Summary Paediatrics revision notes for medical school
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Course
Pediatrics
Institution
Imperial College London (ICL)
Comprehensive revision notes covering all areas of paediatrics required for medical school final exams and postgraduate exams such as the MSRA. 100+ pages of concise, user-friendly and structured notes with a lot of images to aid your learning and help you efficiently revise. Also features a compre...
Immunisation Schedule
Summary:
• BCG is given to infants at high risk of TB infection.
• “5 in 1” vaccine against diphtheria, tetanus, pertussis, Hib and inactivated
polio is given at 2 months, 3 months and 4 months. “6 in 1” includes
hepatitis B vaccination.
• Pneumococcal conjugate vaccine is given at 2 months, 4 months and 12
months.
• Meningococcal group B vaccine is given at 2 months, 4 months and 12
months.
• Rotavirus vaccine is given orally at 2 months and 3 months.
• Booster Hib and MenC are both given at 12 months.
• MMR is given at 1 year and at 3 years 4 months.
• A diphtheria, tetanus, pertussis and polio booster is also given at 3 years 4
months.
• HPV vaccine is given to girls at 12-13 years.
• Tetanus, diphtheria and polio booster and meningococcal ACWY
conjugate vaccine are given at 14 years.
Diseases included in the vaccination programme:
• Diphtheria – infection causes local disease with membrane formation
affecting the nose, pharynx and larynx, but it can also cause systemic
disease with myocarditis and neurological manifestations.
• Pertussis – whooping cough.
• Hib – causes invasive disease in young children.
• Poliovirus – most infected children will be asymptomatic or have a mild
illness, but some develop aseptic meningitis, and 1% will develop paralysis.
• Meningococcus – meningitis and meningococcal sepsis.
• Pneumococcus – rare but severe invasive pneumococcal illness in under-
2s
• HPV – protects against HPV16 and HPV18, the two subtypes most
associated with cervical cancer.
• BCG –TB
Absolute CI = acute current illness or previous severe adverse reaction.
Vaccinations should be postponed if the child is acutely unwell at the time (however, minor infection without any fever or systemic
features is not a contraindication). Relative CI = immunosuppression, egg allergy (egg is present in flu vaccine and MMR vaccine).
Complications include:
• Swelling and discomfort at injection site
• Mild fever and malaise
• Some vaccines, e.g. MMR, are followed by a mild form of the disease 7-10 days later
• More serious reactions, including anaphylaxis, can occur but are very rare
Keywords in paeds SBAs: • Give amoxicillin to treat feverish illness, child comes
• Pale = anaemia, shocked back two days later with florid rash = EBV (NOT allergy
• Pale and jaundiced = haemolytic anaemia to amoxicillin)
• Drooling = epiglottitis • Irritability = meningitis
• Recently moved from abroad and doesn’t have red book • Confusion = encephalitis/encephalopathy
= unimmunised (epiglottitis, pertussis, diphtheria, no • Port wine stain = Sturge-Weber
Guthrie screening – thyroid, PKU, cystic fibrosis) • Fat teenager with limp = SUFE (slipped upper femoral
• Mum has a new boyfriend = child abuse epiphysis)
• Pins and needles in hands (in context of chest pain etc.) • Gower’s sign positive = Duchenne’s muscular dystrophy
= panic attack • Cap refill >3 seconds = shocked
• 5 days of fever = Kawasaki’s • Boot-shaped heart on chest X-ray = tetralogy of Fallot
• Mum unable to let go of your hand = myotonic • Barking cough = croup
dystrophy (is autosomal dominant) • Has been to a birthday party = anaphylaxis
,Causes of common paediatric emergency presentations:
Shock Respiratory Distress Drowsy, unconscious or seizing Surgical Emergencies
Hypovolaemia Upper airway obstruction - Post-ictal Acute abdomen:
- Sepsis (stridor) - Status epilepticus e.g. appendicitis or
- Dehydration – e.g. - Croup - Infection (meningitis or peritonitis
gastroenteritis - Epiglottis encephalitis)
- Diabetic ketoacidosis - Foreign body - Head injury (trauma or non- Intestinal obstruction:
- Blood loss – trauma - Congenital accidental injury) - Intussusception
malformations - Drug or poison ingested - Malrotation
- Trauma - Intracranial haemorrhage - Bowel atresia or
stenosis
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