PBL 5 Flashcards

1
Q

when did the rotavirus injection programme begin

A

rotavirus injection programme began in September 2013.

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2
Q

what does the rotavirus cause

A

o Causes around 140,000 diarrhoea cases a year and 14,000 hospital stays.

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3
Q

what months is the rotavirus given at

A

• Given two separate doses at eight weeks and twelve weeks.
o Oral vaccine expected to halve the number of vomiting/diarrhoea cases caused by rotavirus and lead to 70% fewer hospital stays.

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4
Q

when did the men B vaccine start

A

September 2015.

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5
Q

what months do you give men B vaccination

A

• Given two doses at 2 months and 4 months, and a booster at 12 months

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6
Q

what is the most common cause of bacterial meningitis

A

• Men B is the most common cause of bacterial meningitis in the UK.

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7
Q

When is Men ACWY given

A

• Given to 14-18 year olds and especially new university students.
o Due to close contact in halls of residence.

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8
Q

when did the Men ACWY start to be given

A

• Men W has been rare in the past but is on the rise.

o Combination of vaccine against 4 types of Men started in August 2015.

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9
Q

when are their outbreaks of whooping cough

A

There are outbreaks of whooping cough every three to four years

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10
Q

what is the tipping point of an outbreak

A

• When a large proportion of the population are not immune (especially adults) because the vaccination does not give life-long protection.

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11
Q

describe whooping cough

A

• Serious illness = can lead to complications of pneumonia and brain damage.
o Most babies with whooping cough will need hospital treatment.

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12
Q

describe the outbreak of whooping cough

A

• Outbreak in 2012 (with 13 babies dying).

- lead to vaccination being given

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13
Q

when is the vaccination given to mothers with whooping cough

A

• Lead to whooping cough vaccine given to mothers between 28 and 38 weeks of pregnancy.
o Baby receives whooping cough antibodies across the placenta.
• Receives another vaccination at two months old.

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14
Q

what are the stages of whooping cough

A

First Stage: early symptoms like the common cold.
• Runny nose, sneezing, dry mouth and sore throat, slightly raised temperature.
o This stage lasts around 1-2 weeks.

Second Stage: stage is characterised by intense bouts of coughing.
• Whoop sound with the sharp intake of breath.
• Vomiting after each bout of coughing.
o This stage lasts 2 weeks.

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15
Q

what is the heel prick test

A

• Done at 7 days of age and is used to detect:
o Phenylketonuria (PKU)
o Hypothyroidism (TSH)
o Cystic Fibrosis (immunoreactive trypsinogen)
o Sickle Cell Disease (Haemoglobinopathies)
o Medium Chain Acyl CoA dehydrogenase.
 High Octanoylcarnitine

•	Addition in may 2015:
o	Homocystinuria (HCU)
o	Maple Syrup Urine Disease (MSUD)
o	Glutaric Aciduria type 1 (GA1)
o	Isovaleric Aciduria (IVA)
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16
Q

what day is the heel prick test done at

A
  • done at 7 days
17
Q

what is medium chain acyl-CoA dehydrogenase deficiency

A

• Disorder of fatty acid oxidation that on clinical presentation can mimic SIDS

18
Q

describe how normal fatty acid oxidation works

A

• Normally fatty acids are released during fasting and taken up by the mitochondria in the liver/muscle.
• They are oxidised to produce acetyl-coA which is converted to energy.
o MCAD is a mitochondrial matrix enzyme which catalyses the initial oxidation reaction.

19
Q

what is the incidence of medium chain acyl-CoA dehydrogenase

A

• MCAD affects approximately 1:8000 to 1:15 000 children.

20
Q

how do infants present with MCADD

A

• Intermittent (irregular) hypoglycaemia and vomiting caused by transient (non-intentional) fasting (often associated with undercurrent minor infection).
o If untreated can rapidly lead to coma and death.
• Episodes occur between the ages of 3 months and 2 years.

21
Q

what can the presentation of MCADD lead to

A

This dramatic presentation has sometimes lead to the misdiagnosis of SIDS.
• If fatty liver is found: disorder of FA oxidation.

22
Q

describe the genetics of MCADD

A

• Autosome recessive inherited disorder.
• Caused by a mutation of medium-chain acyl-CoA dehydrogenase gene (ACADM) on chromosome 1.
o Several allelic variants of local 1p31.
• Most common mutation is called G985.
o Substitution of guanine for adenine nucleotide at the 985th residue.

23
Q

What investigation can be used to find out if you have MCADD

A

o Acutely: hypoglycaemia.
o U&E (urea and electrolytes): may show high or low bicarbonate/reduced anion gap.
o LFTs: may show elevated enzymes, low plasma carnitine.
o Urine: medium chain dicarboxylic aciduria/absent ketones.

Skin biopsy: can be performed to confirm diagnosis of primary carnitine deficiency.
• Demonstrating reduced carnitine transport in fibroblasts.
• Fibroblasts may be used for fatty acid oxidation studies or enzyme assay.

24
Q

what are the 4 ways to manage MCUDD

A
  • avoidance of fasting
  • adjustment of diet
  • daily carnitine
  • genetic counselling for family members
25
describe how long you should avoid fasting for in MCUDD
o Maximum duration of fasting should be:  8 hours between 6 months and 1 year of age.  10 hours in the second year of life.  12 hours after that.
26
what kind of diet should you have in MCUDD
o Greater calories in carbohydrates and proteins, while minimising lipids
27
describe why we manage daily carnitine
o Has been suggested conjugation and excretion of toxic bi-products. o Supplementation may promote clearance of accumulating acylcarnitines (especially during exercise), but there is no beneficial effect clinically and biochemically.
28
describe what should happen in genetic counselling
o The heterozygous state is quite common. | o Testing should be offered to first-degree relatives.
29
what is SIDS
• Sudden and unexpected death of an infant/young child for which no adequate cause if found after a thorough post-mortem examination. (1 month to 1 year)
30
what is the most common cause of death of post neonates (1 month to 1 year olds)
SIDS
31
what has reduced the number of infant deaths via SIDS
 Fallen since introduction of back to sleep | • Babies should be nursed on their back.
32
what are the other causes of SIDS
``` o Lethal congenital malformations. o Infections. o Rare inherited conditions. o Accidents. o Non-accidental injury. ```
33
what are the unknown causes of SIDS
• Some babies stop breathing and die without any sign of struggling. • Not uncommon for babies to have brief periods of apnoea. o Lasts up to 10 seconds. • Small number of babies have been smothered by parents. o But autopsy findings are the same as SIDS.  5-10% of so-called SIDS is smothering. o Controversial in the past  distress to parents.
34
when does SIDS usually happen
• Usually overnight period of sleep. | o Can happen any time baby falls asleep.
35
what are the risk factors associated by SIDS
* Males * Premature * Low birthweight * Have parents who smoke * Not breast-fed * Sleeping prone on the belly. * Overheating.
36
what happens in the next visit with the nurse after the next baby after SIDS
• Implanted by many districts. o Nurse visits and supervises subsequent babies: make sure baby is well, weighed regularly, attending child health clinics etc… - care of the next infant (CONI)
37
At approximately what rate does SIDS occur in England and Wales?
0.3 deaths per 1000 live births.