Paediatrics Flashcards
Williams syndrome
Short stature Learning difficulties Transient neonatal hypercalcaemia Supravalvular aortic stenosis Friendly extrovert personality
Prader Willi syndrome
Hypotonia
Hypogonadism
Obesity
Noonans syndrome
Webbed neck
Short stature
Pulmonary stenosis
Pectus excavatum
Edwards syndrome (tri 18)
Rocker bottom feet
Micrognathia
Overlapping fingers
Low set ears
Patau syndrome (tri 13)
Microcephalic, small eyes
Cleft lip/palate
Polydactyly (pink finger slopes inwards)
Scalp lesions
Fragile x syndrome
Leaning difficulties Macrocephaly Long face Large ears Macro-orchidism
fragile x
learning diff big head big ball long face large ears
pierre robin
small chin
cleft palate
infections and agents
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
otitis media
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
pharyngitis and tonsillitis
1/3 bacterial
2/3 viral
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)
tonsillectomy indication
recurrent - missing school
quinsy (peritonsillar abscess)
obstructive sleep apnoea (1%)
often done with adenoidectomy and grommets
Laryngeal and trachael infections
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
Croup
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)
Croup treatment
Oral dexamethasone
Oral prednisolone
Nebulised steroids (budesonide) Nebulised adrenaline (quick but temporary relief)
Epiglotitis
HIb (most now immunised)
V quick onset (hours)
Toxic/ acutely unwell
Sitting still, drooling
Stridor
Mild cough
Do not examine throat - total obstruction
Whooping cough
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
Whooping cough
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
Bronchitis in kids
mostly viral
cough, fever, wheeze and crackles
duration 2 weeks
abx no benefit
whooping cough is rare bacterial bronchitis
- pertussis - should be immunised
Bronchiolitis
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
Asthma
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)
Asthma couselling
MESE
Medication
-relievers and preventers
Environment
- avoid passive smoking
Self monitoring PEFR
Educate
- inhaler technique
Asthma medication
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
Cystic Fibrosis
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
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
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
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
Hand foot mouth disease
Coxsackie a16
Sore throat, fever
Vesicles in mouth hand feet
Hand foot and mouth disease
febrile illness
pupulovesicular rash - hands feet buttock
vesicles on mouth
coxsackie a16
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
Fifth disease
Slapped cheek
Erythema infectiousum
Parvoviruses b19
Lethargy fever head ache
Slapped cheek rash
Chicken pox
Varicella zoster
Fever
Itchy spreading rash
Macule > papule > vesicle
Paracetamol (calpol) and ibuprofen
Measles
Prodrome
- irritable
- conjunctivitis
- fever
- koplick spots
Rash
- ear/face»_space;> body
- discrete macpap»_space;> confluent, blotchy
Tx
Rest, eat and drink, isolation, treat superimposed infection, analgesia
measles complication
encephalitis
pneumonia
rarely 5-10yrs later - subacute sclerosing panencephalitis
Mumps
Fever malaise
Muscle pain
Parotitis (initially unilateral but 70% get bilateral)
Rubella
Pink macpap rash
Face»_space; body
Lymphadenopathy
- sub occipital and post auricular
rubella vs measles
both macpap rash face -> body
rubella - lymphadenopathy (suboccip)
measles - koplick, conjunctivitis, ear ache
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
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
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
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
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
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
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
Epilepsy
Tendency to have recurrent seizures
1 in 200 children
Mainly idiopathic (80%) - secondary to cerebral injury, neurocutaneous conditions
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
juvenile myoclonic epilepsy
three features
- myoclonus
- generalised tonic clonic
- absence
t: boy: sodium val; girls: lamotrigine
status epilepticus
ABC
pre hospital rescue - buccal medaz or rectal diaz
in hosp iv lorazepam - phenytoin -- anaethetics identify casue - temp, glucose
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
Cardiac defects
Often multiple defects
Often other congenital malformation
Acyanotic (ASD / VSD/PDA) are most common
Cyanotic - TOF, AVSD, transposition
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
Cyanotic Cardiac Defects
Cyanotic
- tetralogy
- AVSD
- transposition
Duct dependant pulmonary circulation
Present in first week BLUE BABY
- as duct closes
- give prostaglandin iv
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)
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)
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
Meningococcal septicaemia
Flu illness and fever
Purpurin rash
Must give IM penicillin pre hospitalisation
Progresses to shock coma death
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)
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
Recurrent abdo pain
Majority are IDIOPATHIC
GI
- upper GIT
- inflammation
- infection
- malabsorption
- constip
UTI
Gynaecological
- dysmenorrhea
- PID
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
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?
Vomiting in young baby
Over feeding
Reflux
PS
Bowel obstruction
- rare but must ask about bile stained vom?
Whooping cough
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
Vomiting in older child
Gastroenteritis
Systemic infection
- UTI
- otitis media
- mening
Migraine
Organic abdo pain HISTORY
F.A.N.E.W
Fever Appetite Night Energy Weight
Other bowel/urinary/gynae symptoms
UTI in kids
General symptoms of fever, irritability, vomiting
Maybe frequency, dysuria, bedwetting
Pain? Systemic illness? Constipation?
Advise about wiping and wet nappies
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
First line treatment constipation
Movicol paediatric plain
dietary and fluid advice
Lactulose if not tolerated
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
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
Secondary enuresis
UTI?
Diabetes?
Constipation?
- do urine sample
methyphenidate - also known as..
ritilin
Soiling
Mostly due to retention - pain, anxiety
softener (docusate, lactulose)
stimulant (senna)
retraining
gastroenteritis in children
Rotavirus
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
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
infantile colic
common under 3m
worse in evening
Cows milk protein intolerance
- non IgE
Bloody diarrhoea
Vomiting/abdo pain
IgE
Urticaria
Bronchospasm, angioedema
Substitute soy milk
Resolve within 1-2 years
intersusception
episodes of screaming
- pale, vom
- drawing knees up
- red current jellys stool
- sausage mass in abdo
T: fluid
insufflation (pump air) –> surgery
Nephrotic syndrome
Minimal change glomerulonephritis
Proteinuria
Oedema
Recent viral illness
T: restrict fluid and salt intake
- prednisolone
- will cause immunosupression - avoid vaccines and chickenpox
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
wilms nephroblastoma
common malig in kids
balotable mass, distension, pain/haematuria
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
DKA presentation
General background
- polyuria, polydipsia, weightloss
- infections
- enuresis
Acute
- vomit abdo pain
- kussmaul breathing
- dehydration!
- drowsy confused
Preterm babies
Development will seem delayed
Measure from expected date
Longer term complications of prematurity
Hearing and vision
- retinopathy
Brain injury
- CP
- epilepsy
- leaning difficulties
Chronic lung disease if needed lots of ventilators support
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
Premature baby - what to ask in history
Mums age and health Pregnancy - smoke or drink - infections - abnormalities on scan - diabetes - HTN
Apgar score
0 - 2
2 normal, 0 none
hr >100 resp effort - crying muscle flexion respond to irrritation colour
max 10 = normal
< 7 morbidity
Birth reflexes
Moro
Grasp
Rooting
Stepping
diabetes in pregnancy risk to newborn
macrosomia - trauma, asphyx
hypoglycaemia post delivery
polycythaemia
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
common neonatal infection
group b strep
from mums vag
- can give abx in delivery (preterm, prom, fever)
retinoblastoma
present around 18m - no red reflex, strabismus
10% hered
nb cataracts also cause no red relfex but should be detected earlier
PKU
prob w phenylalanine breakdown
mental retard and seizures
fair hair, blue eyes, eczema
guthrie test at birth (for phe)
phenylpyruvate in urine
Neonatal sound checks
Evoked otoacoustic emission
- test cochlea
Auditory brainstem response audiometry
- EEG shows brains response to sound
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
Areas of development
Gross motor
Fine motor and vision
Hearing, speech and language
Social, emotional and behavioural
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
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
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
Fine motor
2 months - follow object
4 months - reach out
6-8 months - grasp, transfer
10 months - mature pincer
18 months +
- drawing, building
Cognitive develment
Pre-operational
- centre of world, magical events, personifies objects
Operational (school age)
- practical, ordered
Formal operational (adolescence) - reasoning, abstract thought
Down’s syndrome
1 in 800 births
Trisomy 21
Assoc with increased maternal age
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
Downs neonatal symptoms
Hypotonia
Facies
- flat nose
- small eyes/ears (lowset)
- space between eyes
- epicanthic folds
- tongue
Single palmar crease
Wide spaced first toe
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
Downs management
Multi-disciplinary input
- speech and language
- learning support
- health - heart, vision, hearing
Support groups
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
Downs risk
Age 30 approximate chance 1/1000
Divide by 3 for every 5 years older
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
Problems with precocious puberty
Small final height
Psychological
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
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
rashes in kids
macpap - rubella, measles
purpuric - meningeal, henoch schonlein, thrombocytopenia
vesicular - chickenpox, herpes, hfm
pustular - impetigo (golden crust)
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
craddle cap
seborrheic dermatitis
tend to self resolve
- consider baby shampoo /oil
- weak topical steroid if severe
roseola infanatum
6m - 2yrs
fever follow few days later by pink macpap rash
HHV6 (6th disease)
exanthem subitum
steroid ladder
hydrocortison
eumovate
betnovate
dermnovate
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)
Head lice
Pediculus capitits
Diag by fine combing hair
T: malathion, wet combing etc
ITP
Petechiae and bruising
No fever
T: none> steroids> platelet transfusion
Henoch-Scholein Purpura
Systemic vasculitis(small vessel)
No fever
Purpuric rash
- buttocks thighs legs
Joint pain
Abdo pain
Kidney impair
T: supportive
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
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
squints
concomitant - common, due to refractive error
paralytic - rapid, rare, - think space occ lesion
detect w cover test
refer
patch
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
perthes disease
cause of limp
4-8years
avascular necrosis of hip
juvenile idiopathic arthritis
painless limp
slipped femoral upper epiphysis
cause of limp
10-15 years
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
Other possible vaccinations
TB if contact suspected (Pakistan)
Hep B if close contact/mum is positive
live vaccines
bcg, cholera, mmr, intranasal flu
all others are attenuated
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
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
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
paediatric life support
shout help A - open airway B - look listen feel - not breathing - 5 RESCUE BREATHS C - no pulse? - 15:2 chest compressions
2 - 5 parameters
rr 25- 30
hr 90 - 140
5 - 12 parameters
rr 20 - 25
hr 80 - 120
0 - 2 parameters
0-1
hr 110 - 160
rr 30 - 40
1-2
hr 100 - 150
rr 25 -35
