1
Q
What is the APGAR score?
A
Assess health of newborn baby
2
Q
When is APGAR score assessed?
A
1 and 5 minutes.
Repeated at 10 minutes if low score <7
3
Q
What is assessed in the APGAR score?
A
Appearance (colour)
Pulse
Grimace (reflex irritability)
Activity (tone)
Respiration (crying)
4
Q
APGAR score interpretation?
A
0-3 = low
4-6 = moderate
7-10 = good
5
Q
What are the findings for each parameter of the APGAR score for 0, 1 and 2 scores?
A
Appearance - Blue (0), pink body + blue extremities (1), pink (2)
Pulse - Absent (0), <100 (1), >100 (2)
Grimace - Absent (0), Small/grimace (1), large/cries/cough (2)
Activity - Absent/flaccid (0), Limb flexion (1), Motive/active (2)
Respiration - Absent (0), Gasping/irregular (1), Strong cry/regular (2)
6
Q
When is the neonatal heel-prick test carried out?
A
Between 5-9 days
7
Q
What is included in the 6-in-1 vaccine?
A
Diphtheria
Polio
Tetanus
Whooping cough
Hib
Hep B
8
Q
What is included in the 4-in-1 vaccine?
A
Diphtheria
Polio
Tetanus
Whooping cough
9
Q
Which vaccines are given at 2 months?
A
6-in-1
Rotavirus
Men B
10
Q
Which vaccines are given at 3 months?
A
6-in-1
Rotavirus
Pneumococcal
11
Q
What vaccines are given 4 months?
A
6-in-1
Men B
12
Q
What vaccines are given at 12-13 months?
A
Hib
Pneumococcal
Men B+C
MMR
13
Q
What vaccines are given at 3-4 years?
A
4-in-1
MMR
14
Q
When is the HPV vaccine given?
A
13-14 years
15
Q
What vaccines are given between 13-18 years?
A
3-in-1 (diphtheria, polio, tetanus)
Men ACWY
16
Q
What are some conditions the heel-prick tests for?
A
Cystic fibrosis
Congenital hypothyroidism
Sickle cell disease
PKU
MSUD (maple syrup urine disease)
17
Q
Which vaccines are live and should not used in immunocompromised?
A
Oral polio
Nasal flu
MMR
BCG
18
Q
Which virus cause chicken pox?
A
Varicella zoster virus
19
Q
Chicken pox rash appearance/location?
A
Red macules which become raised → blister → crust
Trunk and face most prominent
20
Q
Presentation of chicken pox?
A
Itchy rash
Fever (if >4d bacterial complication?)
4-10d of symptoms
21
Q
When is chicken pox infectious?
A
Before lesions crust/scab over
22
Q
How is chicken pox managed?
A
Calamine/moisturising treatment
PO aciclovir if immunocompromised
23
Q
Possible complications of chicken pox?
A
Pneumonia
24
Q
Which virus causes measles?
A
Paramyxovirus
25
Measles rash appearance/location?
Erythematous maculopapular rash
Oral 'Koplik spots'
Face → trunk → limbs
26
Presentation of measles?
Rash face → trunk
Preceding fever, cough, red eyes
Photophobia if older
4-7d symptoms
27
Infectivity of measles?
Infective until 4d after rash onset
28
Management of measles?
Supportive
Abx if vulnerable
29
Possible complications of measles (3)?
Otitis media
Bronchopneumonia
Encephalitis
30
Which childhood diseases are notifiable?
Measles
Mumps
Rubella
Scarlet fever
Bacterial meningitis
31
Which organism causes scarlet fever?
Group A strep
32
Scarlet fever rash appearance/location?
Fine papular 'sandpaper' rash
Strawberry red tongue
Face/elbows → spreads rapidly to entire body
33
Presentation of scarlet fever?
Rash
Circumoral pallor
Fever
Tonsillitis
5-7d of symptoms
34
Infectivity of scarlet fever?
Up to 24hours after abx given
35
Management of scarlet fever?
Pen V (phenoxymethylpenicillin) for 10d
36
Possible complications of scarlet fever?
Sinusitis
Meningitis
Pneumonia
Septicaemia
Rheumatic fever
37
Rubella rash appearance/location?
Pink macular rash
Forchheimer spots (on palate)
Face/neck → trunk and limbs
38
Rubella presentation?
Prodrome 1-5d before rash:
Fever
URTI
Conjuctivitis
Tender lymph nodes
Sx 1w before rash to 4d after
39
Infectivity in rubella?
Up to 5d after rash appears
40
Management of rubella?
Supportive
AVOID PREGNANT CONTACTS
41
Possible complications of rubella?
Conjunctivitis
Hepatitis
42
Which virus causes erythema infectiosum?
Parvovirus B19
(Fifth disease/slapped cheek)
43
Erythema infectiosum rash appearance/location?
Slapped cheek appearance
Maculopapular rash on trunk/limbs 1-4d after
44
Presentation of Erythema infectiosum (3)?
Slapped cheek rash
Low grade fever
Myalgia/arthralgia
Sx wax and wane over 1-2w
45
Infectivity of Erythema infectiosum?
Not infectious once rash appears
46
Management of Erythema infectiosum?
Supportive treatment
(May need transfusion if aplastic crisis)
47
Which virus cases roseola infantum?
Herpes virus 6 or 7
48
Roseola infantum rash appearance/location?
Blanching, red, macules and papules
very little on face/legs
Trunk → arms/neck
49
Presentation of roseola infantum?
High fever for 3d
Mild URTI
Abdo pain
diarrhoea
Eyelid oedema
1-2d of symptoms
50
Infecivity of roseola infantum?
Orally - no exclusion needed
51
Management of roseola infantum?
Supportive
52
Possible complications of roseola infantum?
Encephalitis/encephalopathy
53
Which virus causes mumps?
Paramyxovirus
54
Symptoms/presentation of mumps?
Bilateral parotid glad swelling
Fever
Headache
Myalgia
Sx 7-14d
*Children commonly asymptomatic*
55
Infectivity of mumps?
2d before - 9d after symptoms
Exclusion for 5d from development of parotitis
56
Management of mumps?
Supportive
57
Possible complications of mumps?
Epididymo-orchitis
Aseptic meningitis
Transient hearing loss
CNS disorders
58
What are the most common causes of bacterial meningitis in <3 months?
Group B strep
E. coli
Listeria
59
What are the most common causes of bacterial meningitis in 1m-6y?
Neisseria meningitidis
Strep. pneumoniae
H. influenzae
60
What are the most common causes of bacterial meningitis in >6y?
Neisseria meningitidis
Strep. pneumoniae
61
Symptoms of meningitis?
Fever
Non-blancing purpura (meningococcal)
Neck stiffness
Bulging fontanelle
Photophobia
+ve Brudzinski and Kernig
62
What is Brudzinski sign?
Flexion of neck causes hip and knee flexion
63
What is Kernig sign?
With hips and knees flexed, pain on extending knee
64
Investigations for meningitis?
Lumbar puncture
Blood glucose and blood gases
Blood/urine/stool/throat swab cultures
FBC, CRP, LFTs, U&Es, clotting
65
When is lumbar puncture contraindicated?
Signs of ↑ICP
Throbocytopenia
Neurlogical signs or seizures
Cardiovascular shock
66
Lumbar puncture CSF results in bacterial meningitis?
Turbid/cloudy
↑↑↑ Neutrophils
↑↑ Protein
↓↓ Glucose
67
Lumbar puncture CSF results in viral meningitis (4)?
Clear
↑↑↑ Lymphocytes
Normal Protein
Normal glucose
68
What should be given if meningitis is suspected in the community?
IM Benzylpenicillin
69
What antibiotics are given empirically before cultures in bacterial meningitis?
3rd gen cephalosporins:
<3m - cefotaxime (+ amoxicillin for Listeria)
>3m - ceftriaxone
70
When should steroids be given in meningitis?
If >3m
LP suggestive of bacterial cause
71
Why are steroids given in bacterial meningitis?
Reduced frequency/severity of hearing/neurological damage
72
What is given to contacts of patients with bacterial meningitis?
Post exposure prophylaxis
Ciprofloxacin/Rifampicin
73
What is Kawasaki disease?
Systemic small-medium vasculitis
74
Risk factors for Kawasaki deases?
6m-4y
Asian or afro-caribbean
Covid-19
75
Presentation of Kawasaki disease?
Persistent high fever
Widespread rash
Desquamation of palms and soles
Strawberry tongue
Cracked lips
Cervical lymphadenopathy
Non-purulent conjunctivitis
76
Investigations in Kawasaki disease?
CRP, ESR, WCC, platelets (all ↑)
Echocardiogram (may show aneurysms)
77
How is Kawasaki disease managed?
High dose aspirin (then low dose 6w)
IV Ig
Supportive - antipyrexials etc
78
Why are aspirin and IVIg given in Kawasaki disease?
Aspirin - reduce risk of thrombosis
IVIg - reduce risk of coronary artery aneurysms
79
Which virus causes infectious mononucleosis/glandular fever?
Epstein-Barr virus (EBV)
80
Presentation of infectious mononucleosis?
Fever
Sore throat
Fatigue
Cervical lymphadenopathy
Maculopapular rash (if <4y)
Splenomegaly
81
Which disease can cause itchy maculopapular rash in response to taking amoxicillin (or cephalosporins)?
Infectious mononucleosis
82
Investigations for infectious mononucleosis?
Monospot test - heterophile antibodies
EBV antibodies - IgG and IgM
Blood film - atypical lymphocytes
83
What is the safety-netting in glandular fever (3)?
No alcohol
No contact sports (splenic rupture)
Avoid close contact with others
84
What is cystic fibrosis (CF)?
Autosomal recessive condition affecting mucus glands
85
What is the inheritance pattern of cystic fibrosis?
Autosomal recessive
86
What is the basic pathophysiology of CF?
Abnormal Cl- transport across epithelial cells
Causes thickened mucus secretions = ciliary dysfunction
87
Which organs are particularly affected in CF?
Lungs
Intestine
Pancreas
Skin
88
In which ways are the lungs affected in CF?
Impaired ciliary function + mucopurulent secretions:
Persistent cough with purulent sputum
Recurrent chest infections
89
Which are the common lung colonisers in CF?
Pseudomonas
Staph. aureus
Burkholderia
90
In which ways is the intestine affected in CF? (In newborns)
Thick viscous meconium in newborns:
Meconium ileus
91
In which ways is the pancreas affected in CF?
Pancreatic duct blocked = enzyme insufficiency:
Malabsoprtion/malnutrition
FTT
Large, pale, greasy stools
92
In which ways is the skin affected in CF?
Excessive Na+ and Cl- in the sweat
93
In which ways can CF be diagnosed?
Heel-prick in newborn
Sweat test
Genetic testing - CFTR mutation
94
Why are males with CF infertile?
Congenital absence of vas deferens
95
How is CF managed?
Lungs:
Prophylactic Abx
Regular chest physio
Hypertonic saline (reduce viscosity)
Nasal steroids (for polyps)
Pancreas:
Pancreatic enzyme replacement
Vitamins + high calorie diet
+ regular monitoring
+ psychological/emotional support
96
Which prophylactic antibiotic is prescribed in CF?
Flucloxacillin
Azithromycin
97
What are some possible complications of CF?
Diabetes mellitus
bronchiectasis
Nasal polyps/sinusitis
98
What is the most common cause of bronchiolitis?
RSV (respiratory syncytial virus)
Others: rhinovirus, adenovirus
99
Which age group is bronchiolitis most common in?
<1 year
100
What is bronchiolitis?
Infection and inflammation of the bronchioles
101
Presentation of bronchiolitis?
Preceding coryzal symptoms
Dry cough
Feeding difficulties
↑Breathlessness
Fever
102
What may be found on examination in bronchiolitis?
Fine inspiratory crackles
High-pitched wheeze
↑WOB
↑HR
↑RR
103
What are signs of respiratory distress in a child?
↑ Resp rate
Accessory muscle use
Intercostal/subcostal recessions
Nasal flaring
Head bobbing
Tracheal tug
Grunting
104
When should a child with bronchiolitis be admitted?
Apnoea/grunting
Child looks seriously unwell to a healthcare professional
Severe respiratory distress
RR <70
Central cyanosis
Persistent O2 sats <92% on air
<50-75% normal fluid intake
Difficulty managing or seeking medical help from home
105
What is management of bronchiolitis?
Supportive:
Humidified O2
Fluids/nutrition (NG/IV if needed)
Nasal saline drops/suctioning
Ventilation if needed
106
Who is given the RSV vaccine?
Pregnant women from 28 weeks
107
Who should be given RSV monoclonal antibodies?
High-risk infants:
Preterm
Congenital heart defects
108
Which virus is the most common cause of hand, foot, and mouth disease?
**Coxsackie** A16
109
What are the symptoms of hand, foot, and mouth disease?
Fever
Sore throat
Oral ulcers
Followed later by vesicles on the palms and soles of the feet
110
Treatment for hand, foot, and mouth disease?
Supportive: rest, fluids, analgesia
111
Exclusion criteria for hand, foot, and mouth disease?
None needed, only keep off if unwell
112
What is the classic presentation of septic arthritis in a child?
Boy w/ limp
Fever
Immobile limb
Tender, swollen, hot, red joint
113
What are the Kocher criteria for diagnosis of septic arthritis (4)?
Fever >38.5
Non-weight bearing
Raised ESR
Raised WCC
114
What features in a history are suspicious of non-accidental injury (NAI)?
Multiple injuries
No explanation/explanation doesn't fit
Delayed presentation
Varying explanations
Unconcerned/vague/aggressive parents
Hx of unusual injuries
Child on at risk register
115
What features on examination are suspicious of NAI?
Fractures:
In non-mobile child
Rib/skull
Multiple fractures without major trauma
Bruises:
In non-mobile child
Shape of hand/bite
Around neck/wrists/ankles/face
Burns:
In shape of instrument
Glove and stocking pattern (immersion)
116
What investigations if abuse is suspected in a child (4)?
Full skeletal x-ray
Full bloods (r/o organic causes)
CT brain (if head trauma)
Ophthalmological exam (if subconjunctival haemorrhage)
117
What is croup?
URTI in infants/toddlers
Causes oedema and inflammation of larynx and airways
118
Presentation of croup?
Peak age 6 months-3 years
'Seal-like' barking cough
Increased WOB
Stridor
Fever
Coryzal symptoms
119
What are the most common causes of croup?
Parainfluenza viruses:
Influenza
RSV
Rhinovirus
120
What is the management of croup?
Single dose oral dexamethasone
If severe:
Oxygen
Nebulised budesonide
Nebulised adrenaline
121
What is the dose of PO dexamethasone in croup?
0.15mg/kg
122
When should children with croup be admitted (3)?
If moderate/severe croup
<3 months age
Known upper airway abnormalities
123
Most common causes of acute epiglottitis in children?
Hib
Strep pneumonia
124
Presentation of epiglottitis?
Rapid onset
Fever
Stridor
Drooling
'Tripod' position
Difficulty/painful swallowing
125
What should NOT be done in suspected epiglottitis?
Inspect/examine throat
Keep child comfortable and minimise distress
126
Management of suspected epiglottitis?
Immediate anaesthetics/ENT referral
Secure airway > IV Abx and O2
127
Signs of candidal infection in nappy rash (5)?
Rash extends to skin folds
Larger red macules
Scaly border
Satellite lesions
Circular pattern spreading outwards
128
Treatment of infected nappy rash?
Fungal = clotrimazole/miconazole cream
Bacterial = fusidic acid cream
129
What is Juvenile idiopathic arthritis (JIA)?
Autoimmune inflammation of the joints
130
Criteria for diagnosing JIA?
- Arthritis without any cause
- Under 16 y/o
- Lasting more than 6 weeks
131
Symptoms of systemic JIA (6)?
Pyrexia
Salmon-pink rash
Lymphadenopathy
Arthritis
Uveitis
Weight loss
132
Which blood tests will and wont be raised in JIA?
↑ANA
↑CRP/ESR
NO RF
NO anti-CCP
133
Possible differentials for child with rash, fevers and joint pain (4)?
Kawasaki disease
Systemic Juvenile idiopathic arthritis
Rheumatic fever
Leukaemia
134
Features of polyarticular JIA (3)?
5 joints or more affected
Usually symmetrical
Minimal systemic symptoms
135
Features of oligoarticular JIA (4)?
4 joints or less
Usually monoarthritis
Larger joints
Anterior uveitis
136
Features of juvenile psoriatic arthritis (5)?
Psoriasis plaques on skin
Arthritis (poly or oligo)
Nail pitting
Enthesitis
Dactylitis
137
Management of JIA (4)?
NSAIDs e.g. ibuprofen
Steroids
DMARDs
Biologics
138
What is Down's syndrome?
Trisomy 21
139
What are some of the features seen in Down's syndrome?
Short neck
Short stature
Flattened face and nose
Prominent epicanthic folds
Upward sloping palpebral fissures
Single palmar crease
Hypotonia
140
What are some possible complications of Down's syndrome?
Congenital heart disease
Duodenal atresia
Hirschsprung's disease
Recurrent otitis media/resp infections
AML
Hypothyroidism
Alzheimer's disease
Learning difficulties
141
Combined test findings in Down's syndrome (B-HCG, PAPP-A, nuchal translucency)?
↑B-HCG
↓PAPP-A
Thickened nuchal translucency
142
Most common congenital cardiac complication in Down's syndrome?
Atrioventricular septal defect
143
What is Klinefelter's syndrome?
Male
47 XXY
144
Features of Klinefelter's syndrome?
Tall stature
Lack of secondary sexual characteristics
Small, firm testes
Infertile
Gynaecomastia
145
What is Turner's syndrome?
Female
45 XO
146
Features of Turner's syndrome?
Short stature
Webbed neck
Shield chest, widely spaced nipples
Prominent epicanthic folds
Late or incomplete puberty
Infertility
Primary amenorrhoea
Bicuspid aortic valve
Coarctation of the aorta
147
What cardiac defect is found in Turner's syndrome and what murmur is associated with it?
Bicuspid aortic valve (aortic reguritation) = early diastolic murmur
Coarctation of aorta = mid systolic murmur
148
Features of Noonan syndrome?
'Male Turner's'
Webbed neck
Widely-spaced nipples
Short stature
Low set ears
149
What is fragile X syndrome?
Trinucleotide repeat disorder
150
Features of fragile X syndrome?
Mostly in males
Long, narrow face
Large ears
ASD/ADHD
Large testicles after puberty
Seizures
Mitral valve prolapse
151
What is Edward's syndrome?
Trisomy 18
152
Features in Edward's syndrome (4)?
Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers
153
What is Patau syndrome?
Trisomy 13
154
Features of Patau syndome (4)?
Microcephalic
Small eyes
Polydactyly
Cleft lip/palate
155
Features of Prader-Willi syndrome?
Hypotonia
Hyperphagia (insatiable hunger)
Hypogonadism
Obesity
156
What is pyloric stenosis?
Hypertrophy/narrowing of pylorus
157
At what age does pyloric stenosis usually present?
2-4 weeks
Before 3 months
158
Presenting features of pyloric stenosis?
FTT
Projectile vomiting after feeds
Olive shaped mass in abdomen
159
What would be found on a blood gas in a child with pyloric stenosis?
Hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
160
Investigations in pyloric stenosis to confirm diagnosis?
USS
161
Management of pyloric stenosis?
Laparoscopic pyloromyotomy
162
What is Hirschsprung's disease?
Congenital condition = aganglionic segment of bowel
163
Presentation of Hirschsprung's disease (5)?
Absent meconium
Abdo distension
Vomiting
Poor weight gain
FTT
164
Investigations in suspected Hirschsprung's disease?
Abdominal x-ray
Rectal biopsy - gold standard
165
Management of Hirschsprung's disease?
Surgical removal of aganglionic bowel
166
What is HAEC?
Hirschsprung-associated enterocolitis
167
Management of Hirschsprung-associated enterocolitis (HAEC) (3)?
Abx
Fluid resus
Decompression of obstructed bowel
168
Presentation of Hirschsprung-associated enterocolitis (HAEC) (4)?
Fever
abdominal distension
Diarrhoea (+/- blood)
Features of sepsis
169
What is intussusception?
Telescoping of one portion of bowel into another
170
Presentation of intussusception (4)?
Severe colicky abdominal ain
Bilious vomiting
Redcurrent jelly stool
Sausage shaped mass
171
Imaging for suspected intussusception and what will it show?
USS showing target sign
172
Management of intussusception?
Air insufflation
Surgical reduction if unsuccessful
Bowel resection if gangrene/perforation
173
Most common ages presenting with transient synovitis?
Children 3-10 years
174
Clinical presentation of transient synovitis?
Limp/Refusal to weight bear
Low grade fever
Groin/hip pain
USUALLY within a few weeks of viral illness
175
Management of transient synovitis?
Rest and analgesia
Safety netting
Follow up at 48hrs and 1 week
176
What is the safety netting advice for transient synovitis?
Attend A&E if symptoms worsen or develop fever
177
What is Perthes' disease?
Avascular necrosis of the femoral head
178
Clinical presentation of Perthes' disease?
Progressively worsening hip/groin pain
Limp
Stiffness/reduced ROM
No history or trauma
179
Investigations for suspected Perthes' disease?
X-ray = may show widening of joint space
180
Management of Perthes' disease?
Conservative = bed rest, traction/cast, crutches, analgesia
Physio
Surgery = severe cases/older children
181
What is SUFE?
Slipped upper femoral epiphysis
Head of femur displaced along growth place
182
Which group of patients if SUFE common in?
Obese children 10-15
More common in boys
183
Clinical presentation of SUFE?
Hip, groin, medial thigh or knee pain
Loss of internal rotation of leg in flexion
Painful limp
184
Investigations in suspected SUFE?
X-ray (frog-leg)
185
What is the management of SUFE?
Surgery = Internal screw fixation
186
Possible complications of SUFE?
Leg length discrepancy
Osteoarthritis
Avascular necrosis of femoral head
187
What is developmental dysplasia of the hip?
Congenital abnormality of formation of hips
Tendency to dislocate or subluxate
188
Risk factors for developmental dysplasia of the hip?
Female sex
Breech
FHx
Multiple pregnancy
189
How is developmental dysplasia of the hip screened for in newborns?
Barlow test - attempt to dislocate femoral head
Ortolani test - attempt to relocate
190
Investigations if suspected developmental dysplasia of the hip?
USS of hips
If >4.5m then xray
191
Management of developmental dysplasia of the hip?
Pavlik harness if <6m
Surgery if harness fails or diagnosed >6m
192
What is Osgood-Schlatter disease?
Inflammation at tibial tuberosity causing anterior knee pain
193
Presentation of Osgood-Schlatter disease?
Hard and tender lump at tibial tuberosity
Pain in anterior knee
Pain exacerbated by physical activity, kneeling and knee extension
194
At what age are febrile convulsions most common?
6 months - 5 years
195
Features of a simple febrile convulsion?
Tonic-clonic
<15 mins
Occur once during illness
196
What are features of complex febrile convulsions?
Partial/focal seizures
>15 mins
May have repeat seizures
197
Management of febrile convulsions?
Exclude other pathology (always assess a first seizure)
Patient education
198
What advice should parents have around febrile convulsions?
Call ambulance if lasts >5 mins
Protect head
Place in recovery position
Regular antipyretics
199
What is necrotising enterocolitis (NEC)?
Disease affecting premature neonates where bowel becomes necrotic
200
Risk factors for NEC?
Very low birth weight
Extremely premature
Formula feeding
Respiratory distress syndrome
Sepsis
PDA
201
Clinical presentation of NEC (5)?
Intolerance to feeds
Blood in stools
Abdominal distension
Absent bowel sounds
Vomiting
202
Investigations in suspected NEC?
Abdo x-ray
203
What may be seen on x-ray in NEC?
Dilated loops of bowel
Bowel wall oedema
Intramural gas
Gas in portal veins
Pneumoperitoneum
204
Management of NEC (6)?
NBM
IV fluids
TPN
Abx
NG tube
Surgery to remove necrosed bowel
205
When does immune/idiopathic thrombocytopenic purpura (ITP) occur in children?
Usually following infection or vaccination
206
How is ITP managed in children?
Usually resolves spontaneously - no management
- Avoid contact sports
- Avoid NSAIDs
- Advice on managing nosebleeds
If bleeding or severely low platelets:
Prednisolone
IVIg
Transfusions
207
What is biliary atresia?
Congenital condition where bile ducts narrowed or absent
208
Clinical presentation of biliary atresia (4)?
Neonates (first few weeks) with:
Jaundice
Hepatosplenomegaly
Abnormal growth
209
Does biliary atresia cause raised conjugated or unconjugated bilirubin?
Conjugated
210
Investigations for suspected biliary atresia?
Bloods - bilirubin (conjugated), LFTs
USS
211
Management of biliary atresia?
Kasai portoenterostomy
Removing bile ducts and attaching small intestine to liver
Liver transplant may be required
212
What is Henoch-Schonlein purpura (HSP)?
IgA mediated small vessel vasculitis
213
Clinical presenting features of HSP (5)?
Following infection (URTI/GI)
Palpable purpuric rash
Abdo pain
Polyarthritis
IgA nephritis features
214
Where is the rash most commonly seen in HSP?
Over buttocks and extensor surfaces of arms/legs
215
Management of HSP?
Analgesia
Supportive tx of nephropathy
216
Primary vs secondary enuresis in children?
Primary = never achieved continence
Secondary = dry for at least 6 months before
217
Underlying causes/triggers to rule out in nocturnal enuresis (3)?
Constipation
Diabetes
UTI
218
Management options for nocturnal enuresis?
Enuresis alarm first line
Desmopressin if short-term control needed
219
What is hypospadias?
Congenital abnormality where urethral meatus is on ventral side (underside) of penis
220
Management of hypospadias?
Referral to urologist - surgery
DO NOT CIRCUMCISE
221
What is phimosis?
Irretractable foreskin
222
Complications of undescended testis?
Infertility
Torsion
Testicular cancer
Psychological
223
Management of unilateral undescended testis?
Refer from 3 months (in unresolved)
Surgery at around 1yr
224
Management of bilateral undescended testes?
Review by senior within 24 hours
225
What is pica?
Eating disorder - compulsive consumption of non-food items
226
Newborn resuscitation steps?
- Dry baby and maintain temp
- Assess tone, RR, HR
- Give 5 inflation breaths
- Reassess
- HR not up (<60) = compressions and ventilation breaths
227
What are some antenatal, intrapartum, and postnatal causes of cerebral palsy?
Antenatal = cerebral malformation, maternal infection (rubella, CMV)
Intrapartum = birth asphyxia/trauma
Postnatal = meningitis, severe neonatal jaundice, heady injury
228
Classification of cerbral palsy?
Spastic = hypertonia, hemi/di/quadraplegic
Dyskinetic = dystonia, athetoid movements, oral motor control
Ataxic = coordinated movement
Mixed
229
Possible signs and symptoms of cerebral palsy?
Failure to meet milestones
↑/↓ tone
Hand preference below 18m
Feeding/swallowing issues
Learning difficulties
230
Management of cerebral palsy (MDT)
Physiotherapy
Occupational therapy
SALT
Dieticians
Social workers
Paediatricians
231
Most common viral cause of encephalitis in children?
HSV-1/HSV-2
232
What is Kwashiorkor?
Severe form of protein malnutrition
Characterised by oedema and ascites
233
What is Meckel's diverticulum?
Congenital diverticulum of small intestine
234
Presentation of Meckel's diverticulum?
Abdo pain mimicking appendicitis
Rectal bleeding
Intestinal obstruction
235
Investigation in suspected Meckel's diverticulum?
Meckel scan - 99m technetium
236
Management of Meckel's diverticulum?
Removal if narrow neck/symptomatic
237
What is a Wilms' tumour?
Nephroblastoma
238
Usual presenting age of Wilms' tumour?
<5y
239
Clinical presenting features of Wilms' tumour?
Asymptomatic abdominal mass
+/-
Abdo pain
Haematuria
Lethargy
Fever
HTN
Weight loss
240
Referral for unexplained enlarged abdominal mass in child in GP?
Paediatric review within 48 hours
241
Investigations in suspected Wilms' tumour?
USS
CT/MRI
Biopsy
242
Management of Wilms' tumour?
Surgical excision (nephrectomy)
+/- chemo
+/- radio
243
Factors contributing to functional constipation in children?
Reduced fluid intake
Reduced fibre intake
Reduced physical activity
Psychosocial issues
244
Red flags for constipation in children (7)?
Not passing meconium within 48h of birth
Neurological signs
Vomiting
Ribbin stool
Abnormal anus
Failure to thrive
Acute severe abdominal pain and bloating
245
Management of idiopathic constipation in children?
Lifestyle changes (fluid, fibre, activity)
1st line = macrogol laxatives
2nd line = stimulant laxatives
246
Is small or large bowel obstruction more common?
Small
247
Top causes of bowel obstruction in children (6)?
Intussusception
Hirschsprung's disease
Meconium ileus
Volvulus
Incarcerated hernia
248
Presenting features of bowel obstruction?
Generalised abdominal pain
Abdo distension
Bilious vomiting
Constipation
Dehydration
Shock
249
Investigations in suspected bowel obstruction?
Abdominal x-ray
250
Management of bowel obstruction?
NBM
IV fluids
NG tube with free drainage
Surgery - depends on underlying cause
251
Most common cause of peritonitis in children?
Ruptured appendicitis
252
Clinical presenting features of neuroblastoma (7)?
Abdominal mass
Pallor
Weight loss
Bone pain
Hepatomegaly
Paraplegia
Proptosis
253
Most common ocular cancer in children?
Retinoblastoma
254
What is haemolytic disease of the newborn?
Haemolysis and jaundice in neonate due to rhesus incompatibility
255
Blood findings in haemolytic disease of the newborn?
Anaemia
Raised bilirubin
256
When will the onset of jaundice present in haemolytic disease of the newborn?
Within first 24 hours
257
Possible features of retinoblastoma?
Absence of red-reflex
Strabismus
Visual problems
258
Management of retinoblastoma?
Enucleation
259
Developmental milestones and ages for gross motor?
6m - pulls self to sitting, rolls front to back
7-8m - sits without support
9m - pulls to standing
12m - cruises
13-15m - walks unsupported
18m - squat to pick up toy
2y - runs
3y - upstairs without holding on
4y - hops on one leg
260
Developmental milestones and ages for speech/hearing?
3m - turn toward sounds
9m - mama, dada
12m - 2-6 words
2y - combin 2 words
3y - short sentences, what, who, where q's
4y - why, when, how q's
261
Developmental milestones and ages for fine motor?
3m - reaches for object
6m - palmar grasp, pass from one hand to another
9m - early pincer
12m - good pincer
262
Developmental milestones and ages for social behaviour/play?
6w - smiles
3m - laughs
6m - not shy
9m - shy, peek-a-boo
12m - waves bye bye
18m - play alone
2y - play near others
4y - play with others
263
Red flag ages for not sitting and not walking?
Not sitting by 9m
Not walking by 15m (girls, 18m boys)
264
Red flag ages for not grasping objects, not transferring objects between hands and hand preference?
Not grasping - 6m
Not transferring - 9m
Hand preference - if before 18m
265
Red flag ages for not babbling, no words, not responding to name or simple commands?
Not babbling - 12m
No words - 16m
Not responding - 12m
266
Red flag ages for not smiling, no interest in people, no pretend or imaginative play?
Not smiling - 8w
No interest in people - 6-9m
No imaginative play - 3y
267
What is considered normal weight loss for babies after birth?
Breastfed babies - up to 10% weight
Formula fed - up to 5% weight
268
When do babies typically lose weight following birth?
Usually by day 5 of life
Regain by 10-14d
269
When should neonates be referred for weight loss?
If do not regain birthweight within 2 weeks, refer to hospital
270
When do babies start weaning?
Around 6 months
271
Which diseases cause 'viral exanthema' (5)?
Measles
Scarlet fever
Rubella
Parvovirus B19
Roseola infantum
272
What is vesicoureteral reflux?
Backflow of urine from bladder into ureter and kidney
273
How may vesicoureteral reflux present in children?
Recurrent UTIs in childhood
Difficulty passing urine
Impaired kidney function
274
How may vesicoureteral reflux be detected antenatally?
Oligohydramnios and Hydronephrosis
275
Investigations in suspected vesicoureteral reflux?
Micturating cystourethrogram
Cystoscopy
276
Management of vesicoureteral reflux?
Urinary catheter while await tx
Ablation/removal of extra tissue
277
What is gastroschisis/omphalocele?
Abdominal wall malformations = abdominal contents protrude through wall
278
What is oesophgeal atresia?
Congenital malformation of oesophagus resulting in blind ending pouch +/- connection to trachea
279
Complications of cleft lip/palate?
Feeding
Swallowing
Speech
280
Management of cleft lip/palate?
Surgical repair
281
What is bronchopulmonary dysplasia?
Long-term lung dysfunction in premature babies
282
Clinical features of bronchopulmonary dysplasia (4)?
Low O2 sats
Increased WOB
Poor feeding/FTT
Increases susceptibility to infection
283
What prophylaxis can be given to prevent bronchopulmonary dysplasia?
Corticosteroids given to mothers with signs of premature labour <35w
Caffeine - stimulate resp effort
284
What injections are given to babies with bronchopulmonary dysplasia?
Palivizumab - prevent RSV and bronchiolitis
285
Is meconium aspiration syndrome more common in pre- or post-term deliveries?
Post-term
286
Signs of meconium aspiration syndrome?
Acute respiratory distress shortly after birth
287
Management of meconium aspiration syndrome?
Suplemental O2
Tracheal suctioning if weak neonate
Abx
Surfactants if severe resp distress
288
What is haemolytic uraemic syndrome (HUS)?
Shiga toxins from e coli 0157 or shigella causing thrombosis in small blood vessels
289
Triad seen in HUS?
Acute kidney injury
Microangiopathic haemolytic anaemia
Thrombocytopenia
290
Presentation of HUS?
Gastroenteritis sx initially (bloody diarrhoea)
Fever
Abdo pain
Lethargy
Pallor
Oliguria
Haematuria
HTN
Bruising
Jaundice
Confusion
291
Investigations in suspected HUS?
Blood film (schistocytes)
Stool culture
U&Es
292
Management of HUS?
Medical emergency - admit to hospital
Supportive care:
IV fluids
Blood transfusion
Haemodialysis
293
What is the most common primary brain tumour type seen in children?
Astrocytoma (from glial cells)
294
How may a paediatric brain tumour present?
Headaches
N+V
Behavioural change
Seizures
Altered GCS
Polyuria/polydipsia
295
Investigations in suspected paediatric brain tumour?
MRI or contrast CT
296
Management of paediatric brain tumours?
Surgical resection
Radiotherapy
Chemotherapy
297
Some features of Angelman syndrome?
Learning disability
Delay/absence of speech development
Ataxia
Happy demeanour
Hand flapping
Abnormal sleep patterns
Hyperactivity
Epilepsy
Microcephaly
Wide mouth
298
Features of Williams syndrome?
Broad forehead
Short nose
Long philtrum
Starburst eyes
Micrognathia
Very soiable
Mild-moderate learning disability
299
What are TORCH infections?
Infections which can be passed from mother to fetus during pregnancy and result in congenital problems
300
What are the different TORCH infections?
**T**oxoplasmosis
**O**thers: syphilis, VZV, parvovirus
**R**ubella
**C**ytomegalovirus
**H**erpes simplex
301
What is failure to thrive (FTT) characterised by?
Insufficient weight gain or growth
302
Possible investigations in FTT?
FBC
U&Es
LFTs
Calcium
TFTs
CRP
ESR
Urinalysis
tTG + IgA
Faecal elastase
GH
Cortisol levels
CXR
Skeletal survey
Echo
303
Possible causes of FTT?
Cardio = congenital heart disease
Neuro = CP, muscular dystrophy
GI disorders = GORD, IBD, coeliac, CMPA
Malignancies = leukaemia, neuroblastoma
Metabolic = Hypothyroid, CF
Nutritional deficiencies = zinc, vit D
Infections = HIV, TB
Psychosocial fx = neglect, poverty, parental mental health
304
What is severe combined immunodeficiency (SCID)?
Absent or dysfunctioning T/B cells
No immunity to infections
305
How is SCID inherited?
X-linked recessive
306
Clinical features of SCID?
Persistent severe diarrhoea
FTT
Opportunistic infections
Unwell after liver vaccines
307
What is the definition of precocious/early puberty?
8 in girls
9 in boys
308
What are the two classifications of early puberty?
Gonadotrophin dependent (central) = premature activation of HPG axis
FSH/LH raised
Gonadotrophin independent (pseudo) = excess sex hormones
FSH/LH low
309
How can early puberty be managed?
Gonadotrophin dependent = GnRH agonists
Delay progression and puberty
310
Risks of early puberty?
Reduction in adult height (early fusion of growth plates)
Psychosocial issues = periods in girls
311
What is congenital adrenal hyperplasia (CAH)?
Impaired adrenal steroid synthesis
Deficiency of 21-hydroxylase
312
Inheritance pattern of congenital adrenal hyperplasia (CAH)?
Autosomal recessive
313
Which hormones are high/low in congenital adrenal hyperplasia (CAH)?
↑ androgens (testosterone)
↓ aldosterone and cortisol
314
Clinical features of congenital adrenal hyperplasia (CAH)?
Virilisation of female genitalia (ambiguous genitalia)
Salt-wasting crisis
Precocious puberty
Infertility
315
Diagnosis of congenital adrenal hyperplasia (CAH)?
ACTH stimulation test
316
Management of congenital adrenal hyperplasia (CAH)?
Glucocorticoid replacement
Fludrocortisone if indicated
Surgery may be considered in female patients for genital abnormalities
317
Possible causes of jaundice within the first 24 hours (4)?
ALWAYS PATHOLOGICAL IN FIRST 24HR
Rhesus disease of newborn
ABO haemolytic disease
G6PD
Hereditary spherocytosis
318
Possible causes of jaundice from 2-14d?
Common - usually physiological
More common in breastfed babies
319
What is considered 'prolonged jaundice' in newborns?
Jaundice after 14d
21d if premature
320
Investigations in prolonged jaundice (8)?
Bilirubin
FBC
Blood film
Coombs test
TFTs
Urine for MC&S
U&Es
LFTs
321
Possible causes of prolonged jaundice in newborn (5)?
Hypothyroid
Biliary atresia
Breast milk jaundice
UTI
Congenital infections
322
Possible treatment for jaundice in newborn?
Phototherapy
323
Definition of neonatal sepsis?
Infection within first 28d of life
324
First line abx for neonatal sepsis?
IV benzylpenicillin + gentamicin
325
What is mesenteric adenitis?
Inflammation of mesenteric lymph nodes in the abdomen
326
Clinical presentation of mesenteric adenitis (5)?
R iliac fossa pain
Preceding viral illness (URTI)
Fever
Nausea
V+D
327
Investigations in suspected mesenteric adenitis?
FBC
CRP
Urinalysis
Stool culture
Abdo USS
CT/MRI
328
Management of mesenteric adenitis?
Supportive (NSAIDs, paracetamol, fluids)
Finals revision
flashcards
Decks in class (29)
# Cards
-
Endocrine283
-
Neurology261
-
Cardiology255
-
Emergency medicine106
-
Pharmacology29
-
Hepatobiliary93
-
Renal87
-
Respiratory200
-
Haematology172
-
Gastroenterology219
-
Urology106
-
Paediatrics328
-
Geriatrics45
-
Dermatology98
-
Obs + Gynae248
-
ENT91
-
GP + Misc72
-
Infections100
-
Orthopaedics150
-
Ophthalmology90
-
Vascular surgery47
-
Rheumatology120
-
Psychiatry154
-
Breast30
-
Anaesthetics42
-
Radiology11
-
Oncology33
-
Sexual health29
-
Public health133
