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Yr 5 PACES > Paeds management > Flashcards

Paeds management Flashcards

1
Q

Down syndrome MDT

A

paediatrician
specialist nurse
PT + OT
SALT
SENCO

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2
Q

Down syndrome monitoring

A

echo
FBC + blood film
TFTs
hearing screening

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3
Q

GBS Rx

A

IV benpen + gentamicin

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4
Q

HDN Rx

A

resus
phototherapy
consider exchange transfusion

immune haemolytic -> IVIG

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5
Q

HDN follow up

A

4-6 weeks: late anaemia
hearing screen

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6
Q

hep B Rx

A

monovalent hep B vaccine <24hrs of birth
6-in-1 vaccine at usual times

HBIG if:
mum HbSag positive
acute hep B during pregnancy
DNA > 1x10^6 in any sample

acute: supportive care

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7
Q

HIE

A

supportive

ventilation
inotropic support
nutrition
seizure management

therapeutic hypothermia

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8
Q

mec aspiration

A

term + no Hx of GBS -> observe

RFs/labs suggestive of infection -> IV ampicillin + gentamicin

oxygen + NIV
surfactant + inotropes

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9
Q

NEC

A

TPN
NG tube
broad-spec abx
IV fluids

perforation/failure to respond -> surgery

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10
Q

asymptomatic neonatal hypoglycaemia

A

blood glucose
encourage feeding
supplemented feeding

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11
Q

symptomatic neonatal hypoglycaemia or pre-feed < 2mmol/L

A

2ml/kg 10% glucose IV bolus
3.6mL/lg/hr 10% glucose infusion
aim 3-4mmol/L

IV delay -> buccal glucose/IM glucagon

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12
Q

neonatal hypoglycaemia <1mmol/L

A

buccal glucose as interim while arranging IV glucose

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13
Q

persistent neonatal hypoglycaemia

A

refer to endo

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14
Q

neonatal jaundice Ix

A

transcutaneous
serum bilirubin
TSH, LFTs, split bilirubin

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15
Q

neonatal jaundice Rx

A

plot on graph
phototherapy
exchange transfusion

treat underlying cause

check for rebound jaundice

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16
Q

neonatal jaundice resource

A

NHS choices factsheet
breastfeeding network
bliss (premature/sick babies)

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17
Q

pneumothorax

A

small -> observe + 100% oxygen

immediate risk of resp failure -> needle drainage

tension/ventilated/preterm -> chest drain

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18
Q

RDS

A

resuscitation

intubation + ventilation
CPAP
supplementary oxygen (aim 91-95%)
endotracheal surfactant

fluids
broad spec IV abx

CXR

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19
Q

TTN

A

observe + supportive care
nasal cannula (aim >90%)

RR >60 -> NG/TPN

persists for >4-6hrs -> amp + gent

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20
Q

atrial septal defect

A

observe

closure at ~2 years
transcatheter/open heart surgery

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21
Q

indications for atrial septal defect closure

A

R heart enlargement
symptomatic pulmonary overcirculation
significant L - R shunting

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22
Q

congenital cyanotic heart disease initial Rx

A

A/B:
intubate
consider hyperoxia test
supplemental O2

C:
2 IV cannulae
consider UVC/UAC
prostaglandin E1 infusion
10ml/kg crystalloid bolus
adrenaline for resistant hypotension

D:
check blood glucose regularly

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22
Q

CoA

A

Prostaglandin E1
supportive
surgical repair

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23
Q

heart failure

A

reduce preload: diuretics
reduce after load: ACEi, alprostadil
enhance contractility: inotropes
nutrition
routine physical activity

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24
Q

PDA

A

IV indomethacin
prostacyclin synthesise inhibitor

premature/VLBW -> ibuprofen

surgical ligation
percutaneous catheter device closure

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25
Q

rheumatic fever

A

NSAIDs
anti-strep abx (pen V, benpen, amox)

heart failure -> diuretics + ACEi +/- pred

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26
Q

SVT

A

1st: vagal manoeuvres

2nd: adenosine

3rd: DC cardioversion

unstable -> DC cardioversion

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27
Q

ToF initial Rx

A

prostaglandin E1 infusion
Blalock-Taussig shunt between subclavian and pulmonary artery

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28
Q

ToF definitive Rx

A

surgical repair from 4 months onwards

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29
Q

hyper cyanotic spells

A

knee to chest position
supplementary O2
morphine (decrease respiratory drive)

IV fluids
beta blockers (relax RV, improve flow to pulmonary vessels)
phenylephrine (increase PVR)

sodium bicarb (met acidosis)

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30
Q

TGA initial Rx

A

supportive
prostaglandin E1 infusion
balloon atrial septostomy (foramen ovale to create large ASD)

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31
Q

TGA definitive Rx

A

arterial switch in first 2 weeks of life

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32
Q

VSD

A

observe
consider prophylactic amoxicillin

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33
Q

large VSD

A

surgical correction (transvenous catheter/open)
diuretics
high calorie diet

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34
Q

acute otitis media

A

paracetamol/ibuprofen
decongestants/antihistamines not helpful

unwell/perforation/otorrhoea -> immediate amoxicillin, otherwise delayed

pen-allergic -> clari

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35
Q

acute epiglottitis

A

senior support
ENT/anaesthetics

blood cultures
IV ceftriaxone 7-10/7
consider supplemental O2, steroids, Adr

stable + extubated -> PO co-amox

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36
Q

acute epiglottitis prophylaxis

A

rifampicin (good gram -ive cover)

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37
Q

mild allergic rhinitis

A

allergen avoidance
consider nasal irrigation

1st line: intranasal antihistamines
PO non-sedating antihistamines

2nd line: intranasal chromone

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38
Q

mod/severe allergic rhinitis

A

continue previous Rx
1st: + intranasal corticosteroid
2nd: consider short course PO corticosteroids for 3-7/7

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39
Q

allergic rhinitis with poor response to therapy

A

nasal congestion -> intranasal decongestant (ephedrine)

rhinorrhoea -> intranasal anticholinergic (ipratropium)

asthma -> LTRA

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40
Q

follow up for allergic rhinitis

A

review in 2-4 weeks for consideration of step up Rx

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41
Q

asthma <5, long term Rx

A

1: SABA
2: + paediatric low dose ICS
3: + LTRA
4: stop LTRA + refer

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42
Q

asthma 5-16, long term Rx

A

1: SABA
2: + paed low dose ICS
3: + LTRA
4: stop LTRA, + LABA
5: switch to MART + paed low dose ICS
6: increase ICS
7: consult specialist

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43
Q

asthma non-pharmacological Rx

A

assess baseline
education
action plan
immunisations
trigger avoidance

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44
Q

asthma review

A

confirm adherence
review technique
assess status
ask about triggers

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45
Q

PEFR asthma severity

A

> 50-75% = moderate
33-50% = severe
<33% = life-threatening

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46
Q

SpO2 asthma severity

A

> 92% = moderate
<92% severe/life-threatening

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47
Q

consciousness asthma severity

A

sentences = moderate
can’t complete sentences = severe
altered consciousness/confusion = life-threatening

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48
Q

HR/RR asthma severity

A

1-5 years:
moderate = <140, <40
severe = >140, >40

5+ years:
moderate = <125, <30
severe = >125, >30

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49
Q

signs of life-threatening asthma attack

A

silent chest
normal pCO2
poor respiratory effort

exhaustion
hypotension
cyanosis

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50
Q

acute life-threatening asthma attack Rx

A

admit, ABCDE, senior support

oxygen
salbutamol nebs (6L/min)
ipratropium nebs
mag sulphate (150mg)
prednisolone

monitor PEFR + sats

2nd line:
IV slabutamol
IV aminophylline
IV mag sulphate

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51
Q

acute moderate asthma exacerbation Rx

A

admit, ABCDE

oxygen
SABA via spacer
ipratroprium bromide
prednisolone

monitor PEFR + sats

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52
Q

prednisolone dose for asthma attack

A

1-2mg/kg/day PO OD
max 40mg/day
IM if oral not possible

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53
Q

acute asthma exacerbation follow up

A

admitted = <2 days of d/c
not admitted = <2 days of presentation

assess:
Sx
PEFR
inhaler technique
treatment
possible non-compliance

consider referral if >2 attacks <12 months

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54
Q

dxic Ix for bronchiectasis

A

high res CT:
bronchial wall thickening
signet ring

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55
Q

bronchiectasis general Rx

A

treat underlying cause
pneumococcal + influenza vax

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56
Q

bronchiectasis Ix for underlying cause

A

CF: sweat chloride test
antibody deficiency: IgG, A, M
primary ciliary dyskinesia

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57
Q

non CF bronchiectasis acute exacerbation Rx

A

airway clearance +/- saline nebs
abx

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58
Q

1st line abx for bronchiectasis

A

1month - 11yrs = amox, clari
12 - 17yrs = doxy

2nd line: co-amox

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59
Q

empirical IV abx for bronchiectasis

A

co-amox
pip-taz
cipro (seek specialist advice)

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60
Q

when to refer to secondary care in bronchiectasis

A

≥3 infective exacerbations in 1 year
severe infection
ineffective abx therapy
cardiorespiratory failure
sepsis

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61
Q

indications for admission in bronchiectasis

A

increased RR
increased WoB
cyanosis
circulatory/resp failure
temp ≥ 38
unable to take oral meds

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62
Q

bronchiectasis resources

A

British Lung Foundation patient info leaflet

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63
Q

Bronchiolitis Rx

A

humidified O2
CPAP
fluids
if secretions -> upper airway suction

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64
Q

Bronchiolitis prevention

A

infection control measures
Palivizumab

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65
Q

indications for admission in bronchiolitis

A

apnoea
central cyanosis
persistent low sats (<92% <6wks, <90% >6 wks)
50-75% reduced fluid intake

severe resp distress:
grunting
recessions
RR > 70

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66
Q

mild/moderate IgE/non-IgE mediated CMPA

A

allergy testing
paeds dietician referral

breastfeeding -> exclude cow’s milk from mother’s diet + calcium + vitamin d supplements
formula/mixed -> extensively hydrolysed formula

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67
Q

severe IgE mediated CMPA

A

as for mild/moderate

consider elemental formula

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68
Q

Sx of severe NON-IgE mediated CMPA

A

skin: pruritus, erythema, atopic eczema
GI: GORD, d&v, food aversion
Resp: cough, wheeze, SoB

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69
Q

severe NON-IgE mediated CMPA

A

interim Rx + urgent referral to local paeds allergy service + dietician

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70
Q

weaning in CMPA

A

reintroduce after 6 months then every 6-12 months
tolerance -> milk ladder from allergy UK

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71
Q

CMPA resources

A

British Dietetic Association fact sheet

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72
Q

All severities of croup Rx

A

0.15mg/kg PO dexamethasone
repeat after 12hrs if required

PO not possible:
2mg inhaled beclomethasone
0.6mg/kg IM dexamethasone

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73
Q
A
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74
Q

mild croup Rx

A

supportive care
safety net

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75
Q

moderate croup Rx

A

oxygen

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76
Q

severe croup Rx

A

admit
oxygen
adrenaline nebs (1 in 1000, 1mg/ml)

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77
Q

CF Rx

A

MDT approach

pulmonary: physio + mucolytics
infection: prophylactic abx
nutrition: high calorie + enzymes
psychosocial: support

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78
Q

CF mucoactive agents

A

1st line: rhDNase
2nd: hypertonic NaCl +/- frhDNase
3rd: mannitol dry powder

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79
Q

CF abx therapy

A

s. aureus prophylaxis -> fluclox
pseudomonas -> azithro, colistin

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80
Q

food allergy Rx

A

dietary:
exclude
dietician referral

pharm:
mild -> non-sedating antihistamine
severe -> IM adrenaline +/- salbutamol

educate:
action plan
epipen use

food challenge:
after 6-12 months Sx free

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81
Q

food challenge in food allergy

A

medical supervision

direct mucosal exposure
titrated oral ingestion as tolerated

previous severe reaction -> consider in hospital, usually after 2 years Sx free

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82
Q

prognosis of food allergies

A

milk and eggs - resolve early
nuts and seafood - persist

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83
Q

foreign body removal

A

1st line: flex/rigid bronchoscopy
2nd line: surgery, thoracotomy

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84
Q

pharm Rx of pneumonia

A

low/moderate -> amox, clari
severe -> co-amox +/- clari

PO if tolerated

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85
Q

scarlet fever Rx

A

notifiable disease

pen V QDS 10/7
pen allergic -> azithro

school exclusion until 24hrs after commencing abx

safety net + follow up

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86
Q

sinusitis Rx

A

< 10/7 -> do not offer abx

> 10/7 -> high dose nasal corticosteroid for 14/7
consider delayed abx
1st line: pen V
2nd line: co-amox

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87
Q

indications for admission in pharyngitis/tonsillitis

A

difficulty breathing
clinical dehydration
abscess/cellulitis
systemic illness/sepsis

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88
Q

indications for abx in pharyngitis/tonsillitis

A

Group A strep
FeverPAIN ≥4
Centor ≥3
severe/high risk of complications

89
Q

abx therapy for pharyngitis/tonsillitis

A

pen V for 5-10/7
pen allergic -> clarithromycin

avoid amoxicillin

90
Q

viral induced wheeze

A

salbutamol burst therapy + weaning regime

monitor for 4hrs

d/c w. salbutamol + spacer
10 puffs every 4hrs
no response -> return to A&E

91
Q

whooping cough

A

notifiable disease

within 21 days onset:
<1month = clarithromycin
>1 month = azithromycin
if macrolides CI: co-trimoxazole

92
Q

indications for admission in isolation in whooping cough

A

<6 months
acutely unwell
apnoea/cyanosis
complications (seizures/pneumonia)

93
Q

exclusion for whooping cough

A

until 48hrs of abx therapy

or 21 days after cough onset

94
Q
A
95
Q

coeliac disease

A

strict gluten free diet
assess for nutritional deficiencies
annual review

96
Q

coeliac disease annual review components

A

height, weight, BMI
review Sx
review adherence: IgA-tTG 3 monthly until normalised then yearly
bone mineral density concerns -> DEXA

97
Q

coeliac disease resource

A

coeliac UK

98
Q

pharmacological Rx of constipation

A

disimpaction regimen:
movicol escalating dose over 2/52
+ dietary/lifestyle modis
unresponsive -> + Senna

maintenance regimen:
effective dose for 3-4/52
can sub in Senna +/- softener

99
Q

behavioural interventions for constipation

A

bowel habit diary
scheduled toileting
reward system
address anxieties
posture

100
Q

high risk Crohn’s Rx

A

induction + maintenance regimen

infliximab (anti-TNF)
+/- methotrexate (immunomodulation)

101
Q

low risk Crohn’s Rx

A

induction: exclusive enteral nutrition for 12 wks
OR corticosteroids

maintenance: methotrexate
can escalate w. anti-TNF therapy

102
Q

Crohn’s monitoring

A

faecal calprotectin + CRP
trough [anti-TNF]

paeds Crohn’s disease activity index

MRI small bowel/endoscopy

103
Q

clinical dehydration Rx

A

≥5% WL

75ml/kg oral rehydration solution every 4 hours

104
Q

fluid resuscitation

A

20ml/kg IV bolus of 0.9% saline

105
Q

dehydration correction calculation

A

% dehydration x kg x 10
over 48hrs

106
Q

fluid maintenance

A

0-10kg = 100ml/kg
10-20kg = 50ml/kg
20+ kg = 20ml/kg
over 24hrs

107
Q

neonatal fluid resuscitation

A

day 1: 50-60ml/kg/day
2: 70-80
3: 80-100
4: 100-120
5-28: 120-150

108
Q

indications for abx in gastroenteritis

A

sepsis
specific bacterial/protozoal infection
extra-intestinal bacterial spread
salmonella <6 months/malnourished/immunocompromised

109
Q

GORD initial Rx if breastfed

A

breastfeeding assessment
smaller more frequent feeds
consider alginate for 1-2/52

110
Q

GORD initial Rx if formula fed

A

review feeding Hx
aim 150-180ml/kg/day

1st: smaller more frequent feeds
2nd: thickened formula
3rd: alginate therapy w.o. thickener for 1-2/52

111
Q
A
112
Q

indications for PPI

A

2-4/52 trial if:
unexplained feeding difficulties
distressed behaviour
faltering growth
failed alginate trial

113
Q

inguinal hernia

A

surgical referral <2/52

114
Q

small asymptomatic umbilical hernia

A

observe
elective repair at 4-5yrs

115
Q

large symptomatic hernia

A

> 1.5cm
elective repair at 2-3yrs

116
Q

incarcerated hernia

A

manually reduced and surgical repair ASAP

117
Q

Hirschsprung disease

A

initial: bowel irrigation
surgical: anorectal pull-through

118
Q

infantile colic

A

reassure (resolve by 6 months)
calming environment
follow up

119
Q

infantile colic resources

A

NHS choices
health visitor
support groups: Cry-sis

120
Q

intussusception

A

ABCDE
fluids +/- NG tube aspiration

1st: rectal air insufflation
clindamycin + gentamicin

2nd: surgical reduction + broad spec abx

121
Q

indications for immediate laparotomy in intussusception

A

peritonitis
perforation

122
Q

asymptomatic Meckel’s diverticulum

A

no Rx

123
Q

symptomatic Meckel’s diverticulum

A

excision

124
Q

malrotation

A

Ladd procedure
cefazolin

125
Q

active bleeding ulcer

A

endoscopy
PPI
surgery/embolisation

126
Q

non-bleeding ulcer

A

H pylori -ive -> treat underlying cause + PPI

H pylori +ive -> PPI + clari + amox 7/7

127
Q

pyloric stenosis definitive Rx

A

Ramstedt pyloromyotomy

128
Q

mild-moderate UC

A

1: Topical/oral ASA
2: Consider oral prednisolone
3. consider oral tacrolimus

129
Q

severe UC

A

high dose IV methylpred
stop oral 5-ASA
parenteral nutrition
+/- abx

surgical: colectomy

130
Q

monitoring in UC

A

FBC
B12 & folate
calcium & vit D
assess risk of osteoporosis
assess mood

131
Q

UC support/resources

A

Crohn’s and Colitis UK
CICRA

132
Q

volvulus

A

supportive
obstruction -> NGT
broad spec abx
IV fluids

emergency surgery: Ladd procedure

133
Q

biliary atresia definitive Rx

A

Kasai procedure <60 days of life
abx cover

2nd: liver transplant

134
Q

biliary atresia complications Rx

A

ursodeoxycholic acid
nutritional supplements
fat soluble vitamins
prophylactic abx (co-trim)

135
Q

abx for meningitis <3 months

A

IV amp/amox + cefotaxime

136
Q

abx for meningitis >3 months

A

IV ceftriaxone

137
Q

meningitis supportive therapy

A

analgesia + antipyretics
oxygen
0.9% NaCl + 5% dextrose

138
Q

meningitis in primary care

A

IM/IV benpen + ambulance transfer

139
Q

indications for dexamethasone in meningitis (>3 months)

A

frankly purulent CSF
CSF WBC > 1000
bacteria on gram stain

DO NOT USE IN MENINGOCOCCAL SEPTICAEMIA

140
Q

meningitis d/c and follow up

A

r/v by paeds 4-6/52 after d/c
audiological assessment

141
Q

contact Rx for meningitis

A

ciprofloxacin

142
Q

meningitis support/resources

A

Meningitis Now

143
Q

exclusion for chickenpox

A

until lesions are crusted over

144
Q

chickenpox

A

supportive care

consider: PO acyclovir if adolescent + <24hrs of rash onset

145
Q

chickenpox Rx in immunocompromised children

A

IV acyclovir
T cell deficient -> HVZIG prophylaxis

146
Q

glandular fever

A

supportive care

upper airway obstruction/haemolytic anaemia -> admit + oral pred

AVOID AMP/AMOX

147
Q

encephalitis

A

IV acyclovir
+/- broad spec abx

supportive care in ICU

f/u for 1year post d/c

148
Q

antivirals for encephalitis

A

HSV -> acyclovir
VZV -> acyclovir/ganciclovir
CMV -> ganciclovir + foscarnet
EBV -> acyclovir (or dicofovir)

149
Q

traffic light: intermediate risk signs

A

pallor

change in behaviour
poor feeding
reduced UO

nasal flaring
6-12 months: RR>50
>12 months: RR>40
sats ≤95% RA
crackles

<12 months: HR>160
12-24 months: HR>150
2-5 years: HR>140
CRT ≥ 3seconds

3-6 months: T ≥ 39
fever ≥ 5 days
rigors
non-weight bearing

150
Q

traffic light: high risk signs

A

pale/mottled/blue
dehydrated

sleepy
no response to social cues

grunting
RR > 60
chest recessions

<3 months T ≥ 38
non-blanching rash
bulging fontanelle
focal seizures

151
Q

traffic light: high risk management

A

immediate ambulance transfer/urgent assessment <2hrs

FBC, CRP, U&Es, blood gas, culture
urine dip
CXR, LP

152
Q

slapped cheek/parvovirus/fifth disease/erythema infectiosum

A

paracetamol or ibuprofen
fluids + rest

> 3 weeks -> IVIG 5/7

153
Q

impetigo

A

local & non-bullous -> topical hydrogen peroxide 1%
OR topical fusidic acid 2%
widespread & non-bullous -> topical fusidic acid 2%
consider PO fluclox
bullous -> PO fluclox

154
Q

impetigo f/u

A

if unresolved after 1/52
r/v dx
swabs (check for MRSA)
consider PO abx

155
Q

kawasaki disease

A

IVIG + high dose aspirin 24-72hrs + low dose aspirin 8/52

2nd line: corticosteroids + infliximab
3rd line: cyclosporin OR anakinra OR plasma exchange

echocardiogram

156
Q

measles

A

notifiable disease
paracetamol + ibuprofen
PO vit A for 2/7

exclusion for 4 days from rash onset

157
Q

mumps

A

notifiable disease
self-limiting
analgesia + fluids + rest
safety net
exclude for 5 days from swollen glands onset

158
Q

rubella

A

notifiable disease
self limiting - 1 week
supportive
avoid pregnant women
safety net

159
Q

mild/moderate acne

A

benzoyl peroxide
clindamycin

160
Q

moderate acne unresponsive to first line

A

oral abx OR topical azelaic acid
oral antiandrogens
COCP
isotretinoin

161
Q

severe acne

A

refer to derm
PO isotretinoin
high dose PO abx for 6/12
flares -> PO corticosteroids

162
Q

eczema

A

avoid triggers
emollients

+ topical corticosteroids
OD/BD to active areas
2nd line: + topical calcineurin inhibitors

163
Q

bandage use in eczema

A

chronic lichenified skin
absorption and protection

do not use with calcineurin inhibitors

164
Q

infected eczema

A

swab
hygiene
fluclox (PO or topical)
alt: erythromycin

165
Q

eczema herpeticum

A

same day referral
oral acyclovir

166
Q

eczema support/resources

A

British assoc. of dermatologists
national eczema society
itchywheezysneezy.co.uk

167
Q
A
168
Q

hand, foot, and mouth disease

A

self-limiting
supportive care
resolves in 7-10 days

169
Q

mild asymptomatic nappy rash

A

zinc/castor oil barrier protection

170
Q

persistant nappy rash/candidal infection

A

NO barrier protection
topical imidazole

171
Q
A
172
Q

persistant nappy rash/bacterial infection

A

PO fluclox 7/7
alt: clarithromycin 7/7

173
Q

scabies

A

5% permethrin
OR 0.5% malathion lotion
wash off after 12 hours

174
Q

ringworm

A

topical antifungal
severe -> systemic antifungal

175
Q

guttate psoriasis

A

self limiting within 3-4/12

1: phototherapy
topical emollient

problematic -> potent topical steroid w. vit D +/- salicylic acid

176
Q

HSP

A

most self-limiting within 4/52

joint pain -> paracetamol/ibuprofen

scrotal involvement/severe oedema or abdo pain -> oral pred

nephrotic range proteinuria/rapid renal decline -> IV corticosteroids

177
Q

hydrocoele <2yrs

A

most resolve by 2yrs
observe

persistent -> surgical exploration/repair

178
Q

testicular torsion

A

immediate admission
refer to uro/paeds surgery

surgical exploration and repair
manual de-torsion if surgery unavailable < 6 hrs

179
Q

undescended testes < 3 months

A

senior paeds referral <24hrs if:
disorder of sexual development
bilateral at birth

paeds referral <2/52 if:
bilateral at 6-8 weeks

unilateral at birth -> r/v at 6-8wks, 4-5months
6 months -> paeds surg referral

180
Q

surgical Rx of undescended testes

A

palpable -> orchidoplexy
non-palpable -> lap exploration + orchidopexy/orchidectomy

181
Q

ALL

A

same day paeds referral

supportive therapy:
fluids
allopurinol
treat pancytopenia

induction - maintenance chemo

182
Q

Hodgkin’s lymphoma

A

combo chemo (ABVD)
+/- radiotherapy

183
Q

ITP: asymptomatic/minor bleeding

A

observe

184
Q

ITP: major bleeding

A

corticosteroids + IVIG
consider platelet transfusion

185
Q

chronic ITP

A

mycophenolate mofetil
rituximab
2nd line: splenectomy

186
Q

SCD prophylaxis

A

encapsulated organisms vax
daily pen V + folic acid
minimise exposure to triggers

187
Q

acute SCD crisis

A

analgesia (avoid morphine in <12yrs)
fluids
abx
oxygen
acute chest syndrome, priapism, stroke -> exchange transfusion

188
Q

SCD long term Rx

A

recurrent hospital admission -> hydroxycarbamide
consider splenectomy
consider HSCT

189
Q

SCD prognosis

A

premature death from complications
50% w. severe disease die <40yrs

190
Q

DDH

A

1st: observe
2nd: splint/Pavlik harness
3rd: surgical reduction + spica casting

191
Q

indications for USS at 6wks for DDH

A

breech at 36wks regardless of delivery
breech delivery
FHx

192
Q

septic arthritis abx

A

IV for 2/52 + PO for 4/52

< 3 months = IV cefotaxime
3 months - 5 yrs = IV ceftriaxone (or clindamycin)
≥ 6 yrs = IV fluclox (or clindamycin)

oral stepdown:
co-amox
fluclox

193
Q

SUFE

A

keep non-weight-bearing
analgesia
immediate ortho referral
surgical repair: in situ screw fixation across growth plate

194
Q

autism spectrum disorder

A

psychosocial
SALT
support for carers
SENCO

195
Q

pharmacological Rx in autism

A

consider if behaviour issues make psychosocial interventions ineffective
r/v at 3-4/52
stop at 6/52 if no clinical indication
treat comorbidities

196
Q

cerebral palsy

A

MDT:
SALT
PT/OT
SENCO

medication:
stiffness => diaz, baclofen
sleep disturbance => melatonin
constipation => laxatives
drooling => anticholinergic

197
Q

DMD

A

physio

glucocorticoids
ataluren: restores dystrophin synthesis

overnight CPAP

may require surgery

198
Q

AED therapy

A

tonic clonic -> valproate
myoclonic -> valproate
focal -> levetiracetam, lamotrigine
absence -> ethosuximide

childbearing potential -> levetiracetam

199
Q

other aspects of epilepsy Rx

A

education
ketogenic diet
vagal nerve stimulation
localised structural cause -> surgery

200
Q
A
201
Q

febrile seizure >5 mins

A

buccal midaz OR rectal diazepam
can repeat after 10 mins
check blood glucose

202
Q

indications for admission in febrile seizure

A

<18 months
dxic uncertainty
complex (>30 mins, focal features, recurrence <24hrs)
neurological deficit

203
Q

hydrocephalus

A

ventriculoperitoneal shunt

204
Q

migraine

A

1: simple analgesia
2: nasal sumatriptan
3: nasal triptan + NSAID/paracetamol

f/u <4/52

205
Q

status epilepticus

A

1:
ABCDE
blood glucose

2: (5 mins)
IV loraz OR buccal midaz OR rectal diaz

3: (15 mins)
2nd dose
call senior
prep phenytoin

4: (25 mins)
anaesthetist/ICU input
20 mg/kg IV phenytoin over 20 mins

5: (45 mins)
rapid sequence induction w. sodium thiopental
consider dexamethasone

206
Q

congenital adrenal hyperplasia long term Rx

A

hydrocortisone: suppress ACTH
fludrocortisone: salt loss
additional hormone replacement if ill/surgery

monitor growth

207
Q

CAH: salt losing crisis

A

IV saline + hydrocortisone 200mg + dextrose

208
Q

delayed puberty in boys

A

1st: observe
2nd: short course oxandrolone/testosterone (3-6/12)

209
Q

delayed puberty in girls

A

1st: observe
2nd: short course oestrogen (3-6/12)

210
Q

DKA fluids

A

10ml/kg 0.9% NaCl IV bolus _{maintenance fluids

NO DEXTROSE until glucose <14mmol/L
then +5% glucose

40mmol/L KCl

211
Q

DKA insulin therapy

A

start 1-2hrs after beginning fluid therapy

FRII 0.05-0.1 u/kg/hr

continue long-acting insulin

SC insulin 30mins before stopping IV insulin

212
Q

DKA monitoring

A

every 1hr:
obs
CRT
fluid balance
modified GCS

2hrs post-Rx then every 4hrs:
glucose
pH and pCO2
U&E
ketones

continuous ECG

213
Q

cerebral oedema

A

mannitol or hypertonic saline

214
Q

support/resources for diabetes

A

Diabetes UK

215
Q

T1DM insulin therapy

A

3 types:
basal-bolus
continuous SC infusion
1-3 injections per day

216
Q

T1DM general Rx

A

dietary management
lifestyle
monitoring
psychosocial support
education and safety netting

217
Q

T1DM monitoring

A

5x per day
fasting: 4-7
post meal: 5-9
driving: >5

HbA1c <48

ketone strips/meter if ill/hyperglycaemic

218
Q

pharmacological Rx of anaphylaxis

A

IM adrenaline 1:1000

< 6 months = 100-150mcg
6 months - 6 yrs = 150mcg
6 - 12 yrs = 300mcg
> 12 years = 500mcg

10mg IV chlorphenamine + 200mg IV hydrocortisone

219
Q

neonatal resuscitation

A

birth:
delay cord clamping
dry baby

<30 sec:
assess tone, RR, HR

<60 sec:
5 inflation breaths
repeat

HR <60bpm -> ventilate for 30sec

chest compressions 3:1

220
Q

do not require school exclusion

A

conjunctivitis
slapped chek
roseola infantum
mono
head lice
threadworms

Yr 5 PACES (5 decks)

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