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Paediatric Flashcards

1
Q

what are common viral cases of tonsilitis

A

adenovirus
EBV

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2
Q

what is the commonest bacterial cause of tonsilitis

A

group A strep (strep. pyogenes)

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3
Q

what risk factor greatly increases the chance of tonsilitis

A

smoking
- either second hand smoke from parents or personal smoking in older children

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4
Q

what will the duration of symptoms likely be in tonsilitis

A

5-7 days

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5
Q

symptoms lasting longer than 7 days are suggestive of what diagnosis

A

glandular fever

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6
Q

what are common presenting symptoms of tonsilitis

A
  • odynophagia
  • fever
  • reduced oral intake
  • halitosis
  • new onset snoring
  • SOB
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7
Q

what are examination findings of tonsilitis

A
  • red inflamed tonsils
  • white exudate spots
  • anterior cervical lymphadenopathy
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8
Q

what are the 2 main scoring criteria used in tonsilitis

A
  1. feverPAIN
  2. Centor

Antibiotics will most likely benefit a patient when their sore throat is caused by streptococcal bacteria

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9
Q

what makes up the Centor Criteria

A
  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenitis
  • Fever or history of fever
  • Absence of cough
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10
Q

how is the centor criteria interpreted

A
  • score of 2 or less suggests bacterial infection is unlikely (80% likelihood)
  • score of 3 or more is highly suggestive of bacterial infection (40-60% likelihood)
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11
Q

what makes up the feverPAIN score

A
  • Fever (during previous 24 hours)
  • Purulence (pus on tonsils)
  • Attend rapidly (within 3 days after onset of symptoms)
  • Inflamed tonsils
  • No cough or coryza
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12
Q

how is the FeverPAIN score interpreted

A
  • Score 0-1 suggests a 13-18% chance of streptococcal infection
  • Score 2-3 is 34-40% chance
  • Score 4-5 is 62-65% chance
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13
Q

what organism is the streptococcal score card specific to

A

group A strep

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14
Q

what are the criteria of the streptococcal score card

A
  • Age 5-15
  • Season (between late autumn and early spring)
  • Fever (>38.3°C)
  • Cervical lymphadenopathy
  • Pharyngeal erythema, oedema, or exudate
  • No viral URTI symptoms (eg. coryza, etc.)
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15
Q

how is tonsillar size graded

A

according to the proportion of the oropharynx occupied

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16
Q

give 5 differential diagnoses for tonsilitis

A
  • quinsy
  • pharyngitis
  • glandular fever
  • tonsillar malignancy
  • epiglottitis
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17
Q

what is the first decision that needs to be made when a child presents to GP with suspected tonsilitis

A

decide whether inpatient admission is required or not

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18
Q

what features suggest severe tonsilitis/alternative diagnosis and require urgent admission & assessment

A
  1. resp compromise e.g. tachypnoea, low sats, accessory muscle use
  2. unable to eat/drink and are at risk of dehydration
  3. have previously been treated with appropriate abx in community and not getting bettern
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19
Q

what is the abx of choice for tonsilitis

A

benzylpenicillin/phenoxymethylpenicillin
- dosed according to weight

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20
Q

what is the duration of abx for tonsilitis

A

7-10 days

switch to oral pencillin V when child clinically improving and able to swallow

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21
Q

why is co-amox often avoided in cases of tonsilitis

A

due to small risk of permanent skin rash if tonsilitis is due to glandular fever

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22
Q

which analgesics may be appropriate in tonsilitis

A
  • paracetamol/ibuprofen
  • topica e.g. difflam spray to reduce pain and allow child to swallow oral analgesics
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23
Q

what are possible complications of tonsillitis

A
  • peritonsillar abscess
  • recurrent tonsillitis
24
Q

what is the management if the tonsillitis infection spreads into the retro or parapharyngeal spaces

A

Prolonged IV abx and sometimes surgical drainage

25
what is croup and what is it characterised by
- **upper respiratory tract infection** seen in infants and toddlers - characterised by **stridor** which is caused by a combination of **laryngeal oedema and secretions**
26
what virus accounts for most cases of croup
parainfluenza
27
what are the features of croup
- cough: barking, seal-like, worse at night - stridor * fever * coryzal symptoms * increased work of breathing e.g. retraction
28
should the throat be examined in croup
NO: risk of precipitating airway obstruction
29
what are the NICE recommendations for admitting a child with croup
* moderate or severe croup * < 3 months of age * known upper airway abnormalities (e.g. Laryngomalacia, Down's syndrome) * uncertainty about diagnosis (important differentials include acute epiglottitis, bacterial tracheitis, peritonsillar abscess and foreign body inhalation)
30
how is croup investigated
- majority - clinical diagnosis - CXR
31
what will CXR of croup show
- PA: subglottic narrowing aka steeple sign - lateral: swelling of epiglottis aka thumb sign
32
what is the management of croup
- **single dose dexamethasone 0.15mg/k**g to all children regardless of severity - prednisolone as alternative
33
what is the emergency treatment of croup
- high flow O2 - nebulised adrenaline
34
what is the most common cause of serious LRTI in <1 yr olds
bronchiolitis
35
what is bronchiolitis
condition characterised by acute bronchiolar inflammation
36
what is the most commonly associated pathogen with bronchiolitis
RSV ## Footnote other causes: mycoplasma, adenoviruses
37
what are the clinical features of bronchiolitis
* coryzal symptoms (including mild fever) precede: * dry cough * increasing breathlessness * wheezing, fine inspiratory crackles (not always present) * feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
38
NICE recommend immediate referral if they have any of the following features of bronchiolitis:
* **apnoea** (observed or reported) * child looks seriously unwell to a healthcare professional * **severe respiratory distress**, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute * **central cyanosis** * persistent oxygen saturation of less than 92% when breathing air
39
how may bronchiolitis be investigated
immunofluorescence of nasopharyngeal secretions may show RSV
40
what is the management of bronchiolitis
largely supportive * **humidified oxygen** is given via a head box and is typically recommended if the oxygen saturations are persistently < 92% * **nasogastric feeding** may be needed if children cannot take enough fluid/feed by mouth * **suction** is sometimes used for excessive upper airway secretions
41
what is viral wheeze in children commonly caused by
RSV rhinovirus parainfluenza
42
what is the management of viral wheeze in children
self resolves in 7-10 days - salbutamol/anticholinergic via spacer - next step is leukotriene receptor antagonist e.g. montelukast or ICS
43
what are red flags of viral wheeze in children
- severe resp distress - silent chest - o2 sats < 92% - poor feeding - lethargy
44
what are important ddx for viral wheeze in children and how can they be differentiated
- asthma - inhaled foreign body - resp infection
45
what is osgood-schlatter's disease
osteochondrosis characterised by inflammation at the tibial tuberosity - traction aphophysitis thought to be caused by repeated avulsion of the apophysis where the patellar tendon inserts
46
how does osgood-schlatter's disease present
gradual onset of symptoms * Visible or palpable hard and tender lump at the tibial tuberosity * Pain in the anterior aspect of the knee * pain is exacerbated by physical activity, kneeling and on extension of the knee
47
what is the management of osgood-schlatter's disease
initially focus on reducing pain and inflammation - reduce physical activity - ice - NSAIDs then once symptoms settle, use stretching and physio to strengthen the joint and improve function
48
what is a rare complication of OSD
complete avulsion fracture where tibial tuberosity separates from the rest of the tibia ## Footnote requires surgical intervention
49
what is the most common cause of gastroenteritis in children
rotavirus
50
what are important ddx for OSD
- injury - Perthe's - SUFE
51
what is the most common cause of chronic diarrhoea in infants
cow's milk intolerance
52
what are other causes of toddler diarrhoea
- coeliac disease - dietary intolerances - infection
53
what organism is threadworm caused by and how does infestation occur
enterobius vermicularis - infestation after swallowing eggs present in the environment
54
what are the clinical features of threadworms
typically asymptomatic in 90% - perianal itching esp at night - girls may have vulval symptoms
55
how are threadworms diagnosed
apply sellotape to perianal areas and send to lab for microscopy to see eggs
56
how are threadworms managed
- combination of **anthelmintic + hygiene measures** for **all** members of household - **single dose mebendazole** 1st line for children > 6 months

GENERAL PRACTISE (13 decks)

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