Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med 4 > ITM 1 The Paediatric Patient > Flashcards

ITM 1 The Paediatric Patient Flashcards

1
Q

What does a full blood count involve

A 
Haemoglobin 
Haematocrit 
Mean corpuscular volume 
Differential white cell count 
Reticulocyte count 
ESR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does Us and Es involve

A 
EGFR 
Creatinine (and clearance) 
Na+ 
K+ 
Urea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does an ECG show

A

Cardiac problems of conduction, pathological changes of heart (LVH), ischaemia and abnormalities of rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can a chest xray show

A

Information regarding respiratory system and heart

Lungs - pneumonia, infections (TB), carcinoma
Heart failure- enlarged heart, signs of pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define safeguard

A

Protect from harm or damage with an appropriate measure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the unicef definition of a child protection system

A

The set of laws, policies, regulations and services needed across all social sectors especially welfare, education, health, security and justice to support prevention and response to protection related risks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define harm

A

Ill treatment or the impairment of health or development eg depriving a child of the tools needed to develop eg sitting in a push chair all day means they wont learn to walk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 4 categories of abuse

A

Physical
Emotional
Sexual
Neglect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define neglect

A

The persistent failure to meet a childs basic physical and / or psychological needs, likely to result in the serious impairment of the childs health or development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define emotional abuse

A

Persistent emotional ill treatment of a child such as to cause severe and persistent adverse effects on the childs emotional development
It may include:
Conveying to the child that they are worthless or unloved
Developmentally inappropriate expectations being imposed on a child
Seeing or hearing the ill treatment of others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is sexual abuse

A

Forcing or enticing a child or young person to take part in sexual activities, including prostitution whether or not the child is aware that this is happening - often children from vulnerable backgrounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can sexual abuse include

A

Penetrative and non penetrative acts, non contact acts such as involving children in looking at or being involved in the production of pornographic material or watching sexual activities or encouraging children to behave in sexually inappropriate ways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What categories of children are at increased risk of abuse

A

Disabled children and non verbal
Asylum seeking / refugee children, private fostered
Children in care and children in secure accommodation
Children <1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why are children <1 year statistically most at risk

A

Injuries can be hidden
Non mobile children should not have bruises
Harder to recognise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are other risk factors that need to be considered

A

Domestic abuse
Are the family already known to social care
Is there a history of mental health problems
Is there a history of substance misuse
Are there other children in the house, they may need immediate protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What should you do if a disclosure is made

A

Tell the child or parent they have done the right thing by telling you
Avoid making comments or judgements about what is shared
Tell the child or parent what will happen next and be honest, dont break a childs trust
Document clearly
Tell a senior colleague

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should you look for when examining a child

A

Look for injuries and document any
Document birth marks, demeanour
Document any rashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should you do if you have a safeguarding concern

A

Ensure everything is documented
Share that worry with a seniour colleague
Refer to childrens social care
Arrange an appropriate child protection medical
CSC will ensure the child is safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does ‘safe’ mean

A

Doesnt necessarily mean that the children are removed from their family, simple things like more support, supervision, behaviour management, housing support or education is often sufficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does a paediatric history taking involve

A 
Antenatal and birth details 
Early development 
Hearing and vision 
Family and social history 
School 
Nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the phases of growth and development and life

A 
Prenatal 
Neonatal 
Infancy 
Pre school 
Primary school 
Secondary school
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What factors are measured in a growth assessment

A

Weight
Height / length
Head circumference (widest possible measurement)
BMI - limited value in a child as many toddlers are chubby but lose it after age 5
Pubertal stage
Bone age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is given if growth is not in conjuction with bone age

A

Growth hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What happens when growth plates are fused

A

You stop growing
No gap between bones as they have been ossified (cartilage in between has gone- looks like a gap on xray as cartilage cant be seen on xray)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is turner syndrome

A

Missing x chromosome
Short stature
Failure of ovaries to develop
Heart defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 4 domains of development

A

Gross motor
Fine motor
Language
Social

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the stages of gross motor development

A 
3 months- head control when sitting 
4-5 months - roll 
9 months - sit unaided 
8-10 months - crawling 
1 yr - standing up 
13-18 months - walking unaided
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Stages of fine motor and vision development

A 
6 weeks - palmar grasp 
3 months - hand play 
5 months - reaching 
6 months - transfer 
9 months - pincer grip 
15 months - scribble
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Stages of language and hearing development

A 
Birth - cry and responds to sounds 
8 weeks - vocalising 
4 months - laughing 
7 months - responds to names 
12 months - single words 
24 months - join 2 words together
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Stages of social and behavioural development

A 
6 weeks - smiles reponsively 
6 months - finger feeds solids 
9 months - wave bye 
15 months - drink from a cup 
22 months - knows body parts 
3 years - feed with knife and fork 
3 years - referential play
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How should you calculate age of a preterm child

A

Up to age 2 subtract how many week premature they were from their age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What should be a concern if a childs development is not sequential

A

Eg they were walking and then reverted to crawling - sign of a brain tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are red flags in abnormal development that require thought

A 
Not similing at 8 weeks - a sign of lack of hearing 
Not sitting at 9 months 
Not walking unsupported at 18 months 
Fewer than 6 words by 18 months 
Apparent loss of skills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the different forms of eczema

A

Atopic eczema (infantile)
Contact dermatitis
Pompholyx - vesicles on hands or feet, related to fungal infection, heat and stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is hyperkeratotic palmar eczema

A

Common in the middle aged

Fissured eczema on hands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is seborrhoeic eczema

A

Cradle cap
Common in babies
Treated with anti fungal shampoo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is asteatotic eczema

A

Reduced lipids in the skin
Drying and cracking
Common in the older patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is atopic eczema

A

Inherited tendency for asthma, hayfever and eczema
Sensitivity to allergens
Dry and inflammed skin aggravated by cold, hear, hard water, infections, clothes
Often develops at 3 months - most grow out of it
Pruritis is prominent
Itchy papules on cheeks
Felxurs affected, elbows and knees; skin dry and lichenified
Infection risk through scratching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How to manage eczema with cleansing

A

Regular but not excessive washing, using emulsifying ointment - avoid soap
Bathe in emollient (hydrating agent)
Regulat emollient cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How to manage eczema with the environment

A

Keep the house cool

Limit allergens in the house- dust house mite increases severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How to manage the scratching element of eczema

A

Cut nails

Sedative oral antihistamine at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When are steroids used in eczema

A

When emollients are not sufficient

Topical 1% hydrocortisone (infants under 1) very effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How to counsel a parent for a child being prescribed steroids for eczema

A 
Apply thinly and evenly spread 
Avoid face (telangiectasia- thinning of skin and prominent blood vessels) and anogenital region (scrotal skin absorbs 80x better than other skin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are some of the side effects of more potent steroids

A 
2 degree infection 
Thinning of skin 
Telangiectasia 
Acne 
Mild depigmentation 
Pituitary-adrenal axia suppression 
Cushings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Treatment options for infected eczema

A

Topical antiseptic - povidone
Topical fusidic acid or mupirocin

If widespread, oral flucoxacillin or erythromycin

Dermatophytes - topical antifungal

Eczema herpeticum (when eczema has been infected with herpes) - emergency IV antivirals in hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is contact dermatitis

A

Irritant reaction to chemicals eg detergents, nickel, cosmetics

Atopy is a predisposing factor

Dryness and chapping
Remove contact

Emollients, barrier creams, topical steroids, oral antihistamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is napkin dermatits

A

Contact dermatitis +/- infection

Irritation to ammonia - skin folds not affected

Improve hygeine, barrier creams, emollients
Infection- skin folds affected. Often fungal

48
Q

Treatment for psoriasis

A

Emollients
Topical steroids - anti inflammatory
Topical dithranol- antiproliferative; inhibits DNA synthesis often 1st line
UV- with psoralen. Bathe in psoralen prior to UVA, photosensitizing agent

49
Q

When are oral retinoids used to treat psoriasis

A

After methotrexate and ciclosporin

They bind to nuclear retinoic acid receptor and affect gene transcription - antiproliferative

50
Q

Risks of oral retinoids

A

Teratogenic
Avoid pregnancy for 3 years after stopping as accumulates in the fat

Negative pregnancy tests and 2 forms of contraception needed

51
Q

What is ringworm

A

Fungal infection
Discoid, scaly regions
Culture of skin scrapings is best practice

52
Q

What is acne vulgaris

A

Excessive sebum production
Comedones (blackheads)
Pustules (white heads)

53
Q

How does co-cyprindiol ethinylestradiol contraceptive treat acne

A

It balances the imbalance of oestrogen and androgens

Androgens drive the excessive sebum production

54
Q

What is rosacea

A

An inflammatory condition
Acneform lesions, telangiectasia but not comedones
Commoner in women, during / after menopause

55
Q

Treatment of rosacea

A 
Topical metronidazole (antibacterial) 
Then oral erythromycin or tetracycline
56
Q

What is a basal cell carcinoma

A

Small blackish area (often on the edge of the ear / temple)
Small colourless lump with pearly edges
Very slow growing - takes years
It is a malignant tumour but with limited local invasion
Cured by surgical removal - 97% cure rate
Extensive lesions may require radiotherapy or cryotherapy

57
Q

What is a malignant melanoma

A

Evolution and possible malignant transformation in a large mole to produce malignant melanoma

More likley in large than small moles, in sun exposed skin
Itch

58
Q

What is the ABCDE signs of a malignant melanoma

A 
Asymmetry 
Border irregular 
Colour irregular 
Diameter >0.5cm 
Elevation irregular
59
Q

Treatment of a malignant melanoma

A

Surgical excision outlook good. If the thickness of the lesion is <1.5mm the 5 year survival is 92% but only 37% for a more neglected lesion of >3mm thickness
Chemotherapy is palliative in disease which has spread

60
Q

What is a pre term neonate

A

23-37 weeks gestation

Rapid growth, fully formed, most systems not fully developed

61
Q

What is a neonate

A

Birth - 1 month

Normal initial period of human development and growth

62
Q

What is an infant

A

One month - one year

High growth rates and rapid changes

63
Q

What is a child

A

One - 12 years

Slower growth and development

64
Q

What is an adolescent

A

12-18 years

Final period of growth and puberty, stretching into adulthood

65
Q

How are children different to adults

A

Organ systems develop throughout infancy, childhood and adolesence
Often poorer reserve in overdose
Inability / reluctance to swallow tablets, have injections etc

66
Q

What are the 4 pharmacokinetic processes

A

Absorption
Distribution
Metabolism
Excretion

67
Q

What is the primary organ for drug

A

Kidney

68
Q

What organ is primarily responsible for drug metabolism

A

Liver

69
Q

Define absoprtion

A

The extent to which the administered dose is transported to the blood stream and the speed with which this happens

70
Q

Describe oral absorption in children

A

Neonatal / early absorption very unpredictable - use IV if patient is acutely unwell and / or the medicine is critical
Similar to adults from 4-6 months of age

71
Q

Describe IM absorption in children

A

Unpredictable due to variable blood flow, reduced muscle mass and fewer muscle contractions in neonates and sedated / paralysed children
Painful - avoid if at all possible - ok for single doses

72
Q

Describe percutaneous absorption in children

A

Enhanced in neonates and infants- higher risk of toxicity from drugs and excipients

73
Q

Describe rectal absorption in children

A

Slow and unpredictable, especially in neonates

74
Q

Describe the process of distribution of drugs in a child

A

Higher total body water in neonates affects water soluble drugs eg gentamicin
Continues to change right through adolescence but greatest changes occur during the first year of life

Reduced plasma protein concentration (drugs carried around the body attached to plasma proteins) binding capacity and affinity in neonates

75
Q

What are hepatic phase I liver enzymes

A

Mature over the first few months of life. Adults levels reached at 6 months

Oxidation, reduction and hydrolysis reactions

76
Q

What are hepatic phase II liver enzymes

A

Increase significantly over first 2-3 months of life. Adult levels reached at about 3 years of age (acetylation and glucuronidation reactions)

Present at birth at similar levels to those found in adults (sulphate conjunction, glycine conjugation)

77
Q

Describe GFR in babies

A

Is bad at birth even in healthy babies
Around 20

90 is the lower end of adult volume

78
Q

Describe excretion in neonates

A

GFR is low initially but improves rapidly in babies born >1.5kg over the first 14 days of life

Tubular secretion increases more slowly and is close to adult values by age 8-12 months of age
Impact is on renally excreted drugs (eg gentamicin, cefuroxime)- some drugs are dosed on post menstrual age, others on post natal age

79
Q

What are the different ways of calculating dosage in a child

A

By age:
Ok for drugs with low toxicity / wide therapeutic window

By weight:
Most common, need to check weight seems sensible. Do not exceed the adult dose

By surface area: most accurate

80
Q

Problems with oral liquid medicines

A

Not available for all drugs

Multiple strenghts of liquid for the same drug (potential for confusion and under / over dose

81
Q

Why are children more likely to be given overdoses than adults

A

Due to dosing being done universally for adults and scaling down for children

82
Q

What is off label prescribing

A

Licensed drugs that have only been tested in adults so there is a greater degree of responsibility placed on the prescriber.
Means safety and efficacy cannot be assured

83
Q

What is a prescribing error

A

The result of a prescribing decision or prescription writing process that results in an unintentional but significant reduction in the probability of the treatmetn given being timely anf effectively or an increased risk of harm compared with generally accepted practice

2-3 times more common in children

84
Q

Why are children at greater risk of medication errors

A

Drug doses calculated individually, based on a patients age, weight or body surface area - often complex

Changing weight and pharmacokinetics throughout childhood

Lack of suitable dosage forms - need for dilution, measurement of small volumes

85
Q

How are child medication errors avoided

A

Review doses frequently

Information in BNFC often complex - find right section for the patient

86
Q

What are examples of common sources of error when prescribing for children

A

Miscalculations (10 fold and 100 fold overdoses)
Confusion between mg/ kg / dose versus mg/ kg / day

Confusion between doses in mg and ml
Confusion between units

87
Q

Things to remember in order to prescribe safely to children

A

Use the BNFC checking that you have the right dose for the patients age, weight and condition
Watch out for maximum doses: should not exceed the adult dose

Check weight is appropriate for age
Check if patient has allergies

88
Q

What are the different stages of childhood

A

Neonates- newborn (anything from preterm to 1 month)
Infants - up to 1 year
Child - 1-12 years
Adolescent - 13-16

89
Q

Describe the upper respiratory system of a neonate / infant

A

Large head, short neck, prominent occiput (lots of mouth breathing, promotes rapid feeding)
Tongue is large
Larynx higher and anterior and more pliable (soft)
Epiglottis is long and stiff
Trachea relatively short
Mainstream bronchi have less of an angle than in adults
Smaller airway

90
Q

Describe the lower respiratory system of the neonate / infant

A

Horizontal ribs (prevent bucket handle breathing action)
Not completely calcified
Diaphragmatic breathing
From birth - adolescence the rib cage increases in size, a decrease in thoracic kyphosis, ribs rotate inferiorly
They have 10% of the total number of alveoli found in adults so exhaust more quickly and have fewer type 1 fibres in respiratory muscles

91
Q

What kind of airway obstruction occurs in the external to lumen

A

Masses

92
Q

What kind of airway obstruction occurs in the intraluminal

A

Oedema
Anaphylaxis
Croup
Epiglottis tracheitis

93
Q

What kind of airway obstruction occurs in the internal to lumen

A

Secretions

94
Q

What is increased resistance in the airway caused by

A

Spasm (asthma)

Infection

95
Q

Describe respiratory rate in infants

A

Increased metabolic rate compared to adults so higher oxygen requirement
Rate varies with age and is irregular
Younger you are the few fatigue resistant fibres

96
Q

Why does a difficulty to increase depth and strength of respirations lead to a greater dependence on respiratory rate

A

Horizontal ribs provide little leverage for increasing the AP diameter of the chest

Heart occupies a grater space in the thorax comparatively, less ability to increase lung volume

Diaphragm main muscle but restricted by small abdominal cavity

Less developed accessory muscle, more difficult to increase the strength and depth of ventilation

97
Q

What are the signs of respiratory distress in an infant

A 
Flared nostrils 
Frightened look 
Pale skin 
Blue nail beds 
Rapid breathing
98
Q

What are some of the major CVS changes that occur after birth

A

Circulation (foramen ovale and ductus arteriosus begin to close)
Heart is large in the thoracic cavity, right V is stronger than the left (reverses in infancy) as heart pumps against a collapsed lung in utero

Size and weight of heart doubles in the first year of life

99
Q

Average blood volume at different stages of childhood

A

Neonates 85-90 ml/kg
Infants 75-80 ml/kg
Children 70-75 ml / kg
Adults 65-70ml/kg

100
Q

Why are musculoskeletal symptoms in children and adolescents common

A

Because the ossification sites are usually still cartilaginous in infants and young children and it is not until around 16 that nearly all the cartilage has been ossified

101
Q

What are some musculoskeletal differences in children and how are they significant

A

More bony mass per unit area - quicker healing time

Greater vascularity - significantly reduced rates of non union

Thicker periosteum - higher degree of energy needed to fracture the bone

102
Q

Why are physeal injuries (a growth plate weak portion of bone)

A

Unique to children

Can be difficult to detect on xray as physis radiolucent and epiphysis may be incompletely ossified

103
Q

What is a toddler fracture

A

Unidisplaced spiral fracture of the tibial shaft only

Usually <3 years

Low energy trauma with a rotational force (falling awkwardly)

104
Q

Describe the oral cavity in an infant

A

Infants oral cavity is relatively small

This combined with a large tongue promotes rapid feeding

105
Q

Describe the salivary gland of an infant

A

Insufficient saliva in the first few months

Salivation increases with teething

106
Q

Describe the stomach of an infant

A

Limited capacity - increases quickly in the first month after birth due to frequent feeding
Immature lower oesophageal sphincter
In horizontally lying of baby the gastric fundus is lower as the antral part of the stomach- causes gastroeosophageal reflux

107
Q

What is the impact of an infant having an underdeveloped liver

A

Decreased glycogen stores

108
Q

Describe the small intestines of an infant

A

The small bowel increases in length with age from 150-200cm in the neonate to almost 6m in the adult

109
Q

Describe the large intestine of the GI tract

A

Peyer’s patches appear at 2-3 years so local protection is weak
Haustra appear after 6 months
Muscle tissue is poorly developed so the propulsion capacity is insufficient
- major cause of constipation

110
Q

Describe the urinary system at birth

A

Is immature
Kidneys are immature until 6 months
Renal blood flow and GFR are low in first 2 years of life due to high renal vascular resistance
Tubular function is immature until 8 months so infants are unable to excrete a large sodium load

111
Q

Describe the skull of an infant

A

Sutures do not fuse until the head has reached adult size
Presence of fontanelle:
Anterior: palpated up to the age of 12-18 months
Posterior: may be palpated up to the age of 2 months
Thinner cranial bones
Growth of paranasal air sinuses

112
Q

Describe the structure of the brain in the infant

A

Neonate - already has about all of the neurons it will ever have
Doubles in size in the 1st year
2/3 years - has up to twice as many synapses as it will have in adulthood
3/4 years - it has reached 8-% of its adult volume

113
Q

Where does the spinal cord terminate

A

Neonates / infants - L2/L3

Adolescent - L1/2

114
Q

Why are infants at an increased risk of brain injury

A

Thinner bones
Head larger, higher centre of gracity - theoretical risk of increased head trauma
Increased risk of hypoglycaemia
Less mature blood brain barrier - increased risk of infection

115
Q

What are protective measures for brain injury

A

Open sutures: volume can expand decreasing the risk of RICP (restricted intra cranial pressure)

116
Q

Developmental factors to monitor in children

A

Visual, hearing, toilet trained
School performance
Behavioural issues
Puberty

117
Q

What is the HEEADSSS acronym

A 
Home and relationships 
Education and employment 
Eating 
Activities and hobbies 
Drugs, alcohol, smoking 
Sex and relationships 
Self harm, depression and self image 
Safety and abuse

Med 4 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions