Class 8 (2/25/21) - Pediatrics Flashcards
______ influence development profoundly.
First hours of life
- Skin to skin contact between mother and child is healing, stabilizing, psychologically and immunologically beneficial.
- It is the best way for healthy and protective regulation of baby’s body temperature.Surface to volume ratio in newborn conducive to rapid heat and fluid losses.
The American Academy of Pediatrics recommends exclusive breast feeding for _____, and continuation during _____ for optimal infant nutrition.
- first 6 months of life
- second 6 months
What are benefits of breast feeding?
- Lower incidence of infections (including otitis media, pneumonia, sepsis and meningitis).
- Human milk contains antibodies (IgA)
- Lactoferrin is a protein found in breast milk that inhibits growth of E. coli.
- Breastfed infants are less likely to experience allergies (eczema) or intolerance (colic).
Do Breastfed infants need supplementation?
- Breastfed infants should get oral Vit. D supplementation, and fluoride if it isn’t available in the drinking water locally.
All states screen for _____ at birth.
hypothyroidism and phenylketonuria
Most states also screen for ______ .
galactosemia and sickle cell disease
Phenylketonuria
- delayed development
- cognitive problem
Galactosemia
- compromised ability to metabolize the sugar galactose
_____ are general markers of health in children.
Height, Weight, and Head Circumference
Weight is below the 5th percentile on standard growth curves, diagnosis?
Failure to Thrive (FTT)
FTT can be nonorganic or organic
- Nonorganic FTT (Poor growth without a medical etiology. Nonorganic FTT is often related to poverty or poor caregiver-child interaction)
- Organic FTT (Poor growth caused by an underlying medical condition, such as inflammatory bowel disease)
Laboratory evaluation in FTT:
Complete blood count (CBC), a lead level, urinalysis and culture and a serum electrolyte level (including calcium, blood urea nitrogen [BUN] and creatinine).
Healthy infants in their first year of life require approx. 120 kcal/kg/d of nutrition, and 100 kcal/kg/d thereafter. What about FTT children?
FTT children require an additional 50%-100% to ensure adequate catch-up growth.
Acquired hearing loss in children can happen due to ____ .
recurrent otitis media.
Risk factors for iron deficiency during infancy are _____ .
prematurity, low birth weight, and poor dietary intake
Baby formulas contain iron supplementation, therefore only _____ need routine anemia monitoring
preterm infants who are being breastfed
Exposure to lead is a risk factor for ____
neurologic damage including retardation, learning disabilities
Lead screening is done in ____
high risk individuals (i.e., child is a paint chip eater, or lives near an old battery factory).
Examples of vaccinations during childhood?
small pox, polio, measles, tetanus, rubella, and diphtheria
True contraindication of vaccinations:
- Immediate hypersensitivity reactions to a vaccine
- Egg hypersensitivity is contraindication to influenza and yellow fever vaccines (both are grown in chick embryo cultures)
_______ are NOT contraindications
mild URI, gastroenteritis, and low-grade fever
In general, live virus vaccines are not given to pregnant women and severely immunocompromised patients, but are they given to a child living in the home with a pregnant woman?
Yes!
Puberty
Delayed puberty: No signs of puberty: girls by age 13, in boys by age 14.
Precocious Puberty: Secondary sexual characteristic onset before age 8 in girls and 9 years in boys.
The patient has Precocious Puberty, what is next step?
- Serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels as well as bone age x-rays are next steps.
- When compared to norms, the serum estradiol level is elevated in girls and the testosterone level is elevated in boys with precocious puberty.
- Bone age radiographs are advanced beyond chronological age.
Tanner Stages
Stage I is pre-adolescent, Stage V is adult.
Increasing tanner stages are assigned for …
Testicular and penile growth in males, and breast growth in females, also for pubic hair development
Average age of puberty (Stage I changes) is ____
11.5 y/o in males (testicular enlargement as first event) and 10.5 y/o in females (breast development as first event).
Treating precocious puberty?
Gonadotropin releasing hormone agonists
Precocious puberty is more common in ____ .
ADHD is more common in ____ .
- Girls
- Boys
The goal of treating precocious puberty is _____ .
to prevent premature closure of the epiphyses, allowing the child to reach full adult growth potential.
We are suspicious about Physical abuse, what is the next step?
- Cases of suspected abuse are reported to Child Protective Services (CPS) or to law enforcement.
- Primary care doctors need to Obtain a full skeletal survey (radiographs of chest, head, …) to assess for other injuries to bone also
Think about child abuse when ____
- If the history of trauma does not fit the patient’s injury patterns, this raises the level of suspicion for child abuse.
- If a child’s development is inconsistent with the injury history, child abuse is also suspected.
- The mother’s delay in seeking care since symptom onset.
Abusive Head Trauma (aka: Shaken Baby or Shaken Impact Syndrome):
- Brain injury resulting from violent shaking of infant followed by collision of head against hard surface.
- Infants may present with seizures
- Intracranial injury is visualized with CT, or MRI.Retinal hemorrhages may be seen on funduscopic (=Ophthalmoscopy) exam of the eyes.
Child maltreatment includes …
neglect and physical, sexual and emotional abuse
… is the most common type of child maltreatment
Neglect - consists of failure to provide adequate nutrition, shelter, supervision, or medical care.
When Lacerations and bruises can be suggestive of abuse?
Lacerations and bruises are common indicators of abuse – but bruises over knees or elbows, shins or forehead are often just normal “wear and tear” on active children.
- Lacerations or bruises over the abdomen, buttocks, thighs, and inner arms are more suggestive of abuse than accidental trauma.
Cigarette burns in child abuse are …
circular
The child with an upper respiratory tract infection (URI) and ear pain can …
Otitis media
If you are suspicious about otitis media, what’s the next step?
- Otoscopy
- Some physicians recommend watchful waiting, especially if there is no evidence of redness or tympanic swelling, and the fever is under 101.4.
- If there is redness and tympanic swelling and fever, antibiotic (amoxicillin) is prescribed.
- If a clinical failure is seen on day 3, a change to amoxicillin-clavulanate (Augmentin)
What are symptoms of otitis media?
- Fever, usually over 104 F, ear pain (often nocturnal, awakening child from sleep), and general malaise.
- Systemic symptoms can include anorexia,nausea, vomiting, diarrhea and headaches.
- Exam findings: A red, bulging TM (tympanic membrane) that does not mobilize easily with pneumatic otoscopy.
- TM may be opaque with pus behind it, middle ear landmarks may be obscured.
- If the TM has ruptured, pus may be seen in the ear canal
The most common bacterial pathogens implicated in causing otitis media (OM) is …
Streptococcus pneumoniae
You are suspicious about pneumonia, what’s the next step?
- First and most important consideration in management of the patient with pulmonary problem (pneumonia, asthma and etc.) is to follow the ABCs (maintaining AIRWAY, controlling BREATHING, and ensuring adequate CIRCULATION).
- Then do Pulse oximetry (non-invasive estimation of arterial oxyhemoglobin concentration) (SaO2) and chest x-ray.
In the newborn with pneumonia, what antibiotics are used?
- Broad spectrum antibiotic therapy
What’s the treatment for herpes simplex virus (HSV)?
Acyclovir
Symptoms of tuberculosis?
cough, bloody sputum, fever and weight loss
If you are suspicious about tuberculosis, what’s the next step?
The purified protein derivative (PPD) test which is defined by induration diameter
Positive PPD?
A 5mm induration may be considered a “positive” PPD at 48-72 hours in a patient with confirmed exposure and abnormal chest radiograph
Tuberculosis treatment:
An initial phase of 2 months on 3-4 medications, with a follow up of 4-7 months on isoniazid and rifampin.
Asthma vs asthma exacerbation:
- Asthma = reversible
- There is a triad for asthma exacerbation: bronchoconstriction, airway inflammation, and mucus plugging
Respiratory distress vs respiratory failure
Respiratory distress symptoms:
Tachypnea, use of accessory muscles like SCM, nasal flaring, position of comfort, grunting respiration, cyanosis
Respiratory failure symptoms:
Decreased consciousness, decreased breath sounds, bradycardia, apnea
In any respiratory distress or respiratory failure, the first step is ___
ABC
A-airway is assessed first, followed by B-breathing, and finally C-circulatory status
Pulsus Paradoxus?
A blood pressure that varies more widely with respiration than normal. A variance of greater than 10mm Hg between inspiration and expiration suggests obstructive airway disease like asthma
Examples of obstructive airway disease:
Asthma, COPD: Chronic Obstructive Pulmonary Disease
Spirometry?
A test of pulmonary function.
Know that cardiac output is measurement of heart function
GFR is measurement of kidney function
children who live in inner city neighborhoods have ___________
significantly higher rates of asthma than those who live in more tree-lined, remote semi-urban neighborhoods
Asthma pathophysiology
Which antibody is produced? IgE
Which WBC will be activated in asthma? Mast cell
Mast cell is a granulocyte that containing histamine which mediate allergic reactions
IgA, IgM, IgE?
Ig A: in breast milk
Ig M: can be transferred from mother to child
Ig E: is produced in asthma
Common Triggers for Asthma
Dust mites
Animal dander (cats, rodents)
Pollen
Cigarette smoke
Air pollution (automobile and industrial)
Weather changes
Exercise (especially when performed in cold air)
Asthma management involves …
identifying and minimizing exposure to triggers.
Allergy testing can be helpful
Repeat assessment of lung function is achieved with spirometry performed in clinic
Asthma medications like albuterol, prednisone
Medications for asthma include:
Pharmacotherapy for asthma includes:
- B-adrenergic agonists (Albuterol)
- Anti-inflammatory agents (corticosteroids, prednisone)
What is the mechanism of albuterol?
Beta-adrenergic agonists (e.g. Albuterol) rapidly reverse broncho-constriction via beta-2 receptors on bronchial smooth muscle dells
What is the benefit of nebulizer or “spacer” inhaler?
They maximize delivery to the deeper airways
The most potent available anti-inflammatory drugs are …
Corticosteroids
Can Corticosteroids be used for asthma exacerbation?
Yes, they are useful for acute exacerbations (prednisone, & prednisolone)
The prevalence of asthma in Western countries has been ________
increasing!
Pathophysiology of ADHD:
decreased activity of certain brain regions in the frontal lobes may be responsible
ADHD has 3 principal areas of dysfunction:
Attention difficulties
Impulsivity
Hyperactivity
ADHD: there is greater incidence in ____
boys
ADHD / Inattention Criteria:
Not listening, Easy distractibility, fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities, difficulty organizing tasks and activities
ADHD / Hyperactivity Criteria:
Running or climbing excessively, often talking excessively, leaves seat in classroom or in other situations in which remaining seated is expected
ADHD / Impulsivity Criteria:
Having difficulty awaiting one’s turn, Interrupting frequently
ADHD treatment:
Behavior Modification:
Positive reinforcement (providing rewards, privileges) Negative consequences (withdrawal of privileges)
Medications: ritalin
Etiology of ADHD:
genetic factors, and psychosocial issues
Stereotypic Movement Disorder:
- The increased motor activity that may occur in Attention-Deficit / Hyperactivity Disorder must be distinguished from the repetitive motor behavior that characterizes Stereotypic Movement Disorder.
- Individuals with Stereotypic Movement Disorder are not generally overactive; aside from the stereotypy, they may be underactive.
=»Stereotypic movement disorder(SMD) is a motor disorder with onset in childhood involving repetitive, nonfunctional motor behavior (e.g., hand waving), that markedly interferes with normal activities or results in bodily injury.
In ADHD: Overactivity is the ___ symptom to remit, distractibility the ____
first, last
______ are currently the most common class of medication used to treat ADHD.
Stimulants
Stimulants work primarily on the frontal lobe of the brain and increase attention and decrease impulsivity
Medication for ADHD treatment:
METHYLPHENIDATE (RITALIN)
