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My Phase 3a Revision > PAEDS - MISCELLANEOUS > Flashcards

PAEDS - MISCELLANEOUS Flashcards

1
Q

CHILD ABUSE
What are some risk factors for child abuse?

A
  • Child = failure to meet expectations (disabled, wrong sex), born after forced or commercial sex work
  • Parent = MH issues, substance abuse, LD, young
  • Family = stepparents, domestic abuse, multiple or closely spaced births
  • Environment = low socioeconomic status
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2
Q

CHILD ABUSE
Give 3 examples of abuse

A
  • Emotional = persistent emotional mistreatment of a child resulting in adverse effects of a child’s emotional development
  • Sexual = forcing a child to take part in sexual activities
  • Neglect = persistent failure to meet a child’s basic physical + psychological needs
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3
Q

CHILD ABUSE
How might childhood sexual abuse present?

A
  • PV/PR bleed or itching
  • PV discharge
  • STIs
  • Bruising
  • Oversexualised child
  • Dilated anus
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4
Q

CHILD ABUSE
Give some examples of neglect
How might neglect present?

A
  • Inadequate food, drink, emotional support, clothing, shelter
  • Inadequate supervision or access to medical care = severe + persistent infections (scabies, lice), failure to engage with child health promotion, failure to attend follow-ups
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5
Q

CHILD ABUSE
What features in the history are suspicious for child abuse?

A
  • Too many injuries, wrong site, unusual shape or pattern
  • Delay in presenting (old injuries), multiple A&E visits
  • No Hx, Hx inconsistent with injuries or that changes
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6
Q

CHILD ABUSE
Where are normal and abnormal places for a child to bruise?

A
  • Shins, knees, elbows, toddlers can bump their heads
  • Abdo, genitalia, insides of arms/legs, behind neck or other soft bits, young babies that cannot roll
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7
Q

CHILD ABUSE
What other features may raise alarms for child abuse?

A
  • # = metaphyseal, multiple # at different healing stages, posterior rib # in babies v. specific, radial, humeral, femoral
  • Bruising, burns, scalds, failure to thrive
  • Torn frenulum (forcing bottle into mouth)
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8
Q

CHILD ABUSE
What is the management for suspected child abuse?

A
  • FBC, clotting screen, bone profile, radiology
  • Developmental + social services assessment
  • If suspected > hospital admission + can break confidentiality
  • Fundoscopy for retinal haemorrhages
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9
Q

CHILD ABUSE
Why do you perform fundoscopy?
Other features?

A
  • Shaken baby syndrome = retinal haemorrhages, subdural haematoma + encephalopathy
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10
Q

CHILD ABUSE
What law is relevant to child abuse?

A
  • Child act 2004 allows to speak to child without parents’ consent, safeguards children
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11
Q

FAS
How much alcohol is safe in pregnancy?
What are some features of foetal alcohol syndrome?

A
  • None
  • Microcephaly
  • Short palpebral fissures, hypoplastic upper lip, small eyes, smooth philtrum
  • LDs, poor growth + cardiac malformations
  • Can have alcohol withdrawal Sx a birth = irritable, hypotonic, tremors
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12
Q

SWELLINGS + CYSTS
What is mastoiditis?
How does it present?
Management?

A
  • Med emergency as can cause meningitis, sinus thrombosis
  • External ear may protrude forwards, severe otalgia (classically behind), fever
  • Swelling, erythema + tenderness over mastoid process
  • Abx ±mastoidectomy
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13
Q

SWELLINGS + CYSTS
What is a thyroglossal cyst?
How does it present?
Management?

A
  • Persistence of thyroglossal duct
  • Midline, smooth + moves when they stick their tongue out
  • USS shows thin walled + anechoic (echoic suggests cyst infection)
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14
Q

SWELLINGS + CYSTS
Where would you find a branchial cyst?
How does it present?

A
  • Not in midline, tend to appear along border of sternocleidomastoid
  • 75% originate from second branchial cleft, often unilateral + smooth
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15
Q

SWELLINGS + CYSTS
What is a cystic hygroma?

A
  • Soft lesion in posterior triangle that transilluminates (seen in Turner’s)
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16
Q

SWELLINGS + CYSTS
What is a dermoid cyst?
Caution?
Investigation?

A
  • Found on lateral aspect of eye + produces sebaceous material
  • Can communicate intracranially causing meningitis
  • USS shows heterogeneous + have variable amounts of calcium + fat
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17
Q

PAEDS FLUIDS
What are 3 essential components to a safe fluid prescription?

A
  • Fluid constituents + bag size = NaCl 0.9% + dextrose 5% + KCl 10mmol (500ml)
  • Rate of administration in ml/hour
  • Signature
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18
Q

PAEDS FLUIDS
What are important things to consider prior to prescribing fluids?

A
  • Weight ([Age + 4] x 2), including weight change
  • Fluid input/output in past 24h
  • Fluid status (dehydrated)
  • Recent bloods (electrolytes)
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19
Q

PAEDS FLUIDS
What is used for maintenance fluids?
How are they calculated?

A
  • 0.9% NaCl + 5% dextrose + KCl 10mmol
  • 100ml/kg/day for first 10kg
  • 50ml/kg/day for next 10kg
  • 20ml/kg/day for every kg after 20kg
  • Divide by 24 = ml/hour
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20
Q

PAEDS FLUIDS
What are some clinical signs of dehydration?

A
  • <5% = slight thirst, dry lips
  • 5-10% = sunken eyes, reduced skin turgor, decreased urine output, dry lips + mucous membranes (no shock)
    >10% = reduced GCS, cold, mottled peripheries, anuria, sunken fontanelle, CRT >2s, hypotension (late)
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21
Q

PAEDS FLUIDS
How can you calculate % dehydration?
How do you calculate fluids to correct dehydration?

A
  • (Well weight [kg] – current weight [kg]) ÷ well weight

- % dehydration x 10 x weight (kg)

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22
Q

PAEDS FLUIDS
What is the general rule for fluid boluses?

A
  • Given in shock
  • 0.9% NaCl at 20ml/kg over <10m
  • After >3 boluses call for paeds intensive care support as risk > pulmonary oedema
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23
Q

PAEDS FLUIDS
What are exceptions to the fluid bolus in shock rule?
What is advised?

A
  • Trauma, primary cardiac pathology (heart failure), DKA (after first 20ml/kg)
  • 10ml/kg boluses to prevent pulmonary oedema
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24
Q

PAEDS FLUIDS
What fluids do neonates require?
What are their intake requirements?

A
  • Day 1 = just 10% dextrose
  • From day 2 = Na (3mmol/kg/day) + K (2mmol/kg/day)
  • Day 1 = 60ml/kg/day
  • Day 2 = 90ml/kg/day
  • Day 3 = 120ml/kg/day
  • Day 4 + beyond = 150ml/kg/day
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25
Q

CHILD ABUSE
What is the most common form of abuse?

A

Neglect

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26
Q

DEVELOPMENTAL STAGES
What is meant by…

i) median age?
ii) limit age?

A

i) When half a standard population of children reach that level of development
ii) Age a child is expected to have reached a milestone (often 2 standard deviations from the mean)

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27
Q

DEVELOPMENTAL STAGES
How do the developmental milestones correspond with prematurity?

A
  • Age correct up to 2 years
  • 9m born 2 months early should only be expected to be at developmental stage of 7m
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28
Q

DEVELOPMENTAL STAGES
What is developmental surveillance?

A
  • Ongoing process of following child over time
  • Can be incorporated into well-child checks, general physical exam or routine vaccine visits
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29
Q

DEVELOPMENTAL STAGES
What are the 4 domains of development?

A
  • Gross motor
  • Fine motor + vision
  • Speech, hearing + language
  • Social, emotional + behavioural
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30
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a new born?

A

New born = Limbs flexed, symmetrical posture, head lag on pulling up

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31
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 8 month old baby?

A

8 months = Crawl (some may bottom shuffle or commando crawl)

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32
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 2 year old child?

A

2 years = Runs, kick ball (2.5y)

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33
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 6 week old baby?

A

Turns head to follow object (fix + follow)

Limit age = 3 months

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34
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 7 month old baby?

A

transfers toys from one hand to the other
- limit age = 9 months

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35
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for an 18 month old child?

A
  • Crayon scribbles
  • 3 brick tower
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36
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 3.5 year old child?

A

draws a cross

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37
Q

DEVELOPMENTAL STAGES
In terms of fine speech, hearing + language development, what would you expect for a new born baby?

A

Startles at loud sounds, quietens to parent’s voice

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38
Q

DEVELOPMENTAL STAGES
In terms of fine speech, hearing + language development, what would you expect for a 9 month old baby?

A

Responds to own name, imitates adult sounds “dada, mama”

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39
Q

DEVELOPMENTAL STAGES
In terms of fine speech, hearing + language development, what would you expect for a 20-24 month old child?

A

joins two or more words together to make simple phrases, “Give me teddy”

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40
Q

DEVELOPMENTAL STAGES
In terms of social, emotional + behavioural development, what would you expect for a 6 week old baby?

A

Smiles responsively
– Limit age 8w

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41
Q

DEVELOPMENTAL STAGES
In terms of social, emotional + behavioural development, what would you expect for a 12 month old child?

A

Drinks from cup with 2 hands

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42
Q

DEVELOPMENTAL STAGES
In terms of social, emotional + behavioural development, what would you expect for a…

i) 3y?
ii) 4y?
iii) 5y?

A

i) Seek out other children + play with them, turn-taking, follows simple rules, bowel control, fork + spoon
ii) Has best friend, bladder control, dresses self, imaginative play
iii) Knife + fork

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43
Q

DEVELOPMENTAL STAGES
What are the primitive reflexes?

A
  • Moro (startle)
  • Grasp (palmar/plantar)
  • Sucking/rooting
  • Stepping
  • Asymmetrical tonic neck reflex
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44
Q

DEVELOPMENTAL STAGES
Explain the following primitive reflexes…

i) moro?
ii) grasp?
iii) sucking/rooting?

A

i) Sudden extension of head causes symmetrical extension then flexion of limbs. Stops 3–4m
ii) Touch palm (palmar) or sole (plantar) + baby will grasp or curl toes. Stops 4–5m
iii) Head turns to stimulus when touched near mouth, assists in breastfeeding. Stops at 4m

45
Q

DEVELOPMENTAL STAGES
Explain the following primitive reflexes…

i) stepping?
ii) asymmetrical tonic neck reflex?

A

i) Stepping movements when held vertically + dorsum of feet touch surface. Stops at 2m
ii) Baby supine + head turned to one side > arm on that side stretches out + opposite flexes at elbow

46
Q

DEVELOPMENTAL STAGES

What are the postural reflexes?

A
  • Parachute
  • Postural support
  • Labyrinthine righting
  • Lateral propping
47
Q

DEVELOPMENTAL STAGES
Explain the following postural reflexes…

i) parachute?
ii) postural support?

A

i) Suspend baby prone + slowly lower head towards a surface > arms + leg extend in protective fashion
i) When held upright if feet touch a surface legs take weight + may push up like a bounce

48
Q

DEVELOPMENTAL STAGES
Explain the following postural reflexes…

i) labyrinthine righting?
ii) lateral propping?

A

i) Head moves in opposite direction to which body is tilted
ii) When sitting, arms extends on the side to which child falls as saving mechanism

49
Q

DEVELOPMENTAL STAGES
What is the relevance of the primitive and postural reflexes?

A
  • Persistence of primitive reflexes + lack of development of postural reflexes is the hallmark of UMN abnormality in the infant (cerebral palsy)
50
Q

DEVELOPMENTAL DELAY
In terms of developmental delay, define…

i) delay?
ii) learning difficulty?
iii) disorder?

A

i) Implies slow acquisition of all skills or of one particular field
ii) Cognitive, physical, both or relate to specific functional skills
iii) Maldevelopment of a skill

51
Q

DEVELOPMENTAL DELAY
In terms of developmental delay, define…

i) impairment?
ii) disability?
iii) disadvantage?

A

i) Loss/abnormality of physiological function or anatomical structure
ii) Any restriction or lack of ability due to the impairment
iii) Results from disability + limits fulfilment of a normal role

52
Q

DEVELOPMENTAL DELAY
In terms of developmental delay, what are the 3 broad aetiological categories?

A
  • Prenatal
  • Perinatal
  • Postnatal
53
Q

DEVELOPMENTAL DELAY
What are some prenatal causes of developmental delay?

A
  • Genetics (Down’s, fragile X)
  • Congenital hypothyroidism
  • Teratogens (alcohol + drug abuse)
  • Congenital infection (TORCH)
  • Neurocutaneous syndromes (tuberous sclerosis, neurofibromatosis)
54
Q

DEVELOPMENTAL DELAY
What are some perinatal causes of developmental delay?

A
  • Extreme prematurity (intraventricular haemorrhage)
  • Birth asphyxia (HIE)
  • Hyperbilirubinaemia
  • Hypoglycaemia
55
Q

DEVELOPMENTAL DELAY
What are some postnatal causes of developmental delay?

A
  • Infection (meningitis, encephalitis)
  • Anoxia (suffocation, near-drowning, seizures)
  • Head trauma (accidental or NAI)
  • Hypoglycaemia
56
Q

DEVELOPMENTAL DELAY
What are some risk factors for developmental delay?

A
  • Bio = prems, LBW, birth asphyxia, hearing/vision impairment
  • Environment = poverty, poor parental education, maternal substance abuse
57
Q

DEVELOPMENTAL DELAY
What is global developmental delay?
How does it present?
What are some causes?

A
  • Slow development in all developmental domains
  • Presents in first 2y of life
  • Down’s, fragile X, foetal alcohol syndrome, Rett syndrome + metabolic disorders
58
Q

DEVELOPMENTAL DELAY
What is abnormal gross motor development?
What are some causes?

A
  • Slow development in gross motor domain
    • Cerebral palsy, ataxia, myopathy, spina bifida + visual impairment
59
Q

DEVELOPMENTAL DELAY
What is abnormal fine motor development?
What are some causes?

A
  • Slow development in fine motor domain
    • Dyspraxia, cerebral palsy, muscular dystrophy, visual impairment, congenital ataxia (rare)
60
Q

DEVELOPMENTAL DELAY
What is abnormal speech or language development?
What are some causes?

A
  • Slow development in speech + language domain
    • Specific social circumstances, hearing impairment, LD, neglect, autism + cerebral palsy, cleft lip/palate
61
Q

DEVELOPMENTAL DELAY
What are some specific social circumstances that can lead to abnormal speech or language development?
What is the management?

A
  • Exposure to multiple languages, sibling that do all the talking
  • Referral to SALT, audiology + health visitor with safeguarding if ?neglect
62
Q

DEVELOPMENTAL DELAY
What is personal + social delay?
What are some causes?

A
  • Slow development in personal + social domain
    • Emotional + social neglect, parenting issues + autism
63
Q

DEVELOPMENTAL DELAY
What is the management of developmental delay?

A
  • Thorough Hx + exam (hearing + vision)
  • Cytogenic (chromosome karyotype)
  • Metabolic (TFTs, LFTs, U+Es, CK, lactate)
  • Infection (congenital infection screen)
  • Focal neuro (CT/MRI head, EEGs)
64
Q

MEASUREMENT
What are some determinants of growth?

A
  • Parental phenotype + genotype
  • Nutrition
  • Pregnancy factors
  • Psychosocial deprivation
  • Endocrine function
65
Q

MEASUREMENT
What are 3 important components to measurements?

A
  • Weight = naked infant or child only in underclothing
  • Height = >2y standing height, <2y horizontal
  • Head circumference = occipitofrontal circumference is a measure of head + accurate representation of brain size + development
66
Q

MEASUREMENT
What are some concerns with various head circumferences?

A
  • Microcephaly = ?brain not formed properly, ?LDs
  • Macrocephaly = ?hydrocephalus
  • Note = small babies likely to have small heads, compare ALL values
67
Q

MEASUREMENT
How might the accuracy of measurements be compromised?
A part of measurement is working out the mid-parent height.
How is this done for boys and girls?

A
  • Faulty technique (inexperienced staff), faulty equipment (wrongly calibrated), uncooperative child
  • Boys = [(Dad + mum height in cm) ÷ 2] + 7
  • Girls = [(Dad + mum height in cm) ÷ 2] – 7
68
Q

MEASUREMENT
What is the role/management of measurements in paediatrics?

A
  • Assess if a child’s overall height is abnormal (<2nd or >98th centile)
    – GP review if <2nd, Paeds review if <0.4th
  • Assess if a child is failing to follow their growth potential (drop centile line)
    – More concerning than consistently 9th centile
  • Assess if a child is losing or gaining weight quickly
    – ?Pathology
69
Q

MEASUREMENT
What are the phases of growth in children?
When does growth end?

A
  • First 2y = growth velocity fastest in utero + infancy, driven by nutritional factors
  • 2y-puberty = steady slow growth (genes, thyroid + growth hormones, health)
  • Puberty = rapid growth spurt driven by sex hormones
  • When the epiphyses fuse
70
Q

DEVELOPMENTAL STAGES
In terms of speech, hearing + language development, what would you expect for a…

i) 3.5y?
ii) 4y?

A

i) Understands comparatives “which one is BIGGER”
ii) “Why”, “when”, “how” questions, understands complex instructions “before you put x in y give z to mummy”

71
Q

NIPE EXAMINATION
What is the process of the NIPE exam?
What are the components?

A
  • First within 72h of birth + second by GP at 6–8w
    • General observation, eyes, heart, hips + genitalia
72
Q

NIPE EXAMINATION
What is looked for in the general observation?

A
  • Weight, height, head circumference (HC = measure of brain size)
  • Palpate sutures + fontanelle
  • Dysmorphic features
  • Reflexes (grasp, sucking, rooting, moro)
73
Q

NIPE EXAMINATION
What is looked for in the eyes examination?

A
  • Red reflex (congenital cataracts, retinoblastoma)
    • Movement (visual loss)
74
Q

NIPE EXAMINATION
What is looked for in the cardiac examination?

A
  • HR 110–160bpm
  • Murmur (CHD)
  • Femoral pulse (coarctation)
  • Central cyanosis (cyanotic CHD)
75
Q

NIPE EXAMINATION
What is looked for in the hip examination?

A
  • Barlow + Ortolani test (DDH)
76
Q

NIPE EXAMINATION
What is looked for in the genitalia examination?

A
  • Testes (cryptorchidism)
  • Ambiguous genitalia (CAH)
  • Genitalia (hypospadias)
  • Imperforate anus (bladder/vaginal fistula)
77
Q

NIPE EXAMINATION

What is the purpose of the NIPE examination?

A
  • Detect congenital abnormalities that were not identified at birth
  • Check for potential problems that could arise due to FHx
  • Provide opportunity for parents to ask questions about baby
78
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what is the age limit for sitting without support

A

9 months old

79
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what is the age limit for walking?

A

18 months

80
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 6 week old baby?

A

6 weeks = Lifts head when lying prone + moves it side-side

81
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 3 month old baby?

A

3 months = Holds head upright when held sitting

82
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for 6 month old baby?

A

6 months = Rolls, sits without support (6m = rounded back, 8m = straight back)

Limit age = 9 months old

83
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 10 month old baby?

A

10 months = Stand independently, cruise around furniture

84
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 12 month old baby?

A

12 months = Walk unsteadily, broad gait hands apart

85
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 15 month old baby?

A

15 months = Walks steadily
– Limit age 18m: ?Duchenne’s, ?hip issues, ?cerebral palsy

86
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 3 year old child?

A

3 years = Jump, stand on 1 leg briefly, pedal tricycle, stairs (1 foot up 2 down)

87
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 4 year old child?

A

4 years = Hops, balance on one leg for few seconds, stairs like adult

88
Q

DEVELOPMENTAL STAGES
In terms of gross motor development, what would you expect for a 5 year old child?

A

5 years = Rides bike, skip on both feet

89
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 4 month old baby?

A

Reaches for toys
– Limit age = 6 months

90
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 6 month old baby?

A

Palmar grasp of objects, transfers toys
– Limit age (toys) 9m

91
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 10 month old baby?

A

mature pincer grip
- limit age = 12 months

92
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 12 month old baby?

A

Index finger to point, casting bricks (disappear by 18m) + builds 2 brick tower

93
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 2 year old child?

A
  • Vertical line
  • 6 brick tower
94
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 2.5 year old child?

A

Copies circle
8 brick tower or train with 4 carriages

95
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 3 year old child?

A

draw a circle
copies or makes bridge

96
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 4 year old child?

A

draws square
makes steps (after demonstration)

97
Q

DEVELOPMENTAL STAGES
In terms of fine motor + vision development, what would you expect for a 5 year old child?

A

draw a triangle

98
Q

DEVELOPMENTAL STAGES
In terms of fine speech, hearing + language development, what would you expect for a 3 month old baby?

A

Cooing noises, vocalises alone or when spoken to “aa, aa”

99
Q

DEVELOPMENTAL STAGES
In terms of fine speech, hearing + language development, what would you expect for a 6 month old baby?

A

Turns head to sounds, understands “bye bye” + “no” (7m), monosyllabic babbles (consonants) “bababa”

100
Q

DEVELOPMENTAL STAGES
In terms of fine speech, hearing + language development, what would you expect for a 12 month old baby?

A

Understands names “drink”,
3 words other than “mama” and “dada”

101
Q

DEVELOPMENTAL STAGES
In terms of fine speech, hearing + language development, what would you expect for an 18 month old child?

A

6-10 words,
understands nouns “show me the SPOON”
is able to show two body parts, “where is your nose?” - baby will point

102
Q

DEVELOPMENTAL STAGES
In terms of fine speech, hearing + language development, what would you expect for a 2.5-3 year old child?

A
  • talks constantly in 3-4 word sentences
  • understands 2 joined commands “push me fast Daddy”
103
Q

DEVELOPMENTAL STAGES
In terms of social, emotional + behavioural development, what would you expect for a 6-8 month old baby?

A

Puts food in mouth,
shakes rattle

104
Q

DEVELOPMENTAL STAGES
In terms of social, emotional + behavioural development, what would you expect for a 9 month old baby?

A

Separation anxiety from parent,
stranger fear (until 2y)

105
Q

DEVELOPMENTAL STAGES
In terms of social, emotional + behavioural development, what would you expect for a 10-12 month old baby?

A

Waves bye-bye, plays peek-a-boo, claps

106
Q

DEVELOPMENTAL STAGES
In terms of social, emotional + behavioural development, what would you expect for an 18 month old child?

A

Uses spoon to feed self

107
Q

DEVELOPMENTAL STAGES
In terms of social, emotional + behavioural development, what would you expect for an 18-24 month old child?

A

Extends interest beyond parents (waves at strangers),
parallel play (next to but not with children),
symbolic play (copies actions like feeding a doll),
dry by day,
removes some clothes

108
Q

CHILD ABUSE
what are the features of shaken baby syndrome

A

Retinal haemorrhages
Encephalopathy
Subdural haemotoma

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