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Paediatrics Flashcards

1
Q

Williams syndrome

A 
Short stature 
Learning difficulties 
Transient neonatal hypercalcaemia 
Supravalvular aortic stenosis
Friendly extrovert personality
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2
Q

Prader Willi syndrome

A

Hypotonia
Hypogonadism
Obesity

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2
Q

Noonans syndrome

A

Webbed neck
Short stature
Pulmonary stenosis
Pectus excavatum

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3
Q

Edwards syndrome (tri 18)

A

Rocker bottom feet
Micrognathia
Overlapping fingers
Low set ears

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4
Q

Patau syndrome (tri 13)

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly (pink finger slopes inwards)
Scalp lesions

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5
Q

Fragile x syndrome

A 
Leaning difficulties 
Macrocephaly
Long face
Large ears
Macro-orchidism
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6
Q

fragile x

A 
learning diff
big head
big ball
long face
large ears
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7
Q

pierre robin

A

small chin

cleft palate

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8
Q

infections and agents

A

Hand foot mouth – coxsackie a16

Croup – parainfluenza

Scarlet – strep pyogenes

Slapped face (5th, eryth infect) – parovirus b19

Whooping – bordatella pertussis - vaccine

Epiglottitis – HIb - vaccine

Bronchiolitis – RSV

Gastroenteritis - rotavirus

Glandular fever (IM) - EBV

Common cold - rhinovirus

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9
Q

otitis media

A

usually 2dry to RTI

80% self limiting

  • ipubrofen, paracetamol
  • but may give amoxicillin (delayed presc?)

20% get recurrent - glue ear
- effusion level, reduced hearing
- worry about learning delay
T: grommets

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10
Q

pharyngitis and tonsillitis

1/3 bacterial
2/3 viral

A

difficult to distinguish bact (eg Gr A strep) vs viral

centor scale >3 give Abx

  • exudate
  • lymphadenop
  • fever
  • no cough

headache and abdo pain also point ot bact

T: Pen V 500 qds
* avoid amoxicillin (if due to EBV casues macpap rash)

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11
Q

tonsillectomy indication

A

recurrent - missing school
quinsy (peritonsillar abscess)
obstructive sleep apnoea (1%)

often done with adenoidectomy and grommets

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12
Q

Laryngeal and trachael infections

A

include croup (parainfl) and epiglottits (HIb)

cause resp distress
- tugging, sub/intercostal recessions

Epi

  • onset over hours -> toxic (t>38.5)
  • minor cough, soft stridor
  • open mouth, drooling, not drinking

Croup

  • onset over days - starts w cold (urti), worse at night
  • barking cough
  • able to drink
  • harsh stridor
  • peak at 1-2yrs
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13
Q

Croup

A

Viral laryngotracheitis
PARAINFLUENZA

Barking cough
Stridor, hoarseness
Respiratory strain (recessions, tugging etc)

Onset over days
1 - 2 years peak incidence

(vs epiglottis: very unwell suddenly)

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14
Q

Croup treatment

A

Oral dexamethasone
Oral prednisolone

Nebulised steroids (budesonide)
Nebulised adrenaline (quick but temporary relief)
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15
Q

Epiglotitis

A

HIb (most now immunised)
V quick onset (hours)

Toxic/ acutely unwell
Sitting still, drooling

Stridor
Mild cough

Do not examine throat - total obstruction

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16
Q

Whooping cough

A

should be immunised

100 days
Bordetella pertussis

Catarrhal phase
Paroxysmal phase (3-6 weeks)
    - may vomit with coughing
    - may have periods with apnoea
    - epistaxis, telangectasia etc
Convalescent phase

Ix: pernasal swab

Tx: erythromycin

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17
Q

Whooping cough

A

type of bronchitis in children

should be immunised

100 days
Bordetella pertussis

Catarrhal phase
Paroxysmal phase (3-6 weeks)
    - may vomit with coughing
    - may have periods with apnoea
    - epistaxis, telangectasia etc
Convalescent phase

Ix: pernasal swab

Tx: erythromycin

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18
Q

Bronchitis in kids

A

mostly viral
cough, fever, wheeze and crackles
duration 2 weeks
abx no benefit

whooping cough is rare bacterial bronchitis
- pertussis - should be immunised

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19
Q

Bronchiolitis

A

Infancy (1-9 months)
RSV - infectious

Causing respiratory distress

  • sharp, dry cough
  • wheeze crackles
  • SOB tachy
  • cyanosis/pallor
  • hr

Tx: paracetamol and review
admit if resp distres/unwell
supportive humidified oxygen if needed

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20
Q

Asthma

A

Cough wheeze dyspnoea
Worse at night
Trigger
- cold air exercise dust smoke virus

Exacerbations?
Missed school?

Other atopy?
FH?

Respond to bronchodilator
- in young infancy hard to differentiate from viral wheeze (neither respond well to bronchodilator)

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21
Q

Asthma couselling

A

MESE

Medication
-relievers and preventers

Environment
- avoid passive smoking

Self monitoring PEFR

Educate
- inhaler technique

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22
Q

Asthma medication

A

1 - saba
2 - add inhaled steroid (200-400 mcg/day)
3 - increase steroid to 400
- laba (can combine)
(- for young children use leukotriene antag)
4 - increase steroid to 800
- consider oral course for exacerbations

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23
Q

Cystic Fibrosis

A

Autosomal recessive CFTR protein on chrom 7
1 in 25 carriers in Caucasian, 1 in 2500 live births

Viscosity of exocrine secretions

  • respiratory
  • pancreatic
  • salty sweat

diabetes
infertility

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24
cystic fibrosis presentation
``` Failure to thrive Recurrent chest infections - persistent cough, sputum, wheeze Malabsorption, steatorrhoea 15% meconium ileus in neonate (obstruction) ``` Can get diabetes Can get bronchiectasis Can get clubbing Male infertility
25
Managements CF
Physiotherapy Mucolytics Enzyme replacement (CREON) Prophylactic Abx every 3 months Parental support - risk that future sibling has CF (1 in 4) Mean survival 32 years
26
Allergy
usually refer to type 1 hypersensitivity Abnormal immune reaction to harmless stimuli Range of types if reaction - severe (angio-oedema, bronchospasm) - milder (rash, GI Sx, coryzal Sx) May grow it of it (not if nuts, seafood) Talk about - avoidance - antihistamines - epipen
27
Hand foot mouth disease
Coxsackie a16 Sore throat, fever Vesicles in mouth hand feet
28
Hand foot and mouth disease
febrile illness pupulovesicular rash - hands feet buttock vesicles on mouth coxsackie a16
29
Scarlet fever
Strep pyogenes Fine red rash on trunk and spreading Fever Sore throat Headache Strawberry tongue T: penicillin v exclusion from school for few days good hygiene
30
Fifth disease Slapped cheek Erythema infectiousum
Parvoviruses b19 Lethargy fever head ache Slapped cheek rash
31
Chicken pox
Varicella zoster Fever Itchy spreading rash Macule > papule > vesicle Paracetamol (calpol) and ibuprofen
32
Measles
Prodrome - irritable - conjunctivitis - fever - koplick spots Rash - ear/face >>> body - discrete macpap >>> confluent, blotchy Tx Rest, eat and drink, isolation, treat superimposed infection, analgesia
33
measles complication
encephalitis pneumonia rarely 5-10yrs later - subacute sclerosing panencephalitis
34
Mumps
Fever malaise Muscle pain Parotitis (initially unilateral but 70% get bilateral)
35
Rubella
Pink macpap rash Face >> body Lymphadenopathy - sub occipital and post auricular
36
rubella vs measles
both macpap rash face -> body rubella - lymphadenopathy (suboccip) measles - koplick, conjunctivitis, ear ache
37
Cerebral palsy - what is it
Disorder of movement Permanent non- progressive lesion in developing brain Can get other neurological/learning difficulties Manifestation may change as child develops, even though lesion doesn't progress
38
Presentation of cerebral palsy
Neonatal FFFF - fits - floppy - feeding - funny mood (irritable) Within 1st year ART - Asymmetry - persistent primitive Reflexes - Tone abnormalities (spasticity) Delayed and abnormal motor development
39
Causes of cerebral palsy
80% antenatal - infection - hypoxia/vascular occlusion 10% hypoxic/ischaemic birth injury - more likely in preterm 10% post-natal cerebral injury - infection - severe hypoglycaemia - kernicterus
40
Types of cerebral palsy
- 70% spastic UMN lesion hemi (one side), di (legs), quadri (4 limbs) ...plegia - 10% dyskinetic (contract/relax in opposing muscle groups - uncoordinated, involuntary, jerky movements) basal ganglia distonia (proximal, trunk), athetoid (distal, finger fanning) - 10% ataxic cerebellum hypotonic, uncoordinated, poor balance
41
cerebral palsy management
CT or MRI - brain lesion Multidisciplinary input - Child Development Services - SALT - nutrition - physiotherapy - occupational therapists (equipment) - educational needs Respite support, financial support
42
Fits faints funny turns
Breath holding - following crying - go limp Reflex anoxic spell - following injury/illness - white/collapse Myoclonic epilepsy - shock-like jerks Syncope/vasovagal - go hot
43
Febrile convulsions
3% kids under 5 Strong familial link Seen early in viral illness As temperature spikes 2/3 will be a one off 1/3 go on to have more febrile convulsion Increase risk of epilepsy (6% vs 1.4%) but not causative But complex seizures could indicate tendency to epilepsy - prolonged, focal, repeated
44
Epilepsy
Tendency to have recurrent seizures 1 in 200 children ``` Mainly idiopathic (80%) - secondary to cerebral injury, neurocutaneous conditions ```
45
seizure types
generalized - tonic clonic, absence - treat sod val or lamot partial - focal neurology - commonly temporal lobe - may be comlex (altered conscious) or simple - often aura, lip smacking, imp conscious - -> must do MRI ?brain tumour - carbamez
46
juvenile myoclonic epilepsy
three features - myoclonus - generalised tonic clonic - absence t: boy: sodium val; girls: lamotrigine
47
status epilepticus
ABC pre hospital rescue - buccal medaz or rectal diaz ``` in hosp iv lorazepam - phenytoin -- anaethetics identify casue - temp, glucose ```
48
migraine in kids
most common headache in kids ``` lasting > 4hrs pulsatile, severe, unilat aggravated by phys activity aura nausea, vom, photo/phono-phobia ``` family hist ``` T: acute - ibuprofen +\- triptan (nasal or oral) - antiemetic - rest in dark quiet room ``` General: avoid triggers (regular food, sleep, avoid caffeine, choc, cheese, ocp) Prevention if 4 per month - propranolol (ci:asthma) - or topiramate (! in females - fetus and contracep) prevent - pizotifen or propranolol
49
Cardiac defects
Often multiple defects Often other congenital malformation Acyanotic (ASD / VSD/PDA) are most common Cyanotic - TOF, AVSD, transposition
50
Acyanotic Cardiac Defects ``` M resus, support (diuretic) iv prostaglandin for coarctation nsaid for pda conservative -> surgery or catherterisation ```
Left-to-right shunts - ASD/VSD/PDA - present with heart failure - pan systolic murmur HEART FAILURE - feeding probs - infections - sweaty - fail to thrive Might get chronically raised pulmonary HTN -- Eisenmenger's Obstructive defects - severe coarctation - stenosis - present with shock/collapse (duct dependant systemic circulation) - GIVE PROSTAGLANDIN
51
Cyanotic Cardiac Defects
Cyanotic - tetralogy - AVSD - transposition Duct dependant pulmonary circulation Present in first week BLUE BABY - as duct closes - give prostaglandin iv
52
Meningitis
Most commonly viral - self limiting Bacterial v serious - newborns: Group B Strep - otherwise: neisseria menigitidis (menigococcus), strep pneumonia - mainly affects young people - up to 10% die - 10% long term probs (deafness, seizures, brain injury - affecting particular limb)
53
Meningitis
Most commonly viral - self limiting Bacterial v serious - mainly affects young people - up to 10% die - 10% long term probs (deafness, seizures, brain injury - affecting particular limb)
54
meningitis presentation
fever,leth, poor feed, irritable vom, HEADACHE septicaemia: shock, PURPURIC RASH !! drowsy, loc, seizure, hypotonia, photophobia !!! bulging fontanelle, stiff neck, opisthotonis - brudinski's - lift head - legs raised - kernig's - hip flexed, extending knee painful
55
Meningococcal septicaemia
Flu illness and fever Purpurin rash Must give IM penicillin pre hospitalisation Progresses to shock coma death
56
meningitis mgmt
septic screen - blood, uti, cxr, csf start acyclovir until known - raised wcc and crp points to bacterial CSF !! dont do lumbar puncture if signs of raised ICP - coma, raised bp, papilloedema, focal neurology - coagulopathy in GP - stat benzylpenicillin (IV or IM) in hospital - IV ceftriaxone - plus dexamethasone (>3m) - plus ampicillin if <3m (vs listeria)
57
CSF in meningitis
Leukocytes + Bacterial - turbid - polymorph - high protein (1-5g/l) low glucose (<40% serum) Viral - clear - less electrolyte change - -> self limiting supportive Mx of bacterial - immediately start abx - dexamethasone if over 3 months - prophylaxis for contacts
58
Recurrent abdo pain
Majority are IDIOPATHIC GI - upper GIT - inflammation - infection - malabsorption - constip UTI Gynaecological - dysmenorrhea - PID
59
Idiopathic recurrent abdo pain
Comparable to recurrent tension headaches/growing pains ``` Reassurance No cause identifiable Safety net - what to look out for Monitor - keep a diary Liase with school - attendance - minimise interference with daily life Address stresses at home/school ```
60
Acute abdomen
Appendix - anorexia, still, fever, vom Intersusseption - intermittent screaming and pallor - under 2 years Mesenteric adenitis - node enlargement 2ary to viral infection DKA? UTI?
61
Vomiting in young baby
Over feeding Reflux PS Bowel obstruction - rare but must ask about bile stained vom? Whooping cough
62
Pyloric stenosis
4-6 weeks Boys Projectile vom post feed Hungry Dehydrated Olive mass in epigastrum Low chloride/potassium/sodium Alkalosis T: resus w fluid and correct electrolytes Ramstedts procedure
63
Vomiting in older child
Gastroenteritis Systemic infection - UTI - otitis media - mening Migraine
64
Organic abdo pain HISTORY
F.A.N.E.W ``` Fever Appetite Night Energy Weight ``` Other bowel/urinary/gynae symptoms
65
UTI in kids
General symptoms of fever, irritability, vomiting Maybe frequency, dysuria, bedwetting Pain? Systemic illness? Constipation? Advise about wiping and wet nappies
66
UTI in kids
under 3 months - refer upper uti - 7-10 days broad spec + refer simple uti - 3days trimethoprim in teenager - ask about sti - advise voiding after sex
67
First line treatment constipation
Movicol paediatric plain dietary and fluid advice Lactulose if not tolerated
68
Enuresis
Delay in sphincter control and nighttime bladder awareness Familial and emotional aspect - but mostly happy and normal just taking a bit longer Nocturnal common - 10% 5y - 5% 10y - 1% 15y Fluid and toilet routine Not afraid of getting out of bed in night Not punish - praise dryness, help change sheets Alarms desmopressin
69
Primary enuresis
Delay in normal sphincter control - quite common Rule out illness ``` Fluid intake and toilet routine No impediments to bathroom at night Star chart Alarm Desmopressin (not lasting cure) ``` Could have neurological component - test reflexes, anal tone, sensation
70
Secondary enuresis
UTI? Diabetes? Constipation? - do urine sample
71
methyphenidate - also known as..
ritilin
72
Soiling
Mostly due to retention - pain, anxiety softener (docusate, lactulose) stimulant (senna) retraining
73
gastroenteritis in children
Rotavirus
74
Chronic diarrhoea
Non-pathological - otherwise thriving - 'toddler diarrhoea' Malabsorption (failure to thrive) - CF (diag: sweat test) - coeliac (anti TTG) - lactose intolerance (follows acute gastroenteritis) soya milk until Sx resolve Inflammatory - cows milk protein intolerance (bloody) - IBD Infection - giardia
75
Coeliac
Gluten intolerance - found in wheat and rye ``` Usually before age of 2 Present w irritability, anorexia, vomiting, diarrhoea Pale, foul smelling stools Abdo distension, wasting, pallor May get clubbing ``` Ix - fe deficiency anaemia * may be mixed w macrocytic - steatorrhoea - anti TTG antibodies - jejunal biopsy
76
infantile colic
common under 3m | worse in evening
77
Cows milk protein intolerance
- non IgE Bloody diarrhoea Vomiting/abdo pain IgE Urticaria Bronchospasm, angioedema Substitute soy milk Resolve within 1-2 years
78
intersusception
episodes of screaming - pale, vom - drawing knees up - red current jellys stool - sausage mass in abdo T: fluid insufflation (pump air) --> surgery
79
Nephrotic syndrome
Minimal change glomerulonephritis Proteinuria Oedema Recent viral illness T: restrict fluid and salt intake - prednisolone - - will cause immunosupression - avoid vaccines and chickenpox
80
Jaundice
in newborn - bad think haemolysis - rhesus/abo incompat - g6pd or spherocytosis otherwise often physiological or breast milk related (breast milk affects conjugation) - continue, ensure good fluid intake - consider phototherapy if there is conjugated bilirubinaemia - this suggests hepatobiliary problem - ? biliary atresia, neonatal hepatitis
81
wilms nephroblastoma
common malig in kids | balotable mass, distension, pain/haematuria
82
Diabetes couselling
DISH Diet - carb counting how effects insulin req - regular meals - don't skip - high fibre, complex carbs, low fat - exercise Insulin regimes - injections or pump Self monitor- glucose - between 4-6 - 4 tests per day Hypos - look out - hungry sweaty faint irritable
83
DKA presentation
General background - polyuria, polydipsia, weightloss - infections - enuresis Acute - vomit abdo pain - kussmaul breathing - dehydration! - drowsy confused
85
Preterm babies
Development will seem delayed Measure from expected date
85
Longer term complications of prematurity
Hearing and vision - retinopathy Brain injury - CP - epilepsy - leaning difficulties Chronic lung disease if needed lots of ventilators support
86
Prematurity counselling
Longer stay in hosp w special care Considerable variety - slight delay -> disbaled - partly depends on how early - 28 weeks - considerable morbid/mortal, months in hosp - 34-37 excellent (probs - hypo, bili, warmth) S.F.W.R.I.H. B.H/V.L Small Feeding probs - close attention Warmth - thermoregulation Respiratory - steroid PRE DELIVERY (or surfactant to baby) - ventilatory support Infection - prophylactic abx - respiratory - NEC Hypo's - hyglycaemia, calcaemia, hyperbilirubin - can damage brain Long term: H/V.B.L - hearing vision - brain - epilepsy, ld, cp - lungs
87
Premature baby - what to ask in history
``` Mums age and health Pregnancy - smoke or drink - infections - abnormalities on scan - diabetes - HTN ```
88
Apgar score
0 - 2 2 normal, 0 none ``` hr >100 resp effort - crying muscle flexion respond to irrritation colour ``` max 10 = normal < 7 morbidity
89
Birth reflexes
Moro Grasp Rooting Stepping
90
diabetes in pregnancy risk to newborn
macrosomia - trauma, asphyx hypoglycaemia post delivery polycythaemia
91
pregnancy TORCH screen
Toxoplasmosis (learning diff, epilepsy, eyes) - uncooked meat, fish, cat feac Other (hiv, measles) Rubella (neonatal deaf, catar, heart def) CMV (cerebral palsy, deafness) Herpes (ocular, neurological) - non immune mum exposed to varic zoster test for antibodies ---> give VZIg, treat w acyclovir
92
common neonatal infection
group b strep from mums vag - can give abx in delivery (preterm, prom, fever)
93
retinoblastoma
present around 18m - no red reflex, strabismus 10% hered nb cataracts also cause no red relfex but should be detected earlier
94
PKU
prob w phenylalanine breakdown mental retard and seizures fair hair, blue eyes, eczema guthrie test at birth (for phe) phenylpyruvate in urine
95
Neonatal sound checks
Evoked otoacoustic emission - test cochlea Auditory brainstem response audiometry - EEG shows brains response to sound
96
Reflux in infants
Can cause fail to thrive Crying after feeds Vomiting Worse lying down To help: Thicken foods Feed upright Can give antacids or cimetidine
97
Areas of development
Gross motor Fine motor and vision Hearing, speech and language Social, emotional and behavioural
98
Key features in history of developmental delay
Problems in pregnancy - smoking, drinking - infection - abnormalities on scan Delivery - antepartum haemorrhage - prolonged PROM - prematurity - traumatic birth Neonate - feeding - infection - kernicterus FH - when did parents walk, specific inherited conditions in the family eg muscular dystrophy Other developmental milestones
99
Delayed development causes
Familial, constitutional Pregnancy: drinking, smoking Neonate: congenital infection Mental handicap - slow to learn Cerebral palsy - hypertonic Syndromes - hypotonic Deprivation, abuse Specific deficit - deafness, blindness
100
Gross motor
Newborn - flexed limbs - symmetrical - head lag ``` 2 months - head raise 4 months - head control 8months - sitting 9 months - crawl 10 months - pull up, stand support ``` 12-15 months - walking development 18 squat to pick up toy 2 - run
101
Fine motor
2 months - follow object 4 months - reach out 6-8 months - grasp, transfer 10 months - mature pincer 18 months + - drawing, building
102
Cognitive develment
Pre-operational - centre of world, magical events, personifies objects Operational (school age) - practical, ordered ``` Formal operational (adolescence) - reasoning, abstract thought ```
103
Down's syndrome
1 in 800 births Trisomy 21 Assoc with increased maternal age
104
Downs diagnosis
Pre-natal diagnosis - choice to have screening (nuchal translucency 11-14 and blood test 16) - gives risk score (w age) - amniocentesis can confirm (1% miscarriage) Postnatal - clinical suspicion - blood test: karyotype If confirmed - screen for congenital heart defects - hearing and visual tests
105
Downs neonatal symptoms
Hypotonia Facies - flat nose - small eyes/ears (lowset) - space between eyes - epicanthic folds - tongue Single palmar crease Wide spaced first toe
106
Further problems in Down's
Congenital heart defects - AVSD Learning difficulties Hearing and visual impairments ``` duodenal atresia (double bubble) - bilious vom Epilepsy Hypothyroid Coeliac Alzheimers Leukaemia ``` Life expectancy: 50's
107
Downs management
Multi-disciplinary input - speech and language - learning support - health - heart, vision, hearing Support groups
108
hirschprungs
abnormal innervation of rectum cant relax --> obstruction fail to pass meconium ileus, distension and vom complicated by colitis assoc w Down's T: fluid, ng tube --> surgery
109
Downs risk
Age 30 approximate chance 1/1000 | Divide by 3 for every 5 years older
110
Puberty
Tanner stages based on testicals/breasts and hair First signs B: testicals enlarge (10-14) G: breasts devel (9-13) Growth spurt - early for girls late for boys Menarche late for girls - delayed if not by 16 Secondary chacs - body shape - acne - odour - mood
111
Problems with precocious puberty
Small final height Psychological
112
Investigate premature puberty
Before 8 in girl Before 9 in boy Precocious puberty means whole thing not just thelarche/pubarche (generally self limiting) Organic causes (as opposed to constitutional) - will have dissonance - virilisation - rapid Central - Gn dependant (large testes) Pseudo - sex steroids from tumour/ hyperplasia (small or one large testicle) end up with short stature
113
Delayed puberty
Normal by G: 13 B: 14 Concerned if still not within one year Majority constitutional - reassure Girls: Turners Low Gn's (hypothalamic dysfunction) - chronic disease - stress Gn's high - chromosomal (Turners) - gonadal damage from surgery/chemo/trauma
114
rashes in kids
macpap - rubella, measles purpuric - meningeal, henoch schonlein, thrombocytopenia vesicular - chickenpox, herpes, hfm pustular - impetigo (golden crust)
115
Acne management
Reassure - common, treatable ADDRESS PSYCHOLOGICAL ISSUES Mild * benzoyl peroxide - wash or cream - good for papulopustular - anti-inflammatory - SE: skin irritation * topical clindamycin Moderate * oral antibiotics - tetracycline, lymecyclin, eryth * cocp for girls (esp diannete) * adapelene gel - topical retinoid - anticomodonal - light sensitive Severe * oral retinoids - isotretinoin - use at night - ! teratogenic - must prove -ve preg, use condoms - SE: light sensitivity, erythema, scaliness
116
craddle cap
seborrheic dermatitis tend to self resolve - consider baby shampoo /oil - weak topical steroid if severe
117
roseola infanatum
6m - 2yrs fever follow few days later by pink macpap rash HHV6 (6th disease) exanthem subitum
118
steroid ladder
hydrocortison eumovate betnovate dermnovate
119
Scabies
Sarcoptes scabie mite V itchy all over due to type 4 hypersensitivity reaction to eggs T: permethrin all over repeat after 7 days Wash sheets Treat contacts Itch may persist for 4-6 weeks (reassure)
120
Head lice
Pediculus capitits Diag by fine combing hair T: malathion, wet combing etc
121
ITP
Petechiae and bruising No fever T: none> steroids> platelet transfusion
122
Henoch-Scholein Purpura
Systemic vasculitis(small vessel) No fever Purpuric rash - buttocks thighs legs Joint pain Abdo pain Kidney impair T: supportive
123
Vaccines general info
All inactive apart from MMR (modified live vaccines) Mild side effect possible with all - sore at site - drowsy Mild fever, malaise, illness possible with MMR Rare: anaphylaxis Do not give if immune compromised Do not give if child has acute illness
124
knee problems in young
chondromalacia patellae - bad up and down STAIRS osteochondritis dissecans - pain after exercise, LOCKING, SWELLING O-S - tibial tuberosity pain, tender, swollen - sport patella tendonitis - chronic, tender, worse after running
125
squints
concomitant - common, due to refractive error paralytic - rapid, rare, - think space occ lesion detect w cover test refer patch
126
developmental dysplasia of hip
``` females more (x6) breech, big baby, oligohydram fh, first baby, foot deform ``` 20% bilat may see asymmetry in young infant hip creases barlow ortolani us self resolve or orthotic or surgery
127
perthes disease
cause of limp 4-8years avascular necrosis of hip
128
juvenile idiopathic arthritis
painless limp
129
slipped femoral upper epiphysis
cause of limp | 10-15 years
130
jabs 5in1= diptheria, tentanus, polio, pertussis, hib
2m: 5in1 + pneum 3m: 5in1 + men c 4m: 5in1 + men c + pneum 1y: mmr + hib + men c preschool: mmr + 4in1 (not hib) teens: girls: hpv all: 3in1 + men c
131
Other possible vaccinations
TB if contact suspected (Pakistan) Hep B if close contact/mum is positive
132
live vaccines
bcg, cholera, mmr, intranasal flu all others are attenuated
133
why have mmr vaccine
serious illnesses: * Measles- can be fatal - affect brain, lungs * Mumps- can cause infertility in boys, deafness * Rubella- if pregnant mother develops can damage her unborn child's heart, brain, hearing, sight Herd immunity - stop diseases from being able to spread
134
Side effects of mmr vaccine
Uses live attenuated viruses ``` Mild fever and rash 7-10 days after injection (measles) Swollen sore joints (rubella) Lymph glands (mumps) ``` No effects are infectious or serious
135
HPV vaccine
Gardasil - vs HPV 6 & 11 (warts), 16 & 18 (cancer) Previously Cervarix - only vs cancer Still need cervical screening - vaccine does not prevent all cases of cervical cancer/ strains of HPV Very safe very effective
136
paediatric life support
``` shout help A - open airway B - look listen feel - not breathing - 5 RESCUE BREATHS C - no pulse? - 15:2 chest compressions ```
137
2 - 5 parameters
rr 25- 30 | hr 90 - 140
138
5 - 12 parameters
rr 20 - 25 | hr 80 - 120
139
0 - 2 parameters
0-1 hr 110 - 160 rr 30 - 40 1-2 hr 100 - 150 rr 25 -35

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