The 7 Deadly Sins Of Acute Paediatrics
Taking care of a sick child is no easy task. A pediatrician is charged with taking proper care of the sick kids. As a medical practitioner how knowledgeable are you about the 7 deadly sins of acute pediatrics? Take up the easy quiz below and find out. Best of luck!
- 1.
An inspiratory chest x-ray is important for: (tick all that are true)
- A.
Diagnosis of a child with cough, fever, right sided basal creps
- B.
Where creps are heard during an acute exacerbation of asthma
- C.
Suspected inhalation of a foreign body
- D.
Diagnosis of child who is toxic and has abdominal pain
- E.
Where tachypnoea is marked but the chest is clear
Correct Answer(s)
D. Diagnosis of child who is toxic and has abdominal pain
E. Where tachypnoea is marked but the chest is clearExplanation
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.Rate this question:
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- 2.
I would start IV fluids on a child with gastroenteritis if: (tick all that are correct)
- A.
Clinical condition worsened after 4 hours of oral rehydration
- B.
Urea was high on bloods
- C.
Child continued to vomit with oral rehydration
- D.
Signs of shock
Correct Answer(s)
A. Clinical condition worsened after 4 hours of oral rehydration
D. Signs of shockExplanation
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.Rate this question:
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- 3.
A&E refer a child with a "febrile convulsion". The following would cast doubt on the diagnosis: (tick all that are correct)
- A.
Age over 6yrs
- B.
Impaired consciousness prior to the seizure
- C.
Seizure lasting more than 30 minutes
- D.
Focal seizure or posturing
- E.
Lack of incontinence
Correct Answer(s)
A. Age over 6yrs
B. Impaired consciousness prior to the seizure
D. Focal seizure or posturingExplanation
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.Rate this question:
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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)
- A.
Treat with antihistamines
- B.
Take blood for IgE to orange
- C.
Diagnose allergy and advise avoidance of orange
- D.
A combination of sedating and non-sedating antihistamines may be required
- E.
Take blood for c1 esterase inhibitor
Correct Answer(s)
A. Treat with antihistamines
D. A combination of sedating and non-sedating antihistamines may be requiredExplanation
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 rashRate this question:
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- 5.
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
- A.
Add potassium 10mmol/500ml to IV fluids
- B.
Increase rate to correct 5% dehydration over 48 hours
- C.
Change to 0.9% saline with 5% dextrose
- D.
Repeat U&Es within 24 hours if continuing to vomit or fails to improve
- E.
Acute pontine myelinosis is a recognized complication of IV rehydration
Correct Answer(s)
A. Add potassium 10mmol/500ml to IV fluids
C. Change to 0.9% saline with 5% dextrose
D. Repeat U&Es within 24 hours if continuing to vomit or fails to improve
E. Acute pontine myelinosis is a recognized complication of IV rehydrationExplanation
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.Rate this question:
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- 6.
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.
- A.
She is probably allergic to amoxicillin
- B.
She might be allergic to amoxicillin, and should avoid it
- C.
She is unlikely to be allergic to amoxicillin and can have it
- D.
She might be allergic to amoxicillin and should have an allergy test
Correct Answer
B. She might be allergic to amoxicillin, and should avoid itExplanation
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.Rate this question:
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- 7.
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.
- A.
He probably has dyspepsia
- B.
He should complete a six week course of Ranitidine
- C.
He should have Helicobacter serology checked
- D.
He should have a Helicobacter stool antigen checked
Correct Answer(s)
A. He probably has dyspepsia
B. He should complete a six week course of RanitidineExplanation
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.Rate this question:
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Current Version
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Mar 18, 2023Quiz Edited by
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Apr 24, 2010Quiz Created by
Adsie
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