Y5 Paediatric Cases (quick made for mock PACES)

Question 1

Key points in headache case?

Answer 1

SOCRATES for headache (inc location)
Headache red flags
Do cranial nerve exam (esp visual fields)

Question 2

Persistent headaches for 3 months in child waking them up at night, affecting school performance + visual problems. Condition(top differential)?

Answer 2

Space-occupying lesion

Question 3

Management for suspected SOL?

Answer 3

Investigate for SOL with MRI (better at visualising soft tissue than XR)
Keep headache diary

Question 4

Key points in CF resp history?

Answer 4

CF-associated recurrent LRTI (pneumonia) always on DDx list
- Staph aureus + H influenzae (young)
- Pseudomonas aeruginosa (older)
Ask for resp exam findings
Investigations for pneumonia include organism + sensitivities (sputum culture)

Question 5

Adolescent with Hx of chest infections, inc one hospital visit 1 month ago. Hx of CF. Cough, green phlegm, fever, difficulty breathing. Condition?

Answer 5

CF-associated recurrent LRTI (pneumonia)

Question 6

Management of CF-associated recurrent LRTI?

Answer 6

Abx
CXR
Bloods (+CRP)
Sputum culture
Continue to manage CF

Question 7

Key points in musculoskeletal history?

Answer 7

Any pain do SOCRATES
Septic arthritis usually in <2y/o
Do glass test on any rash to check meningitis

Question 8

Unwell child (7y in case) + 3d fever + 1d unilateral knee pain + pink blanching macular rash on back. Condition?

Answer 8

Juvenile idiopathic arthritis (systemic onset + 1 joint affected)

Question 9

Management of juvenile idiopathic arthritis?

Answer 9

Ix

• Bloods
• Joint aspirate (rule out septic arthritis)
• xray knee

Educate about disease
Control pain with regular NSAIDs
Physiotherapy + daily exercise

Question 10

Key points counselling about MMR vaccination?

Answer 10

Counselling anti-vax about the science
Measles/mumps and rubella symptoms/signs to explain to mother
Vaccine side effects (any vaccine) to explain to mother

Question 11

Main features of measles, mumps, and rubella?

Answer 11

Measles - fever, rash, loss of appetite, tiredness, cough. Koplik spots in mouth.

Mumps - low grade fever, loss of appetite, swollen glands in the cheeks/neck/under jaw, headache, aches and pains.

Rubella - fever, tiredness, swollen glands, sore eyes, red rash ears and neck

(Measles worst, mumps 2nd, rubella usually mild)

Question 12

Key points in enuresis history?

Answer 12

Types of bedwetting (enuresis) (primary, secondary)
Ask about frequency
Don’t belittle child, assess support need

Question 13

Types of bedwetting?

Answer 13

Primary - never continent at night (subtypes - w/day symptoms, w/o day symptoms)
Secondary - occurs after child has been dry at night for more than 6 months

Question 14

Management of bedwetting/enuresis?

Answer 14

<5y reassure that this is normal
>5y reassure this may resolve without treatment
Offer enuresis alarm + positive reward system (desmopressin if alarm unsuitable)

Question 15

Key points in recurrent abdo pain history?

Answer 15

SOCRATES
Check family history for GI disease (coeliac, IBS)
Don’t make patients feel like they don’t have anything wrong with them

Question 16

Functional abdo pain in child, main condition?

Answer 16

Paediatric IBS

Question 17

Management of paediatric IBS?

Answer 17

Reassure no serious underlying disease
Encourage child not to let the pain make them miss school
Dietary advice + probiotics

Question 18

Key points of sickle cell disease history?

Answer 18

V young child
Swelling of fingers + fever + crying (?pain)
Hx of chest infections

Question 19

Management of SCD?

Answer 19

Acute - Admit if fever >38 + chest signs. Give O2, fluids, abx, paracetamol/NSAIDs

Long-term - immunisation vs pneumococcal, haemophilus influenzae type B, meningococcus infection. Daily oral penicillin throughout childhood. Once-daily oral folic acid. Avoid exposure to cold, dehydration, exercise, stress, hypoxia.

Question 20

Key points of an epilepsy history?

Answer 20

Limbs jerking seizure + FH of epilepsy

Ask about how long the seizure was (status epilepticus >30min)

Question 21

Management of epileptic seizures?

Answer 21

T-C - sodium valproate, lamotrigine
Absence - ethosuximide, sodium valproate
Myoclonic - sodium valproate
Infantile spasms - vigabatrin
Anything else - valproate

Question 22

Key points of DKA history?

Answer 22

7y vomiting, increasing severe + persistent abdo pain, drowsy, nauseous. Recent Hx of bedwetting + weird smell urine. V thirsty + drinking a lot. Some weight loss.

Question 23

DKA management?

Answer 23

Ix

• cap blood glucose + ketones
• U&Es
• cap pH and bicarb

Mx

• ABC
• Fluids (add glucose if <14mmol/L
• Insulin infusion
• potassium replacement

Question 24

Key points of congenital hypothyroidism history?

Answer 24

V young (4m) floppy child. No control of head, can’t roll over, v sleepy. Slow growing.

Question 25

Investigations of congenital hypothyroidism?

Answer 25

Examine for truncal hypotonia + head lag
Blood tests (def incl TFTs), Gurthie screen to exclude other causes

Question 26

Key points of an intussusception history?

Answer 26

Intermittent abdo pain + vomiting + no pooing.

DDx is gastroenteritis (more common than intussusception)

Question 27

Ix and Mx of intussusception?

Answer 27

Abdo x-ray - distended small bowel + no gas in distal colon/rectum
USS abdo - target/donut sign

Mx

• pain relief
• IV fluids if going into shock
• rectal insufflations to reduce intussusception (open surgical reduction if insuff fails/becoming peritonitic)