Paeds ILAs - 1 and 2

Question 1

Septic screen

Answer 1

Identify cause of infection in children with pyrexia and non-specific symptoms

FBC - WCC
Acute phase reactant - ESR/CRP
Blood culture
Urine sample

CXR 
LP - Exclude meningitis 
Rapid antigen screen 
PCR 
ABG 
Coagulation profile

Question 2

Meningitis immediate management

Answer 2

ABCDE

A - Maintain the airway
B - High flow O2
C - Bloods + Bolus (20mls/kg)

Community - IM BENPEN

Question 3

Meningitis antibiotic therapy

Answer 3

< 3 months - Ceftriaxone + Amoxicillin (covers GBS)
> 3 months - Ceftriaxone

Adjunctive dexamethasone may reduce risk of complications

Question 4

What is purpura

Answer 4

Bleeding underneath the skin - Non-blanching

Septic shock 
Bacteria release toxins - Causes thrombosis 
Clotting factors used up 
Vessels bleed 
Disseminated intravascular coagulation

Question 5

Meningitis - Likely causative agent in neonates

Answer 5

GBS
E.Coli
Listeria

Question 6

Meningitis - Likely causative agent in children > 3 months

Answer 6

N. Meningitides
Strep pneumonia
HiB

Question 7

Meningitis ROA and prophylaxis

Answer 7

Bacteria carried in ENT
Passed on by sharing respiratory/throat secretions

Coughing, kissing - Living in the same household

Sharing cutlery, toothbrushes or cigarettes

Prophylaxis - Ciprofloxacin and Men C vaccine

Question 8

Ciprofloxacin side effects

Answer 8

N/D/V
Dizziness
Headache

Question 9

JIA presentation

Answer 9

Arthritis < 16 years for > 3 months

Stiffness in the morning and following rest

Systemic - FLAAAP SALMON

• Fever
• Lymphadenopathy
• Anterior uveitis
• Anorexia
• Arthritis
• Pink rash - SALMON

Question 10

JIE investigations

Answer 10

FBC

• Anaemia
• WCC ^
• ESR ^
• Ferritin ^

ANA +ve

LFT ^

Albumin - LOW

Question 11

JIA management

Answer 11

NSAIDS
Prednisolone
Methotrexate

Alternative therapies

• Intra-articular corticosteroids
• Tocilizumab - IL-6
• Anakinra - IL-1

Question 12

JIA complications

Answer 12

Chronic anterior uveitis 
Anaemia of chronic disease 
Osteoporosis 
Growth failure 
Valgus deformity

Question 13

JIA MDT

Answer 13

Physiotherapist 
Occupational therapist 
Specialist nurse 
Ophthalmologist 
Social worker

Question 14

Kawasaki’s aetiology

Answer 14

Idiopathic
Autoimmune
Vasculitis of the small and medium vessels

Japanese
Chinese
Afro-Caribbean

Question 15

Kawasaki’s presentation

Answer 15

6 months - 4 years

CRASH and BURN

Conjunctivitis 
Rash - Polymorphous 
Adenopathy - Cervical and unilateral 
Strawberry tongue and cracked lips 
Hands/feet erythema 

BURN - FEVER > 38.5

Question 16

Kawasaki’s management

Answer 16

IV IG - First 10 days

High dose aspirin - Reduce thrombosis risk

Severe…

• Steroids
• Anti-TNF - Infliximab
• Ciclosporin

Question 17

Kawasaki’s complications

Answer 17

IV IG - Anaphylaxis
Aspirin - Bleeding and GI irritation

Echo - Check for coronary aneurysms

Question 18

DKA pathophysiology

Answer 18

Hyperglycaemia with NO insulin
Sugar cannot pass into cells

Gluconeogenesis and glycogenolysis in the liver

Ketogenesis - Lowers pH

Question 19

DKA precipitants

Answer 19

Missed insulin

Infection

Question 20

DKA presentation

Answer 20

Abdominal pain 
Kussmaul breathing - Deep and laboured 
Polydipsia 
Polyuria 
Collapse

Question 21

DKA diagnosis

Answer 21

Hyperglycaemic - Glucose > 11
Acidotic - pH < 7.3
HCO3 < 15
Ketones > 3

Question 22

DKA management

Answer 22

Fluid bolus
Deficit replacement
Maintenance fluids

1. Correct potassium
2. 1 hour later - Give insulin
3. BM < 15 - Give dextrose
4. Sodium bicarbonate + Phosphate

Question 23

DKA complications

Answer 23

AKI
VTE
Arrhythmia
Cerebral oedema due to fluid overload

Question 24

Fluid calculations

Answer 24

0.9% NaCl + 5% glucose
+ 10mmol KCl

Bolus

• DKA, trauma and neonates - 10ml/kg/day
• Everything else - 20ml/kg/day

Deficit replacement

• Dehydrated - 50ml/kg/day
• Shocked - 100ml/kg/day

Maintenance fluids

• First 10kg - 100ml/kg/day
• 10-20kg - 50ml/kg/day
• Everything else - 20ml/kg/day

HOURLY RATE - DIVIDE BY 24

Question 25

DKA monitoring

Answer 25

``` Fontanelle tension General observations Cap refill Urine output ECG Kidney function U/E ```

Question 26

Congenital hypothyroidism aetiology

Answer 26

Primary - Thyroid dysgenesis - Absent thyroid - Hypoplasia - Dyshormonogenesis - AR - No anatomical abnormalities Secondary - Lack of iodine

Question 27

Congenital hypothyroidism presentation

Answer 27

Jaundice Distended abdomen Umbilical hernia Hypotonia Hypothermia Myxoedema Macroglossia Large forehead

Question 28

Congenital hypothyroidism investigations

Answer 28

Guthrie heel prick test TSH ^ T4 - LOW

Question 29

Congenital hypothyroidism management

Answer 29

Levothyroxine Same time each day 30 minutes before a meal

Question 30

Congenital hypothyroidism complications

Answer 30

Intellectual impairment Developmental delay Short stature Delayed sexual maturity

Question 31

Unwell neonate DDx

Answer 31

Sepsis or infection CHD Respiratory distress Hypoglycaemia Abdominal emergencies - NEC - Pyloric stenosis

Question 32

Congenital adrenal hyperplasia aetiology

Answer 32

Autosomal recessive 21-hydroxylase deficiency 11-beta-hydroxylase deficiency Aldosterone - LOW Cortisol - LOW Androgens ^^^

Question 33

CAH presentation

Answer 33

Low aldosterone - HYPOnatraemia - HYPERkalaemia - HYPOtension Low cortisol - HYPOglycaemia - ACTH ^ Androgens ^ - Female virilisation - Clitoral hypertrophy - Precocious puberty

Question 34

CAH investigations

Answer 34

Bloods - HYPOnatraemia - HYPERkalaemia - ACTH ^ - HYPOglycaemia 17 alpha hydroxyprogesterone ^ Metabolic acidosis Adrenal USS

Question 35

CAH management

Answer 35

Aldosterone replacement - Fludrocortisone Hydrocortisol replacement - Hydrocortisone