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The history and examination
What are the steps in the general examination of a child?
The first meeting
Why is the introduction important?
How should you address a child?
Why is it important to listen to mothers?
Why is it important to keep the language simple?
The review of any referral information
What is the value of a referral letter?
What is the value of the Road-to-Health Card?
What basic information is needed?
Why are the age and gender important?
How should the child’s size be recorded?
How should you measure the child’s temperature?
How do you start taking a history?
Why is it important to obtain a good history?
Who should give the history?
What are the main parts of the history?
What is important to ask about in the present history?
What is important in the past history?
What is needed in the immunisation history?
Why may the social (home, family, school, economic) history be important?
What question in the social history should not be forgotten?
What special questions should be asked?
When can an interpreter help in taking a history?
Why is confidentiality important in history taking?
What can be learned by observing the mother and child during history taking?
The physical examination
What are the steps in the physical examination?
In what order should the steps of the examination be done?
What are the components of each step of the physical examination?
What is the most important component of the examination?
Where should the examination be done?
Should the child be undressed for the examination?
What is the best approach to the general and regional inspection?
How are the body systems examined?
What are important danger signs?
What are the early signs of dehydration?
What special examination may be needed?
What are the 10 common errors in the general examination of a child?
What special investigations are usually needed?
What additional investigations may be needed?
What is the assessment?
What is a problem list?
How do you make a diagnosis?
A plan of action
What is a plan of action?
Writing good clinical notes
What is the importance of good clinical notes?
How detailed should your notes be?
How should the notes of the first visit be laid out?
How should progress notes be written?
Should notes always be made in the Road-to-Health Card?
What is immunity?
What is immunisation?
What are the advantages of immunisation?
What immunisations should be given to young children?
What is the expanded programme on immunisation
How are immunisations given?
Which vaccines are used in South Africa?
When should immunisations be given?
Why is it important to give immunisations at the recommended time?
What should be done if immunisations are missed or never started?
Why are immunisations opportunities often missed?
How should immunisations be recorded?
What should be done if the Road-to-Health Card is lost?
Should infants born to HIV-positive women be immunised?
Should infants with HIV infection be immunised?
Should malnourished infants be immunised?
Should small or sick newborn infants be immunised?
Should routine immunisations be given to a sick child?
Can immunisations be safely given to an allergic child?
When are immunisations contraindicated?
Is immunisation safe?
What is BCG?
How should BCG be stored and mixed?
When should BCG be given?
How is BCG given?
What are the side effects of BCG immunisation?
What are the contraindications to BCG immunisation?
Which polio vaccine is used?
How should polio vaccine be stored?
How is live polio vaccine given?
Should oral polio immunisation be given to a breastfeeding infant?
What are the contraindications to polio immunisation?
Immunisation against diphtheria, pertussis and tetanus (dpt)
What is DPT vaccine?
How should DPT vaccine be stored?
How is DPT vaccine given?
What are the side effects of DPT immunisation?
What are the possible serious reactions to pertussis immunisation?
When should pertussis vaccine not be given?
What is DT vaccine?
Why is pertussis vaccine not given after 18 months?
What measles vaccine is used?
How should measles vaccine be stored?
How is measles vaccine given?
When should measles immunisation be given?
What are the complications of measles immunisation?
What are the contraindications to measles immunisation?
What is MMR vaccine?
Immunisation against hepatitis b
What is hepatitis B ?
When and how is hepatitis B vaccine given?
What are the side effects of hepatitis B vaccine?
What is the management of an infant born to a mother who is infected with hepatitis B ?
Immunisation against haemophilus influenzae
What is Haemophilus influenzae?
What is Hib vaccine?
How is Hib vaccine stored?
When and how is Hib vaccine given?
Which other immunisations are available?
Why is a booster dose of vaccine given?
Why are some immunisations given on the left and others on the right side of the body?
What equipment is used to give intramuscular immunisations?
What is ‘herd immunity’?
Which infectious diseases in children are notifiable?
What are mass immunisation campaigns?
What is important about storing and handling vaccines?
What is ‘the cold chain’?
What is the correct use of a vaccine fridge?
What is a cool box?
What is an opened multidose vial policy?
Growth and development
What is growth?
Measuring body size
How is body size determined in children?
How is weight measured?
How are height and length measured?
How should head circumference be measured?
How often should the size of children be measured?
How is a child’s size used to assess growth?
The importance of growth monitoring
What is growth monitoring?
What is the value of weight in growth monitoring?
What is the value of measuring height and head circumference?
Can an infant’s growth be determined at a single clinic visit?
What is a centile chart?
What are the important centiles on a centile chart?
What is the normal size for children of a given age?
What size measurements are usually plotted on a centile chart?
When is a child larger than normal?
When is a child smaller than normal?
How should you plot a child’s weight on a centile chart?
Can length and height both be plotted on the same chart?
What is the value of knowing a child’s weight-for-height?
What is a growth curve?
What is the value of a growth curve?
What is the normal growth rate?
How fast should most children grow?
Is weight or height the better measure of growth?
Is it important if a child is heavier than normal?
Is it important if a child is lighter than normal?
What should you do if a child is heavier or lighter than normal?
What is a growth pattern?
What other growth patterns are common?
How can you recognise a large-for-age child?
Which children weigh too much?
What is a wasted child?
What is growth faltering?
How can you recognise stunting?
What is the long term effect of stunting?
What is the common growth pattern in poor communities?
When does the puberty growth spurt occur?
What is the effect of emotion on growth?
Overweight and obesity
How do you decide whether a child is overweight?
When is a child overweight?
What is obesity?
How do you manage childhood obesity?
The road-to-health card
What is the Road-to-Health Card?
What is the importance of the growth chart?
When should the Road-to-Health Card be used?
What is growth promotion?
When and where should children with growth problems be referred?
What is neurodevelopment?
How is neurodevelopment monitored?
What are normal milestones?
What is puberty?
What are the physical changes during puberty?
What is nutrition?
What is the nutritional state?
What is normal nutrition?
What are the main nutrients in the diet?
What are energy foods?
Which foods are carbohydrates?
Which foods are rich in fats and oils?
Which foods are rich in protein?
What are micronutrients?
What is a well-balanced diet?
What foods are needed by children?
What is malnutrition?
How is malnutrition recognised clinically?
Which children are underweight?
Which children are stunted?
Which children are wasted?
Why is malnutrition important?
How is a clinical diagnosis of malnutrition confirmed?
What are the common forms of malnutrition?
Protein energy malnutrition
What is protein-energy malnutrition?
What are the forms of protein-energy malnutrition?
Which children are underweight-for-age?
Why is it important to detect underweight-for-age children?
What is marasmus?
What is kwashiorkor?
What is marasmic kwashiorkor?
How can you determine whether a child has malnutrition?
How can the history help in the diagnosis of malnutrition?
How can a general examination help in the diagnosis of malnutrition?
How common is protein-energy malnutrition?
What factors are commonly associated with malnutrition?
What are the complications of severe malnutrition?
How are malnutrition and infection related?
Is malnutrition always due to a poor diet?
What is the management of an underweight-for-age child?
What is the management of severe malnutrition?
What resuscitation is needed?
What nutritional rehabilitation is required?
How can you prevent malnutrition recurring?
How should you address the underlying causes of malnutrition?
What can be done to prevent malnutrition in poor communities?
What is the effect of severe malnutrition on a child’s mental development?
What are micronutrients?
What are vitamins?
What are the common vitamin deficiencies in children?
Which children are at greatest risk of vitamin A deficiency?
How does vitamin A deficiency present?
How is vitamin A deficiency prevented?
How is vitamin A deficiency treated?
What are the B group vitamins?
What is pellagra?
What is scurvy?
What is rickets?
Trace element and mineral deficiencies
What are trace element and mineral deficiencies?
How common is iron deficiency?
What are the common causes of iron deficiency in children?
What are the clinical signs of iron deficiency?
How is the diagnosis of iron deficiency confirmed?
How can iron deficiency be prevented?
What is anaemia?
What are the presenting symptoms and signs of anaemia?
What are the common causes of anaemia in children?
What is the simplest method of confirming anaemia due to iron deficiency?
What is the treatment of iron deficiency anaemia?
Diagnosis and causes of diarrhoea
What is diarrhoea?
Is diarrhoea common?
Can diarrhoea be dangerous?
What are the common causes of diarrhoea?
What infections cause diarrhoea?
What food intolerances cause diarrhoea?
What is gastroenteritis?
What is acute diarrhoea?
What is persistent diarrhoea?
What is the relationship between diarrhoea and malnutrition?
Is diarrhoea common in children with HIV infection?
Which infants are at greatest risk of dying from diarrhoea?
What is cholera?
What is dysentery?
What is typhoid?
The complications of acute diarrhoea
What are the complications of acute diarrhoea?
How can you recognise dehydration?
How can you recognise loss of skin turgor?
How can the degree of dehydration be assessed?
How can weight loss help to decide the degree of dehydration?
What is shock?
How is a delayed capillary filling time measured?
What causes acidosis in children with diarrhoea?
Why do children with diarrhoea lose electrolytes?
What is ileus?
What is the danger of hypoglycaemia?
How is septicaemia recognised?
What signs suggest that the diarrhoea may have a surgical cause?
Treatment of diarrhoea
What is the management of a child with acute diarrhoea?
Will milk feeds make acute diarrhoea worse?
Can children with acute diarrhoea continue to be fed solid food?
Should anti-diarrhoeal medication be used to treat acute diarrhoea?
Should antibiotics be routinely given to children with acute diarrhoea?
What should you do if the child vomits a lot?
Can a child with acute diarrhoea be treated at home?
What is oral rehydration therapy?
What is oral rehydration solution?
What is commercial oral rehydration solution?
How can a sugar and salt solution be made at home?
Who should know how to make up sugar and salt solution for oral rehydration?
When should oral rehydration therapy be started?
How much oral rehydration solution should be given?
Which children with acute diarrhoea should be referred to hospital?
What is the management of persistent diarrhoea?
What is the management of dysentery?
Management of dehydration
What is the management of a child with diarrhoea but no visible dehydration?
What is the treatment of a child with some dehydration?
What is the treatment of a child with severe dehydration?
What is the treatment of dehydration resulting in shock?
What fluids should be given once dehydration has been corrected?
What is the value of zinc supplements in managing a child with diarrhoea?
Prevention of diarrhoea
Is acute diarrhoea preventable?
Why do children commonly get diarrhoea?
How can the risk of diarrhoea be reduced?
How can a safe water supply be obtained?
How can sanitation be improved?
Why is cup-feeding safer than bottle-feeding?
How can hygiene be improved?
Upper respiratory tract conditions
What is the upper respiratory tract?
What is the lower respiratory tract?
What is a common cold?
What is the cause of a common cold?
What are the signs and symptoms of the common cold?
What are the complications of a common cold?
How can the common cold be prevented?
What is the management of a common cold?
What is acute sinusitis?
What are the symptoms and signs of sinusitis?
What is the treatment of sinusitis?
What is allergic rhinitis?
What are the symptoms and signs of allergic rhinitis?
What is the cause of allergic rhinitis?
What is the management of allergic rhinitis?
Pharyngitis and tonsillitis
What is pharyngitis?
What are the causes of pharyngitis?
What are the symptoms and signs of pharyngitis?
What are the complications of pharyngitis?
What is the management of pharyngitis?
What is tonsillitis?
What are the signs of tonsillitis?
What is the management of tonsillitis?
What are the signs and management of enlarged adenoids?
What is otitis media?
What are the symptoms and signs of acute otitis media?
What is the management of acute otitus media?
What is chronic suppurative otitis media?
What is the management of chronic suppurative otitis media?
What is chronic secretory otitis media?
What is the management of chronic secretory otitis media?
What is otitis externa?
What is the treatment of otitis externa?
What is the epiglottis?
What is epiglottitis?
How is acute epiglottitis recognised?
How must acute epiglottitis be managed?
What is influenza?
What are the symptoms and signs of influenza?
What is the management of influenza?
How can acute respiratory conditions be prevented?
Lower respiratory tract conditions
What is the lower respiratory tract?
What are the signs of breathing difficulty?
What are the signs of respiratory distress?
What is stridor?
What is chest indrawing?
What is a wheeze?
How can you tell when a child is breathing too fast?
What is central cyanosis?
What is viral croup?
What are the presenting signs of viral croup?
How is the degree of stridor assessed?
What is the correct management of viral croup?
What is bronchitis?
What are the symptoms and signs of acute bronchitis?
What is the management of acute bronchitis?
What is bronchiolitis?
What are the signs of bronchiolitis?
What is the correct management of bronchiolitis?
When should children with bronchiolitis be referred to hospital?
What is pneumonia?
What are the causes of pneumonia?
What are the symptoms and signs of pneumonia?
Should all children with pneumonia have chest X-rays?
Is pneumonia a serious infection?
How can you recognise severe pneumonia?
What is the correct management of pneumonia?
What antibiotics are used in pneumonia?
What is asthma?
How common is asthma?
What are the symptoms of asthma?
What are the clinical signs of asthma?
What is the cause of asthma?
How do inherited factors increase the risk of asthma?
What is allergy?
What trigger factors may start an attack of asthma?
How is asthma diagnosed?
How is the severity of asthma graded?
What is the correct management of asthma?
How is the severity of acute asthma assessed?
How should acute asthma be treated?
What should you do if there is no response?
How should inhaled and nebulised drugs be given?
How can repeated attacks of asthma be prevented?
How can trigger factors be avoided?
What education and support is useful in asthma?
An approach to lower respiratory tract conditions
What is the syndromic approach to acute respiratory tract disorders?
What are the important causes of a cough?
What is the management of a cough?
What signs of breathing difficulty suggest specific diagnoses?
When and how should oxygen be given?
What is tuberculosis?
What causes tuberculosis?
How is tuberculosis spread from person to person?
Do all children infected with Mycobacterium tuberculosis develop tuberculosis?
Is tuberculosis common?
In which communities is tuberculosis common?
Why is tuberculosis an important disease?
Which infected children are at greatest risk of developing tuberculosis?
Which children have a weak immune system?
What is primary tuberculosis of the lung?
Can the primary infection cause illness due to spread of the infection within the lung?
Can one have a tuberculous infection more than once?
Can tuberculous infection spread from the lung to other parts of the body?
Which other organs can be involved in tuberculosis?
What are the most common complications of primary tuberculosis in children?
How is tuberculosis diagnosed?
What are the clinical signs and symptoms of tuberculosis?
What are the signs and symptoms of pulmonary tuberculosis?
How can a clinical diagnosis of pulmonary tuberculosis be confirmed?
What are the signs of tuberculosis on a chest X-ray?
What is a tuberculin skin test?
How is the Mantoux skin test done?
How should you read a Mantoux skin test?
Does a negative Mantoux test exclude infection with tuberculous bacilli?
How can tuberculosis bacilli be identified?
Which adults with tuberculosis are most infectious?
How can a sample of sputum be obtained in a child?
What is miliary tuberculosis?
How is miliary tuberculosis diagnosed?
What are the signs and symptoms of tuberculous meningitis?
What are the signs and symptoms of abdominal tuberculosis?
What are the signs of tuberculous infection of the peripheral lymph nodes?
How is tuberculosis affected by HIV infection and AIDS?
How does tuberculosis affect HIV infection and AIDS?
How can tuberculosis be prevented?
What is the value of BCG immunisation?
How is the diagnosis of tuberculosis classified in children?
What is the management of tuberculosis?
What drugs are used to treat tuberculosis in children?
What is short course treatment of tuberculosis?
How is the response to treatment monitored?
What are the side effects of anti-tuberculous drugs?
What is the most common cause of failure to cure tuberculosis?
What is the DOTS strategy?
When are anti-tuberculous drugs given prophylactically to young children?
What is the management of a newborn infant if the mother has tuberculosis?
Is tuberculosis a notifiable disease?
Should adults with tuberculosis be isolated?
How can tuberculosis be controlled in a community?
What are the main responsibilities of the staff in a primary care TB clinic?
What is HIV?
Are there different types of HIV?
What is HIV infection?
What is AIDS?
Can a person have HIV infection but remain well?
How common is HIV infection?
Transmission of HIV to children
How can a person become infected with HIV?
How are children usually infected with HIV?
What is the risk of a child becoming infected with HIV by mother-to-child transmission?
How can the risk of mother-to-child transmission be reduced?
What factors influence the risk of HIV transmission in breast milk?
How can the risk of HIV transmission in breast milk be reduced?
When is it best not to breastfeed?
Diagnosing HIV infection in a child
How is HIV infection diagnosed?
What are the advantages of diagnosing HIV infection early?
The clinical diagnosis of HIV infection and aids
How does HIV infection present clinically in children?
What are the clinical stages of HIV infection?
How is symptomatic HIV infection diagnosed?
What are the signs of stage 1 HIV infection?
What are the clinical signs of stage 2 HIV infection?
What are the signs of stage 3 HIV infection?
What are the signs of stage 4 HIV infection?
How is damage to the immune system documented in children?
How is the clinical severity of HIV infection classified in children?
Management of HIV-exposed infants
How should an infant born to an HIV-infected woman be managed after delivery?
How should HIV prophylaxis be given to the newborn infant to reduce the risk of HIV infection during labour and delivery?
What is the management of HIV-exposed infants during the first year of life?
Is it safe to give immunisations to infants who may be infected with HIV?
What is the role of good nutrition in children with HIV infection?
How and when should prophylactic co-trimoxazole be given?
What is the value of antiretroviral therapy in children?
What is the expected outcome for children with HIV infection?
What factors other than age determine how fast HIV infection will progress?
What are important respiratory problems in children with HIV infection?
What is pneumocystis pneumonia?
Is tuberculosis common in children with HIV infection?
What forms of tuberculosis are common in children with HIV infection?
What gastrointestinal problems are common in children with HIV infection?
What skin conditions are common in children with HIV infection?
What is the effect of HIV infection on neurodevelopment?
Management of children with symptomatic HIV infection
What are the major components of management?
How important is nutrition support?
How should opportunistic infections be managed?
What are the goals of antiretroviral therapy?
When should antiretroviral treatment be started?
What are the guidelines for antiretroviral therapy?
What drugs are used for antiretroviral therapy?
What side effects are seen with antiretroviral drugs?
What monitoring is need with antiretroviral therapy?
Is there a vaccine against HIV infection?
How can emotional and family support be provided?
What is palliative and terminal care?
Which are the common childhood infections?
What is the cause of measles?
What are the signs and symptoms of measles?
What are the complications of measles?
What is the relationship between measles and malnutrition?
How can measles be prevented?
What is the management of a child with measles?
What is the cause of chickenpox?
What are the signs and symptoms of chickenpox?
How is a child with chickenpox managed?
What are the clinical features of mumps?
What are the complications of mumps?
What is the management of children with mumps?
What is herpes stomatitis?
What is the management of a child with herpes stomatitis?
What are fever blisters?
Acute viral hepatitis
What is hepatitis?
What are the common causes of acute viral hepatitis?
What is the clinical presentation of acute viral hepatitis?
What are the complications of acute viral hepatitis?
How can viral hepatitis be prevented?
What is the management of a child with acute viral hepatitis?
What is tickbite fever?
What is the treatment of tickbite fever?
What are the common causes of acute conjunctivitis?
What are the clinical features of acute conjunctivitis?
What is the treatment of acute conjunctivitis?
What are the less common childhood illnesses?
What are parasites?
Which are the common intestinal parasites?
What is a roundworm?
How do children get roundworms?
Do roundworms in the gut cause clinical problems?
How can roundworms cause chest problems?
How are roundworms treated?
How can infection with roundworms be prevented?
When is deworming recommended?