Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A - Paeds > General > Flashcards

General Flashcards

1
Q

What are the systems that we check in newborn exams?

A

General exam:
-asleep/awake, difficulty breathing, jaundice, dysmorphic features

Head
Face
Neck

Chest
Abdomen
Groin

Limbs
Back
Neuro

plot basic measurements on WHO growth chart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what do you check for on an infants :

Head
Face
Neck

A

Head
- Head circumference: occipital-frontal circumference
(plot n compare by length, weight, gestation )
- feel sutures + fontanelles
- Swellings, haematomas, haemorrhage

Face

  • Ear: mobile pinna? patent external meatus?
  • positioning & formation; abnormalities could be associtaed with inherited disorders
  • Eyes; slant/palpebral fissures; normal variants or congenital disorders eg downs syndrome
  • Eyes; Red reflex - +ve = normal retinal vessels
    • > white = retinoblastoma or cataract
  • Nose; patency of nares
  • Mouth; reflex suck, soft & hard palate
    • > cleft palate or lip? tongue tie (usaully normal)

Neck

  • Webbing - Turners
  • Clacivle; fracture - shoulder dystocia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what do you check for on an infants :

Chest
Abdomen
Groin

A

Chest:

  1. Sternum
    - Pectus excavatum - concave
    - Pectus carinatum - convex
    • > Abnormal in marfans
2. Auscultate
A. Heart
- 120-160bpm HR normal
- Machine like murmur - normal and benign resolves within 1 week * patent ductus arteriosus
B. Lungs
- RR (30-60 bpm)
  1. Peripheral saturations
    - put probe on baby foot

Abdomen;
- Distensions? movement with respiration
- Palpate for masses;
->intraabdominal neoplasms - Wilms tumour,
Neuroblastoma
- Palpate liver; should just be plapable in a newborn

Groin

  1. Femoral pulse palpation
    - > cant feel: aorctic coarctation
  2. Inguinal hernias
  3. External genitals - palpate scrotum
    • (testicle descent), hypospadias
      - > Anal patency
  4. Hip dysplsia
    - Barlow before Ortolani manuvre (test of dislocation)
    - if clunk / dislocation refer to orthopaedics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the risk factors for hip dysplasia?

A

FH, Female, Breech presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what do you check for on an infants :

Limbs
Back
Neuro

A

Limbs:
polydactyly
bracydactyly - short digits. or long ones
single trnasverse palmar crease - downs syndrome or normal variant in 1%

Back

  1. Mongolian blue spots - normal
  2. Erythema toxic - pustules - normal
  3. Spinal cord anomalies
    odd patch of hair
    assymetric gluteal cleft
    Sacral dimple: can suggest spina bifida occulta

Neuro

  • Awake/asleep, Irritable/Calm, Consolable/Inconsolable
  • Sensation - do they respond to your touch
  • Movement; moving limbs?

-Pull up by hands:
hypertonic/hypotonic

  • Moro reflex ; want a symmetrical response
  • Palmar grasp reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when would the newborn exam be done?

A

1st week of life ideally <24hrs old

at 6-8 weeks by GP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why do we avoid ceftriaxone in empirical therapy in young infants?

A

risk of kernicterus

far as i know dont use in under 3 months old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define neglect

A

Neglect is the persistent failure to meet a child’s basic
physical and/or psychological needs, likely to result in

the serious impairment of the child’s health or develop-
ment. It may involve a parent or carer failing to provide:

• adequate food and clothing
• shelter, including exclusion from home or
abandonment
• protection from physical and emotional harm or
danger
• adequate supervision, including the use of
inadequate caregivers
• access to appropriate medical care or treatment.
It may also include neglect or unresponsiveness to a
child’s basic emotional needs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the risk factors of child abuse?

A

In the child:
• failure to meet parental expectations and
aspirations, e.g. disabled, ‘wrong’ gender, ‘difficult’ child
• born after forced, coercive, or commercial sex.

Parent/carer:
• mental health problems
• parental indifference, intolerance, or over-anxiousness
• alcohol, drug abuse.

In the family:
• step-parents
• domestic violence
• multiple/closely spaced births
• social isolation or lack of social support
• young parental age.

Environment:
• poverty, poor housing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the different ways child abuse can present?

A

Child abuse may present with one or more of:
• physical symptoms and signs
• psychological symptoms and signs

• a concerning interaction observed between the
child and the parent or carer
• the child may tell someone about the abuse
• the abuse may be observed.

Identification of child abuse in children with disabilities
may be more difficult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the key principles of safeguarding?

A

• safeguarding is everyone’s responsibility: for
services to be effective each professional and
organization should play their full part

• child-centred approach: for services to be effective
they should be based on a clear understanding of
the needs and views of children.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the factors to consider in a presentation of a physical injury?

A

• the child’s age and stage of development
• the history given by the child (if they can
communicate)
• the plausibility and/or reasonableness of the
explanation for the injury (Case History 8.1)

• any background, e.g. previous child protection
concerns, multiple attendances to AnE department or GP

• delay in reporting the injury
• inconsistent histories from caregivers
• inappropriate reaction of parents or caregivers
who are vague, evasive, unconcerned, or
excessively distressed or aggressive.
  • Seek input from paediatric radiologists and paediatric or orthopaedic surgeons, senior members of the team.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the factors to consider in a presentation of a physical injury?

A

• the child’s age and stage of development
• the history given by the child (if they can
communicate)
• the plausibility and/or reasonableness of the
explanation for the injury (Case History 8.1)

• any background, e.g. previous child protection
concerns, multiple attendances to AnE department or GP

• delay in reporting the injury
• inconsistent histories from caregivers
• inappropriate reaction of parents or caregivers
who are vague, evasive, unconcerned, or
excessively distressed or aggressive.
  • Seek input from paediatric radiologists and paediatric or orthopaedic surgeons, senior members of the team.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does child abuse present?

A

• babies:
– apathetic, delayed development, non-demanding
– described by the mother as ‘spoiled, attention
seeking, in control, not loving her’

• toddlers and preschool children:
– violent, apathetic, fearful

• school children:
– wetting, soiling, relationship difficulties, non-attendance, antisocial behaviour
Unexpected awareness or acting out of sexualized
behaviour beyond what would be expected
for age.

• adolescents:
– self-harm, depression, oppositional, aggressive,
and delinquent behaviour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

which typese of physical injuries are likely to be inflicted and non-accidental? NAI

A

Fractures:

  • Any fracture in a non-mobile child (excluding fragile bones)
  • Rib fractures

Burns:
- A ‘glove or stocking’ burn consistent
with forced immersion.
- burns in non-mobile child

Bruising:
Bruising in the shape of a hand
Bruises on the neck that look like
attempted strangulation

Inflicted or accidental injuries are more likely:
Skull fracture in young child.
Long bone fractures in a young but mobile child
Trunk, neck, ear bruising + inconsistent/vague history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when is intercourse with a girl considered sexual abuse?

A

if she is under 13

17
Q

list some differentials for common physical injuries?

A

bruising – coagulation disorders
Mongolian blue spots on the back or thighs

• fractures – osteogenesis imperfecta

The type commonly involved with unexplained fractures is type I, which is an autosomal dominant disorder,
so there may be a family history.
Blue sclerae are a key clinical finding and there may be generalized osteoporosis and Wormian bones in the skull (extra bones within skull sutures) on skeletal
survey

• scalds and cigarette burns – may be misinterpreted in children with bullous impetigo or scalded skin syndrome.

18
Q

What investigations do we do in event of suspecting non-accidental injury (Where brain injury is suspected)?

NAI

A

• an immediate CT head scan followed later by a
MRI head scan if abnormalities found

• a skeletal survey to exclude fractures

• an expert ophthalmological examination to
identify retinal haemorrhages

• a coagulation screen.

forensic assessment?

19
Q

what is the management and full workup of suspected abuse?

OR
what are the procedures pertaining to raising safeguarding concerns about child maltreatment?

A
  1. Histories
    History from parent
    Child’s history
    Child’s Behaviour and interaction with parent
  2. Physical symptoms + Physical examinations
  3. Follow local child safeguarding protocols

If strong case for NAI:

  • Admit child to hospital
  • try to obtain consent from them/parent to alert SS
  • if not CA 1989 S1.1
  • consider other siblings. then:
  1. Social work assessment:
    - they ultimately decide what happens with parent and child
    - calling them doesnt mean they take child away straight away
  2. Child protection conference may be called
    includes social workers, health visitors, police, GP, Paeds, teachers, lawyers and Parents.
    • share infomration about the case
    • decide in child protection plan is needed
    • if application to court for above is needed

Sexual abuse:
Police inquiry - if very serious / sexual abuse / FGM

Forensic assessment - sexual abuse

20
Q

Define the legal framework and explain the principles of managing child maltreatment using case scenarios

A

Children act 1989
S1.1 - the childs welfare is paramount
- takes precedence to parental wishes

Safeguarding laws:
Section 11 - allows us to break confidentiality if in best interest of child

Once a Dr reports concerns -> a social worker has 1 day to decide what kind of investgiation is needed:

A. Section 17 investigation - a child in need
B. Section 47 investigation - a child at risk of significant harm.

Sexual offences act 2003
Cannot consent if under 13 but 13-16 lawful if both between that age.

21
Q

what are the events following a social worker initiating an investigation?

A

The ivx must start within 1.5 months and involves:

  • Social workers meeting with the parents, child’s teacher or doctor.
  • They will look at the child’s records.

Following this:
In cases of serious abuse, and in all cases of sexual abuse, the local authority will tell the police.

Occasionally they will take urgent action to have the child removed from the family home immediately.

Sometimes, a child protection conference is called.

Often, they may decide no further action is needed.

Parental rights If they take child away - can seek legal advice. more advice on citizens advice.org.uk

22
Q

what is the difference between Gillick competence and Fraser guidelines?

A

Gillick competence is concerned with determining a child’s capacity to consent.

Fraser guidelines, on the other hand, are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment.

  • including STIs
  • including terminations
23
Q

what are the Fraser guidelines?

in which cases can confidentiality be broken?

A
  1. He/she has sufficient maturity and intelligence to UNDERSTAND the nature and implications of the proposed treatment
  2. He/she CANNOT be PERSUADED to tell her parents or to allow the doctor to tell them
  3. He/she is very likely to begin or CONTINUE having sexual intercourse with or without contraceptive treatment
  4. His/her physical or mental HEALTH is likely to suffer unless he/she received the advice or treatment
  5. The advice or treatment is in the young person’s BEST INTEREST

Must; offer to tell the parents. try to convince them to tell parents

Can break confidentiality or refuse if:

  • All conditions not met
  • Suspect coercion / exploitation
24
Q

What is the law about 16-17 year olds?

A

Young people aged 16 or 17 are presumed in law, like adults, to have the capacity to consent to medical treatment.

However, unlike adults, their refusal of treatment can in some circumstances be overridden by a parent, someone with parental responsibility or a court, if refusal can cause harm to them

25
Q

what is the lower age limit for Gillick competence and Fraser guidelines?

A

There is no lower age limit for Gillick competence or Fraser guidelines to be applied. That said, it would rarely be appropriate or safe for a child less than 13 years of age to consent to treatment without a parent’s involvement.

When it comes to sexual health, those under 13 are not legally able to consent to any sexual activity, and therefore any information that such a person was sexually active would need to be acted on, regardless of the results of the Gillick test.

26
Q

you are taking a history from a child and you identify some safeguarding concerns

they ask you not to tell anyone. how do you proceed

A

If they are not deemed to be Gillick competent, the health professional is obliged to raise the issue as a safeguarding concern and escalate their concerns through the safeguarding process

If they are deemed to be Gillick competent and disclosure is considered essential to protect them from harm or to be in the public interest, the health professional should escalate concerns through the safeguarding processes

“some of the things you have told me today have lead me to be concerned for your safety. it will be in your best interest if i informed the relevant authorities so that they begin to investigate the case.

Where i have identified concerns in regards to your safety, I have rights under the law to break confidentiality.
if this bring an immediate threat to you, you will be promptly removed from the situation so that no harm is brought upon you”

27
Q

What are some potential causes of epistaxis? What questions to ask?

A 
ITP
VWD, 
Hereditary haemorrhaging telangiectasia
LEUKAEMIA
WHOOPING COUGH
Trauma

See geeky medics for as to ask. Also:
Which nose more frequent? Heavier in one nose? What do they do to stem bleeding usually?

28
Q

what are the age ranges for the different terms used to refer to kids in paediatrics?

A

Neonate (<4 weeks)

Infant (<1 year)

Toddler (Approx 1-2 years)

Preschool - Young child (2-5 years)

Older child - schol age

Teenager - Adolescent

29
Q

when do kids have developmental reviews done?

A

At 9 to 12-months

and at 2-years

30
Q

which newborns have ear test done? what are the ear tests?

A

baby will also have a hearing test soon after birth.

If you have your baby in hospital, this may happen before you leave. Otherwise, it will be done some time in the first few weeks at an outpatient clinic, or at your local health centre. first 5 weeks of life ideally

  1. Otoacoustic emission (OEA):
    Detects normal sound vibrations from outer hair cells in the cochlea. not a test of hearing but a test of cochlear function
    2nd line:
  2. Auditory brainstem response (ABR)

If baby was admitted to SCBU or NICU, they have both tests done!
Negative result doent eman hearing loss -> refer to specialist for more tests.

31
Q

what tests do all newborns routinely get?

A

newborn blood spot test
newborn hearing screening test
newborn physical examination

then vaccinations too

32
Q

name some developmental tests available

A

screening tests, e.g. the Schedule of Growing Skills
and the Denver Developmental Screening Test

tests that assess the overall
development of infants and young children, e.g.
Griffiths and the Bailey Infant Development Scales

tests concentrating on assessing specific aspects of development, e.g. the Reynell
Language Scale, the Gross Motor Function
Measure, the Autism Diagnostic Interview and the
Autism Diagnostic Observation Schedule.

33
Q

What are the ivx involved in a septic screen?

A 
Blood cultures
Blood gas
FBC, CRP, 
Urine MCS
Stool sample for PCR
34
Q

What CXRay findings would you find with the following diseases in paediatrics:

  1. Meconium aspiration
  2. Pneumonia
  3. Respiratory distress syndrome
A
  1. Meconium aspiration
    - bilateral patchy infiltrates
  2. Pneumonia
    - reticulonodular shadowing
  3. Respiratory distress syndrome
    - bilateral white out of lungs
35
Q

How does conjunctivitis present?

what is the aetiology

A

Red eyes

Allergic conjunctivitis
-itchy, watery, red eyes occurring seasonally

Viral = most common cause! Highly infectious

Bacterial more rare!
- discahhrge + redness

Gonorrheal conjunctivitis:

  • in neonates born to mums with active gonorrheal infection
  • presents first 2-3 days of life
  • purulent disharge
  • swelling of eyelids

Chlamydia :

  • presents in 2-3 weeks
  • very serious can cause blindness if not promtply treated

other causes:
HSV,
Subconjunctival haemorrhae -> red eye - self resolves
corneal abrasion - worse with blinking

36
Q

How do we treat conjunctivitis?

A

Allergic:
Artificial tears -> Antihistamines -> Sodium cromoglicate

Viral:
Conservative
Will go on its own
Avoid rubbing eyes and touching people/things
wash hands regularly
Topical antihistamines considered

Gonorrheal:
- Ceftriaxone IM + azithromycin PO + antibact eye drops

Chlamydia:

  • can recur
  • Azithromycin/Erithromycin opthalmic +
  • Oral erythromycin for 2 weeks - Mother, partner need to be checked and treated

Bacterial
Mild - Azithromycin/Erithromycin opthalmic (eye drops)
Moderate - Ofloxacin opthalmic

A - Paeds (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions