Paediatrics Flashcards

Question

What is the most common presentation of **neonatal sepsis**?

Answer 1

Respiratory distress (approximately 85%) ## Footnote Symptoms include grunting, nasal flaring, tachypnoea, and use of accessory respiratory muscles.

Answer 2

* Early-onset sepsis (EOS) * Late-onset sepsis (LOS) ## Footnote EOS occurs within 72 hours of birth, while LOS occurs between 7-28 days of life.

Answer 3

1-5 per 1000 live births ## Footnote Term neonates: 1-2 per 1000 live births; Late pre-term infants: 5 per 1000 live births.

Answer 4

* Group B streptococcus (GBS) * Escherichia coli ## Footnote These account for approximately two thirds of neonatal sepsis cases.

Answer 5

* Previous baby with GBS infection * Current GBS colonisation * Intrapartum temperature ≥38ºC * Membrane rupture ≥18 hours * Premature birth (<37 weeks) * Low birth weight (<2.5kg) * Maternal chorioamnionitis ## Footnote Approximately 85% of neonatal sepsis cases are in premature neonates.

Answer 6

40% ## Footnote Other symptoms include tachycardia, lethargy, jaundice, seizures, and poor feeding.

Answer 7

Around 90% ## Footnote Two blood cultures are usually recommended to distinguish from contamination.

Answer 8

* Intravenous benzylpenicillin * Gentamicin ## Footnote Alternative antibiotics may be needed based on local resistance patterns.

Answer 9

FALSE ## Footnote CRP is not useful for diagnosis but helps guide management and monitor progress.

Answer 10

C-reactive protein (CRP) ## Footnote This helps to monitor ongoing progress and guide duration of therapy.

Answer 11

Approximately 10 days ## Footnote Duration may vary based on ongoing investigations and clinical picture.

Answer 12

RNA paramyxovirus ## Footnote Measles is one of the most infectious known viruses.

Answer 13

Aerosol transmission ## Footnote Measles is infective from prodrome until 4 days after the rash starts.

Answer 14

10-14 days ## Footnote This is the time from exposure to the onset of symptoms.

Answer 15

* Irritable * Conjunctivitis * Fever * Koplik spots ## Footnote Koplik spots are white spots ('grain of salt') on the buccal mucosa that typically develop before the rash.

Answer 16

* Starts behind ears * Spreads to the whole body * Discrete maculopapular rash becoming blotchy & confluent * Desquamation may occur after a week ## Footnote The rash typically spares the palms and soles.

Answer 17

Around 10% ## Footnote Diarrhoea is one of the complications associated with measles.

Answer 18

Mainly supportive ## Footnote Admission may be considered in immunosuppressed or pregnant patients.

Answer 19

Otitis media ## Footnote It is important to monitor for complications during and after the illness.

Answer 20

Pneumonia ## Footnote Pneumonia can occur as a serious complication of measles.

Answer 21

Very rare complication of measles ## Footnote It may present 5-10 years following the illness.

Answer 22

MMR vaccine ## Footnote The vaccine should be given within 72 hours to develop vaccine-induced measles antibody more rapidly than natural infection.

Answer 23

irritable hip ## Footnote It generally presents as acute hip pain following a recent viral infection.

Answer 24

Transient synovitis ## Footnote The typical age group affected is 3-8 years.

Answer 25

* Limp/refusal to weight bear * Groin or hip pain * Low-grade fever (present in a minority) * High fever raises suspicion of other causes ## Footnote High fever may indicate conditions such as septic arthritis.

Answer 26

* Fever is a red flag for urgent specialist assessment * Monitoring in primary care is possible with a presumptive diagnosis ## Footnote This applies if the child is aged 3-9 years, well, afebrile, mobile but limping, and has had symptoms for less than 72 hours.

Answer 27

TRUE ## Footnote It typically resolves on its own without the need for invasive treatments.

Answer 28

30:2 ## Footnote This ratio applies to infants and children (not neonates).

Answer 29

15:2 ## Footnote This ratio is used by responders with a duty to respond.

Answer 30

A child under 1 year of age ## Footnote This definition is crucial for applying paediatric BLS principles.

Answer 31

Aged 1 year until the onset of puberty ## Footnote This age definition is important for paediatric BLS.

Answer 32

* Ensure safety * Check responsiveness * Shout for help ## Footnote These steps are critical for initiating the BLS process.

Answer 33

Open the airway ## Footnote This is followed by looking, listening, and feeling for normal breathing.

Answer 34

No more than 10 seconds ## Footnote Quick assessment is vital to determine the next steps.

Answer 35

Commence CPR ## Footnote This is crucial if unsure or absent signs of life are observed.

Answer 36

* Brachial pulse * Femoral pulse ## Footnote Pulse checks should only be done if trained and should not delay CPR.

Answer 37

* Femoral pulse * Carotid pulse ## Footnote These checks are part of the assessment process if trained.

Answer 38

100–120 per minute ## Footnote Maintaining this rate is essential for effective CPR.

Answer 39

Approximately 4 cm ## Footnote This depth is crucial for effective compressions.

Answer 40

Approximately 5 cm ## Footnote This depth ensures adequate blood circulation during compressions.

Answer 41

Two-thumb encircling technique ## Footnote This method is recommended for healthcare professionals.

Answer 42

Two fingers on the lower half of the sternum ## Footnote This is an alternative method for performing compressions.

Answer 43

Every 2 minutes if possible ## Footnote This helps maintain the quality of CPR.

Answer 44

* Minimise interruptions * Ensure full chest recoil between compressions ## Footnote These practices enhance the effectiveness of CPR.

Answer 45

As soon as available, using paediatric pads/settings if appropriate ## Footnote Early defibrillation is critical in cardiac emergencies.

Answer 46

exanthem subitum, occasionally sixth disease ## Footnote It is a common disease of infancy caused by the human herpes virus 6 (HHV6).

Answer 47

5-15 days ## Footnote It typically affects children aged 6 months to 2 years.

Answer 48

* high fever lasting a few days * maculopapular rash * Nagayama spots (papular enanthem on the uvula and soft palate) * febrile convulsions (10-15%) * diarrhoea and cough ## Footnote These symptoms are commonly associated with the disease.

Answer 49

FALSE ## Footnote Children do not need to be excluded from school.

Answer 50

* aseptic meningitis * hepatitis ## Footnote These conditions can arise from the infection but are less common.

Answer 51

A congenital abnormality of the penis occurring in approximately 3/1,000 male infants ## Footnote It has a significant genetic element, with a risk of around 5-15% for further male children.

Answer 52

* Ventral urethral meatus * Hooded prepuce * Chordee (ventral curvature of the penis) in severe forms * Urethral meatus may open more proximally in severe variants ## Footnote 75% of the openings are distally located.

Answer 53

* Cryptorchidism (present in 10%) * Inguinal hernia ## Footnote Hypospadias most commonly occurs as an isolated disorder.

Answer 54

* Refer infants to specialist services * Corrective surgery typically performed around 12 months of age * Ensure the child is not circumcised prior to surgery ## Footnote The foreskin may be used in the corrective procedure.

Answer 55

FALSE ## Footnote No treatment may be needed in boys with very distal disease.

Answer 56

Around 12 months of age ## Footnote This timing is crucial for effective management.

Answer 57

An abnormal urine stream ## Footnote This can be an indicator of the condition.

Answer 58

10-15 years ## Footnote This condition is primarily seen in children within this age range.

Answer 59

* Obese children * Boys ## Footnote The condition is classically observed in these groups.

Answer 60

Postero-inferiorly ## Footnote This displacement is a key feature of the condition.

Answer 61

* Hip pain * Groin pain * Medial thigh pain * Knee pain * Loss of internal rotation of the leg in flexion ## Footnote These symptoms may present acutely or chronically.

Answer 62

20% ## Footnote Bilateral slips can occur in a significant minority of cases.

Answer 63

AP and lateral (typically frog-leg) views ## Footnote These imaging techniques are essential for diagnosis.

Answer 64

Internal fixation: typically a single cannulated screw placed in the centre of the epiphysis ## Footnote This surgical intervention aims to stabilize the femoral head.

Answer 65

* Osteoarthritis * Avascular necrosis of the femoral head * Chondrolysis * Leg length discrepancy ## Footnote These complications can arise if the condition is not managed properly.

Answer 66

* Retinal haemorrhages * Subdural haematoma * Encephalopathy ## Footnote These three conditions are commonly associated with the effects of shaking an infant.

Answer 67

* Retinal haemorrhages * Subdural haematoma * Encephalopathy ## Footnote These symptoms are indicative of the syndrome caused by the intentional shaking of a child aged 0-5 years.

Answer 68

0-5 years old ## Footnote This age range is critical as children are particularly vulnerable to injury from shaking.

Answer 69

FALSE ## Footnote There is controversy among physicians regarding whether the mechanism of injury is definitively intentional shaking.

Answer 70

Difficulty in convicting suspects ## Footnote This is often due to the controversy surrounding the diagnosis and the mechanism of injury.

Answer 71

A congenital diverticulum of the small intestine ## Footnote It is a remnant of the omphalomesenteric duct and contains ectopic ileal, gastric, or pancreatic mucosa.

Answer 72

* Occurs in 2% of the population * Is 2 feet from the ileocaecal valve * Is 2 inches long ## Footnote These characteristics help in the identification and understanding of Meckel's diverticulum.

Answer 73

* Abdominal pain mimicking appendicitis * Rectal bleeding * Intestinal obstruction ## Footnote Meckel's diverticulum is the most common cause of painless massive GI bleeding requiring a transfusion in children aged 1 to 2 years.

Answer 74

TRUE ## Footnote While it can be asymptomatic, it may present with abdominal pain, rectal bleeding, or intestinal obstruction.

Answer 75

'Meckel's scan' using 99m technetium pertechnetate ## Footnote This scan has an affinity for gastric mucosa and helps in the diagnosis.

Answer 76

* Wedge excision * Formal small bowel resection and anastomosis ## Footnote Removal is indicated if the diverticulum has a narrow neck or is symptomatic.

Answer 77

Attachment between the vitellointestinal duct and yolk sac disappears at 6 weeks gestation ## Footnote The tip is free in the majority of cases and is associated with various anomalies.

Answer 78

Omphalomesenteric artery ## Footnote This artery supplies the diverticulum and is important in its vascularization.

Answer 79

Ileal mucosa ## Footnote Ectopic gastric mucosa can occur, increasing the risk of peptic ulceration.

Answer 80

Developmental dysplasia of the hip (DDH) ## Footnote DDH affects around 1-3% of newborns.

Answer 81

* Female sex: 6 times greater risk * Breech presentation * Positive family history * Firstborn children * Oligohydramnios * Birth weight > 5 kg * Congenital calcaneovalgus foot deformity ## Footnote DDH is slightly more common in the left hip, and around 20% of cases are bilateral.

Answer 82

* First-degree family history of hip problems in early life * Breech presentation at or after 36 weeks gestation * Multiple pregnancy ## Footnote All infants are screened at both the newborn check and the six-week baby check using the Barlow and Ortolani tests.

Answer 83

Attempts to dislocate an articulated femoral head ## Footnote The Ortolani test attempts to relocate a dislocated femoral head.

Answer 84

Attempts to relocate a dislocated femoral head ## Footnote Other important factors include symmetry of leg length and level of knees when hips and knees are bilaterally flexed.

Answer 85

Ultrasound ## Footnote If the infant is > 4.5 months, then x-ray is the first line investigation.

Answer 86

Management most unstable hips will spontaneously stabilise by 3-6 weeks of age Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months older children may require surgery ## Footnote A Pavlik harness is used in children younger than 4-5 months, while older children may require surgery.

Answer 87

Transient tachypnoea of the newborn (TTN) ## Footnote TTN is caused by delayed resorption of fluid in the lungs.

Answer 88

caesarean sections ## Footnote This is possibly due to the lung fluid not being 'squeezed out' during the passage through the birth canal.

Answer 89

* Hyperinflation of the lungs * Fluid in the horizontal fissure ## Footnote These findings are indicative of TTN.

Answer 90

* Observation * Supportive care * Supplementary oxygen may be required ## Footnote Management focuses on maintaining oxygen saturations.

Answer 91

1-2 days ## Footnote This condition is typically self-limiting.

Answer 92

Transient synovitis ## Footnote Recent viral infection is a risk factor. NICE guidelines recommend considering this diagnosis for patients aged 3-9 years with specific symptoms.

Answer 93

* Simple analgesia * Good safety net advice * Follow-up to ensure resolution of symptoms ## Footnote These measures help in monitoring and managing the condition effectively.

Answer 94

FALSE ## Footnote Juvenile idiopathic arthritis is characterized by arthritis lasting at least 6 weeks, not consistent with acute presentation.

Answer 95

An overuse injury causing anterior knee pain in adolescents ## Footnote It is not consistent with the acute presentation described in this case.

Answer 96

* Conjunctivitis * Urethritis * Arthritis ## Footnote This triad is useful to remember for exams, though not always clinically observed.

Answer 97

Displacement of the proximal femoral epiphysis from the metaphysis ## Footnote It should be considered in children aged 10-19 years presenting with a limp, making it less likely in this case.

Answer 98

A degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years ## Footnote It is due to avascular necrosis of the femoral head, specifically the femoral epiphysis.

Answer 99

Impaired blood supply to the femoral head causing bone infarction ## Footnote This leads to degeneration of the hip joint.

Answer 100

5 times more common ## Footnote Around 10% of cases are bilateral.

Answer 101

* Hip pain: develops progressively over a few weeks * Limp * Stiffness and reduced range of hip movement * X-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening ## Footnote These features help in identifying the condition.

Answer 102

Plain x-ray ## Footnote Technetium bone scan or magnetic resonance imaging may be used if normal x-ray and symptoms persist.

Answer 103

* Osteoarthritis * Premature fusion of the growth plates ## Footnote These complications can arise if the condition is not managed properly.

Answer 104

* Stage 1: Clinical and histological features only * Stage 2: Sclerosis with or without cystic changes and preservation of the articular surface * Stage 3: Loss of structural integrity of the femoral head * Stage 4: Loss of acetabular integrity ## Footnote Each stage indicates the progression and severity of the disease.

Answer 105

* To keep the femoral head within the acetabulum: cast, braces * If less than 6 years: observation * Older: surgical management with moderate results * Operate on severe deformities ## Footnote Management varies based on age and severity of the condition.

Answer 106

Most cases will resolve with conservative management ## Footnote Early diagnosis improves outcomes.

Answer 107

3-6% ## Footnote Typically presents in the first 3 months of life in formula-fed infants.

Answer 108

Exclusively breastfed infants ## Footnote Most cases occur in formula-fed infants.

Answer 109

* Immediate (IgE mediated) * Delayed (non-IgE mediated) ## Footnote CMPA is used for immediate reactions, while CMPI is used for mild-moderate delayed reactions.

Answer 110

* Regurgitation and vomiting * Diarrhoea * Urticaria, atopic eczema * 'Colic' symptoms: irritability, crying * Wheeze, chronic cough * Rarely angioedema and anaphylaxis ## Footnote Symptoms can vary in severity.

Answer 111

Clinical diagnosis ## Footnote Improvement with cow's milk protein elimination is a key indicator.

Answer 112

* Skin prick/patch testing * Total IgE and specific IgE (RAST) for cow's milk protein ## Footnote These tests help confirm the diagnosis.

Answer 113

Extensive hydrolysed formula (eHF) ## Footnote This is recommended for formula-fed infants.

Answer 114

Amino acid-based formula (AAF) ## Footnote This is suitable for severe cases.

Answer 115

* Continue breastfeeding * Eliminate cow's milk protein from maternal diet * Consider calcium supplements for breastfeeding mothers ## Footnote Use eHF milk when breastfeeding stops, until 12 months of age.

Answer 116

* CMPI usually resolves in most children * 55% of children with IgE mediated intolerance will be milk tolerant by age 5 * Most children with non-IgE mediated intolerance will be milk tolerant by age 3 ## Footnote A challenge is often performed in a hospital setting due to the risk of anaphylaxis.

Answer 117

Intestinal viruses of the **Picornaviridae** family (most commonly **coxsackie A16** and **enterovirus 71**) ## Footnote This disease is very contagious and typically occurs in outbreaks at nurseries.

Answer 118

* Mild systemic upset: sore throat, fever * Oral ulcers * Vesicles on the palms and soles of the feet ## Footnote These symptoms develop in a sequence, starting with systemic upset and progressing to oral ulcers and then vesicles.

Answer 119

Symptomatic treatment only: general advice about hydration and analgesia ## Footnote There is no specific antiviral treatment for this self-limiting condition.

Answer 120

FALSE ## Footnote Children do not need to be excluded from school, but those who are unwell should stay home until they feel better.

Answer 121

Contact the **HPA** ## Footnote The Health Protection Agency advises contacting them in case of suspected large outbreaks.

Answer 122

Congenital visceral malformations ## Footnote Both conditions involve defects in the abdominal wall.

Answer 123

A congenital defect in the anterior abdominal wall just lateral to the umbilical cord ## Footnote This condition allows abdominal contents to protrude outside the body.

Answer 124

* Vaginal delivery may be attempted * Newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours ## Footnote Timely surgical intervention is crucial for the newborn.

Answer 125

Omphalocoele ## Footnote This condition involves abdominal contents protruding through the abdominal wall.

Answer 126

By an amniotic sac formed by amniotic membrane and peritoneum ## Footnote This covering differentiates it from gastroschisis.

Answer 127

* Beckwith-Wiedemann syndrome * Down's syndrome * Cardiac and kidney malformations ## Footnote These associations highlight the potential for other congenital issues.

Answer 128

Caesarean section ## Footnote This method is preferred to avoid complications during delivery.

Answer 129

A staged repair ## Footnote This approach allows for gradual closure as the infant grows.

Answer 130

The sac is allowed to granulate and epithelialise over the coming weeks/months ## Footnote This forms a 'shell' that helps protect the contents.

Answer 131

When the sac contents can fit within the abdominal cavity ## Footnote At this point, the abdomen can be closed.

Answer 132

3-6% ## Footnote CMPI/CMPA usually presents in the first 3 months of life in formula-fed infants.

Answer 133

* Immediate (IgE mediated) * Delayed (non-IgE mediated) ## Footnote CMPA is used for immediate reactions, while CMPI is used for mild-moderate delayed reactions.

Answer 134

* Regurgitation and vomiting * Diarrhoea * Urticaria, atopic eczema * 'Colic' symptoms: irritability, crying * Wheeze, chronic cough * Rarely angioedema and anaphylaxis ## Footnote These symptoms can vary in severity.

Answer 135

* Clinical improvement with cow's milk protein elimination * Skin prick/patch testing * Total IgE and specific IgE (RAST) for cow's milk protein ## Footnote Diagnosis may involve a combination of clinical assessment and specific tests.

Answer 136

Extensive hydrolysed formula (eHF) ## Footnote This is recommended for formula-fed infants experiencing symptoms.

Answer 137

Amino acid-based formula (AAF) ## Footnote AAF is suitable for infants with severe reactions.

Answer 138

* Continue breastfeeding * Eliminate cow's milk protein from maternal diet * Consider prescribing calcium supplements for breastfeeding mothers * Use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months ## Footnote This approach helps manage the infant's intolerance while maintaining breastfeeding.

Answer 139

* CMPI usually resolves in most children * 55% of children with IgE mediated intolerance will be milk tolerant by age 5 * Most children with non-IgE mediated intolerance will be milk tolerant by age 3 ## Footnote A challenge may be performed in a hospital setting due to the risk of anaphylaxis.

Answer 140

A rare but serious infection caused by Haemophilus influenzae type B ## Footnote Prompt recognition and treatment are essential as airway obstruction may develop.

Answer 141

TRUE ## Footnote It was generally considered a disease of childhood.

Answer 142

The introduction of the Hib vaccine ## Footnote This vaccine has significantly reduced the occurrence of the disease.

Answer 143

* Rapid onset * High temperature, generally unwell * Stridor * Drooling of saliva * 'Tripod' position ## Footnote The 'tripod' position helps the patient breathe easier by leaning forward and extending their neck.

Answer 144

By direct visualisation (only by senior/airway trained staff) ## Footnote X-rays may be done to check for foreign bodies; a lateral view shows swelling of the epiglottis ('thumb sign').

Answer 145

Swelling of the epiglottis - the 'thumb sign' ## Footnote This is in contrast to croup, which shows subglottic narrowing ('steeple sign').

Answer 146

* Immediate senior involvement * Endotracheal intubation if necessary * Do NOT examine the throat * Oxygen * Intravenous antibiotics ## Footnote Senior staff must be involved to provide emergency airway support.

Answer 147

throat ## Footnote This precaution is crucial to prevent worsening the patient's condition.

Answer 148

Developmental dysplasia of the hip ## Footnote DDH is gradually replacing the term 'congenital dislocation of the hip' (CDH) and affects around 1-3% of newborns.

Answer 149

* Female sex: 6 times greater risk * Breech presentation * Positive family history * Firstborn children * Oligohydramnios * Birth weight > 5 kg * Congenital calcaneovalgus foot deformity ## Footnote These factors increase the likelihood of DDH in newborns.

Answer 150

Left hip ## Footnote Around 20% of cases are bilateral.

Answer 151

* First-degree family history of hip problems in early life * Breech presentation at or after 36 weeks gestation * Multiple pregnancy ## Footnote All infants are screened at both the newborn check and the six-week baby check using the Barlow and Ortolani tests.

Answer 152

Dislocate an articulated femoral head ## Footnote This test is part of the clinical examination for DDH.

Answer 153

Relocate a dislocated femoral head ## Footnote This test is also part of the clinical examination for DDH.

Answer 154

Ultrasound ## Footnote If the infant is > 4.5 months, then x-ray is the first line investigation.

Answer 155

Spontaneously stabilise by 3-6 weeks of age ## Footnote A Pavlik harness is used in children younger than 4-5 months, while older children may require surgery.

Answer 156

Transient tachypnoea of the newborn (TTN) ## Footnote TTN is characterized by delayed resorption of fluid in the lungs.

Answer 157

caesarean sections ## Footnote This is possibly due to the lung fluid not being 'squeezed out' during the passage through the birth canal.

Answer 158

* Hyperinflation of the lungs * Fluid in the horizontal fissure ## Footnote These findings are indicative of TTN.

Answer 159

* Observation * Supportive care * Supplementary oxygen may be required ## Footnote Management focuses on maintaining oxygen saturations.

Answer 160

1-2 days ## Footnote This condition is typically self-limiting.

Answer 161

**mild-to-moderate, non-IgE mediated cow's milk protein allergy** ## Footnote This condition typically resolves with dietary exclusion.

Answer 162

**by the age of three** ## Footnote This is a common outcome for children with this condition.

Answer 163

**from 9-12 months of age, or after 6 months of exclusion** ## Footnote Timing for reintroduction is crucial for managing the allergy.

Answer 164

**a structured, stepwise approach to reintroducing cow's milk protein** ## Footnote It starts with well-cooked products and progresses to less-cooked forms.

Answer 165

**products where the milk protein is well-cooked and less allergenic** ## Footnote An example is a malted milk biscuit.

Answer 166

**fresh milk** ## Footnote This is the least processed form of cow's milk protein.

Answer 167

**Yes** ## Footnote It is the standard, guideline-recommended approach for this presentation.

Answer 168

A form of upper respiratory tract infection in infants and toddlers characterized by stridor ## Footnote Caused by laryngeal oedema and secretions, primarily due to parainfluenza viruses.

Answer 169

6 months - 3 years ## Footnote Croup is more common in the autumn.

Answer 170

* Stridor * Barking cough (worse at night) * Fever * Coryzal symptoms ## Footnote These symptoms are indicative of Croup in affected infants and toddlers.

Answer 171

A rare but serious infection caused by Haemophilus influenzae type B ## Footnote Prompt recognition and treatment are essential due to the risk of airway obstruction.

Answer 172

Between 2 and 6 years ## Footnote The incidence has decreased since the introduction of the Hib vaccine.

Answer 173

* Rapid onset * Unwell, toxic child * Stridor * Drooling of saliva ## Footnote These features indicate a serious condition requiring immediate medical attention.

Answer 174

Symptoms depend on the site of impaction ## Footnote Features include sudden onset of coughing, choking, vomiting, and stridor.

Answer 175

A congenital abnormality of the larynx ## Footnote It causes collapse during inspiration due to softening of the cartilage.

Answer 176

4 weeks of age ## Footnote It usually self-resolves before 2 years of age.

Answer 177

* Stridor ## Footnote It should be suspected in an otherwise well infant with noisy breathing.

Answer 178

Bronchopulmonary dysplasia ## Footnote This condition is a significant concern in neonatal care.

Answer 179

To assess the probability of septic arthritis in children ## Footnote It uses specific parameters to evaluate risk.

Answer 180

* Non-weight bearing * Fever >38.5ºC * WCC >12 * 10^9/L * ESR >40mm/hr ## Footnote Each parameter contributes to the assessment of septic arthritis probability.

Answer 181

Very low risk ## Footnote This score reflects a minimal likelihood of septic arthritis.

Answer 182

3% probability ## Footnote This indicates a low risk of septic arthritis.

Answer 183

40% probability ## Footnote This score suggests a moderate risk of septic arthritis.

Answer 184

93% probability ## Footnote This indicates a high risk of septic arthritis.

Answer 185

99% probability of septic arthritis ## Footnote This score indicates an extremely high likelihood of septic arthritis.

Answer 186

A condition where small segments of articular cartilage and bone come loose into the joint due to reduced blood supply ## Footnote It typically affects older children and presents with a more insidious onset.

Answer 187

* Articular cartilage * Bone ## Footnote This condition is linked to reduced blood supply to these areas.

Answer 188

FALSE ## Footnote It tends to present in older children.

Answer 189

More insidious ## Footnote This means the symptoms develop gradually rather than suddenly.

Answer 190

BCG ## Footnote The BCG vaccine is given if the baby is deemed at risk of tuberculosis.

Answer 191

* Diphtheria * Tetanus * Whooping cough * Polio * Hib * Hepatitis B ## Footnote The '6-1 vaccine' combines multiple immunisations into one.

Answer 192

* Men B vaccine * Oral rotavirus vaccine ## Footnote The Men B vaccine is part of the immunisation schedule at this age.

Answer 193

PCV ## Footnote PCV stands for Pneumococcal Conjugate Vaccine.

Answer 194

* MMRV vaccine * PCV booster * Men B booster ## Footnote The MMRV vaccine covers measles, mumps, rubella, and varicella.

Answer 195

6-in-1 vaccine ## Footnote This is a continuation of the immunisation schedule.

Answer 196

Flu vaccine ## Footnote The flu vaccine is given every year to help protect against influenza.

Answer 197

'4-in-1 pre-school booster' ## Footnote This booster includes diphtheria, tetanus, whooping cough, and polio.

Answer 198

HPV vaccination ## Footnote HPV stands for Human Papilloma Vaccine.

Answer 199

* Tetanus * Diphtheria * Polio ## Footnote This booster is important for maintaining immunity.

Answer 200

Meningococcal vaccine covering A, C, W and Y serotypes ## Footnote This vaccine is important for preventing meningococcal disease.

Answer 201

The most likely cause of the baby's respiratory distress is transient tachypnoea of the newborn. This condition is characterized by rapid breathing, grunting, and mild intercostal recession. It occurs due to delayed clearance of fetal lung fluid after birth. The risk factors include elective Caesarean section without labour and maternal diabetes. Oxygen saturations of 95-96% on air are consistent with this diagnosis, as they are typically normal or mildly reduced. Transient tachypnoea of the newborn usually resolves within 24-48 hours with supportive care. Surfactant deficient lung disease, also known as respiratory distress syndrome (RDS), is less likely in this case. RDS typically presents with more severe respiratory distress, including tachypnoea, nasal flaring, and audible expiratory grunting. Additionally, it is more common in preterm infants born before 37 weeks gestation due to insufficient surfactant production. Congenital pneumonia could present similarly to transient tachypnoea of the newborn; however, it is less likely in this scenario because there are no risk factors for infection such as prolonged rupture of membranes or maternal fever during labour. Moreover, oxygen saturations would be expected to be lower if the baby had pneumonia. Persistent pulmonary hypertension of the newborn (PPHN) occurs when there is a failure to transition from fetal circulation to postnatal circulation. PPHN presents with severe hypoxia and cyanosis that does not improve with supplemental oxygen administration. The oxygen saturations, in this case, do not support a diagnosis of PPHN. Finally, pulmonary hypoplasia refers to the underdevelopment of the lungs and can occur due to various causes such as oligohydramnios or congenital diaphragmatic hernia. Pulmonary hypoplasia typically presents with severe respiratory distress and poor oxygenation, making it less likely in this case where the baby has only mild intercostal recession and near-normal oxygen saturations.

Answer 202

which lives on and among the hair of the scalp of humans.

Answer 203

they feed on our blood. Eggs are grey or brown and about the size of a pinhead. The eggs are glued to the hair

Answer 204

fly or swim! When newly infected

Answer 205

diagnosis of lice

Answer 206

treatment is only indicated if living lice are found, a choice of treatments should be offered - malathion, wet combing, chemical insecticide (Malathion)

Answer 207

A genetic bleeding disorder caused by a lack of clotting factor VIII ## Footnote It results in improper blood clotting.

Answer 208

A protein needed to form blood clots ## Footnote Without enough of it, bleeding lasts longer than normal.

Answer 209

A mutation in the **F8 gene** on the X chromosome ## Footnote It is X-linked recessive.

Answer 210

FALSE ## Footnote It mostly affects males; females are usually carriers.

Answer 211

* Easy bruising * Frequent nosebleeds * Bleeding after cuts, dental work, or surgery * Bleeding into joints * Internal bleeding in severe cases * Spontaneous bleeding in severe cases ## Footnote Symptoms depend on the level of factor VIII.

Answer 212

* Mild: 5–40% of normal * Moderate: 1–5% * Severe: <1% ## Footnote Severity affects the frequency and type of bleeding.

Answer 213

* Factor VIII replacement therapy * Desmopressin (DDAVP) for mild cases * Preventive (prophylactic) treatment * Newer therapies like gene therapy ## Footnote There is no permanent cure yet, but it can be managed.

Answer 214

normal lives ## Footnote Management of the condition allows for a good quality of life.

Answer 215

Only males ## Footnote An exception is patients with Turner's syndrome, who have only one X chromosome.

Answer 216

Heterozygote females (carriers) ## Footnote Male-to-male transmission is not seen.

Answer 217

50% ## Footnote Each female child of a heterozygous female carrier has a 50% chance of being a carrier.

Answer 218

FALSE ## Footnote Affected males can only have unaffected sons and carrier daughters.

Answer 219

Extremely rare ## Footnote However, in certain Afro-Caribbean communities, G6PD deficiency is relatively common.

Answer 220

G6PD deficiency ## Footnote This is particularly noted in certain Afro-Caribbean communities.

Answer 221

Kawasaki disease is a type of vasculitis which is predominately seen in children. Whilst Kawasaki disease is uncommon it is important to recognise as it may cause potentially serious complicationsincluding coronary artery aneurysms.

Answer 222

high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics, conjunctival injection, bright red cracked lips, strawberry tongue, cervical lymphadenopathy, red plams of the hand and the soles of the feet which later peel-desquamation

Answer 223

high-dose aspirin, Kawasaki disease is one of the few indications for the use of aspirin in children. Due to the risk of Reye's syndrome aspirin is normally contraindicated in children, intravenous immunoglobulinm, echocardiogram (rather than angiography) is used as the initial screening test for coronary artery aneurysms

Answer 224

coronary artery aneurysm

Answer 225

Little or no head lag on being pulled to sit ## Footnote Also, good head control while lying on abdomen and lumbar curve when held sitting.

Answer 226

* Lying on abdomen, arms extended * Lying on back, lifts and grasps feet * Pulls self to sitting * Held sitting, back straight * Rolls front to back ## Footnote These milestones indicate significant development in strength and coordination.

Answer 227

Sits without support ## Footnote Refer at 12 months for further milestones.

Answer 228

* Pulls to standing * Crawls ## Footnote Crawling is a common precursor to walking.

Answer 229

* Cruises * Walks with one hand held ## Footnote Cruising involves moving while holding onto furniture or other supports.

Answer 230

Walks unsupported ## Footnote Refer at 18 months for further milestones.

Answer 231

Squats to pick up a toy ## Footnote This indicates improved balance and coordination.

Answer 232

* Runs * Walks upstairs and downstairs holding on to rail ## Footnote These skills show increased mobility and confidence.

Answer 233

Rides a tricycle using pedals ## Footnote This milestone reflects coordination and strength.

Answer 234

Walks up stairs without holding on to rail ## Footnote This indicates improved balance and independence.

Answer 235

Hops on one leg ## Footnote This skill demonstrates balance and coordination.

Answer 236

TRUE ## Footnote Some children may 'bottom-shuffle', which is a normal variant and runs in families.

Answer 237

Fragile X syndrome ## Footnote It is also a common genetic cause of autism spectrum disorder.

Answer 238

FMR1 ## Footnote The FMR1 gene normally produces a protein called FMRP, important for brain development.

Answer 239

The gene becomes silenced ## Footnote This stops production of FMRP, leading to learning and developmental problems.

Answer 240

X-linked dominant ## Footnote More severe in males due to having only one X chromosome.

Answer 241

FALSE ## Footnote Females may have milder symptoms due to having two X chromosomes.

Answer 242

* Intellectual disability * Delayed speech * Learning difficulties * Autism-like behaviors * ADHD ## Footnote These features are often observed in affected individuals.

Answer 243

* Long, narrow face * Large ears * Prominent jaw * Macroorchidism * Joint hypermobility ## Footnote Features in females range from normal to mild.

Answer 244

* Chorionic villus sampling * Amniocentesis ## Footnote Diagnosis can also involve analysis of the number of CGG repeats using restriction endonuclease digestion and Southern blot analysis.

Answer 245

* Early educational intervention * Speech and behavioral therapy * Medications for ADHD or anxiety ## Footnote There is no cure for Fragile X syndrome.

Answer 246

FMRP FMR1 = Fragile Mental Retardation 1 (gene) FMRP = Fragile Mental Retardation Protein ⚠️ Note: The term “mental retardation” is outdated and no longer used clinically. Today we say intellectual disability, but the gene name remains the same for historical reasons. ## Footnote FMRP is important for brain development.

Answer 247

Traffic light system ## Footnote These guidelines were modified in a 2013 update.

Answer 248

* Temperature * Heart rate * Respiratory rate * Capillary refill time ## Footnote Signs of dehydration should also be assessed.

Answer 249

With an electronic thermometer in the axilla ## Footnote For older children, an electronic/chemical dot thermometer or an infra-red tympanic thermometer can be used.

Answer 250

* Normal colour * Responds normally to social cues * Strong normal cry/not crying * Normal skin and eyes ## Footnote Indicates low risk for serious illness.

Answer 251

* Pallor reported by parent/carer * Not responding normally to social cues * Tachycardia: >160 beats/minute (age <12 months) * Age 3-6 months, temperature >=39ºC ## Footnote Indicates intermediate risk; further assessment may be needed.

Answer 252

* Pale/mottled/ashen/blue * No response to social cues * Weak, high-pitched or continuous cry * Age <3 months, temperature >=38°C ## Footnote Indicates high risk; urgent referral to a paediatric specialist is required.

Answer 253

Managed at home with appropriate care advice ## Footnote Includes information on when to seek further help.

Answer 254

* Verbal or written information on warning symptoms * Follow-up appointment * Liaison with other healthcare professionals ## Footnote Ensures parents have access to further healthcare if needed.

Answer 255

Refer child urgently to a paediatric specialist ## Footnote This is critical for high-risk cases.

Answer 256

FALSE ## Footnote Antibiotics should not be prescribed in such cases.

Answer 257

A chest x-ray does not need to be routinely performed ## Footnote This applies if the child is not being referred.

Answer 258

The invagination of one portion of the bowel into the lumen of the adjacent bowel ## Footnote Most commonly occurs around the ileo-caecal region.

Answer 259

Infants between 6-18 months old ## Footnote Boys are affected twice as often as girls.

Answer 260

* Intermittent, severe, crampy, progressive abdominal pain * Inconsolable crying * Drawing knees up and turning pale during paroxysm * Vomiting * Bloodstained stool - 'red-currant jelly' (late sign) * Sausage-shaped mass in the right upper quadrant ## Footnote These features are characteristic signs of intussusception in infants.

Answer 261

Ultrasound ## Footnote It may show a target-like mass.

Answer 262

Reduction by air insufflation under radiological control ## Footnote This method is now widely used compared to the traditional barium enema.

Answer 263

TRUE ## Footnote Surgery is necessary in these cases.

Answer 264

25% ## Footnote Wheeze is extremely common in pre-school children.

Answer 265

Viral-induced wheeze ## Footnote There is ongoing debate regarding the classification and management of wheeze in this age group.

Answer 266

* Episodic viral wheeze * Multiple trigger wheeze ## Footnote This classification helps in understanding the triggers and management of wheeze in children.

Answer 267

Wheezes only during viral upper respiratory tract infections (URTI) and symptom-free in between episodes ## Footnote This type of wheeze is not associated with an increased risk of asthma later in life.

Answer 268

Wheezes triggered by viral URTIs and other factors such as exercise, allergens, and cigarette smoke ## Footnote A proportion of children with this type may develop asthma.

Answer 269

Stop smoking ## Footnote This is an important management step for children's respiratory health.

Answer 270

* Short acting beta 2 agonists (e.g. salbutamol) * Anticholinergic via a spacer ## Footnote Treatment for episodic viral wheeze is symptomatic only.

Answer 271

* Intermittent leukotriene receptor antagonist (montelukast) * Intermittent inhaled corticosteroids * Both ## Footnote Oral prednisolone has little role in children who do not require hospital treatment.

Answer 272

4-8 weeks ## Footnote This trial helps determine the effectiveness of the treatment for the child.

Answer 273

3 or 4 years of age ## Footnote This is a typical developmental milestone for children.

Answer 274

Involuntary discharge of urine by day or night in a child aged 5 years or older ## Footnote This occurs in the absence of congenital or acquired defects of the nervous system or urinary tract.

Answer 275

* Primary: child has never achieved continence * Secondary: child has been dry for at least 6 months before ## Footnote Understanding the type of enuresis is important for management.

Answer 276

* Constipation * Diabetes mellitus * UTI if recent onset ## Footnote Identifying these causes is crucial for effective management.

Answer 277

* Fluid intake * Toileting patterns: encourage to empty bladder regularly during the day and before sleep * Lifting and waking * Reward systems (e.g. Star charts) ## Footnote These strategies can help improve continence in children.

Answer 278

Should be given for agreed behaviour rather than dry nights ## Footnote For example, using the toilet to pass urine before sleep.

Answer 279

A device with sensor pads that sense wetness ## Footnote It is generally first-line for children and has a high success rate.

Answer 280

For short-term control (e.g. for sleepovers) or if an enuresis alarm has been ineffective ## Footnote It may also be used if the alarm is not acceptable to the family.

Answer 281

* Quietens to parents' voice * Turns towards sound * Squeals ## Footnote These milestones indicate early auditory and vocal responses in infants.

Answer 282

Double syllables 'adah', 'erleh' ## Footnote This reflects the beginning of babbling and vocal experimentation.

Answer 283

* Says 'mama' and 'dada' * Understands 'no' ## Footnote These milestones show early word recognition and comprehension.

Answer 284

* Knows and responds to own name * Understands simple commands - 'give it to mummy' ## Footnote This indicates growing recognition and comprehension of language.

Answer 285

About 2-6 words ## Footnote It is advised to refer to the child's vocabulary at **18 months**.

Answer 286

* Combine two words * Points to parts of the body ## Footnote This shows the beginning of sentence formation and body awareness.

Answer 287

200 words ## Footnote This reflects significant language development and vocabulary expansion.

Answer 288

* Talks in short sentences (e.g. 3-5 words) * Asks 'what' and 'who' questions * Identifies colours * Counts to 10 ## Footnote These milestones indicate more complex language use and cognitive development.

Answer 289

* 'why' * 'when' * 'how' ## Footnote This reflects curiosity and the ability to engage in more complex conversations.

Answer 290

A chromosomal disorder affecting around 1 in 2,500 females ## Footnote Caused by the presence of only one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes.

Answer 291

45,XO or 45,X ## Footnote These notations indicate the chromosomal makeup associated with Turner's syndrome.

Answer 292

* Short stature * Shield chest, widely spaced nipples * Webbed neck * Bicuspid aortic valve (15%) * Coarctation of the aorta (5-10%) * Primary amenorrhoea * Cystic hygroma (often diagnosed prenatally) * High-arched palate * Short fourth metacarpal * Multiple pigmented naevi * Lymphoedema in neonates (especially feet) ## Footnote These features can vary in presentation among individuals with Turner's syndrome.

Answer 293

* Increased risk of aortic dilatation * Aortic dissection ## Footnote Regular monitoring in adult life for these complications is an important component of care.

Answer 294

Horseshoe kidney ## Footnote This is the most common renal abnormality found in individuals with Turner's syndrome.

Answer 295

TRUE ## Footnote Individuals with Turner's syndrome have a higher incidence of hypothyroidism.

Answer 296

They will be elevated ## Footnote Elevated gonadotrophin levels are a characteristic finding in Turner's syndrome.

Answer 297

Autoimmune thyroiditis ## Footnote Crohn's disease is also noted to have increased incidence among individuals with Turner's syndrome.

Answer 298

Seizures provoked by fever in otherwise normal children ## Footnote Typically occur between the ages of 6 months and 5 years and are seen in 3% of children.

Answer 299

Early as the temperature rises rapidly ## Footnote Seizures are usually brief, lasting less than 5 minutes.

Answer 300

Tonic-clonic ## Footnote These seizures are typically brief and last less than 5 minutes.

Answer 301

* Simple * Complex * Febrile status epilepticus ## Footnote Each type varies in duration and recurrence.

Answer 302

Less than 15 minutes, generalized seizure, typically no recurrence within 24 hours ## Footnote Should have complete recovery within an hour.

Answer 303

15 - 30 minutes, focal seizure, may have repeat seizures within 24 hours ## Footnote Recovery may vary.

Answer 304

More than 30 minutes ## Footnote This type requires immediate medical attention.

Answer 305

Admit to paediatrics if it's the first seizure or has features of a complex seizure ## Footnote Ongoing management is crucial.

Answer 306

Phone for an ambulance ## Footnote Regular antipyretics have not been shown to reduce the chance of a febrile seizure.

Answer 307

Benzodiazepine rescue medication ## Footnote Should only be started on the advice of a specialist.

Answer 308

1 in 3 ## Footnote This risk varies based on several factors.

Answer 309

* Family history of epilepsy * Complex febrile seizures * Background of neurodevelopmental disorder ## Footnote Children with no risk factors have a 2.5% risk of developing epilepsy.

Answer 310

Much higher, e.g., 50% ## Footnote This highlights the importance of monitoring children with febrile convulsions.

Answer 311

Respiratory distress in the newborn due to meconium in the trachea ## Footnote It occurs in the immediate neonatal period.

Answer 312

Post-term deliveries ## Footnote Rates of up to 44% are reported in babies born after 42 weeks.

Answer 313

* Maternal hypertension * Pre-eclampsia * Chorioamnionitis * Smoking * Substance abuse ## Footnote These factors are associated with higher rates of meconium aspiration syndrome.

Answer 314

TRUE ## Footnote The condition can lead to significant respiratory complications in newborns.

Answer 315

* Signs of raised ICP * Focal neurological signs * Papilloedema * Significant bulging of the fontanelle * Disseminated intravascular coagulation * Signs of cerebral herniation ## Footnote For patients with meningococcal septicaemia, a lumbar puncture is contraindicated.

Answer 316

* Blood cultures * PCR for meningococcus ## Footnote A lumbar puncture is contraindicated in these cases.

Answer 317

* IV amoxicillin (or ampicillin) * IV cefotaxime ## Footnote These antibiotics are crucial for managing bacterial meningitis in young children.

Answer 318

* IV cefotaxime (or ceftriaxone) ## Footnote These antibiotics are effective for treating bacterial meningitis in older children.

Answer 319

Against giving corticosteroids ## Footnote Dexamethasone should be considered if specific CSF findings are present.

Answer 320

* Frankly purulent CSF * CSF white blood cell count > 1000/microlitre * Raised CSF white blood cell count with protein concentration > 1 g/litre * Bacteria on Gram stain ## Footnote These conditions indicate a severe infection where corticosteroids may be beneficial.

Answer 321

Treat with colloid ## Footnote Fluids are essential in managing shock in these patients.

Answer 322

Mechanical ventilation if respiratory impairment ## Footnote Monitoring is essential to manage potential complications effectively.

Answer 323

Ciprofloxacin ## Footnote Ciprofloxacin is now preferred over rifampicin for prophylaxis.

Answer 324

All ages ## Footnote Typically resolves between the ages of 4-8 years. Orthotics are not recommended; parental reassurance is appropriate.

Answer 325

Absent medial arch on standing ## Footnote This condition typically resolves between the ages of 4-8 years.

Answer 326

* Metatarsus adductus * Internal tibial torsion * Femoral anteversion ## Footnote 90% of cases resolve spontaneously; severe/persistent cases may require serial casting.

Answer 327

Resolves in the vast majority ## Footnote This condition is one of the causes of in toeing in children.

Answer 328

All ages ## Footnote Common in early infancy and usually resolves by the age of 2 years, typically due to external tibial torsion.

Answer 329

Typically resolves by the age of 4-5 years ## Footnote This condition presents with increased intercondylar distance during the 1st-2nd year.

Answer 330

3rd-4th year ## Footnote This condition presents with increased intermalleolar distance and typically resolves spontaneously.

Answer 331

Intervention may be appropriate ## Footnote If it doesn't resolve, it increases the risk of patellofemoral pain.

Answer 332

A condition caused by hypertrophy of the circular muscles of the pylorus ## Footnote Typically presents in the second to fourth weeks of life with vomiting.

Answer 333

4 per 1,000 live births ## Footnote It is 4 times more common in males.

Answer 334

10-15% ## Footnote First-borns are more commonly affected.

Answer 335

'Projectile' vomiting, typically 30 minutes after a feed ## Footnote Constipation and dehydration may also be present.

Answer 336

A palpable mass ## Footnote This is often associated with the condition.

Answer 337

Hypochloraemic, hypokalaemic alkalosis ## Footnote This occurs due to loss of gastric acid.

Answer 338

Ultrasound ## Footnote This imaging technique is typically used to confirm the diagnosis.

Answer 339

Ramstedt pyloromyotomy ## Footnote This surgical procedure is performed to relieve the obstruction.

Answer 340

S. pneumoniae ## Footnote This bacterium is commonly responsible for pneumonia cases in pediatric patients.

Answer 341

2011 ## Footnote These guidelines provide a framework for treating pneumonia in children.

Answer 342

Amoxicillin ## Footnote This antibiotic is recommended as the initial therapy for pediatric pneumonia.

Answer 343

* If there is no response to first-line therapy * If mycoplasma or chlamydia is suspected ## Footnote Macrolides are used to target specific bacterial infections when necessary.

Answer 344

Co-amoxiclav ## Footnote This combination antibiotic is suggested for treating pneumonia in the context of influenza infection.

Answer 345

16 years or older ## Footnote A young person at this age can make their own medical decisions.

Answer 346

Under 16 years ## Footnote Capacity to decide depends on the child's ability to understand what is involved.

Answer 347

* A person with parental responsibility * The court ## Footnote This authorization must be in the child's best interests.

Answer 348

* 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 continue having sexual intercourse * Without treatment, their physical or mental health is likely to suffer * Their best interests require contraceptive advice or treatment ## Footnote All these requirements must be fulfilled for contraceptive provision.

Answer 349

Contraception ## Footnote It is used when discussing the provision of contraceptives to minors.

Answer 350

General issues of consent in children ## Footnote This term is often used interchangeably with Fraser competency.

Answer 351

FALSE ## Footnote In Scotland, a competent child's refusal cannot be overridden by parental authority.

Answer 352

Recent investigations ## Footnote The rumors about her removing permission or applying copyright have been proven false.

Answer 353

floppiness ## Footnote Hypotonia may be central in origin or related to nerve and muscle problems.

Answer 354

septicaemic ## Footnote This indicates that hypotonia can be a sign of serious underlying health issues.

Answer 355

hypoxic ischaemic encephalopathy ## Footnote This condition occurs due to a lack of oxygen to the brain.

Answer 356

* Down's syndrome * Prader-Willi syndrome * hypothyroidism * cerebral palsy ## Footnote In cerebral palsy, hypotonia may precede the development of spasticity.

Answer 357

* spinal muscular atrophy * spina bifida * Guillain-Barre syndrome * myasthenia gravis * muscular dystrophy * myotonic dystrophy ## Footnote These conditions affect muscle strength and control.

Answer 358

A form of congenital heart defect ## Footnote Generally classed as 'acyanotic', but can lead to late cyanosis in lower extremities if uncorrected.

Answer 359

Between the pulmonary trunk and descending aorta ## Footnote Usually closes with the first breaths due to increased pulmonary flow.

Answer 360

* Left subclavicular thrill * Continuous 'machinery' murmur * Large volume, bounding, collapsing pulse * Wide pulse pressure * Heaving apex beat ## Footnote These features are indicative of the condition.

Answer 361

Initial expectant supportive care ## Footnote Spontaneous closure often occurs; pharmacological closure is recommended if hemodynamically significant PDA remains.

Answer 362

* Ibuprofen * Indomethacin * Paracetamol ## Footnote These inhibit prostaglandin synthesis and are given to the infant, not the mother.

Answer 363

* Moderate or large PDA * Prior episode of endocarditis * Small audible PDA ## Footnote Transcatheter PDA closure is preferred over pharmacological therapy in these cases.

Answer 364

Transcatheter PDA closure ## Footnote Pharmacological therapy (ibuprofen/indomethacin) is not effective in term infants.

Answer 365

Keeps the duct open until after surgical repair ## Footnote Useful if the PDA is associated with another congenital heart defect amenable to surgery.

Answer 366

'Growing pains' ## Footnote This term is a misnomer as the pains are often not related to growth; the current term used is 'benign idiopathic nocturnal limb pains of childhood'.

Answer 367

3-12 years ## Footnote Growing pains are equally common in boys and girls.

Answer 368

* Never present at the start of the day after waking * No limp * No limitation of physical activity * Systemically well * Normal physical examination * Motor milestones normal * Symptoms are often intermittent and worse after vigorous activity ## Footnote These features help differentiate growing pains from other causes of leg pain.

Answer 369

To assess the clinical condition of a newborn immediately after birth ## Footnote It helps determine whether the baby needs immediate medical attention.

Answer 370

At 1 and 5 minutes after birth ## Footnote If the score is less than 7 at 5 minutes, assessment continues every 5 minutes for up to 20 minutes.

Answer 371

* Activity (muscle tone) * Pulse (heart rate) * Grimace (reflex irritability) * Appearance (skin colour) * Respiratory effort ## Footnote This acronym helps healthcare professionals recall each component of the assessment.

Answer 372

2 ## Footnote This indicates good muscle tone.

Answer 373

Critically low – requires immediate resuscitation ## Footnote This score range signifies a need for urgent medical intervention.

Answer 374

Moderately low – may require medical support ## Footnote This score suggests that the newborn may need additional care.

Answer 375

Generally reassuring – good adaptation to extrauterine life ## Footnote This score range reflects a healthy newborn.

Answer 376

Respiratory effort ## Footnote These components are critical for evaluating a newborn's health.

Answer 377

0 ## Footnote This indicates absent muscle tone.

Answer 378

A common and benign set of symptoms in young infants ## Footnote Characterized by excessive crying and pulling-up of the legs, often worse in the evening.

Answer 379

3 ## Footnote It is a condition seen in young infants.

Answer 380

20% ## Footnote This indicates that it is a relatively common condition.

Answer 381

No ## Footnote The cause is unknown, but it is a self-limiting condition.

Answer 382

5 ## Footnote This indicates that the condition is typically temporary.

Answer 383

FALSE ## Footnote NICE does not recommend the use of these drops.

Answer 384

A form of cyanotic congenital heart disease ## Footnote TGA is caused by the failure of the aorticopulmonary septum to spiral during septation.

Answer 385

Diabetes ## Footnote Children of diabetic mothers are at an increased risk of TGA.

Answer 386

* Aorta leaves the right ventricle * Pulmonary trunk leaves the left ventricle ## Footnote These changes result in improper circulation of blood.

Answer 387

* Cyanosis * Tachypnoea * Loud single S2 * Prominent right ventricular impulse * 'Egg-on-side' appearance on chest x-ray ## Footnote These features help in the clinical diagnosis of TGA.

Answer 388

Maintenance of the ductus arteriosus with prostaglandins ## Footnote This is crucial to ensure some mixing of oxygenated and deoxygenated blood.

Answer 389

Surgical correction ## Footnote Surgical intervention is necessary to correct the anatomical defect.

Answer 390

More severe bronchiolitis ## Footnote This indicates a potential complication where congenital heart disease exacerbates the severity of bronchiolitis.

Answer 391

* Ensure intrauterine growth * Check for maternal infections (e.g. HIV) * Ultrasound scan for fetal abnormalities * Blood tests for Neural Tube Defects ## Footnote These checks are crucial for monitoring the health of both the mother and the fetus.

Answer 392

* Clinical examination of newborn * Newborn Hearing Screening Programme (e.g. oto-acoustic emissions test) * Personal Child Health Record given to mother ## Footnote These checks help to identify any immediate health concerns in newborns.

Answer 393

* Heel-prick test (day 5-9) for hypothyroidism, PKU, metabolic diseases, cystic fibrosis, MCADD * Midwife visit up to 4 weeks* ## Footnote The heel-prick test screens for several serious conditions, while midwife visits are intended for ongoing support.

Answer 394

* Health visitor input * GP examination at 6-8 weeks * Routine immunisations ## Footnote These steps are essential for ongoing health monitoring and vaccination.

Answer 395

National orthoptist-led programme for pre-school vision screening to be introduced ## Footnote This program aims to identify vision problems early in children.

Answer 396

* Monitoring of growth * Monitoring of vision * Monitoring of hearing * Health professionals' advice on immunisations, diet, accident prevention ## Footnote These ongoing checks ensure that children continue to develop healthily.

Answer 397

* 5-14 days (newborn) * 6-8 weeks * 9-12 months * 2-2.5 years ## Footnote These reviews are critical for assessing the child's development and health at key stages.

Answer 398

up to 50 per cent ## Footnote This statistic highlights the prevalence of headaches in young children.

Answer 399

up to 80 per cent ## Footnote This indicates a significant increase in headache prevalence during adolescence.

Answer 400

3:1 ## Footnote This reflects a strong increase in migraine prevalence among females post-puberty.

Answer 401

Migraine without aura ## Footnote This type of migraine is prevalent among pediatric populations.

Answer 402

>= 5 attacks ## Footnote This is a key criterion for diagnosing migraine in children.

Answer 403

4-72 hours ## Footnote This duration is critical for classification as a migraine attack.

Answer 404

* Nausea and/or vomiting * Photophobia and phonophobia ## Footnote These features help differentiate migraines from other headache types.

Answer 405

ibuprofen ## Footnote This suggests a preferred choice for acute management of migraines in children.

Answer 406

sumatriptan nasal spray ## Footnote This triptan has proven efficacy but may be poorly tolerated by young patients.

Answer 407

* Tingling * Heat * Heaviness/pressure sensations ## Footnote These side effects can affect patient compliance with treatment.

Answer 408

* Pizotifen * Propranolol ## Footnote These medications are recommended despite limited evidence.

Answer 409

Tension-type headache (TTH) ## Footnote This type of headache is prevalent after migraines.

Answer 410

At least 10 previous headache episodes ## Footnote This is a diagnostic criterion for TTH.

Answer 411

30 minutes to 7 days ## Footnote This duration helps distinguish TTH from other headache types.

Answer 412

* Pressing/tightening quality * Mild or moderate intensity ## Footnote These characteristics help in diagnosing TTH.

Answer 413

FALSE ## Footnote TTH does not typically worsen with physical activity.

Answer 414

* No nausea or vomiting * Photophobia and phonophobia, or one, but not the other is present ## Footnote These criteria help differentiate TTH from migraines.

Answer 415

* Meconium ileus * Prolonged jaundice ## Footnote Around 20% of patients present with these features during the neonatal period.

Answer 416

40% ## Footnote This is one of the common presenting features of cystic fibrosis.

Answer 417

* Steatorrhoea * Failure to thrive ## Footnote Approximately 30% of patients experience these malabsorption issues.

Answer 418

* Liver disease-about 10% * Short stature * Diabetes mellitus * Delayed puberty * Rectal prolapse * Nasal polyps * Male infertility * Female subfertility ## Footnote These features can vary among patients.

Answer 419

TRUE ## Footnote Many patients are identified during newborn screening or early childhood.

Answer 420

A disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain ## Footnote It affects 2 in 1,000 live births and is the most common cause of major motor impairment.

Answer 421

80% ## Footnote Examples include cerebral malformation and congenital infections like rubella, toxoplasmosis, and CMV.

Answer 422

* Antenatal (80%) * Intrapartum (10%) * Postnatal (10%) ## Footnote Intrapartum causes include birth asphyxia/trauma, while postnatal causes include intraventricular hemorrhage, meningitis, and head trauma.

Answer 423

* Abnormal tone in early infancy * Delayed motor milestones * Abnormal gait * Feeding difficulties ## Footnote Children may also experience associated non-motor problems.

Answer 424

60% ## Footnote Other associated non-motor problems include epilepsy (30%), squints (30%), and hearing impairment (20%).

Answer 425

Spastic (70%) ## Footnote Subtypes include hemiplegia, diplegia, or quadriplegia, characterized by increased tone resulting from damage to upper motor neurons.

Answer 426

Dyskinetic ## Footnote This type is characterized by athetoid movements and oro-motor problems.

Answer 427

Ataxic ## Footnote This type presents with typical cerebellar signs.

Answer 428

A multidisciplinary approach ## Footnote Treatments for spasticity include oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopedic surgery, and selective dorsal rhizotomy.

Answer 429

oral diazepam ## Footnote A comprehensive management plan is essential for children with chronic conditions like cerebral palsy.

Answer 430

* Reaches for object * Holds rattle briefly if given to hand * Visually alert, particularly human faces * Fixes and follows to 180 degrees ## Footnote These milestones indicate early engagement with the environment and visual tracking abilities.

Answer 431

* Holds in palmar grasp * Pass objects from one hand to another * Visually insatiable, looking around in every direction ## Footnote This stage shows increased hand coordination and visual exploration.

Answer 432

* Points with finger * Early pincer ## Footnote Pointing indicates communication development, while the early pincer grasp shows fine motor skill advancement.

Answer 433

* Good pincer grip * Bangs toys together ## Footnote These skills reflect improved dexterity and the ability to manipulate objects.

Answer 434

Tower of 2 ## Footnote This milestone indicates the beginning of constructive play.

Answer 435

Tower of 3 ## Footnote This reflects growing fine motor skills and hand-eye coordination.

Answer 436

Tower of 6 ## Footnote This milestone shows significant improvement in fine motor skills.

Answer 437

Tower of 9 ## Footnote This indicates advanced fine motor skills and spatial awareness.

Answer 438

Circular scribble ## Footnote This represents the beginning of creative expression through drawing.

Answer 439

Copies vertical line ## Footnote This milestone indicates developing control over writing instruments.

Answer 440

Copies circle ## Footnote This shows further development in fine motor skills and shape recognition.

Answer 441

Copies cross ## Footnote This indicates increased precision in drawing and understanding of shapes.

Answer 442

* Copies square * Copies triangle ## Footnote Mastery of these shapes reflects advanced fine motor skills.

Answer 443

* Looks at book, pats page ## Footnote This shows early interest in reading and exploration of books.

Answer 444

Turns pages, several at a time ## Footnote This indicates developing fine motor skills and curiosity about stories.

Answer 445

Turns pages, one at a time ## Footnote This reflects improved dexterity and understanding of book handling.

Answer 446

Hand preference before 12 months is abnormal ## Footnote It may indicate cerebral palsy or other developmental issues.

Answer 447

* Proteinuria (> 1 g/m^2 per 24 hours) * Hypoalbuminaemia (< 25 g/l) * Oedema ## Footnote These three features are essential for the diagnosis of nephrotic syndrome.

Answer 448

Between 2 and 5 years of age ## Footnote This age range is when nephrotic syndrome is most commonly diagnosed in children.

Answer 449

Minimal change glomerulonephritis ## Footnote This condition is often associated with a good prognosis.

Answer 450

Around 90% ## Footnote Most children with nephrotic syndrome respond well to steroid treatment.

Answer 451

* Hyperlipidaemia * Hypercoagulable state (due to loss of antithrombin III) * Predisposition to infection (due to loss of immunoglobulins) ## Footnote These features can complicate the clinical picture of nephrotic syndrome.

Answer 452

* Ejection murmurs * Venous hums * Still's murmur ## Footnote These murmurs are typically benign and often resolve without intervention.

Answer 453

Turbulent blood flow at the outflow tract of the heart ## Footnote Ejection murmurs are common and usually harmless.

Answer 454

Turbulent blood flow in the great veins returning to the heart, heard as a continuous blowing noise just below the clavicles ## Footnote Venous hums are typically benign and can be observed in children.

Answer 455

Low-pitched sound heard at the lower left sternal edge ## Footnote Still's murmur is a common innocent murmur in children.

Answer 456

* Soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area * May vary with posture * Localised with no radiation * No diastolic component * No thrill * No added sounds (e.g. clicks) * Asymptomatic child * No other abnormality ## Footnote These characteristics help differentiate innocent murmurs from pathological ones.

Answer 457

* Green - low risk * Amber - intermediate risk * Red - high risk ## Footnote This system is used for risk stratification of children presenting with a fever.

Answer 458

* Temperature * Heart rate * Respiratory rate * Capillary refill time ## Footnote Signs of dehydration should also be assessed.

Answer 459

With an electronic thermometer in the axilla ## Footnote For older children, an electronic/chemical dot thermometer or an infra-red tympanic thermometer can be used.

Answer 460

* Normal colour * Responds normally to social cues * Content/smiles * Stays awake or awakens quickly * Strong normal cry/not crying ## Footnote This indicates low risk for the child.

Answer 461

* Pallor reported by parent/carer * Not responding normally to social cues * No smile * Wakes only with prolonged stimulation * Decreased activity ## Footnote This indicates intermediate risk for the child.

Answer 462

* Pale/mottled/ashen/blue * No response to social cues * Appears ill to a healthcare professional * Does not wake or if roused does not stay awake * Weak, high-pitched or continuous cry ## Footnote This indicates high risk for the child.

Answer 463

Managed at home with appropriate care advice ## Footnote Includes information on when to seek further help.

Answer 464

* Provide parents with a safety net * Refer to a paediatric specialist for further assessment ## Footnote A safety net includes verbal or written information on warning symptoms.

Answer 465

Refer child urgently to a paediatric specialist ## Footnote This indicates immediate medical attention is required.

Answer 466

FALSE ## Footnote Antibiotics should not be prescribed in such cases.

Answer 467

TRUE ## Footnote This is a key point in the management of febrile children.

Answer 468

same-day ## Footnote This is important even if a diagnosis of transient synovitis is suspected.

Answer 469

Guthrie test or 'heel-prick test' ## Footnote This screening is performed at 5-9 days of life.

Answer 470

5-9 days of life ## Footnote This test is crucial for early detection of certain conditions.

Answer 471

* 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) ## Footnote These conditions are critical for early intervention and management.

Answer 472

FALSE ## Footnote The screening is conducted at 5-9 days of life, not at birth.

Answer 473

An immune-mediated reduction in the platelet count ## Footnote Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex. It is an example of a type II hypersensitivity reaction.

Answer 474

Adults ## Footnote ITP in children may follow an infection or vaccination.

Answer 475

* Bruising * Petechial or purpuric rash * Bleeding (less common, typically epistaxis or gingival bleeding) ## Footnote These features help in identifying ITP in pediatric patients.

Answer 476

Isolated thrombocytopenia ## Footnote This finding is crucial for diagnosing ITP.

Answer 477

If there are atypical features such as: * Lymph node enlargement/splenomegaly * High/low white cells * Failure to resolve/respond to treatment ## Footnote These atypical features may indicate other underlying conditions.

Answer 478

FALSE ## Footnote ITP resolves in around 80% of children within 6 months, with or without treatment.

Answer 479

Avoid activities that may result in trauma (e.g. team sports) ## Footnote This precaution helps prevent bleeding complications.

Answer 480

* Oral/IV corticosteroid * IV immunoglobulins * Platelet transfusions (temporary measure) ## Footnote Platelet transfusions are used in emergencies but are soon destroyed by circulating antibodies.

Answer 481

intussusception ## Footnote This condition typically occurs in older children aged 5 months to 12 months.

Answer 482

ultrasound scan ## Footnote The ultrasound scan may show a target sign.

Answer 483

* Can’t break down phenylalanine * Phenylalanine builds up * Can cause brain damage if untreated ## Footnote Clues include musty-smelling urine, fair skin, and developmental delay.

Answer 484

* Can’t burn medium-chain fats for energy * Low blood sugar (hypoglycemia) during fasting or illness ## Footnote Clues include vomiting, lethargy, and it can be life-threatening if not fed regularly.

Answer 485

* Can’t break down branched-chain amino acids * Amino acids build up → toxic to the brain ## Footnote Clues include urine smells like maple syrup, poor feeding, vomiting, and lethargy.

Answer 486

* Can’t break down leucine properly * Build-up of isovaleric acid → toxic to the body ## Footnote Clues include smelly “sweaty feet” odor, vomiting, and lethargy.

Answer 487

* Lysine * Hydroxylysine * Tryptophan ## Footnote Effect includes build-up of glutaric acid → damages brain, especially basal ganglia. Clues include large head, weak muscles, and risk of sudden dystonic movements after illness.

Answer 488

* Can’t break down homocysteine * Homocysteine builds up → affects eyes, skeleton, blood vessels, brain ## Footnote Clues include marfanoid habitus, lens dislocation, risk of blood clots, and learning difficulties.

Answer 489

A form of congenital heart defect ## Footnote Generally classed as 'acyanotic', but can lead to late cyanosis in lower extremities if uncorrected.

Answer 490

Between the pulmonary trunk and descending aorta ## Footnote The ductus arteriosus usually closes with the first breaths due to increased pulmonary flow.

Answer 491

* Premature babies * Born at high altitude * Maternal rubella infection in the first trimester ## Footnote These factors increase the likelihood of developing PDA.

Answer 492

* Left subclavicular thrill * Continuous 'machinery' murmur * Large volume, bounding, collapsing pulse * Wide pulse pressure * Heaving apex beat ## Footnote These features help in the diagnosis of PDA.

Answer 493

Initial expectant supportive care ## Footnote Spontaneous closure often occurs, so early pharmacologic therapy is not always necessary.

Answer 494

* Ibuprofen * Indomethacin * Paracetamol ## Footnote These inhibit prostaglandin synthesis and are given to the infant, not the mother.

Answer 495

* Moderate or large PDA * Prior episode of endocarditis * Small audible PDA ## Footnote Closure is typically done using transcatheter PDA closure rather than pharmacological therapy.

Answer 496

Keeps the duct open until after surgical repair ## Footnote This is particularly useful if PDA is associated with another congenital heart defect amenable to surgery.

Answer 497

Acute lymphoblastic leukaemia (ALL) ## Footnote ALL accounts for 80% of childhood leukaemias.

Answer 498

2–5 years of age ## Footnote Boys are affected slightly more commonly than girls.

Answer 499

* Anaemia: lethargy and pallor * Neutropenia: frequent or severe infections * Thrombocytopenia: easy bruising, petechiae ## Footnote These features arise due to bone marrow failure.

Answer 500

* Bone pain (secondary to bone marrow infiltration) * Splenomegaly * Hepatomegaly * Fever (present in up to 50% of new cases) * Testicular swelling ## Footnote Fever may represent infection or a constitutional symptom.

Answer 501

75% ## Footnote Common ALL is characterized by the presence of CD10 and a pre-B phenotype.

Answer 502

* Common ALL (75%) * T-cell ALL (20%) * B-cell ALL (5%) ## Footnote Each type has distinct characteristics and prevalence.

Answer 503

* Age < 2 years or > 10 years * WBC > 20 * 10^9/l at diagnosis * T or B cell surface markers * Non-white ethnicity * Male sex ## Footnote These factors can negatively impact the prognosis of ALL.

Answer 504

* Leucocytosis or sometimes normal/low WBC * Anaemia * Thrombocytopenia ## Footnote These findings are indicative of bone marrow involvement.

Answer 505

Confirms diagnosis and allows immunophenotyping ## Footnote It is essential for accurate diagnosis and treatment planning.

Answer 506

CNS involvement ## Footnote This test helps evaluate if the leukaemia has affected the central nervous system.

Answer 507

Chemotherapy ## Footnote Management includes induction, consolidation, and maintenance phases.

Answer 508

Achieve remission ## Footnote This phase lasts 4-6 weeks and involves specific chemotherapy drugs.

Answer 509

* Vincristine * Steroids * L-asparaginase * Anthracyclines ## Footnote These drugs are critical for achieving remission.

Answer 510

* Tumour lysis syndrome * Myelosuppression * Steroid effects ## Footnote These complications can arise during the treatment process.

Answer 511

Eradicate residual disease ## Footnote This phase may last weeks to months.

Answer 512

* High-dose methotrexate * Vincristine * Mercaptopurine * Intrathecal chemotherapy for CNS prophylaxis ## Footnote These drugs help to eliminate any remaining cancer cells.

Answer 513

* Methotrexate toxicity * Haemorrhagic cystitis * Neurotoxicity ## Footnote These complications can occur due to the aggressive nature of the treatment.

Answer 514

Prevent relapse ## Footnote This phase lasts 2-3 years.

Answer 515

* Mercaptopurine * Methotrexate * Vincristine/steroid pulses ## Footnote These drugs are used to maintain remission and prevent relapse.

Answer 516

* Hepatotoxicity * Myelosuppression * Poor adherence ## Footnote These complications can affect the long-term management of the disease.

Answer 517

* Blood product support * Infection prophylaxis ## Footnote Supportive care is crucial for managing side effects and complications.

Answer 518

Haematopoietic stem cell transplantation ## Footnote This option is reserved for patients with poor prognostic factors.

Answer 519

Tetralogy of Fallot (TOF) ## Footnote TOF typically presents at around 1-2 months, although it may not be detected until the baby is 6 months old.

Answer 520

* Ventricular septal defect (VSD) * Right ventricular hypertrophy * Right ventricular outflow tract obstruction (pulmonary stenosis) * Overriding aorta ## Footnote TOF results from anterior malalignment of the aorticopulmonary septum.

Answer 521

The degree of cyanosis and clinical severity ## Footnote This is a critical factor in assessing the condition of patients with TOF.

Answer 522

* Episodic hypercyanotic spells * Tachypnoea * Severe cyanosis * Possible loss of consciousness ## Footnote Tet spells typically occur when an infant is upset, in pain, or has a fever.

Answer 523

TRUE ## Footnote This shunt is caused by the right ventricular outflow tract obstruction.

Answer 524

Ejection systolic murmur ## Footnote The VSD usually does not cause a murmur.

Answer 525

25% ## Footnote This is a notable anatomical variation seen in some patients.

Answer 526

'Boot-shaped' heart ## Footnote This radiographic finding is characteristic of Tetralogy of Fallot.

Answer 527

Right ventricular hypertrophy ## Footnote This finding is consistent with the structural changes in the heart.

Answer 528

In two parts ## Footnote This approach is common in managing the condition surgically.

Answer 529

Beta-blockers ## Footnote These can reduce infundibular spasm during cyanotic episodes.

Answer 530

Transposition of the great arteries ## Footnote Patients with TOF generally present later, around 1-2 months.

Answer 531

making good diagnosis and treatment vital.

Answer 532

there has to be an element of developmental delay. For children up to the age of 16 years

Answer 533

about twice that of autism

Answer 534

before a question has been finished

Answer 535

a ten-week 'watch and wait' period should follow to observe whether symptoms change or resolve. If they persist then referral to secondary care is required. This is normally to a paediatrician with a special interest in behavioural disorders

Answer 536

or whose symptoms are severe

Answer 537

nausea and dyspepsia. In children

Answer 538

switch to lisdexamfetamine;

Answer 539

but who can't tolerate its side effects.

Answer 540

and refer to a cardiologist if there is any significant past medical history or family history

Answer 541

whether adult or paediatric

Answer 542

Enterobius vermicularis ## Footnote Threadworms are sometimes called pinworms.

Answer 543

Children in the UK ## Footnote Infestation occurs after swallowing eggs present in the environment.

Answer 544

90% ## Footnote Possible features include perianal itching and vulval symptoms in girls.

Answer 545

* Perianal itching, particularly at night * Vulval symptoms in girls ## Footnote These symptoms may indicate the presence of threadworms.

Answer 546

Applying Sellotape to the perianal area and sending it for microscopy ## Footnote This method helps to see the eggs.

Answer 547

Mebendazole ## Footnote A single dose is given unless infestation persists.

Answer 548

* A combination of anthelmintic * Hygiene measures for all household members ## Footnote This approach helps to prevent reinfestation.

Answer 549

A bacterial infection affecting exposed skin areas, resulting in a vesicular eruption with a 'golden crust' ## Footnote Typically affects areas like the mouth's and nostril's border.

Answer 550

Vesicular eruption with an erythematous border evolving into a 'golden crust' ## Footnote Commonly seen in exposed skin areas.

Answer 551

Pemphigus vulgaris ## Footnote An autoimmune condition.

Answer 552

TRUE ## Footnote The findings do not align with Pemphigus vulgaris.

Answer 553

Plaque and silvery scale ## Footnote Rarely affects infants and may be a differential in treatment-refractory seborrhoeic dermatitis.

Answer 554

Scabies ## Footnote Results in a generalized, intensely pruritic eruption in infants.

Answer 555

* Volar aspect of the wrist * Periumbilical region * Interdigital webspace ## Footnote Scabies presents with evidence of linear burrowing and lesions associated with papules.

Answer 556

eczema ## Footnote This finding is not typical for conditions like Impetigo or Scabies.

Answer 557

* Macules (flat spots) * Papules (raised bumps) * Vesicles (blisters) * Crust over ## Footnote The rash is itchy and associated with constitutional symptoms such as fever, headache, and general malaise.

Answer 558

* Painful vesicular lesions * Around the mouth (cold sores) * Genital area ## Footnote HSV can lead to significant discomfort and is highly contagious.

Answer 559

Chickenpox virus (varicella zoster) ## Footnote It leads to painful vesicles along a nerve dermatome.

Answer 560

* Allergens * Irritants (like poison ivy) ## Footnote It can cause vesicles as a skin reaction.

Answer 561

Enteroviruses ## Footnote It leads to vesicular lesions on the hands, feet, and inside the mouth.

Answer 562

Bacterial infection ## Footnote It can cause vesicular lesions and often leads to a honey-colored crust when the blisters break.

Answer 563

Centrally (face, scalp, or torso) ## Footnote The rash spreads to the extremities and starts as a macular rash.

Answer 564

Typically appears on the oral mucosa, hands, and feet ## Footnote The rash is not typically itchy and may extend to the buttocks.

Answer 565

Measles ## Footnote Measles produces a maculopapular rash that starts on the face and does not become vesicular.

Answer 566

* Maculopapular rash * Starts centrally and spreads ## Footnote It is preceded by several days of high fever and is most common in children under 2 years of age.

Answer 567

* Mildly itchy maculopapular rash * Starts on the face (often behind the ears) ## Footnote The rash does not become vesicular and is typically associated with conjunctivitis and lymphadenopathy.

Answer 568

Transfer immediately to hospital ## Footnote This is critical to ensure the child's safety and proper medical intervention.

Answer 569

SpO2 > 92% and no clinical features of severe asthma ## Footnote Monitoring SpO2 levels is essential for assessing the severity of the attack.

Answer 570

* SpO2 < 92% * Too breathless to talk or feed * Heart rate > 140/min * Respiratory rate > 40/min * Use of accessory neck muscles ## Footnote These signs require immediate attention and potential hospitalization.

Answer 571

* SpO2 < 92% * Silent chest * Poor respiratory effort * Agitation * Altered consciousness * Cyanosis ## Footnote These symptoms are critical and indicate a severe emergency.

Answer 572

Measure PEF in all children > 5 years ## Footnote Peak Expiratory Flow (PEF) measurements help assess the severity of the attack.

Answer 573

SpO2 > 92% and PEF > 50% best or predicted ## Footnote This indicates that the child's asthma is under better control.

Answer 574

* SpO2 < 92% * PEF 33-50% best or predicted * Can't complete sentences in one breath or too breathless to talk or feed * Heart rate > 125/min * Respiratory rate > 30/min * Use of accessory neck muscles ## Footnote These signs require urgent medical evaluation.

Answer 575

* SpO2 < 92% * PEF < 33% best or predicted * Silent chest * Poor respiratory effort * Altered consciousness * Cyanosis ## Footnote Immediate medical intervention is necessary for these symptoms.

Answer 576

* Give a beta-2 agonist via a spacer * For a child < 3 years, use a close-fitting mask * Give 1 puff every 30-60 seconds up to a maximum of 10 puffs * If symptoms are not controlled, repeat beta-2 agonist and refer to hospital ## Footnote This therapy helps to relieve acute asthma symptoms.

Answer 577

Treatment should be given for 3-5 days ## Footnote Steroids help reduce inflammation and improve breathing.

Answer 578

* 20 mg od * 1-2 mg/kg od (max 40mg) ## Footnote Dosing may vary based on specific guidelines.

Answer 579

* 30 - 40 mg od * 1-2 mg/kg od (max 40mg) ## Footnote Proper dosing is crucial for effective treatment.

Answer 580

* 2-6 puffs of salbutamol * Nebulizer every 20 minutes for 1 hour ## Footnote This treatment is a **SABA** (Short-Acting Beta-Agonist) approach.

Answer 581

Oxygen ## Footnote The target is to achieve **94-98% saturation**.

Answer 582

Systemic steroids (oral prednisolone) ## Footnote These are crucial for managing inflammation during severe episodes.

Answer 583

Ipratropium bromide ## Footnote This medication can be particularly beneficial in severe cases.

Answer 584

Monitor closely; escalate care if symptoms worsen or do not improve ## Footnote Continuous assessment is vital for effective management.

Answer 585

Within 24-48 hours ## Footnote A clear **asthma action plan** should also be provided during follow-up.

Answer 586

3-6% ## Footnote CMPI/CMPA usually presents in the first 3 months of life in formula-fed infants.

Answer 587

* Immediate (IgE mediated) * Delayed (non-IgE mediated) ## Footnote CMPA is used for immediate reactions, while CMPI is used for mild-moderate delayed reactions.

Answer 588

* Regurgitation and vomiting * Diarrhoea * Urticaria, atopic eczema * 'Colic' symptoms: irritability, crying * Wheeze, chronic cough * Rarely angioedema and anaphylaxis ## Footnote These symptoms can vary in severity and presentation.

Answer 589

Extensive hydrolysed formula (eHF) ## Footnote This is recommended for formula-fed infants experiencing symptoms.

Answer 590

Eliminate cow's milk protein from maternal diet ## Footnote Consider prescribing calcium supplements to prevent deficiency while excluding dairy.

Answer 591

FALSE ## Footnote CMPI is an intolerance to the proteins in cow’s milk, not an immune-mediated allergic reaction.

Answer 592

* Discomfort * Bloating * Diarrhea ## Footnote Symptoms typically occur after milk consumption and do not trigger an immune response.

Answer 593

Cow's Milk Protein Intolerance (CMPI) ## Footnote Lactose intolerance is due to a lack of the enzyme lactase, leading to symptoms like bloating and gas.

Answer 594

* Hives * Swelling (angioedema) * Wheezing * Anaphylaxis (in severe cases) * Vomiting * Diarrhea ## Footnote Symptoms can occur immediately after milk ingestion.

Answer 595

* Eczema * Abdominal pain * Diarrhea or blood in stools * Failure to thrive or poor weight gain ## Footnote Symptoms may be delayed and can be more difficult to diagnose.

Answer 596

* CMPI usually resolves in most children * 55% of children with IgE mediated intolerance will be milk tolerant by age 5 * Most children with non-IgE mediated intolerance will be milk tolerant by age 3 ## Footnote A challenge is often performed in a hospital setting due to the risk of anaphylaxis.

Answer 597

* Microcephalic * Small eyes * Cleft lip/palate * Polydactyly * Scalp lesions ## Footnote Patau syndrome is characterized by severe developmental issues.

Answer 598

* Micrognathia * Low-set ears * Rocker bottom feet * Overlapping of fingers ## Footnote Edward's syndrome is associated with high mortality rates in infancy.

Answer 599

* Learning difficulties * Macrocephaly * Long face * Large ears * Macro-orchidism ## Footnote Fragile X syndrome is the most common inherited cause of intellectual disability.

Answer 600

* Webbed neck * Pectus excavatum * Short stature * Pulmonary stenosis ## Footnote Noonan syndrome can affect both males and females and is often associated with congenital heart defects.

Answer 601

* Micrognathia * Posterior displacement of the tongue * Cleft palate ## Footnote This syndrome may lead to upper airway obstruction due to tongue positioning.

Answer 602

* Hypotonia * Hypogonadism * Obesity ## Footnote Prader-Willi syndrome is characterized by insatiable appetite leading to obesity.

Answer 603

* Short stature * Learning difficulties * Friendly, extrovert personality * Transient neonatal hypercalcaemia * Supravalvular aortic stenosis ## Footnote William's syndrome is often associated with cardiovascular issues.

Answer 604

* Characteristic cry * Feeding difficulties and poor weight gain * Learning difficulties * Microcephaly * Micrognathism * Hypertelorism ## Footnote The name 'Cri du chat' translates to 'cry of the cat' due to the distinctive cry of affected infants.

Answer 605

TRUE ## Footnote One key difference is that Treacher-Collins syndrome is autosomal dominant, often with a family history.

Answer 606

* Unexplained lump * Unexplained bone pain * Unexplained swelling ## Footnote Osteosarcoma is rare but important to rule out in diagnoses.

Answer 607

* Fever * Rash * Symmetrical joint pain * Swelling ## Footnote These symptoms often present together in juvenile rheumatoid arthritis cases.

Answer 608

A joint disorder where cracks form in the articular cartilage and underlying subchondral bone, causing joint pain, locking, and swelling. ## Footnote This condition can significantly affect joint function.

Answer 609

A condition where the kneecap is formed of 2 separate bones, usually asymptomatic. ## Footnote It is often discovered incidentally during imaging for other issues.

Answer 610

Testing all newborns as part of the Newborn Hearing Screening Programme ## Footnote A computer-generated click is played through a small earpiece; the presence of a soft echo indicates a healthy cochlea.

Answer 611

If the otoacoustic emission test is abnormal ## Footnote This test may be done for newborns and infants.

Answer 612

6-9 months ## Footnote Performed by a health visitor and requires two trained staff.

Answer 613

Uses familiar objects like teddy or cup ## Footnote Simple questions are asked, e.g., 'where is the teddy?'.

Answer 614

* Performance testing * Speech discrimination tests ## Footnote Speech discrimination tests use similar-sounding objects, e.g., Kendall Toy test, McCormick Toy Test.

Answer 615

> 3 years ## Footnote This is done at school entry in most areas of the UK.

Answer 616

A questionnaire for parents asking 'Can your baby hear you?' ## Footnote This helps gather information about the child's hearing ability.

Answer 617

pertussis vaccine ## Footnote This vaccine is typically part of the diphtheria, pertussis, and tetanus vaccination.

Answer 618

at any point of her pregnancy ## Footnote The influenza vaccine is recommended regardless of the stage of pregnancy.

Answer 619

* Provide maternal antibodies to the fetus * Prevent the spreading of pertussis ## Footnote Pertussis can cause severe illness and death in a newborn.

Answer 620

Floppy larynx that collapses during inspiration ## Footnote It presents as inspiratory stridor in infants typically aged between 4-6 weeks.

Answer 621

4-6 weeks ## Footnote Symptoms usually resolve without intervention by 18-24 months.

Answer 622

Inspiratory stridor ## Footnote It leads to a high-pitched noise that worsens in supine positions and during feeding.

Answer 623

60-70% ## Footnote It affects both sexes equally.

Answer 624

* Type 1: tightening of the aryepiglottic folds * Type 2: redundant tissue in the supraglottic region * Type 3: associated with other disorders ## Footnote Type 3 may include neuromuscular weakness or gastro-oesophageal reflux disease.

Answer 625

* Inspiratory stridor: high-pitched and crowing * Symptoms increase in severity during the first 8 months * Rare respiratory distress, failure to thrive, and cyanosis ## Footnote Stridor is usually intermittent, occurring in specific positions or situations.

Answer 626

* Monitor oxygen saturation * Blood gases if desaturation occurs * Laryngoscopy and bronchoscopy if severe features or diagnostic difficulty ## Footnote These investigations are only indicated in specific circumstances.

Answer 627

* 99% resolve spontaneously by 18-24 months * Symptomatic relief by hyperextending the neck * Surgical intervention for severe respiratory distress ## Footnote Surgical options may include tracheostomy, laryngoplasty, excision of redundant mucosa, laser epiglottopexy, or laser division of the aryepiglottic folds.

Answer 628

TRUE ## Footnote It may also be associated with weak cry or hoarseness, which are not described in the case of Laryngomalacia.

Answer 629

biphasic stridor ## Footnote This includes both inspiratory and expiratory stridor along with more severe signs of respiratory distress.

Answer 630

Choanal atresia ## Footnote It results in difficulty breathing through the nose rather than isolated inspiratory stridor.

Answer 631

Laryngomalacia ## Footnote This condition is characterized by a floppy larynx that collapses during inspiration, leading to a high-pitched noise.

Answer 632

* Supine positions * During feeding ## Footnote It usually resolves without intervention by 18-24 months.

Answer 633

FALSE ## Footnote Tracheomalacia leads to expiratory stridor rather than inspiratory stridor.

Answer 634

Vocal cord paralysis ## Footnote These symptoms are not described in the scenario presented.

Answer 635

Biphasic stridor ## Footnote This condition is associated with more severe signs of respiratory distress, which are absent in this case.

Answer 636

FALSE ## Footnote It results in difficulty breathing through the nose rather than isolated inspiratory stridor, especially since symptoms improve when crying.

Answer 637

An aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses ## Footnote Occurs in 1 in 5,000 births and is an important differential diagnosis in childhood constipation.

Answer 638

* Parasympathetic neuroblasts fail to migrate from the neural crest to the distal colon * Developmental failure of the parasympathetic Auerbach and Meissner plexuses * Uncoordinated peristalsis * Functional obstruction ## Footnote This sequence leads to the symptoms associated with the disease.

Answer 639

Males ## Footnote It is also associated with Down's syndrome.

Answer 640

Failure or delay to pass meconium ## Footnote Older children may present with constipation and abdominal distension.

Answer 641

* Abdominal x-ray * Rectal biopsy: gold standard for diagnosis ## Footnote These investigations help confirm the diagnosis.

Answer 642

Rectal washouts/bowel irrigation ## Footnote Definitive management involves surgery to the affected segment of the colon.

Answer 643

One of the most common childhood malignancies ## Footnote Typically presents in children under 5 years of age, with a median age of 3 years.

Answer 644

* Beckwith-Wiedemann syndrome * WAGR syndrome * hemihypertrophy ## Footnote WAGR syndrome includes Aniridia, Genitourinary malformations, and mental Retardation.

Answer 645

Abdominal mass ## Footnote Other features may include painless haematuria and flank pain.

Answer 646

95% ## Footnote Metastases are found in 20% of patients, most commonly in the lung.

Answer 647

* Nephrectomy * Chemotherapy * Radiotherapy if advanced disease ## Footnote Prognosis is good, with an 80% cure rate.

Answer 648

FALSE ## Footnote Metastases are most commonly found in the lung.

Answer 649

Paediatric review ## Footnote This is crucial as it may indicate possible Wilms' tumour.

Answer 650

* Painless haematuria * Flank pain * Anorexia * Fever ## Footnote These symptoms may vary among patients.

Answer 651

Loss-of-function mutation in the **WT1 gene** on chromosome 11 ## Footnote This mutation is significant in the development of the tumour.

Answer 652

* Projectile non bile stained vomiting at 4-6 weeks of life * Diagnosis made by test feed or USS * Treatment: Ramstedt pyloromyotomy (open or laparoscopic) ## Footnote Occurs more frequently in males and has a 5-10% family history in parents.

Answer 653

FALSE ## Footnote When it occurs in this age group, it may present atypically.

Answer 654

* Colicky pain * Diarrhoea and vomiting * Sausage-shaped mass * Red jelly stool ## Footnote Typically occurs in infants aged 6-9 months and involves telescoping bowel.

Answer 655

* High caecum at the midline * Complicated by volvulus * Diagnosis made by upper GI contrast study and USS * Treatment: laparotomy or Ladd's procedure ## Footnote May be associated with conditions like exomphalos and congenital diaphragmatic hernia.

Answer 656

* Absence of ganglion cells from myenteric and submucosal plexuses * Occurs in 1/5000 births * Diagnosis via full-thickness rectal biopsy * Treatment: rectal washouts and anorectal pull-through procedure ## Footnote Symptoms include delayed passage of meconium and abdominal distension.

Answer 657

* Tracheo-oesophageal fistula * Polyhydramnios * VACTERL associations ## Footnote May present with choking and cyanotic spells following aspiration.

Answer 658

* Delayed passage of meconium * Abdominal distension * Majority have cystic fibrosis ## Footnote X-Rays may not show a fluid level; PR contrast studies may dislodge meconium plugs.

Answer 659

* Jaundice > 14 days * Increased conjugated bilirubin ## Footnote Requires an urgent Kasai procedure for treatment.

Answer 660

Prematurity ## Footnote Early features include abdominal distension and passage of bloody stools; treatment involves total gut rest and TPN.

Answer 661

A genetic disorder caused by loss of function of genes on the paternal chromosome 15 (15q11-q13) ## Footnote Usually due to paternal deletion, maternal uniparental disomy, or imprinting defects.

Answer 662

~1 in 10,000–30,000 live births ## Footnote Both sexes are equally affected.

Answer 663

Hypothalamic dysfunction ## Footnote Affects satiety, leading to hyperphagia.

Answer 664

* Paternal deletion (70%) * Maternal uniparental disomy (25%) * Imprinting defect (5%) ## Footnote Paternal deletion results in missing paternal genes, while maternal uniparental disomy has two maternal copies with no paternal genes.

Answer 665

* Hypotonia (“floppy baby”) * Weak cry * Poor sucking * Feeding difficulties * Poor weight gain ## Footnote These features are evident in the neonatal period.

Answer 666

~2–4 years old ## Footnote This can lead to excessive weight gain and obesity risk.

Answer 667

* Almond-shaped eyes * Narrow forehead * Thin upper lip * Downturned mouth ## Footnote These features are often observed in affected individuals.

Answer 668

* Growth hormone deficiency * Hypogonadism * Hypothyroidism (sometimes) * Insulin resistance / obesity complications ## Footnote These features contribute to short stature and reduced muscle mass.

Answer 669

* Temper tantrums * Stubbornness * Obsessive-compulsive behaviors * Sleep disturbances * Daytime sleepiness ## Footnote These behaviors can significantly impact daily life.

Answer 670

* Genetic testing: FISH or methylation analysis for 15q11-q13 region * Hormone studies: GH, sex hormones, thyroid function * Sleep studies: if suspicion of sleep apnea ## Footnote These tests help confirm the diagnosis and assess related issues.

Answer 671

* Nutritional: strict diet control * Endocrine: growth hormone therapy * Behavioral/Psychosocial: structured environment * Complications: monitor for obesity, sleep apnea, osteoporosis ## Footnote This approach is essential for effective management.

Answer 672

Lifespan can be near normal with careful management ## Footnote Mainly limited by obesity-related complications; early interventions improve growth, muscle tone, cognition, and behavior.

Answer 673

hyperphagia ## Footnote This sequence highlights the progression of symptoms in Prader-Willi Syndrome.

Answer 674

Paternal deletion or uniparental disomy 15q11-q13 ## Footnote Understanding the genetic basis is crucial for diagnosis and management.

Answer 675

Multidisciplinary: diet, GH therapy, behavioral support ## Footnote Effective management requires collaboration among various healthcare professionals.

Answer 676

* Radial * Humeral * Femoral ## Footnote These fractures are often indicators of potential child abuse.

Answer 677

* Distal radial * Elbow * Clavicular * Tibial ## Footnote These fractures typically occur in children without the implication of abuse.

Answer 678

* Story inconsistent with injuries * Repeated attendances at A&E departments * Delayed presentation * Child with a frightened, withdrawn appearance - 'frozen watchfulness' ## Footnote These factors can help identify potential cases of child abuse.

Answer 679

* Bruising * Fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing * Torn frenulum * Burns or scalds * Failure to thrive * Sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas ## Footnote These presentations can indicate abuse and warrant further investigation.

Answer 680

hypoxia ## Footnote The most common cause of paediatric arrest is a respiratory arrest.

Answer 681

Meckels diverticulum ## Footnote This condition is significant in pediatric emergency medicine due to its potential severity.

Answer 682

A rare but serious infection caused by Haemophilus influenzae type B ## Footnote Prompt recognition and treatment are essential as airway obstruction may develop.

Answer 683

Childhood ## Footnote In the UK, it is now more common in adults due to the immunisation programme.

Answer 684

The introduction of the Hib vaccine ## Footnote This vaccine has significantly reduced cases of epiglottitis.

Answer 685

* Rapid onset * High temperature, generally unwell * Stridor * Drooling of saliva * 'Tripod' position ## Footnote The 'tripod' position is when the patient leans forward and extends their neck to breathe easier.

Answer 686

By direct visualisation, only by senior/airway trained staff ## Footnote X-rays may be done to check for foreign bodies.

Answer 687

Swelling of the epiglottis - the 'thumb sign' ## Footnote This is in contrast to the 'steeple sign' seen in croup.

Answer 688

* Immediate senior involvement * Endotracheal intubation if necessary * Do NOT examine the throat * Oxygen * Intravenous antibiotics ## Footnote Senior staff should perform direct visualisation and intubation if needed.

Answer 689

FALSE ## Footnote Examining the throat may lead to acute airway obstruction.

Answer 690

3 months ## Footnote After 3 months, the incidence of UTI is substantially higher in girls.

Answer 691

At least 8% ## Footnote For boys, the percentage is at least 2%.

Answer 692

* Poor feeding * Vomiting * Irritability ## Footnote Presentation varies by age group.

Answer 693

* Abdominal pain * Fever * Dysuria ## Footnote Presentation varies by age group.

Answer 694

* Dysuria * Frequency * Haematuria ## Footnote Presentation varies by age group.

Answer 695

* Temperature > 38ºC * Loin pain/tenderness ## Footnote These features indicate a more severe infection.

Answer 696

* If there are symptoms or signs suggestive of a UTI * With unexplained fever of 38°C or higher * With an alternative site of infection but who remain unwell ## Footnote Urine should be tested after 24 hours at the latest.

Answer 697

Clean catch ## Footnote If not possible, urine collection pads should be used.

Answer 698

* Cotton wool balls * Gauze * Sanitary towels ## Footnote Invasive methods like suprapubic aspiration should only be used if non-invasive methods are not possible.

Answer 699

Refer immediately to a paediatrician ## Footnote This is crucial for proper management.

Answer 700

Admission to hospital ## Footnote If not admitted, oral antibiotics should be given for 7-10 days.

Answer 701

* Trimethoprim * Nitrofurantoin * Cephalosporin * Amoxicillin ## Footnote Treatment duration is usually for 3 days according to local guidelines.

Answer 702

Bring the children back ## Footnote This ensures proper follow-up and management.

Answer 703

No ## Footnote It should be considered with recurrent UTIs.

Answer 704

33.5 - 34.5ºC ## Footnote This cooling should occur within a six-hour window of the hypoxia-inducing event.

Answer 705

Reduce the risk of ischaemic injury to tissues ## Footnote It is particularly used after cardiac arrest, traumatic brain injury, or neonatal hypoxic-ischaemic encephalopathy.

Answer 706

* Reduction of Metabolic Rate * Inhibition of Apoptosis * Reduction of Inflammatory Response * Decreased Free Radical Production ## Footnote These mechanisms help in preserving cellular integrity and reducing tissue damage.

Answer 707

* Cardiac Arrest * Neonatal Hypoxic-Ischaemic Encephalopathy * Traumatic Brain Injury ## Footnote These conditions can benefit from therapeutic cooling to improve outcomes.

Answer 708

* Surface Cooling * Endovascular Cooling * Cold Fluid Infusion ## Footnote These methods vary in invasiveness and application.

Answer 709

24-72 hours ## Footnote This is followed by a gradual rewarming period.

Answer 710

* Core temperature * Blood pressure * Heart rate * Cardiac output ## Footnote Close monitoring is essential due to potential complications from hypothermia.

Answer 711

TRUE ## Footnote The immune response is suppressed at lower temperatures, increasing infection risk.

Answer 712

* Bradycardia * Arrhythmias * Hypotension * Coagulopathy * Infection * Electrolyte Imbalance * Shivering ## Footnote These complications require careful management during the cooling process.

Answer 713

Slowly, at a rate of 0.25-0.5°C per hour ## Footnote This approach minimizes risks such as electrolyte imbalances and rebound hyperthermia.

Answer 714

Utilisation of alternate fuels like ketones and lactate ## Footnote This allows them to manage low blood sugar without significant sequelae.

Answer 715

< 2.6 mmol/L ## Footnote There is no universally accepted definition, but this figure is commonly referenced.

Answer 716

TRUE ## Footnote Many newborns experience transient hypoglycaemia shortly after birth.

Answer 717

* Preterm birth (< 37 weeks) * Maternal diabetes mellitus * IUGR * Hypothermia * Neonatal sepsis * Inborn errors of metabolism * Nesidioblastosis * Beckwith-Wiedemann syndrome ## Footnote These conditions can lead to more serious hypoglycaemia in newborns.

Answer 718

* May be asymptomatic * Autonomic changes * Jitteriness * Irritable * Tachypnoea * Pallor * Neuroglycopenic symptoms * Poor feeding/sucking * Weak cry * Drowsy * Hypotonia * Seizures * Apnoea * Hypothermia ## Footnote Symptoms can vary widely, and some may not present any symptoms.

Answer 719

* Encourage normal feeding (breast or bottle) * Monitor blood glucose ## Footnote This approach is suitable for cases where the newborn is not showing symptoms.

Answer 720

* Admit to the neonatal unit * Intravenous infusion of 10% dextrose ## Footnote This is critical for managing more severe cases of hypoglycaemia.

Answer 721

Juvenile idiopathic arthritis (JIA) ## Footnote JIA describes arthritis occurring in individuals under 16 years old lasting more than 6 weeks.

Answer 722

Still's disease ## Footnote Systemic onset JIA is a specific type of juvenile idiopathic arthritis.

Answer 723

* Pyrexia * Salmon-pink rash * Lymphadenopathy * Arthritis * Uveitis * Anorexia and weight loss ## Footnote These features are characteristic of systemic onset juvenile idiopathic arthritis.

Answer 724

FALSE ## Footnote Rheumatoid factor is typically negative in systemic onset juvenile idiopathic arthritis.

Answer 725

ANA ## Footnote Antinuclear antibodies (ANA) may be positive, especially in cases of oligoarticular juvenile idiopathic arthritis.

Answer 726

Neonatal hypoglycaemia ## Footnote Normal term babies often experience hypoglycaemia in the first 24 hours of life without any sequelae.

Answer 727

< 2.6 mmol/L ## Footnote There is no universally agreed definition of neonatal hypoglycaemia.

Answer 728

* Preterm birth (< 37 weeks) * Maternal diabetes mellitus * IUGR * Hypothermia * Neonatal sepsis * Inborn errors of metabolism * Nesidioblastosis * Beckwith-Wiedemann syndrome ## Footnote These conditions can lead to more serious cases of hypoglycaemia in newborns.

Answer 729

* May be asymptomatic * Autonomic changes * Jitteriness * Irritable * Tachypnoea * Pallor * Neuroglycopenic symptoms * Poor feeding/sucking * Weak cry * Drowsy * Hypotonia * Seizures * Apnoea * Hypothermia ## Footnote Symptoms can vary widely among affected newborns.

Answer 730

TRUE ## Footnote It is often seen in normal term babies.

Answer 731

* Encourage normal feeding (breast or bottle) * Monitor blood glucose ## Footnote This approach is taken when the newborn is not showing symptoms.

Answer 732

* Admit to the neonatal unit * Intravenous infusion of 10% dextrose ## Footnote This management is necessary to address more severe cases of hypoglycaemia.

Answer 733

Irritant dermatitis ## Footnote Caused by the irritant effect of urinary ammonia and faeces; creases are characteristically spared.

Answer 734

Candida dermatitis ## Footnote Typically presents with an erythematous rash and satellite lesions.

Answer 735

Erythematous rash with flakes ## Footnote May be coexistent with a scalp rash.

Answer 736

Psoriasis ## Footnote Less common compared to other types of dermatitis.

Answer 737

Other areas of the skin will also be affected ## Footnote This condition can present alongside napkin rash.

Answer 738

Disposable nappies ## Footnote Preferable to towel nappies for hygiene and comfort.

Answer 739

* Expose napkin area to air when possible * Apply barrier cream (e.g. Zinc and castor oil) * Use mild steroid cream (e.g. 1% hydrocortisone) in severe cases ## Footnote These strategies help in managing and preventing further irritation.

Answer 740

Use a topical imidazole ## Footnote Cease the use of a barrier cream until the candida has settled.

Answer 741

A condition incorporating features relating to inattention and/or hyperactivity/impulsivity that are persistent ## Footnote Developmental delay must be present for diagnosis.

Answer 742

2.4% ## Footnote This prevalence is about twice that of autism and is more common in boys than in girls (M:F 4:1).

Answer 743

Between the ages of 3 and 7 ## Footnote Diagnosis typically occurs during early childhood.

Answer 744

* Does not follow through on instructions * Reluctant to engage in mentally-intense tasks * Easily distracted * Finds it difficult to sustain tasks * Finds it difficult to organise tasks or activities * Often forgetful in daily activities * Often loses things necessary for tasks or activities * Often does not seem to listen when spoken to directly ## Footnote These features must be persistent for diagnosis.

Answer 745

* Unable to play quietly * Talks excessively * Does not wait their turn easily * Will spontaneously leave their seat when expected to sit * Is often 'on the go' * Often interruptive or intrusive to others * Will answer prematurely, before a question has been finished * Will run and climb in situations where it is not appropriate ## Footnote These features also need to be persistent for diagnosis.

Answer 746

A holistic approach that includes a ten-week 'watch and wait' period ## Footnote This period is to observe whether symptoms change or resolve before considering further action.

Answer 747

If symptoms persist after the 'watch and wait' period ## Footnote Referrals are typically to a paediatrician with a special interest in behavioural disorders or to CAMHS.

Answer 748

Methylphenidate ## Footnote It should be given on a six-week trial basis and is a CNS stimulant.

Answer 749

* Abdominal pain * Nausea * Dyspepsia ## Footnote Weight and height should be monitored every 6 months in children.

Answer 750

A baseline ECG ## Footnote This is important due to the potential cardiotoxicity of these drugs.

Answer 751

FALSE ## Footnote Drug therapy should be seen as a last resort and is only available to those aged 5 years or more.

Answer 752

There is a possible genetic component ## Footnote This suggests that ADHD may run in families.

Answer 753

Switch to lisdexamfetamine ## Footnote If lisdexamfetamine is not tolerated, dexamfetamine may be considered.

Answer 754

Six features for children up to 16 years; five features for those aged 17 or over ## Footnote This distinction is important for accurate diagnosis.

Answer 755

47, XXY ## Footnote Klinefelter's syndrome is characterized by the presence of an extra X chromosome.

Answer 756

* Often taller than average * Lack of secondary sexual characteristics * Small, firm testes * Infertile * Gynaecomastia * Elevated gonadotrophin levels ## Footnote Gynaecomastia is associated with an increased incidence of breast cancer.

Answer 757

Chromosomal analysis ## Footnote Diagnosis involves analyzing the chromosomes to confirm the karyotype.

Answer 758

Delayed puberty secondary to hypogonadotrophic hypogonadism ## Footnote It is usually inherited as an X-linked recessive trait.

Answer 759

Lack of smell (anosmia) ## Footnote This is observed in boys with delayed puberty.

Answer 760

* Delayed puberty * Hypogonadism * Cryptorchidism * Anosmia * Low sex hormone levels * Inappropriately low/normal LH and FSH levels * Typically normal or above average height ## Footnote Cleft lip/palate and visual/hearing defects may also be present.

Answer 761

End-organ resistance to testosterone ## Footnote This leads to genotypically male children (46XY) having a female phenotype.

Answer 762

Complete androgen insensitivity syndrome ## Footnote This term reflects the complete resistance to androgens.

Answer 763

* Primary amenorrhoea * Undescended testes causing groin swellings * Breast development due to conversion of testosterone to oestradiol ## Footnote These features are indicative of the condition's effects on sexual development.

Answer 764

Buccal smear or chromosomal analysis ## Footnote Diagnosis reveals the 46XY genotype.

Answer 765

* Counselling to raise the child as female * Bilateral orchidectomy * Oestrogen therapy ## Footnote Bilateral orchidectomy is recommended due to increased risk of testicular cancer from undescended testes.

Answer 766

intranasal live attenuated influenza vaccine (LAIV) ## Footnote This vaccine is provided annually to eligible children.

Answer 767

Yes ## Footnote The child is within the age range of 2-15 years.

Answer 768

No ## Footnote Children with asthma are actually a priority group for flu vaccination.

Answer 769

No ## Footnote The child is currently well, so there is no need to defer vaccination.

Answer 770

* Provides better mucosal immunity * More acceptable to children and parents ## Footnote These factors contribute to the preference for LAIV in pediatric vaccination.

Answer 771

Respiratory distress syndrome ## Footnote Previously referred to as hyaline membrane disease.

Answer 772

Insufficient surfactant production and structural immaturity of the lungs ## Footnote Commonly seen in premature infants.

Answer 773

* Decreases with gestation * 50% of infants born at 26-28 weeks * 25% of infants born at 30-31 weeks ## Footnote The risk is significantly higher in earlier gestational ages.

Answer 774

* Male sex * Diabetic mothers * Caesarean section * Second born of premature twins ## Footnote These factors increase the likelihood of developing SDLD.

Answer 775

* Tachypnoea * Intercostal recession * Expiratory grunting * Cyanosis ## Footnote These features are common to respiratory distress in newborns.

Answer 776

'Ground-glass' appearance with an indistinct heart border ## Footnote This characteristic finding helps in diagnosing SDLD.

Answer 777

Maternal corticosteroids to induce fetal lung maturation ## Footnote This treatment helps improve lung development in premature infants.

Answer 778

* Oxygen * Assisted ventilation * Exogenous surfactant given via endotracheal tube ## Footnote These interventions are critical for managing infants with SDLD.

Answer 779

Secondary care paediatric teams ## Footnote This assessment is crucial to rule out **septic arthritis** or **traumatic injury**.

Answer 780

FALSE ## Footnote Septic arthritis can present in patients who are otherwise well, making normal observations not necessarily reassuring.

Answer 781

3 months ## Footnote After 3 months, the incidence is substantially higher in girls.

Answer 782

At least 8% ## Footnote For boys, the percentage is at least 2%.

Answer 783

* Poor feeding * Vomiting * Irritability ## Footnote Symptoms vary by age group.

Answer 784

* Abdominal pain * Fever * Dysuria ## Footnote Dysuria refers to painful urination.

Answer 785

* Dysuria * Frequency * Haematuria ## Footnote Haematuria is the presence of blood in urine.

Answer 786

> 38ºC ## Footnote Other features include loin pain or tenderness.

Answer 787

38°C or higher ## Footnote Urine should be tested after 24 hours at the latest.

Answer 788

Clean catch ## Footnote If not possible, urine collection pads should be used.

Answer 789

* Cotton wool balls * Gauze * Sanitary towels ## Footnote Invasive methods like suprapubic aspiration should only be used if non-invasive methods are not possible.

Answer 790

A paediatrician ## Footnote Immediate referral is critical for this age group.

Answer 791

Admission to hospital ## Footnote If not admitted, oral antibiotics should be given for 7-10 days.

Answer 792

* Trimethoprim * Nitrofurantoin * Cephalosporin * Amoxicillin ## Footnote Treatment duration is usually for 3 days.

Answer 793

24-48 hours ## Footnote This is crucial for monitoring treatment effectiveness.

Answer 794

Recurrent UTIs ## Footnote This approach helps manage future infections.

Answer 795

During acute admission when there are signs of an atypical UTI ## Footnote This is crucial for early diagnosis and management.

Answer 796

* 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 ## Footnote These features indicate a more serious condition requiring immediate attention.

Answer 797

FALSE ## Footnote Raised white blood cells on their own do not confirm septicaemia.

Answer 798

No ## Footnote Abdominal pain is a general feature of UTI, but not necessarily indicative of atypical UTI.

Answer 799

Measures sweat chloride levels ## Footnote Patients with CF have abnormally high sweat chloride levels.

Answer 800

< 40 mEq/l ## Footnote A value greater than 60 mEq/l indicates cystic fibrosis.

Answer 801

> 60 mEq/l ## Footnote This level is indicative of cystic fibrosis in patients.

Answer 802

* Malnutrition * Adrenal insufficiency * Glycogen storage diseases * Nephrogenic diabetes insipidus * Hypothyroidism * Hypoparathyroidism * G6PD * Ectodermal dysplasia ## Footnote These conditions can lead to inaccurately high sweat chloride levels.

Answer 803

Skin oedema ## Footnote Often due to hypoalbuminaemia/hypoproteinaemia secondary to pancreatic exocrine insufficiency.

Answer 804

Cremaster reflex ## Footnote This is a key diagnostic clue for testicular torsion.

Answer 805

Urgent surgery ## Footnote Immediate intervention is necessary to prevent complications.

Answer 806

Cremaster reflex ## Footnote This indicates a different condition compared to testicular torsion.

Answer 807

Prehn sign ## Footnote This sign helps differentiate epididymitis from testicular torsion.

Answer 808

L1–L2 spinal cord injury ## Footnote This is relevant in the context of upper vs lower motor neuron lesions.

Paediatrics Flashcards

(851 cards)