Day 5 Flashcards
Management of threadworm (2)
Single dose of oral mebendazole for the entire household and hygiene advice
Mebendazole is first line therapy for treatment of threadworm
ALL is the most common childhood leukaemia and presents with anaemia, neutropaenia and thrombocytopaenia
Symptoms of ALL
bone pain (secondary to bone marrow infiltration)
splenomegaly
hepatomegaly
fever is present in up to 50% of new cases (representing infection or constitutional symptom)
testicular swelling
A 10-month-old boy is seen in the Emergency Department due to fever, cough and breathlessness. His observations are as follows:
temperature 38.1˚C,
heart rate 180 bpm,
respiratory rate 64/min,
oxygen saturations 93% on room air,
blood pressure 95/60 mmHg,
capillary refill time is 2 seconds.
His parents report a history of poor feeding over the past week. He has had a high temperature the past day. A senior clinician has admitted him and given intravenous (IV) antibiotics, IV fluids and supplementary oxygen. The patient is currently alert.
Which is the following in his presentation is a red flag according to the NICE paediatric traffic light system?
A respiratory rate of >60 per minute (at any age) is a red flag according to the NICE paediatric traffic light system
An 8-year-old boy who is known to have asthma is reviewed. His current treatment is a salbutamol inhaler as required and beclometasone inhaler 100mcg bd.
Despite this, he regularly requires salbutamol for exacerbations and suffers with a night time cough.
Following NICE guidance, what is the most appropriate next step in management?
Child aged 5-16 years with asthma not controlled by a SABA + paediatric low-dose ICS asthma management in children 5-16 - add a leukotriene receptor antagonist
Trial of a leukotriene receptor antagonist
Steps of asthma management
(7)
A 3-year-old girl is brought to her general practitioner by her mother. She has had a dry cough and runny nose for the last 7 days, with a 6-day history of fevers up to 38.7ºC that have been resistant to paracetamol and ibuprofen.
On examination, she appears miserable and generally unwell. Her tongue appears bright red and there is a maculopapular rash on her trunk. There is bilateral conjunctival injection with no obvious discharge. There is palpable submandibular lymphadenopathy.
Given the likely diagnosis, what investigation should be used to screen for long-term complications?
(3)
Coronary artery aneurysms are a complication of Kawasaki disease and this should be screened for with an echocardiogram
A pregnant woman’s perinatal ultrasound indicates that her baby is at risk of a cardiac congenital abnormality.
A cardiac ultrasound showed the foetal aorta and pulmonary trunk lying in parallel with an absence of crossing, confirming the suspected diagnosis.
After delivery, which medication should be commenced urgently in the newborn before corrective surgery can be performed for this condition?
(2)
Maintenance of the ductus arteriosus with prostaglandins is the initial management for duct dependent congenital heart disease
Prostaglandin E1
A 4-month-old baby girl is reviewed. Four weeks ago you started a trial of alginate therapy (Gaviscon) for frequent regurgitation associated with distress.
Unfortunately, this has not resulted in any improvement in the symptoms and her mother now reports she appears to be refusing feeds.
There are no other new symptoms such as diarrhoea, rash and she appears to be putting on weight steadily.
She continues to be completely bottle fed after her mother stopped breastfeeding at 6 weeks of age.
What is the most appropriate next step in management?
PPI should be trialled in infants with GORD who do not respond to alginates/thickened feeds and who have
- feeding difficulties,
- distressed behaviour
or
- faltering growth
A 3-day-old neonate born prematurely at 34 weeks’ gestation has been slow to wean off the ventilator since birth. On examination, she has been found to have a continuous heart murmur.
An echocardiogram has detected a patent ductus arteriosus. No other structural heart abnormalities have been found. A chest x-ray shows cardiomegaly and mildly congested lung fields.
What initial treatment should be started to manage this condition?
Indomethacin or ibuprofen is used in patent ductus arteriosus to promote duct closure
What is the average age that a child can sit up with a straight back, without support?
7-8 months
What is the average age that a child can run?
16 months - 2 years
What is the average a that a child is able to ride a tricycle using pedals
3 years
A 3-year-old boy presents to the GP with nightly coughing bouts for the last 2 weeks. He has noisy breathing with an inspiratory whoop but no cyanosis or other signs on clinical examination. The GP diagnosis the patient with a whooping cough.
What would be the best first-line treatment for this patient?
Whooping cough - azithromycin or clarithromycin if the onset of cough is within the previous 21 days
A 12-month old boy is brought to you by his mother, worried about an apparent developmental delay.
He was born at term without any antenatal or postnatal events. His mother feels he hasn’t developed skills in the same way as his older siblings, particularly with fine motor skills.
He was able to hold things in the palm of his hand at 9 months old and has recently learnt how to transfer an object between his hands.
What is the latest fine motor developmental milestone you would expect this child to have achieved?
Good pincer grip - 12 months
Developmental milestones: fine motor and vision
3 months
6 months
9 months
12 months
A 2-month-old previously healthy girl is brought into the GP by her mother who reports a change in her demeanour. She suspects her child has a fever. On examination the baby is feverish with temperature of 38.5 ºC but no other significant findings.
What is the appropriate next step?
A child aged < 3 months with a fever > 38ºC should be assessed as high risk of serious illness
A child younger than 3 months old with temperature higher than 38ºC warrants an urgent assessment. It is a red flag in the assessment of children with fever.
Tommy is a 5-year-old boy who has been brought in to see you by his mother. She explains that Tommy has had a fever for 3 days and yesterday developed some ulcers in his mouth. Today, she noticed that there are red spots on Tommy’s hands and feet which have now started to concern her.
Out of the following, which virus is most likely the causes of Tommy’s symptoms?
Hand, foot and mouth disease is characterised by mild systemic upset, oral ulcers followed by vesicles on the palms and soles
A 2-year-old child comes in to see you with his mother at the GP surgery. The mother tells you that for the past few months the child has been suffering from diarrhoea. On further questioning, she denies that it is foul smelling but does confirm it sometimes contains undigested food.
There are no other symptoms such as abdominal pain or bloating. You plot their height and weight, and it is appropriate for their age.
What’s the most likely diagnosis?
Toddler’s diarrhoea is a benign condition that causes the child no problems. It is due to the fast transit through their digestive system and often contains undigested food. It requires no treatment. It is prudent to plot their height and weight to ensure no severe underlying diagnosis is present such as coeliac, which would present with the child falling centiles on the growth chart.
Features of toddler’s diarrhoea
(2)
Toddler’s diarrhoea is a benign condition that causes the child no problems.
It is due to the fast transit through their digestive system and often contains undigested food.
Management of Toddler’s diarrhoea
(2)
It requires no treatment.
It is prudent to plot their height and weight to ensure no severe underlying diagnosis is present such as coeliac, which would present with the child falling centiles on the growth chart.
A 7-year-old girl is brought into the general practice by her mother. She has been complaining of itching around her vulva and anus for 2 days. Her mother has noticed that the area is erythematous and she has broken the skin on her vulva from intensely itching. She has been applying sudocrem to the area to alleviate the irritation but it has not been successful. No one else is unwell or has these symptoms at home.
Considering the likely diagnosis, what is the most appropriate management?
Prescribe a single dose of mebendazole for the household and give hygiene advice
Jessica is a 15-year-old girl who is admitted with abdominal pain. An ultrasound scan report comes back with findings consistent with appendicitis.
Her parents do not want her to go for surgery.
Jessica appears intelligent, mature beyond her years and is currently clinically stable.
After lengthy discussions with her parents and the surgical team, Jessica states she would like to go for surgery. Her parents are unhappy and say they will sue the hospital if she has an operation.
What is the right course of action?
Obtain written consent for appendicectomy from Jessica and take her to theatre
Risk factors for developmental dysplasia of the hip (7)
- female sex: 6 times greater risk
- breech presentation
- positive family history
- firstborn children
- oligohydramnios
- birth weight > 5 kg
- congenital calcaneovalgus foot deformity
Oligohydramnios definition
Oligohydramnios is when you have low amniotic fluid during pregnancy. Your healthcare provider diagnoses low amniotic fluid using an ultrasound.
Polyhydramnios definition
Polyhydramnios (pol-e-hi-DRAM-nee-os) is the excessive accumulation of amniotic fluid — the fluid that surrounds the baby in the uterus during pregnancy.
A 6-year-old boy is brought to surgery by his mother.
For the past 2 months he has been complaining of pain in his shins and ankles at night-time.
His symptoms are bilateral he is otherwise well.
There is no family history of note.
Clinical examination is unremarkable.
What is the most likely diagnosis?
A common presentation in General Practice is a child complaining of pain in the legs with no obvious cause. Such presentations, in the absence of any worrying features, are often attributed to ‘growing pains’.
This is a misnomer as the pains are often not related to growth - the current term used in rheumatology is ‘benign idiopathic nocturnal limb pains of childhood’
A 2-year-old boy is brought to the surgery by his mother with earache and pyrexia. On examination of the precordium a murmur is heard.
Which one of the characteristics is not consistent with an innocent murmur?
Diastolic Murmur
Characteristics of an innocent ejection murmurs:
(8)
Characteristics of an innocent ejection murmur include:
- soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
- may vary with posture
- localised with no radiation
- no diastolic component
- no thrill
- no added sounds (e.g. clicks)
- asymptomatic child
- no other abnormality
Still’s murmur
(2)
Low-pitched sound heard at the lower left sternal edge
Venous hums (2)
Due to the turbulent blood flow in the great veins returning to the heart.
Heard as a continuous blowing noise heard just below the clavicles
An 8-year-old boy is referred to the local asthma clinic due to poorly controlled symptoms.
Over the last month, the patient has been waking at night coughing and has been using their salbutamol inhaler at least 3 times a day.
They were started on this inhaler by their GP as a trial and got good relief after using it.
On examination, the patient is otherwise well and developing normally. Their past medical history includes eczema.
What is the next best management step for this patient?
Child aged 5-16 years with asthma not controlled by a SABA asthma management in children 5-16 - add a paediatric low-dose ICS
Beclometasone dipropionate
To which category does
Beclometasone dipropionate
belong?
This medication belongs to a class of drugs known as corticosteroids.
To which category does
monteleukast
belong?
Montelukast is in the leukotriene receptor antagonist family of medications.
It is generally less preferred for this use than inhaled corticosteroids.
It is not useful for acute asthma attacks.
To which family of medications does Theophylline belong?
Theophylline, also known as 1,3-dimethylxanthine, is a phosphodiesterase inhibiting drug used in therapy for respiratory diseases such as chronic obstructive pulmonary disease and asthma
A 7-year-old is referred to paediatric clinic by a GP as they are concerned about the presence of a murmur, heard incidentally.
The patient is otherwise asymptomatic and well.
After examination, the paediatrician is reassured and diagnoses a benign ejection systolic murmur.
Which of the following is a feature of a benign ejection systolic murmur?
A benign ejection systolic murmur varies with posture. All other answers are features of pathological murmurs. ‘Only mild symptoms’ is not a good thing - any symptom at all is a sign that the murmur is not benign.
Characteristics of an innocent ejection murmur include:
- soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
- may vary with posture
- localised with no radiation
- no diastolic component
- no thrill
- no added sounds (e.g. clicks)
- asymptomatic child
- no other abnormality
At what age would the average child start to play alongside, but not interacting with, other children?
2 years
Playing milestones
(4)
Feeding Milestones
(5)
Dressing milestones (4)
A 3-year-old is brought by his Mum to your surgery. He has had a fever and has been refusing to eat. Mum has noticed some spots on his hands and buttocks. On examination, the child has a mild vesicular rash on the hands, buttocks, face and a few spots on his ankles. His temperature is 38.1ºC. Your records state that he had chicken pox when he was 9 months old. What is the most likely diagnosis?
Hand, foot and mouth disease is a viral infection that commonly affects children under 10 years. The symptoms are fever, anorexia, cough, abdominal pain and sore throat. Mouth ulcers commonly follow with a rash that classically affects hands and feet but also face, buttocks, legs and genitals. It is generally a benign self-resolving condition treated with simple analgesia.
A 16-year-old girl is seen by the GP as she has never menstruated. She also has not developed other secondary sexual characteristics.
On examination, she is very short but is in proportion. She also has wide-spaced nipples and low-set ears. There is a very subtle webbing of the neck.
Which of the following is she most likely to have?
Turner’s syndrome is associated with aortic coarctation
A baby is born at full term following a vaginal delivery complicated by a shoulder dystocia. The baby is born in very poor condition and accordingly, the neonatal team resuscitate and intubate the baby. The baby is profoundly acidotic and demonstrates global hypotonia with abnormal neonatal reflexes; the neonatal team decide on the most appropriate step in management as they are concerned about hypoxic brain injury.
Which intervention is most important for this baby?
Therapeutic cooling at 33-35 degrees attempts to reduce the chances of severe brain damage in neonates with hypoxic injury