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SBA 1 part i • A 9 month old child presents to the ED with difficulty breathing whilst feeding. Last week the child had somecoryzal symptoms. On examination the child’s RR is 40 and his HR is 160 and there is sucking under his ribs. • Given the likely diagnosis what is the common cause: • RSV • Rhinovirus • Mycoplasma pneumonia • Influenza • Strep pneumonia SBA 1 part i • A 9 month old child presents to the ED with difficulty breathing whilst feeding. Last week the child had somecoryzal symptoms. On examination the child’s RR is 40 and his HR is 160 and there is sucking under his ribs. • Given the likely diagnosis what is the common cause: • RSV • Rhinovirus • Mycoplasma pneumonia • Influenza • Strep pneumonia SBA 1 part ii • Which of the following will be used in this child’s management? • Hypertonic saline • Antibiotics • Oxygen • Steroids • Bronchodilator SBA 1 part ii • Which of the following will be used in this child’s management? • Hypertonic saline • Antibiotics • Oxygen • Steroids • Bronchodilator Bronchiolitis Condition Bronchiolitis Definition Chest infection mainly affecting infants aged 1-12 months Causes RSV Presentation Cough, wheeze, tachyponea, wheeze Investigations Clinical diagnosis Management Supportive therapy + oxygen Prophylaxis – Palivizumab in high risk patients SBA 2 part i • A 10 month old girl presents to ED with abdominal pain and blood in stools. She draws her legs towards her abdomen and is refusing to feed. The abdomen is soft and there is sausage shaped mass in the right flank • What is the first line management? • Conservative management • Surgical • Air enema • Hydrostatic enema • IV Antibiotics• A 10 month old girl presents to ED with abdominal pain and blood in stools. She draws her legs towards her abdomen and is refusing to feed. The abdomen is soft and there is sausage shaped mass in the right flank • What is the first line management? • Conservative management • Surgical • Air enema • Hydrostatic enema • IV Antibiotics SBA 2 part ii • Which of the following is the diagnostic investigation of choice? • CT Abdomen • Ultrasound scan • Abdominal radiograph • Contrast enema • MRI SBA 2 part ii • Which of the following is the diagnostic investigation of choice? • CT Abdomen • Ultrasound scan • Abdominal radiograph • Contrast enema • MRI Intussusception Condition Intussusception Definition Invagination of proximal bowel into a distal segment passing into the caecum through the ileocecal valve Causes Unknown ; maybe related to infection Presentation Severe colicky pain , child characteristically draws up his/her legs , red-currant jelly stool (late sign) Investigations USS – diagnostic investigation of choice – sausage shaped mass Management Rectal air insufflation or contrast enema SBA 3 part i • A 5 y/o boy is brought to ED as has been suffering from barking cough worse at night and harsh breathing noise. He is not drooling and there is no stridor. He is normally fit and well and up-to-date with all his vaccinations • Which if the following is most likely causative organism? • RSV • Rhino virus • Covid-19 • Haemophillus influenza B • Parainfluenza SBA 3 part i • A 5 y/o boy is brought to ED as has been suffering from barking cough worse at night and harsh breathing noise. He is not drooling and there is no stridor. He is normally fit and well and up-to-date with all his vaccinations • Which if the following is most likely causative organism? • RSV • Rhino virus • Covid-19 • Haemophillus influenza B • Parainfluenza SBA 3 part ii • What is the best initial management? • Dexamethasone • cefotaxime • Prednisolone • Salbutamol • Adrenaline SBA 3 part ii • What is the best initial management? • Dexamethasone • Cefotaxime • Prednisolone • Salbutamol • Adrenaline Croup Condition Croup Definition Aka laryngotracheobronchitis – infection of the upper airway which obstructs breathing and causes characteristic barking cough Causes Parainfluenza Presentation Barking cough, reduced feeding, coryzal symptoms Investigations Clinical Diagnosis Management Oxygen, Dexamethasone , Nebulised adrenaline Important differential Acute Epiglottitis SBA 4 part i • A 5 year old girl presents to the GP with a 8 month history of cough, when exercising and coughing up phlegm. She has also had failure to thrive and past hospitalizations due to chest infections. • Which of the following is a diagnostic test: • Immunoreactive trypsinogen • Genetic testing • Sweat test • Chest x-ray • Stool sample SBA 4 part i • A 5 year old girl presents to the GP with a 8 month history of cough, when exercising and coughing up phlegm. She has also had failure to thrive and past hospitalizations due to chest infections. • Which of the following is a diagnostic test: • Immunoreactive trypsinogen • Genetic testing • Sweat test • Chest x-ray • Stool sample SBA 4 part ii • Which of the following is the child likely to be deficient in • Vitamin B1 • Vitamins ADEK • Vitamin B6 • Iron • B12 and folate SBA 4 part ii • Which of the following is the child likely to be deficient in • Vitamin B1 • Vitamins ADEK • Vitamin B6 • Iron • B12 and folate SBA 4 part iii • Which of the following organisms are most likely to cause chest infections in these group of children • Legionella pneumophila • Psuedomonas aeruginosa • Mycoplasma • Pneumocystis jiroveci • Staphylococcus SBA 4 part iii • Which of the following organisms are most likely to cause chest infections in these group of children • Legionella pneumophila • Psuedomonas aeruginosa • Mycoplasma • Pneumocystis jiroveci • Staphylococcus Cystic Fibrosis Condition CF Definition Progressive, genetic disease that causes lung infection and limits digestion Causes CFTR gene mutations; autosomal recessive Presentation Failure to pass meconium; recurrent chest infections; steatorrhea Investigations Heel prick within first few days of life; sweat test to confirm high salt levels Management Conservative: MDT, chest physios and dieticians Medical: abx, bronchodilators and medicine for secretions, Creon and fat soluble vitamins Surgical : last resort lung transplant SBA 5 part i • A 1 month old male presents with projectile vomiting following each feed, and is not gaining weight well. He is otherwise well. • On abdominal examination, there are no peritonitic features, but, a small firm mass is palpable in the epigastric area • What is the most likely finding on a blood gas? • Hyperkalemic, hypochloraemic, metabolic acidosis • Hypokalemic, hypochloraemic, metabolic alkalosis • Hypokalemic, hyperchloraemic metabolic alkalosis • Hyperkalemic, hyperchloraemic metabolic acidosis SBA 5 part i • A 1 month old male presents with projectile vomiting following each feed, and is not gaining weight well. He is otherwise well. • On abdominal examination, there are no peritonitic features, but, a small firm mass is palpable in the epigastric area • What is the most likely finding on a blood gas? • Hyperkalemic, hypochloraemic, metabolic acidosis • Hypokalemic, hypochloraemic, metabolic alkalosis • Hypokalemic, hyperchloraemic metabolic alkalosis • Hyperkalemic, hyperchloraemic metabolic acidosis SBA 5 part ii • Which of the following is definitive management • Laparoscopic pyloromyotomy • IV fluids • NG tube • Air enema • Emergency laprotomy SBA 5 part ii • Which of the following is definitive management • Laparoscopic pyloromyotomy • IV fluids • NG tube • Air enema • Emergency laprotomoy Pyloric stenosis Condition Pyloric stenosis Definition Hypertrophy of the outlet pyloric sphincter of the stomach Cause Environmental ; genetics Presentation Projectile vomiting after feed, olive sized mass in stomach Investigations Bloods, USS Management Supportive ; Pyloromyotomy SBA 6 part i • A 17-year-old girl presents to the GP worried that she has not started her ear infections. On examination, it is noted she has a webbed neck, low set ears and widely spaced nipples. On auscultation, there is a systolic murmur loudest over the aortic valve. • Which of the following is the most likely diagnosis? • Patau syndrome • PCOS • Turner’s syndrome • William syndrome • McCune-Albright syndrome SBA 6 part i • A 17-year-old girl presents to the GP worried that she has recurrent ear of hypothyroidism and delayed puberty. On examination, it is noted shestory has a webbed neck, low set ears and widely spaced nipples. On auscultation, there is a systolic murmur loudest over the aortic valve. • Which of the following is the most likely diagnosis? • PCOS • Patau Syndrome • Turner’s syndrome • William syndrome • McCune-Albright syndrome SBA 6 part ii • What is the most common congenital heart defect in people with this condition? • Tricuspid regurgitation • Atrial septal defect • Ventricular septal defect • Coarctation of aorta • Aortic stenosis SBA 6 part ii • What is the most common congenital heart defect in people with this condition? • Tricuspid regurgitation • Atrial septal defect • Ventricular septal defect • Coarctation of aorta • Aortic stenosis Turner’s syndrome Condition Turner’s syndrome Definition When one of the X chromosome is missing in females Cause XO karyotype Presentation Short stature, webbed neck, wide carrying angle, delayed puberty Investigations Clinical diagnosis; genetic testing Management Growth hormone; estrogen replacement SBA 7 part i • A 5-year-old girl is brought in with an itchy rash that has appeared in crops. The rash for the past 3 days. and has now spread to her legs. She is irritable and has had a fever • • On examination she is well hydrated and alert. The rash is mainly vesicular with surrounding erythema on her torso and there are some papules on her cheeks. • Question: What is the most likely diagnosis? • • Dermatitis Herpetiformis • Impetigo • Chickenpox • Measles • Rubela SBA 7 part i • A 5-year-old girl is brought in with an itchy rash that has appeared in crops. The rash for the past 3 days. and has now spread to her legs. She is irritable and has had a fever • • On examination she is well hydrated and alert. The rash is mainly vesicular with surrounding erythema on her torso and there are some papules on her cheeks. • Question: What is the most likely diagnosis? • • Dermatitis Herpetiformis • Impetigo • Chickenpox • Measles • Rubela SBA 7 part ii • Her mother informs you that she is 16 weeks pregnant and cannot find she is VZV IgM and IgG negative .x. Upon further investigations you • What is the most appropriate management of the mother? • Give varicella-zoster immunoglobulins • Give IV aciclovir • Give Varicella-zoster vaccination • Give Varicella-zoster Immunoglobulins + IV aciclovir • Give Varicella Zoster vaccination and IV aciclovir SBA 7 part ii • Her mother informs you that she is 16 weeks pregnant and cannot find she is VZV IgM and IgG negative .x. Upon further investigations you • What is the most appropriate management of the mother? • Give varicella-zoster immunoglobulins • Give IV aciclovir • Give Varicella-zoster vaccination • Give Varicella-zoster Immunoglobulins + IV aciclovir • Give Varicella Zoster vaccination and IV aciclovir Chicken pox Condition Chickenpox Definition Paediatric infection/rash Cause Varicella virus HHV3 Presentation Rash raised itchy spots on face or chest then spread to the rest of body -> blisters -> crust over in next few days Investigations Clinical diagnosis Management Conservative mainly as the condition is skef-limiting Other conditions to explore: - Scarlet fever - Measles - Mumps - Hand-foot and mouth disease SBA 8 part i • A 6-week old baby girl is brought in due to poor feeding, going blue when due to maternal diabetes.ive. She was born at term weighing about 4500g • On examination she is smiling and looks pink (well perfused). A loud ejection systolic murmur is heard at left sternal edge. Her chest x-ray shows a boot shaped heart • What is the most likely diagnosis? • Ventricular septal defect • Tricuspid Atresia • Tetralogy of Fallot • Transposition of the Great Arteries SBA 8 part i • A 6-week old baby girl is brought in due to poor feeding, going blue when due to maternal diabetes.ive. She was born at term weighing about 4500g • On examination she is smiling and looks pink (well perfused). A loud ejection systolic murmur is heard at left sternal edge. Her chest x-ray shows a boot shaped heart • What is the most likely diagnosis? • Ventricular septal defect • Tricuspid Atresia • Tetralogy of Fallot • Transposition of the Great Arteries SBA 8 part ii • Suddenly she starts crying intensely and goes cyanotic. The murmur goes quieter. • What is the best initial step in management? • Raise the baby’s legs • Put baby’s knees to her chest • Put the baby on prostaglandin infusion • Try to feed the baby SBA 8 part ii • Suddenly she starts crying intensely and goes cyanotic. The murmur goes quieter. • What is the best initial step in management? • Raise the baby’s legs • Put baby’s knees to her chest • Put the baby on prostaglandin infusion • Try to feed the baby Tetralogy of Fallot Condition Tetralogy of Fallot Definition Congenital cardiac disease PROV – Pulmonary stenosis, Right ventricular hypertrophy, overriding aorta and VSD Causes Congenital Presentation Tet spells, cyanosis, murmur Investigation ECG, Chest X-ray ECHO (definitive investigation) Management Tet spells – beta blockers or knees to chest Definitive management is surgery Other conditions to explore: - VSD - ASD - Innocent murmurs SBA 9 • A 3-year-old boy presents following concerns about language development. He started using words he had previously learnt between 18 and 24 months, but has now regainedopped most of these words. He also seems uninterested in engaging with other children. He also rocks his body while standing and doesn’t point his finger like other children. • What is the most likely diagnosis? • Global developmental delay • Autism spectrum disorder • ADHD • Schizoid personality disorder • Severe hearing impairment SBA 9 • A 4-year-old boy presents following concerns about language development. He started using words he had previously learnt between 18 and 24 months, but has now regainedopped them. He also seems uninterested in playing with other children. He also rocks his body while standing and doesn’t point his finger like other children. • What is the most likely diagnosis? • Global developmental delay • Autism spectrum disorder • ADHD • Schizoid personality disorder • Severe hearing impairment Autism Spectrum Disorder Condition ASD Definition Social, language and behavioural deficits Causes Prematurity; antenatal infections Presentation Associated with learning difficulties; difficulties in social communication and repetitive, restrictive behaviours Investigations Clinical diagnosis; Questionnaires Management MDT approach Other conditions to explore: - ADHD - Anorexia nervosa SBA 10 • A 7 month old child presents to ED with bilious vomiting and constipation for two days. The child appears dehydrated. On small bowel obstruction is confirmed with an oral contrast study. What is the definitive management of this condition? • IV fluids • Enema • Ladd’s procedure • NG tube insertion • IV Antibiotics SBA 10 • A 7 month old child presents to ED with bilious vomiting and constipation for two days. The child is listless and dehydrated. On small bowel obstruction, confirmed with an oral contrast study. What is the definitive management of this condition? • IV fluids • Enema • Ladd’s procedure • NG tube insertion • IV antibiotics Malrotation Condition Malrotation Definition Early in development the midgut rotates and fixates in abnormal position. This makes the bowel prone to volvulus and compression of duodenum ; obstruction is beyond ampulla of vater Presentation Obstruction; vomiting Investigations Upper GI contrast study Management Ladd’s procedure Other conditions to explore: Hirschprung’s disease GORD Coeliac Disease SBA 11 • An 8 year old boy presents to the GP with a limp. • His mother thinks he has been walking strangely for the last 2 days and has been lethargic and feverish at home. He hip is not red but is tender to palpation, and examination of joint movement is severely limited by pain. He has an antalgic gait a low grade fever. • Which of the following investigation is important to rule out a life threatening cause? • Hip radiograph • Blood cultures • Joint aspiration • USS of hip • FBC, CRP SBA 11 • An 8 year old boy presents to the GP with a limp. • His mother thinks he has been walking strangely for the last 2 days and has been lethargic and feverish at home. He hip is not red but is tender to palpation, and examination of joint movement is limited. He also has a low grade fever. • Which of the following investigation is important to rule out a life threatening cause? • Hip radiograph • Blood cultures • Joint aspiration • USS of hip • FBC, CRP Transient Synovitis Condition TS Definition Benign cause of limp caused by inflammation of the synovial lining of hip joint Cause Preceded by viral infection - URTI Presentation Features in TS are milder compared to septic arthritis ; failure to weight bear, fever and acute limp Investigations FBC, CRP, USS of joint and joint aspiration if suspicion of septic arthritis is high Management Supportive Other conditions to explore: - Juvenile Arthritis - Septic Arthritis - Developmental Dysplasia of Hip - Perthes’ disease SBA 12 • A 13 year old boy presents to A&E with sudden onset pain in his lower abdomen and scrotum after being hit bytennis ball. The pain started is exquisitely tender and swollen, with the left testicle raised higher in the scrotum. What is the most appropriate next step? • Urgent Ultrasound • IV Antibiotics • Urgent surgical exploration • Urgent abdominal radiograph • Urgent CT Abdomen-Pelvis SBA 12 • A 13 year old boy presents to A&E with sudden onset pain in hisscrotum after being hit by tennis ball. The pain started around two hours ago and is swollen, with the left testicle raised higher in the scrotum. What is the most appropriate next step? • Urgent Ultrasound • IV Antibiotics • Urgent surgical exploration • Urgent abdominal radiograph • Urgent CT Abdomen-Pelvis Testicular Torsion Condition Testicular torsion Definition Tests twist around the spermatic cord – cuts off blood supply to testes Cause Presentation Sudden onset sever pain, often following a trauma, high riding testicle, loss of cremaster reflex Investigations Clinical Diagnosis Management Surgical exploration with fixation of the testciles Bonus SBA • An 8 year old boy is brought to A&E for difficulty in breathing that started after a run. • On arrival at the department, he is unable to complete sentences, has a respiratory rate of54 and a diffuse wheeze is heard throughout the chest. He is treated with high flow oxygen, salbutamol nebulisers and ipratropium bromide nebulisers. After these treatments, his respiratory rate is 7 8.6.his chest is quiet to auscultation. His blood gas shows a pH of7.38, pCO2 of 5.2 and pO2 of What is the most appropriate next step in managing this patient? • Call the anesthetist • Repeat Salbutamol nebulisers • Give stat dose of IV MgSO4 • Peak flow • Watch and Wait Bonus SBA • An 8 year old boy is brought to A&E for difficulty in breathing that started after a run. • On arrival at the department, he is unable to complete sentences, has a respiratory rate of54 and a diffuse wheeze is heard throughout the chest. He is treated with high flow oxygen, salbutamol nebulisers and ipratropium bromide nebulisers. After these treatments, his respiratory rate is 7 8.6.his chest is quiet to auscultation. His blood gas shows a pH of7.38, pCO2 of 5.2 and pO2 of What is the most appropriate next step in managing this patient? • Call the anesthetist • Repeat Salbutamol nebulisers • Give stat dose of IV MgSO4 • Peak flow • Watch and Wait Useful resources • Oxford handbook of clinical specialties • Teachmepaediatrics website