Flashcards in Pediatrics Deck (53):
4 week Male with conjunctivitis. What is the likely etiology?
Fleshy colored papa unless with Erythematous base containing eosinophils.
Dx and Mgt?
Erythema toxicum neonatorum
Unintentional deaths in Kids.
4 year old with BMI of 17.5, between 90-95th percentile
In patient less than 2, obese is not used! If >95th percentile: classified as overweight!
If patient is more than 2-18,> 95th percentile is obese! If 85-95: Overweight!
True of RSV?
Months of Nov - Apr
Rarely associated with Co infection
Mild to Mod CAP in PEDS
Peds with OSAS; normal height and weight
Slipped Capital Femoral Epiphysis
Age group with sex?
11-13 in Female
13-15 in Male
12 month with a father that have epilepsy.
Vaccine that can increase the risk of febrile seizures?
MMR - up to 2 weeks from administration
Cows milk, not recommended in the US until what age?
Less than 12 months.
Not enough Iron, Vit E and Essential FA
When to give 2nd dose of Pneumococcal vaccine in children?
If sickle cell
- also if there is anatomic functional or functional asplenia, leukemia, HIV
- 3 yrs apart between 1st and 2nd dose
At age 8-10
If less, just observe
Noctural cough in 2 yr old
Not for <12 months due to risk of botulism
Neck mass in kids
1. Developmental - brachial cleft cyst
7 yr old with multiple purple lesions on the leg + limp on walking and stomach pain
- abd pain
TX: Acetaminophen or Ibuprofen
May give prednisone if with renal involvement
May give Amlodipine if with HTN
Duchenne muscular dystrophy
- rolling prone to supine
- rolling supine to prone
- sitting position unassisted
- walking unassisted
- 4 months from prone to supine
- 6 month from supine to prone
- 9 months to sit unassisted
-18 months to walk unassisted
- conjunctivitis bilateral
- rash any
- edema: hands and feet
- adenopathy: >1.5 cm
-Mucocutaneous sign: strawberry tongue
Get ECHO to rule out aneurysm
Exclusively breast fed
1. Vit d 400 IU - will prevent Rickets
2. Iron for 4 months
7 year old with posterior rib fracture on CXR
What to do?
Child abuse investigation
If less than 2, do a skeletal survey
Skeletal survey not needed for 4 yrs and older
When to start screening with MCHAT?
Behavior that may provide evidence?
- Screen at 18 months and 24 months
- being upset with normal noise
Primary Monosymptomatic enuresis?
- never achieved continuous dry nights; no daytime enuresis
- Do bed alarm
If it fails--> Desmopressin, Imipramine, Oxybutynin
Umbilical Hernia in a 2 year old.
Until when to wait?
Surgical repair if persistent between 3-5 yrs old
Most common cause of chest pain in PEDS?
2nd - Psychogenic
3rd - Pulmo
In the US, most common form of child abuse?
ADHD in a 5 yr old
If >6 yrs old, Meds!
3 week old with high fever, does not look toxic.
Admit! Do septic work up: CBC, LP,UA, Cultures and start antibiotics
Do for PT < 29 days old
Acute otitis media
Tx and dose?
Amox 80-90 mg/kg for 10 days
Augmentin if received Amox in the past 30 days or hx of AOM not resposive to amox.
Student with Lice.
How soon to go back to school?
1st line : Permethrin
May return to school ASAP. Does not need to be nit free
Treat again in 1 week
6 y/o with 48 hr hip pain. With a limp, afebrile, Normal labs and X-rays
Transient synovitis: everything normal
Concussion yesterday. No lost of consciousness. Just headaches and balance problems but can recall everything.
What to do for evaluation?
Do physical and cognitive rest
CT only if focal sx or LOC > 60 seconds
When to screen for Autism
18 months and 24 months
Most common cause of hearing loss in New born?
4 y/o with 6 day hx of fever 103.2
PE: maculopapular rash, bilateral eye injection, shorty bilateral lymphadenopathy, erythematous lips, strawberry tongue and pharyngeal edema.
Kawasaki. --> fever for at least 5 days
Tx. 1. Aspirin 80- 100mg/kg /day divided by 6 hrs
2. If no fever anymore, Aspirin 3-5 mg/kg/day q 6 hrs
3. IVIG within 10 days
4. Cardio referral for echo in 6 wks
5. Low dose aspirin while waiting for Cardio
6month female with bronchiolitis
When to give nebulized hypertonic saline?
1. On hospitalized patient
2. Do not give in the ER
When do you start iron supplement to prevent Iron def anemia?
What if the baby is preterm
Newborn found to have ear deformity
Mom had GDM
What test to order for the baby?
13 y/o brought to ED for worsening asthma
Already on inhaled Fluticasone and Albuterol
What drug to give to prevent hospitalization?
New born male brought in for first exam
DX with Downs
test indicated for all downs?
Echo!!! - 50 % has cardiac defects
Screen also for
5. Hematologic : myeloproliferative d/o ; leukemoid rxn; polycythemia
Do Polysomnography between 1-4 yrs old
8 yr old with ADHD
Psychostimulant: Ritalin or Dextroamphetamine
If below 6 y/o, can do behavioral therapy first
Risk factors for SIDS (6)?
Side sleeping or prone sleeping!
2. Native American
3. BW < 2500g
4. AOG < 37 weeks
Use of Pacifier decreases RISK for SIDS + exclusive breastfeeding per AAP
5 wk old female visits in December. Born at 28 wks because of preeclamsia.
Need what immunoprophylaxis?
Palivizumab (Synagis) for RSV
Given in infants born < 29 wks
6 y/o with limp
No fever, pain on the anterior hip joint increased on internal rotation which is limited
Osteonecrosis of the femoral head (Legg-Calve'-Perthes)
Blood pressure in children...
What is a pre HTN?
What is hypertensive?
Pre HTN is 120/80 or less or between 90-95th percentile
Determined by Age, sex and length
Above 95th percentile is HTN!
Day care center needs:
Director has degree in child related field
Staff knows CPR
Care giver ratio is 1:2
Discipline is standard
MMR can be given at age?
Between 12-15 months
If given before 12 months, needs 2 doses at least 1 month apart
Second dose between 4-6 yrs old
-Measles can caused Thrombocytopenia
Vaccines for 2 month old?
2. Prevnar: Pneumococcal
3. IPV! Not oral
6. Hep B
Car seats guidelines?
- till age of 2: rear facing
- till 13 yrs old: rear seat
- booster: lap and shoulder strap
- Safest: rear middle seat
PPD in children
Only in positive exposure, immunocompromise, immigrants
Genetic testing to be repeated is went home before 12 hrs of life?
Phenylketonuria!!!!- baby did not ingest enough phenylalanine.
Heart murmur in 13 y/o, Systolic, Ejection Murmur at Left upper sternal boarder, second sound has splitting with inspiration, louder when supine , softeners with Valsalva or standing
Pulmonary flow murmur!
ASD - Left upper sternal
Venous hum - Right upper sternum
Hypertrophic cardiomyopathy - left lower sternal border
VSD- Left lower sternal boarder
Diastolic murmur: always pathologic
Start at age 6 months
HPV in males?
9- 26 y/o
Two dose if below 15 y/o
- 1st dose should be 0 then the second dose is at 6 months- 12 months
- if second is given less than 5 months from first dose, RPT! Hence 3 doses, 12 weeks after 2nd dose