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Primary Care Pediatrics > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Should feed themselves with a fork/spoon

A

by 2 years

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2
Q

BMI categories

A 
Underweight <18.5
Normal 18.5-25
Overweight 25-30
Obese 1 30-35
Obese 2 35-40
Morbidly obese >40
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3
Q

1 month milestones

A

lift head, coo, track with eyes, recognize parents

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4
Q

6 month milestones

A

Sit up, raking grasp, stranger anxiety, babbles

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5
Q

9 month milestones

A

Walk with assistance, 3 finger grasp, bye bye, pat a cake

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6
Q

1 year milestones

A

Walking, 2 finger grasp, mam/dada, imitate parent

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7
Q

2 year milestones

A

2 word phrases, 2 steps, 2 step command, stack 6 cubes

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8
Q

3 year milestones

A

3 word sentences, ride tricycle, brush teeth, draw circle

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9
Q

4 year milestones

A

hop, copy a cross, play with others

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10
Q

Physical milestones in first year

A

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

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11
Q

Motor red flags at 4, 9, 18 months

A

4: Lack of steady head control while sitting
9: inability to sit
18: inability to walk independently

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12
Q

Social emotional red flags at 6, 9, 12, 15, 18, 24 months

A

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

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13
Q

Cognitive red flags 2, 4, 6, 9, 24, 36 months

A

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

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14
Q

Tests for strabismus

A

Hirschberg and cover/uncover

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15
Q

Order of male puberty sequence

A

Testicular enlargement, penile enlargement, height growth spurt, pubic hair

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16
Q

Order of female puberty sequence

A

Breast buds, height growth spurt, pubic hair, menarche

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17
Q

Hep B schedule

A

birth, 2 months, 6 months

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18
Q

Rotavirus schedule

A

2 months, 4 months, 6 months

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19
Q

DTaP schedule

A

2 months, 4 months, 6 months, 15 months, 4-6 years

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20
Q

HiB schedule

A

2 months, 4 months, 6 months, 12-15 months

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21
Q

PCV13 schedule

A

2 months, 4 months, 6 months, 12-15 months

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22
Q

IPV schedule

A

2 months, 4 months, 6-15 months, 4-6 years

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23
Q

MMR schedule

A

12-15 months (2 doses 4 weeks apart), 4-6 years

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24
Q

Varicella schedule

A

12-15 months, 4-6 years

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25
Q

Hepatitis A schedule

A

12-15 months (second dose 6 months later)

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26
Q

Meningococcal schedule

A

11-12 years, 16 years

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27
Q

Tdap schedule

A

11-12 years

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28
Q

HPV schedule

A

11-12 years or early as 9; 2 dose series with second dose 6 months after the first

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29
Q

White reflex in neonate can be caused by

A

glaucoma, cataract, or tumor (retinoblastoma)

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30
Q

Sepsis in newborn

A

Hypotension, acidemia, neutropenia clinical findings
Labs: low WBC with absolute neutropenia, thrombocytopenia, hypglycemia or hyperglycemia, metabolic acidosis, elevated CRP

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31
Q

Tx sepsis in newborn

A

Ampicillin + aminoglycoside or 3rd gen cephalosporin

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32
Q

LP results if bacterial meningitis

A

CSF protein >150, glucose <30, leukocytes >20, + gram

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33
Q

Omphalitis

A

Umbilical cord infection

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34
Q

Copious purulent discharge in newborn

A

N. Gonorrhoeae

Tx: IV ceftriaxone

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35
Q

Conjunctival congestion, edema and minimal discharge in newborn

A

Chlamydia

Tx: oral erythromycin for 14 days

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36
Q

Children develop in what direction

A

Cephalocaudal

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37
Q

Raking grasp vs pincer grasp

A

Raking by 3-4 months and pincer by 9 months

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38
Q

Babbling reaches peak at

A

12 months

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39
Q

Object permanence

A

9-12 months

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40
Q

Separation and stranger anxiety

A

8-9 months

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41
Q

Parallel play

A

2-3 years

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42
Q

Collaborative play

A

3-4 years

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43
Q

Conservation of length

A

5.5 years

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44
Q

Differentials for wetting of pants by 5-6 years of age

A

DM, DI, seizures, cystitis, neurogenic bladder, anatomical abnormalities

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45
Q

Colic

A

cries >3 hours per day for >3 days per week for >3 weeks

Peaks at 2-3 months

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46
Q

When should autism screening begin

A

18 months

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47
Q

Triad for ADHD

A

Impulsivity, inattention, hyperactivity

Must be present <12 years and in 2+ settings

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48
Q

Tx ADHD

A

Stimulants: methylphenidate, dextroamphetamine

A2 agonists: clonidine or guanfacine

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49
Q

Autism features

A

Deficits in social communication and interaction across multiple contexts and repetitive patterns of behavior
Symptoms present <3 years

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50
Q

18 month developmental tasks

A

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

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51
Q

24 month developmental tasks

A

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

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52
Q

3 year developmental tasks

A

holds crayons, builds 9-10 block tower, copies circle, rides tricycle, dresses with help

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53
Q

3-4 year developemental tasks

A

Climbs stairs with alternating feet, can button and unbutton, knows own sex, feeds self

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54
Q

First line tx of dysmenorrhea

A

NSAIDs and contraceptives to suppress ovulation

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55
Q

BP screening

A

Begin at age 3
Need 3 separate high readings to dx hypertension
Systolic or diastolic >95th percentile for age and height or weight

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56
Q

Visual acuity testing

A

Begin at age 3

Tumbling E chart or picture tests

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57
Q

Lead screening

A

Universal screening for children 1-2 years

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58
Q

Sepsis workup for neonate

A

Fever >100.4

CBC, blood culture, UA, urine culture, gram stain, CSF, glucose

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59
Q

Failure to thrive

A

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

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60
Q

Predominant nutrient in first few months of life

A

40% fat

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61
Q

Absolute CI to breastfeeding

A

Active TB in mother, HIV in mother, galactosemia in infant

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62
Q

Describing skin lesions order

A

Distribution, configuration, color, secondary changes, primary changes
Ex. psoriasis: generalized, discrete, red, or scaly papules

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63
Q

Any flat circumscribed color change in the skin < 1 cm

A

Macule

Ex freckle

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64
Q

Any flat circumscribed color change in the skin > 1 cm.

A

Patch

Ex nevus depigmentosa

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65
Q

A solid, elevated area < 1 cm in diameter whose top may be pointed, rounded, or flat.

A

papule

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66
Q

A solid, circumscribed area > 1 cm in diameter, usually flat-topped

A

Plaque

Ex. psoriasis

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67
Q

A circumscribed, elevated lesion < 1 cm in diameter and containing clear serous fluid

A

Vesicle

Ex. varicella

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68
Q

A circumscribed, elevated lesion > 1 cm in diameter and containing clear serous fluid

A

Bullae

Ex. impetigo

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69
Q

A vesicle containing a purulent exudate

A

Pustule

Ex. acne

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70
Q

A deep-seated mass with indistinct borders that elevates the overlying epidermis

A

nodule

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71
Q

A circumscribed, flat-topped, firm elevation of skin resulting from tense edema of the papillary dermis

A

Wheal

72
Q

Dry, thin plates of keratinized epidermal cells

A

Scales

Ex. psoriasis

73
Q

Induration of skin with exaggerated skin lines and a shiny surface resulting from chronic rubbing of the skin

A

Lichenification

74
Q

A linear split in the skin extending through the epidermis into the dermis

A

Fissure

Ex. angular cheilitis

75
Q

Discrete lesions

A

Independent of each other

76
Q

Topical steroid info

A

2X daily mainstay tx
Can be used under wet dressings
only low potency to the face

77
Q

Drugs that may cause acne

A

ACTH, steroids, androgens, hydantoins, isoniazid

78
Q

Precursors to inflammatory acne

A

Closed comedones–white heads

79
Q

1st line tx acne

A

Topical keratolytics

Retin A, benzoyl peroxide, azelaic acid

80
Q

Topical abx for acne

A

Clindamycin 1%

Topical abx should never be used alone

81
Q

Systemic abx for acne

A

Tetracycline, minocycline, doxycyline

Never use as monotherapy

82
Q

Pathogens in impetigo

A

GAS and staph

83
Q

Tx of impetigo

A

Amoxicillin, cephalosporin, clindamycin, augmentin

If not severe: topical mupirocin, polymyxin, gentamycin, erythromycin

84
Q

Ecthyma

A

Deeper form of impetigo

Tx: penicillin

85
Q

• Erythematous, hot, tender, ill-defined, edematous plaques accompanied by regional lymphadenopathy

A

Cellulitis

86
Q

Tx of fungal infection of hair or nails

A

Griseofulvin or terbinafine

87
Q

Sharply demarcated erythematous patches with eroded areas and satellite lesions

A

Candida infection

88
Q

Tx of choice for diaper dermatitis due to candida

A

Topical imidazole cream

89
Q

Most frequent cutaneous features in child with HIV

A

Persistent oral candidiasis and recalcitrant candida diaper rash

90
Q

umbilicated, flesh colored papules in groups anywhere on the body

A

Molluscum contagiosum

Due to poxvirus

91
Q

Tx of scabes

A

Permethrin single overnight use and repeat in 7 days

92
Q

Tx atopic dermatitis

A

Wet dressings and topical steroids if acute and weeping

If chronic, avoid irritants, bathe every 2-3 days and twice daily lubrication

93
Q

White, scaly macular areas with indistinct borders seen over extensor surfaces of extremities and cheeks; sun tanning exaggerates

A

Pityriasis alba
Tx: low potency steroids and strict sun avoidance
Confused with tinea versicolor

94
Q

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

A 
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
95
Q

Guttate psoriasis

A

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

96
Q

Strongest identifiable predisposing factor to asthma

A

Atopy

97
Q

What shows poor asthma control

A

> 1 cannister per month of albuterol

98
Q

Stepwise tx of asthma

A

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

99
Q

Initial tx of acute asthma exacerbation at home

A

SABA 2-6 puffs every 20 minutes up to 3 times or single nebulizer treatment

100
Q

Tx allergic rhinoconjunctivitis in children

A

Topical steroids > oral antihistamines

101
Q

Approved antihistamines in children

A

Cetirizine >6 months
Loratadine >2 years
Desloratadine >6 months
Fexofenadine >6 months

102
Q

Approved nasal steroids in children

A

Fluticasone furoate >2 years

Fluticasone propionate >4 years

103
Q

Montelukast approved for

A

> 6 months

104
Q

Main cause of common cold

A

Rhinovirus and adenovirus

105
Q

Main cause of croup

A

parainfluenza

Fever, nasal congestion, sore throat, barking cough

106
Q

most common cause of lower respiratory tract illness in children

A

RSV
Causes bronchiolitis
Diffuse wheezing, tachypnea following URI

107
Q

Only licensed antiviral against RSV

A

Ribavirin

108
Q

Roseola

A

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

109
Q

 Fever and rash with slapped cheek appearance followed by symmetrical full body maculopapular rash

A

Erythema infectiosum (5th disease)
Rash occurs at 10-17 days
Contagious prior to but not after rash

110
Q

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

A

Measles

Report to local health department

111
Q

Fever, rash on palms and soles of feet, GI symptoms, headache

A

Rocky mountain spotted fever
Rash appears 2-6 days after fever onset, face is spared
Tx: doxycycline

112
Q

Myopia

A

Nearsightedness

Might squint

113
Q

Hyperopia

A

Farsightedness
Untreated can cause cross eyes
Usually diminishes with age

114
Q

Anisocoria

A

Size difference between 2 pupils

115
Q

Tests for strabismus

A

Hirschberg test (corneal light reflex), cover testing

116
Q

Bruckner test

A

Red reflex test

117
Q

Tx corneal abrasion

A

Erythromycin ointment, patching eye

118
Q

Infection of eyelid margin, meibomiangland obstruction and tear film imbalance

A

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

119
Q

Inflammation of the meibomian flands, produces tender nodule over the tarus of upper or lower lid

A

Chalazion

Tx: same as blepharitis

120
Q

Main organisms causing bacterial conjunctivitis

A

Strep pneumoniae, H. influenzae, m. catarrhalis, staph aureus
tx: erythromycin, polymyxin-bacitracin, tobramycin, fluoroquinolones

121
Q

Most common pathogen in viral cojunctivitis

A

Adenovirus

Stay home from school as long as eyes are red and tearing

122
Q

Periorbital cellulitis

A

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

123
Q

Orbital cellulitis

A

Proptosis, eye movement restriction, decreased vision, eye is red and chemotic
Almost always arises from paranasal sinus infection
Medical emergency

124
Q

Ankyloglossia

A

Tongue tie

125
Q

Most common chronic disease of childhood

A

Dental caries

126
Q

Indications for abx prophylaxis for dental surgery

A

Heart valves, previous infective endocarditis, repaired congenital heart disease, unrepaired cyanotic congenital heart disease
if neutrophil level <2000

127
Q

Malignant OE

A

Spread of infection to the skull base causing osteomyelitis

128
Q

Tx OE

A

Fluoroquinolone drops

129
Q

Dx for OM

A

Bulging of TM, <48 hours of otalgia, intense erythema of TM

Middle ear effusion must be present

130
Q

Mastoiditis

A

AOM almost always present

Infection spreads from middle ear space to mastoid portion of temporal bone

131
Q

most common cause of conductive hearing loss

A

Fluid in middle ear due to AOM or MEE

Other causes: TM perforation, cerumen impaction, cholesteatoma

132
Q

What meds can cause hearing loss

A

Aminoglycosides and diuretics

133
Q

Bacterial sinusitis

A

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

134
Q

Tx bacterial sinusitis

A

amoxicillin or augmentin

Failure to improve after 48 to 72 hours suggests resistance

135
Q

Recurrent sinusitis

A

> 4 times per year

136
Q

Chronic sinusitis

A

does not resolve >90 days

137
Q

Tx of persistent GAS throught despite penicillin

A

Clindamycin for 10 days

138
Q

Untreated strep throat can result in

A

acute rheumatic fever, glomerulonephritis, peritonsillar abscess, OM, cellulitis

139
Q

Diffuse, finely papular erythematous eruption which blanches on pressure; tongue strawberry appearance

A

Scarlet fever rash

140
Q

Fever, respiratory symptoms, neck hyperextension, may have dysphagia

A

Retropharyngeal abscess

Surgical emergency

141
Q

Sudden onset coughing or respiratory distress and difficulty vocalizing

A

Foreign body aspiration

142
Q

Gold standard for dx foreign body aspiration

A

Rigid bronchoscopy

143
Q

New onset stridor in the setting of URI or fever

A

Croup

Acute inflammatory disease of the larynx

144
Q

Viral croup

A 
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
145
Q

Sudden onset high fever, dysphagia, drooling, muffled voice, inspiratory retractions

A

Epiglottitis
Emergency
Need IV abx then oral for 10 days

146
Q

Fever, cough and dyspnea, crackles, abnormal chest X ray with infiltrates, pleural effusion

A

Community acquired pneumonia
Low WBC is ominous sign
Tx: amoxicillin
Macrolides if atypical suspected

147
Q

1-2 days fever, rhinorrhea and cough, followed by wheezing, tachypnea, and respiratory distress

A

Bronchiolitis due to RSV

148
Q

Cause of cradle cap

A

Yeast pityrosporum ovale

Tx: baby shampoo, mineral or baby oil then comb; may use hydrocortisone

149
Q

Tx of contact dermatitis

A

Lotrimin or nystatin

150
Q

Tx molluscum contagiosum

A

Trichloroacetic acid or salicyclic acid or podophyllin or cantharidin

151
Q

Oral abx for impetigo

A

Augmentin, keflex, omnicef, dicloxacilin

152
Q

Multiple oval, scaly, hypopigmented patches on face and extensor surfaces

A

Pityriasis alba
No real tx
Steroids may make worse

153
Q

Cause of 5th disease

A

Human parvovirus B19

154
Q

Borrelia burgdorferi

A

Lyme disease cause

Causes erythema migrans–target lesion

155
Q

Complications of lyme disease

A

Bells palsy, arthritis, aseptic meningitis, peripheral neuritis, Guillain barre syndrome, encephalitis

156
Q

Tests for visual acuity

A

snellen E or allen

157
Q

When is further evaluation by ophthamologist required

A

> 5 years old and acuity of 20/30

>3 years old and acuity of 20/40

158
Q

Major complication of strabismus

A

Development of amblyopia

159
Q

X ray in croup

A

Steeple sign

160
Q

Tx of bacterial sinusitis

A

1st line: amoxicillin
2nd line: augmentin
3rd line: fluoroquinolone if >18 years or macrolide

161
Q

Intermittent asthma

A

Day symptoms <2 times per week

Night sx <2 times per month

162
Q

Mild persistent asthma

A

Day sx >2 times per week but <1 times per day

Night sx >2 times per month

163
Q

Moderare persistent

A

Daily sx

Night sx >1 time per week

164
Q

Severe persistent

A

Day continuous

Night frequent

165
Q

Dosing interval for Hep B

A

Dose 1 to 2: 4 weeks

Dose 2 to 3: 8 weeks and at least 16 weeks from first dose

166
Q

Dosing interval for rotavirus

A

Dose 1 to 2: 4 weeks

Dose 2 to 3: 4 weeks

167
Q

Dosing interval for DTaP

A

Dose 1 to 2: 4 weeks

Dose 2 to 3: 4 weeks

168
Q

Dosing interval for IPV

A

Dose 1 to 2: 4 weeks
Dose 2 to 3: 4 weeks
Dose 3 to 4: 6 months

169
Q

Dosing interval for MMR

A

Dose 1 to 2: 4 weeks

170
Q

Dosing interval for varicella

A

Dose 1 to 2: 3 months

171
Q

Dosing interval for hep A

A

Dose 1 to 2: 6 months

172
Q

Dosing interval for meningococcal

A

Dose 1 to 2: 8 weeks

173
Q

Dosing interval for TdaP

A

Dose 1 to 2: 4 weeks

Dose 2 to 3: 4 weeks

174
Q

Must be on abx eye drops if conjunctivitis for how long before going back to school

A

72 hours

175
Q

When to refer to ENT for tympanostomy tubes

A

If >3 OM in 6 month-1 year period

Primary Care Pediatrics (2 decks)

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