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MS3 - Infant, Child, and Adolescent Care > First Aid for the Wards - "Pediatrics" > Flashcards

First Aid for the Wards - "Pediatrics" Flashcards

1
Q

The __________ temperature is the gold standard.

A

rectal

Axillary and tympanic can be unreliable. Oral temperatures are generally 1ºbelow rectal.

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2
Q

Head circumference is generally only done in children up to ________.

A

2 years of age

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3
Q

In pediatrics, you should not say “vital signs are stable.” Instead, say “_____________.”

A

vital signs are age-appropriate

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4
Q

What things should you comment on for pediatric general appearance?

A
  • Hydration status: drooling, tearing
  • Respiratory status
  • Alertness/playfulness/consolable
  • Nutritional status: obese or underweight
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5
Q

The way you pull a child’s auricle in an ear exam is different by age: ______________.

A

in an infant, you pull backward and downward, while in an older child you pull backward and upward

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6
Q

Describe the quality of innocent murmurs.

A
  • I-II/VI intensity
  • Musical quality
  • Occurrence in systole
  • Varies with respiration
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7
Q

In failure to thrive, children fall off of the height, weight, and head circumference curves in what order?

A

1) Weight
2) Height
3) Head circumference

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8
Q

How should you work up failure to thrive?

A
  • Detailed history (feeding, social, developmental, and birth)
  • Physical exam
  • Trend weight across time
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9
Q

Apgar scores are assessed at what times?

A

1 and 5 minutes

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10
Q

What should you do as a pediatrician at a high-risk delivery?

A
  • Dry and clean the infant
  • Suction nose and mouth
  • Vigorously stimulate the child
  • Perform a head to toe exam
  • Provide any support the child may need: CPR, mask oxygen, intubation
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11
Q

List the important steps to follow in writing a pediatric prescription.

A
  • Find the correct total dose of the drug based on weight (mg/kg).
  • Find the available compositions (because pediatric drugs are usually liquid: e.g., 400 mg / 5 mL).
  • Try to use the strongest formulation to minimize volume.
  • Calculate the volume needed per dose.
  • Find the duration of treatment needed.
  • Calculate the dispense amount.
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12
Q

What weight parameters are diagnostic of failure to thrive?

A
  • Less than 5th percentile for weight or weight-for-length

* Decline of greater than 2 percentile lines on standard growth charts

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13
Q

Go through gross motor development.

A
  • 1 month: can hold head up while prone
  • 2-3 months: can hold head up in all directions
  • 4 months: can hold torso up with arms while prone
  • 6 months: can sit up
  • 9 months: crawls and cruises
  • 12 months: walks unassisted
  • 15 months: walks backward; stoops and recovers
  • 18 months: runs
  • 24 months: walks up and down stairs without help
  • 36 months: rides tricycle
  • 48 months: hops and skips
  • 60 months: jumps over low obstacles
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14
Q

Go through fine motor development.

A
  • 2 months: tracks past midline
  • 5 months: rake
  • 6 months: transfers objects hand to hand
  • 10 months: inferior pincer
  • 12 months: fine pincer
  • 15 months: 2 blocks
  • 24 months: 6 blocks
  • 36 months: draw circle
  • 48 months: cross or square
  • 60 months: triangle
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15
Q

Go through language development.

A
  • 6 months: babble
  • 9 months: mama dada nonspecifically
  • 12 months: mama dad specifically
  • 15 months: 4-6 words
  • 18 months: 15-20 words
  • 24 months: 50 words; 2-word sentences
  • 36 months: 250 words; 3-word sentences
  • 48 months: knows colors
  • 60 months: can print name
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16
Q

Go through social development.

A
  • 2 months: social smile
  • 6 months: stranger anxiety
  • 12 months: plays next to others
  • 24 months: parallel play
  • 36 months: group play
  • 48 months: cooperative play
  • 60 months: can follow rules
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17
Q

What is the moro reflex?

A

Sudden neck extension causes extension, adduction, then abduction of the arms; it disappears by 3-6 months

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18
Q

The palmar reflex typically disappears by what age?

A

9 months

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19
Q

Rooting is _____________.

A

when infants reflexively pursue an object placed near their face with their mouths

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20
Q

The stepping reflex typically disappears by ________.

A

2-3 months

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21
Q

Turning the infants head laterally typically causes what reflex?

A

The fencer pose: ipsilateral extension and contralateral flexion

This disappears by 4-9 months.

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22
Q

The Babinski reflex disappears by ___________.

A

six months

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23
Q

How do height and weight develop by one year?

A
  • Height: doubles

* Weight: triples

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24
Q

What are some contraindications to vaccine administration?

A
  • Current severe illness
  • Severe allergy to past vaccine or vaccine component (includes eggs, neomycin, gelatin, polymyxin, streptomycin)
  • Pregnancy and immunocompromized status (for live vaccines)
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25
Q

Kids usually lose about ________ of their weight in the first 5-7 days of life. If they lose more than this, consider other sources.

A

5% - 10%

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26
Q

Birth weight should double by _________, triple by _________, and quadruple by ____________.

A

5 months; 1 year; 2 years

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27
Q

What is the average weight gain in these periods?
• First three months
•Four to twelve months
•Two years to puberty

A
  • First three months: 25 g/day
  • Four to twelve months: 15
  • Two years to puberty: 5 pounds per year
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28
Q

What is the average birth height in inches and centimeters?

A
  • 20 in

* 50.8 cm

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29
Q

How tall are kids at 1 year, 2 years, and 3 years (on average)?

A
  • 1: 30 inches
  • 2: 36 inches
  • 3: 40 inches
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30
Q

The average birth head circumference is __________.

A

35 cm

Remember the 360º around the 36 cm head?

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31
Q

90% of head growth occurs by age __________.

A

2

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32
Q

Iron is recommended in breastfed infants at four months of age because ________________.

A

maternal stores of iron are usually depleted by that time

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33
Q

In addition to active HIV, HBV, and HTLV infection, breastfeeding is contraindicated in women with _________________.

A

illicit drug use, active breast herpes, or mothers on medicines that pass into breast milk (chloramphenicol, tetracycline, or chemotherapy)

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34
Q

What is a handy rule of thumb for infant formula needs in the first 2-3 months?

A

2-3 ounces every 2-3 hours for the first 2-3 months

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35
Q

The AAP recommends avoiding honey for the first __________ of life.

A

one year

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36
Q

What is the mnemonic for cyanotic heart defects?

A
  • 1: pulmonic stenosis (one vessel)
  • 2: transposition of the great vessels (two vessels)
  • 3: tricuspid atresia (tri- = three)
  • 4: tetralogy of Fallot (tetra- = four)
  • 5: total anomalous pulmonary venus return (five words)
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37
Q

Large VSDs can cause __________.

A

CHF (and may require diuretics)

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38
Q

Where can you best hear VSDs and ASDs?

A
  • VSDs: left-lower sternal border

* ASDs: left-upper sternal border

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39
Q

ASDs can cause what pathologic changes in the heart?

A
  • Right atrial enlargement
  • Right ventricular enlargement
  • Right bundle-branch block
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40
Q

Strangely enough, you can hear a murmur in coarctation over _______________.

A

the left scapula

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41
Q

What two things need to be present in order to survive with transposition of the great vessels?

A

PDA or VSD

Note: if they have a PDA, then give PGE1 to maintain patency.

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42
Q

Chest x-rays of those with ____________ will show the “egg on a string” sign.

A

transposition of the great vessels

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43
Q

Remember, the hallmark sign of rubella that helps distinguish it from measles is ______________.

A

lymphadenopathy

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44
Q

What exanthem classically presents in the spring?

A

B19

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45
Q

____________ presents with a sandpaper-like rash that desquamates.

A

Scarlet fever

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46
Q

True or false: hand, foot, and mouth disease usually presents with the rash as its only symptom.

A

False.

Usually URI, GI symptoms, and fever accompany it.

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47
Q

What exanthem presents with football-like vesicles?

A

HFM

48
Q

What defines precocious puberty?

A

The appearance of secondary sexual characteristics in girls prior to 7 (Hispanics and blacks) or 8 (whites) and in boys prior to 8

49
Q

What can GnRH tests tell you in the evaluation of precocious puberty?

A
  • If GnRH induces an LH surge, then precocious puberty is central.
  • If GnRH fails to induce an LH surge, then the precocious puberty is peripheral (such as a germ-cell tumor).
50
Q

All of the causes of gonadotropin-dependent precocious puberty are _______________.

A

central in origin: hypothalamic hamartoma, brain radiation, brain tumor, hydrocephalus, or head injury

51
Q

Peripheral precocious puberty will typically have low _______________.

A

LH and FSH (because the peripheral source generally secretes sex hormones)

52
Q

What are the treatments for central and peripheral precocious puberty?

A
  • Central: GnRH agonists

* Peripheral: androgen antagonists or aromatase antagonists

53
Q

Those with metabolic ____________ typically have an anion gap.

A

acidosis

Remember, it’s a number of anions (-OH) that you need to neutralize.

54
Q

Intussusception usually occurs at or near the _____________.

A

ileocecal valve

55
Q

What is the classic triad of intussusception?

A
  • Intermittent colicky abdominal pain
  • Bilious emesis
  • Currant jelly stool
56
Q

What predisposes to intussusception?

A

Any kind of GI inflammation:

  • Henoch-Scönlein purpura
  • Viral infection
  • Rotavirus vaccine
57
Q

Ultrasounds of those with ____________ can show the pseudokidney sign.

A

intussusception

58
Q

When does pyloric stenosis often present?

A

2-8 weeks of life

59
Q

What drug is associated with an increased risk of pyloric stenosis?

A

Erythromycin

60
Q

Gastric peristaltic waves after feeding are a sign of ______________.

A

pyloric stenosis

61
Q

____________ can mimic pyloric stenosis.

A

Overfeeding

62
Q

The initial workup of Hirschprung’s includes ________________.

A

rectal manometry

Suction punch biopsy can provide definitive diagnosis.

63
Q

List the four body systems that are primarily affect in Down syndrome.

A
  • GI: duodenal atresia and Hirschprung’s
  • Cardiac: VSD and ASD
  • Neurologic: cognitive delay and hypotonia
  • Hematologic: increased risk of ALL and AML
64
Q

List the constellation of features seen in Patau syndrome.

A
  • Holoprosencephaly
  • Microphthalmia
  • Polydactyly
  • VSD
  • Cutis aplasia
65
Q

List the constellation of features seen in Edwards syndrome.

A
  • Prominent occiput
  • Rocker-bottom feet
  • Horseshoe kidney
  • Hypertonia (clenched fists)
66
Q

List the manifestations of vaso-occlusive crisis in those with sickle cell.

A
  • Priapism
  • Dactylitis
  • Femoral necrosis
67
Q

What does acute chest syndrome show on x-ray?

A

Bilateral lower lung opacities

68
Q

How common is stroke in those with sickle cell?

A

10% have a stroke by age 20, and an additional 20% show evidence of microvasculature infarctions on MRI.

69
Q

Those with sickle cell are at increased risk of what renal disorder?

A

Papillary necrosis

70
Q

When do those with sickle cell typically present?

A

After six months of life, when the fetal hemoglobin levels drop

71
Q

Acute chest syndrome should be treated with ______________.

A

antibiotics, O2, fluids, analgesics, and exchange transfusion

72
Q

What two drugs are those with sickle cell given prophylactically?

A

Penicillin and folate

73
Q

What screening tests do those with sickle cell get?

A
  • Yearly hip x-rays to assess for avascular necrosis
  • Yearly retinal exams to assess for retinopathy
  • Yearly transcranial dopplers to assess for stroke risk
  • Echos for pulmonary arterial pressure every other year
74
Q

What are the signs and symptoms of leukemia?

A
  • Pallor (from anemia)
  • Petechiae and purpura (from thrombocytopenia)
  • Fatigue and lethargy (from anemia)
  • Splenomegaly (from increased cell turnover)
  • Bone pain (from primary malignancy)
75
Q

Patients with ALL often get intrathecal ___________ for CNS prophylaxis.

A

methotrexate

76
Q

Tumor lysis syndrome results in high levels of what three serum assays?

A
  • Potassium
  • Phosphate
  • Uric acid
77
Q

Why do those with Wilms’ tumor often get hypertension?

A

The tumor itself can secrete renin, and in other cases, it compresses the renal vasculature which promotes hypertensive changes.

78
Q

What can cause a renal mass?

A
  • Wilms’ tumor
  • Neuroblastoma
  • Hydronephrosis
  • Multicystic dysplastic kidney
79
Q

Neuroblastoma arises from what tissue?

A

Neural crest cells (hence can ber adrenal medulla or chain ganglia)

80
Q

In addition to abdominal mass, list some of the signs and symptoms of neuroblastoma.

A
  • Hypertension (from compression of renal vasculature)
  • Watery diarrhea (from VIP secretion)
  • Opsoclonus/myoclonus (dancing eyes dancing feet)
81
Q

How long does inflammation need to be present to qualify as JIA?

A

Six or more weeks

82
Q

Which joints are most commonly affected in JIA?

A

Large ones: knees, ankles

83
Q

What number of joints marks the delineation of pauci-/oligoarticular and polyarticular?

A

5 or more = poly

84
Q

Systemic JIA is also called __________.

A

Still’s disease

85
Q

What symptoms characterize Still’s disease?

A
  • Polyarticular arthritis
  • Salmon-pink rash that waxes and wanes with fever
  • Myalgias, growth delays, pericarditis
86
Q

What condition presents with DIC in those with JIA?

A

Macrophage activation syndrome

87
Q

True or false: normal ESR excludes JIA.

A

False

88
Q

How is JIA treated?

A
  • Systemic steroids for systemic disease
  • Local steroids for local disease (e.g., steroid eye drops for uveitis, joint injections for arthritis)
  • Etanercept or infliximab (both TNF inhibitors) for severe cases
  • Calcium supplementation
89
Q

The term “morbilliform” refers to rashes that look ______________.

A

like measles: erythematous macules that are 2-10 mm in diameter and confluence in places; occasional papules may be seen

90
Q

What are the diagnostic criteria for Kawasaki disease?

A
  • Fever for ≥ 5 days without other explanation plus 4 or more of the following:
    • Bilateral conjunctivitis (without exudate)
    • “Strawberry tongue”; dry, red, cracked lips; diffuse erythema of the oral cavity
    • Erythema and/or edema of the hands and feet
    • Polymorphic rash (usually truncal)
    • Cervical lymphadenopathy (1 lymph node ≥ 1.5 cm)
91
Q

The purpura in HSP most often presents on the _____________.

A

legs and buttocks

92
Q

HSP is the systemic version of ____________.

A

IgA nephropathy

93
Q

How is HSP treated?

A

Steroids for GI or renal involvement

94
Q

Admit a child with ITP whose platelet count is less than _____________.

A

20,000

95
Q

List the treatment options for ITP.

A
  • Based on the severity of bleeding; > 80% of patients recover within several months without treatment
  • Admit if platelet count is < 20,000/ml
  • IVIG or anti-Rho antibodies
  • IV methylprednisolone
  • Splenectomy is appropriate for children > 4 years of age and those with severe or chronic ITP (> 1 year)
  • Platelet transfusion is of no benefit
96
Q

Using age, what is a good way to narrow down what immunodeficiency a child with recurrent infections is likely to have?

A
  • B-cell deficiencies and antibody deficiencies typically present after 6 months of age (when the maternal antibodies fall)
  • T-cell deficiencies present around 3 months of life
97
Q
  • B-cell and antibody deficiencies present with ______________ infections.
  • T-cell deficiencies present with ____________ infections.
  • Phagocytic deficiencies present with ______________ infections.
A

sinopulmonary and GI

disseminated intracellular and fungal

sinopulmonary and soft-tissue

98
Q

Milk allergies and diarrhea are common in which immunodeficiency?

A

IgA deficiency

99
Q

Describe common variable immunodeficiency.

A
  • Defect in B-cell maturation
  • Low levels of Ig
  • Bimodal age distribution (1-5 and 15-20)
  • Autoimmune disorders common
100
Q

Explain the pathophysiology of hyper-IgE syndrome.

A

T cells fail to produce IFN-gamma which leads to impaired neutrophil chemotaxis. The body responds by upregulating IgE.

101
Q

What is the mnemonic for Job syndrome?

A 
Job was FATED to suffer: 
•Facies 
•Abscesses 
•Teeth (retained primary) 
•igE elevated
•Dermatitis
102
Q

Chronic mucocutaneous _______________ results from inability of T cells to properly recognize antigens.

A

candidiasis

103
Q

Typically, ins and outs are reported on a _____________ basis in pediatrics.

A

mL/kg/day

104
Q

BMI should only be used in those ______________.

A

older than 2

105
Q

Ataxia, telangiectasias, and ____________ are diagnostic of ataxia telangiectasia.

A

IgA deficiency

106
Q

What immunoglobulin profile is consistent with Wiskott-Aldrich syndrome?

A
  • Decreased IgM
  • Increased IgA and IgE

(Think about it like this: the mnemonic is WATER –Wiskott-Aldrich Thrombocytopenia Eczema Recurrent infections; just remember that there is an A and an E in wAtEr, but the M is tipped upside-down –WAtEr.)

107
Q

How is fever in a 28-90 day-old different than in a neonate?

A

If the child is non-toxic and does not have identified cause of infection (such as a positive UA or CXR), then you can culture blood, urine, and observe them.

108
Q

Typically, UAs and other tests are reserved for toddlers with temperatures greater than ________.

A

39

109
Q

One of the age-specific signs of meningitis (for neonates) is paradoxical irritation. Explain what this is.

A

The infant will be irritable when held and not irritable when not held (because the act of holding manipulates the meninges and causes pain).

110
Q

Discuss the differences in lung auscultation in viral and bacterial pneumonia.

A
  • Viral: diffuse crackles

* Bacterial: focal crackles (with possible egophony)

111
Q

The three pathogens that are the most common cause of AOM are ________________.

A

S. pneumo, H. influenzae, and M. catarrhalis

112
Q

The AAP advocates for an additional ______________ in kids older than 2 with suspected AOM.

A

72 hours of observation

113
Q

List three treatment options for Streptococcal pharyngitis.

A
  • Amoxicillin for 10 days
  • Benzathine penicillin for 1 IM shot
  • Macrolides or clindamycin for 10 days
114
Q

Don’t forget that Sydenham chorea includes _____________ and motor jerks.

A

emotional instability

115
Q

Go through the SEEKS PP mnemonic for UTI pathogens.

A
  • S. saprophyticus
  • E. coli
  • Enterbacter
  • Klebsiella
  • Serratia
  • Proteus
  • Pseudomonas
116
Q

Go through the treatment recommendations for uncomplicated and toxic UTIs.

A
  • Uncomplicated: 7-14 days of Bactrim or cefixime

* Toxic: cefotaxime, amp/gent, pip/taz, ticar/clav

117
Q

Greater than ____________ bilirubin levels is pathologic no matter the age.

A

15

MS3 - Infant, Child, and Adolescent Care (51 decks)

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