Paediatrics 1B Flashcards
State an example of an antibiotic regimen that may be used to eliminate H. pylori.
Amoxicillin + metronidazole/clarithromycin
This is given as a 7-day triple therapy with a PPI
How are the maintenance fluid values for children calculated?
- 100 mL/kg/day for the first 10 kg of weight
- 50 mL/kg/day for the second 10 kg of weight
- 20 mL/kg/day for the weight over 20 kg
How is the amount of fluid required when giving a bolus to a child calculated?
20 ml/kg of NaCl in < 10 mins
NOTE: use 10 mL/kg if DKA, trauma, fluid overload or heart failure
What precaution must be taken when rehydrating a child with hypernatraemic dehydration?
Replace fluid deficit over 48 hours and measure plasma sodium regularly
Rapid reduction in plasma sodium can lead to seizures and cerebral oedema
What should be monitored in children with Coeliac disease?
Annual review
Weight, height and BMI
Review symptoms
Review diet and adherence
Consider blood tests (coeliac serology, FBC, TFT, LFT, vitamin D, B12, folate, calcium, U&E)
If concerns, bone mineral density (DEXA scan) should be evaluated
Management for UC?
Mild to moderate disease
First line: aminosalicylate (e.g. mesalazine oral or rectal)
Second line: corticosteroids (e.g. prednisolone)
Severe disease
First line: IV corticosteroids (e.g. hydrocortisone)
Second line: IV ciclosporin
Maintaining Remission
Aminosalicylate (e.g. mesalazine oral or rectal)
Azathioprine
Mercaptopurine
How is severe fulminating disease in UC managed?
IV corticosteroids (induce remission)
Consider IV ciclosporin
Surgery - colectomy with ileostomy or IJ pouch
What is a major risk of UC and how are patient’s monitored for it?
UC is associated with bowel cancer
Regular colonoscopic screening performed after 10 years of diagnosis
How is constipation with faecal impaction treated?
1 - DISIMPACTION REGIME
Movicol Paediatric Plain
If not effective after 2 weeks - add senna
If not tolerated - senna + lactulose
2 - MAINTENANCE LAXATIVES
Movicol with or without senna (carry on for several months and titrate dose based on stools )
3 - BEHAVIOURAL METHODS (e.g. star charts)
How are anal fissures in children treated?
- Ensure stools are soft and easy to pass
- Increase dietary fibre (include foods containing whole grains, fruits and vegetables)
- Increase fluid intake
- Consider constipation treatment: lactulose, macrogol/movicol
- Stool softeners
- Manage pain
- Glyceryl trinitrate intra-anally
- Offer simple analgesia (paracetamol or ibuprofen)
- Sitting in a shallow, warm bath can help relieve the pain
- Lifestyle
- Advise on the importance of anal hygiene
- Advise against stool withholding
- Advise the parents that if it has NOT healed after 2 weeks or the child remains in a great deal of pain, they should seek help
- Keep in mind the possibility of sexual abuse
How is threadworm infection treated?
If > 6 months: single dose mebendazole for child and all household contacts and hygiene measures (for 2 weeks)
If < 6 months: 6 weeks of hygiene measures
Which antibiotic is used in the management of bacterial meningitis in hospital?
IV ceftriaxone
N. meningitidis - 7 days
H. influenzae - 10 days
S. pneumoniae - 14 days
Which antibiotics might you use in a patient with bacterial meningitis who has a severe beta-lactam allergy?
Vancomycin and moxifloxacin
How should a patient with bacterial meningitis be followed-up?
Discuss potential long-term effects and pattern of recovery (e.g. hearing problems)
Offer formal audiological assessment
Consider testing for complement deficiency if more than one episode of meningococcal septicaemia
How is HSV encephalitis treated?
High-dose IV aciclovir for 3 weeks
