Acutely Unwell Children

Question 1

Describe the general trend of age vs heart rate, resp rate, and systolic blood pressure in children?

Answer 1

As age increase heart rate and resp rate decrease and systolic blood pressure increases

Question 2

Define bronchiolitis?

Answer 2

Acute inflammatory injury of the bronchioles

Question 3

What is bronchiolitis usually caused by?

Answer 3

Viral infection- RSV

Question 4

Who usually gets bronchiolitis?

Answer 4

Usually babies under 18 months/ 2yrs, older children would simply get a cold

Question 5

Symptoms and signs of bronchiolitis?

Answer 5

Tachypnoea, poor feeding, irritating cough, lots of secretions, may get apnoea in small babies
Expiratory wheezing and wet cough

Question 6

Treatment of bronchiolitis?

Answer 6

Supportive

Oxygen, NG feeding, blow oxygen up nose or CPAP for apnoeas

Question 7

Key difference between croup and bronchiolitis?

Answer 7

Bronchiolitis= lower respiratory illness- wheeze and wet cough
Croup= upper respiratory illness- stridor and barking cough

Question 8

Define croup?

Answer 8

Laryngotracheobronchitis

Question 9

What usually causes croup?

Answer 9

Parainfluenza virus

Question 10

Signs and symptoms of croup?

Answer 10

Barking cough and stridor

Question 11

Treatment of croup?

Answer 11

Steroid treatment (1 dose) if child has stridor at rest they stay in hospital if just when moving they can go home

Question 12

Steeple sign on x-ray?

Answer 12

Croup

Question 13

Thumb print sign on head x-ray?

Answer 13

Epiglottitis

Question 14

What is epiglottitis usually caused by? Why is therefore on the decline?

Answer 14

Caused by haemophilius influenzae

There is now a vaccine for this

Question 15

What is the epiglottis?

Answer 15

Flap at the base of the tongue that closes during swallowing to prevent aspiration

Question 16

Hot feverish drooling child=

Answer 16

EPIGLOTTITIS= Medical ENT emergency until proven otherwise

Question 17

Signs and symptoms of epiglottitis?

Answer 17

The child is generally v unwell and stridor

May be feverish and drooling

Question 18

Explain difficulties of diagnosing asthma in children?

Answer 18

Children can get episodic wheeze (some get this after bronchiolitis)
Need to distinguish between this episodic wheeze and asthma driven by IgE

Question 19

Describe the meninges and meningitis?

Answer 19

Meningitis is inflammation of the meninges which are membranous coverings of the brain and spinal cord with 3 layers (dura mater, arachnoid mater and pia mater)

Question 20

Describe the meningitis rash?

Answer 20

Menigicoccal meningitis causes the classic non-blanching rash. The rash simply means meningococcal septicaemia not necessarily meningitis. Other bacteria can also cause meningitis in which case may be no rash.

Question 21

Investigations done for meningitis?

Answer 21

Lumbar puncture and imaging

Question 22

What is encephalitis? What usually causes it?

Answer 22

Acute inflammation of the brain

Usually viral: HSV, VZV, MMR, enterovirus and adenovirus

Question 23

Describe febrile seizures?

Answer 23

peaks about 18 months, lose consciousness, stiff and then shake, generally last under 5 minutes, reaction to temperature, kid will grow out of it (most by age 6)

Question 24

Children can often end up in resp or cardiac arrest?

Answer 24

Resp arrest

They may not be breathing but still have a pulse

Question 25

Describe airway management in children under 1 vs over 1?

Answer 25

Children less than 1= head in more neutral position as larynx is high and easily collapsible
Over a year can do head tilt chin lift like in adults

Question 26

Describe CPR in children?

Answer 26

First check breathing- if none perform 5 rescue breaths
Then do they have a pulse?
If not CPR with a 15 compressions : 2 reduce breath ratio

Question 27

If an under 1 has a pulse below 60 should you perform CPR?

Answer 27

YES- this is way too low

Question 28

Treatment for dropped BP in children? Is this an early or late sign of severe illness?

Answer 28

Late sign- children maintain their BP v well usually

20mls/ kg of 0.9% saline

Question 29

Describe choking management in children?

Answer 29

Less than 1yr 5 back blows and 5 chest thrusts

Over a year 5 back blows and 5 abdominal thrusts

Question 30

Child with temperature over 38 degrees=

Answer 30

sepsis until proven otherwise

Question 31

When would you admit a child with bronchiolitis?

Answer 31

Poor feeding < 50% of usual intake 
Resp rate > 70
Lethargy or history of apnoea
Nasal flaring/ grunting
Severe chest wall recession
Cyanosis
Oxygen Sat < 94%
Uncertainty over diagnosis

Question 32

If a child with bronchiolitis has a very high fever what should you do?

Answer 32

Consider a different diagnosis

Question 33

In severe croup what can you give nebulised?

Answer 33

Adrenaline (cause bronchodilatation)

Question 34

What should you do if infant starts having febrile seizure?

Answer 34

Remove harmful objects, don’t restrain

If last more than 5 mins shout for help

Question 35

Bulging fontanelles in babies may be a sign of?

Answer 35

Meningitis

Question 36

7 signs of shock?

Answer 36

Capillary refill more than 2 secs
Tachycardia and/or hypotension
Resp symptoms
Cold feet/ hands
Unusual skin colour
Altered mental state
Poor urine output

Question 37

Basic blood tests for meningitis?

Answer 37

FBC
U and Es
Coag
LFTs
Blood glucose and blood gas
Cultures

Question 38

10 Red flags for a feverish child?

Answer 38

pale/mottled/ashen/blue skin, lips or tongue
• no response to social cues[1]
• appearing ill to a healthcare professional
• does not wake or if roused does not stay awake
• weak, high-pitched or continuous cry
• grunting
• respiratory rate greater than 60 breaths per minute
• moderate or severe chest indrawing
• reduced skin turgor
• bulging fontanelle