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Paediatrics 2 12/06/25, DrDr Ololade Tijaniholme andLearningObjectives ● Pediatric respiratory conditions: Croup, bronchiolitis, pneumonia ● Pediatric seizures: Types, causes, management ● Pediatric dermatology: Eczema, impetigo, rashes ● Pediatric GI issues: Constipation, reflux, abdominal pain ● Pediatric cardiology: Murmurs, congenital heart disease ● Pediatric metabolic disorders: Phenylketonuria, hypothyroidismQuestion 1 A 2-year-old boy presents with a barking cough, hoarse voice, and inspiratory stridor. He is febrile but alert, with mild respiratory distress. What is the most appropriate initial management? A. Oral prednisolone B. Inhaled salbutamol C. Nebulised adrenaline and dexamethasone D. High-flow oxygen and IV antibiotics E. Oral dexamethasoneQuestion 1-Answer A 2-year-old boy presents with a barking cough, hoarse voice, and inspiratory stridor. He is febrile but alert, with mild respiratory distress. What is the most appropriate initial management? A. Oral prednisolone B. Inhaled salbutamol C. Nebulised adrenaline and dexamethasone D. High-flow oxygen and IV antibiotics E. Oral dexamethasoneQuestion 1-Explanation Croup, or laryngotracheobronchitis, is a common viral respiratory illness in children aged 6 months to 6 years, most commonly affecting 2-year-olds. It involves inflammation and oedema of the upper airway, particularly the subglottic region, leading to airflow obstruction. Typical clinical features: ● Barking seal-like cough ● Hoarse voice ● Inspiratory stridor (especially when crying or agitated) ● Low-grade fever ● Symptoms typically worse at night ● Usually preceded by coryzal symptomsCroup Causes- Most commonly due to parainfluenza virus (especially type 1) but can also be caused by RSV, adenovirus, influenzaCroup-Management 1. Oral dexamethasone (first-line for mild to moderate cases) ● Single dose of 0.15–0.6 mg/kg ● Reduces airway inflammation, improves symptoms ● Reduces the need for hospital admission and shortens symptom duration 2. Nebulised adrenaline + dexamethasone (for moderate to severe croup) ● Nebulised adrenaline (epinephrine): 0.5 mL/kg of 1:1000 (max 5 mL) ○ Used to temporarily reduce airway oedema in acute distress ● Continue with oral or IV steroids for longer-term effect 3. Supportive care: ● Keep child calm to reduce work of breathing (agitation worsens stridor) ● Oxygen if saturations <94% ● Hospital observation may be needed based on severityQuestion 2 A 6-month-old infant presents in winter with cough, poor feeding, and increased work of breathing. On examination, he has wheeze and crackles. What is the most likely diagnosis? A. Asthma B. Bronchiolitis C. Pneumonia D. Viral croup E. Foreign body aspirationQuestion 2-Answer A 6-month-old infant presents in winter with cough, poor feeding, and increased work of breathing. On examination, he has wheeze and crackles. What is the most likely diagnosis? A. Asthma B. Bronchiolitis C. Pneumonia D. Viral croup E. Foreign body aspirationQuestion 2-Explanation Bronchiolitis is most common in infants <1 year, particularly during winter months. It is typically caused by RSV and presents with coryzal symptoms, cough, feeding difficulty, tachypnoea, and widespread wheeze/crackles. Management is supportive (oxygen and fluids if needed).Question 3 A 7-year-old girl is brought in after a seizure. She had brief staring episodes, eye fluttering, and was unresponsive for 10 seconds. What is the most likely diagnosis? A. Temporal lobe epilepsy B. Generalised tonic-clonic seizure C. Absence seizure D. Myoclonic epilepsy E. Febrile seizureQuestion 3 A 7-year-old girl is brought in after a seizure. She had brief staring episodes, eye fluttering, and was unresponsive for 10 seconds. What is the most likely diagnosis? A. Temporal lobe epilepsy B. Generalised tonic-clonic seizure C. Absence seizure D. Myoclonic epilepsy E. Febrile seizureQuestion 3 Absence seizures are a type of generalised seizure, primarily affecting children aged 4–10 years, with a peak incidence around 6–7 years. They are characterised by brief episodes of impaired awareness and lack of responsiveness, often mistaken for daydreaming or inattention. ● First-line treatment: ○ Ethosuximide (especially if absence seizures are isolated) ○ Sodium valproate if: ■ Ethosuximide isn’t tolerated ■ There are other seizure types ● Lamotrigine is an alternative if other options are contraindicated Carbamazepine and phenytoin should be avoided, as they may worsen absence seizures. Prognosis is generally good- Around 65–85% of children outgrow absence seizures by adolescence. However, a small percentage may go on to develop juvenile absence epilepsy or juvenile myoclonic epilepsyQuestion 4 A 1-year-old child presents with itchy, dry, red patches on the cheeks and extensor limbs. What is the most appropriate first-line management? A. Oral antihistamines B. Topical antifungals C. Topical corticosteroids and emollients D. Oral antibiotics E. PhototherapyQuestion 4 A 1-year-old child presents with itchy, dry, red patches on the cheeks and extensor limbs. What is the most appropriate first-line management? A. Oral antihistamines B. Topical antifungals C. Topical corticosteroids and emollients D. Oral antibiotics E. PhototherapyQuestion 4 This is atopic eczema, common in infancy, often affecting cheeks and extensor surfaces. Management includes regular emollients and topical corticosteroids (e.g., 1% hydrocortisone) during flares.Question 5 A 6-year-old child presents with golden-crusted lesions around the mouth and nose. He is otherwise well. What is the most likely diagnosis? A. Eczema herpeticum B. Tinea corporis C. Scabies D. Impetigo E. Molluscum contagiosumQuestion 5 A 6-year-old child presents with golden-crusted lesions around the mouth and nose. He is otherwise well. What is the most likely diagnosis? A. Eczema herpeticum B. Tinea corporis C. Scabies D. Impetigo E. Molluscum contagiosumQuestion 5-Explanation Impetigo is a superficial bacterial skin infection, usually caused by Staphylococcus aureus or Streptococcus pyogenes. It presents with honey-coloured crusts and is treated with topical fusidic acid (mild) or oral antibiotics if widespread.Question 6 A 6-week-old child presents to the GP with non-bilious vomiting following feeds which is very forceful in nature. He has lost weight and appears hungry post feeds. Mum tries to demonstrate what happens during the feed and you examine the baby and feel an abdominal mass. What is the most likely diagnosis? A. Intussusception B. Hirschsprung's C. Cholangitis D. Pyloric stenosis E. Biliary atresiaQuestion 6 A 6-week-old child presents to the GP with non-bilious vomiting following feeds which is very forceful in nature. He has lost weight and appears hungry post feeds. Mum tries to demonstrate what happens during the feed and you examine the baby and feel an abdominal mass. What is the most likely diagnosis? A. Intussusception B. Hirschsprung's C. Cholangitis D. Pyloric stenosis E. Biliary atresiaQuestion 6 ExplanationQuestion 7 A 5 year old child presents to the GP with their parent as they are concerned about soiling with faeces despite the child being previously continent. On further history taking, you are informed that there was no delay in passing meconium, the child was born at full term and there are no medical issues, no weight loss or delay in developmental milestones. What is the optimal option for pharmacological management? A. Senna B. Laxido C. Increased fluid and fibre intake D.Phosphate enema E.Glycerol suppositoryQuestion 7 A 5 year old child presents to the GP with their parent as they are concerned about soiling with faeces despite the child being previously continent. On further history taking, you are informed that there was no delay in passing meconium, the child was born at full term and there are no medical issues, no weight loss or delay in developmental milestones. What is the optimal option for pharmacological management? A. Senna B. Laxido C. Increased fluid and fibre intake D.Phosphate enema E.Glycerol suppositoryQuestion 7ExplanationQuestion 7Explanation Question 8 A diagnosis of phenylketonuria is made from the newborn heel prick test done at 5 days old. What is the inheritance pattern of PKU? A. Autosomal dominant B. X-linked dominant C. X-linked recessive D. Via Mitochondrial DNA E. Autosomal recessive Question 8 A diagnosis of phenylketonuria is made from the newborn heel prick test done at 5 days old. What is the inheritance pattern of PKU? A. Autosomal dominant B. X-linked dominant C. X-linked recessive D. Via Mitochondrial DNA E. Autosomal recessiveQuestion 8 Explanation Question 9 Mum presents to ED with her 2 month old as she is concerned about episodes where baby seems to be breathing faster and turning blue particularly while crying. Which of the following elements constitute the most likely diagnosis? A. ASD, VSD, Pulmonary hypertrophy, Right ventricular defect B. Overriding aorta, Pulmonary stenosis, VSD, RV hypertrophy C. Aortic stenosis, VSD, ASD, LV hypertrophy D. Overriding aorta, Pulmonary stenosis, VSD, LV hypertrophy E. ASD, Overriding aorta, Pulmonary stenosis, LV hypertrophy Question 9 Mum presents to ED with her 2 month old as she is concerned about episodes where baby seems to be breathing faster and turning blue particularly while crying. Which of the following elements constitute the most likely diagnosis? A. ASD, VSD, Pulmonary hypertrophy, Right ventricular defect B. Overriding aorta, Pulmonary stenosis, VSD, RV hypertrophy C. Aortic stenosis, VSD, ASD, LV hypertrophy D. Overriding aorta, Pulmonary stenosis, VSD, LV hypertrophy E. ASD, Overriding aorta, Pulmonary stenosis, LV hypertrophyQuestion 9 Explanation Tetralogy of FallotQuestion 10 A 3 year old is brought to the GP by a concerned mother who migrated to the UK with the baby recently. She reports that baby seems more tired, sleepy and seems to be constipated with what seems to be a yellow appearance to the skin which is also dry. She states that she does not recall a postnatal heel prick test being done. What is the most likely diagnosis? A. Congenital hypothyroidism B. Sickle cell C.Cystic fibrosis D.Maple Syrup urine disease E. HomocystinuriaQuestion 10 A 3 year old is brought to the GP by a concerned mother who migrated to the UK with the baby recently. She reports that baby seems more tired, sleepy and seems to be constipated with what seems to be a yellow appearance to the skin which is also dry. She states that she does not recall a postnatal heel prick test being done. What is the most likely diagnosis? A. Congenital hypothyroidism B. Sickle cell C.Cystic fibrosis D.Maple Syrup urine disease E. HomocystinuriaQuestion 10 Explanation Column text SEEYOUNEXT https://linktr.ee/medtic.teaching THURSDAY! Sign up to our next session on MedAll Take part in our research survey See all our upcoming events www.medticteaching.com | Email: medticteaching@gmail.com | Youtube @medtic | Instagram @medtic.teaching | Tiktok @medticteaching