Paediatrics: Respiratory and infections

Question 1

Paeds traffic light system

Colour

Answer 1

Question 2

Paediatric traffic light system

Activity

Answer 2

Question 3

Paediatric traffic light system

Respiratory including rate (Amber and Red)

Answer 3

Amber

6-12 months: >50

>12 months: > 40

Red

>60

Question 4

Paediatric traffic light system

Circulation + hydration

Answer 4

Question 5

Paediatric traffic light system

Other

Answer 5

Question 6

Barking cough without prominent stridor and raised temperature describes what condition?

Answer 6

Croup

Question 7

Barking cough with biphasic stridor. Week of stability then rapid deterioration

Answer 7

Bacterial tracheitis

Question 8

Snoring stridor, non-prominent cough, raised temp and drooling.

Answer 8

Epiglottis

Question 9

How do you manage a child with croup-like symptoms?

Answer 9

All
- Oral dexamethasone (0.15mg/kg)/oral prednisilone is alternative
Severe:
- Admit
- Can give IM dexamethasone or neb budenoside as alternatives to oral drugs
- Nebulised adrenaline 5ml 1:5000

Question 10

What circumstances would you admit someone with croup-like symptoms?

Answer 10

<6 months
Severe
Uncertainty about diagnosis

Question 11

What causes bacterial tracheitis?

Answer 11

Staph aureus

Question 12

How do you distinguish croup from whooping cough?

Answer 12

Croup: Barking cough
Whooping cough: Inspiratory whoop after cough.
–> Also vomiting and breathless spells

Question 13

What gram negative coccobacillus is responsible for whooping cough?

Answer 13

B. pertussis

Question 14

What is the treatment for whooping cough

Answer 14

If 21 days since the onset
Macrolide (<1yr: Clarithromycin, >1yr: erythromycin)
Co trimoxazole if macrolide not tolerated

Question 15

Other than the patient, who else should receive antibiotics for whooping cough

Answer 15

Premature <32wks, non-immune/partially immune infants 32 wks
Pregnant women >=32 weeks
Those in a lot of contact with infants

Question 16

What urgency should whooping cough be reported?

Answer 16

Urgent if acute phase
Routine if later diagnosis

Question 17

How do you differentiate tonsillitis and quinsy?

Answer 17

Both have sore throat, fever, big red tonsils
Quinsy: + Can’t open mouth

Question 18

How do tonsillitis and quinsy differ in their bacterial agents?

Answer 18

Tonsil: S. pneumoniae (G+ve streptococcus)
Quinsy: S. aureus (G+ve cocci, coag +ve), H.influenzae (G-ve coccobacilli)

Question 19

When and how do you treat a bacterial tonsillitis

Answer 19

When: FEVERPain >4 or CENTOR >3
How:
1. Penicillin V
2. Clarithromycin

Question 20

How do you treat quinsy?

Answer 20

Incision and drainage by ENT

Question 21

What is the most common pathogen of pneumonia in children?

Answer 21

S. Pneumoniae (G+ve streptococcus)

Question 22

How do you treat community acquired pneumonia?

Answer 22

Assess severity using CRB65/CURB65
Non severe: Amox PO 5 days (Clarithromyci alternative)
Severe: Co-amox IV then PO 7 days total

Question 23

Dry cough, wheeze and crackles following on from coryzal symptoms in a 3-6 month old suggests what condition paeds resp infection?

Answer 23

Bronchiolitis (although pretty non-specific tbf)

Question 24

What is the most common cause of bronchiolitis? How is it treated

Answer 24

RSV
Supportive: Humidified 02 (if <92%)
NG tube if can’t feed

Question 25

How to differentiate viral induced wheeze and asthma? How does their management differ?

Answer 25

Lack of atopic history in VIW Management does not differ

Question 26

Since they both present with recurrent chest infections, how can you clinically distinguish between cystic fibrosis and ciliary dyskinesia (Kartagener's)?

Answer 26

CF: Salty sweat and GI problems (greasy stools, Hx meconium obstruction, failure to thrive) CD: Situs inversus, recurrent sinusitis

Question 27

What is the aetiology of CF? What are the chances of being born with CF?

Answer 27

Defect in Cl- channel due to AR mutation of CFTR gene 1/2500

Question 28

How do you diagnose CF and CD?

Answer 28

CF: \>60mmol/L on sweat test; antenatal/neonatal screening CD: Bronchoscopy +biopsy

Question 29

What is the treatment for chest infections in CF/CD?

Answer 29

Prophylactic Oral flucloxacillin 3-6yrs old for staph aureus Acute: S. aureus: Treatment dose flucloxicillin P. aeringuosa: ciprofloxacin, levofloxacin. Chronic: P. aeringuosa: Colistimethate --\> aztreonam/tobramycin

Question 30

What can be done to aid GI problems in CF?

Answer 30

High calorie diet, CREON tablets

Question 31

Aside from resp and GI, what other counselling points must be given for CF?

Answer 31

Infertility Reduced life expectancy (47yrs)

Question 32

What are the red flags for neonatal sepsis?

Answer 32

Suspected sepsis in mother Signs of Shock Seizures Resp distress \> 4hrs after birth Suspected sepsis in other baby if multiple

Question 33

What are the risk factors for neonatal sepsis?

Answer 33

GBS colonisation/sepsis in previous pregnancy Maternal sepsis, chorioamnionitis \>38 degrees \<37 weeks Premature rupture of membranes Prolonged rupture of membrane

Question 34

For neonatal sepsis when do you Observe Start Antibiotics

Answer 34

1 risk factor/feature = observe \>=2 factors/features = start abx

Question 35

What Abx do you give in neonatal sepsis?

Answer 35

Penicillin + Aminoglycoside eg benpen + gent

Question 36

How do you provide further management in neonatal sepsis?

Answer 36

24hr CRP 36hrs Blood cultures Consider stopping abx if well/results normal

Question 37

What constitutes the APGAR score?

Answer 37

Appearance Pulse Grimace Activity Respiration Get up to 2 points for each

Question 38

APGAR appearance score

Answer 38

2: Pink 1: Blue extremeties 0: Blue

Question 39

APGAR pulse score

Answer 39

2: \>100 1: \<100 0: Absent

Question 40

APGAR Grimace score

Answer 40

2: Cries/sneezes/coughs 1: Grimace 0: Nothing

Question 41

APGAR Activity Score

Answer 41

2: Active 1: Flexed arms and legs 0: Floppy

Question 42

APGAR Respiratory Effort

Answer 42

2: Strong/Crying 1: Slow/Irregular 0: Absent

Question 43

APGAR Good Moderate Low

Answer 43

7-10 4-6 0-3

Question 44

What is the most common organism for late onset (\>72hrs) neonatal sepsis?

Answer 44

Coag negative staph eg Staph Epidermidis

Question 45

Outline Neonatal resuscitation

Answer 45

Birth Dry baby and APGAR Gasping/no breath: Airway + 5 breaths No chest movement: Repeat airway + breaths Reassess chest + HR, repeat above if needed If HR \< 60 now: Compressions 3:1 Reassess + consider direct access drugs

Question 46

Male delivered via C-section displays raised RR and intercostal recession. His mother is diabetic. What is his likely condition?

Answer 46

Surfactant deficient lung disease/ARDS

Question 47

How do you manage ARDS?

Answer 47

Antenatal steroids to prevent Oxygen Assisted ventilation

Question 48

What is seen in transient tachypnoea of the newborn and how do you manage it?

Answer 48

Hyperinflation of the lungs + fluid in horizontal fissure Observation + supplementary oxygen

Question 49

Which congenital infection causes: Low birth weight Purpuric skin lesions Sensorineural deafness Microcephaly

Answer 49

Cytomegalovirus

Question 51

Which congenital infection causes: Itchy rash on head/trunk that spreads Macular --\> Papular --\> Vesicular Fever

Answer 51

Chickenpox

Question 52

What congenital infection causes Skin scarring Eye defects limb hypoplasia Microcephaly Learning disabilities

Answer 52

Fetal varciella syndrome

Question 53

Mother unsure if immune to chickenpox, what do?

Answer 53

Check maternal blood for antibodies

Question 54

If a woman is VZ antibody -ve, what is the plan if they are... 19 weeks 27 weeks

Answer 54

under 20 weeks: VZIG ASAP up to 10 days post-exposure Over 20 weeks: VZIG/antivirals between 7-14 days post-exposure

Question 55

How do you manage a pregnant woman who has chickenpox rash after 20 weeks?

Answer 55

Oral aciclovir within 24 hours exposure

Question 56

What childhood infection causes Fever Rash behind ears then all over: maculopapular --\> blotchy White spots in mouth

Answer 56

Measles

Question 57

Which childhood infection causes Pink rash on face that spreads to body, stops between day 3-5 Lymph nodes behind ears and back of head

Answer 57

Rubella

Question 58

How do you confirm and treat measles?

Answer 58

IgM antibodies Supportive unless IC/pregnant

Question 59

Which childhood infection causes Sudden high fever Subsequent truncal rash that spreads to extremeties Affects 6-36 month olds

Answer 59

Roseola infantum HHV 6

Question 61

What childhood infection causes Viral symptoms Slapped cheek 3 days later Itchy rash on trunk and limbs

Answer 61

Parovirus B19 Also called erythema infectiosum and Fifth's disease

Question 63

What infection causes strawberry tongue and tonsilitis? How do you treat it?

Answer 63

Scarlet fever (GAS) Oral penicillin/aminoglycoside 10 days

Question 64

What is the school exclusion for the following? Scarlet fever Whooping cough Measles Rubella Chickenpox Impetigo Mumps Scabies Influenza Diarrhoea & vomiting

Answer 64

Scarlet fever: 24 hours after abx therapy Whooping: 2 days after abx start/21 days from onset Measles: 4 days from rash onset Rubella: 5 days from rash Chickenpox: 5 days after rash onset/crusted over Impetigo: 5 days rash onset/crusted over Mumps: 5 days from gland onset Scabies: Until treated Influenza: Until recovery Diarrhoea + Vomiting: 48 hours after recovery

Question 65

Which congential infections cause sensorineural deafness?

Answer 65

Rubella Cytomegalovirus