"" Flashcards
List 3 common types of dementia
Alzheimer’s
Vascular
Lewy body dementia
Name 2 blood tests that could be done to test for cognition
Thyroid, vitamin B
12, folic acid, CRP, FBC, electrolytes
Vitamin deficiency, infection, or other problems (renal failure) -> may cause confusion in the elderly
List 2 problems with the mini mental health test - one with regards to the test and one with regards to the patient
Problems: Screening tool at most Poorly administered/scored Effects of practise Effects of education, language Ceiling and floor effects Training required
Problems with the patient: Sensory/perceptual deficits – hearing and visual Deficit in attention Slow processing speed Slow reactions Less ability to use strategies
What are the most common diseases associated with obesity?
Acanthosis nigricans Diabetes type 2 Orthopaedic problems PCOS CV disease
A child’s head circumference is on the 60th centile. Write how you would
explain this to his parents in a reassuring
way
60th centile is normal; there is a lot of variation in height
Out of 100 children, there are 60 with a lower head circumference measurement than him, he is just above average
State why it would be difficult to measure the height of:
A new born baby
A 2 year old
A 5 year old with fever and leg pain
New-born:
Can’t stand on their own/straight to be measured against a wall
2 y/o:
Won’t stay still/shy
5 y/o: Can't stand straight on leg Moving around Uncooperative/ restless fatigued so poor posture
Parents are concerned their child may be undergoing pubertal growth spurt - he is 8 y/o - you look at clinical findings, height measurements and medical history. What else could you use to see if he is undergoing a growth spurt
Biochemical tests of hormones (GH, LH, FSH, test, GnRH, sex steroids)
Name and describe the 3 stages of birth
Phase 1: Contractions and cervical effacement
Phase 2: Delivery of baby
Phase 3: Delivery of placenta
Where do contractions start from and where do they spread to?
Start at fundus of uterus where the pacemaker is and spread downwards
Followed by uterine relaxation to allow blood flow to uterus
What is meant by the term ‘effacement’
The thinning and flattening of the cervix
What is menarche?
The start of mensruation - 1st period
Describe the onset of menarche. How has this changed in the past 100 years?
Current age is around 13
Evidence that age of menarche has decreased over the last 100 years
Over the last 3-4 decades it appears to have levelled off (?increasing again)
Population studies suggest that the body weight at menarche has remained relatively constant at about 47kg
When does GnRH pulsatile release occur?
Night time pulses in puberty/adrenarche up to two years before menarche
As a neonatal infant there are still pulsatile releases
Neonate = GABA and NPY are quiescent; glutamate active but negative feedback system sensitive so LH and FSH not released in large amounts
Pre-puberty = inhibitory GABA and NPY are active; glutamate inhibited, no GnRH release
Puberty = GABA and NPY are quiescent, glutamate neurones activated, GnRH release
IGF-1, leptin, ovarian steroids (peripheral signals) inhibit GABA and NPY
A 10 y/o girl is the shortest in her class
What would you look for in her PMH?
Genetic - most short children have short parents
LBW - permaturity
Events - Malnutrition due to GIT lesion, inflammatory ilness
Drugs e.g. steroids
Birth weight, prematurity, past emotional or psychological problems, childhood illness, previous malnutrition or severe GI tract disturbances
A 10 y/o girl is the shortest in her class
What would you look for in her family history?
Parental height
Inherited conditions - endocrine (GH, thyroid, IGF-1 deficiency); syndormes (Turner’s, Down’s, achondroplasia)
Skeleteal abnormality/dysplasias
A 10 y/o girl is the shortest in her class
What would you look for on physical examination?
Evidence of Turner’s syndrome: Hypoplasia of maxillary region, prominent forehead, webbed neck, high carrying angle, hypoplastic nails
Height and proportions
Malnutrition
A 10 y/o girl is the shortest in her class
What features would indicate she needed further investigation?
Plot her on a growth chart; if she is falling in centile
Evidence of genetic syndrome
Evidence of an illness e.g. malnutrition due to GIT lesion
What is height velocity?
Speed of growth = the cms grown in one year
height now–height at last visit)/(age now–age at last visit
What are the values and limitations of using predicted parental target height for a child?
Gives an idea of expected height
Limitations: -so long as someone is growing along their centile there is no clinical issue; likewise, if someone ends up at the predicted height but in an abnormal fashion/via dropping centiles, it might indicate a pathology -parents may overestimate their height -height also depends on environmental factors (in utero) not just genetic factors
What are the factors affecting taking accurate hegiht measurements?
Get the right equipment and make sure it is accurate Position the child carefully: relaxed (Make sure the child doesn’t move) Line up the head, standing straight Remember hair styles, headbands etc
What are the advantages of a mini-mental state exam (MMSE)?
Fairly short time to administer; takes around 30 minutes
Does attempt to cover several areas of cognitive function
Less cultural bias than tests
Widely used and translations available
