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YEAR 5: Specialties (Laz) > Paeds 3 > Flashcards

Paeds 3 Flashcards

1
Q

Which treatment would be recommended for children > 2 years with eczema that has failed to respond to topical steroids?

A

Topical calcineurin inhibitors (e.g. pimecrolimus)

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2
Q

Under which circumstances do bandages tend to be used in eczema?

A

For areas of chronically lichenified skin

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3
Q

When are antihistamines used in eczema?

A

1 month trial of non-sedating antihistamine (e.g. fexofenadine) if severe itching or urticaria

1-2 week trial of sedating antihistamine (e.g. promethazine) if flare is disturbing sleep

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4
Q

How should infected eczema be treated?

A

Swab the affected area
Advice on good hygiene when using emollients
Flucloxacillin

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5
Q

How is eczema herpeticum managed?

A

Refer for same-day dermatology advice
Oral aciclovir
Consider ophthalmological review if around the eyes

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6
Q

How are viral warts treated?

A

Daily administration of salicylic acid, lactic acid paint or glutaraldehyde lotion
Cryotherapy

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7
Q

How is molluscum contagiosum managed?

A

Spontaneous resolution by 18 months
Avoid squeezing lesions
Avoid sharing towels/clothes

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8
Q

What is the first-line treatment option for mild ringworm?

A

Topical antifungals (terbinafine cream)

NOTE: hydrocortisone 1% may be added if there is extensive inflammation

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9
Q

How are more severe ringworm infections managed?

A

Oral antifungals
1st line: terbinafine
2nd line: itraconazole

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10
Q

What is the first-line management option for tinea capitis?

A

Oral griseofulvin (or oral terbinafine)

NOTE: any animal source of the infection would also need treatment

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11
Q

What is the first line treatment option for scabies?

A

Topical permethrin 5% cream
Apply on the whole body (chin downwards) and wash off after 8-12 hours
Second application is required 1 week later

2nd line: malathion aqueous 0.5%

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12
Q

What advice should be given to patients with scabies?

A

Members of the household and close contacts should be treated
Bedding and clothes should be washed at high temperature
Treat post-scabeitic itch with crotamiton 10% cream
Nighttime sedative anti-histamine may be useful to help sleep

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13
Q

How should head lice be treated?

A

Wet combing with a fine-tooth comb every 3-4 days for 2 weeks
Dimeticone 4% lotion

Alternative: malathione 0.5% lotion

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14
Q

List some agents that are used in the treatment of guttate psoriasis.

A

Coal tar preparations
Dithranol
Calcipotriol

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15
Q

What are the treatment options for mild-to-moderate acne?

A

Benzoyl peroxide
Duac (benzol peroxide + clindamycin)
Adapalene (topical retinoid - CI in pregnancy and breastfeeding)
Azelaic acid

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16
Q

Outline the treatment options for moderate acne.

A

Consider oral antibiotics (lymecycline or doxycycline) for a maximum of 3 months
Change to alternative antibiotic after 3 months if no improvement

NOTE: topical benzoyl peroxide or retinoid should be co-prescribed to reduce the risk of antibiotic resistance

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17
Q

What can be used as an alternative to oral antibiotics in girls with acne?

A

COCP

NOTE: POPs and progestin implants can worsen acne

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18
Q

When might you consider dermatology referral for a patient with acne?

A

If not responding to 2 courses of antibiotics or if there is scarring, refer to dermatology for consideration of isotretinoin

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19
Q

When should a patient undergoing treatment for acne be reviewed?

A

At 8-12 weeks

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20
Q

How is heart failure in an infant managed?

A 
Diuretics such as frusemide (reduce preload)
Enhance contractility (e.g. dobutamine) 
Reduce afterload (e.g. ACEi) 
Improve oxygen delivery (beta-blockers)
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21
Q

How are ASDs managed?

A

Secundum - percutaneous closure (cardiac catheterisation with insertion of an occlusive device)
Partial AVSD - surgical correction

22
Q

When are symptomatic ASDs usually treated?

A

3-5 years

23
Q

When do large VSDs and AVSD tend to be treated surgically?

A

3-6 months

24
Q

How can a PDA be closed?

A

Medical: indomethacin (or other NSAID)
Surgical: cardiac catheterisation and coil/occlusive device insertion

NOTE: surgical management usually happens at around 1 year

25
Q

How should a cyanosed neonate presenting within the 1st week of life be managed?

A

Stabilise the airway, breathing and circulation
Artificial ventilation if necessary
Start prostaglandin infusion
Surgery

26
Q

What murmur is associated with ASD?

A

Ejection systolic murmur best heard at the upper left sternal edge and fixed wide split second heart sound

27
Q

What murmur is associated with VSD?

A

Loud pansystolic murmur at the lower left sternal edge, quiet pulmonary second heart sound

28
Q

Which defects require surgical correction in tetralogy of Fallot?

A

Close the VSD

Relive the right ventricular outflow obstruction

29
Q

How may hypercyanotic spells in tetralogy of Fallot be treated?

A

Sedation and pain relief
IV propranolol
IV fluids

30
Q

Which life-saving procedure may be performed for patients with transposition of the great arteries to enhance mixing of the blood?

A

Balloon atrial septostomy

31
Q

How is tricuspid atresia treated?

A

Blalock-Taussig shunt

32
Q

How is aortic stenosis treated?

A

Balloon valvulotomy
Aortic valve replacement

NOTE: same for pulmonary stenosis

33
Q

How is SVT managed?

A

1 - vagal manoeuvres
2 - IV adenosine (DC cardioversion if this fails)
3 - maintenance therapy with fleicainide or sotalol

90% of children have no further attacks

34
Q

How is acute rheumatic fever treated?

A

Bed rest and anti-inflammatory agents (e.g. aspirin)

Penicillin V if evidence of persistent infection

35
Q

What is the most effective prophylaxis for rheumatic fever?

A

Monthly injections of benzathine penicillin
Alternative: oral penicillin OD

NOTE: prophylaxis recommended for 10 years after last episode of rheumatic fever or until 21 years old

36
Q

How is infective endocarditis treated?

A

Beta-lactam and gentamicin

Usually for 6 weeks

37
Q

How would you treat an umbilical granuloma?

A

Regular application of salt to the wound

Cauterise with silver nitrate

38
Q

List some contraindications for MMR.

A

Severe immunosuppression (high dose steroids leave you immunocompromised for 3 months)

Allergy to neomycin

Received another live vaccine by injection within 4 weeks

Pregnancy should be avoided for at least 1 month afterwards

IG therapy within the past 3 months

39
Q

How should children < 3 months with a UTI be managed?

A 
Admit to hospital immediately 
IV antibiotics (e.g. amoxicillin) for at least 5-7 days
40
Q

Which clinical features are suggestive of an upper UTI?

A

Bacteriuria + fever

Bacteriuria + loin pain

41
Q

How should an upper UTI be treated?

A 
Oral antibiotics (e.g. trimethoprim for 7 days) 
If this cannot be used, give IV antibiotics (e.g. coamoxiclav) for 2-4 days and discharge with oral antibiotics
42
Q

How should simple cystitis be treated?

A

Oral antibiotics (e.g. trimethoprim) for 3 days

43
Q

Which children should have an ultrasound after a UTI?

A

Children who have had an atypical UTI

Children < 6 months

44
Q

Which children should have a DMSA and MCUG after a UTI?

A

< 6 months old presenting with atypical or recurrent UTI

45
Q

How should enuresis in < 5 year olds be managed?

A

Reassure that this usually resolves without investigation
Ensure easy access to the toilet at night
Encourage bladder emptying before bed

46
Q

How should enuresis in > 5 year olds be managed?

A

If infrequent (< 2 weeks) reassure and watch-and-wait

1st line if < 7: enuresis alarm and positive reward system
2nd line: desmopressin

Desmopressin may be used first line if rapid short-term control is necessary, or if > 7 years old

47
Q

List some causes of secondary enuresis.

A

UTI

Constipation

Diabetes

Psychological/Family problems

48
Q

How is nephrotic syndrome treated?

A

Oral prednisolone for 4 weeks

Wean and stop after 4 weeks

If the child does not respond or has atypical features, consider renal biopsy

49
Q

List some complications of nephrotic syndrome.

A

Hypovolaemia

Thrombosis

Infection

Hypercholesterolaemia

50
Q

How is Henoch-Schonlein purpura managed?

A

Most resolve spontaneously within 4 weeks

Joint pain can be managed with paracetamol/ibuprofen

IV corticosteroids are recommended for nephrotic-range proteinuria or declining renal function

Oral prednisolone may be given for severe scrotal oedema or abdominal pain

YEAR 5: Specialties (Laz) (12 decks)

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