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Phase 3a > Paediatrics - Investigations and treatment > Flashcards

Paediatrics - Investigations and treatment Flashcards

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1
Q

Febrile convulsions

Investigation
Treatment

A

Clinical diagnosis

Tx
- Admit to paediatrics department
- (If outside hospital call an ambulance if seizure lasts more than 5 mins) –> give rectal diazepam or buccal midazolam

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2
Q

Pneumonia in children

Investigation
Treatment

A

Investigation
LARGELY CLINICAL
- Chest x-ray (if uncertain about diagnosis)
- Nasopharyngeal aspirate

X-ray, FBC, CRP, PCR - investigations (CONTINUE HERE)

Tx
First line - Amoxicillin (IV benzylpenicillin)
Second line - Amoxicillin + macrolides (clarithromycin)

Macrolides - if mycoplasma suspected

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3
Q

Croup (laryngotracheobronchitis)

Investigations
Treatment

A

Largely clinical diagnosis - WESTLEY SCORING TOOL
Mild - occasional barking cough, no stridor, child is happy to eat and play, no sternal retraction

Moderate - Frequent barking cough, stridor at rest, very little distress and can be distracted by environment, slight sternal retraction

Severe - Frequent barking cough, Prominent stridor, significant agitation and distress, significant sternal wall retraction

If chest x-ray is done
(Antero-posterior neck view)
- Steeple sign (subglottic tracheal narrowing)

Tx
Guidelines for admission
- Moderate/severe croup
- <3 months of age
- Uncertainty about diagnosis

  • Single oral dexamethasone (0.15mg/kg)
    (prednisolone alternative)

Emergency
- Nebulised adrenaline - reduces swelling and oedema (more immediate effect)

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4
Q

Asthma in children

Investigations
Acute and chronic treatment

A

Investigations
- Spirometry –> FEV1/FVC <0.8
- Peak expiratory flow
(In children old enough - bronchodilator reversibility)

Moderate - SPO2 >92%

Severe
- SPO2 <92%
- PEF 33-50%
- HR >125
- RR >30

Life threatening
- SPO2 <92%
- PEF <33%
- Silent chest
- Agitation
- Cyanosis
- Altered consciousness

Tx
Mild to moderate
SABA via spacer - Salbutamol (up to 10 doses via spacer) asap
(If they’ve had an attack then prescribe prednisolone for 3 days)

Severe/life threatening
- Oxygen driven nebuliser
- Prednisolone (for 3 days)

Chronic
- Twice daily Paediatric low dose ICS (budesonide) with a SABA (salbutamol)
- If doesn’t work –> check suitability for MART pathway

  • add LTRA (8-12 weeks) - if not suitable for MART
  • If Suitable for MART work –> switch to twice daily paediatric low dose ICS and LABA(salmeterol) combination inhaler + SABA
  • If dosen’t work –> Increase dose of combination inhaler

If symptoms resolved then can stop and review after 3 months.

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5
Q

Bronchiolitis

Investigations
Treatment

A

Investigations
- Immunofluorescence of nasopharyngeal secretions - may show RSV

(Severe disease - Chest x-ray –> hyperinflation)

Tx
Supportive
- Treat hypoxia - Humidified oxygen (high flow nasal cannula therapy OR headbox)
- AND dehydration (NG feeding if child cannot take fluids/food by mouth) - IV fluids

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6
Q

Cystic fibrosis

Investigations
Treatment

A

GS - Sweat test (pilocarpine iontophoresis)- measuring the amount of chloride in the sweat (more chloride than usual) >60mmol/L

(heel prick test shows raised immunoreactive trypsinogen)
(Genetic testing)

Tx
MDT approach
- Chest physiotherapy and postural drainage at least twice a day
- Pancreatic enzyme supplements taken with meals
- Vitamin ADEK supplements - fat soluble - for patients with pancreatic insufficiency

Orkambi- Lumacaftor/Ivacaftor –> used for treatment in homozygous delta F508 mutation

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7
Q

Acute epiglottitis

Investigations
Treatment

A

Investigation
- Lateral neck radiograph - showing “Thumb sign” (done by senior/airway trained staff)

Diagnostic - Direct visualisation via intubation

Tx
(KEEP PATIENT IN UPRIGHT POSITION AND DONT EXAMINE THE THROAT IF acute epiglottis suspected) - due to risk of laryngeal obstruction
- immediate Airway support (senior involvement)
- Endotracheal intubation to protect airway
- Oxygen
- IV antibiotics

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8
Q

Otitis Externa

Investigations
Treatment

A

Clinical diagnosis

(in severe cases - ear culture for identifying the causative organism)

Tx
- Topical antibiotics/combined topical antibiotic with steroid
(Ciprofloxacin or ciprofloxacin/dexamethasone)

Removal of canal debris

2nd line - Oral Flucloxacillin

For fungal (in recurrent otitis externa) – Candida infection treated with Acetic acid

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9
Q

Acute otitis media

Investigations
Treatment

A

Investigations
1) Otoscopy - possible findings include:
- Bulging tympanic membrane (loss of light reflex)
- Perforation with purulent otorrhea
- Erythema of the tympanic membrane

Tx
- Usually self limiting
1st line - ANALGESIA - paracetamol/ibuprofen

If symptoms worsen or don’t improve after 3 days (4th day onwards)
- Start AMOXICILLIN
(penicillin allergy then - clarithromycin)

(Antibiotics should be prescribed immediately if
- Symptoms last more than 3 days
- Systemically unwell
- Immunocompromised
- Otitis media with PERFORATION.

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10
Q

Orbital/peri-orbital cellulitis

Investigations
Treatment

A

Investigations
- Ophthalmological assessment - decreased vision, afferent pupillary defect, proptosis, oedema, erythema
- FBC - elevated WBC, raised inflammatory markers
- Blood culture and microbiological swab to determine organism

For orbital cellulitis - CT with contrast (shows inflammation of orbital tissues, sinusitis)

Treatment

Orbital cellulitis –> IMMEDIATE ADMISSION

Broad spectrum IV antibiotics
- Co-amoxiclav/Flucloxacillin
(Penicillin allergy - clindamycin)

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11
Q

Squint/Strabismus

Investigations
Treatment

A

Investigations
- Cover test - ask child to focus on an object and cover one eye if there is refixation, strabismus is present. (refixation is in the opposite direction of the tropia e.g. eye moves inward in exotropia)

  • Hirschberg test (corneal light reflex test)
    –> Light should be in the same position in both eyes.

Tx
- Refer to ophthalmology

For amblyopia –> Occlusion of the normal eye with an eyepatch
For VA –> correct with spectacles or contact lenses

Definitive for strabismus –> Extraocular muscle surgery

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12
Q

Atrial septal defects

Investigations
Treatment

A

Investigations
- TOE, Echocardiogram –> Visualisation of the defect, right ventricular hypertrophy
- ECG - RBBB (marrow)
- Chest x-ray

Tx
Observation

Surgical closure of the defect

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13
Q

Ventricular septal defects

Investigations
Treatment

A

Investigations
- TOE- shows defect
- ECG
- Chest x-ray - cardiomegaly

Tx
Small VSDs usually close spontaneously –> Just monitor

Surgical closure of defect

  • Ace inhibitor for heart failure
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14
Q

Tetralogy of fallot

Investigations - What do you see on scan?
Treatment

A

Investigations
- Chest x-ray –> Boot shaped heart
- ECG –> Right ventricular hypertrophy (RBBB)
- TOE

Tx
Surgical repair

For cyanotic spells - Propanolol (relieves infundibular spasm - which blocks blood flow to the pulmonary circulation)

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15
Q

Transposition of the great arteries

Investigations
Treatment

A

Investigations
- Chest x-ray –> egg on side appearance

Tx
First line - Prostaglandin E1 (Alprostadil) given to keep the ductus arteriosus open

Surgical treatment - definitive

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16
Q

Patent ductus arteriosus

Investigations
Treatment

A

Investigations
- TOE
- ECG
- CXR - cardiomegaly, increased lung markings

Tx
- Give ibuprofen/indomethacin to infant to promote duct closure (inhibits prostaglandin synthesis) - about a week after baby is born if defect still present

Definitive - transcatheter PDA closure (if severe)

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17
Q

2 causes of cyanotic congenital heart disease and treatment

A

(Common in the first 24 hours of life and may occur when the child is crying or unwell)

(Nitrogen washout test - infant given 100% oxygen for 10 minutes - pO2 <15kPa on an ABG indicates cyanotic congenital heart disease)

  • Tetralogy of fallot
  • Transposition of the great arteries

Tx
- Prostaglandin E1 e.g alprostadil –> keeps the ductus arteriosus patent

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18
Q

Rheumatic fever

Investigation
Treatment

A

investigation
Modified Jones criteria. Evidence of recent group A strep infection (positive throat swab/antigen test/antistreptolysin O titre) + 2 major criteria or 1 major + 2 minor

Major
- Erythema marginatum (defined borders with central clearing)
- Sydenham’s chorea
- Polyarthritis
- Endocarditis
- Subcutaneous nodules

Minor
- Raised ESR, CRP
- Pyrexia
- Arthralgia
- Prolonged PR interval

Tx
Bed rest
- High dose Aspirin to suppress fever and arthritis (2nd line corticosteroids)
- Prophylaxis - Penicillin V
- NSAIDS
- Ace inhibitor - for heart failure

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19
Q

Infective endocarditis

Investigations
Treatment

A

Modified dukes criteria - 2 major, 1 major and 3 minor, 5 minor criteria

Major
- 2 separate positive blood cultures showing typical organisms consistent with IE
- Evidence of endocardial involvement –> Positive Echo

Minor
- Predisposing heart condition/IVDU
- Microbiological evidence not meeting the major criteria
- Fever >38
- Vascular phenomenon - Splinter haemorrhage , janeway lesions
- Immunological phenomena - osler nodes, roth spots

Tx
- Flucloxacillin (+gentamicin)
or
- Vancomycin (+ gentamicin)

(Benzylpenicillin +gentamicin for S.viridans)

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20
Q

Complication of GORD in infants/children

A
  • Aspiration –> recurrent chest infections e.g. pneumonia
  • Failure to thrive from severe vomiting
  • Oesophagitis - haematemesis, discomfort on feeding
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21
Q

Pyloric stenosis

Investigations - What do you expect to see on a VBG
Treatment

A

Investigations
GS - ultrasound

Bloods (VBG) - hypochloraemic alkalosis and hypokalemia

Tx
- FIRST IV fluids (fluid and electrolyte replacement)
- THEN Pyloromyotomy (division of the hypertrophied muscle)

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22
Q

Infective gastroenteritis in children

Investigations
Treatment

A

Investigations
- Usually clinical
but if
- Septicemia suspected
- There is blood/mucus in the stool
- Child is immunocompromised
- Child travelled abroad
- Diarrhoea not improved after 7 days
THEN DO STOOL CULTURE

Tx
- If child is dehydrated –> Give 50ml/kg low osmolarity oral rehydration solution over 4 hours + oral rehydration solution for maintenance often and in small amounts
- Continue breastfeeding

(If all fails, IV fluids for rehydration - also used for shock)

Antibiotics ONLY FOR CONFIRMED SEPSIS

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23
Q

Acute liver failure in children

Investigations
Treatment

A

Investigations
- ALT, AST and ALP raised
- Ammonia elevated (liver function impaired - lack of metabolism of ammonia)

(EEG - may show hepatic encephalopathy)
Increased ammonia can also lead to cerebral oedema - seen on CT head

Tx (treat underlying cause)
- Maintain blood glucose with dextrose
- Prevent sepsis with broad spectrum antibiotics
- Prevent haemorrhage by IV vitamin K
- Mannitol for cerebral oedema
- Urgent transfer to specialist liver unit

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24
Q

Nocturnal enuresis

Investigation
Treatment

A

Investigation
- Urine sample tested for glucose and protein, and checked for infection
- Ultrasound (of kidney and renal tract)

Tx
Enuresis alarm –> have sensor pads that sense wetness

Desmopressin –> If alarm doesn’t work/short-term control needed

Give advice
- Encourage to empty bladder regularly in the day and before sleep

Reward system
- Star charts –> Praising the child for a dry night

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25
Nephrotic syndrome in children Investigations Treatments
Investigations Urinalysis - Proteinuria Biopsy and light microscopy --> No changes ELECTRON MICROSCOPY --> Podocyte fusion and effacement of foot processes (usually only done if unresponsive to treatment) Tx Prednisolone (steroids) (diuretics for oedema) (albumin infusion for severe hypoalbuminemia)
26
Nephritic syndrome in children (all 4) Investigations Treatment
Investigations (for PSG and IgAN) First line - Urinalysis/urine dipstick - Haematuria, proteinuria For Post strep glomerulonephritis - GS - kidney biopsy + light microscopy + electron microscopy --> Starry sky appearance, hypercellular glomeruli For IgA nephropathy - GS Kidney biopsy and immunofluorescence microscopy --> Mesangial IgA deposition Goodpastures - FL- Anti GBM antibodies and GS - renal biopsy - immunoglobulin deposition Lupus nephritis - FL - Anti nuclear antibodies and anti double stranded DNA antibodies (Biopsy - wire loop glomerulonephritis) Tx - Usually just monitoring water and electrolyte balance For IgA nephropathy/Post-strep glomerulonephritis - self limiting, Ace inhibitor for hypertension For good pasture's - Prednisolone + plasma exchange For lupus nephritis - Prednisolone, hydroxychloroquine
27
Acute kidney injury Investigations Treatment
Investigation Urea:Creatinine ratio (determines pre-renal, renal or post-renal cause) Urea:creatinine >100:1 - Pre-renal (due to increased absorption of urea to retain water. Creatinine not reabsorbed) 40:1 Post renal <40:1 - Intra renal - damaged tubules, so less urea absorption Reduced urine output - <0.5ml/kg/hour (for at least 6 consecutive hours) Increased serum creatinine- >1.5x the baseline in 7 days Ultrasound to assess for obstruction Tx Pre-renal - hypovolemia - IV fluids Renal - Hyperkalemia - Calcium gluconate Post-renal- Obstruction - catheterise UNDERLYING CAUSE Stop nephrotoxic medication e.g. gentamicin, NSAIDS Last resort: Renal replacement therapy (haemodialysis)
28
Chronic kidney disease in children Investigations Complications Treatment
Investigations (mostly detected before birth via antenatal ultrasound) Urine dipstick - proteinuria Renal ultrasound - Bilateral small kidneys (mostly) Hypocalcemia - due to low vitamin D GS - eGFR And eGFR function staging (G score 1-5) G1 >90 - normal unless evidence of kidney damage G2 60-89 G3 30-59 G4 15-29 G5 <15 - Renal failure (dialysis/kidney transplant may be required) Complications - Secondary hyperparathyroidism - low vitamin D=low calcium, high PTH, high Phosphate Tx - Reduce intake of phosphate - Vitamin D supplements (Adcal D3 - calcium) - Anaemia → iron and erythropoietin - Ace inhibitors for hypertension (and statins)
29
Vesicoureteric reflux Investigations Treatment
Investigation - Only required in recurrent/atypical UTIs e.g. seriously ill, poor urine flow, abdominal mass, infection with Non-e.coli organisms --> Ultrasound DMSA - Radionuclide scan using dimercaptosuccinic acid --> checks for renal scarring GS - Micturating cystourethrogram (MCUG) - Dimercapto succinic acid scan (radioisotope) - checking for renal scarring Tx - Watch and wait - Treat the UTI if there is one Surgery - Ureteral reimplant
30
Haemolytic uraemic syndrome Investigations Treatment
Investigations - Blood film - prescence of schistocytes (from intravascular RBC fragmentation - MAHA) - FBC - Anaemia, thrombocytopenia - UnE - AKI - Stool culture and PCR for shiga toxin Tx Supportive - Fluids, blood transfusion and dialysis if required - Plasma exchange in SEVERE cases (or eculizumab (a C5 inhibitor monoclonal antibody - in adults))
31
West's syndrome - Infantile spasms Investigations Treatment
Investigations - EEG --> Shows hypsarrhythmia (chaotic and high voltage waves) - MRI/CT head (may show brain disease e.g. tuberous sclerosis) - FBC, UnE Tx First line - Vigabatrin (antiepileptic) + Prednisolone If caused by tuberous sclerosis - Vigabatrin monotherapy for 1 week first (if doesn't work add prednisolone) (Also ketogenic diet) (but poor prognosis)
32
Lennox Gastaut syndrome Investigations Treatment
Investigations - EEG --> Slow spike (large waves) - MRI (check for structural changes) - FBC, UnE Tx First line - Sodium Valproate Second line - Lamotrigine Third line - Lamotrigine + Clobazam KETOGENIC DIET
33
Juvenile myoclonic epilepsy Investigations Treatment
Investigations EEG - 3-6Hz polyspike and wave discharge (Hz means 3-6 cycles per second) Tx - Sodium valproate (ketogenic diet)
34
Cerebral palsy Investigations Treatment
Investigations - MRI brain (clinical diagnosis?) Treatment - Multidisciplinary approach For spasticity - Diazepam or Baclofen - Orthopaedic surgery - Botulinum toxin (BOTOX) Anticonvulsants Analgesia if needed
35
Necrotising enterocolitis Investigations Treatment
Investigations - Abdominal X-ray --> Dilated bowel loops and pneumatosis intestinalis (thickening of bowel wall with intramural gas) (also football sign - gas) Tx (mortality of 20%) - Give broad spectrum antibiotics - Parenteral feeding - Circulatory support (in cases of bowel perforation then surgery)
36
Coeliac disease Investigations Treatment
Investigations First line - Serology Anti TTG antibodies (Total serum IgA levels - as with IgA deficiency, anti-TTG will naturally be low - false positive) Anti endomyseal antibody GS - Endoscopic intestinal biopsy - villous atrophy and crypt hyperplasia (+ increased lymphocytes) Tx Gluten free diet (Due to functional hyposplenism, patients with coeliac disease are recommended to get the pneumococcal vaccine every 5 years)
37
Hirschsprung's disease Investigations Treatment
Investigations - Abdominal x-ray - dilated intestine GS: Rectal biopsy - absence of ganglionic cells Tx Initial: Rectal washout/bowel irrigation (flushing out the bowel with water) (If presents with enterocolitis -> +IV fluids and IV antibiotics) THEN surgery
38
Intussusception Investigations Treatment
Investigations - Ultrasound - target like mass Tx - Reduction by rectal air insufflation (under radiological control - pneumatic reduction under fluoroscopy) UNLESS PERITONITIS If peritonitis or insufflation doesn't work --> Surgery
39
Cow's milk protein allergy/intolerance Investigations Treatment - what to do if breastfed?
Investigations - Often clinical -- Skin prick testing -- Total IgE and specific IgE for cow's milk protein Tx (Bottle fed) - First line (in mild-moderate sx) - Extensive hydrolysed formula milk - Second line/More severe - Amino acid based formula (Breast-fed) If breastfed, continue breastfeeding and eliminate cow's milk protein from maternal diet + calcium supplements for breastfeeding mothers to prevent deficiency whilst they exclude dairy from their diet
40
Biliary atresia Investigations Treatment
Investigations - Serum bilirubin (conjugated bilirubin is abnormally high) GS - Percutaneous liver biopsy with intraoperative cholangioscopy To rule out other causes - Serum A1AT - Sweat chloride test - Ultrasound of the biliary tree and liver Tx Surgery - Hepatoportoenterostomy (Kasai procedure) - A loop of jejunum is anastomosed to the cut surface of the porta hepatis - facilitates drainage of bile. (If unsuccessful - liver transplant)
41
Urinary tract infection in children Investigations Treatment
Investigations - Clean catch (most preferable) - then MCS (otherwise urine collection pads) If non invasive methods not possible, - Suprapubic aspiration Tx (infants less than 3 months old should be immediately referred to a paediatrician) 3 months and older - Upper UTI --> Co-amoxiclav/ceftriaxone for 7-10 days (cefalexin if pregnant) - Lower UTI --> Trimethoprim/nitrofurantoin for 3 days
42
Intestinal malrotation Investigations Treatment
-- Most concern in billous vomiting in a new born (may be complicated with volvulus - bile stained vomit) Investigations - Upper GI contrast study and ultrasound Tx - Laparotomy - If volvulus, Ladd's procedure (widening of base of the mesentry)
43
Anaphylaxis in children Investigation Treatment
Investigation (post anaphylaxis) - Serum tryptase (elecated) Tx - IM adrenaline stat <6 months - 100-150 mcg 6 months-6years - 150mcg 6-12 years - 300mcg >12 years - 500mcg Adrenaline repeated every 5 minutes if necessary (usually given at the anterolateral aspect of the middle of the thigh) Post stabilisation - give cetrizine (antihistamine) especially in patients with persisting urticaria/angioedema Also refer to specialist allergy clinic
44
Measles Investigations Treatment
Investigations - Serology- IgM antibodies detected within a few days of rash onset Tx - Supportive care (Antipyretics, respiratory support) - Paracetamol/Ibuprofen, vitamin A supplementation PREVENTION BY IMMUNISATION
45
Diphtheria Investigations Treatment
Investigations - Culture of throat swab Tx - Erythromycin or pencillin antibiotics - Diphtheria antitoxin - Vaccination
46
Whooping cough (Pertussis) Investigations Treatment
Should be suspected if a person has an acute cough that has lasted for >14 days withought another apparent cause AND has one or more of the following - Paroxysmal cough - Inspiratory whoop - Post-tussive vomiting - Undiagnosed apnoeic attacks in young infants Diagnosis - Nasal swab culture for bordetella pertussis (Notifiable disease) Tx First line - oral macrolide (clarithromycin, erythromysin) -- if onset of the cough is within 21 days (Antibiotic prophylaxis for household contacts, school exclusion) Women that are between 16--32 weeks pregnant are offered the vaccine.
47
Poliovirus infection Investigations Treatment
Investigations - Viral culture from stool or CSF Tx Supportive - Rehydration (oral/IV) - Monitoring for flaccid paralysis
48
Tuberculosis Investigations Treatment
Investigations - Chest X-ray (shows lung cavitations.... Ghon focus/complex Mantoux skin test GS - Sputum culture (acid fast bacilli that stains bright red on a Ziehl-Neelson stain) TB to spine = POTT's disease Tx RI(6)PE(2) Rifampicin Isoniazid Pyrazinamide Ethambutol
49
HIV Investigations Treatment
Investigations - Serum HIV DNA PCR Tx Antiretroviral therapy (Pneumocystis jiroveci pneumonia treated with co-trimoxazole)
50
Kawasaki Disease Investigations Treatment
Investigations - FBC --> Anaemia, leukocytosis and thrombocytosis. ESR and CRP raised Echo to rule out coronary artery aneurysm Criteria --> Bilateral conjunctival injection Changes in the lips and oral cavity Cervical lymphadenopathy Extremity changes - peeling of finger and toes Polymorphous exanthem (rash) Fever lasting more than 5 days Tx - IVIGs AND - High dose aspirin (- exception as Aspirin usually CI in children due to Reye's syndrome) --- aspirin prevents thrombosis Main complication - coronary artery aneurysm (if aneurysm present, long term warfarin)
51
Scarlet fever Investigations Treatment
Investigation - Throat swab and culture (but antibiotic tx commenced immediately before results) Tx - Oral pencillin V (phenoxymethylpenicillin) for 10 days (children can return to school 24 hours after commencing antibiotics)
52
Congenital adrenal hyperplasia Investigations Tx
Investigations First line - Serum 17 hydroxyprogesterone -- Elevated (21 hydroxylase converts 17 OHP to a precursor of cortisol --> without 21 hydroxylase, there will be a build up of 17 OHP) GS - ACTH stimulation testing Tx - Hydrocortisone and fludrocortisone Antenatally - Dexamethasone is used to suppress secretion of androgens from the adrenal gland to reduce the risk of virilisation
53
Slipped femoral capital epiphysis Investigations Tx Complications
Investigations Frog leg radiograph (x-ray) - diagnostic --> klein line does not intersect femoral head Tx Surgical repair - Internal fixation (with a single cannulated screw placed in the centre of the epiphysis) Can lead to osteoarthritis and avascular necrosis of the femoral head and leg length discrepancy
54
Constipation in children Investigations Treatment
Clinical diagnosis - DRE for disimpaction Tx (In faecal impaction) First line - Movicol (osmotic laxative) Second line - add Senna (stimulant laxative) (Substitute movicol with lactulose/docusate if stools are hard)
55
Perthe's disease Investigation Treatment
Investigation - Bilateral hip x-ray (including frog views) --> Widening of joint space, femoral head fragmentation. Catterall staging for severity (1-4) Tx - Brace/cast to keep the femoral head within the acetabulum - younger patients <6 year - mobilisation and monitoring - Older patients can be treated surgically
56
Septic arthritis in children Investigation Treatment
Investigations GS - Joint aspiration for culture (will show raised WBC also) - Raised CRP, ESR - Blood cultures Kocher criteria used to assess probability of septic arthritis in children - Fever >38.5 - Non-weight bearing - Raised ESR - Raised WCC Tx Flucloxacillin (clindamycin if penicillin allergy)
57
Osteomyelitis Investigation Treatment
Investigation - Blood culture (with WBC raised) - MRI - identification of infection in the bone - purulent debris in the bone Tx Flucloxacillin (or cefuroxime)
58
Hypoxic ischemic encephalopathy Investigations Treatment
Investigations - Head ultrasound - MRI - Cerebral function monitoring (CFM) --> records brain activity Tx Mild - observation Moderate-severe --> Cooling therapy for 3 days
59
TORCH infections Investigations Treatment
Investigations - Blood cultures - PCR - Viral swab and cultures (CT scans can be done to identify complications of the infection) Tx - Depends on the disease T- Toxoplasmosis- Pyrimethamine and sulfadiazine (anti protozoals) O- Others R- Rubella - Get vaccinated C- Cytomegalovirus - Ganciclovir H- Herpes simplex virus - Acyclovir
60
What is used to prevent respiratory syncytial virus?
Monoclonal antibody - Palivizumab These include premature infants, infants with lung/heart abnormalities, immunocompromised infants

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