Paediatrics

Question 1

Childhood Immunisation Schedule (I)

Answer 1

● Childhood vaccinations include:
* Diphtheria, Tetanus, Pertussis (DTP)
* Polio
* Haemophilus Influenzae type B (Hib)
* Hepatitis B (Hep B)
* Rotavirus
* Meningitis (Men)
* Pneumococcal Conjugate Vaccine (PCV)
* Measles, Mumps, Rubella (MMR)
* Nasal Flu
* Human Papillomavirus (HPV)

Question 2

Childhood Immunisation Schedule (II)

Answer 2

• 2 months: DTP/Polio/Hib/Hep B + Rotavirus + Men B (6)
• 3 months: DTP/Polio/Hib/Hep B + Rotavirus + PCV (6)
• 4 months: DTP/Polio/Hib/Hep B + Men B (5)
• 1 year: Hib/Men C + Men B + PCV + MMR (5)
• 2 years (to end of primary school years): Annual nasal flu spray (1)
• 3 years, 4 months: DTP/Polio + MMR (3)
• 12-13 years: HPV (boys and girls) – 2 doses, 6-24 months apart (1)
• 14 years: DT/Polio + Men ACWY (3)

So:
DTP/Polio/Hib/Hep B - @ 2&3&4 months
Rotavirus - @ 2&3 months
Men B - @ 2&4 months & 1 year
PCV - @ 3 months & 1 year
MMR - @ 1 year & 3 years 4 months
DTP/Polio - 3 years 4 months
DT/Polio 14 years
Men ACWY - 14 years
HPV - @ 12-13 years (2 doses, 6-24 months apart)

Question 23

Chickenpox (organism, key clinical features, mgt., notifiable or not, school exclusion or not)

Answer 23

Caused by varicella-zoster virus
Clinical features
Fever, malaise, nausea, myalgia, off feeding
Macules, leading to itchy++ vesicles, papules and pustules
○ Crusting usually within 5 days
○ Management
○ Usually self-limiting
○ Supportive management, fluids, analgesia
○ Topical calamine for itching +/- oral chlorpheniramine (>1 year old)
○ Avoid pregnant women, immunocompromised, under 4 week old babies
○ Aciclovir not recommended for healthy children (may be needed in
immunocompromised, adults etc)

○ Complications include
○ Bacterial skin infection eg impetigo, cellulitis
○ Neurological eg meningitis, encephalitis
○ Not notifiable
○ School exclusion until vesicles have crusted over

Question 27

Cystic Fibrosis

Answer 27

● AR condition
● Caused by mutation in CFTR gene (ch. 7)
● Early features:
* Bowel obstruction with meconium Ileus
* Failure to thrive
* Respiratory infections with chronic sputum production
* Nasal polyps
* Pancreatic insufficiency

● Later features:
* Chronic respiratory disease, bronchiectasis
* Infertility
* Diabetes

● Classic findings: Clubbing, crackles in lungs

● Dx.: Sweat test

● Mgt.: Specialist CF teams, regular chest PT, prophylatic abx. pancreatic enzymes

Question 28

Safeguarding

Question 29

Paediatric emergency doses

Answer 29

Anaphylaxis:
* Adults and >12 years: 0.5mg (0.5ml of 1 in 1000) adrenaline IM
* > 12 years (if small): 0.3mg (0.3ml of 1 in 1000)
* 6-12 years: 0.3mg (0.3ml of 1 in 1000)
* Up to 6 years: 0.15mg (0.15ml of 1 in 1000)

Meningitis:
* Adults and >10 years: 1.2g Benzylpenicillin IM/IV
* 1-9 years: 600mg Benzylpenicillin IM/IV
* <1 years: 300mg Benzylpenicillin IM/IV