Medical Screening Part 2 Pediatrics and Adolescence Flashcards
1
Q
what is the range for HR in the newborn population (<1)?
A
100-160 bpm
2
Q
what is the range for RR in the newborn population (<1)?
A
30-60 bpm
3
Q
what is the range for SBP in the newborn population (<1)?
A
> 60mmHg
4
Q
what is the range for HR in the toddler population (1-3)?
A
90-150 bpm
5
Q
what is the range for RR in the toddler population (1-3)?
A
24-40 bpm
6
Q
what is the range for SBP in the toddler population (1-3)?
A
> 70 mmHg
7
Q
what is the range for HR in the preschool population (4-5)?
A
80-150 bpm
8
Q
what is the range for RR in the preschool population (4-5)?
A
22-34 bpm
9
Q
what is the range for SBP in the preschool population (4-5)?
A
> 75 mmHg
10
Q
what is the range for HR in the elementary population (6-12)?
A
70-120 bpm
11
Q
what is the range for RR in the elementary population (6-12)?
A
18-30 bpm
12
Q
what is the range for SBP in the elementary population (6-12)?
A
> 80 mmHg
13
Q
what is one reason that BP increases with age?
A
as children age, they grow vertically and the BP needs to increase to adequately get blood to all areas of the body
14
Q
t/f: normal adult BP would be a hypertensive crisis for a child
A
true
15
Q
t/f: children are little adults
A
FALSE
16
Q
rubella is most contagious when?
A
7 days b4 and 7 days after the rash erupts
17
Q
what are the s/s of rubella?
A
rash starts on face/trunk and spreads to extremities
mild fever (<100 deg)
lymph node adenopathy
cough, congestion, conjunctivitis
18
Q
where does the rash usually start with rubella?
A
on the face/trunk
19
Q
how is roseola spread?
A
via direct contact, cough, or sneeze
20
Q
roseola is most common in what age group?
A
children 9 months to 3 yo
21
Q
what are the s/s of roseola?
A
beware of seizures associated w/high fever
fever x3-4 days f/d rash
maculopapular rash on trunk and spreads to extremities
red bumps may turn white after being touched
cold-like sx
22
Q
why may seizures occur in roseola?
A
bc of high fever
23
Q
where does the rash usually start in roseola?
A
on the trunk then spreads to extremities
24
Q
what kind of rash is characteristic of roseola?
A
a macropapular rash
25
what kind of virus is chicken pox?
varicella
26
what is the incubation period for chicken pox?
11-21 days
27
how is chicken pox spread?
via droplets from coughing, sneezing, or direct contact with blister contents
28
what are the 3 stages of skin lesions in chicken pox?
macule, vesicle, granular scab
29
where do lesions usually start in chicken pox?
head/trunk
30
from the head/trunk, where can chicken pox lesions spread to?
buccal mucosa
scalp
axilla
upper respiratory tract
conjunctiva
31
the varicella virus can sit dormant in the DRG after a chicken pox infection and later cause what?
shingles
32
what are the s/s of chicken pox?
3 stages of skin lesions: macule, vesicle, granular scab
skin lesions start on head/trunk and spread to limbs, buccal mucosa, scalp, axilla, upper respiratory tract, and conjunctiva
itching and general body aches
cold-like sx
33
t/f: chicken pox is a DNA virus
true
34
if you haven't had chicken pox, can you get shingles?
no, but you can get chicken pox
35
t/f: chicken pox can be deadly in adults
true
36
what is the incubation time for measles (rubeloa)?
10-21 days
37
how is measles (rubeloa) spread?
via airborne droplets or fluids in blisters from 1-2 days b4 blisters until they crust over
38
what is often the 1st sign of measles (rubeloa)?
>100 deg fever, sore throat, runny nose, and cough
39
where does the bright red blotchy rash start in measles (rubeloa)?
on the face/neck and spreads to the limbs
40
how long does it take the rash to fade in measles (rubeloa)?
3-5 days
41
what are Koplik's spots?
a signs of measles (rubeloa)
small red spots with bluish white specks in the center
42
what are the s/s of measles (rubeloa)?
1st sign=fever >100 deg, sore throat, runny nose, cough
W/in a few days, bright red blotchy rash starts on face, neck, and spreads to limbs; rash fades in 3-5 days
Koplik’s spots
43
how does scarlet fever usually start?
from initial illness of strep throat
44
how does scarlet fever spread?
through airborne droplets
45
what age group has the peak prevalence of scarlet fever?
4-8 yo
46
how long is scarlet fever contagious for?
until antibiotics are taken for 24 hrs
47
what are the s/s of scarlet fever?
high fever x1-2 days f/b rash
pink skin rash on neck, chest, axilla, groin, and thighs
rash feels like sandpaper
nausea, vomiting, strawberry tongue
48
what does the rash in scarlet fever feel like?
sandpaper
49
where does the rash typically appear in scarlet fever?
on the neck, chest, axilla, groin, and thighs
50
___% of the population being vaccinated for a disease leads to elimination and herd immunity
95
51
t/f: there is no treatment for measles other than prevention through vaccination
true
52
how long is mumps contagious for?
from 6 days prior to and up to 2 weeks after gland swelling
53
how is mumps spread?
through direct contact or aireborne droplets
54
what are the s/s of mumps?
enlarged salivary glands
HA, ms aches, fever, difficulty swallowing (2/2 swelling of salivary glands), vomiting
55
what is a key sign of mumps?
swelling of the salivary glands (looks like a double chin)
56
t/f: mumps is an RNA virus
true
57
what is another common name for conjunctivitis?
pink eye
58
how is conjunctivitis spread?
through direct contact
59
t/f: conjunctivitis is the result of almost all the common childhood illnesses with rashes
true
60
how is conjunctivitis often spread by children?
when they touch their own face or others' faces
61
what are the s/s of conjunctivitis?
most common sx is eye irritation (feels like there is a piece of sand in the eye)
redness and swelling of eye and eyelid
crust of discharge will cause eyelids to be stuck together in the am
photosensitivity and itching
62
what is the most common sx of conjunctivitis?
eye irritation (feels like there is a piece of sand in the eye)
63
t/f: conjunctivitis is not a big deal, but is VERY contagious
true
64
how is conjunctivitis treated?
with eye drops
65
what are the MSK conditions that may affect young populations?
Marphan syndrome
EDS
congenital hip dysplasia
avascular necrosis (Legg-Calve-Perthes disease)
slipped capital femoral epiphysis (SCFE)
transient hip synovitis
salter-harris fx
osteoporosis
hernia
Sinding-Larsen-Johansson syndrome (SLJ)/Osgood Schlatter syndrome
patella-femoral tracking issues
66
what is Marphan syndrome?
a connective tissue disorder that causes disproportionate arms/legs/finger, kyphoscoliosis, defective heart valves, and dissecting aortic aneurysm
67
what is the "thumb sign" and what does it indicate?
it is bringing your thumb to the anterior side of the wrist and wrapping your finger and thumb around your wrist indicating long fingers which could be a sign of Marphan syndrome
68
what systems are involved in Marphan syndrome?
skeletal
CV
pulmonary
ocular
integumentary
69
what is an ocular consequence of Marphan syndrome?
lens dislocation and iris/cornea problems
70
what are CV consequences of Marphan syndrome?
dilated/dissection of the aorta and calcification of the mitral valve
71
what is the Beighton scale of joint hypermobility?
a way to quantify risk for hypermobility in EDS by using a 9 point scale for different body positions (each worth 3 points) and if present are scored their 3 points
72
pts with EDS tend to have A LOT of joint laxity in what joints?
ankles and shoulders
73
what is an important PT consideration with EDS?
these pts DO NOT need to be stretched, they need strengthening and co-contraction
74
what are s/s of EDS?
Beighton scale score of 9 or more
easily damaged blood vessels
hyperplastic skin
(+) Hess test
75
what is the Hess test and how do we perform it?
a test for vascular fragility
inflate a BP cuff on your arm to a pressure bw SBP and DBP and maintain it for 5 minutes then inspect the skin after taking it off
76
what is a (+) Hess Test?
>10 petechiae
77
what is another common name for congenital hip dysplasia?
developmental dysplasia of the hip
78
what is congenital hip dysplasia?
maldevelopment causes a flat acetabulum that leads to bad roll and glide of the hip
79
what is the pathogenesis of congenital hip dysplasia?
in utero, subluxation may occur that results in a flattened posteromedial femoral head, anteversion, and shallow acetabulum
80
t/f: prolonged and repeated dislocation of the femoral head in congenital hip dysplasia leads to greater incidence of hip OA
true
81
t/f: the first few months of congenital hip dysplasia is a critical time to reduce the subluxation or surgery will likely be necessary
true
82
what is the most common abnormality in newborns?
congenital hip dysplasia
83
__/10 children with congenital hip dysplasia have hip instability
1
84
___/500 children with congenital hip dysplasia have dislocations
1
85
~20-30% of those with congenital hip dysplasia are IDed at how old?
after 3 months of age
86
what is the clinical presentation of congenital hip dysplasia?
after 6 weeks, hip may not reduce
asymmetry of thighs or gluteal folds
limitation of hip abduction
unequal femoral length (uneven knees=Galeazzi’s sign)
abnormal gait patterns
(+) Ortolani test
(+) Barlow test
87
If tib plateau goes fwd on one leg with the Galeazzi sign, is the femur or tibia longer?
the femur
88
If knee if higher up on one leg with the Galeazzi sign, is the femur or tibia longer?
the tibia
89
t/f: a leg subluxed posteriorly will look shorter
true
90
what are the abnormal gait patterns we may see in congenital hip dysplasia?
toe-walking, in-toeing, or out-toeing gait
91
what is the Ortolani test?
relocating the femoral head into the acetabulum by pulling out and applying traction
92
what is the Barlow test?
subluxing the femoral head by pushing in and out starting with the legs in frog position
93
what are the interventions for congenital hip dysplasia?
reduce hip
Pavlik harness
94
t/f: double and triple diapering is no longer recommended
true
95
what does the Pavlik harness do?
uses flexion and free abduction to provide effective reduction in most cases of congenital hip dysplasia
96
how long should the Pavlik harness be worn for?
3-6 months of continuous wear
97
if the Pavlik harness is ineffective in reducing the hip in congenital hip dysplasia, what are other options?
skin traction
closed reduction
spica cast
98
t/f: babies can still roll around and move in the Pavlik harness
true
99
when is the cutoff age for effectiveness of the Pavlik harness?
4 months old
100
what is another common name for avascular necrosis?
Legg-Calve-Perthes Disease (LCPD)
101
are more girls or boys effected by avascular necrosis?
boys
102
what is avascular necrosis?
deterioration of the femoral head from being in the wrong position
103
what are the s/s of avascular necrosis?
pain in groin, buttock, proximal thigh
exacerbated by WBing
decreased hip IR and abduction ROM
antalgic gait
coxa magna
demineralization
104
what is coxa magna?
broadening of the head and neck of the femur
105
what is the most common disorder of the adolescent hip?
SCFE
106
at what age is a SCFE most common in girls? in boys?
girls=12 yo
boys=14 yo
107
what is a SCFE (slipped capital femoral epiphysis)?
displacement of the femoral neck from the capital femoral epiphysis
108
what position of the developing femur would produce shear forces in a SCFE?
coxa valga
109
t/f: in a SCFE, the neck of the femur migrates up and out as the head of the femur remains in the acetabulum
true
110
110
45% of those with a SCFE have what as their initial sx?
knee or lower thigh pain
111
t/f: radiographs, physical exam, and sex are used to determine if the hip is stable or unstable in a SCFE
true
112
what are the focuses of intervention for SCFEs?
relief of sx
containment of the femoral head
restoring ROM
113
what are other common names for transient hip synovitis?
toxic synovitis
phantom hip disease
114
t/f: we don't really know what transient hip synovitis is other than an inflamed hip
true
115
what is transient hip synovitis?
acute hip pain w/o any associated MSK or constitutional sx
116
what are the s/s of transient hip synovitis?
limp may be present
child is afebrile
x-rays show nothing
child won’t want to WB (looks like LCP or SCFE, but often insidious)
comes and goes for a few days
117
what are the diagnostic tests for transient hip synovitis?
normal or mildly elevated CBC, ESR, and C-reactive protein levels
x-rays will be normal
hip US may show effusion
118
t/f: transient hip synovitis is self-limiting with oral analgesics
true
119
how is septic arthritis different from transient hip synovitis?
septic arthritis has similar s/s with the addition of fever and requires surgical drainage and IV antibiotics
120
what is a manual test PTs can do to test for transient hip synovitis?
roll the thigh inward in supine with a straight leg to see if it produces symptoms
121
what is a type 1 salter harris fx?
separated bone from epiphysis
122
what is a type 2 salter harris fx?
fx above the epiphysis
123
what is a type 3 salter harris fx?
fx below the epiphysis
124
what is a type 4 salter harris fx?
fx through the epiphysis
125
what is a type 5 salter harris fx?
smashed compression of the epiphysis
126
what is a salter harris fx?
an epiphyseal fx
127
what is a concern with salter harris fx?
growth of the extremity
128
what is the most common type of salter harris fx?
type 2
129
what is a stress fx?
tiny cracks in the bone due to repetitive force
130
what populations most commonly have stress fxs?
common in athletes and military recruits
131
is it more common to see stress fxs in the UE or LE?
LE
132
what are the most common sites of stress fractures (most to least)?
tibia
navicular
fibula
femur
pelvis
133
what are the 2 big factors that play into stress fxs?
mechanical forces and nutrition status
134
which is the bigger factor in stress fxs for teens, mechanical forces or nutrition?
nutrition
135
t/f: not enough calories/energy deficit puts you at risk for many ortho conditions
true
136
what are the risk factors for stress fxs?
>10 alcoholic beverages/week
low levels of vit D
smoking
>25 miles/wk
sudden inc in activity and/or limited rest
female triad: eating disorder, amenorrhea, osteoporosis
137
what is the female triad?
eating disorder
amenorrhea
osteoporosis
138
70% of stress factors are due to what?
metabolic abnormalities or nutritional deficits
139
will x-rays be helpful to look at with stress fxs?
no bc there likely will NOT be evidence on an x-ray for 10-14 days
140
what are some clinical techniques for finding a stress fx?
US (no studies on it, but if US is over the stress fx, it will hurt A LOT )
vibratory pain
tuning fork
bone scan
MRI ($$$$)
Ottawa ankle and foot rules
141
what are the Ottawa ankle and foot rules?
pain at lat mal, med mal, navicular, or base of 5th metatarsal
142
t/f: you need to build up bone mass when you're young or you will hit the osteoporotic levels much quicker as you age
true
143
what are ways to build bone?
WBing
ms pull
good nutrition
144
t/f: fitness at a young age is correlated with good bone strength and structure in children 3-5
true
145
what is the correct term for a "sports hernia"?
athletic pubalgia
146
athletic pubalgia is common in what population?
players that do a lot of cutting (ice hockey, soccer, football, rugby)
147
t/f: more and more females are being effected by athletic pubalgia than in the past
true
148
what is the clinical presentation of someone with athletic pubalgia?
palpable tenderness over the pubic ramus, but the most specific sign is tenderness over the medial inguinal floor, or Hesselbach’s triangle
pain may be more severe with resisted hip adduction but the most specific finding is pain in the inguinal floor with a resisted sit-up
pain with activity and ceases with rest, only to return with activity
149
t/f: athletic pubalgia does well healing with rest
true
150
how can we prevent athletic pubalgia?
with strengthening
151
what is the test for athletic pubalgia?
tug of war
152
what muscles are tested in the tug of war test for athletic pubalgia?
a test for the rectus abdominis and adductor ms
153
what is the tug of war test for athletic pubalgia?
standing with a ball bw the legs (active adductors), press the posterior hips against a treatment table and extend the trunk to get eccentric rectus activation
154
what is a (+) tug of war test?
pain
155
what is a typical progression of treatment in athletic pubalgia from week 1-6?
wk1: rest
wk2: walk
wk3: SLR
156
what is Sinding-Larsen-Johansson Syndrome (SLJ) and Osgood Schlatter syndrome?
forms of apophysitis at the knee where the tendon avulses a bone
157
t/f: patella-femoral tracking is an ACL injury predictor
true
158
what is a test for patella-femoral tracking?
the dynamic jump test
159
what is the dynamic jump test?
a screen for knee tracking issues
160
what would we see on a dynamic jump test that would indicate poor patellar tracking and ACL risk?
knee valgus
161
what are the changes in knee mechanics see with PFP in females?
increased hip IR, 14% less hip abd torque, 17% less hip ext torque, increased glut max recruitment needed to stabilize the hip
162
how do we measure the Q angle?
measure from the ASIS to patella to tib tub
163
what is the key to knee stability?
strengthening the hip ER and abd
164
what neuromuscular condition can affect young populations?
bacterial meningitis
165
t/f: bacterial meningitis is a medical emergency in children
true
166
how is bacterial meningitis spread?
via droplets of saliva
167
what are the s/s of bacterial meningitis?
HA-”worst HA of my life”
fever and light sensitivity
lethargy (hypotonia) and stiff neck
poor feeding; vomiting; chills
respiratory distress, apnea
paradoxic irritability
rash
seizures in 30-40% of cases
168
what is paradoxic irritability?
a sign of bacterial meningitis in children
children usually are soothed by being held and rocked, but these children won’t respond well to this
169
how does bacteria gets into the bloodstream with bacterial meningitis?
via cough, sneeze, kiss, foods, trauma
170
what tests will be (+) with bacterial meningitis?
any dural tension tests (Kernig sign and Brudzinski sign)
171
what is a CVP condition that can affect young populations?
asthma
172
t/f: children w/low levels of activity have 35% increased risk of developing asthma
true
173
what are common asthma triggers?
resp infections
cigarette smoke
allergic rxns
polluntants
exercise
cold environment
emotional factors
GERD
aspirin, NSAIDs, sulfite sensitivity
B-blockers (opthalmic med)
obesity
irritants (household sprays, paint fumes)
174
what are the s/s of asthma?
wheezing
prolonged expiration
cough
SOB
175
in increasing severity, what additional s/s may we see in asthma?
HR>120 bpm
O2 sat (room air) <91% (should be AT LEAST 96-98%)
“tripod position” - sign of struggling even though this is the worst thing to do bc it closes everything in when they should be opening up
176
how can we evaluate asthma?
with spirometry
177
how do we assess asthma with spirometry?
have the pt blow out as hard and fast as they can
178
what are we measuring the spirometry for asthma?
the FEV1
179
what is FEV1?
the forced expiratory value in 1 sec
180
the FEV1 should increase by ___% after 2 puffs of an inhaler within 5 minutes
15
181
if a pt with asthma does see an increase of at least 15% in FEV1 after 2 puffs of an inhaler within 5 minutes, what do we do?
send them to the ED
182
if a pt with asthma takes 2 puffs of an inhaler and their FEV1 increases 15% but not to their baseline level, are their supposed to go back to play?
no, they must return to their baseline, even if they are showing improvement
183
what is the role of the spleen?
it houses RBCs
184
how can we palpate the spleen?
place right hand just below left costal margin
press down and ask pt to take deep breath
it may help to use your left hand to lift the lower rib cage and flank
185
what is a red flag with palpation of the spleen?
if spleen is palpable, it is probably enlarged
reproduction of sx
186
t/f: some people developed sickle cells disease to protect against malaria
true
187
t/f: when a child is born with sickle cell disease, it isn’t possible to predict which sx will appear, when they will start, or how bad they will be
true
188
what can make RBC clump faster in sickle cell disease?
exercise, heat, and dehydration
189
what are the red flag s/s of sickle cell disease?
heat intolerance
severe ms cramping
hyperventilation
tachycardia
hypotension
sx w/intense exercise
sx during preseason conditioning
sx at altitude
190
what is the treatment to cure sickle cell disease?
chemo to wipe out all the cells then a bone marrow transplant to replace them with good cells
191
when crisis occurs in sickle cell disease, what happens?
RBCs block blood flow to limbs and organs
192
t/f: acute pain in sickle cell disease can vary from mild to severe and last hrs to more than a week
true
193
t/f: repeated crisis in sickle cell disease damages tissues
true
194
what NT released with exercise makes sickled RBCs more sticky?
epinephrine
195
why may there be an exacerbation of sx in sickle cell disease with exercise?
bc it increases release of epinephrine and makes the RBCs more sticky and likely to clump together
196
what is involved in tx of sickle cell disease?
immediate oxygen
aggressive fluid replacement (want them as hydrated as possible as quickly as possible)
electrolytes as needed
monitor vitals
RTP (return to play)-VERY gradual return when asymptomatic
197
what is a common name for Epstein-Barr virus?
mono
198
what is the symptoms triad in mono?
fever
sore throat
swollen lymph glands
199
how long does the symptoms triad last in mono?
1-4 wks
200
what is the test for mono?
the heterophile antibody test?
201
is mono able to be treated well?
not really, treat just involved treating the sx
202
there is a wide span of sx in mono, but what is the most common presentation?
a 3-5 day prodrome of low grade HA, malaise, fatigue, decreased appetite, and ms soreness
this is followed by sore throat, moderate fever, chills/sweats and tender, swollen lymph nodes in the neck
203
what are other common symptoms of mono?
cough, rash, nausea, swollen eyelids, jt aches, and abdominal pain
204
what is involved in tx of mono?
usually only self-care is needed for mono
get plenty of rest
gargle with salt water or use throat lozenges to soothe sore throat
take acetaminophen or ibuprophen to reduce fever, relieve a sore throat and HA
NEVER give aspirin to someone younger than 20 yo, bc it can cause Reye syndrome
avoid contact sports and heavy lifting-impact or straining cold cause enlarged spleen to burst
in severe cases, corticosteroids may be used to reduce swelling of the throat, tonsils, or spleen
205
why is there a need to be physically inactive for 21 days with mono?
bc 50% of those who contract mono develop an enlarged spleen that can lead to rupture, so to avoid the possibility to a life-threatening complication, all physical activity is restricted for 21 days
206
what integumentary conditions can affect young populations?
impetigo
ringworm
warts
MRSA
Lyme disease
207
what group has the peak prevalence of impetigo?
preschool children
208
how is impetigo spread?
via direct contact with the infected area
209
where is impetigo usually located on the body?
around the nose and mouth
210
the rash in impetigo is characterized by ...
blisters that burst, ooze fluid, and develop honey-colored crust
211
t/f: scratching the rash can spread the infection with impetigo
true
212
when can children return to school and sports with impetigo?
after being on antibiotics for 72 hrs with no drainage from the infection
213
what is ringworm?
a fungal infection
214
how is ringworm spread?
via direct skin contact with infected people/pet or indirect contact with an object the infected person touched
215
when does the ringworm rash appear?
4-14 days after contact with the infection
216
will ringworm go away on its own?
yes, but it will resolve quicker with ointment
216
t/f: ringworm usually only occurs above the waist
true
217
when can pts with ringworm return to school and sports?
after being on antifungals for 72 hrs and the rash must be covered
218
are warts contagious?
nope
219
when do warts pose an issue?
when in WBing areas like the bottoms of the feet
220
how can warts be removed?
with heat, chemicals, or surgery
221
is there evidence behind the duct tape theory for wart removal?
not really, but it works most times
222
how can duct tape be used to remove a wart?
apply a small piece of duct tape directly on the wart once every 4-7 days
remove the tape, clean the area with soap and water
remove dead skin with an energy board
apply another piece for tape 12 hrs later
repeat this cycle for 4-6 wks
223
what US settings can be used to remove a wart?
3MHz 10-12 min at 1W/cm^2 everyday for 1 to 1 1/2 wks
224
where is MRSA usually found on the body?
in placed where you don't normally see pimples like on the leg
225
is a referral needed for MRSA?
yes, we can still treat them, but send them out to get it treated
226
what are common vehicles of MRSA transmission?
towels
water bottles
hot and cold packs
velcro straps
weights
US applicator
electrodes
stethoscope
227
the initial transmission of bacteria in Lyme disease is from what?
a tick (not all ticks tho)
228
what is the causative agent of Lyme disease?
spirochete
229
t/f: we want to get rid of the ticks properly as soon as possible
true
230
animal studies indicate that ticks must be imbedded for how long to transmit the spirochete?
48 hrs
231
how is Lyme disease diagnosed?
with antibody-based testing
232
why is Lyme disease in pregnancy a concern?
bc untreated Lyme during pregnancy can lead to infection of the placenta and spread from mother to fetus
233
which of the following rash locations is more common to find a Lyme disease rash: hand, wrist, hairline, feet?
hairline bc it is a transition line
234
when does the rash develop in Lyme disease?
w/in7-14 days
235
what causes the bullseye rash appearance in Lyme disease?
the salivary proteins stay put and form the center circle of the bullyseye
the bacteria move away from the site of the bite and form the outer ring of the bullyseye rash
236
t/f: the rash in Lyme disease may or may not be warm to the touch
true
237
is the rash usually painful or itchy in Lyme disease?
no
238
what are the s/s of Lyme disease?
fever
malaise
HA
ms aches
jt pain
cranioneuropathy (esp CN 7)
cognitive sx
mood changes
stomach pain/nausea
paresthesia
neck pain
eye sx
fever/sweats
239
can Lyme disease be "cured"?
not really? there is no test that can "prove" one has been cured
240
what meds are used to treat Lyme disease?
doxycycline, amoxicillin, cefuroxime
241
how long are meds taken for with Lyme disease?
2-4 wks or until sx resolve (take full course of meds to prevent exacerbation of sx)
242
t/f: there is a worse reported QOL with chronic Lyme disease than fibromyalgia, CHF, or DM
true
243
what GI pathology can occur in young populations?
visceral pathology
celiac disease
anemia
appendicitis
244
what is a test for visceral pathology in the GI system?
Blumberg sign (rebound tenderness)
245
how do we perform the Blumberg sign?
in supine, select a site away from the painful area and place your hand on the abdomen pushing down slowly and quickly lifting up
246
what is celiac disease?
a chronic autoimmune disorder triggered in genetically susceptible individuals by gluten proteins (wheat, barley, rye)
247
what two things must an individual have to develop celiac disease?
a genetic predisposition and antigen exposure
248
~30% of those with celiac disease have what genetic markers?
HLA-DQ1 and HLA-DQ8
249
are more males or females effected by celiac disease?
2.5x more females
250
how is celiac disease diagnosed?
TTG antibody test
IgA anti-endomysial antibody test
251
when does celiac disease develop?
6-24 months after gluten is introduced to the diet
252
what are the sx of celiac disease?
diarrhea, abdominal distension/pain
impaired growth, ms wasting
dec appetite, weight loss
lethargy, irritability
short stature (dec pituitary release of GH)
osteoporosis (Ca2+ malabsorption)
infertility
asthenia (ms weakness)
vomiting
hypotension
253
why is there decreased nutrient absorption in celiac disease?
bc there are smaller villi that reduces the surface area for nutrient absorption
254
t/f: in celiac disease, there is diminished RBC production due to low iron stores
true
255
what are the s/s of celiac disease?
dec hemoglobin
dec hematocrit
change in fingernail beds
pale skin color
fatigue
dec DBP
256
what are the top 10 causes for celiac disease?
abnormal uterine bleeding
use of aspirin or other NSAID long term
colon cancer
angiodysplasia
dontating blood
stomach cancer
peptic ulcer disease
celiac disease
gastrectomy
heliobacter pylori infection
257
why do athletes need more iron?
excessive exercise can increase blood volume and cause imbalance in the ratio bw blood and iron (relatively anemic)
258
what iron supplements are the worst and can lead to bad constipation and completes with Ca2+?
metallic iron supplements
259
what iron supplements are the best quality and doesn't compete with Ca2+?
gluconate iron supplements
260
what is the only known substance to inhibit absorption of both heme and non heme iron?
Ca2+
261
what can cause appendix pathology?
obstruction
infection
inflammation
262
when are boys most affected by appendicitis? girls?
boys=10-14 yo
girls=15-19 yo
263
what are the s/s of appendicitis (most to least common)?
RLQ pain
(+) McBurney’s point-->R thigh/testicle
nausea, vomiting, night sweats
guarding of rectus abdominis
(+) psoas sign
(+) obturator sign
low-grade fever unless associated with perforation (then high fever may occur)
(+) rebound tenderness
position of relief: tense abdomen with FB or lie down with both knees to chest
264
how do we test for appendicitis in children?
with jarring activities like bouncing a child on your knee or making them hop or jump
265
what is a sign of appendicitis in children?
intolerance to jarring activities
266
what endocrine condition may affect young populations?
DM type 1
267
what are the s/s of type 1 DM?
high levels of sugar in blood and urine
frequent urination in large volumes (kidney trying to flush excess glucose)
abnormally thirsty (attempts to replace fluid loss)
extreme hunger but loses weight
blurred vision
fatigue, irritability, and mood changes (no glucose for energy)
abdominal pain, nausea, vomiting, and fruity-smelling breath (buildup of ketones)
onset of bedwetting in a child with no prior px
vaginal yeast infection in females prior to puberty
268
what urogenital conditions can occur in young populations?
UTI (cystitis-pyelonephritis)
269
why are UTIs common in children?
bc their urethras tend to be shorter
270
what are the s/s of a UTI?
pain with micturition
leukocytes and bacteria in urine (white casts)
cloudy, malodorous urine
back pain
fever, chills, nausea
loss of appetite
pain with percussion over kidneys
271
t/f: risk factors for eating disorders tend to be over control
true
272
what are some risk factors for eating disorders?
adolescence
higher body weight
LGBTQ
female
emotional negativity
perfectionism or neuroticism
low self esteem
media influence
hx of trauma related to adverse childhood experience, sexual assault, weight comments, bullying
dieting
disordered eating behaviors
fam hx of eating disorders
pubertal hormones
negative energy balance
273
what are the common cancers in childhood?
leukemia
neuroblastoma
pilocystic astrocytoma (brain tumor)
osteosarcoma
274
why is leukemia hard to diagnose?
bc it has vague sx that look like many normal childhood diseases
275
t/f: onset of leukemia can be slow or rapid
true
276
what are s/s of leukemia?
fever and loss of appetite, pale skin and frequent bruising
enlarged cervical lymph nodes, abdominal protrusion 2/2 enlargement of the spleen and liver
277
what is the most common solid tumor of children under 5 yo?
neuroblastoma
278
where does neuroblastoma originate?
in the sympathetic nervous tissues
279
what is the most common site for neuroblastoma?
in the abdomen (near adrenal gland)?
280
what are the first signs of neuroblastoma?
fatigue and loss of appetite
281
abdominal swelling in neuroblastoma may result in what things?
constipation
pain with urination
breathlessness
282
what is the peak age of pilocytic astrocytoma (brain tumor)?
5-14 yo
283
what are the s/s of pylocytic astrocytoma?
HA (90%)-worse in am and increases with activity, Valsalva, stooping (increased ICP)
head down position can be symptomatic
seizures (60%)-don’t want it to get to this point
visual changes
vomiting
ataxia
284
how do we test for pilocytic astrocytoma?
finger tapping
toe tapping
285
what is the most common bone cancer in adolescence?
osteosarcoma
286
t/f: osteosarcoma occurs more in boys than girls
true
287
what are the most common bones to get osteosarcoma?
femur, tibia, fibula
288
what are the s/s of osteosarcoma?
pain and swelling that gets worse with exercise or at night
bone pain that lasts longer than it should
