Common presentations and the sick child

Question 1

What is the cause, course and treatment of Infective conjunctivitis?

Answer 1

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

Question 2

Which babies are at an increased risk of oral thrush?

Answer 2

1. babies, whose immune systems are not yet fully developed - esp premature babies
2. babies who have been treated with antibiotics
3. babies mwhose breast feeding mothers have been treated with antibiotics

Question 3

How does Oral thrush present?

How is it treated?

Answer 3

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

Question 4

What are head lice/ nits? Who is most commonly affected?

Answer 4

Question 5

What is Impetigo and how is it treated?

Answer 5

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

Question 6

Presentation and treatment of Threadworms

Answer 6

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

Question 7

What are Scabies?

Answer 7

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 2^o skin infections

Question 8

What is Molluscum contagiosum and how does it present?

Answer 8

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

Question 9

Molluscum contagiosum is more common in people with ________ and sometimes in people with ________.

Answer 9

atopic eczema, immunosuppression

Question 10

How does chickenpox present?

Answer 10

An itchy spotty rash

Question 11

What virus causes Chickenpox?

Answer 11

Varicella zoster virus (Incubation period 7-21 days)

Question 12

During which periods of a chickenpox infection is it contageous?

Answer 12

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

Question 13

Treatment of chickenpox

Answer 13

Supportive with paracetamol and calamine lotion. In most children it is a mild self- limiting illness

Question 14

List 2 rare complications of chickenpox?

Answer 14

1. pneumonia
2. bacterial skin infections
3. encephalitis

Question 15

List 2 instances where chickenpox can be life threatening

Answer 15

1. Immunocompromised - requires urgent treatment with immunoglobulins
2. Third trimester of pregnancy and newborn babies

Question 16

Slapped cheek syndrome is also known as what?

What is this?

Answer 16

Fifth’s disease or parvovirus B19

A highly contagious common viral illness in children, but can occur at any age.

Question 17

Describe the presentation of slapped cheek syndrome

Answer 17

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)

Question 18

During which stages of slapped cheek syndrome is it contagious?

Answer 18

Highly contagious initially, No longer contagious when the raised rash over body and legs appears

Question 19

Prognosis and treatment of Slapped cheek syndrome?

Answer 19

Normally mild and self limiting, requiring only supportive fluids, rest and paracetamol

Question 20

List 2 instances where Slapped cheek syndrome can cause problems

Answer 20

1. Miscarriage or stillbirth in early pregnancy
2. Anaemia in sickle cell/thallasaemia
3. Problems in the immune suppressed

Question 21

What are Measles and who do they affect?

Answer 21

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

Question 22

How does Measles present?

Answer 22

1. Coryzal type symptoms
2. Reddened eyes
3. Koplik’s spots on the inside of the cheeks precede the generalised macular rash

Question 23

List 3 serious common complications of Measles

Answer 23

1. Otitis media 8%
2. Pneumonia 6%
3. Encephalitis 0.05 – 0.1% e

Question 24

What type of vaccine is the MMR?

Incl one benefit and one disadvantage

Answer 24

Live attenuated vaccine

• • fewer doses + boosters
• • potential for back mutations

Question 25

What is Hand, foot and mouth disease? How does it present?

Answer 25

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.

Question 26

Treatment of Hand, foot and mouth disease

Answer 26

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)

Question 27

What is Mumps and how does it present? During what stage is it infectious\>

Answer 27

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

Question 28

What timeframe defines an acute illness?

Answer 28

Upto 3-4 weeks duration

Question 29

Compare DDx in presentation of an acute cough with sudden vs gradual onset

Answer 29

Sudden: Foreign body Gradual- Infection * Viral-commonest and self limiting * Bacterial * Asthma with acute exacerbation often in association with URTI

Question 30

List 4 DDx for persistent or recurrent cough in a 6 y/o

Answer 30

* 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

Question 31

Longstanding constipation often presents with what symptom?

Answer 31

Overflow and soiling due to distended rectum - will need treating for many months if not years.

Question 32

Common DDx for constipation in a 3 year old

Answer 32

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.

Question 33

Rare DDx for constipation in 3 year old

Answer 33

1. Short segment Hirschsprung disease - delayed passage of meconium and growth failure 2. Hypothyroidism -growth failure 3. Coeliac disease - faltering growth 4. Lumbosacral pathology - abnormal limb neurology 5. Abnormal anorectal anatomy

Question 34

4 DDx for 18 month old pulling at the ear

Answer 34

1. Infection- usually a/w with other symptoms and characteristic appearance of ear drum on examination 2. Presence of wax/foreign body in ear 3. Teething and referred pain 4. Habit - often worse when tired

Question 35

How can we classify Nocturnal enuresis? (bedwetting)

Answer 35

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

Question 36

List 2 DDx for each catagory of 'bedwetting' in a 7 y/o

Answer 36

1^o without daytime symptoms: Polyuria, Bladder dysfunction 1^o with daytime symptoms: Overactive bladder, UTI 2^o bedwetting: diabetes, constipation

Question 37

How does the range for normal resting pulse rate change as a new born ages

Answer 37

↑ age = ↓ resting pulse rate

Question 38

How would you check CRT in a newborn?

Answer 38

Question 39

How does the range for normal RR rate change as a new born ages

Answer 39

↑ age = ↓ RR

Question 40

What defines normal core temperature and fever in a child

Answer 40

Normal: 36.4°C Fever: over 37.5°C

Question 41

Is fever a good indicator of sepsis in a child? Why/why not?

Answer 41

No - very young and those under treatment for cancer may not mount a fever response

Question 42

What system is used to assess fever and sepsis in children?

Answer 42

Traffic light assessment system (revise image below) * ≥38°C in babe less than 3 months Red * \>39°C in 3- 6 months Amber