Pediatric Board Study #2 10/2020 Flashcards
What are the milestones in regards to ability to use the staircase?
18 mos: walk up stairs with one hand held
2 years: walk down stairs holding the rail (takes more coordination to walk down)
3 years: walks up stairs alternating feet (more coordination to alternate feet vs both feet on each step)
4 years: balances on one foot for few seconds (balancing on one foot is like alternating feet, but being able to maintain balance longer)
5 year old milestones?
TIP: All correlate with getting ready to go to school
Ties knots - like shoes
Print letters
Rules of 3 for infantile colic?
3 weeks to 3 months of age
3+ hours of crying / day
> 3 days / wk
Normal, but strange, physical behaviors in children that don’t require interventions
Headbanging: normal 8 months to 4 years
Thumb-sucking: up to 4 years of age
Biting: normal up to 3 years of age
At what age is enuresis considered pathologic?
5
TIP: By 5 years of age, a kindergartener, should be potty-trained
What is considered secondary enuresis?
Having been dry for 6 months, then start to have enuresis
TIP: “6 months” “S”econdary enuresis
Diurnal enuresis cannot be diagnosed under what age?
3 years old
What age should infants sleep THROUGHOUT the night?
4 months
What age can sleep training begin?
4-6 months
Vitamin D2 and Vitamin D3, what are the generic formulations of each?
Vitamin D2 has 2 C’s: ErgoCalCiferol
Vitamin D3 has 3 C’s: CholeCalCiferol
What is the difference between Calcidiol and Calcitriol?
Calcidiol is 25 OH Vit D, storage form synthesized in the liver
Calcitriol is 1,25 OH Vit D, active form synthesized in the kidney
TIP: “DI” means 2, hence 2 numbers, 2 and 5; “TRI” means 3, hence 3 numbers, 1 2 and 5
What is the most common presentation of milk protein allergy? And what age?
First month of life
- Cutaneous - urticaria, oral pruritus, and/or atopic dermatitis
- Gastrointestinal - vomiting and/or diarrhea
- Respiratory - oropharyngeal angioedema, rhinoconjunctivitis, rhinorrhea, and/or stridor or wheezing (reported to occur in 15% of patients)
TIP: Anaphylaxis organs
What vaccines in childhood require at least 4 shots?
IPV
PCV
Hib
DTaP
TIP: of the 6 vaccines given betwen2-6 mos of age, the vast majority require 4 shots
What vaccines are given at 12 mos?
BIG MONTH
TIP: other than 2, 4 and 6 mos, 12 mos is the only other time to receive 6 SHOTS
Hib PCV MMR Varicella Hep A Influenza
What are the list of live vaccines?
The live, attenuated viral vaccines currently available and routinely recommended in the United States are:
- MMR
- varicella
- zoster (which contains the same virus as varicella vaccine but in a much higher amount)
- rotavirus
- influenza (intranasal).
Other non-routinely recommended live vaccines include adenovirus vaccine (used by the military), typhoid vaccine (Ty21a), and Calmette-Guerin (BCG).
Patient with egg allergy leading anaphylaxis. Influenza vaccine? Yellow fever vaccine? Rabies vaccine?
Yes to influenza, but monitor in office
No to yellow fever; allergy testing first regardless of how minor the reaction to egg
- TIP: YELLOW = egg
Yes to Rabies vaccine; only 1 of the formulations is grown in chick fibroblasts and has PICOgrams of egg
Difference between early onset vs late onset sepsis in newborn?
EOS: Within 7 days of life
LOS: Up to 6 months! (Talk about LATE)
Definition of SGA vs LGA?
SGA: BW < 10%ile OR < 2500gm
LGA: BW > 90%ile OR > 3900 gm
How to calculate a baby’s corrected (or adjusted) age?
Chronological age - # of weeks premature
Example:
- Chronological age: 1 year old
- Baby born: 2 months early, AKA 32 weeks
- Corrected age: 1 year old - 2 months = 8 months corrected
Child comes in with suspected abuse, but skeletal survey is negative. What additional test can be obtained that may demonstrate fractures due to child abuse?
Systematic review and Meta-analysis 2020
- low to very low quality evidence
Bone scintigraphy
Results:
-The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15)
- the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7)
Conclusion:
From the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required
Blangis F, Taylor M, Adamsbaum C, et al. Add-on bone scintigraphy after negative radiological skeletal survey for the diagnosis of skeletal injury in children suspected of physical abuse: a systematic review and meta-analysis. Arch Dis Child. 2020 Sep 30. pii: archdischild-2020-319065. doi: 10.1136/archdischild-2020-319065.
