General Paeds Flashcards
1
Q
What are the four categories of developmental milestones?
A
gross motor
vision + fine motor
hearing, speech + language
social, emotional + behavioural
2
Q
gross motor - What is the median age for sitting unsupported?
A
7 months
7 months unsupported
red flag if not by 9
3
Q
gross motor - What is the median age for crawling?
A
8 months (6-9)
6-9 months crawl
4
Q
gross motor - What is the median age for pull to stand?
A
9 months pull to stand
5
Q
gross motor - What is the median age for walking?
A
1 yr walk here
(15 months - steadily)
(red flag if no walk by 18)
6
Q
gross motor - What is the median age for runs + jumps?
A
2 and a half runs + jumps
7
Q
Give me two gross motor RedFlags.
A
- no sitting unsupported by 9 months
- no walking by 18 months
8
Q
vision+finemotor - What is the median age for fix + follow?
A
6 wks
week six, follow n fix
(red flag if not by 3)
9
Q
vision+finemotor - What is the median age for palmar grasp?
A
5 months palmar grasp
five fingers on palm
10
Q
vision+finemotor - What is the median age for pincer grip?
A
10 months pincer grip
red flag if no by 12months
11
Q
Give me two vision + fine motor RedFlags.
A
- no fix + follow by 3 months
- no pincer grip by 12 months
12
Q
Give me 3 hearing, speech + language RedFlags.
A
- no polysyllabic babble by 7 months
- no 6 words w meaning by 18 months
- no joining words by 2yrs
13
Q
hearing, speech + language - What is the median age for saying a 2 or 3 words and understanding own name?
A
1 yr understanding name, 2-3 words
14
Q
hearing, speech + language - What is the median age for simple phrases?
A
2 yrs simple phrases
red flag if not
15
Q
hearing, speech + language - What is the median age for sentences?
A
3 yrs sentences
16
Q
hearing, speech + language - What is median age for polysyllabic babble?
A
7 months polysyllabic babble
red flag if not
17
Q
Give me 3 hearing, speech + language RedFlags.
A
no smiling by 8 wks (h8 when no smile by 8)
no spoon feeding by 18 months
no symbolic play by 2 and a half
18
Q
social, emotional + behavioural- What is median age for smiling?
A
6 wks
red flag if no smile by 8wks
19
Q
social, emotional + behavioural - What is median age for waves bye bye and drinks from a cup?
A
1 yr bye bye + cup drink
20
Q
social, emotional + behavioural - What is median age for finger feeding?
A
7 months
eats 7 party rings
21
Q
social, emotional + behavioural - What is median age for spoon feeding?
A
18 months
red flag if no spoon feeding by 18 months
22
Q
social, emotional + behavioural - What is median age for clean and dry, undress w help ?
A
2 yrs
23
Q
- no polysyllabic babble by 7 months
- no 6 words w meaning by 18 months
- no joining words by 2yrs
RedFlags for…
A
hearing, speech + language
24
Q
no smiling by 8 wks (h8 when no smile by 8)
no spoon feeding by 18 months
no symbolic play by 2 and a half
RedFlags for…
A
social, emotional + behavioural
25
- no fix + follow by 3 months
- no pincer grip by 12 months
RedFlags for...
vision + fine motor
26
- no sitting unsupported by 9 months
- no walking by 18 months
RedFlags for...
gross motor
27
What's a squint (a.k.a strabismus)?
misalignment of visual axes such that eyes don't look in same direction
28
When is it normal to have a squint?
under 3 months old. common in little babies, esp prems.
29
What do you need when a squint persists beyond 3 months?
opthalmologist opinion
30
if the eyes moves, it's a non-paralytic / 'concomitant' squint. If it's a paralytic squint, that might indicate..
space occupying lesion :/
31
Causes of squint are multifactorial. Name a few.
```
refractive errors
FHx
prematurity
Down's / cerebral palsy
SoL
```
32
What is the commonest cause of squint (a.k.a strabismus)?
refractive errors
| e.g. hypermetropia
33
Sudden onset paralytic squint with other neuro signs. What needs to happen?
urgent neuro referral (SoL)
| - MRI / CT brain
34
What is the difference between manifest and latent squint?
manifest - the eyes points in/out all the time
| latent - only apparent when occlude other eye
35
Describe the cover test.
child looks at toy
place occluder over one eye
if fixing eye covered, squinting eye moves to take up fixation
36
How do you test visual acuity in
a) toddlers
b) adults
toddlers - picture test
| adults - Lobmar test
37
What investigations for strabismis? (x4)
1. corneal light reflex test
2. cover test
3. visual acuity
4. test ocular movements (CN palsies)
38
What is pseudostrabsimus?
where it looks like they've got a squint but they haven't, e.g. bc eyes too close together
39
What are the two aims in treating strabismus?
- restore binocular single vision
| - restore alignment (for looks)
40
Describe the management of squint. (x4)
1. glasses or patch
2. orthoptic exercises
3. surgical
4. botox injection
41
Amblyopia is a type of
refractive error
42
What is amblyopia?
decreased visual acuity (lazy eye)
| ambling along - lazy
43
What's refractive error?
a lens thing
| e.g. myopia, hypermetropia, astigmatism, amblyopia
44
What is the posh word for short sightedness?
myopia
| Benji Percival
45
What is the posh word for long sightedness?
hypermetopia
| lots of metres
46
What is hypermetopia?
long sightedness
47
What is myopia?
short sightedness
48
Lazy eye can come from strabismus. But what else?
stimulus deprivation (e.g. ptosis)
49
Investigations for amblyopia?
glasses test - check refraction
| fundoscopy - exclude
50
When should you have treated amblyopia by?
age 7!!!
51
When do you reach visual maturation?
age 7
| make sure you treat amblyopia by then
52
What is treatment for amblyopia (lazy eye)? (x3)
- glasses
- patch
- blurry atropine eye drops
53
Whaat is astigmatism?
abnormal corneal curvature
54
Give me four types of refractive error.
myopia
hypermtropia
astigmatism
amblyopia
55
Give me a genetic cause of visual impairment.
cataracts, retinoblastoma
56
Give me a perinatal cause of visual impairment.
congenital infection
retinopathy of prematurity
HIE
57
Give me a post natal cause of visual impairment.
JIA (uveitis)
| trauma
58
What kind of teachers do you think of when you think of visual impairment or special needs
peripatetic teachers.
59
General investigations for visual impairment.
electroretinogram
| visual evoked potentials
60
How do you roughly work out a child's weight in kilos?
(age + 4) x 2
61
How much would you expect a 7 yr old to weigh, roughly?
22kg
(age + 4) x 2
62
How much breast milk per day does a baby need?
150ml / kg / day
63
What do maintenance fluids contain?
0.9 NaCl + 5% glucose
64
Maintenance fluids per day. How do you work out how much to give?
100ml/ kg/day for first 10kg
50ml/ kg/day for next 10kg
20ml/ kg/day for everything after
65
A child is 22kg. How much maintenance fluid will she need per day?
1,540 ml / day
100 x10 for first 10. 50 x10 for next 10. 20 x2 for next 2.
66
A child is 12kg. How much maintenance fluid will she need per day?
1100 ml / day.
100 x 10. plus 50 x2.
67
When children are CLINICALLY DEHYDRATED how much extra fluid should they get per day?
extra 50ml / kg / day
68
When children are SHOCKED how much extra fluid should they get per day?
extra 100ml / kg / day
69
How much fluid in a fluid bolus?
20 ml / kg STAT
*except DKA /trauma - 10ml/kg stat .
70
100ml/kg/day for first 10kg
50ml/kg/day for next 10kg
20ml/kg/day for everything after
... what does this describe?
maintenance fluids.
71
Child in DKA needs fluid bolus. How much do you prescribe?
10ml/kg STAT
72
Child brought into A+E after a car crash needs fluid bolus. How much do you prescribe?
10ml/kg STAT (trauma)
73
Child is brought in with infective gastroenteritis and is clinically dehydrated. How much extra fluid does she need on top of maintenance?
extra 50ml/kg for dehydration
74
Child is brought in SHOCKED. How much extra fluid does she need on top of maintenance?
extra 100ml/kg for shock
75
What does 'HEADDSS' for communication with adolescents stand for?
```
Home
Education
Activities
Drugs / alcohol / diet
Depression / suicide
Sexual Health
Spirituality / sleep / safety
```
76
define anaphylaxis
severe lifethreatening generalized hypersensitivity reaction
77
severe lifethreatnening generalized hypersensitivity reaction is
anaphylaxis
78
treatment for analphylaxis is IM adrenaline like in pulp fiction. but what else?
```
establish airway
high flow o2
fluid bolus of crystalloid
CHLORPHENIRAMINE
HYDROCORTISONE
?salbutamol if wheeze
```
MONITOR ECG SATS BP
79
three important things to monitor when treating analphylaxis
ECG SATS BP
80
long term pointers for someone after they have had anaphylaxis
strategies for allergen avoidance
epi-pen
instructions for event of reaction
81
in anaphlyaxis you give IM adrenaline, establish airway, high flow o2, fluid bolus of crystalloid. And what medications?
chlorpheniramine
hydrocortisone
?salbutamol if wheeze
82
what is that drug that begins with chl- that you give in anaphylaxis alongisde hydrocortisone?
chlorpheniramine
83
hydrocephalus can be communicating or non-communicating. non-commnicating is due to...
obstruction in ventricular system
| eg interventricular haemorrhage
84
non-communicating hydrocephalus is due to obstruction in ventricular system, whereas communicating hydrocephalus is due to...
failure to reabsorb CSF
| eg subarachnoid haemorrhage
85
what is 'setting sun sign' and what does it make you think of ?
fixed downward gaze
| hydrocephalus
86
treatment for hydrocephalus?
VP shunt
| endoscopic third ventriculostomy
87
give example of thing that can cause non-communicating hydrocephalus
interventrcular haemorrhage
88
failure of fusion of vertebral arch = ?
spina bifida occulta
89
what actually is spina bifida?
failure of fusion of vertebral ARCH
90
apart from spina bifida, name some other neural tube defects
anencephaly
encephalocoele
meningocoele
myelomeningocoele
91
neural plaque bulges out onto outside of spine causing limb paresis, sensory loss and neuropathic bladder/bowel... what's this?
myelomeningocoele
need to surgically close
92
Group of disorders where neural plate doesnt fuse to form tube 28days after conception.
neural tube defects
93
what actually are neural tube defects?
neural plate doesnt fuse to form tube 28days after conception.
94
nerves and skin both come from which embryology layer
ectoderm
| neurocutaneous syndromes
95
which is the commoner form of neurofibromatosis?
NF1
96
what form of inheritance for neurofibromatosis?
autosomal dominant
97
NF 2 can cause what wrong with the ears.
bilateral acoustic neuroma
98
what syndrome is neurofibromatosis associated with?
MEN
| multiple endocrine neoplasia
99
4 features of neurofibromatosis 1
- cafe au lait
- neurofibroma
- optic glioma
- Lisch nodule on iris
100
how mayn cafe au alit spots for diagnosis of neurofibromatosis?
>6 cafe au lait spot which are >5mm
101
Lisch nodule makes you think of
neurofibromatosis 1
102
optic glioma makes you think of
neurofibromatosis 1
103
ash leaf pigmented pathces makes you think of
tuberous sclerosis
104
adenoma sebaceum makes you think of
tuberous sclerosis
105
what is inheritance of tuberous sclerosis
autosomal dominant
106
name 2 features of tuberous sclerosis
ash leaf pigmented patches
| adenoma sebaceum
107
define short stature
<2nd centile
if <0.4th, investigate
108
what is target height?
mean of parents
+ 7 for boy
- 7 for girl
109
three syndromes that can cause short stature?
turners, downs, noonans
110
give me some causes of short stature
```
familial
IUGR / preterm
delayed puberty
malnutrition
chronic illness
psychosocial deprivation
hypothyroidism, GH deficiency, steroids
disproportion (achondroplasia)
```
111
how do you tell if someone's got short stature because of disproportion?
measure sitting height
112
in nutritional obesity, a child is...
tall + fat
113
in endocrine obestiy, a child is...
short + fat
114
there are two types of tall stature...
tall stature with impaired final height
tall stature with increased final height
115
give 3 examples of causes of tall stature with impaired final height
obesity
precocious puberty
congenital adrenal hyperplasia
116
give 3 examples of causes of tall stature with increased final height
GH excess (true gigantism)
Klinefelter's (47XXY)
Marfan's
117
define microcephaly
head circumference <2nd centile
118
define macrocephaly
head circumf >98th centile
119
what is craniosynostosis?
premature fusion of skull sutures
120
triad of issue in autism?
social communication
social interaction
repetitive / restricted behaviour
also social imagination
sensory issues
assoc w phobias, tics, epilepsy
121
management of ASD is highly individualized. some examples
education
parenting workshops
school liasison / support
122
define neglect in context of child protection
standard of care doesn't meet needs of child
123
define child protection
action taken to safeguard children FROM HARM
124
4 types of child abuse
physical injury
sexual abuse
emotional abuse
neglect
125
define child abuse
deliberate infliction of harm to a child
OR
failing to prevent harm to a child
126
give three types of physical injuries that might point to abuse
abnormal bruising - neck, genitalia, stomach
shaken baby - subdural haematoma, rib fractures, retinal haemorrhages
burns
127
investigations you might want to do if suspect NAI
```
X rays (fractures)
clotting screen (bruising)
opthalmology (retinal haemorrahges)
```
128
give three examples of emotional abuse
- making them feel worthless / unloved
- making them feel threatened
- witnessing domestic violence
129
define sexual abuse
forcing child to take part in sexual activities whether or not aware of what's happening
(with or without physical contact)
130
give 4 ways sexual abuse might present in girl
STI
pregnancy
genital injury
PV bleed in pre-pubertal
131
INVESTIGATIONS FOR ALL SAFEGUARDING.
```
FBC, clotting screen
swabs for infection
bone profile - (vitD, PTH etc)
skeletal survey
developmental assessment
```
132
INVESTIGATIONS FOR ALL SAFEGUARDING.
```
FBC, clotting screen
swabs for infection
bone profile
skeletal survey
developmental assessment
```
133
whats the name of the multiagency meeting about child protection?
case conference
come up with child protection plan led by key worker
134
what non-medical investigations would happen for safeguarding
social services assessment
maybe police investigation
case conference!
135
what comes in between universal services and safeguarding?
early help
child in need
then safeguarding
136
what could you offer to diabetic child who has hypo unawareness?
CGMS - continuous glucose monitoring system
| e.g. DexCom, has hypo alarms
137
4 autonomic symptoms of hypo
hungry
pale
nauseous
anxious
138
4 neuroglycopenic symps of hypo
dizzy / confused / headache
blurry vision
slurred speech
seizures
139
hypo in child in glucose less than
4
140
what things do you need to think about when given new diabetes diagnosis to child
educate family
school liaison
diabetes specialist nurse
diabetes UK
141
what's somogyi phenomenon?
hypo through night masked by cortisol surge
142
what is treatment for mild hypo?
fasting acting sugar (glucotab)
THEN long acting carb (bread)
check BM @ 15mins
143
what is treatment for moderate hypo?
buccal glycogen
144
what is treatment for severe hypo?
glucagon injection (IM/sc)
145
why do you increase insulin dose during illness?
adrenaline and cortisol decrease insulin
