Paediatrics

Question 1

Signs of severe pneumonia in children (WHO guidelines)

Answer 1

Fever + Tachypnoea + 1 of the following:

1. Severe respiratory distress
2. Sats <90%
3. Inability to eat/breastfeed
4. Reduced LOC

Question 2

Signs of severe dehydration (WHO guidelines)

Answer 2

2 or more of the following
1. Lethargy/unconsciousness
2. Sunken eyes
3. Unable to drink
4. Skin pinch very slow

Question 3

Treatment of severe pneumonia in children

Answer 3

1. Admit
2. O2 if needed
3. IV antibiotics (ampicillin + gent)
4. Fluid balance
5. Anti-pyretics

Question 4

Treatment of severe dehydration in paediatrics

Answer 4

1. IV/NG hydration (30ml/kg over 30 mins then 70ml/kg over 2.5 hours)
2. Add in ORS orally when tolerates
3. Admit
4. Oral zinc

Question 5

Common causes of diarrhoea in children

Answer 5

1. Viral - rotavirus, norovirus, adenovirus, sapovirus, astrovirus
2. Bacterial - E coli, salmonella, cholera, shigella, campylobacter
3. Protozoal - Giadia, amoebiasis, crypto (HIV)

Question 6

3 key assessments needed in diarrhoea management in children

Answer 6

1. Malnourished?
2. Shock?
3. Dehydration?

Question 7

Causes of pneumonia in children

Answer 7

Viral: RSV, influenza, parainfluenza
Bacterial: Strep pneumo, H influenzae, S aureus, mycoplasma

Question 8

4 management points for ongoing management of diarrhoea in children

Answer 8

1. Replace lost fluid and give extra for ongoing loses
2. Feed early and extra
   (only with-hold food in initial fluid replacement phase)
3. Zinc PO (though limited evidence)
4. Advise when to return
   (worsening/fever/blood in stool/persistent diarrhoea)

Question 9

Management of a child with severe acute malnutrition (10)

Answer 9

Early phase
1. Hypoglycaemia
2. Hypothermia
3. Dehydration
4. Electrolytes
5. Micronutrients
6. Initiate feeding
Later
7. Add in sensory stimulation
8. Increase to catch up feeding
9. Can add iron with micronutrients
10. Prepare for follow up

Question 10

Package of care when starting ARVs in a young child

Answer 10

1. Screen for TB and opportunitic infections
2. Start ARVs according to guidelines
3. Daily co-trimoxacole prophylaxis (all children <1 year and in order children with low CD4)
4. Latent TB treatment
5. Baseline bloods + CD4 count
6. Support parents and family

Question 11

Fever and positive malaria RDT within a few weeks of recent treatment.
1. What are the possibilities?
2. How do you investigate?
3. If it is current infection how do you manage?

Answer 11

1. a) Reinfection b) Treatment failure c) Persistent antigen but no malaria
2. Microscopy or LDH-based RDT
3. <4 weeks from previous treatment failure, give 2nd line anti-malarials. >4 weeks treat as a new infection but consider different oral agent if available

Question 12

What is the best clinical test to confirm cerebral
malaria?

Answer 12

Retinal fundoscopy:
1. Patchy retinal whitening
2. Focal changes of vessel colour
3. Retinal haemorrhages - often white
centred
+/- Papilloedema

Question 13

Presumptive TB treatment “SHINE” trial treatment regime and indications

Answer 13

1. Non-cavitory, non-miliary pulmonary TB in one lung lobe
2. Peripheral LN TB
3. Intra-thoracic LN TB
4. Pleural effusion

Regime: 2 months HRZ(E),/ Isoniazid + rif + pyrazinamide +ethambutol 2 months HR

Question 14

Meningitis B vaccination

Answer 14

1. 6 serogroups A, B, C, W, X, Y with vaccination against ACWY conjugate vaccine from 2005

Question 15

Neonatal tetanus clinical features and differentials

Answer 15

• Fever
• Breath holding
• Difficulty opening mouth
• Sensitive to light, sound, touch

Ddx
- Encephalitis
- Rabies
- Cerebral malaria
- Strychnine poisoning

Question 16

Neonatal tetanus prevention and management

Answer 16

• Clean delivery practice especially cord care
  -2 doses of tetanus toxois (1st dose ASAP in pregnancy and then 3 weeks pre delivery)
• Minimise noise/light/sound
• Source control
• IV penicillin +/- metronidazole
• Tetanus antitoxin
• Sedative, antispasmodic, muscle relaxant

Question 17

Safest antibiotics to use in pregnancy

Answer 17

Penicillin, cephalosporins, erythromycin
Nitrofurantoin (avoid at term)
Clindamycin
Metronidazole (avoid at high dose)

Question 18

Antibiotics to absolutely avoid in pregnancy

Answer 18

Tetracyclines, streptomycin (ototoxicity)

Question 19

Malaria in pregnancy

Answer 19

Significant risks to the mother like anaemia and risks to foetus like spontaneous abortion, stillbirth, prematurity, low birth-weight
Treat with IV artesunate in severe malaria and ACT

Question 20

WHO Integrated Management of Childhood Illnesses (IMCI) initiative

Answer 20

Designed to support in rapidly assessing and providing treatment for common childhood conditions - particularly for children under 5 years old