Paeds 2A

Question 1

How are measles, mumps and rubella diagnosed?

Answer 1

Oral fluid sample

Question 2

How is Kawasaki disease managed?

Answer 2

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)

Question 3

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

Answer 3

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

Question 4

Outline the management of food allergy.

Answer 4

Avoidance

Provide an allergy action plan for managing an allergic attack

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

Severe reactions - provide an EpiPen

Question 5

How is Cow’s milk protein allergy managed?

Answer 5

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

Question 6

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

Answer 6

Skin prick testing

Specific IgE

Question 7

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

Answer 7

Aged 2-5: oral antihistamine

Everyone else: intranasal azelastine

Question 8

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

Answer 8

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

Question 9

How would you treat urticaria?

Answer 9

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

Question 10

How is bacterial tonsillitis treated?

Answer 10

Penicillin V (10 days) 
Allergy: clarithromycin

Question 11

Which medication should be avoided in tonsillitis?

Answer 11

Amoxicillin
Causes a widespread maculopapular rash in infectious mononucleosis

Question 12

How is scarlet fever treated?

Answer 12

Penicillin V QDS for 10 days
Allergy: azithromycin, clarithromycin

Question 13

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

Answer 13

24 hours after starting antibiotics

Question 14

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

Answer 14

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

Question 15

How should sinusitis be managed?

Answer 15

< 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)

Question 16

Which severity of croup requires admission?

Answer 16

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

Question 17

How is croup treated?

Answer 17

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

Question 18

How is severe croup treated in an emergency?

Answer 18

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.

Question 19

How is acute epiglottitis managed?

Answer 19

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

Rifampicin prophylaxis for entire household

Question 20

How is bronchiolitis treated?

Answer 20

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

paeds general: adequate fluid intake , safety net.

Question 21

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

Answer 21

1st line: SABA (up to 10 puffs every 4 hours)
2nd line: Intermittent LTRA or ICS

Question 22

How is multiple trigger wheeze treated?

Answer 22

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.

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

List some non-pharmacological aspects of asthma management.

Answer 25

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