Block test preparation Flashcards
Discuss the causes of pain in a patient with HIV/AIDS
- Oral cavity: aphthous ulcers, candida, herpes
- Abdominal pain: UTI, colitis, pancreatitis, hepatitis
- Headaches: sinusitis, meningitis, encephalitis
- Neuromuscular: encephalopathy
- Ears: otitis media and externa
- Skin: sores and rashes
- Chest: pneumonia/TB
- ART side effects: diarrhoea, headache, muscle pain
- Procedural pain
List the components of total pain
- Physical
- Emotional
- Social
- Spiritual
Discuss the pharmacological management of chronic pain in a 5-year old child,
according to the WHO. Also mention the special considerations.
Management:
• Level 1: non-opioid analgesics (NSAIDS and paracetamol)
• Level 2: weak opioids with/without non-opioids
• Level 3: strong opioids with/without non-opioids
Special considerations according to the WHO:
• “by the clock”
o for persistent pain use a regular schedule
o give breakthrough doses if needed
• “by the mouth”
o give orally where possible
§ simplest
§ most effective
§ least painful
o if oral route is not an option, DON’T use IMI route
• “by the individual”
o dose paracetamol and NSAIDS according to weight
o consider capacity to metabolise
§ malnourished children will have a low metabolism
o use the lowest effective dosage for effective pain relief with
acceptable side-effects
o always titrate opioids
o don’t be scared to use morphine, BUT don’t use codeine
Discuss the pathophysiology of pallor (not anaemia)
- Hypoperfusion
- Anaemia
- Metabolic
- Asphyxia
- Oedema
Discuss how you would approach a pale child
A. Determine whether pallor is acute or chronic B. History • Duration • Other associated symptoms C. Determine the vital signs D. Observe the colour of the child • Skin: not a good indicator for anaemia • Mucous membranes of the mouth • Conjunctiva • Creases of hyperextended hand E. Determine the primary affected system F. Plan investigations and/or management
Discuss the pathophysiology of anaemia (not pallor)
- Decreased haemoglobin
- Decreased production of RBC
- Haemolysis (metabolic)
- Increased destruction (at the spleen)
- Chronic blood loss (leukaemia)
Discuss the characteristics of a lymph node and when you should worry in children
• AGE: Usually benign in children
• CONSISTENCY: Hard and firm LNs indicate malignant
• FIXATION: fixed LNs
• TENDERNESS: tender lymph nodes are worrisome
• LOCATION: supraclavicular lymphadenopathy has the highest risk of
malignancy. Epitrochlear nodes are always abnormal. Isolated inguinal
adenopathy is less likely to be malignant
• SIZE: worrisome if size is 1.5-2cm
• DURATION: nodes lasting more than 2 weeks and showing progression is
worrisome
• ASSOCIATED SYMPTOMS: fever, night sweats, weight loss, bone pain,
petechiae
List the common infectious causes of generalized lymphadenopathy
a. HIV
b. CMV
c. TB
d. Toxoplasmosis
e. Lymphocytic interstitial pneumonitis
What is the significance of enlarged groin lymph nodes in a two-month-old child?
a. Sign of acute regional infection
b. Sign of haematological and other malignancies
c. Sign of TB infection
d. Investigations:
i. Fine needle aspiration to dx TB
ii. Resections of an entire node to diagnose lymphoma
Examining lumps and bumps
Site, Size, Shape, Surface, Skin, Scar Tenderness, Temperature, Transillumination Consistency Attachment Mobility Pulsation Fluctuation
List the signs of childhood cancer
Continued unexplained weight loss
Headaches, often with early morning vomiting
Increased swelling or persistent pain in bones, joints, back or legs
Lump or mass, especially in the abdomen, neck, chest, pelvis or armpits
Development of excessive bruising, bleeding or rash
Constant infections
A whitish colour behind the pupil
Nausea which persist or vomiting without nausea
Constant tiredness or noticeable paleness
Eye or vision changes occurring suddenly and persist
Recurrent or persistent fevers of unknown origin
List the warning signs of cancer in children
Seek : Medical help for persistent symptoms
Eye : White spot, bulging eye, blindness
Lump : Abdomen and pelvis, head and neck, testes, gland, limbs
Unexplained : Fever, loss of weight and appetite, pallor and fatigue,
Aching : Bones, back, joints and easy fractures
Neurological signs : Change in behaviour, balance, gait and milestones
Define a wheeze and state the most common origin.
Continuous, high-pitched whistling sound, accompanied by a prolonged expiration.
Usually from an intra-thoracic origin.
List and discuss three collateral signs of an infant with a wheeze
a. Hyperinflated chest • Increased AP diameter • Loss of cardiac and liver dullness on percussion • Liver inferiorly displaced b. Hoover sign • Paradoxical inward movement of subcostal area during inspiration c. Prolonged expiration • Due to intra-thoracic obstruction
Give a differential diagnosis for an infant with a
wheeze
- Foreign body aspiration
- Asthma
- GORD
- Cystic fibrosis
- Reactive airway disease
- Airway malformation
- Bronchiolitis
- Bronchiectasis
- Bronchomalacia/tracheomalacia
List the typical features of asthma
• More than 1 typical symptom o Wheeze o SOB o Cough o Tight chest • Worse at night or early morning • Symptoms vary over time and in intensity • Usually triggered
List the features of an allergic face in a child
- Periorbital shiners
- Denni-Morgan lines
- Conjunctivitis
- Nasal crease
- Upturned nose
- Long face due to excessive mouth breathing
Provide reasons for poor asthma control
- Inhaler skills
- No medication
- Ongoing triggers
- Wrong diagnosis (asthma responds to bronchodilators)
- Co-morbid conditions eg. allergic rhinitis
- Adherence
- Understanding
How would you assess the degree of control in an asthmatic child?
- Coughing
- Waking up at night due to asthma symptoms
- Using reliever medication more than twice a week
- Exercise induced asthma
List 5 cyanotic heart diseases
Truncus arteriosus Transposition of the great arteries Tricuspid atresia Tetralogy of Fallot Total anomalous pulmonary venous return
List 5 acyanotic congenital cardiac lesions.
- Ventricular Septal Defect
- Atrial Septal Defect
- Patent Ductus Arteriosus
- Atrio-Ventricular Septal Defect
- Endocardial Cushion Defect
Give a list of the modified Jones criteria and when the disease will be diagnostic
5 Major Criteria Carditis Polyarthritis Sydenham chorea Erythema marginatum Subcutaneous nodules
5 Minor Criteria Increased PR interval on ECG Arthralgia Increased CRP?ESR/WBC Fever History of previous RF
Diagnosis:
- Evidence of strep infecion
- Two major/one major + two minor criteria
List five signs of cardiac failure
- Tachypnoea
- Tachycardia
- Hepatomegaly
- Raised JVP
- Oedema
How would you treat cardiac failure?
- Preload decrease – diuretics
- Increase contractility – inotropes/digoxin
- Decrease afterload – vasodilators
- Control compensatory mechanisms – B-blockers
