Pediatrics Flashcards
(46 cards)
1
Q
Possible “red flags” for autism spectrum disorder prior to the toddler years
A
- Does not respond to name by 12 months
- Does not point to objects to show interest by 14 months
- Does not play “pretend” games by 18 months
2
Q
Possible “red flags” for autism spectrum disorder during toddler years and beyond
A
- Avoid eye contact and wants to be alone; has obsessive interests
- Has trouble understanding other people’s feelings or expressing own feelings
- Has delayed speech/language skills; repeats words over and over
- Give unrelated answers to questions
- Gets upset by minor changes; has unusual reactions to environmental stimuli
- Flaps hands, rocks body, or spins in circles
3
Q
True/false: Fragile X syndrome is the most common known cause of autism in either gender
A
True
- Male → large testicles after beginning puberty, large body habits, learning and behavioral differences (hyperactivity, intellectual disability), large forehead and ears, prominent jaw, tendency to avoid eye contact
4
Q
Is Klinefelter’s syndrome (XXY male) associated with developmental issues?
A
Yes - verbal in nature (language impairment)
- Low testicular volume, hip and breast enlargement
5
Q
Otitis media with effusion treatment
A
80% of children will clear middle ear within 8 weeks without interventions
- If due to underlying cause (I.e. allergic rhinitis), treat that
If persists beyond 8 weeks, especially with communication problems or hearing loss, consider tympanostomy (ventilating tube)
6
Q
What is scarlet fever?
A
Characterized by exudative pharyngitis that affects children ages 5-15 years of age
- MCC: GABHS
- Presentation: emerge abruptly with sudden onset fever and sore throat
- Headache
- Tender, localized anterior cervical lymphadenopathy
- Scarlatina-form or sandpaper like rash on day 2 of pharyngitis
7
Q
Scarlet fever diagnostic testing
A
Rapid strep test to identify GABHS in 7 minutes
8
Q
Scarlet fever treatment
A
Treatment the same as strep pharyngitis
- Oral PCN or amoxicillin (first line)
- If PCN allergy, macrolide (azithro-, clarithro-, erythro-, clindamycin)
9
Q
What is roseola?
A
Common childhood disease caused by human herpesvirus-6 seen in children younger than 2 years old
- Found in saliva in older children
- Develop lifelong immunity once contracted
10
Q
Roseola clinical presentation
A
- High grade fever (104 F or greater)
- Discrete rosy-pink macular or maculopapular rash following a period of fever
- Rash indicates infection is no longer contagious
11
Q
Roseola treatment
A
No antiviral used → supportive care
12
Q
Rubella clinical presentation
A
- Mild fever
- Sore throat
- Malaise
- Nasal discharge
- Diffuse maculopapular rash lasts 3 days
- Posterior cervical and postauricular lymphadenopathy
13
Q
Rubella treatment
A
No antiviral therapy → supportive care
- Vaccination with MMR
14
Q
Measles clinical presentation
A
- Generalized lymphadenopathy
- Conjunctivitis (copious clear discharge)
- Photophobia
- Koplik spots (appear two days before onset of rash)
- Fever
- Rash develops 3-4 days after onset of symptoms
15
Q
Measles diagnostic testing
A
Serological testing
- Rubeola IgG
- IgM antibodies
- or RT-PCR assay
16
Q
Measles treatment
A
Supportive care
- Hydration to replace fluids lost through emesis and diarrhea
- Vitamin A supplementation
- MMR to close contacts who have not been vaccinated
- Preventative if given within 3 days of exposure
17
Q
How is varicella spread?
A
Respiratory droplets and contact with open lesions
18
Q
Varicella clinical presentation
A
- Acute onset fever
- Malaise
- Vesicular rash with intense itch
- Appears first on stomach, back, and face
- Spread over entire body (250-500 itchy blisters)
19
Q
Varicella treatment
A
Supportive care
- Calamine lotion, pramoxine gel, oatmeal baths, oral antihistamines for itch
- Consider antivirals (oral acyclovir) for immunocompromised or children with chronic asthma
20
Q
What is infectious mononucleosis?
A
Caused by EBV
- Incubation period → 20-50 days
- 90% of patients can develop rash if given amoxicillin or ampicillin during illness
21
Q
Infectious mononucleosis clinical presentation
A
Most are asymptomatic
- Low grade fever
- “Shaggy” purple-white exudative pharyngitis
- Malaise
- Marked diffuse lymphadenopathy
- Hepatic and splenic tenderness with occasional enlargement
- Nausea and anorexia
22
Q
Infectious mononucleosis treatment and management
A
- Avoid contact sports for 1 month due to increased risk of splenic rupture
- Closely monitor for tonsillar enlargement
- If airway obstruction, systemic corticosteroids
23
Q
Route of transmission hand foot mouth (HFM) disease
A
Oral-fecal or droplet
- Coxsackie virus A16
- Family members and close contacts can develop outbreaks
24
Q
Hand foot mouth (HFM) disease clinical presentation
A
- Fever
- Malaise
- Sore mouth
- Anorexia
- Conjunctivitis or pharyngitis
- Tender macules or vesicles on erythematous base
- 1-2 days following onset, oral lesions develop on buccal mucosa, tongue, and/or hard palate
25
Hand foot mouth (HFM) disease treatment and management
No antiviral treatment
* Supportive therapy as illness lasts 2-7 days
* Ensure adequate fluid intake
* Antipyretics
* Oral anesthetics to reduce oral pain
* Cold drinks, ice popsicles
26
What is fifth's disease?
Also known as erythema infectiosum
* Caused by human parvovirus B19
* Common in school aged and young children who attend daycare
* Droplet transmission
27
Fifth's disease clinical presentation
* Mild flu-like illness that begins 5-7 days after initial infection
* Fever, malaise, headache, nausea, myalgia, rhinorrhea
* 7-10 days red rash that starts at cheeks and spreads to trunk and extremities
* “Slapped cheek” appearance
* Rash onset → no longer contagious
28
Fifth's disease treatment and management
Supportive care
29
What is Kawasaki's disease?
Self-limited vasculitis of unknown etiology
* Occurs in late winter and spring at 3 year intervals
* Leading cause of acquired heart disease in U.S.
30
Diagnostic criteria for Kawasaki's disease
* Fever 5 days or longer usually with irritability plus 4+ of the following:
* Changes in extremities (erythema, edema, desquamation), refuses to bear weight
* Bilateral, nonexudative conjunctivitis
* Polymorphous rash
* Cervical lymphadenopathy
* Changes in lips and oral cavity (pharyngeal edema, dry/fissured or swollen lips, strawberry tongue)
31
Is diagnostic testing (labs, imaging) needed for Kawasaki's disease?
Lab findings may increase suspicion of Kawasaki's
* Mild anemia
* Elevated WBC
* Elevated sedimentation rate
* Increase in platelets
* Albumin and WBCs in urine
If diagnosis in question, echocardiogram
32
Kawasaki's disease treatment and management
Referral to ID
* IV immune globulin and ASA
33
What is a capillary hemangioma?
Congenital vascular malformation
* Present in first weeks of life, grows rapidly in first year, plateaus, then regresses by 9 years of age
34
What is a port-wine stain?
Flat hemangioma with stable course
* Present at birth, deepens in color and grows proportional with the child
* Minimized with laser therapy
35
What is milia?
Caused by maternal androgenic effect on sebaceous glands
* Resolves without special therapy by 4 weeks to 6 months
* Avoid attempting to remove or open milia (leads to scarring)
36
What is erythema toxicum neonatorum?
* Benign rash that begins in first 10 days of life
* Look like flea bites
* Palms and soles spared
* Fade after 5-7 days after eruption without treatment
37
What are Mongolian spots?
Occur in 90% of African and Asian ancestries
* Usually over lower back and buttocks
* Caused by accumulation of melanocytes
* Fade by 7 years old
* No discomfort when pressed or palpated (difference between suspected abuse)
38
What is acne neonatorum?
Open and closed comedones and pustules over forehead and cheeks
* Due to maternal androgens
* Resolves in 4-8 weeks but can persist up to 1 year
* Can resolve without intervention (if needed, benzoyl peroxide)
39
Rehydration therapy for minimal to none degree of dehydration
Rehydration therapy: sips of fluid frequently as tolerated
Replacement of ongoing losses:
* Less than 10 kg → 60-100 mL ORS (pedialyte) for each loss
* Greater than 10 kg: 120-240 mL for each loss
40
Rehydration therapy for mild to moderate degree of dehydration
Rehydration therapy: ORT with ORS
* 50-100 mL/kg over 3-4 hours
* Best tolerated in frequent, small volumes
Replacement of ongoing losses:
* Less than 10 kg → 60-100 mL ORS (pedialyte) for each loss
* Greater than 10 kg: 120-240 mL for each loss
41
Rehydration therapy for severe degree of dehydration
Rehydration therapy (inpatient): LR boluses 20 mL/kg until improved, then 100 mL/kg over 4 hours
Replacement of ongoing losses:
* Less than 10 kg → 60-100 mL ORS (pedialyte) for each loss
* Greater than 10 kg: 120-240 mL for each loss
42
Chromosomal anomalies that can lead to delayed puberty
* Turner's syndrome in girls (XO female)
* Short height
* Delayed or no puberty
* Amenorrhea
* Learning disabilities
* Social difficulties
* Klinefelter's syndrome in boys (XXY male)
* Language impairment
* Low testicular volume
* Hip and breast enlargement
43
Tanner staging for males and females
44
Car seat guidelines: infants and toddlers
Rear facing for as long as possible
* Until child reaches highest weight or height allowed by car safety seats manufacturer (usually 2 years or more)
45
Car seat guidelines: toddlers to preschoolers
Convertible seats and forward facing seats with harness
* Usually up to 65 pounds and more
46
Car seat guidelines: school aged children
Belt positioned booster seat
* Usually until they have reached 4 feet 9 inches in height and are between 8-12 years of age
