Acutely Unwell Child

Question 1

how does infant anatomy differ from adult

Answer 1

have relatively large head and prominent occiput

Relatively large surface area compared to volume - loss heat, fluid more quickly and have problems with fluid and electrolyte balance when ill.

High anterior larynx/floppy epiglottis
- if they become inflamed much easier in children for airway to become compromised

Question 2

what are the common conditions children present with

Answer 2

Bronchiolitis/URTI/Croup 
Gastroenteritis
Seizures/epilepsy
Pneumonia/LRTI
Asthma
'Viral illness'
Head injury
Abdominal pain
UTI

Question 3

presentation of bronchiolitis in children and what causes it

Answer 3

presents in baby to 18 months, with cough, wheeze, poor feed, generally unwell

RSV virus

Question 4

what is a febrile seizure

Answer 4

when a child gets too hot and has a fit

Question 5

what are causes of fits and faints in children

Answer 5

Febrile seizures
Vasovagal episode
Reflex anoxic seizures - white breath holding episode
Breath holding attacks - blue breath holding episodes
Behavioural episodes
Epilepsy
Arrhythmias

Question 6

what are the GI obstructions seen in children and when do they present

Answer 6

congenital pyloric stenosis (6 weeks),
volvulus, intussusception (6 months)
Malrotation

Question 7

what a baby with pyloric stenosis present with

Answer 7

milky vomit

Question 8

what does intussusception present with

Answer 8

vomiting green
bulging in left flank
Strawberry jam nappy

Question 9

little baby, vomiting green - what is this a sign of and what could it be

Answer 9

sign of obstruction

could be malrotation

Question 10

what supplies the midgut

Answer 10

superior mesenteric artery

Question 11

what is hydatid of morgagni

Answer 11

vestigial remnant of the Müllerian duct, present on the upper pole of the testis

Question 12

how can the hydatid of merging be a problem

Answer 12

can twist and die becoming very sore

Question 13

Red, swollen scrotum
Not painful but itch
Redness extending down and up

Answer 13

Idiopathic scrotal oedema

Tx - analgesia, anti-histamines

Question 14

Red scrotum

If a testicle has done a full twist and is black has to be removed

Answer 14

Torsion

Question 15

what is a pre-terminal sign in children

Answer 15

hypotension

Question 16

how can circulation be treated

Answer 16

20mls/kg of 0.99% saline

Question 17

how can a child with UTI present

Answer 17

non-specifically ill child
collapse
septicaemia
vomiting
colic pain

Question 18

what are features of a headache in a child to be concerned about

Answer 18

Headache on waking
Worse with coughing or bending
Associated vomiting- especially in the morning
visual disturbance
Gait disturbance
Cranial nerve palsy

Question 19

what bacteria is the most common cause of uncomplicated UTI in children

Answer 19

E. Coli