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Specialities > Paeds 6 > Flashcards

Paeds 6 Flashcards

1
Q

List some reasons to refer a child who you suspect has developmental delay:

A
  • Regression (at any age)
  • Concerns about vision (tracking, flowing objects)
  • Hearing loss
  • No speech by 18 months
  • Head circumference >99.6th centile
  • unable sit unsupported at 12 months
  • walk by 18 months
  • run by 2.5 years
  • reach for objects at 6 months
  • point and share interest by 2 years
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2
Q

What are some causes of gross motor delay?

A

Cerebral palsy

Duchene muscular dystrophy

Prolonged illness or hospitalisation during key milestone times

SMA

Chromosomal abnormalities

TORCH infections

*referral to specialist physiotherapist and paediatrician

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3
Q

What are some causes of speech delay?

A

Autism

Hearing impairment

Poor social interaction/ deprivation

Down syndrome

*referral to SALT and hearing test

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4
Q

What professionals in the community are usually involved with a child who requires special needs or has complex difficulties?

A

OT

Physio

Community paediatrician

SALT

Specialist nurse

CAMHS

Health visitor

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5
Q

What are the three main domains of ASD?

A

Social interaction behaviour

Social communication

Repetitive/ Ritualised

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6
Q

What is the definitions of nocturnal enuresis:

A

Involuntary bed wetting
x2 weekly
>5 years old

Primary: never managed continence

  • with daytime symptoms
  • without daytime symptoms
  • overactive bladder
  • structural abnormalities
  • chronic constipation
  • neurological deficit

Secondary: previously dry for 6 months

  • diabetes
  • UTI
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7
Q

What are the managements strategies for nocturnal enuresis:

A

Encouragement
Goals set
Enuresis alarm
Desmopressin - for short term use

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8
Q

When can global developmental delay be used up till?

A

5 years old

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9
Q

What are the most common causes of bacterial tracheitis?

A

Staph Aureus

Strep

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10
Q

What type of pneumonia is most common in children and how should it be investigated?

A

Bronchopneumonia is more common in children

Investigations:

bloods:
- FBC
- WBC
- blood cultures

Orifices:
- throat swab

X-ray :
- CXR

*if pneumonia keeps reoccurring then consider sweat test

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11
Q

What are some signs of cardiac disease in a baby?

A 
Feeding problems 
Breathless on feeding 
Sweating 
Failure to thrive 
\+/- 
oedema 
cyanotic attacks
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12
Q

What is the management of severe pneumonia in a paediatric patient?

A

Oxygen
Secretions sucked out
NG feds (if say to do so)

Antibiotics for severe pneumonia:
- IV cefuroxime
+
- IV gentamicin

*if you suspected staph infection (say following Influenza infection) then add Flucloxacillin

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13
Q

When carrying out resuscitation breaths in baby - what important practical point must you remember?

A

Cover over the nose as well as the mouth

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14
Q

In terms of burns - which get referred and which are sent to PICU?

A

All burns over 3% are referred

Full thickness burn >1 % is referred

Any over >10% will ned IV fluids

> 30% need PICU

Any burns in genitals, face or joints are referred

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15
Q

What investigations do you want in a child who has presented with diarrhoea?

A 
Bloods: 
- FBC 
- U&Es 
- CRP 
\+/- 
- Blood cultures

Orifices:

  • Urine dip (check for ketones)
  • Stool culture
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16
Q

What is your fluid replacement for a dehydrated child?

A

5% dehydrated: 50mls/kg + Maintancing fluid over 48 hours

10% dehydrated: 100mls/kg + Maintancing fluid over 48 hours

*maintenance fluid is over 24 ours but the dehydration fluid is over 48 hours

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17
Q

What are some of the complications from meningitis?

A

Cerebral oedema

SIADH

Deafness

Long-term damage:

  • cerebral palsy
  • epilepsy
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18
Q

What is the antibiotics given to a newborns with suspected meningitis?

A

<6 weeks:

  • ceftriaxone
  • Gent
  • Amoxicillin

6weesk - 3 months:
- IV ceftriaxone

> 3 months:
- Ceftriaxone
+
- Dexamethasone (if no purpura)

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19
Q

In a neonate how does an UTI present:

A 
Poor feeding 
Vomiting 
Fever 
Jaundice (conjugated) 
Weight loss
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20
Q

What is the immediate management of child who has swallowed a toxic substance?

A

Induce vomiting
- fingers down throat
or
- Syrup Ipeacac 15ml + glass of water

**this is contraindicated in volatile hydrocarbons or caustic substances.

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21
Q

What are some immediate 1st aid managements to do whilst a child is fitting?

A

Remove anything dangerous around them

Place in prone position
- prevents choking on vomit

Don’t open mouth may cause damage to teeth

Remove restrictive clothing if possible

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22
Q

What is the scoring system used to assess if a child has septic arthritis and how is a septic arthritis in a child managed?

A 
Kocher's 
- unable to weight bare 
- fever >38.5 
- WWC >12 
- ESR >40 
\+/-
- CRP

IV antibiotics (<5 cefuroxime, >6 is flucloxacillin)
- Sepsis 6
Surgical wash out

*no joint aspiration is done

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23
Q

What position is the septic arthritic hip usually held in?

A

Externally rotated and flexed

24
Q

What is the investigations done into DDH and why is treatment needed?

A

< 6 months = ultrasound of hips

> 6 months = x-ray

If not fixed the child in later life will almost certainly need a hip replacement

25
Q

What are some of the signs of Legg-Perthes disease?

A

Loss of abduction
Loss of Internally rotated
LLD

Low social economic status
Maternal smoking
Body shape

<6 = monitoring, with braces to hold hip in place 
>6 = may require surgery
26
Q

What disease are children who have synovitis at an increased risk of developing?

A

Legg - Perthes

- 10% will develop this

27
Q

What foods would you advise to avoid before < 6 month and a year?

A

<6 months:

  • unpasteurised milks/ Cheeses
  • Shell fish
  • Wheat based food

<1 year
- honey

*try to avoid anything that may trigger allergies

28
Q

When should the birth weight lost be regained by?

A

10-14 days

29
Q

Why are infants at risk of faltering growth?

A

High energy demands

Low storage

Smaller in size
- increased metabolic turnover

Reliance of food from others

30
Q

What are the main causes of rectal bleeding in a child?

A

Anal fissure

Swallowed blood from epitaxis

Mekel’s diverticulum

Intussusception

Gastroenteritis

IBD

31
Q

What is the complication that can occur with Port wine stains?

A

These are Capillary defects which enlarge as the person grows.

10% are due to Sturge- Weber Syndrome

  • which affects the V1 branch
  • Ipsilateral arachnoid and pia of the cortex
  • learning difficulties and seizures
  • macrocephaly
  • glaucoma
32
Q

What disease in childhood is associated wit the development of diabetes?

A

Cystic fibrosis

Trisomy 21

*note that steroid induced may also be a cause in those suffering with severe asthma

33
Q

What genetics are associated with diabetes type I? and what percentage of cells need to be destroyed in order for symptoms to be noticed?

A

DR3/ DR4

> 90%

34
Q

If a child presents with DM-1 diabetes - what addition diseases should you consider screening for?

A

Addisons
Coeliac
Thyroid

35
Q

What specific things do you want to monitor during ketoacidosis?

A

GCS
ECG
BP
Ketones

36
Q

What are the causes of CKD in children?

A

Obstructive causes:

  • Pelvis uterieric obstruction
  • Vesicoureteric reflux
  • PUV’s

Dysplasia

Cystic disease

Infection

37
Q

How is Vesicoureteric reflux treated?

A

Prophylactic antibiotics
Surgical (usually done via cystoscopy)

Indication for surgery:

  • UTI prophylaxis
  • Progressive scaring
  • pain on voiding
38
Q

What are the main questions you want to ask following a heard injury to child?

A 
Mechanism? - any large forces involved? 
Unconsciousness - with any amnesia? 
Vomiting? 
NAI - story consistent? 
Any other injuries?
39
Q

What advice can be given to parents for the return of their child following a head injury?

A

ACORN
- after concussion return to normality

*provides info and the do’s and don’t following concussion in a traffic light system as well as worsening advice.

40
Q

What are the indications for a CT head scan in a child following an injury?

A

Witnessed >5 mins loss of consciousness

Amnesia >5mins

> 3 episodes of vomiting

Abnormal drowsiness

Signs of basal skull fracture

Seizure following injury

41
Q

Generically what order should investigations and examinations be done into a child presenting with stomach pain be done?

A 
History 
Examination 
Urine dip 
Bloods 
Repeat examination 
US
42
Q

What are the essential bloods that must be done in a child presenting with abdominal pain?

A 
FBC 
U&Es
CRP 
LFTs
Amylase 
Glucose
43
Q

List some specific referral times:

A

Non-weight baring - 12 months
Non- sitting unsupported - 12 months
Not walking - 18 months
Not running - 2.5 years

No babble - 9 months
No words - 18 months

No symbolic play - 18 months

44
Q

What are some co-morbities to cerebral palsy?

A

Learning difficulties

Seizures

Feeding difficulties
- often need a gastrostomy feeding peg

Osteoporosis

Behavioural problems

Deformity

  • physio
  • ortho
  • botulism injections
45
Q

At what level of spina - bifida will a patient not be able to walk?

A

L3

46
Q

What are the tissues that are present in Meckel’s diverticulum and what is the presentation?

A

Gastric
Pancreatic
Jejunal

Presentation:

  • Haemorrhage (gastric acids)
  • Obstruction (volvulus)
  • Diverticulitis (bacterial infection)
47
Q

What is the special test that can be done to diagnose Meckel’s diverticulum?

A

Meckel’s scan

- binds to gastric mucosa

48
Q

What is a very important point in the history of a child where you suspect NAI to consider with regards to the mechanism of injury, and what will you do in A&E if you suspect NAI?

A

Is the child old enough to be able to perform such an action which could cause that injury
- for example - rolling off a couch at 2 months old is not likely

  • Inform senior
  • Admit child
  • Tell parents what you are doing
49
Q

In a child who is missing developmental milestones - what things would you want to ask the parents?

A

History of pregnancy

History of peri-natal period

Neonatal illness/ prelonged stays in hospital

Notable family history of illness
- duchenes? cystic fibrosis?

50
Q

How far can a baby see at 3 months and when is myelination of the optic nerve complete by?

A

1m at 3 months
or 3ft

*3 months can see 3ft

24 months myelination complete

51
Q

How can visual acuity be tested in a baby?

A

Gratings - 10 weeks old
*lines on a baord which a child will follow when compared to a grey board

Kay pictures
- 3 years old

52
Q

What are some indications for a gastrostomy and why is used for additional feeds over just increasing food volume?

A

Any child where an NG tube is likely to be in place for more than >3 months a gastrostomy should be considered.

  • neurological conditions
  • oesophageal atresia
  • increased nutrients requirements

advantages of increased nutrients requirements:

  • continuous feeding as opposed to bolus
  • night time feeding
  • still allows food to be ate orally
53
Q

What type of genetic defect increases the likely hood of parents having another child with Down’s syndrome - and what is the most common neurological defect seen in almost all Down’s syndrome babies?

A

Robertsonian Translocation
- increases risk of recurrent Down’s syndrome

Hypertonia is a feature seen in almost all Down’s syndrome babies

54
Q

What is the risk of a further febrile convulsion within the same illness? and what actions can be done to reduce another convulsion? and what advice should be given if there is another seizure?

A

33% risk of a further convulsion

Regular paracetamol
Removal of clothing to keep child cool
Regular temperature checking

Call ambulance if >5mins
Remove anything near mouth if seizing
Place in recovery position following seizure

55
Q

How much bacterial growth is needed for there to eb a diagnosis of UTI? and explain how to do a clean - mid- stream catch:

A

> 100,000 bacterial colony forming units/ml of urine

Wait until 1 hour after feed, then hold baby up and tap just above the pubis with 2 fingers.
- this should trigger micturition

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