DIDACTICPediatrics_all lectures Flashcards
1
Q
Koplik spots
A
measles
2
Q
how long does measles usually last?
A
1 week
3
Q
What are the 4 D’s and 3 C’s of measles?
A
4 D’s and 3C’s:
4 days of high fever
Cough, coryza and conjunctivitis
(coryza = rhinitis)
4
Q
virus for Rubella?
A
Togavirus
“toGA! toGA! toGA!” think of a red toga…rubella means “little red”
5
Q
why do we vaccinate against rubella?
A
Rubella is the leading vaccine-preventable cause of birth defects
we want to avoid congenital rubella syndrome - must avoid this for women who could get pregnant.
6
Q
bacteria causing diptheria?
A
Corynebacterium diphtheria
toxin-producing strains!
7
Q
itch worse at night - so bad the pt can’t sleep
A
scabies
8
Q
how long do scabies live?
A
15-30 days
9
Q
how long does it take for scabies eggs to hatch?
A
3-4 days
10
Q
most common treatment for scabies
A
Permethrin 5% cream applied neck down
11
Q
treatment regiment for scabies
A
two Permethrin treatments, 7 days apart
12
Q
what is important for the household of a scabies pt?
A
must treat the whole household
affected people, 2 treatments 7 days apart, unaffected people, 1 treatment
13
Q
key to scabies dx?
A
itch that’s worse at night
siblings have it too
14
Q
what does atopic dermatitis respond to?
A
moisturizers
topical steroids
15
Q
common places for atopic dermatitis rash?
A
antecubital
pop fossa
(flexure spots)
16
Q
“islands of plaques”
A
psoriasis
17
Q
atopic dermatitis vs psoriasis
A
atopic dermatitis is very itchy, vs. psoriasis which is mildly or not itchy
18
Q
how long does topical steroid stay in the skin?
A
12 hours
19
Q
one sternocleidomastoid is shorter than the other
A
torticollis
20
Q
flat spot on head
A
plagiocephaly
"plagio" = oblique, slanting, flat, spread "cephaly" = head, skull, brain
21
Q
high fever + 3 C’s (cough, coryza, conjunctivitis) and a brick-red rash that begins at hairline (and spreads down)
A
measles
22
Q
what is coryza?
A
commonly used synonym for rhinitis
23
Q
most common cause of measles-related deaths
A
pneumonia
24
Q
live, attenuated vaccines
A
(MOVR, “mover”, they’re live, so they move)
M: MMR
O: Oral polio
V: Varicella Zoster
R: Rotavirus
also - smallpox yellow fever oral typhoid Franciscella tularensis
25
why do we care if vaccine is live, attenuated?
good immune response of both humoral (antibody) and cell-mediated immunity
don't usually need booster
don't give them to immunocompromised or pregnant pts!!!!!
26
killed, inactivated vaccines
PIRV A
```
Polio SalK (K for killed)
Influenza
Rabies
Vibrio Cholerae
Hep A
```
27
"food under age of 1....
...is just for fun"
28
rotavirus is most commonly seen in
unimmunized children between 6 mo - 2 yrs of age
29
most common complication of mumps
epididymo-orchitis
| postpubertal males, 15-30%, usually unilateral
about 5-10 days after parotitis
30
Hib vaccine timing
2mo
4 mo
6 mo
12 or 15 mo.
31
EMBRYOLOGY
all organs are formed by week
8
32
EMBRYOLOGY
ovulation day
day 14
33
EMBRYOLOGY
fertilization day
day 15
34
EMBRYOLOGY
implantation day
day 22-24
35
EMBRYOLOGY
expected menses
day 28
36
EMBRYOLOGY
three components of primitive streak
primitive groove
primitive node
primitive pit
37
EMBRYOLOGY
what happens to primitive streak by end of 4th week?
primitive streak shows regressive changes, shrinks, disappears
38
EMBRYOLOGY
primitive streak will be
caudal
39
EMBRYOLOGY
primitive groove will be
mouth
40
EMBRYOLOGY
what is holoprosencephaly?
structures are affected as they are laid out midline on the axis - no reference for laying out structures
(cyclops, close spaced eyes, brain doesn't have its hemispheres)
```
"holo" = whole
"prosencephalon" = forebrain
```
41
EMBRYOLOGY
what is caudal dysgenesis/regression syndrome?
insufficient amt of migration of mesoderm
| Mermaid body, sirenomelia
42
EMBRYOLOGY
what is sacrococcygeal teratoma?
remnants of primitive streak derived from all 3 germ layers
| so you find allll types of tissues - teeth, hair, etc.
43
PEDS 101
after 12 years old, pediatric vitals are...
...more like adults
44
PEDS 101
pediatric HR are usually
higher than adults
45
PEDS 101
pediatric bp ranges are usually
lower than adults
46
PEDS 101
pediatric RR are usually
higher than adults
47
PEDS 101
heads that suddenly stop growing are....
...concerning
- check cranial sutures
- follow closely and refer quickly
48
PEDS 101
when is newborn screening blood collected (heel prick)?
MUST BE COLLECTED AFTER 24 HOURS OLD
49
PEDS 101
who is Dr. Bob Sears?
some guy with his own vaccination schedule which is not supported by CDC or AAP
50
PEDS 101
It's a good idea to avoid honey until baby is 1 year old to avoid botulism. True or false?
True
51
PEDS 101
what food is best for starting a 4-6 month old on food?
cereals
cereals are best to start as they are easy to change consistency– multigrain, barely, oatmeal (not rice only per FDA due to arsenic risk); mix with breastmilk, formula, water
52
PEDS 101
Should 6-9 month old baby still get breastmilk? What class should parents take at this point?
yes -
baby should still be getting 24-32 oz of bm/formula daily
parents should take Heimlich maneuver/baby CPR
53
PEDS 101
eating milestone for the 9-12 month old
may be using spoon or fork
54
PEDS 101
two key changes in eating at 12 months
transition to whole milk
discontinue bottles/pacifiers
55
PEDS 101
typical age of readiness for toilet training
22-30 months
56
PEDS 101
ideally kids should have toilet training complete so that they have daytime dryness by....
5 years old
57
PEDS 101
rear-facing car seat is appropriate for children until about ages...
rear facing car seats are from birth to
AGES 2-4
Keep children rear-facing as long as possible.
58
Did you do the practice med dosing calculation problems provided by Dr. Banderas?
"of course I did"
Good! She says there will be 1-2 questions on the exam that are dosing problems!
59
which hormone, released from the liver, is responsible for bone growth?
IGF-1, aka somatomedin C
"IGF-1 (along with sex steroids) is responsible for bone growth"
60
adrenarche
development of pubic and axillary hair
61
breast budding term
Thelarche
62
teens should consume ______ mg/day of elemental calcium
1300
63
teens should consume ______ amount of Vitamin D every day
400 IU
64
teens should participate in _____type of daily exercise
bone-bearing
65
why do we no longer give MMRV? in other words, why is Varicella separated from MMR vaccine?
there is a risk of febrile seizures with first dose of MMRV (so we give them separately now)
(MMRV CAN be used as a second dose though...)
66
BCG vaccine
protects against
miliary TB and
TB meningitis
(in first five yrs of life, given in areas where TB risk is high, not in US)
67
what children do NOT get live viral vaccine or live bacterial vaccine?
severely immunocompromised kids (those with T cell defects)
68
how long do we wait after prolonged steroid administration (for 2 weeks or more) to give live virus vaccine?
wait at least 3 months
69
common side effects for Hep B vaccine
soreness
pain
LOW GRADE fever
very very very low chance of anaphylaxis
70
common side effects for Rotavirus vaccine
RARELY - intussusception
(but rotavirus itself can cause intussusception)
mild v/d
LOW GRADE fever
71
common side effects for Tetanus vaccine
hives
trouble breathing
low bp
pain
soreness
LOW GRADE fever
72
common side effects for Diphtheria vaccine
pain
soreness
fever
73
common side effects for Pertussis vaccine
mild -
pain
tenderness
fever fretfulness
rarely -
inconsolable crying
febrile sz (super rare)
74
common side effects for Polio vaccine
"well tolerated"
75
common side effects for HiB vaccine
pain
soreness
LOW GRADE fever
76
common side effects for PCV vaccine
fever in 1:100 infants
muscle aches in 1:100
pain
redness
swelling
77
common side effects for MMR vaccine
may have mild breakthrough disease for kids <14 months
fever
soreness
78
common side effects for varicella vaccine
mild chickenpox-like rash
pain
redness
runny nose
cough
79
Does the child have a syndrome?
Check on these three things
- failure to thrive?
- feeding difficulties?
- delayed milestones?
80
When suspecting a syndrome, when do we refer to genetics?
- single MAJOR birth defect discovered
- combination of multiple birth defects
- FH of particular defect (i.e. deafness)
- multiple miscarriages/stillbirths
81
List seven medical issues for children with Down's Syndrome
OD'CLOTH
Obesity- 56%
Diabetes
```
Cardiac defects - 50%
Leukemia
OSA- 30-75%
Thyroid disorders- 54%
Hearing loss- 38-78%
```
82
what is the most common chromosomal abnormality among live born infants?
Down's Syndrome
83
majority of preemies are born in what category of prematurity?
LATE PRETERM
84
gestational age of LATE PRETERM category
34 - 36 6/7 weeks
85
define TERM category based on gestational age
TERM = 37 - 41 6/7 weeks
86
what is the independent risk for mortality for a preemie immediately after delivery?
thermoregulation
87
what is the leading cause of morbidity and mortality in the newborn period?
RDS
Respiratory
Distress
Syndrome
88
what is RDS?
a lack of surfactant
89
what does RDS look like on chest xray?
diffuse reticulogranular pattern
air bronchograms
atelectasis
90
what is BPD?
BronchoPulmonary Dysplasia
impaired pulmonary function
91
what is a common risk of BPD?
CP
| cerebral palsy
92
where is a PDA?
between the aorta and pulmonary artery
93
what closes the PDA medically?
indocin or ibuprofen (NSAIDS close the ductus)
94
what is an intestinal emergency for the preemie?
NEC (necrotizing enterocolitis)
95
what is the treatment of NEC?
decompress the abdomen, either via
NG/OG tubes, or
surgery
96
common s/s of NEC?
grossly bloody stools or
occult blood in stool
distended abdomen
97
one key radiographic findings of NEC?
Pneumatosis intestinalis: air in the wall of the bowel itself
98
duration of cessation of breathing of preemie to qualify for apnea of prematurity?
>20 seconds
99
treatment of apnea of prematurity?
caffeine
100
treatment of anemia of prematurity?
resolves spontaneously in 3-6 months
101
three factors of care for PCP for preemie after discharged home
GROWTH
(expect baby to catch up for first 2 yrs)
PREVENTIVE CARE
(IZ schedule based on chronological age)
MILESTONES/NEURODEVELOPMENTAL ASSESSMENTS
(utilize CORRECTED age until 2 yrs (subtract # of weeks born early))
102
ankyloglossia -
define
name treatment
= the frenulum is connected to end of tongue
snip it
103
dacryostenosis
define
name treatment
= clogged tear ducts
<6 months, just use warm washcloth to clean
>6 months, consider referral to opthamology
104
omphalitis -
| define and describe
infection of umbilical cord
nasty smelling discharge
go to hospital; this baby gets admitted!
105
Diastasis Recti
| what is it? what do we do about it?
abdominal muscles haven't met yet
| nothing - they'll come together
106
umbilical hernia -
| testing and treatment
push it in with your thumb - if baby doesn't cry, no signs of pain, leave it alone - it will heal by the time baby is 5 years old.
just watch out for it to become firm or red, this means trouble for baby
107
baby MSK
| what are Ortolani and Barlow tests?
Barlow - try to dislocate the hips
Ortolani - try to push back into socket
not sure - something to do with making sure hip joints are okay
108
baby MSK
| what hip advice to we give to parents?
Advise parents to keep them in frog leg position as much as possible bc the femur heads in the joint is what develops the deep cartilage socket
109
what five skin changes are vascular malformations?
```
port wine stains
stork bites
angel kisses
hemangiomas
congenital hemangiomas
```
110
baby neuro
| what's the difference between infantile spasm (seizure) and natural sleep jerking motion?
sz = sustained, rhythmic movement, eye deviation - - go to hospital!
natural sleep jerking = one small jerk motion when falling asleep
111
Meconium stools should transition to normal stools by ______.
describe meconium stools
by 2 days
meconium stools are black and tarry
112
by ______, mom's full milk should be present
by 3-5 days
113
physiological jaundice is a diagnosis of
exclusion
114
physiological jaundice peaks at _____ days of age, usually gone by ____.
physiological jaundice peaks at TWO TO FOUR DAYS of age and is usually gone BY TWO WEEKS OF AGE.
115
physiological jaundice should not exceed _____ level of indirect bilirubin
12 mg/dL
116
15-17 mg/dL peak of indirect bilirubin is consistent with ______
breast milk jaundice, or indirect hyperbilirubinemia
117
how long do breast milk jaundice, or indirect hyperbilirubinemia, last?
can last a month or more
118
characteristics of pathologic jaundice
- appears w/in 24 hrs of birth
- any direct hyperbilirubinemia
>17 total serum bilirubin (TSB) in newborns
119
possible causes of pathologic jaundice
```
rubella
sepsis
toxoplasmosis
ABO incompatibility
Rh neg mother with second Rh positive baby
```
120
labs for jaundice?
Transcutaneous Bilirubin: Very close estimation of TSB. Non-invasive
Total Serum Bilirubin: The total amount of Bilirubin circulating in the blood
Coombs’ - are there antibodies attached to RBC’s
Antibody-mediated hemolysis
ABO: Blood type - does it match mom’s? (Tested at birth)
Type O moms are most commonly affected since they can carry both antiA and antiB antibodies. If the infant is A, B or AB then they are vulnerable
Rh testing: Is mom (-) and infant (+)? Erythroblastosis fetalis
121
jaundice: when do I worry?
1 major risk factor + high Bhutani score
known FH of inherited disorder
infant not responding to phototherapy
122
Erythema infectiosum is also known as:
Fifth Disease
123
"slapped cheeks"
lace pattern
name that disease and the virus that causes it
Fifth Disease
parvovirus B19
124
treatment for moderate viral croup
Nebulized/racemic Epinephrine (give 1st)
mainstay of treatment is dexamethasone, but you have to open the airway first
125
"herald patch"
Pityriasis rosea
126
Christmas tree pattern
Pityriasis rosea
127
in cases of FEVER, which children get empiric antibiotics?
```
Neonates
Immunocompromised children
Ill appearing infants
Toxic appearing children
Well appearing infants and abnormal labs (e.g. UA, CSF analysis)
```
128
in cases of FEVER, what antibiotics are given to infants 0-30 days who need them?
Ampicillin and gentamicin
or
ampicillin and cefotaxime
129
in cases of FEVER, what antibiotics are given to infants >31 days and older children who need them?
Ceftriaxone ± vancomycin
130
how many kids with FEVER need antibiotics?
not many - The most common cause of fever in childhood are viruses
Viral testing is not commonly indicated
131
define FEVER in physiologic terms
Centrally mediated rise of body temperature above the normal daily variation in response to many different pathologic insults
132
how is FEVER defined in temperatures?
> 100.4 F (38 C) in neonates and babies < 3 mo)
>101.1 F (38.4 C) in older children
(no single, widely accepted value)
133
Greek word for leather
diptheria
refers to the pharyngeal membrane that is the clinical hallmark of infection
134
initial finding on oropharyngeal examination of diptheria
initial finding on oropharyngeal examination is
mild erythema, which can progress to isolated spots of gray and white exudates
135
unique finding of diptheria
In at least one-third of cases, patients present with the classic coalescing pseudomembrane, which adheres tightly to the underlying tissue and bleeds with scrapping
136
another name for croup
Laryngotracheitis
137
What is the treatment for gonococcal conjunctivitis?
1 gram of intramuscular ceftriaxone.
138
key finding of intussusception
imaging used in intussusception
CURRANT JELLY bloody stools
ultrasound ("target sign")
