Cases for paediatrics and child health (March 2016)

Abstract

Case 1 and note that she is tachycardic and has a peripheral capillary refill time of 4 seconds. You request an ECG (Figure 1): What does this ECG show (Figure 1)? A 6-week-old baby, Danny, presents to A&E with cough, respiratory distress and reduced feeding. Danny was born at term by spontaneous vaginal delivery, following an uneventful pregnancy, other than Mum missed some pregnancy blood tests and immunizations. Danny was discharged home well, 8 hours after birth. Danny’s older brother has had coryzal symptoms this week but has been generally well in himself. On arrival in A&E Danny demonstrates subcostal & intercostal recessions with head bobbing and has saturations of 89% in air. Which of the following actions would you include in your initial management plan: (choose 2): 1. Start face mask oxygen 2. Start optiflow 3. Intubate and ventilate 4. Give him a bottle 5. Insert an NG and give him 150 ml/k/day milk 3 hourly 6. Stop his feeds and observe him for 1 hour 7. Insert a central line and start TPN 8. Prescribe a hypertonic saline nebulizer What is the most likely diagnosis: (choose 1)? 1. Pneumonia 2. Bronchiolitis 3. Congential heart disease 4. Pertussis 5. Viral induced wheeze After 48hours,Danny is noted tobehavingboutsof coughing during which he becomes very distressed and develops a very red face. He desaturates during these episodes and then developed apnoeas. A pernasal swab is sent and he is diagnosed with Bordetella pertussis. You start him on erythromycin. What are the concerns for starting a macrolide antibiotic in this age group: (choose 2) 1. Increased risk of developing hypertrophic pyloric stenosis 2. Increased risk of developing asthma 3. Increased risk of developing cardiac arrhythmias 4. Increased risk of apnoeas 5. Increased risk of developing diabetes mellitus type 1