General Medicine and Ethics Flashcards
What is included in a maternal/antenatal history?
Maternal health during pregnancy
Mode of delivery - including inducing and instruments used
How long was the gestation?
How heavy was the newborn?
Any postnatal problems? (time of Neo ward?)
What is included in the PEWS chart for a chid?
Temperature, respiratory rate, heart rate, oxygen saturation, capillary refill and AVPU level
What is Shaken Baby Syndrome?
If a baby is forcefully shaken, his or her fragile brain moves back and forth inside the skull. This causes bruising, swelling and bleeding. Shaken baby syndrome usually occurs when a parent or caregiver severely shakes a baby or toddler due to frustration or anger.
What are the further investigations for Shaken Baby Syndrome?
Skeletal Survey to look for fractures. Finger tip bruising may suggest that there are posterior rib fractures.
Ophthalmology review to assess for retinal haemorrhages- this could suggest shaken baby syndrome.
Metabolic testing to exclude glutaric aciduria as this is associated with intracerebral haemorrhage.
Detailed testing of blood coagulation e.g. von Willebrands factor (this should be repeated later as can rise to normal levels in the acute phase).
What are the 4 types of abuse to children (and an extra possible type)?
Physical, emotional, sexual, neglect (and factitious/induced injury)
What signs in a history convince you that an injury is Accidental?
Mechanism of injury goes with history
All stories are consistent
No delay in seeking medical help
Appropriately concerned parent
One-off injury
Injury consistent with child’s age and personality
What signs in a history convince you that an injury is Non-accidental?
The mechanism of injury is not consistent with the actual injury/no mechanism of injury is offered
Inconsistent stories
Child confession
Delay in seeking medical help
Inappropriate reactions from parents
Recurrent injuries
Injury inappropriate for child’s age
What type of fractures might indicate an Accidental Injury?
Linear skull fractures
Long bone fractures in >5yrs old
Specific type of fracture e.g. 4% supracondylar fractures are due to abuse Vs non-supracondylar humeral fractures are highly associated with abuse
What type of fractures might indicate Non-accidental injury?
Metaphyseal fractures
Posterior rib fractures
Fractures of different ages
Complex skull fractures
Long bone shaft fractures in non-mobile child
What does this image show?
Finger bruising
What does this image show?
Cigarette bruns
What does this image show?
Glove-stocking scalding mark
What does this image show?
Slapped Cheek
What is a body map?
It is a pictoral document used to map bruises and marks on a childs body if they have come in with an injury.
What is the gross motor ability of a newborn?
Moves head from side to side
What is the gross motor ability of a 6/7 month old?
Sits up alone (no support)
What is the gross motor ability of a 12 month old?
Standing alone (no support)
What is the gross motor ability of a 15-18 month old?
Walks independently
What is the gross motor ability of a child >2 years old?
Runs and jumps
What is the vision and fine motor ability of a 2 week old child?
Following faces
What is the vision and fine motor ability of a 6/7 month old?
Transfering objects from one hand to another
What is the vision and fine motor ability of a 9 month old?
Pincer grip and pointing
What is the vision and fine motor ability of a 15-18 month old?
Immature grip of pencil
Random Scribbles
What is the vision and fine motor ability of a child >2 years old?
Drawing
What is the personal and social ability of a 6 week old?
Smiles at faces
What is the personal and social ability of a 6/7 month old?
Feeding self
Fears strangers
What is the personal and social ability of a 12 month old?
Waves at people
Drinks from a cup
What is the personal and social ability of a 15-18 month old?
Feeds self
Helping with dressing
What is the personal and social ability of a child >2 years old?
Parallel play with other children (won’t share and won’t interact)
What is the hearing, speech and language ability of a newborn?
Stills/Alerts to noise or bell
What is the hearing, speech and language ability of a 7 month old?
Monosyllabic babbling
What is the hearing, speech and language ability of a 12 month old?
Uses 2-3 words
Understands their name
What is the hearing, speech and language ability of a 15-18 month old?
Uses 6-10 words
Points to at least 2 body parts
What is the hearing, speech and language ability of a child >2 years old?
Can say 3-word to 4-word sentences
Understands two joined commands
What is gestational correction?
Correcting age for weight, height and head circumference according to whether a child was born before full term.
For example, if a child is born at 33 weeks’ gestation (40 weeks 33 weeks = 7 week difference), then add 7 weeks onto each milestone, so if they’re expected to use a pincer grip at 12 months, then the child born prematurely (at 33 weeks) would be expected to use a pincer grip at 12 months + 7 weeks, so roughly 14 months
What is the fluid maintenance formula for paediatrics?
First 10kg - 100mL/kg - e.g. 10kg equals 1000mL (1L)
Next 10kg - 50mL/kg - e.g. 10kg equals 500mL
All kgs over 20kg, 20mL/kg
Therefore, a child who is 50 kg would be calculated as 1000mL + 500mL + 600mL = 2100mL (2.1L)
How do you work out how much fluid to give in fluid resuscitation?
% dehydration x weight (kg) x 10 = fluid deficit (what needs to be replaced)
% dehydration = { [weight when well (kg) - current weight (kg)]/[weight when well (kg)] } x 100
What should be asked in an paediatric history, relating to pregnancy?
How many weeks gestation was the child when born?
Where there any problems during pregnancy?
Where there any problems during the birth?
What type of birth? Instruments used?
What was the baby’s birth weight when born?
Is the child developing well?
Up to date immunisations?
What needs to happen before a child receives a vaccination?
The child needs to be bathed, to make sure their skin is clean.
What is a Mongolian Blue Spot?
Flat bluish- to bluish-gray skin markings
