Paeds 1A

Question 1

When is the 6 in 1 vaccine given?

Answer 1

2, 3 and 4 months

Question 2

When is the pneumococcus vaccine given?

Answer 2

3 and 12 months

Question 3

When is the Men B vaccine given?

Answer 3

2, 4 and 12 months

Question 4

When is the rotavirus vaccine given?

Answer 4

2 and 3 months

Question 5

When is the Hib/MenC booster given?

Answer 5

1 year

Question 6

When is the MMR given?

Answer 6

1 year and 3 years 4 months

Question 7

When is the HPV vaccine given?

Answer 7

12-13 years

Question 8

When is the Men ACWY vaccine given?

Answer 8

14 years

New university students aged 19-25

Question 9

Outline the management of DDH.

Answer 9

seek orthopaediac opinion
1st line = <6 months –> observation - monitor progress by repeat ultrasound or x ray
2nd line = splint or pavlik harness to keep hip flexed and abducted - follow up w x-ray at 6 months of age
3rd line = surgery if conservative measures fail (reduction with spica casting)

Question 10

Outline how hearing is tested in the neonate.

Answer 10

1st: evoked otoacoustic emission (EOEA) testing

If this is abnormal –> automated auditory brain stem (AABR) audiometry

Question 11

Briefly outline the steps in the management of necrotising enterocolitis.

Answer 11

Stop oral feeding –> TPN
NG tube
Broad spectrum antibiotics (cefotaxime and vancomycin)
artificial ventilation - rep support
fluids - cardio support
Surgery if perforation/necrosis or failing to respond to medical treatment = laparotomy with resection of necrosed bowel

Question 12

What can be used to close a PDA?

Answer 12

IV indomethacin
Prostacyclin synthetase inhibitor
Ibuprofen

Question 13

How is the bilirubin concentration measured in neonatal jaundice?

Answer 13

If < 24 hours or < 35 weeks gestation = serum bilirubin

If > 24 hours or > 35 weeks gestation = transcutaneous bilirubin (if this is > 250 µmol/L - check serum bilirubin)

Question 14

What serum bilirubin levels suggests increased risk of developing kernicterus?

Answer 14

> 340 µmol/L in babies > 37 weeks

or rising rapidly > 8.5 µmol/L/hr

Question 15

How often should serum bilirubin be measured in a neonate with jaundice?

Answer 15

Every 6 hours until it drops below the treatment threshold

Question 16

Which investigations should be performed in a neonate who developed jaundice within 24 hours of birth?

Answer 16

Haematocrit 
Blood group of mother and baby 
DAT test 
FBC and blood film
Blood G6PD level 
Blood/urine/CSF culture

Question 17

Which antibiotics are used to treat meconium aspiration?

Answer 17

IV ampicillin and gentamicin

Question 18

Which antibiotics may be used in the treatment of early-onset sepsis?

Answer 18

Benzylpenicillin and gentamicin

Question 19

Which organism most commonly causes late-onset sepsis?

Answer 19

Coagulase-negative staphylococcus (e.g. Staphylococcus epidermidis)

Question 20

How is neonatal meningitis treated?

Answer 20

3rd generation cephalosporin + amoxicillin/ampicillin

Question 21

What is the paediatric sepsis 6?

Answer 21

1. Supplemental oxygen
2. Gain IV or IO access and take bloods = blood cultures, blood glucose, blood gas and lactae
3. IV/IO broad-spectrum antibiotics
4. IV fluids (be cautious about fluid overload) and monitor urine output
5. Experienced senior clinicians should be involved early
6. Vasoactive inotropic support (e.g. adrenaline) should be considered early
   a. Considered if normal physiological parameters are NOT achieved after > 40 ml/kg of fluid resuscitation –> consider ICU

Question 22

How should neonatal conjunctivitis be treated?

Answer 22

Mild bacterial (staph or strep) = chloramphenicol
Serious ones require systemic abx:
Gonococcus - IV single dose cefotaxime/ceftriaxone
Chlamydia - oral erythromycin (2 weeks)
Pseudomonas - gentamicin eye drops + systemic abx
viral - clean with saline water, cold compress, artificial tears or luburicating drops

Question 23

What should babies at risk of vertical hepatitis B transmission receive?

Answer 23

Hepatitis B immunoglobulin AND Hep B vaccine

Question 24

How is gastro-oesophageal reflux in a breastfed infant treated?

Answer 24

1st line: Breastfeeding assessment

2nd line: trial of alginate therapy for 1-2 weeks

Question 25

How is gastro-oesophageal reflux in a formula fed infant treated?

Answer 25

1st line: review feeding history (check for overfeeding)
2nd line: offer trial of smaller more frequent feeds
3rd line: offer trial of thickened formula
4th line: offer trial of alginate therapy

Question 26

If conservative measures to treat GORD in an infant fail, what should you do?

Answer 26

Consider a 4-week trial of a PPI or histamine antagonist