Paediatrics in primary care Flashcards
Red flags for headaches in children
- Has the headache interrupted sleep
- Headache present on wakening
- In teenagers ‘headache that never goes away’ suggests space occupying lesion
- Prohibits usual activities
- Worse on lying down
- Altered personality
- Seizures
- Head Trauma
Meningitis symptoms in children with headache
Fever
Photophobia
Neck pain / stiffness
Periorbital cellulitis symptoms
- Unilateral eyelid swelling and erythema
- Eye pain
- Fever/malaise
- Ptosis (drooping upper eyelid)
- ?history of foreign body or trauma
SEND TO HOSPITAL
Treatment of otitis media
- Admit children under 3 months 38C or more temp
- Consider admitting children 3-6 months 39C or more temp
- Give antibiotics - amoxicillin 5-7 days
Otitis externa treatment
Acetic Acid 2% ear drops or spray – available OTC usually otomize
Consider prescribing antibiotics if the person is immunocompromised or the infection is severe
Otitis externa advice to pt
- Keep the ears clean and dry.
- Avoid swimming and water sports for at least 7–10 days during treatment.
- Use ear plugs and/or a tight-fighting cap when swimming.
- Keep shampoo, soap, and water out of the ear when bathing and showering, for example by inserting ear
plugs or cotton wool (with petroleum jelly). - Consider using a hair dryer (at the lowest heat setting) to dry the ear canal after hair washing, bathing, or
swimming
Blocked nose treatment in children
Saline nose drops
DO NOT GIVE ANTIBIOTICS
Epistaxis management
Sit up and lean forward with mouth open
Pinch cartilaginous part of nose and hold for 10-15 mins and breath through mouth
If not stopped in 10-15 mins = A+E
If recurrent = naseptin, if not resolved = ENT referral
Impetigo cause and presentation
Staph infection
yellow crusting around mouth
Candidia treatment in children
Miconazole oral gel - first line
If not suitable give oral nystatin suspension (not in neonates tho)
Treat mother if she is breast feeding regardless of symptoms
Impetigo treatment
Avoid school until healed or 48 hrs after starting treatment
- hydrogen peroxide or fucidic acid
Scarlett fever cause and presentation
Strep A
Flu like symptoms
Sandpaper rash
White coating on tongue that disappears
Strawberry tongue
Notify and give antibiotics (stay away from school and avoid sharing utensils for at least 24 hrs)
Asthmas presentation in children
wheeze, cough, breathlessness, and chest tightness
commonly episodic, diurnal (worse at night or in the early morning),
and/or triggered or exacerbated by exercise, viral infection, and exposure to cold
air or allergens
triggered by emotion and laughter in children
expiratory polyphonic wheeze on auscultations
possible atopy (hayfever, eczema)
Asthma investigations in children
Over 5 = spirometry
5-16 = FeNO testing if diagnosis still undercertain
Cannot diagnose under 5 due to not being able to do tests
Bronchiolitis cause and symptoms
Respiratory synctial virus (RSV)
coryzal prodrome (rhinorrhea + fever + develop increased work of breathing (tachypnoea or chest recession) with wheeze and cough)
Bronchiolitis treatment
Antipyretics
Regular fluids
Supportive
No smoking in household
Viral wheeze presentation and treatment
Wheezing associated to infection only causing difficulty breathing - happens when getting repeated illnesses
Salbutamol 2 puff every 4-6 hrs should improve within 48 hrs
Bacterial acute cough symptoms
Temp
No wheeze
No other symptoms - no runny nose
Productive - colour
Crackles on asucultation
Viral acute cough symptoms
Temp
Ear pain
Sore throat with tonsillar enlargement and no exudate
Wheeze
Runny nose
Respiratory red flags in children
- O2 stats <95%
- Grunting
- Chest recession
- Cyanosis
- doesn’t wake, if roused doesn’t stay awake, not responding
- Temperature 38C or higher in a child aged three months or less
- Tachycardia
- Reduced fluid intake
- Nasal flaring
- Tracheal tug
- Signs of clinical dehydration skin turgor, CRT more than 3 seconds, dry mucus membranes
Red flags for GI pain and constipation in children
Associated vomiting
No flatulence
Ribbon stool patter - anal stenosis
Constipation treatment in children
Movicol
Continue laxatives for weeks after symptoms improval
Movements and massages
Faecal impaction symptoms and treatment
Overflow soiling
Constipation history
Faecal mass palpable on examination
Movicol and review in a week
Acute diarrhoea investigations and treatment
Stay hydrated - safety net for signs of dehydration
Urine dip for ketones
If diarrhoea for 7-10 days - liquid stool MCS
Appendicitis symptoms and treatment
- Temperatures
- Abdominal pain that may have started in the umbilical
region, moved to RIF region - Nausea or Vomiting
- Pain develops quickly
- Loose stools
A+E straight away
Mesenteric adenitis presentation and treatment
Generalised tummy pain for weeks - usually viral
No treatment - may do ultrasound to confirm
Balanitis presentation and treatment
penile discomfort, redness or swelling
sometimes penile discharge
topical hydrocortisone 1% cream
Threadworms presentation
Intense perianal itching, typically worse during the night
Acute UTI Ix and Tx
Refer if under 3 months to paed specialist
Urine MC&S
Upper UTI / acute pyelonephritis if:
>38 C and bacteruria
<38 with loin tenderness and bacteruria
If no fever = lower UTI
Recurrent UTI investigations
Urine MC&S
USS KUB
Paed referral
Testicular torsion presentation
V common in children
Acute pain
Nausea and vomiting
Swelling on one side of scrotum
Abdo pain
Testicle high or in horizontal position
SEND STRAIGHT TO A+E PAEDS
Sever’s disease presentation and treatment
Heel pain in growing and active children
Rest and activity modification
Perthes disease presentation and treatment
Pain, limping and limited movement of hip joint and stiffness in hip joint
SEND TO A&E
Cradle cap treatment
Emollient or oil (not peanut oil)
Soft brush
Don’t pick at it, hair will grow back
THERE SHOULDN’T BE BLEEDING, LEAKING OR SWELLING, JUST YELLOW/WHITE CRUSTING ON SCALP IN UNDER 1 YR OLDS
Varicella zoster virus treatment
Chicken pox
- avoid contact with immunocompromised ppl, pregnant women and infants
Topical calamine lotion for itch
Chlorphenamine for for itch in older than 1 yr
NO IBUPROFEN
Urticaria presentation and treatment
Itching
Wheels
Possible trigger
Possible sneezing etc…
Antihistamines
Eczema presentation and treatment
ITCHY patches of skin
Atopy history
Triggers?
Emollients
Steroids depend on severity
- hydrocortisone - mild
- betamethasone - more sever
If crusting or pustules with fever/malaise send to secondary care for bacterial infection
Febrile convulsion presentation and treatment
6 months - 5 yrs children
Seizure with febrile illness (over 39C)
Seizure lasts 5 mins
Muscle stiffening, jerking and shaking of limbs
Post ictal drowsiness
REFER URGENTLY
+ IF RECENT ABX USE, FEBRILE CONVULSION COULD BE SIGN OF CNS INFECTION
Abdo red flags in children
Frequent forceful projectile vomiting - pyloric stenosis
Abdominal distension, tenderness or mass - obstruction
Bile stained (yellowy green or green vomit) - intestinal obstruction
Blood in vomit
Reflux / GORD presentation in children and treatment
- Distressed behavior shown – excessive crying, unusual neck postures
- Hoarseness or chronic cough
- Single episode of pneumonia
- Refusing to feed, gagging or choking
- Not gaining weight
Gaviscon
Small frequent meals
Usually gets better with age
