Children's Health Flashcards
Recall the 5 age ranges that paediatric patients are divided into
- Neonate - Birth to 1 month
- Infant - 1 Month to 2 years
- Young child - 2 to 6 yeas
- Child - 6 to 12 years
- Adolescent - 12-18 years
Why is the use of closed questions even less reliable when working with children?
Children will often say yes to closed questions with the intention of pleasing the examiner
An infant should have received all of their vaccinations for rotavirus by what age?
12 weeks
At the age of 2 months what hearing, language and communication milestones would the infant be expected to have reached? (2)
- Coo’s and gurgling sounds
2. Turns head towards sounds
At the age of 8 months what hearing, language and communication milestones would the infant be expected to have reached? (2)
- Understands ‘No’
2. Mamma and Dadda sounds
At the age of 18 months what hearing, language and communication milestones would the infant be expected to have reached? (2)
- Can say 10 words
2. Says No and shakes head
At 3 years of age what hearing, language and communication milestones would the child be expected to have reached? (2)
- Understand words such as in/on/under
2. Carries on a conversation using 2-3 sentences
At the age of 2 months what social and emotional milestones would the infant be expected to have reached? (3)
- Begins to smile at people
- Tries to look at parents
- Sucks on hand to self soothe
At the age of 8 months what social and emotional milestones would the infant be expected to have reached? (2)
- Stranger awareness
2. Has a favourite toy
At the age of 18 months what social and emotional milestones would the infant be expected to have reached? (2)
- Temper tantrums
2. Points to show something interesting
At 3 years of age what social and emotional milestones would the infant be expected to have reached? (3)
- Copies adults and friends
- Takes turns playing games
- Shows concern for friends crying
At the age of 2 months what cognitive and fine motor milestones would the infant be expected to have reached? (2)
- Begins to following things with eyes
2. Begins to act bored
At the age of 8 months what cognitive and fine motor milestones would the infant be expected to have reached? (3)
- Transfers from one hand to another
- Picks up cereal between thumb and index finger
- Plays peek a boo
At the age of 18 months what cognitive and fine motor milestones would the infant be expected to have reached? (2)
- Follow one step verbal commands
2. Scribble on own
At 3 years of age what cognitive and fine motor milestones would the infant be expected to have reached? (2)
- Does jigsaw of 3-4 pieces
2. Copies a circle with a pencil
Recall the normal ranges of a 1 minute respiratory rate in each of the 5 paediatric age ranges
- Neonatal: 30-39
- Infant: 25-34
- Young Child: 20-29
- Child: 20-29
- Adolescent: 15-24
Recall the normal ranges for heart rate in each of the 5 paediatric age ranges
- Neonatal: 110-159
- Infant: 100-149
- Young child: 80-119
- Child: 70-119
- Adolescent: 65-99
Recall the normal ranges for systolic blood pressure in each of the 5 paediatric age ranges
- Neonatal: 60 and above
- Infant: 70 and above
- Young child: 85 and above
- Child: 90 and above
- Adolescent: 90 and above
What is the most common cause of congenital cataracts?
Intrauterine infections e.g. rubella
On examination of a neonate, what is the top differential to consider when you observe asymmetrical thigh creases?
Unilateral dislocation of the hip
During paediatric CPR, which vessels should be used to check for circulation? (2)
- Infant - Brachial or femoral
2. Child - Carotid or femoral
What is the CPR ratio protocol for a child or infant?
- Initiate with 5 rescue breaths
- Complete 15 chest compressions
- Continue cycles of CPR at a 2:15 ratio
What is the most likely cause of cardiac arrest in children?
Asphyxiation
What part of the physical examination is contra-indicated when examining a child with a suspected upper airway obstruction?
Examination of the throat as this risks exacerbating the obstruction
Suggest 6 possible differential diagnoses for an infant presenting with stridor
- Viral croup
- Epiglottitis
- Foreign body aspiration
- Anaphylaxis
- Bacterial tracheitis
- Laryngomalacia
Define haemangioma
Benign vascular lesions that typically appear during the first weeks of life - seen as pink or blue macules / patches
What is the first line treatment for a haemangioma?
Systemic beta blockers e.g. propanolol
Describe the natural course of a haemangioma
Enlarges steadily over the first 12-24 months of life
What are the 5 principle clinical features associated with mucopolysaccharidoses?
- Hepatosplenomegaly
- Neurodevelopmental delay
- Cardiorespiratory disease
- Joint contractures
- Failure to thrive
Mucopolysaccharidoses is a form of what type of metabolic disorder?
Hereditary lysosomal storage disease
The red flag symptom: ‘Bile stained vomit’ in the scenario of a vomiting child is indicative of what condition?
Intestinal obstruction
The red flag symptom: ‘Haematemesis’ in the scenario of a vomiting child could be indicative of which condition? (3)
- Oesophagitis
- Peptic ulceration
- Oral/ nasal bleeding
The red flag symptom: ‘Projectile vomiting in the first weeks of life’ in the scenario of a vomiting child could be indicative of which condition?
Pyloric stenosis
The red flag symptom: ‘Vomiting at the end of paroxysmal coughing’ in the scenario of a vomiting child could be indicative of which condition?
Whooping cough (pertussis)
The red flag symptom: ‘Blood in the stool’ in the scenario of a vomiting child could be indicative of which condition? (2)
- Intussusception
2. Gastroenteritis - Salmonella or Campylobacter
What is Intussusception?
The prolapse of one part of the intestine into the lumen of a distal adjoining section which leads to intestinal obstruction in infants between 3 and 12 months
The red flag symptom: ‘Bulging fontanelle or seizures’ in the scenario of a vomiting child could be indicative of which condition?
Raised intracranial pressure
Give 5 potential complications of gastro-oesophageal reflux in infants
- Failure to thrive due to severe vomiting
- Oesophagitis (may also be coupled with an iron deficiency anemia)
- Recurrent pulmonary aspirations
- Dystonic neck posturing (Sandifer syndrome)
- Apparent life threatening events (ALTE)
Name a H2- receptor anatagonist that can be used in the treatment of GORD
Ranitidine
Name a drug that can be used to enhance gastric emptying
Domperidone
Give 3 clinical signs associated with pyloric stenosis
- Visible gastric peristalsis
- Palpable abdominal mass
- Dehydration
What is the typical age of onset of croup?
6 months - 3 years
What dose of adrenaline is used in the immediate management of moderate to severe croup in the hospital setting?
Nebulised adrenaline 5mls 1:1000
What dose of oral steroids should be given in the management of severe croup?
Single dose of dexamethasone 0.15mg/kg (can be repeated 12 hours later)
The term anaphylaxis describes what clinical state? (3)
Hypotension, Bronchoconstriction and/or airway obstruction
What 4 questions must you ask when assessing a child’s risk of future anaphylactic reactions?
- Does the child have asthma?
- If they have asthma, what treatment to they receive?
- Do they take a regular preventer inhaler?
- Before the initial reaction, how much of the allergen/ foodstuff had they been in contact with?
Define type II hypersensitivity
Cytotoxic, antibody dependent hypersensitivity
Define type III hypersensitivity
Immune complex disease caused by IgG
Define type IV hypersensitivity
T cell mediated delayed hypersensitivity. (Antibody independent)
Name the 2 immune mediators that are released by Mast cells
- Prostoglandins
2. Histamine
What are the 4 main physiological actions of histamine?
- Localised irritation
- Endothelial cell separation
- Bronchoconstriction
- Vasodilation
Outline the 6 criteria to consider when prescribing an adrenaline pen
- History of anaphylaxis
- Previous cardiovascular/ respiratory involvement
- Evidence of airway obstruction
- Poorly controlled asthma requiring regular inhaled corticosteriods
- Reaction to a small amount of allergen
- Ease of allergen avoidance
Outline the characteristics of a ‘spontaneous effective cough’ in a child with a foreign body aspiration (4)
- Crying or verbal response to questions
- Loud cough
- Able to take a breath before coughing
- Fully responsive
What intervention should be administered to a conscious child who is choking and exhibits an ‘ineffective cough’ ?
Cycles of 5 back blows followed by 5 thrusts
What is another term for croup?
Laryngotracheobronchitis
What is the most common causative organism of croup?
Parainfluenza virus
What age group are at risk of developing croup?
Children under the age of 6
Recall the ‘mediator’ implicated in each of the 4 classifications of hypersensitivity reaction
Type I - IgE
Type 2 - IgM
Type 3 - IgM
Type 4 - T cells
A penicillin allergy is an example of which type of hypersensitivity reaction?
Type 2 - IgM mediated
Serum sickness ( in response to the therapeutic use of anti-venom) is an example of which type of hypersensitivity reaction?
Type 3 - IgM mediated
Outline 4 potential symptoms that are caused by the deposition of antigen- antibody complexes during a type III hypersensitivity reaction
- Fever
- Vasculitis
- Arthritis
- Nephritis
What are the most common inhaled foreign objects seen in children?
Nuts and seeds
What is the most common birth defect?
Congenital heart disease
Are left to right shunts cyanotic or acyanotic CHD’s?
Acyanotic
What is Eisenmenger’s physiology?
The evolution of an acyanotic CHD to a cyanotic lesion as a result of pulmonary vascular obstructive disease. (i.e. shunt reversal).
Recall the 5 examples of left to right shunting congenital heart lesions
- Ventricular septal defect (VSD)
- Atrial septal defect (ASD)
- Atrioventricular septal defect (AVSD)
- Patent ductus arteriosus (PDA)
- Partial anomalous pulmonary venous connection (PAPVC)
Name 2 obstructive valvular lesions that are seen as congenital heart defects
- Pulmonary valve stenosis
2. Aortic valve stenosis
Name 2 obstructive non-valvular lesions that are seen as congenital birth defects
- Left ventricular outflow tract obstruction
2. Coarctation of the aorta
What is the most common form of congenital heart defect?
Ventricular septal defect
List 4 subtypes of ventricular septal defect
- Perimebranous
- Outlet
- Inlet
- Muscular
Suggest 5 clinical signs which may indicate excess pulmonary blood flow in a newborn
- Tachypnoea
- Tachycardia
- Pallor
- Poor feeding
- Poor weight gain
During a CV examination what are the 3 principle indicators of a VSD?
- Low to mid frequency pansystolic murmur
- Prominent precordial impulse
- Loud/single second heart sound ( in those with pulmonary hypertension)
What characteristics of a VSD may be visible on CXR? (2)
- Cardiac enlargement
2. Increased pulmonary vascular markings
Are atrial septal defects more common in male or female newborns?
Female to male predominance of 2:1
What is the most common subtype of atrial septal defect?
Ostium secundum defect
In what area does an ostium primum atrial septal defect occur?
In the inferior aspect of the atrial septum
Name the 4 subtypes of atrial septal defect
- Ostium secundum
- Ostium primum
- Sinus venosus
- Unroofed coronary sinus
What are the 4 main clinical characteristics of an undiagnosed ASD that only becomes symptomatic later in life?
- Exercise intolerance
- Atrial arrhythmia
- Increased pulmonary blood flow
- Pulmonary vascular obstructive disease (Eisenmenger’s Syndrome)
What form of congenital heart disease is found in around ~40% of individuals with Down’s syndrome?
Atrioventricular septal defect (Endocardial cushion defect)
What is the incidence of a patent ductus arteriosus in full term infants?
Occurs in 1 in 5000 live births
Give 2 circumstances that increase the likelihood of a newborn having a patent ductus arteriosus
- Pre-term
2. Born at high altitude
Name 2 medications that can be used to close a patent ductus arteriosus in pre-term infants
- Ibuprofen
2. Indomethacin
What is Scimitar syndrome?
Syndrome characterised by anomalous venous return from the right lung into the systemic venous drainage instead of directly into the left atrium
Outline the 4 abnormalities that make up the Tetralogy of Fallot
- Outlet ventricular septal defect
- Right ventricular outflow tract obstruction
- Overriding aorta
- Right ventricular hypertrophy
What compound can be used to maintain the patency of the ductus arteriosus?
Prostaglandin E1
Name 3 anomalies that have an association with truncus arteriosus
- DiGeorge Syndrome
- Interrupted aortic arch
- Truncal valve insufficiency
Define Ebstein’s anomaly
Malformation of the tricuspid valve - delamination of the valve leaflet leads to severe valvular regurgitation
Broadly outline hypoplastic left heart syndrome
Spectrum of lesions that consist of an intact ventricular septum with under development of the left ventricle, mitral and aortic valves
Approximately what percentage of the general population have a bicuspid aortic valve?
2%
What form of congenital heart abnormality is associated with William’s syndrome?
Supravalvular aortic stenosis
Aortic coarctation has an association with which genetic condition in females?
Turner’s syndrome
Pulmonary valve stenosis has the strongest association with which genetic syndrome?
Noonan syndrome
Up to one month of age, what is the minimum milk requirement in order to provide the infant with enough calories to grow?
150 mls/kg/day
Give 3 complications that have been linked with an excess maternal sugar intake
- Increased risk of gestational diabetes
- Preeclampsia
- Pre-term birth
Give 2 complications associated with prolonged rupture of the membranes during labour
- Oligohydramnios
2. Increased incidence of neonatal infection
Which 9 diseases does the the newborn blood spot (heel prick) test screen for?
- Sickle cell disease
- Cystic fibrosis
- Congenital hypothyroidism
- Inherited metabolic diseases (6)
Recall the inherited metabolic diseases that are tested for with the newborn blood spot test (6)
- Phenylketonuria (PKU)
- medium chain acetyl-CoA dehydrogenase deficiency (MCADD)
- Maple syrup urine disease (MSUD)
- Isovaleric acidemia (IVA)
- Glutaric aciduria type 1 (GA1)
- homocystinuria (HCU)
Compare the relative congenital risk of gestational and pregestational diabetes
Only pregestational diabetes confers an increased risk of the foetus developing a congenital abnormality. Gestational diabetes offers no additional risk of congenital abnormality
Outline the 8 principle factors to consider when assessing an unwell infant from the end of the bed (8)
- General dysmorphism
- Neurological status
- Colour
- Any extra noises? e.g. Grunting, stridor, wheeze or crying
- Signs of pain
- Any obvious marks or rashes
- Any secretions - eyes, nose or mouth
- Any signs of increased work of breathing
During auscultation of a newborn , listening over which area will accentuate the murmur of a PDA?
Listen over the left scapula
What is a Mongolian blue spot?
A form of benign congenital birth mark - more prevalent in babies of colour
Suggest 6 potential medical causes of increased sleepiness in an infant
- Hypoglycaemia - due to poor feeding
- Exhausted - due to work of breathing and feeding
- Encephalopathic due to infection
- Encephalopathic due to ammonia build up secondary to a metabolic condition
- Neurological secondary to head injury
- Hypoxia
Name the 2 congenital heart abnormalities that can result in a ‘small heart size’ on CXR
- Tetralogy of Fallot
2. TAPVD
Name the 2 congenital heart abnormalities that are NOT expected to alter the size of the heart on CXR
- TGA
2. Pulmonary atresia
What type of murmur is associated with a VSD?
Holosytolic murmur
What is the most likely section in which a VSD may be found
Along the length of the membranous septum (superior section of the ventricular septum)
Over what age does oedema become part of the clinical presentation of heart failure?
2-3 years of age. Children younger than this may present with heart failure in the absense of pulmonary oedema
Why are the ACE inhibitors Captopril and Enalapril the most commonly used in paediatrics?
They are shorter acting than other ACE inhibitors
The embryological ‘cardiac tube’ is formed from what cell type?
Mesenchymal cells from the splanchnic mesoderm
What are the 2 main stages of cardiac tube development?
- Looping
2. Septation
Name 2 acquired heart conditions that are seen in children
- Myocarditis
2. Rheumatic heart disease
What are the 2 different means of forming a antenatal diagnosis of a congenital heart disease?
- Routine scan
2. Family Hx of 1st degree relative
What are the examination findings on palpation and auscultation of an individual with a PDA? (2)
- Bounding pulse
2. Continuous (systolic and diastolic) ‘machinery-like’ murmur
Name 2 other congenital abnormalities that have an association with coarctation of the aorta
- Bicuspid aortic valve
2. VSD
Give 2 examination findings commonly associated with coarctation of the aorta
- Weak or absent femoral pulses
2. Systemic hypertension of the upper limbs
Coarctation of the aorta leaves newborns at an increased risk of developing which medical condition?
Necrotising enterocolitis - as a result of a reduced blood supply to the gut
List the 4 main features of the clinical presentation of an infant with Fallot’s tetralogy
- Central cyanosis
- Pulmonary oligaemia on CXR
- Hypercyanotic episodes
- Loud ejection systolic murmur ( due to pulmonary stenosis)
Name 2 chromosome abnormalities that have an association with coarctation of the aorta
- Turner’s syndrome
2. DiGeorge’s syndrome (22q11 deletion)
Name 5 genetic conditions that have an association with some form of congenital heart defect
- Trisomy 13 - Patau syndrome
- Trisomy 18 - Edward syndrome
- Turner’s syndrome
- Kartagener’s syndrome
- DiGeorge’s syndrome
Recall 5 clinical signs associated with Down’s syndrome
- Hypotonic
- Flat occiput
- Single palmar creases
- Incurved fifth finger
- Wide ‘sandal gap’ between the big and second toe
Give 3 medical conditions for which children with Down’s syndrome have an increased risk of developing
- Hypothyroidism
- Vision and/or hearing loss
- Atlanto-axial instability
What is the most common cytogenetic causal mechanism of trisomy 21?
Meiotic non disjunction
Name 2 gastrointestinal anomalies that have a higher incidence in patients with Down’s syndrome
- Duodenal atresia
2. Hirschsprung disease
Normally when is the ductus arteriosus expected to close?
~ 3 days after birth
Name the 6 most commonly implicated viruses in childhood respiratory tract infections
- Respiratory syncytial virus
- Rhinovirus
- Parainfluenza
- Influenza
- Metapneumovirus
- Adenoviruses
Give 4 types of upper respiratory tract infection seen in children
- Common cold (coryza)
- Sore throat (pharyngitis - including tonsillitis)
- Acute otitis media
- Sinusitis
Describe the clinical sign Harrison’s sulci and give 2 differentials that it may indicate
Groove at the lower edge of the rib margin - seen when the lower chest is drawn in. Can be seen in:
- Infants with abnormally weak bones e.g. Rickets
- Chronic respiratory disease e.g. severe asthma
According to the british thoracic society guidelines on the management of pneumonia in children, the presence of which 3 clinical features is sufficient for a working diagnosis of bacterial pneumonia?
- Persistent or repetitive fever >38.5
- Chest recession
- Raised respiratory rate
Oxygen therapy should be considered for childhood pneumonia if saturations fall below what level?
< 92 Sp02
What is the first line antibiotic used in the treatment of community acquired pneumonia in children?
Amoxicillin
What additional therapy should be offered to a child with community acquired pneumonia not responding to first line empirical therapy?
Macrolide antibiotic
CAP in children caused by either mycoplasma or chlamydia should be treated with which antibiotics?
Macrolide antibiotic
CAP in children caused by influenza should be treated with which antibiotic?
Co-amoxiclav
Give 3 appropriate investigations for a child presenting with recurrent lower respiratory tract infections and possible bronchiectasis
- Sweat chlorine test - to rule out CF
- CT scan of the chest
- Measure serum immunoglobulin levels
What is the inheritance pattern of cystic fibrosis?
Autosomal recessive
Where does the mutation for cystic fibrosis occur?
On the long arm of chromosome 7 - this results in abnormal synthesis of the cystic fibrosis transmembrane regulator protein (a form of chloride channel).
Outline the 4 components of the ‘classical’ presentation of a patient with CF
- Child aged 0-2
- Recurrent chest infections
- Large offensive stools
- Failure to thrive
Name 3 organisms for which CF patients have a predisposition for developing chronic infections of
- S.Aureus
- H. Influenza
- Pseudomonas Aeruginosa
Name a prophylactic oral antibiotic that can be used in the management of CF
Flucloxacillin
List 7 organs that can be affected by cystic fibrosis
- Sinuses - sinusitis
- Lungs
- Skin
- Pancreas - blocked pancreatic ducts
- Liver - blocked biliary ducts
- Intestines - cannot fully absorb nutrients
- Reproductive organs - infertility in men (due to absence of vas deferens) and subfertility in females
What is Mounier-Kuhn syndrome?
A rare condition characterised by tracheobronchial dilatation and recurrent lower respiratory tract infections
What are cromones and give 2 examples
Form of anti-allergic medication - act as mast cell stabilisers i.e. to reduce severity of an allergic response. Examples of this drug class include: Cromoglicate and nedocromil
List 5 examples of non atopic (intrinsic) asthma exacerbators
- Stress
- Exercise
- Occupational exposure
- Aspirin
- Cold
Name the 3 layers that make up the mucosa of the respiratory tree
- Epithelium
- Basement membrane
- Lamina Propria
Compare the relative levels of eosinophils present in asthma and chronic bronchitis
Elevated levels of eosinophils seen in asthma. Chronic bronchitis has no affect on eosinophil production
Which cell type is responsible for the the late phase reaction as part of the pathophysiology of asthma?
Eosinophils