Paeds/Maternity

Question 1

Presentation of Benzylpenicillin

Answer 1

Vial with 600mg powder for solution
Vial with 1.2g of benpen powder for solution

Question 2

Indications of Benpen

Answer 2

Suspected meningococcal disease in the presence of either/both of:

• Non-blanching rash - classical, haemorrhagic that may be petechial or purpuric
• Signs and symptoms of meningococcal septicaemia; photophobia, stiff neck, muscle pain, pale/blotchy skin, pyrexia, vomiting

Question 3

Contra-Indications of Benpen

Answer 3

Known penicillin allergy (more than a simple rash)

Question 4

Actions of Benpen

Answer 4

Narrow spectrum antibiotic

Question 5

Route of Benpen

Answer 5

IV/IO - slow injection
IM

Question 6

Dose; 10+, 12months to 9years and Birth to 9 months

Answer 6

Birth - 9 months: 300mg
12 months to 9years: 600mg
10+: 1.2g

Question 7

Presentation of Dexamethasone

Answer 7

2mg soluble tablets

Question 8

Indications of Dex

Answer 8

Babies and children from 3 to 11 year olds with mild, moderate or severe croup symptoms

Question 9

Contra-Indications of Dex

Answer 9

• Pt is 12 or older
• Patients under 3 months old
• Unconscious and/or unable to maintain airway eg very drowsy
• Known hypersensitivity
• Patients already taking a short course of steroids for current condition
• Pts who are systemically unwell with other conditions such as; epiglottis, bacterial tracheitis, foreign bodies, anaphylaxis, angio-oedema, glandular fever, blunt trauma ect
• Patients with the following medications; anticoags, acencoumarol, aldesleukin, cobicistat, ritonavir, netupitant
• Hx of steroid myopathy
• Myasthenia gravis
• Ocular herpes simplex
• Hx of current gastric ulcer, bleed or perforation
• Thromboembolic disorders

Question 10

Route/Adminstration of Dex

Answer 10

Oral
1. Remove the lunger from a 10ml syringe
2. Place tablet into barrel
3. Draw up 10ml of drinking liquid
4. Make sure all the tablet is dissolved (can draw in air to mix easier)

Question 11

Presentation of Paediatric Paracetamol

Answer 11

Infant suspension - 120mg in 5ml
6+ suspension - 250mg in 5ml

Question 12

Presentation of Synometrine

Answer 12

Ampoule 500mcg in 1ml

Question 13

Indications of Synometrine

Answer 13

• Primary or secondary post partum haemorrhage
• Confirmed miscarriage with excessive bleeding

Question 14

Contra-Indications of Synometrine

Answer 14

• Current severe HTN (140/90+ or 150+), consider misoprostol alternative
• Known anaphylaxis to the active substances
• Known or suspected foetus in utero
• Severe cardiac, liver or kidney disease. Consider administering anyway if cat hem

Question 15

Actions of Synometrine

Answer 15

• Full name is Ergometrine maleate with oxytocin
• The oxytocin is a synthetic form which stimulates contraction of the uterus
• Ergometrine also produced sustained uterine contraction for the control of bleeding after birth
• Onset of action 2-7 minutes

Question 16

Route of Synometrine

Answer 16

IM only

Question 17

Dose of Synometrine

Answer 17

INITIAL: 500mcg ergometrine, 5units of oxytocin in 1ml

REPEAT: None

Question 18

Presentation of Misoprostol

Answer 18

200mcg tablets

Question 19

Indications

Answer 19

• Post-partum haemorrhage within 24 hours of delivery where bleeding is uncontrolled by uterine massage
• (Confirmed diagnosis of) post medical termination with life-threatening bleeding (<500ml/signs of shock)
• Usually given before synometrine, but can be given along side TXA

Question 20

Contra-Indications of Misoprostol

Answer 20

• Known hypersensitivity
• In labour, prior to the birth of the baby
• Possible multiple pregnancies
• Suspected foetus in utero unless a medical termination is in progress

Question 21

Route of Misoprostol

Answer 21

Sublingual - 4 tablets to dissolve if patients able
Rectal - indicated with altered lvls of conciousness

Question 22

Dose of Misoprostol

Answer 22

INITIAL: 800mcg (4 x 200mcg)
REPEAT: No repeat