Paed conditions Flashcards
Describe what croup is
Acute infective respiratory disease affecting young children, typically between 6 months to 2 years
Can be older -> upper respiratory tract infection causing oedema in the larynx
List the common causes of croup
Parainfluenza
Influenza
Adenovirus
Respiratory syncytial virus (RSV)
Diphtheria (rare in developed countries due to vaccination)
List differentials for croup
Epiglottitis
Upper airway foreign body
Describe the symptoms of croup
Increased work of breathing
‘barking’ cough, happening in clusters of coughing episodes
Hoarse voice
Stridor – noisy breathing that occurs due to obstructed air flow through a narrowed airway
Low grade fever
List indications for hospital admission for child with croup
Features of moderate or severe illness/impending respiratory failure
RR > 60, high fever, toxic appearance
Describe the management of croup for children if hospital admission is not indicated
Single dose of oral dexamethasone (0.15mg/kg) to be taken immediately
-symptoms will usually resolve within 48 hours
-use paracetamol/ibuprofen for fever or pain
-check on child regularly
Describe epiglottitis
Inflammation and swelling of the epiglottis caused by infection, typically with haemophilus influenza type B
Can swell to the point of completely obscuring the airway within hours of symptoms developing -> life-threatening condition
List symptoms of epiglottitis
Sore throat and stridor
Drooling
Tripod position (sat forward with a hand on each knee)
High fever
Difficulty or painful swallowing
Muffled voice
Scared and quiet child
Septic and unwell appearance
List investigations to do for epiglottitis
Investigations should not be performed – patient should not be distressed as this could prompt closure of the airway
Lateral x-ray of neck shows a ‘thumb sign’ = soft tissue shadow that looks like a thumb pressed into the trachea (caused by the oedematous and swollen epiglottis)
Describe the management of epiglottitis
999 ambulance transfer so that epiglottis can be examined where there is capacity to carry out immediate intubation should the airway close
Preparations need to be made to perform intubation at any time
Additional treatment when airway is secure:
1) IV antibiotics (ceftriaxone)
2) Steroids (dexamethasone)
List a common complication of epiglottitis
Development of an epiglottic abscess – collection of pus around the epiglottis
-also threatens the airway
-treatment is similar to epiglottitis
Describe bronchiolitis
Inflammation and infection in the bronchioles, the small airways of the lungs
Usually caused by a virus – respiratory syncytial virus is the most common cause
List the symptoms of bronchiolitis
Runny/snotty nose, sneezing, mucus in throat & watery eyes
Signs of respiratory distress
Dyspnoea
Tachypnoea
Poor feeding
Mild fever
Apnoeas (episodes where the child stops breathing)
Wheeze and crackles on auscultation
List signs of respiratory distress in children
Raised RR
Use of accessory muscles of breathing
Intercoastal and subcoastal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noises
List reasons for admission for a child with bronchiolitis
Age < 3 months/any pre-existing condition
50-75% or less of their normal intake of milk
Clinical dehydration
RR > 70
Oxygen sats < 92%
Moderate to severe respiratory distress, apnoeas
Describe the management of bronchiolitis
Ensuring adequate intake
Saline nasal drops and nasal suctioning
Supplementary oxygen, if sats remain low
Ventilatory support if required
What is infantile colic?
Self-limiting condition which is defined clinically as repeated episodes of excessive and inconsolable crying in an infant
Otherwise appears to be healthy and thriving
Describe the symptoms of infantile colic
Excessive, inconsolable crying which starts in the first weeks of life and resolved by around 3-4 months of age
Crying which most often occurs in the late afternoon or evening
Drawing its knees up to its abdomen/arching its back when crying
List differential diagnosis of infantile colic
If symptoms started suddenly and recently:
-intussusception/volvulus
-pyloric stenosis
More persistent symptoms:
-discomfort: hunger/dehydration, excessive heat or cold
-cows’ milk protein allergy/transient lactose intolerance
Describe management of infantile colic
Reassure the patients/carers that infantile colic is a common problem that should resolve by 6 months of age:
-sources of information and support
-advise on strategies that may help to soothe a crying infant
Arrange for follow-up of the infant and family, depending on clinical judgement (consider an alternative underlying cause for symptoms)
What are head lice?
Parasitic insects that infest the hairs of the human head and feed on blood from the scalp
Describe the diagnosis of head lice
Detection combing – most reliable way to confirm the presence of head lice & much more reliable that visual inspection
Live louse must be found in order to confirm active head lice infestation
Describe the symptoms of head lice
Itching
Lice on scalp
Lice eggs
Sores on the scalp, neck and shoulders
Describe the management of head lice
Wet combing – systematic combing on wet hair with a louse detection comb to remove head lice eg. bug buster kit
Physical insecticide
Chemical/traditional insecticide
Describe GORD in children
GOR is the passage of gastric contents into the oesophagus, considered physiological in infants when symptoms are absent/not troublesome
GORD in children = presence of troublesome symptoms or complications arising from GOR
List symptoms of GORD in children
Distressed behaviour shown, by excessive crying, crying while feeding & adopting unusual neck postures
Hoarseness and/or chronic cough
Single episode of pneumonia
Unexplained feeding difficulties
Faltering growth
List differentials for GORD children
Frequent, forceful vomiting
Bile-stained vomit
Abdominal distension, tenderness or palpable mass
Blood in vomit
Describe the management of GORD in children
Reassure parents and carers that in well infants, effortless regurgitation of feeds is very common
Refer if there are any red flag symptoms eg. haematemesis, melaena & dysphagia
What is teething?
Normal physiological process which describes when deciduous teeth emerge through the gums, causing usually mild and localised symptoms
Describe the symptoms of teething
Start 3-5 days before each tooth eruption:
-pain
-increased biting & chewing
-drooling
-gum-rubbing
-sucking
List differentials for teething
Physiological drooling
Eruption cyst
Infection
Eruption hematoma
Describe the management for teething
Exclude any alternative conditions
Offer parents/carers advice on sources of information and support
Self-care measures to relieve teething symptoms: gentle rubbing of the gum with a clean finger, allow the infant to bite on clean and cool object
Consider the use of analgesics if self-care measures don’t work
What is chickenpox?
Caused by the varicella zoster virus, causes a highly contagious generalised vesicular rash
Once a child has had an episode of chickenpox, they develop immunity to the VZV virus & will not be affected again
Describe presentation of chickenpox
Characterised by widespread, erythematous, raised, vesicular (fluid filled), blistering lesions
Rash usually starts on the trunk/face & spreads outwards affecting the whole body over 2-5 days
Eventually the lesions scab over at which point they stop being contagious
Symptoms: fever, itch, general fatigue & malaise
List complications of chickenpox
Bacterial superinfection
Dehydration
Conjunctival lesion
Pneumonia
Encephalitis
Describe management of chickenpox
Mild self limiting condition that does not require treatment in otherwise healthy children
Aciclovir – may be considered in immunocompromised patients, adults and adolescents over 14 years presenting within 24 hours, neonates or those at risk of complications
Complications such as encephalitis require admission for inpatient management
Symptoms of itching – treated with calamine lotion & chlorphenamine (antihistamine)
Patients should be kept off school & avoid pregnant women and immunocompromised – usually 5 days after the rash appears
What is scarlet fever?
Infectious disease caused by toxin-producing strains of the bacterium Streptococcus pyogenes, also known as group A streptococcus
List complications of scarlet fever
Suppurative complications – local spread, such as otitis media, peritonsillar abscess
Non-suppurative complications – acute rheumatic fever & acute post-streptococcal glomerulonephritis
List symptoms of scarlet fever
Initial sore throat, fever, headache, fatigue, nausea and vomiting
Pinpoint, sandpaper-like blanching rash that develops on the trunk 12-48 hours after initial symptoms
Possible strawberry tongue, cervical lymphadenopathy, circumoral pallor
List differential diagnosis for scarlet fever
Rubella
Parvovirus B19 infection
Measles
Describe the management of scarlet fever
If the patient does not need hospital admission, prescribe phenoxymethylpenicillin four times a day for 10 days first-line
Amoxicillin as an alternative, azithromycin once a day for 5 days for people with a true penicillin allergy
Notify PHE within 3 days by completing a notification form if a diagnosis of scarlet fever is suspected
Advise the person to arrange follow up if symptoms worsen or have not improved after 7 days
Describe Perthes disease
Involves disruption of blood flow to the femoral head, causing avascular necrosis of the bone -> affects the epiphysis
Occurs in children aged 4-12 years, mostly between 5-8 & is more common in boys
List the symptoms of Perthes disease
Slow onset of:
-pain in the hip or groin
Limp
Restricted hip movements
May be referred pain to the knee
Describe the management of Perthes disease
Initial management = conservative -> aim of management to maintain a healthy position & alignment in the joint eg. bed rest, traction, crutches & analgesia
Physiotherapy
Regular x-rays
Surgery
Describe slipped upper femoral epiphysis (SUFE)
Head of the femur is displaced along the growth plate
More common in boys & obese children and typically presents aged 8-15 years
Describe the typical presentation of SUFE
Adolescent, obese male undergoing a growth spurt, may be history of minor trauma
Symptoms can be vague: hip, groin, thigh/knee pain, restricted range of hip movement, painful limp, restricted movement in the hip
Examination – patient will prefer to keep the hip in external rotation, limited movement of the hip, particularly restricted internal rotation
Describe the management of SUFE
Surgery – required to return the femoral head to correct position & fix it in place to prevent it slipping further
What is a threadworm?
Parasitic worm which infects the human gut, occurs by the faeco-oral route when threadworm eggs are ingested
Describe the symptoms of threadworm
Intense perianal itching, typically worse during the night
Some people may be asymptomatic & only become aware of infection when small white thread-like worms are seen on the perianal skin/in the stools
Females = genital area can also be involved
Nocturnal itching may lead to disturbed sleep and irritability
List differentials for threadworms
Other causes of perianal & vulvular itch: skin conditions, infections, GI disease
Roundworm
Tapeworm
Describe the management of threadworms
Explain the diagnosis and management to the person
Treat with a single dose of an anti-helminthic (dose may need to be repeated in 2 weeks if infection persists)
Advise rigorous hygiene measures for 2 weeks if treated with mebendazole (anti-helminthic) or 6 weeks if using hygiene measures alone
What is mesenteric adenitis? What is the treatment?
Mesenteric adenitis – inflamed abdominal lymph nodes
Presents with abdominal pain, usually in younger children & often associated with tonsillitis/URTI
No specific treatment is required
