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Year 4 Paeds > Community > Flashcards

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1
Q

At what age should a baby sit?

A

6 months rounded back

8 months straight back

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2
Q

At what age should a baby crawl?

A

Around 8-9 months

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3
Q

At what age should a baby cruise?

A

10 months

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4
Q

At what age should a baby walk?

A

Unsteadily at 12 months and steadily by 15 months

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5
Q

What milestone should occur at 6 weeks?

A

Follows object with head

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6
Q

What fine motor skill occurs at 4-6 months?

A

Palmar grasp

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7
Q

When should a child say their first words

A

7-10 months

Normally Mama / Dada

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8
Q

When should a baby smile?

A

6 weeks

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9
Q

When should a baby wave?

A

10-12 months

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10
Q

What is Child Health Surveillance?

A

Offers families a programme of

Screening tests
Immunisations
Developmental Reviews
Health Promotion (information and guidance)

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11
Q

Define: Delay, Learning Difficulty, Disability

A

Delay - slow acquisition (specifically or globally)

Learning Difficulty - in relation to children of school age, can be cognitive/physical/both

Disability - Any restriction/lack of ability due to impairment

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12
Q

Give two prenatal/perinatal/postnatal causes of abnormal development

A

Prenatal - Infection, Alcohol

Perinatal - Asphyxia, Intraventricular Haemorrhage

Post Natal - seizure

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13
Q

Define Developmental Delay

A

A delay in acquisition of all skill fields, normally becoming apparent in the first two years of life

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14
Q

Give 5 broad categories of investigations that could be done on a child with suspected Developmental Delay

A 
Cytogenic
Metabolic
Infection
Imaging 
Neurological
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15
Q

Describe some of the types of Abnormal Speech and Language

A
  • Pragmatically (difference between intention and meaning)
  • Phonation (Stammering)
  • Language Expression
  • Communication Skills
  • Language Comprehension
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16
Q

Give three causes of abnormal speech and language

A

Hearing Loss
Global developmental delay
Environmental deprivation

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17
Q

How could you test language in a child?

A

Early - Symbolic toy test

Pre-School - Reynell test of expressive and receptive language

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18
Q

Give three managements for speech and language delay

A

Speech and language therapy

Alternate methods of Communication (Makaton, Picture Exchange Communication System)

Learning support

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19
Q

Describe the four classes of Learning Difficulties

A

Mild - IQ70 to 80 (learning assistance in class)
Moderate - IQ50-70 (only emerge as speech and language do)
Severe - IQ35-50 (minimal self care)
Profound - IQ<35 (no significant language)

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20
Q

Define Dyspraxia and it’s management

A

Developmental Coordination Disorder

Disorder of motor planning and execution without significant neurological findings

Managed with therapy

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21
Q

Define Dyslexia and how it’s assessed

A

Disorder of reading skills disproportionate to child’s IQ (>2 years behind chronological age)

Assess vision and hearing, then further assessment by Educational Psychologist

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22
Q

Define Disorders of Executive Function

A

Responsible for planning,organisation,flexibility and problem solving

Often a consequence of acquired brain injury

Manifests as forgetfulness, volatile mood, poor social skills

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23
Q

Give three reasons a child may refuse meals

A

Past history of force feeding
Irregular meal times
Unreasonably large portions

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24
Q

Give three reasons a child may have difficulty sleeping

A

Overstimulation
Use of bedroom as punishment
Too much sleep late afternoon

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25
How should aggressive behaviour be managed?
Often caused by learned behaviour Unlikely to ‘grow out of it’ Encourage attendance of parenting programmes
26
Describe four general management recommendations for behavioural problems
Explanation and reassurance Parenting groups Family therapy Psychodynamic psychotherapy
27
Define Child Protection
Process of protecting individuals as they’re either suffering, or likely to suffer significant harm as a result of abuse or neglect.
28
Give three child related risk factors and three adult related risk factors for child abuse
Child: Consistent Crying, Disabled, Unwanted Adult: Mental Illness, Financial Difficulties, Own experience of child abus
29
When should you suspect physical abuse in a child?
MOA not compatible with injury sustained Inconsistent histories Lack of parental concern
30
Bruising is uncommon in a non mobile child. Give three differentials other than NAI.
``` Bleeding Disorder (eg Haemophilia A) Mongolian Blue Spot Erythema Nodosum ```
31
Name two injuries that can be seen in a ‘Shaken Baby’
Subdural Haematoma | Retinal Haemorrhages
32
If a child presents with a query NAI to A&E, what four investigations should be carried out?
Skeletal Survey CT Head Ophthalmology Coag Screen
33
Define Neglect
Persistent failure to meet child’s basic physical or psychological needs that is likely to result in serious impairment of child’s health and development
34
Define Emotional Abuse
Persistent non physical harmful interactions with child by care giver
35
Define Sexual Abuse
Physical contact (penetrative and non penetrative) , exposure to explicit material and sexual exploitation
36
Define ADHD and give three possible aetiologies
Neurobehavioural disorder characterised by Hyperactivity, Inattention and Impulsivity ``` Neurochemical abnormalities (increased Dopaminergic) Neurodevelopmental abnormalities of prefrontal cortex Social Factors (eg deprivation) ```
37
Describe the ICD10 criteria of ADHD
A: Abnormality of attention/impulsivity and hyperactivity at home B: The above at school C: The above directly observed D: Doesn’t meet criteria for mania/depression/anxiety E: Onset <7y F: Duration >6 months G: IQ>50
38
Give three differentials for ADHD
Auditory Processing Disorder Oppositional Defiant Disorder Conduct Disorder
39
How is suspected ADHD investigated?
Conners Questionnaire Collateral Histories Direct Observations
40
Describe the management of ADHD
Preschool - parent training/education, involvement of teachers School Age (Mild) - Behavioural Strategies, CBT School Age (Severe) - Medication
41
The first line pharmacological management for ADHD is stimulant medication. Give an example and two related side effects.
Methylphenidate Palpitations, Disturbed sleep
42
Define Autism Spectrum Disorder
Pervasive developmental disorder characterised by triad of impairment in social interaction, communication and stereotyped interests
43
Outline the ICD10 criteria for Autism
A - Presence of abnormal/impaired development before the age of 3 B - Qualitative abnormalities in social interaction C - Qualitative abnormalities in communication D - Restrictive/Repetitive stereotyped behaviours E - Not attributable to anything else
44
Give three differentials for Autism Spectrum Disorder
Learning difficulties Retts Syndrome Schizophrenia
45
How is ASD managed?
Parent support groups Behavioural techniques (visual timetables, preparation and explanation for changes in routine) Educational measures
46
Define Cerebral Palsy
A chronic disorder of movement and or posture that presents early (before the age of two) continuing throughout life due to static injury to brain After the age of two - acquired brain injury
47
What are the causes of Cerebral Palsy?
Antenatal - Vascular Occlusion, Genetic Syndromes, Congenital Defects Hypoxic Ischaemic Injury in Pregnancy Postnatal- Meningitis, Encephalitis, Hypoglycaemia
48
Why are premature babies more at risk of Cerebral Palsy?
Due to Periventricular Leukoplacia, secondary to IVH
49
Give 4 early features of cerebral palsy
Feeding difficulties Abnormal Gait Persistence of Primitive Reflexes Not meeting developmental milestones - not sitting unaided at 8m, not walking by 18m, preference of hand before one year
50
90% of cases of Cerebral Palsy are ‘Spastic Type’ due to UMN damage. How would this present?
- Velocity dependent resistance to passive stretch - Increased tone and reflexes - Clasp Knife Phenomenon - Hips wrist and elbows often flexed May involve bulbar muscles (dysphagia and dribbling)
51
What are the three subtypes of Spastic Cerebral Palsy
Hemiplegic - unilateral arm and leg affected, face spared Quadriplegia - all four limbs and trunk involved Diplegia - All four limbs but legs more affected
52
6% of Cerebral Palsy Cases are the Choreoathetosis Type. How does this present?
Involuntary movements with Chorea and Athetosis (twisting and writhing) Usually bulbar involvement Increased reflexes
53
After being diagnosed by history and MRI, Cerebral Palsy can be classified by ‘Gross Motor Function Classification System’. Outline this
``` I - Walks without limitations II- Walks with limitations III- Walks using handheld mobility device IV- Self mobility with limitations V- Manual Wheelchair ```
54
The majority of management for Cerebral Palsy is non pharmacological and occupational. What surgical management can be done?
Botox to Gastrocnemius Muscle Lengthening Osteotomy Dorsal Rhizotomy - Severing nerve fibres at the spinal cord to reduce spasticity
55
Define Anorexia Nervosa
Eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image and endocrine disturbances
56
Give a predisposing and perpetuating risk factor for Anorexia Nervosa
Predisposing - Female Perpetuating - Starvation induces neuroendocrine changes that perpetuate anorexia
57
Describe the ICD10 criteria for Anorexia Nervosa
- Present for Atleast 3 months in the absence of bingeing - Fear of weight gain - Endocrine disturbance resulting in Amenorrhoea/Impotence - Emaciated (<17.5kg/m2) - Deliberate weight loss and distorted body image
58
State four investigations for suspected Anorexia Nervosa
Bloods (Increased Urea, Decreased Electrolytes, Low Albumin) VBG (Alkalosis from vomit, acidosis if laxatives) DEXA ECG
59
How would you manage Anorexic patients?
Weight gain (0.5kg/week OP or 1kg/week IP) CBT Interpersonal Therapy ANFFT
60
What forms of Substance Misuse are the most common in adolescents?
Alcohol and Cannabis
61
Children who are abusing substances may not present directly intoxicated. How else may they present?
Unexplained absences from school Stealing money Medical complications associated with use
62
Name three specific fractures associated with NAI
Metaphyseal Corner Syndrome Rib fractures Spiral fractures
63
Give an outline of the HEADSSS assessment for adolescents
``` H - Home E - Education/Employment A - Activities D - Drugs/Smoking/Alcohol (particularly ruling out trafficking, slavery or abuse) S - Sex and Relationships S - Self harm and depression S - Safety ```

Year 4 Paeds (15 decks)

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