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4th Year > Child health > Flashcards

Child health Flashcards

1
Q

what is helf

A

not us

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2
Q

what is a child

A

us

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3
Q

how much skin to skin does orla need

A

a lot

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4
Q

what causes stridor

A

congenital
laryngitis, EPIGLOTTITIS, croup, anaphylaxis, bacterial traceitis
tumours, trauma

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5
Q

what are the features of croup

A

6 months to 6 years
1/2 days of illness before then suddenly struggle to breath
stridor, barking cough, hoarseness, WOB

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6
Q

what is the treatment for croup

A 
keep child calm to maintain airway avoid all unnecessary exams and procedures 
if mild (minimal stridor/ WOB, no cyanosis) oral dexamethasone/ prednisolone at home 
if mod/ severe: restless, cyanosis, recession, stridor at rest, increased HH and RR, tired/ reduced conscious level) admit, steroids, nebulised adrenaline
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7
Q

what causes croup

A

parainfluenza, RSV

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8
Q

what causes epiglottitis

A

haemophilus influenza B, group A strep, trauma, inhalation, burns

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9
Q

what are the features of epiglottitis

A

present with fever, severe sore throat and stridor, difficulty swallowing, muffled voice, drooling
thumbprint sign on x ray

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10
Q

what is the treatment for epiglottitis

A

get senior help asap, anaesthetist
secure airway
IV antibiotics (ceftriaxone)
steroids

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11
Q

what should’nt you do in suspected epiglotttitis

A

examine throat

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12
Q

what are the features of bronchiolitis

A

children <1

coryza preceeds wheeze, resp crackles, apnoea, recession

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13
Q

tx for bronchioitis

A

if apnoeic episodes, not feeding/ drinking, resp distress then admit. lower threshold for admission if premature, CF, downs syndrome, congenital cardiac disease, underlying health problem
supportive: O2, CPAP, NG feeds
palivizumab prevention for vulnerable

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14
Q

what causes bronchiolitis

A

RSV

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15
Q

what causes whooping cough

A

pertussis

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16
Q

what are the signs of whooping cough

A

apnoea, coughing bouts that end in vomiting, worse at night / after feeds
infants + >14s
lymphoctyosis
admit if <6

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17
Q

what are acute paediatric red flags

A

pale/mottles/ashen/ blue skin
no response to social clues, weak/high pitched/ continuous cry
grunting, tachypnoea, moderate-severe chest indrawing
reduced skin turgor
age <3 with temp >38
non blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal neuro signs, focal seizures

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18
Q

when is the peak age for bronchiolitis

A

3-6 months

most occur under 2

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19
Q

when should pneumonia be considered

A

if high fever and persistently focal crackles

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20
Q

when should you consider asthma or VIW instead of bronchiolitis

A

if persistent wheeze without crackles
recurrent episodic wheeze
personal/ fmaily history of atopy

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21
Q

do you use adrenaline to treat bronchiolitis

A

NO (is a lower airway problem, adrenaline for croup)

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22
Q

acute asthma and viral wheeze tx

A 
OSHIPMAN 
oxygen 
salbutamol and ipatropium nebulised
oral pred/ IV hydrocortisone
neb/ IV magnsium sulphate 
aminophylline if unresponsive
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23
Q

what causes a fixed splitting of the second heart sound

A

ASD

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24
Q

what causes the murmur in TOF

A

pulmonary stenosis (ejection systolic at pulmonary area)

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25
Q

what causes a pan systolic mumur in children

A

MR
TR
VSD

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26
Q

is a murmur that is louder or quieter on standing more worrying

A

louder more worrying

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27
Q

is a diastolic or systolic murmur more worrying in childhood

A

diastolic

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28
Q

what causes a continuous cres-decresc machinery murmur

A

PDA

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29
Q

what are the causes of cyanotic heart disease

A

(right to left shunts)

ASD, VSD, PDA, transposition of the great arteries

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30
Q

what are the duct dependent CHDs

A 
TOF
Epsteins 
Pulmonary stenosis 
transposition of the great arteries (if no VSD or ASD)
coartaction of the aorta 
critical AS 
hypoplastic left heart syndrome 
pulomary atresia and critical stenosis
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31
Q

what are the cyanotic CHDs

A 
VSD 
TOF 
ASD 
PDA 
transposition of the great arteries
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32
Q

why do cyanotic CHD cause cyanosis

A

right to left shunt cause deoxygenated blood to enter circulation (initially in ASD, VSD, PDA will be left to right shunt that causes pulmonary hypertension which then results in right to left shunt)

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33
Q

what is a potential neuro complication from ASD

A

stroke following DVT

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34
Q

what murmurs in ASD and VSD

A

ASD- mid systolic upper sternal border

VSD- pan systolic and lower sternal border

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35
Q

what can plethoric complexion be a sign of

A

polycythaemia due to chronic hypoxia e.g. in VSD

36
Q

what are the components of TOF

A

RVH
pulmonary stenosis (worsens r-l shunt through VSD)
VSD
overiding aorta (above VSD, worsens odeoxygenated blood in circulation- R-l shunt)

37
Q

tx for transposition of the great arteries

A

prostaglandins and balloon septosptomy until open heart surgery

38
Q

what are the general red flags for development

A

regression
occipital frontal circumference >98th or <0.4th centile
squint
marked hyper/ hypotonia
differences between left and right strength, movement or tone
no/ limited eye contact
lack of response to sound or visual stimuli
strong parental concerns

39
Q

if there is delay in more than one domain is it more or less likely to be significant

A

more likely

40
Q

what is the most variable developmental domain

A

speech and language (sensitive to environmental factors)

41
Q

what are the developmental red flags at 6 weeks

A 
no visual fixation/following 
failure to respond to sound 
asymmetrical neonatal reflexes  
excessive head lag
failure to smile
42
Q

what are the developmental red flags at 6-8 months

A 
hand preference (too early), fisting 
not reaching 
persistence of primitive reflexes 
floppy, poor head control 
lack of social response/ vocalisation
43
Q

developmental red flags at 12 months

A

unable to sit or bear weight
absence of saving reactions (parachute reflex)
persistence of hand regard (seen in 3-5 months, when baby on back will watch hands)
poor communication
no babble

44
Q

what are the developmental red flags at 18 months

A 
not walking
cannot understand simple commands 
no pointing 
no words 
no pincer grip
45
Q

red flag developmental points at 2 years

A

not running
cant follow a 2 step command
unable to speak 2-3 words

46
Q

when are all primitive reflexes usually lost

A

by 12 months

47
Q

what questions can you ask in a history to determine sensory issues in children

A

what foods do they eat, restrictive diet
bathing/ hair washing/ hair cutting
noise sensitivities
clothing, dislike of materials

48
Q

when does a hand preference usually develop

A

between 2-4 years

49
Q

when should you not do a LP if you suspect meningitis

A

if signs of raised ICP (bradycardia, hypertension, low RR= cushings response, pupil dilation, abnormal breathing pattern or posture)
GCS min seizure
imaging showing CSF path obstruction
circulatory shock/ meningococcal disease

50
Q

is an absence seizure generalised or focal

A

generalised

51
Q

is a myotonic seizure focal or generalised

A

generalised

52
Q

treatment for status epilepticus

A

5 mins IV lorazepan/ buccal medazolam/ rectal diazepam
10 mins repeat dose
20 mins pheynotoin/ phenobarbitol if alread on regular phentoin
call anaesthetist

53
Q

what is the risk with carbamazepine

A

agranulocytosis

54
Q

what is the risk of prescribing sodium valproate and carbamazepine to girls

A

teratogenicity

55
Q

treatment for focal seizures

A

carbemazepin or lamotrigine

55
Q

what anti seizure medications impair effectiveness of OCP

A

carbamazepine, oxcarbazepine, phenytoin and topiramate

56
Q

treatment for tonic clonic

A

valproate

lamotrigine 2nd line

57
Q

treatment for absence seizures

A

ethosuzimide or sodium valproate

58
Q

describe thrombotic thrombocytopenic purpura

A

haemolytic anaemia and thrombocytopenia

non specific symptoms- fever, renal failure, neuro chanes

59
Q

describe ITP

A

immune thrombocytopenia
preceeding viral illness, lower limb petichiae, bruising, mucosal bleeding
treated with steroids. IV immunoglobulin

60
Q

describe HUS

A

microangiopahtic haemolytic anaemia, thrombocytopenia and AKI
following ecoli bloody diarrhoea
abdo pain, fever, swelling

61
Q

describe HSP

A

IGA vasculitis

purpuric rash, abdo pain, arthritis/arthalgia, glomerulonephritis

62
Q

treatment for whooping cough

A

supportive
arthromycin/ clarithromycin
notifiable disease

63
Q

what are the features of pyloric stenosis

A 
projectile vomiting after feeding in first few weeks of life 
olive mass in upper abdomen 
hypochloric metabolic alkalosis
USS 
laparoscopic pyloromyotomy
64
Q

signs of biliary atresia

A

jaundice for >14 days, >21 if premature

65
Q

features of hirschprungs

A

absence of parasympathetic ganglions
>24hrs to pass meconium, chronic constipation from birth, abdo pain and distention, vomiting, poor weight gain and failure to thrive
need resus and surgery

66
Q

features of intussusception

A 
6 months to 2 years 
severe colicky pain 
vomiting yellow then green 
recurrent jelly stool 
sausage shaped mass 
preceded by viral upper resp infection 
USS- target sign 
air enema
67
Q

features of volvulus

A

baby

bilious vomiting obstruction (malrotation with volvulus) until proven otherwise

68
Q

what vaccinations should kids have had by 1 year

A

2x DTaP/IPV (polio)/HiB/ HepB
2x Men B
2x rotavirus
pneumococcal (PCV)

at 12 months get HiB/MenC, PCV booster, MMR, MenB booster
flu if eligible

69
Q

what vaccinations at 3 years 4 months

A

dTaP/IPV

MMR

70
Q

what vaccinations at 12-13

A

HPV

71
Q

what vaccinations at 14

A

Td/IPV

menACWY

72
Q

what vaccines for adults

A

65- pneumococcal
flu annual
70-70 shingles

73
Q

when do you get head control

A

2-3 months

74
Q

when can you sit without support

A

6 months

75
Q

when can you crawl and cruise

A

9 months

76
Q

when should you follow something by turning head

A

6 weeks (limit 3 months)

77
Q

when should you reach for toys and have a palmar grasp

A

4 months (limit 6)

78
Q

when should you transfer hands between toys

A

9 months

79
Q

when should you have a pincer grip

A

10 months (limit 12)

80
Q

what ages should you be draw: line, circle, square, triangle

A

line 2
circle 3
square 4
triangle 5

81
Q

what ages should you laugh, turn to sound, polysyllabic babble, mama dada, 6-10 words, phrases, 3-4 word sentences

A 
laugh 3-4 months 
turn to sound 7 months 
mama-dada 7-10 
12- 5 words 
18 months 6-10 
phrases (2-3 words) 2 years 
short sentences 3 years
82
Q

limit for symbolic play

A

2 years

83
Q

when should you be able to drink from a cup

A

12 months

84
Q

when should you be able to use spoon by seld

A

18 months

85
Q

limit for social smile

A

8 weeks

4th Year (7 decks)

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