List hypotheses for the causes of acute abdominal pain in an 8 year old child
• Appendicitis• Mesenteric lymphadenitis• Constipation• Gastroenteritis- bacteria such as shigella or E. Coli• Intestinal obstruction• Pelvic inflammatory disease- caused by chlamydia or nisseria
What is the pathophysiology of acute appendicitis?
A blockage in the lining of the appendix causes large amounts of bacteria to harbor and multiply, leaving the appendix inflamed with a potential to burst.
What are the clinical features of acute appendicitis?
• Sudden pain that begins on the right side of the lower abdomen• Sudden pain that begins around your navel and often shifts to your lower right abdomen• Pain that worsens if you cough, walk or make other jarring movements• Nausea and vomiting• Loss of appetite• Low-grade fever that may worsen as the illness progresses• Constipation or diarrhea, abdominal bloating
What are the compliations of acute appendicitis?
ruptured appendix: A ruptured appendix spreads infection to your lower abdomen (peritonitis). This is potentially life threatening leads to a pocket of pus in your lower right quadrant of the abdomen that must be cleaned and drained PRIOR to performing and appendectomy
What investigations would be performed in a suspected case of acute appendicitis?
a) Physical examination: the doctor will palpate various regions of the abdomen to attempt to find the region most sensitive to pain. Appendicitis often presents with a GUARDING reflex, which causes the patient to involuntarily stiffen their abdominal muscles in response to pressureb) Full Blood Count: this allows the doctor to analyze the total WBC, if it is high, an infection is likely presentc) Urinalysis- in order to rule out whether kidney stones or even a UTI is causing the abdominal pain
How is acute appendicitis managed/treated?
Invasive surgery (only treatment)- Laproscopic surgery --> Laproscopic surgery has a few small incisions and the doctor will place specialized surgical tools to remove the appendix.- Open surgery --> If infection has spread, an open surgery will be required so that the surgeon can drain the area of abscess and clean it.
What are the clinical signs of mild to moderate dehydration?
• Dry, sticky mouth• Sleepiness or tiredness — children are likely to be less active than usual• Thirst• Decreased urine output• No wet diapers for three hours for infants• Few or no tears when crying• Dry skin• Headache• Constipation• Dizziness or lightheadedness
What are the clinical signs of severe dehydration?
• Extreme thirst• Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults• Very dry mouth, skin and mucous membranes• Little or no urination — any urine that is produced will be darker than normal• Sunken eyes• Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold• In infants, sunken fontanels — the soft spots on the top of a baby's head• Low blood pressure• Rapid heartbeat• Rapid breathing• No tears when crying• FeverIn the most serious cases - delirium or unconsciousness
Describe the main body fluid compartments, the major differences in their composition, the factors affecting water and solute transport between them.
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What is a drug?
- Any chemical compound/substance that acts on the body to elicit a physiological change- A chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being
Describe the generic properties of drugs that should be analyzed during PBL cases.
PharmacokineticsLiberation- release of active substanceAbsorption- administration --> bloodstreamDistribution- bloodstream --> tissuesMetabolism- drug --> related substancesExcretion- exiting bodyPharmacodynamicsa) physiological effects of drugs on bodyb) mechanism of actionc) drug- receptor interactionsd) dose-response relationshipsAdverse effects/Contraindications
Outline the pharmacology of aspirin
Pharmacokineticsa) route of administrationa. can be taken orally, or administered IVb. readily absorbed by the stomach and intestinec. broken down in the liver by esterasesd. irreversibly excreted in urineb) Adverse effects a. can lead to GI irritation/bleedingb. can cause tinnitus, vertigo, vomiting at very high dosesc) contraindicationsa. peptic ulcerationb. avoid for asthmatics, can cause INCREASE in attack probabilityc. do not administer to young children, can lead to Reye's syndrome [sudden acute brain/liver damage]. Pharmacodynamicsa) Analgesic drug (pain reliever)b) Anti-pyretic (fever reducer)c) Anti-inflammatoryd) Anti platelet aggregation Aspirin specifically inhibits COX enzyme -COX catalyzes the breakdown of arachidonic acid to create prostaglandins (PGs) and thromboxanes (platelet aggregators)Prostaglandins aid in the following functions (Aspirin inhibits PGs)a) sensitization of painb) dilation of blood vessels and an increase in permeability (leads to swelling)c) setting body temperature during fever
Outline the pharmacology of opioid analgesics, using morphine as an example
Pharmacokineticsa) administered orally/IV/rectallyb) undergoes extensive first-pass metabolism through the liverc) Adverse effects- respiratory depression, constipation (inhibition of Ach release in GI tract), hypotension (inhibits compensatory baroreceptor activity), nausea and vomiting, urine retention (decreased renal plasma flow)d) 87% of a single dose of morphine excreted in the urine within 72 hours of administrationPharmacodynamicsa) increases pain threshold by dissociated the perception of pain from the sensation.b) Binds to mu opioid receptors responsible for analgesia and sedationc) Has a half life of approximately 120 minutes
Define the terms "histology" and "histopathology
histology - the study of the microscopic cells and tissues of organismshistopathology - microscopic examination of tissue in order to study the manifestation of disease.
Define the term "vital signs", include age-related values.
• Body temperature --> 36.5-37.2 0C• Pulse rate --> 60-100 beats/min• Respiration (breathing) rate --> 12-16 breaths/min• Blood pressure (not considered a vital but usually measured as well) o Normal: < 120 mm Hg (systolic)/<80 mm Hg (diastolic)o Prehypertension: 120-139 mm Hg (systolic)/80-89 mm Hg (diastolic)o Hypertension: 140+ mm Hg (systolic)/90+ mm Hg (diastolic)
What are the normal vital signs in childhood?
InfantHR: 120-160RR: 25-40BP: 60-90/30-55ToddlerHR: 80-130RR: 20-35BP: 70-100/45-65School-ageHR: 70-110RR: 15-25BP: 90-110/50-70Adolescent HR: 60-100RR: 10-20BP: 95-130/60-80
What are the components of a pain history?
SiteOnset (sudden or gradual?)Character (ache, stabbing?)RadiationAssociations (other signs/symptoms?)Time (course - pain follow any pattern?)Exacerbating/alleviating factors (does anything change the pain?)Severity
Describe the psychological perspective on health, illness and disease and how this can contribute to clinical practice
Health Psychology: - relatively new field concerned with all aspects of health and illness across the lifespan- devoted to understanding the psychological influences on health and illness and people's behaviors in response to illness. Illnesses related to Psychological/Behavioral factors:Heart disease and strokeCancerHIV/AIDSCOPDType II diabetesPoor birth outcomesChronic pain conditionsInfectious illnessesToday --> contagious diseases and infections contribute minimally to illness and death in the Western World- most deaths are caused by heart disease, cancer and strokes, diseases which studies suggest are a by-product of lifestyle Biopsychosocial Model:- Illness and injury have biological, psychological and sociocultural components- Diagnosis and treatment should take into account all of the above components - Mind and body cannot be distinguished in illness and health
Describe the use of the audit cycle in professional development.
1. Measuring current practice2. Comparing results with standards3. Changing practice4. Re-auditing5. Setting standards
What is the role of structured reflection in professional development?
- Reflective practice demands that students are not merely 'doing', but 'learning from doing'- Alert to the human elements of their experiences e.g. emotions, values, challenges and achievements, effect on others etc- Personal and professional- Criterion of academic examinations and clinical work at undergraduate and postgraduate levels.- Evidence that metacognition - understanding how we think - improves cognitive function by ~25%
Define clinical governance
a framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.
What are the 3 main components of clinical governance?
1. Recognizably high standards of care 2. Transparent responsibility and accountability for those standards 3. A constant dynamic of improvement.
Outline the basis of professional behavior of doctors and medical students in relation to practice in the UK
a) not exceed their limitations and ask for help when necessaryb) not mislead anyone by misrepresenting their position or abilitiesc) make sure they are supervised appropriately for any clinical task performedd) respect the decisions and rights of patientse) treatment should be based on patient's priorities and the effectiveness of treatment optionsf) not discriminate against patientsg) behave with courtesyh) report all concerns
Outline the use of reflective practice as a tool for clinicians to improve thier resilience, quality of their work and healthcare outcomes of the organisation they work in (Gibbs Reflective Cycle)
1. Description (what happened?)2. Feelings (what were you thinking and feeling?)3. Evaluation (what was good and bad about the experience?)4. Analysis (what else can you make of the situation?)5. Conclusion (what else could you have done?)6. Action plan (if it rose again what would you do?)