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[OSCE] General Paeds Flashcards

1
Q

What are the features of ADHD?

A

IHI

Inattention - short attention span with difficulty concentrating in class

Hyperactivity - unable to sit still for long periods, fidgeting

Impulsiveness - unable to wait in turn and little sense of danger

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2
Q

What is the criteria for ADHD?

A

Symptoms persisting >6months, Occuring in more than one environment (home, school, shopping), and affects childs normal functioning

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3
Q

What are the risks that affected children with ADHD have?

A

Prone to unprovoked temper tantrums
Reckless behaviour
Learning difficulties

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4
Q

What are the classical features of cerebral palsy?

A 
Abnormal posture (slouched while sitting)
Unsteady gait (scissoring, toe walking)
Facial gestures (involuntary movements)
Movements appearing clumsy
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5
Q

What are the features of cystic fibrosis?

A

CF PANCREAS

Cough (chronic)
Failure to thrive

Pancreatic insufficiency
Appetite decreased
Nasal polyps
Clubbing
Recurrent chest infections
Electrolyte elevation in sweat, salty skin
Atresia of vas deferens (infertility)
Sputum (staph, pseudo)
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6
Q

What are the common causative pathogens of Bronchiolitis?

A

RSV

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7
Q

What are the symptoms of croup?

A

Mnemonic of croup symptoms - Three S’s

Stridor
Subglottic swelling
Seal-bark cough

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8
Q

What are the common causative pathogens of croup?

A

Parainfluenza

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9
Q

What are the features of acute severe asthma?

A 
Child too breathless to speak or feed
.
RR >40 (1-5yrs) or >30 (>5yrs)
HR >140 (1-5yrs) or >125 (>5yrs)
PEFR 33-50% of best predicted value
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10
Q

What are the features of life-threatening asthma?

A 
Agitation (hypoxia)
Reduced consciousness (hypercapnia)
Fatigue or exhaustion
Silent chest, cyanosis, poor respiratory effort
PEFR <33% of best predicted value
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11
Q

What are the features of epiglottitis (a life-threatening condition) that differentiate it from croup?

A 
Rapid onset (hours) vs Slow (days)
Absent/weak cough vs Seal-Bark
Drooling vs Able to swallow
Unable to eat (pain) vs Able to eat
Weak whispering voice vs Hoarse voice
Soft continuous stridor vs Harsh INSpiratory stridor
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12
Q

In what situation may you not perform an ENT examination and why?

A

In suspected Upper Airway Obstruction due to increased distress and breathlessness. In epiglottitis this can lead to Acute Sudden Airway Obstruction

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13
Q

What is the most common causative organisms of epiglottitis?

A

H.Influenza (therefore epiglottitis tends to be very uncommon due to vaccinations early on)

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14
Q

What position may a child with epiglottitis assume as a way of relieving some of the symptoms?

A

Leaning forward

Neck extended

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15
Q

Which causes of upper airway obstruction onset very suddenly and require emergency management/intubation?

A

Epiglottitis
Bacterial Trachitis
Foreign Body Aspiration

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16
Q

Which causes of upper airway obstruction results in drooling on attempts to swallow?

A

Epiglottitis

Bacterial Trachitis

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17
Q

Name an anatomical cause of upper airway obstruction that presents from birth?

A

Laryngomalacia

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18
Q

What is the triad of features found in anaphylaxis?

A

Hypotension (pallor)

Bronchoconstriction (wheezy)

Airway compromise (lip swollen)

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19
Q

What type of gait may you see in cerebellar diseases?

A

Wide base / ataxic gate

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20
Q

What type of gait may you see in cerebral palsy?

A

Hemiplegic CP - Hemiplegic gait

Spastic CP - spastic diplegic gait

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21
Q

What are the precipitating factors for an acute asthma attack?

A

The DIPLOMAT’s son had asthma

Drugs (NSAIDs, Beta Blockers, Aspirin)
Infection (URTI, LRTI)
Pollutants (smoking, gas)
Laughter (emotion)
Oesophageal reflux (nocturnal asthma)
Mites
Activity and exercise
Temperature (cold)
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22
Q

What is the prognosis for children with asthma?

A

1/3 grow out of it

1/3 improve during teens but returns at adults

1/3 continue to have it whole life

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23
Q

What is the definition of cerebral palsy?

How may you say this to a patient?

A

Disorder of TONE, POSTURE and MOVEMENT caused by a NON-PROGRESSIVE lesion in the brain

Cerebral palsy is the name for a group of lifelong conditions that affect movement and co-ordination, caused by a problem with the brain that occurs before, during or soon after birth.

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24
Q

How, and at what age, may pyloric stenosis typically present?

What are the complications?

A

2-7 weeks

Projectile vomiting, no bile
Extremely large volumes
Hungry after vomiting
No diarrhoea

Complications

  • Constipation (starvation stools)
  • Dehydration
  • Failure to thrive
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25
Q

How would you investigate and manage pyloric stenosis?

A

ABCDE
Ensure Obs stable. Take U&Es, LFTs, FBC
Do a PEWS score.

Test-feed, observe LUQ peristalsis during feed
Examine olive-shaped mass in epigastrum
USS to confirm

Manage:
Rehydrate with IV fluids
Pyloromyotomy

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26
Q

What are the typical features of GORD?

A

Recurrent regurgitation related to feeds
Relieved by sitting up
Distressed after feeds - feeding / behavioural difficulties
Apnoea

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27
Q

Name two risk factors for GORD?

A

Premature delivery

Cerebral Palsy

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28
Q

Investigation and management for GORD?

A

Investigation

  • ABCDE, ensure alert
  • History and examination should point towards GORD and be sufficient

Management

  • Rehydrate
  • Reassurance
  • Avoid overfeeding (common cause)
  • Drugs: Infant gaviscon (Na/Mg alginate)
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29
Q

What age does intussucception typically present?

What are the typical signs and symptoms in both early and late intussucception?

A

Typically 5-10 months (m:f = 3:1)

Episodic cockily abdominal pain (every 10-20min)
Drawing knees to chest
Insolable cry

Early
- Vomiting which rapidly becomes bile-stained

Late

  • Mucus and Blood PR
  • Red currant jelly
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30
Q

How would you investigate and manage a patient with intussucception?

A

Investigation

  • abdominal exam may reveal sausage shaped mass
  • USS
  • Ensure to take bloods, FBC, U&E, LFTs, Crossmatch

Management

  • Air enema if diagnosed early
  • Surgery otherwise
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31
Q

What age may coeliac present?

What are the typical signs and symptoms?

A

~4-6 months, around when they begin weaning

Pallor
Steatorrhoea
Vomiting
Abdominal distension
Failure to thrive
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32
Q

How may you investigate coeliac disease?

What is the management?

A

IgA tTg, anti-gliadin, endomysial antibodies
Villous atrophy on small bowel biopsy

Lifelong gluten-free diet

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33
Q

What are the typical signs and symptoms of meningitis?

A 
Vomiting - not taking foods
Fever, irritable, lethargic
Non-blanching purpuric rash
Cold extremities (sepsis)
Signs of raised ICP (bulging fontanelle)
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34
Q

What is the management of bacterial and viral meningitis?

A

Bacterial - Abx (benzylpenecillin IM first, then Cefotaxime IV)

Viral - Antipyretics and analgaesia in viral

Dont forget, always IV fluids in every situation where fluid has been lost!

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35
Q

What investigations would you do in suspected meningitis?

A 
Neuro exam
Look for rash
CT head if suspected raised ICP
LP
Blood cultures
Blood glucose (DEFG!)
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36
Q

What are the typical features in the history of a child with gastroenteritis?

A

Diarrhoea and vomiting
Fever, irritable and unwell
(similar to meningitis at this point)

History of recent TRAVEL
There will be someone else in the family or school with similar symptoms!

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37
Q

What is the recommended imaging modality to investigate UTI?

A

USS

Can view with good specificity, detect scars

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38
Q

What investigations would you do in a child presenting with vomiting, giving reasons for each.

A

Bedside

  • Physical exam
  • Neuro exam (meningitis; rash, neck stiffness etc)
  • LP (meningitis)
  • USS (pyloric stenosis, bowel obst, intussuception)
  • Stool sample

Bloods

  • U&E (dehydration)
  • Antiendomysial/Antigliadin autoantibodies (coeliac)
  • Cultures (meningitis)
  • Glucose (DKA)

Ix

  • CT / MRI of abdomen
  • CT head (raised ICP / SoL)
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39
Q

What symptoms would point towards CF in paediatrics?

A

Recurrent Chest Infections! (productive cough)
Diarrhoea

Failure to thrive
Nasal Polyps
Delayed puberty

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40
Q

What are the organic and non-organic aetiologies for a child with a failure to thrive?

A

Organic PIMM

  • Prenatal
  • Intake issues
  • Malabsorption
  • Metabolic

Non-Organic CI

  • Constitutional delay
  • Inadequate feeds

hint: Organically the problem has to be either the mothers (prenatal), or a problem with them i.e. eating (intake), absorbing (malabsorption) or using whats absorbed (metabolic). Non-organically it has to either be fate (constitutional delay) or bad luck (no being fed).

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41
Q

what are the prenatal causes of failure to thrive?

A 
Premature
Maternal nutrition
Congenital infection
IUGR
Toxins (alcohol, smoking)
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42
Q

what are the causes of intake issues that results in a failure to thrive?

A

Can’t suck or swallow (NMD such as cerebral palsy)
Cleft palate
GORD / vomiting after feeds

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43
Q

what are the causes of malabsorption resulting in a failure to thrive?

A

CF (with URTI, productive cough)
Coeliac (diarrhoea)
IBD
Cow’s Milk Protein Intolerance

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44
Q

what are the metabolic causes of a failure to thrive?

A

either poor metabolism or increased demand

Poor metabolism

  • Hypothyroid
  • Diabetes

Increased demand

  • Asthma
  • Heart failure / renal failure
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45
Q

what are some causes of inadequate feeding that results in a failure to thrive?

A 
Neglect / Lack of knowledge
Underfed or infrequently fed
Distracted during meals
Poor technique
Bottles not made up properly
Problems in home environment
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46
Q

What investigations would you perform in a child presenting with a failure to thrive?

A

Bedside

  • Plot height and weight on growth chart
  • Full system examinations (murmurs, wheeze, bowels)
  • MSU for diabetes, infection, renal problems (culture)
  • Stool culture for ova / parasites / cysts
  • Faecal fat for malabsorption
  • Sweat test

Bloods

  • FBC, U&E, TFT, LFT, Glucose, CRP
  • Antiendomysial & Antigliadin autoantibodies
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47
Q

What are the steps involved in sepsis 6?

A

3 in, 3 out

in

  1. IV fluids
  2. BS Abx
  3. Oxygen

out

  1. Cultures
  2. ABGs (lactate)
  3. Urine output (catheter)
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48
Q

What type of seizures are febrile convulsions?

What age range do they tend to affect? How long do they usually last?

A

Tonic +/- clonic, symmetrical, generalised seizure

Affects those between 6 months - 6 years, lasting <6 minutes

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49
Q

What sign/symptom/detail should alert you to an alternative diagnosis of febrile convulsions?

A

Signs of CNS infection / meningism / neck stiffness
Focal neurological deficit
Previous history of epilepsy
>15 minutes or >1 attack in 24h

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50
Q

How may you Rx a child having a febrile convulsion?

How would you advise the parent about a child having febrile convulsions?

A

Recovery position

If >5m IV lorazepam / buccal midazolam / PR diazepam
Tepid sponging if hot
Paracetamol syrup

Parents

  • Allay fear (child is not dying during a fit)
  • Does not usually mean ^risk of epilepsy
  • If recurrances, teach buccal / PR benzodiazepines
  • -Consider prophylactic PR diazepam during fevers
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51
Q

What investigations would you consider in any patient convulsing regardless of aetiology?

A

Bedside

  • Neuro examination (kernig’s & brudzinski’s)
  • Look for rashes
  • Inspect frontonelle
  • LP & blood cultures if suspected meningitis
  • ECG (arrhythmias)

Bloods

  • FBC
  • U&E
  • LFT
  • Glucose (hypoglycaemia)

(EEG, best done during seizure)

52
Q

What are the features of a reflex anoxic seizure?

How long does it last?

What type of seizure is seen?

Describe in a before/during/after fashion

A

Before

  • Paroxysmal
  • Triggered by pain / fear / anxiety

During

  • <1 minute
  • Pale, limp, LoC brief
  • Involuntary tonic +/- clonic movement of limbs

After

  • Incontinence
  • Groggy
53
Q

What is a differentiating feature between reflex anoxic seizure and epilepsy?

A

Tongue-biting is NOT a feature of Reflex Anoxic Attacks

also…
Much shorter, triggered by vagal stimulation

54
Q

How may you educate a parent about reflex anoxic attacks, its danger and its prognosis?

A

Try avoid the word seizure

Emphasize benign nature and that child usually grows out of it (but may occur in later life, and in older siblings)

55
Q

What is a breath-hold attack?

A

Similar to reflex anoxic attack

Precipitated by emotion (anger, frustration, trauma)

Crying episode, breath withheld, pallor and cyanosis may develop

LoC may occur, recovery is usually very quick!

56
Q

What are some risk factors and precipitants for epilepsy?

A

RF: Birth asphyxia, cerebral palsy, trauma

Precipitants: TV, lack of sleep

57
Q

What is the difference between simple and complex seizures?

A

Simple - No LoC

Complex - impaired Level of Conciousness

58
Q

How may partial and generalised epileptic seizures differ in presentation?

A

Partial; depend on the area of cerebrum affected

  • Deja Vu
  • Paraesthesia down one limb
  • -lasts up to a few minutes

Generalised; whole cerebrum

  • Absence (last up to 2-3 seconds)
  • tonic-clonic (last up to 2-3 min)
59
Q

What medication is reserved for partial and generalised epileptic seizures?

A

Partial - Sodium Valproate

Generalised - Carbamazepine

hint: Sodium-Valproate is 2 part name for a drug.

60
Q

At what age should hand preference be acquired and what may a preference before this indicate?

A

Should NOT be acquired until 1-2 years old

Before this implies pathology present e.g. cerebral palsy or other

61
Q

How many words minimum should a child of 2 years old be able to speak?

A

6 words minimum

Normally 20-50

62
Q

What additional features would be present for cerebral palsy to be the aetiology of motor development delay?

A

Learning difficulty

Epilepsy

63
Q

What are the causes of cerebral palsy?

Antenatal / perinatal / post-natal

A

Causes are usually in the antenatal period

antenatal

  • APH with hypoxia
  • TORCH
  • Alcohol
  • X-Rays

perinatal

  • Birth hypoxia
  • Fetal distress
  • Hypoglycaemia
  • Hyperbilirubinaemia

post-natal

  • head trauma / IVH
  • Meningoencephalitis
  • Hypoxia
64
Q

What inheritance patter does DMD follow?

A

X-Linked recessive

Affects boys only

65
Q

What features are seen in DMD?

A

Delayed achievement of motor milestones
Waddling gait
Global delay possible

Gower’s sign - child climbs up legs with hands to stand up

66
Q

What are some metabolic causes of delayed motor development?

What features would point you towards either diagnosis?

A

Ricket’s

  • Low Vitamin D
  • Inadequate sunlight exposure
  • Calcium deficiency
  • Bony deformities (bow legs)
  • Family history

Hypoglycaemia

  • Tiredness
  • Lethargy
67
Q

What is a common cause of hearing difficulty in childhood?

What are the other symptoms of this?

A

Otitis media

Otalgia
Irritability
Decreased hearing
Vomiting or fever
Ongoing viral respiratory infection
68
Q

What are some causes of speech and language development?

A

New Hearing Aids Cured Larry’s Deafness

Normal variation
Hearing difficulties (otitis media)
Autistic
Cleft palate
Learning difficulties
Deprivation and neglect
69
Q

What are some features of autism?

A

Impaired reciprocal social interaction and communication

Repetitive behaviour

Playing in isolation

Delayed / lack of speech development with no other forms of communication such as miming or gesturing used in its place

70
Q

What other features would make you suspect CF in a child presenting with a cough?

A

Recurrent chest infections?
Productive cough
Wheeze

Failure to thrive
Mecomium ileus (neonate)
Diarrhoea and steatorrhoea due to malabsorption

71
Q

What inheritance pattern does CF transfer by?

A

Autosomal Recessive

72
Q

What extra features / precipitating in a cough history would suggest to you asthma as the diagnosis?

A

Diurnal variation
Wheeze
Family history / personal history of atopy

Precipitated by cold weather, exercise, pets, cigarette smoke

Responds well to bronchodilators

73
Q

What signs would indicate a severe bronchiolitis infection?

A

Fewer wet nappies
Poor feeding
Grunting sounds

74
Q

What is the step ladder approach to asthma in children?

A

Avoid triggers or allergens

Inhalers: SABA > ICS > LABA > Leukotrine antagonist

75
Q

What are the typical features of pertussis?

A

Initially sore throat, dry cough, coryzal symptoms

Intense bouts of coughing 1-2 minutes

Cough - Whoop - Cough - Whoop

Red or blue in the face

Vomiting after bouts

76
Q

What investigation should be performed in a patient suspected of pertussis?

A

Perinasal swab

77
Q

Investigation for bronchiolitis

A

Nasopharyngeal mucus secretion analysis

78
Q

Investigation for asthma

A

PEFR if child capable (usually >7)

Reversible airway obstruction

79
Q

What are the typical signs and symptoms of epiglottitis?

A 
Drooling
Dysphagia
Dysphonia
Dyspnoea (rapidly increasing!)
Soft stridor
Severe sore throat
Feverish and very unwell
80
Q

What investigation is performed for patients suspected of epiglottitis?

How is a patient with epiglottitis managed?

A

Fibre-optic laryngoscopy in theatre

Involve senior paediatrician and anaesthetist
Start broad spectrum Abx e.g. cefotaxime
Likely will need intubation

81
Q

What are the symptoms of ADHD?

A

IHI

Inattention - short attention span with difficulty concentrating in class

Hyperactivity - unable to sit still for long periods, fidgeting

Impulsiveness - unable to wait in turn and little sense of danger

82
Q

What is the criteria for symptoms in ADHD?

What age range does it usually affect?

A

Symptoms must be present for >6 months across atleast 2 different environments (home and school)

Usually affects children aged between 3-7

83
Q

What are some risk factors for autistic spectrum disorder?

A

Gestational age <35 weeks
Family history
Chromosomal disorders
Cerebral palsy

84
Q

What investigations should be performed in any child with behavioural problems?

A

Physical exam to rule out medical causes

Hearing assessment to rule out hearing problems

Speech and language assessemt if developmentally delayed

MDT observing child in different settings

85
Q

What is the management of ADHD?

A

Behavioural modification
Family therapy
Parent education

Methylphenidate can be used in moderate-severe cases

86
Q

What is the management of autism?

A

Behavioural modification
SALT
OT
TEACHH (treatment and education of autistic and communication-related handicapped children)

87
Q

What is the classical tetrad of HSP?

Hint: PAAG

A

PAAG

Purple pupura (non-blanching intradermalbleeding)
Abdo pain (cockily intussusception)
Arthritis/arthralgia (joint pain)
Glomerulonephritis (haematuria)

*commonly preceeded by an URTI, also bruising present

May also see blood in stool, haematuria, scrotal swelling
No history of fever

88
Q

Where on the body may bruisings be evident in HSP?

Where on the body may rashes / pupura be predomintantly seen?

A

Bruising on extensor surfaces of lower limbs and buttock

Palpable Purpuric rash predominantly or exclusively on areas below the wasit

89
Q

What features would point towards a diagnosis of luekemia?

A

Pancytopaenic symptoms (pallor, infection, bleeding, bruising)

Mucosal Bleeding
Lymphadenopathy
Hepatosplenomegaly

Fatigue
Anorexia
Bone pain

90
Q

What other bleeding / bruising disorder may present similar to HSP, also with a preceeding URTI?

A

ITP

91
Q

What are the symptoms / signs of ITP?

A

Acute bruising
Pupura and pitechiea

Recent URTI or GI enteritis

[Arthralgia and abdo pain are uncommon in ITP, platelets are low in ITP but normal in HSP]

92
Q

What investigations should you perform in suspected HSP?

A 
Dipstix for blood and protein
BP (renal impairment)
U&amp;E kidney function
Group A strep infection
Platelet count (if low then >>> ITP)
Stool sample (FOB vs Infection)
93
Q

What is the treatment for HSP?

A

Self limitting, no treatment usually required appart from analgaesia for joint pain.

Most recover in <2 months
Steroids may help resolve abdo/joint pain + reduce kidney damage

If complications (gut/renal involvement), supportive therapy may be necessary)

94
Q

How may you conselle a mother on treating nappy rash?

A

Using water and cotton wool instead of baby wipes (which may contain alcohol or other irritating products)

Using barrier creams such as zinc oxide

Exposure to the air (leave nappy off)

Candida responds to antifungal creams. Groin and mouth may both need treatment.

95
Q

What are the triadic features of autism?

A

Social - Plays alone, fails to make eye contact, doesnt come for comfort when hurt or upset

Communication - never babbled or spoken intelligble words

Ritualisitic - Has marked routines which produce violent temper tantrums if disrupted

96
Q

What features would suggest CHD?

A 
Murmur at birth
Sweating
Poor feeding
Cyanosis
2 days old (PDA closes within hours/days of age suggesting duct-dependent lesion)
97
Q

What investigations would you perform in suspected CHD?

A

ECG

Echo

CXR - cardiomegaly, oligaemic/plethoric lung fields, signs of LTRI

Blood gas - oxygen, lactate, acidosis

98
Q

What may you administer IV to maintain PDA patency?

A

IV Prostoglandin E2

99
Q

What are the contraindications for giving an LP?

A

Signs of cerebral herniation
Focal neurological signs
Cardiorepiratory compromise

100
Q

How may you counselle and safety net a mother worried about her child who has a typical tummy bug / gastroentiritis?

A

Self limiting
Will resolve in around 2 weeks
Keep hydrated with fluids and dyarolyte sachet

Watch for signs of dehydration such as

  • Sunken eyes and glazed look
  • Mottled skin
  • Strong-smelling urine
  • Dry mouth
101
Q

What does the MMR vaccine protect against and what is a serious complication of these infections?

A

Measles, Mumps and Rubella

Meningitis, encephalitis, deafness

102
Q

What age of the child is the MMR vaccine given?

A

1st dose - After 1st birthday (1 year old)

2nd dose - Before starting school (3 years old)

Optional dose - high risk / measles outbreak (6-9 month)

103
Q

How long should a lady avoid getting pregnant for after having an MMR vaccine?

What is a serious complication of a Rubella infection on pregnancy?

Can a woman have the MMR if she is already pregnant?

A

Wait 1 month before getting pregnant

Rubella carries risk of serious birth defects and miscarriage

If already pregnant, can NOT have the MMR. Must avoid exposure to infections. Contact Dr if exposed.

104
Q

What are the side effects of the MMR?

Can I have a single M / M / R vaccine rather than the combined MMR?

A

3in1 therefore will have different side effects onsetting at different times.

Weakened version of the live vaccine means very mild symptoms experienced.

A week after injection, very mild form of measles (rash, temperature, LoA, malaise) lasting 2-3 days.

3-4 weeks after injection, rarely may develop very mild form of mumps (swelling of glands, cheek, neck, under jaw) lasting 1-2 days.

105
Q

How may a muscular dystrophy present and what investigation would you order to investigate further?

A

Delay in walking until 18 months of age

  • toe walking
  • calf hypertrophy
  • hip muscle weakness

Investigate: ↑↑↑CK, genetic testing, muscle biopsy (no dystrophin)

106
Q

What is the management for DMD?

A

Mobility assistance - exercise, physio, physical aids

Support groups - practical and emotional impacts

Surgery - correcting deformities such as scoliosis

Medication - steroids to improve muscle strength, ACEi and B-Blockers for heart problems

107
Q

What vaccinations are given in the first 6 months of life?

A

2 months - 6in1 + Rota + Pneumococcal + MenB
3 months - 6in1 + Rota
4 months - 6in1 + Pneumococcal + MenB

6in1: Diptheria, Tetanus, Polio, H.Influenzae, Hep B, Pertussis

108
Q

What type of condition is HSP?

A

Immune mediated vasculitis associated with IgA deposition

Complexes deposited in skin, gut, glomeruli triggering localised inflammatory response and necrosis of small blood vessles

109
Q

What is the most common infectious trigger for HSP?

A

URTI with a group of bacteria called Group A Strep

110
Q

What are some complications of HSP?

A

Most people have no complications, however in some who do develop them, you may find

  1. Kidney involvement - nephritis (inflammation)
  2. Bleeding in gut - Intussusception
  3. Orchitis - inflammation of testicles causing pain, swelling and redness of scrotum
111
Q

What are the risk factors for SIDS?

A 
Prone position at last sleep
Bed sharing
Formula fed
Premature
Low birth weight
Exposure to cigarette smoke
Maternal cigarette smoking, alcohol and drug use
112
Q

What are the reccommendations for reducing risk of SIDS?

A 
Sleep on back, alone in basket in same room, without blanket, foot to feet
No cigarette smoke exposure
Breastfeed
Firm flat mattress
Room temperature of 16-20 Degree C
113
Q

What causes SIDS?

A

Unknown but thought to have a problem in the way they respond to stresses and how they regulate their heart rate, breathing and temperature

114
Q

What are some physical features of down’s syndrome?

A
  1. Floppiness (hypotonia)
  2. Eyes slanting upwards and outwards
  3. Small mouth with tongue sticking out
  4. Flat back of head
  5. Low birth weight and birth length
  6. Single palmar crease
115
Q

What developmental delays and co-morbid conditions are common in down’s syndrome?

A

Learning disability. Delay in achieving milestones. Will take longer than normal. Varies across population and from child to child.

1/10 will also have autism or ADHD
Heart (septal defect), bowel problems
Hearing and visual difficulties
Greater risk of infection (pneumonia)
Hypothyroidism
116
Q

What tests are offered if there is suspicious findings on nuchal scanning?

A

CVS at 11-14 weeks - small sample of placenta tested

Amniocentesis at 16-20 weeks - sample of amniotic fluid tested

117
Q

What support is available for children with downs syndrome?

A

Good access to healthcare - range of specialities and doctors

Support for development - SALT, Physio, home teaching

Support groups - Downs Syndrome Association, other familities with children with down’s

118
Q

How can a parent help their child with Down’s Syndrome?

A

Using play - show them how to play with toys, to encourage them to reach, grasp and move

Naming and talking about things the child is looking at or interested in

Providing opportunities to mix with other children

Encouraging independance early as possible with things like feeding, dressing, making bed, brushing teeth, going toilet

Playing games to teach new words (SALT or home tutor can give ideas)

Remember to have fun, not all activities have to be purposeful or meaningful, any activity is beneficial

119
Q

What regular health check-ups will a child with down’s syndrome require?

A

Hearing and vision tests
Height and weight
Blood tests for thyroid problems
Checking for signs of heart problems

Regular appointments with paediatrician

120
Q

What finding is present on CXR of a child with ToF?

A

Boot-shaped heart

121
Q

What are the 4 defects found in ToF

A
  1. pulmonary artery stenosis
  2. RVH
  3. VSD (R>L shunt due to RVH)
  4. Aorta overides septal defect
122
Q

What is the most common cause of CYANOTIC CHD?

A

ToF

123
Q

What are the features of ToF in a baby?

A

Cyanosis of lips and fingers

Feeding difficulties
Failure to thrive

124
Q

What are the triadic features of Fetal Alcohol Syndrome?

A
  1. Growth restriction
  2. Facial abnormalities
  3. CNS dysfunction and learning disabilities

also cardiac defects > VSD (holosystolic murmur)

125
Q

What are the triadic features of Fetal Alcohol Syndrome?

A
  1. Brain - CNS dysfunc + learning disability
  2. Body - growth retardation and restriction
  3. Face - facial abnormalities

Paeds (3 decks)

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