Paeds

Question 1

What are the 4 criteria for sepsis? (2 required)

Answer 1

• Abnormal core temperature (<36 or > 38.5)
• Abnormal HR (> 2 S.D. above normal for age)
• Raised RR (> 2 S.D. above normal for age)
• Abnormal WCC

Either temp or WCC required.

Question 2

What are the red flag criteria for sepsis, triggering the sepsis 6 pathway

Answer 2

• Hypotension
• Prolonged capillary refill > 5 seconds
• Oxygen needed to maintain sats >92%
• AVPU of V,P or U
• Confused or abnormal behaviour

Question 3

What organisms cause early onset neonatal sepsis?

Answer 3

E. Coli
Listeria monocytogenes

Guillain-Barré Syndrome

Question 4

What class of organisms cause late onset neonatal sepsis?

Answer 4

Coagulase negative Staphylococcus (CoNS)

Eg staphylococcus epidermidis

Question 5

Which bloods should be taken in a septic child?

Answer 5

Clotting 
Blood culture 
CRP
U&Es
VBG (glucose & lactate)
FBC

Question 6

Which Abx are given for meningococcal sepsis?

Answer 6

IM benzylpenicillin (in community)
IV cefotaxime (in hospital)

Question 7

Which Abx are given for early onset sepsis (<72 hours)?

Answer 7

IV cefotaxime
Amikacin
Ampicillin

Question 8

Which Abx are given for late onset sepsis (>72 hours)?

Answer 8

IV meropenem
Amikacin
Ampicillin

Question 9

What do the following signs of meningitis look like clinically:

Kernig’s sign
Brudzinski’s sign

Answer 9

Kernig’s sign = pain on straightening leg

Brudzinski’s sign = supine neck flexion –> knee / hip flexion

Question 10

In meningitis, Cushing’s triad indicates raised intracranial pressure. What is this trio of signs?

Answer 10

High systolic BP
Low HR
Irregular RR

Question 11

What Abx would you give to a child <3 months old with meningitis?

Answer 11

IV cefotaxime + IV amoxicillin

Question 12

What Abx would you give to a child >3 months old with meningitis?

Answer 12

IM benzylpenicillin stat + IV ceftriaxone

Question 13

What are the three aetiologies of encephalitis?

Answer 13

Direct invasion of cerebellum by neurotoxic virus

Post-infectious encephalopathy of delayed brain swelling following neuroimmunological response to antigen

Slow virus infection

Question 14

What is the management for encephalitis?

Answer 14

3 weeks IV high dose acyclovir

Question 15

What is the management for anaphylaxis?

Answer 15

ABCDE approach

IM adrenaline (1:1000)

Supportive:
Establish airway + O2
IV fluids
IV Chlorpheniramine 
IV hydrocortisone 
Salbutamol (if wheeze)