paeds vol 1 Flashcards
what is tonsilitis and S+S
the result of a viral (common) or bacterial (less common) infection
a clinical diagnosis when uncomplicated
presents as a sore throat, fever, tonsillar exudates and tender anterior cervical chain lymphadenopathy
rhinovirus, respiratory syncytial virus, adenovirus, and coronavirus common causes. STI are also possible causes
Ix of tonsillitis + scoring system + Mx
history and physical- focus on pharynx + ears and nose.
if uvula deviated consider peritonsillar abscess. CT is an option but not usual care.
Centaur score- 1 point for
fever
absence of cough
tonsillar enlargement and/or exudates,
tender cervical lymphadenopathy.
extra point if 3-15 and minus a point if over 45.
0 to 1, no further testing or antibiotics is necessary.
2 to 3 points, rapid strep testing and throat culture is an option.
4 or more - consider testing and empiric antibiotics.
usually self limiting
consider one dose of sted if limited by airway swelling.
if persistant or repeat severe tonsilitis removal is an option.
define pharyngitis, causes of it and S+S
inflammation of the mucous membranes of the oropharynx. self limiting 5-7 days.
50-80% are viral in origin (rhino, influenza, adenovirus, coronavirus, and parainfluenza.- EBV also but rarer)
most common bacteria is group A beta haemolytic strep.
fever, tonsillar exudates, painful cervical adenopathy, pharyngeal erythema, and ear pain.
If viral in origin: coughing, rhinorrhea, conjunctivitis, headache, and a rash.
criteria for treatment, age it most commonly affects (phayrngitis)
same as for tonsilitis
Centaur score- 1 point for
fever
absence of cough
tonsillar enlargement and/or exudates,
tender cervical lymphadenopathy.
under 15 with under 5 most likely again.
Rx/Mx of pharyngitis
antibiotics where appropriate shorten disease course by 16-24 hours.
also prevent development of rheumatic fever (1 in 400)
definition of growth faltering
if in lowest 2 centiles
OR
crosses 2 or more weight centiles.
Or
if weight loss of more than 10% in the first few days of life.
refferal to paediatrician is essential.
management of growth falteration
assessment to rule out any chronic causes/ underlying disease (e.g Ix for ceoliac disease- bloods important)
consider safeguarding approaches
if breastfeeding- consider observed therapy, advice on how to do so, supplimentation if nessicerry but use breast milk first.
encourage relaxed mealtimes with other siblings/ family- 20-30 mins no focus on over staying or too fast.
generally a lot of the treatment is encouraging children to interact with food in a healthy way.
downs syndrome overview + risk factors
trisomey 21. 1 in 800.
brachycephaly, flat occiput, low nasal bridge, low ears, small hands.
global developmental delay, intelectual disability moderate or worse.
RF: advanced maternal age, previous child with down syndrome. parental karyotype translocation.
investigations for downs sydrome+ Rx
chromasonal karyotype.
FBC for hameatological abnormalities
echo- 50% have congen heart disease
hearing test
thyroid function test
vision test
lots of therapy interventions to help acheave developmental milestones.
prevention of developing diseases
life expectancy is 50-60, predisposed to loads of stuff (leukaemia, heart, hirschprung, dislocations inc atlantoaxial)
nuchal fold 2mm at 11 weeks and 2.8 at 13 weeks is normal.
atopic dermatitis overview + RF + key differential
inflammatory skin condition chronic relapsing course.
occurs as atopy- asthma and allergies
either acute or chronic- acute has acute inflammation.
Risk factors- less than 5
other atopic diseases
allergic rhinitis
differnt to allergic contact dermatitis: this presents as
nappy area/ well circumscribed.
extensor joint surfaces- less purutic than atopic dermatitis.
epidaemiology + signs and symptoms of atopic dermatitis
very common with equal male: female.
S+S: puritic, xerotic (in babies- cheeks, forehead, scalp, extensor surfaces)
weeping and crusting skin
lichinefection, sclerosis, hypopigmentation, vesicles.
Ix + Rx of atopic dermatitis
allergy testing
total igE levels and specifics
skin biopsy
generally a clinical diagnosis.
Rx: emolients- restore protective skin function.
in acute flare: topical steroid
if hard to manage or on eyelid: topical calcineurin inhibitor (Tac!) (block T cell response.
UV therapy for tough cases
60-70% grow out of it during puberty- 50% may relapse
definition of child abuse + risk factors
Child abuse (including neglect) is any form of maltreatment of a child, either by inflicting harm or by failing to act to prevent harm.
Risk factors:
domestic violence
substance abuse or mentla health disorder in caregiver
excessive crying or frequent tantrums
poor coping skills in caregiver.
parent/ carer abused as a child.
key diagnostic signs for child abuse
long bone # in pre mobile infants
inconsistent/ changing history.
unexplained/ inconsistent injuries
brusing- head neck torso
dubdural heamorage in infant or todd
multiple/ bilateral #
rib # in abscence of maj trauma
immersion scalds
Ix to order in suspected child abuse
FBC- clotting espesh
doccumentation (inc photos) of injuries.
dilated fundoscopy- if extenside vultilayers haemorhage seen- 85% chance of abuse.
full skeletal exam for occult #
CT brain (shaken baby syndrome)
lipase/ amylase for abdominal blunt force trauma.
