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Step 1 Miscellanous > Developmental Pediatric Table > Flashcards

Developmental Pediatric Table Flashcards

1
Q

What are the four primary infant reflexes? When do they disappear?

A
  1. Moro - 3 months -> Limbs extend when baby is startled
  2. Rooting - 4 months
  3. Palmar - 6 months
  4. Babinski - 12 months

Disappears like the ocular nerve numbers, 3, 4, 6 months

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2
Q

Does stranger or separation anxiety happen first? What’s the logic?

A

Stranger - happens first - 6 months
Separation - happens second - 9 months

Separation anxiety requires object permanence (also arises at 9 months)

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3
Q

What is the order of postural developments in infancy? From lying down to walking.

A 
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
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4
Q

What are the toy playing milestones in infancy?

A

6 months - passes toys hand to hand

10 months - Pincer grab (thumb to finger)

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5
Q

At what age can an infant drink from a cup and point to objects?

A

12 months

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6
Q

What is first aid mnemonic for developmental milestones?

A

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)

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7
Q

What are the three 3 S’s of infancy?

A 
Social Smile (2 months)
Stranger Anxiety (6 months)
Separation Anxiety (9 months)
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8
Q

What are the 3 O’s of infancy and their associated times?

A

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

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9
Q

What are the three R’s of toddlerhood (child Rearing working)?

A

Recreation - parallel play by 2 years
Rapproachment - by 2 years
Realization - of core gender identity

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10
Q

When does gender identity set in and when is it fixed? Is it innate?

A

Begins at 18 months - you feel male or female
Fixed by 36 months (3 years).

Yes, majority of it is innate

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11
Q

What are parallel play and rapprochement?

A

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

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12
Q

What are the four C’s of toddlership (Child rearing working)?

A

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

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13
Q

What is the W of child rearing Working?

A

W = words, knows 200 words by age 2 (two zeros)

Also 2 word sentences by age 2 (string a couple words together)

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14
Q

What are the three D’s of preschool years (Don’t forget they’re still learning)?

A

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)

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15
Q

What are the Drawing ages?

A

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

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16
Q

What are the two F’s of preschool years (don’t Forget they’re still learning)?

A

Freedom - spends part of day away from parents

Friends - cooperative play by age 4

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17
Q

What are the two L’s of preschool years (don’t forget they’re still Learning)?

A

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

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18
Q

What what age can you read, tie shoelaces, and ride a bike?

A

Age 6 (First grade)

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19
Q

What are the leading causes of death in people under 1 year?

A
  1. Congenital malformations
  2. Preterm birth
  3. Sudden infant death syndrome (SIDS)
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20
Q

What are the leading causes of death in people 1-14 years?

A
  1. Accidents
  2. Cancer
  3. Congenital malformations
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21
Q

What are the leading causes of death in people 15-35 years?

A
  1. Accidents
  2. Suicide
  3. Homicide

Cancer falls off because many pediatric cancers are blastemal in origin (i.e. medullablastoma, Wilms tumor)

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22
Q

What are the leading causes of death in 35-44 year olds?

A

Accidents
Cancer
Heart Disease

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23
Q

What are the leading causes of death in 45-64 year olds?

A

Cancer
Heart Disease
Accidents

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24
Q

What are the leading causes of death in 65+ years?

A

Heart Disease
Cancer
Chronic Respiratory Disease

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25
Q

What changes with age with regards to pharmacokinetics? How should this be handled?

A

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

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26
Q

By what age should kids be able to use utensils?

A

Age 3

27
Q

At what age is speech 100% intelligible?

A

Age 4 -> this is the age you can tell legends in the mnemonic

28
Q

What is agenesis vs aplasia?

A

Agenesis - absent organ due to absent primordial tissue

Aplasia - Absent organ despite presence of primordial tissue

29
Q

What is a disruption and give an example?

A

Secondary breakdown of a previously normal tissue or structure (i.e. amniotic band syndrome)

30
Q

What is a deformation vs a malformation?

A

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

31
Q

What is a Field defect?

A

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)

32
Q

What is being assessed on APGAR score and what is the highest score possible? List the best possible state in each category

A

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,

33
Q

When are APGAR scores measured? What indicates good / poor prognosis?

A

1 and 5 minutes

Highest score is 10, >=7 is normal, <3 = poor prognosis for neurological development

34
Q

What is the definition of low birthweight?

A

<2500 g.

35
Q

What causes symmetric / asymmetric growth retardation?

A

Symmetric - Early insult, i.e. chromosomal abnormality or early infection

Asymmetric - uteroplacental insufficiency - head tends to be larger

36
Q

What is spermiogenesis vs spermatogenesis?

A

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

37
Q

What’s the mnemonic for spermatogonia vs spermatozoa?

A

Spermato”gon”ia - Going to be a sperm (diploid currently)

Spermato”zo”a - Zooming to the egg (haploid and ready to rumble)

38
Q

Place the following in the correct order, and define them:

Growth spurt, adrenarche, pubarche, thelarche, menarche

A 
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
39
Q

What is the average timespan between thelarche and menarche and who tends to get it earlier? During what Tanner stage does menarche usually occur?

A

Around 2.5 years, tends to occur earlier in African Americans, with mild obesity

Tanner Stage 3 - Menarche

40
Q

What is the definition of precocious vs delayed puberty in females?

A

Precocious - Tanner Stage 2 at <8 years

Delay - Tanner Stage 1 at age 13, or no menses by age 16.

41
Q

What is Tanner Stage 1-5 for hair growth?

A

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

42
Q

What is Tanner Stage 1-5 for breasts?

A

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

43
Q

What is Tanner Stage 1-5 for Testicles / Penis?

A 
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
44
Q

What week do the fetal limbs begin to form and fetal heart begin to beat?

A

4 weeks = 4 limbs and 4 heart chambers

45
Q

At what week do fetal movements start?

A

Gait at week 8

46
Q

At what week do genitals have male / female characteristics?

A

TENitalia

47
Q

What germ layer gives rise to the bones of the skull, odontoblasts, and laryngeal / tracheal cartilage?

A

Neural crest! Amazing!

48
Q

What layer gives rise to the epidermis vs dermis?

A

Epidermis - Surface ectoderm

Dermis - Mesoderm

49
Q

What layer gives rise to the lens of the eye vs the retina?

A

Lens - Surface ectoderm (optic placode, which induces neuroectoderm)

Retina - Neuroectoderm (induced by optic placode)

50
Q

What gives rise to the middle ear bones vs sensory organs of the ear (i.e. cochlea)

A

Middle ear ossicles / muscles -neural crest

Inner ear - Otic placodes (from ectodermal placodes)

51
Q

What germ layer is messed up in VACTERL?

A

Mesodermal layer

Vertebral defects
Anal atresia
Cardiac defects
Tracheo-esophageal fistula
Renal defects
Limb defects
52
Q

What germ layer gives rise to the internal genitalia?

A

Mesoderm - since derived from gonadal ridge

53
Q

What germ layer gives rise to the bladder / urethra?

A

Endoderm, since it comes from the urogenital sinus

54
Q

What toxicity is associated with aminoglycosides in utero?

A

Ototoxicity - tarantula on gong

55
Q

What toxicity is associated with maternal methylmercury exposure?

A

Neurotoxicity - especially associated with eating seafood.

56
Q

What is the mechanism of toxicity in fetal alcohol syndrome?

A

Failure of cell migration

57
Q

What type of tumor can arise in allantois remanant?

A

Adenocarcinoma (derived from endoderm) -> develops at the dome of the bladder, which is where the urachus comes off to extend to the umbilicus

58
Q

What are pharyngeal clefts, arches, and pouches?

A

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

59
Q

What is the content of the arches of the pharyngeal apparatus?

A

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

60
Q

What’s the mnemonic for branchial pouch derivatives?

A

Ear, Tonsils, Bottom-To-Top

1 - middle ear
2 - palatine Tonsils epithelium
3 - Bottom parathyroids 
3 - Thymus
4 - Top parathyroids
61
Q

What condition is associated with a U-shaped cleft palate and a small mandible (micrognathia)?

A

Pierre Robin sequence

-> also will have glossoptosis (tongue lies more posteriorly than normal due to malformation)

62
Q

What is arch 1&2 syndrome also called? What are its features and What causes it?

A

Treacher Collins syndrome - small lower jaw, facial defects, malformed ears. It is due to insufficient neural crest cells to Arch 1 and Arch 2

63
Q

What is the Galant reflex?

A

When baby is prone, stroking along one side of body causes lateral flexion of towards stimulated side

Step 1 Miscellanous (40 decks)

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