Recognise, investigate & manage

Question 1

investigate space-occupying lesion headache

Answer 1

FBC, U&Es, LFTs,
MRI head (better than CT)

Question 2

manage space-occupying lesion headache

Answer 2

NSAIDs/paracetamol
anti-emetics eg prochlorperazine & metoclopramide if N&V
tx tumour

Question 3

breath holding attacks differentials

Answer 3

epilepsy

Question 4

breath holding attacks investigations

Answer 4

ECG
EEG

Question 5

breath holding attacks mx

Answer 5

reassurance
advice for further episodes (make environment safe, recovery position)
safety-net when to bring back

Question 6

migraine dx & mx

Answer 6

clinical

analgesia & sumatriptan (seretonin agnoist)

Question 7

hydrocephalus ix

Answer 7

cranial USS infants // CT/MRI if older

monitor head circumference on centile chart

Question 8

hydrocephalus mx

Answer 8

ventriculoperitoneal shunt for drainage of symptomatic

symptomatic relief of raised ICP & minimise neurological damage

antiemetics

Question 9

HUS ix

Answer 9

FBC & blood film
U&Es
stool sample, microscopy & culture

Question 10

HUS mx

Answer 10

supportive: fluids, blood transfusions & dialysis
plasma exchange if severe cases (non-diarrhoea associated)
NO Abx needed

Question 11

nephrotic syndrome ix

Answer 11

Urinalysis (dip stick: protein +++), microscopy, culture, and urinary protein/creatinine ratio

Urine microscopy (just in case)

FBC, U&Es, Creatinine, LFTs, C3/C4

Blood pressure

Urinary sodium concentration (helpful for those at risk of hypovolaemia)

Varicella titres (varicella status should be known in all children commencing steroids)

Question 12

nephrotic syndrome mx

Answer 12

4 week course of Prednisolone (Oral steroids)

IV Albumin (indicated if clinical hypovolaemia or symptomatic oedema)

Prophylactic Penicillin V

Salt/fluid restriction

Pneumococcal vaccination

Question 13

anaphylaxis differentials

Answer 13

shock // vasovagal // asthma/COPD

Question 14

anaphylaxis ix

Answer 14

A-E
tryptase later to confirm
vitals
cultures

Question 15

anaphylaxis mx

Answer 15

Position supine and raise legs

Establish airway if compromised and give high flow oxygen.

**Adrenaline (epinephrine)
**
IV saline

Salbutamol

Antihistamine

Steroid

Question 16

measles differentials

Answer 16

rubella, scarlet fever, kawasaki, slapped cheek

Question 17

measles ix

Answer 17

clinical
ENT & chest exam
salivary swab, serum sample - measles IgM & RNA

Question 18

measles mx

Answer 18

Notify the health protection unit

Self-limiting

Advise rest and plenty of fluid intake and calpol for any fevers

Exclusion from school for 4 days from rash onset

Vaccinate other children

Question 19

periorbital cellulitis ix

Answer 19

cultures

Question 20

periorbital cellulitis mx

Answer 20

urgent ophthal review
Abx (co-amoxiclav // ceftriaxone)
hot compresses
nasal decongestants & vasoconstrictors help drain sinuses
surgical drainage (supportive preseptal cellulitis)

Question 21

chickenpox ix

Answer 21

clinical (rash)
VZV IgM serology, e-microscopy of vesicle fluid

Question 22

chicken pox mx

Answer 22

Antipyretic (for pyrexia) and oral antihistamine (for itching).

School exclusion for 5 days (from start of skin eruption).

Acyclovir if severe Varicella (or pregnant, babies, immunocompromised).

Question 23

conjunctivitis ix

Answer 23

clinical
conjunctival swabs
stain eyes
test acuity
check foreign body

Question 24

conjunctivitis mx

Answer 24

abx eye drops - chloramephenicol
fusidic acid (good for staph infections)
if allergic conjunctivitis - topical oral antihistamine & avoid allergen

Question 25

cow milk allergy ix

Answer 25

Skin-prick testing for IgE mediated allergy Measurement of specific IgE antibodies in blood (RAST test)- specifically for cow’s milk If still in DOUBT, the gold standard test is exclusion of the relevant food under dietician’s supervision, followed by a double-blind placebo controlled food challenge, in HOSPITAL

Question 26

cow milk allergy mx

Answer 26

Extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants on formula with mild-moderate symptoms Exclusion of cow’s milk until 6 months of eHF/Until patient is 12 months old. As cow’s milk allergy usually stops 1-2 years of age. (Challenge could be performed in hospital then)

Question 27

IM ix

Answer 27

Blood film (peripheral leucocytosis) positive agglutination test (monospot test) EBV IgM antigen abnormal LFTs

Question 28

IM mx

Answer 28

Avoiding spread – no kissing, sharing utensils etc, avoid collision sports Supportive Management – hydration and analgesia Steroids if severe

Question 29

haemophilia differentials

Answer 29

child abuse // mongolian blue spots

Question 30

haemophilia ix

Answer 30

bloods (FBC, APTT & FVIII/FIX)

Question 31

haemophilia mx

Answer 31

IV infusion of FVIII or vasopressin tranexamic acid for mucosal bleeding joint pain - dressing, rest, ice, compress & elavate can have normal life as long as given appropriate treatment

Question 32

HSP ix

Answer 32

U&Es // FBC urine dipstick

Question 33

HSP mx

Answer 33

rest drink fluids ibuprofen // paracetamol resolves on its own

Question 34

leukaemia/sickle cell anaemia ix

Answer 34

FBC (check WBC - neutropenia RBC-anaemia Bone marrow biopsy

Question 35

leukaemia/sickle cell anaemia mx

Answer 35

Reassurance, Immediate referral

Question 36

otitis media ix

Answer 36

otoscopy // swab & culture

Question 37

otitis media mx

Answer 37

Reassurance abx aren’t needed at present, should be started at 4 days post onset 5 day course of abx – amoxicillin; if allergic – erythromycin or clarithromycin Second line abx: co-amoxiclav Seek specialist advice – ENT specialist and microbiologist

Question 38

epiglottitis ix

Answer 38

Fibre optic laryngoscopy (Gold standard) Throat swab Bloods and blood cultures

Question 39

epiglottitis mx

Answer 39

ABCDE approach. DO NOT EXAMINE THROAT Admit patient Call anaesthetist to intubate patient (most likely scenario) IV or Oral Abx

Question 40

CF ix

Answer 40

sweat test Guthrie test

Question 41

CF mx

Answer 41

MDT approach with annual review Physiotherapy twice a day (Airway clearance at home in younger children) Continuous prophylactic oral antibiotics (usually flucloxacillin) Nebulised antipsudomonal antibiotics (if lung deterioration) Nebulised DNAse or hypertonic saline may be helpful to decrease the viscosity of sputum and so increase its clearance Bilateral lung transplantation for end stage CF lung disease Pancreatic insufficiency is treated with oral enteric coated pancreatic replacement therapy with all meals and snacks High calorie and high fat diet Multivitamin supplementation

Question 42

mesenteric adenitis ix

Answer 42

GI exam (no rebound tenderness but shifting tenderness present) Clinical diagnosis Bloods (FBC, ESR/CRP)

Question 43

mesenteric adenitis mx

Answer 43

Watch and wait to see if symptoms remain the same or worsen Advise to use calpol for fever and for pain If the pain goes to Right Iliac Fossa then come back for surgical exploration

Question 44

pyloric stenosis ix

Answer 44

GI exam gas (hypochloraemic, hypokalaemic metabolic acidosis) test feed USS doughnut shape barium swallow - string sign

Question 45

pyloric stenosis

Answer 45

IV fluids (0.45% saline + 5% Dextrose + 80 mmol/L KCl) Ramstedt's pyloromyotomy + nil by mouth

Question 46

gastroenteritis ix

Answer 46

stool sample analysis assess for shock bloods – U&E’s, urea, creatinine and glucose & Sigmoidoscopy

Question 47

gastroenteritis mx

Answer 47

Continue usual feeds ORS, give frequently and in small amounts; for children >5yrs – give 200ml ORS after each loose stool Abx 5 day course: most organisms respond to Ampicillin, cotrimoxazole or 3rd gen cephalosporin (If campylobacter- erythromycin; PO vancomycin/metronidazole if C diff)

Question 48

appendicitis ix

Answer 48

Clinical examination (guarding, rebound tenderness) Bloods (FBC, U&E’s, LFT’s , CRP and BM) BUFALO CXR/AXR

Question 49

appendicitis mx

Answer 49

ABCDE management High flow O2 non-rebreathe mask, 15L/min; auscultate chest - clear 2 wide bore IV cannula’s, bolus 200ml crystalloid solution + dextrose Heart monitoring equipment, ECG + CXR Bloods – FBC, U&E’s, LFT’s , CRP and BM BUFALO Surgery – remove inflamed appendix

Question 50

coeliac ix

Answer 50

jejunal biopsy TTG FBC gluten challenge

Question 51

coeliac mx

Answer 51

Supervision of diet by dietician, if dx uncertain Prevention - continued breast feeding and weaning Nutritional advice – lifelong gluten free diet; vitamin, calcium and iron supplements Follow-up – membership of www.coeliac.org.uk

Question 52

hypothyroidism ix

Answer 52

TFTs, Growth charts, monitor developmental milestones closely

Question 53

hypothyroidism mx

Answer 53

L-thyroxine, regular TFT monitoring to prevent development of irreversible neurological disability