351

UCL MBBS (Fach) / Clinical conditions (Lektion)

Diese Lektion wurde von eckhard erstellt.

Lektion lernen

Diese Lektion ist leider nicht zum lernen freigegeben.

zurück  |  weiter 6 / 8

• z Cushing's syndrome Definition: Phaenotype associated with ↑circulating cortisolCauses: 1ary: adrenal adeoma / hyperplasia 2ary: pituitary adenoma (Cuhsing's disease), iatrogenic, ectopic ACTH production (e.g. SSLC) Symptoms: Osteoporosis, diabetes, hypertension, cataracts, bleeding, infections, thin skin, striae, moon face, truncal obesity; ±visual field defectsSigns: ↑BP, characteristic habitusInvestigations: Bloods (24h cortisol, ACTH+cortisol, dexamethason (8mg) suppression) Imaging: Adrenal, pituitary CT/MR Management: Treat complications: Diabetes, osteoporosis (>7.mg pred), infections Diet, exercise, withhold drugs Surgery →Addisson's, aldosteronism
• PBC Definition: Primary Billiary Cirrhosis; granulomatous autoimmune cause for liver cirrhosis (AMA positive)Presentation: asymptomatic / coincidental; or obstructive jaundiceInvestigations: LFT, clotting, antibodies; USS; liver biopsyManagement: Medical: Colestyramine, ursodeoxycholic acid; vitamins (A,D,E,K) Surgical: Liver transplant Prognosis: 2 years from onset of jaundice →PSC, AIH, IBD
• PSC Definition: Primary Sclerosing Cholangitis; associated with Ulcerative Colitis (↑ risk of colon ca) Signs / symptoms: Obstructive (pruritus, abdo pain etc) → liver cirrhosis → hepatc failure Investigations: Bloods: LFTs, FBC, UnE; SMA positive; CA19-9 Imaging: ERCP (small vs large ducts) Management: Symptomatic: Colestyramine, ursodeoxycholic acid Surgical: liver transplant → Primary billiary cirrhosis, autoimmune hepatitis; ulcerative colitis/ Crohn's
• Portal hypertension Definitiion: Increased blood pressure in hepatic portal veinCauses: Pre-hepatic: portal / splenic vein trombosis Intra-hepatic: liver cirrhosis Post-hepatic: CCF, Budd-Chiari syndrome Signs / symptoms: caput medusae, ascites, variceal bleedingInvestigations: LFT, USSManagement: Transhepatic stent; OGD + propranolol to prevent variceal bleeding → liver cirrhosis / failure
• Oesophageal varices Prevention of bleeding: with propranololAcute Management DR ABCDE Vasopression endoscopy + banding → portal hypertension, liver cirrhosis
• Wilson's disease Copper storage disorder, aka hepatolenticular degeneration; autosomal recessive, Kayser-Fleischer rings →haemochromatosis
• Haemochromatosis Definition: iron overloadCauses: 1°: Genetic; 2°: haemolysis, dietary iron, excessive blood transfusion Signs / symptoms: Diabetes, liver cirrhosis, cardiomyopathy, testicular failure Investigations: serum ferritin, TIBC, liver biopsy → Wilson's disease
• Crohn's disease Definition: Inflammatory bowel diseaseFacts: Mouth-to-anus, granulomatous, cobble-stone appearance, skip-lesions, Kantor's string sign, inflammation mucoso-serosa, young onset; worsened by smokingSymptoms: Primary: Mucous / bloody diarrhoea, weight loss, abdominal pain Extra-enteric: skin (EN, pyoderma),  enteropathic arthritis, eyes Investigations: Bloods (FBC, CPR, U&E, LFT), stool calprotectin, AXR if risk of obstruction, colonoscopyManagement: Maintenance: Nothing or Azathioprine, sulfasalazine Acutely: Mild → oral pred 30mg for 1w, then 20mg for 1m, then wean off. Severe: Admit, reydrate, IV hydrocrotisone 100 mg/6h IV Perforation / abscess → metronidazole ± cefuroxime ± infliximab ± surgery ± seton Surgery: hemi-/colectomy + stoma → Ulcerative colitis, irritable bowel syndrome
• Ulcerative Colitis Definition: Inflammatory bowel disease (IBS)Facts: p-ANCA and →PSC associated, bimodal onset 15-25 & 55-65, rectum → caecum, pseudopolyps, drainpipe colon, colon Ca, bloody diarrhoea, no inflammation beyond mucosa, crytpt abscesses, HLA B27 assoc, overlap with PSC etc., improved by smokingSymptoms: Abdominal pain, bloody diarrhoea, systemic unwellInvestigations: Bloods (FBC, CPR, ESR, U&E, FBC), CXR, AXR if risk of obstruction, colonoscopyManagement: Maintenance: mesalazine, azathioprine Acutely: Mild (<4 motions/d): steroids (oral pred 20-40mg or 20mg retention enemas or hydrocortisone foam) + mesalazine; max 2wks moderate (4-6 motions/d): higher dose steroids + ASA; max 2 wks Severe (>6 motions + unwell): admit, NBM, IV hydration, IV+rectal hydrocortisone 100mg/6h → [>6 motions / CRP > 45 on d3] → ciclosporin OR infliximab (48h) → colectomy →Crohn's disease, →IBS, →infectious colitis, →PMC, →coeliac disease
• Hepatic encephalopathy Definition: Brain failure (confusion, altered level of consciousness, coma) due to reduced detox capacity of injured liver; Grade 1 (lack of awareness) -4 (coma); Type A-C Use: Child-Pugh score; King's college score for liver transplant
• Anzeige
• Liver failure Definition: Hepatic insufficiency; synthetic & metabolic; chronic (→cirrhosis) vs acute (rapid, fulminant, hyper-/subacute,etc) Causes: Paracetamol overdose Hepatotoxic drugs (Tetracycline, pioglitazone) HELLP syndrome Hepatitis -- viral (A,B), alcohol Idiopathic Metabolic -- Wilson's Signs: Hepatomegaly, hypoalbuminaemia (ascites, oedema), coagulopathy (bruising), encephalopathy, renal failure Management: ICU; King's College Score for transplant (prothrombin time>100s, pH<7.3, encephelopathy, creatinine>300mcmol/l)
• Preterm birth Definition: birth before 38/40 gestations; liability limit at 24/40Epidemiology: (incl risk factors)Symptoms: dyspnoea, not feeding, hypothermia, HIE, cardiacSigns: Investigations: blood gas, MRI brainTreatment: intubation+ventilation, NG feed, hypothermiaPrognosis: may have long term effects, ↑mortality, morbidity, learning disabity etc
• Birth asphyxia Definition: condition resulting from oxygen deprivation during birth Signs: Cyanosis, hypotonia, poor resp effort ⇒ low APGAR score Hypoxic Ischaemic Encephelopathy Investigation: pulsomoetry, ABG Tx: hypothermia Other organs may be affected
• Neonatal jaundice Definition: increased bilirubin > 50; pathological < 24h, > 14d Causes:  physiological: ↓UGT activity, ↓RBC life span pathological: ABO, Rh incompatibility; G6PD deficiency, sphero-/elliptocytosis; sepsis; breast milk jaundice Signs: lethargy, deafness, kernicterus (episthtotonus, bilirubin deposition in basal ganglia) Treatment: Phototherapy, exchange transfusion
• Breast feeding Unlikely to be tested in finals Encouraged up to 6 months, then start bottle and solids Better immunity? Beware mastitis and breast abscess; only stop if severely cracked; can express and bottle feed
• Neonatal screening Baby check! Hearing Guthrie heel prick @5d: sickle cell, CF, hypothyroidism, metabolic (PKU, MCADD, MSUD, IVA, GA1, HCU) 6-8 week check
• Neonatal sepsis Always consider; common in prematurity; caused by GBS Treat (e.g. benpen + amikacin) if risk factors, e.g. PROM, positive GBS screen, meconium stained liquor etc
• Innocent murmurs in children Soft, systolic, position-dependent, due to flow
• Asthma in children Definition: Chronic intermittent airway obstruction due to inflammation, relieved by β-agonists; atopic triad: asthma, hayfever, eczema, food allergyEpidemiology: No diagnosis before 5 years, DDx viral induzed wheezeSymptoms: SoB with diurnal variation (worse in cold, after exercise), night cough, atopySigns: Wheeze, reduced PEFInvestigations: lung function tests Treatment: Acute: "burst therapy" - O2 + salbutamol 2.5mg + ipratropium bromide 200mcg NEB + pred 1-2mg/kg (max 40mg) PO / hydrocortisone 4mg/kg (max 100mg) IV + IV salbutamol / aminophylline / magnesium sulphate + 3-5 day course of steroids Chronic: occasional reliever (SABA e.g. salbutamol) regular preventor (e.g. steroid OR leukotriene antagonist) <2y refer to resp paed; 2-5y add steroid OR leutriene antagonist; 5-18y LABA <5y refer; 5-18y oral steroid 5-18y refer to resp paed Review: Night cough, exercise intolerance, use of reliever
• URTI in children Viral cold (snuffles) Croup Strep throat Epiglottitis Tonsilitis
• Tonsilitis Definition: Inflammation of pharyngeal tonsils, often group A strep infectionSymptoms: Dysphagia, trismus, fever; missing schoolSigns: swollen tonsils, touching in midline; exudateInvestigation: Throat swab → MCSTreatment: ABx, e.g. phenoxymethylpenicillin (pen V); tonsillectomy if recurrent (→ warn about bleeding risk)
• Otitis media Definition: Inflammation of the middle ear; common organisms s. pneumoniae, HiB, mycoplasma; maybe acute / chronic, suppurativeEpidemiology: Common in children; RF adenoidsSymptoms: Ear ache, discharge with pain relief (perforated TM), fever; URTI prodromeSigns: Discharge, red, bulging, perforated TM on otoscopy (if tolerated)Investigations: Swab and culture any dischargeTreatment: ABx, e.g. co-amoxiclav, clarythromycin; +/- grommetsPrognosis: Excellent; complications: mastoiditis, chronic/recurrent infection ⇒ cholesteatoma
• Croup Definition: Viral upper airway infection; caused by parainfluenza A/BEpidemiology: young children < 4years; subacute onsetSymptoms: Cough, fever, cryingSigns: Stridor, barking coughInvestigations: noneTreatment: Steroids - oral dexamethasone / inhaled beclamethasone; inhaled adrenalinePrognosis: excellent; cough may last 3 weeks
• Epiglottitis Definition: Inflammation of the epiglottis, often caused by H. influenzae B + other serotypes Epidemiology: Older children 4-6year; now rare, after HiB immunisation Symptoms: Acute onset shortness of breath, fever, inability to swallow, pain Signs: Stridor, tripod position, drooling Management: EMERGENCY → DR ABCDE Oxygen and nebulised adrenaline, if tolerated; no examination Get paediatrician, senior anaesthesist, ENT surgeon for intubation & ventilation Crycothyroidotomoy Antibiotics
• LRTI in children see → pneumonia, → bronchiolitis
• Bronchiolitis Definition: Inflammation / thickening of bronchioles; LRTI; often due to RSV, adeno, human metapneumo, parainfluenza etc.Epidemiology: Most common in first year of life, esp. in winterSigns & symptoms: respiratory distress, not feeding, cough, irritiable → lethargicInvestigations: non, clinical diagnosisTreatment: supportive = oxygen, NG / IV nutrition; discharge when ready to feedPrognosis: excellent
• Pneumonia in children Definition: Infection of the lung alveoliSymptoms: Fever, cough, off feeds, chest/abdominal pain, reduced urine output, irritable / lethargicSigns: Respiratory distress, dull on percussion, bronchial breathing, increased fremitus; ?shockedInvestigations: CXR, ABG, blood cultures, FBC, CRP, sputum cultures for MCSTreatment: Resuscitate (fluid and oxygen), antibiotics
• Cerebral palsy Definition: Non-progressive motor CNS lesion Clasification: severity: mild - moderate - severe - no CP type: spastic vs ataxic vs dyskinetic (dystonic, athetoid) affected limbs: mono-, di-, hemi-, paraplegia Epidemiology: due to hypoxic brain injury; more common in premature babiesSigns: may be subtle; hypertonia, asymmetryInvestigation: observational scoring by physiotherapistManagement: multi-discplinary; early physiotherapyPrognosis: poor
• Epilepsy in children Types - JME, absence etc Distinguish from febrile convulsions Drugs: Valproate, ethosuximide, lamotrigine etc
• Febrile seizures Definition: Convulsion in a febrile child without CNS pathology; becomes unconscious and stiffEpidemiology: 6m-6y; prevalence 1:30; runs in familiesSigns: fever, stiffness, shaking, typical: symmetrical, <5min, quick recoveryInvestigations: good Hx, septic screen, may do lactate and EEG Treatment:  acute admit and observe future: calpol and light layer of clothes for fever; don't panic +/- midazolam for seizures Prognosis: good; 1:3 have another one; 1:100 develop epilepsy
• Anzeige
• Meningitis in children As per adults: SEPSIS 6 Atyipcal presentations: irritability / lethargy, not using limb, high fever Atypical organisms: Listeria (→ampicillin), mycoplasma (→erythromycin)
• Migraines and tension headaches in children Beware focal neurology, increased intracranial pressure, orbital cellulitis
• Selfharm in children Good history, including HEADSSS Suicide risk Social situation
• Behavioural problems in children ADHD - hyperkinetic disorder triade inattention, hyperactivity, impulsivity pervasive home&school, not learned to observe and process clues (car @ 100mph) treatment: psychoeducation → parenting class (clear borders) → stimulant drugs (methylphenidate, atomoxetine) comorbidities: autism, ticks, epilepsy etc  Autism deficits in social interaction / communication, spech & language, narrow interests / repetitive behaviours spectrum (Asperger's language ok), pervasive home & school, onset before 3y M:F = 3:1 MDT approach Conduct disorder Theft, truancy, damaging property etc
• Cow's milk intolerance Definition: Intolerance to cow's milk proteinSymptoms: Vomiting, diarrhoea, rashes, weight loss when introduced to cow's milk; may be delayedInvestigations: IgE test, check for other allergies (soy, egg, nuts, shell fish)Treatment: Change formula, avoid and slowly reintroduce cow's milkPrognosis: excellent, many grow out of it
• Food allergy Allergens: Cow's milk protein, soy milk, eggs, nuts (pea, tree, sesame), shellfishRx: Rash, anaphylaxis, hypotensive; immediate (IgE) or delayedAssociations: Asthma, hayfever, eczema; family historyInvestigations: Skin prick, specific IgE, food challengeTreatment: allergy plan: avoidance, antihistamines, EpiPen
• Rhinitis / hayfever Definition: IgE mediated allergy to pollen Symptoms: seasonal watery eyes, sneezing, blocked nose Signs: serous conjunctivitis Investigations: skin prick test, family hx, atopy screen (eczema, asthma, food allergy [e.g. apple in pollen-fruit syndrome]) Tx: avoidance, antihistamines, e.g. ceterizine
• Viral exanthems Common signs of viral infections; often blanching Specific rashes: Measles Rubella Chickenpox Meningococcal septicaemia
• Measles Definition: Childhood infection caused by measles virus; highly infectious, incubation period 10dEpidemiology: most common in 1-4years oldSymptoms: fever, cough, cold, light sensitivity, conjunctivitis, rash staring behind the ear spreading on backSigns: Maculopapular rash on back, Koplik spots on buccal mucosa (two days before rash) Investigations: None or saliva for viral PCRTreatment: MMR vaccine at 12-13months + 3-5 years; supportivePrognosis: excellent; mortality 1:5000 from complications, e.g. pneumonia, encephalitis
• Herpes infections HSV 1 vs HSV 2 Cold sores, genital lesions, encephalitis, eczema herpetica Tx: Aciclovir
• Chickenpox Definition: Acute VZV infection, highly infectious (-2d until crusted over); 14d incubation periodEpidemiology: Common childhood disease; reactivation → dermatological shinglesSymptoms: Itchy rashSigns: Macules→papules→vesicles/pustules→ulcers present at different stagesTreatment: none necessary; ABx if superinfection (beware necrotizing fasciitis); aciclovir if invasivePrognosis: excellent; beware pregnant ladies → fetal varicella syndrome (scars, cerebral calcification etc)
• Staph and strep infections in children Skin, bone, joints Lung Throat, ear, mastoid
• Transient synovitis Definition: post-infective joint infection DDx: Septic joint, crystal arthropathy, juvenile arthritis; diagnosis by exclusion Tx: conservative
• Osteomyelitis Salmonella in SCD? MRI → IV ABx
• Septic arthritis Definition: Inflammation of a joint; often s.aureaus, s. pyogenes etcEpidemiology: always suspect in children; also disseminated gonococcal diseaseSymptoms: pain, swelling, fever, reduced mobilitySigns: erythema, swelling, calor, reduced RoMInvestigations: joint aspiration, CRP; later ABG, blood cultures → SEPSIS 6Treatment: admit for IV antibiotics ± washout → gout, pseudogout, osteoarthritis
• Hypoglycaemia in children Definition: Blood repeatedly sugar less than 2 Causes: Metabolic (inborn errors of metabolism), endocrine (↓cortisol, ↑insulin, GF, thryoid) Risk factor: maternal (gestational) diabetes Investigations: panel of blood tests Treatment: acutely: glucose, glucagon
• Rickets Definition: defective mineralization of bone, due to vitamin D or Ca2+ deficiency Symptoms: fractures, deformities Investigations: bone profile, x-ray Treatment: supplementation
• Acute appendicitis Definition: Acute inflammation of the appendixEpidemiology: Common in older children and teenagersSymptoms: Pain (epigastric → right IF), loss of appetite, fever, vomitingSigns: Acute abdomen (guarding, rebound tenderness)Investigations: Bloods (FBC, CRP; UnE, LFT as baseline for OP); USS, MRITreatment: SurgeryComplications: Rupture →peritonitis, abscess; surgery: infection, bleeding, wound problemsDDx: Mesenteric adenitis, gastroenteritis
• Constipation in children Definition: Failure to pass stool at normal frequency; or hard, big, painful stoolsCauses: Dehydration, lifestyle (sedentary, little fibre), hypothyroidism, functionalSymptoms: abdominal pain, toilet aversion, "big painful poo", overflow diarrhoeaSigns: Loaded rectum, avoidant behaviour, suggestive postureInvestigations: first line none, barium defaecogram Treatment:  Lifestyle: fluids (esp fruit juice), exercise, fibre Oral laxatives - movicol sachets Glycerine enemas Manual evacuation
• Gastroenteritis in children Definition: Inflammation of the GI tract; may be bacterial (Salmonella, E.coli, campylobacter), viral (noro, rota), or parasiticEpidemiology: Very common; highly contagious with poor hand hygieneSymptoms: Diarrhoea (sometimes bloody), dehydration, off-feed, vomiting, jaundice, reduced urine outputSigns: DehydrationInvestigations: none; consider stool cultures, coeliac screen, FBC, UnE, LFT, bloo cultures, if HUS suspected Treatment: If viral, supportive if bacterial, consider antibiotics, e.g. metronidazole, ciprofloxacin stay at home until symptoms settled no role for loperamide etc

zurück  |  weiter 6 / 8