NCDs, maternal health, mental health, child health Flashcards

1
Q

What proportion of maternal and neonatal deaths are associated with anaemia

A

40%

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2
Q

Anaemia diagnostics in low resource areas

A

skin prick
colour chart - conjunctival pallor

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3
Q

common causes of anaemia in sub saharan Africa

A

Bacteremia (non-typhi salmonella - asymptomatic)
Malaria
Hookworm
HIV
G6PD
Vit A or B12 deficiency

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4
Q

What feature of sickle cell anaemia improves prognosis

A

High HbF = better prognosis

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5
Q

Clinical features of sickle cell

A

Bony deformities
Haemolysis
Organ damage from sickle cells
Pain crisis
Intercurrent infections → thrombi to spleen causing hyposplenism
Strokes/TIA
Acute splenic sequestration
Young children - dactylitis
Older children - pain in long bones
Adults - painful ulcers, non-healing
AVN

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6
Q

Sickle cell management

A

Do not transfuse unless Hb low
Folate
Pain Mx
Treat infection, fluids, O2.
Prophylactic penicillin
Immunisations
Hydroxyurea - increases proportion of HbF

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7
Q

What was the outcome of the FEAST trial?

A

increased mortality with bolus fluids in children with Sepsis in African setting

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8
Q

Outcome of sepsis protocol in Africa

A

‘usual care’ had a better mortality outcome than the sepsis protocol

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9
Q

Long term outcomes of sepsis

A

Increased mortality over the next 5 years even when compared to age and disease matched controls.

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10
Q

What are neutralizing antibodies

A

Antibodies which are effective in preventing infection - ie. active early when virus enters the body. Stops initial infection from taking hold. Patient never becomes unwell or infective.

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11
Q

What does ETAT stand for?

A

Emergency triage, assessment and treatment

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12
Q

What are the ETAT priority signs?

A

Trauma, Tiny, Temp
Pallor, pain, poisoning
Restless, respiratory distress, urgent referral
Malnutrition, oedema, burns

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13
Q

What are the ETAT emergency signs?

A

A- airway obstruction, central cyanosis
B - not breathing, severe resp distress
C - cold skin + cap refill >3 secs + weak and fast pulse
C - convulsing, coma
D - diarrhoea + lethargy/sunken eyes/ slow skin pinch/ not drinking

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14
Q

Management of child airway as per ETAT

A

Open the airway

<1year - neural position
>1 year - sniffing position

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15
Q

Management of child breathing as per ETAT

A

Respiratory distress:

  • sit patient up
  • give O2 if severe
  • give ABx to all - Amoxil - add gent if severe
  • maintenance fluids if severe (NO BOLUS)
  • if wheeze present give salbutamol spacer
  • CPAP if severe
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16
Q

Management of child circulation as per ETAT

A

Management of Shock

Give blood if Hb <6
Give Hartmans/saline over 30mins - slow to 1 hour and add glucose if malnourished.

If resolved - give maintainence fluids- add ReSoMal if malnourished
If not resolved - give blood - add ReSoMal if malnourished

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17
Q

Management of child dehydration as per ETAT

A

If not- malnourished
- ORS (mild)
- IV fluids (severe)

If malnourished
- ReSoMal

Give Zinc!

18
Q

Management of child coma/convulsions as per ETAT

A

In first 5 mins: A TOOBAA PNB - A toobaa player named B

  • open airway
  • check time
  • check obs
  • O2
  • BSL
  • IV access
  • ABx, Antimalarials
  • Recovery position
  • NG tube
  • Blood tests

After 5 mins
- diazepam –> diazepam –> phenobarbitol/phenytoin

19
Q

What is IMCI and what does it do

A

IMCI = integrated management of childhood illnesses
guidelines by WHO+UNICEF

address 5 major causes of child mortality
Pneumonia
Diarrhoea
Malaria
Measles
Malnutrition

20
Q

What is a missed opportunity for vaccination?

A

attends clinic with no contra-indication and vaccine is not given.

21
Q

What are the types of vaccine wastage?

A

Closed vial waste
Open vial waste

22
Q

What proportion of vaccines are wasted

A

> 30%

23
Q

What is the biggest cost in vaccine programs

A

the cost of the bottles!

24
Q

How to know if a freeze- sensitive vaccine has been frozen

A

Shake test - compare with a control trial that is frozen and thawed. Compare rate of sediment

25
Q

definition of Severe acute malnutrition

A

< 3 STD below the mean weight to length
oedema of feet
MUAC - <115

26
Q

Acute malnutrition appearances

A

Murasmus - old man
Kwashikor - oedematous

27
Q

Causes of fever + rash in children

A

Meningococcal, pneumococcal, scarlet fever
Measles, rubella, parvovirus B19, adenovirus, HHV6, enterovirus, parechovirus
Arbovirus
Rickettsial infections
Leptospirosis

28
Q

Measles incubation, symptoms and complications

A

Incubation - 2 weeks

Symptoms
2-5 day prodrome
Rash - head to toe
Conjuntivitis, coryza, cough, Koplik spots

Complications - very common - occur in 40%
- pneumonia, croup, dehydration, malnutrition, encephalitis,

29
Q

Prevention and follow up of measles

A

Prevention
- Vit A !!
- Vaccination

Follow up
- Gammaglobulin to contacts
- Chronic diarrhoea can occur post measles.

30
Q

What proportion of rheumatic fever becomes rheumatic heart disease?

A

approx 5%

31
Q

what organism causes rheumatic fever?

A

Group A beta haemolytic strep (strep pyogenes)

32
Q

JONES criteria for rheumatic fever

A

J- Joint pain - migratory
O - O shaped heart - carditis, valvular disease
N - Nodules
E - Erythema marginatum
S - Syndenham chorea

(NOTE - most do not have sore throat)

33
Q

Management of rheumatic fever

A

Aspirin
Steroids
IM Benzathine Pen
treat chorea
prophylax against relapse

34
Q

Newborn danger signs

A

Unable to breast feed
Hypothermia
Fever
Grunting
Chest in-drawing
RR >60 or <30
Red eyes - ophthalmia neonatorum - from chlamydia and gonorrhoea
Jaundice
Skin pustules
Redness around umbilicus
Abdo distension
Floppy baby
Convulsions

35
Q

most common cause of neonatal sepsis

A

Group B strep

36
Q

Empirical treatment of neonatal sepsis

A

Ampicillin + Gentamycin

37
Q

Management of hypoxic ischaemic encephalopathy (baby born not breathing)

A

If baby not breathing → stimulate and clear airway
If still not breathing → bag and mask within first minute
Can clamp and cut umbilical cord early if needing to move baby to flat surface

38
Q

recommendations for use of steroids in pregnancies with high premature birth risk

A

Improves mortality in high resources settings but worsens mortality in low resource settings. (still recommended in LMIC if they have the resources to screen and treat infections)

39
Q

Management in newborns which improves mortality

A

kangaroo care
bubble CPAP
breast feeding

40
Q

Coma scales in children

A

AVPU scale
Blantyre coma scale
GCS - adapted for children

41
Q

determinants of reproductive health

A

Family planning
Antenatal care
Treatment if infertility
Unsafe abortion issues
Reproductive tract infections
STI and HIV
Human sexuality and reproductive health
Violence against woman and harmful practices
Appropriate referrals