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Paediatrics > community paeds > Flashcards

community paeds Flashcards

1
Q

features of ADHD

A
  1. inattention
  2. hyperactivity
  3. impulsivity that are persistent.
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2
Q

Mx of ADHD

A

ten-week watch and wait period

5 or more drug

mild/moderate Sx - parents attending education and training programmes

severe Sx

Methylphenidate is first line in children and should initially be given on a six-week trial basis. It is a CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor

If there is inadequate response, switch to lisdexamfetamine;
Dexamfetamine should be started in those who have benefited from lisdexamfetamine, but who can’t tolerate its side effects.

perform ECG prior starting

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3
Q

SEs of ADHD medication

A

abdominal pain, nausea and dyspepsia. In children, weight and height should be monitored every 6 months

leukopenia
pancytopenia
hepatic come

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4
Q

key features of patau syndrome trisomy 13

A

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

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5
Q

features of edwards syndrome trisomy 18

A

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

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6
Q

features of fragile X

A 
Learning difficulties
Macrocephaly
Long face
Large ears
Macro-orchidism
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7
Q

features of noonan syndrime

A

Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis

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8
Q

features of pierre robin syndrome

A

Micrognathia
Posterior displacement of the tongue (may result in upper airway obstruction)
Cleft palate

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9
Q

features of prader willi syndrome

A

imprinting where the phenotype depends on whether the deletion occurs on a gene inherited from the mother or father:

Hypotonia
Hypogonadism
Obesity

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10
Q

features of williams syndrome

A

microdeletion on chromosome 7

  • elfien facies
  • Short stature
  • strabismus
  • broad forehead
  • Learning difficulties
    Friendly, extrovert personality
  • Transient neonatal hypercalcaemia
  • Supravalvular aortic stenosis

Diagnosis - FISH studies

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11
Q

features of autism

A

may have comorbidities
including ADHD, however the core impairments of social interaction difficulties, social
communication difficulties, and rigid repetitive behaviours

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12
Q

features of oppositional defiance disorder

A
  • frequent temper tantrums
  • refusal to comply with adult requests
  • excessive
    arguing with authority figures
  • behaviour intended to annoy, upset or anger other.
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13
Q

screening tools used in the assessment of ADHD

A
  • Conners Questionnaire
  • Dundee Difficult Times of the Day Scale (D- DTODS)
  • SNAP – IV
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14
Q

diagnosis of ADHD involves who

A
  1. the Community Paediatrician (or Child Psychiatrist),
  2. Speech and Language Therapist, and
  3. Educational Psychologist.
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15
Q

DSM 5 Criteria for ADHD

A

inattention 6 or more Sx present for at least 6 months
- careless mistakes
- trouble focusing
does not seem to listen when spoken to directly
- does not follow instructions
- has trouble organising tasks and activities
- cant do mental work for a long period of time
- often loses things necessary for tasks
- easily distracted
- forgetful in daily activities

hyperactivity and impulsivity 6 or more Sx at least 6 months

  • fidgets, taps, squirms
  • leaves sear
  • runs or climb in inappropriate situations
  • cant take part in activities quietly
  • ” driven by a motor”
  • talks excessively
  • blurts out an answer before a q has been completed
  • trouble waiting their turn
  • interrupts/intrudes
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16
Q

Ix done before starting on possible ADHD medication if family has cardiac disease

A

referred to the paediatric cardio assessment

B: Blood pressure measurement
C: ECG with calculation of QTc
D. Echocardiogram

A: 24-hour ECG tape monitoring DONE IF THERE IS A FH OF CARDIAC Hx

17
Q

what is monitored with ADHD meds

SEs

A
  • BP
  • height - appetite suppression -> child’s growth can slow down or even stop
  • weight
  • pulse

cardiac arrest, angina pectoris, neuroleptic malignant syndrome and sudden cardiac death

18
Q

features of autism

A
  1. difficulties of social interaction
  2. social
    communication skills
    - cant have a good convo
    - reduced emotions
    - challenges in understanding or responding to social cues - eye contact/facial expressions
  3. restricted/repetitive behaviours
    - hand flapping toe walking
    - speaking in a unique way

2-3 yrs
more common in boys than girls

19
Q

screening tool for autism

A

GARS questionnaire

Gilliam Autism Rating Scale

20
Q

what is done to give a diagnosis of autism

A

educational psychology assessment ->childs diff in preschool, identify any co-morbid learning difficulties

FH of autism -> parental views about a diagnosis

school report - access support

SALT

DSM-5

  • persistent deficits in each of the three areas of social comm and interaction
  • plus at least two of four types of repetitive behaviour
21
Q

red flags of ASD

A 
not responding to name by 12
doesnt play pretend game
prefers to be alone
flapping hands, rocking body
intense reactions to the way things smell or feel
22
Q

RFs of autism

A 
prematurity
parental schizo
maternal use of valproae
LD
ADHD
neonatal encephalopahty HIE
genetic - fragile X
TS
NF
muscular dystrophies
23
Q

Mx of autism

A 
behavioural Mx
OT
SALT
dietician - supplements
sleep hygiene
24
Q

cerebral palsy

A

chronic condition affects movement posture motor

non progressive permanent lesion in brain
1. spastic - cerebrum, muscle rigidity anterior cerebral artery legs - diplegic, MCA ULs are affected
ICA - quadraplegic
2. basal ganglia dyskinetic - dystonia, athetoid
3. cerebellum - ataxic
4. mixed

25
Q

what is turner syndrome and its features

A

presence of only one sex chromosome (X) or a deletion of the short arm of one of the X chromosomes. Turner’s syndrome is denoted as 45,XO or 45,X.

short stature
shield chest, widely spaced nipples
webbed neck
bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
primary amenorrhoea
cystic hygroma (often diagnosed prenatally)
high-arched palate
short fourth metacarpal
multiple pigmented naevi
lymphoedema in neonates (especially feet)
gonadotrophin levels will be elevated
hypothyroidism is much more common in Turner’s
horseshoe kidney: the most common renal abnormality in Turner’s syndrome

26
Q

CFs of down

A
  • face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face, small mouth, flat nasal bridge
  • hypertelorism
  • flat occiput
  • single palmar crease, pronounced ‘sandal gap’ between big and first toe, clinodactaly (incurved little finger
  • hypotonia
  • congenital heart defects (40-50%, see below)
  • duodenal atresia
  • Hirschsprung’s disease
27
Q

cardiac complications of downs

other compl

A
  • endocardial cushion defect AVSD
  • VSD
  • secundum atrial septal defect (c. 10%)
  • tetralogy of Fallot (c. 5%)
  • isolated patent ductus arteriosus
  • subferitlity
  • learning difficulties short stature
  • repeated repsiratory infections
  • short stature
  • acute lymphobalstic leukaemia
  • hypothyroidism
  • alzheimers
  • atlantoaxial instability
28
Q

most common fractures ass w child abuse

A
  • Radial
  • Humeral
  • Femoral
29
Q

presentation of child abuse

A

story inconsistent with injuries
repeated attendances at A&E departments
late presentation
child with a frightened, withdrawn appearance - ‘frozen watchfulness’

  • pregnancy
  • STIs, recurrent UTIs
  • sexually precocious behaviour
  • anal fissure, bruising
  • reflex anal dilatation
  • enuresis and encopresis
  • behavioural problems, self-harm
  • recurrent symptoms e.g. headaches, abdominal pain

bruising
fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing

torn frenulum: e.g. from forcing a bottle into a child’s mouth

burns or scalds

failure to thrive

sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas

30
Q

Trisomy 21 results from

RFs

Ix

most commonest cardiac anomalies

2 most common GI abnromalities

heam anomalies <3 yrs

A
  1. meiotic non dysjunction
  2. robertsonian translocation
  3. mosaicism
  • pt w a translocation mutation of chromosome 14 and 21
  • advancing maternal age
  • having already had a child w DS
Ix
FBC - thrombocytopenia, neutrophilia and polycythaemia
2. HEARING SCREEN
3. TFTs - hypothyroidism
4. cardiac echocardi

AVSD - SOB , wheeze, failure thrive, poor fedding
surgery before 6ms

Duodenal atresia/Hirschsprung

acute myeloid leukaemia

31
Q

what do u do if a child comes in with inconsistent history and NAI bruises

Ix done in suspected NAI

A

check child protection register

admit for further Ix and senior review

  1. FBC and clotting - exclude bleeding tendency
  2. CT scan of the head
  3. skeletal survey
  4. examination of the fundi
32
Q

Role of the child protection team

A
  1. initially convene a case conference to include the parents, police officer, Paediatrician, GP, health visitor and the social worker
  2. case discussed then they decide whether abby should be placed on child protection register
  3. the social worker and health visitor can support family and check in baby
  4. paediatrician is asked to do a regular follow up in terms of growth and development
33
Q

what is seen in spastic hemiplegia

A

Arm held flexed, adducted, internally rotated.
Leg extended, stiff and in plantar flexion.
Leg dragged in circumduction (semi-circle).

34
Q

Risks of having a downs child

A

pt with translocation mutation
advanced maternal age
child with Downs

Paediatrics (13 decks)

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