Paediatrics

Question 1

What are the motor milestones in childhood development?

Answer 1

Newborn - flex limbs
6-8 weeks - tummy time, head to 45 degrees
6-9 months - sit w/o support and crawling
10 months - stand independently, use furniture to walk
12 months - unsteady walk, limit age = 18 months
15 months - walks steadily
2.5 years - run and jump

Question 2

What are the vision and fine motor milestones?

Answer 2

6 weeks - fixing and following
4 months - reaching for toys
4-6 months - palmar grasp
7 months - toys from one hand to another
10 months - pincer grip
16-18 months - marks w crayons
Then moves on to brick building and pencil skills.

Question 3

What are the hearing, speech and language milestones?

Answer 3

Newborn - startles to loud noises
3-4 months - aa, aa, giggles
7 months - bababalalalal, turns to soft sounds
7-10 months - dada, mama
12 months - understands name, 2-3 words
18 months - 6-10 words, can show parts of body
20-24 months - simple phrases
2.5-3 years - 3-4 word sentences

Question 4

What are the behavioural milestones?

Answer 4

6 weeks - smiles
6-8 months - puts food in their mouth
10-12 months - peek a boo, bye bye
12 months - can drink from cup
18 months - feed w spoon
18-24 months - symbolic play
2 years - toilet training in day
2.5-3 years - takes turns and interactive play

Question 5

What is bronchiolitis?

Answer 5

Inflam of bronchioles, most common LRTI in first year - 1in3 infants get it.

Question 6

What are the clinical features of bronchiolitis?

Answer 6

• Cough w increased work of breathing
• Fever
• Poor feeding
• Lower resp tract signs - wheeze/crackles on auscultation

Question 7

How is bronchiolitis treated?

Answer 7

Supportive - paracetamol, may need NG/IV feeds or ventilation if baby is admitted. Can also give supplemental O2 in hospital.

Question 8

What are the clinical features of croup?

Answer 8

• Sudden onset barking cough w stridor and chest wall indrawing
• Sx worse at night and w crying
• Hoarse voice
• More severe = child can show signs of resp distress = agitation, lethargy, asynchronous chest wall movement, pale, cyanosis, RR >70

Question 9

When does a child w croup need hospital admisison?

Answer 9

• Sternal recession/stridor at rest
• RR>60, high fever
• Comorbidities
• Inadequate fluid intake

Question 10

How do you treat mild croup?

Answer 10

• Single dose dexamethasone immediately
• Explain that sx resolve in 48 hrs
• Safety net when need to go to hospital - stridor or sternal recession/ambulance if struggling to breath
• Advise to keep calm as distress makes worse
• Simple analgesics

Question 11

What is chicken pox?

Answer 11

Varicella zoster virus - itchy vesicular rash, preceded by fever and malaise.

Question 12

What is the treatment of chicken pox in a child?

Answer 12

• Symptomatic - paracetamol not NSAIDs, topical calamine lotion, chlorphenamine for itch >1 yo
• Suspect complication eg. pneumonia, encephalitis, dehydration = admit
• Neonate = need specialist advice

Question 13

How do you confirm headlice infestation?

Answer 13

• Detection combing on wet or dry hair, need to find a live louse = is quite time consuming if do properly

Question 14

What is the management of head lice?

Answer 14

• Wet combing to remove all lice eg. BugBuster kit

- Insecticide - suffocate lice, apply twice 7 days apart eg. dimeticone

Question 15

What is involved in the 6 week post natal check to check the mum?

Answer 15

• Mental health discussion
• Have had period or still having vaginal discharge
• BP check
• Examination to see if stitches healed
• Continence discussion
• How is breastfeeing
• Contraception discussion

Question 16

What is involved in the 6 week post natal check for the baby?

Answer 16

• Check for birth marks
• Top to toe examination - focus on eyes, lungs, spine, heart, hips and testes in boys
• Check baby has had hearing test
• See if baby is smiling and can follow an object
• Discuss baby’s vaccinations
• Weight, length and head circumference

Question 17

What is involved in the newborn examination?

Answer 17

• Stripped for assessment
• Posture and babies movements
• Skin colour, marks or rashes
• Shape of the head, feel fontanelles
• Eyes - red reflex = excludes cataract
• Mouth - cleft lip/palate, suck reflex
• Chest - movement, auscultate, peripheral sats on foot
• Abdomen - distension?, umbilicus, palpate
• Groin - femoral pulses, hernias, ex genitalia
• Limbs - grasp reflex, exclude hip dysplasia = don’t want click, curvature of spine

Question 18

What is Osgood Schlatters?

Answer 18

Cause of knee pain in children - inflam of the epiphyseal plate, boney bump found. In active children due to jumping and running?

Question 19

What are the sx of Osgood Schlatters?

Answer 19

• Pain increased w activitiy and better w rest
• Swelling at tubercle
• Symptoms after growth spurt, normally self limiting but the bump can stay

Question 20

What is SUFE?

Answer 20

Slipper upper femoral epiphyses - head of femur slipped backwards = vague pain in hip, groin and knee. Can get possible limb shortening and ex rotated during flexion of hip.
Most commonly pt present w knee pain.

Question 21

What is Perthe’s disease?

Answer 21

Avascular necrosis of the femoral head epiphyses - reduced ROM in hip.

Question 22

What are threadworms? What are the sx?

Answer 22

Parasite that affects the large intestine.

• Itching especially at night
• Severe = anorexia, weight loss, bed wetting

Question 23

How are threadworms treated?

Answer 23

Mebendazole - given to everyone in the household even if they are asymptomatic. OTC treatment.
Encourage good hand washing, clean linens in the house good hygiene to kill the eggs.

Question 24

What is functional constipation?

Answer 24

Idiopathic constipation - easily treated w laxatives but might need to be taken for several months. Red flag = not passing meconium w/i 48 hours.