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Speciality Medicine II > Lecture 2 (Peds)-Exam 1 > Flashcards

Lecture 2 (Peds)-Exam 1 Flashcards

1
Q

Failure to Thrive (FTT)
* No what?
* What is the definition?
* All definitions identify children with FTT as having what?
* Underlying cause is always related to what?

A
  • A descriptive term with no consensus on definition
  • Inadequate physical growth diagnosed by observation of growth overtime using a standard growth chart (CDC, WHO)
  • All definitions identify children with FTT as having low weight in relation to age or length or insufficient weight gain over time
  • Underlying cause always related to inadequate nutrition
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2
Q

Failure to thrive- 2024 ICD-10-CM Dx code
* A clinical finding indication what?
* A condition of what?

A
  • A clinical finding indicating less than normal growth in infancy or early childhood
  • A condition of substandard growth or diminished capacity to maintain normal function.
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3
Q

Failure to thrive- 2024 ICD-10-CM Dx code
* Growth disorder of infants and children due to what?
* Inability to do what?
* Applicable to who?

A
  • Growth disorder of infants and children due to nutritional and/or emotional deprivation and resulting in loss of weight and delayed physical, emotional, and social development.
  • Inability to grow and develop normally
  • Applicable to pediatric patients aged 0 - 17 years inclusive
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4
Q

FTT
* What are the percentages of children admitted to any hospital, children hospitals and all clinics?

A
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5
Q

What is there is a higher prevalence of: stunting, wasting, overweight?

A

Stunting and wasting is way more of an issue than overweight

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6
Q

Causes of FTT- Organic
* Acute chronic disorders that interfere with what? Give 9 examples?

A
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7
Q

Causes of FTT- NonOrganic
* What is the cause? Give 9 examples

A
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8
Q

What is going on when a baby’s is highlighter green?

A

Mom’s breast milk is high in sugar and low in fats

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9
Q

FTT- Clinical features
* What happens with bowl mvts?
* Crying?
* Sleep?
* Mood?
* Lack of what?

A
  • Constipation (not enough calories+fats to have mvt)
  • Excessive crying
  • Excessive sleepiness (lethargy)
  • Irritability
  • Lack of interest in feeding
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10
Q

FTT- Clinical features
* Dlayed what? (3)
* Appearing what?
* Abnormal what?

A
  • Delayed rolling, sitting, standing, walking
  • Delayed social skills
  • Delayed puberty
  • Appearing much smaller than age expectations
  • Abnormal growth curves
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11
Q

FTT-Dx
* Assess what?
* What does not match?

A
  • Assess growth curves
  • Height, weight, and head circumference do not match standard growth charts
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12
Q

FTT Dx
* What is going on with weight? (2)
* Growth that is what?
* What is the difference btw non-organic and organic?

A
  • Weight <3% of standard growth charts
  • Weight 20% below the ideal weight for their height
  • Growth that has slowed or stopped
  • Non organic: Weight curve affect; Organic: all curves affected
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13
Q

Failure to Thrive: Dx
* What do you need to assess?
* Evaluate what?

A
  • Assess Pmhx (birth hx, chronic illness, surgeries, chronic disease)
  • Assess Social hx (living situation, parental support/resources/education)
  • Asses parent-child interaction
  • Evaluate development (ASQ)

Do this to rule out DDXs

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14
Q

Failure to Thrive: Dx
* What do you need to obtain?
* What do you need to complete? (2)
* What do you need to observe?

A
  • Obtain nutritional history and document (breastfeed, bottle, table foods, amount)
  • Complete ROS (stooling patterns, vomiting, urination, activity levels)
  • Complete PE (dysmorphic features, signs of malnutrition/child abuse, clues to underlying disease)
  • Observe feeding when available

Do this to rule out DDXs

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15
Q

FTT: DX
* What do you need to get for organic causes? List them (4)

A

Labs are obtained if PE, history and all other screening are suggestive of possible Organic Cause

Initial tests:
* CBC w/diff
* CRP
* ESR
* UA w/culture & sensitivity

MOST COMMON in ages under 2

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16
Q

FTT: DX
* What are Additional tests (if history or PE suggest the need)? (9)

A
  • CMP
  • Thyroid panel
  • Celiac panel
  • Sweat chloride test
  • Stool studies
  • TB skin testing
  • HIV
  • Xrays (cardiopulmonary diseae, bone age, child abuse if suspected)
  • Advanced imaging (abdominal U/S, abdominal or head CT, endoscopy
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17
Q

FTT: Treatment and management
* Identify what?
* What type of intervention? (create what)
* Consider what type of referrals?

A
  • Identify cause and treat or refer when appropriate
  • Nutrition and feeding intervention (create feeding plan/schedule, increase daily caloric intake)
  • Consider referral: Lactation, Nutrition, Speech, OT, Social work (if food resource issue), Psych (if parent-child divison)
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18
Q

FTT: Treatment/management
* Frequent what?
* What might be require?
* Parent _
* Involve who?

A
  • Frequent follow-up appointments with provider to monitor growth
  • Hospitalization (severe cases requiring enteral nutrition)
  • Parent Education
  • Involve Child Protective Services when appropriate
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19
Q

FTT
* What is the goal?
* What is the parent education portion (4)?

A

Goal is to create support for caregiver
* Dietary Advice (breastfeeding, formula, foods high in calories)
* Feeding Schedule (increase frequency)
* Feeding Behavior (avoid food battles)
* Feeding Environment (avoid distractions)

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20
Q

Failure to Thrive (FTT)
* Give parents what?
* Faciliate what?

A
  • Give parents a plan to follow, discuss goals and follow up schedule
  • Facilitation of access to WIC, food stamps, and Temporary Assistance for Needy Families
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21
Q

Failure to Thrive (FTT)
* What does 2.1.1, hunger and health organization and myplate provide?

A
  • 2.1.1 -Provides information about school lunch programs, summer food programs, soup kitchens, community gardens, and government-sponsored food programs
  • HungerandHealth.org -Provides a food bank locator and other resources households without enough food
  • MyPlate -Provides tip sheets and recipes for healthy eating at low cost
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22
Q

Growth Delay:
* Also known as what?
* What is it?

A
  • Also known as Delayed growth of childhood or Short Stature
  • A term applied to a child whose height is 2 standard deviations (SD) or more below the mean for children of that sex and chronologic age (and ideally of the same racial-ethnic group)

Height issue

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23
Q

Growth Delay
* Often coreesponds to what?
* Child with what?
* may be what? (2)

A
  • Often corresponds to a height that is < 3rd percentile
  • Child with height below that expected based on genetic potential
  • May be either a variant of normal growth or caused by a disease
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24
Q

What are the normal variants of growth delay? (4)

A
  • Familial or genetic short stature
  • Constitutional delay of growth and puberty
  • Idiopathic short stature
  • Small for gestational age infants with catch-up growth
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25
Q

What are the pathological causes of growth delay? (3)

A
  • Endocrine causes (hypothyroid)
  • Genetic diseases (turner’s, decrease GH)
  • Skeletal dysplasia (osteogenesis perfecta)
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26
Q

Growth Delay: Clinical Findings of Normal Variant
* Confimed by what?
* PE without what?
* Development appropriate for what?

A
  • Confirmed accurate measurements of length/height with decreased height velocity
  • PE without signs of symptoms of disease (no patho sxs)
  • Development appropriate for age without abnormalities
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27
Q

Growth Delay: Diagnosis of Normal Variant
* Assessment of what?
* Calculation of what?
* Absence of what?
* Normal what?
* _ Age

A
  • Assessment of growth curves
  • Calculation of estimated genetic height (mid-parental height)
  • Absence of Genetic condition or disease process
  • Normal Development (maintaining milestones)
  • Bone Age
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28
Q

Growth Delay:
* Estimate what? What are the calculations for boys and girls?

A

Estimated Genetic Height Calculation (no not memorize but need to know concept)
* For boys: [paternal height + (maternal height + 5 inches or 13 centimeters)] / 2
* For girls: [maternal height + (paternal height – 5 inches or 13 centimeters)] / 2

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29
Q

Growth delay: Bone age
* Represents what?
* Most commonly based on what?
* Bones in the x-ray are compared to what?

A
  • Represents degree of maturation of a child’s bones
  • Most commonly based on a single x-ray of the left hand, fingers, and wrist
  • Bones in the x-ray are compared to the bones of a standard atlas, The Greulich & Pyle (GP) Atlas

  • Need to do this at a min of 5 yo
  • Good to be younger because they will grow longer
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30
Q

Growth Delay: familial short stature
* Normal what?
* Height is what?
* Genetic height potential estimated by what?
* What does the growth chart look like?

A
  • Normal variant
  • Height is hereditary
  • Genetic height potential estimated by calculating the mid-parental height
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31
Q

Growth Delay: familial short stature
* Low normal what?
* Bone age is consistent with what?
* Give what?

A
  • Low-normal height velocity throughout life
  • Bone age is consistent with their chronologic age (16 yo-> bones are 16yo)
  • Give parental reassurance child is following parental expected height
32
Q

Growth delay: Constitutional delay of growth and puberty
* Childhood short stature with what?
* Normal what?
* Between 2-4 yrs old grow how?
* What does the chart look like?

A
  • Childhood short stature with relatively normal adult height
  • Normal size at birth
  • Between 2-4 yrs old grow at “new” low-normal rate
33
Q

Growth delay: Constitutional delay of growth and puberty
* What is common?
* What is delayed?
* Often family hx of what?
* Give what?

A
  • Delayed puberty is common
  • Bone age delayed
  • Often family history of same growth pattern
  • Give parental reassurance child will have expected genetic height
34
Q

Growth Delay: Growth hormone deficiency
* What type of cause?
* Can appear when?
* Abnormal what?
* What does the growth chart look like?

A
  • Pathological cause of growth delay
  • Can appears in infancy -> late childhood
  • Abnormal growth, may have obesity
35
Q

Growth delay: GH deficiency
* Males may have what?
* Delayed what?
* What are the labs?
* What is the txt?

A
  • Males may have microphallus, cryptorchidism
  • Delayed Bone Age
  • Labs: GH Stimulation test
  • Treatment: refer to Endocrine for Recombinant Human Growth Hormone
36
Q

Growth delay: parent edcation
* Provide what?
* Discuss what?
* Pathological causes require what?

A
  • Normal variant types provide parent reassurance
  • Discuss growth curves and expected genetic height
  • Pathological causes require diagnosis, possible referral to specialist and close monitoring with treatment where appropriate
37
Q

FTT vs Growth Delay
* What is the difference?

A
  • FTT = severe impairment in weight gain that may impair linear growth (height) overtime
  • Growth Delay = failure of linear growth (height) that is not caused by failure of weight gain
38
Q

ADD/ADHD
* What is it?

A

a disorder that manifests in childhood with symptoms of hyperactivity, impulsivity, and/or inattention. The symptoms affect cognitive, academic, behavioral, emotional, and social functioning.

39
Q

ADD/ADHD: DSM-5 definition
* What is the definition?

A
40
Q

ADD/ADHD: DSM Def
* There is clear evidence of what?
* The symptoms do not occur exclusively during what?

A
  • There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.
  • The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).
41
Q

ADD/ADHD
* One of the most common what?
* How many children are dx?
* Gender difference?

A
  • One of the most common neuropsychiatric disorders of childhood and adolescence, often persists into adulthood
  • 7 million children diagnosed in US between ages 3-17 yrs old
  • Boys (15%) were more likely to be diagnosed with ADHD than girls (8%)

Cannot cure it, just manage it

42
Q

ADD/ADHD
* What happened in 2022

A

In 2022, an additional one million U.S. children aged 3-17 years had received an ADHD diagnosis compared to 2016

43
Q

ADD/ADHD: core sxs of inattention
* Failure to provide what?
* Difficult maintaining what?
* Seems not to do what?
* Fails to do what?
* Difficulty to do what?

A
  • Failure to provide close attention to detail, careless mistakes
  • Difficulty maintaining attention in play, school, or home activities
  • Seems not to listen, even when directly addressed
  • Fails to follow through (homework, chores)
  • Difficulty organizing tasks, activities, and belongings
44
Q

ADD/ADHD: core sxs of inattention
* Avoids what?
* Loses what?
* Easily what?
* what happens in routine activites?

A
  • Avoids tasks that require consistent mental effort
  • Loses objects required for tasks or activities (school books, sports equipment)
  • Easily distracted by irrelevant stimuli
  • Forgetfulness in routine activities
45
Q

ADD/ADHD: hyperactivity and impulsivity sxs
* Excessive what?
* Difficulty remaining what?
* Feelings of what?
* Playing?

A
  • Excessive fidgetiness (tapping the hands or feet, squirming in seat)
  • Difficulty remaining seated when sitting is required
  • Feelings of restlessness (adolescents) or inappropriate running around or climbing in younger children
  • Difficulty playing quietly
46
Q

ADD/ADHD: Hyperactivity and impulsivity sxs
* Difficult to keep what?
* Excessive what?
* difficulty with what?
* Blunting what?
* Interruption of what?

A
  • Difficult to keep up with, seeming to always be “on the go”
  • Excessive talking
  • Difficulty waiting turns
  • Blurting out answers too quickly
  • Interruption or intrusion of others
47
Q

ADD/ADHD
* How does girls and boys differ in sxs?

A
48
Q

ADD/ADHD: DSM-5 diagnosis of ADHD requires (< 17 yrs)
* Needs 6 or more of what?
* What is the other criteria? (6)

A

≥6 symptoms of hyperactivity and impulsivity OR inattention

Also must include:
* Must occur often
* Present in >1 setting
* >6 months of symptoms
* Present before 12 yrs old
* Impair function in academic, social, or occupational activities
* Be excessive for the developmental level of the child

49
Q

DSM-5 diagnosis of ADHD requires (< 17 yrs):
* What needs to be excluded?

A

In addition, other physical, situational, or mental health conditions that could account for the symptoms must be excluded

50
Q

ADD/ADHD: Dx
* Involves what?
* Evaluation can be started when?
* What is average age of dx?

A
  • Involves comprehensive medical, developmental, educational, and psychosocial evaluation
  • Evaluation can be started after ≥ 4 yrs old
  • Average age diagnosis = 7 yrs old
51
Q

ADD/ADHD: Dx
* Must involve who?
* Multiple dicussions with who?
* What type of scales?

A

Must involve family and social/school history
* Often multiple discussions w/parents
* Behavior rating scales: parents, teachers, childcare providers

52
Q

Behavior Rating Scales: ADD/ADHD
* What are the two scales?

A
  • Conners 3rd Edition
  • Vanderbilt Assessment Scales
53
Q

ADD/ADHD
* What is the overall txt? (5)

A
  • Parent & Patient Education
  • School support (IEP)
  • Behavior Modification
  • +/- Medications
  • Initiate referral when appropriate (if younger than 4, must go to behavior psych)
54
Q

What are the different resources for parent education of ADD/ADHD? (3)

A
55
Q

ADD/ADHD: Behavior modification
* Preferred when?
* Adjuct with what?
* Maintain what?
* Keeping what at a minimum?
* Providing what?
* Set what?

A
  • Preferred initial treatment in pre-school age
  • Adjunct with meds in school age & adolescents
  • Maintaining a daily schedule
  • Keeping distractions to a minimum
  • Providing specific and logical places for the child to keep his or her schoolwork, toys, and clothes
  • Setting small, reachable goals
56
Q

ADD/ADHD: Behavior modification
* Reward what?
* Identify what?
* What can you use to help?
* Limiting what?
* Find what?
* Use what?

A
  • Rewarding positive behavior
  • Identifying unintentional reinforcement of negative behaviors
  • Using charts and checklists to help the child stay “on task“
  • Limiting choices
  • Finding activities in which the child can be successful (hobbies, sports)
  • Using calm discipline (time out, distraction, removing the child from the situation)
57
Q

ADD/ADHD: Medication
* Prior to the start all patients must be evaluated for what? (4)

A
  • Cardiovascular- focused Pmhx, Famhx & physical examination
  • Baseline height, weight, BP, HR
  • Pretreatment baseline conditions: appetite, sleep pattern, headaches, abdominal pain (bc these can all be SE)
  • Adolescent should be assessed for substance use/abuse
58
Q

ADD/ADHD: medication
* What are the different types of meds? (4)

A
59
Q

ADD/ADHD: Medication possible SE
* What are all the se? (9)

A
60
Q

ADD/ADHD: follow up
* What pts require follow up? When? (2)
* Always ask what?
* Monitor what?
* Reassess what?

A

All patients on medication require follow-up
* Monthly until dose is established
* Every 3-6 months once patient medication is consistent

Always ask about SE

Monitor Ht, Wt, BPs at every medication recheck (all things can be affected)

Reassess dose and need for adjustments or medication changes

61
Q

ADD/ADHD:
* when should you refer? (7)

A
62
Q

BRUE
* What is it?
* Combination of what?
* No explanation for what?

A
  • Transient event with no clear cause
  • Combination of apnea, color change, muscle tone change, and choking, or gagging in an infant
  • No explanation for event after an appropriate history and physical examination
63
Q
A
64
Q

SIDS/SUID
* What is the definition?
* What are some other names?

A
  • Definition: the sudden death of an infant younger than one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history
  • Other names: previously called crib or cot death
65
Q

SIDS/SUID
* Leading cause of what?
* Accounts for what?
* Often reported in what 3 categories?

A

Leading cause of infant mortality 1 mon-1 yr old

Accounts for ~3,400 deaths in children < 1yr in the US each year

Often reported as 3 categories
* Sudden infant death syndrome (SIDS)
* Unknown cause
* Accidental suffocation and strangulation in bed

In 2020 ~1,389 deaths due to SIDS, ~1,062 deaths due to unknown causes, ~905 deaths due to accidental suffocation and strangulation in bed

66
Q

What is the breakdown of SIDs?

A
67
Q

SIDS/SUID: Risk factors
* What are all the Risk factors? (10)

A
  • Young maternal age
  • Maternal smoking during pregnancy
  • Late or no prenatal care
  • Preterm birth and/or low birth weight
  • Prone sleeping position
  • Sleeping on a soft surface and/or w/ bedding accessories such as loose blankets & pillows
  • Bed-sharing
  • Overheating
  • Swaddling of older infants
  • Siblings of SIDS victims
68
Q

SIDS/SUIDs
* What are the protective factors? (5)

A
  • Room-sharing
  • Breastfeeding
  • Pacifier Use
  • Fan Use
  • Immunizations
69
Q

SIDS/SUID
* What is the proposed pathogenesis? (3)
* Ultimately the belief is SIDS results from what?

A
  • An underlying vulnerability (genetic pattern, brainstem abnormality)
  • Followed by a trigger event (airflow obstruction, maternal smoking, or infection)
  • During a vulnerable developmental stage of the central nervous or immune system
  • Ultimately the belief is SIDS results from the simultaneous occurrence of multiple events
70
Q

SIDS/SUID: Prevention
* What is key?
* What can be prevented in prenatally?
* Sleep?
* Avoid what?
* Feeding?
* What type of time?

A
71
Q

SIDS/SUID: back to sleep
* Campaign initiated in 1994 by a collaboration between what?
* 1993 - 2010 percent of infants placed how to sleep?
* SIDS rates declined considerably how?

A
  • Campaign initiated in 1994 by a collaboration between the National Institute of Child Health and Development, the American Academy of Pediatrics (AAP)
  • 1993 - 2010 percent of infants placed to sleep on their backs increased from 17% - 73%
  • SIDS rates declined considerably from 130 deaths per 100,000 in 1990 to 35 deaths per 100,000 live births in 2018
72
Q

End-of-life/Palliative Care
* What is it?

A

Pediatric palliative and hospice care providers work in interdisciplinary teams to deliver family-centered care that includes the child and family as one unit of care, respecting individual preferences, values, and cultural beliefs, with the child and family active in decision-making regarding goals and plan of care.

73
Q

What are the key aspects of end of life/palliative care? (10)

A
74
Q

Loss of a child:
* As a provider communicate with who?
* Recognize your role in providing what?
* In the hospital setting connect with who?
* Refer families to where?

A
  • As a provider communicate with the family and offer support
  • Recognize your role in providing cultural sensitivity and understanding the scope of family grief reactions
  • In the hospital setting connect the family with spiritual advisors, social services, or other supportive individuals identified by the family
  • Refer families to a local sudden unexpected infant/child death program or to other local bereavement services
75
Q

Examples of Resources For Families
* What are the 4 examples for families? Explain them

A
  • First Candle- organization that provides bereavement support to families who have experienced a loss
  • National Center for Education in Maternal and Child Health -national organization that offers links to resources for family bereavement support
  • Children’s Bereavement Center - organization that provides links to local resources and grief support
  • The Compassionate Friends - network of over 600 chapters with locations in

Speciality Medicine II (11 decks)

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