PSA Specialties- Paeds

Question 1

Treatment for all cases of Croup regardless of severity

Answer 1

Dexamethasone PO (0.15mg/kg) single dose

Question 2

Management of acute epiglottitis

Answer 2

immediate senior involvement, inc. anaesthetics (ET intubation may be necessary)
Do NOT examine throat (risk of acute airway obstruction)
Oxygen
IV Abx: Cefotaxime/ Ceftriaxone

Question 3

Management of bacterial otitis media

Answer 3

Amoxicillin
Pen allergy: Clarithromycin/ Erythromycin

Question 4

Management of reflux in children

Answer 4

Positioning advice: head up 30 degrees
Smaller, frequent feeds
ALGINATE therapy

Question 5

Describe management of anaphylaxis in children

Answer 5

IM Adrenaline (anterolateral aspect of mid thigh)
High flow O2
Repeat after 5 mins if necessary
IV fluids
Non-sedating antihistamine once stabilised

Question 6

What dose of adrenaline should be given in anaphylaxis dependent on age?

Answer 6

<6mo: 100-150 micrograms (0.1-0.15ml 1 in 1,000)
6 mo-6y: 150 micrograms (0.15ml)
6-12y: 300 micrograms (0.3ml)
Adult + >12y: 500 micrograms (0.5ml)

Question 7

What preparation of Adrenaline is used in anaphylaxis?

Answer 7

1 in 1000

Question 8

What can be measured to prove true episode of anaphylaxis?

Answer 8

Serum Tryptase levels
Remain elevated for up to 12h

Question 9

Why should patients be admitted following an anaphylactic attack?

Answer 9

biphasic reactions can occur in up to 20%

Question 10

How should all patients with anaphylaxis be managed after resolution?

Answer 10

Refer to specialist allergy clinic
Give 2x adrenaline auto-injectors in interim
Provide training on use of epipen

Question 11

6 features of severe asthma attack in children

Answer 11

pO2 < 92%

PEF 33-50%

Too breathless to talk or feed

HR
>125 (>5y)
>140 (1-5y)

RR
>30 breaths/min (>5y)
>40 (1-5y)

Use of accessory neck muscles

Question 12

6 features of life-threatening asthma attack in children

Answer 12

PEF <33% best or predicted

Silent chest

Poor respiratory effort

Agitation

Altered consciousness

Cyanosis

Question 13

Describe management of a mild-moderate asthma attack in children

Answer 13

Salbutamol via a spacer (<3y use a close-fitting mask)
1 puff every 30-60s up to max. 10 puffs
+
Prednisolone 1-2 mg/kg od (max 40mg) 3-5 days

Question 14

Describe management of a severe asthma attack in children

Answer 14

Salbutamol via oxygen-driven nebs
Ipratropium nebs
Prednisolone PO
Review by specialist for IV MgSO4/ Salbutamol

Question 15

Describe management of mild-moderate acne

Answer 15

12w TOP combination therapy tried first-line:
Adapalene + Benzoyl peroxide TOP
Tretinoin + Clindamycin TOP
Benzoyl peroxide + Clindamycin TOP

Question 16

Describe management of moderate to severe acne

Answer 16

Adapalene + Benzoyl peroxide TOP
OR
Tretinoin + Clindamycin TOP
OR
Adapalene + Benzoyl peroxide TOP + Lymecycline or Doxycycline PO
OR
Azelaic acid TOP + Lymecycline or Doxycycline PO

Question 17

What is an alternative to oral antibiotics in the treatment of acne in women?

Answer 17

COCP (used in combination with TOP agents)

Question 18

Describe the benefits, risks and use of Dianette (co-cyprindiol) in management of acne

Answer 18

Benefit: Anti-androgen properties.
Risk: Increased risk of VTE compared to other COCPs
Used 2nd-line, only for 3 months + appropriate counselling about the risks

Question 19

What reduces the risk of antibiotic resistance developing in management of acne?

Answer 19

TOP retinoid (if not CI) or benzoyl peroxide should always be co-prescribed with oral abx

Question 20

Describe management of severe/ scarring acne that has not responded to first line treatments

Answer 20

Isotretinoin PO
Only initiated by SPECIALIST
Teratogenic: effective contraception must be used (2 forms)

Question 21

Which acne treatments may have photosensitivity reactions, and patients should be warned of?

Answer 21

Lymecycline
Doxycycline
Isotretinoin

Question 22

What is the most common side effect of isotretinoin?

Answer 22

Dry skin, eyes + lips/ mouth