SSC ED

Question 1

What are the developmental milestones at 2 months?

Answer 1

Eyes follow movement

Smiles and makes noises when spoken to

Question 2

What are the developmental milestones at 3 months?

Answer 2

Holds object placed in hand

Question 3

What are the developmental milestones at 3-4 months?

Answer 3

Turns head to sound

Question 4

What are the developmental milestones at 6 months?

Answer 4

Sits on floor with hands forward for support

Transfers objects from one hand to the other

Question 5

What are the developmental milestones at 9-10 months?

Answer 5

Crawls

Question 6

What are the developmental milestones at 12 months?

Answer 6

Walks with one hand held; says 2 or 3 words with meaning

Question 7

What are the developmental milestones at 13 months?

Answer 7

Walks unaided

Question 8

What are the developmental milestones at 18 months?

Answer 8

Makes tower of 2 or 3 bricks

Question 9

What are the developmental milestones at 21-24 months?

Answer 9

Joins 2 or 3 words together to make a sentence

Question 10

What are the developmental milestones at 2 years?

Answer 10

Can build a tower of 6 or 7 bricks

Question 11

What are the developmental milestones at 2.5 years?

Answer 11

Knows full name and gender; can stand on tiptoes

Question 12

What should be measured and recorded on the febrile child?

Answer 12

• Temperature
• Heart rate
• Respiratory rate
• SaO2
• Capillary refill time
• BP if signs of circulatory compromise

Question 13

What should be assessed and examined on the febrile child?

Answer 13

• Colour and temp of skin
• Level of activity / social cues
• Pulse for strength and character
• Respiratory exam / pattern of breathing / work of breathing
• Hydration status / skin turgor

Question 14

With regard to the febrile child what symptoms and signs are suggestive of Meningococcal Disease?

Answer 14

o Non-blanching rash, particularly with an ill looking child
o Lesions >2mm in diameter (purpura)
o CRT > 3secs
o Neck stiffness

Question 15

With regard to the febrile child what symptoms and signs are suggestive of Meningitis?

Answer 15

o	Neck stiffness
o	Bulging fontanelle
o	Decreased conscious level
o	Convulsive status epilepticus
(classical signs often absent in infants)

Question 16

With regard to the febrile child what symptoms and signs are suggestive of Herpes Encephalitis?

Answer 16

o Focal neurological signs
o Focal seizures
o Decreased conscious level

Question 17

With regard to the febrile child what symptoms and signs are suggestive of Pneumonia?

Answer 17

o	Tachypnoea
o	Crackles in chest
o	Nasal flaring
o	Chest indrawing
o	Cyanosis
o	Oxygen saturation < 95%

Question 18

With regard to the febrile child what symptoms and signs are suggestive of UTI?

Answer 18

o	Vomiting
o	Poor feeding
o	Lethargy
o	Irritability
o	Abdo pain or tenderness
o	Urinary frequency or dysuria
o	Offensive urine or haematuria

Question 19

With regard to the febrile child what symptoms and signs are suggestive of Septic Arthritis / Osteomyelitis?

Answer 19

o Swelling or a limb or joint
o Not using an extremity
o Non-weight bearing

Question 20

With regard to the febrile child what symptoms and signs are suggestive of Kawasaki’s Disease?

Answer 20

o Fever lasting > 5 days and 4 of the following:
 Bilateral conjunctival injection
 Change in mucous membranes: red throat, dry lips, strawberry tongue
 Changes in extremities: oedema, erythema, desquamation
 Polymorphous rash
 Cervical lymphadenopathy

Question 21

When should immediate IV antibiotics be given to the febrile child?

Answer 21

o Signs of shock
o Unrousable
o Younger than 1 month
o 1-3 months who looks unwell
o 1-3 months with peripheral WBC < 5 or >15
o Suspected meningococcal disease / meningitis or herpes simplex encephalitis

Question 22

What antibiotics should be given in the emergency treatment of a child with a fever?

Answer 22

IV Cefotaxime (+ high dose amoxicillin if under 3 months)

Question 23

What puts a child at high risk of sepsis?

Answer 23

• Indwelling catheter
• Postoperative
• < 6 months old
• Comorbidity that makes activity / communication difficult to assess
• VP shunt
• Immunodeficiency

Question 24

What 6 items are considered in diagnosis of severe sepsis or septic shock?

Answer 24

1. Tachypnoea
2. Tachycardia
3. Poor peripheral perfusion
4. Increasing or decreasing systolic to diastolic difference
5. Alteration in conscious state
6. Metabolic acidosis

Question 25

What should a child showing signs of severe sepsis/septic shock be given within the first hour?

Answer 25

1. Give high flow oxygen 2. Obtain IV/IO access and take bloods 3. Give IV/IO broad spectrum antibiotics 4. Consider 20ml/kg fluid resuscitation 5. Involve senior clinicians early 6. Consider inotropic support early

Question 26

What is it important to differential asthma from?

Answer 26

Viral wheeze in pre-school children

Question 27

What are some differential diagnoses of asthma?

Answer 27

Hyperventilation Paroxysmal vocal cord dysfunction Viral or mycoplasmal infection

Question 28

How would you assess the severity of an asthma attack?

Answer 28

Level of activity, speech and colour, work of breathing, respiratory rate, use of accessory muscles, chest movement, air entry and degree of wheeze

Question 29

What observations should be taken in assessing asthma attack severity?

Answer 29

Pulse rate, BP, pulsus paradoxus, measure SaO2, peak flow if > 6 years

Question 30

What are life threatening signs of asthma attack?

Answer 30

``` o Cyanosis o Agitation / confusion or decreased level of consciousness o Inability to talk o Exhaustion o Silent chest ```

Question 31

What is the treatment of an asthma attack?

Answer 31

Oxygen, Bronchodilator (nebulised if sever), oral steroids if no sustained response to bronchodilator, IV hydrocortisone in life threatening asthma

Question 32

What are the indications for admission of an asthma attack?

Answer 32

* Oxygen saturation 92% or less in air * Peak flow <50% usual or predicted * Little or no improvement after 2 doses of bronchodilator * Initial response to bronchodilator but then rapid deterioration * Return to ED within 4 hours of discharge * Parents unable to cope

Question 33

What should the checklist for discharge of an asthmatic include?

Answer 33

* Prophylaxis reviewed * Asthma information / leaflets given * Device technique assessed and documented in the ED notes * Written asthma plan given or reviewed * Peak flow meter given if appropriate * Advised to attend their GP or asthma nurse within 2 days

Question 34

What is the definition of status epilepticus?

Answer 34

continuous or recurrent generalised convulsion lasting 30 minutes or longer or when successive convulsions occur without recovery over a 30 minute period

Question 35

What is the definition of a simple febrile convulsion?

Answer 35

seizure occurring in a child aged 6 months - 5 years, precipitated by a fever arising from outside the nervous system in a child who is neurologically normal and without complex features

Question 36

What is the definition of a complex febrile convulsion?

Answer 36

duration greater than 15 minutes, multiple (i.e. more than one convulsion per episode of fever), partial or focal

Question 37

What information should be obtained from the history of a patient with convulsions?

Answer 37

Possible precipitating factors, Prodromal phase, Abnormal movements, ?Fever, Colour changes, Recent history of: Minor illness, HI, Possible access to drugs/toxins, Change in medication/compliance of known epileptic; PMH, FHx

Question 38

What should be examined for in the patient presenting with convulsions?

Answer 38

 Signs of infection especially petechiae, meningism, ENT  Signs of HI/NAI  Signs of cardiovascular/metabolic abnormality  Signs of ingestion  Abnormal neurological signs