Paedeatrics Flashcards
What system is used to measure a child’s progression through puberty?
Tanner
What 3 measurements do you have to take to measure a child’s growth?
- Weight
- Height
- Head circumference
Why do you have to measure head circumference?
Indicator of brain development
What is Perthes disease?
Idiopathic avascular necrosis of the femoral head of the femur.
How would you treat Perthes disease?
NSAIDs for symptom relief. Offer physio and a cast/brace.
Surgery - osteotomy in children over 8 or where a large percentage of the bone has been destroyed.
What are the symptoms of Perthes disease?
- Hip and groin pain
- Antalgic / trendelenburg gait
- Potential leg shortening
What are the stages in assessing a sick child?
DRABC
- Danger
- Response
- Airways
- Breathing
- Look
- Listen
- Feel - Circulation
How would you conduct CPR on a baby?
DRABC –> if you got to A and discovered they were not breathing, this is when you would commence CPR.
- 5 initial rescue breaths (ensure not too big as a babies lungs are much smaller than an adults!). Need to tilt the head back to open the airways (being careful not to hyper-extent the babies neck).
- 15 chest compressions (using 2 fingers in the sternum).
- 2 breaths.
Repeat the above until help arrives. Check to see if the baby is breathing after steps. If not, continue CPR.
How would you conduct CPR on a young child?
DRABC –> if you got to A and discovered they were not breathing, this is when you would commence CPR.
- 5 initial rescue breaths (ensure not too big as a babies lungs are much smaller than an adults!). Need to tilt the head back to open the airways (being careful not to hyper-extent the babies neck).
- 15 chest compressions (using 1-2 hands on the chest).
- 2 breaths.
Repeat the above until help arrives. Check to see if the child is breathing after steps. If not, continue CPR.
What are the 4 domains of child development?
- Gross Motor
- First 9 months
- How a baby moves around - Fine motor and vision
- 1 year+
- Walking and using hands - Speech, language and hearing
- how the child talks - Social interaction and self care skills
List 3 red flags of child development
- Indicators of safeguarding
- Poor growth
- ## Regression (could do a skill and now they can’t)
List 3 influences that help a child grow into a healthy adult (influence development)
Any of the following:
- Neglect
- Education
- Stimulation
- Nutrition
- Mums Health
What can you expect a child to do at the age of 1? (‘normal’ development)
- Walking
- Scribbling with a pen
- Smiling (6 weeks)
- Can say 1 word
- Use a spoon/fork
What is the healthy child programme?
Universal programme to ensure children have developmental assessments.
- Health Visitors come to assess the baby and address any concerns of the parents.
- Doctor reviews of the child.
- Immunisation and screening.
- Encourage healthy eating and physical activity.
Can you give 5 differentials for paediatric rashes?
- Meningitis
- Chicken Pox
- Measles (rare)
- Birth Mark
What tests can you do to decide between a bacterial and a viral cause of meningitis?
- CSF:
- Protein raised and glucose low in bacterial meningitis.
- Protein and glucose normal with a viral cause.
What is strabismus?
Squint
What is the first line prophylaxis for meningitis contacts? And how long do you give it for?
What are two contraindications for this medication?
Rimfampicin (2 days)
What is the cause of respiratory distress syndrome?
PREMATURITY
Type 2 pneumocytes do not produce surfactant and therefore surface tension is high
Why do you not build feeds up to quickly in a preterm baby?
Necrotising entercolitis -> premature gut is sensitive
What are 2 comorobidities associated with Downs syndrome?
Duodenal atresia
CHD
What is turners syndrome?
45 X
List 4 features of Turners
- Short stature
- Widely spaced nipples
- Webbed neck
- Infertility
- Delayed puberty and mennorhagia
What is Kleinfelters syndrome?
46 XXY
What is fragile X?
Genetic disorder
More affects males
CCG repeat - FMR1
How do you test for trisomies during pregancy?
Scan - 10-14 weeks, Nucchal translucnecy.
Blood test.
How are Angelmans and Praader Willi related?
- Chrosome 15
- Angelmans = maternal
- Praader Willis = paternal
How do you screen for Downs, Pataus and Edwards?
- Blood test
- nucchal translucency
4 features of arthritis on X -ray
- osteophyte formation
- subchondral sclerosis
- cysts
- joint space narrowings
Name the 5 types of JIA
- Oligoarticular (ANA)
- Polyarticular (RF +ve and RF -ve)
- Enthesitis
- Systemic
- Psoratic
What is the treatment for JIA?
- NSAID - oligoarthritis
- Methotrexate (DMARD) - poly
- Biological agent - TNF-alpha
Name 5 signs of dehydration in a child
- Sunken fontanelle
- Reduced urine output
- Reduced skin turgor
- Irritability
- Sunken eyes
- Tachypnoea
- Tachycardia
- Lethargy
- Crying but no tears
How do you calculate the deficit?
deficit % X 10 X Weight (kg)
How do you calculate the weight of a baby if you dont know it?
(Age + 4) x 2 = WEIGHT Kg
How do you calculate the rehydration of a child?
Maintenance + deficit - any boluses that you have given
What bolus would you give a child with DKA?
10 mls/kg 0.9% NaCl + 5% dextrose (+/- KCl)
not 20 as need to be careful with fluid overload - cerebral oedema
What bolus would you give a neonate?
10% Dextrose
What bolus would you give a child in a trauma situation?
10 mls/kg 0.9% NaCl + 5% dextrose (+/- KCl)
first clot is the best clot - high volumes of fluid may dislodge the clot
What picture would you usually see in someone with pyloric stenosis?
METABOLLIC ALKALOSIS
with low potassium and low chloride
What is the most common cause of osteoparosis in children?
Osteomalacia
in kids different cause, not old enough to have the wear and tear that adults have
How is osteomalacia caused?
Defect in the type 1 collagen gene
How is osteomalacia inherited?
Autosommal dominant
How do you detect JIA?
Diagnosis of exclusion
pGALS - detect before it causes too much damage (irreversible)
How can you investigate for rickets, and what would it show ?
- Low fasting phosphate
- Low vitamin D in body
- HIGH PARATHYROID
- Low serum calcium
What is the cause of rickets?
Vit D deficiency (and low calcium)
What is a complicstion of using aspirin in children?
REYES SYNDROME
When should you use apsirin in children?
KAWASAKIS disease
List the features of kawasakis
CRASH AND BURN Cracked lips Rash Adenopathy Strawberry tongue and inflammation of mucus membranes Hands and feet - desquamation Burn = fever
What vitamin should you give malnourished children with measles?
VIT A - higher risk of deafness and blindness
What virus causes chicken pox and shingles?
Varicella Zoster
What can occur once someone has developed chicken pox?
Shingles Dermatome distribution (lie dormant in the nerve root ganglion)
What is the most common cause of meningoccoal disease in neonates?
- GBS
- Ecoli
- Listeria
What is the most common cause of meningoccoal disease in infants?
- Haem. Influenza
- Neisseria meningitis
What type of bacteria is neiserria meningitidis?
Gram NEGATIVE diploccoci
What causes the rash in meningitis?
DIC
- Neiserria meningitidis releases toxins - activate clotting factor 7, causing intravascular coagulation, blood leaks out the skin causing DIC
What would you see in the CSF of someone with a BACTERIAL meningitis?
- Low glucose (bacteria using it all up)
- High protein (bacteria)
What causes fifth disease / slapped cheek?
PARVOVIRUS B19.
What is a complication of a staph A infection?
Staph scalded skin syndrome (SSSS)
- Red blistered skin and fever
After having a recent URTI a child develops red, blistered skin and a high fever. What is the cause of this?
Staph scalded skin syndrome
Toxins released by staph aureus
List the 5 stages of chemotherpay treatment for ALL
- Induction
- Consolidation
- Interim maintenance
- Delayed intensification
- Maintenance
ILL CATS INCREASE MUMS DAILY MILK buying
What is the most common leukaemia in children?
ALL
Name 5 symptoms and 5 signs of ALL
Symptoms
- Bleeding
- Fatigue
- Fever
- BONE OR JOINT PAIN
- recurrent infections
Signs
- Lymphadenopathy
- Gum hyptertrophy
- Anaemia
- Hepatomegaly
What is the name of the vaccination to given at risk individuals of RSV?
Pavaluzimab
What are the two risk factors associated with NEC?
Low birth weight
Prematurity
List 3 complications of long term steroid use
- Osteoparosis
- Stunted growth
- Weight gain
- Thin skin
What marker of CF is measured as part of the newborn screening test?
- IRT
then go on to do genetic testing
What are the three main organisms causing sepsis in the neonate?
Listeria
GBS
Ecoli
