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Pediatrics Flashcards

0
Q

Voluntary grasp ( no release )

Rolls front to back

A

5 mo

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1
Q

Sits with no support

A

7 mo

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2
Q

Voluntary grasp with voluntary release

Waves “ bye- bye”

Plays pat-a-cake

A

10 mo

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4
Q

Can built tower of 6 cubes

Runs well

A

2 yr

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5
Q

Age at milestones are reached

Or

Overall patten of development

A

The overall pattern of development is more important than the age at which individual milestones are reached.

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6
Q

Preventive care measures at pediatric visit;

A

Height, weight, blood pressure, developmental/ behavioral assessment, and anticipatory guidance!

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7
Q

Screening and preventive care are important part of every encounter with patient.

A

eg. Mother complains about her child sleeps 11 hours a day! ( 4 yo) . That is normal behavior.
What should you do next?
Give a objective hearing exam , which is routine screening procedure in a 4 yo!

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8
Q

Screening for metabolic and congenial disorders. First month.

A

All states : hypothyroidism & phenylketonuria

Most states: galactosemia & sickle cell disease

If any is + 1 st step= order A CONFIRMATORY TEST.

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9
Q

Anticipatory guidance for parents:

A
  • keep the water heater < 110-120 * F
  • use car restraints
  • infant sleeps on his back, to prevent ( SIDS) the most common cause of death in 1-2 mo
  • no walkers
  • watch small objects
  • no cow milk before 1 yo
  • introduce solid foods gradually starting at 6 mo
  • supervise swimming pools
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10
Q

Head circumference should be measured

A

At every visit in the first 2 years

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12
Q

First words

Imitates other’s sounds

A

9-12 mo

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13
Q

Growth curve always low are more benign than

A

A patient who goes from normal to abnormal curve. That is worrisome!

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14
Q

Failure to thrive is defined as head circumference, height and or weight less than 50 percentile of age.

A

Due most commonly to psychosocial or functional problems.

Look for signs of neglect/ or child abuse.

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15
Q

Obesity is due to overheating and too little activity ( > 95 % cases)

A

Less than ( 5%) of cases are due to organic causes (USA)

Cushing’s syndrome , Prader- Willi Syndrome

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16
Q

Abnormal head circumference ;

A

INCREASED : hydrocephalus or tumor

DECREASED : microcephaly ( from TORCH)

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17
Q

Hearing and vision may be measured objectively at least once by 4 years of age.

A

After every few years until adulthood

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18
Q

Worried about hearing loss

A

After MENINGITIS(hearing loss is the most common complication)
With ( TORCH)
With measles or mumps
With chronic middle effusions or chronic otitis media
With ototoxic drugs ( aminoglycosides)

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19
Q

TORCH

A 
Toxoplmosis
Other- Syphilis,HIV
Rubella 
Cytomegalovirus 
Herpes simplex
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20
Q

Red reflex?

Penlight shined at the pupil you usually se red because of the underlying fundus.

A

If CATARACT or TUMOR the red reflex disappears.. you see

If CATARACT = black
If TUMOR = white -“Leucocoria” ( Retinoblastoma )

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21
Q

Strabismus ( ocular misalignment ) is normal until..

A

3 mo

After 3 month strabismus should be evaluated by ophthalmologist.

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22
Q

Screening for anemia routine

A

Once in the first year ( 8-12 mo)
Once between 4-6 years
Once during adolescence

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23
Q 
Risk factors for iron deficiency :
Should screening with;
complete blood count 
or 
hemoglobin and hematocrit
A
  • Prematurity
  • Low birth weight
  • Cow milk before 1 year age.
  • low dietary intake
  • Low socioeconomic status
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24
Q

Exclusively breast-feed infants do not require supplementation!

A

All other children should recive IRON
at

4-6 mo
2 mo, in preterm

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25
Q

Screen for LEAD expousure:

High risk ( old buildings, eat paint chips, live near battery recycling plant or parent works there)

A

Low risk: at 12 mo if normal rescreen at 24 mo.

High risk: at 6 mo if normal, rescreen at 12 mo.
And annually!

First step: stop the expousure!

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26
Most Children do not need fluoride supplements ( Fluor)
Only those that lives in areas were the water is not fluoridated (rare) Or eat only ready-to-eat formulas ( which use non fluorated water)
27
Breast-fed infants are more likely to require Vitamin D supplements than formula-fed infants.
True! High risk children; Exclusively breast-fed beyond 6 mo. Little sun light expousure or dark skin All formulas contain Vit. D!
28
Screen TBC?
Universal screen is not recommended. Only high risk factors ( HIV/ institutionalization) screen annually! If the only risk factor is living in an area or immigrant parents, Screen once between 4-6 yo. And once between 11-16 yo.
29
Screening children for renal disease, for congenital/ anatomic abnormalities ( vesico ureteral reflux) after ;
Male < 6 yo. Urinary tract infection. Female < 6 yo. Repeated urinary tract infection. VOIDING CYSTOURETHROGRAM & RENAL ULTRASOUND!
30
Vaccination
-PNEUMOCOCCAL VACCINE to sickle cell disease/ splenectomy -NO MEASLES-MUMPS-RUBELLA OR INFLUENZA VACCINES for egg-allergic patients - NO LIVE VACCINES for inmunocompromised!
31
Sexual active teenaged girls need annual Pap smears and screening for;
Chlamydial and Gonorrhea
32
See Dentist for the first time:
2-3 years
33
Tanner stages, for measure the stages of Puberty. | Stage 1 preadolescent , Stage 5 adult
Females (10.5) First: Breast development ! Males (11.5) First: Testicular enlargement!
34
Delayed Puberty
Females (13) = lack of breast development or pubic hair Males (14) = lack of testicular enlargement The most common cause is : CONSTITUTIONAL DELAY, Normal! Watch for parents with similar history "late bloomers"
35
Causes for Delayed Puberty: Most common; constitutional delay, normal variant!
Primary Testicular failure: OR. Ovarian failure: Klinefelter's syndrome Turner's syndrome Cryptorchidim. Gonadal dysgenesis History of chemotherapy Gonadal dysgenesis Even more rare: hypothalamic/pituitary defect: Kallman's syndrome or Tumor!
36
Causes of Precousius Puberty
Idiopathic McCune-Albright syndrome (girls) Ovarian tumors (granulosa, theca-cell or gonadoblastoma) Testicular tumors (Leydig) CNS disease or trauma Adrenal neoplasia Congenital adrenal hyperplasia # Boys # 21-hydroxilase deficiency
37
If the underlying cause of Precocious Puberty is idiopathic or uncorrectable after diagnosis patients should recieve:
GnRH = gonadotropin-releasing hormone AGONIST. Prevent premature epiphyseal closure with short stature.
38
Cavernous Hemangiomas
Are Benign vascular tumors. Increase within 2 years of life. (20% appears at birth) Observe and follow.
39
Caput succedaneum. Vs. Cephalhematoma
CAPUT SUCCEDANEUM Diffuse swelling or edema of the scalp that CROSS the midline Benign, requires no study or treatment. CEPHALHEMATOMA Subperiosteal hemorrhages that are sharply limited by structures and DO NOT CROSS the midline. Usually benign, BUT in rare cases the may indicate underlying skull fracture! Order: Rx or CT
40
Anterior Fontanelle close
18 mo! ``` Delyed close may indicate Hypothyroidism Hydrocephalus Rickets RCIU ```
41
How many vessels does a normal umbilical cord have?
3 vessels: 2 Arteies & 1 Vein Check at birth If Only ONE ARTERY is present consider; CONGENITAL RENAL MALFORMATIONS
42
First week of life, female newborn;
Milky-white and possibly blood-tinged vaginal discharge, normal. Physiologic due to maternal hormone withdrawal
43
CHILD ABUSE FINDINGS
- failure to thrive - multiple fractures, or injuries in different stages of healing - metaphyseal "bucket handle" or "corner" fractures - "shaken baby" syndrome( subdural hematomas with no external sign of trauma or Retinal Hemorrhages) - behavioral, emotional or interactional problems - ETS - multiple personality disorder (#sexual abuse) - parent story does not fit the child's injury
44
Reporting any suspicion of child abuse is mandatory
You do not need proof and can not be sued for reporting your suspicion.
45
Vital signs in child
Lower blood pressure Higher Heart and respiratory rates than adults Hb/Hto > at birth Hb/Hto < at childhood
46
APGAR Assessed 1-5 min after birth. If the score is < 7 continue to assess every 5 min, until reaches 7 or more.( while resuscitating the child as needed)
``` Heart rate Respiratory rate Muscle tone Reflex irritability Color ```
47
You may have suction or INTUBATE the infant seconds after delivery
Do not wait until the 1 min mark, APGAR
48
Child + AAS ( aspirin)
Reye's syndrome - encephalopathy - liver failure When AAS is given after influenza or varicella infection. Give Acetaminophen !!!
49
When should MORO and PALMAR GRASP Reflex disappear?
By 6 mo !
50
Nontender abdominal mass associated with elevated VMA and HVA
Neuroblastoma
51
The most common type of tracheoesophageal fistula (TEF) | Diagnosis?
Esophageal atresia with distal TEF (85%) Unable to pass NG tube
52
Not contraindications to vaccination
Mild illness and / or low-grade fever Current ATB therapy Prematurity
53
Test to rule out shaken baby syndrome
Ophthalmologic exam CT MRI
54
A neonate has meconium ileus
``` Cystic fibrosis (Hirshprung's disease is associated with failure to pass meconium for 48 hs) ```
55
Bilious emesis within hours after the first feeding
Duodenal atresia
56
A 2-month-old baby presents with no bilious emesis. Diagnosis? What are the appropriate steps in the management?
Pyloric stenosis 1-Correct metabolic abnormalities 2-Then correct pyloric stenosis with pyloromyotomy
57
The most common 1* immunodeficiency
Selective IgA deficiency
58
An infant has high fever and onset of rushes fever breaks | What is he at risk of?
Febrile seizures ( due to roseola infantum) 6ta enfermedad
59
A boy has chronic respiratory infections. Nitroblue tetrazolium test is - What is the immunodeficiency?
Chronic Granulomatous Disease
60
A child has eczema, thrombocytopenia, and high levels of IgA | What is the immunodeficiency?
Wiskott-Aldrich Syndrome
61
A 4-month-old boy has life-threatening Pseudomonas infection
Burton's X-linked agamaglobulinemia
62
Acute-phase treatment for Kawasaki Disease
High dose ASA -Aspirin- for inflammatory and fever | IVIG to prevent coronary artery aneurysm
63
Treatment for mild and severe unconjugated hyperbilirubinemia
Mild= Phototherapy (do not use it for Conjugated!!!) Severe= Exchange transfusion
64
After ASA intake: Sudden onset of mental status changes Emesis Liver dysfunction
Reye's Syndrome
65
A child has loss of red light reflex ( withe pupil) Diagnosis? The child has an increased risk of what cancer?
Suspect Retinoblastoma > Risk = Osteosarcoma
66
Vaccinations at 6-month well-child visit
``` HBV DTaP Hib IPV PCV Rotavirus ```
67
Tanner stage 3 in a 6-year-old girl
Precocious puberty
68
Infection of small airways with epidemics in winter and spring
RSV Bronchiolitis
69
Cause of neonatal RDS
Surfactant deficiency
70
A condition associated with red "currant-jelly" stools, colicky abdominal pain, bilious vomiting, and sausage-shaped mass in
Intussusception
71
A congenital heart disease that cause 2* hypertension | What you find on physical examination?
Contraction of the aorta; < femoral pulses
72
First-line treatment for otitis media
Amoxicillin x 10 days
73
The most common pathogen causing croup
Parainfluenza virus type 1
74
A homeless child is small for his age and has a peeling skin and a swollen belly
Kwashiorkor ( protein malnutrition )
75
``` Defect in an X-linked syndrome Mental retardation Gout Self-mutilation Choreoathetosis ```
Lesh-Nyhan Syndrome | purine salvage problem with HGPRTase Deficiency
76
Newborn girl has a continuous "mashinery murmur" | What drug would you give?
Patent Ductus Arteriosus (PDA) Indomethacin is given to close the PDA
77
A newborn with a posterior neck mass and swelling of the hands
Turner's syndrome

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