الأربعاء، 26 أغسطس 2015

MCQs IN FLUID AND ELECTROLYTE DISORDERS

A two year-old boy was admitted to the Emergency Department after having a witnessed tonic clonic seizure lasting for less than 5 minutes at home. The child is normally fit and well with no previous history of febrile or afebrile seizure or family history of epilepsy. Prior to the seizure, there were no respiratory or coryzal symptoms. No definitive history eliciting head trauma was mentioned. However, the parent noticed that he had been drinking excessively (estimated 2e3 litres) throughout the course of the day.
On examination, the child was post-ictal, drowsy and lethargic. There was no rash. The rest of his examination was unremarkable. His blood results showed a sodium level of 125 mmol/litres with normal renal function. He was fluid restricted and observed overnight. His sodium levels normalized to 135 mmol/litres with good recovery. He was referred to the Endocrinology team for follow up.

1. The child had a hyponatraemic seizure. Which ONE of the following conditions does NOT cause low serum sodium levels?

a. Syndrome of Inappropriate Antidiuretic Hormone
Secretion (SIADH).
b. Diabetes Insipidus
c. Diarrhoea
d. Hypertriglyceridaemia
e. Cirrhosis

2. Which ONE of the following statements in regards to hyponatraemia is false?

a. In hospitalized children, hypotonic fluid use for maintenance hydration is potential risk factor.
b. Acute hyponatraemia can cause brain cell swelling and cerebral oedema.
c. The emergency treatment of hyponatraemia is fluid restriction and 0.9% sodium chloride solution.
d. The recommended rate of correcting low sodium levels should not be faster than 10 mmol/litres a       day.
e. In the treatment of SIADH, Intravenous furosemide may be needed.

3. Select ONE true answer about SIADH
a. Urine osmolality is usually low
b. Urine sodium can be high
c. Serum osmolality is high
d. Occurs commonly with nephrotic syndrome
e. SIADH does not cause hyponatraemia



Answers :


(1. b, 2. c, 3. b).

Hyponatraemia is a serum sodium level less than 135 mmol/litres. The causes of hyponatraemia can be classified according to the patient’s volume status:
1) Hypovolaemic hyponatraemia (seen in diarrhoea secondary to gastroenteritis or cerebral salt wasting
syndrome).
2) Hypervolaemic hyponatraemia (seen in congestive heart failure, cirrhosis or nephrotic syndrome).
3) Normovolaemic hyponatraemia (seen in SIADH or water intoxication).

Pseudohyponatraemia is a laboratory artefact that presents when the plasma contains very high concentrations of protein (Multiple myeloma) or lipid (hypertriglycerideamia).
The treatment of hyponatraemia is based on the specific aetiology. However, it is important to avoid overly rapid correction that might lead to central pontine myelinolysis or osmotic demyelination syndrome. The current recommendation, according to the British National Formulary (BNF),
is to correct sodium levels by a rate not faster than 10 mmol/litres in 24 hours. However, acute hyponatraemia with severe neurological symptoms, requires urgent correction of sodium levels in order to reduce the incidence of cerebral oedema. Intravenous hypertonic saline (4e6
ml/kg of 3% sodium chloride) is the recommended treatment. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is characterized by hyponatraemia, inappropriately concentrated urine, high urine osmolality, low plasma osmolality and normal-to-high urine sodium. It
is an uncommon condition in children. It can be caused by CNS disorders (trauma, infection, tumour, haemorrhage), pneumonia, hypothalamic-pituitary surgery and excessive administration of Vasopressin in the treatment of Diabetes Insipidus. Drugs, such as Carbamazepine and some tricyclic
antidepressants can increase vasopressin secretion or mimic vasopressin action. The recommended treatment is fluid restriction, usually to two-thirds of oral intake or less and diuresis to remove excessive free water.

الاثنين، 24 أغسطس 2015

Pediatric Course Review For 6 year medical Students

1- Hypocalcemia is characterized by all of the following features except :

A- Numbness and tingling of circumoral regions.
B- Hyperactivity tendon reflexes.
C- Carpopedal Spasm
D- Shortening of QT interval in ECG.



2- The first evidence of pubertal development in female is :

A- Appearance of breast buds.
B- Onset of menarche
C- Appearance of axillary hair.
D- Appearance of pubic hair.

3- Boner age is normal in :

A- Hypothyroidism.
B- Genetic short stature.
C- Hypopitutarism.
D- Emotional deprivation.


4- Retardation of skeletal maturity can be caused by all except :

A- Chronic renal failure.
B- Hypothyroidism.
C- Protein energy malnutrition.
D- Congenital adrenal hyperplasia.

5- When the child is not able to perform skipping, walking, on heels, hopping in place or going forward in tandem gait, his motor development is considered to be below :

A- 3 years.
B- 6 years.
C- 4 years.
D- 7 Years

6- The following is a delayed milestone development :

A- Head elevation at 12 week.
B- Pincer grasp at 9 months.
C- Bisyllable at 12 months.
D- Stand with support at 10 months,

7- Vocabulary of 11/2 year old is :

A- 5 words.
B- 10-20 words.
C- 20- 30 words.
D- 30-40 words.



Answers :

1- D
2- A
3- B
4- D
5- B

Skipping - 4 years           Walk on toe-tip - 2.5 years
heel-to--to- walks and jumps on foot - 5 years                       Hopping in a place - 4 year


6- C

Delayed development if :
   - Absence of pincer grip by 10-11 month
   - not able to say ba or da by 8-9 months
   - not able to stand holding on by 9-10 months.7- 

7 - B
          By 12 months - can use 2 words with meaning   
          By 18 months use  10 –25 words