Paeds

Question 1

How old is a neonate, infant, toddler, pre-schooler, school age and adolescent child?

Answer 1

<28 days, 1-12 months, 1-3 years, 3-5 years, 5-12 years, >13 years

Question 2

Features in HPC?

Answer 2

Explode every symptom- time-frame (when started, acute/ gradual onset, duration, progression, intermittent or continuous,) symptom- specific questions e.g. SOCRATES for pain
Paeds systems review- general: fever, behaviour, activity/ apathy/ alertness, rashes, growth+ weight
CR: cough, noisy breathing, dyspnoea, cyanosis
GI: vomiting, abdo pain, diarrhoea/ constipation
GU: wetting/ nappies/ toilet trained, dysuria, frequency
NM: seizures/ fits, headaches, abnormal movements
ENT: sore throat, snoring, noisy breathing, earache

Question 3

Birth hx features?

Answer 3

Pregnancy- problems, maternal illness/ drug use
Birth hx- POB, gestation & birth weight, mode of delivery and birth complications, neonatal problems e.g. jaundice, fits, fevers, bleeding, feeding problems

Question 4

Feeding hx?

Answer 4

Diet+ appetite- breast/ bottle milk< 12 months, which formula milk
Weaning 6-12 months
>12 months= solid meals and cow’s milk
Toileting- toilet training 2-4 years, dry by day 2 years, dry by night 3-4 years, frequency- wet nappies? (usually 5 soaking wet nappies per day and 3 yellow stools)

Question 5

Growth hx?

Answer 5

Weights- ‘the Red Book’ from birth to 5 years

Puberty if older

Question 6

Development hx?

Answer 6

Concerns, school progress& attendance
Screen if< 5 years: smiling by 6 weeks, sitting by 9 months, turns by sounds by 6 months, first words by 18 months, walking by 18 months, talking 3 word sentences by 3 years

Question 7

Other aspects of paeds hx?

Answer 7

Past medical hx- illness, surgery, accidents, hospital/ A&E visits
Drug hx- immunisations up to date, current meds- dose, route, compliance, relevant recent meds, allergies
Family hx: relevant to HPC, anyone else ill
Social hx: family unit (tree,) smokers- inside/ outside, social services involvement, housing situation, playgroup 2-5 years, nursery 3-4 or school 5-16 years, other- hobbies, travel, pets
ICE

Question 8

ABCDE assessment for child?

Answer 8

Wash hands, intro, patient ID, DOB, explain
Airway: stridor, secretions
Breathing: RR, recession, oxygen SATs, auscultate inspirations
Circulation: colour, radial pulse, hydration signs- wet nappies, mucous membranes, skin turgor, CRT, heart sounds, BP if unwell
Disability (neuro): alert and behaviour, AVPU score/ GCS, Fontanelle- bulging= raised ICP
Pupils w/ torch if unwell, limb tone and movement, joint swelling, RASH- look all over, capillary glucose measurement if decreased alertness
Everything else: ENT, temperature

Question 9

Normal HR and RR in <1 y/o? 1-2 y/o? 2-5 y/o? 5-12 y/o? >12 y/o?

Answer 9

30-40 and 110-160
25-35 and 100-150
25-30 and 95-140
20-25 and 80-120
15-20 and 60-100

Question 10

Amber flags?

Answer 10

Nasal flaring, tachypnoea, SATS<95%, pallor, tachycardia, reduced CRT, reduced UO, dry mucous membranes, reduced activity, not responding normally to social cues
Rigors, fever in 3-6 month old

Question 11

Red flags?

Answer 11

Stridor
Resp distress= RR>60, pale/ mottled/ blue, reduced skin turgor, unresponsive/ won’t stay awake, non-blanching rash/ neck stiffness, seizures
Fever< 3 month old

Question 12

Intro to developmental assessment?

Answer 12

Wash hands, intro, patient ID, explain exam, consent
Observe for 30 seconds
Do 3 areas before gross motor with child on parent’s lap
Ask parents questions to fill in any gaps/ anything cannot get them to demonstrate

Question 13

Gross motor skills?

Answer 13

Put child on play-mat on floor
Lie on back- see if can roll
Lift shoulders to sitting position- look for head control (3 months)
See if can sit unaided (6 months)- curvature of spine and sitting reflexes
Pull to stand- see how much support needed (9 months)
Walk if able (15 months) or run (2 years)
Place prone- if lifts head, chest or crawls (10 months)

Question 14

Fine motor and vision?

Answer 14

Get child to take a toy and observe- transfers (6 months), type of grip (palmar grasp 6 months; pincer grip 9-10 months)
Offer bricks- 3-cube tower= 18 months, bridge= 3 years
Paper and pen- scribbles at 18 months
Vision- wave toy, fixes and follows (3 months)

Question 15

Hearing and language?

Answer 15

Click fingers/ use rattles- startles to noise= newborn, turns to sounds= 7 months, turns to name= 12 months
Talk to child and ask parents what the child can say or noises- babble by 6 months, single word by 9 months, Mummy and Daddy by 12 months, name and colours by 3 years
Commands- brick in cup by 2 years

Question 16

Social skills?

Answer 16

Smile by 6 weeks, laughs by 3 months, stranger anxiety at 9 months, peek-a-boo by 9 months, waves bye at 12 months, solids by 6 months, fork and spoon at 2 years

Question 17

Presenting a developmental assessment?

Answer 17

Looking at growth charts and measuring weight, height and head circumference, take a full history
Estimate developmental age if age unknown, if age known- comment if dev is appropriate for age

Question 18

Qs along with diarrhoea and vomiting? For soiling/ enuresis?

Answer 18

Hydration- wet nappies, drinking
Primary/ secondary, full account of toilet training, school toilet behaviour, protest behaviour: stressful life, soiling- faces consistency& painful anal conditions, secondary: urinary/ GI infection symptoms, spinal cord compression symptoms- neuro sys review

Question 19

Failure to thrive/ weight loss Qs?

Answer 19

Growth chart, input: dietary hx, feeding hx, hunger, use: energy, activity level, exercise, anorexic?, output: wet nappies, stools& GI symptoms, others: behaviour, general, happiness, parents health

Question 20

Signs of resp distress?

Answer 20

Cyanosis, tracheal tug, subcostal/ intercostal recessions, hypoxia, tachypnoea, wheeze on auscultation, stridor, head bobbing

Question 21

DDx for wheeze?

Answer 21

Asthma, bronchiolitis, viral induced wheeze, pneumonia

Question 22

DDx for stridor?

Answer 22

Croup, epiglottitis, bacterial tracheitis, diphtheria, laryngomalacia, inhaled foreign body, angiodema/ anaphylaxis

Question 23

Red flag features for a vomiting child?

Answer 23

Bile-stained= intestinal obstruction, haematemesis= peptic ulceration, gastritis, oesophageal varcies,
projectile vomiting= pyloric stenosis
Abdo pain on movement= appendicitis
Blood in stool= intussusception, gastroenteritis, severe dehydration= severe gastroenteritis, DKA, systemic infection, headache/ seizures= raised ICP, failure to thrive= gastro-oesophageal reflux disease, coeliac disease

Question 24

DDx for vomiting?

Answer 24

GORD, cow’s milk protein intolerance, intestinal obstruction, infection

Question 25

Symptoms, invest and managements for GORD?

Answer 25

Recurrent regurg, feeding difficulties, arching of back and neck, sore throat
pH impedance study, 24-hour probe
Smaller and more frequent meals, feed thickeners, optimise position

Question 26

Symptoms, invest and managements for cow’s milk protein intolerance?

Answer 26

Abdo pain, eczema, flatulence, bloody stools, diarrhoea/ constipation
Skin prick/ specific IgE antibody testing
Cow’s milk elimination diet, hypoallogenic infant formula, mothers to avoid cow’s milk

Question 27

Symptoms, invest and managements for intestinal obstruction?

Answer 27

Acute on chronic, billious vomiting, constipation, abdo pain
USS, abdo XR, contrast study
Surgical intervention

Question 28

Symptoms, invest and managements for infection?

Answer 28

D&V and abdo pain (gastroenteritis,) isolated vomiting (UTIs,) altered responsiveness (meningitis)
Find source: cultures, urine dipstick, LP
Treat source of infection