David King lecture

Question 1

fluids:
1. which fluids in older children?
100 mls / kg / day for first 10
50  for next 10
20 for all after

Answer 1

0.9% NaCl +5% glucose (+10mmol KCl unless a good reason to not add - ie if normal K add)

Question 2

what if they’re dehydrated?

Answer 2

5% deficitic - maintenance + extra 50mls/kg/day

Question 3

shocked due to dehydration?

Answer 3

10% deficit - maintenance + extra 100mls/kg/day

Question 4

fluid bolus… - IMPORTANT
what do you give if the child is shocked…?
1. standard
2. trauma / DKA / Neonates

Answer 4

1. 20mls/kg 0.9% NaCl

2. 10mls/kg 0.9% NaCl

Question 5

Blood gases

1. anxious, panic attack
2. pyloric stenosis

Answer 5

1. resp alkalosis

2. metabolic alkalosis (may have increased CO2 slightly to do a bit of resp compensation

Question 6

above which age should you Dx asthma (and what is it below that…)

Answer 6

1. 5yrs

2. Viral induced wheeze..

Question 7

control of asthma?

Answer 7

oral course of steroids in last 6 months?
hospital admissions?
HDU/ITU?

Question 8

treatment of acute asthma and classes?

Answer 8

Almost all will get:

1. brinchodilaters - salb / ipratropium
2. steroids - oral pred / if severe IV hydrocortisone

Rarely - Magnesium (needs cardiac monitoring) /
then - loading bolus of Aminophylline (unless on oral theophylline)
then IV Salbutamol

Question 9

Post asthma attack (AND ANY ASTHMA REVIEW) - what should you always check..

Answer 9

check inhaler technique / compliance
pets
parents smoking

Question 10

1. common causative organism of UTI?
2. Dx?
3. oral or IV ABx? give an example of each..
4. then what…
5. what is a DMSA
6. what is a MCUG
7. what order D/M?

Answer 10

1. E Coli
2. Microscopy of a urine sample - white cells
   Nitrites / leukocytes on urine dipstick
   Culture
3. Trimethoprim oral
   Cefotaxime IV
4. most need an ultrasound - (expect from maybe some with ‘simple fast resolving)
5. Isotope scan showing renal scarring
6. Looks for reflux nephropathy into ureters and kidneys
7. DMSA - then if normal do MCUG

Question 11

1. what is the definition of sepsis?
2. what drives it (usually..)
3. investigations?

Answer 11

1. dysregulated host response leading to end organ dysfunction
2. meningococcal disease / streptococcal infection
3. FBC / Us and Es / LFTs / CRP / cultures (blood + ?urine) / gas incl lactate
4. O2 to keep Sats >94%
   fluid resus (20ml/kg bolus)
   broad spec ABx (cefotaxime)
   Appropriate escalation (Registrar / ICU to consider inotropes and ventilation) - EARLY - if worried - phone the reg early..

Question 12

1. classical cause of croup

2. management of croup

Answer 12

1. parainfluenza virus (also RSV and check others..)
2. DON’T agitate the child - keep them calm ie. don’t examine the throat - KEEP THE CHILD CALM
   ABC+/- O2
   Steroid - Oral dexamethasone or bumetanide (or if too ill - nebulised budesonide)
   Occasionally nebulised adrenaline if V ill - if doing this get HDU down
   Very occasional intubation

Question 13

Childhood malignancy:
Haematological malignancies ~50%
1. how do leukaemias present
2. what’s thesecond most common type of Ca in children

Answer 13

1. Sx of bone marrow failure:
   pale / anaemia / fatigue / easy bruising / big liver / big spleen / infections / new bleeds
2. Brain tumours

others:
neuroendorine - neuroblastoma
kidney - nephroblastoma / Wilm’s tumour
Bone - osteosarcoma / Ewing’s sarcoma

Question 14

Cerebral palsy

1. def
2. types:
3. treatment?

Answer 14

1. Disorder of movement and posture due to an insult to the developing brain
2. hemiplegiac / diplegic / quadriplegic
   athetoid vs spastic vs ataxic
3. mostly supportive
   - OT
   physio
   MDT

Question 15

1. complications of prematurity?

2. go over NEC

Answer 15

1. retinopathy of prematurity (vessels growing at back of eye because of too much O2 at an iniappropriate time - screened for and can be Rx’d with Laser)
   intraventricular haemorrhage or periventricular leukomalacia
   chronic lung disease (ie have an O2 requirement 28days after delivery…)
   NEC

2.