This document provides an overview of key topics in paediatrics for the AMK exam, including common paediatric emergencies, inherited conditions, infections, injuries, and vaccinations. It includes sample exam questions addressing issues like assessing a febrile child, abdominal pain, respiratory distress, childhood injuries, epilepsy management, and more. The correct answers are provided along with brief explanations of topics like rashes, infections, fractures, and inheritance patterns.

1. +
Paediatrics for the AMK
By Dr Eva Wooding

2. +
Learning Objectives
 Revise key Indicative Presentations for the AMK including…
 Paediatric emergencies (“what would you do first?”)
 Common inherited conditions
 Community Paediatrics (normal development,
vaccinations)
 Common childhood infections and their management
 Fractures and common injuries

3. + Q: Febrile Child
 A mother from Totnes brings her 22 month old daughter to ED.
She has been off colour for 5 days and visibly unwell for 48
hours with a coryzal illness, pyrexia and lethargy. She had
Calpol 2 hours ago. O/E: HR 165, RR 35, Sats 97% on air, BP
90/60, Cap Refill 3 secs,Temp 37.6oC. A maculopapular rash
visible on the face, mild cervical lymphadenopathy and
conjunctivitis.The child has not had any regular vaccinations.
She is looked after at home, but attended a playgroup until 2
weeks ago.
What’s your primary diagnosis?
A: Bacterial Meningitis
B: Kawasaki Disease
C: Fifth Disease
D: Chickenpox
E: Rubella

4. + Q: Febrile Child
 A mother from Totnes brings her 22 month old daughter to ED.
She has been off colour for 5 days and visibly unwell for 48
hours with a coryzal illness, pyrexia and lethargy. She had
Calpol 2 hours ago. O/E: HR 165, RR 35, Sats 97% on air, BP
90/60, Cap Refill 3 secs,Temp 37.6oC. A maculopapular rash
visible on the face, mild cervical lymphadenopathy and
conjunctivitis.The child has not had any regular vaccinations.
She is looked after at home, but attended a playgroup until 2
weeks ago.
What’s your primary diagnosis?
A: Bacterial Meningitis
B: Kawasaki Disease
C: Fifth Disease
D: Chickenpox
E: Rubella

5. + Common Childhood Infections
Meningitis
Rash associated with bacterial
septicaemia (non-blanching,
maculopapular). Expect higher fever
Immediate Management?
Rubella
Respiratory spread, 14-21 day incubation.
Fever, then spreading maculopapular rash
(face to trunk) which fades in 3-5 days.
!! Pregnancy !!
Fifth Disease
Aka ‘Slapped Cheek’ caused by
Parvovirus. Painless rash on
one/both cheeks. Mild fever, usually
self-limiting. Peak incidence
April/May
Chickenpox
Respiratory spread. 10-21 day incubation.
Clusters of vesicles over
head/neck/trunk. Intensely itchy. Papule
 Vesicle  Pustule  Crust + Scratch
marks
Kawasaki’s (vasculitis)
Fever >5 days + Strawberry tongue, peeling skin (desquamation) ,
cervical lymphadenopathy, bilateral conjunctivitis. Complications:
myocardial ischaemia and sudden death

6. +
Rashes of Childhood Diseases

7. + Normal Reference Ranges in Children
They are different!

8. +
Q: Abdominal Pain
 A 2 year old boy is brought to his GP with intermittent screaming
and pain, followed by periods where he is quiet and withdrawn.
He has had one loose, jelly-like stool passed today. O/E there is a
mass palpable in his abdomen.
A: Meckel’s Diverticulum
B: Gastroschisis
C: Intussusception
D: Sigmoid volvulus
E: Appendicitis

9. +
Q: Abdominal Pain
 A 2 year old boy is brought to his GP with intermittent screaming
and pain, followed by periods where he is quiet and withdrawn.
He has had one loose, jelly-like stool passed today. O/E there is a
mass palpable in his abdomen.
A: Meckel’s Diverticulum
B: Gastroschisis
C: Intussusception
D: Sigmoid volvulus
E: Appendicitis

10. +
Paediatric Acute Abdomen
Intussusception
Cause of 25% of acute abdomen
in children <5. Male: female 3:2.
Usually sudden onset, colicky in
nature.‘Sausagey mass’,
‘redcurrant jelly stool’
Meckel’s Diverticulum
Embryological remnant of
vitellointestinal tract. Presents
with intermittent, painless blood
PR. Dx via Technetium scan to
find ectopic gastric mucosa
Gastroschisis
Where abdomen is not covered
by peritoneum.
This is found prenatally or
postnatally and repaired
surgically
Appendicitis
Rarer cause of acute abdomen
for age group (usually 10-20y/o).
Migratory pain, not colicky. O/E
usually no mass to palpate

12. +
Q: Respiratory Distress
 A 6 year old African-Caribbean girl comes to ED with her
father. She appears lethargic and is sat quietly, but clearly
struggling to breathe. She has been unwell for around 6
hours and is sat forward dribbling.What is the diagnosis?
A: Epiglottitis
B: Croup
C: Bronchiolitis
D: Foreign body inhalation
E: Sickle cell crisis

13. +
Q: Respiratory Distress
 A 6 year old African-Caribbean girl comes to ED with her
father. She appears lethargic and is sat quietly, but clearly
struggling to breathe. She has been unwell for around 6
hours and is sat forward dribbling.What is the diagnosis?
A: Epiglottitis
B: Croup
C: Bronchiolitis
D: Foreign body inhalation
E: Sickle cell crisis

14. +
So you think it’s Epiglottitis…
 What do you do next?
A: Start broad spectrum antibiotics
B: Examine the throat for site of obstruction
C: Start high flow Oxygen
D: Call the anaesthetist
E: Order a Chest X-ray

15. +
So you think it’s Epiglottitis…
 What do you do first?
A: Start broad spectrum antibiotics
B: Examine the throat for site of obstruction
C: Start high flow Oxygen
D: Call the anaesthetist
E: Order a Chest X-ray

16. +
Respiratory Tract Infections
Epiglottitis
Causes severe life-threatening
stridor quickly due to H.
Influenzae infection. If suspected,
don’t delay urgent GA and upper
airway endoscopy needed
Croup
Usually mild, viral illness. Also
causes stridor and a barking
cough (like a sealion). May have
fever and develops more slowly.
Usually affects children 6m to 5yrs
Bronchiolitis
Viral RTI affecting children
under 2 years (peak 3-6m).
Seasonal illness (winter). Usually
caused by Respiratory Syncytial
Virus (RSV).Treat with fluids, O2
Foreign Body
Sudden onset of SOB ± history of
aspiration from observer.
Unilateral signs
(wheeze/reduced air entry). RHS
more common

17. +
Q: Childhood Injuries
 A 10 month old boy presents to ED crying and clutching his right
arm. He cries out when you attempt examination. His mother
describes an accurate method of injury (fall from side of cot onto
tiled floor) and brought the child immediately to ED. X-ray
demonstrates 
 What part of the history will be most helpful for
informing on going management?
A: Family history
B: Past Medical history
C: Dietary history
D: Developmental history
E: Drug history

18. +
Q: Childhood Injuries
 A 10 month old boy presents to ED crying and clutching his right
arm. He cries out when you attempt examination. His mother
describes method of injury (fall from side of cot onto tiled floor)
and brought the child immediately to ED. X-ray demonstrates 
 What part of the history will be most helpful for
informing on going management?
A: Family history
B: Past Medical history
C: Dietary history
D: Developmental history
E: Drug history

19. +

20. +
Highly Suspicious Injuries
 Long bone fractures in non-ambulatory children
 Any fracture under 6 months
 Spiral fractures
 Rib fractures in infant (Shaken baby) esp. Posterior
 Depressed skull fractures
 NB. Safeguarding!

21. +
Q:Vaccinations
 A 3 1/2 year old girl from Exeter attends her practice nurse with
her pregnant mother for her MMR vaccine. She is usually fit and
well except for Asthma. She recently had a RTI but is now
afebrile following a 1 week course of steroids. She is allergic to
eggs. Her brother has previously had a reaction to the MMR
vaccine.
What is the contraindication to having her MMR today?
A: Egg allergy
B: Recent steroids
C: Family History of vaccine reaction
D: Recent infection
E: Mother’s pregnancy

22. +
Q:Vaccinations
 A 3 1/2 year old girl from Exeter attends her practice nurse with
her pregnant mother for her MMR vaccine. She is usually fit and
well except for Asthma. She recently had a RTI but is now
afebrile following a 1 week course of high dose steroids. She is
allergic to eggs. Her brother has previously had a reaction to the
MMR vaccine.
What is the contraindication to having her MMR today?
A: Egg allergy
B: Recent steroids
C: Family History of vaccine reaction
D: Recent infection
E: Mother’s pregnancy

23. +
Childhood Vaccinations
Live Vaccines
• MMR
• BCG
Inactivated/Polysaccharide/
Toxoid Vaccines
• DTaP/IPV/Hib (Pediacel)
• Tetanus
• Influenza
• Pneumococcus
True Contraindications to
Vaccination
• Egg anaphylaxis (influenza,
yellow fever)
• Prednisolone 2/mg/kg/day
for >6 days
• Impaired immunity
• Chemo/RadioRx in last 6 wks
• Bone marrow transplant in
last 6 months
• Immunosuppression with
cytotoxic drugs

25. +
Q: Mobility Problems
 A 4 year old boy attends Paediatric Outpatient Clinic with
difficulty walking, and trips. Developmentally, he sat up by 9
months and was walking by 20 months. His mother has noticed a
limp. O/E he has unsteady gait and poor balance.
The doctor diagnoses Muscular Dystrophy. How is this inherited?
A: Autosomal Dominant
B: X-linked Recessive
C: Autosomal Recessive
D: Polygenic Inheritance
E: X-linked Dominant

26. +
Q7: Mobility Problems
 A 4 year old boy attends Paediatric Outpatient Clinic with
difficulty walking, and trips. Developmentally, he sat up by 9
months and was walking by 20 months. His mother has noticed a
limp. O/E he has unsteady gait and poor balance.
The doctor diagnoses Muscular Dystrophy. How is this inherited?
A: Autosomal Dominant
B: X-linked Recessive
C: Autosomal Recessive
D: Polygenic Inheritance
E: X-linked Dominant

27. +
Heritance Patterns
Autosomal Dominant
 Familial hypercholesterolaemia – 1
in 500
 Polycystic kidney disease – 1 in 1250
 Marfan Syndrome – 1 in 4000
 Huntington Disease – 1 in 15 000
X-Linked (recessive)
 Red-Green colour-blindness
 Duchenne’s and Becker’s Muscular
Dystrophies
 Fragile X syndrome
 Haemophilia A and B
Autosomal Recessive
 Sickle cell disease – 1 in 625 (Black
African-Caribbeans)
 Cystic fibrosis – 1 in 2500
(Caucasians)
 Tay-Sacs disease – 1 in 3000
(Ashkenazi Jews)
Others
 X-linked (Dominant):Vitamin D
resistance Rickett’s
 Mitochondrial (passed by mother)
 Polyfactorial (congenital or
acquired) e.g. Diabetes, Epilepsy…

28. +
Punnett Square
Which/who is the…?
 Heterozygote
 Homozygote
 Dominant allele?
 Affected child?
 Unaffected?
What type of heritance is
this?

29. +
Bonus Question
What are the names of the two hip tests we carry out to look for
congenital hip disorders in neonates?

30. +
Congenital Hip Malformations
Ortolani’s
 Flex hip to 90o then
move hips OUT
 Tests for posterior
disclotion
Barlow’s
 Move hips inwards
 Tests for
posterolateral
dislocation

31. +
Q: Managing Epilepsy
 A 7 year old child with known Epilepsy is having a seizure in
a GP’s waiting room.You are called to assess them.This
seizure has continued for 5 minutes.What should you do first?
A: Secure the airway
B: Call an ambulance
C: Remove objects from around the child e.g. chairs
D: Give Midazolam
E: Give Diazepam

32. +
Q: Managing Epilepsy
 A 7 year old child with known Epilepsy is having a seizure in
a GP’s waiting room.You are called to assess them.This
seizure has continued for 5 minutes.What should you do first?
A: Secure the airway
B: Call an ambulance
C: Remove objects from around the child e.g. chairs
D: Give Midazolam
E: Give Diazepam

33. +
Seizures and their management
 Emergency Management for seizures lasting >5 mins:
Call 999
Give buccal Midazolam in the community, IV Lorazepam if IV
access available (or PR Diazepam)
Status Epilepticus = seizure (or cluster of seizures) lasting >10
mins.
Treated with Benzodiazepines  Phenobarbitol  Phenytoin

34. +
Summary and Top Tips
 If it’s obvious, go for it; they’re probably not trying to trick you!
 Read the vignettes carefully looking for key words. Bring a
highlighter if that helps
 Write things out if that works for you, especially for genetics
questions
 If the question asks what you’d do FIRST… it’s probably“high flow
oxygen”
 Don’t get too bogged down with details, remember the big stuff
and the common stuff and you’ll be fine!

35. +
Some Key Words/Phrases
 Strawberry tongue and
‘desquamation’ of palms =
Kawasaki’s
 Redcurrant jelly
stool/sausagey mass =
Intussusception
 Sick child sat forward and
drooling = epiglottitis
 Barking cough = Croup
Spiral fracture = Non-accidental
injury

36. +
Learning Objectives
 Revise key Indicative Presentations for the AMK including…
 Paediatric emergencies (“what would you do first?”)
 Common inherited conditions
 Community Paediatrics (normal development,
vaccinations)
 Common childhood infections and their management
 Fractures and common injuries

37. +
Thank you! Any questions?
evawooding@nhs.net

38. +
Further Reading and References
 Etheridge, L (ed.) Oxford Assess and Progress: Clinical
Specialties 2010 OUP: Oxford.
 Core Clinical Cases in Paediatrics 2nd ed. Ewer A, Gupta R,
Barrett T, Gupta J. 2011 Hodder Arnold: London.
 Orekunrin O, Chaplin H. Revision Questions for Paediatrics. 2010
Radcliffe: Oxford.
 Patient UK, 2013. Accessed online:
http://www.patient.co.uk/doctor/Paediatric-Examination.htm
(accessed 08/10/13).
 University of Texas, 2013. Accessed online:
http://www.utmb.edu/pedi_ed/CORE/Abuse/page_08.htm
(accessed 08/10/13).
 Almost A Doctor: Mind Maps, 2013. Accessed online:
http://almostadoctor.co.uk/sites/all/MindMaps/409.pdf
(accessed 08/10/13)

39. +
Picture References
 Pictures are copyright and royalty free unless referenced
 Chickenpox http://www.theintellectualdevotional.com
 Kawasaki’s
disease:http://en.wikipedia.org/wiki/File:Kawasaki_symptoms_B.jpg
 Meningococcal septicaemia:
http://www.wales.nhs.uk/sites3/page.cfm?orgId=457&pid=32261
 Spiral Fracture:
http://www.utmb.edu/pedi_ed/CORE/Abuse/page_08.htm
 https://www.gov.uk/government/uploads/system/uploads/attachment_
data/file/204061/DoH_Imm_schedule_poster_A4_2013_07_accessible.p
df
 Punnett Square:
http://upload.wikimedia.org/wikipedia/commons/2/22/Punnett_Squar
e.svg
 Ortolani/Barlow’s Manoeuvre http://www.cssd.us/body.cfm?id+512