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Phase 3a > Paeds > Flashcards

Paeds Flashcards

1
Q

What are the symptoms of pneumonia

A
  • Raised Temp.
  • Poor feeding
  • Tachypnoea/cardia
  • Cyanosis
  • Sternal/costal recession
  • Grunting
  • Older children may have typical signs/symptoms
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2
Q

How might you manage pneumonia

A
  • Amoxicillin (1st line)
  • Co-amoxiclav
  • Azithro/Erythromycin
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3
Q

What are the symptoms of Croup

A
  • Stridor
  • Barking cough
  • Sternal/costal recession
  • Hoarse voice
  • Raised temp.
  • Poor feeding
  • Tachypnoea/cardia
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4
Q

How might you treat Croup

A
  • Steroids (1st line)
  • Oxygen
  • Nebulised adrenaline if very severe
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5
Q

What is important to recognise/rule out with croup

A
  • Bacterial tracheitis

- Epiglottitis

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6
Q

How might Bacterial tracheitis present and how do you treat it

A
  • Hx of viral infection followed by deterioration
  • Stridor/barking cough/difficulty breathing
  • Thick exudate/tracheal mucus that risks occluding airways as is not cleared by coughing
  • IV antibiotics
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7
Q

How might Epiglottitis present and how do you treat it

A
  • AVOID EXAMINING THROAT
  • Difficulty breathing
  • Severe pain (worse on swallowing)
  • Stridor/braking cough minimal or absent
  • Difficulty swallowing/drooling
  • Intubation by anaesthetist and IV antibiotics
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8
Q

How might Bronchiolitis present

A
  • Fever
  • Poor feeding
  • Tachypnoea/cardia
  • Wheeze
  • Costal/sternal recession
  • Grunting
  • Cyanosis/pallor
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9
Q

What is the most common cause and treatment of Bronchiolitis

A
  • RSV
  • Supportive management
  • Oxygen
  • CPAP
  • Upper airway suctioning
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10
Q

How might Whooping cough (pertussis) present

A
  • Apnoea
  • Bouts of coughing (child can go blue/red) ending in vomiting
  • Whoops
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11
Q

How might you manage whooping cough (pertussis)

A
  • Worse in infants so admit for monitoring

- Erythromycin within first 21 days

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12
Q

What are the symptoms of Asthma

A
  • Bouts of difficulty breathing
  • Wheeze
  • Cough
  • Often worse at night
  • Often identifiable trigger
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13
Q

What are some of the common precipitating factors for asthma

A
  • Cold air
  • Exercise
  • Allergens (eg. pets)
  • Smoke
  • Stress
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14
Q

How might you investigate suspected asthma

A
  • PEFR (diary)
  • Spirometry
  • Functional exhaled NO
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15
Q

How might you manage asthma

A
  • SABA (salbutamol)
  • SABA + ICS (pred.)
  • SABA + ICS + LABA (salmeterol)
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16
Q

How might Cystic fibrosis present

A
  • Meconium Ileus (failure to pass stool or a vomit in first 2 days of life, bowels seen as distended, can sometimes see meconium ileus mass)
  • Lung disease (bronchiectasis like) - coughing, noisy breathing, productive
  • Pancreatic insufficiency - Steatorrhea / vomiting/ malnutrition
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17
Q

How might you manage cystic fibrosis

A
  • Education
  • Vaccination/antibiotic prophylaxis
  • ICS/SABA for resp. relief
  • Panc. enzyme replacement + vitamins
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18
Q

How might Otitis media present

A
  • Sudden onset earache
  • Hearing loss
  • Discharge
  • Fever
  • Poor feeding
  • Balance difficulties
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19
Q

What might you see under the otoscope in otitis media

A
  • Red/yellow/cloudy eardrum - be wary the eardrum can be pink/red in response to fever
  • Bulging of tympanic membrane/fluid and loss of landmarks
  • Perforation
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20
Q

What is the management of otitis media

A
  • Paracetamol/ibuprofen for the pain
  • Otomize
  • Amoxicillin (1st line)
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21
Q

What is glue ear

A
  • Fluid effusion behind the eardrum/in the middle ear
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22
Q

What are the symptoms of glue ear

A
  • Hearing loss (most common)
  • Earache
  • Tinnitus
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23
Q

How might you manage glue ear

A
  • Watch and wait, most resolve spontaneously
  • Auto inflation
  • Grommet insertion
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24
Q

Describe bicuspid aortic valve

A
  • Bi instead of tricuspid valve
  • Most common CHD
  • Mostly asymptomatic at birth but at increased risk of becoming stenosed in adulthood
  • Stenosis is a diastolic murmur heard best in right upper sternal edge
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25
Q

Describe atrial septal defects

A
  • Normal shunt is L-R so acyanotic
  • Can develop PH overtime leading to RH hypertrophy and Eisenmenger’s causing cyanosis
  • Ejection systolic murmur
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26
Q

Describe ventricular septal defects

A
  • Normal shunt is L-R so acyanotic
  • In larger holes Eisenmenger’s can occur leading to cyanosis
  • Systolic murmur at the lower left sternal border
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27
Q

Describe patent arteriosus ductus

A
  • Persistent communication between proximal pulmonary artery and descending aorta
  • Increases load on right heart leading to RH hypertrophy/failure
  • Continuous murmur
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28
Q

Describe tetralogy of fallot

A

Combination of
- Large VSD
- Overarching Aorta (the valve is lower in the ventricle meaning the ventricle has to work harder to eject)
- RV outflow obstruction
- RV hypertrophy
RV outflow obstruction plus hypertrophy lead to raised RH pressure causing flow from R-L causing cyanosis
Ejection systolic murmur at the left mid and upper sternal border

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29
Q

What are the signs/symptoms of infective endocarditis

A
  • Clubbing
  • Splinter haemorrhage
  • Fever
  • Anaemia/pallor
  • Heart failure/murmur
  • Splenomegaly
  • Arthritis/Arthralgia
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30
Q

What is scarlet fever

A
  • Group A strep. infection of the throat
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31
Q

How might scarlet fever present

A
  • Pale red bumpy pinpoint (sandpaper) rash
  • Skin may peel after rash resolves
  • Sore throat
  • Strawberry tongue
  • Fever
  • Cervical lymphadenopathy
  • Flushed face
  • Petechiae inside mouth
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32
Q

How can you treat scarlet fever

A
  • Penicillin V

- Paracetamol/ibuprofen for pain/fever

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33
Q

What is rheumatic fever

A
  • A systemic febrile illness caused by sensitivity reaction to group A strep. infection (scarlet fever)
  • Can cause permanent heart valve damage
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34
Q

How might rheumatic fever present

A
  • 2-4 weeks post scarlet fever/throat infection
  • Fever
  • Inflamed joints
  • Chest pain
  • Difficulty breathing
  • Tachycardia
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35
Q

How can you manage rheumatic fever

A
  • Bed rest until resolved
  • Benzylpenicillin followed by penicillin V
  • Aspirin
  • Steroids in severe carditis
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36
Q

What are the symptoms/signs of GORD

A
  • GOR is common on infants <1 yrs old
  • Poor feeding
  • Vomiting (especially after feeding)
  • Faltering growth
  • Crying when lying flat
  • Hoarseness/cough
  • Older children may have typical symptoms/signs
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37
Q

What investigations might you do for GORD

A
  • 24 hour pH monitoring
  • Barium swallow
  • Endoscopy
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38
Q

How might you manage GORD

A
  • Ant. acids/Gaviscon
  • PPIs/H2 receptor antagonists
  • Fundoplication
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39
Q

What are the symptoms/signs of pyloric stenosis

A
  • Projectile vomiting
  • Constipation
  • Faltering growth
  • Dehydration
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40
Q

What investigations might you do for pyloric stenosis

A
  • Can often feel thickened pylorus after feed

- USS

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41
Q

How do you manage pyloric stenosis

A
  • Surgery
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42
Q

What are the signs/symptoms of IBD

A
  • Diarrhoea
  • Blood/mucus in stool
  • Constipation
  • Abdominal pain
  • Mouth ulcers
  • Weight loss
  • Fatigue
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43
Q

What investigations might you do for IBD

A
  • FBC/inflamm. markers
  • Faecal calprotectin
  • H. pylori stool test
  • Colonoscopy and biopsy
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44
Q

How can you manage IBD

A
  • Steroids
  • Azathioprine
  • Infliximab
  • Surgery
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45
Q

What are the symptoms/signs of Appendicitis

A
  • Severe sudden onset pain (umbilicus, migrates to RIF)
  • Nausea and vomiting
  • Fever
  • Guarding
  • Rebound tenderness
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46
Q

What investigations might you do for appendicitis

A
  • USS (preferred)

- CT/MRI

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47
Q

How might you treat appendicitis

A
  • IV antibiotics

- Surgery

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48
Q

What are the signs/symptoms of coeliac disease

A
  • Steatorrhoea
  • Constipation
  • Reflux/Vomiting
  • Weight loss/malnutrition
  • Bloating/abdominal pain
  • Faltering growth
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49
Q

What investigations might you do for coeliac disease

A
  • IgA tTGA and total serum IgA

- Endoscopic intestinal biopsy (diagnostic)

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50
Q

How might you manage coeliac disease

A
  • Gluten free diet
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51
Q

What are the symptoms/signs of intussusception

A
  • Severe abdominal pain (initially episodic but becomes more constant in nature)
  • Vomiting
  • Constipation (can also be diarrhoea)
  • Poor feeding
  • Redcurrant jelly stools (blood stained mucus)
  • Fever
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52
Q

What investigations might you do for intussusception

A
  • Can sometimes feel in abdomen

- USS

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53
Q

How might you treat intussusception

A
  • Barium or air enema

- Surgery

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54
Q

What is Hirschsprung’s disease

A
  • Congenital abnormality causing absence of nerve ganglions in a segment of bowel, causing loss of intestinal movement leading to constipation and obstruction
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55
Q

What are the signs/symptoms of Hirschsprung’s disease

A
  • Failure to pass meconium
  • Bloating
  • Bilious vomit
  • Constipation
  • Poor feeding/weight gain
  • Hirschsprung’s related enterocolitis (watery foul diarrhoea, fever, vomiting)
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56
Q

What investigations might you do for Hirschsprung’s disease

A
  • Rectal exam

- Rectal biopsy (absence of nerve ganglions)

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57
Q

How do you manage Hirschsprung’s disease

A
  • Surgery (pull through)

- May need a stoma

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58
Q

How might a UTI present

A
  • Often very generalised symptoms
  • Poor feeding
  • Fatigue/distress
  • Fever
  • Vomiting
  • Abdo. pain
  • Offensive urine
  • Dip all fevers without established cause and if no improvement with treatment
  • Older children may have more typical presentation
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59
Q

How do you investigate a UTI

A
  • Urine dipstick
  • Urine culture
    Methods of collecting include
  • Clean catch
  • Catheterisation
  • Suprapubic aspiration
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60
Q

How do you treat UTI

A
  • <3 months iv amoxicillin and gentamycin or iv cephalosporin
  • > 3 months Trimethoprim or nitrofurantoin
  • Pyelonephritis gentamycin
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61
Q

What is nephrotic syndrome

A

Triad of
- Proteinuria
- Hypoalbuminemia
- Generalised oedema
- Often accompanied by hypercholesterolaemia
In children usually caused by minimal change disease

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62
Q

How might nephrotic syndrome present

A
  • Frothy urine
  • Generalised oedema
  • Fatigue
  • Ascites
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63
Q

What investigations might you do for nephrotic syndrome

A
  • Urine dipstick
  • Albumin to Cr ratio
  • Biopsy (rare)
64
Q

How can you treat nephrotic syndrome

A
  • Steroids
  • Diuretics for symptom relief
  • Biologic agents
65
Q

How might glomerulonephritis present

A
  • Coca cola urine (haematuria)
  • Oedema
  • Oliguria
  • Fatigue/malaise/pruitus (Raised urea in bloodstream)
66
Q

What are the two important causes of glomerulonephritis

A
  • Post strep. infection

- Henoch Scholein Purpura

67
Q

Describe post Strep. nephritis

A
  • Preceding (usually) throat infection with group A strep. (scarlet fever)
  • Treat with penicillin
68
Q

Describe Henoch Scholein Purpura

A

A vasculitis caused by IgA attacking the blood vessels post infection (usually)
Causes
- Arthritis + periarticular oedema
- Rash of raised red or purple spots
- GI problems (vomiting, bloody stools)
- Nephritis
If kidney involvement treat with steroids in hospital

69
Q

Describe a macular rash

A
  • A flat skin discolouration
70
Q

Describe a papular rash

A
  • Small raised spots less than 0.5cm in diameter
71
Q

Describe a maculopapular rash

A
  • A rash consisting of flat discolouration and raised spots
72
Q

How might erythema toxicum neonatorum present and how do you treat it

A
  • Onset usually first few days - a week after birth
  • Erythematous macules and white papules
  • May also be pustules (puss filled lesion)
  • Should be otherwise well
  • Does not require treatment
73
Q

How might chickenpox present and how do you treat it

A
  • Itchy red spots
  • Initially spots are filled with fluid, but then scab over
  • Fever
  • Aches pain and malaise
  • Loss of appetite
  • Fluids and paracetamol
  • BE WARY that if fever initially settles then recurs then this can be due to secondary bacterial infection
74
Q

How might measles present and how do you treat it

A
  • Red maculopapular rash widespread
  • Grey/white spots on inside of cheek (kopliks spots)
  • Conjunctivitis (photosensitive)
  • Fever
  • Cold like symptoms (runny nose, cough sneezing etc.)
  • Check their vaccination Hx
  • Fluids + paracetamol/ibuprofen
75
Q

How might Rubella present and how do you treat it

A
  • Pink/light red maculopapular rash, starts in face then spreads
  • Lymphadenopathy
  • Fever
  • Generalised symptoms
  • Check vaccination Hx
  • Can only be diagnosed in a lab
  • Fluids + paracetamol/ibuprofen
76
Q

How might slapped cheek (fifth disease) present and how do you treat it

A
  • Bright red macular rash on both cheeks
  • A few days later develop a maculopapular rash on chest, arms and legs
  • Fever
  • Cold-like symptoms
  • Fluids + paracetamol/ibuprofen
77
Q

How might hand foot and mouth disease present and how do you treat it

A
  • Mouth ulcers
  • Maculopapular rash on hands and feet which develops into blisters
  • Fever
  • Prodrome of malaise, loss of appetite and cough
  • Fluids + paracetamol/ibuprofen
78
Q

How might mumps present and how do you treat it

A
  • Swollen parotid gland (usually one swells for a few days then the other follows)
  • Difficulty swallowing/earache due to swelling
  • Fever
  • Malaise/muscle ache
  • Loss of appetite
  • Check vaccination Hx
  • Diagnosis confirmed via. oral swab
  • Fluids + paracetamol/ibuprofen and warn about complications (epididymo-orchitis/meningitis)
79
Q

How might Herpes simplex labialis present and how do you treat it

A
  • Mouth ulcers typically on lips
  • Fever
  • Malaise/ sore throat
  • Lymphadenopathy
  • Fluids + paracetamol/ibuprofen
  • Anti-virals (acyclovir)
80
Q

How might impetigo present and how do you treat it

A
  • Pustules - red and golden crust, fading to erythema
  • Commonly on face, limbs and flexures
  • Hygiene advice and hydrogen peroxide cream on topical antibiotics
81
Q

How might scalded skin syndrome present and how do you treat it

A
  • Red blistering skin (looks like a burn)
  • Fever
  • Dehydration
  • Hospitalisation for iv flucloxacillin
82
Q

How might meningitis/meningococcal septicaemia present and how do you treat it

A
  • Fever
  • Nausea and vomiting
  • Headache and neck stiffness
  • Non-blanching petechial purpuric rash
  • IV antibiotics (do not delay/wait for cultures)
83
Q

How might Kawasaki disease present and how do you treat it

A
  • A form of acute vasculitis
  • Rash which may be maculopapular or target like (redness with white spot in middle)
  • Red cracked lips and strawberry tongue
  • Redness of eyes (conjunctivitis) without exudate
  • Lymphadenopathy
  • Firm swelling of hands and feet (oedema)
  • Diagnosis mostly of exclusion (eg. scarlet fever presents very similarly)
  • Treated with iv immunoglobulin
84
Q

How might toxic shock syndrome present and how is it treated

A
  • Is when bacteria enter bloodstream (often associated with a wound/burn or tampons)
  • Red/pink sunburn like rash (peels)
  • Lips tongue and white of eyes turn red (conjunctivitis)
  • Malaise/ache
  • Fever
  • Confusion/fainting/light headed and dizzy
  • Difficulty breathing
85
Q

How might scabies present and how is it treated

A
  • Generalised pruritis (worse at night)
  • Maculopapular red rash (often between fingers, flexors, umbilicus, buttocks and inside of thighs)
  • May see white/grey wavy lines on skin (burrows)
  • Ask about close contacts/house itching- often associated with overcrowding
  • Treat contact and patient with topical insecticide (permethrin 5% 1st line)
86
Q

How might eczema present and how is it treated

A
  • Itchy, dry, flaky, erythematous rash
  • In children often affects flexures, behind ears or cradle cap
  • May be atopic/associated with a trigger
  • Emollients - recognise and avoid triggers and steroid cream (hydrocortisone 1% is first line)
  • If infected (Weepy, crusted pustules may have fever) swab and treat with flucloxacillin
87
Q

How might urticaria present and how do you treat it

A
  • Red raised rash, blotchy and irregular sized
  • itching/burning
  • Atopy associated
  • Anti-histamines or steroids if severe
88
Q

What are the main causes of anaemia in children

A
  • Iron deficiency (dietary, malabsorption - coeliac)
  • Haemolysis (malaria - ask travel Hx, sickle cell)
  • Blood loss
  • Chronic disease
89
Q

Why do children get iron deficiency anaemia and how might they present

A
  • They have an increased need for iron and they have poor absorption/ dietary intake
  • Pallor
  • Irritability
  • Tachycardia
  • If severe then heart murmur, splenomegaly and anorexia
90
Q

How can you investigate and manage iron deficiency anaemia

A
  • FBC/ blood film- microcytic, hypochromic, Low ferritin/serum iron
  • Oral iron tablets
91
Q

How might a child with sickle cell anaemia present

A
  • Painful dactylitis (Swollen bones of hands/feet)
  • Severe infections
  • Acute painful crisis
  • Acute chest syndrome
  • Splenomegaly
  • May have delayed development/cognitive difficulties
92
Q

How might you investigate/manage sickle cell anaemia

A
  • FBC/blood film
  • Manage acute crisis/complications
  • Stem cell transplant
93
Q

Describe haemophilia A and B

A
  • Lack of clotting factors XIII (A) and IX (B)
  • Presents with prolonged bleeding and bleeding into joints and muscles
  • Treat with clotting factors XIII and IX
94
Q

Describe ITP

A
  • low levels of thrombocytes
  • Has acute and chronic forms, acute form often follows a viral illness
  • Symptoms include petechiae, prolonged bleeding and bruising
95
Q

What are the two main leukaemia’s that affect children

A
  • Acute lymphoblastic leukaemia (ALL) 85%

- Acute myeloid leukaemia (AML) 13%

96
Q

How might a brain tumour present and what are the most common types

A 
Signs of raised ICP
- Headache
- Vomiting
- Seizures
- Irritability
- Drowsiness
Astrocytoma (40%)
Medulloblastoma (20%)
97
Q

What investigations might you do for a brain tumour

A
  • CT head
  • MRI
  • Bloods
  • Biopsy
98
Q

How might a Wilms tumour (nephroblastoma) present

A
  • Painless abdominal swelling (most common)
  • Pain
  • Haematuria
  • Fever/ weight loss
99
Q

How might you investigate a Wilms tumour

A
  • USS abdomen
  • CT
  • MRI
  • Bloods
  • Biopsy
100
Q

How might a neuroblastoma present

A

Sites commonly affected are

  • Abdomen - Painful swollen abdomen/constipation
  • Chest - Breathlessness/difficulty swallowing
  • Neck - Lump in neck
  • Pelvis/spine - Leg weakness/numbness/difficulty passing urine/back pain
  • Fever/weight loss
101
Q

What are the causes of respiratory problems in a neonate

A

Little or no surfactant
- Retained in the type 2 pneumocytes
Little or no alveoli
- None at 24 weeks then amount rises exponentially

102
Q

How can you treat respiratory distress in a neonate

A
  • Give steroids before birth in premature babies, switches on type 2 pneumocytes to release surfactant
  • Surfactant
  • Oxygen
  • Ventilation
103
Q

What are the complications of respiratory distress in a neonate

A 
Death
Chronic lung disease of prematurity
- Caused by oxygen toxicity and high pressure on ventilators, which causes fibrosis/scarring of lung
- Decreased lung volume
- Decreased alveolar SA
- Decreased diffusion
104
Q

Describe apnoea of prematurity

A
  • Brain stem not fully myelinated until 32-34 weeks
  • This can cause the baby to ‘forget’ to breathe
  • Can often be made worse by sepsis
105
Q

How can you treat apnoea of prematurity

A
  • Phosphodiesterase inhibitors (caffeine)

- NCPAP

106
Q

What is cystic periventricular leukomalacia

A
  • Cysts around the ventricles causing neurological deficit (spasticity)
  • The closer to the ventricle the more likely the contralateral leg is affected, the further the more likely the arm
  • Can also affect other modalities
107
Q

Describe jaundice of the newborn

A

Any jaundice >2 weeks in term or 3 weeks in preterm need investigating!!!!!!!

  • Unconjugated - worrying - Fat soluble bilirubin can dissolve into fat of brain causing kernicterus (damage to basal ganglia of brain casing cerebral palsy)
  • Caused by haemolysis, prematurity, metabolic disease sepsis and dehydration
  • Conjugated high levels are not worrying other than finding cause
108
Q

How might necrotising enterocolitis present

A
  • Swollen tender abdomen
  • Problems feeding/ vomiting
  • Blood in stools
  • Generally unwell
  • More common in premature
  • Can lead to perforation- peritonitis/sepsis
109
Q

How might you treat necrotising enterocolitis

A 
Medical
- Bowel decompression
- Bowel rest
- Broad spectrum antibiotics
Surgical
- Drain
- Bowel resection
110
Q

How might Juvenile idiopathic arthritis (JIA) present

A
  • Persistent swelling
  • Pain
  • Joint stiffness (especially morning)
  • Warmth/redness
  • Joint deformity
  • Loss of range of motion
111
Q

What are the sub types of JIA

A
  • Oligoarticular (4 or less joints - usually knee/ankle)
  • Polyarticular (5 or more joints - usually small joints of hands/feet)
  • Psoriatic arthritis (dactylitis, Nail pitting, family Hx psoriasis)
  • Enthesitis related (often involvement of SI joints)
112
Q

How can you manage JIA

A
  • Steroids
  • Methotrexate
  • TNF alpha inhibitors (infliximab)
  • Biologic agents
113
Q

What is rickets

A
  • Low vitamin D or calcium levels leading to low serum calcium causing reabsorption of calcium form the bones, leading to soft and weak bones, with poor growth
114
Q

How might rickets present

A
  • Bone pain
  • Visible bone deformity
  • Dental problems
  • Poor/stunted growth
  • Fractures
115
Q

What investigations might you do for rickets

A
  • X-ray

- Bloods - Bone profile

116
Q

How can you manage rickets

A
  • Dietary advice

- Supplementation/injection

117
Q

How might osteomyelitis present

A
  • Fever
  • Bone pain
  • Bone swelling
  • Warmth/redness
118
Q

How might you treat osteomyelitis

A
  • IV antibiotics

- Surgery

119
Q

How might septic arthritis present

A
  • Sudden onset severe joint pain
  • Joint swelling
  • Redness/warmth
  • Fever
120
Q

How do you manage septic arthritis

A
  • IV antibiotics

- Surgery/drainage

121
Q

How might reactive arthritis present

A
  • Joint pain
  • Swelling of joint
  • Redness/warmth
  • Post infection
122
Q

How do you manage reactive arthritis

A
  • Treat/manage underlying cause if necessary

- Steroids/DMARDs

123
Q

Describe scoliosis

A
  • Curvature of the spine
  • May appear to be leaning to one side/uneven shoulders
  • Usually given back brace until they stop growing- then surgery
124
Q

What are the 4 domains of child development

A
  • Gross motor
  • Fine motor and vision
  • Speech/language and hearing
  • Social interaction and self care
125
Q

How would a child normally develop their gross motor skills up to a year old

A 
Newborn
- Flexes both arms and legs
- Equal movements
3 Months
- Lifts head on tummy
6 months
- Rolls over 
- Sit unsupported
9 months
- Crawling
- Pulls to stand
1 year
- Cruising furniture
- Walking
126
Q

How would a child normally develop their gross motor skills from 1 to 5 years old

A 
1 year
- Walking
2 years
- Walks up steps
3 years
- Jumping
4 years 
- Hopping
5 years
- Rides bike
127
Q

How would a child normally develop their fine motor and vision
skills up to a year old

A 
4 months
- Grasps objects
8 months 
- Holds a cube
- Transfers hand to hand
1 year
- Good pincer grip
- Scribbles with a crayon
128
Q

How would a child normally develop their fine motor and vision skills from 1 year to 3 years

A 
1 year
- Scribbles with crayon
18 months
- Tower of 2 cubes
3 years
- Tower of 8 cubes
129
Q

How would a child normally develop their speech, language and hearing skills up to a year old

A 
3 months 
- Squeal and laugh
6 months
- Double syllable babble
9 months
- Dada and mama
12 month
- 1 word
130
Q

How would a child normally develop their speech, language and hearing skills from 1 year to 5 years

A 
1 year
- 1 word
2 years
- 2 word sentence
- Name body parts
3 years 
- Mostly understandable speech
4 years
- Colours
- Count 5 objects
5 years
- Meaning of words
131
Q

How would a child normally develop their social and self care skills up to a year old

A 
6 weeks 
- Smiles spontaneously
6 months
- Finger feed
9 months
- Waves bye bye
12 months
- Uses a spoon/fork
132
Q

How would a child normally develop their social and self care skills from 1-5 years

A 
1 year
- Uses a spoon/fork
2 years
- Takes some clothes off
- Feed a doll
3 years
- Plays with others
- Names a friend
4 years
- Dress with no help
- Play board games
133
Q

When do you worry about missing milestones in child development

A 
If there is any regression of development 
Gross motor
- Not sitting by 1 year
- Not walking by 18 months
Fine motor
- Hand preference before 18 months
Speech and language
- No words by 18 months
Social
- Not smiling by 3 months
- No response to carers by 8 weeks
- Not playing with others by 3 years
134
Q

What causes hypoxic ischaemic encephalopathy

A

Occurs secondary to a significant hypoxic event occurring immediately before or during labour/delivery

135
Q

How can hypoxic ischaemic encephalopathy present

A 
Mild 
- Irritable
- Poor feeding 
- Hyperventilation
Moderate 
- Tone/movement abnormalities
- Cannot feed
- Seizures
Severe
- No normal spontaneous movements or response to pain
- Prolonged seizures
- Multi-organ failure
136
Q

How can you manage hypoxic ischaemic encephalopathy

A
  • Respiratory support
  • Anti-convulsants
  • Mild hypothermia may protect brain
  • Fluid and electrolyte balance
137
Q

What can cause small bowel obstruction in a neonate

A
  • Meconium ileus (associated with cystic fibrosis/plug)

- Atresia/stenosis

138
Q

How might small bowel obstruction in a neonate present

A
  • Persistent often bilious vomiting

- Abdominal distention

139
Q

Describe peri-orbital cellulitis

A
  • Erythema/oedema of the eyelid
  • Fever
  • Requires iv antibiotics to stop orbital cellulitis developing
140
Q

Describe orbital cellulitis

A
  • Erythema/oedema of eyelid
  • Ptosis
  • Painful/limited ocular movement
  • Decreased visual acuity
  • Can lead to abscess formation/meningitis
141
Q

How might type 1 diabetes present

A
  • Peaks in pre-school and in teenagers
  • Polyuria and polydipsia
  • Weight loss
  • DKA
142
Q

How can you diagnose type 1 diabetes

A
  • Random blood glucose >11mmol/L
  • Fasting blood glucose >7mmol/L
  • Keton/glycosuria
  • Raised HbA1c
143
Q

How does diabetic ketoacidosis occur

A
  • Decreased insulin leads to decreased glucose uptake by cells causing ketone formation
  • Also there is fluid loss due to marked glycosuria
  • This increases conc. of ketones in blood, leading to acidosis
  • Respiratory and renal compensation cause hyperventilation and renal impairment due to dehydration
144
Q

How might DKA present

A
  • Hyperventilation
  • Tachycardia
  • Vomiting
  • Abdo pain
  • Pear drop scent
  • Dehydration - decreased GCS/confusion
145
Q

How do you manage DKA

A
  • Fluid resuscitation
  • Insulin, followed by glucose (avoid hypo)
  • Fluid/electrolyte balancing
146
Q

How might anaphylaxis present

A
  • Tachypnoea, stridor, wheeze, hoarse voice
  • Cyanosis/low oxygen sats
  • Pale, clammy, tachycardic+hypotensive
  • Oral and facial swelling
  • Hives/urticaria rash
  • Bloody diarrhoea
147
Q

How do you manage anaphylaxis

A
  • Norepinephrine
  • Establish airway
  • Oxygen+ IV fluids
  • Hydrocortisone
148
Q

How do you manage status epilepticus

A
  • Check blood glucose
  • Rectal diazepam or buccal midazolam
  • IV access then administer iv lorazepam
149
Q

What is downs syndrome

A
  • Trisomy 21
  • Small head, short neck, short stature, flat face, single palmar crease
  • Hypothyroid
  • Cardiac - ASD/VSD/TOF/PDA
  • Learning difficulties
  • Leukaemia
  • Dementia
150
Q

How do you test for down syndrome

A
  • Screened for in all women at 11-14 weeks (nuchal translucency)
  • If positive screen then combined test - High bHCG and low plasma protein A
151
Q

What is turners syndrome

A
  • 45XO
  • Short, webbed neck, Downward sloping eyes, broad chest
  • Underdeveloped ovaries/infertility
  • Late puberty
  • Hypothyroid
  • Obesity/Diabetes
  • Learning disability
152
Q

What is fragile X

A
  • FMRI gene mutation on X chromosome
  • Long narrow face, Large ears, large testes, joint hypermobility, hypotonia
  • ADHD
  • Autism
  • Seizure
  • MV prolapse
153
Q

What is prader willi

A
  • Loss of Y genes on chromosome 15
  • Obesity, soft easy bruising skin, narrow forehead, almond eyes, downturned mouth
  • Constant hunger, learning difficulties
154
Q

What is Williams syndrome

A
  • Deletion of one copy of chromosome 7
  • Broad forehead, flattened nasal bridge, wide mouth, small chin
  • Very sociable/trusting
  • Supravalvular AS
  • ADHD
155
Q

What is Edwards syndrome

A
  • Trisomy 18
  • Low birth weight, small features/head, malformed ears, prominent occiput, cleft lip
  • Cardiac defects
  • Loads of gastro tract problems
  • Horseshoe kidney
156
Q

Duchenne’s muscular dystrophy

A
  • Dystrophin gene mutation on Xp21
  • Calf pseudohypertrophy
  • Waddling gait
  • Gross motor/global developmental delay

Phase 3a (5 decks)

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