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Paediatrics Flashcards

1
Q

1st line management of infantile colic and by when should it resolve?

A

advice and reassurance

should resolve by 6 months of age

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2
Q

What are the features of infantile colic?

A

episodes of irritability, fussing or crying that begin and end for no apparent reason and that last at least 3hrs a day on at least 3 days of the week for at least 1 week, in an infant up to 4 months of age with no e/o faltering growth
crying most often in late PM or evening and baby brings its knees up to abdomen or arching back when crying

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3
Q

Children presenting with fever and any “red” features according to traffic light system should be assessed how urgently in a face to face setting if initial contact over the phone (if not immediately life threatening illness)?

A

within 2 hours

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4
Q

Symptoms of iron poisioning in children?

A

usually present within 6 hrs post ingestion

vomiting, abdo pain, bloody diarrhoea, haeamtemesis, hepatic damage, tachycardia, systemic collapse.

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5
Q

Cause of hand, foot and mouth disease?

A

Coxsackie virus

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6
Q

Public health guidance on school exclusion for hand, foot and mouth disease?

A

no exclusion required

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7
Q

If a baby is more than 24 hours old when develops jaundice, when do they require urgent admission?

A
  • Jaundice 1st appears at more than 7 days of age
  • Prolonged jaundice-gestational age of less than 37wks with more than 21 days of jaundice, or age 37 wks or more with more than 14 days of jaundice
  • Gestational age less than 35 wks
  • Unwell neonate-lethagy, fever, vomiting, irritability
  • Poor feeding and/or concerns about weight
  • Pale stools and dark urine
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8
Q

Guidance for use of paracetamol and ibuprofen in children with a fever?

A

they should not be used simultaneously but can be alternated if a patient is distressed by their fever and this distress persists or recurs before the next dose is due

they should NOT be used for the sole aim of preventing febrile seizures

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9
Q

School exclusion for child with chickenpox?

A

until all vesicles have crusted over

usually 5-6 days after onset of illness

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10
Q

School exclusion for child with rubella (German Measles)?

A

4 days from onset of rash

Note risk to pregnant women

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11
Q

School exclusion for child with impetigo?

A

until lesions crusted and healed, or 48hr after starting antibiotic treatment

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12
Q

School exclusion for child with measles?

A

4 days from onset of rash

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13
Q

School exclusion for child with rabies?

A

until had first treatment

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14
Q

School exclusion for child with scarlet fever?

A

can return 24 hours after commencing appropriate antibiotic treatment

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15
Q

School exclusion for child with slapped cheek (parvovirus B19/fifth disease/erythema infectiosum)

A

none once rash developed

note risk to pregnant women

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16
Q

School exclusion for child with shingles?

A

exclude only if rash is weeping and cannot be covered

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17
Q

School exclusion for whooping cough?

A

48 hours from starting antibiotic treatment, or 21 day from start of illness if no Abx treatment

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18
Q

School exclusion for Hepatitis A?

A

exclude until 7 days after onset of jaundice (or 7 days after symptom onset)

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19
Q

School exclusion for mumps?

A

for 5 days after onset of swelling

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20
Q

When do umbilical herniae in a baby require surgery?

A

If persistent at 3 years.

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21
Q

When should a child with a sacral dimple be r/f for lumbar US?

A
  • any abnormal neurology
  • any cutaneous stigmata-hair tufts or haematomas
  • dimple more than 5mm in size or more than 25mm away from anus
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22
Q

At what age might surgery be required for hypospadias?

A

6-12 months

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23
Q

Management of baby with 1 (or both if previous referral to senior paediatrician) undescended testis at 6-8 wk check?

A

Reexamine at 4-5 months of age.
If still problem at 4-5 months child should be seen by paed surgeon by 6 months of age
Orchiodopexy performed at 6-12 months

If suspected b/l undescended testes at 6-8 weeks should be r/f for paediatric review within 2 weeks

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24
Q

Height of fever classifying a child under the age of 5 as having as high risk of serious illness (red criteria)?

A

if aged under 3 months a fever of 38 or higher

if aged 3-6 months a fever of 39 or higher would classify as intermediate risk

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25
Q

What is the FeverPAIN score?

A

Score to assess risk of bacterial infection in sore throat px to assess need for Abx.
Score 1 for each of:
-Fever
-Purulence
-Attend rapidly (3 days or less since onset)
-Inflamed tonsils
-No cough/coryza

Score: 0-1 no Abx
2-3 consider delayed script
4-5 Abx

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26
Q

How to measure fever in a child?

A
  • if age less than 4 weeks then electronic thermometer in axilla
  • if age 4 weeks to 5 years then either electronic thermometer in axilla OR chemical dot thermometer in axilla OR infra-red tympanic thermometer.
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27
Q

Referral pathway for suspected brain or CNS malignancy in children and young people?

A

very urgent referral (to be seen within 48hrs) if newly abnormal cerebellar or CNS function

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28
Q

Referral pathway for suspected leukaemia in children?

A

Refer for immediate assessment if child has unexplained petechiae or hepatosplenomegaly

Very urgent FBC (within 48hrs) if pallor/persistent fatigue/unexplained fever/persistent infection/bone pain/bruising/bleeding/generalised lymphadenopathy.

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29
Q

Referral criteria for suspected Wilms tumour?

A

Consider very urgent referral (appointment within 48hrs) in children with any 1 of:
palpable abdominal mass
unexplained enlarged abdominal organ
unexplained visible haematuria

Note 1st 2 criteria same as for suspected neuroblastoma in children

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30
Q

Characteristic lymphadenopathy in patients with rubella?

A

post-auricular tender lymphadenopathy

patients tend to have prodrome of fever, conjunctivitis, URTI features + lymphadenopathy, then develop transient pink/light red rash that starts on face/neck then moves to trunk and limbs

31
Q

When is there documented risk to the fetus of rubella infection in pregnant woman?

A

up until 20 weeks of gestation
first 16 weeks most substantial risk
16-20 weeks-minimal risk of deafness only

32
Q

Duration of rash in erythema infectiosum (parvovirus B19)?

A

biphasic:

  • confluent erythematous oedematous patches/plaques on cheeks, sparing of nasal bridge and peri-orbital, fade over 1-4 days.
  • spread to trunk and extensor extremities, lacy reticular pattern, may be itchy. Lasts 5-9 days but can recur for weeks to months afterwards with triggers e.g. emotional stress, bathing, change in temperature, exercise.

Pt NOT infectious once rash appears.

33
Q

Cause of roseola?

A

HHV 6 or 7

affects children up to 3 yrs of age

34
Q

Characteristics of rash in scarlet fever?

A
  • fine, papular red rash, feels like sandpaper, as fades peeling affects fingers, toes and groin
  • starts on chest and stomach, rapid spread elsewhere
  • flushing of face and peri oral pallor
  • white coating on tongue, peels and leaves ‘strawberry tongue’
35
Q

Abx for scarlet fever?

A

10/7 of Penicillin V

36
Q

Beyond what age is persistent strabismus significant?

A

2 months-should refer

37
Q

Most common form of glomerulonephritis in children?

A

acute post-infectious glomerulonephritis

38
Q

Time scale for testing a urine sample in children presenting with unexplained fever of 38 or higher?

A

urine should be tested within 24hrs

*5% of children with unexplained fever 38 or higher will have a UTI

39
Q

Management of child with ?UTI with urine dip nitrite +ve leuc -ve?

A

start Abx and send for culture
if leuc +ve nit -ve send for culture and only start Abx if good clinical e/o UTI-even if culture negative if pt clinically has a UTI and there is pyuria then Abx should be started
if both +ve start Abx and send for culture if intermediate/high risk of serious illness or previous UTI

40
Q

What dx should infants and children be considered to have if T 38 or higher with bacteriuria?

A

acute pyelonephritis/upper UTI

41
Q

Which children should have an ultrasound urinary tract during an acute UTI?

A 
-if atypical features:
seriously ill
poor urine flow
non E coli UTI-if responding well to Abx and no other atypical features can have US at 6 weeks
septicaemia
raised creatinine
abdo/bladder mass
failure to respond to appropriate Abx within 48hrs

-or if recurrent infection in child under 6 months

42
Q

Definition of recurrent UTI in children?

A

2 upper UTIs
1 upper and 1 lower UTI
3 lower UTIs
(or more)

43
Q

When should an US urinary tract be performed for children within 6/52 of a UTI?

A
  • if under 6 months with 1st time UTI that responds to treatment
  • if over 6 months and recurrent UTI
44
Q

When should children have DMSA imaging 4-6months after acute UTI?

A
  • if under age of 3 and atypical or recurrent UTI

- if age 3yrs or over and recurrent UTI

45
Q

Contraindications to MMR vaccine?

A

severe immunosuppression
Have received another live vaccine by injection within 4 weeks
allergy to neomycin
pregnancy should be avoided for at least 1 month after vaccination
Ig therapy within the past 3 months

adverse effects: fever, malaise, rash after 1st dose, typically 5-7/7 after and lasts 2-3/7

46
Q

Definition of nocturnal enuresis?

A

involuntary d/c of urine by night in child aged 5 or older.
primary-never achieved continence, secondary-child has been dry for at least 6 months before

tx child under age of 7-enuresis alarm 1st line
over 7-consider desmopressin 1st line

47
Q

If a child who has NOT been vaccinated against measles comes into contact with someone with measles how should they be managed?

A

offer MMR vaccine-should be given within 72hrs

48
Q

At what age can a young person be presumed to have capacity to consent?

A

16 years

49
Q

Who has parental responsibility for a child?

A

Mothers and married fathers
Unmarried fathers of children registered since 01/12/2003 in England as long as the father is named on the child’s birth certificate

50
Q

When do parents lose parental responsibility?

A

when the child is adopted

responsibility can be restricted by court order

51
Q

Who has parental responsibility if a child is subject to a care order?

A

local authority

52
Q

What specific documentation is needed on a prescription for children under 12?

A

their age

53
Q

Developmental red flags at 3 months?

A

poor eye contact

unable to hold head on ventral suspension

54
Q

Developmental red flags at 6 months?

A

unable to support head/chest when prone
not reaching for objects-refer
no vowel sounds
not turning to a rattle sound

55
Q

Developmental red flags at 9 months?

A

unable to sit when supported-urgent referral at 12 months
unable to transfer between hands
no babbling

56
Q

Developmental red flags at 12 months?

A

no attempt to crawl or bottom shuffle (usually starts at 9 months)
unable to stand holding on
no response to familiar words

57
Q

Developmental red flags at 18 months?

A

not walking-urgent referral for boys girls at 2 years
no meaningful single words
no attempt to build a tower of blocks

58
Q

Which nutritional deficiency is associated with chronic spontaneous urticaria in children?

A

Vit D and iron

59
Q

Primary care management of breast fed baby suspected of having GORD?

A

-if sx persist despite breastfeeding assessment and advice then consider 1-2 week trial of alginate therapy e.g. gaviscon, if sx improve then continue with treatment but stop at regular intervals e.g. every 2 weeks, to see if sx improved and can stop treatment.

Notes features of GORD:
distress, faltering growth, feeding difficulties e.g. refusing to feed

60
Q

Stepped care approach to managing formula fed babies with suspected GORD?

A
  • review feeding hx
  • reduce volume of feeds if excessive for child’s weight (normal 150ml/kg over 24 hours with 6-8 feeds)
  • then offer a 1-2 week trial of smaller more frequent feeds
  • then offer 1-2wk trial of feed thickeners, must be endorsed by ACBS if prescribed
  • if unsuccessful stop the thickened formula and trial 1-2 weeks of alginate added to formula.
  • if sx still troublesome after alginate trial in both BF and bottle fed babies trial 4/52 of PPI-omeprazole or H2RA, if sx still persisting consider referral.
61
Q

What treatment alone may be appropriate for children with isolated delay in gross motor skills?

A

physiotherapy

62
Q

Management of a child with a squint/strabismus in primary care?

A 
Routine referral to local paediatric eye service e.g. optometry
Urgent referral to ophthalmology if:
headaches
nystagmus
diplopia
limited abduction
63
Q

Diagnostic criteria for developmental coordination disorders (DCD)?

A
  • motor coordination during daily activities substantially below that expected for age and intelligence
  • resulting motor difficulties interfere with AODL/academic achievement
  • problems not due to general medical problem e.g. cerebral palsy, or pervasive developmental disorder
  • if also learning disability, motor difficulties in excess of those associated with a learning disability
64
Q

In relation to head circumference when is an urgent referral to a paediatrician advised?

A

HC above 99.6th percentile or below 0.4th centile OR
HC has crossed 2 centile (up or down) OR
disproportionate to parental head circumference

65
Q

What feature in relation to language development is highly specific to children with autism?

A

language regression in the 2nd year of life

66
Q

If a child is referred by primary care to social services for suspected child maltreatment, by when should the referral be confirmed in writing?

A

within 48 hours

if this referral has not been acknowledged within 3 working days social services should be contacted again

67
Q

Which children with UTI should have a MCUG?

A

if under the age of 6 months and atypical or recurrent infection
used to identify VUR

68
Q

Urgency of referral for suspected lymphoma if child presents with unexplained lymphadenopathy or splenomegaly?

A

very urgent-within 48 hours

69
Q

When can non infant formula milk be introduced?

A
  • infant formula milk is the only alternative to breast milk in 1st year of baby’s life
  • after 1 year can introduce oat, soya and almond drinks
  • semi skimmed milk from age of 2
  • skimmed milk from age of 5
70
Q

Which is the only licensed medication to treat tic disorders?

A

haloperidol

71
Q

For every child placed on the child protection register what additional number are receiving abuse and neglect and not getting support?

A

8

72
Q

Risk of a further febrile convulsion after 1 episode?

A

1 in 3

if no RFs for epilepsy, then risk of epilepsy if have febrile convulsion is 2.5%

73
Q

Fluid restriction in children on desmopressin for nocturnal enuresis?

A

must restrict from 1 hour before taking desmopressin to 8 hours after taking

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