Exam 1 Flashcards
1
Q
Should feed themselves with a fork/spoon
A
by 2 years
2
Q
BMI categories
A
Underweight <18.5 Normal 18.5-25 Overweight 25-30 Obese 1 30-35 Obese 2 35-40 Morbidly obese >40
3
Q
1 month milestones
A
lift head, coo, track with eyes, recognize parents
4
Q
6 month milestones
A
Sit up, raking grasp, stranger anxiety, babbles
5
Q
9 month milestones
A
Walk with assistance, 3 finger grasp, bye bye, pat a cake
6
Q
1 year milestones
A
Walking, 2 finger grasp, mam/dada, imitate parent
7
Q
2 year milestones
A
2 word phrases, 2 steps, 2 step command, stack 6 cubes
8
Q
3 year milestones
A
3 word sentences, ride tricycle, brush teeth, draw circle
9
Q
4 year milestones
A
hop, copy a cross, play with others
10
Q
Physical milestones in first year
A
Birth weight doubles by 6 months and triples by 1 year
50% increase in length by 1 year
Anterior fontanel closes 12-18 months
Posterior fontanel closes 6-8 weeks
11
Q
Motor red flags at 4, 9, 18 months
A
4: Lack of steady head control while sitting
9: inability to sit
18: inability to walk independently
12
Q
Social emotional red flags at 6, 9, 12, 15, 18, 24 months
A
6: lack of smiles
9: lack of reciprocal vocalizations
12: failure to respond to name, no babbling, lack of waving or reaching
15: lack of protodelcarative pointing
18: lack of pretend play and spoken language
24: lack of 2 word phrases
13
Q
Cognitive red flags 2, 4, 6, 9, 24, 36 months
A
2: lack of fixation
4: lack of visual tracking
6: failure to turn to sound or voice
9: lack of babbling
24: failure to use single words
36 months: failure to speak in 3 word sentences
14
Q
Tests for strabismus
A
Hirschberg and cover/uncover
15
Q
Order of male puberty sequence
A
Testicular enlargement, penile enlargement, height growth spurt, pubic hair
16
Q
Order of female puberty sequence
A
Breast buds, height growth spurt, pubic hair, menarche
17
Q
Hep B schedule
A
birth, 2 months, 6 months
18
Q
Rotavirus schedule
A
2 months, 4 months, 6 months
19
Q
DTaP schedule
A
2 months, 4 months, 6 months, 15 months, 4-6 years
20
Q
HiB schedule
A
2 months, 4 months, 6 months, 12-15 months
21
Q
PCV13 schedule
A
2 months, 4 months, 6 months, 12-15 months
22
Q
IPV schedule
A
2 months, 4 months, 6-15 months, 4-6 years
23
Q
MMR schedule
A
12-15 months (2 doses 4 weeks apart), 4-6 years
24
Q
Varicella schedule
A
12-15 months, 4-6 years
25
Hepatitis A schedule
12-15 months (second dose 6 months later)
26
Meningococcal schedule
11-12 years, 16 years
27
Tdap schedule
11-12 years
28
HPV schedule
11-12 years or early as 9; 2 dose series with second dose 6 months after the first
29
White reflex in neonate can be caused by
glaucoma, cataract, or tumor (retinoblastoma)
30
Sepsis in newborn
Hypotension, acidemia, neutropenia clinical findings
Labs: low WBC with absolute neutropenia, thrombocytopenia, hypglycemia or hyperglycemia, metabolic acidosis, elevated CRP
31
Tx sepsis in newborn
Ampicillin + aminoglycoside or 3rd gen cephalosporin
32
LP results if bacterial meningitis
CSF protein >150, glucose <30, leukocytes >20, + gram
33
Omphalitis
Umbilical cord infection
34
Copious purulent discharge in newborn
N. Gonorrhoeae
| Tx: IV ceftriaxone
35
Conjunctival congestion, edema and minimal discharge in newborn
Chlamydia
| Tx: oral erythromycin for 14 days
36
Children develop in what direction
Cephalocaudal
37
Raking grasp vs pincer grasp
Raking by 3-4 months and pincer by 9 months
38
Babbling reaches peak at
12 months
39
Object permanence
9-12 months
40
Separation and stranger anxiety
8-9 months
41
Parallel play
2-3 years
42
Collaborative play
3-4 years
43
Conservation of length
5.5 years
44
Differentials for wetting of pants by 5-6 years of age
DM, DI, seizures, cystitis, neurogenic bladder, anatomical abnormalities
45
Colic
cries >3 hours per day for >3 days per week for >3 weeks
| Peaks at 2-3 months
46
When should autism screening begin
18 months
47
Triad for ADHD
Impulsivity, inattention, hyperactivity
| Must be present <12 years and in 2+ settings
48
Tx ADHD
Stimulants: methylphenidate, dextroamphetamine
| A2 agonists: clonidine or guanfacine
49
Autism features
Deficits in social communication and interaction across multiple contexts and repetitive patterns of behavior
Symptoms present <3 years
50
18 month developmental tasks
Builds tower of 3-4 cubes, throws ball, seats self in chair, dumps pellet from bottle
Walks up and down stairs with help, says 4-20 words, carries and hugs a doll, feeds self
51
24 month developmental tasks
Kicks ball, speaks short phrases, builds tower of 6-7 cubes, points ot named objects, jumps with both feet, verbalizes toilet needs, turns pages of book
52
3 year developmental tasks
holds crayons, builds 9-10 block tower, copies circle, rides tricycle, dresses with help
53
3-4 year developemental tasks
Climbs stairs with alternating feet, can button and unbutton, knows own sex, feeds self
54
First line tx of dysmenorrhea
NSAIDs and contraceptives to suppress ovulation
55
BP screening
Begin at age 3
Need 3 separate high readings to dx hypertension
Systolic or diastolic >95th percentile for age and height or weight
56
Visual acuity testing
Begin at age 3
| Tumbling E chart or picture tests
57
Lead screening
Universal screening for children 1-2 years
58
Sepsis workup for neonate
Fever >100.4
| CBC, blood culture, UA, urine culture, gram stain, CSF, glucose
59
Failure to thrive
Crossing 2 major percentile lines on a growth chart or if <6 months and not grown for 2 consecutive months or >6 months and not grown for 3 consecutive months
60
Predominant nutrient in first few months of life
40% fat
61
Absolute CI to breastfeeding
Active TB in mother, HIV in mother, galactosemia in infant
62
Describing skin lesions order
Distribution, configuration, color, secondary changes, primary changes
Ex. psoriasis: generalized, discrete, red, or scaly papules
63
Any flat circumscribed color change in the skin < 1 cm
Macule
| Ex freckle
64
Any flat circumscribed color change in the skin > 1 cm.
Patch
| Ex nevus depigmentosa
65
A solid, elevated area < 1 cm in diameter whose top may be pointed, rounded, or flat.
papule
66
A solid, circumscribed area > 1 cm in diameter, usually flat-topped
Plaque
| Ex. psoriasis
67
A circumscribed, elevated lesion < 1 cm in diameter and containing clear serous fluid
Vesicle
| Ex. varicella
68
A circumscribed, elevated lesion > 1 cm in diameter and containing clear serous fluid
Bullae
| Ex. impetigo
69
A vesicle containing a purulent exudate
Pustule
| Ex. acne
70
A deep-seated mass with indistinct borders that elevates the overlying epidermis
nodule
71
A circumscribed, flat-topped, firm elevation of skin resulting from tense edema of the papillary dermis
Wheal
72
Dry, thin plates of keratinized epidermal cells
Scales
| Ex. psoriasis
73
Induration of skin with exaggerated skin lines and a shiny surface resulting from chronic rubbing of the skin
Lichenification
74
A linear split in the skin extending through the epidermis into the dermis
Fissure
| Ex. angular cheilitis
75
Discrete lesions
Independent of each other
76
Topical steroid info
2X daily mainstay tx
Can be used under wet dressings
only low potency to the face
77
Drugs that may cause acne
ACTH, steroids, androgens, hydantoins, isoniazid
78
Precursors to inflammatory acne
Closed comedones--white heads
79
1st line tx acne
Topical keratolytics
| Retin A, benzoyl peroxide, azelaic acid
80
Topical abx for acne
Clindamycin 1%
| Topical abx should never be used alone
81
Systemic abx for acne
Tetracycline, minocycline, doxycyline
| Never use as monotherapy
82
Pathogens in impetigo
GAS and staph
83
Tx of impetigo
Amoxicillin, cephalosporin, clindamycin, augmentin
| If not severe: topical mupirocin, polymyxin, gentamycin, erythromycin
84
Ecthyma
Deeper form of impetigo
| Tx: penicillin
85
• Erythematous, hot, tender, ill-defined, edematous plaques accompanied by regional lymphadenopathy
Cellulitis
86
Tx of fungal infection of hair or nails
Griseofulvin or terbinafine
87
Sharply demarcated erythematous patches with eroded areas and satellite lesions
Candida infection
88
Tx of choice for diaper dermatitis due to candida
Topical imidazole cream
89
Most frequent cutaneous features in child with HIV
Persistent oral candidiasis and recalcitrant candida diaper rash
90
umbilicated, flesh colored papules in groups anywhere on the body
Molluscum contagiosum
| Due to poxvirus
91
Tx of scabes
Permethrin single overnight use and repeat in 7 days
92
Tx atopic dermatitis
Wet dressings and topical steroids if acute and weeping
| If chronic, avoid irritants, bathe every 2-3 days and twice daily lubrication
93
White, scaly macular areas with indistinct borders seen over extensor surfaces of extremities and cheeks; sun tanning exaggerates
Pityriasis alba
Tx: low potency steroids and strict sun avoidance
Confused with tinea versicolor
94
Rash that usually begins as a large circular or oval spot on your chest, abdomen or back. Called a herald patch, this spot can be up to 4 inches
```
Pityriasis rosea
Align with christmas tree pattern
Clinically similar to ring worm
Viral in origin
Main differential is secondary syphilis
Exposure to sunlight can help
```
95
Guttate psoriasis
Common form in children followed by 2-3 weeks of strep throat
Sudden onset of small papules seen predominantly over trunk and covered with thick white scales
96
Strongest identifiable predisposing factor to asthma
Atopy
97
What shows poor asthma control
>1 cannister per month of albuterol
98
Stepwise tx of asthma
step 1: SABA prn
step 2: low dose ICS or cromolyn or montelukast
Step 3: medium dose ICS
Step 4: medium dose ICS + LABA
Step 5: high dose ICS + LABA
Step 6: high dose ICS + LAB A + oral steroids
99
Initial tx of acute asthma exacerbation at home
SABA 2-6 puffs every 20 minutes up to 3 times or single nebulizer treatment
100
Tx allergic rhinoconjunctivitis in children
Topical steroids > oral antihistamines
101
Approved antihistamines in children
Cetirizine >6 months
Loratadine >2 years
Desloratadine >6 months
Fexofenadine >6 months
102
Approved nasal steroids in children
Fluticasone furoate >2 years
| Fluticasone propionate >4 years
103
Montelukast approved for
>6 months
104
Main cause of common cold
Rhinovirus and adenovirus
105
Main cause of croup
parainfluenza
| Fever, nasal congestion, sore throat, barking cough
106
most common cause of lower respiratory tract illness in children
RSV
Causes bronchiolitis
Diffuse wheezing, tachypnea following URI
107
Only licensed antiviral against RSV
Ribavirin
108
Roseola
Benign illness due to HHV 6 or 7
Fever lasting 8 days, fever ceases abruptly and then a characteristic rash may occur--rose pink maculopapular non pruritic
Usually rash begins on trunk and spreads to face, neck and extremities
109
Fever and rash with slapped cheek appearance followed by symmetrical full body maculopapular rash
Erythema infectiosum (5th disease)
Rash occurs at 10-17 days
Contagious prior to but not after rash
110
Prodrome of 2-3 days of fever, cough and conjunctivitis; koplik spots 1-2 days prior to rash
Maculopapular rash spreading from face and hairline to the trunk over 3 days
Spread via respiratory droplets
Measles
| Report to local health department
111
Fever, rash on palms and soles of feet, GI symptoms, headache
Rocky mountain spotted fever
Rash appears 2-6 days after fever onset, face is spared
Tx: doxycycline
112
Myopia
Nearsightedness
| Might squint
113
Hyperopia
Farsightedness
Untreated can cause cross eyes
Usually diminishes with age
114
Anisocoria
Size difference between 2 pupils
115
Tests for strabismus
Hirschberg test (corneal light reflex), cover testing
116
Bruckner test
Red reflex test
117
Tx corneal abrasion
Erythromycin ointment, patching eye
118
Infection of eyelid margin, meibomiangland obstruction and tear film imbalance
Blepharitis
Usually due to staph aureus
Tx: warm compresses and baby shampoo if not severe; erythromycin ointment, azithromycin drops, oral tetracycline, oral macrolides if severe
119
Inflammation of the meibomian flands, produces tender nodule over the tarus of upper or lower lid
Chalazion
| Tx: same as blepharitis
120
Main organisms causing bacterial conjunctivitis
Strep pneumoniae, H. influenzae, m. catarrhalis, staph aureus
tx: erythromycin, polymyxin-bacitracin, tobramycin, fluoroquinolones
121
Most common pathogen in viral cojunctivitis
Adenovirus
| Stay home from school as long as eyes are red and tearing
122
Periorbital cellulitis
Erythematous and edematour eyelids, pain and mild fever, eye and movements all normal
If <2 months old, hospitalize
If >2 months give augmentin or cephalexin and follow up in 24 hours
123
Orbital cellulitis
Proptosis, eye movement restriction, decreased vision, eye is red and chemotic
Almost always arises from paranasal sinus infection
Medical emergency
124
Ankyloglossia
Tongue tie
125
Most common chronic disease of childhood
Dental caries
126
Indications for abx prophylaxis for dental surgery
Heart valves, previous infective endocarditis, repaired congenital heart disease, unrepaired cyanotic congenital heart disease
if neutrophil level <2000
127
Malignant OE
Spread of infection to the skull base causing osteomyelitis
128
Tx OE
Fluoroquinolone drops
129
Dx for OM
Bulging of TM, <48 hours of otalgia, intense erythema of TM
| Middle ear effusion must be present
130
Mastoiditis
AOM almost always present
| Infection spreads from middle ear space to mastoid portion of temporal bone
131
most common cause of conductive hearing loss
Fluid in middle ear due to AOM or MEE
| Other causes: TM perforation, cerumen impaction, cholesteatoma
132
What meds can cause hearing loss
Aminoglycosides and diuretics
133
Bacterial sinusitis
Dx when cold does not improve by 10-14 days or worsens after 5-7 days
Maxillary and ethmoid sinuses most commonly involved
Frontal sinusitis uncommon <10 years
134
Tx bacterial sinusitis
amoxicillin or augmentin
| Failure to improve after 48 to 72 hours suggests resistance
135
Recurrent sinusitis
>4 times per year
136
Chronic sinusitis
does not resolve >90 days
137
Tx of persistent GAS throught despite penicillin
Clindamycin for 10 days
138
Untreated strep throat can result in
acute rheumatic fever, glomerulonephritis, peritonsillar abscess, OM, cellulitis
139
Diffuse, finely papular erythematous eruption which blanches on pressure; tongue strawberry appearance
Scarlet fever rash
140
Fever, respiratory symptoms, neck hyperextension, may have dysphagia
Retropharyngeal abscess
| Surgical emergency
141
Sudden onset coughing or respiratory distress and difficulty vocalizing
Foreign body aspiration
142
Gold standard for dx foreign body aspiration
Rigid bronchoscopy
143
New onset stridor in the setting of URI or fever
Croup
| Acute inflammatory disease of the larynx
144
Viral croup
```
6 months to 5 years
Usually due to parainfluenza
Prodrome of URI symptoms followed by barking cough
Fever usually absent
Tx: supportive
Can use steroids
```
145
Sudden onset high fever, dysphagia, drooling, muffled voice, inspiratory retractions
Epiglottitis
Emergency
Need IV abx then oral for 10 days
146
Fever, cough and dyspnea, crackles, abnormal chest X ray with infiltrates, pleural effusion
Community acquired pneumonia
Low WBC is ominous sign
Tx: amoxicillin
Macrolides if atypical suspected
147
1-2 days fever, rhinorrhea and cough, followed by wheezing, tachypnea, and respiratory distress
Bronchiolitis due to RSV
148
Cause of cradle cap
Yeast pityrosporum ovale
| Tx: baby shampoo, mineral or baby oil then comb; may use hydrocortisone
149
Tx of contact dermatitis
Lotrimin or nystatin
150
Tx molluscum contagiosum
Trichloroacetic acid or salicyclic acid or podophyllin or cantharidin
151
Oral abx for impetigo
Augmentin, keflex, omnicef, dicloxacilin
152
Multiple oval, scaly, hypopigmented patches on face and extensor surfaces
Pityriasis alba
No real tx
Steroids may make worse
153
Cause of 5th disease
Human parvovirus B19
154
Borrelia burgdorferi
Lyme disease cause
| Causes erythema migrans--target lesion
155
Complications of lyme disease
Bells palsy, arthritis, aseptic meningitis, peripheral neuritis, Guillain barre syndrome, encephalitis
156
Tests for visual acuity
snellen E or allen
157
When is further evaluation by ophthamologist required
>5 years old and acuity of 20/30
| >3 years old and acuity of 20/40
158
Major complication of strabismus
Development of amblyopia
159
X ray in croup
Steeple sign
160
Tx of bacterial sinusitis
1st line: amoxicillin
2nd line: augmentin
3rd line: fluoroquinolone if >18 years or macrolide
161
Intermittent asthma
Day symptoms <2 times per week
| Night sx <2 times per month
162
Mild persistent asthma
Day sx >2 times per week but <1 times per day
| Night sx >2 times per month
163
Moderare persistent
Daily sx
| Night sx >1 time per week
164
Severe persistent
Day continuous
| Night frequent
165
Dosing interval for Hep B
Dose 1 to 2: 4 weeks
| Dose 2 to 3: 8 weeks and at least 16 weeks from first dose
166
Dosing interval for rotavirus
Dose 1 to 2: 4 weeks
| Dose 2 to 3: 4 weeks
167
Dosing interval for DTaP
Dose 1 to 2: 4 weeks
| Dose 2 to 3: 4 weeks
168
Dosing interval for IPV
Dose 1 to 2: 4 weeks
Dose 2 to 3: 4 weeks
Dose 3 to 4: 6 months
169
Dosing interval for MMR
Dose 1 to 2: 4 weeks
170
Dosing interval for varicella
Dose 1 to 2: 3 months
171
Dosing interval for hep A
Dose 1 to 2: 6 months
172
Dosing interval for meningococcal
Dose 1 to 2: 8 weeks
173
Dosing interval for TdaP
Dose 1 to 2: 4 weeks
| Dose 2 to 3: 4 weeks
174
Must be on abx eye drops if conjunctivitis for how long before going back to school
72 hours
175
When to refer to ENT for tympanostomy tubes
If >3 OM in 6 month-1 year period
