Child health Flashcards by Elise Giblin

Any fever (>38 celsius) in a baby younger than __ months is a red flag

3 months

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What does APGAR include?

appearance (colour)
pulse
grimace (reflex)
activity (muscle tone)
resp

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Which structural condition can be a cause of late neonatal jaundice?

biliary atresia (obliteration or discontinuity of extrahepatic biliary system)

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You are on the postnatal ward doing baby checks and getting lots of cuddles in. When you take O2 sats on the right hand and right foot, what are you looking for?

Make sure that foot (post-ductal) is no more than 3-5 % points lower than arm (pre-ductal)

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are blue hands/feet in a baby worrying?

no- not a sign of cardiac disease in babies- most cyanotic heart diseases make children blue all over

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In a patient with a cough, what differential do you always have to consider in small children that (hopefully) is not a concern in adults?

foreign body aspiration

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In paediatrics, what is the Finnegan score used to assess?

neonatal abstinence syndrome

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What is a risk factor for transient tachypnoea of the newborn?

C-section delivery

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What would you expect in a neonate with bloody stool and abdominal distension? Investigation shows dilated bowel loops and pneumatosis intestinalis (intramural gas).

necrotising enterocolitis (way more common)
or
hirschprung disease

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classic waiters tip posture-

erbs palsy- upper brachial nerves (C5 and C6)

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In a child, injuries to the cheeks are likely to be accidental/non-accidental

non-accidental injury

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In a child, injuries to the ears, side of face, or neck are likely to be accidental/non-accidental

non-accidental

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In a child, injuries to the forearms or inner arms are likely to be accidental/non-accidental

non-accidental

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A 10 year old girl with increased tone in her right arm and right leg, who walks with a limp. This is what type of cerebral palsy?

hemiplegic

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A 12 year old girl who attends mainstream school walks unaided but has an intoeing gait affecting both right and left. She has normal use of her arms but has increased tone. This is what type of cerebral palsy?

diplegic

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A 5 year old boy with weakness in both legs, requiring the use of a wheelchair. Both arms are normal. This is what type of cerebral palsy

paraplegic

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A profoundly disabled 7 year old boy cannot walk and is unable to feed himself. Both arms have fixed contractures and he requires regular baclofen to relax his muscles. This is what type of cerebral palsy

quadriplegic

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How do you decide if a child has epilepsy versus just a seizure?

At least two unprovoked seizures occurring more than 24 hours apart

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The peak age for febrile seizures is

6 months to 6 years

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What are red flags if a child discloses underage sex?

Age 12 or under (need to report)
Vulnerable child
With individual >16 or >2-year age gap
With individual in position of trust

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What red flags in a child should make you suspect cerebral palsy?

Floppy baby or stiff child
Tongue fasciculations
Hand preference before 1 year of age
Delayed motor milestones
Persistence of primitive reflexes

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What’s the difference between a breath-holding attack and a reflex anoxic seizure?

Breath-holding attack: child gets upset, holds breath, goes cyanosed, collapses with immediate recovery
Reflex anoxic seizure: child gets upset, valsavas themselves, provokes asystole (!!!!), goes pale, collapses with brief seizure
Neither are epilepsy, neither are dangerous, but both will scare the shit out of you

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A child presents with an itchy rash and lymph nodes up at the back of their neck. What viral fever could this be?

Rubella - rash disappears after a few days, mostly not a problem unless you’re a pregnant woman

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At what age do babies gain head control?

3 months

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At what age do babies gain sitting balance?

6 months

Boys experience their peak height velocity towards the beginning/end of puberty?

end

For speech/language/hearing in children, what developmental delay represents a red flag?

6 month delay from what would be expected (eg, not talking by 18 months)

Girls experience their peak height velocity towards the beginning/end of puberty

beginning

In a child, bite marks that are oval shaped are likely to be accidental/non-accidental?

non-accidental

In child development, being unable to sit unsupported by what age is a red flag

12 months

In child development, being unable to walk by what age is a red flag

18 months

In child development, no speech by what age is a red flag

18 months

In child development, not reaching for objects by what age is a red flag

6 months

n children, mild learning disability is defined as IQ...

50-70

In children, profound learning disability is defined as IQ...

<20

In children, severe learning disability is defined as IQ...

20-50

Infant attachment Child avoids or ignores parent, and treats parent same as stranger. Carer is disinterested, uncomfortable with showing affection, and overly encourages separation/independence.

Anxious attachment - avoidant

Infant attachment Child shows disorganised response, including soiling, destruction of possessions, odd noises.

Disorganised attachment response

The average age for a boy to experience his pubertal growth spurt is...

14 years

What are the 'big five' red flags in developmental milestones?

social smile 8 weeks reaching for objects by 6 months sitting unsupported by 12 months walking/talking by 18 months

autistic triad-

communication social interaction flexibility of thought

What is the pubertal stage before thelarche?

adrenarche- greasy skin, spots, hair

genetic syndrome, long face/big ears-

fragile X syndrome

What might you suspect in a child with 2-day history of fever, tonsilitis, tongue with a white coating, and a rough sandpaper-feeling rash all over the body?

Scarlet fever (reaction to S pyogenes toxin) Adenovirus does not cause rash; measles has prodromal conjunctivitis and typically affects the face/shoulders/shawl area

what genetic syndrome presents with small head, intellectual disability, and happy disposition. It is caused by two paternal copies of chromosome 15 (or maternal chromosome 15 deletion).

angel man syndrome

What genetic syndrome is also known as trisomy 18. It presents with micrognathia (undersized jaw), heart defects, low-set ears, rocker bottom feet, and overlapping of fingers.

Edwards syndrome

What genetic syndrome presents with learning difficulties, macrocephaly, long face, large ears, and macro-orchidism. It is caused by trinucleotide expansion on the X chromosome

fragile x syndrome

What genetic syndrome presents with hypotonia, hypogonadism, and obesity. It is caused by two maternal copies of chromosome 15 (or paternal chromosome 15 deletion)

Prader-Willi syndrome

A baby in the NICU stops breathing for 15 seconds. Is this worrying?

If <20 seconds (or <10 with bradycardia) then probably periodical breathing, which is not a cause for concern If at all worried, can give caffeine to encourage respiratory drive

A child's head represents _% of their body surface area

18%

A diastolic murmur in a child is likely to be innocent/pathological

pathological

A harsh or loud murmur in a child is likely to be innocent/pathological

pathological

A murmur in the pulmonary valve area (second left interspace) in a child is likely to be innocent/pathological

innocent

A neonate has a blood glucose of 2.7. Is this worrying?

Apparently it only counts as hypoglycaemia if levels drop below 2, or 2.6 if very unwell

A parent goes to their GP worried about their 2-year-old daughter. She had been completely fine up until now (healthy, no birth issues, all milestones as you'd expect), but now has lost the words she had, can't hold her head straight or bear weight on her legs, and has stopped smiling at people. During the consultaion she doesn't make eye contact and is constantly wringing her hands. What genetic condition couuld this be?

Rett's syndrome Characterised by normal development followed by rapid regression in milestones (losing things the child used to be able to do), as well as repetitive abnormal hand movements. Almost always a de-novo mutation so no family history. Only occurs in females.

A systolic murmur in a child is likely to be innocent/pathological

innocent- especially if soft and not associated with symptoms

aCGH or next-generation sequencing? Down's syndrome

aCGH

aCGH or next-generation sequencing? Prader Willi syndrome

aCGH

aCGH or next-generation sequencing? Sickle cell disease

next-generation sequencing

aCGH or next-generation sequencing? Turner's syndrome

aCGH

Acute swelling of the scrotum in a boy indicates what until proven otherwise

torsion of the testes

After what time should babies have regained their birth centile weight?

2 weeks for premies, its complicated

All infants and young children aged 6 months to 5 years should take a daily supplement containing vitamin D in the form of vitamin drops, true or false?

TRUE

An adult's head represents _% of their body surface area

APGAR scores are assessed at _, _ and _minutes of age

1, 5, 10

Are bronchodilators appropriate to use in bronchiolitis?

At what age should children be referred to speech and language therapy if they show language delay?

27 months

Average age of puberty is _ years in girls and _years in boys

11 years in girls 11.5 years in boys

BMI can be used from age 1 year, true or false?

FALSE- cam only be used from aged 2 (very useful from that point)

Can a testicular torsion be manually reduced?

Yes - provide outwards rotation of the testis if patient presents within 6 h and is still in pain (suggesting that necrosis has not set in) Still refer to urology!

Chromosomal microarray (including CGH) can detect balanced changes, true or false?

FALSE Can detect only unbalanced changes

Delay in passage of meconium more than __hr after birth is a red flag

24 hours

Delayed puberty is defined as no signs of puberty in girls by _years and in boys by _ years

girls- 13 years boys- 14 years

Endocrine causes of childhood obesity general relate to an excess/insufficiency of hormones

insufficiency

Headache associated with vomiting is a red flag, true or false?

true- especially in morning

Headache in the afternoon is a red flag, true or false?

false

Headache on waking is a red flag, true or false?

true

headache worse on coughing/bending is a red flag

true

Headache with auditory disturbance is a red flag, true or false?

false

Headache with gait disturbance is a red flag, true or false?

true

headache with visual disturbance is a red flag true or false

true

Heart rate >140 bpm (under 5 years) or >125 (over 5 years) suggests moderate/severe/life-threatening asthma

severe

How can malaria be diagnosed?

Blood film -> microscopy or rapid diagnostic test

How can you estimate weight for children in an emergency?

(age+4) x2

In adolescents, growth is led by what stimulus

sex steroids

In an infant with bronchiolitis, respiratory rate > _ should prompt hospital referral

>70/min

In asthma, children aged 0-2 should receive medications with what accessory equipment

spacer and facemask

In asthma, children aged 2+ years should receive medications with what accessory equipment

spacer alone

In children, short stature can result from cortisol insufficiency/excess?

excess

In children, short stature can result from growth hormone insufficiency/excess?

insufficiency

In children, short stature can result from thyroid insufficiency/excess?

insufficiency

In psychiatry, what is the Conner's rating scale useful to assess?

ADHD

Jaundice in a baby aged 2-5 days is physiological/pathological

physiological

Most absorption of water is in what part of the GI tract

jejunum

Newborn heel-prick test Preventable cause of growth restriction; premies (<32 weeks) need a repeat test

congenital hypothyroidism

Newborn heel-prick test Test looks for raised levels of immunoreactive trypsinogen, followed by DNA analysis

cystic fibrosis

PEF 33-50% best predicted suggests moderate/severe/life-threatening asthma

severe

PEF <33% best predicted suggests moderate/severe/life-threatening asthma

life-threatening

PEF >50% best predicted suggests moderate/severe/life-threatening asthma

moderate

Permanent reduction to zero of the worldwide incidence of a specified disease due to deliberate efforts is defined as elimination, eradication, or extinction? ongoing vaccinations/interventions no longer needed

eradication

Precocious puberty is defined as true central puberty at age <_ in girls and <_ in boys what are the criteria?

<8 in girls <9 in boys thelarche in girls testicular development >4mm in boys

Reduction to zero of the incidence of a specified disease in a specific area is defined as

Elimination

Roughly what proportion of children have hearing loss?

1:1,000 at birth a further 1:1000 by age 10

Short stature plus obesity is a red flag for endocrinological problems in children, true or false?

true

SpO2 <92% suggests moderate/severe/life-threatening asthma

severe or life-threatening

SpO2 >92% suggests moderate/severe/life-threatening asthma

moderate

The peak incidence of bronchiolitis is age ...

3-6 months

The peak incidence of croup is age...

6 months-3 years

The rash of which condition typically starts behind the ears before spreading across the whole body

measles

Vaccines against measles, mumps, rubella, and polio are given as what type of vaccines

live attenuated vaccines

What diagnosis is most likely in a baby with a pan-systolic murmur, best heard over the tricuspid area (lower left sternal border), radiating to lower right sternal border?

ventricular septal defect

What diagnosis might you suspect in a child with isolated motor delay?

cerebral palsy

What diagnosis might you suspect in a child with joint pain + swelling, and a salmon-pink rash?

juvenile idiopathic arthritis

What diagnosis might you suspect in this child with brush field spots

Down syndrome

What diagnosis must you always consider in a boy with abdominal pain?

testicular torsion

What diagnosis would you suspect in a 2-week-old baby with greenish-yellow vomit?

volvulus- straight to A&E even if look well

What diagnosis would you suspect in a 6-month-old baby with vomiting, constipation, bloody stools, and distress followed by limpness?

intussusception- legs up

What diagnosis would you suspect in a 6-week-old baby with projectile vomiting and abdominal bulges?

pyloric stenosis

What diagnosis would you suspect in a 6-year-old child who presents to A&E with abdominal pain (so bad it hurt going over speedbumps)?

appendicitis

What diagnosis would you suspect in a 6-year-old child who presents to A&E with abdominal pain and a very high temperature?

URTI, but rule out appendicitis

target sign on USS-

intussusception

What four conditions does the 6-week baby check screen for?

congenital cataracts congenital heart disease developmental dysplasia of the hip undescended testes

What imaging investigation is needed in suspected testicular torsion?

USS with colour doppler

What is the treatment for mild croup?

oral dexamethasone

What medications can be used for ADHD in a child >5 years or teenager?

methylphenidate first line

What puberty stage is this (growth chart)? Slight deepening of voice or early public/armpit hair growth or enlargement of penis/testes

In puberty (Tanner 2-3)

What puberty stage is this (growth chart)? Voice fully broken or moustache/early facial hair or adult penis size with pubic and axillary hair

Completing puberty (Tanner 2-5)

What symptom in a child with a sore throat and stridor might make you suspect epiglottitis rather than croup?

drooling

What symptoms in a child with bronchiolitis should make you suspicious of other potential diagnoses?

High fever (>39 celcius)

What treatments can be used for bedwetting in children?

Increased toiletting, rewards Do not restrict fluids generally but avoid excessive intake or in the hour before bed If unsuccessful, enuresis alarm or desmopressin

What would you suspect in a baby who vomits a small amount after every feed? They are not distressed or overfed and are growing normally.

GORD

When is the newborn hearing screening carried out?

4-5 weeks of birth

You suspect a child has bronchiolitis, and measure their O2 sats. What do you do with this information?

<92%: hospitalise >94%: send home 92-94%: further assessment needed

Kawasaki disease is a type of vasculitis which is predominately seen in children. Its complications include coronary artery aneurysms. Treatment is with...

high-dose aspirin and IV immunoglobulin

Patent ductus arteriosus and AVD/ASD/VSD are examples of cyanotic/acyanotic congenital heart disease. The shunt is from ?

acyanotic left to right shunt

is the most appropriate technique to investigate suspected single-point mutations with high clinical index of suspicion (eg, CF).

PCR

Child health Flashcards

(136 cards)