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3rd year > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

What are some of the physiological differences seen in children?

A 
Surface area:volume 
% water content
Metabolic reserves
Faster pulse, resp rate
Lower blood pressure - maintained until very shocked.
  • They more easily get cold, dehydrated, hypoglycaemic.
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2
Q

Describe Physiological differences in terms of Ketotic hypoglycaemia

A 
6-7am hypoglycaemic episode. 
1-2 year old.
Skinny 
Intercurrent illness. 
Most common form of hypoglycaemia between 18 months to 5 years.
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3
Q

What is different in children’s immune system?

A

Trust nature.
Immune system remarkably robust.
MMR, unconjugated pneumococcal vaccine.
Need to have infection before become immune.

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4
Q

What are some of the chronic conditions with childhood onset?

A 
Asthma 
Autism 
Cerebral palsy 
Cystic fibrosis
Gastroschisis 
Hirschusprungs disease
Spina bifida
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5
Q

What are the reasons for reduced mortality of children?

A

Obstetric care
Better housing
Better Nutrition
Immunisations

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6
Q

What are some of the immunisations?

A

Measles
diphtheria
Polio
Rotavirus

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7
Q

What happens usually when children are admitted?

A 
Acute admissions typically <2 years.
Typically respiratory 
Increasing referrals
Mostly watchful waiting
No evidence of increasing severity.
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8
Q

Whats the important thing to remember in child care?

A

Understanding range of normal allows you to understand what is abnormal.
If in doubt review.

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9
Q

What are the 4 points to reflect on in child medicine?

A
  1. Children are not naturally healthy and need the right environment to develop and thrive.
  2. What outcome? All child health outcomes are linked.
  3. Child health and wellbeing is influenced by non-NHS policies e.g. housing, education, environmental.
  4. Children and young people (CYP) are the future… adults, parents, workforce, carers, leaders.
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10
Q

What can determine health and well being of the child?

A

Health and wellbeing of the adult.
Intervene early!
- Lifestyle
- Resilience

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11
Q

What are the key development fields?

A 
Gross Motor 
Fine Motor 
Social and Self help.
Speech and language.
Hearing and vision.
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12
Q

Why is development important?

A

Learning functional skills for later life.
Hone skills in a safe environment.
Allow our brain’s genetic potential to be fully realised.
Equip us with tools needed to function as older children and adults.
Many are completely automatic.

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13
Q

What are some of the influencing factors for development?

A

Genetics
Environment
Positive early childhood experience.
Developing brain vulnerable to insults - antenatal, post natal, abuse and neglect.

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14
Q

What are some of the adverse environmental factors?

A

Antenatal - infections (CMV, Rubella, Toxoplasmosis, VZV)
Toxins (alcohol, smoking, anti-epileptics)

Postnatal - Infection (Meningitis, encephalitis) 
Toxins (Solvents mercury, lead) 
Trauma (Head injuries)
Malnutrition (iron, folate, VitD) 
Metabolic (Hypo/hyperglycaemia)
Maltreatment 
Maternal mental health issues.

Good (sensitive) histories are therefore important.

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15
Q

What are the red flags to notice in development?

A 
No social smile by 2 months.
Not sitting unsupported by 9 months. 
Not walking unsupported by 18 months.
No words by 2 years. 
Hearing loss. 
Persistent low muscle tone/floppiness.
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16
Q

What are the stages of childhood and at what age does it occur?

A 
Neonate <4w
Infant <12m/1yr
Toddler about 1-2y
Pre-school 2-5y
School age 
Teenager / Adolescent
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17
Q

For milestones in children when would you think about a referral?

A

If not achieved by limit age (2 SDs from mean)

Correct for prematurity until 2 years.

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18
Q

What are the reference values for Weight, lenght and OFC at 1. Birth 2. 4 months 3. 12 months 4. 3 years.

A
  1. W - 3.3 L- 50 OFC - 35
  2. W - 6.6 L-60
  3. 12months W- 10 L-75 OFC-45
  4. 3years W-15 L-95
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19
Q

What does failure to thrive indicate?

A

Supply of energy and nutrients is less than the demand for energy and nutrients.

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20
Q

What are the causes of failure to thrive in early life?

A

Deficient intake:
Maternal:
Poor lactation, incorrectly prepared food, unusual milk or other feeds, inadequate care.

Infant:
Prematurity, small for dates, oro palatal abnormalities (cleft palate), neuromuscular disease (cerebral palsy), genetic disorders.

Increased Metabolic demands:
Congenital lung disease
Heart disease
Liver disease 
Renal disease 
Infection 
Anaemia 
Inborn errors of metabolism 
Cystic fibrosis 
Thyroid disease 
Crohn's / IBD
Malignancy 
Excessive nutrient loss:
Gastro oesophageal reflux 
Pylroic stenosis 
Gastroenteritis 
Malabsorption - food allergy, persistant diarrhoea, coeliac disease, pancreatic insuffiency, short bowel syndrome.
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21
Q

Non-medical causes of failure to thrive?

A 
Poverty / socio-economic status. 
Dysfunctional family interactions. 
Difficult parent-child interactions. 
Lack of parental support.
Lack of preparation for parenting/education. 
Child neglect.
Emotional deprivation. 
Poor feeding or feeding skills disorder.
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22
Q

3 months - Gross motor

A

Lifts head and chest when lying on stomach.

Turns around when lying on front.

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23
Q

3 months - fine motor

A

Looks at and reaches for faces and toys.

Picks up toy with one hand.

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24
Q

3 months - Language

A

Cries in a special way when hungry.
Makes sounds - ah,eh.
Laughs out loud.

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25
Q

3 months - Social

A 
Social smile (6-8weeks)
Distinguishes mother from others.
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26
Q

3 months self-help

A

Reacts to seeing bottle/breast.

Comforts self with thumb/dummy.

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27
Q

6 months gross motor

A

Rolls over from back to front.

Sits steadily without support (8-9months)

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28
Q

6 months fine motor

A

Transfers toy from one hand to the other.

Uses 2 hands to pick up large objects.

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29
Q

6 months language

A

Babbles
Responds to name.
Makes sounds like “da-da” - 2 syllable babble.

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30
Q

6 months social

A

Reaches for familiar people.

Pushes things away they don’t want.

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31
Q

6 months self-help

A

Feeds self biscuits / similar foods.

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32
Q

9 months gross motor

A

Crawls on hands and knees.
Pulls to stand.
Walks around furniture while holding on.

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33
Q

9 months fine motor

A

Picks up small objects with thumb and finger princer grip.

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34
Q

9 months language

A

Understands phrases like no no and all gone.

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35
Q

9 months social

A

Looks for objects that fall out of sight - object permanence. (9-12months)
Stranger awareness.
Plays social games.
Waves bye bye.

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36
Q

9 months self help

A

Picks up spoon by the handle.

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37
Q

12 months gross motor

A

Stands without support
Walks without help (by 18months)
Runs (some falls)

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38
Q

12 month fine motor

A

Stacks 2 or more blocks.

Picks up 2 small toys in one hand.

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39
Q

12 months language

A

Has 1 or 2 words with meaning.

Uses “mama” specifically for parents, or similar.

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40
Q

12 months social

A

Gives kisses or hugs.

Shows shared attention / pointing to things of interest.

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41
Q

12 months self help

A

Lifts cup to mouth and drinks.
Insists on doing things by self such as feeding.
Feeds self with spoon.

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42
Q

18 months gross motor

A

Kicks a ball forward.
Runs well - few falls
Walks up and down stairs without support.

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43
Q

18 months fine motor

A

Builds towers of 4 or more blocks.
Scribbles with crayon
Turns pages of picture books, one at a time.

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44
Q

18 months language

A

Uses at least 10 words
Asks for a drink or food using words or sounds.
Names a few familiar objects in picture books.
Follows 2 part instructions.
Starts to join words into sentences (21-24 months)

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45
Q

18 months social

A

Sometimes say “no” when interfered with.
Shows sympathy to other children, tries to comfort them.
Early pretend play.
Usually responds to correction by stopping.

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46
Q

18 months self-help

A

Eats with fork
Eats with spoon
Takes off open coat or shirt without help.

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47
Q

2years gross motor

A

Climbs on play equipment

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48
Q

2 years fine motor

A

Scribbles with circular motion.

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49
Q

2 years language

A

Has a vocabulary of around 30-50 words.

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50
Q

2 years social

A

“helps” with simple household tasks.

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51
Q

2 years self help

A

Opens door by turning knob.

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52
Q

2.5 years gross motor

A

Stands on one foot without support.

Walks up and down stairs one foot per step.

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53
Q

2.5 years fine motor

A

Draws or copies vertical lines.

Cuts with small scissors.

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54
Q

2.5 years language

A

Speaks clearly, understandable most of the time.

Knows what to do with objects.

55
Q

2.5 years Social

A

Plays with other children.
Plays a role in games.
Plays games - tig, hide and seek.

56
Q

2.5 years self-help

A

Washes and dries hands.

Dresses self with help.

57
Q

3 years gross motor

A

Rides on a tricycle, using pedals.

58
Q

3 years fine motor

A

Draws or copies complete circle.

59
Q

3 years language

A

Asks questions beginning with “why”, “When”

Identifies >4 colours by name correctly.

60
Q

3 year social

A

Gives directions to other children

61
Q

3 year self help

A

Toilet trained - may need help wiping.

62
Q

3.5 years gross motor

A

Hops on one foot without support.

63
Q

3.5 years fine motor

A

Cuts across paper with small scissors

64
Q

3.5 years language

A

Answers questions like “what do you do with your eyes”
Talks in long, complex sentences (10+)
Follows a series of 3 simple instructions in order.

65
Q

3.5 years social

A

Plays co-operatively with minimum conflict and supervision.

Protective towards younger children.

66
Q

3.5 years self help

A

Washes face without help.

Dresses and undress without help, except shoelaces.

67
Q

4 years fine motor

A

Draws a recognisable picture

68
Q

4 years language

A

Counts ten or more objects.

Prints a few letters or numbers.

69
Q

4 years social

A

Follows simple rules in board/card games.

70
Q

4 years self help

A

Fastens one or more buttons

71
Q

4.5 years gross motor

A

Skips or makes running jumps.

72
Q

4.5 years fine motor

A

Draws a person with 3 parts

73
Q

4.5 years language

A

Reads a few letters (>5)

74
Q

4.5 years self-help

A

Usually looks both ways before crossing the road.

75
Q

5 years gross motor

A

Self propels on swing

76
Q

5 years fine motor

A

Prints first name

77
Q

5 years language

A

When asked what is an orange answers a fruit.

78
Q

5 years self help

A

Goes to toilet without help.

79
Q

What are the 4 red flag milestones

A
  1. No social smile by 2 months
  2. Not sitting unsupported by 9 months
  3. Not walking unsupported by 18 months
  4. No words by 2 years.
80
Q

What are concerning respiratory symptoms?

A

Grunting
Chest drawing
Consistent fever and rigors
Neck stiffness

81
Q

What are the indications for referral when thinking about dysmorphic syndrome features?

A 
Extreme short / tall stature 
Height below target height 
Abnormal height velocity 
History of chronic disease 
Obvious dysmorphic syndrome 
Early / late puberty.
82
Q

What are the common causes of short stature?

A 
Familial 
SGA/IUGR 
Undernutrition 
Chronic illness (JCA, coeliac) 
Psychological and social
Hormonal (hypothyroidism)
Turner 
P-W syndromes.
83
Q

What is characteristic of thyroid deficiency in children?

A

Loss of height and gain of weight.

84
Q

What is the triad for HUS?

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI/ARF

85
Q

What is the tanner method?

What is it based on?

A 
Staging in puberty.
Breast 
Genital 
Pubic hair
Axillary hair 
Testes
86
Q

What is early puberty and late in female?

A 
Before 8 early 
After 13 (RARE)
87
Q

What is early puberty and late in male?

A 
Before 9 early 
After 14 ( common especially in CDGP)
88
Q

What is the most common GM in children?

A

Minimal change disease:

89
Q

What is the typical presentation of GM in children?

A

Gastroenteritis 10 days ago.
Swollen face, 1 eye closed, pale, inflated weight, peri-orbital oedema, ascites, pitting oedema.
FROTHY URINE.

90
Q

What is the most common cause of CKD in children?

A

Congenital (birth defects)

91
Q

UTI features in a child

A

Irritability
Dysuria
Failure to thrive
Pain on micturation

If more systemic could be pyelonephritis.

92
Q

Treatment for children with a UTI?

A

BP - doppler used for young kids.

Trimethoprim 1st and then amoxicillin 2nd line. for 3-5 days orally.

93
Q

What are the 3 types of diabetes that can be seen in a child?

A

Type 1 - most common
Type 2 - more common now due to obesity
Maturity onset diabetes of the young.

94
Q

What are the 3 Ts in diabetes?

A

THINK - diabetes
TEST - blood glucose levels
TELEPHONE - referral nearest diabetes team.

95
Q

What are the main signs seen in Type 1 in children?

A

Thirst, increased toilet use, decreased weight, more tired.

96
Q

What are the red flag symptoms seen in diabetes in children?

A

Bed wetting / day-wetting after previously being fine.

97
Q

What is the best test to do for children with suspected diabetes?

A

Random bed side capillary blood glucose.

98
Q

What is needed for a diagnosis of diabetes?

A

Symptoms and 1 diagnostic test.

99
Q

What is best treatment for type 1 in children?

A

Basal bolus insulin 4-5 times a day.

100
Q

What are the signs of hypoglycaemia in children?

A 
Headache
Poor concentration
Confusion
Coma
Weakness
Lethargy
Tremor
Sweating
Palpitations
Seizures.
101
Q

If child is awake and aware how do you treat hypo?

A

10-15g immediate acting carbohydrate by mouth.
Check blood glucose within 15mins
Follow up with additional complex carb to maintain.

102
Q

If child is uncoperative how do you treat hypo?

A

Glucogel into buccal cavity.

103
Q

If child has altered consciousness and fitting how do you treat hypo?

A

IM glucagon

IV 10% glucose if in hospital.

104
Q

What do children with diabetes need to do when they are ill?

A

Increase blood glucose monitoring
Maintain carbs
High fluid intake
Ketones / urine check.

105
Q

What headaches need more investigations?

A

Isolated acute
Chronic progressive
Acute severe.

106
Q

What is most common cause of headache in children? Features of this are:

A

Migraine:

Non-specific abdominal pain, nausea, vomiting, focal symptoms, photophobia.

107
Q

Features of tension headache?

A

Band-like distribution
Present most of time
Constant ache
Symmetrical, diffuse.

108
Q

Features of increased ICP?

A

Bend, lift and cough make it worse.
Woken from sleep with headache / vomiting.
Generally well but headache when lying down.

109
Q

What are red flags on imaging and features?

A 
Cerebellar dysfunction 
Raised ICP
Neurological deficit 
Seizures 
Personality changes
110
Q

Treatment for migraine

A

Triptans - amytriptalyine.

Prevention is propanalol.

111
Q

What is epilepsy?

A

Tendency of recurrent, unprovoked epileptic seizures.
EEG only for supportive evidence.
Usually a chemical trigger.

112
Q

Treatment for epilepsy

A

Sodium valporate and levetivarcetam.

Carbamezepine - 1st line focal.

113
Q

What is the most common dermatology problem in children?

A

Eczema atopic.
In neonates - face, neck and cheeks.
In older children - flexural areas.

114
Q

Impetigo - presentation and treatment?

A

Most common - staph aureus.
Pustules and honey comb clusters.
Topical antibacterial. Oral antibiotics (flucloxacilin)

115
Q

Presentation of molluscum contagiosum and treatment

A

Common, peraly papules, 24 months to clear - molluscipox virus. (can use potassium hydroxide)

116
Q

Presentation of chicken pox and treatment

A

Varicella zoster.

Highly contagious - red papules progress to vesicles - start on trunk. Itchy. 10-21 days.

117
Q

What is parvovirus and how does is present?

A

Slapped cheek - risk to pregnant women. Hand foot and mouth blisters.
Enterovirus - self-limiting.

118
Q

What is most common fracture?

A

Clavicle.

119
Q

Toddlers fracture of the tibia

A

Crack - very tender.

120
Q

What is a green stick fracture?

A

Periosteal hinge on opposite side - 2 shape deformity.

121
Q

What is SSSS?

A

Staph scalded skin syndrome - staph aureus - LEss than 5 years. Fever, widespread redness, fluid filled blisters, rupture easily.

122
Q

What is TSS?

A

Toxic shock syndrome - S pyogenes and S.aureus - systemically unwell, widespread rash, multi-organ failure - rapidly fatal.

123
Q

What is the criteria for Kawasaki disease?

A 
Fever for 5 days or more
bilateral conjuctival infection 
Cracked lips / strawberry tongue
Cervical lymphadenopathy 
Polymorphous rash
Changes in extremities
124
Q

What is the criteria for Kawasaki disease?

A 
Fever for 5 days or more
bilateral conjuctival infection 
Cracked lips / strawberry tongue
Cervical lymphadenopathy 
Polymorphous rash
Changes in extremities
125
Q

Treatment for Kawasaki disease

A

Immunoglobulins
Aspirin
Steroid
- leading cause of aquired heart disease in developed world.

126
Q

Biggest complication in kawasaki disease?

A

Coronory artery anerysm

127
Q

What is a bacterial infection of eczema treated with?

A

Flucloxacillin.

128
Q

What is the recommended daily feed of 6 month old per kg?

A

130-160ml

129
Q

What is the treatment for GORD in children?

A

Decrease feed volume
Feed thickners
Positional advice when feeding
Gaviscon

130
Q

8 year old boy with purpuric rash over his buttocks and legs - red urine and palpable rash on examination - what is the most likely diagnosis?

A

Henoch Schonlein Purpura

Colicky abdominal pain and joint pain

131
Q

What tests should be done in Henoch Schonlein purpura?

A 
Blood pressure 
Dipstick 
U &amp; Es
Urine culture 
Urine protein : creatinine ratio
132
Q

What can trigger Steven Jonson’s syndrome in children?

A

Viral infection (EBV)
Vaccinations
Medications i.e. anticonvulsants, NSAIDs

Erythema multiform (target like) rash.

133
Q

Immune thrombocytopenic purpura - presentation and treatment.

A

Spontaneous bruising and isolated thrombocytopenia.

IVIg.

134
Q

If severe bleeding in ITP what would be the treatment?

A

Trauma IV Immunoglobulin + steroids +/- platelet transfusion

Tranexamic acid may also be used for mucosal bleeding

3rd year (22 decks)

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