Paeds 6A

Question 1

Which antibiotics are used to treat meningococcal sepsis?

Answer 1

Community: IM benzylpenicillin
Hospital: IV ceftriaxone

Question 2

Outline the ABC approach to anaphylaxis.

Answer 2

Airway - look for and relieve any obstruction, intubate if necessary

Breathing - check whether it is normal
If unresponsive/not breathing normally - start CPR

Circulation: check pulse and blood pressure

Everything Else: check skin and inside of the mouth for urticaria and angio-oedema

Question 3

Outline the use of adrenaline in anaphylaxis.

Answer 3

IM adrenaline 1:1000 (as per age-related guidelines) into thigh
Assess response after 5 mins
Repeat IM injection at 5 min interval until there has been a response

NOTE: IV adrenaline is only used for advanced life support

Question 4

Aside from adrenaline, what else should be given to a patient in anaphylaxis?

Answer 4

High flow oxygen
IV fluids (titrate against blood pressure)
Chlorphenamine 10 mg IV
Hydrocortisone 200 mg IV

NOTE: if there is a wheeze, may require bronchodilators

Question 5

What should be monitored whilst a patient is receiving treatment for anaphylaxis?

Answer 5

Blood pressure
Pulse
Respiratory function

Question 6

Outline the neonatal resuscitation guidelines.

Answer 6

1. Dry the baby
2. Within 30 seconds: assess tone, breathing and heart rate
3. Within 60 seconds: if gasping or not breathing – give 5 inflation breaths
4. Re-assess: if NO increase in heart rate, look for chest movement
5. If chest NOT moving: recheck head position, consider 2-person airway control and other airway manoeuvres, repeat inflation breaths
6. If NO increase in heart rate: look for chest movement
7. When chest is moving: if heart rate is not detectable or slow (< 60/min) start compression with 3 compressions per breath
8. Reassess heart rate every 30 seconds: if heart rate is not detectable or slow (< 60/min) consider venous access and drugs (e.g. atropine)

Question 7

Outline the steps in paediatric basic life support.

Answer 7

1. Are they unresponsive?
2. Shout for help
3. Open airway
4. Look, listen and feel for breathing
5. Give 5 rescue breaths
6. Check for signs of circulation
7. 15 chest compression: 2 rescue breaths (15:2)

Question 8

List some possible presenting features of cerebral palsy.

Answer 8

Unusual fidget movements (e.g. asymmetry, paucity)
Abnormalities of tone (e.g. hypotonia)
Delayed motor milestones 
Feeding difficulties 
Persistent toe walking

Question 9

Outline the aspects of managing cerebral palsy.

Answer 9

MDT approach
Physiotherapy - encourage movement, build strength
Speech and Swallow - ensure safe swallow, improve language abilities
Occupational therapy
Medications (baclofen for stiffness, melatonin for sleep, laxatives for constipation and anticholinergics for drooling)

Question 10

List some comorbidities that are commonly associated with cerebral palsy.

Answer 10

Learning disability (1 in 2) 
Behavioural difficulties (2 in 10) 
Chronic constipation (3 in 5)
Visual impairment (1 in 2)
Hearing impairment (1 in 10) 
Low bone mineral density 
Epilepsy (1 in 3)

Question 11

What are the three main types of cerebral palsy?

Answer 11

Spastic (hemiplegic, quadriplegic, diplegic)
Dyskinetic
Ataxic

NOTE: injuries causing brain damage up to 2 years can be classified as cerebral palsy

Question 12

Outline the aspects of management of autism spectrum disorders.

Answer 12

Psychosocial interventions (increase attention and reduce repetitive/ritualistic behaviours)
Speech and language therapy
Pharmacological (antipsychotics may be considered for difficult behaviour)
Attend to family/carers needs
Assess for learning disability and discuss EHC plan

NOTE: < 10% can function independently as adults

Question 13

What is the first-line management of ADHD?

Answer 13

ADHD-focused group parent-training programme
Offer individualised training programmes if the needs are too complex

NOTE: consider up to 10-week watch and wait period before this

Question 14

Outline the step by step medical management of ADHD.

Answer 14

Methylphenidate (6 week trial)
If unsuccessful, consider lisdexamphetamine (or dexamphetamine)
If unsuccessful, consider atomoxetine or guanfacine

Question 15

What is an important thing to do before starting patients on medication for ADHD?

Answer 15

Establish baseline physical state (especially HEIGHT) and perform an ECG
The medications can cause loss of appetite and stunted growth and the development of tics (they are also cardiotoxic)

NOTE: recommend yearly off medication trials

Question 16

How should medical treatment of ADHD be monitored?

Answer 16

Consider using symptom rating scales (e.g. Conner’s)
Measure height every 6 months
Measure weight every 3 months
Monitor HR and BP every 6 months

Question 17

Outline the aspects of managing Down syndrome.

Answer 17

• Take blood for genetics and request urgent PCR for trisomy 21
• full clinical examination paying close attention to CVS
• echocardiogram –> if abn refer to cardiologist, AVSD is v common
• FBC and blood film (10% have transient abnormal myelopoiesis –> refer to haematologist)
• MDT approach
• Hearing screening test
• Monitor for associated problems = duodenal atresia, Hirschsprung disease, coeliac disease, hypothyroidism, epilepsy, atlantoaxial instability, hearing and visual defect, peridontal disease
• Speech and language therapist - if difficulty swallowing
• Ophthalmologist (3-6 months)
• Parental counselling and education = Down’s Syndrome Association
• Early intervention therapies in childhood, refer to: physiotherapy, occupational therapy for fine motor skills
• Individualised education plan (special schools)

Question 18

List some conditions that are associated with Down syndrome.

Answer 18

Coeliac disease 
Hypothyroidism
Alzheimer's disease 
Epilepsy 
Hearing and visual defects

Question 19

What are the three types of insulin therapy?

Answer 19

Multiple Daily Injection

Basal-Bolus: injections of short-acting insulin before meals + 1 long-acting insulin (generally the 1st option for new diagnoses)

Continuous SC Insulin Infusion: regular and continuous insulin delivered through a pump

1, 2 or 3 injections per day: mix of short-acting and long-acting insulin

Question 20

How often should capillary glucose be measured in patients with T1DM?

Answer 20

At least 5/day
Fasting/through the day target: 4-7
After meals: 5-9

Question 21

In which patients might you consider continuous glucose monitoring?

Answer 21

Frequent severe hypoglycaemia
Hypoglycaemia unawareness
Inability to recognise or communicate symptoms of hypoglycaemia (e.g. cognitive impairment)

Question 22

Which complications of T1DM require on going monitoring?

Answer 22

Thyroid disease - annually from diagnosis

Diabetic retinopathy, nephropathy and hypertension - annually from 12 years

Question 23

How should mild-to-moderate hypoglycaemia be managed?

Answer 23

Fast-acting glucose by mouth (e.g. lucozade)
Check blood glucose in 15 mins (repeat glucose if necessary)
As symptoms improve, switch to oral complex long-acting carbohydrate

Question 24

How should severe hypoglycaemia be managed?

Answer 24

In Hospital: IV 10% glucose (max 500 mg/kg of body weight)
Community: IM glucagon (500 µg < 8 yrs or 1 mg > 8 yrs) or glucogel

Once symptoms improve, give oral complex long-acting carbohydrate

Question 25

Which observations should be recorded in a patient with DKA?

Answer 25

• Level of consciousness
• Vital signs (HR, BP, Temp, RR)
• History of nausea or vomiting
• Clinical evidence of dehydration
• Body weight