3. PAEDS [General Paediatrics]

Question 1

What is the most common pathogen in bronchiolitis, accounting for 80% of infections?

Answer 1

RSV

Question 2

What is the common age range for bronchiolitis?

Answer 2

Peak at 3-6 months, with 90% 1-9months.

Question 3

Why do newborns not tend to get bronchiolitis?

Answer 3

Maternal IgG protects against it

Question 4

Clinical signs and symptoms of bronchiolitis (6).

Answer 4

Coryzal symptoms first
Dry cough
Increased WOB (recession)
Tachypnoea
Tachycardia
Wheeze (fine inspiratory crackles)

Question 5

What is the most common reason for hospital admission due to bronchiolitis?

Answer 5

Feeding difficulties due to dyspnoea

Question 6

Management of RSV (3 points):

Answer 6

Oxygen

NG fluids / feeding if required
Suction if excessive upper airway secretions

Question 7

5 points that would prompt immediate referral to hospital for a child presenting with bronchiolitis:

Answer 7

Apnoea

Sats <92% persistently

Child looks unwell to a health professional

Central cyanosis

Severe respiratory distress e.g. grunting, marked chest recession or RR >70 bpm

Question 8

What are 3 conditions that would predict a more severe bronchiolitis episode?

Answer 8

Prematurity resulting in bronchopulmonary dysplasia

Congenital heart disease

Cystic Fibrosis

Question 9

What is a febrile convulsion?

Answer 9

An epileptic seizure accompanied by a fever in the absence of an intracranial infection.

Question 10

Give 3 features of a febrile convulsion (type of seizure, when occurs?).

Answer 10

Usually occurs early in a viral infection when temperature rises rapidly.

Usually generalized tonic-clonic seizures

Brief, <5 mins

Question 11

What % of children who have had one febrile seizure will progress to have more?

Answer 11

30-40%

Question 12

Febrile convulsions can be split into simple and complex. Give 3 features of complex febrile convulsions.

Answer 12

Lasting 15-30 mins.

Repeated seizures within 24 hours.

Focal seizure.

Question 13

4 risk factors for recurrence of a febrile seizure.

Answer 13

Age of onset < 18 months

Fever > 39

Positive family history

Short duration of illness before convulsions

Question 14

Give 2 examples of benzodiazepine rescue medications which may be considered if febrile convulsions are recurrent.

Answer 14

Rectal diazepam

Buccal midazolam

Question 15

Why is aspirin normally contraindicated in children?

Answer 15

Risk of Reye’s syndrome; causes encephalopathy and hepatitis.

Question 16

Complications of Kawasaki disease:

Answer 16

Coronary artery aneurysms

Sudden death

Question 17

6 key clinical features of Kawasaki disease:

Answer 17

Fever lasting >5 days, resistant to antipyretics

Strawberry tongue

Desquamating palms and soles

Bright red cracked lips

Cervical lymphadenopathy

Conjunctival injection

Question 18

Management of Kawasaki disease (3):

Answer 18

High dose aspirin

IV Immunoglobulin

Echo for initial screening of aneurysms

Question 19

Typical age affected by Kawasaki disease:

Answer 19

6 months to 4 years, peak at 1 year

Question 20

Typical blood results in Kawasaki disease:

Answer 20

ESR, CRP and WCC typically raised

Platelet count rises in second week of illness

Question 21

Clinical findings in HSP:

Answer 21

Fever

Palpable maculopapular purpuric rash

Arthralgia

Abdominal pain (haematemesis, melaena, intussusception)

Haematuria

Question 22

What is the classic distribution of the HSP rash?

Answer 22

Buttocks
Extensor surfaces of arms and legs
Ankles

Trunk spared

Question 23

What is HSP?

Answer 23

IgA mediated small vessel vasculitis, usually seen in children following an infection.

Question 24

Management for HSP is generally supportive, including analgesia for arthralgia and supportive treatment for nephropathy. What is the prognosis for HSP, and what should be monitored?

Answer 24

Good

Self-limiting usually

Blood pressure and urinalysis (haematuria/proteinuria) should be monitored to check for ongoing renal involvement. Follow up for 1 year!

1/3 relapse

Question 25

What is plagiocephaly and what is thought to be the cause of the increasing incidence of it? + 2 groups at risk of it.

Answer 25

Parallelogram-shaped head with flattening of the back of the skull.

‘Back to Sleep’ campaign thought to contribute, which aimed to reduce SIDS.

Hypotonic babies and preterm infants resting in incubators for a long time.

Question 26

Clinical picture of a reflex anoxic seizure:

Answer 26

Precipitated by sudden surprising pain / emotional stimuli

Stops breathing, goes pale & stiff, +/- brief convulsion

Rapid recovery usually, or if severe will sleep for an hour or more

Question 26

What causes a reflex anoxic seizure (physiologically)?

Answer 26

Cardiac asystole caused by excessive vagal inhibition.
Thought to occur in children with very sensitive vagal cardiac reflexes.

Question 27

What can cause similar symptoms to appendicitis, but is less severe and requires no treatment?

Answer 27

Mesenteric adenitis

Often follows a recent viral infection and cervical lymphadenopathy

Question 28

What indicators of faltering weight are used in clinical practice?

Answer 28

Fall in weight of two or more centile lines

OR

Weight centile two or more centiles below length / height

OR weight / head circumference centile below 2nd for age

Question 29

What are 5 broad categories of causes of faltering growth?

Answer 29

Inadequate intake

Inadequate retention

Increased requirements

Failure to utilise nutrients

Malabsorption