Exam Questions from the Tutorials Flashcards
Know the full history taking by memory and what information is relevant- gives you clues too.
What are the 9 components of history taking? Go
- Presenting Complaint
- Pre-natal
- Perinatal
- Neonatal (-8 weeks) then rest of history.
- Feeding
- Family History
-Developmental history
-Review of systems
At 10 weeks old what are the gross milestones, social and emotional milestones they should have reached?
Ie Essential Milestones of development ?
Birth:
prone, pelvis high, knees flexed under abdomen, ventral suspension - elbow flexed, hips party extended
4-6 weeks:
-Smiles at mum
-vocalised 1-2 weeks later
6 weeks- pelvis flat when prone
12-16 weeks:
-turns head to sound
-holds objects placed in hand
12-20 weeks: hand regard
20 weeks:
goes for objects and gets them without being placed in hand
26 weeks:
-transfers objects, one to another
-chews and feeds self with biscuit
-sits with hands forward for support
-supine- lifts head spontaneously
9-10 months
-index finger approach and finger thumb opposition
-bye bye
-helps dress, arm out for coat foot out for show
13 months walks with no help.
15-18 months:
-Domestic mimicry
15 months: can feed self fully
-picks up cup
-drinks then puts it down
-casting and mouthing ceases
18 months: begins to tell mother about wetting.
21-24 months (joints 2-3 words together)
2 years: dry by day
3 years: dry by night mostly, dresses self and can stand on one foot.
What is a good screening tool for developmental milestone in the first year?
Woodside (0-4yrs)
1. Social
2. Hearing & language
3. gross motor
4. fine motor & vision
(if can do both place x on top line, if can fo 1 put on bottom line of step, if cannot do move down the y axis to level of next step but on same x axis record at this level)
PEDS 0- 11 yrs
Parents evaluation of Developmental Status: developmental milestones
-social and emotional
-screening kids on spectrum or concerns with reading etc
Ages and Stages ASQ
What is Colic?
Is Omeprazol good for colic?
Crying 3 hours a day for more than 3 weeks after 3 weeks old.
Very contentious issue. Unknown source.
There is zero evidence for the use of Omeprazol, silent reflux maybe.
What are your differential diagnosis for Torticollis
Ie ones to rule out.
Grisels (instability) usually a retropharangeal access- retropharnyx to ligaments.
Atlanto-occipital instability
Cupput succedaneum
Infection
Craniosynostostosis?
Trauma
What is caput succedaneum
What do you need to differentiate it from?
Haeomotoma across sutural lines from suction
Skull fracture
Make sure it passes over the sutures
cephalahaematoma can take up to 6 weeks, the caput only a few days
most don’t require any intervention.
How long it takes to get better?
All the Primitive reflexes and their age of integration
Primitive reflexes in a Neonate
Looking for symmetry, strength and age
Rooting: not always present if recently fed
Sucking- evaluate strength of suck
Moro- Strong in first month and should be symmetrical
Galant
Galant (2 months start to diminish) 8 weeks.
Perez (2 months)
Rooting and sucking
Palmar Plantar
Babinksi
Moro (2-3 months) 12 weeks
ATNR (gone by 6 months)
Landau
Pull to Sit (3-4 months neutral)
4-5 months head flexed but no arm use
5-6 months- anticipate movement and flex arms.
Vertical suspension
KNOW THESE WELL
What are you looking for in a Moro reflex, what are the different phases?
Phase 1
Phase 2
Phase 3?
Order in which you check the ROM in Cervical spine?
- Lateral flexion
- Occipital flexion/ Ext
- C2 Flexion (see that it opens as they flex)
- Rotation 110 degrees of rotation
LLF
R occiput flexion
R cervical Rotation
Look at the cervical flow chart
AILP
R ASRI?
Wrong.
Posterior fontanelle what age should it be closed by?
8 weeks
What is Craniosynpsotsis ( 2 types) -brachycephaly - primary and secondary (need to know)
deformational plagiocephaly
Compare them both
Premature closing of a suture
Know how to differentiate them well
What are the musculosketetal components you need to address for plague
Peak age for plagio
What are the short term effects of it
How would you treat it?
What are the other musculoskeletal issues associated with a torticollis
Neuro-developmental delay
cognitive and psychomotor
Autitory processing
tone issues
gross motor delay
Learning and attention deficits
Treatment?
pillow, stretching, positional advice, measure head circumference and track it
Other musculosketal conditions- hip dysplasia, metatarsus adductus- check carefully
2 Criteria for Failure to thrive
How is it diagnosed
If a child has FTH what is the first, then second thing to drop?
Weight then height, then head circumference.
FTT- most greatly affects the neurological system. CNS damage. Development is a consequence.
What age does th post fontanelle close? 8 weeks
Anterior fontanelle- 7-19 months
How do we measure and track the anterior fontanelle (A + B/ 2) -track with time.
a drop in 2 standard deviation in weight
2 measurement - drop below the 3rd percentile line
-
Weight
height
Head circumference
Fontanelles
What does bulging fontanelles?
Sunken fontanelles?
Pulsing fontanelle?
Conditions which can give an enlarged or delayed closure of the fontanelle?
Buldging- Increased ICP.
Pulsing fontanelle- also increased ICP
Down syndrome.
Increased ICP
Rickets
