ILOs 1 Flashcards
Give some causes of global developmental delay
Down’s syndrome
Fragile X syndrome
Fetal alcohol syndrome
Rett syndrome
Metabolic disorders
Give some causes of gross motor delay
Cerebral palsy
Ataxia
Myopathy
Spina bifida
Visual impairment
Give some causes of fine motor delay
Dyspraxia
Cerebral palsy
Muscular dystrophy
Visual impairment
Give some causes of speech and language delay
Specific social circumstances, for example exposure to multiple languages or siblings that do all the talking
Hearing impairment
Learning disability
Autism
Cerebral palsy
Neglect
Give some causes of social delay
Emotional and social neglect
Parenting issues
Autism
What are the main types of pneumothorax seen in children?
spontaneous pneumothorax:
- primary spontaneous pneumothorax (PSP): Occurs without underlying lung disease, often in tall, thin, young individuals, associated with the rupture of subpleural blebs or bullae
- secondary spontaneous pneumothorax (SSP): Occurs in patients with pre-existing lung disease, such as asthma, CF and pneumonia. Certain connective tissue diseases such as Marfan’s syndrome are also a risk factor
traumatic pneumothorax
iatrogenic pneumothorax
What are the sxs and signs of a simple pneumothorax?
Symptoms tend to come on suddenly:
dyspnoea
pleuritic chest pain
Signs
hyper-resonant lung percussion
reduced breath sounds
reduced lung expansion
tachypnoea
tachycardia
What is a tension pneumothorax?
a severe pneumothorax
occurs when a one way valve is created between the lung and the pleura, which leads to an accumulation of air within the pleural cavity = increase in intrathoracic pressure
results in the displacement of mediastinal structures that may result in severe respiratory distress and haemodynamic collapse
What are the signs of tension pneumothorax?
tracheal deviation away from the side of the pneumothorax
hypotension, tachycardia, tachypnoea
quiet heart sounds
cyanosis
Management in primary pneumothorax without shortness of breath, and <2cm in size?
discharge and review
Management of pneumothorax with a rim of air >2cm or clinically short of breath (SOB)?
Chest drain insertion
What is the safe triangle for chest drain insertion?
The triangle is located in the mid axillary line of the 5th intercostal space.
It is bordered by:
Anterior edge latissimus dorsi, the lateral border of pectoralis major, a line superior to the horizontal level of the nipple, and the apex below the axilla.
How can you find out a chest drain is in the right place without doing a CXR?
Chest drain swinging: water level rises on inspiration, falls on expiration
How should a suspected tension pneumothorax be investigated and managed?
A tension pneumothorax should not be investigated if suspected but should be immediately decompressed with a needle (14G needle, 2nd intercostal space)
How can poisoning of unknown origin be investigated?
can consult NPIS or TOXBASE for advice
Blood tests, such as toxicological investigations, FBC, U&Es, LFTs, glucose, clotting and arterial blood gases
urine drug screen
ECG
How can poisoning of unknown origin be managed?
can consult NPIS or TOXBASE for advice
Activated charcoal can bind to the poison and prevent absorption - up to 1 hour after ingestion
Alkalinisation of the urine for salicylate poisoning
Haemodialysis for ethylene glycol, lithium, methanol, phenobarbital, salicylates, and sodium valproate
Antidotes (if available) may be given for certain poisons
Give some key clinical features of malnutrition in children
High susceptibility to infections
Slow or poor wound healing
bradycardia, hypotension, and hypothermia
Depleted subcutaneous fat stores
Low skeletal muscle mass
In children, other indicators of undernutrition include:
Wasting: low weight for height
Stunting: low height for age
Underweight: low weight for age
Give some complications of malnutrition
Impaired immunity (increased risk of infections)
Poor wound healing
Growth restriction in children
Unintentional weight loss, specifically the loss of muscle mass
Multi-organ failure
Death
What signs should you look for on examination of a malnourished child?
shock: lethargic or unconscious; with cold hands, slow capillary refill (> 3 s), or weak (low volume), rapid pulse and low blood pressure
signs of dehydration e.g. decreased skin turgor
severe palmar pallor
bilateral pitting oedema
eye signs of vitamin A deficiency
What is Marasmus?
overt loss of adipose tissue and muscle as a result of total calorie insufficiency
children appear emaciated, weak and lethargic, and have associated bradycardia, hypotension, and hypothermia
What is Kwashiorkor?
‘the sickness of the weaning’ - often occurs on cessation of breastfeeding
severe protein deficiency with fair caloric intake
hypoalbuminaemia may cause bilateral pitting oedema and distended abdomen due to ascites
How should you assess a malnourished child?
detailed dietary history and physical examination
anthropometric measurements (including weight, length, and head circumference in younger children)
skinfold thickness and mid-upper-arm circumference (MUAC)
U&Es, LFTs, serum albumin levels
How should you manage a malnourished child?
treat hypoglycaemia
treat / prevent any hypothermia
rehydrate
refeed slowly with regular refeeding bloods
How should you dx and tx hypoglycaemia in a child?
take capillary BM - blood glucose below < 3 mmol/litre = hypoglycaemia
Give 50 ml of 10% glucose solution orally or by nasogastric tube
If the child is unconscious, treat with IV 10% glucose at 5 ml/kg