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My Child Health > Paediatric problems > Flashcards

Paediatric problems Flashcards

1
Q

What are the most common paediatric issues in secondary care?

A
  • growth concerns
  • UTI
  • constipation
  • abdominal pain
  • headaches
  • funny turns
  • heart murmurs
  • food allergies/intolerances
  • minor abnormalities
  • asthma
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2
Q

What is involved in growth concerns in a child?

A

can be short stature (familial or delay) or can be obesity (think endocrine in short kids)

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3
Q

What are the features of a UTI in a child?

A
  • common
  • could lead to renal scarring and then BP issues
  • most common pathogen is E.coli
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4
Q

What are the red flags for a child with a UTI?

A
  • young
  • recurrent
  • with constipation
  • poor growth
  • raised BP
  • spinal abnormalities
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5
Q

What are the features of constipation in children?

A
  • pain
  • difficulty or delay in pooing
  • can be soiling
  • can cause anal fissures
  • give laxatives and diet advice
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6
Q

What are the red flags of constipation in children?

A

delay in passage of meconium more than 24 hours after birth

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7
Q

What are the red flags of abdominal pain in children?

A 
weight loss
GI blood loss
chronic diarrhoea
appendicitis
Fhx of IBD

major red flag is vomiting with bile

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8
Q

What are the red flags of headaches in children?

A
  • when walking
  • when worse on coughing
  • associated with vomiting
  • gait disturbance
  • cranial nerve palsy
  • associated with mornings
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9
Q

What are the types of fun turns that children can have?

A

examples are seizures, breath-holding, terrors and faints

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10
Q

What are the red flags for funny turns in children?

A
  • syncope when there is known CHD
  • syncope during exercise, FHx of sudden death
  • syncope preceded by palpitations
  • heart murmur
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11
Q

What makes a child’s heart murmur more suspicious?

A
  • associated with unwellness such as SOB
  • loud
  • radiate
  • in diastole
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12
Q

What are some minor abnormalities in children?

A
  • head changes
  • skin lesions
  • feeding concerns
  • crying

red flags are abnormal growth and development

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13
Q

What are the four types of attachment?

A

secure
insecure avoidant
insecure ambivalent
disordered

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14
Q

What is involved in secure attachment?

A
  • 70% of children
  • distress when mum leaves
  • avoidance of stranger when mother is away
  • happy to see mum after
  • the child will use mother as safe base to explore
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15
Q

What is involved in insecure avoidant attachment?

A
  • 15% of children
  • no distress when mother leaves
  • infant is okay with the stranger
  • child will ignore mother when she returns
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16
Q

What is involved in insecure ambivalent attachment?

A
  • 15% of children
  • distress when the mother leaves
  • avoids stranger
  • reject contact after separation but approaches mother
  • infant cries a lot
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17
Q

What is the best stage to test attachment?

A

12-18 months

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18
Q

What are insecure avoidant teens like?

A

(type A)

  • feel unloved and self-reliant
  • think others are controlling and obtrusive
  • cold
  • assume others dislike them
  • avoid intimacy
  • view relationships as unimportant
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19
Q

What are insecure ambivalent teens like?

A

(type C)

  • low self-worth
  • unpredictable
  • attention-seeking behaviour
  • insecure
  • antisocial
  • poor concentration
  • can’t regulate their emotions
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20
Q

What is a secure base?

A

an attachment figure which provides a safe space from which that child can explore the world

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21
Q

What is a safe haven?

A

an attachment figure is a safe place to retreat to in times of danger or anxiety

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22
Q

What is attunement?

A

when the caregiver and the infant tune in to each other’s states of emotion

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23
Q

What are the behavioural signs of disordered attachment?

A
  • Lack of self-control
  • Lack of normal fear
  • Self destructive
  • Destruction of property
  • Sleep disturbance
  • Abnormal eating habits
  • Hyperactive
  • Defying rules
  • Poor hygiene
  • Difficulties with change
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24
Q

What are the cognitive functioning signs of disordered attachment?

A
  • Learning disorders
  • Language disorders
  • Distorted self image
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25
Q

What are the emotional functioning signs of disordered attachment?

A
  • Intense anger, fear, pain and shame
  • Struggle to express emotions
  • Lack of affection
  • Mood swings
  • Low self esteem
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26
Q

What are the social functioning signs of disordered attachment?

A
  • Victimises others
  • No trust in others
  • Superficial relationships
  • Places blame
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27
Q

What are the physical aspects of disordered attachment?

A
  • Poor hygiene
  • Chronic tension
  • Defensive to physical touch
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28
Q

What are the causes of disordered attachment?

A

unplanned pregnancy, postnatal depression, neglect/abuse or poor parenting skills

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29
Q

What is RAD?

A

Reactive attachment disorder (RAD) is disrupted and developmentally inappropriate social relations that begins before 5 years

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30
Q

What is RAD caused by and what does it result in?

A
  • caused by disregard of child’s needs whether that is emotional or physical or could be due to changing caregivers
  • children struggle to form lasting and deep relationships
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31
Q

What are the types of RAD?

A
  • Inhibited: children who fail to initiate social interactions
  • Disinhibited: children who don’t display appropriate selective attachments
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32
Q

What are the most alarming red flag symptoms RAD?

A
  • Persistent unexplained colic
  • Poor eye contact
  • No reciprocal smile
  • Delayed gross motor development
  • Difficulty being comforted
  • Resists affection
  • Poor sucking response
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33
Q

What is CD?

A 
Conduct disorder (CD) is a repetitive pattern of behaviour where the rights of others are violated eg aggression to others/animals, destruction of property, theft or serious violation of rules 
associated with ADHD
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34
Q

What is the triad of ADHD?

A

inattention, hyperactivity and impulsivity and is associated with many symptoms relating to self regulation

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35
Q

What is the treatment for CD?

A
  • therapy- there are many types
  • medication is not main line but can help in extreme cases ie Risperidone
  • (ADHD and depression should be treated too if present)
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36
Q

What are the aspects of child abuse?

A
  • physical injury
  • neglect (failure to provide for child’s basic needs)
  • sexual abuse
  • emotional abuse (blaming or ignoring)
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37
Q

What is the toxic trio for a child being on the child protection register?

A

drug/alcohol
mental health
domestic abuse

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38
Q

Who is included in the interagency referral discussion?

A
  • Social work/education
  • Health
  • Police
39
Q

What is Tanner staging?

A
  • for girls it is B for breasts and P for hair
  • for boys it is just P for hair
    each is given a score out of 5 eg B3P1
40
Q

What happens to the brain in puberty?

A

increase in grey matter and increase in myelination of the long tracts in the brain

41
Q

What are the rules around onset for under 16s?

A

parents cannot authorise the treatment if a deemed competent young person has refused it

42
Q

How are drugs administered for children and teenagers?

A

by weight

NB: when a teen is obese the drug is given fro ideal body weight

43
Q

What is infant mortality rate?

A

number of children that die before reaching the age of 1 and this is expressed per 1000 live births

44
Q

What are the top causes of mortality globally?

A
  • Preterm birth complications
  • Pneumonia
  • Intrapartum-related complications
  • Congenital abnormalities
  • Diarrhoea
45
Q

What easy treatments can reduce birth deaths?

A
  • antenatal tetanus vaccines
  • treatment of maternal infections eg HIV
  • steroids for preterm labour to mature the baby’s lungs
46
Q

What are the four microbiological causes of pneumonia?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Respiratory syncytial virus
  • Pneumocystis jiroveci
47
Q

What are the main risk factors for pneumonia around the world?

A
  • malnutrition
  • overcrowding
  • indoor air pollution from smoke
  • parental smoking
48
Q

What is the most common cause of viral diarrhoea?

A

rotavirus

49
Q

What is the treatment for diarrhoea?

A

oral rehydration and zinc supplements

50
Q

How can transmission of HIV at birth be reduced?

A
  • vertical = mother to baby
  • mother should be on lifelong ART therapy
  • screen for STIs esp Herpes
  • give infant prophylaxis for 6 weeks
51
Q

How does HIV present in

babies?

A

as anything eg recurrent severe infections, failure to thrive, persistent fevers etc

52
Q

What is the treatment for malaria?

A

ACT for 3 days

53
Q

What are the main causes of malnutrition?

A
  • lack of access
  • poor feeding practices
  • infection
54
Q

What are the features of pyloric stenosis in a child?

A
  • 6 weeks
  • visible peristalsis
  • muscle of pylorus is too thick
  • vomiting up milk
  • slit made to open up circular muscle
55
Q

What are the features of intussusecption in a child?

A
  • 6 months
  • cough and cold then tummy pain
  • pain comes in waves
  • no poo, passing blood PR, vomiting food and bile
  • palpate and feel a sausage shape
  • on US, target lesion (three layers of bowel) and pseudo kidney from the side
  • demonstrate with clothing
  • air up rectum can put it back or open surgery
56
Q

What are the features of appendicitis in a child?

A
  • bumps in the road hurt
  • jumps hurt
  • can be peritonitis
  • temperature
  • remove the appendix
57
Q

What are the features of an acute scrotum in a child?

A
  • testicular torsion: red and swollen
  • twisted Hydatid of Morgagni: blue dot, main cause, usually ok
  • idiopathic scrotal oedema: redness down to perineum and up to groin, no surgery
58
Q

What are some day surgery issues with penises?

A
  • BXO: scarring and white around foreskin, won’t stretch, needs circumcision
  • Paraphimosis: foreskin gets stuck and needs pulled forward, squeeze oedema out
  • Hypospadias: urethra comes out somewhere along penis shaft
  • Patent processus vaginalis: fluid runs in and out of testicle
59
Q

How do you find a testicle?

A
  • palpation: soap on the groin and sweep down the canal to feel the bounce
  • keyhole surgery: it will be at the end of the blood vessels in the abdomen
60
Q

What happens to a child’s HR, BP and RR as they get older?

A
  • HR and RR go down

- BP goes up

61
Q

What is a relevant factor when considering burns in children?

A

they have a large SA:V ratio

62
Q

How is intubating children different?

A
  • high anterior larynx

- floppy epiglottis so lift this up in order to intubate

63
Q

What is the difference in children’s ribs?

A

they are more flexible and so are harder to break

64
Q

What are the features of bronchiolitis in children?

A
  • Crackles
  • Bubbles around mouth
  • Difficulty breathing
  • Hard to feed when you can’t drink
  • It is viral eg RSV
  • Supportive treatment
  • For apnoea they may need nasal oxygen or CPAP
65
Q

What are the features of croup in children?

A
  • Viral eg paraflu
  • Stridor so upper airway
  • Barking cough
  • Narrowing of trachea
  • Kids will not be that unwell
  • Treat with steroids
66
Q

What are the differentials for upper airway stridor?

A
  • croup
  • inhaled foreign body
  • epiglottitis (uncommon)
  • bacterial tracheitis (present like croup but lasts longer and has a productive cough)
67
Q

When should peak flow be used?

A

in children over the age of 7 to test for asthma

68
Q

What are the features of meningitis?

A
  • bacterial and viral
  • bulging fontanelle
  • purpuric rash with Tumbler test to test for meningococcemia (the rash is when it is in your blood so you don’t need to have the rash to have the disease)
69
Q

What are the features of encephalitis?

A
  • commonly viral
  • focal seizures
  • this gets better itself
70
Q

What can be used to avoid putting babies on a drip?

A

dioralyte

71
Q

What are the features of febrile seizures?

A
  • peaks at 18 months
  • loss of consciousness
  • under 5 minutes
  • this is a reaction to a temperature
  • find the cause of the temperature
72
Q

What is the most common heart problem in children?

A

SVT arrhythmia

73
Q

What are the most common presentations of neonates in general practice?

A
  • jaundice
  • vomiting
  • temperature
  • failure to thrive
74
Q

What are the most common causes of jaundiced baby in GP?

A 
UTI
hypothyroidism
breast milk jaundice 
biliary atresia
galactosaemia
75
Q

What are the most common causes of neonatal vomiting in GP?

A
  • reflux
  • CMP (cow’s milk protein) intolerance
  • pyloric stenosis (projectile vomiting)
  • sepsis
  • duodenal atresia
76
Q

What are the most common respiratory diseases in children in GP?

A 
cough and cold
infant not feeding
bronchiolitis
croup
viral URTI
asthma
acute tonsillitis
77
Q

What are the important parts of a respiratory exam in a child in GP?

A
  • cyanosis
  • RR
  • nasal flaring/intercostal recession
  • wheeze/stridor/cough
  • pulse oximetry
  • percussion
  • auscultation
  • ENT
78
Q

What are the normal respiratory rates for children?

A 
under 1y: 30-40
1-2y: 25-35
2-5y: 25-30
5-12y: 20-25
over 12y: 15-20
79
Q

What are the common medical GI problems of children in GP?

A 
gastroenteritis
Coeliac disease
constipation
DKA
menstrual issues
80
Q

What are the most common MSK problems in children in GP?

A
  • painful joints: transient synovitis, inflammatory arthritis, perthes disease, slipped femoral epiphysis, osgood schlatters
  • limp: DDH or perthes
  • trauma: sprain, fracture and NAI
81
Q

What are the most common dermatological conditions of children in GP?

A

impetigo
slapped cheek
molluscum contagiosum
scarlet fever

82
Q

What are the most important aspects of the 6-8 week neonatal exam in GP?

A
  • red light reflex (retinoblastoma)
  • hips (barlows,ortolani)
  • genitalia (undescended testes or ambiguous sex)
  • femoral pulse (coarctation of aorta)
83
Q

What are the red flags for sepsis in children?

A
  • Difficult to rouse
  • Worried health professional
  • Weak, high pitched cry
  • Grunting or apnoeic episodes
  • Severe tachypnoea
  • Severe tachycardia
  • No wet nappies
  • Non-blanching rash
  • Temperature
84
Q

What are the amber flags for sepsis in children?

A
  • Parent or clinician still concerned
  • Not smiling
  • Very sleepy
  • Parents say this is abnormal behaviour
  • Moderate tachypnoea
  • SpO2<91 or nasal flaring
  • Moderate tachycardia
  • Cap refill less than or equal to 3
  • Reduces urine output
  • Pale or flushed
  • Leg pain or cold extremities
85
Q

What is the advice for paediatric life support?

A
  • under a year do not head tilt as this will close their airway
  • 5 rescue breaths and then 30:2
86
Q

What fluid is given for shock?

A

0.9% saline at 20mls/kg

87
Q

What is the best test for malrotation or volvulus?

A

abdominal XR

88
Q

What is the best test for pyloric stenosis?

A

US of pylorus will show that it is thickened

89
Q

What is the test for meningitis?

A

meningicoccal PCR

90
Q

What is the diagnosis for a hungry child with projectile vomiting?

A

pyloric stenosis

91
Q

What is the diagnosis for bile stained vomiting?

A

malrotation or volvulus

92
Q

What is the first treatment for a choking baby?

A

chest thrusts

93
Q

What is croup caused by?

A

parainfluenzae

My Child Health (5 decks)

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