Paediatrics Flashcards by John Darlington

What are some clinical signs of respiratory distress?

Grunting
- exhaling against a partially closed glottis

Stridor

Nasal flaring

Trachael tug

Intercostal recession

Paradoxical breathing
- seesaw movement

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When should prematurity be corrected on a growth chart till?

2 years

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How much weight can a baby loose after born which is normal and what are the normal weight increases expected?

10% loss of birthweight in first 10 days is acceptable.

Weight should double by 4 months and tripled by 1 year.

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When is puberty said to have begun in males?

When testes reach 4ml

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What is the term for puberty starting early? and how should it be investigated?

Precocious puberty

females <8 years
Males <9 years

Central causes: normal puberty happening too early:

intracranial tumour
familial

Peripheral causes:

Adrenal tumour
McCune-Albright syndrome

Investigations:

Brain MRI (for pituitary tumours causing GnRH realise)
USS of ovaries and testes (ovarian/ testicular tumours causing hormones)
wrist x-ray to assess if it is affecting the bone maturity
endocrine - hormones and GnRH
Urine steroid profile (for adrenal tumours)
TFTs (hypothyroidism can induce early puberty)

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Highlight key motor skill milestones and red flags:

6 week: head control

6m: sit up right with support

9 -10m: crawling sit up right unsupported

12m: cruise walk
18m: walking

2 y: running

Red flags:

6m no head control
12 month no sitting unsupported
18 month not walking

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Highlight key fine motor skills and visual skills milestones and red flags:

3m: holds objects in palm
6m: transfer objects
9m: immature pincer grip
12m: mature pincer grip
18m: stack bricks

2 years: draw line

3 years: draw circle

Red flags:
- 5m does not hold object in hand

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Highlight some key speech and language skill milestones and red flags:

3m: turns to sound

3-6: makes sounds

9m: Double syllable (mama, dada)
12m: Responds to name

12-15 months - 2-6 words

2 year: links words

4 years: - speaking

Red flags:
3m: no response to sound
9m: no babble
<2-6 words 18 months

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List some key social skill milestones and red flags:

6w: smile
3m: laugh
9m: waves/ stranger danger
12m: Plays peak a boo
18m: spoon feeds
3year: dresses and toilet trained

Red flags:

12 month: no gestures
18 months: no play

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Where might you find information about the childs immunisations, birth weight ete (something that should be asked for during every consultation):

Red book

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What is a key thing in the history that suggests the pregnancy was normal?

If the baby stayed with mum after delivery

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What is the important pulse to feel for in children?

Femoral pulse

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What is an effective way of working out the constitutional height of a child i.e working out how tall they will be?

Mid-parental height:

Males:
[Fathers height + mothers] + 13 / 2

Females:
[Father’s height + Mothers] - 13 / 2

*normal range is +/- 10 cm

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In children what is considered obese?

> 95th centile

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What is the definition of a short stature?

2 standard deviation below or 2nd centile for someone their age and sex

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Which hormones promotes the fusion of the epiphyseal in children?

Estrogen

Aromatase of testosterone and production of oestrogen in both sexes promotes the fusion of the epiphyseal plates.

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Growth spurts are controlled by different hormones at different stages of life - what are they:

Infantile stage 0-2 years:

Growth Hormone
Insulin

Childhood phase 2 - pubertal years:

Growth Hormone
Thyroxine

Puberty:

Sex hormones
Growth hormone

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List some investigations to be done into delayed puberty:

Bloods:

FBC
LH and FSH
Serum prolactin
IGF-1 levels
Celiac screen

Imaging:

MRI of brain
Wrist x-ray
Pelvis Ultrasound scan

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What is the definition of delayed puberty:

Females:

13 years old
Failure of Tanner stage 2

Males:

14 years old
Testes <4ml

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What are some causes for short stature?

Normal genetically short

Constitutional delay

Intrauterine growth restriction

Dysmorphic syndromes
- Down’s, - Turner’s

Skeletal dysplasia

Chronic system disease
- IBD, - CKD, Cystic fibrosis

Endocrine disorders

Social circumstances
- very poor social situations

Medication
- Steroids

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What should the neck position be in infants and children undergoing resuscitation?

Neutral position in infants, with very slight extension

Children: sniffing position with chin lift

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What organism is responsible for croup and how should it be managed?

Parainfluenza

Management:

Oxygen
Nebulised adrenaline 5ml 1:1000
Corticosteroids - dexamethasone (oral if mild)

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How is Bronchiolitis diagnosed? and what is the causative agent?

Study These Flashcards

Nasopharyngeal Aspirate for RSV testing

RSV

what are some of the symptoms and How is whooping cough diagnosed, treated and what are some complications:

Study These Flashcards

Symptoms:

Bouts of coughing fits - especially during the night
inspiratory whoop
subconjunctiva haemorrhage
spells of apnoea
may vomit at end coughing
absolute lymphocytosis may be seen

Diagnosed:

Nasal swab culture
PCR

Treatment:

notify public health
Macrolides within <21 says
Family prophylaxis

*prophylactic antibiotics for family members

Complications:

pneumothorax
bronchiectasis
seizures
can last for 100 days

Which condition is associated with micrognathia, posterior tongue displacement and cleft palate?

Pierre- Robin syndrome

Which condition is associated with short stature, webbed neck, over friendly and supraclavicular aortic stenosis? and what kind of face are the described as having?

William's Syndrome Elf like face

What condition is associated with micrognathia, low set ears, short stature, overlapping digits and rocker bottom feet?

Edward's Syndrome

What are some of the clinical findings of a child with Patau syndrome:

``` Microcephaly - with skin lesions on head Microopathamia Polydactyly Cleft lip Rocker bottom feet ``` Cyclopia - severe Elephant trunk nose

What are some complications of Down's syndrome which may affect the child immediately or affect development?

Congenital heart disease - AVSD Cataracts Hypotonia - affect ability to feed - delay in milestones Intestinal atresia Thyroid dysfunction Hearing loss Developmental impairment - in the milestones - leading to learning disabilites

What health checks are recommended for children with Down's syndrome?

Thyroid tests Eye checks Hearing checks Growth monitoring - have their own chart Heart checks Breathing checks Blood checks

Following a bronchoscopy sample, why might there by lipid laden macrophages?

Due to aspiration of milk

What symptoms would make one think it is NOT asthma:

Cough only when its cold/ following viral infection Moist cough/ productive Signs of finger clubbing (likely something else is going on)

What is the FEV1 post bronchodilator change that is diagnostic in children?

>12% change

What are the typical symptoms of bronchiolitis?

Dry Cough Fever - mild Coryzal symptoms Poor feeding Findings: - Dyspnoea - Wheeze - Bilateral findings - Heading bobbing - Subcostal recession Diagnosis: - Nasal-pharyngeal aspirate for virology Management: - oxygen - fluids (try NG first) +/- nebulised saline/ salbutamol *continual monitoring

What samples are needed for suspected TB in a child?

3x early morning sputum samples or Gastric aspiration *gastric aspiration is in young children because they will have swallowed respiratory secretions from the night before.

What is the chromosome affect in cystic fibrosis and and what is the carrier rate?

Chromosome 7 - F508 1/20 are carriers

How is cystic fibrosis now diagnosed?

Guthrie blood spot test: Immunoreactive trypsinogen - can be diagnosed within 3 weeks *trypsinogen is released into the blood because of blocked pancreatic ducts. This is followed on with a sweat test - Pilocarpine Iontophoresis (makes one sweat) - >60mmol/l of Chloride - 100mg of sweat *following from this there is usually specific genetic testing such as F508 deletion testing

What are some signs that a child may have cystic fibrosis which hasn't been picked up? i.e. they have come from a country where screening is not done:

Meconium ileus Nasal polyps Distal small bowel obstruction - occurs in 10% Failure to thrive Delayed puberty Recurrent chest infections Signs of Cor pulmonale

What is the management of cystic fibrosis?

Chest physiotherapy x2 Good nutrition - NG tube - Gastrostomy Pancreatic enzymes supplements + vitamins Prophylactic antibiotics + IV antibiotics for infection

What signs may you see of someone with Primary ciliary dyskinesia?

Dextrocardia or even - situs inversus (all organs on wrong side)

What factors are taken into account that determine your lung function?

Height Sex Age Ethnicity

List some causes of obstructive lung disease in children:

Asthma Bronchiolitis Cystic fibrosis Primary ciliary dyskineasia

What are some causes of restrictive lung disease in children?

Scoliosis Neuromuscular disease - Duchenne muscular Pulmonary fibrosis * *if a restrictive pattern is seen further investigations should be done which include: - transfer factor - High resolution CT

What are some bronchial challenge testing that are done to diagnose asthma?

6 minute exercise challenge Histamine provocation Mannitol challenge test

What is the condition called which results in inflammation of the foreskin in children and how is it treated?

Balanitis Oral fluids to rehydrate Genital retraction back of foreskin +/- Antibiotics *complications can be cellulitis

What is the condition called where there is increasing scarring of the foreskin and how is it treated and why?

Balanitis Xerotica Obliterans Treatment: - circumcision *treated because it can cause meatal stenosis

What is the most common cause of acute scrotum in a young child?

Torsion of the epididymal appendage

List some other causes of acute scrotum in children:

Henock Schonlein Puprura - can induce swelling of testes Idiopathic scrotal oedema - not painful just discomfort - 7-8 years in summer - settles within 24 hours

What is the formula for working out the predicted functional bladder capacity?

(age x 30) + 30

What is the most common organism to cause meningitis in neonates?

Strep Agalactiae - group B strep. in first 48 hours this is from the mother

Name two clinical signs that may be seen in a child with meningism:

Brudzinski sign: - bending the neck causes the legs to flex Kernig sign: - flexing the hip causes neck pain and forces the leg to flex

How can the child's projected adult height be worked out?

Calculated working out the mid-parental height. Girls: (Father's height + Mother's Height) - 13 / 2 Boys: (Father's height + Mother's Height)+13/ 2 +/- 10cm is normal

List some causes of short stature:

Familial Delayed puberty Growth hormone deficiency - primary - acquired (tumour, iatrogenic, trauma, radiation) Hypothyroidism Corticosteroid use Chronic illness Nutritional deficiency

How can the size of the testes help point to the origins of the cause of precious puberty in males?

Bilateral large testes = central cause Unilateral large teste = testicular tumour Bilaterally small testes = adrenal cause, hyperplasia or tumour

What is the most common cause of painless PR bleeding in a child between 1-2 years old?

Merkel's diverticulum

Paediatrics Flashcards

(55 cards)