Paediatrics

Question 1

What are baby checks?

Answer 1

-Health and development reviews

-Makes sure the babies’ development is on track

-Supports parents/carers of the baby

Question 2

Who performs the baby check?

Answer 2

Health visitor

Question 3

What is the healthy child programme

Answer 3

A series of health and development reviews, screening tests, immunisations and information to support child

Consists of the Personal Child Health Record

Question 4

When do the baby check reviews happen?

Answer 4

Shortly after birth
One to two weeks
Six to eight weeks
Nine months to one year
Two to two-and-a-half years

Question 5

What takes place at the baby check shortly after birth?

Answer 5

weighed at birth and again during their first week.

Thorough physical examination within 72 hours of being born.
Eyes
Heart
hips
testicles.

5-8 days :
blood spot (heel prick) test that screens for cystic fibrosis and sickle cell disease.
Hearing test soon after birth.

Question 6

Things to look out for in the 1-2 weeks baby check review

Answer 6

safe sleeping
vaccinations
feeding your baby (breastfeeding and bottle feeding)
caring for your baby
your baby’s development

Question 7

What takes place at the baby check at 6-8 weeks

Answer 7

Thorough physical examination - eyes, heart, hips and – for boys – testicles

They’ll also have their weight, length and head circumference measured.

GP or health visitor will discuss the baby’s vaccinations. These are offered at 8 weeks, 12 weeks, 16 weeks and one year old, and before the child starts school.

Ask emotional and physical health of parents since child’s birth

Question 8

What takes place at the baby check at 9-12 months

Answer 8

Looks at language and learning, safety, diet and behaviour.

This is usually done by a member of health visiting team.

Health visiting team will send an ASQ-3 questionnaire to fill in before the review.

Question 9

What takes place at the baby check at 2-2.5 years

Answer 9

general development, including movement, speech, social skills and behaviour, and hearing and vision

growth, healthy eating and keeping active

managing behaviour and encouraging good sleeping habits
tooth brushing and going to the dentist

keeping your child safe

vaccinations

Question 10

What is the 5-in-1 vaccine

Answer 10

one of the first vaccines your baby will have

given as a single injection to protect your baby against five serious childhood diseases:

diphtheria
tetanus
whooping cough (pertussis)
polio
Hib (Haemophilus influenzae type b)

Question 11

When should babies have the 5-in-1 vaccine?

Answer 11

when babies are 8, 12 and 16 weeks old.

Question 12

How is the 5-in-1 vaccine given?

Answer 12

The vaccine is injected into your baby’s thigh.

Question 13

paracetamol routes of administration

Answer 13

Orally
Injection / intravenous infusion
Rectal (suppository)

Question 14

Prophylactic medication for MI

Answer 14

Lifestyle changes that can reduce the risk of having further MI or other cardiovascular events following an MI include:
-Smoking cessation.
-A healthy diet.
-Aiming to be moderately physically active for at least 150 minutes per week.
-Losing weight if overweight or obese.
-Keeping alcohol consumption within recommended limits.

Pharmaceutival treatments inc,ude:
-An angiotensin converting enzyme (ACE) inhibitor (or angiotensin-II receptor antagonist).
-Dual antiplatelet therapy.
-A beta-blocker.
-A statin.

Question 15

Chronic ECG changes after an MI

Answer 15

1. This picture shows a normal sinus complex. The ST segment is on the iso-electric line. At the onset of pain the ECG would be normal but the ST segment would soon start to change. In this picture, the T wave has grown taller.

2.Within an hour the ST segment would be noticeably elevated, indicating the onset on myocardial necrosis. (tissue death). This is the point at which we would be aiming to administer the thrombolytic (clot-busting) drug.

3.If thrombolysis is administered, we would be looking for specific changes on the ECG. A 50% reduction in ST segment elevation is a good indicator of success. In this picture, the ST elevation has reduced by more than 50% from picture 2. We would expect to see these changes within 90 minutes of administering thrombolysis. You can also see the T wave invertion is much deeper. This is a good sign of reperfusion. (blood flow returning to the damaged area.)

4.24 hours later, the ST segment may have returned to the iso-electric line. In this picture you can see the ST segment is back on the iso-electric line but the T wave remains inverted. It may stay inverted for days, weeks or months.

5.6. In some cases, after a few months the ECG looks relatively normal. Compare picture 6 with picture 1. They look much the same but for the deep Q wave in picture 6. A deep Q wave is an indicator of myocardial tissue death and will remain on the ECG. A “pathological” Q wave is not “time-specific”. It may be there from a previous heart attack and therefore is not part of the criteria for evaluating an Acute Myocardial Infarction.

Question 16

Heart Failure Drugs

Answer 16

Question 17

ACEi mode of action

Answer 17

Inhibits ACE (in lung). Less Angiotensin 1 is converted into angiotensin 2

Less angiotensin 2 means that you will decrease bp because there is less angiotensin 2 to bind to receptor of target cell

Question 18

How do you remember medication of ACE inhibitor ?

Answer 18

end in (~prils)

Question 19

Side effects of ACEi

Answer 19

Dry cough
Rash
Nausea/Vomiting
Diarrhoea
Angiooedema
Headache

Question 20

What medications are hypertensive African Americans prescribed?

Answer 20

Calcium Channel Blockers due to having low renin dependence

Question 21

NSAIDs mode of actions

Answer 21

-Inhibit cyclooxygenase (COX2)

-Cyclooxygenase is required to convert arachidonic acid into thromboxanes, prostaglandins, and prostacyclins

Question 22

NSAIDs side effects

Answer 22

indigestion – including stomach aches, feeling sick and diarrhoea.

stomach ulcers – these can cause internal bleeding and anaemia; extra medicine to protect your stomach may be prescribed to help reduce this risk.

headaches.

drowsiness.

dizziness.

allergic reactions.

Answer 23

Injury is detected by inflammatory mediators

Inflammatory mediators will stimulate receptors on sensory nerve fibres causing depolarisation thus stimulating of 1st order neuron

Question 24

Examples of inflammatory mediators

Answer 24

Prostaglandin
Bradykinin
ATP
H+
Serotonin
Histamine

Question 25

Drugs used to treat diabetes type 2

Answer 25

Insulin (used for type 1 also)

Biguanide: Metformin

Insulin secretagogue (sulfonylurea) : Stimulate B cell insulin release

Insulin sensitisers (thiazolidinedione) : Increase insulin reissitance, decrease FFA

GLP-1 amalogue : Binds GLP-1 receptor leads to increase in insulin release

AlphaGlucosidase Inhibitor : Decrease glucose absorption

Question 26

Mechanism of action for metformin

Answer 26

Increase insulin sensitivity

Increase glucose uptake

Decrease glycogenolysis

Insulin stmulates glucose moving into the cell and it will also stimulate glcuose to store as glycogen

Question 27

Side effects of metformin

Answer 27

GI upset
Anorexia
Lactic acidosis

Question 28

Contraindications of metformin

Answer 28

Liver and renal dysfunction

Question 29

Assessing Patients with Depression

Answer 29

Question 30

Symptoms of depression

Answer 30

Question 31

Medication for patient suffering from depression

Answer 31

SSRI
(selective serotonin reuptake inhibitor)

SNRI
(serotonin and noradrenalinreuptake inhibitor)

TCA
(tricyclic antidepressants)

Question 32

Mode of Action for SSRIs

Answer 32

Inhibit a mechanism called reuptake. In reuptake, a protein called a transporter transports excess neurotransmitter molecules out of the synaptic cleft, usually back into the neuron that released them. SSRIs inhibit the reuptake of serotonin.

By inhibiting the removal of serotonin from the synaptic cleft, this causes levels of serotonin in the synaptic cleft to rise. These increases in serotonin levels have been hypothesized to be the mechanism by which SSRIs can treat the symptoms of depression.

Question 33

SSRIs (example, main side effect + note)

Answer 33

Question 34

SNRIs mode of action

Answer 34

SNRIs work primarily by inhibiting a mechanism called reuptake. In reuptake, a protein called a transporter transports excess neurotransmitter molecules out of the synaptic cleft, typically back into the neuron that released them. SNRIs inhibit the reuptake of serotonin and norepinephrine. When the removal of serotonin and norepinephrine from the synaptic cleft is inhibited, this causes levels of these neurotransmitters in the synaptic cleft to rise. These increases in serotonin and norepinephrine levels have been hypothesized to be the mechanism by which SNRIs can treat the symptoms of depression. It should be noted, however, that research suggests the neurobiological mechanism of depression is more complex than a simple neurotransmitter deficiency. Thus, it may be that increasing serotonin and norepinephrine levels leads to other effects that can alleviate the symptoms of depression, or that the drugs have other mechanisms that contribute to their effectiveness.

Question 35

SNRIs (example, main side effect + note)

Answer 35

Question 36

Mode of action TCA

Answer 36

They block the reuptake of serotonin and norepinephrine in presynaptic terminals, which leads to increased concentration of these neurotransmitters in the synaptic cleft. The increased concentrations of norepinephrine and serotonin in the synapse likely contribute to its anti-depressive effect. Additionally, they act as competitive antagonists on post-synaptic alpha cholinergic (alpha1 and alpha2), muscarinic, and histaminergic receptors (H1)

Question 37

TCA (example, main side effect + note)

Answer 37

Question 38

What is St. Johns wort

Answer 38

herbal remedy.

It is used as a complementary therapy for mild depression and minor skin wounds