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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
What are ADHD at risk of
Risky behaviour
26
What birth age is likely to lead to ADHD
Preterm birth
27
New accurate test for ADHD
QB test
28
Causes of ADHD
Polygenetic CNS insults Environmental factors
29
CNS insults which can cause ADHD
Prematurity Fetal alcohol syndrome NF
30
Treatment of ADHD
``` Education Parenting programme School support Medications Examinations Healthy lifestyle ```
31
Which disease is high risk in ADHD
Cardiac disease
32
Treatments for ADHD
Stimulants or non stimulants
33
Stimulant for ADHD
Methylphenidate
34
Autism key areas
Social communication Social interaction Social imagination Sensory issues
35
Communication difficulties in autism
Lack of desire to communicate Communicating needs onlyu Disordered or delayed language
36
Language pause at 20 months is suggestive of
Autism
37
What is echolalia
repeating back, happens in autism
38
Social interaction in autism
``` 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 ```
39
Play interaction in autism
``` Using toys as objects Inability to play or write imaginatively Poor problem solving Resist change Obsessions and rituals ```
40
What are the differences in obsessions between OCD and ADHD
``` OCD= anxiety and upsetting ADHD= enjoyable and relaxing ```
41
What commonly coexists with Autism
ADHD
42
Management for autism
Education and information Parenting workshop School support Manage comorbidity
43
What aids are useful in ADHD
Visual aids
44
What should you consider in paediatric haemotology
Different referrence ranges, also depends on gestation
45
Where are blood cells made in childhood
At birth all bone marrow cavities, with age it is central bones
46
Which central bones produce stem cells in later childhood
Vertebrae Sternum Ribs Pelvis
47
Describe pluripotent stem cells
Develop into precursor cells that give rise to mature erythrocytes, monocytes, megacaryoctes or lymphocytes. Regulated by cytokines
48
3 mechanisms of anaemia
Decreased production Increased consumption Increased loss
49
What does low reticulocyte count suggest
Lack of production
50
What does high reticulocyte production suggest
Haemloysis or blood loss
51
Hypochromic microcytic anaemia
Iron deficiency | Thalassaemia
52
Normochromic normocytic anaemia
Chronic Blood loss Malignancy
53
Macrocytic anaemia
Vit B12 Folate Hypothyroid
54
High reticulocyte anaemia
Haemolytic
55
Causes of hameolysis
Haemoglobinopathy Enzymopathy Membranopathy Immune haemolytic anaemia
56
Causes of severe anemia at birth
Haemolytic disease of the newborn | Bleeding
57
Cause of haemolytic disease of the newborn
Rhesus negative mother, rhesus positive baby
58
Signs and symptoms of haemolytic disease of the newborn
Severe anemia | Compensatory enlargement of spleen and liver
59
Treatment of haemolytic disease of the newborn
Prevention of sensitisation with Rh. | Intrauterine transfusion of affected fetuses
60
Physiological anemia of the newborn
Fall in Hb from birth
61
Anaemia of prematuirty
Low birth weight infants have poor erythropoietin response
62
Iron deficiency anaemia
Poor intake and increased requirement Breast feeding and infection Much more dependent on dietary sources
63
Why do cows milk toddlers get anaemia
Reduces absorption of iron
64
Presentation of anaemia
``` Pallor Irritability Anorexia Tachycardia Murmur ```
65
Treatment of iron deficiency
Oral iron dose for 3-6 months (non compliance common)
66
What is haemolysis
Breakdown of red cells more rapidly than the body normal does
67
What is a consequence of haemolysis
Heart, liver and endocrine failure due to increased free iron
68
Intracorpuscular causes of haemolysis
Haemoglobin Enzyme Membrane
69
Extracorpuscular causes of haemoluysis
Autoimmune Fragmentation Hyper splenism Plasma factors
70
Iron overload treatment
Chelation
71
Haemolytic anaemia presentations
High bilirubin Hydrops Failure to thrive Stools
72
Haemoglobinopathies
Sickle cell and thalassemias
73
Sickle cell disease
Point mutation causes HbS to be produced
74
Thalassaemia
Imblance of the hemoglobin chains which means the tetramers dont form
75
What cells might be seen with anaemia on microscopy
Target cells
76
How is sickle cell found
Screened antenatally
77
Treatment for sickle cells
Prophylactic penicillin, immunisations
78
Sickle cell presentation
``` Always anaemia Infarction Infection Acute chest Iron overload ```
79
Sickle cell crisis
Bone pain due to sickling of cells in bones causing infarcts
80
Treatment for sickle cell crisis
Oxygen, antibiotics, opiates | Exchange transfusion
81
What is happening in thalassaemia
Reduced globin chain synthesis
82
Presentation of B thalassaemia minor
Asymptomatic | Mild anaemia, low MCV, riased Hb A2
83
Why dont you see thalassaemia at birth
Lots of HbF still
84
When does thalassaemia occur
6 months
85
B thalassaemia major presentation
``` Progressive severe anaemia Jaundice Splenomegaly Failure to thrive Skeletal deformity Delayed puberty Death ```
86
B thalassaemia major management
Genetic counselling Transfusions Iron chelation Bone marrow transplant
87
G6PD presentations
Neonatal jaundice Chronic anaemia Intermittent intravascular haemolysis
88
What food can cause G6PD
Fava beans
89
Hereditary spherocytosis
AD | Mild to needing transfusion
90
Pure red cell aplasia
RBC failure of bone marrow (parvovirus)
91
Clinical sign of parvovirus
Slapped cheeks
92
Bone marrow failure syndromes
All cell lines affected | fanconi's anaemia
93
Causes of bone marrow infiltration
Leuakaemia Lymphoma Neuroblastoma Osteoporosis
94
Requirements for haemostasis
Platelets Coagulation factors Vascular integrity
95
ITP
Bruises Petichiae Very low platelets
96
Name two bleeding disorders
Haemophilia | Von willebrand disease
97
Name three clotting disorders
Antithrombin, protein C, protein S
98
Von willebrand disease
Reduction in vwf for factor 8.
99
VW disease bleeds
Bleeding from nose and injuries etc
100
Haemophilia bleeds
Joint and muscle bleeds
101
Treatment for VWF
For bleeds/ surgery | Tranexamic acid
102
Haemophilia A and B
X linked recessive. factors 8 and 9.
103
Which factor is haemophilia A
8
104
Which factor is haemophilia B
9
105
Presentation of haemophilia
FHx Bruising Mouth bleeds Following trauma
106
Symptoms of leukaemia
``` Anaemia Infection Bleeding Systemic symptoms Organ infiltration ```
107
What is pathognomic of AML
Auer rod
108
What organisms cause tonsilitis
Gp A strep, adenovirus, EBV
109
What organisms cause epiglotitis
Haemophilius influenze B
110
What organism causes whooping cough
Pertussis
111
What organism causes otitis media
Pneumococcus | GpA strep
112
What organism causes Croup
Parainfluenza
113
What organism causes tracheitis
S. Aureus, strep A, haemophilius
114
What organism causes pneumonia
Strep A, pneumo, staph, haemophilus, TB
115
What organism causes bronchiolitis
RSV, rhino, flu, adeno paraflu
116
Varicella zoster virus presentation
Self limiting but deadly if secodnary staph or strep
117
Herpes simplex virus presentation
Stomatitis Simple cold sore Encephalitis Excema
118
Kawasaki disease presentation
``` Fever Rash Stomatitis Periphery change Adenopathy ```
119
Under 3 months fever investigations
FBC Blood culture CRP Urine culture
120
Child over 3 months fever investigations
FBC Blood culture CRP Urine culture
121
CSF bacterial findings
Raised cell count Raised protein Low glucose Bacteria identified or PCR
122
CSF viral findings
Raised cell count Normal protein Normal glucose Virus identified in CSF, stool, throat or blood
123
Baby looks sick and WCC under 10
Antibiotics
124
Antibiotic for under 3 months meningitis
Cefotaxime and amoxicillin
125
Treatment for herpes simplex virus
Aciclovir
126
Over 3 months mengitis treatment
Cefotaxime
127
Meningitis under 3 months organism
GpB strep
128
Meningitis over 3 months organism
Meningococcus, pneumococcus, haemophilus influenza
129
Meningitis symptoms
``` Neck stiffness Sensitive to light Drowsy Irritable Vomit Headache Full fontanelle ```
130
Septicaemia symptoms
Red non blanching rash Cold hands and feet Tachypnoea Flu like symptoms
131
Bronchiolitis findings
Bilateral crackles and wheeze
132
Which antibody moves across the placenta
IgG
133
10 warning signs of primary immunodeficiency
``` 4+ ear infections 2+ sinus infections 2+ months on antibiotics 2+ pneumonia Failure to grow Recurrent abscesses Thrush IV antibiotics Sepsis FHx ```
134
Treatment of primary immunodeficiency
Antibiotic prophylaxis Prompt treatment of infections Replacement Ig Bone marrow transplant
135
TB screening test
Mantoux test
136
In very young how do stats compare to adult
HR high RR high BP low Temp same
137
Where does croup affect
Below the larynx
138
Respiratory distress symptoms
Recessions Head nod Tracheal tug Cyanosis
139
3 things happening in asthma
Increase mucous production Inflammation and oedema Bronchoconstriction
140
Anaphylaxis affect on the lungs
Bronchospasm | Laryngospasm
141
How do you assess circulation
Capillary refill Blood pressure Heart rate Colour
142
What is a very good surrogate sign to monitor for shock
Urine output
143
Why does lactate rise in shock
Increased anabolic metabolism
144
Causes of increased intercranial pressure
Space occupying lesion Hydrocephalus Trauma
145
Why does 6th nerve palsy occur
Longest intercranial route
146
How does heart rate and metabolism differ with temperature
Every degree increased is heart rate +10
147
What things are higher in children (relating to fluid balance)
Surface/ mass Metabolism Respiratory rate
148
What things are lower in children (relating to fluid balance)
Response to thirst Independence Glomerular filtration
149
% loses in children of water
Urine 60% Skin and lungs 35% Stool 5%
150
Reasons for reduced fluid intake
``` Dysphagia Neurodisability Vomiting Behavioural Psychiatric Social ```
151
Reasons for increased fluid losses
Gut Kidneys Skin Lungs
152
Gut causes of increased fluid loss
Gastroenteritis IBD Stoma
153
Kidney causes of increased fluid losses
Renal tubular disease | Renal dysplasia
154
Skin causes of increased fluid losses
Burns | Sepsis
155
Signs of mild dehydration
Thirst Dry lips Reslessness Irritbaility
156
Signs of moderate dehydration
Sunken eyes Reduced skin turgor Decreased urine output
157
Signs of severe dehydration
Reduced consciousness Cold Mottled peripheries Anuria
158
Chronic dehydration consequences
``` Failure to thrive Malnutrition Developmental delay Constipation UTIs ```
159
How much fluid to a child
Maintenance + 50ml/kg
160
Which fluid do you give to neonates
10% glucose
161
How do you estimate weight in kilo
(Age + 4)x 2
162
Which fluid do you give children for maintenance
0.9% sodium chloride + 5% glucose
163
Less than 10kg how much fluid
100ml/kg/day
164
10-20kg how much fluid
50ml/kg/day
165
20+ kg how much fluid
20ml/kg/day
166
How much fluid to give to a shocked child
100ml/kg extra
167
Side effects of too much fluid
Oedema Renal problems Hyponatraemia Cerebreal oedema
168
What is fluid bolus (exam question)
20mls/kg of 0.9% sodium chloride
169
Treatment of DKA in children
10mls/kg 0.9% sodium chloride
170
How much is too much fluid
More than 100ml in an hour
171
Procedural issues with paediatric radiology
Are they starved
172
Anatomy differences between adults and children
Flexible skeleton Growth plates Plastic bones
173
Why do children loose more heat
Greater surface area to volume ratio
174
Disease of newborns but not adults
Congenital
175
Disease of adults but not newborns
Coronary artery disease Strokes Lung cancer
176
Parent worries about radiology
Radiation | Invasive procedures
177
Why are children susceptible to mutations
Rapidly turning over cells
178
High radiation scans
CT Nuclear medicine PET
179
Low radiation scns
MRI | US
180
Name of end of bone
Epiphysis
181
Name of bit near the end of bone
Metaphysis
182
Where does the bone grow from
Metaphysis
183
What is the shaft of a bone called
Diaphysis
184
Where is the lamboid suture
At the back
185
Name of heart on wrong side
Dextrocardia
186
What is inverted whole system
Situs invertus
187
Fragile bones name
Oesteogensis imperfecta
188
What are the key radiological differences between childrens and adults
Size Normal anatomy Congenital problems Lines and tubes
189
A normal chest xray should be
``` A good quality film No trachea No mediastinal deviation Lungs should be clear Heart borders and diaphragm ```
190
Why measure growth
Sensitive pointer to health problems in children. Growth is narrowly defined in healthy children with adequate nutrition and an emotionally supportive environment
191
Determinants of growth
``` Parental phenotype and genotype Quality and duration of pregnancy Nutrition Specific system and organ integrity Psycho social Growth hormones and factors ```
192
What is chondrogenesis
Growth
193
What regulates growth at a cellular level
Endocrine signals Nutrition Extracellular fluid Inflammatory cytokines
194
What needs to be considered when assessing growth
Parental heights Social inequalities Ethnic background
195
Body proportions of newborn
Larger head, smaller mandible, short neck, rounded chest, prominent abdomen, short limbs
196
Hormone growth problem classic patient
Short and fat
197
Body proportions of adults
Relative growth of limbs compared to trunk
198
What does short limbs suggest
Hypochondroplasia
199
What does short back and long legs suggest
Delayed puberty
200
What measurements are used for growth
Standing height Lying height Sitting height
201
Factors that affect head circumference
Centile position Relation to body size Sutures and fontanelles Familial factors
202
Reasons for unreliable growth measurements
Inaccuracy Uncooperative child Differenct observers Different times of the day
203
Key problem with the normal growth charts in UK
White UK children
204
3 phases of growth
Infant Mid childhood Puberty
205
What is infant growth phase dependent on
Nutrition
206
What is midchildhood growth phase dependent on
Brain
207
What is pubertal growth phase dependent on
Hormones and pregnancy
208
Two common causes of low height
Familial short stature | Constituional delay in growth and puberty
209
Which hormone is needed for fusion of the growth plates
Oestrogen
210
What is an indicator of true male puberty
Testes over 3ml (tanner 2)
211
Klinefelter symptoms
Pubertal problems (small testes, less hair) Azoospermia, gynaecomastia Tall stature Osteoporosis
212
Primary hypogonadism or hypergonadism, where is the problem
Primary
213
Secondary hypogonadism or hypergonadism, where is the problem
Pituitary
214
Tertiary hypogonadism or hypergonadism, where is the problem
Hypothalamus
215
Name of the pubertal growth stages
Tanner stages
216
What is the indicator of true female pubery
Breast bud palpable (tanner 2)
217
Klinefelter (boys) chromosomes
47, XXY
218
Turner (girls) syndrome chromosomes
45, X0
219
Turner presentation
``` Oedema at birth Upper airway infections High arch palate Cardiovacular and renal malformations Short stature ```
220
Hypergonadotrophic hypogonadism
Turners
221
Primary hypogonadism
Klinefelters
222
Normal range of puberty for girls
8-13
223
Normal range of puberty for boys
9-14
224
Which race goes into puberty early
Black
225
Why arent some hand bones seen in children
Theyre sitll cartilage
226
Factors that affect birth weight
``` Maternal size and weight Parity Gestational diabetes Smoking Paternal size ```
227
Common associations of poor growth of children
``` Vomiting Dysmorphic features Diarrhoea Poor social circumstances Actual weight loss ```
228
Common causes of short stature
``` Constitutional Idiopathic Environmental Nutrition Physical disease Skeletal disease Turners Endocrine ```
229
Chronic diseases that cause short stature
``` Coeliac disease IBD Congenital heart disease Chronic anaemia Cystic fibrosis Chronic infection ```
230
Overgrowth with impaired final height causes
Precocious puberty Congenital adrenal hyperplasia McAlbright syndrome Hyperthyroid
231
Overgrowth with increased final height
Androgen or oestrogen deificency GH excess Klinefelter Marfan
232
What social factors can cause growth restriction
Emotional rejection | Abuse
233
Consequence of obesity in children
Non alcoholic fatty liver disease
234
What is a guide for communicating with teenagers (HEADDSSS)
``` Home Education Activities Drugs and alcohol Depression Sexual health Spirituality Sleep ```
235
What is a limp
Assymetric lower limb movement when walking
236
Causes of limp
Pain Weakness Irritability Shortening
237
History points for limping child
``` Age Pain Trauma Acute or chronic Red flags ```
238
Age under 4 limping child
Toddlers fracture
239
Age 4-10 limping child
Transient synovitis | Legg Calve Perthes disease
240
Age 10+ limping child
Osgood schlatter disease | SCFE
241
SCFE (SUFE)
Slipped capital femur epithysis
242
Two problems which can affect any age causing limping
Oesteomyelitis | Septic arthritis
243
Questions for osteogenesis imperfecta
Blue sclera Family history Deficient Social history
244
Toddlers fracture
Undisplaced spiral fracture
245
What prevents toddlers bones displacing
Periosteum (much thicker in children)
246
Greenstick fracture
Bending fracture with intact periosteum
247
Acute limping child
Trauma
248
Chronic limping child
Infection | SUFE
249
Red flags limping child
``` Night pain Sweats Weight loss Unexplained rash or bruising Stiffness ```
250
What does stiffness suggest
Pathology inside joint capsule
251
Henlock shlong purpuria
Can cause joint pain
252
Severe pain, anxiety and agitation after a traumatic injury.
Compartment syndrome
253
How does compartment syndrome work
Increased pressure leads to stop of blood flow and necrosis
254
Examination of limping child
Temperature Rotational profile Joint movements Spine and neurological
255
Criteria for septic arthritis
Kocher criteria
256
Kocher criteria
Non weight bearing Pyrexia WCC high ESR high
257
Perthes disease
Idiopathic avascular necrosis of proximal femoral epiphysis
258
What is the name of the growth plate
Physis
259
Perthe disease associations
Low birth weight | Family history
260
Fat adolescent boy limping
SUFE/ SCFE
261
What is SUFE
Slippage of the metaphysis relative to the epiphysis
262
SUFE associations
Obesity Family history Hypothyroidism
263
What line is used for diagnosis of SUFE
Frog legs view xray with Klein lines
264
Klein lines
If line from femoral head doesnt intersect epiphysis then its SUFE
265
Define child development
Biological, pscyhological and emotional changes that occur between birth and adolescence as the individual progresses from dependency to increasing autonomy
266
What affects healthy development
``` 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
4 Domains of development
Gross motor Fine motor and vision Speech, language and hearing Social interaction and self care
268
When is median for walking
12 months
269
When is worrying for walking
18 months
270
When should baby reflexes diasappear
6 months
271
Name 5 baby reflexes
``` Moro Grasp Rooting Placing Atonic neck reflex ```
272
Moro reflex
Sudden head extension causes symmetrical extension followed by flexion of all limbs. Goes at 4 months (4 letters)
273
Gross motor progression (to 1 year walking)
Flexed arms and legs equal movmeents, Lifts head Rolls, sits unsupported Pulls to stand
274
What do you do at 6 months
Sit
275
Gross motor progression (from 1 year walking)
``` Walking Walk up stairs Jumps Hops Rides bike ```
276
Fine motor and vision development
``` 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
What are you aiming for within a year
1 word with meaning
278
Speech and language and hearing progression (to 1 year)
Laughs and squeels Dada, mama 1 word
279
How many words at 2
2 word sentences
280
How many words at 3
3 word understandably
281
What speech at 4
Knows colours, can count to 5
282
What should you be able to understand at 2
2 part instructions
283
What should you be able to understand at 3
3 part instructions
284
When should you be smiling
6 weeks
285
Social self care, 1 year goal
Uses spoon/fork
286
Development of social self care (to 1 year)
Smiles spontaneously Finger feeds Waves bye bye Uses spoon/fork
287
Can children dress themselves when they go to school
yes
288
Red flags gross motor
Not sitting by a year | Not walking at 18
289
Fine motor red flags
Hand preference before 18 months
290
Speech and language red flags
Not smiling at 3 months | No clear words by 18months
291
Social development red flags
No response to carers by 8 weeks | Not playing with peers by 3 years
292
Tools for developmental assessment
Screening tool | Schedule of growing skills, Griffiths and baileys
293
5 categories of causes of childhood developmental delay
``` Genetics Factors in pregnancy Factors around birth Factors in childhood Environmental factors ```
294
Good easy test for developmental delay
Microarray (and bloods)
295
Definition of disability
Someone who has a physical or mental impairment that results in marked, pervasive limitation of activity
296
Impairment definition
An abnormality of loss of function
297
Physical impairment examples
Cerebral palsy, brain injury, neuromuscular disorders, musculoskeletal conditions
298
Sensory impairments example
Hearing and visual impairments
299
Neurodevelopmental impairments
ADHD, autism
300
Emotional/ behavioural impairments
Depression conduct disorder, attachment disorder
301
Disability determinates
Biopsychosocial model
302
WHO disability assessment schedule has 6 domains of functioning
``` Cognition Mobility Self care Social Life activities Participation ```
303
Steps in supporting children with impairments
Holistic assessments Address medical, social, environmental and psychological factors for best outcomes Child focused Involves work with a multi disciplinary team
304
Aspects of health education social care
``` Physiotherapy SALT Dietician Doctors GP Early years inclusion Housing support Social worker Team around child meetings ```
305
Name paediatric cancers
``` Wilms Neuroblastoma Rhabdomyosarcoma Leukaemia Bone tumours Lymphoma ```
306
Presentation of paediatric malignancy
Localised mass Problems from disseminated disease Problems from localised mass
307
What does not finishing a feed suggest
Anaemia
308
Bone marrow infiltration symptoms
Pain Easy bruising Infections Anaemia
309
Recent URTI, pale and tired
Post viral or leukaemia
310
Lump in neck otherwise well
Atypical mycobacteria or hodgkins
311
Early morning headache
Sinusitis or brain tumour
312
Recurrent fever and bone pain
Arthritis Leukaemia Ewings Neuroblastoma
313
Abnormal red reflex in eye
Retinoblastoma
314
Proptosis
Infection, neuroblastoma, rhabdomyosarcoma
315
Recurrent discharging ear
Infection Rhabdomyosarcoma LCH
316
Acute leukaemia presentation
``` Fever Fatigue Frequent infections Lymphadenopathy Hepatomegaly and splenomegaly Anaemia Bruising, petechiae Bone or joint pain ```
317
Acute leukaemia investigations
``` Blood film Serum chemistry CXR Bone marrow and aspirate Lumbar puncture ```
318
5 phases of chemotherapy
``` Induction Consolidation Interim maintenance Delayed intesification Maintenance ```
319
When do you give stem cell transplant in leukaemia
High risk patients in first remission | Relapsed patients
320
CNS tumours
``` Headache Vomiting Papilloedema Squint Nystagmus Ataxia Personality of behaviour change ```
321
Not doing something they used to be doing
Very bad sign
322
Worrying signs with headache
``` Pappiloedema Decreased acuity, visual loss Neuro signs Recurrent or early morning Vomiting Reduced growth DI Under 3 years old ```
323
CNS tumours treatment
Surgery Chemotherapy Radiotherapy (not brain)
324
Lymphadenopathy causes
HIV infection AI conditions Storage disorders Malignancy
325
Bad signs with lymphadenopathy
``` Enlarging Persistent Unusual site Fever, weight loss, enlarged liver/ spleen Abnormal CXR ```
326
Lymphoma therapy
Chemotherapy Radiotherapy Surgery
327
What is wilms tumour
Renal mass
328
Abdominal mass symptoms
``` Pain Haematuria Constipation Hypertension Weight loss ```
329
Investigations for abdominal mass
Ultrasound CT scans Biopsy
330
Neuroblastoma treatment
Surgery Chemotherapy Radiotherapy
331
Wilms tumour treatment
Chemotherapy Surgery Radiotherapy
332
Symptoms of retinoblastoma
Loss of red reflex and squint
333
Late effects of cancer treatment
``` Endocrine Intellectual Cardiac toxicity Renal toxicity Fertility Psychological ```
334
When do you break most bones
Peak growth velocity
335
Factors affecting fracture rates
Growth Activity Trauma Fragility
336
Define osteoporosis
Disease characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility
337
Two categories of osteoporosis causes
Inherited (osteogenesis imperfecta) Acquired (steroids)
338
Acquired causes of osteoporosis
``` Drug induced Endocrinopathies Malabsorption Immobilisation Inflammation ```
339
Osteogensis imprefecta observations
Fragility, fractures, deformity. Bone pain. Impairs mobility and growth
340
Common treatment for osteoporosis in children
Bisphosphonates
341
Key roles of vitamin D
Makes calcium available Maternal VitD influences bone size and mass Role in immune function and tolerance
342
Presentation of Vit D deficiency
``` Bowed legs Hypocalcaemic convulsions Gross motor delay X-Ray finding Swollen ankle Carpopedal spasm ```
343
Causes of vitamin D deficiency
Maternal vit D insufficiency Lack of exposure to sunlight Lack of vit D in diet
344
Pathologically what is rickets
Failure to mineralise new bone
345
Presnetation of rickets
``` Metaphyseal swellings Bowing deformity Slowed linear growth Motor delay Hypotonia Fractures Respiratory distress ```
346
Biochemical changes in rickets
Low phosphate | Raised AlkPhos
347
Vit D defiency chemical changes
Raised PTH | Low 25 OH-D
348
Vitamin D deficiency treatment
Vitamin D (+- calcium)
349
Vit D facts
Steroid like substance Fat soluble Specific DNA response elements
350
Define self harm
Act with intent to hurt self
351
Define suicide attempt
Act with intent to kill self
352
Do more boys or girls self harm
Girls
353
Do more boys or girls commit suicide
Boys
354
Reasons for self harm
Release tension, make self feel, search for help
355
Best treatment for bullying
Interpersonal therapy
356
CAHMS self harm assessment
``` STAR team assessment Psychological intervention CBT therapy Family therapy Pharmacological intervention ```
357
Is self harm present in nature
Obsessive behaviour | Desire to cope better with internal conflicts
358
What factors can predispose to self harm in young children
Communication difficulties
359
How does depression differ from low mood
Depression is low mood + anhedonia + reduced energy leading to increased fatiguability and diminished activity
360
What is terminal insomnia
Early morning waking. REM sleep comes earlier
361
Criteria for depression affects
Pervasive, persistent, affects other domains of life, persists through different environments
362
Why is depression diagnosis hard in children
They are bad communicators
363
Child symptom of depression
Regression - clinging - bed wetting/ thumb sucking - 3 wish test
364
How to find distressors in children
3 wish test
365
Things that can cause progression from depression to suicide
``` No support Better to be dead Death wishes Plan Attempt Suicide ```
366
Biological basis of depression
Low trypotophan Low serotonin HPA dysregulation Low 5HIAA
367
Risk factors in self harm behaviour
``` Intent Lethality Comorbid mental illness Depression Psychosis PHx FHx Substance abuse ```
368
Which hallucinations are worrying for self harm
Commanding voices Thought echo Discussing auditory hallucinations
369
Where does ductus arteriosus join
Pulmonary artery and descending aorta
370
Where does the formane ovale join
right and left atria
371
Describe ASD clinical signs
Fixed and widely split S2 | Ejection systolic in pulmonary area
372
What symptoms do you get with ASD
Asymptomatic when younger and can get palpitations when older
373
Name three types of ASD
Ostium secundum Ostium primum Sinus venosus ASD
374
PDA clinical presentation
Preterm | Poor feeding, failure to thrive, tachypnoea
375
Clinical signs of PDA
Active precordium, thrill, gallop rhythm Continuous machinery murmur pulmonary area Hepatomegaly Oedema
376
VSD clinical presentation
poor feeding failure to thrive tachypnoea
377
Clinical signs of VSD
Active precordium, thrill, gallop rhythm Pansystolic murmur Hepatomegaly Oed
378
Where does VSD murmur radiate
USE and axillae
379
What is a common defect in trisomy 21
Atrioventricular septal defect
380
What can AVSD lead to
Pulmonary vascular disease
381
AVSD clinical presentation
Poor feeding, failure to thrive, tachypnoea
382
Clinical signs in coarctation of the aorta
Weak femoral pulse 4 Limb BP Murmur over back in older children
383
If duct has closed in coarctation of aorta how will a baby present
Collapsed and acidotic
384
Clinical findings of pulmonary stenosis
Ejection systolic murmur LUSE Radiates to back Right ventricular heave
385
Cyanotic heart conditions
Tetralogy of fallot | Transposition of the great arteries
386
Presentation of cyanotic congenital heart disease (ToF, TpOGA)
Cyanosis Acidosis Collapse/ death
387
What mutation should you check for in tetralogy of fallot
22q deletion
388
Normal range for fasting plasma glucose
3.5-5.6
389
Normal range for post prandial plasma glucose
<7.8
390
What fasting glucose is diabetes diagnostic
>7
391
What fasting glucose is prediabetes
<7
392
What fasting glucose is normal
3.5-5.6
393
What post Oral Glucose Tolerance test is diabetes
>11.1
394
What HbA1C is diabetes
>6.5
395
How do you treat type 1 diabetes
Insulin
396
How do you treat type 2 diabetes
Insulin and or diet and exercise
397
Does type 1 or type 2 diabetes have more genetic transmission
Type 2
398
Actions of insulin
Stimulates formation of glycogen | Stimulates glucose uptake from food
399
What happens when there is insufficient insulin in the body
Increased glucagon, Glycogenolysis Gluconeogenesis Ketogenesis
400
Insulin deficiency and glucagon excess causes what changes in the blood
Increased blood ketones and glucose
401
What causes vomiting in diabetes
Increased blood ketones
402
What causes acidosis in diabetes
Increased blood ketones
403
What causes osmotic diuresis in diabetes
Increased blood ketones and glucose
404
What causes fluid and electrolyte depletion in diabetes
Vomitting and osmotic diuresis
405
What causes acidosis in diabetes
Increased blood ketones
406
What can cause shock in diabetes
Fluid and electrolyte depletion
407
What can cause cerebral oedema in diabetes
Acidossi and fluid and electrolyte depletion
408
How do you manage DKA
``` Fluid Insulin Monitor glucose hourly Monitor electrolytes 2 hourly Strict fluid balance Hourly neuro obs ```
409
Autonomic hypo symptoms
``` Irritable Hungry Nauseous Shakey Anxious Sweaty Palpitations Pallor ```
410
Neuro hypo symptoms
``` Dizzy Headache Confused Drowsy Visual problems Hearing loss Problem concentrating Hearing loss Slurred Odd behaviour LOC Convulsions ```
411
Mild hypo management
Check blood glucose to confirm - 5 glucose tablets - 200ml fizzy drink - 100ml lucozade
412
Vomiting definition
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
Regurgitation definition
Effortless expulsion of gastric contents
414
Rumination definition
Frequent regurgitation of ingested food (largely behavioural)
415
Possetting definition
Small volume vomits during or between feeds in otherwise well child
416
What are the 2 areas of the CNS involved in the vomiting reflex
Vomiting centre | Chemoreceptor trigger zone
417
Receptors involved in vomiting reflex
``` Muscarinic Dopaminergic Histaminergic Serotonin Substance P ```
418
Triggers for vomitting
``` Toxic material in lumen of GI tract Visceral pathology Vestibular disturbance CNS stimulation Toxins in blood or CSF ```
419
Vomiting history
``` Billious? Bloody? Projectile? Age? Febrile? Other symptoms Hydration? ```
420
Red flags vomiting symptoms
Meningism Costovertebral tenderness Abdominal pain ICP raised
421
Vomiting examination
``` General Abdomen Neurological Plot growth Hydration Infection Genetic problems? ```
422
Causes of GI obstruction in children
``` Pyloric stenosis Malrotation and volvulus Intestinal duplication Hirschprungs Foreign body Incarcerated hernia ```
423
GI problems that can cause vomiting
``` Achalasia Gastoparesis Gastroenteritis Peptic ulcer Food allergy IBD Pancreatitis Appendicitis ```
424
Which other systems can cause vomiting
``` Neuro (increased ICP) Infections Metabolic (toxins) Renal (obstruction or renal insufficiency) Toxic Cardiac (Congestive HF) Psychiatric ```
425
Vomiting in neonates
Duodenal or other intestinal atresia | TEF
426
Vomiting in newborn
``` Gastroenteritis Pyloric stenosis Malroatation TEF NEC Milk protein intolerance ```
427
Vomiting in infant
``` Gastroenteritis UTI GORD Ingestion Intusseseption Milk protein intolerance ```
428
Vomiting in child
``` Gastroenteritis UTI DKA Increased ICP Appendicitis ```
429
Vomiting in adolescent
``` Gastroenteritis Appendicitis DKA increased ICP Eosinophilic oesophagitis Bulimia Pregnancy ```
430
Describe malroation/ volvulus presentation
Bilious vomitnig, abdominal distension
431
Describe malrotation/ volvulus management
Contrast study for diagnosis | Urgent surgical referral
432
Describe presentation of hischprungs, meconium ileus and intestinal atresias
Delayed passage of meconium, abdominal distension, bilious vomiting
433
Managmeent of hischprungs meconium ileus and intestinal atresias
Surgical referral
434
Presentation of NEC
Usually pre term, abdominal distension, bilious vomiting
435
Treatement of NEC
Antibiotics Gut rest Surgical referral
436
First line investiagtions in vomiting
U&E, stool virology, abdominal X ray, surgical opinion, exclude systemic disease
437
Consequences of vomiting
``` Metabolic Nutritional Mechanical Dental Anaemia, stricture, aspiration ```
438
Metabolic consequcnes of vomiting
Potassium deficiency Alkalosis Sodium depletion
439
Mechanical consequences of vomiting
Mallory Weiss Boerhaaves syndrome Tears of short gastric arteries
440
GORD symptoms
``` Bilious vomiting GI bleed New onset vomiting Failure to thrive Bulging fonatenelle, spleen and liver ```
441
Define GOR
Passage of gatric contents into the oesophagus with or without regurgitation or vomiting
442
Define GORD
Presence of troublesome symptoms and or complications of persistent GOR
443
What is used to diagnose GORD
pH studies
444
Investigations for GORD
pH studies Barium swallow Endoscopy PPI test
445
Management of GORD
``` Position Thicken feeds Change feeds Antacid H2 blocker PPI Surgery ```
446
What is cows milk protein allergy associated with
``` Atopy IgA deficiency IgA subclass anomaly ```
447
Is cows milk protein allergy a multi system disease
Yes - GI - Respiratory - Skin
448
Magement of cows milk protein allerg
Hydrolysed or amino acid feeds( AA if severe)
449
How to diagnose cows milk protein allergy
Elimination diet
450
Lactose intolerance symptoms
Explosive watery stools, abdo distension, flatulence, audible bowel sounds
451
Lactose intolerance diagnosis
Stool chromatography, lactose hydrogen breath test, small bowel biopsy and elimination diet
452
Lactose intolerance treatment
Lactose free formula, milk free diet, calcium and vitamin D supplements
453
Define contipation
Infrequent passage of stool associated with pain and difficulty or delay in defecation
454
Define encopresis
Involuntary faecal soiling or incontinence secondary to chronic constipation
455
Cycle of functional constipation
Painful fecation Voluntary witholding Prolonged fecal stasis and reabsorption of fluids More pain
456
Consitpation red flags
``` 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
Long term consequences of constipation
Acquired megacolon, anal fissures, overflow incontinence, behavioural problems
458
Which investigations might you do in constipation
``` T4/ TSH Serum calcium Coeliac panel Sweat test AXR Anal manometry Rectal biopsy Spinal imaging ```
459
Management of constipation
``` Explanation of normal bowel function Diet fluids and exercise Behavioural advice Toilet training advice Simple reward schemes ```
460
Name a bowel softener
Lactulose, liquid parrafin
461
Name a bowel bulking agent
Fybogel
462
Name a bowel laxative
Movicol
463
name a bowel stimulant
Senna | Dulcolax
464
Treatment of anal fissure
Anaesthetic cream | Vasodilator
465
Define diarrhoea
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
Viral causes of diarrhoea
Rotavirus Calcivirus Astrovirus
467
Bacterial causes of diarrhoea
C. jejuni Salmonella E coli Shigella
468
Causes of acute diarrhoea
``` infections Hypersensitivity Drugs Haemolytic uraemic syndrome Obstruction ```
469
Presntation of acute diarrhoea
``` Diarrhoea Bloody stools Fever Vomiting Dehydration Redueced conciousness ```
470
Diarrheoa examination
Dehydration - cap refill - skin turgor - absent tears
471
Investigations for diarrhoea
Stool microbiology Glucose U and E
472
Consequences of chronic diarrhoea
Constipation Food intolerance Malabsorption
473
Crohns features
``` Mouth to anus Transmural inflammation Discontinous Granuloma Rectal sparing Fissures Fistula Abscesses and strictures Perianal disease ```
474
Ulcerative colitis features
``` Colon only affected Mucosal inflammation Continous No granuloma No rectal sparing Abscesses and strictures rare Primary sclerosing cholangitis ```
475
How is IBD different in kids
More crohns
476
IBD consequences
``` Growth -delayed puberty Reduced final adult height Catch up growth poor growth ```
477
Treatment for crohns
``` Steroids Aminosalicylates Antibiotics Methotrexate Infliximab Surgery ```
478
UC treatment
Corticosteroids then azathioprine in remission
479
Acute causes of abdominal pain
``` Appendicitis Intussusception Pancreatitis Cholecystitis Pneumonia ```
480
Define chronic abdominal pain
Long lasting, intermittent or constant pain that is functional or organic
481
Define abdominal pain
Abdominal pain without evidence of disease/ pathologic process
482
Organic causes of abdo pain
``` GORD PUD H pylori infection Food intolerance Coeliac disease IBD Constipation UTI Dysmenorrhoea Pancreatitis ```
483
Functional abdo pain causes
Functional dyspepsia IBS Functional abdo pain Abdominal migraine
484
Functional pain pathology
Physiologic stimuli Noxoius stressful stimuli Pyschological stressful stimuli
485
Abdo pain red flags
``` Involuntary weight loss Reduced growth Blood loss Vomiting Diarrhoea RU lower quadrant Fever IBD family history ```
486
Strabismus/ squint definition
Misallignment of one eye
487
Define esotropia
Convergent manifest
488
Define exotropia
Divergent manifest
489
Define hypertropia
Upwards manifest
490
Define hypotropia
Downwards manifest
491
Manifest strabismus
You can see the difference
492
Latent strabismus
No evidence when both eyes open. Cover one eye reveals misallignment
493
Define esophoria
Latent convergent
494
Define exophoria
Latent divergent
495
Define hyperphoria
Latent upwards
496
Define hypophoria
Latent donwards
497
Symptoms of latent squints
Headaches Eye symptoms Intermittent diplopia
498
Causes of strabismus
Often hereditary Refractive error Neurological problems
499
What is hypermetropia
The image is focussed behind the retina
500
What is secondary strabismus
Due to loss of vision in one eye
501
Investigation of strabismus
History Corneal reflections Cover test
502
What are you looking for in corneal reflections
Symmetry
503
Causes of pseduostrabismus
``` Narrow or wide eyes Epicathic folds of skin Facial assymetry Ptosis unilateral Deepset or prominent eyes ```
504
Define amblyopia
Defective visual acuity which persists after correction of the refractive error and removal of any pathology
505
How can you treat amblyopia
Glasses or occlusion of better eye
506
Strabismus treatment
Glasses Orthoptic exercises Surgery Botox
507
Risk of strabismus
Development of amblyopia (lazy eye)
508
Childrens act 1989
Parental responsibility | Safeguarding
509
Who has parental responsibility
Whoever gives birth | Dad only if married
510
How long can babies go unregistered
6 weeks
511
Do dads have rights
Only if married or on birth certificate
512
Childrens act 2004
CCG Child protection GP Health
513
Mental health act 1983
Applies to children
514
When does the child get the right to refuse
18. Can accept from 16
515
Does mental capacity act apply to paediatrics
No
516
What is deontology
What people do, not the consequence
517
What is justice
Fair treatment
518
Capacity
Understand Retain Weigh up Communicate
519
What age gestation do you resuscitate if the parents want
23 weeks
520
At what gestation do you always resuscitate
24 weeks
521
Gillick competence
Capacity | Fraser guidlines
522
Hypo management moderate
As for mild but if needed, glucogel. Bread or biscuit. Check BG in 15 minutes
523
Severe hypo managmenet
Dont give anything by mouth Give glucagon Give sugar when conscious
524
Education for newly diagnosed diabetics
``` Injections Choice of devices BG monitroing Inuslin Hypos Sick day rules Dietary glucose Carb counting Exercise advice ```
525
Diabetes MDT
``` Education School PDSNs Diabetes UK Local groups ```
526
Aims of diabetes managmentt
Normal growth and development Normal childhood Avoidance of SE or hypos
527
Common side effects of diabetes
Retinopathy Nephropathy Neuropathy Microalbuminuria
528
Where to examine in a diabetic
``` Eyes Urine Feet Blood pressure Injection sites ```
529
Do you give fat in a hypo
NO
530
Do you give fluid or insulin first in DKA
Fluid
531
Define oedema
Increase in interstitial fluid
532
Describe oedema clinically
Swelling, pitting oedema, fluid moves under influence of gravity, ascites, pleural effusions, pulmonary oedema
533
Causes of increased interstitial fluid
Lymphoedema Venous obstruction Low oncotic pressure Salt and water retention
534
Causes of. lyphoedema
Congenital blockage
535
Causes of low oncotic pressure
Malnutrition Decreased production by liver Increased loss from gut or nephrotic syndrome
536
Causes of salt and water retention
Kidney- impaired GFR | Heart failure
537
3 symptoms of nephrotic syndrome
Heavy proteinuria Hypoalbuminaemia Oedema
538
Hypoalbuminaemia consequences
Fluid retention | Oedema
539
What is a 4th consequence of nephrotic syndrome
Hyperlipidaemia
540
3 types of nephrotic syndrome
Congenital Steroid sensitive Steroid resistant
541
Bile stained vomit is a sign of
Intestinal obstruction
542
Haematemesis is a sign of
Oesophagitis, peptic ulceration, oral/nasal bleeding
543
Projectile vomiting in the first few weeks of life is a sign of
Pyloric stenosis
544
Vomiting at the end of paroxysmal coughing is a sign of
Whooping cough
545
Abdominal distension and vomitting is a sign of
Intestinal obstruciton, including strangulated hernia
546
Hepatosplenomegaly is a sign of
Chronic liver disease
547
Blood in the stool is a sign of
Intussusception, gastroenteritis- salmonella or campylobacter
548
Severe dehydration, shock is a sign of... in a vomiting child
Severe gastroenteritis, systemic infection (UTI, meningitis)
549
Bulging fontanelle, vomitting and seizures in a child
Raised intracranial pressure
550
Fialure to thrive causes (with vomiting)
GORD, coeliac, chronic GI conditions

Phase 3A (25 decks)

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