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77 Cards in this Set

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Physical parameters change with age. What are some of those parameters?
- Weight.
- Body proportions - BSA:weight ratio decreases with age.
- Airways - < 6m obligate nose breathers. Narrow passages that are easily obstructed. 3-8 year olds - look for tonsillar/adenoid hypertrophy.
- Blood volume - in young children, small absolute amounts of loss can be critical.
What is the normal respiratory rate of a patient under the age of 1?
30-40 breaths per minute.
What is the normal respiratory rate of a patient 1-2 years of age?
25-35 breaths per minute.
What is the normal respiratory rate of a patient 2-5 years of age?
25-30 breaths per minute.
What is the normal respiratory rate of a patient 5-12 years of age?
20-25 breaths per minute.
What is the normal respiratory rate of a patient above the age of 12?
15-20 breaths per minute.
What is the normal heart rate of a patient under the age of 1?
110-160 bpm.
What is the normal heart rate of a patient 1-2 years of age?
100-150 bpm.
What is the normal heart rate of a patient 2-5 years of age?
95-140 bpm.
What is the normal heart rate of a patient 5-12 years of age?
80-120 bpm.
What is the normal heart rate of a patient above the age of 12?
60-100.
What is the normal systolic blood pressure of a patient under the age of 1?
70-90mmHg.
What is the normal systolic blood pressure of a patient 1-2 years of age?
80-95mmHg.
What is the normal systolic blood pressure of a patient 2-5 years of age?
80-100mmHg.
What is the normal systolic blood pressure of a patient 5-12 years of age?
90-110mmHg.
What is the normal systolic blood pressure of a patient above the age of 12?
100-120mmHg.
What are the issues associated with giving IM injections to children? (2 points)
- Painful.
- Lack of muscle bulk.
What do you need to discuss with the parents of a 12 month old well baby coming in for consultation?
Parental concerns and coping

Nutrition - including any food allergy/intolerance

Development:
- Listens to parents talk.
- Copies simple words: Mama/Dada.
- Eyes straight.
- Points.
- Walks holding on or independently.
- Can pick up small objects.
- Drinks from a cup.

Safety:
- Sun protection.
- Climbing.
- Water safety.
- Power points.
- Chemicals.

Dental health
With a 12 month old well baby, what needs to be done at physical examination?
- Weight.
- Height.
- Head circumference.
- ENT.
- CVS.
- Respiratory.
- Eyes.
- Hearing.
What possible diagnoses would you explore with a presenting obese child?
- Depression - ?bullying ?low self esteem.
- Sleep apnoea.
- Lack of fitness.
- Insulin resistant/Type II diabetes.
What BMI percentile would an 'overweight' child be above?
BMI > 85th percentile.
What BMI percentile would an 'obese' child be above?
BMI > 95th percentile.
Obesity is rising at a rate of ___% per annum.
Obesity is rising at a rate of 1% per annum.
Obesity in children is rarely due to an underlying medical condition. Nevertheless, list some of those possible conditions.
- Hypothyroidism.
- Cushing's syndrome.
- Growth hormone deficiency.
- Hypercortisolism.
- Hypothalamic damage.
What are some drugs that can cause obesity in children?
- Steroids.
- Antipsychotics.
- Some antiepileptic drugs.
What are some risk factors for obesity in children?
- Low socioeconomic status.
- Some ethnic groups.
- Parental obesity.
- Sedentary behaviour.
- Consumption of high energy foods.
- Advertising.
- Family dynamics and work patterns.
What percentage of parents do not perceive their obese children as overweight?
~50%.
What are the psychosocial consequences of childhood obesity?
- Bullying.
- Low self-esteem - greater in females and with increasing age.
Low self esteem in obese children is greater in what populations?
- Female.
- Increasing age.
What are the endocrinological consequences of childhood obesity?
- Type II diabetes.
- Insulin resistance.
- Early puberty.
- PCOS (cysts in the ovaries).
What cardiovascular risk factors develop earlier in obese children?
- Hypertension.
- Dyslipidaemia.
What respiratory disorder must be looked out for in obese children?
Sleep apnoea.
What hepatic consequences need to be looked out for in an obese child?
- Steatohepatitis (fatty liver).
- Cholelithiasis.
What orthopaedic consequences need to be looked out for in an obese child?
- Slipped femoral epiphysis.
- Genu valgum.
What is the overall increase in an obese child of becoming an obese adult?
8x increase.
Describe the management of an obese child.
- Dietary modifications.
- Increased physical activity.
- Decreased sedentary activity.
- Family involvement.
- Behaviour modification.
- Sociopolitical factors.
What are the small-airway causes of a wheeze in a child?
- Asthma.
- Transient infant wheeze.
- Acute viral bronchiolitis.
- Cystic fibrosis.
- Gastric reflux.
- Congenital heart disease.
- Chronic neonatal lung disease.
What are the large-airway causes of a wheeze in a child?
- Congenital structural airway disease.
- Mediastinal mass.
- Foreign object.
Infrequent episodic asthma comprise ____% of all childhood asthma.
Infrequent episodic asthma comprise 70-75% of all childhood asthma.
Frequent episodic asthma comprise ____% of all childhood asthma.
Frequent episodic asthma comprise 20% of all childhood asthma.
Persistent asthma comprise ____% of all childhood asthma.
Persistent asthma comprise 5-10% of all childhood asthma.
Infrequent episodic asthma tend to involve episodes that are ___ apart.
Infrequent episodic asthma tend to involve episodes that are more than 6 weeks apart.
Are symptoms common between infrequent episodic asthma attacks?
No.
Frequent episodic asthma tend to involve episodes that are ___ apart.
Frequent episodic asthma tend to involve episodes that are less than 6 weeks apart.
Do symptoms occur between frequent episodic asthma attacks?
Yes.
Persistent episodic asthma tend to involve episodes that are ___ apart.
Persistent episodic asthma tend to involve episodes that are less than 6 weeks apart. Additionally, interepisodal symptoms and abnormal lung function is frequent.
The frequency of daytime symptoms in persistent asthma is _________.
The frequency of daytime symptoms in persistent asthma is more than 2 nights a week.
The frequency of nighttime symptoms in persistent asthma is _________.
The frequency of nighttime symptoms in persistent asthma is more than 1 night a week.
Persistent asthma will not have abnormal lung function in between attacks. True or false?
False.
What are the common triggers of asthma?
- URTIs - mostly viral.
- Exertion.
- Weather change.
- Smoking.
- Allergens - dust mite, pets, food.
What are the common side effects of beta2-agonists?
- Tachycardia.
- Sweating.
What is an asthmatic recommended prior to exercise?
Use a beta-agonist.
List the main inhaled steroids.
- Fluticasone.
- Budesonide.
What are the potential side effects of using an inhaled steroid?
- Oral thrush.
- Sore throat.
- Dysphonia.
What is the recommended treatment for infrequent episodic asthma?
Bronchodilator when needed.
What is the recommended treatment for frequent episodic asthma?
- Bronchodilator.
- Possible low dose inhaled steroid.
What is the recommended treatment for persistent episodic asthma (mild, moderate and severe)?
- Bronchodilator.
- Addition of fluticasone:

Mild: Fluticasone 100-200mcg/day.
Moderate: Fluticasone 200-500mcg/day +/- LABA.
Severe: Up to 500mcg/day + LABA.
What needs to be monitored in childhood asthma?
- Cough frequency and severity.
- Nocturnal cough.
- Exercise capacity.
- Peak flow meter - children > 6 years old.
- Spirometry - children > 12 years old.
What is the protocol for an acute asthma exacerbation in a patient under 6 years old?
- Beta agonist - 6 puffs via spacer. Repeat in 20 minutes or as necessary.
- Prednisolone 1mg/kg od stat for 3 days.
- Seek medical attention.
What is the protocol for an acute asthma exacerbation in a patient over 6 years old?
- Beta-agonist - 12 puffs via spacer. Repeat in 20 minutes or as necessary.
- Prednisolone 1mg/kg od stat for 3 days.
- Seek medical attention.
List the asthma 6 step management plan.
1. Assess asthma severity - identify high risk child.
2. Achieve best lung function.
3. Maintain best lung function by identify and avoid triggers.
4. Maintain best lung function with optimised medication.
5. Develop an action plan.
6. Educate and review regularly.
What things could you address during the interview relating to an opportunistic approach to childhood obesity?
• First, do no harm! Approach with respect.
• Resolve to address the issue.
• Assess the child and parent’s perceptions of the issue (do they even see it as a concern?).
• Highlight the issue of weight in the context of health – show the growth chart to the family and explain what the healthiest weight for their child would be; explain they are still growing in height, so probably do not need to actually lose weight – they need to ‘grow into their weight’.
• Ask what they think they could do and possibly suggest some behaviour change ideas.
• Arrange follow up.
Physical activites you could recommend for obese children and their parents.
• Aim for ‘lifestyle’ exercise: using the stairs, walking to school, walking the dog.
• Involve the entire family (everyone can benefit, regardless of weight).
• Use after school time to get outdoors and be active.
• Decrease screen based activities (eg. television, computer).
• Have bikes, helmets and balls ready to go – by
the door!
What nutrition advice do you give to adults of obese children?
- Water is the best drink for children: omit cordial and soft drinks
- Better to eat fruit than drink fruit juice.
• Low fat (2%) milk (<500 mL/day) is preferred for children over 2 years of age.
• Underline the importance of breakfast, regular meals and healthy snacks.
• Basic food label reading and awareness of the ‘traps’, ie. ‘no fat’ might mean lots of sugar and therefore the same number of calories.
• Serving sizes (does the 5 year old get served as much as mum or dad?).
• Plan ahead, avoiding the need for take-away foods.
A 4 year old child comes in with a UTI. Empirically, what should you prescribe?
One of the following for 5 days:
- Cephalexin.
- Trimethoprim.
- Trimethoprim + sulfamethoxazole.
- Amoxycillin + clavulanate.
A 4 year old child comes in with a UTI. Why shouldn't you prescribe amoxycillin?
Organisms cultured from UTI may be resistant to amoxycillin in half the cases. So it should only be used if culture indicates presence of susceptible organisms.
What advice should you give to the parent of a child with a UTI?
- Encourage high fluid intake to facilitate complete bladder emptying.
- Treat pain and high temperature with paracetamol when necessary.
- Come back if symptoms get any worse.
- ?Discussion of toilet hygiene.
All children with first UTI needs investigating. True or false?
True.
You don't need prophylactic antibiotics after the treatment course is finished while investigating a UTI in a child. True or false?
False.

Antibiotic prophylaxis should start immediately after the treatment course is finished and continue until investigations are completed.
When investigating a child with first-time UTI, what needs to be done?
- Prophylactic antibiotics.
- Culture 24 hours after completing initial antibiotic course to ensure complete eradication.
- Ultrasound of kidneys, ureters and bladder: To ensure two kidneys, no hydronephrosis and no congenital renal abnormalities.
- DMSA scan at least 2 months after UTI (if under 5). This is to rule out renal scarring. Low dose antibiotic prophylaxis should be continued while waiting for the scan.
- Micturating cystourethrogram (MCE excludes reflux) if under 2 years of age.
Nitrofurantoin is generally only used as a prophylactic measure in UTIs? True or false?
True.
At what age are boys more susceptible to UTIs than girls?
Under 3 months. After that, girls are more prone.
UTI is caused by mainly what organisms?
- E.coli (80%).
- Proteus (most common in older boys).
- Klebsiella (typically occurs in neonates).
The history of dysuria and frequency is strongly
suggestive of a UTI. However, in children these symptoms are often absent and a UTI may
present with...
More systemic symptoms of anorexia,
vomiting and fever.
In a child with UTI, what is the best way to collect urine for urinalysis?
In the absence of the more invasive catheter specimen an MSU remains the best option.
Suprapubic aspiration of urine is reserved for more acutely unwell young infants. Bag collection of urine is unhelpful and leads to
false-positive diagnoses.
When could an micturating cystourethrogram (MCU) be done for a patient 2-4 years of age?
Only needs to be done if the patient has:
- Strong family history of vesicoureteric reflux.
- Complicated UTI.
- Documented history of recurrent UTIs.
What sort of urinary tract non-specific symptoms might occur in a child with a UTI?
- Fever.
- Irritability.
- Anorexia.
- Malaise/lethargy.
- Vomiting.
- Diarrhoea.