Paeds

Question 1

Dehydration Management

Answer 1

Mild/Moderate: Oral feeds encouraged along with oral rehydration solution (50ml/kg over 4 hours) + maintenance fluids Severe: IV Fluids 20ml/kg bolus of saline then bolus of 100ml/kg over 4 hours + maintenance

Question 2

Maintenance Fluids Per 24 Hours

Fluid Bolus

Answer 2

100ml/kg for first 10 kg 50ml/kg for next 10kg 20ml/kg onwards
Bolus is 20ml/kg EXCEPT DKA and stuff like that

Question 3

Cradle Cap

Answer 3

Seborrhoeic Dermatitis Manage with emollients, baby shampoo and oils. If severe, consider steroids

Question 4

Candida Infection

Answer 4

Causes and complicates nappy rash. Spares flexures, satellite pustules, good hygiene with topical antifungals Disposable nappies, expose area to air when possible Barrier cream (zinc) and caster oil

Question 5

Atopic Eczema

Answer 5

First year of life. On face and trunks. Management is via avoiding triggers, emollients or moisturising cream. Consider steroids as needed

Question 6

Psoriasis

Answer 6

Emollients, coal, tar, steroid cream

Question 7

Acne

Answer 7

Associated with puberty. Conservative management is avoid over cleaning, less makeup, don’t pop spots, healthy diet. Consider psychosocial factors.
Management is via topical retinoids, consider Abx + benzoyl peroxide.
If severe, consider oral Abx and oral retinoids.
If severe, may require specialist referral. Takes a while.

Question 8

Meningococcal Sepsis Causes and Management

Answer 8

GEL in babies
NHS in older
ceftriaxone and Amoxicillin
Consider Antivirals
Dexamethasone if over 1m and H Influenzae suspected

ABCDE approach, sepsis screen, do urine dip, CXR and regularly monitor.

Complications include hearing loss, cerebral palsy, epilepsy, kidney problems and joint damage

Question 9

Vaccination Contraindications

Answer 9

Acute febrile illness
Egg allergy- Influenza, Yellow fever
Previous anaphylaxis to vaccine
Immunocompromised

Question 10

Guthrie Test

Answer 10

PKU
CF
Hypothyroidism
MCADD
Sickle Cell
MSUD
Homocystinuria
IVA
GA1

Question 11

Resus Guidelines for Paeds

Answer 11

ABCDE
5 rescue breaths
15 compressions and 2 rescue breaths
Defibrillate if VF or pulseless VT

Question 12

Paediatric Choking Algorithm

Answer 12

Encourage cough if possible
If not, 5 back blows and thrusts
Start CPR if unconscious

Question 13

Anaphylaxis Management

Answer 13

ABCDE approach, lie down flat, legs raised. Give oxygen, get IV access and IM adrenaline (1:1000 or 0.3/0.5ml)

Drugs:
Adrenaline, Chlorphenamine, Hydrocortisone and Fluids

Prescribe epipen once stable and admit for monitoring for a biphasic relapse, give steroids and anti-histamines

Differentials include upper airway obstruction, hereditary angiodema and severe asthma exacerbation

Question 14

Acute Asthma Management

Answer 14

ABCDE
Nebulised Salbutamol
Oral/IV Steroids
Nebulised Ipratropium
Also give magnesium sulphate
Call for help

Question 15

Asthma Management Long Term Over 5

Answer 15

Good spacer technique and all that
SABA
Inhaled Steroids
LABA
Leukotriene Receptor Antagonist or Theophylline
Increase inhaled steroids
Oral Steroids

Question 16

Asthma Management Long Term Under 5

Answer 16

SABA
Inhaled Steroids
Leukotriene Receptor Antagonist
Specialist Referral
Good spacer technique.

Question 17

DKA Management

Answer 17

ABCDE
Call for help
Fluids correction over 48 hours with potassium chloride
Once glucose drops to 15, add in insulin infusion and glucose
Regularly monitor blood glucose, urine output and neuro examination and bloods

Must balance cerebral oedema (fluids) and hypoglycaemia (insulin)

Long term: Give long acting insulin at night and short acting before each meal

Question 18

Epilepsy/Seizure Management

Answer 18

ABCDE 
Call for help
IV lorazepam, if not buccal midazolam or rectal diazepam
Then after 10 minutes IV lorazepam
IV Phenytoin infusion
Get anaesthetics involved

ALWAYS rule out sepsis, meningitis, UTI

Question 19

Enuresis Management

Answer 19

Organic Causes: Diabetes, Constipation, UTI
Lifestyle advice on fluid, diet and toileting training
Reward charts for positive behaviour such as going to the toilet before sleeping
Enuresis alarm if that doesn’t work
Desmopressin if not resolved or if child is over 7

Question 20

15 year old wanting a TOP

Answer 20

Focused history
Discuss options
Assess capacity
Advice to speak to family about it
Refer for TOP
Contraception Advice for longer term

Question 21

MMR Counselling

Answer 21

Given at 12-13 months and 3-4 years. Weakened live vaccine
They may get a fever and a rash a few days after the vaccine which often self resolves
Studies have shown that it is effective and the risks of MMR vaccine are significantly lower than the devastating consequences of getting any of the MMR infections Can be fatal, affect pregnant women not immune to it Severe complications are so rare that data is not available on it because of how uncommon it is.
Contains weakened versions of the live virus to help body build immunity to it
No link to autism, no mercury in it
Measles: Coryza, Cough, Conjunctivitis, Koplik spots, then rash
Mumps: Fever and Parotitis, Pancreatitis, Orchitis
Rubella: Rash, fever, lymph nodes, coryza, arthropathy, can cause problems for women who are pregnant, Congenital rubella syndrome

Question 22

Childhood Obesity

Answer 22

Rule out organic causes: Hypothyroidism, Cushings, GH deficiency, Prader-Willi
Age and gender specific charts to work out BMI
Exercise
Healthy diet
Dietician Referral
Consequences include: Bullying, OSA, Fractures risk, T2DM, HTN in the long run

Question 23

ADHD Triad and Management

Answer 23

Attention Deficit
Hyperactivity
Impulsive Behaviour
Management: Methylphenidate is biologic. Psycho is support for family, parenting training and support, psychoeducation, school support,
Healthy diet, if specific food is found, keep a food diary

Before making a formal diagnosis, the family should be referred to CAHMS. Behaviour needs to be consistent at home and at school. Otherwise, consider conduct disorder, oppositional defiant disorder and maybe ASD

If giving drugs, monitor growth every 6 months.

Question 24

ASD Triad and Management

Answer 24

Global Impairment of Language and Communication
Impairment of social relationships
Ritualistic and Compulsive behaviour
Most also have a decreased IQ, high functioning is rare

Management:
Specialist referral MDT approach with psychiatrist, paediatrician, LD specialist, OT, SALT and social services
Parent education and training
Psychosocial treatment for behaviour management
Support at school and aim to build on communication

Girl: Rett’s Syndrome
Boy: Fragile X

Question 25

Migraine Management

Answer 25

Nasal Triptan for paediatrics. Consider metoclopramide or promethazine otherwise. Rule out other causes. No COCP to be given if aura for example.

Question 26

Inhaled Foreign Body Management

Answer 26

ABCDE CXR to confirm diagnosis Specialist help for removal of foreign body Will likely require IV midazolam for sedation before removal attempt is made and anaesthesia and analgesia Consider bronchodilators and Abx and steroids as necessary

Question 27

NAI Management

Answer 27

``` ABCDE Approach Baselines Obs and Full Examination Require senior consultant in charge to come and do it with presence of a chaperone FBC, U+E, CRP, ESR, Bone Profile Skeletal Survey Admit child Social services Child Protection Team Normalise the situation, a child with an injury of this type, we like to do some extra checks because it is unusual ```

Question 28

Constipation Management

Answer 28

Rule out sinister causes. Ribbon stools, no meconium passage, neurological signs, failure to thrive, distended abdomen Management: If impacted, movicol paediatric plan, specialist nurse for constipation referral. add senna if required. Will also need maintenance of movicol as constipation can take a while to resolve and gradually reduce dose as it resolves. Also lifestyle management, exercise, diet, water and reward charts, encourage toileting routine

Question 29

Somatisation in Children Abdo Pain Management

Answer 29

Rule out separation anxiety or truancy and organic causes Psycho-Social Approach: It is real, it is a physical manifestation of the worries a child may be having. Psychoeducation, deal with underlying issues, if there are family problems for example or there is bullying at school...etc...For the child, distraction and relaxation techniques, and avoid precipitating factors

Question 30

Bronchiolitis Management

Answer 30

ABCDE Approach It gets worse before it gets better, course is around 8 to 10 days Caused by a viral infection Will probably admit but will double check with seniors. If child is acutely unwell will admit. Management is supportive with humidified oxygen and possibly an NG tube if feeding is poor

Question 31

Failure to Thrive Management

Answer 31

ABCDE Approach FBC, U+E, LFT, TFT, B12, Folate, Vit D, Bone Profile Can be due to malnourishment, malabsorption or increased requirement Think GORD, Food allergy, Coeliac

Question 32

Limp Causes and Management

Answer 32

Septic Arthritis, DDH, Osteomyelitis, Fractures, Transient Synovitis, Perthe's disease, Slipped upper femoral epiphysis, Neoplasms, JIA, Soft tissue injury, NAI Management: ABCDE approach, bloods and abx as required, hip XR or USS/MRI Some may require surgical management Septic Arthritis/Osteomyelitist- Abx after taking a blood culture and synovial fluid aspirate Transient Synovitis-Conservative Perthe's Disease- Aim to keep femoral head within acetabulum, use braces or casts as required. If young watchful waiting, if over 6 surgery. DDH: Pavlik Harness, diagnosed using USS Slipped Upper Femoral Epiphysis: Restrict movement as much as possible, surgical screw to fixate joint. Consider doing both as it can be bilateral.

Question 33

18m old refuses to eat

Answer 33

Dietitian, health visitor, child psychologist, SALT for swallowing and introduction of food. Think of mechanical or neurological causes for lack of feeding. Lifestyle management, try to make a regular approach. Build a routine.

Question 34

6 year old shortest in class

Answer 34

Normal, Malnourishment, Malabsorption, Excessive Usage, Endocrine Cause, Precoccious puberty Investigations: Growth, Growth velocity, Mid-parental height, GH Levels (IGF-1 surrogate), XR of non-dominant wrist, check for coeliac and allergies

Question 35

Stiff child Causes

Answer 35

Cerebral Palsy Metabolic Disorders Neuromuscular Dystrophy

Question 36

Cerebral Palsy Management

Answer 36

ABCDE approach MDT Approach, specialist approach, SALT, OT, Social Worker, School support, Orthopaedic referral, Physio's Severe spasticity- Give baclofen

Question 37

Down's Syndrome

Answer 37

``` Higher risk of medical problems Heart disease Hirschsprung's disease Biliary Atresia Learning disability (IQ around 80) Physical abnormalities Cleft Lip Palate Prominent tongue (difficulty feeding) Developmental delay, milestones reached eventually Life expectancy is reduced, but people are living longer all the time ``` Biopsychosocial Approach MDT approach, see specialists, will get support throughout, may need to go to special school, OT, social worker, SALT, paediatrician, genetic counselling,

Question 38

CF Fibrosis

Answer 38

Mucociliary Clearance Respiratory infections Failure to thrive Diabetes secondary to pancreatic destruction No cure, shorter life expectancy, but is improving all the time Will need physiotherapy regularly throughout. Will teach how to clear out lungs themselves. Regular enzyme supplements and antibiotics.

Question 39

Blue baby

Answer 39

``` Infection Hypothermia Congenital Cyanotic Heart Disease Respiratory Conditions Meconium Aspiration ``` Do baseline obs FBC, U+E, CRP, ESR, Blood cultures, Urine Culture, US Head, To determine if its respiratory or cardiac cause of blueness, measure pre and post ductal saturation. Nitrogen washout test.

Question 40

3 day old fit

Answer 40

``` IVH Cerebral Palsy Neonatal infections Congenital syndromes Febrile convulsions Shaken baby syndrome ```

Question 41

Febrile Seizures

Answer 41

Roseala Infantum Common, affect 3% of children 6m-6yr and resolve by 5yrs. Precipitated by rapidly rising temperature. Run in families It can reoccur but not always. Manage at home if its less than 5 minutes. If its a typical or longer than 5, ambulance. If at home, put into the reocvery position, don't put anything in their mouth. Slightly increased risk of epilepsy compared to the general population.

Question 42

Breath Holding Attacks

Answer 42

Common and benign. Children do go out of it Happens when they breathe out without breathing back in. If they get scared or if they get hurt. Part of the normal physiology of the body. No medication necessary, would consider checking for anaemia. Blue spells or reflex anoxic seizure. Both benign.

Question 43

8 year old daughter headaches and missing school

Answer 43

``` Tension headache Migraine with/without aura SOL Dehydration Sinusitis Hypertension Benign Intracranial Hypertension ``` ``` Somatisation disorder Hypochondriac Conversion disorder Truancy Separation Anxiety ```

Question 44

6m old screaming with pain and drawing up their legs, has not opened bowels, looks pale.

Answer 44

``` Constipation Intussuception Mesenteric Adentitis Bowel Obstruction Hirschsprung Disease Congenital Malformations Gastroenteritis Hernia's and Testicular torsion in boys Infantile Colic UTI, Meningitis, Sepsis ``` Baseline Obs (Dehydration) Examination Bloods-FBC, U+E, LFT, CRP, ESR Imaging- USS

Question 45

Infantile Colic

Answer 45

Conservative management. Affects many babies, and often goes away on its own. Wrap up baby and comfort the baby.

Question 46

Baby vomits all the time. 6m old

Answer 46

``` GORD Overfeeding Biliary Atresia (Kasai procedure) Pyloric Stenosis Posseting Intussuception TOF Laryngomalacia Aspiration ``` If it's GORD Conservative: Positioning the baby. Fix cot so it's slightly upright Smaller and more frequent feeds, burping the baby. Thicker milk if bottle feeding can be tried. Medicial: Alginates and consider Omeprazole

Question 47

Abdominal Pain with Dark Urine

Answer 47

``` DKA UTI Urinary Calculus Vesicoureteric Reflux T1/2DM IEM WIlm's Tumour ```

Question 48

HUS

Answer 48

Anaemia, Thrombocytopenia and Haematuria E. Coli 0157 FBC, UE, LFT, CRP, ESR, Lactate Dehydrogenase, Clotting

Question 49

Neonatal Jaundice

Answer 49

``` Infection-Sepsis, Meningitis, UTI G6PDD, Hereditary Spherocytosis, Autoimmune Haemolytic Anaemia, Haemolytic Disease of the Newborn, ABO Incompatibility Trauma Biliary Atresia Hepatic Outflow Obstruction ``` After first day Breast Milk and Physiological Neonatal Hepatitis Ask about activity, stool, urine, etc.... ABCDE approach. Bloods, urine dip, etc...all of that stuff. Unconjugated bilirubin is worse. For high levels, phototherapy or exchange transfusion

Question 50

UTI Management

Answer 50

If young, child needs to be admitted and regularly monitored. If older, give antibiotics. Upper UTI, co-amoxiclav for like 10 days Lower UTI, trimethoprim for 3 days with safety netting As always, ABCDE approach first

Question 51

Child with IBD Management

Answer 51

Induce remission Consider steroids, enteral feeding, Maintaining remission includes Azathioprine and mercaptopurine Biopsychosocial support. Counselling, specialist referral bioeducation

Question 52

Chickenpox in Child and Pregnant Mother Management and Complications

Answer 52

Take a full history, ask about previous chickenpox exposure If not sure, then check for varicella IgG antibodies. If negative, then give IVIG. If she gets chickenpox, then give aciclovir. Complications include fetal varicella syndrome, risk is highest in early pregnancy, like 1% but not a risk worht taking. Can lead to foetal abnormalities including microcephaly, eye defects, limb hypoplasia, learning disabilities. It can be fatal. Antibiotics do not work!

Question 53

Ricket's Diagnosis and Management

Answer 53

History includes bowed legs, knock knees, failure to grow in a child, Often due to vitamin D deficiency So management is calcium with vitamin D Bloods show low calcium, low phosphate, low vitamin D, raised PTH XR problems seen most at the growth plates in kids.

Question 54

Pyloric Stenosis Diagnosis and Management

Answer 54

Presents as projectile vomiting, non-bilious, constipation, dehydration too. Hypochloraemic, hypokalaemic metabolic alkalosis May feel a mass on examination and USS can confirm Management is specialist referral, will require surgical management. Ramstedt's Pyloromoytomy

Question 55

Strangulated Hernia Diagnosis and Management

Answer 55

ABCDE approach Oxygen, fluids, analgesia as required More common in premature babies Management is surgical, normally don't need a mesh as the body will grow stronger over time in a baby

Question 56

Abdominal Pain in a Child Causes and Management

Answer 56

``` Causes Mesenteric Adenitis Constipation Appendicitis Peritonitis UTI Somatisation DKA HSP Sickle Cell ```

Question 57

Fever in a Child Causes and Management

Answer 57

``` URTI LRTI Meningitis Encephalitis UTI Septic Arthritis Otitis Media Gastroenteritis PUO (HIV, TB) ``` Management ABCDE approach, oxygen, fluids, check blood glucose, do full head to toe examination. Get baseline observations Measure lactate, get blood cultures, get urine output and urine dip Give oxygen, fluids and antibiotics Plus supportive oxygen and regular monitoring

Question 58

Seizures/Fits/Faints in a Child Causes and Management

Answer 58

Causes include Encephalitis, Febrile Convulsions, Vasovagal syncope, reflex anoxic seizure, breath holding attacks, west syndrome, meningitis, trauma, head injury, hypoglycaemia Management ABCDE approach. Put child in recovery position and call ambulance. Bring child into hospital. Do full septic screen along with baselines obs and examination. Get urine dip too. IV lorazepam/buccal midazolam/rectal diazepam first attempt if still fitting Call for help, establish IV access now If still fitting, IV lorazepam If still fitting, Phenytoin infusion and call ITU ASAP Treat underlying cause. Tonic clonic seizure is less worrying, if the seizure is partial or complex, then do EEG or MRI Safety netting, parents should communicate with school so that they are aware, kid should not be doing activities such as swimming alone.

Question 59

Developmental Delay Causes and Management

Answer 59

Causes include understimulation, neglect, iron deficiency, cerebral palsy, ASD, congenital syndromes, kernicterus Management is specialist referral to assess.