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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
At what age should a child develop pincer grip?
10 months
26
At what age should a child be able to make a tower of 3 blocks?
18 months
27
At what age should a child be able to make a tower of 6 blocks and draw a straight line?
2 years
28
At what age should a child be able to draw a circle?
3 years
29
At what age should a child be able to vocalise with coos and laughs?
3-4 months
30
At what age should a child be able to turn to soft noises?
7 months
31
At what age should a child be able to use 2-3 words other than mama and dada?
12 months
32
At what age should a child be able to show you 2 parts of the body?
18 months
33
At what age should a child be able to smile responsively?
6 weeks
34
At what age should a child be able to put food in their mouth?
6-8 months
35
At what age should a child be able to wave bye-bye and play peek-a-boo?
10-12 months
36
At what age should a child be able to drink from a cup with 2 hands?
12 months
37
At what age should a child be able to hold a spoon and get food to the mouth?
18 months
38
How does a baby being pre-term affect the developmental milestones?
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
What are the terms we use to describe developmental delay in all or some fields?
``` All = global delay Some = specific developmental delay ```
40
Describe the primitive Moro reflex
Sudden extension of the head causes symmetrical extension then flexion of the arms
41
Describe the primitive grasp reflex
Flexion of the fingers when an object is placed in the palm
42
What test can we use to track development?
Denver
43
At what ages should the health visitor review an infant?
``` Antenatal health promoting visit New baby review 6-8 week assessment 1 year 2-2 1/2 years ```
44
What is dyspraxia?
A disorder of motor planning and/or execution with no significant neurological findings
45
Define dyslexia
A disorder of reading skills disproportionate to the child’s IQ
46
Premature puberty is defined as ...
Development of secondary sexual characteristics outside the normal ranges <8 in females <9 in males
47
What is precocious puberty?
A pattern of premature sexual development
48
How do we categorise precocious puberty?
Gonadotrophin dependent - central, ‘true’ | Gonadotrophin independent - pseudo/false
49
What is gonadotrophin dependent precocious puberty?
Premature activation of the HPG axis
50
What is gonadotrophin independent precocious puberty?
Excess sex steroids outside the pituitary gland
51
Give 2 causes of gonadotrophin independent precocious puberty in females
Congenital adrenal hyperplasia | Adrenal tumours
52
Give 1 cause of gonadotrophin dependent precocious puberty in females
Pituitary tumour
53
Why is gonadotrophin dependent precocious puberty uncommon in males?
The testes are relatively insensitive to secretion to gonadotrophins
54
Define delayed puberty
Absence of pubertal development by 14 yrs for females and 15 yrs for males
55
Give some causes of delayed puberty
Constitutional delay - most common Low gonadotrophin secretion: systemic disease, pituitary disease. High gonadotrophin secretion - Turners, Klinefelter Steroid hormone enzyme deficiencies Acquired gonadal damage
56
What is the first sign of puberty in females?
Breast developments | Thelarche
57
Define failure to thrive
Implies growth failure and failure of emotional and developmental progress
58
Describe the order affected measurements during failure to thrive
Weight gain first affected Then length Then head circumference
59
Give a differential diagnosis for weight faltering in children
``` Catch down and constitutional Genetic syndrome Environmental Chronic illness CF GORD Coeliac Intrauterine growth restriction Endocrine dysfunction Immune deficiency ```
60
Describe ‘catch down’
Babies commonly cross centiles in their 1st year Large babies cross down to reach genetically destined centile Important not to cause distress
61
What is Rickets?
Failure in mineralisation of growing bone or osteo tissue
62
Define osteomalacia
Failure of mature bone to mineralise
63
What are the primary causes of Rickets?
``` 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
Which malabsorption diseases can cause Rickets?
Small bowel enteropathy - coeliac Pancreatic insufficiency-CF Cholestatic liver disease
65
How does Rickets present?
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
How do we diagnose Rickets?
Dietary history Blood tests Wrist x-ray
67
What might the blood tests in Rickets show?
``` Low or normal calcium Decreased phosphorus Plasma ALP increased 25-hydroxyvitamin D decreased PTH increased ```
68
What is the management of Rickets?
Advice on a balanced diet and foods rich in vitamin d - oily fish and egg yolk Correction of risk factors Daily vitamin D3
69
What is the most common cause of acute hip pain in children?
Transient synovitis | A.k.a. irritable hip
70
How does transient synovitis present?
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
What is the management of transient synovitis?
Bedrest | Usually improves in a few days although can proceed Perthe’s disease
72
What is Perthe’s disease?
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
How does Perthe’s disease present?
Mainly boys (x5) 5 to 10-year-olds Insidious onset of limp and pain Bilateral in 10 to 20%
74
What investigations should be done for Perthe’s disease?
X-ray hips Bone scan MRI scan
75
What will a hip x-ray show in Perthe’s disease?
Increased density in the femoral heads | Fragmentation and irregularity
76
What is the management of Perthes disease?
Rest Physiotherapy Some cases require traction/casts/surgery
77
What is a slipped capital femoral epiphysis?
Displacement of epiphyses of femoral heads posterio-inferiority
78
What is the management of SCFE?
Prompt management needed to prevent avascular necrosis | Surgery for fixation
79
What is the presentation of SCFE?
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
What is juvenile idiopathic arthritis?
A group of conditions that present in childhood with a joint inflammation lasting six weeks or more with no other cause found
81
What are the classifications of JIA?
``` Systemic Polyarticular Pauciarticular Spondyloarthropathies Juvenile psoriatic arthritis ```
82
What is the most common classification of JIA?
Pauciarticular 49% 4 or less joints involved
83
How does pauciarticular JIA present?
Usually in large joints Common in girls less than four years old Minimal systemic symptoms
84
If you are ANA positive and have pauciarticular JIA what are you at high risk of
Chronic uveitis
85
Describe systemic JIA/still’s disease
``` Fever and malaise Salmon pink rash Arthralgia and myalgia - large and small joints Anaemia and weight loss Hepatosplenomegaly and pericarditis ```
86
Describe a polyarticular juvenile idiopathic arthritis
More than four joints involved Symmetrical large and small joint involvement Poor weight gain and mild anaemia Morning stiffness and irritability
87
What is the management of juvenile idiopathic arthritis?
``` NSAIDs Steroid injections Disease modifying drugs-methotrexate, immunosuppressants Biological agents e.g. infliximab Physio or hydrotherapy Wearing splints ```
88
Where are the most common sites of osteomyelitis?
Distal femur or proximal tibia
89
What are the most common bacterial species to cause osteomyelitis in children?
Staph aureus Strep H influenzae
90
Sickle-cell anaemia increases the risk of which bacterial causes of osteomyelitis?
Staph | Salmonella
91
How does DMD present?
``` 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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