paeds

Question 1

common cause of cough in infants

Answer 1

viral
structural airway
tracheo-oesophageal fistula
vascular rings

Question 2

common cause of cough in toddlers

Answer 2

viral
FB
viral induced wheeze

Question 3

common cause of cough in older kids

Answer 3

viral
asthma (if wheeze or dyspnoea)
chronic rhinitis

Question 4

common cause cough adolescents

Answer 4

viral
asthma (wheeze and/or dyspnoea)
psychogenic

Question 5

paediatric cough red flags

Answer 5

sudden onset without prodrome ?FB
associated with feeds
poor growth
loss of muscle bulk and subcut fat
abnormal cardiac exam
clubbing
differential air entry

Question 6

causes of cough for >4weeks

Answer 6

Normal if well
pertussis (paroxysmal)
asthma
FB
sinusitis
supperative lung disease

Question 7

pertissus greatest risk to

Answer 7

kids under 6 months

Question 8

infectious period of pertusis

Answer 8

just prior to cough developing and for next 21 days if untreated

Question 9

history of pertusis

Answer 9

cough and coryza 1 week (catarrhal)
cough in spells (paroxysmal)
convalescent stage (months)

Question 10

pertussis incubation period

Answer 10

days 4-21

Question 11

pertussis investigations

Answer 11

aboratory confirmation is not necessary for diagnosis, but may be helpful for infection control
A nasopharyngeal aspirate/swab for PCR is the investigation of choice. The test is usually negative after 21 days, or 5-7 days after effective antibiotic therapy has been commenced
Pertussis serology (IgA) may be detectable 2 weeks after the onset of the illness but rarely affects clinical management

Question 12

pertussis treatment considered if?

Answer 12

Consider antibiotics if:

Diagnosed in catarrhal or early paroxysmal phase (may reduce severity)
Cough for less than 14 days (may reduce spread; reduces school exclusion period)
Admitted to hospital
Complications (pneumonia, cyanosis, apnoea)

Question 13

Pertussis antibiotics:

Answer 13

Neonates:

Azithromycin 10 mg/kg oral daily for 5 days
Children who cannot swallow tablets:

Clarithromycin liquid 7.5 mg/kg/dose (max 500 mg) oral BD for 7 days
Children who can swallow tablets:

Azithromycin (for children = 6 months old): 10 mg/kg (max 500 mg) oral on day 1, then 5 mg/kg (max 250 mg) daily for 4 days
If macrolides are contraindicated:

Trimethoprim-sulphamethoxazole (8-40 mg per mL)
0.5 mL/kg (max 20 mL) BD for 7 days

Question 14

infection control with pertussis

Answer 14

Exclude from school and presence of others outside the home (especially infants and young children) until received 5 days of therapy, or coughing for more than 21 days

Question 15

will pertussis infection preclude vaccination

Answer 15

no, infected kids still need to complete schedule

Question 16

is prophylaxis indicated in pertussis close contacts?

Answer 16

yes, if:
- contact with case while infections
AND
- first contact within 14 days (or 21 if under 6m)
AND
- age <6m OR
- incomplete vaccination
- member of house <6m
- attend childcare in same room as infants

Question 17

criteria for adult pertussis prophylaxis

Answer 17

Expectant parents in last month of pregnancy OR
Health care worker in maternity hospital or newborn nursery OR
Childcare worker in close contact with infants <6 months OR
Household member aged <6 months

Question 18

definition protracted bacterial bronchitis

Answer 18

wet cough daily for >4 weeks
no other alt cause
responds to ABX

Question 19

common demographic for protracted bacterial bronchitis

Answer 19

ATSI kids

Question 20

diagnosis of protracted bacterial bronchitis

Answer 20

sputum MCS if able to expectoate (age >7 yrs)
likely + haemophilus influenzae

Question 21

most common cause of limping in kids

Answer 21

transient synovitis
acute myositis
minor trauma

Question 22

severe localised joint pain and fever =

Answer 22

septic arthritis

Question 23

red flags in the limping child

Answer 23

• duration >7days
• severe localised pain
• change to urine or bowels
  -complete inability to weight bear
• nocturnal pain symptoms
• constitutional symptoms
• generalised wasting
• fever
• petichae/purpura (HSP/malig/haem)

Question 24

common differentials of limping a 0-4 years of age

Answer 24

transient hip synovitis
acure myositis
toddlers fracture
developmental hip dysplasia

Question 25

differentials of limping in kids 5-10

Answer 25

transient hip synovitis
acute myostitis
developemtal dysplasia of the hip
-PERTHES

Question 26

caused of limping in kids >10 years

Answer 26

• stress fractures and sprains
• traction apophysitis (osgood schlatters - tibial tuberosity)
• SUFE (slipped upper femoral epiphysis)

Question 27

risk factors for developmental dysplasia of the hip

Answer 27

Risk factors for DDH
* Breech
* Positive family history
* Girls > boys
* Neuromuscular or joint problem (e.g. spina bifi da,
talipes)

Question 28

recent viral illness, limp, pain on hip abduction and rotation?

Answer 28

transient synovitis (irritable hip)

Question 29

risk factors for slipped femoral epiphysis

Answer 29

late childhood/early adolescence
hip or knee pain
90th centile in weight
can be bilateral
hip shortened and ext rotated
reduced movements esp internal rotation

Question 30

XR findings with Perthes disease

Answer 30

increased density of femoral head epiphysis and widened medial joint space (avascular necrosis)

Question 31

infant presents with 4 days of fever which settled then developed a rash.

Likey diagnosis and pathogen

Answer 31

Roseola infantum
Human herpes virus 6

Question 32

vomiting, bloody diarrhoea, acute renal impairment

Answer 32

Haemolytic uraemic sundrome caused by Shiga toxin producing E Coli

Question 33

how is Shiga producing E Coli spread?

Answer 33

eating raw or undercooked beef mince
eating uncooked fermented meat products (for example mettwurst and salami)
eating vegetables, salads and fruit juices contaminated with animal faeces
contact with farm animals
swallowing contaminated water.

Question 34

11 year old child, very active in sports, presents with bilateral heel pain
- Dx
- Patho
- Tx

Answer 34

Severs disease
Injury to achiles tendon insertion to calcaneal bones
Calf stretches, reduce activity, ice, heel gel pads in shoes, time

Question 35

young active boy, knee pain distal patella, worse on activity, limp afterwards, better with rest

Answer 35

Sinding-Larsen-Johansson syndrome - inflammation at insertion of patella tendon to patella

Question 36

features of ITP

Answer 36

petichial rash in a
1. well child
2. isolated thrombocytopenia
3. normal FBE

Question 37

features HSP

Answer 37

small bruise like spots on buttocks, legs, elbows
causes arthritis and abdo pain

Most common in children aged 2–10 years
* Vasculitic process
* Involves the following four organ systems:
* Skin – pathognomonic purpuric rash
* Joints
* Gut
* Kidneys.

Question 38

cough, coryza, conjunctivitis, koplik spots

Answer 38

measles prodrome before rash develops