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Flashcards in Curriculum Deck (141):
1

1) You are the paediatrician assessing an infants growth. Where would you record the measurements of height, weight and head circumference?

2) You have recorded the measurements above. What would indicate a growth problem in the chart?

1) Assessing growth in children record = Growth Chart in Red Book

2) Growth faltering = Crossing Centiles,

2

1) How can you recognise whether the growth pattern is normal in infancy and childhood

2) How can you recognise whether the growth pattern is abnormal in infancy and childhood

3) Name of the puberty staging tool?

4) What instrument helps you assess a boys pubertal development?

5) What may indicate abnormal pubertal development in boys on examination
- Early
- Late

6) What may indicate abnormal pubertal development in girls on examination
- Early
- Late

1 + 2) Look at growth chart, calculate child's expected height from parent.

3)
Orchidometer

4) Pubertal staging = Tanner Staging

5)
Early puberty (before 8)
- Increase in testes volume

Late puberty (after 15)
In boys: the absence of testicular development (or a testicular volume lower than 4 ml) by age 14 years

6)
Early puberty (before 9)
- Breast Development

Late puberty (after 15)
In girls: the absence of breast development by the age of 13 years, or primary amenorrhoea with normal breast development by the age of 1

3

1) What are the most common causes of precocious puberty in boys

2) What are the most common causes of precocious puberty in girls

3) What are the most common causes of delayed puberty in boys

4) What are the most common causes of delayed puberty in girls

5) Rare Cause delayed puberty in boys hint genetics

6) Rare Cause delayed puberty in girls hint genetics + syndrome

1) Boys precocious puberty = any androgen secreting tumour
• pituitary tumour
• Leydig cell tumour
• CAH

2) Girls precocious puberty
• McCune - Albright syndrome
• CAH (precocious)

3) Boys Delayed Puberty =
• Constitutional Delay in growth
• Congenital hypothyroidism
pituitary tumour
• craniopharyngioma

4) Girls Delayed Puberty
• Constitutional Delay in growth
• Congenital hypothyroidism

5) Hypogonads secondary to Klinefelters

6) Genetics
Turner Syndrome
Androgen insensitivity syndrome
Polycystic ovary syndrome

4

1) 4 Broad causes of abnormally short stature in children
S.H,O,R,T

2) abnormally short stature in children malabsorption?

3) abnormally short stature in children hormonal?

4) abnormally short stature in children social?

5) Causes of abnormally tall stature in children

6) When to refer appropriately

1) abnormally short stature =
• Social, Syndromes
• Hormonal,
• Orthopedics,
• Reduced nutrition
• Treatment for Leukaemia


2) Malnutrition short stature
• Crohns
• Cystic Fibrosis
• Coeliac - IgA TTG


3) Hormonal short stature
• Hypothyroid
• Cushing
• GH deficiency


4) Social causes of short stature
• Neglect
• Abuse

5) Tall Stature
Hormonal
Genetics

5


Advantages of breast feeding

How can overcome common difficulties

Immunity
Asthma Eczema (weak)

Sore Nipples - position change
Mastitis - antibiotics

Insufficient milk - encouragement

6

infant weaning advice

When should solid foods be introduced?

(solid) foods should be introduced at 6 months of age (26 weeks)

7

• Understand fluid and electrolyte requirements of the ill neonate

• Understand fluid and electrolyte requirements of the ill child

Treat suspected or confirmed shock with a rapid intravenous infusion of
20 ml/kg of 0.9% sodium chloride solution

Correction of deficit: deficit in ml = wt (kg) x % dehydrated x 10 (ideally the pre-dehydration weight should be used).
Therefore, a 14 kg child who is 5% dehydrated has a deficit of 14 x 5 x 10 = 700 ml.

Maintenance requirements:
100 ml/kg for the first 10 kg
50 ml/kg for the next 10 kg
20 ml/kg for any weight after 20 kg

8

• Define growth faltering

• Recognize growth faltering

• State the common causes of growth faltering

Weight faltering is defined as weight falling through centile spaces, low weight for height or no catch-up from a low birth weight.

Growth faltering is defined as crossing down through length/height centile(s) as well as weight. A low height centile or height less than expected from parental heights.

Causes
Prenatal
Postnatal
Feeding Problems
Poor Absorption

9

• Recognise obesity

• Assess Obesity

Height and weight should be in light clothing with no shoes

Test urine for protein and glucose

Check blood pressure

10

• Vitamin A deficiency present

• Vitamin A deficiencies treatment

• Vitamin D deficiency present

• Vitamin D deficiency treatment

Vitamin A
Eye and vision, Skin and hair

Management
vitamin A-rich foods - for example, liver, beef, chicken, eggs, fortified milk, carrots, mangoes, sweet potatoes and leafy green vegetables

Vitamin D


Management
For a fair-skinned person, it is estimated that around 20-30 minutes of sunlight on the face and forearms around the middle of the day 2-3 times a week is sufficient to make enough vitamin D in the summer months in the UK

Supplements
ergocalciferol or calciferol

11

• Know how to nutritionally support the chronically sick child

richer formulas of milk
check email from diluki

12

Recognise the
common causes of breathlessness

Below 1 year

Up to 3 Years

At any age

Viral Bronchiolitis
-(First 6 months)

CAP
-(Above 2 due to vaccination)

TB
(Any age)

Viral associated wheeze
-(Up to 3 years old)

Asthma
-(to be confirmed)

Cystic Fibrosis
-(Newborn infant - heel prick)

Croup
(6 months to 3 years)
(patient.info)
dexamethasone

Stridor

13

Recognise the common causes of wheeze

In the first 6 months

Up to 3 years

Viral Bronchiolitis
(First 6 months)

Viral associated wheeze
(Up to 3 years old)

Asthma
(to be confirmed)

14

Diagnostic tools for asthma in the school aged child

Significance of readings obtained

Peak Flow Meter
Oxygen Sats
Heart Rate
Resp Rate

Moderate Asthma
PEF>50–75% best or predicted

Acute severe asthma
PEF 33–50% best or predicted

Life-threatening asthma
PEF<33% best or predicted

15

Measure the peak flow rate and instruct the older child in this technique.

Peak Flow Diary
CAPS LOG

16

• Manage asthma in childhood according to the SIGN/British Thoracic Society guidelines.

Moderate

Acute Severe

Life Threatening

MODERATE ASTHMA

1
Treat at home or in surgery and ASSESS RESPONSE TO TREATMENT

2
β2 bronchodilator:
– via spacer (give 4 puffs initially
and give a further 2 puffs every
2 minutes according to response
up to maximum of 10 puffs)

3
If PEF >50–75% predicted/best:
Nebuliser (preferably oxygen driven)
(salbutamol 5 mg)
Give prednisolone 40–50 mg
Continue or increase usual treatment

4
If good response to first treatment
(symptoms improved, respiration and
pulse settling and PEF >50%) continue
or increase usual treatment and
continue prednisolone

ACUTE SEVERE ASTHMA
Consider admission
Oxygen to maintain SpO2 94–98% if
available
β2 bronchodilator:
– nebuliser (preferably oxygen
driven) (salbutamol 5 mg)
– or via spacer (give 4 puffs initially
and give a further 2 puffs every
2 minutes according to response
up to maximum of 10 puffs)
y Prednisolone 40–50 mg or IV
hydrocortisone 100 mg
y If no response in acute severe
asthma: ADMIT

LIFE THREATENING ASTHMA
1
Arrange immediate ADMISSION

2
Oxygen to maintain SpO2 94–98%

3
β2 bronchodilator and ipratropium:
– nebuliser (preferably oxygen
driven) (salbutamol 5 mg and
ipratropium 0.5mg)
– or via spacer (give 4 puffs initially
and give a further 2 puffs every
Two min according to response
up to maximum of 10 puffs)

4
Prednisolone 40–50 mg or IV
hydrocortisone 100 mg immediately

17

• Discuss with parents and children the causes of asthma

• Discuss with parents and children the management

• Discuss with parents and children and prognosis of asthma.

Risk Factors

The management of asthma is based on four principles:

Control symptoms, including nocturnal symptoms and those related to exercise.

Prevent exacerbations and need for rescue medication.

Achieve the best possible lung function (practically, FEV1 and/or PEFR >80% predicted or best).

Minimise side-effects

(Patient info Treatment)
1 SABA
2 add inhaled steroid
3 LABA
4 increase inhaled steroid
5 add oral steroid

Prognosis
Many children will wheeze early in life (about 30% of those aged under 3 years) in response to respiratory tract infections but most appear to grow out of it by the time they go to school

18

• Instruct children and parents how to use an

MDI
Accuhaler
Turbohaler
Spacer

CAPS LOG

19

• Recognise acute stridor

• Recognise chronic stridor

• State the causes of acute stridor

• State the causes of chronic stridor

• When to refer

Acute Stridor
Epiglottitis (Rare - Hib vacc)
Immediate referral

Chronic Stridor
Croup (dexamethasone)
If red flags present immediate referral otherwise managed at home
(tachypnoea, recession, drowsiness, cyanosis)
Treatment
oral dexamethasone

Laryngotracheomalacia
- floppy epiglottis

20

• Describe the causes of LRTI.

• Describe treatment of LRTI.

LRTI lower than larynx

CAUSES
Viral
RSV
Influenza A

Bacterial
Strep Pneumoniae
H. influenzae
Staph
Mycoplasma (atypical)

TREATMENTS
Antibiotic
Amoxicillin in a child-friendly formulation, should be used first-line

21

• presentation of cystic fibrosis in infancy

• presentation of cystic fibrosis in childhood

• presentation of cystic fibrosis in adolescence

• the principles of therapy of cystic fibrosis

Lung: viscid mucous and respiratory infections
Gut: pancreatic insufficiency, meconium ileus
Sweat glands: increased sweat Cl-

Treatment
Nutritional support
Total energy, pancreatic supplements
Micronutrients (fat soluble vitamins)

Physiotherapy

Mucolytics: rhDNAse, hypertonic saline

Antibiotics
H. influenzae, Staphylococcus aureus
Pseudomonas aeruginosa

22

Understand the transition from fetal to extrauterine circulation
6 points

its impact on the presentation of cardiac disease in infants.

Clearance of fetal lung fluid
Surfactant secretion,
Transition of fetal to neonatal circulation
Decrease in pulmonary vascular resistance Increased pulmonary blood flow
Cortisol Surge

https://acutecaretesting.org/en/articles/fetaltoneonatal-transition-what-is-normal-and-what-is-not-part-1

https://acutecaretesting.org/en/articles/fetaltoneonatal-transition-part-2

Cardiovascular problems that lead to cyanosis include congenital heart defects, shock, systemic hypotension or significant anemia that prevents adequate levels of oxygen from being delivered to the body tissues.

23

Recognise the possibility of cyanotic and acyanotic cardiac disease at different ages and know the principles of therapy.

6 cyanotic diseases

Cyanotic Diseases
Right to Left Shunts
1 Tetralogy of Fallot clubbing (MBTS)
2 Eisenmenger
3 Pulmonary Atresia
4 Ebstein
5 Transposition of the great arteries (Prostaglandin, urgent atrial septostomy
The definitive corrective procedure is the arterial switch operation)

aCyanotic Diseases
Left to Right Shunts
1 ASD
2 VSD
3 PDA

Mixed Shunt
AVSD

Principles of therapy covered in treatment deck

24

Recognise congestive cardiac failure and know principles of initial treatment.

Cold Peripheries
Displaced apex
Dynamic precordium
Hepatomegaly
Tachypnoea (WOB)
Thin
Sweaty

Yellow Blood Bottle U&E
ACEi

25

Be able to identify the clinical signs associated with the common paediatric cardiac abnormalities including
1 ventricular septal defect (VSD),
2 patent ductus arteriosus (PDA),
3 atrial septal defect (ASD),
4 coarctation,
5 pulmonary stenosis,
6 aortic stenosis,
7 Tetralogy of Fallot.

1 (pink generally asymptomatic)
if severe reduced feeding
Pan Systolic at Left Lower Sternal Edge +/- Thrill

2 Diastolic murmur at ULSE

3 normally asymptomatic pink bikini incision
(soft systolic ejection murmur ULSE if large defect)

4 radio/radial delay or radio femoral delay
Crescendo-decrescendo murmur in the upper left sternal border

5 Pulmonary Stenosis
Asymptomatic (Not blue)
Ejection systolic murmur at upper left sternal edge

6 Aortic Stenosis
Asymptomatic
Carotid Thrill
Ejection systolic murmur at upper sternal edge

7 Tetralogy of Fallot
Loud murmur 3/6 at ULSE

26

Be aware of the common arrhythmias of childhood

understand treatment principles.

Atrial ectopics
If well, do ECG and 24 hour tape, fax to Bristol
If sick, tachycardia etc, urgent transfer

Ventricular ectopics
Usually resolve
Check Na, K, Ca, Mg

Complete Heart Block
Sick Sinus Syndrome

27

Presentation and management of myocarditis

Presentation and management of cardiomyopaty

1 Myocarditis
Usually postviral – history?
Dilated cardiomyopathy
Cardiomegaly
Pleural effusions
ECG – low voltage

2 Cardiomyopathy
May present with collapse

Dilated Cardiomyopathy
Usually unknown cause
Postviral
Metabolic

Hypertrophied Cardiomyopathy
Infiltration
Metabolic
Non-compaction
Genetic HOCM, Noonan

Management
ECG
Urine Dip
Bloods Carnitine decreased, CPK
Echo


28

Know which children are at risk of infective endocarditis, recognise its clinical signs and treat appropriately

Children at Risk
Valves,
VSD,
prosthetic component
Usually streptococcus viridans or pyogenes
Occasionally staphylococcus aureus, MRSA or CNSA

Clinical Signs - History
Fever,
malaise,
chest/abdo,
arthralgia
New embolic events,
Haematuria

Clinical Signs - Examination
HepatoSplenomegaly,
Temperature
Roth,
Osler,
Janeway,
splinters
murmurs

Investigations
Blood cultures x6 at different times over 2 days,
FBC, CRP, ESR, WBC, Throat Swab
Echocardiogram + ECG

Treatment
6 weeks IV antibiotics
Surgical treatment

29

Know the general principles of medical and surgical therapy used in treating children with cardiovascular disease.

Congenital Heart Defects

MBTS
Atrial Balloon Septostomy
Arterial Switch
Patching

30

Recognise the common causes of vomiting in infancy, childhood and adolescence and know how these are initially managed.

Gastroenteritis
UTI
Raised ICP
DKA
Allergies
Alcohol
Migraine
Pregnancy

Pyloric Stenosis Ranstedt Pylomyotomy
Gastro Oesophageal Reflux H2 Antacids
HUS
Volvulus

Initial Management
Rehydration
Antibiotics
Anti-emetics
NG tube
Surgery

31

Recognise the common causes of acute and chronic diarrhoea in infancy, childhood and adolescence and know how these are initially managed.

acute infective diarrhoea

Viral
- rotavirus (causes gastroenteritis) vaccine treatment 1st dose must be given before 15 weeks
- norovirus
Bacterial
- salmonella
- campylobacter

Management
Assessment of dehydration
Rehydration – iv vs oral
Infection control
Stool samples
antibiotics eg ciprofloxacin for shigella, metronidazole for amoebic dysentery

Parasitic
- giardia, metronidazole
- amoeba

Chronic Diarrhoea
Thriving
Toddler Diarrhoea - Mgx (self resolves)
Constipation with overflow

Not thriving
Cystic Fibrosis
Coeliac
Lactose intolerance
Crohns
UC

32

Recognise the common causes of constipation in infancy, childhood and adolescence and initiate management.

Dietary

Treatment
Initial advice
-Fluid intake
-Dietary management
-Toileting routine
-Laxatives (movicol)

33

Recognise the common causes of acute, chronic and recurrent abdominal pain in children.

Acute
Intussuscpetion 6 - 9 months
Appendicitis
Mesenteric Adenitis
Lower Lobe Pneumonia
Testicular Torsion 12 - 13
Chronic

34

causes of acute bowel obstruction in infants, children and adolescents, presents
principles of management.

intussusception
6-9 months
4:1 ratio M:F

35

Recognise the common causes of an abdominal mass in infancy childhood and adolescence.

wilms - nephrectomy + chemo
neuroblastoma
hepatoblastoma
constipation - osmotic laxative
intussusception
6-9 months
4:1 ratio M:F

36

Know the different causes of jaundice in childhood, how to investigate and the treatments that should be initiated.

Biliary Atresia
Duodenal Atresia

37

Give advice to parent on gastroenteritis including oral rehydration therapy.

PC: Diarrhoea

Mgx
- Plenty of fluids

Advice
- good hygiene

38

Recognise how haematuria may present and know the underlying causes and initial therapies that may be required.

acute nephritic syndrome

39

Recognise how proteinuria may present and know the common underlying causes and initial therapies that may be required.

nephrotic syndrome

swelling
steroids

40

Understand how urinary tract infections present at different ages, how they are investigated, and the treatments that are used.

High temperature (fever).
Being sick (vomiting) and/or diarrhoea.
Drowsiness.
Crying, going off feeds and generally seeming unwell.
Appearing to be in pain.
Blood in the urine (uncommon).
Yellowing of the skin (jaundice).
Cloudy or smelly urine.
nephrotic syndrome
Urine dip

3 day course atbx as per local guidelines

41

Know the major causes of acute and chronic renal failure in childhood. Appreciate how they present and the initial treatment options.

Pre Renal
Hypovolaemia
Cardiac failure
Hypoxia

Renal
HUS
Acute GN
Interstitial Nephritis
Nephrotoxic insults
infection

Post renal
PUV
Stone
Tumour
Retroperitoneal fibrosis

Lethargy
Growth failure

Haemolytic uraemic syndrome

42

Understand the physiological consequences of renal failure.

hyperkalaemia
fluid overload
hypertension
toxin excretion
anaemia
acid base

43

Recognise polyuria, know the common and important causes and how to investigate and treat.

Infection
Diabetes

44

Identify the common causes of bedwetting and be able to give advice to parents.

primary bedwetting - since childhood

The child cannot yet hold urine for the entire night.
The child does not waken when his or her bladder is full.
The child produces a large amount of urine during the evening and night hours.
The child has poor daytime toilet habits.

Daytime wetting

UTI
Diabetes
Structural or anatomical abnormality
Neurological Problems
Emotional Problems (parentala problems / stress / change / abuse)
Constipation

MGX
• 1st Reassure your child
• no drink hour before bed
• wee before going to sleep
• 2nd Enuresis alarm.
• Don't tell them off or punish them
• Normal age for unrinary continence 3 or 4

45

Know the causes, investigations and treatments of hypertension presenting in childhood.

Know how to measure and interpret childhood blood pressure.

renal disease

Renal artery stenosis.
Renal parenchymal disease.
Coarctation of the aorta.
Cushing's syndrome.
Hyperthyroidism.
Obstructive sleep apnoea and sleep disordered breathing.
Phaeochromocytoma.

46

Be able to examine the inguinal area and distinguish between a hernia and a hydrocoele.

transillumination + slow to fill slow to empty + can get above the swelling

vs

abdo pain, constipation, nausea vomiting, bowel sounds in mass

47

Understand the normal development of external genitalia including the foreskin and labia/vulva.

Testes should descend within the 1st couple of months

48

Recognise abnormalities and when to initiate treatment of balanitis and dysuria.

pathological phimosis
paraphimosis
balanoposthitis
torsion of testicle
torsion of a hydatid of Morgagni
Epididymo-orchitis
idiopathic scrotal oedema
incarcerated hernia

49

Have knowledge of normal descent of the testis, recognize abnormalities and know the management of retractile and undescended testis.

undescended
ectopic
impalpable

if palpable
orchidopexy

impalpable
laparoscopy
orchidopexy
staged procedure
microvascular transplant

50

Know how cerebral palsy presents, the possible causes and the therapies used.

delayed developmental milestones
floppy
stiff

milestones
not sitting by 8 months
not walking by 18 months
late head control

ataxic
mixed
spastic
athetoid

51

Define febrile convulsions in children and know how to differentiate these from other seizure disorders.

6 months to 5 years
peaking at 18 - 22 monnths
whilst child feverish

52

Know the causes of and how to assess the ‘floppy’ infant.

paralytic
- muscular dystrophy
- guillain barré
- spinal cord tauma
- myasthenia gravis

non-paralytic
-cerebal palsy
- downs
- prader willi
- hypothyroid
- congenital heart

53

Recognise epilepsy in infancy, childhood and adolescence.

Know the different common types and how they are diagnosed and managed.

Focal e.g.CECTS
Absence
Tonic Clonic
Myoclonic


Absence
2-10
brief
sodium valproate or ethosuximde

CECTS childhood epilepsy with centrotemporal spikes
7-10
retain conscious
1- 2min
EEG
no treatment needed

Juvenile Myoclonic
sodium valproate

54

Be able to outline to parents the nature, treatment and prevention of febrile convulsions and epilepsy.

Secondary to infection
cant prevent
no treatment needed
if lasts too long call ambulance
dont put anything into mouth
recovery position

55

Understand how neuromuscular diseases present in children, how they are investigated and how they are managed.

Duchenne muscular dystrophy (DMD)
Becker muscular dystrophy (BMD)

56

Know the causes and treatments of headaches in childhood.

-migraine - most common
-tension headache - 2nd most common
-meningitis - red flag
-lack of sleep
-missing meals
-stress

Treatment
ibuprofen
triptans (sumatriptan)

57

Know the causes of cerebral haemorrhage and stroke in children and how they are assessed and managed.

trauma
intraventricular haemorrhage - neonates
sickle cell (clot)
vasculitis
arteriovenous malformations (AVMs)


CT
MRI

58

Recognise the presentation of meningitis in different age groups of children, know how to investigate and initiate management.

non-blanching rash
fever
increased cap refill
bulging fontanelle

Mgx
3mths or older Children IV ceftriaxone
Younger than 3 months Cefotaxime + amoxicillin

59

Recognise the common causes of gait disturbance in infancy, childhood and adolescence.

SUFE
Perthes Disease
BMD
DMD

60

Know the common causes of delayed development in childhood.

Hearing Problem
Hypothyroid
Obstructive Sleep Apnoea
Coeliac
Duodenal Atresia
CNS tumours

61

Recognise the importance of loss of or failure to acquire milestones in the major developmental domains.

Physical development
Turner
GH deficiency

Fragile X
Downs (language)
Prematurity
Lack of Oxygen (language)
Deprivation (all)
Maternal Depression
Autism (social)
Cerebral Palsy (gross motor)
Williams Syndrome

62

Know how the important neurocutaneous and neurodegenerative disorders present and how they are managed.

neurofibromatosis
cerebral palsy

63

Appreciate the contribution of the multidisciplinary team to the care of children with chronic neurological problems.

Psychological Assessment
In the lecture given by the nice black lady

64

Know the causes and signs of raised intracranial pressure in infancy and childhood.

Causes
- shaken baby syndrome
- meningitis
- epilepsy
- hydrocephalus
- SOL

Signs
-lowered GCS
-seizures
-papilloedema
-vomiting
-bulging fontanelle
-pupils

65

Recognise spina bifida and its associated problems.

-Occulta
-Meningocoele
-Myelomeningocoele

-Movement problems
-Bowel Problems
-Bladder Problems
-Hydrocephalus

-Surgery within 48 hours of birth

66

Know the causes and treatments required for infants/children and adolescents with depressed conscious states.

Sepsis
Febrile Convulsions
Epilepsy
Hypoglycemia
Meningitis
Hydrocephalus
Abscess
Epiglottitis
Trauma

67

Assess anaemia in infancy and childhood

FBC

68

Know the different presentations of childhood leukaemia

AML
bone pain
frequent nosebleeds
bleeding and swollen gums
easy bruising
excessive sweating (particularly at night)
shortness of breath
unexplained weight loss
heavier than normal periods in women

CML
fatigue, most likely due to anemia
rash
bruising or bleeding easily
bone and joint pain
enlarged spleen
increased risk of infection

ALL
pallor
bleeding from the gums
a fever
bruises
petechiae,
lymphadenopathy, neck, pitts or groin
hepatomegaly,
splenomegaly,
bone pain
joint pain
weakness
fatigue
shortness of breath
testicular enlargement
cranial nerve palsies

CLL
fatigue
fever
frequent infections or illness
unexplained or unintended weight loss
night sweats

69

Assess a child with bruising and bleeding disorders, including petechial and purpuric rashes

AML
CLL
ALL
CLL

Blood Clotting Disorder
ITP
DIC

HSP (HUS)
Meningitis

70

Understand how and why thrombosis may present in childhood

Factor V Leiden. DVT
Prothrombin thrombophilia. second most common type. DVT
Protein C deficiency.
Protein S deficiency.
Antithrombin deficiency.

71

Recognise lymphadenopathy and know its differential diagnosis at different ages in childhood

Hodgkins
Neck Lymphadenopahty
Mediastinal Mass (SVC obstruction)
Fever
Night Sweats
Weight Loss

Non Hodgkins
neck, armpit or groin Lymphadenopathy
Fever
Night Sweats
Weight Loss

Burkitts

72

-Know the major causes of childhood malignancies,
-how children present with malignancy, how they are treated and the medical and psychological challenges associated with both disease and therapies.

Leukaemia
- ALL - chemo

Brain + spinal tumour
- medulloblastoma (most common)
- 3-5 yr Group C
- 6 - 15yr Group D
- astrocytoma - incurable
- presentation
- macrocephaly
- faiure to thrive
- vomiting
- developmental delay

Lymphoma
- HL - chemo + radio

Neuroblastoma
- constipation diarrhoea fever
- racoon eyes
- Mgx -High dose intensity induction
- surgery
- chemo
- radio
- immuno

SE infertility poor growth

Soft tissue sarcoma

Wilms

Retinoblastoma - chemo

Li fraumeni syndrome

73

Diagnose, assess and know the principles of managing diabetes mellitus in children, including the management of Diabetic Ketoacidosis.

Vomiting
Fluids (calculate based on formula)
Insulin

74

Be able to recognize, investigate and treat hypoglycaemia in infants/children and adolescents.

reduced conscious state
BM

75

Know how corticosteroid and mineralocorticoid steroid excesses and deficiencies present and are managed.

Cushing Syndrome
CAH
HTN
Addisons
Hypernatraemia
Hyponatraemia
Conns

76

Understand the principles of screening for inherited metabolic and other conditions at birth (including phenylketonuria, hypothyroidism, cystic fibrosis) and what to do when positive results are detected.

Heel Prick Test (Guthrie Card)
Performed 5-9 days of life

77

Recognise and investigate thyroid problems in the child.

TSH (blood test)

78

Know the causes and management of ambiguous genitalia

the disorders of sexual differentiation.

CAH
salt losing crisis

79

1)
Understand the principles of inborn errors of metabolism

2)
know how inherited metabolic conditions may present in childhood.

- CAH
- Phenylketonuria
- MCAD
- G6P deficiency
- Homocystinuria

- Homocystinuria
- methionine metabolism
- heel prick test
- vitamin b6

80

Recognise the common skin conditions in infancy, childhood and adolescence.

hand foot and mouth disease
viral illness very contagious but can go to school if child feels well
roseola infantum
chicken pox
eczema
psoriasis
acne

81

Recognise the exanthematous infections of childhood and their clinical courses.

roseola infantum
- HHV6

82

Know how Eczema presents and how it is managed.

itchy flexures

83

Understand how staphylococcal and streptococcal skin disease present and their consequences.

scalded skin syndrome
impetigo
scarlet fever

84

Know how Herpes presents in the skin in children and is managed (including gingivostomatitis and eczema herpeticum)

Oral Herpes

eczema herpeticum looks like impetigo

85

Know the skin manifestations of common and serious systemic diseases of childhood.

eczema herpeticum
Scalded skin syndrome
necrotising fasciitis

86

Know the importance of trauma and accidents in childhood for morbidity and mortality.

shaken baby syndrome

87

Be able to assess the significance and sequelae of head injuries in infancy and childhood.

A to E
CT head
MRI

88

Be able to advise parents on strategies to reduce the risk of accidents in the home.

to be completed

89

Understand the causes of accidental and non-accidental poisoning in childhood and how to manage them.

Bruising in abnormal places
behind the ears

90

Be aware of non-accidental injuries (including sexual abuse) and know the outline strategy for handling them.

Inform Social Services

91

Know the principles of underlying management of thermal injury (burns) and chest/abdominal injury.

Superficial epidermal First degree Red and painful

Partial thickness (superficial dermal) Second degree Pale pink, painful, blistered

Partial thickness (deep dermal) Second degree Typically white but may have patches of non-blanching erythema. Reduced sensation

Full thickness Third degree White/brown/black in colour, no blisters, no pain

• Immediate first aid
airway, breathing, circulation

• heat burns - remove the person from source. Within 20 minutes irrigate the burn with cool (not iced) water for 10 - 30 min
layered cling film

• electrical burns: switch off power supply, remove the person from the source

• chemical burns: brush any powder off then irrigate with water. not recommended to neutralise the chemical

• Assessing the extent of the burn
Wallace's Rule of Nines: head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%
• Lund and Browder chart: the most accurate method
the palmar surface is roughly equivalent to 1% of total body surface area (TBSA). Not accurate for burns > 15% TBSA

92

Know variations of normal posture in children.

to be completed

93

Know the causes of limp in childhood and how to investigate and treat them.

Cerebral Palsy

94

• Know the reasons children get painful swollen joints and how to treat them.

JIA

95

Know the causes and how to assess a young child with pseudoparesis of a limb

to be completed

96

Understand the principles for joint deformities and contracture formation in children with disabilities and how they are prevented and managed.

Perthes

97

Understand the reasons children get limb pains and how to treat them.

JIA

98

Know the common causes of abnormality to the spine and neck and how to manage them.

Scoliosis
Spina Bifida

99

Know the common genetic causes of skeletal abnormality.

SUFE
Scoliosis
Perthes

100

• Know the principles of active and passive immunization and be able to advise parents on childhood
vaccinations.

to be completed

101

• Be able to recognize the septic infant /child/adolescent.

Sepsis 6

102

• Know when to suspect immunodeficiency

Recurrent Infections

103

• Know the symptoms and signs of the common exanthematous diseases of childhood

to be completed

104

• Know the common and important reasons for acute and prolonged fever in the
infant/child/adolescent

scarlet fever (grpA strep)
kawasaki disease

105

Know the presentations, management and potential consequences of the common viral infections including
measles,
mumps,
rubella,
herpes virus,
parvovirus B19
enterovirus

Measles
- Parvovirus B19
- white spots inside the mouth
- fever
- irritable
- conjuntivitis

Mumps
- earache

Rubella
- vesicles in mouth
- vesicles on palm

106

Know the presentations, management and potential consequences of common bacterial infections
including

Staphylococcus,
Group a strep,
meningococcus
pneumococcus.

meningococcal septicaemia

107

• Recognise the uncommon manifestations of common diseases
including
toxic shock syndrome,
necrotizing faciitis
Kawasaki’s disease.

to be completed

108

Recognise rare but potentially serious infections including
Septicaemia,
meningitis,
Encephalitis,
Tuberculosis,
HIV
Lyme disease.

to be completed

109

Know how the common tropical disease may present when children have returned from abroad
including
Malaria
typhoid.

to be completed

110

Be able to investigate the child with hearing difficulties

Newborn
otoacoustic emission test

6-9 months
Distraction

1.5 -2.5 years
Where is the teddy test

2.5 - 3 years
Kendall Toy test, McCormick Toy Test

3 years
Pure tone audiometry

111

Know the causes investigations and management of children with sore throats

Viral
Bacterial

112

Understand the presentation and management of obstructive sleep apnoea in childhood and how it
differs from adults.

to be completed

113

• Recognise the common causes of genetic and chromosomal abnormalities in childhood and how to
investigate and treat them.

- Trisomy 21 Downs
- Trisomy 18 Edwards
- Trisomy 13 Patau
- WIlliams Syndrome
- Noonans Sydrome
- Fragile X syndrome - microcephaly

114

Recognise how trisomy 21 presents & the best way to council parents.

Have knowledge of
associated problems with this condition.

Downs

AVSD

115

• Know how to obtain the information necessary for genetic counselling.

to be completed

116

Know the common causes of infant and childhood mortality globally and in the UK and understand
how and why these have changed over time.

to be completed

117

• Recognize the main contributors that have improved health of children in the UK

Vaccinations

118

Understand the impact of social class and inequality for child health

to be completed

119

Know the normal pattern of development of the child from birth to 5 years (Patterns of
gross motor,
fine motor + visual,
hearing + language
social skills

to be completed

120

Understanding of how
vision and hearing are assessed in children.

Vision
Squint - cover test / corneal light reflection test
Kays Picture Cards

121

Know the UK healthy child programme including the UK immunisation programme, universal
screening, the role of the heath visitor and healthy nutrition.

to be completed

122

Appreciate the impact of family, genes and the environment on the physical, emotional and
developmental well being of the child (0-5) and young person (5-15)

to be completed

123

• Safeguarding - Identify the signs and symptoms that suggest children may be suffering from
abuse/neglect or may be at risk of significant harm (physical, emotional and sexual) and know what
action to take to safeguard their welfare.

to be completed

124

Understand multi-agency pathways, procedures used to protect children and the process of serious
case reviews

to be completed

125

• Know how to identify and manage Chronic Fatigue Syndrome (CFS/ME) and identify and manage
common pain problems

6 months symptoms +

Manage Symptoms

126

• Know the presentation and management of high prevalence impairments in childhood (attention
deficit hyperactivity disorder (ADHD), developmental coordination disorder, high functioning autistic
spectrum disorder (Aspergers), specific and mild /moderate learning difficulties)

ADHD
- Impulsivity
- Hyperactivity
- Poor Concentration

127

• Know the presentation and management of low prevalence but severe impairments in childhood
(autistic spectrum disorders, severe global learning difficulties, cerebral palsy)

Autism
- male
- before 3

128

Understand the function of the multi-disciplinary ‘team around the child’, particularly related to the
disabled child.

to be completed

129

Recognise eating disorders including anorexia and bulimia. Know how to investigate and treat.

Restricted Intake
Body Dysmorphia
Increased Exercise

130

• diagnose and treat the common behavioural problems in the preschool child

to be completed

131

diagnose and treat the common psychiatric disorders in pre-school and primary school age children.

to be completed

132

Adolescence : common presentations of mental health disorders in adolescence.

Anxiety
OCD
Aspergers
ADHD

133

Describe the prevalence and clinical presentation of common psychiatric conditions presenting in
young people including: eating disorders; mood disorders (eg anxiety and OCD (obsessive
compulsive disorder); ADHD (attention deficit and hyperactivity disorder); ASD (autism spectrum
disorder) psychotic illness; conduct and emotional disorders and attachment difficulties

to be completed

134

Understand normal life adjustments and transitions (including between age groups) and recognise
the difference between mental illness and the range of normal responses to stress and life events.

to be completed

135

Describe the current common psychological, physical and social and lifestyle treatments for these
conditions.

to be completed

136

Understand the doctor’s duties and the patient’s rights under mental health legislation, Including the importance of confidentiality and when to override this for young people.

to be completed

137

Describe the range of services and professionals involved in the network of young people, and understand the roles of self help, carer / parent groups, schools, social services etc.

to be completed

138

Understand diagnostic criteria for the above conditions, and be aware of common assessment /
diagnostic tools (e.g. Connor’s)

to be completed

139

Communicate effectively with patients, families and multidisciplinary colleagues about psychiatric difficulties.

Discuss with patients and relatives the nature of their illness, (i.e.
basic psycho education), management options and prognosis.

to be completed

140

In young people with mental health difficulties, evaluate information about family relationships and
other social factors (e.g. school) and the impact on a young person.

to be completed

141

Evaluate the impact of psychiatric illness on the young person, their family and others around them.

to be completed