General paeds and psych Flashcards
When do the anterior and posterior fontanelles normally close
Ant-9-18 months
Post- 2 months
What is craniosynostosis?
Early fusion of the sutures
What is the most common non syndromic cause of craniosynostosis
What suture is involved
What does the head look like?
Scaphocephaly
Saggital suture
Long and thin with a prominent occupit
Anterior plagiocephaly
What is the shape of the head
What suture is involved
Asymmetrical
Prominent forehead and hear on the affected side
Coronal- one side
If both coronal sutures are fused what is the head shape called
Brachycephaly
Posterior plagiocephaly
What suture is involved
Head shape?
One lamboid suture
Flat back of the head on the affected side, ear moves back
prominent forehead on the other side
Trigonocephaly
What suture is involved
Meitopic
Multiple sutures fused- what are the two head shapes called
Turricephaly
Kleeblattschadel
Craniosynostosis syndromes
What is the usual inheritance
What gene is involved
What is the most common syndrome
AD
FGFR
Crouzon syndrome
Crouzon syndrome
What gene
Face shape
What syndrome is similar with syndactyly?
FGFR2
Brachycephaly with proptosis, maxillary hypoplasia and a beaked nose
Apert syndrome
Craniosynostosis syndromes
Which is involved with turricephaly
Gene
Hands
Pfeiffers syndrome
FGFR 1
Short, broad widely spaced fingers and toes
Craniosynostosis syndromes
Which is involved with a clover leaf skull
Inheritance
Carpenters
AR
Craniosynostosis syndromes Chotzen syndrome Inheritance and gene Facial shape Hands
AD TWIST gene
Asymmetrical plagiocephaly with ptosis
Some syndactyly
How big does your head have to be to call it macrocephalic?
> 3 SD from normal
CP
When is the insult most likely
Antenatal period
CP What is the most likely cause of Spastic Diplegia Spastic hemiplegia Extrapyramidal Which will have early hand preference
Prematurity- IVH and PVLM
neonatal stroke- has early hand preference
Kernicterus and asphyxia
Rett syndrome
Gene
Inheritance
Main characteristics
X linked dominant MCP2 Progressive microcephalaly Developmental regression Wringing movements of hands (autistic-like) Seizures Cyanotic episodes
Menkes kinky hair disease Inheritance Hair features Features at birth Characteristic blood test Features later in life
X linked recessive Thin friable silvery Hypothermic and hypotonic Low copper and caeruloplasmin GDD and optic atrophy
When do you develop handedness
2 years old
Development
What are the 4 main red flags for gross motor function
Asymmetry, persisting primitive reflexes, not sitting by 8months, not walking by 18m
Development
Outline the normal pattern of gross motor milestones
3m- head control when prone 4m- roll 6m- sit unsupported 9m- pull to stand and crawl 12m- walk 18m- run badly 2y- run well and jump 3- balance for 3s, throw and catch, tricycle 4- hop 5- balance for 6s and heel toe walk
Development
Outline the stages and ages for stairs
2- 2 feet for steps
3- alternate feet up
4- alternate feet down
Development When do the following primitive reflexes go away Placing Moro Palmar Rooting ATNR Landau Parachute
Placing-6w Palmar grasp- 3m Rooting and Moro-4m ATNR- 6m Landau-12m Parachute- never!
Development
Outline the normal pattern of fine motor development
3m- grasp 6m- transfer 9m- pincer 12m- throw and object into a cup 18m- scribble 2y- line, 6 block tower 3y- circle, 9 block tower 4y- square 5y- triangle person
What are 3 red flags for fine motor function?
No transferring at 7m
Early hand preference
No ADLs at 4
Outline the normal pattern of speech development
3m- coos 9m- babbles 12m first words 2- 5-20 words, two word sentences 3- 50-200 words, three word sentences, 3 colours. Understood by family only 4- 4 colours, understood by a stranger
What are red flags for speech development
No words other than mama/dada by 18m
Not understood by family at 3/strangers at 4
<20 words at 2
Outline normal social development
6w- social smile 9m- stranger danger, peek a boo 12m- points waves 18m- undress 2y- partially dress, tantrums, 3y- fully dress, role play, brush teeth 4y- fantasy play, wipe bum 5y- friends, tie shoes
Outline ages and stages for feeding
Cup- 18m
Spoon-2
Knife-3
Knife and fork-4
From when can you use a snellen chart
What is used before then?
6 years
Red reflexes and picture charts
What hearing screening tests can be used for Up to 6m Up to 2 years 2-5 years 5 years plus
OAE or ABRs
Visual reinforced hearing
Play audiometery
Pure tone audiometry
When does crying peak and resolve
6 weeks- 3 hrs a day
4 months
How long does a normal 1 month old and 5year old sleep for
1m 16 hrs
5yrs 11 hrs
When does object permanence start
9 months
When will a child repetitively search for a hidden object
18m-2y
What are the 4 criteria in DSM to diagnose autism
Impaired social communication and interaction
Early developmental period
Impairs school/ social settings
Restrictive or repetitive behaviours
Is ID a criteria to diagnose autism
No!
Hearing loss syndromes
Give 2 AD causes
Give 4 AR causes
Give one feature of each
Waardenburg- hair and skin hypopigmentation and brachio oto renal- absent kidneys and radius
Usher- blindness
Pendred- hypothyroid
Jervel Lange Nelson- QT long
Connexin 26- commonest
What percentage of 5 year olds are dry at night
10 years
What is the first line treatment for nocturnal enuresis
What is second line and how does it work
85%
95%
Bed wetting alarms and desmopressin
Oxybutinin- works for overactive bladders- ACH blocker so relaxes smooth muscle
How many calories are seen in 100mls of standard formula?
Around 280
What are the main side effects of cyclosporine
Gum hyperplasia and hirsuitism
What are the main side effects of tacrolimus
Alopecia, low Mg and diabetes
What is first line treatment for Tourette’s syndrome
Haloperidol
What are the first teeth to erupt normally
When
What is delayed
Lower central incisors
6-12 months
>6m beyond normal
What is the most common hymen shape in pre pubertal girls
“Post pubertal
What is most indicative of abuse
Crescentic
Fimbrated
V shaped indent at 5oclock
What does purchaser retinopathy correlate to
What is the best test for abdominal trauma initially
Chest wall trauma
Transaminases
What percentage of infants never crawl
4%
What is the autism risk of one sibling is affected
“2 or twins
10%
50-60%
What percentage of autistic children have
Low IQ
ADHD
50% both
What screen may pick up concerns of autism
What is the best screening test
Ages and stages
ADOS
What are 2 general screens for developmental delay and when are they used
What is used to test for low IQ over 6. What else needs to be tested
Baileys- up to 3
Griffiths- up to 8
Wechsler- also need to check their reading ability
What is the best measure of outcome in autism
What might be useful for stereotyped behaviours? Anxiety?
Speech at 5
Haloperidol
SSRIs
What percentage of ADHD have ODD and anxiety
How is ODD treated
30% of each
Parent management training
What are 2 screens for ADHD
Connors
SNAP 4
How does methylphenidate work? Does it change final height?
What might be used for tics
Blocks dopamine and NE reuptake
Yes only slightly
Clonidine
What are examples of SSRIs
What are the three main side effects
If doses are altered or meds are changed what are they at risk of
Fluoxetine/paroxetine
Gi, wild dreams and increased suicidal ideation.
Serotonin syndrome
What is the main side effect of TCAs
Weight gain
QT prolonging
NAI
when should a skeletal survey be repeated
What is the best modality of Neuro imaging
2 weeks
CT
What is the most suspicious fracture in NAI
what are 3 others
Metaphyseal corner fractures
Post ribs, scapula, sternal
What are the three DSM criteria for anorexia
What are the 2 sub types
Fear of being overweight
Reduced intake
Distorted perception of body image
Bulimia or restrictive
What are three DSM criteria for bulimia
Bing eating
Compensating- vomiting/exercise/diuretics
At least weekly for 3m
What is the schizophrenia risk
- 1 parent or sibling affected
- twins or both parents
10%
50%
What meds are used first in gender reassignment
Puberty blockers- gnrh agonists
What are three risks of oestrogen treatment for feminisation
Cardiovascular
Prolactinaemia
Hypercoagulability
What are three side effects for masculinising therapy with testosterone
Which prerecording conditions can it worsen?
Acne and hair loss
Cardiovascular
Hyperlipidaemia
Mania and schizophrenia
Are most AEDs safe with the COCP?
Which contraceptive method may not be safe
Yes!
Implants
What is the treatment for
Chlamydia
Gonorrhoea
Azithromycin one off
IM ceftriaxone or cipro AND azithromycin
