Paeds 1 Flashcards
When is the 6 in 1 vaccine given?
2, 3 and 4 months
When is the pneumococcus vaccine given?
2, 4 and 12 months
When is the Men B vaccine given?
2, 4 and 12 months
When is the rotavirus vaccine given?
2 and 3 months
When is the Hib/MenC booster given?
1 year
When is the MMR given?
1 year and 3 years 4 months
When is the HPV vaccine given?
12-13 years
When is the Men ACWY vaccine given?
14 years
New university students aged 19-25
Outline the management of DDH.
If < 2 months, observation and serial examination and ultrasound is recommended (every months)
If it persists/worsens, hip abduction orthosis (splint) or Pavlik harness are recommended (serial follow-up and plain X-ray at 6 months)
Outline how hearing is tested in the neonate.
1st: evoked otoacoustic emission (EOEA) testing
If this is abnormal –> automated auditory brain stem (AABR) audiometry
Briefly outline the steps in the management of necrotising enterocolitis.
Stop oral feeding
Broad spectrum antibiotics (ceftriaxone and vancomycin)
Surgery if perforation/necrosis
TPN
What can be used to close a PDA?
IV indomethacin
Prostacyclin synthetase inhibitor
Ibuprofen
How is the bilirubin concentration measured in neonatal jaundice?
If < 24 hours or < 35 weeks gestation = serum bilirubin
If > 24 hours or > 35 weeks gestation = transcutaneous bilirubin (if this is > 250 µmol/L - check serum bilirubin)
What serum bilirubin levels suggests increased risk of developing kernicterus?
> 340 µmol/L in babies > 37 weeks
or rising rapidly > 8.5 µmol/L/hr
How often should serum bilirubin be measured in a neonate with jaundice?
Every 6 hours until it drops below the treatment threshold
Which investigations should be performed in a neonate who developed jaundice within 24 hours of birth?
Haematocrit Blood group of mother and baby DAT test FBC and blood film Blood G6PD level Blood/urine/CSF culture
Which antibiotics are used to treat meconium aspiration?
IV ampicillin and gentamicin
Which antibiotics may be used in the treatment of early-onset sepsis?
Benzylpenicillin and gentamicin
Which organism most commonly causes late-onset sepsis?
Coagulase-negative staphylococcus (e.g. Staphylococcus epidermidis)
How is neonatal meningitis treated?
3rd generation cephalosporin + amoxicillin/ampicillin
What is the paediatric sepsis 6?
- Supplemental oxygen
- Gain IV or IO access and order blood cultures, blood glucose and arterial/capillary/venous gasses
- IV/IO broad-spectrum antibiotics
- IV fluids (be cautious about fluid overload)
- Experienced senior clinicians should be involved early
- Vasoactive inotropic support (e.g. adrenaline) should be considered early
a. Considered if normal physiological parameters are NOT achieved after > 40 ml/kg of fluid resuscitation
How should neonatal conjunctivitis be treated?
Discharge and redness (staph or strep) - topical ointment (e.g. neomycin)
Gonococcus - 3rd generation cephalosporin
Chlamydia - erythromycin (2 weeks)
What should babies at risk of vertical hepatitis B transmission receive?
Hepatitis B immunoglobulin AND Hep B vaccine
How is gastro-oesophageal reflux in a breastfed infant treated?
1st line: Breastfeeding assessment
2nd line: trial of alginate therapy for 1-2 weeks
How is gastro-oesophageal reflux in a formula fed infant treated?
1st line: review feeding history (check for overfeeding)
2nd line: offer trial of smaller more frequent feeds
3rd line: offer trial of thickened formula
4th line: offer trial of alginate therapy
If conservative measures to treat GORD in an infant fail, what should you do?
Consider a 4-week trial of a PPI or histamine antagonist
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?
0-10 kg = 100 ml/kg/day
10-20 kg = 1000 mL + 50 ml/kg/day
20+ kg = 1500 mL + 20 ml/kg/day
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
What are the management options in a UC patient with:
Mild proctitis
Mild left-sided and extensive disease
Maintaining remission
Mild proctitis
- Oral/topical aminosalicylates
Mild left-sided and extensive disease
- Oral aminosalicylates (consider topical aminosalicylate or oral steroid)
Maintaining remission
- Aminosalicylates
- Consider oral azathioprine or mercaptopurine
NOTE: if aminosalicylates are ineffective after 4 weeks, consider adding oral prednisolone (if this is ineffective, consider oral tacrolimus)
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 - 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 ease of passing stool (consider constipation treatment, advise increase in fluid intake and dietary fibre)
Offer simple analgesia
Advise sitting in a shallow, warm bath to reduce discomfort
Adult treatments (topical diltiazem or GTN)
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
How is toxic shock syndrome managed?
ICU Surgical debridement of infected tissue Clindamycin (stops toxin production) Vancomycin or meropenem IVIG (neutralise the toxin)
How is impetigo treated?
Localised infection = topical fusidic acid (3-4/day for 7 days)
Extensive Infection = oral flucloxacillin (QDS for 7 days)
Clarithromycin if penicillin allergy
How is periorbital cellulitis treated?
High-dose IV ceftriaxone
When is a child with chickenpox considered infectious?
Most infectious 1-2 days before the rash
Infectious until all the lesions have crusted over (usually 5 days after onset)
Which groups of patients should children with chickenpox avoid?
Pregnant women
People who are immunocompromised
Infants < 4 weeks old
NOTE: avoid school until lesions have crusted over
What must young people with EBV avoid doing?
Contact sports
Which medications are occasionally used to treat CMV infection?
IV ganciclovir
Oral valganciclovir
Foscarnet
How long should a child stay away from school for after measles infection?
4 days after rash onset
How long should a child stay away from school for after mumps infection?
5 days after the development of parotitis
