Developmental Pediatric Table Flashcards
What are the four primary infant reflexes? When do they disappear?
- Moro - 3 months -> Limbs extend when baby is startled
- Rooting - 4 months
- Palmar - 6 months
- Babinski - 12 months
Disappears like the ocular nerve numbers, 3, 4, 6 months
Does stranger or separation anxiety happen first? What’s the logic?
Stranger - happens first - 6 months
Separation - happens second - 9 months
Separation anxiety requires object permanence (also arises at 9 months)
What is the order of postural developments in infancy? From lying down to walking.
Lifts head to prone by 1 month Sits and rolls by 6 months Crawls by 8 months Stands by 10 months Walks by 12-18 months
What are the toy playing milestones in infancy?
6 months - passes toys hand to hand
10 months - Pincer grab (thumb to finger)
At what age can an infant drink from a cup and point to objects?
12 months
What is first aid mnemonic for developmental milestones?
Parents Start Observing, (0-12 months, infant)
Child Rearing Working, (12-36 months, toddler)
Don’t Forget, they’re still Learning! (3-5 yrs, preschool)
What are the three 3 S’s of infancy?
Social Smile (2 months) Stranger Anxiety (6 months) Separation Anxiety (9 months)
What are the 3 O’s of infancy and their associated times?
Orients to voice - 4 months, then name at 9 months
Object permanence - 9 months, develops at same time as separation anxiety
Oratory - says mama / dada at 10 months, but actually means mama / dada by 12 months
What are the three R’s of toddlerhood (child Rearing working)?
Recreation - parallel play by 2 years
Rapproachment - by 2 years
Realization - of core gender identity
When does gender identity set in and when is it fixed? Is it innate?
Begins at 18 months - you feel male or female
Fixed by 36 months (3 years).
Yes, majority of it is innate
What are parallel play and rapprochement?
Parallel play - playing next to another child, but not with eachother
Rapprochement - Child wants independence but fears abandonment, will leave caregiver, return briefly, then go out to explore again
What are the four C’s of toddlership (Child rearing working)?
Cruises - takes first steps by 12-18 months, runs by 24 months
Climbs stairs 18 months
Cubes stacked - 3 x age in years = 6 by two years
Cutlery - feeds self with fork and spoon
Kicks ball - not a C, but 24 months
What is the W of child rearing Working?
W = words, knows 200 words by age 2 (two zeros)
Also 2 word sentences by age 2 (string a couple words together)
What are the three D’s of preschool years (Don’t forget they’re still learning)?
Drive - can ride tricycle with 3 wheels (age 3 for three wheels)
Drawings
Dexterity - Hops on one foot by age 4, Uses buttons / grooms self by age 5, can use buttons or zippers by age 5 (full dressing of self by age 5)
What are the Drawing ages?
3 - fits in circle - can copy circle
4 - add a line to a plus - can copy a + (make stick figure now)
5 - fits in square with line on top of 5 - can copy square
6 - tip of 6 points to tip of triangle - can copy a triangle
What are the two F’s of preschool years (don’t Forget they’re still learning)?
Freedom - spends part of day away from parents
Friends - cooperative play by age 4
What are the two L’s of preschool years (don’t forget they’re still Learning)?
Language - 3 zeros for age 3 - knows 1000 words. Can also use complete sentences by age 4.
Legends - At age 4, when can use complete sentences, can also tell complete stories
What what age can you read, tie shoelaces, and ride a bike?
Age 6 (First grade)
What are the leading causes of death in people under 1 year?
- Congenital malformations
- Preterm birth
- Sudden infant death syndrome (SIDS)
What are the leading causes of death in people 1-14 years?
- Accidents
- Cancer
- Congenital malformations
What are the leading causes of death in people 15-35 years?
- Accidents
- Suicide
- Homicide
Cancer falls off because many pediatric cancers are blastemal in origin (i.e. medullablastoma, Wilms tumor)
What are the leading causes of death in 35-44 year olds?
Accidents
Cancer
Heart Disease
What are the leading causes of death in 45-64 year olds?
Cancer
Heart Disease
Accidents
What are the leading causes of death in 65+ years?
Heart Disease
Cancer
Chronic Respiratory Disease
What changes with age with regards to pharmacokinetics? How should this be handled?
Decreased volume of distribution (decreased total body water and lean body mass, however increased fat = increased Vd for lipophilic drugs)
Increased elimination half-life
-> start low and go slow, change one medication at a time, check kidney and liver function
By what age should kids be able to use utensils?
Age 3
At what age is speech 100% intelligible?
Age 4 -> this is the age you can tell legends in the mnemonic
What is agenesis vs aplasia?
Agenesis - absent organ due to absent primordial tissue
Aplasia - Absent organ despite presence of primordial tissue
What is a disruption and give an example?
Secondary breakdown of a previously normal tissue or structure (i.e. amniotic band syndrome)
What is a deformation vs a malformation?
DEMI - cuz Jesus was a baby DEMIgod
Deformation - Extrinsic disruption, occuring after embryonic period -> i.e. arthrogryposis due to oligohydramnios
Malformation - Intrinsic disruption, defect in morphogenesis during the embryonic period - i.e. neural tube defect
What is a Field defect?
Initial embryonic disturbance leads to multiple malformations by disrupting adjacent structural development (i.e. holoprosencephaly with ranging degrees of severity depending on how bad the original defect is)
What is being assessed on APGAR score and what is the highest score possible? List the best possible state in each category
APGAR
Appearance - Completely pink = 2 (vs blue body, or blue extremities)
Pulse - >100 bpm, <100 = 1, 0 = no pulse
Grimace - Cough / Sneeze to nasal catheter and pull away = 2, grimace or cry = 1, no movement = 0
Activity - Active motion = 2 (vs just some flexion = 1)
Respirations - Good / crying is 2 , 1 = slow / irregular,
When are APGAR scores measured? What indicates good / poor prognosis?
1 and 5 minutes
Highest score is 10, >=7 is normal, <3 = poor prognosis for neurological development
What is the definition of low birthweight?
<2500 g.
What causes symmetric / asymmetric growth retardation?
Symmetric - Early insult, i.e. chromosomal abnormality or early infection
Asymmetric - uteroplacental insufficiency - head tends to be larger
What is spermiogenesis vs spermatogenesis?
Spermatogenesis - name for entire process overall. Starts with diploid spermatogonia (germ cells) dividing, which will become primary spermatocytes, and undergo meiosis to become spermatids (haploid).
Spermiogenesis - process of making haploid spermatids into haploid spermatozoa (mature sperm), gaining a tail, losing cytoplasm, and gaining acrosome
What’s the mnemonic for spermatogonia vs spermatozoa?
Spermato”gon”ia - Going to be a sperm (diploid currently)
Spermato”zo”a - Zooming to the egg (haploid and ready to rumble)
Place the following in the correct order, and define them:
Growth spurt, adrenarche, pubarche, thelarche, menarche
Thelarche - breast bud / breast growth Pubarche - pubic hair growth Adrenarche - axillary hair growth (think adrenal glands make hair) Growth spurt - follows hair growth Menarche - first menstrual bleed
What is the average timespan between thelarche and menarche and who tends to get it earlier? During what Tanner stage does menarche usually occur?
Around 2.5 years, tends to occur earlier in African Americans, with mild obesity
Tanner Stage 3 - Menarche
What is the definition of precocious vs delayed puberty in females?
Precocious - Tanner Stage 2 at <8 years
Delay - Tanner Stage 1 at age 13, or no menses by age 16.
What is Tanner Stage 1-5 for hair growth?
1 - No sexual hair
2 - Pubarche (pubic hair)
3 - Coarsening of pubic hair, still early though
4 - Coarse hair in pubis fully developed, but sparing thigh
5 - Coarse hair involving thigh
What is Tanner Stage 1-5 for breasts?
1 - Flat-appearing chest
2 - Thelarche - Breast bud forms
3 - Breast enlarges, mound forms
4 - Breast enlarges, but areola remains raised (4 = mound on mound)
5 - Adult breast contour, with areola flattened
What is Tanner Stage 1-5 for Testicles / Penis?
1 - No development / no sexual hair 2 - Testicular enlargement 3 - Penis size / length increases 4 - Penis width / glans enlarged 5 - Penis and testis enlarge to adult size
What week do the fetal limbs begin to form and fetal heart begin to beat?
4 weeks = 4 limbs and 4 heart chambers
At what week do fetal movements start?
Gait at week 8
At what week do genitals have male / female characteristics?
TENitalia
What germ layer gives rise to the bones of the skull, odontoblasts, and laryngeal / tracheal cartilage?
Neural crest! Amazing!
What layer gives rise to the epidermis vs dermis?
Epidermis - Surface ectoderm
Dermis - Mesoderm
What layer gives rise to the lens of the eye vs the retina?
Lens - Surface ectoderm (optic placode, which induces neuroectoderm)
Retina - Neuroectoderm (induced by optic placode)
What gives rise to the middle ear bones vs sensory organs of the ear (i.e. cochlea)
Middle ear ossicles / muscles -neural crest
Inner ear - Otic placodes (from ectodermal placodes)
What germ layer is messed up in VACTERL?
Mesodermal layer
Vertebral defects Anal atresia Cardiac defects Tracheo-esophageal fistula Renal defects Limb defects
What germ layer gives rise to the internal genitalia?
Mesoderm - since derived from gonadal ridge
What germ layer gives rise to the bladder / urethra?
Endoderm, since it comes from the urogenital sinus
What toxicity is associated with aminoglycosides in utero?
Ototoxicity - tarantula on gong
What toxicity is associated with maternal methylmercury exposure?
Neurotoxicity - especially associated with eating seafood.
What is the mechanism of toxicity in fetal alcohol syndrome?
Failure of cell migration
What type of tumor can arise in allantois remanant?
Adenocarcinoma (derived from endoderm) -> develops at the dome of the bladder, which is where the urachus comes off to extend to the umbilicus
What are pharyngeal clefts, arches, and pouches?
Cleft - ectoderm in groove, caudal to corresponding arch
Arches - mesoderm / neural crest between the grooves.
Pouch - outpockets of pharyngeal endoderm that lies close to to cleft in the grooves (making a membrane).
Arch is cranial to the corresponding cleft/pouch membrane
What is the content of the arches of the pharyngeal apparatus?
Mesoderm - muscles, arches of the aorta (i.e. arch 1 of aorta is in the first subdivision, gives rise to the maxillary artery)
Neural crest - gives rise to bones and cartilages of the face
What’s the mnemonic for branchial pouch derivatives?
Ear, Tonsils, Bottom-To-Top
1 - middle ear 2 - palatine Tonsils epithelium 3 - Bottom parathyroids 3 - Thymus 4 - Top parathyroids
What condition is associated with a U-shaped cleft palate and a small mandible (micrognathia)?
Pierre Robin sequence
-> also will have glossoptosis (tongue lies more posteriorly than normal due to malformation)
What is arch 1&2 syndrome also called? What are its features and What causes it?
Treacher Collins syndrome - small lower jaw, facial defects, malformed ears. It is due to insufficient neural crest cells to Arch 1 and Arch 2
What is the Galant reflex?
When baby is prone, stroking along one side of body causes lateral flexion of towards stimulated side
