Paediatric
CyanToic heart disease all the T's
tetralogy of Fallot transposition of the great arteries (TGA) tricuspid atresia
meconium aspiration syndrome- cxr
this condition is typically seen in post-term infants and presents with significant respiratory distress. A chest x-ray of MAS typically shows hyperinflated lungs with patches of collapse and consolidation.
Prader willi
Hypogonadism Obesity Hypotonia neonatal hypotonia
An 8-year-old boy presents to the emergency department severely short of breath and wheezy. He is extremely short of breath and cannot complete sentences fully. His peak expiratory flow rate is 300 l/min (40% of normal). His oxygen saturations are 93%. His pCO2 is 4.9 kPa.Which of the above is most concerning?
a normal pco2 = indicates life threatening scenario
You are speaking to a 24-year-old man who is known to have haemophilia A. His wife has had genetic testing and was found not to be a carrier of haemophilia. He asks you what the chances are of his future children developing haemophilia. What is the correct answer
0% - males unaffected - females are carriers
A 2-year-old boy with meningococcal septicaemia arrests on the ward. You are the first person to attend. After confirming cardiac arrest and following paediatric BLS protocol, what is the rate you should perform chest compressions at?
100-120 compressions per minute
Daily milk intolerance. When is most common? managment?
12 weeks old/ 3 month. Management: Extensive hydrolysed formula if breast feeding: continue breast feeding eliminate cow's milk protein from maternal diet. Consider prescribing calcium supplements for breastfeeding mothers whose babies have, or are suspected to have, CMPI, to prevent deficiency whilst they exclude dairy from their diet use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months
When is the routine MenB vaccine given?
2 months, 4 months and 12-13 months
2 month old - What is the most appropriate technique for in-hospital chest compressions in a paediatric patient of this age?
2 thumb encircling and raio of 15:2
A 3-year-old child presents to his general practitioner for his immunisations. He has completed all the immunisations scheduled up to his age and had no adverse reaction to any vaccination. He is otherwise well and he is of normal weight and height for his age. There is no relevant past medical history. His parents moved from India six years ago.Which vaccines should the doctor administer to the child today?
4 in 1 and MMR
A baby is born at term via vaginal delivery with no complications, however he is still not showing signs of breathing at one minute. Heart rate is >100bpm, but he is floppy and cyanosed. What is the most appropriate next step in management?
5 breaths of air via non rebreather mask
A 60 year-old man with haemophilia A has just become a grandfather. He wants to know what the chances are of his daughter's son having haemophilia. His daughter's partner is well with no past medical history.What is the probability that his daughter's son has haemophilia A?
50%
What age is the child able to sit upright without suppport?
7-8 months
A 2-week-old infant is brought to the emergency department with abdominal distension and tenderness. The parents describe that there has been a small amount of blood in her nappy and some bilious vomit. Over the last couple of days the parents have noticed decreased movement and that she is struggling to feed.Relevant history is that she was born at 28 weeks following premature rupture of membranes.Which of the following investigations is most likely to give the diagnosis?
Abdo xray - necrotizing enterocolitis
A 5-year-old child presents to the emergency department accompanied by the mother with a week history of cough and low-grade fever. The mother describes the cough as barking. She has completed all the vaccinations to date.On examination, you can observe suprasternal wall retraction at rest, but the child looks alert and reactive. The child produces strident breath sounds at rest.What is the most appropriate management plan?
Admission to peadiatric - due to audible stridor
A 5-year-old boy is brought to the GP by his father. The father is concerned as he has noticed some hair growing in his son's armpits, and although he has not shown any distress or had any other noticeable symptoms, the father is worried that something is wrong as he is too young to begin going through puberty. On examination, the child has axillary hair growth bilaterally, and his testicles are of appropriate size for his age.
Adrenal hyperplasia This scenario describes a case of gonadotrophin independent precocious puberty (GIPP). In GIPP symptoms are caused by increased levels of sex hormones, for example, testosterone, leading to the suppression of LH and FSH. Increased sex hormone secretion may be due to ovarian, testicular or adrenal causes like congenital adrenal hyperplasia. In boys, the testicular volume will tend to be normal or small. In gonadotrophin dependent precocious puberty (GDPP), or 'central' precocious puberty, the levels of the gonadotrophins LH and FSH would be high and testes would be large for age.
A 4-week old infant is reviewed by the health visitor. She was delivered via breech caesarean section at 36+2 weeks gestation due to suspected chorioamnionitis. Post-partum, she required antibiotics due to the suspected infection. Her notes indicate hospital newborn physical examination (NIPE) was unremarkable. She appears to be well and is progressing steadily along the 60th centile.What follow-up should be arranged by the health visitor due to this infant's history?
All breech babies at or after 36 weeks gestation require USS for DDH screening at 6 weeks regardless of mode of delivery
A 14-year-old girl attends the GP with her mother, concerned that her periods have yet to start. On examination, she has normal female genitalia but is noted to have bilateral inguinal hernias. Breast buds and sparse pubic and axillary hair are also present. The girl is a normal weight and IQ for her age.Which of the below is the most likely underlying cause of her complaint?
Androgen insensitivity - classic presentation is 'primary amenorrhoea
You are asked to see a 39-week-gestation boy on your postnatal ward. He is now 38-hours-old. He was born via forceps delivery and have sustained significant bruising to his face. He is being formula-fed regularly and there are otherwise no concerns about his progress in the postnatal period. A transcutaneous bilirubin measurement comes back elevated. What is the most likely cause of this baby's raised bilirubin measurement
Bruising can cause an elevated bilirubin
A 23 month old boy presents to your GP practice with what you suspect is a viral URTI. During the consultation you become concerned about his development. Which of the following would make you most concerned?
By 23-24 months most children would have a vocabulary of between 20-50 words and will be able to join 2 words with meaning.
Which one of the following is not part of the Apgar score for assessing the newborn?
Capillary refill time
You are asked to assess a baby presenting with an increased work of breathing. The baby was delivered 12 hours ago by emergency Caesarean section at 35 weeks gestation. On examination, they are tachypnoeic with a respiratory rate of 55 breaths per minute. A chest x-ray shows hyperinflated lung fields and the presence of fluid in the horizontal fissure.What is the most likely cause of the baby's increased work of breathing?
Chest x-ray in transient tachypnoea of the newborn may show hyperinflation and fluid in the horizontal fissure
Which vaccines do young people usually receive between the ages of 13 - 18 years?
Tetanus, Diptheria, and polio + Men ACWY
Cry du chat
Chromosome 5q deletion Characteristic cry Feeding difficulties Hypertelorism Learning difficulties Poor weight gain
You are asked to attend a preterm delivery. The neonate is born at 36 weeks gestation via emergency Caesarean section. The neonate has difficulty initiating breathing and requires resuscitation. They are dyspnoeic and tachypnoeic at a rate of 85 breaths/min. On auscultation of the chest, there is reduced breath sounds bilaterally. Heart sounds are displaced medially. The abdominal wall appears concave. What is the most likely diagnosis?
Congenital diaphragmatic hernia presents with scaphoid abdomen, due to herniation of the abdominal contents into the cleft
A paediatrician is called to review a 2-day-old neonate born at 37+2 weeks gestation due to concerns in the newborn physical examination. The neonate has absent fundal reflexes bilaterally and a loud machinery murmur is heard on auscultation. Automated otoacoustic emission is suggestive of sensorineural deafness.The mother recently arrived from overseas where she was unable to access antenatal care. She shows a photo of an exanthematous rash on her trunk in the first trimester, though the pregnancy was otherwise unremarkable.Given this information, what is the neonate's likely diagnosis?
Congenital rubella virus
Management depends on the severity of the hypoglycaemia and if the newborn is symptomatic
symptomatic or very low blood glucose- admit to the neonatal unit intravenous infusion of 10% dextrose
What is vesciourteric reflex
Definiton: Pathophysiology of VUR ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle therefore shortened intramural course of the ureter vesicoureteric junction cannot, therefore, function adequately Presentation: antenatal period: hydronephrosis on ultrasound recurrent childhood urinary tract infections reflux nephropathyterm used to describe chronic pyelonephritis secondary to VURcommonest cause of chronic pyelonephritisrenal scar may produce increased quantities of renin causing hypertension Investigation: VUR is normally diagnosed following a micturating cystourethrogram a DMSA scan may also be performed to look for renal scarring
A four-year-old boy has presented with his concerned mother with an abnormal gait and weakness in his lower limbs. A history, examination and subsequent investigations are completed and he is diagnosed with Duchenne muscular dystrophy.What is the most common cardiac pathology associated with this condition?
Dilated cardiomyopathy
You are called by the mother of a 18-month-old boy. He has been unwell with a suspected viral upper respiratory tract infection for the past few days. His mother reports that he has just had a seizure. Three months ago he had a confirmed febrile convulsion following a similar illness. You arrange to see the child that morning. Which one of the following factors should prompt referral to paediatrics?
Drowsy > 2 hr after the febrile convulsion
A baby is delivered on the ward and on the neonatal examination a systolic heart murmur is heard. An echocardiogram shows right atrial hypertrophy and the septal and posterior leaflet of the tricuspid valve attached to the right ventricle. What is this condition most commonly known as?
Ebsteins anomaly
What is the most useful investigation to screen for the complications of Kawasaki disease?
Echo - look for cornoary artery anyersum
A 28-year-old woman is found to have sickle cell trait on antenatal haemoglobinopathy screening. The father of the child consents for further screening and he is found to have the genotype, HbAS.What is the likelihood of their child having sickle cell disease?
For autosomal recessive conditions, if both parents are carriers (heterozygote) there is a 25% chance of having an affected (homozygote) child
You are asked to organise a tutorial on child protection for medical students attached to the surgery. When discussing patterns of behaviour which may point towards child abuse, which one of the following is least likely to be relevant?
Frequent attendance to the A&E department, rather than GP, may point towards child abuse as parents presume they will see a different doctor each time, making it less likely suspicions will be aroused
A 7-year-old girl presents to her GP as she has been suffering from daily epistaxis for the last week. On examination, her legs are covered with petechiae and bruises. She is otherwise well and has no other symptoms. Blood tests show low platelets, with no other abnormalities. On follow-up, the symptoms have completely resolved after 4 months.Which of the following would you expect to precede these symptoms?
Glandular fever. Idiopathic thrombocytopenic purpura may be preceded by a self-limiting viral infection
vWhich one of the following is responsible for causing scarlet fever?
Group A streptocci
A 6-year-old boy comes to see you with his mother. He reports that he has pain in his knees and calves bilaterally at night which has been ongoing for the past 6 months. These pains are worse if he has played football in the daytime. He describes that these pains can cause him to wake up at night time around 1-2 times per month. Examination of the knee is unremarkable. He is otherwise fit and well.Which one of the following is the most likely diagnosis?
Growing pains are a common complaint in children aged 3-12 years. These usually present with children complaining of pains in their legs. When seeing children who are presenting with these symptoms it is important to check that there are no 'red flags'
Defintive investigation for sickle cell anaemia ?
Haemoglobin electrophoresis
Treatment of kawaski disease in children ?
High dose aspirin is indicated in Kawasaki disease, despite it usually being contraindicated in children
A 4-day-old girl who was diagnosed prenatally with Down's syndrome and born at 38 weeks gestation presents with bilious vomiting and abdominal distension. She is yet to pass meconium.
Hirshrung disease
A 15-year-old boy from Birmingham is brought to surgery by his mother complaining of abdominal pains for the past two days. On examination there is a clinical suspicion of appendicitis and a referral to hospital is planned. On discussing this with the patient he refuses to be admitted as he had planned to go to a party tonight. He is able to understand all information you give him and repeat it, including the serious nature of untreated appendicitis. What is the most appropriate course of action?
His mother has the ability to over rule his decision In England and Wales a child has the ability to consent to, but not refuse, treatment. Whether a child has demonstrated capacity (as per the Fraser guidelines) is not the relevant issue.
What are the associations with perthes disease ?
Hyperactivity and short stature
A 5-week-old baby is suffering from projectile vomiting after feeds. The vomit is profuse but not bile-stained and occurs within minutes of a feed. On examination, an olive-sized pyloric mass can be palpated. What is the most likely electrolyte abnormality seen in this infant?
Hypocholermic hypokalemia metabolic alkalosis
Management of meningitis >3 months old?
IV ceftriaxone
Management of meningitis <3 months old?
IV cetriaxone and amoxicillin
A 3-year-old boy presents to the GP with a widespread, blanching, erythematous rash over his torso, arms and legs. He has had a fever and has been generally irritable and lethargic for around a week. He has also been complaining of abdominal pain for the last few days. On examination, the skin on his palms and soles is desquamated, and his tongue is red with a white coating.What is the most likely diagnosis?
Kawasaki disease
Fragile X
Learning difficulties Macrocephaly Long face Large ears Macro-orchidisim
Patellar Tendonitis
More common in athletic teenage boys Chronic anterior knee pain that worsens after running Tender below the patella on examination
management of ITP ?
Management usually, no treatment is required ITP resolves in around 80% of children with 6 months, with or without treatment advice to avoid activities that may result in trauma (e.g. team sports) other options may be indicated if the platelet count is very low (e.g. < 10 * 109/L) or there is significant bleeding. Options include:oral/IV corticosteroidIV immunoglobulinsplatelet transfusions can be used in an emergency (e.g. active bleeding) but are only a temporary measure as they are soon destroyed by the circulating antibodie
Patellar subluxation
Medial knee pain due to lateral subluxation of the patella Knee may give way
Side effects of methylphenidate ?
Methylphenidate is first line in children and should initially be given on a six-week trial basis. It is a CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor. Side-effects include abdominal pain, nausea and dyspepsia. In children, weight and height should be monitored every 6 months
Edwards trisomy 18
Micrognathia Low set ears Rocker bottom feet Overlapping of fingers
Pierre robin syndrome
Micrognathia Displacement of tongue Cleft palte
Which one of the following is the most common cause of nephrotic syndrome in children?
Minimal change syndrome
Treatment of impetigo ?
NICE CKS advises that for localised non-bullous impetigo, you can consider prescribing hydrogen peroxide 1% cream (apply two or three times daily for 5 days) for people who are not systemically unwell or at a high risk of complications. Exclusion from school
Referral for broncholitis?
NICE recommend immediate referral (usually by 999 ambulance) if they have any of the following: apnoea (observed or reported) child looks seriously unwell to a healthcare professional severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute central cyanosis persistent oxygen saturation of less than 92% when breathing air. NICE recommend that clinicians 'consider' referring to hospital if any of the following apply: a respiratory rate of over 60 breaths/minute difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume 'taking account of risk factors and using clinical judgement') clinical dehydration.
A 3-day-old male is admitted to the neonatal unit with bilious vomiting and reduced feeding. He was born at 30 weeks gestation via an uncomplicated delivery. An abdominal X-ray is requested that shows intramural gas. Oral feeding is stopped and he is started on broad-spectrum antibiotics.Which of the following is the most likely diagnosis?
Necrotising enterocolitis Pneumatosis intestinalis is a hallmark feature of necrotising enterocolitison AXR
A two-week-old preterm baby girl is brought into the paediatric assessment unit by her mother, who is concerned that over the last 3 days she is becoming increasing lethargic and refusing to feed.Observations are respiratory rate 66 breaths/min, oxygen saturations 95% on air, heart rate 178bpm, blood pressure 64/48 mmHg and temperature 36.5ºC.Examination is unremarkable except for lethargy and signs of dehydration.What is the most likely diagnosis?
Neonatal sepsis - should be considered in infants with vague signs such as poor feeding, grunting, lethargy
A man with glucose-6-phosphate dehydrogenase deficiency asks for advice regarding his son. Given the x-linked recessive inheritance of the condition, what is the chance his son will also develop the disease?
No increased risk - no male to male transmission
A 7-year-old girl is brought in to see her GP by her mother, who states that she has had a sore throat and developed a skin eruption for the last couple of days. On examination, you note 3-4 mm erythematous macules and papules on the dorsum of her hands and her heels. You diagnose her with hand, foot and mouth disease. The mother asks if she needs to stay off school. What advice will you give her regarding school exclusion?
No need to stay off school
Ventours delivery complication ?
One of the common effects of ventouse delivery (particularly prolonged ventouse delivery) is a localised oedema from the prolonged application of the suction cup on the baby's head called caput succedaneum. This will usually resolve spontaneously within 3 to 6 weeks postnatally.
A 7-year-old boy is brought in to the GP surgery with an exacerbation of asthma. On examination he has a bilateral expiratory wheeze but there are no signs of respiratory distress. His respiratory rate is 24 / min and PEF around 60% of normal. What is the most appropriate action with regards to steroid therapy?
Oral prednisolone for 3-5 days 1
Osteochondritis dissecans
Pain after exercise Intermittent swelling and locking
A male child from a travelling community is diagnosed with measles. Which one of the following complications is he at risk from in the immediate aftermath of the initial infection?
Pnemuonia
Neonatal hypotonia
Prader willi
Gold standard investigation for hirsphrung disease ?
Rectal biopsy
shaken baby syndrome triad?
Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of the shaken baby syndrome SuBDural - S(shaken) B(baby) D(diaper)
Williams syndrome
Short stature Learning difficulties Friendly extrovert personality Transient neonatal hypercalcemia Supravulvar aortic stenosis elfin facies
Features of patau syndrome
Scalp lesions Polydactyly Cleft palates Microcephalic Small eyes
Osgood-Shlatter Disease
Seen in sporty teenagersPain, tenderness and swelling over the tibial tubercle
A 24-year-old man is investigated for visual loss and is diagnosed as having Leber's optic atrophy. Given the mitochondrial inheritance of this condition, which one of the following relatives is most likely to be also affected? Daughter Sister Son Paternal uncle Father
Sister Mitochondrial diseases follow a maternal inheritance pattern
Chondromalacia patellae
Softening of the cartilage of the patellaCommon in teenage girlsCharacteristically anterior knee pain on walking up and down stairs and rising from prolonged sittingUsually responds to physiotherapy
A 13-month-old girl is referred to paediatrics by her GP due to concerns that she is still not attempting to 'pull to stand'. She was born at 29 weeks by emergency cesarean section due to foetal bradycardia and weighed 1.1kg at birth.On examination, she appears healthy and engaged. She responds to her name and has 7 meaningful words. She can drink from a cup using both hands. When put on the floor, she commando crawls to move around. Upper limb tone is normal however lower limb tone is significantly increased.Based on this patient's symptoms, in which part of the brain/nervous system has damage occurred?
Spastic cerebral palsy results from damage to upper motor neurons Upper motor neurons in the periventricular white matter is the likely location for the lesions causing this patient's symptoms. This child has spastic diplegia, a form of cerebral palsy most commonly secondary to periventricular leukomalacia, a condition occurring more frequently in premature infants. Necrosis of the white matter in the fragile area surrounding the lateral ventricles causes upper motor neuron lesions resulting in the spasticity seen in this patient's lower limbs.
A 3-year-old girl is brought in by her mother. Her mother reports that she has been eating less and refusing food for the past few weeks. Despite this her mother has noticed that her abdomen is distended and she has developed a 'beer belly'. For the past year she has opened her bowels around once every other day, passing a stool of 'normal' consistency. There are no urinary symptoms. On examination she is on the 50th centile for height and weight. Her abdomen is soft but slightly distended and a non-tender ballotable mass can be felt on the left side. Her mother has tried lactulose but there has no significant improvement. What is the most appropriate next step in management?
Speak to a local peadatrician The key point to this question is recognising the abnormal examination finding - a ballotable mass associated with abdominal distension. Whilst an adult with such a 'red flag' symptom/sign would be fast-tracked it is more appropriate to speak to a paediatrician to determine the best referral pathway, which would probably be clinic review the same week
An 8-month-old unwell baby is brought to the paediatric emergency department with discolouration over her left arm. Her parents say the arm was 'initially red and warm but now has black patches'. On examination, these black areas are consistent with skin necrosis. She was diagnosed with chickenpox one week ago.Her observations are: Heart rate: 180 beats per minute (normal 80-140) Respiratory rate: 42 breaths per minute (normal 30-40) Temperature: 38.1º (>37.5º) What is the most likely causative organism
Streptoccous pyrogenes ... Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis
A father brings his 16-day old baby presents to the emergency department. The baby is visibly jaundiced and distressed, and the father explains the baby has not been feeding well since yesterday. Examination reveals hepatomegaly and splenomegaly. A newborn jaundice screen indicates no infection, normal thyroid function tests, raised conjugated bilirubin, liver transaminases and bile acids. The urine is negative for reducing substances.Given the most likely diagnosis, what is the first-line management option?
Surgical interventions - biliary atresia Biliary atresia can present with prolonged jaundice (present > 14 days of age), hepatomegaly, splenomegaly, abnormal growth, cardiac murmurs if associated cardiac abnormalities are present.
Abdo x ray findings of intussception?
Target sign and sausage like mass
Autosomal recessive conditions are often thought to be
To be 'metabolic' as opposed to autosomal dominant conditions being 'structural', notable exceptions: some 'metabolic' conditions such as Hunter's and G6PD are X-linked recessive whilst others such as hyperlipidaemia type II and hypokalaemic periodic paralysis are autosomal dominant. some 'structural' conditions such as ataxia telangiectasia and Friedreich's ataxia are autosomal recessive
A neonate begins to turn blue and becomes tachypnoeic 5 minutes after birth. They are administered 100% oxygen for 15 minutes and an arterial blood gas is performed. pH7.427.38 - 7.42PaO212 kPa10.5 - 13.5PaCO26.0 kPa5.1 - 5.6 On auscultation, the neonate has no murmur but a loud single S2. On palpation, there is a prominent ventricular pulse.What is the most likely diagnosis?
Transpositions of the great arteries
Treatment of nets
Treatment - is only indicated if living lice are found a choice of treatments should be offered - malathion, wet combing, dimeticone, isopropyl myristate and cyclomethicone household contacts of patients with head lice do not need to be treated unless they are also affected Diagnosis - fine-toothed combing of wet or dry hair
Patau syndrome
Trisomy 13
Difference in the criteria between septic arthritis and transient synovitis?
Viral illnesses can be associated with transient synovitis. The WCC should ideally be > 12 and the ESR > 40 to suggest septic arthritis.
Noonan syndrome
We need neck Small stature Pectins evactum Pulmonary stenosis
A 6-year-old girl presents to her general practitioner with a three day history of a dry cough. The patient has been suffering from severe coughing fits that cause her to turn blue and vomit. Prior to this she had a coryzal illness with fever, sore throat and a runny nose. She is diagnosed with whooping cough and given a course of clarithromycin.What advice should be given with regards to returning to school?
Whooping cough should stay off school until 48 hours after starting antibiotics
A mother brings her 8-year-old son to the GP with concerns about his recent behaviour. He is taking little interest in other children in his class at school, and is usually off playing by himself. He is doing very well in his schoolwork, despite failing to do what he's told and often getting into trouble. She is worried that her son may be showing signs of autism.Which of the following would make you consider an alternative diagnosis?
age of onset autsim usually detectable around the age of 2-3 years old
A 10-hour-old neonate is reviewed on the neonatal unit, following an uncomplicated vaginal delivery at 34 weeks' gestation. His mother reports no concerns so far.On examination, he appears well at rest. A left subclavicular thrill is noted, and on auscultation, a continuous 'machinery-like' murmur is heard. He has a large-volume collapsing pulse.Given the likely diagnosis, an echocardiogram is performed, which demonstrates the defect in question, but no other abnormalities.What is the most appropriate management at this stage?
condition is Patent ductus arteriosus: indomethacin is given to the neonate in the postnatal period, not to the mother in the antenatal period Treatment - indomethacin if associated with another congenital heart defect amenable to surgery then prostaglandin E1 is useful to keep the duct open until after surgical repair
Management depends on the severity of the hypoglycaemia and if the newborn is asymptomatic
encourage normal feeding (breast or bottle)monitor blood glucose
Clinical features of downs syndrome
face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face flat occiput single palmar crease, pronounced 'sandal gap' between big and first toe hypotonia congenital heart defects (40-50%, see below) duodenal atresia Hirschsprung's disease
A 3-year-old girl is found unresponsive. You shout for help and ask a colleague to phone the arrest team. You open the airway by performing a head tilt and chin lift and note the patient's only respiratory activity is occasional irregular gasps.What is the next step that should be performed?
give 5 rescue breaths The above scenario depicts a cardiac arrest in a child, indicated by the presence of an unresponsive child with occasional irregular gasping breaths. As the majority of cardiac arrests in children are due to hypoxia, basic life support (BLS) guidelines indicate that initial management is the delivery of 5 rescue breaths.
A mother comes to surgery with her 6-year-old son. During the MMR scare she decided not to have her son immunised. However, due to a recent measles outbreak she asks if he can still receive the MMR vaccine. What is the most appropriate action?
give mmr and repeat in 3 months
What is other test should be done with a raised IRT?
indicative of cystic fibrosis additional test Sweat test
Cryptorchidism definition
is correct. 1 in 10 children with hypospadias will also have cryptorchidism (undescended testes). Therefore, it is always important to examine the groin and scrotum in children with hypospadias as done in the above scenario. It is also important to ensure they have passed urine in the first 24 hours of life
Features of hypernatremia deyhdration ?
jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma
A 9-year-old boy is brought to surgery with recurrent headaches. What is the most common cause of headaches in children
migraines
A neonate is born at 32 weeks gestation via spontaneous vaginal delivery. There was no meconium staining of the liquor. Shortly after delivery he develops cyanosis, tachypnoea, grunting and sternal recession. What is the most likely diagnosis?
neonatal respirtory distress syndrome
You are the F2 in the paediatric clinic. A mother comes in saying that she thinks her 6-month-old son has colic. She shows you a video on her phone. The video shows a 6-month-old baby crying, which stops abruptly and the child draws his chin into his chest, throws his arms out. The child then relaxes and starts crying again, and over the course of the minute long video this is repeated around 10 times. The mother also reports that the child has been referred to the community paediatric clinic due to slight delay in reaching developmental milestones. Which one test is most appropriate for you order to help confirm your diagnosis?
next investigation - EEG. In infantile spasms the child will become distressed between spasms, whereas in colic the child will become distressed during the 'spasms'
Constipation in a child management ?
polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) using an escalating dose regimen as the first-line treatment add a stimulant laxative if Movicol Paediatric Plain does not lead to disimpaction after 2 weeks substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose if Movicol Paediatric Plain is not tolerated inform families that disimpaction treatment can initially increase symptoms of soiling and abdominal pain
Treatment for threadworms?
prescribe a single dose of mebendazole for the household and give hygiene advice
Which of the following clinical findings are most likely to be indicative of child sexual abuse?
recurrent UTI and anal fissures
Respiratory distress syndrome - cxr
while this condition does cause early-onset respiratory distress in preterm infants, it tends to cause more severe respiratory distress than TTN. A chest x-ray of RDS typically shows reduced lung volumes and diffuse granular opacities.
