Pediatrics Flashcards
Only vaccination given at birth…
Hepatitis B
Growth and Development: Newborn
- Strong primitive reflexes (e.g., Moro, rooting, fencing)
- Head lag
- Grasps finger tightly if placed on the baby’s hand (grasp reflex)
- Seedy yellow stool after each feeding (if breastfed)
- Eats every 2 to 3 hours or nurses 8 to 10 times a day
- Does not produce tears when crying; tear ducts are not mature at birth
- Sleeps 16 hours per day
- Report high-pitched cry, “catlike” cry, hypotonic microcephaly (concern for cri du chat syndrome)
Growth and Development: 2 Months Old
- Follows objects past midline
- Coos vowels and makes gurgling sounds
- Lifts head 45 degrees when prone
- Smiles in response to another
Growth and Development: 4 Months Old
- Smiles spontaneously (social smile)
- Begins to babble
Fine Motor
- Brings hands to mouth
Can swing at dangling toys
Gross Motor
- Holds head steady and unsupported
- Rolls from front to back (supine to prone)
Growth and Development: 6 Months Old
Fine Motor
- Has palmar grasp of objects
Reaches for toys using palmar grasp
- Brings things to mouth
- Starts to pass things from one hand to the other
Gross Motor
- Begins to sit up independently without support
- Rolls over in both directions (back/supine to stomach and stomach to back/supine)
Language
- Starts to say consonants
- Is very curious and will look around environment
Other
- Report failure to follow objects past midline (180 degrees), poor eye contact
Growth and Development: 9 Months Old
Fine Motor
- Pincer grasp starts and can pick up things (e.g., food) between thumb and forefinger
- Waves “bye-bye”
- May clap hands and play clapping games such as pat-a-cake
Gross Motor
- Pulls self up to stand
- Crawls and “cruises”
- Bears weight well
Language
- Plays peek-a-boo
Report absence of babble, inability to sit alone, strong primitive reflexes such as the Moro (startle reflex) or fencing (tonic neck reflex)
Other
- “ Stranger anxiety” very obvious
Growth and Development: 12 Months Old
Fine Motor
- Can use “sippy” cup
Gross Motor
- Stands independently
- May walk independently
- Starts to cruise (moves from one piece of furniture to the next for support)
Language
- Can say one to two words other than repetitive sounds (e.g., mama, dada)
- Can say exclamations, such as “Uh-oh!”
- Knows first name
- Follows simple directions, such as “Pick up toy”
Other
- Growth rate slows down
- Report absence of weight bearing, inability to transfer objects hand to hand
Coarctation of the Aorta
Congenital narrowing of a portion of the aorta.
Congenital Lacrimal Duct Obstruction
Persistent tearing and eyelash matting in the morning on one or both of the baby’s eyes, but no conjunctival erythema. When the lacrimal duct is palpated, reflux of mucoid discharge or tears may be seen.
Treatment for congenital lacrimal duct obstruction
Lacrimal sac massage/compression: Place a clean finger on the lacrimal sac and apply moderate downward pressure over the lacrimal sac for 2 to 3 seconds. Perform maneuver two or three times per day.
A short course of topical ophthalmic antibiotics can be beneficial if copious or extremely bothersome.
Dacrocystitis
an inflammatory condition of the lacrimal sac, typically caused by obstruction of the nasolacrimal duct
S/S for dacrocystitis
Periorbital cellulitis, including erythema, warmth, and swelling around the eye, along with tenderness and purulent discharge from the tear duct
Treatment for dacrocystitis
Culture discharge and treat with systemic antibiotics for 7 to 10 days to prevent complications of preseptal or orbital cellulitis. Usually caused by streptococcal or staphylococcal organisms.
Barlow Maneuver
Checks for developmental hip dysplasia.
Bend infant’s knees to 90 degrees, place index and middle finger over the greater trochanter. Gently push both knees together at midline downward, then pull upward (Figure 20.3A). Will hear “clunk” sound when the trochanter slips back into the acetabulum (reducible dislocated hip
Ortolani Maneuver
Hold each knee and place your middle finger over the greater trochanter (outer thigh over the hips). Rotate the hips in the frog leg position (abduction with gentle traction anteriorly) (Figure 20.3B,C). During abduction, resistance may be felt at 30 to 40 degrees. Sensation of instability is positive if audible or palpable movement of femoral head over posterior acetabular rim, which allows the hip to “relocate” in the acetabular cavity.
Fever in children
Temp over 100.4F
Colic
- Crying for no apparent reason that lasts ≥3 hours a day in an infant younger than 3 months. - - - Crying usually occurs at the same time each day.
- Crying occurs >3 days in a week.
The excessive crying usually resolves by 3 to 4 months.
Kawasaki disease
Onset of high fever (up to 104.0°F) for 5 or more days and inflammation of the blood vessels.
Presence of at least four of the following clinical signs: enlarged lymph nodes in the neck, bright-red rash (more obvious on groin area), bilateral conjunctivitis (dry, no discharge), oral mucosal changes (e.g., dry cracked lips, “strawberry tongue”), and swollen hands and feet.
After fever subsides, skin peels off hands and feet
Treatment for Kawasaki disease
Treated with high-dose aspirin and IV gamma globulin.
Sequelae for Kawasaki Disease
Aortic dissection, dilation or aneurysms of the coronary arteries, and hearing loss.
Requires close follow-up with pediatric cardiologist for several years because effects may not be apparent until child is older.
S/S of leukemia
- extreme fatigue and weakness. - pale skin and easy bruising
- may have petechial bleeding (pinpoint to small red spots).
- may have bleeding gums and nosebleeds.
Some have bone or joint pain, lymphadenopathy, or swelling in the abdomen.
Acute lymphocytic leukemia
Fast growing cancer of the lymphoblasts.
Almost all patients have neutropenia with varying degrees of anemia and thrombocytopenia.
Reye’s Syndrome
Caused by febrile viral illness (chickenpox, influenza) and aspirin or salicylate intake (e.g., Pepto-Bismol) in a child.
S/S or Reye’s syndrome (stages)
Stage 1: Severe vomiting, lethargic/sleepy, elevated alanine aminotransferase (ALT) and aspartate transaminase (AST)
Stage 2: Deeply lethargic, restless, confused/delirious/combative, hyperactive reflexes, hyperventilation
Stage 3: Obtunded or in light coma, decorticate rigidity
Severe
Stage 4: Coma, seizure, decerebrate rigidity, fixed pupils, loss of reflexes
Stage 5: Seizures, deep coma, flaccid paralysis, absent deep tendon reflexes (DTRs), respiratory arrest, death
Immunization for age 11-12
Tdap, HPV, MCV4
HPV vaccine
2 doses if given prior to age 15, three doses if after 15
Fragile X syndrome
- macrocephaly (>50th percentile for age/sex)
- global developmental delays
- Skills and behavior acquisition slow compared with peers.
- Hyperactive behavior or learning disabilities (math and problem-solving)
- Tends to avoid eye contact
- long face
- prominent forehead, jaw,
- large or protruding ears
- large body with flexible flat feet.
Hand foot and mouth
Viral illness caused by coxsackievirus A16.
Spread by contact with body fluids
S/S of hand foot and mouth
- fever
- severe sore throat
- headache
- anorexia.
- small blisters appear on the hands feet and rectum.
- ulcers present inside the mouth, throat, tonsils, tongue.
- mouth pain with acidic foods.
Treatment for hand foot and mouth
Self-limiting, recovery in 5-10 days
Ibuprofen/tylenol for pain
salt water gargles
Drink cold fluids and avoid acidic drinks (soda, orange juice, tomato juice).
Hodgkin lymphoma s/s
Enlarged lymph nodes with fever, night sweats, and occasionally pain (lymph nodes) after drinking alcohol.
Diagnostics for testicular torsion
Doppler ultrasound
Antidote of acetaminophen poisoning
oral or IV N-acetylcysteine.
Presentation of testicular cancer
A “heaviness” in scrotum or a hardened mass that is usually painless.
Testicle has a firm texture
Chryptochordicism is strong risk factor
S/s of testicular torsion
severe scrotal edema, redness, and testicular pain. Ipsilateral (same side) cremasteric reflex is absent, and the testicle may be noted to be high riding with a transverse lie
Tanner stage III in boys
Elongation of the penis (testes continue to grow
Tanner stage II in boys
Testicular enlargement and scrotal rugation/color starts to become darker
Tanner stange IV in boys
Widening of the penis, testes continue to enlarge
Precocious puberty
Puberty starts before age 8 years in girls, age 9 for boys
Delayed puberty
Absence of secondary sexual characteristics by the age of 13 years for girls (such as a breast bud) or at the age of 14 years for boys.
Tanner stage II girls
Breast budding (thelarche); areolar hyperplasia with small amount of breast tissue
Tanner stage III girls
Further enlargement of breast tissue and areola, with no separation of their contours
Tanner stage IV girls
Separation of contours; areola and nipple form secondary mound above breasts tissue
Dysmenorrhea
Painful periods are due to severe menstrual cramps caused by high levels of prostaglandins.
Dysmenorrhea treatment
Treatment is use of heating pads and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve).
Top causes of death in 15-19 year olds
- Accidents (e.g., motor vehicle crashes)
- Assault/homicide (e.g., intentional firearm use)
- Intentional self-harm (suicide)
Emancipated minors are able to do what without parental consent?
- Legally married
- Active duty in the armed forces
- Living separately from their parents and self-supporting
Scoliosis
Lateral curvature of the spine that may be accompanied by spinal rotation. More common in girls (80% of patients). Painless and asymptomatic. Scoliosis will most likely worsen (66% of cases) if it starts near the beginning of the growth spurt.
Treatment parameters for scoliosis
Curves <20 degrees: Observe and monitor for changes in spinal curvature
Curves of 20 to 40 degrees: Bracing (e.g., Milwaukee brace)
Curves >40 degrees: Surgical correction with Harrington rod used on spine and other options
Screening test for scoliosis is the
Adam’s forward bend test
Types of anorexia
- Patient engages in restriction (dieting, excessive exercise)
- Binge eating and purging.
Some examples of purging are excessive use of laxatives, enemas, diuretics, and vomiting.
Common presentation for pediatric anorexia
- Marked weight loss (body mass index [BMI] ≤18.5), bradycardia (40–49 beats/min), vital signs unstable, hypotension
- Lanugo (increased lanugo, especially in the face, back, and shoulders)
- Osteoporosis or osteopenia
- Swollen feet (low albumin), dizziness, abdominal bloating
- amenorrhea
Interventions for delayed puberty
- pregnancy test
- prolactin level - if elevated CT of pituitary gland
3.
Intervention for primary amenorrhea by age 15?
- rule out hypogonadism by checking hormone levels (e.g., follicle-stimulating hormone [FSH], luteinizing hormone [LH], thyroid-stimulating hormone [TSH]).
- Rule out chromosomal disorders, absence of uterus/vagina, and imperforate hymen.
- X-ray of the hand is used for estimating “bone age.” When the long-bone epiphyses (growth plates) are fused, skeletal growth is finished. Refer to pediatric endocrinologist if no growth spurt, delayed puberty, others.
Gynecomastia
Excessive breast tissue in males. Peak at age 14, usually resolves spontaneously within 6 months to 2 years.
Gynecomastia findings
Round, rubbery, and mobile mound (disklike) under the areola of both breasts. Skin has no dimpling, redness, or changes.
If mass is irregular, fixed, or hard, or if rapid growth in breast size or if secondary cause suspected, refer to specialist.
Gynecomastia treatment
- Evaluate for Tanner stage (check testicular size, pubic hair, axillary hair, body odor).
- Check for drug use of both illicit and prescription (e.g., steroids, cimetidine, antipsychotics).
- Rule out serious etiology (e.g., testicular or adrenal tumors, brain tumor, hypogonadism).
- Recheck patient in 6 months to monitor for changes.
Klinefelter Syndrome
Males are born with an extra X chromosome.
It is one of the causes of primary hypogonadism (deficiency in testosterone). Testicles are small and firm with small penis. Tall stature, wider hips, reduced facial and body hair, and higher risk of osteoporosis (compared with normal males).
Treatment for Kleinefelter syndrome
Testosterone replacement and fertility treatment.
Primary amenorrhea
No menarche by the age of 15 years in the presence of normal growth and secondary sex characteristics.
(half of cases caused by chromosomal abnormalities –> turner syndrome)
Secondary amenorrhea
No menses for more than three cycles or 6 months, if previously had menses. Most common cause is pregnancy.
Other causes are ovarian disorders, stress, anorexia, and polycystic ovary syndrome (PCOS).
Female athlete triad
anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis
Turner’s Syndrome
Females with complete or partial absence of the second sex chromosome (45, X).
S/S of Turner Syndrome
- a particularly short, wide neck (webbed neck)
- a broad chest and widely spaced nipples.
- arms that turn out slightly at the elbows.
- a low hairline.
- teeth problems.
- a large number of moles.
- small, spoon-shaped nails.
- a short 4th finger or toe.
Characteristics of down syndrome child
Round face that presents with decreased anterior–posterior diameter with up-tilted eyes (palpebral fissures) and low-set, small ears. Chronic open mouth caused by enlarged tongue (macroglossia), accompanied by a shorter neck. Short fingers, small palms, and a broad hand with a single transverse palmar crease are additional signs. Newborns have hypotonia and poor Moro reflex. Higher risk of intellectual disability, congenital heart defects, feeding difficulties, congenital hearing loss, thyroid disease, cataracts, sleep apnea, and early onset of Alzheimer’s disease
Fetal alcohol syndrome characteristics
Shortened palpebral fissures and microcephaly with a small jaw.
Small head (microcephaly) with shortened palpebral fissures (narrow eyes) with epicanthal folds and a flat nasal bridge. There is a thin upper lip with no vertical groove above the upper lip (smooth philtrum). Ears have an underdeveloped upper curve that is folded over. Can range from neurocognitive and behavioral problems (e.g., attention deficit disorder [ADD]) to more severe intellectual disabilities.
Fragile X syndrome characteristics
- macrocephaly
- long face
- prominent forehead, jaw, large prodtruding ears
- large body
- flat, flexible feet
- slow to acquire skills
- hyperactivity
- avoids eye contact
- learning disabilities
- high correlation with autism and anxiety
