Paediatrics Flashcards
What’s different about neunatal conjunctivitis vs conjunctivitis in other age groups?
NICE advises that you urgently refer all infants in the first 28 days of life with conjunctivitis for same-day assessment and management - as there could be serious sight-thretening infection or an associated pneumonia.
When can a child with whooping cough return to nursery/school?
- 48hrs after starting antibiotics (often a macrolide).
What are clinical features of whooping cough (pertussis)?
Acute cough that lasted 14 days or more without any other apparent cause and has one of these features:
- paroxysmal cough
- inspiratory whoop
- post-tussive vomiting
- undiagnosed apnoeic attacks in young infant.
How is whooping cough diagnosed?
- per nasal swab culture for Bordetella pertussis - can take days/weeks to come back.
- PCR and serology now increasingly common.
How do we manage Whooping cough?
- infants <6 months with suspected Pertussis should be admitted.
- Pertussis is a notifiable disease.
- Oral macrolide (e.g. clarithromycin or erythromycin) if onset of cough within 21 days (to eradicate and reduce spread).
- Household contacts should be offered abx prophylaxis.
- abx doesn’t alter course of illness.
- School exclusion - 48hrs after commencing Abx (or 21 days from onset of symptoms if no abx).
What are the common causative organisms of hand, foot and mouth disease (HFMD)?
- caused by intestinal viruses of the Picornaviridae family (most commonly Coxsackie A16 and enterovirus 71).
- very contagious, typically occurs in outbreaks at nursery.
What advice would you give to children with HFMD with regards to school attendance?
- children don’t need to be excluded from school.
a) children who feel unwell should be off school until they feel better
What common vitamin deficiency is associated with use of Orlistat?
- Orlistat prescribed in children (not under 12) who are obese with co-morbid conditions e.g. T2DM.
- It is a GI lipase inhibitor so reduce the absorption of fat from the gut, and pt must stick to a very low fat diet.
- it therefore causes deficiency of fat soluble vitamins A, D, E, K.
How do we diagnose obesity in children?
- NICE suggests to use ‘UK 1990 BMI charts to give age- and gender- specific info’
- consider tailour clinical intervention if BMI at 91st centile or above.
- consider assessing for comorbidities if BMI at 98th or above centile.
Whate are some of the causes of obesity in children?
- by most the most common cause is lifestyle factors - associations include: asian children (4x more likely to be obese vs white), female children, taller children.
Other causes:
- growth hormone deficiency
- hypothyroidism
- Down’s syndrome.
- Cushing’s syndrome
- Prader-Willi syndrome.
Tell me a bit about infantile spasms?
- infantile spasms or West syndrome - a type of childhood epilepsy with typical presentation in first 4-8 months of life.
- More common in male infants.
- often associated with more serious underlying condition and has poor prognosis.
Features:
- ‘Salaam’ attacks
- progressive mental handicap
Ix
- CT - diffuse or localised brain disease in 70% - e.g. tuberous sclerosis.
- EEG - hypsarrhythmia in 2/3 of infants.
Mx
- poor prognosis
- Vigabatrin 1st line
- ACTH also used
how many doses of tetanus vaccine provides lifelong protection?
5 doses.
- however, pt with high-risk tetanus-prone wounds (compound fractures or burns with soil contamination) should receive tetanus immunoglobulin - giving a dose of tetanus vaccine at time of injury might not boost immunity quick enough to prevent tetanus developing.
Causes of macrocephaly in children?
- normal variant
- chronic hydrocephalus
- chronic subdural effusion
- neurofibromatosis
- gigantism (e.g. Soto’s syndrome).
- metabolic storage diseases
- bone problems e.g. thalassaemia.
What are the age cut off for precocious puberty?
development of secondary sexual characteristics before 8 yrs in girls and 9 yrs in boys.
