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Flashcards in Week 1 and 2 Deck (66):
1

How does the WHO define the following?

- Adolescence 

- Youth 

- Young people

Adolescence - 10-19 years old

Youth - 15-24 years old

Young people - 10-24 years old 

2

Adolescence - biological developments

Puberty

Growth

CNS development

3

Adolescence - psychological developments

Abstract thinking 

Identity development 

Morality 

4

Adolescence - social developments

Development of autonomy

Changing relationships with family and peers 

5

What scale grades pubertal development and puts them into stages?

Tanner stages 

6

What does the Age of Legal Capacity (Scotland) 1991 Act state?

"A person under the age of 16 shall have legal capacity to consent on his own behalf to any surgical, medical or dental procedure or treatment where, in the opinion of a qualified medical practitioner attending him, he is capable of understanding the nature and possible consequences of the procedure or treatment"

7

In Scotland, can parents authorise a treatment that a compenent young person has refused to?  

No.

If the treatment is in the best interests of a competent young person that refuses treatment, seek legal advice 

8

The HEEADSSS mnemonic helps to remind us of topics that we may want to discuss with young people. What is covered by this mnemonic

H - home

E - education/employment

E - eating 

A - activities 

D - drugs 

S - sex

S - suicide

S - safety 

9

What are the top 5 causes of mortality in under 5s in...

- globally

- specifically Sub-Saharan Africa?

Globally

  • Preterm birth complications 
  • Pneumonia 
  • Intra-partum related complications
  • Diarrhoea
  • Congenital abnormalities 

SSA

  • Pneumonia
  • Preterm birth complications 
  • Intra-partum related complications
  • Diarrhoea 
  • Malaria

10

According to the WHO, what are the 6 most important preventable causes of mortality in children under 5?

1. immediate and exlcusive breast feeding

2. skilled attendants for antenatal, birth and postnatal care

3. access to nutrition and micronutrients 

4. family knowledge of dangers to a child's health

5. water, sanitation and hygiene 

6. immunisations 

11

What is the treatment for TB?

2 RIPE 4 RI

2 months of rifampcin, isoniazid, pyrazinamide and ethambutol

step down to 4 months of rifampicin and isoniazid

12

What are the 4 areas used to chart the progress of child development?

Gross motor

Fine motor and vision

Langauge and hearing 

Social behaviour and play 

13

Name some of the primitive motor reflexes 

By when should these reflexes be lost?

Sucking and rooting

Palmar and plantar grasp

ATNR (asymmetric tonic neck reflex) a.k.a. the "fencing reflex"

Moro - abducting and adducting the arms, as well as crying if the baby loses support

Stepping and placing 

Most of these reflexes are lost by 3-4 months, with some remaining for a little longer (e.g. ATNR is lost at 6 months)

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14

By what age are the following gross motor skills typically developed?

- head control

- balance while sitting 

- crawling

- standing 

- running 

- stairs (two feet on each)

- stairs (one foot on each)

- hops

Head control - 3 months

Balance while sitting - 6 months

Crawling - 9 months 

Standing - 1 year 

Running - 18 months

Stairs (two feet) - 2 years 

Stairs (one foot) - 3 years

Hops - 4 years 

 

15

By what age are the following fine motor and vision skills typically developed?

- hand regard in midline

- grasps toy with hand

- scissors grasp

- pincers grasp 

- tower of 3/4 bricks

- tower of 6/7 bricks/scribbles on paper

- tower of 9+ bricks/copies a circle on paper

- draws a simple man shape 

hand regard in midline - 3 months 

grasps toy with hand - 6 months

scissors grasp - 9 months

pincers grip - 1 year 

tower of 3/4 blocks - 18 months 

tower of 6/7 blocks/scribbles on paper - 2 years 

tower of 9+ blocks/copies a circle - 3 years 

draws a simple man shape - 4 years  

16

By what age are the following hearing and language skills typically developed?

- Vocalises 

- Babbles 

- Imitates sound

- Knows name 

- 2 body parts/5-20 words 

- Simple instructions/50+ words 

- Complex instructions/asks questions 

- Can tell stories of experiences 

Vocalises - 3 months

Babbles - 6 months

Imitates sound - 9 months

Knows name - 1 year 

2 body parts/5-20 words - 18 months

Simple instructions/50+words - 2 years 

Complex instructions/asks questions - 3 years 

Can tell stories of experiences - 4 years 

17

By what age are the following social behaviour and play skills typically developed?

- Social smile 

- Pleasure on friendly handling

- Plays with feet/friendly with strangers 

- Plays peek-a-boo/stranger awareness

- Drinks from cup/waves bye-bye

- Feeds with spoon

- Symbolic play/puts on some clothes 

- Pretend interactive play/toilet-trained

- Understands turn-taking/dresses fully

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 - 1 year

Feeds with spoon - 18 months

Symbolic play/puts on clothes - 2 years

Pretend interactive play/toilet-trained - 3 years 

Understands turn-taking/dresses fully - 4 years 

18

What are the different patterns of abnormal development? How are common are they?

Delayed - global and specific

Deviation e.g. autism

Regression e.g. Rett's syndrome 

These are common - 1% of children on autistic spectrum, 1-2% have mild learning disability, 5-10% have a specific learning disability

19

What are some red flags regarding child development?

Asymmetry of movement

Not reaching for objects by 6 months

Unable to sit unsupported by 12 months 

Unable to walk by 18 months

No speech by 18 months (should be able to do 5-20 words)

Concerns regarding vision or hearing

Loss of skills  

20

What consititutes "global developmental delay"?

Significant delay in 2 or more of the following...

- gross/fine motor, speech and language

- cognition, social/personal, activities of daily living

21

In what condition is Gower's manoeuvre seen in? What is it?

Seen in young boys with Duchenne muscular dystrophy

Weakness of the pelvic girdle means child has to prop themselves up on their legs to be able to stand 

22

Describe the features seen in the following types of cerebral palsy

- Hemiplegic

- Paraplegic

- Diplegic

- Quadraplegic

Hemiplegic - one side affected, other side almost or completely normal. Affected side arm will be spastically contracted or floppy, and foot will be up on tiptoes 

Paraplegic - Both legs affected only, with the upper body either being completely unaffected or only minorly affected

Diplegic - as with paraplegic but with slight involvement elsewhere 

Quadraplegic - all four limbs affected, often never able to walk 

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23

What 3 things feature in the "autistic triad"?

Issues with...

  • Communication
  • Social interaction
  • Flexibility of thought/imagination 

Also see restricted, repetitive behaviours and possibly sensory difficulties 

 

24

When assessing a child for a developmental disorder, what kind of points would you want to cover in the history taking?

Presenting complaint and concern

Past medical history 

Perinatal and birth 

Family and social 

Developmental 

Play and behaviour

School/nursery 

25

When assessing a child for a developmental disorder, what kind of points would you want to cover in the examination?

Observe the child initially

Look for dysmorphism

Take head circumference, height and weight 

System examinations

CNS evaluation

Vision and hearing 

26

What are some common respiratory problems seen in children presenting acutely?

Bronchiolitis (RSV)

Croup (barking cough/stridor)

Viral upper resp tract infection

Asthma (new or exacerbated)

Acute tonsillitis 

27

What are some uncommon respiratory problems seen in children presenting acutely?

Cystic fibrosis 

Acute epiglottitis 

Inhaled foreign body 

Pneumonia

Cardiac causes 

Malignancy

28

What is the normal respiratory rate for children at the following ages...

- <1 year

- 1-2

- 2-5

- 5-12

- >12

<1 year - 30-40

1-2 - 25-35

2-5 - 25-30

5-12 - 20-25

>12 - 12-20

29

What age of child might you see either an intussusception or volvulus? 

Any time from birth to about 5 years old

30

What condition in children presents with a bright red rash and a swollen tongue described as being like a strawberry in appearance? 

What is the causative organism?

Scarlet Fever, caused by Strep pyogenes (GAS)

31

Young child presents with their mum to the GP complaining of being a bit off colour. What questions might you ask?

(Watch the child in the waiting room)

Temperature?

Relieving factors

Eating/drinking?

Bathroom habits?

Vomiting?

Pain?

Rash?

Sleeping okay?

Immunisations?

Been to the doctor for anything else?

32

How long is the embryonic period of gestation i.e. at what point is the embryo termed a foetus?

Lasts up until the end of week 8, from week 9 onwards it is a foetus

33

What is the normal heart rate for children of the following age...

- birth

- 1 year old 

- 2 years old 

- 4 years old

- 10 years old

Birth - 140 +/- 25

1 - 120 +/-20

2 - 110 +/-20

4 - 105 +/- 20

10 - 95 +/- 15

34

Diagnose the following...

1) 5 year old boy presents with symmetrical rash over buttocks, red swollen and tender knees, and vomiting and diarrhoea

2) 6 year old boy presents with swollen legs, scrotum and puffy eyes. Proteinuria and hypercholesterolaemia seen O/E

3) 2 week old boy presents with projectile vomiting, weight loss, palpable epigastric mass during feeding and visible peristalsis

1) Henoch-Schonlein purpura

2) Nephrotic syndrome

3) Pyloric stenosis

35

Diagnose the following...

1) A child with Brushfield spots on the iris, low set ears and a prominent tongue

2) O/E you notice this girl has a webbed neck, broad chest with widely spaced nipples and absent secondary sexual characteristics

1) Down's syndrome

2) Turner's syndrome (XO)

36

By what age should a child be able to do the following...

1) developed head control

2) start to crawl

3) developed social smile

4) stand

5) draw a triangle

6) build a tower of 3 blocks

7) use two or more words to make a simple phrase 

1) 6 weeks

2) 9 months

3) 6 weeks

4) 9/12 months (uses furniture @ 9 months)

5) 3 years

6) 18 months

7) 2 years   

37

Diagnose the following (both organism and disease)

1) 2 year old boy presents with fever, cough, maculopapular rash that first appeared behind his ears and has spread to trunk. Small white lesions also present on oral mucosa

2) 7 year old girl presents with painful lesions around her mouth that have a golden crust

3) 3 year old boy presents with a 1 day history of feeling unwell, high fever and noisy breathing. Noted to be drooling saliva

1) Measles (caused by the measles virus). Classic clues are spreading from the ear and white lesions on mucosa 

2) Impetigo (caused by Staph aureus)

3) Epiglottitis (caused usually by Haemophilus influenzae type B). Classic clues are noising breathing and drooling saliva (unable to swallow)

38

Diagnose the following (both organism and disease)

1) 2 year old boy is admitted at 2am with a cough and stridor. Mum describes him feeling hot and a runny nose for the past 3 days 

2) 8 month old boy presents with a dry cough. On auscultation you hear a high-pitched expiratory wheeze and suspect his chest is hyperinflated 

3) Infant presents with a 1 week history of a cold with coughing fits. Mother is worried that he appears to stop breathing at the end of these fits

1) Parainfluenza virus a.k.a. croup. Clues are stridor, signs of fever

2) RSV a.k.a. bronchiolitis

3) Pertussis a.k.a. whooping cough (Bordetella pertussis)

39

4 year old boy comes into the clinic with his mum complaining of a limp and a painful right knee and hip for the past few weeks.

What is on the list of differentials?

 

DDH 

Perthe's

SUFE

trochanteric bursitis 

Septic arthritis 

NAI/trauma

malignancy

40

What is the treatment for Perthe's disease?

Always start with physiotherapy and rest, may also need to remove necrotised bone

Casting (with a Spica cast)

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41

Brochiolitis is any acute inflammation of the bronchioles in children that causes difficulty breathing/inspiratory wheeze.

What is the most common cause of bronchiolitis? 

RSV causes bronchiolitis in 70-80% of cases

42

If a child (usually a toddler) presents with a history of being fine one moment while playing and then suddenly developing a cough and difficulty breathing, what is the most likely diagnosis?

Inhaled Foreign Body

43

The number 6 is important in paediatric presentations! What commonly presents at the following ages?

- 6 weeks

- 6 months

- 6 years 

6 weeks - pyloric stenosis, child presents with projectile vomiting

6 months - intussusception. Classic presentation is child pulling knees up, crying a lot and then going limp

6 years - appendicitis (think "the journey into hospital was bad because of going over speed bumps")

Rule of thumb - if a child is unable to jump, they should be admitted 

44

When a child is vomiting up bile, what is the most important initial question that will guide diagnosis and treatment?

What colour is it?

Green bile is bad and needs to be seen urgently 

45

What important feature might allow you to differentiate between a child presenting with pyloric stenosis vs a child presenting with malrotation?

Vomit colour - in PS the vomit just tends to be milky in colour, however in malrotation it might have bile through it and will appear green.

It should be classed as being malrotation until proven otherwise

46

What is recommended to be taken by infants consuming <500 mls formula a day after 6 months?

Vitamin A, C and D supplements

47

How many minutes of physical activity should children capable of walking be doing every day? (under 5s)

180 mins (3 hours) throughout the day

48

How much physical activity should children aged 5-18 be doing a week?

At least 60 minutes/day of moderate to vigorous physical activity

Be doing at least 3 days a week of vigorous intensity physical activity 

49

How long is it recommended that children should be breast fed for?

First 6 months of life

50

How much full-fat unmodified cow's milk should an infant be having?

Can be used in small amounts in cooking from 6-9 months

Can be gradually introduced as a drink from 12 months

Semi-skimmed should not be given before 2 years

Skimmed should not be given before 5 years 

51

What does the WHO recommend regarding nutrition within the first 6 months of life?

Why?

Should be exclusively breast feeding

Better chance of having a higher IQ

Lower risk of obesity for the baby in later life

Lower maternal risk of breast cancer 

52

What is the recommended daily intake of protein for a child between 12-18 months?

What is the mean amount of protein actually being taken by this age group?

14.5g

37.7g

53

What is the Reference Nutritional Intake (RNI) for Vitamin A?

What are some dietary sources of Vitamin A?

350-400 micrograms/day

Dietary sources - cheese, egg, yoghurt etc. 

54

What is the Reference Nutritional Intake (RNI) for Vitamin C?

What are some dietary sources of Vitamin C?

25-30 mg/day

Dietary sources - oranges, blackcurrents, potatoes 

55

What is the Reference Nutritional Intake (RNI) for Vitamin D?

What are some dietary sources of Vitamin D?

7-8.5 micrograms/day

Dietary sources - main source is sun exposure, but also small amounts from oily fish, eggs

56

What is the RNI for sodium for the following ages...

- 4-6 months

- 7-9 months

- 10-11 months

- 12-18 months

How much sodium is contained in 1g of salt?

4-6 - 280mg

7-9 - 320mg

10-11 - 350mg

12-18 - 500mg

1g salt = 393mg Na+

57

Clinical scenario - 6 year old girl presents with vomiting over the past 24 hours and increased bouts of bedwetting over the last 4 weeks. 

Has lost some weight recently and very recently developed central abdo pain, but no fever, cough, wheeze, chest pain and until very recently has had a normal appetite.

Has been drinking well, with increased frequency in the last couple of weeks.

Diagnosis?

"vomiting over the past 24 hours"

"increased bouts of bedwetting"

"lost some weight recently" 

"drinking well, with increased frequency in the last couple of weeks"

T1DM - vomiting suggests DKA

58

Children conceived during (summer/winter) months are more likely to develop mental health disorders

Children conceived during the winter months - related to vitamin D deficiency?

59

How do you assess breathing in a child in the emergency setting? (pretty much the same as an adult...)

Effort of breathing

  • resp rate 
  • any recession - sternal or intercostal? Tracheal tug?
  • use of accessory muscles?
  • grunting?
  • nasal flaring?

Efficacy of breathing

  • assess expansion
  • any extra noises?
    • inspiratory - stridor? stertor?
    • expiratory - wheeze
  • pulse oximetry

60

How do you assess circulation in a child in the emergency setting? (again, same as adult)

Heart rate, rhythm, character and volume. Symmetrical?

Cap refill

BP

Effects seen elsewhere - consciousness level, skin colour and temp, urine output

NB - Hypotension is a pre-terminal sign 

61

How do you clinically assess hydration status in a child?

Examine eyes/mucous membranes 

Skin turgor - evidence of tenting?

Urine output 

 

62

What is the most common reason for acute illness in children?

Sepsis! Variable presentations!

63

What's more common in children - respiratory failure or circulatory failure?

Which has the higher rate of survival?

Respiratory failure is much more common in children

Resp has a much higher rate of survival

64

How does child age affect head tilt and chin lift?

If under 1 year old, keep the head and neck in a more neutral position

If over 1 - perform full procedure 

65

What is the difference between decorticate and decerebrate postures?

Which is a worse sign?

Decerebrate is a worse sign 

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