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YEAR 5: Specialties > Paeds 2 > Flashcards

Paeds 2 Flashcards

1
Q

How are mumps and rubella diagnosed?

A

Oral fluid sample

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2
Q

How is Kawasaki disease managed?

A

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)

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3
Q

What steps can be taken to reduce the risk of vertical transmission of HIV?

A

Intrapartum zidovudine infusion

Elective C-section (if high viral load)

Zidovudine treatment for neonate (up to 6 weeks)

Avoidance of breastfeeding

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4
Q

Outline the management of food allergy.

A

Avoidance

Provide an allergy action plan for managing an allergic attack

Mild reactions - non-sedating antihistamine (e.g. fexofenadine)

Severe reactions - provide an EpiPen

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5
Q

How is Cow’s milk protein allergy managed?

A

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

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6
Q

Which tests can you do to further investigate suspected cow’s milk protein allergy?

A

Skin prick testing

Specific IgE

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7
Q

What PRN treatment may be appropriate for patients with allergic rhinitis?

A

Aged 2-5: oral antihistamine

Everyone else: intranasal azelastine

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8
Q

What preventative treatment may be used in patients with allergic rhinitis?

A

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

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9
Q

How would you treat urticaria?

A

Identify and manage triggers

Oral antihistamine for up to 6 weeks

Severe - oral corticosteroid

Refractory - IgE antibody or LTRA

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10
Q

How is bacterial tonsillitis treated?

A 
Penicillin V (10 days) 
Allergy: clarithromycin
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11
Q

Which medication should be avoided in tonsillitis?

A

Amoxicillin

Causes a widespread maculopapular rash in infectious mononucleosis

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12
Q

How is scarlet fever treated?

A

Penicillin V QDS for 10 days

Allergy: azithromycin, clarithromycin

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13
Q

How long should patients with strep throat/scarlet fever stay away from school?

A

24 hours after starting antibiotics

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14
Q

What is the first-line medical management for acute otitis media?

A

Amoxicillin 5-7 days

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15
Q

How should sinusitis be managed?

A

< 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)

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16
Q

Which severity of croup requires admission?

A

Anything worse than mild

I.e. anything worse than a barking cough on its own

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17
Q

How is croup treated?

A

0.15 mg/kg dexamethasone stat

This can be repeated after 12 hours if necessary

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18
Q

How is severe croup treated in an emergency?

A

High-flow oxygen

Nebulised adrenaline

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19
Q

How is acute epiglottitis managed?

A

Urgent hospital admission (ICU)
Secure airway and supplemental oxygen
Take blood culture
IV cefuroxime

Rifampicin prophylaxis for entire household

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20
Q

How is bronchiolitis treated?

A

Conservative
Supplemental oxygen if < 92%
Nasogastric/orogastric tube feeding if poor intake
Consider nebulised 3% saline

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21
Q

What are the first and second line treatment options for viral-induced wheeze?

A

1st line: SABA (up to 10 puffs every 4 hours)

2nd line: Intermittent LTRA or ICS

22
Q

How is multiple trigger wheeze treated?

A

ICS or LTRA for 4-8 weeks

23
Q

Outline the management steps for asthma in someone < 5 years.

A

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

24
Q

Outline the management steps for asthma in someone > 5 years.

A

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

25
Q

List some non-pharmacological aspects of asthma management.

A

Assess impact on life
Provide personalised asthma action plan (Asthma UK)
Advise about trigger avoidance
Ensure clear explanation of peak flow and inhaler technique

26
Q

Which investigations would you request in a patient having an asthma attack?

A

Obs (HR and RR are particularly important)
PEFR
SaO2
VBG/ABG
Examine for signs of increased respiratory effort

27
Q

Outline the management of an acute asthma attack.

A

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

28
Q

Which medication should a patient be given to take home after an acute asthma attack?

A

Oral prednisolone (3-7 days)

29
Q

When should a patient with an asthma attack treated in hospital be followed-up?

A

Within 2 working days of discharge

30
Q

How is foreign body inhalation treated in a conscious patient?

A

ABCDE
Encourage coughing
Back blows
Heimlich manoeuvre (NOT in very young children)
Remove object (rigid/flexible bronchoscopy)

31
Q

How is foreign body inhalation treated in an unconscious patient?

A

ABCDE
Secure the airway
Remove the foreign body (rigid/flexible bronchoscopy)

32
Q

Which patients with whooping cough should be admitted?

A

< 6 months

Significant breathing difficulties

33
Q

Outline the pharmacological treatment of whooping cough.

A

< 21 days after onset of cough: macrolide (clarithromycin/azithromycin)

NOTE: use erythromycin in pregnant women

34
Q

How is pneumonia in children treated?

A

1st line: amoxicillin 7-14 days
2nd line: add macrolide

ALL children with a clinical diagnosis of pneumonia should be treated with antibiotics

35
Q

What are some treatment approaches for bronchiectasis?

A

Airway clearance techniques (physiotherapy)
Inhaled bronchodilator
Inhaled hypertonic saline
Antibiotic prophylaxis (e.g. azithromycin)

36
Q

What are the aspects of managing the respiratory issues in cystic fibrosis?

A

Pulmonary monitoring (every 2 months in children, every 3 months in adults)
Airway clearance techniques (physiotherapy)
Mucoactive agents

37
Q

What is the first-line mucoactive agent for cystic fibrosis?

A

rhDNAse
2nd line: add hypertonic saline
Alternative: mannitol dry powder inhalation

38
Q

What are the management approaches to the infection risk associated with cystic fibrosis?

A

Continuous prophylactic antibiotics (flucloxacillin and macrolides)
Prompt and vigorous IV therapy for infections
End-stage disease: bilateral lung transplantation

39
Q

What are the management approaches to the nutritional problems in CF?

A

Oral enteric-coated pancreatic replacement therapy
High calorie diet
Fat-soluble vitamin supplements

40
Q

What are the main domains of management in cystic fibrosis?

A

Pulmonary management (regular chest physiotherapy)
Infection management
Nutritional management (high calorie and high fat, vitamin supplementation, enzymes)
Psychological management

41
Q

What is a treatment option for severe sleep disordered breathing in a child?

A

Adenotonsillectomy

42
Q

What is some general conservative advice given to parents of an infant with a nappy rash?

A

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)

43
Q

How should an inflamed nappy rash that is causing discomfort be treated?

A

Hydrocortisone 1% cream OD (max 7 days)

44
Q

How should a nappy rash caused by candida be treated?

A

Do NOT use barrier protection

Prescribe topical imidazole (e.g clotrimazole)

45
Q

How should a nappy rash caused by bacterial infection be treated?

A

Oral flucloxacillin for 7 days

46
Q

What is the first-line treatment of seborrhoeic dermatitis?

A

Regular washing of the scalp with baby oils and baby shampoo (gently brush to remove the scales)

47
Q

What treatments for seborrhoeic dermatitis could be used if conservative measures fail?

A

Topical imidazole cream

Hydrocortisone cream

48
Q

What advice would you give a patient regarding emollient use for eczema?

A

Use in large amounts and often
Apply on the whole body
Use as a soap substitute

49
Q

What advice would you give regarding how to apply topical steroids for eczema?

A

Use once or twice daily and only apply to areas of active eczema

50
Q

Give an example of a mild, moderate and potent topical steroid used for eczema.

A

Mild - hydrocortisone 1%
Moderate - betamethasone valerate 0.025% or clobetasone butyrate 0.05%
Potent - betamethasone valerate 0.1%

YEAR 5: Specialties (12 decks)

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