108 - The Normal Child Flashcards

1
Q

How common are heart murmurs?

A

Very - 50% all children. Mostly innocent. Only 0.8% incidence of congenital heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How common are heart murmurs?

A

Very - 50% all children. Mostly innocent. Only 0.8% incidence of congenital heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is an innocent murmur loudest

A

When baby is lying down.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What age is a neonate

A

Birth-1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What age is a toddler

A

1-2yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What age is an infant

A

1 month - 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What age is a pre-school child

A

2-5yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is important to check for when considering a serious illness

A

Growth - if a child is growing well then it is unlikely to be a serious, chronic condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to check for growth in children

A

Measure weight, height and head circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In babies - what additional body parts should always be examined

A

Genitals, hips, femoral pulses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define birth

A

Movement from in-utero to ex-utero environment. Traumatic change that requires respiratory, circulatory, thermal and nutritional adaptations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why important to check SATs of newborns?

A

50% children with significant structural cardiac abnormalities are not prenatally detected. If abnormal - ECG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In newborn babies - always consider

A

Infection.

e.g. Group B Strep. 1/4 women infected. 1/1000 children of +ve mothers die.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2 key structural differences in foetal circulatory system.

A

Ductus arteriosus - aorta and pulmonary artery linked in foetus to bypass lungs. Closes at birth to become ligament arteriosum.

Foramen ovale - Hole in septum between right and left atria to allow blood to shunt past pulmonary circulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 key structural differences in foetal circulatory system.

A

Ductus arteriosus - aorta and pulmonary artery linked in foetus to bypass lungs. Closes at birth to become ligament arteriosum.

Foramen ovale - Hole in septum between right and left atria to allow blood to shunt past pulmonary circulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is an innocent murmur loudest

A

When baby is lying down.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is important to check for when considering a serious illness

A

Growth - if a child is growing well then it is unlikely to be a serious, chronic condition.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How to check for growth in children

A

Measure weight, height and head circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Most important thing to do before resuscitating a newborn.

A

Get it dry and warm. Will not resuscitate a cold, wet baby.

Put a hat on it - 30% babies heat lost through head as large.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define birth

A

Movement from in-utero to ex-utero environment. Traumatic change that requires respiratory, circulatory, thermal and nutritional adaptations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why important to check SATs of newborns?

A

50% children with significant structural cardiac abnormalities are not prenatally detected. If abnormal - ECG.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In newborn babies - always consider

A

Infection.

e.g. Group B Strep. 1/4 women infected. 1/1000 children of +ve mothers die.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why is foetal circulation different to newborn?

A

Foetus gets O2 from placenta but newborn has to get from lungs. Most of circulation work done in right side of heart in foetus compared to left in newborn.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

2 key structural differences in foetal circulatory system.

A

Ductus arteriosus - aorta and pulmonary artery linked in foetus to bypass lungs. Closes at birth to become ligament arteriosum.

Foramen ovale - Hole in septum between right and left atria to allow blood to shunt past pulmonary circulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Changes at birth:

What happens when infant takes first breath.

A

Lungs fill with air, fluid cleared from lungs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Changes at birth:

What happens when lungs fill with air for the first time?

A

Pulmonary capillaries absorb O2, pulmonary arterioles dilate and blood flows into the pulmonary vascular system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What closes the ductus arteriosum?

A

Smooth muscle contracts in response to O2. Closes ductus arteriosus which fibroses over.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What closes the foramen ovale?

A

Pressure changes in the heart as blood starts coming from the lungs instead of the placenta.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does a blue baby at birth indicate

A

Nothing. Only 60% O2 in utero so normal to be blue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What does a white baby at birth indicate.

A

Bad sign - can indicate mother has had a haemorrhage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When do congenital cardiac abnormalities present?

A

May not be at birth as ductus arteriosum doesn’t close fully until day 5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Problems with providing O2 for newborns

A

Can cause blindness if [O2] too high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Difference when looking at blood pressure in newborns compared to adults

A

Look at mean not diastolic/systolic. Should be > weeks of gestation. Term baby should have 40 mean BP

34
Q

What is vermix?

A

‘Yellow cheese’ Helps waterproof baby in utero. Greasy but keeps baby warm. Only seen in preterm babies as disappears by term.

35
Q

What is surfactant?

A

Lines alveoli to lower surface tension and allow newborn to breathe more easily. Can inactivate if baby is cold.

36
Q

Why are metabolic adaptations needed in newborns?

A

In utero - constant sugar supply from mother but halt at birth at the same time as demands increase. Newborn has to adapt to feed/fast cycles

37
Q

What to check if concerns over childs height (tall or short)

A

Parents height
Thyroid hormones
Bone age
If younger - check growth hormones - might be lacking.
If older - something added. Likely sex hormone issue.

Much more likely to be chronic disease in short stature than hormone issues.

38
Q

What is MCAD?

A

Metabolic disease where baby cannot breakdown nutrients for energy. Need to supply constant sugar or will die.

39
Q

Average birth weight

A

3.5kg

40
Q

Average birth length

A

50cm

41
Q

Average head circumference

A

35cm

42
Q

Average newborn temperature

A

36.5-37 celcius

43
Q

Example of genetic disorder with mitochondrial inheritance

A

Leber’s hereditary optic neuropathy

44
Q

Newborn respiratory rate

A

40-60 min. Review if persistently >60

45
Q

Normal blood pressure in a newborn

A

65/40mmHg

46
Q

What is periodic breathing and when does it occur

A

Regular respiration but with successive periods of apnoea. Usually occurs while sleeping.
Occurs in 5% healthy term babies.

47
Q

Difference when looking at blood pressure in newborns compared to adults

A

Look at mean not diastolic/systolic. Should be > weeks of gestation. Term baby should have 40 mean BP

48
Q

What is meconium? When to be concerned if hasn’t occurred.

A

First bowel movement. Should pass in 1st 24 hours. If not find out why.

49
Q

What is physiological jaundice?

A

Jaundice appearing day 2-3 of life (peaks day 5, resolved by day 14). 10% require phototherapy. If severe and untreated can result in brain damage due to bilirubin deposits in brain.

50
Q

What is a morphogen gradient and what is its importance in embryology?

A

Some cells secrete a morphogen which diffuses across the cells creating a gradient. The gradient of the morphogen tells cells where they are in the embryo and dictates how they develop.

51
Q

What to check if concerns over childs height (tall or short)

A

Parents height
Thyroid hormones
Bone age
If younger - check growth hormones - might be lacking.
If older - something added. Likely sex hormone issue.

Much more likely to be chronic disease in short stature than hormone issues.

52
Q

First pubertal change in girls

A

Breast budding. 9-13yrs

53
Q

First pubertal change in boys

A

Increase in testicular volume

54
Q

Precocious puberty

A

Girls - Any sign of puberty

55
Q

Delayed puberty

A

No sign of puberty before 13yrs-girls 14yrs-boys

56
Q

Staging of puberty

A
Tanner staging - based on
Breast development
Pubic hair
penile growth
Testicular sizing
57
Q

Example of genetic disorder with mitochondrial inheritance

A

Leber’s hereditary optic neuropathy

58
Q

In embryology - what is the embryonic period?

A

Fertilisation to end of week 8. Almost all structures of body laid down during this time.

59
Q

In embryology - What is the foetal period?

A

End embryonic period to birth

60
Q

What is classed as a premature birth?

A

Birth that occurs >3 weeks before due date.

Prior to week 35/38 (clinically 37/40)

61
Q

What is growth by proliferation

A

Increase in cell number

62
Q

What is growth by hypertrophy

A

Increase in cell size

63
Q

What is growth by accretion

A

Increase in extracellular material

64
Q

What is a morphogen gradient and what is its importance in embryology?

A

Some cells secrete a morphogen which diffuses across the cells creating a gradient. The gradient of the morphogen tells cells where they are in the embryo and dictates how they develop.

65
Q

What is morphogenesis?

A

Generation of form.

66
Q

What occurs in embryological development on day 0

A

Fertilisation. Ovum released from ovary - 24hr lifespan. Fertilised as travels along fallopian tube.

67
Q

What occurs in embryological development on day 1

A

Zygote - new genetic individual.

68
Q

What occurs in embryological development on day 2

A

Cells divide into smaller cells (Blastomeres) - overall cell mass does not increase.

69
Q

What occurs in embryological development on day 4

A

Morula - ball of >16 cells. Organisation starts to occur - the cells in the middle of the morula will form the embryo while those at the edges form the placenta

70
Q

What occurs in embryological development on day 5

A

Blastocyst/Blastula (sphere of cells with fluid filled central cavity) moves to uterus.

71
Q

What occurs in embryological development on day 6

A

Start of implantation. Blastocyst ‘rolls’ so cells that will become the embryo are on the side of the blastocyst closest to the epithelium of the uterus.

72
Q

What occurs in embryological development on day 7

A

Cells of embryoblast organise into 2 layers - epiblast and hypoblast. Cells of trophoblast begin to invade epithelial cell wall

73
Q

What occurs in embryological development on day 8

A

Formation of syncytiotrophoblast. A large single cell with a loose plasma membrane. Cells of epiblast form the bilaminar embryonic disc - will be the embryo.

74
Q

What occurs in embryological development on day 9

A

Primary yolk sac develops to support embryo until yolk sac is in place. Uterine blood supply to embryo begins to develop.

75
Q

What occurs in embryological development on day 12

A

Uterine epithelium completely surrounds embryo. May lose clot of blood as closes - often mistaken for a light period so can affect dating of pregnancy.

76
Q

What occurs in embryological development on day 13

A

Embryo tiny - most development to this point has been the development of supporting structures.

77
Q

What occurs in embryological development on day 14

A

Human chorionic gonadotrophin (HCG) produced. Signals to ovary that pregnancy has occurred so progesterone will continue to be produced to retain endometrium.

78
Q

What occurs in embryological development on day 15

A

Some cells migrate to midline. Form primitive streak (grove) with primitive node located at one end.

79
Q

What occurs in embryological development on day 17

A

Gastrulation - layers of embryo form. All cells of body originate from one of these 3 layers

80
Q

What develops from the embryological ectoderm

A

Mostly everything external.

81
Q

What develops from the embryological mesoderm

A

Muscle, connective tissue - pretty much everything

82
Q

What develops from the embryological endoderm

A

Internal external surfaces of body - e.g. epithelia of respiratory tract.