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YEAR 5: Specialties > Paeds 4 > Flashcards

Paeds 4 Flashcards

1
Q

How are urinary tract calculi managed?

A

Conservative - fluids, analgesia, antiemetics

Bacterial infection - co-trimoxazole/nitrofurantoin or surgical decompression

Small stones - tamsulosin

Large stones - ESWL or uteroscopy

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2
Q

What are the most common causes of AKI in children?

A

HUS

ATN

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3
Q

How is haemolytic uraemic syndrome managed?

A

Admit to hospital

Monitor urine output and fluid balance

Maintain adequate hydration status

Monitor BP (treat with CCB if necessary)

Some will need dialysis

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4
Q

What long-term follow-up should be offered to patients with HUS?

A

Check for persistent proteinuria, the development of hypertension and progressive CKD

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5
Q

Outline the aspects of managing CKD in a child.

A

Diet - calorie supplements often necessary

Prevention of renal osteodystrophy - phosphate restriction, calcium and vitamin D supplements

Control of salt and water balance

Anaemia - recombinant EPO

Hormonal - human GH for GH resistance

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6
Q

How does CKD affect the growth of a child?

A

Delayed puberty

Subnormal pubertal growth spurt

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7
Q

How are hydroceles in children managed?

A

< 2 years = most resolve spontaneously

2-11 year = open/laparoscopic repair

11-18 years = conservative or surgical

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8
Q

How should unilateral undescended testicles be managed?

A

Undescended at birth –> review at 6-8 weeks

Undescended at 6-8 weeks –> review at 3 months

Undescended at 3 months –> seen by urologist by 6 months

NOTE: if descended but retractile at 3 months, advise annual follow up due to risk of ascending testes through childhood

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9
Q

How should bilateral undescended testicles at birth be managed?

A

Urgent referral to a senior paediatrician within 24 hours (genetic or endocrine testing may be necessary)

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10
Q

How is testicular torsion managed?

A

Urgent exploratory surgery (with orchidopexy/orchidectomy)

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11
Q

How is torsion of the appendix testis managed?

A

Exploratory surgery is often performed because it may be difficult to distinguish from testicular torsion

Otherwise conservative

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12
Q

How are hypospadias managed?

A

May not require treatment

May require surgery (from 3 months) for cosmetic/functional purposes

IMPORTANT: do NOT circumcise any child with a hypospadia

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13
Q

How are labial adhesions treated?

A

Topical steroids or oestrogens

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14
Q

When should phototherapy for neonatal jaundice be stopped?

A

Once the serum bilirubin is at least 50 µmol below the treatment threshold
Patients should be given folic acid supplements

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15
Q

Why should you check the serum bilirubin level 12-18 hours after stopping phototherapy?

A

Check for rebound hyperbilirubinaemia

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16
Q

When is IVIG used in neonatal jaundice?

A

Used alongside intensified phototherapy in cases of rhesus or ABO haemolytic disease where the serum continues to rise by > 8.5 µmol/L per hour

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17
Q

How is biliary atresia managed?

A

Kasai procedure

Complications can be managed using ursodeoxycholic acid, fat-soluble vitamins and prophylactic antibiotics

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18
Q

How is alpha-1 antitrypsin deficiency managed?

A

Advise against smoking and drinking
Pulmonary manifestations are managed like COPD
Liver manifestations are managed similar to other liver diseases (e.g. monitoring for coagulopathy, diuretics for ascites)

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19
Q

Which investigations are used for galactosaemia?

A

Galactose in urine

Measuring red cell Gal-1-PUT

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20
Q

How is galactosaemia treated?

A

Galactose-free diet

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21
Q

How is Hep A managed?

A

Close contacts should be vaccinated within 2 weeks of onset of illness
Unvaccinated patients with recent exposure should receive IVIG or the hepatitis A vaccine

22
Q

How is autoimmune hepatitis managed?

A

Prenisolone and azathioprine
Ursodeoxycholic acid can help in PSC
Liver transplant in severe cases

23
Q

How is hepatic encephalopathy treated?

A

Supportive
Identify and correct precipitating factors (e.g. GI bleed)
Reduce nitrogenous load (dietary protein restriction, lactulose and rifaximin)

24
Q

How long do patients with ALL tend to have chemotherapy for?

A

Girls - 2 years

Boys - 3 years

25
Q

What is the cure rate for lymphoma?

A

80%

26
Q

How is neuroblastoma treated?

A

Localised primaries can be cured by surgery alone

Metastatic disease will require chemotherapy (it may also require stem cell transplantation and radiotherapy)

27
Q

What percentage of patients with Wilm’s tumour are cured?

A

80%

28
Q

How is retinoblastoma treated?

A

Chemotherapy to shrink tumours
Laser treatment of the retina
Radiotherapy maybe used in more advanced disease

NOTE: 90% cure rate but many will be visually impaired

29
Q

Which antibiotics are used for suspected bacterial meningitis in children?

A

< 3 months = IV cefotaxime + amoxicillin
> 3 months = IV cefotaxime

If > 1 month and caused by H. influenzae, give dexamethasone

30
Q

What is the definitive management for slipped upper femoral epiphysis?

A

Internal fixation across the growth plate

31
Q

Which type of fluid should be given for maintenance requirements in children?

A

0.9% NaCl + 5% dextrose

32
Q

How are dehydration corrections calculated when administering fluids?

A 
Usually given over 24 hours 
Give maintenance + % dehydration 
Weigh the child if possible (1 kg loss = 1000 mL)
Estimate clinically (e.g. each kg = 1000 mL, so 3% weight loss in 20 kg child = 3 x 200 mL = 600 mL)
33
Q

How should iron deficiency anaemia be treated?

A

Oral ferrous sulphate 200 mg tablets (2-3/day)

Continue for 3 months after iron deficiency has corrected

34
Q

What advice would you give to someone who is taking iron tablets for iron deficiency anaemia about side-effects?

A

May experience adverse effects (constipation, diarrhoea, faecal impaction)
Discomfort could be minimised by taking the iron supplement with food

35
Q

How should treatment for iron deficiency anaemia be monitored?

A

Re-check Hb after 2-4 weeks (expect 20 g/L rise)

FBC every 3 months for 1 year

36
Q

What are the aspects of treating a neonate with hereditary spherocytosis?

A

Supportive (maybe blood transfusion)
Folic acid supplementation
Phototherapy/exchange transfusion

37
Q

Outline the aspects of treating hereditary spherocytosis in older children and adults.

A

Supportive (maybe blood transfusion)
Folic acid supplementation
Splenectomy and vaccination regimen for encapsulated bacteria
Cholecystectomy for gallstones

38
Q

How can complications of sickle cell disease be prevented?

A

Immunisation against encapsulated organisms
Daily oral penicillin
Daily folic acid
Minimise exposure to cold, dehydration, excessive exercise and hypoxia

39
Q

Outline the treatment of acute sickle cell crises.

A 
Oral and IV analgesia
Good hydration 
Antibiotics if necessary 
Oxygen 
Exchange transfusion (for acute chest syndrome, priapism and stroke)
40
Q

Outline the steps in the analgesic ladder.

A

Step 1: paracetamol
Step 2: cocodamol or NSAIDs (weak opioid)
Step 3: morphine, oxycodone

41
Q

Which drug treatment can be used to reduce sickling in sickle cell patients?

A

Hydroxycarbamide

42
Q

How is haemophilia treated?

A

Factor 8 concentrate (A)
Factor 9 concentrate (B)
Acute bleed - factor concentrates and anti-fibrinolytics

43
Q

Which medications should be avoided in patients with haemophilia and von Willebrand disease?

A

IM injections
Aspirin
NSAIDs

44
Q

Which treatment can be used for mild haemophilia A?

A

Desmopressin (stimulates endogenous release of vWF)

45
Q

What medical treatment can be used for type 1 von Willebrand disease?

A

Desmopressin
NOTE: risk of hyponatraemia

More severe disease is treated with factor 8 concentrate

46
Q

Describe the usual natural course of ITP.

A

In 80% it is an acute, benign and self-limiting disease
Resolves spontaneously within 6-8 weeks
Mild/asymptomatic disease can be managed with observation alone

47
Q

How can severe ITP be managed?

A

IVIG + corticosteroid + platelet transfusions

Antifibrinolytics (e.g. tranexamic acid) may be used

48
Q

How is DIC treated?

A

Treat underlying cause
Supportive care
Replacement therapy (platelets and clotting factors)
Restoration of physiological coagulation pathways (e.g. using heparins)

49
Q

How is acute osteomyelitis managed?

A

High-dose IV empirical antibiotics (for 2-4 weeks)
Switch to oral once clinically recovered (continue for 6 weeks)
Immobilise the affected area
Surgical debridement may be necessary
Possible antibiotics used include flucloxacillin and penicillin

50
Q

How would you counsel a patient with Osgood-Schlatter disease?

A 
Stop or reduce sporting activity 
Analgesia - paracetamol and NSAIDs
Intermittent ice packs 
Protective knee pads 
Stretching

YEAR 5: Specialties (12 decks)

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