Child health Flashcards
1
Q
APGAR mnemonic stand for?
A
Activity
Pulse
Grimace
Appearance
Respiration
2
Q
What is capput succedaneum and how long to resolve?
A
Oedema collection outside scalp
Self-resolving in a few days
3
Q
What is cephalohematoma and how long to resolve?
A
Collection of blood between skull and periosteum
Self-resolving in a few months
4
Q
Difference between Capput succedaneum and Cephalohematoma?
A
Capput succedaneum - fluid crosses suture lines
Cephalohematoma - fluid does not cross suture lines
5
Q
What is Erbs palsy?
A
Injury to C5/C6 nerves in brachial plexus
6
Q
When to suspect Erbs palsy?
A
Lack of movement in arm and:
- Internally rotated shoulder
- Extended elbow
- Flexed wrist facing backwards
7
Q
Erb’s palsy mx?
A
Function returns in a few months
8
Q
What is given antenatally to prevent respiratory distress syndrome?
A
Mother given dexamethasone
9
Q
How to prevent neonate hypothermia?
A
Dry baby, warm towel over head and body, skin-skin with mother
10
Q
Red flags of neonate infection?
A
- Suspected mother sepsis
- Signs of shock
- Resp distress > 4 hours after birth
- Seizures
- Term baby needing ventilation
11
Q
Mx for neonate infection?
A
Any red flag -> antibiotics
Benzylpenicillin + gentamycin
12
Q
Common causes of early and late onset neonate infection?
A
Early onset (<72h) – mother/birth (group B step, e.coli)
Late onset (>72h) – environment (staph e, staph a)
13
Q
When is neonatal jaundice pathological?
A
<24 hours or >14 days is prolonged
14
Q
Causes of neonate pathological jaundice <24 hrs?
A
Haemolysis:
* Rh incompatibility
* ABO incompatibility
* G6PD deficiency
* Spheroctosysis
Congenital infection
15
Q
Why is jaundice dangerous in neonates?
A
Unconjugated bilirubin crossess BBB in neonates -> Kernicterus – seizures, hypotonia, lethargy
16
Q
Mx of pathological jaundice in neonate
A
Mx – phototherapy (converts bilirubin)
* Severe -> exchange transfusion
17
Q
Mx of neonatal abstinence syndrome?
A
Opiate withdrawal -> Morphine sulphate
Non-opiate withdrawal -> Phenobarbitone
18
Q
Ix for hypoxic-ischaemic encephalopthy
A
Sarnat staging
Assess:
- Level of consciousness
- Brainstem and autonomic function
- Motor function
19
Q
What is apnoea of prematurity and mx?
A
Immaturity of autonomic system which controls RR & HR
Neonate attached to apnoea monitor which identifies apnoea and provokes tactile stimulation to prompt baby to restart breathing
20
Q
What is retinopathy of pre-maturity?
A
Hypoxia -> blood vessels develop
Preterm often get O2 in care, once this is removed, there is rebound neovascularization
21
Q
Mx of retinopathy of pre-maturity?
A
Screening every 2 weeks
Mx - Transpupillary laster photocoagulation
Other mx – cryotherapy, anti-VEGF
22
Q
Mx of neonatal hypoglycaemia?
A
Asymptomatic -> encourage feeding + monitor
Symptomatic -> Admit + IV 10% dextrose
23
Q
Causes of jaundice from 24h-2 weeks?
A
Physiological jaundice
Breast milk jaundice
* May last up to 12w
Infection (UTI)
Bruising
Polycythaemia
24
Q
Causes of prolonged jaundiced (>2 weeks)
A
Unconjugated:
* Physiological
* Breast milk jaundice
* Infection – UTI
* High G.I obstruction (pyloric stenosis)
* Congenital hypothyroidism
Conjugated:
* Bile duct obstruction (Biliary atresia)
* Hepatitis
25
Cause of bacterial meningitis in neonates (<3 months) and mx?
Group B strep
Mx - Cefotaxime + amoxicillin
26
Cause of bacterial meningitis in >3 months and mx?
Cause - N.menigitis, strep pneumoniae
Mx - Ceftriaxone +/- dexamethasone to reduce neurological dmg
27
What is Kernig's test?
Meningitis test
Patient lying flat on back and hip flexed with knees at 90 degrees. Straightening leg stretched meninges -> spinal pain and resistance to movement
28
What is
Brudzinski’s test?
Meningitis test
Patient lying flat on back and head lift -> involuntary flexion of hip and knees
29
Px of neonate mengitis?
Hypotonia
Poor feeding
Lethargy
Hypothermia
Bulging fontanelle
Arched back
30
Px of child meningitis?
Fever
Neck stiffness
Vomiting
Headache
Photophobia
Altered consciousness
Seizures
31
What urgent mx if meningitis suspected prior to hospital transfer?
Urgent IM or IV benzylpenicillin
32
What is raised in CSF in bacterial meningitis?
Polymorphs, protein
33
What is raised in CSF in viral meningitis?
Lymphocytes, slightly protein
34
Px of encephalitis?
Altered consciousness / cognition, unusual behaviour, acute focal neurology, seizures, fever
35
When is lumbar puncture contraindicated and alternative Ix?
Contraindicated if GCS <9, haemodynamically unstable or active seizures -> CT scan
36
Mx for HSV or VZV encephalitis?
Aciclovir
37
Mx for CMV encephalitis?
Ganciclovir
38
Cause of scarlet fever?
Exotoxin from group A strep (pyogenes)
39
Px of scarlet fever?
* After throat infection
* Diffuse maculopapular rash with a sandpaper texture
* Red strawberry tongue
* Fever, lethargy, flushed face
40
Mx of scarlet fever?
Phenoxymethylpenicillin for 10 days
41
Impetigo cause?
Staph aureus or strep pyogenes
42
Px of impetigo?
"Golden crusty lesions” usually on face, neck, and hands
Can be bullous or non-bullous
Painful, itchy
43
Mx of impetigo?
Ix – Swabs
Mx:
* Non-bullous – topical fusidic acid
* Bullous – Flucloxacillin
44
Px of staphylococcal skin syndrome?
Impetigo complication where toxin separates epidermal skin
Widespread erythema and tenderness of the skin
Nikolsky sign positive
45
Toxin shock syndrome cause?
Toxin producing staph aureus
46
Triad of toxic shock syndrome?
* Fever > 39
* Hypotension
* Diffuse erythematous, macular rash
47
Mx of toxic shock syndrome?
Mx – intensive care
Ab – ceftriaxone + clindamycin
48
What type of hypersensitivity reaction is rheumatic fever and Px?
Type 2 hypersensitivity
2-4 weeks after strep infection:
* Fever, joint pain, rash, shortness of breath, chorea, nodules
* Carditis
49
Jones criteria for rheumatic fever?
(JONES FEAR)
Major criteria:
J – Joint arthritis
O – Organ inflammation (carditis)
N – Nodules
E – Erythema margintum rash
S – Sydenham chorea
Minor criteria:
F – Fever
E – ECG changes
A – Arthralgia without arthritis
R – Raised inflammatory markers
50
Complications of rheumatic fever?
Mitral stenosis, chronic heart failure
51
What is gingivostomatitis?
HSV infection -> Vesicular lesions on the lips, gums, tongue and hard palate -> painful ulceration & bleeding
+ high fever
52
When to consider acyclovir for chicken pox?
Consider aciclovir if:
>14 yrs
Immunocompromised
Neonates
53
Px of chicken pox?
Fever
Whole body vesicular rash (starts trunk/face then spreads peripherally)
Itching and scratching
54
Px of glandular fever?
Fever, fatigue
Malaise
Tonsillitis
Lymphadenopathy
Splenomegaly
55
CMV mx?
IV ganciclovir
56
What causes 'Slapped cheek syndrome'
Human parvovirus B19
57
Px of Human parvovirus B19 infection?
Fever, malaise, headache and myalgia followed by rash on face a week later which progresses to a maculopapular rash on the trunk and limbs
58
Complication of Human parvovirus B19 infection in pregnancy?
Hydrops fetalis
59
What virus causes hand, foot and mouth disease?
Enterovirus
60
Enterovirus px
Non-specific febrile illness + blanching rash over trunk with fine petechiae
Loose stools, vomiting
Or
Hand, foot & mouth disease
61
Measles px?
Fever, coryzal symptoms, conjunctivitis
Rash – starts at ears -> rest of body
- Severe erythematous, macular rash
Koplick spots – greyish white buccal mucosa spots
Px is 10-12 days after exposure
62
Mumps px?
Flu-like symptoms before parotid swelling – fever, myalgia, lethargy, headache, dry mouth
Parotid swelling – unilateral or bilateral
63
Rubella px?
Mild erythematous macular rash starting face then spreading to whole body
+ mild fever, joint pain, sore throat, lymphadenopathy
64
What to ask in history suspecting immunodeficiency?
S – severe (meningitis or peritonsillar abscess)
P – persistent (does not improve with usual antibiotics)
U – unusual (pneumocystis jirovecii)
R – recurrent (appear to have resolved but reapparead)
+ is there a family history of unexplained deaths?
65
What mx to prevent PCP in immunodeficient patient?
Cotrimoxazole
66
What mx to prevent fungal infections in immunodeficient patient?
Fluclonazole
67
What cell is defective in SCID?
T-cells
68
Px of SCID?
* Persistent, severe diarrhoea
* Failure to thrive
* Opportunistic infections (PCP, CMV, VZV)
* Unwell after vaccinations
69
What cell is defective in selective IgA deficiency and common px?
B-cells
Recurrent mucinous membrane infections
70
What is Kawasaki disease?
Systemic medium sized vessel vasculitis
71
Px of kawaski disease?
Fever >5 days
+ widespread erythematous maculopapular rash
+ skin peeling (desquamation) of palms and soles
+/-:
- Strawberry tongue
- Cracked lips
- Cervical lymphadenopathy
- Bilateral conjunctivitis
72
Ix in Kawasaki disease?
- Echocardiogram to check for coronary artery aneurysms
- FBC, LFT, urinalysis, ESR
73
Mx of Kawasaki disease?
High dose aspirin – reduce rx of thormbosis
IV immunoglobulins – reduces rx of coronary artery aneurysms
74
What is Henoch-Schoenlein purpura
IgA vasculitis affecting skin, kidneys and G.I tract
75
Px of Henoch-Schoenlein purpura?
Hx - URTI or gastroenteritis
Px – Purpuric rash affecting lower limbs and buttocks in children +/- joint pain, abdo pain, nephritis
- IgA nephritis -> microscopic or macrosocpic haematuria + proteinuria -> nephrotic syndrome
76
What is juvenile idiopathic arthritis?
Autoimmune arthritis lasting >6 weeks in patient under age of 16
77
Px of Dow syndrome?
* Hypotonia
* Brachycephaly
* Short neck
* Flattened face/nose
* Prominent epicanthic folds
* Single palmar crease
* Atria-ventricular septal defect
78
Px of Edward syndrome?
* Prominent occiput
* Small mouth and chin
* Short sternum
* Flexed, overlapped fingers
* Rocker bottom feet (soles are convex)
79
Px of Patau syndrome?
* Structural defect of brain
* Scalp defects
* Small eyes
* Cleft lip and palate
* Rocker bottom feet (soles are convex)
80
Px of Turnery syndrome?
* Short stature
* Webbed neck
* Broad chest with widely place nipples
* Underdeveloped ovaries with reduced function (infertile)
* Late or incomplete puberty
* Coarctation of the aorta
81
What are trisomy 21, 18 and 13?
Trisomy 21 - Down's
Trisomy 18 - Edward
Trisomy 13 - Patau
82
Px of klinefelter syndrome?
* Taller height
* Wider hips
* Weaker muscles
* Small testicles
* Reduced libido, infertility
83
Px of Cri du chat?
* High pitched cry like a cat
* Intellectual disability
* Microcephaly, hypotonia
* Low set, posteriorly rotated ears
84
Px of DiGeorge syndrome?
* Cleft palate
* Heart defects
* Recurrent infections
* Feeding problems
* Intellectual disability
85
Px of Williams syndrome?
* Intellectual disability
* Broad forehead
* Starburst eyes
* Flattened nasal bridge, long philtrum
* Very sociable trusting personality
86
Px of angelman syndrome?
* Happy demeanour
* Fascination with water
* Hand flapping, laughter
* Epilepsy, microcephaly
* Widely spaced teeth
87
Px of charot-marie tooth?
* Peripheral neuropathy (sensory and motor)
* Abnormal gait, walking difficulties (weak ankles)
* Pes cavus
88
Px of Marfan syndrome?
* Tall stature
* Long neck
* Long limbs, long fingers
* Hypermobile
* Pectus carinatum or pectus excavatum
89
Px of Fragile X syndrome?
* Intellectual disability
* Long, narrow face
* Large ears
* Large testicles after puberty
* Hypermobile joints
90
Px of Prader-Willi syndrome?
* Constant insatiable hunger
* Hypotonia
* Intellectual disability
* Fairer, soft skin that is prone to bruising
* Thin upper lip, narrow forehead
91
Px of Noonan syndrome?
* Wide space between the eyes (hypertelorism)
* Short stature, broad forehead
* Prominent nasolabial fold
* Webbed neck, widely spaced nipples
92
Mx of respiratory wheeze?
1. 10 puffs SABA + check technique
2. More puffs needed? (every hour?) or nebuliser
3. Consider prednisolone
93
Mx of asthma?
1. SABA – salbutamol (reliever)
2. + Inhaled corticosteroids – beclomethasone (preventer)
3. Either:
a. + Leukotriene receptor agonists – montelukast
b. + Inhaled LABA
4. Other options:
a. LAMA – tiotropium
b. Theophylline (narrow therapeutic window)
c. Maintenance and reliever therapy (MART) - ICS + LABA
94
Ix of asthma?
1. Either:
o Fractional exhaled nitric oxide
o Spirometry with bronchodilator reversibility
2. If diagnostic uncertainty:
o Peak flow variability (diary)
o Direct bronchial challenge test with histamine or methacholine
95
Acute asthma ABG?
Initially – respiratory alkalosis
Late – respiratory acidosis (very bad)
96
Moderate acute asthma px and mx?
Px:
- PEFR 50-75% predicted
Mx:
- Nebulised SABA
- Neublised ipratromium bromide
- Oral prednisolone
97
Severe acute asthma Px and Mx?
Px:
- PEFR 33-50% predicted
- Resp rate >25
- Heart rate >110
- Unable to complete sentences
Mx:
- Oxygen to maintain stats
- Aminophylline infusion
- Consider IV SABA
98
Life-threatening acute asthma Px and Mx?
Px:
- PEFR <33%
- Sats <92%
- Fatigued
- No wheeze (no air entry at all)
- Shock
Mx:
- Magnesium sulphate
- HCU / ICU admission
- Intubation in worst case
99
What is croup?
Inflammation of upper airways causing oedema in the larynx in children aged 6months to 2 years
Mainly viral (parainfluenza)
100
Px of croup?
- Increased work of breathing
- “Barking cough”, occurring in clusters of coughing episodes
- Hoarseness
- Stridor
- Low grade fever
101
Mx of croup?
Mild -> Oral dexamethasone
Moderate -> Oral dexamethasone + monitor for 2-3hrs
Severe -> Adrenaline, gives 30mins more time, O2 by facemask, IV/oral dexamethasone
102
What is bronchiolitis?
Inflammation and infection in the bronchioles usually caused by RSV in children under 1 year
103
Px of bronchiolitis?
Px:
- Coryzal symptoms (viral URTI)
- Signs of respirotry distress
- Dyspnoea
- Tachypnoea
- Poor feeding
- Mild fever
- Wheeze and crackles on auscultation
104
Signs of resp distress in a baby?
Raised RR
Accessory muscle use:
- Sternocleidomastoid
- Abdominal
- Intercostal
Intercostal and subcostal recession
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
105
How long to recover from bronchiolitis?
2-3 weeks?
106
Mx of bronchiolitis?
Supportive
107
Typical cause of epiglotitis?
Haemophilus influenza type B
108
Ix of epiglottis?
Lateral x-ray of neck -> “thumb sign”
109
Px of epiglottitis?
Sore throat & stridor
Drooling
Sat forward with a hand on each knee
High fever
Odynophagia
110
What causes whooping cough?
Bordetella pertussis (GM -ve bacteria)
111
Px of whooping cough?
Mild coryzal symptoms
-> severe coughing fits after a week or more, paroxysmal coughs
Loud inspiratory whoop when cough ends
Complications -> fainting, vomiting, pneumothorax
112
Ix for pertussis?
Nasal swab -> PCR or bacterial culture
If >2weeks can test for anti-pertussis toxin immunoglobulin G
113
Prognosis of whooping cough?
Symptoms typically resolve within 8 weeks
- Complication -> bronchiectasis
114
What does ductus venosus connect?
Umbilical vein to IVC
115
What causes ductus venosus to close?
1. Clamping of umbilical cord
2. No flow in umbilical vein
3. Few days later -> ligamentum venosum
116
What does the foramen ovale connect?
Right atrium to left atrium
117
What causes the foramen ovale to close?
At birth:
1. Decrease in PVR
2. Less pressure in RA
3. LA pressure > RA pressure
4. Foramen ovale closes
5. In few weeks becomes fossa ovalis
118
What does the ductus arteriosus connect?
Pulmonary artery with aorta
119
What causes the ductus arteriosus to close?
At birth:
1. Increased blood oxygenation
2. Drop in circulating prostaglandins
3. Closure -> ligamentum arteriosum
120
Px of PDA?
Murmur (continuous crescendo-decrescendo “machinery” murmur):
- Small PDA can be asymptomatic and present in adulthood with heart failure
- Additional px – Shortness of breath, difficulty feeding, poor weight gain, LRTI
121
Mx of PDA?
Monitor until 1 year with ECHO
>1 year, unlikely to physiologically close -> surgery
122
Px of atrial septal defect?
- Mid-systolic, crescendo-decrescendo murmur loudest at left sternal border
- Fixed splitting of second heart sound (closure of aortic and pulmonary valves at different times)
- Childhood px – SOB, difficulty feeding, poor weight gain, LRTI
- Adulthood – dyspnoea, heart failure or stroke
123
Px of VSD?
Pan-systolic murmur heard at left sternal border in 3rd & 4rth ICS
Possible systolic thrill on palpation
124
What is Eisenmenger syndrome?
Left to right shunt in heart reverses to become right to left shunt -> blood bypasses lungs and cyanotic patient
125
What is coarctation of the aorta?
Narrowing of the aortic arch around ductus arteriosus
-> Reduced pressure in arteries distal to narrowing
-> Increased pressure proximally to narrowing such as heart, first three branches of aorta
126
Px of coarctation of the aorta?
- Low BP in arteries distal to narrowing (weak femoral pulse)
- High BP in arteries proximal to narrowing
- Systolic murmur in left infraclavicular area and below left scapula
- Infancy:
o Tachypnoea
o Poor feeding
o Grey and floppy baby
- Other:
o Left ventricular heave (due to LVH)
o Underdeveloped of limbs distal to narrowing
127
When do we give prostaglandins to keep ductus arteriosus open?
Coarctation of aorta and tetralogy of Fallot
128
What congenital conditions make-up tetralogy of fallot?
- Ventricular septal defect
- Overriding aorta (aorta further to right than normal)
- Pulmonary valve stenosis -> ejection systolic murmur
- Right ventricular hypertrophy
129
Px of tetralogy of fallot?
- Cyanosis
- Clubbing
- Poor feeding / weight gain
- Ejection systolic murmur heard loudest in 2nd ICS left sternal edge
130
Px of aortic valve stenosis?
Ejection systolic murmur loudest at 2nd ICS right sternal border
- Crescendo-descendo
- Radiates to carotids
Mild – Incidental murmur
Severe – fatigue, SOB, dizziness & fainting
- Symptoms worse on exertion
131
What is pulmonary valve stenosis associated with?
- Tetralogy of Fallot
- William syndrome
- Noonan syndrome
- Congenital rubella syndrome
132
Px of pulmonary valve stenosis?
Ejection systolic murmur loudest at 2nd ICS, left sternal border
- Palpable thrill
- Right ventricular heave
- Raised JVP
Mild – Incidental murmur
Severe – fatigue, SOB, dizziness & fainting
- Symptoms worse on exertion
133
Initial mx for baby reflux?
- Small, frequent meals
- Keep baby upright after eating
- Alter cot position
134
Mx for problematic reflux?
* Gaviscon with feeds
* Thickened milk formula
* PPI (omeprazole)
* Faltering growth -> empty stomach faster (domperidone)
135
Dx and Mx of pyloric stenosis?
Dx – abdominal ultrasound
Mx – laparoscopic pyloromyotomy
- Widened pylorus
136
What is biliary atresia?
Section of bile duct is narrowed or absent -> cholestasis
P - prolonged jaundice (>14 days from birth)
137
Dx and Mx of biliary atresia?
Dx – high levels of conjugated bilirubin
Mx – Kasai portoenterostomy
138
Px of intussessecption?
Bowel telescopes into itself
- Severe colicky abdo pain
- “Redcurrant jelly stool”
- Sausage-shaped RUQ mass on palpation
- Intestinal obstruction / vomiting
139
Dx and Mx of intussusception?
Dx – ultrasound or contrast enema
Mx:
- Therapeutic enema
- Surgical reduction
140
Dx and Mx of Hirschsprung’s disease?
Ix – Abdo x-ray
Dx – Rectal biopsy
- Absence of ganglionic cells
Mx – fluid resuscitation
- If Hirschsprung-associated enterocolitis -> antibiotics
141
What is Hirschsprung's disease?
Congenital disease where nerve cells of myenteric plexus are absent in distal bowel and rectum
142
Causative organism of gastroenteritis associated with fried rice left at room temperature?
Bacillus cereus
143
Causative organism of gastroenteritis associated with raw or undercooked pork?
Yersinia enterocolitica
144
Causative organism of gastroenteritis associated with eggs?
Salmonella
Staph A enterotoxin
145
Causative organism of gastroenteritis associated with faeces contaminated drinking water, swimming pools, food
Shigella
146
Campylobacter jejuni spread?
Raw or improperly cooked poultry
Untreated water
Unpasteurised milk
147
Dx of gastroenteritis?
Stool sample -> microscopy, culture and sensitivities
148
Gastroenteritis associated with nurseries?
Rotavirus
149
Gastroenteritis associated with sudden outbreaks?
Norovirus
150
Mx of Giardiasis?
Metronidazole
151
Stool pattern of constipation?
<3 a week
Hard large stools or rabbit droppings
Overflow soiling - very loose, smelly stool passed without sensation
152
Mx of constipation?
High fibre diet and good hydration (give extra water)
Regular toileting and behavioural interventions (praise visiting the toilet)
Start laxatives (Movicol)
153
Mx of faecal impactation?
Movicol + polyethylene glycol 3350
o + stimulant if no response in 2 weeks
154
Auto-antibodies involved in coeliac disease?
Anti-TTG
Anti-EMA
Anti-DGPs
(IgA)
155
Px of coeliac disease?
- Failure to thrive in young children
- Diarrhoea, fatigue, weight loss
- Mouth ulcers
- Anaemia secondary to iron, B12 or folate deficiency
- Dermatitis herpetiformis – itchy blistering skin rash
156
Dx of coeliac disease?
Check IgA levels are normal and raised anti-TTG / raised anti-EMA
Biopsy would show crypt hypertrophy and villous atrophy
157
Mnemonic for Crohns?
N – No blood or mucus
E – Entire GI tract
S – “Skip lesions” on endoscopy
T – Transmural (full thickness) inflammation
S – Smoking is a rx
158
Mnemonic for ulcerative colitis?
C – Continuous inflammation
L – Limited to colon and rectum
O – Only superficial mucosa affected
S – Smoking Is protective
E – Excrete blood and mucus
U – Use aminoacylates
P – Primary sclerosing cholangitis
159
Extra-intestinal px of IBD?
- Finger clubbing
- Erythema nodosum
- Pyoderma gangrenosum
- Episcleritis & scleritis
- Inflammatory arthritis
160
Screening for IBD?
- Bloods (raised CRP indicates active inflammation)
- Screening – Faecal calprotectin (raised when intestines are inflamed)
161
Crohn's Mx?
Inducing remission:
1. Steroids (oral prednisolone or IV hydrocortisone)
2. Add immunosuppressant under guidance
o Azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab
Maintaining remission:
1. Azathioprine or mercaptopurine
2. Alternative – methotrexate, infliximab, adalimumab
Surgical resection of distal ileum if needed
162
Mx of UC?
Inducing remission:
- Mild-moderate:
1. Aminosalicylate (mesalazine)
2. Corticosteroids
- Severe:
1. IV corticosteroids
2. IV ciclosporin
Maintaining remission:
- Aminosalicylate
- Azathioprine
- Mercatopurine
Surgery to remove colon or rectum
163
Triad of T1DM?
o Polyuria
o Polydipsia
o Weight loss
164
DKA px?
Hyperglycaemia, dehydration, acidosis
o + N&V, “fruity breath”, altered consciousness
165
Mx of DKA?
Correct dehydration over 48h, give fixed rate insulin infusion
166
Mx of T1DM?
- Subcut insulin
o Basal – Lantus
o Bolus before meals– Novorapid
- Monitoring dietary carbohydrate intake
- Monitor BG levels
167
What do adrenal glands produce?
Steroid hormones:
- Cortisol
- Aldosterone
168
Types of adrenal insufficiency?
Primary - Damaged adrenal glands
Secondary - Inadequate ACTH stimulating adrenal glands due to loss or damage of pituitary
Tertiary - Inadequate CRH from hypothalamus
169
Biochemistry of primary adrenal insufficiency?
Low cortisol
High ACTH
Low aldosterone
High renin
170
Biochemistry of secondary adrenal insufficiency?
Low cortisol
Low ACTH
Normal aldosterone
Normal renin
171
What causes tertiary adrenal insufficiency?
Long term oral steroids (>3 weeks) which suppresses the hypothalamus
172
Px of adrenal insufficiency in children?
- Nausea and vomiting
- Poor weight gain or weight loos
- Reduced appetite
- Abdominal pain
- Muscle weakness or cramps
- High ACTH -> bronze hyperpigmentation
173
Dx of adrenal insufficiency?
Short synacthen test
174
Mx of adrenal insufficiency?
Replace steroids:
- Hydrocortisone (glucocorticoid)
- Fludrocortisone (mineralocorticoid)
175
What is adrenal crisis?
Severe addisons due to a trigger - infection, trauma, acute illness, sudden withdrawal of steroids
Px:
- Reduced consciousness
- Hypotension
- Hypoglycaemia, hyponatraemia and hyperkalaemia
176
Mx of adrenal crisis?
ICU:
- Parenteral steroids, IV fluids, correct hypoglycaemia
177
Growth hormone px?
Neonates:
* Micro-penis
* Hypoglycaemia
* Severe jaundice
Children:
* Poor growth
* Short stature
* Delayed puberty
178
Ix / Mx of growth hormone deficiency?
Ix – Growth hormone stimulation test
MRI brain for pituitary / hypothalamus issues
Mx – Daily subcut GH (somatropin) + monitor
179
What commonly happens before LOC event suggestive of syncope?
- Prolonged standing
- Lightheaded
- Sweating
- Blurring or clouding vision
180
What happens during a LOC event suggesting seizure?
- Head turning and abnormal limb positions
- Tonic clonic activity
- Tongue biting
- Cyanosis
181
Ix after syncope?
- ECG (assess for arrhytmia)
- Echocardiogram (if structural heart disease suspected)
- Bloods, U&Es, BM
182
Mx of generalised tonic-clonic seizures?
1. Sodium valproate
2. Lamotrigine or carbamazepine
183
Mx of focal seizures?
1. Lamotrigine or carbamazepine
2. Sodium valproate or levetiracetam
184
Px of focal seizure?
Seizure starts in temporal lobe affecting hearing, speech, memory and emotions
- Hallucinations
- Memory flashbacks
- Déjà vu
- Doing strange things on autopilot
185
Mx of infantile spasms?
1. Prednisolone
2. Vigabatrin
186
Febrile convulsion mx?
Paracetamol + Ibuprofen
187
When to consider an MRI after a seizure?
o <2 years of age
o Focal seizures
o No response to first line anti-epileptic mx
188
Advice for seizures?
- Shower instead of bath
- Cautious swimming, with heights, traffic, hot or electrical equipment
- During seizure -> recovery position + soft object under head
- If >5 mins -> call ambulance
189
S/e of phenytoin?
Folate and VitD deficiency -> megaloblastic anaemia, osteomalacia
190
S/e of sodium valproate?
Teratogenic, liver damage, hair loss, tremor
191
S/e of carbamazepine?
agranulocytosis, aplasticanaemia
192
S/e of lamotrigine?
Stevens-johnson syndrome or DRESS syndrome, leukopenia
193
What is status epilepticus?
Seizure lasting more than 5 minutes or 2+ seizures without regaining consciousness
194
Mx of status epilepticus?
- Secure airway
- High concentration oxygen
- Assess cardiac and respiratory function
- Check BM
- Gain IV access
Then pharmacological mx:
1. IV lorazapeam
2. 10 mins later -> repeat IV lorazepam
3. No response -> IV phenobarbital or phenytoin
195
Causes of cerebral palsy?
Antenatal:
- Maternal infections
- Trauma during pregnancy
Perinatal:
- Birth asphyxia
- Pre-term birth
Postnatal:
- Meningitis
- Severe neonatal jaundice
- Head injury
196
Types of cerebral palsy?
- Monoplegia – one limb affected
- Hemiplegia – one side of the body affected
- Diplegia – four limbs are affects, mostly legs
- Quadriplegia – four limbs affected more severely +/- seizures, speech disturbance
197
Px of cerebral palsy?
- Failure to meet milestones
- Increased or decreased tone
- Hand preference < 18 months
- Problems with coordination, speech or walking
- Feeding or swallowing problems
- Learning difficulties
198
Px of congenital hydrocephalus?
- Sutures of skull close at 2 years of age -> enlarged and rapidly increasing head circumference
- Bulging anterior fontanelle
- Poor feeding and vomiting
- Poor tone, sleepiness
199
Mx of congenital hydrocephalus?
VP shunt (CSF drained into peritoneal cavity)
