DIDACTICPediatrics_all lectures Flashcards
Koplik spots
measles
how long does measles usually last?
1 week
What are the 4 D’s and 3 C’s of measles?
4 D’s and 3C’s:
4 days of high fever
Cough, coryza and conjunctivitis
(coryza = rhinitis)
virus for Rubella?
Togavirus
“toGA! toGA! toGA!” think of a red toga…rubella means “little red”
why do we vaccinate against rubella?
Rubella is the leading vaccine-preventable cause of birth defects
we want to avoid congenital rubella syndrome - must avoid this for women who could get pregnant.
bacteria causing diptheria?
Corynebacterium diphtheria
toxin-producing strains!
itch worse at night - so bad the pt can’t sleep
scabies
how long do scabies live?
15-30 days
how long does it take for scabies eggs to hatch?
3-4 days
most common treatment for scabies
Permethrin 5% cream applied neck down
treatment regiment for scabies
two Permethrin treatments, 7 days apart
what is important for the household of a scabies pt?
must treat the whole household
affected people, 2 treatments 7 days apart, unaffected people, 1 treatment
key to scabies dx?
itch that’s worse at night
siblings have it too
what does atopic dermatitis respond to?
moisturizers
topical steroids
common places for atopic dermatitis rash?
antecubital
pop fossa
(flexure spots)
“islands of plaques”
psoriasis
atopic dermatitis vs psoriasis
atopic dermatitis is very itchy, vs. psoriasis which is mildly or not itchy
how long does topical steroid stay in the skin?
12 hours
one sternocleidomastoid is shorter than the other
torticollis
flat spot on head
plagiocephaly
"plagio" = oblique, slanting, flat, spread "cephaly" = head, skull, brain
high fever + 3 C’s (cough, coryza, conjunctivitis) and a brick-red rash that begins at hairline (and spreads down)
measles
what is coryza?
commonly used synonym for rhinitis
most common cause of measles-related deaths
pneumonia
live, attenuated vaccines
(MOVR, “mover”, they’re live, so they move)
M: MMR
O: Oral polio
V: Varicella Zoster
R: Rotavirus
also - smallpox yellow fever oral typhoid Franciscella tularensis
why do we care if vaccine is live, attenuated?
good immune response of both humoral (antibody) and cell-mediated immunity
don’t usually need booster
don’t give them to immunocompromised or pregnant pts!!!!!
killed, inactivated vaccines
PIRV A
Polio SalK (K for killed) Influenza Rabies Vibrio Cholerae Hep A
“food under age of 1….
…is just for fun”
rotavirus is most commonly seen in
unimmunized children between 6 mo - 2 yrs of age
most common complication of mumps
epididymo-orchitis
postpubertal males, 15-30%, usually unilateral
about 5-10 days after parotitis
Hib vaccine timing
2mo
4 mo
6 mo
12 or 15 mo.
EMBRYOLOGY
all organs are formed by week
8
EMBRYOLOGY
ovulation day
day 14
EMBRYOLOGY
fertilization day
day 15
EMBRYOLOGY
implantation day
day 22-24
EMBRYOLOGY
expected menses
day 28
EMBRYOLOGY
three components of primitive streak
primitive groove
primitive node
primitive pit
EMBRYOLOGY
what happens to primitive streak by end of 4th week?
primitive streak shows regressive changes, shrinks, disappears
EMBRYOLOGY
primitive streak will be
caudal
EMBRYOLOGY
primitive groove will be
mouth
EMBRYOLOGY
what is holoprosencephaly?
structures are affected as they are laid out midline on the axis - no reference for laying out structures
(cyclops, close spaced eyes, brain doesn’t have its hemispheres)
"holo" = whole "prosencephalon" = forebrain
EMBRYOLOGY
what is caudal dysgenesis/regression syndrome?
insufficient amt of migration of mesoderm
Mermaid body, sirenomelia
EMBRYOLOGY
what is sacrococcygeal teratoma?
remnants of primitive streak derived from all 3 germ layers
so you find allll types of tissues - teeth, hair, etc.
PEDS 101
after 12 years old, pediatric vitals are…
…more like adults
PEDS 101
pediatric HR are usually
higher than adults
PEDS 101
pediatric bp ranges are usually
lower than adults
PEDS 101
pediatric RR are usually
higher than adults
PEDS 101
heads that suddenly stop growing are….
…concerning
- check cranial sutures
- follow closely and refer quickly
PEDS 101
when is newborn screening blood collected (heel prick)?
MUST BE COLLECTED AFTER 24 HOURS OLD
PEDS 101
who is Dr. Bob Sears?
some guy with his own vaccination schedule which is not supported by CDC or AAP
PEDS 101
It’s a good idea to avoid honey until baby is 1 year old to avoid botulism. True or false?
True
PEDS 101
what food is best for starting a 4-6 month old on food?
cereals
cereals are best to start as they are easy to change consistency– multigrain, barely, oatmeal (not rice only per FDA due to arsenic risk); mix with breastmilk, formula, water
PEDS 101
Should 6-9 month old baby still get breastmilk? What class should parents take at this point?
yes -
baby should still be getting 24-32 oz of bm/formula daily
parents should take Heimlich maneuver/baby CPR
PEDS 101
eating milestone for the 9-12 month old
may be using spoon or fork
PEDS 101
two key changes in eating at 12 months
transition to whole milk
discontinue bottles/pacifiers
PEDS 101
typical age of readiness for toilet training
22-30 months
PEDS 101
ideally kids should have toilet training complete so that they have daytime dryness by….
5 years old
PEDS 101
rear-facing car seat is appropriate for children until about ages…
rear facing car seats are from birth to
AGES 2-4
Keep children rear-facing as long as possible.
Did you do the practice med dosing calculation problems provided by Dr. Banderas?
“of course I did”
Good! She says there will be 1-2 questions on the exam that are dosing problems!
which hormone, released from the liver, is responsible for bone growth?
IGF-1, aka somatomedin C
“IGF-1 (along with sex steroids) is responsible for bone growth”
adrenarche
development of pubic and axillary hair
breast budding term
Thelarche
teens should consume ______ mg/day of elemental calcium
1300
teens should consume ______ amount of Vitamin D every day
400 IU
teens should participate in _____type of daily exercise
bone-bearing
why do we no longer give MMRV? in other words, why is Varicella separated from MMR vaccine?
there is a risk of febrile seizures with first dose of MMRV (so we give them separately now)
(MMRV CAN be used as a second dose though…)
BCG vaccine
protects against
miliary TB and
TB meningitis
(in first five yrs of life, given in areas where TB risk is high, not in US)
what children do NOT get live viral vaccine or live bacterial vaccine?
severely immunocompromised kids (those with T cell defects)
how long do we wait after prolonged steroid administration (for 2 weeks or more) to give live virus vaccine?
wait at least 3 months
common side effects for Hep B vaccine
soreness
pain
LOW GRADE fever
very very very low chance of anaphylaxis
common side effects for Rotavirus vaccine
RARELY - intussusception
(but rotavirus itself can cause intussusception)
mild v/d
LOW GRADE fever
common side effects for Tetanus vaccine
hives
trouble breathing
low bp
pain
soreness
LOW GRADE fever
common side effects for Diphtheria vaccine
pain
soreness
fever
common side effects for Pertussis vaccine
mild -
pain
tenderness
fever fretfulness
rarely -
inconsolable crying
febrile sz (super rare)
common side effects for Polio vaccine
“well tolerated”
common side effects for HiB vaccine
pain
soreness
LOW GRADE fever
common side effects for PCV vaccine
fever in 1:100 infants
muscle aches in 1:100
pain
redness
swelling
common side effects for MMR vaccine
may have mild breakthrough disease for kids <14 months
fever
soreness
common side effects for varicella vaccine
mild chickenpox-like rash
pain
redness
runny nose
cough
Does the child have a syndrome?
Check on these three things
- failure to thrive?
- feeding difficulties?
- delayed milestones?
When suspecting a syndrome, when do we refer to genetics?
- single MAJOR birth defect discovered
- combination of multiple birth defects
- FH of particular defect (i.e. deafness)
- multiple miscarriages/stillbirths
List seven medical issues for children with Down’s Syndrome
OD’CLOTH
Obesity- 56%
Diabetes
Cardiac defects - 50% Leukemia OSA- 30-75% Thyroid disorders- 54% Hearing loss- 38-78%
what is the most common chromosomal abnormality among live born infants?
Down’s Syndrome
majority of preemies are born in what category of prematurity?
LATE PRETERM
gestational age of LATE PRETERM category
34 - 36 6/7 weeks
define TERM category based on gestational age
TERM = 37 - 41 6/7 weeks
what is the independent risk for mortality for a preemie immediately after delivery?
thermoregulation
what is the leading cause of morbidity and mortality in the newborn period?
RDS
Respiratory
Distress
Syndrome
what is RDS?
a lack of surfactant
what does RDS look like on chest xray?
diffuse reticulogranular pattern
air bronchograms
atelectasis
what is BPD?
BronchoPulmonary Dysplasia
impaired pulmonary function
what is a common risk of BPD?
CP
cerebral palsy
where is a PDA?
between the aorta and pulmonary artery
what closes the PDA medically?
indocin or ibuprofen (NSAIDS close the ductus)
what is an intestinal emergency for the preemie?
NEC (necrotizing enterocolitis)
what is the treatment of NEC?
decompress the abdomen, either via
NG/OG tubes, or
surgery
common s/s of NEC?
grossly bloody stools or
occult blood in stool
distended abdomen
one key radiographic findings of NEC?
Pneumatosis intestinalis: air in the wall of the bowel itself
duration of cessation of breathing of preemie to qualify for apnea of prematurity?
> 20 seconds
treatment of apnea of prematurity?
caffeine
treatment of anemia of prematurity?
resolves spontaneously in 3-6 months
three factors of care for PCP for preemie after discharged home
GROWTH
(expect baby to catch up for first 2 yrs)
PREVENTIVE CARE
(IZ schedule based on chronological age)
MILESTONES/NEURODEVELOPMENTAL ASSESSMENTS
(utilize CORRECTED age until 2 yrs (subtract # of weeks born early))
ankyloglossia -
define
name treatment
= the frenulum is connected to end of tongue
snip it
dacryostenosis
define
name treatment
= clogged tear ducts
<6 months, just use warm washcloth to clean
>6 months, consider referral to opthamology
omphalitis -
define and describe
infection of umbilical cord
nasty smelling discharge
go to hospital; this baby gets admitted!
Diastasis Recti
what is it? what do we do about it?
abdominal muscles haven’t met yet
nothing - they’ll come together
umbilical hernia -
testing and treatment
push it in with your thumb - if baby doesn’t cry, no signs of pain, leave it alone - it will heal by the time baby is 5 years old.
just watch out for it to become firm or red, this means trouble for baby
baby MSK
what are Ortolani and Barlow tests?
Barlow - try to dislocate the hips
Ortolani - try to push back into socket
not sure - something to do with making sure hip joints are okay
baby MSK
what hip advice to we give to parents?
Advise parents to keep them in frog leg position as much as possible bc the femur heads in the joint is what develops the deep cartilage socket
what five skin changes are vascular malformations?
port wine stains stork bites angel kisses hemangiomas congenital hemangiomas
baby neuro
what’s the difference between infantile spasm (seizure) and natural sleep jerking motion?
sz = sustained, rhythmic movement, eye deviation - - go to hospital!
natural sleep jerking = one small jerk motion when falling asleep
Meconium stools should transition to normal stools by ______.
describe meconium stools
by 2 days
meconium stools are black and tarry
by ______, mom’s full milk should be present
by 3-5 days
physiological jaundice is a diagnosis of
exclusion
physiological jaundice peaks at _____ days of age, usually gone by ____.
physiological jaundice peaks at TWO TO FOUR DAYS of age and is usually gone BY TWO WEEKS OF AGE.
physiological jaundice should not exceed _____ level of indirect bilirubin
12 mg/dL
15-17 mg/dL peak of indirect bilirubin is consistent with ______
breast milk jaundice, or indirect hyperbilirubinemia
how long do breast milk jaundice, or indirect hyperbilirubinemia, last?
can last a month or more
characteristics of pathologic jaundice
- appears w/in 24 hrs of birth
- any direct hyperbilirubinemia
>17 total serum bilirubin (TSB) in newborns
possible causes of pathologic jaundice
rubella sepsis toxoplasmosis ABO incompatibility Rh neg mother with second Rh positive baby
labs for jaundice?
Transcutaneous Bilirubin: Very close estimation of TSB. Non-invasive
Total Serum Bilirubin: The total amount of Bilirubin circulating in the blood
Coombs’ - are there antibodies attached to RBC’s
Antibody-mediated hemolysis
ABO: Blood type - does it match mom’s? (Tested at birth)
Type O moms are most commonly affected since they can carry both antiA and antiB antibodies. If the infant is A, B or AB then they are vulnerable
Rh testing: Is mom (-) and infant (+)? Erythroblastosis fetalis
jaundice: when do I worry?
1 major risk factor + high Bhutani score
known FH of inherited disorder
infant not responding to phototherapy
Erythema infectiosum is also known as:
Fifth Disease
“slapped cheeks”
lace pattern
name that disease and the virus that causes it
Fifth Disease
parvovirus B19
treatment for moderate viral croup
Nebulized/racemic Epinephrine (give 1st)
mainstay of treatment is dexamethasone, but you have to open the airway first
“herald patch”
Pityriasis rosea
Christmas tree pattern
Pityriasis rosea
in cases of FEVER, which children get empiric antibiotics?
Neonates Immunocompromised children Ill appearing infants Toxic appearing children Well appearing infants and abnormal labs (e.g. UA, CSF analysis)
in cases of FEVER, what antibiotics are given to infants 0-30 days who need them?
Ampicillin and gentamicin
or
ampicillin and cefotaxime
in cases of FEVER, what antibiotics are given to infants >31 days and older children who need them?
Ceftriaxone ± vancomycin
how many kids with FEVER need antibiotics?
not many - The most common cause of fever in childhood are viruses
Viral testing is not commonly indicated
define FEVER in physiologic terms
Centrally mediated rise of body temperature above the normal daily variation in response to many different pathologic insults
how is FEVER defined in temperatures?
> 100.4 F (38 C) in neonates and babies < 3 mo)
> 101.1 F (38.4 C) in older children
(no single, widely accepted value)
Greek word for leather
diptheria
refers to the pharyngeal membrane that is the clinical hallmark of infection
initial finding on oropharyngeal examination of diptheria
initial finding on oropharyngeal examination is
mild erythema, which can progress to isolated spots of gray and white exudates
unique finding of diptheria
In at least one-third of cases, patients present with the classic coalescing pseudomembrane, which adheres tightly to the underlying tissue and bleeds with scrapping
another name for croup
Laryngotracheitis
What is the treatment for gonococcal conjunctivitis?
1 gram of intramuscular ceftriaxone.
key finding of intussusception
imaging used in intussusception
CURRANT JELLY bloody stools
ultrasound (“target sign”)
