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