Learning Objectives (Non-Clic)

Question 1

What is the tumbler test? and what is it used for?

Answer 1

• Place a clear glass and apply pressure over a rash to see if it blanching or non-blanching
• Non-blanching = meningococcal rash septicaemia (either meningitis or septicaemia but usually both together)

Question 2

Name three causes of a rash that fades when tumbler test is carried out.

Answer 2

Eczema

Sunburn

Rubella

Question 3

Name three causes of a rash that will not fade when tumbler test is carried out.

Answer 3

Meningococcal sepsis

Henoch Schonlein Purpura (IgA Vasculitis - affects commonly children, usually with abdominal pain and joint pain)

Thrombocytopaenic Purpura

Question 4

Define sepsis.

Answer 4

Life-threatening organ dysfunction causes by a dysregulated host response to infection

(Can be community of hospital acquired)

Question 5

List risk factors for sepsis.

Answer 5

• <1 yo and >75yo
• Immunocompromised due to illness or medication
• Surgery/invasive procedure in the last 6 weeks
• Breach of skin integrity
• IV Drug Use
• People with indwelling lines or catheters
• Neonates
• Pregnant, given birth or had termination or miscarriage in the last 6 weeks

Question 6

A) List causative agents of sepsis.

B) Name the most common agents in children

Answer 6

A) 
Neisseria Meningitidis 
Streptococcus pneumoniae
Streptococcus pyogenes
Staphylococcus Aureus
Salmonella Typhimurium
Klebsiella Pneumoniae
Gram Negative Bacilli

B)
1- Staphylococcus Aureus 
2- Neisseria Meningitidis
3- Streptrococcus Pneumoniae
4- Klebsiella Oxytocia

(Staphylococcus and Streptococcus = Gram positive cocci

Klebsiella = Gram Negative Bacilli

Neisseria meningitidis = and gonococcus = Gram -ve cocci

Question 7

In an 18 month early old baby what are the most common causative agents of bacterial meningitis?

Answer 7

• Streptococcus Pneumoniae
• Neisseria Meningitidis
• Haemophilus Influenzae type b (Hib)

Question 8

What antibiotics is used for Neisseria meningitidis in the hospital?

Answer 8

Cefotaxime/ceftriaxone

Question 9

A) Name a potential long-term damage that is common after meningitidis in children.

B) Name other complications of meningitis.

Answer 9

A) Acquired deafness

B)
▪ Seizures and epilepsy
- Cognitive impairment and learning disability
- Memory loss
- Cerebral palsy, with focal neurological deficits such as limb weakness or spasticity
- Renal Failure

Question 10

List factors that affect the severity and form of infection.

Answer 10

1- Virulence of pathogen 
2- Bioburden
3- Portal of entry
4- Host Susceptibility 
5- Temporal evolution

Question 11

What are the inflammatory markers released by the cells in innate immunity response?

Answer 11

▪ Interleukins (IL’s)
▪ Tumour necrosis factor alpha (TNF a)
▪ Reactive oxygen species (ROS)

Question 12

What are the effects of TNFa and IL-1 on the:
A) Body?
B) Cardiovascular system?

Answer 12

A) Fever, hypotension, increased HR, corticosteroid and ACTH release, release of neutrophil

B)
Generalised vasodilation (NO), Increased vascular permeability (activated leukocytes), intravascular fluid loss, myocardial depression (tissue hypoxia), circulatory shock
(You have increased heart rate but low stroke volume)
E2

Question 13

Describe suspected sepsis in adults pathway.

Answer 13

1- Does patient look sick?

2- could this be an infection? History of infection or signs of new infection (E.g. Cough/sputum, abdominal pain, distention, diarrhoea, Line infection, Dysuria, Chest pain, Endocarditis etc..) or few score of equal or over 3

3- Are there any red flags? (Yes, then send bloods including FBC, U&E, CRP, LFT, clotting), lactate –> then commence sepsis 6

4- If no, are there any amber flags? yes -> send bloods –> is there an AKI? yes –> commence Sepsis 6 BUT if no AKI then clinician to make antimicrobial prescribing decision

Question 14

Red Flags of Sepsis.

Answer 14

1- Responds only to voice or pain/unresponsiveness
2- Systolic BP < or equal to 90mm Hg (or drop of 40 from normal)
3- Heart Rate >130pm
4- RR > or equal to 25pm
5- Needs oxygen to keep Sp02 > or equal to 92%
6- Non-blanching rash, mottled/ashen/cyanotic
7- Not passed urine in the last 18 hours
8- Urine output less than 0.5ml/kg/hr
9- Lactate > or equal to 2mmol/l
Recent chemotherapy

Question 15

Describe Sepsis 6.

Answer 15

1- Oxygen (needs to be above 94%)
2- Blood Cultures
3- IV Antibiotics (if no source then broad spectrum - follow local guidelines)
4- Fluid Resuscitation - (250ml crystalloid (e.g. Hartman’s) fluid bolus as a fluid challenge over 10 mins) - if someone is overloaded then you shouldn’t give anything. Also low blood pressure doesn’t mean they person isnt over loaded as the leakage in vessels means its outside the tissue etc..
5- Measure Serum Lactate Hb - if someone lactate is still high (above 2 or 4) after fluid resus then this indicates that some anaerobic metabolism is happening in the tissues and hasn’t responded to IV Fluid
6- Measure Urine Output - a quantitative measure of how well the kidneys and organs are functioning. Just because BP is normal doesn’t mean there is good perfusion and the person is getting adequate supply of blood to the organs. Should have at least 0.5ml/kg/hr

Question 16

A patient has presented to you with what you suspect as sepsis. What are the immediate actions you carryout.

Answer 16

→ Blood cultures before prescribing but do not delay prescribing
→ Review once results available
→ Administer antibiotics within 60 minutes of recognition of sepsis using IV
→ If viral still give antibiotics
→ Add IV Fluids, oxygen, and vasopresser if BP is low.

Question 17

What is the first line treatment for sepsis of unknown origin?

Answer 17

→ Amoxicillin (good for staph aureus and gram -ve such as E.Coli) + Gentamicin (good against some gram +ve and many gram -ve

Question 18

A patient presents with severe unknown origin sepsis, with history of MRSA infection. What antibiotics would you use?

Answer 18

→ You suspect another MRSA Infection
→ Piperacillin-tazobactam (anti-pseudomonas, gram +ve (NOT MRSA) gram -ve, anaerobes)
→ Vancomycin (Gram +ve including MRSA + some gram -ve)

Question 19

A patient presents with what is suspected to be sepsis of unknown origin. Drug history reveals a penicillin allergy. Describe the antibiotic treatment you would administer.

Answer 19

→ Vancomycin (G+ve including MRSA)
→ Ciprofloxacin (broad spectrum including pseudomonas)
→ Metronidazole (anaerobes)

Question 20

What do you do if you suspect meningococcal disease?

Answer 20

▪ Transfer to hospital immediately
▪ Community Setting: Intramuscular or Intravenous benzylpenicillin or cefotaxime
▪ Hospital Setting: IV Ceftriaxone

Question 21

List the symptoms/signs of spotting a child with sepsis.

Answer 21

1- Mottled, blue or pale skin
2- Lethargic, or difficult to wake
3- Abnormally cold to touch
4- Breathing fast
5- Non-blanching rash
6- They may also have fits or convulsions
(Take them to the emergency services immediately, or call 999)

Question 22

If there is Febrile Infant of <3 months of age with fever/unspecific clinical features indicating illness, what is the likely cause and why?

Answer 22

• Likely cause is a bacterial infection
• Younger children are protected from viral infections due to the mother’s Immunoglobulins that cross over however they are also immunocompromised due to the lack of the maturation of their immune system

Question 23

List viral causes of Maculopapular Rash in children.

Answer 23

▪ HHV6 OR 7 - <2 YEAR OLD
▪ Enteroviral rash
▪ Parvovirus (slapped cheeks) - usually school age
▪ Measles
Rubella

Question 24

List bacterial causes of Maculopapular rash in children.

Answer 24

• Scarlet Fever (Group A Streptococcus) (this is an contagious infection in children, fever, sore throat, swollen neck, strawberry tongue (swollen tongue with white coating), rash that appears few days later (feels like sand paper), flushed cheeks (not rash)) - you give antibiotics
• Erythema marginatum - rheumatic fever (causative agent: GAS, and streptococcus Pyogenes)
• Salmonella typhi - rose spots
- Lyme Disease (bacterial infection spread to humans through infected ticks, causes rash compromised of circular red lesions (‘bullseye on a darts board’) appears within 4 weeks of being bitten, flu-like symptoms, headache etc..)

Question 25

List Viral causes of Vesicular, Bullous, Pustular Rash in children.

Answer 25

▪ VZV (chickenpox and shingles) (starts on head and trunk, progress to peripheries, could be just few lesions - appears as crops papules, vesicles with surrounding erythema and pustules - itching may lead to depigmented scarring and secondary infection) Herpes Simples Virus

Question 26

List bacterial causes of a vesicular, Bullous, pustular rash in children.

Answer 26

▪ Impetigo - characteristic crusting ▪ Boils - infection of hair follicles ▪ Staphylococcal impetigo

Question 27

List viral causes of Petechial (1-3mm)/Purpuric Rash.

Answer 27

- Enterovirus

Question 28

List Bacterial causes of Petechial/Purpuric rash.

Answer 28

- Meningococcal Infection - Bacterial Sepsis (Other causes include vasculitis and malaria that are not bacterial)

Question 29

List 4 common causes of fever in children.

Answer 29

□ Chickenpox ▪ 10-23 days ▪ Fever ▪ Spread by respiratory droplets - highly infectious during viral shedding (-2 days of onset of illness until the 6th day) ▪ Typical Vesicular Rash: crops of papules, vesicles with surrounding erythema and pustules at different times for one week ▪ Complications: bacterial superinfection (staphylococcal which may lead to toxic shock syndrome), CNS (cerebellitis or generalised encephalitis) □ Measles ▪ 10-14 days ▪ Fever ▪ Spread by respiratory droplets - highly infectious during viral shedding (approx. first 5 days of illness) ▪ Maculopapular rash = starts behind the ears and spreads down the body - initially blotchy and confluent ▪ Kopliks spots = small white spots on the buccal mucosa seen against bright red background □ GABHS (Streptococcus Pyogenes) - Scarlet Fever ▪ Maculopapular Rash: pink-red rash, feels like sand paper, looks like sunburn, on the chest and tummy ▪ White coating on the tongue + swollen (strawberry) tongue □ Rheumatic fever ▪ Jones Criteria for Diagnosis: two major or one major and two minor criteria + supportive evidence of preceding group A Strep such as streptococcal antibodies, or strep on throat culture ▪ Major Criteria: Pancarditis ▪ Minor Criteria:

Question 30

What do you use to differentiate between common and mild from serious causes of fever/illness?

Answer 30

Use traffic light system identifying risk of serious illness (Week 3, LO 2)

Question 31

What do you Do in a septic Shock - what are your priorities? - septic shock means the child is having an organ failure and may require transfer to the intensive care unit.

Answer 31

1. Antibiotics 2. Fluids - vasoactive mediators release -> loss of proteins and fluids -> maldistribution of fluids in the body 3. Circulatory Support - due to depression of myocardial contractility by inflammatory cytokines and toxins in the blood Disseminated Intravascular Coagulation - Abnormal coagulation all over -> depletion of coagulation factors and platelets -> excessive bleeding. - so they may need fresh plasma

Question 32

Describe paediatric Sepsis 6.

Answer 32

1- High flow oxygen 2- Obtain IV access/IO Access and obtain blood (for culture, lactate and blood glucose) 3- Give IV or IO antibiotics 4- Consider IV Fluids Resuscitation 5- Consider Inotropic support (adrenaline, 0.3mg/kg in 50 mls) 6- Involve Senior clinicians early

Question 33

A) Febrile Infants <3 months old? B) Causative agents that are generally are associated: (Bacterial)

Answer 33

A) Clear causes needed otherwise urgent septic screening (look above) + broad spectrum intravenous antibiotics to prevent the illness becoming more severe and spread else where B) - Escherichia Coli - Group B Streptococcus - Listeria Monocytogenes

Question 34

A) What organisms cause Toxic Shock Syndrome? B) What is the nature of the toxin? C) List the clinical signs/characterstics of a toxic shock syndrome?

Answer 34

A) Toxin-producing S-Aureus and Group A Strep (this condition can be life threatening but it is a rare one) B) Super antigen (one molecule activates up to 20% of t cell with a huge amount of cytokines produced) that causes organ dysfunction C) - Fever over 39 degrees - Flu-like symptoms (headache, sore throat, tiredness, feeling cold) - Hypotension (fainting, lightheadedness, confusion) - Diffuse erythematous, macular rash (a sunburn-like rash)

Question 35

What are the causes of Toxic Shock syndrome?

Answer 35

- Mainly tampon use in young woman - can happen to anyone and those primarily healthy - Burns, cuts, and other skin injuries or infections can allow Staph to enter blood and release the TSST-1 toxin

Question 36

Describe treatment of Toxic Shock Syndrome.

Answer 36

- Antibiotics: third generation cephalosporin e.g ceftriaxone + clindamycin (to switch off toxin production) - IV Immunoglobulins which are purified and taken out of donated blood (neutralise circulating toxin) - Could need dialysis if kidneys shut down - Surgical Debriding (removing unhealthy tissue) of areas of infection in skin

Question 37

Name 4 Tropical Infections along with their causative agents.

Answer 37

Repeated card

Question 38

Name 4 Tropical Infections along with their causative agents which cause fever in children with history of travel.

Answer 38

1- Malaria (Plasmodium Falciparum - from female Anopheles mosquitos) 2- Typhoid (Salmonella Typhimurium) 3- Dengue Fever (Virus transmitted by Mosquitos) 4- Gastroenteritis (Traveller's Diarrhea caused by Change in gut flora, viruses like rotavirus, and E.Coli) If there is loose stool with blood and fever then dysentery by shigella or salmonella

Question 39

• Why is prescribing in children a high risk patient safety area?

Answer 39

→ Children are not small adults. Their bodies handle drugs differently in regards to pharmacodynamics and pharmacokinetics of drugs. → More prone to errors = serious consequences → Licensing issues - lack of license = lack of evidence for safe use

Question 40

Recognise the implications of prescribing off-label or unlicensed medicines in children

Answer 40

→ Lack of licence and therefore evidence = uncertainty in dosing = increase in the risk of medication errors → Even appropriate doses may lead to different effects than they do in adults → Prescriber must be able to justify and feel competent in using such medicines in that particular age group or condition, there is increased responsibility.

Question 41

What is the difference between a child and adolescent?

Answer 41

``` child = 2 years - 12 years Adolescent = 12-18 years ``` (Infant = 28 days to 2 years)

Question 42

What do you look at when you are reviewing the pharmacokinetics of paediatric drugs?

Answer 42

ADME Absorption Distribution Metabolism Excretion

Question 43

List potential administration routes when thinking of drug absorption in children.

Answer 43

1- Oral (Over similar to adults, but under 3 they have reduced gastric acid and increased gastric emptying so increased oral absoprtion of penicillin and reduced for drugs like phenytoin) 2- IM (Ineffective and erratic) 3- IV (Extreme care and dilution and calculations needs, not good for needle phobias) 4- Percutaneous (Thin skin and increased SA so will absorb more than adults) 5- Rectal (Variable Response) 6- Buccal (Some drugs this is good for as no swallowing required)

Question 44

Name the two main factors that affect drug distribution in the body.

Answer 44

- Plasma Protein Binding - Body Composition/Volume of distribution (for example neonates have more extracellular fluid which decreases as they age) These two factors affect therapeutic window of a drug which is the level to aim for for a drug for maximum efficacy)

Question 45

Describe the drug metabolism of pre-term and newborns and the effect this has on drugs.

Answer 45

- Reduced rates of hepatic metabolising capacity (Due to immature enzyme systems in the liver) - Increased half-life of drugs and increased side-effects profile

Question 46

Describe the drug metabolism in children 1-9yrs.

Answer 46

- Greater hepatic metabolism than adults | - Due to relative body size, the liver is larger than in adults

Question 47

Describe Drug elimination in neonates? What effect does this have on prescribing?

Answer 47

- Immature capacity to eliminate drugs - Increased plasma-half life - Elimination of a drug most important indices for drug dosing - Effect = decrease dose or increase dosing interval

Question 48

How is critical illness recognised?

Answer 48

* Through track and trigger systems which allow multiple-parameter scoring systems allowing cut0off points, and score that should trigger a response * Example is NEWS score (National Early Warning Score)

Question 49

What is the frequency of monitoring of a patient with a NEWS score of 0?

Answer 49

12 Hourly

Question 50

What is the frequency of monitoring of a patient with NEWS Score of 1-4?

Answer 50

4-6 hours

Question 51

A) What is the monitoring frequency of a patient with a score of 3 in NEWS in a single parameter? B) What about 7 or more?

Answer 51

A) Hourly B) Continuous monitoring (Prompts an emergency assessment by a clinical team)

Question 52

• Describe the techniques which may facilitate undertaking practical procedures in children e.g. play therapy, distraction and topical anesthesia.

Answer 52

▪ Breastfeeding during painful procedures is the most effective I newborn ▪ Oral Sucrose solution can give helpful additional analgesia in neonates ▪ Cuddles by the caregiver/mother ▪ If in PACU (Pediatric Ambulatory Care Unit) then a Play Therapist are available ▪ Topical Anesthesia = Ametop Gel (30 minutes required for effect) or Emla Cream (1 hour required) ▪ For children with repeated venipuncture = sedation with buccal midazolam with appropriate monitoring in the PACU ▪ For cooperating Kids Entonox can also be used (pain-relieving gas mixture)

Question 53

A) Define Stridor. B) Other than Stridor, List other signs of respiratory distress in children.

Answer 53

A) An inspiratory, expiratory, or biphasic noise which gets louder as the narrowing increases. It indicated an upper airway obstruction B) Retractions (Subcostal, intercostal, sternal), Nasal flaring, Grunting (Expiratory noise), Tachypnoea

Question 54

List the 3 most common causes of stridor in children.

Answer 54

- Croup - Epiglottitis - Tracheitis

Question 55

A) Name causative agent of Croup. B) What age group is it common in? C) List symptoms. D) Management?

Answer 55

A) Mostly viral (RSV, Parainfluenza, and influenza) B) 6 months to 6 years C) - Harsh and Loud Stridor - Coryza (Congestion, runny nose, sneezing, sore throat) - Mild Fever - insidious cough onset - Hoarse voice - Barking cough D) Oxygen, IV Steroids (Dexamethasone), and things should settle within 48 hours, however in severe cases give Epinephrine, Oral, nebulise

Question 56

A) Name causative agent of Epiglottitis. B) What age group is it common in? C) List symptoms. D) Management?

Answer 56

A) Haemophilus Influenzae Type B (but rare with the Hib Immunisation) B) 1 year - 6 years C) Acute life-threatening illness - High fever - ill and toxic-looking - Drooling - Stridor - Negative culture D) Airway management (Intubation and antibiotics)

Question 57

A) Name causative agent of Tracheitis B) What age group is it common in? C) List symptoms. D) Management?

Answer 57

A) Staph Aures and Mixed flora B) 3-5 years C) - Similar to croup with URI symptoms (Congestion, sneezing, sore throat, cough) - High temperature - Inspiratory and expiratory stridor - Toxic Looking - Positive culture D) Airway management (Intubation) and antibiotics

Question 58

How do you differentiate between Croup and Bacterial Tracheitis?

Answer 58

1- Croup has barking cough 2- Coup will yield negative culture while the other will be positive 3- Croup the person will not be toxic looking while in tracheitis they will be 4- Croup responds to epinephrine while tracheitis does not (tracheitis require intubation and airway management and antibiotics)

Question 59

Management of Acute Upper Airway obstruction?

Answer 59

1. Keep calm to reduce anxeity 2. Observe for signs of hypoxia/deterioration - agitation or fatigue or cynosis 3. Do not use swab or spatula 4. Oral, nebulised or IV steriods good for croup (90-120 mintes onset) 5. Severe cases = use nebulised adrenaline (just to buy time not to cure - can save life where there is severe respiratory distress) + contact anaesthetist 6. Respiratory failure developed?? URGENT TRACHEAL INTUBATION!

Question 60

List the most common causes of breathing difficulties, cough and wheeze in children.

Answer 60

- Bronchiolitis - Asthma - Pneumonia

Question 61

A) Name causative agent of Bronchiolitis B) What age group is it common in? C) List Risk factors D) List symptoms. E) Management?

Answer 61

A) Commonly by viruses - most common virus is RSV B) 1 month to one year old C) - Premature infant with bronchopulomnary dysplasia - Congenital heart disease - CF D) - Dry, Wheezy cough - Cyanosis or pallor - Hyperinflation of the chest (sternum prominent and liver displaced downwards) - Subcostal and intercostal recession - On Auscultation = E Find End-Respiratory Crackles (Crepitations) - Prolonged expiration/wheeze E) If there is Apnea, persistent oxygen saturation of <92% when on air, inadequate fluid intake of 50-75% of normal volume or respiratory distress then hospital admission, humidified oxygen and fluids through NG tube and also for feeding, also CPAP for assisted ventilation maybe required and small percentage invasive ventilation

Question 62

A) List symptoms of Asthma. B) List triggers of Asthma. C) Management?

Answer 62

A) - Wheeze - Tightness of chest - Breathlessness - Symptoms are variable through out the day and from day to day - Worse at night and early morning - Usually from young age with family history B) - Exercise - Allergens (Pollen, Dust Mites, Pet dander) - Infections C) Inhaler (Bronchodilator)

Question 63

A) Name a causative agent of pneumonia in children. B) List symptoms. C) Management?

Answer 63

A) Most commonly viral in children and in many cases unknown causative agent B) - Fever - Cough with sputum - rapid breathing - Breathlessness Exam: signs of respiratory distress, chest in-drawing, dullness of percussion, end-respiratory crackles, decreased breath sounds, bronchial breathing over affected area are usually absent, oxygen saturation may decrease C) Empirical

Question 64

What is the most common cause of vomiting in infants?

Answer 64

Reflux (Immature muscles around the abdomen)

Question 65

Give reasons why you should not assume that GI tract is only involved if an infant is vomiting.

Answer 65

- Could be due to infections like meningitis and UTI's | - Could be post-tussive emesis (respiratory vomiting after coughing) if a child has whopping cough by pertussis

Question 66

List some obstructive conditions in infants.

Answer 66

1- Pyloric Stenosis + Male infants usually around 4 weeks of age (but can occur from birth to 6 months) + Forceful vomiting that hits the wall (the child looks hungry but every time he eats this occurs) + Tx = 1) resuscitation if dehydrated to correct fluid balance and electrolytes 2) surgery 2- Atresia + Duodenal and other sites + 3- Intussception + 12-18 months + Vomiting and pain (they draw their legs up and go pale) + Exam reveals sausage-shaped mass + Some Ishcaemia leads to red jelly stained stool + Tx = Resuscitation and refer 4- Malrotation + when the gut around 10 weeks of gestational age it goes into the cord and usually rotates back into position, if it doesn’t go back then blood supply is cut causing a volvulus

Question 67

List causes of vomiting in preschool (2.5-4 years old).

Answer 67

- Gastroenteritis - Infection (Respiratory, UTI, Meningitis, Whooping cough) - Appendicitis - Intestinal obstruction (not atresia at this age)

Question 68

List some red flags for vomiting in a child.

Answer 68

- Bile-stained vomit (Intestinal obstruction) - Haematemesis (oesophagitis, peptic ulceration) - Projectile vomiting in first weeks of life (Pyloric stenosis) - Abdominal pain on movement/tenderness (Surgical abdomen) - Vomiting at the end of the paroxysmal coughing (so cough cough vomit) = Whooping Cough (Pertussis)

Question 69

A) What is a common cause of diarrhoea in children B) What is the most common causative agent of this condition.

Answer 69

A) Gastroenteritis (risk of dehydration) B) Rotavirus (60% of children under 20 yo) (Abdominal Pain, Vomiting, Diarrhoea)

Question 70

A) Name a bacterial causative agent that causes diarrhoea in children. B) How may you know that this is bacterial?

Answer 70

A) Campylobacter Jejuni B) Severe abdominal pain and maybe suggested by blood in stools

Question 71

Describe Fluid management of dehydration due to gastroenteritis.

Answer 71

- No Clinical Dehydration = Prevent dehydration (e.g. continue breastfeeding and encourage fluid intake) - Clinical Dehydration = Oral Rehydration Solution (give fluid deficit replacement (50ml/kg) over 4 hours - Shock = IV therapy (give bolus of 0.9% sodium chloride solution) and repeat if necessary

Question 72

List signs of dehydration in a child/Newborn.

Answer 72

- Pale or mottled skin - Reduced skin turgor - Tachypnoea - Tachycardia and weak peripheral pulses - Prolonged capillary refill time - Sunken fontanelle - Dry mucus membranes - Decreased level of consciousness - Hypotension

Question 73

List Red flag symptoms for a child with constipation.

Answer 73

Failure to pass meconium within 24 hours of life = Hirschsprung Disease Faltering growth/growth failure = Hypothyroidism, coeliac disease Gross Abdominal distension = Hirschsprung disease or gastrointestinal dysmotility

Question 74

List common causes of seizures in children.

Answer 74

- Febrile convulsions - Meningitis - Encephalitis - Epilepsy

Question 75

A) Describe the presentation of Febrile convulsions. B) What complications are associated with febrile convulsions. C) Treatment?

Answer 75

A) - Tonic-clonic seizures - Rapid rising fever - May wet or soil themselves - May lose consciousness after - Foam and rolling of eyes - Usually has another infection like Chickenpox B) - Small number get epilepsy C) - No treatment - But do no assume it is make sure you rule out meningitis (bulging fontanelle, neck stiffness, fever) and encephalitis (change in behaviour, focal neurological findings) and other infections

Question 76

What are complex febrile convulsions?

Answer 76

Febrile convulsions that last more than 15 minutes. Can usually occur again within 24 hours

Question 77

How do you diagnose Epilepsy in children?

Answer 77

- Two or more unprovoked seizures

Question 78

What is the most common tumour in children?

Answer 78

Tumours in the posterior fossa - presenting with nausea, vomiting, headache, abnormal gait, papilledema