A: Finals: Paediatrics

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A: Finals: Paediatrics
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  1. Outline the routine exam of a newborn
    • - Head: Size, shape, fontanelle and suture palpation
    • - Face: Dysmorphia
    • - Mouth: Palpate palate for cleft
    • - Eyes: Red reflex/eyelid swelling/conjunctiva
    • - Arms: Posture, cerebral palsy
    • - Hands: Palmar crease and finger number
    • - Lungs: Rate, breath sounds
    • - Heart: Thrill/heave, murmur and femoral AND brachial pulses
    • - Abdomen: Liver (>1cm), meconium, hernia
    • - Genitalia
    • - Back: Sacral dimple/hair
    • - Hips: Barlow-Ortolani exam
    • - Feet: Toes, varrus ankles

    • - Skin: Pallor, jaundice
    • - Muscle: Tone and posture
  2. Give 5 causes of neonatal jaundice
    • Physiological
    • Biliary atresia
    • Haemolysis (ABO, rhesus)
    • Infection
    • Breast milk jaundice
  3. Give 5 causes of respiratory distress in the neonate
    • Transient tachypnoea of the newborn
    • RDS (surfactant deficiency)
    • Meconium aspiration
    • Pneumothorax
    • Infection
  4. Give 4 ways in which GI disorders present in the newborn?
    • Poor feeding
    • Vomiting, possibly biliary
    • Delay in meconium passage
    • Abdominal distension
  5. Give 5 causes of GI dysfunction in the neonate
    • Meconium plug/ileus
    • Duodenal atresia
    • Oesophageal atresia
    • Hirschprung disease
    • Malrotation with volvulus
  6. Give 5 infections commonly transmitted in utero
    • TORCH
    • Toxoplasmosis
    • Other (HIV, syphilis, chlam, chickenpox)
    • Rubella
    • Cmv
    • Herpes
  7. What sign is seen on AXR in duodenal atresia?
    • Double bubble
    • Distended stomach and duodenum, separated by pyloris
  8. What are the VACTERL anomalies
    • Vertebral
    • Anal atresia
    • Cardiovascular
    • Tracheo-osophageal fistula
    • Esophageal atresia
    • Renal
    • Limb defects
  9. What is:
    - Exomphalos
    - Gastroschisis
    - Hypospadia
    • Intestinal hernia into base of the umbilical cord
    • Protrusion of abdominal contents in right umbilicus
    • Urethral opening on underside of penis
  10. What is a diaphragmatic hernia? How does it present?
    • Weakened area of diaphragm causes herniation of abdominal contents into hemithorax
    • Detected antenatally or at birth
    • Withdrawn abdomen, apparent dextrocardia and respiratory distress
  11. Outline the pathophysiology of achondroplasia
    • Autosomal dominant inheritance but usually de novo
    • Fibroblast growth factor deficiency, causing reduced cartilage/epiphyseal growth
  12. Give 5 features seen in achondroplasia
    • Short limbs
    • Large head
    • Flat midface with frontal bossing
    • Lumbar lordosis
    • Trident hand
  13. Give 3 systems which can be affected by Down's and 3 ways in which they are affected each
    • CVS:
    • - AVSD
    • - VSD
    • - Tetralogy of fallot

    • CNS:
    • - Alzhiemer's risk
    • - Epilepsy
    • - Learning difficulties

    • GI:
    • - Hirschrung's
    • - Duodenal atresia
    • - Imperforate anus
  14. Give 6 physical characteristics seen in Down syndrome
    • Epicanthic folds
    • Upwards slanting palpebral fissures
    • Protruding tongue, microstomia
    • Single palmar crease
    • Brachycephaly
    • Short stature
  15. What long term complications are seen in Down syndrome? Give 4
    • Increased risk of ALL and AML
    • Hypothyroidism
    • Alzhiemer's
    • GORD
  16. What karyotype abnormalities are seen in:
    - Edward's
    - Patau's
    - Turner's
    - Klinefelter's
    • Trisomy 18
    • Trisomy 13
    • XO
    • XXY
  17. Give 5 physical features seen in FAS
    • Microcephaly
    • Low nasal bridge + absent philtrum
    • Small chin
    • Epicanthic folds
    • Short stature
  18. Give 5 teratogenic drugs and their effect
    • Phenytoin: Cleft palate, cardiac and craniofacial deformity
    • Valroate: Neural tube defects
    • Lithium: Ebstein's anomaly
    • Warfarin: Microcephaly, cardiac defects, frontal bossing
    • Tetracycline: Discoloured teeth
  19. List the milestones of gross motor development
    • 6 weeks: Lift head
    • 3 months: Hold head upright
    • 5 months: Primitive reflex loss
    • 6 months: Sitting
    • 8 months: Crawling
    • 10 months: Supported walk
    • 1 year: First step
    • 15 months: Walking
  20. List the milestones of fine motor/vision development
    • 6 weeks: Head turn
    • 3 months: Hand regard
    • 5 months: Palmar grasp, hand transfer
    • 10 months: Pincer grip
    • 15 months: Manipulation
    • 2 years: Self feeding/care
    • 3 years: Copies Circle
    • 4 years: Copies cross and square
    • 5 years: Copies triangle, names 4 colours
  21. List the milestones of social behaviour
    • 6 weeks: Smile
    • 10 months: Waving
    • 1 1/2 years: Symbolic play
    • 2 years: Parallel play
    • 3 years: Interactive play
  22. List the milestones of speech and hearing
    • 6 weeks: Respond to voice
    • 4 months: Vowels
    • 6 months: Monosyllables
    • 8 months: Turn to voice
    • 13 months: Appropriate words
    • 2 years: Phrases
    • 3 years: Conversing
  23. Give 4 causes of speech delay
    • Hearing impairment
    • Poor social interaction/deprivation
    • ASD
    • Global developmental delay
  24. Give 7 causes of short stature
    • NIDSCED
    • Normal
    • IUGR
    • Dysmorphia syndromes
    • Skeletal dysplasia
    • Chronic systemic disease (IBD, CF)
    • Endocrine
    • Deprivation
  25. What are the 5 main causes of failure to thrive?
    • Late weaning
    • Periods of illness
    • Feeding problems
    • Inappropriate diet (too healthy)
    • Vitamin deficiency
  26. Give 6 factors of an injury which are suggestive of NAI
    • Any injuries in <6 months
    • Method of injury unlikely vs age
    • Time delay until presentation
    • Multiple injuries separated in space and time
    • Clear method (scald line, circular burn, slap)
    • Genital involvement
  27. How should possible sexual abuse be managed at your level?
    • Take only sufficient history to justify social service referral
    • Avoid questioning child directly
    • Limited examination to exclude major injury
    • Refer immediately
    • If <72hrs, preserve clothing and no bathing
  28. What vaccinations are required before school attendance?
    • Diptheria, tetanus and pertussis (DTaP)
    • Polio
    • Men C
    • MMR
    • HiB
  29. When is the Guthrie test performed? What 5 diseases are tested for?
    • Day 5 of life
    • PKU
    • CF
    • Sickle cell anaemia
    • Congenital hypothyroidism
    • MCADD
  30. What does an MSK examination of a child include?
    • Joint: Focussed examination
    • Bone: Tenderness, mass
    • Muscles: Tender, weak, mass
    • Gait/development
    • Growth assessment
    • Neurology
  31. Give 5 red flags in paediatric leg pain
    • Unilateral
    • Constant pain, including nocturnal
    • Deep, 'boring' with no relieving factors
    • Functional impact/postural shift
    • Mass/bone tenderness
  32. Give 5 features of benign leg pain
    • Night cramping
    • Relieved with massage, analgesia
    • No change in function
    • Bilateral/site change
    • Normal examination
  33. What 3 organisms most commonly cause septic arthritis in children?
    • S.Aureus
    • Pneumococcus
    • HiB
  34. Give 5 clinical features found in a septic joint
    • Extreme pain
    • Heat
    • Swelling
    • Redness
    • Pseudoparalysis (held immobile)
  35. What 4 features are used to differentiate septic arthritis from synovitis/reactive arthritis?
    • WIPE
    • WCC
    • Inability to weight bear
    • Pyrexia within 1 week
    • ESR
  36. Outline the acute management of septic arthritis in a child
    • ABC
    • Blood cultures
    • Urgent aspiration (under GA) with microscopy and gram stain, then culture/sensitivity
    • High dose IV antibiotics
  37. Give 4 paediatric presentations of reactive arthritis
    • All reactive arthritides include recent infection
    • Reiter's syndrome: Urethritis, conjunctivitis and arthritis after gram -ve infection
    • Irritable hip: Sudden or gradual hip pain/limp
    • Discitis: Refusal to walk with low grade fever and l-spine tenderness
    • Rheumatic fever: Carditis, arthritis, rash. Penicillin prophylaxis 4 lyf
  38. What clinical features are seen in JIA and how is it investigated?
    • Persistent swelling in one or more joints
    • Early morning stiffness, warmth, redness etc
    • NO diagnostic tests
    • Ophthalmology referral for anterior uveitis
  39. Give 5 inflammatory disorders seen in paediatrics
    • JIA
    • SLE
    • Scleroderma
    • Kawasaki
    • HS Purpura
  40. Give 4 risk factors for DDH
    • Family history
    • Female
    • Breech after 35 weeks gestation
    • Foot deformity
  41. How is suspected DDH assessed?
    • Risk factors
    • Leg length
    • Range of hip abduction
    • Barlow: Hold knee and adduct while pushing posteriorly. Dislocation = positive
    • Ortolani: After barlow, flex knee + hips to 90, place anterior pressure on greater trochanters and abduct legs. If "clunk" felt, posterior dislocation which is now resolved
  42. What are the 5 S's of normal joint variance?
    • Symmetrical deformity
    • No Symptoms
    • No Systemic illness
    • No Skeletal dysplasia
    • No Stiffness
  43. What are the 2 common causes of rickets?
    • Vit D deficiency
    • Calcium deficiency (coeliac, IBD)
  44. What are rheumatoid factor and antinuclear antibodies? What is their significance in paediatrics?
    • RF: Released in response to a number of inflammatory stimuli - not important in paediatrics unless consistently high
    • ANA: Found in 5% of normal healthy children and negative in many with HIA. Also of little importance
  45. Define cerebral palsy
    A dynamic disorder of posture and movement caused by a non-progressive lesion to the developing, unmyelinated brain
  46. Give 5 signs of respiratory distress in an infant
    • Tracheal tug
    • Sternal/subcostal/intercostal recession
    • Nasal flare
    • Head bob (infants)
    • RR >30
  47. Give 5 causes of acute cough in paeds
    • URTI/pharyngitis
    • Laryngitis
    • Bronchiolitis/pneumonia
    • Asthma
    • Pertussis
  48. What is stridor? Give 5 causes of acute stridor
    • High pitched breath sound from larynx or lower obstruction
    • Croup
    • FB
    • Acute epihlottitis
    • Glandular fever
    • Measles
  49. What causes croup, how does it typically present and how is it managed?
    • Parainfluenza
    • Gradual onset coryza, with horseness and barking cough. Can progress to stridor and respiratory distress
    • Oral dexamethasone, with nebulised adrenaline if severe
  50. What are the most common causes of pneumonia in children?
    • Bacterial: Pneumococcus, S.Aureus, mycoplasma
    • Viral: RSV, influenza, parainfluenza
    • Aspiration
    • Remember group-b strep in neonates
  51. What is bronchiolitis? Describe a typical presentation and its management
    • Acute LRTI affecting infants, usually caused by RSV
    • Cough, breathlessness and hyperinflation
    • Fine crepitations and wheeze on auscultation
    • Supportive; O2, CPAP/intubation if severe
  52. What are the steps of asthma treatment?
    • 1. Short acting Beta-agonist
    • 2. Add regular inhaled steroid therapy BD
    • 3. Add long acting beta-2 agonist +/- increase steroid. In <5 consider montelukast
    • 4. Maximise inhaled steroid
    • 5. Begin oral steroids
  53. Give 3 MDT members required when managing a paediatric patient with CF
    • PT: Daily physiotherapy
    • Medical: Continuous oral antibiotics and creon Dietician: Fat soluble vitamin + High calorie
  54. What are the main points when describing a heart murmur?
    • Loudness (1-6)
    • Timing (systolic/diastolic/continuous)
    • Duration (ejection, mid or pan systolic)
    • Site where loudest
    • Radiation
  55. What are the defects in the tetralogy of fallot?
    • Overriding aorta
    • VSD
    • Right outflow tract obstruction
    • Right ventricular hypertrophy
  56. How much constitutes overfeeding in first few months?
    >150ml/kg/day
  57. What causes epiglottitis and what are the important points in its management?
    • Haemophilus influenza B (but other bacteria posisble)
    • Avoid examining airway
    • Laryngoscopy and intubation urgently required in a controlled setting
  58. Give 7 causes of acute abdominal pain in paeds
    • Infection
    • Constipation
    • Acute appendicitis
    • Intussuception
    • Volvulus
    • Strangulated hernia
    • Torsion of testis/ovary
  59. Give 6 signs of dehydration in infants
    • Dry mucous membranes
    • Sunken fontanelle
    • Oliguria
    • Sunken eyes (ask parents)
    • Tachypnoea/tachycardia/CapRefill
    • Skin turgor
  60. Give 5 differentials for an abnormally bruised child
    • Sepsis
    • Haemorrhage
    • DIC
    • Coag disorders
    • HS Purpura
  61. What is ITP? Outline its presentation
    • Idiopathic thrombocytopenic purpura
    • Low platelets in absence of other causes

    Presents 1-5 years with acute onset bruising/petechiae or epistaxis
  62. What investigations and interventions are required in suspected ITP?
    • Ix
    • Little is gained from history, examination or investigations
    • BM aspirate for malignant DDx

    • Mx
    • Platelet transfusions in acute bleeding
    • IvIg
    • Consider steroids or splenectomy
  63. Give 3 sources of paediatric lymphadenopathy and 2 examples from each
    • Malignancy: Acute leukemias, lymphoma
    • Infection: staph/strep, adenovirus,
    • AI: Kawasaki's, JRA
  64. Patient has rash from face to limbs, fever and cervical lymphadenopathy.

    What is the cause and give 2 complications
    • Measles
    • Pneumonitis
    • Encephalitis
  65. Patient had non-specific prodromal features and abdominal pain, then developed widespread erythema and serous vesicles.

    What is the cause and give 2 complications
    • Varicella zoster
    • Pneumonitis
    • Encephalitis
  66. Patient has bilateral throat swelling and fever.

    What is the cause and give 2 complications
    • Mumps
    • Orchitis and infertility
    • Encephalitis
  67. Patient has non-specific prodromal features. Develops rash on cheeks and trunk

    What is the cause and give 2 complications
    • Parvovirus "Slapped cheek"
    • Arthritis (adult infection)
    • Aplastic crisis (if congenital RBC defect)
  68. Patient has cold symptoms, then develops a maculopapular rash which spreads to trunk. Some mild joint pain

    What is the cause and give 2 complications
    • Rubella
    • Congenital rubella syndrome (in utero infection)
    • SN deafness, ocular abnormalities and cardiac malformation the CRS triad
  69. Young child has 2 week history of rhinorrhoea, then develops cough and some subconjunctival haemorrhage.

    What is the condition and how is it treated?
    • Pertussis
    • Vaccination in first year
    • Erythromycin reduces infectivity but not treatable
  70. What is the most common cause of meningitis?
    • Group B N. Meningitidis
    • Used to be Men C but vaccinations have reduced admissions
  71. How is bacterial meningitis transmitted and how does it generally present?
    • Transmission via infected respiratory secretions from carrier
    • Infection can cause meningitis, septicaemia or more commonly both
  72. Give 5 signs and 5 symptoms of meningococcus infection
    • Signs
    • - Low GCS
    • - Petechia/purpuric rash
    • - Pyrexia
    • - Kernig's sign
    • - Vomiting

    • Symptoms
    • - Headache
    • - Photophobia
    • - Neck stiffness
    • - Irritability/poor feeding/lethargy
    • -
  73. What investigations are essential in a pyrexic infant with a rash?
    • Blood glucose
    • PCR of blood
    • CSF: Microscopy, culture, PCR and glucose
    • CXR
  74. How is meningococcal infection treated?
    • ABC
    • Fluid resuscitation for shock
    • HDU referral
    • Monitor for clotting/metabolic changes
    • Ceftriaxone for 7 days
    • Consider surgical removal of ischaemic peripheries
    • Contact public health for contact chemoprophylaxis
  75. What is the prognosis of meningococcal infection?
    • Septicaemia: 15% mortality
    • Meningitis: 5% mortality
    • 5% risk of neurological sequelae, especially hearing loss
  76. What are the most common causes of nephrotic syndrome in children?
    • Minimal change disease (80-90%)
    • Focal segmental GS (10-20%)
    • Secondary causes (HSP, SLE)
  77. Give 4 complications of nephrotic syndrome
    • Hypovolaemia
    • Thrombosis
    • Infection (Ig and complement lost in urine)
    • Hypertension
  78. Give 3 considerations in the management of nephrotic syndrome
    • Reduce inflammation: High dose tapering prednisolone
    • Fluid management: 20% albumin + furosemide, salt/fluid restriction
    • Infection prophylaxis: Penicillin/pneumococcal vaccination
  79. Give 6 causes of haematuria
    • Infection
    • Trauma
    • Glomerulonephritis
    • Stones
    • Coagulopathy
    • Tumour
  80. Give 3 signs and 3 symptoms of UTI in infants
    • Infants do not present with urinary features
    • Symptoms:
    • - Lethargy
    • - Irritability
    • - Poor feeding

    • Signs:
    • - Fever
    • - Vomiting
    • - Failure to thrive
  81. Give 3 investigations required in a child presenting with UTI symptoms
    • Dipstick: Leukocyte or nitrite positive = culture + treat
    • MSSU: Microscopy for bacteruria or pyuria. Either = culture and treat
    • Imaging: USS if recurrent or atypical UTI
  82. Give 5 indications for dialysis
    OPUAT
  83. Give 3 methods of collecting urine in a child
    • MSSU
    • Catheter specimen urine
    • Suprapubic aspiration: 23G needle into midline at abdominal crease
  84. Give 4 modalities for imaging kidneys in children, and their uses
    • USS: Renal anatomy and vascular perfusion
    • DMSA: Static scan showing difference in function. Performed 3 months after UTI
    • MCUG: Looks for VUR and urethral valve function
    • DTPA: Dynamic scan showing drainage and obstruction
  85. How does acute croup present and how is it managed?
    • Inspiratory stridor, wheeze and fever after mild upset, resembling epiglottitis
    • Humidified air and O2 therapy
    • No Abx or intubation required
  86. Outline the acute management of asthma exacerbation
    • O2 therapy
    • Nebulised beta-adrenergic
    • IV theophylline
    • Consider IV fluid, theophylline and hydrocortisone if refractory
    • Begin oral prednisolone and bronchodilators when possible
    • Abx only if evidence of infection
  87. Give 5 features of a severe asthma attack in a child
    • Difficulty speaking
    • Head extended
    • Flared nostrils
    • Sub-costal, intracostal muscles working
    • Tachycardia
  88. What investigations are required in suspected paediatric pneumonia?
    • CXR
    • Bloods
    • Throat swab
    • Mantoux
    • Consider sweat test if recurrent
  89. Give 5 signs of paediatric heart failure
    • Tachycardia
    • Tachypnoea
    • Hypotension
    • Hepatomegaly
    • Pathological heart sounds
  90. Give 5 considerations in the management of burns and scalds
    • Airway: Consider damage to respiratory tract
    • IV access: Morphine and plasma expanders if >10% body surface
    • Hypovolemia: Monitor Hb, urine output and U+Es for renal failure
    • PICU: If >30% burn
    • NAI: Burns to hands, feet, genitals or with characteristic marks should be suspicious
  91. What investigations are required in a dehydrated child?
    • Blood: Hb, WCC, U+E
    • Stool x 3
    • Throat
    • Urine
    • Blood
  92. Give 4 short-term complications of bacterial meningitis
    • Convulsions
    • Cerebral oedema
    • Subdural effusion
    • Hyponaetremia
  93. Give 5 symptoms of UTI in paediatrics
    • Urine changes
    • Bed wetting
    • Abdominal pain/discomfort
    • Feeling hot
    • General malaise
  94. How is poisoning generally managed acutely?
    • History: Establish name, amount, when
    • Empty: Induce vomiting with ipecac unless caustic. Gastric lavage if <GCS
    • Antidote
    • Observe
  95. Give 4 risk factors for SIDS
    • Male
    • Low birth weight
    • Winter
    • Low socioeconomic class
  96. 5 month old presents with rapidly growing, smooth, red growth on face

    What is this and how is it managed?
    • Cavernous haemangioma
    • Normally recedes by age 7 and not an issue
    • Requires surgical management if near eye or chin
  97. How much maintenance fluid do children require?
    • 421 rule
    • <10kg    =    4ml/kg/hr
    • 10-20kg  =   100ml + 2ml/kg/hr
    • 20kg       =   150ml + 1ml/kg/hr
  98. Give 5 causes of vomiting in baby
    • Overfeeding
    • Possetting
    • GORD
    • Pyloric stenosis
    • Obstruction
  99. Outline the presentation and management of pyloric stenosis
    • 2-6 weeks
    • Sudden projective vomiting without bile, after feed and not billious
    • Dehydrated, hypochloraemic, hypokalaemic and acidotic
    • Diagnosed with test fee; peristalsis and palpable pylorus seen/US
    • IV electrolytes and prepare for surgery
  100. Give 5 causes of billious vomiting in a baby
    • Malrotation +/- volvulus until proven otherwise
    • Sepsis
    • Atresia
    • Hirschpungs
    • Meconium
  101. Outline the pathophysiology of malrotation
    • Bowel does not herniate into cord and rotating while returning to abdomen
    • Midgut mesentery becomes abnormally narrow
    • Prone to volvulus
    • Intestinal infarction and obstruction
    • Collapse, acidosis, distension and vomiting occur
  102. Give 5 signs of necrotising enterocolitis
    • Abdominal distension
    • Blood in stool
    • Feeding intolerance
    • Vomiting
    • Pyrexia
  103. Give 3 signs seen on AXR in acute appendicitis
    • Faecolith
    • Absent right psoas shadow
    • Caecal/small bowel gas
  104. Outline the pathophysiology and presentation of intussusception
    Full thickness invagination of proximal bowel into distal, e.g. ileo-colic often after viral illness

    • Redcurrant jelly stool
    • Vomiting
    • Severe intermittent abdominal pain

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