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Child health > Child health > Flashcards

Child health Flashcards

1
Q

What is secure attachment- describe the child and caregiver?

A

Child- readily explores using care giver as a secure base.
Cries infrequently
Easily put down after being held.

Caregiver- appropriate response to upset. Appropriate encouragement to explore. Tuned in to the childs needs.

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2
Q

What is anxious ambivalent attachment- describe the child and caregiver?

A

Child- unsure how to respond to parent when he/she returns- despite a large emotional response.
May seek comfort. Unsure how to manage attention.

Caregiver- unpredictable
Inconsistent
Frightening

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3
Q

What is anxious avoidant attachment- describe the child and caregiver?

A

Child- avoids or ignores the parent when he/she returns. Shows little indication of emotional response. Often the stranger isn’t treated much differently from the parent.

Caregiver- disinterested.
Uncomfortable showing affection
Overly encourages separation/independence

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4
Q

What is disorganised attachment response?

A

Older children in the context of severe trauma. No cohesive response.
Bizarre behaviour (soiling, destruction of possesions, strange noises)
Overlaps with dissociation.

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5
Q

What is temperament?

A

Inherent constitutionally based characters that make up the core of personality and influence directions for development.

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6
Q

How can temperament be measured?

A

Observation in social situations.
Questionnaires- assessing adaptability, predictability and activity level
Physiological measures- HR, ECG, salivary cortisol.

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7
Q

What does activity mean in terms of temperament?

A

Intensity and pace of a persons behaviour.

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8
Q

What is emotionality in terms of temperament?

A

How positive/negative a person is in general.

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9
Q

What are the 3 dimensions of temperament?

A
  • difficult
  • easy
  • slow to warm up
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10
Q

What is the key point about temperament?

A

Temporament is inherent but development of temperament can be influenced.

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11
Q

What is resilience? Describe the two models?

A

Systemic model- family- having close bonds with at least one family member
School and community
Sport, group membership

Attachment model- ability to make realistic plans and being capable of taking steps necessary to follow them through.
A positive self concept and confidence in ones strengths and abilities
Communication and problem solving skills.

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12
Q

When do children who have faced chronic adversity fare better or recover more successfully?

A

They have a positive relationship with a competent adult
They are good learners and problem solvers (temperament)
They are engaging to other people
They have areas of competence and perceived efficacy valued by self or society.

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13
Q

What are conduct disorders?

A

Diagnostic term used to describe children and young people with persistent, repetitive aggressive antisocial behaviours.

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14
Q

What is the criteria for conduct disorders (generally speaking)?

A

Basically antisocial behaviour- aggressive to adults, often argues, doesn’t abide by rules ect.

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15
Q

How are conduct disorders treated?

A

Three methods:
Collaborative problem solving
Multi-systemic therapy
Psychopharmacology

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16
Q

Basic description of collaborative problem solving used for conduct disorders?

A

Revolves around the fact that when the child and the environment fit- good outcomes are to be expected.

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17
Q

What general skills do children with conduct disorders lack?

A

Flexibility of thinking
Frustration tolerance
Problem solving.

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18
Q

Brief outline of multi systemic therapy used with conduct disorders?

A

Group based therapy with the family and the community.

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19
Q

What drugs might you give to a child with a conduct disorder?

A

Mood stabilisers e.g. lithium, sodium valproate.

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20
Q

Heart rate and resp rate for a child less than 1?

A

HR- 110-160

RR- 30-40

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21
Q

Heart rate and resp rate for a child of 1-2?

A

HR- 100-150

RR-25-35

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22
Q

Heart rate and resp rate for a child of 2-5?

A

HR- 95-140

RR- 25-30

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23
Q

Heart rate and resp rate for a child of 5-12?

A

HR- 80-120

RR-20-25

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24
Q

Heart rate and resp rate for a child of >12?

A

HR- 60-100

RR-15-20

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25
Q

What should you do if a child is hypotensive? What should you do if they remain in shock?

A

20mls/kg of 0.9% saline.

Repeat if still shocked.

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26
Q

If a child is 5-10% dehydrated- what clinical signs will they show?

A 
Mucous membranes- mildly dry
Skin turgor- may be slightly decreased
Urine output- Mildly reduced
Shock- absent
Conscious level- normal
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27
Q

If a child is >10% dehydrated- what clinical signs will they show?

A 
Mucous membranes- dry and sunken
Skin turgor- decreased
Urine output- significantly reduced
Shock- present
Conscious level- altered.
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28
Q

What are the common CNS issues presenting in an acutely unwell child?

A

Meningitis- rash does not fade under pressure
Encephalitis
Presentations and findings vary with age.

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29
Q

What are the common respiratory causes of an acutely unwell child?

A

Pneumonia- any age.
Asthma- not everyone wheezes
Bronchiolitis- acute inflammatory injury to the bronchioles. Viral and needs supportive treatment.
Croup- laryngotracheobronchititis. Viral cause (parainfluenza) Steroid treatment.

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30
Q

What is the commonest reason for acute illness in children? What is the treatment for it?

A

SEPSIS.

Treatment is supportive/antimicrobial.

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31
Q

What can cause fits, faints and funny turns?

A 
Siezures
Vasovagal episode
Reflex anoxic seizures
Breath holding techniques
Behavioural episodes
Epilepsy
Arrhythmias
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32
Q

What are the GI/urogenital causes of an acutely unwell child?

A 
Viral gastroenteritis
GI obstruction- congenital pyloric stenosis, volvulus, intersucception, malrotation
Appendicitis
UTI
Testicular torsion.
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33
Q

What are health inequalities?

A

Differences in health status or in distribution of health determinants between different population groups.

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34
Q

What is mental health?

A

The ability to function well from an emotional and social perspective within your environment.

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35
Q

What is attachment?

A

Strong emotional tie that develops over time between the infant and its primary care-giver.

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36
Q

What is the triad for autism spectrum disorder?

A

Flexibility of thought
Social interaction
Communication

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37
Q

What other features will a child with autism likely have?

A

Repetitive and restricted patterns.

Very keen/fixated on one subject/activity.

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38
Q

How would you diagnose autism?

A

Language delay and regression
Verbal and non-verbal communication impaired
Social impairment
Repetitive-rigid behaviour

Also screening tests exist- generally use parental questionnaires as an adjunct to history

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39
Q

Treatment and management of autism spectrum disorder?

A

Applied behavioural analysis- a behavioural program for treating young children with ASD
Social skills training

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40
Q

What is Retts syndrome?

A

Typically normal development for 24 months then regression of previously acquired skills.

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41
Q

How does Retts present?

A 
Regression of previously acquired skills
Unsteady gait
Progressive cognitive impairment
Repetitive hand movements
Teeth grinding
Seizures.
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42
Q

What mutation is present in (some of) Retts?

A

MECP2 gene (80% have it)

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43
Q

On examination, how does Retts present?

A

Wringing or tapping hand movements.
Ataxic gait (walks bent forward with feet wide apart)
Scoliosis
Hyperventilation

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44
Q

How would you diagnose Retts?

A

Spinal Xray may be normal or show scoliosis
ECG will be abnormal if there is associated epilepsy
MRI of the brain may show reduced brain size and reduced white matter volume.

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45
Q

Treatment of Retts syndrome?

A

No specific care

Manage complications- anti-epileptic medication, physio for scoliosis, walking aids, beta blockers to control HR

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46
Q

Presentation of muscular dystrophy?

A 
Inbalance of lower limb strength
Delayed motor milestones
Diminished muscle tone
Positive Gowers sign
Ambulation falls
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47
Q

What is Gowers sign?

A

Bent forward- hands on knees.

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48
Q

How is Retts syndrome passed down?

A

X linked recessive- almost always seen in girls.

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49
Q

How is muscular dystrophy passed down?

A

X linked recessive.

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50
Q

Diagnosis of muscular dystrophy?

A

Absence of dystrophin due to a defect on the small arm of Xp21
Serum CK will be 50-100 times normal.

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51
Q

Treatment of muscular dystrophy?

A 
Corticosteroids 1st line. 
Creatinine 
Physio + exercise
Surgery for contractures. 
Cardioprotective drugs.
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52
Q

What is Downs syndrome also known as? What occurs in this genetic abnormality?

A

Trisomy 21.

Robertsonian translocation or mocaicism type

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53
Q

Physical features of downs syndrome?

A

Short stature
Hypotonia
Developmental delay

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54
Q

What does downs syndrome have strong associations with?

A

Congenital heart disease
GI disorders

Abnormalities in:
Thyroid
Haematological
Audiological
Visual
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55
Q

Treatment of Downs syndrome?

A

Infants and toddlers with developmental delay should begin immediately with focus on gross motor, fine motor and language development.

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56
Q

What is albinism?

A

Congenital abnormality resulting in complete or partial absence of pink in the skin.

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57
Q

What is albinism often associated with?

A

A number of eye conditions.

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58
Q

How is albinism diagnosed and treated?

A

Clinical diagnosis

Obsessive use of suncream.

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59
Q

What is cerebral palsy?

A

Non-progressive disease of the brain originating during the antenatal, neonatal or early post natal periods.

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60
Q

Presentation of cerebral palsy?

A

Motor delay
Speech delay
Intellectual developmental delay
May also have retention of primitive reflexes.

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61
Q

How would you diagnose cerebral palsy?

A

MRI of the brain will show periventricular leukomalacia, congenital malformation, stroke or haemorrhage and cystic lesions.

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62
Q

Treatment of cerebral palsy?

A

No cure- side effects can be controlled.

Young children often referred to speech therapy.

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63
Q

What is Treacher Collins syndrome?

A

Also called mandibular facial dysostosis.

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64
Q

How does treacher collins present?

A

Down slanting eyes
Notched lower eyelids
Underdevelopment of the eyes and the ears.

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65
Q

Do children with treacher collins reach normal developmental milestones on time?

A

Yes they have normal development and intelligence.

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66
Q

What is cerebral cortical visual impairment?

A

A form of visual impairment caused by the brain rather than the eyes.

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67
Q

How does cerebral cortical visual impairment present?

A

Most people aren’t totally blind.
Vision is variable (one min good, the next bad)
Poor depth perception
Field of view is limited
Vision may be poor but motion detection and balance are normal.
May have problems seeing faces rather than writing
Grabbing and object and looking at it may be hard.
Photophobia
Prefer specific colours.

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68
Q

Tests performed on people with cerebral cortical visual impairment?

A

MRI

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69
Q

Treatment of cerebral cortical visual impairment?

A

Early intervention to stimulate visual response.

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70
Q

Causes of cerebral cortical visual impairment?

A

Asphyixia, ischaemia, hypoxia, developmental brain defects, head injury, hydrocephalus, occipital lobe stroke, CNS infection (meningitis, encephalitis)

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71
Q

What is PKU?

A

Mutation of the phenylalanine hydroxylase gene on chromosome 1.

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72
Q

Presentation of PKU?

A 
Fair hair
Fits
Eczema
Musty urine
Low IQ
Children with this are prone to depression, anxiety, phobia, isolation and less masculine self image.
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73
Q

Diagnosis of PKU?

A

Hyperphenylalaninaemia

AKA heel prick test.

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74
Q

Treatment of PKU?

A

Dietary treatment- protein substitute that lacks phenylalanine.

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75
Q

What is Kabuki syndrome?

A

Genetic disorder that isn’t well understood. Common problems include heart defects, urinary tract abnormalities, hearing loss, hypertonia, recurrent ear infections, postnatal growth deficiency.
Other problems include skeletal abnormality, joint laxity, short stature, unusual dermatoglyphic patterns.
Mild to moderate intellectual disability.

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76
Q

What specific presentations make you think its kabuki syndrome?

A 
Long eyelids with turning up of the lateral 1/3rd of the lower eyelid
Broad and depressed nasal tip
Large prominent ear lobes
High arched palate or cleft
Scoliosis
Short 5th finger
Persistence of finger pads.
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77
Q

Treatment of Kabuki syndrome?

A

Most are resolved with symptomatic specific treatment. No specific one.

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78
Q

What is Prader Willi syndrome?

A

Loss of parental contribution of long arm of chromosome 21.

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79
Q

How does Prader Willi syndrome present?

A

Blue eyes, blonde hair, hypersomnence (excessive day time or nighttime sleepiness, hyperphagia (excessive eating), pica (eating food substances that are abnormal e.g. dog food, paint, paper)
Child may be autistic, introverted or develops unstable moods.

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80
Q

What are the diagnostic points for Prader Willi syndrome?

A

Diagnostic points-
Major- feeding problems, failure to thrive, hypogonadism, developmental delay and low IQ, rapid weight gain, central hypotonia, characteristic facial features.
Minor- infantile lethargy, small hands and feet, short stature, esotropia, myopia, speech articulation defects, sleep disturbance and apnoea, hypopigmentation, thick viscous saliva, skin picking

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81
Q

Tests you would do for Prader Willis syndrome?

A

Chromosome analysis

ECG

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82
Q

Treatment of Prader Willi syndrome?

A

Symptomatic

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83
Q

How does fragile X present?

A

Learning difficulties, social communication difficulties, hyperactive, attention deficit, motor difficulties, nervous speech, family history of learning difficulties.

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84
Q

On examination, what would you find in a child with fragile X

A 
Macrocephaly (big head)
Decreased muscle tone
Long face, high arched palate, prominent jaw
Large testis
Large ears
Strabismus (cross eyed)
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85
Q

What tests would you do to look into fragile X?

A

Prenatal screening can be done

Screening in high risk groups (families with >1 male with learning difficulties)

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86
Q

Treatment of fragile X

A

No current treatment. Medications for ADHD, behavioural interventions may be used.

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87
Q

What is ADHD?

A

Failure to give close attention to details, difficulty concentration, does not seem to listen when spoken too, difficulty organising tasks, easily distracted, fidgets, hyperactive.

88
Q

Diagnosis of ADHD?

A

Impulsivity
Inattention
Hyperactivity

89
Q

Risk factors for ADHD?

A 
Family history of ADHD
Male
low birth weight
epilepsy
maternal nicotine/cannibis use during pregnancy
90
Q

Treatment of ADHD?

A

Depends on case-
Stimulants e.g. amphetamine
Psychoeducation

91
Q

What is the presentation of gastroenteritis?

A 
Vomiting
Non-bloody diarrhoea
Hyperactive bowel sounds
Abdominal pain
Evidence of dehydration and decreased body weight.
92
Q

How would you diagnose gastroenteritis?

A

Clinical diagnosis

Can assess stools and blood but would most likely be normal.

93
Q

What commonly causes gastroenteritis?

A

Rotavirus

94
Q

What are the risk factors for developing gastroenteritis?

A

<5
poor hygiene
exposure to people with it
nursery/day care attendance.

95
Q

What is enuresis?

A

Bed wetting.
Micturition is normal however at wrong time/place
May see an increased fluid intake at night
Increased frequency
Constipation
Bladder irritants

96
Q

Treatment of enuresis?

A

Reassure, educate and lifestyle changes (drink less at night ect)
Behavioural measures

97
Q

Treatment of gastroenteritis?

A

Oral rehydration therapy
Anti-emetics
Age-appropriate diet.

98
Q

What is secondary enuresis?

A

Bedwetting after > 6months of dryness

99
Q

What can cause enuresis?

A

Upper airway obstruction/sleep disturbances

100
Q

How is enuresis diagnosed? Also how is it inherited?

A

Diagnosed clinically however can do urinalysis and urinary tract US to be cautious.
Inherited autosomal dominantly.

101
Q

What is epilepsy? How is it classified?

A

Tendency to intermittent abnormal electrical activity
Classified depending on the whether signs are deferrable to one part of the brain (partial) or generalised
And whether consciousness is affected (complex) or not (simple).

102
Q

What is a simple febrile convulsion?

A

Single, tonic clonic symmetrical seizure lasting less than 20 minutes occurring as temperature rises rapidly in febrile illness.

103
Q

What can cause febrile convulsions?

A

CNS lesions, meningitis, epilepsy

104
Q

What should you look for in seizures of any sort?

A

A possible cause.

Neck stiffness- meningitis.

105
Q

Tests used to look for cause of seizures?

A

MRI (best)

ECG

106
Q

Acute management of seizures?

A

Recovery position during fit
Protect head
Oxygen therapy

107
Q

Presentation of pneumonia?

A 
May be pyrexic
Malaise
Poor feeding
Tachyopneoa 
Cyanosis
Grunting, rib recession

In older children- pleural pain, crackles, bronchial breathing

108
Q

Investigations into pneumonia

A

Chest xray
FBC
sputum culture

109
Q

What are the common causes of pneumonia in the young?

A

Viral causes are more common than bacterial.

Bacterial causes include-pneumococcus, mycoplasma, haemophilus, staph, TB

110
Q

Treatment of pneumonia?

A

If viral- can go home
Ensure follow up if symptoms persist.
Amoxicillin is first line in bacterial.

111
Q

What is meningitis?

A

Can be bacterial or viral inflammation of the meninges.

Subtle symptoms especially in neonates.

112
Q

Presentation of meningitis?

Include signs

A

Irritability, abnormal cry, lethargy, difficulty feeding.

Signs- fever, seizures, apnea, bulging fontanelle, rash, neck stiffness, Kernigs sign, Brudzinski sign, photophobia.

113
Q

Septic signs of meningitis?

A

These more commonly present before menigeal signs.

- fever, cold hands/feet, limb and joint pain, abnormal skin colour, odd behaviour, rash, increased pulse, hypotension

114
Q

Treatment of meningitis

A

Pyogenic meningitis- urgent. NO TIME FOR GRAM STAIN. High flow oxygen.
Ceftriaxone >3 months- 18 years
Cefotaxime if <21 days old- 3 months + amoxicillin

115
Q

Life threatening symptoms of asthma?

A 
Cyanosis
Silent chest
Fatigue/exhaustion
Confused 
Decrease in consciousness

Peak flow <1/2 normal severe
<1/3rd normal- life threatening

116
Q

Presentation of pyloric stenosis

A

First born male infant- 3-6 weeks old.
Non-billious projectile vomit (occurs soon after feeding)
Upper abdominal mass
Peristaltic waves (uncommon presentation)- waves travelling from left to right across the body.

117
Q

Risk factors for pyloric stenosis?

A

First born male infant
Family history of pyloric stenosis
Weak risk factors- premature delivery, early exposure to erythromycin, maternal exposure to macrolides

118
Q

Investigations into pyloric stenosis

A

1st line- Ultrasound of the abdomen
Upper GI Xray after baby drinks contrast element
String sign/railroad track sign.

119
Q

Treatment of pyloric stenosis?

A

IV fluid resus

Pyloromyotomy

120
Q

Presentation of malrotation/volvulus?

A

Billious vomit
Abdominal pain
Other diagnostic factors- age <1 year, normal abdomen exam, distention, tenderness, tachycardia with either hyper or hypotension

121
Q

Risk factor for malrotation/volvulus?

A

Embryological abnormality

122
Q

Investigations into malrotation/volvulus?

A

CT of the abdomen with oral and IV contrast

FBC (elevated WBC, polycythaemia)

123
Q

Treatment of malrotation/volvulus?

A

If full obstruction- urgent open laparotomy and Ladd procedure
If intermittent or partial block- timely surgery: Ladd procedure

124
Q

What is intussuception?

A

Part of the intestine invaginate (folds into) another section. Like in a telescope.

125
Q

Presentation of intussusception?

A 
Age 6-12 months
Male gender
abdominal pain
Vomiting
Lethargy/irritability
Blood PR- current jelly stool
Hypovolaemic shock.

Other diagnostic factors- pallor, palpable abdominal mass, diarrhoea, poor feeding, abdominal distention

126
Q

Investigations into intussusception?

A

Xray of the abdomen
US
Diagnostic emena
Consider CT of abdomen

127
Q

Treatment of intussusception?

A 
IV resus
1st line- contrast enema reduction 
2nd line- surgical reduction
Consider broad spectrum AB
If it is recurrent-retreat and look for causes
128
Q

What are the contraindications to contrast enema reduction in intussusception?

A

Peritonitis, perforation and hypovolaemic shock

129
Q

Presentation of appendicitis?

A 
Abdominal pain
Anorexia (loss of appetite)
RLQ tenderness
Other diagnostic factors- adolescence or early adulthood
Nausea
Fever
130
Q

Investigations into appendicitis?

A

FBC (mild leucocytosis)
CT abdomen/pelvis (abnormal calcified appendix)
Pregnancy test negative
Consider US/MRI if pregnant

131
Q

Treatment of appendicitis

A

Appendectomy
Supportive care
If abscess present- perform drainage and give IV AB
If perforated- give IV AB

132
Q

Risk factors for appendicitis?

A

< 6 months breastfeeding
low dietary fibre
Smoking

133
Q

Presentation of testicular torsion

A 
Testicular pain
Intermittent pain
No pain relief upon elevation of the scrotum
Scrotal swelling or oedema
Scrotal erythema
Reactive hydrocele
HIGH RIDING TESTIS
HORIZONTALLY LYING
ABSENT CREMASTERIC REFLEX

Other diagnostic factors- nausea/vomiting, abdominal pain

134
Q

Risk factors for testicular torsion

A

Age <25 years
Neonate
Bell clapper deformity (anatomical anomaly that allows the testicles to rotate freely in the tunica vaginalis)

Weak risk factors- trauma/exercise, intermittent testicular pain, undescended testis, cold weather.

135
Q

Investigations into testicular torsion

A

Ultrasound

136
Q

Treatment of testicular torsion

A

Immediate urological consultation for emergency scrotal exploration

137
Q

Presentation of coeliac disease?

A 
Diarrhoea
Bloating
Abdominal pain
Weight loss
Failure to thrive/stunted growth
Tiredness
Vomiting
Malnutrition/anaemia
Itchy blistering rash on the elbows, knees and bum
138
Q

What skin disease is coeliac associated with?

A

Dermatitis herpeteforms (Itchy blistering rash on the elbows, knees and bum)

139
Q

Investigations into coeliac disease?

A

FBC- low heamoglobin- small red cells, anaemia
IgA tissue transglutimase- stay on gluten for testing and referred for duodenal biopsy
Endomysal antibody- elevated titre
Histology- Increased intra-epithelial lymphocytes- flatter villi
Clinical improvement on GF diet

140
Q

Treatment of coeliac disease?

A

Avoidance of gluten

141
Q

Symptoms of measles?

A

Symptoms start at 10 days after infection
Cold like symptoms followed by rash 2-4 days later
Cold like- blocked nose, watery eyes, cough, temperature, tired swollen eyes.
Mouthspots- before rash- grey/white
Rash- small, slightly raised red spots that may merge and be itchy.

142
Q

Complications of measles?

A

AOM
Hepatitis
Meningitis
Febrile seizures

143
Q

Investigations into measles?

A

Measles specific IgM and IgG serology

144
Q

Treatment of measles?

A

Relieve symptoms
Fluid intake
Usually clears up in 10 days
Avoid contact with others (highly contagious)

145
Q

Presentation of mumps

A 
Key feature- swollen parotid glands
Headache
Joint pain
Nausea
Vomiting
Dry mouth
Abdominal pain
Tiredness 
Loss of appetite
146
Q

What is mumps caused by?

A

Mumps virus

147
Q

Complications of mumps?

A 
Swollen testes (post puberty)
Swollen ovaries
Sickness, abdominal pain, tenderness
Viral meningitis- milder flu like symptoms, photophobia, neck stiffness, headaches
Pancreatitis
148
Q

What is the risk of mumps in pregnancy?

A

Increased risk of miscarriage

149
Q

Treatment of mumps?

A

symptomatic relief
Avoid contact
Usually passes within 2 weeks

150
Q

What virus causes rubella?

A

Togavirus (RNA virus)- incubation period of 2-3 weeks

Infectivity starts 5 days before and 5 days after the rash

151
Q

Signs of rubella?

A

Macular rash
Suboccipital lymphadenopathy
Thrombocytopenia

152
Q

Investigations into rubella?

A

Anti-rubella IgM

153
Q

Treatment of rubella?

A

Live virus immunisation

Supportive care

154
Q

Complications of rubella?

A 
Small joint arthritis
Malformations in utero
Infection in first 4 weeks- eye anomaly
Infection in 4-8 weeks- cardiac abnormalities
Infection in weeks 8-12- deafness
155
Q

What causes cystic fibrosis?

A

Autosomal recessive genetic condition where a mutation in the CF transmembrane conductance regulator gene (CFTR) on chromosome 7. Codes for cyclic AMP regulated sodium/chloride channel.

156
Q

Diagnosis of cystic fibrosis?

A

10% patients present with meconium ileum (failure to pass stools or vomiting in the 1st days of life) as neonates
Most present later with recurrent pneumonia (+/- clubbing), steatorrhoea, or slow growth

157
Q

Complications of cystic fibrosis

A 
Haemoptysis
Pneumonia
Pneumothorax
DM
Cirrhosis
Cholesterol gallstone
Male infertility
158
Q

Treatment of cystic fibrosis

A

Genetic counselling
Long survival depends on AB and good treatment
Physio 3 x daily
Flu vaccinations
Teach patients percussion and postural drainage
Forced expiration techniques.

159
Q

What common infections can you get with cystic fibrosis?

A

H influenza
Strep pneumoniae
Psuedomonas aureginosa

160
Q

What is rheumatic fever?

A

Systemic febrile illness caused by a cross sensitivity reaction to a group A beta haemolytic strep (in 2% of the population that are susceptible- may cause permanent heart damage)

161
Q

What is needed in addition to diagnostic criteria in rheumatic fever?

A

A preceding strep infection- scarlet fever, a throat swab with beta haemolytic strep or a throat swab with a titre>333.

162
Q

Major diagnostic criteria for rheumatic fever?

A

Using Jones diagnostic criteria
subcutaneous nodules
-erythema marginatum
Polyarthritis
Syndentians chorea (neurological disorder characterised by jerky hand movements affecting the shoulders, hips and face)
Carditis (1 of changed murmur, CCf, cardiomegaly, friction rub +echo)

163
Q

Minor diagnostic criteria for rheumatic fever?

A 
Fever
ESR>20mm or Raised CRP
Arthralgia-pain but no swelling
ECG- PR interval>0.2
Previous rheumatic fever or rheumatic heart disease.
164
Q

Prevention of rheumatic fever?

A

Primary- IM penicillin for sore throats
Secondary- symptoms worse on recurrence
Prevent with phenoxymethylpenicillin

165
Q

Treatment of rheumatic fever?

A

Rest/immobilisation affects joints and heart- NSAIDs or aspirin (high dose)
Severe- get help
Prednisolone may help
Penicillin for pharyngitis preceded by one dose of benzylpeniciilin

166
Q

What is respiratory distress syndrome?

A

Due to a deficiency of alveolar surfactant- mainly confined to premature babies
Insufficient surfactant leads to alveolar collapse- reinflation with each breath exhausts the baby- resp failure follows.
Hypoxia leads to decreased CO2, hypotension, acidosis and renal failure.

167
Q

Signs of respiratory distress syndrome?

A 
Resp distress shortly after birth
Tachyopnia (>60/min
Grunting
Nasal flaring
Intercostal recession and cyanosis
168
Q

What will a chest X ray show on a child with respiratory distress syndrome?

A

Diffuse granular patterns- ground glass appearance

169
Q

Prevention of respiratory distress syndrome?

A

Betamethasone or dexamethasone should be offered to all women at risk of preterm delivery (25-35 weeks)

170
Q

Treatment of respiratory distress syndrome?

A

Delay clamping of cord by 3 mins- promotes placental foetal transfusion
Give oxygen via an oxygen airbender
Wrap it up warm and put it in a ventilator
If blood gases worsen- intubate and support ventilation.

171
Q

What is necrotising enterocolitis?

A

Inflammatory bowel necrosis.

172
Q

Signs of necrotising enterocolitis?

A 
Mild- abdominal distention, a little blood, mucous PR
Severe- sudden abdominal distention, tenderness +/- perforation, shock, DIC (disseminated intravascular coagulation), wide spread activation of clotting cascade
Pneumonitis intestinal (gas in the gut wall seen on Xray.)
173
Q

Risk factors for necrotising enterocolitis?

A 
Prematurity
Enteral feeds
Bacterial colonisation
Mucosal injury
Rapid weight gain
174
Q

Treatment of necrotising enterocolitis?

A

Stop oral feeding (except oral probiotics)
Barrier nurse
Culture faeces
Crossmatch blood
Give AB- cefotoxime and vancomycin
Laparotomy indications- progressive distention and perforation.

175
Q

What is encephalitis?

A

Inflammation of the brain

176
Q

Symptoms of encephalitis?

A 
Flu like early symptoms
Decreased consciousness
Odd behaviour
VOmiting 
Fits
Fever
Meningism
177
Q

Infective causes of encephalitis?

A 
HSV
Mumps (ask about parotiditis and testicular pain)
Varicella zoster (recent chickenpox)
Rabies (dog bites)
Parovirus (slapped cheek syndrome)
Immunocompromised
Influenza
Toxoplasmosis
TB
Mycoplasma 
Malaria
178
Q

Investigations into encephalitis?

A 
CSF
PCR
Bloods
Stool 
Urine
179
Q

Treatment of encephalitis?

A

If HSV- treat with acyclovir

180
Q

Name some risk factors for having congenital heart disease?

A

Downs syndrome
Maternal rubella
Poorly controlled diabetes- type 1 or 2.

181
Q

How do you screen for congenital heart defects?

A

Ultrasound in 2nd trimester
If suspected- foetal echo
Postnatal clinical exam

If suspected defect- echo, cardiac catheterisation, ECG, chest Xray, O2 sats

182
Q

What will septal defects do to the blood flow?

A

Left to right shunts- increase in pulmonary pressure)

183
Q

What will co-arctation of the aorta do to blood flow?

A

Right to left shunts- deoxygenated blood reaching the aorta

184
Q

What will pulmonary valve stenosis do to blood flow?

A

Obstructive valvular and non-valvular lesions- coarctation of the aorta

185
Q

Transposition of the greater arteries (pulmonary and aortic arteries have swapped)

A

Obstructive valvular and non-valvular lesions- coarctation of the aorta
Pulmonary and aortic valve stenosis.

186
Q

Name the 5 primitive reflexes?

A 
Sucking and rooting
Palmar and plantar grasp
Asymmetrical tonic reflexes
Moro reflex
Stepping and pacing
187
Q

What is sucking and rooting?

A

When you stroke a childs cheek- they will turn towards that hand.
Also if anything touches the roof of the childs mouth- it will suck it.
Appears at 28 weeks (during pregnancy) and disappears at 4 months.

188
Q

What is palmar and plantar grasp?

A

Object is placed in an infants palm- they will close their fingers around it. Disapears at 3 months.

189
Q

What are asymmetrical tonic reflexes?

A

When the baby turns its head it thinks its about to fall so puts an arm out to catch itself. Disapears at 3 months.

190
Q

What is the moro relfex?

A

Occurs due to a change in temperature, startled by a loud noise or head suddenly changing position
Legs and head will extend while the arms jerk up and out palms up and thumbs flexed.
Disapears at 3 months

191
Q

What is stepping and pacing?

A

The babies feet reach a flat surface and it starts to put one foot infront of the other. Stops at 1-2 months.

192
Q

Phases of growth of a child?

A

Infant- nutrient led
Child- growth hormone led
Pubertal- sex steroid led

193
Q

What does breast milk contain?

A 
Immunological features
Anti-infective agents
Growth factors
Modulators of intestinal growth
Reduction in diarrhoea 
Reduction in respiratory meningitis
Colonic function
Reduction in atopic disease
194
Q

When should you breast feed a baby up too?

A

6 months

195
Q

What should you ween babies on to first?

A

Gluten free food
Salty foods should be avoided.
Also foods that may cause allergy should be avoided- gluten, eggs, nuts
Give foods rich in absorbable iron (red meat, canned fish)

196
Q

Infants not yet walking should have … physical activity?

A

floor based and water based activities in safe environments

Minimise time spent sedentary for extended periods

197
Q

Infants capable of walking (less than 5) exercise requirements?

A

180 mins throughout the day

198
Q

5-18 year olds physical requirements?

A

greater than 60 mins a day of moderate to vigorous physical activity
3 days a week need vigorous intensity activity.

199
Q

What is global developmental delay?

A

Significant delay in 2+ of gross/fine motor, speech/language, social/personal

200
Q

Give examples of motor developmental delay?

A

Duchennes muscular dystrophy

Cerebral palsy

201
Q

Give examples of a language developmental delay?

A

Specific language impairment

202
Q

Give examples of sensory deficits?

A

Oculocutaneous albinism

Treacher Collins

203
Q

Give examples of a developmental deviation?

A

Autism

204
Q

Red flags in developmental delay?

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 for 18 months
Concerns re vision and hearing
Loss of skills
205
Q

What should you include in a history of a child with susepcted developmental delay?

A 
PMH
Perinatal and birth
Family and social
Development
play and behaviour
School/nursery
206
Q

What is herd immunity?

A

Majority of population immunised which indirectly protects those who are not from the spread of infection,

207
Q

Elimination of disease?

A

Reduction to zero of incidence of a specified group (no new infections)
(neonatal tetanus)

208
Q

Eradication of disease

A

Permanent reduction to zero of worldwide incidence. (smallpox)

209
Q

Extinction

A

The specific infectious agent no longer exists in nature or a lab.

210
Q

What is passive immunity?

A

From mother to baby- transplacental passage of IgG

IgA from breast milk

211
Q

Live attenuated vaccine

A

Contain a version of the living virus that has been weakened e.g. MMR, varicella (chickenpox)

212
Q

Inactivated vaccines

A

Made by inactivating or killing the virus e.g. polio (antigen is still present just not living)

213
Q

Toxoid vaccines

A

Prevent diseases caused by bacteria that produce toxins. The toxins are weakened and cannot cause illness.
DtaP- contains diphtheria and tetanus toxins.

214
Q

Subunit vaccines

A

Vaccines that only contain part of the virus or bacteria. Only contain the essential vaccines

215
Q

Conjugate vaccines

A

Connect a sugar to a protein carrier. Attaching a polysaccharide antigen to a protein carrier the infants body already recognises.

216
Q

What would be worrying associated with headaches in children?

A 
Headache on waking
Worse on coughing
Associated vomiting esp in mornings
Visual disturbance 
Gait disturbance 
Cranial nerve palsy

Child health (3 decks)

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