Primary care for children

Question 1

Neonatal period (up to 4 weeks)?

Answer 1

• Jaundice - urinary tract infection, breast milk jaundice, billiary atresia, galactosaemia, hypothyroidism/CMV/
• Vomiting - reflux, CMP intolerance, pyloric stenosis, sepsis, duodenal atresia
• Failure to thrive
• Sepsis/infection
• ‘Trivia’

Question 2

Clinical presentation of Resp?

Answer 2

• Cold’
• Coryza
• Infant not feeding
• Cough
• Wheeze

Question 3

Causes of Resp?

Answer 3

Common

• RSV Bronchiolitis
• Croup-parainfluenza
• Viral URTI
• Asthma (new or exacerbation)
• Acute tonsillitis
• COVID-19 - disease presentation can range from being asymptomatic in approx. 1/3 of children to severe pneumonia requiring ITU admission

Rare

• Cystic fibrosis
• Acute epiglottitis
• Foreign body
• Pneumonia
• Cardiac causes
• Malignancy

Question 4

Assessment of Resp?

Answer 4

• Cyanosis
• Tachypnoeic - RR
• Nasal flaring/intercostal recession
• Wheeze, stridor, cough
• Pulse oximetry-measuring O2 blood level
• Percussion
• Auscultation
• ENT exam

Question 5

Clinical presentation of Gastrointestinal?

Answer 5

• Abdominal pain
• Vomiting
• Diarrhoea
• Nausea
• Constipation
• Impact on school attendance

Question 6

Common causes of abdominal pain by age group?

Answer 6

Question 7

MSK clinical presentation?

Answer 7

• Painful joint(s)
• Limp
• Trauma

Question 8

Causes of MSK

Answer 8

• Joint pains: transient synovitis, inflammatory arthritis, Perthe’s disease, slipped femoral epiphysis, Osgood Schlatters, growing pains, bone tumours, infective causes
• Limp: DDH, Perthe’s
• Trauma: sprain, fracture, NAI

Question 9

GP public health?

Answer 9

• Childhood immunisations
• Childhood development screening 6-8 week check
  
  • Heart sounds
  • Right light reflex
  • Hips (Barlow’s/Ortalani’s)
  • Genitalia
  • Femoral pulses
• Disease notification

Question 10

Contraindications to vaccines

Answer 10

• Confirmed anaphylaxis reaction to a previous dose of same antigen or vaccine component
• Live vaccines:
  
  • Immunosuppression (primary, radiotherapy, high-dose steroids/other drugs, HIV)
  • Pregnancy
• Egg allergy (yellow fever, flu)
• Severe latex allergy
• Acute or evolving illness - defer till resolved/stabilised

Question 11

Dis and Advantages of passive immunisation?

Answer 11

Advantages of artificial passive immunity

• Rapid action
• Post-exposure
• Can attenuate illness
• Outbreak control
• Can be used if contraindication to active vaccination

Disadvantages of artificial passive immunity

• Short-term protection
• Short time window
• Blood-derived
• Hypersensitivity reaction
• Expensive

Question 12

Vaccination schedules for pre-school and pimary school age?

Answer 12

Question 13

Vaccination schedules for Secondary school age?

Answer 13

Question 14

Selective childhood vaccinations for children in at-risk groups?

Answer 14

• Flu (annual) - aged 2 or older
• Pneumooccal Polysaccharide Vaccine (PPV23) - aged 2 or older
• BCG - aged up to 16
• Hep B - all ages

Question 15

Adult programmes?

Answer 15

• Pneumooccal Polysaccharide Vaccine (PPV23) - 65 year olds
• Shingles - 70 year olds
• Seasonal flu (annual): adults aged 65 or older; at-risk groups; pregnant women
• Various selective programmes e.g. Hep B, travel and occupational