STEP 2: PEDS: CHILD DEVELOPMENT Flashcards

(62 cards)

1
Q

What are the general fields of developement?

A

gross motor, fine motor, language, social/cognitivie

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2
Q

Delay in how many fields of developemnt constitutes a global developmental delay?

A

2 fields

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3
Q

Primitive reflexes in kiddos indicates________________ while in adults it indicates___________________

A

Kiddos: impaired brain development and in adults a frontal lobe lesion

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4
Q

What percentile do we consider head circumferance to be ‘macrocephalic’

A

97th+

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5
Q

What percentile do we consider head circumferance to be ‘microcephalic’

A

3rd-

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6
Q

What are our major causes of macrocephaly?

A

Hydrocephalus or tumor

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7
Q

What are our major causes of microcephaly?

A

Fetal alcohol syndrome, TORCH

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8
Q

What is our rule of thumb for weight gain in a neonate through 2 years of age?

A

Infants may LOSE 5-10% of their BW in first days of life but regain by 14 days, Infants DOUBLE their BW by 4-5 months, tiple it by 1 year, and quadruple it by 2 years

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9
Q

At this age, an infant should be able to hold their head up when prone

A

2 months

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10
Q

At this age, an infant should be able to sit unassisted

A

6 months

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11
Q

Crawls, cruises, pulls to stand

A

9-11 months

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12
Q

What fine motor skills do infants develop at 9-11 months

A

immature (3 finger) pincer grasp

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13
Q

What fine motor skills do infants develop at 12 months?

A

mature (2 finger) pincer grasp

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14
Q

When should an infant be able to build a tower of 2-4 cubes? What about 6?

A

2-4 at 18 months and 6 at 2 years

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15
Q

When should an infant be able to throw a ball?

A

12 months

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16
Q

When do infants start saying mama/dada?

A

9-11 months, actual first words may be at 11 months

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17
Q

Uses 1-3 words and can follow one step commands

A

12 months

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18
Q

Speech is 75% intelligible

A

3 years

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19
Q

speech 50% intelligible

A

2 years

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20
Q

This variant of normal growth is characterized by a child who often lags behind the growth curve but CONSISTENTLY lags and bone age is delayed compared to chronological age

A

Constitutional growth delay

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21
Q

This variant of normal growth is characterized by a child whose growth curve shows low to normal height velocity and bone age = chronological age. Puberty is NOT delayed. Adult height remains low

A

Familial short stature

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22
Q

Persistent weight for age and or length for age that is less than 5th percentule or crosses 2 major percentiles on a growth chart

A

Failure to thrive

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23
Q

What are organic etiologies for FTT?

A

CF, congential heart disease, milk protein allergy, chronic infxn (HIV), hypothyroid, GERD

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24
Q

What are non-organic etiologies for FTT?

A

low milk supply, inaccurate formula mixing, ppd, neglect, abuse

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25
What are the primitive reflexes?
moro, rooting, sucking, galant, palmar, plantar
26
Persistence of plantar reflex after 12 months of age
Babinski sign, indicates UMN issue
27
For infants with FTT, in what order will they fall off the curves?
1st weight, then length, then head circumference
28
When should newborns regain their birthweight by?
2 weeks of life
29
What is delayed puberty in males?
no testicular enlargement (gonadarche) by 14
30
What is delayed puberty in females?
no thelarche by 13
31
what is precoscious puberty in females?
signs of maturation before age 8
32
what is precoscious puberty in males?
signs of maturation before age 9
33
pathologic causes of pubertal delay
IBD/other systemic disease, malnutrition, gonadal dysgenesis, endocrine dysfunction (hypopit, pypothyroid, kallman, AIS, praderwilli)
34
Order of puberty in females
thelarche, pubarche/adrenarche, growth spirt, menarche
35
order of puberty in males
gonadarche, pubarche, adrenarche, growth spurt
36
# What tanner stage: no hair in male or female, chest flat with raised nipple
Tanner 1
37
# What tanner stage: pubic hair appears, testicular enlargement, breast buds/mounds form
Tanner 2 | 8-11.5 yrs ish
38
# What tanner stage: Coarsening of pubic hair, penis size and length increases, breasts enlarge
Tanner 3 | 11.5-13 yrs ish
39
# What tanner stage: coarsening of pubic hair sparing thigh, penis width/glans increases, breasts enlarge, raised areola, mound on mound
Tanner 4
40
# What tanner stage: Coarse hair across pubis and medial thigh, penis and testes enlare to adult size, aereola flattens
tanner 5
41
X linked mutation leading to a genotypic male with phenotype of female. Breast development, absent or minimal axillary and pubic hair. NO uterus, cervix. Primary amenorrhea.
AIS ## Footnote these pts need an elective gonadectomy due to cancer risk
42
What is our first step in assessing primary amenorrhea?
Do they have a uterus???
43
If a pt exhibits primary amenorrhea and an absent uterus, what is on your diff?
AIS, XX mullerian agenesis ## Footnote Note that swyer syndrome (XY dysgenesis) they HAVE a uterus
44
In the assesment of primary amenorrhea, if they have a uterus, what is the next step?
FSH
45
In the assesment of primary amenorrhea and they have a uterus and you do an fsh and find that it is HIGH, what is on your diff?
HIGH FSH should prompt you do think of doing a karyotype anaylsis. This will help you differentiate TURNER from primary ovarian insufficiency!
46
Primary amenorrhea + uterus present + normal FSH should make you think....
imperforate hymen
47
Primary amenorrhea + present uterus + low FSH should make you think....
Pit-thalam-issue of some kind. Get a TSH and prolactin to help you diff hypothyroidism, prolactinoma, and functional hypothalamic amenorrhea
48
the absence of menarche in a girl greater than or equal to 13 with NO secondary sexual characteristics
Primary Amenorrhea
49
In the evaluation of precocious puberty, what is your first test?
Wrist xray for bone age
50
A child exhibiting signs of secondary sex characterstics with normal bone age. They only are demonstrating pubic hair development without other changes. What is the likely culprit?
Premature adrenarche
51
If you are assesing someone for precocious puberty and they exhibit advanced bone age, what is your next move?
LH
52
Precocious puberty assesment--> advanced bone age--> high basal LH--> what should you be thinking?
central precosious puberty (idiopathic, cns tumor)
53
In a patient being evaluated for precocious puberty and they have advanced bone age, high basal LH or high LH w/ a GnRH stim test, what should be your next move?
Head MRI for hypothalamic or pituitary tumor
54
What is our mainstay of treatment for idiopathic central precocious puberty?
GnRH agonist ## Footnote prevents premature epiphyseal plate fusion and maximizes adult height potential. leuprolide, buserelin, goserelin
55
The premature onset of secondary sexual characteristics due to increased gonadotropin-releasing hormone secretion. Typically caused by idiopathic activation of the hypothalamic-pituitary-gonadal axis; can be caused by CNS tumors.
Central precocious puberty Gonadotropin-dependent precocious puberty
56
No increase in LH levels after GnRH administration is characterstic of what kind of precocious puberty?
Peripheral precocious puberty
57
What are some etiologies for peripheral precocious puberty?
Increased androgen production (CAH, sertoli-leydig cell tumor, leydig cell tumor), Increased estrogen production (McCune-Albright, dysgerminoma), elevated beta HCG production (dysgerminoma, embryonal cell carcinoma, choriocarcinoma), primary hypothyroid, exogenous steroid use, obesity related
58
Mosaic mutation in the GNAS1 gene on chromosome 20 (autosomal recessive inheritance) Some cells have a normal version of the GNAS1 gene, while other cells have the mutated version. Embryos only survive if mosaicism occurs. A genetic syndrome caused by a G-protein activating mutation and subsequent continuous stimulation of endocrine functions
McCune-Albright
59
What are the clinical features of McCune albright?
Unilateral cafe au lait, polyostotic fibrous dysplasia, peripheral precocious puberty, cushing, acromegaly, hyperthyroid ## Footnote The 3 P's of McCune-Albright syndrome are Polyostotic fibrous dysplasia, Pigmentation (café-au-lait spots), and Precocious puberty.
60
Klinefelter, turner, and AIS are all considered
primary gonadal insufficiency in hypergonadotropic hypogonadism
61
In patients with delayed puberty, what might the following labs tell you: serum prolactin IGF-1 Karyotype Antiendomysial antibody Ab US Head MRI
serum prolactin: prolactinoma? IGF-1: growth hormone def Karyotype: turner/klinefelter Antiendomysial antibody:celiac + malabsorp Ab US: streak ovaries, testicular mass Head MRI: prolactinoma
62
Primary treatment for constitutional growth delay
expectant managemnt