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OK. No, cool. So, thanks for joining guys. Um Today we're doing the second session of the final series. Um So I'm Catherine and I've got a aid with me as well. Um So let's get started. So today we're gonna cover some peds, respiratory conditions, seizures, dermatology, gi issues, cardiology, um and metabolic disorders. As always, we'll do um 10 multiple choice questions. We'll give you a little bit of time to give you what you think the answer is and then we'll go through an explanation as well. All right. So let's start with question one. So, uh a two year old boy presents with a barking cough, hoarse voice and inspiratory Stridor. He's febrile but alert with mild respiratory distress. What is the most appropriate initial management? Ok. OK. So moving on to the answer if everybody's ready. So the answer here is oral dexamethasone. So this question is talking about croup, which is really commonly seen in Children. So, Croup or um a longer version that I'm not gonna try and say on a recorded teaching session is a common viral respiratory illness. So it's often in Children that are aged six months to six years um, and it's most commonly seen in around the 2, 2.5 kind of age group. So what it is is inflammation and edema of the upper airway, particularly the sub glottic region which leads to airflow obstruction. So, if you were seeing these Children in GP or in A&E, you'd probably see, um, that they came in with a barking seal like cough. They have a hoarse voice. Um, they've got in Inspiratory Stridor. So, especially when they're crying or upset. Um, they have a low grade fever. Um, their symptoms are often worse at night as well. So you'll, they'll often hear parents say that their seal like cough gets worse at night. Um, and it's often preceded by cough or cold kind of symptoms as well. So it's most likely caused by, um, parainfluenza virus. So, especially type one, which is kind of the most common thing in your exams. Um, but it can also be caused by other viruses as well. Um, so this is just, um, a classification of group severity. Um, so, um, I just covering up the mild category. Um, but it's kind of, yeah, obviously as it gets more severe, the cough gets worse, the Stridor gets worse, the work of breathing gets worse and you often see the retractions and things like that when it's really severe. Um, and, um, they get more distressed, obviously, the more severe it is as well. Cool. So we've often, we've obviously said that the first line management is all dexamethasone. Um So the steroid helps to reduce the airway inflammation. It improves symptoms as well. Um I know it reduces the need for Children to, to be put in hospital. Um you use that for mild to moderate cases. So if you're in GP or something like that, it would be ok to manage that like that in the community. Um for moderate to severe croup. Um we use nebulized adrenaline and dexamethasone as well. Um Just because the adrenaline helps to work quickly to temporarily reduce the airway Edem, especially if the child is in distress as well. And then you can give them the steroids on top of that as well. Um And obviously as well. Um supportive care is really important, especially if the child is agitated um trying to keep them calm, giving them oxygen if if needed. Um and they might need a hospital observation for a little while as well based on how severe their creep is cool. So moving on to question two, a six month old infant presents in winter with a cough, poor feeding and increased work of breathing on examination. He has wheeze and crackles. What is the most likely diagnosis? Amazing. So if we move on to the answer for this one, so the answer here is bronchiolitis. So bronchiolitis is most common in Children that are aged one year or less. It's particularly common during the winter months as well, often because Children spend more time inside and are more susceptible to catching things. So it's typically caused by the RSV, um virus, um, which is a big thing for your exams as well. It's quite commonly asked. Um, it presents with kind of cough, cold symptoms, um, feeding difficulties, especially in the age group, um, fast breathing and the widespread wheeze and crackles really is something that differentiates it from other things. Um, So you don't have to give any antibiotics or anything like that to a child with bronchiolitis and the management is supportive. So, oxygen and fluids if needed, but generally they just need a little bit of TLC and some um kind of paracetamol and things like that to help them along as well. So moving on to question three, a seven year old girl is brought in after a seizure. She had a brief uh she has brief staring episodes, eye fluttering and was unresponsive for 10 seconds. What is the most likely diagnosis? Amazing. So well done everybody. Um absent seizure is the correct answer. So, absent seizures are a type of generalized seizure. They're often seen in Children aged 4 to 10 years. So the peak incidence is around 6 to 7 years old. Um They're characterized by brief episodes of impaired awareness. So like the staring episodes where they're not responding. Um and they're often mistaken in school age Children for daydreaming or inattention as well. Um So I've just written down the first line treatment um as well. Um It's important to note that carBAMazepine and phenytoin should be avoided in absent seizures because they can make them worse as well. Um But the prognosis is generally very good for Children. So around 65 to 85% of Children tend to outgrow the absent seizures by the time that they're teenagers. Um but a small percentage may go on to develop juvenile absence epilepsy or myoclonic epilepsy as well. But the um prognosis generally is thought to be very good. Ok. So moving on to question four, a one year old child presents with itchy, dry, red patches on the cheeks and extensor limbs. What is the most appropriate first line management? Just put a photo on there as well for an example of the rash that you're seeing as well? Ok. OK. So we'll move on to the answer. So the answer is c so corticosteroids and Imodium.