Paediatrics Flashcards
(116 cards)
1
Q
What does ADHD stand for?
A
Attention Deficit Hyperactivity Disorder
2
Q
What are the core symptoms?
A
Inattention, Impulsivity, Hyperactivity
3
Q
What is the diagnostic criteria for ADHD?
A
DSM-V
4
Q
What are the criteria for DSM-V?
A
6/9 Inattentive
6/9 Hyperactive/ Impulsive disorder
Present before 12 years
Developmentally Inappropriate
Symptoms interfere with QoL
5
Q
What is Inattention (ADHD)?
A
Easily distracted Not listening Doesn’t like tasks needing sustained mental effort Loses important items Attention to detail low Difficulty organising tasks
6
Q
What are the symptoms of hyperactivity (ADHD)?
A
Fidgety, runs and climbs, talks excessively, can’t perform tasks quietly
7
Q
What are the symptoms of Impulsivity (ADHD)?
A
Not thinking about consequences
Quickly answering
Difficulty awaiting turn
Interrupts
8
Q
What is the epidemiology of ADHD?
A
4-7% of school age children
4:1, Male:female
9
Q
What are some Primary school symptoms of ADHD?
A
Distractability, impulsive behaviour, low self-esteem, rejection by peers, learning disorders
10
Q
What are some adolescent symptoms of ADHD?
A
Difficulty planning and organising
Reduction of motor restlessness,
Antisocial behaviour
11
Q
What are some Adult symptoms of ADHD?
A
Mental health,
Antisocial behaviour,
Lack of professional development
12
Q
In what situations does ADHD worsen?
A
Unstructured situations, Burning situations, When there are distractions, Low supervision, Sustained mental effort
13
Q
In what situations can ADHD not be observable?
A
Structures situations,
Interesting activities,
One-2-one,
Rewards
14
Q
What are the 4 main categories of aetiologies of ADHD?
A
Neuroanatomic, genetic, environmental, CNS insults
15
Q
What are some examples of acquired brain injury (ADHD)?
A
Prematurity, Fetal alcohol syndrome, Neuro fibromatosis 1
16
Q
What is the treatment of ADHD?
A
Education, parenting programme, school support,
Methylphenidate,
Atomoxetine,
Lisdexamfetamine
17
Q
What is important when diagnosing ADHD?
A
Must show impairment in multiple settings (school and home)
18
Q
What is the epidemiology of Autism?
A
1-30%,
4:1 males:females,
Aetiology unknown,
Genetic component
19
Q
What are the 3 principles of autism?
A
Communication,
Social interaction,
Behavioural poor imagination
20
Q
What are some communication difficulties with autism?
A
Lack of desire to communicate, Only their needs, Delayed/ disordered body language, Repeats speech, No social awareness, Poor joke understanding.
21
Q
What are some social interaction difficulties with autism?
A
No unspoken rules understanding,
Limited interaction with unfamiliar people,
Touches inappropriately,
Plays alone, stressful with others,
Poor eye contact, finds it hard to take turns
22
Q
What are some difficulties with imagination in autism?
A
Using toys as objects, Inability to write creatively , Resist change, Using same game repetitively, Obsessions, Asking same question over and over, Inability to see others point of view
23
Q
What is the management of autism?
A
Education,
Parenting education,
School liaison,
Visual timetables in schools
24
Q
What age can Austin be diagnosed from
A
2 years
25
What is the hierarchy of cell haematopoiesis?
Pluripotent stem cells, precursor cells, mature ‘cytes’
26
When would uncleared red cells be seen in a new born?
Stressful, long labour
27
What are reticulocytes?
RBC with nucleus fragments in the serum
28
What are the 3 mechanisms of anaemia?
Decreased production, increased consumption, increased loss
29
What causes severe anaemia at birth?
```
Haemolytic disease (rhesus),
Bleeding (vas’s praevia, umbilical cord, internal haemorrhage)
```
30
What is erythroblastosis fetalis?
Excess of erythroblasts
31
What causes erythroblastosis fetalis?
Rh -VTE mother previously sensitised to Rh +ve cells. Transplacental passage and haemolytic of fetal cells
32
What are the signs and symptoms of erythroblastosis fetalis?
Anaemia,
| Hyperplasia of blood forming organs (spleen and liver)
33
What is the treatment of erythroblastosis?
Anti D,
| Intrauterine transfusion
34
What is the affinity of HbF for oxygen compared to HbA?
Higher, less easy to offload?
35
What causes the physiological anaemia of the newborn?
Switch from HbF to HbA, decreased RBC production, plasma dilution, shorter life span, more fragile
36
When is physiological anaemia of the newborn reached?
2 months
37
What is anaemia of prematurity?
Low birth weight infants have a poor erythropoietin response,
38
What are the symptoms and signs of anaemia of prematurity?
Apnoea, poor weight gain, pallor, decreased activity, tachycardia
39
What causes iron deficiency in neonates?
Poor intake (less requirement in children from recycles cells), breast feeding
40
What are the most common causes of iron deficiency anaemia in children?
LBW, diet, GI Bleeding, hookworm, cows milk intolerance,
41
What is the presentation of iron deficiency anaemia in children?
Pallor, irritability, anorexia, tachycardia, dilation myopathy, murmur, splenomegaly
42
What can be seen on blood film in iron deficiency anaemia?
Microcytic, hypochromic low/normal reticulocytes, pencil cell
43
What is seen in blood tests in iron deficiency anaemia?
Low ferritin, high TIBC, low serum iron, high ZPP
44
What is the treatment of iron deficiency?
Oral ferrous sulphate, 6mg/kg/day, 3-6 months, iron store replenishes in 3 months
45
What are some complications of iron treatment for iron deficiency?
Constipation, non-compliance, not addressing diet
46
What physiological responses occur in haemolysis?
Increased RBC turnover, shortened lifespan, splenomegaly, lysis syndrome
47
What are intracorpuscular causes of RBC destruction?
Haemoglobin, enzyme, membrane
48
What are extracorpuscular causes of increase RBC destruction?
Autoimmune, fragmentation, hyper selenium, plasma factors
49
What can cause iron overload?
Long term haemolysis, with blood transfusions
50
What is the management of iron overload?
Ferritin monitoring, imaging, chelation
51
What is the management of sickle cell disease?
Family history, pneumococcal, influenzas, meningococcal vaccine, prophylactic penicillin
52
What are the problems associated with sickle cell disease?
Anaemia, infarction, sepsis, infection, acute chest, splenic sequestration, aplastic crisis, iron overload, stem cell transplant.
53
What is the blood picture of SCD?
75 Hb, raised reticulocyte count, chronic anaemia, elevated WBC
54
What is the management of SCD infection?
Blood cultures, CxR, Iv fluids, pain killers, pneumonia = admit
55
What can dactylitis indicate?
SCD crisis in the fingers
56
What is the treatment of SCD?
Hydroxycarbamide, transfusion, stem cell transplant.
57
What is the clinical picture of beta thalassemia minor?
Asymptomatic, mild anaemia. Low MCV, raised HbA2
58
What is the clinical picture of beta thalassaemia major?
Progressive severe anemia, low MCV, HbF and A2 increased, jaundice, splenomegaly, skeletal deformity, delayed puberty,
59
What is the management of beta thalassaemia major?
Genetic counselling, blood transfusions, iron overload treatment, bone marrow transplant
60
What are the 3 main presentations of G6PD?
Neonatal jaundice, chronic non-spherocytic haemolytic anaemia, intravascular haemolysis
61
What can cause sporadic haemolysis in G6PD?
Drugs, fav a beans, fever, acidosis
62
When are bite cells seen?
G6PD
63
What is the epidemiology of hereditary spherocytosis?
1 in 5000, commonest haemolytic anaemia in Europeans
64
What is the most common cause of admission to hospital in children?
Respiratory Infection
65
What organisms can cause pharyngitis/ tonsillitis?
Group A strep, adenovirus, EBV
66
What organism causes epiglottitis?
Hamophilis B
67
What organisms cause otitis media?
Pneumococcus, haemophillus, group A strep, moraxella
68
What organisms cause tracheitis?
Staph aureus, strep A, haemophilus
69
What organisms cause pneumonia?
Strep A, pneumococcus, staph aureus, haemophillus, TB
70
What are 2 atypical pneumonia’s?
Bilateral change (mycoplasma, chlamydia)
71
What organisms cause bronchiolitis?
RSV, rhinovirus, flu, adenovirus.
72
What causes complicated chicken pox infections?
Co infections with staph or strep
73
What are the symptoms of HSV?
Stomatitis, cold sore, encephalitis, eczema
74
What are the symptoms of Kawasaki disease?
Fever, rash stomatitis adenopathy, thrombocytosis, coronary artery aneurysm
75
What can affect growth rates in children
Nutrition and emotional support
76
What are the important determinants of child growth?
```
Phenotype and genotype,
Quality and duration of pregnancy,
Nutrition,
Organ integrity,
Psychosocial environment,
Growth promoting hormones
```
77
What is chondrogeneisis?
Growth of the skeleton
78
What are the regulators of bond growth?
```
Nutrition,
Inflammatory cytokines (TNF-alpha, IL-1,6),
Oxygen deficiency,
Toxins,
Acidosis
```
79
What factors must be considered when assessing growth?
Ethnic background,
Social inequalities,
Parental heights
80
What are the anatomical differences between newborns and adults?
Newborns: Larger head, smaller madable, smaller neck, short limbs, abdomen rounded, chest rounded
81
What can short limbs indicate?
Hypochondroplasia
82
What can a short back and long legs indicate?
Delayed puberty
83
What are the causes of inaccuracy in measuring lengths in children?
Faulty technique
| Faulty equipment
84
What is the formula for boys age predication from parents age?
Height=fathers height + (mother’s height + 12.5) / 2
85
What is the formula for girls predicted height from parents height?
Height=mother’s height+(fathers height -12.5) / 2
86
What is the formula for 95 CI for height in children
Mid parental height +/- 8.5cm
87
What is the normal border centipede of heights in children?
3-97th
88
What is the normal centipede border for growth velocity?
25-75
89
What is the Tanner Stages used for?
Indicate puberty in boys and girls
90
What are the categories of the Tanner Stages in boys?
```
Pubic hair,
Testicular length (2.5 in longest diameter),
Testicular volume (>3ml),
```
91
What is the genotype of klinefelter syndrome?
47XXY
92
What is the epidemiology of Klinefelter syndrome?
1 in 1000 males,
93
What are the complications of Klinefelter syndrome?
Hypogonadism, azospermia,
| Osteoporosis, tall stature, reduced IQ, Breast cancer
94
What is hypergonadotrophic hypogonadism?
Primary hypogonadism
95
What is hypogonadotrophic hypogonadism?
Secondary/ tertiary hypogonadism
96
What can cause hypogonadotrophic hypogonadism?
Craniopharyngiomas, astrocytomas (other CNS)
97
What are the categories of the Tanner Stages in girls?
Pubic hair, papilla elevation, breast bud noted,
98
What is the genotype of tuners syndrome?
45XO
99
What are the complications of tuners syndrome?
Recurrent otitis media,
| Cardiac malformations, hypogonadotrophic hypogonadism, short stature, horseshoe kidney, neck webbing,
100
What is the first sign of puberty in girls?
Breast buds
101
What is the first sign of puberty in boys?
Testicular enlargement
102
What is the range of puberty age in boys?
9-14
103
What is the range age of puberty in girls?
8-13
104
What can cause a delayed Bone age?
GH deficiency
105
What is a cause of advanced bone age?
Precocious puberty
106
What factors affect birth weight?
Parity, maternal weight and size, gestational diabetes, smoking, paternal size
107
What are the common associations of weight loss?
Vomiting,
Diarrhoea,
Dystrophic disorder,
Poor social circumstances
108
What are the causes of short stature?
Constitutional, delayed puberty, nutrition, environmental, idiopathic, physical, tuners, endocrine, chronic diseases
109
What can cause overgrowth in children?
Congenital adrenal hyperplasia,
| Precocious puberty, hyperthyroidism, McAlbriet syndrome, Klinefelter, GH Excess, marfans
110
What are the differences between an adult x-ray and a paediatric X-ray?
Size, growth plates, skull sutures, plastic bones, apophyses
111
What congenital abnormalities can be picked up on X-ray?
Dextrocardia, status invertus, osteogenesis imperfecta,
112
What lines and tubes can be seen on X-ray?
NG tube, umbilical vein catheter, umbilical artery catheter, temperature probe, ET tube
113
What things are important to look at on chest X-ray?
Quality of film (penetration/ rotation), trachea, lung fields and volumes, heart and mediastinum, diaphragm, bones, soft tissue
114
What are some indications for abdominal X-ray?
Distension, recurrent UTI, constipation, foreign body, calculi, tube positions
115
What diameter is considered dilated in adult intestine?
>2.5 cm
116
What rib must meet the hemidiaphragm to be a good insiratory effort in an X-ray?
5-6th rib
