Sick Child I

Question 1

What are some important features of the anatomy of children?

Answer 1

Infants have relatively large head and prominent occiput
Sitting height is proportionally more
Relatively large surface area compared to volume
High anterior larynx/floppy epiglottis, more flexible ribs

Question 2

What is the average blood volume of infants?

Answer 2

80ml/kg = foetal Hb at birth

Question 3

What are the most common reasons for children to present to doctors?

Answer 3

Bronchiolitis, URTI and croup = 28%
Gastroenteritis = 8.8%
Seizures/epilepsy = 6.6%
Pneumonia or LRTI = 6.2%
Asthma = 5.7%

Question 4

What is the most common reason for acute illness in children?

Answer 4

Sepsis = varying presentation, treatment is supportive/antimicrobial

Question 5

What is bronchiolitis?

Answer 5

Acute inflammatory injury to the bronchioles caused by viral infection = supportive treatment

Question 6

What is croup?

Answer 6

Viral larygnotracheobronchitis = treated with steroids

Question 7

What is the most common reason for a wheeze in children?

Answer 7

Asthma = important to remember that there are other causes though

Question 8

What are some features of pneumonia in children?

Answer 8

Occurs at any age, different pathogens are more common at different ages, may be viral

Question 9

What are some conditions that affect the CNS?

Answer 9

Meningitis = bacterial and viral
Encephalitis = commonly viral
Presentations and findings may vary at different ages

Question 10

What investigations are done for CNS illnesses in children?

Answer 10

Lumbar puncture

Imaging

Question 11

What are some common causes of fainting, fitting and funny turns in children?

Answer 11

Febrile seizures, vasovagal episode, reflex anoxic seizure, breath holding attacks, behavioural episodes, epilepsy, arrhythmias

Question 12

What is meant by saying accidents and trauma in children are often age specific?

Answer 12

Certain injuries are associated with particular age groups (i.e broken bones aren’t associated with non-mobile babies)

Question 13

What are some common accidents and causes of trauma in children?

Answer 13

RTA, trampoline incidents, sports injuries, burns, ingestion, drowning/near drowning, choking, NA injury

Question 14

What is the initial management for children suffering from trauma?

Answer 14

ABCDE approach

Question 15

What are some things to remember about non-accidental injuries?

Answer 15

Must always be considered
Clues are in the history
First priority is safety and well-being of the child

Question 16

What are some GI and urogenital reasons for children presenting?

Answer 16

Viral gastroenteritis
GI obstruction
Testicular tortion
UTI

Question 17

What are some causes of GI obstruction in children?

Answer 17

Congenital pyloric stenosis, volvulus, intussusception and malrotation (in infants)

Question 18

What may be a cause of an acute abdomen in an older child?

Answer 18

Appendicitus

Question 19

What must be considered in a child with recurrent UTIs or UTIs from a young age?

Answer 19

Abnormal renal tract

Question 20

What are some causes of CV disease in children?

Answer 20

Congenital heart disease (present with cyanosis/heart failure), supraventricular tachycardia, bacterial endocarditis (rare but severe)

Question 21

Why may a child wheeze if they don’t have asthma?

Answer 21

Child had bronchiolitis when they were little and now wheeze every time they get a cold

Question 22

How does epiglottitis present?

Answer 22

Stridor, systemically unwell, drooling

Question 23

What are the differentials for stridor?

Answer 23

Croup, foreign body, epiglottitis, bacterial tracheitis,

Question 24

How does encephalitis present?

Answer 24

Seizures, personality changes, focal weakness

Question 25

Do you do lumbar punctures for suspected meningitis?

Answer 25

No = investigate and treat as for sepsis

Question 26

What is the tumbler test for?

Answer 26

Rash due to meningococcaemia = rash doesn’t blanch when glass is placed around it

Question 27

In what age group are febrile seizures most common?

Answer 27

Babies 18 months old = lasts under five minutes, goes stiff and shakes, due to high temperature

Question 28

When do most children grow out of febrile seizures?

Answer 28

By age 6

Question 29

What investigation should always be done in a child that is having funny turns?

Answer 29

Heart tracing = incase of long QT syndrome

Question 30

What age group is pyloric stenosis most common in?

Answer 30

Babies about 6 weeks old = skinny, starving, vomiting everything back up