Summary

Question 1

differentials for periorbital swelling in a child?

Answer 1

VITAMINCDEF
infection/inflammation/immune-nephrotic syndrome, preseptal and orbital cellulitis, angioedema and anaphylaxis, allergic conjunctivitis
trauma-orbit blowout fracture
metabolic-hypothyroidism e.g. hashimoto’s thyroiditis-most common age in children is adolescence, but can occur at any time
neoplasm

Question 2

causes of neonatal cyanosis?

Answer 2

cardiac:
transposition of great arteries
other R to L shunt defects e.g. tetralogy of fallot-few present with severe cyanosis in 1st few days of life. ?large VSD
common mixing-AVSD e.g. Downs syndrome
resp:
resp distress syndrome
pneumonia-*group b strep
pneumothorax
diaphragmatic hernia

Question 3

main differential for blood in stools in an otherwise well child under 4mnths of age?

Answer 3

cow’s milk protein allergy

Question 4

biggest RF for transient tachypnoea of the newborn?

Answer 4

C section

Question 5

major RF for neonatal RDS?

Answer 5

prematurity

Question 6

major RF for aspiration pneumonia in neonate?

Answer 6

meconium staining*

Question 7

normal RR for children under 1 year of age?

Answer 7

30-40

Question 8

normal RR for children aged 1-2 years?

Answer 8

25-35

Question 9

normal RR for children aged 2-5 years?

Answer 9

25-30

Question 10

normal RR for children aged 5-12 years?

Answer 10

20-25

Question 11

red flags to be aware of to alert parents to present again with child with bronchiolitis?

Answer 11

increasing resp distress-nasal flaring, severe chest recession, grunting
apnoea or cyanosis
fluid intake 50-75% of normal, or no wet nappy for 12 hours
exhaustion-waking only on prolonged stimulation, not responding to normal social cues.

Question 12

children at increased risk of dehydration?

Answer 12

under 1 year, espec. under 6 months
6 or more diarrhoeal stools in last 24hr
3 or more vomiting episodes in last 24hr
low birth weight
have not been offered or not able to take supplementary fluids before presentation
have stopped breastfeeding during the illness
evidence of malnutrition

Question 13

features suggestive of hypernatraemic dehydration?

Answer 13

jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsy/coma

Question 14

NICE recommendations for stool culture in a child who presents with diarrhoea and vomiting?

Answer 14

if suspect septicaemia or
blood and mucus in stool or
child immunocompromised

consider if child recently been abroad, diarrhoea not improved by 7 days or unsure of diagnosis of gastroenteritis

Question 15

what diet may be helpful for some children with epilepsy e.g. lennox-gastaut syndrome?

Answer 15

ketogenic diet-high fat, low carb, controlled protein diet.

Question 16

advantages of breast feeding?

Answer 16

Mother:
bonding
involution of uterus
protection against breast and ovarian cancer
cheap, no need to sterilise bottle
contraceptive effect (unreliable)

Immunological:
IgA (protects mucosal surfaces), lysozyme (bacteriolytic enzyme) and lactoferrin (ensures rapid absorption of iron so not available to bacteria)
reduced incidence of ear, chest and gastro-intestinal infections
reduced incidence of eczema and asthma
reduced incidence of type 1 DM

Reduced incidence of sudden infant death syndrome

Baby is in control of how much milk it takes

Question 17

disadvantages of breast feeding?

Answer 17

transmission of drugs
transmission of infection
nutrient deficiency-Vit D with prolonged BF
Vit K deficiency
breast milk jaundice (cause of prolonged jaundice-baby more than 2 wks)

Question 18

features of NEC (necrotising enterocolitis) on AXR?

Answer 18

• dilated bowel loops, often asymmetrical in distribution
• bowel wall oedema
• pneumatosis intestinalis-intramural gas
• rigler’s sign-air both inside and outside the bowel wall
• pneumoperitoneum-due to bowel perforation
• portal venous gas
• air outlining the falciform ligament (football sign)

Question 19

how long after birth do most neonatal intraventricular haemorrhages occur?

Answer 19

within 72hrs
treatment is largely supportive
but if hydrocephalus and rising ICP develop, then indication for shunting

Question 20

options for managing young child with dehydration?

Answer 20

oral rehydration challenge-with dioralyte
if unsuccessful then NGT for fluids
if unsuccessful then IV fluids

Question 21

how are rehydration fluids calculated in a child?

Answer 21

%dehydration X body weight X 10

Question 22

antibiotic treatment for patient with NEC?

Answer 22

IV flucloxacillin, gentamicin and metronidazole

Question 23

guidelines for neonatal resuscitation?

Answer 23

• following birth, dry the baby, maintain temp and start the clock
• assess tone, breathing and HR
• open airway to give 5 inflation breaths if gasping or not breathing
• reassess
• if no increase in HR, ensure inflation breaths are adequate by checking chest expansion, if not moving assume inadequate, recheck head position, consider 2 person airway control
• if chest moving but HR still not detectable or is less than 60, start chest compressions at 3:1
• reassess HR every 30 s
• consider IV access and drugs