Paeds 3A

Question 1

Which treatment would be recommended for children > 2 years with eczema that has failed to respond to topical steroids?

Answer 1

Topical calcineurin inhibitors (e.g. pimecrolimus)

Question 2

Under which circumstances do bandages tend to be used in eczema?

Answer 2

For areas of chronically lichenified skin

Question 3

When are antihistamines used in eczema?

Answer 3

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

Question 4

How should infected eczema be treated?

Answer 4

Swab the affected area
Advice on good hygiene when using emollients
Flucloxacillin

Question 5

How is eczema herpeticum managed?

Answer 5

Refer for same-day dermatology advice
Oral aciclovir
Consider ophthalmological review if around the eyes

Question 6

How are viral warts treated?

Answer 6

Daily administration of salicylic acid, lactic acid paint or glutaraldehyde lotion
Cryotherapy

Question 7

How is molluscum contagiosum managed?

Answer 7

Spontaneous resolution by 18 months
Avoid squeezing lesions
Avoid sharing towels/clothes

Question 8

What is the first-line treatment option for mild ringworm?

Answer 8

Topical antifungals (terbinafine cream)

NOTE: hydrocortisone 1% may be added if there is extensive inflammation

Question 9

How are more severe ringworm infections managed?

Answer 9

Oral antifungals
1st line: terbinafine
2nd line: itraconazole

Question 10

What is the first-line management option for tinea capitis?

Answer 10

Oral griseofulvin (or oral terbinafine)

NOTE: any animal source of the infection would also need treatment

Question 11

What is the first line treatment option for scabies?

Answer 11

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%

Question 12

What advice should be given to patients with scabies?

Answer 12

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

Question 13

How should head lice be treated?

Answer 13

Wet combing with a fine-tooth comb every 3-4 days for 2 weeks
Dimeticone 4% lotion left on overnight and hair shampooed the following morning. repeat after a week
school exclusion not advised

Dimethicone is a common ingredient in some hair products. It kills the lice by blocking the spiracles, which are pores in the side of a louse through which it breathes

Question 14

guttate psoriasis management

Answer 14

Reassure that it is usually a self-limiting condition that typically resolves within 3–4 months, and reassure that it is not infectious

1st: Phototherapy: narrow band UVB 2-3 times/week (if widespread or unresponsive to topical treatment)

Topical preparation offered:

Emollient to reduce scales and relieve itch (E45, Oilatum, Emulsiderm)

Potent topical corticosteroid with vitamin D preparation +/- salicylic acid if scales are problematic

Refer if lesions are extensive, severe or not responding to treatment

Question 15

What are the treatment options for mild-to-moderate acne?

Answer 15

Benzoyl peroxide
Duac (benzol peroxide + clindamycin)
Adapalene (topical retinoid - CI in pregnancy and breastfeeding)
Azelaic acid

Question 16

Outline the treatment options for moderate acne.

Answer 16

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

Question 17

What can be used as an alternative to oral antibiotics in girls with acne?

Answer 17

COCP

NOTE: POPs and progestin implants can worsen acne

Question 18

When might you consider dermatology referral for a patient with acne?

Answer 18

If not responding to 2 courses of antibiotics or if there is scarring, refer to dermatology for consideration of isotretinoin

Question 19

When should a patient undergoing treatment for acne be reviewed?

Answer 19

At 8-12 weeks

Question 20

How is heart failure in an infant managed?

Answer 20

Diuretics such as frusemide (reduce preload)
Enhance contractility (e.g. dobutamine) 
Reduce afterload (e.g. ACEi) 
Improve oxygen delivery (beta-blockers)

Question 21

How are ASDs managed?

Answer 21

Secundum - percutaneous closure (cardiac catheterisation with insertion of an occlusive device)
Partial AVSD - surgical correction

Question 22

When are symptomatic ASDs usually treated?

Answer 22

3-5 years

Question 23

When do large VSDs and AVSD tend to be treated surgically?

Answer 23

3-6 months

Question 24

How can a PDA be closed?

Answer 24

Medical: indomethacin (or other NSAID)
Surgical: cardiac catheterisation and coil/occlusive device insertion

NOTE: surgical management usually happens at around 1 year

Question 25

How should a cyanosed neonate presenting within the 1st week of life be managed?

Answer 25

Stabilise the airway, breathing and circulation
Artificial ventilation if necessary
Start prostaglandin infusion
Surgery