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Paediatrics > Development > Flashcards

Development Flashcards

1
Q

Positive indicator red flags

A
  • regression
  • concerns about vision/fixing/following
  • Hearing loss
  • Persistently low mm tone/floppiness
  • No speech by 18 months
  • Asymmetry of movement/features of cerebral palsy
  • persistent toe walking
  • complex disabilities
  • head circumference >96th centile or <0.4centile or crosses 2 centiles compared to rest
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2
Q

Negative indicator red flags

A
  • sit unsupported at 12 mo
  • walking by 18M (boy) 2Y (girl)
  • Walk other than on tip toes
  • run by 2.5
  • hold objects in hand by 5years
  • reach for objects by 6mo
  • point at objects by 2Y
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3
Q

Causes of gross motor delay

A
  • muscular dystrophies (neuromuscular)
  • cerebral palsy
  • chromosomal anomalies
  • antenatal infections
  • rickets/malnutrition
  • DDH
  • neglect
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4
Q

Gross motor red flags

A 
Poor head control or floppiness at 6 months.
Unable to sit unsupported at 9 months.
Not weight bearing through legs at 12 months.
Not walking at 18 months.
Not running at 2 years.
Not climbing stairs at 3 years.
Persistent toe walking.
Increased muscle tone.
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5
Q

WHat is the normal Babinski response

A

at birth extensor

by walking flexor

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6
Q

What investigation should you do in an isolated gross motor developmental delay

A

CK to rule out MD

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7
Q

What are the most common red flags for cerebral palsy

A
  • Not sitting by 8 months (corrected for gestational age).
  • Not walking by 18 months (corrected for gestational age).
  • hand preference before 1 year (corrected for gestational age).
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8
Q

What is duchennes muscular dystrophy

A
  • Progressive proximal muscular dystrophy with hypertrophic calves
  • All people display symptoms by 3 years old
  • Only effects males
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9
Q

What are the clinical features of duchennes muscular dystrophy

A
  • motor milestone delay
  • Inability to run - waddles
  • toe walking/falls/can’t hop
  • gowers sign
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10
Q

How is a diagnosis of duchennes musclar dystrophy made

A
  • Genetic analysis
  • Muscle biopsy - with assay for dystrophin protein.
  • Clinical observation of muscle strength and function.
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11
Q

What is Beckers Muscular dystrophy

A
  • similar to Duchennes but a clinically milder form,

- average diagnosis age 11 but may be teens early 20s

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12
Q

What are the complications of muscular dystrophy

A

progressive difficulty walking
dilated cardiomyopathy
arrhythmia
respiratory failure

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13
Q

What tools are used to assess development in under 5

A
  • schedule of growing skills
  • Griffths mental development scales
  • Bayley scales of infant development
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14
Q

What tools are used to assess development in school aged children

A
  • Wechster intelligence scale for children

- British abilities scale

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15
Q

When would you expect to roll

A

8-18 weeks

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16
Q

Pulls self up to stand

A

6-10months

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17
Q

Walks holding furniture

A

10-13 months

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18
Q

head lag

A

<6 weeks

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19
Q

walk

A

11-14 months

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20
Q

Hops, skips:

A

2.5 - 5

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21
Q

visual fixation

A

6w

22
Q

transfers objects between hands

A

6-8 mo

23
Q

pincer grip

A

12mo

24
Q

tower bricks 2-3 blocks, scribbles

A

18mo

25
Q

tower 4-6 bricks, draws verticle line

A

2 years

26
Q

draws circle

A

3 years

27
Q

draws cross/square

A

4 years

28
Q

draws triangle, can do buttons

A

5 years

29
Q

startles to loud sounds

A

6 weeks

30
Q

babbling/turns to name

A

6-8 months

31
Q

understands no

A

9 months

32
Q

2-3 words

A

12 months

33
Q

25-50 words

A

18 months

34
Q

3-4 word sentences

A

3 years

35
Q

smiles

A

6 weeks

36
Q

holds bottle on feeding

A

6-8 months

37
Q

waves bye

A

12 months

38
Q

drinks from cup

A

15 months

39
Q

uses spoon

A

18months

40
Q

interactive play/knife and fork

A

3 years

41
Q

potty trained

A

4

42
Q

endocrine causes of poor growth

A

hypothyroidism
hypopituritism
growth hormon deficiency
cushings disease

43
Q

genetic causes of short stature

A

Noonan
Turner/Di George
Russel-silver syndrome

44
Q

systemic causes of short stature

A

coeliac
inflammatory bowel
renal disease

45
Q

Approach to someone with short staturs

A
  1. accurate measurements of height and weight

2. calcuate mid-parental centile (add 7cm boy, take 7cm for girls) Plot at 18 on growth chart

46
Q

What is a considered a normal growing child

A

height centile will be within 2 centile spaces (one above and one below) of mid-parental centile

47
Q

Nutritional causes of short stature

A 
malnutrition
bulimia
anorexia
chronic disease - malabsorption
psychosocial deprivation
neglect
48
Q

Skeletal causes of short stature

A

achondroplasia
hypochondroplasia
conditions with assoc. spinal/bone abnormalities e.g. rickets

49
Q

What is constitutional delat of growth and puberty

A
  1. deceleration of length/height in first 3 years of life
  2. near normal height velocity during childhood
  3. acceleration late in adolescence.
50
Q

Features of GH DEFICIENCY

A
  • micropenis
  • hypoglycaemia at birth
  • growth deceleration by age 2
  • ‘cherubic’ look
51
Q

Investigations for ?GH deficiency

A

bone age - delayed
IGF 1 - low
GH stimulation tests: low; peak GH level <10 micrograms
MRI brain

52
Q

mNgement GH deficiency

A

recombinant GH
treat underlying cause
treat other pituitary insufficiencies

Paediatrics (21 decks)

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