GP (CAH) Flashcards
When does a congenital haemangioma require treatment?
- Pressure on eyes/nose/trachea
- Blocking field of vision OR large facial lesion
- Ulcerating/painful lesion
- Child has negative social stigma at school age
List 4 common causes of Fever in a child
- Viral infection (URTI, tonsillitis, chickenpox)
- UTI
- Otitis media
- Gastro
Not to be missed Dx of Fever in a child
- Kawasaki’s (high fever, rash, strawberry tongue)
- Appendicitis
- Sepsis
- Meningitis
- Osteomyelitis
- Pneumonia
- Malignancy
What are the pertinent Hx points for a fever in a child?
-Immunisation Hx
-Sick contacts
-Recent travel
-Localising signs
-Signs of dehydration
(*inconsolable child is a bad sign)
What is the GP management of suspected meningiococcal sepsis/meningitis?
IM Benzylpenicillin and immediate transfer to hospital
Differential for bilious vomiting in a neonate
(* Bilious vomiting suggest obstruction = surgery!)
- malrotation/volvulus (within 1st week of life)
- duodenal atresia (very soon after birth)
- necrotising enterocolitis
- intussusception
How do you define “failure to thrive”?
Child is less than 3rd centile for weight
OR
Child crosses 2 centile lines in a short period of time
Outline the management of a febrile convulsion. When do you refer?
- Febrile convulsion occurs in context of fever, lasts less than 15 mins, and usually self resolving
- It is BENIGN: REASSURE PARENTS, treat underlying cause, panadol for pain and fever (not curative)
- REFER with febrile status epilepticus, evolving neurology, recurrence in same febrile episode, or incomplete recovery within an hour.
What are the components of a 6 week baby check?
- Observations (Trisomy 21, other phenotypic syndromes, interaction, eye movements, skin perfusion/jaundice, coarctation of aorta, descended testes, etc.)
- Height/weight/head circumference (charts)
- Developmental Hip dysplasia (Barlow and Ortolani tests)
- Organomegaly (liver usually 3-4 cm below right costal margin)
- Congenital heart disease (VSD)
- Limb movement (predominant ‘hand-ness’ is abnormal before 18 months-may be muscle weakness)
- GENITALS: Testes should descend by 3 months, check hypospadia
When is Enuresis abnormal?
- Child is over 6
- Daytime incontinence (of faeces too)
- parent or child is troubled by bedwetting
- child is punished for bedwetting
What is the management of enuresis?
- motivation/avoid punishment/supportive parents & siblings
- Chart wet and dry nights
- avoid caffinated drinks and nappies
- mattress protection
- bedwetting alarms (80% effective in 6-8 weeks)
- Meds(short term e.g. school camp) DDAVP/Minirin(ADH)
Outline management principles in the acute swollen scrotum.
- First exclude torsion (high-riding testis, absent cremasteric reflex, tender +++) and hernia with surgical consult
- If present - surgical exploration
- If trauma, refer for surg unless testis is palpable as normal w/o pain.
- Once excluded, use Doppler U/S sound to assess vascularity and anatomy (rule out torsion)
- ABx for epididymoorchitis,
- Outpatient referral for varico/hydrocoele.
- If HSP, prednisolone 1mg/kg after surgical consult excludes torsion
Mx of Balanitis
- Good hygiene
- If candida suspected (satellite lesions) use topical antifungal
- Topical hydrocortisone 1% if necessary
- Topical ABx if required (unproven efficacy)
Mx of Impetigo
- Warm wash of blisters
- Topical mupirocin (Bactroban)
- If extensive/unresponsive treat as cellulitis
- Water-tight dressings (Tegederm)
- Exclude from school (HIGHLY CONTAGIOUS)
Mx VZV
- Symptom management with cool compress, calamine lotion
- HIGHLY CONTAGIOUS! EXCLUDE FROM SCHOOL
- IF
What is hand foot and mouth disease?
How is it managed?
Viral infection (coxsackie A 16)
Conservative management (HIGHLY INFECTIOUS)
- Fluids, pain relief, not sharing cutlery, exclude from school
- Refer to hospital w features of meningism
Mx of vulvovaginitis
Conservative
- Keep area dry, loose clothing
- Weight loss if overweight
- Avoid bubble bath/antiseptics and rinse area
- Nappy rash cream/parraffin
- consider referral if bleeding, pain
Signs and Symptoms of Croup
- Barking cough
- inspiratory stridor
- may have fever
- increased work of breathing
(SEVERE SIGNS- lethargy, stridor at rest, tracheal tug, nasal flaring, chest wall retraction)
Management of Croup
AVOID DISTRESSING CHILD FURTHER! (No Ix/Ex)
- Cough only: No Rx required
- Mild-mod: Prednisolone 1mg/kg
- Severe: Nebulised Adrenaline 1% and 0.6mg/kg dexamethasone
If no improvement consider DDx or obstruction
Common causes of Acute otitis media
Strep. pneumoniae (35%)
H. influenzae non-typable (25%)
Viral (25%)
Moraxella catarrhalis (15%)
Parental smoking and dummies are risk factors
Management of Acute Otitis Media
ANALGESIA ONLY ABx only indicated when: -child less than 12/12 -immunocompromised -severly unwell -no improvement in 48 hours
Rx amoxycillin or Augmentin if not responding
Describe the Sx of Strep throat
- B/w 3-14 y/o
- High Fever
- Tonsilar exudate
- Cervical lymphadenopathy
- absent cough/coryzal Sx
Management of Strep throat
- Penicillin V (Phenoxymethyl penicillin)
- 2nd line: cephalexin
- If intolerant/poor PO intake use Pen G
(if pen. sensitive use roxithromycin)
Complications of Strep throat
- Rheumatic fever
- Post strep GN
- Retropharyngeal abscess
- Acute Otitis Media
Typical Hx of Croup
-Non-specific viral prodrome
-develop barking cough 1-2 days
+/- stridor
Management of Croup
- reassurance
- symptomatic relief
- avoid overexamining and distress to child
- prednisolone
- T/F to hospital consider early intubation if severe
DDx of stridor
- Croup (barking cough)
- Epiglotitis (septic, drooling ++ w open mouth)
- Foreign body
- Infective tracheitis
- Retropharyngeal abscess
- Quinzy/peritonsilar abscess
- Diphtheria
What are the side effects of ventolin?
tachycardia/tachypnoea
tremor
headache
nausea/vomiting
Name some common Asthma triggers in children
- irritants (PARENTAL SMOKING and pollution)
- allergens
- cold
- exercise
Name the 4 main management strategies of childhood asthma
- Relievers (SABA)
- Preventer (ICS+LABA)
- Asthma Action Plan
- Info pamphlets
