MSRA pt 5 Flashcards
When should a new-born examination be carried out?
Carry out a complete examination of the baby within 72 hours of the birth and at 6 to 8 weeks after the birth
What is failure to thrive?
Failure to thrive is best described as failure to advance along a centile on a growth chart. Thus, a child whose weight is on the 3rd centile, and always has been, is not failing to thrive, whereas the child who is now on the 3rd centile, after having been on the 50th, is failing to thrive.
What is the significance of neonatal pale stool?
Acholic stools in the neonatal period are pale, clay coloured, and are an important indicator of an obstructed biliary tree. The most important aetiology of this is biliary atresia, in that early intervention can improve prognosis, but acholic stools may result from a variety of other causes of neonatal liver dysfunction.
List the pathological causes of neonatal jaundice
Blood group incompatibility (most commonly Rhesus or ABO incompatibility).
Other causes of haemolysis.
Sepsis.
Bruising.
Metabolic disorders (for example galactosaemia, hereditary fructose intolerance, alpha-1 antitrypsin deficiency, hypothyroidism).
Gilbert’s syndrome and Crigler-Najjar syndrome — rare causes of neonatal jaundice that are caused by liver enzyme problems. For more information, see the CKS topic on Gilbert’s syndrome.
Glucose-6-phosphate-dehydrogenase deficiency — a familial enzyme deficiency more common in Mediterranean, Middle Eastern, South East Asian, and African populations.
Congenital obstruction and malformations of the biliary system, such as biliary atresia — cause obstructive jaundice with conjugated hyperbilirubinaemia.
When do you urgently refer neonatal jaundice?
If there is jaundice with features of bilirubin encephalopathy (for example atypical sleepiness, poor feeding, irritability, vomiting, hypotonia followed by hypertonia).
If jaundice first appears at less than 24 hours of age.
Jaundice first appears at more than 7 days of age.
The neonate is unwell (for example, lethargy, fever, vomiting, irritability).
Gestational age is of less than 35 weeks.
Prolonged jaundice is suspected — that is a gestational age of less than 37 weeks with more than 21 days of jaundice; or a gestational age of 37 weeks or more with more than 14 days of jaundice.
There are feeding problems and/or concerns about weight, particularly in breastfed infants.
Pale stools and dark urine are noted.
What does an absent moro reflex signify?
An absent moro reflex at birth implies brain dysfunction. Persistence of a moro reflex suggests a brain lesion.
Are B symptoms a good or bad marker of lymphoma?
Bad
fever
drenching night sweats
weight loss:
more than 10% of body mass in previous 6 months
If in doubt of transient synovitis what do you do and why?
It is a diagnosis of exclusion, refer to hospital if suspicious
How do you diagnose Cow’s milk protein allergy
Diagnosis is often clinical (e.g. improvement with cow’s milk protein elimination). Investigations include:
skin prick/patch testing
total IgE and specific IgE (RAST) for cow’s milk protein
How do you manage cow protein milk allergy in infants
continue breastfeeding
eliminate cow’s milk protein from maternal diet. Consider prescribing calcium supplements for breastfeeding mothers whose babies have, or are suspected to have, CMPI, to prevent deficiency whilst they exclude dairy from their diet
use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months
What are the 5 specific causes for duputyns contracture in addition to idiopathic causes.
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
When do you use the CHA2DS2-VASc score?
use the CHA2DS2-VASc stroke risk score to assess stroke risk in people with any of the following:
symptomatic or asymptomatic paroxysmal, persistent or permanent atrial fibrillation
atrial flutter
a continuing risk of arrhythmia recurrence after cardioversion back to sinus rhythm
What is the CHA2DS2-VASc score and what are it parameters?
Congestive Heart Failure 1
Hypertension 1
Age >75 years 2
Age between 65 and 74 years 1
Stroke/TIA/TE 2
Vascular disease (previous MI, peripheral arterial disease or aortic plaque) 1
Diabetes mellitus 1
Female 1
When would you refer suspected ankylosing spondyloarthritis?
if a person has low back pain that started before the age of 45 years and has lasted for longer than 3 months, refer the person to a rheumatologist for a spondyloarthritis assessment if 4 or more of the following additional criteria are also present:
low back pain that started before the age of 35 years (this further increases the likelihood that back pain is due to spondyloarthritis compared with low back pain that started between 35 and 44 years)
waking during the second half of the night because of symptoms
buttock pain
improvement with movement
improvement within 48 hours of taking non-steroidal anti-inflammatory drugs (NSAIDs)
a first-degree relative with spondyloarthritis
current or past arthritis
current or past enthesitis
current or past psoriasis.
When would you test for HLA-B27 in suspected ankylosing spondyloarthritis
If exactly 3 of the additional criteria are present, perform an HLA-B27 test.
What are the SE of NRT?
nausea & vomiting, headaches and flu-like symptoms
What is the inheritance pattern of haemachromatosis and what is the management and monitoring of the condition
Haemochromatosis is an autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation. Monitoring the response Is with ferritin and transferrin saturation.
Venesection is the first-line treatment
monitoring adequacy of venesection: transferrin saturation should be kept below 50% and the serum ferritin concentration below 50 ug/l
desferrioxamine may be used second-line
What are the features of lichen planus?
Lichen plants- automimmune MHC I mediated
Purple, planar, pruritic, papule >5cm, plaque <5cm, polygonal - contains white reticular called wicked striae
What is the test used to investigate hyperaldosteronism and what is a positive result
plasma aldosterone/renin ratio is the first-line investigation in suspected primary hyperaldosteronism
should show high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)
What are the features of mania and how is it managed?
Lasts for at least 7 days - Causes severe functional impairment in social and work setting
May require hospitalization due to risk of harm to self or others
May present with psychotic symptoms
Insight is often lost and for this reason manic patients represent a significant proportion of compulsory admissions to hospital.
What is the characterisation of hypomania?
Hypomania, as defined by DSM-IV, is characterised by milder elevation of mood and overactivity (lasting at least 4 days) without psychotic features or significant functional impairment.
What are the features of SUFE
Features
knee or distal thigh pain is common
loss of internal rotation of the leg in flexion
Does perthes disease present in childhood or adolescence?
Childhood
How is gestational HTN managed?
Gestational HTN
Admit if BP over 160/110
Treat BP if over 140/90
Aim for a BP Under 135/85
Measure BP and urine for protein every 2weeks
Measure FBC for platelets, LFT for hepatitis and U&E for renal function weekly
Foetal heart auscultation and foetal US assessment every 2-4 weeks
