Paediatrics Flashcards
What is bronchiolitis ?
Inflammation of the bronchioles.
It usually occurs in the winter and common in very young children
What are the causes of bronchiolitis ?
Most is caused by the respiratory syncytial virus
The remainder are due to other respiratory viruses such as parainfluenza virus, influenza and rhinovirus.
Which groups of children are at risk of bronchiolitis ?
Prematurity
Chronic lung disease
Cardiac / respiratory disease
Immunocompromised
What are some clinical features of bronchiolitis ?
Usually occurs in children under 2
Fever
Poor feeding
Breathlessness
Wheeze
Pyrexia
Tachycardia
What investigations should be performed when suspecting bronchiolitis ?
Nasopharyngeal aspirate
Pulse oximeter
Chest radiograph
What are some differentials for bronchiolitis ?
Bronchial asthma
Congestive heart failure
Foreign body
Pertussis
Pneumonia
CF
What is the treatment for bronchiolitis ?
Treatment is supportive.
Intercostal recession should be hospitalised and give o2 and ventilation may be required
Paracetamol for fever
When should you call 999 when a child has bronchiolitis ?
Apnoea
Child looks seriously unwell
Severe respiratory distress
Resp rate over 70
Central cyanosis
What is chicken pox ?
A highly infectious, acute contagious disease predominately affecting children under 10 years old though it can occur at any age. It is caused by the varicella zoster virus.
How is chicken pox transmitted ?
Direct person to person contact
Airborne droplets
Through infected articles such as clothing or bedding
What are some clinical features of chicken pox ?
Incubation is 14 to 21 days
Rash begins as macular lesions which develop into papular or vesicular lesions which then become pustular.
Erythema and itchy
Scar if scratched
What are some differentials for chicken pox ?
Herpes simplex
Impetigo
Contact dermatitis
Scabies
What is the treatment for chicken pox ?
Paracetamol
Calamine lotion
What are some complications of chicken pox ?
Pneumonia
Cerebellar ataxia
Secondary bacterial infections
Affects pregnancy
What is croup ?
An upper respiratory tract infection occurring in infants and toddlers.
Parainfluenza viruses account for the majority of cases.
What are some clinical features of croup ?
May have a previous history of croup
Slow onset
Barking cough
No dysphagia
Hoarse voice
Agitation
What are some investigations for croup ?
Indicated if child has suffered lots of prisoners of croup
Plain neck radiograph
Bronchoscopy
What are some differentials for croup ?
Cute epiglottis
Foreign body
Diphtheria
Peritonsillar abscess
Smoke inhalation
What is the management for croup ?
Steroid treatment - dexamethasone oral
Nebulised adrenaline
Oxygen with caution
When should a child be admitted for hospitalisation for croup ?
Cynaosis
Pallor
Resp distress
Hypoxaemia
Stridor at rest
What are some differences between croup and epiglottis ?
E : H.Influenza , C : parainfluenza
E : rapid C : gradual
E : dysphagia
C : barking cough
E : grey C : pink
What is head lice ?
An infestation of blood-feeding insects - pediculus capitis.
What are some clinical features of head lice ?
Direct contact needed for transmission
Itching is commonly seen
What is the treatment of head lice ?
All the family should be treated
Insecticides - malathion or pyrethroids
Wet combing
Dimeticone lotion
What are threadworms ?
A common helminthic infection which reside in the caecum which females migrating to the anus to lay eggs usually at night.
How are threadworms transmitted ?
Faecal-oral route
What are some clinical features of threadworms ?
1/3 are asymptomatic
Pruritis ani at night
Irritation may spread to the vagina
Occasionally you might see an adult threadworm in faeces
How is threadworms diagnosed ?
Early morning application of sellotape to the anus with microscopy for typical eggs.
What is the treatment of threadworms ?
Mebendazole - one dose followed by another dose 2 weeks after
What is osgood-schlatter’s disease ?
A painful condition affecting the tibial tuberosity.
What are some differentials for osgood-schlatter’s disease ?
Fracture of the tibial tuberosity
Infre-patellar bursitis
Osteomyelitis
Patellar tendonitis
What is the management of osgood - Schlatter’s disease ?
Self-limiting
Reduce physical activity
Physiotherapy
Ice packs
What is the most common causes of diarrhoea in children ?
Infectious - viral - rotavirus
Why do infectious organisms cause diarrhoea ?
Mucosal damage caused by direct attack
Toxin production after ingestion
Toxin production before ingestion
What are the types of diarrhoea ?
Secretory - deranged membrane transport results in decreased electrolyte absorption and thus decreased water absorption
Osmotic - decreased absorption due to mucosal damage or increased gut motility
What is the treatment for childhood diarrhoea ?
Maintain hydration
Medical intervention is often not recommended
What are some non-infectious causes of diarrhoea in children ?
Monosaccharide intolerance
Cow milk’s intolerance
Coeliac disease
CF
What is GORD ?
The uncontrolled passage of gastric contents into the oesophagus.
Commonly seen in infants
What are some clinical features of GORD ?
Regurgitation or persistent vomiting
Feeding refusal
Back arching
Irritability / persistent crying
Poor weight gain
Sleeping difficulties
What are some investigations for GORD ?
Usually based on clinical presentation
Barium contrast radiography
Upper GI endoscopy
What are some differentials for GORD ?
Cow’s milk allergy
Infections - GI
Medications
Pyloric stenosis
What is the management of GORD ?
Dietary measures - removal of certain foods form diet
Antacids
H2 antagonists
Omeprazole
Domperidone
What is infantile colic ?
A benign condition where there are paroxysms of uncontrollable crying for more than 3 hours per day in more than 3 days a week for more than 3 weeks. They have to be healthy child younger than 3 months old.
What is infantile colic associated with ?
Postpartum depression
Shaken baby syndrome
What are some differentials for infantile colic ?
Infection - meningitis, UTI
Constipation
Cow’ milk allergy
GORD
Hypoglycaemia
Trauma
What is the management of infantile colic ?
Dietary modifications
Self limiting - resolves after 4 months
What is asthma ?
An inflammatory disorder of the conducting airways where they become hyper-responsive and constructive easily in response to a range of exogenous and endogenous stimuli.
What are some risk factors for asthma ?
Genetics
Allergens in environment
Infections
Diet
Stress
What are some clinical features of asthma ?
SOB
Wheezing
Cough
Triggers
What are some differentials ?
Inhaled foreign body
Bronchiectasis
CF
Congenital heart disease
What are some investigations for asthma ?
Spirometry - showing reversibility
Peak flow
FeNo testing
What is the management of asthma ?
SABA - intermittent reliever
Inhaled corticosteroids - regular preventer
What signifies a moderate asthma attack ?
Increasing symptoms
Peak flow of 50-75% of best or predicted
No features of severe asthma
what signifies a severe asthma attack ?
Any one of the following :
- peak flow of 33 - 50 %
- RR over 25
- HR over 110
- Inability to complete a sentence in one breath
What signifies a life threatening asthma attack ?
Any one of the following :
- peak flow lower than 33%
- O2 sats below 92 %
- silent chest
- cyanosis
- arrhythmia
- exhaustion
- hypotension
- altered consciousness
what indicates a near fatal asthma attack ?
Raised PaCO2 and / or mechanical ventilation with raised inflation process
What is atopic eczema ?
A chronic inflammatory itchy skin condition that develops in early childhood in the majority of cases.
Usually presents in episodes - flare ups
What are some features of atopic eczema ?
Relapsing course
Pruritus
Redness
Swelling
Blisters
Dry skin
Excoriations
What investigations can be performed when suspecting atopic eczema ?
Serum IgE levels
Skin prick test
Radioallergosorbent testing
Skin biopsy
White dermographism
What are some complications of atopic eczema ?
infections
Cataract
Growth retardation
What are some associated conditions of atopic eczema ?
Asthma
Allergic rhinitis
Dry skin
Foot intolerance
Alopecia areata
What treatment is offered for atopic eczema ?
Emollients
Topical corticosteroids
What are the types of Allergic rhinitis ?
Seasonal - caused by grass and tree pollen
Perennial - caused by dust mites and animals
Occupational - allergens at the workplace
What are some clinical features of allergic rhinitis ?
Rhinorrhoea
Nasal blockage
Sneezing
Itching
Watery eyes
Malaise
Headache
SOB
What is allergic rhinitis associated with ?
Asthma
Eczema
Chronic sinusitis
What causes seasonal rhinitis ?
Reaction to pollen, usually grass and trees
What causes perennial allergic rhinitis ?
Dust
Mites
Feathers
Animal dander
What is the management of allergic rhinitis ?
Avoid triggers
Oral / nasal antihistamines
Corticosteroids in people with severe symptoms
Leukotriene receptor antagonist
What are some signs and symptoms of idiopathic constipation ?
Infrequent bowel activity
Foul smelling wind and stools
Excessive flatulence
Irregular stool texture
Passing enormous stools or frequent pellets
Abdo pain / distension / discomfort
What are some causes of constipation in children ?
Hypothyroidism
Idiopathic
Anal fissure
Severe vomiting
Cow’s milk intolerance
What are some investigations for constipation ?
Abdominal radiography
Barium enema or rectal biopsy
Blood test - coeliac / hypothyroidism
What is the management of constipation ?
Laxatives
Dietary modifications
Increase fluid and fibre intake
What are some indicators of abuse or neglect ?
Children with behavioural changes - more become aggressive, disruptive or challenging
Children with ill-fitting or dirty clothing
Children with poor hygiene
Children who don’t want to change clothes in front of others
Trouble at school
Developmental delay
Regularly missing from school
Children who shy away from being touched
What are the 4 main types of abuse and neglect ?
Physical
Emotional
Sexual
Neglect
What is physical abuse ?
Deliberately physically hurting a child such as hitting, pinching, shaking, throwing, poisoning, burning, drowning or suffocating.
What are some signs of physical abuse ?
Children with frequent injuries
Children with unexplained or unsual fractures
Children with unexplained bruises, cuts, burns or bite marks
What is emotional abuse ?
The persistent emotional maltreatment of a child. Also called psychological abuse and can affect a child’s emotional development.
What are some signs of emotional abuse ?
Children who are excessively withdrawn, fearful or anxious about doing something wrong
Parents who withdraw attention form their child - cold shoulder
Parents who blame their problems on their child
Parents who humiliate their child - name calling
What is sexual abuse ?
Any sexual activity wit a child. Many children who are victims of sexual abuse don’t recognise themselves as such.
What may sexual abuse involve ?
Physical contact
Rape
Oral sex
Masturbation
Kissing
Rubbing and touching outside clothing
Producing sexual images
Forcing children to look at sexual imagery
What are some indicators of sexual abuse ?
Children who display knowledge or interest in sexual acts inappropriate to their age
Children who use sexual language or have sexual knowledge you wouldn’t expect them to have
Children who ask others to behave sexually or play sexual games
Children with physical sexual health problems - sore genitals or STI
What is sexual exploitation ?
A form of sexual abuse where children are sexually exploited for money, power or status. It can involve violent, embarrassing or degrading sexual assaults.
What are some signs of sexual exploitation ?
Children with unexplained gifts
Older boyfriends or girlfriends
STI’s or pregnancy
Changes in emotional wellbeing
Misuse of drugs or alcohol
Children who go missing for large amounts of time or return late
Regularly miss school
What is neglect ?
A pattern of failing to provide for child’s basic needs whether it be adequate food, clothing, hygiene, supervision or shelter. It can severely impact the child’s heath and development.
What are some signs of neglect ?
Living in a home that is dirty or unsafe
Children who are hungry or dirty
Left without adequate clothing
Living in dangerous conditions - around drugs
Children who are aggressive, angry or self harm
Fail to receive basic healthcare
Parents who fail to seek help when their child is ill or injured
What does the newborn physical examination check for ?
Eyes - appearance and movement, check for cataracts and red reflex
Heart - pulses, arrhythmia
Hips - developmental dysplasia and movement
Abdomen - any hernias
Testicles - located in the correct place
What is tested for in the heel prick spot test ?
Sickle cell disease
Cystic Fibrosis
Congenital hypothyroidism
Phenylketonuria
Homocystinuria
What are developmental milestones separated into ?
Gross motor
Vision and fine motor
Hearing, speech and language
Social, emotional and behavioural
At what age do babies sit without support ?
6 - 8 months
At what age do babies crawl ?
8-9 months
At what age do babies stand independently ?
10 months
At what age do babies walk steadily ?
15 months
At what age do babies run and jump ?
2.5 years
At what age do babies say words such as dada or mama ?
10 months
At what age do babies join 2 or more words together ?
20-24 months
When do babies smile responsively ?
6 weeks
At what age do babies put food in their mouth ?
6 -8 months
At what age do babies become toilet trained ?
2 years
What are some signs that a baby is unwell ?
Poor feeding
Altered cry / drowsy
High temp
Irritability and lethargy
Dry nappies / not passing urine
Prematurity
What are some clinical features of meningitis ?
Non-blanching rash
Neck stiffness
Photophobia
Drowsiness
Vomiting
High temp
What medication is given for meningitis ?
Benzyl penicillin IM
What features of the history are important to ask if a baby is failing to thrive ?
Maternal smoking
Maternal illness during pregnancy
Use of medications during pregnancy
Relationship of symptoms to mealtimes
Ethnic origin
What features of a physical exam would be essential to assess a malnourished child ?
Measuring head circumference
Looking for signs of vitamin deficiency
Assessing skin turgor
What are some physical signs elicited which would indicate malnutrition ?
Oedema
Muscle wastage
Rash or skin changes
Hair colour or texture changes
Mental state changes
What would indicate a dehydrated child ?
Decreased skin turgor
Decreased sensory awareness
Sunken fontanelles
Dry mucous membranes
Absence of tears
Acutely ill appearance
What type of vaccine is MMR ?
Live attenuated
What are some toxoid vaccines ?
Diphtheria
Tetanus
What are some examples of killed vaccines ?
Flu and hepatitis A
