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Y3 GP > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What is bronchiolitis ?

A

Inflammation of the bronchioles.
It usually occurs in the winter and common in very young children

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2
Q

What are the causes of bronchiolitis ?

A

Most is caused by the respiratory syncytial virus
The remainder are due to other respiratory viruses such as parainfluenza virus, influenza and rhinovirus.

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3
Q

Which groups of children are at risk of bronchiolitis ?

A

Prematurity
Chronic lung disease
Cardiac / respiratory disease
Immunocompromised

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4
Q

What are some clinical features of bronchiolitis ?

A

Usually occurs in children under 2
Fever
Poor feeding
Breathlessness
Wheeze
Pyrexia
Tachycardia

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5
Q

What investigations should be performed when suspecting bronchiolitis ?

A

Nasopharyngeal aspirate
Pulse oximeter
Chest radiograph

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6
Q

What are some differentials for bronchiolitis ?

A

Bronchial asthma
Congestive heart failure
Foreign body
Pertussis
Pneumonia
CF

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7
Q

What is the treatment for bronchiolitis ?

A

Treatment is supportive.
Intercostal recession should be hospitalised and give o2 and ventilation may be required
Paracetamol for fever

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8
Q

When should you call 999 when a child has bronchiolitis ?

A

Apnoea
Child looks seriously unwell
Severe respiratory distress
Resp rate over 70
Central cyanosis

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9
Q

What is chicken pox ?

A

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.

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10
Q

How is chicken pox transmitted ?

A

Direct person to person contact
Airborne droplets
Through infected articles such as clothing or bedding

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11
Q

What are some clinical features of chicken pox ?

A

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

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12
Q

What are some differentials for chicken pox ?

A

Herpes simplex
Impetigo
Contact dermatitis
Scabies

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13
Q

What is the treatment for chicken pox ?

A

Paracetamol
Calamine lotion

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14
Q

What are some complications of chicken pox ?

A

Pneumonia
Cerebellar ataxia
Secondary bacterial infections
Affects pregnancy

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15
Q

What is croup ?

A

An upper respiratory tract infection occurring in infants and toddlers.
Parainfluenza viruses account for the majority of cases.

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16
Q

What are some clinical features of croup ?

A

May have a previous history of croup
Slow onset
Barking cough
No dysphagia
Hoarse voice
Agitation

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17
Q

What are some investigations for croup ?

A

Indicated if child has suffered lots of prisoners of croup
Plain neck radiograph
Bronchoscopy

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18
Q

What are some differentials for croup ?

A

Cute epiglottis
Foreign body
Diphtheria
Peritonsillar abscess
Smoke inhalation

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19
Q

What is the management for croup ?

A

Steroid treatment - dexamethasone oral
Nebulised adrenaline
Oxygen with caution

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20
Q

When should a child be admitted for hospitalisation for croup ?

A

Cynaosis
Pallor
Resp distress
Hypoxaemia
Stridor at rest

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21
Q

What are some differences between croup and epiglottis ?

A

E : H.Influenza , C : parainfluenza
E : rapid C : gradual
E : dysphagia
C : barking cough
E : grey C : pink

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22
Q

What is head lice ?

A

An infestation of blood-feeding insects - pediculus capitis.

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23
Q

What are some clinical features of head lice ?

A

Direct contact needed for transmission
Itching is commonly seen

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24
Q

What is the treatment of head lice ?

A

All the family should be treated
Insecticides - malathion or pyrethroids
Wet combing
Dimeticone lotion

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25
Q

What are threadworms ?

A

A common helminthic infection which reside in the caecum which females migrating to the anus to lay eggs usually at night.

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26
Q

How are threadworms transmitted ?

A

Faecal-oral route

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27
Q

What are some clinical features of threadworms ?

A

1/3 are asymptomatic
Pruritis ani at night
Irritation may spread to the vagina
Occasionally you might see an adult threadworm in faeces

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28
Q

How is threadworms diagnosed ?

A

Early morning application of sellotape to the anus with microscopy for typical eggs.

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29
Q

What is the treatment of threadworms ?

A

Mebendazole - one dose followed by another dose 2 weeks after

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30
Q

What is osgood-schlatter’s disease ?

A

A painful condition affecting the tibial tuberosity.

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31
Q

What are some differentials for osgood-schlatter’s disease ?

A

Fracture of the tibial tuberosity
Infre-patellar bursitis
Osteomyelitis
Patellar tendonitis

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32
Q

What is the management of osgood - Schlatter’s disease ?

A

Self-limiting
Reduce physical activity
Physiotherapy
Ice packs

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33
Q

What is the most common causes of diarrhoea in children ?

A

Infectious - viral - rotavirus

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34
Q

Why do infectious organisms cause diarrhoea ?

A

Mucosal damage caused by direct attack
Toxin production after ingestion
Toxin production before ingestion

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35
Q

What are the types of diarrhoea ?

A

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

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36
Q

What is the treatment for childhood diarrhoea ?

A

Maintain hydration
Medical intervention is often not recommended

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37
Q

What are some non-infectious causes of diarrhoea in children ?

A

Monosaccharide intolerance
Cow milk’s intolerance
Coeliac disease
CF

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38
Q

What is GORD ?

A

The uncontrolled passage of gastric contents into the oesophagus.
Commonly seen in infants

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39
Q

What are some clinical features of GORD ?

A

Regurgitation or persistent vomiting
Feeding refusal
Back arching
Irritability / persistent crying
Poor weight gain
Sleeping difficulties

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40
Q

What are some investigations for GORD ?

A

Usually based on clinical presentation
Barium contrast radiography
Upper GI endoscopy

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41
Q

What are some differentials for GORD ?

A

Cow’s milk allergy
Infections - GI
Medications
Pyloric stenosis

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42
Q

What is the management of GORD ?

A

Dietary measures - removal of certain foods form diet
Antacids
H2 antagonists
Omeprazole
Domperidone

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43
Q

What is infantile colic ?

A

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.

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44
Q

What is infantile colic associated with ?

A

Postpartum depression
Shaken baby syndrome

45
Q

What are some differentials for infantile colic ?

A

Infection - meningitis, UTI
Constipation
Cow’ milk allergy
GORD
Hypoglycaemia
Trauma

46
Q

What is the management of infantile colic ?

A

Dietary modifications
Self limiting - resolves after 4 months

47
Q

What is asthma ?

A

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.

48
Q

What are some risk factors for asthma ?

A

Genetics
Allergens in environment
Infections
Diet
Stress

49
Q

What are some clinical features of asthma ?

A

SOB
Wheezing
Cough
Triggers

50
Q

What are some differentials ?

A

Inhaled foreign body
Bronchiectasis
CF
Congenital heart disease

51
Q

What are some investigations for asthma ?

A

Spirometry - showing reversibility
Peak flow
FeNo testing

52
Q

What is the management of asthma ?

A

SABA - intermittent reliever
Inhaled corticosteroids - regular preventer

53
Q

What signifies a moderate asthma attack ?

A

Increasing symptoms
Peak flow of 50-75% of best or predicted
No features of severe asthma

54
Q

what signifies a severe asthma attack ?

A

Any one of the following :
- peak flow of 33 - 50 %
- RR over 25
- HR over 110
- Inability to complete a sentence in one breath

55
Q

What signifies a life threatening asthma attack ?

A

Any one of the following :
- peak flow lower than 33%
- O2 sats below 92 %
- silent chest
- cyanosis
- arrhythmia
- exhaustion
- hypotension
- altered consciousness

56
Q

what indicates a near fatal asthma attack ?

A

Raised PaCO2 and / or mechanical ventilation with raised inflation process

57
Q

What is atopic eczema ?

A

A chronic inflammatory itchy skin condition that develops in early childhood in the majority of cases.
Usually presents in episodes - flare ups

58
Q

What are some features of atopic eczema ?

A

Relapsing course
Pruritus
Redness
Swelling
Blisters
Dry skin
Excoriations

59
Q

What investigations can be performed when suspecting atopic eczema ?

A

Serum IgE levels
Skin prick test
Radioallergosorbent testing
Skin biopsy
White dermographism

60
Q

What are some complications of atopic eczema ?

A

infections
Cataract
Growth retardation

61
Q

What are some associated conditions of atopic eczema ?

A

Asthma
Allergic rhinitis
Dry skin
Foot intolerance
Alopecia areata

62
Q

What treatment is offered for atopic eczema ?

A

Emollients
Topical corticosteroids

63
Q

What are the types of Allergic rhinitis ?

A

Seasonal - caused by grass and tree pollen

Perennial - caused by dust mites and animals

Occupational - allergens at the workplace

64
Q

What are some clinical features of allergic rhinitis ?

A

Rhinorrhoea
Nasal blockage
Sneezing
Itching
Watery eyes
Malaise
Headache
SOB

65
Q

What is allergic rhinitis associated with ?

A

Asthma
Eczema
Chronic sinusitis

66
Q

What causes seasonal rhinitis ?

A

Reaction to pollen, usually grass and trees

67
Q

What causes perennial allergic rhinitis ?

A

Dust
Mites
Feathers
Animal dander

68
Q

What is the management of allergic rhinitis ?

A

Avoid triggers
Oral / nasal antihistamines
Corticosteroids in people with severe symptoms
Leukotriene receptor antagonist

69
Q

What are some signs and symptoms of idiopathic constipation ?

A

Infrequent bowel activity
Foul smelling wind and stools
Excessive flatulence
Irregular stool texture
Passing enormous stools or frequent pellets
Abdo pain / distension / discomfort

70
Q

What are some causes of constipation in children ?

A

Hypothyroidism
Idiopathic
Anal fissure
Severe vomiting
Cow’s milk intolerance

71
Q

What are some investigations for constipation ?

A

Abdominal radiography
Barium enema or rectal biopsy
Blood test - coeliac / hypothyroidism

72
Q

What is the management of constipation ?

A

Laxatives
Dietary modifications
Increase fluid and fibre intake

73
Q

What are some indicators of abuse or neglect ?

A

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

74
Q

What are the 4 main types of abuse and neglect ?

A

Physical
Emotional
Sexual
Neglect

75
Q

What is physical abuse ?

A

Deliberately physically hurting a child such as hitting, pinching, shaking, throwing, poisoning, burning, drowning or suffocating.

76
Q

What are some signs of physical abuse ?

A

Children with frequent injuries
Children with unexplained or unsual fractures
Children with unexplained bruises, cuts, burns or bite marks

77
Q

What is emotional abuse ?

A

The persistent emotional maltreatment of a child. Also called psychological abuse and can affect a child’s emotional development.

78
Q

What are some signs of emotional abuse ?

A

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

79
Q

What is sexual abuse ?

A

Any sexual activity wit a child. Many children who are victims of sexual abuse don’t recognise themselves as such.

80
Q

What may sexual abuse involve ?

A

Physical contact
Rape
Oral sex
Masturbation
Kissing
Rubbing and touching outside clothing
Producing sexual images
Forcing children to look at sexual imagery

81
Q

What are some indicators of sexual abuse ?

A

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

82
Q

What is sexual exploitation ?

A

A form of sexual abuse where children are sexually exploited for money, power or status. It can involve violent, embarrassing or degrading sexual assaults.

83
Q

What are some signs of sexual exploitation ?

A

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

84
Q

What is neglect ?

A

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.

85
Q

What are some signs of neglect ?

A

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

86
Q

What does the newborn physical examination check for ?

A

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

87
Q

What is tested for in the heel prick spot test ?

A

Sickle cell disease
Cystic Fibrosis
Congenital hypothyroidism
Phenylketonuria
Homocystinuria

88
Q

What are developmental milestones separated into ?

A

Gross motor
Vision and fine motor
Hearing, speech and language
Social, emotional and behavioural

89
Q

At what age do babies sit without support ?

A

6 - 8 months

90
Q

At what age do babies crawl ?

A

8-9 months

91
Q

At what age do babies stand independently ?

A

10 months

92
Q

At what age do babies walk steadily ?

A

15 months

93
Q

At what age do babies run and jump ?

A

2.5 years

94
Q

At what age do babies say words such as dada or mama ?

A

10 months

95
Q

At what age do babies join 2 or more words together ?

A

20-24 months

96
Q

When do babies smile responsively ?

A

6 weeks

97
Q

At what age do babies put food in their mouth ?

A

6 -8 months

98
Q

At what age do babies become toilet trained ?

A

2 years

99
Q

What are some signs that a baby is unwell ?

A

Poor feeding
Altered cry / drowsy
High temp
Irritability and lethargy
Dry nappies / not passing urine
Prematurity

100
Q

What are some clinical features of meningitis ?

A

Non-blanching rash
Neck stiffness
Photophobia
Drowsiness
Vomiting
High temp

101
Q

What medication is given for meningitis ?

A

Benzyl penicillin IM

102
Q

What features of the history are important to ask if a baby is failing to thrive ?

A

Maternal smoking
Maternal illness during pregnancy
Use of medications during pregnancy
Relationship of symptoms to mealtimes
Ethnic origin

103
Q

What features of a physical exam would be essential to assess a malnourished child ?

A

Measuring head circumference
Looking for signs of vitamin deficiency
Assessing skin turgor

104
Q

What are some physical signs elicited which would indicate malnutrition ?

A

Oedema
Muscle wastage
Rash or skin changes
Hair colour or texture changes
Mental state changes

105
Q

What would indicate a dehydrated child ?

A

Decreased skin turgor
Decreased sensory awareness
Sunken fontanelles
Dry mucous membranes
Absence of tears
Acutely ill appearance

106
Q

What type of vaccine is MMR ?

A

Live attenuated

107
Q

What are some toxoid vaccines ?

A

Diphtheria
Tetanus

108
Q

What are some examples of killed vaccines ?

A

Flu and hepatitis A

Y3 GP (12 decks)

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