1
Q
Signs of respiratory distress in children?
A
- Raised respiratory rate
- Use ofaccessory musclesof breathing, such as thesternocleidomastoid,abdominal andintercostalmuscles
- Intercostalandsubcostal recessions
- Nasal flaring
- Head bobbing
- Tracheal tugging
- Cyanosis(due to low oxygen saturation)
- Abnormal airway noises
- Wheeze - whistling sound caused by narrowed airways, typically heard during expiration
- Grunting - caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
- Stridor - high pitched inspiratory noise caused by obstruction of the upper airway, for example incroup
2
Q
Stridor vs wheeze?
A
Stridor - on inspiration (croup + acute epiglottitis)
Wheeze - on expiration
3
Q
Vaccine given to babies with chronic lung disease of prematurity?
A
Palivizumab - to prevent RSV causing bronchiolitis
This involvesmonthly injectionsof amonoclonal antibody against the virus calledpalivizumab.
4
Q
Coryzal symptoms?
A
Runny nose
Sneezing
Mucus in throat
Watery eyes
(signs of viral URTI)
5
Q
Features making viral induced wheeze more likely than ASTHMA?
A
- Presenting before 3 years of age
- No atopic history
- Only occurs during viral infections
- Not triggered by asthma triggers like cold, exercise, strong emotions, dust
6
Q
Presentation of viral induced wheeze?
A
Evidence of a viral illness for 1-2 days (fever, cough and coryzal symptoms) preceding the onset of:
- Shortness of breath
- Signs of respiratory distress
- Expiratorywheezethroughout the chest
7
Q
Complications of mumps?
A
- Pancreatitis (abdo pain)
- Orchitis (testicular painand swelling)
- Meningitis (confusion, neck stiffness, headache)
- Sensorineural hearing loss
8
Q
Presentation of measles?
A
- Incubation periodof10 days
- Prodromal period (flu-like illness with conjunctivitis) with fever OVER 39
- Koplik’s spots (RED in mouth; 1-2 days before rash)
- RASH (spreads down from face)
erythematous, macular rash with flat lesions.
9
Q
Complications of measles?
A
Pneumonia
Diarrhoea
Dehydration
Encephalitis
Meningitis
Hearing loss
Vision loss
Death
Subacute sclerosing panencephalitis - rare degenerative disease seen 5-10 years after measles
10
Q
Differential diagnoses for measles?
A
All of them have NO Koplik’s spots
- Rubella
- Parvovirus B19
- HSV6 (roseala infantum)
- Scarlet fever (strep)
- May be early meningococcal disease (it later becomes purpuric
- Kawasaki disease
- EBV - infectious mononucleosis
11
Q
When is the MMR given?
A
- 1 year
- 18 months
12
Q
What vaccines are given at 8 weeks (2 months)?
A
- 6 in 1 (Hib, Hep B, diphtheria, tetanus, polio, pertussis)
- Meningococcal B
- Rotavirus (oral gel)
13
Q
When is the 6-in-1 vaccine given?
A
- 8 weeks (2 months)
- 12 weeks (3 months)
- 16 weeks (4 months)
- 18 months
14
Q
What vaccines are given at 12 weeks (3 months)?
A
- 6 in 1 (Hib, Hep B, diphtheria, tetanus, polio, pertussis)
- Meningococcal type B
- Rotavirus (oral gel)
15
Q
What vaccines are given at 16 weeks (4 months)?
A
- 6 in 1 (Hib, Hep B, diphtheria, tetanus, polio, pertussis)
- Pneumococcal
16
Q
What vaccines are given at 1 year?
A
- MMR(measles, mumps and rubella)
- Pneumococcal
- Meningococcal type B
17
Q
When is the pneumococcal vaccine given?
A
16 weeks (4 months) + 1 year
18
Q
What vaccines are given at 3 years + 4 months?
A
- 4 in 1(diphtheria, tetanus, pertussis and polio)
19
Q
When is the flu vaccine given to children?
A
Annually from age 2 – 8
20
Q
When is the HPV vaccine given?
A
12-13 years
2 doses given 6-24 months apart
21
Q
What vaccines are given at 14 years?
A
- 3 in 1(diphtheria, tetanus, polio)
- Meningococcal ACWY
22
Q
Newborn blood spot screening test
A
Taken on day 5 (day 8 at the latest) after consent from the parent.
Heel prick - 4 drops onto screening card.
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
Maple syrup urine disease (MSUD)
Isovaleric acidaemia (IVA)
Glutaric aciduria type 1 (GA1)
Homocystin
23
Q
Presentation of slapped cheek syndrome / parvovirus B19?
A
Associated with arthritis
- Starts with mild fever, coryza and non-specific viral symptoms such as muscle aches and lethargy.
- After 2 - 5 days the rash appears quite rapidly as a diffuse bright red rash on both cheeks, as though they have “slapped cheeks”.
- A few days later areticularmildly erythematous rash affecting the trunk and limbs appears that can be raised and itchy. Reticular means net-like.
24
Q
Most dangerous complication of slapped cheek syndrome?
A
Aplastic anaemia
(parvovirus B19 reduces erythropoiesis)
25
When is the newborn examination?
Performed within the first 72 hours after birth. Repeated at 6 – 8 weeks by their GP.
26
Features of FASD?
- ***Microcephaly*** (small head)
- ***Thin upper lip***
- ***Smooth flat philtrum*** (the groove between the nose and upper lip)
- ***Short palpebral fissure*** (short horizontal distance from one side of the eye and the other)
- Learning disability
- Behavioural difficulties
- Hearing and vision problems
- Cerebral palsy
27
What is the diagnosis?
6mnth old weaning child with recent viral URTI preceding current features of intestinal obstruction (vomiting, absolute constipation and abdominal distention + RUQ pain)
Intusseption.
Weaning = bacteria in food = bowel telescopes in on itself = bowel ischaemia
(confirm with ultrasound)
28
Investigation & management for intusseption?
- Abdominal ultrasound TO CONFIRM
- Catheter via anus: **AIR ENEMA** - insert air ⇒ pressure forces the bowel to un-telescope
**SURGERY** - if unsuccessful (10% cases)
29
Differential diagnoses:
VOMITING - 6 months old
- Intusseption (milky then green vomit)
- Gastroenteritis
=> caused by weaning
30
Differential diagnoses:
VOMITING - 6 hours old
- GORD (reflux)
- Overfeeding (>150ml/kg/day)
- Duodenal atresia/stenosis
- Sepsis
- **Malrotation** *- causes green/biliary vomiting*
31
Differential diagnoses:
VOMITING - 6 weeks old
- **Pyloric stenosis** - *milky, projectile vomiting*
- Overfeeding
- GORD
- Sepsis
32
Differential diagnoses:
baby with blood in stools
- gastroenteritis
- cows milk protein allergy
- anal fissure
- Intussusception
- meckels diverticulum
- Necrotizing Enterocolitis
- Swallowed maternal blood
(During delivery or breastfeeding)
33
Causes of paediatric intestinal obstruction?
- **Malrotation** of the intestines with a ***volvulus***
- Intussusception
- Meconium ileus
- Hirschsprung’s disease
- Oesophageal atresia
- Duodenal atresia (or colonic atresia)
- Imperforate anus
- Strangulated hernia
34
Differential diagnosis for baby with persistent jaundice?
> 14 days in term babies
>21 days in premature babies
Suspect **biliary atresia** in babies with a persistent jaundice, lasting more than 14 days in term babies and 21 days in premature babies.
35
Investigation for suspected biliary atresia?
Conjugated and unconjugated bilirubin.
- A high level of conjugated bilirubin suggests the liver is processing the bilirubin for excretion (by conjugating it), but it is not able to excrete the conjugated bilirubin because it cannot flow through the biliary duct into the bowel.
36
Surgery for biliary atresia?
The “***Kasai portoenterostomy***” involves attaching a section of the small intestine to the opening of the liver, where the bile duct normally attaches. This is somewhat successful and can clear the jaundice and prolong survival.
Often patients require a full liver transplant to resolve the condition.
37
Jaundice within 24hrs of birth?
TOM TIP: Jaundice in the first 24 hours of life is pathological. This needs urgent investigations and management. Neonatal sepsis is a common cause.
Babies with jaundice within 24 hours of birth need treatment for sepsis if they have any other clinical features or risk factors.
- SEPSIS
- G6PD
- Haemolytic disease of the newborn
38
When does physiological jaundice present in a newborn?
Normal rise in bilirubin shortly after birth, causing a mild yellowing of skin and sclera from 2 – 7 days of age.
This usually resolves completely by 10 days.
There is a high concentration of red blood cells in the ***fetus*** and ***neonate***. These RBCs are more fragile than normal RBCs. The fetus and neonate also have ***less developed liver function***.
Fetal RBCs break down more rapidly than normal red blood cells, releasing lots of bilirubin.
Normally this bilirubin is excreted via the ***placenta***, however at birth the foetus no longer has access to a placenta to excrete bilirubin.
Most babies remain otherwise healthy and well.
39
What is breast milk jaundice?
Babies that are breastfed are more likely to have neonatal jaundice.
- Components of breast milk inhibit the ability of the liver to process the bilirubin.
Breastfed babies = more likely to become dehydrated => slow passage of stools => increasing absorption of bilirubin in the intestines.
40
What is kernicterus?
High levels of unconjugated bilirubin can cause **kernicterus**
(yellow basal ganglia)
Kernicterus is brain damage due to high bilirubin levels. Bilirubin levels need to be carefully monitored in premature babies, as they may require treatment.
Bilirubin can cross the ***blood-brain barrier***. Excessive bilirubin causes direct damage to the CNS.
- Less responsive, floppy, drowsy baby with poor feeding.
The damage to the nervous system is permeant, causing ***cerebral palsy***, ***learning disability*** and ***deafness***.
41
Blood gas finding in pyloric stenosis?
***‘HYPOCHLORIC METABOLIC ALKALOSIS’***
- Cl- low (due to vomiting HCl)
- High pH (alkalosis)
Hypernatraemia due to dehydration from vomiting = more conc Na+
42
Management of pyloric stenosis?
***Laparoscopic pyloromyotomy*** (***Ramstedt’s operation***)
An incision is made in the smooth muscle of the pylorus to widen the canal allowing that food to pass from the stomach to the duodenum as normal.
43
Investigation to diagnose pyloric stenosis?
Abdominal ultrasound
=> shows thickened pyloric sphincter
44
What is Hirschsprungs disease?
Congenital - absence of nerve cells in colon (in the myenteric plexus)
=> reduced bowel peristalsis
=> constricted area of bowel
45
Presentation of Hirschsprungs disease?
- Failure to pass meconium when born (>24 hours)
- Chronic constipation since birth
- Vomiting
- Poor weight gain & failure to thrive
- Progressive abdominal distension
46
Key complication of Hirschsprungs disease?
Hirschsprung-associated enterocolitis (***HAEC***)
=> inflammation and obstruction of the intestine occurring in around 20% of neonates with Hirschsprung’s disease.
Presents within 2-4 weeks of birth
Fever, abdominal distention, diarrhoea (often with blood) and features of SEPSIS
It is life threatening and can lead to ***toxic megacolon*** and ***perforation*** of the bowel.
It requires urgent ***antibiotics***, ***fluid resuscitation*** and ***decompression*** of the obstructed bowel.
47
Management of Hirschsprung's disease?
- Abdominal X-ray: to diagnose intestinal obstruction & any demonstrated features of HAEC
- Rectal biopsy (to confirm diagnosis - absence of ganglionic cells)
- Definitive management ⇒ surgical removal of the aganglionic section of bowel
48
Complications of Meckel's diverticulum?
- usually asymptomatic
- it may produce acid => bleed, become inflamed, rupture (peritonitis)
- cause a volvulus or intussusception
49
Differential diagnoses for diarrhoea in children?
- Infection (gastroenteritis)
- Inflammatory bowel disease
- Lactose intolerance
- Coeliac disease
- Cystic fibrosis (steatorrhoea)
- Toddler’s diarrhoea
- Irritable bowel syndrome
- Medications (e.g. antibiotics)
50
Causes of finger clubbing in children?
Hereditary clubbing
Cyanotic heart disease
Infective endocarditis
Cystic fibrosis
Tuberculosis
Inflammatory bowel disease
Liver cirrhosis
51
Cause of meconium ileus?
When meconium is not passed within 24 hours, this is usually the first sign of cystic fibrosis.
with:
- Distended abdomen
- Green vomiting
52
Treatments for abdominal migraine in children?
ACUTE:
- ibuprofen/paracetamol
- dark quiet room
- sumatriptan
PREVENTATIVE:
- pizotifen (serotonin antagonist)
- Propranolol
- Cyproheptadine (antihistamine)
- Flunarazine (CCB)
53
Painless rectal bleeding in young child?
Key investigation?
?Meckels diverticulum
(ectopic gastric mucosa produces acid = ulcers that bleed)
Technetium-99 scan (Meckel's scan) is the investigation of choice for detecting ectopic gastric mucosa in suspected Meckel’s diverticulum
54
Signs and symptoms of paediatric brain tumours?
- Persistent headaches that are worse in the morning
- Signs of raised ICP; such as nausea, vomiting, and altered consciousness
- Vision changes (blurring or double vision)
- Seizure in an older child with no fever and no previous history of seizures
- Depending on the location of the tumour, patients may present with focal neurological deficits
- If the child is young, they may have macrocephaly and hydrocephalus
55
What are focal neurological deficits?
- Movement changes => paralysis, weakness , loss of muscle control, increased/decreased muscle tone, or movements a person cannot control (involuntary movements, such as tremor)
- Sensation changes => paresthesia (abnormal sensations), numbness, or decreases in sensation
- Ataxia
- Horner syndrome
- Neglect to surroundings (inattention)
- Speech issues
- Visual changes (reduced fields, diplopia, vision loss)
56
A boy is born at term requiring ventilatory support shortly after delivery. He has low set ears, downward slanting eyes and noticeably appears to have a ‘twisted’ posture and extremities. An ultrasound reveals multicystic, dysplatic kidneys.
What is this condition + what is it caused by during pregnancy?
Potter syndrome
Caused by oligohydramnios
=> oligohydramnios (lack of amniotic fluid) means there is a lack of 'cushioning' of the foetus, resulting in it getting squashed by the surrounding maternal organs - resulting in their characteristic appearance
57
11 month old boy. Increasingly lethargic over the past 3 days. Kicking his legs in the air. Vomited 3 times yesterday.
Blood in his nappy this morning which she reports looking like ‘jelly.’ There is no evidence of peritonitis.
He is afebrile.
US abdomen reveals concentric echogenic and hypoechogenic bands.
What is the best intervention?
Intusseption -> air enema
(red currant stool, vomiting, pulling knees up due to crampy pain, palpable RUQ mass)
58
Child coughing at home, dad worried she swallowed something.
Child is fine by the time they got to A&E.
Xray shows halo sign.
What should you do?
Urgent endoscopy
The x-ray findings (halo sign) suggest that this child has swallowed a button battery. Ingestion of button batteries is extremely dangerous as the battery can react with bodily fluids such as saliva, which allows the battery to leak a strong alkaline fluid which can burn through the tissue.
The next best management step is to perform an urgent endoscopy under general anaesthetic to remove the battery and decide if further treatment is needed, for example, if the battery has caused a tracheo-oesophageal fistula.
if you visualise them, they have two "levels" or layers - a smaller circle sits on top of the large circle - this is what creates the "halo" on imaging
59
Diagnosis?
5yo boy
2 days lethargy, headache, sore throat, runny nose + FEVER
Erythematous rash on torso and both cheeks which blanches under pressure
Tongue and buccal mucosa appear normal
Slapped cheek
Parvovirus B19
60
Diagnosis?
6yo boy
Over the past 48 hrs he has developed sore throat, headache and fever.
In the past 24 hrs he has developed a coarse, erythematous rash on his face and torso.
Bright red tongue
Scarlet fever
3x S's of scarlet fever:
- Strep pyogenes
- Strawberry tongue
- Sandpaper rash ('coarse'
61
Cause of rheumatic fever?
5-15 yo
Autoimmune condition triggered by streptococcus bacteria (untreated strep throat or scarlet fever)
Occurs 2–6 weeks following infection with group A streptococcus (GAS), such as Streptococcus pyogenes.
62
Presentation of rheumatic fever?
Jones criteria: (J<3NES for both minor and major)
[<3 means heart]
Major criteria (J<3NES)
- Joint pain (typically a migratory polyarthritis affecting one joint then others in quick succession; most commonly affected joints are the knees, ankles, elbows and wrists)
- Pancarditis (<3)/myocarditis/endocarditis/pericarditis (this may manifest as tachycardia or new murmur)
- Nodules (subcutaneous nodules on tendons/joints)
- Erythema marginatum (pink rings)
- Sydenham's chorea (late sign)
Minor criteria (J<3NES)
- Joint pain - arthralgia not meeting major criteria
<3: prolonged PR interval
- Nothing
- E: ESR/CRP are raised
- S: 'shivering' (fever)
63
Presentation of Henoch-Schonlein Purpura (HSP)
IgA **vasculitis** (IgA deposits in blood vessels)
Can be triggered by upper airway infection (i.e. tonsilitis) or gastroenteritis
Most common under 10 years old
- Non-blanching purpuric rash - start on legs and spreads up
- Joint pain
- Abdo pain
- Kidney impairment (haematuria+proteinuria)
64
Abdominal mass in children under five:
- crosses the midline
- does not cross the midline
- crosses the midline = neuroblastoma - ie of adrenal glands
- does not cross the midline = NEPHROblastoma (Wilms tumour)
BOTH may have hypertension and weight loss
65
Blood tests for chronic constipation in children?
- TFTs (hypothyroid)
- Coeliac - anti TTG and EMA
- FBC - look for anaemia suggesting chronic disease or malabsorption
- Blood glucose (rule out diabetes which can affect motility)
- U&Es for electrolytes
- Calcium (hypercalcaemia can cause)
- CF sweat chloride test
66
Causes of jaundice <24 hours after birth?
- Haemolytic disorders (Rhesus incompatibility, ABO incompatibility, G6PD deficiency, spherocytosis)
- Congenital infections (TORCH screen indicated)
- Sepsis
67
Causes of jaundice from 24hours -> 14 days after birth?
Physiological jaundice
Breast milk jaundice
Dehydration
Infection, including sepsis
Haemolysis
Bruising
Polycythaemia
Crigler-Najjar Syndrome
68
Causes of jaundice after 14 days (>21 if preterm)?
RED FLAG = Biliary obstruction (including biliary atresia)
= Neonatal hepatitis
*** If the neonatal jaundice is due to hepatitis or biliary atresia, there will be pale stools and dark urine seen (conjugated hyperbilirubinaemia = obstruction of bile entering intestines = no colouring by bile)
Other causes:
Physiologic jaundice
Breast milk jaundice
Infection
Hypothyroidism
69
When would you urgently admit neonate with jaundice to the ward?
If:
< 24 hours old
>7 days old
if the neonate is unwell
gestational age < 35 weeks
Pale stools and dark urine (indicates obstructive cause = ie biliary atresia)
70
Chance of having a further febrile convulsion after first seizure?
30-40%
Febrile convulsions (or febrile seizures) are relatively common, occurring in around 3% of children. Once a child has had one febrile convulsion, although the risk of epilepsy is low, the risk of having a future febrile seizure is high, around 30-40%
71
Investigations for children with recurrent UTIs?
Consider requesting:
- ultrasound scan within 6 weeks (to look for urinary tract pathology)
- DMSA scan 4-6 months later (to look for vesicoureteric reflux and subsequent renal damage)
- MCUG
72
Haemolytic disease of the newborn?
When mother (rhesus negative) attacks rhesus positive baby RBCs.
=> bilirubin = severe jaundice
= can cause kericterus
[need anti-D immunoglobulins]
73
Medical management of nocturnal eneuresis?
Desmopressin (DDAVP/synthetic ADH) can be used in children over seven years old who have not responded to enueresis alarm or require rapid control.
This medication promotes water re-absorption in the kidneys and reduces urine production overnight.
74
HSP vs ITP?
Both have non-blanching purpura (rash)
- HSP -> often associated with abdominal and/or joint pain
Normal platelets
May have renal involvement (hematuria/proteinuria)
- ITP -> thrombocytopenia (low platelets)
Petechiae, bruising, mucosal bleeding
Often POST-viral
75
IV fluids:
- Routine maintenance
- Replacement (dehydration)
- First 10kg = 100 x 10 = 1000ml
- Next 10kg = 50 x 10 = 500ml
- extra KGs = 20ml per kg
----------------------------------------------
(% dehydration) x KG x 10
76
WHICH rash spares the nose, perioral and periorbital region?
slapped cheek syndrome
parvovirus b19
77
Treatment for threadworm in children?
oral Mebendazole
(Me-bend-asshole)
78
What should GP do if a child has a hand, foot and mouth rash with a severe headache?
HFMD = ok
But severe headache suggests viral ? meningitis ? encephalitis
79
Child who suffers with eczema, that has developed a widespread, painful, vesicular rash with systemic symptoms such as fever, lethargy, irritability and reduced oral intake
eczema herpeticum
Treat with acyclovir (oral vs IV, depends on severity)
emergency
caused by the herpes simplex virus (HSV) or varicella zoster virus (VZV).
80
7-year-old boy
many bruises
purple pinprick rash on his arms.
freq nosebleeds last week
Last week he had a cold, but he is otherwise well.
FBC shows an isolated thrombocytopenia, with normal Hb and WCC.
What is the most likely diagnosis?
Immune thrombocytopenic purpura (ITP) is characterised by low platelets leading to bruising (purpura) and petechiae.
It is common in children and usually occurs after a viral infection or vaccination.
Most cases of paediatric ITP resolve within 6 weeks.
81
Complication of parvovirus B19 (slapped cheek) in first 20 weeks of pregnancy?
Hydrops Fetalis
Fluid accumulates in the fetus's tissues and organs, causing swelling (edema) in at least two body compartments
82
Complication of congenital rubella?
Sensorineural deafness, blindness & congenital heart disease
83
Risk factors for neonatal sepsis?
- Vaginal GBS colonisation
- Previous baby with GBS sepsis
- Prematurity
- PPROM
- Prolonged ROM (susceptible to infection)
- Maternal sepsis, chorioamnionitis or fever > 38ºC
84
Red flags - requiring treatment for neonatal sepsis?
- Confirmed or suspected sepsis in the mother
- Signs of shock BABY
- Seizures BABY
- Term baby needing mechanical ventilation
- Respiratory distress starting more than 4 hours after birth
- Presumed sepsis in another baby in a multiple pregnancy
85
Treatment option for hypoxic ischaemic encephalitis?
Neonatal ICU - actively cooled using cooling blankets and a cooling hat.
Monitor temperature (rectal probe) = target of 33 -> 34°C
This is continued for 72 hours, after which the baby is gradually warmed to a normal temperature over 6 hours.
86
Risk factors for necrotising enterocolitis?
- Very low birth weight or very premature
- Formula feeds *(it is less common in babies fed by breast milk feeds)*
- Respiratory distress and assisted ventilation
- Sepsis
- Patient ductus arteriosus and other congenital heart disease
87
Risk factors for meconium aspiration syndrome?
- Gestational age >42 weeks
- Foetal distress (tachycardia / bradycardia)
- Placental insufficiency causing intrapartum hypoxia
- Maternal hypertension, diabetes, pre-eclampsia, smoking or drug abuse
- Oligohydramnios *(low fluid)*
- APGAR score <7
88
Antibiotic that covers for listeria
**amoxicillin**
(listeria cover is given in meningitis <3 months)
89
Definition of SIDS
Sudden explained death within 6 months
90
Management of conjunctivitis in neonate?
Neonates under one month with conjunctivitis need urgent ophthalmology assessment.
Need to rule out Chlamydia and gonorrhoea
- Chlamydia conjunctivitis ⇒ 5 days to 2 weeks post-birth
- Gonococcal conjunctivitis ⇒ 24hrs to 5 days post-birth
91
Abdo x-ray ⇒ ‘double bubble’ sign
Duodenal atresia
92
Presentation of duodenal atresia?
- Jaundice
- Green bilious vomit *(as a newborn)*
- Swollen abdomen
- Do not pass meconium (or a very small amount)
There may be polyhydramnios in utero (unable to swallow amniotic fluid)
93
Diagnosis of Reyes syndrome?
Liver biopsy - showing hepatocyte microvesicular steatosis
94
Management of umbillical hernia?
95% self-resolve by 4 years old
Operate aged 4-5 years if persisting
95
What is balanitis xerotica obliterans?
autoimmune white and scarred foreskin
⇒ aggressive scarring of the foreskin so that it keeps getting tighter
⇒ can spread to glans if untreated → tightens urethral meatu
96
Gastroschisis vs Omphalocele
Gastroschisis => abdominal organs protrude outside of the abdomen with NO protective membrane covering them.
Omphalocele => SIMILAR TO GASTROSCHISIS but it has a membranous sac covering the abdominal organs
97
When to admit baby with jaundice?
if:
- UNWELL
- < 24 hours old
- >7 days old
- gestational age < 35 weeks
98
Risk factors for cerebral palsy?
- Jaundice leading to kernicterus
- Foetal alcohol syndrome
- Hypoxic-ischaemic encephalopathy
- Maternal infections
- Prematurity
- Head injury
- Meningitis
99
Causes of hydrocephalus?
- Aqueductal stenosis - stensosi of the cerebral aqueduct (between 3rd and 4th ventricles)
- Arachnoid cysts - block outflow of CSF
- Arnold-Chiari malformation - cerebellum herniates downwards through foramen magnum
- Chromosomal abnormality
- Congenital malformations
100
Presentation of neurofibromatosis?
CRABBING
- C – Café-au-lait spots (more than 15mm diameter is significant in adults)
- R – Relative with NF1
- A – Axillary or inguinal freckling
- BB – Bony dysplasia, such as Bowing of a long bone or sphenoid wing dysplasia
- I – Iris hamartomas (*Lisch nodules*) - yellow-brown spots on the iris
- N – Neurofibromas (skin-coloured, raised nodules or papules with a smooth, regular surface)
- G – Glioma of the optic pathway
101
Cutaneous findings in tuberous sclerosis?
- Poliosis *(patch of white hair)*
- Ash leaf spots *(depigmented)*
- Angiofibromas *(skin coloured papules)*
- Ungual fibromas *(nail beds)*
- Cafe au lait spots
102
What is Perthe's disease?
Avascular necrosis of the femoral head
Mainly 5-8yo boys
Main complication => soft and deformed femoral head, leading to early hip osteoarthritis.
This leads to an artificial total hip replacement in around 5% of patients.
103
Presentation of Perthes disease?
SLOW onset of:
- Pain in the hip or groin
- Limp
- Restricted hip movements
- There may be referred pain to the knee
- No history of trauma
104
Causes of conjugated vs unconjugated hyperbilirubinaemia?
Unconjugated - problem with the liver (or physiological due to baby liver)
Conjugated - problem with the biliary tree
105
Management of epiglottitis?
- securing the airway
- administering intravenous antibiotics such as cefuroxime to treat the underlying bacterial infection, typically caused by Haemophilus influenzae type B (Hib), especially in an unvaccinated child.
106
What would you see on abdominal xray in necrotising enterocolitis?
- dilated loops of bowel
- pneumatosis intestinalis (gas in the gut wall)
107
Treatment for whooping cough?
Azithromycin. [notifiable disease]
108
Treatment for croup?
Dexamethasone (seal, barking COUGH, stridor)
109
Medication for nocturnal eneuresis after failed sticker charts, reduced fluids before bed + eneuresis alarm?
Desmopressin - synthetic ADH analogue
Treatment should be assessed after one month and continued for three months if there are signs of response
110
Rubella - rules for being off school?
Off school for 5 days after rash begins
111
Scarlet fever - rules for being off school?
Off school for 24hrs after starting Abx
112
6-month-old baby
Exclusively breastfed
Presents with bruising, bleeding from gums and nose, and blood in the diaper.
What is the most likely cause of his symptoms?
Vitamin K deficiency
Vitamin K is essential for the production of coagulation factors
=> can lead to bleeding tendencies
113
Investigation for child with - reduced visual acuity, pain on eye movement, and diplopia with periorbital swelling?
Orbital cellulitis
Contrast-enhanced CT scan of orbits, sinuses and brain
114
Explain SUFE
The head of the femur is displaced (slips) along the growth plate
115
What is congenital torticollis?
***shortened sternocleidomastoid muscle***
May be due to the baby’s position in the womb, birth trauma, or abnormal development of the muscle.
116
Investigation needed to diagnose Perthe's disease?
'Frog leg' view - hip xray
you would see an irregular edge to the femoral head
117
Diagnosis:
Adolescent
Palpable mass, tender
Persistent localised bone pain
No history of trauma
? osteosarcoma
118
Diagnosis:
3yo boy
Delayed walking, frequent falls
Prominent forehead (frontal bossing)
Genu varum (bowed legs)
Rickets
Defective bone mineralisation due to vitamin D deficiency
119
Rickets.
What would be seen on x-ray?
Bowed femurs
Widened epiphyseal plates
120
Complication of SUFE?
Prompt treatment is critical to prevent prolonged disruption to blood flow, which can lead to avascular necrosis of the femoral head.
121
Investigation for CHILD unexplained bone swelling + persistent pain
Very urgent (48-hour) referral for an X-ray to assess for bone sarcomas
122
When does the Moro reflex disappear?
usually disappears by 3-4 months of age, but can occasionally persist up to 6 months
123
Age by which most children can sit unsupported?
9 months old
124
Describe atrial septal defect murmur? (ASD)
Ejection systolic murmur with a fixed split second heart sound
125
Describe ventricular septal defect murmur? (VSD)
Pansystolic murmur
heard loudest at left sternal edge (P)
126
What murmur might be heard in Turner syndrome?
Ejection systolic murmur, typically heard loudest between the scapulae
127
Nappy rash VS candida/thrush?
Nappy rash SPARES skin folds.
Candida rash extends into the skin folds.
Thrush has larger red macule
Thrush has a well demarcated scaly border
Thrush has satellite lesions, which are small similar patches of rash or pustules near the main rash
128
Management / advice for nappy rash?
- Switch to highly absorbent nappies
- Change nappy ASAP after wetting
- Clean skin + DRY it well
- Maximise time not wearing a nappy
- Use water or gentle alcohol free products for cleaning the nappy area
129
Management / advice for candida/thrush in nappy area?
candida = anti-fungal cream (clotrimazole or miconazole)
[OR]
bacterial = antibiotic (fusidic acid cream or oral flucloxacillin).
130
Complications of nappy rash?
- Candida infection
- Cellulitis
- Jacquet’s erosive diaper dermatitis
- Perianal pseudoverrucous papules and nodules
131
Skin manifestations in tuberous sclerosis?
- Poliosis *(patch of white hair)*
- Ash leaf spots *(depigmented)*
- Angiofibromas *(skin coloured papules)*
- Ungual fibromas *(nail beds)*
- Cafe au lait spots
132
Features of tuberous sclerosis?
- Skin manifestations
- Infantile spasms (West) with hysarrthymia
- Epilepsy
- Learning disability
- Brain tumours
- ***Rhabdomyomas*** in the heart
- ***Angiomyolipoma*** in the kidneys
- ***Lymphangioleiomyomatosis*** in the lungs
- ***Subependymal giant cell astrocytoma*** in the brain
- ***Retinal hamartomas*** in the eyes
133
What type of epilepsy? and whats the prognosis?
children aged 3-10 years
mostly occurs during sleep.
tonic seizure overnight or find the child on the floor or with disrupted bedding in the morning.
Benign Epilepsy with Centrotemporal Spikes (BECTS) - aka Benign Rolandic Epilepsy
Most common form of childhood epilepsy
Associated with an excellent prognosis - mainly resolves by adolescence.
134
What is West syndrome?
Starts between 4-8 months of age
MYOCLONIC JERKING
Many develop Lennox-Gastaut later in childhood.
Associated with developmental regression + high morbidity
Characteristic EEG findings of hypsarrhythmia
[ ASSOCIATED WITH TUBEROUS SCLEROSIS ]
135
Features of neurofibromatosis?
CRABBING
- C – Café-au-lait spots (more than 15mm diameter is significant in adults)
- R – Relative with NF1= FAMILY HISTORY
- A – Axillary or inguinal freckling
- BB – Bony dysplasia, such as Bowing of a long bone or sphenoid wing dysplasia
- I – Iris hamartomas (*Lisch nodules*) - yellow-brown spots on the iris
- N – Neurofibromas (skin-coloured, raised nodules or papules with a smooth, regular surface)
- G – Glioma of the optic pathway
136
Name for newborn hearing screening?
automated otoacoustic emission (AOAE) test
137
Immediate neonatal care after birth?
Skin-to-skin with mother
Delayed cord clamping (at least 60 seconds)
Dried and kept warm
Feeding is initiated as soon as the baby is alert enough
Vitamin K injection
Measure birthweight
Label with their name and details
138
When is heel prick test done?
Day 5
Results take 6-8 weeks
139
Conditions in heel prick test?
9 CONGENITAL CONDITIONS
Sickle cell disease
Cystic fibrosis
Congenital hypothyroidism
Phenylketonuria
Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
Maple syrup urine disease (MSUD)
Isovaleric acidaemia (IVA)
Glutaric aciduria type 1 (GA1)
Homocystinuria
140
Congenital rubella syndrome?
triad of deafness, blindness and congenital heart disease
141
Duchenne MD vs Beckers MD?
Duchenne MD - loss of dystrophin gene - onset 3yo ish
Beckers MD - mishapen dystrophin, retains some function - later onset 10-20yo ish
142
Undescended testes at newborn examination?
⇒ BILATERAL = see paediatrician within 24 hours to rule out sex disorders or metabolic conditions
⇒ UNILATERAL ⇒ GP to review at 6-8 weeks ⇒ GP to review at 4-5 months ⇒ refer to surgeon (to be seen no later than 6 months old)
143
Findings in haemolytic disease of the newborn? (mother rhesus -ve... baby rhesus +ve)
- ANTENATAL: hydrops fetalis, ascites or hepatosplenomegaly
- POSTNATAL:
Jaundice within 24 hours of birth
Pallor due to anaemia
Hepatosplenomegaly
Lethargy, poor feeding, and irritability
Severe cases: heart failure or kernicterus
KERNICTERUS => mum destroys fetal RBCs = small baby liver cannot conjugate all bilirubin = unconjugated hyperbilirubinemia
144
Triad of HUS?
Microangiopathic haemolytic anemia: Hb 78 g/L, schistocytes
Thrombocytopenia: Platelets low
Acute kidney injury: Creatinine raised
BLOODY DIARRHOEA => Shiga-toxin producing E. coli (STEC)
145
Treatment for retinopathy of prematurity?
Transpupillary laser photocoagulation
= to halt and reverse neovascularisation.
146
Features of Downs syndrome?
Trisomy 21
Brushfield spots
Hypotonia (reduced muscle tone)
Prominent epicanthic folds
Single palmar crease
Upward sloping palpebral fissures
Sandal gap
Brachycephaly (small head with a flat back)
Short neck
Short stature
Flattened face and nose
Congenital heart defects
147
Features of Edwards syndrome?
Trisomy 18
Overlapping 4th and 5th fingers
Rocker bottom feet
Low-set ears
Micrognathia
Microcephaly
Congenital heart disease
Omphalocele
148
Features of Patau's syndrome?
Trisomy 13
Polydactyl
Cleft palate
Rocker bottom feet
Microcephaly
Congenital heart defects
149
Features of Noonan syndrome?
version of Turners that affects males and females
Autosomal dominant mutation
WOOLY hair
- Short stature
- ***Hypertelorism*** (wide space between the eyes)
- Prominent nasolabial folds
- Low set ears
- Webbed neck
- Widely spaced nipples
- Broad forehead
- Downward sloping eyes with ptosis
150
Williams syndrome?
Chromosome 7 deletion
W for wide (mouth and spaced teeth)
- ***Starburst eyes*** (a star-like pattern on the iris)
- Elfin facies” (broad forehead, full cheeks, wide mouth)
- Long philtrum
- Wide mouth with widely spaced teeth
- Small chin
- Very sociable trusting personality
- supravalvular aortic stenosis
- hypercalcaemia
151
Features of Angelman syndrome?
Maternal deletion (15q11–13)
“Angel → always happy”
happy puppet
widely spaced teeth + wide mouth
Severe learning difficulty
ataxia
seizures
inappropriate laughter
152
Features of Turners syndrome?
Short stature
Lymphoedema of hands and feet in neonate, may persist
Spoon-shaped nails
Webbed neck
Widely spaced nipples
Wide carrying angle
Congenital heart defects - bicuspid aortic valve (most common), coarctation of the aorta.
Delayed puberty
Ovarian dysgenesis causing infertility - USS findings of ovary streaks.
Hypothyroidism
Recurrent otitis media
Normal intellect
153
Features of Fragile X syndrome?
“eXtra big testes & ears”
- large ears
- large tesicles (macroorchidism)
- long, narrow face
- mitral valve prolapse
- ADHD /autism
154
Investigations for jaundice in first 24hrs of life?
- DAT (Coombs' test) - used to diagnose ABO or Rhesus isoimmunization.
- G6PD levels - in G6PD deficiency
and more...
155
Indications for Abx in acute otitis media?
- Antibiotics are only indicated in children if:
- Eardrum is perforated
- < 2 years old and bilateral infection
- Present for >4 days
- < 3 months old
156
Complications of acute otitis media?
- Mastoiditis
- Temporary hearing loss
- Eardrum perforation
- Meningitis
- Abscesses
- Facial nerve paralysis
Medicine
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