Paeds 2B

Question 1

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

Answer 1

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

Question 2

Outline the management of an acute asthma attack.

Answer 2

Supplemental oxygen
Nebulised SABA
If ineffective, add nebulised ipratropium bromide
+ mgso4 in life threatening cases
Monitor PEFR and SaO2

NOTE: if mild-to-moderate, SABA can be given through a large volume spacer

Question 3

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

Answer 3

Oral prednisolone (3-7 days)

Question 4

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

Answer 4

Within 2 working days of discharge

Question 5

How is foreign body inhalation treated in a conscious patient?

Answer 5

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

Question 6

How is foreign body inhalation treated in an unconscious patient?

Answer 6

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

Question 7

Which patients with whooping cough should be admitted?

Answer 7

< 6 months
Significant breathing difficulties

Question 8

Outline the pharmacological treatment of whooping cough.

Answer 8

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

NOTE: use erythromycin in pregnant women

Question 9

How is pneumonia in children treated?

Answer 9

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

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

Question 10

What are some treatment approaches for bronchiectasis?

Answer 10

Airway clearance techniques (physiotherapy)
Inhaled bronchodilator
Inhaled hypertonic saline (helps with coughing things out and airway clearance. Unsure exact mechanism)
Antibiotic prophylaxis (e.g. azithromycin)

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

CREON enzyme replacement
High calorie diet
Fat-soluble vitamin supplements

Question 15

What are the main domains of management in cystic fibrosis?

Answer 15

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

Question 16

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

Answer 16

Adenotonsillectomy

Question 17

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

Answer 17

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)

Question 18

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

Answer 18

Hydrocortisone 1% cream OD (max 7 days)

Question 19

How should a nappy rash caused by candida be treated?

Answer 19

Do NOT use barrier protection
Prescribe topical imidazole (e.g clotrimazole)

Question 20

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

Answer 20

Oral flucloxacillin for 7 days

Question 21

What is the first-line treatment of seborrhoeic dermatitis?

Answer 21

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

Question 22

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

Answer 22

Topical imidazole cream eg clotrimazole)
Hydrocortisone cream

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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