CLIPP Main Flashcards
1
Q
Infants born to adolescent mothers are at greater risk for :
A
- lower birth weight
- vertically acquired STI
- worse dev. outcome
- fetal death
NOT chromsomal abnormalities though
2
Q
How do you screen for the three leading causes of death in adolescents
A
HEEADSSS interview (home, education, eating, activity, drug/alcohol, sex, suicide, safety)
- Accidents
- Homicide
- Suicide
3
Q
Effect of maternal tobacco use during pregnancy
A
risk of low birth weight in fetus
4
Q
Effect of cocaine use during pregnancy
A
vasoconstriction = placental insufficiency and low birth weight
5
Q
what are the components of the apgar score?
A
Appearance (skin color) Pulse Grimace (reflex irritability) Activity (mm tone) Respiration
6
Q
What is the Ballard score?
A
Uses neuromuscular and physical maturity to confirm gestational age (i.e. you’re not sure about dates)
7
Q
risks for SGA newborns
A
- Hypoglycemia
- Hypothermia
- Polycythemia
8
Q
DDx for SGA newborn with Microcephaly and Purpuric Rash
A
- TORCH
- FAS
- Chrom abnorm.
- Prenatal tobacco
- HIV
9
Q
T/F: Erythromycin (or tertracycline,silver nitrate) admin topically to prevent gonococcal and chlamydial conjunctivitis
A
False. Only GONOCOCCAL.
–>Chlamydia more common but occurs 7-14 days later so neonatal prophylaxis doesnt help
10
Q
brain imaging findings in congenital CMV
A
- intracranial calcifications
- dec # gyri/thick cortex (lissencephaly)
- enlarged ventricles
11
Q
T/F: CMV infected infants have progressive hearing loss
A
true
12
Q
T/F: CMV infected infants can expect hepatosplenomegaly and rash to resolve spontaneously within few weeks
A
True
13
Q
t/f:Treatment of symptomatic CMV for 6 months has been demonstrated to improve audiologic and neurodevelopmental outcomes at 2 years
A
true
14
Q
Vision screening use a chart begins at age ____, and hearing with audiometry at ____
A
3; 4
15
Q
when should toddlers be in a forward-facing car seat in the back seat?
A
> 2 years old, or have outgrown wt/ht of car seat
16
Q
The itch that rashes
A
Atopic dermatitis (eczema)
17
Q
antihistamines that can be used to help with eczema in kids
A
nonsedating types. Loratidine, fexofenadine, cetirizine
18
Q
Intoeing in toddlers is caused by ____ ____, whereas intoeing in preschool/school kids by ____ ____
A
toddlers: Tibial torsion. resolves~4yo
kids: Femoral anteversion (both knees and feet turn inward). Resolves~8-12yo
19
Q
Misalignment of the eyes
A
Strabismus
20
Q
Anemia screening
A
@ 12 months and @preschool/KG entry
and anytime there are risk factors for anemia (poor diet)
21
Q
4 steps toward improving a toddlers nutrition
A
- Stop the bottle
- Limit eating to 3 meals and 2 snacks, stopping food and drink grazing throughout day
- No bargaining (eat @ the time-limited meals)…desserts should not be an incentive for good eating
- Gradually change diet content (introducing new foods and reducing quantity of old favorite foods)
22
Q
what is weight age/height age
A
time when those would plot at 50th %
23
Q
common side effects of stimulant meds (ADHD)
A
appetite suppression, insomnia
no increases in risk of substance abuse or addiction
24
Q
T/F: Slipped capital femoral epiphysis most commonly occurs at onset of puberty in obese patients
A
true
25
T/F: Obesity increases risk of t1dm
false
26
T/F: Age is generally helpful in diff. btwn T1DM and T2DM
False
27
Age of initiation of screening for diabetes in children at risk
10 years of age or onset of puberty (whichever is earlier)
-->check q3 years
28
Who gets screened for diabetes (what are criteria for "at risk")?
Overweight (BMI>85%) + 2 of the following:
a. FHx of T2DM in 1st/2nd degree rel
b. Native american/african american/hispanic/asian
c. signs of insulin resistance (Acanthosis, PCOS, HTN, dyslipidemia)
d. MHx GDM or DM
29
T/F: Most elevated BP measurements in children are errors in measurement, not true HTN
True
30
BP %'s (don't confuse with BMI)
<90th: Normal
90-95: Pre-HTN
95-99: Stage 1 HTN
>99: Stage 2 HTN
31
T/F: Adolescent with BP 130/90 has HTN
Depends on % for their age. if <95th, its pre-HTN
32
Why are UTI's in childhood one of the leading causes of HTN and renal insufficiency later in life?
Renal scarring following infection
33
What sx of depression is more common adults than adolescents?
Early morning waking/difficulty falling asleep
34
Signs associated with anorexia sequelae
1. Bradycardia
2. Electrolyte abnormalities
- ca/mg def can = arrythmias, neuro changes/increased reflex tone
- hyponatremia from excessive H20 intake
35
T/F: A pt with a bleeding disorder would have a negative ROS unless:
- systemic illness leading to DIC
- neutropenia
- thrombocytopenia
TRUE
36
T/F: Hypothyroidism is ass. with menorrhagia and shorter menstrual cycles
TRUE
37
A late-bloomer in puberty who will attain a normal adult height later than peers
Constitutional short stature
38
Order of puberty for girls
Breast buds, then pubic hair (by 10-11), growth spurt (12), menarche (12-13), attainment of adult height (15)
39
Order of puberty for boys
Growth of testicles, then pubic hair (12), growth of penis/scrotum (13-14), first ejaculations (13-14), Growth spurt (14), adult height (17)
40
Symptoms of vWD
Ecchymoses/bruising, epistaxis, menorrhagia, gingival bleeds, bleeds post dental procedures
41
Tx of vWD
Desmopressin (releases vWF stored in endothelium)
42
T/F: Hyperglycemia is common in LGA infants born to diabetic mothers
False...HYPOglycemia is common
43
clinical complications in SGA babies
Hypothermia, Hypoglycemia, Polycythemia, Hyperviscosity
44
path of oxygenated blood in utero
Placenta to umbilical vein. Some to liver, rest bypasses liver --Ductus Venosus -->IVC....crosses PFO to LA, goes to coronary/cerebral/UE circ. 10% of RV flows through pulm vasc, 90% through PDA to descending aorta.
45
What causes transient tachypnea of the newborn?
First breath results in replacement of lung fluid by air (uterine contractions squeeze it out + pulm lymphatics). Delay in this = TTN (persistent postnatal pulm edema)
46
How does an oxygen challenge test help differentiate btwn cardiac and respiratory causes of cyanosis?
Cardiac: oxygen will not sig. inc PaO2
Resp: oxygen will increase PaO2
47
T/F: Normal bilat breath sounds makes a congenital diaphragmatic hernia unlikely
True
48
____ is the primary anabolic hormone for fetal growth
Insulin
49
When should newborns be screened for hypoglycemia?
- Term infants SGA or LGA
- Late pre-term
- DM moms
Doesn't matter if symptoms present or not, need to screen
50
T/F: Only symptomatic infants should be screened for hypoglycemia
False, even asympotomatic hypoglycemia has negative conseq. for long term neurodev
51
T/F: Insulin and glucose cross the placenta
False, only glucose does
52
Target glucose screen value prior to routine feeds:
>45 mg/dL
53
T/F: Glucometer is used to confirm hypoglycemia
False, its only a screening test. Confirm by lab analysis of serum or plasma glucose (draw blood)
54
Are there CXR findings in TTN?
Yes, lungs will look "wet" i.e. perihilar streaking/densities. but no consolidations.
Pneumonia can look similar, but clinical findings will be more concerning for sepsis
55
The breastfed infant will typically feed on demand every 2-4 hours, feeding _____ minutes on each side
10-15/side
56
T/F: Infants and children <2 years should not be given OTC cough and cold products (i.e. antihistamines/decongestants)
True
57
T/F: Allergic rhinitis presents with fever
False, presence of fever usually decreases suspicion of allergic rhinitis
58
T/F: Persistent URI sxs (>10days) w/day and night cough are common in sinusitis
True
59
Seasonal vs perennial rhinitis
S: environmental allergens i.e. pollen
P: Indoor allergens i.e. dust/animal/mold/tobacco
60
White, bulging, poorly mobile tympanic membranes
AOM
61
T/F: Otitis media with effusion = fluid in the middle ear space with acute inflammation
False. it is WITHOUT inflammation
62
Which viruses can increase risk for AOM?
RSV, influenza, rhino
| alter mucosal lining
63
Amber, non/poorly mobile, opaque, and retracted TM
OME = Otitis Media with Effusion (not AOM)
64
T/F: Antihistamines and decongestants are helpful in clearing otitis media with effusion
False
65
Audiologic eval for children 6mo-2.5years
Visual Reinforcement Audiometry (VRA)...conventional audiometry starts at >4years
66
Tx for OME
Tympanostomy tube placement
67
most accurate method of determining pt's degree of dehydration:
Weight prior to illness - current weight
| (% dehydration)
68
recommended volume for mild-moderate rehydration
50-100mL/kg
69
T/F: Bilious emesis is more commonly seen in gastroenteritis than malrotation with volvulus
False, vice versa
70
Obstruction below ________ is typically when emesis becomes bilious
Ligament of Treitz
71
Study of choice for Pyloric stenosis:
Pyloric US (NOT CT)
...if US not available, can use Upper GI contrast study (shows String Sign)
72
T/F: As soon as pyloric stenosis is identified, corrective surgery can be performed
False, need to to correct metabolic status (electrolytes) first
73
What is the metabolic (electrolyte) status in Pyloric Stenosis
Hypochloremic, Hypokalemic metabolic alkalosis
74
Risk factors for developmental dysplasia of the hip (DDH)
- breech
- female gender
- FHx
75
T/F: Leukemia must always be considered in a kid refusing to walk
True -->replacement of bone marrow by leukemic cells can cause bone pain
76
Acute onset of hip pain, following a URI. Low-grade fever.
Transient synovitis
77
Children <16 years old with arthritis in at least 1 joint for >6 weeks meet the criteria for:
Juvenile Idiopathic Arthritis (JIA)
78
Posterior displacement of the capital femoral epiphysis from teh femoral neck through the cartilage growth place
SCFE
79
Months of vague hip/knee sxs and limp in adolescent
SCFE, or Legg-Calve-Perthe
80
Avascular necrosis of capital femoral epiphysis
| (different than avas. nec or femoral head)
Legg-Calve-Perthe (Boys between 4-10)
81
Hip pain secondary to an effusion (ass. with septic arthritis and transient synovitis) is relieved when patient:
opens hip capsule by holding hip in flexion and external rotation
82
Reactive arthritis presents after what?
Infection outside the joint, esp GI and GU tract....2-4 weeks later
83
Predictors of septic arthritis
- fever
- non wt bearing
- ESR>40
- wbc>12
84
CRP or ESR?
| Indirect measurement of fibrinogen elevation
ESR
| higher fibrinogen = increased cohesion of rbc = faster rate of erythrocyte sedimentation
85
CRP or ESR?
| Direct quantification of an acute phase response
CRP
86
Tx of transient synovitis
Rest + ibuprofen
87
Dosing of Ibuprofen
10mg/kg q6-8hrs
comes in 100mg/5mL oral suspension
88
Describe syncope/breath-holding spells in children
- common ages 1-3
- cyanotic or pallid
- cynotic: upset child = vigorous crying and hyperventilation, then apnea, get transient hypoxia
- quickly self-resolve
- are benign and self-limited condition
89
most common type of seizure in kids
Generalized tonic-clonic
90
Name the seizure: Motor signs in a single extremity/side of of body
Simple partial
91
Name the seizure: Glassy eyes, automatisms (lip-smacking, drooling), n/v, + alteration of consciousness
Complex partial
92
How long do complex partial seizures last?
30 seconds-2minutes + Postictal state (confusion, sleep, headache)
93
Name the seizure:
| Loss of environmental awareness, automatisms (eye-flutter/lip smacking), no loss of tone/urinary continence
Absence seizures
94
Persistent fever, nonpurulent conjunctivitis, rash, erythema/cracking of lips, strawberry tongue, cervical lymphadenopathy, swollen hands/feet
Kawasaki disease
95
Tx of febrile seizures (fever)
Can treat the fear part with acetaminophen or ibuprofen...don't usually tx the seizure
96
Tx of febrile seizures (seizure)
- place child on side
- do not restrain
- call 911 if lasts more than 5 min
only drug that helps with prevention is Phenobarbitol (primidone and valproic also do but toxic)
97
Headaches that occurs with emotional stress, fatigue, lack of sleep
Tension headache
98
Headache that is episodic, worsens through day, feels like a band around the head, can have tenderness of posterior neck muscles
Tension headache
99
Migraines can first manifest as periodic syndromes characterized by:
- cyclical vomiting
- abdominal migraines
- benign paroxysmal vertigo
100
T/F: Tension headaches are usually accompanied by photophobia
False --> migraines are
101
What is a classic (vs common) migraine headache?
Accompanied with an aura
102
What is a common (vs classic) migraine headache?
aka migraine w/o aura.
- Most frequent type in children
- unilateral
- frontal or temporal usually
103
Cushings triad
increased ICP suggested by:
- HTN
- Bradycardia
- Irregular respirations
104
darkness and swelling beneath the eyes due to sinus congestion
Allergic shiners
105
Romberg +
If only when eyes closed = position/vestibular f(x)
Eyes open and closed = cerebellar pathology
106
Prophylactic therapy for migraines
Propranolol
107
Hypsarrythmia pattern on EEG (high amplitude spikes that look same both ways)
Infantile spasms
108
most common cause of acute ataxia in children
Post-infectious cerebellitis (aka acute cerebellar ataxia)...
autoimmune response = cerebellar demyelination few weeks after viral infection
109
Organisms that can cause infectious cerebellitis
Mumps, enterovirus, EBV, and bacteria that cause meningitis (strep pneumo, Neisseria, H flu)
110
Paraneoplastic syndrome occurring with Neuroblastoma
Opsoclonus-myoclonus sndrome (dancing feet-dancing eyes)
111
Ataxia accompanied by intermittent jerking movements and erratic, jerky conjugate movements of the eyes
Opsoclonus-Myoclonus
112
Worsening headaches, especially in the morning, associated with morning emesis and ataxia give concern for:
Increased ICP (Intracranial mass)
113
Cerebellar lesions causing dysarthria, truncal ataxia, and gait abnormalities
in the Vermis (midline)
114
Cerebellar lesions causing ipsilat limb abnormalities, nystagmus, tremor/dysmetria, and spare speech
Hemispheres
115
Cerebellar lesions causing resting tremor, myoclonus, opsoclonus
Deep cerebellar nuclei
116
*Supra/Infra* tentorial lesions present with cerebellar signs + signs of inc. ICP
Infratentorial
117
*Supra/Infra* tentorial lesions present with focal motor/sensory abnormalities on side opposite to lesion
Supratentorial
118
T/F: Cerebellar hemispheric lesions can cause changes in muscle tone and DTR, but usually lead to hypotonia/hyporeflexia
True
119
T/F: Epidimediology:
0-2=Supratentorial tumors>Infra
3-10=Infra>Supra
>10=Supra>Infra
True
120
4 most common childhood brain tumors
- Medulloblastoma
- Juvenile Pilocytic Astrocytoma
- low-grade Astrocytoma
- high grade Astrocytoma
121
Where do ependymomas arise?
4th ventricle --> sxs related to hydrocephalus
122
Tx for ependymoma
Surgical resection + radiation
123
Which tumor in children has best prognosis?
Astrocytoma of cerebellum
124
Most common pediatric tumor?
Medulloblastoma (or infratentorial PNET)
125
Is medulloblastoma benign or malignant?
Malignant...may spread through CNS and extracranial sites
126
Purpura on legs, butt, abdominal pain, joint pain after viral URI
```
Henoch-Schonlein Purpura.
Triad:
-Palpable purpura
-Arthralgia
-Abdominal pain
```
127
Asymptomatic purpura following nonspecific URI
ITP
128
Bone pain is a common presentation of:
Leukemia in children
129
Why is there petechiae in leukemia?
Thrombocytopenia due to marrow replacement by malignant cells
130
T/F: Bacterial endocarditis presents with fever, fatigue, weight loss, petechial rash
True
131
Supraclavicular nodes are concerning for:
Lymphoma
132
Nodes that are hard, rubbery, fixed to skin/tissue:
concern for malignancy
133
Pain in/around a joint without signs of synovitis
Arthralgia
134
T/F: Henoch-schonlein , ITP, and leukemia are not associated with splenomegaly
False. Leukemia is ass. with splenomegaly, the other 2 are not
135
What labs would you order if suspecting HSP or ITP?
- Platelet count (CBC with diff)
- UA...with HSP, important to see renal involvement (can have IgA nephropathy)
- BUN and Creatinine...if hematuria/proteinuria present, need to evaluate extent of renal disease
136
the hallmark of _____ is non-thrombocytopenic purpura
Henoch-schonlein purpura (HSP)
137
T/F: 1/3 of HSP patients will have renal involvement
True, usually hematuria
138
Cause of ITP
antiplatelet antibodies leads to splenic/hepatic destruction of platelets. Tx with steroids and IVIG
139
most common form of bowel obstruction in children 6 mo-6years of age
Intussusception (most at ileocolic j(X))
140
Intussusception in HSP Is ___-____
ileo-ileal (not ileo-colic as normal)
141
causes of altered mental status
```
Alcohol, toxins
Epilepsy/enceph/endo/ electrolyes
Infection, insulin
OD, opiates, o2 deprived
Uremia
Trauma, temp
Insulin, infection
Psychosis
Stroke, shock, SOL
```
AEIOU TIPS
142
Cholinergics (organophosphate)
or Anticholinergic:
Miosis, GI motility, sweating, tearing, bradycardia
Cholinergic
143
Cholinergic (organophosphate) or Anticholinergic:
| Dry as a bone, Mad as a Hatter
Anticholinergic
144
Diphenhydramine is a _______, and Pseudoephedrine is a _______. Both cause what change to pupils ?
D: Anticholinergic
P: Sympathomimetic
Mydriasis
145
Classic findings of TCA ingestion
- cardiac (hypotension)
- dilated pupils
- dry, hot skin
146
Profuse sweaty skin, agitation, fever, mental status changes, diarrhea, myoclonus, hyperreflexia, ataxia, shivering
Serotonin syndrome (OD on SSRI)
147
T/F: Antihistamine ingestions present with anticholinergic effects, similar to TCA ingestions
True (TCA will cause cardiac manifestations uniquely)
148
T/F: OD of decongestant results in a sympathomimetic syndrome
true
149
Iron OD presents with:
severe abdominal sxs + signs of shock
150
OD of ____ presents with agitation and tachycardia, but no mydriasis
Aspirin
151
what evals does child with Down syndrome need during 1st 10 years life?
- thyroid testing
- vision screen
- hearing screen
- CBC in 1st mo (Fe def)
- Peds cardiology ref.
- Annual HCT/Hgb
- early intervention
152
What is one of the first sign's of hypoalbuminemia?
Periorbital edema. Can also get ascites.
153
Why does hepatic failure cause abdominal distention?
Generalized edema due to decreased production of albumin. Would also expect jaundice.
154
Periorbital edema that improves when the child is upright
Nephrotic syndrome
155
most common cause of nephrotic syndrome in children
minimum change disease (fusion and diffuse effacement of podocytes on EM)
156
Urine Protein: Creatinine
Normal:
Suspicious for nephrotic:
Dx'ic for nephrotic:
```
1.0 = suspicious
>2.5 = diagnostic
```
157
tea-colored urine + skin/throat infection
PSGN
158
T/F: Tx'ing strep throat with antibiotics will prevent RF and PSGN
False, it will only prevent RF
159
elevated ASO, +Streptozyme teset, Elevated anti-DNAase B antibodies, low C3
PSGN
160
Albumin and lipid levels in nephrotic syndrome
low albumin
| high lipid
161
Why is there a large risk of venous thrombosis in nephrotic syndrome?
- Urinary loss of proteins that inhibit coagulation (AT3)
- destabilization of platelets by hyperlipidemia
- increased fibrinogen
- increase viscosity
162
Tx of primary nephrotic syndrome
- Corticosteroids
- Sodium restriction (to 1500-2000mg/daily)
- Albumin + IV Furosemide if symptomatic edema (i.e. causing dyspnea/scrotal edema)
163
Next step for steroid-resistant patients with nephrotic syndrome:
Renal biopsy
164
T/F: During a nephrotic syndrome relapse with steroid use, patients are at a high risk of infection
True
165
sickle cell = substitution of _____ for ______
valine for glutamic acid
166
which Hgb patents associated with sickling:
- F
- FS
- FAS
- FSA
- FSC
- FAC
- FS
- FSA (sickle cell beta thalassemia)
- FSC
The F is always written since its predominant hemoglobin @ birth; the letters after are listed in order of concentration
167
2 most common surgeries in sickle cell kids
- Tonsillectomy
| - Cholecystectomy (bilirubin gallstones frequently occur in all pts with hemolytic anemias)
168
Why is transcranial Doppler performed in sickle cell pts?
stroke occurs in 10% of children with SCD
169
Which pneumococcal vaccine do sickle cell kids get
So 13 valent is given @ 2, 4, 6 months; SCD children also get 23-valent at 2 and 5 years
170
Impairment of _____ is common in children with sickle cell disease
Growth
171
What are important parts of the sickle cell physical exam?
Splenic palpation, observe sclera for icterus, neuro exam (stroke risk)
172
T/F: Fever in children with sickle cell disease is a medical emergency
True
173
Tachypnea and chest pain in a sickle cell kid
possibly Acute Chest Syndrome
174
T/F: Pericariditis typically presents with tachypnea and fever
True
175
CXR findings for Acute chest syndrome in sickle cell patients
Multilobar infiltrates; effusions; atelectasis
176
why is an rbc transufion needed during Acute Chest Syndrome in SCD kids?
RBC transfusion is the only way to directly reduce/reverse the sickling process, which is the underlying cause of acute chest syndrome
177
How do you calculate a corrected age (what we use for premature infants)
40 weeks (avg gest age) - gestational weeks of premature infant = X
Chronological age - x = corrected age
Use this CORRECTED AGE to plot growth charts until age 2
178
When can a baby distinguish mother's voice from another woman?
Before 7 days.
before 2 weeks for father
179
When is developmental screening recommended?
At 9 and 18 months, and at 24 or 30 months
180
Effects of anticonvulsants during pregnancy
- cardiac defects
- dysmorphic craniofacial
- hypoplastic nails and distal phalanges
- IUGR
- microcephaly
181
T/F: Smoking during preg = lower weight newborns at birth
True
182
what are the features of homocystinuria?
- marfanoid habitus
- hypercoaguable state
- dev delay
- methionine in urine
183
Why is polycythemia, seen in SGA infants, problematic?
Hyperviscosity = sluggish flow = respiratory distress secondary to inadequate oxygenation of end-organ tissues
