Handbook section 2b Flashcards
Common childhood rashes, Measles
Organism: Measles virus
Rashes: starts from head, spreading downwards
Other symptoms: flu-like symptoms, koplik spots
Treatment: Supportive
Common childhood rashes, Scarlet Fever
Organism: Group A streptococcus
Rashes: Fine papules, rashes at creases
Other symptoms: strawberry tongue, lymphadenopathy, flu like symptoms
Treatment: antibiotic
Common childhood rashes, Fifth disease
Organism: Human parvovirus b19
Rashes: slapped cheek rashes, pruritc lacy rashes avoiding palms and soles
Other symptoms: flu like symptoms
Treatment: supportive
Common childhood rashes, roseola
Organism: Human herpesvirus 6
Rashes: tiny papules on trunk then spreading outward
Other symptoms: high fever prior to rash, flu like symptoms
Infectious mononucleosis(mono)
usually affects teenagers and young adults
Organism: Epstein-Barr virus
Rash: fine pink rash
Other symptoms: spleen enlargment, swollen and painful liver, sore throat
Treatment: supportive, avoid contact sports
Hypertensive disorders during pregnancy
- chronic hypertension: hypertension before 20 weeks pregnancy, without a known cause.
- gestational hypertension: new onset hypertension after 20 weeks pregnancy without any features of pre-eclampsia, followed by return to normal within 3 months after the birth
- pre-eclampsia: gestational hypertension and involvement of other organ systems and/or the fetus. Proteinuria is a common additional feature
- superimposed pre-eclampsia: pre-eclampsia with chronic hypertension
Types of bilirubin
indirect/unconjugated - blood
direct/conjugated - liver
urobilinogen - reabsorbed from the intestine
Early (<40) vs Late (>40) onset schizophrenia
LOS
- worse for affective flattening and social withdrawal
- worse for systematic delusion and hallucinations
- worse for medication side effect
EOS
- worse for negative symptoms
- worse disorganized thoughts
Preseptal (periorbital) cellulitis, definition
Preseptal cellulitis is infection of the skin and subcutaneous tissues anterior to the orbital septum.
Postseptal (Orbital) cellulitis, definition
Orbital cellulitis (or ‘postseptal cellulitis’) is infection of the soft tissues posterior to the orbital septum, and poses risk of vision and life- threatening complications.
Preseptal (periorbital) and postseptal(orbital) cellulitis, back ground and red flags
BACKGROUND
- higher frequency in children
- Often occurs with sinusitis and URTI
• Pathogens: Gram positive cocci (Staphylococcus and Streptococcus species),
Haemophilus species, anaerobes
RED FLAGS
- Urgent surgical intervention may be required in cases of orbital cellulitis with sinusitis, subperiosteal abscess, intraorbital abscess, or foreign body
- Intracranial infection should be suspected with headache, nausea and vomiting, neurologic findings
- Children <4 years of age have an incomplete orbital septum and are at risk of infection from the preseptal to orbital space.
- Children who are systemically unwell
Preseptal (periorbital) cellulitis, causes
- trauma
- chalazion (oil gland)
- dacryocystitis (tear duct)
- URTI
- conjunctivitis
- endogenous seeding
Postseptal (orbital) cellulitis, causes
- sinusitis (ethmoid)
- preseptal( periorbital) cellulitis
- trauma
- dacryocystitis, dacryoadenitis
- dental infection
- facial infection
- endogenous seeding
Preseptal (periorbital) cellulitis, signs and symptoms
- systemically well
- possible fever
- inflamed, possible fluctuance in eyelid
- normal eye (function, movement, conjunctiva)
Postseptal (Orbital) cellulitis, signs and symptoms
- possibly systemically unwell
- often febrile
- inflamed and swollen eyelids
- inflamed eye
- change in vision and eye movements
Preseptal (periorbital) and Postseptal (orbital), investigations
GENERAL
- discharge swab for microscopy, culture and PCR
PRESEPTAL (PERIORBITAL) CELLULITIS
- investigations are usually not necessary
POSTSEPTAL (ORBITAL) CELLULITIS
- blood tests (FBE, UEC, LFT, CRP)
- blood cultures (if systematically unwell)
- CT scan with contrast (orbits, paranasal sinuses and brain)
Preseptal (Periorbital cellulitis), treatment
ADULTS
- Fluocloxacillin
- Penicillin hypersensitive (Cephalexin)
- Penicillin immediate hypersensitivity (Clindamycin)
CHILDREN
- Fluocloxacillin
- Penicillin hypersensitive (Cephalexin)
- Penicillin immediate hypersensitivity (Clindamycin)
Hib INFECTED CHILDREN
- amoxicillin- clavulanate
- Penicillin hypersensitive (Cefuroxime)
- Penicillin immediate hypersensitive (refer)
Postseptal (orbital) cellulitis, treatment
ADMISSION
- under OPAL/ENT team
- possible surgery
ANTIBIOTICS
- Adults (Ceftriaxone, Flucloxacillin)
Adult community acquired pneumonia, severity assessment
CORB
- confusion
- oxygenation
- respiratory rate
- blood pressure
Adult community acquired pneumonia, treatment
MILD (NO CORB)
- amoxicillin
- penicillin allergy (clarithromycin)
MODERATE (1 CORB / ADMITTED)
- benzylpenicillin + doxycyclin/clarithromycin
- penicillin allergy (ceftriaxone + doxycycline/clarithromycin)
SEVERE (2 CORB / ICU / HDU)
- benzylpenicillin + azithromycin + gentamicin
- penicillin allergy (ceftriaxone + azithromycin)
CORB
confusion
O2 sat <90%, pO2 <60mm
RR > 30
BP sys < 90, dias <60
Urethral injury, presentation
- blood at the urethral meatus
- gross hematuria
- inability to void
- absent/abnormal prostate position via DRE
- Ecchymosis/hematoma involving penis, scrotum or perineum
Urethral injury, investigation
- one gentle attempt at urethral catheterization is reasonable
- retrograde urethrogram (contraindicated for pelvic vascular injury as it may interfere with angiogram or CTA)
Type of scientific studies
Randomized controlled trials - the effect of the treatment is often compared with “no treatment” (or a different treatment)
Cohort studies - Two (or more) groups are exposed to different things and are compared with each other over a period of many years
Case-control studies - A generally retrospective comparison of people who have a certain medical condition with people who do not have the medical condition. The two groups are interviewed, or their medical files are analyzed, to find anything that might be risk factors for the disease.
Cross - sectional studies - The classic type is the survey: A representative group of people are interviewed or examined in order to find out their opinions or facts.
Qualitative studies - Information collected by talking to people who have a particular medical condition and people close to them. Written documents and observations are used too.
Common causes of GI Obstruction in children, Necrotizing Enterocolitis
NECROTIZING ENTEROCOLITIS (inflamed intestine)
Population - newborn
Presentation - abdominal distension, bilous vomiting, bloody stool
Treatment - NPO, NG tube, Antibiotics, Surgery referral
Common causes of GI Obstruction in children, Midgut volvulus
MIDGUT VOLVULUS (twisted intestine)
Population - Newborn
Presentation - abdominal distension, bilous vomiting, bloody stool
Treatment - NPO, NG tube, Antibiotics, Surgery Referral
Common causes of GI Obstruction in children, Pyloric stenosis
PYLORIC STENOSIS (semiblocked stomach)
Population - 0-6months
Presentation - projectile vomiting, olive mass RUQ
Treatment - Electrolyte correction, surgery consult
Common causes of GI Obstruction in children, Intussusception
INTUSSUSCEPTION (folded telescope intestine)
Population - 2m - 6 yrs
Presentation - bilous vomiting, bloody stool, sausage mass RUQ
Treatment - Air enema, surgery consult
Liver function test, interpretation
Direct (Conjugated) Bilirubin - Liver bilirubin
Indirect (Unconjugated) Bilirubin - Blood bilirubin
ALT - Liver cell injury
AST - Nonspecific, Alcohol (greater than ALT)
ALP - bone, intestine, liver, placenta
GGT - Hepatobiliary source
Hepatitis B Panel result
HBsAg - active infection
Anti-HBc - any exposure to Hep B virus (except immunization)
Anti-HBs - Immune
IgM anti-HBc - Acute infection
Congenital varicella, presentation
- History of maternal exposure
Incubation - 14-15 days
Infectious - 2 days before rash starts to 5 days after rash starts - skin scarring
- neurologic defects
- eye disease
- skeletal anomalies
Live vaccine contraindication
- pregnancy
- immunodeficiency
- clinical AIDS
- high dose corticosteroids
- previous anaphylaxis to any component
- recent treatment with IgG (within 3 months)
Prophylaxis and treatment options for varicella, pregnant women
PREGNANT WOMAN
- test for antibodies
- seronegative (give ZIG)
- seropositive (reassure)
- with symptoms (oral aciclovir)
Prophylaxis and treatment options for varicella, children
NEONATES (Exposed 7 days prior to delivery to within 1st month of life)
- mother has confirmed varicella (ZIG)
- uncertain maternal history/seronegative (test then if seronegative, ZIG)
- with symptoms (IV aciclovir)
PREMATURE INFANTS <28 WKS, <1KG
- ZIG
- with symptoms (IV aciclovir)
Prophylaxis and treatment options for varicella, adults
IMMUNOCOMPROMISED ADULTS
- test then if seronegative, ZIG
- with symptoms (IV aciclovir)
HEALTHCARE WORKERS
- uncertain immunity/history (test then if seronegative, Vaccine)
- if seropositive (reassign away from clinical duties if rash develops)
Early pregnancy loss, initial interventions
- resuscitate (as needed)
- speculum exam (remove any POC)
- Labs: B hCG, USS, FBC, Blood group
- as needed labs per case
Early pregnancy loss, definitive management for stable intrauterine pregnancy
EXPECTANT
INDICATIONS - patient’s choice, incomplete miscarriage
CONTRAINDICATIONS - patient instability, GTD, IUD (must remove), infection, bleeding risk
REQUIRES - 24/7 emergency contact hospital
ONGOING MANAGEMENT
- initial history and examination
- follow up after 7-10 days
repeat B - hCG (day 8)
USS (optional for possible POC retention and GTD)