General paediatrics Flashcards
Hearing test is indicated for OME if persistent for ____ months or ____
Persistent for more than 3mo or other risk factors (Trisomy 21)
When is grommets recommended for OME ?
Bilateral fluid in ears and hearing impairment
Pure tone audiometry is recommended in children above age _____
5 years
What is automated audiometry brainstem response and when is it used?
It is used to investigate newborns of concern or those that do not pass two OAE tests.
It involves measuring brainstem electrophysiological responses to click stimuli using electrodes placed on the scalp. This assesses hearing throughout the entire hearing pathway; form the external ear through to the brainstem
What age group is …
1) Visual reinforcement audiometry suitable for?
2) Conditioned play audiometry suitable for?
1) Visual reinforcement audiometry suitable for 9mo to 36mo
2) Conditioned play audiometry 2-5 yr
In POTS increase in HR by XX
In POTS increase in HR by 40bpm or >130bpm
How do you manage POTS?
1) Increase blood volume (fluid and salt intake)
2) Exercise (minimise deconditioning)
3) Compression stockings
4) Medication - Fludrocortisone, Beta blocker (no consensus on whether beta 1 selective better)
5) Social supports
Plasma ______ and _____ are the major factors affecting ESR
Fibrinogen and globulin (IVIG thus can lead to increased ESR levels)
____ of congenital torticollis is due to congenital muscular causes. Of these the majority are related to_______
82% due to congenital muscular causes.
Of these, the majority are related to sternocleidomastoid muscle mass - thickening of the SCM muscle and limitation of passive range of motion
Palpable “mass” in inferior 1/3 of affected SCM
Consider surgery for congenital torticolis if persistent after _____ months
If persistent after 6-12mo
Which craniosynostotic syndrome is commonly associated with cloverleaf skull deformity (premature closure or coronal, metopic and lambdoi)
Pfieffer Type 2
Other signs- severe hand and foot anomalies, limb malformations
Nasolacrimal duct obstruction is due to ____
Persistence of membrane at the distal valve of Hasner
_______ is a characteristic lab findings in chlamydia pneumonia
Eosinophilia
What are the major risk factors that indicate neuroimaging in children above 2yo post trauma?
- Focal neurological findings
- Skull fracture, especially findings of basillar fracture
- Seizures
- Persistent altered mental state (e.g. agitation, lethargy, repetitive questioning)
- Prolonged LOC
SGH is between which layers?
Periosteum and aponeurosis
Moderate evidence of benefit that breastfeeding reduces_________
Moderate evidence - prevention of T1DM, IBD, recurrent OME and wheezing
In patients with ITP, the presence of _____ or ______ - identifies patient at increased risk fo ICH
Haematuria or head trauma
What is the rate of ITP following MMR vaccine (within 6 weeks)
1/25,000
What is the mechanism of action of Transexamic acid?
Binds to lysin receptor on plasminogen and inhibits plasmin activity
Plasmin normally cleaves fibrin into fibringogen (dissolves clot)
At what age do pupils start responding light?
At what age is colour perceived?
When do kids start to blink/squint?
Pupils - 30 weeks
Colour is perceived at 34 weeks (red first)
Blinking/squinting after premature birth - 26 weeks
When does suck and swallow reflex start?
When does rooting reflex start?
Swallow - 34 weeks
Rooting - 28 weeks
Peak crying for babies is?
Peak purple crying 6-8 weeks
First tooth comes around when?
First tooth 5-7 months
When should all 20 primary teeth be present?
30 months (2.5yr)
As per Erickson stages:
- Adolescents?
- Toddler?
- School age?
- Adolescent: Identity vs confusion
- Toddler: Attachment vs Autonomy (early infancy)
- School age: Initiative vs Industry
By what age should children be able to sit?
Usually by 6mo; but 9mo is a red flag
By what age do children normally crawl?
9mo
Children should typically walk by______
18mo
Kids should be able to transfer between hands by ________
6mo
Babbling by _______
9mo
Children should be able to scribble by _____
18months
Tower of 3 cubes by _____
18months of age
Draw a vertical line by _____
2 years of age
Draw a circle by ______
3yo
Draw a cross by _____
4y
Draw a triangle by _____
5yo
Speech should be understood by family by _____
Speech should be understood by strangers by _____
Family by 3y (3 word sentences, 3 primary colours)
Strangers by 4y (4 word sentences and name 4 colours) Also count to 5!
Peekabo by ____
9mo (also stranger fear)
Undress, feed doll, point by ____
18mo
Wash hands, dry by day by ____
2yo (partially dress too)
By age 3 most kids can do what (socially/personally)
Dress fully (50% can do button), brush teeth, interactive play
When can kids wipe their bottom by?
4yo (also 90% can do buttons)
When can kids start using fork typically?
3yo
Spoon by 2yo
(Red flag)
If not rolling by _____
9months
Handedness by ______
18-24months
Global developmental delay is being behind in ___ or more milestones
Behind in 2 or more milestones
___% of the population has intellectual disability
3% - characterised by IQ <70 (2SD below) AND adaptive functioning (need both)
Most common screening tests for evaluating development?
Formal assessments to evaluate development?
Most common assessments for cognitive testing in younger kids
PEDS - screening
ADST - screening
ASQ - screening
Formal assessment:
- Bayley Scales of Infant development 0-3yo
(not good for predicting long term future intelligence)
- Griffiths Mental Developmental Scales 0-6yr)
Stanford-Binet Intelligence scale (in kids above 2) (evaluate IQ)
WPPSII (from preschool-7y) (better for cognition)
WISCS - generally above 7yo (better for cognition)
Kids with NF1 may have developmental issues with______
ADHD
Kids with Duchenne Dystrophy may have developmental issues related with_____
Verbal working memory
What are the DSMV criteria for Autism spectrum disorder
Clue RNR + MRIS
Social communication (impairment in all three) :
1) Reciprocity - conversation, building on topics, asking questions
2) Non-Verbal communication - limited use
3) Relationships - difficulty making friends/peers, unimaginative play
Repetitive and restrictive behaviours (Need 2/4):
1) Motor - head hitting, vocalisations
2) Routine and rigidity
3) Interests - highly fixed
4) Sensitivities
Language and intellect separate
3 Most common comorbidities with autism?
Anxiety, ADHD, Sleep issues
Medical conditions Autism is related to?
Seizures, Fragile X syndrome, Tuberous sclerosis
Prevalence of autism is 0.5%; what is the risk of a second child with autism?
5% chance
if you have two children with autism - 25% chance; MCDA twins - 65%
Normal kid to 2-4yr, then regress to autism, quite severely.
Develop bowel and bladder issues….
Heller Dementia
Prevalence of ADHD?
~5-10%
What is the DSM V criteria for ADHD?
1) Inattentive ADHD - inattention in 6 of 9 symptoms
2) Hyperactive ADHD - 6 of 9 symptoms
3) Minimum 6 months
4) Some Sx present before 12y
5) Some impairment present in two or more settings
6) Clear evidence of impairment in school or functioning
7) Does not meet criteria for pervasive developmental disorder or other psych diagnsosis
Most common comorbidities associated with ADHD?
Oppositional defiant disorder, conduct disorder (40%), learning disabilities (40%), and anxiety disorders
4 common controversies associated with treatment for ADHD?
1) Cardiac - unexplained death
- if fam hx need ECHO/ECG but otherwise no significant concerns
2) 1-2 cm growth suppression
3) Drug abuse
- - actually reduced the chances of substance abuse
4) Cause tics
First line stimulant for ADHD?
First try Ritalin short acting; can consider Long acting Ritalin if goes well ( Concerta)
Otherwise can try Dexemphetamine
How do you differentiate Tourettes from Tics?
Tourrettes:
- Multiple motor and one vocal tix
- > 3mo and everyday
- under 18y
+ Functional impact
1st line treatment for Tics?
Haloperidol
if one parent has had issues with eneuresis what are the chances the child will be affected?
60% (75% if both parents had been affected)
Rough rule of sleep for babies to 6yr?
Babies sleep for 16 hours
birth - 6yr
What is the TEN4FACES rule?
If these criteria are met, have clinical concern for abuse:
Bruising in TEN location (Torso, Ear, Neck) in child <4years-old
Any bruising in child <4-6months-old
Injury to FACES (Frenulum, Angle of jaw, Cheek, Eyelid, Sclera) in child of any age
What are the five fractures that are highly suggestive of abuse?
Classic metaphyseal lesions Posterior rib fractures Scapular fracture Spinous process fracture Sternal fracture
First line treatment for catatonia?
Lorazepam
First line treatment for bipolar disorder?
Atypical antipsychotic
What IQ would be mild intellectual disability?
<70 is mild
<55 is moderate
<40 is severe
Which disorder is related to ADHD?
ODD
Which disorder is common in Autsim?
Anxiety
What is the most common age for object permanence?
12 months
What development is important for early infancy?
Early infancy - first 12 months -> secure attachment
First line medication for tics?
Clonidine or Haloperidol
What physiological changes would you note in REM sleep?
Decreased muscle tone, increased HR and increased HR
