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Child Health > Physiology > Flashcards

Physiology Flashcards

1
Q

Term Infant

A

An individual born after 37 weeks of gestation

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2
Q

Post-Term Infant

A

An individual born after 41 weeks of gestation

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3
Q

Normal gestational size

A

2.5-4.0 kg

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4
Q

Large for gestational age

A

> 4.0 kg

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5
Q

Small for gestational age

A

<2.5 kg

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6
Q

Daily weight gain during the third trimester

A

24g

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7
Q

Daily fat gain in the last 4 weeks of gestation

A

7g

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8
Q

The third trimester enables transplacental transfer of what? (5)

A

Iron
Vitamins
Calcium
Phosphate
Antibodies

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9
Q

What hormones can enhance adaptation following birth? (2)

A

Cortisol
Adrenaline

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10
Q

Perinatal Adaptation: Impacts on the lungs (4)

A

First breath or cry
Alveolar expansion
Decreased pulmonary arterial pressure
Increased partial pressure of oxygen

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11
Q

Perinatal Adaptation: Impact on the circulatory system

A

Changes from foetal to newborn circulation

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12
Q

Perinatal Adaptation - how is this measured?

A

Apgar score

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13
Q

Perinatal Adaptation: Normal Apgar Score

A

> 8

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14
Q

What initial change does the baby experience with regards to the GIT system?

A

Dramatic change from continuous glucose infusion to intermittent bolus enteral feeds

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15
Q

Disease Prevention: What infections should be assessed?

A

Hepatitis B and C
HIV
Syphilis
Tuberculosis
Group B Streptococcus infection

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16
Q

Screening: What 5 components take up the general screen?

A

Universal hearing screening
Hip screening
Cystic Fibrosis
Haemaglobinopathies
Metabolic Disease

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17
Q

Screening: What metabolic diseases are babies screened for? (6)

A

PKU - Phenylketonuria
MCADD - Medium Chain Acyl CoA Dehydrogenase Deficiency
MSUD - Maple Syrup Urine Disease
IVA - Isovaleric Acidaemia
GA1 - Glutaric Aciduria Type I
HCU - Homocystinuria

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18
Q

Patients with Homocystinuria (HCU) are unresponsive to what?

A

Pyridoxine

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19
Q

Screening: The Head should be assessed for what? (7)

A

Occipitofrontal circumference
Overlapping sutures
Fontanelles
Ventouse or Forcep marks
Moulding
Cephalhaematoma
Caput Succedaneum

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20
Q

Screening: The Eyes should be assessed for what? (5)

A

Size
Red reflex
Conjunctival haemorrhage
Squints
Iris abnormality

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21
Q

Screening: The Ears should be assessed for what? (5)

A

Position
External auditory canal
Tags or Pits
Folding
Family history of hearing loss

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22
Q

Screening: The Mouth should be assessed for what? (7)

A

Shape
Philtrum - midline groove running from the top of the lip to the nose
Tongue tie
Palate
Neonatal Teeth
Ebsteins Pearl
Sucking and Rooting Reflex

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23
Q

Ebsteins Pearl

A

Cyst formations on the gums and roof of the mouth

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24
Q

Screening: The face should be assessed for what? (2)

A

Facial palsy
Dysmorphism

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25
Q

Screening: A Respiratory Examination should look for what? (6)

A

Chest shap
Nasal flaring
Grunting
Tachypnoea
In-drawing
Breath sounds

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26
Q

Screening: A Cardiovascular Examination should look for what? (5)

A

Colour and Saturation
Femoral Pulses
Apex
Thrill and Heaves
Heart sound abnormalities

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27
Q

Screening: An Abdominal Examination should look for what? (7)

A

Movement with respiration
Distension
Hernia
Umbilicus
Bile-stained vomit
Passage of the meconium
Anus

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28
Q

Screening: A Genitourinary Examination should look for what? (4)

A

Normal passage of urine
Normal genitalia
Undescended testes
Hypospadius

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29
Q

Hypospadius

A

Birth defect in which the opening of the urethra is not located at the tip of the penis

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30
Q

Screening: What primitive reflexes should be assessed in a Neurological Examination? (6)

A

Suckling
Rooting
Moro
ATNR - Asymmetrical tonic neck reflex
Stepping
Grasp

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31
Q

Moro Reflex

A

Startle reflex in the neonate to a loud noise or fast movement

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32
Q

ATNR (Asymmetrical Tonic Neck Reflex)

A

When a babies face is turned to one side, the same side has extended and relaxed limbs whereas the opposite side has flexed limbs

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33
Q

ATNR is also known as the … reflex due to the position that the baby resembles

A

Fencer

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34
Q

Screening: A Skin Examination should look for what? (4)

A

Erythema Toxicum
Congenital dermal melanocytosis
Strawberry haemangioma
Naevus Flammeus

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35
Q

Preterm Infant

A

An individual that is born before 37 completed weeks of gestation

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36
Q

Infant Death is strongly influenced by what 6 factors?

A

Preterm delivery
Low Birth Weight
Maternal Age
Smoking
Deprivation status
Complications during labour

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37
Q

Causes of Preterm Birth (7)

A

Pre-term pre-labour rupture of membranes
Multiple pregnancies
Spontaneous preterm labour
Cervical incompetence or uterine malformation
Antepartum haemorrhage
Intrauterine growth restriction
Pregnancy-associated hypertension

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38
Q

Risk Factors for Pre Term Birth - Obstetric (6)

A

Previous >2 preterm deliveries
Abnormally shaped uterus
Multiple pregnancy - twins or triplets
Interval <6 months between pregnancies
Conceiving through IVF
Multiple miscarriages or abortions

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39
Q

Risk Factors for Pre Term Birth - Life style (4)

A

Smoking
Drinking alcohol
Illicit drugs
Poor nutrition

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40
Q

RDS

A

Respiratory Distress Syndrome

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41
Q

PDA

A

Patent Ductus Arteriosus

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42
Q

IVH

A

Intraventricular Haemorrhage

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43
Q

NEC

A

Necrotising Enterocolitis

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44
Q

Altered Approach: What are the 5 components?

A

Delayed cord clamping
Keep warm
Gentle lung inflation
Initial oxygen concentration
Using a saturation monitor

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45
Q

Thermoregulation: Why may a preterm baby have ineffective thermal regulation? (4)

A

Low BMR
Minimal muscular activity
Subcutaneous fat insulation is negligible
High surface area to mass ratio

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46
Q

Thermoregulation: Mechanisms of Temperature control? (4)

A

Wraps or bags
Skin to skin
Pre-warmed incubator
Transwarmer mattress

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47
Q

Why are preterm babies at a greater risk of nutritional compromise? (4)

A

Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands

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48
Q

EOS

A

Early Onset Neonatal Sepsis

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49
Q

LOS

A

Late Onset Neonatal Sepsis

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50
Q

Early Onset Neonatal Sepsis is mainly due to what?

A

Bacteria acquired before or during delivery

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51
Q

Late Onset Neonatal Sepsis is mainly due to what?

A

Noscomial or Community-acquired infection following birth

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52
Q

Causative Organisms of Early Onset Sepsis (2)

A

Group B Streptococcus
Gram Negative Bacteria

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53
Q

Causative Organisms of Late Onset Sepsis (3)

A

Coagulase Negative Staphylococci
Gram Negative Bacteria
Staphylococcus aureus

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54
Q

Respiratory Complications of Prematurity: Main Concerns (3)

A

Respiratory Distress Syndrome
Apnoea of Prematurity
Bronchopulmonary Dysplasia

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55
Q

Respiratory Distress Syndrome: Primary Aetiology (2)

A

Surfactant deficiency
Structural immaturity

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56
Q

Respiratory Distress Syndrome: Secondary Aetiology

A

Alveolar damage causes the formation of exudate from leaky capillaries with inflammation

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57
Q

Respiratory Distress Syndrome: Clinical features (5)

A

Tachypnoea
Grunting
Intercostal recession
Nasal flaring
Cyanosis

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58
Q

Respiratory Distress Syndrome: Time frame

A

Worsens over minutes to hours

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59
Q

Intraventricular Haemorrhage: Grade 1-2

A

Has a low risk of neurodevelopmental delay or mortality

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60
Q

Intraventricular Haemorrhage: Grade 3-4

A

Has a high risk of neurodevelopmental delay or mortality

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61
Q

Neonatal Jaundice: Jaundice

A

Clinical sign of yellow discolourisation of the skin and sclera

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62
Q

Neonatal Jaundice: Clinical presentation in neonates (2)

A

Cephalocaudal progession - face to toe progression
Appears on day 2-3 of life

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63
Q

Neonatal Jaundice: Physiology - It is a result of what?

A

Elevated bilirubin

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64
Q

Neonatal Jaundice: Physiology - Bilirubin is produced from what?

A

Breakdown of haem of erythrocytes

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65
Q

Neonatal Jaundice: Physiology - Bilirubin breakdown produces what?

A

Unconjugated bilirubin that circulates bound to albumin

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66
Q

Neonatal Jaundice: Physiology - First stage of Bilirubin synthesis

A

Heme forms Biliverdin via Heme Oxygenase via opening of the alpha-oxygenase bridge of heme

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67
Q

Neonatal Jaundice: Physiology - Second stage of Bilirubin synthesis

A

Biliverdin to Bilirubin via Biliverdin Reductase

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68
Q

Neonatal Jaundice: Physiology - First stage of Bilirubin Metabolism

A

Unconjugated bilirubin is converted to conjugated bilirubin via the liver

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69
Q

Neonatal Jaundice: Physiology - Is unconjugated bilirubin water soluble?

A

No

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70
Q

Neonatal Jaundice: Physiology - Is conjugated bilirubin water soluble?

A

Yes

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71
Q

Neonatal Jaundice: Physiology - Conversion of Bilirubin from Unconjugated to Conjugated form is reliant upon what?

A

Bilirubin uptake via Ligandin and UDP conjugation

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72
Q

Neonatal Jaundice: Physiology - Second stage of Bilirubin Metabolism

A

Conjugated bilirubin excreted into the GIT

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73
Q

Neonatal Jaundice: Physiology - In neonates what is different about bilirubin metabolism?

A

Percentage of conjugated bilirubin reverts to unconjugated bilirubin to be recirculated into the blood stream via enterohepatic circulation

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74
Q

Gilberts Disease

A

Mutation of the UGT1A1 gene that results in reduced bilirubin UDP activity to worsen jaundice

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75
Q

Neonatal Jaundice: 2 main complications

A

Kernicterus
Cerebral Palsy

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76
Q

Kernicterus

A

Brain damage as a result of elevated bilirubin concentrations in the neonate due to the movement of Bilirubin across the BBB

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77
Q

Neonatal Jaundice: Exacerbating Factors (7)

A

Decreasing gestational period
Asphyxia - oxygen deprivation
Acidosis
Hypoxia
Hypothermia
Meningitis
Sepsis

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78
Q

Neonatal Jaundice: Timing - Early

A

0-24 hours after birth

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79
Q

Neonatal Jaundice: Timing - Physiological

A

24-72 hours after birth

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80
Q

Neonatal Jaundice: Timing - Late

A

> 14 weeks in term neonates and 21 days in preterm neonates

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81
Q

Neonatal Jaundice: Physiological Jaundice - Onset

A

Day 2

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82
Q

Neonatal Jaundice: Physiological Jaundice - Peak

A

Day 5

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83
Q

Neonatal Jaundice: Physiological Jaundice - Resolves by when?

A

10-14 days

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84
Q

Neonatal Jaundice: Physiological Jaundice - Development pathway (5 stages)

A
  1. Increased production of bilirubin - due to foetal RBC life span being 2/3 of adults
  2. Decreased uptake and binding by liver cells
  3. Decreased conjugation
  4. Decreased excretion
  5. Increased enterohepatic circulation of bilirubin
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85
Q

Neonatal Jaundice: Pathological Jaundice - Onset

A

Day 1

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86
Q

Neonatal Jaundice: Pathological Jaundice - Prolonged after what?

A

Day 14

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87
Q

Neonatal Jaundice: Too Early Jaundice (<24 hours) - Aetiology

A

Haemolysis with excessive production of bilirubin or sepsis

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88
Q

Neonatal Jaundice: Too Early Jaundice (<24 hours) - Haemolysis can be due to what? (3)

A

ABO incompatibility
Rh immunisation
Sepsis

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89
Q

Neonatal Jaundice: Too Early Jaundice (<24 hours) - Consider hepatitis as cause when?

A

Substantial elevation in conjugated bilirubin

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90
Q

Neonatal Jaundice: Too Early Jaundice (<24 hours) - Example of red cell enzyme defects

A

G6PD deficiency

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91
Q

Neonatal Jaundice: Too Early Jaundice (<24 hours) - Example of cell membrane defect

A

Hereditary spherocytosis

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92
Q

Neonatal Jaundice: Too Early Jaundice (<24 hours) - Required Investigations (5)

A

Total Bilirubin Concentration
Maternal blood group and antibody titres - if Rh negative
Babies blood group - agglutination or elution tests
FBC
CRP

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93
Q

Neonatal Jaundice: Too Late Jaundice (24 hours to 10 days of age) - Pathophysiology

A

High levels of unconjugated bilirubin cross the BBB to cause bilirubin encephalopathy

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94
Q

Neonatal Jaundice: Too Late Jaundice (24 hours to 10 days of age) - Aetiologies (5)

A

Mild dehydration or insufficient milk supply
Breakdown of extravasated blood
Haemolysis
Infection
Increased enterohepatic circulation

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95
Q

Neonatal Jaundice: Too Late Jaundice (24 hours to 10 days of age) - Examples of breakdown of extravasated blood (2)

A

Cephalohaematoma
Bruising

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96
Q

Neonatal Jaundice: Clinical Presentation of Encephalopathy - Musculoskeletal (3)

A

Hypotonia
Opisthotonos - arching of the head, neck and back
Spasticity and Seizures

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97
Q

Neonatal Jaundice: Clinical Presentation of Encephalopathy - General (3)

A

Lethargy
Poor feeding
Temperature instability

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98
Q

Neonatal Jaundice: Prolonged Jaundice - Time period

A

> 14 days in term neonates or 21 days in preterm neonates

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99
Q

Neonatal Jaundice: Prolonged Jaundice - Aetiology of Unconjugated Hyperbilirubinaemia (5)

A

Breast milk Jaundice - do not stop breast feeding
Poor milk intake
Haemolysis
Infection
Hypothyroidism

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100
Q

Neonatal Jaundice: Prolonged Jaundice - Aetilogies of Conjugated Hyperbilirubinaemia (4)

A

Hepatitis
Biliary Atresia
Hypothyroidism
Breast Milk Jaundice

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101
Q

Neonatal Jaundice: Prolonged Jaundice (Conjugated Hyperbilirubinaemia) - Causes of Hepatitis (2)

A

Infection - Toxoplasmosis, Rubella, CMV, Hepatitis or Syphilis
Metabolic Disorders - Galactosaemia

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102
Q

Neonatal Jaundice: Prolonged Jaundice (Conjugated Hyperbilirubinaemia) - Biliary Atresia Clinical Presentation

A

Pale stools with dark urine that is not thriving

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103
Q

Neonatal Jaundice: Prolonged Jaundice (Conjugated Hyperbilirubinaemia) - Management of Biliary Atresia

A

Kasai Protoenterostomy before 3 months of age

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104
Q

Neonatal Jaundice: Prolonged Jaundice (Conjugated Hyperbilirubinaemia) - Blood results for Breast Milk Jaundice (3)

A

Normal conjugated portion
Normal FBC
Normal Blood Cross Matching

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105
Q

Neonatal Jaundice: Management - Best way to reduce enterohepatic circulation of bilirubin

A

Enteral feeding

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106
Q

Neonatal Jaundice: Management - Main Treatment

A

Phototherapy

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107
Q

Neonatal Jaundice: Management - Mechanism of Action of Phototherapy

A

Changes the structure of bilirubin so that it is more soluble for excretion

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108
Q

Neonatal Jaundice: Management - UV range for Phototherapy

A

460-490 NM (Blue-Green Light)

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109
Q

Neonatal Jaundice: Management - Exchange Transfusion used for what? (2)

A

Haemolytic Disease
Isoimmune Haemolytic Disease

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110
Q

Neonatal Jaundice: Management - Exchange Transfusion for Haemolytic Disease

A

Remove babies own red blood cells and replace them with blood matched to the mothers

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111
Q

Neonatal Jaundice: Management - Exchange Transfusion for Isoimmune Haemolytic Disease and Indications

A

IV Immunoglobulin delivered to baby if bilirubin rises despite intensive phototherapy

For Rhesus/ABO disease with total bilirubin concentration >8.5 mmol/L/hour OR Bilirubin within 30-50 micromol of exchange transfusion line

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112
Q

Nutrition: Benefits of Skin-to-Skin Care (4)

A
  • Regulation temperature, heart rate and respiratory rate
  • Reduce stress hormones
  • Enables lactation hormones to be produced in the mother
  • Colonisation of babies microbiome by parental microbes
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113
Q

Breast Feeding: Reduces the risk of what? (3)

A

Incidence of otitis media
Dental caries
Malocclusion

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114
Q

Breast Feeding: Breast Milk Reduces the risk of what diseases? (4)

A

Infections
Allergies
SIDS
Leukaemia

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115
Q

Breast Feeding: Reduces the risk of what in mothers?

A

Breast and ovarian cancer
Cardiovascular disease
Osteoporosis
Obesity and Type II Disease

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116
Q

The Prolactin Receptor Theory: Alveolus sacs are surrounded by what? (2)

A

Alveolus
Lactocytes

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117
Q

The Prolactin Receptor Theory: Lactocytes are surrounded by what?

A

Myoepithelial Cells

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118
Q

The Prolactin Receptor Theory: Function of myoepithelial cells

A

Contract to send milk to the ducts and nipples

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119
Q

The Prolactin Receptor Theory: Where are prolactin receptors located?

A

On the cell wall of each lactocyte

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120
Q

The Prolactin Receptor Theory: Prolactin in mothers increases in response to what?

A

Touch and suckling

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121
Q

Lactation: First Stage

A

Lactogenesis 1 - Breast development and colostrum production from 16 weeks gestation

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122
Q

Lactation: Second Stage

A

Lactogenesis 2 - Onset of copious milk secretion occuring between 32 and 96 hours of birth

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123
Q

Lactation: Third Stage

A

Maintenance of milk production

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124
Q

Hormones: When is prolactin high?

A

At night

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125
Q

Hormones: Oxytocin Function

A

Causes milk delivery

126
Q

Hormones: What can delay oxytocin production?

A

Stress

127
Q

Hormones: Function of progesterone

A

Inhibits milk production by inhibiting prolactin

128
Q

Tongue Tie: Presentation - During feeding (2)

A

Difficulty attaching to the breast and staying attached for a full feed
Feed for a long time, have a short break and then feed again

129
Q

Tongue Tie: Presentation - What sound is made when they feed?

A

Clicking sound

130
Q

Tongue Tie: Presentation - Of the tongue (3)

A

Difficulty moving tongue side to side or lifting it
Difficulty sticking their tongue out
Tongue looks heart shaped when they stick it out

131
Q

Vitamin D: Why is Vitamin D important in pregnancy?

A

Pregnant and Breast Feeding women are at risk of Vitamin D deficiency

132
Q

Vitamin D: Vitamin D Dose during pregnancy

A

10 micrograms alongside Vitamin C and Folic Acid
If BMI>30 requires 25 micrograms during pregnancy and breastfeeding

133
Q

Vitamin D: Vitamin D dose during breastfeeding

A

10 micrograms - taken immediately before breast feeding and as a single dose

134
Q

Nipple Trauma: Breast Thrush - Clinical presentation

A

Deep pain in both breasts with itching and dry skin

135
Q

Nipple Trauma: Breast Thrush - Management

A

Miconazole Nitrate Topical Cream

136
Q

Nipple Trauma: Breast Thrush - Management if baby has oral thrush

A

Miconazole Topical Cream + Nystatin

137
Q

Nipple Trauma: Engorgement - Aetiologies (4)

A

Ineffective attachment
Restricted access to the breast
Use of a dummy
Supplementation with formula milk

138
Q

Engorgement

A

Breasts become overly full

139
Q

Nipple Trauma: Engorgement - Clinical Presentation

A

Hard tight and painful breasts

140
Q

Nipple Trauma: Mastitis - Management

A

Prescribe Flucloxacillin 1g 4x per day (Clindamycin if allergic to penicillin)

141
Q

Nipple Trauma: Breast Abscess - Management

A

IV antibiotics
Then drainage if ineffective management with antibiotics

142
Q

Dietary Reference Values: LRNI

A

Lower Reference Nutrient Intake - sufficient for 2.5% of the population with the lowest needs

143
Q

Dietary Reference Values: EAR

A

Estimated Average Requirement - Average energy requirements of a population (50% will need more and 50% will need less)

144
Q

Dietary Reference Values: RNI

A

Reference Nutrient Intake - Sufficient for 97.5% of the population

145
Q

Wasting

A

Low weight for height

146
Q

Stunting

A

Low height for weight

147
Q

Underweight

A

Low weight for age

148
Q

Normal Child Development: Developmental Milestones

A

Key stage when a new skill is developed

149
Q

Normal Child Development: Median Age

A

Age when 50% of the population achieve a new skill

150
Q

Normal Child Development: Limit Age

A

Age when individuals should have been acquired by 97.5% of children

151
Q

Normal Child Development: Main 4 ares of development

A

Gross Motor Skills
Fine Motor and Vision
Language and Hearing
Social behaviour and playing

152
Q

Gross Motor Skill Milestones: 6 weeks

A

Head control in vertical

153
Q

Gross Motor Skill Milestones: 3 months

A

No head lag on pulling to a sit

154
Q

Gross Motor Skill Milestones: 6 months (3)

A

Pushes up on arms in prone
Can roll from stomach to bac
Weight bears on leg

155
Q

Gross Motor Skill Milestones: 9 months (3)

A

Sits well and leans forward to reach toys
Stands holding on to furniture
May crawl

156
Q

Gross Motor Skill Milestones: 12 months (2)

A

Cruises
May take first step

157
Q

Gross Motor Skill Milestones: 18 months (2)

A

Runs
Climbs onto the adult chair

158
Q

Gross Motor Skill Milestones: 2 years (2)

A

Ascends and descends stairs 2 feet per tread
Can throw ball overhead

159
Q

Gross Motor Skill Milestones: 3 years (3)

A

Upstairs with alternating feet
Stands on one foot momentarily
Pedals tricycle

160
Q

Gross Motor Skill Milestones: 4 years (3)

A

Runs up and down the stairs
Can kick, throw and catch a ball
Hops on foot

161
Q

Fine Motor and Vision Skill Milestones: 6 weeks

A

Follows the torch with eyes

162
Q

Fine Motor and Vision Skill Milestones: 3 months

A

Hands held in the midline

163
Q

Fine Motor and Vision Skill Milestones: 6 months (3)

A

Transfer objects hand to hand
Palmar grasps
Mouths objects

164
Q

Fine Motor and Vision Skill Milestones: 9 months (2)

A

Uses index finger to point
Picks up tiny objects between thumb and hand

165
Q

Fine Motor and Vision Skill Milestones: 18 months (3)

A

Builds tower of 3-4 bricks
Has a hand preference
Enjoys picture books

166
Q

Fine Motor and Vision Skill Milestones: 12 months (2)

A

Neat fine pincer grip
Bangs toys together

167
Q

Fine Motor and Vision Skill Milestones: 2 years (2)

A

Build a tower of 6-7 bricks
Circular scribble

168
Q

Fine Motor and Vision Skill Milestones: 3 years (3)

A

Builds tower of 9-10 bricks
Copies circle
Cuts with scissor

169
Q

Fine Motor and Vision Skill Milestones: 4 years (3)

A

Threads beads
Copies cross
Draws a man

170
Q

Language and Hearing Milestones: 6 weeks

A

Stills to voice

171
Q

Language and Hearing Milestones: 3 months (2)

A

Vocalises with a familiar person
Laughs and Coos

172
Q

Language and Hearing Milestones: 6 months (2)

A

Babbles tunefully
Screams when annoyed

173
Q

Language and Hearing Milestones: 9 months (3)

A

Localises sound consistently
Polysyllabic babble
Imitates sounds

174
Q

Language and Hearing Milestones: 12 months (2)

A

Knows and responds to name
Jargons vowels and consonants

175
Q

Language and Hearing Milestones: 18 months (2)

A

5-20 words
Points to body parts

176
Q

Language and Hearing Milestones: 2 years (3)

A

50+ words - joins 2 words
Talks to self
Understands simple instructions

177
Q

Language and Hearing Milestones: 3 years (4)

A

Knows own name and gender
Asks lots of questions
Carries on simple conversations
Understands prepositions

178
Q

Language and Hearing Milestones: 4 years (3)

A

Recounts stories
Sentences
Counts to 20

179
Q

Social and Play Milestones: 6 weeks

A

Social Smile

180
Q

Social and Play Milestones: 3 months

A

Reacts pleasureably to familiar situations

181
Q

Social and Play Milestones: 6 months (2)

A

Still friendly with strangers
Plays with feet

182
Q

Social and Play Milestones: 9 months (3)

A

Anxious around strangers
Plays Peek-A-Boo
Object permanence

183
Q

Social and Play Milestones: 12 months (2)

A

Drinks from cup
Waves bye-bye

184
Q

Social and Play Milestones: 18 months (2)

A

Feeds with spoon
Imitates adult activities

185
Q

Social and Play Milestones: 2 years (2)

A

Puts on hats and shoes
Developing symbolic play

186
Q

Social and Play Milestones: 3 years (3)

A

Washes hands
Vivid pretend play
Understands sharing and plays with others

187
Q

Social and Play Milestones: 4 years (2)

A

Dresses and undresses
Understands turn takers

188
Q

Neonatal Genetics: Options for Genetic Testing in Foetuses (3)

A

Chorionic Villus Biopsy
Amniocentesis
Maternal Serum Sample

189
Q

Neonatal Genetics: Amniocentesis detects what? (2)

A

Skin and urine cells of the foetus

190
Q

Neonatal Genetics: Chorionic Villus Biopsy conducted when?

A

11.5 weeks

191
Q

Neonatal Genetics: Amniocentesis conducted when?

A

15 + weeks

192
Q

Neonatal Genetics: Benefit of Maternal Serum Sample

A

Enables non-invasive prenatal testing via free foetal DNA in the maternal circulation

193
Q

Neonatal Genetics: Maternal Serum Sampling enables determination of what? (4)

A

Sex determination
Trisomy testing
Chromosome deletions
Single gene mutations

194
Q

Neonatal Genetics: Chromosome Microarray - High risk of what if positive on Non-Invasive Prenatal Testing?

A

Chromosomal Trisomy

195
Q

Neonatal Genetics: NIPT - Common cause of false positives

A

Cancer cells present within mother

196
Q

Termination of Pregnancy: Time for surgical termination

A

<13 weeks

197
Q

Termination of Pregnancy: Time for induction

A

> 13 weeks

198
Q

When is child length used for monitoring?

A

Before 2 years of age

199
Q

When is child height used for monitoring?

A

Over 2 years of age

200
Q

When is child height measured?

A

During expiration

201
Q

Peak height velocity for boys

A

14

202
Q

Peak height velocity for girls

A

12

203
Q

Why is the height difference between men and women large? (3)

A

Boys have delayed peak height velocity
PHV is greater in men
Boys are taller in pre-puberty

204
Q

Average age of puberty in females

A

11 years old

205
Q

Average age of puberty in males

A

12 years old

206
Q

Puberty: What staging system is used?

A

Tanner Staging

207
Q

TCPP

A

True Central Precocious Puberty

208
Q

TCPP Definition

A

Normal pubertal development occurring abnormally early
- Females - <8 years old
- Males - <9 years old

209
Q

TCPP: More common in what sex?

A

Females

210
Q

Pubertal Delay

A

Absence of secondary sexual development in a girl aged 13 or a boy aged 14

211
Q

Pubertal Delay is more common in what sex?

A

Males

212
Q

Short Stature

A

Less than 2nd centile or greater than 2 standard deviations below mid-parental height

213
Q

Attachment: Infantile Attachment Features (3)

A

Attend to human voices
Recognise human faces
Gaze into parents eyes when being fed

214
Q

Attachment: First stage of attachment - timing and features

A

Asocial stage - 0-6 weeks
- Smiling and crying is not directed at specific people

215
Q

Attachment: Second stage of attachment - timing and features

A

Indiscriminate Attachment Stage - 6 weeks to 7 months
- Attention sought from different individuals

216
Q

Attachment: Third stage of attachment - timing and features

A

Specific Attachment Stage - 7 to 11 months of age
- Strong attachment to one individual with separation and stranger anxiety

217
Q

Attachment: Fourth stage of attachment - timing

A

Multiple Attachments - About 12 months old

218
Q

Attachment: 4 types

A

Secure
Insecure avoidant
Insecure ambivalent or resistant
Disorganised

219
Q

Secure Attachment: Separation anxiety

A

Distressed when the mother leaves

220
Q

Secure Attachment: Behaviour around Strangers

A

Avoidant when alone then friendly when mother is present

221
Q

Secure Attachment: Reunion with Mother behaviour

A

Positive and happy when mother returns

222
Q

Ambivalent Attachment: Separation Anxiety

A

Infant shows signs of distress when the mother leaves

223
Q

Ambivalent Attachment: Behaviour around Strangers

A

Avoids the stranger and shows fear

224
Q

Ambivalent Attachment: Behaviour when reunited with mother

A

Child approaches the mother but resists contact

225
Q

Ambivalent Attachment: Individual characteristic

A

Cries more and explores less than other types of attachment

226
Q

Avoidant Attachment: Separation Anxiety

A

Infant shows no distress when mother leaves

227
Q

Avoidant Attachment: Behaviour around Strangers

A

Infant plays normally when the stranger is present

228
Q

Avoidant Attachment: Behaviour when reunited when mother

A

Shows little interest in mother

229
Q

Secure Base

A

Attachment figure or relationship provides a safe space from which to explore the world

230
Q

Safe Haven

A

The attachment figure or relationship is a safe place to retreat to at times of danger or anxiety

231
Q

Attunement

A

Process between caregiver and infant in which they are able to tune in to each others physical and emotional stress

232
Q

Disordered Attachment: Aetiologies (4)

A

Separation from primary caregiver
Parental conflict
Maternal addiction to drugs or alcohol
Traumatic experiences

233
Q

Disordered Attachment: Clinical Symptoms (4)

A

Lack of self control - destructive, aggressive and irresponsible
Lack of normal fear
Demanding
Presents with pseudomaturity

234
Q

Disordered Attachment: Clinical Signs (4)

A

Inappropriate Behaviour - stealing, cruelty and defy rules
Sleep disturbance
Chats nonsense
Poor hygiene

235
Q

Disordered Attachment: Core emotions (4)

A

Anger
Fear
Pain
Shame

236
Q

Avoidant Attachment: View of self

A

Unloved and self-reliant

237
Q

Avoidant Attachment: View of Others (3)

A

Rejecting
Controlling
Intrusive

238
Q

Ambivalent Attachment: View of Self (3)

A

Low value
Ineffective
Dependent

239
Q

Ambivalent Attachment: View of Others (3)

A

Insensitive
Unpredictable
Unreliable

240
Q

Temperament: Easy Characteristics (4)

A

Readily approachable
Adapts to new situations
Regular in sleep and eating routines
Overall positive mood

241
Q

Temperament: Difficult characteristics (5)

A

Withdraw from or are slow to adapt to new situations
Intense reactions
Irregular routine
Negative mood
Long and frequent crying episodes

242
Q

Temperament: Slow to Warm Up Characteristics (4)

A

Withdraw from or are slow to adapt to new things
Low level of activity
Negative mood
Thought of as shy or sensitive

243
Q

Immunisations: Aim of immunisation

A

Control communicable disease

244
Q

Immunisations: Herd Immunity

A

Protection of unvaccinated individuals via having a sufficiently large proportion of the population vaccinated

245
Q

Immunisations: For herd immunity, the number required to be vaccinated is based upon what?

A

R0 - Number of individuals infected from one infected individual

246
Q

Vaccinations: Example of Live Virus Vaccine (6)

A

Measles
Mumps
Rubella
Varicella
Rotavirus
Flu

247
Q

Vaccinations: Example of Suspension of Killed Organisms (2)

A

Whole Cell Pertussis
Whole Cell Typhoid

248
Q

Vaccinations: Example of Toxoid Subunit Vaccinations (3)

A

Diphtheria Toxoid
Tetanus Toxoid
Pertussis Toxoid

249
Q

Vaccinations: Example of Polysaccharide Subunit Vaccinations (2)

A

Pneumococcal
Typhoid

250
Q

Vaccinations: Examples of Conjugate Vaccinations (2)

A

Hib
Meningitis C

251
Q

Vaccinations: Contraindications to Vaccinations (6)

A

Confirmed anaphylaxis reaction to previous dose/vaccine
Pregnancy
Egg Allergy
Severe Latex Allergy
Immunosuppression
Acute or Evolving Illness

252
Q

Vaccinations: 8 weeks (4)

A

DTaP/IPV/Hib/HepB
PCV
Rotavirus
MenB

253
Q

Vaccinations: 12 weeks (2)

A

DTaP/IPV/Hib/MenB
Rotavirus

254
Q

Vaccinations: 16 weeks old (3)

A

DTaP/IPV/Hib/HepB
PCV
MenB

255
Q

Vaccinations: 12 to 13 months old (4)

A

Hib/MenC
PCV
MMR
MenB

256
Q

Vaccinations: 3 years 4 months (2)

A

DTap/IPV or dTaP/IPV
MMR

257
Q

Vaccinations: Girls 11-13 years old

A

HPV

258
Q

Vaccinations: 14 years old (2)

A

Td/IPV
MenACWY

259
Q

Control

A

Reduction of disease to a locally acceptable level - requires continued intervention e.g. Diarrhoeal diseases

260
Q

Elimination of disease

A

Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts - requires continued intervention measures e.g. Neonatal Tetanus

261
Q

Eradication

A

Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts - no longer requires intervention measures e.g. Smallpox

262
Q

Extinction

A

The specific infectious agent no longer exists in nature or in the laboratory

263
Q

Diphtheria

A

URTI characterised by a sore throat and low grade fever

264
Q

Diphtheria: Presentation

A

White adherent membrane on the tonsils, pharynx and/or the nasal cavity

265
Q

Diphtheria: Causative organism

A

Corynebacterium diphtheriae

266
Q

Diphtheria: Presentation of Corynebacterium diphtheriae

A

Aerobic gram positive bacteria

267
Q

Meningococcal Disease

A

Invasive infection due to Neisseria Meningitidis

268
Q

Meningococcal Disease: Incubation period of Neisseria meningitidis

A

3-5 days

269
Q

Meningococcal Disease: Colonisation of what region is common?

A

Nasopharynx

270
Q

Meningococcal Disease: Two peaks of disease

A

<5 years old
15-24 years old

271
Q

Meningococcal Disease: Vaccination available for what serogroups? (5)

A

A
C
W
B
Y135

272
Q

Tuberculosis: Causative organism

A

Mycobacterium tuberculosis

273
Q

Tuberculosis: Vaccination programme

A

Bacillus Calmette-Guerin Vaccine (BCG)

274
Q

Adolescence

A

Individuals of 10-19 years of age - variable period between childhood and adulthood characterised by rapid development in psychological, social and biological domains

275
Q

Developmental Delay

A

Failure to attain appropriate developmental milestones for a child’s corrected chronological age

276
Q

Developmental Delay: Prenatal Causes of Developmental Delay (5)

A

Genetic - Down’s Syndrome
Metabolic - PKU and Hypothyroidism
CNS malformations - Neuronal Migration Disorders
Infections - TORCH infections
Toxins - Maternal substance misuse

277
Q

Developmental Delay: TORCH acronym

A

Toxoplasmosis
Other - Syphilis and Hepatitis B
Rubella
Cytomegalovirus
Herpes simplex

278
Q

Developmental Delay: Perinatal Causes (2)

A

Prematurity
Asphyxia

279
Q

Developmental Delay: Post-natal Causes (3)

A

Infection - Meningitis
Trauma
Environmental - Severe neglect or Malnutrition

280
Q

Developmental Delay: Causes of Motor Delay (3)

A

Duchenne Muscular Dystrophy
Cerebral Palsy
Co-ordination disorders

281
Q

Developmental Delay: Causes of Sensory Deficits (2)

A

Oculocutaneous albinusm
Treacher-Collins

282
Q

Global Developmental Delay (example)

A

> 2 areas of delay in development (Downs Syndrome)

283
Q

Developmental Deviations Example

A

Autism Spectrum Disorders

284
Q

Regression (+ 2 examples)

A

Loss of skills that were once present
Examples - Rett’s Syndrome or Metabolic Disorders

285
Q

Intellectual Disability

A

Significant impairment of cognitive and adaptive function with age of onset before 18 years of age

286
Q

Overweight

A

Abnormal or excessive fat accumulation that may impair health

287
Q

Weight: Being overweight is due to what?

A

Long term positive energy imbalance - energy intake exceeds energy output

288
Q

BMI Plots: Overweight Clinical Centile

A

> 91st

289
Q

BMI Plots: Obesity Clinical Centile

A

> 98th

290
Q

Child Abuse: Signs of Physical Abuse (4)

A

Burns
Bruises
Broken Bones
Trauma

291
Q

Child Abuse: Signs of Neglect (4)

A

Appearance - Dirty, Unkempt and Skinny with inadequate clothing
Not receiving healthcare
Faltering growth with developmental delays
Toilet Accidents

292
Q

Child Abuse: Signs of Emotional Abuse (4)

A

Observed caregiver-child interactions:
- Emotionally unavailable or unresponsive
- Developmentally inappropriate interactions
- Exposed to domestic abuse or drug taking
- Does not allow friendships

293
Q

Child Abuse: Signs of Sexual Abuse (4)

A

Inappropriate sexualised behaviours
STI
Pregnancy
Child sexual exploitation

294
Q

Child Protection

A

Process of protecting individual children that are suffering or likely to suffer significant harm as a result of abuse or neglect

295
Q

Signs of Cardiac Syncope (3)

A

Family history of sudden death during infancy
Vagal symptoms during sitting or lying
Symptoms occur at night or during exercise

296
Q

Headaches: Red Flags - Rapid onset of what?

A

Expanding head size in infants

297
Q

Headaches: Red Flags - GI presentation

A

Effortless vomiting in the morning

298
Q

Headaches: Red Flags - Worse on what? (4)

A

Coughing
Sneezing
Straining
Bending over

299
Q

Headaches: Red Flags - Neurological presentation (3)

A

New squint
Cranial Nerve Palsies
Diplopia or visual changes

300
Q

Heart Murmur: Red Flags - In Infants (3)

A

Cyanosis
Signs of failure - poor feeding, sweating or failure to thrive
Abnormal examination - low femoral pulses, liver edge or crepitations

301
Q

Heart Murmur: Red Flags - In Children (3)

A

Fatigue
Breathlessness
Any of infant red flags

302
Q

Cough: Red Flags (3)

A

Night time waking with a cough, wheeze, SOB or obstructive symptoms
Failure to thrive
Recurrent Infections

303
Q

Abdominal Pain: Red Flags (4)

A

Failure to thrive
Bilious or Bloody Vomiting
Bloody stools
Symptoms of Inflammatory Bowel Disease

304
Q

Constipation: Red Flags (2)

A

Symptoms present from birth
Abnormal lower limb neurology

305
Q

Diarrhoea: Red Flags (4)

A

Weight Loss
Blood in stools
Stools at night
Other systemic symptoms - Fatigue, Rashes, Mouth Ulcers and Joint involvement

306
Q

If there is reflux or cow milk protein allergy what must you check?

A

That it is not pyloric stenosis or malrotation

307
Q

Reflux or Cows Milk Allergy: Management (3)

A

Sit it out
Reflux medications
Hydrolysed formula

308
Q

UTI: Main complication concerns (3)

A

Renal scarring secondary to reflux
Renal tract abnormalities
Abnormal bowel or bladder dysfunction due to secondary neurological causes

309
Q

Growth: Failure to Thrive presentation

A

Drop over 2 centiles

310
Q

Growth: Red Flags (4)

A

Other systemic illness
Children who are short and obese
Signs of early puberty - <8 years in a girl or <9 years in a boy
Signs of late puberty - >13 years in a girl/no menarche at 15 OR >14 years in a boy

Child Health (2 decks)

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