Exam 1 Flashcards
Should feed themselves with a fork/spoon
by 2 years
BMI categories
Underweight <18.5 Normal 18.5-25 Overweight 25-30 Obese 1 30-35 Obese 2 35-40 Morbidly obese >40
1 month milestones
lift head, coo, track with eyes, recognize parents
6 month milestones
Sit up, raking grasp, stranger anxiety, babbles
9 month milestones
Walk with assistance, 3 finger grasp, bye bye, pat a cake
1 year milestones
Walking, 2 finger grasp, mam/dada, imitate parent
2 year milestones
2 word phrases, 2 steps, 2 step command, stack 6 cubes
3 year milestones
3 word sentences, ride tricycle, brush teeth, draw circle
4 year milestones
hop, copy a cross, play with others
Physical milestones in first year
Birth weight doubles by 6 months and triples by 1 year
50% increase in length by 1 year
Anterior fontanel closes 12-18 months
Posterior fontanel closes 6-8 weeks
Motor red flags at 4, 9, 18 months
4: Lack of steady head control while sitting
9: inability to sit
18: inability to walk independently
Social emotional red flags at 6, 9, 12, 15, 18, 24 months
6: lack of smiles
9: lack of reciprocal vocalizations
12: failure to respond to name, no babbling, lack of waving or reaching
15: lack of protodelcarative pointing
18: lack of pretend play and spoken language
24: lack of 2 word phrases
Cognitive red flags 2, 4, 6, 9, 24, 36 months
2: lack of fixation
4: lack of visual tracking
6: failure to turn to sound or voice
9: lack of babbling
24: failure to use single words
36 months: failure to speak in 3 word sentences
Tests for strabismus
Hirschberg and cover/uncover
Order of male puberty sequence
Testicular enlargement, penile enlargement, height growth spurt, pubic hair
Order of female puberty sequence
Breast buds, height growth spurt, pubic hair, menarche
Hep B schedule
birth, 2 months, 6 months
Rotavirus schedule
2 months, 4 months, 6 months
DTaP schedule
2 months, 4 months, 6 months, 15 months, 4-6 years
HiB schedule
2 months, 4 months, 6 months, 12-15 months
PCV13 schedule
2 months, 4 months, 6 months, 12-15 months
IPV schedule
2 months, 4 months, 6-15 months, 4-6 years
MMR schedule
12-15 months (2 doses 4 weeks apart), 4-6 years
Varicella schedule
12-15 months, 4-6 years
Hepatitis A schedule
12-15 months (second dose 6 months later)
Meningococcal schedule
11-12 years, 16 years
Tdap schedule
11-12 years
HPV schedule
11-12 years or early as 9; 2 dose series with second dose 6 months after the first
White reflex in neonate can be caused by
glaucoma, cataract, or tumor (retinoblastoma)
Sepsis in newborn
Hypotension, acidemia, neutropenia clinical findings
Labs: low WBC with absolute neutropenia, thrombocytopenia, hypglycemia or hyperglycemia, metabolic acidosis, elevated CRP
Tx sepsis in newborn
Ampicillin + aminoglycoside or 3rd gen cephalosporin
LP results if bacterial meningitis
CSF protein >150, glucose <30, leukocytes >20, + gram
Omphalitis
Umbilical cord infection
Copious purulent discharge in newborn
N. Gonorrhoeae
Tx: IV ceftriaxone
Conjunctival congestion, edema and minimal discharge in newborn
Chlamydia
Tx: oral erythromycin for 14 days
Children develop in what direction
Cephalocaudal
Raking grasp vs pincer grasp
Raking by 3-4 months and pincer by 9 months
Babbling reaches peak at
12 months
Object permanence
9-12 months
Separation and stranger anxiety
8-9 months
Parallel play
2-3 years
Collaborative play
3-4 years
Conservation of length
5.5 years
Differentials for wetting of pants by 5-6 years of age
DM, DI, seizures, cystitis, neurogenic bladder, anatomical abnormalities
Colic
cries >3 hours per day for >3 days per week for >3 weeks
Peaks at 2-3 months
When should autism screening begin
18 months
Triad for ADHD
Impulsivity, inattention, hyperactivity
Must be present <12 years and in 2+ settings
Tx ADHD
Stimulants: methylphenidate, dextroamphetamine
A2 agonists: clonidine or guanfacine
Autism features
Deficits in social communication and interaction across multiple contexts and repetitive patterns of behavior
Symptoms present <3 years
18 month developmental tasks
Builds tower of 3-4 cubes, throws ball, seats self in chair, dumps pellet from bottle
Walks up and down stairs with help, says 4-20 words, carries and hugs a doll, feeds self
24 month developmental tasks
Kicks ball, speaks short phrases, builds tower of 6-7 cubes, points ot named objects, jumps with both feet, verbalizes toilet needs, turns pages of book
3 year developmental tasks
holds crayons, builds 9-10 block tower, copies circle, rides tricycle, dresses with help
3-4 year developemental tasks
Climbs stairs with alternating feet, can button and unbutton, knows own sex, feeds self
First line tx of dysmenorrhea
NSAIDs and contraceptives to suppress ovulation
BP screening
Begin at age 3
Need 3 separate high readings to dx hypertension
Systolic or diastolic >95th percentile for age and height or weight
Visual acuity testing
Begin at age 3
Tumbling E chart or picture tests
Lead screening
Universal screening for children 1-2 years
Sepsis workup for neonate
Fever >100.4
CBC, blood culture, UA, urine culture, gram stain, CSF, glucose
Failure to thrive
Crossing 2 major percentile lines on a growth chart or if <6 months and not grown for 2 consecutive months or >6 months and not grown for 3 consecutive months
Predominant nutrient in first few months of life
40% fat
Absolute CI to breastfeeding
Active TB in mother, HIV in mother, galactosemia in infant
Describing skin lesions order
Distribution, configuration, color, secondary changes, primary changes
Ex. psoriasis: generalized, discrete, red, or scaly papules
Any flat circumscribed color change in the skin < 1 cm
Macule
Ex freckle
Any flat circumscribed color change in the skin > 1 cm.
Patch
Ex nevus depigmentosa
A solid, elevated area < 1 cm in diameter whose top may be pointed, rounded, or flat.
papule
A solid, circumscribed area > 1 cm in diameter, usually flat-topped
Plaque
Ex. psoriasis
A circumscribed, elevated lesion < 1 cm in diameter and containing clear serous fluid
Vesicle
Ex. varicella
A circumscribed, elevated lesion > 1 cm in diameter and containing clear serous fluid
Bullae
Ex. impetigo
A vesicle containing a purulent exudate
Pustule
Ex. acne
A deep-seated mass with indistinct borders that elevates the overlying epidermis
nodule
A circumscribed, flat-topped, firm elevation of skin resulting from tense edema of the papillary dermis
Wheal
Dry, thin plates of keratinized epidermal cells
Scales
Ex. psoriasis
Induration of skin with exaggerated skin lines and a shiny surface resulting from chronic rubbing of the skin
Lichenification
A linear split in the skin extending through the epidermis into the dermis
Fissure
Ex. angular cheilitis
Discrete lesions
Independent of each other
Topical steroid info
2X daily mainstay tx
Can be used under wet dressings
only low potency to the face
Drugs that may cause acne
ACTH, steroids, androgens, hydantoins, isoniazid
Precursors to inflammatory acne
Closed comedones–white heads
1st line tx acne
Topical keratolytics
Retin A, benzoyl peroxide, azelaic acid
Topical abx for acne
Clindamycin 1%
Topical abx should never be used alone
Systemic abx for acne
Tetracycline, minocycline, doxycyline
Never use as monotherapy
Pathogens in impetigo
GAS and staph
Tx of impetigo
Amoxicillin, cephalosporin, clindamycin, augmentin
If not severe: topical mupirocin, polymyxin, gentamycin, erythromycin
Ecthyma
Deeper form of impetigo
Tx: penicillin
• Erythematous, hot, tender, ill-defined, edematous plaques accompanied by regional lymphadenopathy
Cellulitis
Tx of fungal infection of hair or nails
Griseofulvin or terbinafine
Sharply demarcated erythematous patches with eroded areas and satellite lesions
Candida infection
Tx of choice for diaper dermatitis due to candida
Topical imidazole cream
Most frequent cutaneous features in child with HIV
Persistent oral candidiasis and recalcitrant candida diaper rash
umbilicated, flesh colored papules in groups anywhere on the body
Molluscum contagiosum
Due to poxvirus
Tx of scabes
Permethrin single overnight use and repeat in 7 days
Tx atopic dermatitis
Wet dressings and topical steroids if acute and weeping
If chronic, avoid irritants, bathe every 2-3 days and twice daily lubrication
White, scaly macular areas with indistinct borders seen over extensor surfaces of extremities and cheeks; sun tanning exaggerates
Pityriasis alba
Tx: low potency steroids and strict sun avoidance
Confused with tinea versicolor
Rash that usually begins as a large circular or oval spot on your chest, abdomen or back. Called a herald patch, this spot can be up to 4 inches
Pityriasis rosea Align with christmas tree pattern Clinically similar to ring worm Viral in origin Main differential is secondary syphilis Exposure to sunlight can help
Guttate psoriasis
Common form in children followed by 2-3 weeks of strep throat
Sudden onset of small papules seen predominantly over trunk and covered with thick white scales
Strongest identifiable predisposing factor to asthma
Atopy
What shows poor asthma control
> 1 cannister per month of albuterol
Stepwise tx of asthma
step 1: SABA prn
step 2: low dose ICS or cromolyn or montelukast
Step 3: medium dose ICS
Step 4: medium dose ICS + LABA
Step 5: high dose ICS + LABA
Step 6: high dose ICS + LAB A + oral steroids
Initial tx of acute asthma exacerbation at home
SABA 2-6 puffs every 20 minutes up to 3 times or single nebulizer treatment
Tx allergic rhinoconjunctivitis in children
Topical steroids > oral antihistamines
Approved antihistamines in children
Cetirizine >6 months
Loratadine >2 years
Desloratadine >6 months
Fexofenadine >6 months
Approved nasal steroids in children
Fluticasone furoate >2 years
Fluticasone propionate >4 years
Montelukast approved for
> 6 months
Main cause of common cold
Rhinovirus and adenovirus
Main cause of croup
parainfluenza
Fever, nasal congestion, sore throat, barking cough
most common cause of lower respiratory tract illness in children
RSV
Causes bronchiolitis
Diffuse wheezing, tachypnea following URI
Only licensed antiviral against RSV
Ribavirin
Roseola
Benign illness due to HHV 6 or 7
Fever lasting 8 days, fever ceases abruptly and then a characteristic rash may occur–rose pink maculopapular non pruritic
Usually rash begins on trunk and spreads to face, neck and extremities
Fever and rash with slapped cheek appearance followed by symmetrical full body maculopapular rash
Erythema infectiosum (5th disease)
Rash occurs at 10-17 days
Contagious prior to but not after rash
Prodrome of 2-3 days of fever, cough and conjunctivitis; koplik spots 1-2 days prior to rash
Maculopapular rash spreading from face and hairline to the trunk over 3 days
Spread via respiratory droplets
Measles
Report to local health department
Fever, rash on palms and soles of feet, GI symptoms, headache
Rocky mountain spotted fever
Rash appears 2-6 days after fever onset, face is spared
Tx: doxycycline
Myopia
Nearsightedness
Might squint
Hyperopia
Farsightedness
Untreated can cause cross eyes
Usually diminishes with age
Anisocoria
Size difference between 2 pupils
Tests for strabismus
Hirschberg test (corneal light reflex), cover testing
Bruckner test
Red reflex test
Tx corneal abrasion
Erythromycin ointment, patching eye
Infection of eyelid margin, meibomiangland obstruction and tear film imbalance
Blepharitis
Usually due to staph aureus
Tx: warm compresses and baby shampoo if not severe; erythromycin ointment, azithromycin drops, oral tetracycline, oral macrolides if severe
Inflammation of the meibomian flands, produces tender nodule over the tarus of upper or lower lid
Chalazion
Tx: same as blepharitis
Main organisms causing bacterial conjunctivitis
Strep pneumoniae, H. influenzae, m. catarrhalis, staph aureus
tx: erythromycin, polymyxin-bacitracin, tobramycin, fluoroquinolones
Most common pathogen in viral cojunctivitis
Adenovirus
Stay home from school as long as eyes are red and tearing
Periorbital cellulitis
Erythematous and edematour eyelids, pain and mild fever, eye and movements all normal
If <2 months old, hospitalize
If >2 months give augmentin or cephalexin and follow up in 24 hours
Orbital cellulitis
Proptosis, eye movement restriction, decreased vision, eye is red and chemotic
Almost always arises from paranasal sinus infection
Medical emergency
Ankyloglossia
Tongue tie
Most common chronic disease of childhood
Dental caries
Indications for abx prophylaxis for dental surgery
Heart valves, previous infective endocarditis, repaired congenital heart disease, unrepaired cyanotic congenital heart disease
if neutrophil level <2000
Malignant OE
Spread of infection to the skull base causing osteomyelitis
Tx OE
Fluoroquinolone drops
Dx for OM
Bulging of TM, <48 hours of otalgia, intense erythema of TM
Middle ear effusion must be present
Mastoiditis
AOM almost always present
Infection spreads from middle ear space to mastoid portion of temporal bone
most common cause of conductive hearing loss
Fluid in middle ear due to AOM or MEE
Other causes: TM perforation, cerumen impaction, cholesteatoma
What meds can cause hearing loss
Aminoglycosides and diuretics
Bacterial sinusitis
Dx when cold does not improve by 10-14 days or worsens after 5-7 days
Maxillary and ethmoid sinuses most commonly involved
Frontal sinusitis uncommon <10 years
Tx bacterial sinusitis
amoxicillin or augmentin
Failure to improve after 48 to 72 hours suggests resistance
Recurrent sinusitis
> 4 times per year
Chronic sinusitis
does not resolve >90 days
Tx of persistent GAS throught despite penicillin
Clindamycin for 10 days
Untreated strep throat can result in
acute rheumatic fever, glomerulonephritis, peritonsillar abscess, OM, cellulitis
Diffuse, finely papular erythematous eruption which blanches on pressure; tongue strawberry appearance
Scarlet fever rash
Fever, respiratory symptoms, neck hyperextension, may have dysphagia
Retropharyngeal abscess
Surgical emergency
Sudden onset coughing or respiratory distress and difficulty vocalizing
Foreign body aspiration
Gold standard for dx foreign body aspiration
Rigid bronchoscopy
New onset stridor in the setting of URI or fever
Croup
Acute inflammatory disease of the larynx
Viral croup
6 months to 5 years Usually due to parainfluenza Prodrome of URI symptoms followed by barking cough Fever usually absent Tx: supportive Can use steroids
Sudden onset high fever, dysphagia, drooling, muffled voice, inspiratory retractions
Epiglottitis
Emergency
Need IV abx then oral for 10 days
Fever, cough and dyspnea, crackles, abnormal chest X ray with infiltrates, pleural effusion
Community acquired pneumonia
Low WBC is ominous sign
Tx: amoxicillin
Macrolides if atypical suspected
1-2 days fever, rhinorrhea and cough, followed by wheezing, tachypnea, and respiratory distress
Bronchiolitis due to RSV
Cause of cradle cap
Yeast pityrosporum ovale
Tx: baby shampoo, mineral or baby oil then comb; may use hydrocortisone
Tx of contact dermatitis
Lotrimin or nystatin
Tx molluscum contagiosum
Trichloroacetic acid or salicyclic acid or podophyllin or cantharidin
Oral abx for impetigo
Augmentin, keflex, omnicef, dicloxacilin
Multiple oval, scaly, hypopigmented patches on face and extensor surfaces
Pityriasis alba
No real tx
Steroids may make worse
Cause of 5th disease
Human parvovirus B19
Borrelia burgdorferi
Lyme disease cause
Causes erythema migrans–target lesion
Complications of lyme disease
Bells palsy, arthritis, aseptic meningitis, peripheral neuritis, Guillain barre syndrome, encephalitis
Tests for visual acuity
snellen E or allen
When is further evaluation by ophthamologist required
> 5 years old and acuity of 20/30
>3 years old and acuity of 20/40
Major complication of strabismus
Development of amblyopia
X ray in croup
Steeple sign
Tx of bacterial sinusitis
1st line: amoxicillin
2nd line: augmentin
3rd line: fluoroquinolone if >18 years or macrolide
Intermittent asthma
Day symptoms <2 times per week
Night sx <2 times per month
Mild persistent asthma
Day sx >2 times per week but <1 times per day
Night sx >2 times per month
Moderare persistent
Daily sx
Night sx >1 time per week
Severe persistent
Day continuous
Night frequent
Dosing interval for Hep B
Dose 1 to 2: 4 weeks
Dose 2 to 3: 8 weeks and at least 16 weeks from first dose
Dosing interval for rotavirus
Dose 1 to 2: 4 weeks
Dose 2 to 3: 4 weeks
Dosing interval for DTaP
Dose 1 to 2: 4 weeks
Dose 2 to 3: 4 weeks
Dosing interval for IPV
Dose 1 to 2: 4 weeks
Dose 2 to 3: 4 weeks
Dose 3 to 4: 6 months
Dosing interval for MMR
Dose 1 to 2: 4 weeks
Dosing interval for varicella
Dose 1 to 2: 3 months
Dosing interval for hep A
Dose 1 to 2: 6 months
Dosing interval for meningococcal
Dose 1 to 2: 8 weeks
Dosing interval for TdaP
Dose 1 to 2: 4 weeks
Dose 2 to 3: 4 weeks
Must be on abx eye drops if conjunctivitis for how long before going back to school
72 hours
When to refer to ENT for tympanostomy tubes
If >3 OM in 6 month-1 year period
