Common Acute Illnesses

Question 1

Normal HR, RR and systolic BP in a child <1 year?

Answer 1

HR: 110-160 bpm

RR: 30-40 breaths/min

Systolic BP: 70-90 mmHg

Question 2

Normal HR, RR and systolic BP in a child 1-2 years of age?

Answer 2

HR: 100-150 bpm

RR: 25-35 breaths/min

Systolic BP: 80-95 mmHg

Question 3

Normal HR, RR and systolic BP in a child 2-5 years of age?

Answer 3

HR: 95-140 bpm

RR: 25-30 breaths/min

Systolic BP: 80-100 mmHg

Question 4

Normal HR, RR and systolic BP in a child 5-12 years of age?

Answer 4

HR: 80-120 bpm

RR: 20-25 breaths/min

Systolic BP: 90-110 mmHg

Question 5

Normal HR, RR and systolic BP in a child >12 years of age?

Answer 5

HR: 60-100 bpm

RR: 15-20 breaths/min

Systolic BP: 100-120 mmHg

Question 6

Proportions of infants?

Answer 6

Infants have a relatively large head and a more prominent occiput

Sitting height is proportionately more

They have a relatively large surface area compared to volume - important when treating burns and considering fluid replacement

Question 7

Structural differences of the respiratory tract between adults and children?

Answer 7

In children, there is a high anterior larynx with a floppy epiglottis

Question 8

Rib structure in children compared to adults?

Answer 8

Ribs are more flexible so low risk of fracture when resuscitating

Question 9

Blood volume differences between children and adults?

Answer 9

80 mls/kg (much lower than adults); this is important for fluid replacemet

Question 10

Haemoglobin type at birth?

Answer 10

HbF - present for the first 1/2 months; it lasts less time before degrading

It also has a greater affinity for O2

Question 11

What is the most common reason for acute illness in children?

Answer 11

Sepsis

Question 12

Presentation of sepsis in children?

Answer 12

Variable - unlike adults, they may not have specific signs, e.g: fever, off of feeding, irritability and a non-specific rash

Question 13

Treatment of sepsis?

Answer 13

Supportive and with anti-microbials

Question 14

Describe bronchiolitis

Answer 14

Acute inflammation of the bronchioles, mainly caused by RSV but also by metapneumovirus

Usually occurs at ages 1-2 years

Question 15

Treatment of bronchiolitis?

Answer 15

Supportive

Question 16

Describe croup

Answer 16

Laryngotracheobronchitis - the cause is usually viral

Question 17

X-ray signs of croup?

Answer 17

Hypopharynx distension

“Steeple sign” - narrowed sub-glottic air column

Question 18

Treatment of croup?

Answer 18

Steroids aid recovery

Question 19

Causes of pneumonia?

Answer 19

Normally bacterial but could be viral

Question 20

Causes of meningitis?

Answer 20

Bacterial and viral

Question 21

Causes of encephalitis?

Answer 21

An infection of the brain substance that commonly has a VIRAL causes

Question 22

Ix for CNS conditions, e.g: meningitis or encephalitis?

Answer 22

Lumbar puncture

Imaging

Question 23

Which test must always be done with a rash?

Answer 23

Tumbler test - menigococcal/haemorrhagic rash will be non-blanching

Question 24

Potential causes of child fits and fainting?

Answer 24

• Febrile seizures
• Vasovagal episodes
• Reflex anoxic seizures
• Breath holding attacks
• Behavioural episodes
• Epilepsy
• Arrhythmias

Question 25

What are reflex anoxic episodes?

Answer 25

Brief periods of asystole, usually due to a noxious stimulus, e.g: being frightened

They turn white and the heart stops; it is generally benign but frightening

Question 26

What are breath holding attacks?

Answer 26

Often due to a noxious stimulus; they take a big breath, exhale, stop breathing and cannot take a breath in

They become unconscious and may have tonic movements; they go blue

Question 27

Causes of arrhythmias in children?

Answer 27

Rare but SVTs are the most common; it is almost always a congenital abnormality and not due to degenerative atherosclerosis

Question 28

Signs of NAI on thoracic X-ray?

Answer 28

Fractures posterior ribs from grabbing a child too hard; on X-ray, posterior ribs should be straight (anterior are curved), not lumpy

It is unlikely that these would occur by accident

Question 29

GI/GU issues in children?

Answer 29

• Viral gastroenteritis, e.g: rotavirus (there is a vaccination for this)
• GI obstruction
• Acute abdomen (in older children) - appendicitis
• UTI
• Testicular torsion

Question 30

Causes of GI obstruction in children?

Answer 30

Congential pyloric stenosis - presents at ~6 weeks

Volvulus

Intussusception

Malrotation (infants)

Question 31

Potential cause of a UTI in a child?

Answer 31

Consider an abnormal renal tract

Question 32

CVS issues that present in children?

Answer 32

Congenital heart disease (with cyanosis and heart failure)

Arrhythmias (rare but usually an SVT)

Bacterial endocarditis (usually due to a congenitally abnormal heart valve)