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4th Year > Child health > Flashcards

Child health Flashcards

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1
Q

what is helf

A

not us

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2
Q

what is a child

A

us

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3
Q

how much skin to skin does orla need

A

a lot

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4
Q

what causes stridor

A

congenital
laryngitis, EPIGLOTTITIS, croup, anaphylaxis, bacterial traceitis
tumours, trauma

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5
Q

what are the features of croup

A

6 months to 6 years
1/2 days of illness before then suddenly struggle to breath
stridor, barking cough, hoarseness, WOB

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6
Q

what is the treatment for croup

A 
keep child calm to maintain airway avoid all unnecessary exams and procedures 
if mild (minimal stridor/ WOB, no cyanosis) oral dexamethasone/ prednisolone at home 
if mod/ severe: restless, cyanosis, recession, stridor at rest, increased HH and RR, tired/ reduced conscious level) admit, steroids, nebulised adrenaline
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7
Q

what causes croup

A

parainfluenza, RSV

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8
Q

what causes epiglottitis

A

haemophilus influenza B, group A strep, trauma, inhalation, burns

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9
Q

what are the features of epiglottitis

A

present with fever, severe sore throat and stridor, difficulty swallowing, muffled voice, drooling
thumbprint sign on x ray

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10
Q

what is the treatment for epiglottitis

A

get senior help asap, anaesthetist
secure airway
IV antibiotics (ceftriaxone)
steroids

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11
Q

what should’nt you do in suspected epiglotttitis

A

examine throat

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12
Q

what are the features of bronchiolitis

A

children <1

coryza preceeds wheeze, resp crackles, apnoea, recession

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13
Q

tx for bronchioitis

A

if apnoeic episodes, not feeding/ drinking, resp distress then admit. lower threshold for admission if premature, CF, downs syndrome, congenital cardiac disease, underlying health problem
supportive: O2, CPAP, NG feeds
palivizumab prevention for vulnerable

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14
Q

what causes bronchiolitis

A

RSV

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15
Q

what causes whooping cough

A

pertussis

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16
Q

what are the signs of whooping cough

A

apnoea, coughing bouts that end in vomiting, worse at night / after feeds
infants + >14s
lymphoctyosis
admit if <6

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17
Q

what are acute paediatric red flags

A

pale/mottles/ashen/ blue skin
no response to social clues, weak/high pitched/ continuous cry
grunting, tachypnoea, moderate-severe chest indrawing
reduced skin turgor
age <3 with temp >38
non blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal neuro signs, focal seizures

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18
Q

when is the peak age for bronchiolitis

A

3-6 months

most occur under 2

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19
Q

when should pneumonia be considered

A

if high fever and persistently focal crackles

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20
Q

when should you consider asthma or VIW instead of bronchiolitis

A

if persistent wheeze without crackles
recurrent episodic wheeze
personal/ fmaily history of atopy

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21
Q

do you use adrenaline to treat bronchiolitis

A

NO (is a lower airway problem, adrenaline for croup)

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22
Q

acute asthma and viral wheeze tx

A 
OSHIPMAN 
oxygen 
salbutamol and ipatropium nebulised
oral pred/ IV hydrocortisone
neb/ IV magnsium sulphate 
aminophylline if unresponsive
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23
Q

what causes a fixed splitting of the second heart sound

A

ASD

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24
Q

what causes the murmur in TOF

A

pulmonary stenosis (ejection systolic at pulmonary area)

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25
what causes a pan systolic mumur in children
MR TR VSD
26
is a murmur that is louder or quieter on standing more worrying
louder more worrying
27
is a diastolic or systolic murmur more worrying in childhood
diastolic
28
what causes a continuous cres-decresc machinery murmur
PDA
29
what are the causes of cyanotic heart disease
(right to left shunts) | ASD, VSD, PDA, transposition of the great arteries
30
what are the duct dependent CHDs
``` TOF Epsteins Pulmonary stenosis transposition of the great arteries (if no VSD or ASD) coartaction of the aorta critical AS hypoplastic left heart syndrome pulomary atresia and critical stenosis ```
31
what are the cyanotic CHDs
``` VSD TOF ASD PDA transposition of the great arteries ```
32
why do cyanotic CHD cause cyanosis
right to left shunt cause deoxygenated blood to enter circulation (initially in ASD, VSD, PDA will be left to right shunt that causes pulmonary hypertension which then results in right to left shunt)
33
what is a potential neuro complication from ASD
stroke following DVT
34
what murmurs in ASD and VSD
ASD- mid systolic upper sternal border | VSD- pan systolic and lower sternal border
35
what can plethoric complexion be a sign of
polycythaemia due to chronic hypoxia e.g. in VSD
36
what are the components of TOF
RVH pulmonary stenosis (worsens r-l shunt through VSD) VSD overiding aorta (above VSD, worsens odeoxygenated blood in circulation- R-l shunt)
37
tx for transposition of the great arteries
prostaglandins and balloon septosptomy until open heart surgery
38
what are the general red flags for development
regression occipital frontal circumference >98th or <0.4th centile squint marked hyper/ hypotonia differences between left and right strength, movement or tone no/ limited eye contact lack of response to sound or visual stimuli strong parental concerns
39
if there is delay in more than one domain is it more or less likely to be significant
more likely
40
what is the most variable developmental domain
speech and language (sensitive to environmental factors)
41
what are the developmental red flags at 6 weeks
``` no visual fixation/following failure to respond to sound asymmetrical neonatal reflexes excessive head lag failure to smile ```
42
what are the developmental red flags at 6-8 months
``` hand preference (too early), fisting not reaching persistence of primitive reflexes floppy, poor head control lack of social response/ vocalisation ```
43
developmental red flags at 12 months
unable to sit or bear weight absence of saving reactions (parachute reflex) persistence of hand regard (seen in 3-5 months, when baby on back will watch hands) poor communication no babble
44
what are the developmental red flags at 18 months
``` not walking cannot understand simple commands no pointing no words no pincer grip ```
45
red flag developmental points at 2 years
not running cant follow a 2 step command unable to speak 2-3 words
46
when are all primitive reflexes usually lost
by 12 months
47
what questions can you ask in a history to determine sensory issues in children
what foods do they eat, restrictive diet bathing/ hair washing/ hair cutting noise sensitivities clothing, dislike of materials
48
when does a hand preference usually develop
between 2-4 years
49
when should you not do a LP if you suspect meningitis
if signs of raised ICP (bradycardia, hypertension, low RR= cushings response, pupil dilation, abnormal breathing pattern or posture) GCS min seizure imaging showing CSF path obstruction circulatory shock/ meningococcal disease
50
is an absence seizure generalised or focal
generalised
51
is a myotonic seizure focal or generalised
generalised
52
treatment for status epilepticus
5 mins IV lorazepan/ buccal medazolam/ rectal diazepam 10 mins repeat dose 20 mins pheynotoin/ phenobarbitol if alread on regular phentoin call anaesthetist
53
what is the risk with carbamazepine
agranulocytosis
54
what is the risk of prescribing sodium valproate and carbamazepine to girls
teratogenicity
55
treatment for focal seizures
carbemazepin or lamotrigine
55
what anti seizure medications impair effectiveness of OCP
carbamazepine, oxcarbazepine, phenytoin and topiramate
56
treatment for tonic clonic
valproate | lamotrigine 2nd line
57
treatment for absence seizures
ethosuzimide or sodium valproate
58
describe thrombotic thrombocytopenic purpura
haemolytic anaemia and thrombocytopenia | non specific symptoms- fever, renal failure, neuro chanes
59
describe ITP
immune thrombocytopenia preceeding viral illness, lower limb petichiae, bruising, mucosal bleeding treated with steroids. IV immunoglobulin
60
describe HUS
microangiopahtic haemolytic anaemia, thrombocytopenia and AKI following ecoli bloody diarrhoea abdo pain, fever, swelling
61
describe HSP
IGA vasculitis | purpuric rash, abdo pain, arthritis/arthalgia, glomerulonephritis
62
treatment for whooping cough
supportive arthromycin/ clarithromycin notifiable disease
63
what are the features of pyloric stenosis
``` projectile vomiting after feeding in first few weeks of life olive mass in upper abdomen hypochloric metabolic alkalosis USS laparoscopic pyloromyotomy ```
64
signs of biliary atresia
jaundice for >14 days, >21 if premature
65
features of hirschprungs
absence of parasympathetic ganglions >24hrs to pass meconium, chronic constipation from birth, abdo pain and distention, vomiting, poor weight gain and failure to thrive need resus and surgery
66
features of intussusception
``` 6 months to 2 years severe colicky pain vomiting yellow then green recurrent jelly stool sausage shaped mass preceded by viral upper resp infection USS- target sign air enema ```
67
features of volvulus
baby | bilious vomiting obstruction (malrotation with volvulus) until proven otherwise
68
what vaccinations should kids have had by 1 year
2x DTaP/IPV (polio)/HiB/ HepB 2x Men B 2x rotavirus pneumococcal (PCV) at 12 months get HiB/MenC, PCV booster, MMR, MenB booster flu if eligible
69
what vaccinations at 3 years 4 months
dTaP/IPV | MMR
70
what vaccinations at 12-13
HPV
71
what vaccinations at 14
Td/IPV | menACWY
72
what vaccines for adults
65- pneumococcal flu annual 70-70 shingles
73
when do you get head control
2-3 months
74
when can you sit without support
6 months
75
when can you crawl and cruise
9 months
76
when should you follow something by turning head
6 weeks (limit 3 months)
77
when should you reach for toys and have a palmar grasp
4 months (limit 6)
78
when should you transfer hands between toys
9 months
79
when should you have a pincer grip
10 months (limit 12)
80
what ages should you be draw: line, circle, square, triangle
line 2 circle 3 square 4 triangle 5
81
what ages should you laugh, turn to sound, polysyllabic babble, mama dada, 6-10 words, phrases, 3-4 word sentences
``` laugh 3-4 months turn to sound 7 months mama-dada 7-10 12- 5 words 18 months 6-10 phrases (2-3 words) 2 years short sentences 3 years ```
82
limit for symbolic play
2 years
83
when should you be able to drink from a cup
12 months
84
when should you be able to use spoon by seld
18 months
85
limit for social smile
8 weeks

4th Year (7 decks)

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