Membership of the Royal College of Paediatrics and Child Health (MRCPCH) Foundation of Practice: Core Science, Pharmacology and Acute Care Flashcards

24 sample cards from the Foundation of Practice: Core Science, Pharmacology and Acute Care deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. How are rehydration fluids calculated for a dehydrated but not shocked child over 24 hours?

   Total = maintenance + deficit, replaced over 24 hours (slower over 48h if hypernatraemic). Deficit (mL) = % dehydration $\times$ weight (kg) $\times 10$. Use isotonic fluid; reassess electrolytes and clinical status regularly.

2. What are the ECG features and emergency management of severe hyperkalaemia in a child?

   ECG: tall tented T waves, flattened/absent P waves, widened QRS, sine wave, then arrest. Management: IV calcium gluconate (cardioprotection), then salbutamol nebs and insulin-dextrose to shift $\ce{K+}$ into cells, plus measures to remove $\ce{K+}$ (e.g. resonium, dialysis).

3. What is the main danger of correcting chronic hyponatraemia too rapidly, and what is the safe rate?

   Overly rapid correction risks osmotic demyelination (central pontine myelinolysis). Serum sodium should generally rise by no more than ~$8$-$10\ mmol/L$ per 24 hours in chronic hyponatraemia.

4. Distinguish enteral from parenteral nutrition and state the guiding principle for choosing between them.

   Enteral nutrition delivers feed into a functioning gut (oral, NG, NJ or gastrostomy); parenteral nutrition (PN) delivers nutrients intravenously, bypassing the gut. Principle: 'if the gut works, use it' — enteral is preferred as it is safer, cheaper and maintains gut integrity.

5. List two serious complications associated with parenteral nutrition in children.

   Central line sepsis/CLABSI, PN-associated liver disease (cholestasis/IFALD), electrolyte and metabolic disturbances (including refeeding syndrome), hyperglycaemia, and thrombosis. Refeeding syndrome features falling phosphate, potassium and magnesium.

6. Define faltering growth (failure to thrive) and the recommended weight-centile criteria used by NICE.

   Faltering growth is a slower rate of weight gain than expected for age/sex. NICE thresholds: a sustained drop across 1 centile space if birthweight was below the 9th centile; 2 spaces if between 9th-91st; 3 spaces if above the 91st; or current weight below the 2nd centile.

7. What initial nutritional assessment tools and measurements are used in a child with faltering growth?

   Plot serial weight, length/height and head circumference on growth charts; calculate weight-for-age, height-for-age and BMI/weight-for-height. Assess feeding history, dietary intake, and screen for organic causes. Mid-upper arm circumference can assess acute malnutrition.

8. List the components of the structured ABCDE assessment for an acutely unwell child.

   A - Airway (with cervical spine control if trauma); B - Breathing; C - Circulation; D - Disability (AVPU/GCS, pupils, glucose); E - Exposure (full examination, temperature, while preventing heat loss). Reassess after each intervention.

9. In paediatric Basic Life Support, what is the compression-to-ventilation ratio and initial step for a non-breathing child?

   Give 5 initial rescue breaths first (respiratory causes predominate in children), then for a lone rescuer use 30:2 and for healthcare teams 15:2 compressions to ventilations. Compress the lower sternum to one-third of chest depth at $100$-$120$/min.

10. In paediatric Advanced Life Support (APLS/EPALS), which rhythms are shockable and what are the key drug doses?

    Shockable: VF/pulseless VT — defibrillate at $4\ J/kg$. Non-shockable: PEA/asystole. Adrenaline $10\ \mu g/kg$ ($0.1\ mL/kg$ of 1:10000) IV/IO every 3-5 minutes (immediately in non-shockable; after 3rd shock in shockable). Amiodarone $5\ mg/kg$ after the 3rd and 5th shocks.

11. What is the definition of shock, and what is the recognised difference between compensated and decompensated shock in children?

    Shock is inadequate tissue perfusion/oxygen delivery to meet metabolic demands. Compensated: normal blood pressure maintained by tachycardia and vasoconstriction. Decompensated: hypotension develops — a late, pre-terminal sign in children because they compensate well until collapse.

12. State the initial fluid bolus for a child in shock (non-DKA, non-cardiac) and how it is titrated.

    Give $10\ mL/kg$ of isotonic crystalloid (e.g. 0.9% saline) as a rapid bolus, reassess, and repeat as needed. Larger $20\ mL/kg$ may be used in fluid-responsive sepsis; reassess for fluid overload after each bolus and consider inotropes/escalation if refractory.

13. Define status epilepticus and outline the first two steps of the APLS convulsing-child algorithm.

    Status epilepticus is a seizure lasting $\geq 5$ minutes or recurrent seizures without recovery of consciousness. Step 1 (5 min): ABC, oxygen, check glucose, give a benzodiazepine (IV lorazepam $0.1\ mg/kg$ or buccal midazolam). Step 2 (10 min): repeat benzodiazepine, call for senior help.

14. In the convulsing child algorithm, what second-line agent is given if benzodiazepines fail, and what is the final step?

    After two doses of benzodiazepine, give a second-line agent such as IV levetiracetam, phenytoin ($20\ mg/kg$ over 20 min) or phenobarbital. If seizures continue, proceed to rapid sequence induction with thiopental and intubation, involving anaesthesia/PICU.

15. What are the key features and immediate treatment of anaphylaxis in a child?

    Acute onset of Airway (swelling/stridor), Breathing (wheeze/hypoxia) and/or Circulation (hypotension) problems, usually with skin changes. Treatment: IM adrenaline to the anterolateral thigh, repeated after 5 minutes if needed; high-flow oxygen; IV fluid bolus; lay flat with legs raised.

16. State the age-based IM adrenaline (1:1000) doses for anaphylaxis.

    $<6$ years: $150\ \mu g$ ($0.15\ mL$); $6$-$12$ years: $300\ \mu g$ ($0.3\ mL$); $>12$ years/adult: $500\ \mu g$ ($0.5\ mL$). Given IM into the anterolateral thigh and repeated after 5 minutes if no improvement.

17. In major paediatric trauma, what does the <C>ABCDE primary survey prioritise, and how is circulating volume estimated?

    Catastrophic haemorrhage control first (<C>), then Airway with C-spine control, Breathing, Circulation, Disability, Exposure. Estimated circulating blood volume is ~$70$-$80\ mL/kg$; signs of shock appear after ~25-30% loss because of strong compensation.

18. In the hierarchy of evidence, rank these study designs from strongest to weakest: case-control, RCT, cohort, systematic review/meta-analysis, case series.

    From strongest to weakest: systematic review/meta-analysis of RCTs > randomised controlled trial > cohort study > case-control study > case series/case report > expert opinion.

19. Define sensitivity and specificity, and give their formulas.

    Sensitivity = proportion of true cases correctly identified by a positive test: $$\text{Sensitivity} = \frac{TP}{TP + FN}$$ Specificity = proportion of non-cases correctly identified by a negative test: $$\text{Specificity} = \frac{TN}{TN + FP}$$ A highly sensitive test is good for ruling out (SnNout).

20. Distinguish relative risk, absolute risk reduction and number needed to treat.

    Relative risk (RR) = risk in exposed/treated divided by risk in control. Absolute risk reduction (ARR) = control event rate $-$ treatment event rate. Number needed to treat: $$NNT = \frac{1}{ARR}$$ NNT is the number treated to prevent one additional adverse outcome.

21. What does a p-value represent, and what does a 95% confidence interval crossing the null value indicate?

    A p-value is the probability of observing the data (or more extreme) if the null hypothesis were true; $p < 0.05$ is conventionally significant. A 95% CI for a ratio crossing 1 (or 0 for a difference) indicates a non-statistically-significant result.

22. Describe the four stages of a PDSA (Plan-Do-Study-Act) cycle in quality improvement.

    Plan: identify the change/objective and predict outcomes. Do: implement the change on a small scale and collect data. Study: analyse results against predictions. Act: adopt, adapt or abandon the change, then begin the next cycle — iterative, rapid improvement.

23. What is the difference between clinical audit and research?

    Audit measures current practice against established standards/guidelines to improve local care (does not generate new knowledge, no randomisation, completes the loop by re-auditing). Research aims to generate new generalisable knowledge, tests a hypothesis, and usually requires ethics approval.

24. What is the role of NICE guidelines, and how does shared decision-making fit alongside them?

    NICE produces evidence-based national guidance to standardise and optimise care and resource use; guidelines inform but do not replace clinical judgement. Shared decision-making combines the best evidence with the child's/family's values and preferences to reach individualised decisions.

What this deck covers

Foundation of Practice: Core Science, Pharmacology and Acute Care flashcards FAQ