1
Q
what are the symptoms of threadworm?
A
- intense perianal itching - typically worse during the night
- worms seen in stools
- genital itching in women
- secondary infection due to irritation and excoriation of perianal area
2
Q
what is teh managemnt of threadworm?
A
single dose of anti-helminthic treatment such as mebendazole (do not use in <2yrs)
repeated in 2 wks if infection persists
vigorous hygeine for 2 wks in treated, if not treated then for 6 wks
3
Q
what are the symptoms an dsigns for constipation?
A
- fewer than 3 stools a week
- hard, large stool
- rabbit dropping stools
- distress or pain on passing
- bleeding with hard stool
- straining
- abdo pain when passing
- anal pain
4
Q
what clinical features are suggestive of idiopathic constipation?
A
- meconium passed within 48 hours
- onset of constipation at least few wks after birth
- dietary factors
- acute illness
- anal fissure
- drugs causing consitpation
- timing of toileting
- psychosocial factors
5
Q
what examinations are found on a child with idiopathic constipation?
A
- normal appearing anus
- abdo soft and flat
- generally well with normal development
- motor and neuro development in normal limits
6
Q
what is the conservative management for constipation in chidlren?
A
- increased fluid intake (1.2L min)
- increase fibre intake
- increase physical exercise
- toilet training times
- look into psychosocial reasons
- encouragemnt and rewards systems
7
Q
medical treatment of faecal impaction in children?
A
- macrogol sachets (movicol)
- laxatives (senna)
- then a maintenance laxative treatment with regular follow ups
8
Q
what are the symptoms of osgood schlatters disease?
A
- knee pain
- starts in adolesence
- localised to tibial tuberosity
- gradual in onset and initially mild and intermittent but cna progress
- unilateral (bilateral in 30%)
- relieved by rest and made worse by kneeling and activity
9
Q
what are teh signs of osgood schaltters disease?
A
- tenderness over tibial tuberosity
- pain provoked by resisted knee extension
- tightness of quads and hamstrings
- swelling or bony enlargent of tibial tuberosity
- normal passive range of movement
- absence of effusion
10
Q
what is the management of osgood schlatters disease?
A
- refer to physio
- pain relief - NSAIDs/paracetamol
- ice for 10-15 mins x3 a day after exercise
- protective knee pads
- may have to reduce exercise doing
11
Q
what is osgood schlatters disease?
A
a condition that causes pain and swelling below the knee joint, where the patellar tendon attaches to the top of the tibia @ tibial tuberosity
also may have inflammation of patellar tendon
12
Q
what are the sympotms of GORD in children?
A
- regurgitation
- distressed behaviour e.g. excessive crying, crying while feeding
- hoarseness and/or chronic cough
- pnuemonia
- refusing to feed, gagging, choking
- faltering growth
if > 1yr, child may experience heartburn, retrosterna pain and epigastric pain
13
Q
how do you assess a child for GORD?
A
take thorough history about feeding, resp systems,
examine chest for resp symptoms and signs
check childs temp
do abdo exam and review head circumferance
check for faltering growth
14
Q
name some red flag symptoms in children who present with regurgitation and vomiting?
A
- frequent foreceful vomiting
- bile stained vomit
- heamatemesis
- abdo distention, tenderness, palpable mass
- bulging fontanelle or altered responsiveness
- rapisdly increasing head circumferance
- blood in stool
- chronci diarrhoea
- dysuria
- fever/unwell
15
Q
what is the management of GORD in children?
A
For breastfed:
- Gaviscon infant (1-2 week trial and if works continue)
For formulafed:
- offer 1-2 trial of smaller, more frequent feeds
- offer 1-2 trial of feed thickeners
- if neither work offer 1-2 trial of gaviscon infant
- if still doesnt work - try 4 wk trial of PPI as suspension
16
Q
what is croup?
A
childhood viral infection of upper airway characterised by barking cough and stridor
17
Q
what are the symptoms of croup
A
- sudden onset, barking cough
- stridor
- chest wall or sternal indrawing
- symptoms worse at night anf increase w agitation
- hoarse voice
if moderate/severe:
- persistent agitation
- lethargy/fatgiue
- asynchronous chest wall and abdo movemnt
- pallor or cynaosis
- decreased level of consiousness
18
Q
name some differentials fro croup?
A
epiglottitis, upper airway foreign body, retropharyngeal abcess, tonsillar abscess, angioneurotic oedema, or allergic reaction
19
Q
when should you admit a child with croup?
A
if they have mdoerate or severe symptoms (signs of resp distress, stridor, agigitation, lethargy)
or if child <3 months
or if child have underlying health condition that coudl icnrease risk of resp distress
20
Q
how do you manage a patient with croup in primary care?
A
- prescirbe single dose oral dexamethasone immedietly
- self limitng + symptoms usually resolve in 48 hrs
- paracetamol or ibuprofen if needed
- regular fluids
- check on child regualrly during night
21
Q
when would suspect a UTI in a child?
A
signs and symptoms inclduing:
- fever, frequency, dysuria, abdo pain, poor feeding,, cloudy urine, heamuaturia, irritabiliyt, lethargy
22
Q
what is the managment for a UTI in children?
A
- trimethoprim or nitrofurantoin for 3 days (doses change w age)
23
Q
when would you expect pyelonephritis in children with UTI symptoms?
A
unexplained fever of 38 or higher
loin pain/tenderness
24
Q
what is teh management of pyelonephritis?
A
oral ABX - cefalexin or co-amoxiclav for 7-10days (doses change based on age)
25
what is seborrhoeic dermatitis?
a common inflammatory skin condition occuring in areas rich in sebaceous glands (most commonly affects scalp in infants)
26
what is the managemnt of seborrheic dermatitis on scalp in children
self limiting and usually resoles by four months in infants
in adults its chornic - fluctuates with treatment
- emollients
- burshing an washing of scalp w baby shampoo
- imidazole cream (clotrimazole 1%) if ^^ doesnt work, x2-3 daily for 4 wks
- if not healed in 4 wks - dermatology referral
27
what are teh symptoms/signs of seborrhoeic dermatitis?
well defined patches of eythema associated with flaking of skin, scaled may be white, yellow, oily or dry
mild itching
most commonyl affects:
- scalp (cradle cap in infants)
- face
- upper chest + back
- flexures and skin folds
28
what is measles?
airborne infection caused by morbillivirus of paramyxovirus family
infects resp tract
29
what are teh main complications of measles?
- otitis media
- pnuemoina, pneumoniits, tracheobronchitis
- convulsions, encephalitis, blindness
- subacute sclerosing panencephalitis
30
what are the typcial symptoms of measles?
- rash (erythematous, maculopapular, may be confluent)
- fever
- malaise
- cough
- rhinorrhoea
- conjuctivitis
31
how long does a measles rash last for?
5 days - 1 week
32
what is the management for measles?
- notify health protection team
- self limiting so: fluids, pain relief
- isolate for at leat 4 days
- seek advice from HPT if immunocomprimised, preggo or <1y/o
- safety net: admit if: SOB, uncontrolled fever, convulsions/altered consiousness
33
what is hand foot and mouth disease?
acute self limiting viral illness charcterised by vesicualr eruptions in mouth and papulovesicular lesions
34
when would you suspect hand foot and mouth disease in children?
- sore throat
- low grade fever
- tender lesions in mouth and or rash on body
- early symptoms: fever, malaise, loss of appetite, cough, abdo pain, sore mouth
- macules and papules on hands and feet following oral lesions
35
what is the management of hand foot and mouth disease?
```
reassure its self limiting
adequate fluids
soft diet for painful oral lesions
pain relief for fever or pain
reduce risk fo trasnmission
```
36
when do you admit a patient with hand foot and mouth disease?
persistent or severe headache or fever
myoclonus wth sleep disturbances
confusion, weakness, lethargy, drowsiness, irritability, geenralised seizures, coma
37
what is the difference between IgE and non-IgE mediated cows milk allergy?
IgE mediated: typically rapid onset (within mins-2 hrs of ingestion)
Non-IgE mediated: typically delayed (2-72 hrs after ingestion)
38
what some of the skin, GI and resp symptoms of cows milk allergy in children?
skin: pruritus, atopic eczema, acute urticaria/angio-oedema
GI: vomiting, GORD, nausea, diarrhoea, constipation, abdo pain, blood in stools, faltering gorwth
resp: cough, chest tightness, wheezing, SOB, nasal itching, rhinorrhea
39
how do you assess a child for suspcted cows milk allergy?
1. allergy focused Hx: symptoms, onset, reactions, form of ingested milk, FHx,
2. examine: signs of clinical reaction, signs of atopy, BMI
3. skin prick testing and/or serum specific IgE testign
40
how do you manage a child with suspected IgE mediated cows milk allergy?
- referral to specialist allergy clinic for allergy testing to confirm diagnosis
- consider arranging referral to paediatric dietician
- advice to parents of sources of info anf support
41
how shoudl you manage a chidl with mild-moderate non IgE mediated allergy?
- may need referral to specialist allergy clinic
- referral to peadiatric dietitician
- strict adherence to cows milk free diet until child 9-12 months
- advise planned hoem reintoruction of cows milk to assess if tolerance has been acquired
42
how can head lice be detected?
wet or dry detection combing
* wet is more accurate (using a conditioner)
* a live lice must be found to confirm active head lice infestation
43
hwo do you manage head lice in children?
1. wet combing - using louse detection comb to remove lice
or
2. physical insecticide (suffocate lice by coating scalp surfacE) -dimeticone gel, lotion, spray
or
3. chemical insecticide - (posion to lice) - malathion 0.5% aq liquid
44
what are teh clinical features of a fungal skin infection on the scalp?
- scaling and itch of scalp
- single or multiple circular patches of hair loss
- erythema,s cattered pustules, crusting
- painful
- lymphadenopathy whcih may be painful
45
what ivnestigation needs to be doen when assessing for a funal scalp infection in hcildren?
skin and hair sampling for fungal microscopy and culture
46
what is the managment of a fungal scalp infection?
- if pt. has a kerion then urgent referral to derm
- self-care: soften crusts, disinfect objects, dont share towels
- oral antifungal: but seek advice from paed dermatologist before starting treatment (in children!!) oral griseofulvin given for 4 wks
- consider co prescribing topical antifungal treatment (selenium sulfide or ketoconazole shampoo or imidazole cream)
47
what is infantile colic?
self limiting condition which is defined clinically as repeated episodes of excessive and inconsolable crying in an infant that otherwise appears healty and thriving
48
what are the typical signs of infantile colic?
- excessive inconsolable crying which starts in first weeks of life and resolves around 3-4 months
- crying which most often occurs in late afternoon or evening
- drawing knees up to abdo or arching its back when crying
49
what is the managemnt of infantile colic?
- reassure parents that infantile colic is common and should resolve by 6 months
- advice on stratgies to soothe crying infants
- encourgae mother rbeastfeeding
- arrange follow up for infan t
- if no imrpovemnt after 4months arrnage specialist advice from peadiatrician
50
what is slapped cheek syndrome?
parvovirus B19 infection common in children - usually mild and self limiting
51
hwo do you diagnose slapped cheek syndrome in chidlren?
- clinical features (lab investigations not required)
52
what are the clinical features of slapped cheek syndrome?
- erythematous facial rash appearing on one or both cheeks
- 2-5 days prodromal symptoms: fever, nasal discharge, headahce, myalgia, mild nausea, diarrhoea
- faical rash fades after 1-2 wks
- eyrthematous maculopapular rash on trunk, back, limbs may develop few days after facial rash
53
what is the managemnt fo slapped cheek syndrome?
- adequate fluids and analgesia
- children no longer infectious once the rash develops
- self limiting
- if at risk fo complications then: confirm diagnosis of parvovirus B19 infection and check FBC
54
what is the managemnt of a feverish child?
- assess underlyign cause
- paracetamol or ibuprofen (do not give both simultaneously - start on paracetomol and if inffective use ibuprofen)
- ensure adequate fluids and check on child throughout night
- safety netting: if fever lasts mroe than 5 days, is child more unweel, child dehydrated or has a serizure or non blanching rash appears
55
what is whooping cough?
also known as pertussis is a highly infectious disease spread by droplets cuased by bacteria Bordetella pertussis
56
what are the clinical features of whooping cough?
3 phases: catarrhal, paroxysmal and convalescent
catarrhal: 1-2 wks: nasal discharge, conjuctivitis, malaise, sore throat, low grade fever, dry unproducive cough
paroxysmal: 1-6 weeks: short expiratory burst and inspiratory gasp (whoop), more comon at night, can be productive, can cuase cyanosis
convalescent: up to 3 months: gradual improvement
57
how do you make a clinical diagnosis of whooping cough?
acute cough that has lasted 14 days or more with oe more more of:
- paroxysmal cough
- inspiratory whoop
- post tussive vomiting
- undiagnoses apnoeic attack in infants
*if not fully immunized against pertussis then suspicions raised
58
how do you manage whooping cough?
- ABX if onset cough within 21 days
- clarithromycin <1 month
- azithromycin if >1 month
- erythromycin pregnant women
- self care: fluids, paracetomol/ibuprofen,
- isolate for 48 afters after ABX started or 21 days after symptoms onset
59
when woudl you admit a patient with whooping cough?
- if <6 months and acutely unwell
- significant difficulty breathing
- has signifcant complication e.g. seizures, pneumonia
60
what are the clinical features of gastroenteritis?
- sudden onset diarrhoea
- blood or mucus in stool s
- nausea or suddent onset vomiting
- fever or general malaise
- abdo pain or cramps
- headache, myalgia, bloating, flatulence, weigt loss, malabsoprtion
61
how do you assess a patient for gastroenteritis?
- clinical features
- abdo exam fro distension, tenderness, bowel sounds
- assess for malnutrition
- assess for dehyration
- arrange stool culture and sensitivity if indicated (immunocomprimised, acute painful diarrhoea or blood/mucus in stool, recent ABX or PPI, >14 days diarrhoea, recent travel, contact with affect person or an otubreak)
62
what is the managment fro gastroenteritis in a child?
- adequate fluids
- oral rehydration solutions
- encourage milk feeds/reastfeeding as normal
- arrange treatment of confirmed microbial pathogens , if appropraite following stool culture
- prevent transmission
- do not give ABX
63
when shoudl you admit a child with gastroenteritis?
- systemically unwell
- severe dehyration or progession to shock
- bilious vomiting
- acute onset painful bloody diarrhoea
64
how do you manage a child/young person where maltreatment is suspected or considered?
- can seek advice from NSPCC
- if FGM, you must report to police
- refer to children's social care
- ideally discuss with rents too unles child request you not to
- manage injuries as appropriate
- if sexual abuse then refer urgently for collection of forensic evidence + assess need for STI prophylaxis or contraception
- obtain consent to share any information unless required by law or if benefits child to share information
- arrange follow up as required
65
what are the common cuases for cough in children?
- viral induced wheeze
- infection exacerbation of asthma
- bronchiolitis
- pneumonia
- COVID-19
66
when shodul ifnective exacerbation of asthma be considered in chidlren with a cough?
previous asthma diagnosis, Hx of wheeze occuring in absence of infection and in repsonse to partiuclar stimuli
67
when should a viral induced wheeze be considered in children with a cough?
ages 6 months - 5y/o
| with wheezing associated with infection only
68
when shoudl bronchiolitis be suspected in a chidl with a cough
```
affected children <2 y/o
experience coryzal prodrome lasting 1-3 days followed by:
- cough
- tachypnoea
- wheeze/ fine crackles
- fever
- poor feeding
```
69
when shoudl pneumonia be considered in child with a cough?
- high fever (over 39)
- cyanosis
- rasied resp rate
- focal coarse crackles
- o2 <85%
- absent breath soudns and dull percussion note
70
how do you manage a child with viral induced wheeze or ifnection exacerbation of asthma?
- note severity of attack (moderate/acute severe/life threatening)
- salbutamol given immedietely
- if child has asthma then prescribe oral prednisolone
- if bacterial ifnection: amoxicillin
- paracetamol/ibuprofen as antipyretic
- follow up in 48 hrs
71
when woudl you admit a pateitn with viral induced wheeze/ifnective exacerbationof ashtma?
- admit life threatenign and - - admit severe if no do imrpove with bronchdilators - admit moderate if worsen after bronchodialtor treatment
72
How should you manage a child with bronciolitis?
self limiting illness
provide self care: fluids, antipyretics, tepid sponging
safety net and follow up
73
when do you admit a child with bronchiolitis?
- apnoea
- looks v unwell
- severe resp distress
- central cyanosis
- clinical dehydration
- low o2 sats
74
how do you assess the sevristy of bronchiolitis in a patient?
- look for signs of cynaosis, exhaustion, involvment of accessory msucles
- examine childs chest and record obs
- assess cap refill, skin turgor and urine output
75
how should i manage community acquired penumonia in children
- o2 sats <92 (also give o2 straigth away !!)
- cyanosis, v unwell, temp 38 or higher in <3 months
- does not wake
- RR > 60
76
when do you admit a child with pneumonia?
- ABX: amoxicillin 5 days
| - sefl care advice: fluids, analgesia, rest
77
what immunisations do chidlren at 12 weeks old need?
- 1dose DTaP/IPV/Hib/HepB (6in1 vaccine)
- 1 dose PCV
- 1 dose rotavirus
78
what immunisations do children at 16 weeks old need?
- 1dose DTaP/IPV/Hib/HepB (6in1 vaccine)
| - one dose of MenB
79
what immunisations do children at 16 weeks old need?
- 1dose DTaP/IPV/Hib/HepB (6in1 vaccine)
| - one dose of MenB
80
what immunisations do children at 1 year old need?
- Hib and MenC
- PCV booster
- MenB booster
- primary MMR
81
what immunisations do children at 2-11 years old need yearly ?
influenza vaccine
82
what immunisations do children at 3 year old +4 months old need?
- DTap/IPV booster
| - MMR booster
83
what immunisations do children at 12-13 years old need?
HPV vaccination
84
what immunisations do children at 14 years old need?
diptheria, tetanus, poliomyelitis booster
| MenACWY vaccine
85
what are the clinical features of bacterial meningitis and meningococcal disease?
- non blanching rash
- stiff neck
- fever
- lethargy
- headahce
- muscle ache
- leg pain
- bulging fontanelle
- photophobia
- vomiting
- seizures
86
what is the characteristic of a meningococcal rash?
- petechial rash (red or purple macules smaller than 2mm in diameter)
- non blanching
- purpuric rash
87
what vital signs need to be assessed when a patient has potential meningitis?
- conscious level (GCS, AVPU)
- heart rate and blood pressure
- resp rate, o2 sats
- temp
- cap refill time
88
how do you manage suspected bacterial meningitis with a non blanching rash or meningococal septicaemia?
- ambulance to hospital
- single dose IV or IM benzylpenicillin
children <1 - 300mg
children 1-9 yrs - 600mg
everyone >10yr - 1200mg
*if suspected meningitis with no nonblanching rash = ambulance to hsoptial but do not administer benzylpenicillin
Y3 GP
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