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years 5 > Paeds year 5 Lissauer > Flashcards

Paeds year 5 Lissauer Flashcards

1
Q

Four functional areas of child development

A

gross motor
hearing speech and langauge
social emotional and behaviour
Vision and fine motor

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2
Q

What is meant by limit age?

A

Limit age = 2 SD from the mean in terms of skill acquisition

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3
Q

Median and limit age for walking?

A

12 months = median

18 months = limit

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4
Q

What normal variation pattern of gross motor can cause late walking?

A

commando crawl, bottom shuffling

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5
Q

How are development milestones adjusted for prematurity?

A

correction made for preterm birth up till 2 years of age.

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6
Q

what are the 5 primitive reflexes?

A

Moro- sudden extension of head cause symmetrical extension then flexion of the arm
Grasp reflex
Rooting
Stepping response
Asymmetrical tonic neck reflex- lying supine, the infant adopts an outstretched arm to the side to which the head is turned

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7
Q

What are the 4 postural reflexes?

A

Labyrinthine righting- hed moves in opposite direction to which the body is tilted.
Postural support- when held upright legs take weight and may push up
Lateral propping- in sitting, the arm extends on the side to which the child falls as a saving mechanism
Parachute- when suspended face down the arms extends as though to save themself.

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8
Q

Gross motor development median ages

A 
Newborn- marked headlag when pulling up
6-8 weeks- raised head to 45* when prone
6-8 months- sits without support (round back at 6, straight back at 8 months)
8-9 months- crawling
10 months- cruises around furniture
12 months- walks unsteadily, broad gait
15 months - walks steadily
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9
Q

Vision and fine motor development median ages

A

6 weeks- follows moving object or face by turning head
4 months- reaches out for toys
4-6 months- palmar grasp
7 months- toy transfer between hands
10 months - pincer grip
16-18 months- makes marks using crayon
Shapes: line(2years), circle(3), cross(3.5), square(4), triangle(5)

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10
Q

Hearing, speech and language median ages

A

Newborn- startles to loud noise
3-4 months- vocalises alone or when spoken to, coos and laughs
7 months- turns to soft sound out of sight
7-10 months- dada mama
12 months- two to three words other than dada mama
18 months- 6-10 words and shows two parts of body
20-24 months- uses two or more words to make a simple phrase
2.5-3 years- talks constantly in 3-4 words sentences

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11
Q

Social emotional and behavioural development median ages

A

6 weeks- smiles responsively
6-8 months- puts food in mouth
10-12 months- waves bye bye, plays peak a boo
12 months- drinks form a cup with two hands
18 months- holds spoon and gets food safely to mouth
18-24 months- symbolic play
2 years- dry by day
2.5-3 years- parallel play, interactive play evolving, taking turns

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12
Q

Limit ages for gross motor

A

head control- 4 months
sits supported - 9 months
stands independently- 12 months
walking- 18 months

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13
Q

Limit ages for vision and fine motor

A

fixes and follows- 3 months
reaches out for objects- 6 months
transfers- 9 months
pincer grip- 12 months

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14
Q

Hearing, speech and language development limit ages

A 
polysyllabic babble- 7 months
constant babble- 10 months
saying 6 words with meaning- 18 months
joins words- 2 years
3 word sentences- 2.5 years
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15
Q

Social, emotional and behaviour development limit ages

A 
smiles- 8 weeks
fear of stranger- 10 months
feeds self/spoon- 18 months
symbolic play- 2/2.5 years
interactive play- 3/3.5 years
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16
Q

Vaccine timeline babies under 1

A

when born- BCG (repeat 1,2,12 months), Hep B for high risk
8 weeks- 6-in-1 vaccine, Rotavirus vaccine, MenB

12 weeks- 6-in-1 vaccine (2nd dose), Pneumococcal ,(PCV) vaccine, Rotavirus vaccine (2nd dose)

16 weeks- 6 in 1 (3rd dose), Men B

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17
Q

Vaccine timeline 1-15 years

A

1 year- Hib/Men C, MMR, PCV(2nd dose), Men B(third dose)

2-10 years- flu vaccine every year

3 years and 4 months- MMR, 4 in 1 pre school booster

12- 13 years- HPV vaccine

14 years- 3 in 1 teenage booster, Men ACWY

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18
Q

Whats in 6 in 1
4 in 1
3 in 1?

A 
6 in 1 = HHPPDT
hep b, haemophilus influenzae B, polio, pertussis, tetanus, diptheria
4 in 1-  PPDT
polio, pertussis, HiB, diptheria
3in 1-  PDT
polio, tetanus and diptheria
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19
Q

What are the ways to test hearing in a newborn?

A

Evoked otoacoustic emission- misses auditory neuropathy

Automated auditory brainstem response- effected by movement, needs to be done when infant asleep

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20
Q

Define: delay, learning difficulty, disorder

A

Delay- implies slow acquisition of all skills or of one particular field or area of skill particulary in 0-5 years age group
learning difficulty- school age- cognitive, physical both or related to specific functional skill
disorder- maldevelopment of a skill

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21
Q

Define cerebral palsy

A

abnormality of movement and posture, causing activity limitation attributed to non progressive disturbances that occured in the developing fetal or infant brain before the age of 2.

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22
Q

What are the causes of CP?

A

80% antenatal in origin- vascular occlusion, cortical migration disorder or structural maldevelopment during gestation.
10%- due to hypoxic-ischaemic injury during delivery

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23
Q

Which TCA may be used in OCD?

A

Clomipramine - high serotoninergic effect

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24
Q

what is the surgery for OCD?

A

psychosurgery- anterior cingulotomy

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25
Q

what are the symptoms of PTSD?

A

reliving
hypervigilance
avoidance

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26
Q

What are the psychotherapies for PTSD?

A

EDMR, CBT trauma focused

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27
Q

Pharmacological therapy for PTSD?

A

mirtazapine/SSRI/venlaflaxine

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28
Q

what is a dissociative fugue?

A

amnesia + journey

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29
Q

which dementia is micrographia common?

A

parkinson’s

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30
Q

when is expressive dysphasia common?

A

after stroke

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31
Q

what are the most common infections in neonates?

A

listeria, group b strep and ecoli

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32
Q

how are the common infections treated in neonates?

A

cefotaxime and amoxicillin IV

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33
Q

why is ceftriaxone contraindicated in neonates?

A

can cause cholestasis jaundice

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34
Q

What is seen in small bowel biopsy of coeliac disease?

A

villous atrophy, crypt hyperplasia, intraepithelial lympocytes

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35
Q

What is the management of coeliac disease?

A

Lifelong gluten free diet
pneumovax as hyposplenic
Increased risk of enteropathy associated T cell lymphoma.
Other AI e.g. dermatitis herpetiformis- treat with dapsone

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36
Q

What are the most common causes of jaundice <24h life?

A 
Haemolytic disorder:
Rhesus incompatibility 
ABO incompatibility 
spherocytosis, pyruvate kinase deficiency.
Congenital infections
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37
Q

what investigations are done in neonatal jaundice <24h life?

A

Serum bilirubin
Group and DAT(coombs’)
blood culture, CRP and IV abx

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38
Q

Management of neonatal jaundice <24h?

A

phototherapy, exchange transfusion

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39
Q

during phototherapy how often is bilirubin checked?

A

6-12 hours

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40
Q

what causes kernicterus?

A

unconjugated bilirubin can cross BBB and deposit in basal ganglia permanently

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41
Q

How does kernicterus present?

A

acute manifestation- lethargy and poor feeding

severe cases: irritability, increased muscle tone: arched back(opisthotonos)

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42
Q

what type of cerebral palsy is associated with kernicterus?

A

choreoathetoid cerebral al palsy

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43
Q

what can be used to initially check bilirubin level?

A

transcutaneous bilirubin meter- if high check with blood laboratory measurement

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44
Q

How is biliary atresia managed?

A

Kasai procedure

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45
Q

what is the pathophysiology of Wilson’s disease?

A

AR mutation chr 13
reduced synthesis of caeruloplasmin. Defective excretion of copper in bile leading to accumulation in liver, brain, kidney and cornea

46
Q

what are the clinical features of wilson’s disease?

A

Liver disease, neuropsychiatric features- poor school performance, behaviour change\

47
Q

how is wilson’s disease investigated?

A

Serum caeruloplasmin- low

liver biopsy- increased copper deposit

48
Q

How is wilson’s disease managed?

A

treatment- penicillamine - promotes copper excretion

49
Q

organisms that cause UTI in paeds?

A

E.coli
Klebsiella
proteus
serratia

50
Q

management of UTI in paeds?

A

<3 months: admit and IV abx
>3months: 1st line = trimethoprim
2nd line - nitrofurantoin/ amoxicillin/ cefalexin

51
Q

When is USS of renal tract done?

A

atypical features: not e.coli, poor flow , raised creatinine, bladder mass, septic, not responding to treatment

52
Q

when is DMSA done?

A

in all children under 3 with atypical or recurrent

in all children over 3 with recurrent UTI

53
Q

what is recurrent UTI?

A

two upper UTI
1x upper + 1x lower
or 3x lower

54
Q

MCUG full form?

A

micturating cysto urethrogram

55
Q

What are the different grades of vesicoureteric reflux?

A

1: milf reflux into ureter without dilatation
2: reflux into ureter and collecting duct
3: mild dilatation of ureter, renal pelvis and calyces
4: dilation of renal pelvis calyces, tortuous
5: gross dilation.

56
Q

how is vesicoureteric reflux managed?

A

abx proph

surgery

57
Q

how to differentiate between IgA nephropathy and post rep glomerulonephritis?

A

days = IgA

1-2 weeks - post strep. In investigation low c3 level and raised ASOT

58
Q

what is the triad of goodpasture?

A

glomeruolonephritis
pulmonary haemorrhage
anti-GDM antibody formation
Haemoptysis and haematurea

59
Q

how will alports syndrome present?

A

X linked
SBA: haematuria + hearing loss + herieditary
female carriers may have haematuria

60
Q

how does wilms tumour present?

A

most common childhood abdominal malignancy
median age = 3.5 years
abdominal mass doesn’t cross midline, abdo pain, haematuria, HTN, claw sign= CT

61
Q

how is Wilms tumour managed?

A

surgery

chemotherapy

62
Q

how does HSP present?

A

IgA mediated AI vasculitis
preceding URTI
erythematous macular rash, fever, abdo pain, bloody diarrhoea
Age= 3-10 more common male

63
Q

how is HSP managed?

A

Henoch schonlein purpura- supportive, monitor for renal involvement- regular BP and urine dips- weekly for 4 weeks, 5-12 every 2 weeks, then 6 months and 12 months

64
Q

how does nephrotic syndrome present? most common = minimal change disease

A

proteinuria
oedema: periorbital, scrotal, SOB, leg, ankles, ascites
hypoalbuminaemia <30g/L
hyperlipidaemia and thrombophilia

65
Q

how is nephrotic syndrome managed?

A

steroid sensitive: prednisolone 4 weeks and then reduced dose for 4 weeks

66
Q

how is minimal change diagnose?

A

light microscope- looks normal

electron microscope- fusion of epithelial podocytes - it is steroid resistant

67
Q

Molluscum contagiosum presentation

A

pearly - caused by poxvirus

68
Q

impetigo presentation

A

gold crust
Staph A
tx= fusidic acid if mild, flucloxacillin if moderate
stay off school until crusted over- very infectious

69
Q

eczema herpeticum presentation?

A

vesicles = herpes
HSV1/2 on eczema
tx= PO/IV aciclovir
emergency in under 2 years old

70
Q

hand foot and mouth disease?

A

coxsackie virus, associated with fevers and sore throat
symptomatic treatment- antipyretic, difflam spray
continue school

71
Q

what is port wine strain syndrome associated with?

A

sturge weber syndrome= haemangiomatous facial lesion in distribution of trigeminal nerve
CT head- intracranial abnormalities
management- seizure control, laser for PWS, regular monitoring

72
Q

erythema toxicum neonatorum presentation?

A

very common in newborn, improves in 1-2 weeks non threatening

73
Q

croup presentation?

A

also called laryngotracehobronchitis, caused by parainfluenza, RSV, adenovirus
barking cough and stridor, worse at night and better by cold air

74
Q

management of croup?

A

don’t examine throat
PO dexamethasone 0.15mg/kg
severe- nebulised adrenaline

75
Q

Epiglottitis management?

A 
High fever
sore throat
drooling
tripodding
difficulty breathing- secure airways
IV- ceftriaxone
76
Q

when to admit child with bronchiolitis?

A

less than half feeds
requires oxygen or in resp distress
high risk e.g. <3months, premature, chronic lung disease, social concerns

77
Q

orbital cellulitis presentation ?

A 
proptosis
pain on movement
reduce visual acuity
Need CT head to assess spread of infection
urgent ENT and opthalmology assessment
78
Q

management of neonatal sepsis?

A

<72 hours = IV benpen and gent

>72 hours = IV cefotaxime and amoxicillin

79
Q

management of kawasaki?

A

aspirin and IV IG

80
Q

why not give amoxicillin for toncilitis?

A

widespread maculopapular rash if due to in infectious mononucleosis

81
Q

what causes scarlet fever?

A

group a b-haemolytic streptococcus

82
Q

causes of stridor?

A

most common- croup
epiglottitis
foreign body
bacterial tracheitis

83
Q

causes of croup?

A

parainfluenza, rhinovirus, RSV,

84
Q

clinical feature of croup?

A

hoarseness, stridor, barking seal like cough

85
Q

management of croup?

A

oral dexamethasone, oral prednisolone, nebulized budesonide if severe nebulised epinephrine

86
Q

clinical features of acute epiglottitis?

A

severe sore throat, soft whispering stridor, high fever, drooling, cough minimal or absent

87
Q

management of acute epiglottitis?

A

call ENT, anaesthetist, ICU, intubated under GA
after airway secure- take blood for culture
AB- cefotaxime for 3-5 days
prophylaxis with rifampicin offered to household

88
Q

common cause of bacterial tracheitis?

A

staphylococcus aureus

89
Q

causes of bronchiolitis?

A

RSV, parainfluenza, rhinovirus, adenovirus, influenza, human metapneumovirus

90
Q

bronchiolitis clinical presentation?

A

dry wheezy cough, tachypnoea, subcostal and intercostal recession, hyperinflation of the chest, fine end inspiratory crackles

91
Q

Investigation for bronchiolitis and when to admit to hospital?

A

only pulse oximetry

admit when: apnoea, oxygen sat <90%, inadequate oral fluid intake (50-75%), severe resp distress

92
Q

features of severe resp distress?

A

grunting, chest recession, resp rate over 70

93
Q

define bronchiolitis obliterans?

A

permanent damage to the airways, adenovirus

94
Q

clinical feature of wheeze?

A

polyphonic wheeze

eczema?

95
Q

Investigations for asthma/wheeze?

A

history and examination alone
skin prick to identify common allergens
Peak flow meter
spirometry- improvement of FEV after bronchodilators suggests asthma 12% or more improvement

96
Q

salbutamol

A

short acting B2 agonist

97
Q

terbutaline

A

short acting b2 agonist

98
Q

ipratropium bromide

A

anticholinergic

99
Q

examples of inhaled steroids

A

budesonnide, beclometasone

100
Q

example of LABA?

A

salmeterol

101
Q

leukotriene receptor antagonists example?

A

montelukast

102
Q

oral steroid for asthma?

A

prednisolone

103
Q

what should be monitored if a child is started on either inhaled steroids or oral?

A

monitor growth of child

104
Q

management of acute asthma?

A

oxygen if sats <92%
b2 bronchodilator using spaces, if severe nebulised
nebulised ipratropium bromide
prescribe oral prednisolone
Bolus- magnesium sulfate, salbutamol, aminopylline- if already on theophylline omit loading dose and just continuous infusion

105
Q

how is asthma severity assessed?

A 
ability to speak
resp rate
heart rate
Consciousness 
inspiratory effort
oxygen saturation
peak flow
106
Q

brittle asthma definition?

A

rapid onset severe asthma

107
Q

questions to ask in presentation of asthma?

A 
disturbance to sleep
disturbance to school
other allergies: hayfever, eczema, food allergy
peak flow diary?
inhaler technique
exercise intolerance
108
Q

cause of whooping cough

A

bordetella pertussis

diagnosis: culture of organism on pernasal swab, marked lympcytosis on blood film
management: macrolide erythromycin, azithromycin

109
Q

which organisms cause persistent cough?

A

pertussis, RSV, mycoplasma

110
Q

causes of pneumonia in children of different ages?

A

newborn- group b strep, gram neg enterococci

infants and young children: RSV, pneumococcus, HIB, pertussis, chlamydia

years 5 (4 decks)

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