Paediatrics Flashcards

1
Q

How long is exclusive breast feeding recommended for?

A

6 months

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2
Q

What could cause issue with breast feeding? and what does this lead to?

A
  • Poor milk supply, discomfort or pain for mother => inadequate nutrition for baby
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3
Q

Is overfeeding more common in bottle or breast?

A

Bottle

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4
Q

Breast milk benefits (baby + mother)

A
  • contains Ab that protect neonate from infection => reduce infection in neonatal period
  • improved cognitive development
  • decrease risk of SIDS
  • Decrease risk of obesity
  • Mother: reduce risk of breast and ovarian cancer
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5
Q

How much formula feed vol per day?

A

150ml of milk per kg of body weight (from day 4 onwards)

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6
Q

How much weight loss is acceptable in neonate? (breast + bottle) when should the weight be back?

A

acceptable for breast fed to lose <10% and formula fed up to 5% of their body weight by day 5
- then back at birth weight by day 10

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7
Q

What is most common cause of weight loss in neonate?

A

dehydration due to underfeeding

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8
Q

What is weaning? when?

A

transition from milk to normal food
- around 6 months

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9
Q

What does growth chart plot? (x + y axis?)

A

y axis: child’s weight, height + head circumference
x axis: age (and sex)

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10
Q

what do the centiles on a child’s growth chart indicate

A

where the Childs growth compares against normal distribution for their age and sex

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11
Q

What are the different phases of growth in children (3). what does it depend on?

A
  • First 2 years: rapid growth driven by nutritional factors
  • 2 years-puberty: Steady slow growth
  • Puberty: rapid growth spurt driven by sex hormones
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12
Q

What counts as child as overweight? obese?

A

Overweight: BMI > 85th percentile
Obese: BMI > 95th percentile

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13
Q

Child is short and obese. What could this indicate?

A

Possible endocrine issue
(Usually overweight/obese children are tall for age)

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14
Q

causes of failure to thrive (5)

A

anything that lead to inadequate energy and nutrition
- Inadequate nutritional intake
- difficulty feeding
- malabsorption
- increased energy requirments
- inability to precess nutrition

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15
Q

Failure to thrive: causes of inadequate nutritional intake? (5)

A
  • maternal malabsorption if breastfeeding
  • Iron deficiency anaemia
  • Family or parental problems
  • Neglect
  • Availability of food (poverty)
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16
Q

Failure to thrive: causes of difficulty feeding? (3)

A
  • Poor suck (e.g. cerebral palsy)
  • Cleft lip of palate
  • pyloric stenosis
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17
Q

Failure to thrive: causes of malabsorption?

A
  • CF
  • Coeliac disease
  • Cows milk intolerance
  • Chronic diarrhoea
  • IBD
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18
Q

Filaure to thrive: causes of increased energy requirements? (3)

A
  • Hyperthyroidism
  • Chronic disease (congenital heart disease, CF)
  • Malignancy
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19
Q

Failure to thrive: cause of inability to process nutrients properly?

A

type 1 diabetes

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20
Q

what is defined as short stature? what does it depend on

A

height more than 2 standard deviations below the average for their age and sex

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21
Q

how do you work out a child predicated height? girl? boy?

A

Boys: (mother height + fathers height + 14cm)/2
Girls: (mother height + fathers height - 14cm)/2

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22
Q

what could cause short stature?

A
  • familial short stature
  • Constitutional delay in growth and development
  • Malnutrition
    Chronic diseases (coeliacs, IBD, congenital heart disease)
  • Genetic disorders (downs syndrome)
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23
Q

What are the 4 categories of the developemtnatl milestones

A
  • Gross motor
  • Fine motor + vision
  • Language, hearing + speech
  • Social, emotional, behavioural
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24
Q

Describe the developmental milestones of a 6 month old

A
  • Gross: maintain a sitting position
  • Fine: palmar grasp
  • Language: Makes noises with consonants, responds to tone of voice
  • Personal + social: curious and engaged with people
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25
Q

Describe the developmental milestones of a 12 month old?

A
  • Gross: Stand + begin cruising
  • Fine: pincer grasp, hold crayon and scribble randomly
  • Language: says single words, follows v simple instructions
  • personal + social: engages with others by pointing and handing objects, waves bye bye
26
Q

What is global developmental delay?

A

child displays slow development in all developmental domains

27
Q

Name some conditions that can cause global developmental delay? (3)

A
  • Downs syndrome
  • Fragile X syndrome
  • Fetal alcohol syndrome
28
Q

What age range does puberty start for girls? boys?

A

puberty stars age 8-13 in girls
and 9-14 in boys

29
Q

how long does puberty take form start to finish?

A

4 years

(2-5 yrs)

30
Q

describe the overall development of girls during puberty? what develops first?

A

starts with breast bud development => then pubic hair => menstrual periods start (about 2 years form the start of puberty)

31
Q

Describe the overall development of boys doing puberty? what develops first?

A

Starts with enlargement of testicles => enlargement of the penis => gradual darkening of the scrotum => development of pubic hair => deepening of voice

32
Q

Can 16/17 years olds make independent decisions about their health? when can this be overruled?

A

16 and 17 year olds can make independent decisions bout their health
- if they refuse treatment then this can be overruled in certain situations by parents

33
Q

Can children under 16 make decisions about treatment?

A

they can if they are deemed to have Gillick competence

34
Q

What is the upper + lower age limit of Gillick competence ?

A

children under 16 (there is no lower limit but unlikely to be less than 13)

35
Q

What are Frazer guidelines?

A

guidelines for providing contraception to patients under 16 years

36
Q

What is hypogonadism and what does it cause?

A

lack of the sex hormones (oestrogen + testosterone) => delayed puberty

37
Q

What is hypogonadoprphic hypogonadism? describe the hormone levels? abnormal functioning of what?

A

Due to abnormal functioning of hypothalamus or AP
- Deficiency in LH + FSH => deficiencies in sex hormones (testosterone + oestrogen)

38
Q

Causes of hypogonadotrophic hypogonadism?

A
  • GH deficicnety
  • Hypothyroidism
  • serious chronic illness (CF, IBD)
  • Excessive exercise or dieting
  • Constitutional delay
  • Kallman syndrome
39
Q

What is hypergonadoprphic hypogonadism? describe the hormone levels? abnormal functioning of what?

A

Due to abnormal function of the gonads
lack of response to LH + FSH by gonads => no negative feedback => AP produces increased amount of LH + FSh to stimulate the gonads

40
Q

Cause of hypergonadotrophic hypogonadism?

A

Due to abnormal function of the gonads
- Previous damage to gonads
- Kleifelters Syndrome
- Turners syndrome

41
Q

What counts as precocious puberty ? what age in girls and boys ?

A

the development of secondary sexual characteristics <8 in girls, <9 in boys

42
Q

What are the 2 general categories for precocious puberty causes ?

A
  • Central (GnRH dependant)
  • Peripheral (over production of sex hormones)
43
Q

what are some central precocious puberty causes ? (4)

A

GnRH dependant (dysfunction of hypo or AP)
- Tumour
- Infection
- Cyst
- Radiation damage to brain

44
Q

what are some peripheral precocious puberty causes ? (4)

A

(over production of sex hormones)
- cyst/tumour
- genetic coditions
- Dysfunction of glands 9throid, adrenal)
- exogenous sex hormones (meds, creams)

45
Q

How is precocious puberty diagnosed ? (3)

A
  • Tanner scale
  • GnRH levels
  • US/MRI (structural abnormalities of brain + gonads)
46
Q

What is adrenal insufficiency ? what hormones ?

A

when adrenal glands do not release enough steroids hormones (cortisol + aldosterone)

47
Q

Where is cortisol release from ? controlled by what ? describe the pattern of how its secreted

A

cortisol secreted by 2 adrenal glands (cortex) (above kidneys) controlled by hypothalamus
- secreted in pulses in response to stressful stimulus (diurnal variation)

48
Q

briefly describe HPA axis ?

A

hypo secretes CRH => AP secrete ACTH => adrenal secretes cortisol (-ve feedback on hypo and AP)

50
Q

What are the actions of aldosterone ?

A

acts on nephrons of kidney => Na reabsopred (water follows), increase K secretion, Increase H+ secretion => increase BP

51
Q

What type of hormone is cortisol ? aldosterone ?

A
  • cortisol: glucocorticoid
  • aldosterone: mineralocorticoid

(both steroid hormones)

52
Q

What is primary adrenal insufficiency ? another name for this ? usual cause ?

A

Addisons: adrenal glands are damaged (=> low cortisol + aldosterone)
- usually autoimmune

53
Q

what is tertiary adrenal insufficnety ? causes ?

A

adrenal insufficney caused by problem with hypo
- due to long term steroids => suppression of hypo

54
Q

what is secondary adrenal insufficiency ? causes ?

A

adrenal insufficiency caused by problem with AP
- congenital hypoplasia
- surgery
- infection

55
Q

features of adrenal insufficiency in babies ? (6)

A
  • lethargy
  • vomiting
  • poor feeding
  • hypoglycaemia
  • jaundice
  • FTT
56
Q

what investigations for adrenal insufficiency ?

A
  • Cortisol, ACTH, aldosterone, renin
  • Short synacthen test
57
Q

describe the cortisol, ACTH, aldosterone + renin in Addisons ? secondary adrenal insufficiency ?

A
  • Addisons (primary): low cortisol, high ACTH, low aldosterone, high renin
  • Secondary: low cortisol, low ACTH, normal aldosterone + normal renin
58
Q

what is the short synacthen test ?

A

ACTH stimulation test: give synacthen (synthetic ACTH) and see the effect on cortisol ( to see if primary or secondary adrenal insufficiency)

59
Q

adrenal insufficney Mx? (2) name the drugs and what they are replacing

A

replacement steroids
- hydrocortisone
(glucocorticoi to replace cortisol)
- fludrocortison (mineralocorticoid to replace aldosterone)

60
Q

what is addisonian crisis ?

A

adrenal crisis: acute presentation here absence of steroid hormones => life threatening crisis

61
Q

When does s a child start to show hand preference ? when would you be concerned ? what could this indicate ?

A

usually 2-4 yrs
- hand preference before 12 months is abnormal (could indicate CP)