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Paediatrics > General Paeds > Flashcards

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

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2
Q

gross motor - What is the median age for sitting unsupported?

A

7 months

7 months unsupported
red flag if not by 9

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3
Q

gross motor - What is the median age for crawling?

A

8 months (6-9)

6-9 months crawl

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4
Q

gross motor - What is the median age for pull to stand?

A

9 months pull to stand

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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)

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6
Q

gross motor - What is the median age for runs + jumps?

A

2 and a half runs + jumps

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7
Q

Give me two gross motor RedFlags.

A
  • no sitting unsupported by 9 months

- no walking by 18 months

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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)

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9
Q

vision+finemotor - What is the median age for palmar grasp?

A

5 months palmar grasp

five fingers on palm

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10
Q

vision+finemotor - What is the median age for pincer grip?

A

10 months pincer grip

red flag if no by 12months

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11
Q

Give me two vision + fine motor RedFlags.

A
  • no fix + follow by 3 months

- no pincer grip by 12 months

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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
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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

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14
Q

hearing, speech + language - What is the median age for simple phrases?

A

2 yrs simple phrases

red flag if not

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15
Q

hearing, speech + language - What is the median age for sentences?

A

3 yrs sentences

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16
Q

hearing, speech + language - What is median age for polysyllabic babble?

A

7 months polysyllabic babble

red flag if not

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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

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18
Q

social, emotional + behavioural- What is median age for smiling?

A

6 wks

red flag if no smile by 8wks

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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

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20
Q

social, emotional + behavioural - What is median age for finger feeding?

A

7 months

eats 7 party rings

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21
Q

social, emotional + behavioural - What is median age for spoon feeding?

A

18 months

red flag if no spoon feeding by 18 months

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22
Q

social, emotional + behavioural - What is median age for clean and dry, undress w help ?

A

2 yrs

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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

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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

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25
Q
  • no fix + follow by 3 months
  • no pincer grip by 12 months

RedFlags for…

A

vision + fine motor

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26
Q
  • no sitting unsupported by 9 months
  • no walking by 18 months

RedFlags for…

A

gross motor

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27
Q

What’s a squint (a.k.a strabismus)?

A

misalignment of visual axes such that eyes don’t look in same direction

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28
Q

When is it normal to have a squint?

A

under 3 months old. common in little babies, esp prems.

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29
Q

What do you need when a squint persists beyond 3 months?

A

opthalmologist opinion

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30
Q

if the eyes moves, it’s a non-paralytic / ‘concomitant’ squint. If it’s a paralytic squint, that might indicate..

A

space occupying lesion :/

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31
Q

Causes of squint are multifactorial. Name a few.

A 
refractive errors
FHx
prematurity
Down's / cerebral palsy 
SoL
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32
Q

What is the commonest cause of squint (a.k.a strabismus)?

A

refractive errors

e.g. hypermetropia

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33
Q

Sudden onset paralytic squint with other neuro signs. What needs to happen?

A

urgent neuro referral (SoL)

- MRI / CT brain

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34
Q

What is the difference between manifest and latent squint?

A

manifest - the eyes points in/out all the time

latent - only apparent when occlude other eye

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35
Q

Describe the cover test.

A

child looks at toy
place occluder over one eye
if fixing eye covered, squinting eye moves to take up fixation

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36
Q

How do you test visual acuity in

a) toddlers
b) adults

A

toddlers - picture test

adults - Lobmar test

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37
Q

What investigations for strabismis? (x4)

A
  1. corneal light reflex test
  2. cover test
  3. visual acuity
  4. test ocular movements (CN palsies)
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38
Q

What is pseudostrabsimus?

A

where it looks like they’ve got a squint but they haven’t, e.g. bc eyes too close together

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39
Q

What are the two aims in treating strabismus?

A
  • restore binocular single vision

- restore alignment (for looks)

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40
Q

Describe the management of squint. (x4)

A
  1. glasses or patch
  2. orthoptic exercises
  3. surgical
  4. botox injection
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41
Q

Amblyopia is a type of

A

refractive error

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42
Q

What is amblyopia?

A

decreased visual acuity (lazy eye)

ambling along - lazy

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43
Q

What’s refractive error?

A

a lens thing

e.g. myopia, hypermetropia, astigmatism, amblyopia

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44
Q

What is the posh word for short sightedness?

A

myopia

Benji Percival

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45
Q

What is the posh word for long sightedness?

A

hypermetopia

lots of metres

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46
Q

What is hypermetopia?

A

long sightedness

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47
Q

What is myopia?

A

short sightedness

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48
Q

Lazy eye can come from strabismus. But what else?

A

stimulus deprivation (e.g. ptosis)

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49
Q

Investigations for amblyopia?

A

glasses test - check refraction

fundoscopy - exclude

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50
Q

When should you have treated amblyopia by?

A

age 7!!!

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51
Q

When do you reach visual maturation?

A

age 7

make sure you treat amblyopia by then

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52
Q

What is treatment for amblyopia (lazy eye)? (x3)

A
  • glasses
  • patch
  • blurry atropine eye drops
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53
Q

Whaat is astigmatism?

A

abnormal corneal curvature

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54
Q

Give me four types of refractive error.

A

myopia
hypermtropia
astigmatism
amblyopia

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55
Q

Give me a genetic cause of visual impairment.

A

cataracts, retinoblastoma

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56
Q

Give me a perinatal cause of visual impairment.

A

congenital infection
retinopathy of prematurity
HIE

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57
Q

Give me a post natal cause of visual impairment.

A

JIA (uveitis)

trauma

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58
Q

What kind of teachers do you think of when you think of visual impairment or special needs

A

peripatetic teachers.

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59
Q

General investigations for visual impairment.

A

electroretinogram

visual evoked potentials

60
Q

How do you roughly work out a child’s weight in kilos?

A

(age + 4) x 2

61
Q

How much would you expect a 7 yr old to weigh, roughly?

A

22kg

(age + 4) x 2

62
Q

How much breast milk per day does a baby need?

A

150ml / kg / day

63
Q

What do maintenance fluids contain?

A

0.9 NaCl + 5% glucose

64
Q

Maintenance fluids per day. How do you work out how much to give?

A

100ml/ kg/day for first 10kg
50ml/ kg/day for next 10kg
20ml/ kg/day for everything after

65
Q

A child is 22kg. How much maintenance fluid will she need per day?

A

1,540 ml / day

100 x10 for first 10. 50 x10 for next 10. 20 x2 for next 2.

66
Q

A child is 12kg. How much maintenance fluid will she need per day?

A

1100 ml / day.

100 x 10. plus 50 x2.

67
Q

When children are CLINICALLY DEHYDRATED how much extra fluid should they get per day?

A

extra 50ml / kg / day

68
Q

When children are SHOCKED how much extra fluid should they get per day?

A

extra 100ml / kg / day

69
Q

How much fluid in a fluid bolus?

A

20 ml / kg STAT

*except DKA /trauma - 10ml/kg stat .

70
Q

100ml/kg/day for first 10kg
50ml/kg/day for next 10kg
20ml/kg/day for everything after

… what does this describe?

A

maintenance fluids.

71
Q

Child in DKA needs fluid bolus. How much do you prescribe?

A

10ml/kg STAT

72
Q

Child brought into A+E after a car crash needs fluid bolus. How much do you prescribe?

A

10ml/kg STAT (trauma)

73
Q

Child is brought in with infective gastroenteritis and is clinically dehydrated. How much extra fluid does she need on top of maintenance?

A

extra 50ml/kg for dehydration

74
Q

Child is brought in SHOCKED. How much extra fluid does she need on top of maintenance?

A

extra 100ml/kg for shock

75
Q

What does ‘HEADDSS’ for communication with adolescents stand for?

A 
Home
Education
Activities
Drugs / alcohol / diet
Depression / suicide
Sexual Health
Spirituality / sleep / safety
76
Q

define anaphylaxis

A

severe lifethreatening generalized hypersensitivity reaction

77
Q

severe lifethreatnening generalized hypersensitivity reaction is

A

anaphylaxis

78
Q

treatment for analphylaxis is IM adrenaline like in pulp fiction. but what else?

A 
establish airway
high flow o2
fluid bolus of crystalloid
CHLORPHENIRAMINE
HYDROCORTISONE
?salbutamol if wheeze

MONITOR ECG SATS BP

79
Q

three important things to monitor when treating analphylaxis

A

ECG SATS BP

80
Q

long term pointers for someone after they have had anaphylaxis

A

strategies for allergen avoidance
epi-pen
instructions for event of reaction

81
Q

in anaphlyaxis you give IM adrenaline, establish airway, high flow o2, fluid bolus of crystalloid. And what medications?

A

chlorpheniramine
hydrocortisone

?salbutamol if wheeze

82
Q

what is that drug that begins with chl- that you give in anaphylaxis alongisde hydrocortisone?

A

chlorpheniramine

83
Q

hydrocephalus can be communicating or non-communicating. non-commnicating is due to…

A

obstruction in ventricular system

eg interventricular haemorrhage

84
Q

non-communicating hydrocephalus is due to obstruction in ventricular system, whereas communicating hydrocephalus is due to…

A

failure to reabsorb CSF

eg subarachnoid haemorrhage

85
Q

what is ‘setting sun sign’ and what does it make you think of ?

A

fixed downward gaze

hydrocephalus

86
Q

treatment for hydrocephalus?

A

VP shunt

endoscopic third ventriculostomy

87
Q

give example of thing that can cause non-communicating hydrocephalus

A

interventrcular haemorrhage

88
Q

failure of fusion of vertebral arch = ?

A

spina bifida occulta

89
Q

what actually is spina bifida?

A

failure of fusion of vertebral ARCH

90
Q

apart from spina bifida, name some other neural tube defects

A

anencephaly
encephalocoele
meningocoele
myelomeningocoele

91
Q

neural plaque bulges out onto outside of spine causing limb paresis, sensory loss and neuropathic bladder/bowel… what’s this?

A

myelomeningocoele

need to surgically close

92
Q

Group of disorders where neural plate doesnt fuse to form tube 28days after conception.

A

neural tube defects

93
Q

what actually are neural tube defects?

A

neural plate doesnt fuse to form tube 28days after conception.

94
Q

nerves and skin both come from which embryology layer

A

ectoderm

neurocutaneous syndromes

95
Q

which is the commoner form of neurofibromatosis?

96
Q

what form of inheritance for neurofibromatosis?

A

autosomal dominant

97
Q

NF 2 can cause what wrong with the ears.

A

bilateral acoustic neuroma

98
Q

what syndrome is neurofibromatosis associated with?

A

MEN

multiple endocrine neoplasia

99
Q

4 features of neurofibromatosis 1

A
  • cafe au lait
  • neurofibroma
  • optic glioma
  • Lisch nodule on iris
100
Q

how mayn cafe au alit spots for diagnosis of neurofibromatosis?

A

> 6 cafe au lait spot which are >5mm

101
Q

Lisch nodule makes you think of

A

neurofibromatosis 1

102
Q

optic glioma makes you think of

A

neurofibromatosis 1

103
Q

ash leaf pigmented pathces makes you think of

A

tuberous sclerosis

104
Q

adenoma sebaceum makes you think of

A

tuberous sclerosis

105
Q

what is inheritance of tuberous sclerosis

A

autosomal dominant

106
Q

name 2 features of tuberous sclerosis

A

ash leaf pigmented patches

adenoma sebaceum

107
Q

define short stature

A

<2nd centile

if <0.4th, investigate

108
Q

what is target height?

A

mean of parents
+ 7 for boy
- 7 for girl

109
Q

three syndromes that can cause short stature?

A

turners, downs, noonans

110
Q

give me some causes of short stature

A 
familial
IUGR / preterm
delayed puberty
malnutrition
chronic illness
psychosocial deprivation
hypothyroidism, GH deficiency, steroids
disproportion (achondroplasia)
111
Q

how do you tell if someone’s got short stature because of disproportion?

A

measure sitting height

112
Q

in nutritional obesity, a child is…

A

tall + fat

113
Q

in endocrine obestiy, a child is…

A

short + fat

114
Q

there are two types of tall stature…

A

tall stature with impaired final height

tall stature with increased final height

115
Q

give 3 examples of causes of tall stature with impaired final height

A

obesity
precocious puberty
congenital adrenal hyperplasia

116
Q

give 3 examples of causes of tall stature with increased final height

A

GH excess (true gigantism)
Klinefelter’s (47XXY)
Marfan’s

117
Q

define microcephaly

A

head circumference <2nd centile

118
Q

define macrocephaly

A

head circumf >98th centile

119
Q

what is craniosynostosis?

A

premature fusion of skull sutures

120
Q

triad of issue in autism?

A

social communication
social interaction
repetitive / restricted behaviour

also social imagination
sensory issues
assoc w phobias, tics, epilepsy

121
Q

management of ASD is highly individualized. some examples

A

education
parenting workshops
school liasison / support

122
Q

define neglect in context of child protection

A

standard of care doesn’t meet needs of child

123
Q

define child protection

A

action taken to safeguard children FROM HARM

124
Q

4 types of child abuse

A

physical injury
sexual abuse
emotional abuse
neglect

125
Q

define child abuse

A

deliberate infliction of harm to a child
OR
failing to prevent harm to a child

126
Q

give three types of physical injuries that might point to abuse

A

abnormal bruising - neck, genitalia, stomach

shaken baby - subdural haematoma, rib fractures, retinal haemorrhages

burns

127
Q

investigations you might want to do if suspect NAI

A 
X rays (fractures)
clotting screen (bruising)
opthalmology (retinal haemorrahges)
128
Q

give three examples of emotional abuse

A
  • making them feel worthless / unloved
  • making them feel threatened
  • witnessing domestic violence
129
Q

define sexual abuse

A

forcing child to take part in sexual activities whether or not aware of what’s happening

(with or without physical contact)

130
Q

give 4 ways sexual abuse might present in girl

A

STI
pregnancy
genital injury
PV bleed in pre-pubertal

131
Q

INVESTIGATIONS FOR ALL SAFEGUARDING.

A 
FBC, clotting screen
swabs for infection
bone profile - (vitD, PTH etc)
skeletal survey
developmental assessment
132
Q

INVESTIGATIONS FOR ALL SAFEGUARDING.

A 
FBC, clotting screen
swabs for infection
bone profile 
skeletal survey
developmental assessment
133
Q

whats the name of the multiagency meeting about child protection?

A

case conference

come up with child protection plan led by key worker

134
Q

what non-medical investigations would happen for safeguarding

A

social services assessment
maybe police investigation
case conference!

135
Q

what comes in between universal services and safeguarding?

A

early help
child in need
then safeguarding

136
Q

what could you offer to diabetic child who has hypo unawareness?

A

CGMS - continuous glucose monitoring system

e.g. DexCom, has hypo alarms

137
Q

4 autonomic symptoms of hypo

A

hungry
pale
nauseous
anxious

138
Q

4 neuroglycopenic symps of hypo

A

dizzy / confused / headache
blurry vision
slurred speech
seizures

139
Q

hypo in child in glucose less than

140
Q

what things do you need to think about when given new diabetes diagnosis to child

A

educate family
school liaison
diabetes specialist nurse
diabetes UK

141
Q

what’s somogyi phenomenon?

A

hypo through night masked by cortisol surge

142
Q

what is treatment for mild hypo?

A

fasting acting sugar (glucotab)
THEN long acting carb (bread)
check BM @ 15mins

143
Q

what is treatment for moderate hypo?

A

buccal glycogen

144
Q

what is treatment for severe hypo?

A

glucagon injection (IM/sc)

145
Q

why do you increase insulin dose during illness?

A

adrenaline and cortisol decrease insulin

Paediatrics (14 decks)

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