APLS

Question 1

How does adrenaline work on the alpha adrenoceptors

Answer 1

• increases peripheral vascular resistance
• reverses peripheral vasodilatation
• reduces angiodema

Question 2

How does adrenaline work on the B1 adrenoceptors

Answer 2

positive inotropic and chronotropic cardiac effects

Question 3

How does adrenaline work on the B2 adrenoceptors

Answer 3

causes bronchodiltation

reduced inflammatory mediator release

Question 4

what are considered shockable rhythms

Answer 4

VF

pulseless ventricular tachycardia

Question 5

How long should you observe a child with an anaphylactic reaction

Answer 5

6-12 hours as there is a possiblity of a biphasic reaction

Question 6

What blood test should you take if not sure of an anaphylactic reaction

Answer 6

mast cell tryptase

1-2 hours after symptom onset and again at 24hours

Question 7

What shock should you give a child in a shockable rhythem

Answer 7

4J/kg

Question 8

What are the 4Hs of reversable cardiac arrest

Answer 8

hypothermia
hypoxia
hypovolaemia
hypo/hyperkaemia

Question 9

What are the 4Ts of a reversible cardiac arrest

Answer 9

Thrombosis
Toxins
Tamponade (cardiac)
Tension pneumothorax

Question 10

What is the algorhythm in children for BLS

Answer 10

15:2

Question 11

management of anaphylaxis

Answer 11

Im adrenaline
IV chlorenphenamine
IV hydrocortison

Question 12

What dose adrenaline is given in anaphylaxis

Answer 12

12-17 500mcg 0.5ml 1:1000
6-11: 300mcg 0.3ml 1:1000
1 months-6: 150mcg 0.15ml 1:1000

Question 13

What dose chlorenphenamine is given in anaphylaxis

Answer 13

> 12: 10mg
6-12: 5mg
6 months - 6 years: 2.5mg
<6 months: 250 mcg/kg

Question 14

What does hydrocortisone is given in anaphylaxis

Answer 14

> 12: 200mg
6-12: 100mg
6 months - 6 years: 50mg
<6 months: 25mg

Question 15

What are the most common food allergies

Answer 15

cows milk
egg
peanut
treenut
soya
wheat 
seeds
fish/shellfish

Question 16

What constitutes a mild allergic reaction

Answer 16

itchy lips/mouth/throat
erythema/urticaria
angiodema
lump in throat - no voice change
conjunctivitis/rhinitis
nausea
abdo pain

Question 17

What constitutes a severe allergic reaction

Answer 17

impending doom
stridor/voice change
wheeze
dizziness/hypotension
severe abdo pain
impaired conciousness

Question 18

What is the Cushing’s triad

Answer 18

hypertension
bradycardia
irregular breathing

Question 19

what occurs when tentorial herniation begins

Answer 19

decorticate posturing:

• upper limbs flex
• legs extend and rotate inwards

Question 20

What is hydrocephalus

Answer 20

• increased volume of CSF in the cerebral ventricles

- usually as a result of impaired absorption but it may occasionally be due to excessive secretion

Question 21

What are the features of hydrocephalus in an infant

Answer 21

• rapidly growing head circumference/circumference in 98th centile
• Increased limb tone
• dysjunction of sutures
• tense fontanelle
• Setting-sun sign

Question 22

What is the setting sun sign

Answer 22

both ocular globes are deviated downward, the upper lids are retracted and the white sclerae may be visible above the iris

Question 23

what are the acute features of hydrocephalus in an older child

Answer 23

vomiting
headache
papiloedema
impaired upward gaze

Question 24

what are the gradual features of hydrocephalus in an older child

Answer 24

• Unsteady gait: spasticity in the legs.
• Large head
• Unilateral or bilateral sixth nerve palsy secondary to increased ICP.

Question 25

What are the risk factors for ischaemic stroke in young children

Answer 25

• cardiac disorders
• infection
• head and neck trauma
• sickle cell disease
• vascular malformations
• genetic disorders
• autoimmune diseases

Question 26

What is the imaging of choice in patients with ?ischaemic stroke

Answer 26

MRI

Question 27

What are the features benign idiopathic infantile dyskinesia

Answer 27

hip flexion and adduction
distant expression
flushed
followed by sleepiness

Question 28

What is sandifer syndrome

Answer 28

combination of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements with or without hiatal hernia

Question 29

How long do episodes of dystonic body movements in Sandifer’s syndrome occur

Answer 29

1-3 mins up to 10x a day

Usually associated with food but can be whenever