Case study: primary care

Question 1

3m old babies are brought in because mother is worried about their head shape
Plagiocephaly and Brachycephaly

ix?

management?

Answer 1

Measure and plot head
Check and reassure over development
Check for fused sutures/ ridges

Tummy time/ change day time positions
Reposition toys in cot
Reassure; causes no harm, very common, N dev.
We don’t advise helmets

Question 2

A 2y old girl presents to her GP with 2 days of runny nose and cough. She has no fever and no change in appetite or activity.
Examination shows no fever HR 100 RR 25, no chest findings but marked skin pallor.
An FBC shows Hb 5.3, MCV 57, Plt 300, WBC 6.0

1. Diagnosis and differential?
2. inx?
3. mx?

Answer 2

1.MCV low- microcytic anaemia, specifically:
Iron deficiency anaemia secondary to dietary intake
?Alpha/ Beta thalassemia’s
Anaemia of chronic disease

2. Check blood film/ serum ferritin/ ?Hb electrophoresis*

3. For iron deficiency:
Increase dietary iron (red meat, green veg)
Check (and reduce) milk consumption
Dietician referral
Oral iron supplementation (~3m)

Question 3

causes of anaemia in kids? 3 sections

Answer 3

Impaired red cell production

Increased red cell destruction

Blood loss

Question 4

causes of Impaired red cell production

Answer 4

Iron/ folic acid deficiency
Chronic illness/ inflammation (Renal failure/ JIA)
Parvovirus B19 infection/ bone marrow pathology

Question 5

causes of Increased red cell destruction

Answer 5

Hereditary spherocytosis/ G6PD Deficiency
Thalassaemias/ Sickle cell
Auto-immune haemolytic anaemias

Question 6

causes of Blood loss

Answer 6

Gastrointestinal
Bleeding disorders (von Willebrand’s disease)

Question 7

impetigo:

organism
ix
management

Answer 7

Staph. Aureus

Skin swab,

Flucloxacillin

Question 8

Chicken Pox

organism
ix
management

Answer 8

VZV;

Swab if secondary infection;

Supportive care, IV aciclovir if neonate/ immunocompramised

Question 9

Periorbital (Preseptal) cellulitis,

organism
ix
management

Answer 9

Staph and Strep;

Bloods, Cultures, ?CT;

IV Flucloxacillin ?IV Co-Amoxiclav

Question 10

Gingivostomatitis

organism
ix
management

Answer 10

HSV1
?Mouth swab (B/V),

Analgesia,
mouth rinse,
??Aciclovir*

Question 11

Slapped Cheek/5th Disease

organism
ix
management

Answer 11

Parvovirus B19;
No Ix if well,

Supportive care/ Antipyretics;
AVOID PREGNANT WOMEN

Question 12

Erythema Toxicum Neonatorum

organism
ix
management

Answer 12

Nobody knows! (ish);

No Ix unless crusts/ discharge;

Reassure parents

Question 13

what does Plagiocephaly head look like?

Answer 13

the head is flattened on 1 side, causing it to look asymmetrical;
ears may be misaligned
head looks like a parallelogram

Question 14

what does Brachycephaly

head look like?

Answer 14

back of head flattened,
causing the head to widen,
and occasionally the forehead bulges out.