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x 2nd Year Medicine > Child and Family Health > Flashcards

Child and Family Health Flashcards

1
Q

What are the 3 main phases of child growth, and what is each phase led by?

A

Infant - Nutrients
Child - Growth Hormone
Pubertal - Sex steroid

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2
Q

For what % of the population is the RNI sufficient for?

A

97%

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3
Q

From 6 months, in children having <500ml of formula milk daily, what supplements should these children receive?

A

Vitamins A,C + D

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4
Q

What is the ideal time to wean children off breast milk?

A

6 months (no earlier than 4)

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5
Q

At what age should a child be able to have head control?

A

6 weeks

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6
Q

At what age should a child be demonstrating hand regard?

A

3 months

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7
Q

At what age should a child be able to dress and undress, wash and dry their hands, and understand turn taking?

A

4 years

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8
Q

At what age should a child know around 50+ words, talk to themselves, and be able to understand simple instructions?

A

2 years

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9
Q

At what age is a child still friendly with strangers?

A

6 months

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10
Q

At what age will a child build a tower of 3 bricks and enjoy picture books?

A

18 months

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11
Q

At what age will a child start to vocalise?

A

3 months

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12
Q

At what age will a child feed with a spoon and mimic adults?

A

18 months

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13
Q

At what age will a child go up and down stairs using alternate feet, and be able to stand on 1 foot momentarily?

A

3 years

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14
Q

At what age will a child use their index finger to point and be able to pick up tiny objects?

A

9 months

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15
Q

At what age will a child follow a torch with their eyes?

A

6 weeks

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16
Q

At what age will a child know and turn to their name, and know vowels and consonants?

A

12 months

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17
Q

At what age will a child run and climb onto an adult chair?

A

18 months

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18
Q

At what age should a child play peek-a-boo and recognise who is a stranger?

A

9 months

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19
Q

At what age should a child be able to pull to standing and cruise around furniture?

A

12 months

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20
Q

At what age should a child be able to recount stories of recent events and be able to count to 20?

A

4 years

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21
Q

At what age should a child have no head lag on pulling to sit?

A

3 months

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22
Q

At what age should a child be able to bang toys together?

A

12 months

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23
Q

At what age should a child be drinking from a cup?

A

12 months

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24
Q

At what age should a child be babbling and screaming when annoyed?

A

6 months

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25
At what age should a child be able to push up on arms in prone and weight bear on their legs?
6 months
26
At what age should a child be able to grasp toys, transfer them from hand to hand, at mouth objects?
6 months
27
At what age will a child still to voice?
6 weeks
28
At what age will a child wash their hands, do vivid pretend play and understand sharing?
3 years
29
At what age do children know their own name and ask lots of questions and know nursery rhymes?
3 years
30
At what age can a child hop, climb ladders and walk and un on tiptoe?
4 years
31
At what age can a child build a tower of 6-7 bricks, scribble and match toys?
2 years
32
At what age do children react pleasureable to familiar situations?
3 months
33
At what age do children know 5-20 words and can point to body parts?
18 months
34
At what age does a child lean forward to reach out, stand holding onto furniture, and may crawl?
9 months
35
At what age should children be feeding less messily, be able to put on hat and shoes, and develop symbolic play?
2 years
36
At what age should a child be able to localise sound, babble for self-amusement and imitate sounds?
9 months
37
At what age is a child able to thread beads, copy a cross, and draw a man with head, legs and a trunk?
4 years
38
At what age does a child go up and down stairs and sit on a trike and steer?
2 years
39
At what age does a child perform a social smile?
6 weeks
40
At what age should a child be able to build a tower of 9 cubes, copy a circle, and match colours?
3 years
41
What is the sucking reflex?
When an object is places in the babies mouth, it will begin sucking
42
What is the rooting reflex?
Baby turns head towards a stimulus when touched near the corner of the mouth
43
At what age do the sucking and rooting reflexes disappear?
4 months
44
What is the moro reflex?
When the baby is help supine and the head is suddenly allowed to fall back, there is symmetrical opening of the arms before closing again?
45
At what age does the moro reflex disappear?
3 months
46
What is the placing reflex?
When a baby is held upright and the top(dorsum) of the foot is brushed against the edge of a table, the baby will lift the foot and place it on the table
47
What is the stepping reflex?
When a baby is held upright and the foot is placed on a firm surface the baby will take steps
48
At what age do the placing and stepping reflexes disappear?
6 weeks
49
What is the plantar grasp reflex?
Baby will close its foot around an object placed in its sole
50
At what age does the plantar grasp reflex disappear?
10 months
51
What is the palmar grasp reflex?
Baby will close its hand if an object is placed in its palm
52
At what age does the palmar grasp disappear?
3 months
53
What is the Asymmetrical Tonic Neck Reflex (ATNR)?
When the baby is lying on its back with head turned to one side, the arm on that side will extend and the other arm will flex (fencing posture)
54
Between what ages is the ATNR present?
2-6 months
55
What is the lateral propping reflex?
Arm will extend to the side if the baby is tilted
56
At what age does the lateral propping reflex occur?
6-7 months
57
Define developmental delay
Failure to attain appropriate developmental milestones for a child's corrected chronological age
58
What proportion of children have ASD (Autism spectrum disorder)?
1%
59
what percentage of children have a specific learning disability?
5-10%
60
What are the red flags for delayed development?
``` Asymmetry of movement Not reaching for objects by 6 months Unable to sit unsupported by 12 months Unable to walk by 18 months No speech by 18 months Concerns with vision or hearing Loss of skills ```
61
What is global developmental delay?
Significant delay of >=2 of the following: ``` gross/fine motor speech/language cognition social/personal ADL - activities of daily living ```
62
What conditions can cause motor delays?
DMD, Cerebral palsy, Co-ordination disorders
63
What conditions may cause sensory deficits and associated delays?
Oculocutaneous albinism | Treacher-Collins
64
What condition causes developmental deviations?
ASD
65
What screening tests are done in Down's syndrome?
Cardiac, Vision, Hearing, TFTs, sleep-related breathing disorders, growth-charts, development
66
How does hemiplegic cerebral palsy present?
Affects the arm and leg on one side Arm bent, hand spastic or floppy Walks on tiptoe of affected foot Other side almost of completely normal
67
How does paraplegic or diplegic cerebral palsy present?
Knees press together and the legs and feet are turned inwards Upper body is usually normal
68
How does quadriplegic cerebral palsy present?
All of the upper and lower limb problems Head and mouth may twist strangely Can often be so severely brain damaged, they will never walk
69
What conditions are associated with cerebral palsy?
``` Motility, spasticity and orthopaedic problems Learning difficulties Epilepsy Visual/hearing impairment Communication difficulties Feeding difficulties Sleep and behaviour problems ```
70
What comes in the Autistic triad?
Difficulties with: Communication Social interaction Flexibility of thought/imagination
71
Other than the difficulties in the autistic triad what other difficulties may individuals with ASD experience?
Confined to restricted/repetitive behavours | Sensory difficulties
72
What should be included when taking a history of a child with potential developmental delay?
``` Concerns - PC PMH Birth and Perinatal histiry Developmental history Play and behaviour School/nursery ```
73
What should be included in an examination of a child with potential developmental delay?
Observation for any dysmorphism Head circumference Systems - CNS incl. neurocutaneous Vision and hearing
74
What investigations may be done for a child with suspected developmental delay?
Chromosome assay | Neonatal PKU, thyroid studies, CK (for DMD)
75
What intervention can be put in place for children with developmental delays?
EARLIER THE BETTER Therapy - Physio, SLT, OT Family support Educational placements Referral to other agencies
76
When does human brain development start and end?
3rd post conception week | Late adolescence/early adulthood
77
What intrauterine factors may have a affect on fetal brain development?
Maternal health and disease continuous insults e.g. to alcohol or cytomegolovirus infection Placental function and fetal nutrition
78
What extrauterine factors may have an affect on brain development?
``` Physical factors (nutrition, environmental toxins) Emotional and social factors ```
79
In embryology what is the 1st well defined neural structure to form?
Neural tube at day 20-27
80
How is the neural tube formed?
Neural progenitor cells from the neural plate form the neural groove and then the neural tube These progenitor cells line the inside of the neural tube (ventricular zone)
81
What will the hollow centre of the neural tube become?
Ventricular system and the central channel for teh spinal cord
82
What will the anterior/rostral end of the neural tube become?
Brain
83
What will the caudal neural tube become?
Spinal cord
84
What 2 signalling molecules show the distinct functional and structural areas of the mature neocortex?
Emx2 and Pax6
85
What levels of embryological signalling molecules induce the progenitor to differentiate into the motor neurons associated with the anterior end of the embryo?
High Pax6 | Low Emx2
86
What levels of embryological signalling molecules induce the progenitor to differentiate into the visual cortical neurons associated with the posterior end of the embryo?
Low Pax6 | High Emx2
87
When do the primary sulci (folds) of the brain form?
weeks 8-26
88
When do the secondary sulci (folds) of the brain form?
weeks 30-35
89
When do the tertiary sulci (folds) of the brain form?
week 36 - early infancy
90
Neural progenitor cells in the ventricular zone initially divide symmetrically so 2 identical neural progenitor cells arise following this; what happens after this initial division?
Asymmetrical cell division; 1 cell division creates 1 progenitor cell and 1 neuron
91
What happens to the progenitor cells produced by cell division?
Stay in ventricular zone to continue division
92
What happens to the neurons produced by progenitor cell division?
They migrate to take their place in the developing neocortex.
93
How does the brain develop postnatally?
Limited neuronal proliferation from the ventricular zone | Myelination of axons (mostly in first 2 years of life)
94
If a child is deprived of vision of 1 eye in early postnatal life, what happens withing the visual cortex.
The areas supplying the covered eye shrink and the inputs from the active eye invade and use this new space
95
What is spina bifida?
Failure of the neural tube to completely form, leaving a gap in the spine
96
What is anencephaly?
Failure of the head end of the neural tube to form correctly, causing parts of the brain and skull to be missing
97
What is holoprosencephaly?
Failure of the forebrain to develop copletely into 2 lobes
98
What does the PLP1 gene encode for?
A transmembranous proetolipid lipid (predominant myelin protein present in the CNS
99
What is the most severe disorder associated with PLP1 mutations?
Pelizaeus-Merxbacher disease
100
How and when does Pelizaeus-Merxbacher disease present?
Presents in infancy and childhood with nystagmus, hypotonia and cognitive impairment Progresses to severe spasticity and ataxia Life span is considerably shortened
101
What produces 2/3 of the CSF?
Choroid plexus (in the lateral 3rd+4th ventricles)
102
What is the total CSF volume in adults?
150mls
103
How much CSF is produced per day?
500mls/day with a turnover of 3.7x/day
104
What is the function of the CSF?
Cushioning of the brain Maintains ICP at a constant pressure Transports potential toxins away from the brain and spinal cord
105
Where does the CSF flow?
Through the foramens of Magendi and Luschka into the sub-arachnoid space Absorbed through the arachnoid villi into the venous drainage system of the brain
106
What colour should CSF be?
Clear and colourless, same viscosity as water
107
What should the normal biochemistry of the CSF be?
Protein and glucose levels are most commonly measured CSF glucose should be at least 2/3 of BG CF:BG <0.5 is pathological
108
What is a lumbar puncture used for?
Sampling and measuring the pressure of CSF
109
How is CSF taken during a lumbar puncture?
1/2 interspaces above the L4 spinous process is the optimal place to take the sample from in adults (misses spinal cord) in children the spinal cord terminates at a lower level
110
What structures will be penetrated when performing a lumbar puncture?
``` Skin Subcut. connective tissue Supraspinatous ligament Interspinous ligament Ligamentum flavum Epidural space Dura matter Subarachnoid space ```
111
What are the indications for performing a lumbar puncture?
suspected CNS infection Suspected subarachnoid haemorrhage Theraputic reduction of CSF pressure Sampling of CSF for any other reason
112
What are the contraindications for a lumbar puncture?
Localised skin infections over the proposed puncture site Raised ICP Suspected spinal cord mass or intracranial mass lesion Uncontrolled bleeding disorders Spinal column deformities Lack of patient cooperation
113
What does the brain require in order to receive oxygen?
A normal CPP (cerebral perfusion pressure)
114
What causes decreased CPP?
MABP is low | ICP is raised
115
What are the common causes of raised ICP?
Intracranial mass lesions/tumours Blood Blockage
116
What is hydrocephalus?
A disturbance of CSF production, flow or reabsorption resulting in an excessive amount of CSF in the cranial vault
117
How does hydrocephalus present in infancy?
Enlarging head circumference Splaying of sutures, enlarged fontanels, setting sun sign, prominent scalp veins Poor feeding, irritability, decreased activity and vomiting
118
How does hydrocephalus present in adults or older children?
Slowing of mental capacity, cognitive deterioration Heaches (initially in morning) Neck pain suggesting tonsillar herniation Vomiting (more significant in the morning) Blurred vision (papilloedema) Double vision Difficulty walking Drowsiness
119
What investigations should be done for suspected hydrocephalus?
US, CT/MRI brain
120
What are potential causes of hydrocephalus?
Aqueductal stenosis and Arnold Chiari malformation
121
How is hydrocephalus treated?
VP (ventriculoperitioneal) shunt
122
What conditions do children commonly present with?
``` Broncholitis/URTI/Croup Gastroenteritis Seizures/epilepsy Pneumonia/LRTI Asthma ```
123
What is bronchiolitis?
Acute inflammatory injury of the bronchioles due to a viral infection Supportive treatment
124
What is croup
Laryngotracheo bronchitis caused by viral infection | Treated by steroids
125
What is croup
Laryngotracheo bronchitis caused by viral infection | Treated by steroids
126
What immunisations should children have by/at 2 months?
DTaP/IPV/Hib Pneumococcal vaccine Rotarix
127
What immunisations should children have by/at 3 months?
DTaP/IPV/Hib (2nd course) Men C Rotarix (2nd course)
128
What immunisations should children have by/at 4 months?
``` DTaP/IPV/Hib (3rd course) Pneumococcal vaccine (2nd course) ```
129
What immunisations should children have by/at 12-13 months?
Hib - booster Men C - booster MMR PCV
130
What immunisations should children have by/at 3yrs 4 months?
DTap/IPV - booster | MMR - (2nd course)
131
What immunisations should children have by/at 12-18 years?
Td/IPV HPV MenC

x 2nd Year Medicine (10 decks)

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