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)
