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Year 4 Paeds > Community > Flashcards

Community Flashcards

1
Q

At what age should a baby sit?

A

6 months rounded back

8 months straight back

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2
Q

At what age should a baby crawl?

A

Around 8-9 months

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3
Q

At what age should a baby cruise?

A

10 months

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4
Q

At what age should a baby walk?

A

Unsteadily at 12 months and steadily by 15 months

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5
Q

What milestone should occur at 6 weeks?

A

Follows object with head

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6
Q

What fine motor skill occurs at 4-6 months?

A

Palmar grasp

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7
Q

When should a child say their first words

A

7-10 months

Normally Mama / Dada

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8
Q

When should a baby smile?

A

6 weeks

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9
Q

When should a baby wave?

A

10-12 months

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10
Q

What is Child Health Surveillance?

A

Offers families a programme of

Screening tests
Immunisations
Developmental Reviews
Health Promotion (information and guidance)

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11
Q

Define: Delay, Learning Difficulty, Disability

A

Delay - slow acquisition (specifically or globally)

Learning Difficulty - in relation to children of school age, can be cognitive/physical/both

Disability - Any restriction/lack of ability due to impairment

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12
Q

Give two prenatal/perinatal/postnatal causes of abnormal development

A

Prenatal - Infection, Alcohol

Perinatal - Asphyxia, Intraventricular Haemorrhage

Post Natal - seizure

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13
Q

Define Developmental Delay

A

A delay in acquisition of all skill fields, normally becoming apparent in the first two years of life

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14
Q

Give 5 broad categories of investigations that could be done on a child with suspected Developmental Delay

A 
Cytogenic
Metabolic
Infection
Imaging 
Neurological
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15
Q

Describe some of the types of Abnormal Speech and Language

A
  • Pragmatically (difference between intention and meaning)
  • Phonation (Stammering)
  • Language Expression
  • Communication Skills
  • Language Comprehension
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16
Q

Give three causes of abnormal speech and language

A

Hearing Loss
Global developmental delay
Environmental deprivation

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17
Q

How could you test language in a child?

A

Early - Symbolic toy test

Pre-School - Reynell test of expressive and receptive language

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18
Q

Give three managements for speech and language delay

A

Speech and language therapy

Alternate methods of Communication (Makaton, Picture Exchange Communication System)

Learning support

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19
Q

Describe the four classes of Learning Difficulties

A

Mild - IQ70 to 80 (learning assistance in class)
Moderate - IQ50-70 (only emerge as speech and language do)
Severe - IQ35-50 (minimal self care)
Profound - IQ<35 (no significant language)

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20
Q

Define Dyspraxia and it’s management

A

Developmental Coordination Disorder

Disorder of motor planning and execution without significant neurological findings

Managed with therapy

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21
Q

Define Dyslexia and how it’s assessed

A

Disorder of reading skills disproportionate to child’s IQ (>2 years behind chronological age)

Assess vision and hearing, then further assessment by Educational Psychologist

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22
Q

Define Disorders of Executive Function

A

Responsible for planning,organisation,flexibility and problem solving

Often a consequence of acquired brain injury

Manifests as forgetfulness, volatile mood, poor social skills

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23
Q

Give three reasons a child may refuse meals

A

Past history of force feeding
Irregular meal times
Unreasonably large portions

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24
Q

Give three reasons a child may have difficulty sleeping

A

Overstimulation
Use of bedroom as punishment
Too much sleep late afternoon

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25
Q

How should aggressive behaviour be managed?

A

Often caused by learned behaviour

Unlikely to ‘grow out of it’

Encourage attendance of parenting programmes

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26
Q

Describe four general management recommendations for behavioural problems

A

Explanation and reassurance
Parenting groups
Family therapy
Psychodynamic psychotherapy

27
Q

Define Child Protection

A

Process of protecting individuals as they’re either suffering, or likely to suffer significant harm as a result of abuse or neglect.

28
Q

Give three child related risk factors and three adult related risk factors for child abuse

A

Child: Consistent Crying, Disabled, Unwanted

Adult: Mental Illness, Financial Difficulties, Own experience of child abus

29
Q

When should you suspect physical abuse in a child?

A

MOA not compatible with injury sustained
Inconsistent histories
Lack of parental concern

30
Q

Bruising is uncommon in a non mobile child. Give three differentials other than NAI.

A 
Bleeding Disorder (eg Haemophilia A)
Mongolian Blue Spot
Erythema Nodosum
31
Q

Name two injuries that can be seen in a ‘Shaken Baby’

A

Subdural Haematoma

Retinal Haemorrhages

32
Q

If a child presents with a query NAI to A&E, what four investigations should be carried out?

A

Skeletal Survey
CT Head
Ophthalmology
Coag Screen

33
Q

Define Neglect

A

Persistent failure to meet child’s basic physical or psychological needs that is likely to result in serious impairment of child’s health and development

34
Q

Define Emotional Abuse

A

Persistent non physical harmful interactions with child by care giver

35
Q

Define Sexual Abuse

A

Physical contact (penetrative and non penetrative) , exposure to explicit material and sexual exploitation

36
Q

Define ADHD and give three possible aetiologies

A

Neurobehavioural disorder characterised by Hyperactivity, Inattention and Impulsivity

Neurochemical abnormalities (increased Dopaminergic)
Neurodevelopmental abnormalities of prefrontal cortex
Social Factors (eg deprivation)
37
Q

Describe the ICD10 criteria of ADHD

A

A: Abnormality of attention/impulsivity and hyperactivity at home
B: The above at school
C: The above directly observed
D: Doesn’t meet criteria for mania/depression/anxiety
E: Onset <7y
F: Duration >6 months
G: IQ>50

38
Q

Give three differentials for ADHD

A

Auditory Processing Disorder

Oppositional Defiant Disorder

Conduct Disorder

39
Q

How is suspected ADHD investigated?

A

Conners Questionnaire

Collateral Histories

Direct Observations

40
Q

Describe the management of ADHD

A

Preschool - parent training/education, involvement of teachers

School Age (Mild) - Behavioural Strategies, CBT

School Age (Severe) - Medication

41
Q

The first line pharmacological management for ADHD is stimulant medication. Give an example and two related side effects.

A

Methylphenidate

Palpitations, Disturbed sleep

42
Q

Define Autism Spectrum Disorder

A

Pervasive developmental disorder characterised by triad of impairment in social interaction, communication and stereotyped interests

43
Q

Outline the ICD10 criteria for Autism

A

A - Presence of abnormal/impaired development before the age of 3
B - Qualitative abnormalities in social interaction
C - Qualitative abnormalities in communication
D - Restrictive/Repetitive stereotyped behaviours
E - Not attributable to anything else

44
Q

Give three differentials for Autism Spectrum Disorder

A

Learning difficulties
Retts Syndrome
Schizophrenia

45
Q

How is ASD managed?

A

Parent support groups

Behavioural techniques (visual timetables, preparation and explanation for changes in routine)

Educational measures

46
Q

Define Cerebral Palsy

A

A chronic disorder of movement and or posture that presents early (before the age of two) continuing throughout life due to static injury to brain

After the age of two - acquired brain injury

47
Q

What are the causes of Cerebral Palsy?

A

Antenatal - Vascular Occlusion, Genetic Syndromes, Congenital Defects

Hypoxic Ischaemic Injury in Pregnancy

Postnatal- Meningitis, Encephalitis, Hypoglycaemia

48
Q

Why are premature babies more at risk of Cerebral Palsy?

A

Due to Periventricular Leukoplacia, secondary to IVH

49
Q

Give 4 early features of cerebral palsy

A

Feeding difficulties
Abnormal Gait
Persistence of Primitive Reflexes
Not meeting developmental milestones - not sitting unaided at 8m, not walking by 18m, preference of hand before one year

50
Q

90% of cases of Cerebral Palsy are ‘Spastic Type’ due to UMN damage. How would this present?

A
  • Velocity dependent resistance to passive stretch
  • Increased tone and reflexes
  • Clasp Knife Phenomenon
  • Hips wrist and elbows often flexed

May involve bulbar muscles (dysphagia and dribbling)

51
Q

What are the three subtypes of Spastic Cerebral Palsy

A

Hemiplegic - unilateral arm and leg affected, face spared

Quadriplegia - all four limbs and trunk involved

Diplegia - All four limbs but legs more affected

52
Q

6% of Cerebral Palsy Cases are the Choreoathetosis Type. How does this present?

A

Involuntary movements with Chorea and Athetosis (twisting and writhing)

Usually bulbar involvement

Increased reflexes

53
Q

After being diagnosed by history and MRI, Cerebral Palsy can be classified by ‘Gross Motor Function Classification System’. Outline this

A 
I - Walks without limitations
II- Walks with limitations
III- Walks using handheld mobility device
IV-  Self mobility with limitations
V- Manual Wheelchair
54
Q

The majority of management for Cerebral Palsy is non pharmacological and occupational. What surgical management can be done?

A

Botox to Gastrocnemius

Muscle Lengthening

Osteotomy

Dorsal Rhizotomy - Severing nerve fibres at the spinal cord to reduce spasticity

55
Q

Define Anorexia Nervosa

A

Eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image and endocrine disturbances

56
Q

Give a predisposing and perpetuating risk factor for Anorexia Nervosa

A

Predisposing - Female

Perpetuating - Starvation induces neuroendocrine changes that perpetuate anorexia

57
Q

Describe the ICD10 criteria for Anorexia Nervosa

A
  • Present for Atleast 3 months in the absence of bingeing
  • Fear of weight gain
  • Endocrine disturbance resulting in Amenorrhoea/Impotence
  • Emaciated (<17.5kg/m2)
  • Deliberate weight loss and distorted body image
58
Q

State four investigations for suspected Anorexia Nervosa

A

Bloods (Increased Urea, Decreased Electrolytes, Low Albumin)

VBG (Alkalosis from vomit, acidosis if laxatives)

DEXA

ECG

59
Q

How would you manage Anorexic patients?

A

Weight gain (0.5kg/week OP or 1kg/week IP)
CBT
Interpersonal Therapy
ANFFT

60
Q

What forms of Substance Misuse are the most common in adolescents?

A

Alcohol and Cannabis

61
Q

Children who are abusing substances may not present directly intoxicated. How else may they present?

A

Unexplained absences from school

Stealing money

Medical complications associated with use

62
Q

Name three specific fractures associated with NAI

A

Metaphyseal Corner Syndrome

Rib fractures

Spiral fractures

63
Q

Give an outline of the HEADSSS assessment for adolescents

A 
H - Home
E - Education/Employment
A - Activities
D - Drugs/Smoking/Alcohol (particularly ruling out trafficking, slavery or abuse)
S - Sex and Relationships
S - Self harm and depression
S - Safety

Year 4 Paeds (15 decks)

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