Paediatrics Flashcards
Developmental milestones for 6 weeks old: Gross motor
1.) Good head control – raises head to
45o when on tummy,
2.) Stabilises head when raised to sitting
position
Developmental milestones for 6 weeks old: Fine motor
1.) Tracks face/object
Developmental milestones for 6 weeks old: Speech/language
1.) startles at loud noise
Developmental milestones for 6 weeks old: Social
Social smile
Developmental milestones for 6 months old: Gross motor
Gross Motor:
1.) Sit without support, rounded back
2.) Rolls tummy (prone) to back (supine)
. Vice versa slightly later.
Developmental milestones for 6 months old: Fine motor skills
Palmer grasp
Transfer hand to hand
Developmental milestones for 6 months old: Language and speech
1.) Turns head to loud sounds
2.) Understands “bye bye” / “no” (7m)
3.) Babbles (monosyllabic)
Developmental milestones for 6 months old: Social
1.) Puts objects to mouth (stops at 1yr)
2.) Shakes rattle
3.) Reaches for bottle / breast
Developmental milestones for 9 months old: Gross motor skills
Gross Motor:
1.) Stands holding on
2.) Sit up straight
Developmental milestones for 9 months old: Fine motor skills
1.) Inferior pincer grip
2.) Object permanence
Developmental milestones for 9 months old: Language and Speech
1.) Responds to own name
2.) Imitates adult sounds
Developmental milestones for 9 months old: Social
Holds and bites food
Stranger fears
Developmental milestones for 12 months old: Gross motor
Walks alone
A 12-year old girl presented with palpitation for a few week and after performing an ECG was shown to have supraventricular tachycardia. What are the 3 types of SVT?
1) AVRT (including WPW)
2) Atrial:
-Sinus Tachycardia- Regular
-Atrial fibrillation - Irregular
-Atrial Flutter - Regular
3) AVNRT (functional) = most common SVT
What are the measures to treat SVT (Both non-pharmacological in a stable patient, and pharmacological)
Non-pharmacological interventions:
Valsalva manoeuvre
Immersing face in ice water
Pharmacological:
Adenosine (first-line)
Amiodarone
Propranolol
Describe the features of Wolff-Parkinson-White syndrome on an ECG
o Delta waves
o Short PR interval
o Wide QRS complex (>120 ms)
Treatment for WPW (3)
1.) Vagal Manoeuvres
2.) IV Adenosine
3.) Synchronised DC Cardioversion
What is contraindicated in WPW
Digoxin
If SVT persists unrecognised how might infants present with?
1) pallor
2) poor feeding
3) vomiting
4) may progress to lethargy and shock
What structural malformations are associated with SVT? (3)
- Ebstein anomaly (Tricuspid valve defect)
- Transposition of great arteries
- Hypertrophic cardiomyopathy (heart muscles thickened)
3 Months Boy presents with Failure to Thrive for 1 Month. What are the possible differentials?
Inadequate intake:
o Organic: impaired sucking, anorexia
o Non-organic: Psychosocial deprivation
Inability to retain:
o Vomiting
o severe GERD
Malabsorption:
o lactose intolerance, milk intolerance
o IBD, Celiac disease
o short gut syndrome, post necrotising enterocolitis (NEC)
Inability to utilize nutrient
o Chromosomal: Down, IUGR
o Metabolic: congenital hypothyroidism, storage disorder, amino acid disorder
Increase energy demand
o Thyrotoxicosis, malignancy, chronic infection, CHF, CRF, VSD
Heart failure in neonates. Likely reason and causes? (4)
An obstructed systemic circulation
1.) Hypoplastic left heart syndrome
2.) Aortic stenosis
3.) Severe coarctation of the aorta
4.) Interruption of the aortic arch
Heart failure in infants. Likely reason and causes? (3)
High pulmonary blood flow (Left-to-right shunts) - occurs when blood leaks from the systemic circulation to the pulmonary circulation
1.) Ventricular septal defect (VSD) - Hole between R and L ventricles that leads to O2 rich blood flowing back into lungs
2.) Atrioventricular septal defect (AVSD) - Hole between atrium and ventricle
3.) Large patent ductus arteriosus (PDA) - opening between a baby’s aorta and pulmonary artery is large, causing irregular blood flow and increased pressure in the lungs
Heart failure in older children and adolescents. Likely reason and causes?
Right/ left heart failure
1.) Eisenmenger syndrome - congenital heart defect causes abnormal blood circulation in the lungs and heart
2.) Rheumatic heart disease - heart valves damaged by rheumatic fever
3.) Cardiomyopathy
A 3 month old boy presents with a large VSD with Heart Failure. What are the symptoms he may present with.
o Respiratory distress (e.g. during feeding), dyspnea, tachypnea
o Poor feeding and feeding difficulty
o Poor weight gain
o Sweating
o Recurrent chest infection
What are the 2 major reason for FTT in heart failure
o Use a lot of energy to overcome symptoms of congenital heart disease
o Reduced milk intake due to respiratory distress
What are the Common ddx of heart failure with heart murmur in 3 months old?
(heart failure in infant period usually due to high pulmonary blood flow = left to right shunt)
Large VSD, AVSD, PDA
Management for heart failure in infants
Supportive & Nutrition (O2, calorie input) (no fluid and salt restriction in paediatrics unless very
severe)
Pharmacological:
o Diuretics to treat pulmonary and venous congestion: furosemide, spironolactone (K
sparing)
o Inotropic support: digoxin (less used now), dobutamine
o Afterload reduction: ACEI (captopril, only syrup form), hydralazine
o Surgical (Types & Timing)
* can be done at 3-6months old to prevent pulmonary HT
* Open surgical closure
* Interventional catheterization with occlusion device
A boy presenting with vomiting, abdominal pain and rapid breathing and acid-base results suggesting DKA
with respiratory compensation. ABG: Na 152 / K 6.2 / pO2 normal / PCO2 low / HCO3 low / BE -20
Describe the Acid-base balance abnormality
Metabolic acidosis with partial respiratory compensation
Respiratory acidosis we would expect an elevated PCO2 and a near normal or elevated HCO3. A near normal HCO3 would indicate no metabolic compensation while an elevated concentration would represent some level of metabolic compensation.
If the process was a metabolic acidosis, we would expect to see a declined HCO3 level and a near normal or lower PCO3. The former indicates no respiratory compensation and the latter represents some level of respiratory compensation for metabolic acidosis.
DKA signs
Kussmaul breathing
Pear drop breath
Reduced skin turgor
