Random Flashcards
If using formula how much milk should an infant consume per day? (1)
150ml/kg/day
Name 3 reasons mothers give up brestfeeding? (3)
Pain and discomfort from mastitis, cracked nipples, breast abscess
Concerns they are not producing enough milk
Return to work, inadequate facilities, attitudes towards breastfeeding in the workplace.
Give 3 advantages of breastfeeding for the mother? (3)
Contraceptive
Bonding with baby
Practical- free, no prep, right temp
Reduce risk of PPH - oxytocin constricts uterine arteries
Reduce disease- premenopausal breast ca, ovarian ca and osteoporosis
Help get back to pre pregnancy weight
Give 3 advantages to child of breastfeeding. (3)
Bonding with mother
Immunological transfer of humoral and cellular components.
Nutritional - correct amount of protein and vitamins and minerals
Sterile
Reduces risk of GORD, IBD, NEC and lactose intolerance.
Name 2 contraindications to breastfeeding. (2)
Maternal active TB
HIV positive mother
Maternal drugs (carbimazole, methotrexate, lithium, chemo)
What does APGAR stand for? (5)
Activity Pulse Grimacing/ reflex irrirability Appearance Respiratory effort
What is the significance of the APGAR score? (2)
7-10 is normal
4-7 may require some resuscitative measures
<3 requires immediate resuscitation
What is the correct term for Down’s syndrome? (1)
What is the largest risk factor for a child being affected by Down’s syndrome? (1)
Trisomy 21
Extra chromosome from mother.. Increasing maternal age (esp >35)
Age <30 risk 1:2000
Age 30 risk 1:1300
Age 35 risk 1:400Name 4 conditions associated with Downs syndrome. (4)
Congenital heart disease (AVSD, ASD, VSD, PDA, tetralogy of Fallot)
GI (anal, oesophageal and duodenal atresia, Hirschprung’s disease)
Chronic secretory otitis media
Cataracts
Hypothyroidism
Name 5 signs you may notice during examination of a child with Down’s syndrome. (5)
General: neonatal hypotonia, short stature
Developmental: lowered IQ
Craniofacial: microcephaly, brachycephaly, upward slanting eyes, prominent epicanthal folds, flat nasal bridge, protruding tongue, small ears, round face, excess skin at back of neck, atlanto-axial instability
Eyes: strabismus, nystagmus, cataracts
Limbs: single palmar crease, 5th finger clinodactyly, wide gap between first and second toes, hyperflexible joints in infants
CV: murmurs, arrhythmias, chf
Gi: constipation or vomiting
What cancer does Down’s syndrome predispose to? (1)
How is fertility affected? (1)
Why does Down’s syndrome predispose to Alzheimers? (1)
Leukaemia (ALL & AML)
Reduced fertility
Most develop Alzheimers by age of 40 as gene encoding for amyloid protein found on chromosome 21.
What is Wilm’s tumour? (1)
How does it present? (2)
Nephroblastoma. Originates from embryonal renal tissue.
Large abdominal mass. * Pallor Weight loss Hepatomegaly Bone pain
What are the four areas of development? (4)
Gross motor
Fine motor and vision
Speech, Language and Hearing
Social
What is retinoblastoma? (1)
How does it usually present? (1)
What age is it seen by? (1)
Malignant tumour of retinal cells
Loss of red eye on photos, pupil can sometime look white.
Presents by age 4
What developmental milestones may be present in a newborn? (4)
GM: symmetrical movements in 4 limbs, normal muscle tone, Moro reflex
FM&V: Fixes on mothers face and rotates 90 degrees
SL&H: Cries. Undergoes newborn hearing screening tests
Social: Responds to being picked up.
What developmental milestones would you expect in a 6-8 week old infant? (4)
GM: Good head control when pulled up to sitting, when held ventrally holds head transiently in horizontal plane.
FM&V: Stares at and follows mothers face
SL&H: coos, startles to loud noises
Social: smiles in response.
What developmental milestones might you expect to see in a 12 month old child? (4)
GM: crawling and pulling to stand, 50% may be walking.
FM&V: Pincer grip, points to objects
SL&H: uses single words, understands simple commands
Social: finger feeds, waves bye, responds to name
What are the main primitive reflexes? (4)
Moro’s, Rooting, Walking, Palmar grasp.
What age does hand preference develop? (1)
What is the implication of a dominant hand before this age? (1)
18m-24m
Indicates a problem eg weakness on the non-dominant side.
What is TORCH screen? (1)
Screen for infective agents that cause congenital intrauterine infections that may damage the growing foetus. Toxoplasmosis Other- Varicella zoster, syphilis Rubella CMV Herpes simplex
A child who is 12 hours old is noticed to have microcephaly, cataracts, hepatomegaly, splenomegaly, a petechial rash and jaundice. What is the most likely diagnosis? (1)
TORCH infection
A 16/40 pregnant woman attends GP after contracting chickenpox and wants to know if it will affect her child. When is a foetus susceptible in pregnancy? (2)
What is the infective organism? (1)
In first 20/40 pregnancy - 2% risk of severe skin scarring or ocular or neurological damage
If mother develops chickenpox within 5 days before or 2 days after delivery when foetus is unprotected by mothers antibodies. May develop vesicular rash , mortality up to 30%.
Varicella zoster virus.
A pregnant woman attends GP having been exposed to chickenpox virus.
What are the risk factors for her also becoming affected? (3)
Never had chickenpox in the past.
Same room as an affected person for 15 mins
Face to face conversation with someone affected.
When is chickenpox contagious? (2)
From 2 days before the rash develops until all spots have crusted over.
If a pregnant lady believes she is not immune to chickenpox and has had contact with a currently affected individual, how will you manage this? (2)
Serology for VZV antibodies if unsure about immunity.
Give IgG VZV immunoglobulins if within 10 days of exposure.
Why do term infants have high levels of Hb (140-210g/L) at birth? (1)
Levels of HbF are high to compensate for low oxygen concentration in the foetus.
Name 4 causes of anaemia in a child. (4)
Impaired red cell production- iron deficiency*, folic acid deficiency, CRF, leukaemia, aplastic anaemia Increased haemolysis- hereditary spherocytosis, G6PD deficiency, sickle cell Blood loss (rare)- von Willebrand disease
What is pica? (1)
Child eating non-food materials eg soil
What is hereditary spherocytosis? (1)
Autosomal dominant caused by mutations in genes for proteins of red cell membrane. RBCs are spherical and less deformable than normal RBCs so are destroyed by the spleen.
Name 4 features of hereditary spherocytosis. (4)
(Clue: JAPGAS)
What investigation will diagnose? (1)
What management is required? (2)
Jaundice, Anaemia, Pigment Gallstones, Aplastic crisis, Splenomegaly
Blood film
Folic acid for increase RBC production and consider splenectomy for poor growth or bad anaemia
How does Glucose-6-phosphate dehydrogenase deficiency cause anaemia? (1)
Why are men more affected? (1)
Which ethnicities are more commonly affected? (3)
G6PD is essential enzyme for preventing oxidative damage/haemolysis to RBCs.
X-linked. Affects central africa, middle east, far east and mediterranean origins more commonly.
What is the normal composition of HbF and HbA? (2)
Therefore why do β-thallesaemias and sickle cell disease not present until after 6 months of age? (1)
What is the pattern of inheritance in the thallesaemias? (1)
HbF has 2 α and 2 γ components, whereas HbA has α and 2 β chains.
Because iin these 2 diseases only β-chains are affected and as HbF is predominant until about 6 months of age, they do not show symptoms until HbA takes over.
Autosomal recessive
