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Final day prep > Paeds ILAs - 5 and 6 > Flashcards

Paeds ILAs - 5 and 6 Flashcards

1
Q

Developmental milestones at 6 months

A

GM

  • Head control
  • Sits unsupported - Arched back

VFM

  • Palmar grasp
  • Passes objects from one hand to the other

HSL

  • Babbles
  • Turns in response to sound

Social

  • Puts objects in mouth
  • Shakes rattle
  • Reaches for bottle
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2
Q

Developmental milestones at 12 months

A

GM
- Cruises for 10 metres

VFM

  • Refined pincer grip
  • Puts blocks in a cup

HSL

  • Knows and responds to name
  • Knows 2/3 words

Social
- Drinks from a cup with both hands

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3
Q

Primitive reflexes and significance

A

Moro reflex - Sudden loss of support

  1. Arm abduction
  2. Arm adduction
  3. Crying

Persisting after 4 months - Sign of UMN lesion

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4
Q

What is cerebral palsy

A

Non-progressive disorder of movement and position
Occurs in the developing brain

Symptoms may appear to change over time - This is because as the child gets older the things they cannot do become more apparent

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5
Q

Cerebral palsy aetiology

A

Antenatal - 80%

  • Infection
  • Genetics
  • Vascular occlusion

Intrapartum

  • HIE
  • Asphyxia
  • Trauma

Post-partum

  • Trauma
  • Meningitis
  • Periventricular leukomalacia
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6
Q

Cerebral palsy early features

A

Poor feeding

Delayed motor milestones
Asymmetrical hand function < 12 months
Persistent primitive reflexes

Abnormal tone
Abnormal gait

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7
Q

Spastic cerebral palsy

A

80-90% - Damage to motor cortex - UMN signs

Hemiplegic

  • Arm and leg
  • Face sparing
  • Tip toe walk
  • Asymmetrical hand

Diplegic - Periventricular leukomalacia
- Knock-kneed gait

Quadriplegic

  • All 4 limbs
  • Extensor posturing
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8
Q

Dyskinetic cerebral palsy

A

Problem in the basal ganglia - Extrapyramidal tracts

Associated with HIE and kernicterus

Chorea
Athetosis
Dystonia

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9
Q

Ataxic cerebral palsy

A

Lesion in the cerebellum

Broad gait
Hypotonia
Poor balance

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10
Q

Cerebral palsy MDT

A 
Occupational therapy 
S/L
School 
Paediatrician 
Neurologist 
Social worker 
Physiotherapy
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11
Q

Cerebral palsy risk factors

A

Twins
Prematurity
Maternal infections
Difficult delivery

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12
Q

Cerebral palsy associations

A 
Learning difficulties 
Epilepsy 
Squint 
Deafness 
Poor feeding - Poor growth
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13
Q

Cerebral palsy investigations

A 
MRI 
Cytogenetic 
Metabolic profile 
Biopsy and histopathology 
EEG
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14
Q

Absence seizure presentation

A

Child stops what they’re doing
Remains conscious

Can occur with hyperventilation

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15
Q

Absence seizure investigations

A

EEG 3Hz
Hearing test
ADHD assessment

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16
Q

Absence seizure management

A

Valproate

Ethosuximide

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17
Q

Juvenile myoclonic epilepsy presentation

A

Teenage girls

Myoclonic jerks - Suddenly throwing things

History of absence seizures

18
Q

JME investigations and management

A

Investigations - EEG - Polyspike and wave

Management - Valproate

19
Q

Types of strabismus (squint)

A

Paralytic

  • Nerve palsy
  • Can only move the eye in certain directions

Non-paralytic

  • Misalignment
  • Can move the eye in all directions

Manifesto - Always present
Latent - Comes and goes

20
Q

Strabismus investigations

A

ONLY IF PARALYTIC

Cover test

  1. Ask the child to focus on an object
  2. Cover one eye
  3. Observe movement of uncovered eye
  4. Cover other eye and repeat
21
Q

Strabismus management and complications

A

Management - Patching

Complications - Amblyopia

22
Q

RDS presentation

A

Tachypnoea
Intercostal recession
Expiratory grunting
Cyanosis

23
Q

RDS risk factors

A

Prematurity

  • 26-28 weeks - 50%
  • 30-31 weeks - 25%

Maternal diabetes
CS
Male
Second born of premature twins

24
Q

RDS prevention

A

Dexamethasone

Delayed cord clamping - 45 seconds

25
Q

RDS investigations

A

CXR - Ground glass

26
Q

RDS management

A

O2
CPAP
Surfactant therapy - Through ET tube

27
Q

RDS complications

A

Pneumothorax
BPD
Retinopathy
Renal failure

28
Q

BPD

A

Chronic lung disease
Occurs due to mechanical ventilation and oxygen supplementation
Requires long-term oxygen therapy

29
Q

BPD investigations

A

O/E - Crackles and wheeze

CXR

  • Round radiolucent areas
  • Fibrosis

CT - Mosaic lunch parenchyma

30
Q

BPD management

A

Dexamethasone
Palivizumab

O2

31
Q

Neonatal jaundice < 24 hours

A

BAD

Rhesus incompatibility 
ABO incompatibility 
Hereditary spherocytosis 
G6PD 
Infection 
Sepsis
32
Q

Neonatal jaundice

24 hours - 2 weeks

A

NORMAL

Dehydration
Infection
Physiological
Bleeding

33
Q

Neonatal jaundice > 2 weeks

A

BAD

High conjugated bilirubin = Biliary atresia!

Cystic fibrosis 
Congenital hypothyroidism 
Pyloric stenosis 
Hepatitis 
Infection
34
Q

Neonatal jaundice investigations

A

Conjugated bilirubin
Unconjugated bilirubin

Coombs test
Blood film

FBC
U/E
LFT
TFT

Urinalysis

35
Q

Kernicterus

A

Deposition of unconjugated bilirubin in the basal ganglia

Presentation

  • Arching of back
  • Seizures
  • Comas

Complications

  • Learning difficulties
  • Sensorineural deafness
  • Cerebral palsy
36
Q

Necrotising enterocolitis

A

Bacterial infection of ischaemic bowel wall
Inflammatory bowel necrosis due to premature GI tract

Risk factors - Cow’s milk

37
Q

NEC presentation

A

Bilious vomiting

Distended abdomen - Tense, shiny and red

Blood in stool
Decreased bowel sounds
Palpable abdominal mass
Shock

38
Q

NEC investigations - AXR

A

Intramural gas
Distended bowel
Thickening of the bowel

Perforation - Pneumoperitoneum

Rigler sign - Air inside and outside the bowel wall
Football sign - Air outlining the falciform ligament

39
Q

NEC investigations - Bloods

A

Thrombocytopenia
Neutropenia
Acidosis

40
Q

NEC management

A

Broad spectrum abx

Cefotaxime
Vancomycin
Gentamicin

NG tube - Decompress

Surgery - Bowel resection

41
Q

NEC complications

A

Perforation
Peritonitis

Short bowel syndrome - Following surgery

Final day prep (8 decks)

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