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Pathophysiology 4 > Class 8 (2/25/21) - Pediatrics > Flashcards

Class 8 (2/25/21) - Pediatrics Flashcards

1
Q

______ influence development profoundly.

A

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.
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2
Q

The American Academy of Pediatrics recommends exclusive breast feeding for _____, and continuation during _____ for optimal infant nutrition.

A
  • first 6 months of life

- second 6 months

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3
Q

What are benefits of breast feeding?

A
  • 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).
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4
Q

Do Breastfed infants need supplementation?

A
  • Breastfed infants should get oral Vit. D supplementation, and fluoride if it isn’t available in the drinking water locally.
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5
Q

All states screen for _____ at birth.

A

hypothyroidism and phenylketonuria

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6
Q

Most states also screen for ______ .

A

galactosemia and sickle cell disease

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7
Q

Phenylketonuria

A
  • delayed development

- cognitive problem

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8
Q

Galactosemia

A
  • compromised ability to metabolize the sugar galactose
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9
Q

_____ are general markers of health in children.

A

Height, Weight, and Head Circumference

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10
Q

Weight is below the 5th percentile on standard growth curves, diagnosis?

A

Failure to Thrive (FTT)

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11
Q

FTT can be nonorganic or organic

A
  • 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)
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12
Q

Laboratory evaluation in FTT:

A

Complete blood count (CBC), a lead level, urinalysis and culture and a serum electrolyte level (including calcium, blood urea nitrogen [BUN] and creatinine).

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13
Q

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?

A

FTT children require an additional 50%-100% to ensure adequate catch-up growth.

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14
Q

Acquired hearing loss in children can happen due to ____ .

A

recurrent otitis media.

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15
Q

Risk factors for iron deficiency during infancy are _____ .

A

prematurity, low birth weight, and poor dietary intake

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16
Q

Baby formulas contain iron supplementation, therefore only _____ need routine anemia monitoring

A

preterm infants who are being breastfed

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17
Q

Exposure to lead is a risk factor for ____

A

neurologic damage including retardation, learning disabilities

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18
Q

Lead screening is done in ____

A

high risk individuals (i.e., child is a paint chip eater, or lives near an old battery factory).

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19
Q

Examples of vaccinations during childhood?

A

small pox, polio, measles, tetanus, rubella, and diphtheria

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20
Q

True contraindication of vaccinations:

A
  • Immediate hypersensitivity reactions to a vaccine
  • Egg hypersensitivity is contraindication to influenza and yellow fever vaccines (both are grown in chick embryo cultures)
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21
Q

_______ are NOT contraindications

A

mild URI, gastroenteritis, and low-grade fever

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22
Q

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?

A

Yes!

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23
Q

Puberty

A

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.

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24
Q

The patient has Precocious Puberty, what is next step?

A
  • 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.
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25
Q

Tanner Stages

A

Stage I is pre-adolescent, Stage V is adult.

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26
Q

Increasing tanner stages are assigned for …

A

Testicular and penile growth in males, and breast growth in females, also for pubic hair development

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27
Q

Average age of puberty (Stage I changes) is ____

A

11.5 y/o in males (testicular enlargement as first event) and 10.5 y/o in females (breast development as first event).

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28
Q

Treating precocious puberty?

A

Gonadotropin releasing hormone agonists

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29
Q

Precocious puberty is more common in ____ .

ADHD is more common in ____ .

A
  • Girls

- Boys

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30
Q

The goal of treating precocious puberty is _____ .

A

to prevent premature closure of the epiphyses, allowing the child to reach full adult growth potential.

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31
Q

We are suspicious about Physical abuse, what is the next step?

A
  • 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
32
Q

Think about child abuse when ____

A
  • 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.
33
Q

Abusive Head Trauma (aka: Shaken Baby or Shaken Impact Syndrome):

A
  • 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.
34
Q

Child maltreatment includes …

A

neglect and physical, sexual and emotional abuse

35
Q

… is the most common type of child maltreatment

A

Neglect - consists of failure to provide adequate nutrition, shelter, supervision, or medical care.

36
Q

When Lacerations and bruises can be suggestive of abuse?

A

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.

37
Q

Cigarette burns in child abuse are …

A

circular

38
Q

The child with an upper respiratory tract infection (URI) and ear pain can …

A

Otitis media

39
Q

If you are suspicious about otitis media, what’s the next step?

A
  • 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)
40
Q

What are symptoms of otitis media?

A
  • 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
41
Q

The most common bacterial pathogens implicated in causing otitis media (OM) is …

A

Streptococcus pneumoniae

42
Q

You are suspicious about pneumonia, what’s the next step?

A
  • 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.
43
Q

In the newborn with pneumonia, what antibiotics are used?

A
  • Broad spectrum antibiotic therapy
44
Q

What’s the treatment for herpes simplex virus (HSV)?

A

Acyclovir

45
Q

Symptoms of tuberculosis?

A

cough, bloody sputum, fever and weight loss

46
Q

If you are suspicious about tuberculosis, what’s the next step?

A

The purified protein derivative (PPD) test which is defined by induration diameter

47
Q

Positive PPD?

A

A 5mm induration may be considered a “positive” PPD at 48-72 hours in a patient with confirmed exposure and abnormal chest radiograph

48
Q

Tuberculosis treatment:

A

An initial phase of 2 months on 3-4 medications, with a follow up of 4-7 months on isoniazid and rifampin.

49
Q

Asthma vs asthma exacerbation:

A
  • Asthma = reversible

- There is a triad for asthma exacerbation: bronchoconstriction, airway inflammation, and mucus plugging

50
Q

Respiratory distress vs respiratory failure

A

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

51
Q

In any respiratory distress or respiratory failure, the first step is ___

A

ABC

A-airway is assessed first, followed by B-breathing, and finally C-circulatory status

52
Q

Pulsus Paradoxus?

A

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

53
Q

Examples of obstructive airway disease:

A

Asthma, COPD: Chronic Obstructive Pulmonary Disease

54
Q

Spirometry?

A

A test of pulmonary function.
Know that cardiac output is measurement of heart function
GFR is measurement of kidney function

55
Q

children who live in inner city neighborhoods have ___________

A

significantly higher rates of asthma than those who live in more tree-lined, remote semi-urban neighborhoods

56
Q

Asthma pathophysiology

A

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

57
Q

IgA, IgM, IgE?

A

Ig A: in breast milk
Ig M: can be transferred from mother to child
Ig E: is produced in asthma

58
Q

Common Triggers for Asthma

A

Dust mites
Animal dander (cats, rodents)
Pollen
Cigarette smoke
Air pollution (automobile and industrial)
Weather changes
Exercise (especially when performed in cold air)

59
Q

Asthma management involves …

A

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

60
Q

Medications for asthma include:

A

Pharmacotherapy for asthma includes:

  • B-adrenergic agonists (Albuterol)
  • Anti-inflammatory agents (corticosteroids, prednisone)
61
Q

What is the mechanism of albuterol?

A

Beta-adrenergic agonists (e.g. Albuterol) rapidly reverse broncho-constriction via beta-2 receptors on bronchial smooth muscle dells

62
Q

What is the benefit of nebulizer or “spacer” inhaler?

A

They maximize delivery to the deeper airways

63
Q

The most potent available anti-inflammatory drugs are …

A

Corticosteroids

64
Q

Can Corticosteroids be used for asthma exacerbation?

A

Yes, they are useful for acute exacerbations (prednisone, & prednisolone)

65
Q

The prevalence of asthma in Western countries has been ________

A

increasing!

66
Q

Pathophysiology of ADHD:

A

decreased activity of certain brain regions in the frontal lobes may be responsible

67
Q

ADHD has 3 principal areas of dysfunction:

A

Attention difficulties
Impulsivity
Hyperactivity

68
Q

ADHD: there is greater incidence in ____

A

boys

69
Q

ADHD / Inattention Criteria:

A

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

70
Q

ADHD / Hyperactivity Criteria:

A

Running or climbing excessively, often talking excessively, leaves seat in classroom or in other situations in which remaining seated is expected

71
Q

ADHD / Impulsivity Criteria:

A

Having difficulty awaiting one’s turn, Interrupting frequently

72
Q

ADHD treatment:

A

Behavior Modification:
Positive reinforcement (providing rewards, privileges) Negative consequences (withdrawal of privileges)
Medications: ritalin

73
Q

Etiology of ADHD:

A

genetic factors, and psychosocial issues

74
Q

Stereotypic Movement Disorder:

A
  • 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.
75
Q

In ADHD: Overactivity is the ___ symptom to remit, distractibility the ____

A

first, last

76
Q

______ are currently the most common class of medication used to treat ADHD.

A

Stimulants

Stimulants work primarily on the frontal lobe of the brain and increase attention and decrease impulsivity

77
Q

Medication for ADHD treatment:

A

METHYLPHENIDATE (RITALIN)

Pathophysiology 4 (15 decks)

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