Paeds 2A Flashcards

1
Q

How are measles, 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

Antenatal: control viral load during pregnancy using HAART

Perinatal: zidovudine infusion, Elective C-section (if high viral load)

Post-natal: 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 non-sedating antihistamine for up to 6 weeks (eg Certirizine, fexofenadine)

Severe - oral corticosteroid

Refractory - IgE antibody or LTRA

Consider referral to dermatology or immunology if painful/persistent, symptoms not well controlled with antihistamines

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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

*note that most commonly its managed conservatively with encouraiging good fluid intake and paracetamol etc. Abx is often prescribed as a backup and patients are asked to use it if symptoms have not yet improved after 3 days OR worsened

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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

17
Q

How is croup treated?

A

0.15 mg/kg dexamethasone stat
This can be repeated after 12 hours if necessary

The other classic stuff:
give O2 if bad, remind parents of adequate fluid intake and check the child regularly at night as cough is worse

18
Q

How is severe croup treated in an emergency?

A

Oral dexamethasone (for all severities of croup)
High-flow oxygen
Nebulised adrenaline

Nebulised adrenaline is thought to act by stimulating α-adrenergic receptors in subglottic mucous membranes, producing vasoconstriction and decreased mucosal oedema.

19
Q

How is acute epiglottitis managed?

A

Urgent hospital admission (ICU)
Secure airway and supplemental oxygen
Take blood culture
IV cefuroxime (any 2nd/3rd gen cephalosporin)

Rifampicin prophylaxis for entire household

20
Q

How is bronchiolitis treated?

A

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

paeds general: adequate fluid intake , safety net.

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

This refers to wheezing that occurs during discrete exacerbations eg by viral infections but ALSO between these exacerbations possibly by other triggers such as crying, laughter and exercise.

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 (combined spray of steroid + long acting b2 agonist)
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