Pediatrics End Of Year Exam: General Paediatrics

Front 1

Cardiovascular examination: 3 essential questions

Back 1

1. General condition of the child + look for dysmorphic features
2. Assess for evidence of central cyanosis
3. Assess for evidence of congestive heart failure (hepatomegaly , tachypnoea and tachycardia)

Front 2

Cardiovascular examination: % of children with inocent murmours

Back 2

up to 50%

Front 3

Cardiovascular examination:: Characteristics of innocent murmours

Back 3

a) soft
b) systolic
c) no associated symptoms
d) may vary with posture and respiration
e) localized (usually to left sternal border)

Front 4

Innocent cardiac murmour-seen especially in preterm infants , is a physiological finding and disappears after a few weeks

Back 4

1) Increased flow across branch pulmonary artery

Front 5

This is a vibratory murmur Innocent cardiac murmour-found at mid LSB and is caused by turbulence around a myocardial muscle band in the left ventricle

Back 5

Still's murmour

Front 6

Innocent cardiac murmour-it may be easy to hear the venous blood flow returning to the heart especially at the upper LSB or aortic area . This is heart in both systole and diastole and will disappear on lying the child flat

Back 6

Venous hum

Front 7

Incidence of chidlren having congenital heart disease

Back 7

8 per 1000 (just under 1%)

Front 8

ASD contributes to ___% of congenital heart disease in children

Back 8

30%

Front 9

PDA is accounting for ______% of all congenital heart disease

Back 9

12%

Front 10

Risk of recurrence: congenital heart disease: Previous sibling with CHD

Back 10

2%

Front 11

Risk of recurrence: congenital heart disease: 2 siblings with CHD

Back 11

4%

Front 12

Risk of recurrence: congenital heart disease: FAther with CHD

Back 12

5%

Front 13

Risk of recurrence: congenital heart disease: Mother with CHD

Back 13

6%

Front 14

Clubbing is first visible from____ ________ onwards in those with cyanotic congenital heart disease and is first apparent in the ______ or _______

Back 14

Clubbing is first visible from 6 months onwards in those with cyanotic congenital heart disease and is first apparent in the thumbs or toes

Front 15

HS 2 is loud

Back 15

Pulmonary hypertension

Front 16

Usually with ____________the sounds of HS 2 separate and come together on expiration and this is termed ___________ _____________

Back 16

Usually with inspiration the sounds of HS 2 separate and come together on expiration and this is termed physiological splitting

Front 17

In ____________ or _____________you will hear fixed splitting of HS 2

Back 17

In atrial septal defect (ASD) or RBBB you will hear fixed splitting of HS 2

Front 18

CV exam: right lateral thoracotomy scar found after lifting the arms and inspecting the back

Back 18

implies placement of a Blalock-Taussig Shunt (artificial tubing between the subclavian and pulmonary arteries)

Front 19

CV exam: left lateral thoracotomy scar implies:

Back 19

left BT shunt
- repair of coarctation of aorta
- pulmonary artery banding
- PDA ligation

Front 20

CV exam: A median sternotomy scar implies

Back 20

a repair of intracardiac pathology with open cardiac surgery.

Front 21

CV exam: median sternotomy scar+ lateral thoracotomy scar – think

Back 21

Fallot’s with BT shunt and then complete repair

Front 22

If Downs with sternotomy scar – think

Back 22

AV canal defect with residual VSD

Front 23

pansytolic murmur at lower LSB

Back 23

VSD

Front 24

ejection systolic murmur at upper LSB + fixed split HS2

Back 24

ASD

Front 25

Continuous murmur + collapsing pulses
Fallot –Blue + harsh long systolic murmur at upper LSB +/- scars

Back 25

PDA

Front 26

- Ejection systolic murmur URSE + carotid + suprasternal thrill

Back 26

AS

Front 27

Ejection systolic murmur ULSE +/- thrill

Back 27

PS

Front 28

Ejection systolic murmur + weak or absent femoral pulses

Back 28

CoA

Front 29

Signs of respiratory distress –

Back 29

tachypnoea, grunting, use of accessory muscles of respiration, cyanosis

Front 30

“claw hand” what name and level?

Back 30

Klumpke lesion C8, T1

Front 31

“waiter tip” what name and level?

Back 31

(Erb’s C5, C6)

Front 32

shoulder abduction invervation level?

Back 32

C5,C6

Front 33

should abduction invervation level?

Back 33

C5,C6,C7

Front 34

elbow flexion invervation level?

Back 34

C5,C6

Front 35

elbow extension invervation level?

Back 35

C7,C8

Front 36

wrist flexion invervation level?

Back 36

C6,C7

Front 37

wrist extension invervation level?

Back 37

C6,C7

Front 38

hand grip invervation level?

Back 38

C8,T1

Front 39

finger abduction inervation level?

Back 39

C8,T1

Front 40

Biceps and brachioradialis reflex inervation level?

Back 40

C5,C6

Front 41

Triceps reflex inervation level?

Back 41

C7,C8

Front 42

Shoulder dermatome?

Back 42

C4

Front 43

Radial aspect of upper limb dermatome?

Back 43

C5 arms, C6 forearm

Front 44

Tips of fingers dermatome?

Back 44

C7

Front 45

Ulnar aspect of upper limb dermatome?

Back 45

C8 forearm, T1 elbow

Front 46

Axilla dermatome?

Back 46

T2

Front 47

hip flexion inervation level?

Back 47

L1,L2,L3

Front 48

hip extension inervation level?

Back 48

L5,SI,S2

Front 49

knee flexion inervation level?

Back 49

L5,SI

Front 50

knee extension inervation level?

Back 50

L3,L4

Front 51

ankle plantarflexion inervation level?

Back 51

S1

Front 52

ankle dorsiflexion inervation level?

Back 52

L4,L5

Front 53

Knee jerk reflex inervation level?

Back 53

L3, L4

Front 54

Ankle jerk reflex inervation level?

Back 54

S1, S2

Front 55

Plantar response (may be upgoing up until _____ months old)

Back 55

Plantar response (may be upgoing up until 18 months old)

Front 56

Groin sensation

Back 56

L1

Front 57

upper thigh sensation

Back 57

L2

Front 58

knee sensation

Back 58

L3

Front 59

medial aspect of leg below knee sensation

Back 59

L4

Front 60

lateral aspect of leg below knee and continues down onto the medial aspect of the foot

Back 60

L5

Front 61

sole of the foot sensation

Back 61

S1

Front 62

central posterior aspect of the leg and thigh sensation

Back 62

S2

Front 63

Normal Range of motion all movements: wrist

Back 63

Flexion (80 degrees) and extension (70 degrees)
Radial (20 degrees) and ulnar deviation (30 degrees)
Pronation (90 degrees) and supination (90 degrees)

Front 64

Normal Range of motion all movements: Elbow

Back 64

Flexion (135 degrees) and extension (0-10 degrees)

Front 65

Normal Range of motion all movements: Shoulder

Back 65

Abduction (180 degrees) and adduction
Flexion (90 degrees) and extension (45 degrees)
Internal (55 degrees) and external rotation (45 degrees)

Front 66

Normal Range of motion all movements: Cervical spine:

Back 66

Flexion (45 degrees) and extension (55 degrees)
Lateral flexion (ear to shoulder – 40 degrees)
Rotation (chin in line with shoulder – 80 degrees)

Front 67

Normal Range of motion all movements: Hip

Back 67

Flexion (120 degrees) + Thomas Test for fixed flexion deformity
Extension (15 degrees)
Abduction (50 degrees) and adduction (30 degrees)
Internal (35 degrees) and external (45 degrees) rotation

when checking all hip movements, the pelvis should be stabilised.

Front 68

Normal Range of motion all movements: Knee:

Back 68

Flexion (135 degrees) and extension (up to 10 degrees)

Front 69

Normal Range of motion all movements: Ankle:

Back 69

Dorsiflexion (20 degrees) and plantar flexion (50 degrees)
Inversion (5 degrees) and eversion (5 degrees)

Front 70

normally AC>BC but if conductive deafness BC>AC

Back 70

Rinne’s test:

Front 71

held in midline – normally sound arises in midline if N. deafness – appears to arise on healthy side.
If conductive loss – sound referred to affected ear.

Back 71

Weber’s:

Front 72

What is this?

Back 72

NEC

Front 73

What's this?

Back 73

NEC

Front 74

Back 74

NEC

Front 75

What's this?

Back 75

NEC

Front 76

Staging criteria for NEC

Back 76

Bell staging

Front 77

Stage 1 NEC

Back 77

Non-specific signs

Front 78

Stage 2 NEC

Back 78

Definite disease, mild disease and abdo tenderness

Front 79

Stage 3 NEC

Back 79

Surgical NEC peritonitis, distension

Front 80

Treatment options for NEC

Back 80

Peritoneal drainage (buys time if unstable for surgery) vs. surgery (eventually needed)

Front 81

Whats this?

Back 81

Tracheo esophageal fistula. Findings in TEF include: Abdominal bowel gas confirms a distal fistula. Abdominal ‘double bubble’ confirms an associated duodenal atresia

Front 82

Incidence of tracheo oesophageal fistula

Back 82

1: 3000-45000

Front 83

Tracheo esophageal fistula is associated with what 3 syndromes?

Back 83

VATER, VACTERL, CHARGE syndrome

Front 84

Clinical sings of tracheo esophageal fistula

Back 84

– excessive drooling/choking on feeds; polyhydramnios only with pure atresia.

Front 85

x-ray findings of tracheo esophageal fistula

Back 85

Abdominal bowel gas confirms a distal fistula. Abdominal ‘double bubble’ confirms an associated duodenal atresia.

Front 86

Scar/ approach for distal fistula operation

Back 86

Posterolateral thoracotomy

Front 87

What is the problem here?

Back 87

Malrotation and volvulus

Front 88

accumulation of gas in the submucosal layers of the bowel wall, which progresses to necrosis (mucosal -> full thickness). Bowel most often affected, right side of the colon and the distal ileum.

Back 88

Necrotizing enterocolitis

Front 89

NEC is primarily a complication of ____________

Back 89

NEC is primarily a complication of prematurity

Front 90

Risk factors other than prematurity (in a full term infant that can lead to NEC)

Back 90

Sepsis, assisted ventilation, respiratory acidosis, and hypoxemia.

Front 91

What is the onset and progression of NEC

Back 91

Onset occurs 2 weeks to several months after birth
Progression may be rapid

Front 92

Mortality rate in:
Infants <1500g
Infants>2500g

Back 92

Infants <1500g=10-44%
Infants>2500g= 0-20%

Front 93

Mortality rate of premature babies with NEC <1000g

Back 93

40-100%

Front 94

Signs of NEC

Back 94

Feeding intolerance
Delayed gastric emptying
Abdominal distention and/or tenderness
Ileus/decreased bowel sounds
Abdominal wall erythema (advanced stages)
Bloody stool is observed in approximately 25% of patients

Front 95

NEC investigations

Back 95

WCC- moderate neutropenia
Platelets- acute NEC--> thrombocytopenia
ABG's- metabolic acidosis

Front 96

List 2 immediate complications of a tracheo esophageal repair

Back 96

1. Anastomotic failure
2. Recurrent fistula

Front 97

List 4 long term complications associate with a tracheo esophageal fistula

Back 97

Anastomotic stricture
Gastro-oesophageal reflux
Oesophageal dysmotility
Missed fistula (usually upper pouch) with recurrent chest infections

Front 98

whats this?

Back 98

Malrotation and volvulus with necrosis

Front 99

what does this clinical picture suggest?

Back 99

Malrotation and volvulus

Front 100

Name 4 signs of Malrotation and volvulus

Back 100

Bilious vomiting, abdominal distension and PR bleeding.
+ abdominal tenderness

Front 101

T/F if no volvulus the surgery is urgent

Back 101

F- non-urgent but surgery recommended

Front 102

what is this?

Back 102

Congenital Diaphragmatic Hernia, note stomach in thoracic cavity

Front 103

In congenital diaphragmatic hernias approx. ____% of fetuses are stillborn

Back 103

30%

Front 104

Mortality rate for congenital diaphragmatic hernias

Back 104

30-50%