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Pediatrics Clerkship > Case 2 - Infant WCC > Flashcards

Case 2 - Infant WCC Flashcards

1
Q

AAP mandates dev screening at?

A

9, 18 and 30 months

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2
Q

AAP recommends autism screening at?

A

18 mos and 24 mos

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3
Q

Skeleton of a WCC

A

1) Interval/birth hx, 2) Development Screen, 3) Growth chart, 4) Diet Hx, 5) Social hx/HEADSS, 6) PE, 7) Anticipatory Guidance, 8) Immunizations

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4
Q

Components of a birth history?

A

1) Antenatal complications? 2) HIV/RPR/HepB/GBS? 3) Deliv date/term? 4) Deliv route? 5)Deliv wt? 6) Hearing test?

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5
Q

No cows milk until what age? Why?

A

12 months of age; Infants do not tolerate the protein mixture of unaltered cow’s milk and may develop colitis,
causing microscopic bleeding and gradually worsening anemia.

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6
Q

How do you mix powdered formula?

A

2 scoops of the powder are mixed with 4 ounces water

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7
Q

Calorie reqs for term 1-2 mo infants? Premie? VLBW?

A

TERM: 100 to 120 cal/kg/day PREMIE: 115 to 130 cal/kg/day VLBW: up to 150 cal/kg/day

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8
Q

What’s the average daily weight gain for a term infant?

A

The average daily weight gain for a term infant is 20 to 30 grams.

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9
Q

Primitive reflexes and age by which they should extinguish?

A

Palmar grasp (2-3m/o), ATNR (6m/o), Plantar grasp (8m/o), Babs (1-2 y/o),

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10
Q

ATNR?

A

Asymmetric Tonic Neck Reflex (a.k.a. fencing reflex): turn baby’s head to one side and ipsi extremities extend while contra flex

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11
Q

AAP rec for Vit D supplementation?

A

breastfed babies should get 400 IU/day via drops

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12
Q

Car seat for < 2 y/o?

A

Under 2 years of age (and not over the manufacturer’s weight or height requirement for seat): Rear-facing car safety seat, restrained in the rear seat.

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13
Q

Car seat for 2 - 4 y/o’s?

A

Between 2 years and 4 years of age: Forward-facing car safety seat, restrained in the rear seat.

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14
Q

Car seat for 4 to 8 y/o’s?

A

Between 4 years and 8 years of age: Belt-positioning booster seat, restrained in the rear seat.

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15
Q

Car seat for 8 to 13 y/o’s?

A

Over 8 years of age: Lap-and-shoulder seat belts for all who have outgrown booster seats, restrained in the rear seat.

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16
Q

Car seat for >13+ years old?

A

13 years of age and older: Lap-and-shoulder seat belt, rear or front seat.

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17
Q

What’s Prevnar?

A

PCV 13

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18
Q

What’s Pentacel?

A

DTaP-IPV-Hib combined

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19
Q

What’s in Pediarix IM?

A

DTaP, HepB, and IPV

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20
Q

Shots at birth?

A

Hep B #1

21
Q

Shots at 2mo visit?

A

Hep B #2 (can be at 1-2 mo), Rota #1, DTap #1, Hib #1, PCV #1, IPV #1 (Pentacel, Prevnar, Heb B and PO Rotarix)

22
Q

Shots at 4mo visit?

A

Rota #2 (Last dose if Rotarix, 2/3 if RotaTeq), DTaP #2, Hib #2 (Done if Pentacel, others 2/3 for others), PCV #2, IPV #2 (Pentacel, Prevnar and PO Rotarix)

23
Q

Shots at 6mo visit?

A

Rota #3 (if RotaTeq, already done if had 2 Rotarix), Heb B #3 (can be 6-9mo range), DTaP #3, Hib #3 (if certain types, done), PCV #3, IPV #3, IM Flu (Pediarix, Prevnar and Flu)

24
Q

Shots at 12mo visit?

A

Hep B #3, Hib #3/4, PCV #4, IPV #3, MMR #1, Var #1, Hep A #1, IM Flu PRN

25
Q

Shots at 15-18mo?

A

DTaP #4, Hep A #2 (2 doses between 12 and 23 mo), IM flu PRN, MCV if high risk

26
Q

By what ages should an infant double and triple his or her birth weight?

A

Double BW by 4-5mo and triple by 12mo

27
Q

White spots on fundo exam is called?

A

leukocoria

28
Q

DDx for absence of red reflex?

A

congenital cataracts, glaucoma, Rb, chorioretinitis

29
Q

Have Jeremy quiz me on developmental milestones.

A

Please

30
Q

Toddler proofing 101

A

stairs, meds/cleaners, outlets, 1-800-222-1222, cabinet locks

31
Q

Sleeping anticip guidance for 6mo?

A

2 naps per day and, by 4-6mos, should be sleeping through the night

32
Q

Calorie reqs for 9 mo infants?

A

100 cal/kg/day for appropriate growth; about 75% of the calories still come from breast milk or formula (for most children, about 24 ounces per day)

33
Q

Ddx for RUQ abdominal mass in a 9mo infant?

A

Hepatic malig, hydro, neuroblastoma, nephroblastoma (Wilms’ tumor), teratoma (note, poo usually on L side)

34
Q

ROS/exam for RUQ abd mass?

A

pallor?, HSM?, jaundice?, G&D?, LNs? abd pain/n/v?

35
Q

Initial w/u for RUQ mass in infant?

A

CBC, urine VMA/HVA (catecholamine breakdown prods of neuroblastoma), abd u/s & CXR (consider KUB +/- abd CT)

36
Q

If infants are doing both BF and formula, they need at least __ oz of formula to get their RDA of Vit D without supplementation?

A

32oz

37
Q

How many childhood doses do we give of DTaP and when are they given?

A

5 @ 2mo, 4mo, 6mo, 15-18mo and 4-6yo

38
Q

How many childhood doses do we give of IPV and when are they given?

A

4 doses @2mo, 4mo, 6-18mo and 4-6yo; administer the final dose at or after age 4 years and at least 6 months after the previous dose.

39
Q

How many childhood doses do we give of Hib and when are they given?

A

3 or 4 doses (depends on brand); usual 4-dose Pentacel/ActHIB/Hiberix schedule is at 2, 4, 6, 12–15 months

40
Q

How many childhood doses do we give of MMR and when are they given?

A

2-dose series at 12–15 months, 4–6 years

Dose #2 may be administered as early as 4 weeks after dose 1.

41
Q

How many childhood doses do we give of PCV13 and when are they given?

A

4-dose series at 2, 4, 6, 12–15 months

42
Q

How many childhood doses do we give of Varicella and when are they given?

A

2-dose series at 12–15 months, 4–6 years
Dose 2 may be administered as early as 3 months after dose 1 (a dose administered after a 4-week interval may be counted).

43
Q

How many childhood doses do we give of Rotavirus and when are they given?

A

2 or 3 (depends on brand):

  • Rotarix: 2-dose series at 2 and 4 months
  • RotaTeq: 3-dose series at 2, 4, and 6 months
  • *If any dose in the series is either RotaTeq or unknown, default to 3-dose series.
44
Q

How many childhood doses do we give of HepA and when are they given?

A

2-dose series (minimum interval: 6 months) beginning at age of 12 months

45
Q

How many childhood doses do we give of HepB and when are they given??

A

3-dose series at 0, 1–2, 6–18 months (use monovalent HepB vaccine for doses administered before age 6 weeks)
Infants who did not receive a birth dose should begin the series as soon as feasible

46
Q

What is the most common neoplasm of infancy? How does it present?

A

Neuroblastoma (>1/2 pts present < 2y/o).
• tumor may present as a painless mass in the neck, chest, or abd; fever, pallor & wt loss also common
• may also appear chronically ill and may have bone pain from mets
• can be asymptomatic

47
Q

How does teratoma present?

A

very rare, esp in kids; p/w painless abd mass w/o other sx or it may cause pressure effects on neighboring structures resulting in abd or back pain, nausea, vomiting, constipation, and/or urinary tract symptoms.

48
Q

How does Wilm’s Tumor (nephroblastoma) present?

A

asx RUQ abd mass in median age 3 y/o w/o LAN or jaundice & nl growth/dev.
• often discovered by parents or on routine exam
• generally smooth; rarely cross midline
• Assoc’d sx occur in 50% of pts: abd pain, vomit +/- HTN

Pediatrics Clerkship (31 decks)

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