The 7 Deadly Sins Of Acute Paediatrics

1. 12yr old boy with 6 month history of sporadic abdominal pain. His appetite can be affected but he is not losing weight. There is no change in bowel habit. He has had some benefit from Ranitidine.

He probably has dyspepsia

He should complete a six week course of Ranitidine

He should have Helicobacter serology checked

He should have a Helicobacter stool antigen checked

Based on the given information, the 12-year-old boy has a 6-month history of sporadic abdominal pain, with no weight loss or change in bowel habits. He has also experienced some benefit from Ranitidine, which is a medication commonly used to treat dyspepsia. Therefore, it is likely that the boy has dyspepsia, and completing a six-week course of Ranitidine would be an appropriate treatment option. There is no indication in the information provided for checking Helicobacter serology or stool antigen.

Explanation

Based on the given information, the 12-year-old boy has a 6-month history of sporadic abdominal pain, with no weight loss or change in bowel habits. He has also experienced some benefit from Ranitidine, which is a medication commonly used to treat dyspepsia. Therefore, it is likely that the boy has dyspepsia, and completing a six-week course of Ranitidine would be an appropriate treatment option. There is no indication in the information provided for checking Helicobacter serology or stool antigen.

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2. 15yr old girl presents with recurrent vomits over 2 days. Seen by GP, started on Amoxicillin. 2 hours after taking antibiotic, fet tightness in her throat, unable to swallow, some chest pain, itching. Ambulance phoned, gave IM piriton. No rash seen. On admission, obs are normal, examination normal.

She is probably allergic to amoxicillin

She might be allergic to amoxicillin, and should avoid it

She is unlikely to be allergic to amoxicillin and can have it

She might be allergic to amoxicillin and should have an allergy test

The patient's symptoms of throat tightness, inability to swallow, chest pain, and itching after taking amoxicillin suggest an allergic reaction. Although no rash was seen, these symptoms are consistent with an allergic response. Therefore, it is likely that the patient is allergic to amoxicillin and should avoid taking it in the future to prevent further allergic reactions. An allergy test may be considered to confirm the allergy if necessary.

Explanation

The patient's symptoms of throat tightness, inability to swallow, chest pain, and itching after taking amoxicillin suggest an allergic reaction. Although no rash was seen, these symptoms are consistent with an allergic response. Therefore, it is likely that the patient is allergic to amoxicillin and should avoid taking it in the future to prevent further allergic reactions. An allergy test may be considered to confirm the allergy if necessary.

3. I would start IV fluids on a child with gastroenteritis if: (tick all that are correct)

Clinical condition worsened after 4 hours of oral rehydration

Urea was high on bloods

Child continued to vomit with oral rehydration

Signs of shock

Abnormal electrolytes and ongoing diarrhoea or vomiting are not indications for IV fluids. Severe dehydration should be managed with boluses of IV resuscitation fluids, followed by oral/NG rehydration if possible.

Explanation

Abnormal electrolytes and ongoing diarrhoea or vomiting are not indications for IV fluids. Severe dehydration should be managed with boluses of IV resuscitation fluids, followed by oral/NG rehydration if possible.

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4. 6yr old girl presents with widespread itchy rash for last 3 days. Otherwise well, but has had similar rashes in the past. Mum thinks it could be a reaction to orange juice. On examination, she has a marked urticarial rash with some puffiness of the hands and feet. Do you: (tick all that apply)

Treat with antihistamines

Take blood for IgE to orange

Diagnose allergy and advise avoidance of orange

A combination of sedating and non-sedating antihistamines may be required

Take blood for c1 esterase inhibitor

An urticarial reaction that lasts for more than 24 hours is unlikely to be IgE mediated. Treat with antihistamines - Hydroxyzine and Levocetirizine may be better than chlorphenamine and cetirizine. Hereditary angioedema is not itchy and not associated with urticaria, although there can be a serpentine erythematous rash

Explanation

An urticarial reaction that lasts for more than 24 hours is unlikely to be IgE mediated. Treat with antihistamines - Hydroxyzine and Levocetirizine may be better than chlorphenamine and cetirizine. Hereditary angioedema is not itchy and not associated with urticaria, although there can be a serpentine erythematous rash

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5. A&E refer a child with a "febrile convulsion". The following would cast doubt on the diagnosis: (tick all that are correct)

Age over 6yrs

Impaired consciousness prior to the seizure

Seizure lasting more than 30 minutes

Focal seizure or posturing

Lack of incontinence

Age over 6yrs or under 6 months suggests an epileptic condition or other aetiology.
Impaired consciousness or meningism prior to seizure (or after a postictal period) suggests intracranial infection.
Status epilepticus is quite common in febrile convulsions.
Any seizure type other than tonic-clonic suggests an alternative aetiology.
Incontinence and tongue biting are poorly sensitive/specific in children.

Explanation

Age over 6yrs or under 6 months suggests an epileptic condition or other aetiology.
Impaired consciousness or meningism prior to seizure (or after a postictal period) suggests intracranial infection.
Status epilepticus is quite common in febrile convulsions.
Any seizure type other than tonic-clonic suggests an alternative aetiology.
Incontinence and tongue biting are poorly sensitive/specific in children.

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6. An inspiratory chest x-ray is important for: (tick all that are true)

Diagnosis of a child with cough, fever, right sided basal creps

Where creps are heard during an acute exacerbation of asthma

Suspected inhalation of a foreign body

Diagnosis of child who is toxic and has abdominal pain

Where tachypnoea is marked but the chest is clear

Chest X-ray is not necessary to make the diagnosis of pneumonia, although it may reveal effusion or lobar collapse.
Creps are often heard (along with wheeze) during acute exacerbations of asthma, they are not specific to bacterial lower respiratory tract infection.
Suspected inhalation of a foreign body requires a forced expiratory chest X-ray.

Explanation

Chest X-ray is not necessary to make the diagnosis of pneumonia, although it may reveal effusion or lobar collapse.
Creps are often heard (along with wheeze) during acute exacerbations of asthma, they are not specific to bacterial lower respiratory tract infection.
Suspected inhalation of a foreign body requires a forced expiratory chest X-ray.

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7. 2yr old boy is admitted with 24 hour history of recurrent vomiting and diarrhoea. He is moderately dehydrated and fails to improve with a period of oral rehydration. IV 0.45% NaCl and 5% dextrose is started at maintenance rate. His U&Es come back:
Na 130 K 3.3 U 8 Cr 56

Add potassium 10mmol/500ml to IV fluids

Increase rate to correct 5% dehydration over 48 hours

Change to 0.9% saline with 5% dextrose

Repeat U&Es within 24 hours if continuing to vomit or fails to improve

Acute pontine myelinosis is a recognized complication of IV rehydration

Aim to correct dehydration over 8-12 hours unless hypernatraemic. Normal saline is more appropriate in the context of hyponatraemia as 0.45% saline is hypotonic and may exacerbate the situation. Pontine myelinosis (osmotic demyelination syndrome) is caused by overly rapid correction of severe hyponatraemia.

Explanation

Aim to correct dehydration over 8-12 hours unless hypernatraemic. Normal saline is more appropriate in the context of hyponatraemia as 0.45% saline is hypotonic and may exacerbate the situation. Pontine myelinosis (osmotic demyelination syndrome) is caused by overly rapid correction of severe hyponatraemia.

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