Paeds 5B

Question 1

List the median ages for vision and fine motor milestones.

Answer 1

6 weeks: follows moving object or face by turning head
4 months: reaches out for toys
4-6 months: palmar grasp
7 months: transfers toys from one hand to another
10 months: mature pincer grip
16-18 months: makes marks with a crayon, tower of 3
3 years: draws a circle

Question 2

List the median ages for hearing, speech and language development.

Answer 2

3-4 months: vocalises alone or when spoken to, coos and laughs
7 months: turns to soft sound out of sight
10 months: sounds used discriminately to parents (mama/dada)
12 months: 2-3 words other than mama or dada
18 months: 6-10 words, shows two parts of the body
20-24 months: use 2 or more words to make simple phrases
2.5-3 years: talks constantly in 3-4 word sentences

Question 3

List the median ages for social, emotional and behavioural development.

Answer 3

6 weeks: smiles responsively
6-8 months: puts food in mouth
10-12 months: waves bye bye, plays peek-a-boo
12 months: drinks from cup
18 months: uses spoon
18-24 months: symbolic play
2 years: dry by day
2.5-3 years: parallel play, takes turns

Question 4

How is paracetamol overdose managed?

Answer 4

Measure plasma paracetamol concentration at 4 hours and plot on normogram
Treat with IV N-acetylcysteine if necessary

Question 5

How is carbon monoxide poisoning treated?

Answer 5

Presents with headache, nausea, confusion and drowsiness
High-flow oxygen
Hyperbaric oxygen therapy may be considered

Question 6

How is salicylate poisoning treated?

Answer 6

Presentation: vomiting, tinnitus, respiratory alkalosis
Measure plasma salicylate concentration at 2-4 hours
Alkalinisation of urine with sodium bicarbonate increases urinary excretion
Consider haemodialysis

Question 7

How is TCA overdose treated?

Answer 7

Treat arrhythmias and give sodium bicarbonate
Support ventilation

Question 8

How is ethylene glycol poisoning treated?

Answer 8

Presentation: intoxication, tachycardia, metabolic acidosis

Fomepizole inhibits the production of toxic metabolites (ethanol can also be used)

Question 9

How is iron overdose treated?

Answer 9

Presentation: vomiting, diarrhoea, haematemesis, late drowsiness/coma/shock/hypoglycaemia

Serum iron level 4 hours after ingestion is the best measure of severity

IV desferoxamine chelates iron

Question 10

How is organophosphorus pesticide poisoning treated?

Answer 10

Supportive 
Atropine (large dose)
Pralidoxime (reactivates actylcholinesterase) 

NOTE: presentation is mainly cholinergic features

Question 11

What is a port wine stain?

Answer 11

Capillary malformation in the dermis that is present from birth and persists for life
If in the trigeminal nerve distribution, some children may have Sturge-Weber syndrome and should have an MRI

Question 12

Describe the appearance and progression of cavernous haemangiomas.

Answer 12

Appears within the first month of life
Grows before shrinking and disappearing (before 5 years)

Question 13

Describe the inheritance pattern of von Willebrand disease.

Answer 13

Type 1 and 2 = autosomal dominant
Type 3 = autosomal recessive

Question 14

How should bladder outflow obstruction be investigatd?

Answer 14

MCUG

Question 15

What are the two different types of polycystic kidney disease and how do they differ?

Answer 15

Autosomal Dominant - mainly in older children/adults, cysts are large

Autosomal Recessive - presents in childhood with bilateral renal masses, respiratory distress due to pulmonary hypoplasia and congenital hepatic fibrosis with pulmonary hypertension

Question 16

What are the aspects of managing Duchenne muscular dystrophy?

Answer 16

Physiotherapy to prevent contractions
Exercise and psychological support
Surgery (e.g. tendoachilles lengthening)
CPAP for nocturnal hypoxia
Glucocorticoids may slow degeneration

Question 17

What’s the main difference between Duchenne and Becker muscular dystrophy?

Answer 17

Duchenne - no dystrophin - severe symptoms (LE: 20-30 years)
Becker - abnormal dystrophin - milder symptoms

Question 18

What are some consequences of neural tube defects?

Answer 18

Paralysis and muscle imbalance (needs physiotherapy)
Sensory loss (can lead to accidental damage)
Neuropathic bladder
Bowel denervation
Scoliosis
Hydrocephalus

Question 19

How is hydrocephalus treated?

Answer 19

Ventriculoperitoneal shunt

Question 20

Outline the management of idiopathic intracranial hypertension.

Answer 20

Eliminate causal factors
Weight-reduction
Low-sodium diet and fluid restriction
Acetazolamide
Analgesia
VP shunt

Question 21

List some clinical features of a child at high-risk of sepsis.

Answer 21

Behaviour:
• No response to social cues
• Appears ill
• Does not wake, or if roused does not stay awake
• Weak, high-pitched and continuous cry

Heart Rate:
• Tachycardia (different at different ages)
• < 60 bpm at any age

Respiratory Rate
• Tachypnoea (different at different ages)
• Grunting
• Apnoea
• SpO2 < 90% on air

Mottled or ashen appearance
Cyanosis of the skin, lips or tongue
Non-blanching rash
Aged < 3 months with temperature > 38 degrees
Temperature < 36 degrees

Question 22

Which investigations constitute a septic screen?

Answer 22

FBC
Blood culture
CRP
Urinalysis
LP
CXR

Also do a VBG

NOTE: if < 1 month, all children should have an LP

Question 23

Outline the role of a VBG in managing a child with moderate to high risk of sepsis.

Answer 23

> 2 mmol/L or evidence of AKI –> treat as high-risk
< 2 mmol/L = repeat assessment at least hourly, ensure review by senior clinician, identify a cause and manage it

Question 24

Outline the non-pharmacological steps taken in the management of high risk sepsis.

Answer 24

Immediate review by senior clinician
VBG (gas, glucose, lactate, FBC, U&E, creatinine, clotting)
Broad spectrum antibiotics immediately
Monitor continuously
Monitor mental state using GCS or AVPU

Question 25

Outline how the lactate guides treatment in high risk sepsis.

Answer 25

> 4 mmol/L = IV fluid bolus without delay, refer to critical care
2-4 mmol/L = IV fluid bolus without delay
< 2 mmmol/L = consider IV fluids