Paediatrics

Question 1

Management of viral induced wheeze

Answer 1

Episodic viral wheeze:
- 1st line = short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacer

• 2nd line = intermittent leukotriene receptor antagonist (montelukast) or intermittent inhaled corticosteroids, or both

Multiple trigger wheeze
- trial of either inhaled corticosteroids or a leukotriene receptor antagonist (montelukast), typically for 4-8 weeks

Question 2

Most common cause of bronchiolitis

Answer 2

RSV

Question 3

Features of bronchiolitis

Answer 3

coryzal symptoms (including mild fever) precede:

• dry cough
• increasing breathlessness
• wheezing
• fine inspiratory crackles
• feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

Question 4

When would you refer immediately (999), for bronchiolitis?

Answer 4

1. apnoea (observed or reported)
2. child looks seriously unwell to a healthcare professional
3. severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
4. central cyanosis
5. persistent oxygen saturation of less than 92% when breathing air.

Question 5

Ix for bronchiolitis

Answer 5

immunofluorescence of nasopharyngeal secretions

Question 6

Management of bronchiolitis

Answer 6

Management is largely supportive:
1. humidified oxygen is given via a head box (if O2 sats < 92%)

2. nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
3. suction is sometimes used for excessive upper airway secretions

Question 7

What is laryngomalacia?

Answer 7

Congenital abnormality of the larynx.

Infants typical present at 4 weeks of age with:
stridor

Question 8

What is haemolytic uraemic syndrome?

Answer 8

Tirad of:

1. acute kidney injury
2. microangiopathic haemolytic anaemia
3. thrombocytopenia

Question 9

Ix for HUS

Answer 9

1. full blood count: anaemia, thrombocytopaenia, fragmented blood film
2. U&E: acute kidney injury
3. stool culture

Question 10

Management of HUS

Answer 10

1. treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
2. No Abx, despite the preceding diarrhoeal illness in many patients
3. plasma exchange is reserved for severe cases of HUS not associated with diarrhoea
4. eculizumab (in adults)

Question 11

What is cradle cap?

Answer 11

Early sign of seborrhoeic dermatitis

Question 12

How does cradle cap present?

Answer 12

Erythematous rash with coarse yellow scales

Question 13

Management of cradle cap

Answer 13

mild-moderate: baby shampoo and baby oils

severe: mild topical steroids e.g. 1% hydrocortisone

Usually resolves spontaneously by 8 months

Question 14

What is urticaria?

Answer 14

local or generalised superficial swelling of the skin ( hives)

Question 15

Features of urticaria

Answer 15

1. pale, pink raised skin. Variously described as ‘hives’, ‘wheals’, ‘nettle rash’
2. pruritic

Question 16

Management of urticaria

Answer 16

1st line = non-sedating antihistamines

Severe or resistent = prednisolone

Question 17

What is kawasaki disease?

Answer 17

type of vasculitis which is predominately seen in children

Question 18

Features of kawasaki disease

Answer 18

1. high-grade fever which lasts for > 5 days.
   - Fever is characteristically resistant to antipyretics
2. conjunctival injection
3. bright red, cracked lips
4. strawberry tongue
5. cervical lymphadenopathy
6. red palms of the hands and the soles of the feet which later peel

Question 19

Ix for kawasaki disease

Answer 19

clinical diagnosis

Question 20

Management of kawasaki disease

Answer 20

1. high-dose aspirin
2. intravenous immunoglobulin
3. echocardiogram is used as the initial screening test for coronary artery aneurysms

Question 21

What is syndrome of inappropriate ADH secretion (SIADH) ?

Answer 21

hyponatraemia secondary to the dilutional effects of excessive water retention.

Question 22

Management of SIADH

Answer 22

1. correction must be done slowly
2. fluid restriction
3. demeclocycline: reduces the responsiveness of the collecting tubule cells to ADH
4. ADH (vasopressin) receptor antagonists have been developed

Question 23

Typical presentation of flat feet

Answer 23

All ages

Absent medial arch on standing

Typically resolves between the ages of 4-8 years

Question 24

Bow legs

Answer 24

1st-2nd year

Typically resolves by the age of 4-5 years

Question 25

Screening for developmental dysplasia of the hip

Answer 25

all infants are screened at both the newborn check and also the six-week baby check using the Barlow and Ortolani tests

Question 26

Ix for DDH

Answer 26

USS confirms diagnosis

Question 27

Management of DDH

Answer 27

1. most unstable hips will spontaneously stabilise by 3-6 weeks of age
2. Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months
3. older children may require surgery

Question 28

What is Perthes?

Answer 28

Degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years

Due to avascular necrosis of the femoral head, specifically the femoral epiphysis

Question 29

Features of perthes’

Answer 29

1. hip pain: develops progressively over a few weeks
2. limp
3. stiffness and reduced range of hip movement

Question 30

Diagnosis of perthes’

Answer 30

plain x-ray

• early changes include widening of joint space
• later changes include decreased femoral head size/flattening

Question 31

Management of perthes’

Answer 31

1. To keep the femoral head within the acetabulum: cast, braces
2. If less than 6 years: observation
3. Older: surgical management with moderate results
4. Operate on severe deformities