Pediatrics Flashcards
Apgar Score
Recorded at 1 minute and 5 mintues Categories: 0-2 points each Heart rate Respiratory rate Muscle tone Response to catheter in nostril Color
New born physical exam
Vitals Weight, length, head c. Apgar score 1,5 mintues of life Skin color Skeletal exams: congenital anomalies, resting muscle tone, activity HEENT Abdomen Genitalia and anus Neuro: reflexes, sensory
Asymmetric tonic neck
Supine baby, turn head to one side. Arm and leg of that side will extend, opposite arm and leg flex. “Fencing”
Ages: 2-6 months
Rooting
Stroke skin by mouth. Mouth will open and try and suck
Age: 28 wks gestation to 3-4 months
Babinski
Scrap baby foot, upgoing toe is normal.
Age: birth to 2 years.
Negative or diminished response suggestive of neuro abnormalities
Palmer grasp
Place finger in baby hand, baby will grab finger
Age: 28 wks G, to 3-4 months
Startle (moro)
Hold baby supine, abruptly lower. Arms will abduct at the shoulder and extend at the elbow
Age: until 4-6 months per Ted
Place stepping
Hold up from behind, have one sole touch the table. Stepping will alternate.
Age: birth to variable
Prophylaxis within 48 hours of birth
Erythromycin ointment to the eyes: gonococcal opth
Vitamin K: prevent hemorrhag
Hep B vac:
Cord blood: blood typing, coombs test if mom is O or neg
Genetic screen: PKU….
Congenital heart disease
Types of neonate jaundice
Physiologic (normal): Liver is still maturing
Breastfeeding: not enough milk
Breast milk jaundice: caused by breast milk increasing bilirubin to rise.
Blood group incompatibility: Rh, ABO
Sepsis: TORCH
TORCH infections
Most common infections associated with congenital anomalies. Toxoplasmosis Other: syphilis, varicella, parovirus Rubella Cytomegalovirus Herpes infections
Most common causes of respiratory distress in newborn
- transient tachypnea (retained fetal lung fluid)
- aspiration syndromes (aspiration of meconium)
- congential pneumonia (infections before or during labor)
- pneumothorax
Common causes of difficult delivery?
Large fetus
Abnormal presentation position
Fetal distress requiring rapid extraction
Common type of birth trauma
Soft tissue bruising Fractures Cervial plexus palsies Skull fracture and spinal cord injuries Intracranial hemorrhage
Effects of maternal drug abuse:
Cocaine and meth
No specific syndrome:
- irritability, tremors, increased stress response
- Higher risk of neglect, SIDS, abuse
- Higher risk of preterm delivery, stillbirth, placental abruption
Effects of maternal ETOH use
Most common preventable cause of mental retardation
- Craniofacial (vermilion of upper lip, flat philtrum, short palpebral fissures
- Growth deficiencies
- CNS (microcephaly, agenesis of corpus callosum)
Effects of maternal opioid use
Symptoms begin 1-3 days of life
Withdrawal signs: CNS: irritability, hyperactivity, hypertonicity, etc.
GI: v/d/poor feeding, incessant hunger, excessive salivation
Metabolic/Res:
Intrauterine Growth restriction
Effects of maternal tobacco use
Intrauterine growth restriction
common problems of prematurity?
Immature development of organs and systems predisposes to depression of most functions.
Develop Milestones:
2 months
GM: lifts head/chest when prone
FM: eyes tract past the midline
Communication: alert to sound, reciprocal smile
Cog: recognizes parent
Develop Milestones:
4 months
GM: Rolls front to back
FM: Grasps a rattle
Com: Laughs, soothed by parents voice
Cog: orients head to direction of a voice
Develop Milestones:
6 months
GM: Sits with little or no support
FM: Reaches with one hand, transfers objects
Comm: Babbles, developing stranger anxiety
Cog: Feeds self
Develop Milestones:
9 months
GM: pulls to stand
FM: developing pincer grasp, bangs two objects together
Comm: Says: mama/dada indiscriminately, waves bye-bye
Cog: plays, gesture games (pat-a-cake)
Develop Milestones:
12 months
GM: Stands/walks alone
FM: fine pincer grasp
Comm: one word other than mama/dada, Follows on step commands with a gesture
Cog: points to desired object
Develop Milestones:
15 months
GM: stoops and recovers
FM: scribbles in imitation
Comm: uses 3-5 words
Cog: Uses spoon and cup, turn pages in a book
Develop Milestones:
18 months
GM: runs well
FM: builds tower of 3 cubs
Comm: points to 1-3 body parts
Cog: “helps” in house
Develop Milestones:
24 months
GM: throws ball overhand, kicks ball
FM: Copies drawing a line with crayon
Comm: speaks 2-word combos, 50 plus word vocab
Cog: removes article of clothing
Develop Milestones:
36 months
GM: Pedals a circle
FM: copies a circle
Com: 3 word sentances, 75% of language intelligible to stranger
Cog: brush teeth with help
Develop Milestones:
48 months
GM: hops
FM: copies a square or cross
Comm: 100% language understood by stranger, plays cooperatively with group
Cog: knows 4 colors
Develop Milestones:
5 years
GM: skips
FM: copies triangle
Comm: defines simple words, use 5 word sentence
Cog: dresses self
Breast milk: adv and disadvantages
Immunologic factors (IgA); protects baby from everything first 4 months
WHO recommendations for breastfeeding
Exclusive breast feeding for first 6 months of life, continued breast with appropriate comp through first 2 years of life
Recommendations for sleep positions for infants?
Baby sleeps on back, not stomach! On firm surface without the mouth covered.
Define failure to thrive
Child 2 or younger below the 5% for more than one occasion, or crosses 2 major % downward on standarized growth grid.
Most common cause of FTT
Inadequate caloric intake (environmental and behavioral)
What are the core deficits in autism spectrum disorder?
- Persistent deficits in social communication and social interaction across multiple contexts
- Restricted, repetitive patterns of behavior, interests, or activities.
Etiology of autism spectrum disorder?
- None in 80-90% of cases
- Fragile X syndrome or chromosome 15q duplication
- There is a strong familial component.
Evaluation and management of autism:
Age of diagnosis: often not until 3-4
Early characteristics: failure to orient to one’s name, regard people directly, use gestures, develop speech.
Screen at: 18 months, and 24-20 months
Autosomal dominant?
One mutated copy of the gene that is inherited from a parent or results from a new mutation. Ex: Huntington disease or Marfan syndrome
Autosomal recessive:?
Both mutated copies of the gene come from both parents; not typicaly seen in every generation of an affected family. Ex: cystic fibrosis, sickle cell disease
X-linked dominant?
In females: only one of the X chromosomes affects the kid
In males: only have 1 x chromosome, typically more severe symptoms: no male to male transmition. Ex: fragile x syndrome
X-linked recessive?
In females: would need mutation on both X chromosomes to be affected
In males: will always be affected: NO male to male transmission. Ex: hemophilia
Y-linked?
Only father to son inheritance.
Ex: y chromosome infertility
Non-mendelian inheritance?
Disorders of imprinting and mitochondria: Mitochondrial DNA only come from egg cells, every generation has the mutation.
Multifactorial inheritance
Genetic predisposition to a disorder but environmental factors also influence outcome.
Down’s syndrome:
Trisomy 21, increased risk if maternal age greater than 35
Any 6 of these: hypotonia, poor moro reflex, hypermobility of joints, flattened facies + occiput, excess kin on post neck, anomalous auricles, upward-slanting palpebral fissures, pelvic dysplasia, simian crease
Comp: congenital heart disease (septal def)
Encopresis
Repeated passage of stool into inappropriate places by a child who is older than 4 years, occurring each month for 3 month.
S/sx: constipation of 2 or more of the following events in 2 months.
- fewer than three bowel movements in a week
- more than one episode of encopresis per week
- impaction of the rectum with stool
- passage of stool so large it blocks the toilet
- retentive posture and fecal withholding
- pain with defication
Enuresis
Repeated urination into clothing during the day and into the bed at night by a child that is older than 5 with no underlying organic problem.
S/sx: At least twice a week for 3 months
Trisomy 13
Patau syndrome
Eti: F>M
S/sx: CNS and eye malformations, cleft lip/palate, polydactyly, syndactyly, congenital heart dz.
Prog: poor life expectancy
Trisomy 18
Edwards syndrome
Uncommon for fetus to survive.
S/sx: overlapping fingers, clenched fists, low set ears, left-sided clubfeet or rocker-bottom feet, congenital heart dz.
Prog: heart failure or pneumonia common of death
Turner syndrome
Absence of X chromosome, females affected only.
S/sx: shield chest, short stature, web neck, short 4th, coarctation of aorta.
Tx: growth hormone and estrogen
Kleinfelter
47: xxy, males affected only
S/sx: normal appearance prior to puberty, after: long arms and legs, sparse body hair, gynecomastia, small testes, azoospermia, mental disabilities.
Tx: testosterone replacement
Fragile X syndrome
Extra repeated genes on the x chromosome
X-linked condition; most common cause of inherited mental retardation.
S/sx: macroorchidism, large ears, mitral valve prolapse common.
Neonatal acne
Sebaceous glans stimulated by maternal androgens.
Mottling in infants
Dilated cutaneous vessels over extremities / trunk of neonates exposed to lowered temperature
“lace like pattern” reticular discoloaration
Cafe au lait macule
Hyperpigmented macule from birth.
If more than 6 that are greater than 1.5cm = neurofibromatosis Type 1
Hemangioma
Red, rubbery, plaque or nodule.
Blood vessel lesion
Tx: oral porpranolol
Epidermal nevi
Common mole
Well-demarcated, brown/black macules
Miliaria
Heat rash
Eti: obstruction of the eccrine sweat ducts, heat and high humitidity…
Tiny vesicles with or without erythmea crystallina/rubra
Milia
Transient: epidermal cysts filled with keratinous material
Keratosis pilaris
Chicken skin, autosomal dominant.
Characterized by rough, slightly red bumps on light skin and brown bumps on darker skin.
- Often on back and lateral aspects of upper arm.
Acne: Eti, Epi, S/sx, Tx
Eti: Influenced by androgens, plugged sebaceous follicle, increased sebum production
Epi: affects 85% of adolescents
Tx: 1st line: Topical keratolytic agents (retinoids, benzoyl peroxide, azelaic acid).
- Topical abx can be used in conjunction with benzoyl or retinoids.
Impetigo
Eti: staph or strep
S/sx: erosion covered by honey colored crusts
Tx: topical mupirocin or retapamulin
Systemic tx: Dicloxacillin or cephalexin, clindamycin
Cellulitis
Eti: GABHS and staph
S/sx: erythematous, hot, tender, ill-defined, edematous plaques, Regional lymphadenopathy
Tx: systemic abx with coverage: clindamycin
Folliculitis
Eti: staph and strep
S/sx: pustule at a follicular opening.
Tx: Warm wet compress or keratolytics.
- topical (mupirocin, clindamycin)or oral anti-staph abx
Scarlet fever
Eti: group A strep
S/sx: strawberry tongue, sandpaper rash (begins on head and neck and spreads to rest of body, usually sparing hands and feet). Usually sore throat.
Scabies
s/sx: Pruritis! linear burrows, wrists, ankles, finger webs, areolas, axillary folds, genitalia, excoriation
Dx: scrap and examin mite/egg under microscope
Tx: Permethrin 5%, resistnant cases: ivermectin
Pediculoses - Louse
Eti: lice
S/sx: excoriated papules and pustles and a history of severe itching at night,
Dx: wet combing 91% sensitive
Tx: Permethrin, clean bedding and clothing
Urticaria
Eti: hypersensitivity reaction
S/sx: diffuse, pruritic, elevated wheals
Tx: antihistamines
Scalded skin syndrome
staph
S/sx: sudden onset of bright red, acutely painful skin, perioral, periobrit, flexural, neck, axilae etc.
Nikolskys sign
Tx: systemic staph abx
Tinea capitis
fungal infection of the scalp
S/sx: pruritic, scalling area of hair loss, can show black dots (distal ends of hair), can have associated cervical lymphadenopathy
Dx: KOH can see arthroconidia (fungal spores)
Tx: Griseofulvin or terbinafine
Tinea corporis
Eti: trichophyton…
S/sx: annular marginated plaques with thin scale and clear center
Dx: KOH prep - hyphae
Tx: topical anti-fungal BID for 3-4 weeks
Tinea cruris
Eti: trichophyton…
S/sx: symmetrical, sharply marginated lesions in inguinal areas
Tx: topical anti-fungal for 3-4 weeks
Onychomycosis
Eti: trichophyton rubrum
S/sx: loosening of the nail plate from bed, yellow discoloration, thickening of distal nail plate
Dx: KOH prep and fungal culutre
Tx: daily topical ciclopirox 8%, terbinafine 6-12 weeks, itraconazole in 1 week pulses
Atopic dermatitis (eczema)
Epi: onset before 2 yo, unusual after 30
s/sx: Dry skin.
Infants: cheeks and scalp, oval patches on trunk, extensor.
2-adolescence: flexural, anicubital and popliteal fossa, neck, wrists
Adolescent: chroni flexural eczema and hand/feet.
Tx: Acute: wet dressing and medium potency corticosteroids
Chronic: bath every 2-3 days, twice daily lubrication, topical corticosteroids
Contact derm
Eti; poison ivy etc, nickle, neomyocin
S/sx: blister formation, oozing, and crusting
Tx: potent topical corticosteroids, prednisone
Seborrheic dermatitis
Eti: yeast infection, most likely genus Malassezia
s/sx: erythematous scaly dermatitis
Tx: frequent washig with zinc soaps, selenium lotions, etc.
Pityriasis alba
Eti: associated with atopy, sun exposure, frequency of bathing
S/sx: white, scaly macular areas with indistinct borders over extensor surfaces and on cheeks, often present after sun exposure
Tx: low-potency topical corticosteroids for return to normal pigmentation
Tinea versicolor
aka pityriasis veriscolor
Pathogen: pri: Malassezia globosa
S/sx; hypopigmented macules and very fine scales
Dx: KOH, spaghetti and meatballs, woods lamp: yellow to yellow green
Tx: Selenium sulfide, shampoo applied to whole body and leave
Candida infections
Epi: fungal infection
S/sx: itching, flaking, erythema
Dx: KOH, clinical
Tx: topical imidazole cream, nystatin for oral thrush, refractory candidiasis: oral fluconazole
Herpes simplex
Eti: HSV or VZV
S/sx: painful, grouped vesicles on a red base, flu like symptoms w/ first outbreak
Tx: valcyclovir
Varicella zoster: chickenpox
Sx: lesions appear in different stages. Dew drop on a rose petal
Tx: supportive, hydration, analgesics, diphendyramine, antipruritics
Molluscum contagiosum
Eti: poxvirus
S/sx: umbilicated, flesh-colored papules
Tx: cryotherapy, cantharidin
Pityriasis Rosea
Eti: viral infection
S/sx: pink to red, oval plaques with fine scales in “Christmas tree” distribution. Preceded up to 30 days by a herald patch
Tx: reassurance, steroid creams for pruritus.
Psoriasis
Eti: rapidly proliferating epidermal cells produce excessive stratum corneum
S/sx: erythematous papules and plaques with thick, white scales. Elbows, knees, scalp. Nail pitting and distal onycholysis
Tx: Topical steroids. Clobetasol 0.05%
Alopecia areata
Eti: Immunologic pathogenousity
S/sx: complete hair loss in localized area
Tx: Superpotent topical steroids, minoxidil
Erythema infectiosum
5th disease
Eti: Parvovirus B19
S/sx: Flu-like illness followed by rash, contagious prior to rash not after.
Fever and rash with slapped cheek appearnece, full-body maculopapular rash with lacy appearence
Tx: supportive care
Rubeola (normal measles)
Eti: morbillivirus
S/sx: fever, cough, coryza, Koplik spots (white papules on diffusely red base of buccal mucosa.
Maculopapular rash spreading from face (usually the hairline) to trunk.
Tx: vaccination
Rubella: german measles
Eti: toga virus
S/sx: Fever with postauricular occipital adenopathy, sore throat, myalgia
Maculopapular rash beginning on face, rapidly spreading to the entire body
Forchheimer spots (rose-colored spots on soft palate
Roseola
Eti: herpesvirus 6&7, 90% before age of 2)
S/sx: abrupt high fever on onset, 4-8 days then abruptly ceases, then rose-pink maculopapular nonpruritic rash appears on trunk, spreading to face, neck and extremities
Lyme disease
Eti: deer tick with borrelia burgdorferi Epi: NE, mid-atl, midwest, pacific coast S/sx: red lesion that expands with central clearing, HA, stiff neck, arthralgias, myalgias Dx: Clinical, serologic studies Tx: doxy 100 mg BID
Rocky mountain spotted fever
Eti: tick bite, rickettsia rickettsii
S/sx: sudden fever, chills, malaise, photophobia, abd pain, v/d
Rash in 95%: maculopapular involving palms/soles and extremities (face is spared)
Tx: Must start before rash
