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Primary Care Pediatrics > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Infant causes of acute abdomen

A

Colic, intussusception, incarcerated hernia, testicular torsion, malrotation, pyloric stenosis

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2
Q

Preschool causes of acute abdomen

A

appendicitis, intussusception, pneumonia, pharyngitis, trauma, constipation

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3
Q

School age causes of acute abdomen

A

Appendicitis, pneumonia, pharyngitis, pancreatitis, trauma, constipation

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4
Q

Adolescent causes of acute abdomen

A

Appendicits, pancreatitis, cholelithiasis

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5
Q

Female causes of acute abdomen

A

Ectopic pregnancy, PID, ovarian cyst, dysmenorrhea

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6
Q

Tx of reflux in infant

A

Try adding rice cereal to formula and if doesnt work, try ranitidine
Elevate head of bed 45 degrees
Keep head elevated 30 minutes after eating

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7
Q

If hernia still present at ___, refer

A

4 years old

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8
Q

S/S intussusception

A

Crampy pain with N/V

Currant jelly stool

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9
Q

Jumping in place with testicular torsion

A

Pain

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10
Q

Dx tests for acute abdomen

A

CBC, CMP, amylase and lipase, UA/UC, pregnancy test, stool test, abdominal or pevlic US, abdominal X ray

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11
Q

Encopresis

A

Syndrome of fecal soiling or incontinency or incomplete defecation

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12
Q

1st line tx constipation

A 
Miralax--over 1 year
Colace >5 years 
Laxatives or enemas only for disimpaction
Glycerin suppository under 2
Pediatric enema over 2
High fiber diet
Good toileting habits
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13
Q

S/S appendicitis

A

Fever, periumbilical pain wihich localizes to RLQ with signs of peritoneal irritation

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14
Q

Labs in appendicitis

A

Elevated CRP and leukocytosis

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15
Q

Psoas sign

A

Patient lies on side and flex the right hip backwards

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16
Q

Rovsing sign

A

Pain refers to RLQ when LLQ palpated

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17
Q

Obturator test

A

Internally and externally rotate flexed hip

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18
Q

Blumberg sign

A

Pain upon removal of pressure

Rebound tenderness

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19
Q

Colic

A

in first 3 months of life, >3 hours a day

Tx: gripe water or mylicon drops

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20
Q

Labial adhesion

A

Fusion of labia minora
Benign
Caused by lack of estrogen or inflammation
No tx usually needed; if sx estrogen cream topically BID 10-14 days
Second line med is premarin
Mechanical separation not recommended
Follow up in 2-4 weeks

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21
Q

If hydrocele occurs later in life, consider

A

Neoplasm, torsion, injury or infectin

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22
Q

Communicating hydrocele

A

Still a connection between the peritoneal cavity and the tunica vaginalis–peritoneal fluid can shift and hernia can present
Flat scrotum in AM with gradual increase in fluid throughout day
Rarely resolves on its own
Refer to surgery

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23
Q

Non-communicating hydrocele

A

Most common
Residual peritoneal fluid remains after closure of processus vaginalis
Scrotal sac appears full, tense and clear if transilluminated
Fluid gradually resorbs during 1st year of life
No danger of hernia

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24
Q

Swelling and transillumination

A

Light will appear as red glow with serous fluid but not with blood or tissue

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25
Q

Size of testes in infant

A

Should be 1cm

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26
Q

Sudden onset testicular pain, maybe have abdominal pain and N/V, no fever

A

Testicular torsion
Medical emergency
Needs to be fixed within 4-8 hours

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27
Q

UA in testicular torsion

A

Normal

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28
Q

When do testes usually descend

A

By 8 months gestation

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29
Q

Complications of undescended testes

A

Deterioration, testicular CA, testicular torsion

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30
Q

Tx of undescended testes

A

Orchioplexy or open surgery

Hormones

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31
Q

Varicocele

A 
Due to valvular incompetence
Left side more common; right side more dangerous
Bag of worms with bluish discoloration
More prominent when standing 
Asx
Time dependent decline in testicular function 
Order annual semen analysis 
Refer if right side or pain
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32
Q

S/S UTI in infants

A

Fever, hypothermia, jaundice, poor feeding, irritability, vomiting, FTT, sepsis

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33
Q

S/S UTI in pre-school

A

Abdominal or flank pain, fever, urinary frequency and dysuria and urgency, enuresis

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34
Q

S/S UTI in school age

A

Frequency, dysuria, urgency, fever, vomiting, flank pain

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35
Q

Gold standard for dx UTI

A

Culture or urine

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36
Q

Tx UTI <3 months

A

Hospital admit

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37
Q

Tx UTI in children

A

Amoxicillin, Bactrim, 1st gen ceph
7-10 days uncomplicated
10 days if pyelo

38
Q

Types of anorexia

A

Mild: 15% weight loss
Moderate: 20% weight loss
Severe: 30% weight loss

39
Q

Labs with malnutrition due to anorexia

A

Leukopenia and anemia, low serum lactic dehydrogenase estrogens, low T3, low electrolytes

40
Q

When to refer anorexia to hospital

A

Unstable VS HR <50 BP <80/50, Blood glucose <60, EKG changes, failure to gain 1ib/week, SI

41
Q

Bulimia

A

Binge eating and inappropriate compensatory behaviors at least 2x/week for 3 months

42
Q

What med is CI in bulimia

A

Bupropion

43
Q

Screening tools for eating disorder

A

SCOFF: Sick, control, one stone, fat, food

44
Q

Genu varum

A

Bow legs
Normal variant <18 months
Refer if >2 years, if bowing >5 inches between knees, or if only in 1 leg

45
Q

Osgood schlatter

A

Degeneration of tibial tubercle at the insertion site of quad ligament
Painful swelling
Due to overuse injury and rapid growth
Bump will not go away and may get worse with increased overuse

46
Q

Scoliosis

A

Does not usually cause pain
Cervical involvement rare
Observe shoulder, hip and scapular symmetry
Curves progress less rapidly as skeletal growth is complete

47
Q

Adams test

A

Bend test for scoliosis

48
Q

Functional socliosis

A

Appearance of curve due to unequal leg lengths, poor posture, muscle spasms, herniated discs

49
Q

Differentials for scoliosis

A

Muscular dystrophy, polio, CP

50
Q

When to refer to specialist for scoliosis

A

> 10 degree progression or 5 degrees from previous visit

51
Q

Tx scoliosis

A

<20 degrees no tx
20-40 degrees bracing
>40 degrees surgical

52
Q

Hyperactive impulsive ADHD

A 
	Fidgets
	Often leaves seat in classroom
	Excessive running or climbing
	Difficulty in engaging in quiet activities
	Talks excessively
	Blurts out answers
	Difficulty awaiting turns
	Interrupts or intrudes on others
53
Q

Inattentive type ADHD

A

 Fails to give attention to detail/makes careless mistakes
 Difficulty sustaining attention to task
 Does not listen when spoken directly to
 Does not follow direction or follow through on tasks
 Difficulty organizing tasks
 Easily distracted
 Loses things needed for tasks
 Forgetfulness in daily activities
 Misophonia

54
Q

Most common cause of chest pain in peds

A

Costochondritis

55
Q

Diagnostic tests for chest pain

A

Chest X Ray
EKG
Echo
Exercise testing

56
Q

most common cause of syncope

A

Vaso-vagal episodes; benign

Tx: increase fluid intake, salt tablets, leg pumping, leg crossing and squatting, regular aerobic exercise

57
Q

Dx labs for syncope

A 
	ECG
	Pregnancy testing
	Tilt-testing
	24 hour halter monitor
	ECHO
	EEG
	Fasting blood glucose
	H/H
	Electrolytes
	Toxicology screens
	Stool for occult blood based on symptomatology
58
Q

Murmur grading

A 
	1—Barely audible
	II—Easily heard
	III--Moderately loud
	IV—Loud, with a thrill
	V—Heard with edge of stethoscope applied to chest wall
	VI—Heard with stethoscope off chest
59
Q

Still’s murmur

A

2-7 years
Heard best when lying down
Disappears when holding breath, valsalva maneuver or standing

60
Q

Venous hum

A

> 2 years
Best heard when sitting
Disappears when lying down or compressing external jugular vein

61
Q

Murmur may become louder if

A

Fever or exercise or anemia

62
Q

Tetralogy of fallot

A

Cyanotic
Right to left shunting
VSD, Pulmonary stenosis, RV hypertrophy, overriding aorta
S/S: FTT, SOB, clubbing, tet spells

63
Q

most common hematologic disease of infancy and childhood

A

iron deficiency anemia

64
Q

Causes of iron deficiency anemia 6-24 months

A

Poor dietary intake

65
Q

Causes of iron deficiency anemia >2 years

A

Chronic blood loss maybe

66
Q

Full term infants are born with sufficient iron stores to prevent IDA until

A

4-6 months

67
Q

When to first screen for anemua

A

12 month

68
Q

IDA and lead poisoning

A

IDA contributes to lead poisoning by increasing the GI tract’s ability to absorb heavy metals, such as lead

69
Q

Dx tests for IDA

A

CBC, reticulocyte count, lead level, serum iron, blood ferritin level, hgb electrophoresis

70
Q

MCV in IDA

A

<13: Thalassemia

>13: iDA

71
Q

Lab results in IDA

A

< MCV,

72
Q

Earliest lab change in IDA

A

Decreased serum ferritin <20

73
Q

Tx IDA

A

3-6mg/kg/day elemental iron
Results in increased reticulocyte count by 3-5 days
Continue iron therapy for 2 months after rise in hgb

74
Q

If IDA unresponsive to iron, consider

A

Cows milk induced colitis, IBD, menorrhagia, poor compliance

75
Q

Absorpiton of iron

A

Increased with juice or other vitamin c

Decreased with milk or food

76
Q

Follow up of IDA

A

H+H in 1 month, 3 months and completion of therapy (5-6 months maximum)

77
Q

Complications of IDA

A

Progressive anemia, recurrent infection, poor growth rate, learning problems, lethargy

78
Q

Plumbism

A

Lead >10

79
Q

SX of plumbism

A

 Hyperirritability, anorexia, decreased activity, ataxia

 Weight loss, anemia, constipation, personality changes, developmental delay or reversal

80
Q

Late sx of plumbism

A

• Acute encephalopathy – cerebral edema, convulsions, coma most common in children 1-3 years with lead levels over 70-100mcg/dl

81
Q

Dx tests for plumbism

A

CBC, Serum lead, serum ferritin, FEP, whole blood level test, X rays of abdomen for lead containing foreign body

82
Q

Tx for plumbism

A

Pharmacology for >45

83
Q

Juvenile hypothyroidism

A

S/S: Growth retardation, decreased physical activity, weight gain, constipation, dry skin, cold intolerance, delayed puberty, large tongue, hoarse voice
Thyroiditis may cause–peaks in adolescence
More common in females

84
Q

Congenital hypothyroidism

A

o 90% absent or poorly formed gland
o “typical” hypothyroid baby is full term & large
o Lg posterior fontanel, lethargy, umbilical hernia, large tongue, dry skin and hoarse cry
o Early—see jaundice, temp instability, hypoactivity, poor feeding and constipation

85
Q

Abnormal newborn screen results should be confirmed with

A

venous T4 and TSH level

86
Q

Tx hypothyroidism

A

Levothyroxine 75-100mcg/day

87
Q

How to monitor thyroid initially after tx

A

T4; TSH may not normalize for weeks

88
Q

Precocious thelarche

A 
Early breast development
12-24 months
Due to transient bursts of estrogen from prepubertal ovary
No other signs of puberty
Self limited
89
Q

Premature adrenarch

A
  • early appearance of sexual hair before the age of 8 in girls & the age of 9 in boys
  • Benign condition due to early maturation of adrenal androgen secretion
  • Normal linear growth and no bone age advancement
90
Q

Precocious puberty

A

• Definition: onset of puberty before the age of 9 years in males and before the age of 8 in females
• More common in girls
Pattern of puberty progression is normal
Accelerated linear growth and advanced bone age
At first child is tall, but then short stature is end result

91
Q

Constitutional delay

A
  • Children grow & develop at or below the 5th percentile at normal growth velocities
  • Puberty is significantly delayed as well as bone age delay.
  • Do not enter puberty at the usual age, and have short stature & sexual immaturity compared to peers
  • This is a normal growth variant
92
Q

Dx tests for precocious puberty

A

Bone age–left hand x ray
FSH/LH
HCG
Testosterone and/or estradiol

Primary Care Pediatrics (2 decks)

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