SLA 6 & 10 - Paediatrics (A & B) Flashcards
1
Q
What is the aetiology of bronchiolitis?
A
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.
2
Q
What is bronchiolitis?
A
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.
3
Q
Bronchiolitis is most common in children of which ages?
A
Occurs in infants under the age of 2 years, peaking between the ages of 3 months and 6 months.
4
Q
When is the peak seasonal incidence of bronchiolitis in the UK?
A
In the winter months (October - March).
There tends to be an annual 6- to 8-week epidemic where incidence peaks.
5
Q
Give some environmental and social risk factors for contracting bronchiolitis.
A
- older siblings
- nursery attendance
- passive smoke, particularly maternal
- overcrowding
6
Q
Give some risk factors for severe disease and/or complications with bronchiolitis.
A
- prematurity (<37 weeks)
- low birth weight
- age <12 weeks
- congenital heart disease
- immunocompromised
- Down’s syndrome
7
Q
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:
A
- persistant cough; AND
- tachypnoea / chest recession; AND
- wheeze or crackles upon auscultation
Other typical features include fever (<39C) and poor feeding.
8
Q
If a diagnosis of bronchiolitis is made, when should referral to secondary care be made?
A
- respiratory rate >60 breaths/minute
- chest recession or grunting
- central cyanosis
- SpO2 < 92%
- apnoea (observed or reported)
- the child looks seriously unwell
9
Q
Give some differential diagnoses for bronchiolitis.
A
- viral induced wheeze
- pnuemonia
- asthma
- bronchitis
- aspiration
- cystic fibrosis
10
Q
Outline the management of bronchiolitis in primary care.
A
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).
11
Q
What safety netting advise should be given to parents if discharging a child after diagnosis of bronchiolitis?
A
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.
12
Q
If an adult is infected with respiratory syncytial virus (RSV), what condition does it cause?
A
It is the same virus that leads to the ‘common cold’ in adults.
13
Q
What are the signs of dehydration in children?
A
- 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.
14
Q
What is croup?
A
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.
15
Q
What is the aetiology of croup?
A
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.
16
Q
Although rare, give some bacterial causes of croup.
A
- mycoplasma pneumoniae
- Corynebacteria diptheriae
17
Q
Croup commonly affects children in which age bracket?
A
6 months to 3 years.
Note croup affects approx. 3% of children per year.
18
Q
Describe the classical presentation of croup.
A
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.
19
Q
What safety netting advise should be given if a child is discharged following a diagnosis of croup?
A
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
20
Q
Give some differentials of croup.
A
- epiglottitis
- acute anaphylaxis
- diptheria
- peritonsillar abscess
- inhaled foreign body
21
Q
What are the features of mild croup?
A
Seal-like barking cough but no stridor or sternal/intercostal recession at rest.
22
Q
What are the features of moderate croup?
A
Seal-like barking cough with stridor and sternal/intercostal recession at rest; no agitation or lethargy.
23
Q
What are the features of severe croup?
A
Seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
24
Q
What are the features of impending respiratory failure in a child?
A
- sternal / intercostal recession with asynchronous chest wall and abdominal movement
- fatigue, pallor and cyanosis
- respiratory rate > 60 breaths/minute
25
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.
26
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).
27
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.
28
Why are head lice more common in girls?
Head lice are more common in young children with long hair.
29
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.
30
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.
31
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.
32
What is chickenpox?
A highly infectious viral disease caused by the varicella-zoster virus (HHV-3).
33
The varicella-zoster virus (HHV-3) can cause two forms of disease:
1. Primary infection (chicken pox)
2. Reactivation disorder (herpes zoster / shingles)
34
Is chicken pox a notifiable disease?
Notifiable disease in Scotland and Northern Ireland, but not in England.
35
What are the symptoms of chickenpox?
- fever
- headache
- abdominal pain
- crops of itchy vesicles on the head, neck and trunk, and very sparse on the limbs
36
Describe the cycle of the lesions that appear in chicken pox.
Itchy lesions that pass through four stages:
1. Papule
2. Vesicles
3. Pustule
4. Crust
37
Give some complications of chickenpox if the child is immunocompromised.
- skin lesions do not resolve for several weeks
- vesicles large and bleed
- pneumonia
- disseminated intravascular coagulation (DIC)
38
Describe the management of chickenpox.
Simple advice regarding adequate fluid intake and minimising scratching. Encourage the parent to ensure the child avoids contact with a pregnant or immunocompromised person or a neonate.
Can give paracetamol if pain or fever is causing distress.
Sedating antihistamines and emollients can be used to help with pruritus.
Note calamine lotion is no longer recommended, as when it dries it ceases to be effective.
DO NOT GIVE NSAIDS (IBUPROFEN) DUE TO RISK OF NECROTISING SOFT TISSUE INFECTION.
39
What is the 'Healthy Child Programme'?
A programme delivered by the primary healthcare team, aiming to:
- help parents develop a strong bond with children
- encourage care that keeps children healthy and safe
- protect children from serious disease via screening and immunisation
- encourage mothers to breastfeed
- identify problems in children's health and development and safety
40
NICE recommend which prenatal screening scans?
- fetal anomoly scan
- Down's syndrome
- sickle cell and thalassaemia
- infectious diseases (e.g. rubella, syphilis, HIV)
41
The newborn screening component of the healthy child programme includes what?
- immediate physical external inspection of the newborn after birth
- newborn hearing screening test
- newborn blood spot
- physical examination of newborn (within 72hrs)
42
The newborn blood spot screens for:
- cystic fibrosis
- phenylketonuria (PKU)
- sickle cell disease
- congenital hypothyroidism
- medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
43
The six week check of an infant should include:
- a physical examination
- a review of development
- an opportunity to give health promotion advice
- an opportunity for the parent to express concern
44
What are the main purposes of the physical examination in a six week baby check?
Main purpose is to detect:
- congenital heart disease (cyanosis, head, resp distress, murmurs)
- developmental dysplasia of the hip (DDH) (length discrepancy, Barlow's and Ortolani's test)
- congenital cataract (external exam, red reflex)
- undescended testes
- bruises (ie. safeguarding)
45
What are the four categories of child abuse?
1. Physical abuse
2. Emotional abuse
3. Sexual abuse
4. Neglect
46
Give some signs of child neglect.
- absent from school frequently
- lacks needed medical care, dental care, immunisations or glasses
- consistently dirty or poor body odour
- complain of hunger or looks malnourished
47
Give some signs of emotional abuse to a child.
- extremes in behaviour
- delayed physical, emotional or intellectual development
- finds it hard making friends
- bed wetting or soiling in school age
- seem gloomy or depressed
48
What is the normal resp rate a child:
a) 0-5 months
b) 6-12 months
c) 1yr
a) <60 for 0-5 months
b) <50 for 6-12 months)
c) <40 breaths per min
49
What is normal HR for child:
a) <1yrs
b) 1-2yrs
c) 2-4yrs
a) <160bpm
b) <150bpm
c) <140bpm
50
What are the signs of meningitis in a child?
Triad of meningism:
1. Neck stiffness
2. Photophobia
3. Headache
The child may also present with fever, decreased consciousness, epilepsy, a non-blanching purpuric rash and a bulging frontal fontanelle (ie. raised ICP).
51
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.
52
Give 5 amber signs of the traffic light system of a feverish child.
1. Pallor
2. Decreased activity or difficulty waking
3. Tachypnoea or SpO2 < 95%
4. Tachycardia or CRT > 3s
5. Reduced urine output
53
Give 5 red signs on the traffic light system of a feverish child.
1. Pallor / mottled / ashen / blue
2. Continuously crying or does not wake
3. Grunting or chest recession
4. Reduced skin turgor
5. Bulging fontanelle or seizures.
54
How should the temperature of a child <4 weeks old be measured?
Electronic thermometer in axilla
55
What is weaning?
The introduction of solid foods, alongside breast milk.
Note when feeding do not add salt, as this risks damage to the kidneys.
56
At what age is it suitable to start weaning?
At approx. 6 months old.
Clear signs a child is ready include:
* Sit up and hold head steady
* Coordinate eyes, hands and mouth to feed themselves (ie. use a spoon)
* Can swallow food so more goes in mouth than around face
57
What is a Mongolian spot?
Common birthmarks that look like bruises, most commonly seen in asian babies.
They are harmless and usually fade away.
58
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.
59
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.
60
What is Fifth disease?
A common childhood viral infection, also known as slapped cheek disease or erythema infectiosum, which is caused by parvovirus B19.
61
What are the symptoms of Fifth disease?
* rash of the face (typically on cheeks)
* fever
* runny nose
* headache
62
What is the management of Fifth disease?
Rest and plenty of fluids is recommended, as the infection is self-limiting in most instances.
63
What is infantile colic?
When a baby cries excessively but there is no obvious cause. Often the cause is not known, but it may be because babies find it harder to digest food or because of allergy (e.g. cow's milk).
Infantile colic can be diagnosed if a baby cries more than 3 hours a day, 3 days a week, for at least one week.
64
What practical advice can be given to soothe a baby with infantile colic?
* hold or cuddle baby
* sit baby upright during feeding so they do not swallow air
* rock baby over shoulder or in crib
* bathe in warm bath
* keep feeding as usual
65
At what age does gait begin to resemble that of an adult?
Around 3yrs old.
66
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.
67
What are the symptoms of Osgood-Schlatter disease?
* gradual onset of pain and swelling below the knee
* pain relieved by rest and made worse by running or jumping
68
What are the signs of Osgood-Schlatter disease?
Examination reveals tenderness and swelling at the tibial tuberosity, with pain provoked by knee extension against resistance or by hyperflexion of the knee.
69
What is the management of Osgood-Schlatter disease?
Most patients respond well to conservative treatment consisting of rest from painful activities and application of ice.
Check vit D levels.
Physiotherapy advice on quadriceps-strengthening exercises may help recovery.
Simple analgesia (paracetamol and ibuprofen) can be used to relieve pain.
Reassure that symptoms usually resolve as growth slows within 12-24 months.
70
What is viral wheeze?
The chest becomes tight and wheezy when a child has a viral infection, lasting 2-4 days usually.
Children are usually well between infection.
The viruses cause inflammation and oedema of the airways, triggering constriction of the airways.
71
What is the management of viral wheeze?
Salbutamol inhaler via a spacer to relieve wheeze when present.
72
Give some differentials of viral wheeze.
* asthma
* URTI
* inhaled foreign object
73
What is the pathophysiology of GORD in children?
Acid reflux due to an incompetent lower oesophageal sphincter, resulting in damage and inflammation of the mucosal lining of the oesophagus.
Note if GORD is left untreated it can result in aspiration pneumonia, oesophagitis or recurrent otitis media.
74
What are the symptoms of GORD?
* dyspepsia
* retrosternal burning
* cough
* vomiting
75
Give some risk factors for GORD in children.
* obesity
* hiatus hernia
* FHx of GORD
* premature
76
What is the management of GORD in children?
Antacids and alginate therapy to thicken the stomach mucosal lining is first line.
PPIs are the last step.
Note any patient with haematemesis or malaenia should be referred.
77
What is toddler diarrhoea?
The persistant diarrhoea in children aged 1-5yrs, with the child being otherwise well.
78
What is the cause of toddler diarrhoea?
Causes not clear, however related to the balance of fluid, fibre, fats and sugars.
79
Describe the classical presentation of toddler diarrhoea.
- loose stools >3x/day
- offensive smelling
- pale stool
- undigested food visible
- child otherwise well
- some children alternate between constipation and diarrhoea
80
Outline the gross motor development milestones expected at the following ages:
a) newborn
b) 8 weeks
c) 8 months
d) 9 months
e) 10 months
f) 12 months
g) 15 months
h) 2.5 years
a) limbs flexed, symmetrical pattern
b) raises head to 45 degrees in prone position
c) sits without support (with back straightened)
d) crawling
e) stands independently and cruising around furniture
f) walks unsteadily - a broad gait with hands apart
g) walks steadily
h) runs and jumps
81
Outline the vision and fine-motor development milestones expected at the following ages:
a) 6 weeks
b) 4 months
c) 6 months
d) 7 months
e) 10 months
f) 18 months
a) follows moving objects or face by turning the head
b) reaches out for toys
c) palmar grasp
d) transfers toys from one hand to another
e) mature pincer grip
f) makes marks with crayons
82
When assessing fine motor movement, describe the brick building capabilities expected at the following ages:
a) 18 months
b) 2 years
c) 2.5 years
d) 3 years
e) 4 years
a) tower of three
b) tower of six
c) tower of eight
d) bridge (from a model)
e) steps (after demonstration)
83
When assessing fine motor movement, describe the pencil skills expected at the following ages:
a) 2 years
b) 3 years
c) 3.5 years
d) 4 years
e) 5 years
a) line
b) circle
c) cross
d) square
e) triangle
84
What hearing, speech and language milestones are expected at the following ages:
a) newborn
b) 4 months
c) 7 months
d) 10 months
e) 12 months
f) 18 months
g) 2 years
h) 3 years
a) startles to loud noises
b) vocalised alone or when spoken to, coos and laughs ("aa, aa")
c) turns to soft sounds out of sight; polysyllabic babble ("babababa")
d) Sounds used discriminately to parents ("dada" and "mama")
e) understands name; using 5 some words discriminately
f) able to show parts of the body (e.g. baby points to nose when asked); using 12 words discriminately
g) joins two or more words to make simple phrases ("give me teddy")
h) talks constantly in 3-4 word sentences; understands two joined commands ("Push me fast Daddy")
85
What social, emotional and behavioural developmental milestones are expected at the following ages?
a) 6 weeks
b) 8 months
c) 10 months
d) 12 months
e) 18 months
f) 2 years
g) 2.5 years
h) 3 years
a) smiles responsively
b) puts food in their mouth
c) waves bye-bye, plays peek-a-boo
d) drinks from a cup with two hands
e) holds spoon and gets food safely to mouth
f) symbolic play
g) toilet training (dry by day); pulls off some clothing
h) parallel play; interactive play evolving; take turns
86
What are the purpose of 'limit ages' during developmental milestone assessment?
Simplified limit age guides have been produced for health practitioners and parents to facilitate the early identification of developmental delay.
