Essential Conditions (2) Flashcards

Question

Management of non-organic FTT?

Answer 1

MDT - carried out in primary care by increasing energy intake Healthcare visitor - can assess eating behaviour and provide support Dietary advice, behavioural modification, monitoring growth Dietician, SALT, social services, nursery placement

Answer 2

Admission if <6 months requiring active refeeding - can observe and improve mother's feeding skills and demonstrate that child will gain weight when fed appropriately. If it continues despite dietary input - investigations for organic cause

Answer 3

INADEQUATE INTAKE ``` Non-organic = inadequate availability of food, psychosocial deprivaiton, neglect or child abuse Organic = impaired suck/swallow, chronic illness --> anorexia ``` OTHERS ``` Inadequate retetnion (vomiting, severe GORD) Malabsorption (coeliac, CF, CM intolerance) Failure to utilise nutrients Increased requirements (thyroid, CF, malignancy, infection, CHD) ```

Answer 4

Can cause renal scarring --> HTN

Answer 5

``` Constipation Female gender VUR CAKUT (posterior urethral valves, boys only) Previous UTIs Encopresis Nephrolithiasis Uncircumcised boys ```

Answer 6

E.coli = most common Klebsiella, proteus, pseudomonas, strep faecalis

Answer 7

Clean catch MSU Catheter (transurethral or suprapubic) Urine bag

Answer 8

2 or more upper 1 upper and 1 lower 3 lower

Answer 9

``` Seriously ill Poor urine flow Raised creatinine Septicaemia Non-E.coli Failure to respond in 48 hrs ```

Answer 10

<6 months - USS in 6 weeks (during infection if atypical), DMSA/MCUG if atypical/recurrent 6m - 3y - USS in 6 weeks if recurrent, DMSA 4-6 months if atypical/recurrent 3y + - USS in 6 wks if recurrent, DMSA in 4-6 months if recurrent

Answer 11

* High fluid intake * Regular voiding – ensure complete bladder emptying and encourage child to try second empty * Perineal hygiene * Prevent/treat constipation

Answer 12

Oral = trimethoprim, cephalexin, co-amoxiclav IV = cefuroxime, gentamicin Repeat urine culture on completion of abx. <3 months = Admit to hospital. IV abx until temperature settled then oral abx. >3 months upper = Oral abx for 7-10 days OR IV abx for 2-4 days then oral Abx for total treatment duration 10 days (i.e. 6 days oral) >3 months lower = Oral abx for 3 days. If still unwell after 24-48 hours --> reassess.

Answer 13

Affects the face, neck, behind ears, scalp (cradle cap) and extensor surfaces. Nappy area mostly spared. Majority of cases clear within a few months but may progress.

Answer 14

Mostly flexor surfaces – antecubital and popliteal fossae, volar aspect of wrists, neck and ankles. Less weepy and wet than infantile eczema but there is marked lichenification.

Answer 15

Bacterial • Golden crust and sometimes postulation (impetiginized eczema) • Mild cases can be treated with antiseptic washes and topical antibacterial ointments. Oral abx and topical steroids for widespread infections. Viral • Chickenpox can be widespread and severe. Molluscum contagiousum more common. • Eczema herpeticum = serious HSV complication. Monomorphic clusters of vesciles that erode and crust. Systemic acyclovir and same day dermatology referral.

Answer 16

Avoid irritants like soap and biological detergents. Clothing next to skin should be pure cotton where possible – avoid nylon and pure woollen garments. Cut nails short to reduce damage from scratching. Mittens at night in the very young If specific allergen such as cow’s milk proven to be a precipitant --> avoid. Can use antihistamines to stop itching

Answer 17

EMOLIENTS Mainstay of treatment – apply liberally two or more times a day and after a bath. Can also use emollient oil as a soap substitute in bath - apply in direction of hair. STEROIDS Use with care – explain that benefits outweigh risks when used correctly. Prescribe lowest effective strength. Apply thinly and use on the face should be avoided – excessive use can cause skin thinning and systemic side effects – should not deter from their use in exacerbations though.

Answer 18

``` Mild = 1% hydrocortisone Moderate = 2.5% hydrocortisone Strong = Betnovate/dermovate ```

Answer 19

Staph aureus Streptococci in neonates Haematogenous spread Direct innoculation from wound Direct invasion from adjacent focus of infection (osteomyelitis)

Answer 20

Warm, erythematous, swollen and acutely tender joint Severely restricted joint movement (pseudoparalysis) Joint effusion Inability to weight bear – if hip involvement, leg is held flexed and abducted. 75% lower limb – Hip > knee > ankle <10% will have more than one joint affected Systemic features = Fever, rigors, tachycardia

Answer 21

BLOODS FBC - ↑WCC CRP/ESR – both elevated Blood cultures – take before abx commenced IMAGING X-ray USS - effusion and can guide aspiration ASPIRATION Carried out under aseptic conditions by orthopaedic surgeon with US guidance  can culture organisms  guides Abx therapy.

Answer 22

IV ABX Start after joint aspirate and blood cultures taken – splint joint and start empirical broad-spectrum IV abx. • Flucloxacillin – 3 weeks – until inflammatory markers normalise. • Followed by oral abx for 4-6 weeks – tailor according to culture results. SURGICAL Irritgation/drainage/debridement – if resolution does not occur rapidly.

Answer 23

Prognosis is good with prompt recognition and treatment. <10% recurrence and develop chronic infection. Hip joint has worst prognosis. * Joint stiffness – secondary to cartilage damage * Septic dislocation – secondary to damage to the joint capsule and bone * Osteonecrosis – secondary to ischaemia * Shortening of limb – secondary to dislocation and osteonecrosis * Secondary osteoarthritis – secondary to damage to joint capsule

Answer 24

``` Foetal Structural abnormalities (e.g. cerebral malformation), maternal hypothyroidism, chorioamnionitis. ``` Neonatal Premature delivery, birth hypoxia, congenital infections. Intraventricular haemorrhage, hyperbilirubinemia, hypoglycaemia, cerebral infarcts, meconium aspiration syndrome. Infant Hydrocephalus, hypoglycaemia, head injury secondary to non-accidental injury, CNS infection ``` Child Hypoxic events (e.g. drowning), head trauma, lead poisoning, CNS infections ```

Answer 25

UMN lesion --> nerve receptors in spine don't respond to GABA (inhibitory) properly --> hypertonia Velocity dependent --> weakness, increased tone, brisk reflexes, clonus, bulbar palsy (dysphagia/dribbling)

Answer 26

Spastic hemiplegia Spastic diplegia Spastic quadriplegia

Answer 27

Arm and leg on one side, arms affected more, sparing of face. Spasticity greatest in antigravity muscles. Affected Arm = flexed, pronated, fisting of hand. Affected leg = circumduction gait, toe-heel (tip toe) gait. Delayed walking. May have growth arrest in extremities. Moderate incidence of seizure disorders and intellectual impairment.

Answer 28

Common in ex-prems (intra-ventricular haemorrhage) Lower limbs (some involvement of ULs). ‘Paraplegia’ if no involvement of ULs. ``` Commando crawl (dragging legs) Scissoring of lower legs Severely delayed walking Toe-heel gait with feet held in equinovarus position. Legs severely underdeveloped compared to arms. ``` Disuse atrophy, impaired growth of lower extremities. Usually have normal intellectual development. Other learning difficulties and deficits in other neuro pathways (e.g. hearing). Minimal risk of seizures.

Answer 29

All four limbs As for the others, but in all four limbs. Increased tone throughout, decreased spontaneous movements - worse on running ``` Swallowing difficulties (bulbar palsy). Weak suck. Tongue thrust. High incidence of seizure disorders, significant intellectual impairment, associated developmental abnormalities (speech, vision) ```

Answer 30

* Movements are involuntary and uncontrolled. Become more evident with active movement or stress. * Infants = initially hypotonic with poor head control. But show increased tone and dyskinetic movements as they develop. * Oropharyngeal muscles are affected  speech and feeding problems. * Seizures uncommon, intellect usually preserved.

Answer 31

DAC DYSTONIA Involuntary, sustained contractions of opposing muscle groups. Leads to abnormal posture, twisting movements and repetitive movements. ATHEOSIS Slow, involuntary writhing movements – distal (fingers) CHOREA Brief, irregular, non-repetitive/rhythmic movements. Appear to flow smoothly, giving the appearance of dance-like movements.

Answer 32

Rare and poorly understood ``` Lack of voluntary co-ordinated movements of muscle. o Usually symmetrical o Hypotonia o Poor balance o Delayed motor development ``` Later signs o Intention tremor o Ataxic gait (staggering and broad-based) o Poor co-ordination (dysdiadochokinesia, past-pointing)

Answer 33

Abnormal limb and/or trunk posture Delayed motor milestones o May be accompanied by delayed head growth o Primitive reflexes may persist Feeding difficulties o Slow feeding, gagging, vomiting Abnormal gait o Once walking is achieved (usually 12-18 months) Asymmetric hand function o Before 12 years of age

Answer 34

Nutrition At risk of malnutrition and faltering growth. May need NG or PEG feeding. SALT Promote use of language and improve swallowing. Occupational Therapy/Physio Promote mobility and physical activity for normal daily living. Adaptive and Communicative Equipment Walkers, poles, frames, braces, splints, wheelchairs/special seats are useful aids. Education May need special needs education. Vocational training can help prepare adults for jobs. Psychologist/Counsellor Address emotional needs of child/family.

Answer 35

Anti-Muscarinics Prevent drooling. Glycopyrronium bromide, hyoscine patches, botulinum injection into salivary gland. Anti-Reflux Medication Reflux a common feature – domperidone, ranitidine. Bisphosphonates Prevent osteoporosis – pamidronate. Anti-spasmodics Help relieve spasticity – benzos, baclofen (intrathecal), dantrolene, botulinum toxin. Reserpine Vesicular monoamine transporter (VMAT) blocker – good for hyperkinetic movements.

Answer 36

Majority = trisomy 21 due to non-disjunction during maternal oogenesis. 2% are Robertsonian translocation 2% are mosaic with normal cell line and trisomy 21 line.

Answer 37

Most common autosomal trisomy. Most common genetic cause of severe learning disabilities. 1 in 1000 live births. 1 in 110 at maternal age 45.

Answer 38

``` ROSEOLA • Round face • Occiput flattening • Speckled iris (brushfield spots) Epicanthic folds • Open mouth with protruding tongue • Low set ears • Almond (oval) upward slanting eyes ```

Answer 39

Hands • Single palmar crease • Short fingers • Clinodactyly (Curved little finger) Feet • Sandal gap between big toe and other digit

Answer 40

CARDIAC • ASD/VSD/Complete AVSD • Mitral/tricuspid regurgitation Leads to Eisenmenger's syndrome GI • Duodenal atresia • Anal atresia • Hirchsprung’s disease ``` OTHERS • Hypothyroidism • Eczema • Leukaemia (1%) • Developmental hip dysplasia • Deafness (sensorineural and conductive) • Alzheimer’s by 5th decade • Infection • Psychological – anxiety etc ```

Answer 41

``` SCREENING Cardiac - Echo Hip US – Developmental hip dysplasia Audiology – deafness TFTs – acquired hypothyroidism In adulthood, annual health screening in primary care. “Personal health action plan” to address any health needs identified. ``` GENETIC COUNSELLING Parents - only needed if Robertsonian translocation is the cause and are thinking of another baby. MDT Developmental paediatrician, child development centre, physiotherapy, dieticians, occupational therapists, SALT. Almost all educated in mainstream schools with appropriate educational support.

Answer 42

Huge variability. Some lead active, semi-independent lives (education, employment). Life expectancy better now – most live to be over 60. Many will develop Alzheimer’s by 40.

Answer 43

Concomitant (Non-paralytic) • Common • Usually due to refractive error in one or both eyes. • Can be treated with glasses but may require surgery. • Squinting eye most often turns inwards (convergent) but there can be outwards (divergent), or rarely vertical deviation. Non-Concomitant (Paralytic) • Rare • Usually due to paralysis of cranial nerves (III, IV, VI) • Squint varies with gaze direction due to muscle paralysis • Can be sinister as possibility of underlying brain tumour

Answer 44

Convergent (esotropia) = bad eye turns inwards (COMMON) Divergent (exotropia) = bad eye turns outwards Latent = squint controlled by subconscious effort and is not always apparent. In situations such as fatigue, the control is lost and the squint will manifest. Only appears when fixation interrupted (cover test. Pseudosquint = arises when epicanthic folds give the appearance of a squint which is excluded on testing.

Answer 45

Pen torch held at distance to produce reflections on both corneas simultaneously. Light reflection should appear in same position on both pupils – if not, they are misaligned.

Answer 46

Ask child to fix on object 1 metre away. Cover each eye and look for movement of uncovered eye. If manifest... May correct and fix on object being focused on (NON-PARALYTIC) May stay in same position (paralytic) If latent... Can only identify by looking through a semi-transparent ‘cover’ or by quickly removing the cover and looking for correction of the eye.

Answer 47

``` Aim to get weaker eye ‘trained up’ • Correct refractive error – glasses o Hypermetropia = long-sighted – most common refractive error o Myopia = short sighted, common • Eye patch on good eye • Eye muscle exercises • Eye (muscle) surgery if large squint. ```

Answer 48

AMBLYOPIA Signal from bad eye depressed to avoid double vision. Constant depression --> failure of visual development

Essential Conditions (2) Flashcards

(72 cards)