Paediatrics Flashcards
What are the 4 categories in mile stones?
gross motor skills
fine motor skills and vision
language and hearing
social and play
6 week old baby
The surgeon head control in vertical follows light with eyes stops moving when spoken to smiles sociably
6 month old baby
curious baby
pushes on forearms, rolls stomach to back, weight bears
hand to hand transfer, palmar grasp, mouths things
babbles (mamama), screams when annoyed
friendly with strangers, plays with feet
12 month old baby
drunk cruises around furniture, may take first steps pincer grip, bangs and throws toys responds to name, mumbles sounds drinks from cup, waves bye bye
18 month old baby
dinner party
runs, climbs on adult chair
builds tower 3-4 blocks, hand preference, picture books
5-20 words, points to body parts
feeds with spoon, imitates adult activities
2 year baby
Slow adult double tread stairs, throws ball tower 6-7 blocks, scribbles 50 words, talks to self, joins 2 words, simple instructions hat and shoes, symbolic play
4 year baby
Diva runs up and down stairs, kicks and catches ball, hops threads beads, copies cross, draws a man Stories, counts to 20 dresses, takes turns
3 year baby
mini me
alternating feet on stairs, pedals trike
tower 9-10 bricks, copies circle, cuts with scissors
name and gender, lots of questions, simple conversation
washes hands, vivid play, sharing
What is DTaP/IPV/Hib/HepB?
diphtheria, tetanus and pertussis
polio
haemophilus influenzae B
hepatitis B
What does pertussis cause?
whooping cough
When is rotavirus immunisation given?
2 months and 3 months
What is diphtheria?
bacterial infection that infects mucous membranes
pseudomembranes (grey/white patches) develop that can block the airways
toxin produced that enters the blood stream causing myocarditis, arrhythmias, nerve damage
What is tetanus?
bacterial infection (Clostridium tetani commonly found in soil) produce toxins that block release of inhibitory neurotransmitters (glycine and GABA) causing muscle spasms (classically starts as lock jaw)
Difference between clostridium botulinum and clostridium tetani?
botulinum affects synapses at neuromuscular junction whereas tetanus affects synapses in the brain
What is pertussis?
bacterial infection that starts similarly to URTI but followed by violent coughing attacks in whihc patient gasps for air (whoop)
produces toxins that kill ciliated epithelial cells
can develop pulmonary hypertension (increased white blood cells in lungs) that leads to hypoxia
What is polio?
viral infection that attacks the motor neurons and cause permanent muscle paralysis can be fatal if affecting brain or
spread through fecal matter
What is haemophilus influenzae type B?
bacterial infection that can cause septicaemia, meningitis, epiglottitis
What is pneumococcal infection?
bacterial infection (strep pneumoniae) commonly causes meningitis
What is hepatitis B and what problems can it cause?
virus that affects the liver that can persist for years and cause serious liver damage
spread through blood and body fluids
Antibiotic for whooping cough?
macrolide abx: erythromycin
Management of HIB?
ceftriaxone
Management of epiglottitis?
IV ceftriaxone
When is the rotavirus vaccine given?
8 weeks, 12 weeks
What 4 vaccines are given at 8weeks?
DTaP/IPV/Hib/HepB
PCV
rotavirus vaccine
MenB
What 2 vaccines are given at 12weeks?
DTaP/IPV/Hib/HepB
rotavirus vaccine
What 3 vaccines are given at 16weeks?
DTaP/IPV/Hib/HepB
PCV
MenB
What 4 vaccines are given at 1year?
Hib/MenC
PCV
MMR
MenB
What vaccine is given annually between 2-11 years?
flu
What 2 vaccines are given at 3years 4 months?
DTaP/IPV
MMR
What vaccine is given to girls aged 11-13?
HPV (16 &18)
What 2 vaccines are given at 14years?
Td/IPV
MenACWY
Edwards chromosome
18
Patau chromosome
13
Down’s syndrome
21
ADHD triad
hyperactive, inattentitive, impulse
ADHD treatment
methylphenidate or atomextine
Autism
social communication
language
repetitive behaviour
Aspergers
autism but no problem with social communication
What is atresia?
absence or abnormal narrowing of a passageway
What vaccines are given at birth to at risk babies?
BCG (TB)
Flu
Heb B (if mother has hep B
What is an incubation period?
time of infection to onset of symptoms
What do ventral (anterior) horns of spinal cord contain?
cell bodies of motor neurons
What do dorsal (posterior) horns of spinal cord contain?
cell bodies of sensory neurons
What bilirubin is lipid soluble?
UCB
How does UCB get to the liver?
binds to albumin and transported from spleen/lymph nodes to liver
What enzyme conjugates bilirubin?
UGT
What bilirubin is water soluble?
CB
What makes urine yellow?
urobilinogen (CB converted to this by SI microbes)
What is gilberts syndrome?
low UGT levels
liver has reduced ability to conjugate UCB
What is crigler najjar syndrome?
no UGT
liver cant conjugate any UCB (fatal)
What does presence of HBsAg indicate?
active infection (acute or chronic)
What does presence of IgGsAg indicate?
cured or vaccinated
How do you differentiate between HBV cured or vaccinated?
cured individual also has IgGcAg
Vaccine only has surface antigen present so no antibodies can develop against core
What happens in the window period of HBV infection?
HBsAg is so low (due to work of the IgMsAg) that is cant be detected but you are infected (IgMcAg is present and IgGcAg may be present if body is taking longer to clear virus)
What hepatitis virus has double stranded DNA oppose to single stranded RNA?
HBV
What is the ductus arteriosus?
connects pulmonary artery to descending aorta
What is the newest vaccine to be introduced for children?
MenB
When is baby first examined and when is the follow up?
examination of the new born within 72 hours
next examination 6-8weeks (GP)
Epiglottitis presentation?
sudden onset fever, sore throat, drooling, dysphagia, no cough, muffled voice, inspiratory stridor
Thumbprint sign?
epiglottitis
Steeple sign?
croup
Croup presentation?
barking cough with inspiratory stridor
no drooling
Organism commonly causing croup?
viral: parainfluenza
Organism commonly causing epiglottitis?
bacterial: HIB, strep pyogenes
Managment of epiglottitis?
IV ceftriaxone
ITU, endotracheal intubation
management of croup?
serious: O2, nebulised adrenaline, steroids
Non-serious: dexamethasone
Whooping cough presentation?
cold like symptoms
attacks of whooping cough with gasps for air
Management of whooping cough?
erythromycin
Organism in whooping cough?
bordetella pertussis bacteria
inheritance of CF?
AR
What causes CF?
inherited mutation in CFTR gene that codes for NaCl channel
Decreased Cl into secretions which usually draws water in to help thin
fat soluble vitamins?
ADEK
Test for CF?
IRT screening in newborn
Sweat test NaCl >60
Genetic testing for CFTR mutations
Where is CFTR gene found?
chromosome 7
What is cerebral palsy?
group of movement disorders
Overall function of the cerebellum?
balance and coordination
Overall function of the basal ganglia?
helps initiate and prevent certain movements
habits
eye movements
cognition, emotion
Function of the motor cortex?
motor function
What is chorea?
irregular movements that flow from one part to another producing dance like movements
What is dystonia?
sustained muscle contraction
Where does PD affect?
substantia nigra in basal ganglia
What are the three main types of cerebral palsy and what area of the brain is affected in each?
spastic (cerebrum)
dyskinetic (basal ganglia)
ataxic (cerebellum)
What is baclofen?
muscle relaxant
What is juvenille myoclonic syndrome?
brief episodes of involuntary muscle twitchin (myoclonic seizures) +/- absence +/- tonic clonic
common in 12-18yrs
management of generalised epilepsy?
na valproate 2nd line/chil-bearing age lamotrigine
management of focal/partial seizures?
carbamazapine, 2nd line lamotrigine
For infants having repeat febrile convulsions what can you teach the mother?
rectal diazepam
buccal midazolam
ambulance if >5mins
What are the risk factors for febrile convulsions?
age (6months to 5 years)
FH
rapid onset fever >38
vaccines (benefits outweigh risks)
What is the classic presentation for febrile convulsion?
occurs early in viral infection
brief <5mins
generalised tonic-clonic
Do antipyretics reduce chance of febrile seizures?
no
What is a simple febrile seizure?
<15 mins
normal in 1hr
symmetrical generalised tonic-clonic
no repeat in 24hrs
What is a complex febrile seizure?
15-30mins
repeat in 24 hrs
focal
Who gets admitted with febrile seizures?
1st one
any features of complex seizure
What are the chances of a repeat seizure and when does this increase?
1 in 3 increased if <18 months fever <39 onset shortly after fever began FH
What is the childhood chance of developing epilepsy and what are the risk factors that increase this chance?
2.5%
complex febrile seizures
FH
neurodevelopmental disorders
Common cause of meningitis in 0-3months?
listeria
e-coli
GBS
Common cause of meningitis 3months to 6 years?
h. influenzae (gram -ve rods)
n. meningitidis (meningococcus)
s. pneumoniae (pneumococcus)
Common cause of meningitis in >6year olds?
neisseria meningitis (meningococcal)
gram -ve diplococci
s.pneumoniae
What is a positive kernigs sign?
lie on back knee at 90degrees and straighten causes back pain
What is a positive brudzinskis sign?
lie on back and flex neck causes knees to automatically flex
Management of bacterial meningitis?
<3months: cefotaxime and amoxicillin
>3monhts: cefotaxime 1st dose then ceftriaxone
Where is a lumbar puncture done?
between L3 and L4
