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Paeds year 5 Lissauer Flashcards

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1
Q

Four functional areas of child development

A

gross motor
hearing speech and langauge
social emotional and behaviour
Vision and fine motor

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2
Q

What is meant by limit age?

A

Limit age = 2 SD from the mean in terms of skill acquisition

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3
Q

Median and limit age for walking?

A

12 months = median

18 months = limit

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4
Q

What normal variation pattern of gross motor can cause late walking?

A

commando crawl, bottom shuffling

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5
Q

How are development milestones adjusted for prematurity?

A

correction made for preterm birth up till 2 years of age.

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6
Q

what are the 5 primitive reflexes?

A

Moro- sudden extension of head cause symmetrical extension then flexion of the arm
Grasp reflex
Rooting
Stepping response
Asymmetrical tonic neck reflex- lying supine, the infant adopts an outstretched arm to the side to which the head is turned

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7
Q

What are the 4 postural reflexes?

A

Labyrinthine righting- hed moves in opposite direction to which the body is tilted.
Postural support- when held upright legs take weight and may push up
Lateral propping- in sitting, the arm extends on the side to which the child falls as a saving mechanism
Parachute- when suspended face down the arms extends as though to save themself.

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8
Q

Gross motor development median ages

A 
Newborn- marked headlag when pulling up
6-8 weeks- raised head to 45* when prone
6-8 months- sits without support (round back at 6, straight back at 8 months)
8-9 months- crawling
10 months- cruises around furniture
12 months- walks unsteadily, broad gait
15 months - walks steadily
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9
Q

Vision and fine motor development median ages

A

6 weeks- follows moving object or face by turning head
4 months- reaches out for toys
4-6 months- palmar grasp
7 months- toy transfer between hands
10 months - pincer grip
16-18 months- makes marks using crayon
Shapes: line(2years), circle(3), cross(3.5), square(4), triangle(5)

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10
Q

Hearing, speech and language median ages

A

Newborn- startles to loud noise
3-4 months- vocalises alone or when spoken to, coos and laughs
7 months- turns to soft sound out of sight
7-10 months- dada mama
12 months- two to three words other than dada mama
18 months- 6-10 words and shows two parts of body
20-24 months- uses two or more words to make a simple phrase
2.5-3 years- talks constantly in 3-4 words sentences

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11
Q

Social emotional and behavioural development median ages

A

6 weeks- smiles responsively
6-8 months- puts food in mouth
10-12 months- waves bye bye, plays peak a boo
12 months- drinks form a cup with two hands
18 months- holds spoon and gets food safely to mouth
18-24 months- symbolic play
2 years- dry by day
2.5-3 years- parallel play, interactive play evolving, taking turns

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12
Q

Limit ages for gross motor

A

head control- 4 months
sits supported - 9 months
stands independently- 12 months
walking- 18 months

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13
Q

Limit ages for vision and fine motor

A

fixes and follows- 3 months
reaches out for objects- 6 months
transfers- 9 months
pincer grip- 12 months

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14
Q

Hearing, speech and language development limit ages

A 
polysyllabic babble- 7 months
constant babble- 10 months
saying 6 words with meaning- 18 months
joins words- 2 years
3 word sentences- 2.5 years
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15
Q

Social, emotional and behaviour development limit ages

A 
smiles- 8 weeks
fear of stranger- 10 months
feeds self/spoon- 18 months
symbolic play- 2/2.5 years
interactive play- 3/3.5 years
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16
Q

Vaccine timeline babies under 1

A

when born- BCG (repeat 1,2,12 months), Hep B for high risk
8 weeks- 6-in-1 vaccine, Rotavirus vaccine, MenB

12 weeks- 6-in-1 vaccine (2nd dose), Pneumococcal ,(PCV) vaccine, Rotavirus vaccine (2nd dose)

16 weeks- 6 in 1 (3rd dose), Men B

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17
Q

Vaccine timeline 1-15 years

A

1 year- Hib/Men C, MMR, PCV(2nd dose), Men B(third dose)

2-10 years- flu vaccine every year

3 years and 4 months- MMR, 4 in 1 pre school booster

12- 13 years- HPV vaccine

14 years- 3 in 1 teenage booster, Men ACWY

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18
Q

Whats in 6 in 1
4 in 1
3 in 1?

A 
6 in 1 = HHPPDT
hep b, haemophilus influenzae B, polio, pertussis, tetanus, diptheria
4 in 1-  PPDT
polio, pertussis, HiB, diptheria
3in 1-  PDT
polio, tetanus and diptheria
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19
Q

What are the ways to test hearing in a newborn?

A

Evoked otoacoustic emission- misses auditory neuropathy

Automated auditory brainstem response- effected by movement, needs to be done when infant asleep

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20
Q

Define: delay, learning difficulty, disorder

A

Delay- implies slow acquisition of all skills or of one particular field or area of skill particulary in 0-5 years age group
learning difficulty- school age- cognitive, physical both or related to specific functional skill
disorder- maldevelopment of a skill

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21
Q

Define cerebral palsy

A

abnormality of movement and posture, causing activity limitation attributed to non progressive disturbances that occured in the developing fetal or infant brain before the age of 2.

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22
Q

What are the causes of CP?

A

80% antenatal in origin- vascular occlusion, cortical migration disorder or structural maldevelopment during gestation.
10%- due to hypoxic-ischaemic injury during delivery

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23
Q

Which TCA may be used in OCD?

A

Clomipramine - high serotoninergic effect

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24
Q

what is the surgery for OCD?

A

psychosurgery- anterior cingulotomy

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25
what are the symptoms of PTSD?
reliving hypervigilance avoidance
26
What are the psychotherapies for PTSD?
EDMR, CBT trauma focused
27
Pharmacological therapy for PTSD?
mirtazapine/SSRI/venlaflaxine
28
what is a dissociative fugue?
amnesia + journey
29
which dementia is micrographia common?
parkinson's
30
when is expressive dysphasia common?
after stroke
31
what are the most common infections in neonates?
listeria, group b strep and ecoli
32
how are the common infections treated in neonates?
cefotaxime and amoxicillin IV
33
why is ceftriaxone contraindicated in neonates?
can cause cholestasis jaundice
34
What is seen in small bowel biopsy of coeliac disease?
villous atrophy, crypt hyperplasia, intraepithelial lympocytes
35
What is the management of coeliac disease?
Lifelong gluten free diet pneumovax as hyposplenic Increased risk of enteropathy associated T cell lymphoma. Other AI e.g. dermatitis herpetiformis- treat with dapsone
36
What are the most common causes of jaundice <24h life?
``` Haemolytic disorder: Rhesus incompatibility ABO incompatibility spherocytosis, pyruvate kinase deficiency. Congenital infections ```
37
what investigations are done in neonatal jaundice <24h life?
Serum bilirubin Group and DAT(coombs') blood culture, CRP and IV abx
38
Management of neonatal jaundice <24h?
phototherapy, exchange transfusion
39
during phototherapy how often is bilirubin checked?
6-12 hours
40
what causes kernicterus?
unconjugated bilirubin can cross BBB and deposit in basal ganglia permanently
41
How does kernicterus present?
acute manifestation- lethargy and poor feeding | severe cases: irritability, increased muscle tone: arched back(opisthotonos)
42
what type of cerebral palsy is associated with kernicterus?
choreoathetoid cerebral al palsy
43
what can be used to initially check bilirubin level?
transcutaneous bilirubin meter- if high check with blood laboratory measurement
44
How is biliary atresia managed?
Kasai procedure
45
what is the pathophysiology of Wilson's disease?
AR mutation chr 13 reduced synthesis of caeruloplasmin. Defective excretion of copper in bile leading to accumulation in liver, brain, kidney and cornea
46
what are the clinical features of wilson's disease?
Liver disease, neuropsychiatric features- poor school performance, behaviour change\
47
how is wilson's disease investigated?
Serum caeruloplasmin- low | liver biopsy- increased copper deposit
48
How is wilson's disease managed?
treatment- penicillamine - promotes copper excretion
49
organisms that cause UTI in paeds?
E.coli Klebsiella proteus serratia
50
management of UTI in paeds?
<3 months: admit and IV abx >3months: 1st line = trimethoprim 2nd line - nitrofurantoin/ amoxicillin/ cefalexin
51
When is USS of renal tract done?
atypical features: not e.coli, poor flow , raised creatinine, bladder mass, septic, not responding to treatment
52
when is DMSA done?
in all children under 3 with atypical or recurrent | in all children over 3 with recurrent UTI
53
what is recurrent UTI?
two upper UTI 1x upper + 1x lower or 3x lower
54
MCUG full form?
micturating cysto urethrogram
55
What are the different grades of vesicoureteric reflux?
1: milf reflux into ureter without dilatation 2: reflux into ureter and collecting duct 3: mild dilatation of ureter, renal pelvis and calyces 4: dilation of renal pelvis calyces, tortuous 5: gross dilation.
56
how is vesicoureteric reflux managed?
abx proph | surgery
57
how to differentiate between IgA nephropathy and post rep glomerulonephritis?
days = IgA | 1-2 weeks - post strep. In investigation low c3 level and raised ASOT
58
what is the triad of goodpasture?
glomeruolonephritis pulmonary haemorrhage anti-GDM antibody formation Haemoptysis and haematurea
59
how will alports syndrome present?
X linked SBA: haematuria + hearing loss + herieditary female carriers may have haematuria
60
how does wilms tumour present?
most common childhood abdominal malignancy median age = 3.5 years abdominal mass doesn't cross midline, abdo pain, haematuria, HTN, claw sign= CT
61
how is Wilms tumour managed?
surgery | chemotherapy
62
how does HSP present?
IgA mediated AI vasculitis preceding URTI erythematous macular rash, fever, abdo pain, bloody diarrhoea Age= 3-10 more common male
63
how is HSP managed?
Henoch schonlein purpura- supportive, monitor for renal involvement- regular BP and urine dips- weekly for 4 weeks, 5-12 every 2 weeks, then 6 months and 12 months
64
how does nephrotic syndrome present? most common = minimal change disease
proteinuria oedema: periorbital, scrotal, SOB, leg, ankles, ascites hypoalbuminaemia <30g/L hyperlipidaemia and thrombophilia
65
how is nephrotic syndrome managed?
steroid sensitive: prednisolone 4 weeks and then reduced dose for 4 weeks
66
how is minimal change diagnose?
light microscope- looks normal | electron microscope- fusion of epithelial podocytes - it is steroid resistant
67
Molluscum contagiosum presentation
pearly - caused by poxvirus
68
impetigo presentation
gold crust Staph A tx= fusidic acid if mild, flucloxacillin if moderate stay off school until crusted over- very infectious
69
eczema herpeticum presentation?
vesicles = herpes HSV1/2 on eczema tx= PO/IV aciclovir emergency in under 2 years old
70
hand foot and mouth disease?
coxsackie virus, associated with fevers and sore throat symptomatic treatment- antipyretic, difflam spray continue school
71
what is port wine strain syndrome associated with?
sturge weber syndrome= haemangiomatous facial lesion in distribution of trigeminal nerve CT head- intracranial abnormalities management- seizure control, laser for PWS, regular monitoring
72
erythema toxicum neonatorum presentation?
very common in newborn, improves in 1-2 weeks non threatening
73
croup presentation?
also called laryngotracehobronchitis, caused by parainfluenza, RSV, adenovirus barking cough and stridor, worse at night and better by cold air
74
management of croup?
don't examine throat PO dexamethasone 0.15mg/kg severe- nebulised adrenaline
75
Epiglottitis management?
``` High fever sore throat drooling tripodding difficulty breathing- secure airways IV- ceftriaxone ```
76
when to admit child with bronchiolitis?
less than half feeds requires oxygen or in resp distress high risk e.g. <3months, premature, chronic lung disease, social concerns
77
orbital cellulitis presentation ?
``` proptosis pain on movement reduce visual acuity Need CT head to assess spread of infection urgent ENT and opthalmology assessment ```
78
management of neonatal sepsis?
<72 hours = IV benpen and gent | >72 hours = IV cefotaxime and amoxicillin
79
management of kawasaki?
aspirin and IV IG
80
why not give amoxicillin for toncilitis?
widespread maculopapular rash if due to in infectious mononucleosis
81
what causes scarlet fever?
group a b-haemolytic streptococcus
82
causes of stridor?
most common- croup epiglottitis foreign body bacterial tracheitis
83
causes of croup?
parainfluenza, rhinovirus, RSV,
84
clinical feature of croup?
hoarseness, stridor, barking seal like cough
85
management of croup?
oral dexamethasone, oral prednisolone, nebulized budesonide if severe nebulised epinephrine
86
clinical features of acute epiglottitis?
severe sore throat, soft whispering stridor, high fever, drooling, cough minimal or absent
87
management of acute epiglottitis?
call ENT, anaesthetist, ICU, intubated under GA after airway secure- take blood for culture AB- cefotaxime for 3-5 days prophylaxis with rifampicin offered to household
88
common cause of bacterial tracheitis?
staphylococcus aureus
89
causes of bronchiolitis?
RSV, parainfluenza, rhinovirus, adenovirus, influenza, human metapneumovirus
90
bronchiolitis clinical presentation?
dry wheezy cough, tachypnoea, subcostal and intercostal recession, hyperinflation of the chest, fine end inspiratory crackles
91
Investigation for bronchiolitis and when to admit to hospital?
only pulse oximetry | admit when: apnoea, oxygen sat <90%, inadequate oral fluid intake (50-75%), severe resp distress
92
features of severe resp distress?
grunting, chest recession, resp rate over 70
93
define bronchiolitis obliterans?
permanent damage to the airways, adenovirus
94
clinical feature of wheeze?
polyphonic wheeze | eczema?
95
Investigations for asthma/wheeze?
history and examination alone skin prick to identify common allergens Peak flow meter spirometry- improvement of FEV after bronchodilators suggests asthma 12% or more improvement
96
salbutamol
short acting B2 agonist
97
terbutaline
short acting b2 agonist
98
ipratropium bromide
anticholinergic
99
examples of inhaled steroids
budesonnide, beclometasone
100
example of LABA?
salmeterol
101
leukotriene receptor antagonists example?
montelukast
102
oral steroid for asthma?
prednisolone
103
what should be monitored if a child is started on either inhaled steroids or oral?
monitor growth of child
104
management of acute asthma?
oxygen if sats <92% b2 bronchodilator using spaces, if severe nebulised nebulised ipratropium bromide prescribe oral prednisolone Bolus- magnesium sulfate, salbutamol, aminopylline- if already on theophylline omit loading dose and just continuous infusion
105
how is asthma severity assessed?
``` ability to speak resp rate heart rate Consciousness inspiratory effort oxygen saturation peak flow ```
106
brittle asthma definition?
rapid onset severe asthma
107
questions to ask in presentation of asthma?
``` disturbance to sleep disturbance to school other allergies: hayfever, eczema, food allergy peak flow diary? inhaler technique exercise intolerance ```
108
cause of whooping cough
bordetella pertussis diagnosis: culture of organism on pernasal swab, marked lympcytosis on blood film management: macrolide erythromycin, azithromycin
109
which organisms cause persistent cough?
pertussis, RSV, mycoplasma
110
causes of pneumonia in children of different ages?
newborn- group b strep, gram neg enterococci | infants and young children: RSV, pneumococcus, HIB, pertussis, chlamydia

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