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Year 4 Paediatrics > Lecture Day One > Flashcards

Lecture Day One Flashcards

1
Q

What is growth?

A

An increase in height and weight and a failure to grow normally is abnormal

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2
Q

What are the four phases of growth?

A
  1. Intra-uterine/Pre-natal
  2. Infantile
  3. Childhood
  4. Adolescents (Puberty)
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3
Q

What impacts on fetal growth the most?

A

The uterine environment

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4
Q

What impacts on infantile growth?

A
  1. Nutrition
  2. Good health and happiness
  3. Thyroid hormones
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5
Q

What impacts on childhood growth?

A
  1. Growth hormone
  2. Thyroid hormones
  3. Good health and happiness
  4. Genes
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6
Q

What impacts on growth during puberty?

A
  1. Testosterone/oestrogen

2. Growth hormone

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7
Q

What is the average birth weight?

A

7lb-7.5lbs or 3-3.3kg

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8
Q

What is the average head circumference at birth?

A

35cm

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9
Q

When do teeth first appear?

A

6 months

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10
Q

How do you calculate expected weight in kg in a child aged 1 - 10 years?

A

2 x (age + 4)

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11
Q

What is the normal requirement of feed per day for babies?

A

150mls/kg/day

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12
Q

So if a baby weights 5kg, what is the normal requirement of feed for them?

A

150 x 5 = 750mls per day

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13
Q

How many mls are there in an oz?

A

30mls per oz

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14
Q

So how many oz per day if 750mls per day?

A

25oz per day

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15
Q

Up to what age is it recommended that children have full fat milk?

A

5 years of age

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16
Q

How are maintenance fluids calculated in children?

A

1st 10kg = 100mls/kg/day
2nd 10kg = 50mls/kg/day
3rd and subsequent kg = 20mls/kg/day

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17
Q

Freddie is 28kg and is vomiting, requiring maintenance IV fluids, calculate his hourly IV fluid requirement?

A

10kg - 100mls/kg/day = 1000 / day
10kg - 50mls/kg/day = 500 / day
8kg - 20mls/kg/day = 160 / day

1000 + 500 + 160 = 1660/24 to get hourly = = 70mls per hour

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18
Q

How is BMI calculated?

A

Weight/Height(squared)

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19
Q

What are the 4 areas of development?

A
  1. Gross motor
  2. Fine motor
  3. Speech and language (hearing)
  4. Social
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20
Q

At what age is the median for learning to crawl?

A

8-9 months

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21
Q

At what age is the median for walking unsteadily?

A

12 months

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22
Q

At what age is the median for walking steadily?

A

15 months

23
Q

What may be a reason an 18 month old isn’t walking, and it is not a cause for concern?

A

They may be a bottom shuffler - find they get around a lot faster doing this, so less inclined to walk

24
Q

How would you test an 18 month old who isn’t walking to see if there are more worrying signs?

A

Lie them supine and see if they roll over to prone and get themselves off the floor

25
Q

What is important when looking for developmental warning signs? - what can you do to test/find out more?

A
  1. Family history
  2. Maternal concern
  3. Persisting primitive reflexes
  4. Discordant development (one area slower in development than others)
  5. Regression (very concerning)
26
Q

What is the moro reflex?

A

Holding baby carefully, move baby downwards (as if pretending to fall) and see if they splay both arms outwards - looking forward asymmetry in this action

27
Q

What other primitive reflexes can be tested in a baby?

A

Palmar reflex - finger in their palm, they will hold your finger
Finger in mouth - suck finger

28
Q

At what age do primitive reflexes disappear?

A

3 months

29
Q

Which primitive reflex develops from 9 months and stays for life?

A

Parachute reflex - put hands forward to stop falling on face

30
Q

What screening procedures are done in a baby - eyes?

A

Looking for red reflex: loss of this can mean…
Retinoblastoma
Cataracts

31
Q

What is the 1 week Guthrie screening procedure for? (5)

A
  1. PKU
  2. Hypothyroidism
  3. CF
  4. Haemoglobinopathies
  5. Acylcarnitine
32
Q

What is enuresis?

A

Inappropriate voiding of urine after the age at which bladder control should have been achieved

33
Q

What is encopresis?

A

Passage of fences into the clothes by day or night (after the age of 4 years is abnormal)

34
Q

What are the causes of encopresis after the age of 4?

A

Chronic constipation/faecal impaction

35
Q

What is concerning about a 2 year old with a history of asthma has a RR of 12 and a heart rate of 80?

A

They should have a RR and HR higher than those given - sign they may be suffering from hypoxia, and exhaustion

36
Q

What % of babies will have passed meconium within 48 hours?

A

95%

37
Q

What are the possible causes of delayed passage of meconium?

A
  1. Hirschsprungs
  2. Anal atresia/stenosis
  3. Meconium ileus
  4. Volvulus
38
Q

What % of babies will micturate within 24 hours?

A

95%

39
Q

What % of birthweight loss is worrying?

A

10% or more

40
Q

What % of babies should sleep through the night by 6 months?

A

90%

41
Q

How many hours sleep do babies at birth require?

A

16 hours per day

42
Q

How many hours sleep do babies at 6 months old require?

A

14 hours per day

43
Q

At what age range does ‘sudden unexplained death’ occur in children?

A

1-12 months

44
Q

What is the difference in cardiac arrest in children compared to adults?

A

Childrens cardiac arrest is not often of cardiac origin - more commonly respiratory, whereas with adults it is normally cardiac

45
Q

What are the respiratory failures that can lead to cardiac arrest? (6)

A 
Obstructive causes:
1. Foreign body
2. Asthma
3. Croup 
Respiratory depression causes:
1. Convulsions
2. Poisoning
3. Raised ICP
46
Q

What are the circulatory failures that can lead to cardiac arrest? (6)

A 
Fluid maldistribution:
1. Septic shock
2. Anaphylaxis
3. Cardiac failure 
Fluid loss:
1. Vomiting
2. Burns
3. Blood loss
47
Q

How do you open a children’s airway?

A

0-8 years - ensure head is just looking straight up (if lying supine for example)
8+ years - hyperextend head, but not as much as in adults ‘sniffing the morning air’

48
Q

What signs in children are there of respiratory distress? (6)

A
  1. Subcostal/intercostal recession
  2. Tracheal tug
  3. Grunting
  4. Nasal flare
  5. Head bobbing
  6. Exhaustion - increased effort may be absent!
49
Q

How do you test for breathing efficacy? (4)

A
  1. Chest expansion
  2. Auscultation - air entry ok?
  3. Pulse oximetry (>94%)
  4. Blood gas - high CO2?
50
Q

What is the response to breathing if there is a problem? (6)

A
  1. If not breathing - ventilate with a bag-valve mask device
  2. Give 02 15l/min via a non-rebreathe mask with reservoir bag
  3. Aim 02 saturations 94-98%
  4. ABG
  5. CXR
  6. Site an NG tube (especially if used a BVM)
51
Q

What is the response in circulation for emergency response in children? (4)

A
  1. IV/IO acccess
  2. Blood gas, glucose stick, laboratory tests (FBC, U&Es, LFTs, CRP, blood culture, cross-match)
  3. 3-lead cardiac monitoring or 12-lead ECG
  4. Fluid bolus 20mls/kg
52
Q

Why is hypotension in a child worrying?

A

It is a pre-terminal sign! Childrens blood pressures do not drop until the very last minute

53
Q

In the disability category for RRAPID for children, what is important to recognise? (5)

A
  1. AVPU - patient alertness
  2. Pupils - size and reaction to light
  3. Posture
  4. Blood glucose
  5. Evidence of seizure?
54
Q

What is important to assess in exposure in RRAPID? (4)

A
  1. Rashes
  2. Temperature
  3. Injuries (fractures/bruising/burns)
  4. Smells (ketones/poisons)

Year 4 Paediatrics (18 decks)

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