Medical Topics

Attention deficit hyperactivity disorder ( ADHD ) in children and young adults

Attention deficit hyperactivity disorder ( ADHD ) -A persistent pattern of inattention and/ or hyperactivity-impulsivity 
that interferes with functioning or development 
( American Psychiatric Association )

Known as hyperkinetic disorder in Europe and other nations that use the WHO classification system

How common – Most common behavioral disorder in childhood Neurodevelopmental disorder -childhood onset of symptoms and impairment Affects 8-12 % children worldwide
This may also vary depending upon criteria used for diagnosis Symptoms typically appear in children aged 3-7 yrs Rate of ADHD falls with age Prevalence increased Affects all sexes but is more common in boys
More commonly diagnosed in males Also affects adults Associated with poverty ,

Panic disorder in adults

Panic disorder – background Panic disorder is very common and deleterious to mental wellbeing
Lifetime prevalence 1 to14 %
 First described in 1960 – it was seen that patients with panic attacks would respond to imipramine while other patients with anxiety would not
 Often co-exists with agoraphobia- which is avoidance of exposed situations for fear of panic or inability to escape ( Greek- fear of marketplace )

DSM 5 criteria for panic disorder 

A -Individual experiences recurrent unexpected panic attacks- abrupt feelings of intense fear or discomfort that reach heights within minutes ,

Generalised anxiety disorder

Background of generalised anxiety disorder- GAD is a common disorder
prevalence amongst adults in England is thought to be 4.4 %
Recent Lancet paper mentions lifetime prevalence of about 5.7 % The central feature is excessive worry about a number of different events associated with heightened tension Often chronic if untreated and associated with substantial disability Can be difficult to diagnose as the key symptom -excessive persistent worry might not be well recognised and not well articulated by the patient ie GAD may be under-recognised GAD –

Warfarin-High INR

High international normalised ratio ( INR )- Consider aspects which may have caused INR to be out of range and level of INR

Any medication change ? antibiotic , amiodarone Missed dose or taken too much ? Any intercurrent illness ? gastroenteritis
fever , onset of jaundice , weight loss , ? worsening renal function Excessive alcohol consumption ?

Acute cough-antibiotic

 

URTI and not systemically very unwell or at higher risk of complications- do not offer antibiotic

Acute bronchitis and not systemically very unwell or at higher risk of complications-Do not routinely offer an antibiotic-If acute cough associated with acute bronchitis and CRP is available- follow NICE pneumonia in adults guideline

Higher risk of complications –

Heavy menstrual bleeding-NICE

Heavy Menstrual Bleeding- assessment and management

Evaluate impact- Heavy menstrual bleeding ( HMB ) is one of the commonest reason for gynecological referral and consultations About 1 in 20 women aged 30-49 yrs see GP/ year for HMB or menstrual problems Menstrual disorders comprise 
12 % of all referral to gynecology service The guideline states that HMB has a major impact on a womens QOL and advises to ensure that any intervention should aim to improve this rather than focusing on blood loss

HMB -a report has shown- 74 % suffered anxiety 67 % depression 62 % reported impact on physical wellbeing

history Examination and Testing – 

Molluscum contagiosum

Molluscum contagiosum is a common benign viral cutaneous infection
 caused by a DNA pox virus , observed generally in children

Acronym MC used in this chart to denote Molluscum contagiosum

Caused by a poxvirus of the molluscipox genus in the Poxviridae family Four major subtypes MCV 1 to 4
MCV -1 is the most common subtype ( 98 % in US )
MCV -2 affects teenagers and adults and is mainly sexually transmitted
( including HIV ) MC seen in HIV does not represent recurrence of childhood MCV infection

MC is very common but exact prevalence is uncertain Occurs worldwide –

Hyponatremia ( Low Sodium )

Hyponatraemia –Defined as serum sodium ( Na ) concentration of < 135 meq/l

Most common electrolyte disorder in clinical practice Seen in 15-30 % of patients in hospital setting ( particularly ICU ) Incidence and prevalence differs- based largely on study population and clinical setting Heterogenous disorder – often poses diagnostic and therapeutic challenge ( numerous pathophysiological mechanisms and multiple underlying pathological conditions ) Associated with ↑↑ mortality in hospital patients ( independent risk fx )

Mild 130-135
 Moderate- 125-129
 Severe 
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Cellulitis

 

Skin integrity Immunity VasculatureCellulitis is a spreading bacterial infection of the dermis and subcutaneous tissues ( CREST 2005 )

It is a bacterial skin and soft tissue infection Generally affects the lower limbs Erysipelas – Greek erythros (red) + pella (skin ) is considered a subtype
Evidence suggests a large overlap between the two conditions Seen and managed frequently by different specialists as GPs,

UTI ( Catheter ) antibiotics

NICE has published a guideline on management of UTIs in people with a urinary catheter. 

This was published in November 2018 and NICE has reviewed current evidence / experience on this topic and produced this very useful guidance. An easy to use visual is produced here for quick reference

Catheter-associated urinary tract infection 
( UTI ) -symptomatic infection of the bladder or kidneys in a person with a urinary catheter
 NICE guidance suggests that longer the catheter is in place –

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