Pediatrics (p268 - 305) Flashcards
(187 cards)
1
Q
Moro and grasp reflex
A
Newborn
2
Q
Hold head up
A
2 mos
3
Q
Grasps object
A
4 mos
4
Q
Orient to voice
A
4 mos
5
Q
Sit upright
A
6 mos
6
Q
Sleep all night
A
6 mos
7
Q
Crawl
A
9 mos
8
Q
Mama Dada name calling (to anyone)
A
9 mos
9
Q
Mama Dada name calling to parents
A
12 mos
10
Q
Pulling oneself up to a standing position
A
9 mos
11
Q
Stand unassisted
A
12 mos
12
Q
Walk
A
15 mos
13
Q
Temper tantrum
A
15 mos
14
Q
Successful toilet training initiation
A
18 mos
15
Q
4-6 word vocabulary (non sentence)
A
15 mos
16
Q
Can eat with spoon (solid foods)
A
18 mos
17
Q
Speak 2 word sentences
A
24 mos
18
Q
Speak 3 word sentences
A
36 mos
19
Q
Know first and last name
A
36 mos
20
Q
Throw ball
A
18 mos
21
Q
Walk upstairs
A
18 mos
22
Q
Run
A
24 mos
23
Q
Ride tricycle
A
36 mos
24
Q
When do boys go through testicular enlargement
A
11.5 yrs
25
When do girls develop breast buds
10.5 yrs
26
When do girls undergo menarche
12.5 yrs
27
When do boys undergo peak growth?
13.5 yrs
28
What is the mechanism of botulinum toxin?
irreversibly blocks acetylcholine release from the peripheral neurons.
29
What are the sx of Clostridium?
acute flaccid descending paralysis with clear sensorium without fever or parasthesias
30
How does botulinum toxin spread?
ingestion of spores in honey or via inhalation of spores
31
Whats the danger of botulinum toxin? Tx?
respiratory distress, tx by intubation and supportive care.
32
How is toxo transmitted/
Through cat feces and poorly cooked meat
33
What fraction of moms who have toxo transmit to baby? what fraction of babies are clinically affected?
1/3
| 1/3
34
What are the sequelae of toxo?
intracerebral calcifications, hydrocephalus, chorioretinitis, microcephaly, severe mental retardation, epilepsy, IUGR
35
How does the chance of rubella transmission change with each trimester?
80% chance
50% chance
5% chance
36
Pt with rubella will present with...
IUGR, cataracts, glaucoma, chorioretinitis, PDA, ASD, VSD, microcephaly, myocarditis, BLUEBERRY MUFFIN RASH, HEARING LOSS
37
How is Dx of rubella confirmed?
IgM rubella antibody
38
What should be the protocol for women with Herpes who are pregnant How to deliver?
C-section
39
What is the number one congenital infection transmitted through bodily fluids and secretions?
CMV
40
How often is syphillis infected from mother to baby during delievery?
Nearly 100%
41
Why is otitis media with effusion common in young children?
Because their eustachian tubes are smaller and more horizontal.
42
What is the first and second line treatments for otitis media?
Amoxicillin/Azithromycin is 1st line
| Augmented penicillins and TMP-SMX is second line
43
What are the common pathogens seen in otitis media?
S. pneumo, H. influenza and moraxella catarrhalis
44
Erythematous maculopapular rash that erupts 5 days after onset of prodromal sx. Begins on head an spreads down to body. White spots on buccal mucosa, fever, cough conjunctivitis and coryza. Dx?
Measles (Rubeola) Paramyxovirus
45
Suboccipital lumphadenopathy with maculopapular rash that starts on face and generalizes. Reddish spots on soft palate. Dx?
Rubella (German measles)/ Togavirus
46
Vasicular rash on hands and fee with ulcerations in mouth .Rash clears in 1 wk
Hand foot and mouth dz, coxsackie A virus
47
Abrupt high fever persisting for 1-5 days even though child has no physical sx to account for fever and does not feel ill. When fever drops, macular or maculopapular rash appears over trunk and entire body, lasts 24 hours
```
Roseola infantum (Exanthum subitum)
HHV-6
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48
Slapped cheeks erythema on chees. Maculopapular rash spreads from arms to trunk and legs forming a reticular pattern. Dx? Dangerous to what population of pts (2)? and in adults this causes what sx?
Erythema infectiousum (fifth's disease)/ Parvovirus B19
Danger to sickle cell--> aplastic anemia and preggos
In adults, migratory polyarthritis
49
How long are chickenpox lesions contagious?
Take 3 days to crust over, and they are contagious until crusting happens.
50
What should be the management for chronic effusions or repeated OM infections?
surgical placement of pressure equalization tubes
51
What do adults with unilateral serous effusions need to have ruled out?
nasopharyngeal mass
52
One complication of OM and mastoiditis is a Bezold abscess. What is that?
infection that penetrates tip of mastoid and pus travels along SCM forming an abscess in the posterior triangle of neck
53
What is a postauricular abscess?
Complication of OM and mastoiditis --> most common subperiosteal abscess that occurs posterior to auricle--> displacing ear forward
54
What organism is bullous myringitis associated with?
Mycoplasma infection
55
What does bullous myringitis present with?
Large blebs on the tympanic membrane
56
Whats the treatment of bullous myringitis?
Azithromycin
57
How do you diagnose/r/o nasopharyngeal masses in unilateral serous OM in adults?
MRI head, endoscopic visualization and biopsy
58
What age is bronchiolitis mc seen in?
Age less than 2
59
What viruses cause bronchiolitis?
50% RSV
| also --> parainfluenza virus and adenovirus
60
How is RSV diagnosed?
culture or antigen detection of nasopharyngeal secretions
61
Tx of bronchioloitis?
bronchodilators and O2 as needed.
62
3 mo-3yrs pt with barking cough worse at night. Dx? xray? tx?
Coup by parainfluenza virus (aka laryngotrachobronchitis)
Xray - steeple sign
Tx: O2, cool mist, racemic epi
Steroids if severe. Ribavarin for immunocompromized
63
What are the 3 stages of pertussis infection and time frames?
1. Catarrhal 1-2 wks
2. Paroxysmal 2-4 wks with "Whoops"
3. Convalescent stage 1-2 weeks
64
Pt with fulminant inspiratory stridor,drooling, sits leaning forward. Hot potato voice. Dx? organism? xray? Tx?
Epiglottitis secondary to H.flu B
Thumb print sign on xray
Examine, put in OR, intubate as needed, Ceftriaxone
65
>6 mos presents with insspiratory stridor, wheeze, dysphagia. Usually was playing with something, acute onset. Dx? xray? tx?
Foreign body aspiration
xray shows hyperinflation on affected side
Endoscopic or surgical removal
66
Pt with staccato cough and conjunctivitis. Pt afebrile. Dx?
Chlamydia
67
What is the most common pediatric non infectious cause of stridor?
Laryngomalacia
68
What type of stridor would indicate the supraglottis has been affected?
inspiratory stridor
69
What type of stridor would indicate that there's glottic or subglottic narrowing?
Biphasic stridor
70
Pt with frequent OM episodes, snoring at night, constant mouth breathers and nasal congestion with hypernasal voice. What could he have? key feature? tx?
adenoiditis
adenoid facies
tx: surgical removal of adenoids
71
Commonly called "genu valgum"
knock knees
72
If persistent after what age is genu valgum considered abnormal?
after age 4-5 years
73
Commonly called bow leggedness
genu varum
74
What medical condition can cause genu varum?
Rickets - vitamin D deficiency
75
What is the number one cause of a painful limp in 1-3 years old
septic arthritis
76
Pt with acute onset monoarticular hip/knee/ankle pain with limited ROM. Labs show increased WBC, ESR, refusal to walk. Dx? how to make dx? MC etiology? Xray?
Septic arthritis
dx by joint aspiration --> WBC>10000 with neutrophil predominance, low glucose
Xray shows joint space widening
MC organism is S. aureus
77
Pt with insidious onset of pain, seen in boy who are 5-10 years old. WBC and ESR normal. No tenderness, warmth, or joint swelling. Xray normal. Dx? how to make dx? Tx?
Toxic synovitis
Dx with technetium scan which will show uptake of epiphysis
Rest and anelgesics for synovitis for 3-5 days
78
Aseptic avascular necrosis of head of femur, often involving boys ages 5-9
Legg-Calve-Perthes dz
79
Aseptic avascular necrosis of the tibial tubercle
Osgood schlatter
80
What bone does Kohler's bone dz involve?
Navicular
81
Seen in obese male adolescents, dull aching pain in hip or knee with increased pain with activity. Dx? Xray? Tx?
Slipped capital femoral epiphysis - dx made clinically
xray - ice cream scoop falling off cone
Tx: surgical pinning
82
What is the gold standard for osteomylitis? MC organism?
MRI
| S. aureus
83
Chronic inflammation of >1 joint in patient
Juvenile Rheumatoid arthritis
84
What are the 3 categories of jeuvenile rheumatoid arthiritis?
Systemic
Pauciarticular
Polyarticular
85
What is the tx for juvenule rheumatoid arthritis?
NSAIDs, low dose methotrexate and prednisone online in acute febrile onset
86
Whats another name for Kawasaki dz?
Mucocutaneous lymph node syndrome
87
What does CRASH for Si/Sx in Kawasaki's stand for?
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Conjunctivitis
Rash, primarily truncal
Aneurysms of coronary arteries
Strawberry tongue, crusting of lips fissuring of mouth and oropharyngeal erythema
Hands and feet show induration.
```
88
What is the tx for Kawasaki?
IVIG and high dose aspirin.
Prednisone is contraindicated
89
What kind of vasculitis is Henoch-Schonlein Purpura?
IgA small vessel vasculitis
90
What nephropathy is Henoch Schonlein purpura related to?
IgA nephropathy
91
What is the main si/sx of Henoch Schonlein purpura?
pathognomonic palpable purpura
92
Proliferation of histiocytic cells resembling Langerhans skin cells
Histiocytosis X
93
What are the 3 common variants of histiocytosis X?
Letterer-Siwe
Hand-Schuller-Christian
Eosinophilic granuloma
94
Pt with proliferation of histiocytic cells. Also with hepatosplenomegaly, lymphadenopathy, pancytopenia, lung involvement and recurrent infections. Dx?
Letterer Siwe dz
95
Pt with proliferation of histiocytic cells a/w classic triad skull lesions, diabetes insipidus and exopthalmus
Hand-Schuller Christian disease
96
Pt with proliferation of histiocytic cells a/w extraskeletal involvement generally limited to lung. Best prognosis
Eosinophilic granuloma
97
Why does congenital hypothyroidism occur?
Secondary to agenesis of thyroid or defect in enzymes
98
What hormone is crucial in the first 2 years of life for normal brain development?
T4
99
What si/ sx does congenital hypothyroidism present with? at what age?
6-12 weeks with poor feeding, lethargy, hypotonia, coarse facial features, large protruting tongue
100
Why is diagnosis of congenital hypothyroidism crucial by 6weeks?
If dx is delayed, child will be mentally retarded.
101
When does physiologic jaundice clinically begin?
24-48 hours after birth
102
What kind of bilirubin is elevated during phsyiologic jaundice? Why?
unconjugated hyperbilirubinemia
| because there is a relative deficiency of glucuronyl transferase in the immature liver
103
What kind of newborn jaundice is always pathologic?
Jaundice present at birth
104
What are the 2 diseases caused by congenital deficiency of glucuronyl transferase?
Crigler Najjar and Gilberts
105
What are some ways to get congenital hemolytic anemia?
spherocytosis
G6PD
pyruvate kinase deficeincy
106
What are some acquired ways to get hemolytic anemia?
ABO/Rh isoimmunization, infection
drugs
twin-twin transfusion syndrome, chronic fetal hypoxia
delayed cord clamping, maternal diabetes
107
What are some infectious causes to have conjugated hyperbilirubinemia?
sepsis, torch group, syphillis, L.monocytogenes, hepatitis
108
What are some metabolic causes to have conjugated hyperbilirubinemia?
galactosemia, a1-antitrypsin defeciency
109
What are some congenital causes to have conjugated hyperbilirubinemia?
extrahepatic biliary atresia,
Dubin johnson
Rotor syndrome
110
What is the tx for newborn jaundice
phototherapy with blue light (not UV light which can harm the skin and retina) to break down bilirubin pigment
111
Why does new born jaundice need to be urgently treated?
to prevent kernicterus (bilirubin precipitation in the basal ganglia)
112
What is the Ddx if jaundice within 24 hours of birth?
Hemolysis, sepsis
113
What is the Ddx if jaundice within 48 hours of birth?
hemolysis, infection, physiologic
114
What is the Ddx if jaundice after 48 hours of birth?
infection
hemolysis
breast milk (liver can't handle lipids of breast milk)
congenital malformation (biliary atresia)
Hepatitis
115
Acute encephalopathy and fatty degeneration of the liver associated with use of salicylates in children with varicella or influenza-like illness
Reye's syndrome
116
Describe the fever seen in Reye's syndrome
Biphasic course with prodromal fever that rapidly progresses to seizures, coma, death
117
Treatment for Reye's syndrome?
Control of increased intracranial pressure because of cerebral edema - use mannitol with fluid restriction and give glucose because glycogen stores are completely depleted
118
What is the most common convulsive disorder in young children?
Febrile seizures
119
What age do febrile sz most commonly occur?
3months and 5 years
120
What is the cause of febrile seizures?
Usually no CNS infection or defined cause.
121
When in the course of the fever does the febrile seizure occur?
during the rise in temperature, not at the peak of temperature
122
how high is the temp in febrile seizure?
very high, greater than 102
123
Describe the seizure associated with febrile seizures
tonic clonic with most lasting less than 10 minutes with a drowsy post ictal period
124
What should be considered if the seizure lasts longer than 15 minutes?
Most likely because of infection or other toxic process, careful workup should follow, consider lumbar puncture to rule out meningitis
125
Define failure to thrive
Failure of child to grow and develop because of inadequate calorie intake or because of inadequate calorie absorption
126
What are the three diagnostic criteria of failure to thrive?
127
What are some exceptions to the diagnostic criteria of Failure to thrive?
short stature children
small for gestational weight children, normally lean infants
really overweight infants whose rate of height gain increases while weight gain decreases.
128
Why is the prognosis so poor when children have failure to thrive in the first year of life?
Because maximal postnatal brain growth occurs during the first 6 months of life - 1/3 of children with non organic FTT are developmentally delayed
129
What is the mildest form of craniofacial abnormality?
bifid uvula
130
What is the most common malformation of the head and neck? How does this affect feeding? tx?
unilateral cleft lip - doesnt interfere with feeding
| tx: surgical repair
131
Why do anterior cleft palates occur?
because of failure of palantine shelves to fuse with primary plate
132
Why do posterior cleft palates occur?
failure of palantine shelves to fuse with nasal septum
133
How do cleft palates affect feeding?
Interefere with feeding - requires a special nipple
134
What tongue finding is seen in patients with Down's sndrome, gigantism, hypothyroid?
Macroglossia
135
In what situation is glossitis seen? define glossitis
Vitamin B deficiencies
| redness and swelling with burning sensation
136
Pt with arrhinencephaly, holoprosencephaly and Rocker bottom feet. Dx?
Patau's syndrome trisomy 13
137
Pt with srrhinencephaly, corpus callosum agenesis, microcephaly and micrognathia. Dx?
Edward's syndrome - caused by trisomy 18
138
Pt with cardiac septal defects, psychomotor retardation, classic down's facies, increased risk of leukemia, premature alzheimer's dz. Dx?
Down's syndrome
139
What are Down's facies?
flattened occiput, epicanthal folds, upslanted palpebral fissures, speckled irises (Brushfield's spots), protruding tongue, small ears, redundant skin at posterior neck, hypotonia, simean crease in palms
140
What is the number 1 cause of primary amenorrhea
Turner's syndrome bc XO genotype
141
What is the treatment for Turner's syndrome?
hormone replacement therapy to allow secondary sex characteristics to develop
142
What is the trinucleotide repeat for Fragile X?
CGG
143
What is the number one cause of mental retardation in boys
Fragile X
144
Pt with long face, prominnant jaw, large ears, enlarged testes, developmental delay and mental retardation. Dx?
Fragile X
145
Congenital disorder in which pt with caudally displaced cerebellum, elongated medulla passing into foramen magnum, flat base skull, hydrocephalus, meningomyelocele and aqueductal stenosis. Dx? Prognosis?
Dx - arnold chiari malformation
| Prognosis - death as neonate or toddler
146
What marker is elevated in maternal serum if baby has a neural tube defect? Prevent NTD?
Alpha feto protein
| Give folic acid during pregnancy
147
What are some si/sx in fetal alcohol syndrome?
Facial abnormalities, developmental defects, smooth philtrum of lip, microcephaly and ASDs
148
Eye finding: discrete flakes in the anterior and posterior cortex with cortical star shaped opacity.. seen in what kind of pts?
Down's syndrome
149
Autosomal dominant multinodular proliferation of multinucleated astrocytes that form small tubers (white nodules in the cortex and periventricular areas). Dx?
Tuberous sclerosis
150
What is the classic skin finding for pts with tuberous sclerosis?
adenoma sebaceum - small adenomas on the face in distribution similar to acne.
151
What cancer is tuberous sclerosis associated with?
rhabdomyosarcoma
152
Pt with projectile vomiting in the first 2 weeks to 2 months of life. Dx?
congenital pyloric stenosis
153
What demographic is congenital pyloric stenosis most common in?
Boys who are first born
154
What is the pathognomonic physical finding in congenital pyloric stenosis?
palpable "olive" nodule in the mid epigastrium
155
What is the tx for congenital pyloric stenosis?
longitudinal surgical incision in the hypertrophied muscle.
156
What heart sound does an ASD make?
loud S1, WIDE FIXED SPLIT S1, midsystolic ejection murmur
157
What is the most common congenital heart defecT?
VSD
158
What is the heart sound for a VSD?
holosytolic murmer over the entire precordium maximally over the 4th left intercostal space.
159
What is eisenmenger's complex? Sx?
Right to left shunt secondary to pulmonary htn
| Sx: RV hypertrophy, cyanosis and venous thrombi
160
What are the 4 physical defects comprising of tetrology of fallot?
1. VSD
2. Pulmonary outflow tract
3. RV hypertrophy
4. Overriding aorta
161
What is a Tet spell?
Seen in tetrology of fallow where pt has acute cyanosis and panic in child and child adopts a squatting posture to improve blood flow to lungs
162
What does the chest xray of a pt with tetrology of fallot look like?
Classic boot shaped contour
163
Aorta comes off RV and pulmonary artery comes off LV. Dx?
Transposition of the great arteries
164
What does the chest xray of a pt with transposition of the great arteries look like?Tx? nail finding?
englarged egg shaped
surgical intervention
Digital clubbing
165
Pt with decreased BP in the legs, normal BP in arms. Continuous murmer over the collateral vessels in the back. Xray shows ribi notching. Dx?
Coarctation of the aorta
166
What is the murmer of PDA? Tx?
continuous machine murmer heard best in the 2nd left interspace. Tx: Indomethacin (blocks prostoglandins and induces closure)
167
Are clinical and lab evaluations allowed without parental/gaurdian permission in cases of suspected child abuse?
yes
168
What parts of the body are accidental injuries seen?
shins, forearms and hips
169
What kind of fractures are suspicious for abuse? (2)
damage to the metaphysis
| Spiral fractures to the periosteum before child can walk
170
What is a chip fracture?
where the corner of the metaphysis of a long bone is torn off with damage to the epiphysis
171
Circular punched out lesions of similar size on hands and feet may indicate..
Cigarette burn
172
What kind of burns and appearances are suspicious for abuse in children?
summetrical with burn affecting perineum or scalded line on thigh without splash marks, stocking or glove burn on hands/ feet
173
What is a marker for head injury?
Subdural hemorrhages, retinal hemorrhages
174
Sexualized behaviors with peers or objects might indicate what?
Sexual abuse
175
What might you consider ordering, esp if pt is too young to speak
Bone survey (skeletal survey)
176
What other labs might you order for suspected chcild abuse?
PT/PTT for bleeding diathesis
Collect specimens of offender's sperm, blood, hair, nail clippings and clothing.
Get GC cultures from mouth, anus and genetalia
177
What are the indications to admit a child abuse pt?
severe enough, dx is unclear or if no other safe placement is available
178
Pt with hypotension and brady cardia, What toxins might have been ingested?
Organophosphates or b-blocker
179
What might be the most effective and safest way to prevent absorption?
Charcoal.
180
What percent of all deaths in adolecsents are accidental?
50%
181
Most likely cause of accidental death in older kids? younger?
Older- MVA
| younger: drowning and fatal injuries involving weapons
182
Homocide rate is highest for what race?
5x higher for african american males
183
What is the second leading cause of adolescent death?
suicide, males 5x more likely to succeed
184
What is the average age of first substance abuse?
12-14y
185
What age distribution is anorexia mc seen?
14.5 years and 18 years
186
What are the exceptions to confidentiality with regards to minors
Suicidal or homicidal behavior or sexual/physical abuse
187
What is HEADSSS assessment/screening?
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Home environment
Employment/education
Activities
Drugs
Sexual activity
Suicide
Safety
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