Paediatrics

Question 1

How is a one off viral wheeze managed?

Answer 1

Mainly supportive:

Avoid cigarette smoke, paracetamol, salbutamol

Question 2

How is a repeated viral wheeze managed?

Answer 2

Trial preventers

Question 3

How is severe viral wheeze managed?

Answer 3

If hypoxic

Admit to hospital for oxygen and fluid support

Question 4

What symptoms usually accompany a viral wheeze?

Answer 4

Cough
Cold
Chest infection

Question 5

What are the differentials for viral wheeze? How can you rule them out?

Answer 5

CF, metabolic conditions e.g. sickle cell
- heel prick test done day 5-7
Foreign body aspiration
- signs would be unilateral

Question 6

What age range usually experiences viral wheeze?

Answer 6

6 months to 6 years

Question 7

How is toddlers diarrhoea defined?

Answer 7

> /= 3 watery stops /day

Question 8

When is toddler’s diarrhoea most prevalent?

Answer 8

Boys

Age 1-5 y/o

Question 9

What are the differentials for toddler’s diarrhoea? How are these different?

Answer 9

Infection
-acute presentation
Dietary intolerance
-bloating, rashes, triggered by certain foods, severe eczema at a young age may indicate lactose intolerance
IBD
-pain, blood in stools
Coeliac disease
-child not growing as expected

Question 10

What is the most common causative organism of infantile gastroenteritis

Answer 10

rotavirus

Question 11

What is the most common causative organism of gastroenteritis in all age groups?

Answer 11

norovirus

Question 12

What are some risk factors for GORD in children

Answer 12

Premature birth
Parental history
Neurodisability e.g. cerebral palsy

Question 13

How can you differentiate common regurgitation from GORD in younger children?

Answer 13

Using the history of symptoms, in gord:
•	Distressed behaviour
•	Feeding difficulties 
•	Pneumonia
•	Faltering growth

Question 14

What are some differentials for GORD in younger children?

Answer 14

Pyloric stenosis 
Upper GI bleed
Intestinal obstruction
Cow milk allergy
Raised intracranial pressure

Question 15

How is GORD in younger children managed?

Answer 15

1-reduce feed
2-feed thickener
3-alginate
4- if alginate doesnt work, PPI

Question 16

What is Osgood Schlatter’s?

Answer 16

 Osteochondritis of the growth plate at the tibial tuberosity (where the patellar ligament inserts)

Question 17

When does Osgood Schlatter’s usually occur?

Answer 17

Common during growth spurts

Question 18

How does Osgood Schlatter’s present?

Answer 18

Unilateral knee pain after exercise, insidious onset and intermittent
Localised tenderness and swelling over the tibial tuberosity
+/- hamstring/quad tenderness

Question 19

What are some differentials and how can they be distinguished?

Answer 19

Injury
•	Acute onset
•	+ stiffness/mechanical symptoms/reduced ROM/#
Perthes
•	Younger
•	Limp
•	Hip muscle wasting and reduced internal rotation
SUFE
•	Risk fx is childhood obesity
•	Can be acute or insidious
•	Limp
•	Externally rotated hip, shortened, limp 
Bony pathology if presented with a limp
•	Malignancy etc.

Question 20

How do threadworms present?

Answer 20

Itching and discomfort around anus

Can spot worms in stool

Question 21

How are threadworms treated?

Answer 21

All house members have to take mebendazole

• one dose doesn’t kill the worms
• maintain hygiene for 2 weeks, until the eggs die

Question 22

What are the differentials for threadworms? How can they be distinguished?

Answer 22

Candida
•	Itching around anus or vulva
•	White discharge
•	Won’t see worms
•	Can affect anyone not just school children
•	Risk fx- immunosuppression, diabetes, abx 
Napkin dermatitis
•	Nappy dermatitis when its warm

Question 23

What is infantile colic?

Answer 23

Bouts of crying, at least 3 hrs/day, 3days/week, in an infant up to 4 months old

Question 24

How is infantile colic managed?

Answer 24

It is self limiting

Purple crying is a website to support parents

Question 25

What are the differentials of infantile colic and how can they be excluded?

Answer 25

Pyloric stenosis
•	PROJECTILE VOMITING
Obstruction 
•	Blood in stool
•	Bile stained vomit
•	Abdominal distension 
Testicular torsion
•	Swelling, erythema
•	Examination
Allergies
•	Erythema, urticarial, eczema 
Infection
•	Systemic features
•	Otitis media- pulling ears
Dehydration or hunger 
•	Wet nappies
•	Feeding history
Trauma/maltreatment
•	Bruises, wounds, parental risk factors

Question 26

Who is affected by bronchiolitis?

Answer 26

Usually affects children under 2 yrs

1/3 of children will develop bronchiolitis within the first year of life

Question 27

What are the risk factors for bronchiolitis?

Answer 27

 Being breast fed for less than 2 months
 Smoke exposure (eg. parents’ smoke)
 Having siblings who attend nursery or school (increased risk of exposure to viruses)
 Chronic lung disease due to prematurity

Question 28

What are the risk factors for bronchiolitis?

Answer 28

• Being breast fed for less than 2 months
• Smoke exposure (eg. parents’ smoke)
• Having siblings who attend nursery or school (increased risk of exposure to viruses)
• Chronic lung disease due to prematurity

Question 29

How does bronchiolitis present?

Answer 29

	Symptoms usually last 7-10 days, and gradually increase over the first 2-5 days
	Low-grade fever
	Nasal congestion
	Rhinorrhoea
	Cough
	Feeding difficulty
	 Signs
	Tachypnoea
	Grunting
	Nasal flaring
	Intercostal, subcostal or supraclavicular recessions
	Inspiratory crackles
	Expiratory wheeze
	Hyperinflated chest
	Cyanosis or pallor

Question 30

How is bronchiolitis managed?

Answer 30

 At home
• Supportive
 Hospital
• If seriously unwell, in resp distress, cyanosed, RR>60, not eating or drinking
• Managed with oxygen, fluids, upper airway suctioning to remove secretions