Community Pediatrics Flashcards
(176 cards)
1
Q
Definition of community pediatrics
A
the practice of promoting and integrating the positive social, cultural, and environmental influences on children’s health as well as addressing potential negative effects that deter optimal child health and development within a community
2
Q
Goals of the routine well child visit
A
- Provide surveillance of growth and development
- Conduct age-appropriate evidence based screening
- Administer immunizations
- Provide anticipatory guidance
- Address parental concerns.
3
Q
What are the factors that influence health outcomes, and how is the percentage distribution ?
A
Social , environmental and behavioral influence 50-60% of health outcomes
Genetic factors influence 30%
Health care system only 10%
4
Q
What is the definition of SDH? What are these?
A
conditions in which people are born, grow, live, work and age
Economic stability Neighborhood and physical environment Education Food Community and social context Healthcare system
5
Q
Adverse childhood experiences types
A
3 types:
- Abuse( physical, emotional, sexual)
- Neglecct ( physical and emotional)
- Household dysfunction
- Mental illness
- Incarcerated relative
- Mother treated violently
- Substance abuse
- Divorce
6
Q
CDC-Kaiser permanent ACE study
A
largest investigations of childhood abuse and neglect and household challenges and later-life health and well-being.
Found that increased ACEs would lead to:
Increased morbidity and mortality
negative outcomes: alcoholism, illicit drug use, COPD, depression, fetal death, ischemic heart disease, liver disease
7
Q
ACE Pyramid
A
Bottom to top:
- ACE
- Disrupted Neurodevelopment
- Social, emotional, cognitive impairment
- Adoption of health risk behaviors
- Disease, disability and social problems
- Early death
8
Q
What do you consider when choosing a tool for screening SDH
A
The goals of screening in your setting( referral sources, identifying needs, social’s context)
Format used ( paper, electronic, self administered)
Who will respond to positive results
9
Q
What is advocacy
A
to offer pubic support for or recommend a cause or policy
10
Q
ITHELLPS - Screening for social determinants of health
A
income and food security, transportation, housing/utilities, education, legal status/immigration, literacy, personal safety and support
11
Q
Four stages of growth
A
fetal, infant, childhood, and pubertal.
12
Q
What are the MC parameters to assess growth
A
weight, height (or length if the child is measured supine), and head circumference.
13
Q
Which growth chart to use according to age
A
WHO 0-2 years
CDC >2 years
14
Q
Why using WHO growth chart in children < 2 years?
A
- utilize growth of the breastfed infant as the norm for growth.
- The WHO standards are based on high quality data collected for children younger than aged 2 years.
15
Q
There is a modified CDC version for the WHO growth charts in < 2 years
A
The WHO growth charts as modified by CDC use the 2nd percentile and the 98th percentile as the outer most percentile cutoff values.
16
Q
The use of BMI-for-age is not recommended for children younger than aged 2 years at this time
A
true
17
Q
Factors that affect Fetal growth
A
- maternal nutrition
- uterine size
- hormones (including insulin and insulin-like growth factors).
18
Q
Small for gestational age (SGA) definition
A
birth weight is below the 10th percentile for the appropriate gestational age.
19
Q
SGA is different from IUGR
A
IUGR describes a fetus that has not reached its growth potential
20
Q
Symmetric vs. Asymmetric IUGR
A
Symmetric - equally small, early in utero.
chromosomal abnormalities, infections
Asymmetric- spares the head, later onset
Uteroplacental insufficiency
Malnutrition
Smoking
hypertension
21
Q
large for gestational age definition (LGA)
A
infant whose weight is greater than the 90th percentile for gestational age.
22
Q
Children with ADHD often have impaired executive function including ______ and difficulty with response inhibition and control of impulsive behaviors
A
forward planning
abstract reasoning
working memory
mental flexibility
23
Q
Comorbidities of ADHD
A
Oppositional defiant disorder Conduct disorder Learning disabilities Tic disorder Depression Bipolar disorder Anxiety OCD Developmental coordination disorder Substance abuse
24
Q
Etiology ADHD
A
unclear
catecholamine metabolism in cerebral cortex appears to play a role.
other factors that may contribute: maternal alcohol, tobacco, substance
prematurity
pre and postnatal toxin exposure
FOOD DOESNT IMPACT ADHD
25
Diagnosis of ADHD
NICHQ Vanderbilt Assessment - parent, teacher
>= 6 of first 9 questions= inattention, above 18 yo is 5
>= 6 of second 9 questions up to 18 = hyperactivity / above 18 is 5
Ss are present in >= 2 settings
Must impair function and interfere with quality of social, school or work functioning.
and rule out other causes
Symptoms must be present before age 12 and last at least 6 months.
26
Diagnosis of ADHD by DMS-V Inattention dimension:
- Careless mistakes
- Difficulty sustaining attention
- Seems not to listen
- Fails to finish tasks
- Difficulty organizing
- Avoids tasks that require sustained attention
- Loses things
- Easily distracted
- Forgetful
Hyperactivity/Impulsivity dimension
27
Diagnosis of ADHD by DMS-V Hyperactivity/Impulsivity dimension
- Fidgety
- Unable to stay seated
- Moves excessively ( restless)
- Difficulty engaging in leisure activity quietly
- "On the go"
- "Talks excessively
- Blurts answers before questions are complete
- Difficulty awaiting turn
- Interrupts or intrudes others
28
In ADHD at what age does hyperactivity/impulsivity usually starts? at which age does it peak?
starts 4 years
| peaks 7-8 years
29
In ADHD at what age does inattention becomes more apparent?
8-9 years
30
3 types of ADHD
1. Combined presentation- inattention and hyperactivity-impulsivity were present for the past 6 months.
2. Predominantly inattentive presentation- more inattentive, were present for the past 6 months
3. Predominantly hyperactive-impulsive presentation- were present for the past 6 months
31
Differential Dx of ADHD
```
Sympathomimetic toxidrome
hyperthyroidism
absence seizure
anxiety
depression
lead toxicity
OSA (assess freq snore,breath pauses, RF)
intellectual disability ( fetal alcohol syndrome, fragile X syndrome(
Learning disabilities ( dyslexia)
restless leg syndrome
```
32
Dyslexia
difficulty reading due to problems identifying speech sounds and learning how they relate to letters and words
33
MOA methylphenidate
inhibits dopamine and norepinephrine reuptake
34
If ss of ADHD arise suddenly suspect..
```
head trauma
physical or sexual abuse
neurodegenerative disorders
mood or anxiety disorders
substance abuse
major psychological stress in the family or school
```
35
CRAFFT questionaire
Substance abuse
Car, Relax, Alone, Forget, Friends, Trouble
1.Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
2. Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
3. Do you ever use alcohol or drugs while you are by yourself, or ALONE?
4. Do you ever FORGET things you did while using alcohol or drugs?
5. Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
6. Have you ever gotten into TROUBLE while you were using alcohol or drugs?
CRAFFT Scoring: Each “yes” response in Part B scores 1 point.
A total score of 2 or higher is a positive screen, indicating a need for additional assessment.
36
Advocacy and support group for AHDH
CHADD= Children and adults with ADHD disorder
37
Any child who meets the criteria for ADHD should be considered a child/youth with special health care needs
True
38
Treatment of ADHD
* Preschool age ->behavioral therapy
| * School age ->behavioral therapy + trial stimulants
39
Drug of choice for ADHD
| Ohter drugs
Methylphenidate ( Stimulant)
Mixed amphetamine salts (Adderall)
Dextroamphetamine
Lisdexamfetamine
Dexmethylphenidate
Atomoxetine
ER guanfacine
ER clonidine
40
What to order before prescribing methylphenidate for ADHD?
Good PE
Evaluate if ECG is needed- this is based on physician suspicion and is not mandatory.
history of cardiac ss
cardiac family history- arrhythmias, sudden death, deathh young age.
41
Should treatment of ADHD be withheld if an ECG is not done?
NO, doing an ECG is not mandatory and depends on physicians judgement.
42
Give med for ADHD in patient with congenital heart disease?
reasonable in congenital heart disease that is either unrepaired or repaired, but without current hemodynamic or arrhythmic concerns.
43
Which ADHD meds increase and decrease BP and HR?
Increase: methylphenidate, amphetamine, atomoxetine
Decrese: guanfacine, clonidine
44
Which ADHD meds cause ECG changes?
None of the common ones.
The two meds non-FDA approved that can alter ECG:
Bupropion
Desipramine, imipramine.
45
Stimulant medications for ADHD can be effectively titrated every _____
3-7 days. done with the prescription note
Then face-to face visit: 4 weeks
46
In person visits interval to PCP once ADHD meds have been started
every month until there is a consistent optimal response.
then every 3 months in the first year of tto
Subsequent visits at depend on progress, but twice per year.
47
In ADHD By three years after starting medication, continue to impove even if the medication has been discontinued.
TRUE
48
What if you gave max dose of Methylphenidate and kid still with ADHD still not improving?
Give a med from the other stimulant grouop ( amphetamine) with similar titration plan.
Is likely that they improve
49
Atomoxetine black box warning
Suicidal ideation
50
MOA Atomoxetine
selective NE reuptake inhibitor
max response in 4-6 hours
51
Time of medication response in atomoxetine vs. alpha adrenergic agonists for ADHD?
atomoxetine : max response in 4-6 weeks
alpha adrenergic agonists : 2-4 weeks.
WHILE METHYLPHENIDATE IS LONGER.
52
AE Atomoxetine
```
GI symptoms
Sedation early in treatment ( so prescribe half dose initially 0.5 mg/kg)
appetite suppression
tics
headache
weight loss
hepatitis (rare)
```
Black box warning: suicidal ideation
53
AE alpha adrenergic agonists
somnolence
54
Duration of behavioral therapy
12-14 months
55
Which is the only FDA med approved for ADHD in children?
Dextroamphetamine,
But because there is more evidence with methylphenidate we use this one as first line.
56
Before prescribing ADHD med in adolescents what should you consider
substance abuse. Stop this before starting ADHD med
57
effect size calculation
(Treatment mean-control mean)/control SD
58
AE ADHD stimulants
```
appetite loss
abdominal pain
headache
sleep disturbance
increased BP and HR
Potential to exacerbate tics - although in some improve
hallucinations ( uncommon)
in preschoolers: mood liability and dysphoria
```
** decrease growth velocity (1-2 cm) particularly if higher and more consistently doses.(effects diminished by 3rd year of tto)
59
Lisdexamphetamine (Vyvanse)
prodrug of dextroamphetamine
| so less abusive potenital.
60
TIC disorders are NOT a contraindication of ADHD stimulant medications
TRUE
61
What to monitor in follow-up appointment of child with ADHD that has started treatment?
```
BP, HR
Appetite
weight
sleep
counsel about risks of substance abuse
```
62
PHQ-9 FOR DEPRESSION SCORE
```
Total Score Depression Severity
0-4 No or Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression
```
63
Indications to admit newborn to ICU
Birth weight < 2 kg
Gestational age< 37
Inability to PO feed
Any baby who requires IVF or IV med other than ampi/genta
Any baby who is undergoing treatment for infection > 48 hrs
Any baby who received CPR and/epi during initial resuscitation or requires O2 > 60 min after birth
Any baby with thermal instability or requires thermal support
Any baby with pneumothorax; congenital heart disease that requires ongoing observation
64
Why Vit K is low in newborns?
```
Coagulation --2,7,9,10
20% of adult vit K concentration due to:
poor placental transfer
Immature liver with low stores
Uncolonized intestine
Low vit K content in breast milk.
```
65
Why we care about vit K in newborns?
Coagulation --2,7,9,10
Bleeding:
Early onset: 0-2 weeks of age
Late onset 2-12 weeks of age
manifestations may be mild: skin bruising, bleeding at umbilicus or circumcision
Severe: intestinal bleeding and fatal intracranial hemorrhage
RR for developing late VKDB is 81x among infants who do not receive IM vit K vs those who doesnt
66
Vit K IM vs PO
IM has been shown to prevent both early and late forms of VKDeep bleeding ( CNS, intenstine).
PO prevents early VKBD but not late, which is the most scary.
67
IM Vit K dose
0.5-1 mg
68
Dose and why do you apply Erythromycin in babies?
0.5% ophtalmic ointment within 1st hour to all babies ( including C section)
69
Newborns born to mom with clinical gonorrhea?
IV or IM
Asymptomatic- still at risk : single dose of ceftriaxone (25 to 50 mg/kg, up to a total dose of 125 mg IM/IV) or cefotaxime (if available; 100 mg/kg, administered IV or IM) and should be evaluated for chlamydial infection
If disseminated disease:
Treatment of disseminated infection consists of ceftriaxone (25 to 50 mg/kg per dose once daily intravenously [IV] or intramuscularly) [1,2]. The duration of treatment is 7 days for septicemia, arthritis, or scalp abscess and 10 to 14 days for meningitis [1].
70
Gonoccocal conjunctivitis
2-5 days
purulent conjunctivitis, with profuse exudate and swelling of the eye
if untreated: ulceration, scarring, and blindness
Dx: Thayer-Martin medium gram stain + evaluation for chlamydia
TTO single dose of ceftriaxone (25 to 50 mg/kg, not to exceed 125 mg, intravenously or intramuscularly)
71
Why ceftriaxone should be cautiously used in hyperbilirubinemia and Ca containing IV fluids?
since it displaces bilirubin from albumin and may increase the risk of encephalopathy
- and it should be avoided in neonates receiving calcium-containing IV fluids including parenteral nutrition (due to risk of precipitation)
72
Idiopathic orbital inflammation
lacrimal glandextraocular musclesanterior orbitorbital apexdiffuse inflammation through the orbit
73
Idiopathic orbital inflammation presentation ( 5 signs)
Young adults , W>Mpalpable massmotility restrictionswollen- worse in morning, decreases in afternoon.proptosis increased orbital pressureIS LOCALIZED, NOT OFTEN WITH CONSTITUTIONAL SSPT MAY OR NOT PRESENT WITH DECREASED VISUAL ACUITY DEPENDING ON THE LOCATION
74
Idiopathic orbital inflammation presents in patients that also have
Otitis mediaSinusitisUpper respiratiory infectionsImmune related diseases: Crohns, myastenia, Ankylosing spondylitis
75
Diagnosis and treatment of Idiopathic orbital inflammation
Imaging- helps differentiate orbital cellulitis, malignancyBiopsy- eosinophils, plasma cells, lymphocytesTreatment : steroids ( Dexamethasone)
76
What is IgG4 Related disease
IgG4 plasma cell disorder with multiorgan compromise. Pancreatitis of unknown originSclerosing cholangitisBilateral salivary or lacrimal glandorbital pseudotumor or proptosis
77
Diagnosis and tto of IgG4 Related disease
Dx: core needle biopsySerum IgG4 levels Quantity of PlasmablastsTto: steroids.
78
Complications ankyloglossia
Difficulty breastfeeding Speech dificulty - tdzs r, l. Poor oral hygiene: difficulty moving food in the mouth away from the teeth or cheeksswallowing, kissing.
79
Procedure to remove ankyloglossia
Frenotomy early in newborn nursery or outpatient baby may feel little discomfort- arent many nerve endings in the frenulum. Local anesthesia may be usedFrenuloplasty - if the frenulum is to thick. general anesthesia . wound closed with stitches, and they disolve as the tongue heals. risks: minor bleeding , infection, scarring
80
What is milia and what do we do?
Skin newborn: white papules caused by retention of keratin and sebaceous material in the pilaceous follicles. They are frequently found on the nose and cheeks and resolve in the first few weeks of life
81
Miliaria - what is it, why, what do we do
Also called heat rash is a transient cutaneous eruption in newborns due to obstruction of sweat ducts.face, neck, body and under armsin summer and fue to overdressing baby.
82
Congenital dermal melanocytosis
blue-gray, pigmented macule or patch with indefinite borders, although it can also be greenish-blue or brown The most common location is the sacral-gluteal region, followed by the shouldersCause: delayed disappearance of dermal melanocytes. completely benign and usually fades during the first or second year of life By 6 -10 years disappeared 3 %remain into adulthood,
83
Molding
slighlty cone-shaped due to the passage through the birth canal Even babies in c-section head rounds during the first days
84
Caput succedaneum
edematous swelling of the scalp above the periosteum that presents at birth after prolonged engagement of the fetal head in the birth canal or after vacuum extraction . with poorly defined margins Complications: halo scalp ring and erosive and necrotic lesions resulting in long-term scarring and alopecia.
85
Halo scalp ring is a complication of ...
caput succedaneum Halo scalp ring: area of alopecia that develops in some infants with caput succedaneum Alopecia resolves over a period of months to years but can be permanent
86
layers head to identify birth injuries
ScalpGaleal aponeurosis Subgaleal spacePeriostiumSkullDura
87
Cephalohematoma
swelling of the scalp that does not cross suture lines due to a subperiosteal hematoma. instrumented delivery. Complications: calcification or ossification, infection, and sepsis, hyperbilirrubinemia
88
Nevus simplex prognosis when does it fade?disorders?location?
BLANCHABLE LESIONS generally fades within one to two years, although lesions on the back of the neck may persist unchanged with little consequence may be associated with extracutaneous disorders such as spinal dysraphism, Beckwith-Wiedemann syndrome, macrocephaly-capillary malformation syndrome, or other conditions If lumbosacral imaging studies to evaluate for underlying spinal dysraphism - when another lumbosacral abnormality such as a dermal sinus or pit, lipoma, patch of hypertrichosis, or deviated gluteal cleft is present
89
Port-wine stains or nevus flammeus
low-flow vascular malformations of dermal capillaries and postcapillary venules. BLANCHABLE located anywhere on the body, typically with a unilateral or segmental distribution that respects the midline do not regress, but grow in proportion to the child's growth and become thicker and darker in color during adulthood.
90
PUFFY EYELIDS IN NEWBORN
pressure on the face during delivery
91
why baby sneeze
frequently to clear their noses Nasal congestion is common
92
When does hydrocele disappear?
6-12 months to disappear completely check for signs of: increased sizehernia
93
Erections are common in newborn boys and often caused by full bladder
True
94
If undescended testicle, when should I spect to come down?
1st year, otherwise referral to surgery
95
Is it normal that the baby's feet are turned in, out or up, or for legs to appear bowed?
Yes, is caused by newborn;s cramped position in the uterus As long as they are flexible and can move no concerns.
96
Comfort measures when baby cries
see if hungry, diaper change or too cold or hot. Try talking or singing in a soothing voice or trying a shh sound. Hold you him closely and in different positionsTry rocking or swaying in a rhythmic motionDim lights, reduce noiseWarm bathWhite noisePacifier Swaddle baby in a blanket
97
How many bowel movements in breastfed vs. formula
breastfeeding: 3-4formula 1-3
98
Idiopathic orbital inflammation
lacrimal glandextraocular musclesanterior orbitorbital apexdiffuse inflammation through the orbit
99
Idiopathic orbital inflammation presentation ( 5 signs)
Young adults , W>Mpalpable massmotility restrictionswollen- worse in morning, decreases in afternoon.proptosis increased orbital pressureIS LOCALIZED, NOT OFTEN WITH CONSTITUTIONAL SSPT MAY OR NOT PRESENT WITH DECREASED VISUAL ACUITY DEPENDING ON THE LOCATION
100
Idiopathic orbital inflammation presents in patients that also have
Otitis mediaSinusitisUpper respiratiory infectionsImmune related diseases: Crohns, myastenia, Ankylosing spondylitis
101
Diagnosis and treatment of Idiopathic orbital inflammation
Imaging- helps differentiate orbital cellulitis, malignancyBiopsy- eosinophils, plasma cells, lymphocytesTreatment : steroids ( Dexamethasone)
102
What is IgG4 Related disease
IgG4 plasma cell disorder with multiorgan compromise. Pancreatitis of unknown originSclerosing cholangitisBilateral salivary or lacrimal glandorbital pseudotumor or proptosis
103
Diagnosis and tto of IgG4 Related disease
Dx: core needle biopsySerum IgG4 levels Quantity of PlasmablastsTto: steroids.
104
Complications ankyloglossia
Difficulty breastfeeding Speech dificulty - tdzs r, l. Poor oral hygiene: difficulty moving food in the mouth away from the teeth or cheeksswallowing, kissing.
105
Procedure to remove ankyloglossia
Frenotomy early in newborn nursery or outpatient baby may feel little discomfort- arent many nerve endings in the frenulum. Local anesthesia may be usedFrenuloplasty - if the frenulum is to thick. general anesthesia . wound closed with stitches, and they disolve as the tongue heals. risks: minor bleeding , infection, scarring
106
What is milia and what do we do?
Skin newborn: white papules caused by retention of keratin and sebaceous material in the pilaceous follicles. They are frequently found on the nose and cheeks and resolve in the first few weeks of life
107
Miliaria - what is it, why, what do we do
Also called heat rash is a transient cutaneous eruption in newborns due to obstruction of sweat ducts.face, neck, body and under armsin summer and fue to overdressing baby.
108
Congenital dermal melanocytosis
blue-gray, pigmented macule or patch with indefinite borders, although it can also be greenish-blue or brown The most common location is the sacral-gluteal region, followed by the shouldersCause: delayed disappearance of dermal melanocytes. completely benign and usually fades during the first or second year of life By 6 -10 years disappeared 3 %remain into adulthood,
109
Molding
slighlty cone-shaped due to the passage through the birth canal Even babies in c-section head rounds during the first days
110
Caput succedaneum
edematous swelling of the scalp above the periosteum that presents at birth after prolonged engagement of the fetal head in the birth canal or after vacuum extraction . with poorly defined margins Complications: halo scalp ring and erosive and necrotic lesions resulting in long-term scarring and alopecia.
111
Halo scalp ring is a complication of ...
caput succedaneum Halo scalp ring: area of alopecia that develops in some infants with caput succedaneum Alopecia resolves over a period of months to years but can be permanent
112
layers head to identify birth injuries
ScalpGaleal aponeurosis Subgaleal spacePeriostiumSkullDura
113
Cephalohematoma
swelling of the scalp that does not cross suture lines due to a subperiosteal hematoma. instrumented delivery. Complications: calcification or ossification, infection, and sepsis, hyperbilirrubinemia
114
Nevus simplex prognosis when does it fade?disorders?location?
BLANCHABLE LESIONS generally fades within one to two years, although lesions on the back of the neck may persist unchanged with little consequence may be associated with extracutaneous disorders such as spinal dysraphism, Beckwith-Wiedemann syndrome, macrocephaly-capillary malformation syndrome, or other conditions If lumbosacral imaging studies to evaluate for underlying spinal dysraphism - when another lumbosacral abnormality such as a dermal sinus or pit, lipoma, patch of hypertrichosis, or deviated gluteal cleft is present
115
Port-wine stains or nevus flammeus
low-flow vascular malformations of dermal capillaries and postcapillary venules. BLANCHABLE located anywhere on the body, typically with a unilateral or segmental distribution that respects the midline do not regress, but grow in proportion to the child's growth and become thicker and darker in color during adulthood.
116
PUFFY EYELIDS IN NEWBORN
pressure on the face during delivery
117
why baby sneeze
frequently to clear their noses Nasal congestion is common
118
When does hydrocele disappear?
6-12 months to disappear completely check for signs of: increased sizehernia
119
Erections are common in newborn boys and often caused by full bladder
True
120
If undescended testicle, when should I spect to come down?
1st year, otherwise referral to surgery
121
Is it normal that the baby's feet are turned in, out or up, or for legs to appear bowed?
Yes, is caused by newborn;s cramped position in the uterus As long as they are flexible and can move no concerns.
122
Comfort measures when baby cries
see if hungry, diaper change or too cold or hot. Try talking or singing in a soothing voice or trying a shh sound. Hold you him closely and in different positionsTry rocking or swaying in a rhythmic motionDim lights, reduce noiseWarm bathWhite noisePacifier Swaddle baby in a blanket
123
How many bowel movements in breastfed vs. formula
breastfeeding: 3-4formula 1-3
124
Idiopathic orbital inflammation
lacrimal glandextraocular musclesanterior orbitorbital apexdiffuse inflammation through the orbit
125
Idiopathic orbital inflammation presentation ( 5 signs)
Young adults , W>Mpalpable massmotility restrictionswollen- worse in morning, decreases in afternoon.proptosis increased orbital pressureIS LOCALIZED, NOT OFTEN WITH CONSTITUTIONAL SSPT MAY OR NOT PRESENT WITH DECREASED VISUAL ACUITY DEPENDING ON THE LOCATION
126
Idiopathic orbital inflammation presents in patients that also have
Otitis mediaSinusitisUpper respiratiory infectionsImmune related diseases: Crohns, myastenia, Ankylosing spondylitis
127
Diagnosis and treatment of Idiopathic orbital inflammation
Imaging- helps differentiate orbital cellulitis, malignancyBiopsy- eosinophils, plasma cells, lymphocytesTreatment : steroids ( Dexamethasone)
128
What is IgG4 Related disease
IgG4 plasma cell disorder with multiorgan compromise. Pancreatitis of unknown originSclerosing cholangitisBilateral salivary or lacrimal glandorbital pseudotumor or proptosis
129
Diagnosis and tto of IgG4 Related disease
Dx: core needle biopsySerum IgG4 levels Quantity of PlasmablastsTto: steroids.
130
Complications ankyloglossia
Difficulty breastfeeding Speech dificulty - tdzs r, l. Poor oral hygiene: difficulty moving food in the mouth away from the teeth or cheeksswallowing, kissing.
131
Procedure to remove ankyloglossia
Frenotomy early in newborn nursery or outpatient baby may feel little discomfort- arent many nerve endings in the frenulum. Local anesthesia may be usedFrenuloplasty - if the frenulum is to thick. general anesthesia . wound closed with stitches, and they disolve as the tongue heals. risks: minor bleeding , infection, scarring
132
What is milia and what do we do?
Skin newborn: white papules caused by retention of keratin and sebaceous material in the pilaceous follicles. They are frequently found on the nose and cheeks and resolve in the first few weeks of life
133
Miliaria - what is it, why, what do we do
Also called heat rash is a transient cutaneous eruption in newborns due to obstruction of sweat ducts.face, neck, body and under armsin summer and fue to overdressing baby.
134
What is this?
Miliaria crystallina
135
What is this?
Milliaria rubra
136
What is this?
Sebaceous hyperplasia small (1 to 2 mm), white-yellow, smooth papules occurring most prominently on the face, particularly on the nose and upper lip, in up to one-half of normal newborns They gradually involute in the weeks after birth.
137
What is this?
Erythema toxicum neonatorum in body and diaper area common pustular eruption seen in term neonates within the first 1-3 days of life that resolves spontaneously within one weekno scratch. no tto
138
What is this?
Neonatal cephalic pustulosis (also called neonatal acne) a pustular eruption on the head and neck of newbornsonset around 3-4 weeks of life last until 4-6 months Some studies have shown an association with Malasseziacolonization. It resolves spontaneously without scarring in a few months but may be treated with topical azole antifungal preparations or mild topical steroids to speed clearance.
139
What is this?
Sucking blisters single, noninflammatory vesicles or bullae on the wrists, hands, or fingers of newborns due to vigorous sucking in utero
140
What is this?
Benign cephalic histiocytosisself-healing type of non-Langerhans cell histiocytosis infants and young children, with an average age of onset of 15 months small, yellow-red or yellow-brown, asymptomatic macules and/or papules located mostly on the head and neck
141
What is this?
Cradle capscaly white or yellow patches on the scalp that may be oily or dryCause unknownnot contagious, not due to poor hygiene baby oil before washing it with mild shampoo. Dont leave oil on or it may worsen. Do not scratch it
142
Congenital dermal melanocytosis
blue-gray, pigmented macule or patch with indefinite borders, although it can also be greenish-blue or brown The most common location is the sacral-gluteal region, followed by the shouldersCause: delayed disappearance of dermal melanocytes. completely benign and usually fades during the first or second year of life By 6 -10 years disappeared 3 %remain into adulthood,
143
What is this?
Cutis marmorata symmetric, reticular mottling of the skin of the extremities and trunk vascular response to cold and usually resolves with warming. distinguished from cutis marmorata telangiectatica congenita, a vascular malformation in which the lesions do not resolve with warming PLUS HAS body and limb asymmetry, cleft palate, and glaucoma
144
Molding
slighlty cone-shaped due to the passage through the birth canal Even babies in c-section head rounds during the first days
145
Caput succedaneum
edematous swelling of the scalp above the periosteum that presents at birth after prolonged engagement of the fetal head in the birth canal or after vacuum extraction . with poorly defined margins Complications: halo scalp ring and erosive and necrotic lesions resulting in long-term scarring and alopecia.
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Halo scalp ring is a complication of ...
caput succedaneum Halo scalp ring: area of alopecia that develops in some infants with caput succedaneum Alopecia resolves over a period of months to years but can be permanent
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layers head to identify birth injuries
ScalpGaleal aponeurosis Subgaleal spacePeriostiumSkullDura
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Cephalohematoma
swelling of the scalp that does not cross suture lines due to a subperiosteal hematoma. instrumented delivery. Complications: calcification or ossification, infection, and sepsis, hyperbilirrubinemia
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Nevus simplex prognosis when does it fade?disorders?location?
BLANCHABLE LESIONS generally fades within one to two years, although lesions on the back of the neck may persist unchanged with little consequence may be associated with extracutaneous disorders such as spinal dysraphism, Beckwith-Wiedemann syndrome, macrocephaly-capillary malformation syndrome, or other conditions If lumbosacral imaging studies to evaluate for underlying spinal dysraphism - when another lumbosacral abnormality such as a dermal sinus or pit, lipoma, patch of hypertrichosis, or deviated gluteal cleft is present
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Port-wine stains or nevus flammeus
low-flow vascular malformations of dermal capillaries and postcapillary venules. BLANCHABLE located anywhere on the body, typically with a unilateral or segmental distribution that respects the midline do not regress, but grow in proportion to the child's growth and become thicker and darker in color during adulthood.
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PUFFY EYELIDS IN NEWBORN
pressure on the face during delivery
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why baby sneeze
frequently to clear their noses Nasal congestion is common
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What is this?
Epstein pearls painless, harmless cyst spot usually disappear on their own
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When does hydrocele disappear?
6-12 months to disappear completely check for signs of: increased sizehernia
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Erections are common in newborn boys and often caused by full bladder
True
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If undescended testicle, when should I spect to come down?
1st year, otherwise referral to surgery
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Is it normal that the baby's feet are turned in, out or up, or for legs to appear bowed?
Yes, is caused by newborn;s cramped position in the uterus As long as they are flexible and can move no concerns.
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Comfort measures when baby cries
see if hungry, diaper change or too cold or hot. Try talking or singing in a soothing voice or trying a shh sound. Hold you him closely and in different positionsTry rocking or swaying in a rhythmic motionDim lights, reduce noiseWarm bathWhite noisePacifier Swaddle baby in a blanket
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How many bowel movements in breastfed vs. formula
breastfeeding: 3-4formula 1-3
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Typical growth can be classified into four stages:
fetal, infant, childhood, and pubertal.
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Fetal growth is influenced by
maternal nutrition, uterine size (restriction), and hormones (including insulin and insulin-like growth factors).
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Disorders of fetal growth
SGA - birth weight < 10th percentile for the appropriate gestational age. Can be symmetric/asymmetric
IUGR describes a fetus that has not reached its growth potential.
LGA - > 90th percentile
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most common pathology associated with LGA
gestational or pregestational diabetes
maternal obesity
overgrowth syndromes (e.g., Beckwith–Wiedemann and Sotos syndromes)
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How is the infant growth
-10% weight loss within the first few days of birth that is regained (“back to birth weight”) by 2 weeks.
After birth weight is regained, infants gain an average of 20–30 grams/day during the first 3 months.
double their birthweight by 6 months and triple it by one year.
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Mid-parental height formula
can be used as predictor of height in infant but may not be 100% accurate
For boys: [father’s height (cm) + mother’s height (cm) + 13]/2 or [father’s height (in) + mother’s height (in) + 5]/2
For girls: [father’s height (cm) - 13 + mother’s height (cm)]/2 or [father’s height (in) - 5 + mother’s height (in)]/2
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Failure to thrive causes
inadequate nutrient intakeinadequate nutrient absorption or increased lossesincreased nutrient requirements or ineffective utilizationeating disorders
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Overweight/obesity in children consider
hypothyroidism
Cushing disease
overnutrition
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very tall stature differential dx
hyperthyroidism
precocious puberty
growth hormone
excess familial glucocorticoid deficiency
chromosome duplication (e.g., Klinefelter syndrome; 47, XXY)
genetic syndrome (e.g., Weaver, Marfan, or Sotos syndromes)
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Macrocephaly
head size that is larger than expected for age (>98th percentile)
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Causes Macrocephaly
hydrocephalus: the brain is not growing rapidly but the skull grows too large or too fast because of cerebral spinal fluid (CSF) retention
intracranial masssubdural fluid collection
megalencephaly: increased brain mass that may be benign or a result of a syndrome or systemic disorder
benign enlargement of the subarachnoid space seen on head ultrasound of normally developing infants; as the name implies, a nonpathologic cause of macrocephaly often seen in families with large heads
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Domains of development
cognitive: reasoning, memory, and problem-solving skills
language: receptive and expressive communication, speech, and nonverbal communication
fine motor: movements using hands and small muscles
gross motor: movements using large muscles
social-emotional and behavioral: attachment, self-regulation, and interaction with others
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age for autism screen
18 and 24 months
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goal of primary prevention
prevent new disease by reducing risk factors.
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fluoride varnish to reduce risk of cariesvitamin D supplementation for infants to reduce the risk of ricketsvaccinations to prevent disease
are examples of _______ prevention
primary
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goal of secondary prevention
detect disease when a patient is still asymptomatic and early enough that treatment may improve prognosis. Secondary prevention is often achieved by screening
Screening tests are not diagnostic. Rather, they identify patients who need further workup, which may include further diagnostic testing.
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goal of tertiary prevention
reduce the burden of an existing disease and prevent disease-related complications.
