Physiology Flashcards
1
Q
What are the respiratory anatomical differences between children and adults?
A
Higher anterior larynx/floppy epiglottis means minor injuries and slight swelling can rapidly compromise their ability to breath
2
Q
What are the cardiovascular anatomical differences between children and adults?
A
Smaller blood volume means minor blood losses can have major clinical implications
3
Q
What are the musculoskeletal anatomical differences between children and adults?
A
infants have relatively large head and prominent occiput - necks flex easily when lying supine which may contribute to airway compromise
The lack of complete ossification of the ribs and sternum mean the underlying structures are less protected - leads to the potential for pulmonary/mediastinal injury to occur without significant signs of external injury
4
Q
What anatomical difference between children and adults predisposes them to hypothermia?
A
Relatively large surface area compared to volume
5
Q
When is a child’s death classified as a miscarriage?
A
Before 24 weeks gestation
6
Q
When is a child’s death classified as a stillbirth?
A
Between 24 weeks and 40 weeks in utero
7
Q
When is a child’s death classified as a perinatal mortality?
A
Between 24 weeks and 41 weeks out of utero
8
Q
When is a child’s death classified as a neonatal mortality?
A
Between the birth and 4 weeks after birth
9
Q
When is a child’s death classified as a post-neonatal mortality?
A
Between 4 weeks after birth and 52 weeks after birth
10
Q
What is the most common paediatric presentation?
A
Bronchiolitis/URTI/Croup
11
Q
What is classed as a preterm baby?
A
A birth that occurs before 37 completed weeks of gestation
12
Q
What is classed as a term baby?
A
A birth between 37 weeks and 41 weeks of gestation
13
Q
What is classed as a post term baby?
A
A birth after 41 weeks of gestation
14
Q
What is the normal weight of a baby?
A
2.5kg-4.0kg (5.5 lbs to 8.8 lbs)
15
Q
What is large for gestational age?
A
Over 4.0kg
16
Q
What is small for gestational age?
A
Under 2.5kg
17
Q
What events happen during the 3rd trimester?
A
Daily weight gain of 24g during 3rd trimester
Approx 7g of fat per day in last 4 weeks
Transplacental transfer - iron, vitamins, calcium, phosphate and antibodies.
18
Q
What are the challenges for baby during labour?
A
During contractions, the baby is in a hypoxic environment
Foetal Hb helps release O2 to help with this
Prolonged labour reduces foetal reserves
Placental insufficiency can make it difficult for baby to cope with the hypoxia - many reasons including maternal smoking or drug use, pre-eclampsia
Growth restriction or excess can also make it difficult for baby
The stress baby experiences increases cortisol and adrenaline, which enhances perinatal adaptation.
19
Q
How can growth restriction affect labour?
A
Lack of reserves to help during labour
20
Q
How can growth excess affect labour?
A
Large baby can be difficult to get out
21
Q
How does a baby adapt perinatally?
A
First breath/cry causes alveolar expansion, prompting the change from foetal to newborn circulation
Decreased pulmonary arterial pressure increasing PaO2
Early/immediate skin-to-skin and suckling
22
Q
How can we measure the baby’s perinatal adaptation?
A
Through the apgar score
23
Q
What is the normal apgar score?
A
More or equal to 8
24
Q
How is the apgar score calculated?
A
Scored out of 10
0, 1 or 2 per component
Component’s include RR, HR, Responsiveness, Tone, Colour
25
What should be done for baby immediately after birth?
Keep baby warm
Skin-to-skin contact is important for establishing breast feeding
Well grown term infants have little calorific intake in the first 24 hours
Allow attachment - babies are often very alert immediately after delivery and regulates hormonal and emotional response to infant
26
How is haemorrhagic disease of the newborn prevented?
Vitamin K is given in the newborn period preferably IM but can be given orally
27
What infections should be screened for in the newborn?
Based on maternal history
Hep B - consider immediate vaccination/immunoglobulin
Hep. C
HIV
Syphilis
TB
Group B Strep
28
How are babies monitored?
Anticipatory methods used to monitor babies at risk such as the newborn early warning score
29
What vaccines should mum have had in pregnancy?
Pertussis and influenza
30
What other vaccines should be considered for babies?
Hep B at birth and BCG in first month - depending on risk factors
31
What screening tests are done for newborns?
Hearing screen
Around Day 5 - sickle cell disease, Cystic fibrosis, congenital hypothyroidism and inherited metabolic disease such as PKU, MCADD, IVA, GA1, HCU
32
When is the newborn examination done?
Carried out at around 24 hours of age
33
What is examined on the head in a newborn examination?
overlapping sutures, fontanelles, forceps marks, moulding, cephalhematoma, caput succedaneum
34
What is examined in the eyes in a newborn examination?
size, red reflex, conjunctival haemorrhage, squints, iris abnormality
35
What is examined on the ears in a newborn examination?
position, external auditory canal, tags/pits, folding
36
What is examined in the mouth in a newborn examination?
shape, philtrum, tongue tie, palate, neonatal teeth, ebsteins pearls, sucking reflex
37
What is examined in the face in a newborn examination?
facial palsy, dysmorphism
38
What is examined in the respiratory system in a newborn examination?
chest shape, nasal flaring, grunting, tachypnoea, in-drawing, breath sounds
39
What is examined in the cardiovascular system in a newborn examination?
colour/saturation, pulses - femoral, apex, thrills/heaves, heart sounds
40
What is examined in the abdominal system in a newborn examination?
moves with respiration, distension, hernia, umbilicus, bile stained vomiting, passage of meconuim, anus
41
What is examined in the genitourinary system in a newborn?
normal passage of urine, normla genitalia, undescended testes, hypospadius
42
What is examined in the MSK system in a newborn?
movement and posture, limbs and digits, spine, hip examination
43
What is examined in the neurological system in a newborn examination?
alert, responsive, cry, tone, posture, movement, primitive reflexes
44
What is examined on the skin in a newborn examination?
erythema toxicum, congenital dermal melanocytosis, naevus flammeus, strawberry hemangioma
45
What is classed as extremely preterm?
<28 weeks
46
What is classed as very preterm?
28-32 weeks
47
What is classed as moderate or late preterm?
32-37 weeks
48
What are the risk factors of a preterm birth?
>2 preterm deliveries increases the risk of another premature baby by 70%
Abnormally shaped uterus increases the risk of giving birth early by 19%
Women are 9 times more likely to give birth early if they have a multiple pregnancy
Interval of <6 months between pregnancies
Conceiving through IVF
Smoking, drinking alcohol, using illicit drugs
Poor nutrition, some chronic conditions such as high BP and diabetes, multiple miscarriages or abortions
49
What are the issues for preterm baby in early life?
- need more help to stay warm
- have more fragile lungs
- don’t breathe effectively
- Have fewer reserves
50
How can be alter care for preterm babies?
- delay cord clamping if possible by 1-3 mins
- Keep baby warm - plastic bag and radiant heater and hat
- Gentle lung inflation - PEEP important
- Use of saturation monitor - careful use of oxygen
51
How does hypothermia occur in preterm babies?
- Thermal regulation is ineffective due to:
- Low BMR
- Minimal muscular activity
- Subcutaneous fat insulation is negligible
- High ratio of surface area to body mass
52
How can hypothermia be managed in preterm babies?
- Wrap or bags
- Skin-to-skin care
- Transwarmer mattress
- Prewarmed incubator
53
What growth and nutrition issues can preterm babies experience?
Neonates are at increased risk of nutritional compromise due to:
- limited nutrient reserves
- gut immaturity
- immature metabolic pathways
- increased nutrient demands
54
How does neonatal sepsis occur?
- Early onset - mainly due to bacteria acquired before and during delivery (Gram negatives and Group B Strep)
- Late onset - acquired after delivery (Coagulase negative Staph, Gram Negatives, Staph aureus)
55
What is the management of neonatal sepsis?
Prevention, hand washing, super vigilant and infection screening, judicious use of antibiotics, supportive measures)
56
How does respiratory distress syndrome occur in preterm infants?
- Surfactant deficiency and structural immaturity (primary pathology)
- Alveolar damage - formation of exudate from leaky capillaries, inflammation, repair
57
What are the clinical features of RDS in preterm babies?
respiratory distress, tachypnoea (grunting, intercostal recessions, nasal flaring, cyanosis), worsen over minutes to hours
58
What is the management of RDS in preterm infants?
maternal steroid, surfactant and ventilation
59
What are other system immaturity/dysfunction problems for preterm infants?
Neonatal sepsis
RDS
Apnoea of prematurity
Bronchopulmonary Dysplasia
Patent Ductus arteriosus
Intraventricular haemorrhage
Necrotising Enterocolitis
Retinopathy of prematurity
60
What are the metabolic complications for preterm babies?
- Early - hypoglycaemia, hyponatraemia
- Late - osteopenia of prematurity
61
What factors influence development?
Genetics
Nutritional
Environmental
62
How can screen time impact children's development?
as screen time increases → the less you sleep, delayed child development, increases BMI due to less activity. Parental screen use can impact child as less interaction between mum and child
63
What does median age mean in child development?
age when 50% of the population achieve that skill
64
What does limit age mean in child development?
age when skill should have been acquired by 97.5% of children
65
What are the principles of development?
Continuous process dependent on maturation of the nervous system
Sequence of skill development should stay the same between children but the rate will vary
66
What is the process of development in children?
Motor development proceeds in a cephalocaudal direction e.g., child masters head control, then trunkal control and so on
Generalised mass activity changes to more specific controlled movements.
67
What are the areas of development in children?
Gross Motor
Fine motor and vision
Language and hearing
Social behaviour and play
68
What primitive motor reflex is involved in breastfeeding?
Sucking and Rooting
69
What is involved in asymmetrical tonic neck reflex (ATNR)?
If head turns to one side, limbs flex and extend on each side to stabilise baby
70
What are the palmar and plantar reflexes?
Baby will grasp object placed in hand or foot
71
What is the moro reflex?
When babies head suddenly falls back, infant grasps with arms
72
When does hand preference develop?
Around 18 months
73
What age can a baby sit?
6 months
74
What age can a baby crawl?
9 months
75
What age can a baby stand?
12 months
76
What age can a baby run?
18 months
77
What age can a baby scissor grasp?
9 months
78
What age can a baby grasp a toy?
6 months
79
What age can a baby pincer grasp?
12 months
80
What age can a baby create a tower of 3-4 blocks?
18 months
81
When can a baby social smile?
6-8 weeks
82
When can a baby babble?
6 months
83
When can a baby imitate sounds?
9 months
84
When will a baby know names?
12 months
85
When will a baby know 5-20 words?
18 months
86
When will a baby understand simple instructions?
24 months
87
When will a baby ask questions?
36 months
88
When can a baby tell stories of experiences?
48 months
89
When can a baby play with feet/friendly with strangers?
6 months
90
When will a baby play peek-a-boo?
9 months
91
When will a baby drink from a cup?
12 months
92
When will baby eat with spoon?
18 months
93
When will a baby be able to get dressed fully?
48 months
94
What is developmental delay?
Failure to attain appropriate developmental milestones for child's corrected chronological age
95
What are the different patterns of developmental delay?
Global developmental delay
Specific developmental delay
development deviations
regression
96
What is intellectual disability?
Significant cognitive impairment and adaptive function with age of onset before 18 year
97
What are the categories for intellectual disability?
Mild IQ 50-70
Moderate IQ 35-50
Severe IQ 20-40
Profound IQ below 20
98
What are the red flags for development?
Asymmetry of movement, increased or decreased tone
Not reaching for objects by 6 months
Unable to sit unsupported by 12 months
Unable to walk by 18 months
No speech by 18 months
Concerns regarding vision or hearing at any age
Loss of skills (regression) at any age
99
What is global developmental delay?
Termed learning or intellectual disability in school age
Significant delay in 2+ of:
- gross/fine motor
- speech/language
- cognition
- social,
- ADL
100
What gap is seen between child with Global developmental delay and their peers?
It will increase with age - better to look at delay as percentage until ~16 years where development tends to plateau
101
What investigations are done for global developmental delay?
Investigations vary widely between centres but mainly involves genetics and family history
102
What are the causes of global developmental delay?
Genetic e.g., Down Syndrome
Metabolic/Endocrine e.g., PKU, hypothyroidism
Traumatic (accidental or non-accidental)
Environmental e.g., severe neglect, malnutrition
Cerebral malformations e.g., neuronal migration disorders
Complications of prematurity
Infections e.g., meningitis or TORCH infections
Toxins e.g., maternal substance misuse
Unknown
103
How can specific developmental delay be categorised and give examples?
Motor delays e.g., Duchenne Muscular Dystrophy
Language delays e.g., Specific Language Impairment
Sensory deficits e.g., Oculocutaneous albinism
104
What causes DMD?
X-linked recessive disorder
Mutation on dystrophin gene causing lack of dystrophin protein in muscle which is easily damaged. Leads to weakness, fatigue, cramps and pseudohypertrophy
105
How is DMD diagnosed?
CK levels > 10000
Genetic testing
106
What is the management for DMD?
physiotherapy and equipment, steroids, orthopaedic surgery, cardiac rx, ventilatory support, family support, emerging drugs such as nonsense mutation suppression
107
What causes spinal muscular atrophy?
Autosomal recessive disorder
Deletion/mutation in both SMN1 and 2 genes causing decreased SMN protein in spinal cord. Degeneration of motor neurons leading to hypotonia and progressive weakness.
108
How is spinal muscular atrophy diagnosed?
Genetic testing for SMN1 and 2
109
What is the management for spinal muscular atrophy?
- Physiotherapy and equipment, orthopaedic support, nutrition and GI support, respiratory care, palliative care, family support
- Drugs - IT Nusinersen 4/12, IV Xolgensma
110
What is an example of a developmental deviation condition?
Autism Spectrum Disorder
111
What is an example of a regression condition?
Rett's Syndrome
112
What are the assessment tools used for abnormal child development?
Griffiths - 0-6 years
Bayleys - 0-3 years
Schedules of growing skills - 0-5 years
ADOS - ASD
113
What is classed as normal growth?
A child shows normal growth if:
- Their measurements are within the normal range compared with children of their age
- Their rate of growth is within normal range compared with children of their age
A child who is growing normally is unlikely to have any major underlying problems
114
How are growth charts composed?
Composed of a series of normal curves with the x axis being time
115
How do you measure a child's weight?
- Babies without clothes or nappy
- Children 2 years+ can be weighed in vest and pants
116
How do you measure a child's head circumference?
Head circumference → narrow plastic or disposable paper tape where the head circumference is widest
117
How do you measure a child's height?
- Measure length before 2 years with length board/mat
- Height should be measured from 2 years using rigid rule with T piece, or stadiometer
- Shoes should always be removed
118
In girls when is puberty indicated?
by the development of breast buds
119
In boys when is puberty indicated?
by increase in testicular volume
120
What is the average of puberty?
girls 11 years, boys 6 months later
121
What are gonadotropins?
FSH and LH
122
What is true central precocious puberty?
normal pubertal development occurring abnormally early - <8 years for girls, <9 years for boys
123
What is classified as pubertal delay?
the absence of secondary sexual development in a girl age 13 or boy age 14
124
Precocious puberty is more common in boys. True or False?
False more common in girls
125
Pubertal delay is more common in boys. True or False?
True
126
What is the average height difference between adult men and women?
12.5-14cm
127
Why is there a difference in height between adult men and women?
- Boys have delayed PHV (peak height velocity)
- Boys PHV is greater than in girls due to testosterone
- Boys are taller pre-puberty
128
What investigations should be conducted in a potential growth problem?
- Bloods - gonadotrophins, IGF-1, testosterone/oestradiol, thyroid, karyotype (especially in girls - Turner’s), other pathology
- Bone age
- Dynamic function tests e.g., clonidine or ITT for growth hormone
- MRI brain, USS uterus
129
What is classified as short stature?
short stature is defined as less than 2nd centile or > 2SDs below mid-parental height
130
What are the causes of short stature?
- Genetic short stature - short parents
- Constitutional growth delay - diagnosis of exclusion, will reach true height eventually
- Growth hormone used to be given - does increase growth velocity for a few years but end height will not change so GH no longer prescribed.
- Dysmorphic syndromes e.g., achondroplasia
- Endocrine disorders e.g., pituitary gland disorders
- Chronic diseases
- Psychosocial deprivation
