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Flashcards in week 1 Deck (91):
1

what is important in GP Hx of sick child?

first visit?
History of the symptom
Red Flags
Eating/drinking
Bowels/urine
Parental Concern?
PMH
Meds/allergies
Family History
Immunisation History

2

define the neonatal period

first 4 weeks of life

3

what are the common PC for neonates?

jaundice
vomiting
failure to thrive
sepsis
"trivia"

4

what are the red flags for sepsis in children?

Unresponsive to social cues/ difficult to rouse
Health professional very worried
Weak, high pitched or continuous cry
Grunting respiration or apnoeic episodes SpO2 < 90%
Severe tachypnoea + Severe tachycardia/ bradycardia [< 60]
No wet nappies/ not passed urine in last 18 h
Non-blanching rash or mottled/ ashen/ cyanotic
Temperature < 36oC
If under 3 months, temperature > 38oC

5

what is prolonged jaundice?

>14days in infants or >21days (if preterm)

6

what are the causes of jaundice in neonates?

urinary tract infection/ hypothyroidism/ galactosaemia/ breast milk jaundice/ biliary atresia

7

what are the causes of vomiting in neonates?

reflux/CMP intolerance/pyloric stenosis/sepsis/duodenal atresia

8

common paediatric resp PC

“Cold”
Infant not feeding
Cough
Wheeze

9

common causes of resp problems in kids

Bronchiolitis (RSV)
Croup (barking cough)
Viral URTI
Asthma (new or exacerbation)
Acute tonsillitis

10

rare causes of resp problems in kids

Cystic fibrosis
Acute Epiglottitis (rate lowering due to HiB vaccine)
Foreign Body
Pneumonia
Cardiac causes
Malignancy

11

how to assess resp system in kids?

Cyanosis
Tachypnoeic (RR)
Nasal flaring/Intercostal recession/subcostal recession
Wheeze/stridor/cough
Pulse oximetry
Percussion
Auscultation
ENT exam (tonsils, epiglottitis...)

12

adult resp rates?

>20 = unwell
>24 = critically ill

13

children resp rates?

different to adult:
<1=30-40
1-2=25-35
2-5=25-30
5-12=20-25
>12=15-20

14

GI problems in children PC

Abdominal Pain
Vomiting
Diarrhoea
Nausea
Constipation
School attendance…

15

common GI problems in children

Gastroenteritis
UTI
Constipation

16

rarer GI problems in children

Intuscception, volvulus <5years
appendicitis, trauma, ovarian/testicular torsion if older.

17

what is a complication of rotavirus vaccine? treatment

intussception (intestine folds into section next to it). enema then surgery ASAP

18

sign of abdo pain in young child?

draw knees to chest

19

MSK PC in children

Painful joint(s)
Limp
Trauma

20

causes of MSK problems in children

Joint pains:inflammatory arthritis/perthes disease/slipped femoral epiphyses/osgood slatters/growing pains/bone tumours

Limp – DDH/perthes

Trauma – sprain/fracture/NAI

21

public health in GP

Childhood vaccinations

Childhood Development Screening – GP 6-8 week check/health visitors
Red light reflex (retinoblastoma)
Hips (barlows/ortalanis)
Genitalia (undescended testes or ambiguous gentiles)
Femoral pulses (for coarctation of aorta)

Obesity

Disease Notification (TB, HIV...)

22

in children how is obesity measured?

BMI for age (percentile)

91st=overweight, 98th=obese

23

what should you do if child is of short stature and high BMI?

consider endocrine referral

24

what are some endocrine causes of childhood obesity?

hypothyroidism
growth hormone insufficiency
hypopituitarism
hypogonadotrophic hypogonadism
hypogonadism
excessive corticosteroid administration
pseudohypoparathyroidism
craniopharyngioma

25

what should be seen in children who follow the lifestyle advice?

NOT weight loss but maintain weight tad height means lower BMI

to see progress measure Z score/Standard deviation change

26

what are the recommended lifestyle changes that children should make if overweight?

1hr exercise a day
2hr max of screen time
3 balanced meals

27

when can orlistat be prescribed to kids?

only for severely obese adolescents (BMI >99.6th percentile) with comorbidities attending a specialist clinic.

28

can surgery be recommended for kids?

Bariatric surgery can be considered for post-pubertal adolescents with very severe to extreme obesity (BMI >3.5 SD above mean on UK 1990 charts) and severe co-morbidities

29

what is the tanner scale?

a scale of physical development in children, adolescents and adults.(breasts, pubic hair, penis, testicles)

30

what is different about adolescent consultation?

health issues differ (eating disorders, functional disorder, drugs, alcohol, sex, chronic fatigue, mental health...)]
people at different stages of looking after their own health (parents less involved)

31

what factors influence normal development?

Genetic
Nutritional
Environmental

32

how do we assess child development

-Normal milestones
-Normal variations (EG: many types of crawling )
-Developmental age (weight, potential milestones) v chronological age

33

what are the 4 areas of development?

Gross motor
Fine motor and vision
Language and hearing
Social behaviour and play

34

what are the percentages for the median age and limit age for milestone?

50% - average
97.5%. - potential problem

35

examples of children primitive reflexes? why is it a problem if don't lose?

Sucking and rooting
Palmar and plantar grasp
ATNR (fencers)
Moro
Stepping and placing

cerebral palsy possible

36

what are the milestones for Gross motor development?

Head control 3 months
Sitting balance 6 months
Crawling 9 months
Standing 12 months
Runs 18 months
Stairs – 2 feet/tread 24 months
Stairs – alternate feet 36 months
Hops -48 months

37

what are the milestones for Fine motor and visual development?

Hand regard in midline 3 months
Grasps toy - palmar 6 months
Scissor grasp 9 months
Pincer grasp 12 months
Tower of 3-4 bricks 18 months
Tower of 6-7/scribble 24 months
Tower of 9 bricks/copies circle 36 months
Draws simple man -48months

38

what are the milestones for hearing and language development?

Vocalises 3 months
Babbles 6 months
Imitates sounds 9 months
Knows name 12 months
2 body parts/5-20 words 18 months
Simple instructions/50+ words 24 months
Complex instructions/asks questions 36 months
Can tell stories of experiences 48 months

39

what are the milestones for Social behaviour and play development?

Social smile 6 weeks
Pleasure on friendly handling 3 months
Plays with feet/friendly with strangers 6 months
Plays peek-a-boo/stranger awareness 9 months
Drinks from cup/waves bye-bye 12 months
Feeds with spoon 18 months
Symbolic play/puts on some clothes 2 years
Pretend interactive play/toilet-trained 3 years
Understands turn-taking/dresses fully 4 years

40

what are the patterns of abnormal development

delay:EGglobal or specific

deviation EG:autism spectrum disorder/ASD

regression: EG Rett's syndrome or metabolic disorders

41

what are red flags for development?

Asymmetry of movement
Not reaching for objects by 6 months
Unable to sit unsupported by 12 months
Unable to walk by 18 months → check CK
No speech by 18 months
Concerns re vision or hearing
Loss of skills

42

what is global developmental delay classed as?

Affects 1 – 3% of under 5s

Significant delay in 2+ of
gross/fine motor, speech/language,
cognition, social/personal, ADL (activities of daily life)

43

what medical screening is undergone in Down's syndrome?

Cardiac (congential HD)
Vision (cataracts)
Hearing
Thyroid function (hypo badly affects development)
Sleep related breathing (apnoea due to reduced upper airway) disorders
Growth- charts
Development

44

what can cause a specific Motor developmental delay?

DMD, cerebral palsy,
co-ordination disorders

45

what can cause a specific developmental delay in Sensory Deficits and Associated Delay?

oculocutaneous albinaism

treacher-collins

46

what signs are anticipated with DMD?

Gower's manoeuvre.

lumbar lordosis due to pelvic weakness

(early steroid can improve outcomes)

47

what are the different types of cerebral palsy?

hemiplegic (one side)
paraplegic/diplegic (both legs +/- somewhere else),
quadriplegic (all limbs)

48

what conditions are associated with cerebral palsy?

Mobility problems, spasticity and orthopaedic problems
Learning difficulties
Epilepsy
Visual/Hearing impairment
Communication difficulties
Feeding difficulties
Sleep problems
Behaviour problems

49

what is the autistic triad?

Communication
Social interaction
Flexibility of thought/ Imagination

(causes restricted and repetitive behaviours and sensory difficulties)

50

how would you approach a developmental delay case?

Hx, exam, investigation, assessment

51

Hx for a developmental delay case?

Concerns – presenting complaint
Past Medical History
Perinatal and Birth
Family & Social
Developmental
Play and Behaviour
School/Nursery

52

Exam for a developmental delay case?

Observation
Dysmorphism
Head Circumference
Systems
CNS inc neurocutaneous
Vision
Hearing

53

investigation for a developmental delay case?

Chromosomes, FRAX & Oligoarray CGH
Neonatal PKU, thyroid studies, CK
If indicated:
- MRI brain
- EEG
- Metabolic studies
- Genetic consultation
- Others

54

assessment of a developmental delay?

Multidisciplinary Team

Appropriate Assessment Tool

55

intervention for developmental delay?

therapy: physio, SLT, OT
family support
education placement
referral to other agencies

56

what is Rett's syndrome?

affects Girls
fine 1st year
then regress (physical and mental)

57

what are the two types of hearing impairment?

sensorineural (inner ear) and conductive (outer ear)

58

what is a common conductive hearing loss problem in kids and how treated?

glue ear (Otitis media with effusion/serous Otitis media)

grommets.

59

neurofibromatosis type 1 signs?

cafe au lait
freckles in armpit and groin
scoliosis
multiple cutaneous neurofibromas, plexiform neruoma, optic glioma

60

what is fragile X? signs of fragile X?

genetic syndrome, moderate physical and mental disability

long face, large ears and fingers, large testicles.

61

what is prader-willi syndrome?

In newborns symptoms include weak muscles, poor feeding, and slow development.
Beginning in childhood the person becomes constantly hungry which often leads to obesity and type 2 diabetes
typically mild to moderate intellectual impairment and behavioral problems. infertile

62

what is active, passive and herd immunity?

Active immunity is the body's own fighting disease (infection, vaccine)

Passive immunity is the transfer of active immunity, in the form of readymade antibodies, from one individual to another. (mother placenta, artificial human IgG)

Herd immunity stops receiver of disease

63

types of vaccine

live virus [attenuated organism, replicates in host
e.g. OPV, measles, mumps, rubella, varicella, rotavirus, zoster, flu]

inactivated virus [Suspensions of killed organisms
e.g. whole cell pertussis (whooping cough), whole cell typhoid

Subunit vaccines
e.g. diphtheria toxoid, tetanus toxoid

Conjugate vaccines
- polysaccharide attached to immunogenic proteins
e.g. Hib, MenC]

64

what are some contraindications of giving a vaccine

confirmed anaphylaxis to vaccine component/antigen
Egg/latex allergy
actue/evolving illness
pregnancy or immunosuppression = primary, radio toxic, steroid, HIV... (live vaccine)

65

what causes diphtheria (white throat?)

Corynebacterium diphtheriae

white adherent membrane in mouth and URTI

66

what causes meningococcal disease?

Neisseria meningitidis

(survivors left with persistant neurological defect inc hearing loss, speech, limb loss/paralysis...)

67

what vaccine available for meningitis?

MenACWY and now MenB.

two peaks in disease <5yrs and 15-24

68

MMR vaccine what is and when given?

MMR1 and booster - given after 1 year as material antibodies stop

69

travel related immunisation differs to UK immunisation. name some common travel vaccines?

Yellow Fever
Cholera
Rabies
Hepatitis
Typhoid

70

what is elimination of disease

Elimination of disease: Reduction to zero of the incidence of a specified disease in a defined geographical area as a result of deliberate efforts; continued intervention measures are required. Example: neonatal tetanus.

71

what is eradication of disease

Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed. Example: smallpox.

72

what is extinct of disease?

Extinction: The specific infectious agent no longer exists in nature or in the laboratory. Example: none.

73

top causes of under 5 mortality globally?

Preterm birth complications
Pneumonia
Intrapartum-related complications
Diarrhoea
Congenital abnormalities
[Malaria]

74

what simple measures are effective in care for newborns?

Antenatal care:
-Tetanus vaccine
-Treatment of maternal infections including HIV

Steroids for preterm labour

Skilled birth attendant present:
-Provide a clean delivery
-Dry baby & keep warm
-Resuscitate asphyxiated babies
-Recognise warning signs for referral

Antibiotics for sepsis and pneumonia

75

treatment of diarrhoae?

oral rehydration solution, zinc supplements

prevent by clean water, vaccination, good nutrition

(cycle of diarrhoea and malnutrition)

76

what are ORS?

Oral rehydration salts/ORS = A solution of glucose-based salt solution used in oral rehydration therapy. (Instantly absorbed in jejunum avoiding most of intestine, For mild and moderate dehydration avoids IV fluids)

77

HIV prevention in children

Maternal lifelong antiretroviral treatment

Screen for and treat other STDs, especially herpes

Infant prophylaxis for 6 weeks or throughout breastfeeding (test child at birth and 6 weeks of age)

78

HIV PC

"great mimic"

Recurrent or severe common childhood illnesses eg otitis media, diarrhoea
Recurrent oral candidiasis not responding to treatment
Recurrent severe bacterial infections eg meningitis
Failure to thrive or growth failure
Generalised lymphadenopathy, hepatosplenomegaly
Persistent fever
Encephalopathy
Chronic parotitis
PCP, Kaposi sarcoma, TB, lymphocytic interstitial pneumonia...

79

how to diagnose HIV?

<18 months of age: virological PCR for HIV DNA or RNA

>18 months: serological rapid antibody test

(staging done by CD4 count)

80

HIV treatment [= given to ALL children with HIV]

HAART: Two NRTIs plus one NNRTI or protease inhibitor:
Nucleoside reverse transcriptase inhibitors eg abacavir and lamivudine
Non-nucleoside reverse transcriptase inhibitors eg efavirenz for >3yr olds
Protease inhibitor eg kaletra for <3yr olds

Complications:
Compliance and side-effects
Immune reconsitution inflammatory syndrome (IRIS): NSAIDS

Co-trimoxazole prophylaxis, routine vaccinations

81

TB PC

Chronic cough or fever >2 weeks, night sweats, weight loss, lymphadenopathy…

82

risk factors for TB

HIV, malnutrition, household contact

83

investigating TB

Acid-fast bacilli (low yield in children)
Interferon-Gamma Release Assays
Chest Xray
Mantoux

84

treating TB

Two months of : Isoniazid, Rifampicin, Pyrazinamide +/- Ethambutol
Then four months of isoniazid and rifampicin
Longer if TB meningitis, spinal or osteo-articular disease
”Directly observed therapy” to improve compliance

85

prevention of TB

BCG + pre and post-exposure isoniazid

86

malaria causative organism? which is most severe?

Plasmodium parasite from female anopheles mosquito

P. falciparum most severe (can cross Blood brain barrier)

87

PC of malaria

fever, pallor, non-speicifc malasie. then rapid severe cerebral oedema, seizures and coma

88

investigating Malaria

do blood film for microscopy or rapid diagnostic test

89

malaria treatment

Treatment with artemisinin-based combination therapy (ACT) for 3 days

Severe malaria treat with IM or IV artesunate until can tolerate oral

In high transmission areas give preventative treatment to all infants alongside routine vaccinations

Prevention = Long-lasting insecticidal nets (LLINs) [+
Pilot projects for malaria vaccine]

90

severe malnutrition signs

Mid-arm circumference <115mm
Weight for height

91

treating malnutrition

Investigate cause
Vitamin A
De-worm
Ready to use therapeutc food (RUTF) – peanut butter, dried milk, vitamins & minerals
Make sure vaccinated