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Y3 GP > Peadiatrics > Flashcards

Peadiatrics Flashcards

1
Q

what are the symptoms of threadworm?

A
  • intense perianal itching - typically worse during the night
  • worms seen in stools
  • genital itching in women
  • secondary infection due to irritation and excoriation of perianal area
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2
Q

what is teh managemnt of threadworm?

A

single dose of anti-helminthic treatment such as mebendazole (do not use in <2yrs)
repeated in 2 wks if infection persists
vigorous hygeine for 2 wks in treated, if not treated then for 6 wks

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3
Q

what are the symptoms an dsigns for constipation?

A
  • fewer than 3 stools a week
  • hard, large stool
  • rabbit dropping stools
  • distress or pain on passing
  • bleeding with hard stool
  • straining
  • abdo pain when passing
  • anal pain
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4
Q

what clinical features are suggestive of idiopathic constipation?

A
  • meconium passed within 48 hours
  • onset of constipation at least few wks after birth
  • dietary factors
  • acute illness
  • anal fissure
  • drugs causing consitpation
  • timing of toileting
  • psychosocial factors
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5
Q

what examinations are found on a child with idiopathic constipation?

A
  • normal appearing anus
  • abdo soft and flat
  • generally well with normal development
  • motor and neuro development in normal limits
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6
Q

what is the conservative management for constipation in chidlren?

A
  • increased fluid intake (1.2L min)
  • increase fibre intake
  • increase physical exercise
  • toilet training times
  • look into psychosocial reasons
  • encouragemnt and rewards systems
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7
Q

medical treatment of faecal impaction in children?

A
  1. macrogol sachets (movicol)
  2. laxatives (senna)
  3. then a maintenance laxative treatment with regular follow ups
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8
Q

what are the symptoms of osgood schlatters disease?

A
  • knee pain
  • starts in adolesence
  • localised to tibial tuberosity
  • gradual in onset and initially mild and intermittent but cna progress
  • unilateral (bilateral in 30%)
  • relieved by rest and made worse by kneeling and activity
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9
Q

what are teh signs of osgood schaltters disease?

A
  • tenderness over tibial tuberosity
  • pain provoked by resisted knee extension
  • tightness of quads and hamstrings
  • swelling or bony enlargent of tibial tuberosity
  • normal passive range of movement
  • absence of effusion
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10
Q

what is the management of osgood schlatters disease?

A
  • refer to physio
  • pain relief - NSAIDs/paracetamol
  • ice for 10-15 mins x3 a day after exercise
  • protective knee pads
  • may have to reduce exercise doing
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11
Q

what is osgood schlatters disease?

A

a condition that causes pain and swelling below the knee joint, where the patellar tendon attaches to the top of the tibia @ tibial tuberosity
also may have inflammation of patellar tendon

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12
Q

what are the sympotms of GORD in children?

A
  • regurgitation
  • distressed behaviour e.g. excessive crying, crying while feeding
  • hoarseness and/or chronic cough
  • pnuemonia
  • refusing to feed, gagging, choking
  • faltering growth

if > 1yr, child may experience heartburn, retrosterna pain and epigastric pain

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13
Q

how do you assess a child for GORD?

A

take thorough history about feeding, resp systems,
examine chest for resp symptoms and signs
check childs temp
do abdo exam and review head circumferance
check for faltering growth

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14
Q

name some red flag symptoms in children who present with regurgitation and vomiting?

A
  • frequent foreceful vomiting
  • bile stained vomit
  • heamatemesis
  • abdo distention, tenderness, palpable mass
  • bulging fontanelle or altered responsiveness
  • rapisdly increasing head circumferance
  • blood in stool
  • chronci diarrhoea
  • dysuria
  • fever/unwell
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15
Q

what is the management of GORD in children?

A

For breastfed:
- Gaviscon infant (1-2 week trial and if works continue)

For formulafed:

  • offer 1-2 trial of smaller, more frequent feeds
  • offer 1-2 trial of feed thickeners
  • if neither work offer 1-2 trial of gaviscon infant
  • if still doesnt work - try 4 wk trial of PPI as suspension
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16
Q

what is croup?

A

childhood viral infection of upper airway characterised by barking cough and stridor

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17
Q

what are the symptoms of croup

A
  • sudden onset, barking cough
  • stridor
  • chest wall or sternal indrawing
  • symptoms worse at night anf increase w agitation
  • hoarse voice

if moderate/severe:

  • persistent agitation
  • lethargy/fatgiue
  • asynchronous chest wall and abdo movemnt
  • pallor or cynaosis
  • decreased level of consiousness
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18
Q

name some differentials fro croup?

A

epiglottitis, upper airway foreign body, retropharyngeal abcess, tonsillar abscess, angioneurotic oedema, or allergic reaction

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19
Q

when should you admit a child with croup?

A

if they have mdoerate or severe symptoms (signs of resp distress, stridor, agigitation, lethargy)
or if child <3 months
or if child have underlying health condition that coudl icnrease risk of resp distress

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20
Q

how do you manage a patient with croup in primary care?

A
  • prescirbe single dose oral dexamethasone immedietly
  • self limitng + symptoms usually resolve in 48 hrs
  • paracetamol or ibuprofen if needed
  • regular fluids
  • check on child regualrly during night
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21
Q

when would suspect a UTI in a child?

A

signs and symptoms inclduing:

- fever, frequency, dysuria, abdo pain, poor feeding,, cloudy urine, heamuaturia, irritabiliyt, lethargy

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22
Q

what is the managment for a UTI in children?

A
  • trimethoprim or nitrofurantoin for 3 days (doses change w age)
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23
Q

when would you expect pyelonephritis in children with UTI symptoms?

A

unexplained fever of 38 or higher

loin pain/tenderness

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24
Q

what is teh management of pyelonephritis?

A

oral ABX - cefalexin or co-amoxiclav for 7-10days (doses change based on age)

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25
Q

what is seborrhoeic dermatitis?

A

a common inflammatory skin condition occuring in areas rich in sebaceous glands (most commonly affects scalp in infants)

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26
Q

what is the managemnt of seborrheic dermatitis on scalp in children

A

self limiting and usually resoles by four months in infants
in adults its chornic - fluctuates with treatment

  • emollients
  • burshing an washing of scalp w baby shampoo
  • imidazole cream (clotrimazole 1%) if ^^ doesnt work, x2-3 daily for 4 wks
  • if not healed in 4 wks - dermatology referral
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27
Q

what are teh symptoms/signs of seborrhoeic dermatitis?

A

well defined patches of eythema associated with flaking of skin, scaled may be white, yellow, oily or dry
mild itching

most commonyl affects:

  • scalp (cradle cap in infants)
  • face
  • upper chest + back
  • flexures and skin folds
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28
Q

what is measles?

A

airborne infection caused by morbillivirus of paramyxovirus family
infects resp tract

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29
Q

what are teh main complications of measles?

A
  • otitis media
  • pnuemoina, pneumoniits, tracheobronchitis
  • convulsions, encephalitis, blindness
  • subacute sclerosing panencephalitis
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30
Q

what are the typcial symptoms of measles?

A
  • rash (erythematous, maculopapular, may be confluent)
  • fever
  • malaise
  • cough
  • rhinorrhoea
  • conjuctivitis
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31
Q

how long does a measles rash last for?

A

5 days - 1 week

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32
Q

what is the management for measles?

A
  • notify health protection team
  • self limiting so: fluids, pain relief
  • isolate for at leat 4 days
  • seek advice from HPT if immunocomprimised, preggo or <1y/o
  • safety net: admit if: SOB, uncontrolled fever, convulsions/altered consiousness
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33
Q

what is hand foot and mouth disease?

A

acute self limiting viral illness charcterised by vesicualr eruptions in mouth and papulovesicular lesions

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34
Q

when would you suspect hand foot and mouth disease in children?

A
  • sore throat
  • low grade fever
  • tender lesions in mouth and or rash on body
  • early symptoms: fever, malaise, loss of appetite, cough, abdo pain, sore mouth
  • macules and papules on hands and feet following oral lesions
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35
Q

what is the management of hand foot and mouth disease?

A 
reassure its self limiting 
adequate fluids
soft diet for painful oral lesions 
pain relief for fever or pain 
reduce risk fo trasnmission
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36
Q

when do you admit a patient with hand foot and mouth disease?

A

persistent or severe headache or fever
myoclonus wth sleep disturbances
confusion, weakness, lethargy, drowsiness, irritability, geenralised seizures, coma

37
Q

what is the difference between IgE and non-IgE mediated cows milk allergy?

A

IgE mediated: typically rapid onset (within mins-2 hrs of ingestion)

Non-IgE mediated: typically delayed (2-72 hrs after ingestion)

38
Q

what some of the skin, GI and resp symptoms of cows milk allergy in children?

A

skin: pruritus, atopic eczema, acute urticaria/angio-oedema

GI: vomiting, GORD, nausea, diarrhoea, constipation, abdo pain, blood in stools, faltering gorwth

resp: cough, chest tightness, wheezing, SOB, nasal itching, rhinorrhea

39
Q

how do you assess a child for suspcted cows milk allergy?

A
  1. allergy focused Hx: symptoms, onset, reactions, form of ingested milk, FHx,
  2. examine: signs of clinical reaction, signs of atopy, BMI
  3. skin prick testing and/or serum specific IgE testign
40
Q

how do you manage a child with suspected IgE mediated cows milk allergy?

A
  • referral to specialist allergy clinic for allergy testing to confirm diagnosis
  • consider arranging referral to paediatric dietician
  • advice to parents of sources of info anf support
41
Q

how shoudl you manage a chidl with mild-moderate non IgE mediated allergy?

A
  • may need referral to specialist allergy clinic
  • referral to peadiatric dietitician
  • strict adherence to cows milk free diet until child 9-12 months
  • advise planned hoem reintoruction of cows milk to assess if tolerance has been acquired
42
Q

how can head lice be detected?

A

wet or dry detection combing

  • wet is more accurate (using a conditioner)
  • a live lice must be found to confirm active head lice infestation
43
Q

hwo do you manage head lice in children?

A
  1. wet combing - using louse detection comb to remove lice
    or
  2. physical insecticide (suffocate lice by coating scalp surfacE) -dimeticone gel, lotion, spray
    or
  3. chemical insecticide - (posion to lice) - malathion 0.5% aq liquid
44
Q

what are teh clinical features of a fungal skin infection on the scalp?

A
  • scaling and itch of scalp
  • single or multiple circular patches of hair loss
  • erythema,s cattered pustules, crusting
  • painful
  • lymphadenopathy whcih may be painful
45
Q

what ivnestigation needs to be doen when assessing for a funal scalp infection in hcildren?

A

skin and hair sampling for fungal microscopy and culture

46
Q

what is the managment of a fungal scalp infection?

A
  • if pt. has a kerion then urgent referral to derm
  • self-care: soften crusts, disinfect objects, dont share towels
  • oral antifungal: but seek advice from paed dermatologist before starting treatment (in children!!) oral griseofulvin given for 4 wks
  • consider co prescribing topical antifungal treatment (selenium sulfide or ketoconazole shampoo or imidazole cream)
47
Q

what is infantile colic?

A

self limiting condition which is defined clinically as repeated episodes of excessive and inconsolable crying in an infant that otherwise appears healty and thriving

48
Q

what are the typical signs of infantile colic?

A
  • excessive inconsolable crying which starts in first weeks of life and resolves around 3-4 months
  • crying which most often occurs in late afternoon or evening
  • drawing knees up to abdo or arching its back when crying
49
Q

what is the managemnt of infantile colic?

A
  • reassure parents that infantile colic is common and should resolve by 6 months
  • advice on stratgies to soothe crying infants
  • encourgae mother rbeastfeeding
  • arrange follow up for infan t
  • if no imrpovemnt after 4months arrnage specialist advice from peadiatrician
50
Q

what is slapped cheek syndrome?

A

parvovirus B19 infection common in children - usually mild and self limiting

51
Q

hwo do you diagnose slapped cheek syndrome in chidlren?

A
  • clinical features (lab investigations not required)
52
Q

what are the clinical features of slapped cheek syndrome?

A
  • erythematous facial rash appearing on one or both cheeks
  • 2-5 days prodromal symptoms: fever, nasal discharge, headahce, myalgia, mild nausea, diarrhoea
  • faical rash fades after 1-2 wks
  • eyrthematous maculopapular rash on trunk, back, limbs may develop few days after facial rash
53
Q

what is the managemnt fo slapped cheek syndrome?

A
  • adequate fluids and analgesia
  • children no longer infectious once the rash develops
  • self limiting
  • if at risk fo complications then: confirm diagnosis of parvovirus B19 infection and check FBC
54
Q

what is the managemnt of a feverish child?

A
  • assess underlyign cause
  • paracetamol or ibuprofen (do not give both simultaneously - start on paracetomol and if inffective use ibuprofen)
  • ensure adequate fluids and check on child throughout night
  • safety netting: if fever lasts mroe than 5 days, is child more unweel, child dehydrated or has a serizure or non blanching rash appears
55
Q

what is whooping cough?

A

also known as pertussis is a highly infectious disease spread by droplets cuased by bacteria Bordetella pertussis

56
Q

what are the clinical features of whooping cough?

A

3 phases: catarrhal, paroxysmal and convalescent

catarrhal: 1-2 wks: nasal discharge, conjuctivitis, malaise, sore throat, low grade fever, dry unproducive cough
paroxysmal: 1-6 weeks: short expiratory burst and inspiratory gasp (whoop), more comon at night, can be productive, can cuase cyanosis
convalescent: up to 3 months: gradual improvement

57
Q

how do you make a clinical diagnosis of whooping cough?

A

acute cough that has lasted 14 days or more with oe more more of:

  • paroxysmal cough
  • inspiratory whoop
  • post tussive vomiting
  • undiagnoses apnoeic attack in infants

*if not fully immunized against pertussis then suspicions raised

58
Q

how do you manage whooping cough?

A
  • ABX if onset cough within 21 days
  • clarithromycin <1 month
  • azithromycin if >1 month
  • erythromycin pregnant women
  • self care: fluids, paracetomol/ibuprofen,
  • isolate for 48 afters after ABX started or 21 days after symptoms onset
59
Q

when woudl you admit a patient with whooping cough?

A
  • if <6 months and acutely unwell
  • significant difficulty breathing
  • has signifcant complication e.g. seizures, pneumonia
60
Q

what are the clinical features of gastroenteritis?

A
  • sudden onset diarrhoea
  • blood or mucus in stool s
  • nausea or suddent onset vomiting
  • fever or general malaise
  • abdo pain or cramps
  • headache, myalgia, bloating, flatulence, weigt loss, malabsoprtion
61
Q

how do you assess a patient for gastroenteritis?

A
  • clinical features
  • abdo exam fro distension, tenderness, bowel sounds
  • assess for malnutrition
  • assess for dehyration
  • arrange stool culture and sensitivity if indicated (immunocomprimised, acute painful diarrhoea or blood/mucus in stool, recent ABX or PPI, >14 days diarrhoea, recent travel, contact with affect person or an otubreak)
62
Q

what is the managment fro gastroenteritis in a child?

A
  • adequate fluids
  • oral rehydration solutions
  • encourage milk feeds/reastfeeding as normal
  • arrange treatment of confirmed microbial pathogens , if appropraite following stool culture
  • prevent transmission
  • do not give ABX
63
Q

when shoudl you admit a child with gastroenteritis?

A
  • systemically unwell
  • severe dehyration or progession to shock
  • bilious vomiting
  • acute onset painful bloody diarrhoea
64
Q

how do you manage a child/young person where maltreatment is suspected or considered?

A
  • can seek advice from NSPCC
  • if FGM, you must report to police
  • refer to children’s social care
  • ideally discuss with rents too unles child request you not to
  • manage injuries as appropriate
  • if sexual abuse then refer urgently for collection of forensic evidence + assess need for STI prophylaxis or contraception
  • obtain consent to share any information unless required by law or if benefits child to share information
  • arrange follow up as required
65
Q

what are the common cuases for cough in children?

A
  • viral induced wheeze
  • infection exacerbation of asthma
  • bronchiolitis
  • pneumonia
  • COVID-19
66
Q

when shodul ifnective exacerbation of asthma be considered in chidlren with a cough?

A

previous asthma diagnosis, Hx of wheeze occuring in absence of infection and in repsonse to partiuclar stimuli

67
Q

when should a viral induced wheeze be considered in children with a cough?

A

ages 6 months - 5y/o

with wheezing associated with infection only

68
Q

when shoudl bronchiolitis be suspected in a chidl with a cough

A 
affected children <2 y/o 
experience coryzal prodrome lasting 1-3 days followed by:
- cough 
- tachypnoea 
- wheeze/ fine crackles 
- fever
- poor feeding
69
Q

when shoudl pneumonia be considered in child with a cough?

A
  • high fever (over 39)
  • cyanosis
  • rasied resp rate
  • focal coarse crackles
  • o2 <85%
  • absent breath soudns and dull percussion note
70
Q

how do you manage a child with viral induced wheeze or ifnection exacerbation of asthma?

A
  • note severity of attack (moderate/acute severe/life threatening)
  • salbutamol given immedietely
  • if child has asthma then prescribe oral prednisolone
  • if bacterial ifnection: amoxicillin
  • paracetamol/ibuprofen as antipyretic
  • follow up in 48 hrs
71
Q

when woudl you admit a pateitn with viral induced wheeze/ifnective exacerbationof ashtma?

A
  • admit life threatenign and - - admit severe if no do imrpove with bronchdilators - admit moderate if worsen after bronchodialtor treatment
72
Q

How should you manage a child with bronciolitis?

A

self limiting illness
provide self care: fluids, antipyretics, tepid sponging
safety net and follow up

73
Q

when do you admit a child with bronchiolitis?

A
  • apnoea
  • looks v unwell
  • severe resp distress
  • central cyanosis
  • clinical dehydration
  • low o2 sats
74
Q

how do you assess the sevristy of bronchiolitis in a patient?

A
  • look for signs of cynaosis, exhaustion, involvment of accessory msucles
  • examine childs chest and record obs
  • assess cap refill, skin turgor and urine output
75
Q

how should i manage community acquired penumonia in children

A
  • o2 sats <92 (also give o2 straigth away !!)
  • cyanosis, v unwell, temp 38 or higher in <3 months
  • does not wake
  • RR > 60
76
Q

when do you admit a child with pneumonia?

A
  • ABX: amoxicillin 5 days

- sefl care advice: fluids, analgesia, rest

77
Q

what immunisations do chidlren at 12 weeks old need?

A
  • 1dose DTaP/IPV/Hib/HepB (6in1 vaccine)
  • 1 dose PCV
  • 1 dose rotavirus
78
Q

what immunisations do children at 16 weeks old need?

A
  • 1dose DTaP/IPV/Hib/HepB (6in1 vaccine)

- one dose of MenB

79
Q

what immunisations do children at 16 weeks old need?

A
  • 1dose DTaP/IPV/Hib/HepB (6in1 vaccine)

- one dose of MenB

80
Q

what immunisations do children at 1 year old need?

A
  • Hib and MenC
  • PCV booster
  • MenB booster
  • primary MMR
81
Q

what immunisations do children at 2-11 years old need yearly ?

A

influenza vaccine

82
Q

what immunisations do children at 3 year old +4 months old need?

A
  • DTap/IPV booster

- MMR booster

83
Q

what immunisations do children at 12-13 years old need?

A

HPV vaccination

84
Q

what immunisations do children at 14 years old need?

A

diptheria, tetanus, poliomyelitis booster

MenACWY vaccine

85
Q

what are the clinical features of bacterial meningitis and meningococcal disease?

A
  • non blanching rash
  • stiff neck
  • fever
  • lethargy
  • headahce
  • muscle ache
  • leg pain
  • bulging fontanelle
  • photophobia
  • vomiting
  • seizures
86
Q

what is the characteristic of a meningococcal rash?

A
  • petechial rash (red or purple macules smaller than 2mm in diameter)
  • non blanching
  • purpuric rash
87
Q

what vital signs need to be assessed when a patient has potential meningitis?

A
  • conscious level (GCS, AVPU)
  • heart rate and blood pressure
  • resp rate, o2 sats
  • temp
  • cap refill time
88
Q

how do you manage suspected bacterial meningitis with a non blanching rash or meningococal septicaemia?

A
  • ambulance to hospital
  • single dose IV or IM benzylpenicillin
    children <1 - 300mg
    children 1-9 yrs - 600mg
    everyone >10yr - 1200mg

*if suspected meningitis with no nonblanching rash = ambulance to hsoptial but do not administer benzylpenicillin

Y3 GP (10 decks)

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