Ques med Peads

Question 1

What is the most common cause of nephrotic syndrome in children?

Answer 1

-Minimal changes disease
-Roughly accounts for 70% of cases of nephrotic syndrome

Question 2

What is minimal changes disease typically characterised by?

Answer 2

-oedema
-frothy urine (excess protein in urine)
-often follows a viral upper respiratory tract infection
-also causes fatigue and weight gain due to fluid retention

Question 3

Why is it called minimal changes disease?

Answer 3

-it is marked by minimal or no changes visible under light microscopy, but more subtle changes can be detected using electron microscopy

Question 4

What are the investigations that should be carried out in a patient with suspected minimal change disease?

Answer 4

-Urine: look for proteinuria, WBC and blood in urine
-Blood tests: low albumin and elevated cholesterol
-Kidney biopsy: only done when patients do not respond to initial treatment to confirm diagnosis

Question 5

What is the management of minimal change disease?

Answer 5

-1st line: Corticosteroids: Prednisolone
-2nd line: Other immunosuppressants e.g. ciclosporin

Question 6

How to manage oedema and prevent further complication in minimal change disease?

Answer 6

-Fluid restriction and reduced salt intake
-In severe cases with significant fluid overload: Administer albumin and furosemide

Question 7

What is the definition of ITP?

Answer 7

-An autoimmune condition with a reduction of circulating platelets leading to easy purport, superficial bleeding into skin, mucotenesous bleeding.

Question 8

What type of hypersensitivity reaction in ITP and what components are involved?

Answer 8

-It is a type II hypersensitivity reaction where by the spleen produces antibodies that are directed against the glycoprotein IIb/IIIa or ib-V-IX complex

Question 9

What are the main clinical features of vitamin K deficiency?

Answer 9

Increased propensity to bruising and if severe enough, internal bleeding

Question 10

Why are breastfed babies at a bigger risk of vit K deficiency?

Answer 10

Breast milk has lower levels of vitamin K compared to formula

Question 11

Pathogen causing hand foot and mouth disease?

Answer 11

Coxsackie virus A16

Question 12

Diagnosis of rubella?

Answer 12

serological testing, look for rubella specific IgM antibodies

Question 13

What virus is rubella caused by?

Answer 13

Rubella tagovirus

Question 14

What symptoms is rubella characterised by?

Answer 14

Fever, coryza, arthralgia, rash (begins on face and moves to trunk, spares the limbs) , lymphadenopathy (classically post-auricular)

Question 15

How is rubella spread?

Answer 15

Through respiratory droplets

Question 16

How is rubella managed?

Answer 16

-Supportive (analgesia and antipyretics)
-Isolate diagnose individual

Question 17

What is the biggest risk of rubella?

Answer 17

Rubella poses a serious risk to unvaccinated pregnant=t women - causing congenital rubella syndrome, which can cause severe fatal abnormalities

Question 18

What are fatal abnormalities that rubella can cause?

Answer 18

-Cataracts
-Deafness
-PAD
-Brian damage

Question 19

What can be used to confirm glandular fever?

Answer 19

A heterophiles antibody “Paul Bunnell’

Question 20

What is the tretament for bilary atresia?

Answer 20

Hepatoportoenterostomy (Kasai procedure): This surgery creates a new pathway from the liver to the gut to bypass the fibrosed bile ducts.

Question 21

What investigation is used for measles?

Answer 21

Diagnosis is primarily achieved by measles-specific IgM and IgG serology, and measles RNA detection by PCR

Question 22

What is hydrocele?

Answer 22

-A pathological accumulation of serous fluid in a sac-like cavity specifically around the testicle
-It typically presents as an enlarged scrotum

Question 23

What is a nephroblastoma or wilms tumour?

Answer 23

-A malignant embryonic tumour originating from the developing kidney.
-It represents the most common abdominal tumour in paediatric patients

Question 24

What are the features of a nephroblastoma?

Answer 24

Abdominal mass, abdominal distension, haematuria, and hypertension

Question 25

At what age does a nephroblastoma present?

Answer 25

-5 years -Peak incidence between 3-4 years

Question 26

What are the signs and symptoms of nephroblastoma?

Answer 26

-A palpable abdominal mass that does not cross the midline, although it may be bilateral in up to 5% of cases. -Abdominal distension -Haematuria -Hypertension -Often asymptomatic unless the tumour grows sufficiently large to cause pain or disrupt other abdominal structures.

Question 27

What is the management of nephroblastoma?

Answer 27

-Surgical resection -Adjunctive chemo -Prognosis - generally excellent 990% 5 years)

Question 28

What are the investigations of a wilms tumour/nephroblastoma?

Answer 28

-CT scan of the chest, abdomen, and pelvis (spread disease) -Definitive diagnosis and staging are confirmed via renal biopsy, which may reveal small round blue cells on histology. (This finding is not exclusive to nephroblastomas)

Question 29

What is seen on USS for intussusception?

Answer 29

A classic 'target' sign on abdominal ultrasound is seen as concentric echogenic and hypogenic bands, demonstrating the invagination of a bowel segment into an adjacent one.

Question 30

What enzyme deficiency is caused by congenital adrenal hyperplasia?

Answer 30

21-hydroxylase deficiency

Question 31

What are the signs of Roseola?

Answer 31

-Initial fever lasting upto 5 days with high fevers reaching to 40 -As the fever subsides a blanching, rose-pink macular rash erupts, predominantly over the trunk but may also spread to the face and limbs

Question 32

what is the first step in resuscitating a neonate?

Answer 32

The first step is to inflate the lungs by giving 5 breaths via a 250 ml bag-valve mask

Question 33

What is used to stage for puberty?

Answer 33

Tanner staging

Question 34

What is slapped cheek syndrome?

Answer 34

Erythema infectiosum

Question 35

How does erythema infectiosum present?

Answer 35

-initial headache, fever, and cold-like symptoms -Followed by a rash developing over the following few days; appearing bright red on the cheeks and more lacy in pattern over the rest of the body

Question 36

What is Prader Willi syndrome?

Answer 36

-Genetic condition that is inherited by genomic imprinting - A gene on chromosome 15 is imprinted such that the child only expresses the maternally inherited version of the gene

Question 37

What are the key signs and symptoms of prader willi syndrome?

Answer 37

-Hypotonia and poor feeding in infancy -Developmental delay in early childhood -Learning disabilities -Short stature -Hyperphagia (excessive hunger) and resultant obesity in older childhood. Anecdotal reports suggest that children with Prader-Willi Syndrome may consume non-food items out of excessive hunger.

Question 38

Fitting child - 2 doses of buccal Midazolam, what should be given next?

Answer 38

IV Leviteracetam, Phenytoin or Valproate

Question 39

What virus is acute epiglottitis caused by?

Answer 39

Haemophilus influenza B (Hib)

Question 40

Down's syndrome heart abnormality?

Answer 40

-Eisenmenger syndrome - due to ventricular septal defect -Reversal of L-R cardiac shunt to R-L due to pulmonary hypertension

Question 41

What is amniotic fluid embolism?

Answer 41

Amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse

Question 42

what is the triad of amniotic fluid embolism ?

Answer 42

coagulopathy, hypoxia and hypotension

Question 43

Where is lidocaine injected?

Answer 43

Pudneal nerve - pudeneal nerve block

Question 44

What is the regime for medical termiation of pregnancy?

Answer 44

-Oral mifepristone 200mg (antiprogesterone) -Buccal, vaginal, sublingual misoprostol 800mg (prostaglandin analogue) 24-48 hours later

Question 45

How to identify premature rupture of membranes?

Answer 45

Actim-PROM vaginal swab detects insulin-like growth factor binding protein-1 (IGFBP-1) in vaginal fluid

Question 46

What causes inguinal hernia in childremn?

Answer 46

-Almost always indirect in children and are caused by failure of the processus vaginalis to obliterate -More commin in boys and on the right

Question 47

What is the first line investigation for asthma?

Answer 47

-Spirometry and BDR (bronchodilator reversibility) -Positive result confirms presence of an obstructive airway pattern

Question 48

Clinical findings in PDA?

Answer 48

Collapsing pulse

Question 49

When does moro reflex disappear?

Answer 49

6 months -spread out arms -pulls arms -starts crying

Question 50

What is malrotation?

Answer 50

Abnormal development of the midgut during embryogenesis, which increases the bowel's propensity for volvulus and duodenal compression by Ladd bands.

Question 51

How does malrotation present?

Answer 51

Bilious vomiting on the first day of life

Question 52

What is the gold standard for malrotation?

Answer 52

Upper GI contrast study

Question 53

What is tuberous sclerosis?

Answer 53

An autosomal dominant neurocutaneous syndrome typified by cellular hyperplasia, tissue dysplasia, and hamartomas in multiple organs

Question 54

What are the signs and symptoms of tuberous sclerosis?

Answer 54

-Neurological: Infantile spasms with hypsarrhythmia as seen on electroencephalogram; seizures/epilepsy -Skin: Ash leaf macules; shagreen patches; facial angiofibromas; subungual fibromas -Cognitive: Learning disabilities -Renal: Angiomyolipomas -Cardiac: Cardiac rhabdomyomas

Question 55

What kind of reaction occurs when take amoxicillin with glandular fever?

Answer 55

Morbilliform Eruption