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Year 4 Paediatrics > Community paediatrics > Flashcards

Community paediatrics Flashcards

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1
Q

Feeding volumes

A

60 mls/kg/day - Day 1
90 mls/kg/day - Day 2
120 mls/kg/day - Day 3
150 mls/kg/day - Day 4 and onwards

Every 2 - 3 hours, extended to 4 hourly or longer then to on demand

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2
Q

Initial weight loss in babies

A

Normal - 10% for breast fed and 5% for formula fed by day 5

Back at birth weight by day 10

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3
Q

Weaning

A

Occurs at 6 months

Introduce normal foods

Start with puree

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4
Q

Obesity in children

A

Overweight - BMI above 85th centile

Obese - BMI above 95th centile

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5
Q

When to suspect endocrine conditions in children

A

If short and obese

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6
Q

Failure to thrive

A

If dropped 1 + centile spaces if their birthweight was below the 9th centile

If dropped 2 + centile spaces if their birthweight was between the 9th - 91st centile

If dropped 3 + centile spaces if their birthweight was above the 91st centile

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7
Q

Causes of failure to thrive

A

Inadequate nutritional intake - neglect or iron deficiency

Difficulty feeding - cleft lip, pyloric stenosis

Malabsorption - cystic fibrosis, CMPA, Coeliacs, IBD

Increased energy requirement - hyperthyroidism, malignancy

Inability to process nutrition - T1DM

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8
Q

Investigations for failure to thrive

A
  • observe feeding
  • growth chart - mid parental height centile
  • BMI

Presentation dependent:

  • urine dipstick - UTI
  • Bloods - TTG (coeliacs), FBC
  • faecal calprotectin
  • sweat test
  • abdominal USS - pyloric stenosis
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9
Q

Mid parental height

A

Mum’s height + dad’s height / 2

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10
Q

Management of breastfeeding difficulty

A

Support by midwives and health vistiors

Supplement feeds with high nutritional formulas

NGT

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11
Q

Short stature definition

A

Height more than 2 standard deviations below the average expected

Below 2nd centile

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12
Q

Predicted height

A

Boys = mother’s height + farther’s + 14 / 2

Girls = mother’s height + farther’s - 14 / 2

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13
Q

Causes for short stature

A

Inherited
Malnutrition
Chronic disease - IBD, coeliacs, congenital heart disease
Endocrine disease - hypothyroidism
Genetic conditions - down syndrome, achondroplasia

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14
Q

Investigation for constitutional delay in growth and puberty

A

Taking a xray from hands and wrists to estimate the bone age - +ve result is delayed bone age

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15
Q

Refusal of treatment in children

A

Under 18s cannot refuse treatment and can be overruled

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16
Q

Decisions about treatment in children

A

Children under 16 can make decisions about treatment, but only if they are deemed to have Gillick competence

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17
Q

Gillick Competence

A

Assessed on a decision by decision basis
Consent needs to be given voluntarily

  • Weigh up options
  • Understand
  • Retain information
  • Communicate
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18
Q

Frazer Guidelines

A

Guidelines for providing contraception to patients under 16 years without having parental input

  1. Intelligent enough to understand the treatment
  2. Can’t be persuaded to discuss it with their parents
  3. Likely to have intercourse regardless of treatment
  4. Their physical or mental health is likely to suffer without treatment
  5. Treatment is in their best interest
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19
Q

Sexual activity in under 13s

A

Children < 13 yo cannot give consent for sexual activity

All intercourse in children under 13 years should be escalated as a safeguarding concern

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20
Q

Questions to ask in children with deppresion

A

Potential triggers (e.g. loss of a family member)
Home environment and Family relationships
Relationship with friends
Sexual relationships
School situations and pressures -Bullying
Drugs and alcohol
History of self harm and suicide
Family history - Parental depression
Parental drug and alcohol use
History of abuse or neglect

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21
Q

Management of mild depression

A

Managed with watchful waiting and advice about healthy habits

Follow up within 2 weeks is advised.

22
Q

Management of moderate to severe depression

A

Referral to CAMHS:

  • Full assessment to establish a diagnosis
  • 1st line - CBT, non-directive supportive therapy, interpersonal therapy and family therapy
  • 2nd line - Fluoxetine 10mg - first line antidepressant) - can increas to a max of 20mg

3rd line- Sertraline and citalopram

23
Q

How long should antidepressants be taken for

A

Continue 6 months after remission is achieved

24
Q

Assessment of generalised anxiety disorder

A
  • GAD-7 - establish the severity of the diagnosis
  • Assess for co-morbid mental health problems, such as depression and OCD
  • Assess for environmental triggers such as family relationships, friendships, bullies and school pressures
25
Q

Management of mild anxiety

A

Watchful waiting and advice about self-help strategies

26
Q

Management of moderate to severe anxiety

A

Referral to CAMHS services to initiate:

  • Counselling
  • Cognitive behavioural therapy
  • Medical management - SSRI such as sertraline
27
Q

How is mild OCD treated

A

Education and self help resources

28
Q

Managment of moderate to severe OCD

A

Referral to CAMHS
Patient and carer education
CBT - behaviour response prevention
SSRI

29
Q

Autism triad

A

Impaired social interactions
Inpaired communicatoon
Rigid, repetitive routines

30
Q

Features of autism

A

Social interaction:

  • lack of eye contact
  • delay in smiling ( > 10 weeks)
  • avoids physical contact
  • unable to read non verbal cues
  • difficulty establishing friendships
  • doesnt play with others ( > 2 years)

Communication:

  • delay
  • difficulty with imaginiative behaviour
  • repetitive use of words

Behaviour:

  • greater interest in objects than people
  • hand flapping or rocking
  • deep interests
  • repetitived behaviours and fixed routines - anxiety
  • restricted food choices
31
Q

Management of autism

A

MDT

  • child psychology
  • Speech and language specialists
  • dietician
  • social worker
  • specially trained educator - SENCo
  • charities - national autism society
32
Q

ADHD triad

A

Inattention
Hyperactivity
Impulsivity

33
Q

Features of ADHD

A 
Short attention span - inattention 
Easily distracted 
Constantly moving or fidgeting 
Impulsive behaviour 
Lack of fear 
Disruptive
Often have sleep disturbance
34
Q

How to diagnose ASD

A

GARS questionnaire - not diagnostic
School observation
Thorough history taking

35
Q

How to diagnose ADHD

A

Conner’s 3 questionnaire
QB test
Thorough history

36
Q

Managment of ADHD

A

Medication:

  • methylphenidate- stimulant
  • atomexatine
  • dexamfetamine
  • melatonin for sleep if there is a disturbance

Behavioural support
Educational support

37
Q

Conditions associated with eating disorders

A

Personality disorders
Anxiety
ADHD

38
Q

Side effects of methylphenidate

A

Lack of appetite - measure weight and height

High blood pressure - measure BP

39
Q

Features of anorexia nervosa

A
  • Excessive weight loss
  • Amenorrhoea
  • Lanugo hair
  • Hypokalaemia
  • Hypotension
  • Hypothermia
  • Changes in mood, anxiety and depression
  • Solitude
40
Q

Features of bulimia

A 
Normal body weight 
Metabolic alkalosis - due to vomiting 
Hypokalaemia 
Erosion of teeth 
Swollen salivary glands 
Mouth ulcers 
GORD 
Calluses on the knuckles - Russel’s sign
41
Q

Management of eating disorders

A

Self help resources
Counselling
CBT
SSRI - CAMHS

42
Q

Complications of refeeding syndrome

A

Hypomagnesaemia
Hypokalaemia
Hypophosphataemia

Cardiac arrythmias
Heart failure - fluid overload

43
Q

Management of refeeding syndrome

A 
Slowly reintroduce food 
Monitor magnesium, phosphate and pottasium 
ECG - heart monitoring 
Fouids 
Supplements- vitamins like B12
44
Q

Conditions associated with Tourette’s

A

OCD and ADHD

45
Q

Tourettes features

A

Tics - head jerking, sniffing, grunting, eye rolling, blinking or clearing throat
Premonitory sensations - the more they try to suppress it, the greater the urge

46
Q

Copropraxia

A

Urge to make obscene gestures

47
Q

Coprolalia

A

Urge to say obscene words

48
Q

Echolalia

A

Urge to repeat other people’s words

49
Q

When do tics often present

A

Around the age of 5 years old

50
Q

Managment of tics

A
  • Reduce stress, anxiety and triggers

Severe tics:

  • habit reversal training
  • exposure response prevention
  • antipsychotics

Year 4 Paediatrics (19 decks)

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