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Newman Flashcards

1
Q

MC organisms causing acute bacterial meningitis in children of different ages:

1 mo-3 mo:

3 mo-3 yrs:

3 yrs-10 yrs:

10yrs-19yrs:

A

1 mo-3 mo: GBS

3 mo-3 yrs: S. pneumoniae

3 yrs-10 yrs: S. pneumoniae

10yrs-19yrs: N. meningitidis

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2
Q

What is the difference in acquisition between early-onset (7 days) Group B Strep in neonates?

A

EARLY-onset GBS reflects vertical transmission from maternal vaginal flora.

LATE-onset GBS suggests community or nosocomial acquisition, although the maternal flora now colonizing the neonate may still be a source of infection.

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3
Q

TQ Mainstay of therapy for tx of MRSA in the pediatric pt:

A

Vancomycin

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4
Q

classic signs and sx of pediatric bacterial meningitis: (3)

A
  • Fever
  • Headache (less likely in younger children)
  • Meningeal signs (less likely in younger children)
  • Brudzinski and Kernig signs
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5
Q

Signs and sx of pediatric bacterial meningitis in neonates:

A
  • Fever, hypothermia
  • Poor feeding, listlessness, hypotonia, pallor, lethargy
  • Irritability, shrill cry
  • Apnea, seizures
  • Jaundice, bulging fontanelle
  • Hypoglycemia, intractable metabolic acidosis, shock
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6
Q

Signs and sx of pediatric bacterial meningitis in older infants and children:

Definitive diagnosis is based on:

A
  • Fever, hypothermia (if severely ill)
  • Nuchal rigidity, opisthotonos, Kernig sign, Brudzinski sign
  • Headache, irritability, lethargy, photophobia, alteration of the sensorium
  • Vomiting, nausea, anorexia Definitive diagnosis is based on:
  • Bacteria isolated from CSF obtained via lumbar puncture
  • Evidence of meningeal irritation demonstrated by increased pleocytosis, elevated protein level, and low glucose level in the CSF
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7
Q

TQ

Bacterial meningitis

  • Appearance:
  • Pressure:
  • WBC count:
  • Differential count (predominance):
  • Protein:
  • Glucose:
  • Gram stain:
A

Bacterial meningitis

  • Appearance: Turbid
  • Pressure: Elevated
  • WBC count: >1000
  • Differential count (predominance): PMNs
  • Protein: Elevated
  • Glucose: Low
  • Gram stain: G+
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8
Q

Pathophysiology of pediatric bacterial meningitis:

  • Bacteria enter the ____________ _____ hematogenously (across the blood brain barrier)
  • Bacteria reach the meninges directly from a parameningeal infection (eg, sinusitis, mastoiditis, otitis media, brain abscess, spinal epidural abscess)
  • Intense host inflammatory response (cytokines, ___, ____)
  • Ultimate damage to neuron/apoptosis
A

Pathophysiology of pediatric bacterial meningitis:

  • Bacteria enter the SUBARACHNOID SPACE hematogenously (across the blood brain barrier)
  • Bacteria reach the meninges directly from a parameningeal infection (eg, sinusitis, mastoiditis, otitis media, brain abscess, spinal epidural abscess)
  • Intense host inflammatory response (cytokines, IL-1, TNF-a)
  • Ultimate damage to neuron/apoptosis
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9
Q

TQ

What is Cushing’s Triad associated with increased ICP and brain edema?

A
  • BP increases
  • HR decreases
  • Respirations become irregular (signifies brainstem involvement)
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10
Q

List the organisms responsible for neonatal bacterial meningitis. (6)

A

Bacteria acquired from the maternal vaginal flora:

  • Gram negative enteric flora
  • Group B streptococcus (Streptococcus agalactiae) – Early onset (7 days of life)
  • Staphylococcus epidermidis (coag negative Staph)
  • Candida
  • Listeria monocytogenes (well known but uncommon)
  • Citrobacter (uncommon but associated with brain abscesses)
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11
Q

List the organisms responsible for bacterial meningitis in infants (>3 mo) and children: (2)

A
  • S pneumoniae (leading cause)
  • N meningitidis
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12
Q

TQ What would you see on LP in viral meningitis?

  • WBC diff count:
  • RBCs:
  • Protein: Rx?
A
  • WBC diff count: Lymphocytes
  • RBCs: Increased
  • Protein: Increased

Rx acyclovir

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13
Q
  • Fever
  • Racing heart
  • Rapid or labored breathing
  • Cool extremities
  • Color changes
A

Sepsis in pediatric pt

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14
Q

Explain the pathophysiology of sepsis.

A
  • Release of pro-inflammatory mediators exceeds the boundaries of the local infection
  • Generalized inflammatory response (SIRS: Systemic Inflammatory Immune Response)
  • Cytokines (tumor necrosis factor-alpha, interleukin-1)
  • Complement activation
  • Genetic susceptibility
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15
Q

Earliest and mildest manifestation of sepsis: (3)

A
  • Hyperthermia (or hypothermia)
  • Tachypnea
  • Tachycardia
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16
Q
  • Increased cardiac output
  • Peripheral vasodilation
  • Increased tissue oxygen consumption
  • Hypermetabolic state
A

Warm shock

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17
Q
  • Cardiac output falls
  • Peripheral vascular resistance increases
  • Shunting of blood
A

Cold shock

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18
Q

Bacterial etiologies of early-onset neonatal sepsis: (4)

A
  • Group B streptococcus (Streptococcus agalactiae)*
  • Escherichia coli
  • Haemophilus influenzae
  • Listeria monocytogenes
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19
Q

Bacterial etiologies of late-onset neonatal sepsis: (6)

A
  • Coagulase-negative Staphylococcus (S epidermidis)
  • Staphylococcus aureus
  • E. coli
  • Klebsiella species
  • Candida species
  • GBS
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20
Q

MC bacterial etiology of infantile meningitis worldwide:

A

H influenzae type b (Hib)

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21
Q

MC bacterial etiologies in infants and children in the United States and developed world: (5)

A
  • E coli
  • S aureus
  • S pneumoniae
  • N meningitides
  • S pyogenes
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22
Q

TQ

Intrapartum antibiotic prophylaxis

  • When in labor, __________ or __________ is given IV every 4 hours until delivery with at least one dose given 4 hours before birth
  • Due to IAP, the rate of (early/late) onset GBS dz has decreased significantly
A

Intrapartum antibiotic prophylaxis

  • When in labor, PENICILLIN or AMPICILLIN is given IV every 4 hours until delivery with at least one dose given 4 hours before birth
  • Due to IAP, the rate of EARLY onset GBS dz has decreased significantly (IAP has no affected the rate of late onset dz)*
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23
Q

Occurs within the first 24 hours up to 1 week of age

Signs and symptoms

  • Tachypnea
  • Grunting
  • Flaring
  • Apnea
  • Cyanosis
  • Hypotension (25% of cases)
  • Temperature instability
  • Poor feeding
  • Tachycardia
  • Jaundice
  • Lethargy

* Dx: (early/late) onset GBS dz

A

EARLY onset GBS dz Risk factors for EOD

  • Maternal colonization at birth
  • Preterm birth
  • ROM >18 hours prior to delivery
  • Lack of maternal antibodies to type specific capsular polysaccharides and protein antigens
  • Chorioamnionitis
  • Multiple gestation
  • Nonwhite maternal race
  • Intrapartum fever >38 C
  • Intrauterine monitoring
  • Postpartum maternal bacteremia
  • Having had a previous infant with invasive GBS disease
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24
Q

TQ

  • Generally more mildly ill upon presentation
  • 65% present as bacteremia without a defined focus
  • 25% to 30% present with meningitis
  • Septic arthritis (hip, knee, ankle)
  • Osteomyelitis (humerus most common, femur, tibia)***
  • Cellulitis and adenitis

Dx: (early/late) onset GBS dz

A

LATE onset GBS dz

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25
Q
  • Lack of antibodies to the TSST-1 toxin
  • Compromise in mucosal or skin integrity
  • Often the presence of a foreign body (Tampon*, surgical implant)
  • Can occur in children with pneumonia or skeletal infection
  • Blood cultures positive in
A

Toxic Shock Syndrome

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26
Q

Recurrent Staph skin infections:

  • Usually MRSA (obtaining a culture is important)
  • Treat everyone in family with a co-existing infection

Rx?

What Rx is still the go-to choice for therapy in children with infections due to MRSA?

A

Rx nasal mupirocin and bleach baths MRSA

Rx vancomycin

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27
Q

TQ

  • Multisystem inflammatory dz that mostly affects infants and children
  • Vasculitis of medium-sized extraparenchymal arteries
  • MC cause of acquired heart dz in North America, Japan, and Europe
  • Development of coronary artery aneurysms***

Lab findings:

  • Elevated acute phase reactants (CRP, ESR, thrombocytosis, leukocytosis)
  • Normochromic normocytic anemia
  • Sterile pyuria
  • Mild elevation of liver enzymes and bilirubin
  • Mononuclear cells in the CSF
A

Kawasaki dz

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28
Q

TQ

Explain the “C.R.A.S.H.” mnemonic for diagnosis of Kawasaki dz.

A

The presence of unexplained fever for 5 days or more and the presence of 4 of the following 5 findings:

C - Conjunctival injections, generally B/L and bulbar w/o discharge and with sparing of the limbus

R - Rash, polymorphous and generalized, may have perineal desquamation

A - Adenopathy, non-suppurative, generally cervical, and ≥1.5 cm in size

S - Strawberry tongue, or other mucous membrane changes such as dryness and fissuring of the lips, erythema of the oral mucosa

H - Hand and feet changes, generally with swelling, periungal desquamation of the fingers and toes, erythema of palms and soles

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29
Q
  • Fever >5 days
  • 2-3 of the CRASH criteria
A

Incomplete or Atypical Kawasaki dz

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30
Q

Management of Kawasaki dz: (2)

A

IVIG

aspirin

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31
Q

What happens during a well child check?

A
  • Check ht, wt, head circumference
  • BMI @ 2yr
  • BP and Sensory screening- vision @3yo (hearing @4yo)
  • Develop/Behavioral Assessment- 9mo, 18mo, 30mo.
  • Alcohol and Drug use @ 11yo
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32
Q

TQ

When do we screen children for autism and what do we use?

A
  • 18mo and 24mo when kids start socializing and communicating
  • M-CHAT: 10Q questionnaire
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33
Q

TQ

What do we do at EVERY well child check?

A

Full physical exam!!!

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34
Q

Labs:

  • Newborn Screening: birth and w/in 1 mo (metabolic and hgb)
  • Immunizations
  • Hgb/Hct @ 12 mo (iron def!)
  • Lead screening: 12 mo, 24 mo
  • TB test
  • Dyslipidemia (risk @ yo, actual 20yo)
  • STI @11yo
  • Cervical Dysplasia @???
A

11yo

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35
Q

Def: Inform parents what to expect developmentally and advise them accordingly (developmental changes, diet, injury prevention)

A

Anticipatory Guidance

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36
Q

TQ

T/F Growth parameters don’t have to plot out at 50% percentile for age to be normal! Instead, PICK a line on the curve and make sure they grow along that curve (even if at 3%)

A

TRUE

Grow at normal rate, regardless if small or big

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37
Q

TQ

If WEIGHT falls off first, think…(.eg, 90th percentile–>60th–>30th)

A

nutritional!

not getting enough calories (reflux), not absorbing calories (malab), or incr metabolic demands (CHD, Hyperthyroid)

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38
Q

TQ

If HEIGHT falls off first, think….

A

Endocrine abnormalities

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39
Q

TQ

If head circumference falls off first, think…

A

failure of primary brain growth

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40
Q

For nutritional deprivation, what is the 1st growth parameter to be affected? 2nd? 3rd?

A

Wt=1st

Lgth/Ht=2nd

Head circum=3rd (ominous)

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41
Q

TQ

Daily caloric requirements for a term neonate-1 yo? (kcal/kg/d)

Preterm neonate: 120-240

1-7yo: 75-90

7-12yo: 60-75

12-18yo: 30-60

>18yo: 25-30

A

100 (90-120)kcal/kg/day

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42
Q

TQ

How many kcal/ounce are in newborn formula and breast milk?

A

20 kcal/ounce!

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43
Q

TQ

Daily wt gain in gms/day?

Birth-4mo: ?

4mo-8mo: ?

8mo-12mo: ?

A

**Birth-4mo: 30gms/day (1 ounce)

4mo-8mo: 20gms/day

8mo-12mo: 10gms/day

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44
Q

TQ

Newborns may lose up to 10% of their birth wt during the first week of life…usually regain birth wt by when?

A

2 wks of age

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45
Q

If fails a screening…

A

repeat, further, more specific screening/testing…screen isn’t diagnostic!

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46
Q

TQ

What are the speech milestones?

A

1/4, 2/4, 3/4, 4/4 rule!

  • at 1 yr age, strangers understand 1/4
  • at 2 yr age, strangers understand 2/4 of what the baby says
  • at 3 yr age, strangers understand 3/4
  • at 4 yrs of age, should understand all speech
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47
Q

TQ

What is a normal BMI?

A

18.5-24.9

BMI or equal to 30=obese

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48
Q

TQ

What is the normal linear growth rate for ages 6-11 yo?

A

6-7cm/year (2.5 inches)

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49
Q

TQ

How do you estimate the adult height of a child? (2 ways)

A

-Double the height of the child at 2 yo

OR

-Using “mid-parental height”:

For boys…using inches

• [(dad’s ht + mom’s ht)+5] / 2

For girls…using inches

• [(dad’s ht + mom’s ht) – 5] / 2

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50
Q

TQ

When weight falls off first think…

A

nutrition

  • Not enough in (emesis, no food)
  • Not enough absorbed (mal-absorptive conditions)
  • Higher than average caloric requirements
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51
Q

TQ

When length falls off first think…

A

endocrine

  • GH deficiency
  • Hypothyroidism
  • Cushing’s syndrome (iatrogenic?)
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52
Q

TQ

When head circumference falls off first think…

A
  • Primary failure of the brain to grow
  • Severe craniosynostosis
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53
Q

TQ

How do you estimate a child’s skeletal maturation/bone age?

A

By assessing the ossification of the epiphyseal centers

Helps estimate a child’s growth potential!>> X-ray of the left hand and wrist (Compared against Gruelich and Pyle atlas standards)

54
Q

TQ

What is considered delayed skeletal maturation?

A

Two standard deviations below the chronologic age

55
Q

TQ

When does catch-up or catch-down growth occur?

A

1st 18 mo of life

corrections are due to the child trying to reach their genetically determined percentile

56
Q

TQ Some kids make up to a __% downward correction on the growth curve, often due to table/solid food

A

25%

57
Q

TQ

If <36 mo, using 0-36 mo curve, how do you measure the child?

If >24 mo, may use the 2-20 yo curve, but then how do you measure the child?

A

Measure length when child supine (length)

Height when standing up (stature)

58
Q

TQ

What is the defintion of short stature?

A
  • Height 2 std dev below mean ht for age and sex
  • Ht >2 std dev below mid-parental ht
59
Q

TQ

Short stature differential?

A
  • **Constitutional delay (late bloomer)
  • GH defic
  • Neglect
  • Turners
  • Noonan
  • Hypothyroid.
60
Q

TQ

GH-def from hypopit.

What lab findings?

A
  • IGF-1, IGF binding protein 3
  • Ancillary test: GH stimulation test (GHRF-arginine)
61
Q

TQ

  • Obesity
  • Moon facies
  • Violaceous striae
  • Cessation of linear growth

What do you measure?

A

Cushing syn

Measure cortisol

62
Q

TQ

  • Short stature
  • Webbed neck
  • Shield shaped chest
  • Low posterior hairline
  • Mosaic? May have no stigmata

What is the karyotype? What tests do you run?

A

Turner Syndrome

  • Karyotype (45 XO)
  • Ancillary tests:
  • Echocardiography
  • Renal ultrasonography (horseshoe)
63
Q

TQ

  • Craniotabes (softening or thinning of skull)
  • Bulbous, flared wrists
  • Bowing of extremities

What impt lab do you draw?

A

Rickets

**25-hydroxyvitamin D

Also: -1,25-dihydroxyvitamin D -PTH -ALP

64
Q

TQ

  • low birth wt
  • short stature
  • poor wt gain
  • microcephaly
  • epicanthal folds
  • smooth philtrum
  • flat nasal bridge
  • thin upper lip
A

Fetal Alcohol Syndrome

65
Q

TQ

  • big head, big/tall when young, normal adult height
  • Incr Insulin-like growth factor 2
  • Hypoglycemia
A

Beckwith-Wiedemann syndrome

66
Q
  • Incr LH, FSH
  • Decr testoserone
  • 47XXY
A

Klinefelter syndrome

67
Q

TQ

  • Clinical diagnosis using Ghent nosology
  • abnormality of connective tissue
  • Ancillary tests
  • Fibrillin-1 gene mutation
  • Genetic consultation

What inheritance pattern???

A

Autosomal dominant

68
Q
  • Due to either central (GnRH) or peripheral (GnRH indep) causes leading to overgrowth
  • incr tanner staging
  • tall stature
A

Precocious puberty

69
Q

Children may have up to 11 respiratory infxs in infancy, each lasting 8-14 days. Therefore, children w/ recurrent infxs is a common reason for doc visits.

What is the definition of recurrent infx?

A

1) 2+ severe infections in 1 yr
- Persistent fever or confinement to bed for 1wk+
- Failure to respond to oral antibiotics and/or the need for IV antibiotics or hospitalization
- Infections with an unusual pathogen
- Unusual complications (mastoiditis, pleural effusion, abscesses)
- Persistent laboratory/radiologic abnormalities
2) 3+ respiratory infections in 1 yr
3) Need for antibiotics for 2 months/year

70
Q

TQ

Children w/ primary immuno-def are more likely to have what?

hint “SPUR”

A
  • Serious infx (meningitis, peritonsillar abscess)
  • Persistent infx (does not improve)
  • Unusual infx (burkholderia cepacia, pneumocystitis jiroveci)
  • Recurrent infx
71
Q

TQ

Osteomyelitis in kids? infants?

A

Kids=staph

Infants=kingella

72
Q

3 most impt factors in dx of PID?

A
  • FH
  • Need for IV antibx
  • Failture to thrive
73
Q

-Family history of immunodeficiency or unexplained early death

A

Suggestive of a primary immunodeficiency

74
Q

TQ

Inheritance pattern?

Chronic granulomatous disease (CGD) and agammaglobulinemia 

A

X-linked

75
Q

TQ

Inheritance pattern?

Ataxia-telangiectasia

A

AR

76
Q

TQ

Umbilical cord does fall off…think

A

Leukocyte‐Adhesion defects

77
Q

TQ

Absence of T cells? think

A

Complete DiGeorge syndrome

no thymus

78
Q

TQ

Signature organism in chronic granulomatous dz?

A

Staphylococcus aureus

Also: aspergillus

79
Q

TQ

-Petechiae, easy bleeding, eczema, and chronic draining ears

A

Wiskott-Aldrich syn

80
Q

TQ

Oral ulcers, gingivitis, and impetigo

A

leukocyte‐adhesion defects

chronic granulomatous disease

81
Q

TQ -

**Developmental delay

  • Cerebellar defects
  • Spider angiomas
  • AR
  • Ataxia + infx
A

Ataxia-telangiectasia

82
Q

TQ

  • Coarse features, chronic‐infected eczema, and deep‐seated abscesses
  • recurrent staphylococcal skin infections, abscesses, lung cysts, or pneumonia
A

hyperimmunoglobulin E syndrome

83
Q

TQ

  • Growth retardation w/ infection
  • Short stature
  • chondrodystrophy
  • fine hair
A

cartilage‐hair hypoplasia

84
Q

TQ

  • Congenital heart disease
  • developmental delay
  • hypocalcemia (no parathyroid)
  • dysmorphic facies with low‐set ears
  • hypertelorism
  • downturning eyes
  • micrognathia
A

DiGeorge syndrome

No thymus or T cells

85
Q

TQ

  • Oculocutaneous albinism
  • progressive neurologic dysfunction in young adults
A

Chediak‐Higashi disease

86
Q

TQ

  • Appears b/t birth-6 mo
  • Pneumocystis jiroveci (carinii) pneumonia
  • seborrheic dermatitis and alopecia
A

SCID

87
Q

TQ

Autosomal recessive form of severe combined immunodeficiency (SCID) characterized by erythroderma, desquamation, alopecia, chronic diarrhea, failure to thrive, lymphadenopathy, and hepatosplenomegaly

A

Omenn syndrome

88
Q

Supraclavicular LN enlarged is NOT good. How about cervical?

A

Normal

89
Q

TQ Most impt component of the work up for lymphadenopathy?

A

H and P

90
Q

Supraclavicular LN enlarged?

A

Never normal. BAD

91
Q

LN

Tender, warm, red, fluctuant?

Soft, mobile, smooth?

Firm and rubbery?

Fixed and matted?

A

Tender, warm, red, fluctuant? Lymphadenitis

Soft, mobile, smooth? Benign

Firm and rubbery? Possible lymphoma

Fixed and matted? Possible malignant or TB

92
Q

TQ

LDH=marker for?

A

hematologic malignancy

93
Q

TQ

4 yo presents w/ diffuse lymphadenopathy, sore throat, can you do a mono spot on her?

A

NO

5-6 yo cut off…before that don’t form heterophile Ab May be negative

94
Q

Diffuse lymphadenopathy + respiratory symptoms what do you order?

A

CXR

95
Q

Diffuse lymphadenopathy + failure to thrive?

A

HIV considered

96
Q

LN swollen in axilla, knicked when shaved, tender, warm LN, fever, Dx?

A

MC staph aureus

also: strep pyogenes

97
Q

Animal related causes of lymphadenitis:

  • Tularemia
  • TQ Cat scratch dz (?????)
  • Yersinia pestis (plague)
A

Bartonella henselae

98
Q

TQ

Pt presents w/ fever, swollen LN in axilla

  • sore on left hand recently
  • sister has a cat
A

Cat scratch dz (Bartonella henselae)

Tx: Azithromycin

99
Q

TQ

  • Parinaud’s triad: conjunctivitis, preauricular adenitis, conjunctival granuloma
  • Neuroretinitis (macular star)

Dx?

A

Cat scratch fever

100
Q
  • Supraclavicular LN + lump in scrotum (not painful)
  • tired
  • cough
  • nose bleeds
A

Cancer loves the mediastinum!!

101
Q

TQ

Testicular mass, esp painless w/o hx of trauma/injury>>order???

A

chest radiograph indicated (likely malig.)

102
Q

TQ What must you do if you find a supraclavicular LN?

A

work it up! have to know where its coming from

103
Q

TQ

Generalized LAD + respiratory s/s what must you do?

A

Order a chest x-ray

104
Q

What are the 2 categories of tumor like lesions?

A

heterotopia (normal cells in abn location)

hamartoma (overgrowth natives)

105
Q

What are the 4 types benign tumors?

A

1) Hemangioma: MC tumor of infancy (ex: port wine stain)
2) lymphatic tumors
3) Fibrous tumors
4) Teratomas

106
Q

TQ

  • Benign, well-diff cystic lesions (cells with teeth, hair, etc)
  • sacrococcygeal MC
A

teratoma

107
Q

Where do most frequent childhood cancers arise from?

A

Hematopoietic system

108
Q

TQ Why do we always check for red reflex in kids?

A

Retinoblastoma!

109
Q

TQ Age group for wilms tumor?

A

0-4 yrs

110
Q

TQ Age group for retinoblastoma?

A

6 to 9 yrs

111
Q

TQ MC extracranial solid tumor of childhood

A

Neuroblastoma

112
Q

TQ

Older child presents w/ **bone pain, resp s/s, GI complaints, no red reflex

Where is the mets?

A

Periorbital region

113
Q

TQ 90% of neuroblastomas produce what?

A

Catecholamines (VMA, HMA)

114
Q

TQ

MC primary renal tumor of childhood?

Big mass is abdomen

A

Wilms tumor

115
Q

TQ

what chromosome is wilm’s tumor assoc w/?

A

Chrom 11 (deletions)

116
Q

TQ

Pt w/ Beckwith-Wiedemann syn now presents with a tumor. What type of tumor is it?

Beckwith-Wiedemann: enlargement of body organs, macroglossia, hemihypertrophy, omphalocele, chrom 11

A

Wilms tumor!!!

117
Q

TQ

  • large abd mass
  • hematuria
  • pain in abd
  • intestinal obstruc
  • HTN
A

Wilm’s tumor

118
Q

Intentional harm or threat of harm to a child by whomever is taking care of child

A

Child Maltreatment

119
Q

TQ T/F All care providers=mandated reporters. Must report cases of child abuse or neglect to local Child Protective Services.

A

True!

120
Q

Any non-accidental physical injury to child.

A

Physical abuse

121
Q

Any activity w/ child before age of legal consent or beyond child’s comprehension (eg. Retarded) that is for sexual gratification

A

Sexual abuse

122
Q

Repeated damaging interactions stating child is flawed, unloved, unwanted

A

Emotional abuse

123
Q

TQ MC form of child abuse

Caretaker omissions in care that result in actual or potential harm to child. Child’s basic needs not adequately met.

A

Neglect

124
Q

Omissions in medical care that result in actual or potential harm to child

chronic illnesses or failure to f/u

failure to be compliant w/ meds

A

Medical neglect

125
Q

MC perpetrators of maltreatment?

A

Parents

126
Q

Role of medical provider in suspected maltx

A
  • Needs of child=primary concern
  • The parents have the right to know if a report has been or is going to be made, but only after child safety is ensured!!
127
Q

TQ Open and good-faith exchange w/ child abuse agencies and care providers is legal and protected. What is generally trumped?

A

HIPPA

128
Q

TQ Most important when identifying child maltreatment?

A

History! Use quotes when possible

Easy bruising? FHx of fx. Hx of bleeding disorders (Did pt bleed a lot during circumcision).

DO COAG STUDIES.

129
Q

TQ

  • Developmntally inapprop hx (2 mo old was walking and fell down the stairs— can’t walk at 2mo old!).
  • No hx- “no idea what could have happened.”
  • **Hx INCONSISTENT W/ INJURY (serious injuries following supposedly minor incidents).
  • Serious injuries- esp claimed to have been inflicted by other small children.
  • Genital injuries.
  • Changing hx.
  • Delay in seeking medical care.
A

Red flags!

130
Q

TQ When suspect child maltreatment, order labs/rad, and a skeletal survey. What is a red flag on the skeletal survey?

A

Multiple fractures at different stages of healing

131
Q

A reduction of the hemoglobin concentration or red blood cell (RBC) volume below the range of values occurring in healthy persons

A

Anemia

Peds (7 decks)

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