child_health_20231205142245 Flashcards
What is a septic screen?
A group of investigations carried out routinely in febrile children.
What is included in a septic screen?
FBCCRPBlood cultureUrine testing Chest X-rayLumbar puncture
What is used to assess the risk of a febrile child under 5?
NICE traffic light risk tool
What does the CSF profile of a bacterial illness show?
Raised protein Low glucoseWCC >1000 NeutrophilsCloudy appearance
What is the immediate management of meningococcal septicaemia in the community?
Give IM benzylpenicillin
Age < 1 years - 300mg
Age 1-9 - 600mg
Aged 10 and over - 1200mg
What is the management of meningococcal septicaemia in hospital?
Age <3 months - IV cefotaxime and amoxicillin Age >3 months - IV ceftriaxone
What supportive medicines can be used for a child with meningococcal septicaemia?
Dexamethasone and dextrose
How is meningococcal infection spread?
Droplets from the nose or mouth
What is the first line prophylactic treatment of mengicoccal meningitis for close contacts?
Ciprofloxacin - single dose
How is close contact defined?
Household memberAnyone who has frequently visited the house, or shared secretions with the patient Healthcare professionals with unprotected exposure to secretions Anyone with close contact with the patient for over 8 hours e.g air travellers
What is Waterhouse-Frederichsen syndrome?
Meningococcal septicaemia with associated adrenal haemorrhage
What type of bacteria is neiserria meningitidis?
Gram negative diplococci
What are the common causes of bacterial meningitis in adults?
Neisseria meningitidis Streptococcus pneumoniae
What is the most common cause of meningococcal septicaemia in neonates?
Group B streptococcus
What are the green features of the NICE fever under 5 table?
Normal colour
Responds normally to social cues
Normal skin and eyes
Moist mucous membranes
Content/smiles
Strong cry
Stays awake or wakens quickly
No amber or red flags
What are the amber features of the NICE fever under 5 table?
Pallor Not responding normally to social cues No smile Wakens only with prolonged stimulation Decreased activityTachypnoea Sats < 95Tachycardia Dry mucuous membranes Fever > 5 days Rigors
What is Turner’s syndrome?
When a female has a single X chromosome
What is the genotype of someone with Turner’s syndrome?
45XO
What are the classic features of Turner’s syndrome?
Short stature
Webbed neck
Widely spaced nipples
Cubitus valgus - where the forearm is angled away from the body when fully extended
Late or incomplete puberty
Infertility
What are the complications associated with Turner’s syndrome?
Recurrent otitis media Recurrent UTIsCongenital heart defects - coarctation of aortaand biscuspid aortic valveHypertension ObesityDiabetesInfertility
What investigations would you perform for Turner’s syndrome?
Genetic karyotyping
What is the management of Turner’s syndrome?
Growth hormone for short statureOestrogen and progesterone to help establish secondary sexual characteristicsFertility treatment Regular monitoring and managment of complications
What is Klinefelter’s syndrome?
When a male has an additional X chromosome
What is the genotype of someone with Klinefelter syndrome?
47XXY
When does Klinefelter syndrome present?
Males typically appear normal until pubertyPuberty can also be delayed
What are the symptoms of Klinefelter syndrome?
Tall and slimGynaecomastia Small testiclesWeaker muscles ShynessReduced libido
What is the management of Klinefelter syndrome?
Testosterone injections IVF techniques Breast reduction surgery Physiotherapy, speech and language therapy, occupational therapy
What is cystic fibrosis?
A genetic condition affecting mucous glands
What is the inheritance pattern of CF?
Autosomal recessive
What gene is affected in CF?
CFTR gene (cystic fibrosis transmembrane conductance regulatory gene)
What is the most common mutation of the CFTR gene?
delta-F508
Which chromsome is the CFTR gene on?
Chromosome 7
What impact does CF have on the respiratory system?
Thick respiratory secretions due to abnormal transport of chloride ions and sodium
What impact does CF have on the pancreas?
The pancreatic duct is usually congenitally occluded resulting in pancreatic insufficiency
What impact does CF have on the GI system?
The small intestine secretes viscous mucus that can cause bowel obstruction in-utero, resulting in meconium ileus. The secretions can also cause cholestasis and neonatal jaundice
What impact does CF have on the reproductive tract?
98% of men with CF are infertile due to a congenital absence of the vas deferens
How many people are carriers of a CF mutation?
1 in 25
How does CF present in neonates?
Meconium ileus Prolonged neonatal jaundiceFailure to thrive
How does CF present in infancy?
Failure to thriveRecurrent infections Pancreatic insufficiency - steatorrhoea
How does CF present in childhood?
Nasal polyps Rectal prolapse Sinusitis
How does CF present in adolescence?
Pancreatic insufficiency - diabetes
Chronic lung disease
Liver cirrhosis
Gallstones
What is the gold standard investigation for CF?
Sweat test
What results are seen in a positive sweat test?
High chloride level
What test can be done in neonates to diagnose CF?
Newborn heelprick test
What conditions are screened for in the newborn heelprick test?
Cystic fibrosis Sickle cell anaemia Congenital hypothyroidism6 different metabolic conditions
Which bacteria commonly colonise people with CF?
Staphylococcus aureus Pseudomonas aeruginosa
What other investigations can be performed to help monitor CF?
LFTs
CXR
Cough swab/sputum sample
Glucose tolerance test
Bone profile
Spirometry
What are the management options for CF?
Patient and family education Chest clearance and physiotherapy Exercise High calorie dietCREON tablets for pancreatic insufficiency Antibiotics for chest infections BronchodilatorsProphylactic flucloxacillin
What is Patau’s syndrome?
Trisomy 13
What is Edward’s syndrome?
Trisomy 18
What is the management of Turner Syndrome?
Growth hormone Oestrogen and progesterone to establish secondary female sexual characterstics Fertility treatment
What are the associations of Klinefelter’s?
Diabetes
Anxiety
Increased risk of breast cancer
Osteoporosis
What is noonan syndrome?
A genetic disorder with a wide range of features across the body
What is the inheritance pattern of noonan syndrome?
Autosomal dominant
What is the presentation of noonan syndrome?
Short stature Broad forehead Wide space between eyes - hypertelorism Downward sloping eyes with ptosis Prominent nasolabial folds
What conditions are associated with noonan syndrome?
Congenital heart disease - pulmonary valve stenosis, hypertrophic cardiomyopathy, ASDUndescended testesLearning disabilityBleeding disordersLymphodema Increased risk of leukaemia and neuroblastoma
What is the management of noonan syndrome?
SupportiveSurgery for congenital heart disease
What is fragile X syndrome?
A genetic condition that causes a range of developmental problems
What is the inheritance pattern of fragile X syndrome?
X linked (unclear if dominant or recessive)
What is the presentation of fragile X syndrome?
Intellectual disability Long, narrow face Large ears Large testicles post pubertySocial anxietyADHD and autisum
What mutation causes fragile X syndrome?
CGG trinucleotide repeat in the FMR1 gene
What is Prader Willi syndrome?
A genetic condition caused by loss of functionality of the proximal arm of chromsome 15
What are the modes of inheritance of Prader Willi syndrome?
Deletion of the proximal arm
Inheritance of two copies of from mother
What is the presentation of Prader Willi syndrome?
Constant insatiable hungerHypotonia as an infant Learning disability Developmental delay in early childhoodMental health problems Short stature
What is the definitive diagnosis for Prader-Willi syndrome?
Genetic testing
What is the management of Prader-Willi syndrome?
Growth hormone
Dieticians - management of overeating
Education support
PTOT
What is Angelman syndrome?
A genetic condition caused by a loss of function of the UBE3A gene
What is the mode of inheritance of Angelman syndrome?
Deletion on mother’s chromosome 15Inheritance of two copies of gene from father
What is the presentation of Angelman syndrome?
Delayed development - especially speech development Happy demeanour Fascination with water AtaxiaADHDEpilepsy Dysmorphic features Fair skin, light hair and blue eyes Widely space teeth
What is the management of Angelman syndrome?
PTOT
Psychological support
Social services
Educational support
Anti-epileptics
What are the features of Patau’s syndrome?
Holoprosencephaly - failure of the two cerebral hemispheres to divide
Cleft lip and palate
Microcephaly
Polydactyly
Congenital heart disease
What are the features of Edwards syndrome?
Low set ears Small jaw (micrognathia)Overlapping 4th and 5th fingersRocked bottomed feet Congenital heart disease
What is Williams syndrome?
A deletion on chromosome 7 that results in having only one copy of the genes from this region
How does Williams syndrome occur?
A random deletion around the time of conception
What are the features of Williams syndrome?
Broad foreheadStarburst eyes (star like pattern on the iris)Flattened nasal bridgeLong philtrum Wide mouth and widely spaced teeth Mild learning disability Socialable and trusting personality
What conditions are associated with Williams syndrome?
Supravalvular aortic stenosis ADHDHypertension Hypercalcaemia
What is the management of Williams sydrome?
MDT approach Low calcium diet Echocardiograms and BP monitoring (for hypertension and stenosis)
What is Kallmann’s syndrome?
An X-linked recessive condition that delays puberty due to hypogonadotrophic hypogonadism
Why does Kallman’s syndrome cause delayed puberty?
It is thought to be due to a failure of GnRH secreting neurons migrating to the hypothalamus
What is the presentation of Kallman syndrome?
Anosmia
Delayed puberty
Hypogonadism
Normal or above average height
What hormone levels are seen in Kallman syndrome?
Low testosterone levels LH and FSH levels low
What medications can specifically be used to treat the most common CF mutation?
Lumacaftor/ivacaftor
What are the functions of lumacaftor and ivacaftor?
Lumacaftor helps the CFTR protein form and move to the surface Ivacaftor helps the CFTR protein to stay open for longer
What is nocturnal enuresis?
Bed wetting at night
When is nocturnal enuresis normal until?
Until 5 years old
What is the epidemiology of nocturnal enuresis?
More common in boysStrong family history in 2/3 of casesCommon secondary to trauma
What is primary nocturnal enuresis?
Nocturnal enuresis in a child who has never achieved urinary continence overnight
What is secondary nocturnal enuresis?
Nocturnal enuresis in a child who has previously achieved urinary continence overnight
Name 3 organic causes of secondary nocturnal enuresis.
Diabetes Constipation UTI
What investigations are used to diagnose nocturnal enuresis?
Urine dip Full history and examination Urine osmolality Renal ultrasound
How should nocturnal enuresis be explained to the child and parents?
It is very common The child should not be blamed in any way
What are the management options for nocturnal enuresis?
Star chartsNocturesis alarmTreat underlying causeLifestyle changes - drink less fluid before bed, go to the toilet before bed
What is a star chart?
A chart that rewards the behaviour of a child with a sticker or a star
What is a nocturesis alarm?
An alarm that detects water in the underwear, prompting the child to wake up and go to the toilet
What drug can be trialled in children over 7?
Synthetic ADH (DDVAP)
What is JIA?
A chronic paediatric arthritis that presents before age 16 and lasts more than 6 weeks
In which gender is JIA more common?
6 times more common in females
What is the classic presentation of systemic JIA?
Salmon pink rash Joint tenderness, swelling and rednessIntermittent fever
What is the aetiology of JIA?
Thought to be autoimmune in nature, but the exact cause is not known
What are the different subsets of JIA?
OligoarticularRhematoid factor negative Polyarticular Rheumatoid factor positive Systemic onset JIA
What investigations are helpful in diagnosing JIA?
CRP
ESR
FBC
Anti-nuclear antibodies (ANA)
Rheumatoid factor
What are the differentials of JIA?
Septic arthritisMalignancyReactive arthritisOsteomyelitisSLE
What is the first line treatment of JIA?
Methotrexate
What is the second line treatment of JIA?
Sulfasalazine
What treatment option may be considered in children who have fewer joints affected?
Intra-articular steroids
What is oligoarticular JIA?
Less than 4 joints
What is polyarticular JIA?
More than 4 joints involved
Which joints does oligoarticular JIA affect?
Large joints such as the knee and ankle
Which joints does polyarticular JIA affect?
Small joints in the hands and feet, as well as large joints
What is the pathophysiology of Down Syndrome?
Trisomy 21
What are the three genetic mechanisms responsible for trisomy 21?
Gamete non-disjunction Robertsonian translocation Mosaic
What is the most common genetic mechanism responsible for trisomy 21?
Gamete non-disjunction
What are the features of Downs syndrome?
Hypotonia Brachycephaly (small head with a flat back)Short neck Short stature Flattened face and nose Prominent epicanthic folds
What are the complications of Downs syndrome?
Learning disabilityRecurrent otitis media DeafnessVisual problems Cardiac problems HypothyroidismLeukaemia Alzheimer’s
What kinds of cardiac problems are common in patients with Downs?
ASDVSDTetraology of fallot Patient ductus arteriosus
Who is offered Downs syndrome screening in pregnancy?
Every woman
What is the first line test for Downs syndrome?
Combined test
When is testing for Downs syndrome carried out?
During 11 and 14 weeks gestation
What is involved in combined testing for Downs?
Ultrasound scan and maternal blood tests
What does ultrasound look for when screening for Downs Syndrome?
Nuchal translucency - the thickness of the back of the neck
What maternal blood test results could suggest Downs syndrome?
High beta-HCGLow PAPPA
When would further testing be performed for Downs syndrome?
When the calculated risk of Downs is greater than 1 in 150
What further tests are performed?
Amniocentesis or chorionic villus sampling
What is involved in the management of Downs?
MDT approach Regular check ups:- Thyroid checks - Echocardiogram for heart defects- Audiometry - Eye checks
What GI conditions are associated with Downs syndrome?
Hirschsprung’s Duodenal atresia
What is part of the combined test for Downs?
Nuchal translucency PAPP-A - low beta-hCG - high
When is the combined test performed?
Between 11 and 14 weeks
What is part of the quadruple test for Downs?
Nuchal translucency beta-hCG Inhibin ASerum oestriol
When is the quadruple test performed?
Between 14 and 20 weeks gestation
When can amniocentesis be performed?
15-20 weeks
When can chorionic villous sampling be performed?
11-14 weeks
What are the features of IgA vasculitis?
Purpuric non-blanching rash
Joint pain
Abdominal pain
Kidney problems
What is the epidemiology of IgA vasculitis?
Male sexAge 2-10Previous upper respiratory tract infection
What are the differentials of IgA vasculitis?
Meningococcal septicaemia Thrombotic thrombocytopenic purpuraKawasaki diseaseGranulomatosis with polyangiitisSLERheumatoid arthritis
How is IgA vasculitis investigated?
Urinalysis Skin or renal biopsyBlood pressureBlood creatinine Abdominal or renal ultrasound
What is the aetiology of IgA vasculitis?
IgA is deposited in the small vessels, which become inflamed and leak blood
What is the treatment of IgA vasculitis?
Disease is usually self limitingCorticosteroids can be given to prevent kidney damage
What supportive treatments can be given in IgA vasculitis?
NSAIDs for joint painCorticosteroids for kidney damage
What other medications can be considered for kidney protection?
ACE inhibitor Immunosuppressants
What is the main complication of IgA vasculitis?
Reduced renal function
What is Kawasaki Disease?
A disease of unknown cause that results in inflammation of small to medium vessels
What is the epidemiology of Kawasaki Disease?
Kawasaki disease is mostly seen in children under 5 years
What are the differential diagnoses of Kawasaki disease?
Streptococcal infection Staphylococcal infection Scarlet feverRheumatic feverToxic shock syndrome
What criteria is used to diagnose Kawasaki disease?
Fever for more than 5 days plus 4 out of the 5 following criteria:
- Changes to extremities
- - Rash
- - Cervial lymphadenopathy
- - Non-exudative conjunctivitis
- - Lip and mouth changes
What is the first line management of Kawasaki disease?
IVIg within 10 days of presentation High dose aspirin
What other medications may be considered in Kawasaki disease?
CoricosteroidsInfliximab
What investigations are used to diagnose Kawasaki disease?
FBCESRCRPEcho
What are the complications of Kawasaki disease?
PericarditisMyocarditisCoronary aneurysm
How does DKA present?
PolyuriaPolydipsiaDehydration Weight lossNausea and vomiting Acetone smell to breath Altered consciousness
How would you initially manage a patient presenting with DKA?
ABCDEHigh flow oxygen IV fluids Observations
What investigations are used to diagnose DKA?
Blood glucose and ketones Venous blood gasU&E
What fluid would you give immediately to a patient in DKA?
10ml/kg 0.9% sodium chloride solution over 1 hour
What fluid would you immediately give to a patient in DKA with shock?
20ml/kg 0.9% sodium chloride solution over 15 minutes
What fluids are given over 48 hours to a patient in DKA?
Immediate fluid resuscitation Fluid replacement for dehydration Maintenance fluid
What electrolyte should be given with fluids in DKA?
Potassium
How should insulin be used in DKA?
Insulin should be given at a rate of 0.1 units/kg/hour in children
What are the fasting, pre-meal and post-meal glucose targets in children?
Fasting- 4-7 mmol/LPre-meal - 4-7 mmol/LPost-meal - 5-9 mmol/L
Why is potassium given in DKA?
Insulin drives potassium into cells, so potassium is given to prevent hypokalaemia
What two other conditions are children screened for when diabetes is suspected?
Coeliac diseaseThyroid disease
What are the criteria for diagnosis of DKA?
Hyperglycaemia > 11mmol/LKetosis > 3mmol/LAcidosis - pH < 7.3
What is the main complication of DKA?
Cerebral oedema
What electrolye abnormalities would be seen in an adrenal crisis?
Low sodiumHigh potassium
What is the pathophysiology of CAH?
21-hydroxylase deficiency leads to high androgens, but low cortisol and aldosterone
What blood gas picture can an adrenal crisis cause?
Metabolic acidosis
What is the acute treatment of an adrenal crisis in CAH?
High dose hydrocortisone DextroseSodium chlorideIV fluids
Why is dextrose given in an adrenal crisis?
Blood sugar will be low in an adrenal crisis
How do boys present with CAH?
Boys often present with an adrenal crisis shortly after birth
How do girls present with CAH?
Girls typically present at birth with virilised genitalia
What symptoms may girls present with in puberty?
Excess hair growth Tall for their ageDeep voiceEarly pubertyAbsent periods
Is antenatal treatment for CAH possible?
Treatment with dexamethasone is possible in mothers carrying girls. Dexamethasone is started in all mothers suspected of carrying a girl with CAH, and is continued until term if the fetus is a girl
What is the treatment of CAH?
HydrocortisoneFludrocortisone
What happens to the treatment of CAH when the patient is ill?
SIck day rules apply and steroids need to be increased
What is croup?
Croup is inflammation of the upper respiratory tract following a viral illness
What is stridor?
High pitched turbulant sounds that occurs when a child inhales
What is stridor indicative of?
An upper respiratory tract narrowing or obstruction
What is wheeze?
A high pitched turbulant noise that occurs when a child exhales
What is a wheeze indicative of?
A narrowing or obstruction in the lower airway (lungs)
What are the differential diagnoses of croup?
EpiglottitisTonsilitisAnaphylaxis Inhaled foreign body Congenital defects of the upper airway
What are the classic signs of croup?
Coryza in the preceding days
Stridor
Hoarse voice
Fever
What is the most common causative organism of croup?
Parainfluenza virus
At what age is croup common?
Between ages 6 months to 3 years
At what age is croup most prevalent?
2 years
At what time of year is croup most common?
Autumn/early winter
What is the first line treatment of croup?
Oral dexamethasone
What is the second line treatment of croup?
Nebulised adrenaline
What condition may be diagnosed if the symptoms don’t improve with treatment for croup?
Bacterial tracheitis
What is the treatment of bacterial tracheitis?
IV antibiotics
What bacteria typically causes bacterial tracheitis?
Staphylococcus aureus
What sign may be seen on CXR in croup?
Steeple sign - narrowing of the subglottis
What is cerebral palsy?
A group of permenant movement disorders caused by damage to the motor control area of the CNS
How does cerebral palsy progress?
Cerebral palsy is non-progressive
What are the antenatal causes of cerebral palsy?
Hypoxic-ischaemic encephalopathy Infection
What are the post-natal causes of cerebral palsy?
MeningitisTrauma HaemorrhageMedication toxicityNeonatal jaundice
What are the categories of cerebral palsy?
SpasticAthetoid/dyskineticAtaxic
What is the most common category of cerebral palsy?
Spastic
What are the features of spastic cerebral palsy?
Increased tone and reflexesClasp-knife responseFlexed hip and elbowsScissor gait
WWhat is the clasp-knife response?
Initial resistance when performing passive movement, then a decrease in resistance
Where is the damage to the brain in spastic cerebral palsy?
Pyramidal pathways - upper motor neurones
Where is the damage to the brain in dyskinetic cerebral palsy?
Basal ganglia pathways
Where is the damage to the brain in ataxic cerebral palsy?
Cerebellar pathways
What are the features of dyskinetic cerebral palsy?
Parkinsonism Choreiform movements
What investigations would be performed for cerebral palsy?
MRI brain EEG Genetic testing Additional investigations to screen for problems associated with cerebral palsy
What are the general signs of cerebral palsy?
Not meeting milestones Increased or decreased tone Hand preference below 18 months Problems with coordination, speech or walkingFeeding or swallowing problems Learning disability
What medications may be used in cerebral palsy?
Muscle relaxants e.g baclofen
Anti-epileptic drugs for seizures
Glycopyrronium bromide for drooling
When would botox be given to a child with cerebral palsy?
When patients with significant muscle spasticity cannot relieve their symptoms with medication alone
What score is used at birth to determine the risk of cerebral palsy?
APGAR score
When is the APGAR score performed?
1 minute after birth and 5 minutes after birth
What are the components of the APGAR score?
Appearance (skin colour)Pulse Grimace response (reflexes)Activity (muscle tone)Respiration (rate and effort)
What is the highest APGAR score?
10 (0 is the lowest)
How is each parameter scored using APGAR?
Scored from 0-2
What is epiglottitis?
An infection of the supraglottis that can cause airway compromise due to inflammation and swelling
What organism typically causes epiglottitis?
Haemophilus influenzae B
Why is epiglottitis rare in this country?
HiB vaccine
What is the main risk factor for epiglottitis?
Not having had HiB vaccine
What are the symptoms of epiglottitis?
Difficulty breathing and swallowing Tripod positioningDrooling Sore throatFever
What is the first line investigation in epiglottitis?
Laryngoscopy
What is the management of epiglottitis?
Direct larygoscopy and intubation IV ceftriaxone or cefotaxime
What should not be done in a child with epiglottitis?
Anything to disturb or distress the child - Separation of the child from the parent - Establishing IV access- Oral cavitiy exam
What should be given to a child with epiglottitis once stable?
Oral amoxicillin
What prophylactic treatment should be given to contacts of the child?
Rifampicin
What is bronchiolitis?
An acute viral infection of the lower respiratory tract
What is the most common causative organism for bronchiolitis?
RSV - respiratory syncytial virus
What are the risk factors for developing bronchiolitis?
PrematurityChronic lung diseaseSmoke exposureBreastfed for less than 2 months Less than 3 years in age
What investigations are ordered if bronchiolitis is suspected?
Mostly clinical diagnosis Nasopharyngeal aspirate or throate swab for rapid antigen testing or PCR
What are the symptoms of bronchiolitis?
Cough
Tachypnoea
Coryzal symptoms
Fever
Peripheral cyanosis
Difficulty feeding and breathing
What are the differentials of bronchiolitis?
Pneumonia CroupForeign body BronchiectasisHeart failure Asthma Cystic fibrosis
What is the treatment of bronchiolitis?
Supportive treatment - Oxygen - Fluids
What is the prophylactic treatment of bronchiolitis?
Palivizumab
What is palivizumab?
A monoclonal antibody treatment that binds to F proteins of RSV to prevent virus replication
Which group of people is palivizumab given to?
Infants born before 29 weeksPreterm infacts with chronic lung diseaseInfants with haemodynamically unstable congenital heart disease Infants with conditions that make it difficult to keep the upper airways clearUnder 2s who are immunocompromised
What is chronic lung disease?
Lung disease in premature infants characterised by:- A child who is ventilated for more than 4 weeks - Anyone who still needs oxygen at 36 weeks gestation
What is the most important rare chronic complication of bronchiolitis?
Bronchiolitis obliterans (popcorn lung)
What is bronchiolitis obliterans?
An overdrive of the cellular repair after an infection that causes inflammation and thickening of the bronchioles
What virus most commonly causes bronchiolitis obliterans?
Adenovirus
What measure is used to assess neonatal jaundice?
Bilirubin levels
How are bilirubin levels measured in an infant more than 35 weeks or more than 24 hours old?
Transcutaneous bilirubinometer
How are bilirubin levels measured in an infant less than 35 weeks or less than 24 hours old?
Serum bilirubin
When should neonatal jaundice be treated?
When levels are above the gestation specific threshold
When is neonatal jaundice pathological?
Within the first 24 hours of lifeWhen the jaundice develops after the first 24 hours of life but persists for more than 2 weeks
What can excessive bilirubin levels in the newborn cause?
Kernicterus
What is kernicterus?
A type of brain damage that presents with a floppy baby and poor feeding
How does kernicterus occur?
Bilirubin crosses the blood-brain barrier and causes direct damage to the CNS
What are the causes of prolonged jaundice?
Infection Metabolic problems - hypothyroidism, hypopituitarism, galactosaemia, alpha-1-antitrypsinBiliary atresiaHaemorrhageBreast milk jaundicePolycythaemiaHaemolytic disease of the newborn
What are the red flags in a newborn with jaundice?
Pale stools Dark urine FebrileSignificant weight loss in the first week of life Significant bruising Lethargy Poor feeding
What is haemolytic disease of the newborn?
Haemolysis caused by an incompatibility of the rhesus antigens of mother and baby
What is the first line treatment of neonatal jaundice?
Phototherapy
What is phototherapy?
Phototherapy involves shining the baby with blue light that breaks down unconjugated bilirubin into isomers that can be excreted in the urine
When can phototherapy be stopped?
Once the child is more than 50 micromoles/L less than the threshold
After starting phototherapy, how often should bilirubin levels be monitored?
Every 4-6 hours
What investigations should be performed in the diagnosis of neonatal jaundice?
FBC Blood film Blood type Direct coombs test TFTsUrine culture Blood culture G6PD levels
What is the second line management of neonatal jaundice?
Exchange transfusion
After when is jaundice pathological in preterm neonates?
After 21 days
What are the causes of neonatal jaundice within 24 hours of birth?
Haemolytic disorders - rhesus incompatibility, ABO incompatibility, G6PD deficiency Sepsis Congenital infections
What is impetigo?
Impetigo is a skin infection caused by staphylococcal and streptococcal bacteria
What is the most common causative organism of impetigo?
Staphylococcus aureus
What is characteristic of impetigo?
Itchy rash with golden crustingFeverSchool age child
What is the first line medical management of impetigo?
Hydrogen peroxide cream
then
Topical fusidic acid (antibiotic)
What is the second line medical management of impetigo?
Flucloxacillin
What are the differentials of impetigo?
HSV infection Eczema herpeticum Contact dermatitis
What is the definitive investigation for impetigo?
Skin swab for MC&S
What is otitis media?
An infection of the middle ear
What often preceeds a bacterial infection of the middle ear?
A viral upper respiratory tract infection
What is the most common bacterial cause of otitis media?
Streptococcus pneumoniae
What are the symptoms of otitis media?
Ear pain FeverIrritabilityVomiting Follows a viral upper respiratory infection
What is glue ear?
Otitis media with effusion
What is the first line management of otitis media?
Otitis media is often self-limiting - first line management is simple analgesia
What antibiotic strategies are there for otitis media?
No antibioticsDelayed antibioticsImmediate antibiotics
When should immediate antibiotics be given for otitis media?
When the patient is systemically unwell, immunocompromised or has significant co-morbidities
What are the extra-cranial complications of otitis media?
Facial nerve palsyMastoiditisLabyrnthitis
What are the intra-cranial complications of otitis media?
Meningitis Sigmoid sinus thrombosis Brain abscess
What type of hearing loss does glue ear cause?
Conductive hearing loss
What would be seen on examination in a child with unilateral glue ear?
A negative Rinne’s test on the affected side
What are the symptoms of glue ear?
Ear pain Hearing lossTinnitus
What is the treatment of glue ear?
Watchful waiting - first line Autoinflation - second line
What is autoinflation?
Opening up the eustachain tubes by increasing intranasal pressure - this is done by a special device or by holding nose and breathing out through it
What is seen on otoscopy in glue ear?
A dull tympanic membrane with either air bubbles or a visible fluid level Can look normal
What are grommets?
Tiny tubes placed in the tympanic membrane that drain fluid from the middle ear into the ear canal
How long do grommets last?
Grommets typically last a year, until they fall out
When should antibiotics be given for otitis media?
If no improvement after 3 days Younger than 2 years old with exudate Perforation or discharge in canal
What hearing test do newborns have?
Otoacoustic emission
What hearing test is carried out for children under 4?
Distraction test
What hearing test is carried out in children over 4?
Pure tone audiometry
What hearing test is used if a newborn fails a hearing test?
Automated auditory brainstem response test
What is mastoiditis?
Mastoiditis is an infection of the mastoid bone, behind the ear
What is the presentation of mastoiditis?
Tenderness behind the earOne ear sticking out more Ear pain Irritability Hearing lossFever
What are the common causes of otitis media?
RSVRhinovirus Adenovirus Influenza virus Steptococcus pneumoniae Streptococcus pyogenes Haemophilus influenzae
What is the first line antibiotic for otitis media?
Amoxicillin
What is the second line antibiotic for otitis media?
Clarithromycin
What is biliary atresia?
A congenital disorder where part of the bile duct is narrowed or missing leading to hyperbilirubinaemia
What is the presentation of biliary atresia?
Prolonged jaundice - more than 14 daysSigns of biliary obstruction - Pale stools - Dark urine
What investigations are performed to diagnose biliary atresia?
Bloods - high conjugated bilirubinDeranged LFTsCholiangiography (XR) - abnormal structure of the biliary tree
What is the definitive investigation in the diagnosis of biliary atresia?
Choliangiography - absence of biliary tree will be seen
What kind of bilirubinaemia is seen in biliary atresia?
Conjugated
What may be found on examination of a baby with biliary atresia?
RUQ and LUQ masses due to hepatomegaly and splenomegaly
What is the management of biliary atresia?
Surgery to create a new pathway from the liver to the gut- Kasai procedure
What is wilms tumour?
Nephroblastoma - am embryological tumour arising from the developing kidneys
What are the symptoms of nephroblastoma?
Abdominak mass that does not cross the midline Abdominal distention Haematuria Hypertension Pain in later stagesFeverWeight loss Lethargy
What is the gold standard investigation for diagnosis of wilms tumour?
Renal biopsy
What is the initial investigation performed in nephroblastoma?
USS kidneys
What age group does nephroblastoma typically affect?
Under 5s
What investigation is used to stage wilms tumour?
CT chest abdo pelvis
What is the treatment of wilms tumour?
Surgical excision of the tumour and nephrectomy Adjuvant chemotherapy Adjuvant radiotherapy
What is the cause of pyloric stenosis?
Hypertrophy of the pyloric sphincter which leads to narrowing of the pyloric canal
How does pyloric stenosis present?
Projectile vomiting after feedsThin, pale Failure to thrive Palpable abdominal mass
What may a blood gas show in pyloric stenosis?
Hypochloric metabolic alkalosis (hydrochloric acid is being vomited from the stomach)
What is the gold standard investigation for pyloric stenosis?
Abdominal ultrasound to visualise the sphincter
What is the management of pyloric stenosis?
Correct electrolyte abnormalitiesSurgical pyloromyotomy
What electrolye abnormalities might a child with pyloric stenosis have due to vomiting?
Low sodium, low potassium, low chloride
What type of mass is felt in pyloric stenosis?
Olive shaped mass in the epigastrium
What is the name of the procedure used to manage children with pyloric stenosis?
Ramstedt pyloromyotomy
What are the four features of tetralogy of fallot?
Pulmonary stenosis Overriding aortaRight ventricular hypertrophy Ventricular septal defect
Which feature of tetralogy of fallot determines the level of cyanosis?
Pulmonary stenosis
What is a tet spell?
An acute episode of cyanosis
What can trigger a tet spell?
Exertion such as walking, crying or waking
What is the treatment of a tet spell?
Older children can squat Oxygen Beta blockers - prophylacticIV fluids Morphine
What is the definitive management of tetralogy of fallot?
Total surgical repair
What are the signs and symptoms of tetralogy of fallot?
CyanosisClubbing Poor feeding Poor weight gainEjection systolic murmur Tet spellsRecurrent infections
What are the risk factors for tetralogy of fallot?
Diabetic mother
Alcohol during pregnancy
Increased age of mother
Rubella
What feature makes tetralogy of fallot into pentalogy of fallot?
ASD
What feature on ECG will be seen on ECG in patients with tetralogy of fallot?
Right axis deviation
What is a slipped upper femoral epiphysis?
Where the head of the femur is displaced along with the growth plate
What is the typical patient with a SUFE?
Obese adolescent male who has recently undergone a growth spurt
When should SUFE be suspected?
When the pain is disproportionate to the trauma
What are the presenting symptoms of SUFE?
Hip, groin or thigh pain Restricted range of hip movement (particularly internal rotation)
What are the risk factors for SUFE?
Male Adolescent ObesityHypothyroidism Hypogonadism Afro-carribean or hispanic
What investigation is used to diagnose SUFE?
Antero-lateral and frogs leg X-rays
What are the complications of SUFE?
Avascular necrosis ChrondrolysisSUFE of the contralateral hip Persistent late deformity
What is a febrile convulsion?
A seizure that occurs in a child as a cause of a high fever
What is a simple febrile convulsion?
1 seizure in the course of the illnessLess than 15 minutes in duration Generalised tonic-clonic seizure
What is a complex febrile convulsion?
Focal seizuresMore than 1 seizure during the illnessMore than 15 minutes in duration
What are the differential diagnoses of febrile convulsions?
Epilepsy MeningitisIntracranial space occupying lesion Syncopal episodeElectrolyte abnormalities
What is the management of a febrile convulsion?
Identify and manage the underlying source of infection Paracetamol and ibuprofen
What is intussusception?
A condition where the bowel ‘telescopes’ into itself
What conditions is intussusception associated with?
IgA vasculitis Concurrent viral illnessCystic fibrosisIntestinal polyps Meckel’s diverticulum
What is the presentation of intussusception?
Severe, colicky abdominal pain Characteristic position of drawing up legs Recurrent jelly stoolSausage shaped RUQ massVomiting
What investigations can be used to diagnose intussusception?
Abdominal ultrasound Contrast enema
What is the management of intussusception?
Rectal air insufflation or contrast enema Operative reduction
What are the complications of intussusception?
Bowel perforation Peritonitis Gut necrosis
What will be seen on an ultrasound in intussusception?
Concentric echogenic and hypoechogenic bands
What sign is typically seen on ultrasound in intussusception?
Target sign
Where is the most common site of intussusception?
Ileo-caecal junction
What conditions is intussusception associated with?
Meckel’s diverticulum CF
What is rickets?
Defective bone mineralisation as a cause of calcium or vitamin D deficiency
What minerals is vitamin D needed to make?
Calcium and phosphorus
What are the symptoms of rickets?
Bow legs Lethargy Bone pain Stunted growth Swollen wristsMuscle weakness
What bone deformities can occur in rickets?
Bowed legs Knock kneesDelayed teeth Craniotabies - soft skull
What investigations can be performed to diagnose rickets?
Serum 25-hydroxyvitamin D - low
X-ray
Serum calcium - low
Serum phosphate - low
Serum alkaline phosphatase - high
Parathyroid hormone - high
What is the treatment of rickets?
Vitamin D supplements for vit D deficiency
What is immune thrombocytopenia?
An autoimmune condition characterised by low platelets of an unknown cause
What are the features of immune thrombocytopenia?
Preceding viral illnessRash Bleeding Mucousal bleeding
What investigations are carried out to diagnose immune thrombocytopenia?
FBCPlatelet count - lowCRPBlood film
What is the treatment of immune thrombocytopenia?
Steroids - persistent casesSplenectomy - refractory casesPlatelet transfusion - life threatening cases
What would be seen on bloods in someone with immune thrombocytopenia?
Low platelet count Normal coagulation screen
What is the most common cause of UTI in children?
E. coli
What are the risk factors for UTI in children?
Under 1 year oldFemalePrevious UTI Voiding dysfunction Vesicoureteral reflux Sexual abuse ConstipationRenal tract abnormalities
What are the symptoms of UTI in a child under 3 months?
VomitingFeverLethargy Poor feeding Failure to thriveOffensive urine
What are the symptoms of UTI in a child that can verbalise?
Increased frequency DysuriaAbdominal pain
What is an atypical UTI?
Poor urine flow Abdominal or bladder massRaised creatinine SepsisFailure to respond to treatment in 48 hoursNon- E.coli organism
When should pyelonephritis be considered?
Fever of more than 38 + bacteruria Temperature less than 38 + loin pain and bacteruria
What investigations should be performed to diagnose a UTI?
Urine dip Urine microscopy and culture
What is the treatment of a UTI?
Antibiotics Lower UTI - nitrofurantoin or trimethoprim Upper UTI - cephalosporins
Which groups of people should have an ultrasound in 6 weeks after a UTI?
Children under 6 months, children over 6 months with recurrent UTI
Which groups of children should have an ultrasound during the acute infection?
Children under 6 months with an atypical UTI or a recurrent UTI, children over 6 months with an atypical UTI
Which groups of children should have a DMSA 4-6 months following the infection?
Children with atypical UTI or recurrent UTI
Which groups of children should have a micturating cystourethrogram?
Children under 6 months with reccurent or atypical UTI
What is the definition of recurrent UTI?
Three episodes of lower UTI One episode of upper UTI and one episode of lower UTI Two or more episodes of upper UTI
What is vesicoureteric reflux?
Where urine has a tendency to flow back from the bladder into the ureters
What are the complications of vesicoureteric reflux?
Susceptibility to upper UTI Renal scarring
How is vesicoureteric reflux diagnosed?
Micturating cystourethrogram
What is a DMSA scan?
Using radioactive DMSA material to look for renal scarring - if the radioactive material is not taken up by a section of the kidney, this indicates scarring
What is the management of a UTI in < 3 months old?
Refer immediately to paediatrics
What is the management of UTI in >3 months old?
Oral antibiotics for 3 days - Nitrofurantoin - Trimethoprim - Cephalosporin - Amoxicillin
What is the management of an upper UTI in > 3 months old?
Consider admission to hospitalOral cephalosporin or co-amoxiclav for 7-10 days
What is the first step in management of childhood asthma?
Inhaled SABA - salbutamol
What is the second step in management of childhood asthma?
Add low dose ICS
What is the third step in management of childhood asthma?
Add monteleukast if over 5 (can also add a LABA if over 5 years)
What are the additional add on steps in the management of asthma?
Increase dose of ICS Addition of fourth drug - theophylline
What type of hypersensitivity reaction is asthma?
Type 1 hypersensitivity
What is the first line management in an acute asthma attack?
Inhaled salbutamol
What is the second line management in an acute asthma attack?
Nebulised salbutamol
What is the third line management in an acute asthma attack?
Nebulised ipratropium bromide
What treatment should be added if there is no response to inhaled therapies?
IV hydrocortisone IV magnesium sulfate IV salbutamol IV aminophylline
What are the features of a severe exacerbation of asthma?
Respiratory distressHR > 110Peak flow 33-50% of expected
What are the features of a life-threatening exacerbation of asthma?
Peak flow < 33% of expectedOxygen sats < 92%Silent chest on auscultation Hypotension ConfusionCyanosis
What else should all children having an exacerbation of asthma be given?
Oral steroids
What might be seen on a CXR of an asthmatic child?
Hyperinflation of the lungs
What are the symptoms of asthma in children?
Cough BreathlessnessWheeze Tight chest
What are the differentials of asthma in children?
Respiratory tract infections Viral wheeze Foreign body inhalation Bronchiolitis Allergic reaction/anaphylaxis
What is the first line investigation for suspected asthma in children?
Spirometry with bronchodilator reversibility
What other investigations can be performed to diganose asthma in children?
Fractional exhaled FeNO
Serial peak flow readings
Trial of a SABA
What parameters are monitored during an acute asthma attack?
Peak expiratory flow Oxygen saturations
What is transient synovitis?
Temporary irritation and inflammation in the synovial membrane of a joint
What does transient synovitis often follow from?
An upper respiratory viral illness
What is the key difference between transient synovitis and septic arthritis?
Children with transient synovitis will not have a fever, whereas children with septic arthritis will
What are the symptoms of transient synovitis?
Reluctant to bear weight
Limp
Groin or hip pain
Normal observations
No signs of systemic illness
What is the treatment of transient synovitis?
Symptomatic - simple analgesiaGive safety netting advice
What is the prognosis for transient synovitis?
Improvement of symptoms in 24-48 hours Resolution of symptoms in 1-2 weeks
Under which age should a child with a limp always be referred urgently to paediatrics?
3 years
Under which age is transient synovitis rare?
3 years
What is necrotising enterocolitis?
An infected and necrotic bowel affecting preterm neonates
What are the risk factors for developing NEC?
Very low birthweight Very premature Non-breast milk feeds (including expressed breast milk feeds)Respiratory distress or ventilation Sepsis Congenital heart disease
How does NEC present?
Intolerance to feedsBilious vomitingDistended abdomen Absent bowel sounds Blood in stools
What is the definitive investigation for diagnosis of NEC?
Abdominal X-ray
What might be seen on an abdominal X-ray in a child with NEC?
Dilated bowel Thickened bowel wallPneumatosis intestinalis - air in the bowel wall Pneumoperitoneum - air in the peritoneal cavity
What other investigations can be carried out to help diagnose NEC?
FBC - thrombocytopenia, neutropenia CRP - inflammation Capillary blood gas - metabolic acidosis Blood culture - sepsis
What is the treatment of NEC?
IV fluids Nil by mouth AntibioticsBowel decompression by NG tubeImmediate surgical referral
What are the complications of NEC?
Sepsis Bowel stricture Perforation and peritonitis Recurrence Long term stoma
What is perthe’s disease?
Avascular necrosis of the femoral head in children aged 4-8
Which children is perthes disease most common in ?
Boys between 5-8 years of age
What is the cause of perthes disease?
Idiopathic
How quick is the onset of symptoms in perthes disease?
Gradual onset
What are the symptoms of perthes disease?
Pain in the hip/groin
Limp
Restricted hip movement
Radiation of pain to knee
What is the definitive investigation for diagnosis of perthes disease?
Hip X-ray
What would an X-ray show in perthes disease?
Early changes will show widening of the joint space Late changes will show decreased femoral head size
What other investigations can be helpful in diagnosis of perthes disease?
MRI scan
Technetium bone scan
Blood tests - typically normal
What heart defects are cyanotic?
Transposition of the great arteriesTetralogy of FallotTriscuspid or pulmonary valve atresia
What is an innocent heart murmur?
Common benign murmurs during childhood
What are the causes of an innocent heart murmur?
Still’s murmur Venous humAcute infective illness
What are the features of innocent murmurs?
6 Ss- Soft- Systolic - Sensitive- Short- Single- Small
What is the management of an innocent murmur?
Review in a few weeks
What is coarctation of the aorta?
Narrowing of the aorta (typically just before the ductus arteriosus
What is the presentation of coarctation of the aorta?
Varies on severity:- Systolic murmur heard loudest between the scalpulae - Radio-femoral delay- Hypertension - Heart failure
What genetic condition is coarctation of the aorta associated with?
Turner’s syndrome
What are the management options for mild coarctation?
Monitoring using echocardiogramAntihypertensives
What are the management options for more severe coarctation?
Angioplasty - stent placement Surgery
What type of murmur is heard with a patent ductus arteriosus?
Machine wirring murmur - throughout the cardiac cycle
What is the medical treatment of a patent ductus arteriosus?
NSAIDs (indomethacin)- inhibit prostaglandin synthesis that promotes patency
What is Ebstein’s anomaly?
Caused by lithium use in pregnancy - the tricuspid valve doesn’t form properly, leading to a large right atrium and a small left ventricle
What is the most common congenital cardiac abnormality?
VSD
What murmur is associated with a VSD?
Pan-systolic murmur heard loudest at the left lower sternal edge
What is transposition of the great arteries?
Aorta comes out of the right ventriclePulmonary artery comes out of the left ventricle
What are the maternal risk factors for congenital heart disease?
Infectious diseases during pregnancy Type 1 and 2 diabetes (pre-existing)Teratogenic medicines Substance abuse
What is Eisenmenger syndrome?
When a left-to-right shunt is reversed to a right-to-left shunt
How does eisenmenger syndrome occur?
Increased pulmonary vascular pressure as a cause of the left-to-right shunt causes pulmonary hypertensionPulmonary hypertension results in the reversal of the shunt
What is the presentation of Eisenmenger’s syndrome?
Typically presents in late teens Cyanosis Right heart failure
What is the prognosis of Eisenmenger’s?
Irreversible Often progresses to heart failure in 40s
What is the treatment of Eisenmenger’s?
Prevention Heart-lung transplant
What medication can be used to keep the ductus arteriosus open?
Prostaglandin E
What is triscupsid atresia?
A condition where the triscuspid valve does not form
What is a venous hum?
A continuous blowing noise below the clavicles, due to the sound of venous return
What is Still’s murmur?
A low pitched sound heard at the lower left sternal edge created by blood flow through the heart
What sound is associated with an ASD?
Ejection systolic murmur heard loudest over the upper left sternal angle
What sound is heard in coarctation of the aorta?
Murmur heard on the back between the scapulae
What murmur is associated with tetralogy of fallot?
A harsh ejection systolic murmur heard loudest over the upper-left sternal angle
What virus causes slapped cheek?
Parvovirus B19
What are the features of parvovirus infection?
Fever, coryza, diarrhoeaLace like rash and bright red cheeks
What condition can parvovirus infection during pregnancy cause?
Hydrops fetalis
What is the presentation of whooping cough?
Fever and coryzal symptoms Coughing that starts around a week later Spasmodic coughing followed by gasps for airRhinorrhoea Vomiting post cough
What organism causes whooping cough?
Bordatella pertussis
What is the first line management of whooping cough?
Macrolides
What organism causes hand, foot and mouth?
Coxsackie A virus
What is the presentation of a child with measles?
Fever over 40
Coryzal symptoms
Preceeding conjunctivitis
Grey spots inside the mouth
Unvaccinated
What are the complications of measles infection?
Acute otitis media Encephalitis Bronchopneumonia
What are the symptoms of scarlet fever?
Headache FeverSore throat Rash with sandpaper texture Strawberry tongue
What kind of organism is scarlet fever caused by?
Group A streptococcus
What is the treatment of scarlet fever?
Antibiotics - 10 days phenoxymethylpencillin
What bacteria commonly cause gastroenteritis?
Salmonella Shigella E. coli Staphylococcus aureus Bacillus cereusCampylobacter
What viruses commonly cause gastroenteritis?
Norovirus Rotavirus Adenovirus
What parasites can cause gastroenteritis?
SchistosomaGiardia intestinalis Cryptosporidium
What is the main investigation to diagnose gastroenteritis?
Stool sample culture and microscopy
What is the mainstay of treatment in gastroeneteritis?
Rehydration - Oral rehydration if tolerated- IV fluids if oral not tolerated
What antibiotic are salmonella and shigella treated with?
Ciprofloxacin
What antibiotic is campylobacter treated with?
A macrolide such as erythromycin
How long is measles infectious for?
4-5 days after the rash appears
What is the most common complication of measles?
Otitis media
What organism causes roseola infantum?
Human herpes virus 6
What is the presentation of roseola infantum?
High feverMild erythematous macular rash across the body (develops as the fever subsides)
What is the treatment of roseola infantum?
Supportive treatment
What is the first line investigation of measles?
Measles specific IgG and IgM serology
What is the diagnostic investigation of measles?
PCR for measles mRNA
What type of bacteria is bordatella pertusiss?
Gram negative
What investigation will confirm the diagnosis of whooping cough?
Nasal or nasopharyngeal swab with bacterial culture
What can be tested for when a child has had symptoms of whooping cough for more than 2 weeks?
Anti-pertussis toxin immunoglobulin G
What is the most important complication of whooping cough?
Bronchiectasis
What organism is rubella caused by?
Rubella togavirus
How is rubella transmitted?
Via aerosol
What are the symptoms of rubella infection?
FeverCoryza Arthralgia Rash - starts on face and moves down trunk (spares arms and legs)
What are the risks of contracting rubella during pregnancy if unvaccinated?
Fetal:- Cataracts- Deafness- Patent ductus arteriosus - Brain damage
What is glandular fever (infectious mononucleosis) caused by?
EBV - epstein barr virus
How is glandular fever spread?
Through the saliva of infected individuals
What are the features of glandular fever?
Fever
Sore throat
Fatigue
Lymphadenopathy
Tonsillar enlargement
Splenomegaly
What antibody tests can be used to confirm glandular fever?
Heterophile antibodies:
- Monospot test
- Paul-Bunnell test
What is the management and prognosis of glandular fever?
Disease is self limiting and symptoms typically improve in 2-3 weeks Supportive management
What condition is EBV infection associated with?
Burkitt’s lymphoma
What advice is given to people after EBV infection?
Avoid heavy lifting for one month due to the risk of splenic rupture
What kind of rash is seen in parvovirus B19 infection?
Bright red cheeks after 2-5 days of illness Reticular mildly erythematous rash appears on trunk and limbs a few days later
What is the treatment of whooping cough?
Oral macrolide - clarithromycin, azithromycin
What is a common reaction to patients with glandular fever taking amoxicillin?
Widespread maculopapular rash
When are children given the MMR vaccine?
1 year 3 years and 4 months
When are children given the 6 in 1 vaccine?
8 weeks12 weeks 16 weeks
What diseases does the 6 in 1 vaccine protect against?
Diphtheria Hepatitis B Polio Tetanus Whooping cough HiB
When are children given the rotavirus vaccine?
8 weeks and 12 weeks
When are children given the MenB vaccine?
8 weeks 16 weeks 1 year
When are children given the pneumococcal vaccine?
12 weeks 1 year
What diseases does the 4 in 1 pre-school booster vaccine protect against?
Diphtheria Tetanus Whooping cough Polio
What diseases does the 3 in 1 teenage booster vaccine protect against?
Diphtheria Tetanus Polio
When can children with EBV go back to school?
As soon as they feel well enough to
What is testicular torsion?
Where the testes are twisted around the spermatic cord
What is the presentation of testicular torsion?
Acute onset of severe unilateral testicular painVomiting Abdominal pain
What are the examination findings in testicular torsion?
Firm swollen testicleRetracted testicleAbsent cremasteric reflexAbnormal testicular lie
