Paed - L2 Community

Question 1

Sepsis/meningitis: Red flags – 13

Answer 1

1. A progressively ill child
2. Signs of dehydration (look for dry nappies)
3. Blue, pale or blotchy skin, lips or tongue, cold skin
4. Rash that does not fade when you roll a glass over it
5. Difficulty breathing, breathlessness or fast breathing
6. A weak, high-pitched cry (or one that’s different to normal)
7. Not responding like they normally do, or not interested in feeding or normal activities
8. Being sleepier than normal or difficult to wake
9. Confusion, slurred speech or not making sense, change of mental state
10. Fit or convulsion
11. High temperature or low temperature
12. High heart rate
13. Low BP

Question 2

Chicken pox – 4

Answer 2

1. Caused by the varicella zoster virus, a herpes virus
2. Has a relatively long incubation period – 10-20 days
3. Fever, snot, disturbed sleep, headache & sore throat seen first followed a few days later by rash
4. Burst of fluid fills vesicles spreads the virus

Question 3

Chicken pox: Referral symptoms - 7

Answer 3

1. Signs of severe complications (pneumonia, encephalitis)
2. Adults & adolescents at a higher risk of complications, e.g. smokers
3. Any signs of chicken pox in pregnancy or newborn (< 4weeks old)
4. Breastfeeding women
5. Immunocompromised
6. Dehydration
7. Pregnancy (if mother not immune)

Question 4

Chickenpox: Treatment – 6

Answer 4

1. For majority of children, chicken pox is uncomplicated, & treatment is purely symptomatic
2. Antipyretics - avoid ibuprofen
3. Antihistamines
4. Calamine
5. Antivirals might be needed for higher risk patients, & close monitoring for other such as pregnant – referral
6. Lifestyle advice

Question 5

Shingles (Herpes Zoster) – 6

Answer 5

1. May occur following a case of Chicken Pox
2. Caused by varicella zoster virus lying dormant in sensory root nerve ganglia
3. Referral needed for antivirals? Depends on patient/duration of symptoms/age of patient/your competency
4. Painful rash appears on torso, head & eyes
5. Treated early to minimize nerve pain
6. Can’t catch Shingles, but can spread Chicken Pox

Question 6

Measles – 7

Answer 6

1. Infants and children regularly immunised against
2. Incubation period of ~ 10 days
3. Highly infectious
4. Infectious from 4 days before the onset of rash until at least 4 days after it appears
5. Babies under 1 are not vaccinated for measles – check maternal vaccination status
6. Refer, but give symptomatic relief
7. Rash develops after 3-5 days

Question 7

Measles symptoms - 7

Answer 7

1. Prodromal symptoms typically occur about 14 days following infection
2. Fever 39oc
3. Cough & cold
4. Sore throat – swollen lymph nodes
5. Reddish eyes
6. Sensitivity to light
7. Koplik’s spots (red, pin head sized spots in mouth)

Question 8

Measles complications - 6

Answer 8

1. Otitis media
2. Pneumonia
3. Febrile convulsions
4. Encephalitis
5. Blindness
6. More severe in adults, pregnant women, immunocompromised, chronically ill children and infants

Question 8

Mumps - 4

Answer 8

1. Incubation period – 16-18 days typically (12-25 days is normal range)
2. Contagious from about 1-2 days prior to symptoms, for 9 days afterwards
3. Spread by saliva - close contact
4. Virus thrives in parotid salivary glands which lie in cheeks just in front of ears – parotid gland swelling is a characteristic symptom

Question 9

Mumps: Symptoms - 8

Answer 9

1. Begins with 2 days of discomfort
2. Increasing temperature (up to 40oc)
3. Headache, earache, sore throat & pain on opening mouth
4. Jaw stiffness
5. Swollen parotid glands
6. Earlobes may stick out
7. Face looks swollen
8. Refer, but give symptomatic relief

Question 10

Mumps: Complications – 7

Answer 10

1. Orchitis (inflammation in testes, can affect fertility)
2. Oophoritis (inflammation in ovaries)
3. Pancreatitis
4. Meningitis
5. Transient hearing loss
6. Myocardial – ECG changes
7. Pancreatitis

Question 11

Food allergies in children - 7

Answer 11

1. Most common foods that cause an allergy: milk, eggs, peanuts, fish, shellfish, wheat & tree nuts
2. Signs to spot – itching in mouth, throat or ears, skin rash, angioedema, vomiting, anaphylaxis
3. May already have signs of eczema as an infant
4. Immediate 999 referral if there are symptoms of anaphylaxis with or without angioedema
5. Referral needed to discuss potential allergy
   6.Advise keeping a food diary since identifying the causative food is needed & avoiding it
6. Different to intolerance that might lead to GI symptoms alone

Question 12

Whooping cough - 5

Answer 12

1. Whooping cough AKA pertussis, spread via highly contagious Bordetella bacterium
2. Spread via droplets, 7-10 day normal incubation period
3. Characteristic cough follows a catarrhal phase, which then might result in a long-lasting cough (3 months).
4. Prevalence should be low, unless vaccinations are missed
5. Refer if any suspicion of infection, since antibiotics will probably be needed & ND (contacts might be treated also)

Question 13

Croup (laryngotracheobronchitis) - 4

Answer 13

1. Characteristic seal like barking cough, often following an upper respiratory tract viral infection. Presence of stridor (noisy breathing)
2. Most common between 5 months & 3 years of life
3. Generally self limiting, but refer for GP diagnosis & consideration whether treatment is needed
4. Consider analgesics, regular fluids, close observation of child especially at night (especially prior to GP appointment)

Question 14

Impetigo - 6

Answer 14

1. Caused by bacterial infection S. aureus (+/- fluid filled lesion)
2. Most common in young children
3. Often is self limiting, & will heal without scaring, but antibiotics often given
4. Stay away from school/nursery/work till healed, or for 48hrs after antibiotics started
5. Full assessment & antibiotics (topical or systemic)/covered by pharmacy first
6. Hygiene

Question 15

Slapped cheek syndrome (AKA 5th disease) - 8

Answer 15

1. Spread via droplets
2. More common in children but can be more serious in adults
3. Systemic infection presents 1st – high temperature, sore throat & headache
4. Bright red rash develops on cheeks after 1-3 days, doesn’t always present on cheeks of adults
5. Body rash may develop later
6. Adults may get joint pain & stiffness
7. Only refer if pregnant, immunocompromised or blood disorders
8. Self help advice – rest, fluids, analgesics, antihistamines for itch

Question 16

Hand, foot & mouth - 6

Answer 16

1. Acute viral infection (CoxsackieA16 virus), often mild & self limiting
2. Spread via droplets, fluid filled vesicles & faeco-oral transmission (faecal transmission can last for 4-8 weeks)
3. Most common in young patient groups
4. Few serious complications (dehydration most common)
5. Sore throat, fever and rash as described
6. Blisters, cold-like symptoms, fever, sore throat then rash

Question 17

Scarlet fever – 5

Answer 17

1. Bacterial infection caused by Streptococcus pyogenes – ‘Strep A’
2. Sore throat, fever, headache, N&V & red sandpaper like rash (on abdomen and chest, spreading to neck, limbs & extremities) & strawberry tongue
3. Spread via saliva or mucus, short incubation period (2-3 days)
4. Care to avoid spread (very contagious) & immunocompromised patients
5. Refer for antibiotic treatment & ND

Question 18

Glandular fever - 7

Answer 18

1. Caused by Epstein Barr virus
2. Long incubation period, spread via salvia usually via asymptomatic carriers
3. In most people, infections lasts 2-3 weeks
4. Severe sore throat, fatigue, fever, sweats, headache, anorexia, swollen lymph nodes which can be sore
5. Consider referral if symptoms severe in adults and children
6. Analgesics, rest within reason but not imposed bed rest, avoid spreading
7. Avoid contact sports or heavy lifting for the four weeks after illness (increased risk of splenic rupture)

Question 19

Reasons to not breastfeed – 5

Answer 19

1. Other people can feed baby
2. Did not like idea of breastfeeding/difficulty breastfeeding
3. Mother’s own experience
4. Embarrassed to breastfeed
5. Medical condition (e.g. HIV)

Question 20

Breast feeding – 6

Answer 20

1. Contains energy, all essential nutrients & protection against infection & allergies
2. More convenient
3. Cheaper, sterile, easier to digest
4. Closer bonding, natural
5. Releases oxytocin – helps uterus contract
6. Thought to decrease risk of pre-menopausal breast cancer

Question 21

Infant milks - 8

Answer 21

1. All feeds should have the same nutritional components
2. First milks are safe & suitable from birth to 1 year
3. Follow on milks, toddler milks & hungry baby milks are not necessarily needed – advise parents to speak the to their health visitor
4. More nutritionally complete compared with cow’s milk, e.g. iron content
5. Many claim that casein dominant milks satisfy baby more, however, some local authorities suggest whey milks to weaning since there is no good evidence to suggest this.
6. Whey brands – sma gold, first milk, premium
7. Suitable for newborns and when changing from breast to bottle milk in the first year
8. Casein milks – second milk, sma white

Question 22

Specialist milk - 5

Answer 22

1. Soya based - for babies with cow’s milk intolerance (free from cow’s milk protein & lactose)
2. Staydown - for babies experiencing significant reflux from birth
3. Lactose free - for infants with proven lactose intolerance
4. High Energy - for infants with medically identified increased energy & nutrient requirements(e.g faltering growth)
5. Preterm range – for preterm/low birthweight babies

Question 23

Practical baby feeding advice - 3

Answer 23

1. Demand feeding is recommended, although there are guidelines on all products.
2. Overfeeding is more of an issue than underfeeding. Easier to overfeed with bottle-feeding
3. For infants with diarrhoea, especially if dehydration is suspected, infant formula should be stopped & rehydration therapy should be given as an alternative. Not always required if child is not dehydrated. If feeds are stopped, formula should be reintroduced when fully rehydrated and appetite returns.