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Y4 paediatrics > Community > Flashcards

Community Flashcards

1
Q

Abnormal development

A

Significant lag in a child’s physical, cognitive, behavioural, emotional or social development, relative to established growth milestones

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2
Q

Abnormal development aetiology

A

Genetic disorders

Prenatal exposure to toxins/drugs/alcohol

Premature birth

Nutritional deficiencies

Environmental factors

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3
Q

Abnormal development example issues

A

Referral points

  • doesn’t smile at 10 weeks
  • cannot sit unsupported at 12 months
  • cannot walk at 18 months

Final motor skill problems - hand preference before 12 months is abnormal → cerebral palsy

Gross motor problems - variant of normal, cerebral palsy, NMD

Speech and language problems - check hearing, environmental deprivation & general development delay

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4
Q

Abnormal development ddx

A

ASD

Cerebral palsy

Fragile X syndrome - genetic condition causing ID, behavioural challenges & various physical characteristics

Down syndrome

FASDs

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5
Q

Abnormal development initial management

A

Clinical examination

Ix - genetic testing, metabolic screening, neuroimaging studies, hearing/vision assessments

Referral for specialist assessment

Early intervention services - OT, SALT, PT & educational support

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6
Q

Factors which point towards child abuse

A

Children may disclose abuse themselves

Story inconsistent with injuries

Repeated attendances at A&E departments

Delayed presentation

Child with frightened, withdrawn appearance

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7
Q

Physical presentations of child abuse

A

Bruising

Fractures - at different stage of healing

Torn frenulum

Burns/scalds

Failures to thrive

STIs

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8
Q

Turner’s syndrome

A

Chromosomal disorder affecting females

Presence of only one sex chromosome or a deletion of the short arm of one of the X chromosomes

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9
Q

Turner’s syndrome features

A

Short stature

Shield chest, widely spaced nipples

Webbed neck

Bicuspid aortic valve, coarctation of the aorta

Primary amenorrhea

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10
Q

Noonan syndrome

A

‘Male Turner’s’

Autosomal dominant condition associated with a normal karyotype

Thought to be caused by a defect in a gene on chromosome 12

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11
Q

Noonan syndrome features

A

Similar to Turner’s - webbed neck, widely-spaced nipples, short stature, pectus carinatum & excavatum

Pulmonary valve stenosis

Ptosis

Triangular-shaped face

Low-set ears

Coagulation problems - factor XI deficiency

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12
Q

CP

A

Permanent neurological problems resulting from damage to the brain around the time of birth

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13
Q

CP causes

A
  • antenatal
    • maternal infections
    • trauma during pregnancy
  • perinatal
    • birth asphyxia
    • pre-term birth
  • postnatal
    • meningitis
    • severe neonatal jaundice
    • head injury
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14
Q

CP types

A
  • spastic: hypertonia & reduced function resulting from damage to upper motor neurones
  • dyskinetic: problems controlling muscle tone, with hypertonia & hypotonia → athetoid movements and oro-motor problems
    • result of damage to the basal ganglia
  • ataxic: problems with coordinated movement resulting from damage to the cerebellum
  • mixed
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15
Q

CP clinical features

A
  • failure to meet milestones
  • increased/decreased tone, generally/in specific limbs
  • hand preference below 18 months
  • problems with coordination, speech or walking
  • feeding/swallowing problems
  • learning difficulties
  • hemiplegic/diplegic gait
    • caused by increased muscle tone and spasticity in the legs
    • leg will be extended with plantar flexion of feet & toes
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16
Q

CP complications & associations

A
  • learning disability
  • epilepsy
  • kyphoscoliosis
  • muscle contractures
  • hearing & visual imapirment
  • GORD
17
Q

CP mx

A
  • multi-disciplinary team approach
  • physiotherapy is used to stretch and strengthen muscles, maximise function & prevent muscle contractures
  • OT
  • SALT
  • dieticians
  • orthopaedic surgeons
  • paediatricians - optimise medications
    • muscle relaxants
    • anti-epileptic drugs
    • glycopyrronium bromide (for excessive drooling)
  • social workers
  • charities & support groups
18
Q

Down syndrome

A

Caused by three copies of chromosome 21 (called trisomy 21)

  • characteristic dysmorphic features & associated with a number of associated conditions
19
Q

Down syndrome dysmorphic features

A
  • hypotonia
  • brachycephaly (small head with a flat back)
  • short neck
  • short stature
  • flattened face & nose
  • prominent epicanthic folds (folds of skin covering the medial portion of the eye & eyelid)
  • upward sloping palpebral fissure (gaps between the lower and upper eyelid)
  • single palmar crease
20
Q

Down syndrome complications

A
  • learning disability
  • recurrent otitis media
  • deafness (eustachian tube abnormalities)
  • visual problems
  • hypothyroidism
  • cardiac defects affect 1 in 3
  • atlantoaxial instability
  • leukaemia
  • dementia
21
Q

Down syndrome antenatal screening

A
  • all women offered screening for Down’s syndrome
  • combined test - 1st line
    • performed between 11 and 14 weeks gestation
    • combining results from ultrasound & maternal blood tests
      • ultrasound → nuchal translucency
      • maternal blood tests → beta-hCG & pregnancy-associated plasma protein-A (PAPPA)
  • triple test
    • performed between 14 and 20 weeks gestation
    • only involves maternal blood tests
      • beta-hCG
      • alpha-fetoprotein
      • serum oestriol
  • quadruple test
    • performed between 14 and 20 weeks gestation
    • identical to the triple tests but also includes maternal blood for inhibin-A
22
Q

Down syndrome antenatal testing

A
  • screening tests provide a risk score for the fetus having Down’s syndrome → when risk > 1/150 the woman is offered amniocentesis/chorionic villus sampling
  • tests involve taking a sample of fetal cells, with then undergo karyotyping to give a definitive answer
    • chorionic villus sampling - involves an ultrasound guided biopsy of the placental tissue
      • testing is done earlier in pregnancy (< 15 weeks)
    • amniocentesis - involves ultrasound guided aspiration of some amniotic fluid using a needle & syringe
      • later in pregnancy once there is enough amniotic fluid to make it safer to take a sample
23
Q

Down syndrome non-invasive prenatal testing

A
  • relatively new test for detecting abnormalities in fetus during pregnancy
  • simple blood test from mother
  • blood will contain fragments of DNA → some will come from placental tissue
    • can be analysed & detect conditions such as Down’s
  • not definitive test but gives a very good indication
24
Q

Down syndrome mx

A
  • supportive care from the multidisciplinary team
    • OT
    • PT
    • SALT
    • paediatrician
    • health visitors
    • GP
    • dietician
    • many more..
  • routine follow up investigations
    • regular thyroid checks (2 yearly)
    • echocardiogram to diagnose cardiac defects
    • regular audiometry
    • regular eye checks
25
Q

Eating disorder

A
  • stem from an unhealthy and distorted obsession from body image and food
  • strong correlation with personality disorders, OCD, anxiety & other mental health disorders
  • more common in girls, genetic composition
26
Q

Anorexia nervosa features

A
  • excessive weight loss
  • amenorrhoea
  • lanugo hair
  • hypokalaemia
  • hypotension
  • hypothermia
  • changes in mood, anxiety & depression
  • solitude
  • cardiac complications → arrhythmias, cardiac atrophy & sudden cardiac death
27
Q

Bulimia nervosa features

A
  • alkalosis, due to vomiting HCl from the stomach
  • hypokalaemia
  • erosion of teeth
  • swollen salivary glands
  • mouth ulcers
  • GORD & irritation
  • calluses on the knuckles → Russell’s sign
28
Q

Binge eating disorder

A
  • characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress
  • may involve:
    • a planned binge involving ‘binge foods’
    • eating very quickly
    • unrelated to whether they are hungry or not
    • become uncomfortably full
    • eating in a ‘dazed state’
29
Q

Eating disorder mx

A
  • parent and carer education
  • self help resources
  • counselling
  • CBT
  • addressing other areas of life, eg. relationships & past experiences
  • admission for observed feeding & monitoring for refeeding syndrome
  • SSRI medication
30
Q

Refeeding syndrome

A
  • metabolism in the cells & organs dramatically slows during prolonged periods of malnutrition
  • as the starved cells start to process glucose, protein & fats again they use up magnesium, potassium and phosphorus
    • hypomagnesaemia
    • hypokalaemia
    • hypophosphatemia
  • at risk of cardiac arrhythmias, heart failure & fluid overload
  • management
    • slowly reintroducing food with restricted calories
    • magnesium, potassium, phosphate & glucose monitoring along with other routine bloods
    • fluid balance monitoring
    • ECG monitoring may be required
    • supplementation with electrolytes and vitamins, particularly B vitamins & thiamine
31
Q

NAI

A

Any physical harm in a child that is deliberately inflicted or results from the failure of a caregiver to prevent such harm

32
Q

NAI risk factors

A

Caregiver mental health issues

Substance abuse

Stress

Lack of parenting skills

Hx of caregiver being abused

33
Q

NAI clinical features

A

Predominately occurs in children < 2

Delayed presentation following injury

Inconsistencies in the caregiver’s narrative

Unwitnessed injuries

Evidence of drug & alcohol use in the household

O/E - injuries of varying ages, burns/scalds, bruises consistent with gripping, subconjunctival haemorrhage, retinal haemorrhage, human bite marks

34
Q

NAI ix

A

Comprehensive skeletal survey - rib fractures, skull fractures/intracranial bleeds, metaphyseal corner fractures, finger fractures, clavicle fractures

Bloods - rule out organic causes

35
Q

NAI mx

A

Report suspicions

Safeguarding - ensure safety of other children in home as well

Treatment - medical mx for injuries

Documentation

Social care liaison - contact social care to investigate

Y4 paediatrics (8 decks)

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