Paeds

Question 1

Acute epiglottitis
◘ A rare but serious infection
◘ Caused by Haemophilus influenzae type B.
◘ Immediate recognition and treatment is essential as airway obstruction may
develop.
◘ Epiglottitis was generally considered a disease of childhood but in the UK, it
is now more common in adults due to the immunisation programme.

Answer 1

Causative organism of acute epiglottis

is haemophilus influenzae type B

Question 3

Features of acute epiglottis

And management

Answer 3

The incidence of epiglottitis has decreased since the introduction of the Hib
vaccine. (Hib = Hemophilus Influenza type B).

Features
√ rapid onset
√ high temperature,
√ generally unwell, toxic child

√ stridor
√ drooling of saliva
√ Muffling/ hoarse / Changing voice.

√ lateral neck X-ray → Thumb sign
◙ Rx

◙ Call (Summon) anaesthetist → Intubation “before airway obstruction occurs”

◙ Secure His Airways
Any of these two would be a valid answer in Acute epiglottitis

Question 4

Croup (Laryngotracheobronchitis)

◙ An upper respiratory tract infection seen in infants and toddlers.

◙ Commonest organism → Parainfluenza viruses.

Answer 4

◙ Features

√ stridor

√ barking cough (worse at night) “often the hint”

√ fever
√ coryzal symptoms

√ X-ray → Steeple sign.

Question 5

Severe croup symptoms

◙ If moderate to severe, we admit. Look at these features of severe croup:

Answer 5

♠ Frequent barking cough.

♠ Prominent inspiratory (and occasionally, expiratory) stridor at rest
.
♠ Marked sternal wall retractions.

♠ Significant distress and agitation, or lethargy or restlessness (a sign of
hypoxaemia).

♠ Tachycardia occurs with more severe obstructive symptoms and
hypoxaemia.

Question 6

◙ Management of Croup (important √)

Answer 6

√ A single dose of oral dexamethasone 0.15mg/kg to all children regardless of severity.

(Prednisolone is an alternative if dexamethasone is not available).

Question 8

◙ Emergency treatment

Answer 8

high-flow O2

Nebulised adrenaline → In severe cases of croup.

√ The prognosis of most cases of barking cough (Croup) is:
→ natural resolution (complete recovery).

Question 9

Nocturnal Enuresis.

Answer 9

♦ The majority of children achieve day and night time continence by 3 or 4 YO.

♦ Enuresis → ‘involuntary discharge of urine by day or night or both, in a child ≥ 5
YO, in the absence of congenital or acquired defects of the nervous system or
urinary tract’
.
♦ Nocturnal enuresis can either be

:
Primary- the child has never achieved sustained continence before)
or,

secondary
(the child had been dry for at least 6 months before).