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Paediatrics > Community > Flashcards

Community Flashcards

1
Q

What are the developmental domains?

A

Gross motor, fine motor/vision, hearing+speech/language, social

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2
Q

What should be the gross motor skills of a 6 week old?

A

Head lag still present

Head held in same plane in ventral suspension

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3
Q

What should be the fine motor/vision skills of a 6 week old?

A

Eyes follow an object past midline, maintains fixation

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4
Q

When should a baby have a social smile?

A

6 weeks

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5
Q

When should a baby be able to roll over?

A

6 months

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6
Q

When should a baby be babbling?

A

6 months

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7
Q

When should a baby be able to reach out for objects?

A

6 months

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8
Q

When should a baby be able to transfer objects from hand to hand?

A

6 months

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9
Q

When should a baby have good head control by?

A

6 months

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10
Q

When should a baby be cruising?

A

1 year

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11
Q

When should a baby have developed a pincer grip?

A

1 year

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12
Q

When should a baby wave goodbye?

A

1 year

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13
Q

When should a baby have 2 words with meaning?

A

1 year

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14
Q

When should a baby respond to simple instructions?

A

1 year

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15
Q

When should a child be able to kick a ball?

A

2 years

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16
Q

What are the gross motor skills of a 2 year old?

A

Climbs and descends stairs one step at a time, runs, kicks a ball

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17
Q

What are the fine motor skills of a 2 year old?

A

Copies vertical line and builds a tower of 6 bricks

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18
Q

What are the speech and hearing/language skills of a 2 year old?

A

Uses plurals/pronouns, selects toys from others, follows 2 step commands

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19
Q

What should be the social skills of a 2 year old?

A

Plays alone/alongside others

Eats with a spoon

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20
Q

What are the gross motor skills of a 3 year old?

A

Rides a tricycling, jumps, balance on one foot

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21
Q

What are the fine motor/vision skills of a 3 year old?

A

Copies a circle, matches 2 colours

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22
Q

What are the speech and hearing/language skills of a 3 year old?

A

3-4 word sentences

Knows 3 colours

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23
Q

What are the social skills of a 3 year old?

A

Out of nappies, eats with fork and spoon, separates from mother easily

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24
Q

What are the fine motor skills of a 4 year old?

A

Copies a cross and square

Draws man with 3 parts

Imitates bridge with 3 bricks

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25
Q

What are the speech/language skills of a 4 year old?

A

Counts to 10

Identifies several colours

Lots of questions

Tells story

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26
Q

What are the social skills of a 4 year old?

A

Shares toys

Out of nappies at night

Brushes teeth, toilets alone

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27
Q

What are the gross motor skills of a 5 year old?

A

Walks backwards/heel-toe

Bounces and catches a ball

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28
Q

What are the fine motor skills of a 5 year old?

A

Copies triangle

Draws man with six parts

Does buttons

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29
Q

What are the speech and language skills of a 5 year old?

A

Comprehension

Understanding of prepositions

Opposites

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30
Q

What are the social skills of a 5 year old?

A

Chooses friends, acts out role play, eats with knife and fork

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31
Q

What are some developmental screening tools?

A

Ages and stages questionnaire

Denver developmental assessment and schedule of growing skills

Bayley and Griffiths

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32
Q

What are the red flags in development?

A
  • Abnormal muscle tone
  • Any regression
  • Not able to hold object by 5 months
  • No smile by 6 months
  • Not sitting unsupported by 12 months
  • Not walking independently by 18 months
  • Hand preference before 18 months
  • No speech by 18 months
  • No interest in others at 18 months
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33
Q

What are some examples of primitive reflexes?

A

Grasp reflex, Moro’s, rooting reflex, stepping reflex

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34
Q

What is Gower’s sign?

A

Inability to get up from floor or squatting position without using hands - suggestive of muscular dystrophy

35
Q

What is cerebral palsy?

A

Persistent disorder of movement and posture caused by non progressive brain defects sustained before 2 year of age

36
Q

What are some prenatal causes of cerebral palsy?

A

APH with hypoxia, radiation, alcohol, intrauterine infection, rhesus disease

37
Q

What are some perinatal causes of cerebral palsy?

A

Prematurity, birth asphyxia, hypoglycaemia, hyperbilirubinaemia (kernicterus)

38
Q

What are some postnatal causes of cerebral palsy?

A

Trauma, IVH, hypoxia, meningoencephalitis

39
Q

What are the 4 main types of cerebral palsy?

A

Spastic, dyskinetic, ataxic and mixed

40
Q

What sort of lesion does a spastic CP suggest?

41
Q

What are the forms of spastic CP?

A

Spastic hemiplegia, spastic diplegia (legs worse than arms), spastic quadriplegia

42
Q

What sort of lesion does a dyskinetic CP suggest?

A

Extrapyramidal - damage to basal ganglia and thalamus

43
Q

What sort of movements do you get in dyskinetic CP?

A

Involuntary movements

  • Dystonia - twisting and repetitive movements
  • Athetosis - slow movements (athetoid - slow writing movements
  • Chorea - rapid random contractions of small muscle groups
  • associated with kernicterus
44
Q

What sort of lesion does an ataxic CP suggest?

A

Cerebellar

45
Q

How does ataxic CP present?

A

Hypo/hypertonia, speech difficulties, incoordination, poor balance and sense of position in space, intention tremor

46
Q

What is affected in quadriplegia?

A

Both arms and legs

Trunk, face and mouth also often affected

47
Q

What is affected in diplegia?

A

Both legs affected, arms may be affected but to a lesser extent

48
Q

What is affected in hemiplegia?

A

One side of the body

49
Q

Name some people who would be involved in the MDT care of a child with cerebral palsy

A

Community paediatrician, physiotherapist, occupational therapist, speech+language therapist, dietetics, psychology

50
Q

What is ASD?

A

A Neurodevelopmental disorder that affects a person’s social interaction, communication and behaviour

51
Q

What are the 3 core features of ASD?

A
  • Difficulties with social interaction
  • Difficulties with communication
  • Restricted, repetitive behaviours
52
Q

Name 3 people involved in the MDT looking after a child with autism

A

Community paediatrician or child psychiatrist, educational psychologist, speech therapist

53
Q

What are some management techniques for ASD

A

Behavioural management strategies - visual timetables, preparation and explanation for routine changes

Educational measures - higher needs funding, Education Health and Care Plan (EHCP)

Adequate treatment of comorbid conditions eg ADHD, mental health conditions, sleep disorders and learning diabilities

Speech therapy

54
Q

What is ADHD?

A

A neurobehavioral disorder characterised by hyperactivity, inattention and impulsivity

55
Q

What are the 2 main predictors of a poor prognosis in ASD?

A

IQ less than 50 and no communicative speech before the age of 5

56
Q

What are the 3 cardinal features of ADHD?

A

Hyperactivity, inattention and impulsivity

Must be present in more than one setting

57
Q

How should preschool children with ADHD be managed?

A

Parent training/education programme

Inform nursery teachers about diagnosis

Care plan and special educational needs

58
Q

How should mild-moderate ADHD in school-age children with moderate impairment be managed?

A

Behavioural strategies, CBT, social skills training

Medication - eg methylphenidate

59
Q

How should severe ADHD in school-age children with severe impairment be managed?

A

Medication - eg methylphenidate, atomoxetine

60
Q

What are some side effects of ADHD medication?

A

Hypertension, palpitations, disturbed sleep, impaired growth and appetite suppression, aggression

61
Q

What are some adverse outcomes associated with ADHD?

A

Increased substance abuse, more criminal convictions, lower educational attainment, unemployment

62
Q

What other conditions is ASD associated with?

A

ADHD, anxiety, oppositional defiant disorder, learning disability, sleep problems, sensory issues, GI distrurbance, epilepsy

63
Q

What are some risk factors for ASD?

A

Sibling with ASD, gestational age <35 weeks, parental schizophrenia or affective disorder, natural use of sodium valproate during pregnancy, learning disability, ADHD, fragile X, muscular dystrophy, neurofibromatosis, tuberous sclerosis

64
Q

What are some complications and comorbidities of cerebral palsy?

A

Feeding difficulties, drooling, aspiration, recurrent chest infection, GORD, constipation, incontinence, visual impairment, hearing impairment, epilepsy, learning disability, mental health problems, Neurodevelopmental disorders, pain, sleep disturbance

65
Q

What are some prognostic factors for whether a child with CP will be able to walk unaided by age 6?

A

If a child can sit at 2 years it is likely

If a child can’t sit but can roll at 2 years, it is possible

If a child cannot sit or roll at 2 years, it is unlikely that they will be able to walk unaided

66
Q

What factors should be managed in a child with CP?

A

Problems with eating, drinking and swallowing (SALT)

Problems with speech+language (SALT)

Nutritional status - measure height and weight - dietetics

Drooling - anticholinergics

Pain - MSK problems, tone, GORD etc

Sleep disturbances - optimise sleep hygiene, melatonin

Mental health problems

Constipation

Epilepsy

Carer - benefits, respite, education, support groups

67
Q

What is The Gross Motor Function Classification System (GMFCS)?

A

5‑level clinical classification system that describes the gross motor function of people with cerebral palsy based on self-initiated movement abilities. People assessed as level I are the most able and people assessed as level V are dependent on others for all their mobility needs.

68
Q

When is bedwetting considered to be normal?

A

In children younger than 5

69
Q

What are some causes of bedwetting?

A

Sleep arousal difficulties, polyuria, OAB, structural abnormalities, UTI, chronic constipation, neurological disorders

70
Q

How would you advise a parent whose child is wetting the bed below 5 years old?

A

Reassurance

  • Avoid caffeine and sodas before sleep
  • Encourage child to empty their bladder regularly during the day and before sleep (4-7 times)
  • Easy access to toilet or potty at night
  • Waterproof mattress and duvet cover
  • Positive reward systems, avoid punishment
71
Q

How can bedwetting be managed in a child older than 5 years if lifestyle measures fail?

A

Enuresis alarms, desxopressin in the short term

72
Q

When is a UTI considered atypical?

A

Serious illness

Poor urine flow

Abdominal or bladder mass

Raised creatinine

Sepsis

Failure to respond to treatment with suitable antibiotics within 48 hours

Infection with non-E.coli organisms

73
Q

When is UTI classed as recurrent?

A
  • 2 or more episodes of UTI with acute pyelonephritis

or

  • 1 episode of UTI with acute pyelonephritis plus 1 episode of UTI with cystitis

or

  • 3 or more episodes of UTI with cystitis
74
Q

What are the bacterial causes of UTI?

A
  • Escherichia coli (85-90%)
  • Proteus mirabilis
  • Staphylococcus saprophyticus
  • Pseudomonas
75
Q

What are some risk factors for UTI?

A 
Age <1 year
Female
White
Previous UTI
Voiding dysfunction
VUR
Sexual activity
No history of breastfeeding
Immunosuppression
76
Q

What are some complications of childhood UTI?

A

Renal scarring, VUR, hypertension, pre-eclampsia, renal insufficiency

77
Q

When should you suspect UTI in children aged below 3 months?

A

Fever, vomiting, lethargy, irritability, poor feeding, offensive urine

78
Q

How should a urine sample be obtained in an infant?

A

Clean catch urine sample - gentle suprapubic cutaneous stimulation using gauze soaked in cold fluid helps trigger voiding

Urine collection pads

79
Q

How is an upper UTI in children older than 3 months managed?

A

Cefalexin or co-amoxiclav

80
Q

How is a lower UTI in children older than 3 months managed?

A

Trimethoprim or nitrofurantoin

81
Q

When is a urinary tract ultrasound indicated?

A

During acute infection with atypical features

During acute infection with recurrent UTI in children younger than 6 months

6 weeks later in children under 6 months with first time UTI

6 weeks later in children older than 6 months with recurrent UTI

82
Q

What scan is used to detect renal parenchymal defects?

A

Dimercaptosuccinic acid scintigraphy (DMSA) scan

83
Q

When should a DMSA scan be done?

A

Within 4-6 months following the acute infection in all children under 3 years with atypical or recurrent UTI and all children over 3 years with recurrent UTI

84
Q

What screening tools can be used in ADHD?

A

Conners Questionnaire
Dundee Difficult Times of the Day Scale (D- DTODS)
SNAP–IV
Strengths and Difficulties questionnaire

Paediatrics (7 decks)

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