92 Revision Session

92.1 Bex and Fatima

Severe Acute Malnutrition: Any one of: Z Score, MUAC, Oedema

How do you know if a kid has oedema from Kawshiorkor vs Nephrotic : Nephrotic is proteinuria, kwashiorkor isnt

Oedema : Bilateral, Symettrical, Pitting

What are the cut offs for MUAC : <11.5 = Severe, 11.5 - 12.5 is mMderate

How do you decide whether to admit a patient for Severe Acute Malnutrition? : Failing an appetitite test, Presence of Acute Warning Signs/Medical complications (Dehydration, Respiratory Distress, Unconsciousness, Vomiting), Grade 3 Oedema

What are the Acute Warning Signs for Severe Acute Malnutrition: Dehydration, Respiratory Distress, Unconsciousness, Vomiting (anything that worries you)

What are the WHO grading for oedema in Severe Acute Malnutrition : Grade 1 Just feet, Grade 2 Below knees or below elbows, Grade 3 Trunk/Face

Why is it so hard to assess dehydrayion in malnourished kids? : They’ve all got abnormal skin turgor, they’ve all got sunken eyes, they’ve often got cool peripheries. You can use history of peeing/not peeing

How can you assess malnourished kids for dehydration: History of peeing/not peeing, history of diarrhoea. (They’ve all got abnormal skin turgor, they’ve all got sunken eyes, they’ve often got cool peripheries.)

How do you do an appetite test? : You provide a body weight determined dose of RUTF, the kid has 30-60mins. They need clean hands and water available.

What is RUTF for malnutrition: Ready To Use Therapeutic Food

What are the Resp rate cut offs for tachypnoea: 60 Newborn 50 40 1 year 30 5 years

What is a gibbous? : Sign of spinal TB (knobbly destructive spinal lesion)

What big three medical precipitants should you think of for malnutrition? : CP, TB, HIV

Rickettic Rosary : Nobbles where bone meets cartilage in rib cage

ThinkRickets when you see these signs: Bowing of long bones, Soft hair with loss of pigments, Rickettic rosary

Bitot Spots : Vit A Deficiency on the eye. If you see it they need extra vitamin A

10 Steps Strategies for Inpatient Management: Hypoglycaemia, Hypothermia, Dehydration, Electrolye Imbalance, Infection (everyone gets abx), Micronutrient Deficiencies/Anaemia, Initiate Cautious Feeding, Then catch Up growth (with RUTF or F-100), Sensory Stimulation and emotional support, Follow Up and discharge

What’s a super basic approach to fluids in Severe Acute Malnutrition: Unconscious/Shocked with dehydration? Need IV Fluids. Conscious? Try oral/NG first

92.2 Labour and Ed

What’s a normal foetal heart rate? : 120 - 160

What is foetal moulding? : Where the foetal sutures overlap, to allow baby to fit into the birth canal - More moulding with less dilatation gives an idea of severity of obstrucion

Where do you start plotting on the partogram graph? : First measurement of the cervical dilatation needs to be on the ALERT line, so you can follow the trajectory

At what stage do you start plotting on the partogram? : Active Labour, 4cm dilatation

What stage counts as active labour : 4cm cervical dilatation

What are the three delays : Delay in seeking help -> Delay in transfer -> Delay in providing help

What are the two categories of centres providing obstetric care : BMONC or CMONC

92.3 Fever, Seizures, Coma - Bill Jane Shunmay

How long do you give a kid after a seizure, when you can blame their reduced BCS on post-ictal? : Up to half an hour

When is it safe to LP? : SAFE: Seizure, Additional Factors, Focal Neuological Signs, Expressive (deteriorating conscious level / GCS < 13)

If you are treating a kid for cerebral malaria, what else should you treat them for? : Bacterial Meningitis! (In a high endemic area, everyone has parasites everywhere, so you can’t get distracted by it)

Which kids with seizures in a tropical setting should you LP? : Pretty much all of them! It’s more “who shouldn’t I LP”.

92.4 Newborn Health - Cally Al

What are the 4 S’s of ETAT : Setting, Safety, Stimulate, Shout for Help

What’s the fear with giving premature newborns unrestricted oxygen? : Retinopathy of prematurity (you can make them blind!) Before 32 weeks, really worried, 36 weeks less worried

What dose of glucose do you give a neonate when treating hypoglycaemia? : 2mls/kg of 10% glucose

What dose of glucose do you give any child older than a neonate when treating hypoglycaemia? : 5mls/kg of 10% glucose

How do you manage an infant < 12 months airway when it comes to positioning? : Neutral position. Not head tilt/chin lift

How do you manage an infant > 12 months airway when it comes to positioning? : Sniffing position

What is the fear for jaundice in prematurity? : Younger you are in prematurity, lower the threshold is for seizures etc

Good rule of thumb for neonatal jaundice management : If their hands and feet are yellow, they need lights. If they’re premature or septic, they need it earlier than that.

What kinds of organisms cause newborn sepsis? What would you give to cover these?: e.coli, klebsiella, staph, group B strep. ampicillin and gentamicin first line, cefotaxime (or other cephalosporins, cefotaxime is good as its CNS penetration is good) second line

What lines of therapy should you be giving a septic premature patient: Phototherapy. Antibiotics. IV Fluids. NG Feed. Vitamin K (prevents haemorrhagic disease of newborn). Other supportive care

92.5 Obstetric Care

What are the BP cutoffs for preclampsia? : > 140/90 = Preeclampsia, 150-159/100-109 = Moderate, More is Severe

What clinical symptoms make you think severe preeclampsia? : Brisk Reflexes, Severe Headache w visual disturbance, Vomiting, Looks V Sick

How do you control moderate preeclampsia? : Admit, Rest, Oral Anti-HTNs, Plan for delivery (induce or caesarean)

How do you manage severe preeclampsia? : IV Anti-HTNs, Magnesium, Deliver if not already

How do you manage post partum bleed? : IV access, catheterise, manage tone, trauma, and thrombin with (uterine massage, bimanual compression, misoprostol, oxytocin, TXA)

Why would you not give ergometrin for a patient with PPH? : You can kill patients who have eclampsia/severe preeclampsia

Health Centre Classifications, CMONC, BMONC, Level 4, etc

What are the causes of Post Partum Haemorrhage (PPH)? : Tone, Trauma, Tissue, Thrombin

What counts as a Post Partum Haemorrhage (PPH)? : Needs to be > 500ml (if there’re clots it’s prob > 500ml)

What is definition of maternal mortality? : Any time from onset of pregnancy, to 6 weeks post partum

What are the three top causes of maternal mortality? : Sepsis, Haemorrhage, Preeclampsia

What measures for maternal health care are there? : Maternal mortality, Neonatal Outcomes, Staffing Ratios, Complications of labour

92.6 Sick Kids

What is the testing for HIV in infants and what are the timings

What is the testing for TB in infants/kids :

What is the WHO recommendation for severe pneumonia in kids? :

What aspects of preventing maternal to child transmission of HIV? Primary prevention, Screening at antenatal care, Early treatment with ARTs, Nevirapine to mum and baby, Safe delivery (no manipulation if avoidable), Start mum and baby on ART as early as possible, Exculsive breast feeding, Prevent unplanned pregnancies, Comprehensive community support