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USMLE Step 3 Secrets > General Principles > Flashcards

Flashcards in General Principles Deck (79):
1

Age for social smile

1-2 mo

2

Age for cooing

2-4 mo

3

Age for while prone, lifts head up 90 degrees

3-4 mo

4

Age for rolls front to back

4-5 mo

5

Age for voluntary grasp (no release)

5 mo

6

Age for stranger anxiety

6-9 mo

7

Age for sits with no support

7 mo

8

Age for pulls to stand

9 mo

9

Age for waves "bye-bye"

10 mo

10

Age for voluntary grasp with voluntary release

10 mo

11

Age for plays pat-a-cake

9-10 mo

12

Age for first words

9-12 mo

13

Age for imitates others' sounds

9-12 mo

14

Age for separation anxiety

12-15 mo

15

Age for walks without help

13 mo

16

Age for build tower of 2 cubes

13-15 mo

17

Age understands 1-step commands (no gesture)

15 mo

18

Age for good use of cup and spoon

15-18 mo

19

Age for build tower of 6 cubes

2 yr

20

Age runs well

2 yr

21

Age ties shoelaces

5 yr

22

Which is more important, the age at which individual milestones are reached or the overall pattern of development?

Overall pattern of development

23

Screening done at every pediatric visit (5)

1. Height
2. Weight
3. Blood pressure
4. Developmental/ behavioral assessment
5. Anticipatory guidance

24

Most common cause of death in children 1-12 mo

SIDS

25

Testable Anticipatory Guidance (8)

1. Water Heater <120F
2. Proper car restraints
3. Infant sleep on side or back
4. No baby walkers
5. No small objects - aspiration
6. No honey or cow's milk before 1 yr
7. Solids start at 6 mo
8. Supervise around water

26

When is head circumference measured?

Every visit for first 2 years

27

Failure to Thrive

- Head circumference, height, or weight < 5th percentile
- Weight < 80% of ideal weight for age
- Weight loss causes a decrease of 2 or more major percentage lines

28

Organic causes of childhood obesity

< 5% of cases
-Cushing syndrome
-Prader-Willi syndrome

29

Conditions with abnormal head circumference

Increased
-Hydrocephalus
-Tumor

Decreased
-TORCH

30

TORCH

Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections

31

Initial Hearing and Vision Screening

At least once by 4 yrs of age

32

Normal age for strabismus

Until 3 mo of age

33

H&H Screening for Anemia

at 12 months of age

34

Risk factors for anemia during infancy (5)

1. Prematurity
2. Low birth weight
3. Ingestion of cow's milk before 1 yr of age
4. Low dietary intake
5. Low socioeconomic status

35

When should iron supplementation start?

Full-term infants
4-6 mo

Preterm infants
2 mo

36

What children should be screened for lead exposure?

all Medicaid-eligible children

37

Risk factors for TB Testing in Children 2 yr or older (4)

1. Family with TB or pos TB test
2. Born in high-risk country
3. Traveled to high-risk country
4. Consumed unpasteurized milk or cheese

38

How test for vesicoureteral reflux?

Ultrasound scan and either voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC)

39

When test for vesicoureteral reflux?

febrile UTI in children 2 mo to 2 yr old

40

Which special patient populations require pneumococcal vaccine?

Splenectomy
Sickle cell

41

Which vaccine is contraindicated in egg-allergic patients?

MMR
Influenza

42

When not give live vaccines?

Immunocompromised
Pregnancy

43

What are the live vaccines? (3)

MMR
Varicella
Intranasal influenza

44

When should a child see a dentist for the first time?

2-3 yr

45

When does the anterior fontanelle usually close?

18 months of age

46

What disorder should you suspect if it fails to close? (4)

hypothyroidism, hydrocephalus, rickets, or intrauterine growth retardation.

47

Is milky-white and possibly blood-tinged vaginal discharge usually abnormal in the first week of life for a female newborn?

This discharge is usually physiologic and due to maternal hormone withdrawal

48

When should the Moro reflex and palmar grasp reflex disappear?

6 months of age.

49

When can dx of encopresis or enuresis be made?

Encopresis is normal until age 4 years and enuresis is normal until age 5 years

50

Tanner Stage 1

Preadolescence

51

Tanner Stage 5

Adulthood

52

Definition of puberty

when someone first has changes from Tanner Stage 1

53

Average age for puberty

Girls - 10.5 yrs
Boys - 11.5 yrs

54

First event for puberty in boys

Testicular enlargement

55

First event for puberty in girls

Breast Development

56

True precocious puberty

premature activation of the hypothalamic-pituitary axis with sexual maturation

57

When does true precocious puberty occur in males and females?

Males < 9 yrs
Females < 8 yrs

58

Pseudoprecocious puberty

Secondary sex characteristics develop prematurely because of high circulating levels of androgens or estrogen

59

What happens in precocious puberty that does not occur in pseudoprecocious puberty?

Testicular or ovarian enlargement

60

Tests for precocious puberty

GnRH stimulation test
If increased FSH and LH, precocious puberty
MRI brain

61

What causes pseudoprecocious puberty? (5)

1. Exogenous hormones
2. Adrenal tumors
3. Congenital adrenal hyperplasia (e.g. 21-hydroxylase def)
4. Hormone-secreting tumors
5. McCune-Albright syndrome

62

McCune-Albright Syndrome (4)

Females only

1. Ovarian cysts
2. Pseudoprecocious puberty
3. Polyostotic fibrous dysplasia of bone
4. Cafe au lait spots

63

What causes precocious puberty? (7)

1. Usually idiopathic
2. McCune-Albright Syndrome
3. Ovarian tumors (granulosa, theca cell or gonadoblastoma)
4. Testicular tumors (Leydig)
5. CNS disease or trauma
6. Adrenal neoplasm
7. CAH

64

Congenital adrenal hyperplasia

21-hydroxylase deficiency (95% of the time)

Males - precocious puberty or salt-wasting crisis
Females - ambiguous genitalia

65

Treatment for idiopathic precocious puberty

long-acting GnRH agonists

66

Why is it important to treat precocious puberty?

Prevent premature epiphyseal closure and short stature

67

Delayed puberty

Boys - lack of testicular enlargement by age 14 yrs
Girls - lack of breast development by age 12 yrs

68

Most common cause of delayed puberty

constitutional delay (normal variant)

69

What are other causes of delayed puberty?

1. Primary testicular failure (Klinefelter syndrome, cryptorchidism, hx of chemo, gonadal dysgenesis)
2. Ovarian failure (Turner syndrome, gonadal dysgenesis)
3. Hypothalamic or pituitary defect (Kallmann syndrome or tumor)

70

Three leading causes of death in adolescents

Accidents, homicide, suicide

71

People who should get the flu vaccine yearly (6)

1. Children 6mo - 18yrs
2. Women who will be pregnant during flu season
3. Immunosuppressed
4. 50 yrs or older
5. Chronic medical conditions (pulm, CV, renal, hepatic, hematologic, metabolic including DM)
6. Healthcare professionals

72

What age should adults start getting pneumococcal vaccine?

65 yrs

73

What special populations should get pneumococcal vaccine?

For age 2 yrs and older

1. Chronic CV, pulm, or liver disease
2. DM
3. Functional or anatomic asplenia
4. Immunocompromised

74

Who should get rubella vaccine if haven't had in childhood?

1. All women of child-bearing age
2. Healthcare workers
3. HIV-positive patients

75

Can MMR vaccine be given to pregnant women or immunocompromised patients?

No, it's a live vaccine

76

How long should women avoid getting pregnant after getting the MMR vaccine?

4 weeks

77

Can pregnant women receive Tdap vaccine?

yes

78

When should people receive Tdap vaccine?

Once, 11 yrs old or older, in place of Td vaccine

79

When get Td vaccine?

Every 10 yrs