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Child Health > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Define pre-term, term and post-term

A

Pre-term - <37w
Term - 37-41w
Post-term - >41w

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2
Q

Why does hypoxia occur in labour?

A

Hypoxia due to contractions
Foetal hb from placenta helps to provide O2
Placenta reserves decr as labour continues

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3
Q

Describe APGAR score

A

Heart rate
Respiratory rate
Responsiveness
Tone
Colour

Score/10
- 0, 1, 2 for each component
- normal 8

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4
Q

Prevention of haemorrhagic disease of newborn

A

Vitamin K
(breast fed more common)

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5
Q

Key infection prevention in neonates

A

Hep B (immunoglob, vax) and C
HIV (ARV)
Syphilis
TB
Group B strep

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6
Q

Vaccinations post-birth

A

Maternal Pertussis and Influenza vaccines
Routine vaccination schedule
Hepatitis B at birth?
BCG first month?

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7
Q

Describe head (and face) exam of neonate

A

OFC
Overlapping sutures
Fontanelles
Ventouse/forceps marks
Moulding
Cephalhaematoma
Caput succedaneum
(Facial palsy
Dysmorphism)

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8
Q

Describe eye exam of neonate

A

Size
Red reflex
Conjunctival haemorrhage
Squints (frequent)
Iris abnormality

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9
Q

Describe ear exam of neonate

A

Position
External auditory canal
Tags/pits
Folding
Family history of hearing loss

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10
Q

Describe mouth exam of neonate

A

Shape
Philtrum
Tongue tie
Palate
Neonatal teeth
Ebsteins pearls
Sucking/rooting reflex

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11
Q

Describe resp exam of neonate

A

Chest shape
Nasal flaring
Grunting
Tachypnoea
In-drawing
Breath sounds

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12
Q

Describe cardio exam of neonate

A

Colour/Saturation (SaO2)
CHD screening
Pulses: femoral
Apex
Thrills/heaves
Heart sounds

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13
Q

Describe abdo exam of neonate

A

Moves with respiration
Distension
Hernia
Umbilicus
Bile stained vomiting
Passage of meconuim
Anus

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14
Q

Describe GU exam of neonate

A

Normal passage of urine
Normal genitalia
Undescended testes
Hypospadius

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15
Q

Describe MSK exam of neonate

A

Movement & posture
Limbs and digits
Spine
Hip examination

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16
Q

Describe neuro exam of neonate

A

Alert, responsive
Cry
Tone
Posture
Movement
Primitive reflexes

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17
Q

Describe skin exam of neonate

A

Port wine stain
Strawb haemangioma
Erythema toxicum
Congentital dermal melanocytosis

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18
Q

Risk factors for pre-term baby

A

> 2 preterm babies previously
Abnormally shaped uterus
Multiple pregnancy
IVF
Substance use
Poor nutrition
Chronic conditions

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19
Q

Key points of the altered approach to preterm infants

A

delayed cord clamping
keeping warm e.g. bags/heater and skin-to-skin
gentle lung inflation
initial O2 concentration
using a saturation monitor

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20
Q

Common problems in preterm babies

A

Temperature control
Feeding/nutrition
Sepsis
System immaturity/dysfunction e.g. ARDS
Metabolic issues

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21
Q

Why does preterm baby struggle to regulate temp?

A

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

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22
Q

Why are preterm babies at risk of nutritional issues?

A

Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands

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23
Q

Causes of early and late onset neonatal sepsis

A

EOS
- due to bacteria acquired before and during delivery
- strep B, gm neg
LOS
- acquired after delivery (nosocomial or community sources)
- coag neg staph, staph A, gm neg

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24
Q

Describe resp distress syndrome

A

Surfactant defic and alveolar damage
Clin pres:
- tachypnoea (e.g. grunting), worsens over mins/hours
Manage:
- maternal steroid, surfactant, vents

25
Q

Common CV issues of preterm infants

A

Patent ductus arteriosus
Intraventricular haemorrhage (grade 1-4)
Necrotising enterocolitis (NEC)

26
Q

Normal clinical parameters for newborns

A

Respiratory rate: 40 – 60 / minute and Work of breathing
HR: 120 - 140 bpm
Cap refill 2 - 3 seconds
Colour – pink/blue/white
SaO2 95% or above
No BP measurement

27
Q

Presentation of sepsis in newborns

A

Quiet
Poor feeding
Floppy
Tachypnoea
Apnoea
Tachycardia
Bradycardia
Temperature instability

28
Q

Antibiotics of choice in newborns with suspected sepsis

A

Benzylpenicillin
Gentamicin

29
Q

TORCH mneumonic for viral infections of newborns

A

Toxoplasma
Others (syphillis, HepB)
Rubella
CMV
Herpes

30
Q

Most common resp issue in newborn

A

Transient tachypnoea of newborn (TTN)
- delay in clearing lung fluid, resolves in 24h
- more common in C section due to lack of adrenaline

31
Q

Causes of pneumothorax in newborn

A

Meconium
Infection
Resuscitation
Surfactant deficiency

32
Q

Management of HIE

A

Therapeutic hypothermia
- improves neurodev outcomes

33
Q

Features of circ issues in newborn

A

HF
- rhesus disease, chromosomal
Failure to adapt
- PPHN

34
Q

Clin pres of congenital cardiac conditions in newborn

A

Tachypnoea
Cyanosis
Murmur
Weak fem pulses
Circ collapse
(e.g. ToF, transposition, aortic coarctation)

35
Q

Key metabolic disorders of newborn

A

Bilious vomiting
Hypoglycaemia
Inborn errors of metabolism
Jaundice

36
Q

Which metabolic disorder is a cause of hypoglycaemia but is not tested for on newborn blood spot?

A

Galactosaemia

37
Q

How does jaundice progress in newborns?

A

Cephalo-caudal progression (face first)

38
Q

Which type of bilirubin in blood causes jaundice?

A

Unconjugated

39
Q

Risk factors for newborn jaundice

A

decreasing gestation
asphyxia
acidosis
hypoxia
hypothermia
meningitis
sepsis

40
Q

Cause of jaundice less than 24h after birth

A

ALWAYS PATHOLOGICAL
Caused by:
Haemolytic disorders
Congenital infection
Sepsis

41
Q

Causes of jaundice 24h-14 days after birth

A

Physiologic jaundice
Breast milk jaundice
Dehydration
Infection, including sepsis
Haemolysis
Bruising
Polycythaemia
Crigler-Najjar Syndrome

42
Q

Causes of jaundice >14 days after birth

A

Physiologic jaundice
Breast milk jaundice
Infection
Hypothyroidism
Bililary obstruction (incl. biliary atresia)
Neonatal hepatitis

43
Q

Which type of excess bilirubin is always abnormal?

A

Conjugated

44
Q

Management of neonatal jaundice

A

Treat cause
Hydration/supported feeding
Phototherapy
Rarely exchange transfusion
IV Ig for haemolytic disease

45
Q

Define median vs limit age

A

Median - 50% pop achieves skill
Limit - acquired by 97.5% kids

46
Q

Primitive reflexes in motor development

A

Sucking and rooting
Palmar and plantar grasp
Moro
ATNR
Stepping and placing

47
Q

When should primitive reflexes be absent to signify normal development?

A

3-6 months
e.g. cerebral palsy, reflexes remain

48
Q

Define developmental delay

A

Failure to attain dev milestones for child’s corrected chronological age

49
Q

3 main patterns of abnormal development

A

Delay
-global e.g. down syndrome
-specific e.g. duchenne musc dystrophy
Deviation
-e.g. ASD
Regression
-e.g. Rett’s, metabolic disorders

50
Q

Red flags for child development

A

Asymmetry in movement
Not reaching for objects/primitive reflex at 6m
Unable to sit by 12m
Unable to walk by 18m
No speech/pointing by 18m
Vision/hearing concerns
Loss of skills

51
Q

Describe Duchenne’s

A

X-linked recessive, males, mutation of dystrophin gene
Clin pres: weakness, fatigue, psuedohypertrophy, wheelchair bound
Assoc with: cardiomyopathy, resp failure, cognitive difficulties
Gower’s manoeuvre

52
Q

Management of SMA

A

Genetic testing MSN1/2
Physio
Nutrition
Resp support
Palliation
Drugs - IT nusinersen, IV zolgensma

53
Q

PMT tool for motor development assessment

A

Posture - position of limbs/trunk
Movement - symmetry, anti-gravity, smooth/jerk
Tone - floppy/stiff, head control

54
Q

Clin pres of hypoglycaemic babies

A

Sleepiness, very quiet baby
Potentially seizures

55
Q

Significance of early jaundice

A

Must investigate infection/haemolysis

56
Q

Functions of colostrum

A

High Ig
Helps w gut health
Anti-inflam
Concentrated nutrition

57
Q

When can CVS and amniocentesis be carried out?

A

CVS 11.5w
Amnio 15w

58
Q

Causes of floppy baby

A

Birth asphyxia
Genetic e.g. trisomy 21, prader-willi
Congen/acquired infections
Drugs e.g. diazepines
Metbolic
(affects diff areas)

Child Health (3 decks)

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