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Clinical review 3 > Pediatrics > Flashcards

Pediatrics Flashcards

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
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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
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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

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4
Q

Rooting

A

Stroke skin by mouth. Mouth will open and try and suck

Age: 28 wks gestation to 3-4 months

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5
Q

Babinski

A

Scrap baby foot, upgoing toe is normal.
Age: birth to 2 years.
Negative or diminished response suggestive of neuro abnormalities

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6
Q

Palmer grasp

A

Place finger in baby hand, baby will grab finger

Age: 28 wks G, to 3-4 months

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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

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8
Q

Place stepping

A

Hold up from behind, have one sole touch the table. Stepping will alternate.
Age: birth to variable

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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

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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

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11
Q

TORCH infections

A 
Most common infections associated with congenital anomalies.
Toxoplasmosis
Other: syphilis, varicella, parovirus
Rubella
Cytomegalovirus
Herpes infections
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12
Q

Most common causes of respiratory distress in newborn

A
  1. transient tachypnea (retained fetal lung fluid)
  2. aspiration syndromes (aspiration of meconium)
  3. congential pneumonia (infections before or during labor)
  4. pneumothorax
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13
Q

Common causes of difficult delivery?

A

Large fetus
Abnormal presentation position
Fetal distress requiring rapid extraction

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14
Q

Common type of birth trauma

A 
Soft tissue bruising
Fractures
Cervial plexus palsies
Skull fracture and spinal cord injuries
Intracranial hemorrhage
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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
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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)
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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

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18
Q

Effects of maternal tobacco use

A

Intrauterine growth restriction

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19
Q

common problems of prematurity?

A

Immature development of organs and systems predisposes to depression of most functions.

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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

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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

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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

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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)

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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

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25
Q

Develop Milestones:

15 months

A

GM: stoops and recovers
FM: scribbles in imitation
Comm: uses 3-5 words
Cog: Uses spoon and cup, turn pages in a book

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26
Q

Develop Milestones:

18 months

A

GM: runs well
FM: builds tower of 3 cubs
Comm: points to 1-3 body parts
Cog: “helps” in house

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27
Q

Develop Milestones:

24 months

A

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

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28
Q

Develop Milestones:

36 months

A

GM: Pedals a circle
FM: copies a circle
Com: 3 word sentances, 75% of language intelligible to stranger
Cog: brush teeth with help

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29
Q

Develop Milestones:

48 months

A

GM: hops
FM: copies a square or cross
Comm: 100% language understood by stranger, plays cooperatively with group
Cog: knows 4 colors

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30
Q

Develop Milestones:

5 years

A

GM: skips
FM: copies triangle
Comm: defines simple words, use 5 word sentence
Cog: dresses self

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31
Q

Breast milk: adv and disadvantages

A

Immunologic factors (IgA); protects baby from everything first 4 months

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32
Q

WHO recommendations for breastfeeding

A

Exclusive breast feeding for first 6 months of life, continued breast with appropriate comp through first 2 years of life

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33
Q

Recommendations for sleep positions for infants?

A

Baby sleeps on back, not stomach! On firm surface without the mouth covered.

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34
Q

Define failure to thrive

A

Child 2 or younger below the 5% for more than one occasion, or crosses 2 major % downward on standarized growth grid.

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35
Q

Most common cause of FTT

A

Inadequate caloric intake (environmental and behavioral)

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36
Q

What are the core deficits in autism spectrum disorder?

A
  • Persistent deficits in social communication and social interaction across multiple contexts
  • Restricted, repetitive patterns of behavior, interests, or activities.
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37
Q

Etiology of autism spectrum disorder?

A
  • None in 80-90% of cases
  • Fragile X syndrome or chromosome 15q duplication
  • There is a strong familial component.
38
Q

Evaluation and management of autism:

A

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
Q

Autosomal dominant?

A

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
Q

Autosomal recessive:?

A

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
Q

X-linked dominant?

A

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
Q

X-linked recessive?

A

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
Q

Y-linked?

A

Only father to son inheritance.

Ex: y chromosome infertility

44
Q

Non-mendelian inheritance?

A

Disorders of imprinting and mitochondria: Mitochondrial DNA only come from egg cells, every generation has the mutation.

45
Q

Multifactorial inheritance

A

Genetic predisposition to a disorder but environmental factors also influence outcome.

46
Q

Down’s syndrome:

A

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
Q

Encopresis

A

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
Q

Enuresis

A

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
Q

Trisomy 13

A

Patau syndrome
Eti: F>M
S/sx: CNS and eye malformations, cleft lip/palate, polydactyly, syndactyly, congenital heart dz.
Prog: poor life expectancy

50
Q

Trisomy 18

A

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
Q

Turner syndrome

A

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
Q

Kleinfelter

A

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
Q

Fragile X syndrome

A

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
Q

Neonatal acne

A

Sebaceous glans stimulated by maternal androgens.

55
Q

Mottling in infants

A

Dilated cutaneous vessels over extremities / trunk of neonates exposed to lowered temperature
“lace like pattern” reticular discoloaration

56
Q

Cafe au lait macule

A

Hyperpigmented macule from birth.

If more than 6 that are greater than 1.5cm = neurofibromatosis Type 1

57
Q

Hemangioma

A

Red, rubbery, plaque or nodule.
Blood vessel lesion
Tx: oral porpranolol

58
Q

Epidermal nevi

A

Common mole

Well-demarcated, brown/black macules

59
Q

Miliaria

A

Heat rash
Eti: obstruction of the eccrine sweat ducts, heat and high humitidity…
Tiny vesicles with or without erythmea crystallina/rubra

60
Q

Milia

A

Transient: epidermal cysts filled with keratinous material

61
Q

Keratosis pilaris

A

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
Q

Acne: Eti, Epi, S/sx, Tx

A

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
Q

Impetigo

A

Eti: staph or strep
S/sx: erosion covered by honey colored crusts
Tx: topical mupirocin or retapamulin
Systemic tx: Dicloxacillin or cephalexin, clindamycin

64
Q

Cellulitis

A

Eti: GABHS and staph
S/sx: erythematous, hot, tender, ill-defined, edematous plaques, Regional lymphadenopathy
Tx: systemic abx with coverage: clindamycin

65
Q

Folliculitis

A

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
Q

Scarlet fever

A

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
Q

Scabies

A

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
Q

Pediculoses - Louse

A

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
Q

Urticaria

A

Eti: hypersensitivity reaction
S/sx: diffuse, pruritic, elevated wheals
Tx: antihistamines

70
Q

Scalded skin syndrome

A

staph
S/sx: sudden onset of bright red, acutely painful skin, perioral, periobrit, flexural, neck, axilae etc.
Nikolskys sign
Tx: systemic staph abx

71
Q

Tinea capitis

A

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
Q

Tinea corporis

A

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
Q

Tinea cruris

A

Eti: trichophyton…
S/sx: symmetrical, sharply marginated lesions in inguinal areas
Tx: topical anti-fungal for 3-4 weeks

74
Q

Onychomycosis

A

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
Q

Atopic dermatitis (eczema)

A

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
Q

Contact derm

A

Eti; poison ivy etc, nickle, neomyocin
S/sx: blister formation, oozing, and crusting
Tx: potent topical corticosteroids, prednisone

77
Q

Seborrheic dermatitis

A

Eti: yeast infection, most likely genus Malassezia
s/sx: erythematous scaly dermatitis
Tx: frequent washig with zinc soaps, selenium lotions, etc.

78
Q

Pityriasis alba

A

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
Q

Tinea versicolor

A

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
Q

Candida infections

A

Epi: fungal infection
S/sx: itching, flaking, erythema
Dx: KOH, clinical
Tx: topical imidazole cream, nystatin for oral thrush, refractory candidiasis: oral fluconazole

81
Q

Herpes simplex

A

Eti: HSV or VZV
S/sx: painful, grouped vesicles on a red base, flu like symptoms w/ first outbreak
Tx: valcyclovir

82
Q

Varicella zoster: chickenpox

A

Sx: lesions appear in different stages. Dew drop on a rose petal
Tx: supportive, hydration, analgesics, diphendyramine, antipruritics

83
Q

Molluscum contagiosum

A

Eti: poxvirus
S/sx: umbilicated, flesh-colored papules
Tx: cryotherapy, cantharidin

84
Q

Pityriasis Rosea

A

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
Q

Psoriasis

A

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
Q

Alopecia areata

A

Eti: Immunologic pathogenousity
S/sx: complete hair loss in localized area
Tx: Superpotent topical steroids, minoxidil

87
Q

Erythema infectiosum

A

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
Q

Rubeola (normal measles)

A

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
Q

Rubella: german measles

A

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
Q

Roseola

A

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
Q

Lyme disease

A 
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
Q

Rocky mountain spotted fever

A

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

Clinical review 3 (13 decks)

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