Page 1 of 2: paeds---kernicterus

pilgrim · Credits: 947 My Scrapbook

in the pediatric medimock quiz
Kernicterus is
a) Associated with deposition of conjugated bilirubin in basal ganglion
b) Occurs in children
c) Ususlly associated with serum bilirubin > 20 mg% in neonates

d) Exchange transfusion is the treatment of choice

Ans is given as 3

but in ghai,
the treatment for s.bilirubinlevel> 20mg% is Exchange transfusion which means it is the tratment of choice in kenicterus.
Ghai further says that in criggler najar, type I, serum Bilrubin levels of .>30mg% result in kernicterus
Kindly confirm

Bruno · Credits: 44725 My Scrapbook My Reading List 50 Books

Please give the test number and question number. Even though this is a Paediatric Question it was asked in the topic Medicine and because you had said it as Paediatric test, i am sure that many user would have searched for the question and might have been confused

Not all attempt the tests daily and can recollect it quickly. Most users would only turn to the question after you put it inthe board

Quote:

mediMOCK: Medicine [GIT]; Free Online Mock Test 24
Posted on Tuesday, July 08 @ 00:00:00 CEST by RxPG

10) Kernicterus is

One answer only.

a) Associated with deposition of conjugated bilirubin in basal ganglion
b) Occurs in children
c) Usually associated with serum bilirubin > 20 mg% in neonates
d) Exchange transfusion is the treatment of choice

1. It is unconjugated bilirubin
2. Occurs in Neonates
3. Yes. This is correct
4. This is not always correct. That depends on the grade and the level of bilirubin, and the rise of bilirubin/24hours etc

pilgrim · Credits: 947 My Scrapbook

thanks for the answer
next time ill be a little more careful ,with the test number

but what about the info from Ghai

is there a reference that u may be able to provide for the answer
thanks so much

Bruno · Credits: 44725 My Scrapbook My Reading List 50 Books

Ghai gives a lot of criteria, one for Physiologica Jaundice as well.

So we are on the safer side

Exchange transfusion is used for treatment , but it is not always the treatment of choice.

royalgeorge · Credits: 123 My Scrapbook

The answer is exchange transfusion, kernicterus can occur at lower values esp in preterms and in sick neonates.

drsmita_s · Credits: 18649 My Scrapbook

i too feel that exchange transfusion is the answer since, once kernicterus has occured, it is the definitive treatment. as far as values for predicting the occurence of kernicterus is concerned, there are no fixed values- can occur at lower levels in preterms.

check out these lines from emedicine.:

The cornerstone of management of hyperbilirubinemia is prevention of neurotoxicity. The definitive method of removing bilirubin from the blood is via exchange transfusion. This is currently the indicated approach in the presence of clinical bilirubin encephalopathy when the bilirubin level has reached dangerous levels despite preventive efforts. Phototherapy is the most common method aimed at prevention of bilirubin toxicity. Current clinical research is evaluating the use of metalloporphyrins to block bilirubin formation by competing with the enzyme heme oxygenase.

Exchange transfusion: This definitive therapy is used to mechanically remove already-formed bilirubin from the blood. It is indicated whenever clinical signs of acute bilirubin encephalopathy exist in patients who present with critically high serum bilirubin (eg, >25 mg/dL) and dehydration or when the serum bilirubin level continues to rise despite attempts to reduce it. In the presence of Rh isoimmunization, a cord bilirubin level greater than 5 mg/dL or a rate of rise in serum bilirubin greater than 0.5-1 mg/dL/h has been shown to be predictive of the ultimate need for exchange transfusion. This relationship has not been demonstrated in hyperbilirubinemia of other etiologies. This procedure is not without risk.

niyati2002 · Credits: 5492 My Scrapbook

see, KERNICTERUS is unconjugated hyperbilirubinemia ass. ENCEPHALOPATHY ..wich has hypertonia & extrapyramidal symptoms..

no doubt, 3rd ans is rite.. itz ass wth hyperbilirubinemia..but _+nce of encephalopathy is more important not level of bilrubin..

ANS S/B 4TH...EXCHANGE TRANSFUSION IS TOC ...& mx of kernicterus dont d/o serum bilrubin level..

niyati2002 · Credits: 5492 My Scrapbook

& remember..phototherapy is used to prevent KERNICTERUS ...not to treat.it...rt, bruno & smita..

drsmita_s · Credits: 18649 My Scrapbook

niyati2002 · Credits: 5492 My Scrapbook

anyone who wants to share his or her point of view on this topic is MOST WELCOME...

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