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)
