Clinical Flashcards
(114 cards)
1
Q
How far apart are centile lines on a growth chart?
A
2/3 of a standard deviation
2
Q
A child shows normal growth if what two conditions are met?
A
Measurements are in normal range for their age
Growth rate is in normal range
3
Q
What has happened to growth charts over the last 30 years?
A
Right shift
Longer tail
Increase in severe obesity
Similar trend with height
4
Q
How should babies be weighed?
A
Without clothes or nappy
5
Q
How should children older than 2 be weighed?
A
In vest and pants
But no:
- Shoes
- Socks
- Dolls/Teddies
6
Q
How and where do you measure head circumference?
A
With a narrow plastic/disposable paper tape
Measure at widest point
7
Q
When would you measure a babies length before the age of 2?
A
If you were concerned
8
Q
How do you measure a babies length before they are 2?
A
Length board/mat
Requires two measurements
9
Q
What can affect the babies length?
A
Child’s mood
Style of measurer
10
Q
How do you measure a child older than 2?
A
Rigid rule with T-piece
Ensure heels, bottom, back and head touch apparatus
Eyes and ears at 90 degrees
Measure on expiration
11
Q
Where must a recording be on a growth chart for the child to be considered on the centile line?
A
Either on the line of within 1/4 of a space of it
12
Q
What is a centile space?
A
Distance between two centile lines
13
Q
What is the average age of puberty in girls and boys?
A
Girls - 11 years
Boys - 11.5 years
14
Q
When does puberty start?
A
When GnRH is secreted by hypothalamus
15
Q
What cells does LH binds to in boys and what does this cause?
A
Leydig cells -> Testosterone
16
Q
What cells does FSH bind to in boys and what does this cause?
A
Sertoli cells -> Spermatogenesis
17
Q
What is also produced by Sertoli cells and what does it do?
A
Inhibin B -> Reduces FSH secretion
18
Q
What does LH do in girls?
A
Stimulates proliferation of follicular and theca cells
Triggers androgen release from theca cells
19
Q
What does FSH do in girls?
A
Increases granulosa cell proliferation
Enhances aromatase activity:
- Prodcuing oestradiol
Increases progesterone production
20
Q
What cells produce Inhibin B in girls?
A
Granulosa cells
21
Q
What cells produce Inhibin A in girls?
A
Large antral follicles in corpus luteum
22
Q
What do increased levels of sex steroids and insulin cause in both sexes?
A
GH and IGF-1 are enhanced
23
Q
How is puberty staged and how many stages are there? Is this diagnostic of the patient’s actual age?
A
Tanner staging:
- 5 stages
No
24
Q
What is thelarche?
A
Breast budding
25
What is adrenarche?
Body hair and odour
26
What is menarche?
Periods begin
27
When does menarche tend to occur?
2 years post-thelarche
28
What age defines precocious puberty in girls and boys?
Girls -
29
What is pubertal delay and at what ages are boys and girls considered to have delayed puberty?
Absence of secondary sexual characteristis
Girls - 13 years
Boys - 14 years
30
What gender is precocious puberty more common in?
Females
31
What gender is delayed puberty more common in?
Males
32
When are the peak height velocities in each gender?
Girls at B2-3 ie ~12 years
| Boys at G4-5 ie ~14 years
33
What is the average height difference between girls and boys?
12.5-14cm
34
What causes the height difference between girls and boys?
Delayed PHV in boys
Boys PHV > Girls
Boys taller pre-puberty
35
What family history is important to know when determining if there is a growth problem?
Parental heights
| Parental puberty
36
What blood investigations are indicated in determining if there is a growth problem?
Gonadotropins
Growth factors/Testosterone/Oestradiol
TFTs
Karyotype
37
What other investigations might be carried out when investigating a growth problem?
Bone age
Dynamic function tests
MRI brain
USS uterus
38
What type of short stature are the following seen in:
- Healthy, well child
- Short parents
- No endocrine problem; normal bone age
Genetic short stature
39
What type of short stature do the following indicate:
- Late maturation
- Often presents around puberty with delayed onset
- Delayed maturation and bone age
- Stressful
Constitutional growth delay
40
What are other causes of short stature?
Dysmorphic syndromes
Endocrine disorders
Chronic diseases
Psychosocial deprivation
41
What contributes to the obesogenic environment?
High energy-dense foods
Decreased physical activity:
- TV/Gaming
42
What percentile is overweight classed as?
>=91st centile
43
What percentile is obese classed as?
>=98th centile
44
What are some inheritable disorders than can result in obesity?
Down's Syndrome
Prader-Willi Syndrome
DMD
Fragile X
45
With what kids is the lifestyle advice mainly aimed at the parents?
Kids younger than 8 years
OR
Kids with special needs
46
When is lifestyle advice predominantly aimed at the kids with only minor parent interaction?
13+ years
47
When should orlistat be prescribed?
```
BMI >99.6th percentile
AND
Comorbidities
AND
Patient is visiting a specialist
```
48
When is bariatric surgery considered?
Post-puberty
BMI >3.5 standard deviations above mean
AND
Severe comorbidities
49
What is development?
Maturation of the nervous system
50
True or false; development has the same sequence at the same rate in all individuals?
False:
- Same sequence
- Variable rate
51
What direction does development occur in?
Cephalocaudal direction
52
What are the four main areas of development?
Gross motor
Fine motor and vision
Language and hearing
Social behaviour and play
53
At what age should a child be able to do the following (gross motor skills):
- Head control
- Sitting balance
- Crawling
- Standing
- Running
- Stairs (2 feet/step)
- Stairs (1 foot/step)
- Hops
```
Head control -> 3 months
Sitting balance -> 6 months
Crawling -> 9 months
Standing -> 12 months
Running -> 18 months
Stairs (2 feet/step) -> 24 months
Stairs (1 foot/step) -> 36 months
Hops -> 48 months
```
54
What are the primitive reflexes?
```
Sucking and rooting
Palmar and plantar grasp
Asymmetric tonic neck reflex
Moro
Stepping and placing
```
55
At what age should a child do the following (fine motor and vision skills):
- Hand regard in midline
- Palmar grasp
- Scissor grasp
- Pincer grasp
- Tower of 3-4 bricks
- Tower of 6-7 blocks/Scribbles
- Tower of 9 blocks/Copies circle
- Draws simple man
```
Hand regard in midline -> 3 months
Palmar grasp -> 6 months
Scissor grasp -> 9 months
Pincer grasp -> 12 months
Tower of 3-4 bricks -> 18 months
Tower of 6-7 blocks/Scribbles -> 24 months
Tower of 9 blocks/Copies circle -> 36 months
Draws simple man -> 48 months
```
56
At what age should a child do the following (hearing and language skills):
- Vocalise
- Babble
- Imitates sounds
- Knows name
- 2 body parts/15-20 words
- Simple instructions/50+ words
- Complex instructions/Ask questions
- Can tell stories
```
Vocalise -> 3 months
Babble -> 6 months
Imitates sounds -> 9 months
Knows name -> 12 months
2 body parts/15-20 words -> 18 months
Simple instructions/50+ words -> 24 months
Complex instructions/Ask questions -> 36 months
Can tell stories -> 48 months
```
57
At what age should a child do the following (social and play skills):
- Social smile
- Pleasure on friendly handling
- Play with feet/Friendly with strangers
- Play peek-a-boo/Stranger awareness
- Drink from cup/Wave bye-bye
- Feed with spoon
- Symbolic play/Put on some clothes
- Pretend play/Toilet-trained
- Understands turn-taking/Dress fully
Social smile -> 6 weeks
Pleasure on friendly handling -> 3 months
Play with feet/Friendly with strangers -> 6 months
Play peek-a-boo/Stranger awareness -> 9 months
Drink from cup/Wave bye-bye -> 12 months
Feed with spoon -> 18 months
Symbolic play/Put on some clothes -> 24 months
Pretend play/Toilet-trained -> 36 months
Understands turn-taking/Dress fully -> 48 months
58
What is developmental delay?
Failure to attain normal milestones for the child's corrected chronological age
59
What patterns of developmental delay are there?
```
Delay:
- Global
- Specific
Deviation (ASD)
Regression (Rett's syndrome)
Metabolic disorder
```
60
Which of the following isn't a red flag for developmental delay:
- Asymmetrey of movement
- Not reaching objects by 6 months
- Unable to sit unsupported by 12 months
- Unable to walk by 24 months
- No speech at 18 months
- Concerns re. vision or hearing
- Loss of skills
Unable to walk by 24 months:
| - It should be 18 months
61
What is global developmental delay?
Significant delay in 2+ of:
- Gross/Fine motor and Speech/Language
- Cognitions, Social/Personal and ADL
62
What percentage of kids with global developmental delay are due to a genetic cause?
5-25%
63
What screening is imperative in Down's Syndrome?
```
Cardia
Vision
Hearing
Thyroid
Sleep apnoea
Growth
Development
```
64
What are the IQ ranges for the following classes of learning disability
- Mild
- Severe
- Profound
Mild -> 50-70
Severe -> 20-50
Profound -> Less than 20
65
What conditions cause motor delay only?
DMD
CP
Co-ordination disorders
66
What conditions cause language delays only?
Specific language impairment
67
What conditions cause sensory deficits and an associated delay?
Oculocutaneous Albinism
| Treacher-Collins
68
What type of specific developmental delay is Autism-Spectrum Disorder (ASD)?
Developmental deviation
69
What type of cerebral palsy is characterised by:
- Arm and leg on one side affected
- Arm is bent -> Spastic/Floppy/Of no use
- Walks on tiptoe/outside of foot
Hemiplegi
70
How does paraplegic CP present?
Both legs affectd
Upper body normal or having very minor signs
Ankle and feet contractures
71
If there is slight impairment anywhere else in paraplegic CP, what is it called?
Diplegic
72
What is the third kind of CP?
Quadriplegic
73
True or false; CP is associated with epilepsy?
True
74
What percentage of visual impairment is cerebral?
50%
75
Kids with what sort of disabilities tend to have visual impairment?
Those with more complex disabilities
76
What is cerebral visual impairment associated with?
Hydrocephalus
| CP
77
What tracts are often both affected in cerebral visual impairment?
Visual tracts
| Motor tracts
78
What is the autistic triad?
Communication
Social interaction
Flexibility of thought and imagination
79
What is receptive language?
The ability to understand language you hear or read
80
What is expressive language?
Putting thoughts into sentences that are grammatically correct
81
How is receptive language altered in a child with ASD?
Delayed
Abstract language difficult
Visually more able
82
How is expressive language altered in a child with ASD?
```
Delayed
Child echoes others
Odd intonation/pitch
Chunks of video speak:
- Repeating phrases of others
```
83
What other language difficulties to children with ASD possess?
Initiating and sustaining a conversation
Restricted interests
Lack of awareness of reciprocal nature of a conversation
84
Are children with ASD motivated by social approval?
Not typically
85
Do kids with ASD have difficulty sharing pleasure?
Yes
86
What sensory issues are often seen in children with ASD?
```
Fussy eating
Like certain textures of cothing
Sleep
Toilet training
Hair washing/cutting
Noise
```
87
What assessment tools exist and what ages are they suitable for?
Griffiths (0-8 years)
Bayleys (0-3 years)
Schedule of Growing Skills (0-5 years)
ADOS (ADS)
88
At the 6-8 weeks screening of a newborn, what parental concerns might a parent have?
```
Feeding
Appearance
Hearing/Eyes/Sleeping/Movement/Crying
Illness
Weight gain
```
89
What physical examinations are carried out at 6-8 weeks?
```
Length
Height
Heart
Hips
Testes and genitalia
Femoral pulse
Eyes
```
90
How do the head and occiput differ in children>
Head is relatively larger
| Occiput is more prominent
91
How does a child's larnyx and epiglottis differ?
High anterior larynx
| Floppy epiglottis
92
What is the blood volume of a child?
80ml/kg
93
What type of Hb does a baby have at birth?
Foetal Hb
94
How long does the birth Hb persist for?
6 months
95
What is the most common acute presentation of a child?
Bronchiolitis
96
How is bronchiolitis treated?
It is viral:
| - Supportive measures
97
How is croup treated?
It is viral:
| - Streoids
98
What investigations can be done in a child with a CNS infection?
Lumbar puncture
| Imaging (CT/MRI)
99
What can cause fits and fainting in children?
```
Febrile seizures
Vasovagal episode
Reflex anoxic seizures
Breath holding attacks
Behavioural episodes
Epilepsy
Arrhythmias
```
100
What can commonly cause GI obstruction in children?
Congenital pyloric stenosis
Volvulus
Intussusception
Malrotation
101
How can systolic BP be roughly worked out for a child?
Systolic BP = 85 + (Age in years x 2)
102
How do we manage the circulating volume in a child?
20ml/kg of 0.9% saline
103
What do we do if a patient requires more than 20ml/kg of fluid?
Consider inotropes
| May need more fluid
104
When should we contact the PICU?
When 60ml/kg or more is needed
105
At what stage of dehydration do the fontanelle become sunken?
>10%
106
At what stage of dehydration is shock apparent?
>10%
107
What types of posture in a child are important in assessing their conscious level?
```
Decorticate:
- Abnormal flexion
- Arms adducted
- Forearms and wrists flexed -> Like Cs
Decerebate:
- Extension posture
- Arms adducted
- Foraerms pronated and extended
- Wrists flexed
```
108
What is the commonest cause of UTIs in kids?
E. coli
109
What complications can childhood UTIs cause?
Vesicoureteric reflux
Renal scarring
Renal tract abnormalities
110
How do we treat constipation in kids?
Laxatives
Attention to food and drink
Toilet advice
111
What causes of abdominal pain in a child shouldn't be missed?
Coeliac disease
| IBD
112
In terms of headache, which of the following is not a symptom or sign of concern:
- Headache on waking
- Worse with coughing/bending
- More than 5 a week
- Vomiting
- Visual problems
- Gait problems
- CN palsy
More than 5 per week
113
What is the median time between symptoms onset and diagnosis of a child brain tumour?
2.5-3 months
114
What are the signs and symptoms of an innocent murmur?
```
Sensitive -> Changes with position/breathing
Short duration
Single -> No clicks/gallops
Small -> No radiation
Soft
Sweet
Systolic
```
