(SYNOPTIC) Neonates + Paediatrics

Question 1

How should pain be assessed when they are unable to tell you verbally, i.e. a neonate?

Answer 1

Facial Expression?
0 - relaxed
1 - grimace

Crying?
0 - no
1 - whimper
2 - vigorous crying

Arms?
0 - relaxed
1 - flexed/ extended

Legs?
0 - relaxed
1 - flexed/ extended

Posture?
0 - relaxed
1 - flexed/ extended

State of arousal?
0 - asleep/ awake
1 - restless

Heart rate?
0 - baseline
1 - increase by 10-40BPM
2 - increase by ≥40BPM

Respiratory rate?
0 - baseline
1 - alteration in breathing

Question 2

When observing pain of a neonate, and having allocated a score, how are the scores interpreted?

Answer 2

1-3: Nurse-controlled measure

• non-nutritive sucking
• repositioning

4-7: Consider sucrose/ alternative pain relief + nurse-controlled measures

8-10: Review with medical team
- discuss alternative prescription for pain relief

Question 3

What is FLACC, with regard to pain?

Answer 3

Pain assessment score

Face
Legs
Activity
Crying
Consolability

Question 4

What are some physiological indicators of pain?

Answer 4

• heart rate
• respiratory rate
• blood oxygen
• blood pressure

Question 5

For what patient age group is codeine considered suitable?

Answer 5

Patients older than 12

Question 6

For what patient age group is codeine contraindicated?

Answer 6

All children under 18yrs who undergo removal of tonsils/ adenoids

For the purpose of sleep apnoea

Question 7

What is the management of suspected asthma in neonates and paediatrics?

Answer 7

Initiation of treatment with very low-> low dose ICS

Question 8

What is the management ladder of diagnosed asthma in neonates and paediatrics?

Answer 8

(1) Regular preventer

(2) Initial add-on therapy
- VERY low dose ICS
- ≥5 LABA/ LTRA
- <5 LTRA

(3) Consider increasing ICS to low dose
(4) Refer for specialist care

Question 9

What is LTRA treatment?

Answer 9

Leukotriene receptor antagonist therapy

Question 10

What dose of beclometasone dipropionate is considered to be a very low dose for use in children?

Answer 10

50 microgram

2 puffs

BD

Question 11

What dose of beclometasone dipropionate is considered to be a low dose for use in children?

Answer 11

100 micrograms

2 puffs

BD

Question 12

What dose of beclometasone dipropionate is considered to be a medium dose for use in children?

Answer 12

200 micrograms

2 puffs

BD

Question 13

What is the treatment for mild atopic eczema in children?

Answer 13

• emollients

- mild topical corticosteroids (hydrocortisone)

Question 14

What is the treatment for moderate atopic eczema in children?

Answer 14

• emollients
• moderate topical corticosteroids (betamethasone/ clobetasone)
• topical calcineurin inhibitors
• bandages

Question 15

What is the treatment for severe atopic eczema in children?

Answer 15

• emollients
• potent topical corticosteroids (betamethasone/ mometasone)
• topical calcineurin inhibitors
• bandages
• phototherapy
• systemic treatment

Question 16

Name some side effects of systemic corticosteroid use.

Answer 16

• impairment of growth and healing
• fluid retention
• osteoporosis
• weight gain
• peptic ulcers
• altered mood/ psychosis
• electrolyte imbalances
• blood glucose increase

Question 17

Name some side effects of topical corticosteroid use.

Answer 17

• may thin skin if very potent

- if used on younger children, may get systemic exposure via skin

Question 18

When should oral antihistamines be offered to children with eczema?

Answer 18

Not to be used routinely

Offer 1 month trial of NON-SEDATING to children with SEVERE atopic eczema/ severe itching

Offer 7-14 day trial of SEDATING if ≥6 months with sleep disturbance

Question 19

What is the first line treatment for secondary infections of eczema in children?

Answer 19

Flucloxacillin

Erythromycin
- if penicillin allergy

Question 20

What is the treatment for a meningitis infection in children?

Answer 20

Broad spectrum ABx

(1) Cephalosporin
- ceftriaxone
- cefotaxime

(2) Add amoxicillin for babies <3 months

Question 21

What is a potential complication of this drug when used in children?

Chloramphenicol

Answer 21

Neonates cannot metabolise

Can result in grey baby syndrome

Liver is not mature enough to metabolise correctly

Question 22

What is a potential complication of this drug when used in children?

Sulfonamides

Answer 22

Kernicterus in neonates

- Brain damage due to high levels of bilirubin in blood

Question 23

What is a potential complication of this drug when used in children?

Ceftriaxone

Answer 23

Kernicterus in neonates
- Brain damage due to high levels of bilirubin in blood

Forms precipitate with calcium

Question 24

What is a potential complication of this drug when used in children?

Nitrofurantoin

Answer 24

Haemolytic anaemia in children <3 months

Question 25

What is a potential complication of this drug when used in children?

Tetracyclines

Answer 25

Bind to calcium in growing bones + teeth

Causes discolouration

Question 26

What is a potential complication of this drug when used in children?

Quinolones

Answer 26

Arthopathy in children

- joint disease

Question 27

What are some common reasons for having to admit term babies?

Answer 27

• Hypoglycaemia
• Hyperbilirubinaemia
• Infection
• Poor feeding
• Asphyxia during birth

Question 28

What are some common issues for preterm babies?

Answer 28

• hypoglycaemia
• electrolyte imbalance
• hyperbilirubinaemia
• infection/ necrotising colitis
• respiratory distress syndrome
• patient ductus arteriosus
  ø condition where blood flows back to lungs from heart
• intraventricular haemorrhage