Paediatrics

Question 1

Categorise paediatric limp according to age.

Answer 1

ANY AGE

• Septic arthritis
• Cellulitis
• Osteomyelitis
• Trauma
• Haemarthrosis
• Neoplasia

AGE 1 - 3

• DDH
• Transient synovitis
• Toddler’s fracture
• Rickets

AGE 3- 10

• Transient synovitis
• Rickets
• Perthe’s
• Leg length discrepancy

AGE 10 - 16

• SUFE
• Osgood Schlatter
• Frieberg disease
• Chondromalasia

Question 2

List the risk factors for developing bronchiolitis?

Answer 2

• Young infants (age under 3 months)
• Premature birth (born <35 weeks gestation) (infants born at <29 weeks of gestation are at a particularly higher risk for hospitalization from RSV infection)
• Chronic respiratory disease (including bronchopulmonary dysplasia)
• Congenital heart disease (particularly heamodynamically significant congenital heart disease, e.g. with pulmonary hypertension)
• Immunodeficiency
• Severe congenital or acquired neurologic disease (neuromuscular disorders)

Question 3

List the criteria for hospital admission in patient with bronchiolitis?

Answer 3

1. Apnoea (observed or reported)
2. Persistent oxygen saturation of less than 92% when breathing air
3. Inadequate oral fluid intake (50 - 75% of usual volume, taking account of risk factors
4. Persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of more than 70 breaths/minute.
5. Consider risk factors for more severe bronchiolitis.
6. Social issues consider factors that may affect a carer’s ability to look after a child with bronchiolitis, for example:
   – Social circumstances
   – The skill and confidence of the carer in looking after a child with bronchiolitis at home
   – Confidence in being able to spot red flag symptoms
   – Distance to healthcare in case of deterioration (NICE CKS, 2015).

Question 4

What fracture patterns will suggest NAI?

Answer 4

1. Rib fractures
2. Femoral fractures in children who are not walking
3. Metaphyseal fractures in very young children
4. Spiral or oblique fracture
5. Skull fracture
6. Tibia & Fibula fracture in children under 18 months

Question 5

What are the differential for croup?

Answer 5

1. Acute epiglottitis
2. Bacterial tracheitis
3. Foreign body, inhaled or aspirated
4. Allergic reaction / anaphylaxis

Question 6

What are the components of westley croup score?

Answer 6

1. Retraction
2. Air entry
3. Stridor
4. SPO2 < 92%
5. Level of consciousness

Question 7

Contraindication for diamorphine intranasal administration

Answer 7

1. Children < 10 kg
2. Known allergy
3. Head injury or neurological problem
4. Epistaxis
5. Airway compromise

Question 8

Which circumstances in paediatric cardiac arrest would you administer Sodium bicarbonate 8.4% (1ml/kg)?

Answer 8

1. Hyperkalaemia
2. TCA overdose
3. Prolonged arrest

Question 9

When would you admit a child with febrile convulsions for paediatric assessment?

Answer 9

• It is the first presentation of febrile seizure (or a subsequent febrile seizure and the child has not had previous specialist assessment).
• The child is less than 18 months of age
• There is diagnostic uncertainty
• There are any features of a recurrent complex febrile seizure.
• There is any focal neurological deficit.
• There was a decreased level of consciousness prior to the seizure.
• The child has recently taken antibiotics (may mask the signs of central nervous system infection).
• There is parental/carer anxiety and/or difficulty coping.

Question 10

What are the complications of retained foreign body aspiration?

Answer 10

1. Complete airway obstruction
2. Atelectasis
3. Pneumonia
4. Bronchiectasis
5. Abscess

Question 11

What are the 5 low risk features for BRUE?

Answer 11

1. > 60 days
2. Born >32 weeks
3. First event
4. Event lasted for < 1 minute
5. No CPR by trained health care.

Question 12

How would you clinically diagnose whooping cough?

Answer 12

Paroxysmal cough.
Inspiratory whoop.
Post-tussive vomiting.
Undiagnosed apnoeic attacks in young infants.

Question 13

What are the complications of whooping cough?

Answer 13

Serious complications of pertussis include:

• Apnoea.
• Pneumonia (usually caused by secondary bacterial infection).
• Seizures.
• Encephalopathy (rare in adults).

Less serious complications include:

• Otitis media in children (caused by secondary bacterial infection).
• Unilateral hearing loss (rarely reported).
• Increased intra-thoracic and intra-abdominal pressure due to violent and/or prolonged coughing can cause:
  
  • Pneumothorax.
  • Umbilical and inguinal hernias, and rectal prolapse.
  • Rib fracture and herniation of lumbar intervertebral discs.
  • Urinary incontinence.
  • Subconjunctival or scleral haemorrhage, and facial and truncal petechiae.
• Frequent post-tussive vomiting can lead to severe dehydration and/or malnutrition.

Question 14

When would you admit patient with whooping cough?

Answer 14

1. 6 months of age or younger and acutely unwell.
2. Has significant breathing difficulties (for example apnoea episodes, severe paroxysms, or cyanosis).
3. Has a significant complication (for example seizures or pneumonia).

Question 15

How would you differentiate between bacterial tracheitis acute epiglottitis?

Answer 15

Bacterial Tracheitis

• Rapid onset
• Fever > 39
• Productive cough
• Hoarse voice
• Partial or no response to Adrenaline nebs
• Steeple on Lateral neck xray

Epiglotittis

• Very rapid onset
• Fever > 39
• Suppressed cough
• Muffled voice (Dysphagia + Drooling)
• No response to Adrenaline
• Thumb printing sign on lateral neck X-ray

Question 16

What are the rules for assessing a child to be Fraser competent?

Answer 16

1. That the girl (although under the age of 16 years of age) will understand his advice
2. that he cannot persuade her to inform her parents or to allow him to inform the parents that she is seeking contraceptive advice
3. that she is very likely to continue having sexual inter course with or without contraceptive treatment
4. that unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer
5. that her best interests require him to give her contraceptive advice, treatment or both without the parental consent” (Gillick v West Norfold, 1985).