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Year 4 - Paeds > Community Paediatrics > Flashcards

Community Paediatrics Flashcards

1
Q

Developmental delay
- 7 Neuro causes

  1. Vascular
  2. Anatomical
  3. Accidental
A

Developmental Delay:
- Neuro causes

1 CVA
2 HIE
3 IVH

4 Spina bifida
5 Epilepsy

6 Hypoglycaemia
7 Brain trauma

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2
Q

Developmental delay
- 3 Infectious causes

A

Developmental delay
- Infectious cause

  1. ToRCH
    - Toxoplasmosis, Rubella, CMV, Herpes, HSV
  2. Meningitis
  3. Encephalitis
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3
Q

Developmental delay
- 2 Neuromuscular causes

A

Muscular developmental delay

  1. SMA (Spinal muscular atrophy)
  2. DMD (Duchenne’s muscular dystrophy)
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4
Q

Developmental delay

  1. A genetic cause
  2. Endocrine cause
  3. A pervasive disorder
A

Developmental delay

  1. Trisomy 21
    - Genetic cause
  2. Hypothyroidism
    - Endocrine cause
  3. Autism
    - Pervasive disorder
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5
Q

Early Autism Signs

  1. GM
  2. Speech
  3. Social
A

Autism signs

  • GM
    1. Spinning objects
  • Speech
    2. 16 mo only one word
    3. Echolalia
    4. Not babbling
  • Social
    5. No eye contact
    6. No smile reflex
    7. No touching
    8. No mixing with others
    9. Inappropriate laughing/giggling
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6
Q

Developmental red flags

  1. GM
  2. FM
  3. Speech
  4. Social
A

Developmental red flags

  1. GM
    - 12 months no sitting
    - 18 months no walking
  2. FM
    - 12 months hand preference
  3. Speech
    - 18 mo 2-6 words
  4. Social
    - 10 weeks smiling
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7
Q

Global development delay
- 6 Investigations

A

Global delay - Ix:

  1. FBC
    - Iron/B12/folate
  2. U&E
    - CKD/Hyponatraemia
  3. CK
    - DMD
  4. TFTs and LFTs
  5. Vit D
  6. Hearing test
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8
Q

Developmental delay
- Mx

A

Developmental delay - Mx

1 Detailed dev. assessment
2. MDT

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9
Q

ADHD
- Definition

A

ADHD Definition

  1. Neuro-behavioural disorder
  2. Hyperactivity, inattention, impulsivity
  3. Inability to focus
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10
Q

ADHD
- Epidemiology

A

ADHD

  1. Prevalence
    - 7%
  2. Boys 2x Girls
  3. 50% co-morbid
    - ASD
    - LD
    - Communication/defiance
    - Depression/anxiety
    - Tics/Tourettes
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11
Q

ADHD
- Pathophysiology

A

ADHD

  1. Brain changes
    - Structural
    - Functional
  2. Genetic
    - 88% twin hereitability
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12
Q

ADHD
- ICD-10 Criteria

A

ADHD ICD10

  1. Early onset
    - <6yo
  2. Context
    - Two or more settings
    - Child’s age and IQ
  3. Triad
    - Inattention
    - Hyperactivity/Impulsivity
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13
Q

ADHD
- Three subtypes

A

ADHD subtypes

  1. Predominantly inattentive
  2. Predominantly hyperactive/impulsive
  3. Combined
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14
Q

ADHD DDx

  1. Conduct disorder
  2. Oppositional-defiant disorder
A

ADHD DDx

  1. Conduct disorder
    - Marked aggression
  2. Oppositional-defiant disorder
    - Anger/vindictiveness
    - Argumentative
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15
Q

ADHD
- Ix

A

ADHD Ix

  1. Conner’s questionnaire
  2. School observation
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16
Q

ADHD Mx

  1. Pre-school
  2. Mild-moderate
  3. Severe
A

ADHD Mx

  • Pre-school
    1. Parental training
    2. Care plan
    3. SEN
    4. No medication
  • Mild-moderate
    1. Behavioural strategy
  • Parental education
  • Teacher education
    2. CBT
  • Social skills training
    3. Medication if necessary
  • Severe impairment
    1. Medication
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17
Q

ADHD
- Five medications

A

ADHD Medications

  1. Methylphenidate
    - Ritalin/Concerta/Medikinet
    - Stimulant
  2. Atomoxetine (Strattera)
    - ADR: Liver
    - Non-stimulant
    - Used in Tic/anxiety (Ritalin abuse)
  3. Lisdexamfetamine (Elvanse)
    - Stimulant
    - When methylphenidate not effective
  4. Guanfacine (Intuniv)
    - Non stimulant
  5. Antipsychotics
    - Adults
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18
Q

ADHD Medication
- ADRs

A

ADHD Meds

  1. BP and palpitations
    - ECG if heart condition
  2. Disturbed sleep
  3. Impaired growth and appetite
  4. Aggression/emotional
    - Anxiety/depression
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19
Q

ADHD Prognosis

  1. Natural history
  2. ADRs
A

ADHD

  1. 2/3 no evidence in adulthood
  2. Associations
    - Substance abuse
    - Criminal convictions
    - Lower education attainment
    - Unemployment
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20
Q

ASD
- Definition

A

ASD Definition

  1. Neurodevelopmental disorder
  2. Social interaction, communication, behaviour
  3. Diagnosed in childhood
    - Key symptoms present before 3
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21
Q

ASD Epidemiology

  1. UK Prevalence
  2. RFs
  3. Associations
A

ASD

  1. 1% in UK
    - B>G
  2. RFs
    - Prematurity
    - Maternal/paternal age
    - Perinatal hypoxia
  3. Associations
    - Fragile X
    - Tuberous sclerosis
    - Angelmann
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22
Q

ASD Features

  1. Interaction
  2. Communication
  3. Activities
  4. Sensory
A

ASD Features

  • Interaction
    1. Eye contact
    2. Little facial/body language
    3. Difficulty reading signals
  • Communication
    1. Delayed spoken/sign language
    2. Abnormal language
  • Echolalia (repetition)
  • Abnormal intonation, pitch, rate, rhythm
  • Activities
    1. Unusual preoccupations
    2. Need for routine
    3. Motor mannerisms
  • Hand-flapping
  • Sensory
    1. Restricted diet
    2. Haircuts/teeth brushing
    3. Loud noises
    4. Self-harm
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23
Q

ASD
- Examination

A

ASD Examination

  1. NF or TS
    - Wood’s light
    - Skin stigmata
  2. Injury
    - DSH
    - NAI
  3. Congenital
    - Macrocephaly
    - Microcephaly
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24
Q

ASD
- DDx

A

ASD DDx

  1. LD
    - Separate/co-morbid
  2. Attachment disorders
    - No stranger anxiety
  3. Rett’s syndrome
    - Largely girls
    - >18mo regression
    - Speech delay
    - Repetitive hand-movements
  4. Schizophrenia
    - Disordered language/behaviour
  5. Specific language disorders
    - SALT diagnosis
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25
Q

ASD
- Mx

A

ASD Mx

  1. Diagnosis
  2. Co-morbid mx
    - ADHD
    - Sleep disorder
    - LD
    - MH
  3. Behavioral strategies
    - Visual timetables
    - Preparation for changes
  4. Education
    - EHCP (formerly SEN)
    - Education, health, care plan
26
Q

Behaviour disorder
- Eight common underlying disorders

A

Behaviour involving disorders

  1. ADHD
  2. ODD (oppositional defiant)
  3. ASD
  4. Anxiety
  5. Depression
  6. Bipolar
  7. LDs
  8. Conduct disorder
27
Q

Conduct disorder

  1. Behaviour patterns
  2. Mx
A

Conduct disorder

  • Behaviour pattern
    1. Repeated violation of rights/rules
    2. 4 main groups of behaviour
  • Hurtful aggression (people/animals)
  • Property destruction
  • Lying/stealing
  • Serious rule violations
  • Management
    1. Consider psychiatric referral
28
Q

ODD

  1. Pattern of behaviour
  2. Investigations
  3. Management
A

Oppositional defiant disorder

  • Pattern
    1. Hostile, angry, defiant, rebellious
    2. Directed at an authority figure
  • Ix
    1. Conners rating scale
    2. Child behaviour checklist
  • Mx
    1. Consider psychiatric referral
29
Q

Short stature

  1. Definition
  2. Centile
A

Short stature

  1. Definition
    - 2sigma +
  2. Centiles
    - below 2.5th centile
30
Q

Growth deceleration

  1. Definition
  2. Centile change
A

Growth deceleration

  1. Definition
    - Growth velocity below fifth percentile
  2. Centile change
    - Height drop of two centiles
31
Q

Normal growth

  1. Antenatal
  2. Post-natal
  3. Pubertal
A

Normal growth

  • Antenatal
    1. Uterine size
    2. Placental/maternal funciton
    3. IGF, IGF-binding proteins (IGFBPs)
  • Post-natal
    1. Rapid
    2. Plateau at 3yo (5-7cm/year)
    3. Large or small babies ‘channel’ to correct centil by 2yo
  • Pubertal
    1. Pre-pubertal dip
    2. Growth spurt
  • Sex hormones, GH, TFTs
    3. Girls first, then boys, for longer (13m difference)
32
Q

Short stature
- Four common differentials

A

Four common Short Statures

  • Familial
    1. Born adequate for GA
    2. Steady growth below 5th centile
    3. Puberty not delayed
    4. Normal exam, proportionate stature
  • Constitutional delay
    1. First 2 years growth deceleration
    2. Bone age delayed by 1-2 years
    3. Final height close to target
    4. Thin and sexually immature for age
  • Idiopathic short stature
    1. Short but healthy
    2. Normal puberty and exams
    3. Normal bone age, IGF, IGFBP
  • SGA without catch-up (2yo)
    1. IUGR and SGA at birth
    2. Normal exams
    3. Proportionate short stature
33
Q

Short stature DDx

  1. Hormonal causes
  2. Genetic causes
  3. Chronic causes
  4. Dysplasias
  5. Psychosocial causes
A

Eight uncommon Short-Stature

  • Hormonal
    1. GH Deficiency
    2. Hypothyroid
    3. Cushing
    4. GH Insensitivity (Laron)
    5. Craniopharyngioma
  • Genetic
    1. Trisomy 21
    2. 45 X
    3. Nonan
    4. Russell-Silver
    5. Prader-Willi
    6. DiGeorge
  • Chronic disease
    1. Celiac/IBD
    2. CF
    3. CHD
    4. DM
    5. CKD
  • Malignancy
  • Skeletal dysplasia
    1. Juvenile idiopathic arthritis
    2. Achondroplasia
    3. Hypochondroplasia
    4. Osteogenesis imperfecta
  • Psychosocial
    1. AN/BN
    2. FAS
    3. Abuse/institutionalisation
34
Q

JIA
- Subtypes

A

Juvenile idiopathic arthritis

  • Subtypes
    1. Oligoarticular
  • 4 or fewer joints ever involved
    2. Polyarticular
  • 5 or more joints involved
    3. Systemic onset
35
Q

JIA Presentation

  1. RFs
  2. S&S
  3. Ix
A

JIA Presentation

  • RFs
    1. Female sex
    2. Under 6yo
    3. Autoimmune FHx
  • S&S (6 weeks duration)
    1. Pain, swelling, morning stiffness
    2. Diurnal variation
    3. Fever
    4. Macular rashes, psoriatic scales, dactylitis
    5. Purpura, bruising
  • Ix
    1. ESR and CRP
  • Sub-type dependent
    2. FBC
  • Systemic onset
    3. Serology
  • ANA 30-60%
  • Predictive of uveitis
  • RF/Anti-CCP
    4. Chlamydia screen in monoarticular teens
36
Q

Poly articular JIA
- Management

A

Polyarticular JIA - Mx

  1. DMARD
    - Methotrexate
    - Leflunomide/sulfasalazine
  2. Supportive
  3. Biological
    - Adalimumab/etanercept etc
  4. NSAID
  5. IArt CST
  6. PO CST
37
Q

Oligoarticular JIA
- Mx

A

Oligoarticular JIA Mx

  1. IArt CST
    - Triamcinolone acetonide
    - Methylprednisolone acetate

+ Supportive care
+ NSAID
+ Methotrexate

  1. TNF-alpha inhibitor
    - adalimumab/etanercept
    - infliximab

+ Supportive
+ IArt CST
+ NSAID

38
Q

JIA - Systemic onset
- Mx

A

Systemic onset JIA
- Mx

  1. PO/IV CST
    - Methylprednisolone sodium succinate
    - Prednisolone

+ Supportive care
+ NSAIDs

  1. Tocilzumab/canakinumab/anakinra

+ supportive care
+ PO CST
+ NSAID

39
Q

DiGeorge Syndrome

  1. Pathology
  2. Triad
A

DiGeorge Syndrome (22qDS)
- Velo-cardio-facial syndrome
- CATCH22/Shprintzen’s

  • Pathology
    1. Chromosome 22q deletion syndrome
    2. Pharyngeal arch transcription factor deficiency
  • Triad
    1. Cardiac anomalies
    2. Hypoplastic thymus
    3. Hypocalcaemia (hypoplastic PT)
40
Q

DiGeorge Syndrome

  • Two phenotypic components
A

DiGeorge Syndrome Components

  • Pharyngeal phenotypes
    1. CHD
    2. PT hypoplasia
    3. Thymic hypoplasia
    4. Cleft lip/palate
    5. Mild dysmorphic facial features
  • Neurological phenotypes
    1. Mild cognitive dysfunction
  • LD
  • Speech impairment
  • Increased incidence of schizophrenia
41
Q

RTA

  1. Syndrome Characterisation
  2. Definition
A

Renal tubular acidosis

  • Characterisation
    1. Hyperchloremic metabolic acidosis
    2. Normal serum anion gap
  • Definition
    1. Group of disorders
    2. Acid-base homeostasis
    3. Impairment
  • Excretion of fixed acid
  • Reabsorption of bicarb
42
Q

RTA

  • Paeds presentation
    1 S&S
    2 Ix
A

Paeds Renal tubular acidosis

  • S&S
    1. Small for age
    2. Frailty
    3. Bowing of knees
    4. History of UTI, DM, PBC, kidney stones
  • Ix
    1. low pH
  • Metabolic
  • Amino aciduria
  • Hyperuricosuria
  1. Hyperphosphatemia
    - Hypophosphaturia
43
Q

RTA

  • Four types
A

RTA

Type I - Classical

Type II - Proximal

(Type III - Proximal and Distal
- Carbonic anhydrase II deficiency)

Type IV - Distal

44
Q

RTA
- Type 1 Management
- Type 2 Management

A

RTA Mx

I Classical

  1. Alkali solution
    - Sodium alkali
    - Potassium-containing alkali
  2. Potassium supplementation

II Proximal

  1. Alkali solution
  2. Potassium supplementation
  3. Hydrochlorothiazide
    - Volume contraction
    - Proximal reabsorption
45
Q

RTA Management

Type III
Type IV

A

RTA Management

Type III (Rare, mixed)
1. Alkali solution
- Sodium or potassium based
2. Potassium supplementation

Type IV (Distal)

T.iv WITH Mineralocorticoid deficiency
1. Fludrocortisone + low K diet
2. Sodium alkali

T.iv WITHOUT Mineralocorticoid deficiency
1. Loop diuretic +low K + high Na
2. Sodium alkali

46
Q

DBT
- Definition

A

Dialectical behaviour therapy

  1. Intensive psychological treatment
  2. Skills in emotion/behaviour regulation
  3. Balance/resolve difference
  4. 1 year
    - weekly 1-2-1
    - weekly group meetings
47
Q

Therapeutic risk taking
- Definition

A

Therapeutic risk taking

  1. Empowering decision making
  2. Risk not just harm
    - Opportunity
    - Achievement
48
Q

Opioid overdose
- Presentation

A

Opioid overdose

  1. Respiratory depression
  2. Apnoea
  3. CNS depression
  4. Miosis
49
Q

Cocaine use disorder

  1. Gradation
  2. Chronic use sequelae
  3. State
A

Cocaine use disorder

  1. Gradation
    - (Occasional use)
    - Mild/moderate/severe
  2. Chronic use
    - Myocardial remodelling
    - Myocardial hypertrophy
    - Lethal arrhythmias
  3. Hyperadrenergic state
    - Nausea
    - Jitteriness
    - Anxiety and paranoia
    - Trouble concentrating
    - Euphoria
50
Q

Cocaine toxicity
- S&S

A

Cocaine toxicity

  1. Minutes or hours of use
  2. Hyperthermia
  3. Rhabdomyolysis
  4. Dysrhythmia
  5. Ischaemia
  6. Intracranial haemorrhage
  7. Agitation
  8. Psychosis
  9. Seizures
51
Q

MDMA toxicity
- S&S

A

MDMA toxicity

  • S&S
  1. Agitation
  2. Confusion/headache
  3. Seizure
  4. Hypertension
  5. Hyperthermia
  6. Rhabdo
  7. Dysrhythmias/Hypotension
  8. ACS
52
Q

MDMA Toxicity
- Mx

A

MDMA Toxicity Mx

  • Supportive
    1. Hypotension
    2. Hyperthermia
  • Aggressive cooling
  • Benzodiazepines
    3. Hypoxia
    4. Metabolic abnormalities
53
Q

MDMA Toxicity
- Mx

A

MDMA Toxicity Mx

  • Supportive
  1. Hyperthermia
    - Aggressive cooling
    - Benzodiazepines
  2. Hyponatremia
    - Fluid restriction
    - Normal saline
    - Benzos and hypertonic saline
  3. Seizures
    - Benzos/phenobarbitone
    - GA
    - Head CT
  4. Hypotension
    - Fluids
  5. Hypertension
    - BEnzos
    - Nitroglycerin, nitroprusside, phentolamine
  6. Rhabdomyolysis
    - Fluid resuscitation
  7. Hypoxia
  8. Metabolic abnormalities
54
Q

Cannabis use
- Chronic health effects

A

Cannabis use
- Chronic health effects

  1. Cognitive impairment
    - Impaired cognitive development
  2. Dependence
  3. Increased risk
    - Schizophrenia
    - Anxiety disorder
  4. Worsened
    - Bipolar
    - Respiratory symptoms
    - Chronic bronchitis
55
Q

Benzodiazepine overdose
- S&S

A

Benzodiazepine overdose S&S

  1. Excessive sedation
  2. Coma
  3. Respiratory depression
56
Q

Acute alcohol misuse
- Two drugs

A

Acute alcohol misuse
1. Chlordiazepoxide
2. Pabrinex

57
Q

Development
- Speech vs language

A

Development

  1. Speech
    - Sounds
    - Tongue, lips, jaw, vocal
  2. Language
    - Verbal and non-verbal
  3. Speech and language
    - Intact hearing
    - Muscle control
    - Exposure
58
Q

Speech and language
- Development

1 d
6-8 wks
3 mo

6 mo
9 mo
12 mo

18mo
24mo
30mo
36mo

A

Speech and language
- Development

1 d - Cry
6-8wk - Coo
3 mo - Laugh/vocalise

6 mo - mama, dada, byebye, babble
9 mo - Understands no
12 mo - Own name, 2-6 words

18mo - 6-40 words, sing, parts of body
24mo - 200 words, joins words
30mo - continual questions
36mo - 2/3 colours, 1-10, songs, simple conversation

59
Q

Specific language disorder

  1. S&S
  2. Mx
A

Specific language disorder

  • S&S
    1. Delayed/disordered language
    2. Normal social communication
  • MDT
    1. Pediatrician
    2. Psychologist
    3. SALT
    4. OT
60
Q

CAPD
1. S&S
2. Ix
3. Mx

A

Central auditory processing disorder

  • S&S
    1. Verbal instructions
  • Difficulty understanding
  • Difficulty responding
    2. No attention deficit
    3. May have dyslexia
  • Ix
    1. Hearing test
    2. Screening questionnaire
    3. APD listening test
61
Q

Osteogenesis imperfecta

  1. Epidemiology
  2. Pathology
  3. Mx
A

Osteogenesis imperfecta

  • Epidemiology
    1/20,000
  • Pathology
    1. Collagen defect
    2. Minimal impact fractures
    3. Blue sclera
    4. Hypermobility
  • Mx
    1. PT
    2. Bisphosphonates
  • Pamidronate/zoledronic acid
    3. Vitamin D

Year 4 - Paeds (11 decks)

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