paeds general

Question 1

septic screen in kids

Answer 1

F
Urine output
Culture bloods
Culture urine 
LP

Question 2

child with sepsis - how would you recognise it..?

Answer 2

Recognition of a child at risk:
If a child with suspected or proven infection AND has at least 2 of the following:
• Core temperature < 36°C or > 38.5°C
• Inappropriate tachycardia (Refer to local criteria / APLS Guidance)
• Altered mental state (including: sleepiness / irritability / lethargy / floppiness)
• Reduced peripheral perfusion / prolonged capillary refill

Question 3

define JIA

Answer 3

Joint inflammation
Idiopathic (not caused -
Age under 16

Question 4

what are the criteria for kawasakis

Answer 4

four of:
Conjunctivitis
Rash
Adeopathy
Strawberry tongue
hands
and 
BURN  - fever for 5 days or more

Question 5

management of heart disease in kids

Answer 5

high energy regular feeds
Furosemide
ACEi
Digoxin

Question 6

causes of failure to thrive in children:

Answer 6

Inadequate caloric intake/retention

Inadequate nutrition (breastmilk, formula and/or food)
Breast feeding difficulties
Restricted diet (e.g. low fat, vegan)
Structural causes of poor feeding eg. cleft palate
Persistent vomiting
Anorexia of chronic disease
Error in infant formula dilution
Early (before 4 months) or delayed introduction of solids

Psychosocial:
Parental depression, anxiety or other mood disorders
Substance abuse of one or both parents
Attachment difficulties
Disability or chronic illness of one or both parents
Coercive feeding (including feeding child whilst asleep)
Difficulties at meal times
Poverty
Behavioural disorders
Poor social support
Poor carer understanding
Exposure to traumatic incident/family violence
Neglect of this infant or siblings
Current or past Child Protection involvement

Inadequate absorption:
Coeliac disease
Chronic liver disease
Pancreatic insufficiency eg. Cystic fibrosis
Chronic diarrhoea
Cow milk protein intolerance

XS calorie utilisation
Chronic illness
Urinary tract infection
Chronic Respiratory disease eg. Cystic Fibrosis
Congenital heart disease
Diabetes Mellitus
Hyperthyroidism

Question 7

management of failure to thrive

Answer 7

half the size, twice as often

Careful growth charts

Question 8

treating constipation in children

Answer 8

1. movicol

2. stimulant eg. Senna

Question 9

HSP - complications

Answer 9

Intussuception

Question 10

causes of eneuresis

treatment of idiopathic

Answer 10

gu malf
dm
utis

tx if over 5:
sublingual desmo
1 wk break every 5 months

Question 11

causes of eneuresis

treatment of idiopathic

Answer 11

gu malf
dm
utis

tx if over 5:
sublingual desmo
1 wk break every 5 months

Question 12

what types of cerebral palsy are there?

?causes
?botox

Answer 12

1. spastic
2. ataxic
3. athetoid
4. mixed

botox :

Question 13

ddx’s for vacant episodes

Answer 13

hearing 
epilepsy
visual problems
behavioural - adhd / autism 
learning disability 
brain tumour 
iatrogenic - medications

Question 14

how might you investigate her symptoms?

Answer 14

history - social interactions / regression / reccurent ear infections

Question 15

what is the pathognomic finding of a petit mal seizure on EEG?

Answer 15

3hz spike and wave

Question 16

treatment for absence seizures? (petit mal)

Answer 16

ethosuxamide

valproate

Question 17

investigation of squint

Answer 17

1. gross
2. corneal light reflex
3. cover test

Question 18

causes of squint?

Answer 18

short / long sightedness

atigmatism

Question 19

serious neonatal stuff:

Answer 19

issues of prematurity

nec
gastro
neonatal jaundice
resp: bronchopulmonary dysplasia

Question 20

what is the triad of haemolytic uraemic syndrome

Answer 20

thrombocytopenia
microangiopathic haemolytic anaemia (Coombs test negative)
AKI

Question 21

what is the common infection causing HUS?

how does this infection cause HUS

Answer 21

E. coli O157
circulating toxins produced by this (verotoxin / shigella) bind to endothelial receptors - causing deposition of fibrin and thrombin in the microvasculature
erythrocytes are damaged as they pass through the microvasculature - get caught and damaged the partially occluded small vessels

platelets sequestered but without the cascade of clotting factors

Question 22

when can children with HUS go back to school??

Answer 22

after 2 negative stools

Question 23

presentation of HUS?

Answer 23

The classical presenting feature is profuse diarrhoea that turns bloody 1 to 3 days later

It is rare for the diarrhoea to have been bloody from the outset

Question 24

management of HUS?

Answer 24

General management includes appropriate fluid and electrolyte management, antihypertensive therapy and dialysis where required.

Circulating volume must be kept up to protect the kidneys; simply replacing losses with crystalloid and keeping up with faecal loss is inadequate, as circulating volume will be lost by vascular leakage.

Where kidney failure occurs, indications for dialysis are as for any other cause of acute kidney failure.