Paediatrics Flashcards
At what intervals are baby checks done (up to 6 weeks)?
At birth - within 72 hours
At 5-8 days - heel prick test
At 10-14 days - health visitor review
At 4-5 weeks - newborn hearing screening test
At 6-8 weeks - physical examination by GP
What conditions are screened for in heel prick test?
Sickle cell disease Homocystinuria CF Congenital hypothyroidism Phenylketouria Medium chain CoA dehydrogenase deficiency
What is done at 6 week baby check?
Thorough physical examination - eyes, heart, hips, testicles, weight, height, head circumference.
Vaccinations discussed.
What are the key milestones in development of baby?
Newborn = should be able to lie on back and turn head 6-8m = should be able to sit up and look at objects. Should be able to crawl. 12m = should be able to walk with a broad gait.
Types of abuse that need to be considered in child safe guarding?
Neglect - do not meet child’s basic needs
Physical - deliberately hurting a child
Emotional - persistent emotional maltreatment of child
Sexual - any sexual activity with a child.
Signs of abuse in children?
Consistent poor hygiene Ill fitting or dirty clothes Behavioural changes Avoidance of family members Problems at school Child mentions being left alone Do not want to go home Milestones not met Sexualised behaviour Children concern for younger siblings
Causes of neonatal jaundice?
Liver staring to work and take over from placenta (to excrete bilirubin) Neonatal hepatitis Galactosemia Biliary atresia Breast milk jaundice
RF for neonatal jaundice?
Pre-term (before 38wks)
Exclusive breastfeeding
Siblings needed phototherapy
Complication of neonatal jaundice?
High levels of bilirubin = encephalopathy
Management of neonatal jaundice?
Phototherapy
Further investigations needed —>paeds
Describe cradle cap
Seorrhoeic eczema of infant
Starts in first few weeks of life.
Affects body folds - axilla, groin, behind ears, neck, face/scalp
Scaly erythematous flexural lesions
Yellowish crust
Management of cradle cap?
Emollients
1% hydrocortisone
If only on scalp - can get OTC cradle cap cream
Associations to atopic eczema in paeds?
Asthma
Hayfever
How to manage paeds atopic eczema ?
Avoid perfumed products.
Cover area - stop drying out
Bandage at night if very itchy
Flare up = hydrocortisone 1%
Manage any infections in cracked skin or from excoration
Signs and symptoms of H,F&M?
Sore throat Temperature Loss of appetitie Headache Fatigue Ulcers and rash appear after a few days of these initial symptoms
Management of H,F&M?
Self limiting 7-10 days Drink fluids for any dehydration Eat soft foods Paracetamol and ibuprofen for symptom relief Mouth ulcer gel and washes
Management of candidas infection in paeds?
Clotrimazole - topical anti fungal
Symptoms and signs of chicken pox/varicella zoster?
Fever
Blistered rash or itchy erythematous papule that progress to vesicles.
On stomach, back and face.
How does chicken pox spread?
Airborne respiratory droplets
Management of chicken pox?
Self limiting so symptomatic management Trim nails to reduce scratching Warm bath Moisturiser Paracetamol to reduce fever and pian Calamine lotion, antihistamines for itching
Older patients = aciclovir
Presentation of fifth’s disease?
Runny nose Headache High temperature Rash on cheeks Spotty rash on chest, arms and legs
When is pt with fifth’s disease contagious?
Before rash appears
How to manage fifth’s disease?
Symptomatic relief only - fluids, moisturiser on rash, antihistamine for itching, paracetamol, ibuprofen.
What is scarlet fever?
Bacterial infection associated with Group A streptococcus
Pts who have recently had strep throat or impetigo
Presentation of scarlet fever?
High temp/fever Sore throat Swollen LN in neck Loss of appetite Headache Nausea Fatigue Rash appears in 12-48hrs on chest and abdominal then spreads.
Rash = generalised, red, pinpoint “feels like sandpaper”
Investigation for scarlet fever?
Throat swab to confirm Dx
Management of scarlet fever?
Abx - 10 days phenoxymethylpenicillin QDS
Notify local health protection team - as is notifiable disease.
Rest, fluids, symptomatic analgesia
Advise on hygiene measures to reduce spread.
Complications of scarlet fever?
Caused by group A strep, so complications are: Rheumatic fever Otitis media Pneumonia Septicaemia Glomerulonephritis Osteomyelitis Death
What is measles?
Viral illness spread via respiratory droplets. Lasting 7-10days.
Presentation of measles?
Presents 10-12 days after exposure
Cold symptoms
Conjunctivitis
Kopek spots
Rash starts a few days after this:
Red/brown flat rash behind ears and upper neck —> spreads.
Fever starts with rash.
Contagious 5 days after rash starts.
Management of measles?
Symptomatic treatment only for 7-10 days
Complications from measles?
Encephalitis Pneumonia Otitis media Acute glomerulonephritis Myocarditis Pericarditis Laryngobronchitis Measles croup
What is rubella?
Viral infection spreads via direct contact with nasal or throat secretions of an infected individual
Contagious 7 days before rash appears to 7 days after rash appears
Presentation of rubella?
Fever Swollen glands in neck and behind ears Runny nose Malaise Petechaie on soft pallet Rash in face first then spreads - lasts for up to 5 days.
Presentation of osgood schlatters?
Sporty teenager usually
Progressive tenderness and swelling localised to the tibial tuberosity
Pain worse on running, jumping, squatting, stairs, kneeling
Management for osgood schlatters?
Rest, ice
Resolves with apophysis fuses.
What is Perthes disease?
Femoral head loses blood supply and becomes misshapen - 4-10 years old
Presentation of Perthes disease?
Pain in groin, thigh or knee esp after activity
Abnormal gait
Reduced movement of hip joint
Symptoms on and off for many months
Investigation for suspected Perthes disease?
XR - to find misshapen femoral head
Presentation of Slipped upper femoral epiphysis SUFE?
Boys>girls
11-17yrs
Overweight children
Pain in knee, hip or groin. Difficulty walking Externally rotated and shortened Reduced range of movement Sudden onset
What is Slipped upper femoral epiphysis SUFE?
Femoral head slips posteriorly
Investigation for Slipped upper femoral epiphysis SUFE?
XR
Management of Slipped upper femoral epiphysis SUFE?
Surgical fixation
