Physiology Flashcards
(310 cards)
1
Q
Term Infant
A
An individual born after 37 weeks of gestation
2
Q
Post-Term Infant
A
An individual born after 41 weeks of gestation
3
Q
Normal gestational size
A
2.5-4.0 kg
4
Q
Large for gestational age
A
> 4.0 kg
5
Q
Small for gestational age
A
<2.5 kg
6
Q
Daily weight gain during the third trimester
A
24g
7
Q
Daily fat gain in the last 4 weeks of gestation
A
7g
8
Q
The third trimester enables transplacental transfer of what? (5)
A
Iron
Vitamins
Calcium
Phosphate
Antibodies
9
Q
What hormones can enhance adaptation following birth? (2)
A
Cortisol
Adrenaline
10
Q
Perinatal Adaptation: Impacts on the lungs (4)
A
First breath or cry
Alveolar expansion
Decreased pulmonary arterial pressure
Increased partial pressure of oxygen
11
Q
Perinatal Adaptation: Impact on the circulatory system
A
Changes from foetal to newborn circulation
12
Q
Perinatal Adaptation - how is this measured?
A
Apgar score
13
Q
Perinatal Adaptation: Normal Apgar Score
A
> 8
14
Q
What initial change does the baby experience with regards to the GIT system?
A
Dramatic change from continuous glucose infusion to intermittent bolus enteral feeds
15
Q
Disease Prevention: What infections should be assessed?
A
Hepatitis B and C
HIV
Syphilis
Tuberculosis
Group B Streptococcus infection
16
Q
Screening: What 5 components take up the general screen?
A
Universal hearing screening
Hip screening
Cystic Fibrosis
Haemaglobinopathies
Metabolic Disease
17
Q
Screening: What metabolic diseases are babies screened for? (6)
A
PKU - Phenylketonuria
MCADD - Medium Chain Acyl CoA Dehydrogenase Deficiency
MSUD - Maple Syrup Urine Disease
IVA - Isovaleric Acidaemia
GA1 - Glutaric Aciduria Type I
HCU - Homocystinuria
18
Q
Patients with Homocystinuria (HCU) are unresponsive to what?
A
Pyridoxine
19
Q
Screening: The Head should be assessed for what? (7)
A
Occipitofrontal circumference
Overlapping sutures
Fontanelles
Ventouse or Forcep marks
Moulding
Cephalhaematoma
Caput Succedaneum
20
Q
Screening: The Eyes should be assessed for what? (5)
A
Size
Red reflex
Conjunctival haemorrhage
Squints
Iris abnormality
21
Q
Screening: The Ears should be assessed for what? (5)
A
Position
External auditory canal
Tags or Pits
Folding
Family history of hearing loss
22
Q
Screening: The Mouth should be assessed for what? (7)
A
Shape
Philtrum - midline groove running from the top of the lip to the nose
Tongue tie
Palate
Neonatal Teeth
Ebsteins Pearl
Sucking and Rooting Reflex
23
Q
Ebsteins Pearl
A
Cyst formations on the gums and roof of the mouth
24
Q
Screening: The face should be assessed for what? (2)
A
Facial palsy
Dysmorphism
25
Screening: A Respiratory Examination should look for what? (6)
Chest shap
Nasal flaring
Grunting
Tachypnoea
In-drawing
Breath sounds
26
Screening: A Cardiovascular Examination should look for what? (5)
Colour and Saturation
Femoral Pulses
Apex
Thrill and Heaves
Heart sound abnormalities
27
Screening: An Abdominal Examination should look for what? (7)
Movement with respiration
Distension
Hernia
Umbilicus
Bile-stained vomit
Passage of the meconium
Anus
28
Screening: A Genitourinary Examination should look for what? (4)
Normal passage of urine
Normal genitalia
Undescended testes
Hypospadius
29
Hypospadius
Birth defect in which the opening of the urethra is not located at the tip of the penis
30
Screening: What primitive reflexes should be assessed in a Neurological Examination? (6)
Suckling
Rooting
Moro
ATNR - Asymmetrical tonic neck reflex
Stepping
Grasp
31
Moro Reflex
Startle reflex in the neonate to a loud noise or fast movement
32
ATNR (Asymmetrical Tonic Neck Reflex)
When a babies face is turned to one side, the same side has extended and relaxed limbs whereas the opposite side has flexed limbs
33
ATNR is also known as the ... reflex due to the position that the baby resembles
Fencer
34
Screening: A Skin Examination should look for what? (4)
Erythema Toxicum
Congenital dermal melanocytosis
Strawberry haemangioma
Naevus Flammeus
35
Preterm Infant
An individual that is born before 37 completed weeks of gestation
36
Infant Death is strongly influenced by what 6 factors?
Preterm delivery
Low Birth Weight
Maternal Age
Smoking
Deprivation status
Complications during labour
37
Causes of Preterm Birth (7)
Pre-term pre-labour rupture of membranes
Multiple pregnancies
Spontaneous preterm labour
Cervical incompetence or uterine malformation
Antepartum haemorrhage
Intrauterine growth restriction
Pregnancy-associated hypertension
38
Risk Factors for Pre Term Birth - Obstetric (6)
Previous >2 preterm deliveries
Abnormally shaped uterus
Multiple pregnancy - twins or triplets
Interval <6 months between pregnancies
Conceiving through IVF
Multiple miscarriages or abortions
39
Risk Factors for Pre Term Birth - Life style (4)
Smoking
Drinking alcohol
Illicit drugs
Poor nutrition
40
RDS
Respiratory Distress Syndrome
41
PDA
Patent Ductus Arteriosus
42
IVH
Intraventricular Haemorrhage
43
NEC
Necrotising Enterocolitis
44
Altered Approach: What are the 5 components?
Delayed cord clamping
Keep warm
Gentle lung inflation
Initial oxygen concentration
Using a saturation monitor
45
Thermoregulation: Why may a preterm baby have ineffective thermal regulation? (4)
Low BMR
Minimal muscular activity
Subcutaneous fat insulation is negligible
High surface area to mass ratio
46
Thermoregulation: Mechanisms of Temperature control? (4)
Wraps or bags
Skin to skin
Pre-warmed incubator
Transwarmer mattress
47
Why are preterm babies at a greater risk of nutritional compromise? (4)
Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands
48
EOS
Early Onset Neonatal Sepsis
49
LOS
Late Onset Neonatal Sepsis
50
Early Onset Neonatal Sepsis is mainly due to what?
Bacteria acquired before or during delivery
51
Late Onset Neonatal Sepsis is mainly due to what?
Noscomial or Community-acquired infection following birth
52
Causative Organisms of Early Onset Sepsis (2)
Group B Streptococcus
Gram Negative Bacteria
53
Causative Organisms of Late Onset Sepsis (3)
Coagulase Negative Staphylococci
Gram Negative Bacteria
Staphylococcus aureus
54
Respiratory Complications of Prematurity: Main Concerns (3)
Respiratory Distress Syndrome
Apnoea of Prematurity
Bronchopulmonary Dysplasia
55
Respiratory Distress Syndrome: Primary Aetiology (2)
Surfactant deficiency
Structural immaturity
56
Respiratory Distress Syndrome: Secondary Aetiology
Alveolar damage causes the formation of exudate from leaky capillaries with inflammation
57
Respiratory Distress Syndrome: Clinical features (5)
Tachypnoea
Grunting
Intercostal recession
Nasal flaring
Cyanosis
58
Respiratory Distress Syndrome: Time frame
Worsens over minutes to hours
59
Intraventricular Haemorrhage: Grade 1-2
Has a low risk of neurodevelopmental delay or mortality
60
Intraventricular Haemorrhage: Grade 3-4
Has a high risk of neurodevelopmental delay or mortality
61
Neonatal Jaundice: Jaundice
Clinical sign of yellow discolourisation of the skin and sclera
62
Neonatal Jaundice: Clinical presentation in neonates (2)
Cephalocaudal progession - face to toe progression
Appears on day 2-3 of life
63
Neonatal Jaundice: Physiology - It is a result of what?
Elevated bilirubin
64
Neonatal Jaundice: Physiology - Bilirubin is produced from what?
Breakdown of haem of erythrocytes
65
Neonatal Jaundice: Physiology - Bilirubin breakdown produces what?
Unconjugated bilirubin that circulates bound to albumin
66
Neonatal Jaundice: Physiology - First stage of Bilirubin synthesis
Heme forms Biliverdin via Heme Oxygenase via opening of the alpha-oxygenase bridge of heme
67
Neonatal Jaundice: Physiology - Second stage of Bilirubin synthesis
Biliverdin to Bilirubin via Biliverdin Reductase
68
Neonatal Jaundice: Physiology - First stage of Bilirubin Metabolism
Unconjugated bilirubin is converted to conjugated bilirubin via the liver
69
Neonatal Jaundice: Physiology - Is unconjugated bilirubin water soluble?
No
70
Neonatal Jaundice: Physiology - Is conjugated bilirubin water soluble?
Yes
71
Neonatal Jaundice: Physiology - Conversion of Bilirubin from Unconjugated to Conjugated form is reliant upon what?
Bilirubin uptake via Ligandin and UDP conjugation
72
Neonatal Jaundice: Physiology - Second stage of Bilirubin Metabolism
Conjugated bilirubin excreted into the GIT
73
Neonatal Jaundice: Physiology - In neonates what is different about bilirubin metabolism?
Percentage of conjugated bilirubin reverts to unconjugated bilirubin to be recirculated into the blood stream via enterohepatic circulation
74
Gilberts Disease
Mutation of the UGT1A1 gene that results in reduced bilirubin UDP activity to worsen jaundice
75
Neonatal Jaundice: 2 main complications
Kernicterus
Cerebral Palsy
76
Kernicterus
Brain damage as a result of elevated bilirubin concentrations in the neonate due to the movement of Bilirubin across the BBB
77
Neonatal Jaundice: Exacerbating Factors (7)
Decreasing gestational period
Asphyxia - oxygen deprivation
Acidosis
Hypoxia
Hypothermia
Meningitis
Sepsis
78
Neonatal Jaundice: Timing - Early
0-24 hours after birth
79
Neonatal Jaundice: Timing - Physiological
24-72 hours after birth
80
Neonatal Jaundice: Timing - Late
>14 weeks in term neonates and 21 days in preterm neonates
81
Neonatal Jaundice: Physiological Jaundice - Onset
Day 2
82
Neonatal Jaundice: Physiological Jaundice - Peak
Day 5
83
Neonatal Jaundice: Physiological Jaundice - Resolves by when?
10-14 days
84
Neonatal Jaundice: Physiological Jaundice - Development pathway (5 stages)
1. Increased production of bilirubin - due to foetal RBC life span being 2/3 of adults
2. Decreased uptake and binding by liver cells
3. Decreased conjugation
4. Decreased excretion
5. Increased enterohepatic circulation of bilirubin
85
Neonatal Jaundice: Pathological Jaundice - Onset
Day 1
86
Neonatal Jaundice: Pathological Jaundice - Prolonged after what?
Day 14
87
Neonatal Jaundice: Too Early Jaundice (<24 hours) - Aetiology
Haemolysis with excessive production of bilirubin or sepsis
88
Neonatal Jaundice: Too Early Jaundice (<24 hours) - Haemolysis can be due to what? (3)
ABO incompatibility
Rh immunisation
Sepsis
89
Neonatal Jaundice: Too Early Jaundice (<24 hours) - Consider hepatitis as cause when?
Substantial elevation in conjugated bilirubin
90
Neonatal Jaundice: Too Early Jaundice (<24 hours) - Example of red cell enzyme defects
G6PD deficiency
91
Neonatal Jaundice: Too Early Jaundice (<24 hours) - Example of cell membrane defect
Hereditary spherocytosis
92
Neonatal Jaundice: Too Early Jaundice (<24 hours) - Required Investigations (5)
Total Bilirubin Concentration
Maternal blood group and antibody titres - if Rh negative
Babies blood group - agglutination or elution tests
FBC
CRP
93
Neonatal Jaundice: Too Late Jaundice (24 hours to 10 days of age) - Pathophysiology
High levels of unconjugated bilirubin cross the BBB to cause bilirubin encephalopathy
94
Neonatal Jaundice: Too Late Jaundice (24 hours to 10 days of age) - Aetiologies (5)
Mild dehydration or insufficient milk supply
Breakdown of extravasated blood
Haemolysis
Infection
Increased enterohepatic circulation
95
Neonatal Jaundice: Too Late Jaundice (24 hours to 10 days of age) - Examples of breakdown of extravasated blood (2)
Cephalohaematoma
Bruising
96
Neonatal Jaundice: Clinical Presentation of Encephalopathy - Musculoskeletal (3)
Hypotonia
Opisthotonos - arching of the head, neck and back
Spasticity and Seizures
97
Neonatal Jaundice: Clinical Presentation of Encephalopathy - General (3)
Lethargy
Poor feeding
Temperature instability
98
Neonatal Jaundice: Prolonged Jaundice - Time period
>14 days in term neonates or 21 days in preterm neonates
99
Neonatal Jaundice: Prolonged Jaundice - Aetiology of Unconjugated Hyperbilirubinaemia (5)
Breast milk Jaundice - do not stop breast feeding
Poor milk intake
Haemolysis
Infection
Hypothyroidism
100
Neonatal Jaundice: Prolonged Jaundice - Aetilogies of Conjugated Hyperbilirubinaemia (4)
Hepatitis
Biliary Atresia
Hypothyroidism
Breast Milk Jaundice
101
Neonatal Jaundice: Prolonged Jaundice (Conjugated Hyperbilirubinaemia) - Causes of Hepatitis (2)
Infection - Toxoplasmosis, Rubella, CMV, Hepatitis or Syphilis
Metabolic Disorders - Galactosaemia
102
Neonatal Jaundice: Prolonged Jaundice (Conjugated Hyperbilirubinaemia) - Biliary Atresia Clinical Presentation
Pale stools with dark urine that is not thriving
103
Neonatal Jaundice: Prolonged Jaundice (Conjugated Hyperbilirubinaemia) - Management of Biliary Atresia
Kasai Protoenterostomy before 3 months of age
104
Neonatal Jaundice: Prolonged Jaundice (Conjugated Hyperbilirubinaemia) - Blood results for Breast Milk Jaundice (3)
Normal conjugated portion
Normal FBC
Normal Blood Cross Matching
105
Neonatal Jaundice: Management - Best way to reduce enterohepatic circulation of bilirubin
Enteral feeding
106
Neonatal Jaundice: Management - Main Treatment
Phototherapy
107
Neonatal Jaundice: Management - Mechanism of Action of Phototherapy
Changes the structure of bilirubin so that it is more soluble for excretion
108
Neonatal Jaundice: Management - UV range for Phototherapy
460-490 NM (Blue-Green Light)
109
Neonatal Jaundice: Management - Exchange Transfusion used for what? (2)
Haemolytic Disease
Isoimmune Haemolytic Disease
110
Neonatal Jaundice: Management - Exchange Transfusion for Haemolytic Disease
Remove babies own red blood cells and replace them with blood matched to the mothers
111
Neonatal Jaundice: Management - Exchange Transfusion for Isoimmune Haemolytic Disease and Indications
IV Immunoglobulin delivered to baby if bilirubin rises despite intensive phototherapy
For Rhesus/ABO disease with total bilirubin concentration >8.5 mmol/L/hour OR Bilirubin within 30-50 micromol of exchange transfusion line
112
Nutrition: Benefits of Skin-to-Skin Care (4)
- Regulation temperature, heart rate and respiratory rate
- Reduce stress hormones
- Enables lactation hormones to be produced in the mother
- Colonisation of babies microbiome by parental microbes
113
Breast Feeding: Reduces the risk of what? (3)
Incidence of otitis media
Dental caries
Malocclusion
114
Breast Feeding: Breast Milk Reduces the risk of what diseases? (4)
Infections
Allergies
SIDS
Leukaemia
115
Breast Feeding: Reduces the risk of what in mothers?
Breast and ovarian cancer
Cardiovascular disease
Osteoporosis
Obesity and Type II Disease
116
The Prolactin Receptor Theory: Alveolus sacs are surrounded by what? (2)
Alveolus
Lactocytes
117
The Prolactin Receptor Theory: Lactocytes are surrounded by what?
Myoepithelial Cells
118
The Prolactin Receptor Theory: Function of myoepithelial cells
Contract to send milk to the ducts and nipples
119
The Prolactin Receptor Theory: Where are prolactin receptors located?
On the cell wall of each lactocyte
120
The Prolactin Receptor Theory: Prolactin in mothers increases in response to what?
Touch and suckling
121
Lactation: First Stage
Lactogenesis 1 - Breast development and colostrum production from 16 weeks gestation
122
Lactation: Second Stage
Lactogenesis 2 - Onset of copious milk secretion occuring between 32 and 96 hours of birth
123
Lactation: Third Stage
Maintenance of milk production
124
Hormones: When is prolactin high?
At night
125
Hormones: Oxytocin Function
Causes milk delivery
126
Hormones: What can delay oxytocin production?
Stress
127
Hormones: Function of progesterone
Inhibits milk production by inhibiting prolactin
128
Tongue Tie: Presentation - During feeding (2)
Difficulty attaching to the breast and staying attached for a full feed
Feed for a long time, have a short break and then feed again
129
Tongue Tie: Presentation - What sound is made when they feed?
Clicking sound
130
Tongue Tie: Presentation - Of the tongue (3)
Difficulty moving tongue side to side or lifting it
Difficulty sticking their tongue out
Tongue looks heart shaped when they stick it out
131
Vitamin D: Why is Vitamin D important in pregnancy?
Pregnant and Breast Feeding women are at risk of Vitamin D deficiency
132
Vitamin D: Vitamin D Dose during pregnancy
10 micrograms alongside Vitamin C and Folic Acid
If BMI>30 requires 25 micrograms during pregnancy and breastfeeding
133
Vitamin D: Vitamin D dose during breastfeeding
10 micrograms - taken immediately before breast feeding and as a single dose
134
Nipple Trauma: Breast Thrush - Clinical presentation
Deep pain in both breasts with itching and dry skin
135
Nipple Trauma: Breast Thrush - Management
Miconazole Nitrate Topical Cream
136
Nipple Trauma: Breast Thrush - Management if baby has oral thrush
Miconazole Topical Cream + Nystatin
137
Nipple Trauma: Engorgement - Aetiologies (4)
Ineffective attachment
Restricted access to the breast
Use of a dummy
Supplementation with formula milk
138
Engorgement
Breasts become overly full
139
Nipple Trauma: Engorgement - Clinical Presentation
Hard tight and painful breasts
140
Nipple Trauma: Mastitis - Management
Prescribe Flucloxacillin 1g 4x per day (Clindamycin if allergic to penicillin)
141
Nipple Trauma: Breast Abscess - Management
IV antibiotics
Then drainage if ineffective management with antibiotics
142
Dietary Reference Values: LRNI
Lower Reference Nutrient Intake - sufficient for 2.5% of the population with the lowest needs
143
Dietary Reference Values: EAR
Estimated Average Requirement - Average energy requirements of a population (50% will need more and 50% will need less)
144
Dietary Reference Values: RNI
Reference Nutrient Intake - Sufficient for 97.5% of the population
145
Wasting
Low weight for height
146
Stunting
Low height for weight
147
Underweight
Low weight for age
148
Normal Child Development: Developmental Milestones
Key stage when a new skill is developed
149
Normal Child Development: Median Age
Age when 50% of the population achieve a new skill
150
Normal Child Development: Limit Age
Age when individuals should have been acquired by 97.5% of children
151
Normal Child Development: Main 4 ares of development
Gross Motor Skills
Fine Motor and Vision
Language and Hearing
Social behaviour and playing
152
Gross Motor Skill Milestones: 6 weeks
Head control in vertical
153
Gross Motor Skill Milestones: 3 months
No head lag on pulling to a sit
154
Gross Motor Skill Milestones: 6 months (3)
Pushes up on arms in prone
Can roll from stomach to bac
Weight bears on leg
155
Gross Motor Skill Milestones: 9 months (3)
Sits well and leans forward to reach toys
Stands holding on to furniture
May crawl
156
Gross Motor Skill Milestones: 12 months (2)
Cruises
May take first step
157
Gross Motor Skill Milestones: 18 months (2)
Runs
Climbs onto the adult chair
158
Gross Motor Skill Milestones: 2 years (2)
Ascends and descends stairs 2 feet per tread
Can throw ball overhead
159
Gross Motor Skill Milestones: 3 years (3)
Upstairs with alternating feet
Stands on one foot momentarily
Pedals tricycle
160
Gross Motor Skill Milestones: 4 years (3)
Runs up and down the stairs
Can kick, throw and catch a ball
Hops on foot
161
Fine Motor and Vision Skill Milestones: 6 weeks
Follows the torch with eyes
162
Fine Motor and Vision Skill Milestones: 3 months
Hands held in the midline
163
Fine Motor and Vision Skill Milestones: 6 months (3)
Transfer objects hand to hand
Palmar grasps
Mouths objects
164
Fine Motor and Vision Skill Milestones: 9 months (2)
Uses index finger to point
Picks up tiny objects between thumb and hand
165
Fine Motor and Vision Skill Milestones: 18 months (3)
Builds tower of 3-4 bricks
Has a hand preference
Enjoys picture books
166
Fine Motor and Vision Skill Milestones: 12 months (2)
Neat fine pincer grip
Bangs toys together
167
Fine Motor and Vision Skill Milestones: 2 years (2)
Build a tower of 6-7 bricks
Circular scribble
168
Fine Motor and Vision Skill Milestones: 3 years (3)
Builds tower of 9-10 bricks
Copies circle
Cuts with scissor
169
Fine Motor and Vision Skill Milestones: 4 years (3)
Threads beads
Copies cross
Draws a man
170
Language and Hearing Milestones: 6 weeks
Stills to voice
171
Language and Hearing Milestones: 3 months (2)
Vocalises with a familiar person
Laughs and Coos
172
Language and Hearing Milestones: 6 months (2)
Babbles tunefully
Screams when annoyed
173
Language and Hearing Milestones: 9 months (3)
Localises sound consistently
Polysyllabic babble
Imitates sounds
174
Language and Hearing Milestones: 12 months (2)
Knows and responds to name
Jargons vowels and consonants
175
Language and Hearing Milestones: 18 months (2)
5-20 words
Points to body parts
176
Language and Hearing Milestones: 2 years (3)
50+ words - joins 2 words
Talks to self
Understands simple instructions
177
Language and Hearing Milestones: 3 years (4)
Knows own name and gender
Asks lots of questions
Carries on simple conversations
Understands prepositions
178
Language and Hearing Milestones: 4 years (3)
Recounts stories
Sentences
Counts to 20
179
Social and Play Milestones: 6 weeks
Social Smile
180
Social and Play Milestones: 3 months
Reacts pleasureably to familiar situations
181
Social and Play Milestones: 6 months (2)
Still friendly with strangers
Plays with feet
182
Social and Play Milestones: 9 months (3)
Anxious around strangers
Plays Peek-A-Boo
Object permanence
183
Social and Play Milestones: 12 months (2)
Drinks from cup
Waves bye-bye
184
Social and Play Milestones: 18 months (2)
Feeds with spoon
Imitates adult activities
185
Social and Play Milestones: 2 years (2)
Puts on hats and shoes
Developing symbolic play
186
Social and Play Milestones: 3 years (3)
Washes hands
Vivid pretend play
Understands sharing and plays with others
187
Social and Play Milestones: 4 years (2)
Dresses and undresses
Understands turn takers
188
Neonatal Genetics: Options for Genetic Testing in Foetuses (3)
Chorionic Villus Biopsy
Amniocentesis
Maternal Serum Sample
189
Neonatal Genetics: Amniocentesis detects what? (2)
Skin and urine cells of the foetus
190
Neonatal Genetics: Chorionic Villus Biopsy conducted when?
11.5 weeks
191
Neonatal Genetics: Amniocentesis conducted when?
15 + weeks
192
Neonatal Genetics: Benefit of Maternal Serum Sample
Enables non-invasive prenatal testing via free foetal DNA in the maternal circulation
193
Neonatal Genetics: Maternal Serum Sampling enables determination of what? (4)
Sex determination
Trisomy testing
Chromosome deletions
Single gene mutations
194
Neonatal Genetics: Chromosome Microarray - High risk of what if positive on Non-Invasive Prenatal Testing?
Chromosomal Trisomy
195
Neonatal Genetics: NIPT - Common cause of false positives
Cancer cells present within mother
196
Termination of Pregnancy: Time for surgical termination
<13 weeks
197
Termination of Pregnancy: Time for induction
>13 weeks
198
When is child length used for monitoring?
Before 2 years of age
199
When is child height used for monitoring?
Over 2 years of age
200
When is child height measured?
During expiration
201
Peak height velocity for boys
14
202
Peak height velocity for girls
12
203
Why is the height difference between men and women large? (3)
Boys have delayed peak height velocity
PHV is greater in men
Boys are taller in pre-puberty
204
Average age of puberty in females
11 years old
205
Average age of puberty in males
12 years old
206
Puberty: What staging system is used?
Tanner Staging
207
TCPP
True Central Precocious Puberty
208
TCPP Definition
Normal pubertal development occurring abnormally early
- Females - <8 years old
- Males - <9 years old
209
TCPP: More common in what sex?
Females
210
Pubertal Delay
Absence of secondary sexual development in a girl aged 13 or a boy aged 14
211
Pubertal Delay is more common in what sex?
Males
212
Short Stature
Less than 2nd centile or greater than 2 standard deviations below mid-parental height
213
Attachment: Infantile Attachment Features (3)
Attend to human voices
Recognise human faces
Gaze into parents eyes when being fed
214
Attachment: First stage of attachment - timing and features
Asocial stage - 0-6 weeks
- Smiling and crying is not directed at specific people
215
Attachment: Second stage of attachment - timing and features
Indiscriminate Attachment Stage - 6 weeks to 7 months
- Attention sought from different individuals
216
Attachment: Third stage of attachment - timing and features
Specific Attachment Stage - 7 to 11 months of age
- Strong attachment to one individual with separation and stranger anxiety
217
Attachment: Fourth stage of attachment - timing
Multiple Attachments - About 12 months old
218
Attachment: 4 types
Secure
Insecure avoidant
Insecure ambivalent or resistant
Disorganised
219
Secure Attachment: Separation anxiety
Distressed when the mother leaves
220
Secure Attachment: Behaviour around Strangers
Avoidant when alone then friendly when mother is present
221
Secure Attachment: Reunion with Mother behaviour
Positive and happy when mother returns
222
Ambivalent Attachment: Separation Anxiety
Infant shows signs of distress when the mother leaves
223
Ambivalent Attachment: Behaviour around Strangers
Avoids the stranger and shows fear
224
Ambivalent Attachment: Behaviour when reunited with mother
Child approaches the mother but resists contact
225
Ambivalent Attachment: Individual characteristic
Cries more and explores less than other types of attachment
226
Avoidant Attachment: Separation Anxiety
Infant shows no distress when mother leaves
227
Avoidant Attachment: Behaviour around Strangers
Infant plays normally when the stranger is present
228
Avoidant Attachment: Behaviour when reunited when mother
Shows little interest in mother
229
Secure Base
Attachment figure or relationship provides a safe space from which to explore the world
230
Safe Haven
The attachment figure or relationship is a safe place to retreat to at times of danger or anxiety
231
Attunement
Process between caregiver and infant in which they are able to tune in to each others physical and emotional stress
232
Disordered Attachment: Aetiologies (4)
Separation from primary caregiver
Parental conflict
Maternal addiction to drugs or alcohol
Traumatic experiences
233
Disordered Attachment: Clinical Symptoms (4)
Lack of self control - destructive, aggressive and irresponsible
Lack of normal fear
Demanding
Presents with pseudomaturity
234
Disordered Attachment: Clinical Signs (4)
Inappropriate Behaviour - stealing, cruelty and defy rules
Sleep disturbance
Chats nonsense
Poor hygiene
235
Disordered Attachment: Core emotions (4)
Anger
Fear
Pain
Shame
236
Avoidant Attachment: View of self
Unloved and self-reliant
237
Avoidant Attachment: View of Others (3)
Rejecting
Controlling
Intrusive
238
Ambivalent Attachment: View of Self (3)
Low value
Ineffective
Dependent
239
Ambivalent Attachment: View of Others (3)
Insensitive
Unpredictable
Unreliable
240
Temperament: Easy Characteristics (4)
Readily approachable
Adapts to new situations
Regular in sleep and eating routines
Overall positive mood
241
Temperament: Difficult characteristics (5)
Withdraw from or are slow to adapt to new situations
Intense reactions
Irregular routine
Negative mood
Long and frequent crying episodes
242
Temperament: Slow to Warm Up Characteristics (4)
Withdraw from or are slow to adapt to new things
Low level of activity
Negative mood
Thought of as shy or sensitive
243
Immunisations: Aim of immunisation
Control communicable disease
244
Immunisations: Herd Immunity
Protection of unvaccinated individuals via having a sufficiently large proportion of the population vaccinated
245
Immunisations: For herd immunity, the number required to be vaccinated is based upon what?
R0 - Number of individuals infected from one infected individual
246
Vaccinations: Example of Live Virus Vaccine (6)
Measles
Mumps
Rubella
Varicella
Rotavirus
Flu
247
Vaccinations: Example of Suspension of Killed Organisms (2)
Whole Cell Pertussis
Whole Cell Typhoid
248
Vaccinations: Example of Toxoid Subunit Vaccinations (3)
Diphtheria Toxoid
Tetanus Toxoid
Pertussis Toxoid
249
Vaccinations: Example of Polysaccharide Subunit Vaccinations (2)
Pneumococcal
Typhoid
250
Vaccinations: Examples of Conjugate Vaccinations (2)
Hib
Meningitis C
251
Vaccinations: Contraindications to Vaccinations (6)
Confirmed anaphylaxis reaction to previous dose/vaccine
Pregnancy
Egg Allergy
Severe Latex Allergy
Immunosuppression
Acute or Evolving Illness
252
Vaccinations: 8 weeks (4)
DTaP/IPV/Hib/HepB
PCV
Rotavirus
MenB
253
Vaccinations: 12 weeks (2)
DTaP/IPV/Hib/MenB
Rotavirus
254
Vaccinations: 16 weeks old (3)
DTaP/IPV/Hib/HepB
PCV
MenB
255
Vaccinations: 12 to 13 months old (4)
Hib/MenC
PCV
MMR
MenB
256
Vaccinations: 3 years 4 months (2)
DTap/IPV or dTaP/IPV
MMR
257
Vaccinations: Girls 11-13 years old
HPV
258
Vaccinations: 14 years old (2)
Td/IPV
MenACWY
259
Control
Reduction of disease to a locally acceptable level - requires continued intervention e.g. Diarrhoeal diseases
260
Elimination of disease
Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts - requires continued intervention measures e.g. Neonatal Tetanus
261
Eradication
Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts - no longer requires intervention measures e.g. Smallpox
262
Extinction
The specific infectious agent no longer exists in nature or in the laboratory
263
Diphtheria
URTI characterised by a sore throat and low grade fever
264
Diphtheria: Presentation
White adherent membrane on the tonsils, pharynx and/or the nasal cavity
265
Diphtheria: Causative organism
Corynebacterium diphtheriae
266
Diphtheria: Presentation of Corynebacterium diphtheriae
Aerobic gram positive bacteria
267
Meningococcal Disease
Invasive infection due to Neisseria Meningitidis
268
Meningococcal Disease: Incubation period of Neisseria meningitidis
3-5 days
269
Meningococcal Disease: Colonisation of what region is common?
Nasopharynx
270
Meningococcal Disease: Two peaks of disease
<5 years old
15-24 years old
271
Meningococcal Disease: Vaccination available for what serogroups? (5)
A
C
W
B
Y135
272
Tuberculosis: Causative organism
Mycobacterium tuberculosis
273
Tuberculosis: Vaccination programme
Bacillus Calmette-Guerin Vaccine (BCG)
274
Adolescence
Individuals of 10-19 years of age - variable period between childhood and adulthood characterised by rapid development in psychological, social and biological domains
275
Developmental Delay
Failure to attain appropriate developmental milestones for a child's corrected chronological age
276
Developmental Delay: Prenatal Causes of Developmental Delay (5)
Genetic - Down's Syndrome
Metabolic - PKU and Hypothyroidism
CNS malformations - Neuronal Migration Disorders
Infections - TORCH infections
Toxins - Maternal substance misuse
277
Developmental Delay: TORCH acronym
Toxoplasmosis
Other - Syphilis and Hepatitis B
Rubella
Cytomegalovirus
Herpes simplex
278
Developmental Delay: Perinatal Causes (2)
Prematurity
Asphyxia
279
Developmental Delay: Post-natal Causes (3)
Infection - Meningitis
Trauma
Environmental - Severe neglect or Malnutrition
280
Developmental Delay: Causes of Motor Delay (3)
Duchenne Muscular Dystrophy
Cerebral Palsy
Co-ordination disorders
281
Developmental Delay: Causes of Sensory Deficits (2)
Oculocutaneous albinusm
Treacher-Collins
282
Global Developmental Delay (example)
>2 areas of delay in development (Downs Syndrome)
283
Developmental Deviations Example
Autism Spectrum Disorders
284
Regression (+ 2 examples)
Loss of skills that were once present
Examples - Rett's Syndrome or Metabolic Disorders
285
Intellectual Disability
Significant impairment of cognitive and adaptive function with age of onset before 18 years of age
286
Overweight
Abnormal or excessive fat accumulation that may impair health
287
Weight: Being overweight is due to what?
Long term positive energy imbalance - energy intake exceeds energy output
288
BMI Plots: Overweight Clinical Centile
>91st
289
BMI Plots: Obesity Clinical Centile
>98th
290
Child Abuse: Signs of Physical Abuse (4)
Burns
Bruises
Broken Bones
Trauma
291
Child Abuse: Signs of Neglect (4)
Appearance - Dirty, Unkempt and Skinny with inadequate clothing
Not receiving healthcare
Faltering growth with developmental delays
Toilet Accidents
292
Child Abuse: Signs of Emotional Abuse (4)
Observed caregiver-child interactions:
- Emotionally unavailable or unresponsive
- Developmentally inappropriate interactions
- Exposed to domestic abuse or drug taking
- Does not allow friendships
293
Child Abuse: Signs of Sexual Abuse (4)
Inappropriate sexualised behaviours
STI
Pregnancy
Child sexual exploitation
294
Child Protection
Process of protecting individual children that are suffering or likely to suffer significant harm as a result of abuse or neglect
295
Signs of Cardiac Syncope (3)
Family history of sudden death during infancy
Vagal symptoms during sitting or lying
Symptoms occur at night or during exercise
296
Headaches: Red Flags - Rapid onset of what?
Expanding head size in infants
297
Headaches: Red Flags - GI presentation
Effortless vomiting in the morning
298
Headaches: Red Flags - Worse on what? (4)
Coughing
Sneezing
Straining
Bending over
299
Headaches: Red Flags - Neurological presentation (3)
New squint
Cranial Nerve Palsies
Diplopia or visual changes
300
Heart Murmur: Red Flags - In Infants (3)
Cyanosis
Signs of failure - poor feeding, sweating or failure to thrive
Abnormal examination - low femoral pulses, liver edge or crepitations
301
Heart Murmur: Red Flags - In Children (3)
Fatigue
Breathlessness
Any of infant red flags
302
Cough: Red Flags (3)
Night time waking with a cough, wheeze, SOB or obstructive symptoms
Failure to thrive
Recurrent Infections
303
Abdominal Pain: Red Flags (4)
Failure to thrive
Bilious or Bloody Vomiting
Bloody stools
Symptoms of Inflammatory Bowel Disease
304
Constipation: Red Flags (2)
Symptoms present from birth
Abnormal lower limb neurology
305
Diarrhoea: Red Flags (4)
Weight Loss
Blood in stools
Stools at night
Other systemic symptoms - Fatigue, Rashes, Mouth Ulcers and Joint involvement
306
If there is reflux or cow milk protein allergy what must you check?
That it is not pyloric stenosis or malrotation
307
Reflux or Cows Milk Allergy: Management (3)
Sit it out
Reflux medications
Hydrolysed formula
308
UTI: Main complication concerns (3)
Renal scarring secondary to reflux
Renal tract abnormalities
Abnormal bowel or bladder dysfunction due to secondary neurological causes
309
Growth: Failure to Thrive presentation
Drop over 2 centiles
310
Growth: Red Flags (4)
Other systemic illness
Children who are short and obese
Signs of early puberty - <8 years in a girl or <9 years in a boy
Signs of late puberty - >13 years in a girl/no menarche at 15 OR >14 years in a boy
