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AANPCB Board Exam > Pediatrics > Flashcards

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

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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)
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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)

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4
Q

For what does the Vanderbilt tool assess?

A

ADHD

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5
Q

When to refer a child with ADHD?

A

coexisting psych disorders
coexisting neurological or medical disorders
lack of response to stimulants

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6
Q

At what age do we begin to use medications (e.g. stimulants) to manage ADHD?

A

school age (>= 6 years)

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7
Q

At what age does the assessment for autism spectrum disorder begin?

A

9 months

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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

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9
Q

At what ages do we routinely screen for ASD?

A

9 months
18 months
24 months
30 months

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10
Q

At what ages can the M-CHAT be used?

A

ages 18-30 months

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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

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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)

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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

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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

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15
Q

Significant difference in CAP (community-acquired PNA) in children (vs. adults)

A

Adults: assumed to be bacterial
Children: likely to be viral

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16
Q

How to differentiate viral from bacterial pneumonia in children?

A

CBC + Differential

If WBC > 15000, likely bacterial

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17
Q

How to diagnose PNA in children?

A

CBC + Differential

CXR (look for infiltrates)

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18
Q

Preferred antibiotic and dosing for children with CAP

A

high-dose amoxicillin

90mg/kg/day (max 4g / day)

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19
Q

What antibiotic to use for CAP in a child recently exposed to abx?

A

amoxicillin-clavulanate
OR
3rd generation cephalosporin

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20
Q

True or False: bronchiolitis is usually bacterial

A

FALSE: bronchiolitis is usually viral

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21
Q

Key symptom of bronchiloitis

A

impressive wheezing (from narrow tubules)

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22
Q

Bronchiolitis is similar to what illness that adults experience?

A

acute bronchitis

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23
Q

Describe bronchiolitis

A

lower respiratory tract infection

obstructs small respiratory airways (bronchioles)

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24
Q

Who is most commonly affected with bronchiolitis?

A

infancy - 2 years, especially < 12 months

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25
Q

What causes hoarseness in a respiratory infection? What does it imply?

A

vocal cord inflammation and vocal cords no longer come together symmetrically
implication: cough has been present for some time

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26
Q

Typical Progression of Bronchiolitis

A

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

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27
Q

Common name for laryngotracheobronchitis

A

croup

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28
Q

At what ages is croup most common?

A

6 months - 3 years

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29
Q

Symptoms of croup

A

inspiratory stridor
barking cough
hoarseness

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30
Q

What does the steeple sign on x-ray imply?

A

croup

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31
Q

With croup, what pharmacologic therapy is preferred?

A

single dose of dexamethasone (0.6mg/kg)

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32
Q

Why would we administer nebulized epinephrine (and avoid a steroid injection) in a 3-year-old with a croupy cough, stridor, and drooling?

A

drooling is a sign of respiratory distress

avoid steroid injection to avert distress, screaming, crying (could be disastrous)

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33
Q

What does cystic fibrosis cause?

A

cannot transport Na and Cl across epithelial membranes –> makes mucus thick, sticky mucus

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34
Q

What does it mean if an infant with CF has a positive sweat test?

A

test should be repeated

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35
Q

When can CF screening occur?

A

in utero
on day of birth
later with a sweat test (must be repeated if positive)

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36
Q

What symptoms might be present in a child who has suspected CF?

A

a persistent productive cough
frequent sinus and lower respiratory tract infections
blocked pancreatic ducts
weight loss and greasy stools

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37
Q

What 2 major systems does Cystic Fibrosis affect?

A

respiratory

GI

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38
Q

In Sickle Cell Disease, which children will be on daily PCN and why?

A

PCN used for prophylaxis

typically until age 5, sometimes until age 12

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39
Q

Preferred imaging for headaches in children

A

MRI

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40
Q

When would you not obtain an MRI for headaches in children?

A

rapidly developing symptoms: trauma, hydrocephalus, vascular disorders, neoplasms, etc.

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41
Q

RED FLAGS for headaches in children

A 
thunderclap headache
headache awakens child
neurological findings:  nausea, vomiting, altered mental state
age < 3
no family history of migraines
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42
Q

migraine prevention

A 
adequate sleep
caffeine elimination
adequate exercise
stress reduction
don't skip meals
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43
Q

topiramate can be used for migraines in children of what ages?

A

over age 12

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44
Q

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?

A

PATHOLOGICAL

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45
Q

Total bilirubin over what level puts an infant at risk for neurological compromise?

A

25 mg/dL

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46
Q

What is BIND? What causes it?

A

Bilirubin induced neurological demise – comes from free bilirubin that crosses the blood brain barrier

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47
Q

What is bilirubin?

A

a normal component of RBCs

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48
Q

What rids the blood of excess bilirubin?

A

The liver

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49
Q

What might an elevated direct bilirubin indicate?

A

liver or gallbladder disease

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50
Q

In neonates, when does bilirubin usually peak?

A

full term: 3- 4 days of age

premature: 5-7 days of age

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51
Q

Major risk factor for severe bilirubinemia

A

Jaundice w/in 1st 24h of life

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52
Q

Minor risk factors for severe bilirubinemia

A

male gender
exclusive bottle feeding
GA > 41 weeks

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53
Q

Definition for Colic: “Rule of 3”

A

Crying for no apparent reason for 3+ hours/day
3+ days / week
otherwise healthy infant < 3 months of age

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54
Q

At what age are symptoms of colic most likely to occur?

A

4-6 weeks

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55
Q

At what age are symptoms of pyloric stenosis most likely to occur?

A

3-6 weeks

56
Q

What imaging study is used to diagnose pyloric stenosis?

A

pyloric ultrasound

57
Q

major concern with pyloric stenosis

A

dehydration

58
Q

If an infant is found to have pyloric stenosis, what should the NP do? What does the infant need?

A

refer to pediatric GI for a (typically laparoscopic) pyloromyotomy

59
Q

difference between GER and GERD in infants

A

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
Q

mom complains that baby has constipation and wonders about reflux; what does the NP say?

A

reflux NEVER involves the lower GI tract (e.g. constipation is NOT a symptom of reflux)

61
Q

RED FLAGS to look for in infants w/ GER

A 
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
Q

When does GER typically stop?

A

around 9-12 months, can last as long as 18-24 months

63
Q

How to manage GER in infants?

A

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
Q

infant with GERD sx is suspected of having a cow’s milk protein intolerance due to…

A

blood in stools
eczema
strong family history of atopy
poor weight gain

65
Q

When using pharmacologic therapy for an infant with GERD, what is used, and what is the approach?

A

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
Q

An 18-month-old has intermittent abdominal pain and has vomited a few times during these episodes. What is in your differential diagnosis?

A 
intussecption
appendicitis
constipation
gastroenteritis
intestinal obstruction
67
Q

What is a KUB x-ray?

A

kidneys
ureters
bladder

68
Q

ages most commonly affected by intussusception

A

3-36 months (most < age 2)

69
Q

What is intussusception?

A

telescoping of the intestines
causes ischemia, which causes pain
a surgical emergency (because one of the episodes may not spontaneously resolve)

70
Q

How does INTUSSUSCEPTION usually present?

A 
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
Q

What phrase is used to describe intussusception on an ultrasound?

A

“coiled spring appearance”

72
Q

With intussusception, imaging includes a KUB and ultrasound. Why?

A

KUB rules out perforation

ultrasound preferred

73
Q

What are “currant jelly” stools? With what are they classically associated?

A

bloody, mucoid stools

intussusception

74
Q

Classic triad associated with intussusception…

A

vomiting
currant jelly stools
intermittent colicky abdominal pain

75
Q

define encopresis

A

involuntary elimination of stool in a child >= 4 years

76
Q

best measures of dehydration

A

delayed capillary refill
poor skin turgor
increased and deepened respiratory rate
weight loss

77
Q

For mild to moderate dehydration, what is required volume of fluids for replacement? Over what timeframe?

A

over 3-4 hours

50 (mild) - 100 (moderate) mL/kg

78
Q

During the fluid replacement time with dehydration, what should be avoided?

A

sports drinks
chicken broth
high fat foods
lots of sugar

(BRAT diet unnecessary)

79
Q

By what age do testicles typically descend?

A

4 months

80
Q

differentiate cryptorchidism from retractile testes

A

crytorchidism: testes not in scrotum, were never there

retractile testes: move between scrotum and inguinal ring by creamasteric reflex

81
Q

define hydrocele

A

collection of fluid in the scrotum, can be communicating or non-communicating

82
Q

at what age is hydrocele expected to resolve?

A

before 12 months

83
Q

Most likely reason for hydrocele

A

inguinal hernia

84
Q

preferred antibiotic for a UTI in a febrile child

A

2nd or 3rd generation cephalosporin like cefuroxime, cefixime, cefdinir, ceftibuten

85
Q

Why aggressively treat UTIs in children?

A

low ability to communicate discomfort

treat w/in 72 hours to prevent pyelonephritis & prevent renal scarring

86
Q

How long to treat pediatric UTIs…

A

afebrile: 3-5 days
febrile: 10 days (**also refer to pediatric urology)

87
Q

imaging to obtain for pediatric UTI

A

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
Q

red papillae on the tongue are caused by…

A

Kawasaki disease

Strep throat

89
Q

Scoliosis is diagnosed by the _________ angle

A

Cobb

90
Q

What is the minimum Cobb by which to diagnose scoliosis?

A

10 degrees

91
Q

Medical term for Nursemaid’s Elbow

A

Radial head subluxation

92
Q

When radial head subluxation occurs, what is the pathology?

A

Annular ligament slips over the radial head and becomes trapped, causing pain with movement of the elbow

93
Q

Medical term for clubfoot

A

Talipes equinovarus

94
Q

What is metatarsus adductus?

A

When the heel bisector line is laterally displaced, and the foot is shaped like a kidney bean

95
Q

Explain Barlow’s sign

A

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
Q

Explain Ortolani’s sign

A

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
Q

At what age do infants get screened with Ortolani and Barlow tests?

A

Birth through 3 months

98
Q

What is Galeazzi sign?

A

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
Q

How long does the pain of Osgood-Schlatter disease typically last?

A

6 to 18 months

100
Q

Explain Osgood-Schlatter disease

A

Overuse injury

Causes pain of the tibial tubercle

101
Q

Medical term for Osgood-Schlatter disease

A

Osteochondritis of the tibial tubercle

102
Q

What x-ray views to obtain when scoliosis is suspected?

A

Standing
Full length PA
Lateral view of the spine (C7 to iliac crest)

103
Q

Describe the pain of Osgood-Schlatter disease

A

Can reproduce pain by extending knee against resistance

Painless straight leg raise

104
Q

How to manage Osgood-Schlatter disease

A 
Continue activity as tolerated
Ice
Analgesics
Protective pad over tubercle 
Strengthen quads
Improve hamstring flexibility
105
Q

Hip pain at what time of day is more concerning?

A

Nighttime

Concern: neoplastic pain

106
Q

4 etiologies of hip pain

A

Infection
Inflammation
Orthopedic injury
Neoplasm

107
Q

What is Legg-Calve-Perthes disease, and what causes it?

A

Avascular necrosis of the femoral neck

CAUSE: missing blood supply

108
Q

Who typically has Legg-Calve-Perthes disease?

A

Boys > girls

Ages 3-12

109
Q

Symptoms of Legg-Calve-Perth’s disease

A

Pain in hip
Or
Referred pain to medial knee

Limp

110
Q

What is a SCFE?

A

Slipped capital femoral epiphysis

Shift in the head of the femur from its proper location along the growth plate

111
Q

Patients of what age more commonly experience SCFE?

A

Adolescents

112
Q

Symptoms of SCFE

A

History of several weeks or months of hip/knee pain
Intermittent limp
50% have hip pain
25% have any pain

113
Q

What is transient synovitis of the hip? How concerning is it?

A

Most common cause of hip pain
Benign condition
Causes acute limp and hip pain in children
Absence of systemic symptoms

114
Q

How is a SCFE treated?

A

Screw inserted through the head of the femur to prevent slipping from the growth plate

115
Q

Who typically experiences transient synovitis of the hip?

A

Children

History of upper respiratory infection 7 to 14 days prior is very common

116
Q

How long does transient synovitis of the hip take to resolve?

A

7 to 14 days

117
Q

Name an in-office test to check for SCFE and Legg-Calves-Perthes disease. Describe it.

A

Trendelenburg test

Have patient stand on affected hip
POSITIVE: pelvic tilt
Affected hip is higher than the unaffected hip

118
Q

Differentiate EXANTHEM from ENANTHEM

A

EXANTHEM: rash on skin
ENANTHEM: rash on mucus membrane

119
Q

Name this rash:

Maculopapular brick red rash
starts on the head and neck
spreads centrifugally to trunk & extremities

A

Measles

120
Q

Name this rash:

Slapped cheek rash
Lacey, macular rash

A

Fifth disease (Erythema infectiosum)

121
Q

Name this rash:

High fever for 2 to 4 days
Abrupt cessation of fever with appearance of maculopapular rash
Not on face

A

Roseola (Exanthem subitum)

122
Q

Name this rash:

Vesicular lesions on erythematous base appearing in crops

Dew drops on a rose petal

A

Varicella (Chickenpox)

123
Q

Name this rash:

Sandpaperlike rash that usually desquamates
On the trunk
Feels like sandpaper

A

Scarlet fever

Exotoxin rash secondary to Group B strep

124
Q

Name the cause of this rash:

Painful vesicles on the soft palate and mouth

A

Herpangina

125
Q

Major concern with her herpangina

A

Hydration

126
Q

Typical age of a child diagnosed with roseola

A

7 to 13 months

127
Q

Who is typically affected by Hand, Foot, and Mouth disease

A

Children under five years of age

More common in spring and early summer

128
Q

Describe the rash of Hand, Foot, and Mouth disease

A

Fever
Vesicles on oral mucous membranes
Vesicles on the palms and soles of the feet that crust

129
Q

How long does it take Hand, Foot, and Mouth disease to resolve?

A

Illness resolves in 2 to 3 days

Rash can be around for a month

130
Q

Name the symptoms of measles

A

Fever
Malaise
3C’s: conjunctivitis, coryza, cough

131
Q

What is coryza?

A

Runny nose

132
Q

What rash is pathognomonic for measles? What does it look like?

A

Koplik Spots

1-3mm whiteish, bluish, or gray elevations on the buccal mucosa and the hard and soft palates

133
Q

What comes first? Koplik spots or the measles rash?

A

Koplik spots

134
Q

Most common causes of acute otitis media

A

Viral: RAV, influenza
Bacterial: streptococcus pneumoniae, h. Influenza, moraxella catarrhalis

135
Q

Differentiate antibiotic dosing for acute otitis media in children by age

A

< 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
Q

Why do older children not receive antibiotics right away for acute otitis media? (Especially when children under six months of age automatically receive antibiotics)

A

PCV vaccination has decreased incidence of AOM

Children > 2 should have been fully immunized

AANPCB Board Exam (4 decks)

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