Miscellaneous Topics Flashcards
What are the causes of conjunctivitis ?
In adults
- Viral
- Allergic
In children
- Bacterial > staphylococcal or streptococcal
- Allergic
In neonates
>Be wary of sight-threatening conjunctivitis in neonates
- <48hrs = gonococcus
- 1-2wks = chlamydia trachomatis
What are the S/S of conjunctivitis?
Bacterial
- Painful red eyes
- Purulent discharge
- Lacrimation
- ‘Gritty eyes” > may be “stuck together” in the morning
- NO visual change
Allergic
- Bilateral
- Pruritic
- Conjunctival swelling
- Hx of atopy
- May be seasonal (pollen) or perennial (dust mites, washing powder, other allergens)
Neonate gonococcus
- Discharge +/- conjunctivitis
- Swelling eyelids
Neonate chlamydia
- Discharge +/-conjunctivitis
- Swelling eyelids
+/- pneumonia
What are the investigations for conjunctivitis?
· Bacterial > swab MC&S
· Viral > rapid adenovirus immunoassay
· Neonate gonococcal > gram stain, culture
· Neonate chlamydia > immunofluorescent staining
What is the management for conjunctivitis?
Most viral/bacterial infections are self-limiting and resolve without tx in 1-2wks
Neonate
- Cleaning with water and saline is sufficient in most cases
- Discharge / redness suggestive of Staphy/Strep infection can be treated with topical ointment (e.g. neomycin)
Neonate gonococcal
- Immediate empirical tx > 3rd generation cephalosporin (i.e. ceftriaxone)
Neonate chlamydia
- Oral erythromycin 2wks
Allergic
1st line > topical or systemic antihistamines
2nd line > topical mast-cell stabilisers e.g. sodium cromoglicate and nedocromil
Bacterial
- Topical abx therapy e.g. chloramphenicol (drops are given 2-3 hourly initially whereas ointment given qds initially)
- Topical fusidic acid if pregnant
Advice
- Don’t share towels
- School exclusion not necessary
What is hypermetropia?
Long sightedness
(see long distance not close distance, rays focus behind the retina)
· Mild hypermetropia common in early childhood
· Corrected by improvement of accommodation reflex
· Mx = glasses (convex lens)
What is myopia?
Short sightedness
(see short distance not long distance, rays focus in front of retina)
· Uncommon in childhood, more common in teenagers
· Childhood conditions > pre-term refractive errors
· Mx = glasses (concave lens)
What is retinopathy of prematurity (ROP)?
Affects developing blood vessels at the junction of the vascularised and non-vascularised retina
What are the RFs for ROP?
Uncontrolled use of high concentrations of oxygen
(seen in 35% of LBW infants)
What are the S/S of ROP?
Unusual eye movements
White pupils and vision loss
What is the management of ROP?
Screening:
- LBW <1500g
- Prematurity <32wks gestation
1st line:
- Laser photocoagulation
- Or cryotherapy
What is the prognosis of ROP?
Severe bilateral visual impairment in 1% LBW infants (mainly <28wks)
What is strabismus?
Abnormal alignment of eyes
· Diagnosed 1-4yrs
· Normal in young infants before 6m
What are the types of strabismus?
Non-paralytic = refractive error in one or both eyes
Paralytic = squinting eye could be caused by motor nerve paralysis or SOL, i.e. 3rd nerve palsy
What are the S/S of strabismus?
· Eyes look in different directions
· Eyes don’t focus simultaneously on a single point
What is the management of strabismus?
Before 8yrs, as this is when brain connections can be rewired until
· 1st line = eyeglasses
· 2nd line = eye patching
· 3rd line = eye drops
· 4th line = eye muscle surgery
What are parental RFs for NAI?
· Poor socio-economic status
· Co-occurrence of domestic violence within family / abusive relationship between partners
· Psychological problems
· Substance abuse
· Lacking parental knowledge
· Parental / carer exposure to maltreatment as a child
What are child RFs for NAI?
· Children with mental / physical health problems
· Children with disabilities
· LBW
· Excessive crying / frequent tantrums
· Twins / other multiples
What are the most common fractures associated with NAI?
- Radial
- Humeral
- Femoral
What are the S/S of NAI?
· Bruising (on non-contact areas)
· Broken bones (spiral fractures of long bones, non-ambulant)
· Drowsiness (subdural)
· Failure to thrive
· Neglect (unkempt)
· STIs, recurrent UTIs
· History non consistent
· Torn frenulum labii superioris (tongue)
· Glove and stocking burn
· Anal fissures, encopresis
What is shaken baby syndrome?
Classical triad of features:
· Retinal haemorrhages
· Brain swelling / encephalopathy (CT)
· Subdural haematoma (CT)
What are the investigations for NAI?
· Full body +/- skeletal survey (note all blemishes on body on body map)
· Check child protection register
· CT head
· Bloods and bone profile (rule out leukaemia, ITP, haemophilia)
· Fundoscopy
What is the management of NAI?
If suspecting NAI > always safe to admit child
Child in need plan
- Plan made to give children extra support for health, safety +/-developmental issues
Child protection plan
- Plan made to protect children thought to be at risk of significant harm
Communication
- “This is a routine requirement for all children in these situations, and our aim is to keep your child safe”
- “Sometimes when children have similar injuries, they don’t happen by accident and are caused others”
Who do you get involved for NAI?
Senior colleagues, named doctor for child protection, social services (make formal referral)
Consider contacting police (Child Abuse Investigation Team / CAIT)
- Convene a case conference
- Support to parents
- Childs name on child protection register
- Ask for regular follow-up by paediatricians
Consider contacting Multi-Agency Safeguarding Hub (MASH)
- Includes variety of people that help mx different aspects of a child’s life
What is SIDS?
Sudden death of an infant <1yr that remains unexplained after a thorough case investigation, including performance of a complete post-mortem, examination of the death scene and review of clinical hx
