ILA 1

Question 1

Septic screen

Answer 1

FBC, CRP, urine culture, blood culture

CXR, LP, U&Es, blood gas

Question 2

Common sites for sepsis to come from

Answer 2

Lungs - pneumonia
Bladder - UTI
Abdomen - Appendicitis

Pelvic - abscesses
Skin - cellulitis/burns
Nervous System - meningitis

Question 3

Types of bacteria: Group B strep

Answer 3

Gram +ve cocci - often in chains

B-haemolytic, catalase -ve

Question 4

Listeria

Answer 4

Gram +ve bacilli

Question 5

E. coli

Answer 5

Gram -ve bacilli

Question 6

H. influenzae

Answer 6

Gram -ve coccobacilli (choc agar)

Question 7

N. meningitidis

Answer 7

Gram -ve cocci

Question 8

S. pneumoniae

Answer 8

Gram + cocci

Question 9

What causes purpura?

Answer 9

Extravasation of the blood into the skin/mucous membranes

Question 10

Causes of purpura rash

Answer 10

DIC, bacteraemia can cause widespread thrombosis, HSP, ITP, leukaemia

Question 11

Management of patients with meningococcal septicaemia

Answer 11

A - Airway
B - high flow O2 (10L/min)
C - IV access, fluids, abx
D - AVPU (pupillary reaction)
E - body temp, glucose, urine output

Question 12

How is men septicaemia transmitted?

Answer 12

Droplets from the upper resp tract

Question 13

What prophylaxis would you give to a pregnant women who has been in contact with a child with men septicaemia?

Answer 13

Ceftriaxone IM single dose

ciprofloxacin also CI in epilepsy

Question 14

What defines a close contact?

Answer 14

anyone who repeatedly and regularly shares the living space of someone with the infectious disease
anyone who has an intimate relationship with the infected case
anyone who has had transient close contact e.g. during intubation

Question 15

JIA investigations

Answer 15

Limb examination
Bloods - FBC, U&Es, LFTs, CRP/ESR, HLA B27
Urine dip
Imaging - Xray

Question 16

Diseases associated with HLA B27

Answer 16

PAIR
Psoriasis
Ankylosing Spondylitis
IBD
Reative Arthritis

Question 17

What are the baseline bloods for JIA usually like

Answer 17

Often normal

Question 18

Differentials for JIA

Answer 18

Conn tissue disorder, malignancy, infection (sepsis)

Question 19

Who is part of the MDT for a child with JIA

Answer 19

Paed Rheumatologists
Nurses
Physios
Paeds Opthalmologists
Dieticians
GP

Question 20

DD of Kawasaki’s

Answer 20

Scalded skin syndrome
Juvenile rheumatoid arthritis
Scarlet fever
Toxic shock syndrome
Measles
Rheumatic fever

Question 21

What sized arteries does Kawasakis affect

Answer 21

medium-sized

Question 22

Investigations for Kawasaki’s

Answer 22

Increased CRP/ESP/Plts/WCC
May be anaemia
Echo

Question 23

Other than fever, what are the signs of Kawasaki’s

Answer 23

MY HEART
M(y) - Mucosal membrane involvement (lips) - red/dry, STRAWBERRY tongue
H - Hands/feet - red + oedematous, desquamation
E - Eyes, bilateral non-purulent conjunctivitis
A - Adenopathy - cervical lymphadenopathy
R - Rash - widespread erythematous
T - Temp, fever for >5days

Question 24

Tx Kawasaki’s

Answer 24

Aspirin, IV Ig, supportive, Echo (immed, + at 4-6weeks)

Question 25

Causes of diabetes insidious + what is it

Answer 25

High volume of dilute urine d/t impaired water resorption by kidneys Cranial - decreased secretion of ADH from PP Nephrogenic - resistance to ADH in the kidneys

Question 26

What investigations would you do in suspected DKA

Answer 26

ABCDE Blood - glucose, ketones, E&Es, creatinine Blood gas Blood + urine cultures ECG - T wave depression (d/t hypokalaemia) Weight

Question 27

Treatment of DKA

Answer 27

(1) Rehydration (SLOWLY over 48hrs) - fluid bolus + maintenance fluids (2) Insulin - following IV fluids for 1hr. Change fluids to +5% glucose when glucose <14mmol/L (3) Potassium - this will fall with Tx, give replacement with fluids

Question 28

RFs for T1 DM

Answer 28

FH, genetics, 4-7yrs or 10-4yrs, enteroviral infections, low vit D

Question 29

What is the most common cause worldwide of cong hypothyroidism

Answer 29

Iodine deficiency

Question 30

What is the most common cause in the UK of cong hypothyroidism

Answer 30

Maldescent of the thyroid + athyrosis

Question 31

What are the DD for a collapsed neonate

Answer 31

``` THE MISFITS! T - Trauma H - Heart disease E - Electrolyte disturbances M - Metabolic I - Inborn errors of metabolism S - Sepsis F - Formula Mishaps I - Intestinal catastrophes T - Toxins S - Seizures/CNS abnormalities ```

Question 32

What is a stridor?

Answer 32

Usually inspiratory, vibrating sounds of varying pitches caused by air flow through a partially obstructed airway

Question 33

DD of bronchiolitis

Answer 33

LRTI Heart failure GOR

Question 34

Risk factors for bronchiolitis

Answer 34

``` Older children Nursery attendance Smoking in the home Prematurity IC ```

Question 35

How would bronchiolitis differ in a CF pt to a normal one?

Answer 35

More likely to be bacterial, give abx for causative infection (will also prevent secondary bact inf if viral)

Question 36

Causes of heart failure in neonates + infants

Answer 36

``` Cardiac arrhythmias Volume overload Pressure overload Systolic vent dysfunction Diastolic vent dysfunction ```

Question 37

What is failure to thrive

Answer 37

Insufficient weight gain or inappropriate weight loss

Question 38

Causes of FtT

Answer 38

``` Inadequate calories: -Poor breastfeeding technique -Persistent vomiting -Chronic disease Inadequate absorption: -Coeliac disease -Liver disease -CF -Diarrhoea – lactose intolerance, cow’s milk protein intolerance etc Excessive calorie use: -Chronic disease -Diabetes -Hyperthyroidism Psychosocial ```

Question 39

Investigations for FtT

Answer 39

Bloods - FBC, U&Es, LFTs TFTs, ESR | Urine culture

Question 40

Causative agents of urine infection

Answer 40

E.coli, Klebsiella, Proteus, Enterococcus

Question 41

Investigations for nephrotic syndrome

Answer 41

Urine dip, U&Es, LFTs, FBC, Ig, complement levels, varicella titres, BP May be more..

Question 42

Prognosis of nephrotic syndrome

Answer 42

1/3 resolve directly 1/3 infrequent relapses 1/3 frequent relapses - steroid dependent

Question 43

Management of nephrotic syndrome

Answer 43

``` Fluid balance Prednisolone Penicillin prophylaxis Pneumoccocal vaccination Consider albumin infusion ```