Don’t Forget The Christmas Quiz: the Ho Ho Ho Holiday Hunt answers

Cite this article as:
Team DFTB. Don’t Forget The Christmas Quiz: the Ho Ho Ho Holiday Hunt answers, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31403

Don’t forget to post your selfies using the hashtag #DFTBHolidayHunt

Question 1

Andy talks to us about frequency of critical procedures in the paediatric emergency department. How many years does Andy need to practice to get the required number of intubations to maintain competency?

Answer: 106 years (from Andy Never Enough)

In 2016, Andy reviewed Nguyen et al’s paper looking at paediatric critical procedures in the ED. The article was a retrospective chart review of every paediatric attendance that required a resuscitation cubicle in three Victoria hospitals in 2013. Of almost 55,000 attendances, only 37 required any form of critical procedure – approximately 7 per 10,000 presentation.

83% of doctors working at the campuses in the study did not perform a single critical paediatric procedure. At the time Andy was working part time in the hospital and may have seen no more than 20 children a week. He reckoned it could take him 17 months to perform a single critical procedure. 

Andy quotes Ross Hofmeyr who suggests clinicians need to perform 75 intubations a year to maintain their competency and calculated it would take him 106 years to get just get to 75 intubations (Ed: what a statistic!)

Question 2

Preparing for major trauma is a vital pre-patient step, and improvisation can be key. How does Shane say you can improvise a bite block for a Le Fort II/III fracture?

Answer: Use a few tongue depressors taped together! (from Shane Broderick’s Professionals Prepare Properly)

Shane talks us through his approach to preparing for trauma. Quoting his Cian McDermott he tells us that “professionals prepare properly”. He lays out a series of superb tips, with number 5 being “better to be looking at it than looking for it” (aka check and recheck equipment). And when you can’t find it, can you improvise? Shane says, “No McKesson bite blocks for your Le fort II/III? No problem! Use a few tongue depressors taped together (Thanks to Jason van der Velde).”

Question 3

Kids love talking about poo, as do paediatricians! But if you have a sibling with Hirschsprung’s Disease, how much more likely then the general population are you to have it too?

Answer: Siblings of children with Hirschprung’s Disease are 200 times more likely than the general population to have Hirschprung’s; 4% vs. 0.02% (from the post Hirschprung’s Disease by Peter Tormey)

Question 4

General David Morrison AO (Retd), an outspoken opponent of gender bias and discrimination, gave a talk on workplace bullying and harassment. Andy uses General Morrison’s talk to discuss bullying in the workplace: discrimination, unjustified criticism, verbal threats, undue pressure and having jokes made at someone’s expense. Which heroic duo does Andy say characterise ‘defenders’ in the bullying arena?

Answer: Hermione and Ron (from the post Playground behaviour – in adults)

This is such an important post. Andy concludes with “It is okay to speak up and speak out. If you witness bullying, in any off its forms, it is your moral duty to pluck up the courage of Neville Longbottom and stand up for what is right.”

Question 5

At DFTB 2019 Russ and Cian demonstrated how useful POCUS can be. What favourite snack can help you to do a supra-pubic aspiration?

Answer: Toast! (from the post POCUS: Russ Horowitz and Cian McDemott at DFTB19)

Question 6

And finally, our Christmas question. In 2016, the Journal of Happiness published an article entitled, “What makes a merry Christmas?” But, what does make a merry Christmas?

Answer: we are happier when our Christmas plans involve family or faith and less happy when spending money and receiving gifts is the overwhelming aim. (from the post Happy Holidays!)

And that’s our cue to wish you a wonderful festive season and safe and healthy 2021.

from the DFTB team x

Don’t Forget The Christmas Quiz: the Ho Ho Ho holiday hunt

Cite this article as:
Team DFTB. Don’t Forget The Christmas Quiz: the Ho Ho Ho holiday hunt, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31400

We’re wrapping up the Don’t Forget The Christmas Quiz with a Jolly Holiday Christmas scavenger hunt through the DFTB website. Each clue leads you to a DFTB article. Follow the clues, find (and read!) the article, and grab a selfie with the associated prop. Improvisation is welcome if you don’t have access to the required prop. Post to Twitter (#DFTBHolidayHunt) to join in on a global scale, or just follow along at home.

Have a super holiday season wherever you are.

Question 1

Andy talks to us about frequency of critical procedures in the paediatric emergency department. How many years does Andy need to practice to get the required number of intubations to maintain competency?

Selfie with your airway kit please!

Question 2

Preparing for major trauma is a vital pre-patient step, and improvisation can be key. How does Shane say you can improvise a bite block for a Le Fort II / III fracture?

This time, a selfie with your ENT kit.

Question 3

Kids love talking about poo, as do paediatricians! But if you have a sibling with Hirschsprung’s Disease, how much more likely then the general population are you to have it too?

This one needs some Christmas coordination… selfie with your friendly surgical team.

Question 4

General David Morrison AO (Retd), an outspoken opponent of gender bias and discrimination, gave a talk on workplace bullying and harassment. Andy uses General Morrison’s talk to discuss bullying in the workplace: discrimination, unjustified criticism, verbal threats, undue pressure and having jokes made at someone’s expense. Which heroic duo does Andy say characterise ‘defenders’ in the bullying arena?

Selfie with your wonderful team.

Question 5

At DFTB 2019 Russ and Cian demonstrated how useful POCUS can be. What favourite snack can help you to do a supra-pubic aspiration?

Selfie with your favourite snack!

Question 6

And finally, our Christmas question. In 2016, the Journal of Happiness published an article entitled, “What makes a merry Christmas?” But, what does make a merry Christmas?

A final selfie with your workplace Elfie.

Don’t Forget The Christmas Quiz: the picture round answers

Cite this article as:
Team DFTB. Don’t Forget The Christmas Quiz: the picture round answers, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31333

Here are the answers to the picture round. How did you do?

Question 1

a) What name is given to this two-piece intra-articular fracture of the base of the 1st metacarpal of the thumb?

Bennett fracture

This is a Bennett fracture: an intra-articular 2-part fracture of the base of 1st metacarpal bone, named after Edward Hallaran Bennett, an Irish surgeon from Dublin.

Thumb metacarpal base fractures require surgical opinion. Disruption of carpometacarpal joint congruity can result in significant functional impairment.

A similar intra-articular fracture-dislocation of the base of the 5th metacarpal bone is called a reverse Bennett fracture. This fracture pattern is inherently unstable.

b) If the fracture was in three parts, what would it be called?

Rolando fractures of the base of the 1st metacarpal are similar to Bennett fractures, but with at least 3 parts, and a less favourable prognosis. 

Read more about bony finger (and thumb) injuries in this bony finger injuries post.

Question 2

What tendon is being tested in this image?

Flexor digitorum superficialis (FDS). FDS and flexor digitorum profundus (FDP) tendons should be tested individually.

To check FDS function, hold all adjacent fingers in extension and then release the finger you want to assess. Ask the child to flex the free digit at the PIP joint.

To examine FDP, hold the middle phalanx in extension and ask the child to flex the DIP joint.

For more finger examination tips, including digital cascade, wrist tenodesis and assessment of extensor tendon function check out the tendon and ligaments finger injuries post.

Question 3

What type of injury is demonstrated below?

Mallet finger

This is a mallet injury. The top image is a ligamentous mallet injury due to rupture of the extensor tendon. The lower image is a bony mallet injury due to an avulsion fracture of the insertion point of the terminal extensor tendon at the distal phalangeal epiphysis – this is the more common injury type in children. Children present with a flexion deformity and inability to extend at the distal interphalangeal joint. These injuries must be managed by hand specialists, either with 6-8 weeks of splinting if the injury is closed, or operatively if the injury is open, or if the avulsion fragment is larger than 30-50% of the articular surface. 

Finger Tips – tendons and ligaments (dontforgetthebubbles.com)

Question 4

a) What are the names of the three highlighted areas in this shoulder x-ray?

b) What injury is demonstrated in this x-ray?

This is a Y-view of the shoulder. The humeral head is no longer sitting over the glenoid and is instead sat under the coracoid process. This is an anterior shoulder dislocation. Bonus points to anyone who noted flattening of the humeral head suggesting a Hill Sachs lesion (and those are real bonus points as the shoulder dislocation post hasn’t yet been published – but watch this space!)
For more tips on interpreting shoulder x-rays, check out our shoulder x-ray post.

Question 5

This child presents with worsening foot pain with no history of trauma. Which bone is affected and what is this condition called?

Kohler’s disease

The x-ray shows thinning and sclerosis of the navicular bone. This is Kohler’s Disease, an osteochondrosis of the navicular. Osteochondrosis is a disorder of bone growth primarily involving the ossification centres at the epiphysis.  It commonly begins in childhood and results in osteonecrosis of the growth plate.  This can lead to altered bone and cartilage formation beyond the growth plate. A better known osteochondrosis is Perthe’s Disease of the femoral head.

Although often confused with apophysitis, which is more clearly due to traction overuse injuries, osteochondrosis is often described as idiopathic osteonecrosis as there has been no definite cause found.  There have been some links showing genetic factors and high activity levels can increase a person’s risk of developing osteochondrosis. Read more about the different osteochondroses in our ostrochondrosis post.

Question 6

This child has been complaining of heel pain. What does his x-ray show and what is this condition called?

Sever’s disease

This x-ray shows an increased density of the calcaneal apophysis, typically seen in children aged between 7 and 14 years with Sever’s Disease. Apophysitis is a term used to describe a group of overuse traction injuries which commonly cause pain in adolescents. The most common is Osgood Schlatter disease, but other common anatomical areas of apophysitis include the inferior pole of patella (Sinding-Larsen-Johansson), calcaneal tuberosity (Sever’s), medial epicondyle of the elbow (within spectrum of Little League elbow) and various sites on the pelvis. They’re subtly different from osteochondrosis, which is instead due to changes in the epiphyseal ossification centre. Read more about apophysitis in our apophysitis post.

Question 7

Describe this fracture.

Question 8

What type of fracture is this? (Clue: it involves a dislocation. Bonus points if you can name the injured joint)

Galeazzi fracture-dislocation

This is a Galeazzi fracture-dislocation – a fracture of the radius (usually distal third) with dislocation of the distal radio-ulnar joint (DRUJ). They’re often missed but must be checked for – the DRUJ dislocation must be reduced before casting. Always examine the DRUJ on x-ray in any child with an isolated radius fracture.
Read more about Galeazzi fracture dislocations and other wrist injuries in our wrist injuries module.

Question 9

What type of fracture is this?

Tillaux fracture

This is a Tillaux fracture: a Salter-Harris III fracture at the anterolateral distal tibial epiphysis. There is usually avulsion of the tibial fragment by the tibiofibular ligament, attaching it to the fibula.

This is different to a Triplane fracture because there is no fracture through the coronal plane.

Tillaux and Triplane fractures are seen in adolescents. If not recognised and therefore no managed correctly they can be associated with long term morbidity.

Read more about Tillaux fractures and Triplane fractures in these two posts: Tillaux fractures and Triplane ankle fractures

Question 10

Name the Christmas movie

Love, Actually (Ed: Both Andy and Dani profess to loving this movie)

Thank you to @leejrichardson3 for our very own DFTB Lego version

Well done everyone! Happy holidays!

Don’t Forget The Christmas Quiz: the picture round

Cite this article as:
Team DFTB. Don’t Forget The Christmas Quiz: the picture round, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31326

Ready for a picture round? We’ve collated some of the best images from 2020 for you and your teams.

Question 1

a) What name is given to this two-piece intra-articular fracture of the base of the 1st metacarpal of the thumb?

b) If the fracture was in three parts, what would it be called?

Question 2

What tendon is being tested in this image?

Question 3

What type of injury is demonstrated below?

Question 4

a) What are the names of the three highlighted areas in this shoulder x-ray?

b) What injury is demonstrated in this x-ray?

Question 5

This child presents with worsening foot pain with no history of trauma. Which bone is affected and what is this condition called?

Question 6

This child has been complaining of heel pain. What does his x-ray show and what is this condition called?

Question 7

Describe this fracture.

Question 8

What type of fracture is this? (Clue: it involves a dislocation. Bonus points if you can name the injured joint)

Question 9

What type of fracture is this?

Question 10

Name this Christmas movie.

Good luck everyone. Answers will be posted tomorrow.

Don’t Forget The Christmas Quiz: the bubble wrap answers

Cite this article as:
Team DFTB. Don’t Forget The Christmas Quiz: the bubble wrap answers, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31314

And here are the answers…

Question 1

In Nijman et al.’s 2020 single centre prospective evaluation of sepsis screening tools how many febrile children, aged 1 month−16 years, with greater than one warning sign of sepsis across 1,551 disease episodes had an invasive bacterial infection?

Answer: b) 6 (0.4%) children

Only six children (0.4%) had a final diagnosis of an invasive bacterial infection. The authors looked at the utility of sepsis screening tools to predict the presence of an invasive bacterial infection, serious bacterial infection or PICU admission; there were a huge number of false positives. The number of children needed to treat to detect one invasive bacterial infection was 256. 

This study shows us that serious infections are rare and most children who are categorised as ‘at risk of sepsis’ can be managed conservatively with observation. Current guidelines have very poor specificity; and while they tell us to investigate and treat lots of children, a lot of the time we choose to rely on our clinical judgement. Observation and good clear red flagging must not be underestimated. 

Read the original article and our review of it.

Question 2

In Waterfield et al.’s 2020 multi-centre Petechiae in Children (PIC) study, of the 1334 included children (fever and petechial rash) how many had confirmed meningococcal disease? 

Answer: a) 19 (1.4%)

Nineteen children had confirmed N. meningitidis and 8 of these needed intensive care treatment.

The primary outcome of this study was to assess the performance of 8 clinical guidelines on identifying children with invasive meningococcal disease. All 8 guidelines had a sensitivity of 100%, identifying all children with meningococcal disease, but specificity varied from 0% (NICE sepsis guideline) to 36% (Barts Health NHS Trust).

Read the full article and the DFTB review.

Question 3

In a retrospective evaluation by Reeves et al. how many children presented with a suspected magnet ingestion in the United States between 2009 and 2019?

Answer: c) 23756

An estimated 23,756 children (59% males, 42% < 5 years old) presented with a suspected magnet ingestion in a 10 year study period between 2009 to 2019. The U.S. Consumer Safety Commission removed these products from the market in 2012 until a federal court decision reversed this decision in 2016. After 2017, there was a 5-fold increase in the escalation of care for multiple magnet ingestions.

At Christmas, parents and grandparents with full stomachs may not be quite as on the ball at minding children with new toys with magnetic parts. Be aware of the dangers of ingested magnets and be sure to investigate if there’s any suspicion.

Read the original article and the Bubble Wrap Plus it was listed in.

Question 4 

In a single centre study Watkins et al. undertook Bayley Scales of Infant-Toddler Development (BSID-III) and neurologic examination at 18-22 months of corrected age for survivors of birth before 26  weeks. In the surviving infants, no or mild neurodevelopmental impairment in surviving infants was 3 of 4 infants at 24-25 weeks. What was the proportion in the 22-23 week group? 

Answer: d) 2 of 3

This is a retrospective study assessing the survival and neurodevelopmental outcomes of infants born at 22-23 weeks compared with those born at 24-25 weeks of gestation in a single site. The cohort was stratified into 22-23 weeks gestation (n=70) and those born at 24-25 weeks gestation (n = 178). Both groups received antenatal steroids, intubation, surfactant replacement therapy, and high-frequency ventilation as the primary mode of ventilation. Survival to hospital discharge was 78% at 22-23 weeks and 89% at 24-25 weeks or gestational age (P=0.02). At 18 months, surviving infants with no or mild neurodevelopmental impairment at 22-23 weeks was 64% (29/45; 95% CI, 50%-77%) and at 24-25 weeks was 76% (94/124; 95% CI, 68%-83%; P = .16) at 24-25 weeks.

Read the original article and the bubble wrap review.

Question 5 

Trivić et al. undertook a systematic review and meta-analysis evaluating strain-specific probiotic interventions for paediatric functional abdominal pain (FAP) including 9randomised controlled trials published up to April 2020. How many studies reported the authors’ primary outcome which was the number of children with the cessation of pain symptoms after intervention?

Answer: a) 0

Trivić et al. suggest that the probiotic Lactobacillus reuteri can effectively reduce pain intensity and increase the number of pain-free days in children with FAP. But, there was no significant reduction in pain frequency or school absenteeism and no study actually reported the cessation of pain. Probiotics are considered safe in children, but the literature is very heterogenous with different doses and formulations and a diverse range of outcomes, making it difficult to interpret and therefore draw accurate conclusions.

Read the original article, the bubble wrap review and Henry’s 2016 post on probiotics in review.

Question 6

Park et al sought to find evidence to support the claim that Santa Claus “knows if you’ve been bad or good, so be good for goodness sake” in their retrospective observational study of 186 members of staff who worked on paediatric wards in the UK over Christmas. But which of the following did they find?

Answer: e) Distance to the North Pole in km did not have a statistically significant effect on whether Santa Claus would or would not visit a paediatric ward

Park et al found that Santa visited all 8 of the children’s ward in Northern Ireland, with Scotland in second place with 93% coverage. Santa Claus doesn’t discriminate between children who live in areas with surrogate markers for “naughtiness.” There was no correlation between a visit from Santa and primary school absenteeism or young person conviction rates or distance to the North Pole. After Santa, the most popular local superhero visitors to the children’s wards were his elves, followed by footballers. Elsa came way down the list at joint fifth with firefighters. 

This is an amusing study but it revealed a sobering fact: Santa Claus is less likely to visit children in hospitals in deprived areas. As paediatric clinicians, our role is to care for children and it may be that that care involves helping Santa access those “hard to reach” areas so that every child is happy at Christmas.

Read the original article.

Well done! Stay tuned for the Christmas Picture Quiz.

Don’t Forget The Christmas: the bubble wrap treasure hunt

Cite this article as:
Team DFTB. Don’t Forget The Christmas: the bubble wrap treasure hunt, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31311

The bubble wrap treasure hunt is back! Use the clues in the questions to find the original paper to help you choose the correct answer. Good luck!

Question 1

In Nijman et al.’s 2020 single centre prospective evaluation of sepsis screening tools how many febrile children, aged 1 month−16 years, with greater than one warning sign of sepsis across 1,551 disease episodes had an invasive bacterial infection?

  • a) 2 (0.1%) children
  • b) 6 (0.4%) children
  • c) 20 (1.3%) children
  • d) 68 (4.4%) children
  • e) 158 (10.1%) children

Question 2

In Waterfield et al.’s 2020 multi-centre Petechiae in Children (PIC) study, of the 1334 included children (fever and petechial rash) how many had confirmed meningococcal disease? 

  • a) 19 (1.4%)
  • b) 52 (3.9%)
  • c) 63 (4.7%)
  • d) 78 (5.8%)
  • e) 99 (7.4%)

Question 3

In a retrospective evaluation by Reeves et al. how many children presented with a suspected magnet ingestion in the United States between 2009 and 2019?

  • a) 5486
  • b) 11472
  • c) 23756
  • d) 59621
  • e) 112456

Question 4

In a single centre study Watkins et al. undertook Bayley Scales of Infant-Toddler Development (BSID-III) and neurologic examination at 18-22 months of corrected age for survivors of birth before 26  weeks. In the surviving infants, no or mild neurodevelopmental impairment in surviving infants was 3 of 4 infants at 24-25 weeks. What was the proportion in the 22-23 week group? 

  • a) 1 of 5
  • b) 1 of 3 
  • c) 3 of 5
  • d) 2 of 3 
  • e) 4 of 5 

Question 5 

Trivić et al. undertook a systematic review and meta-analysis evaluating strain-specific probiotic interventions for paediatric functional abdominal pain (FAP) including 9randomised controlled trials published up to April 2020. How many studies reported the authors’ primary outcome which was the number of children with the cessation of pain symptoms after intervention?

  • a) 0
  • b) 1
  • c) 3
  • d) 6
  • e) 9

Question 6

Park et al sought to find evidence to support the claim that Santa Claus “knows if you’ve been bad or good, so be good for goodness sake” in their retrospective observational study of 186 members of staff who worked on paediatric wards in the UK over Christmas. But which one of the following did they find?

  • a) Santa Claus visited a greater proportion of children’s wards in Scotland than in Northern Ireland.
  • b) Santa was more likely to visit children in hospitals in areas of higher socioeconomic deprivation 
  • c) Santa was less likely to visit children in areas with high primary school absenteeism. 
  • d) After Santa, the most popular non-clinical visitor to bring festive cheer to paediatric wards on Christmas Day was Disney’s Elsa. 
  • e) Distance to the North Pole in kilometres did not have a statistically significant effect on whether Santa Claus would or would not visit a paediatric ward.

Stay tuned for the answers tomorrow!

Don’t Forget The Christmas Quiz: the crossword answers

Cite this article as:
Team DFTB. Don’t Forget The Christmas Quiz: the crossword answers, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31323

How did your teams fare in our Christmas crossword? Here are the answers and the hidden word.

Down

1. Signs of abnormal breathing and hypoxaemia are valuable clinical findings when diagnosing pneumonia – hypoxaemia

Children with pneumonia may present with fever, tachypnoea, difficulty in breathing, cough, wheeze or chest pain. Tachypnoea is a non-specific sign in children; iIt may be present with fever, with pain or distress and in many non-respiratory cases. Cough and fever are non-specific symptoms and are not grounds for diagnosing lower respiratory tract infections on their own. The Rational Clinical Examination Systematic Review concludes that more important than tachypnoea and auscultatory findings are hypoxia (saturations ≤ 96%) and increased work of breathing/abnormal breathing. Read more on pneumonia in the DFTB Pneumonia Module.

2. An alternative to Levetiracetam for the management of status epilepticus – phenytoin.

The ConSEPT and EcLiPSE trials were published concurrently in May 2019. ConSEPT concluded that Levetiracetam is not superior to phenytoin as a second line agent for convulsive status epilepticus and EcLiPSE concluded that there is no significant difference between phenytoin and levetiracetam in the second-line treatment of paediatric convulsive status epilepticus for any outcome, including time to seizure cessation. Read more about these studies in the Seizing the Truth post and learn more about seizures with the DFTB Seizure module

3. Constipation can lead to this, and as such the two can, and often do, co-exist – UTI (Urinary tract infection)

In a child with abdominal pain, the diagnosis of UTI makes constipation more likely. Constipation can lead to urinary retention and UTI, and as such the two can, and often do, co-exist.  A positive urine dip or culture doesn’t rule out constipation as a cause of abdominal pain. Don’t forget to think about constipation in the child with a history of recurrent UTI. Check out our DFTB Constipation module for more information.

4. A test which detects tuberculosis exposure. Mantoux

Tuberculin skin test (TST), or Mantoux test, and new immunological assays such as IGRAs detect Tuberculosis exposure. A Mantoux is performed by injecting 0.1ml of tuberculin purified protein derivative (PPD) intradermally into the inner surface of the forearm. The skin reaction produced by the PPD should be read between 48 and 72 hours and the reaction is measured in millimetres of induration, not redness. Read more about Tuberculosis and causes for prolonged fever by visiting the DFTB PUO module

5. Characteristic feature of the scarlet fever rash – sandpaper

The symptoms of scarlet fever start with fever (over 38.3°C), sore throat and general fatigue, headache and nausea. 12-48 hours later a rash appears on the abdomen and spreads to the neck and extremities. Characteristic features of the rash are a rough texture (like sandpaper) and worse in the skin folds e.g. groin, axilla, neck folds (Pastia’s lines). Read more about common childhood exanthems in the DFTB Common Rashes Module

6. An uncommon pathogen causing pneumonia – mycoplasma

Atypical pneumonia refers predominantly to an uncommon pathogen causing pneumonia, of which Mycoplasmas are one example. There is also fungal pneumonia which in addition to common bacterial and viral pathogens are considered uncommon and opportunistic microorganisms in a ‘poly-microbial mix’ seen mainly in immunocompromised children such as in HIV-exposed or infected children. While lower respiratory infection decreases with age, the prevalence of atypical infections increases, with a median age of about 7. Read more about Mycoplasma pneumonia in our DFTB Pneumonia Module

7. This rash in this viral exanthem classically presents after a fever and mild upper respiratory symptoms – Roseola

Roseola results in an acute febrile illness lasting between 3 and 7 days, which is then followed by the characteristic rash in around 20% of infected children. The prodrome to the rash is a high fever (39-40 °C), palpebral oedema, cervical lymphadenopathy and mild upper respiratory symptoms. The child appears well and as the fever subsides the exanthem appears. Read more about roseola at the DFTB Common Rashes Module

8. The organism most often associated with the viral exanthem in question 7 – HHV6 (Human Herpes Virus 6)

Roseola is caused most commonly by human herpesvirus 6 (HHV-6) and less commonly by human herpesvirus 7 (HHV-7). Human herpesvirus 7 (HHV-7) was discovered in 1989 as a new member of the beta-herpesvirus subfamily. Primary infection occurs early in life and manifests as exanthema subitum, or other febrile illnesses mimicking measles and rubella. Thus, HHV-7 has to be considered as a causative agent in a variety of macular-papular rashes in children. In addition, HHV-7 was found in some cases of other inflammatory skin disorders, such as psoriasis. Learn more about rashes at our Skin Deep website

DAS UK guidelines suggest that children over 8 should have a “scalpel, finger, bougie” technique used to gain front of neck access. Under 8, the cricothyroid membrane is so small that needle jet insufflation should be utilised. You can read the technique for this as described by DFTB in our RSI and the difficult airway module

10. What do you get if you eat mistletoe? Tinsillitis

A common complaint in Santa’s Grotto.

Across

1. What group of conditions cause focal pain, typically in areas such as the tibial tuberosity and inferior pole of the patella? Apophysitis

Apophysitis of the tibial tuberosity (Osgood Schlatter disease) or inferior pole of patella (Sinding-Larsen-Johansson) have a typical history of gradual onset localised pain in a child from 10-16 years of age.  Pain is exacerbated by activity and initially improves with rest. The typical patient is highly active and may be overtraining.  Examination will typically reveal point tenderness over the area involved with possibly some mild swelling. Read more about apophysitis and other non-traumatic musculoskeletal (MSK) injuries at our DFTB non-traumatic MSK injuries module

2. A tropical infection characterised by prolonged fever, splenomegaly and pancytopaenia – Leishmaniasis

Leishmaniasis is a parasitic disease spread by the sand-fly. Main symptoms are fever, enlargement of spleen and liver and pancytopenia. Leishmaniasis is the second-largest parasitic killer in the world after malaria. Diagnosis is made by histological finding of amastigotes on spleen aspiration/bone marrow aspiration and RK39 Antigen detection. Read more about the causes of prolonged fever in the DFTB PUO Module

3. In paediatric migraine, analgesia and an antiemetic together are more effective than either alone.

In the acute setting, evidence points to antiemetics as an effective migraine symptom reliever. Analgesia and antiemetics together are even more beneficial. Read more about combination therapy and the role of Chlorpromazine in the management of Paediatric migraine in the DFTB Headache Module

4. Significant weight loss, vomiting, lethargy, hypoglycaemia, jaundice and hepatomegaly point to which diagnosis in a neonate? Galactosaemia

Galactosaemia is an inherited metabolic disorder characterised by a defect in the enzyme galactose-1-phosphate uridyl transferase (GALT). It presents after the affected neonate receives the sugar galactose, present in milk. Accumulation of galactose-1-phosphate results in damage to the brain, liver, and kidney. The affected neonate presents with vomiting, hypoglycaemia, seizures due to an inability to metabolise glucose, irritability, jaundice, hepatomegaly, liver failure, cataracts, splenomegaly, and Escherichia coli sepsis. Read more about other inherited metabolic disorders and how to identify them in the ED by reading our DFTB Inherited Metabolic Disorders Module

5. This c-spine rule, when validated in children under 16, has a specificity of 19.9%. NEXUS (National Emergency X-radiography Utilization Study)

NEXUS is a validated clinical decision instrument designed to identify patients who are at extremely low risk of cervical spine injury (CSI). The Viccelilo study looked at the performance of NEXUS in the paediatric subgroup under 18 years. All patients with low risk for CSI were correctly identified (100% sensitivity) but a large proportion were also incorrectly identified as having a CSI (19.9% specificity) making this study unreliable in children under 9 years. Read more about c- Spine injuries here.

6. One of the three types of brain tumours associated with tuberous sclerosis – tubers

Tuberous sclerosis (TS) is a rare multisystem genetic disease affecting the kidneys, heart, eyes, liver and skin. A combination of symptoms may include seizures, developmental delay, intellectual disability and skin conditions. The three types of brain tumors associated with TS include giant cell astrocytomas, cortical tubers and subependymal nodules. Want to know more about seizures or developmental delay? Take a look at our DFTB Seizure Module or this fantastic DFTB post on developmental delay.

7. What does Santa suffer from if he gets stuck in the chimney? Claustraphobia

Of course.

And the hidden word? 

Bauble, a type of Christmas bubble.

And now for the next round

Don’t Forget The Christmas Quiz: the crossword round

Cite this article as:
Team DFTB. Don’t Forget The Christmas Quiz: the crossword round, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31318

Welcome to Don’t Forget The Christmas Quiz, a Christmas quiz with a difference. Over the next four days and nights, we’ve got something to bring a little festive cheer. Who knows their research? Who’s good with images? And who doesn’t love playing scavenger hunt?

We’re kicking off with a Christmas crossword. Can you complete the clues to find the hidden word? If you need some help with any of the clues, take a peek at the DFTB Modules for some inspiration…

Down

1. Signs of abnormal breathing and what are valuable clinical findings when diagnosing pneumonia?

2. An alternative to Levetiracetam for the management of status epilepticus.

3. Constipation can lead to this, and as such the two can, and often do, co-exist.

4. A test which detects tuberculosis exposure.

5. Characteristic feature of the scarlet fever rash.

6. An uncommon pathogen causing pneumonia.

7. This rash in this viral exanthem classically presents after a fever and mild upper respiratory symptoms.

8. The organism most often associated with the viral exanthem in question 7.

9. “Scalpel, finger, bougie” is the recommended technique for front of neck access in children over 8 years in which national society’s guideline?

10. What do you get if you eat mistletoe?

Across

1. What group of conditions cause focal pain, typically in areas such as the tibial tuberosity and inferior pole of the patella?

2. A tropical infection characterised by prolonged fever, splenomegaly and pancytopaenia.

3. In paediatric migraine, analgesia and what together are more effective than either alone?

4. Significant weight loss, vomiting, lethargy, hypoglycaemia, jaundice and hepatomegaly point to which diagnosis in a neonate?

5. This c-spine rule, when validated in children under 16, has a specificity of 19.9%.

6. One of the three types of brain tumours associated with tuberous sclerosis.

7. What does Santa suffer from if he gets stuck in the chimney?

Answers tomorrow!

Don’t forget the Christmas quiz

Cite this article as:
Team DFTB. Don’t forget the Christmas quiz, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.31389

In the run-up to Christmas, we thought we’d bring you some festive fun in the form of a DFTB Christmas Quiz. To keep things fun, lighthearted and in the carefree spirit of the festive season, we’ve come up with four quizzes for you to complete (or compete) with your friends and colleagues who are keeping the fort running over the festive period.

The Don’t Forget The Christmas Quiz launches on Monday 21st December with the DFTB crossword, back by popular(!) demand, curated by Michelle Alisio, one of the fabulous DFTB fellows. And that’s a clue by the way – if you’re stuck for an answer, take a peek at the modules, the creation of which has been overseen by the fantastic fellows.

Tuesday 22nd December brings the Bubble Wrap Treasure Hunt. Damian takes us through 5 important paediatric papers, with a 6th Christmas question (because it’s Christmas and everyone deserves a present).

Wednesday 23rd December is the Picture Round. Dani and Becky have put together some minor injury pictures. If they’re tricky, all the answers can be found in our catalogue of DFTB posts (Editor:- There are over 1000 posts, you know!). And to make it a little less hard, these posts were all published in 2020.

And then our final quiz, on Christmas Eve, is going to be a great one. Kat Priddis and Mieke Foster take you on a tour through the DFTB website with the DFTB Holiday Hunt.

Don’t Forget The Brain Busters – the live final

Cite this article as:
Team DFTB. Don’t Forget The Brain Busters – the live final, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.25641

With 130 teams entering Don’t Forget The Brain Busters, and 50 teams making it through the kids’ round, the toughest round with the toughest critics, we have been bowled over by the incredible answers sent through. We’re delighted to announce the final leader board.

 

 

 

 

The top four teams have made it through to the live final: The Salisbury Paediatric Warriors, Cardiff PPE, Universally Challenged and The Leftovers. The competition was fierce.

 

The live final

The DFTB Brain Busters live final will be on Friday 15th May at 11am – 12pm UK time, 8pm – 9pm Sydney/Melbourne time, 10-11pm NZ time.

The four teams will be fighting for the title of DFTB 2020 Brain Busters champion and a special, limited edition DFTB Brain Busters t-shirt.

Tune in to cheer the teams on – you will need to register in advance. You can do that by filling out the form at the bottom of this page, or here.

 

The Qualifying Rounds

In case you missed them, here are our five qualifying rounds again, this time with answers.

Round 1: The neonatal crossword. Answers here

Round 2: The Bubble wrap treasure hunt. Answers here

Round 3: The minor injuries picture round. Answers here

Round 4: The emoji round. Those long awaited answers here

Round 5: The kids’ round.

 

The kids’ round answers

Our mini quiz masters are allowing us to share their marking criteria along with some of their favourite answers.

 

If you were a Pokemon, which would you be and why? (Kai, age 11)

Kai set a pretty stringent scoring system.

5 points: fire, grass, water (they are the starter pokemon)

4 points: normal (few weaknesses, has the most pokemon), fighting (most damage but can ricochet), steel (one of the strongest), poison (double the damage)

3 points: dragon (not that much damage but good attacks), ice (can freeze but no damage), psychic (make you confused), rock (some throw rocks)

2 points: electric (paralysis and damage but not that strong), ground (can only attack on the ground), dark (can only attack at night), flying (weak, only when flying)

1 point: bug, ghost, and fairy (these are all weak pokemon)

 

The kids loved the rationale behind some of your answers.

“I would be Luxray. The coolest looking of pokemon and has the medical superpower of X-Ray vision. This means children in A and E would have to wait much less time as I could just quickly cast my eyes on them, see what the problem is and make a plan for it to be fixed much sooner.” Universally Challenged (University Hospital North Madlands)

“I’d be a Chansey so I can continue working at the hospital and caring for sick children. Chanseys know a lot about medicine because they are used to work with nurse Joy. Plus they know the power “sleep” to help sedate the patient. Plus they are super cute.” Fri-Burgers

“Dr Anderson says: I would like to be Nurse Joy (because nurses are awesome and she heals other characters) but my children say that I am SNORLAX (because he likes sleeping and he is fat… apparently)” Salisbury Paediatric Warriors

 

If you were a teacher in Hogwarts, what subject would you teach and why? (Jude, age 8)

Like Kai, Jude was pretty specific about the points allocation for this question.

5 points: defence against the dark arts (you only last a year as a teacher but it can save your life), care of magical creatures (scary and fun), Quidditch (world class level)

4 points: potions, transfiguration and flying (super useful and cool)

3 points: charms and astronomy (useful but not fun)

1 point: herbology and arithmancy (just a bit dull)

1 point: muggle studies, history of magic and divination (just too boring)

 

“We would start a new subject called Pomfrey’s Emergency Wiziatrics. This is because young wizards and witches should learn essential first aid skills to deal with their…magical accidents! We would teach them to never forget to use distraction methods for little wizards, such as Pygmy Puffs (or other age-appropriate Weasly Wizard Wheezes products). We would also start an owl-line resource with information on how to provide muggle first aid, in case they need to do so, which of course would be called Don’t Forget The Muggles.” by Haris, age 36 on her approaching birthday, on behalf of Containment Entertainment

“We would be Defence Against the Dark Arts teacher because working in a hospital can be super scary, but we can defend against it really well (plus it’s cool so meet all the crazy monsters and cast spells!)” Myoclonic Jerks, Ireland

“I would be a potions professor, working alongside Madam Pomfrey on the Hospital Wing. I’d be famous from the numerous books I authored such as ” Otitis Media and the philosopher’s itch” “Erythema Neonaturum and other potions to combat spots” and my best work ” Levateracetam and other twitch stopping tinctures.” Universally Challenged (University Hospital North Madlands)

If you could choose a superpower, what would it be and why? (Katie, age 12)

The kids tell us that this was a tough one to score. They were looking for originality, adventure and something that would do good in the world, and of course, something that made them laugh. Here are some of their favourites.

“I can influence the weather by singing. In Belgium, it rains a lot and it can make people grumpy. But not anymore! Now there are only sunny days and happy people due to my cheerful songs.” The Quizmaskers

“Invisibility PPE so that we don’t scare all the children while we look after them in hospital.” Stay Another Day, East End Crew

“I would go back to the day the DFTB team made up the emoji round and tell them not to make it so hard!” Nerd Immunity

“To make people laugh when no one else can – because if you can make people see the funny side of things, you’re most of the way to making everything all right.” Laura, age 27, on behalf of The Tele(health)Tubbies

“I would like to be able to control the weather (Atmokinesis- a bit like Elsa from Frozen) although I would definitely choose sunshine for when I’m off work or on holidays to play outdoors and maybe snow at Christmas as you can’t beat a White Christmas 🙂 or if I choose to befriend a snowman hehe.” Mental Arrythmias

“If I could choose a Superpower I would like to have the superpower of Elsa from Frozen so that I can freeze naughty bugs that make children ill so that they can get better quickly. I could also create magical worlds out of snow and ice. Imagine a giant slippy “Ice slide” going from your house to your best friend’s house? Most importantly, I can fly!” Curosurfing School of Babies

“I’m a doctor, so I think the superpower I would choose would be one I get to use every day… I would love to have a superpower to fix broken bones. Then the children I see who’ve hurt themselves wouldn’t be in pain any more, and they’d be able to run, and jump on trampolines, and play on monkey bars again straight away!” The Smooth Obturators

 

If you had a time machine for a day, what would you do? (Finlay, age 9, and Rhys, age 7)

Another question with some impressive answers and, so we’re told, a tough one to score. These are their top picks.

“We would use the time machine to travel forwards to the day of the DFTB Quiz Final. We would take part in an outwardly light-hearted and whimsical manner, and appear relaxed about our mediocre performance. In reality, however, we would be writing down everyone else’s answers with unwavering focus and a grim determination to win at all costs. We would then return in our time machine to the present day, emotionally numb but looking forward to certain victory and our share of the multimillion DFTB prize fund. Given more time, we would also try to do something about COVID and the JFK assassination, but we only have this time machine for one day, and presumably would need to work in comfort breaks.” Rob, age 36 and ½, on behalf of Containment Entertainment

“I would use the time machine to travel the past to find a couple of Unicorns and bring them back. I’m convinced that Unicorns really did exist in the past because if you look closely at the British Passport, it has a Unicorn on the front of it!” Curosurfing School of Babies

“The ability to teleport. It would mean I could go anywhere, whenever I wanted, even make Brisbane for DFTB20 ;-D” Clinicians Of Varying Intellectual Dispositions

“I would go back in time and show people what is going to happen to the earth we live on if they don’t look after the environment, and ask them to please please take care of the world, so that it can be here for my children and my children’s children to enjoy too.” The Smooth Obturators

“We’d go back in time to just before the chicken stepped out into the road and ask them, “why are you crossing the road?” and then we’d know the answer to the oldest question in the world.” Don’t Forget The Chloral

“Go forward to the day when Tottenham Hotspur win the premier league in 2090.” Tallafornia

 

What’s you best joke? (Will, age 9)

Where do triceratops sit?

On their tricerabottoms

Eliza, 6, on behalf of Universally Challenged (University Hospital North Madlands)

 

What did the finger say to the thumb?

I’m in glove with you.

Mental Arrhythmias

 

Why didn’t Elsa see a doctor for her sore throat and cough?

Because the cold never bothered her anyway.

Curosurfing School of Babies

 

If you’re English in the lounge, German in the hallway, and Italian in the bedroom, what are you in the bathroom?

European

Clinicians Of Varying Intellectual Dispositions

 

What did the magic tractor do?

It drove down the road and turned into a field!

The Smooth Obturators

 

Well, I’ve got this racing snail. It’s not been doing very well for the last couple of weeks. So I took its shell off to see if it would make it go faster.
If anything…….

It’s made it more sluggish!

The LeftOvers

 

Why don’t you give Elsa a balloon?
Because she would just let it go

PJ Masks N95

 

What do you call a sleeping bull?
A Bulldozer

Team Cork’s Crew

 

What do you call two octopuses that look the same?

Itenticle

Nerd Immunity, UK

 

What do you call a sick crocodile?

We were looking for an illigator, crock (or similar) or crocod-ill but we had to laugh when we saw these answers:

A handbag. Baby Sharks

An ambulance (otherwise it would be a very illigator). The Salisbury Paediatric Warriors

 

Why did the chimney call for a doctor?

Common answers were the flue, she wanted to stop smoking and he was burning up. But these were our favourites:

Because it had a foreign body (Santa) stuck inside of it. Broken Pencils

He had a bad cough/has the flue from all his smoking (but also considered differential diagnosis of small brick carcinoma). Herd Immunity

 

The best-paired joke was from the Brancatisano Beasties

What do you call a sick crocodile? A corona-dile?

Why did the chimney call for a doctor? Because the corona-dile was in it?

 

And our favourite team name?

Baby It’s COVID Outside

 

Don’t forget to join us for the live final on Friday 15th May at 11am – 12pm UK time, 8pm – 9pm Sydney / Melbourne time, 10-11pm NZ time. Register by completing this form.

Don’t Forget The Brain Busters – Round 5

Cite this article as:
Team DFTB. Don’t Forget The Brain Busters – Round 5, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.24803

The Kids’ Round

Do you think you have what it takes to talk to kids? These questions have been set by kids and will be marked by kids. So pull out all the stops to impress this panel of mini quiz masters.

If you were a Pokemon, which would you be and why? (Kai, age 11)

If you were a teacher in Hogwarts, what subject would you teach and why? (Jude, age 8)

If you could choose a superpower, what would it be and why? (Katie, age 12)

If you had a time machine for a day, what would you do? (Finlay, age 9, and Rhys, age 7)

What’s your best joke? (Will, age 9)

What do you call a sick crocodile?

Why did the chimney call for a doctor?

Don’t Forget The Brain Busters – Round 4

Cite this article as:
Team DFTB. Don’t Forget The Brain Busters – Round 4, Don't Forget the Bubbles, 2020. Available at:
https://doi.org/10.31440/DFTB.24908

The DFTB team have been having great fun deciphering the Emoji quizzes doing the rounds on social media. But, despite digging deep, we couldn’t find a paediatric one… so we’ve made our own. Can you crack the code? Once you think you’ve sussed it, fill in the form below and press ‘Submit’ to see the answers.

See the answers here: Round 4 answers