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paeds Flashcards

1
Q

SIDS five main risk factors

A
  1. prone sleeping
  2. parental smoking
  3. bed sharing
  4. hyperthermia and head covering
  5. prematurity
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2
Q

Treatment for baby with GORD (regurgitates and gags during feeds)

A
  1. Breastfed infants - 1-2 week trial of alginate e.g. Gavison
  2. Bottlefed infants - 1-2 week trial of feed thickener
  3. Then 4 week trial of omeprazole if no improvement
  4. Refer to paeds if none above work
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3
Q

A formula fed infant with GORD should have feeds reduced to

A

150ml/kg per day

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4
Q

treatment for head lice

A

malathion

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5
Q

children with head lice - do they need to be excluded from school

A

no!

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6
Q

How do you work out the corrected age of a premature baby when working out milestone ages

A

The age minus the number of weeks he/she was born early from 40 weeks

e.g. born prematurely at 32 weeks
- normal milestone to smile = 6 weeks
- for this premature baby = 40-32 = 8, then add on 6 = 14 weeks is their milestone

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7
Q

NICE suggest what regarding chickenpox and school exclusion and infectivity in relation to the rash

A

Most infectious period is 1-2 days before rash appears
Infectivity continues until all lesions are dry and crusted over, usually about 5 days after rash onset

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8
Q

IM benzylpenicillin doses for meningococcal septicaemia for:
(a) <1 year
(b) 1-10 years
(c) >10 years

A

(a) <1 year = 300mg
(b) 1-10 years = 600mg
(c) >10 years = 1200mg

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9
Q

When should premature babies have their vaccines - at normal timetable, or delayed (correct for gestational age)

A

AT NORMAL TIMETABLEq

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10
Q

maintenance and reliever therapy (MART) inhalers are combination of what two

A

LABA + ICS

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11
Q

treatment of asthma in kids aged 5-16

A
  1. SABA
  2. SABA + low dose ICS
  3. SABA + low dose ICS + LTRA
  4. SABA + low dose ICS + LABA
  5. SABA + MART (contains ICS + LABA)
  6. SABA + moderate dose ICS MART
  7. SABA + high dose ICS MART, theophylline, asthma specialist!
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12
Q

Children 15:2 chest compressions to rescure breaths
What speed should chest compressions be for kids

A

100-120/min

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13
Q

Babies with absent or weak femoral pulses at 6-8 week baby check - what should you do

A

Discuss immediately with paeds

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14
Q

what are 3 cyanotic congenital heart diseases (right to left shunt)

A
  1. tetralogy of Fallot
  2. transposition of great arteries
  3. tricuspid atresia
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15
Q

what are 5 acyanotic congenital heart diseases (left to right shunt)

A
  1. ventricular septal defect
  2. atrial septal defect
  3. patent ductus arteriosis
  4. coarctation of aorta
  5. aortic valve stenosis
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16
Q

first line medication option for ADHD

A

methylphenidate

if inadequate response, switch to lisdexamfetamine

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17
Q

NICE do not recommend a proton pump inhibitor (PPI) to treat overt regurgitation in infants and children occurring as an isolated symptom. A trial of one of these agents should be considered if 1 or more of the following apply:

A
  1. unexplained feeding issues e.g. refusing feeds, gagging or choking
  2. distressed behaviour
  3. faltering growth
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18
Q

When should kids have an USS urinary tract with UTIs:

A
  • <6 months with UTI should have USS within 6 weeks
  • > 6 months who have an atypical or recurrent UTI
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19
Q

what scan can be done in children after UTI to identify renal scars

A

Static radioisotope scan e.g. DMSA
4-6 months after initial infection

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20
Q

what scan can be done in children after UTI (atypical or recurrent infections) to identify vesicoureteric reflux

A

micturating cystourethrography (MCUG)

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21
Q

what cardiac issue occurs with Kawasaki’s disease

A

coronary artery aneurysms

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22
Q

Traetment for Kawasaki disease

A

High dose aspirin
IvIg
Echocardiogram - initial screening test for coronary artery aneurysms

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23
Q

High-grade fever > 5 days
Conjunctival injection
Bright red, cracked lips
Strawberry tongue
Red hands + feet with desquamation that peels

what is the diagnosis

A

Kawasaki disease

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24
Q

bronchiolitis is usually caused by what pathogen in 80% of cases

A

respiratory syncytial virus (RSV)

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25
Q

fine inspiratory crackles can be found in what common lower respiratory tract infection in those aged <1 year with acute bronchiolar inflammation

A

bronchiolitis!

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26
Q

Majority of labial adhesions (fusion of labia minora in midline) are symptomatic and spontaneously resolve in puberty. 2 complications that can occur and treatment for that are:

A
  1. problems with micturition with pooling in vagina - this can be managed with oestrogen cream for 6 weeks then emollient
  2. adhesions

if cream fails, then surgical intervention may be warranted

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27
Q

if a child has measles how long do they need to be kept off school for - in relation to their rash

A

keep off school for 4 days from onset of rash

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28
Q

when can chickenpox go back to school in relation to the rash

A

the most infectious period is 1-2 days before the rash appears, but infectivity continues until all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash).

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29
Q

Nose bleeds under what age is rare and need urgent paeds referral for trauma/ bleeding disorders?

A

Under age 2

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30
Q

‘Beefy red’ well-defined patches, involves the flexures, satellite regions on baby’s bum suggest

A

Candida/thrush cause of nappy rash
Rx: Topical antifungals (imidazole). Stop barrier creams until candida has settled.

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31
Q

what pathogen causes croup

A

parainfluenza viruses

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32
Q

stridor
barking cough (worse at night)
fever

what is the diagnosis

A

croup

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33
Q

Mild croup criteria

A

Occasional barking cough
No stridor at rest
No intercostal recession
The child is happy

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34
Q

Moderate croup criteria

A

Frequent barking cough
Stridor at rest
Some intercostal recession
No agitation
The child is happy

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35
Q

Severe croup criteria

A

Frequent barking cough
Stridor at rest
Marked intercostal recession
Significant distress or lethargy
Tachycardia, hypoxaemia

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36
Q

NICE suggest admission for children with what three criteria in croup

A
  1. Moderate or severe croup
  2. < 6 months of age
  3. Known upper airway abnormalities e.g. Downs, larynomalacia
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37
Q

chest x-ray in croup may show what sign in posterior-anterior view

A

steeple sign
i.e. subglottic narrowing

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38
Q

CXR lateral view in acute epiglottitis may show what sign

A

thumb sign
i.e. swelling of epiglottis

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39
Q

management of croup and dose
and alternative Rx, emergency Rx

A
  1. oral dexamethasone 0.15mg/kg
  2. prednisolone is dexamethasone is not available

emergency Rx = high flow oxygen and nebulised adrenaline

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40
Q

non-IgE mediated allergies tend to affect which two bodily systems

A
  1. skin
  2. gastrointestinal system
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41
Q

If there is history suggestive of IgE-mediated allergy (symptoms in skin, GI tract, resp, anaphylaxis), what should be offered?

A

Skin prick test
Or blood tests specific IgE antibodies to suspected allergens

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42
Q

If history is suggested of a non-IgE food mediated allergy, what should be offered?

A

Eliminate the suspected allergy for 2-6 weeks
Then reintroduce
NICE advises to consult with a dietitian for follow up

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43
Q

Treatment for threadworms (for patients >6 months old)

A

Mebendazole

Single dose for patient + household members

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44
Q

what 3 bone marrow failure effects are seen with acute lymphoblastic leukaemia

A
  1. anaemia - lethargy, pallor
  2. thrombocytopenia - easy bruising, bleeding
  3. neutropenia - infections
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45
Q

what is the peak incidence of age of acute lymphoblastic leukaemia (the commonest childhood cancer)

A

peak incident 2-5 years

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46
Q

A 14-month-old girl is diagnosed as having roseola infantum. What is the most common complication of this disease?

A

Febrile seizures

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47
Q

Roseola infantum aka sixth disease is caused by what pathogen

A

HHV6 - sixth! disease

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48
Q

5 vision issues that is seen in Down’s syndrome

A
  1. refractive errors
  2. strabismus - squint
  3. cataracts
  4. recurrent blepharitis
  5. glaucoma
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49
Q

What 3 reasons would infants need a routine ultrasound examination to screen for developmental dysplasia of the hip?

A
  1. First degree family history of hip issues
  2. Breech after 36 weeks GA
  3. Multiple pregnancy
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50
Q

Clinical examination uses Barlow and Ortolani test to look for developmental dysplasia of the hip. What do these do?

A

Barlow test - dislocates articulated femoral head
Ortolani test - relocates dislocated femoral head

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51
Q

What imaging is done to confirm clinical suspicion of developmental dysplasia at what ages

A

Ultrasound if <4.5 months
X-ray if >4.5 months

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52
Q

treatment of developmental dysplasia of hip

A

most spontaneously stabilise by 3-6 weeks of age

Pavlik harness (dynamic flexion-abduction orthosis) in children younger than 4-5 months

Older children may need surgery

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53
Q

what type of primary headache is the most common in children

A

migraine without aura

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54
Q

paediatric migraine treatment

A
  1. ibuprofen > paracetamol
  2. over 12 years, sumatriptan nasal spray
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55
Q

paediatric migraine prophylaxis

A

pizotifen and propranolol

2nd line = valproate, topiramate, amitryptilline

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56
Q

what is first line replacement formula for infants with CMPA with mild to moderate symptoms if the baby is formula fed

A

extensive hydrolysed formula milk

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57
Q

what is second line replacement formula for infants with CMPA i.e. if they have severe CMPA or no response to first line (extensive hydrolysed formula) if the baby is formula fed

A

amino acid based formula

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58
Q

management of CMPA if breastfed

A
  1. continue breastfeeding
  2. eliminate cows milk protein of mum’s diet + supplement Ca
  3. use eHF milk when breastfeeding stops - until 12 months of age, and at least for 6 months
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59
Q

Alpha-thalassaemia is due to a deficiency of

A

alpha chains in haemoglobin

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60
Q

Clinical severity of alpha-thalassaemia depends on the number of alpha-globulin alleles affected.
What happens if:
(a) 1 or 2 allele are affected
(b) 3 alleles are affected
(c) 4 alleles (homozygote) are affected

A

(a) 1 or 2 allele - hypochromic, microcytic, normal Hb
(b) 3 alleles are affected - hypochromic microcytic anaemia with splenomegaly. HbH disease.
(c) 4 alleles (homozygote) are affected - death in utero, hydrops fetalis

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61
Q

Paeds BLS
Number of rescue breaths
And then chest compression to rescue breathe ratio?

A

5 rescure breaths
15:2 chest compressions to rescue breaths

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62
Q

precocious puberty is the development of secondary sexual characteristics at what age for females and males

A

before 8 years in females
before 9 years in males

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63
Q

achondroplasia - what is the mode of inheritance

A

autosomal dominant

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64
Q

side effects of MMR vaccine

A

malaise, fever, rash
usually after 5-10 days and lasts approx 2-3 days

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65
Q

constipation in children - what laxative treatment

A
  1. movicol
  2. add senna
  3. switch to lactulose if no response
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66
Q

A child with scarlet fever can return to school when…?

A

24 hours after starting antibiotics

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67
Q

what pathogen causes scarlet fever

A

group A haemolytic streptococci

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68
Q

patients with scarlet fever (caused by group A strep) who are allergic to penicillin can have what treatment

A

azithromycin

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69
Q

what is the most common complication of scarlet fever (group A strep)

A

otitis media

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70
Q

is scarlet fever a notifiable disease

A

yes

24 hours off school after starting antibiotics

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71
Q

A newborn baby is noted to have low-set ears, rocker bottom feet and overlapping of her fingers. What is the most likely diagnosis?

A

Edward’s syndrome

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72
Q

Macrocephaly
Long face
Large ears
Macro-orchidism

what is the diagnosis

A

fragile X syndrome

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73
Q

what trisomy is Edward’s syndrome

A

trisomy 18

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74
Q

cleft lip or palate, polydactyly (extra digits), microphthalmia (small eyes), scalp defects, and congenital heart disease

what is the disease and trisomy

A

Patau’s syndrome
Trisomy 13

75
Q

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

what is the diagnosis

A

noonan syndrome

76
Q

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

what is the diagnosis

A

Pierre-Robin syndrome

77
Q

Short stature
Learning difficulties
Friendly, extrovert personality
Transient neonatal hypercalcaemia
Supravalvular aortic stenosis

what is the diagnosis

A

william’s syndrome

78
Q

child with fever followed later by rash
febrile seizures common

what is the diagnosis

A

Roseola infantum
sixth disease - HHV6!

79
Q

Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the four following features:

A
  1. paroxysmal cough
  2. inspiratory whoop
  3. post-tussive vomiting
  4. undiagnosed apnoeic attacks in young infants
80
Q

what is the diagnostic test for whooping cough

A

nasal swab culture for Bordetella pertussis

81
Q

three clinical signs of prodomal phase of measles

A

Irritable
Conjunctivitis
Fever

82
Q

how many cases of laryngomalacia self-resolve

A

99% by 18-24 months

82
Q

if a child not immunized against measles comes into contact with measles what should be offered

A

MMR vaccine
give within 72 hours

repeat dose to be given in 3 months

83
Q

what is caused by parvovirus B19

A

erythema infectiosum
fifth disease
slapped cheek syndrome

84
Q

erythema infectiosum
fifth disease
slapped cheek syndrome

is caused by which pathogen

A

parvovirus b19

85
Q

At what age would the average child be expected to have visual acuity similar to that of an adult?

A

2 years

86
Q

papular enanthem on the uvula and soft palate in roseola infantum (HHV-6 sixth disease) are called

A

Nagayama spots

87
Q

Cystic Fibrosis nutritional guidelines recommend what diet for patients

A

High calorie
High fat
Pancreatic enzyme supplementation for every meal

88
Q

Management of cystic fibrosis

A
  1. regular (at least twice daily) chest physio + postural drainage
  2. high fat, high calorie diet
  3. pancreatic enzyme supplements with meals
  4. vitamin supplementation
  5. avoid hanging out with other CF patients
  6. lung transplant
  7. lumacaftor/ivacaftor (orkambi)
89
Q

what are the two medications that can be used to treat homozygous cystic fibrosis delta F508 mutation patients

A

lumacaftor
ivacaftor

90
Q

retinoblastoma average age of diagnosis

A

18 months

91
Q

mode of inhertiance of retinoblastoma

A

autosomal dominant

92
Q

features of retinoblastoma

A

absence of red reflex
strabismis
visual problems

93
Q

prognosis of retinoblastoma

A

excellent
>90% survive into adulthood

94
Q

Parents should be advised to call an ambulance if a febrile convulsion lasts longer than…

A

5 minutes

95
Q

obesity /weight is measured in children using what tools

A

BMI percentile charts

96
Q

5 causes of obesity in childrn

A

GH deficiency
hypothyroidism
Down’s syndrome
Cushing’s syndrome
Prader-Willi syndrome

97
Q

Congenital rubella results in what developmental issues

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease e.g. PDA
Glaucoma

98
Q

what is the most common congenital infection in the UK

A

cytomegalovirus

99
Q

when is the Guthrie test/heel prick test done

A

5-9 days of life

100
Q

Guthrie test/neonatal blood spot heel prick test is usually done at 5-9 days of life. what is screened for?

A

hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
MCADD
MSUD
HCU, GA1, IVA

101
Q

wetting the bed (enuresis) is considered abnormal in age older than what

A

5 years or older

102
Q

management of enuresis (wetting the bed if age 5 and over)

A
  1. reward systems - for agreed behaviour, NOT dry nights
  2. enuresis alarms
  3. desmopressin
103
Q

moderate asthma attack criteria

A

SaO2 >92%
PEFR <50% best (not included if <5 years)
no clinical features

104
Q

severe asthma attack criteria

A

SaO2 <92%
PEFR 33-50% best or predicted (not included if <5 years)
cannot complete sentences
HR >125 (or >140 if <5 years)
RR >30 (or >40 if <5 years)
using accessory neck muscles

105
Q

life-threatening attack in asthma

A

SaO2 <92%
(PEFR <33% best) - not a criteria for <5 years
silent chest
low GCS
cyanosis

106
Q

management of children with mild to moderate acute attack of asthma

A

B-2 agonist (salbutamol) via spacer
1 puff every 30-60 seconds up to maximum of 10 puffs

If not controlled, repeat above and refer to hospital

+ steroids for 3-5 days

107
Q

What is the most useful investigation to screen for the complications of Kawasaki disease?

A

echocardiogram

108
Q

What is the first sign of puberty in boys?

A

Increased testicular volume

109
Q

What is the first sign of puberty in girls?

A

breast development

110
Q

how long should children be excluded from school with scarlet fever

A

24 hours after starting antibiotics

scarlet fever is a notifiable disease

111
Q

how long should children be excluded from school with impetigo

A

48 hours after starting antibiotics OR until all lesions are crusted and healed

112
Q

how long should children be excluded from school with hand foot mouth disease

A

no exclusion

113
Q

how long should children be excluded from school with mumps

A

5 days from onset of swollen glands

114
Q

how long should children be excluded from school with rubella

A

5 days from onset of rash

115
Q

what pathogen causes scarlet fever

A

group A haemolytic strep

usually strep pyogenes

116
Q

management of scarlet fever

A
  1. 10 day course of oral pen V
  2. Penicillin allergy - azithromycin

Throat swab - but start Abx beforehand
Children can return to school after 24 hours of starting Abx

117
Q

What is the most common complication of scarlet fever

A

otitis media

118
Q

Management of autism

A
  1. Early educational and behaviour interventions
    - applied behavioural analysis, ASD preschool, teaching
  2. Medication - SSRIs, antipsychotics, methylphenidate for ADHD
  3. Family support and counselling
119
Q

Croup management

A

single dose of oral dexamethasone (0.15mg/kg)

given immediately regardless of severity

Emergency Rx = high-flow oxygen and nebulised adrenaline

120
Q

if oral dexamethasone is not available for croup, what is second line

A

prednisolone 1-2mg/kg

this may need to be repeated 24 hours later

121
Q

what pathogen causes croup

A

parainfluenza viruses

122
Q

Mild croup criteria

A
  • occasional barking cough
  • no stridor at rest
  • no intercostal recession
  • happy child
123
Q

Moderate croup criteria

A
  • frequent barking cough
  • stridor at rest
  • intercostal recession
  • no distress
  • child is still interested in surroundings
124
Q

Severe croup criteria

A
  • frequency barking cough
  • lots of stridor at rest
  • sternal wall retractions
  • significant distress or tiredness
  • tachycardia
125
Q

When should you admit a child with croup?

A
  • Moderate or severe croup criteria
  • <6 months of age
  • Known upper airway abnormalities e.g. down’s syndrome, laryngomalacia
  • Uncertainty about diagnosis
126
Q

Most croup is diagnosed clinically. if a chest x-ray is done, what sign can it show

A

steeple sign = subglottic narrowing

127
Q

what sign is seen on lateral view in acute epiglottis on chest x-ray

A

thumb sign = swelling of epiglottis

128
Q

Mum having a baby with Down’s syndrome risk for age 20, 30, 35, 40, 45

A
  • 20 = 1 in 1500 risk
  • 30 = 1 in 800 risk
  • 35 = 1 in 270 risk
  • 40 = 1 in 100 risk
  • 45 = 1 in 50 or greater
129
Q

94% of Down’s syndrome cases are due to what mode of cytogenetics

A

Non-disjunction - this is a 1 in 100 risk of recurrence if mother <35 years

Translocation is 5%

130
Q

Which childhood syndrome condition is most strongly associated with supravalvular aortic stenosis?

A

William’s syndrome

131
Q

Asthma in children: prednisolone dose

A

1-2 mg/kg od for 3-5 days

132
Q

how long does a patient need to stay off school for whooping cough

A

48 hours after starting Abx
Or 21 days from start of symptoms if no Abx

133
Q

phimosis (non-retracting foreskin or during micturition in a child) treatment if:
(a) under 2 years
(b) older than 2 years

A

(a) under 2 = physiological, self-resolves
(b) older than 2, or recurrent UTI or balanoposthitis, then treat

134
Q

febrile convulsions occur between ages of ..

A

6 months and 5 years

seen in 3% of children

135
Q

what test is used to screen newborns for hearing problems

A

otoacoustic emission

136
Q

3 innocent murmurs

A
  1. ejection murmurs - due to turbulent blood flow at outflow tract of heart
  2. venous hums - blood in great veins returning to heart, continuous blowing noise
  3. Still’s murmur - low pitched sound at lower left sternal edge
137
Q

are systolic or diastolic murmurs typically more innocent murmurs

A

systolic = innocent

138
Q

Babies found to have bilateral undescended testes at the newborn examination should have what referral

A

Review by senior paediatrician within 1 day

may be associated with endocrine disorder e.g. CAH

139
Q

average age of puberty in males and females

A

males - 12 years
females - 11.5 years

140
Q

if a child has recently been given another live attenuated vaccine, there should be a minimum gap of how long before MMR vaccine is given?

A

4 weeks

141
Q

small, white, keratin-filled cysts that can appear on the gums or the roof of a newborn baby’s mouth. what is the diagnosis

A

epstein’s pearl

142
Q

turner’s syndrome what chromosome abnormality

A

45 XO

143
Q

If a newborn baby has an abnormal otoacoustic emission hearing test at birth they are offered what test

A

the auditory brainstem response test

144
Q

Unilateral undescended testicle - what is management

A

review at age 3 months
if persistent - then refer

145
Q

Fever of over 38 degrees is very common with the Meningitis B vaccine, and it is advised that infants should receive what medication

A

three doses of paracetamol routinely to prevent it developing; the first dose given as soon as possible post-vaccination

146
Q

commonest cause of nephrotic syndrome in children

A

minimal change glomerulonephritis

147
Q

blood stained stool, ‘red-currant jelly’
sausage shaped mass in RUQ

is seen with what diagnosis

A

intussusception

USS shows a target like mass

148
Q

treatment of intussusception

A
  • reduction by air insufflation
  • if signs of peritonitis or above fails, surgery
149
Q

How much oral rehydration therapy should be given over 4 hours on top of usual maintenance fluids?

A

50ml/kg

150
Q

4 central causes of hypotonia in baby

A

Down’s syndrome
Prader-willi syndrome
hypothyroidism
cerebral palsy

151
Q

All breech babies at or after 36 weeks gestation require USS for DDH screening when?

A

at 6 weeks regardless of mode of delivery

152
Q

how much simple emollients should be given for eczema

A

large quantities e.g. 250g/week
ratio to steroids of 10:1

153
Q

should steroids or emollient be applied first

A

apply emollient first
then at least 30mins after apply steroid

n.b. creams soak into skin faster than ointments

154
Q

What is the most common cause of hypertension in children?

A

renal parenchymal disease

155
Q

pain is felt in the anterior aspect of the joint and is worse when walking up and down stairs

what is the diagnosis

A

chondromalacia patallae

156
Q

characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms

seen with what disorder

A

infantile spasms
or west syndrome

157
Q

EEG shows what in infantile spasms/west syndrome

A

hypsarrhythmia in two-thirds of infants

158
Q

Management of infantile spasms/west syndrome

A

Vigabatrin
ACTH

poor prognosis

159
Q

what vaccinations are pregnant women offered (if they have had all other childhood vaccines previously)

A

pertussis (whooping cough)
influenza

160
Q

Swelling on head
Several hours after birth
Doesn’t cross suture lines
Can take months to resolve

A

Cephalhaematoma

161
Q

Swelling on head
Crosses suture lines
Over vertex
Poorly defined margins

A

Caput succedaeneum

162
Q

13-18 years immunisations

A

DPT (3 in 1: tetanus, diphtheria and polio)
Men ACWY

163
Q

The oral rotavirus vaccine is given at

A

2 and 3 months

164
Q

what type of vaccine is the rotavirus vaccine

A

oral, live attenuated vaccine

165
Q

The Men B vaccine is given at what ages

A

2, 4 and 12-13 months

166
Q

routine 6 week baby exam looks for what 4 key issues

A
  1. congenital heart disease
  2. Developmental dysplasia of the hip (DDH)
  3. Congenital cataract - look for red reflex
  4. Undescended testes
167
Q

growing pains usually aged 3-12 years have what features

A
  • usually at night
  • worse after day of activity
  • normal examination
  • no limp, no limitation
  • boys and girls equally affected
168
Q

B-2 agonist (salbutamol) via spacer dose for mild to moderate asthma attacks

A

1 puff every 30-60 seconds up to maximum of 10 puffs

169
Q

What is a common side effect of montelukast to warn them about?

A

nightmares

170
Q

Patients with otitis media with cleft palate or Trisomy 21 (Down’s syndrome) require what management

A

Urgent specialist assessment

171
Q

Any infant with hip abnormality detected at 6-8 week check should be managed with..

A

refer to specialist and hip ultrasound within 10 weeks of age

172
Q

if parents disagree with immunisation, then it cannot go ahead without

A

specific court approval

173
Q

does a person with parental responsibility need to be present with kid during vaccination

A

NO!
can be another childminder as long as parental responsibility has consented in advance
written confirmation is not required

174
Q

what is the most common cause of death in measles

A

pneumonia

175
Q

Why should the first dose of the oral rotavirus vaccine should not be given after 15 weeks

A

Risk of intussusception

second dose cannot be given after 23 weeks

176
Q

what 6 immunisations are included in the 6-in-1 vaccine

A

diptheria
tetanus
polio
pertussis
HiB type B
Hepatitis B

177
Q

urine collection method for children with UTIs

A
  • clean catch is preferable
  • if not possible, then urine collection pads
  • invasive methods such as suprapubic aspiration should only be used if non-invasive methods are not possible
178
Q

Management of UTIs for infants less than 3 months old

A

Refer immediately to paeds

179
Q

Management of UTIs for infants older than 3 months old with UPPER UTI

A

Admit to hospital
If not admitted, oral Abx such as cephalopsorin or co-amoxiclav for 7-10 days

180
Q

Management of UTIs for infants older than 3 months old with LOWER UTI

A

Oral antibiotics for 3 days
Ask parent to bring child back if still unwell after 24-48hours

181
Q

what is an atypical UTI infection

A
  • very ill/sepsis
  • poor urine flow
  • abdo/bladder mass
  • raised Cr
  • infection with non-E.coli organisms
182
Q

investigations for UTI in children

A
  1. urine MC&S
  2. DMSA - identifies renal scars done 4-6 months after initial infection
  3. MCUF - identifies vesicoureteric reflex - only for infants <6 months with atypical or recurrent infections

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