27/11/21 Flashcards
Dermatomes of Upper Limb - C5-T1. Basic Description of regions.
C5 - Upper Arm
C6 - Lateral Forearm + Thumb and Index Finger half
C7 - Palm and middle finger and half indec
C8 - 4th and 5th fingers, medial forearm
T1 - anterior arm and medial forearm
Cervical Spine Level if Biceps and Brachioradialis Reflexes are affected?
C5-C6
Cervical Spine level if triceps reflex is affected?
C7
Movements affected if C5 is affected?
Shoulder Abduction
External Rotation
Elbow Flexion
Forearm Supination
Movements affected if C6 is affected?
Shoulder Abduction
External Rotation
Elbow Flexion
Forearm Supination and Pronation
Movements affected if C7 is affected?
Elbow Extension
Forearm Pronation
Wrist Extension
Wrist Flexion
Movements affected if C8 is affected?
Wrist Extension
Finger Extension + Flexion + Adduction + Abduction
Distal Thumb Flexion
Movements affected if T1 is affected?
Finger Abduction + Adduction
Distal Thumb Flexion
Thumb Abduction
Clinical Manifestations of Cervical Radiculopathy (4 points)
- Neck, Shoulder or Arm Pain
- Upper extremity muscle weakness
- Sensory symptoms
- Diminished Deep Tendon Reflexes
Mechanisms of Cervical Radiculopathy (2)
- Cervical Spondylosis
2. Disc Herniation
Do you use chronological age or adjusted age when calculating timing of vaccination doses of pre-term infants?
if medically stable - use chronological age
Recommended schedule for Hep B vaccinations in premature infants? How is this different to the normal vaccination schedule?
- Recommended Schedule
- Hepatitis B vaccine at birth
- 3 Doses of Hepatitis B Vaccination at 2,4 and 6 months
- BOOSTER HEPATITIS B VACCINATION at 12 months
Pneumococcal Schedule for Preterm Infants? How is this different to the normal vaccination schedule?
- All preterm infants <28 weeks gestation → 4 doses of 13vPCV and 2 doses of 23vPPV
- 13vPCV → 2,4,6 and 12 months of age
- 23vPPV → 1st Dose: 4 years of age, 2nd Dose 5 years after 1st later.
Dose at 6 months is extra
Age range for febrile seizures? Proportion of children that get Febrile Seizures? Associated with_____?
- 6 months - 5 years
- Benign - occur in 3% of healthy children
- Associated with simple viral infections
Recurrence of Febrile Seizures? What does it depend on?
- Recurrence Rate
- Depends on the age of the child at first seizure → the younger the child at initial seizure, the greater the risk of further febrile seizures
Risk Factors to develop epilepsy from having febrile seizures (4 points)
- FHx of Epilepsy
- Neurodevelopmental Problem
- Prolonged or Focal Febrile Seizures
- Febrile Status Epilepticus
Characteristics of Simple Febrile Seizures (4 points)
- FHx of Epilepsy
- Neurodevelopmental Problem
- Prolonged or Focal Febrile Seizures
- Febrile Status Epilepticus
Characteristics of a complex Febrile Seizures (4 points)
Fever and ANY of the following:
- focal features at onset or during the seizure
- duration >10minutes
- incomplete recovery within 1 hour
- recurrence WITHIN the same illness
WTF is an afebrile febrile seizure?
Seizures in an acute infectious illness (particularly gastroenteritis) without documented fever
Features consistent with simple febrile seizures
Investigations for a febrile seizure?
- If focus of infection identified → no investigations are indicated
- NO ROLE for EEG in simple of complex febrile seizures
What NOT to do in a febrile seizure?
- During a seizure → do NOT put child in the bath, do NOT restrain them, DO NOT put anything in their mouth
How long should you wait before calling an ambulance in the context of a febrile seizure?
Call ambulance if seizure lasts for more than 5 minutes
When to refer to a paediatrician in the context of a febrile seizure?
- Complex Febrile Seizure
- Seizures unable to be controlled
- Child clinically unwell
- Child does not return to normal mental state in 1 hour
- Concern regarding nature of febrile illness
- Frequent seizures
Characteristic symptoms associated with alcohol withdrawal? (4 points)
- Anxiety
- Tremor
- Sweating
- Nausea and Vomiting
- Agitation
- Headache
- Perceptual Disturbances
- Occasionally - seizures
Medications to manage alcohol withdrawal (2 points)
- Prescribing short-course of diazepam to reduce withdrawal severity -> Diazepam 20mg PO every 2 hours until symptoms subside → cumulative total of 60mg is usually adequate. Do not use more than 100mg without seeking specialist advice.
- Thiamine to reduce risk of Wernicke’s Encephalopathy -> Thiamine 300mg IM or IV daily for 3-5 days then thiamine 300mg orally daily for several weeks.
Eligibility Criteria for Outpatient Alcohol Withdrawal Management? 5 points
- No previous severe withdrawal including no seizures or delirium tremens
- No concurrent acute medical illness
- No evidence of psychosis, suicidal thoughts or severe depression
- No evidence of other drug use except cannabis
- Supportive, stable and drug free, alcohol free home environment
Options for alcohol cessation? Be Specific with dosing
- Disulfiram 100mg PO, once daily for 1-2 weeks, increased as required and as tolerated to 300mg daily
- Acamprosate 666mg PO TDS (>66kg) OR 666mg PO mane, 333mg midi and nocte (<66kg)
- Naltrexone 50mg PO daily
Basic Principles of each alcohol cessation medication?
Disulfiram - makes patient physically unwell if drink alcohol
Naltrexone - reduces pleasure related to alcohol + reduce cravings
Acamprosate -> reduce withdrawal symptoms which trigger people to drink
Characteristics of an infected diabetic foot ulcer? (5 points)
At least 2 of the following:
- Local Swelling or Induration
- Erythema extending more than 0.5cm in any direction from the wound
- Local Tenderness or Pain
- Local Warmth
- Purulent Discharge
Classification of Mild Infected Diabetic Foot Ulcer?
erythema <2cm from wound margin
involves just skin and subcut tissue
Classification of Moderate Infected Diabetic Foot Ulcer?
erythema >2cm from wound margin OR involving deeper structures -> muscle, joint, bone
Classification of Severe Infected Diabetic Foot
SIRS response
Management of an acute mild diabetic foot ulcer?
- Dicloxacillin 500mg PO Q6H
- OR Flucloxacillin 500mg PO Q6H
Rank the dressings from least absorbent to most. Alginate, Foams, Hydroactive, Hydrocolloid, Hydrogels, Semi-Permable Films.
- Semi-Permable
- Hydrogels
- Hydrocolloid
- Foam
- Alginate
- Hydroactive
Wound dressing for chronic ulcers?
Hydrocolloid Dressings