Paediatrics Flashcards
What is the difference between croup and bronchiolitis?
Croup is an URTI caused by parainfluenza virus most commonly. Affects children between 6months and 2 years. Increased WoB, barking cough, hoarse voice
Bronchiolitis is inflammation and infection of the bronchioles, causes by RSV. Most common in children under 6 months. Coryzal symptoms, wheeze and crackles on auscultation
What is Tourette’s syndrome?
The development of tics that are persistent for over a year. Associated with OCD and ADHD
What is a tic?
An involuntary movement or sound that the child repeated performs
What is a premonitory sensation?
When people with tics feel an overwhelming urge to complete the tic and will do it several times to get relief from the urge
What is a conduct disorder?
Antisocial behaviour characterised by 4 behavioural symptoms - Aggression, destructive, deceitfulness and violation of rules or age appropriate norm
What are the core symptoms of ADHD?
Inattention, hyperactivity and impulsive behaviour
What virus is responsible for a viral induced wheeze?
RSV or rhinovirus
What age group does viral induced wheeze affect and how may they present?
Under 3 years
- No hx of atopy and only occurs during a viral infection
Wheeze (expiratory)
Fever, cough, coryzal symptoms preceding wheeze by 1-2 d
Who gets croup?
6 months - 2 years
URTI causing oedema of the larynx
Usually caused by parainfluenza virus
How does Croup present?
Barking cough, low grade fever, inspiratory stridor, hoarse voice, increased WoB
What vaccines are LIVE?
BCG, MMR, rotavirus, influenza, oral polio
What causes bronchiolitis?
Respiratory syncytial virus
Common in under 6 months
What are the signs of respiratory distress?
Increased RR Intercostals and subcostal recession Use of accessory muscles Head bobbling Grunting Nasal flaring Cyanosis
When might you admit a baby with bronchiolitis?
50-75% or less of their normal intake of milk
Under 3 months
Pre-exisiting conditions - CF, Down syndrome, premature
RR >70, O2 <92%
Moderate to severe respiratory distress
Clinical dehydration
What is epiglottitis?
A life threatening emergency where there is inflammation and swelling of the epiglottis due to heamophilius influenza type B
Who do you need to have a high suspicion of epiglotitis in?
Unvaccinated children
Fever, sore throat, difficulty swallowing, sitting forward (tripoding) drooling
What bacterium causes pertussis / whopping cough?
Bordetella pertussis
What are some possible signs of child abuse?
Change in behaviour or extreme emotional states
Dissociative disorder
Bullying, self harm or suicidal behaviour
Unusually sexualised behaviour
Unusual behaviour during examination
Poor hygiene
Poor physical and. emotional development
Missing appointments or not complying with treatment
What is in the Frazer guidelines?
They are mature and intelligent enough to understand treatment
They cannot be persuaded to discuss it with their parents or let a HCP discuss it with parents
They are likely to have sex regardless of the treatment
Their physical or mental health is likely to suffer without treatment
Treatment is in their best interests
A mother automatically has parental rights from birth, what 2 circumstances allow the father to have parental rights?
They are named as the father on the birth certificate
They are married to the mother
What advice can you give parents to avoid SIDS?
Put the baby to sleep on their backs
Put them in a cot with a fitted sheet and without toys or blankets
Maintain a comfortable room temperature (keep away from windows)
Avoid smoking and handling the baby after smoking
Avoid co-sleeping
Sleep in the same room
What are the important questions to consider when thinking about NAI?
Does the injury fit with the history?
Does history fit with the developmental stage of the child?
What are the 3 common ways someone may become iron deficient because of?
- Insufficient dietary intake
- Loss of Iron - Menorrhoea, bleeding
- Malabsorption - coeliac, crohns
Where is iron absorbed?
Duodenum
Stomach acid is needed to keep it in the soluble form (ferrous)
Where is B12 absorbed?
Terminal ileus
What blood results would you get in B12 deficiency anaemia?
Macrocytic megaloblastic anaemia
Increased LDH, homocysteine and Fe
Hyper-segmented neutrophils
Where is folate absorbed?
Proximal jejunum
In folate deficient anaemia why should you never give folic acid on its own?
If there is also B12 deficiency it can precipitate subacute and combined degeneration of the spinal cord
What is classed as a fever in children?
Temp >38
What symptoms may a patient presenting with VWD (AD) have?
Easy, prolonged or heavy bleeding Menorrhagia Haemarthrosis Bleeding gums Epitaxis Heavy bleeding during surgery or dentist
What is a neutropenic fever?
A single oral temperature of >=38.3 or a temperature of >38 sustained for >= 1 hour in a neutropenic patient
What is the most common leukaemia in adults?
AML (acute myeloblastic)
>=20% blast cells in bone marrow
Auer rods in cytoplasm
Sx of bm failure (anaemia, thrombocytopenia) and increased blast cells in bm (organomegaly)
What is the most common blood childhood cancer?
ALL (acute lymphoblastic)
Associated with Down syndrome
What symptoms may be present in patients with acute leukaemia?
Symptoms of increased blasts in the bm - organomegaly
Symptoms of bone marrow failure - infections, bleeding and bruising, anaemia sx
ALL - limping child
What are the core features of Myeloma?
CRAB Raised Ca Renal failure Anaemia Bone pain/lesions
In a patient with Myeloma, what would you see on peripheral blood film?
Rouleaux (stacked RBC)
Also seen in chronic inflammation and paraproteineamia
What triad is seen in myeloma?
Lytic bone lesions
Clonal Ig or paraproteins
Increased plasma cells in BM
What symptoms should make u suspect a myeloma?
> 60 with persistent unexplained bone pain, particularly back pain, unexplained fractures
Rib pain or back ache
Anaemia - breathless, fatigue, light headed
Sx of hypercalcaemia - polyuria, polydipsia, abdo pain, renal stones
Recurrent infections
What do you look for when diagnosing myeloma?
BLIP Bence jones protein Serum free light chain assay Serum Ig Serum protein electrophoresis
What conditions may cause DIC?
Sepsis, burns, head injury, viral infection, cancer (haematological), solid tumours, pancreatitis, surgery, shock
What is Aplastic anaemia?
A gross reduction or absence of the haemopoietic precursos of all 3 cells lineages in the bone marrow resulting in pancytopenia
What is Immune thrombocytopenic purpura?
IgG against platelets
What is thrombotic thrombocytopenic purpura?
Deficiency or mutation to ADAMTS13
Tiny clots form in small vessels, VWB overactivity due to lack of ADAMTS13 and so platelets used up. Also causes haemolytic anaemia and schiztocytes
What is heparin induced thromocytopenia?
Anti-platelet factor 4 antibodies or heparin antibodies are made in response to exposure to heparin. Causes activation of the clotting cascade - hypercoagulability and also breaks the platelets down - thrombocytopenia
What is looked for in a heel prick test/ guthrie?
PKU, sickle cell disease, CF, congenital hypothyroidism, inherited metabolic diseases, severe combined immunodeficiency
What is the commonest heart defect seen in down syndrome?
AVSD
What is the heart defect commonly seen in turners syndrome (45 XO)?
Co-arctation of the aorta
What are some features of turners syndrome?
Webbed neck, widely spaced nipples, amenorrhoea, short stature, lack of secondary sexual characteristics
What intrauterine infections can cause congenital malformations?
TORCH
Toxoplasmosis, Other (syphilis), rubella, CMV, HSV
In determining if a childs MSK pain is a normal vairent, what things should you look for? (‘pattern recognition’)
Symptoms Symmetry Systemic illness Skeletal dysplasia Stiffness
What may cause hip pain in a child aged 0-4? (limp, refusal to weight bear or use affected leg, inability to walk)
Septic arthritis
DDH
Transient synovitis
What may cause hip pain in a child aged 5-10? (limp, refusal to weight bear or use affected leg, inability to walk)
Septic arthritis
Transient synovitis
Perthes disease
What may cause hip pain in a child aged 10-16? (limp, refusal to weight bear or use affected leg, inability to walk)
SUFE
JIA
Septic arthritis
Whats are the 8 types of fractures that can occur in kids?
Buckle (torus), greenstick, salter-haris*, transverse, oblique, comminuted, segmental, spiral
What are the types of salter-haris fractures?
SALTR Type 1 - Straight through physis Type 2 - Above physis Type 3 - beLow physis Type 4 - through the physis (~45 degree angle through the bone) Type 5 - cRushed
What is scoliosis?
Lateral curvature of the spine with secondary vertebral rotation
What might you find in an examination of a patient with thoracic scoliosis?
Assessment on standing - Shoulder asymmetry Hip and waist asymmetry Prominent shoulder blade Visible curve Assessment while patient bending Upper back raised at side of curve
What is SUFE?
When the femoral head is displaced/ fractured along the physis
More common in obese, adolescent males undergoing a growth spurt
How might someone present with a SUFE?
Hip or groin pain that may travel down the thigh and knee
Painful limp
ROM in the hip
Hip preferred to be in ER with pain and restricted IR
Pain disproportionate to the severity of the trauma
How would you investigate and treat SUFE?
X-ray
Surgery
What is transient synovitis?
Temporary irritation and inflammation of the synovial membrane - synovitis
Commonest cause of hip pain in 3-10 year olds
Commonly a few weeks after a viral URTI
What symptoms may a patient with transient synovitis present with?
Recent history of a viral URTI Refusal to weight bear Hip or groin pain Limp If joint pain + Fever - ?septic arthritis
What is Perthes disease?
Disruption of the blood flow to the femoral head leading to avascular necrosis of the epiphysis of the femoral head.
Idiopathic
No Hx of trauma
How might a patient with Perthes disease present?
Hip or groin pain
Referred pain down to the knee
Limp
Restricted ROM
What is a complication of perthes disease?
If remodelling of the bone makes a soft, deformed femoral head - Early OA
May need a total artificial hip replacement
How might a patient with osteosarcoma present?
Adolescent Common in femur PERSISTENT UNEXPLAINED bone pain Worse at night Wakes them up at night Swelling ± palpable mass Restricted ROM
What is Developmental dysplasia of the hip?
A structural abnormality in the hips caused by abnormal development of the foetal bones. The femoral head and acetabulum fail to develop properly.
Causes instability of the hips with a tendency to subluxate or dislocate
What signs in the born assessment would draw you to think DDH?
Leg length discrepancy
Restricted hip abduction on one side or bilateral restriction in abduction
Difference in knee levels when hips flexed
Clunking and dislocation of hips in Barlows and ortalani
Asymmetry of buttock creases
How might you treat a neonate with DDH?
Pavlik harness for 6-8 weeks to allow development of teh acetabulum around the femoral head
Hips flexed and abducted
How might you treat DDH diagnosed in a child >6 months?
Open (surgery) or closed reduction + Spica cast for 3-6 months
What is congenital talipes equinovarus?
Club foot - an abnormal fixed ankle position presenting at birth
What are the 4 key components of club foot>
CAVE Cavus - high arch Adducted front of foot towards midline Varus of heel Equinus of heel (limited ROM)
What management is available for club foot?
Poseti method 1. Serial casting 2. Achilles tenotomy 3. Abduction foot orthosis ± Tibialis anterior tendon transfer operation
What is rickets?
Defective bone mineralisation causing soft, deformed bones
What is the role of vitamin D?
Help absorption of Ca and PO4 from intestines and kidney. Regulates bone turn over. Helps immune system
What signs might you find in a patient presenting with Rickets?
Bowing legs or knock knees
Rachitic rosary - lumps along chest due to costochondral junction expansion
Craniotables - soft skull with delayed closure of sutures and frontal bossing
Delayed teeth and underdeveloped enamel
What blood results may be seen in rickets?
Serum 25-hydroxyvitamin D < 25nmol/L (= vit D deficiency)
Low Ca, Low PO4, high ALP, high PTH
Marfans is a CTD, its an AD condition with mutation to Fibrillin. Give some features.
Tall, long neck, long arms and legs, arachnodactyly (long fingers), high arched palate, hyper-mobility, Downward slanting palpabre fissures, pectus carinatum or excavatum
What conditions are associated with Marfans?
Scoliosis, Lens dislocation, ocular HTN, joint diclocation, Aortic aneurysms, Aortic or mitral valve prolapse, pneumothorax, GORD
What is Ehlers-Danlos syndrome?
A group of genetic conditions due to defects in collagen. There is joint hypermobility and abnormal connective tissue in the skin, bones, blood vessels and organs
What is the most common type of EDS?
Hypermobile EDS - Hyper-mobility of joints and soft stretchy skin
What can you use to score hyper-mobility?
Beighton score (out of 9)
- Touch the floor with whole hands, knees extended
- Elbows hyperextended
- Knees hyperextended
- Thumb can touch forearm
- Little finger can be hyperextended >90 degrees
In Hypermobile EDS, you can get autonomic dysfunction, what can this lead to and be called?
POTS
Postural orthostatic tachycardia syndrome
What are the 5 types of JIA?
Systemic JIA Polyarticular JIA Oligoarticular JIA Enthesitis related arthritis Juvenile psoriatic arthritis
When might you consider a diagnosis of JIA?
Arthritis without a known cause, lasting > 6 weeks in a child <16
What might you diagnose in a child presenting with 6 weeks of joint pain, a subtle salmon pink rash and a fever?
Stills disease - systemic JIA
What is systemic JIA?
Also known as stills disease
Presents with, salmon pink rash, swinging fever, weight loss, muscle pains, enlarged LN, joint pain and inflammation, splenomegaly and pleuritis or pericarditis
What is a life threatening complication of systemic JIA/stills disease?
Macrophage activation syndrome - can lead to multiple organ failure
What is polyarticular JIA?
Idiopathic inflammation of 5 or more joints
Symmetrical
What is oligoarticular JIA?
Affects 4 or less joints
Associated with anterior uveitis
Anti-nuclear antibody positive
What is Enthesitis related arthritis? (JIA)
Seronegative - HLA-B27
Check for psorasis, IBD and anterior uveitis
How might a child with constipation present?
Change in bowel habit - less frequent (less than 3/wk)
Rabbit dropping stools
Straining and painful passage of stool
Retentive posture
Overflow soiling due to faecal impaction - runny smelly stool
Can’t feel when they need to pass stool (desensitisation)
Hard stool may be palpable in the abdomen
Abdominal pain
What is Encopresis?
Faecal impaction
This is not pathological until >4 years old
A sign of chronic constipation - rectum stretched and desensitised
What causes Encopresis in peads?
Most idiopathic - lifestyle factors (low fibre diet, dehydration, sedentary lifestyle, psychological problems, habitually not opening bowels)
Secondary causes:
Hirschprungs disease, CP, LD, spina bifida abuse, psychological stress
What causes constipation in peads?
Most idiopathic - lifestyle factors (low fibre diet, dehydration, sedentary lifestyle, psychological problems, habitually not opening bowels)
Secondary causes:
Hirschprungs disease, CP, hypothyroidism, sexual abuse, cows milk intolerance, anal stenosis, intestinal obstruction, spinal cord lesions
In patients with constipation, they may have a desensitised rectum, explain how this happens.
If patients develop a habit of not opening their bowels when they need to or they ignore the signal of a full rectum, over time they loose sensation of needing to open their bowels.
They retain faeces in the rectum - faecal impaction, and it becomes stretched. Over time it becomes more stretched and fills with more faeces.
What is the commest cause of abdominal pain in children?
Constipation
If they have had a recent infection - mesenteric adenitis
What would you do if a child was vomiting bile?
SURGICAL EMERGENCY - ? obstruction (malrotation ± volvulus?)
What are some causes of abdominal pain in children?
Constipation, UTI, IBS, IBD, HSP, DKA, coeliac, abdominal migraine, mesenteric adenitis, infantile colic
Appendicitis, intussusception, bowel obstruction, testicular torsion
Commonest surgery in kids?
Inguinal hernia - herniotomy
What are the borders of the inguinal canal?
M - Internal oblique m and transversus abdominis muscle
A - Internal and external oblique aponeurosis
L - Lacunar ligament and inguinal ligamament
T- conjoint tendon and transversalis fascia
What is an abdominal migraine?
Central abdominal pain > 1hr, normal examination
± headache, vomiting, vertigo, pallor, photophobia
What preventative medication can you give in abdominal migraines?
Pizotifen *
Propranolol
Flunarazine
How might a baby with GORD present?
Chronic cough Hoarse cry Distressed and unsettled after a feed Reluctance to feed Poor weight gain Pneumonia
What is a cows milk protein allergy?
Immune-mediated allergic response to 1 or more proteins in cows milk
IgE mediated - immediate, min - 2hr - hives, itcy
Non-IgE mediated - 2-72hr after - diarrhoea
What symptoms might suggest a cows milk protein allergy?
Symptoms after milk ingestion:
Skin - Urticaria, angioedema, puritis, erythema, eczema
GI - D&V, reflux, constipation, colic, abdominal pain
Resp - Wheeze, hoarse, SoB, rhinorrhoea
Hx or FHx of atopy?
What is intussuception?
When the full thickness of the bowel invaginates or telescopes into itself
Commonly 3months - 3 years
Ileo-colic region
How might a child with intussuception present?
Age 3m-3y, male, ?co-morbid CF, HSP, meckels, polyps?
Recent Viral infection eg URTI
Triad - Severe intermitten abdominal pain
Red current jelly stool
Vomiting
RUQ pain and a sausage shaped mass felt in the abdomen. Intestinal obstruction?
How would you manage a child with intussuception?
Therapeutic enema to try unfold the bowel
If doesn’t work - surgery
What is pyloric stenosis?
Hypertrophy and narrowing of the pyloric sphincter
When might pyloric stenosis present?
~2-4 weeks
FTT, thin, pale baby
When fed, peristalsis in the stomach increases in strength to try pass food into duodenum, eventually it caused food to go revere and there is PROJECTILE VOMITING (withOUT bile)
What lab findings do you see in pyloric stenosis?
Hypochloric, hypokalaemic metabolic alkalosis
How do you treat pyloric stenosis?
Laparoscopic pylorormyotomy
What is malrotation?
Intestinal fixation should occur in week 4-12 gestation. If this fails there may be malrotation and a volvulus.
Bilious vomiting**
10w-1y
What are some causes of intestinal obstruction?
Meconium ileus, hirschsprungs disiease, duodena atreia, oesophageal atresia, imperforate anus, intussusception, strangulated hernia, volvulus
What condition is associated with meconium ileus/plug syndrome?
CF - thick, sticky meconium
What may a neonate with meconium ileus present with?
Failure to pass meconium in 48 hours
Abdominal distention
Bilious vomiting
What is Hirschsprung’s disease/ congenital aganglionic megacolon?
When the distal portion of the large colon is aganglionic
There is absence of the myenteric plexus/ auerbach’s plexus. This portion becomes constricted and can present with acute intestinal obstruction
What is a complication of Hirschsprung’s disease?
Hirschsprung’s associated enterocolitis
Inflammation and obstruction of the bowel
Presents 2-4 weeks after birth - fever, diarrhoea, abdominal distention, signs of sepsis
Life threatening - Toxic megacolon and perforation
How would a patient with Hirschsprung’s disease present?
Failure to pass meconium in 24 hours Abdominal pain and distention Chronic constipation since birth FTT and poor weight gain Vomiting FHx of HD Hx of Down syndrome, MEN2
What is necrotising enterocolitis?
Acute inflammation of the bowel that can lead to necrosis. In Premature babies
What are risk factors for NEC?
Premature
Low birth weight < 1500g
Enteral feeding
What is mesenteric adenitis?
Inflamed abdominal LN. Usually occurs after an infection e.g. URTI, tonsilitis
How much weight loss is normal in the first week of life?
Up to 10% of their body weight (mainly water)
By week 3 they should have at least returned to their birth weight
How much should a neonate get to eat?
150ml/kg/day
What are some gross motor mile stones?
6 weeks - head to 45 degrees when prone **4 months - roll over 6 months - sits 9 months - crawls 12 months - walk Need to think about in safeguarding
What are some fine motor milestones?
6wk - fix and follow 6m - palmer grip 10m - pincer grip 18m - 3 block tower 3y - draw circle
What are some language milestones?
Birth - startles to loud noises
4m - babbles
12m - few simple words
2y - says and understands simple phrases
What are some social milestones?
6wk - smiles 6m - hands to mouth 12m - waves bye 18m - feeds self 2y - toilet trained
How long do you measure length rather than height?
Length until 2 years
Children <2 BMI not valid
What are some causes of delayed puberty?
Chronic disease
Malnutrition/ ED
Androgen insensitivity
Genetic disorders
What are some causes of precocious puberty?
Obesity in females
Genetic disorders
Pituitary tumour
Ovarian tumour
What classes as faultering growth?
Slower rate of weight gain than expected for age and gender. Flutuations through centiles can be normal.
A fall through >2 centiles warrants investigation
What are some causes of faultering growth?
Inadequate intake:
Reduced appetitie - chronic infections, anaemia
Feeding problems - GORD, CP, celft lip/palate
Choatic social circumstances/ neglect
Increased calorie expenditure:
Chronic infection
Sever asthma, CF, congenital heart disease
Frequent surgery
Inefficient utilisation of calories (malabsorption):
Coeliac/IBD
Chronic D/V
Endocrine - DM, hyperthyroidism, inborn errors of metabolism
Congenital/ chromosomal:
TORCH
FAS
Trisomy 21, Turners
GH deficiency
What conditions are associated with coeliac disease?
T1DM, Dermatitis herpitiformis, IgA deficiency
What HLA is in coeliac?
HLA-DQ2/8
What are some indications of malabsorption?
Foul smelling diarrhoea, steaohorrhoea, FTT, weight loss, fatigue, nutritional deficiencies (anaemia, bleeding, metabolic bone problems, oedema, neurological sx)
What is cystic fibrosis?
AR mutation in the CFTR gene on chromosome 7. It is a Cl channel that usually helps draw water into secretions to make them watery
How might CF present in a neonate?
Meconium ileus, rectal prolapse, FTT
What screening tests are performed to check for CF?
Immunoreactive trypsinogen
Sweat testing (lots of CL)
Genetics
Faecal elastase
How might CF present in a child?
Resp - wheeze, cough, recurrent infections, bronchiectasis, pneumothorax, resp failure
GI - Gallstones, cirrhosis, pancreatic insufficiency (DM. steatorrhoea)
Other - male infertility, nasal polyps, sinuisitis
When thinking about A-E assessment, how are children different to adults?
Children have: Smaller oral cavity with a larger tongue Short trachea Obligate nasal breathers < 6m Large head Large SA: body mass ratio Compliant elastic skeletons
How would you distinguish between mild and severe croup?
Mild:
Barking cough, no stridor at rest, no sternal recession ± tracheal tug, normal behaviour
Severe:
Persistent stridor at rest, pallor and mottling, severe sternal recession ± tracheal tug, drooling, irritable or lethargic
How do you manage croup?
Minimise distress
Dexamethasone
Nebulised Adrenaline
How much maintenance fluid should children get?
4,2,1
First 10kg - 4ml/kg/Hour or 100ml/kg/day
Next 10kg - 2ml/kg/Hour or 50ml/kg/day
Everything else - 1ml/kg/Hour or 25ml/kg/day
What is a standard amount for a paediatric bolus fluid?
20ml/kg
How would you calculate how many calories a child gets?
~100kcal/kg/day
How much Na, Cl and K might need replaced?
Na - 2-4mmol/kg/day
Cl - 2-4mmol/kg/day
K - 1-2mmol/kg/day
How would you calculate how much blood to give a child in a blood transfusion?
Total Hb (g) x weight (kg) x 4 e.g. Y is 2kg, I want his Hb to go from 8 to 11 - 3g x 2kg x 4 = 24ml
How much fluid would a neonate need on day 1? Is it different from their requirements on days 7?
Day 1 - 50ml/kg/day Day 2 - 70-80ml/kg/day Day 3 - 80-100ml/kg/day Day 4 - 100-120ml/kg/day Day 5-28 - 120-150ml/kg/day
How would you calculate a childs weight from their age?
Weight in Kg = (age (years)+ 4) x2
What is respiratory distress syndrome?
Surfactant deficiency disease
Premature infants
What immunisations are give at 8 weeks?
- Diptheria/tetanus/polio/pertussis/HiB
- Rotavirus
- Pneumococcal
- Meningiococcal group B
What immunisations do you give at 12 weeks?
- Diptheria/tetanus/polio/pertussis/HiB
- Rotavirus
- Meningiococcal group C
What immunisations do you give at 16 weeks?
- Diptheria/tetanus/polio/pertussis/HiB
- Meningiococcal group B
- Penumococcal
What immunisations do you give at 1 year?
Booster of Hib, MenC, MenB, pneumococcal
MMR
What milestones should be seen at 6 weeks?
Super baby -
Smiles, fixes and follows, hold head level, startle to sound
What mile stones should be seen at 3 months?
Rock baby -
Hold head at 90 degrees, laughs and squeal in response, turns to sound, opens palm, hold objects
What mile stones should be met at 6 months?
Secretary -
Sits supported or up with forearm, babbles, recognises own name, reach with palmar grasp, transfer objects, put food in their mouth
What miles stones should be met at 9 months?
Gangster -
Crawls, sits unsupported, says mama and dada, points, pincer grip, pull themselves up to stand, wave bye
What milestones should be met at 12 months?
Watchdog -
Cruising, hands and objects in mouth, casting objects, stranger awareness, understand a few words
What milestones should be met at 18 months?
Banksy -
Walks steadily, carries objects, feeds themselves with a spoon, scribbles, build a tower with 2-4 blocks, symbolic play
What mile stones should be met at 2 years?
Footballer -
Runs, removes garments, dry by day, tower of 6-8 blocks, joins 2-3 words, circular scribbles
What mile stones should be met at 3 years?
Cricketer -
Throw overarm and catch, tower of 9 blocks, stand on 1 foot for 3 seconds, one foot per step, feeds themselves with a fork and spoon, dress themselves, ride a tricycle, cut with scissors, talk in sentences
What might cause a developmental delay in gross motor?
Cerebral palsy, ataxia, myopathy, spina bifida, visual impairment, DMD, autism
What might cause a developmental delay in fine motor?
DMD, Cerebral palsy, autism, dyspraxia, congenital ataxia, visual impairment
What might cause a developmental delay in Language?
Social circumstances - multilingual household, siblings that do the talking
Autism, cerebral palsy, hearing impairment, LD, neglect
What domains are affected in autism?
Communication, behaviour, social interaction
What are the benefits of breast feeding for the mum?
Reduced risk of ovarian cancer, breast cancer, diabetes
Possible reduction in post-natal depression
What are the benefits of breast feeding for the baby?
Reduced risk of a gut infection, respiratory infection, ear infection, CVD, AI conditions, SIDS
Improved cognitive ability
How do you calculate the genetic target height in boys and girls?
Boys = Mums height + dads height /2 + 7 Girls = mums height + dads height /2 -7
How would you define short stature on a growth chart?
> 2 SD below the mean (below 3rd centile)
What are some causes of a short stature?
NICC SEDD Normal genetic short stature IUGR Constitutional delay Chronic systemic disease Skeletal dysplasia Endocrine abnormalities Dysmorphic syndrome Dire social circumstances
What is faltering growth?
Lower weight or rate of weight gain than expected for their age and sex
What is pityriasis alba?
Hypopigmentation of the cheeks with dry, rough skin. Not well demarcated
tx - emollients, suncream to avoid darkening of skin and making it more obvious
What is congenital adrenal hyperplasia?
Congenital deficiency of 21-hydroxlyase enzyme, which leads to low cortisol and aldoesterone and high testosterone from birth. AR
Why is there high androgens and low cortisol and aldosterone in CAH?
21-hydroxlyase is needed to convert progesterone into cortisol and aldosterone, however it is not needed to make androgens. Excess progesterone is then converted to testosterone - Females will present with ambiguous genitalia in severe cases
What are some lab findings in CAH?
Hyponatraemia and hyperkalaemia (no aldosterone to inc absorption of Na and excretion of K), hypoglycamia (no cortisol to increase gluconeogensis)
What is Kallmann’s syndrome?
Isolated deficiency in LH and FSH
Due to failure of migration of the gonadotrophin cells from the olfactory placode to the hypothalamus - anosmia, or hyposmia.
Hypogonadotrophic hypogonadism
What is a common cause of hypogonadism (primary gonadal failure)?
Klienfleter’s - XXY
Presents at puberty
Seminiferous tubules regress and leydig cells don’t function properly
What might you seen on an abdominal X-ray that indicates duodenal atresia?
Double bubble sign
- DA is seen in Down syndrome
What are some causes of neonatal respiratory distress?
- Transient tachypnoea of the newborn
- Meconium aspiration syndrome (term/post-term)
- Respiratory distress syndrome (surfactant def -preterm)
- Persistent pulmonary hypertension of the newborn
- Congenital cyanotic heart lesion
- Pneumothorax
- Infection
How could you tell if a cyanotic neonate had a respiratory problem or cardio?
Giving O2 solves the respiratory function as it takes over the lungs job - cardio would still be cyanotic
At what age do kids get vaccines and how many?
8 weeks - 4 (diptheria/polio/pertusis/tetanus/hiB, menB, pnemo, rotavirus)
12 weeks - 3 (2nd d/p/p/t/hib, rotaV, 1st menC)
16 weeks - 3 (3rd of dipth/hib/polio/tet/pert, 2nd menB, pnem)
1 year - 5 (Boosters - Hib, menB, MenC, pnemo, 1st MMR)
2 years - 1 (influena)
