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Year 2 - Child Health (DP) > Clinical > Flashcards

Flashcards in Clinical Deck (114):
1

How far apart are centile lines on a growth chart?

2/3 of a standard deviation

2

A child shows normal growth if what two conditions are met?

Measurements are in normal range for their age
Growth rate is in normal range

3

What has happened to growth charts over the last 30 years?

Right shift
Longer tail
Increase in severe obesity
Similar trend with height

4

How should babies be weighed?

Without clothes or nappy

5

How should children older than 2 be weighed?

In vest and pants
But no:
- Shoes
- Socks
- Dolls/Teddies

6

How and where do you measure head circumference?

With a narrow plastic/disposable paper tape
Measure at widest point

7

When would you measure a babies length before the age of 2?

If you were concerned

8

How do you measure a babies length before they are 2?

Length board/mat
Requires two measurements

9

What can affect the babies length?

Child's mood
Style of measurer

10

How do you measure a child older than 2?

Rigid rule with T-piece
Ensure heels, bottom, back and head touch apparatus
Eyes and ears at 90 degrees
Measure on expiration

11

Where must a recording be on a growth chart for the child to be considered on the centile line?

Either on the line of within 1/4 of a space of it

12

What is a centile space?

Distance between two centile lines

13

What is the average age of puberty in girls and boys?

Girls - 11 years
Boys - 11.5 years

14

When does puberty start?

When GnRH is secreted by hypothalamus

15

What cells does LH binds to in boys and what does this cause?

Leydig cells -> Testosterone

16

What cells does FSH bind to in boys and what does this cause?

Sertoli cells -> Spermatogenesis

17

What is also produced by Sertoli cells and what does it do?

Inhibin B -> Reduces FSH secretion

18

What does LH do in girls?

Stimulates proliferation of follicular and theca cells
Triggers androgen release from theca cells

19

What does FSH do in girls?

Increases granulosa cell proliferation
Enhances aromatase activity:
- Prodcuing oestradiol
Increases progesterone production

20

What cells produce Inhibin B in girls?

Granulosa cells

21

What cells produce Inhibin A in girls?

Large antral follicles in corpus luteum

22

What do increased levels of sex steroids and insulin cause in both sexes?

GH and IGF-1 are enhanced

23

How is puberty staged and how many stages are there? Is this diagnostic of the patient's actual age?

Tanner staging:
- 5 stages
No

24

What is thelarche?

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