GP Paediatrics

Question 1

What are the challenges of GP medicine?

Answer 1

Undifferentiated illness, lack of access to investigations, dealing with uncertainty, lack of team, 10 minutes to get it right

Question 2

What is the GP approach to paediatric illness?

Answer 2

Look at the child and parent
Is it their first visit?
Detailed history

Question 3

What should be covered in the history?

Answer 3

Presenting complaint, red flags, eating/drinking, bowels/urine, parental concern, PMH, medication/allergies, family history, immunisations

Question 4

When is the neonatal period?

Answer 4

From birth to 4 weeks

Question 5

What do neonates present with?

Answer 5

Jaundice, vomiting, failure to thrive, sepsis

Question 6

What may cause jaundice in a neonate?

Answer 6

UTI, hypothyroidism, galactosaemia, breastmilk jaundice, biliary atresia

Question 7

What are some causes of vomiting in a neonate?

Answer 7

Reflux, CMP intolerance, pyloric stenosis, duodenal atresia

Question 8

How do children with respiratory problems present?

Answer 8

Have a “cold”, not feeding, cough, wheeze

Question 9

What are common causes of respiratory illness in children?

Answer 9

Bronchiolitis, croup, viral URTI, asthma, acute tonsillitis

Question 10

What are some rare causes of respiratory illness in children?

Answer 10

Cystic fibrosis, acute epiglottitis, foreign body, pneumonia, cardiac causes, malignancy

Question 11

How are children with a respiratory complaint assessed?

Answer 11

Pulse oximetry, resp rate, percussion, auscultation, ENT exam
Look for = cyanosis, tachypnoea, nasal flaring, intercostal/subcostal recession, wheeze, stridor, cough

Question 12

What are the normal respiratory rates for children?

Answer 12

Under I year old = 30-40 bpm
Age 1-2 years = 25-35 bpm
Age 2-5 years = 25-30 bpm
>12 years = 15-20 bpm

Question 13

How do children with GI issues present?

Answer 13

Abdominal pain, vomiting, diarrhoea, nausea, constipation

Question 14

What are common GI complaints in children aged birth to 1 year old?

Answer 14

Gastroenteritis, UTI, constipation, intussusception, volvulus, incarcerated hernia, infantile colic, Hirschprung’s disease

Question 15

What are common GI conditions in children aged from 2 to 5 years old?

Answer 15

Gastroenteritis, UTI, constipation, intussusception, volvulus, appendicitis, mesenteric lymphadenitis, Hirschprung’s disease, DKA, sickle cell disease

Question 16

What are common reasons behind GI complaints in children aged between 6 and 11 years old?

Answer 16

Gastroenteritis, UTI, constipation, appendicitis, trauma, testicular tortion, mesenteric lymphadenitis, abdominal migraine, Hirschprung’s disease, DKA, sickle cell disease, pneumonia, functional abdominal pain

Question 17

What GI problems do children aged from 12 to 18 years old present with?

Answer 17

Gastroenteritis, UTI, constipation, appendicitis, trauma, ovarian/testicular tortion, dysmenorrhoea, DKA, Mittelschmerz, threatened miscarriage, ectopic pregnancy, PID, IBD, adrenal crisis

Question 18

How do children with MSK problems present?

Answer 18

Painful joints, limp, trauma

Question 19

What are some causes of joint pain in children?

Answer 19

Inflammatory arthritis, Perthes disease, slipped femoral epiphyses, Osgood-Schlatter’s, growing pains, bone tumours

Question 20

What are some causes of a limp and trauma in children?

Answer 20

Limp = developmental dysplasia of hip, Perthes
Trauma = sprain, fracture, NAI

Question 21

What are some other paediatric areas that a GP may encounter?

Answer 21

Skin complaints, ENT conditions, ophthalmology, mental health issues, behavioural problems, haematology

Question 22

How are GPs involved in paediatric public health?

Answer 22

Childhood vaccinations, disease notification, childhood 6-8 week developmental screening, obesity

Question 23

What is looked at in the 6-8 week childhood developmental screening?

Answer 23

Red light reflex, hip examination (barlows/ortolanis), genitalia, femoral pulses
May also be carried out by health visitor

Question 24

When do routine immunisations begin?

Answer 24

At two months old

End at 14 years old

Question 25

What are some red flags in the paediatric age group?

Answer 25

Unresponsive to social cues/difficult to rouse
Weak, high pitched or continuous cry
Grunting respiration/apnoeic episodes (SpO2 <90%)
Severe tachypnoea or tachycardia
Bradycardia <60 bpm
No wet nappies/not passed urine in last 18hrs
Non-blanching rash or mottled/ashen/cyanotic
Temperature <36 degrees
Temperature >38 degrees if <3 months old

Question 26

What are amber flags in paediatric patients?

Answer 26

Abnormal response to social cues/not smiling
Reduced activity or very sleepy
Moderate tachypnoea or tachycardia
Carer reports behaviour is abnormal
Capillary refill >= 3s
Reduced urine output
Pale of flushed, leg pain or cold extremities

Question 27

What is classed as severe tachypnoea?

Answer 27

<1 year old is >=60 bpm
Age 1-2 years is >=50 bpm
Age 3-4 years is >= 40 bpm

Question 28

What is classed as moderate tachypnoea?

Answer 28

<1 year old = 50-59 bpm
Age 1-2 years = 40-49 bpm
Age 3-4 years = 35-39 bpm

Question 29

What is classed as severe tachycardia?

Answer 29

<1 year old is >= 160 bpm
Age 1-2 years is >= 150 bpm
Age 3-4 years is >= 140 bpm

Question 30

What is classed as moderate tachycardia?

Answer 30

<1 year old = 150-159 bpm
Age 1-2 years = 140-149 bpm
Age 3-4 years = 130-139 bpm