SCA online - paeds Flashcards
DKA
Serious complication of diabetes - the body breaks down fat into ketones causing the blood to become acidic.
Fx/
Polyuria
polydipsia
weight loss
sweating
abdo pain
Mx/
same day admission
Emergency contraception
<72hours
- levonorgestrel (levonelle) - tab
- can quick start POP immediately
<120 hrs
- Ellaone (Ulipristal) - tab
- wait 5 days before starting contraception
<120hrs
- Copper IUD - keep for long term use
SE include spotting, ectopic (rare but red flag)
If vomit within 3 hours take another.
Take preg test if next period is more than a week late
Wanting to start long term contraception?
Screen for STIs
Safeguarding regarding sexual practise - age of relationship, feeling under pressure
Child constipation
Common, usually harmless. Very manageable with treatment
Red flags/
blood, vomit, severe pain, weight loss/ lack of growth
Hx/
what is diet like
potty training habits
what are stools like
Mx/
Diet - fibre, fluids
Behaviour - be positive not pressuring around potty time
Meds
- laxatives - movicol - start with 1 sach, move to 4 per day - Once bowels opening, continue for a few weeks, slowly wean down. do not stop too quickly
Regular FU 2-4 weeks, red flag safety net
COCP counselling
If under 16 - assess capacity, encourage to speak with parents (if not why, safeguarding?)
Check periods
Red flags - IMB, PCB, dyspareunia
Options
if pre menstrual - condoms
COCP
- daily pill with one week break. can be taken 3 monthly with one week break. will bleed during this break.
- SE - headache, breast tenderness, mood changes, nausea
- risk - vte, breast ca
- missed pill - if 1 = take immediately next pill. if 2 = in first week needs emergency contraception.
3 monthly follow up
Gender dysphoria
Sense that a person may have a mismatch between their biological (birth sex) and their gender identity.
Mx/
refer to gender clinic
offer mental health support, assess risk
Autism spectrum disorders (ASD)
Autistic children may have difficulty communicating with people, social situations, difficulty with imagination. It is a spectrum (range) of symptoms.
Soci - do they play with others, seek attention, say bye bye
Comms - speech development
Imagine - difficulty with pretend play
Girls - this can be harder to diagnose. Tend to avoid attention, dress for function over fashion, more withdrawn, difficulty in social situations
Mx/
refer to community paeds
Reflux
Common, most grow out of this condition.
Hx/
Feeding Hx - formula, breast, solids
Allergy - cows milk, skin rash, swelling, breathing difficulty
Growth
Vomit - blood, forceful
PMH/ Fhx
Red flags - shock, vomit blood, unwell
Mx/
1st (2 weeks) Lifestyle - reduce volume, more regular feeds. Thickened formula
2nd (2-4 weeks) - Gaviscon infant, stop thickened feeds
3rd (4 weeks) - PPI
If cows milk allergy suspected try extensive hydrolysed formula
Fu every 2 weeks
Infantile colic
common condition of repeated bouts of excessive crying in a baby who is otherwise well.
Definition is crying more than three hours a day, for more than three days per week, for least three weeks.
Very common, unclear cause. Has no bearing on you as a parent. Normally self resolves at 3-4 months.
Red flags - pain, vomit blood, blood stool, swelling
Mx/
Reassurance
Comfort baby - holding or put in safe place, background noise, continue breast feeding
Parental well being
Support groups - Cry-sis
Nocturnal enuresis
Bedwetting is very common, and is normal up to the age of 5. Most grow out of this. Usually no cause, but most common are stress, caffeine/ fizzy drinks, constipation. Important to remember this is not the child’s fault, and to give plenty of reassurance.
Hx/
Primary - always bedwetting
Secondary - previously okay, now started bedwetting
Mx/
- Lifestyle
Diet and fluids - healthy, no caffeine/ fizzy, stop a couple hours before bed
Toileting regularly and before bed
Positive rewards - drinking and toileting in the day, dry nights
1st -
enuresis alarm - wakes child up when bedwetting
Short term (eg sleep over) - desmopressin
2nd - if no improvement despite above - refer community paeds
Microscopic haematuria (in teen)
Tiny amounts of blood in urine - infection, exercise, issue with kidney/ urinary tract. Usually nothing to worry about, but need to be further investigated.
Ix/
examination
?menstruation (in females)
urine dip repeat
bloods
USS kidney
Childhood asthma
Check adherence, technique (using spacer?)
Triggers - pets, smoking
FU every 6-8 weeks
Lung function test is >5yo
Personalised asthma action plan
Mx/
1st - SABA + ICS
2 - + LTRA (Monteluklast)
3- + LABA
4 - MART. No SABA, only ICS + LABA - use in exacerbations.
5 - refer if maximal dose and no improvements
Slapped cheek (parvovirus b19)
Common viral infection that often self resolves.
Mx/
fluids, paracetamol, rest
safety net
School exclusion - once rash appears, can go back to school if well.
Slapped cheek parvovirus exposure in pregnancy
Exposure - Needs testing for parvovirus and rubella immunity
Confirmed infection - refer Obstetrics - fetal monitoring, USS
If unwell (anaemia) consider haematology
Child abuse/ maltreatment
- Assure parent that you are care for them and the patient and this is a serious matter
- Thorough history of timeline of what happened, who was involved, how does the patient act now
- Examine patient
- Ensure child is in a safe place now
- Refer safeguarding lead at the practise, social services, child protection agencies, NSPCC, police.
- If injuries, refer to paeds for assessment
- FU patient
Termination of pregnancy
- Full gynae Hx - LMP, confirm pregnancy, STIs, abdominal pain (ectopic).
- Why want termination
- Is the father aware of termination
- Can terminate up to 24 weeks - due to mother or baby’s health (including mental health)
- Safeguarding? - age of partner, how they know each other, consensual
Mx/
refer to Early pregnancy assessment unit
- medication termination - two tablets a few days apart
- surgical termination
