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Primary Care Pediatrics > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Infant causes of acute abdomen

A

Colic, intussusception, incarcerated hernia, testicular torsion, malrotation, pyloric stenosis

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2
Q

Preschool causes of acute abdomen

A

appendicitis, intussusception, pneumonia, pharyngitis, trauma, constipation

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3
Q

School age causes of acute abdomen

A

Appendicitis, pneumonia, pharyngitis, pancreatitis, trauma, constipation

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4
Q

Adolescent causes of acute abdomen

A

Appendicits, pancreatitis, cholelithiasis

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5
Q

Female causes of acute abdomen

A

Ectopic pregnancy, PID, ovarian cyst, dysmenorrhea

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6
Q

Tx of reflux in infant

A

Try adding rice cereal to formula and if doesnt work, try ranitidine
Elevate head of bed 45 degrees
Keep head elevated 30 minutes after eating

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7
Q

If hernia still present at ___, refer

A

4 years old

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8
Q

S/S intussusception

A

Crampy pain with N/V

Currant jelly stool

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9
Q

Jumping in place with testicular torsion

A

Pain

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10
Q

Dx tests for acute abdomen

A

CBC, CMP, amylase and lipase, UA/UC, pregnancy test, stool test, abdominal or pevlic US, abdominal X ray

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11
Q

Encopresis

A

Syndrome of fecal soiling or incontinency or incomplete defecation

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12
Q

1st line tx constipation

A 
Miralax--over 1 year
Colace >5 years 
Laxatives or enemas only for disimpaction
Glycerin suppository under 2
Pediatric enema over 2
High fiber diet
Good toileting habits
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13
Q

S/S appendicitis

A

Fever, periumbilical pain wihich localizes to RLQ with signs of peritoneal irritation

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14
Q

Labs in appendicitis

A

Elevated CRP and leukocytosis

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15
Q

Psoas sign

A

Patient lies on side and flex the right hip backwards

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16
Q

Rovsing sign

A

Pain refers to RLQ when LLQ palpated

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17
Q

Obturator test

A

Internally and externally rotate flexed hip

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18
Q

Blumberg sign

A

Pain upon removal of pressure

Rebound tenderness

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19
Q

Colic

A

in first 3 months of life, >3 hours a day

Tx: gripe water or mylicon drops

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20
Q

Labial adhesion

A

Fusion of labia minora
Benign
Caused by lack of estrogen or inflammation
No tx usually needed; if sx estrogen cream topically BID 10-14 days
Second line med is premarin
Mechanical separation not recommended
Follow up in 2-4 weeks

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21
Q

If hydrocele occurs later in life, consider

A

Neoplasm, torsion, injury or infectin

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22
Q

Communicating hydrocele

A

Still a connection between the peritoneal cavity and the tunica vaginalis–peritoneal fluid can shift and hernia can present
Flat scrotum in AM with gradual increase in fluid throughout day
Rarely resolves on its own
Refer to surgery

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23
Q

Non-communicating hydrocele

A

Most common
Residual peritoneal fluid remains after closure of processus vaginalis
Scrotal sac appears full, tense and clear if transilluminated
Fluid gradually resorbs during 1st year of life
No danger of hernia

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24
Q

Swelling and transillumination

A

Light will appear as red glow with serous fluid but not with blood or tissue

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25
Size of testes in infant
Should be 1cm
26
Sudden onset testicular pain, maybe have abdominal pain and N/V, no fever
Testicular torsion Medical emergency Needs to be fixed within 4-8 hours
27
UA in testicular torsion
Normal
28
When do testes usually descend
By 8 months gestation
29
Complications of undescended testes
Deterioration, testicular CA, testicular torsion
30
Tx of undescended testes
Orchioplexy or open surgery | Hormones
31
Varicocele
``` Due to valvular incompetence Left side more common; right side more dangerous Bag of worms with bluish discoloration More prominent when standing Asx Time dependent decline in testicular function Order annual semen analysis Refer if right side or pain ```
32
S/S UTI in infants
Fever, hypothermia, jaundice, poor feeding, irritability, vomiting, FTT, sepsis
33
S/S UTI in pre-school
Abdominal or flank pain, fever, urinary frequency and dysuria and urgency, enuresis
34
S/S UTI in school age
Frequency, dysuria, urgency, fever, vomiting, flank pain
35
Gold standard for dx UTI
Culture or urine
36
Tx UTI <3 months
Hospital admit
37
Tx UTI in children
Amoxicillin, Bactrim, 1st gen ceph 7-10 days uncomplicated 10 days if pyelo
38
Types of anorexia
Mild: 15% weight loss Moderate: 20% weight loss Severe: 30% weight loss
39
Labs with malnutrition due to anorexia
Leukopenia and anemia, low serum lactic dehydrogenase estrogens, low T3, low electrolytes
40
When to refer anorexia to hospital
Unstable VS HR <50 BP <80/50, Blood glucose <60, EKG changes, failure to gain 1ib/week, SI
41
Bulimia
Binge eating and inappropriate compensatory behaviors at least 2x/week for 3 months
42
What med is CI in bulimia
Bupropion
43
Screening tools for eating disorder
SCOFF: Sick, control, one stone, fat, food
44
Genu varum
Bow legs Normal variant <18 months Refer if >2 years, if bowing >5 inches between knees, or if only in 1 leg
45
Osgood schlatter
Degeneration of tibial tubercle at the insertion site of quad ligament Painful swelling Due to overuse injury and rapid growth Bump will not go away and may get worse with increased overuse
46
Scoliosis
Does not usually cause pain Cervical involvement rare Observe shoulder, hip and scapular symmetry Curves progress less rapidly as skeletal growth is complete
47
Adams test
Bend test for scoliosis
48
Functional socliosis
Appearance of curve due to unequal leg lengths, poor posture, muscle spasms, herniated discs
49
Differentials for scoliosis
Muscular dystrophy, polio, CP
50
When to refer to specialist for scoliosis
>10 degree progression or 5 degrees from previous visit
51
Tx scoliosis
<20 degrees no tx 20-40 degrees bracing >40 degrees surgical
52
Hyperactive impulsive ADHD
```  Fidgets  Often leaves seat in classroom  Excessive running or climbing  Difficulty in engaging in quiet activities  Talks excessively  Blurts out answers  Difficulty awaiting turns  Interrupts or intrudes on others ```
53
Inattentive type ADHD
 Fails to give attention to detail/makes careless mistakes  Difficulty sustaining attention to task  Does not listen when spoken directly to  Does not follow direction or follow through on tasks  Difficulty organizing tasks  Easily distracted  Loses things needed for tasks  Forgetfulness in daily activities  Misophonia
54
Most common cause of chest pain in peds
Costochondritis
55
Diagnostic tests for chest pain
Chest X Ray EKG Echo Exercise testing
56
most common cause of syncope
Vaso-vagal episodes; benign | Tx: increase fluid intake, salt tablets, leg pumping, leg crossing and squatting, regular aerobic exercise
57
Dx labs for syncope
```  ECG  Pregnancy testing  Tilt-testing  24 hour halter monitor  ECHO  EEG  Fasting blood glucose  H/H  Electrolytes  Toxicology screens  Stool for occult blood based on symptomatology ```
58
Murmur grading
```  1—Barely audible  II—Easily heard  III--Moderately loud  IV—Loud, with a thrill  V—Heard with edge of stethoscope applied to chest wall  VI—Heard with stethoscope off chest ```
59
Still's murmur
2-7 years Heard best when lying down Disappears when holding breath, valsalva maneuver or standing
60
Venous hum
>2 years Best heard when sitting Disappears when lying down or compressing external jugular vein
61
Murmur may become louder if
Fever or exercise or anemia
62
Tetralogy of fallot
Cyanotic Right to left shunting VSD, Pulmonary stenosis, RV hypertrophy, overriding aorta S/S: FTT, SOB, clubbing, tet spells
63
most common hematologic disease of infancy and childhood
iron deficiency anemia
64
Causes of iron deficiency anemia 6-24 months
Poor dietary intake
65
Causes of iron deficiency anemia >2 years
Chronic blood loss maybe
66
Full term infants are born with sufficient iron stores to prevent IDA until
4-6 months
67
When to first screen for anemua
12 month
68
IDA and lead poisoning
IDA contributes to lead poisoning by increasing the GI tract's ability to absorb heavy metals, such as lead
69
Dx tests for IDA
CBC, reticulocyte count, lead level, serum iron, blood ferritin level, hgb electrophoresis
70
MCV in IDA
<13: Thalassemia | >13: iDA
71
Lab results in IDA
< MCV,
72
Earliest lab change in IDA
Decreased serum ferritin <20
73
Tx IDA
3-6mg/kg/day elemental iron Results in increased reticulocyte count by 3-5 days Continue iron therapy for 2 months after rise in hgb
74
If IDA unresponsive to iron, consider
Cows milk induced colitis, IBD, menorrhagia, poor compliance
75
Absorpiton of iron
Increased with juice or other vitamin c | Decreased with milk or food
76
Follow up of IDA
H+H in 1 month, 3 months and completion of therapy (5-6 months maximum)
77
Complications of IDA
Progressive anemia, recurrent infection, poor growth rate, learning problems, lethargy
78
Plumbism
Lead >10
79
SX of plumbism
 Hyperirritability, anorexia, decreased activity, ataxia |  Weight loss, anemia, constipation, personality changes, developmental delay or reversal
80
Late sx of plumbism
• Acute encephalopathy – cerebral edema, convulsions, coma most common in children 1-3 years with lead levels over 70-100mcg/dl
81
Dx tests for plumbism
CBC, Serum lead, serum ferritin, FEP, whole blood level test, X rays of abdomen for lead containing foreign body
82
Tx for plumbism
Pharmacology for >45
83
Juvenile hypothyroidism
S/S: Growth retardation, decreased physical activity, weight gain, constipation, dry skin, cold intolerance, delayed puberty, large tongue, hoarse voice Thyroiditis may cause--peaks in adolescence More common in females
84
Congenital hypothyroidism
o 90% absent or poorly formed gland o “typical” hypothyroid baby is full term & large o Lg posterior fontanel, lethargy, umbilical hernia, large tongue, dry skin and hoarse cry o Early—see jaundice, temp instability, hypoactivity, poor feeding and constipation
85
Abnormal newborn screen results should be confirmed with
venous T4 and TSH level
86
Tx hypothyroidism
Levothyroxine 75-100mcg/day
87
How to monitor thyroid initially after tx
T4; TSH may not normalize for weeks
88
Precocious thelarche
``` Early breast development 12-24 months Due to transient bursts of estrogen from prepubertal ovary No other signs of puberty Self limited ```
89
Premature adrenarch
* early appearance of sexual hair before the age of 8 in girls & the age of 9 in boys * Benign condition due to early maturation of adrenal androgen secretion * Normal linear growth and no bone age advancement
90
Precocious puberty
• Definition: onset of puberty before the age of 9 years in males and before the age of 8 in females • More common in girls Pattern of puberty progression is normal Accelerated linear growth and advanced bone age At first child is tall, but then short stature is end result
91
Constitutional delay
* Children grow & develop at or below the 5th percentile at normal growth velocities * Puberty is significantly delayed as well as bone age delay. * Do not enter puberty at the usual age, and have short stature & sexual immaturity compared to peers * This is a normal growth variant
92
Dx tests for precocious puberty
Bone age--left hand x ray FSH/LH HCG Testosterone and/or estradiol

Primary Care Pediatrics (2 decks)

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