Paeds 3 Flashcards
Which treatment would be recommended for children > 2 years with eczema that has failed to respond to topical steroids?
Topical calcineurin inhibitors (e.g. pimecrolimus)
Under which circumstances do bandages tend to be used in eczema?
For areas of chronically lichenified skin
When are antihistamines used in eczema?
1 month trial of non-sedating antihistamine (e.g. fexofenadine) if severe itching or urticaria
1-2 week trial of sedating antihistamine (e.g. promethazine) if flare is disturbing sleep
How should infected eczema be treated?
Swab the affected area
Advice on good hygiene when using emollients
Flucloxacillin
How is eczema herpeticum managed?
Refer for same-day dermatology advice
Oral aciclovir
Consider ophthalmological review if around the eyes
How are viral warts treated?
Daily administration of salicylic acid, lactic acid paint or glutaraldehyde lotion
Cryotherapy
How is molluscum contagiosum managed?
Spontaneous resolution by 18 months
Avoid squeezing lesions
Avoid sharing towels/clothes
What is the first-line treatment option for mild ringworm?
Topical antifungals (terbinafine cream)
NOTE: hydrocortisone 1% may be added if there is extensive inflammation
How are more severe ringworm infections managed?
Oral antifungals
1st line: terbinafine
2nd line: itraconazole
What is the first-line management option for tinea capitis?
Oral griseofulvin (or oral terbinafine)
NOTE: any animal source of the infection would also need treatment
What is the first line treatment option for scabies?
Topical permethrin 5% cream
Apply on the whole body (chin downwards) and wash off after 8-12 hours
Second application is required 1 week later
2nd line: malathion aqueous 0.5%
What advice should be given to patients with scabies?
Members of the household and close contacts should be treated
Bedding and clothes should be washed at high temperature
Treat post-scabeitic itch with crotamiton 10% cream
Nighttime sedative anti-histamine may be useful to help sleep
How should head lice be treated?
Wet combing with a fine-tooth comb every 3-4 days for 2 weeks
Dimeticone 4% lotion
Alternative: malathione 0.5% lotion
List some agents that are used in the treatment of guttate psoriasis.
Coal tar preparations
Dithranol
Calcipotriol
What are the treatment options for mild-to-moderate acne?
Benzoyl peroxide
Duac (benzol peroxide + clindamycin)
Adapalene (topical retinoid - CI in pregnancy and breastfeeding)
Azelaic acid
Outline the treatment options for moderate acne.
Consider oral antibiotics (lymecycline or doxycycline) for a maximum of 3 months
Change to alternative antibiotic after 3 months if no improvement
NOTE: topical benzoyl peroxide or retinoid should be co-prescribed to reduce the risk of antibiotic resistance
What can be used as an alternative to oral antibiotics in girls with acne?
COCP
NOTE: POPs and progestin implants can worsen acne
When might you consider dermatology referral for a patient with acne?
If not responding to 2 courses of antibiotics or if there is scarring, refer to dermatology for consideration of isotretinoin
When should a patient undergoing treatment for acne be reviewed?
At 8-12 weeks
How is heart failure in an infant managed?
Diuretics such as frusemide (reduce preload) Enhance contractility (e.g. dobutamine) Reduce afterload (e.g. ACEi) Improve oxygen delivery (beta-blockers)
How are ASDs managed?
Secundum - percutaneous closure (cardiac catheterisation with insertion of an occlusive device)
Partial AVSD - surgical correction
When are symptomatic ASDs usually treated?
3-5 years
When do large VSDs and AVSD tend to be treated surgically?
3-6 months
How can a PDA be closed?
Medical: indomethacin (or other NSAID)
Surgical: cardiac catheterisation and coil/occlusive device insertion
NOTE: surgical management usually happens at around 1 year
How should a cyanosed neonate presenting within the 1st week of life be managed?
Stabilise the airway, breathing and circulation
Artificial ventilation if necessary
Start prostaglandin infusion
Surgery
What murmur is associated with ASD?
Ejection systolic murmur best heard at the upper left sternal edge and fixed wide split second heart sound
What murmur is associated with VSD?
Loud pansystolic murmur at the lower left sternal edge, quiet pulmonary second heart sound
Which defects require surgical correction in tetralogy of Fallot?
Close the VSD
Relive the right ventricular outflow obstruction
How may hypercyanotic spells in tetralogy of Fallot be treated?
Sedation and pain relief
IV propranolol
IV fluids
Which life-saving procedure may be performed for patients with transposition of the great arteries to enhance mixing of the blood?
Balloon atrial septostomy
How is tricuspid atresia treated?
Blalock-Taussig shunt
How is aortic stenosis treated?
Balloon valvulotomy
Aortic valve replacement
NOTE: same for pulmonary stenosis
How is SVT managed?
1 - vagal manoeuvres
2 - IV adenosine (DC cardioversion if this fails)
3 - maintenance therapy with fleicainide or sotalol
90% of children have no further attacks
How is acute rheumatic fever treated?
Bed rest and anti-inflammatory agents (e.g. aspirin)
Penicillin V if evidence of persistent infection
What is the most effective prophylaxis for rheumatic fever?
Monthly injections of benzathine penicillin
Alternative: oral penicillin OD
NOTE: prophylaxis recommended for 10 years after last episode of rheumatic fever or until 21 years old
How is infective endocarditis treated?
Beta-lactam and gentamicin
Usually for 6 weeks
How would you treat an umbilical granuloma?
Regular application of salt to the wound
Cauterise with silver nitrate
List some contraindications for MMR.
Severe immunosuppression (high dose steroids leave you immunocompromised for 3 months)
Allergy to neomycin
Received another live vaccine by injection within 4 weeks
Pregnancy should be avoided for at least 1 month afterwards
IG therapy within the past 3 months
How should children < 3 months with a UTI be managed?
Admit to hospital immediately IV antibiotics (e.g. amoxicillin) for at least 5-7 days
Which clinical features are suggestive of an upper UTI?
Bacteriuria + fever
Bacteriuria + loin pain
How should an upper UTI be treated?
Oral antibiotics (e.g. trimethoprim for 7 days) If this cannot be used, give IV antibiotics (e.g. coamoxiclav) for 2-4 days and discharge with oral antibiotics
How should simple cystitis be treated?
Oral antibiotics (e.g. trimethoprim) for 3 days
Which children should have an ultrasound after a UTI?
Children who have had an atypical UTI
Children < 6 months
Which children should have a DMSA and MCUG after a UTI?
< 6 months old presenting with atypical or recurrent UTI
How should enuresis in < 5 year olds be managed?
Reassure that this usually resolves without investigation
Ensure easy access to the toilet at night
Encourage bladder emptying before bed
How should enuresis in > 5 year olds be managed?
If infrequent (< 2 weeks) reassure and watch-and-wait
1st line if < 7: enuresis alarm and positive reward system
2nd line: desmopressin
Desmopressin may be used first line if rapid short-term control is necessary, or if > 7 years old
List some causes of secondary enuresis.
UTI
Constipation
Diabetes
Psychological/Family problems
How is nephrotic syndrome treated?
Oral prednisolone for 4 weeks
Wean and stop after 4 weeks
If the child does not respond or has atypical features, consider renal biopsy
List some complications of nephrotic syndrome.
Hypovolaemia
Thrombosis
Infection
Hypercholesterolaemia
How is Henoch-Schonlein purpura managed?
Most resolve spontaneously within 4 weeks
Joint pain can be managed with paracetamol/ibuprofen
IV corticosteroids are recommended for nephrotic-range proteinuria or declining renal function
Oral prednisolone may be given for severe scrotal oedema or abdominal pain
