PH1122 - Paediatrics

Question 1

What is colic ?

Answer 1

colic is usually defined as episodes of excessive and inconsolable crying in an infant who otherwise appears to be healthy

Question 2

what causes colic ?

Answer 2

It has been linked to a disorder of the gastrointestinal (GI) tract, where spasmodic contraction of smooth muscle causes pain and discomfort, which might be caused by allergy to cow’s milk, lactose intolerance, or inadequate amounts of lactobacilli. It has also been suggested that it might stem from emotional, behavioural, and social problems that include underdeveloped parenting skills, inadequate social network, postpartum depression, and parental anxiety and stress.

Question 3

what areas should be asked about before diagnosing colic ?

Answer 3

Infants may cry excessively for reasons other than a medical cause, for example, hunger, thirst, being too hot or cold and trapped wind.

Question 4

what is the method of detecting headlice via dry combing ?

Answer 4

1. Straighten and untangle dry hair using normal comb.
2. Switch to a detection comb. (egg removal comb unsuitable for detection)
3. Starting form back of head, comb the scalp from the scalp down to the end of the hair.
4. After each stroke examine the comb for live lice.
5. Continue to comb all hair in sections until the whole head has been combed.
6. The process can take 5 mins or more in people with shoulder length hair.

Question 5

What is the method of detecting head lice via wet combing ?

Answer 5

1. Wash hair with normal shampoo.
2. Apply hair conditioner.
3. Repeat steps 1-5 as for dry combing.
4. Rinse out the conditioner.
5. Wet combing is more time consuming and should be performed for all family members.

Question 6

what age is chicken pox most common?

Answer 6

children under 10 years

Question 7

what is the approximate incubation time for chicken pox ?

Answer 7

11-21 days

Question 8

What are symptoms of chicken pox ?

Answer 8

A rash(small red lumps that develop into blisters into crusted spots) usually starting on the chest back and face
possible raised temperature and headache
general unwellness

Question 9

Should children still go to school if they have chickenpox ?

Answer 9

exclusion from school is not necessary 6 days after the onset of the rash.

Question 10

what other advise could be helpful in the treatment of chicken pox ?

Answer 10

It should clear within a week but to avoid scratching it might be helpful to cut their finger nails shortening them.

Question 11

What is potential treatment that could be used for colic?

Answer 11

Treatments include simeticone, lactase enzymes, low-lactose milk formulas, and Gripe mixtures. None have a credible evidence base.
simeticone = dentinox, infacol
lactase enzyme = colief
gripe mixture= gripe water

Question 12

what is the body’s normal temperature classed as ?

Answer 12

Normal oral temperature is 37°C (98.6°F), plus or minus 1°C, although rectal temperature is about 0.5°C higher and underarm temperature is 0.5°C lower than oral temperature

Question 13

what is the temperature of a fever classed as ?

Answer 13

Fever is often classified as being mild (low-grade; up to 39°C) or high (> 39°C).

Question 14

What age should children automatically be referred if they have fever ?

Answer 14

less than 3 months

Question 15

what does it suggest if there are no associated symptoms with a fever in a child ?

Answer 15

Bacterial infection, often a urine infection.

Question 16

What are symptoms of impetigo

Answer 16

It usually starts as a small, red, itchy patch of inflamed skin that quickly develops into vesicles that rupture and weep. The exudate dries to a brown-yellow sticky crust

Question 17

should children with impetigo be kept off school ?

Answer 17

yes as It is contagious, and children should be kept off school until the lesions have healed, dried, and crusted over.

Question 18

what is treatment for impetigo ?

Answer 18

Antibiotics which are not available OTC

would have to get a prescription

Question 19

what further advice should be given for impetigo ?

Answer 19

keep good general hygiene

don’t share towels etc

Question 20

what are hygiene measures that should be taken with threadworms ?

Answer 20

Strict attention to hygiene needed
Nails kept short and clean
Careful hand washing and nail scrubbing prior to meals and after each visit to the toilet
Wash bed linen regularly – ideally every day
Don’t share towels
Underwear underneath night clothes
Shower daily immediately on rising 
Damp dusting and daily vacuuming

Question 21

How are threadworms treated ?

Answer 21

Mebendazole is available OTC for the treatment of threadworm. There is a large body of evidence to support the effectiveness of mebendazole in roundworm infections but, for other worm infections, including threadworm, cure rates are lower. For threadworm, cure rates between 60% and 82%. A second dose could be taken 2 weeks after if reinfection occurs.

Question 22

what could be possible side effects of mebendazole ?

Answer 22

Side effects include abdominal pain and discomfort (most commonly reported side effect), diarrhoea, and flatulence.

Question 23

what is the minimum age required to take mebendazole ?

Answer 23

2 years OTC

6 months

Question 24

What causes nappy rash ?

Answer 24

Friction and maceration of the skin are key to its cause. This is compounded by excessive heat and moisture combined with the effect of faecal and urinary enzymes when in prolonged contact with the skin (faeces breakdown produces ammonia, and is considered a contributory cause, because ammonia is only an irritant when in contact with damaged skin). Greater exposure of skin surfaces to moisture impairs the skin’s barrier function and makes the skin more susceptible to secondary infection.

Question 25

what preventative measures can be taken against nappy rash ?

Answer 25

Leave the nappy off for as long as possible each day.

Avoiding using soaps for cleaning.
Washed nappies should be thoroughly rinsed to ensure that they do not contain residues of soap and detergent.
Change nappies as soon as they have been soiled.

Question 26

What can be used to treat nappy rash ?

Answer 26

Commonly prescribed products include 
Drapolene, 
Metanium, 
Sudocrem.
For cases causing discomfort (in general, those that are secondarily infected with  Candida ), the use of an imidazole twice a day is recommended. Parents should be told not to use a barrier cream until the infection has settled

Question 27

When should meningitis be considered ?

Answer 27

Meningitis should be considered in any feverish child who is obviously systemically unwell and exhibits symptoms such as severe headache, photophobia (light sensitivity) lethargy, drowsiness, and neck stiffness. The classic textbook sign of a nonblanching rash is often seen late in symptom presentation and should not be routinely expected to be seen in children

Question 28

What would be the treatment for chickenpox ?

Answer 28

Paracetamol can be used if needed

calamine lotion is traditionally used however it may further dry and irritate the skin

Crotamiton cream may also soothe itchy skin

If itching is too severe then oral chlorphenamine is licensed for children over 1 with chicken pox. It may cause drowsiness.

Question 29

when would you refer someone with chicken pox ?

Answer 29

Children less than 4 weeks old
High temperature, vomiting or develop chest pain
Infected lesions
Children with poor immune system that: are taking medicines such as steroids, immune suppressants and are in contact with people with chicken pox
pregnant mothers whose child has chickenpox.

Question 30

what is the best treatment for head-lice once detected ?

Answer 30

Dimeticone
-spray, lotion 4%- apply 10 cm away from hair, distribute evenly. leave on for minimum of 8 hours before washing out with shampoo

Hedrin once spray gel 4% - applied same way ^ but only needs to be on for 15 minutes

Question 31

What would be some reasons to refer nappy rash ?

Answer 31

Involvement of rash away from nappy area- Suggests other causes such as psoriasis As soon as practicable

OTC treatment failure or
Severe rash Requires prescription-only treatments

Question 32

Treatment for impetigo

Answer 32

Crystacide - hydrogen peroxide 1%