General Pediatrics Flashcards
DDx: crying infant
- inconsolable crying in an otherwise healthy infant; 0-3 months; resolves by 4m
- crying; arching of back during or after feeding; frequent spit ups and vomiting; poor weight gain
- crying; recurrent episodes of severe abdominal pain; poor appetite and weight gain; ages 3-36m
- crying; blood streaked or mucousy, loose stools or severe constipation
DDx: crying infant
- Colic
- GERD
- Intusussception
- Milk-protein allergy
Primary Enuresis
- -hyposecretion or receptor dysfxn re: hormone?
- -behavioral tx, then what rx?
Secondary Enuresis
–what is most important test for dx?
Primary Enuresis
- -hyposecretion of ADH or receptor dysfxn
- -behavioral tx
- -rx: imipramine (if behavioral tx fails)
Secondary Enuresis
- -etiologies: psychological, UTI, constipation, diabetes
- -evaluation: UA
Child Abuse and Neglect
NB: no reports of death or serious brain injury from falls less than 10 feet
NB: bruises in various stages are incompatible with single event
NB: suspicious: rib fracture in infant; fractures of different healing stages; bilateral fractures
NB: suspicious: circular punched out burns; immersion burns with glove-stocking distribution with no splashes and sparing of flexion creases
- What type of femoral fracture is suspicious?
- Pathognomonic for abusive head injury?
Child Abuse and Neglect
- Spiral fracture of femur before child can walk independently
- Retinal hemorrhages
Suspicious Signs
- Bruises
- -various stages - Fractures
- -rib fracture in infant
- -fractures of different healing stages
- -bilateral fractures - Burns
- -circular punched out burns
- -burns with glove stocking distribution; sparing of flexion creases; no splashes
Common sites of foreign body aspiration
- -larynx
- -trachea
- -right mainstem bronchus
Which one is more common for children age less than 1y?
Which one is more common for children age more than 1y?
Sites of foreign body aspiration
Children age less than 1y
–larynx
Children age greater than 1y
- -trachea
- -right mainstem bronchus
DTap: diptheria, tetanus, acellular pertussis
- -diptheria and tetanus toxoid
- -acellular pertussis antigens
5 doses before school entry (age 4-6y)
Contraindications
- -to DTap: anaphylactic reaction
- -to acellular pertussis? (2)
DTap
5 doses before school entry (age 4-6y)
Contraindications
- -to DTap: anaplylactic reactioin
- -to ap: progressive neurologic disease; encephalopathy within 1 week of previous dose
NB: fever less than 105; febrile seizures; redness; soreness; swelling are NOT contraindications
NB: Tdap (pertussis booster) is recommended during adolescence regardless of immunization status or previous hx of pertussis dz
Premature newborns should be vaccinated according to chronological age.
What is the only exception to this rule?
Premature newborns should be vaccinated according to chronological age.
Exception: hepatitis B vaccine
–weight should be greater than 2kg (4 lb 6oz)
Hepatitis B Vaccine
mother HBsAg-negative
–first dose at birth; 3 doses by 18m
mother HBsAg-positive
- -at birth: first vaccine dose; HB-Ig at 2 sites
- -3 doses given by what age?
Hepatitis B Vaccine
–inactivated subunit/conjugate
mother HBsAg-negative
- -first dose at birth
- -3 doses by 18m
mother HBsAg-positive
- -at birth: first dose; HB-Ig at 2 sites
- -3 doses given by 6m
Classification of Vaccines
Two pathogens that have an inactivated (killed) vaccine?
Two pathogens that have a toxoid (inactivated toxin) vaccine?
Subunit/Conjugate
- -Hepatitis B
- -Pertussis
- -HiB
- -Pneumococcal
- -Meningococcal
- -HPV
- -Influenza - which route of administration?
Live Attentuated
- -MMR
- -Rotavirus
- -Varicella
- -Influenza - which route of administration?
Classification of Vaccines
Inactivated (Killed)
- -Polio
- -Hepatitis A
Toxoid (Inactivated Toxin)
- -Diptheria
- -Tetanus
Subunit/Conjugate
- -Hepatitis B
- -Pertussis
- -HiB
- -Pneumococcal
- -Meningococcal
- -HPV
- -Influenza (injection)
Live Attenuated
- -MMR
- -Rotavirus
- -Varicella
- -Influenza (intranasal)
Breastfeeding FAQs
Maternal Benefits
–reduced risk of what 2 cancers?
Infant Benefits
- -improved immunity
- -reduced infxns (ear, respiratory, GI, GU)
- -reduced risk of T1DM, childhood cancer, NEC
What is the only infant contraindication to breastfeeding?
Breastfeeding FAQs
Maternal Benefits
–reduced risk of breast, ovarian cancer
Infant Benefits
- -improved immunity
- -reduced infxns
- -reduced risk of T1DM, childhood cancer, NEC
Infant Contraindication
–galactosemia
Gross Motor Milestones: first year
Pair each milestone with 2m, 4m, 6m, 9m, 1y
- -pulls to stand; crawls well; cruises
- -sits with trunk support; begins rolling
- -first independent steps; stands well; throws ball
- -lifts head/chest in prone
- -begins sitting on propped hands (tripod)
NB: by age 12m, a child’s weight should TRIPLE and height should increase by 50 percent
Gross Motor Milestones: first year
2m
–lifts head/chest in prone
4m
–sits with trunk support; begins rolling
6m
–begins sitting on propped hands; tripod
9m
–pulls to stand; crawls well; cruises
12m
–first independent steps; stands well; throws ball
Fine Motor Milestones: first year
Pair each milestone with 2m, 4m, 6m, 9m, 1y
- -2 finger princer grasp; crayon marks
- -raking grasp; transfers object hand to hand
- -tracks past midline
- -3 finger princer grasp; holds bottle or cup
- -hands mostly open; reaches midline
NB: by age 12m, a child’s weight should TRIPLE and height should increase by 50 percent
Fine Motor Milestones: first year
2m
–tracks past midline
4m
–hands mostly open; reaches midline
6m
–raking grasp; transfers object hand to hand
9m
–3 finger princer grasp; holds bottle or cup
1y
–2 finger princer grasp; crayon marks
Language Milestones: first year
Pair each milestone with 2m, 4m, 6m, 9m, 1y
- -says “dada” and “mama”
- -says first words
- -laughs; turns to voice
- -alerts to voice/sounds; coos
- -responds to name; babbles
Language Milestones: first year
2m
–alerts to voice/sounds; coos
4m
–laughs; turns to voice
6m
–responds to name; babbles
9m
–says “dada”, “mama”
1y
–says first words
Social/Cognitive Milestones: first year
- -stranger anxiety
- -social smile; recognizes parents
- -separation anxiety; comes when called
- -enjoys looking around
- -waves “bye”, plays pat-a-cake
Social/Cognitive Milestones: first year
2m
–social smile; recognizes parents
4m
–enjoys looking around
6m
–stranger anxiety
9m
–waves “bye”, plays pat-a-cake
1y
–separation anxiety; comes when called
Vaccines: varicella, MMR, Rotavirus
–live attenuated vaccines
Varicella and MMR
- -1st dose at 1y
- -2nd dose at ?
Rotavirus
–age 2-8m
Varicella, MMR, and rotavirus vaccines
–live attenuated
Varicella and MMR
- -1st dose at 1yr
- -2nd dose at preschool age (4-6yr)
Rotavirus
–age 2-8m
Vaccines: pneumococcal, meningococcal
*conjugate vaccines
Pneumococcal
- PCV13 - 13 serotypes
- -four dose series beginning at 1yr
NB: PS23 (23 serotypes) for asplenic children
Meningococcal
- -1st dose at what age?
- -booster at age 16
- -vaccine college freshmen in dorms if not already done
Pneumococcal and Meningococcal Vaccines
*conjugate vaccines
Pneumococcal
- PCV13
- -four dose series beginning at 1yr
Meningococcal
- -1st dose at age 11-12yr
- -booster at age 16
- -vaccinate college freshmen in dorms if not already done
