Pediatrics Exam I Flashcards
(125 cards)
1
Q
Hepatitis B
A
- Name: HBV
- Series of 3: Birth, 1-2 mos, 6-18 mos
- Contraindications:
- life threatening allergy to yeast
- allergy to vaccine,
- moderate to severe illness
2
Q
Diptheria, tetanus, acellular pertussis
A
- Name: DTaP
- Series of 5: 2mo, 4 mo, 6 mo, 15-18 mo, 4-6 yrs
- Contraindication:
- encephalopathy w/ in 7 days of vaccine
- Allergy
- moderate to severe illness - Precaution: unstable neuro disorder
3
Q
Haemophilus influenzae type B
A
- Name: Hib
- 2 or 3 shot series + booster: 2 mo, 4mo, 6 mo, 12-15 mo (booster)
- Contraindication:
- age less than 6 weeks
- severe latex rxn
- allergy to vaccine
- moderate to severe illness
4
Q
Inactivated poliovirus
A
- Name: IPV
- 4 shot series: 2mo, 4 mo, 6-18mo, 4-6 yrs
- Contraindications:
- anaphlactic rxn to neomycin, streptomycin, polmyxin B
- allergy to vaccine
- moderate to severe illness
5
Q
Pneumococcal conjugate (PCV 13)
A
- Name: PCV 13
2. 4 shot series: 2 mo, 4 mo, 6 mo, 12-15 mo
6
Q
PPSV23
A
- High risk kids 2 years or older
- PCV 13 + PPSV23
- Protects against 23 types of pneumococcal bacteria
7
Q
Strep. Pneumoniae
A
leading cause of bacterial meningitis in US children.
200 children die each year
8
Q
Rotaviris
A
LIVE-ATTENUATED
- Name: Rotarix, RotaTeq
- Rotarix (2 shot), RotaTeq (3 Shot): 2 mo, 4 mo, 6 mo
- Contraindications
- Severe combined immunodeficiency
- in-utero exposure to immunomodulating agents
- Rotarix: severe latex allergy
- history of intussusception
9
Q
Hepatitis A Vaccine
A
- Name: HAV
- 2 shot series: 12-23 mos, 2nd dose w/in 6 to 18 mos
- Contraindications:
- severe allergy to prior dose or vaccine additives - AZ high risk: dose 1 required 15 days prior to enrollment at child care, preschool or headstart
10
Q
Measles, Mumps, Rubella
A
LIVE VACCINE
- Name: MMR
- 2 shot series: 12-15 mo, 4-6 years
- Contraindications:
- anaphylactic rxn to neomycin or gelatin
- Pregnancy
- immunosuppression
11
Q
Varicella
A
LIVE VACCINE
- Name: Varicella
- 2 Shot series: 12-15 mo, 4-6 years
- Contraindications:
- anaphylactic rxn to neomycin or gelatin
- severe immunosuppression
- pregnancy
12
Q
MMR + Varicella
A
LIVE VACCINE
- MMRV
- 2 Shot series: 12-15 mo, 4-6 years
- Contraindications:
- anaphylaxis after previous dose
- immunosuppression
- Pregnancy
13
Q
Quadrivalent Meningococcal Polysaccharide Vaccine
A
- Names: Menactra, Menveo
- 2 Shot series: 11-12 yrs, 16 yrs
- High risk age <11 or age > 18
14
Q
Serogroup B Meningococcal Bexsero Trumenba
A
- Name: MenB
- 2 or 3 shot series: 16-23 yers old
- 10 or older who are at increased risk for serogroup B meningococcal disease
15
Q
HPV Vaccine
A
- Name: Gardasil
- Typically 2 shot series: 0 and 6-12 months
- 11-12 yrs old
- 9-26 in females, 9-21 in males
16
Q
Inactivated Influenza Vaccine
A
- IIV, flu shot
- indicated annually for everyone 6 mos and older
- Children 6mos-8yrs require 2 doses 4 wks apart during first season
- Contraindications:
- severe allergy to an influenza vaccine - Precaution: Guillan Barre w/in 6 weeks of vaccination
17
Q
Intranasal Influenza Vaccine
A
LIVE VACCINE
- Name: FluMist
- ages 2 or older, younger than 50
- Contraindications
- Pregnancy
- Hypersensitivity to vaccine or components
- aspirin therapy in children and adolescents (risk of Reye’s Syndrome
- immunocompromised
- age 2-4 w/ wheezing episode in last 12 mo
18
Q
Common side effects
A
- fussiness
- drowsiness
- low-grade fever
- pain, redness, swelling at site of injection
- loss of appetite
- myalgias
19
Q
Uncommon side effects
A
- anyphylaxis
- seizures
- inconsolable crying for greater than 3 hours
- fever greater than 105
20
Q
Persistance of primitive reflexes
A
sign of neurodevelopmental disorders
21
Q
Absense of primitive reflexes
A
disordered cerebral function
22
Q
Growth Measurements under 2 yo
A
length
weight
head circumfrance
23
Q
growth over 2 yo
A
BMI
height
weight
head circumference
24
Q
Measuring height
A
- 0-2: measured in supine position, plot on standard growth chart
- over 2: standing, plot on standard growth chart
25
Measuring weight
weight in clean diaper
over 3, without shoes
between 5th and 85th percentiles is normal
26
Calculating BMI
(weight/stature^2) x 703
27
Head Circumference
1. 0-3 years
2. neurologic abnormalities and malnutrition
3. should correlate w/ child's length (percentiles should match)
28
Abnormal head size
1. assess pattern of head growth
2. compare w/ other growth parameters
3. look for dysmorphic features
4. neuro/developmental assessment
5. signs and sx of increased intracranial pressure
29
Failure to Thrive Definition
1. drop of 2 or more major percentile line on standardized growth chart
2. height or weight drops below 3rd percentile on standardized growth chart
30
Hx of FTT
1. Early infancy: onset 4-6 months due to underfeeding or HIV, reflux, CHD, CF
2. Later infancy: onset 7-9 months due to food intolerances/diarrhea, battle of spoons
3. Todder: slower weight gain, control issues, developmental issues, distraction
31
FTT Labs
```
CBC
lead screen
stool culture
UA
Urine Culture
CMP
PPD/Quanteferon
Hemacult
Metabolic Screening
```
32
Common FTT problems
1. dilution of formula
2. excessive intake of juice or water
3. infrequent feeding
4. no set feeding times
5. no high chair
6. distractions
7. control issues
33
FTT Tx
Multidisciplinary
1. trial of nutritional therapies
2. Referrals to OT/GI
3. Nutritionist/RD
4. Hospitalization
5. Close f/u
34
Peds BP
1. HTN = systolic/diastolic BP 95th percentile or over on 3 or more occasions
2. annual screening begins at 3 yp
35
H & P: Neck Red Flags
painful, unilateral solitary adenopathy > 2cm
weight loss
36
H & P: Throat
Tonsils enlarged compared to other anatomy
tendency to get pharyngitits
37
H & P: Chest and Lungs
Ascultate through crying
Asthma in peds population
38
H & P: Cardiac exam
PMI at 4th intercostal until 7, then 5th
PMI to left of MCL at 4, MCL at 5-6, Right of MCL at 7
50% of children have innocent murmor during childhood
39
H & P: Abdomen
protuberant until adolescence
facial expression during palpation
Sports physical: presence of kidney is contraindication
40
H & P: GU
inguinal hernia in males with sports or weight lifting
pelvic exam when females become sexually active
Tanner sexual maturity rating to note development of secondary sexual characteristics
41
Vision screening
red light reflex, EOMs, inspection, pupil symmetry and reactivity
Fundoscopic and visual acuity beginning at 3 yo
42
Hearing Screening
infant at 1 mo
Formal hearing 4,5,6,8 and 10
43
Cholesterol and Lipids
screening for BMI > 85th percentile
44
Lead screening
1. high risk
| 2. peak levels 18-24 mo
45
Iron-Deficiency Anemia
1. 8% of all 1-3yo children
46
Dental screening
1-4 yo
47
SIDS
leading cause of infant mortality between 1 mo and 1 year
48
Colic
1. Onset: 2-3 weeks old
2. Resolves around 12 weeks
3. Rule of 3s: 3hrs of crying, 3 days a week, for 3 weeks
4. infants pull knees up, clench fists, want constant movement
49
Causes of colic
overload, immature digestion, environment, parental tension
50
Tx of Colic
1. cope calmly
2. gas medications
3. take breaks
4. soothing positions and noises
5. colic formulas
6. reflux meds: raniditine
7. reassurance
51
Neonate
first 28 days of life
52
infant
29 days to 12 months
53
preemie
birth before 37 weeks
54
APGAR
1. taken at 1 and 5 minutes, from 0-10
Activity:
0-absent
1-arms and legs flexed
2- active movement
Pulse:
0- absent
1- below 100 bpm
2- over 100 bpm
Grimace:
0-flaccid
1- some flexion of extremities
2- active motion (cough, sneeze, pull away)
Appearance:
0-blue, pale
1- body pink, extremity cyanosis
2-completely pink
Respiration:
0-absent
1- slow, irregular
2- vigorous cry
0-3 severely depressed
4-6 moderately depressed
7-10 excellent condition
55
APGAR Interventions @ 1 minute
<4: resuscitation
5-6: some nervous system depression
7-10: normal
56
APGAR Interventions @ 5 minutes
6 or under: high risk for CNS/organ dysfunction
7 or greater: proceed to thorough exam
57
Transitional period assessments
4-6 hours, Assess every 30-60 minutes
1. HR: 120-160 bpm
2: Resps: 40-60
3. Temp: 36.5-37.5 (9.7-99.5)
4. Color: central cyanosis
5. Tone
58
Ballard Scoring System
Estimate gestational age within 2 weeks
Assessment of neuromuscular and physical maturity
59
Gestational Ages
Preterm < 34 weeks
Late-Preterm 34-36 weeks
Term 37-42 weeks
Postterm > 42 weeks
60
Birth weight classification
extremely low < 1000g
Very low < 1500g
Low < 2500 g
Normal 2500g or more
61
Care of the well neonate
1. prophylactic erythromycin ophthalmic ointment (gonococcal ophthalmia)
2. vitamin K (1.0 mg) IM
3. Hep B Vaccine
4. umbilical cord care
5. monitor for hyperbilirubinemia and hymoglycemia
6. Newborn screen: heel stick, pulse ox, hearing screen
7. supine position
62
Newborn screen:
heel stick done at 24-48 hours, and at first doctor's visit or 5-10 days age
1. endocrine disorders
2. organic acid disorders
3. fatty acid oxidation disorders
4. hemoglobin disorders
5. enzyme deficiencies
6. amino acid disorders
7. CF
63
Congenital hypothyroidism
1. common preventable cause of mental redardation
2. 95% asymptomatic at birth
3. 85% thyroid dysgenesis
64
Adrenal hyperplasia
Females: ambiguous genitalia w/ glitoral enlargement and urethral/vaginal orifice. normal female organs
Males: no overt signs. Salt losing crisis. Non salt losing: signs of puberty in toddlers
65
Sickle Cell acute manifestations
1. infection
2. anemia
3. vaso-occlusive pain
4. stroke
5. acute chest syndrome
6. renal infarction, medication toxicity
7. MI
8. thromboembolism
66
Sickle Cell Chronic Manifestations
1. pain
2. anemia
3. neuro deficit
4. renal impairment
5. HTN
6. cardiomyopathy w/ diastolic dysfunction
7. hepatic injury
8. delayed puberty and reduced growth
9. chronic leg ulcers and proliferative retinopathy
67
CF
1. 80-90% of newborns w/ meconium ileus have CF
| 2. sweat chloride test is most important diagnostic test, done in f/u to positive newborn screen.
68
Hearing scren
1. ABR (auditory brainstem reponses)
2. OAE (otoacoustic emissions)
- sound generated from inner ear
- determines cochlear status/hair cell fxn
69
Positive Pulse Ox
1. SpO2 of < 90% in either extremity
2. SpO2 of 90-94% in both upper and lower extremities on 3 measurements separated by an hour
3. SpO2 difference > 3% between upper and lower extremities on 3 measurements separated by 1 hour
70
Infant feeding
1. fed 8-12 times/24 hours for 10-15 minutes
2. vitamin D supplement after birth
3. formula should be standard 20kcal/oz w/ fe
71
Skin/Hair assessment of neonate
1. vernix casosa
2. texture
3. color: jaundice, cyanosis, meconium staining
4. skin eruptions/rashes
5. birth marks/vascular markings
6. lanugo
7. midline hair tufts
72
lanugo
fine, depigmented hair covering neonate
73
milia
1. smooth white pinpoint papules on nose and cheeks
2. retention of keratin and sebaceous material
3. appear w/in first few weeks, disappears over several
74
Neonatal acne
1. 20% of infants
2. multiple papules and pustules
3. primarily affects forehead, cheeks, upper chest
4. starts 2-3 weeks
5. resolves 4-6 months
75
Miliaria rubra
1. scattered vesicles on erythematous base on face, neck, frunk.
2. non-follicular
3. obstruction of sweat glands, heat rash
4. disappears spontaneously
76
Erythema toxicum
1. appears days 2 or 3
2. 31-72% term neonates
3. erythematous macules with central pinpoint vesicles
4. progress to pustules, scatter diffusely
5. disappear w/in 1 week of birth
77
Pustular melanosis
1. more common in black infants
2. 3 stages, superficial white pustules, unroom erythematous macules w/ surrounding scale, hyperpigmented macules that gradually fade
78
Acrocyanosis
1. Bluish discoloration on hands and feet common after birth.
2. mucosa remains pink
3. differentiate from central cyanosis
79
Severe neonatal hyperbilirubinemia
1. TB > 25mg/dl
2. neurotoxic
3. preemie high risk
4. bilirubin-induced neurologic dysfunction (BIND) risk
80
Tx of neonatal jaundice
phototherapy
81
Jaundice pearls
1. w/in 24 hrs is pathologic
2. starts after 2 weeks is pathologic
3. ABO or Rh incompatibility
4. early discharge needs 2 day f/u
82
Cephalohematoma
associated w/ forceps or vacuum delivery
resolves spontaneously w/in 3 weeks
83
positional plagiocephaly
flattening of parieto-occipital region.
Positional changes angle of face, synostotic doesn't
84
Eye examination
1. Visual milestones: birth- blinks, regards a face. 1 mo - fixes on an object
2. inspect sclerae, pupils, irises, EOMs
3. Nystagmus common immediately after birth
4. intermittent strabismus normal w/in first few months of life
85
Red flags for fundoscopic exam
1. dark spots
2. unilateral blunted red reflex
3. absent reflex
4. white pupillary reflex
5. cloudiness of cornea
86
Acoustic blink reflex
blinking when fingers snapped 12 in from ear
87
Ear exam red flags
small deformed or low set auricles indicate potential renal defects
88
Choanal atresia
congenital narrowing of the back of the nasal cavity that causes difficulty breathing
89
Epstin's pearls
small, white benign inclusion cysts
commonly clustered at midpoint of junction btwn soft and hard palate
90
Torticollis
position/injury to SCM, precipitating factor of plagiocephaly
91
Omphalitis
infection of umbilical stump
92
cryptorchidism
undescended testicle.
2/3 descend by 1 year
93
hypospadias
urethral opening at inferior aspect of glans penis
94
hydrocele
swelling of scrotom w/ fluid accumulation
95
Rectal exam of neonate
cannot happen until meconium is passed. usually by 48 hours
96
Galeazzi Test
1. Test for hip dysplasia
2. feet together, not difference in knee height
3. unequeal knee height = positive
97
Barlow Test
1. ability to sublux or dislocate an intact but unstable hip
98
Ortolani test
1. test for the presence of posteriorly dislocated hip
99
Positive babinski
dorsiflexion of big tow and fanning of other toes
100
CN V test
rooting/sucking reflex
101
CN VIII test
acoustic blink reflex
102
Rooting reflex
1. Birth to 3-4 months
2. stroke perioral skin at corners of mouth
3. mouth should open and baby turn head toward stimulated side and suck
103
Moro reflex
1. Startle Reflex
2. Birth to 5-6 months
3. hold baby supine, support head, back and legs
4. abruptly lower entire body 2 ft.
5. arms abduct, extend, hands open, legs flex
104
Palmar grasp
1. Birth to 4-6 mo
2. place fingers into baby's hands and press against palmar surfaces
3. baby will grasp fingers
105
Plantar grasp
1. Birth to 6-8 mo
2. touch sole at base of toes
3. toes curl
106
Asymmetric tonic neck reflex
1. birth to 2-3 mo
2. with baby supine, turn head to one side, hold jaw over shoulder
3. arms/legs on side which head is flexed should extend, while opposite flex
107
Positive support reflex
1. birth or 2 mo - 6 mo
2. hold baby around the trunk and lower until feed touch flat surface
3. hips, knees, ankles extend, baby stands up
4. partial weight bearing, sag after 20-30 seconds
108
Developmental screening
1. Screening at 9, 18, and 24 or 30 mo
2. autism specific screening at 18 and 24/30 mo
3. Parent report is reliable
109
Red flags for autism
1. 12 mo: no babbling, pointing or gestures
2. 16 mo: no single words
3. 24 mo: no 2 word phrases
4. any age: loss of language, social or other skills
110
2 months milestones
1. Physical: lift and turn head, track past midline, primitive reflexes present
2. Language: turns head toward sound
3. Cognitive: alert to voices, follow objects w/ eyes
4. Social/emotional: begins to responsively smile
111
Anticipatory guidance 2 mos
sleep on back, SIDS education. Most common cause of death 2-4 mo
112
4 months milestones
1. Physical: holds head steady, rolls stomach to back
2. language: laughs and squeals
3. Cognitive: follows moving objects side to side
4. Social: enjoys play w/ ppl, copies movements
113
Anticipatory guidance 4 mos
tummy time. regular sleep and feeding schedule. risk of 2nd hand smoke
114
6 months developmental milestones
Physical: sits unsupported, reaches for object and brings to mouth, rolls over both ways
Language: vowel and consonant sounds, responds to sounds
Cognitive: brings objects to mouth
Social: responds to other's emotions
115
Anticipatory guidance 6 mos
feed solids, don't add sugar or salt.
put baby to sleep awake but drowsy
116
9 months developmental milestones
1. Physical: crawling, pull to stand, stand holding on
2. Language: starts saying mama, baba, dada w/out meaning. understands "no"
3. Cognitive: peek-a-boo, object permanence
4. Social: stranger fear first develops
117
12 month developmental milestones
1. Physical: takes steps, stands alone (2 sec)
2. Language: simple gestures, "mama" "Dada" w/ meaning. 2 word vocab. responds to verbal commands
3. Cognitive: copies gestures
4. Social: cries when parents leave
118
15 month developmental milestones
1. Physical: walks well, stoops down
2. language: 4-5+ word vocabulary. Red flag no single words
3. Social: hands things to others to initiate play
4. Cognitive: knows purpose of ordinary things and attempts to use them
119
18 month developmental milestones
1. Physical: run. kick a ball. eat w/ spoon and feed self
2. language: 20-50 word vocabulary
3. Social: looks for help when in trouble.
4. Cognitive: improved function w/ ordinary items
120
Anticipatory guidance
Potty training: await readiness. may introduce potty chair
by 2-4 years daytime control achieved
by 5-7 nighttime control expected
121
24 months developmental milestones
1. Physical: throws ball overhand, stands on tip toes
2. Language: Speaks in short phrases, 2 words or more. Repeats overheard words
3. Social: Helps undress and put items away. Empathy develops
4. Cognitive: completes familiar sentences and rhymes. might use 1 hand more than another
122
36 month developmental milestones
1. Physical: stands on one foot
2. Language: understandable 50% of the time, speaking in sentences
3. Social: pretend play and simple games
4. cognitive: make believe play
123
School age, 6-12, development
1. Language: 5-7 word sentences, 5 step commands by age 10.
| 2. Cognitive: improved focus, should be able to handle a task for at least 15 minutes
124
Immunization schedule mneumonic
B
2 B DR HIP
4 DR HIP
B DR HIP IN 6 Mo
1 MAD HPV
VERY DIM between 4-6pm
Tada! Human Men!
125
Live virus vaccines
MMR, FluMist, Varicella, Rotavirus
