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level: Childrens medicine

Questions and Answers List

level questions: Childrens medicine

QuestionAnswer
Signs children may show when illNon specific Behaviour change Poor feeding Anorexia Failure to thrive Screaming episodes fever Specific Acute stridor Wheeze Non-blanching rash Swollen face/lips
Chronically unwell children may have faltering growth due toDevelopmental delay Chronic inflammatory disease Connective tissue Bowel disease Illness Diabetes Atopic disease
Oval gray roofed vesicles on the hands feet mouth and buttocks may indicateHand foot and mouth disease
What could the following symptoms indicate Refuses to eat Maculopapular rash noted over body Characteristic enanthem osterior mouth Soft palate, uvula, tonsillar pillars Age 3-10 years old Caused by cocksackieherpangina
How is herpangina different to herpes stomatititsHerpes stomatitis is full mouth including gingivae
What disease could the following symptoms indicate 12 hours of sore throat, vomiting, headache Appearance of widespread rash Strawberry tongue Rash Usually appears fist on the enck and face Clear unaffected area around mouth Like sandpaper Tongue Thick, white coating that peels after four or five days – strawberry appearance Cause – Group A streptococcusScarlet fever give penicillin
What could the following symtoms indicate Increased weakness Admitted to ITU and died It causes URT illness, with a sore throat and a high grade fever Get a pseudo-membrane of the tonsils, pharynx and nose which leads to difficulties breathing toxin release leading to paralysis of the respiratory musclesDiptheria
what do the following symptoms indicate and what can the long term affect of this disease be 3 day history of fever, vomiting, and drowsiness. Not feeding Non-blanching rash presentmeningococcal disease
Abuse categoriesNeglect, physical, emotional and sexual abuse
What to document in suspected abuseThe sequence and timing of symptoms The evolution of features over time Possible explanations and contributing factors Inconsistencies and delays in seeking help should be noted
E.g. of some thrombolyticsThrombolytics Streptokinase tPA
Assesing bleeding riskAsk if any non prescribed drugs, assess treatment bleeding liklihood and assess whether condition is lifelong or time limited
How long does aspirin last7-10 days i.e. platelet lifespan
Clopidogrel works by? and lasts how longInhibitint ATP formation in platelets so will work until platelets die and are replaced
If dual antiplatelet therapy may have a greater increase in affectConsult haemologist before tx.
Heparin indicates that complex dental procedures should beAvoided
Heparin can be used for what type of therapybridging
How are low molecular weight heparins administeredSubcutaneously used prophy for DVT and acute chronic conditions etc..
warfarin half life3 days
When is a higher INR e.g. 3.5 okayMechanic heart valves
Adverse affects of warfarinBleeding (from anywhere!) Skin rashes Alopecia Diarrhoea, skin necrosis, jaundice Bleeding peptic ulcer Subconjunctival haemorrhage
What drugs interact with warfarinAspirin – AVOID high dose, even low doses increase bleeding risk NSAIDS – Increased risk of GI Bleed Opioids – not usually a problem ( but tramadol increases effect of warfarin) Paracetamol – not usually a problem (prolonged regular use may increase effect of warfarin)
Why do some antiobiotics affect warfarinInteract with PK enzyme
What herbal remedies can inhibit warfarinSt johns wort, (ginseng and feverfew can also affect)
What should you do when carrying out a procedure on a warfarin patientCheck INR 72 hrs before 24 if unstable and book for early in the day and week
What is thrombocytoponeiaLow platelet count
Warfarin reversalVITAMIN K 5 mg I.V (major bleed) 1-3mg I.V. (minor bleed) Fresh frozen plasma (FFP) Clotting factor replacements (dried prothrombin complex)
Common antidiabetic drugsMetformin
Dental implications of diabetesIncreased risk of infection (eg dental root abscess or post op infections) BUT infection itself can also worsen diabetic control/blood sugars Poor Healing (eg post procedure)
What do mineralcorticoids doControl BP
What do glucocorticoids doInvolved in anti inflammatory activity
Corticosteroids in dentistryTopical corticosteroid therapy used for some forms of oral ulceration E.g. Betamethasone soluble tablets (Betnesol®) dissolved in water used as mouthwash Hydrocortisone oromucosal tablets (dissolved next to affected area) used in recurrent apthous ulceration and erosive lichenoid lesions
Indication for steroid txAsthma/ COPD Inflammatory arthritis eg Rheumatoid Connective tissue disorders Immunosuppression
What could these symtoms indicate ABDOMINAL PAIN NAUSEA VOMITING CONFUSION FEVER HYPOTENSION LOSS OF CONCIOUSNESS DEHYDRATION WEAKNESS HYPOVOLAEMIC SHOCK HYPOGLYCAEMIA HYPERKALAEMIA COMA DEATHAdrenal crisis
Dosage for oral surgery when on steroidsTake usual daily dose Double dose one hour prior to surgery & continue double dose for first post-op day
In major dental proceduresManaged in secondary care Intramuscular or IV hydrocortisone pre-op Double oral dose of corticosteroids for 24 hours post op