paeds

Question 1

rubella

Answer 1

• spread by respiratory droplets
• prodrome of fever/conjunctivitis/rhinorrhoea
• generalised pink maculopapular rash
• lymohadenopathy
• congenital infection –> fetal malformation in the 1st trimester, sensorineural hearing loss/retinopathy in 2nd semester

Question 2

roseola infantum

Answer 2

• prodrome fever - can reach 40o and lead to infantile convulsion
• caused by herpes virus 6 (or7)
• pink spots/rash develops on chest/trunk and spreads to limbs
• no rash on face
• no lymohadenopathy, no itch
• self limiting and Rx with analgesics/ fluids and rest

Question 3

what is the apgar score?

Answer 3

appearance
pulse
grimace
activity
respiration

• done at 1 min and 5min after birth to assess babies wellbeing
• total of 10

Question 4

what are the 5 main categories of cerebral palsy?

Answer 4

1. spastic type (MS):
   - can be subdivided into hemiplegia/ quadraplegia and diplegia
2. dyskinetic type
3. ataxic type
4. hypotonic type
5. mixed type

CP is the name given to the permanent neurological problems resulting from damage to the brain around the time of birth.

Question 5

what is the most common non-motor condition associated with cerebral palsy?

Answer 5

learning difficulties

epilepsy/ strabismus/ hearing impairment are also associated, but not as common

Question 6

what are paediatric resusitation fluids prescribing calculated at?

Answer 6

20ml/kg 0.9% saline STAT

Question 7

why is dextrose never used for resusitation?

Answer 7

will NOT remain in intravascular space

Question 8

how is maintenance fluid calculated in children?

Answer 8

(4 x first 10kg) + (2 x next 10kg) + (1 x next …kg)

Question 9

what aspects to look out for in the hx from mum/dad to suggest a seizure in a child?

Answer 9

• rhythmic tonic or tonic-clonic movements
• lateral tongue biting
• eyes deviations with flickering
• incontinence (in the older child)
• post-ictal state
• child with no post-ictal state is unlikely to have had a seizure. rapid recovery is more likely to suggest an alternative diagnosis
• cardiac work up important if not straight-forward or classic

Question 10

what is a febrile seizure

Answer 10

very common type of seizure which occur in feverish children between 6months and 5years.

usually a single, generalised, short-lived tonic-clonic seizure with a short post-ictal phase after which the child returns to their normal neurological state

main scope of consultation is to reassure the parents, advise on fever control and make sure you have found a focus of infection

‘is it going to happen again?’ - risk of recurrence is around 33% but can be higher if they have a FHx of FC. the risk of a sfebrile seizure is around 1% (v similar to the general population), but again higher if there is a FHx of wpilepsy, or if they had a more complex FC (5%) (occur multiple times in a 24hr perid and be generalised or focused… and need a work up (LP) as meningitis or encephalitis can be a cause)

Question 11

what is the rx of seizure in a child >5mins?

Answer 11

0-3mins: Ox, ABCDE, check and correct blood sugars, gain access

5mins: benzo’s… buccal medazolam, rectal diazapam or iv lorazapam (0.1mg/kg)
10mins: repeat benzo

now wait 10 mins until the med has worked, as per algorithm

> 10min 2nd line phenytoin slow infusion

Question 12

what are the potential causes of afebrile seizures?

Answer 12

• many!
• good hx is key
• blood sugars should always be done as hypoglycaemia is a readily Rx’able cause
• if a child comes into ED having 1st afebrile convulsion and they are neurologically well with no obvious cause on hx or examination, aside from the standard ED observations (including BP) and a blood sugar, no other Ix is liekly to yield useful result. but think NAI!

things in hx that may alter mx:

• Hx inconsistent/unexplained bruising (NAI)
• caf au lait spots (think neurofibromatosis)
• ash leaf spots (think tuberous scleroisis)
• meningism (menigitis/intracranial bleed)
• dysmorphic features
• hepatomegaly or jaundice (metabolic disease)
• signs of ICP/bleeding tendencies/ sickle cell disease/ malignancy/ post-head injury (CT head)

Question 13

what is the treatment of scabies?

Answer 13

topical permethrin cream

must be applied to the whole body and left on for 8-12 hours. Patients will usually continue to complain of itching for a further 2-3 weeks following treatment. All clothes, bedding and towels must also be washed at 50 degrees to kill the mites. The whole immediate family will also require treatment