Development

Question 1

Positive indicator red flags

Answer 1

• regression
• concerns about vision/fixing/following
• Hearing loss
• Persistently low mm tone/floppiness
• No speech by 18 months
• Asymmetry of movement/features of cerebral palsy
• persistent toe walking
• complex disabilities
• head circumference >96th centile or <0.4centile or crosses 2 centiles compared to rest

Question 2

Negative indicator red flags

Answer 2

• sit unsupported at 12 mo
• walking by 18M (boy) 2Y (girl)
• Walk other than on tip toes
• run by 2.5
• hold objects in hand by 5years
• reach for objects by 6mo
• point at objects by 2Y

Question 3

Causes of gross motor delay

Answer 3

• muscular dystrophies (neuromuscular)
• cerebral palsy
• chromosomal anomalies
• antenatal infections
• rickets/malnutrition
• DDH
• neglect

Question 4

Gross motor red flags

Answer 4

Poor head control or floppiness at 6 months.
Unable to sit unsupported at 9 months.
Not weight bearing through legs at 12 months.
Not walking at 18 months.
Not running at 2 years.
Not climbing stairs at 3 years.
Persistent toe walking.
Increased muscle tone.

Question 5

WHat is the normal Babinski response

Answer 5

at birth extensor

by walking flexor

Question 6

What investigation should you do in an isolated gross motor developmental delay

Answer 6

CK to rule out MD

Question 7

What are the most common red flags for cerebral palsy

Answer 7

• Not sitting by 8 months (corrected for gestational age).
• Not walking by 18 months (corrected for gestational age).
• hand preference before 1 year (corrected for gestational age).

Question 8

What is duchennes muscular dystrophy

Answer 8

• Progressive proximal muscular dystrophy with hypertrophic calves
• All people display symptoms by 3 years old
• Only effects males

Question 9

What are the clinical features of duchennes muscular dystrophy

Answer 9

• motor milestone delay
• Inability to run - waddles
• toe walking/falls/can’t hop
• gowers sign

Question 10

How is a diagnosis of duchennes musclar dystrophy made

Answer 10

• Genetic analysis
• Muscle biopsy - with assay for dystrophin protein.
• Clinical observation of muscle strength and function.

Question 11

What is Beckers Muscular dystrophy

Answer 11

• similar to Duchennes but a clinically milder form,

- average diagnosis age 11 but may be teens early 20s

Question 12

What are the complications of muscular dystrophy

Answer 12

progressive difficulty walking
dilated cardiomyopathy
arrhythmia
respiratory failure

Question 13

What tools are used to assess development in under 5

Answer 13

• schedule of growing skills
• Griffths mental development scales
• Bayley scales of infant development

Question 14

What tools are used to assess development in school aged children

Answer 14

• Wechster intelligence scale for children

- British abilities scale

Question 15

When would you expect to roll

Answer 15

8-18 weeks

Question 16

Pulls self up to stand

Answer 16

6-10months

Question 17

Walks holding furniture

Answer 17

10-13 months

Question 18

head lag

Answer 18

<6 weeks

Question 19

walk

Answer 19

11-14 months

Question 20

Hops, skips:

Answer 20

2.5 - 5

Question 21

visual fixation

Answer 21

6w

Question 22

transfers objects between hands

Answer 22

6-8 mo

Question 23

pincer grip

Answer 23

12mo

Question 24

tower bricks 2-3 blocks, scribbles

Answer 24

18mo

Question 25

tower 4-6 bricks, draws verticle line

Answer 25

2 years

Question 26

draws circle

Answer 26

3 years

Question 27

draws cross/square

Answer 27

4 years

Question 28

draws triangle, can do buttons

Answer 28

5 years

Question 29

startles to loud sounds

Answer 29

6 weeks

Question 30

babbling/turns to name

Answer 30

6-8 months

Question 31

understands no

Answer 31

9 months

Question 32

2-3 words

Answer 32

12 months

Question 33

25-50 words

Answer 33

18 months

Question 34

3-4 word sentences

Answer 34

3 years

Question 35

smiles

Answer 35

6 weeks

Question 36

holds bottle on feeding

Answer 36

6-8 months

Question 37

waves bye

Answer 37

12 months

Question 38

drinks from cup

Answer 38

15 months

Question 39

uses spoon

Answer 39

18months

Question 40

interactive play/knife and fork

Answer 40

3 years

Question 41

potty trained

Answer 41

4

Question 42

endocrine causes of poor growth

Answer 42

hypothyroidism hypopituritism growth hormon deficiency cushings disease

Question 43

genetic causes of short stature

Answer 43

Noonan Turner/Di George Russel-silver syndrome

Question 44

systemic causes of short stature

Answer 44

coeliac inflammatory bowel renal disease

Question 45

Approach to someone with short staturs

Answer 45

1. accurate measurements of height and weight | 2. calcuate mid-parental centile (add 7cm boy, take 7cm for girls) Plot at 18 on growth chart

Question 46

What is a considered a normal growing child

Answer 46

height centile will be within 2 centile spaces (one above and one below) of mid-parental centile

Question 47

Nutritional causes of short stature

Answer 47

``` malnutrition bulimia anorexia chronic disease - malabsorption psychosocial deprivation neglect ```

Question 48

Skeletal causes of short stature

Answer 48

achondroplasia hypochondroplasia conditions with assoc. spinal/bone abnormalities e.g. rickets

Question 49

What is constitutional delat of growth and puberty

Answer 49

1. deceleration of length/height in first 3 years of life 2. near normal height velocity during childhood 3. acceleration late in adolescence.

Question 50

Features of GH DEFICIENCY

Answer 50

- micropenis - hypoglycaemia at birth - growth deceleration by age 2 - 'cherubic' look

Question 51

Investigations for ?GH deficiency

Answer 51

bone age - delayed IGF 1 - low GH stimulation tests: low; peak GH level <10 micrograms MRI brain

Question 52

mNgement GH deficiency

Answer 52

recombinant GH treat underlying cause treat other pituitary insufficiencies