Common presentations and the sick child Flashcards
What is the cause, course and treatment of Infective conjunctivitis?
Bacterial or viral
Usually clears in a few days - weeks
Most don’t require treatment - only cleaning of sticky discharge. If it is severe (swelling + inflammation) and thought to be bacterial, Antibiotics may be indicated
Which babies are at an increased risk of oral thrush?
- babies, whose immune systems are not yet fully developed - esp premature babies
- babies who have been treated with antibiotics
- babies mwhose breast feeding mothers have been treated with antibiotics
How does Oral thrush present?
How is it treated?
Presents as a white coating on the mouth and tongue - does not rub off
Treatment is to be scrupulous - sterilisation of bottles and dummies as well as hand washing, and an antifungal gel or liquid after feeds
What are head lice/ nits? Who is most commonly affected?
What is Impetigo and how is it treated?
Common and highly contagious skin infection that causes sores and blisters. Primarily caused by staphylococcus aureus
Not usually serious, often improves within a week of with Antibiotic treatment
Presentation and treatment of Threadworms
Presents with intense anal itching, during which the eggs are transferred to the fingers, so easily passed onto others
Treatment is strict hand hygiene, cleaning towels, sheets, kitchen bathroom AND a single dose of Anthelmintic medication
What are Scabies?
Contagious skin condition caused by tiny mites that burrow into the skin, lay eggs and cause intense itching that’s worse at night
Can lead to a 2o skin infections
What is Molluscum contagiosum and how does it present?
Viral infection that affects the skin and most commonly occurs in children (can occur at any age)
Presents with a number of small, firm, raised papules (spots) on the skin that are NOT painful but can be itchy.
Although they can look unpleasant, it is generally harmless and normally resolves in a few months without treatment
Molluscum contagiosum is more common in people with ________ and sometimes in people with ________.
atopic eczema, immunosuppression
How does chickenpox present?
An itchy spotty rash
What virus causes Chickenpox?
Varicella zoster virus (Incubation period 7-21 days)
During which periods of a chickenpox infection is it contageous?
From the mild coryza 2 days before, until the last of the spots have scabbed over
Generally ~7 days. Children should be kept off nursery and school
Treatment of chickenpox
Supportive with paracetamol and calamine lotion. In most children it is a mild self- limiting illness
List 2 rare complications of chickenpox?
- pneumonia
- bacterial skin infections
- encephalitis
List 2 instances where chickenpox can be life threatening
- Immunocompromised - requires urgent treatment with immunoglobulins
- Third trimester of pregnancy and newborn babies
Slapped cheek syndrome is also known as what?
What is this?
Fifth’s disease or parvovirus B19
A highly contagious common viral illness in children, but can occur at any age.
Describe the presentation of slapped cheek syndrome
Starts with coryzal symptoms and then the child develops the characteristic bright red rash (“slapped cheek”)
May be followed by a slightly raised rash over body and legs, which may be itchy (rash may last upto 2wks)
During which stages of slapped cheek syndrome is it contagious?
Highly contagious initially, No longer contagious when the raised rash over body and legs appears
Prognosis and treatment of Slapped cheek syndrome?
Normally mild and self limiting, requiring only supportive fluids, rest and paracetamol
List 2 instances where Slapped cheek syndrome can cause problems
- Miscarriage or stillbirth in early pregnancy
- Anaemia in sickle cell/thallasaemia
- Problems in the immune suppressed
What are Measles and who do they affect?
Highly infectious viral illness, affecting unimmunised children and adults, (Incubation period of ~ 10 days)
Generally a self limiting miserable illness for the child but serious complications are common
How does Measles present?
- Coryzal type symptoms
- Reddened eyes
- Koplik’s spots on the inside of the cheeks precede the generalised macular rash
List 3 serious common complications of Measles
- Otitis media 8%
- Pneumonia 6%
- Encephalitis 0.05 – 0.1% e
What type of vaccine is the MMR?
Incl one benefit and one disadvantage
Live attenuated vaccine
- fewer doses + boosters
- potential for back mutations
What is Hand, foot and mouth disease?
How does it present?
Highly contagious common childhood illness caused by Coxsachie or Enterovirus infection
Presents with ulcers in the mouth and tongue, followed by a spotty rash on fingers, palms and soles of feet, which in time turn to small blisters
Spots can be itchy, uncomfortable and can last up to 10 days.
Treatment of Hand, foot and mouth disease
Treatment is supportive with fluids and paracetamol.
Mouth ulcers are painful and children need to be encouraged to eat soft food and drink to prevent dehydration
Hygiene and handwashing are very important (spread by coughing and sneezing, excreted in saliva and faeces)
What is Mumps and how does it present?
During what stage is it infectious>
Contagious disease caused by the mumps virus
Causes swelling of the parotid glands, high temperature and generalised symptoms of headache, muscle pains and nausea.
(Incubation period is 17 days) Infectious from ~2 days before to ~ 5 days after swelling appears
What timeframe defines an acute illness?
Upto 3-4 weeks duration
Compare DDx in presentation of an acute cough with sudden vs gradual onset
Sudden: Foreign body
Gradual- Infection
- Viral-commonest and self limiting
- Bacterial
- Asthma with acute exacerbation often in association with URTI
List 4 DDx for persistent or recurrent cough in a 6 y/o
- Recurrent resp infections
- Following specific respiratory infection e.g. RSV or Pertussis
- Asthma
- Persistent lobar collapse post pneumonia
- Gastro-oesophageal reflux
- Cigarette smoking (passive or active)
- Habit
- Tuberculosis
Longstanding constipation often presents with what symptom?
Overflow and soiling due to distended rectum - will need treating for many months if not years.
Common DDx for constipation in a 3 year old
Most will be idiopathic with contributory factors:
- fever
- dehydration
- dietary and fluid intake
- psychological issues
- toilet training difficulties
- side effect of medication
- familial history of constipation.
Rare DDx for constipation in 3 year old
- Short segment Hirschsprung disease - delayed passage of meconium and growth failure
- Hypothyroidism -growth failure
- Coeliac disease - faltering growth
- Lumbosacral pathology - abnormal limb neurology
- Abnormal anorectal anatomy
4 DDx for 18 month old pulling at the ear
- Infection- usually a/w with other symptoms and characteristic appearance of ear drum on examination
- Presence of wax/foreign body in ear
- Teething and referred pain
- Habit - often worse when tired
How can we classify Nocturnal enuresis? (bedwetting)
Primary bedwetting without daytime symptoms
- child/young person has never achieved sustained continence at night
- does not have daytime symptoms
Primary bedwetting with daytime symptoms
- child/young person has never achieved sustained continence at night
- HAS daytime symptoms ie. urgency, frequency, daytime wetting
Secondary bedwetting
- occurs after the child/young person has been previously dry at night for more than 6 months
List 2 DDx for each catagory of ‘bedwetting’ in a 7 y/o
1o without daytime symptoms: Polyuria, Bladder dysfunction
1o with daytime symptoms: Overactive bladder, UTI
2o bedwetting: diabetes, constipation
How does the range for normal resting pulse rate change as a new born ages
↑ age = ↓ resting pulse rate
How would you check CRT in a newborn?
How does the range for normal RR rate change as a new born ages
↑ age = ↓ RR
What defines normal core temperature and fever in a child
Normal: 36.4°C
Fever: over 37.5°C
Is fever a good indicator of sepsis in a child?
Why/why not?
No - very young and those under treatment for cancer may not mount a fever response
What system is used to assess fever and sepsis in children?
Traffic light assessment system (revise image below)
- ≥38°C in babe less than 3 months Red
- >39°C in 3- 6 months Amber
