hodgepudge Flashcards
Approximate gain in length from birth to 3 months
9 cm
Probable age of the child: developed handedness, able to say 2-3 words, and rides a tricycle
36 months (3 yo)
Probable age of the child: crawls up stairs, makes tower of 3 cubes, pointing, hugs parents
15 months
Probable age of the child: walks up stairs with one hand held, makes tower of 4 cubes, imitates scribbling, names pictures, identifies one or more parts of body
18 months (1 1/2 yo)
Probable age of the child: Runs well, walks up and down stairs one step at a time, scribbles in circular pattern, imitates horizontal stroke, Puts 3 words together, Handles spoon well
24 months (2 yo)
Average gain in length during the first year of life.
reaches 25 cm
Probable age of the child: stands momentarily on 1 foot, Knows age and sex, counts 3 objects correctly, Plays simple games (in “parallel” with other children)
36 months (3 yo)
Probable age of the child: Hops on one foot, throws ball overhand, draws man with 2-4 parts besides head, identifies longer of 2 lines, tells story, role-playing, goes to toilet alone
48 months (4 yo)
Probable age of the child: skips, names heavier of 2 weights, Names 4 colors, repeats sentence of 10 syllables, asks questions about meaning of words.
60 months (5 yo)
Posterior fontanel usually closes at
6-8 weeks (Nelson’s)
Anterior fontanel usually closes at
18 mo, but can close normally as early as 9 mo (Nelson’s)
Persistence of open posterior fontanel can suggest
underlying hydrocephalus or congenital hypothyroidism
A very small or absent anterior fontanel at birth might indicate
craniosynostosis or microcephaly
A bulging fontanel indicates
an indicator of increased ICP, but vigorous crying can cause a protuberant fontanel in a normal infant
Peak age of crying
6 weeks
Tanner Staging or
Sexual Maturity Rating (SMR)
SMR 1 in girls
Pubic hair: Preadolecent;
Breasts: Preadolescent
SMR 2 in girls
Pubic hair: Sparse, lightly pigmented, straight, medial border of labia;
Breasts: Breast and papilla elevated as small mound; diameter of areola increased
SMR 3 in girls
Pubic hair: Darker, beginning to curl, increased amount
Breasts: Breast and areola enlarged, no contour separation
SMR 4 in girls
Pubic hair: Coarse, curly, abundant, but less than in adult
Breasts: Areola and papilla form secondary mound
SMR 5 in girls
Pubic hair: Adult feminine triangle, spread to medial surface of thighs
Breasts: Mature, nipple projects, areola part of general breast contour
SMR 1 in boys
Pubic Hair: None
Penis: Preadolescent
Testis: Preadolescent
SMR 2 in boys
Pubic Hair: Scanty, long, slightly pigmented
Penis: Minimal change/enlargement
Testis: Enlarged scrotum, pink, texture altered
SMR 3 in boys
Pubic Hair: Darker, starting to curl, small amount
Penis: Lengthens
Testis: Larger
SMR 5 in boys
Pubic Hair: Adult distribution, spread to medial surface of thighs
Penis: Adult size
Testis: Adult size
% body weight loss in mild dehydration
Sequence of pubertal events in males
Genital 2, genital 3, pubic hair 2, genital 4, pubic hair 3, peak height velocity, pubic hair 4, genital 5, pubic hair 5
Sequence of pubertal event in females
Breast 2, pubic hair 2, peak height velocity, breast 3, pubic hair 3, pubic hair 4, breast 4, menarche, pubic hair 5, breast 5
Clinical manifestations of severe dehydration
Peripheral pulses either rapid and weak or absent; decreased blood pressure; no urine output; very sunken eyes and fontanel; no tears; parched mucous membranes; delayed elasticity (poor skin turgor); very delayed capillary refill (>3 sec); cold and mottled; limp, depressed consciousness
1st sign of puberty in girls
appearance of breast buds (hallmark of SMR 2), 8-12 yr of age
SMR 4 in boys
Pubic Hair: Resembles adult type, but less quantity; coarse, curly
Penis: Larger; glans and breadth increase in size
Testis: Larger, scrotum dark
Diagnosis of anaphylaxis. Any of the 3 criteria. Criteria 3.
Reduced BP following exposure to known allergen for that patient (minutes to several hours):
a Infants and children: low systolic BP (age-specific) or >30% drop in systolic BP
b Adults: systolic BP 30% drop from patient’s baseline
Diagnosis of anaphylaxis. Anyone of the 3 criteria. Criteria 1.
Acute onset of an illness (minutes to several hours) with involvement of the skin and/or mucosal tissue (e.g., generalized hives, pruritus or flushing, swollen lips/tongue/uvula)
AND AT LEAST ONE OF THE FOLLOWING:
a Respiratory compromise (e.g., dyspnea, wheeze/bronchospasm, stridor, reduced peak PEF, hypoxemia)
b Reduced BP or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence)
Diagnosis of anaphylaxis. Anyone of the 3 criteria. Criteria 2.
Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours):
a Involvement of the skin/mucosal tissue (e.g., generalized hives, itch/flush, swollen lips/tongue/uvula)
b Respiratory compromise (e.g., dyspnea, wheeze/bronchospasm, stridor, reduced PEF, hypoxemia)
c Reduced BP or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence)
d Persistent gastrointestinal symptoms (e.g., crampy abdominal pain, vomiting)
% body weight loss in moderate dehydration
5-10% in an infant; 3-6% in an older child or adult
Clinical manifestations of minimal dehydration
Normal or increased pulse; decreased urine output; thirsty; normal physical findings
Most common cause of anaphylaxis occurring outside the hospital
food allergy
Menarche happens
during SMR 3-4 (median age, 12 yr; normal range, 9-16 yr)
1st sign of puberty in boys
testicular enlargement and hallmark of SMR2. (as early as 9 1/2 yr) . Followed by penile growth during SMR3
Probable age of the child: Goes up stairs alternating feet, Refers to self by pronoun I; knows full name, pretend in play
30 months (2 1/2 yo)
In cases of food-associated exercise-induced anaphylaxis, children must not
exercise within 2-3 hr of ingesting the triggering food and, like children with exercise-induced anaphylaxis, should exercise with a friend, learn to recognize the early signs of anaphylaxis (sensation of warmth and facial pruritus), stop exercising, and seek help immediately if symptoms develop.
Clinical manifestations of moderate dehydration
Tachycardia; little or no urine output; irritable/lethargic; sunken eyes and fontanel; decreased tears; dry mucous membranes; mild delay in elasticity (skin turgor); delayed capillary refill (>1.5 sec); cool and pale
Anaphylaxis occurring in the hospital results primarily from
allergic reactions to medications and latex
% body weight loss in severe dehydration
> 10% in an infant; >6% in an older child or adult
The neonate with dehydration due to poor intake of breast milk often has what kind of dehydration?
Hypernatremic dehydration. Hypernatremic dehydration is likely in any child with losses of hypotonic fluid and poor water intake, such as may occur with diarrhea, and poor oral intake due to anorexia or emesis.
Good urine output may be deceptively present in child experiencing dehydration if
If a child has an underlying renal defect, such as diabetes insipidus or a salt-wasting nephropathy, or in infants with hypernatremic dehydration
Patients with latex allergy may also experience food-allergic reactions from homologous proteins in foods such as
bananas, kiwi, avocado, chestnut, and passion fruit
Hyponatremic dehydration occurs in
Occurs in the child with diarrhea who is taking in large quantities of low-salt fluid, such as water or diluted formula.
A serious allergic reaction that is rapid in onset and may cause death, occurs when there is a sudden release of potent biologically active mediators from mast cells and basophils, leading to cutaneous, respiratory, cardiovascular, and gastrointestinal symptoms.
Anaphylaxis
Important cause of food-induced anaphylaxis, accounting for the majority of fatal and near-fatal reactions
peanut allergy
Which growth period is rapid and is critical for neurocognitive development, and bears higher metabolic rate and nutrient requirements, relative to body size?
Infancy growth period
What type of vitamin k deficiency of bleeding at birth occurs at 1-14 days of age? It is secondary to low stores of vitamin K at birth due to the poor transfer of vitamin K across the placenta and inadequate intake during the 1st few days of life. In addition, there is no intestinal synthesis of vitamin K2 because the newborn gut is sterile. Occurs mostly in breast-fed.
Early vkdb
VKBD most commonly occurs at 2-12wk of age, although cases can occur up to 6mo after birth. Almost all cases are in breast-fed infants due to the low vitamin K content of breast milk.
Late VKDB
VKDB occurs at birth or shortly thereafter.secondary to maternal intake of medications, such as warfarin, phenobarbital and phenytoin, that cross placenta and interfere with vitamin k function.
Drug induced VKDB
Vitamin k deficiency due to fat malabsorption can occur in any age. What are the possible etiologies?
cholestatic liver disease, pancreatic disease, and intestinal disorders (celiac sprue, inflammatory bowel disease, short-bowel syndrome), Prolonged diarrhea, Children with cystic fibrosis having pancreatic insufficiency and liver disease
Osmolality equation. Normal osmolality values.
Osmolality (mmol) = 2 x [Na] + [glucose]/18 + [BUN]/2.8
Normal values = 285-295 mOsm/kg
Glucose and blood urea nitrogen (BUN) are measured in mg/dL. Division of these values by 18 and 2.8, respectively, as shown, converts the units into mmol/L. Multiplication of the sodium value by 2 accounts for its accompanying anions, principally chloride and bicarbonate. The calculated osmolality is usually slightly lower than the measured osmolality.
Effect of glucose in plasma osmolality
Hyperglycemia causes an increase in the plasma osmolality because it is not in equilibrium with the intracellular space. During hyperglycemia there is a shift of water from the intracellular space to the extracellular space. This is clinically important in children with hyperglycemia during diabetic ketoacidosis. The shift of water causes dilution of the sodium in the extracellular space, causing hyponatremia despite an elevated plasma osmolality.
The dominant cation of the ECF and it is the principal determinant of extracellular osmolality.
Sodium
Short stature, coarse facies, dry skin, cataracts, macroglossia in an infant
untreated congenital hypothyroidism
physiologic jaundice
- indirect bilirubin 1-3 mg/dl and increases at a rate of <5mg/dl
- starts to rise 1st-3rd day and peaks at 2nd-4th day
- 2mg/dl at 5th-7th day of life
most common pathogen that causes systemic and focal infections in the newborn
Group B Streptococci
transient lower esophageal sphincter relaxation is the primary mechanism for
gastroesophageal reflux
More than 90% of congenital adrenal hyperplasia (CAH) cases are caused by
21-hydroxylase deficiency
What hormone/s are deficient in the most severe, salt-wasting form of the classical 21-hydroxylase deficiency (CAH)
Because both cortisol and aldosterone require 21-hydroxylation for their synthesis, both hormones are deficient in the most severe, salt-wasting form of the disease. This form constitutes about 70% of cases of classical 21-hydroxylase deficiency.
Blood component of choice for patients with Hemophilia A
Cryoprecipitate
Gold standard in the diagnosis of aplastic anemia
Bone marrow aspiration biospsy
Based on EPI, which vaccines should an 11 month old receive?
BCG, DPT3, OPV3, Hepa B3, measles, HiB3
Acute febrile bloody diarrhea followed by development of hemolytic anemia, thrombocytopenia, and renal failure is caused by
Enterohemorrhagic E. coli (EHEC)
most common cause of anemia in children and adolescents
iron deficiency anemia
