Paeds 4B Flashcards
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)
What percentage of patients with Wilm’s tumour are cured?
80%
How is retinoblastoma treated?
Chemotherapy to shrink tumours
Laser treatment of the retina (photocoagulation)
Radiotherapy maybe used in more advanced disease
if eye is not salvageable then enucleation
NOTE: 90% cure rate but many will be visually impaired
Which antibiotics are used for suspected bacterial meningitis in children?
< 3 months = IV cefotaxime + amoxicillin
> 3 months = IV ceftriaxone
If > 3 month and caused by H. influenzae, give dexamethasone
What is the definitive management for slipped upper femoral epiphysis?
Insitu screw fixation across the growth plate
Which type of fluid should be given for maintenance requirements in children?
0.9% NaCl + 5% dextrose
How are dehydration corrections calculated when administering fluids?
for a 5% dehydrated 20kg child:
Rehydration: %dehydration x weight x 10 = 5 x 20 x 10 = 1000mL. This is the volume that should be given over 48hrs.
How should iron deficiency anaemia be treated?
dietary advice - dark green vegetables, iron fortified bread, meat, apricots, consider dietician referral
explore underlying cause
Oral ferrous sulphate 200 mg tablets (2-3/day)
Continue for 3 months after iron deficiency has corrected, to allow stores to be replenished
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
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
What are the aspects of treating a neonate with hereditary spherocytosis?
Supportive (maybe blood transfusion)
Folic acid supplementation (RBC more fragile than normal hence they break down and these pts are more anaemic than usual so need more folic acid)
Phototherapy/exchange transfusion - due to increased RBC breakdown –> increased risk of pigment gallstones and jaundice
later they may need splenectomy because they are prone to splenomegaly as the spherocytes get trapped in the splene
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 (due to bilirubin from increased rbc breakdown)
How can complications of sickle cell disease be prevented?
Protection against infection after splenectomy: Immunisation against encapsulated organisms, Daily oral penicillin
To support the increased need for erythropoiesis: Daily folic acid
To reduce risk of painful crisis: Minimise exposure to cold, dehydration, excessive exercise and hypoxia
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)
Outline the steps in the analgesic ladder.
Step 1: paracetamol
Step 2: NSAIDS or cocodamol (note you shouldnt give codeine to children <12 due to resp depression)
Step 3: morphine (oromorph) But give PRN naloxone
in children, avoid codeine and dihydrocodeine
avoid aspirin due to Reyes
