Paediatrics

Question 1

what respiratory rate is a red flag on the traffic light system?

Answer 1

> 60 /min

Question 2

outside what time window ie neonatal jaundice pathological?

Answer 2

24 hours - 2 weeks (or 3 weeks preterm)

Question 3

why does physiological jaundice occur?

Answer 3

short RBC life, immature hepatic enzymes, no gut flora to eliminate bilirubin

Question 4

what can cause pathological jaundice <24 hours

Answer 4

haemolytic disease of the newborn

infection (TORCH)

Question 5

what can cause pathological jaundice >2/3 weeks

Answer 5

infecton
hypothyroid
GI problems

Question 6

Ix for neonatal jaundice?

Answer 6

transcutaneous serum bilirubin
FBC
TORCH screen
group and save
blood film
LFTs

Question 7

what is a soft early systolic murmur in a neonate?

Answer 7

benign flow murmur

Question 8

what causes machinery murmur?

Answer 8

patent ductus arteriosus

• normally closes functionally 12-18 hours
• normally closes anatomically 2-3 weeks

Question 9

what might cause a harsh pansystolic murmur with S2 split in a neonate?

Answer 9

VSD

Question 10

name some neonate reflexes

Answer 10

moro
rooting
stepping
sucking (all stop at 3-4 mo)

grasping (12mo)
babinski extensor (12 mo)

Question 11

normal RR and HR for

neonate
1-2 yo
5-12 yo

Answer 11

neonate: 40-60 100-170
1-2 yo: 25-35 100-150
5-12 yo: 20-25 80-120

Question 12

respiration is most sensitive for paediatric illness, what signs should you check?

Answer 12

RR
tracheal tug
intercostal recession
harrison’s groove

Question 13

in Piaget’s universal theory of human cognitive development, what stages are there?

Answer 13

Sensorimotor: 0-2 yr then object permanence
Pre-operational: 2-7 yr then conservation of number
Concrete operations: 7-11 yr then abstract thinking
Formal operations: 11+

Question 14

what are the 4 domains of development?

Answer 14

gross motor
fine motor
language
social

Question 15

6 months developmental milestones?

Answer 15

gross motor: sits with support, rolls
fine motor: grasps
language: babbles
social: smiles

Question 16

9 months developmental milestones?

Answer 16

gross motor: sits w/o support, crawls, pulls to stand
fine motor: releases toy
language: turns head to name, responds to bye bye
social: stranger anxiety, eye contact, interaction, attenton seeking, separation anxiety

Question 17

12 months developmental milestones?

Answer 17

gross motor: walks with hand held
fine motor: mature pincer grasp
language: single word
social: waves goodbye

Question 18

18 months developmental milestones?

Answer 18

gross motor: walks up steps, walks unaided
fine motor: build blocks, scribbles
language: 6 words, names pictures
social:

Question 19

24 months developmental milestones?

Answer 19

gross motor: kicks/throws balls, runs
fine motor: stacks 5-6 blocks, turns pages, uses spoon
language: 2-word sentences, 200 word vocab, follows 2 step command
social: selfish, no is favourite word

Question 20

what are the 3 fetal adaptations to circulation?

Answer 20

ductus venosus (umbilical vein to IVC) 
ductus arteriosus (pulm artery to desc aorta)
foramen ovale (atria)

Question 21

what are the 5 domains for APGAR assesment?

Answer 21

appearance   (pink/blue limbs/blue)
pulse   (>100, <100, 0)
grimace   (coughs, depressed cough, none)
activity  (active, flexion, absent)
resp rate  (strong cry, slow cry, none)

Question 22

advantages of breastfeeding for baby?

Answer 22

protects against URTI, GI infections
lowers risk necrotising colitis
reduces risk atopy
attachment

Question 23

what neonatal screening is there?

Answer 23

hearing - day 1

heel prick - day 5: hypothyroid, CF, sickle, metabolics

Question 24

what is checked in NIPE?

Answer 24

eyes
cleft palate
hips
testes
heart

Question 25

what is used to reduce risk of cerebral palsy and resp distress?

Answer 25

magnesium sulphate | corticosteroids