When would you expect an infant to double their birth weight?
Between 4-5 months
Return to birth weight
7–10 days of age
Triple birth weight
1 year
At what age should the anterior fontanelle close?
2 years
Posterior fontanelle should close by
2 months
The moro reflex should be gone by
3-4 months.
The rooting reflex should be gone by
3-4 months
The neck reflex should be gone by
2 months
infants should walk by ______ and sit up by _______
1 year; 9 months
hold neck by age
3 months
roll over by
5 months
sit with own support by `
6 mos
sit without support by `
8 mos
stand holding on
9 m
creep well; stand w/o support by
12 m
walk alone; creep upstairs by
15 m
run by
18 m
walk up and down stairs by
2 yrs
ride tricycle by
3 yrs
hop on one feet; alternate foot on stairs
4 yrs
effects of excess lead in developing children
Decreased intelligence, impaired neurobehavioral development, and decreased growth.
How do we treat the patient with between 10-14 g/dL of lead in their body?
Dietary and environmental changes, follow up with blood lead monitoring in one month, and report the incident to the state
two key characteristics of a patent ductus arteriosus
Wide pulse pressure; Bounding pulses (quincke pulse on fingertips)
first sign of CHF seen in children
Tachycardia
three features of Marfan’s Syndrome
Pectus excavatum Positive wrist and thumb sign Pes planus (flat feet) Scoliosis Arm span > height Tall and thin
major criteria for acute rheumatic fever
Clinical and/or subclinical carditis (Seen on echocardiography)
Monoarthritis, polyarthritis and/or polyarthralgia
Chorea
Erythema marginatum (squiggly rash)
Subcutaneous nodules
In a child with Hypertrophic Cardiomyopathy (HOCM), what maneuver(s) will make the patient’s murmur increase in intensity and duration?
Sudden standing (decreases afterload) Valsalva maneuver (decreases preload) Exercise (increases contractility)
In a child with Hypertrophic Cardiomyopathy (HOCM), what maneuver(s) will make the patient’s murmur decrease in intensity and duration?
Squat or hand-grasp (increases afterload) Leg raise (increases preload)
The posterior fossa and brainstem are best appreciated using this imaging method
MRI is best for imaging posterior fossa and brainstem.
best for imaging after trauma (can detect blood pooling)
CT scan
You observe increased tone in someone with a neuromotor delay. This suggests upper or lower motor neuron disease?
upper motor neuron disease
example of upper nueron motor disease
cereberal palsy
Low tone/hyporeflexia is associated w/
spinal muscular atrophy
Red flags for motor nueron disease
elevated CK fasiculations facial dysmorphism, organomegaly, HF signs, early join contractures MRI brain abnormalities resp insuff with generalized weakness loss of motor milestones motor delays during minor acute
What is the most likely diagnosis in a two-month-old infant with hyporeflexia and respiratory problems?
abnormal muscle function
progressive proximal muscular weakness
increase in CK and transaminases
delays in attainment of developmental milestones
signs and symptoms that might suggest a diagnosis of autism
social interaction defecit; restricted, repetitive pattern of behavior, interest or activities
screens for autism
Screen with MCHAT-R at 18 & 24 months
SMA type 1 characteristics
onset < 6 mos. symmetrical weakness, absent tendon reflexes, unable to sit inden
SMA type II characteristics
onset 6-18 mos, sit unsupported, don’t walk independently
most common pathogens that cause acute otitis media (AOM)
H. Influenza; Strep pneumonia; M. Catarrhalis
Amoxicillin liquid suspension
400 mg/5 ml
common signs and symptoms of allergic rhinitis
allergic shiners, allergic facies
nasal mucosa pale or bluish, turbinates swollen, polyps
cobbelstone throat, serious fluid behind TM
the most common organism that causes croup
Parainfluenza
croup treatment
dexamethasone
croup presentation
barking cough, URI with fever, hoarseness, stridor wheeze
signs and symptoms of GABHS (bacterial) pharyngitis
Fever, chills, fatigue, malaise, myalgia
Sudden onset of sore throat w/painful swallowing
Tonsillar exudate (white spots), palatal petechiae, uvular swelling
Anterior cervical adenopathy
Hairy tongue, halitosis
treatment of GABHS (bacterial) pharyngitis
Obtain rapid test/throat culture (culture is gold standard!)
Amoxicillin 50 mg/kg per day x 10 days
What causes systolic murmur?
turbulence in ventricular outflow; av valve regurg; abnormal vent or arterial comms
what causes diastolic murmurs
turbulence in ventricular inflow; semilunar valve regurg
normal murmurs in first few days of life
PPS, pulmonary flow, closing PDA, transient tricuspid regurg
abnormal murmurs in the first days of life
outflow ob-AS, PS, coarctation, abnormal comms - VSD, PDA
transitional murmurs
closing PDA and transient tricuspid regurg
PDA gets _______ as it gets smaller
louder
When does PDA generally close
12-28 hours
Where to hear Transient tricuspid regurg
LLSB
which septal defect can lead to CHF?
ventricular
which defect causes decreased pluse and BP in lower extermities?
coarctation of aorta
what is the problem if someone has an unrepaired ASD?
increased risk of stroke
what disease can lead to myocarditis?
cocksackie b
ASD characteristics
exercise intolerance, no CHF, wide, fixed splitting of s2
what could aortic dissection be associated with?
Marfan
Patients prefer to lean forward, may refuse
to lie down when they have
pericarditis
which sound can you hear with pericarditis
friction rub or distant heart sounds (if effusion)
90% of endocarditis cases are caused by _________
gram positive cocci
clincial features of endocarditis
fever, tachy, CHF, dysrhytmia, murmur, petichiae, splenomegaly
clincial features of bacterial endocarditis
fevers, conjunctival hem, slpinter, janeways lesons,
what can developin 20% of kawasaki cases
coronary artery aneurysms
Kawasaki disease diagnostic criteria
fever > 5 days and non-purulent conjunctivitis oral mucosal changes (red cracked lips, pharyngitis, strawberry tongue) extremity changes (swelling or peeling) rash (in many perineal) cervical adenopathy
Signs of Moeblus
lack facial expressions micrognathia and microstomia weird tongue or palate missing teeth strabismus
diagnostic test that measures changes in cereberal blood flow
fMRI
diagnostic test that evaluates brain chemistry
MRS
diagnostic test that images blood flow in large arteries and veins and vessel patency
MRA
macrocephaly assessment components
transilumniate head w/ light listen for cranial bruits look for sings of increased ICP look at skin; cafe au lait, nevi, hypopigmented macules extraocular movement bony abnormalities
duchenne muscular distrophy treatment components
steriod, nocturnal ventilation, cardiac support
spinal muscular atrophy is characterized by
degeneration of brainstem and spinal cord motor neurons resulting in progressive weakness and muscle atrophy.
what is the most likely diagnosis of 2 mo with hyporeflexia and resp problems?
SMA1
Many prescription drugs can unmask or worsen symptoms of
myasthenia gravis
extreme episode of weakness that culminates in respiratory failure and the need for mechanical ventilation is ___________
myasthenic crisis
what can you elicit in the office with hyperventilation
absence
which seizures Will not usually remit without anticonvulsants
Juvenile Myoclonic Epilepsy
early signs of CP
alterned tone
persistence of primitive reflexes
abnormal posturing
Cerebral Palsy Associated Disabilities
Mental retardation 1/3 Normal while about 1⁄2 have some intellectual impairment. Epilepsy 20-50% > generalized. Speech disorders 50% delay/dysarthria. Vision and hearing 25%. Behavior abnormalities. Learning difficulties.
diagnostic test for CP
MRI
reflexes associated with CP
landau, parachute, propping reflex
which condition presents with limited or absent mobility of TM,
AOM
Chronic suppurative OM:
- Persistent inflammation of the middle ear or mastoid cavity
- Recurrent or persistent otorrhea through a perforated tympanic membrane
Side Effects of Antihistamines
anticholinergic, CNS stim in children
decongestants s/e
irritablity, nervousness, headache, urinary hesitancy, tachy, HTN
80% of pharyngitis cases are ________
viral
bacterial vs. viral sx of pharyngitis
bacterial: whitis spots, gray furry tongue, swollen uvula; both: red swollen tonsils and throat redness
infectious mono present w/ the triad of
fever, pharyngitis and lymphadenopathy
what causes majority of mono?
epstein-barr (also cytomegalovirus)
why should mono patients avoid sports?
hepatosplenomegaly
differential presentaiton of diphterhia pharyngitis
bull’s neck membrae, pseudo membrane exudate
PANDAS presentation
abrupt onset or exacerbation of OCD or tic behavior (related to strep infection)
Recurrent GABHS: Treatment
clinda, amox/ca, add rifampin to benzathine penicillin G
Peritonsillar Abscess presentation
Fever, chills, malaise, halitosis, toxic appearing, ‘hot potato” voice, drooling
Peritonsillar Abscess mgmt
refer to ED or ENT
Epiglotitis presentation
severe odynophagia, dysphagia, fever, drooling, SOB, distress, stridor
tacnypnea defintion Younger than two months
> 60 breaths/min
tacnypnea 2-12 mos
> 50 breaths/min
Tachypnea 1-5 years
> 40 breaths/min
greater than 5
> 20 breaths/min
1st line tx for pneumonia
amox 90 mg/kg 2 divided doses
most common cause of bronchiolitis
RSV
who is a happy wheezer?
someone with bronchiolitis
what ages to give 2 flu shots?
6 months to 8 years
no live vaccines for thoseI
under 2 over 50 with asthma or COPD contact with immunosupprssed recent use of steroids recent live vaccine
