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Paediatrics > Development and Bones > Flashcards

Development and Bones Flashcards

1
Q

The Denver Developmental Assessment assess children of what age bracket?

A

Birth to 6 years

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2
Q

What are the 4 developmental areas?

A

Social, emotional and behavioural
Fine motor and vision
Hearing, speech and language
Gross motor

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3
Q

What is the classic triad for autism diagnosis?

A

Stereotyped behaviour
Communication impairment
Social interaction impairment

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4
Q

What is the management of autism?

A

Educate patient and parents
Request special educational needs assessment
Manage any sleep problems
Manage challenging behaviour: care plan/mental health team

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5
Q

What is the ratio of males to females with Asperger’s syndrome?

A

M:F
8:1

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6
Q

Define Asperger’s syndrome

A

A pervasive developmental disorder lying on the autistic spectrum but without delayed cognition and language development

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7
Q

What are the early signs of autism?

A 
Decreased eye contact 
Repetitive play
Sensory sensitivity 
Repetitive sounds
Wanting to be held all the time or not at all
Not responding to their name
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8
Q

Describe the theory of mind and why it is important

A

The ability to put yourself in someone else’s shoes, see situations from their perspective and experience how they are feeling
Lack of this is thought to be key reason for some of the main difficulties seen in autism

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9
Q

What are the diagnostic criteria for ADHD?

A

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
Present for the age of 12
Present in 2 or more settings
Clear evidence that symptoms reduce quality of functioning

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10
Q

What are the types of ADHD?

A

Predominantly inattentive
Predominantly hyperactive/impulsive
Combined

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11
Q

What questionnaire is used to aid diagnosis of ADHD?

A

Conners

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12
Q

What medications are used for ADHD?

A

Methylphenidate (1st line)

Atomoxetine

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13
Q

What are the side effects of methylphenidate?

A 
Abdominal pain
BP changes
Dizziness
Arrhythmias 
Depression
Growth restriction
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14
Q

What are the side effects of atomoxetine?

A 
Abdominal pain
Depression
Anxiety
Dizziness
Headache
Increased BP
Sleep disturbances
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15
Q

At what age should a child be able to raise their head?

A

6-8 weeks

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16
Q

At what age should a child be able to sit without support?

A

6-8 months

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17
Q

At what age should a child be able to crawl?

A

8-9 months

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18
Q

At what age should a child be able to stand and cruise?

A

10 months

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19
Q

At what age should a child be able to walk unsteadily?

A

12 months

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20
Q

At what age should a child be able to walk steadily?

A

15 months

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21
Q

At what age should a child be able to follow moving objects with eyes?

A

6 weeks

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22
Q

At what age should a child be able to reach for toys?

A

4 months

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23
Q

At what age should a child develop palmar grasp?

A

4-6 months

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24
Q

At what age should a child be able to transfer toys from one hand to the other?

A

7 months

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25
Q

At what age should a child develop pincer grip?

A

10 months

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26
Q

At what age should a child be able to make a tower of 3 blocks?

A

18 months

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27
Q

At what age should a child be able to make a tower of 6 blocks and draw a straight line?

A

2 years

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28
Q

At what age should a child be able to draw a circle?

A

3 years

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29
Q

At what age should a child be able to vocalise with coos and laughs?

A

3-4 months

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30
Q

At what age should a child be able to turn to soft noises?

A

7 months

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31
Q

At what age should a child be able to use 2-3 words other than mama and dada?

A

12 months

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32
Q

At what age should a child be able to show you 2 parts of the body?

A

18 months

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33
Q

At what age should a child be able to smile responsively?

A

6 weeks

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34
Q

At what age should a child be able to put food in their mouth?

A

6-8 months

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35
Q

At what age should a child be able to wave bye-bye and play peek-a-boo?

A

10-12 months

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36
Q

At what age should a child be able to drink from a cup with 2 hands?

A

12 months

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37
Q

At what age should a child be able to hold a spoon and get food to the mouth?

A

18 months

38
Q

How does a baby being pre-term affect the developmental milestones?

A

We subtract how early they were from how old they are to know where their development should be
Eg. 9 month old, born 3 months early - should be at 6 month developmental age

39
Q

What are the terms we use to describe developmental delay in all or some fields?

A 
All = global delay 
Some = specific developmental delay
40
Q

Describe the primitive Moro reflex

A

Sudden extension of the head causes symmetrical extension then flexion of the arms

41
Q

Describe the primitive grasp reflex

A

Flexion of the fingers when an object is placed in the palm

42
Q

What test can we use to track development?

A

Denver

43
Q

At what ages should the health visitor review an infant?

A 
Antenatal health promoting visit
New baby review
6-8 week assessment
1 year
2-2 1/2 years
44
Q

What is dyspraxia?

A

A disorder of motor planning and/or execution with no significant neurological findings

45
Q

Define dyslexia

A

A disorder of reading skills disproportionate to the child’s IQ

46
Q

Premature puberty is defined as …

A

Development of secondary sexual characteristics outside the normal ranges
<8 in females
<9 in males

47
Q

What is precocious puberty?

A

A pattern of premature sexual development

48
Q

How do we categorise precocious puberty?

A

Gonadotrophin dependent - central, ‘true’

Gonadotrophin independent - pseudo/false

49
Q

What is gonadotrophin dependent precocious puberty?

A

Premature activation of the HPG axis

50
Q

What is gonadotrophin independent precocious puberty?

A

Excess sex steroids outside the pituitary gland

51
Q

Give 2 causes of gonadotrophin independent precocious puberty in females

A

Congenital adrenal hyperplasia

Adrenal tumours

52
Q

Give 1 cause of gonadotrophin dependent precocious puberty in females

A

Pituitary tumour

53
Q

Why is gonadotrophin dependent precocious puberty uncommon in males?

A

The testes are relatively insensitive to secretion to gonadotrophins

54
Q

Define delayed puberty

A

Absence of pubertal development by 14 yrs for females and 15 yrs for males

55
Q

Give some causes of delayed puberty

A

Constitutional delay - most common
Low gonadotrophin secretion: systemic disease, pituitary disease.
High gonadotrophin secretion - Turners, Klinefelter
Steroid hormone enzyme deficiencies
Acquired gonadal damage

56
Q

What is the first sign of puberty in females?

A

Breast developments

Thelarche

57
Q

Define failure to thrive

A

Implies growth failure and failure of emotional and developmental progress

58
Q

Describe the order affected measurements during failure to thrive

A

Weight gain first affected
Then length
Then head circumference

59
Q

Give a differential diagnosis for weight faltering in children

A 
Catch down and constitutional 
Genetic syndrome
Environmental
Chronic illness
CF
GORD
Coeliac 
Intrauterine growth restriction 
Endocrine dysfunction
Immune deficiency
60
Q

Describe ‘catch down’

A

Babies commonly cross centiles in their 1st year
Large babies cross down to reach genetically destined centile
Important not to cause distress

61
Q

What is Rickets?

A

Failure in mineralisation of growing bone or osteo tissue

62
Q

Define osteomalacia

A

Failure of mature bone to mineralise

63
Q

What are the primary causes of Rickets?

A 
Living in the northern latitudes
Dark skin
Decreased exposure to sunlight
Maternal vitamin d deficiency
Diet low in calcium, phosphorus and vitamin d
Strict vegan diet
Prolonged parenteral feeding in infancy
64
Q

Which malabsorption diseases can cause Rickets?

A

Small bowel enteropathy - coeliac
Pancreatic insufficiency-CF
Cholestatic liver disease

65
Q

How does Rickets present?

A

Earliest sign-pressing on occipital/posterior parietal bone gives sensation of pressing a ping-pong ball
Costochondral junction maybe palpable
Wrist and ankle widening
Horizontal depression where ribs meet diaphragm-Harrison’s sulcus
Bowed legs

66
Q

How do we diagnose Rickets?

A

Dietary history
Blood tests
Wrist x-ray

67
Q

What might the blood tests in Rickets show?

A 
Low or normal calcium
Decreased phosphorus
Plasma ALP increased
25-hydroxyvitamin D decreased
PTH increased
68
Q

What is the management of Rickets?

A

Advice on a balanced diet and foods rich in vitamin d - oily fish and egg yolk
Correction of risk factors
Daily vitamin D3

69
Q

What is the most common cause of acute hip pain in children?

A

Transient synovitis

A.k.a. irritable hip

70
Q

How does transient synovitis present?

A

2 to 12-year-olds
Sudden onset of pain or limp
Often follows our presents with a viral infection
No pain at rest
Decreased range of movement especially internal rotation
Pain may be referred to the knee

71
Q

What is the management of transient synovitis?

A

Bedrest

Usually improves in a few days although can proceed Perthe’s disease

72
Q

What is Perthe’s disease?

A

Avascular necrosis of the capital femoral epiphysis of femoral head
Interruption of blood supply followed by neovascularisation and re-ossification over 18 to 36 months

73
Q

How does Perthe’s disease present?

A

Mainly boys (x5)
5 to 10-year-olds
Insidious onset of limp and pain
Bilateral in 10 to 20%

74
Q

What investigations should be done for Perthe’s disease?

A

X-ray hips
Bone scan
MRI scan

75
Q

What will a hip x-ray show in Perthe’s disease?

A

Increased density in the femoral heads

Fragmentation and irregularity

76
Q

What is the management of Perthes disease?

A

Rest
Physiotherapy
Some cases require traction/casts/surgery

77
Q

What is a slipped capital femoral epiphysis?

A

Displacement of epiphyses of femoral heads posterio-inferiority

78
Q

What is the management of SCFE?

A

Prompt management needed to prevent avascular necrosis

Surgery for fixation

79
Q

What is the presentation of SCFE?

A

10 to 15-year-olds especially obese boys
During growth spurt
Bilateral in 20%
Associated with metabolic endocrine abnormalities
Limp or hip pain following trauma or insidious
Decreased abduction and internal rotation

80
Q

What is juvenile idiopathic arthritis?

A

A group of conditions that present in childhood with a joint inflammation lasting six weeks or more with no other cause found

81
Q

What are the classifications of JIA?

A 
Systemic
Polyarticular
Pauciarticular
Spondyloarthropathies
Juvenile psoriatic arthritis
82
Q

What is the most common classification of JIA?

A

Pauciarticular
49%
4 or less joints involved

83
Q

How does pauciarticular JIA present?

A

Usually in large joints
Common in girls less than four years old
Minimal systemic symptoms

84
Q

If you are ANA positive and have pauciarticular JIA what are you at high risk of

A

Chronic uveitis

85
Q

Describe systemic JIA/still’s disease

A 
Fever and malaise
Salmon pink rash
Arthralgia and myalgia - large and small joints
Anaemia and weight loss
Hepatosplenomegaly and pericarditis
86
Q

Describe a polyarticular juvenile idiopathic arthritis

A

More than four joints involved
Symmetrical large and small joint involvement
Poor weight gain and mild anaemia
Morning stiffness and irritability

87
Q

What is the management of juvenile idiopathic arthritis?

A 
NSAIDs
Steroid injections
Disease modifying drugs-methotrexate, immunosuppressants
Biological agents e.g. infliximab
Physio or hydrotherapy
Wearing splints
88
Q

Where are the most common sites of osteomyelitis?

A

Distal femur or proximal tibia

89
Q

What are the most common bacterial species to cause osteomyelitis in children?

A

Staph aureus
Strep
H influenzae

90
Q

Sickle-cell anaemia increases the risk of which bacterial causes of osteomyelitis?

A

Staph

Salmonella

91
Q

How does DMD present?

A 
3 to 5-year-old when symptoms come on
Muscle weakness
Pseudohypertrophy of calves
Delayed walking
Psychological issues
Decreased motor skills
Waddling gait

Paediatrics (8 decks)

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