Pediatrics Flashcards
1
Q
Age - Sit up unassisted? Roll both ways
A
6mo
2
Q
Age - Hold a spoon
A
15-18mo
3
Q
Age – Stand and then walk
A
- Stand: 12mo
- Walk: 12-17mo
4
Q
Age- Pincer grasp develops, palmer grasp goes away
A
6mo
5
Q
Age – Wave bye-bye,
separation anxiety
A
9mo
6
Q
Age -
- 1 hand dominance
A
10-11mo
7
Q
Age –
say mama/dada with meaning
A
12mo
8
Q
Age- ride a bicycle
A
5-6 year
9
Q
Age – Discover midline, strabismus clears
A
4mo
10
Q
Age- Roll over from back to stomach
Roll over both directions?
A
- Back to front: 4mo
- Both: 6mo
11
Q
Age – anterior/posterior fontanelle closes
A
- Posterior: 2-3mo
- Anterior: 12-18mo
12
Q
Age –
1-2 word sentences
stacks objects
finger feeds self
A
15mo
13
Q
Age – 4+ word sentences, 4 body parts, plays pretend, copy square, draw cross
A
4 year
13
Q
Age –
2 word sentences
points to 2 body parts
walks up stairs with 2 legs
A
- 2 years
14
Q
Age-
Dance
Count to 10
Hop on 1 foot
A
- Age 5
15
Q
Age –
3+ words
Scribbles
Drinks from open cup
A
- 18mo
16
Q
Age –
genu varum goes away?
Genu valgum?
A
- Varum: 2-3 years
- Valgum: 7 years
17
Q
Age – first tooth erupts
First full set of teeth?
A
- First tooth: 6mo
- Set of teeth: 2 years
18
Q
How long for baby to catch up if born prematurely?
A
- By age 2
19
Q
Reflexes present at birth (5)
A
- Moro
- Rooting
- Tonic neck
- Grasp
- Stepping
20
Q
What is moro reflex? When is it gone?
A
- Startle reflex
- Gone by 2 mo
21
Q
What is stepping reflex?
When is it gone?
A
- Takes steps when help upright
- Gone by 2mo
22
Q
What is tonic neck reflex?
When is it gone?
A
- When laying down, baby’s head it turned to the right or left with the opposing arm by their head
- Gone by 4mo
23
Q
When does birth weight double? Triple?
How much do infants loose after delivery?
A
- Double: 6mo
- Triple: 1 year
- 7-10% of birth weight
24
Signs of effective breastfeeding
When should infants be back to their birth weight?
- 6-8 wet diapers
- Weight gain: back to birth weight by 2 weeks
25
Supplement needed for breastfed infant
How long should we promote breastfeeding?
- Vitamin D
- 4-6mo
26
What does Hib prevent
- Epiglottitis
27
Catch up vaccine schedule
- It’s Time for Many Happy Happy Happy Vaccines
- IPV
- Tdap
- MMR/Meningitis
- Hep B
- Hib
- HPV
- Varicella
28
Thumbprint sign vs. steeple sign
- Thumbprint: epiglottitis
- Steeple sign: Croup
29
What bili level needs phototherapy?
15
30
What does leukocoria indicate?
- Retinoblastoma
- Congenital cataract
31
When do we commonly see regression?
Older kids withs abdominal complaints?
- Big life changes
- Constipation
32
Tanner stage: breast budding and puberty
When will period start?
- Stage 2
- Period in 2-3 years
33
Tanner stage: breast mounds
1 mound: stage 3
2 mounds: stage 4
34
Tanner stage: penis elongates
- Stage 3
35
Tanner stage: straight pubic hair and scrotal enlargement
- Stage 2
36
Tanner stage: curly pubes on boys
- Stage 4
37
When is precocious puberty? Delayed puberty?
- GIRLS: Precocious: 8, Delayed: 13
- BOYS: Precocious: 9, Delayed: 14
38
What age do we worry if a girl’s period hasn’t started?
Age 15
39
2 risk factors of anorexia
How do we know if anorexia is getting better?
- Heart disease and OP
- Return of menses
40
What is a Salter Harris Fracture?
Common where?
If uncorrected?
- Fracture along growth plate
- Common in long bone fractures
- Stunted growth
41
Salter Harris fx management based on category
- 1-2: cast or splint
- 3-5: surgery
- Refer to ED
42
What is Nursemaid’s elbow?
Causes?
- Radial head subluxation (partial dislocation of elbow)
- Swinging motions (monkey bars)
43
Nursemaid Elbow presentation
- Refuse to use affect arm
- No obvious swelling or deformity
44
Nursemaid Elbow treatment
- Closed reduction in the office
45
When should hydroceles go away by?
usually in 12-24mo
If not -> surgery
46
Other name for Mongolian spots
When do they go away?
- Slate Grey Nevi
- Likely resolve by age 5
47
AOM most commonly precedes what?
URI
48
First and Second line tx AOM
- Watch and wait for 2-3 days if able
- 1st: Amoxicillin
- 2nd Augmentin or cephalosporin
49
Why do we worry about chronic otitis media? (2)
- Hearing loss and speech delay
50
AOM with effusion only – Tx?
- Recent AOM or allergies
- Watch and wait
51
What is Vesicoureteral Reflux?
- Urine flows back up into the ureters and can lead to dilation of the kidneys
52
How to diagnose VUR?
How is it graded?
What stage to refer?
- Voiding cystourethrogram
- Grade 1 (mild) to 5 (severe)
- Refer at stage 3
53
Does VUR usually resolve?
Symptoms?
- Yes, usually resolves on its own
- Usually asymptomatic, but high grades may cause incontinence and UTIs
54
Thin upper lip, smooth philtrum, low nasal bridge
What is it?
- Fetal alcohol syndrome
55
Usual cause of acne in adolescents?
- Genetics
56
What happens in Turner Syndrome
Occurs in who?
- Only 1 of the x chromosomes is present
- Only occurs in females
57
Symptoms of Turners? (2)
- Short stature, webbed neck female
58
Anticipatory guidance for Turner Syndrome
Management?
- Delayed puberty – may need hormones
- Fertility issues
- Refer to endocrine early on
58
Osgood Sclatter
Common with who?
Presentation?
- Runners
- Bump/pain at tibial tuberosity
59
Management of Osgood Schlatter
When does it go away?
- NSAIDs, ice
- Will likely when the bones stop growing
60
Unilateral nasal drainage may indicate what?
- Possible obstruction
61
Keloid scar?
- Extends beyond the site of injury/surgery
- Doesn’t regress over time
62
What happens in Kawasaki Disease?
Leading cause of what?
- Vasculitis
- Leading cause of heart disease in children
63
Symptoms of Kawasaki Disease
- Fever > 5 days
- Strawberry tongue
- Edema and peeling rash on hands/feet
64
Treatment for Kawasaki Disease
- High dose aspirin and IVIG
- Aspirin prevents coronary artery complications
- IVIG decreases inflammation
65
Why don’t we like to give kids aspirin?
- Risk of Reye’s Syndrome (hepatitis, encephalitis)
66
What if Kawasaki Disease is left untreated?
- MIs and aneurysms in children
67
Key symptoms of Pyloric stenosis
Diagnostics?
- Olive shaped mass and projectile vomiting
- Frequent belching and mucus stools
- US
- Refer for surgical correction
68
Trust vs. Mistrust
- Infant
- Rely on caregivers
68
Intussusception key symptoms
Diagnostics?
- Sausage mass
- Currant, jelly stools
- US
69
Most common causes of death
Infants
Age 1-4
Adolescents
- Infants: birth defects/congenital probs
- 1-4: Drowning
- Teens: MVC
70
Industry vs. Inferiority
- 7-11
- Likes and dislikes
70
Autonomy vs. shame
- 1-3
- Test boundaries
71
Initiative vs. Guilt
- 3-6
- Ask questions and make friends
72
Intimacy vs. Isolation
- 19-29
- Search for soulmate
72
Identity vs. Role confusion
- 12-18
- Who am I?
73
When is meningitis vaccine given?
- Age 11
- Also give HPV
73
Generativity vs. Stagnation
- 40-65
Give back to others
74
Integrity vs. Despair
- 65+
- Be proud of life
75
Which vaccines are given at 1-2mo? (5)
Hep B
DTaP
Rotavirus
Hib
IPV
PCV
- DR HIP 1-2mo
76
When is the inactivated flu vaccine first given?
- 6mo
77
Why is HPV given early?
Cervical CA strains
Genital Warts strains
- Want to give before sexual activity
- Cervical CA: 16 & 18
- Genital Warts: 6 & 11
78
Milia treatment?
None
79
Cradle cap also called what?
When does it go away?
- Seborrheic dermatitis
- 3mo
80
When do hemangiomas usually resolve?
When to refer?
- By age 4
- Ulcerations and vision changes if close to the eye
81
Chicken pox contagious until when
- Lesions have all crusted over
82
How long for molluscum contagiosum to resolve?
Contagious?
Management?
- Usually resolve in 6-12 months
- Highly contagious – keep covered
- Worry abouts sexual abuse in groin
83
How does scarlet fever present? (5)
- Sandpaper rash
- Strawberry tongue
- Sore throat
- Fever, LN enlarged
84
How to treat scarlet fever
- Amoxicillin to treat underlying strep
85
Mono and Strep both have what?
- Sore throat
- Lymphadenopathy
- Fever
86
Mono has what that strep doesn’t?
- Splenomegaly
- Immense fatigue
87
Strep usually has what symptoms?
- Palatine petechiae
- Tonsillar exudates
88
How to treat strep with mono?
- PCN VK
- Macrolide, cephalosporin
89
Blocked tear duct also called what
- Dacryostenosis
90
Symptoms of Dacryostenosis
- Goopy, crusted eyelids, because the gunk has nowhere to go
- Eye itself is clear
91
Treatment of Dacryostenosis
When does it usually resolve?
What if it doesn’t?
- Warm compress and gentle massage
- 4-6mo when real tears are produce
- Refer to ophthalmology if no resolution by 1 year
92
When is BP checked after birth?
- Routinely at age 3
93
How is CF diagnosed?
When is it usually diagnosed?
- Sweat chloride test, genetic testing
- Usually before age 2
94
Symptoms of CF
- Frequent infections with thick sputum
- Weight loss
- Foul, greasy stools
- Salty skin
95
Common complication of CF babies?
- Meconium ileus (bowel obstruction)
96
RSV symptoms (4)
Diagnose?
**increasing respiratory rate
**Quick to get worse
- expiratory wheeze
- starts upper airways and goes lower
- do a nasal swab to diagnose
97
RSV management
- Supportive – Tylenol, fluids
98
Complication of RSV
- Bronchiolitis and PNA
- May need hospitalization
99
Croup
Symptoms?
Treatment?
- Decadron
- Stridor, barky cough
100
Pertussis (whooping cough)
Symptoms
Cause?
- Runny nose, cough -> whooping cough so intense they might vomit
- Bordetella Pertussis
101
When is pertussis contagious?
How to prevent spread?
- 2 weeks after cough begins
- Azithromycin
- nasal swab to diagnose
102
When is Tdap given during pregnancy?
- 3rd trimester
103
Epiglottis symptoms
- Muffled, hot-potato voice
- Leaning forward and drooling
104
Symptoms of sickle cell
- Pain, swelling, fussy, anemia, fatigue
105
Management for encopresis?
- Bowel retraining, regular shitting times BID
- Fluids, healthy diet, exercise, stool softeners
106
Nocturnal Enuresis
Normal when what?
Management?
Still doing it?
- Normal to go through phase when first potty trained
- Limit fluids before bed or wake them before parents go to bed to pee
- Refer to pediatric urology
107
When does cryptorchidism usually resolve?
When to refer?
Common in who?
- Usually resolves by 6mo -> refer if not
- Premature infants (usually descend right before birth)
108
Wilm’s Tumor – What is it?
Symptoms
- Nephroblastoma
- Small mass near the flank that does NOT cross the midline
109
Wilm’s tumor exam – what don’t we do
Management?
- Never palpate deeply d/t risk of rupture
- US and refer
110
Risk factors for developmental dysplasia of the hip
- Breech
- Low fluid during pregnancy
- Female
- Family history
- First child
111
DDOH
Presentation
- Asymmetrical gluteal folds
- Unequal leg lengths
- Abnormal gait
112
Is DDOH always present at birth?
Can we prevent it?
- No, it can appear during first year
- No
113
DDOH
Maneuvers (2)
- Orlatoni
- Barlow
- Assess for clicks and clunks
114
DDOH
Management – early vs. late
- Early: Pavlik Harness 1-2mo
- Late: closed reduction and spica cast
115
What is Legg-Calve Perthes Disease
When does it occur?
- Osteonecrosis of femoral head
- Younger children 4-8
116
Legg Calve Perthes disease
Symptoms
- Hip pain
- Limp
- positive Trendelenburg test (can’t stand on one leg without tilting up the pelvis)
117
How to diagnose Legg Calve Perthes
Management?
- XR or MRI
- Refer to Ortho
118
What is Slipped Capital Femoral Epiphysis? (SCFE)
- Femoral head slips out and can damage the growth plate
119
Risk factors for SCFE
- Teens
- Rapid growth spurt
- Trauma
- Obesity
120
SCFE
Symptoms
- Hip pain
- Unequal leg lengths
- Inability to bear weight
- Limp (can’t bear weight on affected side)
- + Trendelenburg
121
SCFE diagnostics?
- XR and refer
122
How is scoliosis measured?
What angle needs referred?
- Cobb angle on imaging
- Refer at 20 degrees
- 25-40: bracing
- >45: surgery
- Mild curvatures usually resolve without intervention as the child grows
123
Medial Tibial Stress Syndrome (shin splints)
Diagnosis?
Complications?
- H&P because XR negative
- Tibial stress fracture – won’t show for 2 weeks
124
Shin splints treatment
- Rest affected leg 7-10 days
125
Flat face, low set ears, almond eyes, poor muscle tone, short, palmer crease?
- Down Syndrome
126
Biggest complications of Down syndrome?
- Alzheimer’s, heart disease, hearing loss, hypothyroidism
127
What happens in Klinefelter Syndrome?
- Boys born with extra X chromosome leading to testosterone deficiency
128
Klinefelter Symptoms
Management?
- Large head, delayed milestones
- Refer to endocrine for possible hormone therapy
129
Long limbs, thin, tall, high/arches palate, cardiomegaly, pes planus
Marfan's
130
Complication of Marfan’s?
- MVP
- Cardiomegaly and aortic aneurysm
131
Febrile SZ anticipatory guidance?
- Do not cause LT damage
- Are treated conservatively
132
When to go to the ED for SZ?
- Can’t lower fever with Tylenol
- SZ > 5min
- Breathing problems/ill
133
When is the M-CHAT done?
When is autism usually diagnosed?
- 18 months
- Usually diagnosed between 18mo and 2 years
134
Symptoms of Autism (4)
- Speaking delays
- Poor eye contact
- Difficulty interacting with others
- Loss of developmental skills
135
ADHD management if <6 and >6
- <6: Therapy and behavioral management
- Stimulants added
136
Things to watch with ADHD?
- Growth, HR, BP
