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Clinical Life Sciences 2 > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What 4 main anatomical reasons result in children being more likely to suffer from respiratory issues

A
  1. Narrower airway
  2. Shorter airway
  3. Tonsils disproportionately large
  4. Epiglottis disproportionately large
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2
Q

Why do children have less surface area for gas exchange?

A

They have fewer alveoli than adults

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3
Q

Why does the larynx sit higher and further forward in children?

A

Because they have a ‘shorter neck’

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4
Q

Children are obligate ……….. breathers?

A

Nose

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5
Q

What structure is primarily drives breathing in children?

A

The diaphragm

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6
Q

Why are children’s chest walls easily collapsible?

A

Cartilaginous skeleton has not fully ossified

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7
Q

What can children’s immature neurological reflexes for blood gas lead to more easily?

A

Acidosis

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8
Q

Why do children consume more energy at rest?

A

Through the work of breathing

Higher BMR

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9
Q

How many times more oxygen do children consume compared to adults?

A

2x

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10
Q

What can be triggered by laryngeal stimulation in children?

A

The aponeic response

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11
Q

What four main things can activate the aponeic response?

A
  1. Foreign bodies
  2. Airway adjuncts
  3. Infection
  4. Irritation
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12
Q

How are childrens ribs orientated differently?

A

They are more horizontal - restricting upward movement

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13
Q

What two cavities does the diaphragm separate?

A

The abdominal and thoracic cavities

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14
Q

Up to what age approximately are children diaphragmatic breathers?

A

~5years old

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15
Q

Why does the paediatric diaphragm have a reduced range of movement?

A

It is anatomically flatter than an adults

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16
Q

What 2 other properties of the paediatric diaphragm lead to issues?

A
  1. Lack of type 1 muscle fibres (resistance to fatigue and fast reaction)
  2. Abdominal organs cause resistance on inspiration
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17
Q

Why do chest retractions occur in respiratory distress?

A

A reduction of pressure in the chest and a less self supporting rib cage

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18
Q

What two locations will paradoxical breathing primarily be seen?

A
  1. Substernally

2. Below the scapula

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19
Q

What happens to respiratory rate as age increases?

A

It decreases

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20
Q

At birth how much of the heart is made up of myocardium?

A

~30%

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21
Q

What two properties result from there being less myocardium?

A
  1. Less mass

2. Less compliance

22
Q

Why do the myocardium cells have less compliance in children?

A

There are fewer mitochondria in paediatric myocardium compared to adults

23
Q

Why do children have the capacity for less stroke volume?

A

Anatomically smaller hearts that are less pliable

24
Q

Is cardiac output higher in children than in adults?

A

Yes

25
Q

What is the equation for cardiac output?

A

HR x SV

26
Q

Why is heart rate in children less sensitive to adrenaline and noradrenaline?

A

Due to the lack of receptors

27
Q

Are heart murmurs common in children?

A

Yes (innocent murmurs)

28
Q

Why are children at an increased risk of dehydration?

A

Due to their volume:surface area ratio their loose more fluid
Tachypnoeic

29
Q

List some signs and symptoms of dehydration in children

A
  • Lack of wet nappies
  • Irritable
  • Sunken eyes
  • Tachycardia
  • Lethargy
  • Dry membranes
  • Skin turgour (lack of)
  • Low B.P.
30
Q

What happens to intersitial fluid distribution as a child ages?

A

It decreases

31
Q

What does increased extracellular fluid in children increase the risk of?

A

Dehydration

32
Q

How does a childs anatomically large liver impact respiratory function?

A

Causes pressure on the Diaphragm

33
Q

Why are children more susceptible to hypoglycemia?

A

Liver enzymes are immature
Store less glycogen
Limited muscle (less AA stores)

34
Q

What are foetal bones layed down as initially in development?

A

Cartilage

35
Q

Why must one be cautious when gaining IO access in paeds?

A

The presence of growth plates in long bones

36
Q

What is the preferred IO site in paediatrics?

A

Proximal tibia

37
Q

Childrens nervous systems are anatomically complete at birth however what does not occur fully until age 7?

A

Full nerve myelination

38
Q

Why do paediatric patients have issues with heat retention?

A

Their homeostatic mechanisms and reflexes are immature

39
Q

What happens to the number of synapses at a young age?

A

Increases rapidly as new connections are formed

40
Q

What is synaptic pruning?

A

The elimination of of excess synapses to increase the efficiency of the neural network?

41
Q

By what % does the number of synapses reduce by between the ages of 2-10 years?

A

50%

42
Q

How are synaptic connections strengthened in children?

A

Synapses that are frequently used such as those with sensory, cognitive and motor functions

43
Q

Which synaptic connections are ‘pruned’?

A

Those connections that have been weakly reinforced and no longer are needed for normal functioning

44
Q

Young children are generally able to recover better from brain injury. Why is this?

A

Extra/redundant synaptic connections that have not been pruned can be used in place of damaged pathways to preserve certain functions

45
Q

Why is Intramuscular injection best avoided in children?

A

Due to their low muscle mass

46
Q

What is the preferred IM injection site in children?

A

Anterolateral thigh (vastus lateralis)

47
Q

Children have less fat stores than adults. How does this affect doses given?

A

Less drug is taken up into fat thus the dose of fat soluble drugs given is reduced

48
Q

How does a childs increased ECF volume affect drug doses?

A

Increased ECF leads to drug dilution

Therefore and increased dose/kg is needed

49
Q

Children metabolise drugs via the liver like adults however why are they at increased overdose risk?

A

The immaturity of the liver and its enzymes

Higher BMR –> Increased dose/kg

50
Q

What can children have impaired drug excretion?

A

Immature renal function (increased half life - metabolism poor)

51
Q

Why may the use of glucagon be ineffective when treating a hypoglycaemic paediatric patient?

A

They store less glycogen… therefore have less to be released

Clinical Life Sciences 2 (7 decks)

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