Paediatrics

Question 1

Hand foot and Mouth

1. Organism
2. Presentation
3. Ix
4. Rx

Answer 1

1. Coxsackie A16/Enterovirus 71 - contagious and often occurs at nursery in outbreaks.
2. Mild upset, sore throat, mild fever, oral ulcers, vesicles on the palm and sole of feet.
3. Clinical
4. Symptomatic Rx only. Cam go to school

Question 2

Intussusception

1. Cause
2. Presentation
3. Ix
4. Rx

Answer 2

1. Telescoping of the bowel into another segment. Proximal to or at the level of the ileocecal valve.
2. 6-9 months/ Colicky pain, red jelly stool, drawing legs up to abdomen, sausage shaped mass.
3. USS, AXR, Clinical
4. Air sufflation

Question 3

Malrotation

1. Cause
2. Presentation
3. Ix
4. Rx

Answer 3

1. Feature in exomphalos, congenital diaphragmatic hernia and intrinsic duodenal atresia.
2. Volvulus may occur. Bile stained vomit.
3. Upper GI contrast study and USS
4. Laparotomy

Question 4

Deafness in children;

1. Causes

Answer 4

1. Conductive; Glue ear, Down’s syn

- SN; usher syn, pendred syn, rubella congenital infection, meningitis, head trauma.

Question 5

Achondroplasia

1. Cause
2. Presentation
3. Ix
4. Rx

Answer 5

1. AD disorder (2 parents = 25% likelihood) mutation in fibroblast growth factor receptor 3 gene.
2. Short limbs, short fingers, large head, flattened nasal bridge, trident hands and lumbar lordosis
3. Genetics, clinical
4. Nil

Question 6

Croup

1. Cause
2. Presentation
3. Ix
4. Rx

Answer 6

1. Parainfluenza virus
2. 6months - 3yo. Stridor, barking cough, fever, coryza, increased work of breathing.
3. Paeds assessment, viral PCR, clinical.
4. Oral dexa (0.15mg/kg) to all kids.
   Emergency - high flow O2 and nebulised adrenaline.

Question 7

Ebsteins anomaly

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 7

1. Lithium in utero
2. Ventriclisation of the right atrium and tricuspid incompetence. Small RV. Associated with WPW
3. Echo, ECG
4. Nil

Question 8

Meconium aspiration

1. Define
2. Risks and causes

Answer 8

1. Aspiration of meconium causing RDS. Common in the neonatal period.
2. More common in post-term deliveries, maternal HTN, pre-eclampsia, chorioamnionitis, smoking.

Question 9

Febrile convulsions

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 9

1. Seizure provoked by fever in healthy kids.
2. Between 6mo and 5yo. Often in a viral infection, brief seizure, most often GTCS.
3. Ix for epilepsy if not clear febrile convulsion
4. Manage at home w/ water and paracetamol. Do not require admission unless seizure >5min. However any child w/ first seizure should be admitted. ~30% have another febrile convulsion.
   If recurrent, rectal or buccal midazolam

Question 10

Innocent murmur - Describe ???

Answer 10

Soft, systolic, short, symptomless, sitting/standing.
Venous hum - due to turbulent blood flow from the great veins to the heart. Continuous blowing just below clavicle.
Still’s murmur - Low pitched lower L sternal edge.

Question 11

Pertussis

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 11

1. Bordetella pertussis
2. Incubation 10-14days.
   - 2-3 days preceding coryza then coughing bouts w/ vomiting and central cyanosis. Inspiratory whoop. Infants may have apnoeic spells.
   - Coughing causes subconjunctival haemorrhages and anoxia (seizures)
   - Lasts 10-14 weeks.
3. Nasal swab + culture.
   - PCR & Serology
4. Admit infants under 6mo
   - Notify PHE
   - Oral azithromycin
   - Contact prophylaxis
   - Vaccination @ 2,3,4mo and 3,5yo

Question 12

Retinoblastoma

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 12

1. AD inherited, loss of function of the retinoblastoma tumour suppressor gene on chromo 13.
2. Absence of red-reflex.
   - White pupil.
   - strabismus
   - vision problems
3. Slit lap exam
   - head CT
4. Enucleation
   - Radio
   - chemo
   - Photocoag

Question 13

Pyloric stenosis

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 13

1. Hypertrophy or the circular muscles of the pylorus.
2. Projectile vomiting, often after feeds.
   - Non-bilous
   - Constipation and dehydration may be present
   - Olive mass in upper abdomen
   - Visual peristalsis
   - Hypochloraemia, hypokalaemia acidosis due to vomiting.
3. USS
4. Ramstedt pyloromyotomy

Question 14

APGAR

Answer 14

2 points for each; 
A  = active movement 
P = >100bpm 
G = Grimace and other 
A = Pink all over 
R = Strong and crying 

1 point for each; 
A = Limb flexion 
P = <100bpm 
G = Grimace only 
A = cyanosed extremities. Pink body
R = Weak 

0 points if absent

Question 15

GORD in kids

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 15

1. Risks = preterm delivery. Neuro disorders.
2. Typically develops before 8 weeks.
   - Vomiting and regurg
   - Often Put weight on okay.
3. Clinical
4. Position more upright in feeds.
   - smaller feeds
   - Thickened feeds
   - Alginate (Gaviscon)
   - PPI or H2 if faltering growth, distress and refusing feeds etc occurs.

Question 16

Hirschsrungs disease

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 16

1. Aganglionic segment of bowel due to developmental failure of the parasym Auerbach and Meissner plexuses.
2. Failure or delay in passing meconium.
   - Constipation
3. Gold standard = rectal biopsy
   - Anorectal manometry
   - DRE followed by explosive diarrhoea
4. Resect the bad part

Question 17

Cerebral palsy

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 17

Disorder of movement and posture due to non-progressive brain lesion.

1. Antenatal - cerebral malformation, congenital infection
   - Intrapartum - birth asphyxia and trauma
   - Post-partum - haemorrhage, trauma and meningitis.
2. Abnormal tone
   - Delayed milestones
   - Abnormal gait
   - Learning difficulties
   - epilepsy
   Can be; spastic, dyskinetic, ataxic or mixed.
3. Clinical
   - Brain imaging
4. MDT approach
   - Manage Sx
   - Spasticity = surgery, splints, baclofen.

Question 18

Roseola Infantum

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 18

1. Human herpes virus 6 (sixth disease)
   - Incubation period of 5-15days.
2. High fever lasting a few days followed by a maculopapular rash starting on chest and spreading to limbs.
   - Febrile convulsions
   - Diarrhoea
   - Cough
   - Nagayama spots on the uvula and soft palate.
3. Clinical
4. Anti-pyretics.

Question 19

Acute Lymphoblastic Leukaemia

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 19

1. Most common cancer in kids.
   - 2-5yo
2. Features are those of bone marrow failure;
   Anaemia - lethargy and pallor
   Neutropenia - infection
   Thrombocytopenia - bleeding and bruising.
   - Others = bone pain, HSM, fever, testicle swelling.
3. FBC - anaemia, thrombocytopenia, neutropenia.
   - Blood film showing blasts.
   - Clotting - DIC
   - Raised LDH
   - Immunophenotyping; Philadelphia chromo etc.
4. Induction of remission (Vincristine +anthracycline + cyclophosphamide), consolidation, maintenance (6-mcp & MTX).
   - CNS prophylaxis.
   - General supportive care; replace RBC + GCSF + Antibiotics/fungals + Allopurinol.
   - Stem cell Tx

Question 20

Kawasaki disease

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 20

1. UK.
   - Vasculitis w/ suspected viral trigger.
2. High grade fever >5days. resistant to anti-pyretics.
   - Conjunctival injection
   - Bright red, cracked lips
   - Strawberry tongue
   - Cervical lymphadenopathy
   - Swollen and red hands and feet.
   - Desquamation of the soles and palms.
   - COMPLICATION = CORONARY ARTERY ANEURYSM.
3. Clinical
4. High dose aspirin (beware Reye’s syn)
   - IVIG
   - Serial Echo for aneurysms.

Question 21

Nocturnal enuresis

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 21

1. Constipation, DM, UTI, abuse
   - Unwanted urination at night in a kid 5yo or older in the absence of congenital or acquired defects or the neuro or uro tract.
2. Pissing at night
3. Look for cause; DM, infection, constipation etc.
4. Rx triggers.
   - Lifestyle; toileting before bed, fluid limitation
   - Reward system; star chart
   - Enuresis alarm (1st line <7yo)
   - Desmopressin (1st line >7yo)

Question 22

Slipped capital femoral epiphysis

1. Causes
2. Presentation
3. Ix
4. Rx

Answer 22

1. UK
   - Related to trauma or more chronic course.
2. Obese boys 10-15yo
   - Slippage of the capital femoral epiphysis.
   - Risk of Avascular necrosis.
   - Displaces postero-inferiorly
   - Hip, groin, medial thigh or knee pain
   - Loss of internal rotation of the leg in flexion.
3. AP and lateral (frog leg) view.
4. Emergency due to avascular necrosis risk
   - Internal fixation across the growth plate.

Question 23

Paediatric BLS

Answer 23

Kids compression to breath ratio = 15:2

Question 24

Puberty - first signs

Answer 24

Males = Increase in testicular size around 12yo

Females = Breast buds 11.5yo
- Menarche at 13 (11-15)

Question 25

Severe asthma attack in children

Answer 25

- SpO2 <92% - PEF 33-50% best or predicted - Too SOB to talk or feed - HR >125 (>5yo) or >140 (1-5yo) - RR >30breath (>5yo) or >40 (1-5yo) - Use of accessory muscles

Question 26

Life threatening asthma attack in kids

Answer 26

- SpO2 <92% - PEF <33% of best or predicted. - Silent chest - Poor resp effort - Agitation - Altered consciousness - Cyanosis

Question 27

Bronchiolitis 1. Causes 2. Presentation 3. Ix 4. Rx

Answer 27

1. Respiratory syncytial virus - Acute bronchiolar inflammation. - More serious in those who are premature, congenital heart disease, CF. 2. Most common in 3-6mo. - Coryza prodrome - Dry cough - SOB - wheeze + fine inspiratory crackles - Feeding problems - -> 999 if; apnoea, severe resp distress (grunting, chest recession, RR >70, cyanosis) 3. Clinical - Immunofluorescence of nasopharyngeal secretions; RSV. 4. Supportive - Humidified oxygen if sats <92% - NG feeding - Suction of secretions.

Question 28

Edward's syndrome

Answer 28

- Micrognathia - Low ears - Rocker bottom feet - Overlapped fingers

Question 29

Patau syndrome (tri 13)

Answer 29

- microcephaly - Small eyes - Cleft palate - Polydactyly

Question 30

Fragile X

Answer 30

- Learning difficulties - Macrocephaly - Long face - Large ears - Huge balls

Question 31

Noonan syndrome

Answer 31

- Webbed neck - Pectus excavatum - Short - Pulmonary stenosis

Question 32

Prader-willi syndrome

Answer 32

- Hypotonia - Hypogonadism - Obesity

Question 33

Congenital hernia management

Answer 33

- Diaphragmatic - repair - Inguinal - Repair - umbilical - manage conservatively, resolves.

Question 34

Brachial Plexus Injury

Answer 34

Erbs palsy - Damage to C5/6 roots - Winged scapula - Breech baby Klumpke's Paralysis - Damage to T1 - Loss of intrinsic hand muscles - Traction