DR LUYTS HIGH YIELD TOPICS

Question 1

2 year old reffered to ED with fever.
1) What are you ddx?

Answer 1

Otitis media.
* Recognisable/rapidly diagnosed viral illness:
* Viral exanthum e.g., roseola, measles.
* Seasonal influenza.
* COVID-19.
* Bacterial infection:
* Urinary tract infection.
* Meningitis/encephalitis.
* Pneumonia.
* Arthritis/Cellulitis.
* Sepsis.

Question 2

2 year old reffered to ED with fever.
2) What is your approach?

Answer 2

Does the child appear unwell?
Rapid ABCDE assessment:
Airway
Breathing
Look, listen and feel for:
1. Signs of airway obstruction.
2. Signs of respiratory distress:
a. Respiratory rate.
b. Use of accessory muscles
3. Observe for any chest deformity.
4. Check position of trachea
5. Auscultate chest for:
a. Presence of breath sounds.
b. Abnormal sounds e.g., wheeze, stridor.
6. Assess oxygenation: cyanosis; SpO2.
Circulation Feel and assess:
1. Colour – blue, pink, pale, mottled.
2. Limb temperature – cool or warm.
3. Capillary refill time.
4. Assess state of veins – underfilled/collapsed
5. Pulse rate.
6. Pulse presence, rate, quality, regularity.
7. Blood pressure.
8. Auscultate heart for murmur/pericardial rub
Disability Observe and note:
1. Level of consciousness.
2. Posture – hypotonic, decorticate, decerebrate.
3. Pupil size and reactivity.
Exposure Examine patient properly; maintain dignity

Question 3

4 year old with a fever.
What are your bedside investigations?

Answer 3

• Capillary blood gas.
• • Blood glucose.
• • Urine dipstix.
• • Naso-pharyngeal aspirate: ‘Flu, COVID, RSV

Question 4

4 year old with a fever

Otitis media presentation?

Answer 4

• Coryzal prodrome: runny nose, mild fever.
• Presenting symptoms: fever, sore throat, earache.
  off feeds ± cough.

Question 5

4 year old with a fever

Complications of otitis media?

Answer 5

• Hearing loss: caused by middle ear effusion.
  sensorineural hearing loss uncommon
• Balance problems: vestibular problems/labyrinthitis
• Tympanic membrane: perforation/retraction.
• Chronic suppurative otitis media.
• Cholesteatoma/Mastoiditis.
• Intra-temporal e.g., facial paralysis, periostitis.
• Intra-cranial e.g., cavernous sinus thrombosis

Question 6

4 year old with a fever

Presentation of pharyngitis?

Answer 6

Coryzal prodrome: runny nose, mild fever.
Presenting symptoms: fever, sore throat, cough.
difficulty swallowing.

Question 7

Pharyngitis causative organisms?

Answer 7

Viral Pharyngitis, Infants and young children:
* Herpangina (enterovirus)
* Respiratory viruses
* SARS-Cov-2
Viral Pharyngitis: Older children and adolescens
EB virus (IM)
* Respiratory viruses
* Herpangina
* SARS-Cov-2

Bacterial Pharyngitis: Infants and young kids:
* Gp A streptococcus
* Other bacteria

Bacterial Pharyngitis:Older children and adolescens
* Gp A streptococcus
* Other bacteria

Question 8

Outline fever pain?

Answer 8

Fever (during past 24 hours)- 1
Purulence (pus on tonsils)-1
Attend rapidly (<3d of onset)-1
Severely inflamed tonsils-1
No cough or coryza-1

Maximum score = 5

Likelihood of isolating
streptococcus
0-1: 13-18%
2-3: 32-56%
4-5 62-65%

Question 9

4 year old with a fever

and maculopapular rash. What are you ddx?
Describe each one.

Answer 9

Roseola infantum (Herpesvirus 6/7):
* Illness of young children – peak age 7 to 13 month.
* Fever for 3-5 days; stops abruptly with rash.
* Cervical, post-auricular and suboccipital LN common.
* Rash persists for 2-4 days; self-limiting condition.

Scarlet fever (Group A Streptococcus):
* Diffuse erythematous eruption following pharyngitis.
* Rash feels like sandpaper; last for a week.
* When rash fades skin peels (fingertips, toes, groin).
* Risk of Rheumatic fever; treat with Penicillin.

Measles (Morbillivirus):
* Cough, coryza and conjunctivitis with fever.
* Rash spreads from face downwards; lasts 3-7 days.
* Complications in about a third; death in 4-10%.
* Asso: respiratory and neurological complications.

Slapped cheek or Fifth disease (Parvovirus B19):
* Mainly affects primary school children.
* Fever lasts 2-5 days; then malar erythema.
* Followed several days later by lace-like rash on body.
* Associations: arthralgia, aplastic anaemia, GBS

Question 10

4 year referred to ED with fever

and vesicular rash.What are you ddx?
Describe each one.

Answer 10

Chicken pox (Herpes zoster – Herpes type 3):
* Incubation period 14-16 days (range 10-21 days).
* >90% of susceptible household contacts infected.
* Rash in crops over body; new lesions stop after 4d.
* Asso: acute cerebellar ataxia, encephalitis, LRTI.

Erythema multiforme (Herpes 1 commonest):
* Immune mediated typically self-limiting.
* Evolves over 3-5 days; resolves in 14 days.
* Mucocutaneous condition with target skin lesions.
* Mucosal blisters – favour mouth; also urogenital.

Herpes simplex virus infection (Herpes virus 1):
* Affects 66% worldwide in low/middle income.
* Presentation depends whether 1○ or 2○ infection.
* 1○: gingivitis with generalised oral vesicles.
* 2○: reactivation – localised vesicular lesion.

Hand foot and mouth disease (Coxsackie A16):
* Common, mild, self-limiting illness.
* Mainly affects children <5 years.
* Vesicle and ulcers in mouth, palate and pharynx.
* Macules, then blisters on palms and soles - later peel.

Question 11

Paeds Sepsis 6 bundle?

Answer 11

Question 12

Macular or maculopapular rash ddx?

Answer 12

• Viruses: Roseola infantum, Slapped cheek, Measles, Rubella.
• Bacteria: Scarlet fever, Rheumatic fever, Typhoid fever, Lyme’s disease.
• Others: Kawasaki Disease, Juvenile Rheumatoid arthritis.

Question 13

Vesicular, bullous and pustular rash Ddx?

Answer 13

• Viruses: Herpes simplex, Herpes zoster, Hand foot and mouth disease.
• Bacteria: Boils, Impetigo, Staphylococcal scalded skin syndrome.
• Others: Erythema multiforme, TEN, SJS.

Question 14

Petechial or purpuric rash ddx?

Answer 14

• Viruses: Enterovirus, Adenovirus and other viral infections.
• Bacteria: Meningococcal and other bacterial sepsis, Infective endocarditis.
• Others: Henoch-Schonlein purpura, Immune thrombocytopenia, Leukaemia.

Question 15

4-year-old with a fever for 5 days, rash and erythema of lips & oral mucosa.

Answer 15

• Kawasaki disease

Question 16

Fun facts about Kawasaki?

For OSCE

Answer 16

• One of the most common vasculitides in children; also occurs in adults.
• Acute self-limiting an acute self-limiting inflammatory disorder affecting predominantly medium sized arteries, particularly coronary arteries causing aneurysms in 15-25% if untreated.
• Commonest causes of acquired heart disease in children in developed countries.

Question 17

Diagnostic criteria for Kawasaki?

Answer 17

Question 18

Management of kawasaki?

Answer 18

• Needs ECG, CXR and cardiac ECHO.
• Treatment: IV Ig; Aspirin - high dose in acute phase followed by low dose maintenance.

Question 19

Lab findings in kawasaki?

Answer 19

• Systemic inflammation with mild anaemia, leucocytosis with left shirt and thrombocytosis (end of week 2).
• Raised ferritin (acute phase reactant).

Question 20

4 year old with acute onset fever and headache. Ddx?

Answer 20

Question 21

Think of some cough types, what is the diagnosis and what inv would you do?

Answer 21

Question 22

4 year old with acute onset fever, cough and dyspnoea. What is the treatment algorithm for severity of the infection?

Answer 22

Question 23

2 year old referred to ED with fever.
1) other symptoms?
2) Inv and findings
3) Treatment?

Answer 23

Question 24

Indication for ultrasound for a UTI in children?

Answer 24

Question 25

How to prevent UTIs in children?

Answer 25

* Use the potty more often: * Time child’s potty sessions: Young children hold their pee as they don’t want to take breaks from their play. After experiencing a UTI, may be afraid to pee as it might burn. Ask child to empty bladder every 2-3 hours. * Empty bladder completely: Some children don’t empty bladder completely when peeing. Just pee enough to make sensation go away because they are in a hurry to go back to play. Ask child to ‘double pee’ each time; or try again before wiping. * Proper wiping: Wipe from front to back. * Stay hydrated: * Avoid constipation: * Choice of clothing: Cotton underpants are recommended. Avoid nylon, synthetic, tight-fitting underwear. * No bubble baths: Frothy soapy water can lead to skin irritation.

Question 26

# 6-year-old boy presents to ED acute onset fever and a limp. Transient synovitis vs septic arthritis?

Answer 26

Question 27

Ddx for atraumatic limp?

Answer 27

Question 28

Common conditions with abx therpay and the duration?

Answer 28

Question 29

# Child present with a cough What would you cover in the hx?

Answer 29

Question 30

Causes of chronic cough in children and RF/ mechanisms?

Answer 30

Question 31

Braindump croup

Answer 31

Question 32

Causes of acute stridor?

Answer 32

* Acute epiglottitis * Bacterial tracheitis * Severe LN swelling * Tonsillar abscess * Retropharyngeal abscess * Measles * Diphtheria * Acute laryngeal oedema (allergy) * Inhaled foreign body * Inhalation of smoke or hot fumes * Trauma to throat * Hypocalcaemia * Psychological (VCD)

Question 33

Braindump bronchiolitis?

Answer 33

Question 34

# Child presents to doctor with wheeze and breathlessness 1) ddx and facts about them

Answer 34

Question 35

Aims of asthma managment?

Answer 35

Question 36

What shows inadequate symptoms control in asthma?

Answer 36

Question 37

Think of asthma medicines. What are their MOA What are their adverse effects?

Answer 37

Question 38

Causes of central cyanosis in the newborn?

Answer 38

Question 39

What is choanal atresia?

Answer 39

Question 40

What is laryngomalacia?

Answer 40

Question 41

What is microganthia?

Answer 41

Question 42

What is congential lobar emphysema?

Answer 42

Question 43

What is congenital diaphragmatic hernia?

Answer 43

Question 44

What are the findings an the ddx for the following?

Answer 44

Question 45

Characteristics of innocent murmus?

Answer 45

Question 46

Grading of murmurs?

Answer 46

Question 47

Causes of abdo pain in children?

Answer 47

Question 48

# An 8-month-old child presents to ED with spasms acute abdominal pain. Intussussception brain dump

Answer 48

Question 49

Constipation braindump | presentaion, red flags and assoc sympts

Answer 49

Question 50

Distinguish between normal, clinical dehydration and clinical shock?

Answer 50

Question 51

When is dehydration more likely?

Answer 51

Question 52

# Diarhoea How to treat: Without dehydration Clinical dehydration Shock

Answer 52

Question 53

Causes of vomiting in children?

Answer 53

Question 54

What is: Posseting Regurgitation Vomitting

Answer 54

Question 55

GORD braindump | causes, complications, management

Answer 55

Question 56

Pyloric stenosis brain dump

Answer 56

Question 57

# A 10 year old boy referred for concern about growth. What is short stature? How do you measure growth failure How to assess height?

Answer 57

Question 58

Causes of short stature

Answer 58

Question 59

Abnormalities in downs syndrome?

Answer 59

Question 60

Causes of downs syndrome?

Answer 60

* Meiotic non-dysjunction (94%) * Robertsonian translocation (5%)

Question 61

Clinical features of turners?

Answer 61

Question 62

Classifications of headaches?

Answer 62

Question 63

Red flags for space occupying lesions?

Answer 63

Question 64

# Child presents with seizure what are your ddx? Which inv would you do? What is status epilepticus?

Answer 64

Question 65

Brain dump epilepsy syndromes

Answer 65

Question 66

Causes of floppy infant?

Answer 66

Question 67

What is spinal muscular atropy?

Answer 67

* Autosomal recessive. * Degeneration of the anterior horn cells. * Defect in Survival Motor Neurone 1 (SMN1) gene. * Leading to progressive denervation and weakness of skeletal muscles. * Variable presentation (5 types) depends on SMN2 gene (backup) numbers.

Question 68

Brainsump Duchenne Muscular dystrophy?

Answer 68

X-linked recessive. Most common inherited neuromuscular disease – affects 1 in 3600 boys. Deletion of dystrophin gene. Leads to progressive myofiber necrosis. Clinical features Diagnosis at about 5 years; although present much earlier with with waddling gait ± language delay. Muscle pseudohypertrophy (especially in calves) due to fat deposition. Gower’s sign – typically starts at 3 years and develops at 5-6 years; using hands to climb over body to stand. Weak back muscles cause kyphoscoliosis Also: cardiomyopathy, GE reflux intellectual impairment. Life expectancy: 20 years.

Question 69

Braindump ITP

Answer 69

Question 70

Braindump nephrotic syndrome

Answer 70

Question 71

Aetiology of neonatal jaundice?

Answer 71

Question 72

Developmental milestones?

Answer 72