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

Lecture One (Peds)- Exam 1 Flashcards

1
Q

Well Child Exam Schedule: History
* Based on what?

A

Based on Bright Futures/American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care

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2
Q

Well Child Exam Schedule: History
* What is bright futures?

A

Bright Futures is a national health promotion and prevention initiative, led by the American Academy of Pediatrics and supported, in part, by the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB).

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3
Q

Well Child Exam Schedule: History
* Bright Futures Guidelines provides what?

A

Bright Futures Guidelines provide theory-based and evidence-driven guidance for all preventive care screenings and well-child visits.

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4
Q

What is the Well Child Exam Schedule?

A
  • Newborn Visit (3 to 5 days old)
  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old (usually vaccine free visit but still need to see development)
  • 12 months old
  • 15 months old
  • 18 months old
  • 2 years old (24 months)
  • 2 ½ years old (30 months)
  • 3 years old and then yearly up to age 21 years
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5
Q

Well Child Exam Schedule->What is the Purpose
* What are the prevent measures? (5)
* What are the growth and development things we what to look at? (4)

A
  • Pevention: Immunizations, Nutrition, Screening, Safety, Parent Education
  • Growth & Development: Growth Curves, Milestones, Social & Cognitive growth
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6
Q

Well Child Exam Schedule->What is the Purpose
* What are some parents concerns? (5)
* How is it a team approach?

A
  • Parent Concerns: Addressing development, behavior, sleep, eating, social skills
  • Team Approach: Providing relationships between provider, parent & child
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7
Q

Vaccine Schedule
* What is given at birth and 12 mo?

A

Birth: RSV, HEP B
12 M: RSV, HEP B, MMR, Varicella

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8
Q

What are special circumstances for immunizations? (7)

A
  • Vaccine hesitancy or refusal
  • Unknown/Uncertain immunization hx (other countries)
  • Preterm Infants (at birth they may be too young)
  • Immuno-compromised (ex. chemo)
  • Pregnancy (no live virus)
  • Travel (need certain vaccines based on location)
  • Increased Bleeding Risk (bleeding disorders-> use smaller needle or medications-> do not give vac after dose)
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9
Q

Contraindications-Immunizations
* If what happens after dose?
* What does pregnancy require?
* Altered what?

A
  • Severe allergic reaction after a previous dose or to a vaccine component
  • Pregnancy –no live virus vaccine
  • Altered Immunocompetence (sometimes cannot have live vaccine or do not make memory cells)
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10
Q

Contraindications-Immunizations
* When should chemo patients be seen for vaccines?

A

3 months after last chemo treatment

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11
Q

Contraindications-Immunizations
* What can happen 7 days after dose?
* What diease or a history of should not get rotavirus vaccine?

A
  • Persons who experienced encephalopathy within 7 days after administration of a previous dose of pertussis-containing vaccine not attributable to another identifiable cause
  • Severe Combined Immunodeficiency (SCID) disease and a history of intussusception are both contraindications to the receipt of rotavirus vaccines
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12
Q

Nutrition
* Educate patients on what?
* Development of what?
* What type of habits?

A
  • Educate parents on proper nutrition for growth: Breastfeeding, Formula, Table foods
  • Development of feeding and eating skills
  • Healthy eating habits (balance diet and water-> juice should really only be used for consitipation)
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13
Q

Nutrition
* What type of relationships?
* Address what?
* What type of supplements?

A
  • Healthy eating relationships: parent and child, socially (do not place in front of TV)
  • Address eating in those with special needs: Developmental, Genetic (lots of issues with food adversions, premines with senory issues, PKU cannot have phenylalaine, Galaemia cannot have normal formula)
  • Vitamins & Mineral Supplements: Iron (babies of anemic moms brestfeeding need iron), Vit D (start at birth), Fluoride (if not on tap), Multivitamins
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14
Q
A
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15
Q

What are all the screenings that a patient should get from birth to 18 yo?

A
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16
Q

Screening:
* How do we do the flordia newborn screening disorder panel? When do you do it?

A
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17
Q

Florida Newborn Screening Disorder Panel
* What does it screen for?
* When might you want to repeat it?

A

Currently screens for 58 different items (this includes hearing and cong heart disease)
* If a few months old and has sxs, you might want to redo the test because the original one might not have caught it

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18
Q

What is the bilitool for?

A

BiliTool is designed to help clinicians assess the risks toward the development of hyperbilirubinemia or “jaundice” in newborns over 35 weeks gestational age.
* Hyperbilirubinemia can cause kernicterus

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19
Q

When does bilirubin levels peak?

A

Peak at 3-7 days old so that newborn visit is very important
* Jaudice will show feet to head then disappear from head to feet

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20
Q

Screening Lead levels:
* Checked when?
* What type of sample is preferred? What can be done?

A
  • Checked at 12 months & 24 months of age
  • Venous sample preferred over capillary. A lot of times capillary is done at the clinic because it is easy. (normal levels do not need a venous sample but if high, you need to get a venous sample)
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21
Q

Screening *
* What are the different levels?

A
  • Level < 5 = low level, does not require repeat testing outside of recommendations
  • Levels >5 = discuss possible environment exposures and repeat levels
  • Level >20= additional studies & evaluation
  • Level >45= oral chelation
  • Level >70= medical emergency
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22
Q
A
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23
Q

Safety:
* _ dependent
* What is the number one cause of death?

A
  • Age Dependent
  • Injury Prevention
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24
Q

What are examples of injury prevention?

A

Car seats, sleep safety, home safety (locking things up) , poison prevention, fires & burns, choking, childcare, falls, drowning (very big issues), biking, sun exposure, sports safety, seatbelts, teen drivers, stranger safety, bullying prevention, drugs/alcohol, violence, suicide prevention (depression and violence)

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25
Q

What are mc causes of calls to poision control?

A
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26
Q

Across all ages 75.5% of poison exposures reported to U.S. poison centers in 2021 were what?
* Break that down into age groups

A

Across all ages 75.5% of poison exposures reported to U.S. poison centers in 2021 were unintentional.
* < 6 years= 99% are unintentional (TALK TO PARENTS)
* 13-17= 29.1% are unintentional (DO IT ON PURPOSE)

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27
Q

What are the most common substances in pediatric poison exposures?

A
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28
Q

What are the most frequent causes of pediatric fatalities?

A
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29
Q

Parent education:
* Educate and discuss what? (5)
* What is required by law and other resources?

A

Educate and discuss: Immunizations, Nutrition, Screening, Safety, Anticipated Milestones

Provide Resource Information:
* Vaccine Information Statements (required by law)
* Healthy Children.org
* Bright Futures

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30
Q

Growth Curves
* Must occur when?
* Who should be doing this?
* What does that CDC recommend?

A
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31
Q

Milestones:
* Important to review what?
* When do they need to be evaluated?

A
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32
Q

Developmental screening
* What are the screenings based on motor (fine+motor), cognitive, speech? (4)

A
  • Ages and Stages Questionnaire (ASQ)
  • Parents’ Evaluation of Developmental Status (PEDS)
  • Child Development Inventories (CDI)
  • Survey of Well-being of Young Children (SWYC)

Basically all the same, just depends on where you work

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33
Q

Developemtnal screening: *
* What are the screening tools for autism (2)?

A
  • Modified Checklist for Autism in Toddlers [MCHAT]
  • Screening Tool for Autism in Toddlers and Young Children (STAT)
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34
Q

Developmental Screening
* What is the Ages and Stages Questionnaire (ASQ)

A

a parent-completed, age dependent based, questionnaire that may be used as a general developmental screening tool

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35
Q

Ages and Stages Questionnaire (ASQ)
* Addresses what? (5)
* What are the ages?
* Currently avilable in what languages?
* Should be completed when?

A
  • Addresses: Communication, gross motor, fine motor, problem solving, and personal-social
  • Ages: 21 total age categories starting at 2 mon old up to 60 months old
  • Currently available: Arabic, Chinese, English, French, Spanish, and Vietnamese languages
  • Should be completed at each Well visit
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36
Q

How is the ASQ scored?

A
  • Below cutoff: Need evaluation
  • Near cutoff: Monitor and may need evaluation
  • Above cutoff: Does not need further evaluation at this stage
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37
Q

Developmental screening:
* What is the modified M-CHAT? What are the age range + most often given when?

A
  • a parent-completed psychological questionnaire that
    evaluates risk for autism spectrum disorder in children ages 16–30 months (NO YOUNGER THAN 16mo)
  • Most often given at 18 month and 24 month Well Visits
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38
Q

MCHAT Scoring
* Scored based on what?
* What is the score levels? (4)

A
  • Scored based on a list of Failed Responses
  • Each failed answer = 1 point
  • Score 0-2 = passed
  • Score 3-7 = requires further questions and may need evaluation
  • Score 8-20 = considered high-risk for ASD and requires further evaluation
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39
Q

MCHAT Scoring
* What should happen regardless of score?

A

Surveillance should continue at all subsequent health supervision visits regardless of the score

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40
Q

Developmental Delay
* What is the definition?
* What are the different areas? (4)

A

a condition in which a child is behind schedule in reaching milestones of early childhood development
* Motor Skills
* Speech/language
* Social
* Cognitive/Problem Solving

41
Q

Developmental Delay
* Cause?
* Can also be a sxs of what?

A
  • Cause often not known
  • Can also be a symptom of other underlying medical conditions
42
Q

Developmental Delay
* What are the risk factors?

A
  • Complications at birth- prematurity, low birth weight, hypoxic birth injury
  • Perinatal exposures- infection, toxins
  • Post natal exposures- lead (can reverse if caught early)
  • Poor nutrition & neglect
  • Recurrent otitis media (muffled hearing)
  • Chronic illness (in and out of hospital)
  • Vision Disturbance
  • Trauma
  • Adoption (esp other countries)
43
Q

Developmental disabilities:
* What is the definition?

A

A group of conditions due to an impairment in physical, learning, language, or behavior areas that begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person’s lifetime (DOES NOT GO AWAY)

44
Q

Developmental Disabilities
* What are the examples?

A
  • Attention-Deficit/Hyperactivity Disorder
  • Autism Spectrum Disorder
  • Cerebral Palsy
  • Fetal Alcohol Spectrum Disorders
  • Fragile X Syndrome
  • Hearing Loss
  • Intellectual Disability (tri 21)
  • Kernicterus (why we care about bilirubin)
  • Language and Speech Disorders
  • Learning Disorders
  • Muscular Dystrophy
  • Tourette Syndrome
  • Vision Impairment (not just glasses: more serious)
45
Q

What type of approach is needed with children with developmental disabilities?

A
46
Q

What is DSM-5 diagnosis of ASD is characterized by ?

A

Persistent deficits in social communication (the big issue) and interaction (eg, deficits in social reciprocity; nonverbal communicative behaviors; and skills in developing, maintaining, and understanding relationships), and may have restricted, repetitive patterns of behavior, interests, or activities

47
Q

Under the DSM-5 what else is included under autism spectrum disorder

A

Classic autism, childhood autism, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified, Asperger disorder

48
Q

Autism
* What ist he prevalence?
* What is the Male to female ratio?

A

Prevalence = Estimates vary with study methodology and the population that is evaluated
* Europe, Asia, US ranges = 2 - 25 /per 1,000 or ~1 in 40 to 1 in 500

Male-to-female ratio = 3-4 times more common in boys than girls

49
Q

Autism Spectrum Disorder (ASD)
* What is the rate in siblings?
* What are associated conditions/syndromes?

A
  • Rate in siblings= 10-20% incidence if one sibling has ASD
  • Associated conditions/syndromes: Intellectual disability, ADD, Epilepsy, genetic syndromes
50
Q

Autism Spectrum Disorder (ASD)
* What are the possible causes of the pathogenesis?(5)

A

Pathogenesis: not completely understood
* Genetic factors
* Neurobiologic factors (atypical neural connectivity)
* Parental Age (Moms over 30 and dads over 40)
* Environmental & Perinatal factors
* Maternal Medication use during pregnancy- seizure medications + SSRIs

51
Q

Autism Spectrum Disorder (ASD)
* What is there a lack of association with?

A

MMR and/or Thimersol were originally believed by some as cause

  • Alleged association was first reported in a 1998 study of 12 children
  • In 2004, 10 of the 13 authors of the study published a statement retracting its interpretation, and the Lancet fully retracted the paper in 2010
  • An investigative reporter found that the study was fraudulent after comparing the paper vs patient medical records
52
Q

Autism Spectrum Disorder (ASD)
* Prospective studies indicate that findings of ASD often are present when? Before what?

A

Prospective studies indicate that findings of ASD often are present during the first year of life, before the first dose of MMR
* 2020 systematic review of two cohort studies (~2 million children) and four case control studies (~9000 children) found no evidence to support a relationship between MMR vaccination and ASD

53
Q

Autism Spectrum Disorder (ASD)
* what vaccines do and do not have thimerosal?
* What also has been a concern?

A
  • In the US Inactivated Flu vaccine may contain (many do not)
  • MMR, Varicella, inactivated Polio, Pneumococcal vaccines never contained thimerosal
  • Before 2001, it was used as a preservative in some vaccines Hep B, dTap, Hib and Rh immune globulin
  • Mercury concerns have also been refuted (2014 systematic review of three cohort studies which included 718,200 children)
54
Q

Autism Spectrum Disorder (ASD)-Clinical Features
* Typically presents when?
* Plateau of what? When?
* Lack of what?

A
  • Typically presents in first 2 years of life
  • Plateau of social skills between 15-24 months
  • Lack of interest in others, failure in empathy, absent or delayed language & communication, restricted interests
55
Q

Autism Spectrum Disorder (ASD)-Clinical Features
* What type of behavior disturbances?
* What type of mannerisms?
* Insistance on what?

A
  • Behavior disturbances- overfocus on preferred topics, difficulty with organization, disruptive behaviors
  • Stereotyped and repetitive motor mannerisms - hand flapping, toe walking, rocking
  • Insistence on sameness/resistance to change- only eats same foods, same routine
56
Q

Autism Spectrum Disorder (ASD)-Clinical Feature
* What type of sensory issues?
* What happens to the head?
* _ Skills

A
  • Sensory Issues -Preoccupation with edges, spinning objects, texture issues with food, Preoccupation with sniffing or licking nonfood objects, resistance to being touched, hypersensitivity to certain types of sound
  • Macrocephaly – ¼ have >97% HC
  • Special Skills (card skills, rubic cubes, etc)
57
Q

Autism Spectrum Disorder (ASD)
* How do you diagnosis it?(4)

A
  • Well Visit Developmental Screening tools: ASQ, MCHAT
  • Clinical Judgement
  • Parental Concerns
  • Correlation with Associated Conditions (more on alert)
58
Q

What are the assoicated conditions of ASD?

A

Learning difficulty often arises in those with normal IQ by 3rd or 4th grade

59
Q

ASD-Provider next step
* Refer to who?

A
  • Refer to Specialist for comprehensive multidisciplinary evaluation
    * developmental-behavioral pediatrician, child psychiatrist, child neurologist, (neuro)psychologist
  • Refer to local Developmental/Behavioral services (Ex. Early Steps, FDLRS)
  • Refer to Speech, OT, PT (when appropriate)
  • Refer to Dentist who works with Developmental Disabilities
60
Q

ASD-Provider next step
* Educate parents on what?
* Continue with what?
* Discuss what?
* Advise parents about what?

A
  • Educate parents on importance of maintaining routine well visits & appropriate f/u
  • Continue with age-appropriate screening (hearing, vision, lead)
  • Discuss with parents’ school-based programs (Individualized Education Program: IEP)
  • Advise parents about support groups & counseling
61
Q

Cerebral Palsy
* A condition marked by what?
* A group of disorders that affect what?

A
  • A condition marked by impaired muscle coordination (spastic paralysis) and/or other disabilities, typically caused by damage to the brain before or at birth.
  • A group of disorders that affect a person’s ability to move and maintain balance and posture.
62
Q

Cerebral Palsy
* MC what?
* How many live births?
* Higher rates in who? (2)
* What group represent most cases?
* Sex preference?

A
63
Q

Cerebral Palsy
* What are the prenatal risk factors?

A
  • Prematurity
  • Intrauterine growth restriction
  • Intrauterine infection
  • Antepartum hemorrhage
  • Severe placental pathology
  • Multiple pregnancy (twin, triplets)
  • Perinatal hypoxic-ischemic injury
  • Intracranial hemorrhage

MCC

64
Q

Cerebral Palsy:
* What are the post natal causes?

A

Post-Natal Causes (~10-18% of all cases)
* Stroke- heart disease, prothrombotic disorder, sickle cell disease, vasculopathy, metabolic disorder
* Trauma
* Severe Hypoxic Event- near-drowning
* Sepsis
* Meningitis
* Kernicterus
* Other causes of encephalopathy- Inborn errors of metabolism

65
Q

Cerebral Palsy
* Clinical features depend on what?
* Many have what?

A
  • Clinical Features depend on subtype of CP
  • Many have overlapping features making classification difficult
66
Q

Cerebral Palsy
* What are the subtypes?

A

Spastic subtypes:
* Spastic diplegia =13-25%
* Spastic hemiplegia =21-40%
* Spastic quadriplegia =20-43%

Dyskinetic subtypes (Choreoathetotic, Dystonic) =12-14%

Ataxic CP =4-13%

67
Q
A
68
Q

Cerebral Palsy- Clinical feature (early stages-birth to one yo)
* Tone?
* _ asymmetry
* Spasticity involving what?
* Early what?

A
69
Q

Cerebral Palsy- Clinical feature (early stages-birth to one yo)
* Inability to use what?
* Poor what?
* What happens to the legs?

A
  • Inability to use both hands in midline or to reach out with the affected limb
  • Poor head control
  • Scissoring of the legs
70
Q

Cerebral Palsy- Clinical feature (early stages-birth to one yo)
* Persistence of what?
* What is delayed?
* _ failure

A
  • Persistence of primitive reflexes (last too long)
  • Motor milestones and language skills delayed
  • Growth failure (because cannot consume food)
71
Q

Cerebral Palsy- Clinical feature (late stages-over 1 yo)
* Tone?
* Tendon reflexes?
* _
* Contractures of what?

A
  • Increased tone
  • Brisk deep-tendon reflexes
  • Clonus
  • Contractures of affected muscles
72
Q

Cerebral Palsy- Clinical feature (late stages-over 1 yo)
* What happens to lower limbs?
* Reduced what?
* What happens to the hips?
* _ deficits?

A
  • Lower limbs can be more affected than the upper limbs
  • Reduced limb length and muscle bulk in lower extremities
  • Flexion, adduction, and internal rotation of the hips
  • Sensory deficits
73
Q

Cerebral Palsy- Clinical feature (late stages-over 1 yo)
* What type of mvts? (2)
* What are some issues in severe forms?

A
  • Involuntary movements (Chorea, Athetosis, Dystonia)
  • Ataxic movements
  • Feeding difficulties, chronic respiratory insufficiency, & seizure disorder in severe forms
74
Q

Cerebral Palsy
* How do you dx it?

A
75
Q

Cerebral palsy
* What are associated conditions?

A
76
Q

Cerebral Palsy- Provider next step
* Refer to who? (3)

A

Refer to Specialist for comprehensive multidisciplinary evaluation
* Ortho, Psychiatrist, Neurologist, Psychologist, Optho, GI, Pulm, ENT, Pain Management Centers

Refer to local Developmental/Behavioral services (Ex. Early Steps, FDLRS)

Refer to Speech, OT, PT (spasticity treatments, orthotics)

77
Q

Cerebral Palsy- Provider next step
* Educate parents on what?
* Continue with what?
* Discuss what?
* Provide what?

A
  • Educate parents on importance of maintaining routine well visits & appropriate f/u
  • Continue with age appropriate screening (hearing & vision)
  • Discuss with parents school-based programs (Individualized Education Program: IEP)
  • Provide families information about support groups & counseling
78
Q

What are some Other Developmental Disorders that a require Team Approach? (7)

A
  • Trisomy 21
  • Klinefelter Syndrome
  • Turner Syndrome
  • Fragile X Syndrome
  • Fetal Alcohol Syndrome
  • Prader-Willi Syndrome
  • Angelmann Syndrome
79
Q

Developmental Disabilities-Provider Responsibilities
* Maintain what?
* Continue with what?
* Refer to who?

A
  • Maintain relationship with families
  • Continue with Routine Health Visits
  • Refer to appropriate Specialists & Therapy Services
80
Q

Developmental Disabilities-Provider Responsibilities
* Provide what?
* Educate families on what? (2)

A
  • Provide families with appropriate resources & support
  • Educate families on being the child’s advocate
  • Educate families on Education/Learning Services
81
Q

Developmental disabilities:
* Why is it important to see if the disability on the CDC list?
* What is free to all children with disabilities?

A
  • Get different things cover that might not have been covered previously without the CDC disability
  • Insure Kids Now
82
Q

Developmental Disabilities-Individuals with Disabilities Education Act (IDEA)
* What happens in the early 1970s?
* More than 1 mil children has no what?
* What happened to many of them?

A
  • Early 1970s, U.S. public schools accommodated only 1 out of 5 children with disabilities
  • More than 1 million children had no access to public school
  • Many of them living at state institutions where they received limited or no educational & rehabilitation services
83
Q

Developmental Disabilities-Individuals with Disabilities Education Act (IDEA)
* What happened in the 1975? What did this cause?
* What did IDEA replace?
* September 6, 2011, the US Department of Education updated what?

A
  • 1975-Originally known as Education for All Handicapped Children Act (EHA) : schools were required to evaluate handicapped children and create an educational plan with parent input
  • 1990 IDEA replaced EHA
  • September 6, 2011, the US Department of Education updated the IDEA to include specific interventions for children <2yrs who have disabilities
84
Q

Under Individuals with Disabilities Education Act (IDEA), what are the 6 key elements that every child is allowed to have?

A
85
Q

Developmental Disabilities*
* What does it not include?
* What must a child fall into?

A
86
Q

Developmental Disabilities-Every Student Succeeds Act (ESSA)
* Passed when?
* What did it replace?
* Set what?
* How is it driven?
* Requires what?

A
  • Passed into law Dec 15, 2011
  • Replaced No Child Left Behind Act (NCLB) 2001
  • Set new mandates on expectations and requirements for students with disabilities
  • State driven education plans
  • Requires states to provide the appropriate accommodations for students with disabilities
87
Q

Gross motor skills
* What happens at 4,5,6, 7 and 9mo?

A
88
Q

Gross motor skills
* What happens at 10, 12, 15, 18, 24 mo

A
89
Q

Gross motor skills
* What happens at 2.5 years, 3 years, 4 and 5 years?

A
90
Q

Fine motor skills
* What are the skills at 2, 4, 5, 6, 9 mo?

A
91
Q

Fine motor skills
* What are the skills at 12, 15, 18, 21 and 24 mo?

A
92
Q

Fine motor skills
* What are the skills in 2.5, 3, 4, 5 years?

A
93
Q

Language skills
* What are the skills for 2, 4, 5, 6, and 9 mo

A
94
Q

Language skills
* What are the skills for 11, 12, 15, 18 and 24 mo?

A
95
Q

Language skills
* What are the skills at 2.5, 3, 4, 5 years?

A
96
Q

Social skills
* What are the skills for 2, 4, 6, 9 and 12 mo?

A
97
Q

Social skills
* What are the skills for 15, 18 and 24 mo?

A
98
Q

Social Skills
* What happens at 2.5, 3, 4, 5 yo?

A

Speciality Medicine II (11 decks)

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