Paediatrics Flashcards
Eczema - presentation and history
- dry, itchy, cracked and sore skin
- Can be inflamed - red on lighter skins and purple/grey on darker
- patches of skin/widespread
- commonly (creases of skin) hands, insides of elbows, backs of knees, face and scalp
- Can have flare-ups
diagnosis q’s
- itching
- FH or personal atopy?
- treatments used
- rashes - onset, patterns, flexural
- triggers
- dry skin in last 12 months
Eczema - management
treatment - self-care, emollients (E45) and then topical corticosteroids (hydrocortisone 1%)
info
- chronic illness characterized by flares, which can usually be controlled with appropriate treatment.
- usually improves with time but can continue and worsen in teenage years
- associated w atopy so this can occur - hay fever, asthma, FH and food allergy
- symptoms and signs
- infective eczema If eczema is weeping, crusted,
pustules, with fever/malaise think secondary
bacterial infection
- and eczema herpeticum, medical emergency
self- care
- frequent use (every 2–3 hours should be considered normal) of emollients even when skin is clear. smoothing them into the skin along the line of hair growth. Wait 15-30mins before applying after using a topical corticosteroid. If a skin reaction occurs, stop the emollient and use a different one.
- avoid trigger factors
- avoid scratching - rub gently instead
- avoid the use of soaps, detergents, and bubble bath when washing
eczema differentials - how to differentiate
Urticaria
- Itchy raised red rash - eczema is a scaly itchy rash
- Angioedema
- anywhere on the body
- Acute urticaria more common in children
Scabies
- Severe itchy rash especially night, whereas eczema presents as flare-ups
- Pimple-like bumps in it, eczema - patches which can blister
- Tiny mites lay eggs in skin - silvery lines w a dot at 1 end
- Very contagious
- Rash typically found on palms of hands, soles of feet and scalp in infants
Functional Constipation
presentation and aetiology
Withholding of faeces as child wants to avoid painful evacuation
Common in children 2-3 years - potty trained.
diagnosis: 2+ of
< 3 complete stools weekly
hard, large stools
rabbit droppings
overflow soiling
- faecal impaction if overflow soiling, palpable mass on abdo exam, severe constipation symptoms
- Other symptoms: soiling, straining, bleeding, stomach pain that resolves after defecation, reduced appetite, painful hard bowel movements
Causes: low fibre in diet, not enough fluids, child being worried/anxious (moving house/school), feeling pressured/interrupted whilst potty training,
F Constipation - treatment
Offering reassurance that underlying causes of constipation have been excluded. - assess red and amber flags
- Laxatives - macrogol - movicol paed plain - Polyethylene 3350 plus electrolytes
Faecal impaction with a recommended disimpaction regimen
- can initially increase symptoms of soiling and abdominal pain, and ensure the child has easy access to a toilet.
- review in 1 wk - max use is 1 wk
Maintenance laxative drug treatment if no impaction/successfully treated
- same macrogol movicol plain treatment
- reduce dose if causes diarrhoea
self - care
- parents staying calm and supportive,
- child can rest their feet flat,
- scheduled toileting, reward system, bowel diary
- physically active
- correct foods and water
F constipation - how to rule out differentials/underlying causes
Red flags
- Symptoms since birth or FH of Hirschsprung’s disease
- Delay in passing meconium >48hrs - CF or HD
- Abdominal distension + vomiting - HD or intestinal obstruction
- Leg weakness/motor delay - neurological/spinal cord deformity
- Abnormal appearance of anus: anteriorly placed, fistulae, bruising, fissures, tight/patulous, absent anal wink (reflex contraction when anus stroked) - suggest neurological/spinal,
- Abnormalities in lumbosacral and gluteal regions - scoliosis or asymmetry of the gluteal muscles
Amber flags
- Faltering growth/developmental delay/any
concerns about wellbeing - systemic condition
e.g. Coeliac disease, CF, hypothyroidism or
electrolyte disturbance
- introduction of cows milk - allergy
- child maltreatment
Threadworms - parasites
Extreme Itching around the anus or vagina, particularly at night
Nocturnal itching – irritability
asymptomatic but seen in poo/perianal skin - white worms
contacts w similar symptoms
investigation - adhesive tape test for eggs if diagnosis uncertain
causes: spread by ingestion of threadworm eggs via faeco-oral route - poor hygiene
Threadworms - treatment
anti-helminthic such as mebendazole - also hygiene measures for 2 wks - unless < 2 yrs or pregnant - ADR w cimetidine (H2 receptor antagonist) and metronidazole (abx) hygiene measures alone for 6 wks - if mebendazole - showering every morning - change bed linen - washing hands - don't bite nails - damp - dusting bathroom
consider whole family treated as contagious
Threadworms differentials
Candida - Presents with white, odourless discharge. Treated with antifungal medication
Haemorrhoids - Swelling of the vasculature around anus. Can be painful if prolapsed/external. Possibly causes itchiness around the anus
GORD - presentation and treatment
<1: excessive crying while feeding; adopting unusual neck position; chronic cough; gagging/choking during feeding
>1: retrosternal pain; epigastric pain; and heartburn.
v common, symptoms self - limiting, resolves before 1yrs medication 1. Gaviscon 2. Pre-thickened Formula 3. PPI'S or H2 receptor antagonists
GORD - differentials
Red flag symptoms:
Frequent, forceful vomiting - Pyloric Stenosis
Frequent diarrhoea - milk allergy
Blood in vomit - oesophageal rupture
Bile in vomit - Intestinal obstructions
Bulging Fontanelles - Meningitis
Hayfever - presentation and treatment
late march - September
other symptoms: pain around temples/forehead, coughing
atopy
treatment - avoid pollen, antihistamine tablets/spray, steroid nasal spray, eye drops
Hayfever differentials
infection - shorter duration, contagious, temperature, yellow/green sputum allergic rhinitis (inflammation) - not dependent on seasons, specific nasal symptoms
Osgood Schlatter’s Disease - presentation and causes
inflammation of patellar ligament at tibial tubercle
young athletes (in their growth spurt) , Male - as caused by overuse/repetitive injury
Presentation: unilateral localised tenderness on palpation, pain, warmth, swelling or increase in size of bony prominence over tibial tuberosity
Investigation: X-ray - initial soft tissue swelling –> enlarged tibial tubercle or fragmentation of the apophysis
Management: Rest, Ice, NSAIDs & Physiotherapy, activity modification (avoiding sports w high impact here e.g. football
OSD differentials
fracture of tibial tuberosity - trauma - x-ray show fracture line w/out fragmentation of OSD
Perthes disease - rare childhood condition, temp disrupted blood supply to femur head so hip X- ray show avascular necrosis of femur head, can cause referred pain
SUFE - slipped upper femoral epiphysis, knee x-ray normal but hip/pelvis abnormal with reduced ROM of hip alone
Toddler Diarrhoea - presentation
generally otherwise well
tends to go as the child grows up,
Symptoms:
- Develop _>3 watery loose stools per day.
- Stools smellier/paler than usual.
- Mild abdominal pain.
- Constipation which alternates with diarrhoea.
diarrhoea treatment
treatment isn’t often needed, but care of 4 F’s helps: fat, fluid, fruit juices and fibre
- normal fibre levels
- not too much fruit juice/squash, some types of sugar not digested/absorbed and get into the large bowel –> watery stools.
- high fat diet good - inc. dairy,
diarrhoea differentials
infection
IBD - bloody diarrhoea , weight loss
Food intolerance - tummy pain, skin rashes/itching, only certain foods cause
Coeliac disease - gluten specific, can have itchy rash, constipation, indigestion
viral wheeze - cause and management
RSV/rhinovirus <3yrs but <5yrs defo
smaller airway diameter –> slightly increased restriction –> wheeze –> resp distress
same as asthma - SABA w large vol spacer if hospital admission not required, check on pt regularly even at night
viral wheeze ddx
asthma - other triggers than infection, atopy association
resp infection - skin colour changes, breathing issues
inhaled foreign body - choking, cough, asymmetrical chest movement / tracheal deviation
weaning
starting solid foods
- avoid honey
Rashes - common ones
jaundice - few days after birth - see dr
self-limiting :
mongolian spots - blue discolouration - look like bruises but are painless, in 1yr,
erythema toxicum - few days after birth, just red,
milia - small white bumps - face
dry skin - normal, was surrounded by fluid before
cradle cap - like dandruff from scalp
baby acne - 2-3 wks of age due to mums hormones
heat rash - on neck diaper area and armpits, can be itchy,
eczema - apply vaseline or moisturiser to treat dry skin
Breastfeeding problems
too little/too much milk tongue tied babies sore/cracked nipples - not correct positioning mastitis thrush engorgement not latching properly
colic
colic if they cry more than 3 hours a day, 3 days a week for at least 1 week. no clear reason
cry more often in the afternoon and evening.
It may also be colic if:
it's hard to soothe or settle your baby clench their fists go red in the face bring knees up to their tummy/arch their back tummy rumbles or they're very windy
speak to health visitor for advice - gently rocking your baby on your shoulder, winding them after feeds or giving them warm baths. can b due to indigestion/food allergy
