General Flashcards
Management for eczema
topical steroids - follow plan
eczema baths - bath oil, soap free wash, clean towel
cool compress
oil based moisturiser - keep clean/uncontaminated
anti-histamine
avoid skin infections? i.e. preventative care
wet dressing
prevent overheating
dry skin and then moisturise - don’t leave water on the skin
AB choice for cellulitits
mild = cefalexin oral
moderate = cefalexin oral or cefazolin IV
severe = flucloxacillin IV
necrotising fasciitis = vancomycin & meropenem AND clindamycin
most common pathogen of cellulitis?
group A strep, followed by staph aureus
Jaundice - compare physiological vs pathological
Physiological:
- appears after 24 hr
- resolves within 2 weeks
- serum bilirubin levels are less than 250umol/L
- max intensity by 4-5th day (term) or 7th day (prefterm)
Pathological:
- within 24hrs
- persists longer than 14 days
- serum bilirubin reaches 250umol/L
- stool colour is pale, dark urine
Causes of jaundice within 24hrs
Hemolysis:
isoimmunisation - ABO or Rh incompatibility
G6PD deficiency
haemorrhage
bruising - instrumental delivery
Sepsis
spherocytosis
Causes of jaundice after 24hrs
Physiological
sepsis
hemolysis
breastmilk jaundice (causes conjugated - increases enterohepatic circulation)
hypothyroidism (causes conjugated - increases enterohepatic circulation)
dehydration/insufficient feeding (breastfeeding jaundice)
bruising/birth trauma
Causes of conjugated bilirubin jaundice (conjugated fraction >10% of total bilirubin) AT ANY POINT
neonatal hepatitis
extrahepatic obstruction -> biliary atresia
metabolic causes - a1 antitrypsin deficiency, galactosaemia
hepatotoxins - paracetamol
hypothyroidism (increases enterohepatic circulation)
Most common organisms of meningitis in:
- 1-2months
- 2mth - 2yrs
PLUS most common viral cause
1-2mths: E.coli, GBS, listeria
2mth-12yrs: S.pneumoniae (pneumococcus(, neiserria meningitis (meningococcus)
Viral causes: enteroviruses and HSV
Kernig’s vs brudzinski’s sign
Kernig’s - raise leg up straight
Brudzinski’s - flex chin to chest (get flexion of lower extremities)
Meningitis diagnosis
LP
Also perform FBC, UEC’s, LFTs, coags, culture
What to order on LP
Glucose, protein, WCC (neutrophilic (viral) or lymphocytic (bacterial)), culture
Contraindications for LP
Skin infection at the sight of LP
Raised ICP - risk of cerebral herniation
Cardiovascular compromise
Suspected spinal epidural abscess
Treatment for meningitis
Empiric IV ABs, await for cultures
Supportive therapy: fluids
Give Acyclovir is HSV is suspected
Viral causes are usually self limiting
Complications of meningitis
Early:
Septic chock
DIC
cerebral herniation
Late:
CVA
sensory-neural losses
seizures
cognitive impairment
meningococcal can result in necrosis of limbs requiring amputation.
Kawasaki disease key clinical manifestations
Fever present for ~ 5days or more plus 4/5 of the following:
- strawberry tongue
- purpuric rash
- cervical lymphadenopathy > 1.5cm
- bilateral non-purulant conjunctival injection.
- peripheral extremity changes -> erythema, oedema, or skin desquamation
Treatment kawasaki
steroids
immunoglobulins
aspirin -> due to complication of coronary artery aneurysm
first sign of CF in a baby?
meconium ileus
What leukemia is most common in young children?
acute lymphoblastic leukemia
What is subacute sclerosing panencephalitis related to?
Measles if let untreated. However otitis media is the most common complication of measles.
CPR breath to compression rate in paeds?
15 compressions to 2 breaths
Treatment of croup?
oral steroids (prednisolone)
ABx do not work with croup as it is usually a viral cause
What is the CPR rate in a neonate?
3 compression to 1 breath
What investigation for suspected hirshprung disease?
rectal suction biopsy
Outline causes of neonatal jaundice at:
<24 hrs
Always pathological and requires further investigation
Should have a FBC and Coombs test performed.
Causes include:
- sepsis
- ABO or Rh alloantibodies
- hereditary conditions: G6DP deficiency, spherocytosis
- haemorrhage: cerebral, intra-abdominal
Causes of neonatal jaundice at:
24hr to 14 days
Breast feeding jaundice occurs because the baby becomes dehydrated due to low supply of breastmilk in the early stages.
Breastmilk jaundice occurs because the breast milk contain glucuronyl transferase inhibitor
Physiological jaundice occurs for a number of reasons:
- increase in foetal hemolysis
- increase in enterohepatic circulation (more reabsorption of billirubin and less excretion)
- neonate has less glucuronyl transferase compared to adults
**Remember physiological jaundice occurs at 24hrs - 14 days
Causes of neonatal jaundice at:
>2 weeks
Causes of conjugated neonatal jaundice (conjugated fraction >10%)
The big one is BILIARY ATRESIA
Biliary atresia is the scarring and fibrosis of the biliary ducts inside and outside the liver. Leads to bile obstruction. Treatment involves hepatoportoenterostomy. Which is the attachment of the small intestine to the liver to remove the bile ducts.
Treatment for neonatal jaundice?
If pathological then need to manage the underlying cause. If bilirubin levels reach unsafe levels, then phototherapy or exchange transfusion may be required.
Asthma treatment guidelines for mild, moderate, severe, critical
mild:
- sulbutamol via spacer. <6yrs then 6 puffs, >/=6 years then 12 puffs. Review frequently. Consider oral pred (~3 day protocol)
Moderate:
- O2 to maintain >94%
- salbutamol burst therapy
- consider ipratropium
- oral prednisolone
Severe:
- O2 to maintain >94%
- salbutamol burst
- ipratropium
- hydrocortisone
- consider theophylline or aminophylline
- consider MgSO4
- get urgent consultant support
O SHIT ME
**“ME” considered in severe cases
Otitis media management
Usually viral, ABx not routinely recommended.
Typically give child simple analgesia. If not improved within 48hrs then give amoxicillin for 5 days.
Otitis external management?
Usually a bacterial cause. AB treatment include ciprofloxacin
Croup symptoms and management?
Onset over a few days with prodromal cold like symptoms. Develop a severe barking cough with stridor.
Usually a viral cause. Treat with steroids. Viral causes include RSV, parainfluenza virus, adenovirus
Epiglotitis symptoms and management
Sudden onset over hours, drooling, unable to swallow, difficulty speaking, toxic appearance, fever.
Cause is usually haemophilus influenza. Incidence has decreased significantly due to vaccination.
3 mechanisms of penicillin resistance?
(1) enzymatic degradation of antibacterial drugs (B-lactamases) (2) alteration of bacterial proteins that are antimicrobial targets (altering the penicillin binding protein - binds to the protein and inhibits transpeptidases which synthesise the cell wall), and (3) changes in membrane permeability to antibiotics
Whooping cough signs/symptoms and management?
Caused by Bordetella pertussis. After 1 week of cold like symptoms, the child will develop a cough. Cough can culminate to vomiting, epistaxis, and subconjunctival haemorrhages. Cough can last 10 or more weeks.
ABx in early phase –> azythromycin or clarithromycin (macrolides)
Keep home from school until 5 days of ABx
Notifiable disease
ABx prophylaxis for close contacts
Causes of stridor in a child?
croup (6mths to 6yrs, viral cold symptoms), treat with steroids, if life threatening then give nebulised adrenaline
epiglottitis (H.influenzae B, acute life-threatening, drooling, severely painful throat)
bacterial tacheitis
inhaled foreign body
Causes of wheeze in a child?
bronchiolitis (supportive O2 therapy, asthma medication doesn’t work as they have not developed the receptors)
pneumonia
asthma
viral induced wheeze
cardiac failure
Croup management?
Mild-moderate: corticosteroids (dexamethasone, prednisolone)
Severe (symptoms include persistent stridor at rest): nebulised adrenaline and dexamethasone
Bronchiolitis management?
Supportive feeding and oxygenation
Bordetella pertussis presentation and management?
coryza symptoms followed by a pronounced paroxysmal cough. Can last >10 weeks.
Vomiting with cough with subconjunctival haemorrhages.
Management:
- swab for infection control and disease notification
- ABx for early stage or to reduce infectiousness (5 days of ABx required)
- ABx prophylaxis for close contacts
- supportive care
- no smoking in the house, small frequent meals and fluids
ABx choice for pneumonia in children?
amoxicillin
Risk factors for severe exacerbation of asthma?
previous admission to ICU for asthma
poorly controlled asthma
poor compliance
representation soon after discharge
What is the 4 x 4 x 4 asthma first aid rule?
give 4 separate puffs, 4 breaths per puff, wait 4 mins
Is hepatosplenomegaly present in EBV?
Presentation of a scarlet fever rash?
sandpaper like
When would a chest x-ray be recommended in a child with pneumonia?
4-6 weeks if there are persistent signs.
S&S of scarlet fever
cause by group A strep
The symptoms usually start with fever (over 38.3°C), sore throat, and general fatigue/headache/nausea. 12-48 hours later, a rash appears on the abdomen and then spreads to the neck and extremities.
Most symptoms resolve in a week. After the symptoms have resolved, it is common to get peeling skin on the fingertips.
complications of group a strep (scarlet fever)
Suppurative complications occur due to the infection spreading and include: otitis media; mastoiditis; sinusitis; peritonsillar abscess; meningitis; endocarditis; retropharyngeal abscess; and invasive group A strep (IGAS).
Non-suppurative complications occur later and occur mainly in untreated patients. They are rheumatic fever and post-strep glomerulonephritis.
Acute otitis media treatment/management?
acute otitis media complications?
tympanic membrane (TM) perforation, mastoiditis, labyrinthitis, petrositis, meningitis, brain abscess, hearing loss, lateral and cavernous sinus thrombosis
Methods of urine collection in children?
midstream urine in toilet trained children
clean catch
suprapubic aspirate (gold standard with lowest contamination rate)
In/out catheter
Treatment of UTI in children?
Oral ABx usually appropriate, but any seriously unwell child or a child under 3mths then should be admitted for initial IV ABx.
Oral: trimethoprim, augmentin, cefalexin
IV: gentamicin + benzylpenicillin
When should a child get a renal US?
boys under 3mths of age or seriously unwell children should have one before discharge
non-urgent US should be ordered for older children with recurrent UTI
UTI S&S in an infant?
fever
vomiting
lethargy
irritability
poor feeding
jaundice
septicemia
offensive urin
Risk factors for UTI in children?
Poor urogenital hygiene
Constipation
vesicoureteric reflux (structural abnormalities such as posterior urethral valve)
Incomplete bladder emptying
What investigations would you perform in a child with a known UTI that requires IV ABx?
FBC (looking for raised WBC)
UEC (checking renal function)
blood cultures (high risk of septicemia)
CRP (assess disease severity and response to treatment)
What is the gold standard investigation for assessing renal abnormalities in a child with recurrent UTI?
micturating cystourethrogram (MCUG)
What is hypospadias?
when the urethral opening is not located at the tip of the penis.
Testicular torsion S&S
sudden onset of testicular pain
swelling and erythema
negative prehns signs (positive in epididymitis)
blue dot sign
elevated and horizontal testes
absent cremasteric reflex
Nephrotic syndrome pathophysiology?
structural damage to the glomerular filtration barrier (podocyte effacement) -> renal loss of protein -> hypoproteinemia which leads to edema -> also get get hyperlipidemia and loss of immunogloblins (making them more susceptible to infections)
What is minimal change disease?
nephrotic syndrome where there is damage to the glomerulus (usually podocyte effacement) -> loss of negatively charged barrier formed by the podocytes around the basement membrane -> causes selective proteinuria
hallmarks of nephrotic syndrome
proteinuria (>3.5 g/day) - foamy urine
hypoalbuminemia
oedema - periorbital and peripheral
hyperlipidemia (response to low protein in blood)
lipiduria
Complications of nephrotic syndrome?
decline in kidney function
hypercoagulable state - increased risk of thrombosis
hypertension
pleural effusion
increased infection risk
investigations performed for nephrotic syndrome?
urine protein
FBC, ESR
UED
electrolytes (CMP)
complement levels (increased C3)
ASOT
urine microscopy and culture hep B and C screen
chest x-ray if signs of fluid overload/pulmonary oedema
Management of nephrotic syndrome? kids vs adults
Kids:
high dose corticosteroids (prednisolone) for 4 weeks, then wean back over 6-8 weeks (85-90% respond to corticosteroid therapy). May need to put of diuretics for fluid overload and/or give supplemental albumin
Adults:
- fluid and salt restriction
- diuretic therapy
- statin
- anti-coagulant
- antiproteinic therapy (ACEi or ARB)
Conditions associated with nephrotic syndrome in children?
henoch-schonlein purpura
SLE
infections
allergens
Post-streptococcal glomerulonephritis pathophysiology?
immune system fights the group A strep infection -> production of antibodies that filter through the kidney and deposit within the glomerular basement membrane -> results in inflammation and damage to the glomeruli
symptoms of nephritic syndrome:
haematuria
hypertension
oligouria
swollen ankles
puffy eyes
causes of acute nephritic syndrome?
post infection (including group A strep)
HSP
AgA nephropathy
goodpasture syndrome
Alport syndrome (chronic)
Investigations for nephritic syndrome?
renal function: UEC, electrolyte levels
FBC
ASOT (antistreptolysin O titre - will be increased in a GAS infection) or anti-DNAase B
complement levels (low C3)
throat swab
Treatment of glomerulonephritis?
supportive
fluid and salt restriction, diuretics
blood pressure control
ABx to treat any left over strep in the body (penicillin)
post strep glomerulinephritis biopsy results?
What percentage of children with idiopathic nephrotic syndrome of childhood will never have a further episode?
75%
Pathophysiology of HSP?
initial viral or bacterial infection (most common is an URTI caused by GAS) -> results in IgA production -> IgA immune complexes deposit within the vascular walls -> activation of complement that leads to vascular inflammation and damage
Clinical features of HSP?
non-blanching rash - palpable purpura (most commonly in the lower extremities and buttocks)
arthritis/joint pain
periarticular oedema
abdominal pain
glomerulonephritis
low grade fever, malaise
what is Peutz Jeghers syndrome?
Peutz-Jeghers syndrome (PJS) is an inherited condition that puts people at an increased risk for developing hamartomatous polyps in the digestive tract, as well as cancers of the breast, colon and rectum, pancreas, stomach, testicles, ovaries, lung, cervix, and other types listed below.
Brownish or bluish-gray spots on the lips, gums, inner lining of the mouth, and skin. Clubbed fingers or toes. Cramping pain in the belly area. Dark freckles on and around the lips of a child
Management of HSP?
Usually self limiting
Mild = NSAIDs
moderate-severe = corticosteroids (prednisolone)
RAAS inhibition (ACEi or ARB for patients with with persistent proteinuria)
Supportive care
Investigations for HSP?
Usually make a clinical diagnosis based on presentation
Investigations:
FBC = increased platelets
coags = normal
serum antibodies = increase IgA
UEC
skin biopsy -> hallmark will be IgA and C3 immune complex deposition in the small vessels of the superficial dermis
How is the APGAR score calculated?
Congenital rubella syndrome symptoms/signs?
Kawasaki disease S&S?
Bordetella pertussis ABx choice?
macrolide - azythromycin or clarithromycin
TORCH infection that would present with a murmur at the left sternal edge (pulmonary valve)?
Rubella infection - peripheral pulmonary stenosis
Features of an ‘innocent’ cardiac murmur in a newborn?
Hallmarks of an innocent murmur all have an ‘S’, innoSent:
- asymptomatic patient
- soft blowing murmur
- systolic murmur only, not dystolic
- at the left sternal edge
Also, there will be no added sounds, no paraternal thrill, no radiation
Symptoms of heart failure in a newborn?
Symptoms:
- breathlessness
- sweating
- poor feeding
- recurrent chest infection
Signs:
- poor weight gain
- tachypnoea
- tachycardia
heart murmur
enlarged heart
hepatomegaly
cool peripheries
What is the most common congenital heart defect?
Ventricular septal defect (VSD)
It is an acyanotic heart defect
S&S of VSD?
In small VSD, they are often asymptomatic and will resolve as the child grows older.
In more severe or large VSD:
- failure to grow
- breathlessness
- pulmonary hypertension can then cause a reverse of blood flow where it becomes a right to left shunt -> results in cyanosis
Name 3 acyanotic cardiac defects?
PDA - patent ductus arteriosis
VSD - ventricular septal defect
ASD - atrial septal defect
Name the 4 cardiac defects in tetrology of fallot?
- A large VSD
- Overriding of the aorta with respect to the
ventricular septum - Subpulmonary stenosis causing right ventricular
outflow tract obstruction - Right ventricular hypertrophy as a result.
Diagnostic criteria for Kawasaki disease?
Fever for at least 5 days plus 4 out of 5 of the following:
- conjunctival injection
- rash -> erythematous, involving trunk and extremities
- oral changes -> strawberry tongue, dry cracking lips
- extremity changes -> hyperaemia and painful oedema of the hands and feet, will begin peeling after a week
- lymphadenopathy -> cervical, commonly unilateral, tender
Also usually experience abdominal pain, arthritis, dysuria
It is a clinical diagnosis - can do laboratory testing in diagnosis is unclear or for monitorin
Treatment of kawasaki disease?
IV immunoglobulin (IVIg)
- 2g/kg dose as a single IV infusion. Give subsequent doses depending on response
Aspirin
- to prevent complication of coronary aneurysm
Corticosteroids
- help with reducing systemic inflammation
Supportive treatment
- fluid, pain relief
What shunts in the heart close after birth?
ductus arteriosus, foramen ovale
They both allow right to left shunting in the foetus so blood bypasses the lungs. If not closed after birth, then there will be left to right shunting due to the decrease in right sided pressure and increase in left sided pressure.
Jone’s criteria for rheumatic fever
List 6 signs of HF in infants?
breathlessness, hepatomegalgy, poor growth, cool peripheries, cardiomegaly, tachycardia
paediatric fluid resuscitation guidelines? Include the amount and the type of fluid
Resuscitation fluid (if child in shock)
- give 10ml/kg bolus of NaCl 0.9% as fast as possible
- e.g. 15kg child = 150ml
Rehydration
- total fluid requirement = maintenance + replacement of deficit
Maintenance calculations:
- 50 + 20 + 10 -> 100ml per kg for 1st 10kg, 50 per kg for the next 20kg, 10 per kg for subsequent kg’s. for example: 25kg child = 1000 + 500 + 100 = 1600 ml/day
OR
- 4, 2, 1 rule: 4 for 1st 10kg, 2 for the next 10kg and 1 for the following kg’s. e.g. 25kg child = 40 + 20 + 5 = 65ml/hr
Deficit:
- either % dehydration of body weight or the weight loss difference
- e.g. 25kg originally and is 5% dehydrated. Dehydration amount is 1.25kg which = 1250ml.
Therefore, this 25kg child requires 1850ml/day., which = 118ml/hr.
TYPE of fluid to use:
- resuscitation = 0.9% NaCl
- rehydration/replacement = 0.9% NaCl + 5% glucose +/- potassium
- maintenance = 0.9% NaCl + 5% glucose +/- potassium
What is the Rome IV criteria for Functional Constipation.
Must include two or more criteria for at least 1mths in infants or 2mths in older children.
- 2 or less stools per week
- history of stool withholding or incomplete evacuation
- hx of painful or hard bowel movements
- hx of large diameter stools
- presence of a large faecal mass in the rectum
- In toilet trained children - at least 1 episode per week of soiling/incontinence
Cause of failure to pass meconium within the first 24hrs of birth?
Hirschsprung disease
Treatment of constipation in children?
Behaviour modification:
- position e.g. footstool
- encourage exercise
- frequently putting child on toilet after meals
- reinforce positive behaviour
Dietary modification:
- avoid excessive cow milk intake as it may result in inadequate dietary fibre
- ensure child is meeting daily fluid maintenance requirements
Medications:
- osmolax, movical, lactulose
- often required for months to years. Does not cause lazy bowel.
Disimpaction:
- use movicol or osmolax
- done over a 7 day period
- start at a lower dose and then build way up
- enemas should be avoided, only consider in older children or severe cases
Assessing the severity of dehyration
When should a seizure be treated?
Child actively seizing with an unknown time duration or a seizure lasting more than 5 mins.
DDx of seizure in a child?
arrhythmia
breath holding spell (occurs when the child is crying)
vasovagal syncope with an anoxic seizure
non-epileptic paroxysmal disorder
What anti-epileptic medication is used in the acute treatment of a seizure lasting more than 5mins?
Benzodiazepine - IV diazepam or IM/buccal midazolam
Investigations performed on a child presenting with seizures?
bloods:
- BGL
- electrolytes
- VBG
EEG not indicated following first seizures.
If a child has presented with their first seizure, what would you tell them to do if the child was to have a second seizure?
General safety:
- have child in safe place
- move dangerous objects
- pillow
Other:
- time seizure
- video
ED or GP:
- call ambulance if it lasts more than 5mins, otherwise take to GP with the details of the seizure
S&S of meningitis in an infant or child
What is HLA DR3/DR4 associated with?
T1DM
What auto-antibodies are associated with T1DM?
islet cell antibodies, GAD antibodies, insulin auto-antibodies, ZnT8.
Causes of DKA
new diagnosis of T1DM
insulin omission
poor management of intercurrent illness (increases insulin requirements)
Hx signs of T1DM?
abdominal pain occurs due to an ileus caused by the DKA
Clinical signs of DKA?
DKA protocol?
Insert 2 cannulas - one for meds and one for fluids
Do coeliac serology at the same time
DKA initial investigations?
DKA treatment protocol
Complications of DKA
also hypokalemia and hypoglycaemia (during rapid insulin infusion)
What is the most common cause of end-stage renal failure?
diabetes
most common cause of acquired blindness?
diabetes
Go over variable bolus dosing for insulin
Functions of thyroid hormones
neurodevelopmental effect
cellular metabolism
protein, lipid, and glucose metabolism
growth and development
Review DKA assessment and management (SCH guidelines)
Suggested investigation for congenital hypothyroidism
Investigation for children presenting with adrenal crisis?
blood glucose (low in cortisol deficiency) - adrenal crisis may be a cause of hypoglycemia in children
UEC (hyperkalemia and hyponatremia indicates mineralocorticoid deficiency)
blood gas (acidosis indicates mineralocorticoid deficiency)
cortisol
ACTH
17 hydroxyprogesterone
plasma renin activity
inheritance pattern of congenital adrenal hyperplasia?
autosomal recessive defects in the enzymes responsible for the production of cortisol
pathophysiology of congenital adrenal hyperplasia?
low levels of cortisol production restuls in the lack of negative feedback to the pituitary gland -> increased ACTH production which causes adrenal hyperplasia.
Hypoglycemia is a prominent clinical feature in infants, as well as failure to thrive, adrenal crisis, and hyperpigmentation.
Risk factors for iron deficiency anemia in children?
- maternal iron deficiency
- prematurity and low birth weight
- exclusive breastfeeding
- excessive cow’s milk consumption
- vegetarian or vegan diets
- gastrointestinal disorders
- chronic blood loss
Management of iron deficiency anemia in children?
iron supplementation + dietary modification - iron rich foods, limit cow’s milk consumption, consider referral to dietitian, include vitamin c rich foods when taking supplement
Management of immune thrombocytopenic purpura
In children, it often occurs after an infection and resolves within 2mths. The immune system produces antibodies that destroy the platelets. Often asymptomatic, however may start to develop purpura, gum bleeding, or epistaxis.
Characteristics of ITP include:
- Isolated thrombocytopenia (platelet count of <100 x109/L, often <20 x109/L)
- Well child with no concerning features on clinical history or examination
- Otherwise normal FBE and film
Review a blood film for leukemia
Typical blood results of a leukemia?
High WCC
Low platelets
Low Hb
Pathophysiology of perthes disease?
Avascular necrosis of the femoral head due to a mismatch between the rapid growth of the femoral epiphyses and the slower development of adequate blood supply to the area.
There will be an initial loss of bone cells where there is softening and collapse of the affected bone. There will then be re-establishment of the blood supply and there is remodelling of the femoral head.
Management of perthe’s disease?
Usually a good prognosis that only needs conservative treatment. This involves casting and bracing of the hip. Also limiting physical activity until it is healed.
Surgery is indicated if there is extensive damage to the femoral head (>50%). Treatment involves a femoral osteotomy.
Slipped upper femoral epiphysis treatment?
avoid weight bearing
urgent surgical internal fixation
prophylactic fixation of the contralateral hip
When is ABO incompatibility most commonly seen in neonates?
ABO incompatibility is most often seen in the setting of mother being group O and the baby being groups A or B.
Organism responsible for rheumatic fever?
Streptococcus beta haemolyticus Group A
a) A neonate with vomiting, jaundice, hepatomegaly, poor
feeding and E.coli bacteraemia in the first few days of life. –
galactosaemia
b) A neonate with vomiting, lethargy, hypoglycaemia, and poor weight gain in
the second week of life. – congenital adrenal hyperplasia
c) A neonate with prolonged jaundice, hypotonia, constipation,
poor feeding. - hypothyroidism
A 3-year-old child presents to you in general practice with a 48 history of passage of
frequent watery stools without blood or mucous, and intermittent vomiting. She is
fully immunized and previously well.
What is the most likely pathogen to cause this presentation?
norovirus
A 5-year-old child presents to your Indigenous health clinic with a 2 day history of left anterior facial
swelling that extends from the upper lip to the lower eyelid. The swelling is diffuse, with mild
erythema and the left eye is partially closed. There is point tenderness just lateral to the left alae
nasi. The child is afebrile and the carer is unaware of the immunisation status.
What is the most likely diagnosis?
dental abscess
A 12-year-old Aboriginal boy admitted to hospital because of high fever and easily fatigued.
He also complained of migration pain on his joints started on his legs.
Physical examination revealed heart murmur and chorea.
Laboratory examination showed increased ESR and leukocytosis. ECG showed prolonged PR interval.
strep beta haemolyticus group A
A 5-year-old has been treated for meningococcal septicaemia and develops watery diarrhoea and
abdominal pain post treatment. A stool culture is positive for Clostridium difficile.
Which antibiotic should be used for its treatment?
oral vancomycin
A 6-week-old boy presents with a one week history of projectile non bilious vomiting post feed. His bowel
motions are soft and regular. He appears hungry but his weight has been static for two weeks.
Which VBG result would help confirm your suspicion?
hypochloremia, hypokalemia, metabolic alkalosis
A 6-week-old boy presents with a one week history of projectile non bilious vomiting post feed. His bowel
motions are soft and regular. He appears hungry but his weight has been static for two weeks.
Which VBG result would help confirm your suspicion?
atrioventricular septal defect
An 8-year-old girl presents to her GP with a 3 week history of worsening left knee pain. She is afebrile and
has an antalgic gait. The examination of her knee is unremarkable but she has limited range of movement
of her left hip.
What is the most likely diagnosis?
Perthes disease
A 5-month-old baby boy is diagnosed with bronchiolitis.
On examination, his respiratory rate is elevated at 72 breaths/ minute with marked tracheal tug and
subcostal recession. He has bilateral inspiratory crackles. His SaO2(pulse oximetry) is 90% on room air and
his temperature is 36.9°C. Nasopharyngeal aspirate is positive for respiratory syncytial virus. A venous
blood gas has a pH 7.36 (reference range 7.35-7.45) and a normal CO2.
In addition to oxygen therapy, what would be most appropriate treatment?
IV fluid
You are a doctor in a General Paediatric Outpatient Clinic seeing an 18-month-old boy brought in by
mum and dad with concern about frequent infections, poor overnight sleep and fussy eating. He is
still breast-fed multiple times per day/night.
His GP arranged the following blood work prior to your appointment.
What is most likely to be reported on the blood film?
pencil forms, anisocytosis
A 6-year-old girl is found to have a heart murmur when she presents in your general practice with a respiratory
tract infection. When you review her the following week, the murmur is still present and is grade 2-3/6, midsystolic
and maximal at the left upper sternal edge.
Which of the following associated features would suggest that the murmur is most likely of an organic origin
warranting further investigation?
She also has a 2/6 mid-diastolic murmur
A 9-month-old was brought into the Emergency Department in respiratory distress.
His mother noticed that he had been coughing and was febrile to 40°C in the last 2 days.
On examination, he appeared lethargic, toxic and drooling and had a soft stridor. He has
no past medical history and is fully vaccinated.
bacterial tracheitis (or epiglottits)
A 4-year-old boy presents to Emergency as he has been unable to walk due to pain in his left
leg since waking this morning.
He has been well over the past few days except for a mild cough and runny nose.
On examination, his temperature is 38.5°C and he refuses to lift his leg off the bed. Passive
movement of the hip is limited to 20 degrees of flexion due to pain.
Blood tests show WCC 18.5 x 109/L, CRP 35 mg/L, and ESR 28 mm/hr.
What is the most likely diagnosis?
septic arthritis
A 6-month-old boy is brought to see you as his parents are worried about his
development.
What would you expect him to be doing at 6 months?
- Exhibiting a stepping reflex
- Sitting with support
- Using a few words
- Using a pincer grip
- Using a preferred hand
Sitting with support (red flag)
A 10-year-old girl presents with a 6 days history of worsening periorbital oedema and
ankle swelling. Her urine is darker than usual. Two weeks ago she had a sore throat. She
has no significant past medical history and takes no regular medication.
On examination, her temperature is 36.8°C, HR 70 bpm, BP 130/90mmHg, RR 23 bpm
and SaO2 99% in room air. There is bilateral pitting oedema to the mid-calf.
Urinalysis shows 4+ blood and 1+ protein
Based on the most likely diagnosis, what should be included in the initial management?
* 20% Albumin
* Frusemide
* Nifedipine
* Penicillin
* Prednisolone
Frusemide
A 6-month-old boy is brought to see you as his parents are worried
about his development.
Which of the following findings would concern you?
* Absence of pincer grip
* Absence of stepping reflex
* Not turning to soft sounds
* Unable to sit with support
* Unable to speak single words
Unable to sit with support
b) A 15-year-old girl with a 10 week history of cramping abdominal pains and
intermittent diarrhoea which sometimes contains bright red blood mixed in.
No vomiting, fevers or dysuria.
Appetite slightly reduced but still tolerating meals and drinking well.
LMP 2 weeks ago.
Urine microscopy: no white cells, no red cells, no epithelial cells.
IBD
Transposition of great arteries
vs
Tetralogy of Fallot
Signs
TOF will have episodic cyanosis and systolic murmur
TOGA will have persistent cyanosis and no murmur but only S2 sound
Benign rolandic epilepsy (benign epilepsy with centrotemporal spikes) affects children between what ages?
6-8 yrs
Characteristics of benign rolandic epilepsy?
twitching, numbness or tingling of the child’s face or tongue. May interfere with speech and cause drooling.
What does hypsarrhythmia in an EEG indicate?
Infantile spasms/West syndrome
Which routine vaccine would you be concerned about administering to a severely immunocompromised child?
MMR (given at 12mth and 18mth)
Varicella (given at 18mth)
Both are live vaccines
what are koplik spots a feature of?
measles
signs of tetrology of fallot ‘spell’
Tachypnoea, cyanosis, dizziness/decreased consciousness, irritability, lethargy
LP contraindications?
bleeding disorder
space occupying lesion - risk of herniation
infection at the injection site
What leukemia are auer rods seen in?
AML
What leukemia are smudge cells seen in?
CLL
Risk factor for Intraventricular hemorrhage in the newborn?
prematurity
low birth weight
Which type of haematoma is most associated with hypovolemia?
subgalael ahemorrhage
neonatal septic workup?
blood cultures, cxr, urinalysis, LP
Indications for ABx treatment in child with acute otitis media?
> 48hr symptoms
Aboriginal or Torres Strait Islander decent
Immunocompromised
<6mths
Only one hearing ear
