Paediatric Diseases

Question 1

Describe the vital signs table for children

Answer 1

insert table

Question 2

When is a child classes an infant?

Answer 2

Up to 18 months/2years

Question 3

In what ways are infants anatomy different to adults?

Answer 3

• large heart with a big surface area to volume ratio
• high anterior larynx and floppy epiglottis
• more flexible ribs
• low blood volume

Question 4

What is the relevance of infants having a different larynx and epiglottis?

Answer 4

Requires a different intubation technique - in children <1 year old the airway must be kept more neutral in an emergency to prevent it from closing up

Question 5

At birth what is the average blood volume of a baby?

Answer 5

80mls/kg - blood loss can occur easily

Question 6

How does physiological jaundice occur?

Answer 6

Foetal haemoglobin is broken down by the babies liver but it is still maturing and does not have all the appropriate enzymes so therefore results in excess unconjugated bilirubin

Question 7

What is the most common respiratory pathology in infants?

Answer 7

Bronchiolitis

Question 8

Describe bronchiolitis

Answer 8

Acute inflammatory injury of the bronchioles presents with coryza, distinct cough, lots of secretions, fever, wheeze, intercostal recession, apnoea, poor feeding

Question 9

What virus commonly causes bronchiolitis?

Answer 9

RSV

Question 10

How is bronchiolitis treated?

Answer 10

Supportive - CPAP can be used for apnoea

Question 11

Describe Croup

Answer 11

Acute laryngotracheobronchitis - causes subglottic oedema, inflammation and exudate. Presents with a barking cough and stridor (usually worse at night)

Question 12

What causes croup?

Answer 12

Usually paraflu

Question 13

How can croup be treated?

Answer 13

Steroids

Question 14

Name the ENT emergency that is more common in children

Answer 14

Epiglottitis

Question 15

Describe epiglottitis

Answer 15

Presents with sudden onset continuous stridor, dribbling, septic but no prominent cough

Question 16

What causes epiglottitis?

Answer 16

Usually haemophilus influenza

Question 17

How is epiglottitis treated?

Answer 17

Steroids and antibiotics

Question 18

Other than croup and epiglottitis name another pathology that presents with stridor in infants

Answer 18

Bacterial tracheitis

Question 19

Describe bacterial tracheitis

Answer 19

Commonly due to staph aureus presents with a productive cough, stridor and an acutely unwell child

Question 20

What signs can be seen on CXR of croup?

Answer 20

• hypopharynx distension

- narrowing of air column (steeple sign)

Question 21

How does pneumonia present in infants?

Answer 21

Fever, cough, crackles in lungs, grunting, nasal flaring, intercostal recession
Bronchopneumonia or focal

Question 22

What is another name for whooping cough?

Answer 22

Pertussis

Question 23

How does pertussis present?

Answer 23

Apnoea, vomiting, ‘whoop’ occurs due to inspiration against closed glottis

Question 24

What is the treatment for pertussis?

Answer 24

Mainly supportive (vaccine for prevention)

Question 25

Describe meningitis

Answer 25

Acute inflammation of the meninges due to infection (bacterial or viral). Presents with stiff neck, photophobia, fever, purpuric rash (non-blanching), arthritis, bulging fontanelles

Question 26

How is meningitis investigated?

Answer 26

Lumbar puncture and imaging but depends on history

Question 27

What is encephalitis ?

Answer 27

Inflammation of the brain, can present with focal seizures, weakness or personality changes

Question 28

What is given to patients with suspected encephalitis?

Answer 28

Aciclovir in case it is due to herpes

Question 29

How is gastroenteritis treated?

Answer 29

Oral rehydration (dioralyte)

Question 30

What is the differential diagnosis for a ‘funny turn’?

Answer 30

• febrile seizures
• reflex anoxic attack
• breath holding attack
• epilepsy
• arrhythmias
• heart abnormality

Question 31

What investigation must always be done in an infant with ‘funny turns’?

Answer 31

Heart tracing to rule out long QT

Question 32

Describe febrile seizures

Answer 32

A single tonic -clonic symmetrical seizure usually lasting <5 mins happen as a result of an increase in temperature due to infection. Important to find and treat the underlying cause.

Question 33

What is a reflex anoxic attack?

Answer 33

Self limiting brief systole triggered by pain/fear/anxiety. Benign and a child will grow out of it.

Question 34

How does congenital heart disease usually present?

Answer 34

Cyanosis and heart failure

Question 35

What is the most common arrhythmia in infants?

Answer 35

Supra ventricular tachycardia

Question 36

How is an SVT in children managed?

Answer 36

With drugs until a pacemaker can be inserted when they are older