1
Q
When is the NIPE (neonatal and infant physical examination) done and why?
A
Multisystem examination done in first 24 hours of life then repeated at about 6-8 weeks. Performed to:
- Identify congenital abnormalities
- Make referrals if necessary
- Opporrunity for health education & parental reassuracne
2
Q
Describe how to complete a newborn examination/NIPE (neonatal and infant physical examination)
A
Multisystem examination done in first 24 hours of life then repeated at about 6-8 weeks. Also an opporutunity for parental reassurance and health education:
- History: find out about pregnancy, birth, any issues/concerns, if baby has pased meconium and urine in first 24hrs, feeding
- Prepare for examination: ask for baby clothes to be removed except for nappy
- General inspection: movements, colour, obvious abnormalities
- Head inspection: shape, feel fontanelles & suture lines, measure occipito-frontal circumference, look in eyes and try and elicit red reflex bilaterally, feel in mouth for cleft palate, check suckling reflex, check ears (mobile pina & patent meatus)
- Chest inspection: check neck for lumps or webbing, feel clavicles, look at shape and movements of chest, ausculate lungs and heart, HR, RR, saturations
- Abdomen inspection: distension, movement with breathing, umbilicus, palpate for masses, ausculatate bowel sounds, feel for femoral pulses, external genitalia inspection (cryptorchidism & hypospadias), anal inspection (position & patency)
- Limb inspection: movement, symmetrical, count digits, palm inspection for palmar crease (single associated with Down’s syndrome), grasp reflex, hips (Barlow’s and Ortoleni’s tests)
- Spine inspection: curvature, palpate spinal processes, assess tone. Moro’s reflex, stepping reflex
- Final documentation: weight, length, occipital-frontal circumference, oxygen saturations and all other findings.
3
Q
State some of the conditions the NIPE screens for
A
- Congenital vascular malformations e.g. coarctation or aorta
- Congential heart murmurs
- Spina bifida
- Hypospadias
- Cryptorchidism
- Congenital cataracts
- Retinoblastoma
- Cleft palate
- Developmental dysplasia of hips
… list not exhaustive
4
Q
What is the red reflex, in eyes, and what does it test for in the NIPE?
A
Asseses for congential cataracts, retinal detachment, vitreous heamorrhage and retinoblastoma.
- Look through opthalmoscope- shine light towards patients eye at distance of approximately one arms length
- Observe for reddish/orange reflection in each pupil caused by light reflecting back from vascularised retina
Absence of a red reflex or a white reflex suggests presence of one of above pathologies and requires immediate opthalmology referral
5
Q
Why do we perform Barlow’s and Ortolani’s tests in the NIPE?
What order should they be done in?
A
Detect any hip joint instability and dislocation. Each hip should be examined individually with all clothing- including nappy- removed.
- Barlow’s
- Ortolani’s
6
Q
Describe Barlow’s test
A
Barlow’s test
- Adduct hip whilst applying light pressure on knee with your thumb directing force posteriorly.
- If hip is unstable, femoral head will slip over posterior rim of acetabulum producing palpable sensation of subluxation or dislocation.
Barlow’s test is used to confirm that the hip is actually dislocated.
7
Q
Describe Ortolani’s test
A
Ortolani’s test
Used to confirm posterior dislocation of hip.
- Flex hips and knees to supine infact at 90 degrees
- With your index fingers placing anterior pressure on greater trochanters gently abduct the infants legs using your thumbs
A positive sign is a distinctive clunk which is heard and felt as the femoral head relocates anteriorly into the acetabulum
8
Q
List members of the interprofessional team involved in the care of pre-school children
A
9
Q
State some reflexes you should assess for in the NIPE
A
- Palmar grasp
- Sucking
- Rooting (newborn will turn its head to anything that strokes it’s cheek or mouth to aid breastfeeding. Disappear 4 months)
- Stepping reflex
- Moro reflex (support infacnts upper back with one hand then drop back once or twice into other hand. Normal refelx is extension of legs and head whilst arms jerk upwards with fingers extended. Arms are then brought together and hands clenched into fists)
10
Q
State some developmental milestones for infants- include the usual age range
A
- 2 months: smile, can hold head up, begins to push up if lie on front
- 4 months: roll over, push up to elbows when led on front, hold and shake a toy
- 6 months: rolls over, begins to sit without supoort, babbles
- 9 months: crawls, stands holding on, makes lots of different sounds
- 12 months: may stand alone, may take a few steps, simple gestures like wave, responds to simple commands, simple words ‘mama’
- 18 months: walk, help undress, hold spoon, says several words, build tower of 3 blocks
- 2 years: sentences with few words, knows names of familiar people
- 3 years: runs easily, climbs, walks up and down steps, copies drawing a circle
- 4 years: plays make-believe, names some colours, sings songs/nursery rhymes
- 5 years: toilet on own, count to 10
11
Q
Discuss community perinatal care (up to the 6 week baby check)
A
- Day 3-4: midwife visits to check health of mum and baby
- Day 5-8: offered newborn hearing screening test & heel prick test
- Day 10: health visitor should visit within 10 days of birth. Check how both mother and baby are doing. Offer advice, safety netting, contraception advice etc..
- 6-8 weeks: GP appointment for them to perform NIPE examination again and check health of mum and baby
After this have numerous health checks by health visitors up to age of 5
12
Q
What’s the cut off for weight loss in first 7 days?
A
10%
13
Q
Dicuss what vaccinations are offered to children in the first 4 months- include at what age they are offered each
A
- 6 in 1: dipheria, polio, hepatitis B, HiB, tetanus, whooping cough
14
Q
Discuss what vaccinations are offered to children aged 1-15 years
A
- 4 in 1 preschool booster: dipheria, polio, tetanus, whooping cough
- 3 in 1: dipheria, tetanus, polio
15
Q
How is the flu vaccination given to children aged 2 and 3?
A
Nasally
16
Q
Discuss some differences between consulting with adults and consulting with children; include any differences aswell as helpful tips
A
When consulting with children need to:
- Use simple language rather than medical terms or acronyms to explain things in an easier way (should avoid jargon in consultations anyway- but be even more aware e.g. say we need to get a picture of inside your tummy rather than we need to do an x-ray
- Talk directly to child, even if parent or guardian present. If child 4 or more your first question/words should be directed towards them
- Make age appropriate
- Be more relaxed and informal
- Extra reassurance as you would with all vulnerable/anxious patients
- If child is anxious, talk to parent or sibling first to gain child’s trust
- Ask young people if they’d like to speak to you on their own
17
Q
State some skin conditions that are commonly seen in the first few months of life
A
- Mongolian spots
- Erythema toxicum
- Milia
- Newborn dry skin
- Cradle cap
- Baby acne
- Heat rash
- Eczema
- Nappy rash
18
Q
What are mongolian spots?
Explain why they occur
What is the management?
A
- A Mongolian spot is a blue-grey marking of the skin that usually affects the lower back and buttock region of newborn babies. Poorly defined edges and can vary in size. Look like bruises.
- Due to functional melanocytes in the dermis (melanocytes failed to reach epidermis)
- They are benign and so reassurance is normally all that is required as most will fade in early childhood, although larger and extra-sacral spots can persist for much longer
19
Q
What is erythema toxicum?
A
- Combination of erythematous macules (flat red patches) and papules (small bumps- can be filled with fluid or puss). Often begins on face and spreads to trunk and limbs. Rash comes and goes, lesions don’t usually last for more than 24hrs. Infant is otherwise well. Generally occurs in first 3-14 days of life.
- No treatment- disappear on it’s own. Reassurance is all that’s needed
20
Q
What are milia?
A
- Small white bumps which are commonly found on nose, cheeks and chin. May find them on the roof of the mouth (Epstein Pearls) and/or on dental ridge (Bohn’s nodules)
- Due to occlusion of developing sweat ducts/accumulation of sweat in blocked pores
- Most resolve in first few weeks of life.
21
Q
Dry skin in newborns is common as they adjust from being in a fluid environment; state some advice you can give to parents if their baby has dry skin
A
- Reduce bath times (only need to bath them ~2/3 times a week. Each bath should be 5-10 mins)
- Apply baby friendly moisturiser
- Protect baby from cold air
- If doesn’t improve within a few weeks- see doctor
22
Q
Describe the appearance of cradle cap
What is it’s ‘proper name’?
What causes cradle cap?
What is the management?
A
- Looks like patches of greasy and yellow crust; crusts can flake an dmake skin look red. Mainly occurs on scalp but can occur in other areas like eyebrows, nose and nappy area. Not itchy or painful. Typically occurs in first few weeks; usually disappears on it’s own. If it doesn’t disappear,
- Infantile seborrheic dermatitis
- Unclear what causes it. Not contagious.
23
Q
What does this image show?
A
Infantile seborrhoheic dermatitis
24
Q
What is baby acne?
What is it’s ‘proper name’?
What is the management?
A
- Raised rash characterised by red and white bumps or pimples and some small pus-filled spots. Can look similar to erythema toxicum but isn’t as transient as erythema toxicum
- Erythema toxicum neonatorum
- Disappear on it’s own. Do not pick. Treat baby’s skin as norma;l
25
Describe the appearance of heat rash in a baby
Discuss the management of heat rash
* Small red spots. Can be itchy so may notice baby scratching.Often found on neck, armpits and nappy area
* Disappears on own; keep baby at comfortable temperature
26
Describe the appearance of eczema in a baby
Discuss the management of eczema in a baby
* Itchy rash that can leave skin looked red, dry, flaky and/or weepy. In first few months of life most prominent on cheeks, forehead and scalp. As baby crawls then may spread to elbows and knees (extensor surfaces) then as they get older become more prominent on flexor surfaces
27
Breastfeeding mothers can get sore and/or cracked nipples; it's important they adress and treat the issue otherwiseit may get worse and there is infection risk. Midwifes and health visitors will be able to offer help. State some advice you could give to breastfeeding mothers to help with sore and/or cracked nipples
Most common cause is that baby is not positioned properly, advise:
* Baby's head and body should be in straight line
* Support neck and shoulders but allow them to tilt head back so they can swallow easily
* Bring baby's nose to nipple- will encourage them to open mouth wide to get a good latch
Other advice:
* Change breast pads at each feed
* Wear cotton bra
* Feed baby for as long as they want as oppose to doing frequent short feeds because you think this will help the nipple
* Try dabbing a bit of expressed milk on cracked nipples after feeds
* Avoid nipple shields
* Warn signs of infection
28
State some signs that indicate a baby is getting enough milk
* Starts with few rapid sucks then longer sucks
* Cheeks stay rounded during feeds
* Appear content after most feeds
* Gaining weight
* At least 6 wet nappies per day
* At least 2 soft or runny yellow poos per day
29
Breast engorgement occurs when the breasts get too full of milk; they may feel hard, tight and painful. Discuss:
* When it commonly occurs
* What mums can do to help/soothe
* Commonly occurs in first few days as mother is getting used to matching milk supply to baby's needs and also when you start weening a baby
* What can do to help:
* Make sure you alternate feeding between breasts
* Wear a good breastfeedng bra
* Warm flannels on breast just before expressing if they are leaking
* Paracetamol and ibuprofen
30
Breastfeeding mums can get blocked ducts (which will feel like a lump in breast) and/or mastitis (inflammation of breast tissue). Discuss what you should advise a woman who has blocked duct or mastitis
* Continue to breast feed
* Start feeds with sore breast first
* Massage breasts (blocked duct)
* Tips to ease pain: warm flannel or bath, paracetamol & ibruprofen
* See GP if symptoms no better after 24hrs even though you've continued to breastfeed
31
For headlice, discuss:
* Difference between the lice and eggs
* Symptoms
* Contagiousness
* Management
* Can you prevent head lice
* Lice are the insects that move and the eggs (also known as nits) are brown or white empty shells attached to hair
* Symptoms:
* Itching
* Feel like something is moving
* Visible eggs or lice
* **Contagious** therefore must check other members of household and treat them if lice or nits are seen. Keep checking regularly. Don't need to keep kids off school or wash laundry on hot wash.
* Management:
* **Wet combing**
* If lice still present after 17 days, pharmacist may prescribe **lotion or spray**
* **Can't prevent headlice** but can stop spread by catching and treating early
32
Describe 'wet combing' as treatment for head lice
33
What is colic (in children)?
* Colic is when baby cries a lot for no obvious cause (\>3hrs a day- mostly in afternoon & evening)
* Other signs include:
* Hard to soothe
* Clenched fists
* Red in face
* Knees up to tummy or arched back
* Very windy
* Can start when few weeks old but usually resolves by 6 months
* If worried, nothing seems to work to soothe baby or it has persisted past 6 months contact GP
34
It is recommended that all babies and children, aged 6 months to 5 years, are given vitamins ______ every day
A, C and D
35
Why must you not give honey to a child under 1 years old?
Honey has been known to contain Clostridium botulinum spores which can cause infantile botulism
36
Children have a different gait to adults; discuss some normal variations in a child's gait. For each variation, state by age they should resolve
* Toe walking- 3 years
* Bow legs- ealry toddler
* Knock knees- 7 years
* Flat feet- 6 years
* In-toeing- common between 3-8 years
If normal variations persist past expected age, are progressive or asymmetric, there is pain and/or functional limitation then referral is needed. Consider hypophosphataemic rickets in children with bow legs or knock knees especially if child is also short
37
Remind yourself of some abnormal gaits
* Antalgic
* Circumduction
* Spastic *(foot dragging with foot inversion)*
* Ataxic
* Trendelenburg *(seen in Perthes' disease, SCFE, developmental dysplasia of hip)*
* Stepping gait
* Clumsy gait
38
State some questions you should ask if a child presents with an abnormal gait
* Other symptoms e.g. poor coordiination
* Sitting habits
* Any pain
* Aggrevating factors
* Any unwitnessed trauma
* Variation in symptoms
* Detailed pregnancy and birth history
* Family history
* Any other conditions
39
What is metatarsus adductus?
Lateral aspect of foot is a C shaped curve rather than a straight border
Most resolve by 1 year
40
State some common rashes in older children
* Measles
* Scarlet fever
* Rubella (German measles)
* Erytheam infectiosum (Fifth's disease/slapped cheek)
* Roseola infantum
* Varicella
41
What is an xanthem?
What are the 5/6 childhood xanthems?
Exanthem is the medical name given to a widespread rash that is usually accompanied by systemic symptoms such as fever, malaise and headache
42
For measles, discuss:
* Pathophysiology
* Signs & symptoms
* Investigations
* Management
* Complications
* Infectious disease caused by **measles virus**. Virus spreads via **droplets** and **infects epithelial cells of nose and conjunctivae**
* Risk factors:
* Not immunised
* Exposure to measles
* Not responded to vaccine
* **Starts with cold like symptoms 10 days after initial infecction then rash develops few days later**:
* Fever
* Cough
* Rhinitis
* Conjunctivitis
* Koplik's spots
* Maculopapular rash
* Investigations: **measles specific IgM and IgG serology (ELISA)**
* Management:
* **Supportive** e.g. paracetamol for fever
* Vitamin A in SOME patients
* Complications
* Pneumonia
* Otitis media
* Encephalitis
* Subacute sclerosing panencephalitis (SSPE)
* Death
43
Describe the appearance and progresion of the measles rash
* Small red-brown flat, or slighly raised, spots that may join together to form larger blotchy patches
* Usually fist appears on head or neck then spreads to rest of body
* Resolution of fever after rash appears
44
What sign is pathognomonic of measles?
Koplik's spots *(red spots often with a blue-ish white central dot found on erythematous mucosa in mouth)*
45
For scarlet fever, discuss:
* Pathophysiology
* Aetiology
* Signs & symptoms
* Investigations
* Management
* Complications
* Contagious infection with **Streptococcus pyogenes** (Group A Streptococcus)
* Mainly affects children- some children will get the infection but remain asymptomatic.
* **Flu-like symptoms followed by a rash a few days later:**
* Sore throat
* Fever
* Headache
* Nausea & vomitting
* Cervical lymphadenopathy
* Rash
* Strawberry tongue
* Flushed face
* Forchemier spots
* Investigations**: no specific investigations are routinely done** however may do throat swab and culture for Group A Strep if unsure of diagnosis, there is a local outbreak... see NICE for more.
* Management is antibiotics:
* **First line= phenoxymethylpenicillin 10 days**
* Second line= amoxicillin 10 days
* Third line if true penicilin allergy= azithromycin 5 days
* Complications:
* Otitis media
* Throat infection & abcess
* Acute rheumatic fever
* Acute post-streptococcal glomerulonephritis
46
Scarlet fever is usually a mild and self-limiting illness however in some it can be very serious; true or false
True
47
Describe the appearance and progression of the scarlet fever rash
* Erythematous, rough like sandpaper rash
* Usually starts on trunk then spreads
* May be accenuated in folds of skin e.g. neck, axilla, groin
48
Describe the appearance of strawberry tongue in scarlet fever
* Initially a white coating appears
* Then this peels off leaving tongue red and swollen
49
Scarlet fever rash primarily affects the face; true or false
FALSE- rash doesn't affect face however cheeks may be flushed
50
For rubella, discuss:
* Pathophysiology
* Signs & symptoms
* Investigations
* Management
* Complications
* Rubella (also known as German measles) is a viral infection spread by direct contact with an infected person or droplet spread from respiratory secretions. Generally a mild infection but can cause serious complications in pregnancy
* Signs & symptoms:
* Maculopapular rash
* Lymphadenopathy
* Fever
* Headache
* Sore throat
* Athralgia
* Investigations:
* Rubella specific IgM serology
* FBC
* Management= supportive e.g. paracetamol & NSAIDs. If pregnant refer immediately to specialist
* Complications:
* Encephalitis
* Congenital rubella syndrome
51
Describe the appearance and progression of rubella rash
* Erythematous
* Maculopapular
* May be accenuated by heat
* May be mildy pruritic
* Usually begins on face and spreads to feet
52
State some alternative names for Fifth's disease
* Erythema infectiosum
* Slapped cheek
53
Discuss for fifth's diease:
* Pathophysiology
* Signs & symptoms
* When infectious
* Management
* Complications
* Infection caused by parvovirus B19 which is spread via respiratory droplets and tends to affect children
* Flu-like illness followed by rash few days later
* Infectious when have pro-dromal symptoms before develop rash
* Management: supportive (rest, paracetamol, moisturise itchy skin, fluids)
* Complications:
* Chronic anaemia
54
Describe the appearance and progression of fifth's disease rash
Erythematous rash that starts on cheeks and spreads
55
For roseola infmatum, dsicuss:
* What it is
* Age of children it commonly affects
* Presentation
* Managaement
* Infection caused by human herpes virus 6
* Affects children commonly between 6 months and 2 years
* Presentation:
* Sudden high temperature, sore throat, loss of appetite
* Followed by rash 3-5 days later
* Manage at home supportively: paraceatmol, encourage fluids, rest. Contact GP if child gets worse, shows signs of dehyration etc..
56
Describe the appearance and progression of the roseloa infantum rash
* Pinkes-red spots, patches or lumps
* Starts on chest, tummy and back before spreading elsewhere
57
For varicella (chickenpox), state:
* Signs & symptoms
* Management
* Signs & symptoms
* Rash: red spots that fill with fluid (become blisters) then blisters burst and form scab. VERY itchy
* High temperatues
* Achiness
* Loss of appetite
* Usually resolves itself in 1-2 weeks:
* Paracetamol
* Plenty of fluids
* Antihistamines to stop itching e.g. chlorphenamine
* Wear socks/mittens to bed to stop scratching
* Use cooling creams/gels from pharamcy
* Bathe in cool water
* Wear loose clothes
58
What's the incubation period for varicella zoster?
1-3 weeks
59
How long is chicken pox infectious for?
Usually froom 2 days BEFORE spots appear until ALL spots have crusted over (usually around 5 days after rash has appeared)
60
Which populations are we more concerned about in regards to chicken pox?
* Pregnant
* Immunocompromised
* Newborn babies
61
Pregnant women are at increased risk from chicken pox (especially in the first 20 weeks, the week before and after birth); state some of the potential complications of chicken pox in pregnant women and fetus
_Pregnant women_
* Varicella pneumonia
_Fetus_
* Intrauterine infection
* Fetal varicella syndrome (skin scarring, eye defects, hypoplasia of limbs, neurological abnormalities)
62
Dicuss whether you can catch chicken pox from someone with shingles and vice versa
* You **CAN catch chicken pox from someone with shingles** if you **have NOT had chicken pox** before
* You cannot catch shingles from someone with chicken pox
63
For bronchiolitis, discuss:
* What it is
* Signs & symptoms
* Management
* Inflammation of the bronchioles which occurs in children under 2 years of age caused by RSV virus (respiratory syncytial virus) which spreads via droplets
* Early symptoms are similar to those of a common cold (runny nose, cough etc..) then over next few days the following develop:
* Fever
* Difficulty feeding
* Breathing difficulties e.g. increased RR, wheeze
* Most cases can be managed at home with paracetamol, fluids etc... around 2-3% of babies will need to be admitted to hospital and will receive supportive therapy such as supplemental oxygen, salbutamol, feeding assistance e.g. via NG
64
For croup, discuss:
* What it is
* Signs and symptoms
* Viral infection of the larynx and trachea; numerous viruses are associated with it but one of the most common ones is parainfluenza virus
* Prodromal symptoms (such as fever, rhinitis, non-barking cough) may have been present for 12-48hrs followed by:
* Sudden onset of barking cough
* Stridor
* Hoarseness of voice
* Drooling
* Signs of respiratory distress e.g. subcostal and intercostal recessions, tracheal tug
* Agitation
* Lethargy
65
Croup can be classifed as mild, moderate and severe; discus each
66
Dicsus the management of croup; think about the differences in management of mild, moderate and severe disease
_Mild_
* **Single dose of oral dexamethasone** (0.15mg/kg)
* **Supportive**: paracetamol, encourage fluids
* **Educate** about croup: usually last 48 hours, what to look for, regularly check
* **Safety netting:**
* Advise to take to hospital if develop stridor or recessions
* Advise to call ambulance if colour change or lethargic
_Moderate-Severe_
* Hospital admission
* Whist waiting for admission:
* Supplemental oxygen
* Single dose of oral dexamethasone (0.15mg/kg) or 2mg nebulised budenoside or IM dexamethasoone (0.6mg/kg)
67
For eczema, discuss the typical presentation:
* Signs and symptoms
* Risk factors/triggers
* Management
* Signs & symptoms:
* Dry skin
* Itching
* Redness
* Excoriation
* Flares & remission
* Risk factors/triggers:
* Atopy
* Family history
* Triggers: animal dander, house dust mites, pollen
* Management:
* Education: regarding triggers, washing etc
* Emollients *(advise to use liberally!)*
* Topical corticosteroids:
* Hydrocortisone 1%
* Eumovate
* Betnovate
* Dermovate
* Non-sedating antihistamines *(to help itching)*
* Oral corticosteroids *(at this point they'd be reffered to a dermatologist)*
68
Eczema typically occurs in flexor regions; however, in babies it can have a different distribution- discuss this
In first few months of life most prominent on cheeps, forehead and scalp. As baby crawls then may spread to elbows and knees (extensor surfaces) then as they get older become more prominent on flexor surfaces
69
State the 4 topical corticosteroids used in eczema in order of increasing potency
* Hydrocortisone
* Eumovate
* Betnovate
* Dermovate
70
State some examples of emollients used in eczema
71
What is eczema herpeticum?
What investigations are required?
/
Management
* **Disseminated herpes simplex virus infection** characterised by **fever, clusters of itchy and painful blisters, punched out erosions and symptoms such as fever and malaise**. It can then occasionally be complicated by a secondary staphylococcal infection. Occurs in children with **atopic eczema who are infected with herpes simplex virus**. **Medical emergency** as it can cause have eye or meningeal involvement and cause scarring.
* Investigations: swabs of blister to confirm HSV as cause and check for secondary bacterial infection
* Management:
* Oral aciclivor
* Flucloxacillin if secondary staphyloccoal infection
72
State the 7 types of eczema
* Atopic dermatitis
* Contact dermatitis
* Dyshidrotic eczema
* Neurodermatitis
* Nummular eczema
* Seborrheic dermatitis
* Stasis dermatitis
73
What would make you think someone's eczema is infected?
What is the management of infected eczema?
* Eczema is weeping, crusting, pustules or fever and malaise
* Management:
* _Localised areas of infection_
* Consider topical antibiotics
* _Widespread areas of infection_
* First line= oral flucloxacillin
* Second line= oral erythromycin
74
What is meant by functional constipation in children?
At what times in their lives are they prone to developing it?
State some reaons/causes of functional constipation
* Constipation that doesn't have organic etiology (e.g. doesn't have a structural cause)
* Prone to develop at following times:
* After introduction of cereals and solid fod
* During toilet training
* During start of school
* Reasons may develop:
* Fear
* Lack of toiletting routine
* Busy playing so don't want to go
* Poor fluid intake
75
What is the **_key_** question you must ask when asking any bowel related history in a child?
Whether they passed meconium in first 24hrs *(if they did, helps rule out a lot of major structural causes)*
76
Discuss the management of functional constipation *(think about RAPRIOP model)*
* Reassurance that underlying causes of constipation have been ruled out
* Advice/prevention and health promotion:
* Diet and lifestyle
* Importance of a good toileting routine
* Reward system
* Laxatives may be required for several months
* Prescription:
* First line= macrogol
* Second line= add stimulant e.g.senna
* Observation: reassess in few months time
77
What is a viral wheeze in children?
Discuss the management of a viral induced wheeze
* Child develops a wheeze as a result of viral infection. In majority of children tendancy to wheeze remits by age of 6yrs
_Management:_
* Consider if need hospital admission e.g. if severe/life threatening, not improving after initial treatment, underlying condition etc... see NICE for more
* If doesn't need hospital admission:
* Give SABA, see if shows improvement, if so give SABA pmdi and spacer to take home
* Whilst awaiting hospital admission:
* Oxygen
* Nebulised salbutamol
78
For Osgood-Schlatters disease, discuss:
* What it is
* How it typically presents
* If any investigation is required
* Management
* Apophysitis of tibial tuberosity (where patella ligament inserts onto anterior tibia) caused by repetitive strain
* Presentation:
* Unilateral anterior knee pain (bilateral up to 30%)
* Relieved by rest
* Worsened by kneeling or activity
* Pan provoked by resisted extension of knee
* Localised to anterior knee
* Swelling/ bony growth where tibial tuberosity is
* As long as ruled out other causes no investigation is required. Check for nights sweats, weight loss, effusions etc...
* Management:
* Education- give leaflets
* Analgesia e.g. paracetamol, NSAIDs
* Intermittent application of ice packs over tibial tuberosity 10-15 mins up to 3 times per day
79
Discuss whether hayfever just affects people, including children, in the spring & summer
Different tyes of hayfever:
* **Seasonal**: *occur in spring & summer- usually due to pollen allergy*
* **Perennial:** *symptoms persist all year round- usually due to allergy to dust mites, animal dander etc..*
* **Occupation:** *due to exposure to allergens in the workplace*
80
Discuss the management of hayfever
_Conservative_
* Advice on how to avoid triggers- advice will vary dependent on what triggers eczema e.g. pollen or animal dander
_Pharmacological_
* First line: intranasal or oral antihistamines *(key is for pts to start antihistamines ~6weeks before symptoms usually start)*
* Second line: + regular intranasal corticosteroid e.g. flutiasone furoate *(NOTE: maximal effect may not be until ~2 weeks after first use)*
81
Nasal antihistamines (e.g. azelastine) have a slower onset of action and are less effective than oral antihistamines; true or false?
FALSE- nasal antihistamines have a faster onset and are more effective than oral antihistamines
82
What is meant by toddler/functional diarrhoea?
How would you diagnose toddler/functional diarrhoea?
* Diarrhoea in a toddler with no other symptoms/ **chronic non-specific diarrhoea in childhood** (normal growth, no weight loss, no blood, no ulcers, otherwise well). Common aged 6months to 3 years.
* **Diagnosis by exlcusion**
* Exclude red flags
* Stool culture to investigate for infection
* Faecal calprotectin
* Coeliac serology
* FCC
* ESR/CRP
* **Use ROME IV criteria**
83
Desribe the ROME IV criteria for functional diarrhoea
* Daily, painless recurrent passage of 4 or more unformed stools
* Symptoms last more than 4 weeks
* Onset between 6 and 60 months of age
* No failure to thrive (providing calorie intake is adequete)
* Must have all of the above
84
Discuss the management of toddler diarrhoea
* Reassurance
* Education regarding correct amount of fibre
* Ensuring adequete fluid intake
* Safety netting/follow up
85
For threadworms, discuss:
* What it is
* Symptoms
* Whether it is contagious
* Threadworms, also known as pinworms, infect gut and lay eggs around the the anus- eggs are typically laid at night. Common amongst children.
* Symptoms:
* **Itching around anus and +/- vagina** (can cause vulvovaginitis if spread to vagina)
* **Itching worse at night and in morning**
* **Irritability and waking in night**
* **Visible worms in faeces**
* **Very contagious**. Worms survive ~6weeks and eggs ~2 weeks. If itch anus, sleep with no underwear etc... can get under nails/on bed sheets, then put fingers in mouth/eat food etc... eggs get back in GI system and cycle starts again
86
Discuss the management of threadworms: include pharmacological and conservative
_Pharmacological_
* **Mebendazole**: liquid or chewable tablet available from pharmacy. _GIVE ONCE_. Not suitable for pregnant, breastfeeding or under 6 month (these individuals must just use hygiene measures). Mebendazole not licensed children under 2 yrs.
_Conservative_
* Regular hand washing & srub under nails
* Shower in morning
* Wash sleepwear, towels etc regularly
* Rinse toothbrushes
* Wear underwear at night
* Do not share towels
* Avoid: shaking bedsheets, biting nails, sucking thumb
87
There is a test you can do for threadworms (although it is rarely done); describe this test
_Adhesive Tape Test_
* Apply transparent tape to perianal area first thing in morning
* Then examined under a microscope
88
Discuss the difference between GOR and GORD
* **GOR**= gastroesophageal reflux (passage of gastric contents into oesophagus; considered physiological in children when s**ymptoms are absent or not troublesome**)
* GORD= gastroesophageal reflux disease (passage of gastric contents into the oesophagus in the **presence of troublesome symptoms e.g. pain or complications**)
89
What is regurgitation (often known as possetting)?
Voluntary and involuntary movement of part or all of the stomach contents up the oesophagus at least as far as the mouth and often emerging from the mouth.
* In infants (younger than 1 year of age), regurgitation may be considered entirely normal.
* In older children, it may be a symptom of GOR or GORD.
90
State some risk factors for GORD
* Premature birth.
* Parental history of heartburn or acid regurgitation.
* Obesity.
* Hiatus hernia.
* History of congenital diaphragmatic hernia (repaired).
* History of congenital oesophageal atresia (repaired).
* Neurodisability (such as cerebral palsy)
91
Discuss when you may suspect GORD
Frequent effortless regurgitation of feeds is common and normal in infants younger than 1 year of age. It may be difficult to differentiate between gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD) as there is no reliable diagnostic test.
Suspect GORD in an infant (up to 1 year of age) or child if they present with regurgitation and one or more of the following:
* Distressed behaviour shown, for example, by excessive crying, crying while feeding, and adopting unusual neck postures, arching of back
* Hoarseness and/or chronic cough.
* A single episode of pneumonia.
* Unexplained feeding difficulties, for example, refusing to feed, gagging, or choking.
* Faltering growth.
92
State some red flag features in infants and children who present with regurgitation and vomitting (these red flags suggest alternative diagnosis to GORD)
* Frequent forceful projectile vomitting *(pyloric stenosis in up to 2 months old)*
* Bile stained vomit *(intestinal obstruction)*
* Abdominal distension, tenderness or palpable mass *(intestinal obstruction)*
* Blood in vomit
* Bulging fontanelle or altered responsiveness *(raised ICP)*
* Head circumference increase (\>1cm per week- *raised ICP*)
* Blood in stool
93
Discuss the management of **GORD**
* Alginate (e.g. Gaviscon children) *\*Advise parent to stop this after 2 weeks and see if improved, if not continue*
* If formula fed, consider smaller more frequent feeds or feed thickener
* If symptoms still persist, consider PPI e.g. omeprazole or H2 receptor antagonist e.g. ranitidine
94
Discuss the management of regurgitation or GOR
* Reassurance that it is normal
* Signpost to helpful information e.g. NHS website
* Advise if gets worse, loses weight, other red flags to seek medical attention
95
What is Perthe's disease?
How does it present?
What investigations are required?
Discuss the management
Prognosis
* Rare condition in which part or all of the femoral head loses its blood supply and may become mishapen leading to arthritis later in life.
* Symptoms:
* Pain in groin, thigh or knee
* Pain worse after physical activity
* Limp
* Stiffness/reduced ROM in affected hip
* Symptoms are transient (on and off. Disease lasts a few years)
* Investigations:
* Examinations every few months
* X-rays every few months
* Arthrogram
* Management:
* Limit physical activity during flare
* Analgesia
* Physiotherapy
* Crutches
* Operation to reshape bone
* 60% recover without any treatment. Some pts end up with arhritis as an adult
96
For SUFE, dicusss:
* What it is
* Who common in
* Symptoms & signs
* Investigations
* Management
* Displacement of femoral epiphysis from the metaphysis of the femur
* Common in boys aged 11-17yrs
* Symptoms:
* Pain in knee, hip or groin
* Difficulty walking/limp
* Affected leg may appear shorter and externally rotated
* Limited movement
* Investigations: x-ray of hip
* Management:
* Operation: surgical screw inserted across growth plate. Followed by few days best rest & no weight-bearing for 6 weeks- physio involvement
Yr3: GP
flashcards
Decks in class (21)
# Cards
-
Remote Consulting9
-
Acute Emergencies & Pre-hospital Care61
-
Safeguarding26
-
MSK47
-
Paediatrics96
-
Minor Illness36
-
Health Promotion54
-
Men's & Women's Health76
-
Dermatology123
-
ENT79
-
Contraception & Sexual Health93
-
Mental Health81
-
Diabetes61
-
Hypertension, CKD & Hyperlipidaemia76
-
Asthma & COPD76
-
IHD & Heart Failure54
-
Palliative Care25
-
Medicines Optimisation16
-
ENT 261
-
STIs42
-
Scoring Systems & Emergency Drugs52
