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Pediatrics I - OSCE > PEM > Flashcards

PEM Flashcards

1
Q
A
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2
Q

Def of Protein Caloric (Energy) Malnutrition

A
  • Syndromes resulting from deficiencies of calories and/or protein intake.
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3
Q

Better Term for Protein Caloric (Energy) Malnutrition

A

Because PEM is almost always accompanied by deficiency of other nutrients, the term severe childhood undernutrition (SCU) may be more accurate and is preferred.

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4
Q

Wellcome Classification of PEM

A
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5
Q

Limitations of Wellcome Classification of PEM

A
  • Patient length is not in the consideration.
  • Edema falsely increases the weight.
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6
Q

WHO Classification of Severe malnutrition

A
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7
Q

Def of Marasmus

A
  • It’s a chronic state of undernutrition characterized by progressive loss of weight due to caloric deficiency.
  • The problem is protein + caloric deficiency
  • Marasmus is not a disease but complex symptoms from some underlying causes.
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8
Q

FTT

A
  • It means failure to gain weight, drop of weight 2 major percentiles on follow up or weight below 5th percentile for age and sex.
  • Thus, FTT includes marasmus and not the reverse.
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9
Q

Etiology of Marasmus

A
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10
Q

Etiology of Marasmus

  • Non-Organic Causes
A
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11
Q

Etiology of Marasmus

  • Organic Causes
A
  • Inadequate Intake
  • Poor Absorbtion
  • Increase Metabolic Demands
  • ??????
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12
Q

Organic Causes of Marasmus

A
  • Inadequate Intake
  • Poor Absorbtion
  • Increase Metabolic Demands
  • ??????
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13
Q

Organic Causes of Marasmus

  • Inadequate Intake
A

Dieteic & Non

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14
Q

Dieteic Causes of Marasmus

A
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15
Q

Dieteic Causes of Marasmus

  • Quantitative
A
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16
Q

Dieteic Causes of Marasmus

  • Qualitative
A
  • Too prolonged breast-feeding.
  • Lack of sugar in the formula or much-diluted formulae.
  • Prolonged use of fluids in children after gastroenteritis.
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17
Q

Non-Dieteic Causes of Marasmus

A
  • Anorexia (anemia, CNS disorders, infections).
  • Inability to suck or swallow (CNS defects, congenital anomalies).
  • Vomiting.
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18
Q

Absorbtion Causes of Marasmus

A
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19
Q

Absorbtion Causes of Marasmus

  • GIT
A

Celiac disease, Cystic Fibrosis, Schwachman syn.

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20
Q

Absorbtion Causes of Marasmus

  • Renal
A

Renal failure, RTA

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21
Q

Absorbtion Causes of Marasmus

  • Endocrine
A

DM, thyroid, GH deficiency

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22
Q

Absorbtion Causes of Marasmus

  • Chronic Infection
A

TB, HIV, parasites

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23
Q

Metabolic Causes of Marasmus

A
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24
Q

Metabolic Causes of Marasmus

  • Chronic Diseases
A

Heart Failure, Chronic Heart Disease, BPD

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25
Q

Metabolic Causes of Marasmus

  • Choronic Inflammatory Diseases
A

IBD, SLE

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26
Q

Metabolic Causes of Marasmus

  • Renal
A

Renal failure

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27
Q

Metabolic Causes of Marasmus

  • Endocrine
A

Hyperthyroidism

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28
Q

Pathophysiolgy of Marasmus

A
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29
Q

CP of Marasmus

A
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30
Q

CP of Marasmus

  • Weight Loss
A

Weight < 60% of normal.

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31
Q

CP of Marasmus

  • Characters
A
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32
Q

CP of Marasmus

  • Cardinal Sign
A

Loss of SC fat from abdomen then Limbs then Pads of check.

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33
Q

CP of Marasmus

  • Vitals
A
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34
Q

CP of Marasmus

  • GIT
A
  • Gastroenteritis
  • Constipation
  • Starvation stool (small amount, dark in color, increased mucus)
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35
Q

CP of Marasmus

  • Others
A

Recurrent infection - Anemia - Vit B def

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36
Q

Degrees of Marasmus

A
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37
Q

Labs in Marasmus

A
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38
Q

Complications of Marasmus

A
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39
Q

Causes of Death in Marasmus

A
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40
Q

Prevention of Marasmus

A
  • Adequate feeding.
  • Immunization.
  • Early diagnosis & treatment of infection.
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41
Q

Another Name of Kwashiorker

42
Q

Def of Kwashiorker

A
  • Clinical syndrome due to supply of protein & amino acids with adequate caloric supply.
  • It is acute not a chronic disease
43
Q

Etiology of Kwashiorker

44
Q

Etiology of Kwashiorker

  • Dietary inadequacy
45
Q

Etiology of Kwashiorker

  • Post-Infectious
46
Q

Etiology of Kwashiorker

  • Psychological Factors
A
  • The consequence of another pregnancy or another birth may lead to a maternal deprivation syndrome of the breast fed infant in which anorexia is a main feature
47
Q

CP of Kwashiorker

48
Q

CP of Kwashiorker

  • Constant Diagnostic Features
49
Q

CP of Kwashiorker

  • Variable Features
50
Q

Growth Retardation in Kwashiorker

51
Q

Growth Retardation in Kwashiorker

  • Weight
52
Q

Growth Retardation in Kwashiorker

  • Height & Head Circumference
A

Are less affected than weight.

53
Q

Growth Retardation in Kwashiorker

  • Muscles
54
Q

Growth Retardation in Kwashiorker

  • SC Fat
A
  • Preserved (indicating adequate caloric intake).
  • Detected by skin fold.
55
Q

Edema in Kwashiorker

56
Q

Edema in Kwashiorker

  • Site
A
  • Starts in the dorsum of feet then hands then become generalized.
  • Never associated with ascites & pleural effusion.
57
Q

Edema in Kwashiorker

  • Type
A

Soft Pitting

58
Q

Edema in Kwashiorker

  • Pathogenesis
59
Q

Psychomotor & Mental Changes in Kwashiorker

60
Q

Psychomotor & Mental Changes in Kwashiorker

  • Features
A
  • Lethargy, apathy, loss of interest to surrounding & misery.
  • Mental development appears to be below normal for the age.
61
Q

Psychomotor & Mental Changes in Kwashiorker

  • Pathogenesis
A
  • Decreased Manganese.
  • A defect in the metabolism of aromatic amino acids.
62
Q

Skin Changes in Kwashiorker

63
Q

Skin Changes in Kwashiorker

  • Site
A

Common over pressure & flexure sites (e.g., buttocks & elbow).

64
Q

Skin Changes in Kwashiorker

  • Pathogenesis
65
Q

Hair Changes in Kwashiorker

  • CP
66
Q

Hair Changes in Kwashiorker

  • Pathogenesis
67
Q

GIT Disorders in Kwashiorker

  • CP
A

Anorexia, vomiting, diarrhea & steatorrhea.

68
Q

GIT Disorders in Kwashiorker

  • Pathogenesis
69
Q

Anemia in Kwashiorker

A
  • Deficiency of iron, protein, folic acid and B12.
  • Recurrent infections
70
Q

Vitamin Deficiency in Kwashiorker

A
  • Signs of vitamins deficiency may be encountered as (Vit A, B, C)

E.g., Signs of riboflavin (B2) def. angular stomatitis, cheilosis, glossitis and blepharitis.

71
Q

Investigations in Kwashiorker

72
Q

Investigations in Kwashiorker

  • Urea N / Creatinine N
73
Q

Investigations in Kwashiorker

  • Non Essential AA / Essential AA
74
Q

Investigations in Kwashiorker

  • Plasma Proteins
75
Q

Investigations in Kwashiorker

  • total Serum AA
76
Q

Investigations in Kwashiorker

  • Serum Cholesterol
77
Q

Investigations in Kwashiorker

  • Serum Electrolytes & Minerals
78
Q

Investigations in Kwashiorker

  • Serum Enzymes
79
Q

DDx of Kwashiorker

80
Q

Complications & Causes of Death Kwashiorker

81
Q

Prevention of Kwashiorker

82
Q

TTT of PEM

A
  • Hospitalization
  • Dietetic Managment
  • TTT of associated Conditions
83
Q

TTT of PEM

  • hospitalization
84
Q

Dieteic Managment ofPEM

  • Route
A

Nasogastric tube “gavage feeding” due to presence of anorexia.

85
Q

Dieteic Managment of PEM

  • Frequency
A

Every 1-2 Hours

86
Q

Dieteic Managment of PEM

  • quantity
87
Q

Dieteic Managment of PEM

  • Regimen (Quality)
88
Q

Dieteic Managment of PEM

  • Supplments
89
Q

Dieteic Managment of PEM

  • Complications
A
  • Refeeding syndrome D2 hypophosphatemia
  • Protein intoxication
90
Q

Complications of Dietetic managment of PEM

  • Reefeding Syndrome
91
Q

Complications of Dietetic managment of PEM

  • Protein Intoxication
A

with hepatomegaly, hyperammonemia.

92
Q

Refeeding Syndrome

93
Q

TTT of PEM

  • TTT of Associated Conditions
94
Q

TTT of Associated Conditions with PEM

  • Anemia
A
  • Iron (after 1st week of nutritional rehabilitation)
  • Vitamin B12, folic acid
95
Q

TTT of Associated Conditions with PEM

  • dermatitis
A

2% aqueous gentian violet solution.

96
Q

TTT of Associated Conditions with PEM

  • Xerophthalmia
A

Vitamin A drops orally and locally, antibiotic.

97
Q

TTT of Associated Conditions with PEM

  • diarrhea & Infection
A

Proper antibiotics

98
Q

Time frame for treatment of PCM

99
Q

Time frame for treatment of PCM

  • Initial Phase
100
Q

Time frame for treatment of PCM

  • Rehabilitation Phase
101
Q

Time frame for treatment of PCM

  • Follow up Phase

Pediatrics I - OSCE (20 decks)

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