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Peds > Deck 1 > Flashcards

Deck 1 Flashcards

1
Q

developmental quotient is calculated how?

A

developmental age/chronologic age

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2
Q

what is normal developmental quotient?

A

> 85 is normal, less than 70 is abnormal

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3
Q

primitive reflexes

A

present at birht

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4
Q

example of primitive reflec

A

moro reflex

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5
Q

when do primitive reflexes disappear?

A

3-6 months of age

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6
Q

what should you be concerned about if primitive reflexes stay?

A

CNS injuries

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7
Q

postural reaction

A

acquired (not present at birth)

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8
Q

example of postural reflex

A

parachute reaction

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9
Q

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

A

cns damage

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10
Q

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

A

prox to distal

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11
Q

gross motor milestone at birth

A

turn head side to side

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12
Q

gross motor milestone at 2 months

A

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

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13
Q

gross motor milestone at 4 months

A

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

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14
Q

gross motor milestone at 6 months

A

sits alone, leads with head when pulled from supine position

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15
Q

gross motor milestone at 9 months

A

pulls to stand; cruises

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16
Q

gross motor milestone at 12 months

A

walks

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17
Q

four primitive reflexes

A

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

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18
Q

two postural reactions

A

head righting, parachute

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19
Q

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

A

appears at birth and disappears at 3 months

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20
Q

hand grasp

A

appears at birth and disappears at 1-3 months

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21
Q

atonic neck (fencer) reflex

A

appears at 2-4 weeks and disappears at 6 months

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22
Q

rooting reflex

A

appears at birth and disappears at 6 months

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23
Q

head righting

A

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

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24
Q

parachute

A

8-9 months appears and then persists

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25
Q

fine motor milestone at birth

A

keeps hands tightly fisted

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26
Q

fine motor milestone 3-4 months

A

brings hands together to midline and then to mouth

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27
Q

fine motor milestone at 4-5 months

A

reaches for objects

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28
Q

fine motor milestone at 6-7 months

A

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

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29
Q

fine motor milestone at 9 months

A

uses immature pincer (bt thumb and index finger)

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30
Q

fine motor milestone 12 months

A

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

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31
Q

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

A

during the second year of life

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32
Q

what is often the earlies sign of neuromotor problems?

A

persistent fisting beyond 3 months of age

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33
Q

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

A

spasticity

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34
Q

early hand dominance

A

before 18 months of age

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35
Q

what can early hand dominance tell us?

A

sign of weakness of the opposite upper extremity associated with hemiparesis

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36
Q

when is optimal language development?

A

first two years of life

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37
Q

what are the periods of speech development?

A

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

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38
Q

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

A

6-8 months after their first word

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39
Q

basic language milestone at birth

A

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

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40
Q

basic language milestone at 2-3 months

A

cooing, musical sounds

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41
Q

basic language milestone at 6 months

A

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

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42
Q

basic language milestone at 9-12 months

A

jargoning, begins using mama, dada (nonspecific)

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43
Q

basic language milestone at 12 months

A

1-3 words, mama and dada (specific)

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44
Q

basic language milestone at 18 months

A

20-50 words; beginning to use two word phrases

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45
Q

basic language at 2 years

A

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

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46
Q

basic language milestone at 3 years

A

three word sentense; 75% intelligible

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47
Q

when is the “sensorimotor period”?

A

birth to age 2

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48
Q

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

A

begins at 1 year

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49
Q

when does imaginitive play begin

A

24-30 months

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50
Q

when does concrete thinking start?

A

preschool

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51
Q

when does abstract thinking start?

A

adolescence

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52
Q

when does object permanence develop

A

9 months, think sep anxiety at this time too

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53
Q

when does separation anxiety develop?

A

6-18 months

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54
Q

when does cause and effect develop?

A

9-15 monhs

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55
Q

when is parallel play? Social play?

A

parallel during first 2 years and social at about 3 years

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56
Q

cerebral palsy

A

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

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57
Q

what is prevalence of cerebral palsy?

A

0.2-0.5%

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58
Q

How do you dx cerebral palsy?

A

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

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59
Q

two types of cerebral palsy

A

spastic, extrapyramidal,

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60
Q

spastic diplegia cerebral palsy

A

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

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61
Q

maternal risk factors for cerebral palsy

A

multiple gestation, preterm labor

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62
Q

prenatal risk factors for cerebral palsy

A

intrauterine growth retardation, congenital malformatios, TORCH infections

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63
Q

extrapyramidal cerebral palsy

A

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

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64
Q

mental retardation

A

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

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65
Q

scissoring may be a sign of what?

A

spastic diplegia

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66
Q

early hand dominance can be a sign of what?

A

spastic hemiplegia

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67
Q

extrapyramidal

A

involuntary reflexes

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68
Q

athetoid movements

A

slow involuntary convoluted writhing movements; seen in extrapyramidal cerebral palsy

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69
Q

kernicterus

A

bilirubin-induced brain dysfunction;

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70
Q

mild retardation IQ

A

55-69

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71
Q

moderate retardation

A

40-54

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72
Q

severe retardatn

A

25-39

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73
Q

profound mental retardation

A

less than 25

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74
Q

the most common cause of learning disability

A

idiopathic

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75
Q

pervasive developmental disorder

A

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

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76
Q

what is the prototypical pervasive developmental disorder (PDD)

A

autism

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77
Q

when is onset for autism

A

prior to 3 years

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78
Q

echolalia

A

repetitive words and phrases, seen in kids with autism

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79
Q

difference between autism and aspergers

A

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

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80
Q

how heritable is ADHD?

A

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

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81
Q

etiology of ADHD

A

abnormalities in neurotransmitter function (dopamine and norepi)

82
Q

when must ADHD start?

A

before age 7

83
Q

stimulants used for ADHD

A

methylphenidate (Ritalin) and amphetamines (Adderall)

84
Q

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

A

tricyclic antidepressants and adrenergic agonists like clonidine

85
Q

effect of methylphenidata (ritalin) on growth stature

A

may decrease growth velocity but ultimately stature is not affected

86
Q

prevalence of hearing loss in newborns

A

1/600

87
Q

when should intervention occur for hearing impaired child

A

before 6 months of age

88
Q

most common cause of hearing impairment

A

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

89
Q

why should creatinine level be checked in kids born deaf?

A

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

90
Q

what imaging can be useful in dx deaf kids?

A

CT scan of the ear

91
Q

primary cause of blindness worldwide?

A

chlamydia trachomadas

92
Q

what are two other causes of blindness in kids?

A

retinopathy or prematurity, congenital cataracts

93
Q

definition of colic

A

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

94
Q

when does colic usually start age-wise?

A

starts at 2 weeks and resolves by 4 months

95
Q

definition of enuresis

A

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

96
Q

secondary enuresis

A

enuresis after 6 months of being dry

97
Q

nocturnal enuresis

A

there’s actually a gene on chrom 13

98
Q

treatments for nocturnal enuresis

A

behavioral modification, alarms, and pharmacotherapy

99
Q

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

A

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

100
Q

side effect of tricyclic antidepressants

A

fatal cardiac dysrhythmia with overdose

101
Q

management of diurnal enuresis

A

bladder stretching exercises, timed voiding, treatment of coexisting constipation

102
Q

when do most infants sleep through the night?

A

3 months of age- defined as 5 hours after midnight

103
Q

what stage of sleep do nightmares occur in?

A

REM

104
Q

what stage do night terrors occur in?

A

stage 4, non-REM sleep

105
Q

difference between nightmares and nightterrors?

A

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

106
Q

temper tantrums are common at what age

A

between 1 y and 3 y

107
Q

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

A

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

108
Q

bowel control age range

A

16-48 months (1-4 years)

109
Q

bladder control age range

A

18-60 months (1.5-5 years)

110
Q

length of the growth spurt

A

2-3 years

111
Q

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

A

50% of weight and 25% of height

112
Q

first sign of puberty in males?

A

testicular enlargement, between 11 and 12 years

113
Q

what does HEADSS stand for?

A

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

114
Q

leading causes of death for adolescents

A

unintentional accidents, homicide, suicide

115
Q

DSM IV criteria for depression

A

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
Q

what is dysthymic disorder?

A

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
Q

definition of problem drinking

A

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

118
Q

binge drinking

A

5 or more drinks in one sitting

119
Q

CAGE questionaire

A

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
Q

definition of obesity

A

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

121
Q

tibia vara

A

bowlegs

122
Q

weight cut off for anorexia

A

must be >15% lower than ideal body weight

123
Q

another criterion for anorexia

A

absence of 3 consec menstrual cycles

124
Q

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

A

half

125
Q

most common cause of vaginitis

A

BV

126
Q

other causes of vaginitis

A

trichomonas, candida

127
Q

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

A

trichomonas, not BV or candida

128
Q

causes of urethritis (which is more common in males)

A

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

129
Q

presumptive dx of urethritis

A

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
Q

what percent of male adolescence get gynecomastia at some point?

A

60%

131
Q

management of gynecomastia?

A

reassurance. Usually resolves within 12-15 months

132
Q

what is most common cause of acute painful scrotal swelling?

A

torsion of spermatic cord

133
Q

clinical findings in torsion of spermatic cord

A

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

134
Q

lab studies to confirm torsion of spermatic cord

A

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

135
Q

management of torsion

A

surgical detorsion and fixation of both testes within the scrotum,

136
Q

when must sugery be done?

A

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

137
Q

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

A

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

138
Q

what do doppler and radionuc scans show?

A

normal or incr flow or uptake

139
Q

management of testicular appendage torsion

A

rest and analgesia; usuallyresolves within 2-12 days

140
Q

epidydimitis caused by what organisms

A

g/c

141
Q

dx of epididymitis

A

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

142
Q

cryptochordism

A

testes fail to descend; associated with high chance of malignancy

143
Q

dx of painless scrotal masses

A

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

144
Q

indirect inguinal hernia

A

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
Q

what does indirect inguinal hernia look like?

A

painless inguinal swelling

146
Q

hydrocele

A

collection of fluid within the tunica vaginalis

147
Q

what does hydrocele look like on testicular exam?

A

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

148
Q

how do you manage a hydrocele

A

reassurance; surgery only if very large, painful

149
Q

varicocele

A

dilation and tortuosity of veins in the pampiniform plexus

150
Q

how prevalent are varicoceles

A

10-20%

151
Q

bag of worms

A

varicocele

152
Q

clinical findings of varicocele

A

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
Q

management of varicocele

A

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

154
Q

puberty occurs in males how much later than in females

A

6-12 months

155
Q

gram neg intracellular diploccoci

A

gonorrhea

156
Q

chancre (h ducrei)

A

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

157
Q

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

A

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

158
Q

apgar heart

A

absent, less than 100, greater than 100

159
Q

apgar respiration

A

absent, slow/irreg, good/crying

160
Q

apgar muscle tone

A

limp, some flexion, active motion

161
Q

apgar reflex irritabilit (response to catheter in nose)

A

none, grimace, cough/sneeze/cry

162
Q

color

A

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

163
Q

how is lanugo different among babies of different gestational ages?

A

lanugo covers pretermers and minimally present in term infants

164
Q

how is vernix different among babies of different gestational ages

A

present in term infants, absent in post-term infants

165
Q

acorcyanosis (cyanosis of the hands and feet)

A

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
Q

cutis marmorata

A

mottling of the skin with venous prominence

167
Q

when is jaundice abnormal?

A

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

168
Q

milia

A

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

169
Q

treatment for milia?

A

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

170
Q

mongolian spots- clinical signif?

A

of no pathological significance

171
Q

pustular melanosis

A

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

172
Q

erythema toxicum neonatorum

A

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
Q

how common is erythema toxicum neonatorum

A

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

174
Q

erythema toxicum neonatorum lesions are filled with what?

A

eosinophils

175
Q

treatment for erythema toxicosum neonatorum

A

no treatment necessary

176
Q

nevus simplex

A

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
Q

nevus flammeus

A

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

178
Q

what can you expect for nevus flammeus and increasing age

A

get darker with age;

179
Q

what to be aware of with nevus flammeus

A

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
Q

sturge weber syndrom

A

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
Q

strawberry hemangiomas

A

benign proliferative vascular tumors

182
Q

how common are strawberry hemangiomas

A

10% of infants

183
Q

what should you expect with strawberry hemangiomas?

A

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

184
Q

which hemangiomas need attention

A

those that compromise the airway or vision

185
Q

neonatal acne occurs in what percent of newborns?

A

20%

186
Q

treatment for neonatal acne?

A

no

187
Q

when does neonatal acne appear?

A

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

188
Q

caput succendaneum

A

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

189
Q

cephalahemotomas

A

confined and limited by the sutures

190
Q

craniotabes

A

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

191
Q

what does an abnormal red reflex in a newborn indicate?

A

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

192
Q

choanal atresia

A

back of the nasal passage is blocked

193
Q

Pierre Robert syndrome

A

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

194
Q

Beckwith-Wiedemann syndrome

A

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

195
Q

other causes of macroglossia

A

hypothyroidism or mucopolysaccharidosis

196
Q

meausre head circum until what age

A

2 year

197
Q

failure to thrive

A

growth RATE less than expected

198
Q

particular concern with FTT

A

weight crosses 2 percentile isobars

199
Q

isolated short stature

A

only height is abnormal

200
Q

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

A

weight, then height then head circumfrence

Peds (99 decks)

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