Applied Knowledge in Paediatrics: : MRCPCH Mastercourse

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Applied Knowledge in Paediatrics: MRCPCH Mastercourse
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Contributors
Acknowledgements
Preface
1 - Preparing for the AKP exam
	Examination structure
	Question journey
	Question types
		Single best answer (SBA)
			Multiple best answer (MBA)
			Multipart question (MPQ)
			Extended matching questions (EMQ)
			Detailed advice
			Evidence-­based paediatrics
2 - Neonatology
	Antenatal assessment of fetal growth
		Definition and classification
	Screening for intrauterine growth restriction
		Fundal height (FH) measurement
			Selective ultrasonography
			Growth indices
		Perinatal events and birth injury
			Hypoxic-­ischaemic encephalopathy
				Investigations
				Treatment and managment
				Important sequelae
			Brachial plexus injury
				Investigations
				Treatment and management
		Antenatal management of preterm labour
			Management of preterm labour
			Management of the high-­risk pregnancy
				Following birth
	Medical conditions in the preterm neonate
		Respiratory distress syndrome
			Differential diagnosis
				Investigations
				Treatment and management
				Mechanical respiratory support
			Bronchopulmonary dysplasia
				Treatment and management
			Patent ductus arteriosus
				Treatment and management
			Necrotising enterocolitis (NEC)
				Investigations
				Treatment and management
			Germinal matrix and intraventricular haemorrhage (GM-­IVH)
				Treatment and management
				Neurodevelopmental outcome
			Periventricular leukomalacia
				Treatment and management
				Neurodevelopmental outcome
			Retinopathy of prematurity (ROP)
				Treatment and management
	Medical conditions in the term neonate
		Meconium aspiration syndrome
			Transient tachypnoea of the newborn (TTN)
				Treatment and management
			Persistent pulmonary hypertension of the newborn (PPHN)
				Investigations
				Treatment and management
			Neonatal hypoglycaemia
				Clinical presentation
				Investigations
				Treatment and management
			Hyperbilirubinemia
			Unconjugated hyperbilirubinaemia
				Treatment and management
				Complications
			Conjugated hyperbilirubinemia
				Investigations
				Treatment and management
			Neonatal sepsis
				Investigations
				Treatment and management
			Neonatal seizures
				Clinical presentation
				Investigations
				Treatment and management
			Neonatal abstinence syndrome
				Investigations
				Treatment and management
			Neonatal thrombocytopenia
				Treatment and management
		Common surgical conditions affecting the term neonate
			Malrotation with or without midgut volvulus
				Treatment and management
			Meconium ileus
			Duodenal atresia and duodenal web
			Tracheo-­oesophageal fistula and oesophageal atresia
				Investigations
				Treatment and managment
			Anorectal malformations
			Vacterl association
			Exomphalos
			Gastroschisis
				Treatment and management
			Congenital diaphragmatic hernia
				Treatment and managment
3  - Adolescent medicine
	Adolescent health needs
		Legal framework
	Risk-­taking behaviour
		Substance abuse
		Alcohol
			Alcohol use disorders
		Tobacco and vaping
			Nicotine replacement therapy
			E-­cigarettes and vaping
	Illicit drugs
		Cannabis
			Other drugs of abuse
			Inhalants
		Self-­harm
			Assessment of risk
			Safety planning
			Outcomes
	Eating disorders
		Anorexia nervosa
			Bulimia nervosa
				Clinical presentation
				Investigations
				Treatment and management
				Potential complications
				Important sequelae
	Sexual health
		Teenage pregnancy
			Risk factors
				Consequences of teenage parenthood
				Health outcomes of child born to young parents
				Reducing teenage pregnancy
			Sexually transmitted infection
			Acne
				Management
4  - Growth and puberty
	Disorders of growth
	Short stature
		Clinical presentation
			Investigations
				Important sequelae
		Specific conditions
			Familial short stature
			Small for gestational age (SGA)
			Chronic conditions
			Endocrine causes
		Growth hormone deficiency
			Clinical presentation
				Investigations
				Treatment and management
				Pharmacological agents used
			Hypothyroidism
			Cushing syndrome or disease
			Syndromic causes
			Turner syndrome
			SHOX mutations
			Noonan syndrome
			Silver Russell syndrome (SRS)
			Fetal alcohol spectrum disorder
			Skeletal dysplasias
	Tall stature
		Syndromic causes with disproportionate long-­limbed tall stature
			Marfan syndrome
			Klinefelter syndrome
			Syndromic causes without disproportionate long-limbed tall stature
			Beckwith–Wiedermann syndrome
			Sotos syndrome
	Disorders of puberty
	Sexual precocity
		Clinical presentation
			Gonadotropin-­dependent sexual precocity
				Investigations
				Treatment and management
				Potential complications
				Important sequelae
		Gonadotrophin-­independent sexual precocity
			Premature thelarche
			Exaggerated adrenarche
			McCune–Albright syndrome
	Delayed puberty
		Clinical presentation
			History
				Examination
			Central delayed puberty
		Primary gonadal failure
			Primary ovarian failure
			Testicular failure
				Investigations
				Treatment and management
5  - Genetics and dysmorphology
	Chromosomal abnormality and mutations
		Numerical abnormalities
			Structural abnormalities
			Sex chromosome abnormalities
			Genetic sequence variants (point mutations)
			Autosomal dominant conditions
			Autosomal recessive conditions
			X chromosome linked conditions
			Mitochondrial mutations
			Imprinting conditions
	Common genetic and dysmorphological conditions
		Down syndrome
			Patau syndrome
			Edward syndrome
			Turner syndrome
			Klinefelter syndrome
			Wiskott-Aldrich syndrome
			Chromosome 22q11.2 deletion (Di George syndrome, Velo-cardio-facial syndrome)
			Williams syndrome
			Prader-Willi syndrome
			Angelman syndrome
			Peutz-Jeghers syndrome
			Beckwith–Wiedemann syndrome
			Noonan syndrome
			Fragile X syndrome
			Marfan syndrome
			Silver Russell syndrome
			Rett syndrome
			Achondroplasia
			Albright’s Hereditary Osteodystrophy
			(also known as pseudohypoparathyroidism type 1a)
	Genetic testing
		Screening of individuals
			Diagnostic genetic testing
				Predictive genetic testing
				Genetic carrier testing
			Population screening
				Population carrier screening
				Prenatal screening
				Newborn screening
				Disease susceptibility screening
		Effects of environmental factors affecting the foetus
			Smoking
			Drugs
			Alcohol
6 - Nutrition
	Breast feeding
		Formula feeding
			Alternative milks and their clinical indications
		Complimentary feeding
	Assessment of nutritional status
		Growth charts
	Malnutrition (undernutrition)
		Investigation
			Treatment and management
	Obesity
		Vitamin, mineral and micronutrient deficiencies
			Vitamins
			Vitamin A
			Thiamine (vitamin B1)
			Riboflavin (vitamin B2)
			Niacin (vitamin B3)
			Pantothenic acid (vitamin B5)
			Pyridoxine (vitamin B6)
			Folate (vitamin B9, folic acid)
			Vitamin B12
			Ascorbic acid (vitamin C)
			Vitamin E
			Vitamin K
		Micronutrients
			Zinc
			Iodine
7  - Behavioural medicine and mental health
	Sleep Problems
		Bedtime resistance or refusal
			Delayed sleep onset
			Nightmares and night terrors
			Delayed sleep-­wake cycle disorder
			Relevant pharmacological agents used
		Feeding difficulties
			Avoidant and Restrictive Feeding Intake Disorder (ARFID)
		Pica
	Behavioural manifestations in physical disease
		Impact of chronic disease
		Somatic symptom disorders
			Somatic symptom disorder
			Illness anxiety disorder
			Conversion disorder (functional neurological symptom disorder)
	Antisocial behaviour and conduct disorder
		Conduct disorders
		Oppositional defiant disorder
			Treatment and management
		Challenging behaviour in children with intellectual disability
	Child and adolescent mental health services (CAMHS)
	Mental health conditions
		Depressive disorder
			Clinical presentation
			Differential and comorbid diagnoses
			Treatment and management
			Relevant pharmacological agents used
		Bipolar disorder
			Clinical presentation
			Differential and comorbid diagnoses
			Treatment and management
		Early onset psychosis and schizophrenia
			Clinical presentation
			Treatment and management
		Anxiety disorders
			Clinical presentation
			Separation anxiety disorder
			Generalised anxiety disorder
			Social anxiety disorder
			Panic disorder
			Specific or simple phobias
			Agoraphobia
			Post-traumatic stress disorder
			Differential and comorbid diagnoses
			Treatment and management
			Relevant pharmacological agents used
		Obsessive compulsive disorders (OCD)
			Clinical presentation
			Treatment and management
			Relevant pharmacological agents used
8 - Emergency medicine
	Initial assessment of a collapsed or unconscious child
	Paediatric cardiac arrest
		Treatment and management
	Shock
		Clinical manifestations
			Investigations
				Treatment and management
				Relevant pharmacological agents used
	Anaphylaxis
		Investigations
			Management of acute episode
				Management following acute episode
				Relevant pharmacological agents used
	Acute airway obstruction
		Investigations
			Acquired acute upper airway obstruction
			Croup
				Treatment and management
			Peritonsillar abscess
			Retropharyngeal abscess
			Epiglottitis
				Clinical presentation
				Treatment and management
			Bacterial tracheitis
			Airway foreign bodies
				Treatment and management
		Acute seizures
			Convulsive status epilepticus (CSE)
				Investigations
				Treatment and management
				Medication
	Acute neurological emergencies
		Treatment and management
			Stroke
				Treatment and management
9 - Unintentional injuries and poisoning
	Trauma
		Primary survey
		Drowning
			Treatment and management
			Investigations
	Life-­threatening haemorrhage
		Treatment and management
		Head and spinal injuries
			Head injury
				Extradural
				Subdural haemorrhage
				Classification of head injury
				Investigations
				Treatment and management
			Spinal injury
				Treatment and management
	Burns and scalds
		Investigations
			Treatment and management
				Potential complications
	Limb-­threatening injuries
		Vascular injuries
			Compartment injuries
			Neurological injuries
			Open fractures
	Common poisonings
		Nonpharmaceuticals and household products
		Advice to parents on unintentional injuries and their prevention
			Head injuries and fractures
				Falls
				Foreign body aspiration or ingestion
				Poisoning
				Burns
				Drowning
				Road traffic impact
10 - Fluids and electrolyte management
	Appropriate intravenous fluid
		Ongoing losses
			Monitoring
		Assessment of hydration status
	Management of dehydration
		Oral rehydration therapy
		Resuscitation
		Risk of acute kidney injury
	Electrolyte disturbance
		Hyponatraemia
			Causes of hyponatraemia
			Clinical presentation
			Investigations
			Treatment and management
		The child with normal or increased volume status
		The child with moderate dehydration and serum sodium 130–135 mmol/l
		The child with severe dehydration or dehydration with serum sodium less than 130 mmol/l
		Acute hyponatraemic encephalopathy is a medical emergency
			The hyponatraemic child with seizures or CNS depression
		Hypernatraemia
			Clinical presentation
			Treatment and management
			For hypernatraemic dehydration with serum sodium greater than 150 mmol/l
		Hypokalaemia
			Causes
			Clinical presentation
			Treatment and management
			Oral supplementation
			Intravenous supplementation of maintenance fluids
		Hyperkalaemia
			Causes
			Clinical presentation
			Treatment and management
			Moderate hyperkalaemia (potassium over 5.9 mmol/l)
			Severe hyperkalaemia (potassium over 7 mmol/l)
			Relevant pharmacological agents used
11 - Safeguarding
	Physical abuse
		Bruises
			Plausible explanations for bruises
			Fractures
				Plausible explanations for causes of fracture
			Burns
				Plausible explanations for causes of skin lesions
			Head trauma
	Neglect and emotional abuse
		Perplexing presentation and fabricated or induced illness (FII)
	Sexual abuse
		Presentation
		Assessment of a child where abuse is suspected
		Organisation of child protection services
	Long-­term effects of abuse
12 - Infectious diseases
	Bacterial Infections
		Bacterial Septicaemia
			Investigations
			Treatment and management
			Potential complications
		Bacterial meningitis
			Investigations
			Treatment and management
		Pneumococcal infections
		Meningococcal disease
		Streptococcal disease
			Investigations
			Treatment and management
			Potential complications
		Staphylococcal infections
		Pertussis
			Alternative diagnoses and differing features
			Investigations
			Treatment and management
			Potential complications
			Important sequelae
		Lyme disease
			Investigations
			Treatment and management
			Pharmacological agents used
		Tuberculosis
			Investigations
			Treatment and management
			Relevant pharmacological agents used
		Non tuberculous mycobacterium
	Viral Infections
		Rotavirus
			Alternative diagnoses
			Investigations
			Treatment and management
		Enterovirus and parechovirus
			Alternative diagnoses
			Investigations
			Treatment and management
		Human herpes virus
		Herpes simplex virus (HSV)
			Investigations
			Treatment and management
			Complications
		Varicella-­zoster virus (VZV)
			Treatment and management
		Cytomegalovirus (CMV)
			Investigations
			Treatment and management
		Epstein Barr virus (EBV)
			Associations
			Investigations
			Treatment and management
		Respiratory viruses
		Influenza
			Investigations
			Treatment and management
			Pharmacological agents used
		Respiratory Syncytial Virus (RSV)
			Investigations
			Treatment and management
		SARS-­CoV-­2 (COVID-­19)
			Investigations
			Treatment and management
			Potential complications
			Important sequelae
		Hepatitis B (HBV)
			Investigations
			Treatment and management
		Hepatitis C (HCV)
			Investigations
			Treatment and management
		Human Immunodeficiency Virus (HIV)
			Investigations
			Treatment and management
	Fungal infections
		Candida albicans
			Investigations
				Treatment and management
			Aspergillus
				Investigations
				Treatment and management
				Pharmacological agents used
		Infections acquired overseas
			Travellers’ diarrhoea
				Investigations
				Treatment and management
			Malaria
				Investigations
				Treatment and management
			Typhoid fever/enteric fever
				Investigations
				Treatment and management
				Potential complications
		Kawasaki disease
			Clinical presentation
				Alternative diagnoses
				Investigations
				Treatment and management
				Potential complications
13 - Infection control
	Infection control
		Modes of transmission
			Droplet
				Airborne
				Contact
				Infectious period
				Standard precautions
		Immunisation
			Routine immunisation
				Complications of vaccination
				Contraindications to vaccinations
				Vaccination in pregnancy
				Vaccination of children with unknown or incomplete immunisation status
		Immunising the immunocompromised child
			Children with clinical conditions where vaccinations are contraindicated
				Children with clinical conditions may need extra vaccinations
				Children where some vaccinations may not be effective
				Children where family members to be vaccinated
	Antimicrobial use
		Infection control for epidemic and pandemic infections
14 - Allergy
	Clinical presentation
		Treatment and management
			Investigations
			Relevant pharmacological agents used
			Important sequelae
		Food allergy
			Clinical presentation
			Investigations
			Treatment and management
	Acute and chronic urticaria
		Clinical presentation
			Investigations
			Treatment and management
			Relevant pharmacological agents used
		Asthma and allergy
			Clinical presentation
			Investigations
			Management of allergic aspect of asthma
		Allergic rhinoconjunctivitis
			Clinical presentation
			Common allergens
			Investigations
			Treatment and management
			Relevant pharmacological agents used
			Important sequelae
		Drug allergy
			Clinical presentation
			Investigation
			Treatment and management
15 - Immunology
	Antibody immunodeficiencies
		Clinical presentation
			Investigations
				Treatment and management
			X-­linked agammaglobulinaemia
				Clinical presentation
				Investigations
				Treatment and management
			Common variable immunodeficiency disorder (CVID)
				Treatment and management
			Selective IgA deficiency
				Clinical presentation
				Treatment and management
			Specific antibody deficiency (SPAD)
			Transient hypogammaglobulinemia of infancy (THI)
			Secondary antibody deficiencies
	Combined immunodeficiencies
		Severe combined immunodeficiency (SCID)
			Management
			Combined immunodeficiencies
			Combined immunodeficiencies with syndromic features
	Complement deficiencies
		Abnormalities of neutrophil function
			Congenital neutropenia
			Severe congenital neutropenia (SCN)
			Cyclical neutropenia
			Schwachman-­Diamond syndrome (SDS)
			Chronic granulomatous disease (CGD)
	Autoimmune disorders
	Autoinflammatory disorders
		Periodic Fever syndromes
			Clinical presentation
				Alternative diagnoses and differing features
				Investigations
				Treatment and management
16 - Cardiology
	Chest radiograph
		Electrocardiogram
		Ambulatory ECG monitoring
		Echocardiography
		Cardiac catheterisation
		Hyperoxia test
	Congenital heart disease
		Clinical features
			Left to right shunt (table 16.3)
			Atrial septal defect (secundum)
				Investigations
				Treatment and management
			Partial atrio-­ventricular septal defect
			Ventricular septal defect
			Persistent ductus arteriosus
				Investigations
				Treatment and management
			Right to left shunt (table 16.4)
			Tetralogy of Fallot
				Investigations
				Treatment and management
			Transposition of the great arteries
				Investigations
				Treatment and management
			Common mixing (table 16.5)
			Complete AV septal defect
		Well children with obstruction
			Pulmonary stenosis
				Investigations
				Treatment and management
			Aortic stenosis
				Investigations
				Treatment and management
			Vascular ring
		Sick children with obstruction
			Coarctation of the aorta
				Investigations
				Treatment and management
		Cardiac symptoms and signs
			Murmurs
			Chest pain
			Palpitations, cardiac arrhythmias
				Supraventricular tachycardia (SVT)
				Emergency management of acute arrhythmias
				Supraventricular tachycardia (SVT)
				Ventricular tachycardia (VT)
				Further management of cardiac arrhythmias
			Examples of abnormal ECG rhythms
			Relevant pharmacological agents
				Adenosine. Adenosine blocks conduction, primarily at the atrioventricular node, and has a very short half-­life of a few seconds...
				Flecainide. Flecainide is contraindicated if heart failure, haemodynamically significant valvar heart disease or conduction defe...
				Amiodarone. Amiodarone is contraindicated if bradycardia, thyroid dysfunction and iodine sensitivity are present. Side effects i...
			Syncope
			Heart failure
				Investigations
				Treatment and management
			Relevant pharmacological agents used
				Potassium sparing diuretics (amiloride, spironolactone). There is evidence that spironolactone can help the ventricle remodel, s...
				Loop diuretics (bumetanide, furosemide). These inhibit the reabsorption of sodium, potassium and chloride in the kidney. Contrai...
				Digoxin. Digoxin decreases the automaticity of sinoatrial node and reduces conductivity within the atrioventricular node. It is ...
		Other cardiac conditions
			Myocarditis
				Treatment and management
			Kawasaki disease
			Pericardial disease
			Rheumatic fever
				Investigations
				Treatment and management
				Important sequelae
			Cardiomyopathy
				Dilated cardiomyopathy
				Management
				Hypertrophic cardiomyopathy
		Hypertension
			Systemic hypertension
			Pulmonary hypertension
				Investigations
				Management
			Relevant pharmacological agents used
				Sildenafil. Promotes relaxation of vascular smooth muscle. It is contraindicated if the patient has sickle-­cell disease or rece...
				Prostanoids—epoprostenol, iloprost, selexipag. Prostanoids produce a vasodilatation but are contraindicated in veno-­occlusive d...
				Nitric oxide. Nitric oxide is a potent and selective pulmonary vasodilator as it is given by inhalation. Side effects include in...
	Infective endocarditis
		Investigations
			Treatment and management
				Potential complications
		Cardiac complications of other system disorders
17 - Respiratory
	Blood gases
		Chest radiograph
		Pulse oximetry
		Spirometry
		Bronchodilator reversibility test
		Bronchoprovocation test
		Fraction of exhaled nitric oxide (FeNO)
		Bronchoscopy
		Whole body plethysmography (or the ‘body box’)
		Transfer factor of the lung for carbon monoxide (TLCO)
	Cough
		Protracted bacterial bronchitis
			‘Red flags’ for cough
				Investigations
				Treatment and management
	Wheezing disorders
		Asthma
			Asthma in the acute setting
				Associations
				Investigations
			Treatment and management of chronic asthma
				Treatment and management of acute attack
	Lower respiratory tract infections
		Clinical presentation
			Alternative diagnoses
				Investigations
				Treatment and management
				Important sequelae
			Respiratory failure or cardiovascular collapse
			Pleural effusion and empyema
			Bronchiectasis
			Bronchiolitis obliterans
		Other respiratory conditions
			Primary ciliary dyskinesia
			Chronic aspiration
				Complication of foreign body inhalation
	Cystic fibrosis
		Clinical presentation
			Investigations
				Treatment and management
			Nutritional management
				Management of pulmonary exacerbations
				Measurement of lung function
		Respiratory complications
			Allergic bronchopulmonary aspergillosis
				Haemoptysis
				Pneumothorax
				End-­stage lung disease
		Non respiratory complications
			CF liver disease
				CF-­related diabetes
				CF-­related arthritis
				Fertility
			Annual assessment
			Transition to adult care
			CFTR modulator drugs
	Sleep-­disordered breathing
		Life-­threatening events and sudden infant death
			Acute life-­threatening event (ALTE)
			Sudden infant death in infancy (SUDI)
	Long-­term ventilation
		Surgical respiratory conditions
			Eventration of diaphragm
				Treatment and management
			Congenital pulmonary airway malformation (CPAM)
				Investigations
				Treatment and management
			Chest wall deformities
				Treatment and management
			Surgical emphysema
18 - Hearing and ENT
	Hearing Testing
		Newborn Hearing Screening Tests
			Visual Reinforcement Audiometry
			Play Audiometry
			Pure Tone Audiometry
			Tympanometry
		Types of Hearing Loss
			Conductive Impairment
			Sensorineural Impairment (SNHL)
			Mixed impairment
			Treatment and management
	Conditions Affecting Ears, Nose or Throat
		Otitis Media
			Otitis Media with Effusion
				Treatment and management
				Acute Otitis Media
		Epistaxis
		Tonsillar Hypertrophy
		Pharyngotonsillitis
			Clinical presentation
				Investigations
				Treatment and management
		Sinusitis
		Mastoiditis
19 - Gastroenterology and hepatology
	Acute abdominal pain
		Chronic abdominal pain
	Organic causes of chronic abdominal pain
		Gastric acid–related conditions
			Treatment and management
		Helicobacter gastritis
			Investigations
			Treatment and management
			Potential complications
		Functional causes of chronic abdominal pain
			Treatment and management
		Irritable bowel syndrome (IBS)
			Treatment and management
		Abdominal migraine
			Treatment and management
	Diarrhoea
		Acute diarrhoea
			Investigations
				Treatment and management
			Chronic diarrhoea
				Investigations
			Specific conditions causing chronic diarrhoea
			Coeliac disease
				Associations
				Investigations
				Treatment and management
			Inflammatory bowel disease (IBD)
				Investigations
				Treatment and management
				Relevant pharmacological agents used
			Short bowel syndrome
				Treatment and management
			Protein-­losing enteropathy
				Treatment and management
			Lactose intolerance
				Investigations
	Constipation
		Investigations
			Treatment and management
				Relevant pharmacological agents used
			Encopresis
	Vomiting
		Investigations
			Treatment and management
			Infant regurgitation
			Gastro-­oesophageal disease (GORD)
				Treatment and management
			Cyclical vomiting syndrome
				Treatment and management
	Gastrointestinal bleeding
		Investigations
			Treatment and management
		Diseases of the pancreas
			Pancreatitis
				Investigations
				Treatment and management
	Diseases of the liver
		Prolonged neonatal jaundice
			Conjugated jaundice in neonatal period and in infancy
			Biliary atresia
				Investigations
				Treatment and management
			Alagille syndrome
			Alpha-­1-­antitrypsin deficiency
			Cystic fibrosis
			Incidental finding of an elevated transaminases
				Investigations
			Autoimmune liver disease
			Wilson’s disease
				Investigations
				Treatment and management
			Nonalcoholic fatty liver disease (NAFLD)
				Treatment and management
			Acute liver disease
				Investigations
				Treatment and management
			Acute liver failure
				Treatment and management
			Chronic liver disease
				Treatment and management
	Surgical conditions and congenital malformations
		Oesophageal stricture
			Achalasia
				Treatment and management
			Hiatus hernia
				Treatment and management
			Infantile hypertrophic pyloric stenosis
				Treatment and management
			Ingested foreign body
				Treatment and management
			Malrotation and volvulus
				Treatment and management
				Treatment and management
			Meckel’s diverticulum
			Intussusception
				Treatment and management
				Treatment and management
			Hirschsprung disease
				Treatment and management
				Treatment and management
			Rectal prolapse
				Treatment and management
				Treatment and management
20 - Nephro-­urology
	Proteinuria
		Haematuria
			Radiological investigations
	Congenital anomalies of the kidney and urinary tract
		Hydronephrosis
			Causes
			Treatment and management
		Pelviureteric junction obstruction
		Posterior urethral valve
		Polycystic kidney disease
	Acute kidney injury
		Treatment and management
			Haemolytic uraemic syndrome
	Chronic kidney disease
		Investigations
			Treatment and management
	Urinary tract infection
		Investigations
			Treatment and management
	Renal tubular disorders
		Renal tubular acidosis (RTA)
			Distal RTA (type I)
			Bartter syndrome
				Investigation
				Treatment and management
			Nephrogenic diabetes insipidus
	Hypertension
		Investigations
			Treatment and management
			Phaeochromocytoma
	Acute glomerulonephritis
		Causes
			Investigations
				Treatment and management
			Henoch-­Schoenlein purpura
			IgA Nephropathy
				Investigations
				Treatment and management
			Alport syndrome
	Nephrotic syndrome
		Treatment and management
			Potential complications
	Renal calculi
		Investigations
			Treatment and management
	Enuresis
		Investigations
21 - Haematology
	Investigations
	Impaired red cell production
		Iron deficiency anaemia
			Investigations
			Treatment and management
			Relevant pharmacological agents used
		Bone marrow failure
			Investigations
	Inherited bone marrow failure syndromes
		Fanconi anaemia
		Diamond Blackfan anaemia
		Schwachman-­Diamond syndrome
	Acquired bone marrow failure
		Aplastic anaemia
			Treatment and management
	Haemoglobin disorders
		Thalassaemia
		α-­thalassaemia
			Treatment and management
		HbH
		Hb Barts Hydrops fetalis
		β-­thalassaemia
			Investigations
			Treatment and management
			Potential complications
			Relevant pharmacological agents used
	Increased red cell destruction or loss
		Haemolytic anaemia
			Investigations
			Treatment and management
	Specific haemolytic conditions
		Spherocytosis
		Autoimmune haemolytic anaemia
		Paroxysmal nocturnal haemoglobinuria (PNH)
		Sickle cell disease
			Clinical features
			Investigations
			Treatment and management of acute vaso-­occlusive episodes
			Treatment and management of chronic problems
			Important sequelae
	Transfusion of blood products
	Coagulation disorders
		Investigations
			Prothrombin time
				Activated partial thromboplastin time
				Thrombin Time
				Fibrinogen levels
				D-­dimers
				Relevant pharmacological agents used
			Bleeding disorders
			Haemophilias
				Investigations
				Treatment and management
				Relevant pharmacological agents used
				Potential complications
			von Willibrand Disease
				Investigations
				Treatment and management
			Disseminated intravascular coagulation (DIC)
				Investigations
				Treatment and management
				Potential complications
			Thrombophilia
		Platelet disorders
			Acquired thrombocytopenias
				Treatment and management
				Relevant pharmacological agents used
			Kasabach-­Merritt phenomenon
	Neutropenia
		Congenital neutropenia
			Acquired neutropenia
			Congenital neutropenia
				Treatment and management
22 - Oncology
	Clinical presentation
		Alternative diagnoses
		Aplastic anaemia
			Investigations
			Treatment and management
			Important sequelae
	Lymphoproliferative disorders
	Non-­Hodgkin Lymphoma (NHL)
		Clinical presentation
			Alternative diagnoses
			Associations
			Investigations
			Treatment and management
			Potential complications
			Important sequelae
	Hodgkin Lymphoma (HL)
		Clinical presentation
			Investigations
			Treatment and management
			Important sequelae
	Central nervous system tumours
		Clinical presentation
			Associations
			Investigations
		The common types of tumours include
			Treatment and management
			Potential complications
	Solid tumours
		Neuroblastoma
			Clinical presentation
				Alternative diagnoses and differing features
				Investigations
				Treatment and management
		Nephroblastoma (Wilms tumour)
			Clinical presentation
				Associations
				Investigations
				Treatment and management
				Important sequelae
		Hepatoblastoma
			Clinical presentation
			Investigations
				Treatment and management
		Osteosarcoma
			Clinical presentation
			Investigations
				Treatment and management
				Potential complications
		Ewing Sarcoma
			Clinical presentation
			Investigations
				Treatment and management
				Important sequelae
			Soft tissue sarcomas
		Langerhans cell histiocytosis (LCH)
			Clinical presentation
				Investigations
				Treatment and management
		Syndromes with propensity to malignancy
		Oncological emergencies
			Neutropenic fever
				Clinical presentation
				Treatment and management
		Tumour lysis syndrome
			Clinical presentation
				Investigations
				Treatment and management
				Important sequelae
			Superior vena caval obstruction
	Radiotherapy
		Peripheral stem cell harvest and transplantation
			Treatment and management
				Potential complications
	Shared care services
		Common pharmacological agents used
23 - Dermatology
	Associations
		Alternative diagnoses and differing features
			Investigations
			Treatment and management
			Relevant pharmacological agents used
	Bacterial skin infections
		Staphylococcal scalded skin syndrome
			Investigations
				Treatment and management
			Impetigo
				Treatment and management
			Cellulitis
				Treatment and management
			Scarlet fever
				Treatment and management
				Potential complications
	Viral skin infections
		Systemic viral infections
			Localised viral skin infections
	Fungal skin infections
		Tinea (dermatophyte) infections
			Candida (yeast) infections
	Infestation
		Clinical features
	Urticaria
		Clinical presentation
			Investigations
				Treatment and management
	Cutaneous drug eruptions
		Clinical presentation
			Diagnosis and management
		Systemic disorders involving the skin
			Connective tissue disease
			Clinical presentation
			Lupus erythematosus
			Juvenile dermatomyositis
			Scleroderma
			Cutaneous vasculitis
			Henoch-­Schönlein purpura
			Kawasaki disease
			Endocrine disorders
				Diabetes-­related disorders
			Autoimmune disorders
		Other disorders
			Coeliac disease
			Erythema multiforme
			Erythema nodosum
			Langerhans cell histiocytosis
	Ectodermal dysplasias
	Epidermolysis bullosa
		Epidermolysis bullosa simplex
			Junctional epidermolysis bullosa
			Dystrophic epidermolysis bullosa
		Birthmarks
			Vascular malformations
				Capillary malformations
				Port wine stain (also known as naevus flammeus)
				Venous malformations
				Lymphatic malformations
		Vascular tumours
			Infantile haemangiomas
				Associations
				Treatment
			Pigmented birthmarks
	Neurocutaneous syndromes
		Neurofibromatosis
			Clinical presentation
				Investigations and management
			Tuberous sclerosis complex
				Clinical presentation
			Sturge Weber syndrome
			Incontinentia pigmenti
			Ataxia telangiectasia
24 - Diabetes mellitus
	Clinical presentation
		Investigations
			Treatment and management
			Potential complications
	Type 2 diabetes mellitus
		Clinical presentation
			Treatment and management
				Relevant pharmacological agents used
	Monogenic diabetes
		Types of monogenic diabetes
			Neonatal diabetes
			Monogenic diabetes in children and adolescents
				Investigations
				Treatment and management
	Diabetic ketoacidosis (DKA)
		Clinical presentation
			Investigations
				Treatment and management
				Fluid resuscitation and fluid deficit
				Maintenance fluids
				Metabolic acidosis
				Intravenous insulin
				Potential complications
			Cerebral oedema
				Other complications
	Hypoglycaemia
25 - Endocrinology
	Anterior pituitary hormone deficiency
		Clinical presentation
		Investigations
			Associations
			Treatment and management
			Relevant pharmacological agents used
			Inappropriate or excess anterior pituitary hormone production
		Posterior pituitary hormone deficiency
			Investigations
			Treatment and management
	Posterior pituitary hormone excess
		Syndrome of inappropriate antidiuretic hormone (SIADH)
			Associated conditions
			Investigations
			Management and complications
	Adrenal disorders
		Adrenal insufficiency
			Adrenal insufficiency in the neonate
				Adrenal insufficiency in the older child and adolescent
				Alternative diagnoses and differing features
				Investigations and expected results in primary adrenal insufficiency
				Treatment and management
			Cushing syndrome
				Alternative diagnoses
				Investigations
				Treatment and management
			Phaeochromocytoma
		Thyroid disorders
			Hypothyroidism
				Investigations
				Treatment and management
			Hyperthyroidism
				Investigations
				Treatment and management
				Antithyroid medication
				Radioiodine
				Thyroidectomy
				Potential complications
		Disorders affecting calcium regulation
			Disorders resulting in hypocalcaemia
				Investigations
				Alternative diagnoses
				Treatment and management
			Disorders resulting in hypercalcaemia
				Treatment and management
				Other specific measures include
			Rickets
				Investigations
				Treatment and management
		Endocrine complications of other diseases
			Chronic disease
				Complications of steroid treatment
				Endocrine problems in childhood cancer
26 - Neurology
	Neurophysiological investigations
		Electroencephalogram (EEG)
			Cerebral function monitoring
			Nerve conduction studies and electromyography
	Neuroimaging
		Cranial ultrasound
			Computed tomography (CT) imaging
			Magnetic resonance imaging (MRI)
	Abnormal head shape
		Microcephaly
		Macrocephaly
		Plagiocephaly
		Craniosynostosis
	Epilepsy
		Neonatal seizures
			Epilepsies of infancy
			Epileptic spasms (ES)
		Epilepsies in young children
			Childhood absence epilepsy
			Myoclonic atonic and myoclonic absence epilepsy
			Childhood epilepsy with centrotemporal spikes
			Lennox Gastaut syndrome
		Epilepsies of adolescence
			Juvenile absence epilepsy
			Juvenile myoclonic epilepsy
			Structural focal epilepsies (temporal, frontal and occipital lobe epilepsy)
				Outcomes
				Treatment and management
		Seizure-­like disorders
			Normal and abnormal paroxysmal events
	Headache
		Primary headache disorders
			Treatment and management
			Secondary headache disorders
		Ataxia
			Acute ataxia
			Episodic ataxias
			Chronic ataxia
			Progressive ataxias
	Neurocutaneous syndromes
		Neurofibromatosis type 1 (NF1)
			Treatment and management
			Neurofibromatosis type 2 (NF2)
				Treatment and management
			Tuberous sclerosis
				Treatment and management
			Sturge Weber syndrome (SWS)
				Treatment and management
		Neuromuscular disorders
		Floppy infant syndrome
			Central hypotonia
			Peripheral hypotonia
			Spinal muscular atrophy (SMA)
				Treatment and management
		Duchenne muscular dystrophy (DMD)
		Becker muscular dystrophy (BMD)
			Investigation
				Treatment and management
			Progressive muscular conditions
			Metabolic myopathies
			Myasthenia
		Peripheral neuropathies
			Guillain Barre syndrome (GBS)
				Investigations
				Treatment and management
				Rare causes of peripheral neuropathy
			Hereditary sensory and motor neuropathy (HMSN)
			Spina bifida
				Treatment and management
	Stroke
		Perinatal arterial ischaemic stroke
			Arterial ischaemic stroke
				Treatment and management
			Haemorrhagic stroke
27 - Neurodevelopmental medicine
	Associations
		Investigations
			Treatment and management
			Development
			Medical
			Social and well-­being
		Cerebral palsy
			Classification
			Alternative diagnoses
			Associations
			Investigations
			Treatment and management
			Relevant pharmacological agents used
			Complications and sequelae
		Specific syndromes
			Down syndrome
			Complications and sequelae
			Fetal alcohol syndrome disorder
			Alternative diagnoses and differing features
			Rett syndrome
			Williams syndrome
			Alternative diagnoses and differing features
			Chromosome 22q11.2 deletion (Di George syndrome, velocardiofacial syndrome)
			Prader Willi syndrome (PWS)
			Alternative diagnoses and differing features
			Angelman syndrome
			Complications and sequelae
		Communication disorders
			Treatment and management
				Complications and sequelae
		Neurodevelopmental disorders
			Executive function
				Autism spectrum disorder (ASD)
					Treatment and management
					Complications and sequelae
				Attention deficit hyperactivity disorder (ADHD)
					Associations
					Investigations
					Treatment and management
					Relevant pharmacological agents used
					Complications and sequelae
				Developmental coordination disorder (DCD)
					Investigations
					Complications and sequelae
28 - Ophthalmology
	Eye and vision screening programmes
		Visual development and visual impairment
		Testing visual function
		Assessment of the red reflex
	Abnormal ophthalmic findings
		Proptosis
			Causes of proptosis
			Treatment and management
		Ptosis
			Causes of ptosis
			Clinical presentation
			Treatment and management
		Strabismus (squint)
			Causes of strabismus
			Treatment and management
		Nystagmus
			Causes of nystagmus
	Specific ophthalmic disorders
		Optic nerve head swelling
			Causes of optic nerve head swelling
			Treatment and management
		Cataract
			Causes of childhood cataract
			Treatment and management
		Glaucoma
			Causes of childhood glaucoma
			Treatment and management
		Optic nerve hypoplasia (ONH)
			Investigations
29 - Musculoskeletal disorders
	Septic arthritis
		Investigations
			Management and treatment
		Reactive arthritis
			Treatment and management
		Juvenile idiopathic arthritis (JIA)
			Investigations
			Treatment and management
		Oligoarticular JIA
			Treatment and management
		Systemic onset JIA
		Polyarticular JIA
		Psoriatic JIA
		Enthesitis-­related JIA
			Relevant pharmacological agents used
	Vasculitic disorders
		Juvenile systemic lupus erythematosus (jSLE)
			Investigations
			Treatment and management
		Other systemic rheumatic diseases
		Rheumatic fever
		Henoch-­Schonlein purpura (HSP)
			Treatment and management
	Common inherited bone disorders
		Osteogenesis imperfecta (OI)
			Clinical presentation
			Investigation
			Treatment and management
		Achondroplasia
		Marfan syndrome
	Developmental bone disorders
		Scoliosis
			Treatment and management
		Developmental dysplasia of the hip (DDH)
			Investigations
			Treatment and management
		Perthes disease
			Investigation
			Treatment and management
		Slipped femoral caput epiphysis
			Investigation
			Treatment and management
30 - Metabolic medicine
	Hypoglycaemia
		Investigations
			Treatment and management
		Metabolic acidosis
			Investigations
			Treatment and management
	Metabolic diseases
		Idiopathic ketotic hypoglycaemia
			Treatment and management
		Glycogen storage disease (GSD)
			Investigations
			Treatment and management
		Galactosaemia
			Investigations
			Treatment and management
		Medium chain acyl-­CoA dehydrogenase deficiency (MCADD)
			Investigations
			Treatment and management
		Mucopolysaccharidoses
			Investigations
			Treatment and management
		Urea cycle disorders
			Investigations
			Treatment and management
		Phenylketonuria (PKU)
			Investigations
			Treatment and management
		Homocystinuria
			Alternative diagnoses
			Investigations
			Treatment and management
		Organic acidaemias (acidurias)
		Methylmalonic acidaemia and propionic acidaemia
		Maple syrup urine disease
			Treatment and management
		Familial hypercholesterolaemia
			Investigations
			Treatment and management
		Mitochondrial disease
		Newborn blood screening programme
31 - Palliative care
	The principle of double effect
	Proportionality and directness
		Proportionality
			Directness
		Withdrawing versus withholding
		The process of making difficult decisions
		End of life discussions: uncertainty and futility
	Paediatric Palliative Care (PPC)
		Children who need palliative care
			Palliative care and disease-­directed treatment
			Symptoms
			Psychosocial aspects of the symptom experience
			Symptoms as spiritual phenomena
			Assessment of symptoms
		Management of specific symptoms
		Pain
			Nausea and vomiting
			Dyspnoea
			Other symptoms
			When treatment fails
32 - Ethics and law
	Autonomy
		Nonmaleficence
		Beneficence
		Justice
		Confidentiality
	Research ethics
	Law
		Definition of a child
			Children in the family
				Welfare of the child is paramount
				Parental responsibility
				Consent
				Consent by a young person
				Withholding treatment
			Mental Capacity Act
			The child under arrest
				Discrimination and protected status
				Duty of candour
33 - Patient safety and clinical governance
	Practical aspects of clinical governance
		Clinical effectiveness
			Multidisciplinary teams
			Clinical audit
			Near misses and mistakes
			Risk management
			Effective communication
			Engaging with public and users
			Information governance
			Apply patient safety thinking
	Human factors in patient care
		Health care institution
			Communication
				Team structure
				Team leadership (supervisors)
				Decision making
				Stress
				Fatigue
				Work environment
				Education and training
	Safe and effective handover
34 - Evidence-­based paediatrics
	Methods
		Statistical and sample size
			Bias
	Data analysis
		Statistical tests
		Data outcomes
			Interpretation of confidence intervals and p-­values
			Confidence intervals
			Explanation of answers for Example 1
			Interpretation of confidence intervals: difference between the means
			P-­values
	Data interpretation
		Odds
			Odds ratio
			Explanation of answers to Example 2
			Relative risk (RR)
		Explanation of answers to Example 3
			Risk difference
		Number needed to treat
35 - Exam questions and answers
	Questions
	ANSWERS