Pediatrics Flashcards
(181 cards)
1
Q
Sucking reflex
A
Newborn sucks in response to a nipple in the mouth; observed by 14 wks
2
Q
Rooting reflex
A
Head turns to the side of a facial stimulus, present by 28 wks
3
Q
Traction response
A
The infant is pulled by the arms to a sitting position. Initially, the head lags, then with active flexion, comes to midline briefly before falling forward
4
Q
Palmar grasp
A
Placement of examiners finger in newborn’s palm; develops by 28 wks and disappears by 4 months
5
Q
Deep tendon reflex’s in newborns
A
A few beats of ankle clonus and an upgoing Babinski reflex may be normal
6
Q
Moro (startle) reflex
A
Holding infant supine, allow head to drop suddenly and the arms will abduct and extend followed by adduction. this develops by 28 wks and disappears by 3 months
7
Q
Tonic neck reflex
A
Turn infants head to one side; the arm and leg on that side will extend while the opposite arm and leg flex. Disappears by 8 months
8
Q
Contraindications to early newborn discharge
A
- Jaundice at 24 hrs
- High risk for infection
- Known or suspected narcotic addiction or withdrawl
- Physical defects requiring eval
- Oral defects (clefts for ex)
9
Q
Define “physiologic jaundice”
A
Visible jaundice appearing after 24 hrs of age.
Total bilirubin rises by < 5 mg/dL/day and peaks around 3-5 days of age (doesn’t usually exceed 15 mg/dL
10
Q
When does physiologic jaundice usually resolve? (in full-term and pre-term)
A
Full-term: 1 week
Pre-term: 2 weeks
11
Q
Why does physiologic jaundice peak in 3-5 days?
A
The liver isn’t conjugating well in the first few days of infancy.
Sepsis, trauma, etc causes increased hemolysis too
Infant needs to be eating!
12
Q
Causes of pathologic unconjugated hyperbilirubinemia
A
- Hemolytic causes (immune mediated, non-immune mediated, sepsis)
- Non-hemolytic causes (extravascular hemorrhage, polycythemia, bowel obstruction, functional ileus, breast-feeding associated (inadequate intake of breast milk)
- Decreased rate of conjugation –> Crigler-Najjar syndrome, Gilbert syndrome, hypothyroidism
13
Q
Presentation of Acute Bilirubin Encephalopathy
A
- Lethargy, poor feeding
- Irritability, high-pitched cry
- Arching of neck (retrocollis) and trunk (opisthotonos)
- Apnea, seizures, coma
14
Q
Presentation of Chronic Bilirubin Encephalopathy
A
- Gaze abnormality, especially limitation of upward gaze
- Auditory disturbances
- Dysplasia of the enamel of deciduous teeth
15
Q
Tx for Jaundice (2 things)
A
- Phototherapy
- -> Pre-term infants are at higher risk but pretty much every infant that levels greater than 20 get phototherapy - Exchange Transfusion
- -> Done once levels get above 25 after 5 days
16
Q
_______ is a NEVER EVENT
A
Kernicterus
17
Q
Hypoglycemia in infants
- Definition
- Reason why it often occurs in diabetic mothers
A
Definition: Blood glucose < 45 mg/dL
Diabetic mothers have high glucose –> gets passed to infant –> they become large and their insulin is working at a higher rate. When born and umbilical cord gets cut off, insulin cells don’t know to turn off and are “working overtime” creating hypoglycemia
18
Q
Tx for hypoglycemia in infants
A
20-45 mg/dL, no symptoms = feed and frequent monitoring, if unable to feed give IV glucose
< 45 mg/dL w/ symptoms = provide glucose bolus followed by IV
< 20 mg/dL w/ or w/o symptoms = bolus followed by IV
19
Q
1st disease
A
Measles
20
Q
2nd disease
A
Scarlet Fever
21
Q
3rd disease
A
Rubella (German measles)
22
Q
5ths disease
A
Erythema infectiosum
23
Q
6th disease
A
Roseola
24
Q
Which disease has the lowest vaccine prevention?
A
Pertussis
25
Why can you not give a child < 12 mos a live vaccine?
Infants have maternal antibodies still that will null the vaccine
26
Reasons why parents DO NOT want to vaccinate their children (besides their ignorance)
1. Painful to get multiple shots at once
2. Too many vaccines in first 2 yrs of life
3. Unsafe ingredients --> the whole autism thing
4. Not tested enough for safety
5. May cause chronic diseases
27
What are the vaccines that should be given by 2 months?
DTaP
IPV
HIB
PCV 13/PCV 7
28
HbSAg =
| HBeAg =
```
HbSAg= carrier of HepB
HBeAg= active infection of HepB
```
29
Despite access to vaccines, people still die from vaccine preventable disease. the number 1 cause is ______. The number 2 is _____.
1. Influenza
| 2. Pneumococcal
30
How do you differentiate smallpox vs. varicella?
Rash is more on the trunk in varicella while the rash is more often located on the extremities and face in smallpox
31
3 stages of Pertussis
1. Catarrhal
2. Paroxysmal
3. Convalescence
32
Presentation of measles/rubeola/morbilli
3 C's --> Cough, Coryza, Conjuctivitis
Koplik spots
Maculopapular rash beginning ton head/face and disappearing in the same order
33
Clinical syndromes of pneumococcal disease (PPV 14, 23, PCV 7&13)
Pneumonia
Bacteremia
Meningitis
34
What patient populations are at an increased risk of pneumococcal diseases?
```
Smokers
Immunocompromised
Cochlear implant
Alaska native
American Indians
```
35
How many doses is the varicella vaccine?
2
36
Genetic Syndromes of Obesity (6)
1. Prader-Willi Syndrome
2. Pseudohypoparathyroidism
3. Laurence-Moon-Biedl
4. Cohen Syndrome
5. Down Syndrome
6. Turner Syndrome
37
Clues to an obese child having a hormonal disorder
Wt gain is out of character of faily, obesity in short child, weight gain w/o linear growth, stretch marks, excessive facial hair
38
Medications that cause weight gain
1. Steroids
2. Progesterone
3. OCPs
4. Insulin
5. Risperidone (atypical anti-psychotics)
39
Screening in obese children. When should you do it? What should be tested?
Screen any child above 95% or a child between 85-90th %ile with risk factors (fam hx, etc)
Check fasting glucose, A1C, insulin levels, thyroid, adrenal, karyotype, GH, reproductive hormones, lytes, ALT/AST
40
The ultimate appetite suppressant...
Tabacco
41
An amino acid metabolism disorder w/ decreased phenylalanine hydroxylase (converts phenylalanine to tyrosine)
Phenylketonuria
42
What is the presentation of an infant who develops hyperphenylalaninemia?
```
Severe mental retardation (IQ 30)
Hyperactivity
Seizures
Light complexion, blonde
Eczema
```
43
How to tx Phenylketonuria?
Outcome is best if elimination diet is started in 1st month of life
Want levels to be <6 mg/dL
Regulate maternal hyperphenylalaniemia before conception and throughout pregnancy to prevent fetal damage, microcephaly & cardiac anomalies
44
A metabolic error due to deficiency of the enzyme catalyzing oxidative decarboxylation of the branched-chain keto acid derivatives of leucine, isoleucine, and valine
Maple Syrup Urine Disease
45
Presentation and tx of Maple Syrup Urine Disease
Infant is nml at birth and one week later will develop feeding difficulties, coma and seizures
Tx w/ dietary leucine restriction and avoidance of catabolism...most die within 1st month if no diet restriction ismade
46
What is the main dietary energy source in infants?
Fats (lipids) - 40-50% of diet in first yr of life should come from fats
By the time a child is 2 fat intake should be decreased to 30% of diet w/ limited saturated and polyunsaturated fats
47
Fat soluable vitamins
A,D,E,K
48
Benefits of breast feeding
1. Immunologic factors
2. Protection against URIs and GI infections (maybe leukemia?)
3. Exclusive breastfeeding for at least 4 months decreases chance of atopic dermatitis and cow's milk allergy
4. Maternal caloric balance (500-700 kcals/day)
5. Helps develop mother/baby interactions - uninterruptable time
49
Two contraindications to breastfeeding
1. TB in mother
| 2. Galactosemia
50
Medications that are passed through breast milk
```
Antimetabolites
Radioactive compounds
lithium
Diazepam
Chloramphenicol
Antithryoid drugs
Tetracycline
```
51
Failure to thrive - two ways to define it
1. Weight falls by 2 major percentiles
| 2. Weight is below the 5%ile
52
TPN is rarely used as nutritional support except for what two instances
1. Short bowel syndrome
| 2. Severe liver disorders
53
If the BP of an infant w/ a murmur greater than 24 hr is > 15mmHg higher in the arm than the leg then what congenital heart defect would you suspect?
Coarctation of the aorta
54
An infant's murmur persists beyond the first 24 hrs but coarctation of the aorta is ruled out. What are your next steps?
Infant can be d/c home and needs to come back in 2-3 days for ausculation and eval for signs of CHF or cyanosis
55
At what pulse ox in an infant would be required to work them up with an echo?
< 95%
56
What are the 4 innocent murmurs?
1. Still's murmur
2. Pulmonic flow murmur
3. Venous hum
4. Carotid bruit
57
Which of the 4 innocent murmurs persists into the diastolic phase? (the others are only systolic)
Venous hum
58
Which of the 4 innocent murmurs goes away if patient lies supine?
Venous hum
59
If the heart appears tipped upward and "boot-like" then this is likely...
Tetrology of Fallot...right ventricle enlargement
60
If the heart appears tipped downward this is likely...
Whatever could cause left ventricular hypertrophy
61
Continuous machinery type murmur
Patent Ductus Arteriosus
62
Pt's who have bicupsid aortic valve, marfan, loeys-dietz, and turner's syndromes are all at risk for...
aortic dilation and dissection
63
Phasic variation int he heart rate (sinus arrhythmia) is normal or abnormal? How do you check/test it?
NORMAL
Have pt do jumping jacks (anything to increase the HR) and if HR becomes more regular, it is benign
64
Are PAC or PVC's more common?
PACs
65
Ventricular premature beats are usually benign and disappear as HR increases but what are two things that can suggest underlying disease?
1. If exercise results in an increase or coupling of contractions
2. Multifocal ventricular premature beats are always abnormal
66
Iritis in a child is associated w/ what two diseases?
1. Juvenile idiopathic arthritis
| 2. Inflammatory bowel disease (Crohn's more than UC)
67
The most common primary intraocular malignancy of childhood....
Retinoblastoma
68
Most nystagmus in children is due to _____ when it is congenital. When it is acquired you should look at _____ causes.
Ocular origin = congenital
CNS = acquired
**Refer to Opthalmology regardless
69
Esotropia treatment
Surgery is mainstay of tx or congenital esotropia (to 2 yo)
Glasses w/ or w/o bifocals, amblyopia tx, surgery
70
If a patient has esotropia after age 5 of acute onset what must be ruled out?
CNS disease
71
Pseudostrabismus
Looks like child has amblyopia but look at light reflexes and they are symmetrical. Many times d/t child having fat bridges of nose
72
Cross Cover Test
- When covering one eye and the other moves outward....
- When covering one eye and the other moves inward.....
Eye moving outward? --> The eye was deviated inward (esotropic)
Eye moving inward? --> The eye was deviated outward (exotropic)
73
Treatment of amblyopia
Patching good eye to make the bad eye do work
Tx is usually discontinued after age 9 because the critical period of visual development is in the 1st decade
74
Patient's at a high risk for hyphema?
Sickle cell anemia
75
Complications of hyphema (4)
1. Inc. intraocular pressure
2. Glaucoma
3. Permanent corneal staining
4. Vision loss
76
Is vision normal or abnormal in papilledema?
Normal
77
Pre-septal v. Orbital Cellulitis
Infection behind the eye (orbital septum) is orbital cellulitis and causes ptosis (eyeball sticking out).
78
Predisposing factors of Otitis Media
1. Bacterial
2. Viral URI
3. Smoke exposure
4. Eustachian tube dysfunction
5. Impaired host immune defenses
6. Bottle feeding/pacifier
7. Genetic susceptibility
79
Otitis Media tx guidelines
< 2 = abx
> 2 = observation if not severe (but give pain meds)
Abx: amoxicillin, cephalosporin if allergic
2nd line - amoxicillin/clavulanate
3rd line - typmanocentesis considered
If recurrences > 4 weeks it is probably a new pathogen so use amoxicillin again
80
Congenital Ear Malformations (5)
1. Agenesis/Atresia
2. Microtia
3. Lop ears (Dumbo Ears)
4. Low-set ear (below palpebral fissure)
5. Preauricular tags
81
Which congenital ear malformations are said to be associated w/ renal syndromes?
Low-set ears and preauricular tags)
82
Which sinus' are present at birth?
Ethmoid, Maxillary, Sphenoid
83
When does the frontal and sphenoid sinus' come in?
Frontal: 2-4 yrs; rarely site of infection until 6-10 years
Sphenoid: present at birth but not clinically significant until 5th to 8th year
84
Which sinus is the site for orbital cellulitis?
Sphenoid
85
To diagnose as sinusitis how long should the URI symptoms persist?
10+ days
86
Complications from sinusitis?
1. Orbital cellulitis (ethmoid/sphenoid)
2. Pott's Puffy Tumor (frontal sinus)
3. Cheek cellulitis (maxillary sinus)
87
Tx of sinusitis
Mild/mod: amoxicillin
Severe, in daycare, or on abx within past 3 months: high dose amoxicillin-clavulanate
If toxic or signs of CNS infection: hospitalized w/ nafcillin & 3rd gen cephalosporin
88
Choanal Atresia: unilateral v. bilateral
Unilateral: may be mistaken for chronic rhinosinusitis
B/L: severe respiratory distress @ birth...requires immedate placement of an oral airway and surgical consult
89
Over 90% of sore throats and fever in children are due to....
viral infections
90
Presentation of Infectious Mononucleosis (Epstein-Barr)
Exudative tonsilitis
Generalized cervical adenitis
Fever
> 5 yo
91
What is NOT a good tx for mono?
Amoxicillin...drug will precipitate a rash (this can be diagnostic when you tx one as if they had strep)
92
Acute bacterial pharyngitis is mainly caused by what bacterium? What is the 2nd most common bacterium?
Group A streptococcal
2nd most common -- mycoplasm
93
Presentation and Tx of Strep Pharyngitis
Pres: sore throat, odynophagia, fever, abdominal pain, headache
Tx: Definitive dx is by throat culture or rapid antigen test...DO NOT PUT ON ABX WHEN WAITING FOR THROAT CULTURE
Abx= PCN
94
Untreated strep can lead to...
Scarlett Fever
| --rash on skin, tongue has strawberry appearance
95
Indolent ("cold") mildly tender adenopathy is caused by...
Cat...cat-scratch disease caused by Bartonella henselae
96
Cervical lymphadenitis look alikes
1. Thyroglossal Duct Cyst
2. Branchial Cleft Cyst
3. Parotitis
4. Ranula
5. SCM Muscle Hematoma
97
How is Early Childhood Caries (ECC) defined?
Presence of one or more decayed, missing (d/t carries), or filled tooth surfaces in any primary tooth in a child age 6 or under
98
Is the frequency or quantity of sugar more important in determining ECC risk in children?
Frequency
99
Where do children receive the most of cariogenic bacteria?
From their mother
100
Current recommended range of fluoride in the water system
0.7 to 1.2 mg/L
101
A pt presents w/ chronic cough, wheezing, chronic OM and when chest is x-ray you see situs inversus. What is the disease and what diagnostic tests are needed to confirm this?
Primary Ciliary Dyskinesia (Kartageners)
Get EM (electron microscopy) of cilia and check sperm motility (should not be mobile...males are infertile)
102
Lung developmental stages (5) including their time length
1. Embryonic Stage (3-7weeks)
2. Pseudoglandular (5-17 weeks)
3. Canalicular (16-26 weeks)
4. Sacular (26-36 weeks)
5. Alveolar (36 weeks - 3-8years)
103
FEV1/FVC ratio in both obstructive and restrictive lung disease
FEV1/FVC decreased in obstructive, increased in restrictive
104
When should you start doing spirometry readings on children w/ asthma?
4 years old (so that they can properly do spirometry)
105
Laryngomalacia presentation and tx
Pres - intermittent to persistent stridor in first 6 weeks, stridor is worse in supine position, w/ inc. activity, URI, or during feedings
Tx: benign disorder that goes away by 2 usually...surgery if it is serious
106
Child presents w/ a barking cough and stridor that is worse at night and improves during the day. What radiographic sign would you expect to see and what is the tx?
Viral Croup
- -> Steeple Sign
- -> Tx: cool, moist air, racemic epi via neb, maybe dexamethasone
107
Thumbprint sign is..... and the tx is....
Epiglottitis
Tx: Immediate endotracheal intubation and then IV abx (ceftriaxone usually) after cultures and blood have been taken.
108
Most common cause of bacterial tracheitis (pseudomembranous croup)
Staph aureus
109
How do you tx bacterial tracheitis?
Debridement of airway w/ intubation and IV abx for H flu
110
What do kids usually present w/ first w/ underlying Cystic Fibrosis?
GI symptoms...many have myconium ileus when born
111
Bronchiectasis can be caused by these 6 things....
1. CF
2. Severe PNA
3. FB aspiration
4. Primary Ciliary Dyskinesia (Kartageners)
5. Chronic aspiration
6. Immune deficiency
112
What would you see on a CXR of a pt w/ bronchiectasis?
Increased bronchovascular markings and areas of atelectasis with hyperinflation
113
Ground glass appearance on CXR, preterm infant
Hyaline Membrane Disease (RSD type 1)
Tx: corticosteroids, O2, nasal CPAP, Early intubation and surfactant
114
RSD Type 2 (Transietn tachypnea of newborn) presentation and tx
Caused by delayed clearance of fetal lung fluid in late premature to full term babies...associated w/ C sections
Tx: O2 support for 12-24 hours
115
A premature infant requiring prolonged oxygen supplementation and PPV is at risk for developing...
Bronchopulmonary Dysplasia
116
Most pneumonia's in children are of ____ origin.
Viral
117
Lower airway viral infection in children < 2 yo that is most commonly caused by RSV
Bronchiolitis
118
Which side of the lung is most commonly affected in aspiration pneumonia
Right side...RUQ
119
Diagnose Children's Interstital Lung Disease Syndrome (chILD)
Needs 3 of 5 criteria:
1. Symptoms of impaired respiratory function
2. Evidence of impaired gas exchange
3. Diffuse infiltrates on imaging
4. Presence of adventitious sounds (rales/wheeze)
5. Abnl spirometry, PFTs, CO2 diffusion capacity
120
Scoliosis tx's
< 20 degree Cobb angle = observation
20-40 = controversial bracing
40-60 = spinal fusion if progressive
> 60 = poor pulmonary function, do surgery
121
Pleural effusions often accompany...
bacterial pneumonia
122
If you find a mediastinal mass on the anterior/superior portion it is likely _____ tissue. On middle? On posterior?
Ant/Superior = thymus tissue
Middle = Lymphomas
Posterior = Neural tissue
123
An infant presents w/ postprandial regurgitation that improves when the child sits up. What is your diagnosis and tx
Gastroesophageal Reflux
Tx: antacids (these are diagnostic as well) and smaller, thicker, more frequent meals
124
An infant presents w/ postprandial regurgitation that does not improve when you give antacids. What diagnostic test should you perform to confirm your suspicions (include what you expect to see) and your ultimate tx
Eosinophilic Esophagitis
--> Endoscopy: shows white exudate w/ eosinophils, hypertrophied mucosal rings, possible strictures
--> Tx: Elimination diet, swallowed inhaled steroids, dilation if strictures
125
Birds beak seen on barium esophagram
Achalasia of Esophagus
126
Which does greater damage to the esophagus? pH < 2 or pH > 12?
pH > 12...deeper injury w/ liquefactive necrosis
127
What is the most commonly swallowed foreign body in children?
Coins
128
80-90% of foreign bodies pass. When is removal recommended?
1. Button batteries
2. Open safety pin in stomach
3. More than 1 magnent (2 can stick together and perforate mucosa causing necrosis)
4. Objects > 5cm
5. Wooden tooth picks
129
Postprandial nonbilious vomitting that can be projectile w/ gastric wave noticed. (include tx)
Pyloric Stenosis
Tx: Pyloromyotomy w/ fluid resuscitation prior to surgery
130
If you find that a child has an ulcer caused by H pylori what abx do you use?
Triple therapy: PPI + Amoxicillin + clarithromycin (abx for 10-14 days, PPI for 6 weeks)
131
Congenital diaphragmatic hernia affects the ____ side 80% of the time
Left side
132
At what age does rebound occur in BMI? If a child rebounds early, what is this predictive of?
5 yo
Those who rebound before 5 have a higher risk of obesity in childhood and adulthood
133
Congenital pathologic short stature vs. Constitutional growth delay vs. familial short stature
Pathologic -- infant born small and growth gradually tapers off throughout infancy.
Constitutional --wt and ht drop in their percentiles near the end of infancy, parallel the norm through middle childhood, and accelerate towards the end of adolescence. Adult size is normal
Familial -- Parents are small, growth runs below normal curves
134
Most common cause of serious injury/death in children and teens
Motor Vehicle Accidents
135
Routine disease prevention measures given to all newborns (4 are listed)
1. Vit K prophylaxis
2. Abx eye prophylaxis (erythromycin)
3. HepB immunization
4. Breast feeding
136
Presentation of ALL (Acute lymphoblastic leukemia)
- -Leg & joint pain
- -Fever
- -Petechiae
- -Heptaosplenomegaly
137
Most common childhood CA
Leukemia...ALL accounts for 75% of these and AML (acute myeloblastic leukemia) accounts for 20%
138
ALL is known as "The Great Imitator". What are some other differentials that present similar to ALL
1. Idiopathic thromboctopenic purpura (ITP)
2. Aplastic anemia
3. Mono
4. Juvenile Rheumatoid Arthritis
5. Leukemoid reaction
139
What is required for dx of ALL?
Examination of bone marrow
- -> total leukocyte counts less than 10,000/mm3
- -> 25% blasts (nml bone marrow contains < 5%)
140
ALL Tx: Maintenance therapy
Methotrexate and 6-mercaptopurine, vincristine, and prednisone given for 2-3 years to prevent relapse
Discontinued in children who remain in complete remission for 2-3 years
141
5 yr survival rate for childhood ALL
80%
142
ALL has a peak incidence at age ___ and affects ____ more than ____.
age 4
| affects boys more than girls
143
High susceptibility to leukemia is associated w/ certain heritable diseases...name the common one
1. Down's (10-15x inc. risk)
144
Vaccines and ALL chemo tx
Live virus vaccines are CONTRAINDICATED while taking chemo tx and also for family members for at least 6 months after completion of tx
Non-live vaccines are not absolutely contraindicated but still not useful and not routinely done
145
Two wks after a viral syndrome, a 2-yo develops bruising and generalized petechiae that is more prominent over the legs. He has neither hepatosplenomegaly nor lymph node enlargement. Lab testing revelas nml hemoglobin, hematocrit, and WBC and differential. Platlet count in 15,000. What is likely diagnosis and tx?
Immune (idiopathic) thrombocytopenic purpura (ITP)
Tx: IVIG, anti-immunosuprressives, or steroids
146
Healthy adolescent male with preceeding pharyngitis, has periorbital edema and HTN, developed tea-colored urine that has RBCs in it
Acute Poststreptococcal Glomerulonephritis (APSGN)
147
Interval between GABHS pharygitis and APSGN
1-2 wks
148
Most important lab tests for APSGN
Serum C3 and C4 levels
C3 is low and C4 is nml
Confirm dx by evidence of strep infection such as elevated anti-DNAase B titer
149
Most common postiinfectious nephritis...prognosis?
Streptococcal glomerulonephritis (APSGN)
Prognosis is good...98% recover fully
150
16 yo adolescent male complains of intermittent dark urine of several yrs duration usually when he has a cold. Otherwise well w/ no complaints. Appears healthy on PE. What is the most likely cause?
IgA nephropathy
151
Benign familial hematuria
Autosomal dominant that causes persistent or intermittent hematuria w/o progression to renal failure. Bx reveals a thin basement membrane
152
16 yo previously healthy adolescent w/ recent behavior changes and declining school performance has a most likely diagnosis of....
Drug abuse (cocaine, amphetamines)
153
Most commonly used drugs in adolescents...
Most commonly used illicit drug used in adolescents...
Alcohol and cigarettes
Weed
154
14 yo presents w/ ataxia. Appears emotionally labile, bit disorientated. Nystagmus & hypersalivation. Has abusive language. Which drug is responsible for this behavior?
PCP
155
In appendicitis does the emesis come before or after periumbilical pain?
AFTER onset of pain
156
Criteria for ADHD diagnosis
Symptoms must be present for at least 6 mos in two or more settings (school and home), some symptoms must have been present before age 7 and must result in impaired function
157
Children w/ ADHD frequently have coexisting learning disorders including...
```
Oppositional-defiant disorder (35%)
Conduct disorder (25%)
Anxiety disorder (25%)
Depression (18%)
```
158
Commonly used pharmacologic agents used to tx ADHD
Methylphenidate
| Dextroamphetamine
159
3 most common pathogens of AOM
1. S. pneumoniae
2. H. influenza
3. M. catarrhalis
160
___ is the most common childhood movement disorder
Cerebral Palsy
161
Cerebral Palsy if suspected when a child fails to meet these developmental milestones: (3)
1. A stepping response after age 3
2. Moro reflex beyond 6 months
3. Asymmetrical tonic neck reflex beyond 6 months
162
A disorder of movement or posture resulting from an insult to, or an anomaly of, the CNS
Cerebral Palsy
163
T/F: Most children w/ cerebral palsy have no identifiable risk factors
True
164
A small appearing 5 yo previously dx w/ asthma, rectal prolapse, and sinusitis presents w/ fever, scant purulent rhinorrhea, abnl breath sounds, digital clubbing. What is most likely dx?
CF
165
T/F: A negative sweat chloride test rules out CF
False
166
A term infant develops vomitting and abdominal distention at 10 hrs. No stool passage. Abnl radiograph shows distended bowel loops and a "bubbly" pattern in a portion of intestine; the colon is narrow. What is this?
Possible meconium ileus
- -> almost always assoc. w/ CF
- -> surgical emergency
167
2 month old infant arrives w/ bulging of his anterior fontanelle. He is fussy, refuses to nurse or take a bottle, and has vomited once en route to the hospital. He has had no fever. CT scan of the head is negative for trauma or tumor. In addition to meningitis, your differential should include...
Vitamin A excess
168
Full term 1 wk old boy presents w/ bilious vomiting and lethargy. Noted to have significant abdominal distention and blood in diaper. Most likely dx?
Malrotation w/ volvulus
| --> surgical intervention!!
169
Classic features of intussusception
Fever
Intermittent colicky abdominal pain
Currant jelly stools
Sausagelike abdominal mass
170
If you suspect intussusception what is your best next step in management? (diagnostic study)
air contrast enema is the "Gold Standard"
171
You suspect muscular dystrophy in a child...what is your diagnostic test of choice?
DNA peripheral blood analysis or immunohistochemical detection of abnormal dystrophin on a muscle biopsy
172
Duchenne MD is genetic. How is it passed on?
X-linked recessive trait
173
Most common hereditary neuromuscular degenerative disease
DMD
174
T/F: All DMD patients have some degree of cardiomyopathy
True...does not correlate w/ degree of skeletal involvement.
175
The second most common MD in the US is...
Myotonic Dystrophy
176
T/F: Creatine kinase levels are elevated in 80% of male carriers of DMD
False...80% of FEMALE carriers
177
In suspected DMD should you do a muscle bx or Cr kinase measurement first?
Cr kinase measurement b/c it is less invasive and rapid results
178
8 yo girl presents w/ positive NAAT for N gonorrhoeae and disclosed that her mother's boyfriend sexually abused her. Next steps in tx/management
1. Confirm test result by testing a 2nd time
2. Administer tx --> single dose of ceftriazone IM
3. Blood tests for HIV and Syphillis
4. Notify child protective services and/or law enforcement
179
T/F: Most victims of sexual abuse know their abusers; may be family members, friends, acquaintances
True
180
What type of hematomas are more common in younger children? Older children?
Younger: Subdural hematomas
Older: Epidural hematomas
181
T/F: Seizures are more common in epidural hematomas.
False. They are more common in subdural hematomas
