common chronic conditions

Question 1

what is coeliac?

Answer 1

Autoimmune conditions where exposure to gluten causes immune reaction and creates inflammation in small intestine

Question 2

what is the pathophys of coeliac?

Answer 2

Autoantibodies are created in response to gluten
- They target epithelial cells of intestine
- Anti-TTG
- Anti -EMA
Inflammation: small bowel mainly causing atrophy of intestinal villi (causing malabsorption of nutrients)

Question 3

how would coeliac present?

Answer 3

Often asymptomatic
Failure to thrive
Diarrhoea, fatigue, weight loss, mouth ulcers
Anaemia secondary to iron, B12, folate deficiency
Dermatitis herpetiformis  itchy blistering skin rash that typically appears on abdo
Neuro symptoms: peripheral neuropathy, cerebellar ataxia and epilepsy

Question 4

why would could there be neuro symptoms in coeliac?

Answer 4

lac of absorption - lack of B12

Question 5

how do you diagnose coeliac?

Answer 5

Pt needs to remain on gluten diet for diagnostics
Anti TTG and anti EMA  disease specific antibodies
Total immunoglobulin A levels  exclude IgA deficiency
Endoscopy + intestinal biopsy  crypt hypertrophy and villous atrophy

Question 6

how do you manage coeliac?

Answer 6

Gluten free diet  FODMAP diet trial?
Checking antibodies to monitor

Question 7

what are complications of coeliac?

Answer 7

Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T cell lymphoma (EATL) of intestine
Non-Hodgkin’s lymphoma
Small bowel adenocarcinoma

Question 8

what do T1DM get screened for when they are first diagnosed?

Answer 8

coeliac screening

Question 9

what other conditions are linked to coeliac?

Answer 9

Linked to other conditions: T1DM, thyroid disease, autoimmune hepatitis, Primary biliary cirrhosis, primary sclerosing cholangitis, Down’s syndrome

Question 10

what is the pathophys of T1DM?

Answer 10

Mechanism is unclear, potentially genetic component
Could be triggered by certain viruses eg coxsackie B virus and enterovirus
When there is no functioning insulin, cells of the body cannot take glucose from blood  insulin allows glucose into cell
No insulin = cells can not use glucose = blood glucose continues to rise = hyperglycaemia
Insulin is produced from beta cells in Islets of Langerhan’s within the pancreas

Question 11

how does T1DM present?

Answer 11

Most children present with DKA
Hyperglycaemia symptoms: polyuria, polydipsia, weight loss
Other: secondary enuresis (bedwetting when previously dry) and recurrent infections

Question 12

what diagnostic investigations are done for T1DM?

Answer 12

Baseline bloods: FBC, U+E, BMs, HbA1c, TFT and TPO(associated disease)
Need anti-TTG  could have coeliac too
Insulin antibodies, anti-GAD antibodies and islet cell antibodies  destruction of pancreas

Question 13

how do you manage T!DM in paeds?

Answer 13

Want pt and family to be involved in care  complex and chronic
Subcut insulin regimes  long acting and basal bolus

Question 14

what monitoring is required with T1DM?

Answer 14

Monitoring dietary carbs
Monitoring BMs: waking up, each meal and before bed
Monitoring and managing complications: short term and long term
Need HbA1c checked every 3-6mths

Question 15

what are the short term complications of poorly managed T1DM?

Answer 15

hypo/ hyperglycaemia
DKA

Question 16

what are the different types of complications within diabetes?

Answer 16

microvascular
macrovasculAR
INFECTION

Question 17

what are macrovascular complications of poorly controlled diabetes?

Answer 17

Macrovascular: coronary artery disease, peripheral ischaemia (diabetic foot), stroke, HTN

Question 18

what are microvascular complications of diabetes?

Answer 18

Microvascular: peripheral neuropathy, kidney disease – glomerulosclerosis

Question 19

what infections can arise from poorly controlled diabetes?

Answer 19

Infection: UTI, pneumonia, skin and soft tissue in feet, fungal infections – oral and vaginal candidiasis

Question 20

what is epilepsy?

Answer 20

Epilepsy is umbrella term where there is a tendency to have seizures  transient episodes of abnormal electrical activity in the brain

Question 21

how would a GTC seizure present?

Answer 21

Generalised tonic- clonic: loss of consciousness, tonic (muscle tensing) and clonic (jerking)  may have tongue biting, incontinence, ireegular breathing

Question 22

how would a focal seizure present?

Answer 22

Focal: start in temporal lobe: affect hearing, speech, memory, hallucinations, memory flashbacks, déjà vu, doing strange things on autopilot

Question 23

how would an absence seizure present?

Answer 23

more in children – staring blankly into space and then abruptly returns to normal  can not be broken from ‘day dream’

Question 24

how would an atonic seizure present?

Answer 24

Atonic: drop attacks – brief lapses in muscle tone

Question 25

how would a myoclonic seizure present?

Answer 25

Myoclonic: sudden brief muscle contractions  jump suddenly. Typically within juvenile myoclonic epilepsy

Question 26

what is another name for infantile spasms?

Answer 26

west syndrome

Question 27

what are infantile spasms?

Answer 27

Infantile spasms: west syndrome – clusters of full body spasms, poor prognosis

Question 28

what are febrile convulsions?

Answer 28

Febrile convulsions: occur in children with a high fever. Only in children 6mths – 5yrs. Having this increases risk of epilepsy in future

Question 29

how is epilepsy diagnosed?

Answer 29

EEG: can show typical patterns in different forms of epilepsy Children can have one simple seizure before investigation MRI brain: investigate potential structural problems ECG, electrolytes, BM rule out Infection ?: blood cultures, urine cultures, lumbar punctures

Question 30

how is absence seizures managed?

Answer 30

sodium valproate or ethosuximide

Question 31

how is infantile spasms managed?

Answer 31

Infantile spasms: prednisolone, vigabatrin

Question 32

how are febrile seizures managed?

Answer 32

Infantile febrile: symptomatic management of fever

Question 33

what general advice is given to those with epilepsy?

Answer 33

General advice: showers rather than baths, caution with swimming, caution with heights/ traffic/ heavy + hot equipment

Question 34

what is the pathology by hayfever?

Answer 34

Allergy path: caused by when the body’s natural defences mistake a generally harmless substance (pollen/ certain food) as something harmful and this triggers immune response  imbalance of histamine

Question 35

what are common allergy triggers?

Answer 35

- Pollen - House dust - Pets - Weather: can affect pollen count

Question 36

what symptoms are seen with hayfever?

Answer 36

itchy, red, watery eyes, sneezing and coughing - Wheezing - Runny nose/ blocked nose - Tiredness - Need to spot pattern of trigger May need specialist allergen referral

Question 37

how can you manage hayfever?

Answer 37

- Petroleum jelly/ special pollen barrier blam around nostrils to trpa pollen - Washing clothes after being outside – get rid of pollen - Keeping windows/ doors shut in high pollen days - Vacuuming regularly and dusting with damp cloth - Buying pollen filter for in car air vents - Priton antihistamine liquid medicine

Question 38

what are types of priton medication?

Answer 38

chlorphenamine or cetirizine hydrochloride

Question 39

what is difference between food allergy and intolerance?

Answer 39

abnormal response of body to certain food  food intolerance does not effect immune system despite similar symptoms

Question 40

what make sup 90% of food allergies?

Answer 40

: 90% of food allergies are from these 8 foods - Milk, eggs, wheat, soy, tree nuts, peanuts, fish, shellfish

Question 41

are food allergies common in paeds?

Answer 41

- Nearly 5% of children under 5 have food allergies - Most children ‘outgrow’ allergies but peanut, tree nut, fish and shellfish remain lifelong

Question 42

what are symptoms of food allergies?

Answer 42

: hives, itching in mouth, trouble breathing, stomach pains, vomiting/ diarrhoea - Cramping, eczema, tightness of throat, wheezing, lowered BP

Question 43

how do you manage food allergies?

Answer 43

: no medication to prevent food allergy  want to avoid triggering foods - If child allergic and breastfeeding – mum should avoid those foods may need an epi-pen

Question 44

who is mainly affected by a cows milk allergy?

Answer 44

typically affecting infants and young children <3yrs - Hypersensitivity to cows milk

Question 45

what is IgE mediated cows milk allergy?

Answer 45

- IgE mediated  rapid response to cows milk, occruing within 2hrs of ingestion

Question 46

what is non-IgE cows milk mediated?

Answer 46

- Non igE mediated  slow response – over 2-3days

Question 47

how would cows milk allergy present?

Answer 47

usually <1yr when weaning from BF to formula/ food containing milk - GI symptoms: bloating and wind, abdo pain, D+V - Allergic symptoms: urticarial rash, angio-oedema, cough/ wheeze, sneezing, watery and eczema - Can cause anaphylaxis

Question 48

how would you diagnose cows milk allergy?

Answer 48

full history and examination - Skin prick testing - Avoid milk products and symptoms resolve

Question 49

how would you manage cows milk allergy?

Answer 49

- Hydrolysed formula elemental formula try and re assess every 6mths on milk ladder eg trying malted milk first and progress towards normal cows milk

Question 50

what is hydrolysed formula?

Answer 50

- Hydrolysed formula: contain cows milk but protein have been broken down so do not trigger immune response

Question 51

what is elemental formula?

Answer 51

- Elemental formula: severe cases and this is made of amino acids