30/11/21 Flashcards
Clinical Features of Cystic Fibrosis?
Diagnosis of Cystic Fibrosis?
Screening for immunoreactive trypsin and trypsinogen in newborns detects 75%
Sweat test for elevated chloride and sodium levels
Risk Factors for Suicide?
Psychiatric Disorder → especially major depression, bipolar disorder, schizophrenia, schizoaffective disorder, substance use disorder, personality disorder
Current Psychosis
Family History of Suicide
Access to Means of Suicide with high potential lethality → guns, firearms, ropes, hosepipes
Definite plan of suicide attempt
History of dangerous behaviour on impulse
Low likelihood of suicide attempt being detected
Ambivalence toward survival of suicide attempt
Social isolation or absence of social supports
Chronic Medical Illness → especially if painful
Recent Major Loss → includes loss of face in some cultures
Feeling of Hopelessness
Severe Acute Asthma Management
Salbutamol (100microg/actuation) via pMDI plus spacer
- 1-5yo → 6 puffs
- 6yo → 12 puffs
Ipratropium Bromide (21microg/acutation) via pMDI plus spacer
- 1-5 yo → 4 puffs
- 6yo → 8 puffs
Repeat dose every 20-30mins as required for the first hour if needed (or sooner as needed)
Start O2 → titrate O2 >95%
- If no improvement (within minutes) → for transfer from non-acute settings to ED
Prednisolone (within 1st hour if no improvement or worsening symptoms) → 1mg/kg for 3-5 days
- in children 1-5yo → if mild/moderate wheezing responds to bronchodilator therapy → avoid systemic corticosteroids
Reaction following MMR vaccine?
MMR Vaccine - develop fever 7-10 days after vaccination → can last 2-3 days
fever can be associated with malaise and non-infectious rash
Lithium is associated with ______ diease? Explain what needs to be done.
lithium inhibit release thyroid T4 and T3
lithium can cause goitre and hypothyroidism
if thyroid function abnormal → still give lithium but thyroid dysfunction should be treated
TSH and AntiTPO antibody titres should be conducted prior to lithium treatment commencement
TFTs shold be reevaluated every 6-12 months for several years.
Investigations when on lithium?
Serum Lithium Concentration - 3-6 months
Serum Creatinine and Urea Concentrations - 3-6 months
Serum Sodium Concentration - assess hydration, assess hypernatraemia in patients with altered conscious state, review every 6-12 hours
TFTs - 6-12 months
Serum Calcium - 12 months
ECG
Signs of mild, moderate and severe dehydration in a child?
Mild: No Clinical Signs, Increased Thirst
Moderate: Delayed CRT >2 seconds, Increased RR, Decreased Tissue Turgor
Severe: Very delayed CRT >3 seconds, Increased RR, Signs of Shock, Mottled Skin, Deep Acidotic Breathing
Rabies Exposure? When do you need postexposure prophylaxis? what is it?
If nibbling of uncovered skin or minor scratches or abrations without beleding or anything more than this.
if less - no prophylaxis
if more - if non-immune for vaccine d0,3,7,14
if more if immune <3months - nothing
if more and if immune >3 monts -> d0 and d3 doses
Inferior FOot pain
Plantar Fascia
Calcaneal Fat Pad
PF FP
Posterior Foot Pain
Achilles Tendon Insertion
Superficial Calcaneal Bursa
Posterior Impingement of Soft Tissues/Os Trigonum in active people
Calcaneal Apophysitis - Severs Disease
Lateral Foot Pain
Lateral Ligaments of the Ankle
Sinus Tarsi
Medial Foot Pain
Tibialis Posterior Tendon and Sheath
Tibialis Posterior Insertion and Apophysis in Adolescents
What is a toddler fracture? Who gets it and why?
Occult fracture of the lower limb bones
9 months to 3 years
result of new stressors on bone due to recent and increasing ambulation
Clinical Features and Treatment of Toddlers Fracture?
Clinical Features
- vague symptoms
- refuse to weight bear
- irritable
No treatment and spontaneously heal
can have a backslab → fracture clinic in 2 weeks with X-ray
Classification of Medical Epicondyle Fracture? How does this change management?
If displacement <5mm -> backslab for 3 weeks and then fracture clinic and collar and cuff for 3 weeks
if displacement >5mm -> refer to ortho. if >15mm -> for reduciton and ORIF
What is a maisoneuve fracture?
Combination of fracture of the proximal fibular together with an unstable ankle injury - widening of the ankle mortise on xray often comprising of ligamentous injury and/or fracture of the medial malleolus.
What is a Galeazzi Fracutre Dislocation? What is the management?
Galeazzi Fracture-Dislocation → fracture of the distal third of the shaft of the radius with a disruption to the DRUJ
Management - arm should be splinted and refer to ortho
What is a Jones Fracture? How do you treat it and why?
Fracture at the base of the 5th metatarsal bone
Treatment → prone to non-union
displacement is increased with persistent weight bearting
immobilsiation is important → non-weight bearing cast for 6-8 weeks
Clinical Features of Alcohol Intoxication
Clinical Features
- slurred speech, nystagmus, disinhibited behaviour, incoordincation, unsteady gait, memory impiarment, coma, stupor
- hypotension and tachycardia
- euphoria at low BAL → ataxia and impaired judgement → nausea and vomiting, confusion → stupor and LOC
Investigations in the context of heavy alcohol use?
- LFTs + Albumin
- FBE
- INR
- B12/Folate - nutrition
- UEC
- CMP - decreased
- HbA1c + FBG
- Serum Ferritin - elevated
Alcohol Cessation Medication
Naltrexone 50mg PO daily
Disulfiram 100mg PO daily
Acamprosate 666mg TDS
Vaccinations at 4 months.
RIP
Rotarix
Infarix Hexa
Prevenar13
Max age for rotarix virus?
24 weeks - 6 months
diagnostic criteria of prader-willi syndrome?
NEONATAL HYPOTONIA + FEEDING DIFFICULTIES + OBESITY
Clinical Features of Prader-Willi Syndrome
Perinatal → reduced fetal movements, SGA, polyhydramnios, breech positioning, asymmetrical intrauterine growth
INfancy → hypotonia, feeding difficulties (poor suck → failure to thrive), weak cry + genital hypoplasia
Childhood → Late acquisition of major milestones
Progressive development of obesity
Causes of Hypotonia and Weakness in INfancy?
- Ill infant
- Genetic Syndromes - Down syndrome, prader willi, trisomy 18, trisomy 13
- Inborn errors of metabolism
- Hypothyroidism, hypoglycaemia
- Primary muscular disorders - DMD, BMD, Hypoxic Ischaemic Myelopathy
- Cerebral palsy
Vaccinations at 2 months.
Rotarix → Rotavirus
Infarix Hexa → Diptheria, Tetanus, Pertussis, Hepatitis B, Haemophilus Influenzae Type B, Polio
Prevenar 13 (13vPCV) → Pneumococcal
