Paeds Flashcards
Good questions to ask for constipation
- when passed meconium
- any walking/ lower limb difficulties that are recently onset
Differentials for constipation in a child (not neonate)
Normal constipation- could be anxiety, diet, water intake
Hirschprung
Obstruction
Questions for neonate with just a fever
How long for
Have measured
Seem unwell/not self?
Breathing difficulty? Noises?
Wees and poos?
Skin changes?
Travel?
Anyone else ill that you know of?
How manage an infant with fever
Obs
Examine
- ears
- throat
- in head to toe
Urine dip and MUS
Bloods
- FBC
- U&E
- LFTs
- CRP
- Blood cultures
CXR
LP
Stool sample
What does a fever suggest about UTI
That it is probably upper UTI
In the presence of bacteriuria this confirms it
When do CT in case of acute meningitis
Focal neuro
Signs of ICP
If none just do LP straight away unless contraindicated
How to assess patient who comes in with first time asthma presentation
Obs
Examine chest
Peak flow
Treat with 10 puffs of salbutamol
Questions for child in ambulatory clinic/GP presenting with asthma (non-urgent)
Triggers for cough
- cold
- exercise
- animals
- smoking
- worse at night
History of haye fever and eczema or allergies
People live with smoke?
How to counsel a parent over asthma
Explain what it is
- certain triggers such as the cold, dust can cause our airways to become smaller
It is a very common condition that affects millions of people who go on to live completely normal lives. To help you cope with this we can give you a personalised asthma action plan which involves some drugs, specificadvice on how to manage some triggers which cause you to get your symptoms and then regular follow ups
The drugs available are inhalers which provide a drug into the lungs which causes the airways to open up and become wider
On top of this there are things you mentioned which can trigger your sx such as….. therefore when …. important to have inhaler on you
Additionally mention about how if smoke then need to encourage quitting
Talk about drugs which must be avoided
What we can do is follow you up in about 2 months and assess how getting on, in the meantime keep using your inhaler when you need however be careful if after a few puffs of it you find its not working it is important to come to hospital
Questions for abdo pain in a child
SOCRATES
Vomiting
Diarrhoea/constipation
Blood
Urinary sx
Jaundice and any skin changes
How should DKA be counselled
Explain that this is the first manifestation of type 1 diabetes
This is a condition where your body is unable to produce enough insulin, which is the hormone that is responsible for controlling blood glucose levels
This can lead to blood glucose levels being higher than normal
This can be dangerous in the long run because it can damage blood vessels and nerves in various important organs
The good thing is that it’s a very well-known disease with well-established management options
The condition that is ongoing in called diabetic ketoacidosis – it’s a condition that arises when a lack of insulin in the patient leads to very high glucose levels and high levels of another chemical called ketones which leads to all the symptoms Jonny has been suffering
Our main priority is to deal with the DKA now and make sure that Jonny is feeling better
Then we can discuss the long-term management of diabetes
There are some good fact sheets about DKA and diabetes on diabetes.org
Questions for vomiting in an infant
How much
What look like
Ever red or yellow/green in it
Forceful
Related to food?
Diarrhoea
Skin discolouration
Assessment of vomiting patinet
Obs
Examination- abdo, hydration satus
Weight and height and plot
Urine dip
Bloods
- FBC
- U&es
- LFTs
- glucose
- VBG
Counselling a parent on CF
Explain that it is likely to be cystic fibrosis, a condition that Hamza was born with and has been responsible for his regular chest infections, poor growth and bowel problems
The rectal prolapse is likely the result of frequent coughing
It results from a genetic mutation that leads to secretions being much thicker than usual (this affects several parts of the body including the lung (most commonly), GI tract, pancreas and testes)
Lung symptoms are most common (difficulty breathing, coughing, recurrent infections) and can be managed with physiotherapy, prophylactic antibiotics and some agents to loosen the mucus
This is a chronic condition and there is no cure but with the help of the specialist MDT, Hamza will be able to live a very fulfilling life
It is caused by two gene mutations, both of which are required for the gene to manifest (1 from father, 1 from mother)
If planning on having another child or when her other son is thinking about starting a family, may want to consider genetic testing beforehand
Management consists of dealing with lung symptoms, nutrition, infection and psychological issues
Management of bronchiolitis in hospital
Obs
If O2 less than 92 give oxygen
If signs of resp distress- grunting, marked chest recession, RR over 70 admit to ward
If severely preterm, cyanotic heart condition give pavlizumab
If have teenager with chronic condition what is important thing to do
Screen for depression and assess impact on mental health/social life
In counselling talk about things can do for mental health support
Managing someone with IBD
Obs
Examination- abdo, DRE
Bloods
- FBC
- U&Es
- LFT
- CRP
Stool sample for caeruplasmin
Refer to gastro for colonoscopy
Managing a first febrile seizure
If at GP send to A&E
If in hospital
Obs
Exam
Bloods
- FBC
- U&Es
- LFTs
- CRP
- VBG
- glucose
Septic screen
- urine dip
- CXR
- LP
Questions for a seizure in a child
What happened before?
- seemed off?
- what doing?
During
- hit head?
- shake?
- for how long?
After
- LOC
- return to normal
Has this happened before?
Fever recently?
Been unwell?- cough, SOB, rash, toilets?
Counselling for a febrile seizure
We think that alfie has had what we call a febrile seizure
These tend to occur while people have a viral infection and can be caused by the rise in temperature
Short ones such as what he has had can be very distressing as a parent but have no long term consequences
Talk about how this is not epilepsy
If ask there is a marginally increased risk compared to the rest of population
Is risk of happening again- if does protect their head but do not try to restrain their movements at all
If happens for longer than 5 mins then call ambulance
Specialist assessment if
- under 18 months
- first presentation
- focal neurology
Questions for joint pain
SOCRATES
- when hurt
- sport
How long
Happened before
Swollen
Limp
Functional impairment
Tender
Ill recently
Fever
Skin changes
Differentials for joint pain in a child
Reactive arthritis
Trauma
Juvenile idiopathic arthritis
SUFE
Perthes and osgood schlatters
Septic arthritis
Cancer
Growing pain
Management of a blue baby on post natal ward
Immediately set up IV prostaglandins
Senior support
Paediatrics surgeons in loop
Obs
Examination
ECG and cardiac monitor
Can do hyperoxia test where give 100% oxygen and reassess saturations
CXR
Echo- gold standard
When is suspicion of NAI what need to do
Obs
Examination head to toe including fundoscopy
Admit to ward
Skeletal survey
Contact seniors and safeguarding leads
Differentials for a drowsy baby
Sepsis
Intracranial pathology
- bleed
- enceph/meningitis
Hypoglycaemia including poor feeding technique
ELectrolyte abnormalities
NAI
Counselling for enuresis
Bedwetting is a common thing we see in children a lot and it is important to remember that at some point all children will be able to achieve continence. It is no ones fault as it happens when the volume of urine becomes too much for the bladder and as is the case in your child this sensation is not being felt by them
There are a few things that we can do
- remember to remain neutral as i said its no ones fault so remember not to punish them
- things like drinking all of your fluid in the day a few hours before bed can really help and making sure they go to wee before bed can go a long way to stopping it from happening so often
in the cases does this is important to reward these behavioiurs and not having a dry night
How to manage GORD in primary care
Obs
Examine- signs of dehydration
Measure weight and height
Refer if signs of faltering growth, no response to medical treatment, avoiding feeding
Counselling on GORD
Very common cause of vomiting, caused by slower development of what we call the sphincter at the bottom of your feeding tube which goes into the stomach. It acts as valve and as its not working yet it is hard to keep the food in the stomach
Differentials for cough in a child
Croup
Pneumonia
Inhaled foreign object
Bronchiolitis
Pertussis
