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Pediatrics 2 > general 2 > Flashcards

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

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2
Q

at what age should a child be:

brushing his teeth with help

A

3

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3
Q

at what age should a child be:

articulating well

A

5

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4
Q

at what age should a child be:

naming colors

A

4

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5
Q

at what age should a child be:

singing a song

A

4

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6
Q

at what age should a child be:

printing some letters and numbers

A

5

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7
Q

at what age should a child be:

building a tower of 6-8 cubes

A

3

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8
Q

at what age should a child be:

hopping on one foot

A

4

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9
Q

at what age should a child be:

balancing on one foot

A

5

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10
Q

at what age should a child be:

feeding themselves

A

3

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11
Q

at what age should a child be:

stating first and last name

A

4

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12
Q

at what age should a child be:

can tell the difference between real and make believe

A

5

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13
Q

at what age should a child be:

counting to 10

A

5

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14
Q

at what age should a child be:

speaking in 2-3 word sentences

A

3

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15
Q

at what age should a child be:

aware of gender

A

4

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16
Q

at what age should a child be:

knows name and use of cup/ball/spoon/crayon

A

3

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17
Q

at what age should a child be:

drawing a person with more than 6 body parts

A

5

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18
Q

at what age should a child be:

copying squares

A

5

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19
Q

at what age should a child be:

copies a cross

A

4

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20
Q

at what age should a child be:

balances for 2 second

A

4

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21
Q

at what age should a child be:

rides a tricycle

A

3

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22
Q

at what age should a child be:

copies a circle

A

3

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23
Q

at what age should a child be:

tying a knot

A

5

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24
Q

at what age should a child be:

hops and skips

A

5

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25
Q

at what age should a child be:

most speech is identifiable

A

4

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26
Q

at what age should a child be:

knows gender and age

A

4

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27
Q

at what age should a child be:

listens and attends

A

5

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28
Q

at what age should a child be:

shows sympathy and concern for others

A

5

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29
Q

at what age should a child be:

draws perso with 3 body parts

A

4

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30
Q

at what age should a child be:

has a mature pencil grasp

A

5

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31
Q

at what age should a child be:

pours, cuts, and mashes own food

A

4

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32
Q

at what age should a child be:

tells a story with full sentences

A

5

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33
Q

at what age should a child be:

friendly to other children

A

4

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34
Q

at what age should a child be:

engages in fantasy play

A

4

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35
Q

what is eczema

A

“the itch that rashes”

cycle of irritation leading to scratching leading to the rash

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36
Q

ddx of eczema

A

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

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37
Q

what can precipitate guttate psoriasis

A

strep

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38
Q

treatment of eczema

A
  1. lubricate skin extensively to protect it
  2. use anti-inflammatories in short bursts
  3. treat associated skin infections aggressively
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39
Q

what meds can be used to treat eczema

A
  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
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40
Q

where do toddlers get most of their iron

A

meat
legumes
iron fortified cereals

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41
Q

why do we care if toddlers get iron

A

it is a CNS cocatalyst

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42
Q

when should you distcontinue the bottle

A

by 12-15 months

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43
Q

what are the most common causes of injury in a toddler

A
  1. car accidents
  2. swimming pools
  3. falls
  4. firearms
  5. poisonings
  6. fires
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44
Q

what condition increases lead absorption

A

iron deficiency

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45
Q

what is strabismus

A

misalignment of the eyes

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46
Q

why do we care about strabismus

A

can lead to amblyopia, or poor visual development if not corrected

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47
Q

how do you assess strabismus

A
  1. hirschberg light reflex

2. cover/uncover test

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48
Q

what is the most common gait variant seen in toddlers

A

intoeing

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49
Q

what causes intoeing in toddlers

A

tibial torsion usually

when patella faces straight, foot turns inward

resolves naturally with weight bearing usually by age 4

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50
Q

what causes intoeing in preschool and school age kids

A

femoral anteversion usually

both feet and knees turn inward

usually resovles spontaneously by 8-12 years old

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51
Q

what should you check for in a neurodevelopmental exam in a three year old

A

language
fine motor
gross motor
cognitive

cranial nerve function (normal, symmetric facial and eye movements)

deep tendon reflexes

muscle tone

gait

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52
Q

how do you calculate BMI

A

weight in kg/height in m squared

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53
Q

what does the BMI tell you

A

amount of body fat compared to weight from muscle or bone

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54
Q

core symptoms of ADHD

A

inattention

hyperactivity

impulsivity

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55
Q

prevalence of ADHD in the US

A

8-10%

most common neurobehavioral disorder of childhood and among most common chronic health conditions of school aged kids

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56
Q

list some causes of school failure

A
  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
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57
Q

how common is depression in kids

A

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

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58
Q

what is a learning disability

A

disorder of cognition that manifests itself as a problem involving academic skills

IQ normal but academic achievement is low

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59
Q

what things characterize oppositional defiant disorder

A

pattern of negativistic, hostile, defiant behavior

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60
Q

what is conduct disorder

A

more severe disorder of habitual rule breaking, characterized by pattern of aggression, destruction, lying, stealing and/or truancy

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61
Q

what is the psychiatric condition with the highest comorbidity association with ADHD

A

ODD/CD

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62
Q

list red flags for risk of learning disability

A
  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
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63
Q

why % of kids with ADHD respond to stimulant meds

A

80%

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64
Q

list the adverse effects of ADHD medications

A
  1. appetite suppression
  2. tic disorders
  3. insomnina
  4. decrease in growth velocity
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65
Q

what is the most common SE of stimulant use

A

appetite suppression

weight loss, if any, is typically minor

66
Q

how many kids who are on stimulants get tic disorder

A

fewer than 1%, usually go away when meds discontinued

67
Q

how common is insomnia on stimulants

A

common, dose related side effects

typically worse on first days of meds

68
Q

are there risks of addiction to stimulants

A

not when taken at prescribed doses but may be addictive is abused or used for euphoric effect

69
Q

are kids on stimulants at higher risk for substance abuse

A

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
Q

what are risk factors for obesity

A
  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
Q

list complications of obesity

A
  1. sleep apnea
  2. dyslipidemia
  3. HTN
  4. slipped capital femoral epiphysis (SCFE)
  5. T2DM
  6. steatohepatitis
72
Q

what is SCFE

A

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
Q

what is the most prominent risk factor for development of T2DM in kids

A

obesity

74
Q

what is the most common form of diabetes in kids

A

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
Q

natural history of T1DM

A
  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
Q

what relationship does puberty have to T2DM

A

in puberty, insulin sensitivity is 30% lower than in preadolescents or adults–> hyperinsulinemia to compensate

77
Q

what is the classic new onset of T1DM in childhood

A
  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
Q

questions to ask when you suspect new dx of diabetes?

A
  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
Q

physical exam for T1DM new onset

A
  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
Q

physical exam for T2DM new onset

A
  1. body weight, height, BMI
  2. lying and standing BP
  3. skin–> acanthosis nigricans
  4. feet–> decreased sensation and circulation?
  5. visual acuity
81
Q

ddx of diabetes mellitus

A
  1. DM 1 or 2
  2. diabetes insipidus
  3. UTI
  4. malabsorption (celiac)
  5. secondary diabetes
  6. maturity onset diabetes of the young
82
Q

diagnostic criteria for diabetes in kids

A
  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
Q

define HTN in kids (diagnostic criteria)

A

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
Q

define hypertensive urgency in kids

A

severely elevated BP with no evidence of target organ damage–> may cause end organ damage if untreated

85
Q

define hypertensive crisis in kids

A

elevated BP above 99th percentile for age and sex, with evidence of end organ damage

86
Q

why is pediatric essential HTN on the rise

A

increasing prevalence of obesity in kids

more common on teens and adults (kids usually have another disease that causes HTN)

87
Q

what can cause secondary HTN

A

renal disease

endocrine causes

CHD

elevated ICP

exogenous meds/toxins

**rule out secondary causes in kids

88
Q

what organs are damaged from HTN

A

kidneys

CV system

CNS

89
Q

common symptoms of pediatric HTN

A

often asymptomatic

headache

nosebleeds

irritability

impaired academic and athletic performance

90
Q

in whom in malignant HTN common

A

adolescent boys of african descent

91
Q

what symptoms should you ask about related to HTN

A

headache

weakness from CNS disease

blurred vision from retina disease

angina pectoris for CV disease

dyspnea from pulm edema or CHF

92
Q

what can be some sx of an endocrine disorder causing secondary HTN

A 
flushing 
sweating
fevers
palpitations
muscle cramps
93
Q

how do you screen for risk factors for secondary HTN

A
  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
Q

list common causes of secondary HTN

A
  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
Q

common causes of newborn HTN

A
  1. renal–
    thombosis
    stenosis
    anomalies
  2. heart–
    coarctation
  3. endocrine–
    pheo
    cushings
96
Q

common causes of preschool/kindergarten HTN

A
  1. renal–
    parenchymal disease
    vascular disease
  2. heart–
    coarctation
  3. endocrine–
    pheo
    cushings
97
Q

common causes of school age HTN

A

endocrine–> cushings, pheo

98
Q

common causes of adolescent HTN

A
  1. essential HTN
  2. renal–
    parenchymal, vascular
  3. endocrine–
    pheo
    cushings
  4. drugs of abuse
99
Q

list diseases that can mimic hypertensive encephalopathy

A
  1. meningitis
  2. brain tumour
  3. intracerebral hemorrhage
  4. epidural hemorrhage
  5. stroke
100
Q

list signs of hypothyroidism in the adolescent

A
  1. cold skin
  2. slowness
  3. fatigue
  4. preferring hot weather to cold
  5. doing poorly at school
  6. coarse hair
101
Q

what is “mono”

A

infections of lymphocytes caused by the epstein barr virus

sx–extreme fatigue, pharyngitis, LAD

102
Q

how might you ID depression in adolescents

A
  1. mood swings
  2. adjustment reactions
  3. suspicion on evaluation

*screen for suicidality whether depressed or not

103
Q

what are the first signs usually noted in anorexia

A

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
Q

describe the typical order of puberty stages in females

A
  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
Q

when do girls start pubery

A

between 8-13 years old

106
Q

when do boys start puberty

A

between 10-15 years

107
Q

describe the typical order of puberty stages in males

A
  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
Q

define constitutional short stature

A

“late bloomer”

short in puberty but will attain normal adult height just later than peers

109
Q

what is the most common hereditary bleeding disorder

A

von willebrands disease (vWD)

110
Q

frequency of vWD

A

1% of general pop

111
Q

inheritance pattern of vWD

A

autosomal dominant with variable penetrance (type 1 and 2)

type 3 is less common and is autosomal recessive

112
Q

symptoms of vWD

A
  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
Q

what is the most common type of vWD

A

type 1 (70%)–mildest

bleeding generally not life threatening

114
Q

how to confirm dx of vWD

A

check vW factor antigen and/or platelet function analysis and factor VIII levels

115
Q

tx for vWD

A

intranasal or intravenous desmopressin

sometimes use human plasma derived, virally inactivated vWF concentrated

116
Q

how do you treat menorragia

A

combination OCP or IUD

117
Q

what is osgood schlatter disease

A

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
Q

what is precordial catch syndrome

A

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
Q

what features of chest pain suggest cardiac pain

A
  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
Q

tanner stage 1 males

A

childlike phallus, testicular volume less than 1.5 ml

no public hair

121
Q

tanner stage 2 males

A

childlike phallus, testicular volume 1.6-6ml–reddened, thinner and larger scrotum

small amount of fine hair along base of scrotum and phallus

122
Q

tanner stage 3 males

A

increased phallus length, testicular volume 6-12 ml, greater scrotal growth

moderate amount of more curly, pigmented, coarser hair extending laterally

123
Q

tanner stage 4 males

A

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
Q

tanner stage 5 males

A

adult scrotum and phallus, testicular volume above 20 ml

adult type hair extending to medial surface of thigh

125
Q

tanner stage 1 female

A

prepubertal

126
Q

tanner stage 2 female

A

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
Q

tanner stage 3 female

A

further enlargement of breast and areola, no separation of contour

darker, coarser more curled hair, spreads sparsely over junction of pubes

128
Q

tanner stage 4 female

A

areola and papilla form a secondary mound above level of breast

adult hair in type but covering smaller area than adult

129
Q

tanner stage 5 female

A

mature stage

projection of papilla only, related to recession of areola

adult hair in type and quantity

130
Q

what characteristics of a murmur warrant further evaluation

A

louder than III/VI

any diastolic murmur

any murmur that increases with standing or valsalva

131
Q

define syncope

A

abrupt loss of consciousness and postural tone

132
Q

what is the most common cause of sudden death in young athletes

A

hypertrophic cardiomyopathy

133
Q

define turners syndrome

A

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
Q

what is the most common type of turners syndrome

A

classic syndrome

50% of all cases

involves loss of one X chromosome–> 45XO karyotype

135
Q

clinical presentation of turners

A

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
Q

generally, how do yo u manage a patient with turners

A
  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
Q

how do you treat short stature in turners

A

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
Q

how do you treat primary amenorrhea in turners

A

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
Q

how do you treat lymphedema in turners

A

supportive stockings

vascular surgery is rarely indicated

140
Q

define prematurity

A

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
Q

what gestational age is viable

A

do not rescuscitate less than 23 weeks

most born at 26 weeks survive to 1 year

142
Q

define low birth weight infant

A

less than 2500 g (5.5 Ibs)

very low–> less than 1500g
extremely low–> less than 1000g

143
Q

what % of kids are born premature

A

12%

144
Q

what can premature babies often not do?

A

(often below 2500g…low birth weight)

may be unable to feed by mouth, breathe without apneas, or thermo-regulate

145
Q

what gestational age at birth is most likely to have severe health risks

A

born before 32 weeks

146
Q

what conditions are most likely in a premature infant

A
  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
Q

list the risk factors for a premature birth

A

(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
Q

what is the most common ischemia brain injury in premature infants

A

periventricular leukomalacia (PVL)

those that survive often go on to develop cerebral palsy, intellectual impairment or visual disturbance

149
Q

why are mothers in preterm labour given steroids

A

can speed the development of the preterm infants lungs

help promote production of surfactant which prevents alveolar collapse

150
Q

what happens when a premature baby’s lungs are not mature enough to make surfactant

A

RDS

rapid shallow breathing, indrawing, grunting, nostril flaring

151
Q

what is broncho pulmonary dysplasia

A

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
Q

when does the ductus arteriosus close in normal weight full term neonates

A

3 days after birth

153
Q

symptoms of a PDA

A

hyperdynamic precordial impulse

full pulses

widened pulse pressure

hepatomegaly

high parasternal systolic murmur

–usually appear about day 5 onwards

154
Q

what is the most common GI disorder of the premature infant

A

necrotizing enterocolitis (NEC)

unknown etiology and cant prevent

155
Q

signs of NEC

A

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
Q

how do you diagnose NEC

A

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
Q

tx of NEC

A

stop feeds

NG drainage

IV fluids or fluid replacement and nutrition

frequent exams and abdo xrays

158
Q

what is retinopathy of prematurity

A

vessels to retina stop growing or grow abnormally causing bleeding in the eye

159
Q

define sensorineural hearing loss

A

originates in the inner ear–frequently due to prenatal infections, asphyxia during or shortly after birth, or genetic factors

usually not reversible

160
Q

define conduction hearing loss

A

middle or outer ear

caused by obstructions such as wax, fluid or rupture and/or puncture of ear drum

can usually be treated

161
Q

define failure to thrive

A

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
Q

why do we measure head circumference

A

indication of brain growth

Pediatrics 2 (19 decks)

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