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mx Flashcards

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1
Q

Management of croup

A

ABCD

Admit?

  • If current or previous moderate/severe croup
  • Under 6 months old
  • Poor feeding.
  1. Oxygen
  2. Oral dexamethasone (or, if unavailable, prednisolone)
  3. If deteriorating further nebulised adrenaline (1:1000)
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2
Q

Management of molluscum contagiosum

A

Conservative:

  • Resolves on its own approx. 18 months
  • Avoid towel/clothes sharing
  • Stay in school/nursery
  • Squeezing spots but this shouldn’t be necessary

Surgical:
- Cryotherapy

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3
Q

Management of eczema

A

Tailored approach based on the severity of their eczema using a ‘stepped approach’

Mild eczema:

  • Emollient (cream, lotion, bath/shower, ointment)
  • Mild topical steroid (~1% hydrocortisone)

Moderate eczema:

  • Emollient
  • Moderate topical steroid (Betnovate, Eumovate)
  • Topical calcineurin inhibitor (tacrolimus)
  • Bandages and wet wraps

Severe eczema:

  • Emollient
  • Potent topical steroid (Betnovate, Beclametasone)
  • Topical calcineurin inhibitor
  • Bandages and wet wraps
  • Phototherapy
  • Systemic therapy (oral steroids or non-steroidal immunosuppresants)
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4
Q

Management of acne vulgaris

A

Conservative:

  • Washing no more than twice a day
  • Do not pick or scratch
  • Fragrance free emollients if dry skin is an issue
  • Avoid lots of make-up/buy some derm-friendly stuff

Mild acne:

  • Benzoyl peroxide or topical retinoid
  • azelaic acid if above doesn’t work
  • Consider COC, e.g. Yasmin in female patients who want contraception
  • Follow-up in 6-8 weeks

Moderate/severe acne:

  • As above plus …
  • topical (or oral if difficult to reach areas) antibiotics like tetracyclines
  • Refer if risk/current scarring, psychological impact or endocrine pathology suspected
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5
Q

Management of scabies

A

Conservative:

  • Avoid body contact until patient/partners treated
  • Machine was clothes/towels/linen on first day of treatment

Medical:

  • Permethrin (2nd-line malathion) applied whole body, twice 7 days apart. Allow to dry then wash about 12-24 hours later.
  • All contacts (symptomatic or not) must simultaneously be treated.
  • Hydrocortisone for itching
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6
Q

Management of ringworm/tinea

A

Conservative:

  • wash affected skin daily including skin folds
  • wash clothes/linen frequently
  • Don’t share towels
  • No need to exclude from school

Medical:

  • topical miconazole/econazole/clotrimazole consult dermatologist before prescribing to under 16s though
  • if inflamed –> hydrocortisone
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7
Q

Management of pyloric stenosis

A

ABCD

Conservative:

  • Plot weight
  • NBM
  • Fluid resus with saline bolus
  • NG drainage/aspirations
  • IV fluids for deficit and maintenance
  • Electrolyte/Acid-base monitoring regularly

Surgical:

  • Once stable surgery review
  • Pyloromyotomy is gold standard
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8
Q

Management of status epilepticus

A

Call for senior paediatric SpR/Consultant and on call anesthetist

A - ensure patency
B - high flow oxygen mask
C - Assess and gain IV or IO access. Get BM, U+Es, gases

If IV/IO access:

  1. Diazepam/Lorazepam/Midazolam and wait 5 minutes
  2. repeat step 1
  3. Phenytoin 18mg/kg over 20 mins
  4. Anaesthetist for RSI

If no IV/IO access:

  1. Buccal midazolam/rectal diazepam, wait 10 minutes.
  2. If access go to step 2 above otherwise Buccal midazolam/rectal diazepam, wait 10 minutes.
  3. If access go to step 3 above, otherwise Paraldehyde PR and try for access again.
  4. Anesthetist for RSI
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9
Q

Management after a febrile seizure?

A

ABCD

  1. Rule out underlying cause, e.g. meningitis, meningococcal disease, encephalitis
  2. Admit if:
    - 1st febrile seizure or never been seen by a paediatrician for a febrile seizure
    - Child is less than 18 months
    - Seizure: longer than 15 minutes; focal features; seizure within same febrile illness or 24 hours; incomplete recovery by 24 hours
    - Current/Recent antibiotic use
    - Parents are anxious that they can’t cope
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10
Q

Management of ?viral encephalitis

A

ABCD + glucose

  1. Sepsis work-up:
    - FBC
    - Throat/rectal swabs
    - Blood culture
    - Urine (ideally suprapubic aspirate)
    - LP
    - CXR
    (also send for PCR analysis)
  2. Neuroimaging e.g. MRI
  3. Consider EEG
  4. Therapy as indicated by causative virus
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11
Q

Management of slipped upper femoral epiphysis

A

ABCD

  1. Don’t walk
  2. Painkillers
  3. Hip X-ray (widened growth plate, femoral neck anteriorly rotated, femoral epiphysis slipped down and back)
  4. Ortho referral for surgical pin fixation
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12
Q

Management of acute infective conjunctivitis (not neonatal)

A

ABCD

Conservative:

  • Clean secretions with wet cotton wool
  • Wash hands regularly, avoid sharing towels/pillows
  • Advise condition usually resolves on its own

Medical:

  • Ocular antibiotics usually makes little difference to outcome
  • e.g. Chloramphenicol or fusidic acid (the latter in pregnant ladies)
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13
Q

Management of lower UTI

A

ABCD

If under 3 months –> admit
If 3months to 3 years –> low threshold for admission, otherwise as below
If more than 3 years…

Conservative:

  • Obtain urine specimen for culture before antibiotics
  • Encourage and monitor fluid intake

Medical:

  • Fever or pain then give paracetamol
  • Oral antibiotics for three days, e.g. trimethoprim, nitrofurantoin, cefalexin, amoxicillin

Follow-up:

  • Review within 48 hours in person/telephone
  • If responding but the organism is sensitive then switch antibiotics and send urine for test of cure analysis after Abx treatment
  • If still unwell –> reassess
  • If responded consider referral if recurrent UTIs
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14
Q

Management of constitutional delay?

A

Observe and monitor
If psychosocial adjustment (usually due to short stature) then consider:

  • giving boys a weak androgen or testosterone for 3-6/12
  • giving girls oestradiol for 3-6/12
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15
Q

Management of ADHD

A

Conservative:

  • Manuals/DVDs/Leaflets for parents on positive parenting techniques
  • Maintain a balanced diet and adequate exercise, consider a food-behaviour diary and see if any links. Consider dietitian input.

Pre-school children:

  • parent/carer training/education
  • drug treatment not recommended

Moderate ADHD:

  • Parent/carer training/education
  • Offer patient group therapy CBT/social skills, consider individual sessions for older patients
  • Drug treatment not recommended

Severe ADHD:

  • Drug treatment for severe ADHD
  • Methylphenidate (Ritalin) … or if that fails then atonmoxetine
  • Titrate over about 1 month until symptoms improve no further
  • Consider modified release
  • Provide clear instructions written/pictures on how to take drug.
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