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YEAR 5: Specialties > Paeds 4 > Flashcards

Paeds 4 Flashcards

1
Q

How are urinary tract calculi managed?

A

Conservative - fluids, analgesia, antiemetics

Bacterial infection - co-trimoxazole/nitrofurantoin or surgical decompression

Small stones - tamsulosin

Large stones - ESWL or uteroscopy

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2
Q

What are the most common causes of AKI in children?

A

HUS

ATN

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3
Q

How is haemolytic uraemic syndrome managed?

A

Admit to hospital

Monitor urine output and fluid balance

Maintain adequate hydration status

Monitor BP (treat with CCB if necessary)

Some will need dialysis

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4
Q

What long-term follow-up should be offered to patients with HUS?

A

Check for persistent proteinuria, the development of hypertension and progressive CKD

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5
Q

Outline the aspects of managing CKD in a child.

A

Diet - calorie supplements often necessary

Prevention of renal osteodystrophy - phosphate restriction, calcium and vitamin D supplements

Control of salt and water balance

Anaemia - recombinant EPO

Hormonal - human GH for GH resistance

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6
Q

How does CKD affect the growth of a child?

A

Delayed puberty

Subnormal pubertal growth spurt

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7
Q

How are hydroceles in children managed?

A

< 2 years = most resolve spontaneously

2-11 year = open/laparoscopic repair

11-18 years = conservative or surgical

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8
Q

How should unilateral undescended testicles be managed?

A

Undescended at birth –> review at 6-8 weeks

Undescended at 6-8 weeks –> review at 3 months

Undescended at 3 months –> seen by urologist by 6 months

NOTE: if descended but retractile at 3 months, advise annual follow up due to risk of ascending testes through childhood

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9
Q

How should bilateral undescended testicles at birth be managed?

A

Urgent referral to a senior paediatrician within 24 hours (genetic or endocrine testing may be necessary)

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10
Q

How is testicular torsion managed?

A

Urgent exploratory surgery (with orchidopexy/orchidectomy)

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11
Q

How is torsion of the appendix testis managed?

A

Exploratory surgery is often performed because it may be difficult to distinguish from testicular torsion

Otherwise conservative

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12
Q

How are hypospadias managed?

A

May not require treatment

May require surgery (from 3 months) for cosmetic/functional purposes

IMPORTANT: do NOT circumcise any child with a hypospadia

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13
Q

How are labial adhesions treated?

A

Topical steroids or oestrogens

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14
Q

When should phototherapy for neonatal jaundice be stopped?

A

Once the serum bilirubin is at least 50 µmol below the treatment threshold
Patients should be given folic acid supplements

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15
Q

Why should you check the serum bilirubin level 12-18 hours after stopping phototherapy?

A

Check for rebound hyperbilirubinaemia

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16
Q

When is IVIG used in neonatal jaundice?

A

Used alongside intensified phototherapy in cases of rhesus or ABO haemolytic disease where the serum continues to rise by > 8.5 µmol/L per hour

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17
Q

How is biliary atresia managed?

A

Kasai procedure

Complications can be managed using ursodeoxycholic acid, fat-soluble vitamins and prophylactic antibiotics

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18
Q

How is alpha-1 antitrypsin deficiency managed?

A

Advise against smoking and drinking
Pulmonary manifestations are managed like COPD
Liver manifestations are managed similar to other liver diseases (e.g. monitoring for coagulopathy, diuretics for ascites)

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19
Q

Which investigations are used for galactosaemia?

A

Galactose in urine

Measuring red cell Gal-1-PUT

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20
Q

How is galactosaemia treated?

A

Galactose-free diet

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21
Q

How is Hep A managed?

A

Close contacts should be vaccinated within 2 weeks of onset of illness
Unvaccinated patients with recent exposure should receive IVIG or the hepatitis A vaccine

22
Q

How is autoimmune hepatitis managed?

A

Prenisolone and azathioprine
Ursodeoxycholic acid can help in PSC
Liver transplant in severe cases

23
Q

How is hepatic encephalopathy treated?

A

Supportive
Identify and correct precipitating factors (e.g. GI bleed)
Reduce nitrogenous load (dietary protein restriction, lactulose and rifaximin)

24
Q

How long do patients with ALL tend to have chemotherapy for?

A

Girls - 2 years

Boys - 3 years

25
What is the cure rate for lymphoma?
80%
26
How is neuroblastoma treated?
Localised primaries can be cured by surgery alone | Metastatic disease will require chemotherapy (it may also require stem cell transplantation and radiotherapy)
27
What percentage of patients with Wilm's tumour are cured?
80%
28
How is retinoblastoma treated?
Chemotherapy to shrink tumours Laser treatment of the retina Radiotherapy maybe used in more advanced disease NOTE: 90% cure rate but many will be visually impaired
29
Which antibiotics are used for suspected bacterial meningitis in children?
< 3 months = IV cefotaxime + amoxicillin > 3 months = IV cefotaxime If > 1 month and caused by H. influenzae, give dexamethasone
30
What is the definitive management for slipped upper femoral epiphysis?
Internal fixation across the growth plate
31
Which type of fluid should be given for maintenance requirements in children?
0.9% NaCl + 5% dextrose
32
How are dehydration corrections calculated when administering fluids?
``` Usually given over 24 hours Give maintenance + % dehydration Weigh the child if possible (1 kg loss = 1000 mL) Estimate clinically (e.g. each kg = 1000 mL, so 3% weight loss in 20 kg child = 3 x 200 mL = 600 mL) ```
33
How should iron deficiency anaemia be treated?
Oral ferrous sulphate 200 mg tablets (2-3/day) Continue for 3 months after iron deficiency has corrected
34
What advice would you give to someone who is taking iron tablets for iron deficiency anaemia about side-effects?
May experience adverse effects (constipation, diarrhoea, faecal impaction) Discomfort could be minimised by taking the iron supplement with food
35
How should treatment for iron deficiency anaemia be monitored?
Re-check Hb after 2-4 weeks (expect 20 g/L rise) | FBC every 3 months for 1 year
36
What are the aspects of treating a neonate with hereditary spherocytosis?
Supportive (maybe blood transfusion) Folic acid supplementation Phototherapy/exchange transfusion
37
Outline the aspects of treating hereditary spherocytosis in older children and adults.
Supportive (maybe blood transfusion) Folic acid supplementation Splenectomy and vaccination regimen for encapsulated bacteria Cholecystectomy for gallstones
38
How can complications of sickle cell disease be prevented?
Immunisation against encapsulated organisms Daily oral penicillin Daily folic acid Minimise exposure to cold, dehydration, excessive exercise and hypoxia
39
Outline the treatment of acute sickle cell crises.
``` Oral and IV analgesia Good hydration Antibiotics if necessary Oxygen Exchange transfusion (for acute chest syndrome, priapism and stroke) ```
40
Outline the steps in the analgesic ladder.
Step 1: paracetamol Step 2: cocodamol or NSAIDs (weak opioid) Step 3: morphine, oxycodone
41
Which drug treatment can be used to reduce sickling in sickle cell patients?
Hydroxycarbamide
42
How is haemophilia treated?
Factor 8 concentrate (A) Factor 9 concentrate (B) Acute bleed - factor concentrates and anti-fibrinolytics
43
Which medications should be avoided in patients with haemophilia and von Willebrand disease?
IM injections Aspirin NSAIDs
44
Which treatment can be used for mild haemophilia A?
Desmopressin (stimulates endogenous release of vWF)
45
What medical treatment can be used for type 1 von Willebrand disease?
Desmopressin NOTE: risk of hyponatraemia More severe disease is treated with factor 8 concentrate
46
Describe the usual natural course of ITP.
In 80% it is an acute, benign and self-limiting disease Resolves spontaneously within 6-8 weeks Mild/asymptomatic disease can be managed with observation alone
47
How can severe ITP be managed?
IVIG + corticosteroid + platelet transfusions | Antifibrinolytics (e.g. tranexamic acid) may be used
48
How is DIC treated?
Treat underlying cause Supportive care Replacement therapy (platelets and clotting factors) Restoration of physiological coagulation pathways (e.g. using heparins)
49
How is acute osteomyelitis managed?
High-dose IV empirical antibiotics (for 2-4 weeks) Switch to oral once clinically recovered (continue for 6 weeks) Immobilise the affected area Surgical debridement may be necessary Possible antibiotics used include flucloxacillin and penicillin
50
How would you counsel a patient with Osgood-Schlatter disease?
``` Stop or reduce sporting activity Analgesia - paracetamol and NSAIDs Intermittent ice packs Protective knee pads Stretching ```

YEAR 5: Specialties (12 decks)

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