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PACES Y5 Investigations and management > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Down’s syndrome presentation investigations

A
  • Look for features of Down’s Syndrome (give examples)
  • Karyotyping - Trisomy 21 (confirms diagnosis)

Health complications
• Cardiac echo - ASD, VSD, Tetralogy of Fallot
• Abdo USS - biliary/duodenal atresia

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2
Q

Down’s syndrome counselling

A
  • What - Extra chromosome 21
  • Re-occurence - higher age and genetics, can get genetic testing for both parents
  • General care - LD, long-term care, health problems
  • Heart disease, hearing problems (otitis media), vision problems (cataracts), hypothyroidism

Management
• MDT (paeds, GP, social worker, specialists (cardio, neuro, gastro etc.)
• Educate parents - support groups
• Early - physio, SALT
• Medium - specialist school, regular review
• Long - help with employment, living independently, fertility

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3
Q

Neonatal jaundice investigations

A 
Bedside and bloods approach
• Obs
• Skin examination
• Abdominal examination
• Urine dip, MC&S
  • Blood group
  • DAT
  • FBC and blood film
  • G6PD
  • Blood culture
  • Bilirubin
  • TSH
  • LFT
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4
Q

Neonatal jaundice (hyperbilirubinaemia) management

A
  • Phototherapy or exchange transfusion - refer to treatment threshold graph
  • In phototherapy - eyes protected, blood samples taken regularly, can breastfeed and provide skin to skin contact, heated incubator to make baby feel comfortable

• Hydration e.g. encourage frequent breastfeeding

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5
Q

Asthma investigations

A
  • Obs
  • Peak expiratory flow rate
  • Resp exam
  • Consider spirometry
  • Consider skin-prick testing
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6
Q

Asthma management

A

10 puffs of salbutamol through a spacer

Long-term:

  1. SABA
  2. Low-dose ICS
  3. Add LTRA
  4. Stop LTRA, start LABA
  5. Change ICS and LABA for MART (maintenance and reliever therapy)
  6. Increase ICS to moderate dose
  7. Specialist referral, consider high-dose ICS and trial of theophylline

Provide personalised asthma action plan from Asthma UK
Trigger avoidance
Ensure patient has own peak flow meter
Explain how to use inhalers

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7
Q

Bronchiolitis investigations

A
  • Obs
  • Resp exam - coughing, work of breathing, auscultation of lungs
  • Nasopharyngeal swab would show RSV (not routine)
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8
Q

Bronchiolitis counselling

A

Reassure and discharge
• Common virus causing these symptoms, should resolve in 2 weeks
• Oxygen sats showing they are oxygenating well
• We think its mild and no medication needed, (palivizumab for high-risk preterm)
• Make sure they are feeding well, return if <75%
• Contagious - avoid other infants

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9
Q

Cow’s milk protein allergy investigations

A
  • Obs

* Examination - skin (signs of anaphylaxis), abdominal, resp

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10
Q

Cow’s milk protein allergy management

A

IgE-mediated (minutes after ingestion)
• Allergy testing
• Paeds dietician referral
• Exclude cow’s milk protein from mother’s diet if breastfeeding
• Extensively hydrolysed formula if formula fed
• Elemental (amino acid) formula if that doesn’t work

Non-IgE mediated (2-72 hours after ingestion)
• Same as above but first 2 steps only if severe

Weaned
• Exclude CMP from diet
• Nutritional counselling from paeds dietician
• Regularly monitor growth
• Reintroduce into diet - follow Milk Ladder (Allergy UK)

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11
Q

Croup investigations

A
  • Obs - A-E approach (RR, O2 sats, HR)
  • Avoid examining throat
  • Fluid balance assessment
  • Resp exam
  • Urine dip

• CXR - thumb and steeple sign, not usually done

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12
Q

Croup mild, moderate, severe management (according to Westley croup severity score)

A

All
• Oral dexamethasone (single dose for all patients, inhaled bec or IM dex if not possible)
• Analgesics

Mild
• No admission
• Safety net

Moderate
• Oxygen

Severe
• Admit
• Can give steroids while transported if travelling from GP
• Airway support (paeds, nurse, anaesthetists involved)
• O2 high flow via non-rebreathe mask
• Nebulised adrenaline (1 in 1000 1mg/ml), risk of rebound so close monitoring

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13
Q

Mild croup counselling

A
  • Infection and inflammation of the airways
  • Very common, have given some medication and should get better within 48 hours
  • Keep caring at home with calpol, plent of fluids, and sitting upright
  • Comfort child if distressed
  • Come back to if symptoms don’t go away
  • Call ambulance if drooling, trouble breathing, lethargic
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14
Q

Cystic fibrosis investigations

A
  • Obs
  • Examination
  • Sweat test
  • Genetic testing (and family) - delta F508 mutation
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15
Q

CF counselling

A
  • Lifelong condition with recurrent resp infections and malabsorption
  • Referred to specialist cystic fibrosis centre
  • MDT approach
  • Lungs - physio, mucoactive agents (lumacaftor - potentiator, ivacaftor - corrector)
  • Infection - prophylaxis (staph aureus), acute infection (pseudomonas aerigunosa)
  • Nutrition - enzyme tablets (creon), high-calorie diet, monitor growth
  • Psychosocial - support for child and carers

Consider genetic testing if planning on having another child

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16
Q

Food allergy investigations

A
  • IgE immunoassay

* Skin prick

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17
Q

Food allergy management/counselling

A
  • Avoid allergens
  • Mild - non-sedating antihistamines
  • Severe - IM adrenaline and salbutamol if bronchospasm
  • Educate on how to manage allergic attack (allergy action plan) and provide epi-pen
  • Consider food challenge after 6-12 months of being symptom-free
  • Consider in hospital if previous severe reaction
  • Nuts and seafood allergies usually persist into adulthood
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18
Q

Pneumonia investigations

A

Bedside, bloods, imaging approach

  • Obs
  • Resp exam
  • Urinalysis
  • FBC and CRP
  • Cultures

• CXR

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19
Q

Pneumonia management

A
  • Amoxicillin/clarithromycin 5 days
  • Co-amoxiclav high severity
  • Antipyretics
  • Adequate hydration
  • Advise against parental smoking
  • CHeck child regularly during day and night
  • Return if RR increases, dehydration, or worsening fever

Hospital admission if O2 < 92%, grunting, marked chest recession, RR > 60

  • Supplemental O2
  • PO abx if tolerated, otherwise IV and review to switch back after 48 hours
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20
Q

Sore throat (pharyngitis and tonsillitis) investigation

A
  • Obs
  • Top to toe examination including throat, skin, cervical lymph nodes and ears
  • Consider throat swab (rapid antigen test for group A strep)
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21
Q

Sore throat management

A

Group A strep confirmed (FeverPAIN 4/5 or Centor 3/4) or very unwell

  • Phenoxymethylpenicillin (5-10 days) or clarithromycin
  • Avoid amoxicillin in case mono
  • Adequate fluid intake
  • Antipyretics
  • Salt water gargling, difflam
  • Return to school 24 hours after taking abx / feeling well
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22
Q

Scarlet fever abx

A

Phenoxymethylpenicillin or azithromycin

Notify Health Protection Unit

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23
Q

Sinusitis treatment

A

< 10 days
• Antipyretics
• Nasal saline
• IN corticosteroid

> 10 days
• IN corticosteroid 14 days
• Back-up prescription (7 days) - 1. phenoxymethylpenicillin, 2. co-amoxiclav

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24
Q

Viral-induced/episodic wheeze management

A

Burst therapy
• 10 puffs of salbutamol using a high-volume spacer
• Puff every 30 seconds

Assess for response, repeat every 10-20 minutes
Discharge after 4 hours with no symptoms
Give salbutamol weaning regime (explain similar management to hospital, at home)

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25
Q

Whooping cough investigations

A

Bedside and bloods approach
• Obs
• Respiratory exam (cardio and abdo for completion)
• PCR of nasopharyngeal aspirate
• Consider IF antibody testing of perinasal swabs

• FBC, CRP, U&E

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26
Q

Whooping cough management

A
  • ABx - macrolide e.g. clarithromycin (cough can still persist after ABx)
  • Fluids
  • Rest
  • Calpol
  • School exclusion until 48 hours after starting ABx or 21 days after onset of cough if not treated
  • Prophylaxis - macrolide to close contacts, particularly if not immunised
  • Safety net - come back if seizures, signs of respiratory distress, dehydration or weight loss
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27
Q

Coeliac investigations

A

Bedside, bloods, imaging approach
• Obs
• Abdo exam
• Faecal fat - Sudan Stain

  • FBC, glucose, LFTs, U&E
  • Vit D, Vit B12, folate, iron
  • Calcium
  • CRP/ESR
  • IgA TTG ab
  • EMA ab

• Jejunal/distal duodenal biopsy endoscopically

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28
Q

Coeliac counselling

A
  • Inability to digest gluten
  • Common but lifelong condition
  • MDT - gastro, dietician, endo, speicalist nurse
  • Dietician can help modify diet, how to manage in social settings and avoid cross contamination. Also iron supplementation.
  • Annual review to monitor height and weight, review symptoms, assessment of diet
  • Coeliac UK
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29
Q

Constipation investigations

A
  • Abdominal examination - masses, tenderness

* Could do obs and further examination for completeness but not necessary

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30
Q

Constipation management

A
  • Balanced diet with fibre and adequate fluid intake
  • Regular toileting
  • Behavioural interventions e.g. star chart
  • Consider asking health visitor to support

Faecal impaction

  1. Osmotic laxative (movicol paediatric plain - polyethelene glucol 3350) for 2 weeks or until impaction resolves
  2. Stimulant laxative (senna)

• Can continue at maintenance dose until regular bowel habit established

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31
Q

Constipation management for infants not weaned and weaned

A

Not weaned
• Breast-fed: unsual, consider organic
• Bottle-fed: extra water between feeds, abdo massage, bicycling legs

Weaned
• Extra water, diluted juice
• Lactulose if not effective

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32
Q

Crohn’s investigations

A

Bedside, bloods, imaging approach
• Obs
• Abdominal examination (including mouth)

  • FBC (anaemia)
  • CRP
  • Faecal calprotectin
  • Vitamin B12 and vitamin D
  • AXR - dilated loops, strictures
  • Colonoscopy - inflamed, thickened, strictures/fistulae, skip lesions ‘cobble-stone’
  • Biopsy - inflammation in all layers, increased goblet cells and granulomas
  • Small bowel enema/barium study - Kantor’s string sign, ‘rose thorn’ ulcers
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33
Q

Crohn’s counselling

A
  • Condition with unknown cause
  • Digestive system is inflamed and problems absoring nutrients
  • Life-long, risk of relapse - important we control it now
  • Medication can be used to settle down the inflammation every time it flares up
  • Will be seen by gastroenterologist
  • No special diet, but may find certain foods will make it worse
  • Recommend liquid diet during flare ups
  • Complications - osteoporosis, erythema nodosum, bowel cancer

• Support: Crohn’s Colitis UK

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34
Q

How to induce remission in Crohn’s (first 2 options)?

A
  1. Corticosteroids

2. Aminosalicylates e.g. mesalazine

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35
Q

How to maintain remission in Crohn’s?

A
  • Check thiopurine methyltransferase
  • Give azathioprine (methotrexate 2nd line)
  • Monitor for neutropaenia
  • Monitor monthly - check for anaemia, vit deficiency
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36
Q

Gastro-oesophageal reflux investigations

A
  • Obs
  • Alert, hydration status
  • Abdominal exam
37
Q

Gastro-oesophageal reflux management

A
  • Very common, tends to start <8 weeks, becomes less frequent with time
  • Due to immature lower oesophageal sphincter
  • Advise 3- degree head-up during feeds
  • Health visitor can provide support with technique
  • Consider trial of smaller and more frequent feeds
38
Q

Gastro-oesophageal reflux DISEASE management (??????????? difference)

A
  • Trial of thickened formula
  • Trial of alginate therapy e.g. Gavison, but not same time as thickening agents
  • Breastfeeding assessment
  • Consider specialist referral and PPI if no resolution or distressed
  • May consider enteral tube feeding if faltering growth
39
Q

Gastro-oesophageal reflux
• RFs
• Reasons for admission

A

RF
• Preterm
• Cerebral palsy
• Oesophageal atresia or diaphragmatic hernia surgery

Admission
• Faltering growth
• Not responding to meds
• Not feeding
• Sandifer's syndrome (sudden postures/arching/head throwing after eating)
40
Q

Colic investigations

A
  • Obs
  • Alert, hydration status
  • Abdominal exam
41
Q

Colic counselling

A

• Common, resolves by 6 months

  • Breastfeeding: continue in semi-upright position
  • Formula: check bottle teat size
  • NHS Choices leaflet, health visitor
  • Sooth baby by holding when crying, gentle motion, white noise, warm bath
  • Encourage parents to look after themselves - meet other parents, rest, support from family and friends
  • Don’t recommend infacol and colief
42
Q

Intussusception investigations

A

Bedside, bloods, imaging approach
• Obs
• Inspection - pallor, behaviour
• Abdominal examination

  • Bloods - FBC, U&E, blood gas, glucose, group & save
  • USS - target sign
43
Q

Intussusception management

A
  • Secure IV access
  • NBM
  • Initial resus - 20ml/kg fluid bolus of 0.9% NaCl
  • NG tube
  • Analgesia
  • Reduction by air insufflation under radiological control
  • Surgery if peritonitis
44
Q

Ulcerative colitis investigations

A

Bedside, bloods, imaging approach
• Obs
• Abdominal examination

  • FBC (anaemia)
  • CRP
  • Faecal calprotectin
  • AXR
  • Colonoscopy
  • Biopsy
45
Q

Ulcerative colitis counselling

A
  • Condition with known cause that leads to inflammation of bowel
  • Uncommon but well-known
  • No cure and comes and goes in flare-ups
  • Medication to reduce likelihood and treat flare-ups
  • Complications include growth issues and bowel cancer
  • Seen by gastro
  • Support: Crohn’s and Colitis UK
46
Q

Bacterial meningitis investigations

A

ABCDE approach, MDT support (acute paediatrician, anaesthetist)

  • RR, O2
  • HR, ABG
  • GCS, AVPU
Examine 
• Brudzinski's (lift head)
• Kernig's (straighten leg)
• Focal neurology for raised ICP
• Temperature
• Bloods - FBC, blood culture
• LP
47
Q

Brief bacterial meningitis counselling

A
  • Infection and inflammation around the brain
  • MDT involved
  • Admitted - line to give fluid and abx
  • Hopefully better in next couple of days but can’t say for certain how long they will get better
  • Will follow up after clearance of infection in 4-6 weeks
  • Possible complications include hearing loss - can offer audiological assessment as follow-uo
  • Notify public health who will ask who has been in close contact, and they may need to receive antibiotics (ciprofloxacin) too
48
Q

Traffic light: green signs

A

Colour
• Normal

Activity
• Responds normally
• Smiles
• Awake
• Strong cry / no cry

Resp n/a

Circulation + hydration
• Normal skin and eyes
• Moist mucous membranes

49
Q

Traffic light: amber signs

A

Colour
• Pallor reported

Activity
• Not responding normally
• Not smiling
• Wakes with prolonged stimulation

Resp
• Nasal flaring
• Tachypnoea
• Low O2

Circulation + hydration
• Tachycardia
• Long cap refill
• Dry mucous membranes
• Poor feeding
• Reduced urine output
  • Temp 39+ aged 3-6m
  • Fever 5+ days
  • Rigors
  • Swollen limb
50
Q

Traffic light: red signs

A

Colour
• Mottled/ashen

Activity
• No response to social cues
• Does not stay awake
• Weak, high-pitched, continuous cry

Resp
• Grunting
• Tachypnoea >60
• Chest indrawing

Circulation + hydration
• Reduced skin turgor

• Temp 38+ aged <3m
• Non-blanching rash
• Bulging fontanelle
etc.

51
Q

Kawasaki investigations

A

Bedside, bloods, imaging approach
• Obs
• Urine dip + MC+S

  • FBC (anaemia, high WCC with left shift)
  • ESR, CRP
  • Blood cultures, LP
  • Echo (coronary artery abnormalities)
  • ECG
  • CXR (cardiomegaly)
52
Q

Kawasaki management

A
  • IVIG (single dose) + high dose aspirin until 24 hours after fever cessation
  • Low dose aspirin
  • Drink lots of fluids and continue on meds when discharged
  • Follow up with cardiologists for echo as outpatient
  • Reduce physical contact for now, stay active and maintain healthy diet
  • Stop taking aspirin when all normal
53
Q

Atopic eczema investigations

A

x

54
Q

Atopic eczema management

A

Conservative
• Identification and education of triggers
• Cut nails short
(• Consider food allergy diagnosis)

Emollients
• Large amounts and often
• E45, cetraben

Topical corticosteroids
• Only areas of active eczema
• Not in <12 months
• Mild - hydrocortisone
• Moderate/severe - betamethasone

Topical calcineurin inhibitors
• Second line for moderate/severe
• Not in <2 years
• Tacrolimus

Bandages
• Chronic lichenified skin

Urgent referral (2 weeks) if no response to optimum therapy

55
Q

Infected eczema and eczema herpeticum management

A
  • Swab
  • Hygiene e.g. using spatula for emollients
  • Flucloxacillin / erythromycin
  • Antiseptics e.g. chlorhexidine if recurrent

Eczema herpeticum
• Immediate referral
• Oral aciclovir
• Same-day opth/derm specialist review if around eyes

56
Q

Mild eczema counselling

A
  • Dry, itchy skin
  • Common, many children grow out of it
  • Steroids may be used, they are not systemic and only short course (1-2 weeks) so don’t have as many of the side effects
  • Emollients
  • Avoid triggers
  • Safety net infection
  • Itchywheezysneezy.co.uk
57
Q

Minimal change disease investigations

A

Bedside and bloods approach
• Obs - normal
• Urine dip - frothy, protein

  • Blood glucose
  • Low albumin
  • Hyperlipidaemia (overcompensation)
  • Normal FBC
  • Consider complement levels - low C3 could be postinfectious glomerulonephritis or SLE
58
Q

Minimal change disease counselling

A
  • Kidneys aren’t working as they should and protein is leaking into the urine
  • Could be related to a problem with the immune system - don’t know for sure
  • Something we can treat - steroid tablets every day for 6 weeks, then every other day for a further 6 weeks
  • Low-salt diet and restrict fluid intake
  • Come straight back if this reoccurs
  • 1/3 have one episode, 1/3 have infrequent relapses, 1/3 have frequent relapses
  • Usually stops before adulthood
59
Q

Septic arthritis investigations

A

Bedside, bloods, imaging approach
• General inspection for lymphadenopathy, rashes, bruising
• Closer knee examination (temperature, swelling, movement)
• Obs (HR, temp)

(if in GP, now refer to A&E)

  • FBC (WCC, neutrophil left shift)
  • ESR
  • Blood cultures
  • Joint aspirate and culture
  • USS
  • CTI/MRI
60
Q

Septic arthritis treatment

A
  • Flucloxacillin or clindamycin
  • IV 2 weeks, oral 2 weeks

MRSA - vanc
Gonococcal - cefotaxime

61
Q

Blood differences in septic arthritis from transient synovitis

A

High ESR
High temp
Very high WCC

(non-weight bearing too)

62
Q

Cerebral palsy investigations

A
  • Height and weight
  • Tone and reflexes
  • Hand dominance

• Consider MRI/CT/cranial USS to assess cause but not timing of injury (GA or sedation may be needed for procedure)

63
Q

Cerebral palsy ddx

A
  • Muscular dystrophy
  • Chromosomal e.g. Fragile X
  • Foetal alcohol syndrome
  • Inherited metabolic disorders e.g. maple syrup urine
64
Q

Cerebral palsy management

A

Refer to paediatrician specialising in developmental disorders

MDT approach
• Assessment of LD, swallowing, visual, hearing, bone mineral density
• Physiotherapy - encourage movement, prevent loss of motion
• SaLT - improve language abilities
• OT - identify difficult tasks and make them more accessible

Medication
• Stiffness - baclofen, diazepam
• Sleep - melatonin
• Constipation - laxatives
• Epilepsy - anticonvulsants
• Drooling - anticholinergics or botulinum toxin A
• Low BMD - calcium and vit D intake
65
Q

Epilepsy investigations

A
  • Obs
  • Examination (alert, resp, hydration, skin)
  • FBC
  • Metabolic panel
  • Blood glucose
  • Septic screen and CRP - infective cause?
  • EEG
  • ECG - exclude cardiac causes
66
Q

Epilepsy management (first fit)

A 
Advice
• Recognise seizure
• Record future episode
• Avoid dangerous activity until diagnosis confirmed
• Make school aware
• Want to promote independence

Epilepsy specialist nurse
• Education and advice

Antiepileptic drug therapy
• Not all children
• Depends on type
• Rescue therapy (buccal midazolam) if prolonged seizures
• Discountinued after 2 years free of seizures

67
Q

Febrile seizure investigations

A
  • Obs
  • Examination via NICE traffic light system
  • Resp, skin, ENT, abdo, neuro
  • Urine dipstick
  • FBC, CRP - signs of infection
  • Blood cultures, lactate, glucose - signs of infection
  • Metabolic panel
  • U&E - electrolyte imbalance
68
Q

Febrile seizure (6 months - 6 years) management

A

If first febrile sizure, <18 months, diagnostic uncertainty, abx to mask:
• Arrange immediate hospital assessment by paediatrician
• Refer to first fit clinic
• Period of observation

At home
• Not same as epilepsy (although risk slightly higher)
• Cushion head and remove dangerous objects
• Check airway and recovery position after
• Call ambulance if > 5mins
• Reducing fever does not prevent recurrence but may help with symptoms
• Carry on with routine imms

69
Q

Diabetic ketoacidosis investigations

A
  • Obs
  • Examination - sunken eyes, skin turgor, alert
  • Urine dipstick - glucose and ketones

At this point, call for help e.g. acute paediatric reg on-call, anaesthetist and other MDT

Start ABCDE approach with a focus of circulation
• Measure body weight and monitor blood gases
• IV 0.9% saline and IV insulin (1-2 hours after fluids)
• Give with 40mmol/L KCl unless renal failure
• Once glucose <14, switch to IV 0.9% saline + 5% dextrose

Only consider stopping if child is alert, ketosis is resolving, and can take oral fluids

70
Q

What to do if if blood ketone level is not falling in DKA treatment?

A

Think about increasing insulin dosage and seek senior help

71
Q

What should you consider in DKA if child is vomiting and has reduced level of consciousness?

A

NG tube - risk of aspiration

72
Q

Signs and treatment of 2x DKA complications

A

Cerebral oedema
• Headache, drop in HR, increased BP
• Mannitol or hypertonic sodium chloride

Hypokalaemia
• ST depression, prominent U waves, flattened P waves
• Stop insulin temporarily, central venous catheter for IV potassium solutions (discuss with paeds crit care specialist)

73
Q

T1DM management

A
  • Insulin: basal-bolus, insulin pump, 1/2/3 injections per day
  • Diet and lifestyle
  • Blood glucose and HbA1c monitoring: 5 capillary glucose tests a day (fastin 4-7, after meals 5-9)
  • Blood ketone monitoring
  • Psych/social support
74
Q

Anaphylaxis management

A

Medical emergency
• ABCDE approach
• Airway
• Breathing
• If unresponsive and not breathing normally, start CPR
• Otherwise examine chest for obstruction, check circulation

• Sit up if airway difficulty, legs up if blood pressure problem/feeling faint, recovery if unconscious but breathing

  • IM adrenaline 1:1000
  • Repeat at 5 min intervals until adequate response
  • High flow O2
  • IV fluids
  • IV chloramphenamine + IV hydrocortisone
75
Q

Sepsis investigations + management

A
  • Behaviour
  • Examination - resp, cardio, skin, dehydration, fontanelle
  • Obs

Transfer to acute hospital setting (if meningitis, IM benzylpenicillin first) + involve senior clinicians + start sepsis 6

  1. Give high flow O2
  2. IV/IO access (take gas, glucose, cultures)
  3. IV/IO abx
  4. Consider fluid resus and monitor urine output
  5. Involve senior clinicians
  6. Consider inotropic support
76
Q

Sepsis abx

A

< 72 hours: IV benzylpenicillin + gentamycin
< 3 months: IV amoxicillin + cefotaxime
> 3 months: IV cefotaxime

In meningococcal: ciprofloxacin for close contacts

77
Q

NAI investigations

A

Bedside, bloods, imaging approach

  • Obs
  • Examination inc. physical signs of neglect e.g. dirty clothes

• FBC, bone profile (rule out leukaemia, ITP)

  • Fundoscopy - retinal haemorrhages
  • Skeletal survey
  • CT head if injuries found
78
Q

NAI management

A
  • Make sure child is in a safe space
  • Contact child safeguarding team and consult seniors e.g. on-call paediatric consultant
  • Consider contacting the police (Child Abuse Investigation Team)
  • Document everything well, as I would in any other scenario, as I could be expected to provide written reports for further investigations
79
Q

NAI counselling

A
  • We have to talk about what to do next
  • Whenever we have a case where we don’t know why an injury has occurred, we have to involve some other people
  • This includes social services and the child safeguarding team (and maybe the police)
  • This is a routine requirement for all children in these situations, and our aim is to keep your child safe
  • May be necessary to move child to a place of safety while ongoing investigations are conducted
80
Q 
Conditions exluded from school for following times:
• 24 hours after abx started
• 48 hours after abx started
• 48 hous after symptoms settled
• 4 days from rash onset
• Lesions crusted
• Treated
• Recovered
A

24 hours after abx started
• Scarlet fever

48 hours after abx started
• Whooping cough

48 hous after symptoms settled
• D&V

4 days from rash onset
• Measles
• Rubella

Lesions crusted
• Chickenpox
• Impetigo

Treated
• Scabies

Recovered
• Influenza

81
Q

Exclusion from school for mumps

A

For 5 days from onset of swollen glands

82
Q

When are most children dry by day only and day + night?

A

Day only: 4 years

Day + night: 5 years

83
Q

Enuresis investigations

A
  • Obs
  • Abdominal examination - constipation a cause (detrusor muscle instability)?
  • Urinalysis
84
Q

Enuresis management

A 
< 5 years (night)
• Normal
• Ensure easy access to toilet at night e.g. potty near bed
• Encourage bladder emptying before bed
• Consider positive reward system

> 5 years (night)
• Watch-and-see / star chart if < 2 per week
• Long-term: 1. enuresis alarm, 2. desmopressin, 3. refer to secondary care/enuresis clinic/community paediatrician

(day)
• Refer to secondary care

(secondary - dry for 6 months before)
• Consider management of underlying causes e.g. UTI or constipation

85
Q

Obesity investigations

A

Heigh and weight for BMI

Weight / square of height

86
Q

Obesity counselling

A
  • Be a good role model - children learn by example
  • Encourage physical activity every day
  • Keep to child-sized portions
  • Eat healthily
  • Less screen time and more sleep
87
Q

Necrotising entercolitis investigations + management

A

Acute - ABCDE approach + sepsis 6
Abdominal exam
Abdominal X-ray - dilated bowel loops, intramural gas, bowel wall oedema

Senior help - on-call paeds reg
Stop feeding - TPN
Triple abx as per local policy
Fluids and resp support
Analgesia
88
Q

Necrotising entercolitis counselling

A
  • Serious condition we know affects newborn babies, especially when born early or have low birthweight
  • Severe inflammation of the gut and can make babies unwell
  • Need to admit to NICU, give fluids and abx, feed through tube, and monitor closely
  • Will likely need surgery as the inflammation can cause some of the bowel to die, which needs to be removed

PACES Y5 Investigations and management (4 decks)

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