Paeds 4B Flashcards

1
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)

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2
Q

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

A

80%

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3
Q

How is retinoblastoma treated?

A

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

if eye is not salvageable then enucleation
NOTE: 90% cure rate but many will be visually impaired

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4
Q

Which antibiotics are used for suspected bacterial meningitis in children?

A

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

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

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5
Q

What is the definitive management for slipped upper femoral epiphysis?

A

Internal fixation across the growth plate

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6
Q

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

A

0.9% NaCl + 5% dextrose

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7
Q

How are dehydration corrections calculated when administering fluids?

A

for a 5% dehydrated 20kg child:

Rehydration: %dehydration x weight x 10 = 5 x 20 x 10 = 1000mL. This is the volume that should be given over 48hrs.

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8
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

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9
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

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10
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

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11
Q

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

A

Supportive (maybe blood transfusion)
Folic acid supplementation (RBC more fragile than normal hence they break down and these pts are more anaemic than usual so need more folic acid)
Phototherapy/exchange transfusion - due to increased RBC breakdown –> increased risk of pigment gallstones and jaundice

later they may need splenectomy because they are prone to splenomegaly as the spherocytes get trapped in the splene

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12
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 (due to bilirubin from increased rbc breakdown)

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13
Q

How can complications of sickle cell disease be prevented?

A

Protection against infection after splenectomy: Immunisation against encapsulated organisms, Daily oral penicillin
To support the increased need for erythropoiesis: Daily folic acid
To reduce risk of painful crisis: Minimise exposure to cold, dehydration, excessive exercise and hypoxia

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14
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)

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15
Q

Outline the steps in the analgesic ladder.

A

Step 1: paracetamol
Step 2: NSAIDS or cocodamol (note you shouldnt give codeine to children <12 due to resp depression)
Step 3: morphine (oromorph) But give PRN naloxone

in children, avoid codeine and dihydrocodeine
avoid aspirin due to Reyes

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16
Q

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

A

Hydroxycarbamide (Hydroxyurea increases HbF in RBC which makes your red blood cells bigger. It helps them stay rounder and more flexible — and makes them less likely to turn into a sickle shape.)

17
Q

How is haemophilia treated?

A

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

18
Q

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

A

IM injections
Aspirin
NSAIDs

(IM injections, aspirin and nsaids increase bleeding risk)

19
Q

Which treatment can be used for mild haemophilia A?

A

Desmopressin (stimulates endogenous release of vWF)

20
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

21
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

22
Q

How can severe ITP be managed?

A

IVIG + corticosteroid + platelet transfusions
Antifibrinolytics (e.g. tranexamic acid) may be used

23
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)

24
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

25
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