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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
Q

At what age should a child be able to push up on arms in prone and weight bear on their legs?

A

6 months

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26
Q

At what age should a child be able to grasp toys, transfer them from hand to hand, at mouth objects?

A

6 months

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27
Q

At what age will a child still to voice?

A

6 weeks

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28
Q

At what age will a child wash their hands, do vivid pretend play and understand sharing?

A

3 years

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29
Q

At what age do children know their own name and ask lots of questions and know nursery rhymes?

A

3 years

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30
Q

At what age can a child hop, climb ladders and walk and un on tiptoe?

A

4 years

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31
Q

At what age can a child build a tower of 6-7 bricks, scribble and match toys?

A

2 years

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32
Q

At what age do children react pleasureable to familiar situations?

A

3 months

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33
Q

At what age do children know 5-20 words and can point to body parts?

A

18 months

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34
Q

At what age does a child lean forward to reach out, stand holding onto furniture, and may crawl?

A

9 months

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35
Q

At what age should children be feeding less messily, be able to put on hat and shoes, and develop symbolic play?

A

2 years

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36
Q

At what age should a child be able to localise sound, babble for self-amusement and imitate sounds?

A

9 months

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37
Q

At what age is a child able to thread beads, copy a cross, and draw a man with head, legs and a trunk?

A

4 years

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38
Q

At what age does a child go up and down stairs and sit on a trike and steer?

A

2 years

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39
Q

At what age does a child perform a social smile?

A

6 weeks

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40
Q

At what age should a child be able to build a tower of 9 cubes, copy a circle, and match colours?

A

3 years

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41
Q

What is the sucking reflex?

A

When an object is places in the babies mouth, it will begin sucking

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42
Q

What is the rooting reflex?

A

Baby turns head towards a stimulus when touched near the corner of the mouth

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43
Q

At what age do the sucking and rooting reflexes disappear?

A

4 months

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44
Q

What is the moro reflex?

A

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?

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45
Q

At what age does the moro reflex disappear?

A

3 months

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46
Q

What is the placing reflex?

A

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

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47
Q

What is the stepping reflex?

A

When a baby is held upright and the foot is placed on a firm surface the baby will take steps

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48
Q

At what age do the placing and stepping reflexes disappear?

A

6 weeks

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49
Q

What is the plantar grasp reflex?

A

Baby will close its foot around an object placed in its sole

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50
Q

At what age does the plantar grasp reflex disappear?

A

10 months

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51
Q

What is the palmar grasp reflex?

A

Baby will close its hand if an object is placed in its palm

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52
Q

At what age does the palmar grasp disappear?

A

3 months

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53
Q

What is the Asymmetrical Tonic Neck Reflex (ATNR)?

A

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
Q

Between what ages is the ATNR present?

A

2-6 months

55
Q

What is the lateral propping reflex?

A

Arm will extend to the side if the baby is tilted

56
Q

At what age does the lateral propping reflex occur?

A

6-7 months

57
Q

Define developmental delay

A

Failure to attain appropriate developmental milestones for a child’s corrected chronological age

58
Q

What proportion of children have ASD (Autism spectrum disorder)?

A

1%

59
Q

what percentage of children have a specific learning disability?

A

5-10%

60
Q

What are the red flags for delayed development?

A 
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
Q

What is global developmental delay?

A

Significant delay of >=2 of the following:

gross/fine motor
speech/language
cognition
social/personal
ADL - activities of daily living
62
Q

What conditions can cause motor delays?

A

DMD, Cerebral palsy, Co-ordination disorders

63
Q

What conditions may cause sensory deficits and associated delays?

A

Oculocutaneous albinism

Treacher-Collins

64
Q

What condition causes developmental deviations?

A

ASD

65
Q

What screening tests are done in Down’s syndrome?

A

Cardiac, Vision, Hearing, TFTs, sleep-related breathing disorders, growth-charts, development

66
Q

How does hemiplegic cerebral palsy present?

A

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
Q

How does paraplegic or diplegic cerebral palsy present?

A

Knees press together and the legs and feet are turned inwards
Upper body is usually normal

68
Q

How does quadriplegic cerebral palsy present?

A

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
Q

What conditions are associated with cerebral palsy?

A 
Motility, spasticity and orthopaedic problems
Learning difficulties
Epilepsy
Visual/hearing impairment
Communication difficulties
Feeding difficulties
Sleep and behaviour problems
70
Q

What comes in the Autistic triad?

A

Difficulties with:

Communication
Social interaction
Flexibility of thought/imagination

71
Q

Other than the difficulties in the autistic triad what other difficulties may individuals with ASD experience?

A

Confined to restricted/repetitive behavours

Sensory difficulties

72
Q

What should be included when taking a history of a child with potential developmental delay?

A 
Concerns - PC
PMH
Birth and Perinatal histiry
Developmental history
Play and behaviour
School/nursery
73
Q

What should be included in an examination of a child with potential developmental delay?

A

Observation for any dysmorphism
Head circumference
Systems - CNS incl. neurocutaneous
Vision and hearing

74
Q

What investigations may be done for a child with suspected developmental delay?

A

Chromosome assay

Neonatal PKU, thyroid studies, CK (for DMD)

75
Q

What intervention can be put in place for children with developmental delays?

A

EARLIER THE BETTER

Therapy - Physio, SLT, OT
Family support
Educational placements
Referral to other agencies

76
Q

When does human brain development start and end?

A

3rd post conception week

Late adolescence/early adulthood

77
Q

What intrauterine factors may have a affect on fetal brain development?

A

Maternal health and disease
continuous insults e.g. to alcohol or cytomegolovirus infection
Placental function and fetal nutrition

78
Q

What extrauterine factors may have an affect on brain development?

A 
Physical factors (nutrition, environmental toxins)
Emotional and social factors
79
Q

In embryology what is the 1st well defined neural structure to form?

A

Neural tube at day 20-27

80
Q

How is the neural tube formed?

A

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
Q

What will the hollow centre of the neural tube become?

A

Ventricular system and the central channel for teh spinal cord

82
Q

What will the anterior/rostral end of the neural tube become?

A

Brain

83
Q

What will the caudal neural tube become?

A

Spinal cord

84
Q

What 2 signalling molecules show the distinct functional and structural areas of the mature neocortex?

A

Emx2 and Pax6

85
Q

What levels of embryological signalling molecules induce the progenitor to differentiate into the motor neurons associated with the anterior end of the embryo?

A

High Pax6

Low Emx2

86
Q

What levels of embryological signalling molecules induce the progenitor to differentiate into the visual cortical neurons associated with the posterior end of the embryo?

A

Low Pax6

High Emx2

87
Q

When do the primary sulci (folds) of the brain form?

A

weeks 8-26

88
Q

When do the secondary sulci (folds) of the brain form?

A

weeks 30-35

89
Q

When do the tertiary sulci (folds) of the brain form?

A

week 36 - early infancy

90
Q

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?

A

Asymmetrical cell division; 1 cell division creates 1 progenitor cell and 1 neuron

91
Q

What happens to the progenitor cells produced by cell division?

A

Stay in ventricular zone to continue division

92
Q

What happens to the neurons produced by progenitor cell division?

A

They migrate to take their place in the developing neocortex.

93
Q

How does the brain develop postnatally?

A

Limited neuronal proliferation from the ventricular zone

Myelination of axons (mostly in first 2 years of life)

94
Q

If a child is deprived of vision of 1 eye in early postnatal life, what happens withing the visual cortex.

A

The areas supplying the covered eye shrink and the inputs from the active eye invade and use this new space

95
Q

What is spina bifida?

A

Failure of the neural tube to completely form, leaving a gap in the spine

96
Q

What is anencephaly?

A

Failure of the head end of the neural tube to form correctly, causing parts of the brain and skull to be missing

97
Q

What is holoprosencephaly?

A

Failure of the forebrain to develop copletely into 2 lobes

98
Q

What does the PLP1 gene encode for?

A

A transmembranous proetolipid lipid (predominant myelin protein present in the CNS

99
Q

What is the most severe disorder associated with PLP1 mutations?

A

Pelizaeus-Merxbacher disease

100
Q

How and when does Pelizaeus-Merxbacher disease present?

A

Presents in infancy and childhood with nystagmus, hypotonia and cognitive impairment
Progresses to severe spasticity and ataxia
Life span is considerably shortened

101
Q

What produces 2/3 of the CSF?

A

Choroid plexus (in the lateral 3rd+4th ventricles)

102
Q

What is the total CSF volume in adults?

A

150mls

103
Q

How much CSF is produced per day?

A

500mls/day with a turnover of 3.7x/day

104
Q

What is the function of the CSF?

A

Cushioning of the brain
Maintains ICP at a constant pressure
Transports potential toxins away from the brain and spinal cord

105
Q

Where does the CSF flow?

A

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
Q

What colour should CSF be?

A

Clear and colourless, same viscosity as water

107
Q

What should the normal biochemistry of the CSF be?

A

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
Q

What is a lumbar puncture used for?

A

Sampling and measuring the pressure of CSF

109
Q

How is CSF taken during a lumbar puncture?

A

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
Q

What structures will be penetrated when performing a lumbar puncture?

A 
Skin
Subcut. connective tissue
Supraspinatous ligament
Interspinous ligament
Ligamentum flavum
Epidural space
Dura matter
Subarachnoid space
111
Q

What are the indications for performing a lumbar puncture?

A

suspected CNS infection
Suspected subarachnoid haemorrhage
Theraputic reduction of CSF pressure
Sampling of CSF for any other reason

112
Q

What are the contraindications for a lumbar puncture?

A

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
Q

What does the brain require in order to receive oxygen?

A

A normal CPP (cerebral perfusion pressure)

114
Q

What causes decreased CPP?

A

MABP is low

ICP is raised

115
Q

What are the common causes of raised ICP?

A

Intracranial mass lesions/tumours
Blood
Blockage

116
Q

What is hydrocephalus?

A

A disturbance of CSF production, flow or reabsorption resulting in an excessive amount of CSF in the cranial vault

117
Q

How does hydrocephalus present in infancy?

A

Enlarging head circumference
Splaying of sutures, enlarged fontanels, setting sun sign, prominent scalp veins
Poor feeding, irritability, decreased activity and vomiting

118
Q

How does hydrocephalus present in adults or older children?

A

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
Q

What investigations should be done for suspected hydrocephalus?

A

US, CT/MRI brain

120
Q

What are potential causes of hydrocephalus?

A

Aqueductal stenosis and Arnold Chiari malformation

121
Q

How is hydrocephalus treated?

A

VP (ventriculoperitioneal) shunt

122
Q

What conditions do children commonly present with?

A 
Broncholitis/URTI/Croup
Gastroenteritis
Seizures/epilepsy
Pneumonia/LRTI
Asthma
123
Q

What is bronchiolitis?

A

Acute inflammatory injury of the bronchioles due to a viral infection
Supportive treatment

124
Q

What is croup

A

Laryngotracheo bronchitis caused by viral infection

Treated by steroids

125
Q

What is croup

A

Laryngotracheo bronchitis caused by viral infection

Treated by steroids

126
Q

What immunisations should children have by/at 2 months?

A

DTaP/IPV/Hib
Pneumococcal vaccine
Rotarix

127
Q

What immunisations should children have by/at 3 months?

A

DTaP/IPV/Hib (2nd course)
Men C
Rotarix (2nd course)

128
Q

What immunisations should children have by/at 4 months?

A 
DTaP/IPV/Hib (3rd course)
Pneumococcal vaccine (2nd course)
129
Q

What immunisations should children have by/at 12-13 months?

A

Hib - booster
Men C - booster
MMR
PCV

130
Q

What immunisations should children have by/at 3yrs 4 months?

A

DTap/IPV - booster

MMR - (2nd course)

131
Q

What immunisations should children have by/at 12-18 years?

A

Td/IPV
HPV
MenC

x 2nd Year Medicine (10 decks)

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