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Community Flashcards

1
Q

developmental delay define

A

a delay in two or more areas - gross motor, fine motor, speech and language, social and emotional

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2
Q

developmental delay risk factors/causes

A

neurological - spina bifida, intraventricular haemorrhage, stroke
infection - herpes, HIV, meningitis
neuromuscular - SMA, duchenne muscular dystrophy
others - hypothyroid, downs, autism, phenylketonuria, prematurity

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3
Q

types of delay

A

single area or generalised

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4
Q

red flags of developmental delay

A

not smiling - 10 weeks
not sitting unsupported - 12 months
not walking - 18 months
showing hand preference - 12 months
not knowing 2-6 words - 18 months

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5
Q

where refer developmental delay

A

paediatric specialist assessment

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6
Q

investigations developmental delay

A

FBC, folate and B12 - iron defiency, pernicious
U+E - renal failure and low sodium
CK - DMD
TFT - congenital hypothyroidism
LFT - metabolic disorder
vit D - low
hearing test
can perform karyotyping

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7
Q

head lag when pulled up

A

1 month

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8
Q

no head lag, lifts head and chest when prone

A

3 months

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9
Q

stands and sits with straight back when held
bears most of own weight

A

6 months

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10
Q

sits withut support, moves around floor

A

9 months

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11
Q

stands without support, crawls/bottom shufflers, walk unsteadily

A

12 months

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12
Q

better walking

A

15 months

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13
Q

walks steadily, climbs stairs holding a hand

A

18 months

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14
Q

runs safely, throws balls

A

24 months

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15
Q

jumps on2 feet, kicks ball

A

30 months

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16
Q

walks backwards and sideways, catches large balls

A

36 months

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17
Q

runs up and down stairs, on tiptoes

A

48 months

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18
Q

hops, catches ball, heel toe walking

A

5 years old

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19
Q

grabs finger when placed in palm

A

1 month

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20
Q

holds toy briefly

A

3 months

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21
Q

palmar grasp, puts objects in mouth

A

6 months

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22
Q

pincer grip

A

9 months

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23
Q

release objects intentionally, points

A

12 months

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24
Q

builds tower of 2 cubes

A

15 months

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25
Q

tower of 3 blocks

A

18 months

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26
Q

tower of 6 blocks, draw horizontal line

A

24 months

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27
Q

tower of 7 blocks, tripod grip

A

30 months

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28
Q

draws circle

A

36 months

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29
Q

draws cross

A

42 months

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30
Q

draws square

A

48 months

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31
Q

draws triangle, use knife and fork

A

60 months

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32
Q

cries

A

newborn

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33
Q

coos

A

6-8 weeks

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34
Q

laughs and vocalises

A

3 months

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35
Q

understands mama, dada, babbles

A

6 mths

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36
Q

imitates adult words, understand simple commands

A

9 months

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37
Q

responds to own name, uses 2-6 words

A

12 mths

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38
Q

uses 6-40 words, tries to sing

A

18 mths

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39
Q

speaks over 200 words, joins words

A

24 mths

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40
Q

continually asks questions

A

30 months

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41
Q

name 2/3 colours, simple conversations

A

36 mths

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42
Q

talks fluently, enjoys jokes

A

48 mths

43
Q

fluent in speech, gramatically correct

A

60 mths

44
Q

responds to being picked up

A

newborn

45
Q

gazes at adult faces

A

6 weeks

46
Q

smiles at familiar faces

A

3 mths

47
Q

feeds self with fingers

A

6 mths

48
Q

waves bye, plays peek a boo

A

9 mths

49
Q

drink from a cup with 2 hands, separation anxiety

A

12 mths

50
Q

uses spoon, eager to independent

A

18 mths

51
Q

displays tantrums, express feelings

A

24 mths

52
Q

may use toilet independently, parallel play

A

30 mths

53
Q

shows affection for younger siblings, toilet trailed, has friends

A

36 mths

54
Q

eats skilfully, brushes own teeth, takes turn

A

48 mths

55
Q

shows sympathy, likes and dislikes, engages in play co-operatively

A

60 mths

56
Q

fascinated by human faces, turns head to light

A

newborn

57
Q

startles at loud noises

A

1 mth

58
Q

focuses eyes on sampe oint, moves head deliberately

A

3 mths

59
Q

adjusts position to see objects

A

6 mths

60
Q

sees almost as well as adult
knows and responds to own name

A

12 mths

61
Q

recgonises themselves in mirror

A

18 mths

62
Q

recognises familiar faces in photos

A

24 mths

63
Q

recognises self in photos and small details

A

30 mths

64
Q

matches primary colours, listen to long stories with attention

A

48 mths

65
Q

can match 10 colours

A

60 mths

66
Q

ASD more common

A

boys
premature
perinatal hypoxia
advanced maternal or paternal age
twin with autism (multiple genes )

67
Q

genetic syndromes increased risk ASD

A

fragile X syndrome
tuberous sclerosis
angelmann syndrome

68
Q

ASD investigations

A

clinical diagnosis - seen in different environments
post mortem studies and studies with neuroimaging - structural changes

69
Q

clinical features ASD

A

abnormality of social interaction - poor eye contact, not use facial expression/body language, problems making friends, difficulty reading social cues
impaired social communication - delay or failure to develop spoken or sign language, abnormal use of language/pitch (echolalia - repetition of another person’s spoken words)
restrictive or repetitive activities - preoccupations with unusual subjects, need for routine, motor mannerisms (hand flapping)
sensory issues
severely restricted diet
not tolerate loud noises
may self harm (head banging)

70
Q

examination ASD

A

skin stigmata of neurofibroma or tuberous sclerosis with a wood’s light
signs of injury
congenital anomalies and dysmorphic features - microencephaly

71
Q

ASD diagnosis

A

should be features present from all three catergories and one from:
- lack of social attachment
- abnormal/delayed receptive or expressive speech
- abnormal or lack of symbolic play
before age of 3

72
Q

ASD ddxq

A

attachment disorder
Rett’s syndrome
schizophrenia

73
Q

ASD management

A

support - parent support groups, community based services
no meds
behaviour management strategies - routine
educational measures - school can access higher needs funding using EHCP
if aggressive - can try antipsychotics
treat co morbidities

74
Q

risk factors ADHD

A

male
co-morbid conditions (up to 50% will)

75
Q

co-morbid contiions ADHD

A

ASD
dyslexia
communication disorders
oppositional defiance disorder
depression, anxiety
tourette’s

76
Q

cause ADHD

A

structural changes in brain
dopamine levels
genetic component - twin
environment

77
Q

ADHD diagnosis

A

early onset - before 6 years old and present for some time before diagnosis
two or more settings
out of context of children’s IQ

78
Q

3 main features ADHD

A

hyperactivity
inattention
impulsivity
—impaired attention and over activity

79
Q

ADHD DSM-V criteria

A

inattention criteria
hyperactivity criteria
impulsivity criteria
at least 6 of criteria from inattention or hyperactivity/impulsitivity criteria before 12 years old for at least 6 mths..in more than one setting

80
Q

ADHD ddx

A

auditary processing disorder
opoositional-defiant disorder or conduct disorder

81
Q

ADHD investigations

A

Conner’s questionnaire
observe clinical features

82
Q

ADHD management

A

pre- school - not meds
mild-mod - 1st line: behaviour strategies (parent education sessions), or CBT
severe - 1st line: meds - 1st line is methylphenidate, then atomoxetine or lisdexamfetamine, or guanfacine

83
Q

s/e of ADHD meds

A

raised BP
palpitations
insomnia
impaired growth and appetite suppression
aggression

84
Q

pathophysiology pierre robin sequence

A

7-10 weeks of gestation - lower jaw should undergo rapid growth and tongue should drop down to allow palate to fuse but tongue blocks this and palate remains cleft + tongue far back causing airway difficulties
SOX9 gene mutation on chromosome 17 assc

85
Q

PRS risk factors

A

geentic
oligohydraminos
C.T disease
myotonia of muscles in face

86
Q

PRS clinical features

A

micrognathia - lower jaw
cleft palate
glossoptosis - posterior tongue

87
Q

PRS associated conditions

A

CHARGE syndrome
Di george
strickler

88
Q

PRS investigations

A

20 week anomaly USS
more imaging
bronchoscopy
sleep studies
geneticist

89
Q

PRS initial management

A

breathing support - sleep on fronts, nasopharyngeal airway, intubation
feeding support - special teet for bottle feedings, feeding specialist

90
Q

definitive management PRS

A

surgery before 1st birthday - glossopexy (tongue-lip adhesion)
cleft palate repair
tracheotomy
feeding tube insertion

91
Q

PRS complications

A

OSA
difficulty intubating
aspiration
feeding difficulties
malnutrition
middle ear effusions - hearing loss

92
Q

down’s syndrome genetics

A

trisomy 21
- most likely occurs sporadically
- additional chromosomal material inherited from one of the parents
- mixtureof some cells containing 3 forms of chromosome 21

93
Q

down’s risk factors

A

sporadic mutations associated with maternal maturity

94
Q

down’s antenatal screening

A

combination test - biochemical markers in maternalblood and nuchal translucency on USS
can also from 2nd trimester onwards - chronic villi sampling or amniocentesis

95
Q

down’s clinical features

A

small, dysplastic ears
flat nasal bridge
small mouth
short stature, short neck
epicanthic folds
upwards slanting palpebral fissures, brushfield spots
brachycephaly
single palmar crease

96
Q

down’s associated conditions

A

congenital cataract
conductive hearing loss
OSA
AVSD
recurrent chest infection
oesophageal atresia or tracheo-oesophageal fistula
duodenal atresia
imperforate anus
hypotonia
poor growth and stature
developmental delay
neurodisability
risk fo hypothyroidism
TMD

97
Q

down’s ddx

A

Patau, edwards’ - all trisomies differentiated by G banded analysis

98
Q

down’s early management

A

senior paediatrician and midwife in charge
blood test - QF-PCR test, followed by G banded analysis, FBC, blood film
newborn eye assessment
universal newborn hearing screen
guthrie test - congenital hypothyroidism
ECG and echo

99
Q

down’s definitive mangeemnt

A

treat any comorbidites
MDT
promote health
genetic counselling

100
Q

Down’s complications

A

reduced life expectancy - <60
increased alzheimer’s

101
Q

asd - features, ddx, used to make diagnosis, associated conditions, poor prog

A

ASD- SALT. community psychiatric nurses/asd nurse, teacher
ASD - tuberous sclerosis, fragile X
Poor prog - IQ less than 50, no communicative speech before 5
OCD

102
Q

bowel habit in children tx

A

rewards
scheduled toileting, bowel habit diary

103
Q

if chronic history of GI upset

A

dont ask about N+v

104
Q
A

Paediatrics (17 decks)

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