Week 3

Question 1

What are the trends for Heart rate, respiratory rate and blood pressure for children as they age?

Answer 1

Decreasing HR
Decreasing RR
Increasing BP

Question 2

1. What causes bronchiolitis?
2. what clinical features characterise it?
3. How is it managed?

Answer 2

1. Mainly RSV
2. Dyspnoea, hyperexpansion of the chest, subcostal/intercostal recession.
3. Supportive management

Question 3

1. What is croup also known as?
2. What is the usual cause?
3. what are the differentials? How is it managed?
4. How does it present?
5. How is it managed?

Answer 3

1. Laryngotracheobronchitis
2. Parainfluenza
3. Epiglottitis, foreign body etc
4. Barking cough (croup), stridor (inspiratory wheeze), hoarse voice, fever, possible cyanosis
5. Steroid treatment

Question 4

What are the two most common bacterial causes of pneumonia in children? What is the most common viral cause?

Answer 4

Streptococcus pneumonia
Haemophilus influenza
RSV

Question 5

1. What bacteria most commonly causes meningitis?

2. What are the most common symptoms of meningococcal meningitis?

Answer 5

1. Neisseria Meningitidis

2. fever, headache, neck stiffness, petechial/purpuric rash

Question 6

Name 4 viruses that cause gastroenteritis

Answer 6

Rotaviruses
Enteric adenoviruses
caliciviruses
astroviruses

Question 7

Identify a symptom that is associated with fever in children but not commonly with adults

Answer 7

Febrile seizures

Question 8

Name the two arrhythmias that should be checked for in children

Answer 8

Long QT syndrome

Supraventricular tachycardias

Question 9

What is the primary cause of growth in 1. infancy 2. childhood 3. adolescence

Answer 9

1. Nutrition
2. Growth hormones
3. Sex-steroid led

Question 10

What does EAR stand for?

Answer 10

Estimated Average Requirements

Question 11

What are the three types of malnutrition? What effect does each have?

Answer 11

Undernutrition- stunting, wasting, underweight
Micro-nutrient related- deficiency or excess
Overweight/obesity- related health problems

Question 12

What does RNI stand for?

Answer 12

Reference nutrient intake

Question 13

Should children under 12 months take unmodified cows milk? What about 2 year olds?

Answer 13

No

Only if full fat

Question 14

Identify 6 health benefits of breast feeding for children

Answer 14

Reduced D and V
Reduced CVD incidence
Reduced SIDS
Reduced infections
Higher IQ
Reduced childhood obesity

Question 15

What are the weight BMI ranges which signify 1. Healthy weight 2. overweight 3. Obesity

Answer 15

1. 18.5- 25kg/m2
2. 25-30kg/m2
3. > 30kg/m2

Question 16

How do you calculate BMI? What is classified as obesity in children? Is waist circumference helpful to measure in children?

Answer 16

Weight kg/height m2
BMI >95th centile for age
No bruh

Question 17

Identify some of the risk factors for being overweight aged 3yrs and over

Answer 17

Parental overweight
Black ethnicity
Greater birthweight
smoking during pregnancy
Mother works >21 hours a week
lone motherhood
Solid foods before 4 months
prepregnancy overweight

Question 18

Name the two most prevalent genetic conditions which cause obesity in children

Answer 18

Prader-Willi syndrome
Bardet-Biedl syndrome
Both present with hyperphagia

Question 19

How much exercise should under 5s who are walking get each day? What about for 5-18 year olds?

Answer 19

180 minutes at least

60 minutes at least

Question 20

Name the drug licensed in the NHS for weight loss. What increases the rate of side effects with this drug?
When can it be given to adolescents?
What are the three surgical options?

Answer 20

Orlistat
More GI side effects if not accompanied by dietary adjustment
Only given if in >3.5SD from the mean or severe obesity >99.6 centile
Gastric band
Gastric bypass
Sleeve gastrectomy

Question 21

Define infant mortality rate

Answer 21

Probability of a child dying before the age of 1 (per thousand people)

Question 22

1. Give four causes of pneumonia in children
2. What condition is associated with deaths from PCP?
3. Give four risk factors for pneumonia in children
4. What drug should be given to children to prevent PCP pneumonia?

Answer 22

1. Strep pneumonia, Hib, RSV, Pneumocystis Jiroveci (PCP)
2. HIV infection
3. Malnutrition, overcrowding, indoor air pollution, parental smoking
4. Daily cotrimoxazole given to HIV positive children to prevent PCP infection

Question 23

1. What is the most common cause of death worldwide in children under 5?
2. What are the two most common pathogenic causes of this?
3. What is the major risk factor?
4. Give two treatments

Answer 23

1. Diarrhoea
2. Rotavirus and E. coli
3. Faeces contaminated water
4. ORS (oral rehydration solution), Zinc supplements

Question 24

1. Give three situations where HIV can be transmitted from mother to child
2. What does MTCT stand for?
3. Give three modes of MTCT prevention

Answer 24

1. Pregnancy, delivery, breastfeeding
2. Mother to child transmission
3. Maternal lifelong antiretroviral treatment so that undetectable viral load in mother, screen for and treat other STDs, Infant prophylaxis for 6 weeks

Question 25

Identify some major signs of childhood HIV infection

Answer 25

Recurrent childhood infections, bacterial infections, candidiasis encephalopathy persistent fever, lymphadenopathy PJP pneumonia

Question 26

1. What is the HIV test for a child <18 months and >18 months? 2. Identify three forms of the staging of HIV 3. Identify three treatments for HIV in children 4. What are the two main prophylactic treatments for HIV?

Answer 26

1. <18months= virological PCR for HIV DNA/RNA >18 months= serological rapid antibody test 2. Clinical staging (damage to immune system), Immunological staging (CD4), Virological staging (Viral load) 3. Nucleoside reverse transcriptase inhibitors, Non-Nucleotide reverse transcriptase inhibitors >3yrs, Protease inhibitors <3yrs 4. Cotrimoxazole and vaccinations

Question 27

When is Ethambutol given to TB positive children?

Answer 27

If in an area of isoniazid resistance or if HIV positive

Question 28

1. What parasite causes malaria? 2. What parasite causes the most severe malaria? 3. How is malaria treated? 4. Prevention?

Answer 28

1. Plasmodium 2. Plasmodium falciparum (crosses BBB) 3. artemisinin-based combination therapy (ACT), IV/IM artesunate if severe 4. Nets and vaccine

Question 29

Define intussusception

Answer 29

Where the bowel telescopes in on itself- severe cause of abdominal pain in infants

Question 30

Identify some Paediatric red flag symptoms

Answer 30

``` Headaches with associated symptoms disordered turns and movements Heart Murmurs Night time cough/wheeze/SOB Recurrent infections Bilious/bloody vomiting Blood in stools Failure to thrive Constipation from birth Weight loss Delayed or precocious puberty ```

Question 31

How common is milk intolerance in infants? What about wheat allergy? How may a child with a food allergy present?

Answer 31

3% 1% rhinorrhoea, glue ear, cough, vomiting, constipation, abdo pain, rashes, fatigue, itch, myalgia

Question 32

How do Vaccines work?

Answer 32

Vaccines teach the immune system to recognise bacteria and viruses before the individual encounters them as potential pathogens, so allowing the body to fight against the pathogens

Question 33

Identify four different types of vaccine

Answer 33

1. Attenuated organism that replicates in the host 2. Suspensions of killed organisms 3. Subunit vaccines 4. Conjugate vaccines

Question 34

What is the most major contraindication to Vaccines?

Answer 34

Confirmed anaphylaxis to vaccine or same antigen

Question 35

What is Herd immunity?

Answer 35

Protecting unvaccinated individuals through having a sufficiently large proportion of the vaccinated

Question 36

1. Name 6 vaccines given to children 2. Name 2 vaccines given to young teenagers 3. Name two vaccines given to the elderly

Answer 36

1. Rotavirus, flu, Hib, MenC, MMR, MenB, HepB, IPV, PCV, DTaP 2. MenACWY, HPV 3. Shingles, annual flu

Question 37

What centile of BMI signifies that a child is overweight? what about obese? Severely obese? What is the healthy range? What low weight demands referral?

Answer 37

``` 91st centile 98th centile 99.6th centile 2nd centile to 91st centile below 0.4th centile ```

Question 38

What congenital heart defect presents with an egg-on-the-side defect in neonates?

Answer 38

Transposition of the great arteries

Question 39

Identify some of the signs of intussception

Answer 39

Abdominal pain, lifting legs to chest, red current jelly stools, ileo-caecal region normally

Question 40

What is the classical triad of symptoms for congenital toxoplasmosis Gondii?

Answer 40

congenital toxoplasmosis = chorioretinitis, intracranial calcifications, hydrocephalus

Question 41

What are the characteristic features of congenital Rubella?

Answer 41

Sensorineural deafness Congenital cataracts Congenital heart disease (e.g. patent ductus arteriosus) Glaucoma

Question 42

What sign on an x-ray indicates croup?

Answer 42

Steeple sign

Question 43

What are the characteristic symptoms of epiglottitis? | What sign is noticed on a lateral x-ray?

Answer 43

Dysphagia, Drooling, distress | Thumb sign

Question 44

What disease results from avascular necrosis of the femoral head?

Answer 44

Perthes Disease

Question 45

What neonatal respiratory condition is more common with Caesarean sections?

Answer 45

Transient Tachypnoea of the newborn