Paediatric 2

Question 1

Symptoms of obstructive sleep apnoea

Answer 1

COgnitive deficits, behavioural abnormalities, impulsivity, hyperactivity, bed wetting, poor growth: usually thin

Question 2

IS sleep study essential for sleep apnoea diagnosis

Answer 2

NO. sometimes history is enough. Otherwise healthy child is not necessary

Question 3

MOst comprehensive type of sleep study

Answer 3

Polysomnogrophy: measures HR, sats, Co2, EEG, airflow sensors, chest/abdo sensors

Question 4

obstructive sleep apnoea treatment

Answer 4

Conservative if low clinical concern
Adenotonsillectomy in persistent OSA
ANasal steroid spray (mild OSA)
Airway craniofacial surgery depending on pathology

Question 5

Chronic lymphadenopathy in children worrying? Treatment

Answer 5

NO they are very common. Be worried if there is a history of malignancy, if it is >2cm, it is supraclavicular and if they are getting bigger or are fixed/hard (lymphoma)

CXR, FBC. if abnormal then biopsy
Give abx and review in 2 weeks and biopsy if getting bigger

Question 6

What is non-tuberculous mycobacteria

Answer 6

Occurs in a well child with violet skin colour over cold abscess, usually submandibular area. Abx or nil as settles spontaneously over 1-2 years. Often conservative management is better

Question 7

Normal reactive lymph nodes

Answer 7

Size <1cm, fluctuates in size, worse with URTI. Clear source of infection e.g. scalp disease or tonsillitis, jugulodigastic area, well child, no other nodes or B symptoms. Offer reassurance and conservative management/monitoring

Question 8

Treatment of thyroglossal duct cysts and branchial cysts

Answer 8

Need excision

Question 9

Do you need to excise pre auricular sinus

Answer 9

Only if symptomatic

Question 10

Complications of DNSI

Answer 10

Airway compromise
Rupture: pneumonia, empyema, lung abscess
Mediastinitis
Menierre’s syndrome: IJV thrombosis
Carotid artery erosion

Question 11

Treatment of DNSI

Answer 11

Airway protection: observation/intubation/trache
IV abx
Surgical drainage/aspiration

Question 12

What is Ludwig’s angina

Answer 12

Floor of mouth swelling

Question 13

How to examine airway in children

Answer 13

Ask about breathing, blue episodes, feeding, weight gain (red book), voice, prematurity/intubation (risk factor for subglottic stenosis), skin, haemangioma (symptoms in child that get worse), PMH

Look for accessory muscle used, head bobbing, sniffing position, drooling, intercostal/subcostal/suprasternal recession

Bad signs: quiet child, no crying, marked recession, mottled, increasing tachycardia

Question 14

Commonest causes of stridor

Answer 14

LAryngomalacia (floppiness of larynx which causes squeaky inspiratory sound)

BIlateral vocal cord palsy at birth

Unilateral vocal cord palsy after cardiac surgery

Acquired subglottic problems with formation of cysts and occur in children who have been intubated because of prematurity

Question 15

Commonest causes of paediatric stridor in a newborn

Answer 15

M=Vocal cord motion impairment

Question 16

Commonest cause of paediatric stridor in weeks old child

Answer 16

Laryngomalacia /haemangioma

Question 17

Commonest causes of paediatric stridor in a months old

Answer 17

Recurrent respiratory papillomatosis

Question 18

Commonest causes of paediatric stridor in intubated NNU/PICU child

Answer 18

Subglottic stenosis

Question 19

Common causes of paediatric stridor in years old

Answer 19

Croup, epiglottitis, foreign body

Question 20

What to do if someone presents with a vocal cord motion impairment (unilateral vs bilateral)

Answer 20

Unilateral is usually iatrogenic
SO is bilateral. But needs a posterior fossa brain scan to rule out malformations in the brain leading to damage to vagus nerve. Half need trashy. 2/3 will recover at least partially

Question 21

Factfile of laryngomalavia. treatment?

Answer 21

Flexiscope. See a epiglottis that is folded. Inspiratory stridor worse with feed, prone position, agitation

If they are otherwise well and ti is not bad, then nothing really needs to be done. IF bad, can have supraglottoplasty

Question 22

Factfule of haemangioma
Management?

Answer 22

Rapid growth during first few months of life then convolution over next 2-3 years. There is a biphasic stridor (inspiratory and extrinsic).

MAnagement: Propranolol

Question 23

Recurrent respiratory papillomatosis warts factfile and treatment

Answer 23

HPV causes warts. Acquired from vertical transmission (still occurs with C section). Risk factors: first child, vaginal delivery, young mother

Presentation: husky voice and eventually airway obstruction

Treatment: repeated debulking

Question 24

Factfile of acquired subglottic stenosis

Answer 24

happens in children who are extubated (taken off intubation). Present with stridor when intubated. Wait until there is no infection, minimal respiratory support and normal O2 requirements and give them dexamethasone before reinserting tube.

Question 25

Acute epiglottis presentation

Answer 25

Bacterial infection
Septic/pyrexial
Drooling
Leaning forward
Very unwell

Question 26

Management of acute epiglottis

Answer 26

DOnt examine
Call paediatric anaesthetist/ENT surgeon so they can go to theatre
Intubate. Rarely tracheostomy

FBC, blood cultures, swab
Ceftriaxone and steroids
Often can be extubated after 48hours

Question 27

Inhaled foreign body investigation

Answer 27

If positive history [choking, coughing bout, playing with object], exam, CXR (2/3) positive, need rigid bronchoscopy

Question 28

Symptoms of swallowed foreign bodies

Worrying sign of battery ingestion

Answer 28

Complete dysphagia, drooling and distressed.

Battery: two rings seen on Xray