Counselling

Question 1

ADHD

Answer 1

Mild: 10 week watchful waiting
Moderate: refer to CAMHS -> MDT
Social: environmental modification, support groups, OT, psychologist, diet and exercise, sleep

<7yo: parent training in behaviour management
7-11yo: group parent training (2) individual parent training (3) CBT for child
>12yo: multimodal (PTBM, CBT, group)

First line: methylphenidate for 6 weeks
Second line: lisdexamphetamine, dexamphetamine, atomoxetine, guanfacine

Measure weight every 3 months <10 then 3 months, 6 months and every 6 months after >10
Height, BP, HR and ECG every 6 months
BP and HR must be done before and after every dose change

Side-effects: loss of appetite, mood changes, palpitations, tics, N&V, abdo pain
Cardiotoxic
Growth retardation
Measure weight every 3 months <10 then 3 months, 6 months and every 6 months after >10
Height, BP, HR and ECG every 6 months
BP and HR must be done before and after every dose change

Side-effects: loss of appetite, mood changes, palpitations, tics, N&V, abdo pain
Cardiotoxic
Growth retardation

Question 2

Allergic rhinitis

Answer 2

First line: avoid allergen, non-sedating antihistamines (cetirizine, loratadine, fenofexadate) ± intranasal azelastine
Second line: intranasal steroid( (beclomethasone)
Third line: specific allergen immunotherapy (SCIT)

Solutions of an allergic allergen are injected SC or sublingually on a regular basis for 3-5 years
It can provide protection for many years but has a risk of inducing anaphylaxis (specialist supervision)

Question 3

Anaemia

Answer 3

Dietary advice ± dietician
Iron supplements: ferrous sulphate 200mg (2/3 a day) for 3 months – take with food
Frequent monitoring – first 2-4 weeks then 2-4 months, every 3 months for 1 year then after 1 year

Iron: meat, green leafy vegetables, iron-fortified bread, prunes, raisins

SE: constipation, diarrhoea, BLACK STOOL, GI irritation