema/desquamation of the hands/feet
8
Q
Why is aspirin not normally used in children?
A
Risk of Reye’s syndrome
9
Q
What is the management for Kawasaki disease?
A
High dose aspirin
Intravenous immunoglobulin
Echocardiogram (screen for coronary artery aneurysms)
10
Q
What is the main complication of Kawasaki disease?
A
Coronary artery syndrome
11
Q
What is the difference between primary amenorrhoea and secondary amenorrhoea
A
Primary- never started periods
Secondary- had regular periods but have stopped
12
Q
What is the average age of diagnosis for a retinoblastoma?
A
18 months
13
Q
What is the most common feature of a retinoblastoma?
A
Loss of red reflex- replaced with white
14
Q
What is the management of a retinoblastoma?
A
Enucleation
Radiation beam therapy
Chemotherapy
15
Q
What causes precocious puberty with small testes?
A
Adrenal hyperplasia
16
Q
What are the features of ALL in children?
A
Anaemia (lethargy), neutropenia (frequent/severe infections), thrombocytopenia (easy bruising). Bone pain, splenomegaly, hepatomegaly
17
Q
Which virus causes hand, foot and mouth?
A
Coxsackie virus A16 and Enterovirus 71
18
Q
What are the features of hand, foot and mouth?
A
Systemic illness and oral ulcers followed by hand and feet rash
19
Q
What is the treatment for pyloric stenosis?
A
Ramstedt pyloromyotomy
20
Q
When is transient tachypnoea of the newborn more common?
A
Following a caesarean section
21
Q
What does a chest x-ray show in transient tachypnoea of the newborn?
A
Hyperinflation of the lungs and fluid in the horizontal fissure
22
Q
What is the management of transient tachypnoea of the newborn?
A
Supportive
Supplemental oxygen if required
23
Q
What are the features of pyloric stenosis?
A
Projectile vomiting
Olive shaped mass
Constipation, dehydration, willingness to feed, failure to thrive
Hypochloraemic, hypokalaemic alkalosis due to vomiting
24
Q
How do you diagnose pyloric stenosis?
A
USS
25
What is the first line treatment for constipation?
Polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)
2nd- Add a stimulant laxative
3rd- Substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose
26
Which conditions make bronchiolitis more serious?
Bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis
27
What are the presenting features of CF?
Neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
Recurrent chest infections (40%)
Malabsorption (30%): steatorrhoea, failure to thrive
Other features (10%): liver disease
28
Name some other features of CF?
Short stature
Diabetes mellitus
Delayed puberty
Rectal prolapse (due to bulky stools)
Nasal polyps
Male infertility, female subfertility
29
Which vaccine do boys and girls get at 12-13 years old?
The HPV vaccine
30
Precocious puberty in males may be defined as the development of secondary sexual characteristics before what age?
9 years
31
Precocious puberty in females may be defined as the development of secondary sexual characteristics before what age?
8 years
32
What are the causes of jaundice within the first 24 hours of life?
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
Glucose-6-phosphodehydrogenase
33
What are the causes of prolonged jaundice (present at over 14 days of life)?
Biliary atresia
Hypothyroidism
Galactosaemia
Urinary tract infection
Breast milk jaundice
Prematurity
Congenital infections e.g. CMV, toxoplasmosis
34
What are febrile convulsions?
Febrile convulsions are seizures provoked by fever in otherwise normal children.
35
Between what ages do febrile convulsions typically occur?
Between the ages of 6 months and 5 years
36
What urgent rescue medication should be used for febrile convulsions?
Rectal diazepam or buccal midazolam
37
Write out the immunisation program
A
38
Write out the developmental milestones
A
39
Where are hand, foot and mouth lesions found?
Mouth, hands, feet, buttocks, groin
40
What is the autism triad?
Communication impairment + impairment of social relationships + ritualistic behaviour
41
What is the investigation for pyloric stenosis?
US Abdomen
42
What investigation would you do for Kawasaki disease complications?
Echocardiogram for coronary artery aneurysms
43
Aspirin is normally contraindicated in children due to the risk of Reye's syndrome, for what disease is it used?
Kawasaki disease
44
What is the most common complication of measles?
Otitis media
45
What are the features of measles?
Prodromal phase- irritability, conjunctivitis, fever
Koplik spots- white spots on buccal mucosa
Rash- Starts behind ears and spreads to whole body, discrete macropapular rash that becomes blotchy
Diahorroea in 10% of patients
46
What is the management of measles?
Supportive treatment
Admission considered in immunosuppressed patients
Notifiable disease- tell public health
MMR offered/given to contacts within 72 hours
47
What are the complications of measles?
Otitis media- most common complication
Pneumonia- most common cause of death
Encephalitis- 1-2 weeks after illness onset
Subacute sclerosing encephalitis- rare and presents 5-10 years after illness
48
What organism is threadworm caused by?
Enterobius vermicularis
49
What symptoms are indicative of threadworm?
Perianal itching, particularly at night- potentially affecting family members
Girls may have vulval symptoms
50
What is the management of threadworm?
Hygiene for household and anthelmintic- mebendazole in children over 6 months
51
What are the features of an atypical UTI?
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E. coli organisms
52
What are the features of GORD?
Typically develops before 8 weeks
Vomiting/regurgitation
Excessive crying, especially while feeding
53
What is the management of GORD?
Advise on overfeeding and position during feeds
Trial a thickened formula
Trial alginate therapy
54
What are the features of Turner's syndrome?
Short stature
Webbed neck
Bicuspid aortic valve, coarctation of the aorta
Primary amenorrhoea
Lymphoedema in neonates
Gonadotrophin levels will be elevated
Horseshoe kidney
High arched palate
55
Generally what level is neonatal hypoglycaemia?
<2.6 mmol/L
56
What can cause neonatal hypoglycaemia?
Preterm birth (< 37 weeks)
Maternal diabetes mellitus
IUGR
Hypothermia
Neonatal sepsis
Inborn errors of metabolism
Nesidioblastosis
Beckwith-Wiedemann syndrome
57
What is the management of neonatal hypoglycaemia?
Asymptomatic- encourage normal feeding and monitor blood glucose
Symptomatic or very low- admit to neonatal unit and administer 10% dextrose
58
What are the features of croup?
Stridor
Barking cough (worse at night)
Fever
Coryzal symptoms
59
What is the management of croup?
Single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
Emergency treatment with high flow oxygen and nebulised adrenaline if necessary
60
Difference between getting prader-willi and angelman syndrome
Prader-Willi syndrome if gene deleted from father
Angelman syndrome if gene deleted from mother
61
Prader willi features
Hypotonia during infancy
Dysmorphic features
Short stature
Hypogonadism and infertility
Learning difficulties
Childhood obesity
Behavioural problems in adolescence
62
What inheritance pattern is prader willi an example of?
Imprinting
63
What are the features of patent ductus arteriosus?
Left subclavicular thrill
Continuous 'machinery' murmur
Large volume, bounding, collapsing pulse
Wide pulse pressure
Heaving apex beat
64
What is the management of patent ductus arteriosus?
Give indomethacin or ibuprofen
65
What keeps PDA open?
Prostoglandin E1- until surgery can be done if associated with congenital heart defects
66
What inheritance pattern is haemophillia A?
X linked recessive- only effects males (apart from Turners syndrome) and X always comes from mother
67
What is the triad of shaken baby syndrome?
Retinal haemorrhages, subdural hematoma and encephalopathy
68
What are the risk factors for neonatal sepsis?
Mother who has had a previous baby with GrouoBStrep infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy
Premature (<37 weeks): approximately 85% of neonatal sepsis cases are in premature neonates
Low birth weight (<2.5kg): approximately 80% are low birth weight
Evidence of maternal chorioamnionitis
69
What is the main cause of neonatal sepsis in the UK?
Group B Streptococcus
70
What is the presentation of neonatal sepsis?
Respiratory distress
Tachycardia
Apnoea
Change in mental status
Jaundice
Seizures
Poor feeding
Abdominal distention
Vomiting
Temperature
71
What are the risk factors for surfactant deficient lung disease (respiratory distress syndrome)?
Male
Diabetic mother
Caesarean section
Second born of premature twins
72
What does x-ray show in respiratory distress syndrome?
Ground glass appearance
73
What features are indicative of slipped capital femoral epiphysis (SCFE)?
Obesity, unilateral groin pain, trauma, loss of internal rotation of the leg in flexion
74
What bacteria causes whooping cough?
Bordetella pertussis
75
What are the diagnostic criteria for whooping cough?
(Lots of coughing fits)
Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features:
Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.
76
Is whooping cough a notifiable disease?
Yes
77
What is the management for whooping cough?
Admitted if under 6 months
Notify public health
Oral macrolide (azithromycin) if onset of cough within 21 days to reduce spread
Household contacts offered antibiotic prophylaxis
Antibiotic therapy does not alter course of illness
School exclusion for 48 hours after initiation of antibiotics or for 21 days if no antibiotics
78
What are the complications of whooping cough?
Subconjunctival haemorrhage
Pneumonia
Bronchiectasis
Seizures
79
What are some high risk symptoms in children?
Pale/mottled/ashen/blue
No response to social cues
Appears ill to healthcare professional
Does not wake or if roused does not stay awake
Weak, high pitched or continuous cry
Grunting
Resp rate > 60
Moderate or severe chest indrawing
Reduced skin turgor
Under 3 month with temp over 38
Non blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures
80
What is the most common cause of cardiac arrest in children?
Respiratory problems (Hypoxia)
81
What is the first line management for cow's milk protein allergy?
Extensive hydrolysed formula
2nd- Amino acid based formula
82
When does CMPA present?
Within the first 3 months
83
How does CMPA/CMPI present?
CMPA- immediate IgE mediated, CMPI- delayed non-IgE mediated
Regurgitation and vomiting
Diarrhoea
Urticaria, atopic eczema
Colic symptoms: irritability, crying
Wheeze, chronic cough
Rarely angioedema and anaphylaxis may occur
84
What are the components of APGAR?
APGAR is an mnemonic for the assessment of:
Appearance (colour)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
85
What is the RR and HR of healthy infants?
RR- 30-60
HR- 100-160
86
What are the symptoms of necrotising enterocolitis?
Feeding intolerance, abdominal distension, bloody stools which can progress to abdominal discolouration, perforation and peritonitis
87
What is the investigation for necrotising enterocolitis and what does it show?
X-rays-
Dilated bowel loops
Bowel wall oedema
Pneumatosis intestinalis (intramural gas)
Portal venous gas
Pneumoperitoneum resulting from perforation
Air both inside and outside of the bowel wall (Rigler sign)
Air outlining the falciform ligament (football sign)
88
What is the treatment for ADHD?
Behavioural therapy
Drug therapy last resort and in those aged 5 or older
Methylphenidate or lisdexamfetamine
Both drugs are cardiotoxic so ECG before starting them
89
What is the recommended compression to ventilation ratio for a newborn?
3:1
90
What causes roseola infantum?
Human herpes virus 6
91
What are the features of roseola infantum?
High grade fever followed by a maculopapular rash (roses bloom from inside first)
Nagayama spots
Febrile convulsions
Diarrhoea and cough
92
What are the characteristics of a life threatening asthma attack?
SpO2 < 92%
PEF <33% best or predicted
Silent chest
Altered of consciousness
Cyanosis
Agitation
Poor respiratory effort
93
What is the management of cystic fibrosis?
Minimise contact with other CF patients to limit cross infection- Burkholderia cepacia complex and Pseudomonas aeruginosa
Physiotherapy twice daily
High calorie high fat diet
Enzyme supplements for digestion
Potential lung transplantation
94
What is the typical age range for febrile convulsions?
Between 6 months and 5 years
95
What type of seizure is a febrile convulsion most likely to be?
Tonic-clonic seizure
96
What age do infantile spasms present?
4-8 months
97
What are the features of infantile spasms?
Characteristic salaam attacks lasting 1-2 seconds and repeated up to 50 times
Looks like colic
Progressive mental handicap
Poor prognosis- vigabatrin is first line
98
What does the EEG show in infantile spasms?
Hypsarrythmia
99
What syndrome are infantile spasms part of?
West syndrome
100
What are the main causes of chronic diarrhoea in infants?
Cow's milk intolerance
Toddlers diarrhoea- stools vary in consistency- often undigested food
Coeliac disease
Post-gastroenteritis lactose intolerance
101
What is the most common cause of gastroenteritis?
Rotavirus
102
What is the treatment for gastroenteritis?
Avoid dehydration
Rehydration treatment
103
What is the management of chicken pox?
Supportive
Keep cool, trim nails
Calamine lotion
School exclusion- Advise that the most infectious period is 1–2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash).
Immunocompromised and newborns with peripartum exposure should receive varicella zoster immunoglobulin, if chicken pox develops then IV aciclovir should be considered
104
What is the classic electrolyte balance disturbance in pyloric stenosis?
Hypochloremic, hypokalaemic metabolic alkalosis
105
What are the differences between caput succedaneum and cephalohaematoma?
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106
What are the features of epiglottitis?
Rapid onset
High temperature, generally unwell
Stridor
Drooling of saliva
'Tripod' position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position
107
What are the presenting features of cystic fibrosis?
Neonatal period (around 20%): meconium ileus, less commonly Prolonged jaundice
Recurrent chest infections (40%)
Malabsorption (30%): steatorrhoea, failure to thrive
Other features (10%): liver disease
Short stature
Diabetes mellitus
delayed puberty
Rectal prolapse (due to bulky stools)
Nasal polyps
Male infertility, female subfertility
108
What is the combination of a distended abdomen and bilious vomiting suggestive of?
Intestinal malrotaion
109
What are displaced apex beat and decreased air entry suggestive of?
Congenital diaphragmatic hernia
110
What are undescended testes associated with?
Increased risk of infertility, torison and testicular cancer
111
Osgood-Schlatter disease is caused by inflammation of what?
The tibial tuberosity
112
What type of rash is scarlett fever?
Sandpaper rash (rough)
113
What causes rapid onset fever, stridor and drooling?
Acute epiglottis caused by Haemophilius influenzae B
114
What are the components of APGAR score?
Made up acronym
Appearance (colour)
Pulse rate (100+ is good)
Grimace (reflex irritability cry,cough, sneeze)
Activity (muscle tone)
Respiratory rate
Out of 10 points
115
Asthma management for under 5's
1. SABA
2. SABA + Moderate dose ICS
3. SABA +ICS +LTRA
4. Stop LTRA and refer to specialist
116
Asthma management for 5-16 year olds (similar to adults)
1. SABA
2. SABA + ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA
5. SABA + MART (which includes low dose ICS)
6. SABA + MART (Moderate dose)
7. SABA + either high dose ICS (can be part of MART), trial of additional drug such as theophylline or specialist advice
117
How long shoud a febrile seizure last before the ambulance is called?
5 minutes
118
At what age can nocturnal enuresis be diagnosed?
Over 5 years of age
119
What is the management of nocturnal enuresis?
1. Look for causes (diabetes, constipation, UTI)
2. General advice- fluid intake, toileting patterns
3. Reward systems
4. Enuresis alarm
5. Desmopressin
120
What are the meningitis organisms in children?
Neonatal to 3 months:
Group B strep
E.coli
Listeria monnocytogenes
1 month to 6 years:
Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae
Greater than 6 years:
Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)
121
What is atlantoaxial instability?
Unstable neck- down syndrome children more likely to dislocate neck when trampolining, gymnastics and other sports
122
What are the clinical features of downs syndrome?
Face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
Flat occiput
Single palmar crease,pronounced 'sandal gap' between big and first toe
Hypotonia
Congenital heart defects (40-50%, see below)
Duodenal atresia
Hirschsprung's disease
123
What are the later complications of downs syndrome?
Subfertility: males are almost always infertile due to impaired spermatogenesis. Females are usually subfertile, and have an increased incidence of problems with pregnancy and labour
Learning difficulties
Short stature
Repeated respiratory infections (+hearing impairment from glue ear)
Acute lymphoblastic leukaemia
Hypothyroidism
Alzheimer's disease
Atlantoaxial instability
124
Which condition will show pneumatosis intestinalis (intramural gas)?
Necrotising enterocolitis
125
What condition if bowel sounds heard in lung fields on respiratory examination?
Congenital diaphragmatic hernia
126
What is the treatment for croup?
A single dose of oral dexamethosone (0.15mg/kg) given to all children regardless of severity
Prednisone is an alternative
Emergency: high flow oxygen and nebulised adrenaline
127
What causes croup?
Parainfluenza viruses
128
What is cryptorchidism?
Undescended testes
129
What conditions are associated with hypospadias?
Cryptorchidism (undescended testes)
Inguinal hernia
130
What is the management of umbilical hernias?
Very common and usually resolve around 3- watch and wait
Is still present at 2 years arrange surgical referral
131
What causes acute epiglottitis?
Haemophilus influenzae type B
132
What are the features of acute epiglottitis?
Rapid onset
High temp/systemically unwell
Stridor
Tripod position
Drooling of saliva
133
How is epiglottitis diagnosed?
Direct visualisation by senior airway trained staff
X-rays done if foreign body concern- lateral view- thumb sign
Posterior-anterior in CROUP is steeple sign
134
How to remember the trisomys
Puberty Starts @ 13 --> Patau
Education Finishes @ 18 --> Edward's
Degree Finishes @ 21 --> Down's Syndrome
134
Epiglottitis management
Immediate senior involvement- airway (endotrachial intubation)
Do not examine throat (potential airway obstruction)
Oxygen
IV antibiotics
135
What could Webbed neck be?
In girls- Turner's syndrome (+short stature/missed periods)
In boys- Noonan syndrome
136
What causes slapped cheek syndrome?
Parvovirus B19
137
Features of hand, foot and mouth?
Mild systemic upset: sore throat, fever
Oral ulcers
Followed by vesicles on palms and soles of the feet
138
Hand, foot and mouth treatment?
Symptomatic treatment
No exclusion
Reassurance no link to cattle disease
139
Treatment for threadworm?
Single dose of mebendazole for the whole house + hygiene advice
140
Is jaundice in the first 24 hours pathological?
Yes always
141
Causes of jaundice in the first 24 hours?
Rhesus haemolytic disease
ABO haemolytic disease
Hereditary spherocytosis
Glucose-6-phosphodehydrogenase
142
Is jaundice common 2-14 days?
Yes
143
What do you do if jaundice still present after 14 days?
Prolonged jaundice screen-
Conjugated and unconjugated bilirubin (raided conjugated could indicate biliary atresia (urgent surgical intervention))
Direct antiglobulin test (Coombs' test)
TFTs
FBC and blood film
Urine for MC&S and reducing sugars
U&Es and LFTs
144
Causes of prolonged jaundice?
Biliary atresia
Hypothyroidism
Galactosaemia
Urinary tract infection
Breast milk jaundice
Prematurity
Congenital infections e.g. CMV, toxoplasmosis
145
Intussusception investigation?
Ultrasound scan
IntUSSusception
146
What sign is seen on USS intussusception?
Target sign
147
Pyloric stenosis presentation
Projectile non-bile stained vomiting at 4-6 weeks
148
Pyloric stenosis diagnosis?
Test feed/USS
149
Pyloric stenosis treatment?
Ramstedt pyloromyotomy
150
Acute appendicitis treatment?
Laparoscopic appendicectomy
151
Intusussception presentationn?
Colicky pain, diarrhoea, vomiting, sausage shaped mass, red jelly stool
152
Age range intusussception?
6-18 months old
153
Investigation for intestinal malrotation?
Upper GI contrast study and USS
154
Intestinal malrotation treatment?
Lapaotomy, if volvulus present or high risk then Ladd's procedure performed
155
Biliary atresia treatment?
Urgent Kasai procedure
156
Diagnosis criteria biliary atresia?
Jaundice>14 days
Increased conjugated bilirubin
157
Difference between gastroschisis and omphalocele?
Gastroschisis is a defect lateral to the umbilicus wheras an omphalocele is a defect of the umbilicus itself
158
What is omphalocele also known as?
Exomphalos
159
What causes rickets?
Malnoutrision- vitamin D deficiency
160
Rickets risk factors?
Dietary deficiency of calcium
Prolonged breast feeding
Lack of sunlight
161
Features of rickets?
Aching bones/joints
Bow legs/knock knees
Swelling at costochondral junction
Kyphoscoliosis
Soft skull bones in early life
Harrison's sulcus
162
Rickets investigations?
Low vit D levels
Reduced serum calcium
Raised alkaline phosphtase
163
Rickets management?
Oral vit D
164
What is laryngomalacia?
Congenital abnormality of the larynx- typically presents at 4 weeks of age with stridor
165
What are the causes of stridor in children?
Croup, acute epiglottitis, inhaled foreign body, laryngomalacia
166
What is a Wilms' tumour?
Nephroblastoma- common
Typically under 5- common in 3 year olds
167
Wilms' tumour features?
Abdominal mass (common)
Painless haematuria
Flank pain
Anorexia, fever
Unilateral in 95%
Metastses in 20%
168
Wilms' tumour management?
Nephrectomy, chemotherapy, radiotherapy
169
By what time should testes descend in males?
3 months- refer after 3 months- unilateral
170
Bilateral undescended testes management?
Reviewed by senior pediatrician within 24 hours
171
Causes of neonatal hypoglycaemia?
Preterm birth
Maternal DM
IUGR
Hypothermia
Neonatal sepsis
Inborn errors of metabolism
172
What are the four features of tetralogy of fallot?
Ventricular septal defect
Right ventricular hypertrophy
Right ventricular outflow tract obstruction
Overriding aorta
173
What are the features of TOF?
Cyanosis- hypercyanotic tet spells- tachypnoea, severe cyanosis, LOC- occur when upset or in pain
Right to left shunt
Ejection systolic murmur due to pulmonary stenosis
Right sided aortic arch in 25%
X-ray- boot shaped heart, ECG- right ventricular hypertrophy
174
TOF management?
Surgical repair
Cyanotic episodes helped with beta blockers
175
What age do TOF patients ususally present?
1-2 moths- transposition of great arteries more common at birth
176
Management umbilical hernias?
Usually self resolve
If large/symptomatic- elective surgery at 2-3
If small/asymptomatic- elective surgery at 4-5 years of age
177
What is a cephalohaematoma?
Develops after hours after birth, bleeding between the periosteum and the skull- may take 3 months to heal and jaundice is a complication
178
Difference between caput succedaneum and cephalohaematoma
Caput succedaneum- present at birth, crosses suture lines, resolves in days
Cephalohaematoma- develops after hours, more common in parietal region, doesn't cross suture lines, months to resolve
179
Risk factors for developmental dysplasia of the hip?
Female sex: 6 times greater risk
Breech presentation
Positive family history
Firstborn children
Oligohydramnios
Birth weight > 5 kg
Congenital calcaneovalgus foot deformity
180
What is Ebstein's anomaly?
Tricuspid valve set low so larger right atrium
181
What are the clinical features of Ebstein's anomaly?
Patients often have ASD/ Wolff-Parkinson White syndrome
Cyanosis
Hepatomegaly
Tricuspid regurgitation- pansystolic murmur
RBBB
182
What is the ratio of CPR in children?
5 rescue breaths
15 chest compressions: 2 rescue breaths
100-120/min compressions
183
What does a bicuspid valve increase the risk of? (Turner's)
Aortic dissection
184
Before what age is hand preferance abnormal?
12 months
185
Give some development problem milestones?
Referral points
doesn't smile at 10 weeks
cannot sit unsupported at 12 months
cannot walk at 18 months
Fine motor skill problems
hand preference before 12 months is abnormal and may indicate cerebral palsy
Gross motor problems
most common causes of problems: variant of normal, cerebral palsy and neuromuscular disorders (e.g. Duchenne muscular dystrophy)
Speech and language problems
always check hearing
other causes include environmental deprivation and general development delay
186
How quickly should a child fully recover from a febrile seizure?
Within an hour
187
Haemophilia is X-linked, how can a girl get it?
Turner's syndrome as they only have one X chromosome
188
Characteristic features of rubella?
Prodrome- low grade fever
Rash- maculopapular, initially on face before spreading to whole body- 3 to 5 days
Lymphadenopathy
(In question not had vaccines-MMR)
189
Which diseases require no school exclusion?
Conjunctivitis
Slapped cheek
Roseola
Infectious mononuleosis
Head lice
Threadworms
Hand, foot and mouth
190
Can you go to school with scarlet fever?
No, 24 hours after commencing antibiotics
191
Can you go to school with whooping cough?
2 days after commencing antibiotics (or 21 days from onset if no antibiotics)
192
Can you go to school with measles?
No, 4 days after onset of rash
193
Can you go to school with rubella?
No, 5 days after onset of rash
194
Can you go to school with chickenpox?
No, when all lesions crusted over
195
Can you go to school with mumps?
No, 5 days from onset of swollen glands
196
School with D+V?
No, 48 hours
197
School with impetigo?
No, crusted lesions or 48 hours after antibiotics
198
School with scabes?
No, until treated
199
School with influenza?
No, until recovered
200
What causes scarlet fever?
Group A steptococcus
201
Is scarlet fever a notifiable disease?
Yes
202
What are the complications of scarlet fever?
Otitis media- common
Rheumatic fever
Acute glomerulonephritis
203
What is another name for infectious mononucleosis?
Glandular fever
204
What causes infectious mononucleosis?
Epstein-Barr virus
205
What is the triad of infectious mononucleosis?
Classic triad of-
Sore throat
Lymphadenopathy
Pyrexia
206
Features of infectious mononucleosis?
Malaise, anorexia, headache
Palatal petechiae
Splenomegaly
Hepatitis
Lymphocytosis
Haemolytic anaemia
A maculopapular, pruritic rash develops in most patients who take ampicillin/amoxicillin
207
What test is used to diagnose infectious mononucleosis?
Heterophil antibody test (monospot test)
208
Management of infectious mononucleosis?
Rest, simple analgesia, avoid contact sports to reduce risk of spelenic rupture
209
Measles features?
Prodromal- irritable, fever, conjunctivitis
Koplik spots
Rash- starts behind ears then whole body- discrete to blotchy
Desquamation spares palms and soles after a week
Diarrhoea in 10%
210
Measles investigations?
IgM antibodies
211
Measles management?
Supportive
Admission if pregnant/immunosuppressed
Notify public health
Contacts immunised within 72 hours
212
Measles complications?
Otitis media- common
Pneumonia - common death cause
Encephalitis
Subacute sclerosing panencephalitis- rare and 5-10 years after illness
213
What causes roseola infantum?
Human herpes virus 6
214
What age range does roseola infantum affect?
6 month- 2 years
215
What are the features of roseola infantum?
High fever- lasting a few days and followed by
Maculopapular rash
Nagayama spots- papular enanthem on the uvula and soft palate
Febrile convulsions 10-15%
Diarrhoea and cough
216
ADHD management?
Period of 10 weeks observation- behavioural advice and educational programme for parents
Drug therapy last resort for age 5+
First line is methylphenidate (ritalin)
2nd- lisdexamfetamine
217
What are the side effects of methylphenidate?
Abdo pain, nausea and dyspepsia. Weight and height monitored every 6 months
218
What do you need to do before starting methylphenidate? (or ADHD drugs)
Perform a baseline ECG as potentially cardiotoxic
219
What finding supports a diagnosis of biliary atresia in a 15 day old?
Raised conjugated bilirubin
220
What is the presentation of biliary atresia?
Present in the first weeks of life with-
Jaundice
Dark urine/ pale stools
Appetite and growth disturbance (maybe normal)
Signs:
Jaundice
Hepatomegaly/splenomegaly
Abnormal growth
Cardiac murmurs
221
Biliary atresia investigations?
Serum bilirubin- conjugated bilirubin high
LFTs
222
What are the features of eczema?
Itchy, erythematous rash
Infants- face and trunk
Young- extensor surfaces
Older- flexor surfaces
223
Eczema management?
Avoid irritants
Simple emollients
Topical steroids
Wet wrapping
224
Features of fetal alcohol syndrome?
(Withdrawl symptoms at birth)
Short palpebral fissure
Hypoplastic/thin upper lop
Smooth/absent filtrum
Learning difficulties
Microcephaly
Growth retardation
Cardiac malformations
225
How many days of fever for Kawasaki disease?
More than 5
226
What are the indications for head CT within an hour in under 16s?
Suspicion of non-accidental injury
post-traumatic seizure
On initial emergency department assessment, a GCS score of less than 14 or, for babies under 1 year, a GCS score (paediatric) of less than 15
At 2 hours after the injury, a GCS score of less than 15
Suspected open or depressed skull fracture, or tense fontanelle
Any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign)
Focal neurological deficit
For babies under 1 year, a bruise, swelling or laceration of more than 5 cm on the head.
227
CT head risk factors where you need more than one?
Loss of consciousness lasting more than 5 minutes (witnessed)
Abnormal drowsiness
3 or more discrete episodes of vomiting
Dangerous mechanism of injury (high-speed road traffic accident as a pedestrian, cyclist or vehicle occupant, fall from a height of more than 3 m, high-speed injury from a projectile or other object)
Amnesia (anterograde or retrograde) lasting more than 5 minutes (it will not be possible to assess amnesia in children who are preverbal and is unlikely to be possible in children under 5)
Any current bleeding or clotting disorder.
If only 1 observe for four hours- if further vomiting, GCS under 15 or further episode drowsiness get CT
228
What immunisations are included in the 6-in-1 vaccine?
Diptheria, tetanus, pertussis, polio, haemophilus influenzae type b and hepatitis B
229
When is the 6-in-1 vaccine given?
8, 12 and 16 weeks
230
Which vaccines are given at birth?
BCG if risk factors (against TB)
231
What vaccines at 2 months?
6-1
Oral rotavirus
Men B
232
3 months
6-1
Oral rotavirus
PCV
233
4 months
6-1
Men B
234
12-13 months
Hib/Men C
MMR
PCV
MenB
235
2-8 years
Flu vaccine annual
236
3-4 years
4 in 1 pre school booster
MMR
237
What is in the 4 in 1 pre school booster vaccine?
Diphtheria, tetanus, whooping cough and polio
238
12-13 years
HPV vaccine
239
13-18 years
3 in 1 teenage booster
Men ACWY
240
What is in the 3 in 1 teenage booster
Tetanus, diphtheria, polio
241
Roseola infantum?
6th disease
3 days fever
3 days rash
242
What could you think of when a question has meconium ileus?
CF
Hirschsprung's disease
243
Gold standard investigation for Hirschsprung's disease?
Rectal biopsy
244
Management Hirschsprung's disease?
Rectal washouts/ bowel irrigation
Surgery
245
Features of slipped femoral epiphysis?
Hip, groin, medial thigh or knee pain
Loss of internal rotation of the leg in flexion
Bilateral slip on 20%
246
What would cause you to admit a child with bronchiolitis?
Apnoea
Oxygen sets under 92%
Inadequate oral fluid intake
Severe respiratory distress- grunting, marked chest recession, resp rate over 70
247
What type of murmur in patent ductus arteriosus?
Continuous 'machinery' murmur
248
In what conditions can you find an ejection systolic murmur?
Aortic stenosis
Pulmonary stenosis
Atrial septal defect
Hypertrophic obstructive cardiomyopathy
Tetralogy of Fallot
249
Which conditions have recurrent chest infections?
Cystic fibrosis
Downs syndrome
250
Which conditions have overlapping of fingers?
Edward's syndrome (trisomy 18)
251
What causes brochiolitis?
Respiratory syncytial virus
252
What are the acyanotic causes of CHD?
Ventricular septal defects (VSD) - most common
Atrial septal defect (ASD)
Patent ductus arteriosus (PDA)
Coarctation of the aorta
aortic valve stenosis
253
What are the cyanotic causes of CHD?
Tetralogy of Fallot
Transposition of the great arteries (TGA)
Tricuspid atresia
254
When do Fallot's present compared to TGA?
Tetralogy of Fallot- 1-2 motnhs
TGA- at birth
255
Asthma management in under 5's?
1. SABA
2. SABA + 8 week triak moderate ICS
3. Add LTRA
4 Stop LTRA and refer to specialist
256
Asthma management 5-16?
1. SABA
2. SABA + low dose ICS
3. SABA + ICS + LTRA
4. SABA + ICS + LABA
5. SABA + switch ICS/LABA for MART
6. SABA +moderate ICS MART
6. SABA + either Increase ICS/ trial additional drug (theophylline)/get specialist help
257
Developmental dysplasia of the hip investigation?
Ultrasound
258
What are the features of croup?
Stidor
Barking cough (worse at night)
Fever
Coryzal symptoms
259
Average age for croup?
6 months to 3 years
260
What are the features of mumps?
Fever, malaise, muscular pain
Parotitis (earache, pain on eaing)- unilateral then becomes bilateral
261
What are the names for slapped cheek syndrome?
Erythema infectiosum or fifth disease
262
Rubella features?
Pink maculopapular rash, initially on face before spreading to whole body- fades in 3-5 days
Lymphadenopathy- suboccipital/ postauricular
263
What is the presentation of Meckel's diverticulum?
Abdo pain mimicking appendicitis
Rectal bleeding
Intestinal obstruction- secondary to an omphalomesenteric band (most common), volvulus and intussusception
264
Which conditions are autosomal recessive?
Cystic fibrosis
Sickle cell anaemia
Haemochromatosis
Gilbert's syndrome
265
Which conditions are X-linked recessive?
Haemophilia A, B
Duchenne muscular dystrophy
G6PD deficiency
266
What closes the patent ductus arteriosus?
Indomethacin
Or ibuprofen
267
Features of hand, foot and mouth
Mild systemic upset- sore throat, fever
Oral ulcers
Followed later by vesicles on the palms and soles of the feet
268
What causes scarlet fever?
Streptococcus pyogenes
269
What are the three major congenital infections?
Rubella, toxoplasmosis and cytomegalovirus
Cytomegalovirus is most common and maternal infection is usually asymptomatic
270
Rubella congenital infection characteristics
Sensorineural deafness
Congenital cataracts
Congenital heart disease (patent ductus arteriosus)
Glaucoma
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
'Salt and pepper' chorioetinitis
Microphtalmia
Cerebral palsy
271
Toxoplasmosis congenital infection characteristics
Cerebral calcification
Chorioetinitis
Hydrocephalus
Anaemia
Hepatosplenomegaly
Cerebral palsy
272
Cytomegalovirus congenital infection characteristics
Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly
Visual impairment
Learning disability
Encephalitis/seizures
Pneumonitis
Hepatosplenomegaly
Anaemia
Jaundice
Cerebral palsy
273
What is the investigation for bronchiolitis?
Immunofluorescence of nasopharayngeal secretions may show RSV
274
Features of bronchiolitis?
Coryzal symptoms (including mild fever)
Dry cough
Increasing breathlessness
Wheezing, fine inspiratory crackles
Feeding difficulties associated with dyspnoea
275
Presentations of Hirschprung's disease?
Neonatal period- failure or delay to pass meconium
Older children- constipation, abdominal distension
276
What is the most common cause of ambiguous genitalia?
Androgen insensitivity syndrome
277
What is the emergency treatment for croup in severe respiratory distress?
High flow oxygen
Nebulised adrenaline
278
What are reflex anoxic seizures?
A syncopal episode that occurs in response to pain or emotional stimuli
279
Age range for reflex anoxic seizures?
6 months to 3 years
280
What is the most common cause of stridor in infants?
Laryngomalacia
281
Causes of CHD, DDH, congenital cataract and spina bifida
Congenital heart defect- lithium (Epstein's anomaly)
DDH- Breech presentation
Congenital cataract- congenital rubella
Spina bifida- No folic acid taken
282
Causes of hypotonia in infants?
Down's syndrome
Prader-Willi
Hypothyroidism
Cerebral palsy
283
Mnemonic for Kawasaki?
CRASH and Burn
Conjunctivitis
Rash
Adenopathy (cervical lymphadenopathy)
Strawberry tongue
Hands and feet: swollen and peeling
Burn: high fever that does not respond to antipyretics
284
What age does benign rolandic epilepsy occur?
Between 4 and 12
284
What are the features of benign rolandic epilepsy?
Seizures at night
Partial (eg face) but secondary generalised may occur
Child otherwise normal
285
When is a routine USS for DDH?
At 6 weeks of age, following breech delivery
286
When x-ray for DDH
If child is over 4.5 months
287
Classic signs of congenital CMV?
Hearing loss, low birth weight, petechial rash, microcephaly and seizures
288
Classic triad of symptoms for congenital rubella?
Sensorineural deafness, eye abnormalities and congenital heart disease
289
What are the features of gastro-oesophageal reflux in children? (GORD)
Develops before 8 weeks
Vomiting/regurgitation- milky vomits after feeds/may occur after being laid flat
Excessive crying, especially while feeding
290
Rare complications of chicken pox?
Pneumonia
Encephalities
Disseminated haemorrhagic chickenpox
Arthritis, nephritis and pancreatitis
291
Common complication of chickenpox?
Secondary bacterial infection of lesions- NSAIDs may increase this risk
In small number of patients- invasive group A step soft tissue infections causing necrotising fasciitis
292
What is a contraindication of an LP?
Meningococcal septicaemia
293
Which signs of raised ICP would contraindicate an LP?
Focal neurological signs
Papillodema
Significant bulging fontanelle
DIC
Signs of cerebral herniation
294
Management of meningitis?
1. Antibiotics-
If under 3 months- IV amoxicillin + IV cefotaxime
Over 3 months- IV Cefotaxime
2. Steroids- (No corticosteroids in under 3 months)
Dexamethasone considered if LP reveals- frankly purulent CSF, CSR WCC greater than 1000/microlitre, raised WCC with protein greater than 1g/litre
Bacteria on gram stain
3. Fluids
4. Cerebral monitoing
5. Public health notification and antibiotic prophylaxis of contacts- ciprofloxacin
295
What are the four areas of developmental milestones?
1. Speech and hearing
2. Fine motor and vision
3. Social behaviour and play
4. Gross motor
296
Causes of neonatal hypotonia?
Neonatal sepsis
Hypothyroidism
Prader-Willi
Werdnig-Hoffman
Maternal drugs- benzos
Maternal MG
297
School exlusion with head lice?
No
298
Head lice management?
Malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone
Household contacts do not need to be treated
299
What should all children who have an asthma attack get?
Steroids
300
What is Kocher's criteria used for?
Probability of septic arthritis in children
301
What are the 4 parameters in Kocher's criteria?
Non-weight bearing- 1 point
Fever >38.5- 1 point
WCC >12 * 109/L - 1 point
ESR > 40mm/hr
302
How might an older child present with DDH?
Trendelenberg gait and leg length discrepancy
303
Difference between mitchondrial diseases vs X-linked
All women in family get mitochondrial, no children of men
X-linked some women won't have it
304
What does a normal pCO2 suggest in an acute asthma attack?
Life threatening
305
What is menarche?
The first period
306
What is Perthes' disease and when does it present?
Degenerative condition in hip of children 4-8
Due to avascular necrosis of the femoral head
5x more common in boys
307
What are the features of Perthes' disease?
Hip pain- develops progressively over a few weeks
Limp
Stiffness and reduced range of movement
X-Ray- widening of joint space and decreased femoral head size
308
Perthes' disease diagnosis?
Plain x-ray
Technetium bone scan or MRI
309
Perthes' disease management?
Keep femoral head within acetabulum- cast, braces
Less than 6 years- observation
Older surgical management
Most cases resolve with conservative management
310
When is corrective hypospadias surgery performed?
Around 12 months of age
Essential child not circumcised before surgery as sometimes used
311
What is the triad of shaken baby syndrome?
Retinal haemorrhages, subdural haematoma and encephalopathy
312
Which condition presents with a salmon pink rash?
Juvenile idiopathic arthritis
313
JIA features?
Pyrexia
Salmon pink rash
Lymphadenopathy
Arthritis
Uveitis
Anorexia and weight loss
314
JIA investigations?
ANA may be positive
Rheumatoid factor usually negative
315
Features of a life threatening asthma attack?
A CHEST
Arrhythmia/ Altered conscious level
Cyanosis, PaCO2 normal
Hypotension, Hypoxia (PaO2<8kPa, SpO2 <92%)
Exhaustion
Silent chest
Threatening PEF < 33% best or predicted (in those >5yrs old)
316
What is thelarche?
The first stage of breast development
317
What is adenarche?
First stage of pubic hair development
318
What are the two types of precocious puberty?
Gonadotrophin dependant- premature activation of axis- FSH and LH raised
Gonadotrophin independant- excess sex hormones- FSH and LH low
319
Testes in precocious puberty?
Bilateral enlargement- gonadotrophin release from intracranial lesion
Unilateral enlargement- gonadal tumour
Small testes- adrenal cause
320
At what rate should paediatric compressions be?
100-120/min
321
What are you vaccinated against between 13-18 years?
Tetanus/diptheria/polio + MenACWY
322
Risk factors for DDH?
The F's-
- Female
- Feet first (breech px)
- Family Hx
- Firstborn
- Fluid (oligohydramnios)
- Fat kid (macrosomia)
- Foot deformity (congenital calcaneovalgus foot deformity)
323
Management of DDH?
Most unstable hips stabilise by 3-6 weeks
Pavlik harness in children younger than 4-5 months
Older children require surgery
324
What noise is associated with croup?
A barking noise
325
What are the investigations for biliary atresia?
Serum bilirubin- total bilirubin may be normal, conjugated bilirubin is high
LFTs
Serum alpha 1-antitrypsin
Sweat chloride test
Ultrasound biliary tree and liver
326
When is the oral rotavirus vaccine given?
At 2 and 3 months
327
What is a complication of the oral rotavirus vaccine?
If given late, intussusception
328
Tip for inheritance patterns?
Most structural stuff = Autosomal Dominant
Most metabolic stuff = Autosomal Recessive
329
Hyperinflated lungs on x-ray and fluid in horizontal fissure?
Transient tachypnoea of the newborn
330
Roseola infantum presentation?
High fever for few days followed by a maculopapular rash
331
How to remember Roseola Infantum?
(R)oseola (I)nfantum= (R)ash when (I)mproving
332
What procedure for malrotation with volvulus?
Ladd's procedure and laparotomy
333
What age is croup most common?
6 months- 3 years in the autumn
334
Croup features?
Stridor
Barking cough
Fever
Coryzal symptoms
335
X-ray signs in croup (normally clinical diagnosis)?
Steeple sign (subglotic narrowing)
Thumb sign (epiglottis)
336
What do all children with croup get?
Dexamethosone
337
Croup emergency treatment?
High flow oxygen
Nebulised adrenaline
338
What features prompt admission with croup?
Moderate or sever croup
Under 6 months
Known airway abnormalities (laryngomalacia, Down's syndrome)
Uncertainty about diagnosis
339
What age babies class as neonatal death?
0-28 days after birth
340
Calculate perinatal death rates?
Maternal mortality rate = deaths in pregnancy, labour & 6 weeks afterwards / total maternities * 1000
Stillbirth rate = babies born dead after 24 weeks / total births (live + stillborn) * 1000
Neonatal death rate = babies dying between 0-28 days / total live births * 1000
341
Patau syndrome (trisomy 13) features?
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
342
Edward's syndrome (trisomy 18) features?
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
343
Should you use corticosteroids in children under 3 months with bacterial meningitis?
No
344
What condition is Hirschprung's disease associated with?
Down's syndrome
345
What are children's with Down's prone to?
Snoring
346
What are the presentations of UTI by age?
Infants: poor feeding, vomiting, irritability
Younger children: abdominal pain, fever, dysuria
Older children: dysuria, frequency, haematuria
Features which may suggest an upper UTI include: temperature > 38ºC, loin pain/tenderness
347
What should happen with a child under 3 months with suspected UTI?
Immediate referral to a paediatrician
348
What to do with unborn exomphalos?
Plan a cesarean insection
349
Hand preference before which age is abnormal?
12 months
350
Some key developmental referral points?
Doesn't smile at 10 weeks
Cannot sit unsupported at 12 months
Cannot walk at 18 months
351
Should suspected transient synovitis be reffered same day anyway?
Yes, to rule out septic arthritis
352
Temperature over 38 under 3 months?
Urgent referral to paediatrics
353
What is juvenile myoclonic epilepsy associated with?
Seizures in the morning or after sleep deprivation
354
What is the definitive investigation for acute epiglottitis?
Flexible laryngoscopy (visualisation by a senior/airway trained staff member)
355
Characteristics of an innocent ejection murmur?
Soft blowing murmur in the pulmonary area
May vary with posture
Localised no variation
No diastolic component
No thrill
No added sounds
Asymptomatic child
No other abnormality
356
What are the investigations for myesthenia gravis?
CT thorax to exclude thymoma
Antibodies to acetylcholine receptors
357
What is the management of a myasthenic crisis?
Plasmapheresis
Intravenous immunoglobulins
358
How to remember levodopa side effects?
D - dyskinesia
O - on-off
P - Psychosis
A - Arterial BP down (hypotension)
M - Mouth dryness
I - Insomnia
N - N/V
E - Excessive daytime sleepiness
359
When should APGAR be calculated?
1 and 5 minutes of age
If low repeat again at 10 minutes
360
What do the APGAR scores mean?
0-3 very low
4-6 is moderate
7-10 good state
361
APGAR Score specific
Pulse
2- >100
1- <100
0- Absent
Appearance
2- Pink
1- Pink w/blue extremities
0- Blue
Grimace
2- Cries on stimulation
1- Grimace
0- Nil
Activity
2- Active movement
1- Limb flexion
0- Flaccid
Resp effort
2- Strong, crying
1- Weak, irregular
0- Nil
362
What should you not give children with chicken pox?
NSAIDs- risk of necrotising facialiitis
363
When is the neonatal blood spot screening (heel prick test) carried out?
Between 5-9 days of life
364
What are the conditions screened for on the neonatal blood spot screening (heel prick test)?
Congenital hypothyroidism
Cystic fibrosis
Sickle cell disease
Phenylketonuria
Medium chain acyl-CoA dehydrogenase deficiency (MCADD)
Maple syrup urine disease (MSUD)
Isovaleric acidaemia (IVA)
Glutaric aciduria type 1 (GA1)
Homocystinuria (pyridoxine unresponsive) (HCU)
365
What type of dementia is MND associated with?
Frontotemporal dememntia
366
What is theraputic cooling?
The deliberate lowering of a patient's body temperature with the intention of cooling the brain and preventing damage
Used to limit hypoxic brain injury
367
Order of puberty in girls?
Boobs, pubes, grow, flow
368
Order of puberty in boys?
Grapes (testicles), drapes (hair), grow, blow
369
5 T's cyanotic heart diseases (CHD)?
Give prostoglandin E1 to keep the PDA open
Transposition of the great vessels (TGA)
Tetralogy of fallot
Tricuspid atresia
Total anomalous pulmonary venous return
Truncus arteriosus
370
What are the two innocent murmurs?
Venous hums- Turbulent blood flow in the great veins- continuous blowing noise heard just below the clavicles
Still's murmur- low pitched sound heard at the lower left sternal edge
371
Key visual field defects (check passmed page)?
Left homonymous hemianopia means visual field defect to the left, i.e. Lesion of right optic tract
homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)
incongruous defects = optic tract lesion; congruous defects = optic radiation lesion or occipital cortex
372
Caput Succedanum key features?
Swelling on head
Present at birth
Crosses suture lines
Resolves in days
373
Cephalohematoma key features?
Swelling on head
Develops hours after birth
Doesn't cross suture lines
May take months to resolve
374
Investigations for child under 3 months with a fever?
Full blood count
Blood culture
C-reactive protein
Urine testing for urinary tract infection
Chest radiograph only if respiratory signs are present
Stool culture, if diarrhoea is present
375
What should happen to a baby with weak femoral pulses at 6-8 week baby check?
Same day referral to paeds
Worry about coarctation of the aorta
376
What should be fulfilled to meet the fraser guidelines?
The young person understands the professional's advice
The young person cannot be persuaded to inform their parents
The young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
Unless the young person receives contraceptive
treatment, their physical or mental health, or both, are likely to suffer
The young person's best interests require them to receive contraceptive advice or treatment with or without parental consent
377
STI tests in young people?
Young people should be advised to have STI tests 2 and 12 weeks after an incident of unprotected sexual intercourse (UPSI)
378
Which is the LARC of choice for young people (under 20)?
The progesterone only implant (nexplanon)
379
Which medication can you not use the implant (nexplanon)?
Enzyme inducers- rifampicin
380
Osgood-Schlatter disease?
Seen in sporty teenagers
Pain and tenderness over the tibial tuberosity
381
Osteochondritis dissecans?
Pain after exercise
Intermittent swelling and locking
382
What is the management of cystic fibrosis?
Regular- at least twice daily- chest physiotherapy and postural drainage
High calorie, high fat diet
CF patients minimise cross infection with each other Burkholderia cepacia complex and Pseudomonas aeruginosa
Vitamin supplementation
Pancreatic enzyme taken with meals
Lung transplantation
383
What is the most common cause of primary headache in children?
Migraine
384
Cushing's triad in raised ICP?
Widening pulse pressure, bradycardia and irregular breathing
385
Management of paediatric migraine?
Acute:
Ibuprofen more effective than paracetamol
Maybe triptans in children 12 or over
Prophylaxis:
Evidence limited
Propanolol 1st
386
Is pregnancy a risk factor for Bell's Palsy?
YEs
387
Management of Bell's palsy?
Oral prednisolone within 72 hours
Maybe antivirals not 100%
Eye care important to prevent exposure keratopathy
388
Distal sensory loss + tingling + absent ankle jerk/ extensor plantars + gait abnormalities/Romberg's positive?
Subacute combined degeneration of the spinal cord
389
What are the causes of oligohydraminos?
Premature rupture of the membranes
Potter sequence- (bilateral renal agenesis + pulmonary hypoplasia)
IUGR
Post-term gestation
Pre-eclampsia
390
Features of an ectopic pregnancy?
Lower abdominal pain- may be unilateral
Vaginal bleeding
Recent history of amenorrhoea
Peritoneal bleeding can cause shoulder tip pain, pain on defecation/ urination
Dizziness, fainting or syncope
Breast tenderness
391
Examination findings ectopic pregnancy?
Abdominal tenderness
Cervical excitation (cervical motion tenderness)
Adnexal mass- donn't examine might rupture
Serum bHCG levels over >1500 point to diagnosis of an ectopic in pregnancy of unknown location
392
Perthe's disease boys or girls?
5x more common in boys
393
What are the three key signs of ALL?
Anaemia: lethargy and pallor
Neutropaenia: frequent or severe infections
Thrombocytopenia: easy bruising, petechiae
394
What is Henoch-Schonlein purpura?
IgA mediated small vessel vasculitis. Seen in children following an infection
395
What are the features of Henoch-Schonlein purpura?
Palpable purpuric rash (with localized oedema)
over buttocks and extensor surfaces of arms and legs
Abdominal pain
Polyarthritis
Features of IgA nephropathy may occur e.g. haematuria, renal failure
396
What is the treatment for Henoch-Schonlein purpura?
Analgesia for arthralgia
Treatment nephropathy generally supportive
Prognosis good- BP and urinalysis monitored to detect progressive renal involvement, can relapse
397
Premature baby milestones and immunisations?
Immunisations - same age as usual
Developmental milestones - age + weeks born from 40 weeks
398
How to find out jaundice level in newborn?
A transcutaneous bilirubinometer cannot be used under 24 hours
Get a serum bilirubin within 2 hours
399
What can palivizumab be used for?
Monclonal antibody to prevent RSV
400
What is seborrhoeic dermatitis?
Cradle cap
It typically affects the scalp ('Cradle cap'), nappy area, face and limb flexure
Characterised by an erythematous rash with coarse yellow scales, appears in first few weeks of life
401
What is the management for seborrhoeic dermatitis?
Reassurance that it doesn't affect the baby and usually resolves within a few weeks
Massage a topical emollient onto the scalp to loosen scales, brush gently with a soft brush and wash off with shampoo.
If severe/persistent a topical imidazole cream may be tried
402
Which babies need ultrasound at 6 weeks?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
403
What are the clinical tests for DDH?
Barlow test: attempts to dislocate an articulated femoral head
Ortolani test: attempts to relocate a dislocated femoral head
404
Can a patient under 16 refuse treatment?
No
A patient under 16 can agree to treatment in their best interest against parental wishes but cannot refuse it if it is in their best interests
If deemed to be competent
405
Kallman's?
Tallman
FSH and LH Fallman
406
What causes impetigo?
Staphylococcus aureus
Streptococcus pyogenes
407
Impetigo features?
Face flexures and limbs not covered by clothing
Spread by direct contact with discharges of another person
'golden', crusted skin lesions typically found around the mouth
Very contagious
408
What is the management of impetigo?
Hydrogen peroxide 1% cream
Topical antibiotic creams- topical fusidic acid
Extensive disease:
Oral flucloxacillin
409
What is vesicoureteric reflux?
The abnormal backflow of urine from the bladder into the ureter and kidney
Investigation: micturating cystourethrogram
hydronephrosis on ultrasound
reccurent UTIs
410
What do you do for vaccines/development in premature infants?
Vaccines- the same
Development- correct for gestational age
411
What can cause Ebstein's anomaly?
Exposure to lithium in vitro
412
Features of Ebstein's anomaly?
Cyanosis
Prominent 'a' wave in the distended jugular venous pulse,
Hepatomegaly
Tricuspid regurgitation
Pansystolic murmur, worse on inspiration
right bundle branch block → widely split S1 and S2
413
Most common complication of roseola infantum?
Febrile convulsions
414
Is breastfeeding ok with antiepileptics?
Yes nearly all of them
415
LAMBAST mothers ceen taking
LAMBAST mothers ceen taking:
Lithium
Amiodarone
Methotrexate
Benzodiazepines
Aspirin
Sulphonamide
Tetracyclines
+
Carbimazole, Ciprofloxacin, Chlorampenicol
416
Delayed puberty short vs normal?
Delayed puberty with short stature
Turner's syndrome
Prader-Willi syndrome
Noonan's syndrome
Delayed puberty with normal stature
polycystic ovarian syndrome
androgen insensitivity
Kallman's syndrome
Klinefelter's syndrome
417
What is used to treat CF patients who are homozygous for the delta F508 mutation?
Lumacaftor/Ivacaftor (Orkambi)
418
1 year milestones?
At their 1st birthday party...
* gross motor: walk/cruise
* fine motor: pincer grip their cake and bangs their new toys together
* social: stranger anxiety (meeting family for 1st time)
* speech and language: knows and responds to their own name + can say muma/dada
419
Which condition do you get polydactyly as well as cleft lip and small eyes?
Patau- Trisomy 13
420
Diseases causing heart problems?
Kawasaki- coronary artery spasms
Duchenne- dilated cardiomyopathy
421
Features of duchenne muscular dystrophy?
Progressive proximal muscle weakness from 5 years
Calf pseudohypertrophy
Gower's sign: child uses arms to stand up from a squatted position
30% of patients have intellectual impairment
422
Ventricular septal defect murmur?
Pansystolic murmur in lower left sternal border
423
Coarctation of the aorta murmur?
Crescendo-decrescendo murmur in the upper left sternal border
424
Patent ductus arteriosus murmur?
Diastolic machinery murmur in the upper left sternal border
425
Pulmonary stenosis murmur?
Ejection systolic murmur in the upper left sternal border
426
Atrial septal defect murmur?
Ejection systolic murmur and fixed splitting of the second heart sound
427
Snoring causes in children?
obesity
nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
recurrent tonsillitis
Down's syndrome
hypothyroidism
428
Fragile X syndrome features?
Features in males
learning difficulties
large low set ears, long thin face, high arched palate
macroorchidism
hypotonia
autism is more common
mitral valve prolapse
Features in females (who have one fragile chromosome and one normal X chromosome) range from normal to mild
Diagnosis
can be made antenatally by chorionic villus sampling or amniocentesis
analysis of the number of CGG repeats using restriction endonuclease digestion and Southern blot analysis
429
Hearing tests in children?
Newborn Otoacoustic emission test
Newborn & infants Auditory Brainstem Response test- done if otoacustic abnormal
> 3 years Pure tone audiometry- done at school entry
430
Androgen insensitivity syndrome overview?
X-linked recessive
'primary amenorrhoea'
little or no axillary and pubic hair
undescended testes causing groin swellings
breast development may occur as a result of the conversion of testosterone to oestradiol
buccal smear or chromosomal analysis to reveal 46XY genotype
after puberty, testosterone concentrations are in the high-normal to slightly elevated reference range for postpubertal boys
counselling - raise the child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy
431
Haemolytic uraemic syndrome overview?
Triad of:
acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia
Most commonly caused by E.Coli 0157
Investigations: FBC, U&E: acute kidney injury, Stool culture
Treatment: supportive
432
What is the triad of haemolytic uraemic syndrome?
Acute kidney injury
Microangiopathic haemolytic anaemia
Thrombocytopenia
433
What are the signs of congenital adrenal hyperplasia?
Reduced production of cortisol and aldoesterone
Less sodium retention and increased potassium excretion In an adrenal crisis they may present with metabolic acidosis
Hyperkalaemia, hyponatraemia, metabolic acidosis
434
Nephrotic syndrome triad?
Proteinuria (> 1 g/m^2 per 24 hours)
Hypoalbuminaemia (< 25 g/l)
Oedema
435
What is minimal change disease?
Most common cause of nephrotic syndrome in children
436
Other features of nephrotic syndrome?
Hyperlipidemia, hypercoagulable state and predisposition to infection
437
Nephrotic syndrome management?
Urine dipstick
High dose corticosteroids- prednisolone
Furosemide
438
What is the triad for nephritic syndrome?
Inflammation within nephrons of kidney- likely after infection such as tonsilitis
Reduction in kidney function
Haematuria
Proteinuria
439
Investigations/ management for nephritic syndrome?
Urine microscopy
Support renal failure
Diuretics and anihypertensives
440
What determines the severity of TOF?
How bad the pulmonary stenosis is
441
Pneumonia in children treatment?
Amoxcillin firt line
Macrolides used if no response or mycoplasma/chlamydia- erythromycin
Influenza pneumonia is co-amoxiclav
442
MENINGITIS MANAGEMENT?
<3 months- amoxicillin and cefotaxime
>3 months cefotaxime
Dexomethosone to over 3 months if-
purulent CSF
CSF with white cell count over 1000/microlitre
Raised CSF WCC
Bacteria on gram stain
FLUIDS
Cerebral monitoring
Notify public health- ciprofloxacin to contacts
443
Edward's syndrome features?
Low set ears, rocker bottom feet, overlapping of fingers and micrognathia
444
Difference between CF, Hirchprung's and NEC?
Muconeum ileus -> Hirschsprung or CF
Blood in stool in pre-term baby -> NEC
445
Obesity causes in children?
Cause of obesity in children
Growth hormone deficiency
Hypothyroidism
Down's syndrome
Cushing's syndrome
Prader-Willi syndrome
Assess by age adjusted BMI
446
Poor prognosis factors ALL?
Poor prognostic factors
age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex
447
When are women offered the pertussis vaccine?
Between 16 and 32 weeks
448
Which pulses checked in infants?
Brachial and femoral
Children use femoral
449
First line for infantile spasms?
Vigabatrin
450
Nagayama spots are associated with which disease?
Roseola infantum (HHV6)
451
HUS vs HSP vs ITP
HUS is incorrect - HUS is associated with a triad of microangiopathic haemolytic uraemia, acute kidney injury and thrombocytopenia. The symptoms are typically bloody diarrhoea, abdominal pain, fever and vomiting, and the history usually includes exposure to farm animals. The child in the question hasn't experienced these symptoms so this diagnosis is unlikely
HSP is incorrect - Features of HSP are typically a non-blanching rash affecting the legs and buttocks, arthralgia and abdominal pain. This child has presented with a non-blanching rash but not in the distribution of HSP and has not experienced any other symptoms of HSP. The child has presented with a typical history of ITP so a diagnosis of ITP is more likely
ITP is correct - ITP is correct as it is a differential in any child presenting with petechiae and no fever and is usually preceded by a viral illness. We need blood results to confirm the diagnosis but these typically present with isolated thrombocytopenia and this low platelet count causes the classic petechial rash
452
Viral induced wheeze treatment?
SABA
LTRA (montelukast) or ICS
Wheezy - viral induce wheeze
Crackles - bronchiolitis
453
Kallman's presentation and key feature?
Key feature in questions could be lack of smell
'delayed puberty'
hypogonadism, cryptorchidism
anosmia
sex hormone levels are low
LH, FSH levels are inappropriately low/normal
patients are typically of normal or above-average height
454
Risk if get rotavirus vaccine late?
Intussusseption
455
First line investigation for coeliac disease?
Tissue transglutaminase (TTG) antibodies (IgA) are first-choice
Endoscopic intestinal biopsy is gold standard
456
Features of growing pains?
Features of growing pains:
Never present at the start of the day after the child has woken
No limp
No limitation of physical activity
Systemically well
Normal physical examination
Motor milestones normal
Symptoms are often intermittent and worse after a day of vigorous activity
457
What is mesenteric adenitis?
Mesenteric adenitis is inflamed lymph nodes within the mesentery. It can cause similar symptoms to appendicitis and can be difficult to distinguish between the two. It often follows a recent viral infection and needs no treatment
458
Feverpain and centor?
The Centor criteria are: score 1 point for each (maximum score of 4)
presence of tonsillar exudate
tender anterior cervical lymphadenopathy or lymphadenitis
history of fever
absence of cough
The FeverPAIN criteria are: score 1 point for each (maximum score of 5)
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza
459
Birth marks?
Naevus flammeus- port wine stain and grows with the infant
Cavernous haemangioma (strawberry naevus)- Not present at birth and appears in first month of life
460
What is opthalmia neonatorum?
Infection of newborn eye
Same day referral
Could be chlamydia or gonorrhoea
461
Most common cause of worsening neurological function within a premature infant?
Intraventricular haemorrhage
Most common in premature infants within 72 horus of birth
462
Heart murmurs summary?
Cyanotic
TGA: loud S2 and prominent RV impulse
ToF: ejection systolic murmur (due to pulmonary stenosis)
Tricuspid: ejection systolic and prominent apical impulse
Acyanotic
VSD: pan systolic associated with chromosomal abnormalities e.g. Down's
ASD: more common in adults, ejection systolic and fixed splitting S2
PDA: 'machinery' murmur associated with prematurity/rubella
CoA: radio-femoral delay, apical click and mid systolic
463
Child under 3 with an acute lip?
Urgent refferal to specialist
464
HSP four symptoms?
Rash
Joint pain
Abdo pain
Kidney involvement
465
When do children normally toilet train?
At or after 3 months of age
466
Investigation for Meckel's diverticulum?
Technetium scan
467
Another way of saying Turner's syndrome?
Gonadal dysgenesis
468
Thickened formula vs alginate therapy?
Breastfeeding- alginate therapy first line
Not breastfeeding- thickened formula first line
469
Which type of cyst has hair in them?
Dermoid cyst
470
Paeds red flag symptoms?
Red Flag Symptoms
1. Moderate or severe chest wall recession.
2. Does not awake if roused.
3. Reduce skin turgor.
4. Mottled or blue appearance.
5. Grunting
471
Anaphylaxis treatment?
IM adrenaline- repeat after 5 mins
IV Fluids
IV adrenaline
After stabilisation:
Antihistamines
472
How often chest physiotherapy in CF patients?
Twice daily
473
Rubella starts on face and moves down to the torso but spares the limbs
Apparently, but remember suboccipital ad postauricular lymphadenopathy
Rash from face to rest of the body
Prodrome
474
Difference between Barlow and Ortolani tests?
Barlow tries to dislocate
Ortolani tries to relocate
475
Perthe's disease treatment?
<6 observation- prognosis is good
>6 surgical repair
476
Criteria to diagnose otitis media?
Acute onset of symptoms
Otalgia or ear tugging
Presence of a middle ear effusion
Pulging of the tympanic membrane, or
otorrhoea
Decreased mobility on pneumatic otoscopy
Inflammation of the tympanic membrane
i.e. erythema
477
Treatment for otitis media?
Conservative and treat otalgia with analgesia
Antibiotics should be prescribed immediately if:
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
I
mmunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal
5-7 days amoxicillin is first line
478
Biggest VSD condition complication?
Endocarditis
479
Otitis media causes?
Haemophilius influenzae
Strep pneumoniae
Moraxella catarrhalis
(RSV, influenza virus, rhinovirus)
480
Otitis media treatment?
1st- Amoxicillin
2nd- Clarithromycin
481
Surfactant deficient lung disease RFs?
Premature infants
Male sex
Diabetic mothers
Caesarean section
Second born of premature twins
482
Features of SDLD?
Clinical features are those common to respiratory distress in the newborn, i.e. tachypnoea, intercostal recession, expiratory grunting and cyanosis
X-ray- ground glass appearance with an indistinct heart border
483
Management of SDLD?
Management
Prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
Oxygen
Assisted ventilation
Exogenous surfactant given via endotracheal tube
484
UTI treatment?
<3 months- urgent referral to Paeds
>3 months with upper UTI- cephaloporin or co-amoxiclav
>3 months with lower UTI- oral antibiotics- trimethoprim, nitrofurantoin
485
Difference between reflex anoxic seizures and seizures?
Reflex anoxic seizures have a rapid recovery (syncope)
486
Premature vaccines?
Give as normal
If under 28 weeks give first in hospital
487
Simple vs complex febrile seizures?
Simple:
Less than 15 mins
Generalised seizure
No reccurence witin 24 hours
Complete recovery within an hour
Complex:
15-30 mins
Focal seizures
Repeat within 24 hours
Febrile status epilepticus:
>30 mins
488
Remember question- girl without condition, what is chance she is a carrier?
2/3
Can exclude aa as know she does not have it
489
PDA features?
Features
left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat
490
Fluids summary?
0-10kg- 100ml/kg
10-20kg- 50ml/kg
20+kg- 20ml/kg
Up to 2.5L
% dehydration = (well weight - ill weight) / well weight x 100
Fluid deficit (ml) = %dehydration x well weight (kg) x 10
Give over 24 hours with normal fluids
Resuscitation bolus is 10ml/kg repeat up to 40ml/kg
491
Hydrocele?
Fluid in tunica vaginalis
Soft, non tender swelling that transilluminates
Confined to scrotum and get above the mass
USS
Repair if don't resolve
492
Varicocele?
Enlargement of testicular veins
Bag of worms
Subfertility
Utrasound
Conservative
493
Torsion?
Twisting of the spermatic cord
Pain severe
N+V
Swollen, tender testis unilateral
Cremasteric reflex lost
Prehn's sign- lift ball doesn't ease pain
Urgent surgical exploration
494
What virus is measles?
RNA paramyxovirus
495
Chicken pox IgG, IgM?
IgG- got antibodies
IgM- met someone with virus
496
How to look for scarring in vesicouteric reflux?
DMSA scan
497
Clinical features of Down's syndrome?
Clinical features
face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
flat occiput
single palmar crease, pronounced 'sandal gap' between big and first toe
hypotonia
congenital heart defects (40-50%, see below)
duodenal atresia
Hirschsprung's disease
498
Cerebral palsy causes?
80% congenital infections- rubella
10% birth asphixiation/trauma
10% trauma meninigits intraventricular haemorrhage
499
Pierre-Robin triad?
Micrognathia
Cleft lip
Glossoptosis (posterior displacement of the tongue)
