General Paeds

Question 1

What is reflex anoxic seizures?

Answer 1

Syncopal episode followed by brief clonic movements that occurs in response to pain or emotional stimuli.
Caused by vagal induced brief cardiac asystole.
Seen in children aged 6m-3y.

Question 2

What are the features and treatment for reflex anoxic seizures?

Answer 2

Presentation - Child goes very pale, falls to floor, may have seizure and then reapid recovery.
No specific treatment as prognosis excellent.

Question 3

Explain breath holding in babies and children?

Answer 3

Described as an episode of breath holding (up to 1 minute) associated with painful, fearful or unpleasant stimulus.
Child may turn pale/blue, be floppy or stiff and may faint.
Should stop when baby is aged 4-5 years.

Question 4

What is bronchiolitis?

Answer 4

Acute bronchiolar inflammation commonly caused by RSV.
Most common cause of serious LRTI in kids < 1 year old, more common in winter.
More serious if premature baby, congenital heart disease or cystic fibrosis.

Question 5

What are the features of bronchiolitis?

Answer 5

coryzal symptoms,
Dry cough,
Increasing breathlessness,
Wheezing, fine inspiratory crackles,
Feeding difficulties.

Question 6

When do you immediately refer a child with bronchiolitis to hospital?

Answer 6

Apnoea,
Child looks seriously unwell,
Severe respiratory distress eg, grunting, chest recession or resp rate > 70.
Central cyanosis.
O2 sats persistently less than 92%

Question 7

What are the risk factors for bronchiolitis?

Answer 7

Age < 12 weeks of life.
Chronic lung disease,
Congenital heart disease,
Prematurity < 32 wks.
Immunodeficiency
Neuromuscular disorders

Question 8

What is the management of bronchiolitis?

Answer 8

Mainly supportive!
Humidified oxygen via head box if O2 sats below 92%.
NG feed if feeding issues
Suction for upper airway secretions.

Question 9

Signs of respiratory distress in paeds? IMPORTANT

Answer 9

Increased respiratory rate.
Use of accessory muscles - SCM, intercostal and abdominal muscles.
Intercostal/subcostal recessions.
Nasal flaring.
Head bobbing with breathing.
Tracheal tugging.
Cyanosis.
Abnormal airway noises.

Question 10

Features of cellulitis in children

Answer 10

Different types - erysipelas, impetigo, bites, paronychias (sides of fingernail folds), nec fasciitis.
Treatment - Drainage, flucloxacillin. Add clindamycin if significant concern.

Question 11

What are the causes of constipation in children?

Answer 11

Combination of painful defecation, hard stools due to low fibre, poor nutrients, anal fissure, hirschsprung’s disease and dehydration.
Occasionally can be caused by delated colonic motility

Question 12

What is the definition of conspitation?

Answer 12

Infrequent passage of stools leading to one or more of following:
Painful defecation,
Overflow incontinence,
Rectal faecal impaction
Active defecation avoidance behaviour

Question 13

What are the presenting features of constipation in children?

Answer 13

Painful/difficult defecation.
Long intercals between stools,
Fecal incontinence,
Abdominal pain,
Abdominal distention,
Palpable faecal mass per abdomen,
Otherwise healthy

Question 14

What are the red flag symptoms of constipation suggesting underlying disorder

Answer 14

Constipation reported from birth/first few weeks of life.
Passage of meconium > 48 hours
Faltering growth
Undiagnosed leg weakness,
Distension

Question 15

Signs of fecal impaction?

Answer 15

Symptoms of severe constipation,
Overflow soiling,
Fecal mass palpable in abdomen (DRE only done by expert)

Question 16

Management of constipation if fecal impaction is present?

Answer 16

First line = Movicol paediatric plain (Polyethylene glycol 3350 and electolytes).
Add stimulant if movicol paedicatric plain hasn’t worked within two weeks or if not tolerated.

Question 17

What is the maintenance therapy for constipation?

Answer 17

First line - Movicol paediatric plain.
Add stimulant if no response or not tolerated.
Continue meds for several weeks after regular bowel habit established then reduce dose gradually.

Question 18

Management of constipation in infants not yet weaned

Answer 18

Bottle fed - give extra water in between feeds. Abdominal massage and bicycling infants legs.
Breast fed - unusual and orgnaic cause should be considered

Question 19

What are the causes of faltering growth?

Answer 19

Inadequate caloric intake (environmental factors, poor appetite, feeding problems).
Increased calorific demand (infections, surgery or chronic illnesses).
Excess caloric loss (persistent vomiting, pyloric stenosis),
Inefficient use of calories (GI disorders, endocrine disorders)

Question 20

Investigations for faltering growth?

Answer 20

Blood screen: FBC, U&Es, LFTs, TFTs, bone profile, CRP +/- coeliac screen

Question 21

What are febrile convulsions and their presentation?

Answer 21

Seizures provoked by fever in otherwise normal children. Typically occur in children aged 6months - 5 years.
Presentation - early in viral infection, breif seizure which is commonly clonic tonic.

Question 22

Definition of simple febrile seizure

Answer 22

Fever and all of following - <15mins, generalized tonic clonic seizure, no recurrence in same febrile illness, completely recovered in hour.

Question 23

Definition of complex febrile seizure

Answer 23

Fever and any of the following: Focal features at onset/duration of seizure, duration > 15mins, incomplete recovery in 1hr and recurrence within same febrile illness.

Question 24

Afebrile febrile seizure

Answer 24

Seizure in an acute infectious illness without documented fever.
Features consistent with simple febrile seizure.

Question 25

What is the management of febrile convulstions?

Answer 25

Admit to hospital - first seizure or complex seizure.
Ongoing management - tell parents to phone ambulance if seizure > 5mins. If recurrent then benzodiazepines rescue medication.
Antipyretics do not reduce chance of febrile seizure occuring as they are not absorbed fast enough.