Pediatrics Flashcards
What are the features of slipped capital femoral epiphysis?
It usually occurs between the ages of eight and 15 and is more common in boys and overweight or obese children. It presents with limping and pain, and limited internal rotation of the hip is noted on physical exam.
What is the most common cause of community acquired pneumonia in children less than two?
Streptococcus pneumoniae is one of the most common etiologies in this age group and high-dose amoxicillin is the drug of choice.
Typical presentation for intussusception
Usually children under 2, most common cause of intestinal obstruction from 6-36 months. presents with paroxysms of colicky abd pain, with drawing the legs up toward the abdomen. Vomiting may follow episodes, it may become bilious. Palpable RUQ mass in about 2/3 of pts. About 70% of pts stool contains occult or gross blood, +/- current jelly appearance.
Age at presentation of pyloric stenosis
4-6 wks
Presentation of choledochal cyst
Classic triad of RUQ pain, jaundice and palpable mass
Typical presentation for Meckel’s diverticulum in children
Painless lower GI bleeding
What tinea infection in children always requires systemic antifungal therapy?
Tinea capitis. It requires systemic therapy to penetrate the affected hair shafts.
What are the most common causes of isolated protein urea in children?
Transient proteinuria is the most common cause of a positive urinary dipstick for protein in children. It is associated with fever, the Griss exercise, or exposure to extreme cold, which may act by altering renal hemodynamics. This benign condition is distinguished from orthostatic proteinuria because it resolved when the underlying condition is no longer present. Orthostatic proteinuria, also called benign postural proteinuria, is the most common cause of non-transient proteinuria in children.
How is the diagnosis of orthostatic protein urea made?
The simplest way is to collect two urine specimens for urinary protein to creatinine ratio. The first is collected after the child has been recumbent during the night and is collected as a first morning specimen. The second is collected after the child has been upright for it at least 40 to 60 minutes. An increased protein to creatinine ratio in the upright specimen and normal in the recumbent specimen establishes the diagnosis.
Deliberate suffocation rather than SIDS should be suspected in what circumstances?
When the child is older than six months, if there were previous similar deaths in siblings, simultaneous twin deaths, or evidence of pulmonary hemorrhage. There is usually no history of recurrent apnea or cyanosis in cases of SIDS; when such reported events have only been witnessed by one caretaker, deliberate suffocation should be suspected.
Should infants be given vitamin D supplementation? Which infants? When? How much?
Infants who take less than 1 L of formula per day and breast-feeding infants should receive vitamin D supplementation. They should be given 400 IU of vitamin D daily. The supplementation should be started within the first two months of birth.
What is the likely etiology of a homogeneous beefy red rash in the perineal area of a child, especially if it does not respond to treatment for Candida?
Group A Streptococcus pyogenes
At what level of fluoride in water is fluoride supplementation in children unnecessary?
Greater than 0.6 ppm
At what age should a lumbar puncture be performed to rule out meningitis in a febrile child with a fever?
Children less than 18 months of age. Over 18 months of age the child would be expected to demonstrate meningeal signs and symptoms or clinical findings suggesting an intracranial infection.
What is the age breakdown regarding when children who may have an infection should be admitted to the hospital?
Any child younger than 29 days old with a fever and any child who appears toxic, regardless of age should undergo a complete sepsis workup and be admitted to the hospital for observation until culture results are known or the source of the fever is found and treated. Observation with close follow-up follow-up is recommended for nontoxic infants 3 to 36 months of age with a temperature of less than 39.0 Celsius or 102.2 Fahrenheit. Children who are 29 to 90 days old who appear to be non-toxic and have negative screening laboratory studies including a CBC and urinalysis, can be sent home with precautions and with follow up in 24 hours.
When should testing for neonatal herpes simplex virus infection be considered?
In patients with risk factors which include: maternal infection at the time of delivery, use of fetal scalp electrodes, vaginal delivery, cerebrospinal spinal fluid pleocytosis, or herpetic lesions. Testing should also be considered when a child does not respond to antibiotics.
What are the pediatric recommendations for oral intake prior to surgery?
No solid food for eight hours, no formula for six hours, no breastmilk for four hours, and no clear liquids for two hours prior to the surgery.
How does Kawasaki disease present?
It is most common under the age of five. To diagnose the disease, fever must be present for five days or more with no other explanation. In addition at least four of the following must be present: 1) non-exudative conjunctivitis that spares the limbus 2) changes in the oral membranes such as diffuse erythema, injected or fissured lips, or strawberry tongue 3) erythema of palms and soles, and/or edema of the hands or feet followed by periungual desquamation 4) cervical adenopathy in the anterior cervical triangle with at least one node larger than 1.5 cm in diameter and 5) and erythematous polymorphous rash, which may be target like or purpuric and 20% of cases. It untreated it can cause heart failure, coronary artery aneurysm, myocardial infarction, arrhythmias, or occlusion of peripheral arteries.
What is the treatment of Kawasaki disease?
Hospitalization for treatment with I V immunoglobulin. In addition aspirin should be used for both its anti-inflammatory and it’s antithrombotic effects. Prednisone is considered unsafe in Kawasaki disease as a previous study showed an extraordinarily high rate of coronary artery aneurysm with its use.
What is the appropriate schedule for rotavirus vaccine?
The usual schedule is two months, four months and six months. The first dose should be given between six and 12 weeks of age, with additional doses given at 4 to 10 week intervals. The vaccine cannot be initiated after 12 weeks of age and should not be administered after 32 weeks of age, due to concerns about intussusception
What are the risk factors for, and the clinical findings in transient tachypnea of the new born?
TTN is the most common cause of neonatal respiratory distress. It is a benign condition due to residual pulmonary fluid remaining in the lungs after delivery. Risk factors include Caesarian delivery, Macrosomia, male gender, and maternal asthma and or diabetes.
Clinical findings include tachypnea without hypoxemia. Chest radiograph shows diffuse parenchymal infiltrates and fluid in the pulmonary fissures. The symptoms resolve without treatment within 24 hours.
Who should get two doses of influenza vaccine?
Children under the age of nine years unless they have been vaccinated previously. Children 3 to 8 years of age should receive one or 2 .5 mL doses of split virus vaccine intramuscularly.
What is the most common congenital infection? What are the risk factors for transmission?
Cytomegalovirus or CMV is the most common congenital infection and occurs in up to 2.2% of newborns. It I s the leading cause of congenital hearing loss it is transmitted by contact with infected blood, urine, or saliva, or by sexual contact. Risk factors for CMV include low socioeconomic status, birth outside North America, first pregnancy prior to age 15, history of cervical dysplasia, and a history of sexually transmitted diseases.
What supplement should play breast-feeding infants get as well as older children who are not breast-feeding?
Infants should have 400 international unit of vitamin D per day starting in the first few days of life if they are exclusively breast-feeding. Older children through adolescence should also be getting 400 international units of vitamin D per day. This is equivalent to 1 L of formula or milk per day– if they are drinking less than that they need to be supplemented in addition.
What is an acceptable percentage of weight loss in the first two weeks of life?
Up to 10%. Infants should regain their birth weight by two weeks of age.
What is the most common cause of cyanosis in a neonate? How about in a toddler?
In neonates it is transposition of the great vessels. In toddlers it is tetralogy of Fallot.
What is the cut off level of Billy Rubin the crying transfusion in a neonate who is 24 hours old?
11.7/
What is the difference between breast-feeding jaundice versus breastmilk jaundice?
Breast-feeding jaundice has early onset at 2 to 5 days of age, is transient and lasts only about up to 10 days. It is an exaggeration of physiologic jaundice and is essentially a starvation jaundice. it is due to insufficient frequency of feeds and is associated with infrequent stools.
Breast milk John just has a later onset at 5 to 10 days of age. It persists for more than one month. It is a prolongation of physiologic jaundice which is caused by a factor in human milk. These infants have normal frequent feeds and normal stooling. There serum bilirubin level eventually returns to normal without stopping breast-feeding.
If it persists for more than a month and there is question about whether some other process might be going on breast-feeding can be stopped for 24 to 48 hours and formula substituted. If the jaundice improves or resolves the diagnosis is clinched.
Mike when should a newborn have their first stool? When should you begin to consider abnormalities and what are they?
70% of infants pass meconium in the first 12 hours of life. After 24 hours secondary causes of failure to stool should be considered which include: Hirschsprung’s, imperforate anus, and cystic fibrosis. Another possibility is necrotizing enterocolitis, which is the most common cause of acute intestinal obstruction and septic abdomen neonates.
Define failure to thrive. What is its most common cause?
Inadequate physical growth diagnosed by observation of growth over time using a standard growth chart. The child’s weight falls below the 5th percentile or crosses two major percentile lines.
It is most commonly caused by inadequate caloric intake or some other form of parental neglect.
What is the most common malignancy seen in children?
Leukemia is the most common malignancy. The most common solid tumor is brain tumor.
How is lacrimal duct obstruction managed in a child?
There is limited evidence that milking or massaging the duct may help. Antibiotics or steroids are not indicated. It usually resolves by six months. If it has not resolved by one year a referral should be made for Dr. dilatation.
Briefly describe Wilms tumor
It is an embryonal neoplasm of the kidney and it commonly occurs between ages one and three.
Briefly describe retinoblastoma in children
It presents as a white instead of a red reflex. It may also present with strabismus. It is most common age 13 to 18 months.
Briefly describe neuroblastoma and children.
It is the second most common solid tumor after brain in children. one half Are found before the age of two and most have metastasized.
Briefly describe rhabdomyosarcoma on children
It is the most common soft tissue sarcoma in children. It usually occurs in ages 2 to 5; head and neck are the most common area.
When should the first pediatric dental visit occur?
At age one
What parental guidance issues should be discussed at 2 to 4 weeks of age?
Sleep position, feeding, crying, response, growth. Car seats, exposure to smoking and shaking baby.
