Paeds 2 Flashcards
How are mumps and rubella diagnosed?
Oral fluid sample
How is Kawasaki disease managed?
High-dose aspirin (7.5-12.5 mg/kg QDS for 2 weeks or until afebrile, then 2-5 mg/kg once daily for 6-8 weeks)
IVIG (2 g/kg daily for 1 dose)
Echocardiogram (check for coronary artery aneurysms)
What steps can be taken to reduce the risk of vertical transmission of HIV?
Intrapartum zidovudine infusion
Elective C-section (if high viral load)
Zidovudine treatment for neonate (up to 6 weeks)
Avoidance of breastfeeding
Outline the management of food allergy.
Avoidance
Provide an allergy action plan for managing an allergic attack
Mild reactions - non-sedating antihistamine (e.g. fexofenadine)
Severe reactions - provide an EpiPen
How is Cow’s milk protein allergy managed?
Breastfed - advise mother to exclude dairy from her diet (consider prescribing vitamin D and calcium supplements)
Formula-fed - use extensively hydrolysed formula
Trial for at least 6 months, and consider gradually reintroducing dairy following a milk ladder under medical supervision
Which tests can you do to further investigate suspected cow’s milk protein allergy?
Skin prick testing
Specific IgE
What PRN treatment may be appropriate for patients with allergic rhinitis?
Aged 2-5: oral antihistamine
Everyone else: intranasal azelastine
What preventative treatment may be used in patients with allergic rhinitis?
if main issue is nasal blockage or polyps - intranasal corticosteroid (e.g. beclometasone)
If main issue is sneezing/nasal discharge - oral antihistamine or intranasal corticosteroid
How would you treat urticaria?
Identify and manage triggers
Oral antihistamine for up to 6 weeks
Severe - oral corticosteroid
Refractory - IgE antibody or LTRA
How is bacterial tonsillitis treated?
Penicillin V (10 days) Allergy: clarithromycin
Which medication should be avoided in tonsillitis?
Amoxicillin
Causes a widespread maculopapular rash in infectious mononucleosis
How is scarlet fever treated?
Penicillin V QDS for 10 days
Allergy: azithromycin, clarithromycin
How long should patients with strep throat/scarlet fever stay away from school?
24 hours after starting antibiotics
What is the first-line medical management for acute otitis media?
Amoxicillin 5-7 days
How should sinusitis be managed?
< 10 days: reassure that it is usually viral and self-resolving
> 10 days: high-dose intranasal steroids (if > 12 years)
Consider back-up antibiotic prescription if not improved by 7 days (pen V)
Which severity of croup requires admission?
Anything worse than mild
I.e. anything worse than a barking cough on its own
How is croup treated?
0.15 mg/kg dexamethasone stat
This can be repeated after 12 hours if necessary
How is severe croup treated in an emergency?
High-flow oxygen
Nebulised adrenaline
How is acute epiglottitis managed?
Urgent hospital admission (ICU)
Secure airway and supplemental oxygen
Take blood culture
IV cefuroxime
Rifampicin prophylaxis for entire household
How is bronchiolitis treated?
Conservative
Supplemental oxygen if < 92%
Nasogastric/orogastric tube feeding if poor intake
Consider nebulised 3% saline
What are the first and second line treatment options for viral-induced wheeze?
1st line: SABA (up to 10 puffs every 4 hours)
2nd line: Intermittent LTRA or ICS
How is multiple trigger wheeze treated?
ICS or LTRA for 4-8 weeks
Outline the management steps for asthma in someone < 5 years.
1) SABA
2) 8-week trial of moderate-dose ICS
After 8 weeks:
- If symptoms resolve but recur < 4 weeks = restart low-dose ICS
- If symptoms resolve but recur > 4 weeks = repeat 8-week trial of moderate-dose
3) Add LTRA
4) Refer to specialist
Outline the management steps for asthma in someone > 5 years.
1) SABA
2) Low-dose ICS
3) Add LTRA (review in 4-8 weeks)
4) Stop LTRA, add LABA
5) Change to MART
6) Increase ICS to moderate-dose
7) Refer to specialist
List some non-pharmacological aspects of asthma management.
Assess impact on life
Provide personalised asthma action plan (Asthma UK)
Advise about trigger avoidance
Ensure clear explanation of peak flow and inhaler technique
Which investigations would you request in a patient having an asthma attack?
Obs (HR and RR are particularly important)
PEFR
SaO2
VBG/ABG
Examine for signs of increased respiratory effort
Outline the management of an acute asthma attack.
Supplemental oxygen
Nebulised SABA
If ineffective, add nebulised ipratropium bromide
Monitor PEFR and SaO2
NOTE: if mild-to-moderate, SABA can be given through a large volume spacer
Which medication should a patient be given to take home after an acute asthma attack?
Oral prednisolone (3-7 days)
When should a patient with an asthma attack treated in hospital be followed-up?
Within 2 working days of discharge
How is foreign body inhalation treated in a conscious patient?
ABCDE
Encourage coughing
Back blows
Heimlich manoeuvre (NOT in very young children)
Remove object (rigid/flexible bronchoscopy)
How is foreign body inhalation treated in an unconscious patient?
ABCDE
Secure the airway
Remove the foreign body (rigid/flexible bronchoscopy)
Which patients with whooping cough should be admitted?
< 6 months
Significant breathing difficulties
Outline the pharmacological treatment of whooping cough.
< 21 days after onset of cough: macrolide (clarithromycin/azithromycin)
NOTE: use erythromycin in pregnant women
How is pneumonia in children treated?
1st line: amoxicillin 7-14 days
2nd line: add macrolide
ALL children with a clinical diagnosis of pneumonia should be treated with antibiotics
What are some treatment approaches for bronchiectasis?
Airway clearance techniques (physiotherapy)
Inhaled bronchodilator
Inhaled hypertonic saline
Antibiotic prophylaxis (e.g. azithromycin)
What are the aspects of managing the respiratory issues in cystic fibrosis?
Pulmonary monitoring (every 2 months in children, every 3 months in adults)
Airway clearance techniques (physiotherapy)
Mucoactive agents
What is the first-line mucoactive agent for cystic fibrosis?
rhDNAse
2nd line: add hypertonic saline
Alternative: mannitol dry powder inhalation
What are the management approaches to the infection risk associated with cystic fibrosis?
Continuous prophylactic antibiotics (flucloxacillin and macrolides)
Prompt and vigorous IV therapy for infections
End-stage disease: bilateral lung transplantation
What are the management approaches to the nutritional problems in CF?
Oral enteric-coated pancreatic replacement therapy
High calorie diet
Fat-soluble vitamin supplements
What are the main domains of management in cystic fibrosis?
Pulmonary management (regular chest physiotherapy)
Infection management
Nutritional management (high calorie and high fat, vitamin supplementation, enzymes)
Psychological management
What is a treatment option for severe sleep disordered breathing in a child?
Adenotonsillectomy
What is some general conservative advice given to parents of an infant with a nappy rash?
Use high absorbency nappy
Leave nappy off as much as possible to help the skin dry
Clean the skin/change the nappy every 3-4 hours and ASAP after soiling/wetting
Bath the child gently
Use barrier protection (e.g. sudocrem)
How should an inflamed nappy rash that is causing discomfort be treated?
Hydrocortisone 1% cream OD (max 7 days)
How should a nappy rash caused by candida be treated?
Do NOT use barrier protection
Prescribe topical imidazole (e.g clotrimazole)
How should a nappy rash caused by bacterial infection be treated?
Oral flucloxacillin for 7 days
What is the first-line treatment of seborrhoeic dermatitis?
Regular washing of the scalp with baby oils and baby shampoo (gently brush to remove the scales)
What treatments for seborrhoeic dermatitis could be used if conservative measures fail?
Topical imidazole cream
Hydrocortisone cream
What advice would you give a patient regarding emollient use for eczema?
Use in large amounts and often
Apply on the whole body
Use as a soap substitute
What advice would you give regarding how to apply topical steroids for eczema?
Use once or twice daily and only apply to areas of active eczema
Give an example of a mild, moderate and potent topical steroid used for eczema.
Mild - hydrocortisone 1%
Moderate - betamethasone valerate 0.025% or clobetasone butyrate 0.05%
Potent - betamethasone valerate 0.1%
