Paediatrics Flashcards
Eczema presentation-
Children- scalp, extensor regions, face.
Chronic eczema- flexure regions
Adults- Fingers/hands
DDx- Urticaria, scabies
Eczema Management-
Avoid irritants Emollients Steroids few times a week for 4-6wks to enter remission. 1) 1% hydrocortisone 2) betnovate, eumovate 3) beclometasone, betnovate 4) dermovate
Functional constipation criteria-
Need 2 or more of: <3 stools/week Hard lump stool Rabbit dropping stool Overflow soiling in >1yrs
Functional constipation red and yellow flags:
Red: Hirschburg's disease- Megacolon (large bowel) due to absence of autonomic innervation. Meconium produced >48hrs after birth, constipated since birth, abdominal distension + vomiting, FHx. CF- Constipated since birth. Anal stenosis- Ribbon stool. Anal abnormalities; fissures, fistulae. Lumbosacral abnormalities/weakness.
Yellow;
Poor growth- coealiacs, hypoT, CF.
Constipation post cows milk- allergy.
Child maltreatment
Functional constipation management-
Reassurance
1) Movicol paediatric plan
2)+ Stimulant laxative if not resolved within 2 wks.
If allergic to (1) then use lactulose instead.
Should continue meds for several weeks after normal bowel function returned, then wean off.
Viral wheeze-
Common LRTI in primary school.
RNA virus.
DDx- Asthma, respiratory infection.
Manage with symptom relief, SABA for acute symptoms, may use LTRA intermittently.
Osgood-Schlatters disease-
RF
Features
Inflammation of the epiphysis, usually at time of growth spurt, if lots of physical activity requiring knee bending.
Usually unilateral knee pain, at the point of PL insertion onto TT. Slow progressing, starts of mild and intermittent then progresses to severe and constant. Relived with rest, worse on activity.
Osgood Schlatters disease-
DDx
Management
Knee injury following trauma- Onset post trauma, affecting any age.
Perthes disease- Avascular necrosis of the femoral head, pain at hip, affecting 4-8yrs old.
Slipped Upper Femoral Epiphysis- Can occur acute post trauma or chronic. Pain at hip, groin, medial thigh and knee.
Management- Reassure/advice that pain should subside (max 2yrs). Analgesia, ice packs.
Reduce activity to reduce pain.
Prevention through hamstring and quadricep stretches.
Threadworms-
Parasite, spreads via OF route. Test with tape test.
Symptoms include perianal itching, worse at night, aymptomatic or in females can get vulval itching.
Manage-
>6months- mebendazole + strict hygeine.
<6 months/breastfeeding/pregnant- 6 weeks strict hygeine.
Toddlers diarrhoea-
Common in 1-5yrs old.
DDx
Infection->3 stool movements/day, abdominal pain/cramping, +/- N+V, fever, malaise.
IBD- FHx, failure to thrive, extra-intestinal manifestations.
Coeliac- within 9-24months, malabsorption, weight loss, steatorrhea, failure to thrive, child miserable/behavioural changes.
Dietary intolerance- usually within 2hrs of ingestion.
Toddlers diarrhoea-
Management
Usually child is fine
Reassure with resolve by age 5-6yrs.
Avoid full strength fruit juice, carrots, peas and corn
Allergic Rhinitis-
DDx- Infective or non allergic rhinitis.
Manage-
Remove/refrain from triggers.
Nasal decongestant
Nasal saline irrigation (wash nose out with salt water)
Medications; chlorphenamine (drowsy), cetirizine, intranasal anti-histamines (work faster).
If mild/moderate/intermittent- oral/intranasal AH
If non-resolving/severe/persistent- intranasal corticosteroids.
If still persisting then oral corticosteroids.
GORD in children-
Suspect if >1yr with retrosternal pain, epigastric pain and reflux. May also have hoarse cough, difficulty eating, single pneumonia episode etc.
Management-
Ensure reflux is normal and will self resolve.
In breastfeeding- give alginate.
Non breast feeding-> 1) Ensure not over fed 2) Feed little but often 3) Use feed thickener 4) Stop feed thickener but use alginate.
Headlice-
Only diagnose if live lice found.
Chicken pox-
Infectious 1-2 days before the rash appears until it has crusted over. Rash at head/trunk initially-macular then papular then vesicular.
Pregnancy chicken pox can lead to fetal varicella syndrome. Later in pregnancy can lead to neonatal chicken pox.
Usually self limiting
Can apply calamine lotion.
