Halo-halo Flashcards
Mostly nephro, Preventive pedia, DevPed, Psych
1
Q
Cushing Triad
A
Bradycardia, Hypertension, altered breathing;
can be a sign of life-threatening increased intracranial pressure
2
Q
Blood anion gap computation
A
[Na+] - [Cl- + HCO3-]
<12 : absence of anion gap
>20 : presence of anion gap
3
Q
Bartter syndrome
A
hypokalemic, hypochloremic metabolic alkalosis with hypercalciuria and salt wasting
4
Q
Gitelman Syndrome
A
hypokalemic, hypochloremic metabolic alkalosis with distinct features of hypocalciuria and hypomagnesemia
5
Q
Type of RTA resulting from impaired bicarbonate reabsorption
A
Proximal (type II) RTA
6
Q
Type of RTA resulting from failure to secrete acid
A
Distal (type I) RTA
7
Q
Distinguishing features of distal RTA
A
nephrocalcinosis, hypercalciuria
8
Q
Most common cause of ESRD in adolescents
A
Focal segmental glomerulosclerosis
9
Q
Type of RTA occuring as the result of impaired aldosterone production (hypoaldosteronism) or impaired renal responsiveness to aldosterone (pseudohypoaldosteronism
A
Hyperkalemic (type IV) RTA
10
Q
Disorder of water metabolism characterized by an inability to concentrate urine, even in the presence of anti-diuretic hormone
A
Nephrogenic Diabetes Insipidus
11
Q
How can you differentiate Central from Nephrogenic Diabetes insipidus?
A
Administer vasopressin followed by serial urine & serum Osmolality measurements hourly for 4 hours
12
Q
Treatment for central DI
A
Desmopressin (synthetic analogue of ADH)
13
Q
Treatment for Nephrogenic DI
A
> Maintain adequate fluid intake and access to free water
Minimize UO by limiting solute load with a low osmolar, low sodium diet
Medications directed at decreasing UO
> Thiazide diuretic (induce Na+ loss and stimulate proximal tubule reabsorption of water
> K+-sparing diuretics (amiloride)
14
Q
Rapid correction of acidosis with bicarbonate can precipitate what in a patient with renal failure
A
Tetany (because of reduction in ionized Calcium concentration)
15
Q
Procedures to deplete body potassium stores
A
> Sodium polystyrene sulfonate resin (Kayexalate)
Calcium gluconate 10% - counteracts the K+-induced increase in myocardial irritability but does not lower the serm K+ level
Sodium bicarbonate - shifts K+ from extracellular to intracellular
Glucose-insulin solution - same MOA as NaHCOe-
Dialysis
16
Q
Recommended storage time of breast milk at room temp (<25oC)
A
4 hours
17
Q
Recommended storage time of breast milk at room temp >25oC
A
1 hours
18
Q
Recommended storage period of breastmilk in the refrigerator
A
8 days
19
Q
Recommended breastmilk storage period in the freezer compartment of a 1-door refrigerator.
A
2 weeks
20
Q
Recommended breastmilk storage period in the freezer compartment of a 2-door refrigerator.
A
3 months
21
Q
Recommended breastmilk storage period in a deep freezer with constant temp (-20oC)
A
6 months
22
Q
Deworming must not be done in the children with…
A
> severe malnutrition
high-grade fever
profuse diarrhea
abdominal pain
serious illness
previous hypersensitivity to antihelminthic drug
23
Q
Vitamin A supplementation as recommended by the DOH…
A
> Infants 6-11mos - 100,000iu (given anytime between 6-11 mos but usually given @ 9 mos of age during the measles immunization)
Children 12-59 mos - 200,000iu q6 mos.
24
Q
Iron supplementation for low birth weight infants
A
7.5mg elemental Fe OD to start at 2mos until 6 mos when complementary foods are given
25
Iron supplementation for Infants 6-11mos.
15mg elemental Fe OD for 3 mos
26
Iron supplementation for children 1-5 yrs
30mg elemental Fe OD for 3 mos, or 30mg elemental Fe once a week for 6 mors with supervised administration
27
Iron supplementation for adolescent girls
60mg elemental Fe + 400mcg folic acid OD
28
For newborns discharged <48hrs after delivery, a definitive appointment must be made for the infant to be examined within ___ hours of discharge?
48
29
In PPD reading, an induration of >5mm is considered positive in the presence of (4)...
1. hx of close contact with a known or suspected case of TB
2. clinical findings suggestive of TB
3. CXR suggestive of TB
4. Immunosuppressed condition
30
EINC practice for immediate care of the normal newborn
1. immediate and thorough drying of the newborn
2. early skin to skin contact
3. properly-timed cord clamping and cutting, and
4. non-separation of newborn and mother for early breastfeeding
31
PSDBP recommends that developmental screening be done at which specified ages?
9, 18, and 30 months, and yearly thereafter
32
Process by which the health care professional recognizes the children who may be at risk of developmental and behavioral conditions
Developmental surveillance
33
Process of administering a standardized tool designed to identify children who are at risk for developmental and behavioral disorders
Developmental screening
34
Normal Visual Acuity for children starting at 3 y/o
3 y/o - 20/50 or better
4 y/o - 20/40 or better
5 y/o - 20/30 or better
35
Recommended fluoride concentration / amount for 6mos to < 2y/o
1000 ppm, 2.5mm smear, twice daily
36
Recommeded fluoride concentration / amount for 2-6 y/o
1000ppm, 5mm pea size, twice daily
37
Recommended fluoride concentration/ amount for 6 y/o above
1500ppm, full length bristle 10-20mm, twice daily
38
Most common infectious etiology for adrenal insufficiency
Meningococcemia
39
Adrenal crisis arising from meningococcemia infection is called...
Waterhouse-Friderichsen Syndrome
40
Prolonged use of this anesthetic may cause hemodynamic collapse, bradycardia, metabolic acidosis, cardiac failure, rhabdomyolysis, hyperlipidemia, profound shock, and death
Propofol (Propofol infusion syndrome)
41
Most common form of extrapulmonary TB
TB Lymphadenitis
42
After primary infection, when does disseminated and meningeal TB occur in children?
After 2-6 months
43
This activity in the well-child care occurs in every health encounter and is enhanced by repeated visits and observations with advancing developmental stages.
Surveillance
44
The tasks of each well-child visit include
> Disease detection
> Disease prevention
> Health promotion
> Anticipatory guidance
45
ATVs (all-terrain vehicles) should not be recommended to children younger than ___ years of age
16
46
The safest place for children in a motor vehicle / car.
rear middle seat, properly restrained for their age and size
47
Most common cause of death in skiing and snowboarding
head injuries
48
This permits the central nervous system to reorganize neuronal networks in response to environmental stimulation, both positive and negative, and is critical to learning and remembering (and therefore development).
Neuronal plasticity
49
This describes the stable, early-appearing individual variations in behavioral dimensions, including emotionality, activity level, attention, sociability, and persistence
Temperament
50
Refers to a biologically determined tendency of a young child to seek proximity to the parent during times of stress and also to the relationship that allows securely attached children to use their parents to reestablish a sense of well-being after a stressful experience
Attachment
51
# True or False.
Infants who are consistently picked up and held in response to distress cry less at 1 yr and show less-aggressive behavior at 2yr.
True
52
In infants, crying normally peaks at about ___ wks of age.
6 wks; healthy infants may cry up to 3hr/day
53
Infants rate of growth
1st month: 30g/day
3-4mos: 20g/day
4 mos: weight is doubled
54
Disappearance of the asymmetric tonic neck reflex occurs when?
3-4 mos... infants can begin to examine objects in the midline and manipulate them with both hands
55
Developmental Milestones. Ability to sit unsupported
6-7 mos
56
Developmental Milestones. Thumb-finger grasp
8-9 mos
57
Developmental Milestones. Pincer grasp
12 mos
58
Developmental Milestones. Crawling, pulling to stand.
8 mos; this is followed by cruising
59
Developmental Milestones. Object permanence (constancy)
9 mos
60
Time when stranger anxiety usually sets in.
9 mos, also corresponding to the time when object permanence develop
61
Anthropometrics at 1 yr in relation to birth weight, length, and head circumference.
BW has tripled, BL increased by 50%, HC increased by 10cm.
62
Developmental Milestones. Points to major body parts and uses 4-6 words spontaneously and correctly
15 mos
63
Developmental Milestones. Increased clinginess. Stage of "raprochement"
18 mos
64
Visual acuity reaches 20/20 by age ____
4 yrs
65
All 20 primary teeth will have erupted by age ___
3 yrs
66
Handedness is usually established by age ___
3 yrs
67
Bedwetting is normal until what age
4 yrs in girls; 5 yrs in boys
68
Language development occurs most rapidly between ______ yrs of age
2 - 5 yrs
69
Stuttering resolves in 80% of children by age ____
8 yrs
70
By age __, children have self-identified their sex
3 yrs
71
Tantrums peak in prevalence between _____ of age
2 and 4 yrs
72
Tantrums normally appear when___ ?
toward the end of the 1st yr of life
73
Modesty appears gradually between age ____
4 and 6 yrs
74
The process that allows the child to internalize controls on behavior.
Discipline
75
Effective time-out duration
~ 1min/ yr of age
76
What is a more dramatic sign of maturation in middle childhood?
Loss of deciduous teeth
77
When is the diagnosis of failure to thrive usually considered?
FTT is usually a diagnosis of children younger than 3 yr of age, is considered if...
> a child's weight is below the 5th centile
> the child's weight drops down more than 2 percentile lines, or
> if weight for height is less than the 5th centile
78
What remains the single best growth chart indicator of acute undernutrition?
Weight for height below the 5th percentile
79
The lower-body segment is defined as the length from ___
Symphysis pubis to the floor
80
Ratio of upper-body segment to lower body segment (U/L ratio)
at birth - 1.7
3 y/o - 1.3
after 7 y/o - 1.0
Higher U/L ratios are characteristic of short-limb dwarfism or bone disorders
81
In familial short stature, the bone age is ____ (compared to chronological age)
Normal (similar to chronological age)
82
In constitutional delay, endocrinologic short stature, and undernutrition, the bone age is ___ and comparable to the height age.
Low
83
True or False. The timing of dental development is highly correlated with other processes of growth and maturation
False
84
Delayed eruption is usually considered when there are no teeth at approximately ___ mos of age
13
85
Based on the AAP policies, these are specific ages when formal developmental screening should occur
9-, 18-, 24-, 30- mo. Screening/ surveillance should be provided at all well visits.
86
This refers to ongoing monitoring (tracking over time) of such issues as parental concerns, children's progress with milestones, psychosocial risk and resilience factors, providers' efforts to both detect and address problems, and follow-up regarding child/family outcoumes
Surveillance
87
Time of exclusion from school when child has been diagnosed with impetigo
Until treatment has been started
88
Time of exclusion from school when child has been diagnosed with Steroptococcal pharyngitis
Until 24hr after treatment has been started
89
Time of exclusion from school when child has been found with pururlent conjunctivitis
Until after treatment has been initiated
90
Time of exclusion from school when child has been diagnosed with Pediculosis (head lice)
Until after the first treatment
91
Time of exclusion from school when child has been diagnosed with Scabies
Until after treatment has been given
92
Time of exclusion from school when child has been diagnosed with Chicken pox
Until all lesions have dried or crusted
93
Time of exclusion from school when child has been diagnosed with Rubella
Until 6 days after onset of rash
94
Time of exclusion from school when child has been diagnosed with Pertussis
Until 5 days of appropriate antibiotic treatment
95
Time of exclusion from school when child has been diagnosed with Mumps
Until 5 days after onset of parotid gland swelling
96
Time of exclusion from school when child has been diagnosed with Measles
Until 4 days after onset of rash
97
Time of exclusion from school when child has been diagnosed with Hepatitis A Virus
Until 1 wk after onset of illness or jaundice if the child's symptoms are mild
98
What is the doctrine of double effect?
The doctrine of double effect holds that an action with good and bad effects is morally justifiable if the good effect is the only one intended, and the bad effect us foreseen and accepted, but not desired.
99
Hallmark of primary insomnia
Excessive worry about sleep and an exagerrated concern of the potential daytime consequences
100
Gold standard for diagnosing Obstructive Sleep Apnea.
in-lab overnight polysomnogram
101
These are episodic nocturnal behaviors that often involve cognitive disorientation and autonomic and skeletal muscle disturbance occurring primarily during non-REM sleep
Partial Arousal Parasomnias, which include sleepwalking, sleep terrors, and confusional arousals. They typically occur when slow-wave sleep (SWS) predominates
102
This is a chronic neurologic disorder, characterized by an almost irresistible urge to move the legs, often accompanied by uncomfortable sensations in the lower extremities.
Restless legs syndrome (Willis Ekbom syndrome). It is a clinical diagnosis, versus periodic limb movement disorder which requires overnight PSG to diagnose.
103
This is characterized by periodic, repetitive, brief, and highly sterotyped limb jerks typically occurring at 20-40 sec intervals
Periodic Limb movement disorders
104
This is a clinical term that is used to describe a group of disorders characterized by recurrent episodes of excessive daytime sleepiness, reduced baseline alertness, and/or prolonged nighttime sleep periods that interfere with normal daily functioning
Hypersomnia
105
This is a chronic lifelong CNS disorder, typically presenting in adolescence and early adulthood, that is characterized by profound daytime sleepiness and resultant significant functional impairment
Narcolepsy
106
This term refers to the sudden and temporary loss of muscle tone, without loss of consciousness, classically triggered by an intense positive emotion
Cataplexy. It is considered pathognomonic for narcolepsy.
107
The underlying pathogenesis of narcolepsy
Involves the selective loss of cells that secrete hypocretin/orexin in the lateral hypothalamus
108
This is considered pathognomonic for narcolepsy
Cataplexy
109
These involve vivid visual, auditory, and sometimes tactile sensory experiences occurring during transitions between sleep and wakefulness, primarily at sleep offset (___) and sleep onset (____)
Hypnogogic / hypnopompic hallucinations
110
This is the inability to move or speak for a few seconds or minutes at sleep onset or offset, and often accompanies the hallucinations
Sleep paralysis
111
These are symphatomimetic drugs that act both in the CNS and peripherally by enhancing dopaminergic and noradrenergic transmission
STimulants
112
This class of drug is a selective inhibitor of presynaptic norepinephrine reuptake; it increases dopamine and norepinephrine in the frontal cortex
Atomoxetine. (with risk of suicidal thinking) less effective in the tx of ADHD
113
This class of drug appear to stimulate inhibitory presynaptic autoreceptors in the CNS
alpha-adrenergic agents (clonidine, guanfacine)
114
These drugs act on pre- and postsynaptic receptors affecting the release and reuptake of brain neurotransmitters, including norepinephrine, serotonin, and dopamine
antidepressants
115
Approx 5% of youth taking this drug class, particularly children, develop behavioral activation (increased impulsivity, agitation, and irritability) that can be confused with mania, but the activation symptoms typically resolve when the dose is decreased or medication is discontinued
SSRI (e.g. fluoxetine)
116
What characterize the serotonin syndrome?
Triad of:
1. mental status changes (e.g. agitation, hallucinations, delirium, coma)
2. autonomic instability (e.g., tachycardia, labile BP, dizziness, diaphoresis, flushing, hyperthermia), and
3. neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination)
117
Tricyclic antidepressant that is used in the treatment for obsessive-compulsive disorder
Clomipramine
118
This syndrome generally manifests with fever, muscle rigidity, autonomic instability, and delirium. It is a rare, potentially fatal reaction that can occur during antipsychotic therapy.
Neuroleptic malignant syndrome. This is also associated with elevated creatine phosphokinase levels, a metabolic acidosis, and high end-tidal CO2 excretion.
119
How is persistent (chronic) motor or vocal tic (PTD) differentiated from Tourette disorder (TD)?
PTD is limited to either motor or vocal tics (not both), whereas TD has both motor and vocal tics at some point in the illness (although not necessarily concurrently).
120
When is the onset of stereotypic movement disorder?
Early developmental period, often before age 3 yrs.
121
The behavioral intervention with the strongest empirical support for Tourette Disorder is...
Habit reversal therapy (HRT)
122
Separation anxiety is developmentally normal when it begins at about ____ of age and tapers off by ____.
10mos, 18 mos.
123
The only US FDA-approved medications to treat Tourette disorder in children and adolescents are _(3)_.
2 1st gen antipsychotics (haloperidol, pimozide), and 1 atypical antipsychotic (aripiprazole).
124
When is the average age of onset of separation anxiety disorder?
7.5 y/o
125
The only antidepressants approved by the US FDA for the treatment of depression in youth.
Escitalopram and Fluoxetine (both SSRIs). Only Fluoxetine alone is approved for pre-adolescents
126
Most efficacious agents in the treatment of mania in bipolar I disorder
Haloperidol, risperidone, and olanzapine
127
Most common method of attempted suicide in youth
Ingestion of medication
128
The most common method used to complete suicide in the US
Firearms
129
This condition involves significant overestimation of body size and shape, with a relentless pursuit of thinness
Anorexia nervosa
130
This condition is characterized by eating large amounts of food in a brief period, followed by compensatory vomiting, laxative use, exercise, or fasting to rid the body of the effects of overeating in an effort to avoid obesity
Bulimia nervosa
131
In these conditions, food intake is restricted or avoided because of adverse feeding or eating experiences or the sensory qualities of food, resulting in significant unintended weight loss or nutritional deficiencies and problems with social interactions
Avoidant / restrictive food intake disorder (ARFID)
132
Parenting style that is warm, responsive, and accepting but that also sets expectations for behavior and achievement. Differences are approached with reasoning and discussion rather than by exerting control.
Authoritative parenting. This style is most likely to be associated with positive child outcomes across multiple domains
133
Most common form of self-injury.
Cutting
134
Most common neurobehavioral disorder of childhood
Attention-deficit/Hyperactivity Disorder
135
The most consistent and telling sign of reading disability in an accomplished young adult
slow and laborious reading and writing
136
Refers to the correct use of speech sounds to form words
Phonology
137
Refers to the correct use of words
Semantics
138
Refers to the appropriate use of grammar to make sentences
Syntax
139
The most common neck mass in the newborns
Lymphangioma (cystic hygroma) - a multiloculated cyst comprised of dilated lymphatics
140
The most common fracture in newborns
Clavicular fracture. The humerus and ulna are the 2nd and 3rd most commonly fractured bones at delivery
141
Manifested by an arm that is extended, internally rotated, and with limited movement
ERb's palsy
142
Characterized by difficulties in social interaction, eccentric behaviors, and abnormally intense and circumscribed interests despite normal cognitive and verbal ability
Asperger syndrome
143
Defined as failure to speak in specific social situations despite speaking in other situations
Selective mutism
144
Form of shock in cardiac tamponade
obstructive
145
Mild blood loss in pediatric patients is defined as ___, with systemic response of (CNS, CVS, Skin, UO)...
<30%
CVS: Increased heart rate; weak, thready peripheral pulses; normal systolic blood pressure; normal pulse pressure
CNS: Anxiety, irritability, confusion
Skin: cool, mottled, CRT prolonged
UO: Low to very low
146
Moderate blood loss in pediatric patients is defined as ___, with systemic response of (CVS, CNS, Skin, UO)...
30-45%
CVS: Markedly increased heart rate; weak, thready central pulses; peripheral pulses absent; low normal systolic blood pressure; narrowed pulse pressure
CNS: Lethargy; dulled response to pain
Skin: Cyanotic; capillary refill markedly prolonged
UO: Minimal
147
Severe blood loss in pediatric patients is defined as ___, with systemic response of (CVS, CNS, Skin, UO)...
>45%
CVS: Tachycardia followed by bradycardia; central pulses very weak or absent; peripheral pulses absent; hypotension; narrowed pulse pressure (or undetectable diastolic blood pressure).
CNS: coma
Skin: pale and cold
UO: None
148
