Pediatrics Flashcards
(92 cards)
1
Q
Apgar Score
A
Recorded at 1 minute and 5 mintues Categories: 0-2 points each Heart rate Respiratory rate Muscle tone Response to catheter in nostril Color
2
Q
New born physical exam
A
Vitals Weight, length, head c. Apgar score 1,5 mintues of life Skin color Skeletal exams: congenital anomalies, resting muscle tone, activity HEENT Abdomen Genitalia and anus Neuro: reflexes, sensory
3
Q
Asymmetric tonic neck
A
Supine baby, turn head to one side. Arm and leg of that side will extend, opposite arm and leg flex. “Fencing”
Ages: 2-6 months
4
Q
Rooting
A
Stroke skin by mouth. Mouth will open and try and suck
Age: 28 wks gestation to 3-4 months
5
Q
Babinski
A
Scrap baby foot, upgoing toe is normal.
Age: birth to 2 years.
Negative or diminished response suggestive of neuro abnormalities
6
Q
Palmer grasp
A
Place finger in baby hand, baby will grab finger
Age: 28 wks G, to 3-4 months
7
Q
Startle (moro)
A
Hold baby supine, abruptly lower. Arms will abduct at the shoulder and extend at the elbow
Age: until 4-6 months per Ted
8
Q
Place stepping
A
Hold up from behind, have one sole touch the table. Stepping will alternate.
Age: birth to variable
9
Q
Prophylaxis within 48 hours of birth
A
Erythromycin ointment to the eyes: gonococcal opth
Vitamin K: prevent hemorrhag
Hep B vac:
Cord blood: blood typing, coombs test if mom is O or neg
Genetic screen: PKU….
Congenital heart disease
10
Q
Types of neonate jaundice
A
Physiologic (normal): Liver is still maturing
Breastfeeding: not enough milk
Breast milk jaundice: caused by breast milk increasing bilirubin to rise.
Blood group incompatibility: Rh, ABO
Sepsis: TORCH
11
Q
TORCH infections
A
Most common infections associated with congenital anomalies. Toxoplasmosis Other: syphilis, varicella, parovirus Rubella Cytomegalovirus Herpes infections
12
Q
Most common causes of respiratory distress in newborn
A
- transient tachypnea (retained fetal lung fluid)
- aspiration syndromes (aspiration of meconium)
- congential pneumonia (infections before or during labor)
- pneumothorax
13
Q
Common causes of difficult delivery?
A
Large fetus
Abnormal presentation position
Fetal distress requiring rapid extraction
14
Q
Common type of birth trauma
A
Soft tissue bruising Fractures Cervial plexus palsies Skull fracture and spinal cord injuries Intracranial hemorrhage
15
Q
Effects of maternal drug abuse:
Cocaine and meth
A
No specific syndrome:
- irritability, tremors, increased stress response
- Higher risk of neglect, SIDS, abuse
- Higher risk of preterm delivery, stillbirth, placental abruption
16
Q
Effects of maternal ETOH use
A
Most common preventable cause of mental retardation
- Craniofacial (vermilion of upper lip, flat philtrum, short palpebral fissures
- Growth deficiencies
- CNS (microcephaly, agenesis of corpus callosum)
17
Q
Effects of maternal opioid use
A
Symptoms begin 1-3 days of life
Withdrawal signs: CNS: irritability, hyperactivity, hypertonicity, etc.
GI: v/d/poor feeding, incessant hunger, excessive salivation
Metabolic/Res:
Intrauterine Growth restriction
18
Q
Effects of maternal tobacco use
A
Intrauterine growth restriction
19
Q
common problems of prematurity?
A
Immature development of organs and systems predisposes to depression of most functions.
20
Q
Develop Milestones:
2 months
A
GM: lifts head/chest when prone
FM: eyes tract past the midline
Communication: alert to sound, reciprocal smile
Cog: recognizes parent
21
Q
Develop Milestones:
4 months
A
GM: Rolls front to back
FM: Grasps a rattle
Com: Laughs, soothed by parents voice
Cog: orients head to direction of a voice
22
Q
Develop Milestones:
6 months
A
GM: Sits with little or no support
FM: Reaches with one hand, transfers objects
Comm: Babbles, developing stranger anxiety
Cog: Feeds self
23
Q
Develop Milestones:
9 months
A
GM: pulls to stand
FM: developing pincer grasp, bangs two objects together
Comm: Says: mama/dada indiscriminately, waves bye-bye
Cog: plays, gesture games (pat-a-cake)
24
Q
Develop Milestones:
12 months
A
GM: Stands/walks alone
FM: fine pincer grasp
Comm: one word other than mama/dada, Follows on step commands with a gesture
Cog: points to desired object
25
Develop Milestones:
| 15 months
GM: stoops and recovers
FM: scribbles in imitation
Comm: uses 3-5 words
Cog: Uses spoon and cup, turn pages in a book
26
Develop Milestones:
| 18 months
GM: runs well
FM: builds tower of 3 cubs
Comm: points to 1-3 body parts
Cog: "helps" in house
27
Develop Milestones:
| 24 months
GM: throws ball overhand, kicks ball
FM: Copies drawing a line with crayon
Comm: speaks 2-word combos, 50 plus word vocab
Cog: removes article of clothing
28
Develop Milestones:
| 36 months
GM: Pedals a circle
FM: copies a circle
Com: 3 word sentances, 75% of language intelligible to stranger
Cog: brush teeth with help
29
Develop Milestones:
| 48 months
GM: hops
FM: copies a square or cross
Comm: 100% language understood by stranger, plays cooperatively with group
Cog: knows 4 colors
30
Develop Milestones:
| 5 years
GM: skips
FM: copies triangle
Comm: defines simple words, use 5 word sentence
Cog: dresses self
31
Breast milk: adv and disadvantages
Immunologic factors (IgA); protects baby from everything first 4 months
32
WHO recommendations for breastfeeding
Exclusive breast feeding for first 6 months of life, continued breast with appropriate comp through first 2 years of life
33
Recommendations for sleep positions for infants?
Baby sleeps on back, not stomach! On firm surface without the mouth covered.
34
Define failure to thrive
Child 2 or younger below the 5% for more than one occasion, or crosses 2 major % downward on standarized growth grid.
35
Most common cause of FTT
Inadequate caloric intake (environmental and behavioral)
36
What are the core deficits in autism spectrum disorder?
- Persistent deficits in social communication and social interaction across multiple contexts
- Restricted, repetitive patterns of behavior, interests, or activities.
37
Etiology of autism spectrum disorder?
- None in 80-90% of cases
- Fragile X syndrome or chromosome 15q duplication
- There is a strong familial component.
38
Evaluation and management of autism:
Age of diagnosis: often not until 3-4
Early characteristics: failure to orient to one’s name, regard people directly, use gestures, develop speech.
Screen at: 18 months, and 24-20 months
39
Autosomal dominant?
One mutated copy of the gene that is inherited from a parent or results from a new mutation. Ex: Huntington disease or Marfan syndrome
40
Autosomal recessive:?
Both mutated copies of the gene come from both parents; not typicaly seen in every generation of an affected family. Ex: cystic fibrosis, sickle cell disease
41
X-linked dominant?
In females: only one of the X chromosomes affects the kid
| In males: only have 1 x chromosome, typically more severe symptoms: no male to male transmition. Ex: fragile x syndrome
42
X-linked recessive?
In females: would need mutation on both X chromosomes to be affected
In males: will always be affected: NO male to male transmission. Ex: hemophilia
43
Y-linked?
Only father to son inheritance.
| Ex: y chromosome infertility
44
Non-mendelian inheritance?
Disorders of imprinting and mitochondria: Mitochondrial DNA only come from egg cells, every generation has the mutation.
45
Multifactorial inheritance
Genetic predisposition to a disorder but environmental factors also influence outcome.
46
Down’s syndrome:
Trisomy 21, increased risk if maternal age greater than 35
Any 6 of these: hypotonia, poor moro reflex, hypermobility of joints, flattened facies + occiput, excess kin on post neck, anomalous auricles, upward-slanting palpebral fissures, pelvic dysplasia, simian crease
Comp: congenital heart disease (septal def)
47
Encopresis
Repeated passage of stool into inappropriate places by a child who is older than 4 years, occurring each month for 3 month.
S/sx: constipation of 2 or more of the following events in 2 months.
- fewer than three bowel movements in a week
- more than one episode of encopresis per week
- impaction of the rectum with stool
- passage of stool so large it blocks the toilet
- retentive posture and fecal withholding
- pain with defication
48
Enuresis
Repeated urination into clothing during the day and into the bed at night by a child that is older than 5 with no underlying organic problem.
S/sx: At least twice a week for 3 months
49
Trisomy 13
Patau syndrome
Eti: F>M
S/sx: CNS and eye malformations, cleft lip/palate, polydactyly, syndactyly, congenital heart dz.
Prog: poor life expectancy
50
Trisomy 18
Edwards syndrome
Uncommon for fetus to survive.
S/sx: overlapping fingers, clenched fists, low set ears, left-sided clubfeet or rocker-bottom feet, congenital heart dz.
Prog: heart failure or pneumonia common of death
51
Turner syndrome
Absence of X chromosome, females affected only.
S/sx: shield chest, short stature, web neck, short 4th, coarctation of aorta.
Tx: growth hormone and estrogen
52
Kleinfelter
47: xxy, males affected only
S/sx: normal appearance prior to puberty, after: long arms and legs, sparse body hair, gynecomastia, small testes, azoospermia, mental disabilities.
Tx: testosterone replacement
53
Fragile X syndrome
Extra repeated genes on the x chromosome
X-linked condition; most common cause of inherited mental retardation.
S/sx: macroorchidism, large ears, mitral valve prolapse common.
54
Neonatal acne
Sebaceous glans stimulated by maternal androgens.
55
Mottling in infants
Dilated cutaneous vessels over extremities / trunk of neonates exposed to lowered temperature
"lace like pattern" reticular discoloaration
56
Cafe au lait macule
Hyperpigmented macule from birth.
| If more than 6 that are greater than 1.5cm = neurofibromatosis Type 1
57
Hemangioma
Red, rubbery, plaque or nodule.
Blood vessel lesion
Tx: oral porpranolol
58
Epidermal nevi
Common mole
| Well-demarcated, brown/black macules
59
Miliaria
Heat rash
Eti: obstruction of the eccrine sweat ducts, heat and high humitidity...
Tiny vesicles with or without erythmea crystallina/rubra
60
Milia
Transient: epidermal cysts filled with keratinous material
61
Keratosis pilaris
Chicken skin, autosomal dominant.
Characterized by rough, slightly red bumps on light skin and brown bumps on darker skin.
- Often on back and lateral aspects of upper arm.
62
Acne: Eti, Epi, S/sx, Tx
Eti: Influenced by androgens, plugged sebaceous follicle, increased sebum production
Epi: affects 85% of adolescents
Tx: 1st line: Topical keratolytic agents (retinoids, benzoyl peroxide, azelaic acid).
- Topical abx can be used in conjunction with benzoyl or retinoids.
63
Impetigo
Eti: staph or strep
S/sx: erosion covered by honey colored crusts
Tx: topical mupirocin or retapamulin
Systemic tx: Dicloxacillin or cephalexin, clindamycin
64
Cellulitis
Eti: GABHS and staph
S/sx: erythematous, hot, tender, ill-defined, edematous plaques, Regional lymphadenopathy
Tx: systemic abx with coverage: clindamycin
65
Folliculitis
Eti: staph and strep
S/sx: pustule at a follicular opening.
Tx: Warm wet compress or keratolytics.
- topical (mupirocin, clindamycin)or oral anti-staph abx
66
Scarlet fever
Eti: group A strep
S/sx: strawberry tongue, sandpaper rash (begins on head and neck and spreads to rest of body, usually sparing hands and feet). Usually sore throat.
67
Scabies
s/sx: Pruritis! linear burrows, wrists, ankles, finger webs, areolas, axillary folds, genitalia, excoriation
Dx: scrap and examin mite/egg under microscope
Tx: Permethrin 5%, resistnant cases: ivermectin
68
Pediculoses - Louse
Eti: lice
S/sx: excoriated papules and pustles and a history of severe itching at night,
Dx: wet combing 91% sensitive
Tx: Permethrin, clean bedding and clothing
69
Urticaria
Eti: hypersensitivity reaction
S/sx: diffuse, pruritic, elevated wheals
Tx: antihistamines
70
Scalded skin syndrome
staph
S/sx: sudden onset of bright red, acutely painful skin, perioral, periobrit, flexural, neck, axilae etc.
Nikolskys sign
Tx: systemic staph abx
71
Tinea capitis
fungal infection of the scalp
S/sx: pruritic, scalling area of hair loss, can show black dots (distal ends of hair), can have associated cervical lymphadenopathy
Dx: KOH can see arthroconidia (fungal spores)
Tx: Griseofulvin or terbinafine
72
Tinea corporis
Eti: trichophyton...
S/sx: annular marginated plaques with thin scale and clear center
Dx: KOH prep - hyphae
Tx: topical anti-fungal BID for 3-4 weeks
73
Tinea cruris
Eti: trichophyton...
S/sx: symmetrical, sharply marginated lesions in inguinal areas
Tx: topical anti-fungal for 3-4 weeks
74
Onychomycosis
Eti: trichophyton rubrum
S/sx: loosening of the nail plate from bed, yellow discoloration, thickening of distal nail plate
Dx: KOH prep and fungal culutre
Tx: daily topical ciclopirox 8%, terbinafine 6-12 weeks, itraconazole in 1 week pulses
75
Atopic dermatitis (eczema)
Epi: onset before 2 yo, unusual after 30
s/sx: Dry skin.
Infants: cheeks and scalp, oval patches on trunk, extensor.
2-adolescence: flexural, anicubital and popliteal fossa, neck, wrists
Adolescent: chroni flexural eczema and hand/feet.
Tx: Acute: wet dressing and medium potency corticosteroids
Chronic: bath every 2-3 days, twice daily lubrication, topical corticosteroids
76
Contact derm
Eti; poison ivy etc, nickle, neomyocin
S/sx: blister formation, oozing, and crusting
Tx: potent topical corticosteroids, prednisone
77
Seborrheic dermatitis
Eti: yeast infection, most likely genus Malassezia
s/sx: erythematous scaly dermatitis
Tx: frequent washig with zinc soaps, selenium lotions, etc.
78
Pityriasis alba
Eti: associated with atopy, sun exposure, frequency of bathing
S/sx: white, scaly macular areas with indistinct borders over extensor surfaces and on cheeks, often present after sun exposure
Tx: low-potency topical corticosteroids for return to normal pigmentation
79
Tinea versicolor
aka pityriasis veriscolor
Pathogen: pri: Malassezia globosa
S/sx; hypopigmented macules and very fine scales
Dx: KOH, spaghetti and meatballs, woods lamp: yellow to yellow green
Tx: Selenium sulfide, shampoo applied to whole body and leave
80
Candida infections
Epi: fungal infection
S/sx: itching, flaking, erythema
Dx: KOH, clinical
Tx: topical imidazole cream, nystatin for oral thrush, refractory candidiasis: oral fluconazole
81
Herpes simplex
Eti: HSV or VZV
S/sx: painful, grouped vesicles on a red base, flu like symptoms w/ first outbreak
Tx: valcyclovir
82
Varicella zoster: chickenpox
Sx: lesions appear in different stages. Dew drop on a rose petal
Tx: supportive, hydration, analgesics, diphendyramine, antipruritics
83
Molluscum contagiosum
Eti: poxvirus
S/sx: umbilicated, flesh-colored papules
Tx: cryotherapy, cantharidin
84
Pityriasis Rosea
Eti: viral infection
S/sx: pink to red, oval plaques with fine scales in "Christmas tree" distribution. Preceded up to 30 days by a herald patch
Tx: reassurance, steroid creams for pruritus.
85
Psoriasis
Eti: rapidly proliferating epidermal cells produce excessive stratum corneum
S/sx: erythematous papules and plaques with thick, white scales. Elbows, knees, scalp. Nail pitting and distal onycholysis
Tx: Topical steroids. Clobetasol 0.05%
86
Alopecia areata
Eti: Immunologic pathogenousity
S/sx: complete hair loss in localized area
Tx: Superpotent topical steroids, minoxidil
87
Erythema infectiosum
5th disease
Eti: Parvovirus B19
S/sx: Flu-like illness followed by rash, contagious prior to rash not after.
Fever and rash with slapped cheek appearnece, full-body maculopapular rash with lacy appearence
Tx: supportive care
88
Rubeola (normal measles)
Eti: morbillivirus
S/sx: fever, cough, coryza, Koplik spots (white papules on diffusely red base of buccal mucosa.
Maculopapular rash spreading from face (usually the hairline) to trunk.
Tx: vaccination
89
Rubella: german measles
Eti: toga virus
S/sx: Fever with postauricular occipital adenopathy, sore throat, myalgia
Maculopapular rash beginning on face, rapidly spreading to the entire body
Forchheimer spots (rose-colored spots on soft palate
90
Roseola
Eti: herpesvirus 6&7, 90% before age of 2)
S/sx: abrupt high fever on onset, 4-8 days then abruptly ceases, then rose-pink maculopapular nonpruritic rash appears on trunk, spreading to face, neck and extremities
91
Lyme disease
```
Eti: deer tick with borrelia burgdorferi
Epi: NE, mid-atl, midwest, pacific coast
S/sx: red lesion that expands with central clearing, HA, stiff neck, arthralgias, myalgias
Dx: Clinical, serologic studies
Tx: doxy 100 mg BID
```
92
Rocky mountain spotted fever
Eti: tick bite, rickettsia rickettsii
S/sx: sudden fever, chills, malaise, photophobia, abd pain, v/d
Rash in 95%: maculopapular involving palms/soles and extremities (face is spared)
Tx: Must start before rash
