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HYMS phase II H&S > Block 41 > Flashcards

Block 41 Flashcards

1
Q

1) After birth, a mother and baby can go home in 24-48 hours if what conditions have been met?
2) When might a mother and baby not be able to go home after 24-48 hours?

A

1) If feeding is established and mother and baby have both opened their bowels and bladder.
2) After a c-section a longer period of observation may be needed.

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2
Q

1) When does the first NIPE take place?
2) When is it recommended that the Newborn blood spot test takes place?
3) When should newborn hearing screening take place?
4) When does the second NIPE take place?

A

1) within 72 hours of birth.
2) 5-8 days after birth but can be done up to 1 year of age (test for CF MUST be done within 8 weeks of birth).
3) Birth to 5 weeks of age.
4) 6-8 weeks of age.

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3
Q

State which 8 conditions are tested for with the newborn blood spot test.

A

1) Cystic fibrosis
2) Congenital hypothyroidism
3) Sickle cell disease
4) Phenylketonuria
5) Medium chain acyl-Coa dehydrogenase deficiency
6) Maple syrup urine disease
7) Isovaleric acadaemia
8) Glutaric acuduria

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4
Q

Aside from the normal screening tests of newborn babies, in what 2 circumstances might additional follow up be required?

A

Extra follow up is required if the mother is HIV positive or is treated for Syphillis during pregnancy.

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5
Q

What is needed if a hepatitis B positive mother gives birth to a baby?

A

Vaccination ± IV immunoglobulin within 24 hours.

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6
Q

Give 6 ways as to how HCPs can act to prevent the spread of childhood infection.

A

1) Isolation (e.g. on the ward)
2) Hand washing
3) PPE
4) Chemoprophylaxis
5) Vaccination
6) Contact tracing

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7
Q

1) What is meningitis?
2) Name 3 viral infections that can cause meningitis.
3) What proportion of cases of meningitis are caused by viruses?
4) Generally, how is viral meningitis treated?

A

1) Inflammation of the meninges which cover the brain and spinal cord.
2) enterovirus, EBV, adenovirus and mumps.
3) 2/3rds.
4) Viral meningitis is often self-resolving.

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8
Q

Give 6 ways in which viral meningitis may be diagnosed.

A

1) CSF culture/ PCR
2) Stool
3) Urine
4) Nasopharyngeal aspirate
5) Throat swabs
6) Serology

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9
Q

1) In what age groups does incidence of meningitis peak?
2) What percentage of meningitis cases occur in patients under 16?
3) When is incidence of meningitis infections highest?

A

1) Infancy and adolescents
2) 80%
3) In winter

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10
Q

1) Briefly describe the distribution of meningitis infections across the population.
2) What is the mortality rate in patients with meningitis?

A

1) 97% of cases are sporadic, but cases may cluster in outbreaks.
2) 5-10%

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11
Q

Give the 3 main causes of bacterial meningitis in the neonatal to 3 month old period.

A

Group B streptococcus
E. coli and other coliforms
Listeria monocytogenes

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12
Q

Give the 3 main causes of bacterial meningitis in the 1 month to 6 year period.

A

N. Meningitides
S. Pneumoniae
H. Influenzar

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13
Q

Give the 2 main causes of bacterial meningitis in children >6 years old.

A

N. Meningitides

S. Pneumoniae

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14
Q

1) Who must you notify if you suspect a patient may have meningitis?
2) If a person is diagnosed with meningitis, who should you trace?

A

1) Public health

2) Close contacts with the last 7 days prior to symptom onset.

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15
Q

Who is classified as being a close contact of a person if they are diagnosed with meningitis?

A
  • People in the patient’s household
  • People the patient has shared a room with
  • People who the patient has eaten with
  • Partner of intimate kissing
  • Healthcare workers exposed to droplet secretions
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16
Q

1) What should close contacts of a patient with meningitis be offered?
2) What is the aim of treating close contacts?

A

1) Antibiotics (Rifampicin/ Ciprofloxacin)

2) The aim is to decrease nasopharyngeal carriage of the strain and to decrease risk for others.

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17
Q

What is a communicable disease?

A

An illness due to an agent or its toxic product which arises through transmission from an infected person, animal, or reservoir to a susceptible host.

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18
Q

List the 5 stages in the chain of infection.

A

1) Infectious agent
2) reservoir/ environment
3) Mode of transmission
4) Portal of entry
5) Host

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19
Q

State the characteristics of an infectious agent or pathogen.

A

a. Ability to reproduce
b. Survival (including environmental)
c. Ability to spread
d. Infectivity (ability to cause infection, also consider colonisation without infection)
e. Pathogenicity (severity of the illness)

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20
Q

1) What is infectivity?
2) What is colonisation?
3) What is pathogenicity?

A

1) The capacity to enter, survive and multiply in a host.
2) Infection but no immunological response
3) Capacity to cause disease.

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21
Q

Name 4 types of host.

A

Humans
Animals
Water systems
Environmental contamination

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22
Q

Name 4 different modes of transmission of disease.

A

1) Respiratory
2) Ingestion
3) Blood borne
4) Sexual contact

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23
Q

Name 5 portals of entry for infections in humans.

A

1) Mouth
2) Nose
3) Ears
4) Genital tract
5) Skin (barrier breakdown)

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24
Q

Name 5 host factors that can affect the speed of spread of infections.

A

1) Chronic illness
2) Nutrition
3) Age (the very young and the very old)
4) Immunity (immune condition, chemotherapy, transplant)
5) Lifestyle factors (drugs, alcohol abuse, SES, occupation)

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25
Q

Give the 2 main types of direct transmission.

A

1) Immediate transfer (contact, droplet)

2) Vertical transmission (HIV, syphillis, Hep B)

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26
Q

Give the 3 main types of indirect transmission

A

1) Airborne (aerosol, droplet)
2) Vector-borne (mechanical/ biological)
3) Vehicle-borne (water, food, blood, organs)

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27
Q

What is surveillance?

A

“Systemic collection, collation and analysis of data and dissemination of the results so that appropriate control measures can be taken”

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28
Q

Define the term ‘outbreak’.

A

An outbreak is an incident in which two or more people, thought to have a common exposure, experience a similar illness or proven infection (at least one of them having been ill).

29
Q

Define the term ‘epidemic’.

A

Occurrence of a disease in a community in excess of what is normally expected.

30
Q

What is a pandemic?

A

An epidemic occurring over a very wide area, crossing international boundaries.

31
Q

1) How many notifiable diseases are there?

2) How many causative agents are there that should be reported to PHE if detected?

A

1) 31

2) 60

32
Q

Name the 5 steps in outbreak investigation and control.

A

1) Establish existence of outbreak (verify diagnosis)
2) Identify and count cases/ exposures (define the case)
3) Identify time and place of exposure and people exposed
4) Formulate a hypothesis and test it
5) Evaluate control measures through surveillance (report findings)

33
Q

Give 3 factors that influence the spread of hospital acquired infections.

A

1) Age extremes
2) Underlying disease
3) Breach of defence mechanisms
4) Antibiotic resistance

34
Q

What are the most common hospital acquired infections?

A

C. difficile
UTIs
Pneumonia

35
Q

Mandatory surveillance of what 3 hospital acquired infections occurs?

A

C. difficile
MRSA
MSSA

36
Q

Give 5 ways in which spread of infections can be prevented.

A

1) Education and training
2) National policies
3) Investigation of outbreaks
4) Screening patients (e.g. MRSA)
5) Barrier nursing (quarantining infected patients)
6) Appropriate sharps disposal
7) Antibiotic prescribing policies
8) Hand washing

37
Q

Give 5 ways in which optimum transition of a patient from child to adult health services can be achieved.

A

1) Involve young people and carers in service design, delivery and education.
2) Ensure transition is developmentally appropriate.
3) Use a person centred approach.
4) Start the transition early where possible.
5) Have a named worker for the patient
6) Aim to build independence.
7) Sharing of important clinical details (aim for no disruption to care)
8) Have crossover/ joint appointments involving the child and adult services physicians.
9) Be holists - support health, education, community inclusion and employment.
10) Support continues after transfer (6 months before and 6 months after).

38
Q

Give 3 contraindications to note for ALL vaccines.

A

1) Previous anaphylaxis to vaccine with same antigen
2) Acute febrile illness
3) Egg anaphylaxis (of concern in influenza and yellow fever vaccines)

**Influenza and yellow fever vaccines may be given under controlled conditions.

39
Q

State the contraindications of live vaccines.

A

Primary Immunodeficiency (IgA deficiency, transient hypogammaglobulinaemia of infancy, Bruton X-linked agammaglobulinaemia)

OR

Patient is on high dose of steroids

**Live vaccines can be given to HIV positive patients - except BCG in low TB prevalence countries.

40
Q

Live vaccines can generally be given at any time, but what are the 3 exceptions?

A

1) Yellow fever and MMR need to be at least 4 weeks apart.
2) Varicella zoster virus and MMR can be given at the same time, but if not on the same day then there needs to be at least 4 weeks between them.
3) MMR and Mantoux test: MMR should be delayed until after Mantoux test is read. After the MMR is given, wait at least 4 weeks before doing the Mantoux test.

41
Q

State which vaccines are given at the following ages:

1) 2 months
2) 3 months
3) 4 months
4) 12-13 months
5) 2-10 years
6) 3 years, 4 months
7) 12-13 year old girls
8) 14 years

A

1) 6 in 1, rotavirus, Men B
2) 6 in 1, rotavirus, PCV
3) 6 in 1, Men B
4) Hib/ Men C, MMR, PCV, Men B
5) Nasal flu spray annually.
6) 4 in 1 pre-school booster, MMR
7) HPV
8) 3 in 1, Men ACWY

42
Q

State which vaccines are given to the following:

1) Adults aged 65 years
2) Adults aged 70 years
3) Pregnant women

A

1) Pneumococcal vaccine, annual flu vaccine
2) Shingles vaccine
3) Whooping cough vaccine (from >16 weeks pregnant) and annual flu vaccine.

43
Q

Describe the ethics of decision making in a child under the age of 16.

A
  • Child <16 may consent if Gillick competent.
  • If not Gillick competent, then consent is needed from someone with parental responsibility.
  • Person with parental responsibility is legally obliged to act in best interests.
  • If person fails to act in best interests, they can be taken to court.

**In emergencies, those <16 should just be treated.

44
Q

Describe the ethics of decision making in those aged 16 and 17.

A
  • Those aged 16-17 are presumed competent to consent.
  • However, those aged 16-17 are not presumed competent to refuse treatment.
  • If a doctor thinks that treatment is in the patients best interests, they can take the case to court, even if both the patient and the parents refuse the treatment.
45
Q

What diseases are vaccinated against in the 6 in 1 vaccine?

A

1) Diphtheria
2) Tetanus
3) Pertussis
4) Polio
5) Hib
6) Hep B

46
Q

What is the principle of ‘parental autonomy’ based upon?

A

This is grounded in the assumption that parents know their child’s best interests and that the close parental bond motivates them to do their best for the child.

47
Q

What is the ‘harm principle’?

A

The only purpose for which power can be rightfully exercised over any member of a civilised community against his/ her will is to prevent harm to others.

48
Q

Why is it thought that 85% of child abuse goes unreported?

A

Because most children will not recognise that what they are enduring isn’t normal.

49
Q

1) When can a newborn baby be registered with a GP practice?
2) How does a baby get a pink card?
3) If a baby does not have a pink card, how can they be seen at a GP practice?

A

1) They can be registered with a GP practice ASAP using the pink card given at the hospital.
2) After registration of the birth.
2) Parent can fill in a registration form at the GP practice.

50
Q

What is a health visitor?

A

Health visitors are nurses with specialist neonatal training or midwives who have additional training in community public health nursing.

51
Q

What is the role of child health clinics?

A

Hold regular GP clinics for vaccinations and development reviews.

They also screen maternal health.

52
Q

What are the roles of ‘sure start’ children’s centres?

A

1) Focus on increasing outcomes for young children and families
2) Focus on the most disadvantaged families.
3) Aim to reduce inequalities in child development and school readiness.

53
Q

What information can family information services give?

A

Parental information and links with job centre plus, schools, careers advisors, youth clubs and libraries.

54
Q

Name 6 avenues of community support available to the families of newborn infants.

A

1) GP
2) Health visitors
3) Child health clinics
4) Local authority services (Sure start children’s centre/ family information service)
5) Local advice centres (citizens advice bureau, housing aid centres)
6) Websites, helplines and support groups for parents.

55
Q

Describe the spectrum of adolescent cognitive response to being diagnosed with an illness or disease.

A

The cognitive response can lie anywhere on a spectrum between over-acceptance to denial.

The cognitive response can fluctuate between these two extremes over time.

56
Q

What is meant by over-acceptance of an illness by an adolescent?

A

The child may allow the illness to define them, allowing it to take over their life.

This can lead to a level of impairment above what would be expected for their symptoms.

57
Q

What is meant by denial of an illness by an adolescent?

A

Where symptoms and advice are ignored and treatment is poorly adhered to.

58
Q

Describe what an emotional response of a child to a diagnosis of an illness or disease may be.

A

The emotional response to diagnosis of an illness or disease may be similar to a bereavement reaction (and this is considered to be normal).

59
Q

Describe possible behavioural responses of children to diagnosis of an illness or disease.

A

A young child may regress and behave younger than they are and this could manifest in:

1) bed-wetting
2) decreased school performance
3) poor peer relationships

60
Q

What is meant by a ‘somatic’ response of a child to diagnosis of an illness/ disease?

A

The conversion of emotions to bodily symptoms.

61
Q

How may family members act in the event of a child being diagnosed with an illness or disease?

A

Similar to the child

OR

Suppression of emotions rather than dealing with them in an attempt to appear stoic and strong for their child

62
Q

Child/ adolescent reactions to diagnosis of an illness or disease are dependent

on what factors? (6)

A

1) Nature of illness and symptoms
2) Stage of illness
3) Age of the child
4) Temperament
5) Family factors
6) Intellectual capacity

63
Q

Give 3 reasons as to why a child/adolescent may rebel to treatment adherence.

A

1) When children become adolescents, autonomy and independence increase and the adolescent may not understand or think medication is important (poor disease knowledge may influence this)
2) Peer relationships and self-image are very important - they don’t want to seem different or become labelled (assessment of risk is skewed - risk of being socially disregarded is&raquo_space;> risk of not taking meds)
3) Side effects of medications may affect appearance (delayed puberty, short stature)

64
Q

Give 3 ways that might be helpful in order to increase the likelihood of children/ adolescents adhering to treatment.

A

1) Think about practicality (is OD injection more acceptable than 2-3 times daily?)
2) Check knowledge level
3) Work in partnership and be willing to make compromise
4) Motivate to focus on solutions to problems
5) Encourage daily routines to anchor adherence (i.e. take with breakfast and dinner, instead of ‘take two times daily’)

65
Q

Describe the basis of the children’s act 1989.

A

Allocates duties to local authorities, courts, parents and other agencies in the UK to ensure children are safeguarded and their welfare is promoted.

66
Q

The children’s act of 2004 amended the children’s act of 1989, largely in consequence to what?

A

The Victoria Climbié inquiry.

67
Q

What are the key points of the children’s act 2004?

A

1) Integration of services for children so they can be traced across services and local authorities.
2) The safeguarding of children is everybody’s responsibility.
3) The interests of children and young people are paramount in all considerations of welfare and safeguarding.

68
Q

According to the children’s act of 2004, there is an obligation of what?

A

Obligation to share information and an obligation to co-operate to safeguard and promote the welfare of children.

69
Q

If a HCP has concerns about welfare or safeguarding based on information given by a child, what should they do?

A

Explain to the child that they are unable to maintain confidentiality in this instance, but will keep the child in the loop.

The HCP should then obtain advice from named or designated professionals for safeguarding children ASAP.

HYMS phase II H&S (12 decks)

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