Neonatal: The 1st trimester is from conception to week 12. During this time: 1. Week 4: ____ closes 2. Week 5: ____ forms and beats; head, eyes, ears and nose, and limbs form 3. Week 6: ____ starts developing; gut legnthens and twists 4. Week 9: ____ organs begin to develop 5. Week 11: All vital organs are formed and functioning; gut returns to abdominal cavity

1. Neural tube closes 2. Heart forms and beats; EEN, limbs 3. Brain develops; gut twists 4. Sexual organs 5. All organs formed/function most congenital anomalies occur during 1st trimester

Neonate: A concerned mother presents to your clinic complaining her newborn has a new rash. Upon examination, you note: 1. Hearing loss 2. Cataracts 3. Blueberry muffin rash 4. Congenital Heart defect You suspect

Rubella sensorineural hearing loss cardiac salt and pepper retinopathy First 20 weeks

Neonate: This virus affects the fetus with Intrauterine growth retardation (symmetric). Newborns are typically asymptomatic, but may present with 1. Petechial rash (similar to blueberry muffin) 2. microcephaly 3. periventricular calcifications 4. hearing loss 5. mortality (liver failure, DIC, sepsis)

Cytomegalovirus maternal risk factor: infection during first 1/2 of pregnancy Tx: gancyclovir - hearing loss

Exam I Flashcards by Jesi Whitley

Neonatal: The 1st trimester is from conception to week 12. During this time:

Week 4: ____ closes
Week 5: ____ forms and beats; head, eyes, ears and nose, and limbs form
Week 6: ____ starts developing; gut legnthens and twists
Week 9: ____ organs begin to develop
Week 11: All vital organs are formed and functioning; gut returns to abdominal cavity

Neural tube closes
Heart forms and beats; EEN, limbs
Brain develops; gut twists
Sexual organs
All organs formed/function

*most congenital anomalies occur during 1st trimester

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Neonatal: The 2nd trimester is from week 12 to week 24. Which of the following correctly describes this phase of growth?

a. limbs start growing
b. sex of the fetus can be determined by ultrasound
c. hearing develops
d. alveolar sacs form in the lungs

A - C

limbs (week 16)
gender (week 18)
hearing (week 20)

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Neonatal: The 3rd trimester is from week 24 to 40. This is the stage where viability of life is determined. Which of the following correctly describes this phase of growth?

a. alveolar sacs form by week 25/26
b. immune system fights off infections and lungs are more developed
c. alveoli form and baby practices breathing, sucking and swallowing
d. baby comes to term

All of the above

Alveolar sacs - 25/26
Immunity - 34
Alveoli and breathing - 36
Term - 40

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Neonate: Touch develops at what gestational age?

8-15 weeks

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Neonate: Taste develops at what gestational age?

13 weeks

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Neonate: Hearing develops at what gestational age?

20 wks

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Neonate: Sight develops at what gestational age?

29 weeks

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Neonate: Smell develops at what gestational age?

28-32 weeks

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Neonate: TORCHes describes common microorganisms that can cause infection during fetal growth/development.

List these

Toxoplasmosis
Other (HBV, syphillis, VZV, EBV, coxsackie, parvo)
Rubella
Cytomegalovirus
Herpes (HSV)

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Neonate: An infection caused by exposure to undercooked meat (pork), consumption of pasteurized milk, or exposure to cat feces during pregnancy.

The most significant risk factor is maternal primary infection during pregnancy

Toxoplasmosis

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Neonate: A mother comes into the clinic complaining that her 3 week old child has been having frequent seizures. Upon physical exam, you note hepatosplenomegaly.

Further workup reveals:

intracranial calcifications
hydrocephalus
chorioretinitis.

You suspect

Toxoplasmosis

obstructive hydrocephalus, IUGR, ocular and CNS disease
abortion or stillbirths

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Neonate: You deliver a baby to a mother suspected to be an I.V. drug user. Her baby is born prematurely and you note low birth weight. However, no symptoms are infection are noted.

What should you be concerned about?

HBV infection

newborns asymptomatic but low birth weight
maternal risk factors: IVDA, multiple sex partners, healthcare workers, Asian ethnicity

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Neonate: You deliver a baby to a mother with a history of IV drug abuse. She is HBV positive and you suspect her newborn to be also. What is the Tx for HBV infection?

vaccine + HBIG

*test mothers

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Neonate: Infection by this virus occurs during the first 20 weeks of pregnancy OR between 5 days before delivery until 2 days post. Common characteristics of infection include:

cutaneous lesions
eye and limb abnormalities
pneumonia
encephalopathy
severe mental deficiency
early death

Maternal risk factor is non-immune status.

Varicella Zoster virus (VZV)

*vaccine contraindicated in pregnancy (live virus)

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Neonate: Infection by this virus most often causes anemia, CHF and hydrops in the fetus.

A newborn may present with the above symptoms, or may be asymptomatic.

Parvo B19

Tx: supportive

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Neonate: A concerned mother presents to your clinic complaining her newborn has a new rash. Upon examination, you note:

Hearing loss
Cataracts
Blueberry muffin rash
Congenital Heart defect

You suspect

Rubella

sensorineural hearing loss
cardiac
salt and pepper retinopathy

*First 20 weeks

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Neonate: This virus affects the fetus with Intrauterine growth retardation (symmetric). Newborns are typically asymptomatic, but may present with

Petechial rash (similar to blueberry muffin)
microcephaly
periventricular calcifications
hearing loss
mortality (liver failure, DIC, sepsis)

Cytomegalovirus

maternal risk factor: infection during first 1/2 of pregnancy
Tx: gancyclovir - hearing loss

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Neonate: A newborn presents at birth with a maculopapular skin rash, “snuffles”, hepatomegaly and osteochondritis.

You treat with Penicillin G, which successfully rids the newborn of the infection.

What was the cause?

Treponema pallidum (Syphillis)

maculopapular
snuffles (mucupurulent rhinitis)
osteochondritis
lymphadenopathy
hepatomegaly

Dx: VDRL, RPR, FTA abs

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Neonate: Neonatal presenation of this disease varies based on the age of the newborn. Congenital infection is rare, but affects the fetus’s brain, eyes and skin.

HSV

*maternal risk factor: primary genital lesion during delivery (HSV 2)

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Neonate: A newborn presents with his mother at 4-10 days of life with fever, lethargy, poor oral intake. On PE, you note hepatomegaly. You order tests and find that he is positive for HSV with CNS deficits and SEM.

This version of HSV has high morbidity (30-80%) and mortality (30%).

Disseminated

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Neonate: A newborn presents with his mother at 6-9 days of life with conjunctivitis, keratitis and papulovesicular lesions. You order tests and find that he is positive for a HSV infection. You tell his mother that with treatment, he has a >90% chance of normal development.

What type of disease (disseminated, SEM, or CNS) is this?

SEM (skin, eye, mucous membrane)

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Neonate: Neonate: A newborn presents with his mother at 10-18 days of life with fever, lethargy, apnea and seizures.

On PE, you note bulging fontanels. You order tests and find that he is positive for HSV with skin and CNS involvement. What type of disease (disseminated, SEM, or CNS) is this?

Encephalitis

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Neonate: A teratogen that can cause hypoplasia of the skull, renal tubular dysgenesis, and limb deformations

ACE inhibitor

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Neonate: A teratogen that can cause a long smooth philtrum, thin upper lip, VSD, microcephaly , IGUR, and behavioral issues

alcohol

*epicanthal folds, low nasal bridge, micrognathia, flat midface

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Neonate: An anti-convulsant that acts as a teratogen. It can lead to craniofacial defects and neural tube defects

Carbemazapine

Neonate: True/False - Cigarettes act as a teratogen causing IUGR and/or pre-term delivery

True

Neonate: An anti-seizure drug that, if given during pregnancy can cause cleft lip/palate, digit and nail hypoplasia, IUGR and cardiac defects

Hydantoin Hydan-TOE-in (nails and digits)

Neonate: An anti-coagulant that if given during pregnancy can cause nasal hypoplasia, severe mental deficiency, seizures, stippled bone epiphyses

Warfarin

Neonate: A teratogen that can cause spontaneous abortion/stillbirth, cardiac issues, microtia, hydrocephalus, limb defect, thymic or parathyroid issues

Isoretinoin

Neonate: A teratogen that can lead to Ebstein anomaly

Lithium

Neonate: A teratogen that can cause cleft lip/palate and/or cardiac defects

Phenobarbital

Neonate: A teratogen that causes limb anomalies

Thalidomide

Neonate: A teratogen that can increase risk of bleeding, cause premature closure of the PDA, and induce pulmonary HTN

Salicylates

Neonate: A teratogen that can cause neural tube defects, cardiac issues, hypospadias*, facial defects and long thin fingers

Valproic acid

Neonate: True/False -In utero, the fetus lives in a hypoxic environment. The placenta (low pressure) provides the source of gas exchange for fetal blood. After birth, fetal lungs provide the source of O2.

True --O2 90% to head; 10% to lower aorta NOTE: uterine artery (90-100 O2); intervillous space (50); umbilical artery (20); umbilical vein (30-35)

Neonate: In utero, the fetus lives in a hypoxic environment. The placenta (low pressure) provides the source of gas exchange for fetal blood. After birth, fetal lungs provide the source of O2. What are the changes that must be undergone for fetal lungs to function correctly? a. decrease FRC b. absorb fluid within the lungs c. dec. pulmonary vascular resistance

B and C - absorb fluid (within lungs) - build up FRC - dec. pulmonary vascular resistance - inc. blood flow to lungs

Neonate: An APGAR score is an assessment for appearance (color), pulse, grimace (reflex irritability), activity (muscle tone) and respirations. Each category is scored as O, 1, or 2. Which of the following features would represent a score of 0? a. blue or pale appearance b. absent pulse c. no response (grimace) d. some flexion

A-C - blue/pale - absent pulse - no grimace - floppy (activity) - absent respirations

Neonate: An APGAR score is an assessment for appearance (color), pulse, grimace (reflex irritability), activity (muscle tone) and respirations. Each category is scored as O, 1, or 2. Which of the following features would represent a score of 1? a. pink body, blue extremities (acrocyanosis) b. 60-100bpm pulse c. grimace present d. some flexion

All of the above **also slow, inconsistent respirations

Neonate: An APGAR score is an assessment for appearance (color), pulse, grimace (reflex irritability), activity (muscle tone) and respirations. Each category is scored as O, 1, or 2. Which of the following features would represent a score of 2? a. completely pink b. > 100bpm c. grimace w/ cough or sneeze d. flexion of all extremities e. good cry

all of the above

Neonate: A neural tube defect where the skull and brain do not form. It is incompatible with life and is responsive only to supportive care

Anencephaly

Neonate: A neural tube defect of the spine that can usually be repaired by may have paralysis and is at risk for infection. Tx involves covering w/ sterile gauze and contacting neurosurgery

Spina bifida

Neonate: A neural tube defect of the skull with protrusion of the brain and covering membranes. Seizures, paralysis, meental retardation can occur. Physician must protect the area and call neurosurgery

Encephalocele

Neonate: Malformation of the diaphgragm allowing abdominal contents into the chest cavity. It presents with 1. scaphoid abdomen (sunken) 2. breathing issues

Congenital diaphragmatic hernia * Intubate immediately * consult surgery

Neonate: In utero defect where intestines do not return into abdominal wall cavity through the umbilical ring are covered with a sac. It usually has other birth defects associated. Treatment involves protecting the area and placing sterile guaze around it. Consult surgery

Omphalocele

Neonate: Defect in which the intestines protrude through a hole in the abdominal wall next to the umbilicus. NO sac is present to protect the contents. No associated abnormalities. Consult surgery for repair

Gastroschischis

Neonate: Failure of the duodenal lumen to recanalize early in gestation. It presents with polyhydramnios in utero and bilious emesis within hours after first feeding.

Duodenal atresia * Down's syndrome or GI/cardiac issues * "double bubble" X-ray * Tx: surgical repair

Neonate: a tract between the trachea and esophagus that is associated with esophageal atresia and VACTERL: It presents with polyhydramnios in utero, increased oral secretions, gagging, inability to feed, aspiration pneumonia or respiratory distress. CXR - OG or NG tube coiling in esophagus Tx: surgical repair

TE fistula (EA w/ distal TEF MC) ``` VACTERL: Vertebral Anal Cardiac Tracheal Esophageal Renal Limb ```

Neonate: True/False - Airway anomalies such as cleft lip/palate or Pierre-Robin sequence may occur. In this case, provide a secure airway if needed so the baby can breath OR assist the baby with breathing.

True

Neonate: Usually due to prematurity and surfactant deficiency

respiratory distress

Neonate: Yellow discoloration in first few days of life and is more common in premature infants. It could by physiologic or pathologic in nature. Tx with phototherapy.

Jaundice

Neonate: Sepsis can be Early or Late onset. Prematurity is a risk factor for both. Maternal infection is usually responsible for ____ onset

Early

Neonate: brain ischemia due to global hypoxia or localized stroke

hypoxic-ischemic encephalopathy

Neonate: eye tumor

retinoblastoma

Neonate: in utero exposure to drugs leaves newborn cold turkey once born. Signs of withdrawal occur

Neonatal withdrawal syndrome

Neonate: low blood sugar, failure to thribe, special nutrition needs, electrolyte abnormalities

Growth/nutrition

Neonate: Neonatal death can occur during the first 28 days of life. The MC causes are a. prematurity and birth defects b. birth trauma c. infection d. asphyxia or SIDS

prematurity and birth defects

Well Child: List the components of the well child check

1. Vital signs: - -note: 3 and older = blood pressure 2. Growth - -growth charts - -head circumference (<2) - --BMI (>3) 3. Developmental monitoring/Surveillance: MCHAT, ASQ 4. History/PE 4. Anticipatory Guidance 5. Immnization 6. Health Screening 7. Disease prevention 8. Chronic disease management

Well Child: List the components of a health screen

BP, H/H, lead, hearing, vision, cholesterol

Well Child: List the aspects of disease prevention

fluoride, varnish, lead screening, infectious diseae, obesity

Well Child: True/False: Growth is most accurately assessed over time. Growth should always be viewed within the context of previous measurements. If measurements look incorrect, they should be repeated.

True

Well Child: 1. With regard to weight, infants should be weighed ___ on the ____ scale every time. 2. With regard to height, infants should be measured lying flat. Children 2 and older should be measured using a stadiometer. Shoes OFF for all ages. 3. Head circumference (FOC) should be measured using flexible tape measure or a designated FOC tape measure. Always measure the area with the _____ diameter.

1. naked, same scale 2. shoes OFF 3. largest diameter (above eyebrow, above ear)

Well Child: The designated growth chart for children 0-24 months is the _______, whereas growth for children 2-18 years is determined using ________.

1. WHO (0-24) - -breasfed infant as norm for growth - -physiologic growth 2. CDC * special populations: premature infants, Down, Turner,, Achondroplasia, Cerebral Palsy

Well Child: Occurs at each well child check. It is mostly subjective. It includes development assessment and psychosocial risk assessment. It assesses: 1. risk for delay 2. cognition, gross/fine motor, communication, social/emotional development Concerns discovered should prompt a deeper screening with a validated tool

Sureveillance

Well Child: Which of the following is NOT one of the 5 components of Surveillance? a. eliciting and attending to the parent's concerns b. documenting and maintaining a developmental history c. determining diagnoses based on parent's observations d. identifying risk and protective factors

Answer: C 1. elicit/attending to parent's concerns 2. document/maintain dev. Hx 3. make accurate observations 4. identify risk and protective factors 5. maintain accurate record of document the process and findings

Well Child: Use of a validated tool to measure developmental progress against norms. It is an objective tool that is more specific and sensitive, but used less often than surveillance. Examples include: ASQ, PEDS, MCHAT, Pediatric Symptom Checklist

Screening *doesn't determine Dx

Well Child: Examples of Screening tests include ASQ (Ages and Stages Questionnare) and the MCHAT (Modified checklist for autism). When would each of these tests be performed?

1. ASQ - -9 months, 18 mos, 30 mos - -anytime if suspected delays 2. MCHAT - -autism - -18 and 24 mos

Well Child: What are the 5 developmental domains? 1. _____: hold a pencil, button a shirt, snaps 2. ____: walk, run, climb, jump 3. ____: # of words, how well understood 4. _____: how they interact with others 5. _____: point, name objects, follow commands

1. Fine motor 2. Gross motor 3. Communication 4. Social-Emotional 5. COgnition

Well Child: Part of a well child check is taking a good history and PE. 1. _____ includes birth history, PMH, PSH, hospitalizations, meds, diet, allergies, developmental, Family Hx, Social Hx 2. _____ can be performed mostly through observation. Majority of the exam can be done in the mother's arms or lap (except hip exam). Start with the least invasive parts (heart/lung exam) and then move to more invasive

1. History | 2. PE

Well Child: The act of providing information regarding safety and development for caregivers. It may cover areas of developmental expectations (what's next), normal growth patterns, nutrition, physical activity, immunizations and safety. It should always be age specific

Anticipatory guidance

Well Child: Health screening are specific to age and level of development. Examples include: 1. ____ and CBC at 1 and 2 y/o 2. _____ screening (w/ eruption of first tooth and then every WCC) 3. Vision screening: age starting at age ___ to ___ and then yearly - Behavioral Health: age 5 and then yearly

1. Lead 2. Dental screening 3. 3-5 4. Behavioral Health

Well Child: Sudden death of a previously healthy infant under 1 year of age that remains unexplained by Hx, by thorough post-mortem exam (autopsy/toxicology); investigation of death scene and review of medical history

SIDS * no typical pathognomonic findings -- sometimes low grade asphyxia (petechial hemorrhages, pulmonary edema) * back to sleep campaign helped decrease

Well Child: Give examples of differential diagnoses that should be distinguished from SIDS

explained at autopsy: --infections, congenital anomaly, unintentional injury, traumatic child abuse, not explained: --SIDS, intentional suffocation

Wel Child: _______ is the death of an infant age < 1 year that occurs suddenly and whose cause is not immediately obvious. Most are due to: 1. SIDS 2. Infection 3. Accidental suffocation and strangulation in bed 4. Homicide

Sudden unexpected infant death (SUID)

Well Child: Environmental risk factors for SIDS can be modifiable or non-modifiable. What are examples of modifiable risk factors? a. low socioeconomic status b. maternal smoking during pregnancy c. post-natal smoke exposure d. less prenatal care and low birth weight

B - D

Well Child: Environmental risk factors for SIDS can be modifiable or non-modifiable. What are examples of modifiable risk factors? a. low socioeconomic status b. African or Native American c. Highest at 2-4 months of age (msot by 6 mos) d. highest in winter

All of the above * males * midnight to 9 am

Well Child: What are the Sleep environment risk factors associated with SIDS? a. higher incidence with prone sleeping b. soft bedding/surfaces or loose bedding c. overheating d. higher incidence with pacifier

A-C * pacifier decrease risk * supine = better than side lying (until 1 y/o) NOTE: home monitors do not decrease risk

Well Child: True/False: Other risk factors for SIDS include 1. episodes of an apparant life threatening event 2. subsequent sibling of SIDS victim 3. Prematurity (inverse w/ gestational age)

True

Well Child: To help avoid SIDS, infants should lie supine while asleep up until 1y/o. When can they be prone?

while infant is awake and observed *also avoid soft materials, surfaces, overheating

Infant: The following are what skills in the newborn? 1. Moro, Grasp, Suck, Root, ATNR, Babinski, Step

Primitive Reflexes

Infant: A child comes into your office with the following gross motor skills: 1. lift/turn head when prone 2. move all extremities reflexively 3. head lag on ventral suspension 4. flex body posture when supine At what stage of development is she in?

Newborn development

Infant: What are the fine motor skills associated with newborn development? a. Reflexive grasp b. holds fingers closed c. open and close hands d. hold a pencil

Reflexive grasp and holds fingers closed

Infant: Which of the following is a social/emotional skill in newborn development? a. spontaneous smile b. focus on faces c. startle to noises d. alert periods increase in legnth and predictability

all of the above

Infant: A child has the following language skills: 1. Cries with discomfort 2. Soothes to calm voice He is most likely in what developmental stage?

Newborn

Infant: The following are newborn reflexes and their expected appearance and disappearance times respectively 1. ____: Birth; 4 mos 2. ____: Birth; 3 mos 3. _____: Birth; 7 mos 4. _____: Birth; 8 to 15 mos 5. _____: 2 wks; 6 mos

1. Moro 2. Hand grasp 3. Crossed adductor 4. Toe grasp 5. ATNR

Infant: 1. The first phase of the Moro response is symmetrical ________ and extension of the extremities following a loud noise or an abrupt change in the infant's head position. 2. The 2nd phase of the Moro response is symmetrical ____ and flexion of the extremities, accompanied by crying.

1. abduction | 2. adduction

Infant: ______ is when a newborn reflexively grasps at a finger placed in the palm

reflex hand grasp

Infant: _______ reflex occurs when the baby's head is turned to one side, the baby extends the arm and leg on that side. They also flex the arm and leg on the other side. **first step in developing hand-eye coordination (line of sight)

Asymmetric tonic neck reflex

Infant: In the newborn, the body is held in a ____ position when supine, and all extremities move symmetrically.

Flexed *hands = reflexive grasp

Infant: Anticipatory guidance for the newborn includes: a. sleep position/SIDS b. Fever c. Voiding/Stooling d. Nasal congestion/sneezing

All of the above *car seat, bathing, circumcision care, crying/colic, infantile acne, hiccups, NB screen, hearing screen

Infant: You perform a well child check on a baby who has the following gross motor skills: 1. lift head to 45 degrees when prone (hold head up) 2. head lag when supine 3. brings hands to midline 4. visual tracking past midline (180o) What developmental age is this baby?

2 months *Fine motor: Open and close hands Red flag: Lack of fixation

Infant: Which of the following is an example of the social/emotional activity of a 2 month old? a. social smile b. sleep-wake pattern follows day-night pattern c. laughing d. attachment to mother

A and B

Infant: Which of the following is an example of the communication development in a 2 month old? a. Cooing b. Varied cries (hunger/pain) c. Alerts and quiets to sounds d. Takes turns

A-C cooing, varied cries, alert/quiet

Infant: True/False - At 3 mos, an infant can respond to interesting sounds by looking in the direction of the sound

True

Infant: During a well child check you not the infant has the following gross motor skills: The moro reflex is absent, she can hold her head steady unsupported, and lift her chest off the floor when prone. She can roll from a prone position to a supine position and can sit with maximal support. What stage of development is this child?

4 months Red flags: Lack of steady head control sitting; lack of visual tracking

Infant: During a well child check, you note the infant is "social hatching" and laughing in the presence of his mother. He turns toward her voice and extends his cooing. When assessing his fine motor skills, you note that he is NOT able to grasp objects easily. At his current stage, you would expect him to be able to grasp objects and bring them to his mouth. What age of development is this?

4 months *fine motor Cognitive: self-discovery, finds hands and feet

Infant: During a well child check, you note the infant is "babbling". She takes turns when speaking and can express vowel sounds. Her mother states that she likes to look at herself in the mirror, laughs a lot and is responsive to others' emotions. At what stage of development is she?

6 months *age of discovery and autonomy

Infant: Which of the following is a gross motor skill seen in 6 month old development? a. bears weight on feet when held upright b. sits with maximal support c. sits up with minimal assistance and may begin to sit without support d. rolls both directions

A, C, D Red flags: lack of smiles; failure to turn to sound or voice

Infant: Which of the following is a fine motor skill seen in a 6 month old baby? a. dysconjugate gaze resolved b. transfers objects from one hand to the other c. raking grasp d. waves bye bye

A-C * dysconjugate gaze * object transfer * raking grasp

Infant: Which of the following is an example of a topic for anticipatory guidance for babies 2 to 6 months old? a. infantile acne b. never leave unattended c. parentease (talk to baby) d. child proofing

All of the above -car seat transition, introduction to solids, no discipline, no screens, no boddles in bed, no infant walkers

Infant: A mother brings her baby in for a well child check. You note that the baby can sit without support, can crawl and pull to stand. As you continue to perform your exam, he throws his pacifier onto the floor and says "mama". At what developmental age is this baby?

9 months | *gross and communication skills throw objects, sits, crawls; consonants

Infant: Which of the following is a fine motor skill we would expect to see in a 9 month old? a. pincer grasp b. bang objects together c. drinks from a cup

A and B

Infant: Which of the following is a social-emotional skill seen in 9 month old babies? a. object permanence b. stranger anxiety c. peek-a-boo d. waves bye bye

All of the above * copies sounds/gestures of others * looks for things you hide Red flag: Lack of reciprocal vocalizations, smiles, facial expressions; lack of babbling; consonants

Infant: List the steps of pincer grasp development

1. Rake (6 mos) 2. Inferior scissors grasp (7 mos) 3. Scissors grasp (8 months) 4. Inferior pincer grasp (9 mos) 5. Pincer grasp (10mos) 6. Fine pincer grasp (12 mos)

Infant: At a well child check you not a baby who cruises, stands without support and can take a few steps. Her fine motor skills include: putting a block into a cup, drinking from a cup, and a refined pincer grasp. What age of development is she?

12 months

Infant: What Social-Emotional behaviors are expected in a 12 month old child? a. points at objects desired/joint attention b. watches and imitates c. responds to name d. makes postural adjustments when dressing

All of the above

Infant: An infant who can speak 1-3 meaningful words and is mama and dad specific is at what age of development?

12 months * understands simple requests * symbolic thought

Infant: Anticipatory guidance for 6 to 12 month olds includes: a. childproofing b. choking c. water d. hot surfaces

All of the above *introduce finger foods, introduce cup, transition from bottle, move to whole milk, separation anxiety, night awakenings, oral health, speech development, no screens

Infant: What are Motor Red flags in babies?

1. 4 mos: lack of steady head control while sitting 2. 9 mos: can't sit 3. 18 mos: can't walk independently

Infant: Which of the following is a cognitive red flag? a. lack of fixation at 2 mos of age b. lack of visual tracking at 4 mos c. failure to turn to sound or voice at 4 mos d. failure to turn to sound or voice at 6 mos

A, B, D * lack of babbling consonants (9 mos) * failure to use single words (24 mos) * failure to speak in 3-word sentences (36 mos)

Infant: WHich of the following is a social-emotional red flag? a. lack of smiles/joyful expressions at 6 mos b. lack of reciprocal vocalizations, smiles or facial expressions by 9 mos c. failure to respond to name when called or absence of babbling by 12 mos d. loss of previously acquired babbling, speech or social skills at any age

All of the above * 15 mos: - no reciprocal gestures (waving, reaching), no pointing, - lack of single words * 18 mos: - no pretend play or spoken language/gesture combos, - inability to walk independently * 24 mos: - no 2-word phrases (without imitating or repeating)

Toddler: A child presents to your office for his well child check. He walks well and is able to walk backwards. He bends over to pick up a toy (stoops) and recovers by straightening back up. His mother states he climbs onto their furniture often. These gross motor skills describe what age development?

15 months

Toddler: A child presents to your office for her well child check. Her mother states that she has been able to throw a ball overhead, likes to scribble, and drinks from a cup with little spillage. She also eats independently and likes to put her toy blocks in her cup. At what age of development is this little girl?

15 mos (fine motor skills)

Toddler: Which of the following is a social/emotional behavior for a 15 month old? a. imitates use/housework b. shows toys to caregiver c. can speak 3 words or more d. jargon

A and B * take pride in own accomplishments * 3 words or more and jargon = 15 month communication skills

Toddler: With regard to fine motor development, describe the skills that would be expected 1. _____ month: imitates or scribbles spontaneously 2. ____ month: imitates vertical/circular strokes 3. _____months: copies circle 4. _____ months: copies corss 5. ____ months: copies square 6. ____ months: copies triangle

1. 15 month 2. 24 month 3. 36 month 4. 48 month 5. 54 month 6. 60 month

Toddler: An ______ month old patient presents to your office with her mother. You note that she is able to walk backwards and sideways. Her mother mentions she loves to run and climb outside, she is able to walk upstair with help, and she likes to sit in a chair and listen to her father read her stories before bedtime.

18 month *gross motor skills

Toddler: Which of the following is an example of a fine motor skill seen in age 18 months? a. 2 cube tower b. takes off clothing c. uses fork/spoon with little spillage d. imitation

A-C *imitation = social/emotional

Toddler: An 18 month old male comes in with his mother who complains he has been throwing tantrums. You tell her that it is normal at his age. What are other normal behaviors for his age? a. imitation b. parallel play/simple pretend c. saying 6 or more words d. knowing 1 body part

All of the above Social-Emotional: Imitation, tantrums, parallel play Communication: 6 or more words Cognition: 1 body part, One step commands

Toddler: A concerned father visits your clinic with his daughter. He tells you that his daughter throws frequent tantrums and is unable to express herself without imitating or repeating. He states she also has difficulty using single words. During your observation, you note she is able to jump in place and runs well. What is her suspected age, and is there cause for concern?

Age 2 y/o Gross: walks upstairs, kicks ball forward/throws ball, runs well, jumps in place Communication: 2 word sentences, speech 1/2 understandable, knows 50+ words *Red flags: lack of 2-word meaningful phrases (w/out imitating or repeating) and failure to use single words

Toddler: List the fine motor skills we would expect to see in a 2 year old

1. Wash/dry hands and brushes teeth with help 2. draws lines 3. Stacks 6 blockes

Toddler: Which of the following is a social-emotional skill in a 2 year old toddler? a. parallel play b. peak tantrum age c. responds to commands d. potty training

all of the above *separation anxiety resolves

Toddler: Which of the following is a Cognitive development of a 2 year old? a. knows 3 body parts b. Asks questions c. Follows 1-step commands

Asks questions * knows 6 body parts * Follows 2 step commands

Toddler: Which of the following is an example of anticipatory guidance for a toddler? a. read books b. name objects c. praise good behavior d. temper tantrums

all of the above Others: NO bottles, healthy snacks, appetite, outdoor safety, toilet training, choking, car seat transition, street safety, pool safety, gun safety

Young Child: A 3-year old presents to the clinic with his mother. She states he is able to walk upstairs alternating his feet, can catch a ball against his chest, and rides a tricycle. You note during the exam he is balancing on 1 foot for 1-2 seconds at a time. These are all example of what types of skills?

Gross motor skills for 3 y/o Fine motor: Copies circles; wash hands and brush teeth

Young Child: A young child presents to the clinic with his mother. She expresses concern that he is unable to speak in 3 word sentences and babbles. This is expected of what age group? What are other Communication skills?

3 year old Communication: - Speech 75% to mostly understandable - 3 word sentences

Young child: Which of the following is a Social-Emotional skill of a 3 year old? a. dresses and undresses self b. shows empathy and a wide range of emotions c. looks at self in mirror

A and B

Young child: Which of the following is a Cognitive skill of a 3 year old? a. understands 3-step commands b. names pictures and sounds c. knows colors and counts (1-3) d. knows name, age and gender

All of the above

Young child: A 4 year old male enters the clinic with his mother. She states he is able to count to 10 and knows 3-4 colors. He uses action words and likes to tell stories. He often plays hide and seek with his dad. What skills are these?

Cognition: Counting, Colors Communication: Action words, Storytelling, Hide and Seek

Young Child: Which of the following is a gross motor skill consistent with 4 year old development? a. hops/climbs ladder b. balances on 1 foot (2-3 sec) c. up/downstairs without holding on d. dresses self well

A-C Dressing self, cut/paste, copies cross and circle - Fine motor skills

Young Child: A mother presents to the clinic with her son. She states he knows how to define words, knows left from right and opposites, and can pick the longer line in a drawing. These are all examples of what skills?

Cognition

Young child: A 5 year old presents to the clinic with her mother. You note she speaks in understandable 5-word sentences. She tells you she plays board games and card games, likes to draw stick men, and brushes her teeth. These are examples of what skills?

1. Communication: 5 word sentences 2. Social Emotional: board games, prepares own cereal, drink 3. Fine motor: stick men, brush teeth, copies cross, square and circle

Young child: What gross motor skills would you expect in a 5 year old child? a. balances on one foot (4-5 sec) b. skips c. ties shoelaces (maybe) d. copies cross/square in addition to circle

A-C

Young child: Which of the following is a developmental skill of a 6 year old child? a. heel to toe walk b. balance on one foot (6 sec) c. writes letters d. draws triangles and stick men

All of the above

Young child: Anticipatory guidance for ages 3-6 will vary by age. What are the topics that could be included? a. choking b. drowning/water safety c. booster seat d. good touch/bad touch and stranger danger

all of the above *guns, name, address, phone number, school performance/transition

Adolescent: What are some other things to consider when taking the history of an adolescent (aside from PMH, PSH, etc.)

stitches, broken bones, injuries menstrual history diet/nutrition/exercise habits

Adolescent: HEADSS(S) and SAFETEEN are psychosocial screening tools for adolescents. What do they stand for?

HEADSSS - home, education, activities, drugs, sexuality, suicide (safety or social media) SAFETEEN - sexuality, accidents/abuse, firearms/homicide, emotions (suicide/depression), toxins (drugs, alcohol), environment (school, home, friends), exercise and nutrition

Adolescent: A surge in appetite around the age of 10 in girls and 12 in boys foreshadows the growth spurt of puberty. 1. In females, peak height velocity is _____ year(s) prior to menarche, SMR 2-3. Growth usually ceases by 16 (2-3 years after menarche). 2. In males, peak growth velocity is later than that of females. Height velocity peaks at SMR 3-4 and generally slows by age ____.

1. 1 year 2. age 18 *growth spurt begins distally (8-9 cm/yr females; 9-10 males)

Adolescent: The body demands more calories during early adolescence than at any other time of life. 1. Boys require an average of _____ calories per day 2. Girls require an average of _____ calories per day Typically, this ravenous hunger wanes once growth ceases (unless active or big/tall).

1. 2800 boys 2. 2200 girls *protein, carbs, fats

Adolescent: Which of the following is a food fau pas of adolescence? a. skipping meals (specifically breakfast) b. eating on the run c. snacking d. freshman 15

All of the above #1 - skipping meals

Adolescence: ______ marks the period between the onset of puberty through transition into adulthood. It is divided into 3 stages: Early, Middle and Late. It involves physiologic growth and puberty changes, as well as intellectual, psychological and social development.

Adolescence * purpose: form one's own identity * independence, autonomy, push limits

Adolescence: The following describes what stage of adolescence? 1. Age: 10-13 y/o 2. SMR: 1-2 3. Biological: Secondary sex characteristis; awkward; begin rapid growth 4. Sexual: interest exceeds activity 5. Cognitive and Moral: Concrete operations; Conventional morality

Early Adolescence

Adolescence: The following describes what stage of adolescence? 1. Self Concept: Preoccupation with changing body; self-conscious 2. Family: bids for increased independence, ambivalence 3. Peers: Same-sex peer group, conformity, cliques 4. Relationship to Society: Middle school adjustment

Early Adolescence

Adolescence: A 14 year old patient presents to your clinic for a well child check. She states that she has begun menarche. You note acne and slight odor. She expresses interest in dating, but is concerned with her attractiveness. What stage of adolescence is she in?

Middle Adolescence Age: 14-16 SMR: 3 to 5 Self concept: concern with attractiveness, increased introspection Peers: Dating; peer groups less important

Adolescence: The following describes what stage of adolescence? 1. Biological: Height growth peaks, body shape/comp change; acne and odor; menarche or spermarche 2. Sexual: sex drive surges, experimentation, questions of sexual orientation 3. Cognitive and moral: abstract thought; questioning; self-centered 4. Self concept: increased introspection, concern with attractiveness 5. Relationship to society: Gauging skills and opportunities 6. Family: struggle for acceptance of greater autonomy

Middle Adolescence

Adolescence: What Stage of Adolescence does the following describe? What cognitive changes would you expect in an adolescent with the following characteristics: ``` Age: 17-20 SMR: 5 Biological: Slower growth Sexual: Identity consolidation Self Concept: Relatively Stable Body Image Society: Career decisions ```

Late Adolescence *Cognitive: Idealism, Absolutism

Adolescence: Which of the following correctly describes the concept of family during late adolescence? a. Practival independence b. Family remains secure base c. Continuing struggle for acceptance of greater autonomy d. Ambivalence

A and B --practical independence; family = security

Adolescence: Which of the following correctly describes peers in late adolescence? a. Intimacy or Commitment b. Dating c. Peer groups less important d. Same sex peer groups

A. Intimacy or Commitment

Adolescence: What are aspects to consider while taking a PE on an adolescent?

``` General: mood, affect, interaction, cooperation Neuro Extremities Spine, Musculoskeletal Tanner stage, Gynecologic, Testicular Vision, Hearing ```

Adolescence: The period during which adolescents reach sexual maturity and become capable of reproduction. Girls may start from 8-13 y/o (avg. 10) and boys may start from 9-14 (avg. 11). It may occur earlier in overweight childre

Puberty *vocal instability, acne, near sightedness, gawky, inc. sleepiness, inc. appetite, moody

Adolescence: Development of body odor as well as axillary and pubic hair (androgen dependent) >8y/o in girls > 9 y/o in boys

Adrenarche

Adolescence: Onset of breast development | Avg. 11 y/o can be 8-13

Thelarche

Adolescence: Start of Menses *2 years after thelarche

Menarche

Adolescence: Tanner Stages in the Female assess development of breasts and growth of pubic hair. Describe the progression of pubic hair from pre-adolescent to adult. Stage 1: _________ Stage 2: sparse, lightly pigmented, straight, located along _____ border of labia Stage 3: darker, beginning to curl, increased Stage 4: ______, curly, abundant. Less than adult Stage 5: Adult feminine triangle. Spread to medial surface of ______

1. Pre-adolescent (no pubic hair) 2. Medial border of labia (lat. vulva) 3. beginning to curl; darker 4. coarse 5. medial surface of thighs

Adolescence: Tanner Stages in the Female assess development of breasts and growth of pubic hair. Describe the progression of breast development from pre-adolescent to adult. Stage 1: Preadolescent Stage 2: breast and papilla elevated as ____; inc. areola diamter Stage 3: breast and areola ______; no contour separation Stage 4: areola and papilla form _____ mound Stage 5: Mature; nipple projects; areola part of general breast contour

``` Stage 1: preadolescent Stage 2: small mound Stage 3: enlarge Stage 4: secondary mound Stage 5: mature ```

Adolescence: Tanner Stages in the male assess development of pubic hair, the penis and testes. Describe the progression of pubic hair from pre-adolescent to adult. Stage 1: None Stage 2: Scanty, long, slightly ______ Stage 3: Darker, starting to ______, small amt. Stage 4: Resembles _____ type, but less quantity. Coarse and curly Stage 5: Adult distribution. Spreads to _____ surface of thighs

1. None 2. Slightly pigmented 3. Starting to curl 4. Resembles adult type; less 5. Spread to medial surface of thighs

Adolescence: Tanner Stages in the male assess development of pubic hair, the penis and testes. Describe the progression of penile growth from pre-adolescent to adult. ``` ______: pre-adolescent ______: minimal change/enlargement ______: lengthens ______: larger; glands and breadth increase in size ______: adult size ```

``` Stage 1: pre-adolescent Stage 2: minimal change Stage 3: lengthens Stage 4: larger; inc. glands/breadth Stage 5: adult size ```

Adolescence: Tanner Stages in the male assess development of pubic hair, the penis and testes. Describe the progression of the testes from pre-adolescent to adult. ``` Stage 1: pre-adolescent Stage 2: enlarged _____; pink; texture altered Stage 3: Larger Stage 4: Larger; Scrotum is ____ Stage 5: Adult size ```

``` Stage 1: pre-adolescent Stage 2: Enlarged scrotum Stage 3: Larger Stage 4: Larger; Scrotum is dark Stage 5: Adult size ```

Adolescence: True/False - Anticipatory guidance should be based on patient and parental concerns as well as Hx and PE. It should be done with and without the parent in the room, and should be individualized based on stage of adolescence, maturity level, and psychosocial factors.

True

Adolescence: Which of the following is an example of anticipatory guidance for an adolescent? a. high risk behaviors (speeding) b. personal safety and homicide c. drugs, alcohol, tobacco d. STI's, sexual behaviors and pregnancy

All of the above *eating disorders, school environment; depression, suicide, education, social media

Adolescence: Which of the following is a leading cause of death between the ages of 10-14? a. Unintentional accidents b. Cancer c. Suicide d. Homicide

All of the above (in that order) #1 Accidents *congenital, heart disease, chronic lower resp.

Adolescence: Rank the following in order of MC cause to least common cause of death b/t the ages of 15-19? a. Unintentional accidents b. Suicide c. Homicide d. Cancer e. congenital f. heart disease g. flu

``` Unintentional accidents Suicide Homicide Cancer Heart disease Congenital Influenza ```

Adolescence: List the immunizations for adolescents

1. Influenza (yearly) 2. HPV 3. TDaP 4. Meningococal (MenACWY and serogroup B) 5. Other catch up (Hep A, B; Varicella)

Adolescence: True/False - Physicians may administer medical treatment in emergencies and to emancipated minors without parental consent. Access to the medical record generally follows the same guidelines for conesent and confidentiality as the laws governing Tx

True

Adolescence: True/False - Any person, regardless of age, has the capacity to consent to examination and treatment by a licensed physician for any STI. Minors may give consent for confidential treatment of pregnancy, STI, and/or drug and substance abuse

True

Adolescence: emancipation in OK is defined as: a. minors with one or more dependent children b. married minors c. minors who are self supporting and separated from their guardians

All

Vaccines: Administration of all or parts of a microorganism or modified product or microorganisms (toxoid) to stimulate an immunologic response. It mimics natural immunity, long-term, vaccines

Active immunity

Vaccines: Administration of pre-formed antibody. It provides transient, but immediate immunity. It is composed of Igs. Examples include: HBIG, Rabies, IG, IVIG, Synagis

Passive immunization

Vaccines: Which of the following is a component of vaccines? a. active immunizing antigens/immunogens b. conjugating agents c. adjuvants (e.g. aluminum salts) d. preservatives (thimerosal)

ALl of the above 1. conjugating agents: - -vaccine Ag conjugated to protein carrier (inc. immune response) 2. adjuvants: - -improve immune response to Ag 3. preservatives: - -inhibit microbial growth - -thimerosal (multi-dose vials)

Vaccines: Which of the following is a component of vaccines that ensures the potency of the vaccine is NOT affected during the manufacturing process, storage or tansport. a. stabilizer b. suspending fluid c. antimicrobial agent d. other

Stabilizer *sugars, aa's (glycine), proteins (gelatin) 1. suspending fluid - -sterile water or normal saline (tissue culture fluid) 2. anti-microbial agents - -neomycin, polymyxin B, streptomycin 3. other - -trace amts. formaldehyde, antibiotics, bacterial/cell cutlture components

Vaccines: True/False: Thimerosal (ethyl mercury) has been the most commonly used preservative in vaccines. It is used most often in multi-dose vials to prevent growth of substances inadvertently introduced due to repeated penetrations. It is associated with rare, mild allergic reactions, and doesn't inc. risk of neurodevelopmental disorders (autism)

True

Vaccines: 1. _______ vaccines include MMR, Varicella, Rotavirus, LAIV, Yellow fever 2. ______ vaccines include Inactivated (hep A, flu, polio, rabies); Recombinant (HIb, Hep B, HPV, meningococcal) and Toxoid (diptheria, tetanus)

1. Live-attenuated | 2. Inactivated

Vaccines: Childhood Immunization Schedule 1. DTaP (D); Tdap (Tada) 2. IPV (inactivated polio; I) 3. MMR (M) 4. HepB (B) 5. Hep A (A) 6. Varicella (V, Very) 7. PCV (P) 8. Hib (H) 9. Influenza (In) 10. Rotavirus (R) 11. Meningococcal (Men) 12. HPV (Human)

``` Birth: B 2 mos: B DR HIP 4 mos: DR HIP 6 mos:B DR HIP In 18 mos: A 1-1.5yr: MAD HPV 4-6 yr: Very DIM 11-12: Tada, Human, Men 16-18: Men booster ```

Vaccines: Adolescent Immunization Schedule 1. Tdap 2. HPV 3. Meningococcal conjugate 4. Meningococcal

1. Tdap - 1 x (11-12) 2. HPV - 2 doses (11-12) 3. Meningococcal conjugate - 1 does (11-12; 2 doses 16-18) 4. Meningococcal - -2 doses (16-18)

Vaccines: True/False - Vaccines are spaced out at 4 to 8 week intervals to avoid competing immune responses. There is a 6 month gap between the last primary and first booster dose allowing completion of the affinity-maturation process and development of highly specific memory B cells.

True

Vaccines: What vaccines are given ONLY after 6 months of age to avoid neutralization by maternal antibodies and to allow for immune maturity?

MMR and Varicella * 95% protected after 12 mos * 5 % protected after 2nd dose

Vaccines: True/False - Skipping vaccine doses increases the risk of acquiring vaccine preventable diseases such as measles and pertussis. There is no alternative immunization schedule. Delaying vaccines only leaves a child at risk of disease for a longer period of time; it does not make vaccinating safer.

True

Vaccines: 1. _____: provides advice and guiance on effective control of vaccine-preventable diseases. 2. _____: monitors current developments in the prevention, diagnosis and treatment of infectious diseases. It also prepares updated editions of the Red Book (report of committe on infectious diseases) 3. ______: coordination of vaccine and immunization activities among federal agencies and other stakeholders 4. _____: program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay

1. ACIP (Advisory Committee on Immunization Practices) 2. COID (Committee on Infectious Disease) 3. NVP (National Vaccine Program 4. VFC (Vaccine for children)

Vaccines: True-False A primary contraindication for most vaccines is history of severe allergic reaction to the vaccine or a component of the vaccine. However, a severe egg allergy is not a contraindication.

True * MMR, flu NOT contraindicated (not enough egg for IgE rxn) * Yellow fever, TIV, and LIV ARE contraindicated

True 1. Not contraindicated (egg): * MMR, flu (not enough egg for IgE rxn) 2. Contraindicated: * Yellow fever, TIV, and LIV

Vaccines: True/False - 25% of children experiencing an immediate reaction to the MMR vaccine had specific IgE to gelatin on skin or blood testing.

True NOTE: latex allergy is also possible, but not likely allergen

Vaccines: What is NOT found in MMR vaccine?

streptomycin and thimerosal

Vaccines: List the Vaccines indicated for International Travelers

1. Japanese encephalitis - Inactivated - -> 2 mos - -2 doses (28 days apart) 2. Measles - -Live attenuated - -> 12 mos = 2 doses at least 28 days apart - -6-12 mos = single dose

Vaccines: List the Vaccines indicated for International Travelers

1. Japanese encephalitis - Inactivated - -> 2 mos - -2 doses (28 days apart) 2. Measles - Live attenuate - - > 12 mos = 2 doses at least 28 days apart; no booster - -6-12 mos = single dose + booster after 12 mos 3. Rabies - inactivated - -all ages + booster (if exposed) - -day 0, 7, 21, 28 4. Yellow fever - Live - -> 9 mos (1 dose) + booster every 10yrs

Vaccines: Measles is transmitted via respiratory droplets. The virus is infectious 3-5 days prior to onset of rash, and 4 days after rash develops. Prevention of un-immunized children exposed to measles occurs via

1. IM immune globulin (0.25; max 15ml) - -within 6 days of exposure - -immunocompromised receive 0.5

Vaccines: Which of the following is a high risk individual who cannot be immunized with Varicella zoster vaccine? a. newborns of mothers who develop chickenpox within 5 days before (or 48 hours after) delivery b. newborns > 28 weeks gestation whose mothers lack evidence of immunity c. newborn < 28 weeks gestation or < 1000 g regardless of maternal immunity d. immunocompromised persons without evidence of immunity

all of the above

Vaccines: True/False: For children 7 or older who have not completed the DTAP series, the first dose in the catch up series should be Tdap.

True DTap: < 6/yo Tdap: 7 y/o or older

Vaccines: True/False: Hib and PCV 13 are not routinely given to healthy children after 59 months of age (5 years)

True

Vaccines: It is recommended that infants age 6-11 months receive 1 dose of _____ vaccine prior to any international travel

MMR *give add'l 2 doses if 1st dose prior to 12 mos

Vaccines: Measles vaccine given within ___ hours of the exposure is the preferred method of controlling measles outbreaks in school and childcare settings in susceptible individuals

72 hours

Vaccines: Because there are over 90 serotypes of pneumoccocus, PCV13 and PCV23 are used to target the more likely causes of infection in humans. They are indicated in healthy infants (4-dose series). What is the recommendation for high risk individuals (e.g. cochlear implants, CSF fluid leaks)?

1 or 2 dose series starting at 2 years of age | chronic heart disease, chronic lung disease, cochlear implants, CSF fluid leaks

Vaccines: When is tetanus booster indicated?

contaminated wounds (animal bites) IF 5 years have elapsed since receipt of a tetanus toxoid containing vaccine

Vaccines: Rabies treatment should involve Rabies Ig and rabies vaccine (within 24 hours of exposure). Rabies vaccine is given on day 0, 3, 7, 14 for immunocompetent individuals. How does this differ from immunocompromised individuals?

additional dose at day 28 for immunocompromised

Vaccines: True/False - A documented pertussis infection should not alter the standard immunization schedule (6 doses; 5 DTap + 1 Tdap)

True *waning immunity cause for resurgence

Vaccines: A quadrivalent conjugate meningococcal vaccine is recommended for: a. all US children 11-12 year olds + a booster at 16. b. infants and young children w/ underlying conditions that predispose them to developing invasive meningococcal infections c. vaccination against serogroup B in 16 year olds

All of the above *pre-disposing conditions: sickle cell disease and anatomic asplenia

Vaccines: True/False - In the US, a total of 4 doses of live polio vaccine is recommended for all infants and children. These doses are administered at 2, 4 and 6 to 18 months, and 4 and 6 years.

4 doses of inactivated *polio vaccine before travel

Parasites: The following are causes of chronic diarrhea in children: 1. _____: petting zoos, contaminated water (swimming pools). 2. ____: contaminated lakes and streams 3. ____: unpasteurized apple juice, imported raspberries, salads 4. entameoba histolytica: _______

1. Cryptosporidium 2. Giardia 3. Cyclospora 4. fecal-oral transmission

Parasites: A 5 year old boy presents with fever, vomiting, and bloody stools. The microorganisms was transmitted by fecal-oral route. What do you suspect?

Entamoeba histolytica *dysentery, blood stool, vomiting and fever

Parasites: A 2 year old presents with bloating and malabsorption. His mother states he went swimming in the lake over the weekend with his grandparents. You suspect

Giardia intestinalis

Parasites: A 3 year old boy presents to the clinic with his mother who states she found small worms in his anal region. She states he has been scratching the are profusely. You suspect

Enterobius vermicularis (pinworm) * perirectal itching, small worms * NOT malabsorption issue Tx: Albendazole

Parasites: A 24 month old girl presents to the clinic with her mother who states her daughter has had loose, bloody stools with worms that are about 4cm long. On PE you note rectal prolapse. You suspect

Trichuris trichuria

Parasites: Ascaris lumbricoides is the largest nematode that can infect humans. Many patients can be asymptomatic. Which of the following is a possible symptom of Ascaris lumbricoides infection? a. malabsorption and malnutrition b. obstruction from large worm burden c. pulmonary symptoms (wheezing)

All of the above Dx: eggs in stool

Parasites: Rank the major worm infections of children from most common to least common Intestinal Helminth Infections (Ascariases, Trichuriasis, Hookworm, Enterobiasis) Schistosomiasis Cysticercosis Toxocariasis

1. Intestinal helminth infections 2. Schistosomiasis 3. Toxocariasis 4. Cysticercosis

Parasites: True/False: Severe morbidity results from high worm intensity (# worms per individual on average). Worm intensity peaks in school-aged children or in adolescents possible due to environment, biological and socioeconomic factors

True

Parasites: The following describes what type of worm infections? 1. stunted growth 2. cognitive and intellectual deficits

Intestinal helminth infections

Parasites: The following describes what type of worm infections? 1. Asthma 2. Vitamin A malabsorption 3. Intestinal obstruction

Ascariasis

Parasites: The following describes what type of worm infections? 1. Colitis 2. Trichuris dysentery syndrome

Trichuriasis

Parasites: Parasites: The following describes what type of worm infections? 1. hematuria 2. renal failure 3. hydronephrosis 4. female genital schistosomiasis

Urogenital schistosomiasis

Parasites: The following describes what type of worm infections? 1. diarrhea 2. liver fibrosis 3. intestinal bleeding

Intestinal schistosomiasis

Parasites: The following describes what type of worm infections? 1. Epilepsy 2. Asthma 3. Lung dysfunction

Toxocariasis

Parasites: Which of the following worms should NOT be treated with Albendazole? a. Ascariasis b. Strongyloidiasis c. Toxocariasis d. Schistosomiasis

B and D Strongyloidiasis: Ivermectin Schistosomiasis: Praziquantel *others - Albendazole

Viruses: The common types of Herpesvirus include: 1. HHV 1 and 2 (Herpes Simplex) 2. HHV-3 (Varicella Zoster) 3. HHV-4 (EBV) 4. HHV-5 (Cytomegalovirus) 5. Human Herpes 6 and 7 (HHV 6,7) 6. Kaposi Sarcoma-associated (HHV-8) Which of the above is known for causing Gingivostomatitis (swelling and perioral lesions) followed by painful ulcers in the anterior mucous membranes of the mouth?

HHV-1 *foul breath, erythemetous gingiva, inflamed, friable

Virus: Perinatal Herpes can be transmitted vertically and via close contact with skin. What are the main sites affected by HSV 1 and 2 in the neonate?

1. SEM = localized 2. CNS (w or w/out skin involvement) = localized 3. Multiple organs (*liver, lungs, CNS) = disseminated

Virus: Perinatal HSV 1 and HSV 2 can be diagnosed via the acquisition of 1. ______: conjunctiva, nasopharynx, mouth, anus 2. ______: for HSV PCR 3: ______: HSV PCR and treated with IV acyclovir.

1. Surface skin Cx - -24-36 hours post delivery - -severe cases 2. Skin vesicle lesions (un-roofed) 3. CSF, Blood NOTE: Tx w/ IV acyclovir prior to skin test (if suspect HSV)

Virus: Which of the following is the greatest risk factor for neonatal Herpes? a. Mother has active primary genital HSV-2 lesions and a vaginal delivery b. Mother with recurrent +HSV infections c. C-section w/ < 4 hours ROM

Answer: A *primary genital HSV-2 lesion w/ vaginal delivery - mother w/ recurrent infection: not as likely to transmit - C section: protects infants from HSV

Virus: Varicella zoster is a highly contagious virus that establishes lifelong latent infection in the DRG neurons. In infants, it can cause congenital varicella syndrome (rare; mom to baby). In kids, primary infection typically manifests as chicken pox, a benign, self-limited disease with fever, fatigue, headache and rash. What are the features of the rash?

1. Macules (pruritic, erythemetous) on scalp, face, trunk 2. Turn to papules 3. become clear fluid vesicles 4. finally become crust/scabbing lesions * different stages of rash * resolves within a week

Virus: When is it safe for a child infected with Varicella to return to school?

When ALL the lesions have crusted/scabbed over

Virus: Describe Dx and Tx of VZV

Dx: - -PCR of VZV - -Viral Cx, Txanck Smear, IgG and IgM Tx: - -symptomatic care - -anti-viral: within 24-48 hours of onset * oral acyclovir/valacyclovir (moderate-severe infection)

Virus: What populations are likely to contract moderate to severe varicella? a. unvaccinated patients > 12 y/o b. patients with chronic pulmonary disorders c. chronic skin deseases (atopic dermatitis) d. people taking steroids e. neonates and pregnant women

all of the above

Virus: A 3 year old patient presents with what appears to be strep throat. She has fever, exudative pharyngitis, and cervical lymphadenopathy. You also note atypical lymphocytosis*. You obtain a throat culture, MonoSpot and titers. What is the suspected cause?

EBV (infectious mononucleosis) MonoSpot: heterophile IgM (1st 2 wks) EBV titiers: obtain <4 y/o Tx: Symptomatic care - -**NO amoxicillin - -NO contact sports at least 3 wks

Virus: EBV has a spectrum of disease ranging from asymptomatic to severe neurologic or hematologic complications. Which of the following is a neurologic complication? a. Aseptic meningitis b. Facial Nerve palsy c. Splenic rupture d. TTP

A and B

Virus: This virus is the MCC of non-hereditary sensorineural hearing loss. In neonates, it causes microcephaly, and periventricular calcifications (on CT). Purpuric rash is also common.

Cytomegalovirus Dx: - -CMV in urine (gold standard) - -CMV from CSF, stool, or resp. secretions Tx: IV gancyclovir

Virus: HHV-6 causes this childhood exanthem. It presents as an erythematous maculopapular rash on the trunk and extremities for 1-2 days. It usually follows high fevers (> 103F) that last 3-7 days. *HHV6B MC post-birth

Roseola *MC complication: Febrile seizure Dx: Clinical Tx: Supportive

Virus: True/False - HHV-7 usually occurs in adulthood and is present in saliva. There is no reported history of HHV-7 congenital infection.

True * asymptomatic/mild symptoms * Dx, Tx same as HHV-6

Virus: ______ is associated with Kaposi Sarcoma and primary lymphoma. It is shed in saliva of infected people and becomes latent for life in CD19 B-lymphocytes. Common symptoms include: fever, rash, lymphadenopathy, splenomegaly, diarrhea and arthralgia. How is it Dx and Tx?

Dx: -PCR HHV-8 on blood, tissue biopsy Tx: None

Virus: TORCH syndromes are a cluster of congenital infections that present with hepatosplenomegaly, fever, difficulty feeding, petechial and purpuric rash, and jaundice. They may develop before birth (cause stillbirth/miscarriage) or cause secondary complications after birth. What are the TORCH syndromes?

``` T = toxoplasmosis O = others (VZV, Parvo, Hep B, T. pallidum) R = Rubella C = CMV H = HSV 1 and 2 ```

Virus: _______ is caused by a protozoan but is one of the TORCH syndromes. It causes 1. hepatosplenomegaly 2. seizures 3. intra-cranial calcifications 4. hydrocephalus 5. chorioretinitis

Toxoplasmosis

Virus: A TORCH syndrome that, in newborns causes: 1. fetal hydrops 2. IUGR 3. fetal demise if infected in pregnancy.

Parvovirus B19 Children: - -"slapped cheek" facial rash; "glove sock" (symmetric, lacy rash on trunk moves peripherally to arms, butt, thighs) - -arthralgias/arthritis

Virus: Dx and Tx for Parvovirus involve

Dx: --IgM Tx: Supportive care **transfusion if aplastic anemia crisis

Virus: Rubella (German measles) can cause Congenital Rubella syndrome in children. Which of the following is an effect of rubella? a. Opthalmalogic abnormalities b. COngenital Heart disease c. Hearing impairment d. Rash

All of the above *Cataracts, PDA, developmental delays, microcephaly, Blueberry muffin rash Dx: Rubella IgM Tx: Multi-disciplinary care, isolate from other babies in nursery

Virus: Enteroviruses (Echo, Entero-, and Coxsackie) are common causes of infection in children. Coxsackievirus is one of the TORCH syndromes causing Hand, Foot and Mouth disease. Coxsackie is more common in the summer months and is spread fecally-orally. What are symptoms?

*enteroviral vesicular stomatitis w/ exanthem --fever, rash, oral ulcers, elliptical vesicles on hands and feet (+/- buttocks)

Virus: Enteroviruses cause Herpangina (eneroviral vesicular pharyngitis). It affects neonates up to adolescents. Symptoms include: fever, sore throat, headache, dysphagia and lesions in the ______ oropharynx.

Posterior oropharynx Complications: encephalitis

Virus: Measles virus is transmitted via direct contact w/ infectious droplets. Patients are contagious 4 days before rash up to 4 days after rash. Patients present with the 4 C's: Cough, Coryza, Koplik, and Conjuntivitis. Which of the following is the appropriate method for Dx Measles? a. throat culture b. clinical c. serology (IgM) d. there is no way to detect

Rash: --red, blotchy from head down to body Dx: --clinical, serology (IgM) Tx: - -Vit. A - -no anti-virals

Virus: Which of the following is a complication of measles infection? a. otitis media b. pneumonia c. croup d. subacute sclerosing pan-encephalitis

all of the above *febrile seizures

Critical Care: High risk deliveries include 1. Fetal conditions 2. Maternal conditions 3. Antepartum complications 4. Delivery complications List examples of each

1. Fetal conditions: - -Prematurity (<37 weeks) - -post maturity - -multiple gestation 2. Maternal conditions - -diabetes, HTN, substance abuse 3. Antepartum complications - -placental anomalies; hydramnios 4. Delivery: - -meconium staining, caesarean, infection, etc.

Critical Care: Assessment of the newborn includes asking the following questions: a. full (term?) b. breathing or crying? c. good muscle tone Assessment should occur within the _____ minute(s) of the baby's life

within 1st minute

Critical care: Routine care involves which of the following? a. dry the baby with clean towel b. provide warmth (via dry towels/blankets, radiant warmer, or skin to skin) c. gentle tactile stimulation d. clear secretions if needed

A, B, D * if all good = stay with mother * if not = gentle tactile stimulation, position airway and clear secretions NOTE: Targeted O2 after 1 min = 60-65%; after 10 min = 80-85%

Critical care: As part of routine care, positioning the airway, clearing secretions and stimulating the baby are essential steps if the baby has poor tone or difficulty breathing. What are the steps involved?

Position: -shoulder roll Clearance: --bulb suction = mouth first, then nose Stimulation: - -drying and suctioning - -slap or flick soles of feet - -rub infants back

Critical care: During your 1 minute assessment of a newborn, you note labored breathing and persistent cyanosis. What is your next step?

- -position and clear airway - -SPO2 monitor - -supplement O2 - -consider CPAP

Critical care: During your 1 minute assessment of a newborn, you note she is gasping for air. You palpate her umbilical artery and record HR 70bpm. pulse = count 6sec x 10 What is your next step?

* *look for apnea or gasping * *HR < 100 bpm 1. Start PPV w/ bag and mask - -mask should cover nose and mouth - -light pressure - -C hold w/ ant. pressure on mandible - -40-60 breaths/min 2. SpO2 monitor and ECG monitor

Critical Care: You applied positive pressure ventilation (PPV) to the baby, and re-check her heart rate. It is still below 100/min. What is the next step?

- Check chest movement and bilateral breath sounds - Ventilation (corrective steps) * MR SOPA - -mask adjustment, reposition, suction (mouth/nose), open mouth, pressure increase, airway alternative

Critical Care: If MR SOPA is not effective in opening the airway, what is the next thing that should be considered?

ETT tube or laryngeal mask

Critical Care: If the HR remains below 60/min, what must be done?

- Intubate (if not already) - Chest compressions (coordinate with PPV) - 100% O2 - ECG monitor - -emergency UVC

Critical Care: Chest Compressions should be _____ beats per minute with ____ depth AP diameter. They should occur in a 2 second cycle of ______ compressions and _____ ventilation. Compressions should be continued with PPV. Endotracheal intubation should be considered.

90 bpm 1/3 depth AP diameter 2 second cycle: --3 compressions + 1 ventilation (1 and 2 and 3 and breathe)

Critical care: If the heart rate remains below 60bpm after 45-60 sec of performing compressions + PPV, what is the next thing to consider?

IV epinephrine (umbilical vein)

Critical Care: Pediatric Basic Life support begins with assessment of the patient and the environment. Determine the responsiveness of the patient by asking "are you okay?" and assess breathing. The next steps include: 2. Assess for pulse 3. Send for help and AED What must be done if there is no pulse?

C-A-B 1. Begin compressions! - -1 rescuer: 30:2 breaths - -2 rescuers: 15:2 - -use AED when available NOTE: Infant - brachial pulse; Child - carotid pulse

Critical Care: 1. Compressions in an infant (< 1) with 1 rescuer should involve _____ on lower sternum. 2. Compression on an infant with 2 rescuers should involve hands encircling thumbs on lower sternum.

1. 2 fingers on lower sternum 2. hands encircling thumbs on lower sternum *1/3 chest AP diameter; 1.5 inches

Critical Care: Compressions in a child should involve the ______ of one or two hands on the lower sternum, and 100-120 compressions per minute. Rescue breaths should be delivered over 1 second, and you should see the chest rise.

- heel of one/two hands - -1/3 AP chest diameter - --allow chest to recoil NOTE: advanced airway - 8-10 breaths/min

Critical Care: Pediatric Advanced Life support first involves assessment: 1. _____: brief visual/auditory observation of appearance, work of breathing, circulation 2. ____: airway, breathing (rate, effort, pulse ox); circulation (skin color, HR, etc.); disability (alert, voice, unresponsive); Glascow coma scale; exposure (trauma, fever)

1. General assessment | 2. Primary assessment

Critical Care: Respiratory distress can be associated with common respiratory conditions of the upper airway (e.g. croup) and lower airway (asthma, bronchilitis, pneumonia). In cases of respiratory distress, what should be done to open up the airway and enhance breathing?

1. Airway - -100% O2 - -allow child to assume position of comfort - -clear airway (suction) 2. Breathing - -assist ventilation as needed (albuterol, racemic epi) - -endotracheal intubation

Critical Care: Respiratory disease of the Upper airway characterized by barking cough, steeple sign on X-ray, and inspiratory stridor. Caused by parainfluenza

Croup Tx: dexamethasone, racemic epinephrien

Critical Care: Respiratory illness of the lower airway characterized by diminished breath sounds and hyperinflation on chest X-ray. It is commonly associated with eczema, allergies (atopic).

Asthma Tx: albuterol, steroids

Critical Care: Patient < 2 y/o presents with noisy breathing, coarse breath sounds and wheezes on auscultation. Most commonly associated with RSV

Bronchioloitis *Tx: suctioning, supportive care

Critical Care: Patient presents with fever, and crackles. She is positive for Mycoplasma.

Pneumonia *S. pneumonia, mycoplasma, viral Tx: supportive care, antibiotics

Critical Care: When O2 delivery is less than O2 needs pediatric shock occurs. Shock can be compensated (normal b.p.) or hypotensive. List the different types of shock

1. Hypovolemic 2. Septic 3. Anaphylactic 4. Cardiogenic 5. Obstructive Management: Oxygen, Support respirations, rapid IV fluid administration, vasoconstrictors, inotropic meds, underlying cause

Laboratory medicine: All children 3 and older should have b.p. measured during every visits to their provider. An appropriately sized cuff is imperative to obtaining an accurate blood pressure. The cuff bladder width should be _____ % of the arm circumference as measured at a point that is midway between the olecranon and the acromion.

40% *inflate cuff 20mm Hg past point where radial pulse is no longer palpated --deflate while auscultating NOTE: children under 3 -- measure if pre-disposing condition

Laboratory medicine: Normal values for A1c, fasting plasma glucose, and oral glucose

1. ~5 2. <99 3. <139

Laboratory medicine: Normal cholesterol values 1. Total cholesterol 2. LDL 3. HDL

1. < 170 = acceptable 2. < 110 = acceptable 3. > 35 = acceptable borderlines: 170-199; 110-129; 35

Laboratory Medicine: List the screening that should be performed for: 1. Newborn 2. 9 months 3. 12 mos 4. 18 mos

1. Newborn: Metabolic, Hearing 2. 9 mos: Developmental, dental 3. 12 mos: Anemia, Lead 4. 18 mos: Developmental; Autism

Laboratory Medicine: List the screening that should be performed for: 1. 2 Year 2. 30 mos 3. 3 Yr 4. 4 year 5. 11 year 6. 18 year

1. 2 year: Lead, Autism 2. 30 mos: Developmental 3. 3 year: Vision 4. 4 year: Vision, Audiometry 5. 11 year: Vision, Audiometry, Dislipidemia 6. 18 year: Vision, Audiometry, Dislipidemia

Laboratory medicine: Hematocrits vary by collection method. Typically, newborn measurements are obtain by capillary venous sampling (heel stick). True/False: Hematocrits obtained via peripheral venous collection can be up to 15% lower than capillary draws, and therefore, it is important to obtain a venous sample (peripheral or umbilical) to confirm the elevated hematocrit seen in capillary measurements.

True

Laboratory medicine: Lead screening is performed at ages 1 and 2, and 3-6 in children who meet the criteria but were not previously screened. Which is more accurate, venous sample or capillary?

Venous sample *false positives in capillary due to skin contamination

Laboratory medicine: Vision screening tests are ranked in order of the level of cognitive ability needed for their use from highest to lowest: 1. Snellen: 6 years and older 2. Tumbling E: ______ 3. HOTV matching test: ____ 4. Allen card test: _____

1. Snellen (6 yrs) 2. Tumbling E (3-5; closer to 5) 3. HOTV (3-5; closer to 4) 4. Allen card (3-5; closer to 3)

Laboratory medicine: This test uses the letter E in spatial orientation, with the child needing to identify what direction the "legs" of the E are pointing. *Age 5

Tumbling E test

Laboratory medicine: This vision test uses the letters H, O, T, V on a testing board that need to be matched with the letters on the wall chart. *Age 4

HOTV test

Laboratory medicine: This vision test requires that the child be able to look at the pictures shown and either identify verbally or match the pictures shown on the wall chart.

Allen card test

Laboratory medicine: This vision test checks for ocular alignment. Eye movement during this test is an indication for referral

Cross cover test

Laboratory Medicine: What are important things to screen in infants (< 6 mos) with regard to vision?

1. red reflex 2. pupillary reflex 3. external aspects 4. fixation and tracking * 2 mos = infants should fixate on a familiar caregiver's face * 3 mos = track moving objects * 5-6 mos = depth perception, reach for object

Laboratory medicine: Children and adolescents with a family history of premature cardiovascular disease secondary to hypercholesterolemia need a lipoprotein analysis. Universal screening for lipid disorders should occur between 9 and 11 years of age and again at _____ years of age

18 yrs *ages 2-8 -- fasting lipid profile (if parent total cholesterol 240 or greater; repeat test 2 wks - 3 mos

Laboratory medicine: Environmental tobacco exposure is the MC indoor pollutant and involuntary in-home toxic exposure for children. What are the MC adverse effects of indoor tobacco smoke exposure?

chronic cough and recurrent respiratory infections

Laboratory medicine: The visual acuity in a term newborn is approximately 20/200. Vision usually improves in the first 4-8 months. True/False: Infants fixate best on the construct of the human face, but may also fixate on a graphically depicted face or bright red object. Gaze is usually conjugate, and color detection is apparent at greater distances (compared to closer; 18 - 24 inches).

True

Laboratory medicine: True/False: Gradations of shading are not appreciated well by newborns, but this aspect of vision improves over the first 2-3 post-natal months.

True

Laboratory Medicine: Although it is normal for infants to have a disconjugate gaze in the first 2-4 months of life (after birth), eye movements should be conjugate by 6 mos. Even in young infants, disconjugate gaze should be random, and not occur consistently. In the case of an infant with suspected strabismus, what is the recommended action?

referral to opthalmologist

Laboratory Medicine: True/False: For children 2-8 years old with a parent who has a total cholesterol of 240 ml/dL or greater, a fasting lipid profile should be obtained and then repeated after 2 weeks to 3 months, regardless of the result. The average of the tests should be taken.

True

Laboratory Medicine: True/False - A systolic and diastolic blood pressure below the 90th percentile for age, sex and height is normal

True

Sports Medicine: Pre-participation physicals should take place 4-6 weeks before the beginning of practice. Aspects of this physical include: 1. History 2. PE 3. Musculoskeletal exam 4. Clearance to Play _____ should be complete by the athlete and parent. It is the key to ID'ing conditions that cause problems.

History *most important

Sports Medicine: Pre-participation physicals should take place 4-6 weeks before the beginning of practice. Aspects of this physical include: 1. History 2. PE 3. Musculoskeletal exam 4. Clearance to Play A cardiovascular exam is a component of the PE. It includes peripheral pulses, murmurs and blood pressure. All diastolic murmurs and grade _______ systolic murmurs warrant further eval.

all diastolic, grade 3/6 systolic murmurs

Sports Medicine: True/False - Marfanoid habitus should be evaluated for silent aortic root dilations, which could increase the risk of sudden death during athletic participation.

True

Sports Medicine: Pre-participation physicals should take place 4-6 weeks before the beginning of practice. Aspects of this physical include: 1. History 2. PE 3. Musculoskeletal exam 4. Clearance to Play True/False: Blood pressures obtained during the PPE are often low (often due to small cuff). Therefore, you must compare to age-based norms.

False -- often high *HTN rarely excludes athlete from particpation

Sports Medicine: Pre-participation physicals should take place 4-6 weeks before the beginning of practice. Aspects of this physical include: 1. History 2. PE 3. Musculoskeletal exam 4. Clearance to Play _______ typically accounts for 50% of abnormal findings. The exam should focus on previously injured or symptomatic areas.

Musculoskeletal *90% orthopedic injuries detected by Hx alone

Sports Medicine: Pre-participation physicals should take place 4-6 weeks before the beginning of practice. Aspects of this physical include: 1. History 2. PE 3. Musculoskeletal exam 4. Clearance to Play True/False - few athletes are disqualified from activity based on conditions ID'd. Classification is based on likelihood of collision injury. Defer to specialist if necessary.

True

Sports Medicine: Which of the following is an absolute contraindication for sports? a. acute pericarditis or myocarditis b. cardiomyopathy c. sever pulm. HTN d. single kidney

A - C * R to L cardiovascular shunting * Fever

Sports Medicine: Which of the following is NOT a contraindication to avoid contact sports? a. splenomegaly b. acute hepatomegaly c. psoriasis d. single kidney

Psoriasis Avoid contact sports: - -splenomegaly - -acute hepatomegaly - -single kidney - -contagious skin lesions

Sports medicine: Which of the following is a contraindication for high dynamic sports? a. splenomegaly b. ventricular dysfunction c. left heart obstructive disease d. Marfan syndrome

Ventricular dysfunction

Sports medicine: Which of the following is a contraindication for high static sports? a. essential HTN b. Inc. risk of aortic dissection c. Left heart obstructive disease d. hepatomegaly

A - C - essental HTN - -aortic dissection (e.g. Marfan) - -Left heart obstruction

Sports medicine: Well controlled epilepsy is NOT a contraindication for most sports. However, patients with poorly controlled epilepsy should avoid a. swimming b. diving c. riflery d. archery

All of the above

Sports medicine: True/False - Diabetic patients may participate in sports, but hydration and insulin must be monitored.

True

Sports medicine: Sickle cell disease and sickle cell trait are not contraindications for playing sports. It depends on the illness status. What should be avoided with sickle cell disease? trait?

Disease: --ensure hydration --avoid over-exertion, over-heating, dehydration, chilling and altitudes Trait: - -ensure hydration - -avoid high altitude

Sports medicine: True/False - Patients with HIV may participate in all sports if the viral load is low or undetectable

True

Sports Medicine: Kids with Down syndrome have abnormal collagen that results in general ligamentous laxity and decreased muscle tone. This can lead to hypermobility of the joints, flexible flat feet, and joint instability. What are potential risks/thing to monitor for athletes with Down syndrome?

1. Cardiac (congenital heart disease) - -must have cardiology eval and clearance 2. AA subluxation - -laxity of annular ligament of C1; excessive mobility C1/C2 - -detect with lat. views of C-spine in max flexion and extension

Sports Medicine: A 12 year old female with Down Syndrome visits your clinic for a pre-participation sports physical. She complains of fatigue and difficulty walking. You examine her and note abnormal positioning of her neck, and unusual gait. You also note sensory deficits. You tell her you want to send her to get an MRI. What do you suspect?

AA subluxation **MRI evaluates

Sports Medicine: a medical condition resulting from athletic activity that causes a limitation or restriction on participation in that activity or for which medical treatment was received. Most often occurs in practice

Injury * Girls cross country - highest risk * Boys cross country - 5th place * Football, wrestling, soccer

Sports Medicine: an injury resulting directly from participating in the skills of the sport (e.g. tackling in football). Trauma is caused by these injuries

Direct injury **direct fatalities: head, neck and brainstem

Sports medicine: an injury causes by a systemic failure as the result of exertion while participating in a sport or activity, OR by complication that results from a non-fatal injury (e.g. sudden cardiac death, dehydration, anaphylaxis)

Indirect injury * non-traumatic * Cardiovascular (MC) - Hypertrophic Cardiomyopathy

Sports medicine: Warning signs of this cardiovascular illness include: - chest pain, palpitations, pre-syncope and syncope - systolic murmur - abnormal ECG - family Hx

Hypertrophic cardiomyopathy * aut. dominant * cardiology eval if 1st degree relative * annual evaluation

Sports medicine: A disruption of the cardiac electrical system that can cause sudden death (e.g. baseball pitche hit in the chest with high velocity baseball)

Commotio Cordis *AED Tx

Sports medicine: results from high impact trauma injuring the venous structures below the dura matter. Symptoms may take minutes to days to occur

Subdural hematoma

Sports medicine: results most often from damage to the middle meningeal artery via temporal skull fracture. Symptoms include lucid interval followed by severe headache

Epidural hematoma

Sports medicine: A transient, traumatic disruption of neural function. It causes increased demand for intracellular glucose and results in a transient mismatch in glucose delivery and utilization. As a result, cerebral blood flow regulation is altered.

Concussion * baseline testing should be performed and documented * difficult to evaluate for changes if baseline unknown

Sports medicine: A 15 year old girl presents to your clinic with her mother following a soccer match. Her mother states her daughter has been complaining of headache, dizziness and nausea. She has had difficulty concentrating, sleeping, and has had amnesia. You suspect

Concussion *confusion, sleep disturbance, unsteady, difficulty concentrating, amnesia (retrograde, post-traumatic), tinnitus, seizure, irritability

Sports medicine: 1. A concussion that resolves spontaneously in 10 or fewer days. No complications or sequelae. 2. A concussion that is either persistent in symptoms or specific sequelae. More likely on subsequent concussions.

1. Simple concussion | 2. COmplex concussion

Sports medicine: Variant of a complex concussion that consists of varying degrees of: 1. headache 2. difficulty concentrating 3. irritability 4. concentration/memory impairment 5. dizziness 6. sleep disturbance and fatigue Symptoms last more than a month

Post concussive syndrome

Sports Medicine: In an acute concussion, if the patient is unconscious, what should always be assumed? What steps should be taken?

- -assume possible neck injury = immobilize cervical spine - -establish airway - -monitor circulation

Sports medicine: In a conscious concussion, what should be evaluated? a. cervical spine injury b. distracting injury c. gait, balance and orientation

all of the above

Sports medicine: In the case of an acute concussion, what should be evaluated? a. orientation b. speech c. memory d. cranial nerves

all of the above * tympanic membranes * concentration and coordination

Sports medicine: What should you do to treat a concussion? a. rest b. observe closely for 24 hours c. provide pain medications d. follow up daily while patient has symptoms

A, B, D * avoid pain meds (may inc. bleeding risk) * cognitive rest

Sports medicine: Return to play after a concussion is based on the individual. Progression to full, unrestricted activity should be in a stepwise approach. Having a good report with the athlete will encourage honest reporting of the symptoms and improvement. What are the restrictions if the athlete is symptomatic?

1. No physical activity 2. Cognitive rest - -modify academic activities - -advance as tolerated - -avoid bright lights, loud noise - -encourage sleep

Advance cognitive activities to full - -stationary biking, calisthenics, jogging, advance to sprinting - -non-contact, sport specific drills - -contact drills advance to full participation *if symptoms return, return to symptomatic restrictions

Sports medicine: Apophysitis of the tibial tubercle. It results from repetitive tension that causes microavulsions of the apophyseal cartilage where the patellar tendon inserts on the tibial tuberosity apophysis. Symptoms include: achy pain on the tibial tubercle and point tenderness over a prominent swollen tibial tubercle.

Osgood-Schlatter - -gradual onset = achy pain on tibial tubercle - -point tenderness over a prominent swollen tibial tubercle Tx: hamstring/quad stretch, infrapatellar strap

Sports medicine: Apophysitis of the calcaneous. It is caused by traction related stress reactions at the insertion sites of the Achilles tendon and the plantar fascia (on calcaneal apophysis). It occurs between ages 8-15 and presents with heel pain.

Sever's disease *heel pain in one or both heels Tx: stretching calf and achilles

Sports medicine: Focal areas of hypovascularity that can lead to necrosis of the bone, to bony collapse, or detachment fragment of bone and its overlying cartilage. Symptoms include pain, swelling, catching, or locking of the knee

Osteochondritis dissecans *MC - lateral aspect of medical femoral condyle Tx: limit activity, surgery

Child Abuse/Neglect: Emotional duress that results when an individual hears about the first hand trauma experiences of another person. It can manifest as: - increased arousal - re-experience of own personal trauma - avoidance amongst other things.

Secondary traumatic stress - changes in memory and perception - altered sense of self-efficacy - sleeplessness - fear - chronic exhaustion

Child abuse/Neglect: Which of the following is a risk factor for secondary traumatic stress? a. personal trauma b. ID'ing with the victim c. negative personal circumstances d. low levels of social support

all of the above --related risk factors: inexperience, poor/no supervision, high frequency of exposure, exposure to critical incidents

Child abuse/Neglect: True/False - Secondary traumatic stress can be measured by PROQoL (professional quality of life) and other scales.

True

Child Abuse/Neglect: In child abuse/neglect cases it is important to take a medical exam. What is a component of this exam? a. medical history from all available historians b. social history c. assessment of development d. head to toe exam

all of the above * photos of injuries * occassional radiology or blood work

Child Abuse/Neglect: In cases of child abuse/neglect, what are important histories to consider? a. previous DHS history b. previous criminal history c. history of intimate partner violence/domestic violence d. other children in home

all of the above *current court proceedings

Child Abuse/Neglect: Any recent act or failure to act on the part of the caregiver which results in death, serious physical or emotional harm, sexual abuse, or exploitation OR an act or failure to act which presents imminent risk or serious harm

Neglect *MC maltreatment type (when children's need are not being adequately met)

Child Abuse/Neglect: Normal growth in infancy involves gaining 30g/day (first 3 mos), 18 g/day (3-6 mos) and around 10g/day between 6-12 mos. What is the underlying defect in children who fail to thrive?

*malnutrition = underlying defect Loss of muscle mass due to food witholding, genetic defects

Child Abuse/Neglect: The following describe failure to thrive patients based on the standard growth curve. Which one is WRONG? a. < 5 months old and have no growth or weight loss over 2 mos b. > 5 months old and no growth or weight loss over 3 mos c. drop of 1 percentile on a standard growth chart d. weight for height is less than 5th percentile

Answer: C * drop of more than 2 percentiles * weight drops off before height (which drops off before FOC) * if pattern is different, think medical problems first

Child Abuse/Neglect: True/False - It is important to have more than one growth point for children. When obtaining growth measurements, use the same scale and measure in the same manner each time (naked/dry diaper).

True

Child Abuse/Neglect: If there are no medical clues in H & P of children who are failing to thrive, a trial of improved feeding (inpatient or outpatient) with instructions for the parent should be implemented. Further testing may be done. What are examples of this?

1. Basic Lab - -CBC, chemistry, TSH, UA, urine culture, albumin 2. Labs based on H &P - -urine organic acids, serum aa's, serum ammonia, sweat test 3. Radiology - -skeletal survey - -CT head - -wrist for bone age (>1 yr); hemiskeleton for bone age (< 1 yr) - -wrist/distal femur (rickets, scurvy) - -echo, MRI

Child Abuse/Neglect: Occurs when a child has sustained an injury at the hands of a caregiver

Physical abuse

Child Abuse/Neglect: Which of the following is a MYTH about bruising? a. bruises in infants are rare b. the age of bruises can be determined based on their color c. presence of abrasion or swelling was NOT a reliable indication of injury age d. 2 bruises caused by a single event may be different colors and may change color at different rates

Answer: B Facts: - bruises are rare - abrasion/swelling NOT reliable for age of injury - 2 bruises may be different colors - color is NOT reliable for determining age of a bruise

Child Abuse/Neglect: An injury in the past that was missed or documented, but was not referred or followed up on. The child may present later with worse trauma.

Sentinel injuries *many abused infants had previous sentinel injury

Child/Abuse: What bruise sites provide the highest index of suspicion for abuse?

TEN-4 - trunk - ears - neck - facial (soft tissue) *4 mos of age

Child Abuse: Abdominal trauma is the 2nd MC form of childhood physical abuse that results in fatality. Peak incidence occurs in toddlers. What is the MC injured structure?

Small bowel * Dx: - -Hx, PE, Labs, Imaging, Forensic significance - -elevated ALT, AST

Child Abuse: Abdominal trauma has a high mortality rate, especially in abuse victims. Many often have other injuries which contribute to the high mortality. What are long term issues that may be associated with abdominal trauma?

strictures, adhesions, post-op complications

Child Abuse/Neglect: This is the MC form of death from abuse. It tends to cause tension and rupture of the bridging veins in the subdural space. Clinical presentation may vary depending on the amount of brain damage. Children may present with difficulty feeding, vomiting, irritability, lethargy and limpness.

abusive head trauma * *Seizures (large majority) * hypoventilation, hypothermia, bradycardia * coma, decreased responsiveness

Child Abuse/Neglect: What are the questions that should be asked when obtaining the history of a child with abusive head trauma? a. when was the child last seen well? b. when did the symptoms first occur? c. what were the symptoms? d. what did the caregivers do at that time?

all of the above * was CPR attempted? * when was help called? * what kind of help was called?

Child Abuse/Neglect: True/False - When performing a physical exam on a head trauma patient, be sure to follow CABs and Trauma protocol. Make sure the examination is complete, and do NOT ignore less urgently compromised organ systems, as this can be fatal.

True * bleeding visceral organs = most glaring * skin for bruises, oral cavity, neck, anogenital * photo-documentation * pediatric indirect opthalmological exam

Child Abuse/Neglect: Which of the following imaging studies should/could NOT be performed in cases of abuse head trauma injury? a. CT scan with contrast b. Bone windows c. Plain radiograph of skull d. MRI

Answer: A Yes: - CT scan w/out contrast - bone windows - plain radiograph (fractures) - MRI (3-5 days post injury)

Child Abuse/Neglect: Which of the following is a possible associated injury to abusive head trauma? a. bruising of any part of the body b. rib fractures c. metaphyseal fractures of long bones d. retinal hemorrhages

all of the above

Child Abuse/Neglect: 11-25% of burns are abusive. Increased incidence occurs in 2-4 year olds, with scalding being the MC mechanism. Which of the following is a risk factor for burns? a. males b. language delays c. small for age

All of the above * perpetrator - mom or unrelated male * *beware of the "sibling did it"

Child Abuse/Neglect: Which of the following is correct about burn abuse? a. common to delay seeking care b. burns change in appearance quickly c. look for pattern marks, symmetry, unusual location d. consider NEGLECT as contributing factor

All of the above * is developmental ability consistent with the burn? * what happened before and after?

Child Abuse/Neglect: Any fracture of any bone on any child can be caused by abuse. The examiner must correlate with the mechanism of injury. The following are the types of fractures: 1. _____: torsion. 2. _____: axial loading 3. ______: bending or direct trauma to extremity 4. ______: combined loading (compression, rotation and bending) 5. _____: shearing force

1. Spiral fracture - -torsion - -NOT always abuse 2. Buckle/Cortical (axial) - -bone crunch on itself 3. Transverse fracture (bending/direct trauma) - -straight through bone 4. Oblique - -combined loading - -angle 5. CML/Epiphyseal fracture - -shearing force

Child Abuse/Neglect: Which of the following is correct about fractures? a. spiral fractures do NOT always mean abuse b. non-spiral fractures do not always mean an accident c. absence of bruising does NOT rule out abuse d. 80% of abuse fractures are in children <18 mos

All * multiple fractures = inc. risk of abuse * 43% clinically unsuspected

Child abuse/Neglect: Which of the following is a high specificity fracture that should promote a high index of suspicion of abuse? a. metaphyseal fractures (CML's) b. posterior rib fractures c. scapular fractures d. thumb fractures

A-C Also: spinous process fractures and sternal fractures NOTE: If suspect abuse, repeat X-ray 10-14 days post-injury to look for healing

Child Abuse/Neglect: Which of the following is a moderate specificity fracture that should promote suspicion of abuse? a. multiple, bilateral fractures b. fractures at different ages c. epiphyseal separations d. vertebral body fractures and subluxations

All of the above * digital fractures * complex skull fractures

Child Abuse/Neglect: Which of the following is a low specificity fracture? a. sub-periosteal new bone formation b. clavicular fractures c. long bone shaft fractures d. linear skull fractures

all of the above * complex skull fracture - egg shell appearance * linear - soft tissue swelling, subdural hematoma, lines of parietal bone

Child Abuse/Neglect: An act of commission including intrusion or penetration, molestation with genital contact or other forms of sexual acts in which children are used to provide sexual gratification for the perpetrator

Sexual abuse *under reported

Child Abuse/Neglect: What are the steps that should be taken in the case of sexual abuse? a. child's safety b. report to child protection authorities c. child's brain/mental health d. physical examination (general; consent) e. need for forensic evidence collection

All of the above * forensic evidence: - -pre-pubertal: < 72 hours - -post-pubertal: < 120 hours

Child Abuse/Neglect: What should be done during a PE of a sexually abused child? a. complete head to toe exam b. look for signs of physical abuse, neglect, self-injurious behavior c. convey interest in the child as a whole (not just the genital) d. arrange for SANE if reported contact is < 72 hours;< 120 hours

All of the above

Child Abuse/Neglect: tell your patient that it is normal to be normal. The vast majority of sex abuse exams produce normal results. Why is this so? a. genital tissue elastic and made to stretch b. genital tissue is highly vascular -- heals quickly c. perpetrator doesn't usually try to hurt the victim d. PE often performed long after incident/delayed disclosure

all of the above

Child/Abuse: What reassurance should you offer a child of sexual abuse? a. their bodies are normal b. abuse is not their fault c. no one can tell by looking at them that they have been abused

ALL of the above * assess need for treatment/discuss counseling with child and family * assess family support * screen for suicidal thoughts

Child Abuse/Neglect: In 30-60% of families where child abuse occurs, so does intimate partner violence. If IPV is present in the home in the 1st 6 months, a. physical child abuse is more likely b. child psychological abuse is more likely c. child neglect is more likely

all * physical violence against caregiver is common * one or more incidents within the last year

Child Abuse/Neglect: What are the lifetime consequences of trauma? a. Impaired brain development b. Improved stress response c. Altered physical growth d. Gene by environment interactions for depression and aggression

A, C, D * impaired stress response (inc. cortisol, sympathetic, inlammation) * brain (dec. size, cognition, emotion and impulse control) * physical: 2x risk for obesity

Bacteria: An infant presents with: - issues feeding - irritability - hypothermia - neck stiffness - seizures You suspect meningitis. What is the suspected cause? How do you diagnose and Tx?

Neisseria meningitidis Dx: - -CSF culture - -blood Culture Tx: - -manage septic shock - -broad spectrum antibiotic - -once Cx show susceptibilities: penicillin * hearing screen

Bacteria: Patients with MAC (C5-C9) and properdin deficiencies have increased risk of recurrent meningococcal infections. How do we test for this?

CH50

Bacteria: Describe prophylactic antibiotics that may be used for N. meningitidis, and what populations should receive post-exposure prophylaxis.

1. Antibiotics - -children: rifampin, cipro 2. Post-exposure - -household contacts (kids <2) - -childcare/preschool contacts (7 days before onset) - -direct exposure to secretions - -household or passengers (> 8 hours)

Bacteria: N. gonorrhea infects the genitals, throat and eyes. It can cause septic arthritis and pelvic inflammatory disease (in females). If left untreated, PID may lead to infertility. How do you Dx and Tx N. gonorrhea?

Dx. - -Cx urine - -urethral swab - -vaginal swab Tx: Ceftriaxone + Azithromycin

Bacteria: 3rd MCC of bacterial-Otitis Media. It also presents with the following symptoms: 1. otitis media ** 2. sinusitis 3. bronchitis 4. PNA Diagnosis varies. What do you suspect based on these findings? How do you Tx?

Moraxella C. Tx: Amoxicillin clavulanate or 3rd gen cephalosporin * penicillin resistant (B-lactamase) * 3rd MCC of bacterial Otitis Media

Bacteria: Is part of the normal flora of the mouth, GI, and female GU tract. It is known to cause: 1. dental infections and abscesses 2. peritonsillar/retropharyngeal abscesses 3. aspiration PNA 4. intra-abdominal abscess 5. PID 6. post-op wound infections

Bacteroides fragilis Dx: --culture Tx: penicillin, amp, clinda

Bacteria: Cat scratch (or bite) disease often caused by kittens < 6 months old. Symptoms: -tender lymph nodes (axillary, neck, groin) after bite

Bartonella Dx: B henselae IgG, IgM Tx: Supportive (+ azithromycin)

Bacteria: Which of the following is a complication of Bartonella? a. neurologic b. hematologic c. bone/joint d. endocarditis

all

Bacteria: This bacteria has a toxin which stimulates adenylate cyclase in intestinal epithelial cells. This results in increased salt and water secretion leading to diarrhea. Symptoms of this infection include "rice water stool" (secretory diarrhea) and vomiting.

Vibrio cholera Dx: clinical or stool Tx: Supportive

Bacteria: This is caused by Pasteur's dog and cat. It is often transmitted via dog/cat bites. Symptoms include skin infection with: - erythema - induration - fluctuance Incubation is short and presentation is quick (within 24 hours).

Pasteurella multocida ``` Dx: wound Cx Tx: -wound care -tetanus booster -rabies (post-exposure) -amoxicillin/clav (1st line ORAL) -ampicllin/sulb (IV) ```

Bacteria: If allergic to penicillin, what can be used to treat Pasteurella multocida?

Cefuroxime + Clindamycin

Bacteria: If you ingest beef (hamburger), unpasteruized juices (apple sauce, cider) or visit a petting zoo, you can be at risk for this bug. Clinical issues include: 1. Gastroenteritis (*6 groups) 2. UTI's (**MCC) 3. Sepsis and meningitis (Newborns **) 4. Bacteremiai in immunocompromised

E. coli * EHEC w/ HUS (O:157:H7) - bloody diarrhea + HUS * ETEC: Traveller's diarrhea

Bacteria: E. coli most often causes diarrhea and hemorrhagic colitis. It may also cause UTI. How is diagnosed? Treated?

``` Dx: Stool PCR Tx: --rehydration --NO antibiotics for EHEC (inc. HUS) --antibiotic for ETEC okay ```

Bacteria: Non-typhoid salmonella is caused by this bug. It comes from animals (poultry, cats and dogs, TURTLES) and food (eggs, chicken, etc.) Symptoms include: Gastroenteritis (non-bloody diarrhea) + fever

Enterobacteracea Dx: stool, blood culture Tx: rehydration, supportive

Bacteria: Cause of: 1. Swimmer's ear 2. Nosocomial UTI's 3. pneumonia in CF 4. Nail puncture wound

Psuedomonas Dx: wound culture Tx: Cefepime, Ceftazidime IV, Ciprofloxacin

Bacteria: Acquired from eating contaminated/improperly cooked poultry or raw milk. It causes vomiting and bloody diarrhea. Complications include reactive arthritis, Guillan Barre.

Campylobacter Dx: Stool Tx: Supportive; Rehydrate --antibiotics for immunocompromised OR persists > 1 wk

Bacteria: This bacteria lives in soild and survives in moist or dry surfaces (ventilators). It is MC associated with nosocomial infection (HAP, and VAP). Symptoms include: fever, Inc. O2 demand or ventilation. Prevention includes: elevate head, oral hygeine, extubating ASAP

Acinetobacter Dx: - sputum/tracheal culture - labs - CXR Tx: resistant

Bacteria: This bacteria most commonly infects CF patients, causing pneumonia, and bacteremia (indwelling catheters).

Stenotrophomonas maltophelia Dx: Culture relevant specimens Tx: multi-resistant

Bacteria: This bacteria loves to contaminate water or foods (e.g. salad) and spreads at daycares. It causes dysentery: - bloody mucous diarrhea - high fever - abd. cramps

Shigella (shiga toxin) *ONLY gastroenteritis bacteria that causes SEIZURES Dx: Stool Tx: Rehydrate

Bacteria: A tick-borne illness (cocobacilli) that causes 1. fever 2. rash 3. severe headache If untreated, case-fatality rate is ~25%

Rickettsia rickettsii Dx: IFA or PCR --low platelet; hypnatremia Tx: Doxy for ALL ages

Bacteria: A patient presents with a discrete, red, blanching macular rash on the wrists, ankles and legs. He said he was out hunting with his dad. What is a good suspicion?

RIcketsia Rickettsii Later rash: petechial, spread rapidly - entire body, soles and palms

Bacteria: The vector for this tick-borne illness is the Lone Star Deer tick. The reservoir is the white-tailed deer. It causes: -fever, myalgia, HA, and rash

Ehrlichia chafeensis (Ehrlichiosis) Dx: IFA or PCR --pancytopenia; inc. liver fxn; hyponatremia Tx: Doxy ALL

Bacteria: A patient presents complaining of a rash that started 3 days ago. She described it as discrete, red blanching macules on the extremities (wrists, ankles, legs). Upon examination, you note the rash is now a petechial rash that has spread rapidly along the entire body including the soles and palms. She states she was in a wildlife preserve where she saw a lot of deer. What is your suspicion?

Erlichiosis Tx: DOXY

Bacteria: This coccobacilli is acquired from handling infected Goats, or consuming unpasteruized raw Goat/Camel milk. It presents with: - fever - arthralgia - hepatosplenomegaly

Brucella ``` Dx: serologic (agglutination titers); blood culture Tx: -Doxy + gentamicin -Doxy + rifampin -Bactrim + rifampin ```

Bacteria: This coccobacilli infects the ciliated epithelium causing whooping cough. Signs/Symptoms occur in 3 stages: 1. Catarrhal 2. Paroxysmal 3. Convalescent *cough, INSPIRATORY whooping, runny nose, post-tussive vomiting

Bordetella pertussis Dx: --PCR nasopharyngeal aspirate Tx: Azithromycin + PEP

Bacteria: This coccobacilli can infect 100's of animal species (e.g. rabbits, game meats). Human infection is through direct contact with animals, or bit from tick. It presents with abrupt fever, chills, headache, and localized LARGE lymphadenopathy with painful skin ulcers.

Francisella tularensis Dx: Serology (IgG and IgM) Tx: Streptomycin

Bacteria: This coccobacilli is known for causing otitis media, preseptal/orbital cellulitis, conjuntivitis, *pneumonia and *meningitis. It is the 2nd MCC of bacterial otitis media.

Haemophilus influenza Dx: blood, CSF, fluid culture Tx: Augmentin or Cefdinir

Bacteria; Haemophilus influenza type B has a vaccine that is completed 12-15 months. Unimmunized children < 4 years old are at inc risk of invasive HiB disease. Who are also at risk for this infection?

**asplenia, HIV, sickle cell disease, cancer

Bacteria: Causes lyme disease. It is spread by the deer tick. Symptoms include: target skin lesions (erythema migrans ? 5cm); isolated facial palsy, meningitis and carditis.

Borrelia burdorferi Dx: ELISA or IFA Tx: Doxy (> 8 y/o); Amoxicillin if younger

Bacteria: Treponema pallidum causes syphillis, which has a LONG incubation period (3+ weeks). It can be congenital (transplacental) or acquired (direct sexual contact). How is it Dx and Tx?

Dx: - -Screen: VDRL, RPR (pregnancy) - -Confirm: TP-EIA, FTA-abs Tx: Penicillin G

Bacteria: This bacteria causes latent TB infection | + TB skin test; - chest X-ray

Mycobacterium TB DX: CXR, sputum AFB, Tuberculin Skin Test (TST) Tx: Isoniazid (kids)

Bacteria: A component of the microbiota of the GI tract that produces lactic acid and prevents growth of harmful bacteria.

Lactobacillus *activia

Bacteria: This bacteria is often acquired in hospitals or from recent antibiotic use (altering microbiome). Symptoms include diarrhea, abdominal pain, distension and history of recent antibiotic use. Children (< 2) can often by asymptomatic carriers.

C. diff Dx: stool EIA (toxins A and B) Tx: Cease antibiotic --oral metronidazole first, then again for 1st recurrent --oral vancomycin in 2nd recurrence

Bacteria: Causes food poisoning, diarrhea, and vomiting after ingestion of raw meat, poultry, gravies. It is the 3rd MCC of food poisoning in the U.S. It can also cause gangrene in diabetic foot ulcers.

C. perfringes *no fever, no abdominal pain Dx: Tx: supportive, rehydrate

Bacteria: Obtain spores via contaminated wound or from soil. It is the cause of tetanus There are 4 general kinds: 1. Generalized (lockjaw) 2. Local (local muscle spasms) 3. Neonatal (generalized) 4. Cephalic (CN's)

Clostridium tetani Dx: clinical Tx: Human tetanus globulin; Debride wound

Bacteria: Known for causing botulism. Exposure in newborns causes flaccid, descending paralysis. Symptoms include: --constipation, poor feeding, floppy, loss of head control. *no fever, normal sensorium

Clostridium botulinum *toxins A, B, F = honey exposure Dx: botulism toxin in stool, gastric aspiration, blood test Tx: supportive; anti toxin human BIG-IV

Bacteria: This bacteria is acquired from eating contaminated foods (unpasteurized dairy/milk) or packaged vegetables. It is tranmitted transvaginally to newborns. It infects the brain, spinal cord membranes and blood stream. It is the 3rd MCC of newborn meningitis.

Listeria monocytogenes Dx: blood, urine, CSF culture (newborns) Tx: Neonatal: ampicillin + gentamicin Mothers: do not eat soft cheese Food-borne: hand--washing

Bacteria: Acquired from fried rice (or dishes sitting at room temperature) or soil. It has a short incubation period (<24 hours). Symptoms are due to enterotoxin which causes diarrhea and vomiting (NO fever).

Bacillus cereus Dx: clinical Tx: supportive

Bacteria: Bacteria that occurs in clusters. It has enterotoxins that are in ham, cream filled pastries and egg/potato salad. Common illnesses include: 1. skin (cellulitis, abscess) 2. gastroenteritis (nausea, vomiting, diarrhea) 3. respiratory (pneumonia, empyema) 4. sepsis 5. osteomyelitis 6. septic arthritis 7. UTI 8. toxic shock syndrome * *MRSA

Staph aureus Dx: wound/blood Cx Tx: -I and D of abscess -Clindamycin or Vancomycin *MRSA resistant to B-lactams, penicllin, cephalosporins (only use vancymycin or linezolid)

Bacteria: A part of the normal skin flora, but can form biofilms around prosthetic devices (Foley, surgical implants). It is also a frequent contaminant of blood cultures.

Staph epidermidis Dx: wound culture Tx: remove infected device

Bacteria: Causes honeymoon cystitis (bladder infection) and UTI in females. *2nd MCC of UTI

Staph saprophyticus Dx: urine culture Tx: nitrofurantoin, SMX-TMP

Bacteria: Group A strep that is B-hemolytic. It causes strep pharyngitis, impetigo, endocarditis, pericarditis, Scarlet fever, erysipelas (outer skin infection - bright red rash on face), rheumatic fever and necrotizing fasciitis.

Strep pyogenes Dx: rapid strep antigen; throat culture Tx: penicillin/Cephalo

Bacteria: Group B strep that is B-hemolytic. It causes early onset neonatal sepsis (< 7 days old) and late onset (> 7 days old). 1. Early onset -- sepsis 2. Late onset -- sepsis + meningitis It is the #1 MCC of early onset, severe newborn sepsis-meningitis.

Strep agalactiae Dx: blood, urine, CSF Tx: Penicillin G (confirmed) --ampicillin + gent (< 1 mo) --cefotaxime or ceftriaxone (> 1 mo) NOTE: pregnant moms tested for GBS @ 35-37 weeks

Bacteria: An a-hemolytic type strep that colonizes the upper respiratory tract. It causes otitis media, sinusitis, pneumonia, bacteremia, or meningitis. It is the MCC of bacterial Otitis Media!!

S. pneumo Dx: varies Tx: depends on area --Otitis media: amoxicillin --Hospitalized Pneumonia: Ampicllin or Ceftriaxone

Bacteria: 2 main organisms in GI tract: E. faecalis and E. faceium. These cause UTI's, bacterimia and endocarditis. Symptoms vary.

Enterococcus Dx: urine, blood, CSF Tx: ampicillin (if susceptible), Vancomycin

Virus: This virus can live on surfaces for a long time (fomites). Its portal entry is through the conjuntiva. It causes the common cold, pharyngitis, and tonsillitis (w/ or w/out exudate). It can also cause otitis media, pharyngo-conjunctival fever.

Adenovirus Dx: rapid antigen PCR Tx: supportive NOTE: causes croup, bronchiolitis, cystitis; life threatening disseminated disease in young children

Virus: This virus can be spread by sexual contact, blood, or mother to child transmission via breastfeeding. The usual age of onset for infants is 12-18 months if untreated.

HIV Dx: 1. HIV DNA PCR - -< 18 mos 2. HIV enzyme immunoassay (ab test) - - > 18 mos Tx: Zidovudine (retrovir) prophylaxis **start within 6 hours delivery

Virus: Highly contagious virus but is minor and self-limiting in its effects. It is the number one cause for the common cold and associate w/ 2/3 of all asthma exacerbations. Signs and symptoms include: Infants: fever, nasal congestion, fussy, dec. feeding Kids: fever, congestion, cough, sneeze, HA It can also cause otitis media, sinusitis, pneumonia and asthma exacerbation.

Rhinovirus Dx: CLinical Tx: Supportive

Vaccines: 1. Patients exposed to varicella can be treated by the varicella vaccine within ____ to ____ after exposure(healthy people without evidence of immunity > 12 months of age) 2. The Varicella zoster Ig must be administered within ___ hours of exposure and is for high risk individuals who cannot be immunized.

1. Varicella vaccine - -72 - 120 hours after exposure 2. Varicella Ig - 96 hours NOTE: Patients with Hx of 1 prior dose of varicella vaccine should receive the 2nd dose if 3 mos have elapsed since the 1st dose

Exam I Flashcards

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