Acutely Ill Child

Question 1

Anatomy of infant head

Answer 1

large head and prominent occiput.
Sitting height proportionally more.
Large surface area compared to volume

Question 2

infant blood volume

Answer 2

80mls/kg

Question 3

most common acute illness presentation of children in uk

Answer 3

bronchioloitis/urti/croup 28%

RESP illness huge for children!

Question 4

second most common acute illness presentation in children in uk

Answer 4

gastroenteritis 8.8%

Question 5

Most common reason for acute illness in children

Answer 5

SEPSIS

Question 6

Treatment for sepsis

Answer 6

supportive until proven infection then target organism with ABs.
Avoid broad spectrum ABs in children

Question 7

Acute inflammatory injury of the bronchioles

Answer 7

Bronchiolitis
mostly caused by RSV (also cold, flu, adenovirus)
Treatment entirely supportive (fluid + nutrition + O2)

Question 8

Laryngotracheobronchitis

Answer 8

Croup
Viral (sometimes bacterial overgrowth)
Barking cough!
Steroid treatment

Question 9

Pneumonia

Answer 9

Any age (CF and congenital dysmorphic lungs more susceptible).
Different pathogens more common at different ages.
Can be viral.

Question 10

CNS investigations

Answer 10

Lumbar puncture (quite readily done) also imaging.

Question 11

Meningitis

Answer 11

Acute inflammatio of protective membranes in brain.

Bacterial and viral causes

Question 12

Encephalitis

Answer 12

Inflammation of the brain.

Commonly viral

Question 13

CNS treatment

Answer 13

supportive (parenteral nutrition) and specific treatment

Question 14

Test to recognise meningococcal disease

Answer 14

tumbler or glass test

Question 15

Meningococcal big killer

Answer 15

meningococcal septicaemia

Question 16

Accidents and trauma in children

Answer 16

RTA, trampoline/sports, burns, ingestion (dishwasher tablets!), drowning(near drowning), choking

Question 17

Injury without explanantion think about …

Answer 17

non-accidental injury

Child support

Question 18

Acute abdomen in older children

Answer 18

appendicitis

Question 19

GI obstruction causes

Answer 19

congenital pyloric stenosis, volvulus, intussusception and malrotation (infants)

Question 20

UTI causes

Answer 20

Think abnormal renal tract.

Hard to diagnose as very general symptoms (hard to get urine sample)

Question 21

Urogenital illnesses

Answer 21

UTI

Testicular torsion

Question 22

Cardio causes

Answer 22

Non-degenerative, CONGENITAL!
Present with cyanosis or heart failure
SVT
Bacterial endocarditis RARE but severe

Question 23

commonest reason for acutely ill child

Answer 23

Sepsis

Question 24

Normal parameters for kid <1

Answer 24

HR = 110-160
RR = 30-40

Question 25

Normal parameters for kid >12

Answer 25

HR = 60-100
RR = 15-20

Question 26

Assess airway by

Answer 26

putting head in neutral position
Assess rate, recession, accesory muscles, grunting, nasal flaring.
Check for expansion, additional noises (stridor, wheeze), pulse oximeter, end organ affect (pallor)

Question 27

Assessment of circulation

Answer 27

HR, rhythm, ulse volume, cap refill, BP, effects on other organs

Question 28

Management of Circulation

Answer 28

20mls/kg of 0.9% saline if in shock

Question 29

Presentation of dehydration

Answer 29

Mucous membranes = dry
fontanelle = sunken
Skin turgor decreased
urine output reduced
May be in shock
Reduced conscious level

Question 30

posture of bringing arms inwards to chest

Answer 30

decorticate

Question 31

Toes pointed and arms flexed (charity burbage)

Answer 31

decerebrate