Wk 17: Paediatrics OTC

Question 1

What is the usual temperature taken in different places of the body?

Answer 1

37:

• Rectal: 0.5 higher
• Underarm: 0.5 lower

Question 2

What are the presentations of pyrexia?

Answer 2

• Irritability
• Not eating
• Clingy
• Cold/cough
• Inc RR

Question 3

When would you refer for a child with pyrexia?

Answer 3

under 3 months REFER - unless post immunisation

Question 4

What are the differential diagnosis of pyrexia?

Answer 4

• URTI - viral + self limiting, earache = bacterial
• UTI - scarring urinary tract REFER
• Meningitis - REFER (glass test)

Question 5

What is the treatment for pyrexia?

Answer 5

• Paracetamol: 3 months
• Ibuprofen: 3 months + >5kg
• Fluids

Question 6

What are the doses for paracetamol?

Answer 6

Every 4-6 hrs:

• 3-5 months: 2.5ml
• 6-23 months: 5ml
• 2-3 yrs: 7.5ml
• 4-5 yrs: 10ml
• 6-7 yrs: 5ml
• 8-9 yrs: 7.5ml
• 10-11: 10ml

Question 7

What are the requirements for the diagnosis of atopic eczema?

Answer 7

Itchy in last 12 months + 3/more:

• Hx of skin creases
• Atopic illness
• Dry skin in last year
• Under 2
• Visible flexural eczema

Question 8

What is the presentation of atopic eczema?

Answer 8

• Lesions most/weeping
• Skin thickened lichenified
• Darker skin appear papular

Question 9

What are children with atopic eczema more prone to?

Answer 9

• Herpes simplex infection
• Staphylococcal folliculitis secondary infection due to emollients/occlusive dressing

Question 10

When would you refer atopic eczema?

Answer 10

• Severe
• Psoriasis or herpetic complications: eye involvement
• Treatment failure
• 2ndry infection

Question 11

What are the OTC treatment for atopic eczema?

Answer 11

• Emollient
• Antihistamine esp sedating (chloramphenamine) - helps nocturnal itch
• Corticosteroids - not under 10

Question 12

What are the lifestyle advice for atopic eczema?

Answer 12

• Avoid irritants: house dust mite, perfumed bath oils, wool + pet dander
• Add emollient to bath water or soap substitute
• Liberally apply the emollient
• Beware of slippy baths + naked flames

Question 13

What are the symptoms of teething?

Answer 13

3 months - 3 yrs:

• Pain
• Swollen gums
• Red, hot checks
• Excessive dribbling
• Nappy rash
• Change to sleep pattern

Question 14

What is the treatment for teething?

Answer 14

• Paracetamol/ibuprofen suspensions
• Topical teething gels: lidocaine

Question 15

What is the cause of colic?

Answer 15

• Immature GI tract
• Milk/lactose intolerance
• Excessive gas swallowing on feed

Question 16

What are the presentations of colic?

Answer 16

• Pulling arms + legs
• Persistent/spasmodic bouts of crying
• Difficult to console
• More often in evening

Question 17

What is the treatment for colic?

Answer 17

• Dimethicone
• Red surface tension allow gas bubbles to join

Question 18

What is the treatment for constipation?

Answer 18

• Glycerin suppositories
• Dietary advice: fruit/veg + fluids

Question 19

What is the typical presentation of threadworms?

Answer 19

Nocturnal perianal itching

Question 20

How is thread worms transmitted?

Answer 20

• Faecal
• Retro infection
• Inhalation

Question 21

When do you refer for threadworms?

Answer 21

• Treatment failure
• 2ndry infection

Question 22

What is the treatment for thread worms?

Answer 22

Mebendazole

• Avoid in pregnancy (teratogenic)
• For 2 yrs

Question 23

What are the counselling points for treating thread worms?

Answer 23

• Treat entire family
• Repeat after 14 days to avoid reinfection
• Nails kept short + clean
• Scrub nails + hands after toilet + before meals
• Wash bed linen daily if possible
• Wear underwear under night clothes to prevent scratching

Question 24

What is the first line for head lice?

Answer 24

• Dimethicone
• Vamousse
• Avoid alcoholic prep in asthmatics

Question 25

What is the counselling points for the treatment of head lice?

Answer 25

• Wet comg throughout treatment period + after to prevent re-infestation
• Repeat after 7 days