General Pediatrics Flashcards
Which growth charts should be used for children between 0 and 2years?
World Health Organization (WHO) chart
Which growth charts should be used for children >2years?
CDC growth charts
Birth weight of newborn usually regained at what age?
10–14days
Birth weight doubles at what age?
5–6months
Birth weight triples at what age?
1year
Normal weight gain after 2years of age per year
2–3kg/year approximately
Body mass index (BMI) should be used starting at what age?
2years
How is BMI calculated?
Weight (kg)/[height (m)]2
What is the most common cause of failure to thrive?
Inadequate caloric intake
How much is birth length increased by 1year of age?
50%
Birth length doubles at what age?
3–4years
What is the average growth length (growth velocity) per year after 2years of age (later childhood)?
5cm/year approximately
What is the approximate range of pubertal peak growth velocities in boys and girls?
7–12cm/year in boys 6–10.5cm/year in girls
How much does the head circumference increase per month in the 1st year?
1cm/month
When does the head grow the fastest?
First 60days of life (0.5cm/week)
Head circumference should be measured routinely in each well visit until what age?
2years
What is the risk for a premature infant with an enlarged head circumference?
Hydrocephalus
What is the study of choice for an infant who presents with macrocephaly?
Head ultrasound (US)
What is the study of choice for an infant who presents with absolute microcephaly?
Brain MRI
Child with enlarged head >98th percentile, similar to the father, no symptoms and normal cognitive function, head imaging study showed prominent subarachnoid space especially in the frontal region
Benign familial macrocephaly
Anterior displacement of the occiput on one side and the frontal region on the ipsilateral side and the ear is more anterior on the side of occipital flattening (parallelogram)
Positional plagiocephaly
Anterior displacement of the occiput on one side and frontal bossing on the contralateral side and the ear is displaced more posteriorly (trapezoid)
Posterior plagiocephaly (craniosynostosis)
The most common type of craniosynostosis
Long narrow head (scaphocephaly), which is an early closure of the sagittal sutures
A 6-month-old with progressive head enlargement and crossing percentiles from 25th percentile at 2months to 98th percentile at 6months well visits. The head is elongated in the anterior–posterior diameter and shortened in the biparietal diameter. Ridging of the sagittal suture is palpable
Scaphocephaly (craniosynostosis)
What is the next best step in a child with suspected craniosynostosis?
Refer to a pediatric neurosurgeon (imaging studies are not required to make the diagnosis in typical cases)
What is the only vaccine that can be given at birth?
Hepatitis B
Infant born to HBsAg positive mom what should be given?
Hepatitis B and HepB immunoglobulin in the first 12h
What is the maximum age you can give DTaP?
DTaP is only for children younger than 7years old
Encephalopathy within 7days of administration is an absolute contraindication in which vaccine?
DTaP
When can Tdap or Td be given?
7years and older
Rotavirus, measles, mumps, rubella (MMR), oral poliovirus vaccine (OPV), and varicella are
Live attenuated virus vaccines
How are MMR, varicella, and inactivated polio (IPV) given?
Subcutaneously (IPV can be given either IM or SC)
Can you give MMR vaccine and perform a purified protein derivative (PPD) test at the same time?
Yes
If you give only MMR vaccine, how long should you wait to do PPD test?
4–6weeks
Which vaccines are contraindicated to be given to immunocompromised children?
Live vaccines, e.g., MMR, varicella, and rotavirus
Anaphylaxis reaction to neomycin or gelatin is an absolute contraindication to which vaccine?
MMR
The child who received MMR vaccine 2weeks ago is now having pain in the hip joints. Which component of the vaccine is responsible for this reaction?
Rubella
When does Haemophilus influenzae type b vaccination not need to be given to healthy children?
5years or older
When does pneumococcal (PCV13) vaccination not need to be given to healthy children?
5years or older
For which conditions can you give Haemophilus influenzae type b vaccination at 5years of age or older?
One dose for unimmunized persons with functional or anatomical asplenia and HIV infection. 3 doses after hematopoietic stem cell transplant (HSCT) regardless of the history of HIB immunization
Which pneumococcal vaccines should be given to high-risk children 2years and older, e.g., HIV, sickle cell disease, asplenia, cochlear implant?
PCV13, and PPSV23 (PPSV23 is given at least 8weeks after any prior PCV13)
An 11-year-old female is here for HPV vaccination; how many doses are recommended?
2 doses 6–12months apart
A 15-year-old female is here for HPV vaccination; how many doses are recommended?
3 doses 0, 1–2months, and 6months are recommended
Children younger than 9years of age, never been vaccinated for influenza before; how many doses should they receive during the first instance of influenza vaccination?
2 doses 1month apart
Child has a severe egg allergy (anaphylaxis). Can he or she receive the MMR vaccine?
Yes
Child is allergic to eggs (only hives). Can he or she receive the influenza vaccine today?
Yes
Child has a severe egg allergy (anaphylaxis). Can he or she receive the influenza vaccine?
Yes. Under the supervision of a health care provider who can recognize and manage severe allergic conditions
Child with a previous severe allergic reaction (anaphylaxis) to the flu vaccine. Can he or she receive the influenza vaccine?
No
A 4-year-old boy has 104°F fever and ear infection; can he be vaccinated today?
Yes
An unimmunized 4-month-old child came for catch-up vaccination. Can he or she receive the rotavirus vaccine?
No
A 9-month-old boy came for catch-up vaccination, and he had only one dose of rotavirus vaccine at 2months well visit. Can he receive the rotavirus vaccine?
No
If a household member is immunocompromised, e.g., HIV, leukemia, or severe combined immunodeficiency (SCID), can you give the 4-month-old who is living in the same house oral poliovirus vaccine (OPV)
No
A 2-month-old child with complement component deficiency. What are the vaccines that should be given at the 2-months well visit?
Routine 2months vaccines plus meningococcal vaccine
mother declined vaccination of her child. What is the next best step?
Explore any misconceptions about the safety and efficacy of vaccines
Visual acuity for a newborn is
20/400
At what age is a social smile seen?
1–2months
An infant is able to track an object to 180°
2months
Moro reflex disappears by what age?
3–6months
An infant is able to roll from front to back and has no head lag
4months
An infant is able to roll from back to front, supports weight with legs and bounces, able to transfer objects from hand to hand, knows familiar faces, knows own name, and begins to have separation anxiety
6months
An infant should be able to sit without support
7months
An infant pulls to stand, says “mama/dada” nonspecifically, and imitates sounds
9months
An infant is able to stand and take steps, says “mama/dada” specifically, has a mature pincer grasp
12months
Child is able to say 3–5 words, turns pages of a book, builds a tower of 3 blocks
15months
Child is able to say 10–25 words, throws a ball overhand, builds 4 blocks towers, uses a spoon, and knows 3 body parts
18months
At what age are most toddlers able to use a cup well?
15–18months
Child says 50 words, 2-word sentences, throws overhand, goes upstairs both feet on each step, engages in parallel play
24months
Child copies a circle, three-word sentences, alternates feet on stairs, knows 2 colors, 75% intelligible speech
36months (3years)
Child copies a square, 5-word sentences, identifies gender, knows 5 colors, 100% intelligible speech
48months (4years)
Child copies a triangle, uses scissors, and can count to ten
60months (5years)
At what age are most children able to copy a diamond?
6–7years
Inability to hold the head steady is a red flag for abnormal motor development at what age?
4months
Inability to sit alone and lack of rolling are a red flag for abnormal motor development at what age?
9months
Inability to walk independently is a red flag for abnormal motor development at what age?
18months
A 1-year-old boy is unable to stand or crawl, unable to point and is not speaking a single word
Motor, cognitive, and language delay
An 18-month-old with only 3 words, lack of joint attention, not sharing the interest in an object
Screen for autism spectrum disorder and developmental delay with 2 separate tools, e.g., M-CHAT and ASQ
A 2-year-old uses only 5 words. What is the best test to order?
Hearing test
The American Academy of Pediatrics (AAP) recommends that universal hearing screening of all infants occur by what age?
All infants with significant congenital hearing loss should be identified by 3months of age, and necessary intervention initiated by 6months of age
AAP recommends universal screening for anemia with determination of Hb concentration at what age?
1year of age
AAP recommends lead screening at what age?
All Medicaid-eligible children and those whose families receive any governmental assistance must be screened at ages 1 and 2years
What is the non-hematologic consequence of iron deficiency anemia?
Neurocognitive changes
AAP recommends autism screening at what age?
18months and 24months
AAP recommends discussing tobacco, alcohol, or drug use with children at what age?
11years
The US Preventive Services Task Force (USPSTF) recommended age to begin screening all adolescents for HIV
Once between 15 and 18years (younger if increased risk, e.g., male-to-male sexual contact)
Screening for depression should be done annually starting at what age?
Starting at 12years
Screening for dyslipidemia should be done at what ages?
Between 9 and 11years and again between 17 and 21years, or if there are risk factors (obesity, diabetes, etc.)
A 7-year-old boy has a parent with total cholesterol of 300mg/dL.What is the next best step?
Order fasting lipid profile, then repeat after 2weeks to 3months
Infant is exclusively breastfed. At what age should you recommend daily vitamin D supplementation (400IU)?
First few days of life
Infant is feeding more than 1liter of formula per day in addition to breastfeeding; does he or she need vitamin D supplementation?
No (1liter of formula has 406IU of vitamin D)
Infant is exclusively breastfed. At what age should you recommend daily iron (1mg/kg/day)?
4months
At what age should you recommend starting solid foods in infants?
4–6months
What is the reason for starting solid foods between 4 and 6months of age?
May decrease the risk of allergy to that specific food
A 4-week-old infant has been exclusively breastfeeding, and the mother is scheduled for MRI with contrast
Continue breastfeeding
A 4-week-old infant has been exclusively breastfeeding, and the mother has mastitis
Continue breastfeeding (can continue on the other side if breast abscess or cellulitis with direct contact with infant’s mouth)
A 4-week-old infant has been exclusively breastfeeding, and the mother recently diagnosed with active tuberculosis. No treatment yet
Discontinue breastfeeding until effective maternal treatment for the initial 2weeks or the infant is receiving isoniazid)
Newborn with a mother who is HIV positive
Breastfeeding is contraindicated (except in resource-limited settings)
What is the age when infants can drink cow’s milk?
12months
At what age can a child be given low-fat milk?
> 2years
AAP recommends the initial visit to the dentist at what age?
12months of age
What usually are the first teeth to erupt?
Lower anterior incisors
What is the latest age for first tooth eruption?
18months (after that, dental consult)
Child with white lines and spots at the bases of several teeth
Referral to a dentist (sign of dental caries)
A 5-year-old boy hit his head and knocked out his 2 primary central incisors 5min ago. What is the next best step?
Reassurance (re-implantation of the primary tooth may damage the developing permanent tooth)
A 10-year-old boy hit his head and knocked out his 2 permanent central incisors 5min ago. What is the next best step?
Re-implant the teeth immediately (best prognosis if avulsed tooth re-implanted within 15–30min)
If a tooth has been knocked out, it should be placed back into its socket until the child can see the dentist, should that prove impossible, what is the best solution in which to keep it?
Cold milk
When should the knocked-out tooth be implanted?
Immediate treatment is essential
At what temperature should you set the water heater at home?
120°F or less
Child with a capillary lead level of >5μg/ dL.What is the next best step?
Obtain venous sample
What is the safe blood lead level (BLL)?
There is no safe BLL, and any detectable lead level must be managed
Children should be secured with a rear-facing seat?
Birth to 2 years, as long as possible, or until they reach the highest weight or height allowed
Children who have outgrown their rear-facing seat should use?
Forward-facing car seat until they reach the highest weight or height allowed or at least 5years of age
Children who have outgrown their forward seating and are less than 57in. (4ft 9in.) tall should use?
Booster seat
Children who have outgrown their booster (57in., or 4ft 9in. tall) seat should use?
Seatbelt; if the seat belts fit properly when the lap belt lays across the upper thighs (not the stomach), and the shoulder belt lays across the chest (not the neck)
What is the recommended preventative measure to help prevent drowning?
Enclosing the pool with a 4-ft fence
What is the recommended measure to prevent accidental gun injuries?
Gun and bullets stored inlocked and separate locations
AAP does not recommend the use of repellents for children at what age?
Children younger than 2months
Treatment of a large local reaction after a mosquito bite
Antihistamine, ice, and topical hydrocortisone cream
What is the significant risk of sunburns?
Increases risk of melanoma at all ages
What are the long-term complications of artificial ultraviolet rays (e.g., skin tanning)
Cataracts, skin aging, and cancer
