Pediatrics Flashcards
Possible “red flags” for autism spectrum disorder prior to the toddler years
- Does not respond to name by 12 months
- Does not point to objects to show interest by 14 months
- Does not play “pretend” games by 18 months
Possible “red flags” for autism spectrum disorder during toddler years and beyond
- Avoid eye contact and wants to be alone; has obsessive interests
- Has trouble understanding other people’s feelings or expressing own feelings
- Has delayed speech/language skills; repeats words over and over
- Give unrelated answers to questions
- Gets upset by minor changes; has unusual reactions to environmental stimuli
- Flaps hands, rocks body, or spins in circles
True/false: Fragile X syndrome is the most common known cause of autism in either gender
True
- Male → large testicles after beginning puberty, large body habits, learning and behavioral differences (hyperactivity, intellectual disability), large forehead and ears, prominent jaw, tendency to avoid eye contact
Is Klinefelter’s syndrome (XXY male) associated with developmental issues?
Yes - verbal in nature (language impairment)
- Low testicular volume, hip and breast enlargement
Otitis media with effusion treatment
80% of children will clear middle ear within 8 weeks without interventions
- If due to underlying cause (I.e. allergic rhinitis), treat that
If persists beyond 8 weeks, especially with communication problems or hearing loss, consider tympanostomy (ventilating tube)
What is scarlet fever?
Characterized by exudative pharyngitis that affects children ages 5-15 years of age
- MCC: GABHS
- Presentation: emerge abruptly with sudden onset fever and sore throat
- Headache
- Tender, localized anterior cervical lymphadenopathy
- Scarlatina-form or sandpaper like rash on day 2 of pharyngitis
Scarlet fever diagnostic testing
Rapid strep test to identify GABHS in 7 minutes
Scarlet fever treatment
Treatment the same as strep pharyngitis
- Oral PCN or amoxicillin (first line)
- If PCN allergy, macrolide (azithro-, clarithro-, erythro-, clindamycin)
What is roseola?
Common childhood disease caused by human herpesvirus-6 seen in children younger than 2 years old
- Found in saliva in older children
- Develop lifelong immunity once contracted
Roseola clinical presentation
- High grade fever (104 F or greater)
- Discrete rosy-pink macular or maculopapular rash following a period of fever
- Rash indicates infection is no longer contagious
Roseola treatment
No antiviral used → supportive care
Rubella clinical presentation
- Mild fever
- Sore throat
- Malaise
- Nasal discharge
- Diffuse maculopapular rash lasts 3 days
- Posterior cervical and postauricular lymphadenopathy
Rubella treatment
No antiviral therapy → supportive care
- Vaccination with MMR
Measles clinical presentation
- Generalized lymphadenopathy
- Conjunctivitis (copious clear discharge)
- Photophobia
- Koplik spots (appear two days before onset of rash)
- Fever
- Rash develops 3-4 days after onset of symptoms
Measles diagnostic testing
Serological testing
- Rubeola IgG
- IgM antibodies
- or RT-PCR assay
Measles treatment
Supportive care
- Hydration to replace fluids lost through emesis and diarrhea
- Vitamin A supplementation
- MMR to close contacts who have not been vaccinated
- Preventative if given within 3 days of exposure
How is varicella spread?
Respiratory droplets and contact with open lesions
Varicella clinical presentation
- Acute onset fever
- Malaise
- Vesicular rash with intense itch
- Appears first on stomach, back, and face
- Spread over entire body (250-500 itchy blisters)
Varicella treatment
Supportive care
- Calamine lotion, pramoxine gel, oatmeal baths, oral antihistamines for itch
- Consider antivirals (oral acyclovir) for immunocompromised or children with chronic asthma
What is infectious mononucleosis?
Caused by EBV
- Incubation period → 20-50 days
- 90% of patients can develop rash if given amoxicillin or ampicillin during illness
Infectious mononucleosis clinical presentation
Most are asymptomatic
- Low grade fever
- “Shaggy” purple-white exudative pharyngitis
- Malaise
- Marked diffuse lymphadenopathy
- Hepatic and splenic tenderness with occasional enlargement
- Nausea and anorexia
Infectious mononucleosis treatment and management
- Avoid contact sports for 1 month due to increased risk of splenic rupture
- Closely monitor for tonsillar enlargement
- If airway obstruction, systemic corticosteroids
Route of transmission hand foot mouth (HFM) disease
Oral-fecal or droplet
- Coxsackie virus A16
- Family members and close contacts can develop outbreaks
Hand foot mouth (HFM) disease clinical presentation
- Fever
- Malaise
- Sore mouth
- Anorexia
- Conjunctivitis or pharyngitis
- Tender macules or vesicles on erythematous base
- 1-2 days following onset, oral lesions develop on buccal mucosa, tongue, and/or hard palate
Hand foot mouth (HFM) disease treatment and management
No antiviral treatment
- Supportive therapy as illness lasts 2-7 days
- Ensure adequate fluid intake
- Antipyretics
- Oral anesthetics to reduce oral pain
- Cold drinks, ice popsicles
What is fifth’s disease?
Also known as erythema infectiosum
- Caused by human parvovirus B19
- Common in school aged and young children who attend daycare
- Droplet transmission
Fifth’s disease clinical presentation
- Mild flu-like illness that begins 5-7 days after initial infection
- Fever, malaise, headache, nausea, myalgia, rhinorrhea
- 7-10 days red rash that starts at cheeks and spreads to trunk and extremities
- “Slapped cheek” appearance
- Rash onset → no longer contagious
Fifth’s disease treatment and management
Supportive care
What is Kawasaki’s disease?
Self-limited vasculitis of unknown etiology
- Occurs in late winter and spring at 3 year intervals
- Leading cause of acquired heart disease in U.S.
Diagnostic criteria for Kawasaki’s disease
- Fever 5 days or longer usually with irritability plus 4+ of the following:
- Changes in extremities (erythema, edema, desquamation), refuses to bear weight
- Bilateral, nonexudative conjunctivitis
- Polymorphous rash
- Cervical lymphadenopathy
- Changes in lips and oral cavity (pharyngeal edema, dry/fissured or swollen lips, strawberry tongue)
Is diagnostic testing (labs, imaging) needed for Kawasaki’s disease?
Lab findings may increase suspicion of Kawasaki’s
- Mild anemia
- Elevated WBC
- Elevated sedimentation rate
- Increase in platelets
- Albumin and WBCs in urine
If diagnosis in question, echocardiogram
Kawasaki’s disease treatment and management
Referral to ID
- IV immune globulin and ASA
What is a capillary hemangioma?
Congenital vascular malformation
- Present in first weeks of life, grows rapidly in first year, plateaus, then regresses by 9 years of age
What is a port-wine stain?
Flat hemangioma with stable course
- Present at birth, deepens in color and grows proportional with the child
- Minimized with laser therapy
What is milia?
Caused by maternal androgenic effect on sebaceous glands
- Resolves without special therapy by 4 weeks to 6 months
- Avoid attempting to remove or open milia (leads to scarring)
What is erythema toxicum neonatorum?
- Benign rash that begins in first 10 days of life
- Look like flea bites
- Palms and soles spared
- Fade after 5-7 days after eruption without treatment
What are Mongolian spots?
Occur in 90% of African and Asian ancestries
- Usually over lower back and buttocks
- Caused by accumulation of melanocytes
- Fade by 7 years old
- No discomfort when pressed or palpated (difference between suspected abuse)
What is acne neonatorum?
Open and closed comedones and pustules over forehead and cheeks
- Due to maternal androgens
- Resolves in 4-8 weeks but can persist up to 1 year
- Can resolve without intervention (if needed, benzoyl peroxide)
Rehydration therapy for minimal to none degree of dehydration
Rehydration therapy: sips of fluid frequently as tolerated
Replacement of ongoing losses:
- Less than 10 kg → 60-100 mL ORS (pedialyte) for each loss
- Greater than 10 kg: 120-240 mL for each loss
Rehydration therapy for mild to moderate degree of dehydration
Rehydration therapy: ORT with ORS
- 50-100 mL/kg over 3-4 hours
- Best tolerated in frequent, small volumes
Replacement of ongoing losses:
- Less than 10 kg → 60-100 mL ORS (pedialyte) for each loss
- Greater than 10 kg: 120-240 mL for each loss
Rehydration therapy for severe degree of dehydration
Rehydration therapy (inpatient): LR boluses 20 mL/kg until improved, then 100 mL/kg over 4 hours
Replacement of ongoing losses:
- Less than 10 kg → 60-100 mL ORS (pedialyte) for each loss
- Greater than 10 kg: 120-240 mL for each loss
Chromosomal anomalies that can lead to delayed puberty
- Turner’s syndrome in girls (XO female)
- Short height
- Delayed or no puberty
- Amenorrhea
- Learning disabilities
- Social difficulties
- Klinefelter’s syndrome in boys (XXY male)
- Language impairment
- Low testicular volume
- Hip and breast enlargement
Tanner staging for males and females
Car seat guidelines: infants and toddlers
Rear facing for as long as possible
- Until child reaches highest weight or height allowed by car safety seats manufacturer (usually 2 years or more)
Car seat guidelines: toddlers to preschoolers
Convertible seats and forward facing seats with harness
- Usually up to 65 pounds and more
Car seat guidelines: school aged children
Belt positioned booster seat
- Usually until they have reached 4 feet 9 inches in height and are between 8-12 years of age
