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Phase 3A > Paediatric lectures > Flashcards

Paediatric lectures Flashcards

1
Q

Paediatric history differences

A

Antenatal/ postnatal
Immunisations
Development

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2
Q

Antenatal and postnatal questions

A 
Gestation
Growth scans
Special care
Mode of delivery
Weight
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3
Q

Immunisations questions

A

Shows how theyre interacting with healthcare

Measles?

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4
Q

Development history

A

Ask parents what they can do

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5
Q

Paediatric social history

A

Smoking
School
Pets

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6
Q

Examination differences

A

Observation is important

Opportunistic

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7
Q

Which pulse do you do in babies

A

Femoral

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8
Q

Heart failure in children

A

Scrotal and labial oedema (gravity)

Perioorbital oedema

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9
Q

How is oedema different in children

A

No pitting

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10
Q

How to assess hydration in children

A

Fontanelle

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11
Q

Respiratory examination differences

A

They get recessions as rib cage isnt calcified

  • tracheal tug
  • head nod
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12
Q

Abdominal examination differences

A

Do SHRUG

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13
Q

Neurological examination differences

A

chair?

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14
Q

4 domains of development

A

Gross motor
Fine motor and vision
Speech and hearing
Social and emotional

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15
Q

When should you smile by

A

6 weeks

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16
Q

Who developed pGALS

A

Versus arthritis

Theres an app

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17
Q

What to use for development

A

MRCPSYCH A4 sheet

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18
Q

ADHD age

A

kids act a 3rd younger than they are

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19
Q

3 core symptoms of ADHD

A

Inattention
Impulsivity
Hyperactivity

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20
Q

ADHD Diagnosis

A

Inattentive

Hyperactive/impulsive symptoms

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21
Q

Criteria for hyperactive/ impulsive symptoms

A

Present before 12 years
Developmentally inappropriate
Several symptoms in 2 or mroe symptoms
Clear evidence symptoms effect on function

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22
Q

Inatttentive symptoms

A

Easily distracted

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23
Q

Hyperactive symptoms

A

Talks excessively, cannot perform quietly

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24
Q

Impulsive symptoms

A

Blurts out answers, difficulty awaiting turn

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25
Q

What are ADHD at risk of

A

Risky behaviour

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26
Q

What birth age is likely to lead to ADHD

A

Preterm birth

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27
Q

New accurate test for ADHD

A

QB test

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28
Q

Causes of ADHD

A

Polygenetic
CNS insults
Environmental factors

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29
Q

CNS insults which can cause ADHD

A

Prematurity
Fetal alcohol syndrome
NF

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30
Q

Treatment of ADHD

A 
Education
Parenting programme
School support
Medications
Examinations
Healthy lifestyle
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31
Q

Which disease is high risk in ADHD

A

Cardiac disease

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32
Q

Treatments for ADHD

A

Stimulants or non stimulants

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33
Q

Stimulant for ADHD

A

Methylphenidate

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34
Q

Autism key areas

A

Social communication
Social interaction
Social imagination
Sensory issues

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35
Q

Communication difficulties in autism

A

Lack of desire to communicate
Communicating needs onlyu
Disordered or delayed language

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36
Q

Language pause at 20 months is suggestive of

A

Autism

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37
Q

What is echolalia

A

repeating back, happens in autism

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38
Q

Social interaction in autism

A 
No desire to interact with others
Being interested in others to have needs met
Lack of motivation please others
Affectionate on own terms
ONE SIDED IN PLAY
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39
Q

Play interaction in autism

A 
Using toys as objects
Inability to play or write imaginatively
Poor problem solving
Resist change
Obsessions and rituals
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40
Q

What are the differences in obsessions between OCD and ADHD

A 
OCD= anxiety and upsetting 
ADHD= enjoyable and relaxing
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41
Q

What commonly coexists with Autism

A

ADHD

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42
Q

Management for autism

A

Education and information
Parenting workshop
School support
Manage comorbidity

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43
Q

What aids are useful in ADHD

A

Visual aids

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44
Q

What should you consider in paediatric haemotology

A

Different referrence ranges, also depends on gestation

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45
Q

Where are blood cells made in childhood

A

At birth all bone marrow cavities, with age it is central bones

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46
Q

Which central bones produce stem cells in later childhood

A

Vertebrae
Sternum
Ribs
Pelvis

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47
Q

Describe pluripotent stem cells

A

Develop into precursor cells that give rise to mature erythrocytes, monocytes, megacaryoctes or lymphocytes.
Regulated by cytokines

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48
Q

3 mechanisms of anaemia

A

Decreased production
Increased consumption
Increased loss

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49
Q

What does low reticulocyte count suggest

A

Lack of production

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50
Q

What does high reticulocyte production suggest

A

Haemloysis or blood loss

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51
Q

Hypochromic microcytic anaemia

A

Iron deficiency

Thalassaemia

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52
Q

Normochromic normocytic anaemia

A

Chronic
Blood loss
Malignancy

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53
Q

Macrocytic anaemia

A

Vit B12
Folate
Hypothyroid

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54
Q

High reticulocyte anaemia

A

Haemolytic

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55
Q

Causes of hameolysis

A

Haemoglobinopathy
Enzymopathy
Membranopathy
Immune haemolytic anaemia

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56
Q

Causes of severe anemia at birth

A

Haemolytic disease of the newborn

Bleeding

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57
Q

Cause of haemolytic disease of the newborn

A

Rhesus negative mother, rhesus positive baby

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58
Q

Signs and symptoms of haemolytic disease of the newborn

A

Severe anemia

Compensatory enlargement of spleen and liver

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59
Q

Treatment of haemolytic disease of the newborn

A

Prevention of sensitisation with Rh.

Intrauterine transfusion of affected fetuses

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60
Q

Physiological anemia of the newborn

A

Fall in Hb from birth

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61
Q

Anaemia of prematuirty

A

Low birth weight infants have poor erythropoietin response

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62
Q

Iron deficiency anaemia

A

Poor intake and increased requirement
Breast feeding and infection
Much more dependent on dietary sources

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63
Q

Why do cows milk toddlers get anaemia

A

Reduces absorption of iron

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64
Q

Presentation of anaemia

A 
Pallor
Irritability
Anorexia
Tachycardia
Murmur
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65
Q

Treatment of iron deficiency

A

Oral iron dose for 3-6 months (non compliance common)

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66
Q

What is haemolysis

A

Breakdown of red cells more rapidly than the body normal does

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67
Q

What is a consequence of haemolysis

A

Heart, liver and endocrine failure due to increased free iron

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68
Q

Intracorpuscular causes of haemolysis

A

Haemoglobin
Enzyme
Membrane

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69
Q

Extracorpuscular causes of haemoluysis

A

Autoimmune
Fragmentation
Hyper splenism
Plasma factors

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70
Q

Iron overload treatment

A

Chelation

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71
Q

Haemolytic anaemia presentations

A

High bilirubin
Hydrops
Failure to thrive
Stools

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72
Q

Haemoglobinopathies

A

Sickle cell and thalassemias

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73
Q

Sickle cell disease

A

Point mutation causes HbS to be produced

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74
Q

Thalassaemia

A

Imblance of the hemoglobin chains which means the tetramers dont form

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75
Q

What cells might be seen with anaemia on microscopy

A

Target cells

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76
Q

How is sickle cell found

A

Screened antenatally

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77
Q

Treatment for sickle cells

A

Prophylactic penicillin, immunisations

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78
Q

Sickle cell presentation

A 
Always anaemia
Infarction
Infection
Acute chest
Iron overload
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79
Q

Sickle cell crisis

A

Bone pain due to sickling of cells in bones causing infarcts

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80
Q

Treatment for sickle cell crisis

A

Oxygen, antibiotics, opiates

Exchange transfusion

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81
Q

What is happening in thalassaemia

A

Reduced globin chain synthesis

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82
Q

Presentation of B thalassaemia minor

A

Asymptomatic

Mild anaemia, low MCV, riased Hb A2

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83
Q

Why dont you see thalassaemia at birth

A

Lots of HbF still

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84
Q

When does thalassaemia occur

A

6 months

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85
Q

B thalassaemia major presentation

A 
Progressive severe anaemia
Jaundice
Splenomegaly
Failure to thrive
Skeletal deformity
Delayed puberty
Death
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86
Q

B thalassaemia major management

A

Genetic counselling
Transfusions
Iron chelation
Bone marrow transplant

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87
Q

G6PD presentations

A

Neonatal jaundice
Chronic anaemia
Intermittent intravascular haemolysis

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88
Q

What food can cause G6PD

A

Fava beans

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89
Q

Hereditary spherocytosis

A

AD

Mild to needing transfusion

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90
Q

Pure red cell aplasia

A

RBC failure of bone marrow (parvovirus)

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91
Q

Clinical sign of parvovirus

A

Slapped cheeks

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92
Q

Bone marrow failure syndromes

A

All cell lines affected

fanconi’s anaemia

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93
Q

Causes of bone marrow infiltration

A

Leuakaemia
Lymphoma
Neuroblastoma
Osteoporosis

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94
Q

Requirements for haemostasis

A

Platelets
Coagulation factors
Vascular integrity

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95
Q

ITP

A

Bruises
Petichiae
Very low platelets

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96
Q

Name two bleeding disorders

A

Haemophilia

Von willebrand disease

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97
Q

Name three clotting disorders

A

Antithrombin, protein C, protein S

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98
Q

Von willebrand disease

A

Reduction in vwf for factor 8.

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99
Q

VW disease bleeds

A

Bleeding from nose and injuries etc

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100
Q

Haemophilia bleeds

A

Joint and muscle bleeds

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101
Q

Treatment for VWF

A

For bleeds/ surgery

Tranexamic acid

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102
Q

Haemophilia A and B

A

X linked recessive. factors 8 and 9.

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103
Q

Which factor is haemophilia A

A

8

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104
Q

Which factor is haemophilia B

A

9

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105
Q

Presentation of haemophilia

A

FHx
Bruising
Mouth bleeds
Following trauma

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106
Q

Symptoms of leukaemia

A 
Anaemia
Infection
Bleeding
Systemic symptoms
Organ infiltration
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107
Q

What is pathognomic of AML

A

Auer rod

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108
Q

What organisms cause tonsilitis

A

Gp A strep, adenovirus, EBV

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109
Q

What organisms cause epiglotitis

A

Haemophilius influenze B

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110
Q

What organism causes whooping cough

A

Pertussis

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111
Q

What organism causes otitis media

A

Pneumococcus

GpA strep

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112
Q

What organism causes Croup

A

Parainfluenza

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113
Q

What organism causes tracheitis

A

S. Aureus, strep A, haemophilius

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114
Q

What organism causes pneumonia

A

Strep A, pneumo, staph, haemophilus, TB

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115
Q

What organism causes bronchiolitis

A

RSV, rhino, flu, adeno paraflu

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116
Q

Varicella zoster virus presentation

A

Self limiting but deadly if secodnary staph or strep

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117
Q

Herpes simplex virus presentation

A

Stomatitis
Simple cold sore
Encephalitis
Excema

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118
Q

Kawasaki disease presentation

A 
Fever
Rash
Stomatitis
Periphery change
Adenopathy
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119
Q

Under 3 months fever investigations

A

FBC
Blood culture
CRP
Urine culture

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120
Q

Child over 3 months fever investigations

A

FBC
Blood culture
CRP
Urine culture

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121
Q

CSF bacterial findings

A

Raised cell count
Raised protein
Low glucose
Bacteria identified or PCR

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122
Q

CSF viral findings

A

Raised cell count
Normal protein
Normal glucose
Virus identified in CSF, stool, throat or blood

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123
Q

Baby looks sick and WCC under 10

A

Antibiotics

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124
Q

Antibiotic for under 3 months meningitis

A

Cefotaxime and amoxicillin

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125
Q

Treatment for herpes simplex virus

A

Aciclovir

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126
Q

Over 3 months mengitis treatment

A

Cefotaxime

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127
Q

Meningitis under 3 months organism

A

GpB strep

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128
Q

Meningitis over 3 months organism

A

Meningococcus, pneumococcus, haemophilus influenza

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129
Q

Meningitis symptoms

A 
Neck stiffness
Sensitive to light
Drowsy
Irritable
Vomit
Headache
Full fontanelle
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130
Q

Septicaemia symptoms

A

Red non blanching rash
Cold hands and feet
Tachypnoea
Flu like symptoms

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131
Q

Bronchiolitis findings

A

Bilateral crackles and wheeze

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132
Q

Which antibody moves across the placenta

A

IgG

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133
Q

10 warning signs of primary immunodeficiency

A 
4+ ear infections
2+ sinus infections
2+ months on antibiotics
2+ pneumonia
Failure to grow
Recurrent abscesses
Thrush
IV antibiotics
Sepsis
FHx
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134
Q

Treatment of primary immunodeficiency

A

Antibiotic prophylaxis
Prompt treatment of infections
Replacement Ig
Bone marrow transplant

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135
Q

TB screening test

A

Mantoux test

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136
Q

In very young how do stats compare to adult

A

HR high
RR high
BP low
Temp same

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137
Q

Where does croup affect

A

Below the larynx

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138
Q

Respiratory distress symptoms

A

Recessions
Head nod
Tracheal tug
Cyanosis

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139
Q

3 things happening in asthma

A

Increase mucous production
Inflammation and oedema
Bronchoconstriction

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140
Q

Anaphylaxis affect on the lungs

A

Bronchospasm

Laryngospasm

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141
Q

How do you assess circulation

A

Capillary refill
Blood pressure
Heart rate
Colour

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142
Q

What is a very good surrogate sign to monitor for shock

A

Urine output

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143
Q

Why does lactate rise in shock

A

Increased anabolic metabolism

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144
Q

Causes of increased intercranial pressure

A

Space occupying lesion
Hydrocephalus
Trauma

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145
Q

Why does 6th nerve palsy occur

A

Longest intercranial route

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146
Q

How does heart rate and metabolism differ with temperature

A

Every degree increased is heart rate +10

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147
Q

What things are higher in children (relating to fluid balance)

A

Surface/ mass
Metabolism
Respiratory rate

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148
Q

What things are lower in children (relating to fluid balance)

A

Response to thirst
Independence
Glomerular filtration

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149
Q

% loses in children of water

A

Urine 60%
Skin and lungs 35%
Stool 5%

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150
Q

Reasons for reduced fluid intake

A 
Dysphagia
Neurodisability
Vomiting
Behavioural
Psychiatric
Social
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151
Q

Reasons for increased fluid losses

A

Gut
Kidneys
Skin
Lungs

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152
Q

Gut causes of increased fluid loss

A

Gastroenteritis
IBD
Stoma

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153
Q

Kidney causes of increased fluid losses

A

Renal tubular disease

Renal dysplasia

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154
Q

Skin causes of increased fluid losses

A

Burns

Sepsis

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155
Q

Signs of mild dehydration

A

Thirst
Dry lips
Reslessness
Irritbaility

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156
Q

Signs of moderate dehydration

A

Sunken eyes
Reduced skin turgor
Decreased urine output

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157
Q

Signs of severe dehydration

A

Reduced consciousness
Cold
Mottled peripheries
Anuria

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158
Q

Chronic dehydration consequences

A 
Failure to thrive
Malnutrition
Developmental delay
Constipation
UTIs
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159
Q

How much fluid to a child

A

Maintenance + 50ml/kg

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160
Q

Which fluid do you give to neonates

A

10% glucose

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161
Q

How do you estimate weight in kilo

A

(Age + 4)x 2

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162
Q

Which fluid do you give children for maintenance

A

0.9% sodium chloride + 5% glucose

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163
Q

Less than 10kg how much fluid

A

100ml/kg/day

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164
Q

10-20kg how much fluid

A

50ml/kg/day

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165
Q

20+ kg how much fluid

A

20ml/kg/day

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166
Q

How much fluid to give to a shocked child

A

100ml/kg extra

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167
Q

Side effects of too much fluid

A

Oedema
Renal problems
Hyponatraemia
Cerebreal oedema

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168
Q

What is fluid bolus (exam question)

A

20mls/kg of 0.9% sodium chloride

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169
Q

Treatment of DKA in children

A

10mls/kg 0.9% sodium chloride

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170
Q

How much is too much fluid

A

More than 100ml in an hour

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171
Q

Procedural issues with paediatric radiology

A

Are they starved

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172
Q

Anatomy differences between adults and children

A

Flexible skeleton
Growth plates
Plastic bones

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173
Q

Why do children loose more heat

A

Greater surface area to volume ratio

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174
Q

Disease of newborns but not adults

A

Congenital

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175
Q

Disease of adults but not newborns

A

Coronary artery disease
Strokes
Lung cancer

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176
Q

Parent worries about radiology

A

Radiation

Invasive procedures

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177
Q

Why are children susceptible to mutations

A

Rapidly turning over cells

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178
Q

High radiation scans

A

CT
Nuclear medicine
PET

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179
Q

Low radiation scns

A

MRI

US

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180
Q

Name of end of bone

A

Epiphysis

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181
Q

Name of bit near the end of bone

A

Metaphysis

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182
Q

Where does the bone grow from

A

Metaphysis

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183
Q

What is the shaft of a bone called

A

Diaphysis

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184
Q

Where is the lamboid suture

A

At the back

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185
Q

Name of heart on wrong side

A

Dextrocardia

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186
Q

What is inverted whole system

A

Situs invertus

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187
Q

Fragile bones name

A

Oesteogensis imperfecta

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188
Q

What are the key radiological differences between childrens and adults

A

Size
Normal anatomy
Congenital problems
Lines and tubes

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189
Q

A normal chest xray should be

A 
A good quality film
No trachea
No mediastinal deviation
Lungs should be clear
Heart borders and diaphragm
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190
Q

Why measure growth

A

Sensitive pointer to health problems in children. Growth is narrowly defined in healthy children with adequate nutrition and an emotionally supportive environment

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191
Q

Determinants of growth

A 
Parental phenotype and genotype
Quality and duration of pregnancy
Nutrition
Specific system and organ integrity
Psycho social 
Growth hormones and factors
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192
Q

What is chondrogenesis

A

Growth

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193
Q

What regulates growth at a cellular level

A

Endocrine signals
Nutrition
Extracellular fluid
Inflammatory cytokines

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194
Q

What needs to be considered when assessing growth

A

Parental heights
Social inequalities
Ethnic background

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195
Q

Body proportions of newborn

A

Larger head, smaller mandible, short neck, rounded chest, prominent abdomen, short limbs

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196
Q

Hormone growth problem classic patient

A

Short and fat

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197
Q

Body proportions of adults

A

Relative growth of limbs compared to trunk

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198
Q

What does short limbs suggest

A

Hypochondroplasia

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199
Q

What does short back and long legs suggest

A

Delayed puberty

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200
Q

What measurements are used for growth

A

Standing height
Lying height
Sitting height

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201
Q

Factors that affect head circumference

A

Centile position
Relation to body size
Sutures and fontanelles
Familial factors

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202
Q

Reasons for unreliable growth measurements

A

Inaccuracy
Uncooperative child
Differenct observers
Different times of the day

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203
Q

Key problem with the normal growth charts in UK

A

White UK children

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204
Q

3 phases of growth

A

Infant
Mid childhood
Puberty

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205
Q

What is infant growth phase dependent on

A

Nutrition

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206
Q

What is midchildhood growth phase dependent on

A

Brain

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207
Q

What is pubertal growth phase dependent on

A

Hormones and pregnancy

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208
Q

Two common causes of low height

A

Familial short stature

Constituional delay in growth and puberty

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209
Q

Which hormone is needed for fusion of the growth plates

A

Oestrogen

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210
Q

What is an indicator of true male puberty

A

Testes over 3ml (tanner 2)

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211
Q

Klinefelter symptoms

A

Pubertal problems (small testes, less hair)
Azoospermia, gynaecomastia
Tall stature
Osteoporosis

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212
Q

Primary hypogonadism or hypergonadism, where is the problem

A

Primary

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213
Q

Secondary hypogonadism or hypergonadism, where is the problem

A

Pituitary

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214
Q

Tertiary hypogonadism or hypergonadism, where is the problem

A

Hypothalamus

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215
Q

Name of the pubertal growth stages

A

Tanner stages

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216
Q

What is the indicator of true female pubery

A

Breast bud palpable (tanner 2)

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217
Q

Klinefelter (boys) chromosomes

A

47, XXY

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218
Q

Turner (girls) syndrome chromosomes

A

45, X0

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219
Q

Turner presentation

A 
Oedema at birth
Upper airway infections
High arch palate
Cardiovacular and renal malformations
Short stature
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220
Q

Hypergonadotrophic hypogonadism

A

Turners

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221
Q

Primary hypogonadism

A

Klinefelters

222
Q

Normal range of puberty for girls

A

8-13

223
Q

Normal range of puberty for boys

A

9-14

224
Q

Which race goes into puberty early

A

Black

225
Q

Why arent some hand bones seen in children

A

Theyre sitll cartilage

226
Q

Factors that affect birth weight

A 
Maternal size and weight
Parity
Gestational diabetes
Smoking 
Paternal size
227
Q

Common associations of poor growth of children

A 
Vomiting
Dysmorphic features
Diarrhoea
Poor social circumstances
Actual weight loss
228
Q

Common causes of short stature

A 
Constitutional
Idiopathic
Environmental
Nutrition
Physical disease
Skeletal disease
Turners
Endocrine
229
Q

Chronic diseases that cause short stature

A 
Coeliac disease
IBD
Congenital heart disease
Chronic anaemia
Cystic fibrosis
Chronic infection
230
Q

Overgrowth with impaired final height causes

A

Precocious puberty
Congenital adrenal hyperplasia
McAlbright syndrome
Hyperthyroid

231
Q

Overgrowth with increased final height

A

Androgen or oestrogen deificency
GH excess
Klinefelter
Marfan

232
Q

What social factors can cause growth restriction

A

Emotional rejection

Abuse

233
Q

Consequence of obesity in children

A

Non alcoholic fatty liver disease

234
Q

What is a guide for communicating with teenagers (HEADDSSS)

A 
Home
Education
Activities
Drugs and alcohol
Depression
Sexual health
Spirituality
Sleep
235
Q

What is a limp

A

Assymetric lower limb movement when walking

236
Q

Causes of limp

A

Pain
Weakness
Irritability
Shortening

237
Q

History points for limping child

A 
Age
Pain
Trauma
Acute or chronic
Red flags
238
Q

Age under 4 limping child

A

Toddlers fracture

239
Q

Age 4-10 limping child

A

Transient synovitis

Legg Calve Perthes disease

240
Q

Age 10+ limping child

A

Osgood schlatter disease

SCFE

241
Q

SCFE (SUFE)

A

Slipped capital femur epithysis

242
Q

Two problems which can affect any age causing limping

A

Oesteomyelitis

Septic arthritis

243
Q

Questions for osteogenesis imperfecta

A

Blue sclera
Family history
Deficient
Social history

244
Q

Toddlers fracture

A

Undisplaced spiral fracture

245
Q

What prevents toddlers bones displacing

A

Periosteum (much thicker in children)

246
Q

Greenstick fracture

A

Bending fracture with intact periosteum

247
Q

Acute limping child

A

Trauma

248
Q

Chronic limping child

A

Infection

SUFE

249
Q

Red flags limping child

A 
Night pain
Sweats
Weight loss
Unexplained rash or bruising
Stiffness
250
Q

What does stiffness suggest

A

Pathology inside joint capsule

251
Q

Henlock shlong purpuria

A

Can cause joint pain

252
Q

Severe pain, anxiety and agitation after a traumatic injury.

A

Compartment syndrome

253
Q

How does compartment syndrome work

A

Increased pressure leads to stop of blood flow and necrosis

254
Q

Examination of limping child

A

Temperature
Rotational profile
Joint movements
Spine and neurological

255
Q

Criteria for septic arthritis

A

Kocher criteria

256
Q

Kocher criteria

A

Non weight bearing
Pyrexia
WCC high
ESR high

257
Q

Perthes disease

A

Idiopathic avascular necrosis of proximal femoral epiphysis

258
Q

What is the name of the growth plate

A

Physis

259
Q

Perthe disease associations

A

Low birth weight

Family history

260
Q

Fat adolescent boy limping

A

SUFE/ SCFE

261
Q

What is SUFE

A

Slippage of the metaphysis relative to the epiphysis

262
Q

SUFE associations

A

Obesity
Family history
Hypothyroidism

263
Q

What line is used for diagnosis of SUFE

A

Frog legs view xray with Klein lines

264
Q

Klein lines

A

If line from femoral head doesnt intersect epiphysis then its SUFE

265
Q

Define child development

A

Biological, pscyhological and emotional changes that occur between birth and adolescence as the individual progresses from dependency to increasing autonomy

266
Q

What affects healthy development

A 
Education
Genetics
Maternal nutrition
Pregnancy
Domestic violence
Attachment
Substances
Parenting style
Prematurity
Nutrition
Medical conditions
Hearing and vision
Stimulating environment
Abuse
Mental health
Peer relationships
267
Q

4 Domains of development

A

Gross motor
Fine motor and vision
Speech, language and hearing
Social interaction and self care

268
Q

When is median for walking

A

12 months

269
Q

When is worrying for walking

A

18 months

270
Q

When should baby reflexes diasappear

A

6 months

271
Q

Name 5 baby reflexes

A 
Moro
Grasp
Rooting
Placing
Atonic neck reflex
272
Q

Moro reflex

A

Sudden head extension causes symmetrical extension followed by flexion of all limbs. Goes at 4 months (4 letters)

273
Q

Gross motor progression (to 1 year walking)

A

Flexed arms and legs equal movmeents,
Lifts head
Rolls, sits unsupported
Pulls to stand

274
Q

What do you do at 6 months

A

Sit

275
Q

Gross motor progression (from 1 year walking)

A 
Walking
Walk up stairs
Jumps
Hops
Rides bike
276
Q

Fine motor and vision development

A 
4m- grasp, use both hands
8m- takes cube in each hand
12m- scribble with crayon
18m- 2 cube tower
3 years- 8 cube tower
277
Q

What are you aiming for within a year

A

1 word with meaning

278
Q

Speech and language and hearing progression (to 1 year)

A

Laughs and squeels
Dada, mama
1 word

279
Q

How many words at 2

A

2 word sentences

280
Q

How many words at 3

A

3 word understandably

281
Q

What speech at 4

A

Knows colours, can count to 5

282
Q

What should you be able to understand at 2

A

2 part instructions

283
Q

What should you be able to understand at 3

A

3 part instructions

284
Q

When should you be smiling

A

6 weeks

285
Q

Social self care, 1 year goal

A

Uses spoon/fork

286
Q

Development of social self care (to 1 year)

A

Smiles spontaneously
Finger feeds
Waves bye bye
Uses spoon/fork

287
Q

Can children dress themselves when they go to school

A

yes

288
Q

Red flags gross motor

A

Not sitting by a year

Not walking at 18

289
Q

Fine motor red flags

A

Hand preference before 18 months

290
Q

Speech and language red flags

A

Not smiling at 3 months

No clear words by 18months

291
Q

Social development red flags

A

No response to carers by 8 weeks

Not playing with peers by 3 years

292
Q

Tools for developmental assessment

A

Screening tool

Schedule of growing skills, Griffiths and baileys

293
Q

5 categories of causes of childhood developmental delay

A 
Genetics
Factors in pregnancy
Factors around birth
Factors in childhood
Environmental factors
294
Q

Good easy test for developmental delay

A

Microarray (and bloods)

295
Q

Definition of disability

A

Someone who has a physical or mental impairment that results in marked, pervasive limitation of activity

296
Q

Impairment definition

A

An abnormality of loss of function

297
Q

Physical impairment examples

A

Cerebral palsy, brain injury, neuromuscular disorders, musculoskeletal conditions

298
Q

Sensory impairments example

A

Hearing and visual impairments

299
Q

Neurodevelopmental impairments

A

ADHD, autism

300
Q

Emotional/ behavioural impairments

A

Depression conduct disorder, attachment disorder

301
Q

Disability determinates

A

Biopsychosocial model

302
Q

WHO disability assessment schedule has 6 domains of functioning

A 
Cognition
Mobility
Self care
Social
Life activities 
Participation
303
Q

Steps in supporting children with impairments

A

Holistic assessments
Address medical, social, environmental and psychological factors for best outcomes
Child focused
Involves work with a multi disciplinary team

304
Q

Aspects of health education social care

A 
Physiotherapy
SALT
Dietician
Doctors
GP
Early years inclusion
Housing support
Social worker
Team around child meetings
305
Q

Name paediatric cancers

A 
Wilms
Neuroblastoma
Rhabdomyosarcoma
Leukaemia
Bone tumours
Lymphoma
306
Q

Presentation of paediatric malignancy

A

Localised mass
Problems from disseminated disease
Problems from localised mass

307
Q

What does not finishing a feed suggest

A

Anaemia

308
Q

Bone marrow infiltration symptoms

A

Pain
Easy bruising
Infections
Anaemia

309
Q

Recent URTI, pale and tired

A

Post viral or leukaemia

310
Q

Lump in neck otherwise well

A

Atypical mycobacteria or hodgkins

311
Q

Early morning headache

A

Sinusitis or brain tumour

312
Q

Recurrent fever and bone pain

A

Arthritis
Leukaemia
Ewings
Neuroblastoma

313
Q

Abnormal red reflex in eye

A

Retinoblastoma

314
Q

Proptosis

A

Infection, neuroblastoma, rhabdomyosarcoma

315
Q

Recurrent discharging ear

A

Infection
Rhabdomyosarcoma
LCH

316
Q

Acute leukaemia presentation

A 
Fever
Fatigue
Frequent infections
Lymphadenopathy
Hepatomegaly and splenomegaly
Anaemia
Bruising, petechiae
Bone or joint pain
317
Q

Acute leukaemia investigations

A 
Blood film
Serum chemistry
CXR
Bone marrow and aspirate
Lumbar puncture
318
Q

5 phases of chemotherapy

A 
Induction
Consolidation
Interim maintenance
Delayed intesification
Maintenance
319
Q

When do you give stem cell transplant in leukaemia

A

High risk patients in first remission

Relapsed patients

320
Q

CNS tumours

A 
Headache
Vomiting
Papilloedema
Squint
Nystagmus
Ataxia
Personality of behaviour change
321
Q

Not doing something they used to be doing

A

Very bad sign

322
Q

Worrying signs with headache

A 
Pappiloedema
Decreased acuity, visual loss
Neuro signs
Recurrent or early morning
Vomiting
Reduced growth
DI 
Under 3 years old
323
Q

CNS tumours treatment

A

Surgery
Chemotherapy
Radiotherapy (not brain)

324
Q

Lymphadenopathy causes

A

HIV infection
AI conditions
Storage disorders
Malignancy

325
Q

Bad signs with lymphadenopathy

A 
Enlarging
Persistent
Unusual site
Fever, weight loss, enlarged liver/ spleen
Abnormal CXR
326
Q

Lymphoma therapy

A

Chemotherapy
Radiotherapy
Surgery

327
Q

What is wilms tumour

A

Renal mass

328
Q

Abdominal mass symptoms

A 
Pain
Haematuria
Constipation
Hypertension
Weight loss
329
Q

Investigations for abdominal mass

A

Ultrasound
CT scans
Biopsy

330
Q

Neuroblastoma treatment

A

Surgery
Chemotherapy
Radiotherapy

331
Q

Wilms tumour treatment

A

Chemotherapy
Surgery
Radiotherapy

332
Q

Symptoms of retinoblastoma

A

Loss of red reflex and squint

333
Q

Late effects of cancer treatment

A 
Endocrine
Intellectual
Cardiac toxicity
Renal toxicity
Fertility
Psychological
334
Q

When do you break most bones

A

Peak growth velocity

335
Q

Factors affecting fracture rates

A

Growth
Activity
Trauma
Fragility

336
Q

Define osteoporosis

A

Disease characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility

337
Q

Two categories of osteoporosis causes

A

Inherited (osteogenesis imperfecta)
Acquired
(steroids)

338
Q

Acquired causes of osteoporosis

A 
Drug induced
Endocrinopathies
Malabsorption
Immobilisation
Inflammation
339
Q

Osteogensis imprefecta observations

A

Fragility, fractures, deformity. Bone pain. Impairs mobility and growth

340
Q

Common treatment for osteoporosis in children

A

Bisphosphonates

341
Q

Key roles of vitamin D

A

Makes calcium available
Maternal VitD influences bone size and mass
Role in immune function and tolerance

342
Q

Presentation of Vit D deficiency

A 
Bowed legs
Hypocalcaemic convulsions
Gross motor delay
X-Ray finding
Swollen ankle
Carpopedal spasm
343
Q

Causes of vitamin D deficiency

A

Maternal vit D insufficiency
Lack of exposure to sunlight
Lack of vit D in diet

344
Q

Pathologically what is rickets

A

Failure to mineralise new bone

345
Q

Presnetation of rickets

A 
Metaphyseal swellings
Bowing deformity
Slowed linear growth
Motor delay
Hypotonia
Fractures
Respiratory distress
346
Q

Biochemical changes in rickets

A

Low phosphate

Raised AlkPhos

347
Q

Vit D defiency chemical changes

A

Raised PTH

Low 25 OH-D

348
Q

Vitamin D deficiency treatment

A

Vitamin D (+- calcium)

349
Q

Vit D facts

A

Steroid like substance
Fat soluble
Specific DNA response elements

350
Q

Define self harm

A

Act with intent to hurt self

351
Q

Define suicide attempt

A

Act with intent to kill self

352
Q

Do more boys or girls self harm

A

Girls

353
Q

Do more boys or girls commit suicide

A

Boys

354
Q

Reasons for self harm

A

Release tension, make self feel, search for help

355
Q

Best treatment for bullying

A

Interpersonal therapy

356
Q

CAHMS self harm assessment

A 
STAR team assessment
Psychological intervention
CBT therapy
Family therapy 
Pharmacological intervention
357
Q

Is self harm present in nature

A

Obsessive behaviour

Desire to cope better with internal conflicts

358
Q

What factors can predispose to self harm in young children

A

Communication difficulties

359
Q

How does depression differ from low mood

A

Depression is low mood + anhedonia + reduced energy leading to increased fatiguability and diminished activity

360
Q

What is terminal insomnia

A

Early morning waking. REM sleep comes earlier

361
Q

Criteria for depression affects

A

Pervasive, persistent, affects other domains of life, persists through different environments

362
Q

Why is depression diagnosis hard in children

A

They are bad communicators

363
Q

Child symptom of depression

A

Regression

  • clinging
  • bed wetting/ thumb sucking
  • 3 wish test
364
Q

How to find distressors in children

A

3 wish test

365
Q

Things that can cause progression from depression to suicide

A 
No support
Better to be dead
Death wishes
Plan
Attempt
Suicide
366
Q

Biological basis of depression

A

Low trypotophan
Low serotonin
HPA dysregulation
Low 5HIAA

367
Q

Risk factors in self harm behaviour

A 
Intent
Lethality
Comorbid mental illness
Depression
Psychosis
PHx
FHx
Substance abuse
368
Q

Which hallucinations are worrying for self harm

A

Commanding voices
Thought echo
Discussing auditory hallucinations

369
Q

Where does ductus arteriosus join

A

Pulmonary artery and descending aorta

370
Q

Where does the formane ovale join

A

right and left atria

371
Q

Describe ASD clinical signs

A

Fixed and widely split S2

Ejection systolic in pulmonary area

372
Q

What symptoms do you get with ASD

A

Asymptomatic when younger and can get palpitations when older

373
Q

Name three types of ASD

A

Ostium secundum
Ostium primum
Sinus venosus ASD

374
Q

PDA clinical presentation

A

Preterm

Poor feeding, failure to thrive, tachypnoea

375
Q

Clinical signs of PDA

A

Active precordium, thrill, gallop rhythm
Continuous machinery murmur pulmonary area
Hepatomegaly
Oedema

376
Q

VSD clinical presentation

A

poor feeding
failure to thrive
tachypnoea

377
Q

Clinical signs of VSD

A

Active precordium, thrill, gallop rhythm
Pansystolic murmur
Hepatomegaly
Oed

378
Q

Where does VSD murmur radiate

A

USE and axillae

379
Q

What is a common defect in trisomy 21

A

Atrioventricular septal defect

380
Q

What can AVSD lead to

A

Pulmonary vascular disease

381
Q

AVSD clinical presentation

A

Poor feeding, failure to thrive, tachypnoea

382
Q

Clinical signs in coarctation of the aorta

A

Weak femoral pulse
4 Limb BP
Murmur over back in older children

383
Q

If duct has closed in coarctation of aorta how will a baby present

A

Collapsed and acidotic

384
Q

Clinical findings of pulmonary stenosis

A

Ejection systolic murmur LUSE
Radiates to back
Right ventricular heave

385
Q

Cyanotic heart conditions

A

Tetralogy of fallot

Transposition of the great arteries

386
Q

Presentation of cyanotic congenital heart disease (ToF, TpOGA)

A

Cyanosis
Acidosis
Collapse/ death

387
Q

What mutation should you check for in tetralogy of fallot

A

22q deletion

388
Q

Normal range for fasting plasma glucose

A

3.5-5.6

389
Q

Normal range for post prandial plasma glucose

A

<7.8

390
Q

What fasting glucose is diabetes diagnostic

A

> 7

391
Q

What fasting glucose is prediabetes

A

<7

392
Q

What fasting glucose is normal

A

3.5-5.6

393
Q

What post Oral Glucose Tolerance test is diabetes

A

> 11.1

394
Q

What HbA1C is diabetes

A

> 6.5

395
Q

How do you treat type 1 diabetes

A

Insulin

396
Q

How do you treat type 2 diabetes

A

Insulin and or diet and exercise

397
Q

Does type 1 or type 2 diabetes have more genetic transmission

A

Type 2

398
Q

Actions of insulin

A

Stimulates formation of glycogen

Stimulates glucose uptake from food

399
Q

What happens when there is insufficient insulin in the body

A

Increased glucagon,
Glycogenolysis
Gluconeogenesis
Ketogenesis

400
Q

Insulin deficiency and glucagon excess causes what changes in the blood

A

Increased blood ketones and glucose

401
Q

What causes vomiting in diabetes

A

Increased blood ketones

402
Q

What causes acidosis in diabetes

A

Increased blood ketones

403
Q

What causes osmotic diuresis in diabetes

A

Increased blood ketones and glucose

404
Q

What causes fluid and electrolyte depletion in diabetes

A

Vomitting and osmotic diuresis

405
Q

What causes acidosis in diabetes

A

Increased blood ketones

406
Q

What can cause shock in diabetes

A

Fluid and electrolyte depletion

407
Q

What can cause cerebral oedema in diabetes

A

Acidossi and fluid and electrolyte depletion

408
Q

How do you manage DKA

A 
Fluid
Insulin
Monitor glucose hourly
Monitor electrolytes 2 hourly
Strict fluid balance
Hourly neuro obs
409
Q

Autonomic hypo symptoms

A 
Irritable
Hungry
Nauseous
Shakey
Anxious
Sweaty
Palpitations
Pallor
410
Q

Neuro hypo symptoms

A 
Dizzy
Headache
Confused
Drowsy
Visual problems
Hearing loss
Problem concentrating
Hearing loss
Slurred 
Odd behaviour
LOC
Convulsions
411
Q

Mild hypo management

A

Check blood glucose to confirm

  • 5 glucose tablets
  • 200ml fizzy drink
  • 100ml lucozade
412
Q

Vomiting definition

A

Physical act that results in the gastric contents forcefully brought up to and out of the mouth.

  • contraction of abdo muscles and diaphragm
  • cardia of stomach is raised
  • pylorus is contracted
413
Q

Regurgitation definition

A

Effortless expulsion of gastric contents

414
Q

Rumination definition

A

Frequent regurgitation of ingested food (largely behavioural)

415
Q

Possetting definition

A

Small volume vomits during or between feeds in otherwise well child

416
Q

What are the 2 areas of the CNS involved in the vomiting reflex

A

Vomiting centre

Chemoreceptor trigger zone

417
Q

Receptors involved in vomiting reflex

A 
Muscarinic
Dopaminergic
Histaminergic
Serotonin
Substance P
418
Q

Triggers for vomitting

A 
Toxic material in lumen of GI tract
Visceral pathology
Vestibular disturbance
CNS stimulation
Toxins in blood or CSF
419
Q

Vomiting history

A 
Billious?
Bloody?
Projectile?
Age?
Febrile?
Other symptoms
Hydration?
420
Q

Red flags vomiting symptoms

A

Meningism
Costovertebral tenderness
Abdominal pain
ICP raised

421
Q

Vomiting examination

A 
General
Abdomen
Neurological
Plot growth
Hydration
Infection
Genetic problems?
422
Q

Causes of GI obstruction in children

A 
Pyloric stenosis
Malrotation and volvulus
Intestinal duplication
Hirschprungs
Foreign body
Incarcerated hernia
423
Q

GI problems that can cause vomiting

A 
Achalasia
Gastoparesis
Gastroenteritis
Peptic ulcer
Food allergy
IBD
Pancreatitis
Appendicitis
424
Q

Which other systems can cause vomiting

A 
Neuro (increased ICP)
Infections
Metabolic (toxins)
Renal (obstruction or renal insufficiency)
Toxic
Cardiac (Congestive HF)
Psychiatric
425
Q

Vomiting in neonates

A

Duodenal or other intestinal atresia

TEF

426
Q

Vomiting in newborn

A 
Gastroenteritis
Pyloric stenosis
Malroatation
TEF
NEC
Milk protein intolerance
427
Q

Vomiting in infant

A 
Gastroenteritis
UTI
GORD
Ingestion
Intusseseption
Milk protein intolerance
428
Q

Vomiting in child

A 
Gastroenteritis
UTI
DKA
Increased ICP
Appendicitis
429
Q

Vomiting in adolescent

A 
Gastroenteritis
Appendicitis
DKA
increased ICP
Eosinophilic oesophagitis
Bulimia
Pregnancy
430
Q

Describe malroation/ volvulus presentation

A

Bilious vomitnig, abdominal distension

431
Q

Describe malrotation/ volvulus management

A

Contrast study for diagnosis

Urgent surgical referral

432
Q

Describe presentation of hischprungs, meconium ileus and intestinal atresias

A

Delayed passage of meconium, abdominal distension, bilious vomiting

433
Q

Managmeent of hischprungs meconium ileus and intestinal atresias

A

Surgical referral

434
Q

Presentation of NEC

A

Usually pre term, abdominal distension, bilious vomiting

435
Q

Treatement of NEC

A

Antibiotics
Gut rest
Surgical referral

436
Q

First line investiagtions in vomiting

A

U&E, stool virology, abdominal X ray, surgical opinion, exclude systemic disease

437
Q

Consequences of vomiting

A 
Metabolic
Nutritional
Mechanical
Dental
Anaemia, stricture, aspiration
438
Q

Metabolic consequcnes of vomiting

A

Potassium deficiency
Alkalosis
Sodium depletion

439
Q

Mechanical consequences of vomiting

A

Mallory Weiss
Boerhaaves syndrome
Tears of short gastric arteries

440
Q

GORD symptoms

A 
Bilious vomiting
GI bleed
New onset vomiting
Failure to thrive
Bulging fonatenelle, spleen and liver
441
Q

Define GOR

A

Passage of gatric contents into the oesophagus with or without regurgitation or vomiting

442
Q

Define GORD

A

Presence of troublesome symptoms and or complications of persistent GOR

443
Q

What is used to diagnose GORD

A

pH studies

444
Q

Investigations for GORD

A

pH studies
Barium swallow
Endoscopy
PPI test

445
Q

Management of GORD

A 
Position
Thicken feeds
Change feeds
Antacid
H2 blocker
PPI
Surgery
446
Q

What is cows milk protein allergy associated with

A 
Atopy
IgA deficiency
IgA subclass anomaly
447
Q

Is cows milk protein allergy a multi system disease

A

Yes

  • GI
  • Respiratory
  • Skin
448
Q

Magement of cows milk protein allerg

A

Hydrolysed or amino acid feeds( AA if severe)

449
Q

How to diagnose cows milk protein allergy

A

Elimination diet

450
Q

Lactose intolerance symptoms

A

Explosive watery stools, abdo distension, flatulence, audible bowel sounds

451
Q

Lactose intolerance diagnosis

A

Stool chromatography, lactose hydrogen breath test, small bowel biopsy and elimination diet

452
Q

Lactose intolerance treatment

A

Lactose free formula, milk free diet, calcium and vitamin D supplements

453
Q

Define contipation

A

Infrequent passage of stool associated with pain and difficulty or delay in defecation

454
Q

Define encopresis

A

Involuntary faecal soiling or incontinence secondary to chronic constipation

455
Q

Cycle of functional constipation

A

Painful fecation
Voluntary witholding
Prolonged fecal stasis and reabsorption of fluids
More pain

456
Q

Consitpation red flags

A 
Delayed passage of meconium
Fever, vomiting, bloody diarrhea
Failure to thrive
Tight, empty rectum with presence of palpable abdominal faecal mass
Abnormal neuro mass
457
Q

Long term consequences of constipation

A

Acquired megacolon, anal fissures, overflow incontinence, behavioural problems

458
Q

Which investigations might you do in constipation

A 
T4/ TSH
Serum calcium
Coeliac panel
Sweat test
AXR
Anal manometry
Rectal biopsy
Spinal imaging
459
Q

Management of constipation

A 
Explanation of normal bowel function
Diet fluids and exercise
Behavioural advice
Toilet training advice
Simple reward schemes
460
Q

Name a bowel softener

A

Lactulose, liquid parrafin

461
Q

Name a bowel bulking agent

A

Fybogel

462
Q

Name a bowel laxative

A

Movicol

463
Q

name a bowel stimulant

A

Senna

Dulcolax

464
Q

Treatment of anal fissure

A

Anaesthetic cream

Vasodilator

465
Q

Define diarrhoea

A

Change in the consistency of stools and increase in the ferquency of evacuations with or without fever or vomiting which lasts less than 7 days and not longer than 14 days

466
Q

Viral causes of diarrhoea

A

Rotavirus
Calcivirus
Astrovirus

467
Q

Bacterial causes of diarrhoea

A

C. jejuni
Salmonella
E coli
Shigella

468
Q

Causes of acute diarrhoea

A 
infections
Hypersensitivity
Drugs
Haemolytic uraemic syndrome
Obstruction
469
Q

Presntation of acute diarrhoea

A 
Diarrhoea 
Bloody stools
Fever
Vomiting
Dehydration
Redueced conciousness
470
Q

Diarrheoa examination

A

Dehydration

  • cap refill
  • skin turgor
  • absent tears
471
Q

Investigations for diarrhoea

A

Stool microbiology
Glucose
U and E

472
Q

Consequences of chronic diarrhoea

A

Constipation
Food intolerance
Malabsorption

473
Q

Crohns features

A 
Mouth to anus
Transmural inflammation
Discontinous 
Granuloma
Rectal sparing
Fissures
Fistula
Abscesses and strictures
Perianal disease
474
Q

Ulcerative colitis features

A 
Colon only affected
Mucosal inflammation
Continous
No granuloma
No rectal sparing
Abscesses and strictures rare
Primary sclerosing cholangitis
475
Q

How is IBD different in kids

A

More crohns

476
Q

IBD consequences

A 
Growth
-delayed puberty
Reduced final adult height
Catch up growth
poor growth
477
Q

Treatment for crohns

A 
Steroids
Aminosalicylates
Antibiotics
Methotrexate
Infliximab
Surgery
478
Q

UC treatment

A

Corticosteroids then azathioprine in remission

479
Q

Acute causes of abdominal pain

A 
Appendicitis
Intussusception
Pancreatitis
Cholecystitis
Pneumonia
480
Q

Define chronic abdominal pain

A

Long lasting, intermittent or constant pain that is functional or organic

481
Q

Define abdominal pain

A

Abdominal pain without evidence of disease/ pathologic process

482
Q

Organic causes of abdo pain

A 
GORD
PUD
H pylori infection
Food intolerance
Coeliac disease
IBD
Constipation
UTI
Dysmenorrhoea
Pancreatitis
483
Q

Functional abdo pain causes

A

Functional dyspepsia
IBS
Functional abdo pain
Abdominal migraine

484
Q

Functional pain pathology

A

Physiologic stimuli
Noxoius stressful stimuli
Pyschological stressful stimuli

485
Q

Abdo pain red flags

A 
Involuntary weight loss
Reduced growth
Blood loss
Vomiting
Diarrhoea
RU lower quadrant
Fever
IBD family history
486
Q

Strabismus/ squint definition

A

Misallignment of one eye

487
Q

Define esotropia

A

Convergent manifest

488
Q

Define exotropia

A

Divergent manifest

489
Q

Define hypertropia

A

Upwards manifest

490
Q

Define hypotropia

A

Downwards manifest

491
Q

Manifest strabismus

A

You can see the difference

492
Q

Latent strabismus

A

No evidence when both eyes open. Cover one eye reveals misallignment

493
Q

Define esophoria

A

Latent convergent

494
Q

Define exophoria

A

Latent divergent

495
Q

Define hyperphoria

A

Latent upwards

496
Q

Define hypophoria

A

Latent donwards

497
Q

Symptoms of latent squints

A

Headaches
Eye symptoms
Intermittent diplopia

498
Q

Causes of strabismus

A

Often hereditary
Refractive error
Neurological problems

499
Q

What is hypermetropia

A

The image is focussed behind the retina

500
Q

What is secondary strabismus

A

Due to loss of vision in one eye

501
Q

Investigation of strabismus

A

History
Corneal reflections
Cover test

502
Q

What are you looking for in corneal reflections

A

Symmetry

503
Q

Causes of pseduostrabismus

A 
Narrow or wide eyes
Epicathic folds of skin
Facial assymetry
Ptosis unilateral
Deepset or prominent eyes
504
Q

Define amblyopia

A

Defective visual acuity which persists after correction of the refractive error and removal of any pathology

505
Q

How can you treat amblyopia

A

Glasses or occlusion of better eye

506
Q

Strabismus treatment

A

Glasses
Orthoptic exercises
Surgery
Botox

507
Q

Risk of strabismus

A

Development of amblyopia (lazy eye)

508
Q

Childrens act 1989

A

Parental responsibility

Safeguarding

509
Q

Who has parental responsibility

A

Whoever gives birth

Dad only if married

510
Q

How long can babies go unregistered

A

6 weeks

511
Q

Do dads have rights

A

Only if married or on birth certificate

512
Q

Childrens act 2004

A

CCG
Child protection
GP
Health

513
Q

Mental health act 1983

A

Applies to children

514
Q

When does the child get the right to refuse

A
  1. Can accept from 16
515
Q

Does mental capacity act apply to paediatrics

A

No

516
Q

What is deontology

A

What people do, not the consequence

517
Q

What is justice

A

Fair treatment

518
Q

Capacity

A

Understand
Retain
Weigh up
Communicate

519
Q

What age gestation do you resuscitate if the parents want

A

23 weeks

520
Q

At what gestation do you always resuscitate

A

24 weeks

521
Q

Gillick competence

A

Capacity

Fraser guidlines

522
Q

Hypo management moderate

A

As for mild but if needed, glucogel. Bread or biscuit. Check BG in 15 minutes

523
Q

Severe hypo managmenet

A

Dont give anything by mouth
Give glucagon
Give sugar when conscious

524
Q

Education for newly diagnosed diabetics

A 
Injections
Choice of devices
BG monitroing
Inuslin
Hypos
Sick day rules
Dietary glucose
Carb counting
Exercise advice
525
Q

Diabetes MDT

A 
Education
School
PDSNs
Diabetes UK
Local groups
526
Q

Aims of diabetes managmentt

A

Normal growth and development
Normal childhood
Avoidance of SE or hypos

527
Q

Common side effects of diabetes

A

Retinopathy
Nephropathy
Neuropathy
Microalbuminuria

528
Q

Where to examine in a diabetic

A 
Eyes
Urine
Feet
Blood pressure
Injection sites
529
Q

Do you give fat in a hypo

A

NO

530
Q

Do you give fluid or insulin first in DKA

A

Fluid

531
Q

Define oedema

A

Increase in interstitial fluid

532
Q

Describe oedema clinically

A

Swelling, pitting oedema, fluid moves under influence of gravity, ascites, pleural effusions, pulmonary oedema

533
Q

Causes of increased interstitial fluid

A

Lymphoedema
Venous obstruction
Low oncotic pressure
Salt and water retention

534
Q

Causes of. lyphoedema

A

Congenital blockage

535
Q

Causes of low oncotic pressure

A

Malnutrition
Decreased production by liver
Increased loss from gut or nephrotic syndrome

536
Q

Causes of salt and water retention

A

Kidney- impaired GFR

Heart failure

537
Q

3 symptoms of nephrotic syndrome

A

Heavy proteinuria
Hypoalbuminaemia
Oedema

538
Q

Hypoalbuminaemia consequences

A

Fluid retention

Oedema

539
Q

What is a 4th consequence of nephrotic syndrome

A

Hyperlipidaemia

540
Q

3 types of nephrotic syndrome

A

Congenital
Steroid sensitive
Steroid resistant

541
Q

Bile stained vomit is a sign of

A

Intestinal obstruction

542
Q

Haematemesis is a sign of

A

Oesophagitis, peptic ulceration, oral/nasal bleeding

543
Q

Projectile vomiting in the first few weeks of life is a sign of

A

Pyloric stenosis

544
Q

Vomiting at the end of paroxysmal coughing is a sign of

A

Whooping cough

545
Q

Abdominal distension and vomitting is a sign of

A

Intestinal obstruciton, including strangulated hernia

546
Q

Hepatosplenomegaly is a sign of

A

Chronic liver disease

547
Q

Blood in the stool is a sign of

A

Intussusception, gastroenteritis- salmonella or campylobacter

548
Q

Severe dehydration, shock is a sign of… in a vomiting child

A

Severe gastroenteritis, systemic infection (UTI, meningitis)

549
Q

Bulging fontanelle, vomitting and seizures in a child

A

Raised intracranial pressure

550
Q

Fialure to thrive causes (with vomiting)

A

GORD, coeliac, chronic GI conditions

Phase 3A (25 decks)

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