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Pediatrics > The infant or child with abnormal development or poor school performance > Flashcards

The infant or child with abnormal development or poor school performance Flashcards

1
Q

Neurological assessment history

A
  1. Pregnancy/neonatal
  2. Development
    - >Regression in developmental milestone
    - >Pattern of the delay
  3. Headache
  4. Vomiting early morning
  5. Involuntary movements, convulsions, unexplained collapse, ALOC
  6. Sensory
  7. Bladder and bowel
  8. Ataxia, clumsiness, incoordination
  9. Hearing and vision
  10. Behaviour, mood, apathy, concentration
  11. School performance
  12. Function
  13. Home environment->parents, siblings
  14. Additional support->parental respite
  15. Family history of neurological->epilepsy, hearing/vision,metabolic, congenital, learning difficulty
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2
Q

Neurological physical examination

A
  1. Observation
    - >AVPU, GCS
    - >Posture, movement, gait
    - >Limb deformity
    - >Growth/HC
    - >Skin sigs->pigmentation, vascular birth marks
    - >dysmorphic features, xsomal, CNS malformation, FAS
    - >equiptment to aid neurological problems
  2. Eye->movement, pupils, fundoscopy
  3. Peripheral
    - >Muscle bulk, tone, power, coordination, reflexes
    - >Sensory
  4. Developmental exam
  5. Hepatosplenomegaly (metabolic)
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3
Q

Neurological examination in infants

A
  1. Moving spontaneously
  2. Positioning->hypoT= frogs legs
  3. Palpate posterior fontanelle/head circumference
  4. Assess tone by posture and handling->ventral position, pull to sit->++tone= resistance, scissoring of legs
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4
Q

Define cerebral palsy

A

Motor impairment
Permanent
Non-preogressive lesion in developing brain->however clinical picture changes

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5
Q

Most common form of cerebral palsy and location of lesion

A

Spastic type

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6
Q

Types of cerebral palsy (5)

A
  1. Hemiplegia
  2. Diplegia
  3. Total body involvement
  4. Atatxic
  5. Athetoid
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7
Q

Features of hemiplegia

A

Arms more affected than legs
Delayed walking
Tiptoe gait, dystonic posture when running

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8
Q

Athetoid cerebral palsy

A

Basal ganglia
Writhing movement
Intelligence often normal
Major physical impairment

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9
Q

Ataxic cerebral palsy

A

Cerebral damage

Ataxia and poor coordniation

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10
Q

Diplegia

A

Both legs
++Hip adduction, nappy difficult to put on
Scissoring of legs
Feet in equinovarus and walking on tiptoe

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11
Q

Total body involment

A 
All limbs
\+Learning difficulties
Seizures
Swallowing difficulties and GOR
Flexion contractur    es of knees and elbows often present by late childhood
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12
Q

Prevalence of cerebral palsy

A

Is 2 / 1000

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13
Q

Etiology- pre, peri, post-natal of cerebral palsy

A 
1. Prenatal
Cerebral malformation
Maternal infection
Metabolic
2. Perinatal
Birth trauma
Hypoxic-ischemic
Prematurity
3. Postnatal
Head injury
Non-accidental injury
Meningitis/encephalitis
Cardiopulmonary arrest
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14
Q

Diagnosis of cerebral palsy

A

Clinical, based on findings abnormalities:

  1. Tone->spasticity
  2. Patterns of development ->abnormal in quality
  3. Motor developmental delay
  4. Persistent reflexes

If cause not clear:

  1. Urine/plasma metabolic screen
  2. Consider congenital infections
  3. Xsomal analysis
  4. MRI->vascular, malformations, periventricular leucomalacia
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15
Q

Associated problems (8) in cerebral palsy

A 
Hearing
Vision->50%, squint
Epilepsy->50%
Respiratory problems
Undernutrition, poor intake
Learning difficulties
Behavioural
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16
Q

Multidisciplinary team involved in managment of cerebral palsy

A

Child development team

  1. Pediatrician->support, liason
  2. Physiotherapist->handling and mobilising, prevent contractures
  3. Occupational therapist->equiptment and play materials
  4. Speech and language therapist->feeding and language
  5. Health visitor
  6. Psychologist
17
Q

Define visual impairment and blind

A

Impairment= visual acuity

18
Q

Prevalence of blind/partially sighted

19
Q

Etiology of blindness in children, most common 3

A

Optic atrophy
Congenital cataracts
Choirodoretinal abnormalities

20
Q

Clinical features of visually impaired children

A 
Eyes may appear different
Smilining inconsistent
Do not turn head toward sound
Slower language development
Pincher, reach abnormal
May have associated hearing/learning difficulties
21
Q

Management of visual impairment

A
  1. Opthalmological referral
  2. Advice to parents, adaptations to home, stimulation in non-visual way
  3. Mainstream preschool generally appropriate with support
  4. Attend to learning difficulties
  5. Mobility training
22
Q

Prevalence of hearing deficits

A

Prevalence 4%

23
Q

Etiology

A

Most commonly conductive due to OM
Genetic
Pre, peri, post natal problems
Cerebral insult

24
Q

Risk of deafness->neurosensory and conductive

A 
1. Neurosensory
Meningitis
Cerebral palsy
FHx
Aminoglycoside
Congenital CMV
  1. Conduction
    Cleft palate
    Recurrent OM
25
Q

Clinical presentation of hearing impairment

A

Universal neontal screening
Audiology->at risk, speech, concerns about deafness

  1. Lack response to sound
  2. Poor speech
  3. Behavioural
  4. Associated->learning disabilities, neurological, visual
26
Q

management of hearing impairment

A
  1. Grommets in conductive
  2. Hearing aids in sensorineuronal
  3. Cochlear
  4. Genetic counselling may be needed
27
Q

Management considerations for cerebral palsy->3 categories (4, 9, 4)

A 
1. Associated disability
Hearing and vision
Epilepsy and cognitive assessment
2. Health 
Growth
Obesity
Reflux
Chronic lung disease
Constipation
VP shunt
Osteoporosis
Dental
Emotional
3. Consequences of motor
Drooling->speech therapy, anticholinergics
Incontinence due to cognition, access, communication, overactive bladder
Orthopedic->contractures, dislocations, scoliosis
Spestcity->diazepam, inhibitory casts, BTA, intrathecal baclofen (GABA), selective dorsal rhizotomy
28
Q

Common presentations to the ED with cerebral palsy

A

Respiratory problems particularly pneumonia
Uncontrolled seizures / status epilepticus
Unexplained irritability - consider acute infections, oesophagitis, dental disease, hip subluxation, pathological fracture. Review medications.

29
Q

History in speech delay

A
  1. Birth/developmental
  2. Family history of speech/hearing
  3. Isolated developmental delay->Ages and stages screening
  4. Features of ASD present
  5. History of saying words in the past
30
Q

Examination in speech delay

A
  1. General, behaviours to suggest ASD
  2. Neurocutaneous marking
  3. Dysmorphic features
  4. Neurological examination
  5. Hearing
  6. Motor, fine motor, social development
31
Q

What investigation must be done with speech delay and why

A

Audiogram->a high frequency deafness can only be diagnosed this way

32
Q

Next steps for speech delay

A
  1. Referral to pediatrician

2. Referral to speech and language therapist

33
Q

Causes of developmental delay

A
  1. Idiopathic
  2. CNS malformations
  3. Xsomal
  4. Metabolic
  5. Pre/per/post natal
34
Q

Investigations for developmental delay

A

Xsome analysis
Thyroid function
Urine screen for metabolic abnormalities

35
Q

Follow up for developmental delay

A 
Complete developmental assessment with:
Pediatrician
Psychologist
Speech and language therapist
OT
Physiotherapist

Pediatrics (58 decks)

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