Paediatrics Flashcards
A 4 year old boy presents with his parents due to nocturnal enuresis. What is your management? (3)
Explain (age 4 around 30% children still wet the bed).
- Reassure likely to resolve
- Ensure lots of daily fluid, restrict intake before bed
- Avoid caffeine, especially before bed
What are 1st and 2nd line treatments for a 7 year old boy wetting the bed at night?
1) Alarm training (to condition to wake up, takes 3-5 months to work). Finish once 14 dry nights consecutive
2) Desmopressin (age >7)
When is chicken pox considered to be infective and what is classed as significant contact?
From 2 days before rash until 5days after/ lesions crust over
Face to face OR 15 mins in same room is significant
What are the hallmark features of croup? (4)
Stridor
Barking cough (worse at night)
Fever
Coryzal symptoms
What factors should prompt consideration of admission for a child with croup (4)
< 6 months Frequent barking cough Easily audiable stridor at rest Sternal wall retractions Lethargy Tachycardia
What is the treatment for Croup (3)
Single dose oral dextamethosone (regardless of severity)
If emergency:
- High flow O2
- Nebulised adrenaline
At what age should a child be able to control their head?
3 months
At what age should a child be able to sit?
7-8 months
refer at 12 months
At what age should a child be able to roll front to back?
6 months
At what age should a child voice bable?
7-8 months (refer at 10 months)
At what age should a child be able to crawl?
9 months
At what age should a child start to walk unsupported?
13-15 months (refer at 18 months)
At what age should a child speak 1-2 words?
12 months
At what age should a child be able to run or walk up stairs?
2 years
At what age should a child be dry in the day time?
2.5 years
What are the two signs associated with meningitis?
Kernigs (hip and knee at 90 degrees, extend knee - causes pain in back = meningitis or SAH)
Brudzinski’s (neck stiffness means when neck is flexed, hip and knees also flex)
How should meningitis be managed in those (a) under 3 months and (b) over three months? (3)
Bacterial until proven otherwise All given dexamethasone to reduce hearing complications (<3mths) (a) Cefotaxime and amoxicillin (b) Ceftriaxone Supportive management
What assessment should also children have following an episode of meningitis?
Hearing assessment at 4 weeks
Followed up in paeds clinic for neurological complications
Which bacterium carries the worst prognosis for meningitis?
Strep Pneumoniae
30% mortality
Which bacterium carries the best prognosis for meningitis?
Neisseria meningitdes
3.5-10% mortality
Which is more specific of leucocytes and nitrates on urine dip?
Nitrates
93% so if +ve for nitrates then always treat for UTI
If leucocytes are +ve on urine dip but nitrates are -ve, what is the appropriate management of suspected UTI?
Leucocytes are more sensitive but less specific
If clinical signs = treat
If no clinical signs = don’t treat
What characteristic features are associated with nephrotic syndrome?
Massive proteinuria, low albumin and oedema
A father attends the surgery with his seven-year-old son. His son is experiencing intermittent nose bleeds with minimal blood loss. They always self-terminate and he is not currently bleeding. He has no significant past medical history or family history of bleeding disorders. What is the most appropriate management?
There are no sinister features and the child is over the age of two, so the most appropriate first-line management would be to prescribe a short course of nasceptin (topical chlorhexidine and neomycin), and discourage the child from picking his nose. Further investigations or referral does not need to be undertaken at this stage.