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Year 1 SBA revision > 108 - The Normal Child > Flashcards

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

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2
Q

How common are heart murmurs?

A

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

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3
Q

When is an innocent murmur loudest

A

When baby is lying down.

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4
Q

What age is a neonate

A

Birth-1 month

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5
Q

What age is a toddler

A

1-2yrs

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6
Q

What age is an infant

A

1 month - 1 year

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7
Q

What age is a pre-school child

A

2-5yrs

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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.

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9
Q

How to check for growth in children

A

Measure weight, height and head circumference

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10
Q

In babies - what additional body parts should always be examined

A

Genitals, hips, femoral pulses.

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11
Q

Define birth

A

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

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12
Q

Why important to check SATs of newborns?

A

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

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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.

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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.

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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.

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16
Q

When is an innocent murmur loudest

A

When baby is lying down.

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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.

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18
Q

How to check for growth in children

A

Measure weight, height and head circumference

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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.

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20
Q

Define birth

A

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

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21
Q

Why important to check SATs of newborns?

A

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

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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.

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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.

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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.

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25
Q

Changes at birth:

What happens when infant takes first breath.

A

Lungs fill with air, fluid cleared from lungs.

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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.

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27
Q

What closes the ductus arteriosum?

A

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

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28
Q

What closes the foramen ovale?

A

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

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29
Q

What does a blue baby at birth indicate

A

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

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30
Q

What does a white baby at birth indicate.

A

Bad sign - can indicate mother has had a haemorrhage.

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31
Q

When do congenital cardiac abnormalities present?

A

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

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32
Q

Problems with providing O2 for newborns

A

Can cause blindness if [O2] too high

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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.

Year 1 SBA revision (37 decks)

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