Pediatrics Flashcards
1
Q
What are the cues indicate that a new board is not be fed enough?
A
HUNGRY
H- Hypoglycemia- characterized by protracted, high-pitched cry, jitteriness, seizures
U- unsatisfied nursing, feeding more frequently than every two hours with hunger cues
N- not waking for feeding every 2 to 3 hours, not latching appropriately (especially if latched appropriately in the past), limpness, lethargy, findings indicate low blood sugar, dehydration, or electrolyte disorder
G- growth or weight loss greater than 7% at any given time, especially outside the first week of life, which increases the risk of neonatal jaundice in hypernatremia
R- reduce number in frequency of wet and or soil diapers, especially if no wet diapers for more than six hours, dry, Brit, colored stools, especially if a newborn has evidence of a dry mouth or crying without tears
Y- yellowing of the skin and eyes, indicating hyper bilirubinemia and jaundice, noted, particularly in the first few weeks of life when feeding and fluid intake are in adequate.
2
Q
When should we be concerned about weight loss or growth in a newborn?
A
7% weight loss or close
3
Q
How often should a newborn feed regardless, if their breast or formula, fed
A
Every 2 to 3 hours
4
Q
What are the risks of underfeeding a newborn
A
Jaundice
Dehydration
Hypernatremia
5
Q
At what age should solid foods be introduced to infants
A
No sooner than 4 to 6 months of age
6
Q
What is considered the neonatal period?
A
Birth to 28 days
7
Q
How much growth should occur in the neonate period
A
 Two or more pounds and grows about 1 to 1.5 inches in length.
8
Q
How much fluid should you instruct a breast-feeding mother to drink with each feeding?
A
16 ounces of water
9
Q
When does the transformation from colostrum to mature breastmilk occur?
A
2 to 5 days after birth
10
Q
What are some signs of an inappropriate latch when breast-feeding?
A
 Dimpling of the babies cheeks, and or clicking noise with attempts at suck and swallow 
11
Q
What does inappropriate latch look like in breast-feeding?
A
The babies, chin and stomach should be comfortably resting against the mothers, body, babies, mouth, wide open, the lips flange at work, and the areola, minimally visible
Your mother should be able to hear the baby swallowing and see the babies ears move slightly with each suck and swallow 
12
Q
When does physiologic jaundice typically start? And what causes it?
A
Usually starts 3 to 5 days of life or within the first few weeks. A result of normal breakdown of fetal, hemoglobin, immature, liver, metabolism.
No underlying liver disease is involved in this condition
In adequate feedings can trigger this response
13
Q
How does physiologic jaundice usually spread?
A
From the head, then spreads to the body
14
Q
How much of a drug does does a breast-fed baby get from the mother?
A
One percent or less
15
Q
What antibiotics are considered safe during breast-feeding?
A
Beta lactam, such as penicillin in cephalosporins
16
Q
If a mother takes a problematic drug that is harmful to the infant how should she proceed?
A
Pump and dump for at least 3 to 5 half-life of the medication
17
Q
What two substances pass easily into the breast, milk and reduce milk supply
A
Nicotine and EtOH
18
Q
What is the recommended feeding frequency during the first and second months of life
A
Breast-feeding: a minimum of 10 minutes on each breast every one and a half to three hours
Bottle-fed: 2 to 3 ounces every 2 to 3 hours
19
Q
What supplement is recommended for breast fed in infants?
A
Fluoride
20
Q
What supplement is recommended for breast-fed infants? And at what age do they speak in?
A
Iron supplementation
Begin at four months of age
Dose 1 mg per kilogram
21
Q
What are some signs that an infant is ready for solid food?
A
Double their birth weight, and at least 4 to 6 months of age
Taking more than 32 ounces of formula per day, or more than 8 to 10 feedings per day
22
Q
Describe the Moro reflex, when it should be present in when it should dissipate
A
Set an loud noise, causes also known as startle reflex: symmetric, abduction, and extension of the arms, followed by adduction in flexion of the arms over the body
Present at birth
Should disappear by 3 to 4 months of age
23
Q
A strong moro reflects in an infant older than six months of age is indicative of what
A
Brain damage
24
Q
Describe the tonic neck reflects
A
A.k.a. fencing, reflex: Turning head to one side with a jar over shoulder, causes the arm and leg on that same side to extend the arm and leg on the opposite side will flex
25
What is the Moro reflex is absent on one side?
Rule out brachial, plexus injury, fracture, or shoulder dystocia
26
What is the Moro reflex is absent on both sides?
Rule out a spinal cord or brain lesion
27
What is the rooting reflex? When is it present? And when should it disappear? should it disappear?
Stroking the corner of a a baby’s mouth causes the baby to turn towards the stimulus and suck
Should disappear by 3 to 4 months
28
What is the step reflects? When is it present? And when should it disappear?
When, holding the baby upright, allow the dorsal surface of the foot to touch the edge of the table. Baby will flex the hip and knee and placed the simulated foot on the table top in a stepping motion.
Should disappear by six weeks
29
When is the stepping reflects absent?
In breech births
Paresis
30
What are the primitive reflexes?
Tonic neck
Palmar grasp
Babinski
Routing, awake, and asleep
Sucking
31
What are the anticipated, developmental milestones at one to two months?
Lifts head with TWO arms
Responds TWO sounds
Smiles when smiled Two
Regards face
Follows objects in visual field
Moro and palmar grasp reflex receding
Social smile
Recognize his parents
Pneumonic: at two months, the baby has two eyes and two arms they can hold themselves up and see follow and recognize their parents
32
What are the anticipated, developmental milestones for a four month old?
Reaches FOR objects
Smiles FOR fun
Grasps cube
Brings objects to mouth
Makes raspberry sounds
Laughs, squeals, vocalizes in response to others
Recognizes food by sight
Rolls back to side
Imitates others
Repeat, interesting actions 
Pneumonic:
Reaches FOUR things, holds a FOUR sided cube. I like raspberries in my wine but by my FOURTH glass I’m laughing, squealing, playing charades,
, and looking for food. Then I roll from my back to side all night.
33
At what age is stranger in separation anxiety begin
Six months
34
When should a child be able to sit without support?
6-8months
35
When should a child be able to transfer objects from hand to hand?
6-8 months
36
When should a child be able to roll back to stomach and stomach to back?
6-8 months
37
When should a child be able to babble things like mama papa?
6-8 months
Pneumonic: mama, papa= 8 letters
38
When does a child begin to recognize the word no
6-8 months
Pneumonic: sideways 8 looks like NOO
39
What should a child be doing at 9 to 11 months?
Crawling
Stands initially holding onto furniture and then independently
Imitates, peekaboo, and Patticake
Picks up small object with thumb and finger
Follow simple commands
Connects meaning to words like mama Papa
Pneumonic: 11
Stand tall like an 11
11 looks like tweezers for pincher grasp
11 two hands to play pat-a-cake
11 letters in “understands”
40
When should a child scoop of small objects with rake grip
Six months
Pneumonic: there are six prongs on a rake
41
What should a child be able to do developmentally at age 12 to 15 months?
Walk with help then solo
Pincher grasp fully developed
Can place a cube in a cup
Hands over objects on request
Build a tower of two bricks
Says one to two words
Indicates once by pointing
Scribble spontaneously
Imitates animal sounds
Pneumonic: think of playing corn coffee with Coop. He could put the corn in the bowl hand it back to me, say corn coffee, which is two words.
42
What period of time is considered infancy
The first year of life
43
What period of time is considered a toddler
1-2 yo
44
What period of time is considered preschool age
3-4 years
45
What period of time is considered school-age
5 to 12 years
46
What is the vision range for a newborn?
8 to 12 inches. Think of distance from baby to mothers face while breast-feeding.
47
Is a bluish scleral tint normal in a newborn? If so, when is it abnormal?
Bluish clear all tent is normal in the first months of life
If it persist, it could be a sign of osteogenesis imperfecta
48
Other than loud noise, what can trigger the startle reflex in a newborn?
Bright lights
49
What is considered a term pregnancy?
37 to 41 weeks +6 days in duration
50
When does the rooting reflex disappear?
6 to 12 months
51
When should the Moro reflex disappear?
By 16 weeks
52
When should the palmar grasp disappear?
2-3 months
53
When should the Babinski reflex disappear?
By six months
54
When is a baby’s hearing typically checked
Prior to discharge from the hospital
55
What should the provider recommend regarding tummy time?
Start tummy time immediately after birth building absolutely to a total of 30 minutes a day until the child can roll tummy to back and back to tummy- this should occur around six months of age
56
When should a newborn be back to its original birth weight
By 3 to 4 weeks of age
57
What type of jaundice is typically seen in a newborn less than 24 hours old?
Pathologic
58
When should phototherapy be initiated for a child with pathologic jaundice?
If total serum bilirubin is greater than 25
59
When does chlamydial conjunctivitis typically appear and what is the most common symptom?
5 to 14 days post exposure
Chemosis (conjunctival edema) is the most common symptom
60
What developmental milestones are expected in an 18 month old
Think of an 18-year-old
Says no like an 18 year old
Can copy things adults do like an 18-year-old
Speaks and single word sentences like an 18-year-old
61
What developmental milestones are expected in a two-year-old
Speaks in TWO word sentences
Follows TWO word
Build a TWO block tower
Can walk up to the second floor with help
62
What are the expected developmental milestones of a three year old
Build a three block tower
Rides a three wheeled bike
Draws a circle like a three ring circus
63
What developmental milestones are expected of a four-year-old
Build a FOUR block tower
SPEAKS IN FOUR word sentences
Can draw a cross with four points
64
When should 100% of a toddler speech be recognizable by strangers?
3 to four years
65
When should about 75% of a child speech be recognizable to strangers
2 to 2.5 years
66
What percentage of speech should be understandable in a child that is 16 to 18 months old
25%
67
What percentage of speech should be understandable in a child that is 16 to 18 months old
25%
68
At what age should a child speech be about 50% comprehensible to strangers
19 to 21 months
69
At what age would you expect the lower central incisors to begin coming in?
6-10 months
70
At what age would you expect the upper central incisor teeth to erupt?
8 to 12 months
71
List the developmental red flags up to 24 months
By six months: no smiles or other warm, joyful expressions.
By nine months: no back-and-forth sharing of sounds, smiles, or other facial expressions
By 12 months: lack of response to name, no babbling or baby talk, and no back-and-forth gestures, such as pointing, showing, reaching, or waving
By 16 months: no spoken words
By 24 months: no meaningful two word phrases that don’t involve imitating or repeating
72
At what age should children be screened for autism?
18 and 24 months
73
When should a child have their first dental exam?
With the eruption of the first tooth
74
When performing a wellness exam on a child born prematurely, how should you gauge the developmental milestones?
If they were born prior to 40 weeks, gestation adjust their milestones to what their age should be until the child reaches 24 months of age
75
What is the most common demographics for pyloric stenosis?
Firstborn males typically presents around three weeks of life
76
What is the Pathophysiology associated with pyloric stenosis?
Thickening of the pyloric muscle, which prevents food from moving from the stomach to the small intestines
77
What are the signs and symptoms of pyloric stenosis?
-Non-bilious projectile vomiting
-Wanting to eat immediately after vomiting
-Signs of dehydration and malnutrition
-Jaundice
-An olive shape can be palpated in the right upper quadrant of the abdomen due to an enlarged pylorus
78
What does his preferred to diagnose pyloric stenosis?
Ultrasound
79
What are the signs and symptoms of intussusception?
sudden onset of severe, colicky, intermittent, abdominal pain.
Baby will often draw knees into chest due to abdominal discomfort
Rectal passage of blood and mucus
Sausage shaped, palpable, abdominal mass
80
What is the typical demographics for intussusception?
Boys 6 to 12 months
81
What are the diagnostic test to check for intussusception?
Ultrasound
Contrast enema
82
Normal reflux is typically outgrown by what age?
14 months
83
When is it acceptable to give a child an MMR vaccine when under the age of one
Children, 6 to 11 months of age or traveling outside the United States should receive one dose of MMR
84
How long is a infant, supported by its mothers, iron stores?
Six months
85
What is the most potent risk factor for iron deficiency anemia in a child greater than 12 months old?
Cows, milk intake in excess of 16 ounces a day
86
What is the most potent risk factor for iron deficiency anemia in an infant less than nine months old
Maternal iron, depletion or prematurity
87
Should preterm infants receive iron supplementation? If so, what is the dosing?
Preterm infants, receiving breastmilk should be supplemented with iron 2 mg/kg/day through supplements or food, starting by age 1 month through 12 months
88
When would you check a ferritin level on an infant?
If the hemoglobin was less than 10
89
At what age does universal screening for iron deficiency anemia begin?
12 months
90
What is the dose of daily vitamin D recommended for supplementation in a child not getting enough from the diet
400 IU daily
91
What are the most common causative organisms of acute otitis media?
S. pneumonia
H. Influenzae.
m. Catarhalis
92
What population is watchful waiting appropriate for when treating acute otitis media
Older than six months
Non-severe illness
Fever less than 39° in past 24 hours
Mild ear pain for less than 48 hours
Ensure there is ability for the patient to follow up in 48 to 72 hours for antibiotic therapy. If no improvement in condition.
93
What is considered severe illness in a child with acute otitis media?
Moderate to severe otalgia
Or
Otalgia greater than 48 hours
Or
Fever greater than 39°
94
When is antibiotic therapy Absolutely necessary for acute otitis media.
Children under six months of age, regardless of severity
Severe illness with unilateral or bilateral acute otitis media in children, age greater than six months
Non-severe illness with bilateral acute otitis media and children 6 to 23 months
95
What is the first line treatment for acute otitis media in a child?
Amoxicillin 80-90 mg/kg/day
In 2 divided doses
Or
Amoxicillin-clavulanate 90mg/kg/day of amoxicillin w/ 6.4mg/kg/day of clavulanate in 2 divided doses
96
What is the length of treatment for acute otitis media? Her age group?
< 2 yo: 10 days
2-6 yo: 7 days
> 6 yo: 5-7 days
97
If a child has a P penicillin allergy what antibiotic class can be used to treat acute otitis media
Cephalosporins
Cefdinir
Cefuroxime
Cefpodoxime
Ceftriaxone IM or IV
98
If a child has a P penicillin allergy what antibiotic class can be used to treat acute otitis media
Cephalosporins
Cefdinir
Cefuroxime
Cefpodoxime
Ceftriaxone IM or IV
99
If a child with acute otitis media fails treatment after 48 to 72 hours on anabiotic’s what anabiotic can you use?
If patient is only on amoxicillin switch to amoxicillin clavulanate
If already on amoxicillin clavulanate may use Ceftriaxone IM or IV for three days
Or
Clindamycin PO with or without a third generation cephalosporin
100
What is the most common cause of temporary speech delay in early childhood?
Persistence, otitis media with effusion
101
What is the treatment for otitis media with effusion?
No treatment necessary should resolve in three months. If persistent past three months order audiology evaluation.
102
When does the rash associated with scarlet fever usually appear
Sandpaper, feeling rash appears Day two of pharyngitis and often peels a few days later
103
What virus causes roseola?
Herpesvirus six
104
What is the typical demographic for roseola and what is the presentation?
Most common in 6 to 24 month oldS
Typically child will have a high fever for 3 to 7 days then will develop a discrete, rosy pink macular or maculopapular rash that last hours to three days
105
Which child hood exanthem is most related to febrile seizures
Roseola
106
How does (Rubella) German measles present?
Mild symptoms: fever, sore throat, malaise, nasal discharge and diffuse maculopapular rash last thing about three days. Rash happens with symptoms.
Posterior cervical impose, our regular lymphadenopathy begins 5 to 10 days prior to onset and continues to be present during the rash
Arthralgia is common in about 25%
107
When is rubella most contagious?
One week prior to onset of the rash to two weeks after the rash disappears
108
What is most concerning during a rubella infection?
It is one of the most teratogenic viruses. There is an 80% rate of congenital rubella syndrome, if a pregnant woman contracts, the virus while pregnant.
109
What virus causes the measles?
Rubeola
110
How does rubeola present?
Measles:
Fever
Nasal discharge
Generalize lymphadenopathy
Conjunctivitis
Photo phobia
Koplik spots
Maculopapular rash 3 to 4 days after onset of symptoms may Coalesce to generalized erythema
111
What is the classic finding associated with rubeola? describe
Koplik spots
White spots with blue rings, held within red spots on the oral mucosa
112
Which childhood exanthem is no longer contagious once a rash breaks out
Fifths disease
113
What virus causes fifth disease?
Paro virus
Pneumonic: think par five
114
How should a febrile neonate be treated?
Neil needs are considered anyone less than 28 days old
Empiric therapy with IV antibiotics and admission to the hospital for evaluation for sepsis
115
What should be included in a sepsis work up of a child, regardless of age
CBC with diff
Blood cultures
UA with culture and sensitivity via transurethral catheter or superpubic tap
LP
Chest x-ray
Stool culture
Sepsis markers, such as lactate, ESR, CRP, Procal
116
How does peritonsillar abscess typically present in a child?
Hot potato voice
Difficulty swallowing
Difficulty opening mouth
Contralateral, uvula deviation
117
What is the most common cause of epiglottitis in children?
H. Influenza type B.
118
What is the most common demographic and presenting symptoms of epiglottitis?
Children, age 2 to 7 years
Abrupt onset of high-grade, fever, sore throat, dysphasia, and drooling
119
What is the most common demographic and presenting symptoms of epiglottitis?
Children, age 2 to 7 years
Abrupt onset of high-grade, fever, sore throat, dysphasia, and drooling
120
What two common throat issues in children should be referred to the hospital
Epiglottitis
Peritonsillar abscess
121
What is the most common cause of acute bronchiolitis?
RSV
122
What is the treatment for acute bronchiolitis?
Supportive treatment only wheezing me last up to three weeks
123
When starting asthma treatment on a child, when should you measure FEV1?
At the start of treatment, and after 3 to 6 months of controller treatment to record patient’s personal best lung function, then periodically for ongoing assessment
124
What are considered medically emancipated conditions in the United States
Contraception
Pregnancy (but not abortion)
Sexually transmitted infections
Substance abuse
Mental health
125
How long after a girl develops breast buds, will she begin to Menstruate?
2 years
T2-to menses= 2 years
126
How long after a girl enters Peabody will she reach her full adult height?
Three years after entering Tanner 2 (breast buds)
127
What happens to girls during Tanner stage 2?
Breast buds develop
Downey pigmented pubic hair along the labia majora
T2= 2 breasts
128
What happens to boys during tanner stage two
Testes enlarge
Squirtle skin reddening with a change in texture
Sparse growth of long slightly pigmented pubic hair at base of penis
129
What tanner stage starts the growth spurt and both girls and boys
Tanner stage three
130
At what age does tanner stage two typically begin for girls?
7-13 years old for breast development
8-13 for pubic hair
131
What is considered an alteration in puberty in girls?
Breast development prior to seven years old
Pubic hair prior to eight years old
No start of Tanner 2 by age 14
132
What is the typical age of onset onset for Tanner to invoice
9 to 14 years old
133
When do we consider puberty altered in boys
Tanner stage two at less than nine years old
No onset of puberty at age 14
134
What happens in boys during tanner stage three
Increase in penile length, but not width
Further scrotal enlargement
Pubic hair, Darkins becomes more course in covers a Greater area
Onset of growth spurt
135
What happens to girls during tanner stage three
Breast mounds in large
Darker, courser, curling pubic hair on mons pubis and labia majora
Onset of growth spurt
136
What happens to girls and tanner stage four
Ariola and papilla elevated to form a second mound above the level of the rest of the breast
Adult type pubic hair with no spread to medial surface of thighs
Menarche
137
What happens to girls and tanner stage four
Ariola and papilla elevated to form a second mound above the level of the rest of the breast
Adult type pubic hair with no spread to medial surface of thighs
Menarche
138
In what stage do females develop menarche
Tanner stage four
139
What happens to boys in tanner stage four
Penis grows in length and width
Glands
Glans of penis develops
Further darkening of the scrotal skin
Adult tight pubic hair with no spread to the thighs
140
What happens to boys during tanner stage five
Full adult genitalia
Adult type pubic hair
Pubic hair that spreads to medial surface of thighs and possibly abdomen
141
What happens to boys during tanner stage five
Full adult genitalia
Adult type pubic hair
Pubic hair that spreads to medial surface of thighs and possibly abdomen
142
What happens to girls during tanner stage five
Recession of Ariola to mount a breast
Extension of pubic hair to medial thigh
143
What age group and tanner stage is most commonly affected by gynecomastia
Tanner stage 3 to 4
Scene and 50% of males 13 to 14 years old
Typically last 6 to 24 months
144
What genetic condition is associated with macroorchidism
Fragile X syndrome
145
What causes Klinefelter syndrome?
XXY chromosomes
Only occurs in males
Results in low, testicular volume, hip and breast, enlargement, infertility
146
What are two important educational pieces when prescribing acne therapy
I’ll acne therapy take 6 to 8 weeks of use prior to significant clinical affect
Topical therapy should be used over entire skin region, not simply for spot therapy of existing lesions
147
What are two important educational pieces when prescribing acne therapy
I’ll acne therapy take 6 to 8 weeks of use prior to significant clinical affect
Topical therapy should be used over entire skin region, not simply for spot therapy of existing lesions
148
What coverage of the spine is considered scoliosis 
Cover the spine of at least 10°
149
What coverage of the spine is considered scoliosis 
Cover the spine of at least 10°
150
At what point would you consider ordering a brace for scoliosis in a child?
If their spinal curvature was 25 to 40°
151
What childhood skin disorder is associated with umbilicated papules with an end it in the middle and what is the treatment for this condition?
Molluscum contagiosum is a highly contagious skin disorder of childhood. There is no treatment required however, resolution may take anywhere from a few months to a few years.
152
What type of child abuse is most common
Neglect
153
What interval of time should live vaccines be separated by
4 weeks
154
If prescribing a tetracycline to a child, what educational piece of information is important?
Take the medication through a straw or a dropper, due to teeth staining
155
What reflection disappear by four months of age
Tonic neck
156
Which reflection disappear by two months of age
Stepping
157
At what age can babies waved bye-bye
10 months
Think two hands bye-bye
158
When does a patient with fifths disease stop being contagious
With the onset of rash
159
When vaccinating for diphtheria, tetanus and pertussis at what age should a child switch from DTaP to T dap
DTaP is administered till seven years of age at which time they can receive the T dap
160
What population traditionally, believe that the evil eye is responsible for illness?
Hispanic
Mal. De Ojo.
