Pediatric Flashcards
Until what age do we use the Denver 2 screening tool?
up to 6 years old
What age able to know 4 colors?
5 years
for exclusively breast-fed infants, how much iron is recommended after 6 months of age?
1 mg/kg/day
AKA knock-knee
genu valgum
What test is used to confirm Lyme disease?
Western blot assay
staphylococcal abscess on the upper or lower eyelid
hordeolum (stye)
What is the management for the common cold?
rest/hydration, nasal saline drops, humidifier; No OTC cold preps, No antibiotics; and avoid antitussives for <6 yrs. old
3 classes of GERD
physiological, functional, pathological
What is the finding in sensorineural hearing loss with the Rinne test?
normal in the affected ear
Conductive vs. Sensorineural hearing loss: Weber test - sound lateralizes to the affected ear
conductive
“bowed legs”
genu varum
small (<1 cm) pus-filled lesion
pustule
adjustment of developmental expectations for premature infants through the age of 2 years
corrected gestational age
term for fissures at lip corners, which may show vitamin deficiency
cheilosis
Which Hepatitis is related to IV drug use and blood transfusions?
Hep. C
Genu varum normal variant in which age group?
toddlerhood
What is considered a fever in an infant younger than 30- days old?
rectal temp of >100.4
Psoas vs. Obturator: pain with right thigh extension
Psoas sign
Genetic disorder - defect of the parathyroid, thymus; conotruncal region of heart - will have congenital heart defects; hypoparathyroidism w/ hypocalcemia, leading to seizures in infancy
DiGeorge (Velocardiofacial) syndrome
Tanner stage: Breast enlargement without separate nipple contour
Tanner Stage 3
At what age do we worry about strabismus?
After 6 months of age
How are pinworms spread?
fecal-oral
What is given for strep pharyngitis?
Penicillin VK 250mg TID x10 days; if allergic to PCN, erythromycin 250mg QID x10 days
At what age should we start measuring blood pressure?
3 years old
What medication is used for Kawasaki disease?
high dose aspirin therapy
What condition is associated with a “slapped cheek” appearance, is not contagious after fever breaks, and pathogen is Human Parvovirus B19?
Erythema infectiosum (fifth disease)
Which vaccine is contraindicated in those w/ a Hx of anaphylaxis to streptomycin?
IPV
AKA bowleg
genu varum
What would you suspect in a child with fever 101 or higher and exudate pharyngitis (days 1-2) and then rash presentation (12-48 hr after fever onset)?
scarlet fever
Inflammatory vs. Non-Inflammatory: Legg-Calve-Perthes disease & slipped capital femoral epiphysis (SCFE)
non-inflammatory
Hib not recommended for children over what age?
5 years old
Tdap vaccine
series of 1 (11 or 12 years) and subsequent Td boosters every 10 years
genu valgum: bowleg or knock-knee?
knock-knee
national car seat laws
< 1 y/o must sit facing backwards / < 4 y/o & 40 lbs. must be in booster seat
Fetal alcohol syndrome will show abnormal ____ features on PE.
facial - small eye openings, thin upper lip, smooth philtrum, upturned nose, small head size
Genu valgum normal variant in which age group?
preschooler
What age is school-age children?
6-12 years old
What condition is associated with Koplik’s spots?
Rubeola (ordinary measles)
self-limiting inflammation of the hip, most likely due to a viral or immune cause. Most often ages 2-6 years. Internal rotation of hip causes spasm; no obvious signs of infection
toxic synovitis
What is the proper dose of acetaminophen for an infant?
10-15 mg/kg every 4-6 hours
Which condition will show a “steeple”-shaped narrowing of the trachea on a frontal radiograph of the neck?
croup
What age able to copy a circle?
3 years
Children between 2-5 years old, what is the recommendation for screen time?
limited to no more than 1 hour per day
Tanner stage: Pubic hair darker, increased amount, curlier
Tanner Stage 3
elevated, firm lesion >1cm
nodule
Varicella vaccine
series of 2 (between 12 months & 12 years, minimum 3 months apart)
most common sex-chromosome anomaly of females
XO Karyotype (Turner’s syndrome)
Which diagnostic test for pyloric stenosis?
abdominal ultrasound
AKA hypo/hyperpigmentation macules on limbs
tinea versicolor
What is the finding in conductive hearing loss with the Rinne test?
abnormal in affected ear (AC < BC)
Where is tinea capitus?
scalp
Which skin disorder has linear or curved burrows and interdigital lesions?
scabies
DTaP vaccine
series of 3 primary (2-4-6 months) & 2 boosters (15 months & 6 years)
What would you suspect in a previously healthy infant who develops acute colicky pain?
intussuception
AKA tinea corporis
body ringworm
Polio vaccine (IPV)
series of 4 (2-4-6 months & 6 yrs.)
Weber vs Rinne: sound should be heard equally in both ears and not lateralize
Weber
What would you suspect in a patient with an aversion to second-hand smoke and alcohol odors, fatigue, malaise, anorexia, N/V, headache?
Pre-icteric hepatitis
“knock-knees”
genu valgum
why is fine motor development of hand-to-hand transfer important by 5-6 months of age?
means that both brain hemispheres are working. If not present, may be the first sign of cerebral palsy.
a granulomatous (beady nodule) on the eyelid; infection or retention cyst of the meibomian gland
chalazion
“knees are stuck together with gum)
genu valgum (knock-knee)
What is a pyloric olive?
a palpable mass after vomiting in patient’s with pyloric stenosis
Skin disorders must have which 3 descriptors?
morphology, configuration, distribution
Genetic disorder only in females, “shield”-shaped chest (widely spaced nipples), HTN, bicuspid aortic valve, coarctation of aorta
XO Karyotype (Turner’s syndrome)
What is Auspitz’s sign?
droplets of blood when scales are removed
What test is used to detect antibody to B. Burgdorferi in Lyme disease?
ELISA screening
Genu varum (bowleg) is considered a normal variant until what age?
2 years old (walking age)
DTaP is not indicated for children over what age?
7 years
sensitivity vs. specificity
sensitivity +=+ and specificity - = -
What age able to turn a doorknob?
2 years
Which diagnostic test for intussusception?
radiograph to clarify diagnosis and barium enema is diagnostic & produces reduction
What skin disorder is associated with Auspitz’s sign (droplets of blood when scales are removed)?
psoriasis
Rotavirus vaccine (Rota)
series of 3 from 6 weeks to 8 months at 4-week intervals (b/c antibodies take about 1 month to build)
Which vaccine should not be given to those who are pregnant or immunosuppressed?
MMR
Psoas vs. Obturator: pain with internal rotation of the right thigh
Obturator sign
What age able to copy a square?
5 years
What virus causes mononucleosis?
Epstein-Barr virus
Genetic disorder - inherited connective tissue disorder, long arms, & risk of aortic aneurysm
Marfan syndrome
Genetic disorder with an extra X chromosome & only occurs in males; will have more feminine properties
XXY syndrome (Klinefelter’s syndrome)
Do not administer Rotavirus vaccine after what age?
32 weeks (8 months)
Which skin condition is associated with a “herald patch” and a pruritic rash in a Christmas tree pattern?
pityriasis rosea
Which condition? Associated with “Gower’s maneuver”, which is where a child “walks” hands up legs to attain standing position when getting up. It is genetic, affects males, and will have elevated creatine kinase.
muscular dystrophy (Duchenne)
Consider antibiotic therapy (& which drug is first-line?) for diarrhea if patient has how many stools daily?
> 8-10 stools per day, consider antibiotics. First-line is Bactrim.
Posterior fontanel closes when?
2-3 months
Hirchsprung’s disease (aganglionic megacolon): bilious or non-bilious vomiting
bilious
serous fluid-filled vesicles >1 cm
bulla
dots on top of starburst lines in iris of eye
Brushfield spots
Will the common cold have fever and/or lymphadenopathy?
neither
normal gestational age
37-41 weeks
What would you suspect in a patient with currant jelly stool and/or sausage shaped mass in RUQ?
intussusception
“3 wheels at 3”
able to ride a tricycle at age 3
to what age do we measure head circumference?
2 y/o
a pus-filled lesion >1 cm
abscess
“too much rum, wide-center of gravity”
genu varum (bowleg)
continuous humming murmur; heard best in sitting position, disappears in supine position; also obliterated by turning head and/or compressing neck ispilaterally
Venous hum
Pyloric stenosis: projectile vomiting or not?
Yes
Which standardized testing tool is the gold standard for the diagnosis of developmental delays in infants/toddlers to 42 months of age?
Bayley Scales of Infant and Toddler Development
Weber vs Rinne: air conduction (AC) > bone conduction (BC)
Rinne
Which condition will show a “thumb sign,” a thumb-shaped patch appearing on a radiograph of the neck?
epiglottitis
What condition is associated with a rash that starts on the face, spreads to extremities & trunk, and is gone in 72 hours; also is teratogenic?
Rubella (3-day measles)
What is the most common vector-borne disease in the U.S.?
Lyme disease
What treatment is used for pinworms?
anthelmintics to eradicate infection
By what age should the testes be fully descended?
3 months old
When would you need to order diagnostic tests for gastroenteritis (N/V/D)?
if symptoms persist >72 hrs. or bloody stool is present
At what age is ibuprofen approved to use?
after 6 months old
what age does BMI start?
2 years old
scaly, elevated lesion; the classic lesion of psoriasis
plaque
Which 2 medication classes can exacerbate acne?
steroids & anticonvulsants
What is the treatment for a chalazion?
warm compresses and referral for surgical removal
What antibiotic is used for sinusitis?
amoxillin-clavulanate (Augmentin) x10 days; change to Levaquin (or other secondary antibiotic) if no improvement in 3 days
what is bone age?
x-ray of tarsals and carpals to determine extent of ossification
What should be on the differential diagnosis in a child who is stuttering?
hearing and/or visual impairment
aseptic or avascular necrosis of the femoral head. Most common age 4-9 years old.
Legg-Calve-Perthes disease
less suck reflex, less airway control
hypotonia
Clinical features most suggestive of group A beta-hemolytic streptococci (GABHS) include FLEA mnemonic:
Fever, Lack of cough, pharyngo-tonsillar Exudate, anterior cervical Adenopathy. If 2/4 are present, do a strep test
A condition in which the foreskin is tightly stretched around the head of the penis and cannot be pulled back freely
phimosis
Which skin infection is associated with honey-crusting lesions?
impetigo
Which condition? Typically <3 y/o, with RSV being responsible for more than 50% of cases
bronchiolitis
How old are preschoolers?
4-5 years old
psychosexual theorist
Sigmund Freud
Tanner stage: Penis elongates
Tanner Stage 3
What condition? child holds arm across body with thumb up
nursemaid elbow
Conductive vs. Sensorineural hearing loss: Rinne test - abnormal in affected ear (AC < BC)
conductive
3 primary domains of growth and development
physical, cognitive, psychosocial
What age does physiologic and pyschological readiness for toilet training begin?
between 1.5-2.5 years
Which diagnostic test for Hirchsprung’s disease (aganglionic megacolon)?
abdominal x-ray
AKA tinea cruris
jock itch
Term for onset of puberty before age 8 in girls and 9 in boys
precocious puberty
Anterior fontanel closes when?
approx. 18 months
What are 2 treatments used for scabies?
Permethrin (Nix) or ivermectin
How old are toddlers?
1-3 years old
primary theorist for the psychosocial domain
Erik Erikson
Kawasaki disease is most commonly noted in children of what age and what ethnicity?
under 2 years old and of Asian ethnicity
What condition? positive Kernig’s sign and Brudzinski’s sign
meningitis
If child has port wine stain, especially if comes to midline & stops, rule out what?
Sturge-Webber - serious neuro condition w/ seizures
At what age is a neuroblastoma most common?
before age 5 years
Which condition would be suspected in a patient with posterior cervical lymphadenopathy, white exudate on tonsils, and splenomegaly?
mononucleosis
What is the proper dose of ibuprofen in an infant?
10 mg/kg every 6 hours
Suspect what if there are many large cafe au lait spots OR if more than 6 spots in a child older than 5 y/o?
neurofibromatosis
small (<1 cm) lesion filled with serous fluid
vesicle
When should a child’s first dental visit be?
By 1 year of age
Which skin condition may show an elevated serum IgE?
atopic dermatitis (eczema)
Influenza vaccine in children
1 dose annually, start at 6 months old. 6-35 months, 0.25 mL IM … 3 y/o, 0.5 mL IM … <9 y/o, 2 doses 1 month apart
firm, elevated lump
tumor
Which vaccinations will help prevent AOM?
Hib, PCV13, annual flu
What does egophony suggest on lung auscultation?
consolidation
Consider what if newborn has radio-femoral pulse delay?
coarctation of aorta - get pulse ox readings in all 4 extremities
What condition are you checking for with a pilocarpine iontophoresis (sweat test)?
cystic fibrosis
inflammation of the tibial tubercle as a result of repetitive stressors in patients with immature skeletal development. Peak age 11-14 years, associated with rapid growth spurt.
Osgood-Schlatter disease
infants should be exclusively breast fed for how many months?
6 months
a neurocutaneous syndrom characterized by numerous cafe-au-lait spots on the body, and nerve tumors on the skin and in the body
neurofibromatosis (von Recklinghausen disease)
small (<1 cm), elevated, firm lesion
papule
Which Hepatitis is blood-borne and present in body fluids?
Hep. B
primary theorist for the cognitive domain
Jean Piaget
generalized assessment tool, used from birth to 6 years of age. Measures gross & fine motor development, language, & personal-social development
Denver 2
What condition is associated with a highly contagious virus that affects the salivary glands?
mumps
What to suspect in a patient with enlarged abdominal mass, FTT, profuse sweating, tachycardia?
neuroblastoma
Genetic disorder with presence of a third #21 chromosome, hypotonia, Brushfield spots
Trisomy 21 (Down Syndrome)
Which conjunctivitis is considered an opthalmic emergency?
gonococcal
Conductive vs. Sensorineural hearing loss: Weber test - sound lateralizes to the unaffected ear
sensorineural
Which Hepatitis is transmitted via oral-fecal route?
Hep. A
Term for bulky, foul stool (as seen in malabsorption).
steatorrhea
What lab test can diagnose fetal alcohol syndrome?
none exist; diagnosed through PE
most common cause of hypogonadism & infertility in men
XXY (Klinefelter’s) syndrome
Pyloric stenosis: bilious or non-bilious vomiting?
non-bilious vomiting after eating
Which skin condition? Hyperproliferative; plaques with silvery scales
psoriasis
Intussusception: bilious or non-bilious vomiting?
bilious
Inflammatory vs. Non-Inflammatory: Osgood-Schlatter disease & toxic synovitis
inflammatory
What is the hallmark treatment for atopic dermatitis (eczema)?
dry skin management: moisturizing lotion immediately after bathing; must blot dry
What condition is associated with a high fever that abruptly stops when rash develops, and is caused by Herpesvirus 6?
Roseola infantum (sixth disease)
What is the finding in conductive hearing loss with the Weber test?
sound lateralizes to the affected ear
What condition is associated with Borrelia Burgdorferi, a spirochete?
Lyme disease
What is the first line medication for AOM?
Amoxicillin 80-90 mg/kg/day, BID x10 days
Conductive vs. Sensorineural hearing loss: Rinne test - normal in the affected ear
sensorineural
acute febrile syndrome causing vasculitis
Kawasaki disease
Genetic disorder of Ashkenazic Jews; progressive deterioration beginning 3-6 months of age. Often cherry red macula is 1st sign
Tay-Sachs disease
Which vaccine is contraindicated in pregnant women & immunosuppressed persons, & in those with a streptomycin allergy?
Varicella
What is Russell’s sign in adolescents?
bruised knuckles from self-induced vomiting
genu varum: bowleg or knock-knee
bowleg
What is the finding in sensorineural hearing loss with the Weber test?
sound lateralizes to the unaffected ear
What would you suspect in infrequent, explosive bowel movements?
Hirchsprung’s disease (aganglionic megacolon)
phenotype vs. genotype
phenotype - presentation specific to a genetic disorder … genotype - diagnostic characteristics
Which condition has umbilicated papules with a cheesy core?
molluscum contagiosum
Which bacteria causes scarlet fever?
group A beta-hemolytic streptococci (GAHGS)
AKA tinea manuum and tinea pedis
athlete’s foot
What is the difference between bacterial vs. gonococcal conjunctivitis?
Gonococcal will have purulent drainage that is more copious than bacterial. Treatment is with IV Pen G (neonatal) or ceftriaxone IM
AKA hordeolum
stye
Rheumatic fever follows which type of infection?
Group A strep infection of the upper respiratory tract
Hip dysplasia - what is the difference between Ortolani’s click & Barlow’s maneuver?
Ortolani’s click - dislocation is REDUCED
Barlow’s - CAUSED the dislocation
Term for BMI greater than the 95th percentile for age/gender
obesity
most common innocent murmur; musical systolic murmur; due to turbulence in the left ventricular outflow tract
Still’s murmur
How long should a child with impetigo abstain from school and other community events?
until 48 hours of treatment
What does MCV measure? and lab values
mean corpuscular volume; average volume & size of individual erythrocytes; microcytic = 80, normocytic = 80-100, macrocytic = 100
Lab values of MCHC
“color”. Hypochromic <32% ; normochromic 32-36%
iron deficiency anemia: normal, increased, or decreased RCDW?
increased
thalassemia: normal, increased, or decreased RCDW?
normal or slightly increased
anemia of chronic disease: normal, increased, or decreased RCDW?
normal
number of new, young RBCs in circulation
reticulocyte count
What is a normal reticulocyte count, and what does it measure?
1-2%; index of bone marrow health and response to anemia
anemia due to hemorrhage or hemolysis - what will reticulocyte count be?
increased, approx. 20%
iron deficiency anemia, what will reticulocyte count be?
0%
iron deficiency anemia - What -cytic and -chromic?
microcytic, hypochromic
what anemia is pica associated with?
iron deficiency anemia
Which lab test is diagnostic of thalassemia?
hemoglobin electrophoresis
What anemia is associated with Howell-Jolly bodies?
sickle cell anemia
What levels of lead is considered lead poisoning?
> 5
bluish discoloration of gingival border
burtonian lines
What condition is associated with Burtonian lines?
lead poisoning
Describe diagnostic criteria of serum fasting blood sugar for Type 1 DM.
> = 126 on 2 separate occasions
What is the Somogyi effect in Type 1 DM?
nocturnal hypoglycemia, SURGE of hormones that raise blood sugar. Hypoglycemia at 0300 and hyperglycemia at 0700. (Somogyi = tsunami)
What is the dawn phenomenon in Type 1 DM?
blood sugar slowly rises throughout the night due to tissue desensitization of insulin (“dawn is slowly rising”)
Is Metformin okay to use in children?
yes
What is the treatment for chlamydia?
zithromax 1 gram once OR (if not pregnant) doxycycline 100mg BID x7 days
Which STD is the leading cause of infertility in females?
gonorrhea
What culture media is used for gonorrhea?
Thayer-Martin or Transgrow media
What STD’s are reportable to the health department?
GCS (gonorrhea, chlamydia, syphilis)
What is the treatment for gonorrhea?
ceftriaxone IM single dose & zithromax 1 g once to cover chlamydia
What STD shows treponemes?
syphilis
What screening tests for syphilis?
VDRL or rapid plasma reagin
What confirmatory test for syphilis?
treponemal tests
What is the treatment for syphilis?
benzathine penicillin G
What tests for bacterial vaginosis?
wet mount will show clue cells; & positive amine “whiff” test
What is the treatment for bacterial vaginosis?
metronidazole or clindamycin
What tests for herpes?
papanicolaou or Tzanck stain; viral culture
What is the treatment for herpes?
acyclovir or valocyclovir
What screening tests for HIV/AIDS?
infants - PCR ; older children - ELISA
What confirmatory test for HIV/AIDS?
Western blot test
