Tutorials & Teaching on the Wards

Question 1

Give some ddx for acute cough in young children

Answer 1

Bronchiolitis (RSV) – high temperature makes this less likely
Other viral infection e.g. influenza
LRTI or pneumonia – lobar or bronchial pneumonia
Croup
Whooping cough
Laryngomalacia
Foreign body inhalation
Reflux
Heart failure

Question 2

Repeated intubation in children may increase risk of what?

Answer 2

subglottic stenosis
Premature babies may have repeated bouts of ‘croup’ that is actually subglottic stenosis

Question 3

What is the difference between polyphonic and monophonic wheeze?

Answer 3

Polyphonic wheeze is more melodic – suggests smaller airway involved e.g. bronchiolitis
Monophonic wheeze is less melodic - occurs in larger airways – tracheomalacia, laryngomalacia

Question 4

Prolonged focal seizure should make you consider what?

Answer 4

Encephalitis

Question 5

Babies who are sleepy with reduced feeding =

Answer 5

sepsis until proven otherwise

Question 5

What percentage of their body weight can children safely lose within the first few days of life?

Answer 5

up to 10%
should regain birth weight by 10 days old

Question 6

What can cause asymmetry in the way a young baby moves their arms?

Answer 6

more commonly = Erb’s palsy, clavicular fracture
less commonly = cerebral palsy

Question 7

What is the main thing you are looking for when assessing a child’s red reflex?

Answer 7

congenital cataracts
also congenital glaucoma and retinoblastoma

Question 8

When can you not assess a child’s fontanelle?

Answer 8

when they are crying - it will be bulging / tense

Question 9

How does a typical strawberry naevus present?

Answer 9

not present at birth, appears afterwards and may grow over time, usually resolves spontaneosly by 18 months, fades from the inside out

Question 10

What should you consider in a child with multiple strawberry naevi who presents with noisy breathing?

Answer 10

consider that they may have internal haemangiomas - if there are lots on the outside there may be some on the inside!

could cause airway obstruction if they grow large enough

Question 11

How would you give a concise handover for a baby to a senior paediatrician?

Answer 11

x week old, born at x weeks/ term, with a history of…/ previously completely well, presents with ….

currently being investigated for/ treated with ….
good / poor response to tx …
main concern is…

Question 12

How could you investigate a baby with a fever of unknown origin?

Answer 12

repeat temperature
look in ears for any obvious signs of ear infection
examine all over their body for any obvious rashes
listen to their chest
palpate abdomen

FBC, CRP
blood culture
capillary blood gas (lactate)
urine dipstick, MC&S
lumbar puncture
CXR

Question 13

Can you rely on peripheral capillary refill in babies?

Answer 13

no - it may be prolonged despite them being healthy

use either their forehead or sternum

Question 14

What is the issue with capillary blood gas taken from a babies heel?

Answer 14

squeezing the heel can cause the sample to haemolyse and affect the results

Question 15

Top tips for taking a capillary blood gas from a baby?

Answer 15

get someone to distract the child and hold their leg still

use a small amount of lubricant so that the blood forms droplets which are easier to catch on the tube

Question 16

How can you investigate for viral infections in young children?

Answer 16

nasopharyngeal aspirates - small amount of sterile saline pushed up the nose and then suctioned out

Question 17

What are the main complications of hypothermia in neonates?

Answer 17

lethargy, poor feeding, reduced release of surfactant from Type 2 pneumocytes which can lead to respiratory distress

Question 18

Where should you measure a child’s head circumference?

Answer 18

from their eyebrows to their occipital protuberance

HC and AC helps you to determine if a child is symmetrically or asymmetrically small

Question 19

What can you give to preterm babies to reduce apnea?

Answer 19

caffeine!

Question 20

When should murmurs in neonates be investigated?

Answer 20

when they persist after 24 hours
consider ECG and echo

Question 21

What is the main risk of missed cleft palates?

Answer 21

can lead to aspiration

Question 22

Give one tool that can be used on the ward to quickly assess a jaundiced child

Answer 22

TCB - transcutaneous bilirubin level monitor

Question 23

What do you need to assess in a NIPE?

Answer 23

Go from head to toe:
Weight and length
Head circumference
Use an ophthalmoscope to look in the eyes
Assess for cleft palate / lip
Heart - auscultate for murmurs
Hips - assess for DDH
Testes - check if descended
Check for patency of anus and hypospadias (boys)
Femoral pulses
Check hands and feet for number of digits
Check over skin for birthmarks and bruises

Reflexes- e.g. Moro’s reflex, palmar grasp

Question 24

What can you use to decide if transfusion is required in a child with low Hb?

Answer 24

Can look at reticulocyte count to decide if transfusion is needed – if there are enough reticulocytes (>75) you know the bone marrow is working so the Hb may go up on its own

Question 25

Generally, PO2 is low when a VBG is performed. What may have happened if the PO2 on VBG is high?

Answer 25

child may be on oxygen

Question 26

At what age do febrile convulsions classically occur?

Answer 26

from 6 months - 6 years

Question 27

If you don’t know whether meningitis is viral or bacterial =

Answer 27

give aciclovir for viral cover!!!

Question 28

What should you ask about in the history if suspecting neonatal herpes / herpetic meningitis ?

Answer 28

Is there parental hx of herpes or cold sores?

Question 29

Differentials for seizures in a young baby?

Answer 29

epilepsy, West syndrome, febrile convulsions, meningitis, encephalitis, sepsis, IVH

Question 30

Why may CO2 be high on a blood gas post seizure?

Answer 30

because benzos given in seizures are sedative and may cause a mild respiratory depression

Question 31

What is the quickest way to get imaging of the brain in a neonate?

Answer 31

USS of the fontanelle - quicker than CT head

Question 32

What may be the cause of a baby becoming cyanotic when breastfeeding but breathing normally otherwise?

Answer 32

Choanal atresia: a congenital disorder in which the nasal choanae, (paired openings that connect the nasal cavity with the nasopharynx), are occluded

Question 33

palpable purpura =

Answer 33

a vasculitis

Question 34

What must the clinical picture include to be considered anaphylaxis?

Answer 34

ABC compromise

Question 35

What is the most common cause of urticaria in kids?

Answer 35

viruses

Question 36

Potential risk of SABA in children?

Answer 36

can cause tachycardia and hypokalaemia

Question 37

Asthma can be diagnosed in children aged 5 and up. What are these symptoms called in infants?

Answer 37

multi-trigger wheeze

Question 38

What is purple tubing used for?

Answer 38

enteral feeds

Question 39

How can you work out the required length on an NG tube?

Answer 39

NEX measurement - nose ear xiphisternum

Question 40

How can you tell if an NG tube is in the right place without an X-ray?

Answer 40

if it is in trachea they will cough / cry

can aspirate to determine if in stomach - gastric pH is from 1-5 (may be altered by recent alkaline foods)

you should aspirate before every feed and NEVER feed if pH > 5