Paediatrics 1B

Question 1

State an example of an antibiotic regimen that may be used to eliminate H. pylori.

Answer 1

Amoxicillin + metronidazole/clarithromycin
This is given as a 7-day triple therapy with a PPI

Question 2

How are the maintenance fluid values for children calculated?

Answer 2

• 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

Question 3

How is the amount of fluid required when giving a bolus to a child calculated?

Answer 3

20 ml/kg of NaCl in < 10 mins

NOTE: use 10 mL/kg if DKA, trauma, fluid overload or heart failure

Question 4

What precaution must be taken when rehydrating a child with hypernatraemic dehydration?

Answer 4

Replace fluid deficit over 48 hours and measure plasma sodium regularly
Rapid reduction in plasma sodium can lead to seizures and cerebral oedema

Question 5

What should be monitored in children with Coeliac disease?

Answer 5

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

Question 6

Management for UC?

Answer 6

Mild disease

• First line: aminosalicylate (e.g. mesalazine rectal suppository initially PO if no remission within 4 weeks)
• continue as maintenance if no relapse
• relapse: oral prednisolone and taper - if relapse with steroids = steroid dependent disease

Moderate disease

• oral prednisolone for 2-4 weeks and taper
• if good response –> oral mesalazine and continue for maintenance
• if relapse frequent = steroid dependent disease
• if bad response to oral prednisolone –> IV. taper off to oral and maintain remission

Steroid dependent disease

• thiopurine or infliximab

Severe disease

• medical emergency
• high dose IV methylprednisolone
• stop oral 5-ASA
• antibiotics if bacteraemia

Support: Crohns and Colitis UK

Question 7

How is severe fulminating disease in UC managed?

Answer 7

IV methylprednisolone (induce remission)

stop oral 5-ASA
Surgery - colectomy with ileostomy or IJ pouch

Question 8

What is a major risk of UC and how are patient’s monitored for it?

Answer 8

UC is associated with bowel cancer
Regular colonoscopic screening performed after 10 years of diagnosis

Question 9

How is constipation with faecal impaction treated?

Answer 9

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)

Question 10

How are anal fissures in children treated?

Answer 10

• 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

Question 11

How is threadworm infection treated?

Answer 11

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

Question 12

Which antibiotic is used in the management of bacterial meningitis in hospital?

Answer 12

IV ceftriaxone
N. meningitidis - 7 days
H. influenzae - 10 days
S. pneumoniae - 14 days

Question 13

Which antibiotics might you use in a patient with bacterial meningitis who has a severe beta-lactam allergy?

Answer 13

Vancomycin and moxifloxacin

Question 14

How should a patient with bacterial meningitis be followed-up?

Answer 14

All children should be reviewed by a paediatrician 4-6 weeks after discharge

There can sometimes be long term complications, the most common is hearing loss –> offer formal audiological assessment

Treat contacts: ciprofloxacin (anyone in close contact in the last 7 days)

Support: Meningitis Now

Question 15

How is HSV encephalitis treated?

Answer 15

High-dose IV aciclovir for 3 weeks

Question 16

How is toxic shock syndrome managed?

Answer 16

Intensive care unit: IV fluids, antibiotics, vasopressor support
Surgical debridement of infected tissue
Start clindamycin (stops toxin production) and either vancomycin or meropenem before cultures return
example regime = clindamycin and vancomycin

Question 17

How is impetigo treated?

Answer 17

Localised non-bullous infection = hydrogen peroxide 1% cream. if unsuitable - topical fusidic acid 2% for 5 days
Extensive or bullous Infection = oral flucloxacillin (QDS for 7 days)
Clarithromycin if penicillin allergy

Arrange followup if no improvement after 7 days: review diagnosis, check compliance with treatment and hygiene measures, take a swab, consider PO abx if fusidic acid was used

Question 18

How is periorbital cellulitis treated?

Answer 18

High-dose IV ceftriaxone

Question 19

When is a child with chickenpox considered infectious?

Answer 19

Most infectious 1-2 days before the rash
Infectious until all the lesions have crusted over (usually 5 days after onset)

Question 20

Which groups of patients should children with chickenpox avoid?

Answer 20

Pregnant women
People who are immunocompromised
Infants < 4 weeks old
NOTE: avoid school until lesions have crusted over

Question 21

What must young people with EBV avoid doing?

Answer 21

kissing, sharing utensils, heavy lifting, contact sports

Question 22

Which medications are occasionally used to treat CMV infection?

Answer 22

IV ganciclovir
Oral valganciclovir
Foscarnet

Question 23

How long should a child stay away from school for after measles infection?

Answer 23

4 days after rash onset

Question 24

How long should a child stay away from school for after mumps infection?

Answer 24

5 days after the development of parotitis