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Clinical Medicine > pediatrics > Flashcards

pediatrics Flashcards

1
Q

at what age is a fever of 100.4 most concerning?

A

less than 3 months

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2
Q

at what age is a fever of 100.4 most concerning?

A
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3
Q

HR starts ___ and gets ____ as a child grows

A

higher and gets lower

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4
Q

how to observe respiratory rate inkids

A

abdominal excursions, stethoscope in front of mouth, listen to chest

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5
Q

respiratory rate starts __ and gets ___ throughout childhood

A

higher and gets lwoer

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6
Q

blood pressure starts __ and gets __ throughout childhood

A

low and gets higher

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7
Q

when can we do a standing heigh for a kid?

A

> 2 years old

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8
Q

stuff to look for at 2 months:

A 
Gross motor
Holds head steady while sitting
Raises head to 45 degrees prone
Fine motor
Grasps objects put in hand
Hands to midline
Social
Social smile
Language
Cooing, vowel sounds “eh”
Visual
Fixes and follows
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9
Q

what age does pincer grasp start?

A

9 months

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10
Q

what age does stranger anxiety start?

A

9 months

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11
Q

when to start screening for lipids if family history?

A

5 years!

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12
Q

• Interruption of the normal progression of retinal vascularization

A

retinopathy of prematurity (premies at risk of retina not developing–need dilated fundoycopic exams0

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13
Q
A

weight, length (laying down) and head circumference

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14
Q

increased risk of ear infections

A

First episode at

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15
Q

stuff to look for at 2 months:

A 
Gross motor
Holds head steady while sitting
Raises head to 45 degrees prone
Fine motor
Grasps objects put in hand
Hands to midline
Social
Social smile
Language
Cooing, vowel sounds “eh”
Visual
Fixes and follows
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16
Q

what age does pincer grasp start?

A

9 months

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17
Q

what age does stranger anxiety start?

A

9 months

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18
Q

when to start screening for lipids if family history?

A

5 years!

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19
Q

• Interruption of the normal progression of retinal vascularization

A

retinopathy of prematurity (premies at risk of retina not developing–need dilated fundoycopic exams0

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20
Q

ddx of wheeze in kids

A 
Functional 
•	GERD 
•	Cystic Fibrosis
•	Immune Def. 
•	Vocal cord dysfunction 
•	Aspiration 
•	BPD 
•	primary ciliary disease 
Chronic 
•	Anatomic 
•	Vascular compression 	•	Cardiomegaly 
•	Chronic lung disease
•	Congenital Heart disease
Acute 
•	asthma 
•	Infectiousbronchiolitis 
•	FB 
•	Esophageal FB 
•	Bacterial tracheitis
•	Anaphylaxis
•	Acute respiratory distress syndrome
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21
Q

increased risk of ear infections

A

First episode at

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22
Q

concomitant ear infection and conjunctivitis is usu d/t?

A

h flu, start amox/clav first

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23
Q

3 main RFs of CDH

A

female, first born, family history

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24
Q

what test do you use for a baby 4 mos old with suspected CDH?

A

US and look at angles, or can use barlow (disc locatable?) or ortolanis test (reducible?) also “fresh” position

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25
Q

• Insidious onset of limping and pain in groin, hip, thigh, knee regions in a kid makes you think of what?

A

perthes

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26
Q

ddx of limping in kid or pain in knee, groin, hip thigh

A 
•	perthes
Transient synovitis
•	Osteonecrosis-septic arthritis
•	Sickle cell disease
•	Corticosteroid therapy
•	Skeletal dysplasias
mucopolysaccharidoses
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27
Q

are SCFEs most often unilateral or bilateral?

A

usually unilateral but still get bilateral anyway b/c other things that can cause hip pain can be bilateral

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28
Q

causes of SCFE

A
  • Weakened or compromised physis and physiologic forces and vice versa
  • Endocrinopathies: thyroid, Growth hormone, hypogonadism, parathyroid hormone
  • Renal osteodystrophy
  • Prior radiation therapy
  • Mechanical: obesity, increased femoral retroversion (angle of head of femur is toward spine, ours are usually anteverted or more angled toward front of body), decreased neck shaft angle, increased physeal obliquity
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29
Q

how long does genu varum (bow legged) last for? after that what do you work it up for?

A

usually 2 years, after that work up for Bone dysplasias, rickets, blounts disease

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30
Q

when do you become concerned about genu valgum (knocked knees)

A

after age 7

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31
Q

juvenile arthritis with poorest pg

A

systemic

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32
Q

work up of juvenile arthritis

A

multiple painful, swollen joints, ESR, CRP, RF, ANA

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33
Q

which marker for JIA is most associated with uveitis?

A

ANA

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34
Q

4 types of jIA

A

systemic, oligarticular, polyarticular (>5 joints), and seronegative (i..e reiters, etc)

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35
Q

ddx of cough in kids (not d/t lung disease)

A
  • GERD
  • Aspiraton d/t suck and swallow fcn
  • CNS disease/hypotonia leading to GERD and/or aspiration
  • Cardiac
  • Psych/habit
  • Anatomic
  • Med induced (ACEI?)
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36
Q

ddx of stridor in kids

A
  • Foreign body aspiration
  • Anaphylaxis
  • Viral induced (croup?)
  • Post-intubation complications
  • Retropharyngeal abscess
  • Laryngomalacia (floppy larynx that doesn’t create tight seal)
  • Tracheomalacia (trachea collapses)
  • Inhalational injury
  • Blunt tracheal disruption
  • Epiglottitis?
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37
Q

which group of kids always gets antibiotics for ear infections?

A
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38
Q

which sinus is least likely to be infected in a 2 or 3 year old?which are most likely?

A

frontal, doesn’t develop until 3-9 years, ethmoid and maxillary develop earlier and are more likely

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39
Q 
which disease has sx of: •	Low grade fever
•	Malaise
•	HA
•	Myalgias
•	Anorexia
•	Parotitis
and potential complications of •	Meningitis
•	Encephalitis
•	Orchitis
A

mumps

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40
Q

what physical exam techniques do you need to do for pediatric cardiology every time?

A 
mumur
pulses (ue AND le)
BP
HR 
location of pMI
newborn pulse ox screen
growth pattern
other abnormalities: cyanosis, retractions, clubbing, diaphoresis, mottling,
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41
Q

types of q

A 
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the Aorta
Tetralogy of Fallot
Ebstein’s Anomaly
Hypoplastic Left Heart Syndrome
Atrioventricular Septal Defect
Transposition of the Great Arteries
Vascular Ring
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42
Q

what will the EKG of an ASD show?

A

Right axis deviation, right ventricular hypertrophy +/- RBBB

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43
Q

what complications can develop from a ASD/

A

CVA (stroke), untx’d adults: pulm HOTN, CHF and RV dysfcn

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44
Q

harsh holocystic murmur at LLSB +/- thrill means what?

A

ventricular septal defect (both small and moderate)

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45
Q

what kind of sx can occur with moderate to large

A

Sx of CHF at 6-8 wks: tachypnea, poor feeding/weight gain, sweating, irritability, hepatomegaly, increased pulmonary infections

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46
Q

what is diagnostic for congenital heart disease?

A

echocardiogram

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47
Q

what can an EKG show in VSD?

A

normal (small VSD), LVH, or BVH

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48
Q

what can CXR show in VSD/

A

cardiomegaly, increased pulmonary vascular markings, enlarged MPA shadow

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49
Q

Postnatal communication between main pulmonary trunk & descending aorta

A

patent ductus arteriosis

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50
Q

what is a very common heart problem in premature babies?

A

80% have patent ductus arteriorsis

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51
Q

continuous systolic “machinery” murmur heard at LUSB/left infraclavicular area +/- thrill +/- apical diastolic rumble

A

patent ductus arteriorsis

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52
Q

tx of pPDA in preterm babies

A

indomethacin (prostaglandin inhibitor)

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53
Q

tx of PDA in term babies

A

surgery (ligation +/- division), cath lab (device closure)

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54
Q

Narrowing of aortic arch, usually at ductal insertion (juxtaductal)

A

coarctation of aorta

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55
Q

what syndromes are assoc with coarc of aorta?

A

turner syndrome and trisomy 13 and 18

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56
Q

Systolic ejection murmur left sternal border (absent in 50%), > in back (left subscapular area)
Thrill in suprasternal notch
Ejection click (if bicuspid AV or hypertension)
Diminished/absent peripheral pulses (LE)
Hypertension (UE)
CHF: Hepatomegaly, gallop

A

coarctation of the aorta

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57
Q

in a neonate:
Diminished lower body perfusion as PDA closes
Signs of shock (severe acidosis, renal/hepatic failure, NEC, death)
infant: tachypnea, heart failure, FTT

A

coarc of aorta

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58
Q

which disease? EKG: LVH in children, normal, RBBB

CXR: “rib notching” (rare

A

coarc of aorta

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59
Q

treatment of critical coA

A

keep PDA open with prostaglandins

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60
Q 
what do these four criteria indicate?
Ventricular Septal Defect
2.Pulmonary Stenosis (Subvalvar, Valvar, Supravalvar)
Infundibular stenosis 45%
Infundibular + PV stenosis 30%
Pulmonary atresia 10%
3.Right Ventricular Hypertrophy
4.Overriding Aorta
A

tetralogy of fallot

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61
Q

signs and sx of tetralogy of fallot

A

murmur of VSD and PS, pulmonary stenosis: cyanosis

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62
Q

which dx? EKG: RAD, RVH CXR: boot shaped heart (main PA segment has an upturned apex)

A

tetralogy of ballot

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63
Q

Downward displacement of septal & posterior leaflets of TV into RV cavity (portion of RV is incorporated into RA) (atrialized RV)

A

ebstein’s anomaly

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64
Q

most frequent syndrome causing CHD

A

down syndrome

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65
Q

tx of hypertrophic cardiomyopathy?

A

Tx: Beta-blocker 1st line, surgery if severe (septal myotomy), ICD placement, avoid strenuous exercise, screen family, transplant

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66
Q

lymes disease can present as what kind of heart problem?

A

AV block

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67
Q

causes of sudden cardiac death in kids

A

Coronary abnormalities (anomalous origin, aneurysm-Kawasaki’s disease), arrhythmia, myocarditis, HCM, Long QT syndrome

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68
Q

challenges in pediatric prescribin

A

lack of adequate studies or suitable pediatric dosage forms, optimal dose is hard to know, adherence is hard

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69
Q

neonates don’t feel pain T or F

A

F: they may feel it even more

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70
Q

T or F: distraction is better with painful procedures than empathy or reassuranc

A

T!

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71
Q

black box warning in pedaitrics

A

no codeine or tramadol after tonsillectomy or adenoidectomy because of risk of OSA and higher breathing problems

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72
Q

which pain killer is best to use for tonsillectomy or adenoidectomy?

A

morphine

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73
Q

which ethnicities are more likely to be ultra rapid metabolizers of codeine, tramadol, hydrocodone and oxycodone?

A

n. african and arabs (30% are ultra rapid metabolizers) and 5% of AA and whites

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74
Q

what should be noted about how pediatric drugs are dose?

A

mg/kg and look closely for PER DAY OR PER DOSE

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75
Q

how should a drug be dosed for a child

A

weight based

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76
Q

how should a drug be dosed for children >40 kg?

A

weight based unless patients dose >adult dose or specific medication labeling notes a diff dose max for kids

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77
Q

ways to reduce dosing errors in kids

A

Always double-check calculations
 Computerized dose checking programs can reduce errors
 Always use a leading zero before a decimal point (0.1 vs .1)
 Never use a trailing zero after a decimal point (1 vs. 1.0)
 Use current reference books
 Use a small personal formulary
 Include use for drug on prescription

78
Q

medications that taste good

A

Ceclor, Suprax, Lorabid, Omnicef, Cefzil taste pretty good

79
Q

medications that taste bad

A

Prednisone intensol, dicloxacillin, KCl, Biaxin, Vantin taste pretty bad

80
Q

identifying measles

A

koplik spots and rash while fever, rash coalesces

81
Q

identifying rubella

A

tender LAD, low grade fever, swollen glands, discreet pink spots that don’t coalesce

82
Q

identifying roseola

A

under 2, high fever that stops and rash breaks out, mildly maculopapualr

83
Q

identifying erythema infectiosum

A

elementary schooler,

84
Q

what is tx for inguinal hernias in babies/

A

ALWAYS SURGERY

85
Q

what is tx for umbilical hernia?

A

reduce it, reassure it most likely goes away

86
Q

what else can get trapped in hernias in babies?

A

ovaries, intestines, etc

87
Q

red, moist thing in belly button of baby is what? how do you treat it?

A

umbilical granuloma. treat topically with silver nitrate, unless really big then can do surgery

88
Q

• Embryologic connection to urinary bladder from umbilicus

A

urachus

89
Q

baby presents with vomiting, abdominal distention (bowel obstruction) but has no signs of incarcerated hernia. what do you think of?

A

patent omphalomesenteric duct

90
Q

meckel’s diverticulum rule of 2s

A
  • 2% of population
  • 2 years, age at common presentation
  • 2 feet from ileocecal valve(ileum)
  • 2 inches long
91
Q

3 ways a meckel’s diverticulum can present or cause problems

A

bleeding, obstruction, diverticulitis

92
Q

Bleeding per rectum (>1/3)- Dark red blood, painless, decrease hemoglobin substantially, what do you think of?

A

bleeding meckel’s diverticulum from heterotypic gastric mucosa that is causing ulceration into blood vessels

93
Q

what condition can cause peritonitis and bowel pain and can look like appendicitis?

A

meckel’s diverticulitis

94
Q

what do these sx make you think of? • Cramping episodes, pulling up the legs
• Interspersed lethargy, Vomiting
• Bloody mucoid stools - “currant jelly”-

A

intussusception

95
Q

tx of intussusception

A

hydrostatic/pneumatic reduction by radiologist

96
Q

• Concentric hypertrophy of pyloric muscle

A

pyloric stenosis

97
Q

string sign or palpable “olive” in epigastric region makes you think of?

A

pyloric stenosis

98
Q

lump at level of hyoid cartilage makes you think of what?

A

thyroglossal duct cysts

99
Q

• Anterior border sternocleidomastoid muscle +/- hole or drainge in neck of kids makes you think of?

A

branchial cleft cyst

100
Q

• Fibrotic mass in midportion of sternocleidomastoid and turning of neck

A

torticollis

101
Q

soft spongy cystic ballotable mass in kids

A

lymphangioma

102
Q

if a baby is born with down syndrome what do you want to do?

A

get a karyotype–if d/t translocation that has huge repercussions for reproduction of parents

103
Q

gold standard test for newborns with CF: what result does it show?

A

sweat test: elevated chloride is diagnostic

104
Q

is pulm disease and pancreatic insufficiency leading to malnutrition and FTT is suggestive of what?

A

cystic fibrosis

105
Q

if a newborn has a positive CF screen, does that mean they have CF?

A

no–it could be just a carrier–send off for sweat test

106
Q

if newborn has negative CF test does that mean they don’t have CF?

A

no–it could be the mutation they have is not covered in the panel

107
Q

history questions for diarreha

A
  • Ask- how many times?
  • Color?
  • Watery? blood; mucus?
108
Q

history qs for vomiting

A
  • How many episodes?
  • Last time?
  • Fluids since then? • Related to foods?
  • Forceful? (key element) Color? Yellow is stomach secretions, green is bile (farther down obstruction) Blood?
  • Smell? feces smell means even lower blockage
  • Still drinking?
  • How’s he acting?
  • Apparent pain? • Urinary changes?
  • Cough/cold symptoms?
  • Fever? Rash?
  • Ill contacts? Day care? Water source, food source?
  • Recent travel or “just got off the boat”?
  • Lots of antibiotics recently? C. diff
  • Past medical history: “normal” child? Or, chronic GI issues? UTIs? •
109
Q

PMH, SX, FMHX, ETC for kids with vomiting

A

ROS: not as important in this case. Sore throat? Scrotal swelling? Swellings of extremities? Skin pallor? Decreased mental status?
• Social history: not as important here. Many office/ED visits?
• Family history: not as important here. In infant, pyloric stenosis, In older child: appendicitis, IBD, celiac disease

110
Q

life threatening causes of vomiting by age

A
  • Newborn: anatomic problems, central nervous system infection, inborn errors of metabolism
  • Older infant: obstruction (intussusception, pyloric stenosis, incarcerated hernia, malrotation with volvulus), gastroenteritis with dehydration, occult head trauma
  • Older child: GI (intussusception, appendicitis), neurologic (mass lesions), renal (uremia), infectious, metabolic (DKA, adrenal insufficiency, inborn errors), toxins/drugs
111
Q

definition of severe dehydration in kids (by weight)

A

• 15% loss of weight in infant, 9% loss in older child

112
Q

most dehydration is usually isotonic, isonatremic T or F?

A

T

113
Q

why are children more susceptible to dehydration than adults?

A
  • The smaller the child, the more susceptible- Higher surface area-to-volume ratio
  • Higher metabolic rate • Behavioral: “won’t drink”
  • Depend on adults for care
114
Q

are most cases of gastroenteritis viral or bacterial/

A

viral

115
Q

in which case do you suspect salmonella in gastroenteritis?

A

food born outbreaks

116
Q

in which case do you suspect s type in gastroenteritis?

A

typhoid fever

117
Q

in which case do you suspect shigella in gastroenteritis?

A

usually mild; if severe, causes fever, abdominal pain, stools with blood and mucus; toxin may irritate CNS, seizures possible; antibiotic treatment is recommended

118
Q

in which case do you suspect yersinia and campylobacter in gastroenteritis?

A

abdominal pain prominent

119
Q

in which case do you suspect c diff in gastroenteritis?

A

pseudomembranous colitis; associated with antibiotic use

120
Q

what are the results of hemolytic uremic syndrome from e coli 0157:h7?

A

hemolytic anemia, thrombocytopenia, acute renal failure; usually in children under 5 y/o

121
Q

signs of bacterial infection in gastroenteritis

A
  • More than 10 stools/day or more than 4 days diarrhea
  • Blood in stool
  • Temp 39.5
  • Clinical toxicity
  • PMNs in stool
122
Q

• Antibiotics in E coli O157:H7 might increase incidence of what?

A

HUS

123
Q

approach to vomiting and diarrhea–questions to ask?

A
  • Does vomiting OR diarrhea predominate?
  • What age and sex is the child?
  • Is pain a significant part?
  • Fever or other systemic sx?
  • Blood?
  • On exam, degree of dehydration and toxicity
124
Q

what should topical abx always be used with to avoid resistance when txing acne?

A

BPO

125
Q

cause of infantile acne, tx

A

maternal androgens. can do BPO. reassure.

126
Q

identifying miliaria rubra, tx

A

covered areas, flexural areas. papules/vesicles on erythematous base. reassure. avoid over clothing

127
Q

identiyfing milia, tx

A

white or yellow (sebaceous) bumps on newborn. really common. superficial epithelial cysts. reassure.

128
Q

identifying erythema toxicum, tx

A

local immune response to new skin flora (most likely) 50% of newborns have it in first 24-48 hours. reassure

129
Q

how do you distinguish between irritant and candidate diaper rashes?

A

irritant will have flaky confluent erythema and will not be in intertriginous areas, candidate will be in intertriginous areas and will have satellite lesions

130
Q

distinguishing points of measles

A

starts on face, starts with prodrome persisting through rash, dark and red rash that coalesces, koplik spots

131
Q

distinguishing rubella from measles

A

both start on face, though rash of rubella does not coalesce (is more discreet) isn’t as red as measles, and the kid doesn’t look as sick. it also spreads faster than measles and can have arthralgia.also + tender LAD

132
Q

distinguishing roseola from other rashes

A

starts with high fever that goes away then rash. rash usually ends up mostly on trunk. coalescing pink maculopapules. kid will be happy. no URI. also kids will usually be under 2.

133
Q

distinguishing erythema infectious from other diseases

A

“slapped cheeks’ + mild URI. cheeks distinguishes from measles and rubella, URI distinguishes from roseola + lack of high fever.+ lacy appearance on rest of body also adults may have arthralgia. and rash can recur with stimuli like sunlight.

134
Q

virus in erythema infectiosum

A

parvovirus b19

135
Q

can kids with erythema infectious go back to daycare?

A

yes, not contagious once rash starts.

136
Q

sandpaper rash after strep throat that looks like a sunburn

A

scarlet fever

137
Q

features of down syndrome

A 
(1)Dysmorphic
features
•Upslanting
palpebral
fissures
• Epicanthal
folds
• Flatnasalbridge
• Low
set
small
ears
• Brachycephaly
• Protruding
tongue
• Short
neck/excessive
skin
at
back
of
neck
• Short
stature
(2)
Extremities
• Short
broad
hands
• Curved
fifth
finger
• Transverse
palmar
crease
(single)
• Sandal
gap
(wide
space
between
first
&
second
toes
• Hypermobile
joints
CHD, VISION AND HEARING LOSS, LEUKEMIA, IMMUNODEFICIENCY, ENDOCRINE, INTELLECTUAL DISABILITY AND GI probs
138
Q

required test to confirm down syndrome

A

karyotype

139
Q

which congenital genetic disorder i x linked dominant?

A

fragile x syndrome

140
Q

gene of fragile x syndrome, what goes wrong?

A

FMR1, CGG repeats

141
Q

if someone comes in with new onset tremor or ataxia, or premature ovarian insufficiency what should you consider in your ddx?

A

fragile x syndrome carrier

142
Q

tx of fragile x syndrome

A

tx of mental health issues

143
Q

autosomal dominant syndrome with CHD, bleeding problems, delayed puberty and vision and hearing problems

A

noonan syndrome

144
Q

causes of spina bifida

A

folate deficiency, AEDs, genetics

145
Q

disorder of motor or postural abnormalities noted during development

A

cerebral palsy

146
Q

is familial CP common or uncommon?

A

uncommon

147
Q

sx of CP

A

low muscle tone, muscle spassms/stiff, feeding/swallowing difficulties, delayed mile stones, late to walk or speech

148
Q

T OR F there is great variability between adolescents

A

T!

149
Q

average age of height spurt for girls and guys

A

guys 11-13.5, girls 9-12

150
Q

characteristics of psychosocial development for 10-14 yo

A

rapid growth, concerns about deviations from normal, curiosity about sexuality, reliant on friends, independence/dependence struggle

151
Q

characteristics of psychosocial development for 15-17 yo

A

less precipitation with physical changes, formal operational thinking, less family influence, highly influenced by peer subculture

152
Q

characteristics of psychosocial development for 18-21 yo

A

emotional stability, individuality, willing to seek parental advice, formalized sense of values, perspecgive

153
Q

important points of adolescent history taking: HEADSSS

A

home, education/employment, activities, drugs/etoh/tobacco, sexuality, suicide, safety

154
Q

anticipatory guidleines for parents of teens; PANTSED

A

physical changes, alcohol/drugs/substances, need for privacy, talk, sex, emotional changes, diet/exercise

155
Q

causes of ADHD

A

genetics, environmental :lead, etoh, tobacco, diet, nutritional deficiencies, Parenting and Society
• Fast paced, high stimulus
• Instant gratification

156
Q

components of ADHD diagnosis

A
  • Symptoms lasting at least 6 months
  • Impairment in two or more settings
  • Significant impairment in social, academic, and occupational functioning all need to be affected • Some of symptoms present before age of 12- changed from age 7, more accurate for adult diagnosis, adults with new onset sx prob not ADHD
  • Symptoms not due to another mental disorder or oppositional behavior or failure to understand tasks or instructions
  • Has 6 or more of either Inattentive or Hyperactive-Impulsive symptoms
157
Q

examples of inattention sx

A

Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level (for individuals ≥ 17 only 5 symptoms needed):
• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• Often has difficulty sustaining attention in tasks or play activities need to not be able to pay attention in all areas whether you like it or not
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• Often has difficulty organizing tasks and activities • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

158
Q

when is inattentive type of ADHD usually diagnosed?

A

9-10 (later b/c not causing behavioral problems in class)

159
Q

ddx of ADHD

A

Developmental
• Normal variation
• ASD
• Giftedness
• Learning disorders Emotional/Behavioral
• Mood disorders
• Anxiety (PTSD or OCD)
• ODD
• Conduct disorder Environmental
• Child abuse/neglect- not completing homework
• Poor parenting
• Sociocultural differences
• Inappropriate school setting
Medical
• Fetal Alcohol Syndrome negative response to stimulant
• Fragile X
• Lead Poisoning
• Neurodegenerative d/o • Tourette syndrome
• Iron deficiency anemia
• Thyroid abnormalities
• Diabetes mellitus • Substance abuse- in older children and adults
• Medication side effects: Bronchodilators, Corticosteroids, Neuroleptics, isoniazid

160
Q

what is req’d for a dx of ADHD?

A

meeting DSM-V criteria, must be verified by parents and teachers, need to assess for coexisting conditions

161
Q

2 categories of drugs for ADHD

A

methylphenidate (ritalin and concerta) and amphetamines (dexedrine and vyvanse, adderall)

162
Q

does autism cause intellectual disability?

A

no–they go together but they are separate entities

163
Q

etiology and risks of autism

A

etiology: no one knows, vaccinations don’t cause it
risks: • Very nonspecific
• Older parental age
• Low birth weight
• Fetal exposure to Depakote only specific med that shows slight increase, don’t know why this is yet

164
Q

early characteristics of autism

A

may appear deaf–doesn’t turn when you enter room, may seldom cry, or may be really fussy, fussy eater, no anticipatory response, avoids looking at people, tunes out, delayed speech, doesn’t like changes, don’t imitate friends or peers, sensory sensitivity

165
Q

when are medications appropriate for autism?

A

for sx of − Aggression
− Hyperactivity and inattention may have ADHD but can’t tx it the same way
− Behavioral rigidity
− Perseveration and/or stereotyped behaviors
− Depression and/or anxiety

166
Q

Is an isolated hydrocele or one with a communicating hernia most likely to persist?

A

one with a communicating hernia, isolated hydroceles are more likely to spontaneously reduce

167
Q

tx of a hernia and hydrocele in infant

A

hernia: always needs surgery: elective if reducible and immediate if incarcerated; hydrocele wait to see if spontaneously resolves after 1 year and if it doesn’t then surgery b/c most likely

168
Q

do umbilical hernias usually incarcerate?

A

no–just observe, may take years

169
Q

what does this make you think of: substantial drainage of meconium from belly button + visible sinus. how to treat?

A

patent omphalomesenteric duct: tx with surgery

170
Q

patent urachus

A

connection between umbilicus and urinary bladder, may be filled with fluid or may be flat with a hole in it: needs surgery

171
Q

rule of 2s for meckel’s diverticulum (remnant of omphalomesenteric duct)

A
  • 2% of population
  • 2 years, age at common presentation
  • 2 feet proximal to ileocecal valve(ileum)
  • 2 inches long
172
Q

what portions of intestines are involved in most intussusception cases

A

ileo-colic

173
Q

projective vomiting, non bilious in a 3-6 wk yo

A

pyloric stenosis

174
Q

what areas are rare to have bruises on for kids?

A

upper arms, genitalia, trunk, face, buttocks, ears, neck

175
Q

currant jelly + cramping and vomiting makes you think of what?

A

intussusception

176
Q

tx of intussusception

A

hydrostatic/pneumatic reduction/enema

177
Q

palpable “olive’ and string sign mean what?

A

pyloric stenosis

178
Q

Vasculitis of unknown etiology in kids

A

kawasakis disease

179
Q

dx of kawasakis must include?

A

fever for 5 days + 4/5: changes in extremities, rash, oropharyngeal changes, bulbar conjuctival injection, cervical lymphadenopathy

180
Q

coronary artery aneursym in kid on echo makes you think of what?

A

kawaskaki’s dz

181
Q

immunoglobulin A deposition

dz

A

HSP

182
Q

most common cause of acute renal failure in young children

A

HUS

183
Q

Classic triad of what dz?
Microangiopathic hemolytic anemia
Thrombocytopenia
Renal insufficiency/injury

A

HUS

184
Q

when a kid has UTI, what cause do you have to think about?

A

vesicoureteral reflux

185
Q

how can we try to prevent vesicoureteral reflux?

A

prenatal ultrasounds looking for hydronephrosis

186
Q

UTI sx in kids

A

Clinical symptoms: fever, vomiting, diarrhea, irritability, poor feeding, jaundice (nonspecific findings)
Failure to Thrive
Malodorous urine
Fever without source (5% have UTI) UA part of any fever work up

187
Q

what test should be done in everyone

A

voiding cystourethrogram or radionuclide cystogram

188
Q

T OR F: you should work up every kid with UTI

A

T!

189
Q

indications for sending kids to pediatric trauma center

A 
Multi-system trauma
Unstable vital signs NEVER reassure yourself that their abnml vital sign (HR) is b/c they are crying
Axial skeleton #
Neurovascular injury
Acute cord injury
Complicated TBI
Low trauma score
190
Q

signs of hypoxemia in kids

A

Cyanosis
Agitation
Poor capillary refill fingers, head, neck
Bradycardia esp bad if started tachy then went brady—about to go into respiratory arrest, may still have to start compressions even if really low but not gone
Desaturation measured by pulse oximetry
Signs of inadequate ventilation
Stridor (croup? Epiglottitis?) or wheezing (asthma?)
Tachypnea not normal
Nasal flaring
Grunting
Retractions

191
Q

indications for CT scan in kids

A 
abdominal tenderness
abdominal distention
abdominal bruising
hematuria
vomiting, neurologic obtundation
falling or low hematocrit
absent bowel sounds

Clinical Medicine (19 decks)

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