Term
what is the Harrison sulcus? what condition would you see it in? |
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Definition
indrawing of the chest wall from diaphragmatic tug.
it is from poorly controlled asthma. |
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Term
what is the normal respiratory rate in neonates? |
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Definition
30-50 normal >60 tachypnoea |
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Term
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Definition
20-30. tachypnoea is >50
in young children it is also 20-30 but tachypnoea is >40 |
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Term
in young children, splitting of which heart sound is easily heard and normal? |
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Definition
the second heart sound.
fixed splitting suggest ASD also 3rd heart sound in mitral area is normal in young children |
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Term
out of wilm's tumour and neuroblastoma, which one is more likely to cross the midline? |
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Definition
neuroblastoma
in this condition, the child is usually very unwell. |
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Term
high spiking fever, salmon coloured rash and arthritis... what disease are you thinking? |
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Definition
Still's disease AKA systemic juvenile idiopathic arthritis. |
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Term
in extra pyramidal tract disorders which direction does the trunk and head tend to arch towards? |
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Definition
it arches backwards. this is known as an extensor posturing. |
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Term
what does tall stature and obesity do to BP? |
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Definition
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Term
what is the median age and limit age for walking? |
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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. |
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Term
when can a baby raise their head to 45 degree in prone? |
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Definition
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Term
when can baby sit w/o support? |
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Definition
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Term
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Definition
10 months
walks unsteadily 12months walks steadily 15 months |
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Term
vision and fine motor: when can baby follow a moving object/face by turning the head? |
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Definition
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Term
when can baby reach out for toys? |
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Definition
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Term
when does the palmar grasp develop? |
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Definition
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Term
transfers toys from one hand to the other? |
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Definition
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Term
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Definition
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Term
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Definition
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Term
when can baby vocalise when spoken to, coos and laughs? |
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Definition
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Term
turns to soft sound sour of sight? |
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Definition
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Term
2 -3 words other than dada or mama? |
|
Definition
12 months
18months: 6-10 words and can point to parts of the body |
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Term
social smile? puts food in mouth? waves bye bye plays peekaboo drinks from cup with both hands? |
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Definition
6 weeks 6-8 months 10-12months 12months |
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Term
when can child hold spoon and get food safely in the mouth? |
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Definition
18 months
18-24m symbolic play |
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Term
what are the gross motor limit ages for the following? head control sits unsupported stands independently walks independently |
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Definition
4 months 9 months 12 months 18 months |
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Term
vision and fine motor limit ages? fixes and follows visually reaches for objects transfers pincer grip |
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Definition
3 months 6 months 9 months 12 months |
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Term
limit ages for the following polysylabbic babble constant babble 6 words with meaning join words 3 word sentences |
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Definition
polysylabbic babble -7m constant babble -10m 6 words with meaning - 18m join words 2 years 3 word sentences 2.5 years |
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Term
limits ages for social behaviour
social smile stranger danger self feeds symbolic play interactive play |
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Definition
social smile 8 weeks stranger danger 10months spoon feeding 18months symbolic play 2-2.5 years interactive play 3-3.5 years |
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Term
name 2 screening test used to asses development? |
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Definition
Schedule of growing skills Denver Developmental Screening Test |
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Term
what is the griffiths and bailey infant development scales? |
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Definition
used in follow up studies of preterm infants. |
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Term
how to test hearing in a new born? |
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Definition
evoke otoacoustic emission auditory brainstem response |
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Term
what is the inheritance in CF? what does CF cause? |
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Definition
AR. carrier rate 1 in 25. it causes increased viscosity in secretions e.g. lung and pancreas |
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Term
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Definition
cystic fibrosis transmembrane conductance regulator (CFTCR) it codes for a cAMP regulated chloride channel |
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Term
in the UK 80% of cases are due to which mutation on long arm of chromosome 7? |
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Definition
delta F508.
CF affects 1 in 2500 live births. |
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Term
which organisms are likely to affect someone with CF? |
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Definition
Staph aureus Psuedomonas aeruginosa Burkholderia cepacia Aspergillus |
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Term
what are the presenting features of CF in the neonatal period? |
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Definition
Meconium ileus, less commonly prolonged jaundice
other features of CF are recurrent chest infections, malabsorbtion, steatorrhoea, FTT, liver disease |
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Term
name some features of CF i.e what might someone with CF also have? |
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Definition
short stature diabetes delayed puberty rectal prolapse (due to bulky stools) nasal polyps male infertility, female sub fertility |
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Term
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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 |
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Term
hand dominance is not acquired until 1-2 years. what might asymmetry of motors skills in early years suggest? |
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Definition
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Term
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Definition
disorder of movement and posture due to non progressive lesion of the motor pathways in the developing brain. |
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Term
how many people does cerebral palsy affect? |
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Definition
2 in 1000 live births and is the most common cause of major motor impairment. |
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Term
is the lesion progressive or non progressive in cerebral palsy? |
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Definition
it is non progressive.
the disturbances occurred in the developing or feral brain |
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Term
name some clinical presentations of CP in the young |
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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 |
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Term
what happens to primitive reflexes in those with CP? |
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Definition
they may persist or become obligatory |
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Term
diagnosis is made clinically in CP. what are the 3 main subtypes? |
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Definition
Spastic Dyskinetic Ataxic
a mixed pattern may also occur |
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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 |
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Term
in which type of CP is there damage to the UMN pathway? |
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Definition
Spastic CP. there is persistently increased limb tone with associated brisk reflexes and extensor planters |
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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. |
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|
Term
what are the 3 main types of spastic cerebral palsy? |
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Definition
Hemiplegia Quadriplegia Diplegia |
|
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Term
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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 |
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|
Term
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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 |
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Term
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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 |
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|
Term
which pattern of CP is associated with preterm birth due to periventricular brain damage? |
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Definition
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Term
what are the 2 main causes of Dyskinetic CP? |
|
Definition
HIE at birth Kernicterus due to rhesus disease of newborn |
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|
Term
features of Dyskinetic CP |
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Definition
movements that are involuntary, uncontrolled, occasionally stereotyped and primitive reflexes predominate |
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|
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. |
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Term
what is the affect on intellect in Dyskinetic CP? |
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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. |
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Term
where is the damage in Dyskinetic CP? |
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Definition
damage/dysfunction is in the basal ganglia or their associated pathways (extrapyramidal) |
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|
Term
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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. |
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Term
what might cause scissoring of the legs? |
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Definition
excessive adduction of the hips. This may be seen in spastic quadriplegia |
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Term
what does the symbolic Toy test assess? |
|
Definition
very early language development |
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|
Term
what does the Reynell test assess? |
|
Definition
Receptive and expressive language in pre school children |
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|
Term
features of Autistic Spectrum Disorders? |
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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 |
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Term
what must any child with poor or delayed speech or language have assessed? |
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Definition
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|
Term
how does the Child development services in the Uk allow MDT sharing of information? |
|
Definition
They use the Common Assessment Framework |
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|
Term
whats the line on pain in children? |
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Definition
it should be anticipated and prevented rather than treated |
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Term
what are the approaches to pain management? (2) |
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Definition
explanation and information medical management |
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Term
what is the name of pain scale using faces? |
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Definition
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|
Term
what affects absorption of drugs in young children? |
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Definition
gastric emptying acidity gut motility effects of milk in stomach |
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|
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 |
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|
Term
in first few months of life how are the plasma protein levels? what affect will this have on drugs? |
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Definition
plasma protein is low More of a drug may be unbound and pharmacologically active |
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|
Term
how is elimination affected in neonates? |
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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 |
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Term
who needs to approve child research trials? |
|
Definition
Research Ethics Committee |
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|
Term
what is the formula to get the correct size ET tube in children? |
|
Definition
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|
Term
describe the technique for intro osseous infusion into the tibia |
|
Definition
18 gauge trochar with needle 2-3 cm below tibial tuberosity |
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|
Term
|
Definition
Focussed Abdominal Sonography in Trauma |
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|
Term
RR ranges in infants, young and older children |
|
Definition
infant 40-30 young 30-25 older children 25-20 |
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|
Term
HR range in young, infant and older children |
|
Definition
infant 160-110 young 140-95 older 120-80 |
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|
Term
SBP range in infant, young and older children |
|
Definition
infant 70-90 young 80-100 older 90-110 |
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|
Term
what is capillary refill time affected by? |
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Definition
body exposure to a cold environment |
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|
Term
in AVPU scale what does a score of P mean? |
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Definition
that the childs airway is at risk and will need to be maintained by a manoeuvre or adjunct |
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|
Term
what should you do after successfully resuscitating a child? |
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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 |
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|
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 |
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|
Term
causes of drowsy, unconscious or seizing child? |
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Definition
post ictal infection: meningitis, encephalitis metabolic: DKA, hypoglycemia Head injury drug/poison intracranial hemorrhage |
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|
Term
common causes of surgical emergencies in children? |
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Definition
acute abdomen: peritonitis, appendicitis intestinal obstruction: malrotation, intusesseption, bowel atresia, colic |
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|
Term
which pulse would you check in ABC of a child <1 years? what if they are >1 years old? |
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Definition
<1 brachial or femoral > 1 carotid or femoral pulse. |
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|
Term
how much Joules of shock should you administer in Peads BLS? |
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Definition
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|
Term
when should you give amiodarone 5mg/kg in leads BLS? |
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Definition
after the 3rd and 5th shock. |
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|
Term
reversible causes of CVS collapse |
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Definition
hypoxia hypothermia hypovolemia hypo/hyperkalemia tamponande toxins thormboembolism tension pneumothorax |
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|
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 |
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|
Term
late decompensated signs of shock? |
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Definition
acidotic kussmaul breathing bradycardia confusion/depressed cerebral state blue peripheries absent urine output hypotension |
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|
Term
|
Definition
morphine barbiturates pontine lesion |
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|
Term
ddx of fixed dilated pupils |
|
Definition
severe hypoxia during or post seizures anticholinergic drugs hypothermia |
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|
Term
ddx of unilateral dilated pupil? |
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Definition
explanding ipsilateral lesion tentorial herniation 3rd nerve palsy seizures |
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|
Term
signs of clinical dehydration in children? |
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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 |
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|
Term
in clinical dehydration describe any changes in BP, CRT and peripheral pulses? |
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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 |
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|
Term
describe what you may see in a child with clinical shock |
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Definition
they may have decreased consciousness, cold extremities and pale or mottled skin
signs tachycardia tachypnoea weak peripheral pulses prolonged CRT hypotension |
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|
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. |
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|
Term
when assessing hydration status the child is classed as NOMRAL, Dehydrated or SHOCKED what is the mx for each of these? |
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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 |
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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 |
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|
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. |
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|
Term
risk factors associated with SIDS? |
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Definition
age 1-6 months sex (boys 60%) low income single mum multiparity over crowded smoking in family infant sleeps prone infant is overwrapped |
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|
Term
recommendations of the back to sleep campaign? |
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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 |
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|
Term
what is the major cause of death in children aged 1-14 in the uk? |
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Definition
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|
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 |
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|
Term
what is the antibiotic of choice in animal bites? |
|
Definition
co-amoxiclav.
This also covers Pasteurella infection. |
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|
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 |
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|
Term
name some low, intermediate and high risk household products that an infant may ingest? |
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Definition
Low: chalk, crayons, washing powder medium: bleach, disinfectants, window cleaners high: acids, alkalis, organophosphorus insecticides, petroleum distillates |
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|
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 |
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|
Term
what does TCA ingestion do to pupils? |
|
Definition
dilate them
ddx: cocaine, amphetamines, cannabis |
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|
Term
what does organosphosphate ingestion do to pupils? |
|
Definition
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|
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 |
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|
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. |
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|
Term
what is activated charcoal ineffective for? |
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Definition
iron, hydrocarbons insectisides |
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|
Term
what are the 5 categories of child abuse? |
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Definition
physical emotional sexual neglect fabricated |
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|
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 |
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|
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. |
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