Paediatrics Flashcards
Where should temp be taken in children?
less than 4 weeks of age, use or recommend an electronic thermometer in the axilla.
In children aged 4 weeks to 5 years of age, use or recommend either an electronic thermometer or a chemical dot thermometer in the axilla, or an infra-red tympanic thermometer.
What thermometers are not appropriate
Head
Oral
Rectal
What are the 8 red symptoms in a child with fever?
Pale/mottled No response/difficult to rouse Weak/high pitched cry Resp - grunting/chest indrawing/RR>60 DeHydration Fever >5 days meningism Seizures
How does the traffic light system work for feverish children?
Green - self care
Amber - face to face review
Red - CED
Safety net for children with fever
The child develops a non-blanching rash or other signs of central nervous system infection. .
The child has a seizure..
The child is becoming dehydrated and self-management measures are not helping.
The fever lasts longer than 5 days (may indicate Kawasaki disease or other serious illness if there are associated symptoms and signs).
The child is becoming more unwell.
They are distressed or concerned that they are unable to look after the infant or child at home.
How should antipyretics be used in kids with fever?
If they are upset/uncomfortable
Stop when they are comfortable
Don’t use if they have a fever but are alright
Can you use antipyretics prophylactically to reduce febrile seizures?
No
How should you use paracetamol of ibuprofen to treat kids with fever?
Paracetamol OR Ibuprofen
Do NOT give simultaneously
Aside from medication what 5 self care advice to parents with feverish child?
Regular fluids - Signs of dehydration Dress appropriately for environment Avoid tepid sponging Check regularly No school
Mina symptom of threadworm?
Intense perianal itching, typically worse during the night
In female pts may migrate to vulva
3 symptoms that would lead to suspected threadworm infection?
perianal and/or vulval itching and restlessness or insomnia.
Appearance of threadworms in the stools or on the peri-anal skin.
Contacts with similar symptoms or confirmed infection
What might you find on examination in pt with threasworm?
Signs of scratching (excoriation) and localized secondary bacterial infection in the perianal area.
Worms in the perianal area (it is unusual to see these when the person is examined during the day).
Is exclusion from school necessary for threadworm infection?
No
Treatment for threadworm
single dose of an anti-helminthic such as mebendazole
Family will need it
Bedding cloths all washed for 2 weeks
Hygiene measures for threadworm infection
Wash hands thoroughly with soap and warm water after using the toilet, changing nappies and before handling food.
Cut fingernails regularly, avoid biting nails and scratching around the anus.
Shower each morning, including the perianal area, to remove eggs from the skin.
Change bed linen and nightwear daily for several days after treatment.
Do not shake out items as this may distribute eggs around the room.
Washing/drying in a hot cycle will kill pinworm eggs.
Thoroughly dust and vacuum (including vacuuming mattresses) and clean the bathroom by ‘damp-dusting’ surfaces, washing the cloth frequently in hot water.
Time difference between acute and chronic otitis externa?
Acute if it has lasted for 3 weeks or less.
Chronic if it has lasted for longer than 3 months.
Most common cause of acute otitis externa?
Bacterial infection
Non infective causes of acute otits externa?
Seborrhoeic dermatitis
Contact dermatitis
Trauma
Swimming in polluted water
What is the most likely cause of chronic otits externa?
Contact dermatitis
Fungal infection
Bacterial possible but unlikely
Risk factors for malignant otitis externa?
DM
Immunosuppression
Radiotherapy
Tap water irrigation
How long does acute otits media clear up following initiation of treatment?
48–72 hours
What do you suspect with these symptoms?
Itch (typical).
Severe ear pain, disproportionate to the size of the lesion (typical).
Pain made worse when the tragus or pinna is moved, or when an otoscope is inserted (typical).
Tenderness on moving the jaw.
Otitis externa
What do you suspect with these signs?
The ear canal or external ear, or both, are red, swollen, or eczematous with shedding of the scaly skin.
Swelling in the ear canal is typical of an early presentation of localized otitis externa; later the swelling has a white or yellow centre filled with pus; occasionally this progresses and the swelling eventually completely occludes the ear canal.
Discharge (serous or purulent) may be present in the ear canal.
Inflamed eardrum, which may be difficult to visualize if the ear canal is narrowed or filled with debris
Otitis externa
Management for localised otits externa?
Analgesia and heat
Antibiotics rarely indicated
Drain pus if necessary
Management in people with acute otits externa?
Cleaning of debris
Analgesia
Topical antibiotics
Most common cause of otitis media in children?
Viral
Risk factors for otits media in kids?
Premature No breast feeding Passive smoking No vaccine Daycare/siblings
What is the prognosis of otits media if you don’t use antibiotics?
symptoms will improve within 24 hours in 60% of children with acute otitis media (AOM) [Venekamp et al, 2015], and most people will recover within 3 day
Other than earache what are the symptoms of ottis media in young children?
Pulling/tugging at the ear
Crying
Off food
Restless
You see the following on examination with the otoscope what is the likely diagnosis?
A distinctly red, yellow, or cloudy tympanic membrane.
Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks and an air-fluid level behind the tympanic membrane (indicates a middle ear effusion).
Perforation of the tympanic membrane and/or discharge in the external auditory canal.
Otitis media
On examination with otoscope what clinical feature is NOT suggestive of AOM?
Non bulging tympanic membrane
Red flags for otitis media?
systemic infection
Meningitis
facial nerve paralysis
What is the general course of otitis media?
3 days but can be up to a week
What would the advice be in uncomplicated otitis media?
Analgesia
No evidence that decongestants or antihistamines help
Which may benefit from antibiotics in AOM?
those with otorrhoea, or those aged less than 2 years with bilateral infection
Do antibiotic make any difference to the symptoms, development of complications in acute otitis media?
No
Safety net for AOM?
If not better in 3 days
pain gets markedly worse
systemically unwell
How do you manage kids with recurrent otitis media?
Unless systemically unwell same as initial presentation
Advise to avoid passive smoking
What is the usual presenting feature for acute otitis media with effusion
Hearing loss
Aural discharge — persistent foul smelling discharge requires urgent referral.
Recurrent ear infections, upper respiratory tract infections, or frequent nasal obstruction.
In suspected OME what night you see on examination with otoscope?
normal-looking tympanic membrane does not exclude otitis media with effusion (OME).
There are usually no signs of inflammation or discharge on examination.
An effusion can be serous, mucoid, or purulent
Investigations in suspected OME?
Tympanometry
Audiometry
What congenital features make children more prone to OME?
Downs syndrome
Cleft palate
Main distinguishing features between OME and AOM?
AOM - pain hearing usually normal
OME - not usually painful and hearing loss
Management of OME in children?
6-12 week observation as usually self resolving
reassess during this period
What treatments are not recommended for OME and why?
Antibiotics. Antihistamines. Mucolytics. Decongestants. Corticosteroids. - no evidence
How do you diagnose an active infestation of head lice?
Combing and finding a live one
Treatment choices for headlice?
Physical insecticide
Chemical insecticide
Wet combing
What is the name of the physical insecticide for head lice?
dimeticone
What is the name of the chemical insecticide for headlice?
Malathion
With headlice is it important to treat all household members on the same day?
Yes
Do you need to boil wash clothes to get rid of headlice?
No
Can kids with headlice still attend school
Yes
What is the regimen for wet combing?
Four sessions over two weeks
Can head lice be prevented?
No - just do regular checks
5 Common rashes in children
Chicken pox Roseola Measles Rubella Erythema Infectiousom
Rash - everywhere, vesicles on papules, very pruritic, 1-3 prodrome and fever
Chicken pox
Rash - starts on neck, non pruritic, high fever, cough, respiratory symptoms, erythematous pharynx and tonsils
Roseola
Rash - starts on face, non pruritic, Cough, Coryza, Conjunctivitis, Koplick spots,
Measles
Rash - starts on face, pink, pruritic, non-specific prodrome,
Rubella
5 days fever, conjunctival injection, cervical
lymphadenopathy, Oropharyngeal changes
(including hyperaemia, oral fissures, strawberry
tongue, Peripheral extremity changes (including
desquamation of hands and feet, erythema,
oedema)
Kawasaki disease
What are the primitive reflexes in a newborn and when should they disappear by?
Moro
Babinski
6 months
When does tummy time start?
6-8 weeks
When sit unsupported and limit?
6months
deadline 9
When start crawling?
8 months
When standing and cruising?
10 months
Start walking and deadline?
12
deadline 18 months
When fix and follow and deadline?
6 weeks
deadline 3 months
Reach for toy normal and deadline?
4 months
6 deadline
Transfer deadline
9 months
Pincer grip deadline
12 months
Cooo
2 months
laugh
4 months
babababa
6 months
mama/dada
10 months
Words
12 months
50+ words
2 years
When social smile/fix and follow
2 months
Stanger anxiety starts
6 months
Symbolic play and deadline
18 months
2 years
