1. A 2 year child is brought to your clinic due to persistent diarrhea and has developed swelling of legs and lean chest muscles. A Diagnosis of Severe Acute Malnutrition is made
a. Give 2 forms of malnutrition and mention how the 2 will be differentiated
b. Give 2 indication of admission for the child with severe acute malnutrition
c. What is the criteria of discharging the following individuals with severe acute Malnutrition give 2 for each
i. Children less than 6 month
ii. Children above 6 month
d. When will Iron be added on the treatment for this child
e. Explain how the child of severe malnutrition will be managed if happens to have Diarrhoea with Severe dehydration
f. What kind of fluid is preferred in in the management of Diarrhoea in malnutrition and why
2. James is an eight year old boy known Epileptic patient who has come for review. He is on Phenobarbitone and Carbamazepine. He looks drowsy and he is unkempt.
a. On the review what 2 questions will you ask the mother
b. Explain the 3 types of epileptic seizure c. apart from carbamazepine and Phenobarbitone mention 2 other antiepileptic drugs and what are their side effects
d. Give 3 advise you are going to advise the mother about James
a. Two forms of malnutrition are marasmus and kwashiorkor. They can be differentiated based on characteristic features such as presence of edema in kwashiorkor and severe wasting in marasmus.
b. Two indications for admission for a child with severe acute malnutrition are: presence of medical complications such as severe dehydration or infections, and failure to respond to outpatient therapeutic feeding.
c. Criteria for discharging individuals with severe acute malnutrition:
i. Children less than 6 months: stable weight gain for 2 consecutive weeks, no medical complications
ii. Children above 6 months: weight-for-height has reached -2 SD, appetite has improved
d. Iron will be added to the treatment for this child once they are stabilized and have started gaining weight.
e. The child with severe malnutrition and diarrhea with severe dehydration will be managed with a combination of rehydration therapy, antibiotics if indicated, and nutritional rehabilitation.
f. Oral rehydration solution (ORS) is preferred in the management of diarrhea in malnutrition because it helps replace lost fluids and electrolytes, preventing dehydration.
a. On review, two questions to ask the mother would be about James' seizures frequency and any changes in his behavior or mood.
b. The three types of epileptic seizures are focal seizures, generalized seizures, and unknown onset seizures.
c. Two other antiepileptic drugs are Valproic acid and Lamotrigine. Side effects may include drowsiness, dizziness, and liver toxicity.
d. Three pieces of advice for the mother regarding James would be to ensure he takes his medication regularly, to watch for any changes in his behavior or mood, and to schedule regular follow-up visits with the doctor.