Paeds 5A

Question 1

How is chondromalacia patellae managed?

Answer 1

Physiotherapy for quadriceps strengthening

Question 2

How is osteochondritis dissecans managed?

Answer 2

Pain relief
Rest and quadriceps exercise
Occasionally need surgery

Question 3

How is subluxation of the patella treated?

Answer 3

Reduction and immobilisation
Rehab

Question 4

Outline the treatment of Perthes disease.

Answer 4

non surgical tx - benign self limiting condition

supportive care for acute pain: simple analgesia, ice packs, protective pad over the tibial tubercle

activity continuation

physical therapy: stretching of the quadriceps and hamstring muscles, strengthening of the quadriceps, encourage hip abduction

education about exacerbations and managemnt

surgical tx if >6yo and fail to respond to conservative measures

Question 5

How is septic arthritis treated?

Answer 5

Antibiotics (initially IV for 2 weeks, followed by 4 weeks oral)

Suspected Gram-positive
Vancomycin + joint aspiration
2nd line = clindamycin or cephalosporin + joint aspiration

Suspected Gram-negative
3rd generation cephalosporin (e.g. ceftriaxone) + joint aspiration
2nd line = IV ciprofloxacin + joint aspiration

Affected joints should be aspirated to dryness as often as required (through closed needle aspiration or arthroscopically)

Question 6

What are the aspects of managing juvenile idiopathic arthritis?

Answer 6

managed by a specialist paediatric rheumatology multidisciplinary team
Physiotherapist and occupational therapist

inactivity leads to deconditioning, disability and decreased bone mass –> swimming or cycling

meds: paracetamol, NSAIDs
Corticosteroids
DMARDs (methotrexate is first-line)

Question 7

How is vitamin D deficiency/Rickets treated?

Answer 7

Calcium and ergocalciferol OR cholecalciferol

NOTE: pseudovitamin D deficiency is treated with alfacalcidol or calcitriol

Question 8

How might you investigate a patient presenting with migraines?

Answer 8

Headache diary for 8 weeks to help identify triggers

Question 9

Outline the steps in the acute management of a migraine.

Answer 9

Step 1: simple analgesia
Step 2: nasal sumatriptan
Step 3: nasal sumatriptan and NSAID/paracetamol
Step 4: consider adding prochlorperazine or metoclopramide

Question 10

Which medications are used to prevent migrianes?

Answer 10

Topiramate and propranolol

Question 11

How should you manage a febrile convulsion during the seizure?

Answer 11

Protect them from injury

Do not restrain

When the seizure stops, check the airway and place in the recovery position

If > 5 mins –> rectal diazepam (can be done twice) or buccal midazolam (only one dose)

An ambulance should be called if the seizure continues

Question 12

What should be tested in all children who have a seizure?

Answer 12

Blood glucose

Question 13

Which children who have had a febrile convulsion require hospital assessment by a paediatrician?

Answer 13

First febrile convulsion
Diagnostic uncertainty about the cause of the seizure
Focal features of the seizure
Seizure recurs within the same febrile illness (or within 24 hours)
< 18 months old
Parents are anxious
No apparent focus of infection

Question 14

What is the recurrence rate of febrile convulsions?

Answer 14

1 in 3

Question 15

What are some cardinal features of childhood rolandic epilepsy?

Answer 15

Unilateral facial sensorimotor symptoms
Oropharyngeal ictal manifestations
Arrest of speech
Hypersalivation

NOTE: this is not usually treated and children will grow out of it (around 14-18 years)

Question 16

What is the first-line AED for generalised seizures?

Answer 16

Valproate

NOTE: ethosuximide can be used for absence seizures

Question 17

Name some antiepileptics that can worsen certain forms of epilepsy.

Answer 17

Lamotrigine - worsens myoclonic
Carbamazapine - worsens absence

Question 18

What is the first-line AED for focal seizures?

Answer 18

Carbamazepine or lamotrigine

Question 19

What advice should you give to parents with regards to activities that may be dangerous with epilepsy?

Answer 19

Avoid situations where having a seizure could lead to injury or death (e.g. swimming unsupervised)
Driving is allows only after 1 year free of seizures
The school should be made aware of the diagnosis

Question 20

How is Guillain-Barre syndrome managed?

Answer 20

Supportive
Respiratory support
IVIG
Plasma exchange

Question 21

Which milestones would you expect the average child to have reached by 7 months?

Answer 21

Gross Motor: sits without support
Fine Motor: transfers objects from hand to hand
Hearing, Speech and Language: turns to voice, polysylabic babble
Social/Emotional: finger feeds, fears strangers

Question 22

Which milestones would you expect the average child to have reached by 1 year?

Answer 22

Gross Motor: stand independently
Fine Motor: pincer grip (10 months), points
Hearing, Speech and Language: 1-2 words, understands name
Social/Emotional: drinks from cup, waves

Question 23

Which milestones would you expect the average child to have reached by 15-18 months?

Answer 23

Gross Motor: walks independently
Fine Motor: immature grip of pencil, random scribble
Hearing, Speech and Language: 6-10 words, points to 4 body parts
Social/Emotional: feeds self with spoon, beginning to help with dressing

Question 24

Which milestones would you expect the average child to have reached by 2.5 years?

Answer 24

Gross Motor: runs and jumps
Fine Motor: draws
Hearing, Speech and Language: 3-4 word sentences, understands 2 commands
Social/Emotional: parallel play

Question 25

List the median ages for gross motor development milestones.

Answer 25

6-8 weeks: raises head to 45 degrees when prone
6-8 months: sits without support (first with round back, then straight back)
8-9 months: crawling
10 months: cruising
12 months: walks unsteadily
15 months: walks steadily