SLA 6 & 10 - Paediatrics (A & B) Flashcards
What is the aetiology of bronchiolitis?
Commonly caused by viral infection, notably respiratory syncytial virus (RSV) accounts for approx. 80% of cases.
Other possible viral causative agents include adenovirus, rhinovirus and influenza viruses.
What is bronchiolitis?
An acute viral infection that begins as an URTI and evolves to involve the LRT, giving signs of respiratory distress, cough, wheeze and bilateral crepitations.
Bronchiolitis is most common in children of which ages?
Occurs in infants under the age of 2 years, peaking between the ages of 3 months and 6 months.
When is the peak seasonal incidence of bronchiolitis in the UK?
In the winter months (October - March).
There tends to be an annual 6- to 8-week epidemic where incidence peaks.
Give some environmental and social risk factors for contracting bronchiolitis.
- older siblings
- nursery attendance
- passive smoke, particularly maternal
- overcrowding
Give some risk factors for severe disease and/or complications with bronchiolitis.
- prematurity (<37 weeks)
- low birth weight
- age <12 weeks
- congenital heart disease
- immunocompromised
- Down’s syndrome
NICE guidelines advise that bronchiolitis should be considered in children under the age of 2 years who present with a 1- to 3-day history of coryzal symptoms, followed by:
- persistant cough; AND
- tachypnoea / chest recession; AND
- wheeze or crackles upon auscultation
Other typical features include fever (<39C) and poor feeding.
If a diagnosis of bronchiolitis is made, when should referral to secondary care be made?
- respiratory rate >60 breaths/minute
- chest recession or grunting
- central cyanosis
- SpO2 < 92%
- apnoea (observed or reported)
- the child looks seriously unwell
Give some differential diagnoses for bronchiolitis.
- viral induced wheeze
- pnuemonia
- asthma
- bronchitis
- aspiration
- cystic fibrosis
Outline the management of bronchiolitis in primary care.
Most infants with acute bronchiolitis will have a mild, self-limiting illness that can be managed at home. Advise the parents that symptoms tend to peak between 3-5 days of onset.
Supportive measures are the mainstay of treatment, with attention to fluid input, nutrition and temperature control (note anti-pyretic agents are needed only if a raised temperature is causing distress to the child).
What safety netting advise should be given to parents if discharging a child after diagnosis of bronchiolitis?
Call 999 or attend A&E if:
- difficulty breathing, for example you hear grunting noises or their tummy sucks under their ribs
- pauses when the child breathes
- the child’s skin, tongue or lips are blue
- the child is floppy and will not wake up or stay awake
A parent may know if their child seems seriously unwell and should trust their own judgement.
If an adult is infected with respiratory syncytial virus (RSV), what condition does it cause?
It is the same virus that leads to the ‘common cold’ in adults.
What are the signs of dehydration in children?
- few or no tears when crying
- sunken frontal fontanelle
- dry mouth
- dark yellow urine or have not passed urine for 12 hours
The child may also seem drowsy, breathe fast or have cold and blotchy-looking hands and feet. If any of these signs are present, the child should be taken to the GP urgently or go to A&E.
What is croup?
A viral infection that causes inflammation of the upper respiratory tract.
Note severe cases may compromise the upper airway and so while most cases are mild and self-limiting, the condition of the child needs to be assessed carefully.
What is the aetiology of croup?
Parainfluenza virus (types 1 to 3) account for approx. 75% of cases.
Other viral causes include influenza A and B, adenovirus, respiratory syncytial virus (RSV) and enterovirus.
Although rare, give some bacterial causes of croup.
- mycoplasma pneumoniae
- Corynebacteria diptheriae
Croup commonly affects children in which age bracket?
6 months to 3 years.
Note croup affects approx. 3% of children per year.
Describe the classical presentation of croup.
Croup normally starts with nonspecific symptoms of URTI, for example runny nose, sore throat, fever and cough.
Over a few days, a characteristic barking cough and hoarseness will develop that is worse at night.
What safety netting advise should be given if a child is discharged following a diagnosis of croup?
Call 999 or attend A&E:
- child is struggling to breathe (tummy sucking inwards or breathing sounds difficult)
- skin or lips start to look pale or blue
- unusually quiet and still
- they suddenly get a very high temperature of become very ill
Give some differentials of croup.
- epiglottitis
- acute anaphylaxis
- diptheria
- peritonsillar abscess
- inhaled foreign body
What are the features of mild croup?
Seal-like barking cough but no stridor or sternal/intercostal recession at rest.
What are the features of moderate croup?
Seal-like barking cough with stridor and sternal/intercostal recession at rest; no agitation or lethargy.
What are the features of severe croup?
Seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
What are the features of impending respiratory failure in a child?
- sternal / intercostal recession with asynchronous chest wall and abdominal movement
- fatigue, pallor and cyanosis
- respiratory rate > 60 breaths/minute
When should a child be admitted to hospital with croup?
If they are displaying features of mild or severe croup, or features of impending respiratory failure.
A lower threshold for admission may be warranted if the child has a comorbidity.
What is the management of mild croup?
Prescribe a single dose of oral dexamethasone to be taken immediately (shortens time to resolution and reduces risk of complications).
Symptoms usually resolve within 48 hours.
Self-care advice includes paracetemol / ibuprofen if pyrexia is causing distress, and ensuring the child remains adequately hydrated.
It is important to give safety netting advice on when to attend A&E or contact 999, and encourage the parent to check on the child regularly at home (including through the night).
What are head lice?
Headlice are small grey/brown insects that cling to hair, staying close to the scalp.
They lay eggs which hatch (nits) after around 7-10 days. It takes a further 7-10 days for a newly hatched louse to grow into an adult and start to lay eggs.
Why are head lice more common in girls?
Head lice are more common in young children with long hair.
What are the symptoms of head lice?
Many people will have no symptoms, however they can sometimes cause itching of the scalp due to a reaction to lice bites or saliva.
What practical management advise can be given to the parent of a child with head lice?
Attempt to remove the lice with a fine-toothed comb while the hair is wet (note can also do while hair is dry). Do this twice weekly for 2 weekly.
Note that there is no formal need to keep the child off school, however advise the parents to contact the school as they may have a procedure in place.
If head lice do not resolve following fine-combing, what medical management can be offered?
OTC medicated lotion and spray treatments (insecticides) from the pharmacy.
The parent may still need to use a fine-comb to remove the nits and dead lice.
What is chickenpox?
A highly infectious viral disease caused by the varicella-zoster virus (HHV-3).
The varicella-zoster virus (HHV-3) can cause two forms of disease:
- Primary infection (chicken pox)
- Reactivation disorder (herpes zoster / shingles)
Is chicken pox a notifiable disease?
Notifiable disease in Scotland and Northern Ireland, but not in England.
Describe the cycle of the lesions that appear in chicken pox.
Itchy lesions that pass through four stages:
- Papule
- Vesicles
- Pustule
- Crust
What tool can be used for assessment of a feverish child with no localising symptoms?
Traffic light system
Green = not at high risk of serious illness.
Amber / Red = high risk of serious illness and referral to A&E necessary.
Give 5 amber signs of the traffic light system of a feverish child.
- Pallor
- Decreased activity or difficulty waking
- Tachypnoea or SpO2 < 95%
- Tachycardia or CRT > 3s
- Reduced urine output
Give 5 red signs on the traffic light system of a feverish child.
- Pallor / mottled / ashen / blue
- Continuously crying or does not wake
- Grunting or chest recession
- Reduced skin turgor
- Bulging fontanelle or seizures.
What is a Mongolian spot?
Common birthmarks that look like bruises, most commonly seen in asian babies.
They are harmless and usually fade away.
The following rash is suggestive of erythema toxicum. What is this?
A common new-born rash that goes away within a few days - no medical treatment is necessary.
Describe the rash that is typical of scarlet fever.
A fine and light red maculopapular rash that develops into a partially confluent rash within 1-2 days.
Typically begins on the neck and face, and is non-blanching. The child may have a bright red strawberry tongue.
What are the symptoms of Fifth disease?
- rash of the face (typically on cheeks)
- fever
- runny nose
- headache
What is Osgood Schlatter disease?
A self-limiting disorder of the knee, common in active adolescents, which is thought to be caused by multiple small avulsion fractures from contractions of the quadriceps muscles at their insertion into the proximal tibial apophysis.
