Paediatrics

Question 1

When should lumbar puncture be delayed?

Answer 1

1. Sepsis or rapidly spreading rash
2. Respiratory/ cardiovascular compromise
3. High risk of bleeding
4. Sign of raised ICP
   - papilloedema
   - GCS <= 12
   - uncontrolled seizures
   - focal neurological deficits

Question 1

Meningitis mx

Answer 1

< 3 months: cefotaxime + amoxicillin

3 months - 50 years: ceftriaxone ± Dexamethasone

> 50 years: ceftriaxone + amoxicillin

*notifiable disease

Question 2

When to hold Dexa in meningitis?

Answer 2

• septic shock
• meningococcal septicaemia
• immunocompromised
• meningitis after surgery

**ideally should be given within 12 hours of starting abx

Question 3

bacterial meningitis prophylaxis

Answer 3

contact within 7 days before rash onset - Oral ciprofloxacin or rifampicin

Question 4

minimal change disease 1/3 rule

Answer 4

1/3 recovers
1/3 infrequent relapse
1/3 frequent relapse (stops before adulthood)

Question 5

Intussusception

Answer 5

• 6-36 months. more in boys
• triggered by infection e.g. viral URTI, Rota, HSP
• non-bilious vomiting -> bilious vomiting
• intermittent abdo-pain (15 mins)
• inconsolable crying, drawing knees
• late: red currant jelly stool
• o/e RUQ sausage mass

Ix US
Mx air enema unless perforated and peritonitis

Question 6

Richter hernia

Answer 6

strangulation without obstruction

Question 7

Congenital inguinal hernia

Answer 7

Patent processus vaginalis
More common in premature babies, on the right side

Mx urgent surgical repair, risk of incarceration

Question 8

Infantile umbilical hernia

Answer 8

More common in premature and afro-Caribbean

Spontaneous resolution by 4-5

Question 9

Hodgkin lymphoma - what age?

Answer 9

Bimodal
20s and 60s

Question 10

Hodgkin lymphoma subtypes

Answer 10

1. Nodular sclerosing
2. Mixed cellularity
3. Lymphocyte predominant
4. Lymphocyte depleted

Question 11

Hodgkin lymphoma poor prognostic factors

Answer 11

B symptoms:
Night sweats
Fever > 38ºC
Weight loss >10% in 6 months

Question 12

Testicular torsion presentation

Answer 12

• Severe scrotum pain, radiating to lower abdomen
• N+V
  o/e:
• testis is swollen, tender, and retracted upwards
• cremasteric reflex lost
• Prehn’s sign negative (elevation of testis doesn’t relieve pain)

Question 13

Pyloric stenosis presentation and cause

Answer 13

2nd-4th weeks old
Projectile vomiting 30 mins after feeding
Palpable mass in upper abdomen

Hypertrophy of the circular muscles of pylorus

Question 14

Testicular torsion mx

Answer 14

Urgent surgical exploration and fixation bilaterally
(Bell clapper deformity)

Question 15

Pyloric stenosis risk factors

Answer 15

1. Boys
2. Family history
3. First-borns

Question 16

Pyloric stenosis Ix and Mx + complications

Answer 16

Abdominal US

Mx Ramstedt pyloromyotomy

Complications: Hypochloraemia, hypokalaemia and alkalosis

Question 17

Acute epiglottitis

Answer 17

HiB, tripod and drooling

• Call seniors, do not examine
• Give O2, IV abx and steroids
• Endotracheal intubation may be necessary

Question 18

Type 1 DM Ix

Answer 18

• Test for ketones (urine dip or blood)
• Random blood glucose
• C peptide (low in T1DM)
• autoantibodies

*c peptide and autoantibodies in atypical presentations

Question 19

Features of DKA

Answer 19

• polyuria, polydipsia
• NV, abdominal pain
• Kussmaul respiration (deep hyperventilation)
• Acetone breath (fruity, pear breath)

Question 20

Type 1 DM diagnostic criteria

Answer 20

Symptomatic: fasting glucose > 7mM or random glucose > 11.1mM (or after 75g OGTT)

Asymptomatic: above but on two occasions

Question 21

DKA diagnostic criteria

Answer 21

all 3
1. Random blood glucose > 11mM/ or known diabetic
2. Blood ketones >= 3mM or urine ketone 2+
3. Bicarbonate < 15 or pH < 7.3

Question 22

DKA mx

Answer 22

1. Fluid replacement
2. Insulin
3. Potassium and cardiac monitoring

Question 23

Fluid replacement in DKA

Answer 23

isotonic saline (0.9% saline)
1L over 1 hr
1L over 2 hrs
1L over 2 hrs
1L over 4 hrs
1L over 4 hrs
1L over 6 hrs

Question 24

Insulin in DKA

Answer 24

0.1unit/kg/hr - rapid acting If glucose < 14mM, add 10% dextrose at 125ml/hr *may need long acting too

Question 25

Potassium in DKA

Answer 25

K+ can drop while giving insulin add 20mM KCl in 500ml *may need cardiac monitoring *normal potassium: 3.5-5.3

Question 26

Down syndrome features

Answer 26

Question 27

Down syndrome cardiac complications

Answer 27

1. Endocardial cushion disease (atrioventricular septal canal defect) 2. VSD 3. Tetralogy of fallot

Question 28

Down syndrome associated conditions

Answer 28

- Hypothyroidism - Subfertility - learning difficulty - ALL - atlantoaxial instability - Alzheimer’s disease - repeated resp infections + glue ear - short stature

Question 29

Kawasaki disease fx

Answer 29

crash and burn - Conjunctivitis - rash (maculopapular) - lymphadenopathy - strawberry tongue - hand and feet desquamation high fever

Question 30

Kawasaki disease mx

Answer 30

high dose aspirin IvIg echocardiogram for coronary artery aneurysm

Question 31

UTI under 3 months

Answer 31

urgent paediatrics review

Question 32

When to do urinalysis in kids?

Answer 32

- Sx of UTI - Unexplained fever >38º - other infection not responding to treatment

Question 33

upper UTI in >3 months

Answer 33

3 days abx nitrofurantoin, cefalexin *safety net that they'll improve in 1-2 days if not seek help

Question 34

US post-UTI

Answer 34

under 6 months - US after 6 weeks over 6 months - US only if atypical or recurrent UTI

Question 35

UTI prevention

Answer 35

1. use the potty more often 2. time potty sessions 3. empty bladder completely 4. drink water 5. avoid constipation 6. cotton underpants 7. no soap or bubble bath

Question 36

Paracetamol overdose within 1 hr mx

Answer 36

activated charcoal

Question 37

Paracetamol overdose mx

Answer 37

IV acetylcysteine over 1 hr if - plasma paracetamol concentration above treatment line - staggered overdose - 8-24 hrs after 150mg/kg overdose even if concentration unknown - >24hrs with jaundice and sign of hepatotoxicity

Question 38

Acetylcysteine side effects

Answer 38

Anaphylactoid reaction (non-IgE mast cell release) mx: stop and restart at lower rate

Question 39

Prognostic factors for paracetamol overdose

Answer 39

- prothrombin time - arterial pH <7.3 - encephalopathy - raised creatinine

Question 40

Croup age group

Answer 40

6 months - 6 years autumn

Question 41

Croup virus

Answer 41

parainfluenza virus

Question 42

Croup mx

Answer 42

all get single dose PO dexamethasone emergency: O2 and nebulised adrenaline admit if - under 3 months, or moderate/ severe croup