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AKT Prep > Child Health/ Paeds/ Allergy > Flashcards

Child Health/ Paeds/ Allergy Flashcards

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1
Q

What is NICE guideance RE using paracetamol and ibuprofen together in children?

A

Paracetamol and ibuprofen should not be used simultaneously and only to consider alternating these agents if the distress persists or recurs before the next dose is due

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2
Q

Name 5 reasons which would indicate emergency admission for a patient with anorexia

A

BMI is under 15 (or rapid weight loss)
Hypothermia (under 35.5°C)
Suicidal ideation or severe self-harm
Severe electrolyte disturbance (potassium <3mmol)
Cardiac arrhythmia
Significant oedema
Orthostatic hypotension (more than 10mmHg systolic)
Bradycardia (<50 beats/min)
Severe intercurrent infection

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3
Q

What are the clinical features of Positional plagiocephaly?

A

Flattening of back/ side of head, normal head shape at birth and flattening first noticed around 2-3 months.

“Parallelogram shaped head”

Usually self corrects by age 3-5

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4
Q

At what age do each of the fontanelles close?

A

Anterior - 18-24 months (abnormal if happens before 12 months)

Posterior - Around 2-3 months

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5
Q

How should positional plagiocephaly be managed?

A

Self resolves age 3-5yrs

Encourage periods of supervised tummy time and supported sitting, and vary head position when sleeping and in cot using toys, moving the cot
(Still sleep on back to reduce SIDS risk)

No evidence for helmets and may be harmful

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6
Q

When should a child with a mishaped head be referred (consider craniosynostosis instead of positional plagiocephaly)

A

Refer babies with micro- or macrocephaly, signs of raised intracranial pressure or premature fusion of the fontanelles or sutures (felt as ridges), or if there are associated development concerns, etc.

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7
Q

How should temprature be measuered in < 4 weeks? What shouldn’t be used <5yrs?

A

Axillary probe only
Shouldn’t use forehead thermometer (not accurate)

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8
Q

You are doing a telephone consultation with a 4 year old with red flag nice traffic light features - what does the NICE guidance say should happen?

A

Need to be seen F2F within 2 hours

But if very unwell may need to advise admission

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9
Q

What are the 5 pieces of NICE safetynetting advice for febrile children?

A

Seek help if:
- Seizure
- Non blanching rash
- Child gets worse not better
- Has fevers longer than 5 days
- You don’t feel able to care for them at home

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10
Q

Who should NICE fever traffic guidance not be used for?

A

Don’t use if high risk (CF, immunosuppresed, sickle cell etc)

If learning disability etc traffic light is less accurate

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11
Q

You see a child with bronchiolitis - what are the indications for immediate 999 ambulance?

A

Apnea within this illness
Signs severe resp distress (grunting, severe recessions)
Signs exhaution
Central cyanosis
RR > 70

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12
Q

What are the indications for immediate same day referral in bronchiolotis (but not 999 ambulance)

A

RR > 60 (if >70 ambulancce)
Feeding difficulty (<75% normal)
Clinical dehydration
Sats <92%

Lower threshold for those with RF’s (prematurity, < 3months, other diseases, concern about parents etc)

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13
Q

When do you give oxygen in primary care for bronchiolitis?

A

Sats < 90% if > 6 weeks
Sats < 92% if under 6 weeks

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14
Q

You can’t get hold of dexamethasone for croup - what alternative steroid could you use?

A

Prednisolone 1mg/ kg is non-inferior to dex for croup

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15
Q

According to GINA 2022 guidance what 4 factors can help you distinguish between recurrent viral wheeze and asthma?

A

Duration of symptoms (longer - asthma)
Frequency of episodes (more - asthma)
Symptoms between episodes
Hx of atopy

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16
Q

You suspect asthma is likely in a pre-school child - what is the most appropriate first step?

A

3 month trial SABA and ICS
- Then monitor

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17
Q

What is the indication to give ICS when managing recurrent wheeze in pre-school children?

A

All get SABA every 4-6 hours until symptoms resolve (1-7 days)

If you think asthma likely - add ICS AND >3 episodes in a season > start ICS and review

If uncertain asthm and repeated episodes - consider 3 month trial ICS but also refer

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18
Q

In pre-school children being managed for viral wheeze in primary care - what is the role of oral steroids?

A

Do not use in pre-school children with ViW that doesn’t need admission - do not give oral steroid

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19
Q

How should parovirus B19 (slapped cheek) exposure be managed in pregnancy?

A

Urgent blood tests to check if mother has immunity
- May be offered blood transfusions to reduce risk hydrops fetalis

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20
Q

How may measles present?

A

3C’s (Cough, coryza, conjunctivitis)
- Rash > starts face, spreads across body, confluent rash - spares hands and legs

Koplik spots in mouth

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21
Q

How should measules be managed?

A

Test for IgM (notifiable disease)
Isolate for 4 days after rash appears

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22
Q

How might scarlet fever present? Name 3 symptoms and 3 signs?

A

Syx: Sore throat, fever, headache and then followed with rash

Signs: Sandpaper rash, straweberry tongue, cervical lympadenopathy, malar flush

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23
Q

How is scarlet fever managed in usual and pen allergic patients ? (3 aspects)

A

Pen V QDS for 10 days

If pen allergic azithromycin OD for 5 days

Remember scarlet fever is a notifiable disease (notify within 3 days)

Can go back to school 24 hours after starting ABx

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24
Q

What are the two types of impertigo?

A

Bullous (>1cm larger bullae)
Non bullous (most common)

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25
How should uncomplicated impetigo be managed?
Hydrogen peroxide 1% BD for 5-7 days Fucidic acid 2% 5-7 days (Topical in uncomplicated)
26
How should widespread or bullous impetigo be managed?
Fluclox or clarithromycin for 5-7 days
27
What is the most common cause of a limp in age: a) 1-3yrs b) 4-10yrs c) 11-16yrs
a) Toddler fracture, missed DDH b) Transient synovitis (don't miss perthe's) c) SUFE, osgood sclatters, bone tumours
28
What are the indications for same day assessment for a child with limp? (name 5)
Limp > 72 hours Child < 3years Fever Unable to weight bear Age >9yrs with hip pain NAI
29
What features of child with limp would suggest it would be safe to manage in primary care?
Age 3-9yrs Well child No fever Limp <72hrs Most likely transient synovitis (Follow all up in 1 week and refer if not resolved)
30
What is the incidence of CMPA in a) Bottle fed babies and b) Exclusively breast fed babies
a) 7% b) 0.5%
31
What type of reactions can you get with CMPA and how might these present?
IgE mediated - Start within 2 hours (Skin reactions, wheeze, itch, N+V, diarrhoea) Non IgE mediated - Hours to days (Skin itching, worsening eczema, colicky pain (including infantile colic), reflux, blood or mucus in stools, constipation or diarrhoea). May also be pale/ FTT
32
How should CMPA be managed in a bottle fed baby?
Remove cows milk - Switch to EHF milk - Symptoms should resolve within 2 weeks of stopping cows milk If symptoms persistent on EHF milk then switch to amino acid milk (expensive and less well tolerated)
33
How should CMPA be managed in a breast fed baby?
Mum to remove all milk and milk products (contain casein, whey or lactose). Mum needs to be referred to dietican and offered Ca and VitD tablets
34
When a diagnosis of CMPA has been made - when should a child be re-challenged?
Most CMPA - 70% - will resolve within 1 year Work up milk ladder (start at the bottom) and rechallenge every 6 months
35
How do you distinguish between CMPA and lactose intollerance?
LI - Presents during older childhood/ adulthood (Can often tolerate products like yohurt and cheese where lactose broken down) CMPA - Almost always diagnosed in 1st year of life Note - common for babies to get transient lactose intollerance following episodes acute gastroenteritis
36
What is the minimum amount of exercise children should be encouraged to aim for according to NICE?
60 mins per day (one session/ day or several lasting 10mins or more)
37
In which risk groups is the mortality rate from influenza HIGHEST?
Those with chronic liver disease
38
What babies should recieve VitK, how and when?
2 doses in first week of life Breast fed babies may need 3rd dose at 1 month Usually IM but can be given orally in drops
39
Maternal chickenpox infection in 1st two trimesters gives what risk of infection in the fetus?
25%q
40
When should aciclovir be given in pregnancy if a woman has developed chickenpox?
In pregnancy oral aciclovir if they present within 24 hours of the onset of the rash and if they are more than 20 weeks' gestation. IV aciclovir if severely unwell or high risk (immunosupressed) at any gestation No benefit in treatment of well patient who presents late under 20 weeks - but all should be refered to fetal medicine to be seen
41
Neonatal blood spot test at 10 days - how does it assess for cystic fibrosis?
Immunoreactive trypsin (IRT) assay. A positive IRT test is not diagnostic; it only identifies infants at risk Then need confirmation - this includes a positive sweat test and two-stage mutation analysis of the CFTR gene.
42
Expected total duration of illness for children with: a) Croup b) Bronchiolitis c) Common cold/ generic URTI
a) 2 days b) 3 weeks c) 2 weeks
43
Expected total duration of illness for children with: a) Sore throat b) Earache c) Acute cough
a) 2-7days b) 7-8 days c) 3 weeks
44
Name 3 things screened for by neonatal blood spot programme?
Sickle cell disease (SCD) Cystic fibrosis (CF) Congenital hypothyroidism (CHT) Inherited metabolic diseases (IMDs) (list of 6)
45
How does pyloric stenosis classically present (2 features and age)?
4-6 weeks Projectile vomiting but still keen to feed Persistent - may drop centiles More common in boys Possible RUQ mass
46
First 4 management steps of babies with GORD?
Work way down ladder, if medical unsucessful or faltering growth then refer 1) 2 week trial of smaller feeds 2) 2 week trial of thickened formula feeds 3) 2 weeks trial alginates administered in the middle of the feed 4) 4 week trial of PPI
47
How should temprature be checked? a) under 4 weeks b) Age 4wk - 5yrs
a) Electronic thermometer in the axilla b) Electronic or a chemical dot thermometer in the axilla or an infra-red tympanic thermometer
48
What are the application instructions for Hedrin (dimeticone 4% lotion) for nits?
Apply the lotion to dry hair and scalp, allow to dry naturally, remove by washing after eight hours. The application can then be repeated in seven days.
49
Which is the SINGLE MOST accurate method of diagnosing head lice infestation requiring treatment?
Combing of the hair with a head lice detection comb is the most reliable way to confirm the presence of head lice.
50
Hand foot and mouth is caused by what virus?
Coxsackie virus
51
When and how does the neonatal blood spot test happen?
Day 5 via a heel prick by the health visitor or the midwife in the community
52
Name the 5 classic features of Kawasaki disease?
Fever >5 days: - Bilateral conjunctival injection - Change in mucous membranes - Change in the extremities - Polymorphous rash - Cervical lymphadenopathy
53
Name 3 possible treatments for headlice?
Malathion 0.5% lotion Dimeticone 4% lotion Dimeticone 4% Spray Wet combing
54
Name two criteria for delayed puberty in girls?
Absence of breast development by 13 Breast development but ammenorrhoea by 15
55
Night terrors: a) Classic features b) Typical age of presentation
a) Child will seem to be awake and may scream, thrash around and look about. Night terrors often occur at the early part of the night and children will have no memory of the episode the next day. b) Common from age 3-8
56
Aspirin is not recommended for children under what age?
16
57
How may Reye's syndrome present? What may bloods show?
Personality change, drowsiness or altered consciousness, and frequent or persistent effortless vomiting. Liver dysfunction, abnormal clotting, hypoglycemia
58
How should inguinal hernia's be managed in babies?
Urgent surgical opinion (Risk of incaceration)
59
What topical local anaesthetics can be used for bloods in children?
EMLA® (lidocaine 2.5% with prilocaine 2.5%) Ametop® (tetracaine 4%)
60
Name 4 causes of physiological jaundice in babies?
Breast-feeding, cephalhaematoma, prematurity and low birth weight
61
Regarding timeline of jaundice in babies, name 3 time points where jaundice can occur where you would suspect a diagnosis other than physiological jaudnice?
Appears in first 24 hours Jaundice first appears at more than seven days of age Jaundice over 3 weeks (if <37wks) or over 2 weeks if (>37wks)
62
What side effect of desmopressin should patients be advised on?
fluid retention and may cause hyponatraemia - Stop during episodes D+V
63
What age do you consider starting treatment for bedwetting? What % children still wet the bed age 10?
Treat over age 7 5% of children are still bedwetting by the age of 10
64
Most common causative organism in viral encephalitis in children?
Herpes simplex
65
You see a nine-year-old boy with Down syndrome. His mother reports that he has been more lethargic recently. On examination his temperature is 35.8°C and he has hepatosplenomegaly. What is the SINGLE MOST appropriate management for this patient?
Refer immediately (same-day admission) children or young people with unexplained petechiae or hepatosplenomegaly to exclude leukaemia.
66
What is the gold standard test for food allergies?
Oral food challenge
67
Following needlestick what is the ideal timeline for HepB vaccine?
Ideally within 24 hours but latest within 7 days

AKT Prep (22 decks)

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