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PAEDIATRICS > Community pediatrics > Flashcards

Community pediatrics Flashcards

1
Q

MOH

duties of an MOH

A
  • Conduct polyclinics - antenatal, postnatal, child welfare
  • School medical inspection
  • Supervise immunization
  • Health education
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2
Q

MOH

Staff under MOH

A
  • PHNS - Supervising PHM, PHM
  • Supervising PHI - PHI
  • Non health staff
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3
Q

MOH

Rough population under MOH

A

60,000 population

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4
Q

MOH

Number of MOH in SL

A

328

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5
Q

MOH

Rough population under PHI

A

10,000

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6
Q

MOH

One MOH area needs…. PHIs

A

6

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7
Q

MOH

Public health midwife (PHM) covers

A

3500- 5000 population

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8
Q

Antenatal care

antenatal care is conducted by

A
  • MO
  • Registered or assistant MOs
  • Nursing officers
  • Public health midwives
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9
Q

Antenatal clinic

registration methods

A
  • walk-in registration
  • informing PHM
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10
Q

Antenatal clinic

Booking visit consists of

A
  • detailed Hx
  • Examination
  • Ix-FBC/ HB, Blood grouping, Rh typing
  • VDRL
  • HIV
  • Urine for sugar and protein
  • OGTT (28 weeks)
    Mx
  • Referred to hospital for shared care
  • Folic acid 1mg daily
  • Thriposha 2 packets/ daily
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11
Q

PMH

total no. of routine home visits

A

9 routine visits

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12
Q

Low risk PG mothers should attend the clinic on

A
  1. 6-8 weeks
  2. 12-14 weeks
  3. 18-20 weeks
  4. 22-24 weeks
  5. 26-28 weeks
  6. 32-34 weeks
  7. 36 weeks
  8. 38 weeks
  9. 40 weeks
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13
Q

Activities of an antenatal clinic

A
  • Hx
  • Examination- weight, Pallor, edema, BP, Abd ex, Auscultate FHS, mental health
  • Ix- OGTT, Hb, Urine for protein and sugar
  • Supplements given
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14
Q

supplements given in the antenatal clinic

A
  • folic acid 1mg daily from day 1
  • Calcium lactate 300mg mane (from 12 weeks onwards)
  • ferrous sulphate 200mg nocte (12 weeks onwards)
  • Vit C 100mg daily (12 weeks onwards)
  • tetanus toxoid
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15
Q

Where is USS done in PG

A

done in hospitals. not available in MOH

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16
Q

Antenatal classes

A

3 classes. 1 per Trimester. couples participate together

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17
Q

The antenatal classes

A
  1. Nutrition
  2. post partum contraception
  3. delivery and breast feeding
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18
Q

No of home visits done by a midwife during a PG

A

3 in low risk PG ( one per trimester)

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19
Q

Post partum home visits after NVD

A

4 home visits
1. 1st week
2. 2nd week
3. 3rd week
4. 6th week

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20
Q

No of home visits for a home delivery

A

3 within the first 10 days after a delivery

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21
Q

When should the PMH refer every mother to a postpartum clinic

A

4-6 weeks after delivery

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22
Q

micronutrients issued in the postpartum clinic

A

Folic acid 1mg mane
Ca lactate 300mg
FeSO4 200mg nocte
Vit C 100mg nocte

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23
Q

Postpartum clinic

when is post partum depression screening done

A

at home visit and PNC at 1 month

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24
Q

Postpartum clinic

conditions that needed to be reported by the PMH

A
  • Low birth weight
  • Antenatal and postnatal morbidities
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25
Q

Postpartum clinic

Family planning advices are given in

A

Postpartum clinic

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26
Q

Child welfare clinic

Who attends

A

PHM
PHNS

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27
Q

Child welfare clinic

Goals of Child welfare clinic

A
  • Growth
  • Development
  • breast feeding/ nutrition
  • immunization
  • create awareness among parents
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28
Q

Child welfare clinic

frequency

A

10 visits between 0-5 years

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29
Q

How often is a school medical inspection held

A

annually

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30
Q

Grades the SMI is included if the total number of students were <200

A

done in all grades

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31
Q

Grades the SMI is included if the total number of students were >200

A

Grades 1, 4, 7, 10

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32
Q
A
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33
Q

Types of schools covered by the SMI

A

all government schools and requested private schools

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34
Q

SMI is conducted by

A
  • MOH - hospital, GPs, well- wishers
  • MOMCH (Medical officer maternal and child health)
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35
Q

SMI is organized by

A

PHI

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36
Q

What happens in an SMI

A
  • Complete assessment of health
  • Micronutrient supplementation according to WIFS
  • Referrals to clinics
  • Annual sanitary survery
  • Suwanari clinic for teachers
  • Awareness programs/ lectures
  • Monitor the implementation of dental programs, mosquito control, supervision of school canteen
  • Immunization
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37
Q

Referral form used in SMI

A

Referral card H606

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38
Q

children who are referred in SMI is supposed to attend clinics on

A
  • secondary clinics
  • tertiary clinics
  • saturday clinics
  • evening clinics
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39
Q

Annual sanitary survery is conducted by

A

the PHI

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40
Q

Vaccine given at one year if not given before

A

DT/OPV

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41
Q

Vaccine given at 7 years

A

aTD

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42
Q

Vaccine given at grade 8

A

MMR- if a rubella containing vaccine is not given before

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43
Q

CHDR

parts of the educational component

A
  • Home visits by PHM
  • Exclusive breast feeding
  • Complimentary feeding
  • weight assessment
  • length/ height assessment
  • love and care for baby
  • family planning
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44
Q

CHDR

the neonatal examination details are filled by the

A

doctor

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45
Q

CHDR

Immunization details

A
  • vaccine given
  • date of administration
  • batch number
  • AEFI (ADRs to immunization)
  • BCG Scar
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45
Q

CHDR

Vitamin A dose for the mother and the baby

A
  • mother - 200,000 IU
  • 6 month to 5y/o- 100,000 IU
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46
Q

CHDR

frequency of worm Rx for 18 month to 5 year old child

A

every 6 monthly

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47
Q

CHDR

hearing and vision assessment is done by

A

parents upto 1 year

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48
Q

CHDR

Developmental milestones are assessed from

A

6 weeks to 5 years

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49
Q

CHDR

developmental milestones are assessed by

A

initially by parents later by PHM

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50
Q

CHDR

child health record is done by

A

the medical officer of health

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51
Q

CHDR

child health record includes

A
  • assessment of eyes and vision
  • hearing
  • growth
  • development
  • CVS assessment
  • Hip joint
  • Congenital deformities
  • Any other disease condition
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52
Q

CHDR

the dental hygiene covers

A

6 months to 18 months

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53
Q

CHDR

Preschool medical examination is done by

A

the MOH at 3 years of age

54
Q

CHDR

weight assessment

A
  • 0-2 years- monthly
  • 2-5 years- every 3 monthly
55
Q

CHDR

weight scales used
1. 0-1 years
2. 1-2 years
3. >2 years

A
  1. seca scale
  2. salter scale
  3. weighing scale
56
Q

CHDR

height assessment is done on

A
  • at 4 months
  • 9 months
  • 12 months
  • 1-5 years- 6 monthly
57
Q

CHDR

BMI is calculated at

A

> 2 year old children

58
Q

CHDR

referrals and hospital admissions are included. (T/F)

59
Q

CHDR

Educational components pages are

A

yellow colour

60
Q

CHDR

important growth charts

A
  • weight for age
  • height for age
  • weight for height
  • BMI charts
  • Head circumference chart
61
Q

Immunization programme

Immunization programme is done according to

A

EPI ( expanded program for immunization)

62
Q

Immunization programme

How many vaccines are given in the first year of life

63
Q

Immunization programme

time durations the vaccines are given during the first year of life

A
  1. during 0-4 weeks
  2. on completion of 2 months
  3. on completion of 4 months
  4. on completion of 6 months
  5. on completion of 9 months
64
Q

Immunization programme

vaccines given during the first year of life

A
  1. 0-4 weeks BCG
  2. 2 months OPV and pentavalent (DTP-HepB-Hib) (1st dose) flPV (Fractional IPV) (1st dose)
  3. 4 months OPV and pentavalent (DTP-HepB-Hib) (2nd dose) flPV (Fractional IPV) (2nd dose)
  4. 6 months OPV and Pentavalent (DTP- HepB- Hib) (3rd dose)
  5. 9 months MMR (1st dose)
65
Q

Immunization programme

ideal time to give the BCG vaccine

A

within 24 hours of life before leaving the hospital

66
Q

Immunization programme

If the BCG scar doesn’t appear whats the next step

A

if it doesn’t appear by six months can repeat the vaccine after six months upto 5 years

67
Q

Immunization programme

Why is the repeat BCG vaccine not done after five years

A

BCG vaccine offers protection upto five years

68
Q

Immunization programme

MMR doses are given on

A
  1. on completion of 9 months
  2. on completion of 3 years
69
Q

Immunization programme

how many vaccines are given during the second year of life

A

two vaccines

70
Q

Immunization programme

vaccines given during the second year of life

A
  1. on completion of 12 months - live JE
  2. on completion of 18 months - OPV and DTP (4th dose)
71
Q

Immunization programme

vaccine given during completion of 5 years

A

OPV and DT (5th dose)

72
Q

Immunization programme

the vaccines given during completion of 10 years

A
  • HPV (1st dose)
  • HPV (2nd dose)
73
Q

Immunization programme

time gap between the HPV vaccines

74
Q

Immunization programme

generally HPV vaccine is given in grade

75
Q

Immunization programme

vaccine given during grade 7

A

aTd (adult tetanus diptheria)

76
Q

Immunization programme

collectively how many tetanus diptheria vaccines are given under EPI

77
Q

Immunization programme

another MMR is given during

A

15- 44 years of females in the child bearing age

78
Q

breast feeding is indicated to start within

A

30 minutes to 1 hour

79
Q

Breastfeeding

colostrum comes upto

80
Q

Breastfeeding

exclusive breastfeeding

A

until 6 months

81
Q

Breastfeeding

Breastfeeding is continued upto

82
Q

Breastfeeding

who trains the post-natal clinic on skills to train mothers on proper breastfeeding

A

Public health midwife

83
Q

Breastfeeding

First step to successful breastfeeding

A

Hospital policies- hospitals support mothers to breastfeed by
1. not promoting infant formula, bottles, teats
2. making breastfeeding care standard practice
3. keeping track of support for breastfeeding

84
Q

steps to successful breastfeeding

Second step to successful breastfeeding

A

Staff competency- hospitals support mothers to breastfeed by
1. training staff on supporting mothers to breastfeed
2. assessing health workers’ knowledge and skills

85
Q

steps to successful breastfeeding

Third step to successful breastfeeding

A

Antenatal care- hospitals support mothers to breastfeed by
1. discussing the importance of breastfeeding for babies and mothers
2. preparing women in how to feed their baby

86
Q

steps to successful breastfeeding

Fourth step to successful breastfeeding

A

Care right after birth- hospitals support mothers to breastfeed by
1. encouraging skin- to skin contact between mother and baby soon after birth
2. helping mothers to put their baby to the breast right away

87
Q

steps to successful breastfeeding

Fifth step to successful breastfeeding

A

Support mothers with breastfeeding
1. checking positioning, attachment and suckling
2. giving practical breastfeeding support
3. helping mothers with common breastfeeding problems

88
Q

steps to successful breastfeeding

Sixth step to successful breastfeeding

A

Supplementing
1. Giving only breast milk unless there are medical reasons
2. prioritizing donor human milk when a supplement is needed
3. helping mothers who want to formula feed to do so safely

89
Q

steps to successful breastfeeding

Seventh step to successful breastfeeding

A

Rooming-in
1. letting mothers and babies stay together day and night
2. making sure that mothers of sick babies can stay near their baby

90
Q

steps to successful breastfeeding

Eighth step to successful breastfeeding

A

Responsive feeding
1. Helping mothers know when their baby is hungry
2. not limiting breastfeeding times

91
Q

steps to successful breastfeeding

Ninth step to successful breastfeeding

A

Bottles, teats, pacifiers
1. counsel mothers on the use and risk of feeding bottles, teats and pacifiers

92
Q

steps to successful breastfeeding

Last step to successful breastfeeding

A

Discharge
1. referring mothers to community resources for breastfeeding support
2. working with communities to improve breastfeeding support services

93
Q

Breastfeeding

proper positioning of breastfeeding

A
  1. head is supported
  2. one hand in the child
  3. other hand in the breast un C shape meneuver
94
Q

breastfeeding

proper attachment of baby on mother’s breast

A
  1. baby’s mouth wide open
  2. lower lip turned outwards
  3. baby’s chin touches mother’s breast
  4. majority of areolar inside baby’s mouth
95
Q

Breastmilk, cow’s milk, infant formula

Protein content is high in

A

cow’s milk

96
Q

Breastmilk, cow’s milk, infant formula

Whey is high in

A

breastmilk

97
Q

Breastmilk, cow’s milk, infant formula

Fat is lowest in

A

breast milk

98
Q

Breastmilk, cow’s milk, infant formula

Sodium, calcium, phosphorus is high in

A

cow’s milk

99
Q

Breastmilk, cow’s milk, infant formula

iron content is high in

100
Q

Breastfeeding

Advantages for the infant

A
  • provides ideal nutrition for infants during 4-6 months of life
  • life saving in developing countries
  • reduce the risk of GI infections, and necrotising enterocolitis in pre-term infants
  • enhance the mother- child relationship
  • reduce the risk of insulin- dependant diabetes, HTN, obesity
101
Q

Breastfeeding

advantages for the mother

A
  • promotes close attachment between mother and baby
  • increase the time interval between children, which is important to reduce the birth rate in developing countries
  • helps with a possible reduction in premenopausal breast cancer
102
Q

Breastfeeding

Disadvantages of breast feeding

A
  • Unknown intake
  • transmission of infections- maternal CMV, Hep B, HIV
  • breast milk jaundice- mild, self-limitng
  • transmission of drugs- antimetabolites
  • nutrient inadequencies- only breast milk after 6 months can lead to poor weight gain and rickets
  • Vit K deficiency- may cause hemorrhagic disease of the newborn
  • potential transmission of environmental contaminants - nicotine, alcohol, caffeine
  • less flexible- difficult in public places, other family members cannot help
  • emotional upset
103
Q

Breastfeeding

Does the mother being anemic affect breast milk flow

A

no unless the mother is severely anemic

104
Q

Breastfeeding

does LSCS affect breast milk production

A

no unless adequate analgesia is given

105
Q

Breastfeeding

composition may vary depending on whether the baby was pre-term or term, also from mother to mother

106
Q

weaning?

A

introduction of other food in addition to breast milk

107
Q

weaning

why is it necessary to introduce one food at a time

A

to detect if any allergy occurs

108
Q

WEANING

what types of food and amount of food needs to be introduced

A

energy dense and extra protein rich food
frequent small feeds
mashed and soft
variety of food

109
Q

weaning

why is it necessary to give variety of food

A

to keep the child wanting to eat more, rather than the same food

110
Q

Nutritional assessment

anthropometry

A
  • weight
  • height
  • Mid- arm circumference
  • skin- fold thickness
111
Q

Malnutrition

Kwashiorkor

A

children with protein deficient diets

112
Q

Kwashiorkor

common age of presentation

A

6 months to 3 years

113
Q

Kwashiorkor

clinical manifestations

A
  • preserved subcutaneous fat
  • edema
  • enlarged fatty liver
  • ribs are not very prominent
  • lethargic
  • muscle wasting mild or absent
  • poor appetite
  • poor wound healing
  • ascites
  • xerosis and itchy rash
114
Q

malnutrition

energy preserved but protein is low in

A

Kwashiorkor

115
Q

malnutrition

energy and protein are both low in

116
Q

Kwashiorkor

fatty liver?

A

carrier protein to carry fat from the liver is absent

117
Q

Kwashiorkor

Refeeding syndrome Sx

A
  • Vomiting
  • Diarrhea
  • Vitamin deficiency- exhausted from trying to digest food
  • electrolyte imbalance
  • Phosphate disorders
118
Q

Kwashiorkor

refeeding Xd mechanism

A

if a child with Kwashiorkor is fed with a high protein diet, they will be digested to Amino acids and then to ammonia. The body doesn’t have NH3 detoxifying enzymes. so NH3 accumulate and leads to encephalopathy

119
Q

Kwashiorkor

Mx

A
  • NG tube feeding
  • start with a low calorie, low protein diet
  • gradually increase
120
Q

Marasmus

clinical manifestations

A
  • subcutaneous fat is not preserved
  • no edema
  • no fatty liver
  • prominent ribs
  • alert and irritable
  • severe muscle wasting
  • voracious feeder
121
Q

Marasmus

Mx

A

diet with adequate protein, carbs and fats

122
Q

estimated body weight calculation

A

(Age+4) x 2

123
Q

chronic malnutrition

A

weight and height both reduced

124
Q

acute malnutrition

A

weight reduced
height normal for age

125
Q

complications of reduced weight

A
  • hypoglycemia
  • dehydrated
  • hypothermia
  • sodium, potassium imbalance
126
Q

Severe acute malnutrition

A

weight for height <-3SD

127
Q

Moderate acute malnutrition

A

weight for height between -2SD and -3SD

128
Q

Mild acute malnutrition

A

weight for height between -1SD to -2SD

129
Q

protein malnutrition can be detected by

A

reduced mid- arm circumference for age and sex

130
Q

fat malnutrition can be detected by

A

reduced skin fold thickness for age and sex

131
Q

typical age of onset for malnutrition

A

6 months when breast feeding is weaned off

132
Q

complications of SAM

A
  • hypoglycemia
  • electrolyte imbalance
  • dehydration
  • hypothermia
  • infections
  • loss of protein
  • iron deficiency anemia
  • vitamin deficiency
  • heart failure
  • hypothyroidism

PAEDIATRICS (15 decks)

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