Peds 3 Flashcards
During what age WCC is vision screening with a chart recommended to start? How about for hearing?
Vision - 3 years old
Hearing - 4 years old
What is pharmacological management for atopic dermatitis (eczema)?
- First line
- Second line
- Adjunct
First line - Hydrocortisone 2.5% ointment
Second line - Calcineurin inhibitors (Tacrolimus, Pinecrolimus)
Adjunct - antihistamine (non-sedating antihistamines loratadine, fexofenadine, and cetirizine; more sedating diphenhydramine and hydroxyzine are often used at bedtime to decrease itch)
What are 3 causes of iron deficiency anemia?
- Lack of iron intake
- Excessive ingestion of cow’s milk (drinking more than 24 oz of milk daily)
- chronic GI blood loss (e.g., food allergies and gluten enteropathy)
A 3-year-old boy is brought to the clinic by his parents for follow-up of iron deficiency anemia. His diet consists mostly of sweet, bland, low-texture foods. He drinks 32 ounces of milk daily from a bottle. In addition to prescribing oral iron supplementation, what is the best advice to give the parents concerning this patient’s diet?
A. Bribe the patient to eat healthy food
B. Continue bottle-feeding
C. Encourage eating small amounts of food throughout the day
D. Gradually introduce new foods and slowly decrease his old favorites
E. No change is needed since he is on the optimal diet for his age
Gradually introduce new foods and slowly decrease his old favorites
A 2-year-old girl is brought to the clinic by her mother for a health maintenance visit. While waiting for the pediatrician, her mother reads her a short book. When you enter the room, her mother asks her to take the book and return it to a bookshelf. Developmental history reveals that the patient can scribble with a pencil but cannot write her name. She can kick and throw a ball, but cannot jump in place. How would you describe (delayed, appropriate, advanced?) her gross motor, fine motor, language, and social development?
Age-appropriate development
A child is able to hop on 1 foot, copy a cross, and brush teeth. How old would you expect this child to be?
4 years old
A 5-year-old girl is brought by her mother to the clinic for a well-child visit. Medical history is significant for three upper-respiratory infections in the past year. She does well in preschool, is toilet trained, and enjoys eating mostly pasta, bread, and milk. Review of systems is otherwise unremarkable. She lives with her mother and father in a home built in 1985. Her height is at the 50%tile, weight is at the 50%tile and BMI is at 60%tile. Vital signs are normal. Physical examination is normal. Lab studies today show a hemoglobin of 10.0 g/dL. Her hemoglobin was in the normal range at her 3-year-old visit. Which of the following is the most likely cause of her anemia?
Iron deficiency
A child has a mature pencil grasp, is able to print letters and numbers, skip, tie a knot, copy a triangle, and draw a person with 6+ body parts. How old would you expect this child to be?
5 years old
A child is able to throw a ball overhand and build a tower of 6-8 cubes. How old would you expect this child to be?
3 years old
You order a fingerstick for a 3 year old child who is reportedly a picky eater. His results come back with a capillary hgb of 9.5 g/dL.
- What’s the normal range for hgb?
- What’s your dx?
- What is the most likely cause and how do you manage?
- Follow-up plan?
10.5-14 g/dL normal
Dx - mild anemia
Cause - iron deficiency
Manage with:
- iron trial of 2-4mg/kg/day. Take with vitamin C to increase absorption. If hgb recovers to normal range, can conclude that this is iron deficiency anemia
- Decrease milk intake.
F/u in 6 weeks
3yoM presents with a rash. Mom reports using moisturizing cream almost every day and OTC hydrocortisone 1% cream for the past couple of weeks, but he keeps scratching at it, especially at night. On exam, you note mild erythematous excoriated patches on anterior trunk and antecubital fossae of elbow. What is your dx and treatment plan?
Dx - Eczema (atopic dermatitis)
Treatment - Protect skin via frequent daily moisturizer, use topical anti-inflammatories in short bursts, treat associated skin infections aggressively
If you suspect developmental problems, what is the recommended management for a child < 3yo? For children 3-5 years old?
< 3yo → early childhood intervention, developmental-behavioral pediatrician, child psychiatrist/psychologist, early childhood learning specialists
3-5yo → school system services to help child catch up to peers
During what age WCC is developmental screening recommended? Autism screening?
Developmental at 9, 18, 30 months
Autism at 18, 24 months
