Dr Ewa’s Cases

Question 1

Mx of NEC

Answer 1

Complete bowel rest, fluids and ABx

Surgery - Ladds procedure

Question 2

Intussusception Sx

Answer 2

Prodromal coryzal symptoms causing enlarged lymph nodes
Abdo pain
Red currant jelly stool
Baby crying in episodes due to colicky pain

Question 3

Mx of abdo pain

Answer 3

Fluids, analgesia
Rectal air enema / contrast enema
Surgery detangling or resection of bowel

Question 4

Causes of abdo pain in kids

Answer 4

NEC
Pyloric stenosis 
Constipation 
Appendicitis 
Intussusception 
DKA 
HSP 
Mesenteric addenitis
Gastroenteritis 
Coeliac

Question 5

Abdo pain after eating in slim teenager ? Mx?

Answer 5

H Pylori - stool sample

Question 6

What is seen on CXR of duodenal atresia?

Answer 6

Double bubble sign

Question 7

Sx of pyloric stenosis ?

Answer 7

Projectile Vomiting & crying

Question 8

Sx of cows milk protein allergy mild and severe

Answer 8

Mild to mod - colick, diarrhoea, food aversion, constipation, blood in stool, erythema
Severe - failure to thrive, atopic dermatitis

Question 9

What type of reaction is anaphylaxis

Answer 9

IgE mediated

Question 10

Mx of cows milk protein allergy

Answer 10

Avoid all milk products - inc cheese yoghurt etc (mother and baby if breastfeeding)
Tell mother to take vitamin D while breastfeeding
Try above for 6 weeks then rechallenge
Try hydrolysed formula is formula fed baby

Question 11

Causes of breathing difficulty

Answer 11

Asthma
Croup
Bronchiolitis
Anaphylaxis

Question 12

Description of asthma Sx

Answer 12

Interval symptoms

Question 13

Signs of difficulty breathing

Answer 13

Can’t speak full sentences
RR high 
Intercostal and sub coastal recessions 
Nasal flaring 
Tracheal tug 
Head bobbing 
Shunting

Question 14

What is a bad sign in asthma?

Answer 14

Rising and normalising PCO2
Can’t speak full sentences
Peak flow < 33%

Question 15

PC of bronchiolitis

Answer 15

Fever, cough, breathing difficulties, inspiratory creps (crunchy noise) plus wheeze. High RR

Question 16

What causes bronchiolitis

Answer 16

RSV

Question 17

Mx of bronchiolitis

Answer 17

Supportive - o2 and NG feeding if needed

CPAP if needed

Question 18

What can be given to prevent bronchiolitis in at risk babies? Eg prem

Answer 18

Panulizimab AB given every month

Question 19

Features of croup

Answer 19

Coryzal Sx
Barking cough
Stridor

Question 20

What causes croup

Answer 20

Parainfluenza

Question 21

Mx of croup

Answer 21

All get dexamethasone

Can give nebulised adrenaline if needed but they can get worse v quickly after

Question 22

What score is used to categorise croup?

Answer 22

Westley score

Question 23

Features of epiglottitis

Answer 23

Stridor 
Drooling 
Leaning at end of bed 
High fever 
Look toxic

Question 24

Cause of epiglottis

Answer 24

HiB

Question 25

Mx of epiglottitis

Answer 25

ABx IV Senior anaesthetist help Intubation if needed

Question 26

Sx of pneumonia

Answer 26

``` Fever Productive cough Chest pain Coryzal symptoms Tachypnoea and tachycardia ```

Question 27

Mx of pneumonia

Answer 27

CAP - amoxicillin, antipyretics | Complicated - IV ABx, plus fluids

Question 28

What causes whooping cough

Answer 28

Bordatella pertussus

Question 29

Mx of whooping cough and why

Answer 29

Erythromycin - makes them less infectious to others

Question 30

Complication of whooping cough

Answer 30

Apnoea

Question 31

Sx of meckels

Answer 31

Blood in stool | Pain in abdo

Question 32

Sx of periorbital cellulitis

Answer 32

Swollen eyes Sometimes can’t open eye Reduced eye movements and vision

Question 33

Mx of periorbital cellulitis

Answer 33

ABx Nasal wash and sprays Decongestants MRI to check it’s not spread backwards

Question 34

What is orbital cellulitis ?

Answer 34

ENT emergency

Question 35

Sx of otitis media

Answer 35

Pain Fever Bulging red ear drum

Question 36

Mx of otitis media

Answer 36

Usually nothing as it was resolve | ABx

Question 37

When does foreign body in ear need to be removed immediately?

Answer 37

If it’s organic, as it will swell

Question 38

Features that make febrile seizure into complex

Answer 38

More than 15 mins May be repetitive May have Todd’s paresis - paralysis of one side in seizure Fever over 38

Question 39

Does simple febrile convulsions risk you for epilepsy?

Answer 39

No - complex do

Question 40

What is petite mal seizure?

Answer 40

Absence seizures - kid will zone out then come back

Question 41

What are infantile spasms?

Answer 41

Repetitive movements in between crying | Common in children with HIE

Question 42

EEG sign of infantile spasms

Answer 42

Hipps arrhythmia

Question 43

Complications of infantile spasms

Answer 43

Regression of skills and development

Question 44

Mx of infantile spasms

Answer 44

IV steroids and vigabatrin

Question 45

What is adrenarchy?

Answer 45

Starting puberty early

Question 46

When is delayed puberty?

Answer 46

13 in girls, 13.5 in boys

Question 47

Causes of delayed puberty

Answer 47

``` Poor nutrition Turners Inflammatory disorders - UC/coeliac Pituitary issues Radiation ```

Question 48

Normal growth velocity in pre pubertal child

Answer 48

5cm a year

Question 49

How do you calculate growth velocity

Answer 49

Measure in 6 month periods

Question 50

How is jaundice Ix and Mx in neonates?

Answer 50

Check SBR Phototherapy If bad, exchange transfusion

Question 51

Big cause of prolonged jaundice in neonates

Answer 51

Breast milk jaundice

Question 52

Important cause of jaundice in neonates to pick up

Answer 52

ABO mismatch - haemolysis of RBCs

Question 53

Causes of unconjugated high BR

Answer 53

General infection eg UTI | Sickle cell / G6PD infection

Question 54

What happens if you get BR in basal ganglia?

Answer 54

Conictrus - permanent damage causing CP

Question 55

Causes of conjugated high BR

Answer 55

Biliary / liver problems - eg atresia

Question 56

Causes of leg pain

Answer 56

``` Transient synovitis Septic arthritis SUFE Congenital hip Dyslocation Rickets Trauma Juvenille idiopathic arthritis Sickle cell ```