Week 3 - Paediatrics & Minor Illness

Question 1

Common Atopic/Respiratory Childhood Conditions

Eczema
Hayfever
Viral Wheeze

Answer 1

1. ) Eczema - inflamed, itchy, cracked rough skin
   - treat w/ emollient or corticosteroid (hydrocortisone)
   - differentials: urticaria, scabies
2. ) Hayfever/Allergic Rhinitis
   - triggers: pollen, dust mites, animals
   - sneezing, itchiness, blocked/runny nose
   - treat w/ intranasal or oral antihistamines
3. ) Viral Wheeze - viral infection inflaming airways
   - wheeze associated w/ cough or cold, and usually presents before the age of 2
   - differentials: asthma, inhaled foreign body

Question 2

Common GI Childhood Conditions

GORDs
Functional Constipation
Toddler Diarrhoea
Threadworms

Answer 2

1. ) GORDs - in children, regurgitation plus one of:
   - distressed behaviour, hoarseness/chronic cough
   - pneumonia, feeding difficulties, faltering growth
2. ) Functional Constipation - unknown cause
   - infrequent bowel activity, excessive flatulence, abdominal pain, poor appetite, irregular stools
   - treated w/ laxatives (macrogol), ↑fibre and oral intake
   - scheduled toileting, reward systems, bowel diary
   - differentials: intestinal atresia, Hirschsprung’s disease, meconium ileus, milk bolus obstruction
3. ) Toddler Diarrhoea - unknown cause
   - chronic diarrhoea in young children (1-5)
   - not due to poor absorption so child will still get the nutrients they need to grow
   - differentials: gastroenteritis, dietary intolerance, IBD
4. ) Threadworms - parasitic worms infecting the gut
   - white thread-like appearance, 2-5mm in length
   - perianal itching which worsens at night
   - treat entire household with 1 dose of mebendazole

Question 3

Common MSK Childhood Conditions

Osgood-Schlatters
Perthes’ Disease
Slipped Upper Femoral Epiphysis (SUFE)
Chondromalacia Patellae

Answer 3

1. ) Osgood-Schlatters - active 10-19 year olds
   - inflammation of patellar ligament into tibial tuberosity
   - pain/swelling usually resolves at skeletal maturity
2. ) Perthes’ Disease - common from 3+
   - idiopathic avascular necrosis of the femoral head
   - ↓hip rotation w/ referred pain to groin, thigh, or knee
   - systemically well, no evidence of joint inflammation
3. ) SUFE - slipped upper femoral epiphysis
   - demographic: overweight, boys, 10-19 years old
   - can be associated with endocrine abnormalities
   - acute pain in hip, thigh or knee, shortened limb
4. ) Chondromalacia Patellae - common in 10-19 yr olds
   - anterior knee pain walking up and down stairs

Question 4

The Common Cold (Acute/Viral Rhinitis)

Clinical Features
Management
Self Care Strategies
Safety Netting

Answer 4

1. ) Clinical Features
   - sneezing, rhinorrhoea, nasal irritiation, congestion
   - sore throat, cough, malaise, hoarse voice
2. ) Management
   - self-limiting, resolves in 7 (adults) - 14 (kids) days
   - mild cough may persist for 3 weeks
3. ) Self Care Strategies
   - steam inhalation to relieve congestion
   - vapour rubs to sooth respiratory symptoms
   - gargling salt water or sucking menthol sweets
4. ) Safety Netting
   - symptoms worsen in 5 days or persist after 2 weeks
   - meningism: fever, photophobia, rash

Question 5

The Sore Throat (Tonsillitis/Pharyngitis)

Clinical Features
Differential Diagnosis
Investigations
Management
Safety Netting/Complications

Answer 5

1. ) Clinical Features
   - sore throat, painful swallowing, hoarse voice
   - fever, headaches, malaise, myalgia, N/V, abdo pain
   - lymphadenopathy in anterior cervical and submandibular regions
2. ) Differential Diagnosis
   - common cold, the flu, glandular fever
3. ) Investigations
   - FeverPAIN Score: fever <24hrs, Purulence, Attend rapidly (<3 days), Inflamed Tonsils, No cough
   - rapid antigen test for Group A Strep in patients which are immunocompromised (risk of rheumatic fever)
4. ) Management - symptoms resolve after 3-4 days
   - Abx if 4/5 in FeverPAIN: PO Penicillin V QDS for 10d
   - Delayed antibiotics if 2/3 in FeverPAIN
   - ↑fluids, paracetamol/ibuprofen, lozenges, saltwater gargling, avoid hot drinks
5. ) Safety Netting/Complications - urgent ENT referral
   - epiglottitis: difficulty swallowing, drooling, stridor, SOB
   - peritonsillar abscess (quinsy): neck pain, lockjaw, one-sided neck swelling

Question 6

Urinary Tract Infection

Clinical Features
Red Flags
Investigations
Management

Answer 6

1. ) Clinical Features
   - polyuria, nocturia, dysuria, urgency
   - cloudy urine, haematuria, suprapubic tenderness
   - elderly: cognitive impairment
2. ) Red Flags - pyelonephritis/sepsis
   - haematuria, loin/flank pain, rigors, N/V, ↓cognition
3. ) Investigations
   - urine dip: nitrite, leuckocyte, blood
   - urine culture if complicated: >65, <65 w/ haematuria, man, pregnant, catheterised, recurrent UTIs (2 in 6 months), <
   - pregnancy test
4. ) Management
   - Nitrofurantoin (eGFR >45) or trimethoprim for 3 days
   - trimethoprim should be avoided in the first trimester
   - Nitrofurantoin should be avoided near term due to risk of neonatal jaundice
   - 7 day course if complicated UTI
   - fluids, paracetamol/ibuprofen
   - safety netting for red flags

Question 7

Vaginal Thrush (Vulvovaginal Candidiasis)

Clinical Features
Differential Diagnoses x7
Investigations
Management

Answer 7

1. ) Clinical Features
   - vulval itching, soreness, irritation
   - vaginal discharge (cheese-like, non-odourous)
   - dysuria, dysparaeunia
2. ) Differential Diagnoses
   - bacterial vaginosis: less itchy, white discharge
   - trichomoniasis: profuse green discharge
   - chlamydia: not usually itchy
   - gonorrhoea: not itchy, pain, purulent discharge
   - herpes: pain, discharge is uncommon
   - UTI: polyuria or urgency
   - atrophic vaginitis: post-menopausal women
3. ) Investigations - not usually needed
   - examniation if severe symptoms or high risk of STI
   - not routine but: pH testing (<4.5), high vaginal swab
4. ) Management - antifungal
   - oral (fluconazole) or intravaginal cream/pessary
   - avoid excessive washing of vulval areas
   - symptoms should resolve within 7-14 days

Question 8

Eye Infections

Conjunctivitis (bacterial, viral, allergic)
Stye
Early Orbital Cellulitis
Anterior Uveitis

Answer 8

1. ) Conjunctivitis - conjunctival redness caused by adenovirus (or S. pneumoniae, aureus, N. gonorrhoea)
   - feeling of grittiness, foreign body or burning
   - bacterial: mucopurulent discharge
   - viral: watery discharge, often unilateral
   - allergic: no discharge, bilateral, pruritis
   - self-limiting: lubricating drops, cool compress
   - chloramphenicol eye drops if bacterial
   - usually gets better in 5-7 days
2. ) Stye - localised lump/swelling near eyelid margin caused by infected eyelash follicle (usually S. aureus)
   - acute onset, painful, red, usually unilateral
   - self-limiting, do not attempt to puncture
   - warm compress, avoid makeup and contact lenses
3. ) Early Orbital Cellulitis - eyelid oedema caused by extension of infection of periorbital structures
   - acute onset, swelling, redness, warm, fever, malaise
   - ptosis, gaze restriction, painful moving eye
   - treated using oral co-amoxiclav or referral to ENT for IV antibiotics
4. ) Anterior Uveitis (Iritis) - inflammation of the anterior portion of the uvea - iris and ciliary body.
   - acute onset, eye pain/discomfort worsened w/ use)
   - red eye, blurred vision, photophobia, ↓visual acuity
   - small/irregular pupils due to sphincter muscle contraction, ciliary flush, lacrimation, hypopyon
   - HLA-B27 association: IBD, spondyloarthropathies, sarcoidosis, Behcet’s disease
   - requires urgent referral to ophthalmology, steroid eye drops, cycloplegics (dilates the pupil to relieve pain and photophobia) e.g. atropine, cyclopentolate
5. ) Bacterial Keratitis - cornea infection
   - affects contact-lens wearers
   - pain, redness, ↓vision, photophobia, discharge
   - urgent referral to opthalmologist

Question 9

Headlice

Pathophysiology
Diagnosis
Management

Answer 9

1. ) Pathophysiology - aka pediculosis capitis or ‘nits’
   - small insects that live in human hair that lay eggs (grey/brown, size of pinhead) glued to hair
   - nits are white/shiny empty egg shells
   - spread by direct head-to-head contact
2. ) Diagnosis
   - itching and scratching occurs 2-3wks after infection
   - diagnosed with fine-toothed combing of wet or dry hair to visualise live head lice
   - differentials: dandruff, seborrheic dermatitis, eczema
3. ) Management
   - 1°wet combing: using shampoo and conditioner, comb through hair for 10-30mins every 3 days for 2 wks, if still present after 17 days, seek advice from GP
   - other treatments: Hedrin (dimeticone), isopropyl myristate, cyclomethicone
   - not to do w/ poor hygiene, no need to wash linen
   - children do not need to stay off school

Question 10

Scabies

Clinical Features
Management
Practical Advice

Answer 10

1. ) Clinical Features
   - rash: itchy+++, red, widespread, symmetrical papules
   - linear burrows, nodules
2. ) Management
   - topical insectisides (permethrin or malathion) applied all over the body, then repeated one week later
   - crotamiton lotion for itching,
   - treat all close physical contacts even if asymptomatic
   - seek specialist advice if crusted scabies
   - follow up if itching still present after 2-4 weeks
3. ) Practical Advice
   - wash all bedding and clothing at 60 degrees
   - put non-washable clothing in sealed bag for 3 days
   - avoid close physical contact

Question 11

Nappy Rash

Clinical Features
Differential Diagnosis
Practical Advice
Treatment

Answer 11

1. ) Clinical Features
   - child appear distressed as rash can be painful or itchy
   - rash: well-defined, confluent erythema w/ papules
   - not present in inguinal folds and gluteal clefts
2. ) Differential Diagnosis
   - allergic contact dermatitis, eczema, psoriasis
   - if rash persists or becomes moist w/ white or red pimples in skin folds, it may be an infection instead
   - streptococcal or seborrhoeic dermatitis
3. ) Practical Advice - should resolve in 3 days
   - use nappy with high absorbency e.g. disposable gel matrix nappies compared to non-disposable nappies
   - leave nappies off as long as possible to help dry skin
   - clean and change nappy every 3-4hrs or
   - avoid irritants such as soap or bubble baths
4. ) Treatment - if baby is in distress and rash is inflamed
   - hydrocortisone 1% cream once a day for up to 7 days

Question 12

Failure to Thrive

Definition
Risk Factors
Physical Signs of Malnutrition
Signs of Food Intolerance
Management

Answer 12

1. ) Definition - height or weight measurements fall by at least 2 centile lines over a period of time
   - often secondary to food intolerances
2. ) Risk Factors
   - maternal: smoking, illness, medical use
   - ethnicity: Asian children are genetically smaller
3. ) Physical Signs of Malnutrition
   - oedema, muscle wasting, hepatomegaly
   - rash/skin changes, hair colour/texture changes
   - mental state changes, signs of vitamin deficiency
   - dehydration: ↓skin turgor, sunken anterior fontanelle, dry mucous membranes, absence of tears
4. ) Signs of Food Intolerance
   - sudden weight drop after weaning from breast milk
   - colic pain, diarrhoea, vomiting
   - relationship of symptoms to meal times
5. ) Management
   - measure height, weight, head circumference
   - parental education on diet for proper preparation of formula milk