ILA Ill child

Question 1

Which vaccines are part of the child immunisation schedule as of 2020?

Answer 1

Diptheria, tetanus, pertussis 
Polio
Haemophilus influenzae type b
Hepatitis B 
Meningiococcal A, B, C, W, Y 
Rotavirus 
Influenza 
Measles, mumps and rubella 
HPV - 16 and 18 (and genital warts caused by 6 and 11)

Question 2

Which vaccines are live?

Answer 2

Rotavirus
Influenza
Measles, mumps rubella

Question 3

How does immunisation uptake vary by deprivation?

Answer 3

More deprived, reduced uptake

Question 4

What other factors might cause lower vaccine uptake?

Answer 4

Single parenthood
Higher family size
Ethnic minorities

Question 5

What are the ethical dilemmas surrounding vaccinating children?

Answer 5

Consent
Primary prevention - do we need to give interventions to medically fit children?
Should vaccinations be compulsory?

Question 6

List 5 common notifiable diseases

Answer 6

• Acute encephalitis
• Acute meningitis
• Meningococcal septicaemia
• Cholera
• Food poisoning
• Haemolytic uraemic syndrome (HUS)
• Infectious bloody diarrhoea
• Measles, Mumps, Rubella
• Rabies
• Severe Acute Respiratory Syndrome (SARS)
• Scarlet fever
• Tuberculosis
• Whooping cough

Question 7

Who would you report a notifiable disease to?

Answer 7

the ‘proper officer’ at their local council or local health protection team (HPT)

Question 8

Should you wait for laboratory confirmation before notifying PHE?

Answer 8

NO

Question 9

How would you inform PHE about a suspected or confirmed notifiable disease and what time frame does this need to be done in?

Answer 9

Fill in and send a notification form to the proper officer within 3 days if routine
If urgent, need to notify them by phone within 24 hours

Question 10

What happens when a PHE notification is made?

Answer 10

• track and trace close contacts and identify vulnerable contacts
• try and find the source of infection

provide public health advice on:

• Isolation; exclusion and decontamination
• Further laboratory testing
• Post-exposure prophylaxis or immunisation
• Other control measures

Question 11

What are the key aspects of a paediatric history?

Answer 11

Intro: greet the child, carers and parents, observe how the child is playing and interacting, address questions to the child when appropriate, can think about whether you may need to speak to the child on their own for confiendeitality

HPC: eating, drinking, passing urine, stool frequency and form, vomiting, rash, fever, runny nose, weight change, pain, is the child their normal self?

PMH: detailed birth and antenatal history, developmental milestones, obstatric problems in pregnancy, meds taken during pregnancy, problems in delivery, neonatal admissions, weight and growth centiles, immunisation, surgery and hospital admissions

DH: medications and allergies

SH: who does the child live with, any carers, parental/carer occupation and smoking status and relationships/marital status, housing, child’s preferred play and leisure activities, are they happy at school or nursery? Any social services involvement, health visitor or social worker?

Question 12

In terms of examination, what would you do as part of the A for Airway?

Answer 12

Asessment

• Assess if airway is patent or obstructed - stridor, SOB, hoarse voice
• can the pt speak? Are their added noises eg grunting, wheeze
• Look in the mouth for blood, broken teeth, gastric contents and foreign objects.
• see saw movement of chest and abdomen

Treatment

• head tilt
• suction
• oxygen

Question 13

In terms of examination, what would you do as part of the B for Breathing?

Answer 13

Assessment

• rate, depth and pattern of breathing
• symmetry of chest movement
• intercostal recession, nasal flaring
• use of accessory muscles
• colour of pt
• oxygen saturation

Treatment

• oxygen
• bag valve mask
• nebulisers

Question 14

In terms of examination, what would you do as part of the C for Circulation?

Answer 14

Assessment

• pulse
• capillary refil time
• urine output
• fluid balance
• temperature
• skin colour: normal, pale or mottled
• cool peripheries

Management

• insert cannula
• take bloods
• give fluids

Question 15

In terms of examination, what would you do as part of the D for Disability?

Answer 15

Assessment

• consciousness level using AVPU - this measures how alert the pt is (Alert, response to Verbal stimuli, response to Pain, Unresponsive)
• Paediatric glasgow coma scale
• pain
• pupil size and reaction
• signs of seizures
• fitting, stiff or floppy

Management

• take blood glucose level
• correct blood glucose
• control seizures
• control pain

Question 16

In terms of examination, what would you do as part of the E for Exposure?

Answer 16

Assessment

• head to toe examination
• front and back
• rashes eg non blanching

Question 17

What are the signs of dehydration in a child with a fever?

Answer 17

• prolonged capillary refill time
• abnormal skin turgor
• abnormal respiratory pattern
• weak pulse
• cool extremities.

Question 18

What is the NCIE traffic light system on the unwell child used for?

Answer 18

Assesses risk of serious illness in children with under 5 presenting to primary care

Question 19

What are the main headings of the traffic light system?

Answer 19

CAR.Co

Colour of skin, lips and tongue
Activity 
Respiratory 
Circulation and hydration 
Other

Question 20

What are the risk stratifications used as part of the traffic light system?

Answer 20

Green = low risk 
Amber = intermediate risk 
Red = high risk

Question 21

What is green, amber and red for colour of skin, lips and tongue?

Answer 21

green = normal
amber = pallor 
red = pale/mottled/ashen/blue

Question 22

What are the red symptoms in the traffic light system?

Answer 22

colour = pale/mottled/ashen/blue 
no response to social cues 
appears ill to healthcare professional 
Does not wake, or if roused, dose not stay awake
Weak/high pitched continuous cry
Grunting 
tachpnoea 
Chest indrawing 
reduced skin turgor 
temperature >38-39 - depending on age 
Non-blanching rash 
bulging fontanelle 
neck stiffness 
status epilepticus 
focal neurological signs 
focal seizures

Question 23

How would you manage a pt with green, amber and red risk?

Answer 23

green = can be cared for at home with appropriate advice for carers, including advice on when to seek further attention from healthcare services

Amber = refer to specialist paediatric care for further assessment or provide carers with safety net ie info on warning symptoms, follow up at a specific time and place

Red but not life threatening: refer urgently to a paediatrician

Red and life-threatening: emergency medical care immediately usually 999

Question 24

Which paediatric conditions commonly present with fever?

Answer 24

Bacterial meningitis 
Herpes simplex encephalitis 
Pneumonia 
UTI 
Septic arthritis 
Kawasaki disease

Question 25

What is the FeverPAIN score used for?

Answer 25

Used to identify who would benefit from antibiotics when presenting with a sore throat

Question 26

What are the aspects that the FeverPAIN score measures and how would you use the score to influence management?

Answer 26

• Fever (during previous 24 hours)
• Purulence (pus on tonsils)
• Attend rapidly (within 3 days after onset of symptoms)
• Severely Inflamed tonsils
• No cough or coryza (inflammation of mucus membranes in the nose)

Score 0-1 = 13-18% streptococci, use NO antibiotic strategy
Score 2-3 = 34-40% streptococci, use 3 day back-up antibiotic prescription strategy
Score ≥4 = 62-65% streptococci, use immediate antibiotic if severe, or 48 hour short back-up prescription

Question 27

when would you give antibiotics to a child with suspected meningococal disease?

Answer 27

at the earliest opportunity (either benzylpenicillin or a third-generation cephalosporin).

Question 28

Would you prescribe antibiotics to children with pyrexia of unknown origin?

Answer 28

No

Question 29

What are the aspects of the Centor criteria (the ILA stressed the FeverPAIN score more)?

Answer 29

C - absence of cough
E - exudate (tonsilar exudates)
N - nodes (tender cervical adenopathy)
T - temperature