General Pediatrics

Question 1

What is the cutoff for fever in children depending on where the temperature is taken?

Answer 1

Mouth: >37.5
Armpit: >37.3
Rectal >38
Ear depends

<3mths old may need hospitalisation

Question 2

What is the role of antipyretics in treatment of fever in children?

Answer 2

Purely symptomatic
- does NOT change course of disease
- ↓risk of cardiorespiratory/ metabolic decompensation
- ↓ risk of epileptic/ febrile seizures

Question 3

Why is aspirin not used as an antipyretic?

Answer 3

Risk of Reye’s syndrome (life-threatening encephalopathy and liver failure)

Question 4

What are 2 antipyretics for fever in children and their adminstation regiments?

Answer 4

1) Paracetamol
- Oral: 10-15/mg/kg/4-6hr (max 75mg/kg/day)
- Supp: 15-20mg/kg/dose/6-8hr (max 75mg/kg/day)
- caution i hepatic failure

2) Ibuprofen (>1y/o)
- Oral: 5-10mg/kg/6-8hrly

3) Diclofenac
- Supp: 1mg/kg/12hr
- both caution in renal impairment, gastritis

Question 5

What is the anatomical landmark separating the upper and lower respiratory tract?

Answer 5

Vocal cords

Question 6

What is the most common causative organism for rhinitis in children?

Answer 6

> 90% viral
- rhinovirus, adenovirus, RSV, parainfluenza, influenza

Question 7

What is the most common causative organism for otitis media and acute sinusitis in children?

Answer 7

1) Respiratory viruses
- rhinovirus, adenovirus, RSV, parainfluenza, influenza

2) Bacterial
- pneumococcus, hemophilus, moraxella

Question 8

How is otitis media and acute sinusitis treated in children?

Answer 8

1) PO amoxycillin or oral macrolide (if penicillin allergy) 10 days

2) Decongestants

Question 9

What is the most common causative organism for acute pharyngitis, tonsilitis in children?

Answer 9

1) EBV
2) GAS
- oral penicillin, or macrolides 10days

Question 10

What is the most common causative organism for croup in children?

Answer 10

Parainfluenza

Question 11

What is the most common causative organism for bronchiolitis in children?

Answer 11

RSV

Question 12

What is the most common causative organism for epiglottitis in children?

Answer 12

Hemophilus influenza type B (very rare now due to 6 in 1 conjugate vaccine)

Question 13

What are the common causes for pneumonia in a child and how is it managed?

Answer 13

Neonate
- maternal flora (eg. GBS, listeria, Chlamydia, G-)
- empiric with IV ampicillin, gentamicin (clarithromycin if chlamydia !!pyloric stenosis)

1mth-5y/o
- mostly viral (RSV, influenza, paraflu,) or Bacterial (Strep pneumo, Staph, H flu)
- PO amoxycillin/augmentin 7-10days

5 y/o
- Strep pneumo, m. pneumo, H. flue
- PO amoxycillin/augmentin 7-10days
- atypical pneumonia PO clarithromycin 7-10days

Question 14

What are 4 decongestants for children with sinusitis, etc.?

Answer 14

1) Topical Oxymetazoline (Iliadin) nose drops
- <1yr: 0.01%
- 1-6yr: 0.025%
- >6yr: 0.05%

2) Non-sedating antihistamine (Cetirizine)
- 6mth-2y: 2.5mg/day
- 2-5y: 2.5-5mg/day
- >5y: 5-10mg/day

3) Sedating antihistamine (chlorpheniramine)
- 0.1mg/kg/TDS

4) Cough suppressant (promethazine)
- 0.25mg/kg/TDS
- CI in <2y

Question 15

What are 3 common triggers of asthma in children?

Answer 15

1) Viral infections
2) Environmental allergens
3) Exercise

Question 16

How is asthma treated in children?

Answer 16

Quick acting
1) SABA (salbutamol)
2) Oral steroids (prenisolone)
3) Anti-muscarininc (ipratropium)

LT control
3) Inhaled corticosteroids (ICS)
4) Montelukast
5) LABA

Question 17

What are the advantages to nebulised/inhaled treatment?

Answer 17

1) Direct to site of action
2) Small qty
3) Rapid onset
4) Minimal systemic absorption

Question 18

What are 3 methods of nebulised/inhaled treatments?

Answer 18

1) Nebuliser
- ex and bulky BUT no need coordinated breathing and higher doses

2) Spacer devicers
- bulky and need cleaning BUT better for lower airway and no need coordination

3) Inhaler
- metered dose: small and portable but req. hand-breath coordination
- dry powdered: need good inspiratory effort (cannot in <5y/o)

Question 19

How is croup treated in children?

Answer 19

Adrenaline

Question 20

How is cystic fibrosis managed in children?

Answer 20

Corticosteroids + antibiotics

Question 21

What are 5 differentials for a red eye in children?

Answer 21

1) Infection
- viral: mucoid discharge, itchy, ± fever
- bacterial: purulent
- neonates (chlamydia, gonococcus)

2) Allergy
- periorbital swelling, chemosis (conjunctival edema)
- watery discharge

3) Physical irritation
- clear discharge
- pain → dont scratch

4) Trauma
5) Exposure
6) Others (congenital glaucoma, iritis/uveitis, (epi)scleritis

Question 22

What lubricants are used for red eye?

Answer 22

Artificial tears/0.9% saline

Question 23

How is anterior uveitis (JIA) and allergic conjunctivitis treated in children?

Answer 23

1) Corticosteroids
2) Antihistamines (olopatadine)
3) Mast cell stabiliser (sodium cromoglycate)

Question 24

What are the anti-infective eye drops for children?

Answer 24

Antibacterial
- chloramphenicol
- cipro/ofloxacin
- gentamicin/tobramycin
- fusidic acid

Antiviral
- acyclovir

Question 25

What are 5 causes of acute conjunctivitis in children?

Answer 25

Viral - adenovirus - HSV - Coxsackie A24 - Enterovirus 70 Bacterial - SA - Strep pneumo - Moraxella - Pseudomonas Neonatal - Chlamydia - Gonococcus

Question 26

What are 2 mechanical causes of red eye in children?

Answer 26

1) Foreign body 2) Trichiasis (inward turning of eyelashes)

Question 27

What are 5 differentials for otalgia in children?

Answer 27

1) Infection - otitis externa/media (w or w/o tympanic membrane perforation) 2) Impacted ear wax 3) Trauma (eg. digging) 4) Foreign body 5) Eustachian tube dysfunction

Question 28

How is chicken pox treated in children?

Answer 28

Children: antipyretic + moisturisersw ergojewngiwhjgn

Question 29

How are HFMD ulcers differentiated from HSV ulcers?

Answer 29

HSV: anterior HFMD: posterior pharynx

Question 30

How is HFMD rash differentiated from chicken pox?

Answer 30

HFMD: localised ZVZ: generalised

Question 31

What is the pathophysiology of "swimmer's ear"?

Answer 31

Prolonged water exposure → cerumen washed away + normally acidic canal is neutralised → growth of pathogenic bacteria

Question 32

What are 4 causative organisms for otitis externa?

Answer 32

1) Pseudomonas 2) Staph aureus 3) Aspergillus 4) Candida 5) ZVZ

Question 33

Which antibiotic should be avoided if tympanic membrane is perforated?

Answer 33

Aminoglycosides (ototoxic)

Question 34

What are 2 indications for ear drops?

Answer 34

1) Uncomplicated otitis externa 2) Removal of ear wax

Question 35

What is the best way to administer ear drops to a child?

Answer 35

RMB to keep child in position for 3-5mins for max penetration <3: Lying on side with affected ear up, pull pinna back and down >3: lying on side with affected ear up, pull pina straight back Adults: pull pinna back and upwards

Question 36

How is atopic dermatitis treated?

Answer 36

1) Anti-inflammatory - corticosteroids - calcineurin inhibitors 2) Moisturisers/emollients

Question 37

What are 3 indications for topic antibacterials?

Answer 37

1) Cellulitis 2) Impetigo 3) Folliculitis

Question 38

What are 2 indications for topical antifungals?

Answer 38

1) Cutaneous candidiasis 2) Tinea

Question 39

What is the main indication for topical antivirals?

Answer 39

Herpes labialis

Question 40

What are 2 indications for topical parasiticides?

Answer 40

1) Scabies 2) Pediculosis