Lecture Day Two

Question 1

Why is it important to protect children from unnecessary radiation, more so than in adults?

Answer 1

Their tissues are more radiosensitive, and due to them normally having a smaller size, the effective dose is higher.

Question 2

What is the investigation used in suspected GORD in children?

Answer 2

Contrast swallow - barium meal. This is not ideal, and best thing is to have a clinical picture (recurrent vomiting after feeds, non-bilious, crying and difficulties sleeping) and treat, to see if it improves

Question 3

What is the investigation of choice for pyloric stenosis?

Answer 3

USS

Question 4

What are the signs/symptoms of pyloric stenosis?

Answer 4

vomiting after feeds, with weight loss and metabolic alkalosis

Question 5

What is the first-line investigation in a child with green bilious vomiting?

Answer 5

Upper GI study - contrast

-these symptoms may indicate a malrotation with volvulus due to an abnormal fixation of the small bowel mesentery, making it prone to twisting

Question 6

What is the first-line investigation for a suspected bowel obstruction?

Answer 6

Abdominal X-ray

Question 7

Why can intussusception occur after a viral illness?

Answer 7

The lymph nodes are involved in causing the bowel to telescope in on itself (invagination of proximal bowel into distal)

Question 8

What is the first line investigation for intussusception?

Answer 8

Ultrasound scan

Question 9

In suspected appendicitis in a younger child, what is the first-line investigation method?

Answer 9

USS

Question 10

What is the important differential diagnosis in girls with suspected appendicitis?

Answer 10

Ovarian cyst (important to identify to avoid unnecessary surgery)

Question 11

When referring a child for a scan due to breathlessness, what information is important to provide?

Answer 11

1. Age of the child
2. Clinical examination findings - fever, cyanosis?
3. Cough - productive, non-productive?
4. Known underlying problem?

Question 12

What is the first line investigation for a child with breathlessness?

Answer 12

Chest X-ray

Question 13

What is the typical type of pneumonia seen in children on CXR?

Answer 13

Round pneumonia (may appear as a mass in the lung which would be worrying in adults, but not so much in children)

Question 14

What may be seen on a CXR in a child with asthma?

Answer 14

Overinflation
Bronchial wall thickening
Infection
Collapse due to mucous plug

Question 15

Why would a child with asthma have a CXR?

Answer 15

If they are experiencing complications i.e. infection

Question 16

What is vesicoureteric reflux?

Answer 16

Retrograde flow of urine from bladder towards the kidney, associated with pyelonephritis and scarring

Question 17

What imaging is performed in children with suspected vesicoureteric reflux?

Answer 17

Cystogram - contrast outlines ureters and renal collecting

Question 18

What is Perthes disease?

Answer 18

An idiopathic avascular necrosis (infarction of the hip)

On imaging: fragmented flattened femoral head.

Question 19

What is a slipped capital femoral epiphysis?

Answer 19

An idiopathic fracture through the proximal femoral growth plate - often occurs in obese children and the pain may be in the hip but can be referred to the knee

Question 20

Which fractures are more common to see in children suffering abuse?

Answer 20

Metaphyseal fracture - corner fractures with a triangular piece of bone or ‘bucket handle’’ fracture.

Question 21

What is a useful equation to remember for calculating oral/IV medications?

Answer 21

what you want / what you’ve got X volume its in

e.g. you want 160mg, you’ve got 120mg/5ml so..
160/120 x 5 = 6.6ml