General Paediatrics

Question 1

What is a normal anion gap?

Answer 1

10-18 mmol/l

Na + K - (Cl + HCO3)

Question 2

Measles

Answer 2

ADD
Koplik spots
Purulent conjunctivitis
Pneumonia

Question 3

Herpetic whitlow

Answer 3

Caused by herpes virus
- in herpes get ulcers and can get gingival hyperplasia

In herpetic whitlow get swelling of digits with redness and pain. Can get lesion

Question 4

Causes of multiple # (other than NAI) in different stages of healing
= bone fragility

Answer 4

• Hypervitaminosis A
• Infantile cortical hyperostosis
• Osteoid osteoma
• Scurvy
• Hypophosphatemia
• Syphilis
• Copper deficiency
• Menke’s kinky syndrome
• OI
• Hyper IgE syndrome

Question 5

Kawasaki disease

Answer 5

Fever for ≥five days AND four out of the five following features:
◾Bilateral non-purulent conjunctival injection (94%).
◾Oral changes (generally red oropharynx, red lips which may be dry or cracked, “strawberry” tongue) (91%).
◾Peripheral extremity changes → erythema of palms or soles (80%), oedema or induration (acute phase), desquamation (late sign, 94%).
◾Rash – often diffuse and polymorphic. Vesicles are rare.
◾Cervical lymphadenopathy – usually unilateral, >1.5 cm, painful (59%).

AND the illness is not explained by another disease process.

Associated features of Kawasaki Disease that are not part of the diagnostic criteria:
◾Irritability (very common)
◾Diarrhoea, vomiting, abdominal pain (very common 62%)
◾Arthralgia/arthritis (common, 25%)
◾Coryza and cough (relatively common)
◾Periungual, perineal or generalised desquamation (2nd-3rd week)
◾Erythema or crusting / reactivation around BCG site
◾Aseptic meningitis (25%)
◾Hepatic dysfunction (40%)
◾Urethritis with sterile pyuria (70%)
◾Raised inflammatory markers (WCC, neutrophils, ESR, CRP)
◾Thrombocytosis (2nd week)

Question 6

Less common symptoms of Kawasaki disease but important to be aware of

Answer 6

Less common features
◾Otitis media
◾Pancreatitis
◾Myositis
◾Uveitis (mild)
◾Obstructive jaundice
◾Pericarditis and myocarditis
◾Asymptomatic pulmonary infiltrates on chest x-ray
◾Aneurysm formation (can involve any artery – including coronary, iliac, femoral and renal arteries, and lead to peripheral gangrene, poor circulation or cerebral infarction)

◾Hydrops of the gallbladder

• acute acalculous distention of gallbladder
• RUQ mass seen in 75-100% cases
• usually begins in the subacute phase (marked by when fever stops)
• During this period coronary aneurysms may also occur

Question 7

Presentation to ED with traumatic head injury in shaken baby syndrome

Answer 7

• most common present with respiratory sx (breathing difficulty, apnea)

other sx include:
include seizures, lifelessness

• May have physical findings ranging from a normal neurologic examination, to nonspecific signs related to brain injury (such as vomiting and altered mental status), to coma and profoundly unstable vital signs (apnea, bradycardia) requiring resuscitation
• Retinal hemorrhages are frequently noted in children with abusive head injury –> severity of haemorrhages correlate with severity of injury
• Although retinal hemorrhages have been reported in other conditions, those associated with abusive head injury are characteristically numerous, involve multiple layers of the retina, and extend beyond the posterior pole to the peripheral retina

Question 8

Measles

Answer 8

• Transmitted via respiratory tract
• Prodrome with fevers, cough, red and watery eyes, mild conjunctival injection
• Koplik spots pathognomonic –> disappear as rash spreads down trunk
• Widespread maculopapular rash
• Associated LEUCOPENIA in uncomplicated measles
• encephalopathy
• looks unwell
• fluctuating consciousness/ disorientated
• Risk of mortality is 13-15% if develops encephalopathy
• Purulent otitis media is MOST common BACTERIAL complication