Pediatrics

Question 1

Milestones of a 2mth old

Answer 1

Can lift himself up with 2 arms when lying on tummy.
Responds 2 sounds.
Smiles when smiled 2.

Question 2

Milestones at 4 months

Answer 2

Reaches 4 a toy or other object smiles 4 fun (spontaneously)

Rolls from tummy to back

Question 3

Milestones at 6 mths

Answer 3

Looks like the number 6 when sitting up.

Rolls from back to tummy and back

Question 4

Milestones at 8 mths

Answer 4

Once able to sit up, child can transfer objects from hand to hand with ease.

Question 5

Milestones at 12 mths

Answer 5

Stands tall like the number 1 and walks on 2 legs

Question 6

Milestones at 18 mths

Answer 6

Can name single word objects.
Says “no” a lot like an 18 year old.
Acts like an 18 year old by copying work that adults do (play vacuum, mowing)

Question 7

Milestones at 2 years

Answer 7

Speaks in 2 word sentences.
Follows 2 step commands.
Can walk up stairs one leg, then bringing the other leg up to meet.
Builds a tower of 2 blocks.

Question 8

Milestones at 3 years

Answer 8

Builds a tower of 3 blocks.
Rides a tricycle.
Speaks in 3 word sentences.
Can draw a circle.

Question 9

Milestones at 4 years

Answer 9

Speaks in 4 word sentences.
Can build a tower with 4 blocks.
Can draw a cross.

Question 10

Milestones at 5 years

Answer 10

Speaks in 5 word sentences.

Can draw a square.

Question 11

Milestones at 6 years

Answer 11

Speaks in 6 word sentences.

Can draw a triangle.

Question 12

Tooth eruption begins at what age?

Adult teeth at what age?

Answer 12

As early as 6 mths

Adult teeth beginning at 6 years

Question 13

At what age does the baby return to birth weight?

Answer 13

2 weeks

Question 14

Pyloric stenosis

Answer 14

Thickening of pylorus muscle, preventing food from moving from the stomach to the small intestine.
Projectile NON-BILIOUS vomiting, RUQ OLIVE SHAPED MASS

Question 15

Intussusception

Answer 15

When sections of intestines invaginates into the adjoining intestinal lumen, causing bowel obstruction. Can be fatal in 3-5 days if untreated. Palpable SAUSAGE SHAPED MASS in abdomen.
Contrast enema is diagnostic and sometimes curative

Question 16

Tanner I

Answer 16

Pre-puberty

Question 17

Tanner 2

Answer 17

Early changes
Male- testes enlarge, scrotal skin reddens, changes in texture, sparse growth of long slightly pigmented hair at base of penis.
Female- breast buds and papilla elevate, downy pigmented pubic hair along labia majora

Question 18

Tanner 3

Answer 18

Growth spurt, penile length growth/breast enlargement

Question 19

Tanner 4

Answer 19

Peak of growth spurt
Male-increase in penile length and width with development of glans.
Female- areola and papilla elevate to form a second mound above level of the rest of breast

Question 20

Tanner 5

Answer 20

Full adult genitalia with hair growth extended to the medial thigh.

Question 21

Scarlet fever presentation, Tx

Answer 21

Anterior cervical adenopathy. Sand-paper rash with exudative pharyngitis, fever, headache.
Tx- same as strep throat (Pcn, macrolide)

Question 22

Roseola presentation, Tx

Answer 22

Rosy pink maculopapular rash lasting hours to 3 days, follows a 3-7 day period of fever. Febrile seizures common 10%
Tx- supportive (viral)

Question 23

Rubella presentation, Tx

Answer 23

Mild fever, sore throat, malaise, nasal discharge, diffuse maculopapular rash lasting 3days.
Posterior and post-auricular lymphadenopathy 5-10 days prior to rash onset.
80% rate congenital rubella syndrome (esp in pregnancy 1st trimester exposure)
Tx- supportive (viral) PREVENT EXPOSURE TO PREGNANT WOMEN
VACCINE PREVENTABLE

Question 24

Measles presentation, Tx

Answer 24

Acute fever, nasal discharge, cough, generalized lymphadenopathy, conjunctivitis, photophobia, KOPLIK SPOTS (white spots w/ blue rings in the oral mucosa)
Permanent neuro impairment or death possible
Tx- supportive, complications intervention, VACCINE PREVENTABLE

Question 25

Mononucleosis presentation, Tx

Answer 25

Fever, “shaggy” purple-white exudative pharyngitis, malaise, diffuse lymphadenopathy, hepatic/spleen tenderness.
Dx- mono spot test, leukopenia and lymphocytosis (atypical lymphocytes)
Tx- steroids prn, avoid contact sports >1mth.
>90% will develop rash if given PCN (misdiagnosed for strep throat)

Question 26

Hand, foot, mouth (coxsackie) virus presentation, Tx

Answer 26

Fever, malaise, sore mouth, anorexia. Blistering and peeling of mouth, hands, feet.
Tx- supportive, analgesia. HIGHLY CONTAGIOUS-transmission thru oral-fecal or droplet

Question 27

Fifth disease presentation

Answer 27

3-4 days of mild flu-like illness followed by 7-10 days of red rash that begins on face with SLAPPED CHEEK appearance, spreads to trunk and extremities.
Tx- supportive, avoid exposure with pregnancy due to high risk of HYDROPS FETALIS. Transmission thru droplet

Question 28

Kawasaki presentation, Tx

Answer 28

Fever >104 lasting >5 days, polymorphic exanthem on trunk, flexor regions, erythema of oral cavity STRAWBERRY TONGUE, extensive chapped lips, bilateral conjunctivitis, cervical lymphadenopathy
Tx- IVIG, Asa po high dose for anti platelet effect, ER!

Question 29

What age should iron supplements start in breast fed babies?

Answer 29

4-6 mths ( due to depletion of maternal iron stores)

Question 30

When should vitamin D supplementation begin in breast fed babies?

Answer 30

400IU/day shortly after birth, until baby is weaned and consuming >1,000 ml/day of vitamin D fortified milk/ formula

Question 31

Treatment of croup (viral)

Answer 31

Supportive treatment, systemic steroids po if severe

Question 32

Prevention of RSV in premature babies

Answer 32

Palivizumab (Synagis)

Question 33

First line treatment for AOM (after watchful waiting or severe sx)

Answer 33

Amoxicillin (high dose) 80-90mg/kg/day or Augmentin 90/6.4mg/kg/day
*Pcn allergy- Cefdinir, cefuroxime

Question 34

First line treatment of OME

Answer 34

Watchful waiting, 75-90% resolve within 3 months without tx. Antibiotic not indicated.

Question 35

Treatment of pediatric UTI

Answer 35

Amoxicillin 20-40mg/kg/d x3 days
Bactrim (TMP/SMX) 6-12/30-60 mg/kg/d
Cephalosporin

Question 36

Treatment of CAP in pediatric pt

Answer 36

Amoxicillin alt Augmentin

Question 37

Treatment of atypical CAP in pediatric pt

Answer 37

Azithromycin alt clarithromycin