general 2 Flashcards
1
Q
what topics should you review at a three year olds healthcare visit
A
social
nutrition
exercise
toilet training
dental
safety
2
Q
at what age should a child be:
brushing his teeth with help
A
3
3
Q
at what age should a child be:
articulating well
A
5
4
Q
at what age should a child be:
naming colors
A
4
5
Q
at what age should a child be:
singing a song
A
4
6
Q
at what age should a child be:
printing some letters and numbers
A
5
7
Q
at what age should a child be:
building a tower of 6-8 cubes
A
3
8
Q
at what age should a child be:
hopping on one foot
A
4
9
Q
at what age should a child be:
balancing on one foot
A
5
10
Q
at what age should a child be:
feeding themselves
A
3
11
Q
at what age should a child be:
stating first and last name
A
4
12
Q
at what age should a child be:
can tell the difference between real and make believe
A
5
13
Q
at what age should a child be:
counting to 10
A
5
14
Q
at what age should a child be:
speaking in 2-3 word sentences
A
3
15
Q
at what age should a child be:
aware of gender
A
4
16
Q
at what age should a child be:
knows name and use of cup/ball/spoon/crayon
A
3
17
Q
at what age should a child be:
drawing a person with more than 6 body parts
A
5
18
Q
at what age should a child be:
copying squares
A
5
19
Q
at what age should a child be:
copies a cross
A
4
20
Q
at what age should a child be:
balances for 2 second
A
4
21
Q
at what age should a child be:
rides a tricycle
A
3
22
Q
at what age should a child be:
copies a circle
A
3
23
Q
at what age should a child be:
tying a knot
A
5
24
Q
at what age should a child be:
hops and skips
A
5
25
at what age should a child be:
| most speech is identifiable
4
26
at what age should a child be:
| knows gender and age
4
27
at what age should a child be:
| listens and attends
5
28
at what age should a child be:
| shows sympathy and concern for others
5
29
at what age should a child be:
| draws perso with 3 body parts
4
30
at what age should a child be:
| has a mature pencil grasp
5
31
at what age should a child be:
| pours, cuts, and mashes own food
4
32
at what age should a child be:
| tells a story with full sentences
5
33
at what age should a child be:
| friendly to other children
4
34
at what age should a child be:
| engages in fantasy play
4
35
what is eczema
"the itch that rashes"
cycle of irritation leading to scratching leading to the rash
36
ddx of eczema
psoriasis --> rare in young kids (often presents as droplet shaped "guttate" rash in kids, usually precipitated by strep)
seborrhea--> "cradle cap" in early infancy for example; unusual to have new case when older than 3
37
what can precipitate guttate psoriasis
strep
38
treatment of eczema
1. lubricate skin extensively to protect it
2. use anti-inflammatories in short bursts
3. treat associated skin infections aggressively
39
what meds can be used to treat eczema
1. steroids--> topical, alternate higher potency for severe flares with low potency for minor bouts
2. topical anti inflammatories--> calcineurin inhibitors are second line
3. antihistamines--> loratidine, fexofenadine and cetirizine are approved for kids and are non sedating; topical antihistamines at bedtime to decrease itch
40
where do toddlers get most of their iron
meat
legumes
iron fortified cereals
41
why do we care if toddlers get iron
it is a CNS cocatalyst
42
when should you distcontinue the bottle
by 12-15 months
43
what are the most common causes of injury in a toddler
1. car accidents
2. swimming pools
3. falls
4. firearms
5. poisonings
6. fires
44
what condition increases lead absorption
iron deficiency
45
what is strabismus
misalignment of the eyes
46
why do we care about strabismus
can lead to amblyopia, or poor visual development if not corrected
47
how do you assess strabismus
1. hirschberg light reflex
| 2. cover/uncover test
48
what is the most common gait variant seen in toddlers
intoeing
49
what causes intoeing in toddlers
tibial torsion usually
when patella faces straight, foot turns inward
resolves naturally with weight bearing usually by age 4
50
what causes intoeing in preschool and school age kids
femoral anteversion usually
both feet and knees turn inward
usually resovles spontaneously by 8-12 years old
51
what should you check for in a neurodevelopmental exam in a three year old
language
fine motor
gross motor
cognitive
cranial nerve function (normal, symmetric facial and eye movements)
deep tendon reflexes
muscle tone
gait
52
how do you calculate BMI
weight in kg/height in m squared
53
what does the BMI tell you
amount of body fat compared to weight from muscle or bone
54
core symptoms of ADHD
inattention
hyperactivity
impulsivity
55
prevalence of ADHD in the US
8-10%
most common neurobehavioral disorder of childhood and among most common chronic health conditions of school aged kids
56
list some causes of school failure
1. sensory impairment--> vision, hearing especially
2. sleep disorder
3. mood disorder--> prevalence of mood disorders increases with age
4. learning disability
5. conduct disorder
57
how common is depression in kids
affects an estimated 1-2% of elementary school age children and 5% of adolescents
childhood depression is marked by high rates of conversion to bipolar
58
what is a learning disability
disorder of cognition that manifests itself as a problem involving academic skills
IQ normal but academic achievement is low
59
what things characterize oppositional defiant disorder
pattern of negativistic, hostile, defiant behavior
60
what is conduct disorder
more severe disorder of habitual rule breaking, characterized by pattern of aggression, destruction, lying, stealing and/or truancy
61
what is the psychiatric condition with the highest comorbidity association with ADHD
ODD/CD
62
list red flags for risk of learning disability
1. history of maternal illness or substance abuse during pregnancy
2. complications at the time of delivery
3. hx of meningitis or other serious illness
4. history of serious head trauma
5. parental history of learning disability or difficulty at school
63
why % of kids with ADHD respond to stimulant meds
80%
64
list the adverse effects of ADHD medications
1. appetite suppression
2. tic disorders
3. insomnina
4. decrease in growth velocity
65
what is the most common SE of stimulant use
appetite suppression
weight loss, if any, is typically minor
66
how many kids who are on stimulants get tic disorder
fewer than 1%, usually go away when meds discontinued
67
how common is insomnia on stimulants
common, dose related side effects
typically worse on first days of meds
68
are there risks of addiction to stimulants
not when taken at prescribed doses but may be addictive is abused or used for euphoric effect
69
are kids on stimulants at higher risk for substance abuse
not when treated appropriately
some data suggests positive response to stimulant meds may reduce a patient's likelihood of substance abuse as well as other high risk behaviors
70
what are risk factors for obesity
1. high birth weight
2. maternal diabetes
3. having an obese parent, even higher if both are obese
- -1 parent: odds ration 3
- -2 parents: odds ratio over 10
4. lower socioeconomic status
5. certain genetic syndromes like prader wili, bardet-biedl and cohen
71
list complications of obesity
1. sleep apnea
2. dyslipidemia
3. HTN
4. slipped capital femoral epiphysis (SCFE)
5. T2DM
6. steatohepatitis
72
what is SCFE
displacement of the femoral head from the femoral neck through the physeal plate
most commonly occurs at the onset of puberty in obese patients with delayed sexual maturation
typical sx are antalgic gait due to pain referred to hip, thigh and/or knee, with limited ROM on exam
dx on plain XR of pelvis--> shows widening on pelvis
73
what is the most prominent risk factor for development of T2DM in kids
obesity
74
what is the most common form of diabetes in kids
T1DM--about 2/3 of new dx in kids is T1DM
first peak of onset at age 4-6, next peak at 10-14 year (bimodel onset in kids)
equal in both genders
75
natural history of T1DM
1. preclinical autoimmune destruction of the pancreatic beta cells
2. onset of clinical symptoms
3. transient remission
4. established diabetes with acute and chronic complications
76
what relationship does puberty have to T2DM
in puberty, insulin sensitivity is 30% lower than in preadolescents or adults--> hyperinsulinemia to compensate
77
what is the classic new onset of T1DM in childhood
1. polyuria--> serum glucose above 10mmol/L
- -can present as nocturia, bedwetting, daytime incontinence in previously continent child
2. polydipsia--> due to increased serum osmolality and hypovolemia
3. weight loss--> due to hypovolemia and increased catabolism
78
questions to ask when you suspect new dx of diabetes?
1. have you been very thirsty? drink alot?
2. urinating more than usual?
3. bedwetting?
4. recent weight loss?
5. feeling tired lately?
6. increased appetite lately?
7. more frequent minor skin infections?
79
physical exam for T1DM new onset
1. assess hydration status
2. circulation--HR, BP, cap refill
3. temp
4. growth chart to look for weight oss
5. neck exam--thyroid?
6. resp--> RR up with hyperventilation in DKA; ketones on breath?
80
physical exam for T2DM new onset
1. body weight, height, BMI
2. lying and standing BP
3. skin--> acanthosis nigricans
4. feet--> decreased sensation and circulation?
5. visual acuity
81
ddx of diabetes mellitus
1. DM 1 or 2
2. diabetes insipidus
3. UTI
4. malabsorption (celiac)
5. secondary diabetes
6. maturity onset diabetes of the young
82
diagnostic criteria for diabetes in kids
1. fasting plasma glucose of over 7mmol/L
2. symptoms of hyperglycemia, random venous plasma glucose of over 11.1 mmol/L
3. abnormal oral glucose tolerance test--plasma glucose above 11.1 mmol/L measured 2 hours after glucose load of 1.75g/kg
4. HbA1c above 6.5%
83
define HTN in kids (diagnostic criteria)
average sBP and/or dBP in the 95th percentile or higher matched with gender, age and height
high values must be met on 3 or more occasions
84
define hypertensive urgency in kids
severely elevated BP with no evidence of target organ damage--> may cause end organ damage if untreated
85
define hypertensive crisis in kids
elevated BP above 99th percentile for age and sex, with evidence of end organ damage
86
why is pediatric essential HTN on the rise
increasing prevalence of obesity in kids
more common on teens and adults (kids usually have another disease that causes HTN)
87
what can cause secondary HTN
renal disease
endocrine causes
CHD
elevated ICP
exogenous meds/toxins
**rule out secondary causes in kids
88
what organs are damaged from HTN
kidneys
CV system
CNS
89
common symptoms of pediatric HTN
often asymptomatic
headache
nosebleeds
irritability
impaired academic and athletic performance
90
in whom in malignant HTN common
adolescent boys of african descent
91
what symptoms should you ask about related to HTN
headache
weakness from CNS disease
blurred vision from retina disease
angina pectoris for CV disease
dyspnea from pulm edema or CHF
92
what can be some sx of an endocrine disorder causing secondary HTN
```
flushing
sweating
fevers
palpitations
muscle cramps
```
93
how do you screen for risk factors for secondary HTN
1. growth and devel abnormalities--> ?endocrinopathy
2. recent head injury--> hemorrhage--> increased ICP? can mimic HTN
3. renal trauma?--> thrombosis
4. blood in urine or wetting bed--> renal cause?
5. meds etc...
6. family hx --> including HTN, stroke, diabetes, obesity, renal disease, CHD, hyperlipidemia, endocrinopathy
7. hx of umbilical artery/vein catheterization as infant (renal thrombosis)
94
list common causes of secondary HTN
1. coarctation of aorta
2. renal vein thrombosis
3. renal artery stenosis
4. renovascular HTN
5. renal parenchymal disease
6. renal tumour
7. pheochromocytoma
8. primary hyperaldosteronism
9. cushings
95
common causes of newborn HTN
1. renal--
thombosis
stenosis
anomalies
2. heart--
coarctation
3. endocrine--
pheo
cushings
96
common causes of preschool/kindergarten HTN
1. renal--
parenchymal disease
vascular disease
2. heart--
coarctation
3. endocrine--
pheo
cushings
97
common causes of school age HTN
endocrine--> cushings, pheo
98
common causes of adolescent HTN
1. essential HTN
2. renal--
parenchymal, vascular
3. endocrine--
pheo
cushings
4. drugs of abuse
99
list diseases that can mimic hypertensive encephalopathy
1. meningitis
2. brain tumour
3. intracerebral hemorrhage
4. epidural hemorrhage
5. stroke
100
list signs of hypothyroidism in the adolescent
1. cold skin
2. slowness
3. fatigue
4. preferring hot weather to cold
5. doing poorly at school
6. coarse hair
101
what is "mono"
infections of lymphocytes caused by the epstein barr virus
sx--extreme fatigue, pharyngitis, LAD
102
how might you ID depression in adolescents
1. mood swings
2. adjustment reactions
3. suspicion on evaluation
*screen for suicidality whether depressed or not
103
what are the first signs usually noted in anorexia
weight loss
amenorrhea
bradycardia
- -> may lead to decreased cardiac output severe enough to lead to postural hypotension
- -> must hospitalize at this point
electrolyte abnormalities may start as disease progresses
- -> hypoalbuminemia, hypoglycemia, hyponatremia, hypocalcemia, hypomagnesemia
- -> can lead to compromised cardiac function
104
describe the typical order of puberty stages in females
1. breast buds appear (10-12 years)
2. pubic hairs appear (10-11 years)
3. growth spurt (12 years)
4. periods begin (12-13 years)
5. attainment of adult height (15 years)
105
when do girls start pubery
between 8-13 years old
106
when do boys start puberty
between 10-15 years
107
describe the typical order of puberty stages in males
1. growth of testicles (12 years)
2. pubic hair appears (12)
3. growth of penis, scrotum (13-14 years)
4. first ejaculations (13-14 years)
5. growth spurt (14 years)
6. attainment of adult height (17 years)
108
define constitutional short stature
"late bloomer"
short in puberty but will attain normal adult height just later than peers
109
what is the most common hereditary bleeding disorder
von willebrands disease (vWD)
110
frequency of vWD
1% of general pop
111
inheritance pattern of vWD
autosomal dominant with variable penetrance (type 1 and 2)
type 3 is less common and is autosomal recessive
112
symptoms of vWD
1. ecchymoses
2. epistaxis
3. menorrhagia (why its dx more often in women)
4. bleeding post tonsillectomy and dental extractions
5. gingival bleeds
*in absence of major trauma, bruising in no exposed areas needs to be thought of as abnormal
113
what is the most common type of vWD
type 1 (70%)--mildest
bleeding generally not life threatening
114
how to confirm dx of vWD
check vW factor antigen and/or platelet function analysis and factor VIII levels
115
tx for vWD
intranasal or intravenous desmopressin
sometimes use human plasma derived, virally inactivated vWF concentrated
116
how do you treat menorragia
combination OCP or IUD
117
what is osgood schlatter disease
caused by irritation of the growth plate at the tibial tuberosity
usually self limited growing pain that resolves with rest and with finishing the growth spurt
ica and NSAIDS can help with discomfort
resolves after bone stops growing and usually causes no lasting problems
118
what is precordial catch syndrome
most common cause of chest pain in adolescents and is of unknown etiology
benign condition characterized by sudden, sporadic onset of sharp pain--usually long left sternal border
often exacerbated by deep inspiration
brief--seconds to minutes
resolve spontaneously
not usually associated with exercise
119
what features of chest pain suggest cardiac pain
1. triggered by exertion or stress
2. pressure or crushing sensation
3. lasts 10-15 min
4. syncope or palpitations associated with pain
5. murmur, thrill or hyperdynamic precordium on exam
120
tanner stage 1 males
childlike phallus, testicular volume less than 1.5 ml
no public hair
121
tanner stage 2 males
childlike phallus, testicular volume 1.6-6ml--reddened, thinner and larger scrotum
small amount of fine hair along base of scrotum and phallus
122
tanner stage 3 males
increased phallus length, testicular volume 6-12 ml, greater scrotal growth
moderate amount of more curly, pigmented, coarser hair extending laterally
123
tanner stage 4 males
increased phallus length and circumference, testicular volume 12-20 ml, further scrotal growth and darkening
coarse curly adult like hair that doesnt fully yet extend to the medial surface of thighs
124
tanner stage 5 males
adult scrotum and phallus, testicular volume above 20 ml
adult type hair extending to medial surface of thigh
125
tanner stage 1 female
prepubertal
126
tanner stage 2 female
breast bud stage with elevation of breast and papilla, enlargement of areola
sparse growth of long, slightly pigmented hair--straight or curled along labia
127
tanner stage 3 female
further enlargement of breast and areola, no separation of contour
darker, coarser more curled hair, spreads sparsely over junction of pubes
128
tanner stage 4 female
areola and papilla form a secondary mound above level of breast
adult hair in type but covering smaller area than adult
129
tanner stage 5 female
mature stage
projection of papilla only, related to recession of areola
adult hair in type and quantity
130
what characteristics of a murmur warrant further evaluation
louder than III/VI
any diastolic murmur
any murmur that increases with standing or valsalva
131
define syncope
abrupt loss of consciousness and postural tone
132
what is the most common cause of sudden death in young athletes
hypertrophic cardiomyopathy
133
define turners syndrome
one of the most common chromosomal abnormalities
important cause of short stature and primary amenorrhea in young females
*should be considered in any girl with short stature
collection of X chromosome disorders resulting from deletion or silencing of a particular set of genes on the short arm of X
134
what is the most common type of turners syndrome
classic syndrome
50% of all cases
involves loss of one X chromosome--> 45XO karyotype
135
clinical presentation of turners
can be variable and subtle (especially for mosaics)
1. short stature despite normal growth hormone levels
2. dysmorphic features--webbed neck, short fourth metacarpal, nail dysplasia, high palate
3. sensorineural hearing loss
4. congenital lymphedema of hands and feet
5. primary amenorrhea or early ovarian failure
6. ocular abnormalities-->amblyopia, strabismus, ptosis, hypertelorism, epicanthus
7. renal abnormalities--> horseshoe kidney, abnormal vascular supply
8. CV abnormalities--> coarctation, bicuspid aortic valve
9. cognitive, learning, emotional disorders
136
generally, how do yo u manage a patient with turners
1. treat short stature
2. treat primary amenorrhea
3. treat lymphedema
4. investigate and treat CV anomalies
5. assess for hypothyroidism
6. assess for metabolic syndrome
7. assess for ocular abnormalities
8. assess for renal abnormalities
9. assess and treat cognitive and learning disabilities
137
how do you treat short stature in turners
subQ growth hormone when falls below 5th percentile for age (usually between 2-5 years old)
between ages of 9 and 12, girls with extreme short stature require daily injections of growth hormone and anabolic steroid before epiphyseal fusion
138
how do you treat primary amenorrhea in turners
after age of 12, estrogen therapy should be administered to induce normal pubertal growth and maintain bone mineral density
after growth has stopped, hormone replacement with both estrogen and progestin should be used to stimulate normal menses--> make sure to use cyclic progestin therapy to present endometrial hyperplasia
139
how do you treat lymphedema in turners
supportive stockings
vascular surgery is rarely indicated
140
define prematurity
underdeveloped newborn with low birth weight born before 37 weeks GA
moderately premature--35-37 weeks
very premature--29-34 weeks
extremely premature--28 weeks or less
141
what gestational age is viable
do not rescuscitate less than 23 weeks
most born at 26 weeks survive to 1 year
142
define low birth weight infant
less than 2500 g (5.5 Ibs)
very low--> less than 1500g
extremely low--> less than 1000g
143
what % of kids are born premature
12%
144
what can premature babies often not do?
(often below 2500g...low birth weight)
may be unable to feed by mouth, breathe without apneas, or thermo-regulate
145
what gestational age at birth is most likely to have severe health risks
born before 32 weeks
146
what conditions are most likely in a premature infant
1. intraventricular hemorrhage
2. RDS
3. bronchopulmonary dysplasia
4. anemia of prematurity
5. neonatal sepsis and other infections
6. CHD
7. hypoglycemia
8. hyperbilirubinemia
9. retinopathy of prematurity
10. necrotizing enterocolitis (severe intestinal inflammation)
11. delayed growth and development
147
list the risk factors for a premature birth
(40% of premature births have unknown cause)
1. previous premature delivery
2. premature rupture of membranes
3. infections of urinary tract or cervix
4. weak cervix
5. abnormalities in uterus, i.e fibrouds
6. multiple gestation
7. smoking, drinking or other substance use
8. poor nutrition
9. polyhydramnios
10. chronic diseases carried by mother
11. diabetes
12. heart disease
13. kidney disease
14. SLE
15. HTN--pregnancy induced and HELLP
148
what is the most common ischemia brain injury in premature infants
periventricular leukomalacia (PVL)
those that survive often go on to develop cerebral palsy, intellectual impairment or visual disturbance
149
why are mothers in preterm labour given steroids
can speed the development of the preterm infants lungs
help promote production of surfactant which prevents alveolar collapse
150
what happens when a premature baby's lungs are not mature enough to make surfactant
RDS
rapid shallow breathing, indrawing, grunting, nostril flaring
151
what is broncho pulmonary dysplasia
chronic lung disease caused by high levels of oxygen for long periods of time or with prolonged treatment of respiratory distress syndrome with a ventilator
can cause asthma, CF
may make kids more susceptible to resp infections
152
when does the ductus arteriosus close in normal weight full term neonates
3 days after birth
153
symptoms of a PDA
hyperdynamic precordial impulse
full pulses
widened pulse pressure
hepatomegaly
high parasternal systolic murmur
--usually appear about day 5 onwards
154
what is the most common GI disorder of the premature infant
necrotizing enterocolitis (NEC)
unknown etiology and cant prevent
155
signs of NEC
poor tolerance to feeds
feeds stay in stomach longer than expected
decreased bowel sounds
abdo distension and tenderness
greenish vomit
redness of abdo
bloody stools
apnea
bradycardia
lethargy
156
how do you diagnose NEC
presence of abnormal gas pattern as seen on xray
"bubbly" appearance of gas in the walls of the intestine, large veins of the liver or presence of air outside the intestines in the abdo cavity
157
tx of NEC
stop feeds
NG drainage
IV fluids or fluid replacement and nutrition
frequent exams and abdo xrays
158
what is retinopathy of prematurity
vessels to retina stop growing or grow abnormally causing bleeding in the eye
159
define sensorineural hearing loss
originates in the inner ear--frequently due to prenatal infections, asphyxia during or shortly after birth, or genetic factors
usually not reversible
160
define conduction hearing loss
middle or outer ear
caused by obstructions such as wax, fluid or rupture and/or puncture of ear drum
can usually be treated
161
define failure to thrive
weight less than the third percentile on standard growth chart
weight 20% below ideal weight for height
fall off from previously established growth curve
162
why do we measure head circumference
indication of brain growth
