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Year 3 GP > GP paediatrics > Flashcards

GP paediatrics Flashcards

1
Q

Red flags for jaundice in newborns

A

If not eating well
Hard to wake
More yellow than expected
Not urinating frequently

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2
Q

Mongolian spots

A

Common birthmarks that look like bruises

  • painless
  • eventually fade
  • common on bottom, legs and back
  • caused by a difference in skin colour and can range in size
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3
Q

Erythema toxicum

A

common in newborns 2 - 3 days after birth

  • red and raised initially
  • on face, legs and arms
  • normal
  • not hot to touch
  • fades in a few days
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4
Q

Milia

A

Tiny white bumps on noe

  • fade by itself
  • on forehead, cheeks, nose and chin
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5
Q

Newborn dry skin

A

Normal, as was covered by placenta in vitro

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6
Q

Cradle cap

A

Like dandruff - scales on baby’s scalp
Resolves by itself
Appears in first several weeks
If severe can be treated

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7
Q

Baby acne

A

2 - 3 weeks of age due to hormones

  • harmless and wont cause scarring
  • keep area clean with warm water
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8
Q

Heat rash - prickly heat

A

If baby overheating
On neck, armpits and diaper area
May itch
Control temperature

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9
Q

Eczema

A

Environmental allergens and triggers

  • itchy rash
  • dry skin
  • mostly on scalp, elbows, knees, diaper area and trunk
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10
Q

Treatment of eczema in newborns

A

Apply vaseline to prevent dryness

If severe - weak hydrocortisone

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11
Q

Sore or crackled nipples

A

Commonly caused when baby does not latch on in the correct position

  • seek advice from midwife
  • continue to use both nipples
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12
Q

Not enough breast milk mx

A
  • Offer baby both breasts at each feed and alternating starting breast helps stimulate milk production
  • exclusive breastfeeding recommended for 6 months
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13
Q

Signs baby is getting enough milk

A
  • Wet and dirty nappies are good indication baby is feeding well
  • Baby lets go by itself
  • can hear swallowing
  • mouth is moist
  • baby gains weight
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14
Q

Breast engorgement

A

Breast gets too full of milk can be due to:

  • producing more milk than baby requires
  • milk duct blockage - feel small lump
  • Mastitis
  • breast abscess
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15
Q

Presentation of breast engorgement

A

Breast feels hard, tight and painful
Can occur when first starting to breastfeed
May occur when baby is older and eating solids

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16
Q

Breast engorgement mx

A

Express a little breast milk by hand
Use a well fitted breast feeding bra
Warm flannels on breast just before
Paracetamol (don’t use NSAIDs)

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17
Q

Milk duct blockage mx

A

Feed from the affected breast
Gently massage lump towards the nipple while baby is feeding
Warm flannel

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18
Q

Mastitis symptoms and tx

A

Symptoms:

  • fever and flu symptoms
  • hot and tender
  • red and painful patch
  • achy, tired and tearful
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19
Q

Breast abscess

A

Can be caused by untreated mastitis

Tx - drainage

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20
Q

Thrush presentation

A

Pain in both breasts
After period of pain-free breast feeding
Pain last up to 1 hour after a feed
Creamy white plaques on tongue, gums and roof of mouth of baby
Baby may have persistent nappy rash

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21
Q

Head lice presentation, risk factors and management

A

Presentation:
- itchy scalp - feels like something is moving

RF:
- Schools

Investigations:

  • Use lice comb - find live lice
  • check everyone in household

Management:

  • Wet comb on days 1, 5, 9 and 13
  • Apply lots of conditioner
  • Medicated lotions and sprays
  • cannot prevent lice, not due to hygiene
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22
Q

Colic presentation and management

A

Presentation: When baby cries a lot due to unknown cause

  • Cries fro more than 3 hours a day, 3 days a week for more than 1 week
  • hard to settle baby
  • clench fists
  • goes red
  • brings knees to tummy or arches back
  • windy and tummy rumbles

Mx :

  • hold or cuddle when crying a lot
  • wind baby after feeds
  • hold upright during feed
  • bathe in warm bath
  • rock baby
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23
Q

Weaning

A

When introducing first solid foods alongside breastfeeding or formula milk after 6 months

  • start with fruit and veg
  • small amounts
  • mashed, lumpy food
  • progress to carbs and meats
  • avoid ready-made food with added salt and sugar (bad for kidneys)
  • wean when can sit up in high chair and hold head steady
  • when can put spoon in mouth
24
Q

Gait abnormalities

A

Antalgic gait - caused by pain, can be due to juvenile idiopathic arthritis (JIA)

Circumduction gait - excessive hip abduction as leg swings forwards.
- can be due to leg length discrepancy with stiff joint i.e. JIA or unilateral spasticity

Spastic gait: stiff foot-dragging with inversion, in UMN, disease

Ataxic gait - instability with an alternating narrow to wide base, cerebral palsy

25
Q

History of newborn

A

Establish parent’s concerns (ICE)
Detailed pregnancy, birth and development hx
FHx
Vaccinations

26
Q

When does walking delay require investigation

A

Beyond 18 months

27
Q

Measles

A

Partially confluent dark red rash
Starts behind ears and spreads to rest of body
Koplik’s spots - white patches in mouth
Conjunctivitis

28
Q

Scarlet fever

A 
Fine, light red, confluent rash 
On face, armpits and groin 
Begins on neck 
Non-blanching petechiae
Strawberry tongue - bright red tongue with papillae
29
Q

Rubella

A

Non confluent
pink
Begins behind ears and extends to rest of body

30
Q

Erythema infectiosum

A

Asymptomatic
may not develop rash
red patches may develop on body and limbs
Slapped cheek syndrome

31
Q

Roseola infanctum

A

Patchy
Rose pink
More pronounced on torso
3 days fever followed by sudden decrease in temperature

32
Q

Chickenpox rash - varicella zoster

A

Widespread rash
Small lumps develop into pustules and form scabs
Different stage of blister formation
Highly contagious

33
Q

Chickenpox presentation and mx

A

Symptoms:

  • nausea
  • myalgia
  • malaise
  • loss of appetite

Conservative:

  • Fluid intake, keep nails short
  • avoid pregnant women and newborns
  • Paracetamol
  • Chlorphenamine - treats itch

If immunocompromised:
- aciclovir

34
Q

Croup presentation

A

Presentation:

  • sudden onset, seal - like barking cough
  • accomponied by stridor and intercostal indrawing
  • URTI symtpoms e.g. fever and cough present for 12 - 48 hrs
  • hoarse voice

Moderate/ severe:

  • lethargy and fatigue
  • pallor/ cyanosis
  • decreased level of consciousness
35
Q

Croup severity

A

Mild – seal-like barking cough

Moderate – seal-like barking cough with stridor and sternal recession at rest

Severe – seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.

Impending respiratory failure – increasing upper airway obstruction

  • sternal/intercostal recession
  • asynchronous chest wall and abdominal movement
  • fatigue
  • pallor or cyanosis
  • decreased level of consciousness or tachycardia.
  • RR over 70 breaths/minute
36
Q

When to admit croup pt to hospital

A

Moderate/ severe illness, or impending respiratory failure.

37
Q

Croup mx

A

If mild:
Pharmacological:
- 1 dose of oral dexamethasone (0.15 mg/kg) taken immediately
- Should resolve in 48 hours

If severe +:

  • Give controlled supplementary oxygen whilst waiting for hospital admission
  • a dose of oral dexamethasone (0.15 mg/kg).
  • OR inhaled budesonide (2 mg nebulised as a single dose)
  • OR intramuscular dexamethasone
38
Q

Croup

A

laryngotracheobronchitis synptomatic due to upper airway obstruction

39
Q

Bronchiolitis

A
  • commonly affects infants less than 12 months up to 2 years
  • caused by respiratory syncytial virus, of the epithelial lining of the lower bronchial tree
  • Infected epithelial cells slough off into the small airways and the alveolar spaces.
  • mucus and sloughing causes obstruction of the small airways
  • Impaired gas exchange leading to hypoxia and breathlessness
40
Q

Viral induced wheeze

A

Considered in children between the ages of six months and five years with wheezing associated with infection only

Ix:

  • PEFR
  • Obs

Mx:

  • assess severity
  • if not severe - self limiting
  • can give a SABA via a large-volume spacer to relieve acute symptoms. Give a puff every 30–60 seconds, up to 10 puffs
41
Q

Symptoms of bronchiolitis

A

Coryzal prodrome - due to inflammation of mucous membranes

Fever
Cough
Dehydration

Followed by:

  • tachypnoea
  • wheeze
42
Q

Bronchiolitis mx

A

Self limiting - symptoms peak between 3 - 5 days

  • paracetamol
  • fluids
43
Q

6 week baby check

A
  1. History
  2. Inspect
  3. Head
    - shape, fontanelles and suture lines
    - eyes - ophthalmoscope
    - mouth - cleft
    - ears
  4. Chest
    - clavicles
    - auscultate
    - HR and RR
    - oxygen saturation
  5. abdomen
    - femoral pulses
    - resp movements
    - shape
  6. External genitalia
  7. Limbs , hips and back
    - all digits
    - grasp reflex
    - hips dysplasia
    - spine
  8. Reflexes
    - moro’s reflex - sudden loud noise
    - stepping reflex
44
Q

APGARS

A

Screening tool for general health at birth

45
Q

Hayfever

A

Common allergy to pollen
Seasonal rhinitis - spring/summer

Sx:

  • sneezing
  • rhinorrhoea
  • itchy eyes
  • itchy nose

Tx:

  • Avoid allergens
  • Antihistamine - non sedative (cetirizine)
46
Q

Threadworm summary

A
  • Common parasitic worm which infests the gut
  • White and thread like, can be found in stool
  • Transmission via faeco - oral route

Sx:

  • Perianal itching
  • worse during night

Tx:

  • anti-helminthic - mebendazole
  • dose may need to be repeated in 2 weeks if infection persists
  • Children under 6 months and pregnant/breastfeeding women - treated with hygiene methods alone
47
Q

GORD summary

A
  • Passage of gastric contents into the oesophagus
  • Reflux is common in under 1 yo
  • Physiological in infants if asymptomatic
  • Does not usually need investigation or treatment
  • Mx - advising and reassuring patients
48
Q

When to suspect GORD

A

Distressed behaviour

  • excessive crying
  • crying while feeding
  • adopting unusual neck postures.
  • Hoarseness and/or chronic cough.
  • A single episode of pneumonia.
  • Unexplained feeding difficulties i.e. refusing to feed, gagging, or choking.
  • Faltering growth
49
Q

Pharmacological management of GORD

A

Gaviscon® Infant

if not better after 1 - 2 weeks - 4-week trial of liquid proton pump inhibitor

50
Q

Functional constipation summary

A

Fewer than 3 complete stools per week in children
Type 3/4 stools - semi soft

sx:
- straining
- pain
- blood due to hard stool

Mx:
Conservative: 
- increase fibre - fruit and veg 
- increase fluid intake 
- increase activity 
- bowel diary

Pharmacological:
- laxatives

51
Q

Red flags for constipation

A

Constipation appearing from birth or during the first few weeks of life — may indicate Hirschsprung’s disease
Delay in passing meconium for more than 48 hours after birth, in a full-term baby
Abdominal distention with vomiting — may indicate intestinal obstruction
Family history of Hirschsprung’s disease.
Ribbon stool pattern — may indicate anal stenosis (more likely to present in a child younger than 1 year of age).
Leg weakness or motor delay — may indicate a neurological or spinal cord abnormality.

52
Q

Faecal impaction

A

A history of severe symptoms of constipation.
The presence of overflow soiling.
Faecal mass palpable on abdominal examination

Tx - initially increases soiling

  • macragol - movicol
  • 2nd line - senna
53
Q

Hirschsprung’s disease

A

Pathophysiology : absence of parasympathetic ganglion cells in the myenteric and submucosal plexus of the rectum

Presentation:

  • Abdominal distention
  • failure of passage of meconium within the first 48 hours of life
  • repeated vomiting

Older infants:
- chronic constipation that is resistant to the usual treatments (daily enema may be required)
- Rare - soiling and overflow incontinence.
- Early satiety, abdominal discomfort and distension
- Poor nutrition and poor weight gain.
Ix:
- Bloods WCC - may be raised if enterocolitis
- AXR
- Rectal biopsy - gold standard

Mx: surgery

54
Q

Osgood Schlatter summary

A

Pathophysiology: apophysitis of the tibial tuberosity that causes anterior knee pain during adolescence and is usually self-limiting

Causes: repetitive strain on patella tendon ( common in active children undergoing growth spurt.g. football)

Presentation:

  • unilateral but can be bilateral
  • gradual onset
  • worse with activity
  • tender over tibial tuberosity

Mx:

  • Analgesia
  • exercise modification
55
Q

Eczema (atopic dermatitis)

A

chronic, itchy, inflammatory skin condition that is episodic

  • normally flexor distribution (in infants, can be extensor)
  • atopy
56
Q

Eczema Tx

A 
Mx: 
- corticosteroid 
- emollient 
- antihistamine for pruritis 
Mild
 - mild topical corticosteroid i.e. hydrocortisone 1% continue 2 days after controlled

Moderate:
- betamethasone valerate 0.025% or clobetasone butyrate 0.05%

Severe:
- betamethasone valerate 0.1%

Infective exacerbation: flucloxacillin

57
Q

Perthe’s disease

A

Pathophysiology: idiopathic ischaemia and subsequent necrosis of the femoral head

Presentation:

  • no history of trauma
  • limited hip rotation and limp
  • typically unilateral
  • systemically well

Ix:

  • FBC and ESR.
  • Early X-rays may show widening of the joint space or may be normal. Seen later
  • Technetium bone scan or MRI scanning can be used to identify pathology

Mx:

  • Restriction of activities and weight-bearing until ossification is complete
  • Physiotherapy
  • NSAIDs can be prescribed for pain relief.
  • Operation if 6 + yo

Year 3 GP (20 decks)

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