Paeds

Question 1

Outline the management of an acute exacerbation of asthma

Answer 1

1. BURST: 10 puffs of salbutamol with spacer OR 3 doses of salbutomol nebs
2. Add iprabopium bromide to nebs if needed
3. CALL SENIOR HELP
4. BOLUS: IV MgSO4
5. IV: aminophylline or IV salbutomol
6. PANIC: I+V

F/U:
Admit and only d/c when salbutamol is stretched to 4h
Assess medication and inhalor technique
Safety net 
GP f/u within 2 days

SAFETY NET

Question 2

What investigations would you do for West Syndrome?

Answer 2

Bedside: Neuro exam, GI Exam, Woods lamp test for ash leaf patch, look for hyperpigmented skin lesions, rough skin on pt back, angiofibromata butterfly rash on face, developmental assessment (tuberous sclerosis)

Bloods: FBC, U+Es, Glucose
Imaging: MRI, EEG

Question 3

What is the management of West syndrome?

Answer 3

1. Daily ACTH injection
2. Vigabatrin

Overall poor prognosis, risk of seizures in later childhood and learning difficulties

Question 4

Outline the management of anaphalxis

Answer 4

A - swelling, hoarse, stridor
B - high RR
C - SpO2 <92%
Skin - urticaria, angioedema

1. IM adrenaline 1:1000 in thigh, repeat after 5mins if if needed
2. high flow O2 non-rebreathe mask
3. IM/slow IV chlorpheniramine 10mg
4. IM/slow IV hydrocortisone
5. Salbutomol

Monitoring:
Serial mast tryptase, ECG, Obs

Question 5

What is the distrubtion of eczema by age?

Answer 5

Babies: head/neck/trunk
Younger children: extensor surfaces
Older children: flexor surfaces

Question 6

Management of DKA

Answer 6

1. Fluid bolus: 20ml/kg if shocked, 10ml/kg if non shocked
2. Deficit fluids: % weight loss x 200 (- non-shocked bolus)/48h
3. Maintainence fluids: first 10 = 100ml/kg, second 10 = 50ml/kg, everything after 20kg 20ml/kg
4. Insulin after 1-2h
5. Dextrose when glucose is <14mmol/L
6. SandoK/pottassium if <3mmol/L

Question 7

What are the signs/symptoms of a SOL?

Answer 7

BAN HENS
Blurred vision
Ataxia
Nystagmus

Headache
Endocrine dysfunction
Nausea and vomiting
Squint (6th nerve palsy)

Question 8

List some red flags of a SOL

Answer 8

Worse when lying down or with coughing/straining
Headache wakes up child from sleep
Assoc confusion, morning/persistent nausea and vomiting
Recent change in personality, behaviour or educational performance
Developmental delay
Seizures

Question 9

Outline the management of T21

Answer 9

AT BIRTH
Echo for AVSD
paediatric evaluation (duodenal atresia)

GENERALLY
annual hearing test
annul TFTs
annual eye tests 
education plan
Hb
Monitor for for OSA
Monior growth