Child and adolescent health

Question 1

special features of a child

Answer 1

large head and occiput 
high ant larynx and floppy epiglottis 
flexible ribs 
smaller blood volume
large surface area to volume

Question 2

how can a large SA to volume cause issues in children

Answer 2

burns of proportional size on adults affect a larger % of child SA
dehydration more common

Question 3

true/false - curved laryngoscopy blade is used to intubate babies

Answer 3

false - a straight one is used to push back the epiglottis

Question 4

most common pathogen in bronchiolitis

Answer 4

RSV

Question 5

most treatment of bronchiolitis is supportive. what may be done in cases that are more severe

Answer 5

NG tube to feed
IV resus
oxygen, or CPAP

Question 6

what is the most common cause of croup

Answer 6

parainfluenza

Question 7

x ray on a patient with croup reveals

Answer 7

steeple sign

Question 8

differential for child with croup

Answer 8

croup
epiglottitis
bacterial tracheitis
foreign body

Question 9

management of croup

Answer 9

consider admitting

single dose oral steroids

Question 10

characteristic symptoms of croup

Answer 10

barking cough

stridor

Question 11

symptoms of meningitis

Answer 11

stiff neck 
non blanching purputic petechial rash 
fatigue 
confusion 
tiredness 
photophobia 
pyrexia

Question 12

what should be considered in UTI in children

Answer 12

abnormal renal tract

consider performing USS

Question 13

what is a febrile seizure

Answer 13

generalised tonic clonic seizure in response to fever

Question 14

what is a breath bolding attack

Answer 14

TLOC and possible fit in response to breath holding whilst crying

Question 15

how do you identify PQTS in a child with syncope

Answer 15

screen for cardiac arrhythmia with an ECG

Question 16

causes of fits, blackouts and seiziure

Answer 16

epilepsy 
breath holding attack 
febrile seizure 
vasovagal episode 
PQTS 
non-epileptic events 
other arrhythmia

Question 17

possible causes of trauma in children?

Answer 17

RTA 
trampoline 
burns 
ingestion 
choking

Question 18

first and foremost priority in NAI

Answer 18

safety and welfare of child

Question 19

surgical causes of GI obstruction

Answer 19

pyloric stenosis
intusseption
volvulus
malrotation

Question 20

features of pyloric stenosis

Answer 20

6 weeks old
vomiting
alkalotic ABG

Question 21

acute abdomen in older children is often _____

Answer 21

appendicitis

Question 22

emergency cause of abdominal pain in boys

Answer 22

testicular torsion

Question 23

biological development in adolescents?

Answer 23

puberty
CNS development
growth

Question 24

psychological development in adolescents?

Answer 24

abstract thought
morality development
development of identity

Question 25

social development in adolescents?

Answer 25

independence | changing relationship

Question 26

what makes a competent young person

Answer 26

understand simple terms, nature and purpose of treatment benefits, risks, alternatives make choice free of coercion retain info long enough

Question 27

true/false - <16s can consent to treatment without parental consent

Answer 27

true

Question 28

true/false- parents can overrule an under 16s decision to consent

Answer 28

false - they cannot unless the patient is not deemed clinically competent

Question 29

when can a young persons confidentiality by invalidated

Answer 29

risk to their health or welfare or grave risk to others without disclosure

Question 30

assessing adolescent development

Answer 30

``` STEP sexual maturity thinking education and employment peers and parents ```

Question 31

things to discuss with adolescents in social hx

Answer 31

``` HEEADSSS home education/employment eating activities drugs sex suicide safety ```

Question 32

age for the majority of childhood deaths

Answer 32

<1

Question 33

second highest age for majority of childhood deaths

Answer 33

15-19 | most preventable

Question 34

mental health issues in adolescents

Answer 34

``` eating disorders mental illness pre-existing condition chronic fatigue functional ```

Question 35

physical health conditions in adolescents

Answer 35

epilepsy asthma IBD diabetes

Question 36

social health conditions in adolescents

Answer 36

sexual relationships | smoking, drugs and alcohol

Question 37

features to include in a transfer from paediatrics to adult clinic

Answer 37

involve the patients transition planning with concerns raised support before and after transfer with clinics

Question 38

pros of specialist hospital adolescent units

Answer 38

highly skilled staff, used to dealing with risk behaviour developmentally appropriate supports health promotion increased independence

Question 39

cons of specialist hospital adolescent units

Answer 39

encourages mimicry inappropriate behaviour takes skilled workers away from other clinics too comfortable

Question 40

what can be given for reflux in babies

Answer 40

gaviscon

Question 41

common respiratory conditions in primary care

Answer 41

``` bronchiolitis croup viral URTI asthma tonsillitis ```

Question 42

rare respiratory conditions in primary care

Answer 42

``` CF epiglottitis foreign body pneumonia malignancy ```

Question 43

medical causes of abdominal pain in children

Answer 43

uti gastroenteritis constipation

Question 44

surgical causes of abdominal pain in children

Answer 44

``` intussception volvulus incarcerated hernia appendicitis testicular trauma ovarian torsion ```

Question 45

medical, but not abdomen specific causes of abdomional pain in children

Answer 45

``` DKA adrenal crisis sickle cell disease function ectopic pregnancy PID IBD ```

Question 46

causes of arthralgia in children

Answer 46

``` inflammatory arthritis transient synovitis perthes SUFE osgood schlatters growth pains tumour infection ```

Question 47

what is hydrocephalus and how is it investigated

Answer 47

head growth out of proportion to rest of body due to fluid accumulation USS to look at ventricle size

Question 48

what conditions are caused due to abnormal head suture formation

Answer 48

scaphocephaly gonocephaly plagacephaly

Question 49

red flags for headache

Answer 49

``` expanding head size vomiting young age waking at night corse on cough/sneeze change in behaviour change in cognitive ability new squint/ CN palsy diplopia or vision change ```

Question 50

red flags for heart murmur

Answer 50

``` cyanosis poor feed SOB fatigue fail to thrive sweating colour change absent fem pulses liver edge gallop creps oedema ```

Question 51

red flags for cough

Answer 51

night time waking failure to thrive recurrence

Question 52

red flags for abdo pain

Answer 52

fail to thrive bloody/bilious vomiting bloody stool

Question 53

what rare conditions may lead to constipation

Answer 53

hirschprings disease gut atresia spinal lesions

Question 54

red flags for issues with bowels

Answer 54

``` weight loss blood fatigue joint/eye involvement rash mouth ulcers ```

Question 55

how common is a type 1 food allergy?

Answer 55

pretty uncommon, anaphylaxis is rare

Question 56

symptoms of a food allergy

Answer 56

``` constipation rhinorrhoea glue ear vomiting cough abdominal pain rash fatigue myalgia itch ```

Question 57

red flag diseases associated with fatigue?

Answer 57

``` inflammtory brain tumours addisons thyroid disease coeliac anaemia ```

Question 58

what type of children suggest having a GH deficiency

Answer 58

short and obese children

Question 59

features of functional pain in children

Answer 59

``` headache abdo pain fatigue poor sleep anxiety ```

Question 60

describe the presentaiton of pyloric stenosis

Answer 60

projectile vomiting milky and following feed 6wks abdominal swelling, visible peristalsis

Question 61

diagnosis and management of pyloric stenosis?

Answer 61

USS sees short thick channel at bottom of stomach | single cut along pylorus to expand valve

Question 62

presentation of intussception?

Answer 62

``` bilious/food vomiting upset legs drawn up visible/palpable mass blood in nappy ```

Question 63

diagnosis and management of intissception

Answer 63

USS reveals sausage shape lesion telescoping in on itself | air enema or surgical intervention

Question 64

describe how malrotation can lead to volvulus

Answer 64

longest distance in abdomen is from terminal ileum to DJ flexure this is supplied by SMA if terminal ileum lies high and DJ flexure lies low then this can lead to volvulus and ischaemia

Question 65

investigation of malrotation and volvulus

Answer 65

upper GI with contrast and follow through

Question 66

how does idiopathic scrotal oedema appear and how is it managed

Answer 66

redess and scotal swelling extending to groin and down to perineum analgesia/antihistamines

Question 67

what is a hydrocele and how does it appear

Answer 67

on descent of the testicel a piece of peritoneum is brought with it, causing fluid accumulation diffuse non tender swelling that transilluminates light

Question 68

how does a hernia in the groin area appear anf how is it managed

Answer 68

appear as swelling with extension to groin cannot get above it need to operate as there is risk of strangulation