Curriculum Flashcards
1) You are the paediatrician assessing an infants growth. Where would you record the measurements of height, weight and head circumference?
2) You have recorded the measurements above. What would indicate a growth problem in the chart?
1) Assessing growth in children record = Growth Chart in Red Book
2) Growth faltering = Crossing Centiles,
1) How can you recognise whether the growth pattern is normal in infancy and childhood
2) How can you recognise whether the growth pattern is abnormal in infancy and childhood
3) Name of the puberty staging tool?
4) What instrument helps you assess a boys pubertal development?
5) What may indicate abnormal pubertal development in boys on examination
- Early
- Late
6) What may indicate abnormal pubertal development in girls on examination
- Early
- Late
1 + 2) Look at growth chart, calculate child’s expected height from parent.
3)
Orchidometer
4) Pubertal staging = Tanner Staging
5)
Early puberty (before 8)
- Increase in testes volume
Late puberty (after 15) In boys: the absence of testicular development (or a testicular volume lower than 4 ml) by age 14 years
6)
Early puberty (before 9)
- Breast Development
Late puberty (after 15) In girls: the absence of breast development by the age of 13 years, or primary amenorrhoea with normal breast development by the age of 1
1) What are the most common causes of precocious puberty in boys
2) What are the most common causes of precocious puberty in girls
3) What are the most common causes of delayed puberty in boys
4) What are the most common causes of delayed puberty in girls
5) Rare Cause delayed puberty in boys hint genetics
6) Rare Cause delayed puberty in girls hint genetics + syndrome
1) Boys precocious puberty = any androgen secreting tumour
• pituitary tumour
• Leydig cell tumour
• CAH
2) Girls precocious puberty
• McCune - Albright syndrome
• CAH (precocious)
3) Boys Delayed Puberty = • Constitutional Delay in growth • Congenital hypothyroidism pituitary tumour • craniopharyngioma
4) Girls Delayed Puberty
• Constitutional Delay in growth
• Congenital hypothyroidism
5) Hypogonads secondary to Klinefelters
6) Genetics
Turner Syndrome
Androgen insensitivity syndrome
Polycystic ovary syndrome
1) 4 Broad causes of abnormally short stature in children
S.H,O,R,T
2) abnormally short stature in children malabsorption?
3) abnormally short stature in children hormonal?
4) abnormally short stature in children social?
5) Causes of abnormally tall stature in children
6) When to refer appropriately
1) abnormally short stature = • Social, Syndromes • Hormonal, • Orthopedics, • Reduced nutrition • Treatment for Leukaemia
2) Malnutrition short stature
• Crohns
• Cystic Fibrosis
• Coeliac - IgA TTG
3) Hormonal short stature
• Hypothyroid
• Cushing
• GH deficiency
4) Social causes of short stature
• Neglect
• Abuse
5) Tall Stature
Hormonal
Genetics
Advantages of breast feeding
How can overcome common difficulties
Immunity Asthma Eczema (weak)
Sore Nipples - position change
Mastitis - antibiotics
Insufficient milk - encouragement
infant weaning advice
When should solid foods be introduced?
(solid) foods should be introduced at 6 months of age (26 weeks)
- Understand fluid and electrolyte requirements of the ill neonate
- Understand fluid and electrolyte requirements of the ill child
Treat suspected or confirmed shock with a rapid intravenous infusion of
20 ml/kg of 0.9% sodium chloride solution
Correction of deficit: deficit in ml = wt (kg) x % dehydrated x 10 (ideally the pre-dehydration weight should be used).
Therefore, a 14 kg child who is 5% dehydrated has a deficit of 14 x 5 x 10 = 700 ml.
Maintenance requirements:
100 ml/kg for the first 10 kg
50 ml/kg for the next 10 kg
20 ml/kg for any weight after 20 kg
- Define growth faltering
- Recognize growth faltering
- State the common causes of growth faltering
Weight faltering is defined as weight falling through centile spaces, low weight for height or no catch-up from a low birth weight.
Growth faltering is defined as crossing down through length/height centile(s) as well as weight. A low height centile or height less than expected from parental heights.
Causes Prenatal Postnatal Feeding Problems Poor Absorption
- Recognise obesity
* Assess Obesity
Height and weight should be in light clothing with no shoes
Test urine for protein and glucose
Check blood pressure
- Vitamin A deficiency present
- Vitamin A deficiencies treatment
- Vitamin D deficiency present
- Vitamin D deficiency treatment
Vitamin A
Eye and vision, Skin and hair
Management
vitamin A-rich foods - for example, liver, beef, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes and leafy green vegetables
Vitamin D
Management
For a fair-skinned person, it is estimated that around 20-30 minutes of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the UK
Supplements
ergocalciferol or calciferol
• Know how to nutritionally support the chronically sick child
richer formulas of milk
check email from diluki
Recognise the
common causes of breathlessness
Below 1 year
Up to 3 Years
At any age
Viral Bronchiolitis
-(First 6 months)
CAP
-(Above 2 due to vaccination)
TB
(Any age)
Viral associated wheeze
-(Up to 3 years old)
Asthma
-(to be confirmed)
Cystic Fibrosis
-(Newborn infant - heel prick)
Croup
(6 months to 3 years)
(patient.info)
dexamethasone
Stridor
Recognise the common causes of wheeze
In the first 6 months
Up to 3 years
Viral Bronchiolitis
(First 6 months)
Viral associated wheeze
(Up to 3 years old)
Asthma
(to be confirmed)
Diagnostic tools for asthma in the school aged child
Significance of readings obtained
Peak Flow Meter
Oxygen Sats
Heart Rate
Resp Rate
Moderate Asthma
PEF>50–75% best or predicted
Acute severe asthma
PEF 33–50% best or predicted
Life-threatening asthma
PEF<33% best or predicted
Measure the peak flow rate and instruct the older child in this technique.
Peak Flow Diary
CAPS LOG
• Manage asthma in childhood according to the SIGN/British Thoracic Society guidelines.
Moderate
Acute Severe
Life Threatening
MODERATE ASTHMA
1
Treat at home or in surgery and ASSESS RESPONSE TO TREATMENT
2 β2 bronchodilator: – via spacer (give 4 puffs initially and give a further 2 puffs every 2 minutes according to response up to maximum of 10 puffs)
3 If PEF >50–75% predicted/best: Nebuliser (preferably oxygen driven) (salbutamol 5 mg) Give prednisolone 40–50 mg Continue or increase usual treatment
4 If good response to first treatment (symptoms improved, respiration and pulse settling and PEF >50%) continue or increase usual treatment and continue prednisolone
ACUTE SEVERE ASTHMA Consider admission Oxygen to maintain SpO2 94–98% if available β2 bronchodilator: – nebuliser (preferably oxygen driven) (salbutamol 5 mg) – or via spacer (give 4 puffs initially and give a further 2 puffs every 2 minutes according to response up to maximum of 10 puffs) y Prednisolone 40–50 mg or IV hydrocortisone 100 mg y If no response in acute severe asthma: ADMIT
LIFE THREATENING ASTHMA
1
Arrange immediate ADMISSION
2
Oxygen to maintain SpO2 94–98%
3 β2 bronchodilator and ipratropium: – nebuliser (preferably oxygen driven) (salbutamol 5 mg and ipratropium 0.5mg) – or via spacer (give 4 puffs initially and give a further 2 puffs every Two min according to response up to maximum of 10 puffs)
4
Prednisolone 40–50 mg or IV
hydrocortisone 100 mg immediately
- Discuss with parents and children the causes of asthma
- Discuss with parents and children the management
- Discuss with parents and children and prognosis of asthma.
Risk Factors
The management of asthma is based on four principles:
Control symptoms, including nocturnal symptoms and those related to exercise.
Prevent exacerbations and need for rescue medication.
Achieve the best possible lung function (practically, FEV1 and/or PEFR >80% predicted or best).
Minimise side-effects
(Patient info Treatment) 1 SABA 2 add inhaled steroid 3 LABA 4 increase inhaled steroid 5 add oral steroid
Prognosis
Many children will wheeze early in life (about 30% of those aged under 3 years) in response to respiratory tract infections but most appear to grow out of it by the time they go to school
• Instruct children and parents how to use an
MDI
Accuhaler
Turbohaler
Spacer
CAPS LOG
- Recognise acute stridor
- Recognise chronic stridor
- State the causes of acute stridor
- State the causes of chronic stridor
- When to refer
Acute Stridor
Epiglottitis (Rare - Hib vacc)
Immediate referral
Chronic Stridor
Croup (dexamethasone)
If red flags present immediate referral otherwise managed at home
(tachypnoea, recession, drowsiness, cyanosis)
Treatment
oral dexamethasone
Laryngotracheomalacia
- floppy epiglottis
- Describe the causes of LRTI.
* Describe treatment of LRTI.
LRTI lower than larynx
CAUSES
Viral
RSV
Influenza A
Bacterial Strep Pneumoniae H. influenzae Staph Mycoplasma (atypical)
TREATMENTS
Antibiotic
Amoxicillin in a child-friendly formulation, should be used first-line
- presentation of cystic fibrosis in infancy
- presentation of cystic fibrosis in childhood
- presentation of cystic fibrosis in adolescence
- the principles of therapy of cystic fibrosis
Lung: viscid mucous and respiratory infections
Gut: pancreatic insufficiency, meconium ileus
Sweat glands: increased sweat Cl-
Treatment
Nutritional support
Total energy, pancreatic supplements
Micronutrients (fat soluble vitamins)
Physiotherapy
Mucolytics: rhDNAse, hypertonic saline
Antibiotics
H. influenzae, Staphylococcus aureus
Pseudomonas aeruginosa
Understand the transition from fetal to extrauterine circulation
6 points
its impact on the presentation of cardiac disease in infants.
Clearance of fetal lung fluid
Surfactant secretion,
Transition of fetal to neonatal circulation
Decrease in pulmonary vascular resistance Increased pulmonary blood flow
Cortisol Surge
https: //acutecaretesting.org/en/articles/fetaltoneonatal-transition-what-is-normal-and-what-is-not-part-1
https: //acutecaretesting.org/en/articles/fetaltoneonatal-transition-part-2
Cardiovascular problems that lead to cyanosis include congenital heart defects, shock, systemic hypotension or significant anemia that prevents adequate levels of oxygen from being delivered to the body tissues.
Recognise the possibility of cyanotic and acyanotic cardiac disease at different ages and know the principles of therapy.
6 cyanotic diseases
Cyanotic Diseases Right to Left Shunts 1 Tetralogy of Fallot clubbing (MBTS) 2 Eisenmenger 3 Pulmonary Atresia 4 Ebstein 5 Transposition of the great arteries (Prostaglandin, urgent atrial septostomy The definitive corrective procedure is the arterial switch operation)
aCyanotic Diseases Left to Right Shunts 1 ASD 2 VSD 3 PDA
Mixed Shunt
AVSD
Principles of therapy covered in treatment deck
Recognise congestive cardiac failure and know principles of initial treatment.
Cold Peripheries Displaced apex Dynamic precordium Hepatomegaly Tachypnoea (WOB) Thin Sweaty
Yellow Blood Bottle U&E
ACEi
Be able to identify the clinical signs associated with the common paediatric cardiac abnormalities including 1 ventricular septal defect (VSD), 2 patent ductus arteriosus (PDA), 3 atrial septal defect (ASD), 4 coarctation, 5 pulmonary stenosis, 6 aortic stenosis, 7 Tetralogy of Fallot.
1 (pink generally asymptomatic)
if severe reduced feeding
Pan Systolic at Left Lower Sternal Edge +/- Thrill
2 Diastolic murmur at ULSE
3 normally asymptomatic pink bikini incision
(soft systolic ejection murmur ULSE if large defect)
4 radio/radial delay or radio femoral delay
Crescendo-decrescendo murmur in the upper left sternal border
5 Pulmonary Stenosis
Asymptomatic (Not blue)
Ejection systolic murmur at upper left sternal edge
6 Aortic Stenosis
Asymptomatic
Carotid Thrill
Ejection systolic murmur at upper sternal edge
7 Tetralogy of Fallot
Loud murmur 3/6 at ULSE
Be aware of the common arrhythmias of childhood
understand treatment principles.
Atrial ectopics
If well, do ECG and 24 hour tape, fax to Bristol
If sick, tachycardia etc, urgent transfer
Ventricular ectopics
Usually resolve
Check Na, K, Ca, Mg
Complete Heart Block
Sick Sinus Syndrome
Presentation and management of myocarditis
Presentation and management of cardiomyopaty
1 Myocarditis Usually postviral – history? Dilated cardiomyopathy Cardiomegaly Pleural effusions ECG – low voltage
2 Cardiomyopathy
May present with collapse
Dilated Cardiomyopathy
Usually unknown cause
Postviral
Metabolic
Hypertrophied Cardiomyopathy Infiltration Metabolic Non-compaction Genetic HOCM, Noonan
Management ECG Urine Dip Bloods Carnitine decreased, CPK Echo
Know which children are at risk of infective endocarditis, recognise its clinical signs and treat appropriately
Children at Risk
Valves,
VSD,
prosthetic component
Usually streptococcus viridans or pyogenes
Occasionally staphylococcus aureus, MRSA or CNSA
Clinical Signs - History Fever, malaise, chest/abdo, arthralgia New embolic events, Haematuria
Clinical Signs - Examination HepatoSplenomegaly, Temperature Roth, Osler, Janeway, splinters murmurs
Investigations
Blood cultures x6 at different times over 2 days,
FBC, CRP, ESR, WBC, Throat Swab
Echocardiogram + ECG
Treatment
6 weeks IV antibiotics
Surgical treatment
Know the general principles of medical and surgical therapy used in treating children with cardiovascular disease.
Congenital Heart Defects
MBTS
Atrial Balloon Septostomy
Arterial Switch
Patching
Recognise the common causes of vomiting in infancy, childhood and adolescence and know how these are initially managed.
Gastroenteritis UTI Raised ICP DKA Allergies Alcohol Migraine Pregnancy
Pyloric Stenosis Ranstedt Pylomyotomy
Gastro Oesophageal Reflux H2 Antacids
HUS
Volvulus
Initial Management Rehydration Antibiotics Anti-emetics NG tube Surgery
Recognise the common causes of acute and chronic diarrhoea in infancy, childhood and adolescence and know how these are initially managed.
acute infective diarrhoea
Viral - rotavirus (causes gastroenteritis) vaccine treatment 1st dose must be given before 15 weeks - norovirus Bacterial - salmonella - campylobacter
Management Assessment of dehydration Rehydration – iv vs oral Infection control Stool samples antibiotics eg ciprofloxacin for shigella, metronidazole for amoebic dysentery
Parasitic
- giardia, metronidazole
- amoeba
Chronic Diarrhoea
Thriving
Toddler Diarrhoea - Mgx (self resolves)
Constipation with overflow
Not thriving Cystic Fibrosis Coeliac Lactose intolerance Crohns UC
Recognise the common causes of constipation in infancy, childhood and adolescence and initiate management.
Dietary
Treatment Initial advice -Fluid intake -Dietary management -Toileting routine -Laxatives (movicol)
Recognise the common causes of acute, chronic and recurrent abdominal pain in children.
Acute Intussuscpetion 6 - 9 months Appendicitis Mesenteric Adenitis Lower Lobe Pneumonia Testicular Torsion 12 - 13 Chronic
causes of acute bowel obstruction in infants, children and adolescents, presents
principles of management.
intussusception
6-9 months
4:1 ratio M:F
Recognise the common causes of an abdominal mass in infancy childhood and adolescence.
wilms - nephrectomy + chemo neuroblastoma hepatoblastoma constipation - osmotic laxative intussusception 6-9 months 4:1 ratio M:F
Know the different causes of jaundice in childhood, how to investigate and the treatments that should be initiated.
Biliary Atresia
Duodenal Atresia
Give advice to parent on gastroenteritis including oral rehydration therapy.
PC: Diarrhoea
Mgx
- Plenty of fluids
Advice
- good hygiene
Recognise how haematuria may present and know the underlying causes and initial therapies that may be required.
acute nephritic syndrome
Recognise how proteinuria may present and know the common underlying causes and initial therapies that may be required.
nephrotic syndrome
swelling
steroids
Understand how urinary tract infections present at different ages, how they are investigated, and the treatments that are used.
High temperature (fever). Being sick (vomiting) and/or diarrhoea. Drowsiness. Crying, going off feeds and generally seeming unwell. Appearing to be in pain. Blood in the urine (uncommon). Yellowing of the skin (jaundice). Cloudy or smelly urine. nephrotic syndrome Urine dip
3 day course atbx as per local guidelines
Know the major causes of acute and chronic renal failure in childhood. Appreciate how they present and the initial treatment options.
Pre Renal
Hypovolaemia
Cardiac failure
Hypoxia
Renal HUS Acute GN Interstitial Nephritis Nephrotoxic insults infection
Post renal PUV Stone Tumour Retroperitoneal fibrosis
Lethargy
Growth failure
Haemolytic uraemic syndrome
Understand the physiological consequences of renal failure.
hyperkalaemia fluid overload hypertension toxin excretion anaemia acid base
Recognise polyuria, know the common and important causes and how to investigate and treat.
Infection
Diabetes
Identify the common causes of bedwetting and be able to give advice to parents.
primary bedwetting - since childhood
The child cannot yet hold urine for the entire night.
The child does not waken when his or her bladder is full.
The child produces a large amount of urine during the evening and night hours.
The child has poor daytime toilet habits.
Daytime wetting
UTI Diabetes Structural or anatomical abnormality Neurological Problems Emotional Problems (parentala problems / stress / change / abuse) Constipation
MGX • 1st Reassure your child • no drink hour before bed • wee before going to sleep • 2nd Enuresis alarm. • Don't tell them off or punish them • Normal age for unrinary continence 3 or 4
Know the causes, investigations and treatments of hypertension presenting in childhood.
Know how to measure and interpret childhood blood pressure.
renal disease
Renal artery stenosis. Renal parenchymal disease. Coarctation of the aorta. Cushing's syndrome. Hyperthyroidism. Obstructive sleep apnoea and sleep disordered breathing. Phaeochromocytoma.
Be able to examine the inguinal area and distinguish between a hernia and a hydrocoele.
transillumination + slow to fill slow to empty + can get above the swelling
vs
abdo pain, constipation, nausea vomiting, bowel sounds in mass
Understand the normal development of external genitalia including the foreskin and labia/vulva.
Testes should descend within the 1st couple of months
Recognise abnormalities and when to initiate treatment of balanitis and dysuria.
pathological phimosis paraphimosis balanoposthitis torsion of testicle torsion of a hydatid of Morgagni Epididymo-orchitis idiopathic scrotal oedema incarcerated hernia
Have knowledge of normal descent of the testis, recognize abnormalities and know the management of retractile and undescended testis.
undescended
ectopic
impalpable
if palpable
orchidopexy
impalpable laparoscopy orchidopexy staged procedure microvascular transplant
Know how cerebral palsy presents, the possible causes and the therapies used.
delayed developmental milestones
floppy
stiff
milestones
not sitting by 8 months
not walking by 18 months
late head control
ataxic
mixed
spastic
athetoid
Define febrile convulsions in children and know how to differentiate these from other seizure disorders.
6 months to 5 years
peaking at 18 - 22 monnths
whilst child feverish
Know the causes of and how to assess the ‘floppy’ infant.
paralytic
- muscular dystrophy
- guillain barré
- spinal cord tauma
- myasthenia gravis
non-paralytic
- cerebal palsy
- downs
- prader willi
- hypothyroid
- congenital heart
Recognise epilepsy in infancy, childhood and adolescence.
Know the different common types and how they are diagnosed and managed.
Focal e.g.CECTS
Absence
Tonic Clonic
Myoclonic
Absence
2-10
brief
sodium valproate or ethosuximde
CECTS childhood epilepsy with centrotemporal spikes 7-10 retain conscious 1- 2min EEG no treatment needed
Juvenile Myoclonic
sodium valproate
Be able to outline to parents the nature, treatment and prevention of febrile convulsions and epilepsy.
Secondary to infection cant prevent no treatment needed if lasts too long call ambulance dont put anything into mouth recovery position
Understand how neuromuscular diseases present in children, how they are investigated and how they are managed.
Duchenne muscular dystrophy (DMD)
Becker muscular dystrophy (BMD)
Know the causes and treatments of headaches in childhood.
- migraine - most common
- tension headache - 2nd most common
- meningitis - red flag
- lack of sleep
- missing meals
- stress
Treatment
ibuprofen
triptans (sumatriptan)
Know the causes of cerebral haemorrhage and stroke in children and how they are assessed and managed.
trauma intraventricular haemorrhage - neonates sickle cell (clot) vasculitis arteriovenous malformations (AVMs)
CT
MRI
Recognise the presentation of meningitis in different age groups of children, know how to investigate and initiate management.
non-blanching rash
fever
increased cap refill
bulging fontanelle
Mgx
3mths or older Children IV ceftriaxone
Younger than 3 months Cefotaxime + amoxicillin
Recognise the common causes of gait disturbance in infancy, childhood and adolescence.
SUFE
Perthes Disease
BMD
DMD
Know the common causes of delayed development in childhood.
Hearing Problem Hypothyroid Obstructive Sleep Apnoea Coeliac Duodenal Atresia CNS tumours
Recognise the importance of loss of or failure to acquire milestones in the major developmental domains.
Physical development
Turner
GH deficiency
Fragile X Downs (language) Prematurity Lack of Oxygen (language) Deprivation (all) Maternal Depression Autism (social) Cerebral Palsy (gross motor) Williams Syndrome
Know how the important neurocutaneous and neurodegenerative disorders present and how they are managed.
neurofibromatosis
cerebral palsy
Appreciate the contribution of the multidisciplinary team to the care of children with chronic neurological problems.
Psychological Assessment
In the lecture given by the nice black lady
Know the causes and signs of raised intracranial pressure in infancy and childhood.
Causes
- shaken baby syndrome
- meningitis
- epilepsy
- hydrocephalus
- SOL
Signs
- lowered GCS
- seizures
- papilloedema
- vomiting
- bulging fontanelle
- pupils
Recognise spina bifida and its associated problems.
- Occulta
- Meningocoele
- Myelomeningocoele
- Movement problems
- Bowel Problems
- Bladder Problems
- Hydrocephalus
-Surgery within 48 hours of birth
Know the causes and treatments required for infants/children and adolescents with depressed conscious states.
Sepsis Febrile Convulsions Epilepsy Hypoglycemia Meningitis Hydrocephalus Abscess Epiglottitis Trauma
Assess anaemia in infancy and childhood
FBC
Know the different presentations of childhood leukaemia
AML bone pain frequent nosebleeds bleeding and swollen gums easy bruising excessive sweating (particularly at night) shortness of breath unexplained weight loss heavier than normal periods in women
CML fatigue, most likely due to anemia rash bruising or bleeding easily bone and joint pain enlarged spleen increased risk of infection
ALL pallor bleeding from the gums a fever bruises petechiae, lymphadenopathy, neck, pitts or groin hepatomegaly, splenomegaly, bone pain joint pain weakness fatigue shortness of breath testicular enlargement cranial nerve palsies
CLL fatigue fever frequent infections or illness unexplained or unintended weight loss night sweats
Assess a child with bruising and bleeding disorders, including petechial and purpuric rashes
AML
CLL
ALL
CLL
Blood Clotting Disorder
ITP
DIC
HSP (HUS)
Meningitis
Understand how and why thrombosis may present in childhood
Factor V Leiden. DVT Prothrombin thrombophilia. second most common type. DVT Protein C deficiency. Protein S deficiency. Antithrombin deficiency.
Recognise lymphadenopathy and know its differential diagnosis at different ages in childhood
Hodgkins Neck Lymphadenopahty Mediastinal Mass (SVC obstruction) Fever Night Sweats Weight Loss
Non Hodgkins neck, armpit or groin Lymphadenopathy Fever Night Sweats Weight Loss
Burkitts
- Know the major causes of childhood malignancies,
- how children present with malignancy, how they are treated and the medical and psychological challenges associated with both disease and therapies.
Leukaemia
- ALL - chemo
Brain + spinal tumour
- medulloblastoma (most common)
- 3-5 yr Group C
- 6 - 15yr Group D
- astrocytoma - incurable
- presentation
- macrocephaly
- faiure to thrive
- vomiting
- developmental delay
Lymphoma
- HL - chemo + radio
Neuroblastoma
- constipation diarrhoea fever
- racoon eyes
- Mgx -High dose intensity induction
- surgery
- chemo
- radio
- immuno
SE infertility poor growth
Soft tissue sarcoma
Wilms
Retinoblastoma - chemo
Li fraumeni syndrome
Diagnose, assess and know the principles of managing diabetes mellitus in children, including the management of Diabetic Ketoacidosis.
Vomiting
Fluids (calculate based on formula)
Insulin
Be able to recognize, investigate and treat hypoglycaemia in infants/children and adolescents.
reduced conscious state
BM
Know how corticosteroid and mineralocorticoid steroid excesses and deficiencies present and are managed.
Cushing Syndrome CAH HTN Addisons Hypernatraemia Hyponatraemia Conns
Understand the principles of screening for inherited metabolic and other conditions at birth (including phenylketonuria, hypothyroidism, cystic fibrosis) and what to do when positive results are detected.
Heel Prick Test (Guthrie Card)
Performed 5-9 days of life
Recognise and investigate thyroid problems in the child.
TSH (blood test)
Know the causes and management of ambiguous genitalia
the disorders of sexual differentiation.
CAH
salt losing crisis
1)
Understand the principles of inborn errors of metabolism
2)
know how inherited metabolic conditions may present in childhood.
- CAH
- Phenylketonuria
- MCAD
- G6P deficiency
- Homocystinuria
- Homocystinuria
- methionine metabolism
- heel prick test
- vitamin b6
Recognise the common skin conditions in infancy, childhood and adolescence.
hand foot and mouth disease viral illness very contagious but can go to school if child feels well roseola infantum chicken pox eczema psoriasis acne
Recognise the exanthematous infections of childhood and their clinical courses.
roseola infantum
- HHV6
Know how Eczema presents and how it is managed.
itchy flexures
Understand how staphylococcal and streptococcal skin disease present and their consequences.
scalded skin syndrome
impetigo
scarlet fever
Know how Herpes presents in the skin in children and is managed (including gingivostomatitis and eczema herpeticum)
Oral Herpes
eczema herpeticum looks like impetigo
Know the skin manifestations of common and serious systemic diseases of childhood.
eczema herpeticum
Scalded skin syndrome
necrotising fasciitis
Know the importance of trauma and accidents in childhood for morbidity and mortality.
shaken baby syndrome
Be able to assess the significance and sequelae of head injuries in infancy and childhood.
A to E
CT head
MRI
Be able to advise parents on strategies to reduce the risk of accidents in the home.
to be completed
Understand the causes of accidental and non-accidental poisoning in childhood and how to manage them.
Bruising in abnormal places
behind the ears
Be aware of non-accidental injuries (including sexual abuse) and know the outline strategy for handling them.
Inform Social Services
Know the principles of underlying management of thermal injury (burns) and chest/abdominal injury.
Superficial epidermal First degree Red and painful
Partial thickness (superficial dermal) Second degree Pale pink, painful, blistered
Partial thickness (deep dermal) Second degree Typically white but may have patches of non-blanching erythema. Reduced sensation
Full thickness Third degree White/brown/black in colour, no blisters, no pain
• Immediate first aid
airway, breathing, circulation
• heat burns - remove the person from source. Within 20 minutes irrigate the burn with cool (not iced) water for 10 - 30 min
layered cling film
- electrical burns: switch off power supply, remove the person from the source
- chemical burns: brush any powder off then irrigate with water. not recommended to neutralise the chemical
• Assessing the extent of the burn
Wallace’s Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%
• Lund and Browder chart: the most accurate method
the palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA
Know variations of normal posture in children.
to be completed
Know the causes of limp in childhood and how to investigate and treat them.
Cerebral Palsy
• Know the reasons children get painful swollen joints and how to treat them.
JIA
Know the causes and how to assess a young child with pseudoparesis of a limb
to be completed
Understand the principles for joint deformities and contracture formation in children with disabilities and how they are prevented and managed.
Perthes
Understand the reasons children get limb pains and how to treat them.
JIA
Know the common causes of abnormality to the spine and neck and how to manage them.
Scoliosis
Spina Bifida
Know the common genetic causes of skeletal abnormality.
SUFE
Scoliosis
Perthes
• Know the principles of active and passive immunization and be able to advise parents on childhood
vaccinations.
to be completed
• Be able to recognize the septic infant /child/adolescent.
Sepsis 6
• Know when to suspect immunodeficiency
Recurrent Infections
• Know the symptoms and signs of the common exanthematous diseases of childhood
to be completed
• Know the common and important reasons for acute and prolonged fever in the
infant/child/adolescent
scarlet fever (grpA strep) kawasaki disease
Know the presentations, management and potential consequences of the common viral infections including measles, mumps, rubella, herpes virus, parvovirus B19 enterovirus
Measles
- Parvovirus B19
- white spots inside the mouth
- fever
- irritable
- conjuntivitis
Mumps
- earache
Rubella
- vesicles in mouth
- vesicles on palm
Know the presentations, management and potential consequences of common bacterial infections
including
Staphylococcus,
Group a strep,
meningococcus
pneumococcus.
meningococcal septicaemia
• Recognise the uncommon manifestations of common diseases including toxic shock syndrome, necrotizing faciitis Kawasaki’s disease.
to be completed
Recognise rare but potentially serious infections including Septicaemia, meningitis, Encephalitis, Tuberculosis, HIV Lyme disease.
to be completed
Know how the common tropical disease may present when children have returned from abroad
including
Malaria
typhoid.
to be completed
Be able to investigate the child with hearing difficulties
Newborn
otoacoustic emission test
6-9 months
Distraction
1.5 -2.5 years
Where is the teddy test
2.5 - 3 years
Kendall Toy test, McCormick Toy Test
3 years
Pure tone audiometry
Know the causes investigations and management of children with sore throats
Viral
Bacterial
Understand the presentation and management of obstructive sleep apnoea in childhood and how it
differs from adults.
to be completed
• Recognise the common causes of genetic and chromosomal abnormalities in childhood and how to
investigate and treat them.
- Trisomy 21 Downs
- Trisomy 18 Edwards
- Trisomy 13 Patau
- WIlliams Syndrome
- Noonans Sydrome
- Fragile X syndrome - microcephaly
Recognise how trisomy 21 presents & the best way to council parents.
Have knowledge of
associated problems with this condition.
Downs
AVSD
• Know how to obtain the information necessary for genetic counselling.
to be completed
Know the common causes of infant and childhood mortality globally and in the UK and understand
how and why these have changed over time.
to be completed
• Recognize the main contributors that have improved health of children in the UK
Vaccinations
Understand the impact of social class and inequality for child health
to be completed
Know the normal pattern of development of the child from birth to 5 years (Patterns of gross motor, fine motor + visual, hearing + language social skills
to be completed
Understanding of how
vision and hearing are assessed in children.
Vision
Squint - cover test / corneal light reflection test
Kays Picture Cards
Know the UK healthy child programme including the UK immunisation programme, universal
screening, the role of the heath visitor and healthy nutrition.
to be completed
Appreciate the impact of family, genes and the environment on the physical, emotional and
developmental well being of the child (0-5) and young person (5-15)
to be completed
• Safeguarding - Identify the signs and symptoms that suggest children may be suffering from
abuse/neglect or may be at risk of significant harm (physical, emotional and sexual) and know what
action to take to safeguard their welfare.
to be completed
Understand multi-agency pathways, procedures used to protect children and the process of serious
case reviews
to be completed
• Know how to identify and manage Chronic Fatigue Syndrome (CFS/ME) and identify and manage
common pain problems
6 months symptoms +
Manage Symptoms
• Know the presentation and management of high prevalence impairments in childhood (attention deficit hyperactivity disorder (ADHD), developmental coordination disorder, high functioning autistic spectrum disorder (Aspergers), specific and mild /moderate learning difficulties)
ADHD
- Impulsivity
- Hyperactivity
- Poor Concentration
• Know the presentation and management of low prevalence but severe impairments in childhood
(autistic spectrum disorders, severe global learning difficulties, cerebral palsy)
Autism
- male
- before 3
Understand the function of the multi-disciplinary ‘team around the child’, particularly related to the
disabled child.
to be completed
Recognise eating disorders including anorexia and bulimia. Know how to investigate and treat.
Restricted Intake
Body Dysmorphia
Increased Exercise
• diagnose and treat the common behavioural problems in the preschool child
to be completed
diagnose and treat the common psychiatric disorders in pre-school and primary school age children.
to be completed
Adolescence : common presentations of mental health disorders in adolescence.
Anxiety
OCD
Aspergers
ADHD
Describe the prevalence and clinical presentation of common psychiatric conditions presenting in
young people including: eating disorders; mood disorders (eg anxiety and OCD (obsessive
compulsive disorder); ADHD (attention deficit and hyperactivity disorder); ASD (autism spectrum
disorder) psychotic illness; conduct and emotional disorders and attachment difficulties
to be completed
Understand normal life adjustments and transitions (including between age groups) and recognise
the difference between mental illness and the range of normal responses to stress and life events.
to be completed
Describe the current common psychological, physical and social and lifestyle treatments for these
conditions.
to be completed
Understand the doctor’s duties and the patient’s rights under mental health legislation, Including the importance of confidentiality and when to override this for young people.
to be completed
Describe the range of services and professionals involved in the network of young people, and understand the roles of self help, carer / parent groups, schools, social services etc.
to be completed
Understand diagnostic criteria for the above conditions, and be aware of common assessment / diagnostic tools (e.g. Connor’s)
to be completed
Communicate effectively with patients, families and multidisciplinary colleagues about psychiatric difficulties.
Discuss with patients and relatives the nature of their illness, (i.e.
basic psycho education), management options and prognosis.
to be completed
In young people with mental health difficulties, evaluate information about family relationships and
other social factors (e.g. school) and the impact on a young person.
to be completed
Evaluate the impact of psychiatric illness on the young person, their family and others around them.
to be completed
