Flashcards in Pediatrics Deck (375):
Which immunization is universally recommended for all children at age 1 year (12-23 mos)
What is the hepatitis B schedule
3 dose series
0, 1-2 mos, 6 months after first
*must delay blood donation for 28 days
How do you treat pertussis
Which one do you get before 7 years of age
Which one do you get after 7 years
Which immunization should a pregnant woman get in the third trimester
What booster immunization does an 11-12 year old get
What immunization is recommended for healthcare workers And patients 65 years or older
Which immunization git rid of epiglottis
Which immunization creates a rash
Which vaccine is important for infants due to tiny airways
Is polio a live or dead virus
Ok to give in immunocompromised patient
Which vaccine is contraindicated in allergies to neomycin, streptomycin, or polymixin B
Live attenuated vaccines equal
Fever & rash
What are to live attenuated vaccine examples
MMR and varicella
At what age should I live attenuated vaccine be given
(MMR and Varicella)
After the age of one years old
Which immunizations should not be given if a patient is allergic to neomycin or gelatin
MMR and varicella
At what age should the meningococcal conjugate vaccine be given (MCV4)
Age 11 to 12 years old
W what is a common reaction with the HPV, MC4, and TDap vaccines
A vaccine should be given in how many days prior to the scheduled time to be considered a valid dose
In how many days given prior to the scheduled time would in a ministration be considered invalid and should be repeated
What type of medication is contra indicated in receiving a varicella or MMR live attenuated vaccination
What is the CDC's recommendation for length of time to monitor a child after receiving an immunization
Which immunization is administered in order to protect the patient from pertussis
A 12 month old received the MMR immunization three weeks ago. When can the varicella vaccination be given
in 1 week
You must wait 4 weeks in between live attenuated vaccinations
What are the core symptoms of ADHD
Hyperactivity, impulsivity, and inattention
What are the names of the rating scales for ADHD assessment
Child behavior checklist, Connors rating scales, Vanderbilt ADHD rating scales
The most commonly prescribed and tested medications for a ADHD are schedule
Highly addictive and often abused. Requires urine drug screen
What drug is used in the treatment of childhood asthma
Leukotriene receptor agonist
Administered via nebulizer
The most common pathogen in pneumonia for children six months to five years old is
When a child has bacterial pneumonia the most common pathogen is
What is the most sensitive sign of pneumonia in children and older adults who are not running a fever
What is the gold standard of diagnostic studies for pneumonia
Besides a chest x-ray what other diagnostic studies should be given to a child with pneumonia
CBC with differential
WBC >15000 if bacterial
What antibiotic choice is first line treatment for pediatric patients who have bacterial pneumonia
Amoxicillin 90 mg per kilogram per day with drug resistant strep pneumo use high dose amoxicillin
If a pediatric patient with bacterial pneumonia is allergic to penicillin, what type of medication should you prescribe
Either a macrolide, or clindamycin
What type of infection is bronchiolitis
How is bronchiolitis treated
How is croup managed
Single dose of oral dexamethasone
On what basis should a child be admitted with croup symptoms
Retractions, stridor, respirations >=20, and history of asthma
What test is used to diagnose cystic fibrosis
What is cystic fibrosis
The inability to transport sodium and chloride across epithelial membranes
What symptoms might be present in a child with suspected cystic fibrosis
Recurrent pulmonary infections
Re-current upper respiratory infections are usually due to
What does lead toxicity masquerade as
Iron deficiency anemia
What are the most common symptoms associated with lead toxicity
Stomach ache, constipation
If you see pan cytopenia on a CBC what is the most likely diagnosis
What type of cancer is failure of the bone marrow
What are the most common presenting signs of leukemia
Fever in the evening, bleeding, long bone pain in legs, lymphadenopathy
At what size are nodes considered to be enlarged
Should you give ibuprofen to a child under 6 mos of age
At what age should the time out method of discipline be initiated
18 to 24 months old
How long should a child remain in time out
One minute for each year of life
In a 3 1/2 year-old child what percentage of speech should be intelligible by people who are not in daily contact with the child
At what age does the child have separation anxiety
Age 7 to 8 months
Went to the lower central incisor teeth start to erupt
When do the upper central incisor teeth erupt
At 8 to 12 months
At what age does a baby respond to their own name and sit up without support
6 to 8 months old
At what age does a baby reach for a toy with one hand and recognize familiar people and objects at a distance
4 to 6 months old
At what age does a baby babble mama baba and transfer objects hand to hand without difficulty.
6 to 8 months
At what age does a baby vocalize AH and OH sounds, and is able to lift had briefly when positioned on the tummy and turn it from side to side.
6 to 8 weeks old
For a baby that was born prematurely, the adjusted age calculation should be used to assess their development until age
In examining a healthy two month old baby boy the foreskin cannot be retracted it is considered that
In most instances, the foreskin is not easily retractable until the child is about three years old
When do symptoms of pyloric stenosis typically begin to emerge
4 to 6 weeks
Olive shaped mass that is palpated on a baby's stomach after projectile vomiting
A four week old has suspected pyloric stenosis. What imaging study is most commonly used to diagnose this?
What symptom might indicate GERD instead of GER in an infant?
Irritability during reflux episode
If a baby is having GER symptoms should the mother continue to breast-feed or not?
Yes she should continue to breast-feed, and please baby in supine position to sleep
This pediatric condition is due to intestinal obstruction, and the child will cry and pull their legs up to their chest. The age of onset is usually 3 to 11 months old. In order to diagnose the distance condition a KUB, abdominal ultrasound would be done. This is a surgical emergency.
What pediatric condition causes currant jelly stools
This pediatric condition consist of involuntary soiling of stool in a child four years old or older. It is more common in males, and the underlying problem is constipation.
How do you treat encopresis?
Laxatives for initial cleansing , then daily until normal stools . encourage child to sit on the toilet for five minutes to to three times daily after meals to establish normal bowel movements . the goal is one soft store per day .
What is the preferred means of oral rehydration for a child who has diarrhea?
Commercially prepared electrolyte solution such as Pedialyte
When should a patient with cryptorchidism be referred to urology?
6 mos. of age
A nine month old has hydrocele. What advice should be given to the caregiver?
It should resolve by 12 months of age. If not then the patient needs a referral to urology
A one-year-old has persistent hydrocele. What might be an underlying cause?
A five-year-old has nocturnal enuresis. How should this be managed?
Allow the child and caregiver to decide when treatment should be initiated.
How do you treat a pediatric urinary tract infection
Collect a specimen and then prescribe a can a third generation cephalosporin such as Cefixime, cefdinir, and ceftibuten
What is the imaging of choice for pediatric urinary tract infection for all and friends ages 2 to 24 months of age with a fever
Renal and bladder ultrasound
An eight-year-old male has a sore throat and a tongue with a prominent, erythematous papillae. What should be part of the differential diagnosis
Strawberry tongue is associated with
Acute generalized systemic vasculitis of the medium size vassals around the heart
What pediatric condition produces conjunctivitis without exudate, macular rash, inflammation of the lips and oral cavity, cervical lymphadenopathy, and EDEMA OF THE HANDS AND FEET
What diagnostic tests are given for a Kawasaki disease?
CBC, ESR, CRP, ALT/AST, UA, throat culture
How is Kawasaki disease treated?
Patient is referred to a pediatric cardiology for IV immune globulin and aspirin. Aspirin daily for two months.
What condition is always a result of a pole injury or twisting of the arm
What condition leads to knee pain in an adolescent
Osgood Schlatter Disease
At what age does Osgood Schlatter disease occur most often
15 years old
What term describes the cause of pain in a patient who has Osgood Schlatter disease?
When does Osgood Schlatter disease occur?
After a growth spurt
How do you manage a patient with Osgood Schlatter disease?
Continuation of activity as pain tolerates, ice, analgesics for 3 to 4 days, kneepad.
When a pediatric patient presents with hip pain what type of x-rays do you get
AP, and frog leg views
What pediatric condition is osteonecrosis of the capital femoral head due to lack of blood supply
What is the Ann office diagnostic tool for Leggs-calves-Perthes disease
What to pediatric hip conditions need x-rays
Slipped Capital Femoral Epiphysis (SCFE) and Leggs-Calves-Perthes Disease
What pediatric hip condition starts with a history of upper respiratory infection 7 to 14 days prior.
Transient Synovitis of the hip
Subsides on its own
Coxsackie A virus is associated with
Coxsackievirus A16 is associated with
Hand foot mouth
Which viral exanthem is a maculopapular brick red rash, that starts on the head and neck and spreads to the trunk and extremities
Which viral exanthem creates a slapped cheek rash, Lacy, macular rash
Fifth Disease (Erythema infectiosum)
Which viral exanthem creates a high fever for 2 to 4 days, then abrupt cessation of fever with the appearance of maculopapular rash but not on the face
Rose Ola (Exanthem subitum)
When can a child with roseola go back to school
24 hours after the patient is fever free
When can a patient with chickenpox go back to school
24 hours fever free and after all vesicles have crusted over
Which viral exanthem is an exotoxin rash secondary to group A strep infection, sandpaper like rash that ultimately desquamates
What disease manifests as vesicles that rupture and produce painful alterations on the soft palate in the mouth
Do all viral exanthem rashes blanche
Does petechiae and purpura Blanche
A three-year old is diagnosed with fifth disease. Her mother is pregnant in the first trimester and has had significant exposure to the sick child. If her mother is not immune, what is the risk of the fetus?
Intrauterine fetal death
At what age is roseola usually diagnosed
7 to 13 months
Koplik spots are associated with
Resembles grains of sand of the oral mucosa and precedes rash
Cough, runny nose, and conjunctivitis are findings of
A bulging and cloudy TM is associated with
acute otitis media
How do you treat otitis media for a child that is under six months of age
How do you treat otitis media in a child six months to two years of age
Antibiotics if severe, observe if not severe
How do you treat otitis media in a child that is greater than two years of age
Antibiotics if severely ill otherwise observation only
A two-year-old is diagnosed with otitis media and an antibiotic is prescribed. When should her fever resolve after receiving the antibiotic?
48 to 72 hours
How do you treat a patient who has had recent antibiotic exposure for otitis media
Amoxicillin clavulanate or Augmentin
If a patient is allergic to pcn, what should be prescribed for otitis media?
2nd or 3rd generation cephalosporins
Pyloric stenosis usually occurs in
The first born male
A mild fever may occur after which vaccination
Pneumococcal conjugate 13 valent vaccine
When is screening for autism recommended
18 to 24 months
What tanner stage is pre-puberty
What tanner stage has breast butts and the popular elevated, Downey pigmented pubic hair along the labia majora. Testes enlarge, scrotal skin reddening with change in texture, sparse growth of long slightly pigmented pubic hair at base of penis.
What Tanner stage is consistent with breast mound enlargements, darker, courser, curly pubic hair on mons, labia majora, onset of growth spurt. Increase in penile length but minimal change in width, sometimes called the pencil penis stage. Further scrotal enlargement, pubic hair darker, courser, covers great area, onset of growth spurt
What tanner stage is consistent with having an areola and papilla elevated to form a second mound above level of rest of breast, adult type pubic hair with no spread to medial surface of thighs, menarche. Increase in penile length and width with development of glans, further darkening of scrotal skin, adult type pubic hair with no spread to medial surface of thighs.
What tanner stage is consistent with the recession of areola to mound of breast, extension of pubic hair to medial thigh. Full adult genitalia, adult type pubic hair with spread to medial surface of thighs, possibly abdomen
What Tanner stage can gynecomastia be found
Tanner stage III
Symptoms of this condition include macroorchidism, large body habitus, history of learning differences.
Fragile X syndrome
What is the most common known cause of autism in either gender, occurring in all racial and ethnic groups.
Fragile X syndrome
Which condition only affects males and has a low testicular volume, hip and breast enlargement, and infertility.
What syndrome is characterized by a short stature, usually evident by age 5, white, webbed neck, Brad, shield shaped chest, absent menses, infertility.
What medication is indicated for cystic acne that does not respond to other therapies such as oral antibiotics and topical retinoids
Anabolic steroid use is consistent with which type of acne
In the USA which of the following is the most common cause of adolescent death
Do the majority of states require either a parental consent or notification for teenagers younger than 18 to have a pregnancy termination
If a child with a BMI of 40 presents with a lipid profile that reveals low HDL, elevated triglycerides, and an acceptable A1c what is the best treatment option
A full-time newborn is diagnosed with hyperbilirubinemia. When would his Billirubin be expected to peak
3 to 4 days
At what age should initial blood pressure screening take place
Which reflex would not be expected in a one month old
Cafe au lait spots are associated with
Neurofibromatosis and Von Recklinghausens Disease
For patients with down syndrome what are they at risk for with high-risk sports
Contact sports such as football, soccer, trampoline, or gymnastics can be a risk of spinal cord injury. Especially after the age of six years. These patients are also at risk for early onset of Alzheimer’s disease
Microcephaly with shortened palebral fissures (narrow eyes) with epicanthal folds and a flat nasal bridge. There is a thin upper lip with no vertical groove above upper lip (smooth philtrum). Ears are underdeveloped. Can range from severe Disease with mental retardation to mild developmental defects that may not be obvious until adolescence (ADD).
Fetal alcohol syndrome
Any neonates with acute conjunctivitis presenting within 30 days or less from birth should be tested for
Chlamydia, gonorrhea, herpes Symplex, and bacterial infection. Order GC culture (Thayer-Martin), heroes simplex culture, and chlamydial PCR with Gram stain of eye exudate. Hospitalize and treat with high dose IV or IM ceftriaxone. Preferred prophylaxis is with topical 0.5% erythromycin ointment (1cm ribbon per eye). Test and treat mother and sexual partner for sexually transmitted diseases.
Symptoms of this will show within 4 to 10 days after birth. Eyelids become edematous and red with Profuse watery discharge initially that later becomes purulent. When obtaining a sample, collect not only the exudate, but also conjunctival cells as well. Treat with systemic antibiotics such as azithromycin IM or oral erythromycin QID for 14 days. Treatment only 80% effective. Many need second course. Use only systemic antibiotics. Prophylaxis is with topical 0.5% erythromycin or tetracycline ointment 1m ribbon per eye. Reportable Disease. Test and treat mother and sexual partner for STDs.
Chlamydial Opthalmia Neonatorum (trachoma)
In infants with opthalmia neonatorum, what else needs to be ruled out
Chlamydial pneumonia. Obtain nasopharyngeal culture for chlamydia. Infant will have frequent cough with by bibasilar rails, tachypnea, hyperinflation, and diffused infiltrates on chest x-ray. Treated with erythromycin QID times two weeks. Daily follow up as this is a reported disease
What place is an infant at a higher risk for sudden infant death syndrome
Prematurity, low birth weight, maternal smoking and or drug use, and poverty. Cause is unknown. Theories range from central nervous system abnormalities, cardiac arrhythmias, suffocation from soft, thick bedding, and so on. To decrease risk, position infants 👶🏻 on their back or supine only. Avoid the side lying and prone position. Avoid overheating infant and use of thick quilts, soft beds, pillows, And so on.
Weight loss of up to 7% of birth weight should be regained by how many days
10 to 14 days
Small pustules that are whitish to yellow color that are 1 to 3 mm in size and surrounded by a red base. Erupts during the second to the third day of life. Located on the face, chest, back, and extremities. Last from 1 to 2 weeks and resolves spontaneously.
Erythema Toxicum Neonatorum
Tufts of hair overlying spinal column usually at lumbosacral area. Maybe a sign of spina bifida occulta. Order an ultrasound of the lesion to rule out a occult spina bifida.
Faun Tail Nevus
Flat, light brown to dark brown spots greater than 5 mm. If six or more spots larger than 5 mm in diameter are seen rule out Nuro fibromatosis or von Recklinghausen’s disease which is a neurological disorder marked by seizures, learning disorders. Referred to pediatric neurologist if the spots me the same criteria to rule out neurofibromatosis
Cafe au lait spots
Neonates with pink to red flat skin like lesions on the skin located on the upper and lower eyelids or on the V1 and V2 branches of the trigeminal nerve should be referred to a pediatric ophthalmologist to rule out congenital glaucoma. Blanches to pressure. Irregular in size and shape. Large lesion is located on half the facial area may be a sign of trigeminal nerve involvement and Sturg-Weber Syndrome which is a rare neurological disorder. The lesions and do not regress and grow with the child. These lesions can be treated with the PDL laser.
Port wine stain (Nevus flammeus)
At what distance can a newborn focus their vision
8 to 10 inches
What is amblyopia
What is esotropia
Misalignment of one or both eyes. Cross eyed.
If there is a presence of a white reflects on funduscopic exam what must be ruled out
What is the screening test for cataracts and retinal blastoma
What does it mean if there are opacities in the red reflex
What does it mean if there are white spots in the red reflex
What is the screening test for strabismus
Hirschberg test or light reflex test or corneal light reflex. Abnormal if corneal light reflex is not clear or if it’s off-center.
What are high-risk factors for hearing loss
E ear infections that are frequent
A apgar scores low at birth
R rubella, CMV, toxoplasmosis infections
When should high-risk children be screened for lead poisoning
1 to 2 years
If a mother chooses to use formula what type of formula should she use
One that is fortified with iron
What do you breast-fed infants need to be given to them within the first few days of life
Vitamin D drops
Does breast-feeding reduce the risk of otitis media
Why must cows milk be avoided for the first year of life
Because it causes G.I. bleeding. It is also a common cause of iron deficiency anemia in babies younger than 12 months.
Failure for an infant to pass meconium within the first 24 hours at birth may be a sign of
When can an infant start eating solid foods
4 to 6 months. Start with rice cereal fortified with iron before other types of cereal or food groups. Introduce one food at a time for 4 to 5 days.
Defused edema of the scalp that crosses the midline. Caused by intrauterine and vaginal pressure from prolonged or difficult vaginal labor. The scalp becomes molded and cone shaped. Self-limited and resolves spontaneously.
Trumatic subperiosteal hemorrhage. Rule out skull fracture and order Radiographs of the skull. Swelling does not cross the midline or suture lines.
When should Infants 👶🏻 regain their body weight that was lost after birth
The weight should be we gained by two weeks of age. Newborns double their weight by six months and triple their weight by 12 months
How often is head circumference measured
At each wellness visit until the age of 36 months or three years
In newborns is the chest less in size than the head circumference
Yes it is about 1 to 2 cm less in size
When do the lower central incisors erupt
6 to 10 months of age
When does an infant have their complete set of primary teeth which is 20 teeth
2 1/2 years of age
When does the child have their first permanent tooth or deciduous teeth
Six years of age: central incisors and the first molars
Urethral meatus located on the ventral aspect of the penis. Location may be at the glands or at the shaft. Some have two urethral opening’s, one opening is normal and the other opening is lower on the glass or shaft. Referral to pediatric urology.
Hydro spa Dias
Urethral meatus is located on the dorsal aspect of the penis or upper side
If a newborn female has a small amount of blood in the vagina is this normal
Caused by maternal hormones and will disappear within a few days
What increases the risk of testicular cancer
Order inguinal and abdominal ultrasound
Head circumference close by how much in the first 12 months
An abscence of an anal wink in a patient can indicate
When does the Moro reflex disappear
3 to 4 months
If an older infant aged six months or older has a strong Moro reflex, what does that mean
Abnormal and indicates brain damage
White papules found on the gumline that resembles errupting tooth
If a patient has a symmetry of the thigh or gluteal folds what must be ruled out
Hip dysplasia or hip fracture
Urethral opening under the glans/shaft
Urethral opening on top of glans/shaft
At what age is hepatitis A immunization universally recommended
Age 1 (12-23 months)
The two doses should be administered at least six months apart. Delay vaccine in moderately or severely ill 😷
When is the hepatitis B vaccine given
Three does series: zero, 1 to 2 months, six months after the first. Delay blood donation for 28 days as screening test could mistake vaccine for hepatitis B infection
When is D tap given
You get a lot of them. Age less than 7 years old. Five Dose series starting at two months old. Minimum age for initial dose is six weeks.
When is Tdap given
Age 11 to 12 years get T Dap booster. T Dap can be administered regardless of the last interval since the TD immunization. After T Dap, patients should receive TD booster every 10 years routine.
What adults need TDap
Age 65 and over and pregnant women in the third trimester.
When is Hib given
You get a lot of them. Starting at two months old. For unvaccinated children aged 15 months or older, administer only one dose.
What vaccine got rid of epiglottitis
When is HPV-Gardasil given
Three dose series: zero, 1 to 2, and six months. Avoid in pregnant women. OK if breast-feeding to receive vaccine.
Can the MMR vaccine cause a rash
When is the HPV 9 vaccine given
Minimum age is nine years old. Administer the first dose to females at age 11-12 years (HPV2, Ceravix)
When is the pneumococcal conjugate vaccine given
PCV13: 4 Dose series starting at 2 months of age. Infants have tiny airways
Can you give the IPV or polio vaccine in the immunocompromised
What vaccine is contra indicated for patients that have allergies to neomycin, streptomycin, or polymyxin B
What are two examples of live attenuated immunizations
MMR and varicella. May cause rash or fever which is a favorable response. Do not give to a patient under the age of 1 year old
If a patient is allergic to neomycin or gelatin what vaccines are contraindicated
MMR and Varicella
When is the influenza vaccine given
Recommended annually age is greater than six months old. If a child is eight years old or younger and receiving the flu vaccine for the first time they need 2 doses separated by four weeks.
A vaccine has to be given how many days prior to the scheduled time in order for it to be considered a valid dose
When should the meningococcal conjugate vaccine be given
Late high school and early college are at risk so administer to all children age 11 to 12 years old. Or 13 to 18 years if not previously vaccinated, booster at age 16. If administered at age 16, no booster needed
What are some adverse reactions to vaccines
Local redness, systematic fever, allergic
What is the most common reaction among adolescents to HPV, MCV four, and TDap
What is the CDC is recommendation for length of time to monitor a child after receiving an immunization
When is the rash from an MMR immunization most likely to occur
About seven days after immunization
If a mother has Hepatitis B, what should be given to her baby at birth
Hepatitis B immunoglobulin and hepatitis B vaccine
If Jaundice is found in a full-time infant after two weeks of age what should be done
Check Bilirubin level. Use noninvasive method first such as Billirubinometers. If suspect pathologic, order Serum fractionated BiliRubin level, Coombs test, CBC, reticulocyte count, and peripheral smear. Treatment is usually not needed. Keep baby well hydrated with breast milk or formula. Feed baby every 2 to 3 hours. First line treatment is phototherapy. Light used in the blue spectrum is the most effective wavelength. The skin converts BiliRubin into a non-toxic water soluble form so that it is excreted in the urine. All newborns 👶🏻 should be seen for follow up within the first 5 days of life to check for jaundice.
A neurological disorder caused by high levels of unbound BiliRubin in circulation that damaged the infants central nervous system. Associated with severe mental retardation and seizures.
An infants mother reports persistent tearing and crusting in the morning on one or both eyes. When the lacrimal duct is palpated, reflux of mucoid discharge or tears maybe seen. Yellow to green colored purulent Eye discharge is abnormal and is due to secondary bacterial infection.
Congenital lacrimal duct obstruction (dacrostenosis)
Look for redness, warmth, tenderness, and swelling on one of the lacrimal duct. Culture discharge and treat with systemic antibiotics for 7 to 10 days. Usually caused by strep or staph organisms.. Severe cases may spread and cause orbital cellulitis.
What does the Ortolani maneuver test for
Developmental dysplasia of the hip. Hold each knee and place your middle finger over the greater trochanter. Rotate the hips in a frog leg position. During abduction resistance maybe felt at 30 to 40°. The test is positive if A click or clunk sound and or if examiner palpate the trochanter becoming displaced temporarily from the hip socket.
What does the Barlow maneuver test for
Developmental dysplasia of the hip. Place your index finger and middle finger over the greater trochanter. Gently push both knees together at midline downwards. Test is positive if clunk sound or palpating trochanter being displaced by the index/middle finger. If either exam is positive, refer to a pediatric orthopedist. Order an ultrasound of the hips.
If an infant makes a clicking noises while breast-feeding what does this mean
Poor latch. Remedy is to push more of the Areola inside the infants mouth. Most of the Areola should be inside the infants mouth.
What are the core symptoms of ADHD
Hyperactivity, impulsivity, in attention
Does hyperactivity and impulsivity always occur together
Yes. This is characterized by the inability to sit still and inhibit behavior. Examples are excessive talking, fidgetiness, restlessness, constantly on the go difficulty remaining seated, difficulty waiting turns, interrupts others. Observed by age 4 with Peak in symptoms over the next 3 to 4 years. Hyper active symptoms begin to decline after eight years or second grade. Not usually observable my adolescence.
What is the DSM-V diagnostic criteria for ADHD
For children greater than or equal to 12 years old, greater than or equal to six symptoms of inattention, and six symptoms of hyperactivity and impulsivity. And children greater than or equal to 17 years old, greater than or equal to five symptoms of inattention, and greater than or equal to 5 symptoms of hyperactivity and impulsivity. Symptoms must present before the age of 12 years old. Symptoms last greater than six months. Be evident in different settings such as school and home. Need feedback from caregiver and teacher.
What is the physical examination or evaluation for ADHD
Medical exam will include hyperthyroidism, pinworms, allergies, and medication reconciliation. Developmental, educational, and psychosocial.
What is the rating scale for ADHD assessment
Child behavior checklist and Connors rating scales and Vanderbilt ADHD rating scales
When do you refer a patient with ADHD
Coexisting psychological disorders such as oppositional defiant disorder and emotional problems, coexisting neurologic or medical disorders such as tics, autism spectrum disorder, and sleep disorder
Lack of response to stimulant therapy
The most commonly prescribed and tested medications for ADD are drug schedule
Highly addictive and often abused. Requires urine drug screen as needed
What medications are used for ADHD
Stimulants are first line. Consider methylphenidate in preschoolers.
How was asthma treated in children
Lukotriene receptor agonist such as Singulair, and the drug is administered via nebulizer
Zafirlukast (Accolate) are examples of
Recommend for ages 12 and up
When should a leukotriene blocker be considered
For a child patient with mild asthma if the patient can’t or won’t use an inhaled steroid. Steroids are preferred for any form of persistent asthma. Steroids prevent remodeling.
When can prevnar 23 be given to children at high-risk for an ammonia
Greater than two years of age
What is the most sensitive sign of confirmed pneumonia in children and adults
What is the diagnostic study for a child with pneumonia
Chest x-ray: shows infiltrates, but may be a normal x-ray in early Pneumonia especially if dehydrated. CBC with differential, left shift if bacterial, usually white blood cell count is greater than 15,000 is bacterial. No need for follow-up chest X-ray if resolves as expected.
What antibiotic choice is first line treatment for pediatric patients who have bacterial pneumonia
Amoxicillin 90 mg per kilogram per day. Treats DRSP with high dose amoxicillin. This dose is also for otitis media. We are killing strep
For weight based doses Of pediatric antibiotics, at what weight is a child most often dosed as an adult, no longer by weight
If the child patient has bacterial pneumonia what should be given
High dose amoxicillin 90-100 mg per kilogram per day, Augmentin, or third generation cephalosporin. If patient has a type one reaction to Penicillin, get a macrolide like clindamycin
Increased RR (40-60/min)
Thick purulent nasal secretions
These are assessment findings for
Is croup viral or bacterial
A 3 year-old child presents with mild croup symptoms. How might they be relieved
Single dose of oral dexamethasone 0.6 mg per kilogram’s. Long half-life last for 72 hours and can also be used for asthma exacerbations
It’s three-year-old child presents with croup symptoms. What symptoms indicate a need for admission
Retractions, Strider, respiratory rate greater than or equal to 20, history of asthma.
Multi system disease that affects the pulmonary, G.I., and sweat glands. Autosomal recessive genetic disorder that causes excess loss of sodium through sweat. It is a mutation on chromosome seven. Abnormal transport of sodium and chloride across epithelial membrane’s.
How is cystic fibrosis most commonly diagnosed in the US
What symptoms might be present with a child with suspected cystic fibrosis
Recurrent pulmonary infections. Infections of the lower airways.
Mucus thickens and there are frequent sinus and lower respiratory tract infections. Mucus can block ducts of the pancreas. Weight loss and greasy stools.
What does it mean when all of the cells are low on the CBC
Which cancer is due to the failure of the bone marrow. Related to white blood cells, red blood cells, and platelets. Pancytopenia is seen.
What are you presenting signs of leukemia
Evening fevers, bleeding, platelet count less than 100,000, bone pain especially in the long bones of the leg, lymphadenopathy but not painful
If a node is greater than how many mm is if enlarged
If a lymph node is nontender, firm, rubbery and matted what must be considered
What are common findings associated with leukemia
Bruising, bleeding, frequent nosebleeds, thrombocytopenia, bone pain in the long bones, recurrent infections, fever, low white blood cell count, swollen lymph nodes, fatigue, poor appetite, anemia, hepatosplenomegaly
What are the diagnostic tests for leukemia
CBC with differential, thrombocytopenia, white blood cells, peripheral smear, bone marrow
Most common neurologic disorder of infants and young children. Mostly age-dependent, but occurs before age 5. Occurs during fever, viral infection, immunization such as DTaP and MMR, and genetic susceptibility
What characteristics must be present for a diagnosis of febrile seizures
It does not reoccur in 24 hours and it occurs in the setting of illness
This occurs with a rapid rise and fall of body temperature. Often first clue that a child is ill and could happen on the first day of illness.
What is the criteria for febrile seizures
Seizure with the temperature greater than 38°C.
Age < or equal to 6 years
Absence of CNS infection
Absence of an acute metabolic abnormality
No history of febrile seizures
How do you treat febrile seizures
Conservative management as long as simple and associated with fever and no other indication that there is underlying pathology.
Treat underlying fever
How do you manage fevers
Fever is a response. Ibuprofen or acetaminophen. Dose based on weight not age 10 mg per kilogram per dose. Ibuprofen not recommended less than six months of age. If the temperature remains elevated 3 to 4 hours after administration, switch to agent not used. Do not combine or alternate treatments. Increased risk for medication error, toxicity, and temperature reduction and not clinically significant.
Why are patients with sickle cell anemia susceptible to infection
Most common presentation is a painful abdominal mass that is fixed, firm, irregular, and frequently crosses the midline. The most common site is the adrenal medulla that sits on top of the kidneys. About half of patients present with metastatic disease. Maybe accompanied by weight loss, fever, Horner’s syndrome, Periorbital ecchymoses, bone pain, hypertension, others. Most are diagnosed in children between the ages of one and four. Elevated urinary catecholamines and anemia. Initial imaging test is the ultrasound. Refer to nephrologist.
Asymptomatic abdominal mass that extends from the flank toward the midline. The nontender and smooth mass rarely crosses the midline of the abdomen. Some patients have abdominal pain and hematuria. One fourth of patients have hypertension. Higher incidence in black, female children 👶🏻 While performing the abdominal exam, palpate gently to avoid rupturing the renal capsule as it causes bleeding and seating of abdomen with cancer cells. Initial imaging test is an abdominal ultrasound.
Wilms tumor (nephroblastoma)
Acute and rapid onset of high fever, chills, and toxicity. Child complains of severe sore throat and drooling saliva. Won’t eat or drink, Muffled hot potato voice, and anxious. Characteristics sitting posture with hyperextended neck with open mouth breathing. Strider, tachycardia, and tachypnia. Usually occurs between ages 2-6. Now rare due to Hib vaccine. Prophylaxis with Rifampin for four days and for close contacts. Reportable disease. Medical emergency. Call 911
More common in infants and children. Infected bone or joint is red, swollen, warm, and tender to touch. Patient is febrile and irritable. If patient walks with a limp, may have infection on the hip, knee, or leg. If infection involves the upper extremities, well favor infected limb. Growth plate infection results in growth stunting of the affected limb. Referral for hospitalization and high-dose antibiotics.
Young child complains of abrupt onset of deep Eye pain that is aggravated by Eye movements and is accompanied by a high fever and chills. Affected Eye will appear to be bulging. Extra ocular Eye movements exam will be abnormal due to ophthalmoplegia form infection of the ocular fat pads and muscles. More common in younger children. Ethmoid sinus -itis is more likely to cause this condition with frontal and maxillary sinus -itis. Can be life-threatening. A serious complication of rhinosinusitis, Acute or otitis media, or dental infections. Refer to ED. CT scan or MRI is done in the ED.
More common than orbital cellulitis. An infection of the anterior portion of the eyelid that does not involve the orbit/globe or the eyes 👀 Rarely causes serious complications compared with orbital cellulitis. Younger children are most likely affected. Young child complains of the new onset of red swollen eyelids and Eye pain. Eye movements do not cause pain and extraocular movements exam is normal. No visual impairment. Maybe hard to distinguish from orbital cellulitis. Refer to the ED.
How do you know that a child is ready for toilet training
Child is walking, indicates when diaper is dirty, child can pull down his own pants, can stay dry for up to two hours at a time, interested about the toilet or potty seats. Most children are ready for potty training from 18 to 24 months. Some children may not be ready until three years of age. By age five most achieve both daytime and nighttime control. Daytime control is achieved first before night time control. Some infants are trained in as early as 3 to 6 months, but each child is different.
When do signs of autism spectrum disorder appear
18 months. Usually autism becomes more apparent in early childhood from ages 2 to 6 years. Five behaviors to look for: patient does not point, wave, or grasp by 12 months. No babbling or cooing by 12 months. Does not say single words by 16 months. Does not say two word phrases on his own by 24 months. Any loss of language or social skills by 24 months. Does not gesture by waving, grasping, or pointing at 24 months.
What are some safety indications for toddlers
Use rare burners. Turn pot handles away from Reach. Child should be supervised at all times. Hold child’s hand when crossing the street or when shopping. Keep tools and sharp objects out of reach. Inspect toys for loose parts or breakage. Water safety education. Fences around pools. Never leave a child alone in the pool.
Does Wilms tumor cross the midline
Yes. Congenital tumor of the kidneys. More common in African-American girls.
What disease presents with sitting posture with hyper extended neck with open mouth breathing
Is pyloric stenosis most common in males or females
First born males. Symptoms begin 3 to 5 weeks of age and worsen.
What is the classic presentation of pyloric stenosis
3 to 6 week old male with projectile, non-bilious vomiting. Olive like mass better palpated immediately after vomiting.
A four week old has suspected pyloric stenosis. What imaging study is most commonly used to diagnose this
What should be included in the differential diagnosis of pyloric stenosis
Gerd, milk protein intolerance, intestinal obstruction
How do you manage pyloric stenosis
Referral for surgical correction (laparoscopic pyloromyotomy). Allows normal passage from stomach into duodenum
Frequent regurgitation in the abscence of anything pathological.
Occurs 30+ times daily in healthy infant
What are red flags to look out for with GER in infants
Choking with eating, coughing with eating, forceful vomiting, G.I. bleeding, poor weight gain, refusal to feed, constipation or diarrhea, abdominal tenderness, fever. Any complications secondary to reflux such as esophagitis and failure to thrive
Before giving acid suppressants for Gerd, what must be done
Assess feeding, sleep habits, maternal child interaction. Assess exposure to cows milk and soy. Thickened formula, tobacco, smoke avoidance are needed. Trial of acid suppresants for two weeks, if improvement consider used for 2 to 3 months.
What symptom might indicate GERD instead of GER in an infant
Irritability during reflux episode with cough and irritable esophagus
How do you manage GER
Usually no interventions. Continue to breast-feed, place supine to sleep. Small frequent thickened feedings (with rice cereal) Consider non-cows milk protein formula for 1 to 2 week trial. Avoid soy-based formula. 1 to 2 week trial of hypoallergenic formula.
Does GER resolve
Usually resolves by one year of age.
Intestinal obstruction. Common pediatric abdominal emergency. 80 to 90% in less than two years of age. Usually idiopathic but has been associated with the rotavirus vaccine.
Sudden onset of intermittent, crampy, progressive abdominal pain. Normal behavior in between episodes. Classic: child 👶🏻 3 to 11 months that cries and pulls legs up to the chest. Diagnosis by KUB and abdominal ultrasound. Surgical emergency. Invagination of bowel. Classic triad: intermittent colicky abdominal pain, vomiting, bloody mucousy stools. Currant jelly stools.
How is interssusception managed
Non-operative reduction by enema under fluoroscopy: possible treatment in a stable child. Surgical correction if episodes long duration or suspected perforation
Involuntary soiling of stool in a child 4!years or older. Usually boys or males. Underlining problem is constipation.
As stool accumulates in the rectum, enlargement can result in loss of sensation. Loss of urge to defecate, then internal anal sphincter relaxes and stool leaks out
how do you manage encopresis
Laxatives for initial cleansing such as MiraLAX then daily until normal stools. Behavior changes: sit for five minutes, 2 to 3 times daily after meals to establish normal bowel movements. Dietary changes: fiber, fluids. Reward system. Goal is one soft stool daily. Tapering laxative gradually after daily bowel movements several months of normal stools.
What is the preferred means of oral hydration for a child who has diarrhea
Commercially prepared electrolyte solution such as Pedialyte
Goal is to correct the fluid deficit and prevent electrolyte imbalance. Oral rehydration from mild to moderate dehydration. Age appropriate diet as soon as rehydration is complete.
When do you refer a patient who is testicles have not descended
What kind of hydrocele is fluid from the peritoneal area
What kind of hydrocele does the fluid have no connection to the peritoneum
Non communicating hydrocele
A nine month old has hydrocele. What advice should be given to the caregiver
This should resolve by 12 months of age. Then referred to urology.
A one-year-old has persistent hydrocele. What might be an underlying cause
Why are you in urinary tract infections aggressively treated in infants
Treatment is needed within 72 hours in order to prevent renal scarring. Collect specimens and treat empirically. Consider third-generation cephalosporin such as Cefixime, Ceftdinir, ceftibuten if no GU abnormalities. Gram negative bacteria. Duration 3 to 5 days if afebrile and 10 days if febrile.
What is the imaging study of choice for pediatric UTI
Renal and bladder ultrasound for all infants 2 to 24 months for first febrile UTI.
What disease might manifest itself with a strawberry tongue.
Kawasaki disease and strep throat. Prominent papilla on tongue
Acute generalized systemic vascular -itis of the medium sized vessels: coronary artery‘s; self-limited. Inflammatory reaction to an unknown etiology. Fever for five days +4 of five criteria or coronary vessel involvement.
Bilateral conjunctival injection without exudate
polymorphous, macular rash Urticarial or pruitic Inflammatory changes of lips and oral cavity
cervical lymphadenopathy (unilateral, anterior cervical)
changes in extremities: edema or desquamation of hands and feet.
CBC, ESR, or CRP, ALT/AST, UA, throat culture for strep
Echo (coronary aneurysm)
Refer for IV immune globulin and ASA
ASA daily for 2 months
Symptoms that include swollen hands and feet with fever, elevated ESR, and elevated PLT are consistent with what disease
What are some innocent murmur clues in children
Grade less than or equal to two, softer intensity when sitting compared to supine, not holosystolic, minimal radiation of murmur, musical or vibratory quality
If a patient presents with a greater than or equal to three grade murmur what must be done
Palpate for thrill
If a child presents with knee pain what must be ruled out
Osgood Schlatter Disease
At what age does Osgood Schlatter dose occur most often
15-year-old or adolescent
Osteochondritis of the tibial tubercle
common cause of adolescent knee pain between 6 to 18 months
more common in athletes; especially if recently had growth spurt.
Osgood Schlatter Disease
What is the management for Osgood Schlatter Disease
Continuation of activity as pain tolerance, ice, analgesics for 3 to 4 days, protective pad over tubercle or Knee pad
What lab studies are indicated for a patient that presents with hip pain
CBC, CRP, sed rate
AP and frog leg views X-ray
Osteonecrosis of the capital femoral epiphysis due to interrupted vascular supply.
Males > females
Pain to hip or referral to medial aspect of knee (usually present for 2-3 weeks before child complains)
What is the test for Legg-Calves-Perthes Disease
Positive Trendelenburg sign: asking Childs to stand on affected side causes a pelvic tilt with the unaffected side lower. This test is positive in Slipped Capital Femoral Epiphysis, Legg-Calves-Perthes, and developmental dysphasia
What type of x-rays are indicated for Legg-Calves-Perthes Disease
AP, Frogleg. Be careful for gonadal radiation. Limit x-rays to suspected tumors, trauma, Legg-Calves-Perthes, Slipped Capital Femoral Epiphysis
History of several weeks or months of hip/knee pain with an intermittent limp. Common in adolescents .
Diagnosis often missed because 50% have hip pain and 25% have knee pain.
Positive Trendelenburg test.
Slipped Capital Femoral Epiphysis
Refer for X-ray or OR
Most common cause of hip pain. Benign condition causing acute limp and hip pain in children. Evidence of small effusion on ultrasound. Absence of systemic symptoms. History of upper respiratory infection 7 to 14 days prior is common. Usually results in 7 to 14 days. No x-rays. Treat symptomatically. Negative trendelenburg test.
Transient Synovitis of the hip
What virus causes roseola
Human herpesvirus six
What virus causes fifth disease
Parvovirus B 19
What virus causes Rubella
What virus causes rubeola or measles
What virus causes the chickenpox
What virus causes herpangina
Coxsackie a virus
What virus causes hand foot mouth
Coxsackie virus a 16
Maculopapular brick red rash, starts on head and neck, spreads to trunk and extremities
Measles or Rubeola
Slapped cheek rash, lacy macular rash
Fifth disease or erythema and infectiosum
Maculopapular rash, looks like measles rash, remarkable lymphadenopathy, macules on soft palate
High fever for 2 to 4 days then abrupt cessation of fever with appearance of maculopapular rash but not on the face
Roseola or exanthem subitum
Vesicular lesions On erythematous base appearing in crops
Exotoxin rash secondary to Group A strep infection. Sandpaper like rash that ultimately desquamates.
When can a child go back to school after chickenpox
24 hours after fever free and after all that vesicles have crusted over
What symptoms most typically characterize the lips/oral cavity of a patient who has herpangina
Painful vesicles on the soft palate and mouth. Increased risk for dehydration.
Do viral exanthem rashes Blanche
Does petechiae and Pupura Blanche
A three-year old is diagnosed with fifths disease. Her mother is pregnant in the first trimester and has had significant exposure to the sick child. If her mother is not immune, what is the risk to the fetus
Intrauterine fetal death
What is the usual age at which roseola is diagnosed
What age does hand 🤚 foot mouth disease manifest
3-5 years old. Affects children in spring and early summer.
What disease presents with fever, oral vesicles on oral mucous membranes, cutaneous vesicles that ulcerate and crust and resolves in 2 to 3 days. Lesions in hands and feet are very blister like
Hand, foot, mouth disease
Measles is characterized by what clinical findings
Cough, runny nose, conjunctivitis and Koplick’s spots
Fever, malaise, and the three C’s such as conjunctivitis, coryza (runny nose, congestion) and cough
Develop Kolpick’s spots: 1-3 mm whitish, bluish, or gray elevations on the buccal mucosa, hard and soft palate.
Measles or Rubeola
What is the best predictor of acute otits media
Cloudy, bulging TM with impaired mobility
What vaccine has decrease the incidence of a cute otitis media
How do you treat acute a tightest media in a child less than six months of age
How do you treat otitis media that is severe in a child that is six months to two years of age
Antibiotics if severe and observe if not severe
How do you treat otitis media and a child that is greater than two years old
Antibiotics of severe if not observation
A two-year-old is diagnosed with otitis media and an antibiotic is prescribed. When should her fever resolve after the medication
48 to 72 hours
History of febrile illness such as chickenpox or influenza and aspirin or salicylate intake such as Pepto-Bismol and a child. Abrupt onset with quick progression. DEF can occur within a few hours to a few days.
Children are at risk for reye’s syndrome after which vaccine
Varicella. Avoid using aspirin before, during, and after immunization.
A condition in which downs syndrome patients have an increased distance between the C1 and C2 joints. Medical Clearance is necessary for sports participation. Patient needs cervical x-rays with lateral view before playing sports
Down’s syndrome atlantoaxial instability
Large head circumference. Mental retardation. Delayed physical developmental milestones such as crawling and walking. autism common. Hyperactive behavior. Tends to avoid eye contact. Patient has a long face with prominent forehead, jaw, and large ears. Large body with flatfeet.
Fragile X syndrome
What is the treatment plan for a patient with fragile X syndrome
Refer patient for genetic testing. Refer a patient to psychiatrist or psychologist for psychosocial, behavior, and mental evaluation.
When is the patient with hand foot mouth disease most contagious
During the first week of illness
Smooth wax like round papules 5 mm size. Central umbilication with white plug.
What immunizations are needed at age 11 to 12 years old
Tdap, HPV, MCV four
What stage what an 11-year-old be at by Piaget standards
Early abstract thinking
What is molluscum caused by
What is the youngest age group for Gardasil
Nine years old
Turner’s syndrome presents exclusively in
A hoarse cry in a newborn may indicate
A high-pitched cry in an infant is associated with
Cri du chat
A four-year-old presents to the clinic with Circumoral pallor and an intense red eruptions on both cheeks which appeared last night. The child has low-grade fever but no other symptoms. What is most likely the diagnosis
What is least likely to cause ophthalmia Neonatorum
Do children with juvenile rheumatoid arthritis achieve remission
Most children with juvenile rheumatoid arthritis achieve complete remission by adulthood, but it’s affects might cause lifelong limitations.
An important measure to prevent complications in children with sickle cell anemia is
Staying well hydrated
The mother of a two week old infant with hypospadia’s requests circumcision for her infant. The nurse practitioners best response to this mother should be to
Explain why the infant with hypospadias should not be circumcised
How should a newborn infant with fracture of the clavicle be treated
Instructions must be given to the patient to handle the Neo Nate gently. This will be for 3 to 5 weeks.
Infants with celiac disease are at high risk for multiple complications. The most urgent complication of this disease is
Intussusception or volvulus
A 12 month old has conjunctivitis in his right eye with mucopurulent discharge. The mother asks if the child can forgo the antibiotic eyedrops because he doesn’t like to put eyedrops in his eyes. The nurse practitioner replies that
If untreated, conjunctivitis may permanently damage the cornea
Does kyphosis in an adolescent indicate scoliosis
If there is a concern about labial adhesions and urinary obstruction in a female infant what is the most appropriate intervention
Local application of conjugate estrogen cream
Which of the following is the current recommendation for cholesterol screening in children using fasting lipid profile by the AAP
Children should be screened between nine and 11 years and between 18 and 21 years
A two week old African-American male infant has ecchymotic like marks over his lower back and upper body buttocks. The most appropriate intervention is to
Reassure the infant mother that this is a normal finding. Mongolian spots
A four-year-old female complains of leg pain at night which resolved by morning. This has lasted for the past four months. The nurse practitioner should tell the patient’s mother that
These are growing pains that last from 1 to 2 years. This is a common complaint in this age group.
A three day old infant is brought into the clinic with a history of failure to pass meconium, poor feeding, vomiting, and excessive flatulence. The infant was diagnosed in the nursery with trisomy 21. Which of the following would be included in the differential diagnosis
What is the most common complication and cause of most pertussis related deaths
Secondary bacterial pneumonia
Which age group is at the greatest risk of developing lead poisoning
6 to 36 months
The posterior fontanelle should be completely closed by
At what age should an infant be expected to triple his birthweight
A two-year-old has several discreet, shiny, flesh colored papules with the domed shaped tops and firm waxy centers. The area surrounding them is erythematous and the child scratches them frequently. The mother asks what should be done for my child?
This is molluscum contagiosum and it may regress spontaneously in 6 to 9 months, but cryosurgery will eliminate them
Is coarctation of the aorta assessed during systole or diastole
The mother of a six month old infant asks about the use of an infant walker. What is the most appropriate response
Discourage the use of walkers and encourage parental holding and floor play
Hand foot and mouth disease can be distinguished from herpangina by the presence of
Exanthem on the hands and the feet
You are examining a five-year-old child who has been diagnosed with Kawasaki disease. Which of the following skin conditions would be most indicative of this disease?
Bright red and swollen skin palms and soles