Pediatrics Flashcards
1
Q
FTT criteria
A
-weight for age <3rd to 5th percentile
2
Q
Most common chromosomal disorder in US
A
DS
3
Q
DS presentation
A
- flat face
- upward slanting eyes: palpebral fissures
- low-set ears
- macroglossia
- short neck
- broad hands with transverse palmar crease (simian crease)
- newborns with hypotonia
- poor reflexes
4
Q
What should children with DS avoid using before age 6
A
trampoline
5
Q
FAS presentation
A
- microcephaly
- shortened palpebral fissures
- epicanthal folds
- flat nasal bridge
- thin upper lip with smooth philtrum
- ears underdeveloped
6
Q
When is surgical correction needed for cryptochoridism
A
within first year of life it not spontaneously descending
7
Q
Neonate presenting with acute conjunctivitis within 30 days or less from birth, concerned about what
A
- chlamydia
- gonorrhea
- herpes simplex
- bacterial infection
8
Q
Treatment for neonate with gonococcal ophthalmia neonatorum
A
ED for IV abx
9
Q
Trachoma
A
chlamydial ophthalmia neonatorum
10
Q
What else to rule out if neonate presents with trachoma
A
-chlamydial pneumonia
11
Q
Risks for SIDS
A
- prematurity
- LBW
- maternal smoking and/or drug use
- poverty
12
Q
Expected newborn weight loss
A
- formula fed: up to 5%
- breast fed: 7-10 %
- loss within 5-7 days
13
Q
When should neonatal weight loss be regained
A
-within 10-14 days
14
Q
Signs of severe dehydration in neonates
A
> 10% weight loss
- tachycardic
- tachypneic
- parched mucous membranes
- anterior fontanelle sunken
- tenting
- cool skin
- acrocyanosis
- anuria
- change in LOC
15
Q
Mongolian spot
A
- present in almost all Asians
- blue to black colored patches or stains
- most commonly on lumbosacral area
16
Q
what age do Mongolian spots typically fade
A
-by 2-3 years
17
Q
MIlia, Milaria, or Prickly Heat
A
- papules on forehead, cheeks, nose
- retention of sebaceous material and keratin
- resolves spontaneously
18
Q
Erythema toxicum neonatorum
A
- small pustules surround by red base
- erupts during 2nd-3rd day of life
- lasts 1-2 weeks
- resolves spontaneously
19
Q
Seborrheic dermatitis
A
- cradle cap
- thick scaling on scalp
- treat with soaking with vegetable oil or mineral oil
- shampoo and gently scrub
- prevention with frequent shampooing with mild baby shampoo
- resolves in a few months
20
Q
Faun Tail Nevus
A
-tufts of hair overlying spinal column usually at lumbosacral area
21
Q
What can faun tail nevus indicate
A
-possible NTD
22
Q
Plan for faun tail nevus
A
- neuro exam
- US of lesion to r/o occult spina bifida
23
Q
Cafe au lait spots
A
- flat spots
- > 6 or larger than 5 mm –> r/o neurofibromatosis or von Recklinghausen’s disease
- refer to pediatric neuro if it fits this criteria
24
Q
Port wine stain
A
- Nevus Flammeus
- pink to red, flat, stain like lesions on upper and lower eyelids of branches of CN V
- blanches
- Large lesions on half of face may be sign of trigeminal nerve involvement
25
Port wine stain treatment
- does not regress
- grows with child
- treat with pulse-dye laser therapy
26
Hemangioma
- strawberry hemangioma
- rapid vascular lesions 0.5-4 cm
- bright red in color
- soft to palpation
- majority spontaneously resolve
- PDL therapy
27
Newborn vision: far or near sighted
- Myopia (near sighted)
| - 20/200
28
T/F: newborns may appear with crossed eyes and is a normal finding
- True
| - unless one eye is consistently turned in or out ---> ophto
29
T/F: newborns shed tears
-False: lacrimal ducts not fully mature at birth
30
Horizontal strabismus may be
Estropia
inward turning of eyes
Extropia
outward turning of eyes
31
Vertical strabismus may be
Hypertropia
one eye higher than the other
Hypotropia
one eye lower than the other
32
What can uncorrected strabismus lead to
permanent visual loss
| abnormal vision
33
What is strabismus
misalignment of one eye
34
Amblyopia
lazy eye
35
Esotropia
misalignment of both eyes (cross eyed)
36
Indications for optho referral
- abnormal red reflex
- (+) white reflex
- strabismus
- greater than two line difference between each eye
- esodeviation present after 3-4 months
- corneal light reflex with abnormal
- shape/appearance of pupils not equal
- new onset strabismus
37
Hirschberg test
corneal light reflex test
38
High risk factors for hearing loss
```
-HEARS
Hyperbilirubinemia
Ear infections that are frequent
Apgar score low
Rubella, CMV, toxoplasmosis
Seizures
```
39
Phenylketonuria
- severe mental retardation if not treated
- inability to metabolize phenylalanine to tyrosine
- test only performed after being fed for at least 48 hours
40
Which hemoglobin do normal newborns have
F and A
41
When is screening for anemia done for in infants
9-12 months
42
Lead screening
- high risk screened at 1 to 2 years
| - early as 6 months
43
Dose of vitamin D drops
400 IU
44
Why is cow's milk avoided
- avoid for 1st year of life
- causes GI bleeding
- common cause of IDA in <12 month olds
45
Failure to pass meconium within 24 hours of birth is concerning for what
- intestinal obstruction
| - cystic fibrosis
46
When can solid foods start
4-6 months
- start with rice cereal
- introduce one food at a time
47
First time teeth erupt
-6-10 months
48
First teeth to erupt
-lower central incisors
49
When are all the primary teeth erupted by
2.5 years
50
When do first permanent teeth erupt
6 years
51
Hypospadias
-urethral meatus on ventral aspect of penis
52
Positive Babinski reflex is normal up until
2 years old
53
T/F a strong Moro reflex in a 6 month old is normal
False
| indicative of brain damage
54
MMRV vaccine schedule
1 at 12 months
| 2 at 4-6 years
55
Trivalent flu vaccine given to minimum what age
6 months
56
Quadrivalent flu vaccine given to minimum what age
18 years
57
Is FluMist recommended?
No
58
DTaP schedule
```
2 months
4 months
6 months
16-18 months
4-6 years
```
59
Tdap age requirement
at least 7 years
60
Vaccine Adverse Event Reporting System (VAERS)
Report adverse reactions to vaccines
61
Which vaccines should be completed by age 15-18 months
- Hepatitis B
- Hib
- PCV 13
- Rotavirus
62
What is the only vaccine given at birth
hepatitis B
63
When is Tdap given as a booster
11-12 years
64
Physiological jaundice spreads how
starts on head
| progresses downward to chest, abdomen, legs, and soles of feet
65
When does physiological jaundice start
24 hours after birth
| clear up in 2-3 weeks
66
Breast milk jaundice begins when
after 7 days
peaks in 2-3 weeks
can take a month to clear
67
Possible cause of breast milk jaundice
- insufficient breast milk intake
| - some women may have a substance that slows down hepatic conjugation of bilirubin
68
Why does jaundice happen in neonates
- increased breakdown of fetal RBC
| - bilirubin exceeding the infants liver capacity to conjugate bilirubin
69
Treatment plan for pathologic jaundice
- serum fractionated bilirubin level
- Coombs test
- CBC
- retic count
- peripheral smear
- treatment usually not needed, keep well hydrated
70
First line therapy for jaundice
- phototherapy
- light in blue-spectrum most effective
- bilirubin excreted in urine
71
Kernicterus
- complication of high levels of unbound bilirubin
| - severe mental retardation, seizures
72
When does Hgb drop to the lowest level in neonates
6-8 weeks
73
Why does physiological anemia of infancy occur
-stimulates kidneys to produce more erythropoietin to prompt BM to make more RBC
74
Dacryostenosis
- congenital lacrimal duct obstruction
| - spontaneously resolves within 6 months
75
Dacryostenosis presentation
persistent tearing and crusting in am
- reflux of mucoid discharge when lacrimal duct palpated
- yellow to green is abnormal
76
Acute dacrocystitis
- redness, warmth, tenderness, and swelling on one or both lacrimal ducts
- usually due to staph or strep
- systemic abx for 7-10 days
77
Acute dacrocystitis lacrimal sac massage
-palpate sac and massage down toward mouth
78
Infant colic rule of 3s
1. crying and irritability >3 hours a day in <3 month old. crying occurs at the same time each day
2. crying occurs more than 3 days a week
3. colic resolves by 3-4 months
79
Up to 30% of neonates with coarctation of the aorta also have what syndrome
Turner syndrome
80
Normal finding for screening coarctation of the aorta
-systolic BP higher in legs than arms
81
Higher risk for developmental dysplasia of hip
- breech births
- female
- family history
- oligohydramnios
82
Ortolani test
- hold each knee and place middle finger over greater trochanter
- rotate hips in the frog leg position (abduction, then adduction)
- (+) click or clunk, or trochanter displacement palpated
83
Barlow test
- place index and middle finger over greater trochanter
- push both knees together at midline and downward, then pull upward
- (+) clunk heard when trochanter slips back into acetabulum
84
Galeazzi sign
-one femur appears shorter when infant is supine
85
When can a child play patacake and peek a boo
9 months
86
Neuroblastoma most common presentation
painful abdomen crossing midline
87
Neuroblastoma Horner's syndrome
- miosis
- ptosis
- anhidrosis
88
Initial imaging for Wilm's tumor
abdominal US
89
Epiglottis organism
Haemophilus influenzae
90
Prophylaxis of close contacts for epiglottitis
Rifampin
91
Is epiglottis a reportable disease
yes
92
Ophthalmoplegia
limited movement of eyeball
93
Preseptal cellulitis
-infection of anterior portion of eyelid that does not involve orbit
94
Greenstick fractures may indicate what
child abuse
95
Top 3 cancers in children
- leukemia
- bran and CNS tumors
- neuroblastoma
96
Clues a child is ready for toilet training
- walking
- can reach potty chair
- indicates when diaper is dirty
- can pull down pants
- can stay dry for 2 hours
- interested about toilet
- can understand basic instruction
97
When are most children typically ready for toilet training
18-24 months
| -some not ready until 36 monhs
98
When will a child usually have complete nighttime bowel control
4-5 years
99
When should a child not dry at night be evaluated
if >5 years old
100
How long should all infants and toddlers ride in a rear-facing car seat
2 years
101
Car safety for toddlers and preschoolers
back seat with car seat facing forward
102
Until what age do children need to be restrained in the back seat
12
103
When do early signs of autism begin to show
18 months
104
Autism screening times
18 months to 24 months
105
Autism signs to watch for
- no pointing, waving, grasping by 12 months
- no babbling or cooing by 12 months
- no single words by 16 months
- no two words by 24 months
- loss of language or social skills by 24 months
- no gesturing at 24 months
106
What population are Wilm's tumors more common in
AA females
107
At what age is speech understood by strangers
3 years
108
What age is speech understood mostly by family members
2 years
109
Kawasaki disease presentation
- high fever
- enlarged lymph nodes in neck
- bright red rash
- conjunctivitis
- dry cracked lips
- strawberry tongue
110
Kawasaki disease treatment
- aspirin
| - IVIG
111
Kawasaki disease sequelae
- aortic dissection
- aneurysms of coronary arteries
- blood clots
- need f/u with pediatric cardiologist for several years
112
Reye's syndrome
- history of febrile viral illness and took ASA or salicylate (Pepto Bismol)
- stage 1: severe vomiting, lethargy, stupor, elevated LFTs
- stage 2: change in LOC, hyperactive reflexes
- stage 3-5: confusion, delirious, cerebral edema, coma, seizures, death
113
DS without atlantoaxial stability and sports
-low-impact sports and sports not requiring extreme balance
114
Still's murmur
- benign systolic murmur
- vibratory or musical quality
- louder in supine
- grade 1-2
- usually resolved by adolescence
115
Can patients with MVP be cleared for sports
NO
possible sudden cardiac death
-cardio referral for clearance
116
If a child had documented history of chickenpox, do they still need the chicken pox vaccine
no
117
If child did not complete hepatitis B series, do they need to repeat series
no
118
Menactra lowest age to adminsiter
9 months
119
Menveo lowest age to adminster
2 months
120
When is Menactra or Menveo first dose given
11-12 years
121
When is Menactra/Menveo booster typically given
16 years
122
Autism treatment plan
- refer to psychiatrist for testing and eval
- OT, PT, speech therapy
- some prescribed Risperdal
123
Hand-foot-mouth disease organism
coxsackievirus A16
124
When is a patient with hand foot mouth the most contagious
-during first week
125
Hand foot mouth treatment
- supportive care
| - complete recovery usually in 5-7 days
126
Measles aka
rubeola
127
Functional constipation aka
encoporesis
128
Rome IV criteria for diagnosis functional constipation
- must meet 2 or more at least once per week for at least 1 month
1: history of withholding stool
2: history of painful or hard BM
3: history of large-diameter stools that may obstruct toilet
4: presence of large fecal mass in rectum
5: two or fewer defecations in toilet per week
6: at least one episode of fecal incontinence per week (thin fluid with feces that passes large stool), ask about soiling of underwear
129
Treatment for functional constipation
- laxatives (PEG, Miralax)
- behavior modifications
- dietary changes
- reward system
- goal for one soft stool a day
- plain film xray for retained stools
130
All 11-12 year old children should be vaccinated with what single dose
quadrivalent meningococcal vaccine (MenACWY)
| Menactra or Menveo
131
Which immunizations are needed at age 11-12
Tdap
HPV
MCV4
132
What organism is molluscum caused by
poxvirus
133
Youngest age for HPV vaccination
9
134
acetaminophen is also known as
paracetamol
135
Antidote for acetaminophen poisoning
-N-acetylcysteine IV
136
Testicular torsion initial diagnostic test
doppler US
137
Precocious puberty in females
<8 years
138
Delayed puberty in females
no breast development (Tanner 2) by 12 years
139
Skeletal growth is considered complete within __ years after menarche
2
140
Mittelschmerz
-unilateral midcycle pelvic pain caused by enlarged ovarian follicle
141
Average age of menarche
12
142
After which tanner stage do girls typically start menses within 1-2 years
2
143
Dysmenorrhea is caused by
elevated prostaglandins
144
Precocious puberty in boys
<9
145
Delayed puberty in boys
no testicular/scrotal growth by age 14
146
Spermarche average age
13.3
147
Which situations are parental consent not necessary
- contraception
- treatment of STD
- diagnosis and management of pregnancy
148
Criteria for emancipated minor
- legally married
| - active duty in armed forces
149
Which situations can confidentiality be broken
- gunshot wounds and stab wounds --> must be reported to police
- child abuse--> authorities
- SI or SA
- HI or intent
150
What is a mature minor rule
- unemancipated minor (15-17) with the mental capacity to understand the consequences of a decision
- Has the right to refuse or to request treatment (even if parents disagree)
- Each state has its own laws about this
151
What Tanner stage does puberty start
Stage 2
152
Primary amenorrhea
no menarche by age 15
with or without development of secondary sexual characteristics
-50% caused by chromosomal disorders
153
Secondary amenorrhea
- no menses for 3 cycles or 6 months if previously had menses
- most common cause is pregnancy
- others: ovarian disorders, stress, anorexia, PCOS
154
Secondary amenorrhea associated with exercise and underweight
-higher incidence due to caloric deficiency
155
Female athlete triad
- anorexia nervosa/restrictive eating
- amenorrhea
- osteoprosis
156
Secondary amenorrhea labs
- pregnancy test
- serum prolactin
- serum TSH, FSH, LH
- if amenorrhea for >6 months, measure bone density
157
Secondary amenorrhea d/t exercise treatment
- educate about caloric intake
- decrease exercise
- Calcium and vitamin D 1200-1500 mg and vitamin E 400 IU daily
158
Physiological gynecomastia
benign
more common during infancy and adolescence
normal in up to 40% of prepubertal boys
resolve by 6 months to 2 years
159
Gynecomastia findings
- round, rubbery, mobile mound under areola
- no skin changes
- if mass if hard or fixed, suspect a secondary cause and refer.
160
Pseudogynecomastia
- bilateral enlarged breasts due to fatty tissue
- common in obesity
- no breast bud or disk
161
Scoliosis testing
Adam's Forward Bend Test
162
Cobb angle
-degree of spinal curvature
163
Scoliosis curve <20 degrees treatment
-observe and monitor for changes
164
Scoliosis curve 20-40 degrees treatment
- bracing
| - Milwaukee brace
165
Scoliosis curve >40 degrees
-surgical correction with Harington rode
166
What is needed to measure Cobb angle of spine
spinal xray PA view
167
Scoliosis treatment
refer all patients with scoliosis to a pediatric orthopedic specialist
168
Osgood-Schlatter disease
- common knee pain in young athletes
- overuse of knee
- pain, tenderness, and swelling at tibial tuberosity
- pain improves with rest
- rule out avulsion fracture or posttrauma with xray
169
Osgood-Schlatter disease treatment
- RICE
| - stretching
170
Klinefelter syndrome genetics
extra X chromosome
171
Klinefelter presentation
- testicles small and firm with small penis
- tall with wide hips
- reduced facial and body hair
- higher risk of osteoporosis
172
Klinefelter treatment
-testosterone replacement and fertility treatment
173
Klinefelter syndrome is due to a ____ leading to a deficiency of ___
primary hypogonadism
| testosterone
174
Turner's syndrome genetics
partial absence of second X chromosome
175
Turner's syndrome presentation
- webbed neck
- congenital lymphedema of hands and feet
- high-arched palate
- short fourth metacarpal
- short stature
- ovarian failure
- CVD and renal issues
- ear malformations
- amenorrhea
176
Primary amenorrhea labs
- serum pregnancy
- prolactin (if elevated --> CT of sella turcica; location of pituitary gland)
- r/o hypogonadism: estrogen, progesterone, DHEA, FSH, TSH
177
Hepatitis A dosing schedule
12 months
| 18 months
178
If mother HBsAg positive, what to do with newborn
- HBIG within 12 hours of birth
| - give hep B vaccine
179
Hib vaccination lead to the almost eradication of what disease
epiglottitis
180
MMR and MMRV is contraindicated with which allergy
neomycin or gelatin
181
For children <8 receiving flu shot for first time, 2nd dose needs to be given by
4 weeks
182
HPV vaccine for 9-14 year old
0, 6-12 months later
183
HPV vaccine for >15 year old
0, 1-2 months, 6 months
184
CDC recommends monitoring a child for at least ___ after receiving a vaccine
15 minutes
185
T1DM labs will show what
- pancreatic antibodies
- insulin levels
- C-peptide levels
186
DSM-V criteria for ADHD
- Symptoms present prior to 12 years old
- Symptoms last >6 months
- symptoms evident in 2 different settings
187
ADHD treatment first line
meds considered first line for patients >6 years old
| -methyphenidate, amephetamines
188
What schedule are medications for ADHD
2
189
Screening tool for autism
MCHAT-R/F
| 18-30 months
190
What age can montelukast be given
starting 2 years
191
When can asthma treatment be stepped down
-if well controlled at least 3 months
192
Step 2 of child 0-4 with asthma
- low dose ICS
| - alt: Singulair, Cromolyn
193
Step 3 of child 0-4 with asthma
-medium dose ICS
194
Step 4 of child 0-4 with asthma
- medium dose ICS
| - AND either Singulair or LABA
195
Step 5 of child 0-4 with asthma
- high dose ICS
| - AND either Singulair or LABA
196
Step 6 of child 0-4 with asthma
- high dose ICS
- AND either sinulair or LABA
- AND oral corticosteroid
197
Montelukast (Singular) class
Leukotriene Receptor Antagonist
198
Nedocromil class
Mast cell stabilizer
199
Alternative medications that can be used for 5-11 year olds with asthma
- LTRA
- Nedocromil
- Theophylline
- Cromolyn
200
Cromolyn class
Mast cell stabilizer
201
Which 2 alternative medications can be used with Step 3-6 for 5-11 year olds with asthma
- LTRA
| - Theophylline
202
Step 3 of 5-11 year old with asthma
- preferred low dose ICS + LABA, LTRA, or
- theophylline
- or med dose ICS
203
Step 4 of 5-11 year old with asthma
-medium dose ICS + LABA
204
Step 5 of 5-11 year old with asthma
-high dose ICS +LABA
205
Step 6 of 5-11 year old with asthma
-High dose ICS + LABA + oral steroid
206
PCV13 plus PCV23 should be given to who
high risk children >2 years old
207
PNA management in children
- Amoxicillin 90 mg/kg/day first line (Augmentin, or 3rd gen ceph if recent abx exposure)
- PCN allergy: macrolide, clindamycin
208
Bronchiolitis treatment
-supportive
209
Best steroids to give to children if needed
-single dose oral dexamethasone 0.6 mg/kg
210
Fastest onset medication for GFR
-nebulized epinephrine
211
Cystic fibrosis patho
-abnormal transport of Na and Cl across epithelial membranes
212
Cystic fibrosis testing
- sweat test
- if positive once, repeat again
- it positive twice, send to CF clinic
213
Symptom to suspect CF
persistent productive cough
weight loss
greasy stools
214
Patients with sickle cell anemia may take daily what
-daily PCN for Strep pneumo prophylaxis
215
Lead toxicity presentation
- fatigue
- GI complaints
- irritability
216
Leukemia presenting signs
- anorexia
- hepatosplenomegaly
- fever
- bleeding
- plts <100,000 (thrombocytopenia)
- lymphadenoapthy
- bone pain
- pancytopenia
217
What presentation of nodes should be considered malignant
-nontender
-firm
-rubbery
immoble
218
Headache red flags
- <3 years old
- HA awakens child
- thunderclap HA
- N/V
- altered mental state
- absent family history of migraine
219
Headache in children management
- avoid caffeine
- avoid daily analgesics
- possibly refer
220
What age are pyloric stenosis symptoms most likely to present
-3-6 weeks
221
Imaging study for pyloric stenosis
US
222
Normal amount of reflux in healthy infant
>30
223
Red flags of possible pathologic reason for reflux
- choking
- coughing with eating
- forceful vomiting
- bilious vomiting
- blood in stool
- poor weight gain
- refusing to eat
- constipation, diarrhea
- abdominal tenderness
- fever
224
GERD management
- usually no intervention
- avoid cigarette smoke
- consider non-cows milk protein formula
225
Acid suppressants and infants
- assess feeding, sleep habits
- assess soy and cow milk exposure
- thickened feeds
- avoid smoke
- Trial: PPI for 2 weeks, if improving, extend to 2-3 months
- refer to pedi GI if no improvement
226
Reflux usually resolves by what age due to what
- 1 year
| - due to immature LES, matures by 9-12 months
227
Most common cause of intestinal obstruction in children
intussusception
228
Classic triad of intussusception
- intermittent colicky abdominal pain (pulls up legs to chest)
- vomiting
- bloody mucosy stools (currant jelly)
229
Preferred means of rehydration for child with viral gastroenteritis
commercially prepared electrolyte solution (Pedialyte)
230
Retractile testes
- movement of testes between scrotum and inguinal ring by cremasteric reflex
- not associated with same risks as cryptochordism
- send to urology
231
How much time is given for a testicle to descend
6 months
232
When should a hydrocele in a child resolve
by 1 year
233
What is the most important to rule out when a child presents with hydrocele
-inguinal hernia
234
Treatment for first ever pediatric UTI
-aggressive treatment to prevent PN and renal scarring
235
First pediatric UTI medication treatment
- consider 2nd, 3rd gen ceph if no GU abnormalities
| - Ceftin, Suprax
236
When is imaging for a UTI needed
- 2-24 month patient with first febrile UTI treatment--> renal and bladder US
- voiding cystourethrogram test of choice for VUR
- Child of any age with recurrent febrile UTI
- UTi with fam hx of renal or urologic disease
237
When should BP screening begin for children
3
238
Innocent murmur clues
- grade <2
- softer intensity when sitting compared to supine
- not holosystolic
- minimal radiation
- musical or vibratory quality
239
Pathologic murmur cluse
- Grade >3
- holosystolic
- max at LUSB
- harsh or blowing
- systolic clicks
- diastolic murmur
- increased in upright position
- gallop or friction rub
240
Metatarsus adducts
Forefoot turned inward, may be an incomplete club foot
treat with stretching and extending
-if not stretchable, refer to ortho
241
Club foot aka
- talipes equinovarus
| - urgent ortho referral
242
Nursemaid elbow cause
-annular ligament slips over head of radius and becomes trapped
243
Nursemaid elbow maneuver
-Supination-flexion technique
244
Osgood Schlatter disease occurs in conjunction with
rapid growth spurt
245
Characteristics of Osgood Schlatter disease
- pain reproduced with extension of knee against resistance
| - straight leg raise test negative
246
Legg-Calve-Perthe's disease
-osteonecrosis of capital femoral epiphysis due to interrupted vascular supply
247
Trendelnburg's test
- (+) stand on affected side causes pelvic tilt (unaffected side lower)
- positive with Legge-Calve-Perthes, SCFE, developmental dysplasia
248
Slipped capital femoral epiphysis presentation
- chronic hip/knee pain with intermittent limp
- adolescent
- refer
249
Most common cause of hip pain in children
- transient synovitis of hip "irritable hip"
- benign
- absent systemic symptoms
- history of URI within 7-14 days
- resolves in 7-14 days
250
Exanthem
rash on skin
251
Enanthem
rash on mucous membranes (Koplik)
252
Roseola agent
Human herpesvirus 6
253
Fifth disease agent
Parvovirus B19
254
Herpangina agent
-Coxsackie A virus
255
Fifth disease aka
erythema infectiosum
256
Fifth disease presentation
- 3 stages
- prodrome: symptoms of URI with low-grade fever, HA, chills, malaise
- second: slapped cheek rash, resolves in 2-3 days
- third: rash moves to arms and legs, lacy-appearing rash, flat and appears purple, may last for a few weeks
257
Roseola aka
Exanthem subiitum
| Roseola infantum
258
Roseola presentation
- high fever for 2-4 days, abrupt cessation
| - appearance of maculopapular rash not on face
259
Herpangina presentation
-painful vesicles on soft palate and mouth
260
Measles 3 "C's"
- conjunctivitis
- coryza
- cough
261
AOM treatment for <6 month old
antibiotics
262
AOM treatment for 6 month to 2 year old
- certain OM: abx if severe or bilateral, observe if unilateral
- uncertain: abx if severe, observe if mild
263
AOM treatment for >2 year old
- certain: abx if severe, observe if not
| - uncertain: observation
264
First choice medication for AOM
- amoxicillin 80-90 mg/kg/day
| - recent abx: Augmentin
265
Referral for OM
- 3 or more distinct and well-documented episodes in 6 months
- 4 episodes in 12 months
266
First permanent teeth to appear
-first molars
| around 6 years old
267
What to do with child with nits and no itchyness
- if more than 1/4 inch from scalp and no itching --> most likely not viable
- remove nits by soaking head with distilled vinegar which will break down the protein of the nit casings, making it easy to comb them out of the hair
268
non-amphetimine ADHD medication
- Straterra (Atomoxetine)
| - SNRI
