Term
what is the Harrison sulcus?
what condition would you see it in? |
|
Definition
indrawing of the chest wall from diaphragmatic tug.
it is from poorly controlled asthma. |
|
|
Term
| what is the normal respiratory rate in neonates? |
|
Definition
30-50 normal
>60 tachypnoea |
|
|
Term
|
Definition
20-30. tachypnoea is >50
in young children it is also 20-30 but tachypnoea is >40 |
|
|
Term
| in young children, splitting of which heart sound is easily heard and normal? |
|
Definition
the second heart sound.
fixed splitting suggest ASD
also 3rd heart sound in mitral area is normal in young children |
|
|
Term
| out of wilm's tumour and neuroblastoma, which one is more likely to cross the midline? |
|
Definition
neuroblastoma
in this condition, the child is usually very unwell. |
|
|
Term
| high spiking fever, salmon coloured rash and arthritis... what disease are you thinking? |
|
Definition
Still's disease AKA
systemic juvenile idiopathic arthritis. |
|
|
Term
| in extra pyramidal tract disorders which direction does the trunk and head tend to arch towards? |
|
Definition
| it arches backwards. this is known as an extensor posturing. |
|
|
Term
| what does tall stature and obesity do to BP? |
|
Definition
|
|
Term
| what is the median age and limit age for walking? |
|
Definition
median age 12m. 50% will take 1st step by then
limit age is 18m. 97.5% will take 1st step by then..
limit age is 2SD away from median age
further ix should be done if skill isn't achieved by the limit age. |
|
|
Term
| when can a baby raise their head to 45 degree in prone? |
|
Definition
|
|
Term
| when can baby sit w/o support? |
|
Definition
|
|
Term
|
Definition
10 months
walks unsteadily 12months
walks steadily 15 months |
|
|
Term
| vision and fine motor: when can baby follow a moving object/face by turning the head? |
|
Definition
|
|
Term
| when can baby reach out for toys? |
|
Definition
|
|
Term
| when does the palmar grasp develop? |
|
Definition
|
|
Term
| transfers toys from one hand to the other? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| when can baby vocalise when spoken to, coos and laughs? |
|
Definition
|
|
Term
| turns to soft sound sour of sight? |
|
Definition
|
|
Term
| 2 -3 words other than dada or mama? |
|
Definition
12 months
18months: 6-10 words and can point to parts of the body |
|
|
Term
social smile?
puts food in mouth?
waves bye bye plays peekaboo
drinks from cup with both hands? |
|
Definition
6 weeks
6-8 months
10-12months
12months |
|
|
Term
| when can child hold spoon and get food safely in the mouth? |
|
Definition
18 months
18-24m symbolic play |
|
|
Term
what are the gross motor limit ages for the following?
head control
sits unsupported
stands independently
walks independently |
|
Definition
4 months
9 months
12 months
18 months |
|
|
Term
vision and fine motor limit ages?
fixes and follows visually
reaches for objects
transfers
pincer grip |
|
Definition
3 months
6 months
9 months
12 months |
|
|
Term
limit ages for the following
polysylabbic babble
constant babble
6 words with meaning
join words
3 word sentences |
|
Definition
polysylabbic babble -7m
constant babble -10m
6 words with meaning - 18m
join words 2 years
3 word sentences 2.5 years |
|
|
Term
limits ages for social behaviour
social smile
stranger danger
self feeds
symbolic play
interactive play |
|
Definition
social smile 8 weeks
stranger danger 10months
spoon feeding 18months
symbolic play 2-2.5 years
interactive play 3-3.5 years |
|
|
Term
| name 2 screening test used to asses development? |
|
Definition
Schedule of growing skills
Denver Developmental Screening Test |
|
|
Term
| what is the griffiths and bailey infant development scales? |
|
Definition
| used in follow up studies of preterm infants. |
|
|
Term
| how to test hearing in a new born? |
|
Definition
evoke otoacoustic emission
auditory brainstem response |
|
|
Term
what is the inheritance in CF?
what does CF cause? |
|
Definition
AR. carrier rate 1 in 25.
it causes increased viscosity in secretions e.g. lung and pancreas |
|
|
Term
|
Definition
cystic fibrosis transmembrane conductance regulator (CFTCR)
it codes for a cAMP regulated chloride channel |
|
|
Term
| in the UK 80% of cases are due to which mutation on long arm of chromosome 7? |
|
Definition
delta F508.
CF affects 1 in 2500 live births. |
|
|
Term
| which organisms are likely to affect someone with CF? |
|
Definition
Staph aureus
Psuedomonas aeruginosa
Burkholderia cepacia
Aspergillus |
|
|
Term
| what are the presenting features of CF in the neonatal period? |
|
Definition
Meconium ileus, less commonly prolonged jaundice
other features of CF are recurrent chest infections, malabsorbtion, steatorrhoea, FTT, liver disease |
|
|
Term
| name some features of CF i.e what might someone with CF also have? |
|
Definition
short stature
diabetes
delayed puberty
rectal prolapse (due to bulky stools)
nasal polyps
male infertility, female sub fertility |
|
|
Term
|
Definition
BD chest physio and postural drainage. parents usually taught how to do this. deep breathing exercises are also useful
High calorie diet including high fat intake
Vitamin supplementation
Pancreatic enzyme supplements takens with meals
Heart and lung transplants |
|
|
Term
| hand dominance is not acquired until 1-2 years. what might asymmetry of motors skills in early years suggest? |
|
Definition
|
|
Term
|
Definition
| disorder of movement and posture due to non progressive lesion of the motor pathways in the developing brain. |
|
|
Term
| how many people does cerebral palsy affect? |
|
Definition
| 2 in 1000 live births and is the most common cause of major motor impairment. |
|
|
Term
| is the lesion progressive or non progressive in cerebral palsy? |
|
Definition
it is non progressive.
the disturbances occurred in the developing or feral brain |
|
|
Term
| name some clinical presentations of CP in the young |
|
Definition
abnormal limb/trunk posture
delayed motor milestones
slowing of head growth
feeding difficulties with oromotor incoordination
slow feeding, gagging, vomiting
abnormal gait once walking is achieved
asymmetric hand function before 12 months of age |
|
|
Term
| what happens to primitive reflexes in those with CP? |
|
Definition
| they may persist or become obligatory |
|
|
Term
| diagnosis is made clinically in CP. what are the 3 main subtypes? |
|
Definition
Spastic
Dyskinetic
Ataxic
a mixed pattern may also occur |
|
|
Term
| in CP how is functional ability described using? |
|
Definition
Using the Gross Motor Fx Classification System
there are 5 levels
Level 1 - walks without limitations
Level 2 - walks with limitations
Level 3 - walks using a handheld mobility device
Level 4 - self-mobility with limitations; may use powered mobility
Level 5 - transported in a manual wheelchair |
|
|
Term
| in which type of CP is there damage to the UMN pathway? |
|
Definition
Spastic CP.
there is persistently increased limb tone with associated brisk reflexes and extensor planters |
|
|
Term
| in spastic CP what is the tone dependent upon? |
|
Definition
velocity. This means the faster the muscle is stretched, the greater the velocity it will have.
this elicits a dynamic catch which is the hallmark of spasticity. |
|
|
Term
| what are the 3 main types of spastic cerebral palsy? |
|
Definition
Hemiplegia
Quadriplegia
Diplegia |
|
|
Term
|
Definition
unilateral involvement of hand and leg. arm affected > than leg with face spared.
children present at 4-12 months with fisting of affected hand, flexed arm, pronated forearm, assymetric reaching or hand fx.
subsequently a tip toe walk on the affected side may become evident.
the PMH may be normal with unremarkable birth hx and no evidence of HIE.
in some it is cause by neonatal stroke and in larger brain lesions there may be hemianopia on the same side of the affected limbs |
|
|
Term
|
Definition
all 4 limbs affected often severely.
trunk involved with extensor posturing
this CP associated with seizures, microcephaly and moderate/severe intellectual impairment.
there may have been a hx of HIE |
|
|
Term
|
Definition
all 4 limbs but legs affected > so hands may seem normal.
hand difficulties apparent with functional use of hands
walking is abnormal
this pattern associated with preterm birth due to periventricular brain damage |
|
|
Term
| which pattern of CP is associated with preterm birth due to periventricular brain damage? |
|
Definition
|
|
Term
| what are the 2 main causes of Dyskinetic CP? |
|
Definition
HIE at birth
Kernicterus due to rhesus disease of newborn |
|
|
Term
| features of Dyskinetic CP |
|
Definition
| movements that are involuntary, uncontrolled, occasionally stereotyped and primitive reflexes predominate |
|
|
Term
| name 3 types of movement in dyskinetic CP |
|
Definition
Chorea - irregular, sudden and brief non repetitive movements
Athetosis - slow writhing movement occurring more distally such as fanning of fingers
dystonia - simultaneous contraction of agonist and antagonist often giving a twisting appearance. |
|
|
Term
| what is the affect on intellect in Dyskinetic CP? |
|
Definition
it is relatively unimpaired.
signs: floppiness, poor trunk control, and delayed motor development in infancy.
abnormal movements may only appear towards the end of the first year of life. |
|
|
Term
| where is the damage in Dyskinetic CP? |
|
Definition
| damage/dysfunction is in the basal ganglia or their associated pathways (extrapyramidal) |
|
|
Term
|
Definition
aka hypotonic CP
early trunk and limb hypotonia
poor balance
delayed motor development
incoordinate movements, intention tremor and an ataxic gait may be evident later. |
|
|
Term
| what might cause scissoring of the legs? |
|
Definition
| excessive adduction of the hips. This may be seen in spastic quadriplegia |
|
|
Term
| what does the symbolic Toy test assess? |
|
Definition
| very early language development |
|
|
Term
| what does the Reynell test assess? |
|
Definition
| Receptive and expressive language in pre school children |
|
|
Term
| features of Autistic Spectrum Disorders? |
|
Definition
impaired social interaction
speech and language disorder
routine and ritualistic behaviour
usually presents in 2-4 year olds
managed by Applied behavioural analysis (can help to reduce fit |
|
|
Term
| what must any child with poor or delayed speech or language have assessed? |
|
Definition
|
|
Term
| how does the Child development services in the Uk allow MDT sharing of information? |
|
Definition
| They use the Common Assessment Framework |
|
|
Term
| whats the line on pain in children? |
|
Definition
| it should be anticipated and prevented rather than treated |
|
|
Term
| what are the approaches to pain management? (2) |
|
Definition
explanation and information
medical management |
|
|
Term
| what is the name of pain scale using faces? |
|
Definition
|
|
Term
| what affects absorption of drugs in young children? |
|
Definition
gastric emptying
acidity
gut motility
effects of milk in stomach |
|
|
Term
| in a neonate, how much is water? |
|
Definition
80%
in an adult it is 55%
PO formulations need to be given as LIQUID in infants/young children |
|
|
Term
| in first few months of life how are the plasma protein levels? what affect will this have on drugs? |
|
Definition
plasma protein is low
More of a drug may be unbound and pharmacologically active |
|
|
Term
| how is elimination affected in neonates? |
|
Definition
liver enzymes are immature so drug biotransformation is reduced.
This leads to a prolonged half life of drugs metabolised in the liver e.g. theophylline |
|
|
Term
| who needs to approve child research trials? |
|
Definition
| Research Ethics Committee |
|
|
Term
| what is the formula to get the correct size ET tube in children? |
|
Definition
|
|
Term
| describe the technique for intro osseous infusion into the tibia |
|
Definition
| 18 gauge trochar with needle 2-3 cm below tibial tuberosity |
|
|
Term
|
Definition
| Focussed Abdominal Sonography in Trauma |
|
|
Term
| RR ranges in infants, young and older children |
|
Definition
infant 40-30
young 30-25
older children 25-20 |
|
|
Term
| HR range in young, infant and older children |
|
Definition
infant 160-110
young 140-95
older 120-80 |
|
|
Term
| SBP range in infant, young and older children |
|
Definition
infant 70-90
young 80-100
older 90-110 |
|
|
Term
| what is capillary refill time affected by? |
|
Definition
| body exposure to a cold environment |
|
|
Term
| in AVPU scale what does a score of P mean? |
|
Definition
| that the childs airway is at risk and will need to be maintained by a manoeuvre or adjunct |
|
|
Term
| what should you do after successfully resuscitating a child? |
|
Definition
| move then to Peads HDU or ITU |
|
|
Term
| causes of shock in children? |
|
Definition
hypovolemic: DKA, blood loss from trauma, fluid loss from gastroenteritis
Maldistribution of fluids e.g septicaemia, anaphylaxis
cardiogenic: HF, arrhythmia's |
|
|
Term
| causes of respiratory distress in children? |
|
Definition
upper airway obstruction (stridor) : croup, epiglottitis, foreign body, congenital malformations, trauma
Lower airway disorders: asthma, bronchiolitis, pneumonia, pneumothorax |
|
|
Term
| causes of drowsy, unconscious or seizing child? |
|
Definition
post ictal
infection: meningitis, encephalitis
metabolic: DKA, hypoglycemia
Head injury
drug/poison
intracranial hemorrhage |
|
|
Term
| common causes of surgical emergencies in children? |
|
Definition
acute abdomen: peritonitis, appendicitis
intestinal obstruction: malrotation, intusesseption, bowel atresia, colic |
|
|
Term
| which pulse would you check in ABC of a child <1 years? what if they are >1 years old? |
|
Definition
<1 brachial or femoral
> 1 carotid or femoral pulse. |
|
|
Term
| how much Joules of shock should you administer in Peads BLS? |
|
Definition
|
|
Term
| when should you give amiodarone 5mg/kg in leads BLS? |
|
Definition
| after the 3rd and 5th shock. |
|
|
Term
| reversible causes of CVS collapse |
|
Definition
hypoxia
hypothermia
hypovolemia
hypo/hyperkalemia
tamponande
toxins
thormboembolism
tension pneumothorax |
|
|
Term
| what are the early (compensated signs of shock?) |
|
Definition
tacypnoea
tachycardia
decreased skin turgor
sunken eyes and fontanelle
CRT >2 secs
mottled pale cold skin
core-peripehral temperature gap of >4 degrees
decreased urinary output |
|
|
Term
| late decompensated signs of shock? |
|
Definition
acidotic kussmaul breathing
bradycardia
confusion/depressed cerebral state
blue peripheries
absent urine output
hypotension |
|
|
Term
|
Definition
morphine
barbiturates
pontine lesion |
|
|
Term
| ddx of fixed dilated pupils |
|
Definition
severe hypoxia
during or post seizures
anticholinergic drugs
hypothermia |
|
|
Term
| ddx of unilateral dilated pupil? |
|
Definition
explanding ipsilateral lesion
tentorial herniation
3rd nerve palsy
seizures |
|
|
Term
| signs of clinical dehydration in children? |
|
Definition
the child is unwell or deteriorating
decreased urine output
skin colour unchanged and warm peripheries
There may be altered responsiveness such as being irritable or lethargic
signs to look out for:-
sunken eyes
dry mucous membrane
tachycardia
tacypnoea
NORMAL peripheral pulses and normal CRT and BP
reduced skin turgor |
|
|
Term
| in clinical dehydration describe any changes in BP, CRT and peripheral pulses? |
|
Definition
They are normal. They change in clinical shock where you get weak peripheral pulses, prolonged CRT and hypotension
in dehydration signs to look for included: the eyes may be sunken and dry mucous membranes with reduced urine output and a lethargic/irritable child |
|
|
Term
| describe what you may see in a child with clinical shock |
|
Definition
they may have decreased consciousness, cold extremities and pale or mottled skin
signs
tachycardia
tachypnoea
weak peripheral pulses
prolonged CRT
hypotension |
|
|
Term
Gastroenteritis:
common cause
duration of diarrhoea and vomiting
fluid replacement mx |
|
Definition
commonest cause is ROTAVIRUS
diarrhoea usually lasts for 5-7 days and stops within 2 weeks
vomiting usually lasts 1-2 days and stops within 3 days
fluid replacement criteria
if you suspect clinical shock then admit child for IV fluids
if no dehydration: cx breast milk and encourage additional fluid intake but not fruit juices and not carbonated drinks
if you suspect dehydration:50ml/kg low osmolarity ORS over 4 hours plus ORS for maintenance. cx breast feeding and supplementation of fluids but not fruit juice nor carbonated drinks. |
|
|
Term
| when assessing hydration status the child is classed as NOMRAL, Dehydrated or SHOCKED what is the mx for each of these? |
|
Definition
Normal: cx breast feed, encourage additional fluids but not from fruit juice nor carbonated drinks.
Dehydrated: 50ml/kg low osmolarity ORS over 4 hours plus some ORS for maintenance. cx breast feeds and encourage fluid intake but not from fruit juice nor carbonated drinks
Shock: admit for IV fluids |
|
|
Term
you are administering adrenaline in anaphylactic shock. what amount would you give to a 5 year old? a 7 year old and a 13 year old?
The dilution is 1 in 1000 for IM administration |
|
Definition
< 6 years give 150mcg 0.15ml
6-12 years 300mcg 0.3ml
>12 years is 500mcg 0.5ml |
|
|
Term
| what ages does sudden infant death syndrome most commonly occur. which campaign has helped to reduced the rates in the uK? |
|
Definition
2-4 months commonest age. peak 12 weeks.
the campaign was called "Back to Sleep' encouraging mums to put child to sleep on their back and not their front. |
|
|
Term
| risk factors associated with SIDS? |
|
Definition
age 1-6 months
sex (boys 60%)
low income
single mum
multiparity
over crowded
smoking in family
infant sleeps prone
infant is overwrapped |
|
|
Term
| recommendations of the back to sleep campaign? |
|
Definition
put infant on back when they are sleeping
temperature between 16-20
feet to foot position
head uncovered
do not smoke in the same room as your child |
|
|
Term
| what is the major cause of death in children aged 1-14 in the uk? |
|
Definition
|
|
Term
what degree of burns need assessment by a specialist?
how can you measure surface era of burns?
after what % of burns is the prognosis bad? |
|
Definition
>5% full thickness or > 10% partial thickness or significant burns to special sites (FACE, perineum)
the palm and adducted fingers =1% surface area of body. there is a burns charts that you can use to measure surface area
>70% surface area burns carries a poor chance of survival |
|
|
Term
| what is the antibiotic of choice in animal bites? |
|
Definition
co-amoxiclav.
This also covers Pasteurella infection. |
|
|
Term
| name some low, intermediate and high risk medicines that can be ingested by the infant? |
|
Definition
low: COC, most ABX
medium: paracetamol, salbutamol
high:alcohol, digoxin, salicylates, Iron, TCA |
|
|
Term
| name some low, intermediate and high risk household products that an infant may ingest? |
|
Definition
Low: chalk, crayons, washing powder
medium: bleach, disinfectants, window cleaners
high: acids, alkalis, organophosphorus insecticides, petroleum distillates |
|
|
Term
| name some low, intermediate and high risk plants that can be ingested by the infant? |
|
Definition
Low: sweet pea, cyclamen
Medium: Fuchsia, holly
High: deadly nightshade, laburnum, yew |
|
|
Term
| what does TCA ingestion do to pupils? |
|
Definition
dilate them
ddx: cocaine, amphetamines, cannabis |
|
|
Term
| what does organosphosphate ingestion do to pupils? |
|
Definition
|
|
Term
lead poisoning
features
mx |
|
Definition
children may present with pica
X-rays may show metaphyseal lead lines
mild cases: D-penicillamine PO
severe: sodium calcium edetate EDTA |
|
|
Term
signs and symptoms of iron poisoning
management |
|
Definition
D and V, heamatemesis, melena
There is a latent period of improvement
Hours later: drowsiness, coma, shock, liver failure, hypoglycaemia, convulsions
Long term: gastric strictures
toxicity: serious is >60mg/KG iron in body
Mx: xray to count number of pills, serum fe levels, gastric lavage if presenting <1hour after ingestion.
IV desferrioxamine for chelation. |
|
|
Term
| what is activated charcoal ineffective for? |
|
Definition
iron,
hydrocarbons
insectisides |
|
|
Term
| what are the 5 categories of child abuse? |
|
Definition
physical
emotional
sexual
neglect
fabricated |
|
|
Term
| if the child is <30months of age and you suspect abuse what ix should you do? |
|
Definition
| radiographic skeletal survey with oblique views of the ribs |
|
|
Term
| what are wormian bones? which condition might you find them in? |
|
Definition
| these are extra bones within the skull suture and you may find them in osteogenesis imperfect type 1. this is the most commonest type and is AD inheritance. |
|
|
