Community Flashcards
1
Q
What are the developmental domains?
A
Gross motor, fine motor/vision, hearing+speech/language, social
2
Q
What should be the gross motor skills of a 6 week old?
A
Head lag still present
Head held in same plane in ventral suspension
3
Q
What should be the fine motor/vision skills of a 6 week old?
A
Eyes follow an object past midline, maintains fixation
4
Q
When should a baby have a social smile?
A
6 weeks
5
Q
When should a baby be able to roll over?
A
6 months
6
Q
When should a baby be babbling?
A
6 months
7
Q
When should a baby be able to reach out for objects?
A
6 months
8
Q
When should a baby be able to transfer objects from hand to hand?
A
6 months
9
Q
When should a baby have good head control by?
A
6 months
10
Q
When should a baby be cruising?
A
1 year
11
Q
When should a baby have developed a pincer grip?
A
1 year
12
Q
When should a baby wave goodbye?
A
1 year
13
Q
When should a baby have 2 words with meaning?
A
1 year
14
Q
When should a baby respond to simple instructions?
A
1 year
15
Q
When should a child be able to kick a ball?
A
2 years
16
Q
What are the gross motor skills of a 2 year old?
A
Climbs and descends stairs one step at a time, runs, kicks a ball
17
Q
What are the fine motor skills of a 2 year old?
A
Copies vertical line and builds a tower of 6 bricks
18
Q
What are the speech and hearing/language skills of a 2 year old?
A
Uses plurals/pronouns, selects toys from others, follows 2 step commands
19
Q
What should be the social skills of a 2 year old?
A
Plays alone/alongside others
Eats with a spoon
20
Q
What are the gross motor skills of a 3 year old?
A
Rides a tricycling, jumps, balance on one foot
21
Q
What are the fine motor/vision skills of a 3 year old?
A
Copies a circle, matches 2 colours
22
Q
What are the speech and hearing/language skills of a 3 year old?
A
3-4 word sentences
Knows 3 colours
23
Q
What are the social skills of a 3 year old?
A
Out of nappies, eats with fork and spoon, separates from mother easily
24
Q
What are the fine motor skills of a 4 year old?
A
Copies a cross and square
Draws man with 3 parts
Imitates bridge with 3 bricks
25
What are the speech/language skills of a 4 year old?
Counts to 10
Identifies several colours
Lots of questions
Tells story
26
What are the social skills of a 4 year old?
Shares toys
Out of nappies at night
Brushes teeth, toilets alone
27
What are the gross motor skills of a 5 year old?
Walks backwards/heel-toe
Bounces and catches a ball
28
What are the fine motor skills of a 5 year old?
Copies triangle
Draws man with six parts
Does buttons
29
What are the speech and language skills of a 5 year old?
Comprehension
Understanding of prepositions
Opposites
30
What are the social skills of a 5 year old?
Chooses friends, acts out role play, eats with knife and fork
31
What are some developmental screening tools?
Ages and stages questionnaire
Denver developmental assessment and schedule of growing skills
Bayley and Griffiths
32
What are the red flags in development?
- Abnormal muscle tone
- Any regression
- Not able to hold object by 5 months
- No smile by 6 months
- Not sitting unsupported by 12 months
- Not walking independently by 18 months
- Hand preference before 18 months
- No speech by 18 months
- No interest in others at 18 months
33
What are some examples of primitive reflexes?
Grasp reflex, Moro's, rooting reflex, stepping reflex
34
What is Gower's sign?
Inability to get up from floor or squatting position without using hands - suggestive of muscular dystrophy
35
What is cerebral palsy?
Persistent disorder of movement and posture caused by non progressive brain defects sustained before 2 year of age
36
What are some prenatal causes of cerebral palsy?
APH with hypoxia, radiation, alcohol, intrauterine infection, rhesus disease
37
What are some perinatal causes of cerebral palsy?
Prematurity, birth asphyxia, hypoglycaemia, hyperbilirubinaemia (kernicterus)
38
What are some postnatal causes of cerebral palsy?
Trauma, IVH, hypoxia, meningoencephalitis
39
What are the 4 main types of cerebral palsy?
Spastic, dyskinetic, ataxic and mixed
40
What sort of lesion does a spastic CP suggest?
Pyramidal
41
What are the forms of spastic CP?
Spastic hemiplegia, spastic diplegia (legs worse than arms), spastic quadriplegia
42
What sort of lesion does a dyskinetic CP suggest?
Extrapyramidal - damage to basal ganglia and thalamus
43
What sort of movements do you get in dyskinetic CP?
Involuntary movements
- Dystonia - twisting and repetitive movements
- Athetosis - slow movements (athetoid - slow writing movements
- Chorea - rapid random contractions of small muscle groups
* associated with kernicterus
44
What sort of lesion does an ataxic CP suggest?
Cerebellar
45
How does ataxic CP present?
Hypo/hypertonia, speech difficulties, incoordination, poor balance and sense of position in space, intention tremor
46
What is affected in quadriplegia?
Both arms and legs
Trunk, face and mouth also often affected
47
What is affected in diplegia?
Both legs affected, arms may be affected but to a lesser extent
48
What is affected in hemiplegia?
One side of the body
49
Name some people who would be involved in the MDT care of a child with cerebral palsy
Community paediatrician, physiotherapist, occupational therapist, speech+language therapist, dietetics, psychology
50
What is ASD?
A Neurodevelopmental disorder that affects a person's social interaction, communication and behaviour
51
What are the 3 core features of ASD?
- Difficulties with social interaction
- Difficulties with communication
- Restricted, repetitive behaviours
52
Name 3 people involved in the MDT looking after a child with autism
Community paediatrician or child psychiatrist, educational psychologist, speech therapist
53
What are some management techniques for ASD
Behavioural management strategies - visual timetables, preparation and explanation for routine changes
Educational measures - higher needs funding, Education Health and Care Plan (EHCP)
Adequate treatment of comorbid conditions eg ADHD, mental health conditions, sleep disorders and learning diabilities
Speech therapy
54
What is ADHD?
A neurobehavioral disorder characterised by hyperactivity, inattention and impulsivity
55
What are the 2 main predictors of a poor prognosis in ASD?
IQ less than 50 and no communicative speech before the age of 5
56
What are the 3 cardinal features of ADHD?
Hyperactivity, inattention and impulsivity
Must be present in more than one setting
57
How should preschool children with ADHD be managed?
Parent training/education programme
Inform nursery teachers about diagnosis
Care plan and special educational needs
58
How should mild-moderate ADHD in school-age children with moderate impairment be managed?
Behavioural strategies, CBT, social skills training
Medication - eg methylphenidate
59
How should severe ADHD in school-age children with severe impairment be managed?
Medication - eg methylphenidate, atomoxetine
60
What are some side effects of ADHD medication?
Hypertension, palpitations, disturbed sleep, impaired growth and appetite suppression, aggression
61
What are some adverse outcomes associated with ADHD?
Increased substance abuse, more criminal convictions, lower educational attainment, unemployment
62
What other conditions is ASD associated with?
ADHD, anxiety, oppositional defiant disorder, learning disability, sleep problems, sensory issues, GI distrurbance, epilepsy
63
What are some risk factors for ASD?
Sibling with ASD, gestational age <35 weeks, parental schizophrenia or affective disorder, natural use of sodium valproate during pregnancy, learning disability, ADHD, fragile X, muscular dystrophy, neurofibromatosis, tuberous sclerosis
64
What are some complications and comorbidities of cerebral palsy?
Feeding difficulties, drooling, aspiration, recurrent chest infection, GORD, constipation, incontinence, visual impairment, hearing impairment, epilepsy, learning disability, mental health problems, Neurodevelopmental disorders, pain, sleep disturbance
65
What are some prognostic factors for whether a child with CP will be able to walk unaided by age 6?
If a child can sit at 2 years it is likely
If a child can't sit but can roll at 2 years, it is possible
If a child cannot sit or roll at 2 years, it is unlikely that they will be able to walk unaided
66
What factors should be managed in a child with CP?
Problems with eating, drinking and swallowing (SALT)
Problems with speech+language (SALT)
Nutritional status - measure height and weight - dietetics
Drooling - anticholinergics
Pain - MSK problems, tone, GORD etc
Sleep disturbances - optimise sleep hygiene, melatonin
Mental health problems
Constipation
Epilepsy
Carer - benefits, respite, education, support groups
67
What is The Gross Motor Function Classification System (GMFCS)?
5‑level clinical classification system that describes the gross motor function of people with cerebral palsy based on self-initiated movement abilities. People assessed as level I are the most able and people assessed as level V are dependent on others for all their mobility needs.
68
When is bedwetting considered to be normal?
In children younger than 5
69
What are some causes of bedwetting?
Sleep arousal difficulties, polyuria, OAB, structural abnormalities, UTI, chronic constipation, neurological disorders
70
How would you advise a parent whose child is wetting the bed below 5 years old?
Reassurance
- Avoid caffeine and sodas before sleep
- Encourage child to empty their bladder regularly during the day and before sleep (4-7 times)
- Easy access to toilet or potty at night
- Waterproof mattress and duvet cover
- Positive reward systems, avoid punishment
71
How can bedwetting be managed in a child older than 5 years if lifestyle measures fail?
Enuresis alarms, desxopressin in the short term
72
When is a UTI considered atypical?
Serious illness
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Sepsis
Failure to respond to treatment with suitable antibiotics within 48 hours
Infection with non-E.coli organisms
73
When is UTI classed as recurrent?
- 2 or more episodes of UTI with acute pyelonephritis
or
- 1 episode of UTI with acute pyelonephritis plus 1 episode of UTI with cystitis
or
- 3 or more episodes of UTI with cystitis
74
What are the bacterial causes of UTI?
- Escherichia coli (85-90%)
- Proteus mirabilis
- Staphylococcus saprophyticus
- Pseudomonas
75
What are some risk factors for UTI?
```
Age <1 year
Female
White
Previous UTI
Voiding dysfunction
VUR
Sexual activity
No history of breastfeeding
Immunosuppression
```
76
What are some complications of childhood UTI?
Renal scarring, VUR, hypertension, pre-eclampsia, renal insufficiency
77
When should you suspect UTI in children aged below 3 months?
Fever, vomiting, lethargy, irritability, poor feeding, offensive urine
78
How should a urine sample be obtained in an infant?
Clean catch urine sample - gentle suprapubic cutaneous stimulation using gauze soaked in cold fluid helps trigger voiding
Urine collection pads
79
How is an upper UTI in children older than 3 months managed?
Cefalexin or co-amoxiclav
80
How is a lower UTI in children older than 3 months managed?
Trimethoprim or nitrofurantoin
81
When is a urinary tract ultrasound indicated?
During acute infection with atypical features
During acute infection with recurrent UTI in children younger than 6 months
6 weeks later in children under 6 months with first time UTI
6 weeks later in children older than 6 months with recurrent UTI
82
What scan is used to detect renal parenchymal defects?
Dimercaptosuccinic acid scintigraphy (DMSA) scan
83
When should a DMSA scan be done?
Within 4-6 months following the acute infection in all children under 3 years with atypical or recurrent UTI and all children over 3 years with recurrent UTI
84
What screening tools can be used in ADHD?
Conners Questionnaire
Dundee Difficult Times of the Day Scale (D- DTODS)
SNAP–IV
Strengths and Difficulties questionnaire
