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Year 4 - Paeds > Community Paediatrics > Flashcards

Community Paediatrics Flashcards

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1
Q

Developmental delay
- 7 Neuro causes

  1. Vascular
  2. Anatomical
  3. Accidental
A

Developmental Delay:
- Neuro causes

1 CVA
2 HIE
3 IVH

4 Spina bifida
5 Epilepsy

6 Hypoglycaemia
7 Brain trauma

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2
Q

Developmental delay
- 3 Infectious causes

A

Developmental delay
- Infectious cause

  1. ToRCH
    - Toxoplasmosis, Rubella, CMV, Herpes, HSV
  2. Meningitis
  3. Encephalitis
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3
Q

Developmental delay
- 2 Neuromuscular causes

A

Muscular developmental delay

  1. SMA (Spinal muscular atrophy)
  2. DMD (Duchenne’s muscular dystrophy)
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4
Q

Developmental delay

  1. A genetic cause
  2. Endocrine cause
  3. A pervasive disorder
A

Developmental delay

  1. Trisomy 21
    - Genetic cause
  2. Hypothyroidism
    - Endocrine cause
  3. Autism
    - Pervasive disorder
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5
Q

Early Autism Signs

  1. GM
  2. Speech
  3. Social
A

Autism signs

  • GM
    1. Spinning objects
  • Speech
    2. 16 mo only one word
    3. Echolalia
    4. Not babbling
  • Social
    5. No eye contact
    6. No smile reflex
    7. No touching
    8. No mixing with others
    9. Inappropriate laughing/giggling
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6
Q

Developmental red flags

  1. GM
  2. FM
  3. Speech
  4. Social
A

Developmental red flags

  1. GM
    - 12 months no sitting
    - 18 months no walking
  2. FM
    - 12 months hand preference
  3. Speech
    - 18 mo 2-6 words
  4. Social
    - 10 weeks smiling
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7
Q

Global development delay
- 6 Investigations

A

Global delay - Ix:

  1. FBC
    - Iron/B12/folate
  2. U&E
    - CKD/Hyponatraemia
  3. CK
    - DMD
  4. TFTs and LFTs
  5. Vit D
  6. Hearing test
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8
Q

Developmental delay
- Mx

A

Developmental delay - Mx

1 Detailed dev. assessment
2. MDT

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9
Q

ADHD
- Definition

A

ADHD Definition

  1. Neuro-behavioural disorder
  2. Hyperactivity, inattention, impulsivity
  3. Inability to focus
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10
Q

ADHD
- Epidemiology

A

ADHD

  1. Prevalence
    - 7%
  2. Boys 2x Girls
  3. 50% co-morbid
    - ASD
    - LD
    - Communication/defiance
    - Depression/anxiety
    - Tics/Tourettes
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11
Q

ADHD
- Pathophysiology

A

ADHD

  1. Brain changes
    - Structural
    - Functional
  2. Genetic
    - 88% twin hereitability
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12
Q

ADHD
- ICD-10 Criteria

A

ADHD ICD10

  1. Early onset
    - <6yo
  2. Context
    - Two or more settings
    - Child’s age and IQ
  3. Triad
    - Inattention
    - Hyperactivity/Impulsivity
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13
Q

ADHD
- Three subtypes

A

ADHD subtypes

  1. Predominantly inattentive
  2. Predominantly hyperactive/impulsive
  3. Combined
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14
Q

ADHD DDx

  1. Conduct disorder
  2. Oppositional-defiant disorder
A

ADHD DDx

  1. Conduct disorder
    - Marked aggression
  2. Oppositional-defiant disorder
    - Anger/vindictiveness
    - Argumentative
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15
Q

ADHD
- Ix

A

ADHD Ix

  1. Conner’s questionnaire
  2. School observation
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16
Q

ADHD Mx

  1. Pre-school
  2. Mild-moderate
  3. Severe
A

ADHD Mx

  • Pre-school
    1. Parental training
    2. Care plan
    3. SEN
    4. No medication
  • Mild-moderate
    1. Behavioural strategy
  • Parental education
  • Teacher education
    2. CBT
  • Social skills training
    3. Medication if necessary
  • Severe impairment
    1. Medication
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17
Q

ADHD
- Five medications

A

ADHD Medications

  1. Methylphenidate
    - Ritalin/Concerta/Medikinet
    - Stimulant
  2. Atomoxetine (Strattera)
    - ADR: Liver
    - Non-stimulant
    - Used in Tic/anxiety (Ritalin abuse)
  3. Lisdexamfetamine (Elvanse)
    - Stimulant
    - When methylphenidate not effective
  4. Guanfacine (Intuniv)
    - Non stimulant
  5. Antipsychotics
    - Adults
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18
Q

ADHD Medication
- ADRs

A

ADHD Meds

  1. BP and palpitations
    - ECG if heart condition
  2. Disturbed sleep
  3. Impaired growth and appetite
  4. Aggression/emotional
    - Anxiety/depression
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19
Q

ADHD Prognosis

  1. Natural history
  2. ADRs
A

ADHD

  1. 2/3 no evidence in adulthood
  2. Associations
    - Substance abuse
    - Criminal convictions
    - Lower education attainment
    - Unemployment
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20
Q

ASD
- Definition

A

ASD Definition

  1. Neurodevelopmental disorder
  2. Social interaction, communication, behaviour
  3. Diagnosed in childhood
    - Key symptoms present before 3
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21
Q

ASD Epidemiology

  1. UK Prevalence
  2. RFs
  3. Associations
A

ASD

  1. 1% in UK
    - B>G
  2. RFs
    - Prematurity
    - Maternal/paternal age
    - Perinatal hypoxia
  3. Associations
    - Fragile X
    - Tuberous sclerosis
    - Angelmann
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22
Q

ASD Features

  1. Interaction
  2. Communication
  3. Activities
  4. Sensory
A

ASD Features

  • Interaction
    1. Eye contact
    2. Little facial/body language
    3. Difficulty reading signals
  • Communication
    1. Delayed spoken/sign language
    2. Abnormal language
  • Echolalia (repetition)
  • Abnormal intonation, pitch, rate, rhythm
  • Activities
    1. Unusual preoccupations
    2. Need for routine
    3. Motor mannerisms
  • Hand-flapping
  • Sensory
    1. Restricted diet
    2. Haircuts/teeth brushing
    3. Loud noises
    4. Self-harm
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23
Q

ASD
- Examination

A

ASD Examination

  1. NF or TS
    - Wood’s light
    - Skin stigmata
  2. Injury
    - DSH
    - NAI
  3. Congenital
    - Macrocephaly
    - Microcephaly
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24
Q

ASD
- DDx

A

ASD DDx

  1. LD
    - Separate/co-morbid
  2. Attachment disorders
    - No stranger anxiety
  3. Rett’s syndrome
    - Largely girls
    - >18mo regression
    - Speech delay
    - Repetitive hand-movements
  4. Schizophrenia
    - Disordered language/behaviour
  5. Specific language disorders
    - SALT diagnosis
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25
ASD - Mx
ASD Mx 1. Diagnosis 2. Co-morbid mx - ADHD - Sleep disorder - LD - MH 3. Behavioral strategies - Visual timetables - Preparation for changes 4. Education - EHCP (formerly SEN) - Education, health, care plan
26
Behaviour disorder - Eight common underlying disorders
Behaviour involving disorders 1. ADHD 2. ODD (oppositional defiant) 3. ASD 4. Anxiety 5. Depression 6. Bipolar 7. LDs 8. Conduct disorder
27
Conduct disorder 1. Behaviour patterns 2. Mx
Conduct disorder - Behaviour pattern 1. Repeated violation of rights/rules 2. 4 main groups of behaviour - Hurtful aggression (people/animals) - Property destruction - Lying/stealing - Serious rule violations - Management 1. Consider psychiatric referral
28
ODD 1. Pattern of behaviour 2. Investigations 3. Management
Oppositional defiant disorder - Pattern 1. Hostile, angry, defiant, rebellious 2. Directed at an authority figure - Ix 1. Conners rating scale 2. Child behaviour checklist - Mx 1. Consider psychiatric referral
29
Short stature 1. Definition 2. Centile
Short stature 1. Definition - 2sigma + 2. Centiles - below 2.5th centile
30
Growth deceleration 1. Definition 2. Centile change
Growth deceleration 1. Definition - Growth velocity below fifth percentile 2. Centile change - Height drop of two centiles
31
Normal growth 1. Antenatal 2. Post-natal 3. Pubertal
Normal growth - Antenatal 1. Uterine size 2. Placental/maternal funciton 3. IGF, IGF-binding proteins (IGFBPs) - Post-natal 1. Rapid 2. Plateau at 3yo (5-7cm/year) 3. Large or small babies 'channel' to correct centil by 2yo - Pubertal 1. Pre-pubertal dip 2. Growth spurt - Sex hormones, GH, TFTs 3. Girls first, then boys, for longer (13m difference)
32
Short stature - Four common differentials
Four common Short Statures - Familial 1. Born adequate for GA 2. Steady growth below 5th centile 3. Puberty not delayed 4. Normal exam, proportionate stature - Constitutional delay 1. First 2 years growth deceleration 2. Bone age delayed by 1-2 years 3. Final height close to target 4. Thin and sexually immature for age - Idiopathic short stature 1. Short but healthy 2. Normal puberty and exams 3. Normal bone age, IGF, IGFBP - SGA without catch-up (2yo) 1. IUGR and SGA at birth 2. Normal exams 3. Proportionate short stature
33
Short stature DDx 1. Hormonal causes 2. Genetic causes 3. Chronic causes 4. Dysplasias 5. Psychosocial causes
Eight uncommon Short-Stature - Hormonal 1. GH Deficiency 2. Hypothyroid 3. Cushing 4. GH Insensitivity (Laron) 5. Craniopharyngioma - Genetic 1. Trisomy 21 2. 45 X 3. Nonan 4. Russell-Silver 5. Prader-Willi 6. DiGeorge - Chronic disease 1. Celiac/IBD 2. CF 3. CHD 4. DM 5. CKD - Malignancy - Skeletal dysplasia 1. Juvenile idiopathic arthritis 2. Achondroplasia 3. Hypochondroplasia 4. Osteogenesis imperfecta - Psychosocial 1. AN/BN 2. FAS 3. Abuse/institutionalisation
34
JIA - Subtypes
Juvenile idiopathic arthritis - Subtypes 1. Oligoarticular - 4 or fewer joints ever involved 2. Polyarticular - 5 or more joints involved 3. Systemic onset
35
JIA Presentation 1. RFs 2. S&S 3. Ix
JIA Presentation - RFs 1. Female sex 2. Under 6yo 3. Autoimmune FHx - S&S (6 weeks duration) 1. Pain, swelling, morning stiffness 2. Diurnal variation 3. Fever 4. Macular rashes, psoriatic scales, dactylitis 5. Purpura, bruising - Ix 1. ESR and CRP - Sub-type dependent 2. FBC - Systemic onset 3. Serology - ANA 30-60% - Predictive of uveitis - RF/Anti-CCP 4. Chlamydia screen in monoarticular teens
36
Poly articular JIA - Management
Polyarticular JIA - Mx 1. DMARD - Methotrexate - Leflunomide/sulfasalazine 2. Supportive 3. Biological - Adalimumab/etanercept etc 4. NSAID 5. IArt CST 6. PO CST
37
Oligoarticular JIA - Mx
Oligoarticular JIA Mx 1. IArt CST - Triamcinolone acetonide - Methylprednisolone acetate + Supportive care + NSAID + Methotrexate 2. TNF-alpha inhibitor - adalimumab/etanercept - infliximab + Supportive + IArt CST + NSAID
38
JIA - Systemic onset - Mx
Systemic onset JIA - Mx 1. PO/IV CST - Methylprednisolone sodium succinate - Prednisolone + Supportive care + NSAIDs 4. Tocilzumab/canakinumab/anakinra + supportive care + PO CST + NSAID
39
DiGeorge Syndrome 1. Pathology 2. Triad
DiGeorge Syndrome (22qDS) - Velo-cardio-facial syndrome - CATCH22/Shprintzen's - Pathology 1. Chromosome 22q deletion syndrome 2. Pharyngeal arch transcription factor deficiency - Triad 1. Cardiac anomalies 2. Hypoplastic thymus 3. Hypocalcaemia (hypoplastic PT)
40
DiGeorge Syndrome - Two phenotypic components
DiGeorge Syndrome Components - Pharyngeal phenotypes 1. CHD 2. PT hypoplasia 3. Thymic hypoplasia 4. Cleft lip/palate 5. Mild dysmorphic facial features - Neurological phenotypes 1. Mild cognitive dysfunction - LD - Speech impairment - Increased incidence of schizophrenia
41
RTA 1. Syndrome Characterisation 2. Definition
Renal tubular acidosis - Characterisation 1. Hyperchloremic metabolic acidosis 2. Normal serum anion gap - Definition 1. Group of disorders 2. Acid-base homeostasis 3. Impairment - Excretion of fixed acid - Reabsorption of bicarb
42
RTA - Paeds presentation 1 S&S 2 Ix
Paeds Renal tubular acidosis - S&S 1. Small for age 2. Frailty 3. Bowing of knees 4. History of UTI, DM, PBC, kidney stones - Ix 1. low pH - Metabolic - Amino aciduria - Hyperuricosuria 2. Hyperphosphatemia - Hypophosphaturia
43
RTA - Four types
RTA Type I - Classical Type II - Proximal (Type III - Proximal and Distal - Carbonic anhydrase II deficiency) Type IV - Distal
44
RTA - Type 1 Management - Type 2 Management
RTA Mx I Classical 1. Alkali solution - Sodium alkali - Potassium-containing alkali 2. Potassium supplementation II Proximal 1. Alkali solution 2. Potassium supplementation 3. Hydrochlorothiazide - Volume contraction - Proximal reabsorption
45
RTA Management Type III Type IV
RTA Management Type III (Rare, mixed) 1. Alkali solution - Sodium or potassium based 2. Potassium supplementation Type IV (Distal) T.iv WITH Mineralocorticoid deficiency 1. Fludrocortisone + low K diet 2. Sodium alkali T.iv WITHOUT Mineralocorticoid deficiency 1. Loop diuretic +low K + high Na 2. Sodium alkali
46
DBT - Definition
Dialectical behaviour therapy 1. Intensive psychological treatment 2. Skills in emotion/behaviour regulation 3. Balance/resolve difference 4. 1 year - weekly 1-2-1 - weekly group meetings
47
Therapeutic risk taking - Definition
Therapeutic risk taking 1. Empowering decision making 2. Risk not just harm - Opportunity - Achievement
48
Opioid overdose - Presentation
Opioid overdose 1. Respiratory depression 2. Apnoea 3. CNS depression 4. Miosis
49
Cocaine use disorder 1. Gradation 2. Chronic use sequelae 3. State
Cocaine use disorder 1. Gradation - (Occasional use) - Mild/moderate/severe 2. Chronic use - Myocardial remodelling - Myocardial hypertrophy - Lethal arrhythmias 3. Hyperadrenergic state - Nausea - Jitteriness - Anxiety and paranoia - Trouble concentrating - Euphoria
50
Cocaine toxicity - S&S
Cocaine toxicity 1. Minutes or hours of use 2. Hyperthermia 3. Rhabdomyolysis 4. Dysrhythmia 5. Ischaemia 6. Intracranial haemorrhage 7. Agitation 8. Psychosis 9. Seizures
51
MDMA toxicity - S&S
MDMA toxicity - S&S 1. Agitation 2. Confusion/headache 3. Seizure 4. Hypertension 5. Hyperthermia 6. Rhabdo 7. Dysrhythmias/Hypotension 8. ACS
52
MDMA Toxicity - Mx
MDMA Toxicity Mx - Supportive 1. Hypotension 2. Hyperthermia - Aggressive cooling - Benzodiazepines 3. Hypoxia 4. Metabolic abnormalities
53
MDMA Toxicity - Mx
MDMA Toxicity Mx - Supportive 1. Hyperthermia - Aggressive cooling - Benzodiazepines 2. Hyponatremia - Fluid restriction - Normal saline - Benzos and hypertonic saline 3. Seizures - Benzos/phenobarbitone - GA - Head CT 4. Hypotension - Fluids 5. Hypertension - BEnzos - Nitroglycerin, nitroprusside, phentolamine 6. Rhabdomyolysis - Fluid resuscitation 7. Hypoxia 8. Metabolic abnormalities
54
Cannabis use - Chronic health effects
Cannabis use - Chronic health effects 1. Cognitive impairment - Impaired cognitive development 2. Dependence 3. Increased risk - Schizophrenia - Anxiety disorder 4. Worsened - Bipolar - Respiratory symptoms - Chronic bronchitis
55
Benzodiazepine overdose - S&S
Benzodiazepine overdose S&S 1. Excessive sedation 2. Coma 3. Respiratory depression
56
Acute alcohol misuse - Two drugs
Acute alcohol misuse 1. Chlordiazepoxide 2. Pabrinex
57
Development - Speech vs language
Development 1. Speech - Sounds - Tongue, lips, jaw, vocal 2. Language - Verbal and non-verbal 3. Speech and language - Intact hearing - Muscle control - Exposure
58
Speech and language - Development 1 d 6-8 wks 3 mo 6 mo 9 mo 12 mo 18mo 24mo 30mo 36mo
Speech and language - Development 1 d - Cry 6-8wk - Coo 3 mo - Laugh/vocalise 6 mo - mama, dada, byebye, babble 9 mo - Understands no 12 mo - Own name, 2-6 words 18mo - 6-40 words, sing, parts of body 24mo - 200 words, joins words 30mo - continual questions 36mo - 2/3 colours, 1-10, songs, simple conversation
59
Specific language disorder 1. S&S 2. Mx
Specific language disorder - S&S 1. Delayed/disordered language 2. Normal social communication - MDT 1. Pediatrician 2. Psychologist 3. SALT 4. OT
60
CAPD 1. S&S 2. Ix 3. Mx
Central auditory processing disorder - S&S 1. Verbal instructions - Difficulty understanding - Difficulty responding 2. No attention deficit 3. May have dyslexia - Ix 1. Hearing test 2. Screening questionnaire 3. APD listening test
61
Osteogenesis imperfecta 1. Epidemiology 2. Pathology 3. Mx
Osteogenesis imperfecta - Epidemiology 1/20,000 - Pathology 1. Collagen defect 2. Minimal impact fractures 3. Blue sclera 4. Hypermobility - Mx 1. PT 2. Bisphosphonates - Pamidronate/zoledronic acid 3. Vitamin D

Year 4 - Paeds (11 decks)

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