PSA 2

Question 1

When should vaccinations be given to a premature infant?

Answer 1

Premature infants should have their immunisations at the appropriate chronological age, counted from their date of birth. This includes live vaccines. They should not be withheld or delayed.

Very premature infants (<28 weeks) should have respiratory monitoring for 48-72 hours when given the first dose.

Question 2

When might the rotavirus vaccine be withheld?

Answer 2

Babies with complex GI surgical conditions because of risk of intussusception.

Question 3

What should the management be if a patient has taken a staggered overdose of paracetamol, if >75mg/kg taken in >1 hour [paediatric population]?

Answer 3

Start NAC

Take bloods 4 hours from the last ingestion

Question 4

Which is the preferred route of administering vitamin K in newborns, and why is it given?

Answer 4

IM is best
If have to give IV e.g. very premature babies with extremely low muscle mass, must repeat at 7 days and 4 weeks.

Given to reduce risk of VKDB and HD.

Question 5

Which vaccines contain gelatin?

Answer 5

MMR

Varicella

But there is a porcine gelatin-free version of the MMR vaccine which should be offered.

Question 6

Rotavirus is a live vaccine and is usually given at 8-12 weeks. Can it be administered after this period?

Answer 6

First dose after 15 weeks is associated with significant increased risk of intussusception at the second dose. Should never be given after 24 weeks.

Question 7

Discuss vaccination indications for children born of mothers who were on immunosuppressive biological therapy during pregnancy.

Answer 7

Live vaccines should be delayed for 6 months.

This means rotavirus vaccine is contraindicated, and BCG should be deferred if it is indicated.

MMR is a live vaccine, but is not offered until 1 year anyway.

Question 8

What is the benefit of co-prescribing methotrexate and infliximab in paediatric arthritis?

Answer 8

Methotrexate is co-prescribed to prevent him developing antibodies to his infliximab.

Question 9

What is the formula for a paediatric resuscitation blood transfusion with active bleeding?

Answer 9

10mls / kg

Question 10

What is the formula for top up transfusion blood volume?

Answer 10

Blood transfusion volume (ml) = (weight in kg) x (aimed increment in haemoglobin in g/dL to correct to Hb10g/dL) x (3/haematocrit)

Question 11

Which class of drugs can reduce hypoglycaemic awareness and how?

Answer 11

Beta blockers

Mask the symptoms such as tachycardia and tremors, by blocking the effects of adrenaline. This can lead to reduced awareness in patients with DM.

Additionally, BBs may impair glucose metabolism and delay recovery from hypoglycaemia.

Question 12

What type of fluid should be avoided in patients who have had a stroke and why?

Answer 12

5% glucose, due to increased risk of cerebral oedema.

Question 13

Digoxin levels can only be properly interpreted in the context of which other test and why?

Answer 13

Can only be properly interpreted in the context of serum potassium as toxicity may occur at low-normal concentrations if hypokalaemia is present.

Question 14

What is SIADH? Give 6 drugs / drug classes that can cause it.

Answer 14

Excessive release of ADH = water retention and volume expansion but NOT clinical volume expansion usually, excess fluid is usually uniformly distributed throughout all body fluid compartments. Dilutional hyponatraemia occurs, with raised urine osmolality.

SSRIs
Tricyclics
Carbamazepine
Vincristine
Cyclophosphamide
?Sulfonylurea, just glimepiride, glipizide