Pediatrics Flashcards
1
Q
How to diagnose ADHD?
A
DSM-5 Criteria:
symptoms prior to age 12
symptoms > 6 months (not situational)
symptoms in 2+ settings
2
Q
3 subtypes of ADHD
A
combined: both hyperactive and impulsive predominantly inattentive (d/n meet hyperactivity/impulsivity criteria) predominantly hyperactive-impulsive (d/n meet inattentive criteria)
3
Q
Consider the DSM-5 Criteria for ADHD. At what age is the cutoff for the change in minimum # of sx a child must exhibit? How many sx must a child exhibit in the different domains?
A
Age 17
< age 17: >=6 sx of inattention or (hyperactivity and impulsivity)
<= age 17: >=5 sx of inattention or (hyperactivity and impulsivity)
4
Q
For what does the Vanderbilt tool assess?
A
ADHD
5
Q
When to refer a child with ADHD?
A
coexisting psych disorders
coexisting neurological or medical disorders
lack of response to stimulants
6
Q
At what age do we begin to use medications (e.g. stimulants) to manage ADHD?
A
school age (>= 6 years)
7
Q
At what age does the assessment for autism spectrum disorder begin?
A
9 months
8
Q
2 things to look for in screening for ASD
A
impairment in:
social communication & social interaction
restricted, repetitive patterns of behavior, interests, and activities
9
Q
At what ages do we routinely screen for ASD?
A
9 months
18 months
24 months
30 months
10
Q
At what ages can the M-CHAT be used?
A
ages 18-30 months
11
Q
2 main differences in pediatric and adult asthma…
A
in children:
use a leukotriene receptor antagonist
nebulize a lot of the treatments to make administration more effective
12
Q
Key pharmacologic therapy in management of asthma in children 0-4
A
except step 1 (SABA PRN), use ICS as base, and add montelukast or LABA in steps 4-6 (plus oral corticosteroid in step 6)
13
Q
With asthma in children, when to refer? (HINT: Difference in youngest children.)
A
Ages 0-4: refer at step 3; consider at step 2
> age 4: refer at step 4; consider at step 3
14
Q
s/sx of pneumonia in children
A
**kind of like older adults
fever = unreliable sign (same as older adults)
increased respiration = most sensitive sign (if not running fever, just like with older adults)
cough, malaise
many nonspecific findings
15
Q
Significant difference in CAP (community-acquired PNA) in children (vs. adults)
A
Adults: assumed to be bacterial
Children: likely to be viral
16
Q
How to differentiate viral from bacterial pneumonia in children?
A
CBC + Differential
If WBC > 15000, likely bacterial
17
Q
How to diagnose PNA in children?
A
CBC + Differential
CXR (look for infiltrates)
18
Q
Preferred antibiotic and dosing for children with CAP
A
high-dose amoxicillin
90mg/kg/day (max 4g / day)
19
Q
What antibiotic to use for CAP in a child recently exposed to abx?
A
amoxicillin-clavulanate
OR
3rd generation cephalosporin
20
Q
True or False: bronchiolitis is usually bacterial
A
FALSE: bronchiolitis is usually viral
21
Q
Key symptom of bronchiloitis
A
impressive wheezing (from narrow tubules)
22
Q
Bronchiolitis is similar to what illness that adults experience?
A
acute bronchitis
23
Q
Describe bronchiolitis
A
lower respiratory tract infection
obstructs small respiratory airways (bronchioles)
24
Q
Who is most commonly affected with bronchiolitis?
A
infancy - 2 years, especially < 12 months
25
What causes hoarseness in a respiratory infection? What does it imply?
vocal cord inflammation and vocal cords no longer come together symmetrically
implication: cough has been present for some time
26
Typical Progression of Bronchiolitis
URI for 1-3 days that progresses to lower respiratory tract infection
paroxysmal wheezing peaks on days 3-5 (usually impressive wheezing d/t narrow tubules)
resolves over 2-4 weeks
27
Common name for laryngotracheobronchitis
croup
28
At what ages is croup most common?
6 months - 3 years
29
Symptoms of croup
inspiratory stridor
barking cough
hoarseness
30
What does the steeple sign on x-ray imply?
croup
31
With croup, what pharmacologic therapy is preferred?
single dose of dexamethasone (0.6mg/kg)
32
Why would we administer nebulized epinephrine (and avoid a steroid injection) in a 3-year-old with a croupy cough, stridor, and drooling?
drooling is a sign of respiratory distress
| avoid steroid injection to avert distress, screaming, crying (could be disastrous)
33
What does cystic fibrosis cause?
cannot transport Na and Cl across epithelial membranes --> makes mucus thick, sticky mucus
34
What does it mean if an infant with CF has a positive sweat test?
test should be repeated
35
When can CF screening occur?
in utero
on day of birth
later with a sweat test (must be repeated if positive)
36
What symptoms might be present in a child who has suspected CF?
a persistent productive cough
frequent sinus and lower respiratory tract infections
blocked pancreatic ducts
weight loss and greasy stools
37
What 2 major systems does Cystic Fibrosis affect?
respiratory
| GI
38
In Sickle Cell Disease, which children will be on daily PCN and why?
PCN used for prophylaxis
| typically until age 5, sometimes until age 12
39
Preferred imaging for headaches in children
MRI
40
When would you not obtain an MRI for headaches in children?
rapidly developing symptoms: trauma, hydrocephalus, vascular disorders, neoplasms, etc.
41
RED FLAGS for headaches in children
```
thunderclap headache
headache awakens child
neurological findings: nausea, vomiting, altered mental state
age < 3
no family history of migraines
```
42
migraine prevention
```
adequate sleep
caffeine elimination
adequate exercise
stress reduction
don't skip meals
```
43
topiramate can be used for migraines in children of what ages?
over age 12
44
All newborns experience stress at birth. RBCs often break down faster than the liver can clear the excess bilirubin.
Jaundice in a newborn in the first 24 hours of life is considered...
NORMAL or PATHOLOGICAL?
PATHOLOGICAL
45
Total bilirubin over what level puts an infant at risk for neurological compromise?
25 mg/dL
46
What is BIND? What causes it?
Bilirubin induced neurological demise -- comes from free bilirubin that crosses the blood brain barrier
47
What is bilirubin?
a normal component of RBCs
48
What rids the blood of excess bilirubin?
The liver
49
What might an elevated direct bilirubin indicate?
liver or gallbladder disease
50
In neonates, when does bilirubin usually peak?
full term: 3- 4 days of age
| premature: 5-7 days of age
51
Major risk factor for severe bilirubinemia
Jaundice w/in 1st 24h of life
52
Minor risk factors for severe bilirubinemia
male gender
exclusive bottle feeding
GA > 41 weeks
53
Definition for Colic: "Rule of 3"
Crying for no apparent reason for 3+ hours/day
3+ days / week
otherwise healthy infant < 3 months of age
54
At what age are symptoms of colic most likely to occur?
4-6 weeks
55
At what age are symptoms of pyloric stenosis most likely to occur?
3-6 weeks
56
What imaging study is used to diagnose pyloric stenosis?
pyloric ultrasound
57
major concern with pyloric stenosis
dehydration
58
If an infant is found to have pyloric stenosis, what should the NP do? What does the infant need?
refer to pediatric GI for a (typically laparoscopic) pyloromyotomy
59
difference between GER and GERD in infants
GER = not pathologic
happens 30+ times/day in healthy infants
GERD = gastroesophageal reflux disease
reflux of stomach contents w/ pathologic consequences (weight loss, esophagitis, etc.)
60
mom complains that baby has constipation and wonders about reflux; what does the NP say?
reflux NEVER involves the lower GI tract (e.g. constipation is NOT a symptom of reflux)
61
RED FLAGS to look for in infants w/ GER
```
choking with eating
coughing with eating
forceful vomiting
bilious vomiting
blood in stool
poor weight gain
refusal to feed
constipation or diarrhea
abdominal tenderness
fever
```
62
When does GER typically stop?
around 9-12 months, can last as long as 18-24 months
63
How to manage GER in infants?
usually no interventions needed
avoid overfeeding
avoid exposure to cigarettes smoke (decreases LES pressure)
can try:
thickening feeding
consider non-cow's milk protein formula (not soy, either) for a 1-2 week trial; choosing hypoallergenic formula
64
infant with GERD sx is suspected of having a cow's milk protein intolerance due to...
blood in stools
eczema
strong family history of atopy
poor weight gain
65
When using pharmacologic therapy for an infant with GERD, what is used, and what is the approach?
a PPI for 2 weeks
reassess
if no improvement, refer
if improvement, use for another 2-3 months; try to discontinue due to difficulty absorbing nutrients when on a PPI
66
An 18-month-old has intermittent abdominal pain and has vomited a few times during these episodes. What is in your differential diagnosis?
```
intussecption
appendicitis
constipation
gastroenteritis
intestinal obstruction
```
67
What is a KUB x-ray?
kidneys
ureters
bladder
68
ages most commonly affected by intussusception
3-36 months (most < age 2)
69
What is intussusception?
telescoping of the intestines
causes ischemia, which causes pain
a surgical emergency (because one of the episodes may not spontaneously resolve)
70
How does INTUSSUSCEPTION usually present?
```
infant 3-11 months of age
normal between episodes
sudden onset crampy abdominal pain
focal abdominal tenderness
child pulls legs to chest (fetal position)
no abdominal distention
```
can have vomiting, rectal bleeding, fever
71
What phrase is used to describe intussusception on an ultrasound?
"coiled spring appearance"
72
With intussusception, imaging includes a KUB and ultrasound. Why?
KUB rules out perforation
| ultrasound preferred
73
What are "currant jelly" stools? With what are they classically associated?
bloody, mucoid stools
| intussusception
74
Classic triad associated with intussusception...
vomiting
currant jelly stools
intermittent colicky abdominal pain
75
define encopresis
involuntary elimination of stool in a child >= 4 years
76
best measures of dehydration
delayed capillary refill
poor skin turgor
increased and deepened respiratory rate
weight loss
77
For mild to moderate dehydration, what is required volume of fluids for replacement? Over what timeframe?
over 3-4 hours
| 50 (mild) - 100 (moderate) mL/kg
78
During the fluid replacement time with dehydration, what should be avoided?
sports drinks
chicken broth
high fat foods
lots of sugar
(BRAT diet unnecessary)
79
By what age do testicles typically descend?
4 months
80
differentiate cryptorchidism from retractile testes
crytorchidism: testes not in scrotum, were never there
| retractile testes: move between scrotum and inguinal ring by creamasteric reflex
81
define hydrocele
collection of fluid in the scrotum, can be communicating or non-communicating
82
at what age is hydrocele expected to resolve?
before 12 months
83
Most likely reason for hydrocele
inguinal hernia
84
preferred antibiotic for a UTI in a febrile child
2nd or 3rd generation cephalosporin like cefuroxime, cefixime, cefdinir, ceftibuten
85
Why aggressively treat UTIs in children?
low ability to communicate discomfort
| treat w/in 72 hours to prevent pyelonephritis & prevent renal scarring
86
How long to treat pediatric UTIs...
afebrile: 3-5 days
febrile: 10 days (**also refer to pediatric urology)
87
imaging to obtain for pediatric UTI
if 2-24 months of age, and febrile UTI, renal and bladder ultrasound
also, for child of any age with recurrent febrile UTIs
UTI w/ family history of renal or urologic disease, poor growth, hypertension
88
red papillae on the tongue are caused by...
Kawasaki disease
| Strep throat
89
Scoliosis is diagnosed by the _________ angle
Cobb
90
What is the minimum Cobb by which to diagnose scoliosis?
10 degrees
91
Medical term for Nursemaid’s Elbow
Radial head subluxation
92
When radial head subluxation occurs, what is the pathology?
Annular ligament slips over the radial head and becomes trapped, causing pain with movement of the elbow
93
Medical term for clubfoot
Talipes equinovarus
94
What is metatarsus adductus?
When the heel bisector line is laterally displaced, and the foot is shaped like a kidney bean
95
Explain Barlow’s sign
The examiner places the 2nd - 5th digits on the greater trochanter and presses the thigh posteriorly to try to displace the femoral head out of the acetabulum
Examiner pushes BACK
96
Explain Ortolani’s sign
TESTS FOR HIP DYSPLASIA
The examiner has the 2nd - 5th digits on the greater trochanter and ABDUCTS the hips to try to restore the femoral head into the acetabulum
Examiner moves knees OUTWARD
97
At what age do infants get screened with Ortolani and Barlow tests?
Birth through 3 months
98
What is Galeazzi sign?
TEST FOR HIP DYSPLASIA
Baby supine
Flex knees so feet are on surface and ankles touch buttocks
POSITIVE: Shortening of the femur, knees not at equal heights
99
How long does the pain of Osgood-Schlatter disease typically last?
6 to 18 months
100
Explain Osgood-Schlatter disease
Overuse injury
Causes pain of the tibial tubercle
101
Medical term for Osgood-Schlatter disease
Osteochondritis of the tibial tubercle
102
What x-ray views to obtain when scoliosis is suspected?
Standing
Full length PA
Lateral view of the spine (C7 to iliac crest)
103
Describe the pain of Osgood-Schlatter disease
Can reproduce pain by extending knee against resistance
| Painless straight leg raise
104
How to manage Osgood-Schlatter disease
```
Continue activity as tolerated
Ice
Analgesics
Protective pad over tubercle
Strengthen quads
Improve hamstring flexibility
```
105
Hip pain at what time of day is more concerning?
Nighttime
Concern: neoplastic pain
106
4 etiologies of hip pain
Infection
Inflammation
Orthopedic injury
Neoplasm
107
What is Legg-Calve-Perthes disease, and what causes it?
Avascular necrosis of the femoral neck
CAUSE: missing blood supply
108
Who typically has Legg-Calve-Perthes disease?
Boys > girls
| Ages 3-12
109
Symptoms of Legg-Calve-Perth’s disease
Pain in hip
Or
Referred pain to medial knee
Limp
110
What is a SCFE?
Slipped capital femoral epiphysis
Shift in the head of the femur from its proper location along the growth plate
111
Patients of what age more commonly experience SCFE?
Adolescents
112
Symptoms of SCFE
History of several weeks or months of hip/knee pain
Intermittent limp
50% have hip pain
25% have any pain
113
What is transient synovitis of the hip? How concerning is it?
Most common cause of hip pain
Benign condition
Causes acute limp and hip pain in children
Absence of systemic symptoms
114
How is a SCFE treated?
Screw inserted through the head of the femur to prevent slipping from the growth plate
115
Who typically experiences transient synovitis of the hip?
Children
| History of upper respiratory infection 7 to 14 days prior is very common
116
How long does transient synovitis of the hip take to resolve?
7 to 14 days
117
Name an in-office test to check for SCFE and Legg-Calves-Perthes disease. Describe it.
Trendelenburg test
Have patient stand on affected hip
POSITIVE: pelvic tilt
Affected hip is higher than the unaffected hip
118
Differentiate EXANTHEM from ENANTHEM
EXANTHEM: rash on skin
ENANTHEM: rash on mucus membrane
119
Name this rash:
Maculopapular brick red rash
starts on the head and neck
spreads centrifugally to trunk & extremities
Measles
120
Name this rash:
Slapped cheek rash
Lacey, macular rash
Fifth disease (Erythema infectiosum)
121
Name this rash:
High fever for 2 to 4 days
Abrupt cessation of fever with appearance of maculopapular rash
Not on face
Roseola (Exanthem subitum)
122
Name this rash:
Vesicular lesions on erythematous base appearing in crops
Dew drops on a rose petal
Varicella (Chickenpox)
123
Name this rash:
Sandpaperlike rash that usually desquamates
On the trunk
Feels like sandpaper
Scarlet fever
Exotoxin rash secondary to Group B strep
124
Name the cause of this rash:
Painful vesicles on the soft palate and mouth
Herpangina
125
Major concern with her herpangina
Hydration
126
Typical age of a child diagnosed with roseola
7 to 13 months
127
Who is typically affected by Hand, Foot, and Mouth disease
Children under five years of age
| More common in spring and early summer
128
Describe the rash of Hand, Foot, and Mouth disease
Fever
Vesicles on oral mucous membranes
Vesicles on the palms and soles of the feet that crust
129
How long does it take Hand, Foot, and Mouth disease to resolve?
Illness resolves in 2 to 3 days
| Rash can be around for a month
130
Name the symptoms of measles
Fever
Malaise
3C’s: conjunctivitis, coryza, cough
131
What is coryza?
Runny nose
132
What rash is pathognomonic for measles? What does it look like?
Koplik Spots
1-3mm whiteish, bluish, or gray elevations on the buccal mucosa and the hard and soft palates
133
What comes first? Koplik spots or the measles rash?
Koplik spots
134
Most common causes of acute otitis media
Viral: RAV, influenza
Bacterial: streptococcus pneumoniae, h. Influenza, moraxella catarrhalis
135
Differentiate antibiotic dosing for acute otitis media in children by age
< 6 months: antibiotics regardless
6 months to 2 years:
—severe (bilateral): antibiotics immediately
—mild & unilateral: watch and wait
> 2 years:
—severe (bilateral): antibiotics
—otherwise: observation
136
Why do older children not receive antibiotics right away for acute otitis media? (Especially when children under six months of age automatically receive antibiotics)
PCV vaccination has decreased incidence of AOM
Children > 2 should have been fully immunized
