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Flashcards in Deck 1 Deck (200):
1

developmental quotient is calculated how?

developmental age/chronologic age

2

what is normal developmental quotient?

>85 is normal, less than 70 is abnormal

3

primitive reflexes

present at birht

4

example of primitive reflec

moro reflex

5

when do primitive reflexes disappear?

3-6 months of age

6

what should you be concerned about if primitive reflexes stay?

CNS injuries

7

postural reaction

acquired (not present at birth)

8

example of postural reflex

parachute reaction

9

delayed development of postural reactions should make you concerned for what?

cns damage

10

fine motor skills progress from prox to distal or vice versa?

prox to distal

11

gross motor milestone at birth

turn head side to side

12

gross motor milestone at 2 months

lift head when lying prone; head lag when pulled from supine position

13

gross motor milestone at 4 months

rolls over; no head lag when pulled from supine position; pushes chest up with arms

14

gross motor milestone at 6 months

sits alone, leads with head when pulled from supine position

15

gross motor milestone at 9 months

pulls to stand; cruises

16

gross motor milestone at 12 months

walks

17

four primitive reflexes

moro, hand grasp, atonic neck reflex (fencer); rooting

18

two postural reactions

head righting, parachute

19

moro reflex- what is it, when does it appear and when does it disappear

appears at birth and disappears at 3 months

20

hand grasp

appears at birth and disappears at 1-3 months

21

atonic neck (fencer) reflex

appears at 2-4 weeks and disappears at 6 months

22

rooting reflex

appears at birth and disappears at 6 months

23

head righting

ability to keep head vertical despite body being tilted; appears at 4-6 months and persists

24

parachute

8-9 months appears and then persists

25

fine motor milestone at birth

keeps hands tightly fisted

26

fine motor milestone 3-4 months

brings hands together to midline and then to mouth

27

fine motor milestone at 4-5 months

reaches for objects

28

fine motor milestone at 6-7 months

rakes object with whole hand; transfers object from hand to hand

29

fine motor milestone at 9 months

uses immature pincer (bt thumb and index finger)

30

fine motor milestone 12 months

uses mature pincer (bt thumb and tip of index finger)

31

when does the infant learn to use objects as tools (building blocks)?

during the second year of life

32

what is often the earlies sign of neuromotor problems?

persistent fisting beyond 3 months of age

33

what would early rolling over, early pulling to a stand instead of sitting, persistent toe walking indicate?

spasticity

34

early hand dominance

before 18 months of age

35

what can early hand dominance tell us?

sign of weakness of the opposite upper extremity associated with hemiparesis

36

when is optimal language development?

first two years of life

37

what are the periods of speech development?

prespeech (0-10 months); naming (10-18 months); word combination (18-24 months)

38

when, relative to when they say their first word, are infants able to combine words?

6-8 months after their first word

39

basic language milestone at birth

attunes to human voice; develops differential recognition of parents' voices

40

basic language milestone at 2-3 months

cooing, musical sounds

41

basic language milestone at 6 months

babbling (ba-ba-ba, da-da-da)

42

basic language milestone at 9-12 months

jargoning, begins using mama, dada (nonspecific)

43

basic language milestone at 12 months

1-3 words, mama and dada (specific)

44

basic language milestone at 18 months

20-50 words; beginning to use two word phrases

45

basic language at 2 years

two word telegraphic sentences (mommy come); 25-50% of child's speech should be intelligible

46

basic language milestone at 3 years

three word sentense; 75% intelligible

47

when is the "sensorimotor period"?

birth to age 2

48

when is functional play (using a toy telephone as a telephone), i.e. recognizing objects and associates them with their function

begins at 1 year

49

when does imaginitive play begin

24-30 months

50

when does concrete thinking start?

preschool

51

when does abstract thinking start?

adolescence

52

when does object permanence develop

9 months, think sep anxiety at this time too

53

when does separation anxiety develop?

6-18 months

54

when does cause and effect develop?

9-15 monhs

55

when is parallel play? Social play?

parallel during first 2 years and social at about 3 years

56

cerebral palsy

injury to the brain during development, such that motor function is primarily affected; intelligence can be normal or can not be; lots of other associated things like seizures, cognitive deficits, mental retardation, learning disabilities, sensory loss, and visual and auditory d

57

what is prevalence of cerebral palsy?

0.2-0.5%

58

How do you dx cerebral palsy?

repeated neurodevelopmental exams showing increased tone or spasticity, hypotonia, asym reflexes or movement disorder, or abnormal patterns in disappearance of reflexes or emergence of postural responsess

59

two types of cerebral palsy

spastic, extrapyramidal,

60

spastic diplegia cerebral palsy

one of the three types of spastic cerebral palsy; involves the lower extremities more than the upper extremities or face

61

maternal risk factors for cerebral palsy

multiple gestation, preterm labor

62

prenatal risk factors for cerebral palsy

intrauterine growth retardation, congenital malformatios, TORCH infections

63

extrapyramidal cerebral palsy

patients have trouble controlling the face, trunk, extremities, often writhing. Signif oral motor involvement occurs

64

mental retardation

significant subaverage intellectual functioning in adaptive behavior; it is manifested before 18 yo

65

scissoring may be a sign of what?

spastic diplegia

66

early hand dominance can be a sign of what?

spastic hemiplegia

67

extrapyramidal

involuntary reflexes

68

athetoid movements

slow involuntary convoluted writhing movements; seen in extrapyramidal cerebral palsy

69

kernicterus

bilirubin-induced brain dysfunction;

70

mild retardation IQ

55-69

71

moderate retardation

40-54

72

severe retardatn

25-39

73

profound mental retardation

less than 25

74

the most common cause of learning disability

idiopathic

75

pervasive developmental disorder

spectrum of disabilities affecting multiple developmental areas, with a wide range of severity

76

what is the prototypical pervasive developmental disorder (PDD)

autism

77

when is onset for autism

prior to 3 years

78

echolalia

repetitive words and phrases, seen in kids with autism

79

difference between autism and aspergers

autism is more severe; in aspergers you don't see signif language delay

80

how heritable is ADHD?

30-50% of affected chilren have a first degree relative with ADHD

81

etiology of ADHD

abnormalities in neurotransmitter function (dopamine and norepi)

82

when must ADHD start?

before age 7

83

stimulants used for ADHD

methylphenidate (Ritalin) and amphetamines (Adderall)

84

what are the nonstimulant (second line) treatments for ADHD?

tricyclic antidepressants and adrenergic agonists like clonidine

85

effect of methylphenidata (ritalin) on growth stature

may decrease growth velocity but ultimately stature is not affected

86

prevalence of hearing loss in newborns

1/600

87

when should intervention occur for hearing impaired child

before 6 months of age

88

most common cause of hearing impairment

genetic causes account for 80% and 80%of those are recessive

89

why should creatinine level be checked in kids born deaf?

there is an association between hearing loss and kidney problems; Alport disease

90

what imaging can be useful in dx deaf kids?

CT scan of the ear

91

primary cause of blindness worldwide?

chlamydia trachomadas

92

what are two other causes of blindness in kids?

retinopathy or prematurity, congenital cataracts

93

definition of colic

crying that lasts greater than 3 hours per days and occurs at least 3 days per week

94

when does colic usually start age-wise?

starts at 2 weeks and resolves by 4 months

95

definition of enuresis

urinary incont beyond the age when the child is developmentally capable of continence

96

secondary enuresis

enuresis after 6 months of being dry

97

nocturnal enuresis

there's actually a gene on chrom 13

98

treatments for nocturnal enuresis

behavioral modification, alarms, and pharmacotherapy

99

two typs of meds that are used (but only with behavioral mod and alarms)

desmopressin acetate (DDAVP) decreases urine volume but relapse common after stopping med; tricylcic antidepressants (imipramine) but don't work that well

100

side effect of tricyclic antidepressants

fatal cardiac dysrhythmia with overdose

101

management of diurnal enuresis

bladder stretching exercises, timed voiding, treatment of coexisting constipation

102

when do most infants sleep through the night?

3 months of age- defined as 5 hours after midnight

103

what stage of sleep do nightmares occur in?

REM

104

what stage do night terrors occur in?

stage 4, non-REM sleep

105

difference between nightmares and nightterrors?

the child awakes glassy eyed and does not remember night terrors the next day.

106

temper tantrums are common at what age

between 1 y and 3 y

107

when are breath holding spells (involuntary, harmless) typically seen?

start between 6 and 18 months and disappear by 5 years of age

108

bowel control age range

16-48 months (1-4 years)

109

bladder control age range

18-60 months (1.5-5 years)

110

length of the growth spurt

2-3 years

111

what percent of adult weight and what percent of adult height are gained during growth spurt?

50% of weight and 25% of height

112

first sign of puberty in males?

testicular enlargement, between 11 and 12 years

113

what does HEADSS stand for?

home, education/employment, activities, drugs, sex, suicide/depression

114

leading causes of death for adolescents

unintentional accidents, homicide, suicide

115

DSM IV criteria for depression

must have 5 out of 9: depressed or irritable mood, diminished interest in activites, weight gain or loss, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness, diminished ability to concentrate, recurrent thoughts of death or suicide

116

what is dysthymic disorder?

milder sx than depression that last at least 1 year; 2 out of 5 sx: poor appetite or overeating, insomnia or hypersomnia, diminished energy, difficulty concentration, feelings of hopelessness

117

definition of problem drinking

6 or more episdoes a year of being intox OR having problems (like missing school) associated with the drinking

118

binge drinking

5 or more drinks in one sitting

119

CAGE questionaire

felt like you had to cut down? Have others annoyed you by criticizing your drinking? Have you felt guilty about drinking? Have you ever had a drink first thing in the morning (eye opener)/

120

definition of obesity

weight greater than 20% over ideal body weight; BMI greater than 95% for age and sex;

121

tibia vara

bowlegs

122

weight cut off for anorexia

must be >15% lower than ideal body weight

123

another criterion for anorexia

absence of 3 consec menstrual cycles

124

what percent of kids are sexually actve by the end of hs?

half

125

most common cause of vaginitis

BV

126

other causes of vaginitis

trichomonas, candida

127

partners should be treated if what is the cause of vaginitis?

trichomonas, not BV or candida

128

causes of urethritis (which is more common in males)

gonoccocus or non-gonoccoccal (chlamydia, usually, or HSV or trichomonas)

129

presumptive dx of urethritis

mucupurulent urethral discharge, greater than 5 wbcs per hpf on gram stain of urethral secretions, greater than 10 wbcs per hpf on first void urine specimen, pos leukocyte esterase

130

what percent of male adolescence get gynecomastia at some point?

60%

131

management of gynecomastia?

reassurance. Usually resolves within 12-15 months

132

what is most common cause of acute painful scrotal swelling?

torsion of spermatic cord

133

clinical findings in torsion of spermatic cord

pain, n/v, swollen tender testicle, absent cremasteric reflex on the affected side,

134

lab studies to confirm torsion of spermatic cord

decreased uptake on 99m pertechnetate radionuclide scan or absent pulsations on doppler u/s of the scrotum

135

management of torsion

surgical detorsion and fixation of both testes within the scrotum,

136

when must sugery be done?

within 6 hours- it's an emergency! Otherwise you lose testicular function

137

pain of tosion of testicular appendage can mimic spermatic cord torsion. How can you tell them apart?

testicular appendage torsion has a blue dot sign which is the twisted appendage visible through the skin of the scrotum

138

what do doppler and radionuc scans show?

normal or incr flow or uptake

139

management of testicular appendage torsion

rest and analgesia; usuallyresolves within 2-12 days

140

epidydimitis caused by what organisms

g/c

141

dx of epididymitis

u/a shows incr WBC and also pos culture of urethral discharge; doppler shows increased flow and radio scan shows increased uptake

142

cryptochordism

testes fail to descend; associated with high chance of malignancy

143

dx of painless scrotal masses

doppler u/x of the scrotum; eval for serum tumor markers hcg and afp; eval for distant mets

144

indirect inguinal hernia

the processeus vaginalis fails to obliterate; this results in a defect in the abdominal wall that allows bowel to extend through the internal inguinal ring

145

what does indirect inguinal hernia look like?

painless inguinal swelling

146

hydrocele

collection of fluid within the tunica vaginalis

147

what does hydrocele look like on testicular exam?

painless, soft, cystic scrotal mass that may be smaller in the morning and larger at night; dx with transillumination of the scrotum

148

how do you manage a hydrocele

reassurance; surgery only if very large, painful

149

varicocele

dilation and tortuosity of veins in the pampiniform plexus

150

how prevalent are varicoceles

10-20%

151

bag of worms

varicocele

152

clinical findings of varicocele

most commonly found in the left half of the scrotum; diminish in side when the patient is supine and enlarges with standing and valsalva

153

management of varicocele

reassurance; if painful or distended or associated with a small testicle (means diminished blood flow), refer to urologist

154

puberty occurs in males how much later than in females

6-12 months

155

gram neg intracellular diploccoci

gonorrhea

156

chancre (h ducrei)

painful multiple ulcers with red irreg borders and purulent discharge; ainful inguinal adenopathy; treat with oral azithromycin, erythromicin or IM ceftriaxone

157

if apgars arent good at 1 and 5 mins, what's the protocol

scoring should be continued every 5 minutes until a final score of 7 is reached

158

apgar heart

absent, less than 100, greater than 100

159

apgar respiration

absent, slow/irreg, good/crying

160

apgar muscle tone

limp, some flexion, active motion

161

apgar reflex irritabilit (response to catheter in nose)

none, grimace, cough/sneeze/cry

162

color

blue/pale, body pink with blue extremities, completely pink

163

how is lanugo different among babies of different gestational ages?

lanugo covers pretermers and minimally present in term infants

164

how is vernix different among babies of different gestational ages

present in term infants, absent in post-term infants

165

acorcyanosis (cyanosis of the hands and feet)

very frequent during the first 48-72 hours and for some infants can last through the first month of life, particularly if the baby is very cold

166

cutis marmorata

mottling of the skin with venous prominence

167

when is jaundice abnormal?

within the first 24 hours of life; it is normal if seen within the first few days after birth

168

milia

very small cysts formed around the polosebacceous follicles; look like white papules on the nose, cheeks, forehead and chin

169

treatment for milia?

no, they disappear within a few weeks and do not require treatments

170

mongolian spots- clinical signif?

of no pathological significance

171

pustular melanosis

benign transient rash with small dry vesicles over a dark macular base; must be differentiated from infections like herpes and impetigo

172

erythema toxicum neonatorum

benign rash seen most frequently in the 72 hours after birth; erythematous macules, papules, and pustules resembling flea bites; on the trunk and extremites and face but spares the palms and soles;

173

how common is erythema toxicum neonatorum

about 50% of full term infants and is found much less freq in preterm infeants

174

erythema toxicum neonatorum lesions are filled with what?

eosinophils

175

treatment for erythema toxicosum neonatorum

no treatment necessary

176

nevus simplex

aka salmon patch or telangiectatic nevus; most common vascular lesion of infancy; pink macular lesion on the nape of the neck ("stork bite"), upper eyelids, or nasolabial region. It is transient

177

nevus flammeus

aka port wine stain; congenital vascular malformation composed of dilated capillary-like vessels on the face or trunk

178

what can you expect for nevus flammeus and increasing age

get darker with age;

179

what to be aware of with nevus flammeus

those located in the opthalmic branch of the trigeminal nerve (cranial nerve V-1) are associated with intracranial or spinal vascular malformations, seizures, and intracranial calcifications (sturge weber syndrome)

180

sturge weber syndrom

when nevus flammeus are in the opthalmic region of cranial nerve V, then they may be associated with intracranial or spinal vascular malformations, seizures, and intracranial calcifications

181

strawberry hemangiomas

benign proliferative vascular tumors

182

how common are strawberry hemangiomas

10% of infants

183

what should you expect with strawberry hemangiomas?

first noticed a few days after birth, grow , and then resolve by 18-24 months

184

which hemangiomas need attention

those that compromise the airway or vision

185

neonatal acne occurs in what percent of newborns?

20%

186

treatment for neonatal acne?

no

187

when does neonatal acne appear?

1-2 weeks of life (virtually never present at birth)

188

caput succendaneum

diffuse swelling of the soft tissue of the scalp that crosses the cranial sutures

189

cephalahemotomas

confined and limited by the sutures

190

craniotabes

soft areas of the skull with a ping pong ball feel; usually within weeks or months

191

what does an abnormal red reflex in a newborn indicate?

may be caused by cataracts, glaucoma, retinoblastoma, or severe chorioretinitis

192

choanal atresia

back of the nasal passage is blocked

193

Pierre Robert syndrome

micrognathia, cleft palate, glossoptosis, and obstruction of the upper airway

194

Beckwith-Wiedemann syndrome

a cause of LGA infants; causes hemihypertrophy, visceromegaly, macroglossia

195

other causes of macroglossia

hypothyroidism or mucopolysaccharidosis

196

meausre head circum until what age

2 year

197

failure to thrive

growth RATE less than expected

198

particular concern with FTT

weight crosses 2 percentile isobars

199

isolated short stature

only height is abnormal

200

in children with FTT, what is affected first- height or weight?

weight, then height then head circumfrence