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
what staging is used for delayed and or precocious puberty
Tanner staging
normal diagnosis counselling
we’ve rulled out all the sinsiter causes and the good news is that they all appear to be reassuring.
Of course we can see that this is clearly causing a lot of distress so there’s a few things we can do to help you
precocious puberty school support options
contact school if theres concerns of bullying, if the pt gives consent
School can provide pastoral support
important things to ask in enuresis hx
psycho/headss assessment:
any bullying in school etc
What is important to ask about in babies who are vomiting
feeding - HOW MUCH
over feeding is common
any coughing when feeding (theres a risk of aspiration from feed due to reflux so need to screen for this)
Any back arching (associated with GERD)
What is important to say in addition to management for vomiting
remember to always follow up with the pt to see if feeding improves
DDx for chronic diarrhoea (>14 days)
infective- baterial eg salmonella, capylobacter, protozoa causes eg giardia
malabsorptive - lactose intolerance, CMPA, CF, coeliac
Inflammatory - IBD
miscellaneous
IBD Ix
find danica’s slides
remember to always examine perianal area for IBD - look for skin tags etc
IBD Rx
find danica’s slides
