Paeds 2A Flashcards
How are measles, mumps and rubella diagnosed?
Oral fluid sample
How is Kawasaki disease managed?
High-dose aspirin (7.5-12.5 mg/kg QDS for 24 hours after the fever then low dose 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?
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
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
treatment for mild-mod intermittent or mild persistent allergic rhinitis
1st line = allergen avoidance
consider nasal irrigation with saline to rinse nasal cavity
intranasal antihistamine (azelastine) +/- oral antihistamine
2nd line = intranasal chromone
treatment for persistent moderate or severe, uncontrolled allergic rhinitis?
1st line = continue as per treatment for less severe (allergen avoidance, nasal irrigation, intranasal antihistamines +/- PO non sedating antihistamines
add regular intranasal corticosteroid (e.g. mometasone) during allergen exposure
2nd line = short course oral prednisolone
How would you treat urticaria?
avoid triggers
symptom diaries - determine frequency, duration and severity of urticarial episodes
urticary activity score - assess severity. <7 in a week = control, >28 per week = severe
mild = self limiting
Oral non-sedating antihistamine for up to 6 weeks (eg Certirizine, fexofenadine)
Severe - oral corticosteroid
Consider referral to dermatology or immunology if painful/persistent, symptoms not well controlled with antihistamines
How is sore throat (pharyngitis and tonsillitis) treated?
antibiotics given if either:
- group A strep has been confirmed via throat culture, rapid antigent testing, FeverPAIN score (4 or 5) or centre score (3 or 4): immediate or back up prescription
- person is experiencing severe symptoms, systemically very unwell or high risk of complications: immediate prescription
give phenoxymethylpenicillin for 5 to 10 days
Allergy: clarithromycin
advice: adequate fluid intake, paracetamol, salt water gargling, anaesthetic sprays (Difflam)
return to school after fever has resolved and feeling well or after taking abx for 24 hours
recurrent tonsillitis –> refer to ENT for tonsillectomy
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
*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
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
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
How is severe croup treated in an emergency?
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.
How is acute epiglottitis managed?
Urgent hospital admission (ICU)
Secure airway and supplemental oxygen
Take blood culture
IV cefuroxime (any 2nd/3rd gen cephalosporin)
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
paeds general: adequate fluid intake , safety net.
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
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.
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 (combined spray of steroid + long acting b2 agonist)
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
When should hospital admission be considered for sore throat
difficulty breathing, clinically dehydrated, peri-tonsillar abscess or cellulitis, signs of marked systemic illness, a suspected rare cause
