Recognition + management of the sick child

Question 1

Causes of airway obstruction in children

Answer 1

foreign body
asthma
croup
bronchiolitis

Question 2

Causes of respiratory depression in children

Answer 2

convulsion
sepsis
poisoning
raised ICP

Question 3

Causes of alveolar/chest wall failure in children

Answer 3

pneumonia
chest trauma
myopathy
bronchiolitis

Question 4

Causes of fluid loss in children

Answer 4

bleeding
burns
diarrhoea + vomiting

Question 5

Causes of fluid maldistribution in children

Answer 5

sepsis
anaphylaxis

Question 6

Causes of heart failure in children

Answer 6

congenital abnormality
myocarditis

Question 7

What is the structured approach to assessment of acutely unwell children?

Answer 7

3 minute toolkit

Question 8

What is the most common presentation to acute paediatric services?

Answer 8

fever

Question 9

What is the most common thing to cause cardiac arrest in children?

Answer 9

respiratory failure

Question 10

What is PEWS chart?

Answer 10

national paediatric early warning system chart

Question 11

What to comment on/look for in B of A-E in children

Answer 11

effort of breathing
is breathing effective
are there effects of inadequate breathing on other organs

Question 12

How to assess capillary refill time in children

Answer 12

press on skin of sternum or a digit at the level of the heart
apply blanching pressure for 5s
measure time for blush to return
prolonged capillary refill if >2s

Question 13

Phases of shock in children

Answer 13

compensated: completely reversible

uncompensated: may still be treatable with aggressive appropriate management

irreversible: multiple organ failure

Question 14

Management of shock in children

Answer 14

fluid resuscitation
fluid bolus = 10ml/kg isotonic crystalloid
reassess

Question 15

Causes of hypovolaemic shock

Answer 15

haemorrhage
gastroenteritis
intussusception

Question 16

Causes of distributive shock

Answer 16

sepsis
anaphylaxis

Question 17

Causes of cardiogenic shock

Answer 17

arrhythmias
heart failure

Question 18

Causes of obstructive shock

Answer 18

congenital cardiac disease
tension pneumothorax

Question 19

Causes of dissociative shock

Answer 19

profound anaemia
CO poisoning

Question 20

Meningitis in children immediate management

Answer 20

IV ceftriaxone

Question 21

Management priorities in meningitis (neisseria meningitiditis)

Answer 21

antibiotics
fluids
circulatory support
management of DIC

Question 22

Under what age with a fever suggests serious illness?

Answer 22

under 3 months
almost always serious
always take fever seriously in this age group

Question 23

Kawasaki disease symptoms/signs

Answer 23

fever >5 days

bilateral non-exudative conjunctivitis

oropharyngeal mucous membrane changes (pharyngeal erythema, red/cracked lips, strawberry tongue)

cervical lymphadenopathy with at least one node >1.5cm diameter

peripheral extremity changes (diffuse erythema + swelling of hands + feet)

polymorphous generalised rash - non-vesicular + non-bullous

Question 24

Complication of kawasaki disease

Answer 24

coronary artery aneurysms

Question 25

General causes of prolonged fever in children

Answer 25

infection inflammation neoplastic

Question 26

Key points about fever in children

Answer 26

beware in children<3 months examine fully to find source height of fever does not correlate with severity of illness (in over 6 months) use antipyretics sensibly - not needed if child happy length of fever - >5 days needs further workup

Question 27

Does meningitis cause a non-blanching rash?

Answer 27

no non-blanching rash caused by meningococcal septicaemia/other sepsis/DIC

Question 28

Do you do a lumbar puncture in a child in septic shock?

Answer 28

no risk of more complications - bleeding, may not cope with being turned, clotting problems

Question 29

Why do you not do a lumbar puncture in a patient with raised ICP?

Answer 29

risk of coning (brainstem herniating into foramen magnum)

Question 30

What is purpura fulminans?

Answer 30

acute purpuric rash characterised by coagulation of the microvasculature, which leads to purpuric lesions and skin necrosis can be caused by meningococcal septicaemia often needs amputations due to necrosis

Question 31

How many ml in an oz?

Answer 31

30ml

Question 32

Septic screen in children

Answer 32

blood culture lumbar puncture urine culture chest xray (looking for source of infection)

Question 33

Kawasaki disease management

Answer 33

high dose aspirin intravenous immunoglobulin echocardiogram to screen for coronary artery aneurysms

Question 34

What fevers do you take seriously in children?

Answer 34

prolonged fever (>5 days) babies <3 months