Paediatrics Flashcards
Where should temp be taken in children?
less than 4 weeks of age, use or recommend an electronic thermometer in the axilla.
In children aged 4 weeks to 5 years of age, use or recommend either an electronic thermometer or a chemical dot thermometer in the axilla, or an infra-red tympanic thermometer.
What thermometers are not appropriate
Head
Oral
Rectal
What are the 8 red symptoms in a child with fever?
Pale/mottled No response/difficult to rouse Weak/high pitched cry Resp - grunting/chest indrawing/RR>60 DeHydration Fever >5 days meningism Seizures
How does the traffic light system work for feverish children?
Green - self care
Amber - face to face review
Red - CED
Safety net for children with fever
The child develops a non-blanching rash or other signs of central nervous system infection. .
The child has a seizure..
The child is becoming dehydrated and self-management measures are not helping.
The fever lasts longer than 5 days (may indicate Kawasaki disease or other serious illness if there are associated symptoms and signs).
The child is becoming more unwell.
They are distressed or concerned that they are unable to look after the infant or child at home.
How should antipyretics be used in kids with fever?
If they are upset/uncomfortable
Stop when they are comfortable
Don’t use if they have a fever but are alright
Can you use antipyretics prophylactically to reduce febrile seizures?
No
How should you use paracetamol of ibuprofen to treat kids with fever?
Paracetamol OR Ibuprofen
Do NOT give simultaneously
Aside from medication what 5 self care advice to parents with feverish child?
Regular fluids - Signs of dehydration Dress appropriately for environment Avoid tepid sponging Check regularly No school
Mina symptom of threadworm?
Intense perianal itching, typically worse during the night
In female pts may migrate to vulva
3 symptoms that would lead to suspected threadworm infection?
perianal and/or vulval itching and restlessness or insomnia.
Appearance of threadworms in the stools or on the peri-anal skin.
Contacts with similar symptoms or confirmed infection
What might you find on examination in pt with threasworm?
Signs of scratching (excoriation) and localized secondary bacterial infection in the perianal area.
Worms in the perianal area (it is unusual to see these when the person is examined during the day).
Is exclusion from school necessary for threadworm infection?
No
Treatment for threadworm
single dose of an anti-helminthic such as mebendazole
Family will need it
Bedding cloths all washed for 2 weeks
Hygiene measures for threadworm infection
Wash hands thoroughly with soap and warm water after using the toilet, changing nappies and before handling food.
Cut fingernails regularly, avoid biting nails and scratching around the anus.
Shower each morning, including the perianal area, to remove eggs from the skin.
Change bed linen and nightwear daily for several days after treatment.
Do not shake out items as this may distribute eggs around the room.
Washing/drying in a hot cycle will kill pinworm eggs.
Thoroughly dust and vacuum (including vacuuming mattresses) and clean the bathroom by ‘damp-dusting’ surfaces, washing the cloth frequently in hot water.
Time difference between acute and chronic otitis externa?
Acute if it has lasted for 3 weeks or less.
Chronic if it has lasted for longer than 3 months.
Most common cause of acute otitis externa?
Bacterial infection
Non infective causes of acute otits externa?
Seborrhoeic dermatitis
Contact dermatitis
Trauma
Swimming in polluted water
What is the most likely cause of chronic otits externa?
Contact dermatitis
Fungal infection
Bacterial possible but unlikely
Risk factors for malignant otitis externa?
DM
Immunosuppression
Radiotherapy
Tap water irrigation
How long does acute otits media clear up following initiation of treatment?
48–72 hours
What do you suspect with these symptoms?
Itch (typical).
Severe ear pain, disproportionate to the size of the lesion (typical).
Pain made worse when the tragus or pinna is moved, or when an otoscope is inserted (typical).
Tenderness on moving the jaw.
Otitis externa
What do you suspect with these signs?
The ear canal or external ear, or both, are red, swollen, or eczematous with shedding of the scaly skin.
Swelling in the ear canal is typical of an early presentation of localized otitis externa; later the swelling has a white or yellow centre filled with pus; occasionally this progresses and the swelling eventually completely occludes the ear canal.
Discharge (serous or purulent) may be present in the ear canal.
Inflamed eardrum, which may be difficult to visualize if the ear canal is narrowed or filled with debris
Otitis externa
Management for localised otits externa?
Analgesia and heat
Antibiotics rarely indicated
Drain pus if necessary
Management in people with acute otits externa?
Cleaning of debris
Analgesia
Topical antibiotics
Most common cause of otitis media in children?
Viral
Risk factors for otits media in kids?
Premature No breast feeding Passive smoking No vaccine Daycare/siblings
What is the prognosis of otits media if you don’t use antibiotics?
symptoms will improve within 24 hours in 60% of children with acute otitis media (AOM) [Venekamp et al, 2015], and most people will recover within 3 day
Other than earache what are the symptoms of ottis media in young children?
Pulling/tugging at the ear
Crying
Off food
Restless
You see the following on examination with the otoscope what is the likely diagnosis?
A distinctly red, yellow, or cloudy tympanic membrane.
Moderate to severe bulging of the tympanic membrane, with loss of normal landmarks and an air-fluid level behind the tympanic membrane (indicates a middle ear effusion).
Perforation of the tympanic membrane and/or discharge in the external auditory canal.
Otitis media
On examination with otoscope what clinical feature is NOT suggestive of AOM?
Non bulging tympanic membrane
