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TN Pédiatrie > 1. Primary care > Flashcards

1. Primary care Flashcards

1
Q

Nommez les valeurs normales: TA, FR, FC

  • < 1 an
  • 1-2
  • 2-5
  • 5-12
  • >12
A
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2
Q

Nommez les fréquences des rencontres pédiatrique

A
  • newborn (within 1 wk post-discharge), 1, 2, 4, 6, 9, 12, 15, 18, 24 mo
  • annually between age 2-5; every 1-2 yr between age 6-18
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3
Q

Name: Adverse Reactions Associated With Any Vaccine (5)

A
  • Local: induration,tenderness,redness, swelling
  • Systemic: fever, rash, irritability
  • Allergic: urticaria,rhinitis,anaphylaxis
  • Contraindications
    • Moderate/severeillness ± fever
    • Allergy to vaccine component
  • No need to delay vaccination for mild URTI (Upper respiratory tract infections)
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4
Q

Name adverse reaction (3) and contraindication (3) for this vaccination: TdaP-IPV

A
  • Adverse reaction
    • Prolonged crying
    • Hypotonic unresponsive state (rare)
    • Seizure on day of vaccine (rare)
  • Contraindication
    • Evolving unstable neurologic disease
    • Hyporesponsive/hypotonic following previous vaccine
    • Anaphylactic reaction to neomycin or streptomycin
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5
Q

Name adverse reaction (2) and contraindication (4) for this vaccination: Rot-1

A
  • Adverse reaction:
    • Cough
    • Diarrhea, vomiting
  • Contraindication
    • History of intussusception
    • Immunocompromised
    • Abdominal disorder (e.g. Meckel’s diverticulum)
    • Received blood products (e.g. immunoglobulin) within 42 d
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6
Q

Name adverse reaction (5) and contraindication (3) for this vaccination: MMR

A
  • Adverse reaction:
    • Measle-like rash (7-14 d)
    • Lymphadenopathy, arthralgia, arthritis
    • Parotitis (rare)
    • Especially painful injection
    • Transient thrombocytopenia (1/30,000)
  • Contraindication
    • History of intussusception
    • Immunocompromised
    • Abdominal disorder (e.g. Meckel’s diverticulum)
    • Received blood products (e.g. immunoglobulin) within 42 d
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7
Q

Name adverse reaction (2) and contraindication (2) for this vaccination: Var

A
  • Adverse reaction:
    • Mild varicella-like papules or vesicles
    • 2 wk may get local or generalized rash
  • Contraindication:
    • Anaphylactic reaction to Baker’s yeast
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8
Q

Name adverse reaction (1) and contraindication (1) for this vaccination: Hep-B

A
  • Adverse reaction:
      • Contraindication:
    • Anaphylactic reaction to Baker’s yeast
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9
Q

Name adverse reaction (0) and contraindication (1) for this vaccination: HepB

A
  • Adverse reaction
  • Contraindication:
    • Anaphylactic reaction to Baker’s yeast
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10
Q

Name adverse reaction (0) and contraindication (1) for this vaccination: DTaP

A
  • Adverse reaction:
  • Contraindication:
    • 1st trimester pregnancy
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11
Q

Name adverse reaction (4) and contraindication (3) for this vaccination: Inf

A
  • Adverse reaction:
    • Malaise, myalgia
    • Febrile seizure when given with Pneu-C 13 or DTaP
    • Hypersensitivity reaction
  • Contraindication:
    • <6 mo of age
    • Immunocompromised
    • Egg-allergic individuals – Live attenuated influenza vaccine is not recommended for those with an egg allergy. In these individuals, trivalent or quadrivalent vaccine can be given in environment where anaphylaxis can be managed
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12
Q

Name adverse reaction (1) and contraindication (0) for this vaccination: HPV-4

A
  • Adverse reaction:
    • Pruritis
  • Contraindication:
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13
Q

Name adverse reaction (0) and contraindication (1) for this vaccination: MenB

A
  • Adverse reaction:
  • Contraindication:
    • Anaphylactic reaction to MenB vaccine or its components in the past
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14
Q

When is the most rapid growth? (2)

A
  • most rapid growth during first 2 yr
  • and at puberty
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15
Q

Premature infants (<37 wk) use corrected GA until when?

A

age 2

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16
Q

What’s the average growth at birth of this parameter: Birth Weight

  • Normal
  • Growth
  • Comments
A
  • Normal: 3.25 kg (7 lbs)
  • Growth:
    • Gain 20-30 g/d (term neonate)
    • 2 x birth wt by 4-5 mo
    • 3 x birth wt by 1 yr
    • 4 x birth wt by 2 yr
  • Comments:
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17
Q

What’s the average growth at birth of this parameter: Length/Height

  • Normal
  • Growth
  • Comments
A
  • Normal: 50 cm (20 in)
  • Growth:
    • 25 cm in 1st yr
    • 12 cm in 2nd yr
    • 8 cm in 3rd yr then
    • 4-7 cm/yr until puberty
    • 1/2 adult height at 2 yr
  • Comments:
    • Measure supine length until 2 yr of age, then measure standing height
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18
Q

What’s the average growth at birth of this parameter: Head Circumference

  • Normal
  • Growth
  • Comments
A
  • Normal:
    • 35 cm (14 in)
  • Growth:
    • 2 cm/mo for 1st 3 mo
    • 1 cm/mo at 3-6 mo
    • 0.5 cm/mo at 6-12 mo
  • Comments:
    • Measure around occipital, parietal, and frontal prominences to obtain the greatest circumference
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19
Q

Describe: Moro reflex

  • Maneuver to Elicit Reflex
  • Appropriate Reflex Response
  • Age of Disappearance
A
  • Maneuver to Elicit Reflex: Infant placed semi-upright, head supported by examiner’s hand, sudden withdrawal of supported head with immediate return of support
  • Appropriate Reflex Response: Abduction and extension of the arms, opening of the hands, followed by flexion and adduction of arms
  • Age of Disappearance: 4-6 mo
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20
Q

Describe: Galant reflex

  • Maneuver to Elicit Reflex
  • Appropriate Reflex Response
  • Age of Disappearance
A
  • Maneuver to Elicit Reflex: Infant held in ventral suspension and one side of back is stroked along paravertebral line
  • Appropriate Reflex Response: Pelvis will move in the direction of stimulated side
  • Age of Disappearance: 2-3 mo
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21
Q

Describe: Grasp reflex

  • Maneuver to Elicit Reflex
  • Appropriate Reflex Response
  • Age of Disappearance
A
  • Maneuver to Elicit Reflex: Placement of examiner’s finger in infant’s palm
  • Appropriate Reflex Response: Flexion of infant’s fingers
  • Age of Disappearance:
22
Q

Describe: ATNR reflex

  • Maneuver to Elicit Reflex
  • Appropriate Reflex Response
  • Age of Disappearance
A
  • Maneuver to Elicit Reflex: Turn infant’s head to one side
  • Appropriate Reflex Response: “Fencing” posture (extension of ipsilateral arm and leg and flexion of contralateral arm and leg)
  • Age of Disappearance:
23
Q

Describe: Placing reflex

  • Maneuver to Elicit Reflex
  • Appropriate Reflex Response
  • Age of Disappearance
A
  • Maneuver to Elicit Reflex: Dorsal surface of infant’s foot placed touching edge of table
  • Appropriate Reflex Response: Flexion followed by extension of ipsilateral limb up onto table (resembles primitive walking)
  • Age of Disappearance:
24
Q

Describe: Rooting reflex

  • Maneuver to Elicit Reflex
  • Appropriate Reflex Response
  • Age of Disappearance
A
  • Maneuver to Elicit Reflex: Tactile stimulus near mouth
  • Appropriate Reflex Response: Infant turns head and opens mouth to suck on same side that cheek was stroked
  • Age of Disappearance: 2-3 mo
25
Q

Describe: Parachute reflex

  • Maneuver to Elicit Reflex
  • Appropriate Reflex Response
  • Age of Disappearance
A
  • Maneuver to Elicit Reflex: Tilt infant to side while in sitting position
  • Appropriate Reflex Response: Ipsilateral arm extension, present by 6-8 mo
  • Age of Disappearance: Does not disappear
26
Q

Name: Developmental Red Flags (4)

A
  • Gross motor: not walking at 18 mo rolling too early at <3 mo
  • Fine motor: hand preference at < 18mo
  • Speech: < 10 words at 18mo
  • Social: not smiling at 3 mo; not pointing at 15-18 mo
27
Q
A
28
Q

What are the dietery needs/requirements for these weights:

  • <10 kg
  • 10-20 kg
  • > 20 kg
A
  • <10 kg: 100 kcal/kg/d
  • 10-20 kg: 1000 cal + 50 kcal/kg/d for each kg >10
  • > 20 kg: 1500 cal + 20 kcal/kg/d for each kg >20
29
Q

What are the Dietary Recommendations for: 0-6mo (2)

A
  • breast milk or formula
  • exclusive breast milk during first 6 mo recommended over formula unless contraindicated
30
Q

Breastfed infants require supplements. Name them. (3)

A
  • vitamin D (400 IU/d)
  • Fluoride (after 6 mo if not sufficient in water)
  • Iron (6-12 mo, only if not receiving fortified cereals/meat/meat alternatives)
31
Q

What are the Dietary Recommendations for: > 6 mois (8)

A
  • >6mo: solid food introduction– do not delay beyond 9mo
  • 2-3 new foods per wk, wait at least 2 d in between each food to allow time for adverse reaction identification
    • common allergens: eggs, milk, mustard, peanuts, seafood, sesame, soy, tree nut, wheat
  • early introduction of highly allergenic foods is recommended
  • offer lumpy, soft-cooked, pureed, mashed textured foods
  • 9-24 mo: switch to homogenized (3.25%) milk, offer 16oz/d to non-breast feeding infant
  • offer vegetables, fruit, grains, and full-fat milk in any order after iron-rich foods are given
  • provide up to 3 large feedings (meals) with 1-2 smaller feedings (snacks), depending on child’s hunger/satiety cues
  • encourage self-feeding and introduce open cup (should be done by 18 mo)
32
Q

Name foods to avoid (7)

A
  • honey until past 12 mo (risk of botulism)
  • added sugar, salt
  • excessive milk (i.e. no more than 750 mL or 24 oz/d after 1 yr)
  • limit juice intake (not nutritious, too much sugar), maximum 4-6 oz (1/2 cup) daily
  • anything that is a choking hazard (chunks, round foods like grapes)
  • 2-6 yr: switch to 2% milk (500 mL/d)
  • can maintain breastfeeding during this time complementary to solids
33
Q

Name content of breastmilk (2)

A
  • colostrum (first few days): clear, rich in nutrients (i.e. high protein, low fat), immunoglobulin
  • mature milk: 70:30 whey:casein ratio, fat from dietary butterfat, carbohydrate from lactose
34
Q

Name advantages: Breasfeeding (4)

A
  • easily digested, low renal solute load
  • immunologic
    • reduction of acute illnesses (i.e. diarrhea, respiratory tract illnesses, acute otitis media) and may have longer term benefits
    • contains IgA, macrophages, active lymphocytes, lysozymes, lactoferrin (which inhibits E. coli growth in intestine)
    • lower pH promotes growth of Lactobacillus in GI tract
  • parent-child bonding
  • economical, convenient
35
Q

Name: Maternalcontraindications of breastfeeding (4)

A
  • chemotherapy, radioactive compounds, or medications known to cross to breast milk
  • HIV/AIDS, active untreated TB, herpes in breast region
  • >0.5 g/kg/d of alcohol or illicit drugs
  • OCPs are not a contraindication to breastfeeding (estrogen may decrease lactation, but is not dangerous to infant)
36
Q

If poor weight gain by breastfeeding, what to do? (1)

A

consider dehydration or FTT and may consider formula supplementation if insufficient milk production or intake

37
Q

Describe: Oral candidiasis (thrush) (2)

A
  • treat baby with antifungal such as nystatin;
  • can occur in breast or bottle-fed infants
38
Q

Décrire this formula compared to breask milk: Cow’s Milk-Based (Enfamil®, Similac®)

  • Indications (3)
  • Content (as compared to breast milk) (2)
A
  • Indications:
    • Prematurity
    • Transition to breastfeeding
    • Contraindication to breastfeeding
  • Content (as compared to breast milk):
    • Lower whey:casein ratio
    • Plant fats instead of dietary butterfat
39
Q

Décrire this formula compared to breask milk: Fortified Formula

  • Indications (2)
  • Content (as compared to breast milk) (2)
A
  • Indications:
    • Low birth weight Prematurity
  • Content (as compared to breast milk):
    • Higher calories and vitamins A, C, D, K
    • May only be used in hospital due to risk of fat- soluble vitamin toxicity
40
Q

Décrire this formula compared to breask milk: Soy Protein (Isomil®, Prosobee®)

  • Indications (2)
  • Content (as compared to breast milk) (1)
A
  • Indications:
    • Galactosemia
    • Desire for vegetarian/vegan diet*
  • Content (as compared to breast milk):
41
Q

Décrire this formula compared to breask milk: Partially Hydrolyzed Proteins (Good Start®)

  • Indications (2)
  • Content (as compared to breast milk) (1)
A
  • Indications:
    • Delayed gastric emptying
    • Risk of cow’s milk protein allergy
  • Content (as compared to breast milk):
42
Q

Décrire this formula compared to breask milk: Protein Hydrolysate (Nutramigen®, Alimentum®, Pregestimil®, Portagen®)

  • Indications (2)
  • Content (as compared to breast milk) (3)
A
  • Indications:
    • Malabsorption
    • Food allergy including cow’s milk protein allergy
  • Content (as compared to breast milk):
    • Protein is 100% casein with no whey
    • Corn syrup solids, sucrose, or tapioca starch instead of lactose
    • Expensive
43
Q

Décrire this formula compared to breask milk: Amino Acid (Neocate®, PurAminoTM)

  • Indications (2)
  • Content (as compared to breast milk) (3)
A
  • Indications:
    • Food allergy
    • Short gut
  • Content (as compared to breast milk):
    • Free amino acids (no protein)
    • Corn syrup solids instead of lactose
    • Very expensive
44
Q

Décrire this formula compared to breask milk: Metabolic

  • Indications (1)
  • Content (as compared to breast milk) (1)
A
  • Indications: Inborn errors of metabolism
  • Content (as compared to breast milk): Various different compositions for children with galactosemia, propionic acidemia, etc.
45
Q

10-35% of children with cow’s milk protein allergy also have reactions to ?

A

soy-based formula

46
Q

Name leading cause of death in children >1 yr of age (2)

A
  • Injuries
  • main causes: motorvehicle crashes, burns, drowning, falls, choking, infanticide
47
Q

Describe Injury Prevention Counselling: 0-6 mo (6)

A
  • Do not leave alone on bed, on changing table, or in tub
  • Keep crib rails up
  • Check water temperature before bathing
  • Do not hold hot liquid and infant at the same time
  • Check milk temperature before feeding
  • Appropriate car seats are required before leaving hospital
48
Q

Describe Injury Prevention Counselling: 6-12 mo (7)

A
  • Install stair barriers
  • Discourage use of walkers
  • Avoid play areas with sharp-edged tables and corners
  • Cover electrical outlets
  • Unplug appliances when not in use
  • Keep small objects, plastic bags, cleaning products, and medications out of reach
  • Supervise during feeding Appropriate car seats
49
Q

Describe Injury Prevention Counselling: 1-2 yr (4)

A
  • Never leave unattended
  • Keep pot handles turned to back of stove
  • Caution with whole grapes, nuts, raw carrots, hotdogs, etc. due to choking hazard
  • No running while eating Appropriate car seats
50
Q

Describe Injury Prevention Counselling: 2-5 yr (5)

A
  • Bicycle helmet
  • Never leave unsupervised at home, driveway, or pool
  • Teach bike safety, stranger safety, and street safety
  • Swimming lessons (>4 yr), sunscreen (from 6 mo), fences around pools
  • Appropriate car seats
51
Q

Décrire: Circumcision (3)

A
  • elective procedure
  • CPS affirms that circumcision is not medically indicated, and does not recommend routine circumcision for every newborn male
  • often for religious or culture reasons
52
Q

Name benefits, complications and contraindications: Décrire: Circumcision (3)

A
  • benefits:
    • prevention of phimosis
    • and slightly reduced incidence of UTI, STI, balanitis, cancer of the penis
  • complications (<1%): local infection, bleeding, urethral injury
  • contraindications: presence of genital abnormalities (e.g.hypospadias) or known bleeding disorder

TN Pédiatrie (14 decks)

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