Neurology/Developmental Flashcards
1
Q
What is Down syndrome?
A
a genetic chromosome 21 disorder causing developmental and intellectual delays
2
Q
What is Down syndrome?
A
a genetic chromosome 21 disorder causing developmental and intellectual delays
3
Q
What is the most common chromosomal disorder and cause of mental retardation?
A
down syndrome
4
Q
What are the characteristic of Down syndrome?
A
characterized by trisomy 21 (most often) or chromosomal translocation
5
Q
What are the risk factors for Down syndrome?
A
risk factors include advanced maternal age
- 1:1500 in women under 20
- 1:25 in women over 45
6
Q
What is Down syndrome associated with?
A
- acute lymphocytic leukemia
- early-onset Alzheimer’s disease
- atlantoaxial instability
7
Q
What are the dysmorphic features of Down syndrome?
A
- microcephaly, flat occiput, flattened face, epicentral folds, flat nasal bridge, upward-slanting palpebral fissures, small nose/mouth, protuberant tongue, low-set/small ears, short neck, excessive nuchal skin, Brushfield spots (small white/grayish spots on periphery of iris), shortened extremities, big gap between first toe (hallux)
- other = single transverse palmer crease, short fifth finger with clinodactyly
8
Q
How is Down syndrome dx?
A
Ultrasound
- prenatal diagnosis = nuchal translucency (weeks 11-14)
- increased nuchal translucency and a hypoplastic nasal bone in a first-trimester ultrasound
Lab results = prenatal diagnosis
-chorionic villus sampling/amniocentesis
Amniocentesis
- an amniotic fluid sample is obtained with a fine needle through the abdomen and uterus
- performed during 15th week of pregnancy or later
- less risk to the child than chorionic villus sampling
- usually indicated for mothers> 35 years old
Chorionic villus sampling (CVS)
- placental tissue sampling is relieved via vagina and cervix
- usually performed between the 10th and 12th week of pregnancy
- more risk to the child, but can be performed earlier
- usually indicated in mothers > 35 years of age
Quadruple screen (normally does some time between the 15th and 22nd): looks for four specific substances: AFP, hCG, estriol, and inhibin-A
- increased serum beta-human chorionic gonadotropin (B-hCG), inhibin A
- decreased unconjuaged estiol (uE3), alpha-fetoprotein (AFP)
Postnatal diagnosis
- fluorescent in situ hybridization (FISH), karyotyping
- postnatal diagnosis = clinical identification of dysmorphic features
9
Q
How is Down syndrome dx?
A
Ultrasound
- prenatal diagnosis = nuchal translucency (weeks 11-14)
- increased nuchal translucency and a hypoplastic nasal bone in a first-trimester ultrasound
Lab results = prenatal diagnosis
-chorionic villus sampling/amniocentesis
Amniocentesis
-an amniotic fluid sample
10
Q
What is the most common chromosomal disorder and cause of mental retardation?
A
down syndrome
11
Q
What are the characteristic of Down syndrome?
A
characterized by trisomy 21 (most often) or chromosomal translocation
12
Q
What are the risk factors of febrile seizure?
A
- elevated fever (>38 C)
- age - potentially due to developing nervous system being vulnerable to fever
- viral infection (HHV-6, influenza virus)
- family history - potential genetic component
- recent immunizations - the absolute risk is small
13
Q
What is Down syndrome associated with?
A
- acute lymphocytic leukemia
- early-onset Alzheimer’s disease
- atlantoaxial instability
14
Q
What is the tx of febrile seizure?
A
- mostly counseling, reassurance, and education the parent, antipyretics help alleviate symptoms of fever
- further consideration for complex febrile seizures more commonly associated with infection or structure abnormalities
- consider obtaining EEG though not required
- may treat with benzodiazepine if lasts > 5 minutes
- terminate status epileptics with benzo or phenytoin
- initiate status epileptics protocol if continues
- rarely develops into epilepsy
- monitor complex febrile seizures as more likely to recur
15
Q
What are the most common issues for those affected with Down’s syndrome?
A
- septal defects between atria
- duodenal atresia
- increased risk for acute lymphoblastic leukemia
- mental retardation and an increased risk for Alzheimer disease
- sterility in males
16
Q
How is Down syndrome dx?
A
Ultrasound
- prenatal diagnosis = nuchal translucency (weeks 11-14)
- increased nuchal translucency and a hypoplastic nasal bone in a first-trimester ultrasound
Lab results = prenatal diagnosis
-chorionic villus sampling/amniocentesis
Amniocentesis
-an amniotic fluid sample
17
Q
What is the tx of Down syndrome?
A
prenatal genetic counseling; supportive management of affected body systems
18
Q
What is a febrile seizure?
A
convulsion associated with an elevated temperature greater than 38 (100.4 F)
-associated with fever without evidence of CNS infection, afebrile seizure history, or metabolic disturbance
19
Q
What is the most common seizure in infants and young children?
A
febrile seizure
-occurs between 6 months and 5 years of age, with a slight male predominance
20
Q
What are the risk factors of febrile seizure?
A
- elevated fever (>38 C)
- age - potentially due to developing nervous system being vulnerable to fever
- viral infection (HHV-6, influenza virus)
- family history - potential genetic component
- recent immunizations - the absolute risk is small
21
Q
How are febrile seizure dx?
A
clinical diagnosis
- consider lumbar puncture if suspicious of meningitis
- lack of Haemophilus influenza type B or streptococcus pneumonia vaccination
- physical exam suggesting meningitis or some CNS infection
- lab may be used for seizure evaluation in the setting of complex febrile seizure
- do if useful to identify fever source
22
Q
What is the tx of febrile seizure?
A
- mostly counseling, reassurance, and education the parent, antipyretics help alleviate symptoms of fever
- further consideration for complex febrile seizures more commonly associated with infection or structure abnormalities
- consider obtaining EEG though not required
- may treat with benzodiazepine if lasts > 5 minutes
- terminate status epileptics with benzo or phenytoin
- initiate status epileptics protocol if continues
- rarely develops into epilepsy
- monitor complex febrile seizures as more likely to recur
23
Q
What are the CSF finding on lumbar puncture for meningitis?
A
- bacterial: increase protein, decrease glucose (bacteria love to eat glucose
- viral: no specific characteristics but may have lymphocytes
-make sure the patient does not have increased intracranial pressure prior to LP check for papilledema and get a CT scan if you are unsure if there is swelling in the brain (risks include age >60, immunocompromised, AMS, focal near finding or papilledema)
24
Q
What is the classical triad of meningitis?
A
headache, fever, and a stiff neck (nuchal rigidity)
25
What are most cases of meningitis caused by?
viral infection, but bacterial, parasitic and fungal infections are other causes
- unlike encephalitis no mental status changes
- N. meningitidis (most likely if pt. has a rash) = petechiae
26
What are the physical exam findings of meningitis?
Kernig sign - knee extension causes pain in the neck
| Brudzinski sign - leg raise when bend neck
27
What are the bacterial etiologies of meningitis?
- neonate: E. coli (gram-negative rods) and S. agalactiae (group B streptococcus)
- most people: S. pneumonia (gram-postive diplococci), n. meningitidis (gram-negative diplococci)
- immunocompromised: cryptococcus neoformans (diagnosis: india ink stain
28
What are the viral etiologies of meningitis?
- most cases in United States are caused by a group of viruses known as enteroviruses, which are most common in late summer and early fall
- viruses such as herpes simplex virus, HIV, mumps, West Nile virus and other also can cause viral meningitis
29
What is the fungal etiology of meningitis?
cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS
30
How is meningitis dx?
spinal tap: increased opening pressure, decreed glucose, increased WBC (neutrophils), increased protein
31
What is the tx of meningitis?
dexamethasone + empiric IV antibiotics (cephalosporin, vancomycin, penicillins)
-household contacts: treat with rifampin, Cipro, Levaquin, azithromycin, ceftriaxone
32
What is aseptic meningitis?
- etiology: enterovirus, HSV, TB, fungus
- spinal tap - normal pressure, increased WBC (lymphocytes)
- treatment: symptomatic of IV acyclovir for HSV
33
What is a focal seizure with retained awareness (consciousness maintained)?
- this type of focal seizure was previously known as a simple partial seizure
- no alteration in consciousness
- abnormal movements or sensations
34
What is a focal seizures with a loss of awareness (consciousness impaired)?
- this type of focal seizure may also be called a focal dyscognitive seizure (previously known as complex partial seizures)
- altered consciousness, automatisms (lip-smacking)
- present with a postictal state (confusion and loss of memory) which differentiate them from absence seizures
35
What is the tx of focal seizure?
phenytoin, and carbamazepine are drugs of choice
36
When do generalized seizures occur?
when there is widespread seizure activity in the left and right hemispheres of the brain
-start midbrain or brainstem and spread to both cortices
37
What is an absence seizures?
(firmly known as petit Mal)
- characterized by a brief impairment of consciousness with an abrupt beginning and ending
- at times involuntary movements may occur, buy they are uncommon and the patient has no recollection and witnesses commonly miss them
38
What are tonic-clonic seizures?
or convulsie seizures (formerly known as grand Mal)
- bilaterally symmetric and without focal onset
- begins with a sudden loss of consciousness - a fall to the ground
- tonic phase: very stiff and rigid 10-60 seconds
- clonic phase: generalized convulsions and limb jerkin g
- postical phase: a confused state
39
What is an atonic seizures?
also known as drop attacks
| -looks like syncope, sudden loss of muscle tone
40
What is clonic seizure?
- during a clonic seizure, a person may lost control of bodily functions and begin jerking in various parts of the body
- he/she may temporarily lose consciousness, followed by confusion
41
What is a tonic seizure?
extreme rigidity then immediate LOC, but not followed by a clonic phase
42
What is a myoclonic seizure?
muscle jerking, but not the tonic phase, occurs in the morning
43
What is a febrile seizure?
convulsion associated with an elevated temperature greater than 38, >6 months <5 years, absence of central nervous system infection or inflammation
44
What is an infantile spasms?
type of epilepsy seizure but they do not fit into the category of focal or generalized seizures
45
What is a psychogenic non-epileptic seizure (PNES)?
not due to epilepsy but may look very similar to an epilepsy seizure
46
What is status epilepticus?
a single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without there person returning to normal between them
-two forms: convulsive and non convulsive
47
What is convulsive status epileptics?
presents with a regular pattern of contraction and extension of the arms and legs
48
What is non convulsive status epilepticus?
includes complex partial status epilepticus and absence status epilepticus
49
What is the tx for seizures?
benzodiazepines (lorazepam) are the preferred initial treatment after which typically phenytoin is given
50
When does teething generally occur?
between 6 to 24 months of age
51
What teeth are the first teeth to come in?
the two bottom front teeth (lower central incisors) are usually the first to appear, followed by two top front teeth (upper central incisors)
52
What are the classic signs and symptoms fo teething?
- excessive drooling
- chewing on objects
- irritability or crankiness
- sore or tender gums
- a slight increase in temperature - but no fever
53
What is the tx for teething?
the management of teething symptoms is palliative (chewing on a chilled [not frozen] teething ring or other teething devices, systemic analgesia)
- teething rings and other chewing devices should be one piece
- these devices should not be dipped in sugary substances
- teething necklaces, bracelets, or anklets that are made of beads should be avoided
- avoid over-the-counter (including homeopathic remedies) or prescription-strength topical analgesics (lidocaine, benzocaine) for teething pain
- over-the-counter pain medications such as acetaminophen (Tylenol, others) or ibuprofen (advil, Motrin, others) if especially fussy
54
What is the routine dental care?
- run a soft, clean cloth over baby's gums twice a day - after the morning feeding and before bed
- the cleansing can keep food debris and bacteria from building up in the baby's mouth
- when a baby's first teeth appear, use a small, soft-bristled toothbrush to clean his or her teeth twice a day
- until children learn to spit - at about age 3 - use a smear of fluoride toothpaste no bigger than the size of a grain of rice
- then switch to a pea-sized dollop as children approach 2 to 3 years of age
- the American dental association and the American academy of pediatric dentistry recommended scheduling a child's first dental visit at or near his or her first birthday
55
What is Turner syndrome?
a genetic disorder caused by missing X chromosome in females (45XO)
56
What is the most common cause of primary amenorrhea (uterus present)?
turner syndrome
| -most patients are infertile
57
What are the most common features of Turner syndrome?
features include streak ovaries, short stature, lymphedema, neck webbing, and congenital heart and renal defects
58
What are the symptoms of turner syndrome?
- amenorrhea
- short stature
- webbed neck
59
What are the physical exam of turner syndrome?
- amenorrhea with a present uterus
- coarctation of the aorta may be evident on auscultation
- low hairline in back
- low-set ears
- extremity edema
- hypertension
- signs of thyroid dysfunction
- stool guaiac may identify GI bleedng
60
How is the dx of Turner syndrome made?
based primarily on physical exam and patient history
- labs = low anti-mullerian hormone
- karyotype analysis is the diagnostic test of choice = may identify 45XO, confirming the diagnosis
- fertility testing may identify 45XO, confirming the diagnosis
- endoscopy may identify GI telangiectatic causing lower GI bleeding
61
What is the tx of Turner syndrome?
growth hormone therapy and sex hormones replacement therapy
62
What is the injury prevention for birth and/or 3-5 days?
- crib safety
- hot water heaters <120 F
- car safety seats
- smoke detectors
- back to sleep
- crib safety
63
What is violence prevention for birth and/or 3-5 days?
- assess bonding and attachment
- identify family strife, lack of support, pathology
- educate parents on nurturing
64
What is nutritional counseling for birth and/or 3-5 days?
- exclusive breastfeeding encouraged (should breastfeed every 2-3 hours)
- formula as the second-best option (every 3-4 hours)
65
What is the fostering optimal development for birth and/or 3-5 days?
- discuss parenting skills
| - refer for parenting education
66
What is the injury prevention for 2 weeks of 1 month?
- fall back to sleep
| - tummy time when awake: 5-10 minutes 2-3 times per day
67
What is the violence prevention for 2 weeks of 1 month?
- discuss sibling rivalry
| - assess if guns in the home
68
What is the nutritional counseling for 2 weeks of 1 month?
- assess breastfeeding and offer encouragement, problem solving
- should be back to birth weight at 2-weeks
69
What is fostering optimal development for 2 weeks of 1 month?
- recognize and manage postpartum blues
| - child care options
70
What is the injury prevention for 2 months?
- burns/hot liquids
| - back to sleep
71
What is violence prevention for 2 months?
reassess firearm safety
72
What is nutritional counseling for 2 months?
after 3 they do not need to eat during the night
73
What is fostering optimal development for 2 months?
parent getting enough rest and managing returning to work
74
What is injury prevention for 4 months?
- infant walkers
- choking/suffocation
- back to sleep
75
What is the violence prevention for 4 months?
reasses
76
What is the nutritional counseling for 4 months?
introduction of solid foods
77
What is fostering optimal development for 4 months?
- discuss central to peripheral motor devlopment
| - praise good behavior
78
What is the injury prevention for 6 months?
- burns/hot surfaces
| - place on back to sleep, but once infant can roll no need to worry about rolling to tummy
79
What is the violence prevention for 6 months?
reassess
80
What is the nutrional counseling for 6 months?
start water and baby food
81
What is the fostering optimal development for 6 months?
- consistent limit-setting versus "spoiling" an infant
| - praise good behavior
82
What is injury prevention for 9 months?
- water safety
- home safety review
- ingestions/poisoning
83
What is violence prevention for 9 months?
assess parents' ideas on discipline and "spoiling"
84
What is nutritional counseling for 9 months?
- avoiding juice
- begin to encourage practive with cup drinking
- no honey until 1 yo
85
What is fostering optimal development for 9 months?
- assisting infants to sleep through the night if no accomplished
- praise good behavior
86
What is injury prevention for 12 months?
- firearm hazards
| - auto-pedestrian safety
87
What is violence prevention for 12 months?
- discuss timeout versus corporal punishment
- avoiding media violence
- review firearm safety
88
What is nutritional counseling for 12 months?
- introduction of whole cow's milk (and constipation with change discussed)
- assess anemia, discuss iron-rich foods
89
What is fostering optimal development for 12 months?
- safe exploration
- proper shoes
- praise good behavior
90
What is injury prevention for 15 months?
review and reassess topics
91
What is violence prevention for 15 months?
encourage nonviolent punishments (timeout or natural consequences)
92
What is nutritional counseling for 15 months?
- discuss decline in eating with slower growth
| - assess food choices and variety
93
What is fostering optimal development for 15 months?
- fostering independence
- reinforce good behavior
- ignore annoying but not unsafe behaviors
94
What is injury prevention for 18 months?
- review and reassess topics
| - rear-facing seat until 2 y/o
95
What is violence prevention for 18 months?
- limit punishment to high yield (not spilled milk)
| - parents consistent in discipline
96
What is nutritional counseling for 18 months?
discuss food choices, portions, "finicky" feeders
97
What is fostering optimal development for 18 months?
- preparation for toilet training
| - reinforce good behavior
98
What is the injury prevention for 2 years?
- falls-play equipment
| - forward-facing car seat
99
What is violence prevention for 2 years?
assess and discuss any aggressive behaviors in the child
100
What is nutritional counseling for 2 years?
- assess body proportions and recommend low-fat milk
| - assess family cholesterol and atherosclerosis risk
101
What is fostering optimal development for 2 years?
toilet training and resistance
102
What is injury prevention for 3 years?
review and reassess topics
103
What is violence prevention for 3 years?
review, especially avoiding media violence
104
What is nutritional counseling for 3 years?
- discuss optimal eating and the food pyramid
| - healthy snacks
105
What is fostering optimal development for 3 years?
- read to the child
- socializing with other children
- head start if possible
106
What is injury prevention for 4 years?
- booster seat versus seat belts
| - bike helmets
107
What is nutritional counseling for 4 years?
healthy snacks
108
What is fostering optimal development for 4 years?
- read to child
| - head start or pre-K options
109
What is injury prevention for 5 years?
- bicycle safety
| - water/pool safety
110
What is violence prevention for 5 years?
- developing consistent, clearly defined family rules and consequences
- avoiding media violence
111
What is nutritional counseling for 5 years?
- assess for anemia
| - discuss iron-rich foods
112
What is fostering optimal development for 5 years?
- reinforcing school topics
- read to child
- library card
- chores begun at home
113
What is injury prevention for 6 years?
fire safety
114
What is violence prevention for 6 years?
- reinforce consistent discipline
- encourage nonviolent strategies
- assess domestic violence
- avoiding media violence
115
What is nutritional counseling for 6 years?
asses content, offer specific suggestions
116
What is fostering optimal development for 6 years?
- reinforcing school topics
- after-school programs
- the responsibility is given for chores (and enforced)
117
What is injury prevention for 7-10 years?
- sports safety
- firearm hazard
- lap and shoulder safety belt in back seat (8-12 y/o)
118
What is violence prevention for 7-10 years?
- reinforcement
- asses domestic violences
- assess discipline techniques
- avoiding media violence
- walking away from fights (either victim or spectator)
119
What is nutritional counseling for 7-10 years?
assess content, offer specific suggetions
120
What is fostering optimal development for 7 -10 years?
- reviewing homework and reinforcing school topics
- after-school programs
- introduce smoking and substance abuse prevention (concrete)
121
What is injury prevention for 11-13 years?
- review and reassess
| - child can start sitting in the front seat at 13 y/o
122
What is violence prevention for 11-13 years?
- discuss strategies to avoid interpersonal conflicts
- avoiding media violence
- avoiding fights and walking away
- discuss conflict resolution techniques
123
What is nutritional counseling for 11-13 years?
junk food versus healthy eating
124
What is fostering optimal development for 11-13 years?
- reviewing homework and reinforcing school topics
- smoking and substane abuse prevention (begin abstraction)
- discuss and encourage abstinence
- possibly discuss condoms and contraceptive options
- avoiding violence
- offer availability
125
What is injury prevention fro 14-16 years?
- motor vehicle safety
| - avoiding riding with substance abuser
126
What is violence prevention for 14-16 years?
establish new family rules related to curfews, school, and household responsibilities
127
What is nutritional counseling for 14-16 years?
junk food versus healthy eating
128
What is fostering optimal development for 14-16 years?
- review school work
- begin career discussions and college preparation (PSAT)
- review substance abuse, sexuality, and violence regularly
- discuss condoms, contraceptive options, including emergency contraception
- discuss sexually transmitted disease, HIV
- providing no questions-asked ride home form at-risk situations
129
What is injury prevention for 17-21 years?
review and reassess
130
What is violence prevention for 17-21 years?
establish new rules related to driving, dating, and substance abuse
131
What is nutritional counseling for 17-21 years?
heart-healthy diet for life
132
What is fostering optimal development for 17-21 years?
- continuation of above topics
- off to college or employment
- new roles within the family
133
When is the Hepatitis B vaccine given for 0-6 years?
- first dose within first 24 hours of life
- second dose at 1-2 months
- thrid dose at 6-18 months
134
What are the characteristics of Hepatitis B vaccine?
- subunit vaccine
| - in HBs-Ag positive mothers, the infant should receive the hepatitis B vaccine and hepatitis B immune globulin
135
When is the rotavirus vaccine given for 0-6 years?
- first dose at 2 months
- second dose at 4 months
- third dose at 6 months
136
What are the characteristics of the rotavirus vaccine?
- live-attenuated vaccine
| - can increase the risk for intussusception
137
When is diphtheria, tetanus, and/or pertussis vaccine given for 0-6 years?
- first dose at 2 months
- second dose at 4 months
- third dose at 6 months
- fourth dose at 15-18 months
- fifth dose at 4-6 years
- booster doesr are given starting at 11 years of age
138
What are the characteristics of the diphtheria, tetanus, and/or pertussis vaccine?
inactivated vaccine
139
When is the H. influenze type b conjugate given for 0-6 years?
- first dose at 2 months
- second dose at 4 months
- third dose at 12-15 months
140
What are the characteristics of H. influenze type b conjugate?
inactivated vaccine
141
When is pneumococcal conjugate (PCV 13) given for 0-6 years?
- first dose at 2 months
- second dose at 4 months
- third dose at 6 months
- fourth dose at 12-15 months
142
What are the characteristics of pneumococcal conjugate (PCV 13)?
inactivated vaccine
143
When is the poliovirus vaccine given for 0-6 years?
- first dose at 2 months
- second dose at 4 months
- third dose at 6-18 months
- fourth dose at 4-6 years
144
What are the characteristics of the poliovirus vaccine?
inactivated vaccine
145
When is the influenza vaccine given for 0-6 years?
annually >6 months of age
146
What are the characteristics of the influenza vaccine?
- intramuscular vaccine is an inactivated vaccine
| - intranasal vaccine is a live-attenuated vaccine
147
When is the measles, mump, and rubella vaccine given for 0-6 years?
- first dose at 12-15 months
| - second dose at 4-6 years of age
148
What are the characteristics of the measles, mump, and rubella vaccine?
live-attenuated vaccine
149
When is the varicella vaccine given for 0-6 years?
- first dose at 12-15 months
| - second dose at 4-6 years of age
150
What are the characteristics of the varicella vaccine?
live-attenuated vaccine
151
When is the hepatitis A vaccine given for 0-6 years?
- first dose at 12-24 months
| - second dose given at least 6 months after the first dose
152
What are the characteristics of hepatitis A?
inactivated vaccine
153
When is the tetanus, diptheria, acellular pertussis (Tdap) given to 7-18 year old?
11-12 years of age
154
What are the characteristics of the tetanus, diptheria, acellular pertussis?
inactivated vaccine
155
When is the human papillomavirus to 7-18 year olds?
- two doses at 9-14 years of age
- in patients between the ages of 9-14, the 2 dose are administered 6-12 months after the first dose
- three doses at >15 years of age
- given at 0, 1-2 and 6 months
156
What are the characteristics of human papillomavirus?
- subunit vaccine
| - three doses of this vaccine are also recommended in immunocompromised adolescent patients
157
When is the meningococcal vaccine to 7-18 years old?
- first dose at 11-12 years of age
| - second dose at 16 years of age
158
What are the characteristics of meningococcal vaccine?
inactivated vaccine
159
When is the influenza vaccine given for 7-18 years old?
first dose given at 7-10 years of age and then annually
160
What are the characteristics of the influenza vaccine?
- intramuscular vaccine is an inactivated vaccine
| - intranasal vaccine is a live-attenuated vaccine
161
When is the influenza vaccine in >18 years of age?
one dose annually
162
When is the tetanus, diphtheria, aceullar pertussis (Tdap) or tetanus and diphtheria (tTd)?
one dose Tdap and then Td booster every 10 years
163
What are the characteristics of the tetanus, diphtheria, aceullar pertussis (Tdap) or tetanus and diphtheria (tTd)?
in pregnant women, 1 dose Tdap should be given during each pregnancy between 27-36 weeks gestation
164
When is varicella given >18 years of age?
two doses 4-8 weeks apart if the patient is without immunity to varicella
165
When is the zoster vaccine given >18 years of age?
two doses given 2-6 months apart at >50 years of age
166
When is the pneumococcal (PPSV23) given >18 years of age?
- given at least 1 years after PCV13 administration in adults >65 years of age
- PPSV23 is indicated in patients 19-64 with the following
- chronic heart disease (excluding hypertension)
- chronic liver disease
- chronic lung disease
- diabetes mellitus
- cigarette smoking
- patients >19 with
- immunodeficiency disorders
- HIV
- anatomical or functional asplenia
- chronic renal failure or nephrotic syndrome
- cerebral spinal fluid leak
- cochlear implant
167
What are the characteristics of pneumococcal (PPSV23)?
- PPSV23 is given after PCV13
| - PPSV23 is not conjugated and does not stimulate a helper T-cell response
168
What is the motor development for 0-1 month old?
moro and grasp reflex, visual tracking
169
What is the language for 0-1 month old?
crying
170
What is the social interaction for 0-1 month?
minimal
171
What is the motor development for 2 months?
holds head up, swipes at objects
172
What is the language for 2 months?
cooing
173
What is the social interaction for 2 months?
social smile
174
What is the motor development for 3 months?
lifting head and chest, moro reflex disappears
175
What is the motor development for 4 months?
rolls from prone to supine, grasp objects
176
What is the language for 4 months?
- orients to voice
| - colic resolves in most babies by this age
177
What is the social development for 4 months?
laughs
178
What is the motor development for 6 months?
sits upright
179
What is the language development for 6 months?
babbles
180
What is social development for 6 months?
stranger anxiety
181
What is motor development for 9 months?
crawls, pull-to-stand, pincer grasp, eats with fingers
182
What is language development for 9 months?
mama-dada (nonspecific)
183
What is the social development for 9-month-old?
waves bye-bye, responds to name
184
What is the motor development for 12 month old?
stands
185
What is the language development for 12 month old?
mama-dada (specific)
186
What is social development for 12 month old?
picture book
187
What is the motor development for 15 month old?
walks, uses cup
188
What is the language development for 15 month?
severl words
189
What is social development for 15 month old?
temper tantums
190
What is motor development for 18 month olds?
walks up staris, throws ball
191
What is language development for 18 month olds?
names objects
192
What is social development for 18 month olds?
toilet-training begins
193
What is the motor development for 24 month olds?
runs
194
What is the language development for 24 month olds?
2-word sentences, several hundred word vobaculary
195
What is the social development for 24 months?
follows 2-step commands
196
What is motor development for 36 month old?
rides a tricycle (36 years), eats with utensils
197
What is language development for 36 month old?
3-word sentences
198
What is social development for 36 month old?
knows first and last name
199
What is the development for 6-11 years?
development of conscience (the super-ego), has same-sex friends
200
What is the normal development for girls age 11 and boys age 13 years?
abstract reasoning, the formation of personality, may have friends of the opposite sex
