Kids 2 Flashcards
Whooping cough Ix
mostly clinical diagnosis but can do a bedside:
obs
head to toe exam (resp)
swab (if in secondary care?)
Bloods- FBC
Imaging : maybe CXR?
Whooping cough Rx
Notify health protection unit
• Explain the diagnosis (cough that lasts for a reasonably long time)
• Explain that it isn’t seen very often because of the immunisation programme (and discuss concerns about immunisation with the parent)
• Explain that having it once does not mean you can’t have it again
• Explain that antibiotics can help treat the condition, but the cough often persists for a long time
abx: <1 month = clarithromycin
>1 month and not pregnant= azithromycin (use erythromycin if pregnant)
• Exclude from school until 48 hours after starting antibiotics
- explain that jabs are very safe and are widely used
safety net
When do you admit for whooping cough
<6 months OR demonstrating any red flags eg seizures, cyanosis etc
what is important to ask in hx for whooping cough
immunisations - explore if they had it and why not
chickenpox Rx
Lifestyle: - wear smooth cotton clothing - keep nails short to avoid scratching damage - Advise that the most infectious period is 1–2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually around 5 days after onset of the rash). Avoid contact with: o School o Immunocompromised o Pregnant women o Infants <4 weeks old
Drugs:
- paracetamol to help with fevers and topical OTC emollients (calamine) or chlorphenamine to reduce itching
- in more severe cases: oral aciclovir. In Immunocompromised = IV aciclovir (rufus JIA)
Safety net: (think of rufus)
- signs of confusion (encephalitis)
- very high fevers that don’t go down with paracetamol
- SOB (can cause pneumonia)
- symptoms getting worse
septic arthritis Ix
Bedside:
- bedside obs
- urine dip (reactive arthritis)
- head to toe examination: look for extra-articular manifestations suggestive of other causes: rashes (IBD), eyes (reactive arthritis)
- general inspection of the joint and joint examination
Bloods:
- FBC
- U and Es
- LFTs
- Cultures
- VBG if very unwell/septic
Other:
arthrocentesis
septic arthritis Rx
IV antibiotics
gram +ve = vancomycin
gram -ve = 3rd gen ceph eg ceftriaxone
Frequent joint aspiration
Admit + senior input + ID referral
Speech delay dont forget…
otoscopy - chronic otitis media? recent ear infection
Rx: SALT, audiology assessment,
if it is chronic otitis media (you can see glue ear etc)- needs grommet tube so refer to ENT
why is it important to ask about passive smoking in speech delay
it is a risk factor for chronic otitis media. Other causes include crowding, poor living conditions etc
maculopapular rash DDx and how would you differentiate them
Measles: starts from behind ears and spreads downwards. Prodrome of cough, conjunctivitis, coryza, malaise, koplik spots which progresses to high T (38-39)
Rubella: rash is similar to measles but fever is low grade. Forschheimer spots
Herpes 6 (Roseola): rash starts from chest and spreads to limbs, rash appears as fever goes away (high fever), Nagayama spots
Hand foot and mouth disease (though can give u vesicles too)
Kawasaki
maculopapular rash ix
bedside:
obs
head to toe examination:
- eyes (kawasaki?)
- ENT: pharyngitis for measles. Ears to rule out ear infection. Strawberry tongue in kawasaki
- hands for desquamation? hand foot mouth disease? ?kawasaki
- assess for cervical lymphadenopathy
- oral fluid sample for measles and rubella
Bloods:
- FBC, CRP, ESR (platelets might be raised in kawasaki), LFTs
Imaging:
Echo to rule out any cardiac complications
Kawasaki Rx
explain the condition:
- we dont know the cause
- autoimmune condition where the body attacks the blood vessels in your body
Admit IVIG infusion High dose aspirin for 8 weeks Senior review refer to paediatric rheumatology/cardiology
Intussusception Rx
A-E approach
Admit
Call senior
Explain: when part of the intestine slides into an adjacent part of the intestine ‘ telescope’.
NBM, Drip and Suck, pain relief
1st: rectal air insufflation
2nd: operation
precocious puberty Hx (eg first period at age of 7)
ask about Puberty features (eg vaginal bleeding: discharge, volume, frequency, anaemia symptoms) + find out the ORDER of the development of puberty features is correct
birth history - ask about congenital adrenal hyperplasia by asking if theres any genital abnormalities at birth
HEADSSS
Home, education, activity (hobbies), drugs, sex, safety and social media
