When I was a very new paediatric doctor I worked in a unit that routinely used steam to treat children who had croup. It was a fantastic treatment—you could tell that you were doing something seriously efficacious; you would open the cubicle door to review the child and walk into this thick humid atmosphere—you could almost hear the witches chanting ‘Double, double toil and trouble; Fire burn, and caldron bubble’ in the distance. There was just one problem. It was rubbish. This was roundly demonstrated when new smoke detector systems were installed which were triggered by the steam, so we had to stop using it; it made absolutely no difference to the children we were treating. The evidence that steam was a waste of time was well established even by this time—plus the risks of directly or indirectly teaching parents insanities like ‘boil a kettle in the corner...]]>
Cases of limbic encephalitis are being increasingly recognised by paediatric neurologists. As they usually present initially to paediatricians it is vital they are aware of the presentation, important investigations and management (
Key clinical features of limbic encephalitis: Cognitive, and particularly memory impairment Temporal lobe seizures MRI signal change within limbic structures, particularly in the hippocampus.
None.
Commissioned; internally peer reviewed.
An overview of investigation findings in some causes of limbic encephalitis
By successfully answering the questions, readers will be able to demonstrate to their own satisfaction that they have fully grasped the article, and thereby contribute to their own continuing professional development.
Annotated answers will always be available in the same edition.
The questions below are based on two articles which appeared in the June 2012 edition of Education and Practice:
Gleeson H, Turner G. Transition to adult services. Arch Dis Child Educ Pract Ed 2012;97:86–92. http://ep.bmj.com/content/97/3/86.full
White B, Viner RM. Improving communication with adolescents. Arch Dis...]]>
Case 1: An otherwise healthy 6-month-old boy presents with several patches of alopecia, slowly increasing in size over the past month. He is noted to have two school-aged brothers at home. On examination, there is an erythematous, boggy mass on the scalp with associated alopecia and occipital lymphadenopathy (
Case 2: A healthy 9-year-old girl presents with an enlarging patch of alopecia on the posterior scalp for 5 months. It is asymptomatic, and she denies any pustules or pruritus. The child is very upset by the hair loss but is otherwise healthy. On physical examination, there is a large patch of alopecia with fairly well-defined borders on the posterior scalp (
Amy is 13 months old and presented to the children's emergency department with a 5-week history of wheezing. Her parents explain that they have seen her general practitioner twice and attended the local walk-in centre three times over the last month. She has been prescribed antibiotics and salbutamol both of which Amy ‘hates’. On examination, she had a dry cough with mild respiratory distress. She has occasional crepitations and widespread wheeze. Parents smoke ‘outside the house’ but neither has asthma. She is their first child. Clinically, she is well but parents would like to know whether inhalers will help.
Birth cohort studies have demonstrated that approximately one-third of the children aged between 1 and 5 years suffer recurrent episodes of respiratory symptoms including wheeze. Wheezing prevalence in UK children has increased from twofold to threefold during the past 40 years but may have stabilised or even...]]>
From questions on
2004—Standard 4 in the National Service Framework for Children, Young People and Maternity Services (Department of Health, 2004)
2006—Transition: Getting it Right for Young People (Department of Health, 2006)
2007—Aiming High for Disabled Children (AHDC): Better Support for Families (Department for Education, 2007) and A Transition Guide for All Services: Key Information for Professionals about the Transition Process for Disabled Children (Department of Health, 2007)
2007—You're Welcome quality criteria (Department of Health, 2007)
2008—Transition: Moving on Well (Department of Health, 2008)
Fidelity, confidentiality, competency, honesty, a global perspective, non-judgemental approach, continuity
Level 3: Complex needs (5%)
Care requires health and social care system to work together. This calls for case management, with a key worker actively managing and joining up care for...]]>
From questions on
The answer is (D), kerion. This is a manifestation of tinea capitis, ringworm of the scalp. It can occur in more severe cases and in the very young, resulting in a boggy mass on the scalp with loss of hair. Diagnosis can be difficult as potassium hydroxide preparations can be negative in the presence of such inflammation; culture is frequently needed to prove scalp infection. Treatment must be in the form of an oral antifungal drug indicated for tinea capitis for sufficient duration. Use of a topical antifungal shampoo is recommended concurrently to decrease spread of the disease.
The answer is (A), alopecia areata. Alopecia areata is a common, usually patchy and often unpredictable hair loss on the scalp and the body, thought to be primarily...]]>